Sanitation and Statistics: How Public Health Professionals Revolutionized the U.S. Census

On March 11, 2020, the Census Bureau issued a statement that said the agency was 

“carefully monitoring the coronavirus (COVID-19) situation...We have also 

established the Census Bureau COVID-19 Internal Task Force to continuously 

monitor the situation.”1

 In the following months, the Census Bureau adopted its 

2020 Census decennial operations to meet the challenges associated with conducting 

a decennial census during a historic public health emergency. As the Covid-19 

pandemic continues to unfold, perhaps, the U.S. government can draw upon the 

lessons of the 19th Century federal statisticians, who revolutionized how the U.S. 

government collected and organized the vital statistics2 related to the lives and health 

of the nation’s expanding population.

Before “the great sanitary awakening” of the mid-19th century, the history of vital 

statistics in the United States and the development of a national public health system 

ran parallel to each other but rarely intersected. As early as the mid-late 1600s, 

colonial governments in places such as Virginia, Massachusetts, and Connecticut, used vital records as a 

tool for officials with administering the law and protecting the rights of individuals.3

 Recognizing the 

administrative advantages of collecting population data, the Founding Fathers empowered Congress to 

carry out a national decennial census in “such a manner as they shall by Law direct.”4

 By conducting a 

decennial census, the Founding Fathers established a method for accurately recording the nation’s 

population and distributing political power among the states.5

 Yet, the nation’s founders failed to fully 

recognize the vital role census data, or a national registration system could play in improving the nation’s 

health.6

The enormous task of improving America’s infant public health system using vital statistics fell to 19th

Century reformers, like Lemuel Shattuck, and medical professionals, like John Shaw Billings. Although 

these two individuals primarily focused on vital statistics and public health, their respective contributions 

to 1850, 1880, and 1890 U.S. Censuses, led to a series of methodological and technological 

improvements that remain pertinent to the modern Census Bureau.

Lemuel Shattuck and the 1850 Census

Born in Ashby, Massachusetts, on October 15, 1793, Lemuel Shattuck embarked upon a diverse career 

that spanned a little more than four decades and culminated in him pioneering the collection and use of 

Above: As one the most influential 

17th preachers and authors in the 

Massachusetts Bay Colony, Cotton 

Mathers used vital statistics to 

promote inoculation as a means of 

preventing smallpox and reducing the 

danger posed by epidemics.

Courtesy of the Smithsonian National 

Portrait Gallery.
vital statistics for the United States’ government’s budding interest in public health.7

 After retiring from 

his career as a bookseller and publisher at the age of 46, Shattuck devoted the remainder of his 

professional career to public service. By the time Shattuck embarked upon his public service career, 

many of the twenty-six states had laws requiring a state official or clergy member to record births, 

marriages, and deaths in the community.8

 However, most state governments struggled to enforce these 

local laws and only Massachusetts (1841), New York (1847), New Jersey (1848), and New Hampshire

(1849) had “modern” registration laws before the 1850 Census.

9

 

Having been active in Massachusetts politics and played an important role in helping to pass the 1842 and 

1844 revisions to the 1841 registration law, Shattuck developed an appreciation for the utility of vital 

statistics and dedicated the remainder of his life to establishing a modern public health system that 

mirrored those emerging in Europe.10

By the time Joseph C.G. Kennedy, the Superintendent of the 1850 Census, invited Shattuck and 

two of his colleagues to serve as consultants in the planning of the 1850 Census, Shattuck had 

helped found the American Statistical Association (1839); championed numerous pieces of 

legislation related to the creation a Massachusetts’s statewide vital registration system; overseen 

the City of Boston’s 1845 Census; and begun research for his famous “Plan for a Sanitary 

Survey of Massachusetts”, a document that provided a template for America’s modern public 

health system.11 Given the breadth of Shattuck’s previous experiences, Kennedy hoped Shattuck 

and his colleagues would produce a national census that eliminated the faults and some of the controversy 

that had resulted from the 1840 Census’s data.12

According to J.D.B. DeBow, Kennedy’s successor as the Superintendent of the Census, 

Shattuck exceeded expectations and almost single-handily improved how the U.S. 

government conducted censuses.13 For example, DeBow wrote, “The feature of 

recording the name of every person enumerated, was proposed by this gentleman, and 

was first adopted in the Boston census of 1845...”14 Prior to this, the U.S. marshals only 

recorded the names of the head of household. By using the individual as the primary 

census unit instead of the household, the marshals and their assistants collected more 

information about each person. With more accurate and better-organized data, the 

census clerks, leaders, and external statisticians produced more informative reports and 

tables about the United States’ population, economic activities, social problems, and 

efforts in the field of public health.15

Lemuel Shattuck (1793-

1859).

