Pennsylvania is often regarded in the historiography of public health, medicine, urban, and industrial history as little more than a disaster; her chief cities, Philadelphia and Pittsburgh, highlighted the health disparity between rich and poor, their tenements among the most degraded in the nation, their water poisonous, and their skies leaden. The plight of the state’s city dwellers were exceeded in misery and mortality rates only by the wretched conditions of the coal patches, small steel towns, and timber camps that dotted the Commonwealth. By the turn of the twentieth century enough political will was mustered to overcome objections to a state department of health. Benjamin Franklin Royer emerged from the public health apparatus of Philadelphia to assume a critical role in the department, eventually rising to its head and guiding the state through the influenza pandemic of 1918. In the early 1920s, after a titanic explosion leveled most of Halifax, Nova Scotia, Royer took the lessons he learned in the state and rebuilt Halifax, starting the first public health nursing program in Canada. Between 1926 and 1932 he was medical director of the National Society for the Prevention of Blindness where he led a campaign against bacteria-induced blindness in newborns and adolescents before returning to Pennsylvania to work on antiblindness and tuberculosis control efforts.