It’s easy to forget that during the 1930s, Adolf Hitler and his National Socialist Party—though seen as radical by many—were not necessarily considered a threat to world peace. It’s even easier to forget that Hitler had more than a few sympathizers, even outright supporters, in the United States. Here are some pieces of history that are seldom discussed, but should serve as a reminder as to how extremist ideals can take hold anywhere, anytime.

10The Bund

A great portion of Nazi ideology revolved around the purity of the German “race,” and Hitler shrewdly realized early on that this could be exploited in the German migrant populations of his potential foes. A mere four months after his rise to power in 1933, an American organization known as “Friends of the New Germany” was assembled from several smaller organizations around the US. Originally made up of both German nationals and US citizens of German descent, it was restructured in 1936 into the German American Bund (“Bund” meaning “Alliance”), which admitted only German-Americans.

Since a quarter of the US population at the time had some German ancestry, membership was higher than one might imagine. The Bund’s leader, Fritz Kuhn, was even dubbed the American Fuhrer. While taking care to ensure its perception as an American organization remained solid (expressions of American patriotism were plentiful in Bund gatherings, which often took place on American holidays or on presidents’ birthdays) the fact remains that American citizens gave the Nazi salute, shouted “Heil Hitler,” and otherwise behaved much as an attendee at any German Nazi Party gathering would have. Fritz Kuhn was exposed by undercover journalists in 1937 and jailed for embezzlement two years later.

9Nazi Summer Camps

After its 1936 restructuring, the Bund began making a concerted effort to advance Nazi ideology in the hopes that the US could be made sympathetic to, or even a stronghold for, Hitler and his armies. Among its most alarming projects: summer camps for American youths. While not supported by or directly related to the infamous Hitler Youth program, the similarities were nevertheless glaring. Parents and children alike saluted the Fuhrer and wore the same armbands their German counterparts did. By the time they were shut down shortly after the start of the war, 16 of these camps existed all across the country, from New York to Los Angeles.

Anti-Semitic sentiment was at an all-time high in the US at this time, and programs like these were intended to indoctrinate America to racist, fascistic ideologies. Children from eight to 18 were taught to speak German and participated in military-style drills. Nazi ideology and German heritage were essentially presented as part of the same package, and many German-Americans were receptive to the message.

8The New York Nazi Community

The most prominent of these camps was Camp Siegfried in upstate New York, outside the small town of Yaphank. The town’s small houses were originally built as bungalows for the summer campers. Anyone seeking to purchase land in the town had to be primarily of “German extraction.” Many of its main streets were named after Hitler, Goebbels, and other prominent Nazi Party leaders.

Even after the beginning of the war, pro-Nazi sentiment would, shall we say, not get one kicked out of the town of Yaphank. Nazi-themed parades were held on its streets, Nazi and SS flags were flown side by side with American flags, and residents carved a giant hedge into the shape of a swastika.

Though the land was eventually seized by the FBI after the war, the town still stands, retaining the original tract homes built for pro-Nazi summer campers. Unfortunately, though many of its residents are unaware, its racist bylaws are still in effect. Even today, virtually all of its resident are white and of German ancestry.

7The Madison Square Garden Rallies

Friends of the New Germany, and later the Bund, were headquartered in New York, making the state a primary hub of American pro-Nazi activity. As early as 1934, the predecessor organization was holding rallies at Madison Square Garden. Participants gave the Nazi salute, chanted slogans, and bore banners with sentiments such as “Stop Jewish Domination of Christian Americans.”

The most infamous of these gatherings took place on February 20, 1939, when the Bund was at the height of its power. A Bund gathering wrapped in the title of a “Pro-America” rally at the Garden was attended by over 20,000 people that day. Four times that number protested outside the venue, attempting to storm it and shut it down. They were unsuccessful, but this was among the last such events. The Bund was dissolved after the US declared war on Germany in late 1941.

6The Bush Connection

Conspiracy theories have long examined a possible collusion between the US government and the Nazi regime. Circumstantial evidence abounds, from the similarities between the CIA’s reviled MKUltra program and similar programs developed by the Nazis, to the role of some of Hitler’s top rocket scientists in the development of NASA.

