USA > Alabama > Memorial record of Alabama. A concise account of the state's political, military, professional and industrial progress, together with the personal memoirs of many of its people. Volume II pt 1 > Part 15
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(5) Another very distinctive feature of the association is the college of counselors, which is limited to 100 members on the active roll. The
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position of counselor is intended to be permanent, but it may be vacated by death, by resignation, by removal from the state. by losing member- ship in county society. by impeachment, and by failure to pay dues or to attend meetings of the association. The great burthen of the work and expense of the association rests on the shoulders of the counselors. All the officers of the association are selected from their ranks. They are the old guard, the Spartan band. the Roman legion of the association. After twenty years of consecutive service they are transferred to the life roll, retaining all the privileges of the counselorship. but relieved of all its compulsory obligations.
(6) The association is composed of the affiliated county societies of the state, each of which holds a charter from the association prescribing their duties and their privileges. The county societies are oragnized on the same plan as the state association. so far as circumstances admit of it. Every county society is the board of health of its county; is entitled to send two delegates to all the sessions of the association: and its mem- bers are ipso facto members of the association. Every county society, also, lias a board of censors composed of five members, each one elected for five years. one every year, which is the general business committee of the society, the committee of public health of the county, and the county board of medical examiners.
(7) At every annual session of the association there is a formal re- vision of the four rolls-the roll of the county societies, the roll of the counselors, the roll of the correspondents, and the roll of the officers. If any county society is found delinquent in dues, delegates and reports, it. is referred to the board of censors for investigation. If any counselor is delinquent, in either dues or attendance, his name is dropped from the roll by simple order of the president. The officers are elected by ballot and without nomination.
(8) The most remarkable characteristic of this remarkable association is that its constitution. regulations, and its enacted ordinances, are vigor. ously enforced-are enforced certainly, promptly, inexorably, and without either fear or favor.
THE MEDICAL LAW OF 1877.
The medical law of Alabama, which is now in force, was rendered pos- sible of administration by the peculiar organization of the medical association of the state. This organization has been sufficiently described in a previous section of this historical sketch. It was accomplished in 1878, and the next step was to endeavor to secure such legislative action as would enable its provisions to be enforced under the sanction and authority of the state.
To this end the draft of an act to regulate the practice of medicine in Alabama was submitted for the consideration of the association at the annual session of 1-74, in the city of Selma. The proposed act was approved by the unanimous vote of the association, and the board of
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censors was charged with the duty of presenting it to the legislature of the state. This was done at the legislative session of 1876-7. Active opposition to the measure was organized in the house of representatives, but, after some modifications and an active canvass, the bill passed both houses of the general assembly, and received the approval of the gov- ernor on the 12th of February, 1877. The leading features of the law are as follows:
(1.) That the board of censors of the medical association of the state of Alabama, and the boards of censors of the county medical societies holding charters from the state association, are constituted authorized boards of medical examiners.
(2.) That the standard of qualifications and the rules for the govern- ment of the authorized boards of medical examiners are such as may be from time to time prescribed by the medical association of the state.
(3.) That all persons legally engaged in the practice of medicine in the state at the time of the passage of the law, are continued in the enjoy- ment of that right under certain regulations.
(4.) That no one shall be allowed, under fines and penalties, to begin the practice of medicine in Alabama until he has passed a satisfactory examination before some one of the authorized boards of medical exam- iners, and had registered the certificate thereof in the office of the probate judge of the county in which he proposes to practice.
The rules for the government of the examining boards at present in force may be briefly summarized as follows:
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(1.) All examinations must be in writing, and must comprise ten different branches, namely: chemistry, anatomy. physiology. natural history and diagnosis of diseases, physical diagnosis, principles and practice of surgery, mechanism of labor, obstetric operations, hygiene, medical jurisprudence. Materia medica. therapeutics, and the practice of medicine are intentionally omitted from this schedule.
(2.) The examinations are conducted by a paid supervisor, who can- not be a member of the board, in such way as to make consultation of books or persons impossible. The questions are prepared and the answers valued by the members of the examining board. Each answer is separately valued. The values range from one hundred. which indi- cates a perfect answer, down to zero, according to the judgment of the examiner; and for a successful result the final average of the values of the answers must reach seventy-five. The time consumed in an exami- nation is usually from four to six days.
(3) Every written examintion made by the county boards is sent up to the state board, is reviewed by them. and their opinion of it is trans- mitted in annual reports to the state association. Neither the state board nor the state association ean reverse the decision of a county board; but if the association is not satisfied with the way a county board does its work, a reprimand or censure will secure better work in future.
(4) Examinations are accorded only to regular graduates of reputable medical colleges: and all examination papers are bound and kept on file so that they can be produced, if needed for testimony, in the courts or for other purposes.
