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Growth through Natural Increase: Deaths, Improved Sanitation

Granger movement, New Deal agency, Civil Works Administration, pasteurization of milk, health advances

These outbreaks prompted the first concerted efforts at health reform in the late 18th and early 19th centuries. Major northern cities began constructing central water systems and collecting garbage. Central water systems meant that people in the largest cities had cleaner water for drinking and water for washing more frequently. Central water systems also made obsolete the rain barrels where disease-carrying mosquitoes bred. Cities invested in nuisance abatement, which included measures such as draining swamps and flooded areas, cleaning outhouses untended by landlords, tearing down abandoned housing, killing rats and mice, rounding up stray dogs, supervising cemeteries and burial practices, enforcing sanitation measures and market inspections, removing trash, and cleaning streets. Cities also enforced the quarantine of arriving passengers until all seemed healthy. Merchants often protested when their ships were quarantined. However, merchants were convinced of the effectiveness of such measures after quarantines helped diminish death rates during cholera epidemics in the 1840s.

By the middle of the 19th century, these civic reforms made the northern cities healthier than the countryside. Rural areas, however, could not afford the public health measures that improved conditions in the largest and most prosperous cities. Cholera was a major killer on wagon trains heading West. Yellow fever, malaria, hookworm, and other maladies still prevailed in the South, which experienced major yellow fever epidemics in the 1850s and in 1873. These epidemics led to the creation of the National Board of Health and a federal quarantine system.

In the mid-19th century, the development of the germ theory, which stated that microorganisms cause infectious diseases, helped people understand how diseases were transmitted. Antiseptic procedures began to be used, saving many lives in surgery and childbirth. Concerned individuals and private groups carried on much of the early fight against germs and disease. Mothers sought to improve health by attacking the germs that might harm their families. They taught their children to brush their teeth, use a handkerchief when blowing their nose, cover their mouths when coughing, wash with soap, and never spit. This concern for health and sanitation even helped fuel the woman’s suffrage movement, as many women demanded the right to vote in order to push for clean water, clean streets, and the pasteurization of milk. In the second half of the 19th century, the health and longevity of African Americans and their children improved substantially after the end of slavery enabled them to form permanent families. Enslaved children had been undernourished, poorly clothed, and denied education. When plantation owners no longer made the decisions about child care, children were healthier and better educated. And after 1867 the Granger movement, which brought farmers together to solve common problems, helped raise standards of sanitation on farms.

By the turn of the 20th century, the United States was a major center for medical research, and vaccines, antiseptic methods, and preventive measures substantially improved medical care. One estimate is that by 1910 a patient had a 50-50 chance of being cured by a doctor’s advice. As the 20th century began, deaths from communicable diseases were generally declining, although deaths from tuberculosis and influenza remained significant. At the same time, degenerative diseases of old age, such as heart disease, started to become more common causes of death.

Improvements in medicine, sanitation, and health, however, were countered by rapid industrialization of the United States in the late 19th century, which created air and water pollution, overcrowded cities, and substantial pockets of abject poverty in urban and rural areas. The Progressive movement of the late 19th and early 20th centuries addressed the health problems of the urban poor. Its many reforms included meat inspections, the Pure Food and Drug Act, and pasteurization of milk. State and federal governments began to enforce public health measures. The well-being of residents was no longer only a personal or a municipal matter, as state and federal agencies began to bring health reforms to larger numbers of Americans.

The New Deal, the government’s program in the 1930s to counteract the effects of the Great Depression, continued the Progressive agenda of improving health and sanitation. It was particularly effective in improving conditions in the South, which lagged behind the health advances made in the North. This regional disparity was largely because the rural, agricultural South lacked the financial resources of the industrial North. The Civil Works Administration, a New Deal agency that provided work relief in 1933 and 1934, targeted malaria as a severe problem in the South. One aspect of the agency’s activities was building improved housing with screened windows to keep out disease-carrying mosquitoes.

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