Features appear in each issue of Pennsylvania Heritage showcasing a variety of subjects from various periods and geographic locations in Pennsylvania.
Before Department of Health regulations on sanitation, many Pennsylvanians got their drinking water from places like this stream in Harrisburg, photographed around 1900. Pennsylvania State Archives/MG-43

Before Department of Health regulations on sanitation, many Pennsylvanians got their drinking water from places like this stream in Harrisburg, photographed around 1900.
Pennsylvania State Archives/MG-43

In 1930 A. J. Bohl was proud to work in the Pennsylvania Department of Health (DOH). After 25 years there, he wrote an article in Pennsylvania’s Health in which he recalled growing up in the 1880s, when disease and illness ravaged the state. “There wasn’t much attention paid to the communicable diseases. Everybody, as a matter of course, had measles, chicken pox, whooping cough and mumps, and small boys used to boast, after school of how many diseases they had acquired.” Bohl remembered when he was a boy in Harrisburg drinking raw Susquehanna River water, “muddy and malodorous. . . . We had to like it.”

As a young man working at DOH, Bohl was on call 24 hours a day to respond to reports of disease and mortality across Pennsylvania. It was customary for him to get calls at 2 a.m. with orders to report at the train station for travel to the scene of an outbreak. Working tirelessly day and night, Bohl and his colleagues had to pinpoint the source of the disease. Sometimes it was a contaminated well or a contagious milkman. Other times their search would lead to a backed-up sewage system or unvaccinated students at school. “Those were the not so good old days, but they certainly were exciting.”

Bohl remembered how a single disease could wipe out a whole community in one fell swoop: “Just imagine the entire population of the city of Butler, or of Lebanon, sick with typhoid fever, helpless and delirious, and from these sick people the ruthless hand of death selecting more people than live in Jenkintown or in Red Lion. . . .  And it’s true, it all happened.”

Ironically, the epidemics that plagued Pennsylvania were also the catalyst for an effective statewide public health system. On April 27, 1905, the Pennsylvania Department of Health was established after deadly typhoid epidemics in 1885 and 1903 frightened citizens, energized reformers, and persuaded elected officials to turn away from Pennsylvania’s laissez-faire approach to public health.

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After his own daughter Margaret succumbed to smallpox in 1772, artist Charles Willson Peale depicted the anguish it caused him and his wife Rachel in his oil-on-canvas painting Mrs. Peale Lamenting the Death of Her Child (Rachel Weeping). A vaccine for the disease would be discovered in 1796 but would not be widely available in Pennsylvania until the 20th century. Philadelphia Museum of Art (Gift of the Barra Foundation Inc. 1977-34-1)

After his own daughter Margaret succumbed to smallpox in 1772, artist Charles Willson Peale depicted the anguish it caused him and his wife Rachel in his oil-on-canvas painting Mrs. Peale Lamenting the Death of Her Child (Rachel Weeping). A vaccine for the disease would be discovered in 1796 but would not be widely available in Pennsylvania until the 20th century.
Philadelphia Museum of Art (Gift of the Barra Foundation Inc. 1977-34-1)

Smallpox, yellow fever and many other diseases migrated to Pennsylvania with the first European settlers. William Penn himself nearly died when smallpox broke out during his 1682 voyage to Pennsylvania (one-third of his fellow ship passengers perished). The diaries and journals of colonial Pennsylvanians are replete with references to “distempers” from places like the Palatinate, Holland and Barbados. Not surprisingly, the first public health laws passed in the colony forbade ships with diseased passengers or crew from entering the port of Philadelphia.

But there were no laws or government plans to deal with disease after it took hold in Pennsylvania. When yellow fever decimated Philadelphia in 1793, the unprepared state government fled the city, leaving municipal officials and volunteers to fend for themselves. “When the mortality came to its greatest stage,” survivors Richard Allen and Absalom Jones remembered, “it was impossible to procure sufficient assistance, therefore many whose friends, and relations had left them, died unseen, and unassisted.”

For most of the 19th century, Pennsylvania’s public health was guarded only by a weakly enforced smattering of state laws. Responsibility for health education, preventative medicine and public sanitation were left entirely to local communities. Some cities, like Philadelphia, created their own boards of health, but they were often underfunded and lacked the authority to prosecute individuals or companies that threatened public health and sanitation. After disease-laden milk was discovered to be a leading cause of infant death in Philadelphia in the 1880s, an exasperated city official complained: “What can we do? Under the stupid State law we have no authority.”

