Download Infectious Diseases in the 19th-Century City

Infectious Diseases in the 19th-Century City
Today I want to talk about the role of medical science and the
conquest of disease in the developed world. That's a very
grandiose title, but it's very easy for us to take for granted the
achievements that make the comforts of our everyday life
possible -- for example, clean water, food that is certified pure,
sanitation systems for the easy removal of human waste,
immunizations and preventive vaccines that protect us from
many infectious diseases. Well, in the 19th century, each of
these things were very hard to come by for all but the most
privileged, and in the case of immunizations and preventive
vaccines, they only became widely available during the last
decade of the 19th century. Infectious diseases affected
thousands of people every year; therefore the control of these
things is one of the great triumphs of modern medicine and
public health.
So I want to begin by describing the 19th-century city, and I'm
going to use New York City as my case study. New York City
in the 19th century was the most diverse city in America. By
mid-century it had also the worst health statistics in the nation.
Data gathered by the city showed that one out of every 36
people died in 1863, as compared to one out of 44 in Boston
and in Philadelphia. New York also compared poorly with
London and with Liverpool. New York did not turn its
attention to the conditions of its city until the middle of the
century. And studies in the 1840s attributed the high rates of
disease to the poor housing and also the immoral conditions
that certain susceptible or unworthy individuals in
communities had created.
In 1864, the New York Citizens' Association organized a
district-by-district and block-to-block inspection of living
conditions in Manhattan. What did they find? They found that
many of the cobblestone streets were very filthy with
accumulations of manure from the horses that traversed them.
Dead dogs, cats, and rats littered the streets. Household and
vegetable refuse collected in the cracks of the cobblestones to
the depths of three feet or more in the winter. So-called
garbage boxes were rarely emptied, and they overflowed with
awful animal carcasses and household waste. There were
pools of stagnant water collected in the carcasses of dead
animals, and they collected also over sewer drains, and they
were generally very clogged. So filth of every kind was
thrown into the streets, covering their surface, filling the
gutters, obstructing the sewer culverts, and sending forth what
were called the "perennial emanations which must generate
pestiferous disease."
So filth of every kind was thrown into the streets at all times
of the day, and poorly designed sewers had been installed
throughout the city, but most of the population depended upon
these sort of outdoor water closets and privies in the
courtyards of their homes. And in tenement buildings, these
privies were often placed very close to the wells that people
used to get their drinking water from.
Amenities were very few. These so-called water closets were
generally covered and surrounded by filth so as not to be
approachable. Others were merely trenches, sunken one or two
feet into the ground. And the fluids in some instances were
allowed to run into the courtyards. And most houses had no
sewers, which made the stench that arose in the summer
"absolutely unbearable and perilous," as one observer noted.
Those concerned about the city were most concerned about the
stench. I mean, if you can imagine garbage piled three feet
high in the streets, this smelled very, very, very, very badly.
And so people believed that this stench itself, the smell itself,
was the cause of disease. They believed that the garbage in the
streets produced these miasmas -- that is, the stench that
people smelled -- and these miasmas sort of polluted the air,
spreading across the city, carrying disease with it.
It was also feared that unworthy and worthy, the rich and the
poor, all were susceptible to the fevers and plagues that were
carried throughout the air. And so in New York City, the
observers of the conditions found that disease, debasement,
and pauperism -- that is, disease, immorality, and poverty -were the major threats to the healthy conditions of the city.
Throughout the city, dirty streets, clogged sewers, polluted
wells were commonplace.
As a result of all this garbage and stench and filth in New
York City, epidemics of infectious diseases were
commonplace. In the 19th and early 20th centuries, there were
four outbreaks of cholera in New York, where more than
5,000 residents died in 1849. Smallpox epidemics waxed and
waned over the century, as did typhoid, typhus, malaria,
yellow fever, pneumonia, diphtheria, and tuberculosis. I bet
many of those things we don't even recognize their names
anymore, they have so much disappeared from our landscape.
