This is a timeline to illustrate major events in the history of public health. We will refer to it in class and I encourage you to look back at it as we continue to explore the public health system in subsequent sessions.;xNLx;;xNLx;There are four categories in this timeline - (1) American PH History (green), (2) Environmental Health History (blue), (3) Ethical Health History (orange), and (4) European PH History (purple). You may explore the timeline as 2d or 3d by clicking on the tab located on the left bottom corner.;xNLx;;xNLx;This timeline was created for the Georgia State University School of Public Health PH7010 - Foundations of Public Health course.
Starting in 1347 and ending in the late 1700s, Europe experienced multiple waves of bubonic plague epidemics. It is believed that the bubonic plague originated in Asia and traveled along trade routes to the Black Sea and then to the Mediterranean Sea. From there, it swept through Sicily and Italy and then up through France and the northern European countries all the way to Scandinavia. There were many subsequent waves of plague that swept through Europe until the late 1700s. The map to the left shows the spread of plague over a three year period from Asia across the Black Sea and through Europe.
The cause of the plague was not known, but there were many theories. The most popular explanation was that it was caused by "miasmas," invisible vapors that emanated from swamps or cesspools and floated around in the air, where they could be inhaled. Others thought it was spread by person to person contact, or perhaps by too much sun exposure, or by intentional poisoning. The miasma theory was the most popular, however. One of the popes kept large fires burning at both ends of the room he worked in to counteract the miasmas. The illustration on the left shows a "plague doctor," who is covered from head to toe, including a hood, a mask, gloves, and a beak-like sack on his nose. The covering on the nose contained aromatic herbs, which were believed to neutralize miasmas. There were also crude medicines that were concocted to prevent or cure the bubonic plague; one of them was known as theriac. Of course, smoke, aromatic herbs, and theriac were ineffective, because the plague was primarily spread by flea bites (although sometimes victims developed a plague pneumonia that caused them to cough up a bloody, plague-filled aerosol that could be transmitted to others by inhalation; this was the 'pneumonic' form of the plague). The image to the left shows a "plague doctor" wearing clothing intended to protect him from miasmas.
Western Settlement in Greenland abandoned, possibly due to the deteriorating climate caused by the onset of the Little Ice Age
Girolamo Fracastoro was an Italian physician, poet, astronomer, and geologist who wrote about “disease seeds” carried by wind or direct contact. In essence, he was proposing the germ theory of disease more than 300 years before its formal articulation by Louis Pasteur and Robert Koch. In 1546, Fracastoro outlined his concept of epidemic diseases in "De contagione et contagiosis morbis" and speculated that each disease was caused by a different type of rapidly multiplying 'seed' and that these could be transmitted by direct contact, through the air, or by contaminated clothing and linens. Similar speculation had been mentioned as a possible cause of disease by the Roman scholar Marcus Varro in the 1st century BC.
Huaynaputina erupts in South America. The explosion had effects on climate around the Northern Hemisphere (Southern hemispheric records are less complete), where 1601 was the coldest year in six centuries, leading to a famine in Russia
Beginning around 1592 parish clerks in London began recording deaths. In 1662 John Graunt, a founding member of the Royal Society of London, summarized the data from these "Bills of Mortality" in a publication entitled "Natural and Political Observations Mentioned in a Following Index, and Made Upon the Bills of Mortality." Graunt analyzed the data extensively and made a number of observations regarding common causes of death, higher death rates in men, seasonal variation in death rates, and the fact that some diseases had relatively constant death rates, while others varied considerably. Graunt also estimated population size and rates of population growth, and he was the first to construct a "life table" in order to address the issue of survival from the time of birth.
Hooke published "Micrographia" in 1665 after devising a compound microscope and using it to examine the structure of insects, feathers, and plants on a microscopic level. In fact, it was Hooke who discovered plant cells and coined the term "cells."