In rural parts of Pennsylvania far from city health authorities, neighbors relied on each other for survival when illness or injury struck. Midwives and other women shared folk remedies and Old World healing rituals learned from their immigrant ancestors. Pennsylvania Dutch communities often relied on folk healers known as powwowers who employed a variety of rituals and blessings for curing and preventing ailments. Though these lay practices may have helped many rural Pennsylvanians, the lack of preventative medicine, good sanitation, and professional doctors versed in modern scientific knowledge meant disease was ever-present. Reports from the Medical Society of Pennsylvania estimated that around 20 percent of all deaths in Pennsylvania each year were caused by preventable diseases.

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In the 19th century, rural areas were fortunate if they had a local doctor’s office such as this one in Bowers, Berks County. Pennsylvania State Archives/MG-280

In the 19th century, rural areas were fortunate if they had a local doctor’s office such as this one in Bowers, Berks County.
Pennsylvania State Archives/MG-280

By the mid-19th century new medical knowledge of germ theory and proper sanitation led to prevention and even cures for diseases that previously seemed impossible to survive. Armed with this expertise, a small but determined band of physicians, progressive politicians and scientists began to lobby the Pennsylvania government for a board of health. With authority over the entire state, they argued, a board could protect public health everywhere by promoting preventative health measures and keeping drinking water free of disease.

In the 1870s several bills were introduced in the General Assembly to create a Pennsylvania board of health, but each one was defeated. In a state controlled by Gilded Age machine politics, laws needed the support of powerful political leaders who controlled legislative votes and priorities of the executive branch of government. Support for bills faltered as politicians bickered over how many patronage positions would be on the board and who would control appointments. Some legislators objected to a state board of health, concerned that it would have too much control over private property. Others worried that it would be yet another office that would accomplish little and provide more opportunities for graft and outright theft from a government already riddled with corruption.

Public support for a costly state board was also lukewarm. In 1874 an editor at the Norristown Herald wrote, “it was a pretty safe rule to discourage all legislation having for its object the creating of additional public offices.” Several years later, an editorial in the Harrisburg Telegraph called the proposed board “useless” and “extravagant” and hoped that it would die quietly in committee.

Year after year physicians and other advocates lobbied the General Assembly for a state board of health without success. The loudest reformer in the state was Dr. Benjamin Lee (1833–1913), a Civil War veteran and member of Philadelphia’s municipal board of health. From his experiences, he knew how many lives could be saved by modern medicine and a good public health program. But even his influence and the backing of the Medical Society of the State of Pennsylvania (later Pennsylvania Medical Society) could not sway stubborn politicians.

A relief party arrives at a Plymouth home devastated by typhoid, 1885. From Frank Leslie’s Illustrated Newspaper, May 23, 1885

A relief party arrives at a Plymouth home devastated by typhoid, 1885.
From Frank Leslie’s Illustrated Newspaper, May 23, 1885

After legislators rejected another proposal in 1884, a despondent Lee wrote that an “aroused popular interest” in public health was the only way to find success. The terrible truth was that lobbying was fruitless; he realized it would take more drastic measures. “When the Legislature is convinced that the people want a Health Bureau” he continued, “they will be ready to create it, not before.”

The following year another bill to create a board of health was proposed. It seemed destined to fail like all its predecessors, but then an unexpected twist of fate occurred — a terrible outbreak of typhoid in the small Luzerne County borough of Plymouth.

In late 1884 Plymouth resident David Jones had traveled to Philadelphia to visit family. He stayed in a neighborhood where the dirty drinking water was described as “coffee-colored or inky fluid.” Before long he came down with a severe case of typhoid. A waterborne or foodborne illness carried by bacteria, typhoid was ever-present in large cities like Philadelphia, where health inspectors considered the water “vile” and said, “one picking up a glass of it will think twice before drinking it.”

Jones returned to Plymouth that winter and brought his deadly typhoid with him. As he recuperated in his home just upriver from town, his nurse emptied his chamber pot in the snow by the nearby riverbank. When the frozen ground melted, the infected waste flowed into the water and quickly made its way into town. Soon more than 1,000 people (out of a population of 8,000) contracted typhoid and were bedridden.

