Ella Bless V.

Menses November 13, 2019

BSMT – 1B

HISTORY OF COMMUNITY AND PUBLIC HEALTH

During the past 150 years, two factors have shaped the modern public health system: first, the growth
of scientific knowledge about sources and means of controlling disease; second, the growth of public
acceptance of disease control as both a possibility and a public responsibility. In earlier centuries, when
little was known about the causes of disease, society tended to regard illness with a degree of
resignation, and few public actions were taken. As understanding of sources of contagion and means of
controlling disease became more refined, more effective interventions against health threats were
developed. Public organizations and agencies were formed to employ newly discovered interventions
against health threats. As scientific knowledge grew, public authorities expanded to take on new tasks,
including sanitation, immunization, regulation, health education, and personal health care.

Eighteenth Century - isolation of the ill and quarantine of the exposed became common measures for
containing specified contagious diseases. Several American port cities adopted rules for trade
quarantine and isolation of the sick. In 1701 Massachusetts passed laws for isolation of smallpox
patients and for ship quarantine as needed. (After 1721, inoculation with material from smallpox scabs
was also accepted as an effective means of containing this disease once the threat of an epidemic was
declared.) By the end of the eighteenth century, several cities, including Boston, Philadelphia, New York,
and Baltimore, had established permanent councils to enforce quarantine and isolation rules. These
eighteenth-century initiatives reflected new ideas about both the cause and meaning of disease.
Diseases were seen less as natural effects of the human condition and more as potentially controllable
through public action. Also in the eighteenth century, cities began to establish voluntary general
hospitals for the physically ill and public institutions for the care of the mentally ill. Finally, physically and
mentally ill dependents were cared for by their neighbors in local communities. This practice was made
official in England with the adoption of the 1601 Poor Law and continued in the American colonies. By
the eighteenth century, several communities had reached a size that demanded more formal
arrangements for care of their ill than Poor Law practices. The first American voluntary hospitals were
established in Philadelphia in 1752 and in New York in 1771. The first public mental hospital was
established in Williamsburg, Virginia in 1773.

The Nineteenth Century: The Great Sanitary Awakening - The nineteenth century marked a great
advanced in public health. "The great sanitary awakening" the identification of filth as both a cause of
disease and a vehicle of transmission and the ensuing embrace of cleanliness was a central component
of nineteenth-century social reforms. Sanitation changed the way society thought about health. Illness
came to be seen as an indicator of poor social and environmental conditions, as well as poor moral and
spiritual conditions. Cleanliness was embraced as a path both to physical and moral health. Cleanliness,
piety, and isolation were seen to be compatible and mutually reinforcing measures to help the public
 resist disease. At the same time, mental institutions became oriented toward "moral treatment" and
cure. Sanitation also changed the way society thought about public responsibility for citizen's health.
Protecting health became a social responsibility. Disease control continued to focus on epidemics, but
the manner of controlling turned from quarantine and isolation of the individual to cleaning up and
improving the common environment. And disease control shifted from reacting to intermittent
outbreaks to continuing measures for prevention. With sanitation, public health became a societal goal
and protecting health became a public activity.

Early Twentieth Century: The Move toward Personal Care Further Development of State and Local
Health Agencies - In the early twentieth century, the role of the state and local public health
departments expanded greatly. Although disease control was based on bacteriology, it became
increasingly clear that individual persons were more often the source of disease transmission than
things. "The work of the laboratory led the Board to define the existence and character of an increasing
number of the most dangerous diseases and to provide medical means for their control." Identification
and treatment of individual cases of disease were the next natural steps. Massachusetts, Michigan, and
New York City began producing and dispensing antitoxins in the 1890s. Several states established
disease registries. In 1907, Massachusetts passed a law requiring reporting of individual cases of 16
different diseases. Required reporting implied an obligation to treat. For example, reporting of cancer
was later added to the list, and a cancer treatment program began in 1927.

It also became clear that providing immunizations and treating infectious diseases did not solve all
health problems. Despite remarkable success in lowering death rates from typhoid, diphtheria, and
other contagious diseases, considerable disability continued to exist in the population. There were still
numerous diseases, such as tuberculosis, for which infectious agents were not clearly identified. Draft
registration during World War I revealed that a substantial portion of the male population was either
physically or mentally unfit for combat. It also became clear that diseases, even those for which
treatment was available, still predominantly affected the urban poor. Registration and analysis of
disease showed that the highest rates of morbidity still occurred among children and the poor. On the
premise that a healthier society could be built through health care for individuals, health departments
expanded into clinical care and health education. In the early twentieth century, the New York and
Baltimore health departments began offering home visits by public health nurses. New York established
a campaign for education on tuberculosis. School health clinics were set up in Boston in 1894, New York
in 1903, Rhode Island in 1906, and many other cities in subsequent years. Numerous local health
agencies set up clinics to deal with tuberculosis and infant mortality. By 1915, there were more than 500
tuberculosis clinics and 538 baby clinics in America, predominantly run by city health departments.
These clinics concentrated on providing medical care and health education. As public agencies moved
into clinical care and education, the orientation of public health shifted from disease prevention to
promotion of overall health. Epidemiology provided a scientific justification for health programs that
had originated with social reforms. Public health once again became a task of promoting a healthy
society. In the twentieth century, this goal was to be achieved through scientific analysis of disease,
medical treatment of individuals, and education on healthy habits. In 1923, C. E. A. Winslow defined
public health as the science of not only preventing contagious disease, but also of "prolonging life, and
promoting physical health and efficiency."
Rosenkrantz, Barbara G. 1972. Public Health and the State. Harvard University Press, Cambridge, Mass.

Rosenkrantz, Barbara G. 1974. "Cart Before the Horse: Theory, Practice, and Professional Image in
American Public Health." Journal of History of Medicine and Allied Sciences 29:55–73. [PubMed]