1609 to 1888, the chapter "Medicine and Medical Men" concludes with a directory of all physicians registered with the clerk of the peace. The detailed list starts on page 507 and ends halfway down page 508 after just 230 names. He does not mention other healthcare providers, such as barbers, nurses, or unregistered doctors. With a population of ~146,608, Delaware doctors were outnumbered 638 to one. 1 Though when bleeding, blistering, and purging are used as curatives, this ratio of providers-to-patients likely benefited many nineteenth-century patients and increased their chances of survival.However, even as medical science improved and the population increased, the number of doctors in the state remained roughly the same. In 1910, the state had grown to 202,322 inhabitants but added only 17 physicians-approximately 820 people for every doctor. 2 Today, the ratio of primary care providers to patients in the state remains alarmingly high at 1,418 to one. While the COVID-19 pandemic has exacerbated the situation, our state has grappled with a healthcare workforce deficit for over a century.

On the first page of its 1947 anniversary program, Edgewood Sanatorium (see Figure 1) proudly claims to be the "first sanatorium in the United States to be used exclusively for tuberculosis Negros." Piedmont Sanatorium in Lynchburg, VA, made a similar declaration, even though it opened two years after Edgewood in 1917 and six years after the Wilson, NC, facility. Pickford Sanatorium in Southern Pines, NC, wins the title of being the first, having opened in 1899. This bit of trivia, however, does not take away from Edgewood's historical significance. As a segregated facility managed by a Black doctor, the sanitorium is simultaneously a celebration of broader access to healthcare for Black Delawareans and a representation of the disastrous impact of racism in healthcare.

The 1870s and 1880s smallpox epidemics in the United States can be attributed to the successful mass vaccination efforts in the first half of the century. As cases became rare toward the midcentury, vaccine use decreased. Out of sight, out of mind. With the population susceptible to the ravages of the disease once more, physicians and governments pushed for a return to former immunization rates by enforcing existing mandates or creating new ones. The pushback was immediate. Inspired by their counterparts in Europe, anti-vaccination activists railed against the laws, citing concerns regarding the safety and efficacy of vaccinations as well as violations of their civil liberties. 1 With smallpox cases on the rise, the Board of Health of the State of Delaware called upon Dr. John K. Kane, Jr, M.D., to address the public's concerns. John K. Kane Jr. was born in Philadelphia in 1833. He attended University of Pennsylvania and received his medical degree from Jefferson College. After passing an examination before the Naval Commission, he sailed on the polar expedition sent out in 1854 to search for his brother, Dr. Elisha Kent Kane. The expedition was successful and Dr. John K. Kane accompanied his brother to Cuba, remaining with him until he died. He continued his medical studies in Paris, and then returned to Philadelphia to practice. During the American Civil War, he served as an army surgeon in Cairo, Illinois and Chester, Pennsylvania. In l868, he was appointed surgeon of the Philadelphia, Wilmington, and Baltimore Railroad Company and in 1879 Dr. Kane was elected president of the Delaware Medical Society.

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The First State has more to offer residents than tax-free shopping. In addition to world-class museums, quiet neighborhoods, and many acres of park and farm land, Delaware is a convenient central location within the Mid-Atlantic region. Its largest city is half an hour from Philadelphia, an hour from the beaches, and two hours from New York City. For those working in the nation's capital, a quick train ride makes living in New Castle County an attractive alternative. While modern Delawareans may enjoy proximity to larger cities, epidemics often made this less appealing to our eighteenth-century predecessors. Regarding yellow fever, Wilmington's location mattered in surprising ways.