Like most other Pennsylvania towns, Plymouth had no local health authorities and few physicians to respond to the epidemic. Without any health officials or public health laws, the state government was equally helpless and unable to provide any aid or support to the struggling town. In desperation, small groups of physicians traveled up from Philadelphia and formed volunteer committees to lead medical relief efforts. By the time the epidemic had passed, 114 people had died, more than 10 percent of everyone who caught the deadly typhoid.

Shock and frustration at Pennsylvania’s inadequate health laws spurred fierce criticism in the press. What if a similar epidemic struck a larger city like Philadelphia? Thousands would die and entire communities would be devastated for generations. Fearful legislators quickly passed Lee’s bill establishing the Pennsylvania State Board of Health (BOH). It was the victory that physicians had fought many years for, but Lee was horrified at the terrible price it cost: “thus out of the agonies of Plymouth was the State Board of Health of Pennsylvania born,” he wrote.

 

Dr. Benjamin Lee, seated on the left, was the founder and first secretary of the Pennsylvania State Board of Health. Other board members in this May 1905 photograph are, standing from left, Col. Milton Embick, Dr. J. H. McClelland, Prof. George G. Groff, Dr. Charles H. Harvey and John Fulton and, seated on the right, Dr. Samuel T. Davis. Pennsylvania State Archives/RG-11

Dr. Benjamin Lee, seated on the left, was the founder and first secretary of the Pennsylvania State Board of Health. Other board members in this May 1905 photograph are, standing from left, Col. Milton Embick, Dr. J. H. McClelland, Prof. George G. Groff, Dr. Charles H. Harvey and John Fulton and, seated on the right, Dr. Samuel T. Davis.
Pennsylvania State Archives/RG-11

The new BOH was given a modest annual budget and staffed by six volunteer physicians and civil engineers. The legislation gave the board and its first secretary, Lee, responsibility to “make sanitary investigations and inquiries respecting the causes of disease,” disseminate health and sanitation information to the people of Pennsylvania, and propose public health laws to the General Assembly. In emergencies, BOH could step in and enforce health regulations in areas where there was no local board of health.

BOH was a significant step in the right direction, but it soon became evident that Lee and his staff did not have the resources or authority to prevent epidemics or respond effectively when they occurred. Without clear regulatory powers it would struggle to make a meaningful impact.

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In 1886 another deadly outbreak of typhoid struck, this time in Allentown, Lehigh County, and BOH sprang into action. Determining that the cause of the epidemic was a spring contaminated by a militia encampment’s privy and nearby slaughterhouse cesspool, a BOH inspector urged Allentown’s mayor to replace leaky waterpipes and build protective covers to keep drinking water clean. But city leaders were convinced that these extra costs were unnecessary and refused to implement BOH’s recommendations, going so far as to claim that the city’s sanitation was exemplary because it sat at the top of a hill. Despite the “primitive and almost barbarous state” of Allentown’s sanitation, Lee and BOH were powerless to stop the outbreak.

When the Johnstown Flood ravaged Cambria County in 1889, Lee was astonished to learn that he could not receive any money from the Pennsylvania Treasury to fund emergency public health and sanitation efforts. Thousands of dead flood victims lay in wreckage along the Conemaugh River. Without quick action their bodies could spread disease to local water supplies used by survivors and other communities downriver. An embarrassed Gov. James A. Beaver borrowed $400,000 from personal friends so that BOH officials could begin cleaning up contaminated debris and monitoring temporary shelters for disease.

 

The 1889 Johnstown Flood killed 2,208 people, many of whom remained trapped in watery wreckage for days. It was the Board of Health’s job to recover these bodies and make sure they didn’t infect the drinking water of communities living downriver. Pennsylvania State Archives/MG-286

The 1889 Johnstown Flood killed 2,208 people, many of whom remained trapped in watery wreckage for days. It was the Board of Health’s job to recover these bodies and make sure they didn’t infect the drinking water of communities living downriver.
Pennsylvania State Archives/MG-286

To make matters worse, attempts by BOH to cremate the decaying bodies were met with such a “storm of indignation” from locals who wanted to bury their loved ones that all plans had to be abandoned. “The warnings of science were lost,” author James Walker reported, “in the eager demands of those that sought the remains of the near and dear.”

BOH faced many challenges from within state government as well. Each year Lee and his colleagues recommended public health laws aimed at preventing disease and its spread, but without the support of political bosses they were never passed. In 1899 bills to prevent pollution and sewage dumping in public water sources failed after industrialists looking to avoid extra costs lobbied against them. Gov. Samuel Pennypacker even personally vetoed a 1903 antituberculosis law that would ban public spitting, arguing that Pennsylvanians had a constitutional right to spit.

