Because medicine deals with the human body, emotions can run high. When the issue is contraception, emotions run even higher. As part of Banned Books Week, consider two early U.S. works on birth control that shaped a congressional career, led to imprisonment at hard labor, and resulted in a conviction for blasphemy.
The first author is Robert Dale Owen (1801–1877). Son of Robert Owen, the British textile manufacturer and socialist reformer, Owen emigrated to the United States in 1825 to the utopian community that his father had founded that year in New Harmony, Indiana. There, with feminist and socialist Frances Wright (1795–1852), he published the newspaper New-Harmony Gazette, an outlet that expressed their then-radical views on women’s rights, slavery, public education, marriage, and birth control. After he and Wright relocated to New York City, they published Owen’s Moral Physiology; or, a Brief and Plain Treatise on the Population Question (1830), one of the first books on birth control in the United States. The book was a response to the ideas of English economist Thomas Malthus (1766–1834), who posited that, otherwise unchecked, population would always outpace food supply; Owen also saw birth control within a broader political and social context of personal freedom and equality of the sexes.
While in New York, Owen became acquainted with Charles Knowlton (1800–1850), a western Massachusetts physician. A materialist and freethinker, Knowlton published Fruits of Philosophy; or, the Private Companion of Young Married People in 1832. Designed as an aid to the couples he attended, the book was originally published anonymously and printed in a small format so it could be readily concealed. Fruits of Philosophy was the first U.S. birth control book written by a physician and went into detail on methods and practicality.
Birth control was a contentious issue for many reasons. Besides the works’ frankness about subjects not openly discussed, contraception was opposed on moral and religious grounds. One reason was the traditional idea that sex within marriage should have procreation as its purpose. Beyond this, birth control was thought to lead to greater immorality, promoting sex outside of marriage and even prostitution, as the natural obstacle against freer sexual activity—that is, pregnancy—had been removed.
Owen’s and Knowlton’s books had consequences. Owen returned to Indiana in 1833 and became an Indiana state legislator in 1835. Twice, though, he ran for a seat in the U.S. House of Representatives and lost, partly on the reputation of Moral Physiology. He eventually prevailed on the strength of a Democratic electoral wave and served in the House from 1843 to 1847, helping to establish the Smithsonian Institution. His plans to remain in the House failed, though, due in part to his views on birth control, and he was defeated for re-election in 1846.
For Knowlton the consequences were far more severe. After he published Fruits of Philosophy, he was prosecuted and fined for obscenity. His booklet was then taken up by a former Unitarian minister, Abner Kneeland (1774–1844), who printed a second edition in Boston in 1832. The resulting publicity led to Knowlton’s again being convicted for obscenity and this time imprisoned for three months at hard labor. The controversy played into Kneeland’s trial for blasphemy, still a crime in Massachusetts. He was convicted in 1838 and served 60 days in jail, the last person to be imprisoned on that charge in the country. Upon his release, Kneeland moved to Iowa and set up “Salubria” (Health), a community of like-minded freethinkers.
Restricting access to contraceptive knowledge was American practice up to the mid-20th century, under the guise of anti-obscenity laws. The 1873 Federal statute known as the Comstock Law, made it illegal to use the U.S. Postal Service to distribute such information, while a 1909 act extended this ban to interstate common carriers such as railroads. Many states also had their own laws. Congress made one of the most severe laws for the District of Columbia, over which it had direct control: giving birth-control literature to another Washingtonian could result in 5 years’ imprisonment at hard labor and a $2,000 fine. Not until 1972 were all these laws overturned.
September 15 marks the beginning of National Hispanic Heritage Month, which celebrates the cultures, traditions, heritage, and achievements of those in the United States who trace their roots to Spain and the Spanish-speaking countries of Latin America. At the New York Academy of Medicine, we are celebrating the accomplishments and contributions of Hispanic Americans to medicine and public health in the United States. According to survey data compiled by the National Center for Health Workforce Analysis in 2018, more than 10% of registered nurses in the United States identified as Hispanic, Latino, or Spanish. Contrast this with Ildaura Murillo-Rohde’s remarks about the paucity of representation in Washington, DC, for Hispanic nurses early in her career: “I saw that I was the only Hispanic nurse who was going to Washington to work with the federal government, review research and education grants, etc. There was nobody else. I looked behind me and thought: ‘Where are my people?’”
