Mental Health in the Metropolis: The Midtown Manhattan Study

By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

How can we improve urban health? That is one of the missions of the New York Academy of Medicine, and a question public health professionals have been asking for decades. One of the landmark urban health studies, Mental Health in the Metropolis: The Midtown Manhattan Study, was published more than half a century ago.1 The study was intended to be a deep and exhaustive look into the mental health of residents in one of the most urban environments in the country, Midtown Manhattan. In many ways it was to be a model of the state of urban health throughout the country.2 And it was shaped by the medical experience of World War II.

Title page of Mental Health in the Metropolis, 1962.

Title page of Mental Health in the Metropolis, 1962.

Many veterans developed mental illnesses over the course of the war. Dr. Thomas A. C. Rennie, associate professor of psychiatry at Cornell University Medical College, saw many cases directly. He organized rehabilitation services for veterans during the war, and in 1944 published When He Comes Back and If He Comes Back Nervous.3 This booklet was followed by Mental Health and Modern Society,4 a professional discussion of the effects of war on society. In his war and postwar experience, Rennie encountered many people suffering from mental difficulties, and concluded that the long and extended psychoanalytic approach would never treat them effectively, for lack of time and resources.

Dedication of Mental Health in the Metropolis to Thomas A. C. Rennie.

Dedication of Mental Health in the Metropolis to Thomas A. C. Rennie.

Instead, Rennie began to look at the relationship between mental health and the social community.5 In the process he created a new field—social psychiatry. In 1950, he was appointed the first professor of social psychiatry at Cornell, arguably holding the first position of this kind anywhere in the United States.6 He conceived the Midtown study this same year, and launched it in 1952. Upon Rennie’s sudden death from a cerebral hemorrhage in mid-1956, the program was continued by Dr. Alexander Leighton, a colleague, medical sociologist, and psychiatrist at Cornell. The study ended in 1960, with publication of its results in 1962.7 It was a large undertaking; overall, the project utilized the services of some 200 people.

What did the study look like? In the words of the lead author, sociologist Leo Srole of SUNY Medical Center Brooklyn (SUNY Downstate), “An investigation focused upon Midtown can, in a special sense, be likened to an intensive case study. Here a community, rather than an individual, is the case.”8 Mental health was investigated as an outcome of community function and dysfunction, as much as or even more so than of the individual. That community was studied along many lines: age, sex, marital status, socioeconomic status, “generation-in-the-U.S.,” and various frames of origination: rural or urban, nationality, and religious affiliation. Researchers also assessed access to and outcomes of mental health and psychiatric care by surveying community residents and treatment workers. Their work seemed to show that Midtown held large numbers of untreated ill individuals, most of whom still functioned at an acceptable level. But definitive results were difficult to come by, and more studies were called for.

Correspondence between sick-well ratios for 12 socioeconomic status strata, reported in 4 groups, with highest SES marked “1” and lowest “12”. The “sick-well” ratio is found by comparing the numbers of “impaired” persons in a particular grouping, with the number of “well” persons. Two other rankings lie between these designations: “mild symptom formation” and “moderate symptom formation.” Mental Health in the Metropolis, Figure 5, p. 231. Click to enlarge.

Correspondence between sick-well ratios for 12 socioeconomic status strata, reported in 4 groups, with highest SES marked “1” and lowest “12”. The “sick-well” ratio is found by comparing the numbers of “impaired” persons in a particular grouping, with the number of “well” persons. Two other rankings lie between these designations: “mild symptom formation” and “moderate symptom formation.” Mental Health in the Metropolis, Figure 5, p. 231. Click to enlarge.

Mental Health in the Metropolis was the report of a large and complex analysis, marrying the different disciplines of psychiatry and sociology to understand and address medical problems using social means. As such it was a child of the war—the war that created mass problems, and suggested ways towards solving them. And it was the harbinger of studies to come.

References

1. Authored by Leo Srole, Thomas S. Langner, Stanley T. Michael, Marvin K. Opler, and Thomas A. C. Rennie, volume 1 in the Thomas A. C. Rennie Series in Social Psychiatry (New York: Blakiston Division, McGraw-Hill, [1962]).

