THE MEMORIAL OF THE STATE BOARD OF HEALTH. To the Honorable the Senate and House of Representatives of the General Assembly of the State of Alabama: The undersigned, the Committee of Public Health of the Medical Association of the State of Alabama, were instructed at the last annual session of the said Association to present to the favorable consideration of your honorable bodies, the accompanying draft of an act to carry into effect the health laws of the State. In the discharge of this duty we beg leave to make the following statements: By an act of the General Assembly, which was approved on the 19th day of February, 1875, the Medical Association of the State of Alabama, was constituted the Board of Health of the State of Alabama. This trust was formally accepted by the Association at its annual session in Montgomery in April, 1875. At this session, also, in order to facilitate the execution of its health functions the Association created a permanent committee, to be composed of ten of its members and to be called the committee of Public Health. Of this committee the undersigned are the present incumbents. In calling your attention to the bill which we have the honor to present, it is no part of our purpose to discuss the importance of Public Hygiene, or State Medicine, and the various ways in which it contributes to the welfare of the people and to the prosperity of States. Its value, indeed, is now so universally recognized amongst all cultivated and thoughtful persons, that it cannot be necessary to dwell upon it here. What we have to consider is this, namely: What special work can our State Board of Health properly undertake to do? and what assistance ought the State to contribute towards the accomplishment of that work? We know very well that many of the functions of Boards of Health in populous and wealthy communities, are prohibited to us on account of the poverty of our State; while others are rendered difficult or inexpedient on account of the sparseness of our population. We feel, for example, that it would be unwise in us to advise the State to engage in protracted and costly investigations, such as during several years have been conducted under the auspices of the health department of the British Government at an expense of time, labor, and money entirely beyond the reach of private enterprise. Hereafter it may be that circumstances will justify us in turning our attention to this alluring field of original reseach. Whenever, indeed, we are able to afford the expense, it should be a matter of pride with us to contribute something to the common fund of sanitary knowledge from which we must draw such large and frequent drafts in the practical supervision of the health interests of the State. But for the present, we appreciate the fact that we must limit our counsels to such measures as lie within the compass of existing knowledge, and as the means and circumstances of our people may render available. Already we have observers scattered all over the State); already our annual volumes of Transactions have become the recipients of many valuable contributions in relation to the climatology and medical topography, and to the endemic and epidemic diseases of the State; so that already the work of our Association, done at the expense of its own members, is of very considerable sanitary value; and this work we propose to continue with undiminished industry. But it is evident that a large part of the work that ought to be done under our direction, cannot be done without the employment of skilled officials and the consequent expenditure of money. It should be our purpose ultimately, to have a Board of Health in every county of the State. The wise organization of these, and their subsequent supervision so that all of them may work together harmoniously towards one common end, is a work which will require many years for its completion, and which is from the beginning beset with many difficulties. The gathering together, in such way as to illustrate important principles and to furnish reliable indications for legislative action, of the vital and mortuary statistics of the several sections of the State, is a work that ought to be at once commenced, even while from the nature of the case, it is certain that it can make but slow progress. Of the skilled investigation into the origin and progress of the destructive endemics and epidemics, which levy such dreadful tribute upon the lives of our people and do so much to drive prosperity from our borders, the importance is so great that we need do nothing more than to mention it here to have it appreciated. It is in connection with such labors as these, that we make application to the State for the modest and reasonable sum which we have named in our bill; and we believe that no possible objection can be urged against the legislative action which is here invoked, except that it imposes this slight expense upon the public treasury. But if the service to be done is of the important character, which we have represented it to be, this objection is too paltry for serious discussion; and in reference to it we will only say, that for the protection of lite and property against violence and outrage; for the punishment of crime and the vindication of justice; for the education of the people; and for many other purposes of public concern, the State scatters her promiscuous thousands in every direction. For the conservation of the public health, which is certainly not inferior to many of these in importance to the public welfare, she expends-not one single dollar. We say it with all possible respect, that if this were not the result of negligence and of untoward circumstances, it would be a reproach to our civilization. All of which is respectfully submitted. JEROME COCHRANE, M. D., GEO. E. KUMPE, M. D., It now becomes incumbent upon us to enter practically upon the work of the supervision of the sanitary interests of the State. The Law Establishing Boards of Health in the State of Alabama, furnishes us with the necessary authority; and the new law to carry into effect the Health Laws of the State furnishes us with the necessary means. We have never undertaken an enterprise of greater difficulty than this; and it is therefore important that we shall proceed with the utmost prudence and circumspection. We have to create for ourselves all the details of the system that we are to put into operation; and we have to put this system into operation amongst a people who, for the most part, know nothing, and through the instrumentality of agents who, for the most part, know but little of sanitary science and of the administration of sanitary regulations. It is easy to see, therefore, what indeed we have alway fully recognized, that we need in the beginning of our sanitary work the services of an executive officer skilled in the principles of public hygiene, and endowed with considerable powers of organization and