Ildaura Murillo-Rohde (1920–2010) was a Panamanian American nurse, academic, and health policy advocate who championed of the unique health care needs of Hispanic populations. Murillo-Rohde earned a nursing diploma from the Medical and Surgical Hospital School of Nursing in San Antonio, Texas, before obtaining an undergraduate degree in the teaching and supervision of psychiatric nursing from Teachers College, Columbia University, in 1953. Upon graduation, she joined Bellevue Psychiatric Hospital, working with patients diagnosed with “Puerto Rican syndrome,” the name for a condition first used to describe traumatized Puerto Rican soldiers in the Korean War. Wayne County General Hospital’s Psychiatric Division in Michigan then recruited her before she returned to New York to open Elmhurst General Hospital’s first psychiatric division in Queens. In 1971 she became the first Hispanic nurse to earn a PhD from New York University.
Throughout her career Murillo-Rohde maintained a strong commitment to growing the ranks of Hispanic nurses. Informed by her experience as a reviewer of federal research and education grants, she also sought to boost the number of policy experts advising lawmakers on the health care concerns of Hispanic communities. In the 1970s, Murillo-Rohde was an active member of the American Nurses Association (ANA), where she mounted a two-year-long effort to include the Ad Hoc Committee of the Spanish-Speaking/Spanish Surname Nurses’ Caucus in the ANA’s administrative structure. In 1975, with a group of about 15 nurses, Murillo-Rohde formed the National Association of Hispanic Nurses (NAHN) after the ANA rejected attempts to formally recognize the caucus.
Since its inception, NAHN has worked broadly to improve health care delivery and outcomes for the Hispanic community in the United States. Today, the organization sponsors an award for distinction in nursing scholarship, research, and practice, as well as a scholarship for Hispanic students enrolled in nursing programs that lead to licensure.
NAHN also publishes Hispanic Health Care International, featuring research and scholarship on issues of import to US and international Hispanic populations. Judith Aponte, a 2012 NYAM Fellow and Associate Professor of Nursing at Hunter College, is a former editor-in-chief of HHCI.
Beyond her role as founder and first president of NAHN, Murillo-Rohde was an expert on psychotherapy, marriage, and family therapy, and served in several roles in academic administration, including Dean of the College of Nursing at SUNY Downstate Medical Center. Murillo-Rohde’s influence was felt internationally as well through her appointment as WHO’s psychiatric consultant to the Guatemalan government, establishing a pilot program to train personnel in psychiatric care. She further served as Permanent UN Representative to UNICEF for the International Federation of Business and Professional Women. Murillo-Rohde passed away in her native Panama in 2010 at the age of 89.
Paul Klemperer (1887–1964) spent much of his career at Mount Sinai Hospital, where he held the position of pathologist from 1927 until his retirement in 1955. Born outside of Vienna, Klemperer first enrolled at the University of Vienna, intending to become a lawyer. At the suggestion of his father, he took a class on psychoanalysis taught by family friend Sigmund Freud and began to study medicine instead. After receiving his medical degree in 1912, he spent two years studying pathological anatomy, and then served as a physician during World War I. In 1921, he emigrated to the United States, spending a year in Chicago before moving to New York, teaching briefly at the New York Post-Graduate Medical School before joining the staff at Mount Sinai. He also taught pathology at the College of Physicians and Surgeons of Columbia University for many years, and after retirement continued to teach the Albert Einstein College of Medicine.
His students and colleagues were devoted to him. In 1962, the Academy presented him with the Academy Medal for Distinguished Contributions to Biomedical Science. In his remarks George Baehr, his colleague at Mount Sinai, noted that Klemperer’s skill as a pathologist combined with his skill as a teacher made him a much-loved figure in all the institutions to which he had a connection. Neuropathologist Stanley Aronson, in a 1989 reminiscence in the Mount Sinai Journal of Medicine, recalled him as “one who was shy yet effective, retiring yet generous, undemonstrative yet passionate, learned yet learning, always learning. For he was truly our teacher.”
After he retired, Klemperer devoted significant time to the study of the history of medicine. He wrote the preface and introduction to the Academy’s publication of a translation of Giambattista Morgagni’s noted book on pathology, The Seats and causes of diseases investigated by anatomy, as well as translating five letters of Morgagni. He also wrote the introductions to several other volumes in the Academy’s history of medicine series. To honor his memory and his devotion to the history of medicine, some years after his death an anonymous group of donors endowed the fellowship that bears his name, first awarded in 1996.
William H. Helfand (1926–2018), a Philadelphia native, pursued a career as a pharmaceutical executive for Merck. His work dovetailed with his collecting interests in prints, posters, and such pharmaceutical ephemera as trade cards and almanacs, and he wrote extensively on their social history. He and his wife, Audrey, endowed positions and fellowships at several institutions, including the Philadelphia Museum of Art, the Library Company of Philadelphia, and the Grolier Club. In 1998, the couple endowed the NYAM Library fellowship that bears their name, with the first fellowship awarded in the 1999–2000 academic year.
