Title: American Public Health
1American Public Health
2Credits
Unless stated otherwise, images and tables on
school-health issues in New York are from William
H. Allen, Civics and Health (Boston, 1909), an
important survey of the public health movement in
American cities
3Water, Sewage, and Roads
The basic concerns of early community government
were to provide the necessary survival services
water, sewage removal, etc.
Well in Jamestown colony, dug, ca. 1620.
4Roads, animals and humans
As had been the custom in Europe, early American
cities built wood or stone sidewalks to separate
walking traffic from vehicle traffic, not only to
prevent accidents but to reduce the spread of
illness from animal waste.
5Tax Dollars at Work
As cities grew, so too did the size of services
needed to maintain the community. Sewage removal
called for large-scale construction of sewers
Nashville Tennessee undertook a major project to
build these conduits in 1900.
www.sewerhistory.org
6As city population grew, sewage had to be
upgraded in order to stem the spread of disease
in densely populated neighborhoods. Philadelphia
spent millions in 1900 to upgrade its sewage
system.
www.sewerhistory.org
7Industrial Environment
Industries and employers denied for decades that
their factories had any connection to the
increase in lung ailments in urban areas. It
took medical research to prove the connection.
8Basic Services and Growth
1916 -- A series of very heavy rain storms, in
conjunction with the alleged rainmaking
activities of Charles Hatfield, hit the county.
The San Diego River floods Mission Valley from
cliff to cliff cutting all highways to the north.
Lower Otay Dam, built without a spillway, tops
out and bursts, flooding the Otay Valley with
loss of life and property. 1918 -- Lower Otay
Dam, now renamed Savage Dam, reconstruction
completed. Lake Hodges Dam and San Dieguito Dam
completed by the Santa Fe Land Improvement Co.
Both were later purchased by the City. 1922 --
City forces complete Barrett Dam and the Dulzura
Conduit built to link Morena Reservoir and the
Cottonwood Creek/Pine Creek watersheds with the
City's water supply system at Lower Otay.1923
-- City of East San Diego consolidated annexed
into the City of San Diego.1928 -- Construction
of what is now Sutherland Dam is halted after
only one year of construction. The Metropolitan
Water District of Southern California (MWD) is
formed to bring Colorado River Water to Southern
California. San Diego was not a member.1930 --
The U.S. Supreme Court determines the City of San
Diego has prior and paramount rights to the water
of the San Diego River.1931 -- Current San
Diego City Charter adopted formalizing the
Council-Manager form of government.1935 -- With
water rights secured, the City completes
construction of El Capitan Dam and the El Capitan
Pipeline connecting it to the City's water supply
system. University Heights Filtration Plant
enlarged.1936 -- The City decommissions water
well fields operated in Mission Valley.1943 --
San Vicente Dam and pipeline are dedicated
following two years of construction. This
provides another source of water for San Diego's
booming wartime population. The U.S. Navy
completes the City's first sewerage treatment
plant to reduce the health risks to sailors on
ships in San Diego Bay.
CITY OF SAN DIEGOWater Service History 1850 --
California becomes a state and the City of San
Diego is incorporated.1852 -- City declared
insolvent. Management oversight by the state
instituted.1873 -- San Diego Water Company
formed to provide an organized water supply to
serve a population of approximately 2,000. Water
is .25 per bucket. An army private soldier makes
13.00 per month. 1885 -- Sewer service begins
along the lower portion of 5th and 6th Avenues
with the raw effluent discharged directly into
San Diego Bay.1887 -- Old Town Reservoir built
to store water from 12 wells located in the San
Diego River bed adjacent to the old
Presidio.1889 -- The San Diego Flume Company
completes a 35.6 mile wooden flume to carry water
from Boulder Creek to La Mesa Reservoir (the duck
pond at Grossmont Summit).1897 -- Lower Otay
Dam completed by what becomes the Southern
California Mountain Water Company. Construction
of Morena Dam begun. Work is soon suspended.
1901 -- Following a vote of the people, the
City of San Diego enters into the municipal water
supply business by purchasing the facilities of
the San Diego Water Company.1906 -- The Lower
Otay water supply is connected to the City's
distribution system by the Bonita Pipeline to a
filtration plant located at Chollas Heights
Reservoir.1912 -- The City purchases the Otay
River-Cottonwood Creek system from the Southern
California Mountain Water Company. Morena Dam
completed. The City of East San Diego
incorporated.1914 -- The City purchases Morena
Dam.
SOURCE Researched and written by Phil Abbey
1996. Revised and uploaded 14 March 2005.
9Population Density -- Pneumonia
Table IX Death Rate per 10,000 Population,
Pneumonia and BronchitisFive-Year Period,
1896-1900
10Illness and public cost
Note value is based on span of years -- 1500
value to community for each child from birth to
age 5, etc. Figures are based on 1905
calculations.
11Theories of Disease
- 3 Prevailing theories of how disease spread
- Miasma (before Pasteur) filth spread disease,
so solution was sanitation to remove garbage,
contaminated water, etc. with well designed sewer
systems. Engineering predominates. - Contagion (Pasteur, Lister, etc.) bacteria
spread disease solutions are medical and social
(especially by quarantine). Doctors and
bureaucrats predominate. - Limited contagion both miasma and contagion are
causes, so a comprehensive program supports
medical and sanitary actions. Government
predominates.
12Infectious Diseases
Cases of Infectious and Contagious Diseases
Reported
For NYC schools, 1908
13Man-made Dangers
Patent medicines flourished in urban America and
were purchased in quantities among the poor
(especially immigrants) who could not afford to
see doctors. Late 1800s newspapers ran constant
stories about the dangers of patent medicines.
