1906 Earthquake & Fire

Looking Back at the Public's Health

According to a late-twentieth century Institute of Medicine report, public health is “…what we, as a society, do collectively to assure the conditions in which people can be healthy.”

This definition is illustrated in each of the three main public health stories that emerged from the disaster:

1. Care of the Injured. Many were injured. Emergency and other hospitals were damaged. Physicians and nurses from the city's emergency hospitals, volunteer physicians and nurses, policemen, the Red Cross, the Army, and others collaborated to quickly establish emergency care for the injured.
2. Sanitation. The supply of fresh water was cut off. Sewer lines were broken. Supplies of fresh food began to spoil. Faced with the threat of infectious disease outbreaks, the Department of Public Health worked with the Department of Public Works, the Army, and volunteers to assure healthy living conditions.
3. Plague. Although a safe supply of food and water was established, and toilet facilities were quickly created, the disaster created a new urban lanscape. Many San Franciscans lived in crowded temporary shelters and cottages in refugee camps. Accumulated garbage and debris created a congenial environment for rats, some of which carried bubonic plague. By 1907, a bubonic plague outbreak occurred. In response, San Franciscans engaged in an extremely successful public health campaign that mobilized the public and private sectors, civic organizations, and the public citywide to eliminate rats and to change the environments that supported them.

Lessons Learned. Scientists sometimes call stories like these “natural experiments.” What did we learn from them? In each case, the local health authorities were able to promptly assess the nature of the problem. The policies needed to address them and assure the right outcome required a broad collaboration with all sectors of society