of Selma on the 13th, 14th and 15th days of April of the present year (1874), were charged with the duty of presenting for the consideration of your honorable bodies the subjoined draft of "A bill to establish Boards of Health in the State of Alabama." In the performance of this duty we would most respectfully state: 1. That the need of legislative enactments for the promotion of the public health has been recognized in almost all civilized communities, health-boards and health-laws being a part of the regular machinery of government in most European countries, and in several of the States of the American Union. 2. That here in the State of Alabama thousands of deaths and tens of thousands of cases of sickness occur every year from diseases which might be prevented, entailing on the people an amount of physical suffering and of pecuniary loss, which it would not be easy to exaggerate. 3. That the Medical Association of the State, after mature deliberation, has unanimously endorsed the plan for the organization of a health-system, which is now presented to the General Assembly. 4. That this plan will secure the co-operation of the entire Medical Profession of the State. 5. That the expense to the State which it involves is extremely small. 6. That the expense to the several counties and cities of the State which it involves, is left entirely to the proper legal authorities of such counties and cities as choose to avail themselves of its advantages. All of which is respectfully submitted. JEROME COCHRAN, M. D., JAMES GUILD, M. D., R. F. MICHEL, M. D., Board of Censors of the Medical Association of the State of Alabama. All the members of the Board of Censors, fully appreciating the importance of the movement, both to the Medical Profession and to the people of the State, did what they could to facilitate the passage of the bill; and in furtherance of this purpose they received the cheerful assistance of the members of the Association generally. One member of the Association, and only one so far as we know, was so far forgetful of his duty to the Association, and of the implicit obligation he was under to forbear from all overt opposition to its decisions, as to make himself quite active in endeavoring to influence the General Assembly against the approval of the bill. It also met with opposition from several medical gentlemen who are not members of the Association, and who make it a rule to oppose whatever the Association favors, a sort of opposition not so much to be wondered at, and which need give us but little con cern. By the members of the General Assembly the proposed plan was for the most part favorably received. Indeed, we have reason to believe that it would have been approved without hesitation but for the factious opposition of members of the Medical Profession to which we have just alluded. After much discussion, particularly in the Senate, the bill finally passed both houses of the General Assembly and was approved by the Governor of the State on the 19th of February of the present year. It is necessary, however, for us to explain that the bill, in the form which it ultimately assumed, differs in two particulars from the original draft which was endorsed by the Association. The changes are as follows: The third section has been amended so as to provide that instead of a specific appropriation of one thousand ($1,000) dollars per annum to defray the expenses of publishing our Transactions, the publication shall be done at the expense of the State in the same way as other public documents are published. The last section of the bill has been amended by the addition of a clause, providing that the bill may be at any time amended or repealed, at the pleasure of the General Assembly. We assented to both of these amendments, under the pressure of circumstances; but we did so reluctantly, and have still to regret the necessity which required the concession. We regret the change in the third section, in the first place because the publication and distribution of our Transactions ought to be, and indeed must be, under our own control, inasmuch as any other arrangement might lead to unpleasant complications; and because, in the second place, while the Association meets in April of each year, the General Assembly does not meet until November, so that we will either have to print our Transactions ourselves and trust to the General Assembly to refund the amount expended, or else have the publication inconveniently delayed. As to which of these two courses it is expedient for the Association to adopt, we have no hesitation whatever in recommending the former—namely, that we have our printing done as heretofore, under our own supervision, and at our own immediate expense. If the General Assembly is pleased to refund the amount, of course we will be pleased to receive it. If, on the contrary, the General Assembly refuses to refund the amount, we are glad to be able to say that we are able to do without it. In the meantime, we are of the opinion that whenever circumstances war rant the attempt, we should make application to the General Assembly to restore this third section to its original form. We object to the change in the last section because it seems virtually to ignore the fact that the arrangement by which the Medical Association assumes the supervision of the public health is really of the nature of a contract between the Association and the State. And while we concede that it is entirely proper for the General Assembly to have the power to annul the contract at any time, we cannot concede that one of the contracting parties can have the right to alter the terms of the agreement without consultation with the other. But we are of the opinion that this amendment is more likely to prove objectionable in theory than in practice, and we therefore dismiss it without further argument. After careful consideration of the whole subject we are of the opinion that the Association should accept the provisions of the bill in the form in which it passed the General Assembly. A copy of the bill in this form is here subjoined: AN ACT TO ESTABLISH BOARDS OF HEALTH IN THE STATE OF ALABAMA. SECTION 1. Be it enacted by the General Assembly of the State of Alabama, That the Medical