14Public Health Campaigns
Early public health campaigns were largely
voluntary efforts, often connected to
reform-minded political campaigns that linked
poverty to political corruption to wages and
health. City governments only became involved
once the social dangers threatened public
safety.
15Labor Violence
1877 a series of very violent strikes in the
railroads raised fears that disruptions of
industrial production would to national economic
ruin and perhaps also spark social revolutions.
The writings of Karl Marx were frequently quoted
in labor newspapers.
16Revolution?
The killing of several policemen in Chicago,
1886, led to calls for improving the lot of the
poor to prevent widespread bloodshed.
17Political Reformers
Political Reformers like John P. Altgeld,
Governor of Illinois (1893-97) made alliances
with voluntary reform leaders (Jane Addams, etc.)
to improve labor wages, urban housing, education,
etc. Such reformers seldom argued that this was
the right thing to do. Instead they said this
would preserve order.
18Re-designing the city
Chart from Natl. Conference of City Planning,
1911 using engineers and other experts, cities
around the world redesigned their public and
private spaces.
19Sidewalks
As streets became the domain of the motor
vehicle, the widths of streets grew (1st column)
and the size of bulding lots declined (2nd
column)
20New York Leads the Way
As secretary of the NYC Charity Organization
Society, Edward T. Devine supervised studies of
housing, health, and poverty. Although he spent
most of his life in charge of voluntary efforts
that would today be termed social work, he was
convinced that only government-assisted reforms
could produce true social justice and prevent
class warfare.
21Government and Health
NYC government (dominated by the Democratic
Party, centered at the Tammany Hall lodge, in
existence since the 1789) embraced public
health reforms that were connected to children
and education. One of the first was to reduce
the spread of lung- and throat-illnesses among
children. Reformers had long before noted that
poor children had the characteristic swollen
faces of adenoid troubles, untreated throat
infections, etc. Infections killed hundreds each
year.
22Trash
Collection of garbage in NYC was usually handled
by private contract before the 1890s. Crews paid
by the private contractor used pigs to remove
garbage (edibles), collected trash and refuse
(old clothes, paper etc.) and hauled it in scows
to dump in the ocean or in dumps placed in the
poorer sections of the city.
23Tuberculosis White Plague
Schools mounted enormous campaigns to educate
students and their families about the dangers of
tuberculosis. Until the antibiotic streptomycin
was developed during World War II, there was no
effective way to combat the disease. Preventing
its spread was the only way to limit the deaths.
In the 1980s, drug resistant forms of TB began to
appear in Asia.
24Mouth Breathers
A term later used as an insult in regard to low
mental capacity, it originally denoted poor
children with serious nasal and sinus problems.
NYC added funding to education for school
nurses who could identify the problems and
arrange treatments.
25School-Private Alliances
School medical personnel would advise parents of
potential health risks and refer them to private
organization for treatment.
26NYC Grants in Aid
The next logical step was for NYC to provide
direct financial assistance to some
organizations, like this free dental clinic run
by the Childrens Aid Society. Sometime city
were given to private societies as donations from
Tammany leaders (off the books).
27Vision
William Allen believed that eye strain
contributed to lack of concentration and called
for better lighting, etc.
28Expanding School Facilities
Urban schools had no such thing as playgrounds
or gymnasiums so schools developed some rather
make-shift exercise programs.
29Playgrounds
After voluntary charity associations collected
information to show that illness (and crime)
rates fell in areas that had playgrounds, the NYC
government spent money on such facilities in the
city schools.
30Copy-cat Cities
Detroit, Philadelphia, and other cities copies
NYC ideas (the South failed to follow suit for
decades for due to racial and tax issues). By
the 1950s, when schools handled the polio
vaccinations, few questioned the role of
government in school health issues.
31City Services
Technology made cities (and eventually rural
America) more comfortable. Electricity made
homes and businesses more comfortable and
productive. But government again took a hand in
regulating the safety and cost issues.
32Food Inspection
33Growth of Government
By 1910 NYC employed hundreds of employees to
inspect the wares of Push-cart vendors, stores
selling milk, restaurants, and hundreds of other
health related businesses. Before civil service
offices, many of these jobs were part time and
political rewards, tied to getting out the vote
at elections.
34Controversy -- Sexual Hygiene
Questions for teachers in a 1907 study by the NYC
Society for Sanitary and Moral Prophylaxis,
"Instruction in the Physiology and Hygiene of
Sex." 1. Do you wish a pamphlet on sex subjects
to hand to your pupils? Why? 2. Do you wish
separate pamphlets for boys and girls? 3. For
what age limits and social conditions do you wish
them? 4. What topics do you wish the pamphlets
for boys to "handle"? 5. What topic do you wish
the pamphlet for girls to "handle"? 6. If you
think one pamphlet sufficient for both sexes,
what should it consider? 7. How far do you go in
teaching sexual hygiene or reproduction? By what
method? 8. What special difficulties do you find
in teaching it? 9. What special need of teaching
it have you found? 10. What special benefits (or
otherwise) have you noticed from teaching it? 11.
What criticisms (favorable or otherwise) do you
encounter?
35Birth Control
Early efforts to teach birth control by
Margaret Sanger and others -- were efforts that
city and state governments generally kept at
arms length too controversial to defend to the
voters.
The mother in this photo was 31 year's old when
the photo was taken.
36The Public-Private Alliance
Additional government regulation followed the
pattern set by schools. Fire escapes were
mandated due to fire disasters, factory safety
measures in response to deaths in accidents,
etc. Since all this was occurring at the same
time that social work was becoming a profession,
it was natural for many professional social
workers to favor a public-private alliance for
helping those in need.