This Collection: | Timeline | Search/Browse | Contributors | Permissions | Help | HOME

Cholera Epidemics in the 19th Century

The Great Plague of London, 1665

The Boston Smallpox Epidemic, 1721

“Pestilence” and the Printed Books of the Late 15th Century

Spanish Influenza in North America, 1918–1919

Syphilis, 1494–1923

Tropical Diseases and the Construction of the Panama Canal, 1904–1914

Tuberculosis in Europe and North America, 1800–1922

The Yellow Fever Epidemic in Philadelphia, 1793

General Materials

Notable People

Related Links


Public Health

Formulaire d’Hygiène Infantile Collective. J.-B. Baillière et Fils, 1899. From the holdings of Center for the History of Medicine/Francis A. Countway Library of Medicine—Harvard Medical School
Formulaire d’Hygiène Infantile Collective. From the holdings of Center for the History of Medicine/Francis A. Countway Library of Medicine—Harvard Medical School.

Public health is a population–based concept for addressing the causes and the prevention of disease among demographic groups rather than among individuals. Experts in public health regard social and environmental factors as fundamental to understanding the relative health and longevity of particular populations. These social and environmental factors change over time—just as the understanding of diseases, their causes, and their prevention changes.

Studying the history of public health can add many dimensions to the study of class, economics, politics, gender, race, ethnicity, and religion—all of which play significant roles in public health.

Epidemics and Social Conditions

In 1848, after studying a typhus epidemic, the German pathologist Rudolf Virchow stated that all epidemics had social causes—most typically poverty, hunger, and poor housing. Virchow believed that improving social conditions would have a positive effect on public health. This important early perspective plays a significant role in today’s thinking about public health, especially when there are major health disparities among social classes within an individual society or between rich and poor countries.

Hygiene and Sanitation

Hygiene and sanitation are major factors in the history of public health. In Europe and the United States, public sanitary practices and the professional discipline of public health came of age in the mid-19th century in response to urbanization, immigration, and industrialization, and to the 19th-century cholera epidemics. Until the development of germ theory in the later part of the 19th century, sanitary practices were based primarily on miasmatic theories of disease (where disease was thought to be caused and spread to susceptible people by decaying plant and animal matter, various kinds of waste, bad smells, and bad air), on contemporary ideas about infection and contagion, and on beliefs about the health impact of personal behaviors, morality, and innate susceptibility associated with particular social classes or ethnic groups.

By the end of the 19th century, most major urban areas had sewer systems, and indoor plumbing could be found in many middle-class and most well-to-do homes. Although there had been some earlier state-based or other organized responses to individual epidemics—primarily quarantine and disinfection measures related to outbreaks of plague—it was in the period from the mid-19th to the early 20th centuries that permanent boards of health were established in many major urban centers.

Public Health, Medicine, and the State

Tensions sometimes arise between medicine and public health. Each discipline has its distinct priorities. Medicine aims at cures for individual diseases and primarily involves individual patients. Public health emphasizes the prevention of disease and a population–based understanding of its causes.

The methods and goals of public health officials are also sometimes at odds with local governments and members of the public who object to the role of the state in personal health. Within the discipline of public health there have also been differences in priority, often between lab-based or other scientific work and work that studies other factors involved in disease. For example, vaccination campaigns have sometimes been criticized for deemphasizing the sanitary, nutritional, and other social contributors to the transmission and severity of infectious disease.

The Demographic Transition

The mortality rate from infectious diseases had risen during the 19th century with urbanization. The rate began to drop toward the end of the 19th century, and historians have theorized that public sanitation and improved nutrition were responsible for most of this improvement. However, with the decline in severity of infectious disease came a rise in chronic diseases, cancer, and injuries and health damage associated with industrial labor.


Selected Contagion Resources

This is a partial list of digitized materials available in Contagion: Historical Views of Diseases and Epidemics. For additional materials on the topic “Public Health,” click here or search the collection’s Catalog and Full Text databases.

