“Filth is the Arch Enemy of Health”: The Committee on Public Health and Waste Management in New York City

This guest post is by Tina Peabody, 2019 Audrey and William H. Helfand Fellow at the New York Academy of Medicine, and a doctoral candidate in history at the University of Albany, SUNY focusing on the urban environment in the United States. She is currently completing her dissertation entitled “Wretched Refuse: Garbage and the Making of New York City”, a social and economic history of waste management in New York City between the 1880s and 1990s.

The Committee on Public Health at the New York Academy of Medicine is well known for their role in creating the Department of Sanitation in 1929, through the development of the Committee of Twenty on Street and Outdoor Cleanliness. However, the broader Committee’s activism on sanitation has a longer and more complex history. Soon after its formation in 1911, the Committee on Public Health decried the conditions of city streets. They held conferences on sanitation in 1914 and 1915 which included representatives of the Department of Street Cleaning and other municipal departments.[1] While Department of Street Cleaning Commissioner J. T. Fetherston claimed he could not update equipment nor flush streets with water, he nonetheless encouraged the Committee to educate the public about the connections between dirt and disease.[2]  With that in mind, the Committee wrote a report in 1915 which connected the pathogens in street dirt to illness.[3]

Two men hauling garbage into an open refuse truck.

Commitee of Twenty, Dusty Trucks 2

The Committee of Twenty was particularly concerned about open refuse trucks which could spew dust and debris. Images: Committee of Twenty, Committee on Public Health Archives, New York Academy of Medicine, ca. 1930.

In 1928, a subcommittee called The Committee of Twenty was formed, in part because conditions did not improve substantially after the conferences and report.[4]  Among their recommendations, the Committee of Twenty supported the creation of a unified sanitation agency with full control over street cleanliness.[5]  They envisioned themselves as educators for the Department of Sanitation as well as the public, and they researched the latest collection methods and equipment from Europe to recommend improvements.[6] The newly-created Department of Sanitation, however, resisted investing in the recommended equipment, partially due to the expense.[7] Still, the Committee monitored street conditions, and kept photographic evidence of city and private sanitation trucks spewing dust and debris on the streets or other violations of sanitary ordinances.

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Picture of overflowing refuse cans from the Committee of Twenty. Image: Committee of Twenty, Committee on Public Health Archives, New York Academy of Medicine, ca. 1930.

The Committee of Twenty also educated the public about outdoor cleanliness and especially the connections between dirt and disease. They issued pamphlets warning that “filth is the arch enemy of health,” and urged them to take personal responsibility for clean streets. “Do not put all the blame on the city administration,” one pamphlet read. “This is your city. A clean city means better health, better business; greater happiness for all; respect for law and order.”[8]  Along with educational literature, they placed litter baskets around the city, and posted signs which reminded New Yorkers of sanitary practices like “curbing” dogs.[9]  They also encouraged public participation in solving sanitary problem in novel ways, such as holding a contest for the best litter basket design in 1930.[10] 

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Educational Pamphlet from the Committee of Twenty. Image: Committee of Twenty, Committee on Public Health Archives, New York Academy of Medicine, ca. 1930.

The Committee was also influential in the citywide cleanup effort in preparation for the 1939 New York World’s Fair. Members of the Committee of Twenty and their allies argued that the Fair was the perfect opportunity for improving street cleanliness. Committee members Bernard Sachs and E. H. L. Corwin wrote that New York City was “the ‘Wonder City of the World,’ beyond a doubt; the ‘cleanest city,’ by no means. But we must make it that.”[11]  In line with the idea, Mayor Fiorello LaGuardia declared April 1939 “dress up paint up” month, and launched a broad beautification effort which included removal of litter, dog waste, and even “beggars, vagrants and peddlers.”[12]  Bernard Sachs was the representative for the Committee of Twenty on the Mayor’s Committee on Property Improvement, which was developed for the cleanliness campaign.

Committee of Twenty, Why Clean Streets 1

Educational pamphlet from the Committee of Twenty. Image: Committee of Twenty, Committee on Public Health Archives, New York Academy of Medicine, ca. 1930.

Committee of Twenty, Why Clean Streets 2

Educational pamphlet from the Committee of Twenty. Image: Committee of Twenty, Committee on Public Health Archives, New York Academy of Medicine, ca. 1930.

In 1950, the Committee on Public Health supported an initiative to introduce alternate side street parking to allow street cleaning unobstructed from parked automobiles, but otherwise was much less active on sanitation issues after the 1939 World’s Fair.[13]  At a meeting with Department of Sanitation Commissioner Andrew Mulrain in 1950, the Committee even debated whether unclean streets actually did cause disease.[14]  One Dr. Lincoln wondered if clean streets were not simply a matter of “public pride.” [15]  Still, the Committee’s early work on outdoor cleanliness would have a lasting legacy, particularly in terms of public education. The Outdoor Cleanliness Association, which was formed shortly after the Committee of Twenty [16], continued their educational work with regular cleanliness drives through the 1950s and 1960s in coordination with the Sanitation and Police departments.

References

 [1] “Minutes of the Meeting of the Public Health, Hospital, and Budget Committee October 26, 1914,” The Public Health Committee of the New York Academy of Medicine Minutes 1914–1915 (New York, NY), 74; “Minutes of the Meeting of the Public Health, Hospital, and Budget Committee Conference on Street Cleaning May 7, 1915,” The Public Health Committee of the New York Academy of Medicine Minutes 1914–1915 (New York, NY), 153–55.

[2] “Minutes of the Meeting of the Public Health, Hospital, and Budget Committee,” November 16, 1914, The Public Health Committee of the New York Academy of Medicine Minutes 1914–1915 (New York, NY), 84–85; “Minutes of the Meeting of the Public Health, Hospital, and Budget Committee Conference on Street Cleaning May 7, 1915,” The Public Health Committee of the New York Academy of Medicine Minutes 1914–1915 (New York, NY), 153-54 .

[3] Committee on Public Health, “Thirty Years in Community Service 1911–1941: A Brief Outline of the Work of the Committee on Public Health Relations of the New York Academy of Medicine” (The New York Academy of Medicine, 1941), 79.

[4] Committee on Public Health, “Thirty Years in Community Service 1911–1941,” 80.

[5] “Minutes of the Meeting of the Executive Committee of the Committee on Public Health Relations,” May 14, 1928, The Public Health Committee of the New York Academy of Medicine Minutes 1927–1928 (New York, NY), 134; Committee on Public Health, “Thirty Years in Community Service 1911–1941: A Brief Outline of the Work of the Committee on Public Health Relations of the New York Academy of Medicine,” 10.

[6] Committee on Public Health, “Thirty Years in Community Service 1911–1941,” 80.

[7] Committee on Public Health, “Memorandum of a Conference between Dr. William Schroeder, Jr., Chairman, Sanitary Commission…..May 19, 1931,” 1–4, Committee on Public Health Archives, Box 4, Folder 50c.

[8] Committee of Twenty on Street and Outdoor Cleanliness, “Why Clean Streets? Because Filth Is the Arch Enemy of Health” (New York Academy of Medicine, n.d.), Special Collections, New York Academy of Medicine Library.

[9] Committee on Public Health, “Thirty Years in Community Service 1911–1941: A Brief Outline of the Work of the Committee on Public Health Relations of the New York Academy of Medicine,” 80.

[10] Committee of Twenty on Street and Outdoor Cleanliness, “Prize Contest for the Design of a Litter Basket For New York City” (New York Academy of Medicine, n.d.), Special Collections, New York Academy of Medicine Library.

