Address ii State Medicike. 
Delivered at the Annual Meeting of The American 
Medical Association in Washington, D■ G., 
Friday, May 9th, 1884. 
BY 
PEERING J, ROBERTS, M. D.. 
ni 
Professor of Theory and Practice of Medicine in the 
Medical Department of the University of 
Tennessee. 
Chairman of The Section in State Medicine, American 
Medical Association. ADDRESS IN STATE MEDICINE. 
BY 
LEERING J. ROBERTS, M. D., NASHVILLE, TENN., 
Professor Theory and Practice of Medicine in the Medical De- 
partment University of Tennessee. 
Chairman of the Section on State Medicine, American Medical Association. 
Mr. President and Gentlemen of the Association: 
The Section of State Medicine, as many of you are doubtless 
aware, was established and thoroughly organized at the twenty- 
fifth annual meeting of the Association, at Detroit, in 1874, and 
has been presided over by some of the ablest, most learned, and 
illustrious members of this Association. In accepting the chair- 
manship one year ago, it was with no inconsiderable degree of 
apprehension and doubt as to my ability to properly discharge 
one of the duties of the position, and to place before you an ad- 
dress worthy the attention of those who have listened with pleas- 
ure and benefit to such men as Bowditch, of Boston; Kedzie, of 
Michigan; Cabell, of Virginia; Hunt, of New Jersey; and others 
whose names have been heralded far and wide, at home and 
abroad, as active, earnest, and able workers in this most impor- 
tant department of medical science. 
The work of this Section since its organization, as well as that 
in its particular line in the earlier years of the Association, whether 2 
embraced in the reports of the various committees on Epidemic 
Diseases, or the individual papers and essays in the special prov- 
ince of State Medicine, forms a most important part of the pub- 
lished Transactions in each year of the Association’s existence, 
and has accomplished fully as much as other even more popular 
Sections, towards adding to the glory of the Association, its pres- 
tige and its reputation ; towards giving “ frequent, united, and 
emphatic expression to the views and aims of the medical profes- 
sion,” or “cultivating and advancing medical knowledge; eleva- 
ting the standard of medical education; promoting the usefulness, 
honor, and interests of the medical profession; enlightening and 
directing public opinion ; exciting and encouraging emulation and 
concert of action in the medical profession; and facilitating ind 
fostering friendly intercourse between those who are engaged in 
it.” Careful examination of the 33 volumes of Transactions, and 
the now completed first volume of the Association Journal, will 
reveal a vast amount of valuable labor, rich in fruitage, teeming 
with evidences of successful progress—an intellectual mine, in 
which is treasured up the matured experience, the scrutinizing 
thought, and earnest work in this important department. 
Accepting the graphic, yet concise definition of Dr. Stanford 
E. Chaille, of New Orleans, than which we can get no better if 
we would, and would not if we could: u State medicine is the ap- 
plication by the State of medical knoidedge to the common weal; and 
embraces every subject for the comprehension of which medical 
knowledge, and for the execution of which State authority are indis- 
pensable,” we shall not undertake to tax your patience with a 
repetition of the gradual, yet positive progress made therein. 
Suffice it to say, that while there have been no discoveries or ad- 
vances of a meteoric brilliancy in the past twelve months, yet 
there has been progress. Some old things have been unlearned 
—which is sometimes no less important than that some new ones 
should have been learned. 
While new discoveries and new developments in State medi- 
cine are of such importance and value, we can patiently wait sev- 
eral successive years in expectation of some one finding a Koh-i- 
--noor, and profitably spend our time and skill in polishing up, 3 
and patting into practical use the rich discoveries of the past. 
The germ factor of cholera—distinctly stated more than thirty 
years ago by a Tennessee doctor,1 as well as the germ theory of 
fevers by another Tennessee doctor,2 a little later, have been burn- 
ished, polished and crystallized by later observers into cognate 
fa'cts; and to these have been added by more recent investigators 
a like cause for tuberculosis, as well as other diseases. Granted 
that these aetiological studies are of greatest importance to the in- 
dividual physician in his essays at individual prophylaxis, yet 
how much more important in State and National work! 
The studies in regard to sewage and drainage; the purities and 
impurities of the air we breathe, the water we drink, and the food 
we eat; contagion, infection, heredity, zymotic or other influences 
are being prosecuted day by day with a vigor, and an earnest- 
ness, and an enthusiasm that will surely result in progress. It 
may be slow, but it will be none the less sure. 