Among the many outlandish claims, a truth was revealed near the turn of this century that is somehow even more outlandish: Prescott Bush—a US senator and father of future president George H.W. Bush—had mutually beneficial business relationships with German companies that were directly involved with Hitler’s rise to power.

While the secretive nature of these dealings helped them avoid scrutiny for decades, the eventual reveal prompted speculation as to whether Bush should have been tried for war crimes. The assets of his company were seized in 1942 under the Trading With The Enemy Act. Not only may this relationship have played a substantial role in helping fund the Nazi war effort, it may have also laid the foundation for the Bush family fortune.

5Nazi Radio

As previously suggested, fascism was not as dirty of a word in the 1930s as it is today. Still, the vast majority of Americans were wary of fascist regimes and their tactics; after German paramilitary forces and citizens took to the streets on November 9, 1938—the infamous Kristallnacht—an American poll revealed that 94 percent of Americans disapproved, despite the pervading anti-Semitic sentiment of the time.

Yet throughout it all, one loud voice could be relied upon to defend and explain Hitler’s actions: Father Charles Coughlin, a Catholic priest and radio personality with an audience of millions. Coughlin had built his audience attacking “bankers” during the Great Depression, and he extended this criticism specifically to Jews in a broadcast that took place a mere 11 days after Kristallnacht. He railed against German Jews for appropriating Christian property and attempting to spread Communism.

Although his show was canceled shortly thereafter, the damage was done. Coughlin became the hero of Berlin . . . and America. The station owner reported that that, in response to the cancellation, “several thousand people encircled the block where our studios are located, denounced . . . WMCA as un-American, and shouted its slogan of ‘Don’t buy from Jews,’ ‘Down with Jews,’ etc.”

4American Roots Of Eugenics

Eugenics was a crucial component in Nazi ideology. The concept is largely thought to have originated with the Nazis or at least in Europe, but in reality, eugenics originated in America with some of the most prominent scientific and business leaders of the era.

Financed by such venerable entities as the Carnegie Institute and Rockefeller Foundation, many of America’s most respected scientists were busy working up theories of “race science” at the behest of their corporate financiers. Data was tweaked and faked to serve the premise that non-white races are genetically inferior and must be bred out of existence.

This “science” became prominent in the early part of the 1900s and became a vital part of Hitler’s ideology. The United States at this time actually had laws pertaining to eugenics on the books. Hitler was familiar with these, enabling him to frame his anti-Semitism in (completely invalid) medical and scientific terms. He once confided to a subordinate, “I have studied with great interest the laws of several American states concerning prevention of reproduction by people whose progeny would, in all probability, be of no value or be injurious to the racial stock.”

3Failure Of The American Press

After Hitler’s initial rise to power in 1933, much of the American press seemed to be confused—and even at odds with each other—over what the ramifications were and how it should be reported. The Nazis had risen from small fringe party to majority political party in just a couple years. Many newspapers seemed to think that he would calm down with his expansionist rhetoric once in office. Some reporters even thought he’d bring peace and prosperity to Germany after all.

The Christian Science Monitor, in a 1933 piece, praised the “quietness, order, and civility” observed by a visiting reporter; there seemed to be “not the slightest sign of anything unusual afoot.” Later in the decade, the New York Times reported “a new moderation” in the German political atmosphere since Hitler’s rise, with the New York Herald declaring stories of atrocities against Jews to be “exaggerated and often unfounded.”

While much of this can be explained by the Nazi regime’s deft handling of foreign press, much of it can also be explained by a deep misunderstanding on the part of Americans as to the nature of Hitler’s problem with Jews. Many US newspaper editors framed the conflict as one between ideologies of differing political views, rather than one between a race of people and those who wished them exterminated.

2Celebrity Supporters

Aviator Charles Lindbergh was an American hero of the 1930s. He performed the first solo flight across the Atlantic in 1927 and had endured the very public ordeal of the kidnapping and murder of his infant son in 1935. He was unfortunately also a proponent of eugenics, having become close with French scientist Alexis Carrel, who was a firm believer. In a 1935 interview, Lindbergh asserted, “There is no escaping the fact that men were definitely not created equal,” and discussed Dr. Carrel’s eugenics-based ideas on race. A 1939 radio address was the final blow to his weakened public image. In it, he opined that “our civilization depends on a Western wall of race and arms which can hold back . . . the infiltration of inferior blood.”

