1. Medicine and the public’s health: from cleanliness to antisepsis in cities, hospitals, and homes
HI31L
Lecture 9

2. What Makes the Public Healthy?

3. Sanitarian Public Health: Profit or Loss?

4. Governmental Involvement
1890 Quarantine Act
PHS (from Marine Hospital Service) so constituted in 1902, so named in 1912
FDA 1880s, agricultural chemistry dept starts looking into adulteration of foods;
FDA 1890s expands to meat under pressure from muckrackers like Upton Sinclair [The Jungle];
FDA c first Food and Drug laws passed (but lots of loopholes)
1900 US District Court rules in favour of Chinese Six Companies that San Francisco quarantine was ‘arbitrary and racially discriminatory’
1907 Federal law allowing doctors essentially to decide to exclude immigrants on grounds of health (as likely to become burden on the state) NOTE that doctors resisted taking up this task

5. Hospitals?
Hospital in New York City, circa 1870

6. Hospitals before the germ
In 1873, 178 hospitals in entire USA;
Hospital patients drawn almost entirely from dependent poor;
Physicians were generally unpaid, and served for status, as a moral duty, and for access to ‘clinical material’;
Some linked with medical schools, but many simply private (‘voluntary’) or municipal charities;
Other locations for care: home; public/charitable dispensaries; drug stores; doctors’ offices; asylums; workplaces; isolation wards; sanitaria
No earned income = no complex accounting or record keeping.

7. Hospitals (before the germ…)
New York City Hospital, 1871: patient care, patient carers

8. “If we can make our hospitals sufficiently attractive to induce patients to remain during convalescence, to come in for diagnosis instead of going to hotels and visiting the doctor at his office, and to come in for treatment of more or less chronic forms of disease, we will not only increase the number of possible patrons, but the prolonged stay will mean added work and further, the average profit per patient will increase.”
Hospital Superintendent to American Hospital Association convention in 1908.

9. Medicine tools up By 1923, 6380 hospitals (increase of 3700%)
Driving forces: industrialisation (via industrial accidents) and urbanisation; ‘gospel of hygiene’; rise of surgery; specialism; ‘medical science’; prosperity; commodification
Key features: private wards, new tech, ‘efficiency’, ‘scientific management’; standardisation;

10. The Socialism of the Microbe

11. The Socialism of the Microbe

12. Public Health, Women’s Work

13. Germ Theory Public Health: Who was responsible for heath
Germ Theory Public Health: Who was responsible for heath? Who could profit from sickness?

14. Germ Theory, Food Hygiene, and the ‘Laws of Health’

15. Crusading for Health

16. Children as vectors, victims

17. Readings: terms and concepts
Perfect Motherhood
‘republican motherhood’
The Maternal Physician
The American Woman’s Home
The Bitter Cry of Children
‘scientific motherhood’
“profession of motherhood”
Milk stations
‘Little Mothers’
Children’s Bureau
Watsonian Behaviorism
‘Spock Generation’
Ourselves and Our Children
Tyler Walrond
The Gospel of Germs
Progressivism
PHS
“an impregnable chain of defenses”
“House disease”
“filth diseases”
Zymotic theory
“chain of disease”
“socialism of the microbe”
“health crusaders”
National Tuberculosis Association
“laws of health”
Charles Chapin
Chick Gin

18. Questions
‘Who is responsible for health and disease: the individual, the group, or the State?’ How would this question be answered differently by Sanitarians and Germ theorists. Under which theory would you prefer to live as a middle class white? An immigrant? An African-American? A woman?
Who/what did ‘germ theory’ affect most directly, how, and why? What were the competing interests operating on the planning of public health measures? What was surprising about medical claims to authority – and what made them compelling? How were individuals, families and communities recruited to the cause of hygiene?