From the beginning, the Helfand fellowship supported research on the ways that visual materials enhance the study of the history of medicine, public health, and the medical humanities. Our own Library collections are far richer in these areas because Bill supplemented his endowment with gifts of materials from his own collections, Chief among these is the William H. Helfand Collection of Pharmaceutical Trade Cards, which is digitized and available here. In addition to trade cards, Bill gave the Library almanacs, broadsides, caricatures, prints, sheet music, and other medical ephemera. Our Helfand collection is one of many; others can be found at the Huntington Library, Yale University, Duke University, and the Library Company of Philadelphia.
If you are a scholar working on a history of medicine project, please consider our fellowships. Applications are being accepted until September 17, 2021, for a month’s residence at the Library. Successful applicants will be notified by October 22, and the next two fellows may work any time during the 2022 calendar year.
Lists of all the projects that have been supported through these endowments can be found on the fellowship pages for the Klemperer Fellowship and the Helfand Fellowship; application procedures are found there as well.
 Baehr, George. “Citation and Presentation of the Academy Medal to Paul Klemperer, MD.” Bulletin of the New York Academy of Medicine 38, no. 4 (1962): 240; Aronson, S. M. “The legacy of Paul Klemperer.” The Mount Sinai Journal of Medicine, New York 56, no. 5 (1989): 347–350.
Dr. Stephen Smith (1823–1922), Academy Fellow for 68 years, had a career as a Bellevue Hospital surgeon and a professor of surgery and anatomy at Bellevue Hospital Medical College and New York University. He wrote a field manual for Civil War army surgeons, was Health Commissioner of New York from 1868 to 1875, and was a founder of the American Public Health Association and its first president. Through his work the condition of the city, the state, and the nation markedly improved by the application of public health regulations for the common good.
Stephen Smith was born on a farm in Skaneateles, New York, on February 19, 1823, the son of a cavalry officer in the Revolutionary War and his wife.  He first studied medicine at Geneva Medical College, where a fellow student was Elizabeth Blackwell, the first woman medical school graduate in the United States. He left Geneva for Buffalo Medical College and then relocated to New York City, where he finally received his medical degree from the College of Physicians and Surgeons in 1850. Smith completed his residency at Bellevue Hospital and became an attending surgeon there in 1854; the following year he was elected a NYAM Fellow. He served on the faculty of Bellevue Hospital Medical College from its founding in 1861 until 1874, when he joined the faculty in the medical department of New York University.
In addition to his work as a practicing physician and surgeon, Smith shared the editorial responsibilities for the New York Journal of Medicine with NYAM luminary Dr. Samuel Smith Purple and assumed the editorship completely when Purple retired in 1857. The journal changed its name to the American Medical Times three years later, and Smith continued as its editor until 1864. 
Mid-nineteenth-century New York City was subject to recurring outbreaks of deadly diseases. As Smith later proclaimed, “The unsanitary condition of the city prior to 1866 cannot be described so that an audience of today can fully appreciate the reality. Nuisances dangerous to life and detrimental to health existed everywhere.”  Smith used his investigative skill and editorial position to campaign for wide-ranging reforms, including sanitary inspections, street cleaning, garbage collection, and the regulation of tenement housing and slaughterhouses.
“[Smith] had no law on his side to begin with and he made his fight by publicity. He traced twenty individual typhus cases to one house in East Twentieth Street, which he found full of immigrant families suffering from typhus. Through the tax records he reached the owner, a wealthy and prominent man who flatly refused to do anything about it. Dr. Smith looked up the law and found that there was no way to proceed against the owner. He then went to William Cullen Bryant, then the editor of The New York Evening Post. ‘At the suggestion of Mr. Bryant,’ said Dr. Smith, ‘I finally succeeded in bringing the owner of the fever nest into court on the change of maintaining a nuisance. Bryant’s reporter, who had been instructed, so frightened the owner that he promised to close and repair the house if only the matter were kept out of the papers. Bryant agreed and the owner kept his promise.’” 
Smith’s work led to the noted Citizens’ Association 1865 investigation and report on sanitary conditions in the city  and the passage of the 1866 Metropolitan Health Law. He was appointed one of New York City’s first health commissioners, serving until 1875.