Auto manufacturer Henry Ford was also an unrepentant anti-Semite and Nazi sympathizer, allowing recruiters for the Bund to work in his factories and employing Gestapo-like thugs to crack down on those employees who might have tried to unionize. Konrad Heiden, a biographer for Hitler, stated that Ford supplied Hitler with direct financial support totaling at least $340,000. Ford even paid for the reprinting and distribution of the racist hoax pamphlet “Protocols of the Learned Elders of Zion” to libraries in the United States.

1Continued Influence

In politics and culture, “Nazis” and “Hitler” have become catch-all comparisons for those who would brutalize or subjugate others. Nevertheless, the legacy of America’s brief flirtation with this poisonous ideology is all around us.

White supremacist movements and neo-Nazi groups have long flourished in the US, but Hitler’s failed attempt at world domination gave many of them a new focus and a defined ideology. According to the Southern Poverty Law Center, which tracks hate groups, neo-Nazi organizations still exist in every single state as of 2016.

The CIA isn’t spotless, either. Documents uncovered in 2014 indicated that as many as 1,000 former Nazis were employed by the agency as spies during the Cold War, with some still living in the United States under government protection as late as the 1990s.

Jackie Robinson famously broke baseball’s color barrier as a member of the Brooklyn Dodgers in 1947. But he’s not alone in having an impact on the civil rights movement through his position as an athlete, and many lesser-known figures played sports while positively affecting society through civil rights advocacy.

10Peter Norman

This Australian sprinter surprised many observers of the 1968 Olympics by taking the silver in the 200-meter dash. Norman finished second to American Tommie Smith and ahead of Smith’s teammate, John Carlos, setting the stage for what may be the most recognizable piece of sports photography ever. Smith and Carlos each wore black gloves and raised their fists in the air in the Black Power Salute. While Norman stands somewhat anonymously to the side, he actually played a significant role in the photo. He suggested that Smith, who was wearing both gloves before the ceremony, give the other glove to Carlos so that both men could join in the salute.

Many who see the photo do not immediately notice that all three men—Smith, Carlos, and Norman—wear pins reading “Olympic Project for Human Rights,” representing a group opposing racism in sports. This act of solidarity caused Norman a great deal of trouble in his home country of Australia (he was not selected for the 1972 team despite holding the fifth-fastest time in the world), but it served as a powerful and enduring image of unity in the fight for equality.

9Dock Ellis

Dock Ellis was quite a character and likely is best known for the no-hitter he threw while high on LSD. That notoriety is unfortunate given how much he accomplished as a civil rights advocate during his playing days and as a drug and alcohol counselor once his career ended. He never wavered in standing up to the injustices of inequality, and he took action as far back as his high school career, once refusing to play in game as a protest against the coach’s racism.

Ellis was very outspoken, and he was never one to let someone get away with an injustice. He challenged manager Sparky Anderson to start him in the All-Star Game so that he could face Vida Blue, saying that Anderson “wouldn’t pitch two brothers against each other.” Despite some of his on-field antics—which include tying the MLB record for being hit by pitches, an act he admitted was intentional—Ellis worked diligently in charitable endeavors, most notably helping to found the Black Athletes Foundation for Sickle Cell Research in 1971.

Among the many men who appreciated Ellis’s efforts in civil rights was Jackie Robinson, who wrote a moving letter praising Ellis and advising him on some of the difficulties he would encounter. Footage from a recently released documentary on Ellis shows him reading the letter, which moved him to tears even several decades after it was received.

8The Boston Celtics & Bill Russell

Boston—owing perhaps to protests and riots in the 1970s after Boston public schools were desegregated by a court order—has had to endure a stigma as a racist town. But the city’s hometown basketball team, the Boston Celtics, was among the most progressive when it came to matters of race. The team was the first in professional basketball to draft an African-American player in Chuck Cooper, whom they selected in 1950. The Celtics were also the first in North American sports to hire an African-American coach when Bill Russell took over the team from the legendary Red Auerbach in 1966, a time of significant unrest throughout the country.

