The Origins of Public Health in the United States

Abstract

DURING the second half of the 19th century the United States changed from a predominantly agricultural and rural to an industrial and urban civilization. The rise of the city forced upon the attention of the American people many problems which previously they had largely neglected; among these was public health. Spurred by social necessity and motivated by humanitarian idealism, economic and life-saving benefits, and increased popular faith in the value of science, public health officials and public spirited laymen advanced municipal public health practices from almost nothing to a vigorous and useful function of local government. Prior' to the Civil War sporadic attempts were made to protect the public against infectious diseases by governmental action. Massachusetts Bay Colony, for example, set up quarantine regulations as early as 1647 when news arrived of a mortality in the West Indies.' Petersburg, Va., set. up what was probably the first board of health in 1780, and New York, Baltimore, and Boston took similar action in the 1 790's.2 The outstanding Report of the Massachusetts Sanitary Commission in 1850, resulting from a survey undertaken by Lemuel Shattuck, reviewed the past history of sanitation and envisaged a remarkably comprehensive system of state public health administration far in advance of its time.3 In 1857 Wilson Jewell of the Philadelphia 'Board of Health arranged the first of four annual meetings of the National Quarantine and Sanitary Convention,4 but this promising organization was discontinued when the Civil War broke out. In the field of infectious diseases, effective methods of smallpox prevention, though not widely applied, had slowly been developed: inoculation and, later, vaccination had long been striving for recognition, and in addition laws requiring quarantine, notification, isolation in pesthouses, and disinfection had found their way into the statute books and city ordinances. But despite these glimmerings of future light, little had in fact been actually accomplished prior to the Civil War. Typical was the board of health organized in New Haven, Conn., in 1806: it confined itself largely to matters of quarantine and nuisance removal; in some years when the town was generally healthy, it did not bother to meet.5 Meanwhile, in England where the advent of the Industrial Revolution in the 18th century was already posing problems of urban health, steps were being taken which were to have a great influence on the United States. In London, effective legislation to end the gin drinking menace in 1751, improved care of parish children, extension of medical practice among the poor, together with street paving, better drainage and scavenging, and increased watersupplies helped to lower the death rate markedly.6 More significant were the investigations initiated in 1838 by Edwin Chadwick, a member.of the British Poor Law Commission, on the relations of poverty and disease, culminating in the famous Gen-