(5) If any applicant believes that he has not been fairly treated by any county board, he can at any time appeal to the state board; which gives him a new examination. If any applicant is rejected by any county
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board, he cannot have another examination by the same or by any other county board until after the lapse of twelve months.
Eclectics and homeopaths must pass the same examinations as reg- ulars. Our law, indeed, does not recognize sectarian differences amongst doctors; that is to say, the state knows nothing about regulars, eclectics, or homeopaths, but puts them all on the same legal footing and requires the same standard of qualifications for all. All legal doctors, of what- ever name or school, have the full legal right to membership in our medical societies, and all are eligible to be members of the examining boards. All legal doctors, also, are freely admitted to consultations, and to all other professional privileges.
The strong point in this system, that which secures and guarantees its efficiency, is the supervision of the state medical association. Any one, not familiar with our work, would very naturally suppose that its weak point would be found in the large number of our county boards. But our county boards give us strength other ways, and in practice we find it easy to hold them up to quite a sufficiently high standard. At the worst, they can not fall below the standard of the medical colleges. As a matter of fact, the rejections average about twenty per centum of the examinations.
It may be freely granted that, if thoroughness of examination was the only thing to be considered, this could be better accomplished through a single state board. But thoroughness of examination is not the only thing we have to consider. Indeed, strange as it may seem, it is not even the principal thing we have to consider. Our great aim is the organization and discipline of the medical profession throughout the tate: and the most potent of all the factors we are able to invoke in the accomplishment of this object grows out of the fact that the county med- ical societies, through their board of censors, have been made the agents of the state for the administration of the law to regulate the practice of medicine.
It will be seen at a glance, that by this law and for the first time in the history of American legislation, the organized medical profession of the state is invested with the power to fix the terms of admission into its own ranks, and to prescribe the character and amount of the qualifi- tion which shall entitle any one to practice medicine in the state.
THE HEALTH SYSTEM OF ALABAMA.
Before the war health legislation in Alabama was confined to the en- actment of a few general provisions, authorizing municipal and county authorities to establish and maintain quarantines against infectious epi- demic diseases, and especially against yellow fever. But even quarantine had fallen greatly into disuse; and this for two reasons: (1) Because from 1850 up to 1860 it was very much the fashion amongst southern physicians to teach that in the southern states yellow fever was always
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of indigenous origin. and therefore not capable of exclusion by quaran- tine barriers. The existence of this opinion was largely due to the influ- ence of two remarkable books, namely: the great work of LaRoche on yellow fever, and the report of Barton on the great yellow fever epidemic of 1853. (2) Because our ante bellum quarantines were conducted in such loose and bungling fashion, and with such abundant want of expert knowledge, that they afforded in practice very little protection to the people whose fears led to their establishment. But during the war the blockade of southern ports served incidentally the purpose of an almost impassable quarantine-a quarantine of almost complete non-intercourse; and the result was, that during the war we had no invasion of yellow fever.
The first step toward the better supervision in Alabama was the establishment in the city of Mobile, by a city ordinance. of a city board of health with executive powers. By the terms of this ordinance the municipal authorities invested the board of health with all the powers usually conferred upon such boards in older and more populous commu- nities, such as the authority to inspect yards, houses, streets, markets, etc., and to cause the removal or suppression of all nuisance deemed detrimental to health; also to require reports of births. deaths, and cases of infectious diseases; and also the management of quarantine by land and by sea. The peculiarity of this board was that it was elected by the Mobile Medical society, was composed exclusively of medical men. and had the power to elect all the health officials needed for the carrying out of the provisions of the ordinance-such as city health officer, quarantine physician, physician to the pest house, sanitary inspectors, etc. The necessary appropriations were made from time to time by the municipal government. This Mobile ordinance was taken as the model in the organ- ization of the health system of the state.
HISTORICAL SKETCH.
Massachusetts was the first state in the union to create a state board of health, said board being composed of seven members-some of them physicians, some lawyers, some merchants, etc., and all of them appointed by the governor of the state. This system was established by an act of the legislature in 1867. since which time it has undergone various modifications, not necessary to be mentioned here. By an older law, which was continued in force, the municipal and town authorities, composed almost exclusively of non-medical men, were charged with the supervision of the health of their respective communities. In 1570 this Massachusetts system was adopted by the state of California, which was thus the second state in the union to create a state board of health. Since then it has been substantially adopted by quite a number of the states. Indeed, in all the states, except Alabama, in which state boards of health have been established, some thirty-eight at the time of this writing, the Massachusetts law has been taken as the model.