[11] Bernard Sachs and E. H. L. Corwin, “Fair Offers Opportunity: City Is Urged to Institute a Program of Outdoor Cleanliness,” New York Times, July 4, 1938.

[12] Marshall Sprague, “Clean City for Fair: Public and Private Groups Hard at Work Dressing Up New York for April, 1939 Mayor Is Enthusiastic Keeping Waters Pure Refurbishing Statues Beautification Drives,” New York Times, September 18, 1938; Elizabeth La Hines, “Drive Is Begun For a Tidy City During the Fair: Outdoor Cleanliness Group to Ask Wide Aid in Fight on Sidewalk Rubbish One Nuisance Abated Aid Through New Equipment Model for Other Cities,” New York Times, April 9, 1939.

[13] Committee on Public Health, “Pioneering in Public Health for Fifty Years” (The New York Academy of Medicine, 1961), 62.

[14]  “Minutes of the Meeting of the Subcommittee on Street Sanitation,” June 21, 1950, The Public Health Committee of the New York Academy of Medicine Minutes 1949–1950 (New York (N.Y.)), 473.

[15]  Ibid.

[16]  George A. Soper, “Attacking the Problem of Litter in New York,” New York Times, November 5, 1933.

 

 

 

 

 

The Medical Journals of U.S.-Occupied Haiti

This guest post is by Matthew Davidson, a doctoral candidate at the University of Miami and the 2019 Paul Klemperer Fellow at the New York Academy of Medicine. His research examines public health in Haiti during the 1915-1934 U.S. occupation.

During the nineteen years of the early twentieth century that the United States occupied Haiti (1915-1934), U.S. officials liked to claim that they had brought modern medical thought to the Caribbean country. Their contention was bunk, but it apparently felt very real when the Haitian physician, Dr. François Dalencour, received a letter from a French colleague asking for copies of any Haitian medical publications. “I was ashamed,” Dalencour later wrote, “of being obliged to tell the truth, to say that there were none. [i] He would have been able to send along reports authored by the occupation medical service, but there was apparently nothing current otherwise. Haiti, Dalencour decided, needed a medical journal.

Soon after, he established one.

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The first issue of Le Journal Médical Haïtien (NYAM). 

The occupation, it turns out, was indeed an important period for Haitian medical thought. As was the case in other fields, it provoked a flurry of intellectual production. Consequently, whereas doctors such as Dalencour lamented the lack of Haitian medical publications at the start, by the end the local medical establishment could boast of several. U.S. officials claimed this was a sign of how far medicine in Haiti had “progressed” under their tutelage, but it was truly more the product of Haiti’s own medical tradition. [ii] Meant to advance medical practice and public health policy, the journals provided a forum for Haitian practitioners to debate and discuss all sorts of matters related to health and medicine in the country.

Dalencour’s periodical, Le Journal Médical Haïtien, was arguably the most important of the occupation-era publications. Not only was it the first, founded in May 1920, but it also did the most to open up space for the Haitian medical profession to articulate ideas and positions about their field. With U.S. personnel otherwise completely dominating all aspects of medicine and public health in Haiti, Le Journal Médical Haïtien was the only venue (outside of individual private practices) actually controlled by Haitians. It accordingly brought together “all members of the Haitian Medical Corps, without any distinction”: doctors, pharmacists, dentists and midwives. [iii] In doing so, the journal bridged longstanding divisions within the medical corps and laid the foundation for further independent initiative.

As Le Journal Médical Haïtien facilitated the reorganization of the Haitian medical profession, it also laid bare the lie that the occupation brought medical modernity to the country. After all, it was not because the U.S. introduced “scientific medicine” or any other set of ideas to Haiti that the journal appeared. Rather, it had its genesis in the pre-occupation period. As Dalencour wrote in the first issue, the project was first conceived in 1903. He was still a medical student at the time, so establishing a journal for medical reform was a “somewhat pretentious idea.” [iv] Nonetheless, it was then, well before the Americans landed, that the first steps were taken to establish a “general review of the medical movement in Haiti” (as Le Journal Médical Haïtien was later billed). The principles laid out by Dalencour and his collaborators in 1920 were even the same as those declared in 1903. All that had changed was the name. Dalencour had originally chosen the title Haïti Médicale, but – further reflecting the strength of Haiti’s pre-occupation medical and intellectual traditions – another journal had taken that name in 1910. [v]

The next to emerge was Les Annales de Médecine Haïtienne. Established in 1923 by two young doctors, Drs. N. St. Louis and F. Coicou, Les Annales was associated with a newly reorganized union, le Syndicat des Médecins. Much more oppositional in outlook, the journal was conceived as an “organ for the expansion of medicine in Haiti and for the defense of the interests of the medical corps.” [vi] Explicitly anti-occupation, it actively contested the U.S. health project in Haiti and worked to organize Haitian doctors against it under the auspices of le Syndicat des Médecins. It was not merely a political publication, though, for it also carried articles dedicated to public health education and research in the medical sciences. Over time, such articles became more and more prominent, and as the occupation ended Les Annales de Médecine Haïtienne essentially transitioned to purely scientific journal. U.S. medical sciences, however, continued to be received coolly.

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May-June 1932 issue of Les Annales de Médecine Haïtienne (Schomburg Center, NYPL).

The last of the occupation-era publications was the only one that owed its existence to the occupation health project. The Bulletin de la Société de Médecine d’Haïti, founded with that society in 1927, was the sole journal fostered by U.S. officials, and it was the only one to have U.S. practitioners on its editorial board or to publish articles authored by occupation doctors. The society itself was organized and controlled by the occupation health service, the Service d’Hygiène. Accordingly, most independent doctors (i.e., those not directly employed by the Service d’Hygiène) tended to find the Société “too American” and remained outside of it. [vii] Nonetheless, the Bulletin was more than just an American journal based in Haiti.

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The first issue of the Bulletin de la Société de Médecine d’Haïti (NYAM).

The Bulletin de la Société de Médecine d’Haïti was an important register for the medical sciences in Haiti. From 1927 until the end of the occupation, it published an impressive array of scholarship, much of it by Haitian practitioners. With an emphasis on medical specialization, it tended to be more concerned with the medical sciences than with public health policy or practice, and it accordingly developed a reputation for being the most scientific of the journals. As a project, however, the Bulletin mostly just brought to fruition ideas and proposals first put forth in the pages of Le Journal Médical Haïtien (or by the 1890 Société de Médecine de Port-au-Prince before that). In form as much as in content, then, the Bulletin was as Haitian as it was American. Consequently, when the American editors shuttered the journal in 1934 with the end of the occupation, the Haitian medical establishment remained committed to the project: it lived on as the Bulletin du Service d’Hygiene et d’Assistance Publique – Medicale et Sanitaire.

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The first issue of the Bulletin du Service d’Hygiene et d’Assistance Publique – Medicale et Sanitaire (NYAM).

Each of these journals have largely been overlooked by historians, despite being incredibly rich sources. With their debates about public health policy, research on various health matters, clinical notes, correspondence between doctors and medical officials, translated articles from abroad, social commentary, and more, they offer significant insight into the state of medical care and the politics of health during the occupation. They would also be of interest to anyone thinking about Haitian social and intellectual history more generally. Few copies of each journal still exist, but they – with the exception of Les Annales – can be found at the New York Academy of Medicine library.

References

[i] Dalencour, François, « En Manière de Programme. » Le Journal Médical Haïtien (Première Année, No. 1, May, 1920; New York Academy of Medicine Library).

