In 1905, the state board of health for Connecticut looked back over the last half century and noted the tremendous change that had occurred. In the first half of the nineteenth century, “all the towns and cities in Connecticut were very rural in character, and nowhere were populations so dense from overcrowding as to affect the public health. Hence there was no conspicuous disparity in the salubrity of different towns.” As Connecticut industrialized and urbanized, disparity in the salubrity of different parts of the state increased. It became “an accepted fact, sustained by careful observation, that the death-rate was always higher in cities than in the country.” Although the pure past to which the Connecticut State Board of Health alluded may not have been as pure and healthful as it assumed, nonetheless, the board was correct in noting the increase in mortality in the industrial towns and cities that grew up over the century. Growing awareness of the “effect of environment and employment upon the prevalence o f . . . disease” created momentum for public action. The vision of an activist state promoting public health and protecting the citizens, particularly the “weak” and “poor,” from the vagaries of the market—whether those were represented by “foul” water or depleted resources—increasingly found support among other reformers. The urban industrial setting that made Connecticut’s cities so unhealthy also generated concerns overworking children, long working hours for women in the paid labor force, industrial diseases, and overcrowded tenements. Like the antipollution reformers, those who were concerned over these conditions increasingly looked to the state to legislate remedies. Laws that limited women’s working hours and child labor and that controlled the conditions of tenements found favorable hearings among legislatures attuned to an electorate demanding reform of the conditions they found in their daily lives. Environmental reformers—both public health activists and supporters of protection for fish—were important voices in this rising chorus that favored a more active state. The momentum for public action began in Massachusetts, the most industrialized and urbanized New England state, and spread to the other states of the region and ultimately to the entire nation.
The Relation of Public Health Nursing to Other Phases of Work of the State Board of Health, with Special Reference to That of the Division of Child Hygiene