“His splendid work in preventive measures and his prompt handling of contagious diseases have given Pennsylvania a security of health possessed by no other great community." – Pennsylvania Governor Martin Grove Brumbaugh, 1918.
“...a man of unusual ability and achievements, one who succeeded not merely in one profession but in several, and who has left upon his city, state and nation an enduring impression.”
- Dr. Edwin G. Conklin, Vice President of the Academy of Natural Sciences to his fellow members after Dr. Dixon’s death.
Laurel Hill Cemetery, resting place of Dr. Samuel G. Dixon (Courtesy of Laurel Hill Cemetery). 
The idea of hygiene was not entirely foreign in the United States, but it was also not widely practiced. The late 19th and early 20th centuries saw an influx of immigrants into the city of Philadelphia. Along with the growing population came overcrowding and living in too-close quarters which often resulted in poor hygienic practices. Coupled with a lack of sanitary knowledge and resources, it was a recipe for widespread contagion. Dr. Dixon believed disease prevention and eradication started with common people’s behavior toward hygiene. Dr. Dixon would use this knowledge to “[protect] the people of his State from scourge of disease” and pave the way for hygiene and sanitation to become staples of everyday life. He wrote frequently and fervently for many journals such as the Pennsylvania Health Bulletin and Annals of the American Academy of Political and Social Science in hopes of circulating ideas and practices across the state.
Early in his career as Health Commissioner, vaccinations regarding school children became a statewide controversy. In the midst of the vaccination issue, Dr. Dixon was also dealing with pollution infiltrating the Schuylkill River. In addition to statewide and large city issues, Dr. Dixon took preemptive action writing about hygiene and disease prevention concerning suburban and rural areas.
In the early 20th century, smallpox was a dangerous threat, especially to children. Between 1898 and 1903 there were 20,700 cases of small pox reported in Pennsylvania with 1,629 of those cases resulting in death. Dr. Dixon strongly believed in stopping the spread of smallpox among school age children and young adults and intended to fight, if needed, to make sure the disease was kept under control. As an experienced physician, he was well aware of the physical consequences the horrific disease caused. He also knew that simply educating people on the calamities of smallpox would not necessarily encourage them to vaccinate their children.
Although the Pennsylvania law requiring schools to “refuse admission to any child” who was not vaccinated from or had previously had smallpox was written in 1895, it was not strictly enforced until September 1905 under Dr. Dixon’s appointment as Health Commissioner of Pennsylvania. In 1901, Dr. Dixon promoted physical examinations for all Pennsylvania teachers prior to their hiring so as to prevent the spread of disease. Tests to determine contagions in early stages were required for teachers before they were allowed to enter the classroom. These examinations were only the beginning of what was become a full blown controversy of the enforcement of vaccination laws.
By September 1905, children were not permitted to attend classes if they did not have the requisite vaccine. To make sure public schools and colleges adhered to the law, Dr. Dixon imposed a fine on school leaders and/or teachers “between $5 and $100 or imprisonment up to sixty days” for noncompliance. It did not go over well with several school leaders, teachers and parents. Many parents, school officials and teachers felt that children should not be deprived of an education simply because they were not vaccinated. The Pennsylvania Department of Health felt the necessity of disease prevention was of greater importance and pushback regarding the vaccination law was not taken lightly by the Health Commissioner. He even considered taxing those who were in violation of the small pox vaccine law in order to defray the costs associated with the spread of the disease.
Despite the severity of the law, Dr. Dixon did not see all teachers as an opposing force to the vaccination law. Many teachers were on board with the vaccination laws refusing to allow unvaccinated children into their classrooms. In Boiling Springs, Pennsylvania the matter became heated between teachers and the school board. Four teachers were turning away unvaccinated children at the dissent of the school board. The board attempted to force the teachers to take the children in, but the teachers appealed to Dr. Dixon and the Health Department for help. One particular teacher had been threatened with bodily harm from a school director who had sided with angry parents. Dr. Dixon commended her bravery “for the protection of her little pupils as well as the whole of the community.” Dr. Dixon recognized the opportunity to help those educators who were feeling bullied by others and praised the teachers who stood up to the opposition as ‘heroes’. He also publicly expressed his concern for potential harmful situations and reassured the educators the law would stand behind them. Information regarding the detriment of smallpox was widely distributed to parents and teachers along with reminders of the consequences for breaking the vaccination law. Supplementary educational information and the enforcement of the law began to take further hold and slowly, but surely, more parents were having their children vaccinated.
Diseases were not only spread through human contact, but also commonly through polluted waterways. The Schuylkill River and local waterways in this Philadelphia area were in danger of high levels of pollution from sources outside of the region, and, in the summer of 1905, a thorough inspection of the river and the sources of pollution was completed.