[ii] See, for instance, Parsons, Robert P., History of Haitian Medicine (New York: Paul B. Hoeber Inc., 1930).

[iii] Dalencour, François, « En Manière de Programme. » Le Journal Médical Haïtien (Première Année, No. 1, May, 1920; New York Academy of Medicine Library).

[iv] Dalencour, François, « En Manière de Programme. » Le Journal Médical Haïtien (Première Année, No. 1, May, 1920; New York Academy of Medicine Library).

[v] Haïti Médicale was published from 1910-1913, and then was briefly revived again in 1920.

[vi] Les Annales de Médecine Haitienne (9eme Année, No. 3 &4, Mars-Avril 1932; Schomburg Center for Research in Black Culture, New York Public Library).

[vii] Bordes, Ary, Haïti Médecine et Santé Publique sous l’Occupation Américaine, 1915-1934 (Haiti: Imprimerie Deschamps, 1992), 300.

NYAM’s First Female Fellow: Mary Putnam Jacobi

By Carrie Levinson, Reference Services and Outreach Librarian

The history of the New York Academy of Medicine (NYAM) includes many great figures, including Samuel Smith Purple, a founding Fellow as well as advocate for our Library, author of a large number of medical works, and the ward physician under the Board of Health during the NYC cholera epidemic of 1849 (“Dr. Samuel Smith Purple”, 1900); Valentine Mott, an eminent surgeon who helped to found Rutgers Medical College and was chair of surgery at Columbia College (“Obituary: Death of Dr. Valentine Mott”, 1865); and Abraham Jacobi, a pioneer in pediatrics and President of the Academy from 1885-1889 (Watson, 1896). These doctors all had one thing in common (besides, of course, being physicians): they were all men. Until 1880, there had never been a female NYAM Fellow. The woman who managed to break this glass ceiling? Mary Putnam Jacobi – by one vote (U.S. National Library of Medicine, 2015).

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Mary Putnam Jacobi (Watson, 1896).

Mary Putnam was born on August 31, 1842, in London. Her parents, who were both Americans, returned to the States in 1847, and settled in New York City. In 1859, she began studying medicine, first receiving a diploma from the New York College of Pharmacy in 1862 (the first woman to do this) and then graduating with her MD from the Woman’s Medical College of Pennsylvania in 1864. In 1866, she traveled to Paris to enroll in the École de Médecine – once again, the first woman to be admitted – and graduated from there in 1871 (Watson, 1896).

Just these accomplishments would have been enough to put Putnam in the history books, but she hadn’t even begun to make her mark. Women’s education at the time was often separate from men’s, and she argued that higher education, particularly medical school, should be co-educational, as women’s medical colleges did not have the same resources as those affiliated with large hospitals. Returning to New York, she organized the Association for the Advancement of the Medical Education of Women and served as its president for almost 30 years (U.S. National Library of Medicine, 2015).

In 1876, Jacobi (now married to Abraham Jacobi) published an important essay: “The Question of Rest for Women during Menstruation”, which won the Boylston Prize at Harvard University (U.S. National Library of Medicine, 2015). Why was that so significant?

Jacobi was a stickler for rigor in scientific research. She believed that many other doctors did not live up to these expectations and allowed their biases to color their research. One of these biases was the widespread belief, specifically argued for in Edward H. Clarke’s Sex in Education; or, a Fair Chance for the Girls, that women who exerted themselves during menstruation could face serious health issues. This belief was used to justify separating women from higher education and certain professions. Relying heavily on statistics and empirical evidence, Jacobi thoroughly debunked this notion (Bittel, 2009).

Jacobi continued her work in fighting for equality for women throughout her lifetime – she wrote in favor of suffrage and taught at the Women’s Medical College of the New York Infirmary for Women and Children until 1889, assisting in elevating educational standards (U.S. National Library of Medicine, 2015).

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Letter from Mary Putnam Jacobi to Sophie Boaz, February 27, 1884, documenting Jacobi’s son’s death from diphtheria, a major public health problem at the time. NYAM Collection.

Jacobi even considered her own life as a means to advance medical research – when diagnosed with a brain tumor, she wrote a paper about it before passing on at the age of 63: “Description of the Early Symptoms of the Meningeal Tumor Compressing the Cerebellum. From Which the Writer Died. Written by Herself” (U. S. National Library of Medicine, 2015).

NYAM’s collection of Mary Putnam Jacobi’s productions can be found in our catalog.

References

Bittel, C. (2009). Mary Putnam Jacobi & the politics of medicine in nineteenth-century America. Chapel Hill: University of North Carolina Press.

Dr. Samuel Smith Purple. (1900, October 1). The New York Times. Retrieved from https://www.nytimes.com

Obituary: Death of Dr. Valentine Mott. (1865, April 27). The New York Times. Retrieved from https://www.nytimes.com/

U.S. National Library of Medicine. (2015, June 3). Changing the Face of Medicine: Dr. Mary Corinna Putnam Jacobi. Retrieved from https://cfmedicine.nlm.nih.gov/physicians/biography_163.html

Watson, I. A. (Ed.). (1896). Physicians and surgeons of America: A collection of biographical sketches of the regular medical profession. Concord, NH: Republican Press Association.

“Alas, Poor Daft Jamie’s Pickled!”: Poetry Concerning the Resurrectionists

By Carrie Levinson, Reference Services and Outreach Librarian

You may have heard about “Resurrection Men” – people who robbed graves and even killed people to fill the unprecedented demand for cadavers in medical schools in the nineteenth century. You may have even heard the names William Burke and William Hare: two of the most notorious body-snatchers and murderers who ever lived. But did you know that there is poetry about these bizarre and tragic events?

 The New York Academy of Medicine Library has a digital collection, The Resurrectionists, which contains broadsides, ballads, pamphlets, poetry, and other literature concerning Burke and Hare, their accomplices, and their victims. Since it is National Poetry Month, we’ve decided to feature some of the poetry contained in this collection.

First, however, a little bit of background. William Burke and William Hare were two ne’er-do-wells in 1820s Scotland who enjoyed drinking and working as little as possible (Barzun, 1974). When another occupant in their lodging house passed away from natural causes, they sold the body. Soon they found that bodies for the medical schools (particularly, the anatomy and physiology class in Edinburgh taught by Dr. Robert Knox) were in high demand, but not in ready supply. To capitalize on this newly-discovered stream of funds, the group quickly turned to murder. Their first victim was likely a miller by the name of Joe, and more followed (Barzun, 1974).

Unfortunately for them, Burke, Hare, and their accomplices made a number of mistakes resulting in their capture: they murdered a prostitute by the name of Mary Paterson, who was a client of one of the doctors and whom he recognized (though he kept quiet at the time); they also killed a well-known and -liked young man known in town as Daft Jamie, whose disappearance was immediately noted and speculated upon (bringing suspicion upon Dr. Knox as well); and they also began to quarrel amongst themselves. Their arrest came after a couple who knew their last victim, Mrs. Docherty, went to the police (Barzun, 1974).

 

 

 

Hare was offered immunity to testify against Burke and Helen MacDougal, Burke’s mistress. After the trial, deliberations took less than an hour: Burke was declared guilty, while MacDougal went free. Burke’s punishment: he was to be publicly hanged, his skin to be tanned and sold in strips, and his body to be dissected and then lectured upon, much like the bodies he had murdered for profit (Barzun, 1974). Burke was hanged on January 28, 1829, and his skeleton is still on view in the Anatomical Museum of the Edinburgh Medical School. Hare left Edinburgh in disguise and soon disappeared. One enduring legacy was a new verb, to burke, originally meaning to kill by smothering (in order to leave a good body to dissect!), and now broadened to mean to suppress.