Russell is known as one of the most successful professional athletes in history, but he has also been an outspoken advocate of civil rights, and he has recently spoken out in support of gay athletes as they endure what Russell sees as issues black athletes encountered when he played. In 2010, Russell was awarded the Presidential Medal of Freedom, the nation’s highest civilian honor, for his work as “an impassioned advocate of human rights.”

7The Starting Five At Texas Western In 1966

Texas Western’s role in the civil rights movement was something of a surprise to them, as many did not realize that they were members of the first collegiate basketball team to field an all-African-American starting lineup—and, ultimately, the first to win an NCAA Championship. In recollecting the game, most of the Texas Western players recall not understanding its importance until years later, when strangers would approach them to thank them for opening doors that had previously been shut.

That championship game, played against Kentucky, took on greater significance after famous Kentucky coach Adolph Rupp reportedly declared that no all-black team could defeat his all-white squad. Pat Riley, then a member of the Kentucky squad, recalled how motivated Texas Western was after learning of Rupp’s comments, saying, “It was a violent game. I don’t mean there were any fights—but they were desperate and they were committed and they were more motivated than we were.”

Ultimately, Texas Western’s coach, Don Haskins, did not choose his starting five because of their race but rather in spite of it. He simply wanted to win, and those five gave him the best opportunity to do so. His assistant, Moe Iba, confirmed this, saying, “The fact that he was doing something historic by playing five blacks, that probably never crossed Don’s mind. Hell, he’d have played five kids from Mars if they were his best five players.”

6Stewart Udall, Secretary Of The Interior

Udall, the Secretary of the Interior to both John F. Kennedy and Lyndon B. Johnson in the 1960s, became involved in the civil rights movement through his intervention with a Washington Redskins football franchise that refused to integrate. The Redskins had been adamant in this refusal, with its team owner, George Marshall, once saying that the team would “start signing Negroes when the Harlem Globetrotters start signing whites.” Marshall’s position on the matter was assailed by many, with one columnist referring to him as “an anachronism, as out-of-date as the drop kick.”

Despite the pleading of the press and fans, not until Udall stepped in and threatened retribution on the federal level did the Washington Redskins become the last team in the NFL to integrate. Since the Redskins’ new stadium was on federal land, Udall informed Marshall that if he continued to refuse to be integrated, the team would not be allowed to use it. In 1962, Marshall heeded Udall’s ultimatum, and the Redskins were finally integrated.

5Don Barksdale And His US Olympic Teammates

Barksdale was the first African American to represent the US on the Olympic basketball team, and his role in the civil rights movement was in a Kentucky arena in 1948, the year after Jackie Robinson broke baseball’s color barrier with the Brooklyn Dodgers. Barksdale’s moment was during an exhibition game when his teammates passed a water bottle down the bench, with each man taking a sip. After Barksdale took his, he passed it to a teammate—“Shorty” Carpenter of Arkansas—who drank from the bottle without hesitation.

While this moment seems like nothing more than a minor detail today, the water bottle drew the attention of all those in attendance, many of whom felt that Carpenter could have made a statement by refusing to drink. This was especially true given that whites and blacks in the South rarely, if ever, drank from the same glass or from the same water fountain at the time. He didn’t refuse, and the game went on. Barksdale would later go on to become the first African-American All-Star in the NBA, playing for the Boston Celtics alongside Chuck Cooper.

4Kathrine Switzer & Roberta Gibb

Before 1967, no woman had officially run in the Boston Marathon, and the Boston Athletic Association (BAA) did not willingly issue bib numbers to women who applied. The Amateur Athletic Association (AAU) did not formally accept women as participants in distance running, fearing that their bodies could not handle the rigors of long distances. Roberta Gibb ran the Boston Marathon in three consecutive years (1966–1968) but did so without a bib number, having to hide in the bushes at the race’s starting line to avoid being spotted.

Switzer, however, was issued a bib number but not with the full blessing of the BAA—according to the BAA, she did not clearly identify herself as a female entrant and signed her entry form as “K.V. Switzer.” She started the race unnoticed, but around the fourth mile, the press bus caught sight of her, causing a stir. Once race officials were notified, one of them even tried to rip off her bib number and physically remove her from the race before another runner—“Big” Tom Miller, a nationally ranked hammer thrower and former All-American football player—pushed him aside. Switzer officially finished the race and helped to clear the path for female participation in distance running events.

