Public Health. For much of American history, protecting local business figured prominently in public‐health efforts. During the
Colonial Era,
smallpox and
yellow fever ravaged seaports, paralyzing business activity. Townspeople fled; shops closed; visitors avoided the stricken cities. To revitalize trade, local authorities often published false reports minimizing the danger. They also quarantined ships, established pesthouses (isolation hospitals), introduced short‐term sanitary reforms, and experimented with smallpox inoculation. A major vindication of inoculation came during a 1721
Boston epidemic that claimed nine‐hundred lives. Cotton Mather championed the procedure, while Boston's most prominent physicians opposed it. Smallpox vaccination, developed by the English physician Edward Jenner, became available by 1800.
During the nineteenth century, outbreaks of
cholera, especially in 1832–1833, 1849–1850, and 1866, and other epidemic
diseases shaped public‐health practice. As yellow fever devastated southern cities, physicians disagreed about whether it was contagious and how to combat it. Those who supported the broad exercise of government authority sought to quarantine incoming ships, whereas those favoring free trade and individual liberty urged the removal of decaying organic wastes, whose noxious “miasmas,” they believed, caused most epidemics. (In 1900 an army medical team led by Dr. Walter
Reed at last discovered yellow fever's mode of transmission: the
Aëdes egypti mosquito.)
By midcentury, local governments increasingly addressed public‐health issues.
New York City built a municipal water system in 1842. Dr. John H. Griscom's
The Sanitary Condition of the Laboring Class of New York with Suggestions for Its Improvement (1845) proved highly influential. New York created a permanent Metropolitan Board of Health in 1866, in response to a threatened cholera epidemic, and reformers in other cities soon followed suit. As municipal water and sewer systems replaced backyard wells, cesspools, and privies, outbreaks of cholera,
typhoid fever, dysentery,
malaria, and typhus diminished. As in the past, local business groups often led these sanitary reforms.
At the federal level, Congress in 1798 had created the U.S. Marine Hospital Service, under a Surgeon General, to care for ailing seamen. The U.S. Sanitary Commission, a volunteer agency headed by Frederick Law
Olmsted, worked to improve health and sanitary conditions in
Civil War military camps. Meanwhile, the Marine Hospital Service steadily expanded its activities, including a bacteriological research laboratory founded in the 1890s. Renamed the U.S. Public Health and Marine Hospital Service in 1902, it eventually became simply the U.S. Public Health Service (PHS). Early PHS campaigns combated hookworm and pellagra.
With the triumph of the germ theory of disease and the advent of bacteriology in the early twentieth century, the rationale for public‐health efforts shifted from ridding the environment of “miasmas” to attacking disease‐causing microbes. Public health became professionalized as lay reformers gave way to physicians and scientists. The laboratory became the principal battleground against disease, with impressive results. Vaccines, serums, and tests attacked rabies,
diphtheria, typhoid fever, tuberculosis, and later, yellow fever,
poliomyelitis, measles, and whooping cough. The
Progressive Era's reform ethos opened new public‐health vistas, including school‐vaccination programs, maternal and child care, rural health efforts, medical inspection of immigrants, regulation of nuisance industries, inspection of food processors and providers, and campaigns to reduce infant mortality and
tuberculosis. In many of these programs, the federal government played a central role. By
World War I, there existed a vast network of governmental public‐health agencies, supported by the American
Red Cross,
settlement houses, and other volunteer groups. Although organized
medicine, led by the
American Medical Association, enthusiastically supported the public‐health movement, it strenuously sought to limit activities to prevention, not treatment.
As the acute, communicable diseases were defeated, attention shifted to the chronic and degenerative afflictions, especially
cancer, diabetes, stroke, and
heart disease. Public‐health workers alerted the public to risk factors they could control, such as obesity; poor nutrition; lack of exercise; and, in the case of
venereal disease, unprotected sex. In the 1930s, Surgeon General Thomas Parran lifted the veil of silence surrounding syphilis. Beginning in the
New Deal Era, the federal government increasingly funded municipal and state public‐health programs.
By the late twentieth century, public‐health efforts at all governmental levels had vastly expanded in size and complexity. In the 1990s the PHS, now a part of the Department of Health and Human Services, included the Surgeon General's Office, with a corps of over six thousand public‐health professionals; specialized agencies such as the
Indian Health Service, the Food and Drug Administration, the data‐gathering
Centers for Disease Control, and the research‐oriented
National Institutes of Health; and offices addressing such issues as aging,
mental illness, minority health, women's health, physical fitness, and the AIDS epidemic. The landmark
Surgeon General's Report on Smoking and Health (1964) alerted citizens to the hazards of smoking and led to health warnings on cigarette packages, advertising restrictions, congressional investigations, and major legal challenges to the
tobacco industry. Other federal bodies addressing public‐health issues included the Bureau of Prisons, the
Environmental Protection Agency, the Consumer Product Safety Commission, the Immigration and Naturalization Service, and the Occupational Safety and Health Agency. Globally, the PHS cooperated with the
World Health Organization, a
United Nations agency. From small beginnings, public health had emerged as a major governmental responsibility as the twenty‐first century dawned.
See also
Acquired Immunodeficiency Syndrome;
Federal Government, Executive Branch: Other Departments (Department of Health and Human Services);
Health and Fitness;
Hospitals;
Immigration;
Immigration Law;
Industrial Diseases and Hazards;
Mather, Increase and Cotton;
Professionalization;
Pure Food and Drug Act;
Tobacco Products;
Tuskegee Experiment;
Urbanization.
Bibliography
Charles E. Rosenberg , The Cholera Years: The United States in 1832, 1849, and 1866, 1962.
Judith Walzer Leavitt , The Healthiest City: Milwaukee and the Politics of Health Reform, 1982.
Allan M. Brandt , No Magic Bullet: A Social History of Venereal Disease in the United States since 1880, 1985.
Stuart Galishoff , Newark, the Nation's Unhealthiest City, 1832–1895, 1988.
John Duffy , The Sanitarians: A History of American Public Health, 1990.
Margaret Humphreys , Yellow Fever in the South, 1992.
Stuart Galishoff
