Concerning the Present Condition 
of State Medicine in the 
United States. 
BY FRANKLIN STAPLES, M.D. 
WINONA, MINN. 
REPRINTED EROM THE 
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 
APRIL 10, 1897. 
CHICAGO: 
American Medical Association Press. 
1897. Concerning the Present Condition 
of State Medicine in the 
United States. 
BY FRANKLIN STAPLES, M.D. 
WINONA, MINN. 
REPRINTED FROM THE 
JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 
APRIL 10, 1897. 
CHICAGO: 
American Medical Association Press. 
1897. CONCERNING THE PRESENT CONDITION 
OF STATE MEDICINE IN THE 
UNITED STATES. 
State medicine as now understood belongs entirely 
to modern times. It began in England just before 
the middle of the present century, when Edwin Chad- 
wick, a barrister, made what has been called his 
"Epoch-making report" to parliament on the health 
of towns. By his investigations and report he secured 
the attention of the government and the interest of 
the people; laws were passed, and English sanitary 
work and control were inaugurated. More than fifty 
years have passed, and England's system of sanitary 
control, both inland and marine, is a strong feature of 
her government. The statistics in the Register Gen- 
eral's office show that the annual death rate for 
England and Wales for the ten years 1871-1880, 
averaged 21.27 per 1,000; while for the period 1881- 
1890 it was 19.8, a decrease of more than 11 per cent. 
The former death rate in England was given at 32 
per 1,000. The present annual death rate in the 
United States varies slightly in different States and 
cities from 16 to 18 per 1000. In some favored cities 
and towns it is less. 
The beginning of State medicine in the United 
States was in this wise: In 1849 the Governor of 
Massachusetts, by authority of an act of the Legis- 
lature, appointed a commission consisting of three 
citizens to prepare a plan for a sanitary survey of the 
State. Lemuel Shattuck, Nathaniel P. Banks and 
Jehiel Abbott were made to constitute this commis- 
sion. The work of investigation began, but delays 
were inevitable, and the Massachusetts State Board 
of Health was not formed until the year 1869. Dr. 4 
Henry I. Bowditch was properly placed at its head. 
The names of Shattuck, Banks, Abbott and Bowditch 
of the old Bay State are well remembered. 
Because of the frequent invasions of yellow fever 
in New Orleans the Legislature of Louisiana estab- 
lished a State Board of Health in 1885, whose duty 
was to maintain a quarantine and have some control 
of the sanitation of that city. This, then, was the 
first named as a State Board of Health in the country. 
The powders of this Board were enlarged in 1867. Its 
service was valuable for the purpose at the time, but 
it had not at first the means and general power of 
control that have since been given to State boards of 
health. 
A little more in the line of history is best given in 
an account of the work of Dr. Bowditch. In the 
centennial year of 1876, an International Medical 
Congress wTas held in Philadelphia. The president of 
the Massachusetts State Board made the address on 
" Hygiene and Preventive Medicine." The discourse 
was historical, showing much of the condition of 
things at the time, and the work of pioneer sanitarians. 
He said: " I have been requested to speak to you on 
public Hygiene and its great resultant, State preven- 
tive medicine, as it appears to an observer looking 
back upon the centennial period now just closing." 
" As a matter of vital importance to the well-being 
of any community, and, as such, wrorthy to be cheer- 
fully and amply sustained by great cities and States, 
public hygiene, as wye now understand that term, has, 
till within a short time, been wofully neglected, save 
when, under the stimulus of some great and terrible 
epidemic, frantic but temporary efforts have been 
made to stay the plague by hygiene or by other means. 
Of late, however, a new and better era seems opening 
to our view, and State preventive medicine affords us 
higher hopes for all coming time." 
Farther on in this address Dr. Bowditch spoke of 
the work immediately preceding, viz., from 1869 to 
1876, as that ''which is destined to continue and pro- 5 
gress while the nation itself lives, the noblest and 
most beneficient of all, viz., that in which the pro- 
fession, joining heartily with the laity and aided by 
the material and intellectual resources of great States, 
will study to unravel the primal causes of all disease 
with the object of preventing it. It is the epoch of 
State preventive medicine.1 As it now seems, this 
was a true representation of the condition and spirit 
of the times and was correctly prophetic. 
As shown above, the organization of State boards 
of health in this country began in Massachusetts in 
1869. Time was required to bring the country to a 
general understanding and appreciation of the advan- 
tage of State sanitary laws and management. Eight 
years were required for the establishment of the first 
ten boards. A little more than a quarter of a century 
has passed, and in the forty-six States there are thirty- 
eight State boards of health, which are operating 
under laws of uniform general requirements. 
The following figures represent the sanitary machin- 
ery of a single State; 1,801 local boards of health; 40 
in cities, 355 in villages, and 1409 in townships. These 
report vital statistics and anything notable in disease- 
prevalence to the State board monthly, and receive 
its directions (Minnesota). 