2. Mental Health in the Metropolis, p. 338. The precise boundaries of the study area were not disclosed for reasons of confidentiality; it was described as “more or less midway up the length of Manhattan Island,” bounded by the business district, two major thoroughfares, and a river, and “almost wholly residential in character,” with 175,000 inhabitants (p. 72, and fn 14). Using the name “Midtown” to describe this community was surely inspired by the famous “Middletown” studies of Muncie, Indiana, done by Robert Staughton Lynd and Helen Merrell Lynd, and published in 1929 and 1935.

3. With Luther E. Woodward: New York: The National Committee for Mental Hygiene, [c1944].

4. Also with Luther E. Woodward: New York: Commonwealth Fund, 1948.

5. He was not the first to explore this connection, of course, and he profited from his work with Adolf Meyer of The Johns Hopkins Medical School from 1931 to 1941, Oskar Diethelm, “Thomas A. C. Rennie, February 28, 1904 — May 21, 1956,” Cornell University Faculty Memorial Statement, https://ecommons.cornell.edu/handle/1813/17813, accessed March 18, 2016.

6. Mental Health in the Metropolis, pp. viii.

7. Mental Health in the Metropolis, pp. 336–37.

8. Mental Health in the Metropolis, p. 28.

Surviving the Great Blizzard of 1888

By Johanna Goldberg, Information Services Librarian

After the snowstorm on January 22–23, 2016 dropped 26.8 inches of snow on New York City, lists circulated of the worst snowstorms in the city’s history dating back to 1869. Of the top ten storms, only one occurred in the 19th century: the blizzard of 1888, which resulted in 21 inches of snow falling on the city from March 12–14 of that year.

"Entrance to the Astor House facing Broadway between Barclay and Vesey Streets. Taken in March 1888 during the Great Blizzard." From Strong, The Great Blizzard of 1888.

“Entrance to the Astor House facing Broadway between Barclay and Vesey Streets. Taken in March 1888 during the Great Blizzard.” From Strong, The Great Blizzard of 1888.

The blizzard arrived unexpectedly. The forecast for Sunday, March 11 called for slight wind and evening rain. But late that night, a storm from the south altered its course at the same time that the wind changed direction. Rain turned to sleet, hail, and finally snow. New Yorkers woke up on Monday to 10 inches of snow and bitter cold.

“Looking north on Madison Avenue during the March 1888 Blizzard.” From Strong, The Great Blizzard of 1888.

Not realizing that the worst was yet to come—11 more inches of wind-swept snow fell before the storm ended—many ended up stranded on their way to work or school. Eighty mile an hour wind gusts blew snow into drifts as high as second story windows and, along with the snow and ice, stopped elevated trains and toppled phone, electric, and telegraph poles. After the suspension of ferry service, people attempted to cross the frozen East River on foot (many were rescued by tugboats). More than 200 New Yorkers died as a result of the storm.1,2

"45th Street and Grand Central Depot, New York, Blizzard, March 1888." From Strong, The Great Blizzard of 1888.

“45th Street and Grand Central Depot, New York, Blizzard, March 1888.” From Strong, The Great Blizzard of 1888.

"149 Broadway, now the site of the Singer Building, March 1888." From Strong, The Great Blizzard of 1888.

“149 Broadway, now the site of the Singer Building, March 1888.” From Strong, The Great Blizzard of 1888.

In 1938, fifty years after the blizzard, Samuel Meredith Strong, M.D., “Former President of ‘The Blizzard Men of 1888,’” published The Great Blizzard of 1888, a collection of oral histories and printed articles from those who survived the storm. Below are some selections from the book:2

Excerpt from an article by Julian Ralph in the New York Sun, September 2, 1933:

“Few of the women who worked for a living could get to their work places. Never, perhaps, in the history of petticoats was the imbecility of their design better illustrated. ‘To get here I had to take my skirts up and clamber through the snowdrifts,’ said a washerwoman when she came to the house of the reporter who writes this. She was the only messenger from the world at large that reached that house up to half-past 10 o’clock. ‘With my dress down I could not move half a block.’ It was so with many thousands of women; the thousand few who did not turn back when they had started out.”2

11th Street, New York, looking west." From Strong, The Great Blizzard of 1888.