Web Pages

The Boston Smallpox Epidemic, 1721
Cholera Epidemics in the 19th Century
Concepts of Contagion and Epidemics
Domestic Medicine
Germ Theory
International Sanitary Conferences
Robert Koch, 1843–1910
Medical Geography
Florence Nightingale, 1820–1910
“Pestilence” and the Printed Books of the Late 15th Century
Syphilis, 1494–1923
Tropical Diseases and the Construction of the Panama Canal, 1904–1914
Tuberculosis in Europe and North America, 1800–1922
Rudolf Virchow, 1821–1902


Boston Overseers of the Poor Records.
Papers of Benjamin Waterhouse, 1786–1836 (inclusive).


16th Century

Riva di San Nazarro, Gianfrancesco. De peste libri tres. Avignon: Imp[re]ssum fuit p[re]sens opus in ciuitate Auenioni per solertem impressorem magistrum Johanem de channey, anno domini 1522 die 12 Septembus.

17th Century

Bologna (Italy). By the King, a Proclamation Concerning the Prorogation of the Parliament (forthcoming). London: Printed by John Bill and Christopher Barker, 1665.
Strauss, Gottfried, 1641–1706. De jure arcendi ob metum pestis…praeside…Godofredo Strauss…; publico exmini submittit Carolus Godofr. Vollmarus. Wittenbergae: Literis Viduae Brüningianis, 1683.
The Shutting Up Infected Houses as It Is Practised in England Soberly Debated. London: s.n., Printed in the year 1665.

18th Century

Chalmers, Lionel, ca. 1715–1777. An Account of the Weather and Diseases of South-Carolina. London: Printed for Edward and Charles Dilly, 1776.
Frank, Johann Peter, 1745–1821. System einer Vollständigen Medicinischen Polizey. Wien: Gedruckt bey J.T. Edlen von Trattnern, 1786–1790.
Grainger, James. An Essay on the More Common West-India Diseases: And the Remedies Which That Country Itself Produces, to Which Are Added, Some Hints on the Management, &c. of Negroes. London: Printed for T. Becket and P.A. De Hondt, 1764.
Howard, John, 1726–1790. An Account of the Principal Lazarettos in Europe: With Various Papers Relative to the Plague, Together with Further Observations on Some Foreign Prisons and Hospitals, and Additional Remarks on the Present State of Those in Great Britain and Ireland. The second edition, with additions. London: Printed for J. Johnson, C. Dilly, and T. Cadell, 1791.
Savoy (Duchy). Magistrat de Santé. Manifeste pour se Garantir du Mal Contagieux. A Chambery: Jacques Gorrin, imprimeur du Roy, 1740.


Baker, Thomas, b. 1819. The Laws Relating to Public Health: Sanitary, Medical, Protective: Including the Legislation to the End of the Last Session of Parliament. London: W. Maxwell, H. Sweet and Stevens, Sons & Haynes; Dublin: Hodges, Smith, & Co., 1865.
Great Britain. Poor Law Commissioners. Edwin Chadwick, Secretary. Report to Her Majesty’s Principal Secretary of State for the Home Department, from the Poor Law Commissioners on an Inquiry into the Sanitary Condition of the Labouring Population of Great Britain. London: Printed by W. Clowes and Sons, for H.M.S.O., 1842.
Maclean, Charles, fl. 1788–1824. Remarks on the British Quarantine Laws: And the So–Called Sanitary Laws of the Continental Nations of Europe, Especially Those of Spain. London: 1823.
New York Sanitary and Chemical Compost Manufacturing Company. The New York Sanitary and Chemical Compost Manufacturing Company: Organized 1864 ... For the Purpose of Cleansing Cities, Towns, and Villages in the United States, By the Use of Smith’s Patent Street-Sweeping Machines and Other Mechanical Appliances, the Manufacture and Sale of Chemical Compounds and Manures, Manufactured from the Offal and Refuse of Cities, the Introduction of Portable Water Closets in Public Buildings, Offices, Factories, and Work–Shops. New York: Published for gratuitous distribution, 1865.
Nightingale, Florence. How People May Live and Not Die in India. London: Emily Faithful, 1863.
Tardieu, Ambroise. Dictionnaire d’Hygiène Publique et de Salubrité. Paris: J.B. Baillière; Londres; New York: H. Baillière; Madrid: Bailly-Baillière, 1852–1854.


