PUBLIC HEALTH. Since the days of Spanish sovereignty, Texas governments have demonstrated an interest in public health. The first royal order concerning the care of the sick and wounded in Spanish Texas was issued in 1777. Indians and early settlers of the province received medical care from Spanish missionaries. Each Texas mission had a hospital and a lay brother who looked after the sick and acted, after a fashion, as apothecary and dietitian. Even so, because of the epidemics and fevers that regularly ravaged eighteenth-century Texas, the provincial governor frequently appealed to the king of Spain for medicines and doctors. Hoping to protect his subjects in the New World from smallpox, King Charles IV made arrangements to prevent the dreaded disease by means of a newly discovered vaccine. In 1806 the first smallpox inoculations were administered in San Antonio de Béxar. After initial resistance to the experiment, the townspeople came to accept the procedure, and the threat of smallpox was lessened for a time. Under Mexican rule, when Texas was combined with the state of Coahuila in 1824, the impoverished new government and the sparse population limited effective attention to public-health problems. Certain laws of the period, however, indicated an awareness of the difficulties. The most significant pieces of legislation were decrees of 1830 that authorized financial aid to smallpox sufferers and appointed inspectors to conduct examinations of tobacco leaves "to prevent notoriously serious injury and abuse" from low-quality crops. The early experiments in smallpox vaccination led in the same year to the compulsory immunization of all children in San Antonio. In 1831 the first board of health in Texas was formed at San Felipe de Austin. Soon to follow were boards in San Antonio, Goliad, and Nacogdoches. All of these were established to deal with the panic that inevitably attended outbreaks of smallpox and cholera, and they ceased functioning as soon as the epidemics passed.
Since vital statistics and an organized system of reporting the incidence of communicable diseases were not to come for nearly seventy-five years, little is known of health in the Republic of Texas and early statehood. Epidemics-particularly of smallpox, yellow fever, and cholera-were frequent. Between 1836 and 1867 yellow fever epidemics occurred nearly every year, and a cholera outbreak that hit Indianola in 1846 was so severe that the dead lay unburied in the streets. Though the Texas government enacted very few public-health measures before the twentieth century, in 1836 the Republic did enact a pure-food statute that called for the punishment of those who sold the flesh of unslaughtered animals or any other "unwholesome food or drink." This legislation was improved and expanded in 1854. As in the rest of the United States, local public-health activities preceded state health organization by more than half a century. The early acts of incorporation of Texas towns reveal that local interest was focused primarily on measures to assure pure food and, to some extent, community sanitation. The first act of incorporation of a municipality that contained public-health provisions was that of the city of Austin, approved by the Congress of the Republic of Texas on December 27, 1839. The mayor and council were granted the authority "to determine the mode of inspection of all comestibles sold publicly in the market or in other places; and to regulate everything relative to bakers, butchers, tavern-keepers or grog-shops." Similar provisions were included in the acts incorporating Texana (1840), Jefferson (1848), San Antonio (1852), and Galveston (1856). An act to reincorporate Galveston was the first to provide for a local board of health, as well as an appointed "health physician" and as many health inspectors as deemed necessary.
By far the most significant local action concerned the power to quarantine. Galveston led the way in 1850, when the first quarantine regulations in the state were passed after several yellow fever epidemics had visited the island. Still more stringent regulations were voted by Galvestonians in 1853. The continuing prevalence of smallpox and yellow fever made the necessity of quarantine felt over the whole state. In 1856 the state legislature enacted a law that enabled county courts and municipal corporate authorities to quarantine when necessary. Quarantines became widespread: Galveston, Houston, Brenham, Bryan, Hempstead, and other communities took turns quarantining each other. By 1888, boards of health were organized in nearly every city and town to attend to sanitation and other measures to improve health. In 1879 the quarantine law was amended to make the governor the head of a state health department with authority to appoint a state health officer known as the state medical officer. Dr. Robert Rutherford, the first, was followed after two years by Dr. Richard M. Swearingen, nationally recognized as an outstanding contributor to public health. The 1879 law provided the basis for the first statewide system of quarantine. With increases in personnel and financial resources, quarantine stations sprang up throughout the state, and quarantines were used even more frequently toward the end of the century.