In 1881 and 1887, nearly 5,000 residents died of diphtheria,
while typhoid accounted for thousands of deaths in 1864 and
'65. The influenza epidemic in 1918 killed 12,562 persons in
one year alone. And one of the most disturbing statistics was
the large number of infants and young children who died of
diarrhreal diseases, especially in the summer. In 1840,
approximately 190 of every 1,000 infants born in New York
City never reached their first birthdays. By 1930, however,
fewer than 70 in 1,000 infants born in New York City died in
the first year of life. Young adults also faced harsh conditions.
In 1840 and 1870, nearly one-quarter of those reaching the age
of 20 would not live to the age of 30.
Many of the diseases that caused all these deaths thrived in the
dirty water, unpasteurized milk, and untreated sanitation and
deplorable housing conditions that were the normal conditions
of life for most of New York's inhabitants, especially its
poorest inhabitants. It is also important to realize, in the deaths
of children and youth, that because epidemic diseases took so
many of these from these groups during this period, the
expectation of many parents was that their children would not
live. Generally people thought that one or two of their children
would probably die before they reached the age of 5 or the age
of 10. To have many children in a family survive to the age of
20 was not a usual condition, so there was a kind of fatalism
among the population and the ways in which they accepted
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that many of their children might not survive. This, too, was a
fact of life that has radically changed for us in the late 20th
century.
Now, despite the fact that widespread epidemic outbreaks in
New York City were really relatively minor contributions to
the overall death rates, the problem is that these epidemics
were highly visible and dramatic experiences where
inhabitants of the city often saw people literally dying in the
streets. And it had an enormous impact on the psychological
feelings of people who lived in this city at the time. The rich,
when these diseases would occur, often fled to the countryside
when epidemics broke out. Others simply moved further and
further away from whatever parts of the city the diseases had
appeared. So many people who lived near the downtown
tenement house districts would just move uptown. Others
would move out of the city altogether.
In particular, port cities like New York, like Boston, like
Philadelphia, were particularly susceptible to outbreaks of
infectious diseases because these were places where ships
coming in from other parts of the world also brought travelers
who would have been exposed to these diseases in the cities
where they had departed. Cholera, for example, had largely
been restricted to the Far East until advances in shipping
shortened the travel time between the world's major ports. And
because cholera has a very short incubation period and a rapid
course, the fact that there was more rapid transportation
between the Far East and the U.S. increased the spread of this
disease.
Now, one of the major changes that occurs toward the end of
the 19th century, as people tried to figure out how to control
infectious diseases, was the introduction of the germ theory of
disease. It became clear that impure water, crowding, poor
housing, spoiled food, and other environmental conditions
were contributing factors to high rates of disease in the cities.
As I said also, people believed that immoral behavior also
facilitated the spread of infectious diseases. But during
moments of crisis, some also sought to focus on personal
hygiene, child care practices, as also leading culprits in the
spread of disease. But these differing explanations for high
disease rates have profound implications for prevention
planning. The only means of preventing these diseases at this
time was to clean up the city, improve the housing stock,
reduce overcrowding, provide better sanitation, et cetera.
Now, this environmental emphasis implied the need for
massive social investment and a change in social and
economic relationships; that is, to provide better housing for
people, to use taxpayers' funds to build major systems, like
sewerage systems. One of the causes of diseases that people
believed at this moment also implied that there had to be also
an emphasis on personal hygiene, and placing the
responsibility for hygiene on individuals. This led to a kind of
blaming the poor and the sick for their diseases as opposed to
saying that diseases lay outside of individuals.
But slowly, as medical experts carefully analyzed transmission
of diseases, of these infectious diseases, the belief grew that
there were specific causes, specific pathogens associated with
specific diseases, and these pathogens turned out to be
microscopic organisms or bacteria. So beginning in [the]
1870s and 1880s, researchers abroad discovered the
microorganisms associated with tuberculosis, with cholera,
with typhoid, and with diphtheria. Now, American physicians
were initially a little bit skeptical that a little microbe, a little
bacteria, could actually cause diseases that wreaked such
havoc in the cities, but with the development of diphtheria
antitoxin in [the] 1890s, which dramatically reduced the
mortality associated with this disease, a number of physicians
were finally convinced that the germ theory was correct.
