It's no surprise to find the history of public health in Philadelphia closely linked with the history of the city's growth. William Penn's "greene countrie towne," home to many of the nation's first great civic institutions, was the first American city to provide free hospital care for its poorest citizens: the Philadelphia Almshouse at Third and Pine Streets was originally built in 1732, then relocated to 10th and Spruce in 1767. The Almshouse became a series of different health care facilities over a span of more than a century, finally ending in 1919 as Philadelphia General Hospital ("Old Blockley"), at 34th Street and University Avenue. The Hospital was closed in 1977.
In 1793, five years after the drafting of the United States Constitution, Philadelphia was swept by an epidemic of yellow fever. A Board of Health, with Dr. Benjamin Rush as a member, was created to counter the plague and monitor sanitary conditions within the city. As a related measure, The Guardians of the Orphan Children was instituted the following year to provide physical and economic aid for children left parentless by yellow fever.
The Board of Health employed inspectors to monitor and eliminate potential health hazards. This included the 1799 construction of the Lazaretto, a quarantine hospital on an island in the Delaware River, just south of the city. All ships, foreign and domestic, were inspected here before entrance to the city was allowed. The Board of Health continued this function for the Port of Philadelphia until 1893, when the Commonwealth of Pennsylvania took over.
The Board's organization was frequently changed over time, existing as a unit under the Department of Public Safety in 1887, then becoming the Department of Public Health and Charities in 1903. In 1919, the City of Philadelphia reformed the DPHC as the Department of Public Health, as which it remains at present.
By the middle of the 19th century, the Board of Health was an official branch of the city government. Emphasis was placed on the active prevention and control of disease, and the Board's duties expanded to include vaccinations, compilation of health statistics, eradication of "public nuisances" and maintenance of the local water supply.
While the smallpox vaccine was available as early as 1801, Philadelphians were generally reluctant to be inoculated, only doing so in considerable numbers during times of epidemic, such as 1871-72. State law finally compelled smallpox vaccinations as a prerequisite for school attendance in 1895.
One of the Bureau's major achievements during this period was the institution of recorded health statistics. As early as 1819, the Bureau of Health began to register all births in Philadelphia, when new State legislation required physicians to record all births under their care. As the city's population expanded through the 19th century, additional laws were passed to mandate registration of all "life statistics": births, marriages and death. In 1915, this responsibility passed to the State Bureau of Vital Statistics.
Philadelphia experienced all the attendant problems of expansion many of which manifested themselves as "public nuisances." Overcrowded housing, open sewage, decaying buildings, and insufficient garbage collection were some of the problems monitored by the Board of Health. Inspectors made frequent site visits to problematic areas (tenements, privies, slaughterhouses) in ongoing efforts to keep such areas in line with city codes.
The impact of the yellow fever epidemic was still felt as the Board of Health pushed for a dependable supply of clean water for the city. The Bureau's efforts were largely responsible for the completion of the Fairmount Water Works in 1820, a landmark of municipal construction and, through the 19th century, second only to Niagara Falls as an American tourist attraction, rating mention in Charles Dickens' travel book American Notes, and in Herman Melville's White-Jacket).
The present-day Philadelphia Board of Health addresses a vast number of contemporary urban issues: AIDS, Environmental Health, Noise Pollution and the West Nile Virus, along with such traditional standbys as tuberculosis, drug and alcohol abuse and standard vaccinations. From its headquarters in Center City, and in Health Care Centers in locations in the city's various neighborhoods, the DPH works "to promote and ensure the availability, accessibility and quality of preventive and personal health services necessary to protect and improve the health and well-being of the Philadelphia community."
Philadelphia Department of Public Health
Hardwick, Mary-Angela (2001). Here is to your health: a salute to the history and service of the Philadelphia Department of Public Health [A public exhibition co-sponsored by the City of Philadelphia Department of Records and the Philadelphia Department of Public Health]
Sher, Dena (2001). Fairmount water works: past & future. Retrieved May 29, 2001.