Anton van Leeuwenhoek of Holland was "the father of microscopy." He began as an apprentice in a dry goods store where magnifying glasses were used to inspect the quality of cloth. Van Leeuwenhoek was fascinated by them and experimented with new methods for grinding and polishing more powerful lenses. He was able to achieve magnifications up to 270x diameters. He used these to create the first useful microscopes. Using his inventions, he was the first to see bacteria (in 1674), yeast, protozoa, sperm cells, and red blood cells.
The Enlightenment was a period that saw an embrace of democracy, citizenship, reason, rationality, and the social value of intelligence and new information. These ideas provided important underpinnings for public health. In the early 1800s Jeremy Bentham (pictured on the left) and his disciples (the “theoretical radicals”) developed the philosophy of utilitarianism, which provided a theoretic underpinning for health policy and wider social policies. One theme was that the reduction of mortality and improvements in health provided economic to society because healthy workers were able to contribute more to the economy of the state. Implicit in utilitarianism was the notion that one could measure 'evil' by the degree of misery that was created or (relieved) by a particular action. To Bentham the welfare of both the wealthy and the poor could be achieved most efficiently with good government.
John Pringle was a Scot who served as physician general to the British forces during the War of the Austrian Succession (1740–48). In London he became physician to the Duke of Cumberland and to King George III. Pringle published "Observations on the Diseases of the Army" in 1752, in which he proposed a number of measures aimed at improving the health of soldiers, including improvements in hospital ventilation and camp sanitation, proper drainage, adequate latrines, and the avoidance of marshes. He wrote extensively on the importance of hygiene to prevent typhus or "jail fever," which was a common malady among soldiers and prisoners. Pringle incorrectly believed that typhus was caused by filth. In fact, it is caused by a small bacterium (a rickettsia). Lice are vectors for the disease; when infected lice defecate on the skin of lice-infested soldiers or prisoners, the bacteria can gain entry through small scratches or abrasions in the skin. The bacteria then multiply and cause a severe febrile illness which is often fatal if not treated. Pringle also coined the term 'influenza'.
The Industrial Revolution brought an explosion of development. There were new jobs (particularly in the cities), new goods, and increased trade. However, it also brought new problems to Europe. Further expansion of the population and mass migration caused explosive growth of cities, where poor workers were often housed in cramped, grossly inadequate quarters. Working conditions were difficult and exposed employees to many risks and dangers, including cramped work areas with poor ventilation, trauma from machinery, toxic exposures to heavy metals, dust, and solvents. Consequently, progress brought a new set of health problems to Europe and America.
The Industrial Revolution turns to use of coal and other fossil fuels to drive steam engines and other devices. Anthropogenic carbon pollution presumably increases.
Scurvy is caused by a deficiency in vitamin C, which leads to weak connective tissue and abnormally fragile capillaries that rupture easily, causing bleeding, anemia, edema, jaundice, heart failure, and death. Scurvy was a huge problem in sailors several centuries ago because of the lack of fresh fruit and vegetables during long sea voyages. James Lind, a Scottish naval surgeon, suspected that citrus fruits could prevent it based on some anecdotal observations. In 1754 Lind conducted what may be the world's first controlled clinical trial on 12 sailors with scurvy. Lind divided the 12 sailors into pairs, giving each group a different treatment (sea water, various other concoctions, and lemons and oranges). The two who received lemons and organs were cured, and the others were not. Lind concluded that his hypothesis was correct, reported his findings, and recommended that sailors receive a ration of lime or lemon juice. Unfortunately, 50 years passed before the British navy acted on Lind's recommendations and began to provide lime juice to sailors at sea. (This led to the nickname "Limeys" for British sailors.) It is also noteworthy that Lind was able to correctly identify a means of preventing scurvy even though he misunderstood the cause. He believed toxins within the body were normally released through pores in the skin and that scurvy was the result of damp sea air causing pores to close, thus trapping toxins within the body.
The volcano Laki erupts, emitting sufficient sulfur dioxide gas and sulphate particles to kill a majority of Iceland's livestock and cause an unusually cold winter in Europe and Western Asia.