Now, for public health experts, the germ theory proved to be
especially rewarding, making visible the agents of disease in
water, food, and blood. And by the 1910s, physicians were
provided with precise tests to identify a variety of diseases.
And so the germ theory seemed to promise a precision, not
only in the diagnosis of disease, but also in the prevention of
disease. And proponents of public health adopted a new
approach to their work. They rejected the idea that they had to
simply clean up the environment and get rid of the filth. The
new public health emphasized that germs were spread by
personal contact, and the new practices centered on educating
individuals in their responsibility for the prevention of disease.
In sum, the focus of public health work changed from citywide
sanitation and disease control to closer observation of
individuals, their habits, and their contagiousness.
And that brings us to the case of "Typhoid Mary." Typhoid
was a significant problem in American cities. It is a water- and
food-borne systemic bacterial infection. It is important to
know what it looks like when people saw it. Its symptoms are
sustained fever, headache, malaise, gastrointestinal problems.
A few days following exposure, the patient experiences a
headache, loss of appetite, chills; and about 10 percent of
those who are infected with it die. It struck mostly in cities
that had untreated water supplies, and thus, it responded well
to the implementation of water-filtration systems and
sanitation. But as cities began to build these systems, they still
saw typhoid, and they couldn't understand it. Why do we still
have typhoid? We've cleaned up the water; we've cleaned up
the sewage. And it turns out that the answer was that there
were typhoid carriers -- people who had either been exposed
to the disease and had an outbreak of it and recovered, or those
who do not remember being sick at all, but who nevertheless
carry typhoid bacilli in their bodies and could infect other
people.
The most famous germ carrier, as you know, was an Irish
immigrant cook, Mary Mallon, and she has the distinction of
being the first typhoid fever carrier to be identified and
charted in North America. Mallon worked for several wealthy
New York-area families, and in the summer of 1906, she
found employment in the rented summer home of a New York
banker. When typhoid fever struck six people in the household
of 11, the owner of the home, thinking that he would be
unable to rent the property again unless he solved the mystery
of these cases, hired a civil engineer whose name was George
Soper, known for his work on the epidemiology of typhoid, to
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investigate the outbreak. And Soper's report ruled out all the
factors that might be contributing to these cases; that is,
contaminated water or milk and other possible sources. And
he concluded that the prime suspect had been the cook. By
tracing the cook's job history and outbreaks of typhoid, he
finally identified Mary Mallon.
Now, when Soper met Mallon and tried to explain to her that
she was a carrier of the disease, she threw him out of her
house. Soper then turns to the New York City health
department, showed them his data, and convinced them that
Mallon should be brought in to have her urine and feces tested
for the presence of the typhoid bacillus. And in 1907, she was
forcefully apprehended by city health officer S. Josephine
Baker with the help of the police. She was taken against her
will to the Willard Parker Hospital, which was New York's
hospital for contagious diseases, and there they subjected her
to careful laboratory tests. And the results showed high
concentrations of typhoid bacilli in her feces. She was kept in
health department custody in an isolation cottage on the
grounds of the Riverside Hospital on North Brother Island. In
1909, she unsuccessfully sued for her release. In 1910, she
was freed, but she was arrested again later after officials traced
a house-hospital outbreak of typhoid fever to her kitchen. And
this time, when they apprehended her, she was placed in
custody until her death in 1938. She lived in health
department-imposed isolation for a total of 26 and a half years.
Typhoid, Polio, and Diphtheria: Science and Class Issues
Professor Hammonds: What conclusions did people come up
with about the health department's decision, the issues that her
incarceration and isolation raise? Yes?
Ron Morrison: I took the position of one of the health
officials, that isolating her, putting her in her own, separate
cabin was the right thing to do. I sort of started off feeling bad.
And then as I -- as you gave me the other information, I said,
well, maybe I wasn't too wrong in what they did, for the
simple fact -- You know, isolating a few individuals for the
good of the greater majority seems to be the way, or was the
way back then. What we know now, we wouldn't have to do
what was done then.
Professor Hammonds: So -- but it could happen now. That's
the point I was trying to make. It could still happen.