11th Street, New York, looking west.” From Strong, The Great Blizzard of 1888.

From Wm. Chamberlain, Maspeth, New York:

“Mount Olivet Cemetery at Maspeth, New York, had two orders for burials to take place that day, and the Superintendent had men with a small plow drawn by horses work to keep the roads in the cemetery open. Along about ten o’clock he got me on the job shoveling, and after dinner sent me for men in the neighborhood. I think I got two or three and with others and the plows we worked until about 4:30 in the afternoon, but it was no use as the wind blew the snow back faster than we could handle it. We quit, licked to a frazzle, cold and tired and hungry. The funerals, according to the records in the cemetery, did not take place until two or three days later.”

"Copy of photograph taken in Flushing, Long Island, by Mr. William James in March 1888. Mr. Frederick Morris at the left, Dan Beard standing in the center." From Strong, The Great Blizzard of 1888.

“Copy of photograph taken in Flushing, Long Island, by Mr. William James in March 1888. Mr. Frederick Morris at the left, Dan Beard standing in the center.” From Strong, The Great Blizzard of 1888.

Dr. Charles Gilmore Kerley, published in Medical Clinic of North America, November 1935:

“I was a resident physician at the New York Infant Asylum in Westchester County, N.Y. At this institution there were a few over 400 children and about 200 mothers. The age of the child population ranged from infants of a few weeks to children five or six years of age. Among those under one year were perhaps 100 who were partly or entirely dependent on cow’s milk feeding. Eight cans of loose milk a day were supplied by a dairy eight miles distant, the milk being delivered in a horse-drawn truck—then came the big blizzard completely blocking traffic of every nature—in our case for seven days. I well remember the consternation and alarm at the thought of being cut off from all food supplies with over 600 people to be cared for. A few days before the historic storm, through error a large consignment of Borden’s condensed milk arrived at the institution. Twelve dozen cans had been ordered and 12 gross (1728) cans were received. Our greatest anxiety naturally centered on the bottle fed; the condensed product was at once brought in to use and a blizzard feeding plan was inaugurated through dilution with barley water. Greatly to our surprise the marasmic and difficult feeders, struggling along on diluted sterilized milk, took on new life, began to smile and gain in weight.”

Baxter Street, New York, Blizzard, March 1888." From Strong, The Great Blizzard of 1888.

Baxter Street, New York, Blizzard, March 1888.” From Strong, The Great Blizzard of 1888.

John Potter of Lowville, New York:

At that time I had a room on West 24th Street. I was employed as bookkeeper by a firm on Beach Street and started for work at 8:00 o’clock on that morning, taking the 6th Avenue elevated railroad from West 23rd Street. The train proceeded slowly until we reached the curve at Bleeker and 8th Streets when we came to a standstill and remained there until 3:00 o’clock in the afternoon without any heat in the car. About that time a man appeared on the street from a corner saloon with a long ladder which he placed against the elevated railing. The railing being coated with ice it was a difficult matter to climb over and reach the ladder. I recall carrying a young woman and, missing my footing partly down, we both landed in a snow bank. The man charged us fifty cents for the privilege of using his ladder.”

Hotel Martin 17-19 University Place, corner of 9th Street during the March 1888 Blizzard. Abandoned horse-car." From Strong, The Great Blizzard of 1888.

Hotel Martin 17-19 University Place, corner of 9th Street during the March 1888 Blizzard. Abandoned horse-car.” From Strong, The Great Blizzard of 1888.

Caroline Kleindienst, from Cranbury, New Jersey:

“Through the long lone hours of that night we were blessed with our eleven pound boy, without nurse or doctor.… Next morning we found we were completely snowed in. My husband started to shovel his way out, through snow as deep as he was tall….It was three weeks before the roads were cleared and the Doctor then made his first visit to our home and congratulated me on the fine new baby who came into this world unaided and alone in the Big Blizzard of 1888 and twenty-six years and six months later left this world in the Wright chemical explosion [an accident at a factory in Elizabeth, NJ that killed three workers3].”

