In lieu of an abstract, here is a brief excerpt of the content:

Chapter 2 The Nineteenth Century: From Miasmas to Microbes P UBLIC HEALTH as an enterprise distinct from curative medicine is a product of the nineteenth century, as are—not coincidentally— nation-states and social movements as we know them today. Through complex and mutually reinforcing processes, industrial and geographic expansion created increased and novel demands on governments , greatly enlarging the reach and capacity first of European and much later of North American states, and offered new opportunities and targets for citizen organization and protest. Confronted with the palpable costs of urbanization—masses huddled together in conditions of appalling brutality—and persuaded not only of the relation between misery and disease but also of the threat this relation posed to public order and the public purse, state and (elite) citizenry became interested in public health. Public health was nonetheless controversial. The principal axes of controversy—the limits of intervention by the state in private property and private affairs, the extent to which individuals bring their misery on themselves, where to draw the line between those who are deserving and undeserving of private or state care—have changed very little between the nineteenth century and the twenty-first. My story begins with a brief account of the social and economic context within which public health was first identified as a significant public problem. Revolution, War, and Social Change In the United States, France, Britain, and Canada, the broad parameters of change were much the same: urbanization and industrialization; the large-scale movement of populations from country to town and, in North America, from overseas and across the continent; wars, civil or colonial; and the fear of revolution if not its reality. The pace of change was nonetheless quite different across the four countries, and each country’s 25 experience of and response to these changes were shaped by unique historical circumstances. Industrialization was relatively slow in Britain and even slower in France, the two countries with the earliest start. It was comparatively rapid in the United States, however, and very rapid in Canada, the country that started last. Whereas the process occupied Britain and France during most of the nineteenth century, the United States was transformed from an agricultural to an urban-industrial society in the five decades that followed the end of the Civil War and Reconstruction. The same process was completed in Canada in less than half the time. Industrialization was accompanied by population growth, notably in the United States: by 1900 the U.S. population had grown from the smallest of the (three recorded) populations at the beginning of the century to one and a half times that of Britain or France. The French population, at the other extreme, increased in the same period by less than half. Of perhaps even greater impact than industrialization or population growth on turn-of-the-century society, politics, and—in particular—the politics of public health, was urbanization, a process that took place under different circumstances and assumed quite different forms in each of the four countries. Presenting “a dramatic contrast with the past and with any other economy” (Matthew 1984, 520), Britain by the middle of the nineteenth century had more people living in towns than in the country. Rapid urban growth far outpaced the availability of housing, and the results were, by all accounts, extremes of overcrowding in conditions of Dickensian squalor (Flinn 1965; Rosen 1993). Urbanization proceeded more slowly in France. Throughout the nineteenth and well into the twentieth century it retained “one of the largest rural populations among the industrialized states” (Stone 1985, 12). The human toll of urbanization and its impact on contemporary observers—largely concentrated in Paris—was nevertheless much the same: “Public health in the early nineteenth century was largely a matter of the sanitary state of [urban] working class dwellings” (Flinn 1965, 3). The urban populations of Britain and France came from their respective countrysides. In sharp contrast, the urban populations of the United States and Canada were drawn primarily from overseas. Between 1890 and 1910, close to 13 million immigrants entered the United States, amounting to 21 percent of its population in 1890. Canada during the same period received approximately 2 million immigrants, a much smaller number but fully 43 percent of its 1890 population. The bulk of these immigrants settled in cities. By 1900, “60 percent of those who lived in [America’s] twelve largest cities were first- or second-generation immigrants, 40 percent came from the nation’s smaller...

Share