ABSTRACT
Smith’s Civil War experience changed him and shaped America’s postwar public health movement. Smith inspected Union Army hospitals for the Sanitary Commission in 1862, which brought him further into the sanitary and hygienic challenges of the war, while professional animosities around the surgeon-general pushed him away from his youthful goal of becoming a medical leader. Following the 1863 New York City draft riots, he organized a landmark sanitary survey of Manhattan. He encountered a tenement he called a “fever nest,” which became an iconic but misinterpreted moment in later public health histories. He and The Citizens’ Association pushed unsuccessfully for a metropolitan health department in 1864 and 1865. Shortly after the war ended the Roosevelt Hospital trustees sought his advice on their new building. In 1866, with his city-wide survey in the forefront, the threat of a cholera epidemic, and victorious Republicans in control of New York, the state legislature passed the Metropolitan Health Act, the first law in the country giving police powers to an urban public health board.