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At the annual session of the American Medical association. which was held in San Francisco in 1871, a committee was appointed, composed of one member for each of the states, which was charged with the duty of urging upon the legislatures of the several states the importance to the public welfare of the establishment in all the states of state boards of health. This committee in due time prepared a memorial addressed to the several state legislatures, urging upon them the adoption of the Massachusetts plan: and this memorial was presented to the general assembly of Alabama in the winter of the same year by the distinguished Alabama member of the committee. Dr. J. S .- Weatherly, who pressed its claims with great energy and with the countenance and support of many of our leading physicians. In the meantime, however. some members of the state medical association had already thought out for themselves a different, 'and, as they believed, a much better system, the system, namely, which was subsequently adopted in this state: and these threw their influence into the scale against the Massachusetts plan, and thereby secured its defeat.
At the session of the association which was held in Huntsville in 1872, both of these rival plans of state health supervision-the old Massachusetts plan and the new Alabama plan-were brought up by their respective advocates for consideration. The discussion was conducted with much earnestness on both sides and resulted in the emphatic endorsement by the association of the new plan. At the annual session of the association in Selma, in 1874, this scheme was again presented for discussion, this time in the shape of a formal bill, including all the details which it was thought expedient to lay before the general assembly. for legal enact- ment. This bill was unanimously approved by the association, and was enacted into a law by the general assembly in January, 1875.
The distinctive features of this Alabama system are as follows:
(1.) That in it the state medical association, as organized under its constitution of 1873, is made the state board of health, with a general supervision of the county boards of health.
(2.) That the functions of county and municipal boards of health are invested in the county medical societies holding charters from the state association, thus virtually engaging all the doctors of the state in the sanitary service of the people and in the administration of the health laws of the state.
(3.) That the extent and character of the sanitary work, to be done in any county, city, or town. is made a matter of negotiation and agree- ment between the county and municipal authorities, on the one hand. and the board of health on the other hand.
(4.) That in all these agreements the full control of all appropria- tions for sanitary purposes is reserved to the county or municipal authorities; while the selection of all the agents to be employed in sani- tary work, such as connty and city health officers. quarantine physicians, sanitary police, etc., is reserved to the boards of health. This arrange- ment, in effect, makes the county and municipal authorities component 9*
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factors of the boards of health, while it places the appointment of the health officials, aud the administration of the health laws, entirely beyond the reach of political influences.
The large grant of powers given to the state board of health by the legislation of 1875 was all that the most exacting sanitarian could have desired; but the board was able actually to accomplish very little for want of funds. This difficulty was overcome. to a large extent, by a supplementary act, which was passed in 1779, making an annual appropriation of three thousand dollars for the uses of the state board of health and to carry into execution the health laws of the state.
Another great step in the evolution of our public health system was taken in 1881, when the general assembly passed an elaborate act defining the duties of the state board of health. and the duties of the county boards of health, and providing for the collection and registration of the vital and mortuary statistics of the state; that is to say, of births and deaths and infections diseases in the several counties of the state. This law provides for the election in each county by the county board of health of a county health officer to serve as the active and responsible agent of the board in this work, and that said health officer shall be paid by the county commissioners.
In 1887 an act was passed by the general assembly to regulate the practice of quarantine in Alabama-said act placing the administration of all state quarantines in the hands of the state board of health, and ap- . propriating annually, to defray the expenses thus incurred, the sum of $5,000.
Also, in this same year, 1887, a law was passed for the protection of the traveling public against accidents caused by color blindness and defective vision of which the administration was also entrusted to the state board of health. The appointment of the examiners under this law was in the hands of the governor. The result was that the examiners were not always competent men; that the law did not prove satisfactory; and that at a recent session of the general assembly. 1892. it was repealed. It is probable that another law of similar character will be passed, plac- ing these examinations under the control of the railroad officials.
COMMENTARY.
From this brief historical outline of the evolution of our system of `health laws it is easy to see that our scheme of health supervision in Alabama is theoretically almost of ideal excellence. In practice it will grow more and more efficient and admirable as the wealth and population of the state increases-that is to say, as the various communities of the state are able to make more liberal expenditures for the improvement of sanitary conditions.
The most important and the most difficult part of the system, so far as it is at present in operation, is that which relates to the collection of vital and mortuary statistics. As to the value of such statistics all
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sanitarians and statesmen are agreed. The problem giving most trouble is how to accomplish their collection, in sparsely settled counties, in such way that the accruing advantages may not be bought at too high a price-at too large an expenditure of time and money. In cities, where there are large numbers of people gathered together within narrow limits of space, and where wealth is abundant, with efficient local laws, active health boards. and salaried health officers. the corresponding problem is easy of solution; but in sparsely settled country neighborhoods. where these agencies are available only to a slight extent or not at all. the diffi- culties that stand in the way of success are very great. The plan adopted in Alabama seeks to obtain the desired information through the agency of the medical profession, and especially of the medical profession as organized in the state association and the affiliated county societies. Some one or more of the members of these organizations can be found in" almost every neighborhood, and the facts wanted are such as naturally come to their knowledge, and of which they alone can be competent judges. Public policy and professional advantage both require that the profession generally shall engage in this work without pecuniary compensation. Accordingly, it has been found necessary, outside of the cities, to pay salaries only to a single health officer in each county, and these salaries are so moderate in amount that they are not felt to be burthensome to the taxpayers. The success so far achieved has been such as to demonstrate the efficiency of the system. Already in most of the cities, and in many of the counties outside of the cities, the results have been entirely satis- factory ; and they have been satisfactory in a sufficient number of sparsely settled counties outside of the cities to show that success is possible of achievement throughout the state.
