Historians have argued that American social welfare reformers looked to Europe for examples of successful programmes. This article provides a counter-case where a progressive American state, Massachusetts, developed public health reforms prior to their British counterparts. Social concerns about reducing cases of tuberculosis in Massachusetts' cotton manufacturing cities led to the transference of the public health discourse from the urban living environment to the workplace. This same relationship could have been applied within the Lancashire industry. Instead, the urban public health discourse focused on living conditions. In both countries, local and state political structures influenced health campaigners' actions.