"Wreck at Coleman's Station, New York & Harlem R. R., March 13, 1888." From Strong, The Great Blizzard of 1888.

“Wreck at Coleman’s Station, New York & Harlem R. R., March 13, 1888.” From Strong, The Great Blizzard of 1888.

The blizzard contributed to slow but successful city efforts to move power lines underground and replace elevated trains with the underground subway. It also spurred a more organized response to future weather events from the Department of Street Cleaning, now called the Department of Sanitation.1

Park Place, Brooklyn, N. Y., March 14, 1888." From Strong, The Great Blizzard of 1888.

Park Place, Brooklyn, N. Y., March 14, 1888.” From Strong, The Great Blizzard of 1888.

The next time a blizzard comes to New York, be grateful for modern weather forecasting technology and heated subway cars. And don’t try to cross the East River by foot!

References

1. Virtual New York. Blizzard of 1888. Available at: http://www.virtualny.cuny.edu/blizzard/bliz_hp.html.

2. Strong SM, Overton M. The great blizzard of 1888. [New York]; 1938.

3. GUNCOTTON KILLS THREE. Explosion Wrecks Factory and Shakes a New Jersey County. New York Times. http://query.nytimes.com/gst/abstract.html?res=9D00EEDB1438EF32A2575AC1A96F9C946596D6CF. Published September 19, 1914. Accessed March 4, 2016.

From Cholera to Zika: What History’s Pandemics Tell Us about the Next Contagion

By Sonia Shah

Sonia Shah, today’s guest blogger, is a science journalist and author of Pandemic: Tracking Contagions from Cholera to Ebola, and Beyond (Sarah Crichton Books/Farrar, Straus & Giroux, February 2016), from which this piece, including illustrations, is adapted.

On February 23 at 6pm, Shah will moderate the panel “Where Will the Next Pandemic Come From?,” cosponsored by the Pulitzer Center on Crisis Reporting. Register to attend.

Over the past 50 years, more than 300 infectious diseases have either newly emerged or re-emerged into territory where they’ve never been seen before. The Zika virus, a once-obscure pathogen from the forests of Uganda now rampaging across the Americas, is just the latest example. It joins a legion of other diseases that have similarly broken out of earlier constraints, including Ebola in West Africa, Middle East Respiratory Syndrome (MERS) in the Middle East, and novel avian influenzas in Asia, one of which hit the U.S poultry industry last spring, causing the biggest animal disease epidemic in U.S history.

When such pathogens spread like a wave across continents and global populations, they cause pandemics, from the Greek pan (“all”) and demos (“people”). Given the number of pathogens in our midst with pandemic-causing biological capacities, pandemics themselves are relatively rare. In modern history, only a few pathogens have been able to cause them: Yersinia pestis, which causes bubonic plague; variola, which causes smallpox; influenza A; HIV; and cholera.

Cholera is one of the history’s most successful pandemic-causing pathogens. The first cholera pandemic began in the Sundarbans in present-day Bangladesh in 1817. Since then, it has ravaged the planet in no fewer than seven pandemics, the latest of which is currently smoldering just a few hundred miles off the coast of Florida, in Haiti.

Cholera first perfected the art of pandemics by exploiting the rapid changes in transportation, trade, and demography unleashed by the dawn of the factory age. New, fast-moving transatlantic clipper ships and sailing packets, which moved millions of Europeans into North America, brought cholera to the New World in 1832. Thanks to the opening of the Erie Canal in 1825, the bacterial pathogen easily spread throughout the country, including into the canal’s southern terminus, New York City, which suffered repeated cholera epidemics over the course of decades.

The spread of cholera after the opening of the Erie Canal.

Cholera was well-poised to exploit the filth of 19th-century cities. The pathogen spreads through contaminated human waste. And outhouses, privies, and cesspools covered about 1/12 of New York City, none of which were serviced by sewer systems and few of which were ever emptied. (Those that were had their untreated contents unceremoniously dumped into the Hudson or East Rivers.) The contents of countless privies and cesspools spilled out into the streets, leaked into the city’s shallow street-corner wells, and trickled into the groundwater.