Is it necessary that I should inform you that Asiatic cholera 
again began its accustomed westward march from its lair on the 
Ganges, in the far distant East; that it advanced its skirmish line 
even to Western Europe, with heavy battalions doing their mur- 
derous work hieath the shadow of the Pyramids? But, “ Thus 
far shalt thou go, and no farther,” was the edict of State medicine 
in the good year 1883. 
Yellow fever had even fastened its fangs on our Southern 
border, but by the strong arm of State medicine was it held at 
bay. Although small-pox has been claiming a victim here and 
there at long and distant intervals, in gratifying contrasts to its 
former holocausts, yet even the few and infrequent sacrifices it 
has claimed were the result of neglect of the dictates and teach- 
ings of State medicine. 
But enough of this. That familiarity with the scientific litera- 
ture of the day which is incumbent on every member of this rep- 
resentative scientific organization, or a cursory walk through the 
Museum of Hygiene of the Navy Department here at hand, and 
JW. D. Dorris, M. D., Nashville Journal of Medicine and Surgery, Yol. I. No. 
3, June, 1851, p. 154. 
2Thompson on Fevers, 1859. an examination of its records, will give you a better idea of the 
recent developments pertaining directly to State medicine, and 
will be decidedly more entertaining than any that I can lay be- 
fore you. Therefore I may be pardoned, if following the line of 
some of my predecessors, I omit a citation of the “ advances and 
discoveries of the past year” in this particular Section, more es- 
cially as there are one or two questions to which I desire to call 
especial attention. In doing so I must ask your indulgence if 
the views advanced, perchance, may seem to all or some of my 
audience to transcend the pale of orthodoxy. Yet I can sincerely 
claim honesty of purpose, and will yield to none in a sincere and 
earnest desire to do good to my fellow-man, and will invoke a 
calm, dispassionate and impartial consideration of questions 
fraught with greatest importance to ourselves as physicians and 
as men, as well as to our fellow-man. 
A cursory review of the published transactions of this Associ- 
ation, beginning with the Convention that gave it origin in 1846, 
down to the present day, will convince the most casual reader of 
the importance of the subject of medical education. Time and 
again does it show up in our printed minutes and published 
papers and essays. The effort all along the line has been to bring 
the aid of legislative enactments to bear upon it. 
Am I heterodox when I say that it is not a subject for the 
State or national law-maker? Is State authority “indispensable” 
for its elevation? Is there need of legislative interference in be- 
half of medical education ? The conditions under which men 
shall be allowed to practice medicine, the amount and kind of 
knowledge which they should be obliged to show, the way in 
which their possession of that knowledge should be tested, the 
preliminary education prior to, and the length of time they ought 
to study, the extent to which the details of that study should be 
regulated by compulsory rules or left to individual option—these 
are questions upon which there are wide differences of opinion 
in this country. In England during the nearly thirty years past, 
and on the continent of Europe for a longer period, entire gov- 
ernmental control obtains. Here, we have free medicine, as well 
as free religion, and freedom of speech, A few States from time to time have essayed their hands, and with what result? Over fifty 
years ago, Daniel Drake, than whom this country never produced 
a more original mind, ? closer reasoner, or one of deeper thought, 
in an “ Essay on Medical Education,” enunciated the following : 
“ More than half the States of the Union have laws to regulate 
the practice of medicine, but I am by no means convinced that 
they have ever done any real good to the profession or society. 
New York and Ohio have such laws; Kentucky and Virginia 
none. It remains to be shown whether the profession in the two 
former is more respectable than in the latter. lam disposed to 
believe not.” 
And to-day what shall we say ? Are the people, or the doctors, 
in a better condition in Illinois than in Indiana ? Take Michi- 
gan in the Northwest, and Kentucky in the Southwest, and com- 
pare their medical men with those of Massachusetts. At Ann 
Arbor we can see that regular medicine has been brought down to 
a level with one faction of the irregulars, while grand old Har- 
vard holds her head aloft, and the glorious banner of regular 
medicine floats in its purity, its glory, and a most enviable 
renown. My own State of Tennessee has furnished in the past an 
honored and an honorable delegation to your councils. The late 
A. H. Buchanan, of Tennessee, was one of your first Vice-Presi- 
dents, and two of his colleagues had the honor to occupy subse- 
quently the Presidential chair with credit to themselves and this 
Association, The State from which they hailed has ever left 
medical matters solely to medical men. 