administration. In furtherance of this end, we respectfully recommend the adoption of the following Ordinance : AN ORDINANCE CREATING A HEALTH OFFICER FOR THE STATE OF ALABAMA. Be it ordained by the Medical Association of the State of Alabama (1), That this Association, acting in the capacity of the Board of Health of the State of Alabama, hereby authorizes the election, from time to time as occasion may require, of an executive health officer to be entitled the Health Officer of the State of Alabama. (2). That the said Health Officer shall be elected by the Committee of Public Health of this Association; that his term of service shall be for five years; and that he shall be paid out of the annual appropriation made to the State Board of Health to carry into effect the health laws of the State, such annual salary as the Committee of Public Health may from time to time determine. (3). That it shall be the duty of the said Health Officer to keep the books and papers, and to conduct the correspondence of the State Board of Health; to give such assistance in the organization of the County Boards, and in the conduct of their subsequent operations, as may be ordered by the State Board of Health; to obtain from the County Boards of Health, and from other available sources, the fullest possible reports in regard to the diseases of the several counties, and of the causes in which such diseases originate; to prepare, under the direction of the State Board of Health, an annual report upon the vital and mortuary statistics and the sanitary condition of the State; and to make such special investigations of endemic and of epidemic diseases, and of other problems in sanitary science as may be ordered by the State Board of Health, (4). That the said Health Officer shall be the general executive officer of the State Board of Health; that in the intervals between the annual sessions of the Association he shall be under the orders of the Committee of Public Health of the Association; and that he may be at any time removed from office by the said Committee of Public Health for incompetence, or malfeasance in office, or other sufficient cause. Done in annual session in the City of Selma, April 11th, Anno Domini, one thousand eight hundred and seventy-nine. We do not submit for your consideration the many details that are necessarily involved in any general system of sanitary administration; because it seems to us that these details can be better settled, from time to time, as occasion may seem to demand; and because, also, the preparation of plans and details will constitute naturally a considerable part of our first year's work, under the new system of things. THE YELLOW FEVER EPIDEMIC OF 1878. The year that has just passed away will for a long time remain memorable in our history as the great year of pestilential invasion—the year in which, so far as the experience of the current generation of men is concerned, Yellow Fever, the great epidemic of the Western Continent, has extended its contests most widely over our territory, and levied its largest tribute upon the lives of our people. We shall not attempt to give, even in outline, the history of the epidemic. It is sufficient for our purpose to say of it, that something like one hundred and forty (140) towns and cities have suffered from its ravages; that the number of cases of sickness which it inflicted upon us reaches the grand total of about one hundred and twenty-five thousand (125,000); and that the number of deaths for which it is responsible, aggregates about eighteen thousand (18,000). The cost of the epidemic, in money and in money's worth, was very great, but we have no data on which to base even an approximate estimate of the real amount. The loss to the wealth of the nation was also very great, but of this also we are not able to make any estimate. All that we can say is, that the losses and expenses of the epidemic would certainly foot up many millions of dollars. But these statistics convey to the imagination only the faintest and most inadequate conceptions of dreadful details of the epidemic. In many of the more sorely stricken communities, as for example, in Memphis, and Granada, and Vicksburg, and Holly Springs, the pestilence was King; and Panic and shuddering Horror, and the black shadow of Death, were his ministers. Hope of escape there was none except by flight; and all the routes of travel leading from the infected localities were populous with fugitives. The times indeed were times of tribulation, and such as try men's souls. No wonder that even brave men fled; and, indeed, since all who remained at all remained to feed the pestilence and increase its horrors, flight became a sort of sacred duty. But universal flight was impossible. Many were too poor in the goods of this world to be able to travel away from home; and many others were constrained to remain, out of the sentiment of Christian charity, to minister to the wants of suffering friends and neighbors. Amongst those who fought most bravely under the banners of humanity, in that terrible combat with the pestilence which walketh by night, and the desolation which wasteth at noon-day, we hope we may be excused if we single out for special mention the members of our own profession, who, upon this occasion, acted as they have always done from immemorial ages. They recognized in all its fullness of meaning the truth of the trite maxim, that the epidemic is the battle field of the physician-recognized that it was their peculiar mission to carry hope to the hopeless, help to the sick, comfort to the dying. None else knew so well as they the character of the danger they were called upon to face; and certainly none else confronted it with such unflinching courage. In the principle centres of infection they knew well that for them there was no hope of escape. All of them went surely to beds of sickness; and many of them to beds of death. The immortal charge of the six hundred at Balaklava, Into the valley of Death, was not so desperate as the warfare waged by our professional brothers against the invisible armies of the pestilence. Let us not be misunderstood. We intend to apply these remarks to those local physicians who, without the guarantee of exemption afforded by previous attacks of yellow fever, remained in the midst of unacclimated populations, and braved all the horrors of the epidemic, from a high sense of duty. An epidemic so wide-spread and so destructive could not fail to excite a very large amount of public interest. The newspapers of the day were filled with the details of its daily progress. The telegraphs and the railroads were generously placed at the disposal of a generous public, and money and supplies of all kinds flowed in generous streams into the suffering cities and towns, week after week, and month after month, until the armies of the pestilence were met and conquered by the armies of the frost. Great were the |