Ron Morrison: Yes. I agree with you wholeheartedly.
Professor Hammonds: Other comments? I saw a couple -yes?
Larry David: One of the things that we discussed was, what
is the nature of a public health crisis? What determines what
crisis is in general? And we bandied that about in our group.
And one of the things we noted is that it changes with the
time. Previously there hadn't been -- It hadn't been perceived
to be a crisis in the 1830s and 1840s, '50s, and '60s. While you
have the disease, it's not perceived as a crisis. In the
progressive era it is, because of the changing mind-set of the
public, and especially the middle class.
Professor Hammonds: Well, no, I think outbreaks of disease,
especially infectious diseases that cause large numbers of
deaths, are always perceived as a crisis. Even today they
would be perceived as a crisis.
Larry David: It depends on who is affected. It depends on the
segment of the population.
Professor Hammonds: Well, does it depend on who is
infected? Let me ask your colleagues to answer that. Does a
crisis depend on -- calling it a crisis depend on who is
infected? Or is it a crisis no matter who is infected? Yes?
Ed Morrison: She was poor; she was Irish; she was Catholic;
she was an immigrant; she was a woman -- all people who
really had no status or perceived position in society at that
point in time. I just think she was easy pickings. I think she
was victimized.
Professor Hammonds: So you think they were making an
example of her?
Ed Morrison: Exactly. An example. And then, to the extent
that that example even wasn't established to be looked upon as
a precedent later -- I mean, I just feel it was an awful injustice.
Professor Hammonds: Are you sure about that?
Professor Hammonds: Okay. Other opinions? Yes?
Ron Morrison: In some cases, yes.
Yvonne Powell: And we've had more recent experience with
the AIDS crisis. When that first started, they were
homosexuals, gay people, drug addicts, throwaways in our
society, and in more recent times, obviously African
Americans -- again, not the most prominent group of people
that we address. So I agree. I think it's those who are the most
vulnerable, who are the least, that oftentimes are susceptible to
be mistreated when a crisis comes, and their liberty taken
away.
Professor Hammonds: Suppose we faced a new disease, and
we didn't quite know what was going on, and the only thing
we knew was that there were some people out there who were
infecting other people. We tried to ask -- The public health
officials asked them to stop. They don't stop doing whatever it
is that causes the disease to be transmitted. What are we going
to do with them?
Ron Morrison: Isolate them. I mean, you bring them in, and
you isolate them, if need be.
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Professor Hammonds: Does anybody else want to argue that
there were good reasons for isolating Mary, that it makes
sense? Yes?
Eugenia Rolla: They really needed to kind of legitimize their
position within this kind of new, emerging, progressive time,
and so they needed to take a stand. That's not to say what they
were doing was correct or just. But from their perspective,
from a bureaucratic perspective, in order to kind of say, "Hey,
this is what our job is, and we're facing this crisis, and this is
what we're doing," I think it was necessary for them to set a
precedent to a certain extent
Professor Hammonds: You raise a good point. It is clear that
they wanted to establish a precedent about what to do about
carriers. What they're doing is, they have a new kind of issue
to deal with: How do you control people who are otherwise
healthy, are not sick themselves, but can cause disease? Now,
Mary Mallon is saying, "Well, I've never been sick. I don't
know what these people are talking about. I don't understand
this. They tell me I have these germs, that I give the what? I
don't know anything about this." And most people didn't
understand it. And it's a very abstract notion for most people
that there is such a thing as a carrier, right? And so how is the
health department going to have to make this abstract notion
concrete? In part because, as I said, the germ theory, as it is
applied to public health, changed the focus of public health to
individuals' behavior and their responsibility in transmitting
infectious diseases. Yes?
Steven Seto: The evidence was brought to the board of health.
They didn't go search it out. And from the -- Given the
information that I have, it didn't sound -- it didn't seem as if
they went out to look for anybody else afterwards. I mean,
there were still over 4,000 cases of typhoid while they had
Mary in isolation.
