PUBLIC HEALTH ADVISORY CONCERNING FENTANYL AND FENTANYL-LACED SUBSTANCES

Health Department History Pre - 1900

The history of systematic efforts to protect public health in Tennessee is predated by earlier works of many individuals who were involved in fields of healthcare. Notable among these are Felix Robertson, the first non-native born in Nashville, who became a physician and surgeon; Thomas Waddle, believed to be the first physician to set foot on what is now Tennessee soil (in 1748); and Patrick Vance, believed to be the first physician to settle permanently within current state boundaries (in Sullivan County).

There was a winding road from informal efforts to an organized, state-sanctioned program to protect public health. The first law directly affecting public health records was one brought from North Carolina in 1778; it focused on marriages and was eventually amended by the Tennessee General Assembly in 1838.

The first documented attempt at any state effort toward regulation occurred in 1803 when Dr. Thomas Claiborne authored a bill providing for the regulation of the practice of medicine. It did not pass. Two years later, in 1805, a bill was passed appropriating $500 to help defray the cost of a hospital in Natchez in what is now Mississippi, to help care for those who became ill while traveling up and down the Mississippi river. That 1805 bill is believed to be the first formal legislation that can be associated with public health. Other early milestone included:

1830: Legislation enacted establishing a state medical society, which later became the Tennessee State Medical Society and then the Tennessee Medical Association.  The organization, from its start, played a major role in advocating for a state board of health and for the development of Tennessee’s public health system. Its stated purpose: “The advancement of medical science, the elevation of the standards of medical education, the enactment of just medical laws and the enlightenment and direction of public opinion in regard to the great problem of state medicine, so that the profession shall become more capable and honorable within itself and more useful to the public in the prevention and cure of disease and in prolonging and adding to comfort of life.”  The organization made unsuccessful efforts in 1848, 1854, 1860 and 1868 to have a law enacted to create a State Board of Health

1838: An epidemic of cholera strikes the Knoxville area.

1849: County courts are given authority (chapter 225, section 9) by the state legislature to combat smallpox by “such measures as it may think best to put a stop to same.”

1877: During the 1876-’77 General Assembly, the Senator elect from Shelby County (Dr. Maddox), at the request of a committee appointed by the Tennessee State Medical Society, introduced a bill that after several modifications would be termed: AN ACT to create a State Board of Health, for better protection for life and health, and the prevention of the spread of diseases in the state of Tennessee.  The bill passed March 26, 1877 and was signed by Hugh M. McAdoo, Speaker of the Senate, and by Edwin T. Tallisaferro, Speaker of the House of Representatives.  It was then signed by Governor James D. Porter that same night.  As a result, Tennessee became the 14th state in the Union to have a state board of health.

A few days later (April 3) a small group of physicians appointed by the Governor met in Secretary of State Charles N. Gibbs’ office,  where Dr.  J.D. Plunket gave them their charge: “At the request of the Governor of our Commonwealth, I have called you to meet at this time for the purpose of promptly completing the organization of ‘The State Board of Health of the State of Tennessee’ and at once entering upon the duties pertaining thereto.  The physicians at that meeting also included T.A. Atchison, MD, James M. Safford, MD, E.M. Wright, MD, and R.B. Maury.  Plunket was elected to serve as president.  

1878: From August to November of 1878, 5,150 people in Memphis died from Yellow Fever. The epidemic made many people aware of the critical role of public health in preventing and controlling future outbreaks.  The following year, 1879, the General Assembly provided emergency funding for use in preventing, combatting and controlling epidemics.  For the next two decades, the principal activity of the board was fighting epidemics, though the board directed its attention to other areas, including school sanitation, formation of county boards of health and maintenance of vital records. 

1879: The General Assembly of 1878-’79 added an amendment to the earlier Act to create a State Board of Health that strengthened the authority of the State Board of Health to effectively address epidemics.  The legislation was signed by Senate Speaker H.P. Fowlkes and House of Representative Speaker J.R. Neal; it was signed by Governor Albert S. Marks Marcy 26, 1879. Among its provisions was “That the State Board of Health be, and they are hereby, empowered to declare, quarantine whenever in their judgment the welfare of the people requires it, and prescribes such rules and regulations as they may deem proper for the prevention of the introduction yellow fever, cholera and other epidemic diseases in the State of Tennessee; and whenever the yellow fever, cholera, smallpox or other epidemic disease appear in any locality within the state, and information thereof is brought to the knowledge of the State Board of Health, they shall prepare  and carry into effect such rules and regulations as in their judgment will, with the least inconvenience to commerce and travel, prevent the spread of disease.”  

1881:  The first vital statistics law for Tennessee was passed, requiring registration of marriages, births and deaths.  The law was repealed 20 months later.  Another vital statistics law was passed in 1909; it too was repealed within 20 months.  The service went into effect Jan. 1, 1914, and has operated continuously since then.

1885: A law establishing county boards of health is passed by the General Assembly.  The County Health Officer was sometimes referred to at the time as the “Jail Physician” and was designated as the reporter of health conditions in his county.  The Officer worked needs of inmates in jails and residents of county “poor farms.”

That same year, the state Weather Service was moved from the authority of the Bureau of Agriculture, Statistics and Mines to the State Board of Health.  The Weather Service remained a function of the Board for the next ten years.

1897: The number of physicians on the State Board of Health was reduced from five to three, with one each representing the grand divisions of the state (east, west and middle), and a livestock breeder was added. The reorganization followed a tick fever epidemic among cattle in the state.  The reorganization of the Board also provided for the Commissioner of Agriculture to become an ex officio member. 

The State Board of Health obtained the services of Dr. Ernest B. Sangree as state biologist and Dr. Louis Leroy as his assistant.  Both were faculty members at Vanderbilt School of Medicine and served the state without compensation.  Dr. William Litterer succeeded Sangree and Leroy in 1908 as state biologist.  He served without compensation until 1908, when he was paid a part-time salary.