Each year BOH struggled to protect Pennsylvania’s citizens. Because of its tiny annual budget, most of its field agents were unsalaried and were unable to monitor sanitary conditions or early warning signs of disease in the vast territories they inspected. BOH still had no means for implementing public health measures and was hamstrung by stubborn local officials who resisted their efforts. In 1897 one BOH agent even complained that his suggestions for disease prevention went unheeded in Phoenixville, Chester County, where local physicians accused him of “spoiling epidemics” and hurting their business.

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Then, in 1903, another typhoid outbreak gripped the state and convinced legislators that current public health measures were inadequate. Just like Plymouth 20 years earlier, a terrible epidemic spurred meaningful change in public health that advocates were unable to achieve on their own.

That autumn the population of Butler was exposed to contaminated drinking water when the local water company began distributing an untreated supply from a nearby creek. Before long typhoid reared its ugly head with more than 1,200 people sick by year’s end. More than 100 died. Even though BOH called the Butler outbreak “one of the greatest epidemics in proportion to the population in the history of the world,” it lacked the resources and authority to help. Instead local charity organizations and a Red Cross contingent personally led by 82-year-old Clara Barton provided medical care and led recovery efforts.

Samuel Gibson Dixon served as the Pennsylvania commissioner of health from 1905 until his death in 1918. Pennsylvania State Archives/RG-25

Samuel Gibson Dixon served as the Pennsylvania commissioner of health from 1905 until his death in 1918.
Pennsylvania State Archives/RG-25

International press coverage kept Butler in the news for months and was a constant source of embarrassment to Pennsylvania’s state government. Using this publicity as an opportunity, public health advocates lobbied the General Assembly for a more powerful health department. With the support of Charles Penrose, a respected Philadelphia physician and younger brother of Republican political boss Boies Penrose, the General Assembly approved a bill in 1905 that created the Pennsylvania Department of Health (DOH). Looking to avoid the issues that plagued BOH, the new department was given vast regulatory and enforcement authority to protect public health and keep sources of water clean.

With a lengthy list of powers and responsibilities, DOH was the most formidable state agency and its commissioner one of the most powerful government officials in Pennsylvania. Before prominent physician and tuberculosis expert Dr. Samuel Dixon (1851–1918) agreed to serve as DOH’s first commissioner, he demanded that it be made an independent agency so that its work would not be hindered by political scheming. With memories of the Butler epidemic still fresh, Pennypacker quickly promised that there would be no interference in the department’s budget or staff hires.

Under Dixon’s leadership, DOH worked quickly and assertively to prevent disease and respond to outbreaks as soon as they were identified. A vital statistics office helped track the spread of disease and monitor other factors by recording the birth and death of every citizen. Tuberculosis sanitariums were built across the state. A public health code regulated water and sanitary standards and required local communities to keep water clean. New licensing requirements forced lay healers out of business and prosecuted those who continued practicing without professional medical training. Aggressive vaccine campaigns protected children from picking up deadly maladies and new laws written by DOH kept unvaccinated children out of schools.

To protect public health, DOH officials could enforce regulations everywhere from giant factories to tiny farms and private homes. Many Pennsylvanians worried about these intrusions into their privacy and tried to resist DOH directives and quarantines. DOH inspectors were harassed and even attacked by people who felt threatened by intrusive state government. One Reading farmer fractured the skull of an inspector trying to check sanitary conditions of a stream on his land; another lost an eye while disinfecting the house of a measles victim.

Dixon braved personal threats and violence too. After a compulsory vaccination law was passed in 1905, angry protestors in Waynesboro marched in the streets and burned the commissioner in effigy. One man, convinced vaccinations would kill his children, waited outside Dixon’s house to assassinate him but was foiled when the commissioner took a different route home that evening.

Undeterred, DOH used its powers to enforce vaccinations, keep water sources clean, and stifle epidemics with preventative medicine and quarantines. With a healthy annual budget and the trust of elected officials, DOH expanded its programs to manage many different health risks from venereal disease to occupational safety and drug abuse.

