The 1870's became the decade for urban public health reform as Congress made the move to reorganize the Marine Hospital Service. It was also at that time the Surgeon General position was created and still exists today.

The Surgeon General was charged with overseeing public health issues and providing advice, guidelines and mandates as to how they would be best handled.

During the 1880's the movement toward public health moved away from the political arena and into the laboratories around the nation.

It was at this time scientists began to learn how to isolate disease producing organisms for communicable diseases.

This was a major breakthrough especially for the major cities in the nation as they began to understand how the diseases were being spread and they knew the answer in part was to provide public education, and fresh water systems and waste disposal services to try and reduce the ability for diseases to spread.

With the growing acceptance of the germ theory of disease causation in the 1890's and the emergence of the diagnostic laboratories as the focal point of public health activities, the American public health movement underwent several major changes. The main emphasis, which during much of the 19th century had been on cleaning up the environment, now shifted to direct control of communicable diseases (Erlen, (http://www.publichealth.pitt.edu/supercourse/SupercoursePPT/20011-21001/20181.ppt)."

New York City

By the late 19th century New York City had one of the highest mortality rates in the nation due to poor sanitation citywide.

Members of the New York Sanitary Association were convinced that the diseases that contributed to this high rate were primarily due to the absence of proper sanitary practices and could be prevented. Sanitarians wanted to improve public health law and educate the populace about proper hygiene (Apostles of cleanliness (http://pubs.acs.org/subscribe/journals/mdd/v05/i05/html/05ttl.html)."

In 1864 New York undertook a large survey project in which the city tried to ascertain the exact living conditions for most residents. When the survey came in from the inspectors the city found that its residents were living in substandard conditions that promoted squalor and filth.

Public and shared restrooms were overflowing with human fecal matter. The city streets were covered in filthy slime created by horse manure and local slaughterhouses were dumping their blood and carcasses into tenement properties and leaving them there to rot (Apostles of cleanliness (http://pubs.acs.org/subscribe/journals/mdd/v05/i05/html/05ttl.html).

In addition the blood and animal gut liquids were being washed into the river that was being used as drinking and bathing water by many city residents.

It was common knowledge that youngsters could earn nickels by standing along Broadway and sweeping a path through the muck for those who wanted to cross the wretched boulevard (Apostles of cleanliness (http://pubs.acs.org/subscribe/journals/mdd/v05/i05/html/05ttl.html)."

New York officials were appalled at what the survey results indicated and set to work immediately to develop a comprehensive sanitation program to remove and dispose of waste. In addition the city provided representation on the American Public Health Association Board.

Chicago

The city of Chicago was dealing with its own public health issues following the end of the Civil War. It had problems with widespread disease because of its random and haphazard waste disposal program. Because no major city in the nation had implemented a sewage system at that time representatives from Chicago made the trip to Europe to examine and educate themselves about such systems and brought their knowledge back to the city to develop.

The sewage project transformed the look of the city itself as streets were raised, buildings torn down, and vacant lots filled (Apostles of cleanliness (http://pubs.acs.org/subscribe/journals/mdd/v05/i05/html/05ttl.html).Chesbrough's innovations decreased epidemics and greatly improved public health, although he and his peers still worked within the miasmic paradigm of disease (Apostles of cleanliness (http://pubs.acs.org/subscribe/journals/mdd/v05/i05/html/05ttl.html)."

Newark

One of the most pressing problems in public health at this time was water supply. Metropolitan areas were not providing water services that would be acceptable by even the most relaxed standards today.

Drinking water supplies were not being sanitized and in many cases were being drawn from the same water that human waste and raw sewage was being...

DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm).Cities were degenerating into unhealthy places putting their residents at risk. For modern cities to survive, they had to implement large public works programs to improve and safeguard public health (U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm).Sewer systems, also called the "invisible city," perceptibly altered the shape of the city, allowing it to expand into its modern form (U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm)."
Newark tackled the problem by first promoting the construction and use of makeshift restrooms and then implementing a waste disposal system. The next thing the city did was take advantage of the fact that is geographically situated between two bodies of water.

Unfortunately resident privies were often placed in the backyards and their run off would enter the water supplies (U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm).

Newark realized how important it was to supply fresh water to its residents and became one of the first large cities in the nation to employ workers who would go through yards in the middle of the night and clean out the outhouses so that there would be no run off or overflow to get into the water supply.

Unfortunately as the city's population continued to explode the problems once again got out of hand and it was not long before waterways were being contaminated by animal carcasses left in streets, and human waste products being openly dumped into the same rivers that residents drank from.

From a public health standpoint this created very unsanitary living conditions under which disease thrived.

To answer the call to action Newark became one of the first U.S. cities to implement a sewer system (U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm).

In addition to man-made sewers, the extant streams that once flowed through the city were used as sewer receptacles but were gradually covered over to contain offensive odors (U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm).Of these vanished streams, Mill Brook or First River was the largest and most important. Mill Brook was formed by the junction of two smaller brooks near what is now the southern end of Branch Brook Park (U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm).By 1863 Mill Brook, as a watercourse, had outlived its usefulness and began to disappear as new streets were laid out above it, until by 1890 the last piece was covered to from the approach to the Clay Street Bridge. Mill Brook still flows today, but it is contained within a twin-tubed sewer, each 6 feet 9 inches high and 9 1/4 feet wide (U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm)."

The Board of Trade created a special committee for sanitation concerns that was aimed at improving Newark's sanitation crisis. The committee also addressed the pollution problem as members believed the two elements worked hand in hand to create poor public health statistics.

At the time the committee undertook the issue the city had the highest mortality rate in the nation with 27 out of every 1,000 people dying (U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm).

It was between 1894 and 1910 that the city doubled its sewer system size to try to deal with the disposal of waste issue, unfortunately all of the sewage from the sewer system still dumped into the Passaic River, which was used as a main drinking and bathing water supply for the city residents (U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm).

By 1919 Newark had sewered over 95%of its improved area, and its mortality rate had dropped nearly 60%(U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm)."

The river pollution continued to cause sickness and disease throughout the city so in 1895 the city held a meeting to discuss remedies. The Newark Board of Trade pressured the area residents and communities to restructure their sewer system to dump into New York Bay, which in turn took the waste out to the ocean.

All told the project took until shortly before World War II to complete but once it was done it provided not only a state of the art modern sewer system but also a clean water supply (U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE Public (http://www.ci.newark.nj.us/Water/sewerhistory.htm).

Seattle

History of Public Health's Water Safety program (http://www.metrokc.gov/health/about/history/water.htm)

With all of the urban developments and research with regard to public health and the importance of fresh water supplies and waste disposal the 1900's saw significant changes in attitude about such matters.

In Seattle, for example, the city implemented something called a Chlorine Boat. It was a boat that traveled on Green Lake and deposited gallons of chlorine into the water in effort to purify the water supply to that area.

At that time the Seattle Health Department and Water Department worked in tandem to try and provide the purest water supply possible in the interest of public health.

For many years before…