SCIENTIFIC MEDICINE COMES TO PHILADELPHIA: PUBLIC HEALTH TRANSFORMED, 1854-1899 (BACTERIOLOGY, PENNSYLVANIA)

Contemporaries explained public health practice in late nineteenth-century Philadelphia in terms of the prevailing view of disease causation: the filth theory of disease in the 1850s and \u2760s, and the germ theory in later decades. However, critical examination of records of the Board of Health and of other nineteenth-century sources reveals that the central motivation for public health activity was the maintenance of social order. Public health activity was divided between port quarantine and sanitary campaigns. The latter generally served as a means to discipline the underclass and other disruptors of order. The class content of port control was most manifest in 1892, when health authorities used the threat of cholera to justify extreme measures against immigrants. Smallpox prevention was somewhat distinct from both of these arenas, because smallpox was preventible by vaccination, and because--in the 1850s and \u2760s--it was almost uniquely understood as contagious and therefore controllable by isolating its victims. During the 1870s and \u2780s, city officials determined to make use of science in safeguarding the city\u27s salubrity. The Board of Health\u27s interest in milk analysis led to the establishment of a chemistry laboratory; but by 1892, it appeared that bacteriology would provide tools of greater power. In 1895 the Board established a second laboratory, whose main tasks were bacteriological diagnosis and treatment of diphtheria. By the late 1880s, diphtheria--now recognized as contagious and bacterial--had become a central concern of public health. The three-part smallpox strategy (isolation, disinfection and medical intervention) was applied against it, but with greater force than ever before. Throughout the 1890s poor families were forced to choose between police-enforced household quarantines, or removal of their sick children to an isolation hospital. For the most part, members and employees of the Board of Health in the nineteenth century were sincere, hardworking people. Although their efforts were efficacious in a few areas, the overall effect of public health work on disease incidence and death was barely noticeable. However, by serving as gatekeepers at the port, by keeping watch on the sanitary condition of the city, and by using coercion to isolate victims of contagious disease, health authorities helped enforce behavioral standards appropriate to a growing industrial city