 

A huge amount of literature was generated from these morbid events, including, arguably, the genre of crime fiction (Barzun, 1974). Here are a few examples of the poetry: one, an elegy for William Burke, and two poems lamenting the death of Daft Jamie (Jamie Wilson).

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We hope you will peruse this collection and marvel at the many effects Burke and Hare’s dastardly deeds had on the law, medicine, and literature. Perhaps you’ll be inspired to write a poem of your own!

  References

Barzun, J. (1974). Murder for profit and for science. In J. Barzun (Ed.), Burke and Hare: Resurrection men: A collection of contemporary documents including broadsides, occasional verses, illustrations, polemics, and a complete transcript of the testimony at the trial (pp. v-xii). Metuchen, NJ: Scarecrow Press.

Finding Cause in Street Cleanliness:  The Citizens’ Association of New York Report of 1865

By Anne Garner, Curator, Rare Books and Manuscripts

It’s 1863. New York’s streets are dismal.  Downtown, the scents of manure, garbage and chemicals permeate the air.  The streets are littered with debris, and in some places, are navigable only by wading through standing water. The gaps between cobblestones catch sewage and other dirt discharged from nearby tenements.

Public health statisticians estimate that New York has upwards of 200,000 cases of preventable and needless sickness every year. The Board of Health, controlled by corrupt politicians, is ineffective.  In newspapers like Frank Leslie’s Illustrated News and Harper’s Weekly, the condition of New York’s thoroughfares is a punchline. Editorials, cartoons and newspaper stories blame immigrant populations, the poor, and an indifferent municipal government. [1]

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T. Bernhard Gillam, “The Streets of New York,” Harper’s Weekly, February 26, 1881.

What to do?  In December of that same year, a group of citizens met with Mayor Gunther, the recently elected reform candidate to consider the city’s social problems. The following year, these concerned citizens formed the Citizens’ Association of New York, dedicated to a cause they describe in simple terms: “public usefulness.” [2]  The organization quickly determined that physicians should play a prominent role in sanitary reform, and organized the Association’s Special Council of Hygiene and Public Health. [3]

In May of 1864, the Council embarked on a street-by-street sanitary inspection of New York City. Medical inspectors – all physicians—were assigned to 31 districts throughout the city in an attempt to gather detailed information about New Yorkers and their living conditions. For seven months, the inspectors visited every household in Manhattan and used a nine-page survey as their guide. [4]

​​During the course of the survey, the inspectors filled seventeen volumes of observations and notes comprising the most “precise and exacting account of a city’s health and social conditions ever compiled.” Many of these notebooks, including some remarkable hand-drawn maps, are available at The New-York Historical Society. The image below is taken from the Society’s archives and shows a tenant house for 200 people at 311 Monroe Street, in the 9th District. [5]

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Record of Sanitary Inquiry, 7th ward, 9th District, {BV Citizens’ Association}. Reposted with permission of the New-York Historical Society.

This survey, presented by medical inspector William Hunter to former New York Academy of Medicine President Joseph M. Smith, records the living conditions of a family of three recent Irish immigrants living in a three-story tenement on W. 14th Street in late October of 1864. The unit was comprised of David, age 30, described in the survey as an “intelligent but uneducated” gardener, Ellen, age 28, and Margaret, age 6. The survey suggests that all three family members had typhoid fever, likely contracted on their journey to America from Ireland just a few months before.  Though the family’s living conditions were described as “good,” Hunter notes that the six families in their apartment were living in close quarters in just six rooms, with only two windows as a source of light and ventilation, and in such proximity to the horse stable that the horse could freely wander into their hallway. [6]

Surveys of this depth and length were kept for every household throughout the city’s 31 wards.  Wards were frequently assigned to physicians who knew the neighborhoods and the residents.  Most of the residents were given a thorough medical exam, and the nuisances of their environment were recorded in detail. [7]  Each ward’s physician contributed a district report, summarizing their findings. Ezra Pulling, who was the sanitary inspector for the fourth ward, contributed a report on his district and his data was poured into the making of this extraordinary map, published along with the report in 1865.  ​

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Map of the Fourth Ward of the City of New York. Report of the Council of Hygiene and Public Health of the Citizens’ Association of New York. New York:  Appleton, 1865.

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Fourth Ward map, detail of Gotham Court

The long, rectangular building that you see here at the center of this detail is a tenant house called Gotham Court.  The stars here indicate that outbreaks of typhus and smallpox have occurred in the house.  Privies in the basement were discharged into subterranean drains or sewers that run through each alley and then outside through grated openings, blocking much of the waste. Inside, each individual has an average of 275 cubic feet.  If these dimensions are difficult to picture, imagine a closet 5 feet square and 11 feet high, allotted per person, for their body and for everything they own as well. Nineteen children were recorded as unvaccinated for smallpox (the only vaccine available at this time) here, and it was also noted that clothes were being manufactured in the building as well—clothes that were exposed to cases of typhus and measles. [8]

In another section of the map, we see a number of tenant houses north of the Bowery surrounded by stables, with a brewery and a coal yard at the east.  Less than 30 percent of the privies in this district are connected with drains and sewers, and at least ten of these, as marked on the map by black squares, are in extremely offensive condition. A number of these are indicated on the map below.

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Fourth Ward map, detail of the Bowery

The impact of the publication of the Citizens’ Association report and the map itself was mixed. The report led to higher sanitation standards throughout the city, and forced the attention of government officials, who passed a law to create the Board of Health.[9]  Under this law, at least three of the Board’s nine commissioners needed to be physicians. Though the Council went to great lengths to visually and verbally document the city’s housing conditions, the Council didn’t investigate wage equity or the frequency and rate of unemployment. Historian Elizabeth Blackmar has argued that “the surveys fueled the movement for developing building codes and sanitary inspection as a means of guaranteeing better housing, but they also erased from discussion reflection on the larger economic relations that produced them.” [10]  In some cases, the report’s writers unfairly drew a line of causation directly from better living conditions to economic security, implying that given the right housing, the poor could flourish, independent of employment opportunities, fare wages, and access to healthcare.

In spite of its shortcomings, the report offered keen observations about the city’s conditions, and was instrumental in inspiring great reform in the city.  Today, IMAGE NYC, a project launched by the Academy with the CUNY Mapping Service at the Center for Urban Research / CUNY Graduate Center earlier this year, embraces the methodology the Citizens’ Association deployed over 150 years ago, and largely for the same reason: to better understand the social determinants of health.  The site has an interactive map of New York City’s current and projected population, 65 and older.  Much like the Citizens’ Association map, the idea is to determine environmental risks and benefits to certain populations.  Here, instead of physicians canvassing the neighborhoods to note conditions, community members can use the 311 app to take pictures and send them to the city.

The Fourth Ward Map, published as part of the 1865 Report of the Council of Hygiene and Public Health, as well as the 1864 survey form documenting the household of the Irish immigrants living on 14th street, are on view in Germ City: Microbes and the Metropolis, until this Sunday, April 28th.

References

[1] Bert Hansen. “The Image and Advocacy of Public Health in American Caricature and Cartoons from 1860 to 1900.”  American Journal of Public Health. Nov. 1997, v. 87, no. 11.

