WORLD OF MICROBIOLOGY AND IMMUNOLOGY History of Public Health275•
yet known. By the sixteenth century, the idea of a microbial
cause of disease (e.g., “contagion”) was being debated.
In the United States, the organized public health initia-
tive that is today’s Public Health Service began in the late
eighteenth century. Legislation passed by the United States
Congress in 1798 provided care and relief for afflicted
mariners. Hospitals to serve seamen were established on the
eastern seaboard and later in cities on the Great Lakes, Gulf
coast and Pacific coast. In 1870, the control of these hospitals
became the responsibility of the newly formed Marine
Hospital Service, headquartered in Washington, DC.
Because mariners were often the carriers of infectious
diseases acquired in other countries, the Marine Hospital
Service soon became concerned with infectious diseases. In
1887, a small bacteriology laboratory (the Hygienic Laboratory)
was created at a marine hospital on Staten Island in the New
York harbor. The laboratory was later relocated to Washington,
DC, where it became the National Institutes of Health.
The increasing responsibility for infectious disease treat-
ment and research prompted a name change of the organization
to the Public Health and Marine Service (1902) and the Public
Health Service (1912). In the twentieth century, the services’
role in controlling infectious microbial diseases and funding
infectious disease research expanded. For example, among the
agencies that comprise the Public Health Service are the
Centers for Disease Control, the National Institutes of Health,
and the Food and Drug Administration. Approximately 60,000
people are employees of the Public Health Service, whose
annual budget now exceeds 15 billion dollars.
As the public health infrastructure was growing in the
nineteenth century, public health nursing was also growing in
the United States. In 1898, Los Angeles became the first city
to employ a nurse to care for sick people in their homes.
Thereafter, more governments recognized that caring for the
populace in the homes and workplaces had a positive effect on
the society as a whole, in terms of reducing the spread of
infectious diseases.
During the nineteenth century, microbiologists such as
Louis Pasteurand Robert Kochdemonstrated the involvement
of bacteriain disease. The importance of maintaining a
hygienic atmosphere in hospitals was recognized. Indeed,Joseph Lister’s implementation of the use of a disinfectant
spray and fresh changes of operating smocks for surgeons
greatly decreased the mortality rate associated with opera-
tions. Because of these public health efforts, operations moved
from a position of last resort to a procedure that could improve
the health and alleviate suffering in people.
The increasing disparity between the developed and
underdeveloped countries of the world spawned major inter-
national public health efforts in the twenty-first century. The
most prominent example is the World Health Organization
(WHO), created in 1948. Other agencies are noteworthy as
well, such as the United Nations International Children’s
Emergency Fund (UNICEF), which was created in 1946 to aid
children victimized by World War II.
At the time of the creation of UNICEF and the WHO,
the average life expectancy in the world was 46 years. As of
the late 1990s, this average life expectancy had risen to 65
years of age. Much of this increase is attributable to organized
public health initiatives such as vaccination, medical care and
hydration programs.
The recognition of the involvement of microorganisms
and disease has continued to the present day. Since the 1970s,
a series of microbiologically related diseases (i.e., Acquired
ImmunodeficiencySyndrome) has prompted renewed empha-
sis on public health. Other diseases that were thought to be due
to a genetic or physiological abnormality (e.g., stomach
ulcers, heart disease) have been demonstrated to be at least
partially due to chronic bacterial infections. Lessening the
chances of exposure to such infectious agents has become
another public health concern.
Another watershed in the history of public health has
occurred in the latter decades of the twenty-first century. Then,
the importance of the adherent bacterial populations known as
biofilms to the establishment and maintenance of long-lasting
infections that are extremely resistant to treatments became
known. Biofilmsare important in environments ranging from
the operating room to the drinking water treatment plant. This
importance has focused public health efforts on the prevention
of biofilm build-up and on the creation of strategies that elim-
inate the biofilm bacteria.The scourge of epidemics.womi_H 5/6/03 3:21 PM Page 275