3Francois Pienaar & Nelson Mandela

Francois Pienaar grew up under apartheid in South Africa, when it was common to hear Nelson Mandela referred to as a terrorist who deserved to have been imprisoned for all of those years. As a rugby player, Pienaar was a part of the 1995 Rugby World Cup that came to symbolize the changing of South Africa, and Mandela supported the South African team and dismissed the notion that the springbok—the team’s emblem and a notorious symbol of apartheid—should be tossed aside. Instead, Mandela used the Rugby World Cup as an opportunity to unite the nation once again under the banner of sports.

Upon South Africa’s victory, Mandela, who wore a South Africa rugby shirt that prominently featured the springbok, presented the cup to Pienaar, the white South African team captain. The image was an important one, as it came to be recognized as a moment of reconciliation for a formerly divided nation. Pienaar and Mandela became quite close thereafter, and the man known as Madiba ended up attending Pienaar’s wedding and becoming godfather to one of the Rugby captain’s children.

2Al Davis

Oakland Raiders owner Al Davis saw his football legacy somewhat tarnished during the last decade of his life, as the Raiders endured an extended period of futility that has continued to the present day. The team has not made the playoffs since its Super Bowl run of 2002, and many observers blame Davis for being out of touch with the game. Too many forget that Davis was an innovator of the highest order throughout the overwhelming majority of his life in football, and that included his attitude toward issues of civil rights.

In 1963, just a year after the Washington Redskins had to be forced to integrate its team, Davis was refusing to play a preseason game in Mobile, Alabama as a protest against the state’s laws on segregation. Davis, again protesting the inherent unfairness of segregation, also implemented a policy stating that the Raiders would not play in cities in which players would have to stay in different hotels due to race.

Davis was also responsible for hiring the second African-American head coach in the NFL in Art Shell and also the first female front-office executive in Amy Trask. Shell, a former offensive tackle with the Raiders, played under the league’s second Latino head coach, Tom Flores, who was also hired by Davis.

1Willie O’Ree

O’Ree didn’t even realize that he had broken the color barrier in the NHL in 1958, saying, “It just didn’t dawn on me. I was just concerned about playing hockey.” O’Ree grew up in Canada, playing both hockey and baseball, and as a teenager, he had the opportunity to meet Jackie Robinson in Brooklyn after being invited to camp with the Milwaukee Braves. The two spoke briefly, and after Robinson told him that there were no black kids playing hockey, O’Ree corrected him, saying, “Yeah, there’s a few.” Less than 10 years later, O’Ree would be making his NHL debut for the Boston Bruins.

O’Ree had to endure taunts and insults while playing games on the road, but he was steadfast in his belief that those taunts deserved no response from him. There were even times when, while in the penalty box, O’Ree would be spit on and have objects thrown at him because of his race. O’Ree went on to work with the NHL after completing his professional hockey career, serving as the director of youth development for the NHL’s diversity program.

J. Francis Wolfe is a freelance writer whose work can be seen daily at Dodgers Today. When he’s not writing, he is most likely waiting for “just one more wave” or quietly reading under a shady tree.

We expect clean streets and long lives in the developed Western world, where health care programs and disease prevention comprise a thriving industry. But public health infrastructure is a relatively recent development in modern society, born and brought up on the backs of some of the greatest engineers, researchers, and physicians history has ever known.

Here is a list providing an overview of the facts and events that occurred during the Western sanitation movement of the 19th and 20th centuries. You can thank this movement for the fact that you don’t have to trudge through feces for your morning cup of coffee or risk contracting cholera every time you get a drink of water.

10 The Industrial Revolution And Increasing Population

The 19th-century sanitation movement came at a key point in early American and European history. The cleanliness and health of city reisdents was quite poor. Sanitation increasingly became an issue because of two factors: the Industrial Revolution and immigration. The Industrial Revolution began in Britain because of an abundance of coal and changing ideologies about the economy. Wealth and travel would increase, and as a result, many people would immigrate to big cities in Britain and the United States looking for work and wealth.

