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Progress update: Still under construction. But the work feels like it is reaching an analytical plateau, I think I'll be able to call this finished (pending comments) within the next week or so - 01/27/10. |
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< | This project examines United States quarantine laws between the late 1870s and the first decade of the 20th Century, to see how the States and federal government worked together in the area of public health. This timeframe spans several epidemics of yellow fever, cholera and smallpox, the first national laws addressing quarantine, and the creation of a federal body called the National Board of Health. |
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> | This project examines United States quarantine laws from the 1870s until the first decade of the 20th Century, to see how the States and federal government worked together in the area of public health. This time frame spans several epidemics of yellow fever, cholera and smallpox, the first national laws addressing quarantine, and the creation of a federal body called the National Board of Health. |
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< | The Board initially came into existence through an Act in 1879 with a sunset clause to expire in 1883. It came close to being revived by repeal of this sunset clause in early 1883, due to its excellent performance. But it was not ultimately revived. |
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> | The Board initially came into existence through an Act in 1879 with a sunset clause to expire in 1883. It came close to being revived by repeal of this sunset clause in early 1883, due to its excellent performance. But it was not ultimately revived. |
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< | After three more years of existence in the shadow of the 1879 Act, with a series of rapidly diminishing grants, the Board failed. I was drawn to this project primarily out of curiosity as to why it failed, and what if anything could be inferred from its failure about systemic State and federal tensions. My time frame ends with the creation of the first successful federal quarantine laws and the federal Department of Health. |
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> | After three more years of existence in the shadow of the 1879 Act, with a series of exponentially diminishing grants, the National Board of Health failed. I was drawn to this project primarily out of curiosity as to why it failed, and what if anything could be inferred from its failure about systemic State and federal tensions. My time frame ends with the creation of the first successful federal quarantine laws and the federal Department of Health. |
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< | Background: Disease and Quarantine in the Late 19th Century |
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> | Background: disease and quarantine in the late 19th century |
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< | The 19th Century overall brought with it groundbreaking advances in medical science. Pasteur's initially radical germ theory was beginning to be accepted in the medical and public health literature by the beginning of the timeframe in this project, although not universally (here is a review of its impact in Massachusetts in the early 1870s). |
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> | The 19th Century brought with it groundbreaking advances in medical science. Pasteur's initially radical germ theory was beginning to be accepted in the medical and public health literature by the beginning of the time frame in this project, although not universally (here is a review of its impact in Massachusetts in the early 1870s). |
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< | The literature around this time reflects great hope for rapid scientific advancement in many areas including disease origins and nature. There were hot debates both about the validity of new discoveries, and how these could best be translated into frameworks for prevention and remedy. A broad movement for public health had begun in Great Britain around the 1850s, and was slowly taking off in America, with interest turning to sewers and school hygiene. Later within in my chosen time period, the introduction of publicly provided childhood vaccinations began. |
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> | The literature during the 1870s reflects great hope for rapid scientific advancement in many areas including disease origins and cures. There were hot debates both about the validity of new discoveries, and how these could best be translated into frameworks for prevention and remedy. A broad movement for public health had begun in Great Britain around the 1850s, and was slowly taking off in America, with interest turning to sewers and school hygiene. Later within in my chosen time period, the introduction of publicly provided childhood vaccinations began. |
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< | Quarantine measures, a very old disease prevention technology, were being updated to reflect new understandings of the mechanics of infection. Good examples of this were in relation to cholera (which had recently been discovered to be transmitted from feces-contaminated water) (see e.g. The Sanitarium, 1894, pp 3-4). |
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> | Quarantine measures, a very old disease prevention technology, were being updated to reflect new understandings of the mechanics of infection. Good examples of this were in relation to cholera (which had recently been discovered to be transmitted from feces-contaminated water, see e.g. The Sanitarium, 1894, pp 3-4). |
