In our colonial history, and also in the early part of our national existence, public sanitation was almost exclusively a function of local government. As occasion arose from the presence of epidemics, the towns through their regular officers, or more often through special committees, would take such preventive measures as in each case seemed to them best. It was not until the close of the eighteenth century that permanent boards of health were established, and for three quarters of a century such boards were confined almost exclusively to the larger cities.

If we except Louisiana, where a state board of health was established in 1855, almost exclusively for the purpose of maintaining quarantine at New Orleans, the first state to establish a state board of health was Massachusetts in 1869. This marks the beginning of the states' activity in sanitary affairs. The idea of a central control in such matters has grown so rapidly that during the 35 years that have since elapsed, central boards of health have been established in all the states and territories except Idaho, and also in Hawaii, Porto Rico and the Philippine Islands.