Even in England there are to-day wide differences of opinion 
on this subject. They are not altogether satisfied that their plan 
of protection is the better one. Quite a respectable minority 
hold that they are not benefited by legal control, and that al- 
though freedom in medicine is subject to some abuses, it is per- 
haps the better plan. The medical literature of most benefit to 
the world is the growth of the present century, and notably the 
latter half of it. Are not American works being reproduced in 
the tongues of Europe ? Has it received no aid from this side of 
the Atlantic ? 
“ Flint on Practice,” or “ Gross ” or “ Hamilton on Surgery,” as well as many other volumes of indigenous origin, are as favor- 
ably commented on by foreign writers and readers as the most 
noted productions of the Old World. 
The London Medical Times and Gazette of Nov. 12, 1881, in 
discussing in a remarkably fair, candid and impartial article the 
subject of “ Medical Education and Registration in America/’ 
says that “American medical literature is very voluminous, char- 
acterized by great originality, inventive genius, industry and 
practicality.” And again, can we not see that certain depart- 
ments of our art have been created in this country, and others 
notably improved ? Did it require legislative aid to develop the 
genius of a Sims or the inventive originality of a Sayre? The 
discoveries of Jenner and of Harvey occurred when medicine was 
as free in England as in the day of Morton, of Massachusetts, or 
Long, of Georgia, when anaesthesia first dawned upon suffering 
humanity, to say nothing of Dorris and Thompson, of Tennessee, 
who were the discoverers of the germ world, as much as was 
ever Columbus the discoverer of this continent. 
Professor Huxley in an address “On the Intervention of the 
State in the Affairs of the Medical Profession,” delivered at the 
London Hospital Medical College, and published in the British 
Medical Journal of Oct. 13, 1883, is thus reviewed in a very able 
editorial in the Chicago Medical Journal and Examiner: 
“Professor Huxley practically presents three questions: 1. 
Why should the State interfere with medicine and the medical 
Profession ? 2. If there be ground for such intervention, what 
should be its extent ? 3. If such intervention be right and 
proper, how can it best be carried into effect? The answers 
which he proposes to these several inquiries, seem to us eminently 
wise and judicious ; and some of the commentaries they suggest, 
are interesting to us on this side of the Atlantic. 
With respect to the first question the speaker took the ground 
that it was not the duty of the State to take medical charge of the 
public, to protect it against incompetent persons in general, and 
in particular against quacks and impostors. He thought that it 
was more wholesome for the public to take charge of itself wher- 
ever it can do so in this as well as in other matters, and that on the whole there should be no interference with the liberty of each 
person to do that which he likes when he does not interfere with 
others. The actual impossibility [which all reasonable men must 
admit, and of which we, in the State of Illinois, have seen the 
most conspicious and notorious examples], of absolutely prohibit- 
ing the practice of medicine by people not specially qualified for 
it, is freely admitted by Professor Huxley. The old lady who 
orders a cranberry poultice, the druggist who undertakes to re- 
lieve the pain of an aching tooth, or of any other afflicted organ of 
the body, will enjoy these peculiar pastimes in the face of all 
legal restrictions. The charlatan will do no less, and always 
more. “ Facilis decensus Averni.” He has smiled equally at the 
British, Gallic, and Teutonic barriers to bar his progress. Where 
there is a throne, there will always be a pretender. The shadow 
will always follow the substance. We shall always have him 
with us. Whether the truth or its counterfeit prevail, is deter- 
mined not by a National Legislature, but by the extent ot the 
diffusion of knowledge among the people whose feeblest index 
that Legislature often is. 
Professor Huxley, however, strikes the key-note of the whole 
question when he points to the death of the individual citizen as 
the important moment which the State should officially* recog- 
nize. Here the volition of the individual ceases. In civil and 
criminal cases, the law should be able to have recourse to persons 
qualified to give expert evidence. Here lies the justification of 
the intervention of the State. It says to one class of men : 
‘ Practice medicine, if you like, on any basis, on any theory, 
whether you are qualified or not qualified;’ and to another class : 
‘ Consult whom you choose, pay whom you will for attendance 
upon you in your illness; but before I can receive from you a 
certificate of death, before I can appoint any of you to my civil 
or military service, the standard of my qualifications must be at- 
tained. The giver of the certificate, the incumbent of the office, 
must be those whom I can recognize as fit for such service.’ In 
brief, the State intervenes only at those points where the State 
touches the individual. With the old woman’s elder-flower tea, 
with the druggist’s cough panacea, with the quack’s startling an- nouncement of the cure for consumption, the State has no more 
to do than with the numerous patent religious enterprises of the 
day in which we live.” 
