Dr. Charles Chapin was an internationally renowned pioneer in the field of public health and epidemiology who served as Providence’s Superintendent of Health from 1884 to 1932. His book, The Sources and Modes of Infection, published in 1910, influenced physicians and public health officials across the United States and Europe by establishing public health standards. He was one of the earliest American health officers to apply the techniques and findings of bacteriology to sanitary science. He attacked common misconceptions that filth caused diseases indiscriminately transmitted through the air. He developed the first method for evaluating the effectiveness of state agencies’ health services. Diphtheria became almost non-existent due to the Schick test and diphtheria immunization, both introduced by Dr. Chapin. A compelling speaker and productive writer, he helped broaden the concept of community health, including innovations such as the antituberculosis campaign, the infant hygiene movement, the inspection and care of schoolchildren, and public medical attention for the poor. More than any other person, Dr. Chapin changed the image of the American health officer from that of a political hack to that of a professional scientist.
Dr. Chapin was born in Providence on January 17, 1856, the son of Joshua B. and Jane (Value) Chapin. His father was a physician who became Rhode Island State Commissioner of Education. His mother was the daughter of a refugee from the French Revolution. Charles was the second of their three children and only son. He attended the Mowry and Goff School in Providence and Brown University, graduating with a B.A. in 1876. His medical training continued with a year at the College of Physicians and Surgeons of New York, followed by a year at the Bellevue Hospital Medical College, where he studied pathology and received his M.D. degree in 1879. He interned at Bellevue Hospital for a year, then opened a private practice in Providence in 1880. He made hundreds of house calls for the next two years as a physician. He became acquainted with the sordid living conditions of many people experiencing poverty in Providence and the diseases with which they were afflicted.
In May of 1881. Dr. Chapin presented his first paper before the Providence Medical Association on “The Pathology of Phthisis (tuberculosis). In this paper, he described the microscopic structure of tubercles, questioned the theory that tuberculous was a tumor, and suggested that it was an infectious disease. Lacking a comforting bedside manner with patients and impatient with the routine of private practice, Dr. Chapin welcomed his appointment as Superintendent of Health in 1884. He resigned from the staff at Rhode Island Hospital but retained his teaching connection with Brown University. He gave lectures in hygiene to freshmen and a semester course in physiology to juniors. His lectures, popular for their stimulating and imaginative style, earned him a promotion to a full professorship in physiology in 1886. In 1893, he established a coordinated program in premedical studies at Brown and started a physical education program for all Brown students in 1893.
When he took over the Health Department, the age of bacteriology was beginning to flower. His training in New York and his experience as a pathologist at Rhode Island Hospital proved invaluable to him. He was the first public health officer in America to bring this background to bear in developing his philosophy of public health administration. Dr. Chapin’s influence on public health began in 1901 with the publication of “Municipal Sanitation in the United States.” In 1902, he delivered an address to the American Public Health Association, attacking the conventional sanitation theories. “Instead of an indiscriminate attack on dirt, we must learn the nature and mode of transmission of each infection and must discover its most vulnerable point of attack,” Chapin warned, “We are crowding our hospitals with scarlet fever cases and crying for more buildings, but who has figured the amount of case prevention and the cost per case.” He argued that the progress of science is mainly dependent upon the extent to which quantitative methods are employed in research. “Science can never be a closed book. It is like a tree, ever-growing, ever reaching new heights. Occasionally, the lesser branches, no longer nourishing the tree, slough off. We should not be ashamed to change our methods; rather, we should be ashamed never to do so. We should try new things but show common sense about it,” Dr. Chapin said.
He believed the city should become involved in eight categories of public health:
- control of communicable diseases;
- abatement of nuisances;
- removal of garbage and refuse
- supervision of conditions in schools and public institutions;
- supervision of factories and trade
- inspection of water, ice, and milk;
- local scientific investigations into sanitary matters (including registration and analysis of vital statistics) and,
- the dissemination of sanitary information.