PHARMACY LAWS.
The earliest law in Alabama for the regulation of the sale of drugs and medicines is to be found in the code of 1852. There is doubtless an antecedent act of the general assembly. but the writer of this sketch has not been able to find it. The code of 1552 provides that no one shall be allowed to sell drugs and medicines, or to engage in the business of a druggist. without having first obtained a license from some board of medical examiners authorized by the laws of the state, under a penalty of not less than $100. and all contracts for the sale of drugs to be void. In the code of 1867 it is further provided that license to deal in drugs may be issued by the Medical college of Alabama. There was no further change in the law until 1957. when the existing law to regulate the prac- tice of pharmacy was enacted by the general assembly, at the instance of the Alabama Pharmaceutical association. Under the terms of this new law all persons except registered pharmacists are prohibited. under pen- alty of not less than twenty nor more than $100 for each and every of- fense, from conducting any pharmacy, drug store, apothecary shop, or
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store, located in any village, town, or city of the state of more than 1,000 inhabitants, or within two miles of any such village, town, or city. for the purpose of retailing., compounding, or dispensing medicines or poisons for medical use. This law created a state board of pharmacy, composed of three members appointed by the governor, to examine, in such man- ner as the said board may determine, all persons who shall desire to conduct the business of selling at retail. compounding, or dispensing drugs, medi- cines, or chemicals for medicinal use, or compounding or dispensing physicians prescriptions. Druggists engaged in business before the pass- age of the law may register without examination; and all persons authorized to practice medicine in the state may at any time register as pharmacists without examination. The fee for registration with- out examination is $2. The fee for examination and for registration by the board is 83. The graduates of such pharmaceutical colleges as require four years' practical experience as a pre-requisite for gradua- tion are registered without examination. Poisonous drugs, except on physicians' prescriptions, are to be sold only after due inquiry, and must be labeled with the name of the drug and the word "poison." Itinerant drug vendors must pay a license of $100; but this act does not apply to the sale of proprietary medicines.
In 1889 this law was amended so as to apply to towns or cities of 900 population; and so as to apply also to the sale of patent and proprietary medicines. In the meantime, the old law, which places the power of granting licenses to sell drugs in the hands of the authorized boards of medical examiners, remained in force as regards all country neighbor- hoods and villages of less than 900 population-the rules governing the issue of such licenses to be such as may be made from time to time by the State Medical association.
THE ALABAMA PHARMACEUTICAL ASSOCIATION.
The Alabama Pharmaceutical association was organized in 1881. Its membership now numbers 199. The whole number of registered pharma- cists in the state is 599. Of these, 513 were registered without examina- tion, and eighty-six after examination. The meetings of the Pharmaceu- tical association, with times. places, and presidents, have been as follows: 1881, Mobile. P. C. Candidus: 18-2. Mobile, P. C. Candidus: 1883. Mobile, P. C. Candidus; 1884. Mobile, P. C. Candidus; 1855, Birmingham, P. C. Candidus: 1886, Birmingham. A. L. Stollenwerck: 1587. Opelika, A. L. Stollenwerck; 1888, Opelika, J. B. Collier: 1889, Birmingham, J. B. Collier: 1890. Mobile, G. W. Bains: 1891. Huntsville. W. F. Punch: 1592. Mobile, J. D. Humphrey; 1893, Blount Springs, Mosely F. Tucker.
THE PRACTICE OF DENTISTRY.
The first law in Alabama for the regulation of the practice of dentistry was passed in 1841. It provided that no person should practice dentistry
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without having first obtained a license from some board of medical ex - aminers authorized by the law of the state, which boards. for this pur- pose, were required when practicable to add to their membership a practical dentist. The penalty for practicing dentistry in violation of the law was fifty dollars for each offense, half to go to the prosecutor and half to the county. The fee for examination was five dollars. This law remained on the statute books of the state for more than forty years; but it is believed that no effort was ever made to enforce it. A few dentists, perhaps, obtained licenses under it, but for the most part it was entirely disregarded.
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