Dr. Cofer—Mr. President, Ladies and Gentlemen: I do not think any invitation has ever been received with more satisfaction than the one for a representative of our service to appear before you. It was received with the greatest gratification.
The Public Health Service is absorbed in the work of health conservation and Surgeon-General Blue evinced the greatest interest in your invitation for him to send a representative to explain the scope of the work being performed and discuss the question of authority in connection therewith.
This topic is now receiving the consideration of many authorities on public health matters, and on this account one may approach the subject in a hopeful attitude. I say “hopeful” because public health as an institution is rapidly growing, and its practical value is becoming more and more manifest, and sanitary science is not now nearly so far in advance of its practical application as it was even a few years ago. The possibilities of sanitation in the general advancement are being made a part of all high ideals of government, so that it is not to be wondered at that the general government should be called upon to do its share. The difficulty lies in determining just what the government should do in aid of public health and just what should be left to the States and municipalities.
History furnishes no precedents for this Nation to follow. It is almost useless to seek a model for our guidance in some foreign country. A nation with our conditions of boundary and magnitude, with millions of immigrants coming to our shores from all parts of the earth, has its own salvation to work out in the public health as well as in many other problems. In other words, we must rely upon ourselves, whether we proceed in haste or by feeling our way step by step. There is a marked divergence of sentiment growing in regard to national health control. One is that the government should do far more than it is now doing towards the protection of the public health, another that too much is expected of the National Government, and that there is a tendency on the part of State governments to call upon the Federal Government for service which should be performed by the States themselves, but which service is asked for largely in the interest of economy. These widely differing ideas in regard to the apportionment of public health responsibility lead us to a consideration of the provisions of the Constitution of the United States relative to this matter. These provisions are contained in Section VIII, paragraphs I and 3:
Section VIII. The Congress shall have power—
Par. 1. To lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States.
Par. 3. To regulate commerce with foreign nations and among the several States, and with the Indian tribes.
It has been held by some that the powers of the National Government, relating to public health, are restricted to paragraph 3, which gives the right to Congress to regulate commerce, and, in regulating commerce, to so regulate it as to prevent its being a carrier of disease. Others have held that under the general welfare clause, in paragraph 1, Congress has the right to legislate for the public health.
Should the latter interpretation be the correct one, Congress could establish the national health control over States and municipalities with regard to municipal and domestic sanitation, with all details as to house drainage, plumbing, sewerage, and disposal of garbage, water supply, ventilation, school houses and public buildings ventilation, examination of milk supply, food and drugs, disposal of the dead, disinfection of dwellings, etc. Would it be desirable for the National Government to have such authority? Would it be tolerated by the people? It is a fact that the American people have already decided this question when the old National Board of Health was abolished.
The National Board of Health was created by an act of Congress, approved March 3, 1879. Another act was approved June 2, 1879, clothing the board with certain quarantine powers, but this last act was limited to a period of four years, at the expiration of which time Congress declined to renew it. The National Board of Health, therefore, had an active existence from 1879 to 1883. The act establishing the board remained upon the statute books until February 15, 1893, when it was formally repealed by Congress.