Norristown, approximately 10 miles upriver from Mill Creek, had been the primary cause of pollution in the Schuylkill River and a significant cause of typhoid fever. Open sewers emptying trash and raw sewage flowed directly into the Schuylkill creating deadly ramifications to the inhabitants of Norristown and ultimately those downstream, including the residents of both Montgomery and Philadelphia counties. The fear of the pollution affecting the drinking water of the region was of great concern. Mill Creek was “one of only two clean creeks” to flow into the Schuylkill River at the time. All other tributaries in region had some level of pollution. Dr. Dixon was highly disappointed “that in a civilized and enlightened community such conditions were allowed to exist.”  Immediate plans were put into place to create closed sewer systems in Norristown to rid waste properly. Eventually several cities implemented solutions to prevent downstream pollution of Schuylkill River due to Dr. Dixon’s research and persistent management of sewage problem solutions. Not surprisingly, Lower Merion was already ahead of the game and had completed the installation of an efficient sewer system in May 1905. While many other regional creeks and streams were falling prey to sewage, Mill Creek managed to steer clear of the refuse.
In the midst of cleaning up the Philadelphia region’s sewage problem, Dr. Dixon’s focus on rural and suburban areas flourished. As the larger cities became more populated, many people opted to move and build in rural areas. Dr. Dixon was well aware of the lack of resources his fellow physicians practicing in the countryside had at their disposal to treat the growing number of patients and sought to change the problem.
Beginning in 1906, Dr. Dixon and the Pennsylvania Department of Health implemented a first of its kind program to build laboratories in suburban and rural towns of Pennsylvania to aid country doctors. Concern for the comfort of the sick was high on his list, but Dr. Dixon also saw an opportunity to prevent widespread contagion. Ill patients no longer had to travel to the city for treatment. The program saved time, money and reduced the potential for the spread of disease. After the establishment of the laboratory program, Dr. Dixon also wrote an informational journal for the benefit of physicians in rural and suburban areas aptly called “Some Duties, Ideals and Opportunities of the Country Doctor”.
Doctors were not the only people in rural areas to benefit from Dr. Dixon’s knowledge. The Dixon family’s Lower Merion homestead took at least five years to build before the house was ready for occupancy. During this time, Dr. Dixon had researched the proper way to build the optimum home for happy and healthy country living. His life and home at Black Rock Farm had been the inspiration for many of his publications and he modeled several of his journals and articles on hygiene after his experiences living in Lower Merion.
“The Rural Home”, written about seven years after Dr. Dixon moved into his home in Lower Merion, was a guide in how to select land and build a home most beneficial to a healthy life in the countryside. The detailed tutorial was broken down into several steps beginning with the selection of a location. Very specific instructions were given to the construction of the home including shape, geographical direction, topographical situations, water supply, plumbing, heating, lighting and the materials to be used. “The Rural Home” was not an instruction booklet for architects and builders; it was a non-complicated guide for the average person seeking to live a comfortable life in the countryside.
A few months after “The Rural Home” was published in the Annals of the American Academy of Political and Social Science, Dr. Dixon’s “Health of Suburban Residences” was printed in the Pennsylvania Health Bulletin. Similar to “The Rural Home”, “Health of Suburban Residences” was a wealth of information offering instructions regarding building individual residences outside of the city. “Suburban Residences” had expanded on “The Rural Home” and was far more detailed regarding the construction of a home. The journal also provided comprehensive explanations for such instructions. Stables were also discussed in both publications since a large number of the properties were farms. Dr. Dixon believed that the health of farm animals correlated with the health of people.
Dr. Dixon saw newly inhabited suburban and rural areas as a clean slate and took preemptive action to make sure places, like Lower Merion, started off on the right foot. As people moved into these areas it was necessary to educate them on hygiene and disease prevention specific to the locale. He shared his findings with the public in hopes of creating hygienic communities in suburban and rural areas. He frequently wrote lengthy journals for the Pennsylvania Health Bulletin regarding hygiene and disease prevention in hopes of getting the word out to the public. As informative as the Bulletin had been, a more popular avenue was necessary to extend his reach to the common people. In order to help the public see the advantages of good hygiene, he wrote health tips for common people slated for publication in newspapers. He discussed the necessity of children playing outdoors in woods away from the pollution of the city and that fresh air and clean water were conducive to a productive and happy life. He educated people on how to prevent contracting the painful and deadly diseases of the time period. Dr. Dixon’s articles were “written with the idea of prevention, not with cure.”
Between 1912 and 1918, Dr. Dixon offered his short and straightforward articles called “Little Talks on Health and Hygiene” to both city and small town newspapers. The Ardmore Chronicle and nearly all other Pennsylvania newspapers published Dr. Dixon’s articles on a weekly basis. “Little Talks on Health and Hygiene” eventually stretched out beyond the borders of the state to towns such as Aberdeen, South Dakota and Duluth, Minnesota. His Monday morning tips on food and water safekeeping, preventing insect infestation, and general hygiene were popular among suburban readers, especially to his neighbors in Lower Merion.
