How We Died: Public and Private Health in Early America

Was there a meaningful shift in early American health? Certainly, some groups of people in the North experienced positive transformations between 1790 and 1830. White, native-born, northeastern men could expect to live longer than previous generations, and the municipal regimes they elected assumed more responsibility for their public’s health. By the nineteenth century, independent health boards were convened in towns across New England and the mid-Atlantic. They employed trained and licensed experts to define and track contagious diseases such as influenza, bubonic plague, scarlatina, measles, and typhus. During epidemics, state authorities funded and empowered a so-called health police to condemn buildings and cleanse streets, while city governments tackled complex health ventures such as quarantines and the relocation of cemeteries to sites outside town limits. Eventually, medical training standardized, and physicians were more likely to question heroic interventions such as bloodletting and purging and embrace cutting-edge theories such as contagionism, palliative care, sanitationism, and race science.1 Colonial disease paradigms such as “virgin soil epidemics,” the “Columbian Exchange,” the weaponization of differential immunity, and the “Great Dying”—now associated with mass Indigenous death and imperial warfare—became distant memories as William J. Novak’s well-regulated (or at least better-regulated and more democratic) society ascended. By 1800, white American adults were more likely to be inoculated against smallpox and reside in crowded towns with epidemiological dangers different to those of their youths. But while these average Americans were more likely to contract and die from crowd diseases such as tuberculosis and pneumonia—the nineteenth century’s great killers—they did so within cities and a nation that increasingly equated public health with modernity.2