Public Health

Why public health at all?

• Why let in dangerous people?• Is health so very complicated?• Is fun more important than health?• Does God want us to die? Does God want

them to die?• For your own good, for the public good: the

incontestable mandate

Three kinds of public health

• Reactive – responding to epidemics• Boards of Health

• Police – regulating commerce• Medical registrars, nuisance convictions

• Proactive – preventing disease; improving life• Liberal evangelicals• Utilitarians• Moralists -- the Chadwick Report 1842

The American Context

• Individual Liberty• State’s rights

– The marine hospital service

• The evangelical mandate• Americanism vs foreigners

Public Health and the Federal Government

• 1798 Marine Hospital Service• 1879 –82 U.S. National Board of Health --

$500,000• 1902 U.S. Public Health Service and Marine

Hospital Service• 1912 Public Health Service• After WWII – National Institutes of Health

Health and Immigration

• Opposition: to Scotch-Irish/German 18th c– G. Washington: “ignorant” B. Franklin “most stupid”

1785-1830 3750001830-1860 4.5 m, inc. 1.7 m Irish (1841-60), 1.4 m

Germans(Catholic population frm 75K to 3M)1864 – immigration encouragement, 1875 immigration

restriction; 1879, 1882 health related versions: contagion, dependency, mental illness

Health and Immigration/2

1882-1943 Chinese Exclusion Act (100K Chinese by 1880)

1891 Medical exclusion Epileptics, beggars, and anarchists

1907 Dillingham CommissionSlavs, Hebrews, Italians – literacy test

1921 numerical quotas1924 National Origins Act

Constituencies for public health

• state issues– Population, prosperity, authority

• Community issues– Property, public safety, disease

• Class issues– Political and economic power, access to medical care

• Professional issues– Who controls? Doctors or others?

SF

• March 1900-May – Suspicion of plague in Chinatown – cordon sanitaire

• Late May – Federal decision against inoculation

• June -- federal decision against racial quarantine

Typhoid Mary

• Mary Mallon 1869-1938• Soper investigation 1907• First confinement 1907-10• Second confinement 1915-38• Issues – gender roles, ethnicity, class, politics• Why did Mallon become the cause celebre?

Disease theories and government

• Contagion• Miasm• Epidemic Constitution – atmosphere• Social sin

WHY IS THE COW IN A SLING?

PLANNED? SPACE UTILIZATION IN 19TH CENTURY NEW YORK

West Gotham Court. Harper’s Weekly, 1879Image: http://maggieblanck.com/NewYork/ImagesNYC09/2109c.jpg

WHO IS RESPONSIBLE?

TENEMENT HOUSING PLAN – NOTE LACK OF WINDOWS

Report of the Council of Hygiene and Public Health of the Citizens By Citizens' Association of New York Council upon the Sanitary Condition of the City, 1865

New York City

• 1790 33100• 1810 96300• 1830 197100• 1850 515500• 1860 805500

Public Health in New York

• Croton Aqueduct, 1842• 1842 NY Association for Improving the Condition of

the Poor• 1845 Sanitary Condition of the Laboring Population

of New York -- John Griscom• 1864 Report on the Sanitary Condition of the City

(Citizens Commission)• 1866 Metropolitan Health act

• Medical inspectors, disinfectant stations, hospitals, laboratory

Griscom vs Hartley: progressive and conservative Evangelicals

• Griscom: Environmental evangelism • Hartley: Sin and grace – what must I do?• Public health as religious freedom?• Their attitudes to St. Vincent’s and Dr

McNeven

New York 1864, 5th ward• Pop ~ 22000• 74 blocks (32 good, 25 mixed, 17 bad)• Houses: 1244 inc. 450 tenements (> 3 families, but

most fewer than 6 families)• Most of the rest are boarding houses• Liquor stores 341 (1:3.65 dwellings)• Brothels 81+• Stores, etc 283• Factories 151• Stables 108

Interpretations of New York’s Experience

• “The passage of the … act was hailed as a great victory for American democracy, yet what it did was to take away from New York voters responsibility for the City’s health.” J Duffy

• Pioneering in the expansion of medical responsibility• An anodyne to social tension

– Draft riots of 1863• Professionals on the make

New York City, 1855

Image courtesy of California Digital Library New  York  City, 1855.Source: Prints and Photographs Division, Library of Congress.

Which is the real New York?

Street Scene in New York, Courtesy of the National Library of Medicine, National Institutes of Health

New-York. (1849), Courtesy of The New York Public Library.  www.nypl.org

The peculiar problem of slavery In whose interest is health?

• Power of the sick role: freedom through disease?• Slave diseases

– Racial – malaria, tuberculosis (tabes mesenterica), pneumonia– Corn-pork diet - selling quarters crops

• “that [some]… sold… food indicates that … some received sufficient nutrition from their regular rations.”

– Environment• Hookworm, respiratory diseases, typhoid

– Medical care• Whipping• Medicine as punishment?• Reliance on folk healing