Blackwell, Elizabeth. Why Hygienic Congresses Fail: Lessons Taught by the International Congress of 1891. London; New York: G. Bell, 1892.
Farr, William, 1807–1883. Vital Statistics: A Memorial Volume of Selections from the Reports and Writings of William Farr. Edited for the Sanitary Institute of Great Britain by Noel A. Humphreys. London: The Sanitary Institute, 1885.
France. Commission d’études des Odeurs de Paris. Rapport Préliminaire sur les Causes des émanations Odorantes de Paris et de la Banlieue. Par A. Le Roy des Barres. Paris: Impr. et Libr. centrales des chemins de fer, Impr. Chaix, 1896.
Virchow, Rudolf Ludwig Karl. Gesammelte Abhandlungen aus dem Gebiete der öffentlichen Medicin und der Seuchenlehre. Berlin: A. Hirschwald, 1879.
Waring, George E. The Sanitary Drainage of Houses and Towns. New York: Hurd and Houghton; Cambridge: Riverside Press, 1876.


International Sanitary Conference of the American Republics (3rd: 1907: Mexico City, Mexico). Actas de la tercera Conferencia Sanitaria Internacional de las Repúblicas Americanas: Celebrada en la Ciudad de México del 2 al 7 de diciembre de 1907. Washington, D.C.: Oficina Internacional de las Repúblicas Americanas, 1908.
Sanitary Progress: Charts from the Prudential Insurance Company of America. New York: Statistician’s Dept., Prudential Insurance Co. of America, ca. 1920.
Save the Babies!: Rules to be Observed in the Care and Management of Infants During the Summer. Commonwealth of Pennsylvania, Department of Health. Harrisburg, Pa.: Dept. of Health, ca. 1915.
Rubinow, I. M. Health Insurance in Relation to Public Health. Pittsburgh, Pa.: Standard Sanitary M’frs’g Co., 1901.
Standard Sanitary Manufacturing Company. Modern Bath Rooms and Appliances: A Few Suggestions About Plumbing Valuable to Home Builders or Those About to Remodel Their Present Dwellings. Pittsburgh, Pa.: Standard Sanitary M’frs’g Co., 1901.


The following sources were used in writing this page.

Baldwin, Peter. Contagion and the State in Europe, 1830–1930. Cambridge, UK: Cambridge University Press, 1999.
Barnes, David S. The Great Stink of Paris and the Nineteenth–Century Struggle Against Filth and Germs. Baltimore: Johns Hopkins University Press, c2006.
Delaporte, Francois. Disease and Civilization: The Cholera in Paris, 1832. Arthur Goldhammer, trans. Cambridge, MA and London: MIT Press 1986.
Farmer, Paul. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press, 2003.
Harrison, Mark. Public Health in British India: Anglo-Indian Preventive Medicine 1859–1914. Cambridge: Cambridge University Press, 1994.
Jones, David S. Rationalizing Epidemics: Meanings and Uses of American Indian Mortality Since 1600. Cambridge, Mass.: Harvard University Press, 2004.
Latour, Bruno. The Pasteurization of France. Translated by Alan Sheridan and John Law. Cambridge, Mass.: Harvard University Press, 1988.
McKeown, Thomas. The Role of Medicine: Dream, Mirage, or Nemesis? Princeton, N.J.: Princeton University Press, 1979.
Rosen, George. A History of Public Health. Expanded edition. New York: MD Publications Inc., 1958. Baltimore: Johns Hopkins University Press, 1993.
Rosen, George. From Medical Police to Social Medicine: Essays on the History of Health Care. Expanded edition. New York: MD Publications Inc., 1958. Baltimore: Johns Hopkins University Press, 1993.
Rosenberg, Charles E. The Cholera Years: The United States in 1832, 1849, and 1866. Chicago: Chicago University Press, 1962, 1987.
Sigerist, Henry. Civilization and Disease. Ithaca, NY: Cornell University Press, 1943.
Tomes, Nancy. The Gospel of Germs: Men, Women and the Microbe in American Life. New York: Science History Publications, 1974.


OCP Home | Selection of Web–Accessible Collections | HOLLIS | Harvard Libraries | Harvard Home | Contact | ©2018 The President and Fellows of Harvard College