[2] Report of the Council of Hygiene and Public Health of the Citizens’ Association of New York. New York: Appleton, 1865, P. vii.

[3] John Duffy.  A History of Public Health in New York City 1625-1866.  New York: Russell Sage, 1968. Pp. 553-556.

[4] Report of the Council of Hygiene and Public Health of the Citizens’ Association of New York. New York:  Appleton, 1865.

[5] See also the excellent blog by Reference Librarian Mariam Touba of The New York Historical Society, here.

[6] Citizens’ Association of New York: Council of Hygiene and Public Health. Report of pestilential diseases and insalubrious quarters. New York: n.p., 1864.

[7] Duffy, p. 556.

[8] Report of the Council of Hygiene and Public Health…1865. P. 49-54.

[9] Duffy, 557.

[10] Elizabeth Blackmar.  “Accountability for Public Health: Regulating the Housing Market in Nineteenth-Century New York City.” In Hives of Sickness, edited by David Rosner. Rutgers University Press, 1995. Pp. 42-64.

Death, Deformity, Decay: Memento Mori and the Case of the Colloredo Twins

This guest post is by Rach Klein. Rach is an art history Masters Candidate at McGill University whose research focuses on the early modern grotesque, medical illustration, and print. She is a current recipient of a Joseph-Armand Bombardier grant, as well as a Michael Smith Foreign Studies scholarship.

Throughout the last month I have had the privilege of working in the NYAM Library, looking directly at their remarkable collection of broadsheets and rare books.  The opportunity to closely examine the objects and images that I am studying is unparalleled. My research locates a framework for viewing 17th-century non-normative and “freakish” bodies in the memento mori traditions of the previous century. Memento mori, a Latin phrase meaning, “remember you will die,” became shorthand for a host of visual imagery and cultural objects rooted in medieval Christian theory, which permeated the European early modern.  With a specific focus on the culture of spectacle employed by early modern “shows of wonder” and touring freak shows, the research that I have been doing at NYAM combines visual analysis with medical history and disability studies to suggest that integral to the creation of early modern “freaks” is a manipulation of non-normative persons into objects that spark mortuary contemplation. Guiding this research is the case of Italian conjoined/parasitic twins Lazarus Colloredo and Joannes Baptista Colloredo (1617–1646). Their journey, which is remarkably well-documented in both text and image (for example, see Fig. 1), showcases the duality of the so-called “freak body” and its links to mortuary philosophy.

Historia Ænigmatica, de gemellis Genoæ connati

Fig. 1. Mylbourne, R. (Publisher). (1637). Historia Ænigmatica, de gemellis Genoæ connatis, [Engraving]. © The Trustees of the British Museum. Licensed under CC-BY-NC-SA 4.0.

In 1617, Lazarus and Joannes Baptista Colloredo were born into a life of spectacle and uncertainty. Protruding laterally from the breast of Lazarus was his twin brother, Joannes Baptista, whose malformed body lived partially inside him. Unable to speak or move independently, Joannes Baptista was deemed a “parasitic twin”.  As living persons that defy expectations of the “normative,” visual documentation of the Colloredo twins’ spectacular bodies/body provides insight into anxieties about the boundaries between animate/inanimate, normal/abnormal, beauty/ugliness, soul/body, and, ultimately, life/death. Jan Bondeson calls attention to how remarkable their story is, even within the history of conjoined twins. He says:

Conjoined twins are the result of imperfect splitting of a fertilized ovum and the site of conjunction depends on which part of the splitting has not occurred. Lazarus and Joannes Baptista Collerado represent one of the very few convincing cases of viable omphalopagus parasiticus twins (who lived).[1]

The words in parentheses here, “who lived,” iterate the challenges of piecing together a history of marginalized persons such as those who are disabled and deformed, and the gentle surprise provoked by the twins’ survival.

Perhaps the most interesting discovery found throughout my research is the nonlinear timeline in scholarship about these twins due to a misattributed/incorrectly labelled print from Giovanni Battista de’Cavalieri’s series of engravings, Opera nel a quale vie molti Mostri de tute le parti del mondo antichi et Moderni (Monsters from all parts of the ancient and modern world), published in 1585 (Fig. 2). This image, which is reprinted in Fortunio Liceti’s 1634 De Monstrorum Caussis (Fig. 3), is captioned with the twins’ names and place of birth, despite having been created thirty-years prior to their birth. As with many “freakish” bodies, the accuracy of their experience exists separately from its visual history.[2]

Although these contradictions of dates and attributions make reproducing a clean narrative difficult, they reflect a larger theme of teratology: that bodies are detached from persons, and imaginative ideals misaligned from lived experience. The image by de’ Cavalieri was likely a representation of an earlier set of conjoined twins in the 16th century, perhaps based on conjoined twins mentioned by Ambrose Paré in 1530. This image is subsequently reproduced in Liceti’s 1665 edition of his work, now titled De Monstris. Hence, the twins’ image has been collapsed into a narrative that took place well before their birth, and which frames them as simultaneously alive and dead.

 

Liceti_DeMonstrorumCaussis_1634_117_watermark

Fig. 3. Liceti, F. (1634). [Rueffo puer Amiterni natus uno brachio, fed pedibus tribus in hanc effigiem] (p. 117). De monstrorum caussis, natura, et differentiis libri duo … Padua, Italy: Apud Paulum Frambottum.

Worries and uncertainties over death and the body make themselves known in images and stories documenting the “freakish” body. Art that has been traditionally deemed “grotesque,” “macabre,” or more colloquially, simply “disturbing” is part of a symbolic system that expresses metaphysical anxieties about what lurks beneath the surface of the body. I am not attempting to medicalize nor romanticize the history of those who are or have been designated as disabled, deformed, monstrous, and freakish. Rather, my aim is to provide a critical and historical study of how non-normative bodies have been catalogued as a memento mori for its witnesses and used by able-bodied viewers as tools of self-reflection and meditation, a practice that actively erases personhood in favour of objectification.[3]

References

[1] Bondeson, Jan. The Two-headed Boy: And Other Medical Marvels. Ithaca, NY: Cornell University Press, 2000.

[2] Jillings, Karen. “Monstrosity as Spectacle: The Two Inseparable Brothers’ European Tour of the 1630s and 1640s.” Popular Entertainment Studies 2, no. 1 (2011): 54–68.

[3] My work is particularly indebted to the disability, feminist, and race scholarship of Tobin Siebers (Disability Aesthetics), Rana Hogarth (Medicalizing Blackness: Making Racial Difference in the Atlantic World, 1780-1840), and Elizabeth Grosz (Volatile Bodies).

Further Reading

Bates, A. W., Emblematic Monsters: Unnatural Conceptions and Deformed Births in Early Modern Europe. Amsterdam: Rodopi, 2009.

Benedict, Barbara M. Curiosity: A Cultural History of Early Modern Inquiry. Chicago, IL: University of Chicago Press, 2002.

Daston, Lorraine, and Katharine Park. Wonders and the Order of Nature, 1150-1750. New York: Zone Books, 2012.

Thomson, Rosemarie Garland. Freakery: Cultural Spectacles of the Extraordinary Body. New York: New York University Press, 2008.

