Medical America in the Nineteenth Century: Readings from the Literature

Introduction

INTRODUCTION The nineteenth century witnessed the birth of sanitary science, or public health, as a professional specialty. As with most medical developments at that time, the movement for sanitary reform began in Europe, particularly in England. In recent years, more historians have been attracted to the history of public health in America. Their work has clearly demonstrated the importance of social history for the medical historian. Books such as Charles Rosenberg's The Cholera Years have taken the level of analysis an important step beyond the older, less imaginative histories of laws, health departments, or biographies. Medicine must always be seen in terms of the society in which it functions; nowhere is this more vivid than in the history of public health. The early American sanitarians, most of whom lived in the large eastern cities where the sanitary problems were greatest, did much to improve their surroundings as well as the status of the medical profession. Their surveys and reports were widely read and reviewed, and in some cases led to civic action.1 One of the less well known, but important, American sanitarians was the New York physician John H. Griscom. His report on The Sanitary Conditions of the Laboring Population of New York, of 1845, was an attempt to "engage the attention of the magistracy" of his city to the problems of the public's health. He was obviously influenced and impressed by the work of Chadwick in England and Parent Du Chatelet in France, using the title of the former's report of 1842 for his own work. Beyond describing the stark conditions under which many of the citizens of New York had to live, Griscom also continued to work for an effective health department and for the establishment of a professional corps of health workers.2 A number of these reports have become classics and have been reprinted in whole or in part (see references to McCready, Griscom, Shattuck). The 1837 paper by McCready and the 1850 Shattuck report are unfortunately again out of print. Perhaps the best of all the sanitary surveys was that carried out in New York in 1864 and published by the Citizens' Association in the next year. It has never been reissued, but the section by Stephen Smith that follows is based on that report. Part of Griscom's report has recently been reprinted in Charles N. Glaab, The American City, A Documentary History (Homewood, 111.: Dorsey, 1963), pp. 117-28. See also Charles E. Rosenberg and Carroll S. Rosenberg, "Pietism and the origins of the American 253 254 HYGIENE Sanitary science, Griscom wrote in 1857, was a part of medical science yet distinguished by its special relation to society. Both medicine and sanitary science required a thorough knowledge of chemistry, pathology, and therapeutics : But for the sanitarian physician, superinduced, upon these, there is especially requisite a knowledge of forensic medicine, or the relations of the science of medicine to law; of meteorology, or the effects of climate and atmospheric influences on the body; of the physical character of dynamics of the atmosphere; of the philosophy and practice of ventilation; of various matters of a mechanical kind, bearing on sewerage, house building, street cleaning, and water supply; of statistics of life and mortality ; of the literature of epidemics, and of all sanitary improvements. And, lastly, to be a good sanitarian, requires the possession of sound logical faculties.3 From this catalog one can readily see the main problems with which the sanitarians concerned themselves. These problems of the public's health in nineteenth-century America existed in both rural and urban settings. The growth of the cities, however, by an influx of immigrants from the countryside and from abroad, led to more crises and greater sanitary evils. During times of epidemics, such as from cholera, typhus, or smallpox, it was the residents of the large city slums, or what we today somewhat more delicately refer to as the inner city, who were hardest hit. The findings of the surveys by Shattuck, Griscom, or the Citizens' Association in the mid-century years revealed many tenements so crowded as to make poor health conditions inevitable. More than one hundred years later many similar conditions remain. That so many urban problems are still with us, illustrates the difficulty of their solution. Technological developments have, of course, brought many health improvements , but, as with most progress, there goes paradox. The automobile, for instance, is a prime source of air pollution and cause of accidental death...