Less than a third of Providence’s houses were connected to the public sewerage system when Dr. Chapin took office. Many residents still depended upon public wells for water; most had defective plumbing, and backyards were piled high with decaying garbage. He urged that all wells be abandoned, yards be cleaned, and private homes be connected to the sewerage system. He established the first municipal bacteriology laboratory in the United States in 1888. Dr. Chapin complained about the lack of suitable buildings to house patients with contagious diseases in small wards. Because of his efforts, the “City Contagious Disease Hospital” opened on June 13, 1896. The facility soon became overcrowded, and more space became an issue.
After long delays, Providence City Hospital opened its doors in 1910. It was the first contagious disease hospital in the United States to apply aseptic nursing techniques on a full scale. It was based on the concept that transmission of infections between patients was through contact rather than air. Dr. Chapin applied isolation principles for patients with infectious diseases and aseptic nursing practices in the new hospital. Strict cleanliness was enforced throughout the hospital. Nurses and doctors who handled patients scrubbed their hands carefully after contact and changed their gowns before leaving a room or area to care for a different infectious disease. The Providence City Hospital had an extremely low cross-infection rate and proved the value of Dr. Chapin’s methods in its first year of operation. The hospital became a center for training nurses and doctors in modern techniques throughout the United States.
After two years of engagement, he married Anna Balch, a Providence girl of old New England stock, on May 6, 1986, in what was described as a “fashionable” wedding. Dr. Chapin traveled nationwide to study water filtration and conducted experiments that attracted national attention. As a result of these studies, he recommended mechanical filtration using an aluminum sulfate coagulum as both inexpensive and effective.
In the face of a threat of cholera, he obtained tighter quarantine regulations, put inspectors at the railroad station and the New York boat landings, fumigated newly arriving immigrants, and conducted clean-ups on an emergency basis. Cholera did not come to Providence as a direct result of these efforts. He obtained authority in 1892 to compel the removal of privies and cesspools where street sewage lines were operating. The garbage system in Providence in the 1890s was among the best among American cities.
In 1915, Dr. Chapin published a “Report on State Public Health Work” based on a State Boards of Health survey. It was the first comprehensive analysis of health department procedures in the world. It inspired the founding of the Committee on Administrative Practice of the American Public Health Association, which transformed public health. He served as president of the American Health Association (1926-1927) and the first president of the American Epidemiological Society (1927.)
Dr. Chapin was described as a man who combined wisdom and charm. When his associates did not perform their duties as expected, he reportedly could express his displeasure as effectively as a drill sergeant, venting scathing sarcasm when confronted with sham or pretense. Yet he rarely offended because of his fairness and unfailing courtesy. He had hoped to complete fifty years as Superintendent of Health, but illness forced him to resign in 1932, two years short of his goal. Tributes rolled in from all over the world. The Providence City Hospital was renamed the Charles V. Chapin Hospital. The Rhode Island Medical Society described him as “the greatest physician who has ever lived in Rhode Island” when it established the Charles Value Chapin Annual Oration Award. The first oration was delivered at the annual meeting of the Society on June 3, 1942. The tradition has been carried on since then, with the mayor of Providence presenting the medal annually. “He was the greatest contributor to humanity of any Brown graduate,” Henry Wriston, Brown president said at Dr. Chapin’s funeral. Dr. Chapin was awarded the Marcellus Hartley Honor Medal of the National Academy of Sciences. He was the first recipient of the Sedgwick Memorial Medal of the American Public Health Association for “distinguished service in public health.” In London, he was awarded an Honorary Fellowship of the Society of Medical Officers of Health, an honor that has come to few Americans.
After two years of poor health, Dr. Chapin died on January 31, 1941, at the age of 85. He was inducted into The Rhode Island Heritage Hall of Fame in 1966.
For additional reading:
1. Charles V. Chapin and the Public Health Movement by James H. Cassidy, Harvard University Press, 1962.
2. Papers of Charles V. Chapin, edited by Clarence L. Scamman, Oxford University Press, London, 1934. 1934.
3. Guide to the Charles V. Chapin Papers, 1880-1941, Rhode Island Historical Society, 2009.