Association of the State of Alabama, organized in accordance with the provisions of the Constitution, which was adopted by said Association at its annual meeting, in the city of Tuscaloosa, in March, 1873, be and is hereby constituted the Board of Health of the State of Alabama. SECTION 2. Be it further enacted, That the Board of Health of the State of Alabama, thus established, shall take cognizance of the interests of health and life among the people of the State; shall investigate the causes and means of prevention of endemic and of epidemic diseases; shall investigate the influences of localities and employments upon the public health; shall from time to time make to the General Assembly such suggestions as to legislative action as in their judgment may seem advisable; and shall be, in all ways, the medical advisors of the State. SECTION 3. Be it further enacted, That such Board of Health of Alabama shall make to the Governor for transmission to the General Assembly an annual report of their investigations and transactions; of which annual report there shall be annually published, as other reports transmitted through the Governor to the General Assembly, a sufficient number of copies for distribution among the members of the General Assembly, and the members of the Board of Health of the State of Alabama, and such additional numbers as may be deemed advisable for the purpose of exchanging for the reports of similar Associations in other States. SECTION 4. Be it further enacted, That the County Medical Societies, in affiliation with the Medical Association of the State of Alabama, and organized in accordance with the provisions of the Constitution of the said Association, as described in the first section of this act, be and are hereby constituted Boards of Health for their respective counties; and, as such, shall be under the general direction of the Board of Health of the State of Alabama, created by the first section of this act. SECTION 5. Be it further enacted, That the County Boards of Health, thus established, shall have only advisory powers, and shall be conducted without expense to the State or to their respective counties, except under the conditions provided for under the sixth section of this act, which here follows: SECTION 6. Be it further enacted, That the competent legal authorities of any county in this State, or of any incorporated town or city of any such county, shall, whenever in their judgment it becomes expedient to do so, proceed to invest the Board of Health of the county, with such executive powers and duties for the promotion of the public health, and under such rules and stipulations as shall be agreed upon between the two parties. SECTION 7. Be it further enacted, That in any such agreement, as is contemplated in section six of this act, the right to elect or appoint the officers and servants employed in the administration of the sanitary regulations so agreed upon shall, in all cases, be reserved to the Board of Health; and further, that all questions relating to salaries, appropriations, and expenditures, shall be reserved to the legal authorities of the county, town, or city, as the case may be. SECTION 8. Be it further enacted, That no Board of Health, or advisory, or executive medical body of any name or kind for the exercise of public health functions, shall be established by authority of law in any county, town, or city of this State, except such as are contemplated by the provisions of this act, the object of this prohibition being to secure a uniform system of sanitary supervision throughout the State. But nothing in this article shall be so construed as to prevent any of the Boards of Health created by section four of this act from accepting and executing any special powers that may be granted them by the General Assembly of the State; Provided, That this act may be changed, modified, or repealed at any time, at the pleasure of the General Assembly of this State. Approved February 19th, 1875. STATE OF ALABAMA, I, R. K. Boyd, Secretary of State of the State of Alabama, do hereby certify that the foregoing act entitled An act to establish Boards of Health in the State of Alabama, approved February 19th, 1875, is a true and correct copy of the original now on file in this office. (Signed) L. S. Given under my hand and the Great Seal of the State, In order to facilitate the action of the Association in reference to this matter we have prepared the following resolutions, and respectfully recommend their adoption: Resolved, That the Medical Association of the State of Alabama hereby accept for themselves and for the County Medical Societies under their jurisdiction the provisions of an act entitled An act to establish Boards of Health in the State of Alabama, and approved by the Governor on the 19th day of February, A. D. 1875; and will endeavor to discharge the duties assigned to them in said act in good and with earnest purpose, to be of service to the people of Alabama. Resolved further, That a copy of these resolutions, properly certified by the President and the Secretary of the Association, be transmitted to the Governor of the State. If the Association, in accordance with our recommendation, should accept the terms of agreement authorized by the State, then at once several questions of practical importance present themselves for solution. We must decide, for example, whether we ought to expect the State to defray the expenses of publishing the Transactions of our present session; and whether the Transactions of our present session should be designated in its subordinate title as the report of the State Board of Health. We are unhesitatingly of the opinion that both of these questions must be answered in the negative-that the Association does not, in fact, become the State Board of Health until it has made formal acceptance of the terms of agreement and notified the State accordingly. Still further, if we accept the terms and undertake to discharge the functions of the Board of Health of the State, we must proceed to what specific duties the discharge of these functions devolves upon us, and what special action is necessary for their execution. In other words, we must decide what we are to do, and how we are to do it. |