In the fall of 1916, the Lower Merion, Radnor and Haverford Boards of Health had planned to open a contagion hospital in the Mill Creek Valley area to house people suffering from extremely contagious diseases such as Tuberculosis and Diphtheria. The board had secured “an old house” to use as the hospital. Mill Creek Valley residents, upon finding out the details, which had not been publicized from the beginning, were highly put off by the idea of a “pest house” near their homes. The residents, knowing that the Dixon family also resided in the area, appealed to Dr. Dixon to put a stop to the local health boards. Dr. Dixon’s previous experience with contagious diseases and pollution problems may have been more than enough to convince him to side with the Mill Creek residents, but having lived near the Mill Creek for over a decade was equally, if not more of, a reason to oppose the plan. The risk of putting his family and neighbors in danger was far too high.
Having spent several years dealing with the frustrating, costly and time consuming sewage problems in Norristown and Reading, Dr. Dixon was fearful that the old decrepit building would not be able to handle efficient sewage disposal without risk of harming the residential area and local water supplies. He expeditiously wrote a letter to Lower Merion officials stating that the site offered was a fire trap without adequate water supply and its “plumbing [was] unsanitary.” He stated that the property in the surrounding area is of high value and that a contagion hospital “would ruin the immediate neighborhood…” Ultimately, Dixon knew the wealthy taxpayers in Mill Creek Valley would put up a fight if required pay additional taxes to fix a problem the townships had created. The officials conceded and the hospital was never opened.
July 1917 saw the beginning of a struggle with anemia for Dr. Dixon, and by the autumn of the same year he was bedridden at the University of Pennsylvania Hospital. Although he was in a weakened state, Dr. Dixon still practiced diligently for six months from his hospital bed. He had held his position as Health Commissioner until his death on February 26, 1918 and had been writing his “Little Talks on Health and Hygiene” articles up to two weeks before he passed.
Dr. Dixon was a beacon of health care in Pennsylvania. His enthusiasm, intelligence and industriousness were the backbone of his significant contributions to hygiene and sanitation. Before he passed he saw cases of typhoid fever drop by seventy-three percent and the overall death rate in Pennsylvania at the lowest the state had ever seen. Dr. Dixon was well-liked and viewed as a gentleman with a yearning to research and improve the health and prevent physical suffering of as many people as possible. As Health Commissioner he was able to bring his hopes to fruition.
 Conklin, et al., “Meeting,” 119.
 “Dr. Dixon Tells Small-Pox Burden,” The Philadelphia Inquirer, January 14, 1906, 13.
 “Physical Examination for Teachers,” The Philadelphia Inquirer, September 26, 1901, 6.
 “Dixon to Enforce Vaccination Law,” The Patriot [Harrisburg], September 11, 1905, 5.
 “Vaccination Hard problem to Solve,” The Philadelphia Inquirer, October 15, 1908, 14.
 “Dr. Dixon Tells Small-Pox Burden,” 13.
 “Boiling Springs Dispute,” The Patriot [Harrisburg], October 13, 1905, 7.
 “Teachers Heroic for Law’s Sake,” The Philadelphia Inquirer, December 11, 1905, 2.
 “Plan to Inspect River Pollution,” The Philadelphia Inquirer, July 29, 1905, 1.
 “Norristown is Principal Cause of River Filth,” The Philadelphia Inquirer, August 2, 1905, 1.
 “Dixon Indorses Pollution Fight,” The Philadelphia Inquirer, February 7, 1906, 5.
 “Rich Men Eager to Protest Tax,”The Philadelphia Inquirer, May 19, 1905, 7.
 “State is Aiding Country Physician,” The Philadelphia Inquirer, July 30, 1911, 3.
 Dixon, Samuel, “The Rural Home,” Annals of the American Academy of Political and Social Science, 40, (1912):168-174 and Dixon, Samuel G., “The Health of Suburban Residences,” Pennsylvania Health Bulletin, 36, (1912): 1-7.
 Dr. Dixon’s Ill Health Stops His ‘Little Talks’,” The Patriot [Harrisburg], February 24, 1908, 5.
 “Dixon Nips Pest House Plan in Lower Merion,” The Philadelphia Inquirer, October 9, 1916, 5.
 “Dr. Samuel G. Dixon, Health Officer, Dies” The Philadelphia Inquirer; February 27, 1918, 14.
 “Dr. Dixon’s Ill Health Stops His ‘Little Talks’,” 5.
 “Dr. Samuel G. Dixon is Re-appointed,” The Ardmore Chronicle, May 22, 1915, 1.
 Images from the History of Medicine (http://ihm.nlm.nih.gov)
 Laurel Hill Cemetery (http://forever-care.com/laurel-hill.php)
Portrait of Dr. Samuel G. Dixon (Courtesy of Images from the History of Medicine (IHM))