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< | It should be remembered that each change in regulations could have significant commercial impact. For instance, a cholera-affected vessel that under new regulations did not have to destroy its cargo of hides or cotton or wool or food would face significantly different profit margins to one operating under older rules. The potential benefits to both lives and commercial enterprise strongly favored the constant change of processes to reflect advances in scientific and medical knowledge. |
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> | It should be remembered that each change in quarantine regulations could have significant commercial impact. For instance, a cholera-affected vessel that under new regulations did not have to destroy its cargo of hides, cotton, wool or food could face significantly different profit margins to one operating under older rules. The potential benefits to both lives and commercial enterprise strongly favored the constant change of processes to reflect advances in scientific and medical knowledge. |
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< | Nonetheless, the scientific understanding of transmission was incomplete for many diseases. For instance, until the work done by Walter Reed to confirm the transmission of yellow fever by mosquitoes in 1900, the disease was assumed to be transferred either from direct contact with infected people, or to be airborne. This pamphlet in 1879 favors the latter theory, recommending quarantine measures for ships based on the new science of thermodynamics that would have been largely ineffective.Yellow Fever, A Nautical Disease, Its Origin and Prevention (1879). In the face of this ongoing uncertainty, undoubtedly there were regulations adopted based on commercial convenience as much as scientific advancement. |
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> | Nonetheless, the scientific understanding of transmission was incomplete for many diseases. For instance, until the work done by Walter Reed to confirm the transmission of yellow fever by mosquitoes in 1900, the disease was assumed to be transferred either from direct contact with infected people, or to be airborne. This pamphlet in 1879 favors the latter theory, recommending quarantine measures for ships based on the new science of thermodynamics that would have been only partially effective:Yellow Fever, A Nautical Disease, Its Origin and Prevention (1879). In the face of debate and ongoing technical uncertainty, undoubtedly there were regulations adopted based on commercial convenience or local rent-seeking as much as scientific advancement. |
| | Many of the professional sources indicate a welcoming attitude to State regulation. An example is Henry I. Bowdich, Public Hygiene in America: Being the Centennial Discourse Delivered Before the International Medical Congress, Philadelphia, September 1876 p 2. His address opined:
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< | Only the State with its great resources, with a large corps of able and earnest agents occupied in the observation of the rise and progress of disease, and in the analysis of such observations for many generations, can hope to unravel even a few of the many mysterious causes of the diseases of any nation, especially of one covering so large a proportion of the earth’s surface as the United States. |
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> | Only the State with its great resources, with a large corps of able and earnest agents occupied in the observation of the rise and progress of disease, and in the analysis of such observations for many generations, can hope to unravel even a few of the many mysterious causes of the diseases of any nation, especially of one covering so large a proportion of the earth's surface as the United States. |
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Mr Bowdich went on to become one of the original members of the National Board of Health in 1879. |
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< | This attitude extended into the 1880s. Here is an address from the Army Surgeon John S Billings, President of the Sanitarian |
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> | This attitude extended into the 1880s. Here is an address from the Army Surgeon John S Billings, President of the Sanitarian (link): |
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< | Until quite recently, very little has been done in this country towards increasing our knowledge of the causes of diseases by observation and experimentation towards that end … We have not had the statistical data, such as the registration system of Great Britain provides, nor the laboratories for experimentation in comparative physiology and pathology such as are to be found in Germany, nor the trained statisticians and scientific observers who could make proper use of these things if we had them. All these, however, will come; some of them are now here. For the most part they can only be provided by governments, their cost and the length of time required to produce really valuable results, placing them beyond the reach of individual effort. |
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> | Until quite recently, very little has been done in this country towards increasing our knowledge of the causes of diseases by observation and experimentation towards that end ; We have not had the statistical data, such as the registration system of Great Britain provides, nor the laboratories for experimentation in comparative physiology and pathology such as are to be found in Germany, nor the trained statisticians and scientific observers who could make proper use of these things if we had them. All these, however, will come; some of them are now here. For the most part they can only be provided by governments, their cost and the length of time required to produce really valuable results, placing them beyond the reach of individual effort. |
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The move to create the National Board of Health should be understood in this context of favorable opinion towards State regulation and overall coordination favoring a national approach to epidemic prevention and management.