Once the Metropolitan Board of Health had been established, Smith argued for the establishment of a State Board of Health. To bolster his case, he used evidence from the success of other state boards of health and of the city’s board. He made his case in a series of publications, notably The Care of Health and Life in the State of New York and A State Board of Health. A Communication to a Member of the Legislature …, both published in 1880. In the latter work he noted, “Already the agitation necessary and incident to the effort to secure the passage of this Bill has produced the most gratifying results in awakening thoughtful minds all over the State to the value of preventive medicine. Not only medical men, but laymen in every pursuit of business, have expressed their surprise at their previous apathy, and their determination now to press these questions upon the attention of the Legislature until adequate legislation is obtained.” The New York State Legislature created the State Board of Health that same year; in 1901 the board was reorganized as the State Department of Health.
In between, Smith’s ambitions reached the national scene. In 1872, he was one of the founders of the country’s premier professional public health organization, the American Public Health Association. He served as its first president up to 1875. 
In later life, Smith was widely honored for his work in American public health.  He took time to reflect on the changes that his efforts achieved. His best-known book, The City That Was (1911), tells the story of the deplorable public health conditions that existed in New York City at the beginning of the 19th century and the measures he recommended to remedy those conditions, including regular sanitary inspections. 
Smith believed man’s natural lifespan to be one hundred years, based on his contention that most animals live for five times the number of years required for the complete formation of their bones. He died on August 27,1922, some six months short of his 100th birthday. 
 During the Civil War, he wrote Hand-book of Surgical Operations, with many printings in New York in 1862 and 1863. Its preface announced:
“This Hand-Book of Surgical Operations has been prepared at the suggestion of several professional friends, who early entered the medical staff of the Volunteer Army.”
After the war, Smith produced another surgical work: Manual of the principles and practice of operative surgery, which went through numerous editions between 1879 and 1887.
 “Dr. Stephen Smith Dies in 100th Year.” The New York Times, August 27, 1922, p. 28.
 Citizens’ Association of New York, Council of Hygiene and Public Health, Report of the Council of Hygiene and Public Health of the Citizens’ Association of New York Upon the Sanitary Conditions of the City (New York, NY: Appleton, 1865).
 Stephen Smith, The Care of Health and Life in the State of New York (New York, 1880)and idem, A State Board of Health. A Communication to a Member of the Legislature on Sanitary Organization and Administration in the State of New York (New York, 1880).
On February 18, 1911, a dinner in honor of Smith’s 88th birthday took place at the Hotel Plaza. The Library holds both the program for the dinner and the speeches:
Dinner in honor of Doctor Stephen Smith and in celebration of his eighty-eighth birthday on Saturday evening, the eighteenth of February, one thousand, nine hundred and eleven at the Hotel Plaza (New York: Tiffany & Co., 1911).
Addresses in recognition of his public services, on the occasion of his eighty-eighth birthday, Feb. 19, 1911 (s.l., 1911).
Ten years later, the American Public Health Association published A Half Century of Public Health Jubilee Historical Volume of the American Public Health Association in Commemoration of the Fiftieth Anniversary Celebration of its Foundation, New York City, November 14–18, 1921 (New York, 1921). The work began with Smith’s historical overview of public health. The commemorative medal has Smith’s portrait on the front, with this legend on the reverse:
To Commemorate the Semicentennial Meeting of the American Public Health Association 1872 – New York – 1922 Noteworthy because of the Participation of its Founder Dr. Stephen Smith Born Feb. 19, 1823.
 Stephen Smith. The City That Was (New York: Frank Allaben, 1911).
by guest contributor Jacob Steere-Williams, PhD, Associate Professor of History, College of Charleston.
Join us for Steere-Williams’ talk on typhoid on September 23.
For decades, thinking about and learning from past pandemics has largely been an academic exercise, one for historians and archivists who specialize in public health. Now, in the midst of a generation-defining pandemic, COVID-19, there has been an explosion of public interest in epidemics and epidemiology. Before 2020, few Americans outside of infectious disease specialists routinely spoke the words “contact tracing” and “case fatality,” or knew the difference between isolation and quarantine.
The recent surge in popular understandings of epidemics has centered on some familiar examples, such as the 1918–1919 influenza pandemic, the mistakenly called “Spanish Flu.” As this was the most significant pandemic of the 20th century, the comparisons make sense, and the public health struggle between individual rights and community health is as apt now as it was then. Other historians, seeing the rise of xenophobia as a cultural response to COVID-19 in the West, have perceptively turned our attention to 19th-century pandemics of cholera and bubonic plague. Then, as now, a uniquely durable, yet startlingly western approach to framing pandemics has been to blame Asian people and Asian cultural practices.
