A map of the Cambridge
(Massachusetts) health districts, from the Annual Report of the State Board of Health of Massachusetts, 1878.The public health movement began in Germany in the 1840s. The industrialization of Europe which started in the 18th century produced urban slums which were swept periodically by epidemics of typhoid and typhus. In the 1830s, a cholera epidemic hit London. As the epidemic spread to Germany, Rudolf Virchow (1821– 1902) studied the obvious connection between poor sanitation and disease which became the genesis for the public health movement.
While isolated geographically from the scourges of Europe, America was occasionally hit with epidemics of its own, especially in the growing east coast cities. Recognizing that disease may be coming from the ships that docked in their ports, cities instituted quarantines during outbreaks.
Treatments for widespread disease did not improve. Benjamin Rush, America's leading physician, made detailed observations of the yellow fever epidemic that hit his native Philadelphia in 1793, but refused to accept contagion as the likely cause. Rush prescribed a treatment of intense bleeding and purging with Calomel.
America largely escaped the typhus epidemics that devastated Europe in the early 19th century because the mostly rural country lacked overcrowding, poverty, and filth which promoted typhus transmission by lice. Typhus did strike ships ferrying passengers from Europe to the United States, however. An outbreak of the disease in Pennsylvania Hospital in 1836 provided the opportunity for physician William Wood Gerhard to study the disease carefully and differentiate it from typhoid. Typhoid was much deadlier in America: there were 75,000 reported cases during the Civil War alone. Dysentery too swept the United States, especially during the war, as did many of the common childhood diseases such as diphtheria, scarlet fever, and measles which hit young soldiers from isolated rural areas who had not developed immunities to them.
In 1847, the newly-formed American Medical Association sponsored an investigation of large U.S. cities and found that living conditions for many residents had become as bad as the worst slums of Europe. The organization concluded that without improvements in hygiene and living standards, European-type epidemics would soon hit American cities. The organization also advocated collecting vital statistics to track the country's birth and death rates. Soon thereafter, many bureaus of vital statistics were organized, including in Ohio, where birth and death statistics were collected at the county level beginning in 1867.
Local sanitary commissions formed in cities and towns, spurred on by reform movements which stressed healthier living and clean water. The Massachusetts Sanitary Commission, for example, sought better venting of city homes to remove any noxious odors and fumes that might cause disease. To provide plentiful water, 32 waterworks were built in the country by 1825, and almost 600 were added by 1880. Unfortunately it was assumed that free-flowing water was pure, so the first filtration plant was not built until 1871.
In 1856, Dr. Wilson Jewell of Philadelphia proposed a national convention to establish uniform quarantine laws. The first convention met in that city in May 1857, and four more such conventions to discuss public health issues were held before the Civil War disrupted the movement. The American Public Health Association was founded in 1872 by some of those who attended these earlier conventions. The following year the number of boards of health in the U.S. increased from 4 to 123.
The most significant event in the public health movement, however, was the development of the germ theory and the realization that disease could be contagious.
Buck, Albert H., ed. A Treatise on Hygiene and Public Health.New York: William Wood & Company, 1879.
Massachusetts State Board of Health. Annual Reports of the State Board of Health of Massachusetts. Boston: Wright & Potter, 1872, 1876-1878.
Shakespeare, Edward O., United States Commissioner. Report on Cholera in Europe and India. Washington: Government Printing Office, 1890.