Courtesy of the Library of 

Congress.

Above: The assistant marshal 

enumerated President James

Buchanan using the schedule 

designed by Shattuck for the 

1850 Census.

Courtesy of the National Archives
In addition to changing the primary census unit, Shattuck also introduced 

the practice of writing an explanatory introduction at the beginning of 

each census report and of providing enumerators with instructions and 

specialized census schedules for collecting vital statistics. By 

implementing these changes, Shattuck recognized the importance of 

contextualizing and organizing vital statistics and other census data in 

such a way as to be useful for policymakers. Yet, J.E.D. DeBow later 

admitted, “The tables of the census which undertake to give the total 

number of Births, Marriages, and Deaths, in the year preceding the first 

of June, 1850, can be said to have but very little value. Nothing short of a 

registration system in the States can give the required data 

satisfactorily...”.16 DeBow’s statement about the 1850 Census suggested that despite the Shattuck’s help 

in improving the decennial census, the national government continued to struggle to develop its vital 

statics infrastructure a larger public health apparatus.17 Ultimately, despite DeBow’s misgivings with the 

1850 Census, Shattuck’s improvements to the 1850 Census provided a solid foundation for Census Office 

employees and special agents to the Office’s efforts to accurately collect and analyze America’s vital 

statistics. Describing the Census Office’s methodology for collecting vital statistics during the 1860 and 

1870 censuses, Carroll D. Wright, the Commissioner of Labor,

18 wrote, “The detail required at the 

succeeding censuses was not greatly changed, but one or two features were added and the numbers of 

inquires slightly increased...”19 Thus, Wright acknowledged that the Census Office relied on Shattuck’s 

census methodology in two decennial censuses following his death in 1859.

Dr. John Shaw Billings Makes Vital Improvements to the Census Office

In 1880, Dr. John Shaw Billings, a U.S. Army surgeon, and Civil War veteran, utilized his nineteen years 

of medical and federal government experience to expand the national Census Office’s role in collecting, 

processing, and analyzing the nation’s vital statistics. While Billings had a small role in the 1870 Census,

he had a more significant impact Census Office as a special agent for the 1880 and 1890 Censuses.20 For 

example, during the 1880 Census, Billings encouraged the Census Office to collect mortality data by 

having physicians complete and return “a small register of death...” for each patient who died under their 

care.

21 Once the Census Office collected these forms, a skilled physician examined the returns and 

determined the medical terms used in the final report.22 By collecting data using this administrative 

procedure, Billings agreed with Dr. Edward Jarvis, the third president of the American Statistical 

Wright included the above table in one of his 

congressional reports to highlight the additional 

inquires added to the mortality tables between 

1850 and 1890.

Courtesy of the U.S. Census Bureau
Association and a consultant for the 1850, 1860, and 1870 Censuses, who suggested physicians would 

have an easier time collecting, interpreting, and analyzing mortality data compared to inexperienced 

enumerators and census respondents.23

Having implemented methodological improvements to the 1880 Census and overseen the completion of 

the vital statistics portion of the 1880 Census, the Census Superintendent, Robert P. Porter, made Billings 

the special agent for the 1890 Census’s vital statistics. In his revised role, Billings made two important 

contributions to America’s emerging public health system. 

First, Billings and Census officials worked with local health officials and law 

enforcement to create small and permanent geographic entities called “sanitary 

districts.” These “sanitary districts” allowed Census Office clerks to analyze and 

compare the effect of population, topography, and housing on the mortality rate 

of the inhabitants of large cities, such as New York, Philadelphia, Brooklyn, 

Boston, Baltimore, and Washington D.C.,24 at a micro-level without having the 

data skewered by the fluidity of political boundaries.25 With this granular-level data, Billings and the 

Census Office produced colorful and detailed maps, which public health officials, sociologists, and health

reformers utilized as they sought to help immigrant populations assimilate into their adopted 

communities. 

Additionally, public health officials used these more detailed maps to help them prevent or halt the 

epidemics that continued to affect the population of these urban centers. Finally, the creation of sanitary

districts served as an early example of federal and local governments cooperating to design a set of small 

geographic units based on population and housing characteristics. Having established a precedent of 

cooperating to produce more accurate tools for collecting and analyzing data sets, the federal officials 

continued to work with local researchers as they developed what eventually became the modern censustract.26

Above: A map of Billings's Sanitary Districts in 

New York City. c. 1894.

