A starkly contrasting model of public health development occurred in the United States. There were only thirty-three cities in the United States with populations over 2,500. The role of John Henry Griscom in New York exemplified the relationship between the philosophies of hygiene and Evangelical piety which characterized the development of public health consciousness in the United States in the nineteenth century. Hygiene and physiology had a spiritual as much as a material message, because morality and the physical world were all part of God's design of nature. The new philosophy of scientific rational government was reflected in the health sphere in the demand for professionalization to replace charitable and moralistic reform. By 1884 the Association had spread its influence throughout the United States and beyond, attracting members from Canada and later from Mexico and Central America.