Remembering the Syphilis Study in Tuskegee

This guest post is by Dr. Susan Reverby, the Marion Butler McLean Professor Emerita in the History of Ideas and Professor Emerita of Women’s and Gender Studies at Wellesley College. This year she is a fellow at the Project on Race and Gender in Science and Medicine at the Hutchins Institute for African and African American Research at Harvard University. Reverby is most recently the author of the multiple prize winning book, Examining Tuskegee: The Infamous Syphilis Study and its Legacy and the historian whose work on immoral U.S. led research in Guatemala in the late 1940s led to a federal apology in 2010. She is currently completing her latest book, The Revolutionary Life of Brother Doc: A 20th Century White Man’s Tale (University of North Carolina Press, 2020).

Conspiracy theories and myths, medical and otherwise, often reflect ways to cope with racism in its multiple nefarious forms.   Many such tales focus on destruction of the black body: from the fears that Church’s chicken, now Popeye’s, put something in their frying that caused Black men to become sterile to the beliefs in South Africa that the HIV virus was spread by false vaccinations funded by the C.I.A. and British intelligence. Did you hear the one about the U.S. government letting hundreds of black men in and around Tuskegee, Alabama with syphilis not get to treatment that went on for four decades between 1932 and 1972?  Or that the government actually gave the men the syphilis and you can see it in the photographs, especially if you cannot differentiate between a blood draw and an injection?

Photograph of Participant in the Tuskegee Syphilis Study

Centers for Disease Control: Venereal Disease Branch. (ca. 1953). Photograph of Participant in the Tuskegee Syphilis Study. Image from https://catalog.archives.gov/id/824612

Only the fact that the government tried to make sure the men who already had late latent syphilis did not get treatment for forty years is true among these tales, and horrendous enough. Now we have to consider the meaning given to this Study over the nearly fifty years since it became widespread public knowledge.

The exposure of the Study came at the end of the modern Civil Rights era and after the medical community was beginning to acknowledge that even the “good guys” did immoral work. Along with the unethical studies at Willowbrook [1] and the Jewish Chronic Disease Hospital [2], the experiment in Tuskegee led to the federal Belmont Report [3] and the modern era of institutional review boards and regulations surrounding informed consent.

Kenan Thompson Hugh Laurie

King, D. R. (Director).  (2006, October 28). Modern Medicine: Hugh Laurie/Beck [Television series episode].  In L. Michaels (Producer), Saturday Night Live. New York, NY: NBC.

For many in the health care community and general public the words “Tuskegee” became symbolic of racism in medical research and care, making its way into popular culture in songs, plays, poems, rap, and cultural imagination.   In 2006, Hugh Laurie (T.V.’s irascible Dr. House) hosted Saturday Night Live and played the wife in a skit with patient Kenan Thompson. When the doctor offers care to Thompson, Laurie and Thompson both look at one another and yell “We know what this is: Tuskegee, Tuskegee, Tuskegee.” Others have done academic studies that prove and disprove that it is the memory of Tuskegee that keeps African American patients from seeking care or participating in research trials.  What we do know is that the subtle, and not so subtle, forms of racism create an aura of distrust that affects the kind of health care African Americans both seek and receive whether they know the details of what happened half a century ago or not.

So can there be another Tuskegee?  If by this question we mean the misrepresentation in informed consent, the danger of scientific hubris, and the misuse of patients of color:  probably in some form. Just as importantly, we need to ask what meaning is given to these experiences once they become public? How can the health care and public health communities create what historian Vanessa Northington Gamble calls “trustworthiness.”  It is the meaning of the study in Tuskegee that needs to be assessed, taught and considered. For it is this meaning that reverberates long after the men caught in its grasp wandered in the medical desert for 40 years, and long after any knowledge of its facts actually fade.

Join Susan Reverby along with moderator Aletha Maybank and Monique Guishard for our panel on February 26th, Could Tuskegee Happen Today?, addressing the history and legacy of the study and why it remains relevant today.

Footnotes

[1] J.D. Howell, R.A.Haywood, “Writing Willowbrook, Reading Willowbrook: The Recounting of a Medical Experiment. In: J. Goodman, A. McElligott and L. Marks, eds. Using Bodies: Humans in the Service of Medical Science in the 20th Century (Baltimore: Johns Hopkins University Press, 2003), pp. 190-213.

[2] Barron H. Lerner, “Sins of Omission—Cancer Research without Informed Consent,” New England Journal of Medicine 351 (2004): 628-630.

[3] Office of the Secretary, The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research, April 18, 1979.

Charles Terry Butler: An American Doctor in World War I

By Paul Theerman, Ph.D., Director of the Library

A hundred years ago this week, medical doctor Lt. Charles Terry Butler (1889–1980) entered Germany with the Army of Occupation. Yes, the Armistice had been signed a full three weeks prior, but “Charlie’s war” was not yet over. He would remain in uniform for over four more months. Through his detailed memoir, A Civilian in Uniform [1], we have   insight into his war service and the work of Evacuation Hospital #3, which followed the American war effort across France and into Germany in 1918 and 1919.

1st Lt. Charles T. Butler, MRC, US Army Sept. 1917

Image: A Civilian in Uniform, b/t. pp. 124-125.

As detailed in a previous blog entry, in 1916, Butler, newly graduated from medical school, spent six months as a volunteer surgeon in a British-French military hospital outside Paris, the “war before the war” for Americans.  His experience at Ris-Orangis turned out to be crucial for his later war service. Three months after he returned home, the United States entered the war on the side of the Allies. Butler’s adventures over the next two years capture much of the American medical experience of the Great War.

Butler’s first “battle” was to avoid getting drafted into the infantry so that he could serve in the medical corps.  A draft started right upon declaration of war on April 6th, and as a young man of 27, Butler was likely to be called up. He instead volunteered for the Army Medical Reserve Corps, where, with a medical degree, he received a commission as a first lieutenant in August. He was directed to go to Camp Greenleaf in Fort Oglethorpe, Georgia, by September 15th for additional training. [2] Afterwards, Butler shipped from Hoboken on January 12, 1918, bound for Saint-Nazaire, France, at the mouth of the Loire River, arriving on the 27th. Within a few weeks, Butler’s medical contingent was sent up the Loire and was divided, half to a hospital in Tours and half to one in Blois, both well behind the lines. He would serve separately in these locations over the next five months.

In early July, as part of “Evacuation Hospital #3,” he was moved to Rimaucourt, in the département of Haute Marne, close to the front. On July 29th, the operation moved to La Ferté-Milon “70 K. from Paris, about 23 K. from the Front.” [3]

The sound of guns was plainly audible; the signs of war were everywhere about. The station was almost wrecked—one end blown to atoms by a shell that had come through the roof. Everywhere were shell holes; among the tracks, in the platforms, and in the fields.… Houses everywhere were gaping ruins—roofs knocked off, holes in the walls, windows smashed. For, until the first Allied counteroffensive started, the enemy were within 4K. of the town. [4]

Entire route of Evacuation Hospital #3, 1/27/1918-4/12/1919.

Entire route of Evacuation Hospital #3 in France, where Butler served, from St. Nazaire to Brest. Image: A Civilian in Uniform, b/t pp. 354 and 355.