At a time when the cultural mileage of past pandemics is perhaps at its height in modern history, we might fruitfully turn to the history of a relatively unexplored disease, typhoid fever, to think about our current moment.
Typhoid fever is a food- and water-borne infectious disease, the most virulent of the Salmonella family. The disease continues to wreak havoc on the Global South, killing about 200,000 people each year. In the western world typhoid was at its height in the 19th century, when it was a ubiquitous and insidious reality in North America and Western Europe. In Britain, for example, typhoid annually struck up to 150,000 people, taking the lives of 20,000 each year.
Typhoid’s patterns of distribution were erratic; it might spare a community for months or even years, then erupt as a local outbreak. Epidemiologists today discuss COVID-19 as a cluster disease, exploding in localized events not unlike the way that typhoid did in the past.
Interestingly, typhoid outbreaks continued after the introduction of early sanitary improvements such as toilets, pumped water, and sanitation systems. In the second half of the 19th century no infectious disease was as central to the rise of public health than typhoid. Typhoid was a model disease because the burgeoning group of public health scientists, the first to call themselves epidemiologists, saw that stopping typhoid’s different pathways—through food, water, and healthy human carriers—could transform the nation through preventive public health.
The story of typhoid in the 19th century is one deeply tied to the emergence of modern epidemiology, which George Buchanan, Chief Medical Officer of Britain’s central public health office, called “the minute observations of particular outbreaks.” Epidemiological practice does not operate in a vacuum, then or now with COVID-19; it is inherently a political exercise. Everyday people, business owners, and politicians have to be convinced about the science of disease communication, requiring complex rhetorical strategies that tell us a great deal about the inherent struggles of public health.
 George Buchanan, “On the Dry Earth System of Dealing with Excrement,” Annual Report of the Medical Officer of the Privy Council for 1870. Parliamentary Papers. London: Eyre and Spottiswoode, 1871, 97.
From July 2019 until March 2020, with few exceptions, I spent one day out of every week in the Drs. Barry and Bobbi Coller Rare Book Reading Room of the NYAM Library. As a volunteer, I wrote for this blog, Books, Health, and History, on various topics that utilized sources from the Library’s collections; I wrote about monsters, famous female physicians, and even libraries themselves. In March, as the threat of COVID-19 became clearer, the reading room closed, and I (among many others) could no longer consult the physical collections at the NYAM Library. After discussing with Library staff, I decided that my next project would use the digital resources and collections I am lucky to have access to as a student. I compiled a bibliography of historical literature on the topic du jour—pandemics.
Awareness that one is living through a historical moment is relatively rare; this awareness has led many to look to the past for hints as to how the current COVID-19 pandemic might impact the world going forward. In compiling this bibliography, I hoped to curate a resource that historians and history enthusiasts alike could use for research on epidemic history, personal interest, or simply to try to place our present moment in a larger historical context. I searched through several databases, including JSTOR, Project MUSE, and the History of Science, Technology, and Medicine database, looking specifically for journal articles from the last two decades which used a historical perspective to discuss pandemic or epidemic diseases.
A plague visitation scene from a 1509 edition of Fasciculus Medicinae, one of the earliest illustrated medical books to be printed. Image from the NYAM Digital Collections.
I limited my search to only those articles which are available in full digitally. This choice was made in part out of necessity—during a pandemic, a person may not be able to visit a library to find and read the journal they are looking for. Since I was “volunteering from home,” I could only read through and write descriptions for articles to which I had full digital access. Of course, this is not a perfect solution. Many articles were omitted from this bibliography because they are not available online, and they would surely have been useful. The digital articles are still for the most part only available to readers with either individual or institutional subscriptions to the relevant databases or journals.
My own experience compiling this bibliography taught me quite a bit about the long and ever-changing relationship between humanity and disease throughout history. Some diseases and disease events, such as the influenza pandemic of 1918, can provide an example (or a warning) of how different public health responses can affect long-term outcomes. Others, such as the Black Death, HIV/AIDS, and countless others, show us how disease has changed art, politics, the environment, and even the minutiae of human behavior. We have already seen many of the ways COVID-19 has changed our daily lives. While it is important not to underplay the devastation wrought by epidemic disease, reading about the impacts of other, similar disease outbreaks makes it clear that this pandemic will bring with it (and perhaps already has) significant cultural, social, and economic change, and perhaps offers us some guidance in navigating the “new normal.”