Courtesy of the U.S. Census Bureau
Billings also sought a way to process the raw 1890 Census data using technology 

quickly and accurately. Fortunately, in 1888, Herman Hollerith, a former Census 

Office statistician and Billings’ protégée, invented a mechanical tabulator and 

devised a revolutionary punch-card system, which the Census Office used to 

compile the 1890 census data. Billings recognized the importance of the machine in 

his 1890 final report, writing, “All these mechanical methods of compiling and 

computing will be more important in a permanent census bureau which is badly 

needed in this country...”.27 

By the time Carroll D. Wright transmitted Part I of Billing’s final report to Congress, Billings had 

accepted the directorship of the recently established New York Public Library. For the remaining 17 

years of his life, Billings dedicated much of his time to expanding the reach and collections of the New 

York Public Library.

Conclusion

For over fifty more years, the Census Bureau served as the primary federal agency 

responsible for collecting the nation’s vital statistics and working with external stakeholders 

to interpret the data. In 1946, President Harry Truman officially transferred “the functions 

of the...Bureau of the Census...with respect to vital statistics...to the Federal Security 

Administrator and shall be performed under his direction and control by the United States 

Public Health Service.”28 While this signaled an end of the Census Bureau’s direct 

involvement with managing the nation’s vital statistics on a massive scale, Shattuck’s and 

Billings’ legacy of revolutionizing data collection and processing remains as pertinent today 

as it did in the 19th century. 

Notes

1 United States Census Bureau, “Census Bureau Statement on Coronavirus and the 2020 Census.” U.S. 

Census Bureau. press release, March 11, 2020, on census.gov, accessed November 4, 2020, 

https://www.census.gov/newsroom/press-releases/2020/statement-coronavirus.html. 

2 Throughout this article, the “vital statistics” are statistics relating to births, deaths, marriages, health, 

and disease. The term “vital records” describe records of life events kept under governmental authority, including 

birth certificates, marriage licenses (or marriage certificates), and death certificates.

3 Alice M. Hetzel, National Association for Public Health Statistics and Information Systems, “History and 

Organization of the Vital Statistics System: Historical Development,” in U.S. Vital Statistics System: Major Activities 

and Developments, 1950-95, U.S. Department of Health and Human Services, February 1997, (Hyattsville, MD: 

1997), DHHS Publication No. (PHS) 97-1003, pg. 44.

Above: Hollerith's tabulating system 

consisted of three different 

components, a card puncher, the 

tabulator, and a sorting box.

Courtesy of Smithsonian’s National 

Museum of American History.

Portrait of Colonel John Shaw 

Billings, M.D., by Cecilia 

Beaux (1895).

Courtesy of the U.S. National 

Library of Medicine.
4 U.S. Const. art. I, cl. II.

5 For the 1790 Census, U.S. marshals and their assistant marshals listed the name of each head of 

household, and asked the following questions: (1) The number of free White males (1a) under 16 years and (1b) 16 

years and upward; (2) number of free White females; (3) number of other free persons; and (4) number of slaves. 

“An Act providing for the enumeration of the Inhabitants,” in Annals of Congress, 1st Cong., 2nd sess., March 1, 

1879, Ch. 2, pg. 101. 

6 Alice M. Hetzel, National Association for Public Health Statistics and Information Systems, “History and 

Organization of the Vital Statistics System: Historical Development,” in U.S. Vital Statistics System: Major Activities 

and Developments, pg. 44.

7 Alice M. Hetzel, National Association for Public Health Statistics and Information Systems, “History and 

Organization of the Vital Statistics System: Historical Development,” in U.S. Vital Statistics System: Major Activities 

and Developments, pgs. 47-48; “Shattuck, Lemuel,” in Dictionary of American Biography, ed. Dumas Malone (New 

York, NY: 1935), vol. 17, pgs. 33-34; and “Lemuel Shattuck Papers, 1829-1855, Vault A45, Shattuck Unit,” Concord 

Library, last modified March 14, 2012, accessed September 1, 2020, https://concordlibrary.org/specialcollections/fin_aids/shattuck.

