HISTORY: Public health

S.C. Encyclopedia  |  The historian Edward H. Beardsley concluded that the story of public health in South Carolina is a “history of neglect.” Indeed, since 1914, when data on vital statistics in South Carolina were first collected, the state’s residents have been significantly less healthy than most Americans. A confluence of poverty, racism, close alliances between government and industry, and adherence to states’ rights and limited government worked to prevent significant improvements in public health throughout much of South Carolina’s history. When improvements finally came, they did so for the most part due to federal largesse and changes in the workplace (air conditioning in textile mills, for example) undertaken largely to increase efficiency (machinery broke down less often and could be run at higher speeds with less humidity).

South Carolina’s doctors enforced medical segregation, ignored occupational health issues, and fought perceived encroachments on private practice by public health officials who offered free or low-cost clinics and vaccinations. Public health officials rarely questioned the legacy of paternalism and social practices that led to ill health among both whites and blacks. Even the state’s few black physicians were slow to challenge medical segregation and second-class care. The advent of the civil rights movement of the 1950s and 1960s pushed most southern black physicians into the battle for health and medical equality, although most did so as followers, not leaders.

Despite the history of neglect, South Carolina’s public health history contains its share of heroic practitioners and public-spirited health officers who fought against great odds to improve the health of their communities. As early as 1796 a Charleston ordinance permitted any one of three commissioners of health to order ships removed, cleaned, aired, and fumigated if deemed dangerous. Residents of the city established quarantine stations shortly after the turn of the nineteenth century and a Board of Health in 1815. Beginning in 1813 a Ladies Benevolent Society provided nursing services for “such persons as suffer under the anguish of disease and penury.” Early public health efforts in Charleston focused on the removal of decomposing animal and vegetable matter that was thought to spread disease. According to popular beliefs that attributed illness to “marsh miasmas,” disturbing the soil led to epidemics of yellow fever and malaria. As late as 1910 critics condemned the city’s health department for digging sewer lines during hot South Carolina summers. Still, under the direction of Dr. John Mercier Green, Charleston built a water-filtering plant, piped clean water into the city from Goose Creek, and inspected food and milk by the 1910s. …

Calls for limited government still prevailed in South Carolina, and public medicine remained suspect at the start of the twenty-first century. Despite significant improvements in the past thirty years, South Carolinians compared poorly to residents of other states in most health categories — a legacy of the state’s history of neglecting the health care needs of those unable to afford or without access to private physicians.

– Excerpted from the entry by Patricia Evridge Hill.  To read more about this or 2,000 other entries about South Carolina, check out The South Carolina Encyclopedia by USC Press. (Information used by permission.)