In 1903 what had been called the Texas Quarantine Department became the Department of Public Health and Vital Statistics, and in 1909 a seven-member State Board of Health was formed in response to longstanding agitation by the Texas State Medical Association. The next twenty years witnessed the birth of nine major public-health programs that have survived to this day: (1) Vital Statistics. Although legal requirements to register each person in Texas date back to the Mexican colonization laws, and statutes mandating registration were enacted in 1873, many decades elapsed before vital statistics were reported efficiently. In 1907, the state health officer began collecting statistics despite the legislature's failure to appropriate funds for this effort. The Sanitary Code of 1910 included a vital-statistics law that was modified many times to improve efficiency of reporting, but conditions remained unsatisfactory until 1933, when Texas was admitted to the United States registration area. (2) Pure Food and Drug. A pure-food statute was passed in 1883, but money was not regularly appropriated until 1907, when the legislature formed an agency called the Dairy and Food Commission to administer newly passed food and drug laws. In 1921 the State Board of Health became responsible for enforcing these statutes. (3) Sanitation. Although the act of 1879 pledged the state health officer to both quarantine and sanitation, the latter function received little attention for many years. In 1915 the first sanitary inspector was added to the staff of the state health department, and in 1917 the Bureau of Sanitary Engineering was established. Sewage treatment and disposal became a major concern, as did the supervision of water supplies. Mosquito-control programs were inaugurated in the early twenties. (4) Public-Health Education. In 1913 the legislature outlined a detailed program that called for the distribution of information on communicable disease. In 1927 a Bureau of Public Health Education was constituted in the Texas State Department of Health. (5) Maternal and Child Hygiene. The fight against the state's high infant mortality began in 1922 with inspection of maternity homes and the provision by public-health nurses of health education, prenatal treatment of mothers, and care of babies and preschool children. (6) Rural Health Sanitation. Attacking health problems in rural areas of Texas began in 1912 with the establishment of the Hookworm Commission, which was soon followed by the Anti-Plague Commission and the Anthrax Commission. Dr. P. W. Covington became the first state director of rural sanitation in 1916. (7) Venereal Disease. In 1916 the State Board of Health established a Bureau of Venereal Disease to conform with a request from the National War Department. (8) Communicable Disease. The Sanitary Code of 1910 made mandatory the reporting by physicians of all contagious and infectious diseases. The original activities of the state Bureau of Communicable Diseases, established in 1922, focused on educational work. Epidemiological studies were introduced in 1924, and the next year tuberculosis and venereal disease programs were incorporated. (9) Laboratory Investigation. In 1912 a state bacteriological laboratory was established. In 1928 it merged with the Pasteur Institute of Texas and the laboratory of the Pure Food and Drug Commission to form the Bureau of Laboratories, administered by the state health department.
After 1910, organized volunteer tuberculosis and other health-related work began in Texas. As a result of a request to the National Tuberculosis Association made by several prominent citizens, a state association was formed; it ultimately became the Texas Public Health Association. Its early activities included the construction of Children's Hospital at Galveston, initiation of a program in public-health nursing to benefit children, and race-specific health promotion among African and Mexican Americans. The turn of the century saw the emergence of many examining boards, designed to conduct reviews of health practitioners and aid in the enforcement of state laws regulating the delivery of health care. Significantly expanded activities in the following decades occurred largely as a result of funds obtained through the Social Security Act of 1935, the La Follette-Bulwinkle Act of 1938, the Work Projects Administration and the activities of the United States Public Health Service. Existing programs were improved, and many new ones were introduced. In 1933 large-scale sanitation programs were implemented as part of a malaria-control project. That same year the legislature inaugurated a physical-restoration service for crippled children, and the Children's Bureau of the United States Department of Labor provided funds to extend and improve this service. Dental health education and prevention efforts were underway by 1936. In that same year, a Division of Industrial Hygiene was instituted in the state health department; under various names it grew to encompass program responsibilities for air pollution, radiation control, defense against chemical and radiation hazards, and the medical and nursing aspects of occupational health. Cancer-control activities were begun in 1947, primarily to educate physicians in the diagnosis and treatment of the disease. Principally because of the publication in 1944 of the results of the first field studies of cancer incidence in the country, the program was quickly expanded to include tissue diagnosis and the compiling of cancer statistics. Activities relating to hospital planning and certification began in 1946, and the hospital licensure law became effective in 1960. A Division of Mental Health was formed in the state health department in 1947 to promote mental health and prevent mental illness. (This function was transferred in 1964 to the Board for Texas State Hospitals and Special Schools and is now the province of the Texas Department of Mental Health and Mental Retardation.) The State Board of Health began licensing nursing and convalescent homes in 1953. A Division of Water Pollution Control was formed in 1956, as was a Division of Emergency Medical Services. A program to deal with chronic disease was initiated in 1957. Since the 1960s, many new programs have been added to the state's public-health arsenal, including expanded emergency medical and tuberculosis programs, Medicare certification, wastewater technology and surveillance, shellfish sanitation, veterinary public-health and meat-inspection programs, program-planning services, nutrition services, and kidney-health care.
The public-health program in the 1990s consisted of a wide array of activities including education, planning, surveillance, epidemiological study, laboratory analysis, environmental protection, regulation, licensure, and complaint investigation. Governments at all levels-federal, state, and local-cooperate to provide health services to the public. Universities and research centers conduct the medical research necessary to develop improved methods for promoting health and preventing disease. Community-based organizations and interest groups provide strong advocacy for particular populations and specific health-related issues. The modern public-health campaign represents the culmination of a 200-year struggle to lengthen the productive lives of Texans.
See also HEALTH AND MEDICINE, ENVIRONMENTAL HEALTH, EPIDEMIC DISEASES, GOVERNMENT, MEDICAL EDUCATION, OCCUPATIONAL MEDICINE, PUBLIC-HEALTH NURSING, TEXAS ANIMAL HEALTH COMMISSION, TEXAS COMMISSION ON ALCOHOL AND DRUG ABUSE, TEXAS DEPARTMENT OF HEALTH, and TEXAS MEDICAL ASSOCIATION.
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