The Healthiest City: Milwaukee and the Politics of Health Reform

CHAPTER TWO- The City Health Department

CHAPTER TWO The City Health Department Milwaukee always made some provision for its sick poor. In the years before the establishment of the permanent board of health in 1867, the city supplied physicians to the almshouse or to the local hospital to care for poor city residents. In times of epidemics it created temporary boards of health to deal with emergencies, allocating money and authority to a group of physicians selected by the Milwaukee City Medical Association. Although health-related expenditures were not a major part of the city budget, Milwaukee assumed ultimate responsibility for those activities beyond the purview of private charity. Individual physicians and private hospitals provided some charity care. Milwaukee offered a wide range of healing services within the private sector. The majority of practitioners were regulars or allopaths, variously trained in the country's numerous medical schools or by apprenticeships. The quality of their training, and no doubt of their practices , ranged from excellent to extremely marginal, as did their economic success. In addition to its regularly trained physicians, Milwaukee boasted a large number of sectarian practitioners, who also represented diverse training experiences and quality. Most numerous among the sectarians were the homeopaths, followers of the German physician Samuel Hahnemann, who treated patients with infinitesimal drug doses. Fully one-third of Milwaukee's doctors were homeopaths during much of the late nineteenth cen42 Copyrighted Material THE CITY HEALTH DEPARTMENT tury. Hydropathic and eclectic doctors also practiced in Milwaukee. The differences among available kinds of medical care, while important to individuals, only rarely intruded into public health concerns, because both regular and sectarian physicians participated in health department activities in the nineteenth century. I The regular Milwaukee City Medical Association, formed in 1845, displayed a collective sense of public responsibility. Their first charter demanded members' vigilance "for the welfare of the community," urging them to "give counsel to the public ... [in] public hygiene" and to "face the danger" willingly if pestilence struck.2 Although these physicians individually recognized their duty to respond to health emergencies, as a group they responded only when the city paid for their services. The association agreed in 1848, for example, to send physicians to attend the "Almshouse, Pesthouse and wards of the city in every pauper care, and also furnish a board of health" for "the sum of six hundred dollars to be paid quarterly."3 In 1852 the fee rose to $700 per year.4 I Elizabeth Barnaby Keeney, Susan Eyrich Lederer, and Edmond P. Minihan, "Sectarians and Scientists: Alternatives to Orthodox Medicine," in Ronald L. Numbers and Judith Walzer Leavitt, eds., Wisconsin Medicine: Historical Perspectives (Madison: University of Wisconsin Press, 1981), pp. 47-74. See also Ronald L. Numbers, "Do-It-Yourself The Sectarian Way," in Medicine Without Doctors: Home Health Care in American History, ed. Guenter B. Risse, Ronald L. Numbers, and Judith Walzer Leavitt (New York: Science History Publications, 1977), pp. 49-72, and Martin Kaufman, Homeopathy in America: The Rise and Fall of a Medical Heresy (Baltimore: Johns Hopkins Press, 1971). 2 Constitution, By-Laws and Code of Ethics of the Milwaukee City Medical Association, 1847, p. 22. 3 MCMA Minutes, June 22,1848, p. 33. See also June IS,July 6,1848. Others have claimed that the MCMA provided a free board of health. See George A. Dundon, compo "Health Chronology of Milwaukee," unpublished typescript in the Milwaukee Health Department Library, 1848 entry; and G. Kasten Tallmadge, "Confutations I," Milwaukee Medical Times (November 1939), p. 49. The MCMA allocated jobs among its members either by louery or through bidding. MCMA minutes, July II, 43 Copyrighted Material THE CITY HEALTH DEPARTMENT The early boards of health created under these arrangements dealt only with epidemic emergencies. The city appointed its first boards during the smallpox epidemics of 1843 and 1846 and others during the cholera scares of 1848 to 1854.5 The boards located and isolated the sick, vaccinated (in smallpox epidemics) to protect the well, and provided treatment in isolation hospitals for those who could not be taken care of at home. From 1855 to 1866 the mayor and the common council constituted the board of health, but they rarely, if ever, met in that capacity.6 Although Milwaukee survived these sporadic attempts to control the ravages of infectious diseases, many physicians and business people realized that failure to adopt a more comprehensive policy hampered city growth. They realized , too, through lessons in sanitation and...