In the US, the population in the urban areas of the country rose from around 1.8 million to over 54 million between 1840 and 1920. As a result, waste would build up, in the form of both human filth and industrial debris, and there would initially be no organized public effort to preserve the health of the people.^[1]

9 John Howard’s Prison Reform

John Howard was a dedicated philanthropist in the mid- to late 18th century, and his greatest contribution was his advocacy for prison reform and improvements in sanitation and overall public health. Howard became the sheriff of Bedfordshire in 1773. Supervising the county jail, he observed the horrid conditions of the facility and its prisoners. English prisoners were expected to pay for all of their essentials. The poorest of them couldn’t afford commodities as fundamental as food, bedding, and clothing. Prisoners were expected to pay off their jailers upon release, so those who could not afford to do so would stay in jail long after their sentence had ended.

Howard’s reporting highlighted the unsanitary conditions of the jails he visited. He wrote three editions to his book on the subject, The State of Prisons in England and Wales, and his frank recollection of the facts gave his words enough credence to avoid any trouble with the authorities in England and Wales. Howard’s advice for improvements would set the standard for what the sanitary movement would advocate for. His calls for proper health care and clean accommodations regardless of economic status, and other suggestions outside of the sanitary conditions, spurred the movement into the public eye for the first time.^[2]

8 Quarantine

Quarantine of the diseased and otherwise ill became a common practice in the 19th century, although implementing such a tactic was sporadic. In the United States, federal involvement in the form of legislation passed by Congress only occurred in 1878 after yellow fever outbreaks.^[3] Port cities with lots of trade ships and immigration were areas in the US that implemented quarantine councils, voluntary general hospitals, and community health centers most fervidly.

In 1808, the Boston Board of Health ordered that ships coming from certain tropical posts such as the Mediterranean and Caribbean had to be quarantined for three days or until 25 days had passed since they left port, whichever came later, before crew and cargo could integrate with society. These planned, public actions against diseases like cholera and smallpox were the first of their kind and paved the way for further focused attempts to keep these illnesses at bay.

7 Edwin Chadwick And Miasma Theory

The most ironic thing about the Western sanitary movement was the people who peddled it. There were two opposing theories about how diseases spread: germ theory and miasma theory (aka anti-contagionist theory), both of which had their fair share of believers. The germ theory, which we currently accept, states that certain diseases enter the body as microorganisms invisible to the naked eye. The miasma theory affirmed that exposure to the environment, from things such as sewage, noxious fumes, and, crucially, poor sanitation, caused the diseases around us. Miasma theory would prove to be false, but the effect it had on the sanitary awakening is astonishing.

One of miasma theory’s biggest advocates, and one of the most influential sanitary reformers of his time, was Edwin Chadwick. Chadwick campaigned for the passage of the Public Health Act of 1848, an act which reflected most of the arguments Chadwick had written about years earlier in General Report on The Sanitary Condition of the Labouring Population of Great Britain. Chadwick was sure that if we improved the health of the poor, it would have a positive effect on the country’s economy, as fewer people would need to seek poor relief for sick and dying family members. Improvements such as better drainage systems for the sewers, clean drinking water, and a medical officer appointed to each town were listed in the act, but a limitation on money and influence dimmed its effectiveness at making lasting change.^[4]

Ironically, even if Chadwick’s beliefs about diseases would be disproven, they still positively affected society by pushing for the public health awareness and systems we benefit from today.

6 John Snow And The Cholera Outbreak

John Snow was a staunch opponent of Edwin Chadwick on the battlefield of 19th-century disease theory. Snow was the physician to Queen Victoria, and the germ theorist determined the source of an outbreak of cholera, an intestinal disease that wreaked havoc across England. Snow was skeptical of the idea that cholera entered the body through the air, instead believing that it stemmed from contamination in the water that sufferers drank. In the 1800s, sewage systems hadn’t been standardized yet, so people would have to collect their drinking and bathing water from community pumps or wells while dumping waste into the Thames river or pits called cesspools. Snow suspected that the waste from these areas was seeping into the drinking water, but he couldn’t prove it to other scientists of the time until a cholera outbreak in 1854.