In 1798, Congress passed the Act for the Relief of Sick and Disabled Seamen, authorizing the formation of the US Marine Hospital Service (MHS), which was the forerunner of the Public Health Service. Seamen often became ill while at sea and often were unable to find adequate health care in port cities. Their health was viewed as essential to the developing country, and a network of hospitals to care for sick and disabled seamen, mainly in port cities, was established by Congress in 1798. Seamen were taxed 20 cents a month in order to pay physicians and support the network of hospitals. This tax was abolished in 1884. From 1884 to 1906 funds were raised by a levy on merchant ships, and after 1906 funds were allocated by the US Congress.
Boston established the first board of health and the first health department in the United States 1799. Paul Revere was named as the first health officer.
Castle Island in Boston Harbor was chosen as the temporary site for the first marine hospital. Dr. Thomas Welsh, a Harvard College graduate and participant in the Revolutionary War battles at Lexington and Bunker Hill, was appointed as the head physician.
Dr. Benjamin Waterhouse introduced smallpox vaccination to the United States.
The Boston Marine Hospital was moved to the Charlestown section of Boston in 1804. Dr. Benjamin Waterhouse was appointed as its head physician from 1807-1809.
In many respects, public health as we think of it today (as a function of good government) took shape in London and Paris in the wake of the devastating health consequences of the Industrial Revolution. However, the circumstances that propelled the development of public health as a discipline are more complex than the emergence of new health crises. One factor was the notion that the influence and power of a state could be assessed not only by the scale of commerce and trade it engaged in, but also by the size of its population or the health and fitness of its working population. Another factor was the emergence of new cultural values during Enlightenment in the 18th century, including democracy, citizenship, reason and rationality. Another factor was the recognition that poor health was a burden that fell disproportionately on the poor. Louis-Rene Villerme, a physician in Paris in the 1800s, noticed that mortality rates varied widely among the districts of Paris. He tried to correlate Parisian districts’ mortality rates with the distance of each district from the Seine River, the relationship of their streets to prevailing winds, their sources of water, exposure to the sun, elevation, and inclination. None of these things correlated. However, when he used tax rates (as an indicator of wealth), Villerme found a striking correlation with mortality rates. This relationship has persisted for centuries, and it is a powerful predictor of health.
Francois Broussais was a prominent Parisian physician and a strong proponent of bloodletting with leeches. He used bloodletting to treat many diseases, including cholera. In the engraving to the left Broussais can be seen instructing a nursing sister to continue to apply leeches to his patient (who is already quite pale from loss of blood). It is believed that his vigorous use of bloodletting to treat victims of a cholera epidemic in Paris substantially contributed to the mortality rate. Pierre Louis was a contemporary of Broussais's who believed in using numerical methods to evaluate treatment. Louis studied bloodletting and found it ineffective, but many dismissed his conclusions. Bloodletting had been practiced for centuries, and although it had never been tested for efficacy, it was embedded in medical practice.
Ignaz Semmelweis was a Hungarian physician who practiced in the maternity department of the Vienna General Hospital in the 1840s. Postpartum sepsis (puerperal fever) was a common occurrence and was almost invariably fatal. There were two maternity wards in the hospital, one where births were attended by medical students, and another where births were attended by midwives. The students often came directly from the dissecting rooms where they had been working with corpses with their bare hands. Puerperal fever was much more common in the ward tended by the medical students, but no one knew why. A colleague of Semmelweis cut his hand while performing an autopsy, developed a similar clinical picture of overwhelming sepsis, and died. Semmelweis began to wonder whether contagion could be carried on the hands and transferred to the women during giving birth. He decided to require all attendants to wash their hands in chlorinated lime water before attending to a birth, and the rate of infection plummeted. Some were impressed by these findings, but others, including Semmelweis's superior, ignored them. Oliver Wendell Holmes, Sr. was an American physician, professor, lecturer, and respected literary author. He received his M.D. from Harvard Medical School in 1836 and served as professor and chairman of anatomy and physiology at Dartmouth Medical School and later at Harvard Medical School. He advocated for medical reforms and was a strong proponent of the idea that doctors and nurses could carry puerperal fever from patient to patient. In 1843 he presented a paper entitled "The Contagiousness of Puerperal Fever" at the Boston Society for Medical Improvement (see engraving to the left). This was a controversial position. Holmes was opposed by a number of members of the society, including Dr. Charles Meigs, a prominent obstetrician. With regard to puerperal fever, Meigs's position was: "I prefer to attribute them to accident, or Providence, of which I can form a conception, rather than to a contagion of which I cannot form any clear idea, at least as to this particular malady."