This is rather a lengthy quotation. But as enunciated in a re- 
view of an address delivered on British soil, in the leading medi- 
cal journal of the most protected of all protected States of Amer- 
ica, we cannot refrain from using it. Yes, when you select your 
servant, your lawyer, or your preacher, he must rise to the stand- 
ard of your requirements. So with the State. This right has 
been delegated to the State. Has the other? With the enlisted 
men and commissioned officers of the Army and Navy, the State 
has a distinct contract to provide them with medical attention, 
and has a right to require a certain standard in that particular as 
in the bread, the beans, and other supplies furnished them. 
Certain requirements are exacted in all civil and military ap- 
pointments, and the appointing power has the right to fix the 
standard. 
Nay, further, the State has the right, and exercises it, ot pre- 
scribing the very garb of her appointees. And shall you, or I, 
array ourselves in cotton or linen in winter, or in furs or heavy 
woolens in mid-summer, so long as we remain private citizens, 
attending to our own business, and molesting no one ? Granted, 
that in the one instance a life is sacrificed to pneumonia, or in 
the other to sun-stroke, has any legislator, State or National, 
other right than to pity the suicide for his folly? It might jus- 
tify a writ of “ lunatico de inquirendo,” but alone, would not se- 
cure a verdict of lunacy. 
The State may prevent fraud in the sale of unwholesome bread 
or unsound meats—for fraud is criminal; it may prohibit as a 
nuisance to one or more citizens, the keeping of such articles by 
one; but if he annoy not his neighbor, can the State prohibit 
his eating them himself? If he give it to his wife, his child, his 
servant, or the stranger within his gates, I grant you that he may 
be chargeable with murder. But eating it himself—is it an of- 
fense against the State? Would not public opinion even, readily 
agree, that the sooner the State is rid of such a one, the better ! 
I can readily and heartily agree with England’s “ uncrowned king of science,” in protesting against State authority prescribing 
my pill, my potion, or my plaster,—I might be compelled to sub- 
mit to infinitesimals. 
To take another view of the subject. Can we better ourselves, 
our profession, or our fellow-man ? Take the history of our own 
great country and compare it with other nations. Will we suffer 
thereby ? In the March number of the Sanitarian, I find on 
pages facing each other, that the death rate of Toledo, Ohio, was 
15.3, while in Loudon, it was 18.8 per 1,000. In 28 of the 
largest towns of England, with a population of 8,500,000, the 
death rate for the third quarter of 1883, averaged 19.9 per 1,000, 
while in 28 of the largest towns of the United States, with a pop- 
ulation of 7,395,000 the death rate for four weeks ending, Janu- 
ary 26, 1884, was 19.36. In the Sanitary Engineer of March 6, 
1884, page 337, the statement is made that the death rate per 
1,000 in 30 of the cities of the United States for the week ending 
February 23, was 20.3, while in 28 of the large towns of England 
for the week ending February 2, it was 20.5. We think we can 
stand the comparison. 
Take the Medical and Surgical History of the War of the Re- 
bellion, published by the late Surgeon-General of the United 
States Army. Will it not bear favorable comparison with any 
military and surgical records of a like period ? 
We have already cited the field of general medical literature; 
but we think it will bear repetition. Medical journalism, which 
in my humble opinion, has done, and will do, far more to elevate 
the standard of medicine in an educational, as well as a practical 
point of view, than all State and national legislation, had its very 
origin in our own goodly soil. Yes, by far, the brightest diadem 
the coronet of medicine ever bore is “ native and to the manner 
born.” 
Take the discoveries in medicine, whether in anatomical or 
physiological facts, therapeutical or prophylactic edicts, the de- 
vices of surgery, the suggestions of practice, or the grand innova- 
tions of the specialists, from gynaecology to ophthalmology, and 
is not a fair and honorable portion ours? These are questions for 
us to consider, and to consider well, before we throw down our grand and glorious birthright of free medicine—alike honorable 
and independent. 
