Beginning in 1818, Board of Health members were elected by the City Council and the Commissioners of the Districts and Townships. By 1855, the Board was clearly designated a branch of the City Government. Gradually the Board's responsibilities increased to include protection of the city's water supply, public vaccinations, keeping vital statistics, licensing of midwives and ridding the city of public nuisances.

The Bullitt Bill of 1887 placed the Board of Health under the control of the newly created Department of Public Safety. In 1899, the Board was reduced to three mayoral appointees and the Bureau of Health was officially organized. At that time the Board of Health became an advisory and policy-making body - the role it still continues today. The Bureau of Health was placed under the Department of Public Health and Charities in 1903. After restructuring in 1919, that Department became known as the Department of Public Health.

The Philadelphia Almshouse

The Philadelphia Almshouse, built in 1732, was the first American institution to provide hospitalized care for the poor. Initially located at Third and Pine Streets, the Almshouse was managed by the City's Overseers of the Poor, later called the Guardians of the Poor. The Almshouse also provided housing for the indigent. In 1767, the Almshouse moved to larger quarters at Tenth and Spruce Streets.

Yellow Fever Epidemic

In the summer of 1793, Philadelphia was struck by a yellow fever epidemic that killed 1/10 of the city's population (almost 5,000 persons) in less than five months. It is considered one of the worst epidemics to ever hit an American city. Over one-third of the inhabitants fled the city leaving only a courageous few behind who were willing to risk their lives to help the sick and the dying. Dr. Benjamin Rush, one of Philadelphia's most prominent physicians, was one of them. Rush served on a temporary Board of Health established to enforce sanitary regulations. The Board worked with the Guardians of the Poor to set up a hospital beyond the city limits to quarantine the victims. During the epidemic Philadelphia Mayor Matthew Clarkson asked for additional volunteers to help with the care of the sick. Two of the few who stepped forward were African-American clergymen Richard Allen and Absalom Jones. Most of the 2,500 African Americans living in the city were free. Through the Free African Society Allen and Jones recruited volunteers to bring the sick to the quarantine hospital, serve as nurses in the infected areas and help bury the dead. At the time of the epidemic many believed blacks were immune to it. In the end, they were proved wrong as more than 300 African Americans perished.

The Guardians of the Orphan Children was created in 1794 specifically to care for the orphaned children of victims of the yellow fever epidemic the year before. A city appropriation was made to provide suitable clothing, food, education, and employment and housing arrangements for the children.

Vital Statistics

The development of effective public health policies and programs requires accurate and complete data on births and deaths. In 1819, the Legislature of Pennsylvania passed an act requiring all physicians to register the births that took place under their care. In Philadelphia these Returns of Births were submitted directly to the Board of Health. The City passed a law in 1860 that called for the quick and exact recording of all city births, marriages and deaths in a systematic and continuing manner by the Board. The Civil War brought a significant increase in the number of requests to the Board for certified birth certificates. Widows and families were compelled to make such requests to obtain pensions due from the federal government. Philadelphia's rich religious and cultural diversity was reflected in the Board of Health's 1868 vital statistics report on marriages which noted no less than 21 different religious ceremonies were employed in the city. The Board worked diligently to ensure the accuracy of all vital statistics records until the state Registration Act of 1915 transferred the recording of births and deaths to State Bureau of Vital Statistics.

Fairmount Water Works

Considered a universal marvel, the Fairmount Water Works, completed in 1820, was an early achievement of the Board of Health in its advocacy for a clean municipal water supply to improve public health and prevent epidemics. It would take almost another 100 years to build a complete citywide filtered water and sewage system. Chlorination of the water supply began in 1912; fluoridation in 1954.