Early Public Health Movement

Source

The Problem. Serious public health problems existed in the urban areas of the antebellum United States. Recurrent yellow fever epidemics, and major cholera epidemics in 1832 and 1849, aroused great concern. A rapidly expanding population fueled the growth of cities, but no concept of corporate social responsibility for sanitation existed. Procuring clean water and disposing of sewage and garbage were seen as individual rather than social problems. Furthermore, most people viewed dirt, disease, and poverty as inextricably linked to a common source, the immorality of the poor. The vibrant reform

culture of this period attacked that trio of problems by attempting to raise public morals. Reformers believed that improved behavior would eliminate public health problems.

Changing Assumptions. By the 1840s those assumptions were beginning to change. In 1842 British researcher Edwin Chatwick published a report of his study of the health of the British laboring classes. He maintained that poor people lacked good health and had short life expectancies but argued that their poor health was caused by their physical living and working environments, not by vice and immorality. Chatwick’s attack on the evils of the modern industrial factory system spawned interest in sanitary reforms in England, and his ideas soon generated interest in the United States.

Early Response. “Sanitary science,” as the antebellum public health movement was called, had stronger roots outside the medical profession than within it. Most of its advocates were evangelical reformers motivated by charitable concerns. The leader of American sanitary science in this period, John Griscom, actually was a physician, but his interest in reform stemmed from his Quaker roots. In 1844 Griscom delivered his lecture, the “Sanitary Conditions of the Laboring Population of New York,” which was published as a pamphlet the following year. Griscom argued that health and morality were in fact related, but he reversed earlier assumptions. Poor health, he claimed, produced poor morals. He concluded that the living conditions of the working classes in New York City were terrible but that the people were victims and not causes of those conditions. Poor working people, he noted, did not have the time, energy, or money to find clean water or properly dispose of human and animal waste. He proposed that the city establish a permanent public health board to ensure a clean water supply, construct a sewage system, and clean up the streets. Cleaning up the living environment, he claimed, would improve the health of the city’s poor as well as improve their morals and work ethic.

THE CHOLERA EPIDEMIC OF 1832, NEW YORK CITY

A member of the Committee on the Cholera Epidemic of the Board of Commissioners of Health of the City of Boston wrote:

The city council of Boston voted to send a medical delegation to New York, to inquire into the character of the epidemic, and the preparations to be made in case of its approach to Boston, A commission, consisting of Drs. Bigelow, Ware, and Flint, was sent to New York to investigate and report on the state of the disease in that place. In pursuance of their duty, this committee at once proceeded to New York, and spent several days in that city, most of the time being occupied in the cholera hospitals.

The hospitals were all crowded, the attendance of suitable nurses could hardly be obtained, and the dead remained for a long time unremoved In the hospital at Bellevue, we counted at one time thirty-one unremoved dead bodies, They were lying as chance might direct, in beds or on the floor, and in several instances a double bed was occupied by a living and a dead patient.

The mortality from Cholera in New York that season amounted to about 3000, In some other American cities it was 2000. In Boston, a comparatively healthy place, it was less than 100.

On our return from New York, in one of the Sound Steamers, we were stopped a mile below Providence by the health officers of that city, and forbidden to land. We learned that the whole population was in a state of panic from imagined contagion. After waiting a whole day, and sending various remonstrances to the city council, we were at last permitted to land at Seekonk in Massachusetts, from which place we made our way in stagecoaches, as we might, to Boston,

Source: George Ellis, Memoir of Jacob Bigelow, M.D., LL.D. (Cambridge, Mass.: John Wilson & Sons, 1880).

Reasons for Failure. Griscom did not see results from his efforts for another twenty years. The idea that the poor were responsible for their own health problems was too firmly entrenched to be quickly overthrown. No scientific basis existed as yet for advocating clean water and clean streets. Griscom simply believed that dirty conditions created miasma, or a generally unhealthy atmosphere. Furthermore, physicians on the whole took little interest in his ideas; preventive health measures were still the domain of medical sectarians and moral reformers. Finally, the unsettled economic conditions of the 1840s made city officials and state legislatures unresponsive to recommendations that would be expensive to implement and that offered no guarantee of success. Griscom’s efforts did, however, lay the groundwork for future campaigns beginning in the 1860s after the third major cholera epidemic of the century. The public health

movement that began then greatly improved sanitary conditions in some urban areas and contributed immeasurably to the late-nineteenth-century decline in infectious diseases as leading causes of death.

Source

Charles E. Rosenberg and Carroll Smith-Rosenberg, “Pietism and the Origins of the American Public Health Movement: A Note on John H. Griscom and Robert M. Hartley,” in Sickness and Health in America: Readings in the History of Medicine and Public Health, edited by Judith Walzer Leavitt and Ronald L. Numbers (Madison: University of Wisconsin Press, 1985).