The outbreak began in the suburb of Soho, where Snow just so happened to live at the time. Snow wrote of the epidemic, “Within 250 yards of the spot where Cambridge Street joins Broad Street there were upwards of 500 fatal attacks of cholera in 10 days. As soon as I became acquainted with the situation and extent of this irruption [sic] of cholera, I suspected some contamination of the water of the much-frequented street-pump in Broad Street.”^[5] So Snow documented where those who had contracted cholera lived and compared their locations to the different water pumps in the suburb by drawing his own map. Eventually, he pinpointed the water pump on Broad Street as the source of the contamination.

Snow’s map helped pioneer the field of epidemiology, a branch of medicine focused on how diseases distribute and how they can be contained and controlled. Most miasma theorists, Chadwick included, weren’t convinced that their beliefs were false by Snow’s research. But regardless of Snow’s personal convictions, both sides of the disease debate took his findings as evidence that proper city sanitation had to be a priority to avoid outbreaks of illness in the future.

5 The New York Sanitary Survey

Focusing back on the States, New York City was a garbage dump. Manure sat in the streets, and noxious fumes filled the air. It is estimated that over 200,000 cases of entirely preventable diseases caused by an ineffective Board of Health occurred every year. In 1850, Lemuel Shattuck would write a plan for a new public health program in the US based on miasma theory. Out of the 50 suggestions that Shattuck proposed, more than half would become universally accepted practices in modern times.

In 1865, more than a decade after Shattuck’s report, the Association’s Special Council of Hygiene and Public Health would assign a group of inspectors to conduct a citywide survey of all 31 districts of New York.^[6] The survey in question was nine pages long, and by the end of the program, 17 volumes of review would lead to the enactment of the 1866 Metropolitan Health Bill. Many revisions to New York’s health codes would follow over the next century, but this survey would continue to form the basis of all public health laws from this point on.

4 Chesbrough’s Sewage System Design

To the west, Chicago was also amid a health crisis after a fierce outbreak of intestinal and bowel infections. Chicago’s waste disposal system was unfortunately similar to the situation John Snow had faced in Soho. Sewage dumped in the Chicago River had dispersed into Lake Michigan, Chicago’s main water source. Also, because of how close the water they were drawing from was to the land, small fish would regularly be sucked into the drain and shot out of flowing water faucets. Residents would joke about the water, saying, “When you turned on the water, you got chowder!”^[7]

Ellis S. Chesbrough had started working as a chainman on a railway survey when he was only 13 years old, missing out on much of his schooling. Regardless of his lacking education, Chesbrough’s career as an engineer flourished until he was eventually hired as the chief engineer of the Boston Water Works in 1846. He built many of Boston’s most important water-related structures, such as the Brookline Reservoir, which supplied water to every resident in Boston.

Later, after leaving Boston for Chicago, Chesbrough became an engineer for the Chicago Board of Sewerage Commissioners. He was tasked with giving the city the first comprehensive sewer system in the entire country. After studying several of Europe’s best sewage systems, Chesbrough first constructed a water crib, which is a boat-like structure that collects water from the bottom of lakes and sends it to pumping stations on the shore. Next, Chesbrough decided that drainage was being hindered by the city itself being too low to the ground for his new sewers to fit. So, in a feat famous among civil engineers and all of Chicago, Chesbrough had the city raised roughly 3 meters (10 ft) off the ground. Lifting the buildings using jackscrews, Chesbrough had new foundations built under every single domicile, despite the complaints and legal threats of the business owners because of the costs of the project.

Chesbrough’s design revolutionized the city streets, as waste was now properly filtered and managed under his innovations, which furthered his reputation as America’s best authority on urban water and sewer issues.

3 George E. Waring

After the horrors of the US Civil War and a yellow fever outbreak that ravaged Tennessee in 1878, one of the most influential figures in both miasma theory and 19th-century sanitation would build his reputation. George E. Waring was a drainage and agricultural engineer and a Civil War veteran who would be the first man to establish sanitary engineering as a reputable career.

Waring had already earned praise in New York City during the late 1850s for his design and construction of Central Park’s drainage system, which would form the park’s ponds and lakes. In 1878, during a yellow fever epidemic, Waring would create a drainage system in Memphis, Tennessee, that mirrored the work of Chesbrough in Chicago. By separating the stormwater runoff that flooded the paved roads of Memphis from regular sewage waste, Waring could reduce the sizes of the sewage pipes and lower the chances of leakage.

