Living through COVID-19: What can we learn from typhoid epidemics of the past?

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.”[1] 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.[2] 

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.

Thomas Godart, “Head and Neck of a Patient Suffering from Typhoid Fever.” Courtesy of the Wellcome Library.

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.[3]

“Avoid the Grip of the Typhoid Hand,” in G.S. Franklin, “Sanitary Care of Privies” (1899), from “Health and Sanitation: Disease and the Working Poor,” https://www.wm.edu/sites/wmcar/research/danvilledig/millworker-life/health-sanitation/index.php.

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.”[4] 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.

“Transmission of Typhoid Fever,” in George Whipple, Typhoid Fever; Its Causation, Transmission, and Prevention (New York: John Wiley and Sons, 1908).

__________

Notes

[1] See, for example, a recent blog post in Nursing Clio: Jessica Brabble, Ariel Ludwig, and Thomas Ewing, “‘All the World’s a Harem’: Perceptions of Masked Women During the 1918–19 Flu Pandemic,” Nursing Clio. https://nursingclio.org/2020/09/08/all-the-worlds-a-harem-perceptions-of-masked-women-during-the-1918-1919-flu-pandemic/.

[2] Catherine E. Shoichet, “What historians hear when Trump calls coronavirus ‘Chinese’ and ‘foreign,’” CNN. https://www.cnn.com/2020/03/12/us/disease-outbreaks-xenophobia-history/index.html.

[3] Graham Mooney, “How to Talk About Freedom During a Pandemic,” The Atlantic. https://www.theatlantic.com/ideas/archive/2020/05/freedom-pandemic-19th-century/611800/.

[4] 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.

Reflections on Past Pandemics: A Bibliography of Historical Articles

By Hannah Johnston, Library volunteer

Danzig_1709 0001

The plague in Danzig (in what is now Poland) in 1709, giving the death tolls from within the city (24,533), the outskirts (8,066), and the total of the two (32,599). From “Abbildung von der groszen Pest in Dantzig, 1709

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. 

 

Fasciculus Plague 1509

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.”

 

1918 flu pandemic

Red Cross volunteers wearing and making gauze masks at Camp Devens near Boston in 1918. From the Centers for Disease Control 1918 Pandemic Historical Image Gallery.

 

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.

Check out Pandemics in Historical Perspective: A Bibliography for Evaluating the Impacts of Diseases Past and Present .

 

Highlighting NYAM Women in Medical History: Daisy Maude Orleman Robinson, MS, MD

by Hannah Johnston, Library Volunteer

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.

IMG_1380

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.[1] 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.[2] 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.[3]

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.[4] 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.[5]

IMG_1381

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.[6] 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.[7] 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.[8] 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.”[9] 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.[10]

IMG_1631

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.[11]

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.[12] 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.[13]

IMG_1374

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.

__________
[1] David M. Pariser, “Daisy Maude Orleman Robinson: The first American woman dermatologist,” Clinics in Dermatology 33 (2015), 404.
[2] Daisy Maude Orleman, “The Ill Effects of the Roentgen Rays as Demonstrated in a Case Herewith Reported,” The Medical Record (1899), 8–10.
[3] Pariser, 399–400. As she did this work prior to her 1904 marriage to Andrew Rose Robinson, we refer to her as “Orleman.”
[4] Ibid., 397, 404.
[5] Ibid., 399; Bulletin of the New York Academy of Medicine 18/6 (June 1942), 430.
[6] Orleman, 8.
[7] Ibid., 10.
[8] Ibid., 10.
[9] Ibid., 8, 10.
[10] Ibid., 8.
[11] Pariser, 399.
[12] Ibid., 402.
[13] Ibid., 403.

Quarantine in Nineteenth-Century New York

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.[1] 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.

Cholera faces

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.[2] 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.[3] 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.[4]

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.

New York Harbor

Map of quarantined vessels in New York City. Elisha Harris. The Annual Report of the Physician-in-Chief of the Marine Hospital at Quarantine: Presented to the Legislature February 4, 1857. Albany: Charles Van Benthuysen, 1857.

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.”[5] 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.”[6]

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.[7] 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.


[1] John Duffy, History of Public Health in New York City, 1625–1866: Volume 1 (Russell Sage Foundation, 1968), 104.

[2] J. S. Chambers, The Conquest of Cholera: America’s Greatest Scourge (New York: The Macmillan Company, 1938), 63.

[3] Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: University of Chicago Press, 2009), 114.

[4] Duffy, 588.

[5] “Yellow Fever and Quarantine—Letter from a Non-Contagionist,” New York Daily Times, September 9, 1856.

[6] Rosenberg, 212.

[7] Paul S. B. Jackson, “Fearing Future Epidemics: The Cholera Crisis of 1892,” Cultural Geographies, 2012, 43–65, 52.