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National Health Council. 2d. That said Council shall be auxil. iary to this Association, and constitute a special Section on Iy. giene."

In 1872, a report was made upon these resolutions, and the committee asked to be continued. In the report, suggestions were again made to appeal to the Government to establish a department of health to be connected with the Government but under the surveillance of this Association.

The appeal to the Government was objected to by the Association, but the committee was continued as a special Section on State Medicine and Public Hygiene. (Trans. Am. Med. Assoc. 1872, p. 51, and 1873, pp. 29 and 30, also p. 408.)

In 1873, Dr. A. N. Bell offered a vote on the establishment of a National Sanitary Bureau. It was referred to the Committee on Hygiene. (Trans. 1873, p. 51.) At the same meeting Dr. Howard of Baltimore, from a special committee, reported a new organization of this Association, providing for a Section on State Medicine. This puts the Section on this subject under the same rules as those guiding other sections. (Trans. p. 28 et seq. 1873.)

In 1874, the project of appealing to Congress was again urged in the Section on State Medicine, and a resolution was passed to that effect by that Section. A committee was appointed to report, at the meeting of the Section this year, a bill for the purpose

of establishing a National Department of Public Health at Washington.

It will thus be seen that this Association has wisely declined, as yet, to make any appeal to the National Government for this object; although the subject has been discussed freely in the Section, and at times at the meetings of the whole body of the Association.

IMPORTANCE OF THE SUBJECT, AND OF ITS BEING THOROUGHLY

DISCUSSED.

We must all admit that only by fair, manly reasoning and steady work, not by frantic appeals to patriotism or to rapid and imperfect talk or work, can we gain a broad and firm basis on which a National Council can rest. So important do I deem this preliminary discussion and work in order that we may start rightly on any plan, that I would willingly devote years, if necessary, to the thorough discussion of it before attempting to organize a Na. tional undertaking. This business of governmental attention to

the public health is to be one of the great labors of the coming centuries in all civilized countries, and a properly devised plan for these United States, after ample consideration, is therefore allimportant.

OPINIONS OF MY COLLEAGUES UPON THE SUBJECT OF STATE AND

NATIONAL BOARDS OF HEALTH.

I sent a circular letter to each one of them. I desired to get their opinions upon the character of any future National Health Council which might be established, and when it should be estab. lished. I likewise wished to learn what had been done and was doing each State in regard to the establishment of State Boards of Health. I considered the latter question as really fundamental in the inquiry relative to the former.

IMPERFECT RETURNS, AND REMARKS THEREUPON.

Including Massachusetts, the circular was sent to 36 States and Territories. From 28 have I received replies. But six virtually

' gave no response, one circular being returned from the Dead Letter Office; another correspondent had moved from the State; a third was ill; two felt unqualified to give any opinion; and the sixth informed me of professional difficulties in his State, but gave no response to my questions. Twenty-two have more or less defi. nitely replied.

One word here en passant. Are we really in a fit condition for a National Health Council, especially one to be under the guidance of this Association, as some have earnestly argued, when so many correspondents, all appointed at our last meeting as men especially interested in Public Hygiene in the different States, fail to respond to a very few simple questions requiring only a certain amount of reflection and scarcely an iota of' solid work?

VARIOUS OPINIONS AS TO THE ESTABLISHMENT OF A HEALTH

COUNCIL FOR THE NATION,

Of twenty-two correspondents, seventeen have answered with various degrees of earnestness for, or of indifference to the project

I See Appendix A., Names of Correspondents.

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of a National Health Council. These answers afford striking evidence of the indecision of the profession of the country as to our ability to establish such an organization at present.

Six are enthusiastically in favor of proceeding immediately, and of pressing forthwith the matter on the notice of Congress. One gentleman in his abundant zeal advances views which few of us, I think, would entertain as a whole, although we might agree to some of his details.• He says that a Health Department of the National Government "would be more important than the Judiciary—that it could send a journal of health to every family in the Union—that all the people would consent willingly and without a dissenting voice to be taxed for its support!" and the writer adds that he “will, if wished, present working plans for such an institution." Another wisely says that such a bureau “would save millions of money." Another claims that a letter is too brief for details, “but let us have forth with a convention and debate." One thinks that a National Board should be established in order to stimulate the formation of State and Municipal Boards. Others deem the subject very important, but they wish to wait until State Boards are formed. Another speaks of it as one of the greatest objects we can strive for—and says that it would do honor to the age and the country; in all of which I fully agree, provided that, after a thoroughly matured plan is made, it be commenced and carried on wisely. No amount of praise or of almost Utopian hope would I object to, provided that I could be sure of these prelimi. naries.

