For the Greater Good?: Public Health Regulation at the Turn of the Twentieth Century

Public Health Governance

OHSU Historical Collections & Archives' recent digital project, Public Health in Oregon: Discovering Historical Data, digitized and transcribed historical vital statistics on public health in Oregon. Improved access to and use of this data will inform current and future studies relating to public health in the state and around the globe. This exhibit examines the work of some of the regulatory authorities at the turn of the twentieth century in Oregon and the surrounding area, for better or for worse.

Regulations regarding public health in Oregon began to take shape in the late 1800s. In the1860s and 1870s, the City of Portland initiated several formal mechanisms for controlling infectious diseases in the area. The city appointed its first Board of Health in 1873, along with a designated physician dedicated to inspecting infectious disease cases. The Office of State Dairy and Food Commissioner was established in 1893. Ten years later, as one of only three states left without one, Oregon finally established its own Board of Health in 1903;spurred by fears over an outbreak of bubonic plague in San Francisco.

An important addition to the rules and regulations being put into place was the keeping of vital statistics, a charge made to the State Board of Health in 1915. Without accurate knowledge and data about the spread and extent of diseases in the state, control and prevention of further spread would be nearly impossible.

portland board of health

Esther Pohl Lovejoy, seated at left, and Portland Board of Health staff, 1907. Esther Pohl Lovejoy Papers.

Dr. Esther Pohl Lovejoy, head of the Board of Health, Portland, Oregon, with staff at the health office: Dr. Lovejoy was Chairman of the Board from 1907 to 1909 and was the first woman to head a health department in a major U.S. city. Lovejoy was a proponent of Progressive ideals, believing that it was the responsibility of government to support the health and well-being of the people.

Food Safety and Sanitation

Food and dairy safety were of major concern for all in the early twentieth century. Contaminated dairy products especially were known to spread diseases, such as tuberculosis and typhoid fever. New ordinances and inspection standards at national, state, and local levels helped ensure that milk production and storage were of the highest quality possible. Enforced penalties deterred producers who attempted to evade the rules and pass off substandard products.

A major factor in the concern over milk was the health of children. Cow's milk was seen as the best substitution for breast milk. Babies who could not be breastfed had no other options and also could not refuse what was given to them. The infant mortality rate was too high and milk was often the focus of efforts to decrease infant deaths. Expansion of the population further exacerbated the issues of dairy production; as cities grew, farms were pushed further and further out, creating more problems for safely storing and transporting dairy.

Sanitation was another difficulty in growing communities of Oregon. Many cities and towns lacked an adequate clean water supply or systems for waste removal. Sewers frequently flowed into the same waterways that served as the local water supply, if sewer systems were even in place. Outhouses were often located in close proximity to living and eating areas of the home. Garbage and other refuse removal was often left to the individual to dispose of, leading to more unsanitary conditions.

water tower in Canby OR
Water tower and Chlorinator, 1930. Public Health Survey Records.

Communicable Diseases

Communicable diseases have always been a major concern for public health professionals.While the Spanish explorers who landed on the Oregon coast in the 1770s brought with them smallpox, malaria, and other diseases then unknown to the local inhabitants, it wasn't until 1833 that Oregon recorded its first reported case of tuberculosis. In 1900, tuberculosis was the number one cause of death in the U.S.

Laws requiring the reporting of tuberculosis cases and ordinances designed to curtail disease spread (such as Portland's anti-spitting ordinance) were all poorly enforced and relatively ineffective in controlling infections. In 1905, the first open-air sanatorium in the Pacific Northwest opened just south of Portland, in Milwaukie Heights. The State Tuberculosis Hospital, the first state owned and operated tuberculosis sanatorium in the West, followed in 1910. Further hospitals opened to help stem the outbreaks, with Oregon State Tuberculosis Hospital in 1928 and the University State Tuberculosis Hospital on Marquam Hill in 1939.

Besides the scourge of tuberculosis, early public health officials were also concerned with smallpox, diphtheria, typhoid, and venereal diseases, along with many other contagions. Education of the public was one way boards of health could work to stem the progression of diseases. Focusing on immunizations and vaccinations whenever possible was another vital effort, along with keeping and analyzing vital statistics about the propagation and transmission of diseases.

Portland pest house
Pest house, 1899. Historical Image Collection.

This "pest house," which the city's Committee on Health and Police purchased in 1899, was located on two acres of land in the West Hills of Portland. It was used to isolate cases of communicable diseases, such as smallpox, from the general public.

Eugenics

The eugenics movement became popular in the United States in the late 1800s as state governments sought to control the reproductive choices of citizens that they deemed "defective." It was believed that evolutionary science and genetics could be used to solve social problems. Through selective reproduction, supporters of the movement thought that they could advance the human race by "weeding out" undesirable traits.

In 1917, eugenics advocates such as physician Bethenia Angelina Owens-Adair successfully lobbied for a eugenics law in Oregon, creating the State Board of Eugenics. Members of the Board included superintendents from the Oregon State Hospital, Eastern Oregon State Hospital, the State Institution for the Feeble-Minded, and the State Penitentiary. The law allowed for the sterilization of inmates, psychiatric patients, orphans,and other wards of the state to avoid passing along their "defective" genes.The Board would review cases of "undesirables," rule on sterilization and order the surgery deemed most appropriate, which, in the early days, included at least 160 castrations. In the 1920s and 1930s, this work extended into orphanages and homes for delinquents.

The Board's name changed from Eugenics to Social Protection in 1967, well after World War II and during the height of the Civil Rights Movement, but it largely carried on as usual, carrying out its last forced sterilization in 1981 before being abolished in 1983. During its active years, the Board oversaw more than 2,600 acts of sterilization in the state.

Child Guidance Clinics

The idea of "child guidance," which is often seen as a prophylactic strategy for implementing eugenic ideas, originated in 1909 in Chicago. After developing its juvenile court system, the city moved on to create the first clinic focused on "social control" of children. Child guidance clinics sought to remediate troubled children and to instill in them "essential values" such as "reliability, control of animalism, steadiness of endeavor, and the social spirit or sense of social justice." Run by specialists in applied education, psychology, psychiatry, and sociology, the clinics sought to create a "systematic approach to the study and treatment of specific instances of personality unadjustment." This "unadjustment" was defined as a lack of balance between one's "individual promptings and their satisfaction in the social milieu." The approach generally began with a combination of social-history, psychometric, and medical studies of the child and led to a psychotherapeutic treatment plan for both the child and parents, as well as efforts to manipulate the child's environment.

Child guidance came to Oregon in 1932 with the founding of the Child Guidance Clinic at the University of Oregon Medical School (UOMS), and in 1937 the program grew to include an extension service –a traveling clinic that visited many rural parts of Oregon that lacked adequate medical and psychological care. The 1937 Child Guidance Extension Act appropriated $24,000 to clinic operations outside of Multnomah County and delegated administrative duties of the program to UOMS. While this clinical role would be controversial today, the "experimental" clinics were seen as "ahead of the times" in 1937, to the point that UOMS feared that failure of the program might tarnish their reputation.

Child Guidance chart
State Child Guidance Program. Child Guidance in Oregon: With Recommendations of the Governor's Special Committee. Portland, OR: State Guidance Program, University of Oregon Medical School, 1937.