I can readily see how you can bring medicine down* by legisla- 
tion, but pardon the obscurity of ray vision when I say that I can 
see no way of raising it up by the same means. I can see how 
legislation can force me to stand on the same plane with those 
“ who claim a special designation and trade upon the same.” I 
can see how honorable, regular medicine can be pulled down to 
the level of the irregular, the nostrum-vender, and the charlatan. 
If medicine is to rise, there is ample power within her own do- 
main. If medicine is to be elevated, to medical men alone must 
be entrusted the lever. If medicine is to be regulated, in this 
Association can we find the power which but needs to be put into 
action. In a series of resolutions adopted by this Association in 
1869 we find the following preamble: 
“ Whereas, The history of medical legislation in the 
various States of this Union clearly shows that no reliance can be 
placed on either the uniformity or the permanency of an}1 laws 
relating to the practice of medicine—” 
In 1872, Df*. David W. Yandell, of Kentucky, in his address 
as President of the Association, stated that: 
“ The profession does not appear to my mind ‘ corrupt and de- 
generate.’ Ido not believe cit is going from bad to worse/ and 
that the people will have to rise in their might and stay its down- 
ward progress. I cannot see the thing in this light at all, and so 
am not ready to appeal to Federal Legislation to correct our evils, 
and certainly should not go to Congress to establish National 
Medical Schools.” 
In 1874, at the twenty-fifth meeting of the Association, Dr. J. 
M. Toner, of this city, as your presiding officer, said : 
“The hope entertained by some physicians of excluding irreg- 
ular and incompetent practitioners from the profession by legis- 
lative enactment and penalties is, I apprehend, in our country, 
not to be realized.” 
Consulting the published transactions of this Association from 
1846 until to-day, will evince to you that this subject has been 
carefully and well considered; effort after effort has been made, and yet National legislation has not been accomplished. The peo- 
ple through their representatives have said that they did not want 
it. Shall we not abide by their decision, that State authority is 
not needed, and thus relieve State medicine from a futile and un- 
necessary straggle, and free its arms the more successfully to cope 
and grapple with the many foes to be found in its own proper 
field ? 
The next subject to which I wish to call your attention is 
a more perfect organization for State medicine. And in doing so 
I do not propose to become the partisan of either faction involved 
in an unfortunate wrangle in regard to National Sanitary matters. 
I most cordially recognize and acknowledge the excellent results 
as accomplished by the National Board of Health, both in its 
labors of investigation and as the custodian of the appropriation 
made by Congress for the prevention of epidemic diseases up to 
July, 1883. The members of that Board as Scientists and as 
Sanitarians are deserving of the lasting gratitude of the Ameri- 
can people. As cheerfully do I accord the same meed of praise 
to the Marine Hospital Service from July, 1883, to the present 
day. But I must deplore and sincerely regret the contest that 
has arisen between them. Having carefully examined into this 
imbroglio, having impartially considered both sides of the ques- 
tion, and having patiently and carefully read the statements made 
by the opposing parties, I can only say : Unfortunate for the 
National Board of Health, unfortunate for the Marine Hospital 
Department, and most unfortunate for National Sanitation. 
But let us try and correct the error. The National Board of 
Health is the result of earnest and faithful work on the part of 
this Association, and its younger ally, the American Public 
Health Association. It was authorized and established by Con- 
gress in answer to repeated applications of the two organizations, 
so terribly emphasized by the yellow fever epidemic of 1878. 
With a morbid dread of an autocracy, with an apprehension of 
placing too much power in the hands of one man, I am of the 
opinion that error was committed in its inception. It was made 
too unwieldy. Incompatible elements, apparently, have entered 
into its composition, and in the struggle that has ensued we have seen that these representative men have “ degenerated into de- 
traction, ridicule and unseemly personalities which can only result 
in great injury to the public health service.” By its representa- 
tive organization, by selecting its members partly from four de- 
partments of the public service, and with seven civilians from as 
many different States, have we not secured a “ divided responsi- 
bility ” ending “in inefficiency and failure ? ” Can it be possi- 
ble that with its brief but brilliant record, the auspicious future 
presaging its advent, it is so soon a stranded wreck? 
Would it not have been better to have modelled it in exact 
conformity with the Departments of our National Government? 
Surely the Department of Justice is of no greater importance, is 
of no more utility or benefit than a Department of Health, if or- 
ganized and sustained in the same manner and on the same basis. 