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| | Timeline with linked sources |
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> | Early moves to create a National Board of Health
There had been discussion among the public and professional societies of creating a National Board of Health since at least the early 1870s. This newspaper article canvassing the possibility of a National Board, for instance, is dated 18 October 1873 Public Ledger, Philadelphia National Board Vol LXXVI, issue 22, p 1. |
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> | Nothing concrete came from this discussion until late 1878, when there was a convention of the public health association in Virginia. It seems that this convention shaped the discussion sufficiently to draw a proposal for a National Board to Congressional attention. It took the yellow fever epidemic in 1878, however, to provide the impetus to secure legislation and national funding for the Board. |
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The 1878 yellow fever epidemic and its aftermath |
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< | Yellow fever was a frequently recurring problem in the Mississippi region, but the epidemic of 1878 was particularly severe. Over 20,000 people died. There was mass panic and many people attempted to relocate to other States, and there were reported instances of communities enforcing 'shotgun quarantines', paralyzing trade and commerce around the country even away from the worst affected areas. The far-reaching consequences of the epidemic managed to galvanize institutional support behind a national response. In 1878, Congress passed an Act that came to be known as the Woodworth law, allowing the Surgeon-General of the Marine Hospital Services under the Secetary of the Treasury to frame quarantine regulations. This had no appropriation attached to it, but was the United States' first national quarantine law (link). |
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> | Yellow fever was a frequently recurring problem in the Mississippi region, but the epidemic of 1878 was particularly severe. Over 20,000 people died. There was mass panic and many people attempted to relocate to other States. There were reported instances of communities enforcing 'shotgun quarantines', paralyzing trade and commerce around the country even away from the worst affected areas. The far-reaching consequences of the epidemic managed to galvanize institutional support behind a national response. In 1878, Congress passed an Act that came to be known as the Woodworth law, allowing the Surgeon-General of the Marine Hospital Services under the Secetary of the Treasury to frame quarantine regulations. This had no appropriation attached to it, but was the United States' first national quarantine law (link). |
| | Another national form of the yellow fever response was the creation of the National Board of Health. A nationally co-ordinated solution (although in the form of a national Sanitary Commission rather than a Board per se) was recommended to Congress by the Commission set up to investigate yellow fever:
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| | State Boards of Health and the National Board's operation
Section 3 of the 1879 Act creating the National Board of Health (the 'founding Act') sets out a two-step process. First, it encourages the co-operation of the National Board with the State Boards of Health and their regulations. Second, it allows the Board to displace these rules with Presidential approval. It seems reasonable to assume that this two-step process, and the Presidential approval requirement, was an attempt to secure State support for the Bill and the possibility of diminution of State authority. |
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< | State Boards of health had been in operation for decades in the largest States. New York was the first State with such a Board. It had a State Board of health since 1805, and one fully independent from the Legislature since 1866 (reference link). Massachusetts had a well-organized State Board of Health since 1869 (reference link). In these States, and presumably others where the historical records are more scarce, the functions of the Boards of Health were broader than we would necessary associate with 'health' today, including such functions as the supervision of abattoirs, building codes and prostitution, as well as disease prevention, statistical analysis and providing a forum to produce and disseminate research and learning about medicine and diseases. |
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> | State Boards of health had been in operation for decades in the largest States. New York was the first State with such a Board. It had a State Board of health since 1805, and one fully independent from the Legislature since 1866 (reference link). Massachusetts had a well-organized State Board of Health since 1869 (reference link). In these States, and presumably others where the historical records are more scarce, the functions of the Boards of Health were broader than we would associate with 'health' today, including such functions as the supervision of abattoirs, building codes and prostitution, as well as disease prevention, statistical analysis and providing a forum to produce and disseminate research and learning about medicine and diseases. 'Public health has a vast deal to do with public morals, and immorality is the most fatal blow struck at the public health' noted a report on the convention establishing the National Board of Health in Virginia, just as the yellow fever epidemic of 1878 struck Galveston News, Galveston Texas, 11-25-1878, p 2 'The National Board of Health'. |
