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Progress update: Still very much under construction, but taking shape. |
| | I'm looking at 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 (yellow fever and cholera), and the creation of a federal body (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 was revived by repeal of this sunset clause in early 1883 due to its excellent performance. But after 1885, Board failed. I'm curious why it failed. My time frame ends with the creation of the first successful federal quarantine laws. |
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> | The Board initially came into existence through an Act in 1879 with a sunset clause to expire in 1883. It was revived by repeal of this sunset clause in early 1883 due to its excellent performance. But after 1885, Board failed. I'm curious why it failed. My time frame ends with the creation of the first successful federal quarantine laws. |
| | Background: Disease and Quarantine in the Late 19th Century
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). 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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< | 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 eg 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 |
| | 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.Yellow Fever, A Nautical Disease, Its Origin and Prevention (1879)
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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| | Mr Bowdich went on to become one of the original members of the National Board of Health in 1879.
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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| | 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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| | The rise and fall of the National Board of Health |
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> | The yellow fever epidemic and its aftermath
Yellow fever was a recurring problem in the Mississippi region, but the epidemic of 1878 was particularly severe. It seems that the epidemic managed to galvanize institutional support behind a national response, and the form of that response was the creation of the National Board of Health. A National solution (although in the form of a national Sanitary Commission rather than Board per se) was recommended to Congress by the Commission set up to investigate yellow fever:
The public, we may almost now say national health, is too vast and important a concern to be entrusted to inefficient boards of health and spasmodic Congressional legislation (Report to Congress in the wake of the 1878 yellow fever epidemic from the Commission as to the Causes and Prevention of Yellow Fever. Link here.)
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> | State models and the Board's operation |
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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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< | The public, we may almost now say national health, is too vast and important a concern to be entrusted to inefficient boards of health and spasmodic Congressional legislation (Report to Congress in the wake of the 1878 yellow fever epidemic from the Commission as to the Causes and Prevention of Yellow Fever. Link here.) |
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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. |
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> | Funding |
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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' |
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> | Clashes over funding were ongoing. In 1881, the annual report reveals that the Board received only 1/3 of the funds it wanted to build new quarantine stations in Virginia, Georgia and Texas (link). |
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< | Key points: 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. It 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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> | Motives
The historical documents are largely silent as to the motives behind the Board's slow death due to underfunding. My conclusion is that it was controversial. The address of the President of the American Public Health Organization in 1887 (reported in Science, Vol X No. 251, link here) notes that:_It is unnecessary for me to refer to the various circumstances that conspired to paralyze the effective energy of this Board. Unhappily it is a thing of the past, and the hopes which we had founded on this our bantling are but a thing of the past._ |
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< | Clashes over funding were ongoing. In 1881, the annual report reveals that the Board received only 1/3 of the funds it wanted to build new quarantine stations in Virginia, Georgia and Texas (link). |
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> | These are words alluding to extreme and well-known controversy, not agreement. The battlelines of the controversy, however, are not apparent from the historical sources I have collected. It is possible that the change to a Democratic President in 1885 was part of the ultimate collapse of appropriations, but the funding gap for the Board predates this change of political leadership. |
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< | The mood was generally optimistic: '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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> | Situation after the Board |
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> | The last report of the Board 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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> | 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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< | Court Response
Dunwoody v United States 138 U.S. 578 (1892) held that Mr Dunwoody, the chief clerk and sometime secretary of the National Board of Health, could not recover money from the federal government in the absence of specific grants payable to the Board. |
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< | Louisiana v Texas 176 US 1 (1900) held that there was no interstate federal jurisdiction merely because the quarantine actions of one state (Texas) hurt those of another (Louisiana). The facts of the case concerned the Texan embargo on interstate trade during the yellow fever outbreak in 1899. The Supreme Court point-blank refused to get involved. |
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> | Court Response
Dunwoody v United States 138 U.S. 578 (1892) held that Mr Dunwoody, the chief clerk and sometime secretary of the National Board of Health, could not recover money from the federal government in the absence of specific grants payable to the Board. |
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< | The enaction of federal quarantine laws |
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> | Louisiana v Texas 176 US 1 (1900) held that there was no interstate federal jurisdiction merely because the quarantine actions of one state (Texas) hurt those of another (Louisiana). The facts of the case concerned the Texan embargo on interstate trade during the yellow fever outbreak in 1899. The Supreme Court point-blank refused to get involved. |
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Conclusions |
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> | The creation of the National Board of Health, even if it ultimately failed, was a significant step in creating uniformity of quarantine standards and broader public health measures more generally. Nonetheless, it is in some ways surprising that a national response to disease and quarantine took so long to formulate. Even before the Supreme Court's expansive reading of the commerce clause in the 1930s, it was relatively uncontroversial that the federal government had the power to regulate quarantine measures under this clause. My best guess as to why this is the case is the politically sensitive nature of quarantine regulations that have a potentially significant effect on trade between States (see Louisiana v Texas 176 US 1 (1900), analyzed below). Also, it is by no means uncontested that a national response to health and safety regulation beyond the specific issue of immigrant quarantine and epidemic management is most efficiently done at a federal rather than State level. The nature of federalism involves weighing State autonomy and ability to tailor regulation to local circumstances on the one hand, and the potential for national coordination, economies of scale and (relative) neutrality of regulation on the other. The rise and fall of the National Board of Health should be seen in the light of these competing forces, as an aspect of broader federal tensions inherent in the nature of the American political system. |
| | Acts |