Some ways and means.-Interstate and sea-coast 
notification is now an important means of protection 
from the importation of contagious diseases. This is 
possible only by cooperation between sea-board quar- 
antine and State organization. To illustrate: A 
steamer arrives with immigrants, is inspected and 
passes quarantine at New York. No cases of con- 
tagious disease are found on board, but the vessel is 
from an infected port, and certain passengers are sup- 
posed to have been exposed to contagion. The New 
York quarantine telegraphs the secretary of the State 
of Minnesota, for instance, that suspected immigrants 
have left ship and are on their way to such a town in 
i Address.-Transactions International Medical Congress, Philadel- 
phia, 1876. 6 
the State. The health officer of this town is notified 
and his inspector is on the lookout. The same arrange- 
ment for notification to the State holds with the 
United States ports and with the Canadian quarantine 
in the St. Lawrence River; this much for complete 
organization, interstate and international reciprocity 
and governmental control. 
The great discoveries and advances in bacteriology 
made in late years have laid a foundation for practical 
work in preventive medicine not before known. 
Laboratories are provided for by State and municipal 
authorities, and expert bacteriologists and chemists 
are employed not only in the analysis of water and 
food products, but in furnishing the means of diag- 
nosis of disease, and, of late especially, in developing 
the various means for rendering the human body 
immune to the poison of infection. Physicians and 
scientists make the discoveries and improvements, 
and the State may well aid in supporting the same 
and extending the advantages in the public service. 
The department of diseases of animals in the work 
of State boards of health is an important one. The 
flesh of animals as a food product, and the liability of 
the communication of disease from animals to man 
through milk products and in other ways, make this 
an essential part of State sanitary management and 
control. 
The influence of State medicine in the United 
States on the advancement of the standard of medical 
education has been notable. The position and work 
first of the Illinois State Board of Health, then of 
other States by their examining boards, in fixing a 
lawful standard of requirements for admission to the 
practice of medicine in the States, has given character 
to medical practice in this country not before possible. 
Competing medical colleges of the lowTer grade have 
been allowed the choice of elevating their courses 
and standard of instruction or of retiring from busi- 
ness. The condition of the few States which have 
not fully advanced to the enactment of wholesome 7 
laws has been pitiable. The quacks of the country, 
being refused admittance to or driven out of the bet- 
ter States, have sought refuge here, and are doing 
their work in communities whose State governments 
have not yet advanced. Time is required to advance 
a whole people by education, but the higher civiliza- 
tion lies in this direction. 
The great American Public Health Association has 
for its territory the United States, the Dominion of 
Canada, and the Republic of Mexico. Its member- 
ship includes the leading sanitarians of these countries, 
and its published literature covers the field of modern 
public hygiene and State medicine. Prof. Stephen 
Smith of New York City was the founder of this 
Association and its first president (1872, 1873 and 
1874). Dr. Irving A. Watson, Concord, N. H. is the 
secretary. 
The National Association of State Boards of Health 
maintains an active existence, and holds annual ses- 
sions for the discussion of matters pertaining to sani- 
tation and for promoting unity of action. 
The economic advantage of public sanitation has 
been shown as an argument in favor of the public 
support of State medicine; that to prolong the aver- 
age time of active human life by the suppression of 
preventable disease, is of much greater advantage to 
the State than is the cost of the means employed. 
Moreover, it is agreed that to ward off the calamity of 
disease and to prevent the coming of pestilence, is to 
increase the sum of human happiness and to elevate 
the race. The standard of what is done in this way 
now indicates the degree of intelligence and the virtue 
of a people. 
Attempts have been made from time to time to 
establish a National Board of Health, and at onetime 
with temporary or partial success. Different plans 
have been proposed with reference to having the dif- 
ferent States and State boards represented in the 
National Board; also to having this a Department of 
State, with its chief officer a member of the cabinet. 8 
The national control is now in the hands of the Marine 
Hospital Service in the Department of the Treasury. 
All matters of quarantine are in charge of this office. 
Reports, foreign and domestic, are made to it, includ- 
ing vital statistics, disease prevalence, and weather 
reports. A weekly bulletin of Public Health Reports 
is issued and distributed regularly to health officers 
throughout the country. 
At the first Pan-American Congress held in Wash- 
ington, D. C. in 1893, a Committee on Department of 
Public Health was appointed, which committee when 
complete consisted of Dr. Henry L. E. Johnson of 
Washington, D. C.; Dr. William Pepper of Philadel- 
phia, Pa., and Dr. Charles A. L. Reed of Cincinnati, 
Ohio. This committee reported to the second Pan- 
American Congress, held in the City of Mexico in 
November, 1896, the draft of a bill to be presented to 
the Congress of the United States which, becoming a 
law, would create a National Department of Public 
Health and provide for its support. This bill specifies 
the duties of the Secretary at length, showing the 
extent and importance of this department. This 
report was accepted by the Congress and the bill has 
been presented to the U. S. Senate. (See Journal 
of the American Medical Association, March 6, 
1897). 
A committee of the American Medical Associa- 
tion, of which Dr. U. O. B. Wingate, Secretary of the 
Wisconsin State Board of Health, is chairman, is also 
engaged in the preparation of a bill for the establish- 
ment of a National Department of Public Health. 
It remains for the American people to understand 
the case, take a lively interest therein, and help the 
action that shall be for the greatest good.