Even those who enjoyed piped water were vulnerable to the contagion. The company chartered by New York State to deliver drinking water to the city’s residents—the Manhattan Company, which started a bank now known as JPMorgan Chase—dug their well among the tenements of the notoriously crowded Five Points slum, in what is today part of Chinatown. They delivered the slum’s undoubtedly contaminated groundwater to one third of the city’s residents.

The 1832 cholera outbreak in New York City. the Manhattan Company, now JP Morgan Chase, sank its well amidst the privies and cesspools of the Five Points slum, atop the site of the Collection Pond, which had been filled in with garbage. The water was distributed to 1/3 of the city of New York.

The 1832 cholera outbreak in New York City. The Manhattan Company, now JP Morgan Chase, sank its well amidst the privies and cesspools of the Five Points slum, atop the site of the Collection Pond, which had been filled in with garbage. The water was distributed to 1/3 of the city of New York.

Just as the Zika and MERS viruses confound modern-day medicine, so too did cholera confound 19th-century medicine. Under the 2,000-year-old spell of miasmatism—the medical theory that diseases spread through stinky airs, or miasmas—doctors couldn’t bring themselves to admit that cholera spread through water, despite convincing contemporary evidence that it did.

But that doesn’t mean there was nothing that could have been done to mitigate the cholera pandemics of the 19th century.

The Manhattan Company knew the water they distributed was dirty. As a former director of the company admitted in 1810, Manhattan Company water was rich with its users’ “own evacuations, as well as that of their Horses, Cows, Dogs, Cats, and other putrid liquids so plentifully dispensed.” New Yorkers decried its smell and taste, which they variously derided as “abominable” and “nauseating.”1 They suspected, too, that the company’s water made them sick. “I have no doubt,” one letter writer opined to a local paper in 1830, “that one cause of the numerous stomach affections so common in this city is the impure, I may say poisonous nature of the pernicious Manhattan water which thousands of us daily and constantly use.”2

And New York’s physicians knew that cholera was coming down the Erie Canal and the Hudson River, heading straight for the city. Dr Lewis Beck, who collected the data mapped above admitted that the pattern of disease did “favor the idea that cholera is contagious,”3 and travelling down the waterways into New York City. So many people feared the migrants coming down the waterways during cholera outbreaks that residents of towns lining the canal refused to let passengers on passing boats disembark. In 1893, in fear of a cholera outbreak, an armed mob surrounded the cholera-infected passengers of the Normannia, a vessel recently arrived from Hamburg, Germany, trapping hundreds aboard for days.

But despite the public’s fears of contagion and contaminated water, little was done to protect the city from either. The city’s leadership refused to enact quarantines along the canal or the Hudson for fear of disrupting the lucrative shipping trade that had transformed New York from a backwater to the Empire State. The Manhattan Company retained its charter, despite public outcry about the quality of their water. The political machinations of the infamous Aaron Burr, pursuing his murderous rivalry with the now-storied founding father Alexander Hamilton, assured that.

Instead, each wave of deadly contagion was met with minor adjustments to society’s defenses against pathogens. International conferences began in 1851 to organize cross-border quarantines against cholera and other diseases. New York City opened its first independent health department, staffed by physicians rather than political appointees, in 1865, as cholera loomed (thanks in large part to the efforts of the New York Academy of Medicine). These reactive, incremental measures couldn’t stave off nearly a century of deadly cholera pandemics, but as the decades passed, they formed the foundation for the global health system we enjoy today. Following New York City’s example, independent health departments were built across the country. The international conferences to tame cholera led to the formation of the World Health Organization, in 1946.

Today, we continue to fight contagions in a similarly reactive, incremental fashion. After Ebola infected tens of thousands in West Africa and elsewhere, hospitals in the United States and other countries beefed up their investments in infection control. After mosquito-borne Zika infected millions across the Americas, public health agencies focused anew on the problem of disease-carrying insects.