Compiling the bibliography was certainly a survey for me in the history of disease, but also highlighted several obstacles brought on or exacerbated by the modern-day pandemic. The biggest of these, at least in relation to this bibliography, is access—for all the work I did to collect and curate these digital articles, and despite the fact that many databases, journals, and other resources have made some or all of their articles free to read, many of them are still accessible only to a select few. The debate over who has or should have access to academic works is one that predates the pandemic, and is perhaps beyond the scope of a blog post. The COVID-19 crisis, however, impacts everyone, and the articles in this bibliography would almost certainly be of value to any reader. When the day finally comes that the coronavirus is no longer the threat it is today, it will still be important to read and write about it—work which everyone should have the resources to do.
I hope this bibliography can be a useful and informative resource for anyone who wishes to better understand how the coronavirus pandemic fits into a much larger historical context. The history of epidemic disease can inform how we interpret our experiences and plan our next steps in the current crisis. No less important, we can consider how our modern-day experience with a pandemic informs the ways we interpret the past.
Academy Fellows lead by serving, now during the COVID-19 crisis as in the past. This the third entry in our series on early women NYAM Fellows and their contributions to society; for earlier posts, see Sara Josephine Baker, and Martha Wollstein. Please also see our biographical sketch of Mary Putnam Jacobi, the first female Fellow of the New York Academy of Medicine.
A portrait of Daisy Orleman in her youth (date unknown). Photograph courtesy Paul Austin Orleman.
Widely lauded as the first female dermatologist in the United States and one of the first women to become a NYAM Fellow, Daisy Maude Orleman Robinson (1868–1942) had an illustrious career in patient care, public health, and health scholarship that spanned decades. Among her long list of achievements is being the first woman to publish scholarly work in the field of dermatology. The work, an 1899 case report entitled “The Ill Effects of the Roentgen Rays as Demonstrated in a Case Herewith Reported,” was one of the first scholarly works to examine the harmful effects of X-rays, which at that time were being widely used as treatments for a variety of ailments. The work is important in its own right, but is particularly interesting because the patient whose experience formed the case study was none other than Orleman herself.
Orleman began her medical education at age 19 at the National Medical College of Columbian University in Washington, D.C. She was the only woman in her medical school class. After her graduation in 1890, she spent several years continuing her education, eventually earning a bachelor’s degree and a master’s degree, as well as engaging in coursework on a wide range of specialties. In 1896 she obtained a medical license in the state of New York, and she was elected a NYAM Fellow in May 1897.
Orleman in her room at Peekskill Military Academy, where she was the resident physician from 1899 to 1903. Photograph courtesy Paul Austin Orleman.
That same year, Orleman suffered a fracture in her femur. Between January and May of 1898, she received three X-ray treatments intended to heal the fracture. She noted the first two as being “unsuccessful” but having no ill effects, and reported a “slight tingling sensation” upon her final treatment on May 14, 1898, with a similar lack of success. Twenty-one days later, she noticed a small patch of inflamed and itchy skin where she had received the treatments. With each passing day, the inflamed area increased in size and became more and more uncomfortable. Eventually, the inflamed area became an ulcer, and over the course of several months continued to worsen. Only after ten months did the “severe injury” finally heal with the help of several doctors, various ointments, tinctures, and washes to heal the wound, and, eventually, a skin graft on the affected area. She determined that, aside from the relief of pain (for which she occasionally used opium and morphine), “[maintaining] the limb in a perfect state of rest” was essential to her recovery. She admitted to forgoing her doctors’ advice to rest early on in her treatment, noting that “[had she] given this precedence in the beginning … [she] might have had a more speedy recovery.” Irritated by her ordeal, Orleman kept meticulous records of her symptoms and treatments, as well as the advice and theories of her medical providers. She published her case study—of herself—in 1899. In it, she lamented the lack of knowledge among physicians of the harmful effects of X-ray treatments and shared her experience in the hopes of both improving medical response to future cases and preventing them from developing in the first place.
Orleman’s paper in The Medical Record provides an overview of her injury and treatment.
Orleman’s painful experience with what would come to be known as radiation dermatitis likely sparked her interest in dermatology. In addition to pioneering female dermatological scholarship and providing us with an excellent example of a physician’s understanding of her own experience with injury and illness, “The Ill Effects of the Roentgen Rays” was, in fact, Orleman’s first scholarly publication.
Orleman continued to innovate in the field of dermatology throughout the rest of her career. From 1908 until 1910, she worked with Hideyo Noguchi on developing more accurate diagnostic tests for syphilis. Her publication on what came to be known as the “Noguchi reaction test” earned her the Gold Palms from the French Academy of Science in 1910. During World War I, she joined the French Army’s medical corps and was decorated for her work there, becoming the first woman and the first American to receive a Gold Medal of Epidemics and Contagious Diseases from the French minister of war. After the war, she turned her attention to public health and sex education, becoming an officer in the United States Public Health Service and focusing her work on the eradication of sexually transmitted infections such as syphilis. She was also invested in educating women’s groups, becoming one of the founding members of the Medical Women’s International Association in 1919.