I think it would have been far better if we had demanded, and I 
do not believe it is yet too late, that a Department of Health be 
created by Congress, with a Chief, the Secretary of Health, or 
Medical Director of the United States, a member of the Presi- 
dent’s Cabinet, nominated by him and confirmed by the Senate 
as other Cabinet officers, and with equal rank and compensation 
as other members of the Cabinet; said Chief to organize his De- 
partment by the appointment of the necessary assistants, sanita- 
rians, scientists, chemists, physicians, surgeons, clerks and other 
subordinates, just as is organized the Department of Justice and 
other Departments. Said Chief to advise with the President 
when necessary, and to report the working of his Department to 
Congress as required. 
To this Department would be referred all matters of National 
Sanitation, such as quarantine of seaports, the regulation of 
inter-State quarantine, and the aid and assistance to be granted 
State and local sanitary organizations, when occasion required, 
under certain restrictions. But I have not time or space to go 
into specific details, and they will readily suggest themselves. 
With the advice of this Department, Congress could intelli- 
gently legislate as regards all matters of National sanitation, in- 
cluding marine and inland quarantine. With the advice of such 
a Department Congress could intelligently and successfully aid State and local health boards and officers in their efforts at pre- 
vention of diseases requiring more ample means of suppression 
than within their power. 
The objection, and I believe the principal one that can be 
brought against the National Board of Health, was that it was 
too unwieldy. That there was an objection, and a tangible one, 
is evidenced by the tact of its failure to secure that confidence 
necessary for its proper maintenance, or to hold the position orig- 
inally assigned it. 1 have no hesitation in asserting that a simi- 
lar result would have inevitably ensued if the Department of the 
Navy, or the Army, the Department of Justice, or the Interior, 
had been organized on a similar basis—no matter how able, how 
eminent, or how efficient the members of the Board in charge. 
As before stated, a Department of Health is of fully as much 
importance as that of justice, war, or the navy. Recognition of 
this fact is but an evidence of progress in civilization. “ Public 
health is public wealth ” is an established axiom in civilized and 
intelligent communities at this day. As enunciated by England’s 
great primate, “ it should be the statesman’s greatest care.” 
Fully recognizing its needs, as our entire people now do, the 
question is, how best to meet the issue ? Our national legislators 
are elected by the people, and from the people. They are ever 
ready to pass any law that will benefit those whom they represent, 
and while occasionally they may have one in their midst who has 
had special training in medical or sanitary science, or one who 
like our distinguished Senator from Tennessee—the Hon. Isham 
G. Harris—under the pressure of impending circumstances, will 
turn the entire weight of his intellect, and bring his every nerve 
and fibre to bear upon questions of National sanitation, yet the 
outcome so far has been indifferent y:ood. 
The bill establishing a National Board of Health, together with 
the one for the prevention of epidemic diseases has found serious 
objections in more quarters than one. Hon. Casey Young, of 
Tennessee, has recently, in a bill introduced, made certain sug- 
gestions to this question. So also may be said of Hon. 
Mr. Pettibone. These suggestions, I apprehend, will not fully 
cover the ground. They do not sufficiently comprehend the mag- nitude of the question at issue, its many intricacies and the nu - 
merous conflicting interests to be reconciled. 
The army and the navy have their own particular needs. 
While their medical staff are composed of able, talented, scientific, 
thoroughly educated and energetic men, and men who have closely 
studied the question of sanitation as regards their particular 
branch of the service, yet this is entirely different in many par- 
ticulars from National sanitary work. That the Marine Hospital 
Service—a sub-department of a department—has quite enough 
to do in its own particular line, is well demonstrated by the fact 
that only during the winter just past, individuals under its own 
care and for whom it was organized, have become charges upon 
the counties of my own State, and thereby have disseminated the 
seeds of small-pox in more than one locality on the banks of the 
Tennessee river. 