Professor Hammonds: What happens is, they began a much
more concentrated health education effort to get those people
who work as cooks, who may have been exposed to typhoid,
to wash their hands; to really begin to mandate that people
who work in restaurants, around food, who may have been
exposed to typhoid, to wash their hands. You've all seen those
signs in the bathrooms. So they begin this kind of effort
because they know they can't go hunting for these carriers.
They don't have anywhere to put these people. They don't
have the manpower to trace whether each individual carrier is
responsible for particular outbreaks of disease unless
something happens, and they, you know, they have to
intervene. But by and large, they don't have the manpower to
track down all these people.
So again, as I say, in a strange kind of paradoxical way, Mary
becomes this sort of symbol for them of what can happen. But
they know that they can't do this to everyone, so they institute
health education efforts to encourage the rest of the public to
comply with the kinds of things that are going to prevent the
spread of these kinds of diseases. Yes?
Matthew DeBoer: Do you think that Mary posthumously
became a martyr, and if so, what did her martyrdom represent?
Professor Hammonds: Yeah, I do think she becomes a
martyr, in the sense that what would most of us know about
"Typhoid Mary," just sort of a general kind of popular view?
It's almost as if she was this woman who deliberately went
about spreading disease and trying to hurt people, you know?
Even the cartoons that appear about her in newspaper accounts
at the time show her as evil and malevolent in some kind of
deliberate way, right? And I think the fuller context of the
story shows that she didn't set out to spread typhoid. She didn't
set out to kill people. She didn't do it maliciously. I think after
the evidence is presented to her, she had a lot of doubts about
the evidence. And I think the fundamental basis for her doubt
is simply that she was never sick. And it's very hard, I think,
for people to understand that you could transmit disease when
you're not sick. She couldn't remember ever having typhoid.
Here the authority is telling her this. You know, it sort of gets
picked up and exploded into this other set of issues, and I
think she comes down through history as, you know, "Typhoid
Mary," as sort of the evil one.
There is another case that we might look at as just counter to
that is in diphtheria, which is childhood disease. In the case of
diphtheria, many, many adults are carriers. There are
thousands of diphtheria carriers in New York City. And one
doctor says, "Well, I just think, you know, we just need to set
up a testing thing on every corner and just test all these people
down here in the Lower East Side, in the tenements, and any
of them that have diphtheria bacilli in their throats, they can't
be servants; they can't be teachers; they shouldn't be able to
work in candy stores," where it killed children, anywhere that
they could have any contact with children. And that's what he
wanted to do. And of course the public health officials said,
"We can't do that. How are we going to do that?"
Yvonne Powell: It is rather interesting how impotent the
judicial system appears to be, however, in this process. I
mean, the writ of habeas corpus is not -- is overturned. The
14th Amendment is absolutely ignored. The judiciary is
almost an agent of the public health department.
Professor Hammonds: I think that there are some interesting
tensions there in what happened in the courtroom. My reading
of that has to do with the authority of the scientific evidence
and the way in which the court deferred to that as the bottomline explanation, and I also think because they don't put Mary
in jail, for example, that she is isolated in a cottage and that
there are ways in which I think people might see that as a
fairly benign kind of "punishment." My reading of the case
sees it -- I think those factors play in as well, but I think the
key of it is that the bacteriological evidence that the health
department presents and the stature of the health department at
that time carries the day in the court.
I also want to say that outbreaks of infectious disease raise a
whole host of issues beyond simply ones about individual
rights versus the public's health. And I want to turn to another
epidemic -- the outbreak of polio in New York City in 1916 --
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as a good example to look at some of the other issues that
emerge. Poliomyelitis is a viral disease, characterized by
fever, headache, and sometimes stiffness of the neck and back.
In paralytic cases, the virus attacks the motor nerve cells in the
spinal cord, which governs your muscles, and if the muscles
needed for breathing or swallowing are affected, the patient
may die. Now, unless weakness or paralysis of the muscles in
the limbs is minor or improves after the acute attack, most
victims of polio will be crippled for life. In 1916, a national
epidemic of polio emerged with 27,000 cases in 26 states, with
6,000 deaths. In June 1916, New York City had the largest
single incidence of the disease, with over 8,900 cases and
2,400 deaths, and a mortality rate of more than one child in
four.
