Cholera Outbreaks Led to Monmouth's First Health Department

This is the first of four blogs about Monmouth County's six Health Departments.

On September 12, 1872, members of the Metropolitan Board of Health of New York City and other state officials convened in Long Branch, New Jersey, to create the first permanent organization for public health professionals in the United States.

“If a date can be assigned to the professionalization of public health it would be the appearance in 1872 of the American Public Health Association” wrote the public health historian John Duffy in his book The Sanitarians.

Two years later in 1874, Monmouth County’s first health department was established in Long Branch. Six years after that, on March 11, 1880, legislation was passed that required every municipality in New Jersey to form a local board of health.

Because of this law, 376 of the 3000 boards of health in the nation are now located in the state’s 565 municipalities. These boards oversee about one hundred local, regional and county health departments in the twenty one counties. Monmouth County presently has six: one county, one regional, and four local health departments.

Why was public health so popular in the 1870’s? Almost forty years of Asiatic cholera.

It had spread from the Ganges delta in India and developed into three pandemics: 1832-1833, 1849-1854, and 1866-1867.

The epidemics began suddenly, lasted a few months, then returned years later. Severe vomiting and diarrhea were followed by cramping and dehydration. Without treatment, an attack could be fatal within a few hours.

Cholera is usually spread through contaminated water, and is now known to be caused by the bacteria Vibrio cholerae. But this bacteria would not be identified by Robert Koch, one of the founders of the science of bacteriology, until 1884. So two theories had developed about how disease spread.

Public Health Evolves

Followers of the contagionist, or germ theory, believed that disease could only be caused by physical contact. The anticontagionist, or miasma theorists speculated that disease was not spread just by direct physical contact. It could be caused by gases from sewage and garbage. They believed environmental sanitation was needed to stop an epidemic.

Miasma became the prevailing theory during the first outbreak in 1832. It even impacted the farm economy in Middletown, according to Thomas Leonard's From Indian Trail to Electric Rail. In 1832, vegetables and fruit shipped to Manhattan from Leonardville (Leonardo) and Chanceville (New Monmouth) were sent back because produce had been linked to the spread of the disease:

“1832 was the year of the first cholera in this country. The doctors forbid the citizens of New York and other cities eating of the farmer’s produce, new potatoes, green corn, cucumbers, watermelon and citron. … We had twenty acres that year in watermelons. They would not buy them in the city of New York. Captain Henry Schenck took a large schooner load up to New Haven, but brought them all back.”

The miasma theory gained popularity in England after Edwin Chadwick published his "General Report of the Sanitary Conditions of the Labouring Population of Great Britain" in 1848. His report was barely in print when the second wave of cholera began in 1849.

One of the most famous if short-lived breakthroughs in public health happened near the end of the second cholera pandemic. On September 7, 1854, Dr. John Snow convinced London officials to remove the handle on a well pump on Broad St so that the residents could no longer drink from it. He drew a dot map of the home addresses of everyone who had contracted cholera and overlaid the location of the communal well pump in their neighborhood. He used statistics to confirm that the Broad Street pump had the largest cluster of cases.

The pump handle was removed the next day. He is now remembered as one of the founding fathers of modern epidemiology and the germ theory of disease.

What is less discussed is that the pump handle was put back about a year later on September 26, 1855. Cholera seemed to be gone that fall, and the residents wanted their well back.

Public health cycles out of favor as the memory of the disaster fades. The pump handle wasn’t permanently removed until the third epidemic of cholera in 1866.

The third time was a charm for public health in Monmouth County as well. Five thousand people had died of cholera in New York in 1849. By 1866, the public wanted something done. Now.

Long Branch may have formed the County’s first health department in 1874 because it had become a popular ocean resort for New York City, which had established the nation’s most progressive health department in 1866.

Part 2: Long Branch Forms Two Health Departments

RESOURCES

Condran, Gretchen A. 1995. "Changing Patterns of Epidemic Disease in New York City, 1625-1990."in Hives of Sickness, Rutgers University Press. http://www.columbia.edu/itc/hs/pubhealth/rosner/p8773/readings/condran.pdf

Cowen, D. 1964. Medicine and Health in New Jersey: A History. D. Van Nostrand and Company, Inc. Princeton, NJ.

Duffy, J. 1990. The Sanitarians. A History of American Public Health. University of Illinois Press. Urbana and Chicago.

Leonard, Thomas H. 1923. From Indian Trail to Electric Rail. The Atlantic Highlands Journal. Atlantic Highlands, NJ.

McGuire, Michael. Accessed 8/3/13. This Day in Water History (September 7, 8, 26). http://thisdayinwaterhistory.wordpress.com/

New Jersey Department of Health and Senior Services. 4/2008. A study of New Jersey’s Local Public Health System. Div. of Health Infrastructure Preparedness and Emergency Response. http://www.state.nj.us/health/lh/documents/study_report.pdf

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Powitz, R. Accessed 12/31/09. The History of the Sanitarian Profession. National Environmental Health Association (NEHA). http://www.neha.org/pdf/articles/Brief_History_of_the_Sanitarian.pdf

Rosenberg, Charles.1962. The Cholera Years. University of Chicago Press.

Safedrinkingwaterdotcom. Accessed 8/3/13. 30 Days of #DrJohnSnow. http://safedrinkingwaterdotcom.wordpress.com/2013/02/19/30-days-of-drjohnsnow-2/

Wikipedia. Accessed 8/3/13. John Snow (physician). http://en.wikipedia.org/wiki/John_Snow_(physician)

Wikipedia. Accessed 8/10/13b. Miasma theory. http://en.wikipedia.org/wiki/Miasma_theory

Writers Project, Works Projects Administration, State of NJ.1940. Entertaining a Nation. The Career of Long Branch. Sponsored by the City of Long Branch. American Guide Series.

World Health Organization. July 2012. Cholera. Fact sheet #107. http://www.who.int/mediacentre/factsheets/fs107/en/