Orleman wearing the Gold Medal of Epidemics and Contagious Diseases, awarded to her by the French minister of war at the end of World War I. Photograph courtesy Paul Austin Orleman.
Daisy Maude Orleman Robinson had a long, wide-ranging, and influential career, but her interest in using her own experience as a patient to inform her medical writing and practice makes her particularly extraordinary. With “The Ill Effects of the Roentgen Rays,” she used a fractured femur to cement her place in the history of her field.
__________  David M. Pariser, “Daisy Maude Orleman Robinson: The first American woman dermatologist,” Clinics in Dermatology 33 (2015), 404.  Daisy Maude Orleman, “The Ill Effects of the Roentgen Rays as Demonstrated in a Case Herewith Reported,” The Medical Record (1899), 8–10.  Pariser, 399–400. As she did this work prior to her 1904 marriage to Andrew Rose Robinson, we refer to her as “Orleman.”  Ibid., 397, 404.  Ibid., 399; Bulletin of the New York Academy of Medicine 18/6 (June 1942), 430.  Orleman, 8.  Ibid., 10.  Ibid., 10.  Ibid., 8, 10.  Ibid., 8.  Pariser, 399.  Ibid., 402.  Ibid., 403.
By Lorna Ebner, Guest Contributor, Stony Brook University
As COVID-19 races through New York, we asked Lorna Ebner to tell us about previous attempts to mitigate disease in the city. Ms. Ebner is a PhD student in history at Stony Brook University, currently researching the 1858 destruction of the Staten Island Marine Hospital by residents upset at the presence of the quarantine hospital in their community.
As COVID-19 numbers continue to climb, the sounds of New York City are uncharacteristically muted. Many living in the city are understandably disquieted by the absence of the familiar soundtrack of city life, but this is far from the first time Broadway and Times Square have been silenced by an epidemic. Over the course of the nineteenth century, New York City officials have struggled to understand and alleviate the spread of disease. By the end of the century, one practice, when properly executed alongside sanitation measures, was proven to successfully stem the tide and save lives: Quarantine has conclusively mitigated the spread of disease for hundreds of years.
Throughout the long nineteenth century, New York City faced disease epidemics that felled thousands. Yellow fever (1795, 1798, 1804, and 1856) and cholera (1832, 1849, 1854, 1862) caused alarm through their high mortality rates. However, the number of deaths recorded is likely a vast underestimation as disease reporting was not kept up and counting was often skewed. From the early to mid-nineteenth century, limited medical knowledge combined with a lack of a standing public health authority limited the city’s reactions to contagious disease. Yellow fever, spread through mosquitoes, hit New York City in 1795, 1798, and 1804. In an effort to curtail the rising number of cases, a Health Committee made up of physicians was assembled and given authority by the City Council. Its first act sanctioned quarantine for all ships that carried any form of illness and those arriving from affected areas, particularly Philadelphia. In 1795, the quarantine was violated by a merchant vessel that denied incidences of sickness on board. This violation and blatant disregard for the dangers posed by yellow fever led to an outbreak in the city. Over 750 New Yorkers died, nearly 2 percent of the city’s population. In 1805, New York City’s first Board of Health was appointed by the mayor and City Council. It was generally an apathetic government body with little power that met only at irregular intervals over the next six decades until called upon by a crisis.
The nineteenth century saw more devastating outbreaks as cholera swept through the city in 1832, 1849, and 1854. Cholera’s victims suffered from acute dehydration which caused patients to turn blue.
Horatio Bartley. Illustrations of Cholera Asphyxia; In Its Different Stages. Selected from Cases Treated at the Cholera Hospital, Rivington Street. New York: Printed by S. H. Jackson, New-York, 1832.
The visceral sights relentlessly reminded New Yorkers of the disease’s dangerous presence. In 1832, a cholera pandemic approached New York City after leaving a destructive trail through Asia and Europe. After cases were reported in Quebec in late June, Mayor Walter Browne enacted a blanket quarantine on all incoming vessels. The Board of Health was called out of hibernation to enforce quarantine and enact efforts to clean up impoverished neighborhoods, such as the Five Points District. The board also commissioned special quarantine hospitals. These were either converted warehouses, taverns, and schools, or were hastily constructed on empty lots, as hospitals at the time did not accept patients with infectious diseases. New Yorkers of means fled the city in hopes that the country air and distance would deter cholera’s onslaught. Between June and September of 1832, 3,515 deaths were attributed to cholera, while 70,000 New York citizens fled for the country, spreading the disease unknowingly across the United States. Cholera descended upon New York City again in 1849. The Board of Health quarantined all incoming vessels and made it illegal to keep hogs within city limits as part of its ongoing sanitation efforts. In this outbreak, the Board of Health reported 5,017 deaths over the course of the summer. Preparedness and stringent sanitary measures during the 1854 epidemic led to a lower mortality rate, and the number of deaths attributed to cholera dropped by almost half, to 2,509.