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DOUBT OR OPPOSITION TO THE SAME PROJECT.

Five are doubtful of success, and their reasons are a “fear that political intrigue will settle the choice of health officers;" one says that “private self-seeking will destroy all good effects;" another that men will seek the office not for the public weal, but for private pecuniary gain;" still a fourth fears that the General Health Department would interfere with and override State and Municipal organizations, which the writer thinks "would be a nuisance ;” and the fifth is “afraid of the difficulty of arranging and getting good men, so that now certainly he would not be in favor."

Finally, one sees no need for the Council, because we have two

already, viz., “this Section of the American Medical Association and the Public Health Association."

WHAT A NATIONAL HEALTH COUNCIL SHOULD BE, ACCORDING TO

THE OPINIONS OF MY COLLEAGUES.

These opinions may be classified as follows:

1st. Scientific Labor.- The Council could not have too high an aim. It should study scientifically and carefully all the laws of health; the connection of meteorology with disease; vital statistics;

: ; and the facts of preventable disease. The causes of great epidemics should be investigated. It should employ experts to examine various endemic influences as exhibited under the different climates and places in our country.

2d. Practical Work. The Council should collect all facts bear. ing on health, and draw together the facts made known by the various local boards, arrange and collect them.

3d. Diffusion of Knowledge.—It should publish reports, but only those which are real advances in public hygiene. It should bave no long, voluminous documents compiled by means of the scissors or from one's own consciousness—papers not founded on fact. It should spread a knowledge of the rules of health generally, and of special diseases, as fevers, cholera, etc., and how they are to be avoided, etc. etc.

4th. Advisory.—The Board could suggest to Congress and the various States, laws in reference to healtb; quarantine; “for the prevention of prostitutes from China and elsewhere;" for drainage and the arrangement of public lands, thereby fitting them to be bealthy abodes for future residents thereon.

WHEN, ACCORDING TO MY CORRESPONDENTS, SHOULD SUCH A

COUNCIL BE ESTABLISHED?

Of seventeen answers obtained to this question, only two are for immediate action; three wish for it as soon as practicable. The remainder (twelve) advise more or less delay. Six of these twelve would wait until State Boards are generally established by legislative action..

DATA FROM MY CORRESPONDENTS ON THE ESTABLISMENT OF STATE

BOARDS OF HEALTH IN THE VARIOUS STATES OF THIS UNION.

A knowledge of how many States had Boards of Health, or whether any efforts had been made to establish them, and their precise organization where legally established, I deemed of vital importance to the solution of the question of establishing a National Council. Accordingly I asked for information on these points. Only eight States (California, Georgia, Maryland, Michigan, Minnesota, Massachusetts, and Virginia) have been reported to me as having State Boards of Health. From other, and as I think accurate sources, I learn that Louisiana has one.

Sixteen correspon. dents reply in the negative (Arkansas, Connecticut, Delaware, Kentucky, Mississippi, Missouri, Nebraska, New Jersey, New Hampshire, Ohio, Rhode Island, South Carolina, Texas, West Virginia, Wisconsin, and Vermont). Five of these (Nebraska, Ohio, Texas, New Jersey, and Vermont) are trying to induce their Legislatures to establish Boards. Three bave already made ineffectual efforts (Kentucky, New Hampshire, South Carolina), and finally five (Mississippi, Missouri, Rhode Island, West Virginia, and Wisconsin) bave never tried to establish one. In other words, of all these United States, only eight have State Boards of Health, while twenty-eight have nothing of the kind.

HOW ARE THE STATE BOARDS, ALREADY ESTABLISHED, COMPOSED,

AND SHOULD THOSE HEREAFTER ESTABLISHED CONSIST OF
PHYSICIANS SOLELY OR OF PHYSICIANS WITH THE LAITY?

Of the six States from which I have definite information on this matter, three (Georgia, Michigan, and Massachusetts) have a min. gling of the two; the others are composed of physicians only. Allow me, in this connection, to refer very briefly to my own experience. A priori, I should have objected to the admission of the laity. The composition of the Massachusetts Board was decided upon by the Legislature after a plan laid down by a very accomplished sanitarian, a layman, twenty-five years ago. But the practical work. ing of the plan in our Board has been so entirely satisfactory and there has been so much harmony, and yet diversity of opinions introduced by the combination of professional and lay members, that I am now a strenuous advocate of that combination.

i See Appendix B, Sanitary Legislation of Massachusetts.

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