So again, we've just talked about typhoid in New York City.
This is coterminous with typhoid. So you have outbreaks of
typhoid in New York City; you have outbreaks of diphtheria;
you have this huge outbreak of polio. Again, look at the
landscape of the city at this point in time. This is not a healthy
place in many respects.
New York City remained a center for polio epidemics for the
next four decades. And initially it was seen, as many
infectious diseases were, as a disease of unsanitary living
conditions and of the immigrants -- the immigrants' bad
behaviors. But polio slowly became more associated with the
middle classes by the 1930s, and then was considered as a
danger to all. The agent, the pathogen that causes polio was
identified in 1908 as a filterable virus, but the 1916 epidemic
generated enormous fear in the public. Health officials had to
deal with families fleeing the center of the disease, and they
also had to deal with people who stayed behind. The officials
tried to restrict people's movement; they tried to identify the
sick; they tried to placard people's houses where the sick were.
They also tried to calm public fears, though they weren't quite
successful with that. And in New York City, as people, many
people, just, again, tried to leave, you know, it's like, time to
leave, take the kids, get out of the city.
To identify those free of the disease, the city's health
commissioner introduced a system of health certificates, in
part because neighboring towns were restricting entry to
people from New York City who didn't have a certificate
certifying that their children were free of the disease. These
certificates gave communities outside New York City one way
to assess whether a child was free of infection. By the end of
the epidemic -- that is, it went into the early fall -- 68,000
certificates had been issued. Even so, New York children were
frequently refused entrance to neighboring towns, are
threatened with quarantines that lasted as long as four weeks.
In a few cases, like the city of Paterson, New Jersey, they said
until further notice, no nonresidents will be allowed to enter
the city. And a city on Long Island just put big red signs up on
the main road entering the town that all children who lived
outside of the town would not be allowed to enter it.
Placards identifying housing where there were many cases of
the disease were placed outside tenement buildings, but these
placards were never placed outside of middle-class homes,
because it was at -- In one sense, the health officials believed
that the disease was less dangerous in middle-class
communities than it was in the immigrant communities, so
you see constantly the ways in which the fear of the immigrant
classes and their threats to the city get pretty wrapped up in
public health policies, even after the introduction of
bacteriology and more scientific-based public health.
The other thing that happened to poor parents is they were
faced with the prospect of their children being removed from
their homes and taken to the contagious disease hospital if
health officials felt that they couldn't provide adequate care for
the children inside of their homes. All manners of public
gatherings were cancelled during the epidemic. Theaters... The
health commission instructed all motion picture theaters to bar
entry to children under 16. And even though the theater
owners protested and said they were losing money, the city
maintained the closure of the theaters. Playgrounds were
closed. Sand piles were disinfected. Children's reading rooms
in public libraries were closed. And parents were also urged to
guard the behavior of their children. One official told parents
to avoid caressing or kissing children, to forbid children from
buying fruit or other exposed foods from street vendors, and to
keep them from exchanging toys, marbles, candy, or chewing
gum with other children.
Now, despite the dominance of the new public health, the
department ended up blaming the epidemic on the
irresponsible sanitary behavior of immigrants. But this began
to wear thin, because this kind of explanation couldn't explain
the appearance of the disease in middle-class homes. And
eventually, epidemiological research would show that children
in more affluent homes were in fact more at risk to polio than
poor children. Poor children, in fact, were more exposed to the
virus when they were very young, because the virus was very
prevalent in New York City. So they were exposed at a very
young age and tended to have a mild reaction, in many cases.
Middle-class kids were not exposed to the virus. They're kept
inside much more, shielded from contact with other children
much more as infants, and so they weren't exposed at the same
early period, and when they were finally exposed, the virus
had more severe effects.
So as historian Naomi Rogers has noted, the 1916 polio
epidemic and the campaign to contain it, we have to
understand this in the context of its time. These health
officials, as someone mentioned earlier, were part of a
progressive reform movement, and they tried to use legislative
power -- that is, the laws on the books that public health
officials could invoke -- in the time of outbreaks of disease.