 

At the 50th anniversary commemoration of the Battle of Gettysburg in 1913, the Department of Health operated an emergency hospital. Pennsylvania State Archives/RG-25

At the 50th anniversary commemoration of the Battle of Gettysburg in 1913, the Department of Health operated an emergency hospital.
Pennsylvania State Archives/RG-25

In preparation for the 1913 reunion for the 50th anniversary of the Battle of Gettysburg, DOH was given “entire control of health affairs” of the borough for several months. As 100,000 veterans, visitors and guests of honor descended on the community of 5,000 residents, DOH staff expanded sewers and sanitation systems, established relief stations and emergency hospitals, and raised its own army of doctors and nurses ready for anything from heatstroke to food poisoning. Dixon even recruited a local Boy Scout troop to serve as a hospital and ambulance corps, making sure that the thousands of elderly veterans remained healthy and comfortable during their stay.

Over the course of the three-day reunion, the DOH hospital treated more than 1,000 cases, including heat exhaustion, sunburn, asthma, hernias, broken bones and insect stings. Grateful for the their professional and effective work, Gettysburg borough passed a resolution commending the department, noting its success was “due to the wise policy of the General Assembly in the liberal provision of funds necessary for the development of the Department and for the maintenance of its power and activity in safeguarding the health of the citizens of the Commonwealth and of sojourners within its borders.”

Elected officials breathed a collective sigh of relief as DOH’s efforts paid off. Within just a few years, the mortality rate from diseases like diphtheria and scarlet fever dropped by more than 50 percent; deadly typhoid deaths were reduced by more than 75 percent. Governor Pennypacker was thrilled with these successes and predicted “there is good ground for hope that many of the inflammatory diseases due to specific poisons, such as typhoid fever, smallpox, diphtheria, and tuberculosis, may be in time stamped out of existence.”

When Dixon died in 1917, the 12-year-old DOH had an impressive list of achievements. Disease rates had dropped precipitously and the department estimated its work had saved the lives of 120,266 Pennsylvanians. “There are very few citizens in the State who are not touched in one way or another by the work of the Department,” Lafayette College biologist B. W. Kunkel wrote. “Even those who have not known a day of sickness in their lives have escaped sickness by the laws and regulations of the local health boards and the Department of Health of the State.”

 

The Pennsylvania Department of Health charted the steady drop in state mortality rates in the years after it was created. The exception was the spike in 1918 during the influenza pandemic.

The Pennsylvania Department of Health charted the steady drop in state mortality rates in the years after it was created. The exception was the spike in 1918 during the influenza pandemic.

The growth of state-sponsored public health and the creation of Pennsylvania’s Department of Health were the result of years of hard work and lucky breaks. Lives lost at Plymouth and Butler, though horrific, spurred government to act. Looking back, Lee called these epidemics “a friend to our board” and admitted they had a bigger impact on advancing public health in Pennsylvania than anything else.

Pennsylvanians continue to benefit from the public health work of the 19th and early 20th centuries. The lessons learned from the epidemics helped DOH respond to public health disasters like the outbreak of influenza in 1918. As disease and other health threats continue to impact Pennsylvania today, it is important to remember the role the Department of Health plays in keeping citizens healthy and the price that was paid for it.

 

Additional Reading

The most succinct history of public health in Pennsylvania is Jim Higgins’ “Under the Stimulus of Great Epidemics: Reformers, Epidemics, and the Rise of State Level Public Health in Pennsylvania, 1872−1905,” Pennsylvania History 84, no. 2 (2017), 214−238. Equally useful is B. W. Kunkel’s Milestones to Public Health in Pennsylvania (1967), a chronicle on public health in the state from the days of William Penn to the 1960s.

Vikki Daniel’s “Public Health and the Dead at Johnstown,” Nursing Clio, December 2, 2015, contains an excellent account of the public health disaster after the infamous flood and how the State Board of Health struggled to respond. Karol Weaver’s “She Knew All the Old Remedies: Medical Caregiving and Neighborhood Women of the Anthracite Coal Region of Pennsylvania,” Pennsylvania History 71, no. 4 (2004), 421−444, is an informative piece about the health care that was available to rural Pennsylvanians before the Department of Health.

The Pennsylvania State Archives has a wealth of records related to the Department of Health, particularly in Record Group 11: Records of the Department of Health and Manuscript Group 717: Samuel W. Pennypacker Papers.

 

Tyler Stump is an archivist at the Pennsylvania State Archives and regular contributor to the Picturing PA department in Pennsylvania Heritage.