Preliminary Survey and Current Data

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Preliminary Survey and Current Data

Public Health Reaches Counties

Official document

By: Alabama Department of Public Health

Date: 1937

Source: Alabama Department of Public Health. Manual for the Conduct of County Health Departments. Wetumpka, Ala.: Wetumpka Printing, 1937.

About the Author: Alabama's Department of Public Health was created by the state legislature in 1875. County health departments were established the following year.


When it was first settled, the territory that became the United States was quite rural: Population was sparse; settlements were made up of groups of homesteads, farms, and the like that were, for the most part, widely separated. Life in the New World was hard and filled with physical labor. Life expectancy was short by contemporary standards, averaging only forty to fifty years. Disease, even when epidemic or transmitted by animals or insects, tended to concentrate in areas of dense population and rarely jumped from one location to another. Small settlements kept outbreaks of illness relatively confined.

As the Industrial Revolution spread from Europe to America, major demographic shifts began to occur. People moved away from rural areas and into cities, where jobs were plentiful. There they mixed with an influx of immigrants, who also flocked to burgeoning industrial areas. People worked long hours in crowded factories and lived in decrepit, tightly clustered, poorly ventilated dwellings. There was no indoor plumbing, drinking water was often unclean, sewage and trash were dumped on the streets, and food often spoiled while it was transported from farm to city.

These conditions created a growing health crisis, forcing governments to address the problems of disease, pollution, violence, and the conditions under which they flourished. This was the dawn of the public health system in the United States, when state legislatures began to collect and monitor data about the population to assess needs and implement appropriate remedies. At the same time, scientific and medical research were rapidly improving public hygiene and discovering new ways to treat and even eradicate some major diseases of the time.

By the 1930s, health departments were organizing at the county level. The following document outlines instructions for a county health officer to assess the resources and needs of a local population.



133. Foreword: The county health officer, upon assuming his duties, should spend the first few weeks visiting the various parts of the county, during which time he should begin collecting the information suggested below. As time goes on, the missing items and those of lesser importance can be secured. At all times, the data should be kept current and as accurate as possible. As far as practicable, the information should be collected through personal contact. The collection of this information offers an excellent entree, and an opportunity to explain the purpose and work of a county health department.

134. General:

Pertinent facts in history of county.

Area in square miles.

Topography and character of soil.

Political subdivisions and natural community groupings of population, government and county, civil districts, incorporated and unincorporated communities.

Name, position and address of public officials.

Principal industries and number of persons employed.

Assessed valuation—real, personal, corporations—total.

Public revenue—county, improvement districts, schools, cities, and special tax, if any.

Income—per capita, per family.

Expenditures chargeable to public revenue.

135. Statistics:

Population—total, and by towns, civil districts, or other political subdivisions.

Number native white, colored, and foreign-born by nationalities.

Population figures should include last two federal censuses and estimate for current years.

Morbidity, mortality, and birth statistics for last 5 years.

Name and address of local registrars.

136. Rural Districts:

Population—total, by political subdivisions, and by rural community groupings.

Number of homes.

General housing conditions and economic status.

Number of home owners.

Number of homes with safe water supply.

Number of homes with sanitary excreta disposal.

Number of homes effectively screened.

Principal farm pursuits and products.

137. Cities (each city and village):


Population figures analyzed as indicated.

Brief description and pertinent facts in history.

Principal industries and number of persons employed.

Number of homes.

Number of home owners, tenants.

General housing conditions and economic status.

Form of government; officials—name, position and address.

Copy of sanitary code.

Public revenue, expenditures chargeable to public revenue.


(a) Public Water Supply:

Source, method of purification, operating control, sanitary analyses.

Number of connections, percentage of population served.

(b) Private Water Supplies:

Number, population served.

Sanitary quality.

(c) Excreta Disposal:

Public sewerage system—number connected, disposal of effluent.

Cesspools—number, population using.

Privies—number, types, population using.

Scavenger service—type, population served.

(d) Garbage:

Method storage, collection, disposal, percentage of population served.

(e) Milk Supply:

Quantity consumed; amount raw; amount pasteurized, sanitary quality of each.

Number of cows tuberculin tested.

Number of dairy farms in good sanitary condition.

Copy of milk ordinance.

(f) Morbidity, mortality, and birth statistics for last five years.

138. School System:

Population—school age, enrollment, daily attendance, total.

School districts—number rural, number town, total.

School buildings—number rural, number town, total.

Safe water supply—number rural, number town, total.

Sanitary drinking facilities—number rural, number town, total.

