Public Health Measures and Mortality in U.S. Cities in the Late Nineteenth Century

In this paper we examine the decline in mortality rates by cause of death in U.S. cities during the last decade of the 19th century. Causes of death are grouped according to their probable relationship to specific public health measures. The reduction which occurred in the death rates from some disease, e.g., typhoid and diarrheal diseases, can probably be attributed in part to the provision of sewers and waterworks. Large declines also occurred in the death rates from tuberculosis and diphtheria, but the relationship between the declines in these diseases and public health practices designed to combat them is more ambiguous. We therefore conclude that public health measures had some impact on the decline in mortality, but that these measures do not provide a complete explanation of the mortality decline.