In 1842 Sir Edwin Chadwick, a social reformer, published a report entitled the “Report into the Sanitary Conditions of the Labouring Population of Great Britain” proving that life expectancy was much lower in towns than in the countryside. Chadwick believed that it was possible for the government to improve people's lives through reform, arguing that a healthier population would be able to work harder and would cost less to support. He concluded that what was really needed was not more physicians, but civil engineers to provide drainage of streets and to devise more efficient ways of delivering clean water and removing sewage and other noxious substances. Chadwick was instrumental in creating a central public health administration that paved the way for drainage, sewers, garbage disposal, regulation of housing, and regulations regarding nuisances and offensive trades. This "sanitary idea" resulted in remarkable improvements in health and well-being, and Chadwick's report provided momentum for the establishment of a number of societies and pressure groups consisting of politicians, civil servants, and social reformers. These social, economic, political, and philosophical developments all contributed to the emerging idea that the public's health was a legitimate interest of government. It is interesting to note that many of the proponents of the "Sanitary Idea," including Chadwick, were "miasmatists" who clung to the belief that disease was caused by breathing foul vapors. Since sewage and garbage smelled bad, they were associated with disease, so the miasmatists pushed to clean up the environment. Despite the fact that the belief in miasmas would prove to be incorrect, the end result of improved sanitation was that many of the sources of infectious disease were removed.
Lemuel Shattuck, a Massachusetts legislator, established the first US system for recording births, deaths and marriages. Largely through his efforts, Massachusetts’ system became the model for all the other states in the Union. Among Shattuck's many contributions were his proposal for a standard nomenclature for disease; establishment of a system for recording mortality data by age, sex, occupation, socioeconomic level, and location; and the application of data to programs in immunization, school health, smoking, and alcohol abuse.
Unusually wet weather in Northern Europe causes crop failures. The worst crop affected was the potato on which both Ireland (the Great Famine) and Scotland (the Highland Potato Famine) were heavily dependent. Elsewhere in Europe, the food shortages lead to civil unrest and the revolutions of 1848. Counting the Irish diaspora and the forty-eighters, millions of Europeans emigrate to North America, South America, and Australia.
The Nuisances Removal Act was passed in 1846, giving local justices the power to prosecute and fine landlords for infractions having to do with sanitation (poor housing, garbage, cesspools and faulty drains).
The Public Health Act of 1848 created a General Board of Health in London that could direct localities to create local boards empowered to deal with environmental filth.
The Massachusetts legislature appointed a Sanitary Commission "to prepare and report to the next General Court a plan for a sanitary survey of the State," with Lemuel Shattuck as Chief Commissioner and author of its report. The report (1850) was enthusiastically received by the New England Journal of Medicine, but the 50 recommendations in the report were largely ignored. Twenty years later the Secretary of the Board of Health of Massachusetts based his plans for public health on Shattuck's recommendations.
In the 1800s there were large epidemics of cholera in Europe and America that killed thousands of people. John Snow, considered the father of epidemiology, was a physician in London who spent several decades studying cholera in a systematic way. He is most often credited with explaining an outbreak of cholera that occurred in London in 1854, though his studies of cholera were much more extensive than that. The first cholera epidemic in London struck in 1831, when Snow was still an apprentice. Another large epidemic occurred in 1848 and lasted through 1849. In August 1849 Snow published a paper entitled "On the Mode of Communication of Cholera," in which he presented his theory that the disease was acquired by ingestion of contaminated water. His theory did not get much traction with the medical establishment, but Snow continued to collect data after the 1849 epidemic ended on the pattern of disease, and he eventually found evidence that linked cholera to specific sources of water.