Later, Waring set his sights back on New York. Improvements had been made in the Big Apple, but the standard of living was still lacking. Garbage was dumped into the streets in places that the majority of the working class and immigrant population called home, causing disease to amass in spades. After becoming the head of New York’s sanitation department, Waring recruited his own personal army called the “White Ducks” (or the “White Wings”) because of their stark white uniforms. Two thousand men strong, Waring’s army organized a new recycling ethic when they cleaned 697 kilometers (433 mi) of street. They boiled organic waste to make oil and grease, they swept the ash off the roads, and they sorted the garbage from the recyclables.^[8]

Sixteen years later, half of all cities in the US would have sewage systems, and the rest of the developed world would soon follow. Waring left the United States in 1898 to study sanitation techniques in Cuba, where he would tragically die after, ironically, contracting yellow fever. The New York Times paid tribute to him by writing, “There is not a man or a woman or a child in New York who does not owe [Waring] gratitude for making New York, in every part, so much more fit to live in than it was when he undertook the cleaning of the streets.” Waring would be remembered as America’s “apostle of cleanliness.”

2 The Founding Of Bacteriology

As the health of the individual became a public issue rather than a private one, society would advance its knowledge on the diseases it had once feared. This newfound curiosity soon killed the miasma theory of disease and thrust the germ theory that people like John Snow had advocated for into the spotlight. One founder of bacteriology was Ferdinand Cohn, who had started to study bacteria in the late 1860s. Cohn organized known bacteria into a classification system based on their morphological differences.

Cohn would be a consultant of Robert Koch, a German bacteriologist who discovered the bacteria responsible for diseases such as tuberculosis and cholera. A French chemist and microbiologist named Louis Pasteur would discover the bacteria that causes anthrax. Pasteur would eventually develop a vaccine against the disease and another vaccine against rabies. His experiments in the fermentation process of souring milk and alcohol would also provide evidence for the germ theory of fermentation in living organisms.

All of these discoveries would inspire intervention efforts to prevent the spread of diseases and eventually wipe them out. The germ theory and bacteriology would force a sound scientific basis into all public health efforts as the sanitary movement closed in on its final objective.^[9]

1 Laboratory Research And Federal Health Services

On February 24, 1888, Surgeon General John B. Hamilton testified in front of the United States Congress. Hamilton was the first to inform Congress of the Laboratory of Hygiene (which would eventually become the National Institutes of Health) when he announced, “I desire to invite the attention of the Committee to the Weekly Abstract published a few weeks ago, in which the diagnosis of cholera was made of the cases that occurred in New York, by an officer of my service by the name of Kinyoun, who spent nearly five years in the study of bacteriology. We spent several hundred dollars in forming a laboratory in New York.”

A few years later, and the US would establish a series of local and state health departments, starting in New York and Massachusetts. The discoveries prior to these laboratories were made in private, and the improvements to water and sewage systems, although revolutionary, were done in the name of a faulty theory. Now, efforts were being put into studying city water systems to detect and control the bacteria recognized as the cause of deadly diseases. At the center of this new era was biologist William T. Sedgwick, a founder of the Harvard School of Public Health in 1913. Sedgwick identified bacteria from fecal matter that causes typhoid disease, eventually developing the first treatment technique. One historian described Sedgwick’s book on his research, Principles of Sanitary Science and Public Health, as “possibly the most potent single factor in awakening leaders in medicine, engineering, and science to the importance of sanitation in that era of rapid urban and industrial development.”^[10]

All the research done in these facilities would allow doctors to diagnose patients far earlier, which helped keep contagious illnesses from spreading. Still, scientists soon realized that treatment and immunization wouldn’t be enough to fully eradicate the diseases that festered most aggressively in the poor and uneducated. So, at the beginning of the 20th century, the sanitation movement would reach its final stage: the education of the common man about personal health care in favor of a healthier society. Federal health services would fund public and military disease control programs. These efforts would have their successes, failures, steps forward, and steps backward. The fight continues to this day as a combination of scientific research and social values that set the foundation for solid public health.

Savannah O. Skinner is a freelance writer and author sometimes working under the pen name S.O. Skinner.