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Public Health

Public health is a magic word which ever grows more potent as we realize that the very existence of the modern city would be an impossibility, had it not been discovered that the health of the individual is dependent upon the hygienic condition of his surroundings. -- Jane Addams, Charity and Social Justice, May 19, 1910.

With modernization, industrialization, and urbanization, American cities had to deal with a crisis in public health. Never before had so many lived together in such crowded spaces and worked in such dangerous and unsanitary conditions. Cities, particularly, became a target for Progressive reformers who worked to investigate the causes of disease and sickness and work to eradicate it on the local, state, and national level. Activists for improved public health championed reforms  ranging from street cleaning, pure milk programs, building and factory inspection, and efforts to combat contagious diseases. Poor regions of cities like Chicago and New York were in terrible condition, buildings in disrepair, garbage and litter everywhere, and little sanitation. Immigrants from the farms around the city and from Europe were crammed into these spaces and disease and illness followed. The city services designed to deal with these issues were failing, whether due to an inability to handle the problem, or due to municipal corruption.

Industries were a big contributor to the polluted cities --  factories spewed ash and poisonous chemicals into the city air, while the materials that workers handled, like white phosphorus and lead, caused serious health problems to workers. The stench from meatpacking and slaughtering districts as well as horse-drawn carts covered the streets with waste and clogged  waterways. Where there was garbage, rats and insects followed.  Most people’s homes were no safer. Landlords built tenements cheaply and did not maintain them. There were few regulations or inspections, and people crammed as many as they could into these spaces. Diseases spread rapidly in these confined spaces.

The public health crisis was a result of the industrial revolution that people had not foreseen. In reaction to the horrific conditions, Jane Addams saw the need to reform these conditions so as to ensure that her neighbors and others in Chicago had chance at good health and living conditions.

Addams' campaign for public health began as a fight for proper public sanitation. There was no system in place to deal with the enormous amounts of garbage in the streets, no proper system for removing waste in an era when plumbing had not yet reached most houses. Addams believed that people new to city life needed training on how to discard their trash in ways that wouldn’t pollute the city. She educated her neighbors in the 19th Ward on danger of dumping trash in the streets. She also turned to the city and demanded that sanitation officers do a better job removing the waste that was discarded in trash bins. Whether due to overwork or corruption, she noted that many trash boxes were overflowing, unattended, and a danger to the children who played in the streets. Addams sought not only to have sanitation improved, but also argued for playground reform. She thought that building safe spaces for children to play would let them exercise and play creatively without the danger from the filth in the streets.

Addams found her efforts blocked by municipal corruption and inefficiency. Chicago was just developing systems of waste removal and there were no strong laws to keep people and industries from dumping waste. The city government did not want to drive industries out of the city by enforcing dumping restrictions. Furthermore, Addams discovered that corruption in the 19th Ward meant that the task of sanitary inspection was given to political cronies of the ward boss. Addams found that the immigrant neighborhoods were particularly affected as many of the immigrants had never been in a city before and did not realize that the conditions they were forced to live under would be unacceptable to most Americans. Addams did more than speak out against the sanitation issues, she organized women to help inspect and complain about the garbage pickup, and in 1895 she was appointed garbage inspector of the 19th Ward>.

Addams urged reform for public health when ever she saw the need. In 1907 she blasted the way that hospitals treated the poor. Addams charged that hospital workers were obsessed with “red tape” and bureaucracy to the point that it could threaten a patient's life. In one case< she described a patient whose emergency treatment was delayed because the nurses insisted that the patient be bathed and hair braided. She was also critical of the disparity in care between wealthy and poor patients.

<Addams' reform work for better public health in Chicago addressed problems that had sprung from the industrial revolution. Her ideas about public health came from her experiences talking with and living in an immigrant slum in West Chicago, and because she worked closely with immigrants, she was able to explain the city leaders how these conditions damaged the city’s population. Success did not happen overnight, but gradually over time conditions improved. As a result of the attention paid to sanitary conditions, Chicago eventually created civil service jobs to manage sanitation, removing the job from the ward bosses.

Recommended primary sources:

Jane Addams, The Housing Problem in Chicago, July 1907.

Jane Addams, Address to the Hull-House Woman's Club, April 16, 1902.<

Jane Addams, The "Piece-Work" System as a Factor in the Tuberculosis of Wage-Workers, 1908.

Jane Addams, Neighborhood Improvement, June 22, 1904

Jane Addams, Charity and Social Justice, May 19, 1910

Additional resources:

William Kovarik. Ellen Swallow Richards and the women’s reform movement (Environmental History Timeline).

Ruth Clifford EngsClean Living Movements: American Cycles of Health Reform(2000)

Robert Hunter, Tenement Conditions of Chicago (1901).

Suggested subjects:

Addams, Jane, and public health

Addams, Jane, views on poverty>

Addams, Jane, views on social work

neighborhood improvement

public health

social welfare

urban improvement

Photo credit:

Lewis Hine, 'Hull-House, Our Backyard' (1910). Jane Addams Memorial Collection, University of Illinois at Chicago.