8 In 1632, the Grand Assembly of Virginia passed a law requiring a minister or warden from every parish to

appear annually at court on June 1st. Upon their arrival, the minister or warden presented a register of 

christenings, marriages, and burials for the year. To learn more about this topic and decentralized development of 

the U.S.’s Vital Statics System, see Alice M. Hetzel, National Association for Public Health Statistics and 

Information Systems, “History and Organization of the Vital Statistics System: Historical Development,” in U.S. Vital 

Statistics System: Major Activities and Developments, 1950-95, pgs. 44-49 & 58. 

9 S. Shapiro, “Development of Birth Registration and Birth Statistics in the United States,” Population 

Studies, 4, no 1 (June 1950), pg. 87 & Amasa Walker, Secretary of the Commonwealth, Ninth Report to the 

Legislature of Massachusetts, Relating to the Registry and Returns of Births, Marriages and Deaths, in the 

Commonwealth, for the Year Ending December 31, 1850, (Boston, MA., Dutton & Wentworth, State Printers, 1851), 

pg. 73.

10 “Lemuel Shattuck (1793-1859): Prophet of American Public Health”, American Journal of Public and 

Nation’s Health, 49, no. 5 (May 1959), pgs. 676-677.

11 “Lemuel Shattuck (1793-1859): Prophet of American Public Health”, pgs. 676-677.

12 To learn more about the controversy surrounding the results of the 1840 Census, see Dr. Edward Jarvis, 

Insanity Among the Colored Population of the Free States (Philadelphia, PA, T.K. & P.G., Printers, 1844) & “Chapter 

23: The Politics of Census,” in Hen’s Teeth and Horse’s Toes, by Stephen Jay Gold (New York, NY: 1983), pgs. 303-

309.

13 J.D.B. DeBow, U.S. Census Bureau, Statistical View of the United States...Compendium of the Seventh 

Census, (Washington, D.C.: A.O.P. Nicholson, Public Printer, 1854), pgs. 12-13.

14 J.D.B. DeBow, U.S. Census Bureau, Statistical View of the United States...Compendium of the Seventh 

Census, pg. 13.

15 Alice M. Hetzel, National Association for Public Health Statistics and Information Systems, “History and 

Organization of the Vital Statistics System: Historical Development,” in U.S. Vital Statistics System: Major Activities 

and Developments, 1950-95, pg. 48 & Frank H. Godley, National Center for Health Statistics, “Lemuel Shattuck: 
American Pioneer in Population,” in Proceedings of Social Statistics Section, Los Angeles, 1966, pgs. 474-476. Los 

Angeles: American Statistical Association.

16 J.D.B. DeBow, U.S. Census Bureau, Statistical View of the United States...Compendium of the Seventh 

Census, pg. 57.

17 Gerald N. Grob, "Edward Jarvis and the Federal Census: A Chapter in the History of Nineteenth-Century 

American Medicine," Bulletin of the History of Medicine, vol. 50, no. 1 (Spring, 1976), pgs. 14-15; J.D.B. DeBow, 

U.S. Census Bureau, Statistical View of the United States...Compendium of the Seventh Census, pgs. 8-11; and 

“Letter From Dr. Edward Jarvis, of Massachusetts, Upon the Classification of Diseases” in Mortality Statistics of the 

Seventh Census of the United States, 1850, J.D.B. DeBow, (Washington, DC: A.O.P Nicholson), 33rd Cong., 2nd sess., 

Ex. Doc. No. 98, pgs. 45-48.

18 Carroll D. Wright, the Commissioner of Labor, accepted the leadership of the Census Office after the 

departure of Robert P. Porter. Given his new role, Wright oversaw the completion and publication of the final 

reports 1890 Census reports. To learn more about Carroll D. Wright, see “History: Directors 1893-1909,” U.S. 

Census Bureau, last modified January 25, 2021, accessed February 9, 2021, 

https://www.census.gov/history/www/census_then_now/director_biographies/directors_1893_-_1909.html.

19 Carroll D. Wright (Commissioner of Labor), The History and Growth of the United States Census...

(Washington, D.C., GPO, 1900), 56th Cong., 1st sess., Senate, No. 194, pg. 98.

20 Francis A. Walker, Superintendent of the Census, The Vital Statistics of the United States,...From the 

Original Returns of the Ninth Census, (June 1, 1870)... (Washington, D.C., GPO, 1872), pgs. v-viii.

21 John Shaw Billings (Surgeon-U.S. Army), Department of the Interior: Census Office, Report on the 

Mortality and Vital Statistics of the United States as Returned at the Tenth Census (June 1, 1880) (Washington, D.C., 

GPO, 1885), pt. 1, pg. xi.