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< | The National Board of Health was modeled on these State Boards. Its statutory functions include making regular assessments of the conditions of foreign ports, and receiving weekly reports of the conditions of domestic ports. Note that in practice it appears that the functions of the Board in relation to foreign ports were only partially carried out, if at all (link). The founding Act for the Board requires it to publish weekly summaries of the information it receives for the benefit of the Marine Hospital Service, and State and municipal Boards of Health. The inclusion of municipal boards of health is an important reminder that not all parts of the founding Act fit into a simplistic dualist 'federal vs state' regulatory model. These municipal boards were also an important (and in some places long established) part of the regulatory infrastructure for disease prevention and public health (reference link). |
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> | The National Board of Health was modeled on the existing State Boards. Its statutory functions include making regular assessments of the conditions of foreign ports, and receiving weekly reports of the conditions of domestic ports. Note that in practice it appears that the functions of the Board in relation to foreign ports were only partially carried out, if at all (link). The founding Act for the Board requires it to publish weekly summaries of the information it receives for the benefit of the Marine Hospital Service, and State and municipal Boards of Health. The inclusion of municipal boards of health is an important reminder that not all parts of the founding Act fit into a simplistic dualist 'federal vs state' regulatory model. These municipal boards were also an important (and in some places long established) part of the regulatory infrastructure for disease prevention and public health (reference link). |
| | The Board was composed of one medical officer from the Army; one from the Navy; one from the Marine Hospital Service. There were also seven members appointed by the President and confirmed by the Senate, not more than one from any State. |
| | Another possibility is that of military views of health management clashing with civilian ones. One of the more expensive projects of the National Board of Health was the creation of the Ship Island quarantine station. A report for the Bill dismantling this station reveals that the United States Marine Hospital Service opposed this station from the outset (link and compare the report establishing the station). If construed along these lines, it is possibly significant that the 1893 Act, some time after the Board had been in practice abolished, vested its powers in the Marine Hospital Service(link), a strategy not favored by the American Public Health Organization (link). Against this reading is the presence of Army, Navy and Marine Hospital Officers on the Board, although they would not have been a majority. |
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< | Finally, State-level interests may have created a backlash against the nationalization of the Board's functions. There is no conclusive positive evidence of this, although the careful crafting of the Board's initial functions, as I have argued above, reveals a careful attention to the State/Federal balance. Additionally, the report recommending the repeal of the Board's sunset clause is clearly drafted with a mind to alleviate concerns about Congressional power under the commerce clause (link, see eg pp 4,5). Note that the 1884 report of the Board makes it clear that the prevailing constitutional interpretation was that Congress did not have the power to authorize a national compliance certificate that, once obtained, would guarantee a vessel entry into any State. Instead, State police powers were considered to trump a federal quarantine certification. In 1882, some petitioners in New York and Massachusetts were anxious enough about protecting State interests in health that they petitioned the Senate to prevent the Board gaining 'vice' powers (link). The official reply was that the Board's powers were very narrow, but it is clear from the Board's annual reports that it undertook investigations into matters such as livestock health and sewers, as well as its more publicized work on cholera, smallpox and yellow fever quarantine measures. The annual reports, however, also reveal instances of close cooperation with numerous State Boards of Health, and an interest in the strengthening of State sanitary legal infrastructure (for example, State legislation). If there was significant State resistance to the National Board's efforts, it does not appear to have originated in the State Boards of Health. Although State forces may have played a part in the unraveling of the Board, countervailing factors perhaps include that many of its core functions were returned to a national level after its demise, a situation which will be examined now. |
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> | Finally, State-level interests may have created a backlash against the nationalization of the Board's functions. Dissent to the Board existed since its inception. In early 1879 when the Board's founding Act was before Congress, a newspaper in Cincinnatti, Ohio, crowed 'National Board of Health Project likely to fail', stating 'the General Government is becoming so burdened with bureaus of all sorts, and officers multiplied with fat pay and little to do, that strong opposition is developed among the members...':The Cincinnati Commercial, 02-08-1879 Vol XXXIX Issue 149 p 3.
Perhaps better evidence of entrenched interests is demonstrated by the careful crafting of the Board's initial functions, which, as I have argued above, reveals a keen attention to the State/Federal balance. Additionally, the report recommending the repeal of the Board's sunset clause is clearly drafted with a mind to alleviate concerns about Congressional power under the commerce clause (link, see eg pp 4,5). Note that the 1884 report of the Board makes it clear that the prevailing constitutional interpretation was that Congress did not have the power to authorize a national compliance certificate that, once obtained, would guarantee a vessel entry into any State. Instead, State police powers were considered to trump a federal quarantine certification.
