American Urban History

¶ … 1820-1855" at first glance would seem to be wide sweeping review of public health history within the United States. However, the title itself is a bit misleading, for the contents reveal it to be more limited and specific in nature. However, as a text on the historiography of American public health it is an exemplary expansion and welcome addition to the field. The work is a collection of four essays selected by the editors to discuss the rise of institutions of public health throughout the early to mid 1800s. Charles Rosenberg, the chief editor of this book is the Ernst Monrad Professor of the Social Sciences in the Department of the History of Science at Harvard University. He is one of the most pre-eminent science historians of the past fifty years and he carefully chose the works selected within this text. The essays are selected based on an examination of public health in three different cities. David Hosack writes on New York in 1820 and the rise of public health within America's most populace city. John H. Griscom also presents a study on New York City and the expansion of public health organizations. Bennet Dowler's essay focuses on New Orleans in 1850. While Henry G. Clark's focus is on Boston in 1852. Each of these authors is prestigious in their field of historiography and they bring a litany of perspectives on the multiplicity of urban health problems during that particular era.

All of these texts are secondary sources since they are research conducted by different authors on the subject of public health in America during the 1800s. However, each other use primary sources within their work to justify their conclusions and to provide a focused and contextual analysis and rhetoric. The central purpose of these four bodies of work taken together is to show that there was not only a multitude of health problems within urban areas, but that there was a diversity of medical and social opinions about how to go about solving these problems. The control measures open to health officials during this period were ultimately the context upon which public health expanded.

The actual purpose of this historical approach is not to assess the actual origins of public health, but the beginnings of effective permanent public health organizations in the mid nineteenth century United States. The primary argument of all of these authors focuses on the vast amount of disease and sanitary measures in the three cities of New York, Boston and New Orleans. During this time period, when sanitation measures were scarce and business control was almost non-existent there were many problems with diseases. Most of these diseases were in fact preventable, but the lack of sanitation standards prohibited an effective mechanism for health officials to deal with this crisis. Hosack and Griscom noted that this problem was especially evident in New York, since the explosion of immigration from Europe led to no need for the majority of factories and "ethnic ghettos" from instituting strong sanitation measures. The demand for healthy and clean workplaces were non-existent and as a result, communicable diseases such cholera, hay fever, and other viral infections wrecked havoc upon the city (pg. 32). The authors here make the successful argument that public health organizations at its outset were ineffective not because they lacked the knowledge necessary to remedy such situations, but that the social institutions of the times prevented them from carrying out massive reform.

However, these authors did emphasize their next major point that the problems of disease and general ill-health resulted in discussion of both medical and social opinions on how to solve these problems. Dowler's account of Bostonian health debate explains that the beginning of unified public health organizations began because there were so many conflicting opinions on how to solve emerging medical crisis of the city. They are success and persuasive in their argumentation because they cite primary sources on the many conflicting opinions from differing sectors of society. Not only did doctors have an opinion on how to cure diseases, but politicians also interjected their opinions on the social issues that need to be resolved in order to prevent disease and promote public health (pg. 68). The strength the authors' rhetoric in these discussions is that they do not "tell" but "show" us the confusion of public health officials during this era through the direct analysis of many primary source materials.

The final argument of this book is that the beginnings of public health organizations was the result of having many different control measures open to health officials but no unifying body to control and implement them. The need for centralization even within cities was clear during this era, because while control mechanisms on a city wide level were in place, such as prohibition of dumping of chemicals in drinking water, or the overuse of certain products in foods, there was no governing body to administer these changes (pg. 28). Ultimately the creation of public health organizations was the organic outgrowth of prohibitive efforts and control measures (pg. 71).

The reason that this particular book is very respected and popular within the field of medical historiography is the ability to provide differing demographic perspectives on the same issues of public health. During the early to mid 1800s, the United States did not have a centralized governing public health body and as a result, the only way to provide a holistic understanding of how public health organizations began is to look not at one particular organization or region, but the vast growth of urban social systems to promote public health. The essence of this book is to provide a comprehensive understanding of how the social, political, economic and medical conditions of this particular era contributed to the growth of governmental and centralized responses to the growing crisis of disease control.