That afternoon he and his comrades explored the devastated town; less than a week later, the hospital was moved to Château-Thierry and then Crezancy. Butler’s hospital formed part of the medical services supporting the first major American military action in the War. “The camp at Crezancy was the first at which the organization came face to face with all kinds of casualties straight from the front.” [5] His unit remained close to the fighting, treating the wounded of the many battles of the Meuse–Argonne offensive, up until the Armistice on November 11th that marked the War’s end. On that day, Butler wrote to his mother from behind the lines at Verdun:

Everyone is wild with joy! The war ended this morning at eleven. But it’s hard to realize. Automatically we camouflage our lights, but I don’t doubt will get out of that habit before long. . . . They had a big bonfire after supper [tonight] to celebrate with speeches, song, etc. . . . Now we are wondering what will happen to us. There is some talk of our going into Germany with the Army of Occupation, but we have as good chance of getting home fairly early. [6]

Home early was not to be: in December the unit moved north through Luxembourg to Trier, Germany. There it provided medical services for Allied soldiers held in a military prison hospital. For the first time, Butler noted the Spanish Flu in his war reminiscence:

Worn out by months of fighting, their resistance exhausted from the long march, hundreds fell easy prey to the virulent flu-pneumonia bug that was epidemic. While I was in charge of the pneumonia ward, of the 153 admissions, 50 died—one-third. A soldier would come in on his feet and be dead in 48 hours.  The work was utterly frustrating. . . . [7]

Charles Terry Butler July to December 1918 personal diary

Pages from Butler’s diary, which was written from July to December, 1918. Image: Charles Terry Butler papers, New York Academy of Medicine.

After four months, the unit was ordered home. It left Trier on March 27th and arrived in Brest, France, on the 31st, then embarked by ship on April 12th for Hoboken, arriving on the 20th. On April 27th, Butler was discharged from the military at Fort Dix. Between his volunteer service in 1916–1917, and his military service in 1917–1919, he had served over two years, or half of the war.

Charles Terry Butler in July 1975.

Charles Terry Butler in July 1975. Image: A Civilian in Uniform, p. 399.

After the war, Butler married, had children, and entered private practice, but by 1923 rheumatoid arthritis led him to retire. Moving to the Ojai Valley of Ventura County, California, he became a prominent civic and cultural leader. In 1975, after many years of work, he privately published A Civilian in Uniform as perhaps “the most complete account of one of the most active large mobile evacuation hospitals” in the First World War. Butler died in 1980.

Reading through A Civilian in Uniform one learns the reason for its writing: to combine the historical and the personal. Throughout the work, Butler mixed his letters and diary entries with understanding of the war and the official account of his hospital unit. He was justly proud of that unit:

This outfit, through trial and error and after many varying experiences in battle areas, had reached a state of efficiency in all departments that may have served as a useful guide for the structure and administration of evacuation hospitals in World War II. [8]

And of his role:

Yet when, from the multi-thousands of wounded who passed through the portals of these two hospitals, are sorted out the hundreds who owe much of their future physical well being to the professional performance of one single individual, and perhaps that man’s work during those years of bloodshed warrants, in philosophical perspective, a place a notch or two above the microscopic level. [9]

For many, the attraction of war may come from the desire to play a role in a venture of world-wide consequence. For Butler, this played out through his medical work in World War I.

The New York Academy of Medicine Library also houses Butler’s papers.

References:

[1] Charles Terry Butler, A Civilian in Uniform (Ojai, CA: “Private edition,” 1975).
[2] Butler was expected to outfit himself for his service, in the amount of $275.00 for uniforms, insignia, blankets, cots, and incidentals such as mirrors, electric lights, and candles. He received $2,000 a year in compensation, from which were deducted the premium for War Risk Insurance—life and disability insurance provided through the government—and $1.00 a day for officers’ mess! Butler, A Civilian in Uniform, 123–24.
[3] Butler, “Diary,” July 30, 1918, A Civilian in Uniform, p. 230.
[4] Butler, “Diary,” July 30, 1918, A Civilian in Uniform, pp. 230–31.
[5] Butler, A Civilian in Uniform, p. 248.
[6] Butler to “Mother” [Louise Collins Butler], November 11, 1918, in A Civilian in Uniform, pp. 312–13.
[7] Butler, A Civilian in Uniform, p. 332. There also Butler was assigned the task of writing the history of Evacuation Hospital #3, which formed much of the basis of A Civilian in Uniform.
[8] Butler, A Civilian in Uniform, p. 364.
[9] Butler, A Civilian in Uniform, p. 355–56.

Looking Out for the Health of the Nation: The History of the U.S. Surgeon General

By Judith Salerno M.D., M.S., President; and Paul Theerman, Ph.D., Director of the Library

It is widely recognized that the role of the U.S. Surgeon General is to set the national agenda for health and wellness. In describing the position, the Surgeon General’s website states that: “As the Nation’s Doctor, the Surgeon General provides Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury.”

The position, and the role of today’s U.S. Public Health Service, evolved from very modest beginnings. The story begins in 1798, during President John Adams’ term, with the passage of a law that created a fund to provide medical services for merchant seamen. The following year military seamen were included as well, with the cost of their care paid through a deduction from the seamen’s wages. Over the next 60 years, the government built hospitals in the country’s seaports and river ports.

Fast forward to the Civil War, in the course of which the Federal marine hospitals almost ceased to function. In the aftermath of the War, the Marine Hospital Service was established in 1870 to revitalize them as a national hospital system. Administration was centralized under a medical officer, the Supervising Surgeon, who was later given the title of Surgeon General. The first Supervising Surgeon, Dr. John Woodworth, set about creating a corps of medical personnel to run the Marine Hospital Service. In 1889, Congress officially recognized this new personnel system by formally authorizing the creation of the Commissioned Corps. These public health workers, all of whom initially were physicians, were organized along military lines, with the Surgeon General as their leader. The Surgeon General was given a rank equivalent to a three-star Admiral.

MarineHospital_StatenIsland

“Aerial View U.S. Marine Hospital Stapleton, Staten Island, N.Y.” From the collection of Dr. Robert Matz, New York Academy of Medicine Library.

In the decades following the Civil War, the federal government began to assume many duties and responsibilities that heretofore had been undertaken by the states. The Marine Hospital Service took over the administration of quarantines and the health inspection of immigrants. It established a bacteriological lab on Staten Island (the “Hygienic Laboratory”) to better understand infectious diseases, and it ran a hospital on Ellis Island. The Service also coordinated state health efforts and standardized and published health statistics. In 1878, it began the publication of Public Health Reports (the official journal of the U.S. Surgeon General and the U.S. Public Health Service).

QuarantineSketches_15watermarked

“Doctor’s Examination.” From Quarantine Sketches.

At the turn of the previous century, as part of the progressive era reforms, the Service was given responsibility for controlling the quality of newly developed vaccines. And in 1912, the Service was given a new name—the U.S. Public Health Service (USPHS). Its mission was to:

“Investigate the diseases of man and conditions influencing the propagation and spread thereof, including sanitation and sewage and the pollution either directly or indirectly of the navigable streams and lakes of the United States.”

Throughout the first half of the 20th century, the Public Health Service took on an increasingly important role. Its staff grappled with the Spanish Flu Pandemic of 1918 and, for a time, it attended to the needs of injured veterans who were returning from World War I. It also undertook research into endemic diseases. For example, a USPHS physician, Dr. Joseph McMullen, did pioneering work in controlling trachoma (an infectious eye disease) and another USPHS doctor, Joseph Goldberger, made the discovery that a dietary deficiency causes pellagra.

The Service set up hospitals for the treatment of narcotics addiction in Lexington, Kentucky, and Fort Worth, Texas. Its efforts to control malaria in the American South led to the establishment of the Centers for Disease Control and Prevention, and the move of the Hygienic Laboratory from New York to Washington was the precursor to the establishment of the National Institutes of Health. USPHS also assumed responsibility for providing medical services to Native Americans and federal prisoners and, regrettably, it also oversaw shameful medical experiments in Tuskegee, Alabama, and in Guatemala.