In 1882, some petitioners in New York and Massachusetts were anxious enough about protecting State interests in health that they petitioned the Senate to prevent the Board gaining 'vice' powers (link). The official reply was that the Board's powers were very narrow, but it is clear from the Board's annual reports that it undertook investigations into matters such as livestock health and sewers, as well as its more publicized work on cholera, smallpox and yellow fever quarantine measures.
The annual reports, however, also reveal instances of close and mutually beneficial cooperation with numerous State Boards of Health, and demonstrate a genuine-seeming interest in strengthening State sanitary legal infrastructure (for example, State legislation). I think the better view is that State resistance to the National Board's efforts probably did not originate specifically in the State Boards of Health, but was a reflection of more general attitudes and trends. There is also some evidence of some State-level authorities preferring their autochthonuos regulatory infrastructure and quarantine procedures: see eg The Daily Picayune, New Orleans Louisiana, p 4 1-17-1884 'The Defunct National Board of Health'.
Overall, I think the federalist analysis is the best lens through which to analyze the decline of the Board. In 1893 the centralizing forces, which had peaked in response to the chaos of the 1879 yellow fever epidemic, were outweighed by the interests of local and regional autonomy. In the slightly longer term, however, countervailing forces meant that many of the National Board's core functions were returned to a national level after its demise. |
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After the Board |
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< | The last report of the Board in 1885 takes a generally optimistic tone in parts in relation to the overall effects of the Board: 'it is believed that the country was never in better condition to resist the progress of epidemics than it is at the present time' declared the National Board of Health's Annual report for 1885. |
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> | The Woodworth law of 1878 remained in operation after the National Board, allowing the promulgation of national quarantine standards from the Marine Hosptial Service. This was the federal compromise: allowing some national coordination but in a very narrowly confined area, unlike the broader interests of the Board. |
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< | The report notes that 32 of the States had, in 1885, boards of health or 'other forms of sanitary organization charged with the duty of devising and enforcing such measures as may serve to promote the well-being of the people'. Note that in 1885 there were only 38 States. The 1884 report the previous year stated that there were 27 State boards of health, and noted the rapid increase in State and local preventative health measures sparked and facilitated by the National Board. |
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> | In the mid 1880s there was a virulent cholera epidemic in Europe, and American authorities were anxious to resist its introduction as much as possible. Cholera spread to New York (city and quarantine station) in 1892. The Surgeon General reports that this anxiety prompted the passage of the Federal quarantine Act in 1893 granting more powers to the Marine Hospital Service link, at p 265. A plain English translation of the Bill is also in the report, linked here. The Surgeon-General does not comment on section 9 of the Act, formally repealing the now defunct National Board of Health. |
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< | In the mid 1880s there was a virulent cholera epidemic in Europe, and American authorities were anxious to resist its introduction as much as possible. Cholera spread to New York (city and quarantine station) in 1892. The Surgeon General reports that this anxiety prompted the passage of the Federal quarantine Act in 1893 link, at p 265. A plain English translation of the Bill is also in the report, linked here. The Surgeon-General does not comment on section 9 of the Act, repealing the National Board of Health. |
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> | The last report of the Board in 1885 takes a generally optimistic tone in parts in relation to the overall effects of the Board: 'it is believed that the country was never in better condition to resist the progress of epidemics than it is at the present time' declared the National Board of Health's Annual report for 1885. |
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> | The report notes that 32 of the States had, in 1885, boards of health or 'other forms of sanitary organization charged with the duty of devising and enforcing such measures as may serve to promote the well-being of the people'. Note that in 1885 there were only 38 States. The 1884 report the previous year stated that there were 27 State boards of health, and noted the rapid increase in State and local preventative health measures sparked and facilitated by the National Board. |
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Court Response |
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- opinion_politics.pdf: Public Ledger, Philadelphia 10-18-1873 Op ed piece on National Board Vol LXXVI, issue 22, p 1.
- Ohio_fail.pdf: The Cincinnati Commercial, 02-08-1879 Vol XXXIX Issue 149 p 3
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