I do not wish to be understood as recommending an “ auto- 
cratic power to be conferred on any one man, with sole discretion 
in regard to quarantine,” marine or inland, or other matters be- 
longing to State Medicine. By no means. I, as much as any 
one, believe in certain rights belonging to the people, certain 
rights belonging to the States, and certain rights by the 
people and by the States delegated to the National Gov- 
ernment. There is no autocracy in the Treasury. Yet, 
without this Department as now organized, how could our Na- 
tional law-makers as successfully grapple with the intricate and 
delicate problems of finance? Is the “ dollar of our daddies ” of 
more importance than the lives of our fathers, our mothers, our 
wives, our children, or ourselves? Are monetary questions more 
difficult of solution than sanitary, that we grant to Congress an 
able adviser, with able assistants, educated and trained as each 
separate need demands, for carrying out the regulations and edicts 
of that Congress ? Are they more important? It is by no means 
an autocracy that is needed. Let Congress, as the voice of the 
people, say what steps shall be taken to meet the invasion of 
foreign or domestic disease ; and that it may act advisedly, and 
that it may have the means of carrying out its dictates—let it 
have a Department for this special purpose. Recruit this De- 15 
partment from the army, the navy, the Marine Hospital Service, 
or from civil life, from its head to its most humble subordinate; 
but these recruits, when in its service, owe allegiance to it alone. 
And when necessity occurs, or emergency arises, give such aid as 
may be needed from other departments of the government, as such 
need or emergency may demand. 
Is there danger that an inefficient or unsuitable man may be 
placed at its head ? No more danger than that our Chief Exec- 
utive will appoint, and the Senate will confirm an inefficient or 
or unsuitable man as Secretary of State or of the Treasury. He 
is responsible to the people. His appointee is responsible to him, 
and through him to the people for the faithful execution of such 
laws and regulations as the people, through their representatives 
in Congress assembled, may decree to preserve them from foreign 
pestilence or domestic disease. 
Dr. J. F. Hibberd, of Indiana, as Chairman of the Section on 
State Medicine, in his annual address in New York, 1880, very 
justly compliments the National Board of Health in “that some 
degree of harmony of action was established among the various 
State and local Boards of Health that were charged with the im- 
mediate execution of sanitary regulations.” And further says, 
that “it should be clearly recognized that the National Board 
does not supercede local sanitary organizations.” Recognizing as 
we do certain rights and duties belonging and pertaining to 
towns, cities, States, and the inhabitants thereof, I can clearly 
foresee and confidently expect a far greater degree of harmony 
as the outcome of a properly organized department, with a respon- 
sible head, than with a cumbrous Board. To use the words of 
one of the most eminent members of the National Board, Dr. 
Stephen Smith : “ Divided responsibility must end in inefficiency 
and failure.” As in many of our States, we have quite a diver- 
sity of legal, social, commercial and other regulations as pertain- 
ing to the varied questions of political economy in the different 
States, all working smoothly together as a whole without conflict, 
because harmonized and properly restrained as regards each other 
by the various departments of the National Government; so, also, 
there is just as positive a certainty of harmonizing National, 
State and local questions of Health by a similar department. Dr. C. C. Cox, of this city, in 1871, advocated views some- 
what similar to the suggestions I have the honor to submit. And 
in 1872 a bill was introduced into the U. S. Senate providing for 
the establishment of a national sanitary bureau, with a chief ex- 
ecutive officer; but as advocated by Dr. Cox, subordinate to the 
Department of the Interior. The duties of the chief, which are 
specified at length in the bill, were to collect information on san- 
itary matters and to report on the same from time to time. He 
having the appointing power to select such additional officers 
required, as chief clerk, chemists, experts, etc. Dr. Jno. S. Bill- 
ings in his report on the National Board of Health and Quaran- 
tine to this Association in 1880, says that “ 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 prej- 
udicial to the cause of public hygiene. It therefore received 
little or no cordial support. The American Public Health Asso- 
ciation did not recommend its passage, and it was practically 
pigeon-holed in the Congressional Committee to which it was re- 
ferred.” 
A similar idea was suggested in the American Public Health 
Association in 1873, by a resolution recommending a National 
Health Department similar to that of Agriculture or the Bureau 
of Education. The resolution does not say to what department it 
should be subordinate. 
My objection to Dr. Cox’s suggestion is, that if either should 
be subordinate, the Department of the Interior might be made 
as an annex to the Department of Health. For of the two, I 
cannot but tnink that our National Health, and the questions 
pertaining thereto, are paramount. As for the political bias that 
seemed to be so much dreaded, it has no fears for me. If a de- 
partment is created as suggested, we can, I think, very safely 
trust the chief magistrate elected by the American people, no 
matter from what particular political field he may come, to select 
a head for that department, to manage it according to the regula- 
tions of a Congress elected by the same people.