During the mid-nineteenth century, cholera was not the only disease for which public health officials demanded immediate quarantine for all contaminated incoming vessels. As yellow fever approached New York in 1856, the head physician of the Marine Hospital, which served as a quarantine hospital for both people and products, mapped the incoming quarantined vessels. Elisha Harris’s map indicates where in the harbor the quarantined ships anchored as well as areas along the coast that he believed were susceptible to contaminated paraphernalia.
While public health officials and many in the medical field espoused the belief that yellow fever was indeed contagious and in need of strict quarantine, some expressed other concerns. “The restrictions laid upon commerce, with a view to prevent the introduction of yellow fever, are grounded upon the supposition of its contagious and infectious character; whereas, it is a disease of local origin, and incapable of propagation from person to person, or by emanations from the human body.” Though restrictions on commerce continued, despite people’s belief that trading should continue, yellow fever ran rampant through Staten Island and the shores of Long Island. Fort Hamilton and Tompkinsville suffered dozens of cases. Because health was not prioritized by all and quarantine regulations were not strictly adhered to, New York again suffered loss of life.
The cholera epidemic of 1866 saw the advent of the Metropolitan Board of Health, which proactively enforced strict quarantine and sanitary measures prior to the outbreak. Unlike with the previous epidemics, the newly established board set out strict sanitary measures that applied to all businesses and tenement owners. While many New Yorkers vocalized their dissatisfaction with what they thought of as harsh and unnecessary measures, the numbers speak for themselves. Despite an exponentially growing population, the third cholera epidemic claimed the lives of 1,137 New Yorkers as compared to over 5,000 in 1849, and over 3,000 in 1832. As historian of medicine Charles E. Rosenberg wrote, “Physicians had tried to cure cholera; 1866 had shown them their duty was to prevent it.”
The city’s measures proved effective in the late nineteenth century. A worldwide cholera pandemic began in 1881. For over a decade, cholera spread throughout Europe and Asia. After a century of battling the disease, most cities instituted precautions to mitigate loss of life. By the time cholera approached New York City in fall of 1892 in the form of a contagious vessel from Hamburg, Germany, city officials and public health authorities had already prepared strict quarantine procedures. As a result, the expected onslaught never arrived. It is estimated that 32 deaths occurred because of cholera in the fall of 1892, and that the majority of these occurred on quarantined vessels that arrived from contagious cities. The century of experience definitively illustrated that preparation and preemptive quarantine proved effective in slowing or even stopping the spread of contagious disease.
New York’s resilience through nineteenth-century epidemics demonstrates the effectiveness of public health measures such as enforced quarantine and increased sanitation. Though the population of New York City continued to grow throughout the nineteenth century, the number of deaths from epidemic disease fell. The Board of Health, once a listless and irregular fixture, grew into a metropolitan medical authority whose public health measures alleviated the spread of contagion. A version of quarantine has always been employed during times of crisis. Public health in the twentieth century expanded the practice to include individual and self-quarantine. In late 2019, news broke of a novel, deadly, and extremely contagious virus Despite the developing information concerning COVID-19’s spread, the federal government did not have a consistent response to the possibility of a worldwide outbreak. And, unlike previous contagious threats, such as cholera in 1880 and smallpox in 1947, the city did not quarantine immediately and did not implement sanitary measures until after the coronavirus—unbeknownst to authorities—had already spread through the population. New York City’s history conclusively shows that basic public health measures, properly enacted, serve as New York’s most powerful weapon against epidemics. The consequences of ignoring and downplaying serious medical threats result in needless loss of life, a story shown over and over again in the nineteenth century, up to the great influenza pandemic of 1918, and now replayed in our current day.
 John Duffy, History of Public Health in New York City, 1625–1866: Volume 1 (Russell Sage Foundation, 1968), 104.
 J. S. Chambers, The Conquest of Cholera: America’s Greatest Scourge (New York: The Macmillan Company, 1938), 63.
 Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: University of Chicago Press, 2009), 114.