Public Health in the Progressive Era
Despite the growth of social movements such as temperance, abolition, and suffrage in the U.S. during the mid-nineteenth century, a cultural emphasis on “individual health rather than community health” and a lack of public support for medical professionals stunted the growth of a public health movement along the lines of what had begun in Europe many decades earlier.[1] The earliest organized public health efforts, undertaken by a group known as “sanitarians,” were motivated by what they viewed as the interrelated problems of infectious disease and urban pollution. Historian John Duffy notes that several important advances in medicine including the collection of vital statistics and the promotion of community health by medical societies occurred in the generation prior to the Civil War from the work of sanitarians.[2] It was the Civil War, however, that “marked a watershed in the history of American public health.” It was then that formalized, state-authorized agencies took a leading role in promoting advances in pathology and chemistry, which led to a range of sanitation regulations.[3]
The organizational changes in this developing health movement were based on a solid foundation of the scientific advancements of laboratory testing, an understanding of disease vectors, and thus the cause of epidemics, and vaccines, to name but a few. New state agencies began to look upon the range of urban health problems not in terms of morality or sinfulness but of a poor environment. And that environment could be methodically sampled, put under a microscope, and accurately addressing root causes. As Duffy explains, this translated into a broad range of concerns by health reformers and “witnessed the rise of professions and of specialization within them.” The American Public Health Association (APHA), formed in 1872, and led by physicians in New York, exemplified this trend. By 1892, hundreds of public health professionals from cities across the country and from Canada, Mexico, Cuba, and Central America convened at their yearly conferences.[4]
Hygienic Laboratory in the Marine Hospital, Staten Island, New York.
One measure of the expansion and diversification of public health was the growth in the number of hospitals and asylums and accompanying health care professions such as psychiatry. In 1873, there were fewer than two hundred hospitals across the country but by 1910 there were more than four thousand.[5] Similarly the growth of densely populated urban areas led to the development of asylums for the care of the mentally ill. Historian David J. Rothman notes that only a few manufacturing states such as New York and Massachusetts had asylums in the 1830s and by the Civil War, 28 of 33 states had public institutions for the insane.[6] These new mental asylums not only created “a new institutional market for doctors, but also a new sphere in which they could exercise authority” and platforms to lecture the public “on the relationship of mental illness, vice, and the disorders of modern civilization.”[7] With the breakthroughs in identifying the causes of potentially epidemic diseases and thus addressing health concerns at the population level, these new medical professionals began to turn their attention to “identifying more ambiguous conditions and syndromes such as feeblemindedness, constitutional psychopathic inferiority, and poor physique.”[8]
To oversee treatment in those new asylums, academics in the 1870s, first in Germany and then in the U.S., began to advocate for psychology as an empirical science and its separation in universities from the discipline of philosophy.[9] After two years of postgraduate work in Germany, G. Stanley Hall, an early advocate of this psychology, received a lectureship at Johns Hopkins University in 1882, set up the first laboratory a year later, and then founded the discipline’s first scholarly journal, the American Journal of Psychology, in 1887. In 1892, the American Psychological Association (APA) was founded.[10] Coming of age in an era that increasingly privileged scientific expertise, psychologists pressed their case for theirs as the “master science”; it was ahistorical, the foundation of all other social sciences, and supplied “the fundamental laws governing all human activity.”[11] To establish their credibility, to secure the necessary funding to establish university departments and laboratories, and to assert their knowledge in the private sphere, psychologists appealed to businessmen and politicians, “men in positions of genuine social power,” who could leverage new insights into the control over the actions of others into business or social improvements. The enormous and very human-centered problems that came from a wave of global migration unseen before, the urbanization of America, and an industrial revolution meant psychologists might become leaders in this new era “if they could reasonably promise to develop the technical competence needed to deal appropriately with these problems.”[12] It was their claim to understand “all human activity” and their preoccupation with “attaining social utility” that would make them attractive immigration gatekeepers. They could make pronouncements on the character of an individual using methods that measured innate intelligence or mental fitness that would serve the nation’s best interest.[13]
[1] John Duffy, The Sanitarians: A History of American Public Health (Chicago: University of Illinois Press, 1990), 66.
[2] Duffy, The Sanitarians, 93.
[3] Duffy, The Sanitarians, 126.
[4] Duffy, The Sanitarians, 128-31.
[5] Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 73.
[6] David J. Rothman, The Discovery of the Asylum: Social Order and Disorder in the New Republic (New York: Routledge, 2017), 130.
[7] Starr, The Social Transformation of American Medicine, 72-3.
[8] Howard Markel and Alexandra Minna Stern, “Which Face? Whose Nation? Immigration, Public Health, and the Construction of Disease at America's Ports and Borders, 1891-1928” American Behavioral Scientist 42, n. 9 (June/July 1999): 1316.
[9] Thomas M. Camfield, “The Professionalization of American Psychology, 1870-1917,” Journal of the History of the Behavioral Sciences 9 (January 1973): 66.
[10] Camfield, “Professionalization of American Psychology,” 67. Camfield notes there is some uncertainty about the exact date and precipitating events that led to the founding of the APA.
[11] Camfield, “Professionalization of American Psychology,” 70; Kurt Danziger, “The Social Origins of Modern Psychology,” in Psychology in Social Context, ed. Alfred R. Buss (New York: Irvington, 1979), 27, 35.
[12] Danziger, “The Social Origins of Modern Psychology,” 35.
[13] Camfield, “Professionalization of American Psychology,” 74.