THE NATIONAL BOARD OF HEALTH, AND BY JOHN S. BILLINGS, M.D., SURGEON U. S. ARMY. IT has seemed good to the chairman of this Section that there should be presented to it, at this meeting, an account of the origin and organization of the National Board of Health, in order that some account of this new medical departure shall form a part of the records of this body, so that Macaulay's New Zealander will be able to prepare a full report on the subject, if he can only obtain a complete set of the "Transactions of the American Medical Association." I have acceded to the request that I should prepare this paper, with some misgivings; but attempts to excuse myself have proved fruitless, and I can only say that I have done the best I could, with the very limited time at my disposal. That some form of a central sanitary organization must sooner or later be created by the United States, has long been foreseen by those who have given attention to such matters; but it is only within the last ten years that the discussions on this subject have taken any definite form. In saying this, it is not meant to assert that definite proposals for a national quarantine system have not been of a much older date. But a national quarantine system is by no means the equivalent of a national health organization, and the two will be considered as quite distinct in this paper. Each has had its partisans and opponents— the one being in some cases arrayed against the other; and, in order to understand some of the controversies which have arisen. with regard to the National Board of Health, it is essential to know that those in favor of such a board, may or may not favor a national quarantine; while some of those most prominent in urging the creation of a national quarantine, have not only not 43 desired the organization of a National Board of Health, but have most strenuously opposed it. For more than eighty years, and in spite of repeated failures, attempts have from time to time been made to induce Congress to place under some department of the government the control or supervision of the quarantine systems of the several ports of the United States. The immediate cause of these attempts has usually been the occurrence-in some part of the country-of an epidemic of cholera or yellow fever, believed to be due to importation from abroad. The arguments in favor of a national quarantine system are well known. The various local systems of our several national maritime ports are not uniform as to time, carefulness of inspection, or methods of treating infected ships; nor are the great majority of such ports either willing or able to meet the heavy expense of a really efficient quarantine system, which shall permit vessels to return to commerce with no more delay than is necessary to secure their proper inspection and thorough cleansing. If any port fails to keep up such a system, it to a great extent destroys the value of the quarantines of other ports, and of other places. Hence, the interior of Alabama has been infected through Florida ports; and Arkansas, Mississippi, and Tennessee are to a great extent dependent for safety upon what New Orleans may choose to do, and have suffered severely in consequence. The prevailing ideas, with regard to the powers of the general government, in this respect, may be briefly stated as fol lows: The United States, by virtue of the control which the constitution gives it over commerce with foreign nations, and between States, has the right to prevent ships coming from a foreign country or from another State, from entering any port, unless they have complied with such regulations as it may prescribe. In like manner, it has the right to prevent any conveyance, person, or thing from passing from one State into another, unless such passage be made in accordance with the rules which it may establish. It cannot, however, undertake to interfere with conveyances or persons going from one part of a State to another place in the same State. Whether it has a right to compel a State or city to admit a conveyance or person coming from foreign countries or other States, is a question upon which there is more difference of opinion among jurists; but at present the decided majority are of the opinion that it has no such right, and nearly all those who think that it does possess such power are of opinion that it would be inexpedient to exercise it. As it is not proposed in this paper to give any account of the various efforts to secure a national quarantine system, except in so far as these have immediate relation to the origin of the present National Board of Health, it is sufficient to merely allude to the proceedings of the quarantine conventions held in 1859-1860, as containing some interesting and valuable discussions on this subject. Let us now turn to the subject of a national health organization properly so called. In 1869 the fact that such a department of the Government would soon become necessary, together with its probable needs, were used as arguments before Congressional committees in favor of the formation of a large medical library in Washington, and the commencement of a complete collection of sanitary reports and statistics; and in the spring of 1870, in connection with reports to the Secretary of the Treasury upon the reorganization of the Marine Hospital service, the relations of a department of public health to the several medical departments of the Government were briefly discussed. The first published scheme for such a department was the bill prepared by Dr. C. C. Cox in 1871. This bill as introduced into the Senate, in December, 1872, together with the report of Dr. Cox upon the necessity for a national sanitary bureau, will be found in the first volume of the reports of the American Public Health Association. This bill provided for the establishment, under the direction of the Department of the Interior, of a national sanitary bureau with a chief executive officer to be known as the commissioner of such bureau. His duties, which are specified at great length in the bill, may be summed up as being to collect information on all matters connected with sanitary science, and to report on the same from time to time. He was to appoint whatever additional officers might be required, including chief clerk, chemists, experts, etc. etc. There was a general feeling among sanitarians that this bill. was not opportune, that the circumstances were such that it would lead to purely political appointments, and that the result would be upon the whole prejudicial to the cause of public hygiene. It, therefore, received little or no cordial support. The American Public Health Association did not recommend its passage, and it was practically pigeon-holed in the Congressional committee to which it was referred. The yellow fever epidemic in 1873 resulted in the introduction, by Hon. Mr. Bromberg, M. C. of Alabama, of a bill for a national quarantine, which bill was based mainly on the recommendations of Dr. Harvey Brown, U. S. A., who had in 1872 made a report on quarantine on the Southern and Gulf coasts, in which he strongly urged the importance of a national system. During the winter of 1873-74 several conferences were held at Washington on the subject of a national health bureau and a national quarantine system. The discussions at these conferences made it clear that there were two distinct parties; the first represented by Mr. Bromberg's bill, which was to prevent the importation of contagious and infectious diseases into the United States-in other words, to secure quarantine alone. For this purpose the surgeon-general of the army, the surgeon-general of the navy, and the supervising surgeon-general of marine hospitals were to constitute a board, whose duty it should be to prepare quarantine regulations which were to be enforced by an officer from one of these services to be detailed for that purpose. The other party urged that the utility of such a board would be comparatively small, and its existence probably brief. They desired that its scope should be made much wider, somewhat like that of the national sanitary bureau proposed by Dr. Cox, although they did not approve the placing such a bureau at that time under the control of any one man-in other words, preferred a board to a commissioner. The size of this board, the manner of selecting its members, its precise duties, and the amount which should be allowed for its support, were all subjects upon which it was found hard to reconcile the opposing views. Mr. Bromberg's bill passed the House and failed in the Senate, not so much because of any active opposition as because of a request made by Mr. Thurman, that it should be passed over to give time for reflection, and his statement of the difficulties of the question is worth quoting. He said: "Every seaboard State, and I believe every State bordering on either of the great lakes, has its police and quarantine regulations for the preservation of its people against any danger of vessels coming into port |