Sanitary lavatory facilities—number rural, number town, total.

Safe excreta disposal—number rural, number town, total.

Proper heating, lighting and seating facilities—number rural, number town, total.

Name and address of teachers, school board members.

Health service, health education, recreation.

139. Churches:

Safe water supply—number.

Safe excreta disposal—number.

Name and address of pastors.

140. Institutions:

Hospitals—type, bed capacity, requirements for admission.

Sanatoria—type, bed capacity, requirements for admission.

Charity homes—type, capacity, population, requirements for admission.

Others—type, capacity, population, requirements for admission.

141. Health Service (past and present):

Cities and County—personnel, budget, program, activities, accomplishments.

Schools—personnel, budget, program, activities, accomplishments.

142. Physicians:

Number in active practice, name and address.

Professional organizations—officers, name, address.

Public health activities.

143. Dentists:

Number in active practice, name and address.

Professional organizations—officers, name, address.

Public health activities.

144. Organizations:

Private, civic, commercial, community, or other organizations: Number, purpose, officers, name, address.

Note: The above data should be recorded on cards and cross-indexed for ready reference.

145. Laws and Ordinances: The health officer should become acquainted with the principal state health laws and should secure a copy of all state health regulations and local health ordinances. State health laws and regulations are contained in the Compilation of Public Health Laws, available to all county health departments.

146. Individual Homes: Time should not be taken in the beginning for a detailed survey, but the family folder should be completed when the home is visited for any other purpose.


The need for a public health system to curb epidemics was reflected in Civil War casualty statistics: disease killed roughly twice as many soldiers as wounds from battle. Among the primary causes of death were typhoid, malaria, (often indistinguishable in the years before blood tests and called "typhomalaria"), measles, respiratory infections, and diarrheal diseases.

The very first public health efforts, enacted locally, were aimed at reducing the infectious diseases that arrived with immigrants—particularly smallpox and measles. Local regulations were established to inspect ships as they arrived and to quarantine those on vessels where infection was found.

In rural areas, smaller-scale systems drafted local regulations regarding sanitation and hygiene. Inspectors traveled to dwellings and businesses in their assigned areas, making visual inspections and gathering data, assessing fines and penalties for those out of compliance.

Beyond the local loosely organized public health commissions and inspectors, however, was a great need for the development of a broader system—America was expanding rapidly and developing a host of social and medical problems as a result. Not only did epidemics erupt in rapidly growing cities and industrialized areas, there were increased outbreaks of violence, increasing use of alcohol, poor working conditions, and widespread child labor.

As women entered the workforce, they worked to earn suffrage and began to agitate for political, social, and health reforms. Schools of nursing and public health clinics were established, producing public health nurses who helped reform maternal and infant care, dramatically decreasing mortality for mothers and infants.

There was also a growing recognition of the need to standardize disparate local public sanitation programs and to train public health officers. Other professionals also played important roles: physicians and research scientists to diagnose illness and develop treatments; civil engineers to create public sewage, trash, and drinking water systems; public health nurses to oversee health, wellness, and nutrition programs; local health inspectors and surveyors; and legislators and government officials to draft and enforce regulations.

By the early decades of the twentieth century, the public health system had become part of America's social fabric. Using media campaigns to educate people about immunizations and illness-prevention programs, it was a driving force in controlling tuberculosis, diphtheria, polio, and rubella. Public health agencies created wellness centers, developed maternal and infant clinics, and created educational programs. With the Social Security Act of 1935, the public health system became even more stable, and remains an integral part of the American health system.



Gostin, Lawrence O. Public Health Law and Ethics: A Reader. Berkeley, Calif.: University of California Press, 2002.


"Achievements in Public Health, 1900–1999: Changes in the Public Health System." MMWR: Morbidity and Mortality Weekly Report 48, no. 50 (December 24, 1999): 1141-1147.

"Achievements in Public Health, 1900–1999: Healthier Mothers and Babies" MMWR: Morbidity and Mortality Weekly Report 48, no. 38 (October 1, 1999): 849-858.

"Achievements in Public Health, 1900–1999: Safer and Healthier Foods" MMWR: Morbidity and Mortality Weekly Report 48, no. 40 (October 15, 1999): 905-913.

"Ten Great Public Health Achievements" MMWR: Morbidity and Mortality Weekly Report. 48, no. 12 (April 2, 1999): 241-243.

Web sites

Jefferson County Department of Health. "History: Public Health Before 1917." 〈〉 (accessed November 11, 2005).