22 John Shaw Billings (Surgeon-U.S. Army), Department of the Interior: Census Office, Report on the 

Mortality and Vital Statistics of the United States as Returned at the Tenth Census (June 1, 1880) (Washington, D.C., 

GPO, 1885), pt. 1, pgs. xi-xii.

23 “Letter from Dr. Edward Jarvis, of Massachusetts, Upon the Classification of Diseases” in Mortality 

Statistics of the Seventh Census of the United States, 1850, pgs. 45-46.

24 Although the historical record is unclear about how or why the Census Office included Washington D.C., 

Baltimore, Philadelphia, New York City, Brooklyn, and Boston as subjects in one of three special reports about vital 

and social statistics, Billings noted these cities had an efficient registration system and knowledgeable physicians 

or a local medical board that could share their own collection of vital statistics. Additionally, these six cities had 

some of the largest populations in the U.S. and were geographically close to each other. For more information, see 

John S. Billings, M.D., (Deputy Surgeon-General, U.S. Army (Retired))..., Department of the Interior: Census Office, 

Report on Vital and Social Statistics in the United States at the Eleventh Census: 1890...Cities of 100,000 Population 

and Upward, (Washington, D.C., GPO, 1896), pgs. 1-2; John Shaw Billings, (Expert Special Agent), Department of 

the Interior: Census Office, Vital Statistics of the District of Columbia and Baltimore Covering a Period of Six Years 

Ending May 31, 1890 (Washington, D.C., GPO, 1893), pgs. 1-3; John Shaw Billings (Surgeon U.S. Army, Expert 

Special Agent), Department of the Interior: Census Office, Vital Statistics of New York City and Brooklyn Covering a 

Period of Six Years Ending May 31, 1890 (Washington, D.C., GPO, 1894), pgs. 1-3; and John Shaw Billings (Surgeon 

U.S. Army, Expert Special Agent), Department of the Interior: Census Office, Vital Statistics of Boston and 

Philadelphia Covering a Period of Six Years Ending May 31, 1890 (Washington, D.C., GPO, 1895), pgs. 1-2. 

25 John Shaw Billings (Surgeon-U.S. Army), Department of the Interior: Census Office, Report on the 

Mortality and Vital Statistics of the United States as Returned at the Tenth Census (June 1, 1880), pg. xvi; John 
Shaw Billings (Surgeon U.S. Army, Expert Special Agent), Department of the Interior: Census Office, Vital Statistics 

of New York City and Brooklyn Covering a Period of Six Years Ending May 31, 1890, pg. 1; and “History: Tracts and 

Block Numbering Areas,” U.S. Census Bureau, last revised August 07, 2020, accessed October 20, 2020, 

https://www.census.gov/history/www/programs/geography/tracts_and_block_numbering_areas.html.

26 “History: Tracts and Blocking Numbering Areas.”

27 John Shaw Billings, “Mechanical Methods Used in Compiling Data of the 11th U.S. Census...,” in 

Proceedings of The American Association for the Advancement of Science. For the Fortieth Meeting, held at 

Washington D.C. August 1891, by Frederic W. Putnam, ed. (Permanent Secretary), (Salem: Published by the 

Permanent Secretary, July 1892), pg. 409; “History: Herman Hollerith,” United States Census Bureau, last revised 

June 26, 2020, accessed October 21, 2020, 

https://www.census.gov/history/www/census_then_now/notable_alumni/herman_hollerith.html; “Count Me In,” 

United States Patent and Trademark Office, last modified January 31, 2020, accessed October 21, 2020, 

https://www.uspto.gov/learning-and-resources/journeys-innovation/historical-stories/count-me; and “History: 

1890,” United States Census Bureau, last revised December 17, 2019, accessed October 21, 2020, 

https://www.census.gov/history/www/through_the_decades/overview/1890.html. 

28 On April 11, 1953, President Eisenhower transferred the U.S. Public Health Service and its newly created 

National Office of Vital Statistics from the Federal Security Administrator to the Department of Health, Education, 

and Welfare (HEW). HEW became the modern Department of Health and Human Services on May 4, 1980. 

President Harry Truman, Reorganization Plan No. 2 of 1946: Federal Security Agency and Department of Labor, The 

White House, May 16, 1946, accessed October 30, 2020, 

https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5a-node84-leaf92&num=0&edition=prelim.

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