The Texas Department of Health traces its beginnings to the need for quarantine in the nineteenth century. The many epidemics that visited Texas early in that century made quarantine necessary, particularly at principal ports of entry. Although before 1879 responsibility for quarantine in Texas lay with the governor, practical application of quarantine began with local authorities. In 1879 an act amending and supplementing the Quarantine Act of 1870 authorized the governor to appoint a "medical health officer for the State." This person was to be a physician "familiar with yellow fever," old enough to have mature judgment but not too old to be capable of active duty, and "pledged to the importance of both quarantine and sanitation." He was to operate exclusively under the direction of the governor and to be paid ten dollars for each day of service, plus travel expenses. Later that year, $12,000 was appropriated to build quarantine stations along the coast and at the principal points of entry from other states.
The original organization was called the Texas Quarantine Department. By 1891 it consisted of two branches, Quarantine and Internal Sanitation, both administered by the state health officer, who was also surgeon-general ex officio. The early years of the department were ones of austerity and slow progress. Despite the existence of a large number of disturbing health-related problems, available financial resources limited activities predominantly to quarantine work. The entire legislative appropriation for the first biennium (1879–81) was but $57,164.56. Only .6 percent of all state funds expended during fiscal years 1898 and 1899 was devoted to the Quarantine Department, a situation that was not to change for many years. The administrative staff under the first state health officers was limited to one office assistant, except for the personnel operating the quarantine stations, and the state office itself consisted of one dark and poorly ventilated room in the Capitol. Dr. Richard M. Swearingen, the second state health officer, wrote in 1884 that "the advances made by scientific investigators into the causes of epidemics, though positive and unquestionably in the right direction, have not been sufficient to give greater protection than heretofore, or to mitigate in any way the burdens and annoyances of quarantine."
In 1903 the legislature renamed the department the Department of Public Health and Vital Statistics, even though no appropriation was made for the latter function. Early state health officers regularly appealed in vain to the legislature for additional staff to accomplish a variety of functions: enforcement of vital statistics laws, bacteriological examination of food and water, and inspection necessary to enforce sanitary regulations. More and more, the health officers advocated the promotion of good health and the advancement of preventive techniques in order to forestall the social and economic dislocations of quarantine. In 1908 Dr. William M. Brumby listed the goals:
To fortify the body by building up the resisting powers; to ascertain our dangers by accurate vital statistics; to make safe the bedroom by preaching hygiene of the home; to shield the house by screening against flies and disease-breeding insects; to preserve the water supply by preventing pollution; to guard the neighbors by draining all premises; to protect the community by exterminating rodents; to promote the general welfare by proper sanitary law.
Organized agitation for a state board of health was begun by the Texas State Medical Association soon after its organization in 1869. Despite numerous rebuffs from the legislature, the association continued its advocacy for the next forty years. The eventual result was the abolition of the Department of Public Health and Vital Statistics and the establishment of the Texas State Board of Health in 1909. The first board consisted of seven members, all of whom had to be legally qualified physicians with at least ten years of medical practice in Texas. The president and executive officer of the board was also designated state health officer. Texas was now able to expand its programs beyond the quarantine activities that had almost totally defined the state public-health campaign during the preceding forty years. Some notable achievements during the next two decades included centralization of vital records (1909), greatly expanded education for public health (1913–14), the first sanitary inspector (1915), institution of the Bureau of Venereal Disease (1916), establishment of the Bureau of Sanitary Engineering (1917), appointment of a director of rural sanitation in order to eradicate soil-borne diseases and to control soil pollution (1916), and establishment of the Bureau of Child Hygiene (1922). By 1925, activities were grouped under six bureaus: Vital Statistics; City and County Health Officers; Food and Drugs; Water, Waste Control and Inspection; Child Hygiene; and Communicable Diseases. In that year the state appropriation of just under $160,000 for public-health work represented only 3.1 cents per capita. Only two other states made a lower per capita investment in the health of their citizens.
A reorganization took place in 1927. The administrative agency was now officially called the Texas State Department of Health, a name that it had used occasionally during the preceding years. Responsibility for selecting the state health officer was shifted from the governor to the State Board of Health. Administratively, the department remained relatively stable for the next fifty years, although it grew considerably. Its growth resulted from the expansion of public-health activities into new areas, including the Bureau of Laboratories (1928), the Division of Industrial Hygiene (1936), the Bedding Division (1939), the independent Dental Division (1945), the Hospital Survey and Construction Division (1946), the Cancer Control Division (1947), the enforcement of licensing statutes covering nursing homes (1955), the Water Pollution Control division (1956), the Division of Emergency Medical Services (1956), and the responsibility for consolidated activities designed to eradicate tuberculosis (1965). In 1970, the first of the department's public health regions was established in Tyler. The regional program was designed to deliver a broad range of services directly to people in counties and rural areas with no other public-health agency and to assist local health departments in the performance of their duties.
In 1974 the department again underwent reorganization, in part to align itself with new budgeting procedures advocated by the legislature. The agency briefly assumed the name Texas Department of Health Resources before adopting its current name, Texas Department of Health. Recent accomplishments of the department include development of a state health planning program (1975), activation of a Cancer Information Service (1976), establishment of nutrition services (1977), and development and expansion of HIV-related activities (1983–89). In 1993 the Texas Department of Health was organized into six broad areas: Family Health Services, Disease Prevention, Environmental and Consumer Health, Special Health Services, Community and Rural Health, and Departmental Administration. The department had more than 5,000 employees and administered a budget of more than $623 million, more than half of which came from the federal government. The central office was in Austin, and the agency maintained offices in eight public-health regions throughout the state. The department is governed by an eighteen-member board appointed by the governor to overlapping terms and approved by the Senate. Sixteen members must be licensed professionals with five years' professional medical experience in Texas. The two other members are to represent the general public. In 1991 the department was one of several agencies to come under the oversight of the new Health and Human Services Commission. In 1992 all environmental programs were transferred to the Texas Water Commission, and in 1993 a number of long-term-care functions were transferred to the Department of Protective and Regulatory Services. At the same time the department added a number of health services to its responsibilities. Appropriations by the Texas legislature were $478,983,385 in 1992 and $476,981,632 in 1993. As of 1993 the Department of Health had twenty-three bureaus and fifty divisions and programs. See also HEALTH AND MEDICINE, PUBLIC HEALTH.