The Epidemiologic Society of London was formed, consisting of local physicians, ex-military commanders, and civil servants who presented papers related to public health issues.
John Tyndall discovers that some gases block infrared radiation. He suggests that changes in the concentration of these gases could bring climate change.
Reorganization of the Marine Hospital Service changed the general character of the Service. It became national in scope and military in outlook and organization. Medical officers, called surgeons, were required to pass entrance examinations and wear uniforms.
The Massachusetts State Board of Health instituted a voluntary plan for weekly reporting of disease by physicians.
Eruption of Krakatoa in Indonesia. The sound of the explosion is heard as far as Australia and China, the altered air waves causes strange colours on the sky and the volcanic gases reduce global temperatures during the following years.
Massachusetts passed legislation requiring the reporting of "diseases dangerous to the public health" and imposed fines for not reporting.
A small "Hygienic Laboratory" was established at the marine hospital on Staten Island to aid in the diagnosis of infectious diseases among passengers of incoming ships. The laboratory later moved to Washington, D.C., and eventually evolved into the National Institutes of Health.
The Commissioned Corps was formally recognized by legislative action, and medical officers were given titles and pay corresponding to Army and Navy grades. Physicians who passed examinations were appointed to the general service, rather than to a particular hospital, and were assigned wherever needed. The goal was to create a professional, mobile, health corps, free as possible from political favoritism and patronage, and able to deal with the new health needs of a rapidly growing and industrializing nation.
The Immigration Act of 1891 required that all immigrants entering the US be given a health examination by PHS physicians. The law stipulated the exclusion of "all idiots, insane persons, paupers or persons likely to become public charges, persons suffering from a loathsome or dangerous contagious disease," and criminals. The largest inspection center was on Ellis Island in New York Harbor.
After raking in a fortune as co-owner of Macy’s, Nathan Straus devoted himself to making life better for New York’s poor tenement dwellers. In 1893 he built his own pasteurization plant on East Third Street and opened 18 milk stations in the city that sold sterilized milk for only a few cents and gave free milk to those of extremely limited means.
Svante Arrhenius mathematically quantifies the effects of carbon dioxide on climate change related to the Industrial Revolution and the burning of fossil fuels.
The US Congress expanded the scientific research work at the Hygienic Laboratory and gave it a definite budget. The legislation required the Surgeon General to organize conferences of local and national health officials in order to coordinate state and national public health activities. The Marine Hospital Service was renamed the Public Health and Marine Hospital Services (PHMHS) to reflect its broader scope.
The Galveston Hurricane of 1900 hits Galveston, Texas and reverses the city's previously rapid growth.
Some estimates indicate that HIV was transmitted from monkeys to humans as early as 1884-1924, but was either unrecognized or failed to initiate human to human transmission until later.
Congress passed the Federal Meat Inspection Act, which required the Department of Agriculture to inspect meats entering interstate commerce, and the Food and Drugs Act, which forbade adulteration and misbranding of foods, drinks, and drugs in interstate commerce, but contained few specific requirements to insure compliance.
San Francisco earthquake causes collapse of insurance markets and the Panic of 1907.
The working environment and its effect on workers’ health became a major area of study for the Public Health Service starting in 1910. Investigations in the garment industry revealed unsanitary conditions and an excessive rate of tuberculosis. Other studies were done of silicosis among miners, sanitation and working conditions in the steel industry, lead poisoning in the pottery industry, and radiation hazards in the radium dial painting industry.
The PHMHS was renamed the United States Public Health Service and authorized to investigate human diseases such as, tuberculosis, hookworm, malaria, and leprosy, as well as sanitation, water supplies and sewage disposal.
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