They also tried to use moral persuasion to address these kinds
of outbreaks and to deal with a whole host of urban problems.
But one of the things that I think is an aspect of these kinds of
reformers in situations like this is that they believe that the city
was both an incredible place to be, but it was also a very
threatening place to be. It was dirty; it sort of had a kind of
immoral cast to it. And these things had to be contained,
controlled, and regulated in order for the city to be a healthy
place for either the poor or the middle class to live.
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And these reformers believed that regulation wasn't enough.
The behavior of individuals had to be altered, and that -whether that behavior could be changed through education,
that was the best way, so to educate people about what to do in
the face of these kinds of infectious disease outbreaks,
including putting screens on their windows when it was
widely believed that polio was being transmitted to humans
via flies, and that meant that everybody had to defer to
scientific authority. If the experts said it was time to get your
window screen, you had to get your window screen, or else
you were going to be stigmatized as someone who was
threatening everybody else's health.
In a sense, through this education campaign and deference to
the authority of scientific experts, these reformers really hoped
to transform the family, home, community, and ultimately the
American society as a whole. And to achieve their goal, health
officials really exalted the role of medical science and
supported the use of government power. Now, in this case,
exalting the role of medical science in the case of polio in
1916 turned out not to be such a great idea, because the
medical, the scientific knowledge about polio was very
uncertain. Though the virus was identified, they couldn't
figure out how it was transmitted, and they could not figure
out how to stop it. A number of vaccines were promoted and
failed. And in the case of the 1916 epidemic in New York
City, as it got colder -- you started in the summer -- as the
winter came along, it seemed to die out. And that's how -that's basically how it ended.
compassion in the initial days. Once children became infected
with AIDS, you know, I think you sort of see change in
people's willingness to think about ways we might contain the
epidemic that were not so harsh.
After the discovery of the vaccine for polio, along with the
development of other vaccines, the memories of fear and
stigma associated with outbreaks of these diseases tended to
fade from public view, and a kind of complacency set in.
People thought, well, we've conquered all the great infectious
diseases of the 19th century: tuberculosis -- we know how to
deal with that; syphilis, gonorrhea, typhoid, typhus, yellow
fever, malaria, polio, diphtheria, all the great killers -- we had
really effective means of controlling them. And people
thought we were now entering the golden age when we would
be free of infectious diseases. And then the 1980s came, and
AIDS came, and people said, "Uh-oh." Our complacency was
truly shattered. The control of infectious diseases, I want to
end by saying, is one of the great triumphs of public health
and scientific research in this century. But I think the major
point to take away is that with every success came very real
challenges to the values that Americans hold dear. Thank you.
Polio continued to appear in the United States through the
1930s and well into the 1950s. And on April 12, 1955, on the
10th anniversary of the death of President Franklin Roosevelt,
is when Jonas Salk announced the development of a vaccine to
wide acclaim, huge acclaim. You know, this was really the
conquest of something that had brought such fear and so many
deaths and left such vivid memories -- and real people who
were crippled -- around for people who had lived through this
period. So in part, people were so enthusiastic and positive in
their response because of the memories of the 1916 epidemic
and outbreak, but also in the ones that followed, right? But this
seemed as well to be a real triumph for science, conquering
something that had caused so much pain and suffering.
So these two cases, "Typhoid Mary" and this polio epidemic
in 1916, tells us that outbreaks of disease always engender
fear, stigma, the need for government intervention. But the
broader lesson is that societies can address these kinds of
issues in ways that preserve certain values of equity, of justice,
of community trust. Or you can address outbreaks of these
diseases and institute rules that disrupt those kinds of values.
And it's very interesting for historians of medicine to look at
which choices are made, at which particular times, with which
particular diseases, so diseases that are carrying with them an
image of really irredeemable bad behavior, we can see that
often societies and communities respond quite harshly. And
someone mentioned earlier the AIDS epidemic. AIDS initially
[was] thought of to be a disease of gay men, of drug addicts,
of people engaging in various sexual, sexually deviant
behavior. The response did not evoke a great deal of
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