From the 1930s onward, the role of the Surgeon General became more and more public. In 1964, Surgeon General Dr. Luther Terry took the campaign against tobacco use to the American public with the publication of Smoking and Health. This led in due course to major changes in the way cigarettes were advertised and eventually to tobacco regulation.

Prior to 1968, the Surgeon General was the head of the USPHS and all administrative, program, and financial responsibilities ran through this office, with the Surgeon General directly reporting to the Secretary of Health, Education and Welfare (HEW). Following a departmental reorganization that year, the USPHS’s responsibilities were delegated to HEW’s Assistant Secretary for Health (ASH) and the Surgeon General became a principal deputy and advisor to the ASH. In 1987, the Office of the Surgeon General was reestablished and the Surgeon General again became responsible for managing the Commissioned Corps.

Over the past 40 years, the Surgeon General has increasingly become the public face of health for the country. In the 1980s, Dr. C. Everett Koop made information about AIDS available to every American—in the form of an unprecedented direct mail campaign—as he sought to frame the disease as a public health threat demanding public health measures. In recent years, the Surgeons General have sought to publicize and address disparities in health care and outcomes among the nation’s increasingly diverse population. As the Commissioned Corps itself has become more diverse, so too have those holding the position of Surgeon General, with the appointment of the first female, African American, and Hispanic Surgeons General.

The New York Academy of Medicine was honored to host four illustrious former U.S. Surgeons General, Drs. Joycelyn Elders, David Satcher, Antonia Novello, and Richard Carmona, in conversation with Dr. Freda Lewis-Hall on October 15. They shared their reflections on what it takes to ensure the health of the nation. Above they are exploring with Curator Anne Garner our current exhibition on public health, “Germ City: Microbes and the Metropolis,” co-curated with the Museum of the City of New York, on view through April 2019.

References:
Parascandola, John. “Public Health Service,” in A Historical Guide to the U.S. Government, ed. George Thomas Kurian (New York: Oxford University Press, 1998), pp. 487–93.
Quarantine sketches : glimpses of America’s threshold. New York: Maltine Co., 1903.
 “The Reports of the Surgeon General,” Profiles in Science, https://profiles.nlm.nih.gov/NN/, accessed September 14, 2018.

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The First Yellow Fever Pandemic: Slavery and Its Consequences

Today’s guest post is by Billy G. Smith, Distinguished Professor in the Department of History, Philosophy, and Religious Studies at Montana State University. He earned his PhD at University of California Los Angeles. His research interests include disease; race, class and slavery; early America, and mapping early America.

Bird flu, SARS, Marburg, Ebola, HIV, West Nile Fever.  One of these diseases, or another, that spread from animals and mosquitoes to humans may soon kill most people on the planet.  More likely, the great majority of us will survive such a world-wide pandemic, and even now we have a heightened awareness that another one may be on the horizon.  This blog focuses on these issues in the past, outlining a virtually unknown voyage of death and disease that transformed the communities and nations bordering the Atlantic Ocean (what historians now refer to as the Atlantic World).  It traces the journey of a sailing ship that inadvertently instigated an epidemiological tragedy, thereby transforming North America, Europe, Africa, and the Caribbean islands.  This ship helped to create the first yellow fever pandemic.

1-Hankey

The Hankey. From “Ship of Death: The Voyage that Changed the Atlantic World.”

In 1792, the Hankey and two other ships carried nearly three hundred idealistic antislavery British radicals to Bolama, an island off the coast of West Africa, where they hoped to establish a colony designed to undermine the Atlantic slave trade by hiring rather than enslaving Africans.  Poor planning and tropical diseases, especially a particularly virulent strain of yellow fever likely contracted from the island’s numerous monkeys (through a mosquito vector), decimated the colonists and turned the enterprise into a tragic farce.

1-Bulama

 From “Ship of Death: The Voyage that Changed the Atlantic World.”

In early 1793, after most colonists had died and survivors had met resistance from the indigenous Bijagos for invading their lands, the Hankey attempted to return to Britain.  Disease-ridden, lacking healthy sailors, and fearing interception by hostile French ships, the colonists caught the trade winds to Grenada.  They and the mosquitoes in the water barrels spread yellow fever in that port and, very soon, throughout the West Indies.  This was only a few months before the British arrived to quell the slave rebellion in St. Domingue (now Haiti).  The British and subsequently the French military had their troops decimated by the disease—one reason why the slave revolution succeeded.  The crushing defeat in the Caribbean helped convince Napoleon to sell the vast Louisiana territory to the United States.  He turned eastward to expand his empire, altering the future of Europe and the Americas.

A few months after the Hankey arrived in the West Indies, commercial and refugee ships carried passengers and mosquitoes infected with yellow fever to Philadelphia, the nation’s capital during the 1790s.  The resulting epidemic killed five thousand people and forced tens of thousands of residents, including George Washington, Thomas Jefferson, and other prominent federal government leaders, to flee for their lives.  The state, city, and federal government all collapsed, leaving it to individual citizens to save the nation’s capital.  Meanwhile, doctors fiercely debated whether “Bulama fever” (as many called it) was a “new” disease or a more virulent strain of yellow fever common in the West Indies.  Physicians like the noted Benjamin Rush fiercely debated the causes of and treatment for the disease.  They mostly bled and purged their patients, at times causing more harm than good because of the rudimentary state of medicine.

Among those who stepped forward to aid people and save the city were members of the newly emerging community of free African Americans. Led by Absalom Jones, Richard Allen, and Anne Saville, black Philadelphians volunteered to nurse the sick and bury the dead—both dangerous undertakings at the time.  Many African Americans and physicians, exposed to yellow-fever infected mosquitoes, made the ultimate sacrifice as both groups died in disproportionately high numbers.  When a newspaper editor subsequently maligned black people for their efforts, Jones and Allen wrote a vigorous response—among the first publications by African Americans in the new nation.

A Refutation_internetarchive

For one of the first times in American history, blacks responded in print; Revd.s Allen and Jones published a pamphlet answering the charges; Courtesy of the Internet Archive.

During the ensuing decade, yellow fever went global, afflicting every port city in the new nation on an annual basis.  Epidemics also occurred in metropolitan areas throughout the Atlantic World, including North and South America, the Caribbean, southern Europe, and Africa.  Among other consequences, this disaster encouraged Americans to fear cities as hubs of death.  The future of the United States, as Thomas Jefferson argued, would be rural areas populated by yeomen farmers rather than the people in teeming metropolises.  The epidemics also helped solidify the decision of leaders of the new nation to move its capital to Washington D.C. and away from the high mortality associated with Philadelphia.

After the Hankey finally limped home to Britain, its crew was taken into service in the Royal Navy; few of them survived long.  More importantly, the image of Africa as the “white man’s graveyard” became even more established in Britain and France, thereby providing a partially protective barrier for Africa from European invasion until the advent of tropical medicine.  The “Bulama fever” plagued the Atlantic World for the next half century, appearing in epidemic form from Spain to Africa to North and South America.  The origins and treatment of the disease drew intense debates as medical treatment became highly politicized, and the incorrect idea that Africans enjoyed immunity to yellow fever became an important part of the scientific justification of racism in the early nineteenth century.

Join Billy Smith along with epidemiologist Michael Levy on October 24 for Sickness and the City for a conversation that uses both science and history to understand the intersection of urban development and the spread of contagions.

References
Billy G. Smith. Ship of Death: The Voyage that Changed the Atlantic World. New Haven, CT: Yale University Press, 2013.