Whether these measures will be sufficient to defuse the next pandemic remains to be seen. But a more comprehensive, proactive approach to defanging pandemics is now possible, too. The history of pandemics reveals the role of human activity in the emergence and spread of new pathogens. Industrial developments that disrupt wildlife habitat; rapid, ad hoc urbanization; intensive livestock farming; sanitary crises; and accelerated trade and travel all play a critical role, just as they did in cholera’s heyday. In some places, we can diminish the pathogenic threat these activities pose. In others, we can step up surveillance for new pathogens, using new microbial sleuthing techniques. And when we find the next pandemic-worthy pathogen, we can work to contain it—before it starts to spread.

References

1. Pandemic, p 64. From Koeppel, Gerard T. Water for Gotham: A history. Princeton University Press, 2001, 121, 141.

2. Pandemic, p 63. from Blake, Nelson Manfred. Water for the cities: A history of the urban water supply problem in the United States. No. 3. Syracuse University Press, 1995, 126.

3. Pandemic, p 106. from Tuite, Ashleigh R., Christina H. Chan, and David N. Fisman. “Cholera, canals, and contagion: Rediscovering Dr Beck’s report.” Journal of public health policy 32.3 (2011): 320-333.

Cholera Comes to New York City

By Anne Garner, Curator, Center for the History of Medicine and Public Health

In December, the Academy hosted the Commissioner’s Medical Grand Rounds Ebola: Past and Present panel discussion. In conjunction with this event, the Center for History prepared a small exhibition on the history of cholera in New York City.

Cholera first reached New York City in June of 1832. Three thousand New Yorkers died within weeks, while an estimated one third of the city’s 250,000 inhabitants fled. The disease hit the working class neighborhoods of lower Manhattan the hardest. Many city officials implicated the residents of the poorest neighborhoods for contracting cholera, blaming their weak character, instead of viewing the epidemic as a public health problem. Competing notions of the cause of the disease’s spread impeded effective response to this initial outbreak. John Snow’s research, tracing the spread of cholera to contaminated water in London, was made public in 1855. Snow’s work, combined with the establishment of the New York Metropolitan Board of Health in 1866, did much to curb the last significant outbreaks in the city, in 1866 and 1892.

[Scrapbook of Clippings]. Official Reports of the Board of Health during the Cholera, in the City of New York, in the year 1832.

[Scrapbook of Clippings]. Official Reports of the Board of Health during the Cholera, in the City of New York, in the year 1832.

[Scrapbook of Clippings]. Official Reports of the Board of Health during the Cholera, in the City of New York, in the year 1832.

The first case of cholera in New York City was reported on June 26. A scrapbook collection of broadside reports, spanning July 8–August 23, documents the catastrophic results of that first summer’s outbreak. The street addresses and the number of dead at each address are given, as well as the number of new cases and the number convalescing in hospitals at Park Street, Greenwich Street, Crosby Street, Rivington Street, the Alms-House, and elsewhere.

Batchelder, J. P. Cholera: Its Causes, Symptoms, and Treatment, considered and explained. New York: Dewitt & Davenport, 1849.

Batchelder, J. P. Cholera: Its Causes, Symptoms, and Treatment, considered and explained. New York: Dewitt & Davenport, 1849.

Batchelder, J. P. Cholera: Its Causes, Symptoms, and Treatment, considered and explained. New York: Dewitt & Davenport, 1849.

The 1832 arrival of cholera in the United State inspired a host of publications by physicians about the disease. By 1849, many New York physicians had accepted that cholera was “portable,” if not contagious. This pamphlet, by the eminent New York lecturer and surgeon J. P. Batchelder, documents a moment when the medical community was studying the spread of epidemic diseases in earnest, but the science was not yet understood. In a section on causes, Batchelder enumerates a long list of populations susceptible to the disease, including those suffering from hunger and those exposed to the night air. Our copy of this pamphlet was presented by the author to the Academy, and bears the Academy’s early bookplate.

[Collection of manuscript notes, related to the 1854 cholera epidemic in New York City.]

[Collection of manuscript notes, related to the 1854 cholera epidemic in New York City.]

Collection of manuscript notes, related to the 1854 cholera epidemic in New York City.

The second major outbreak of cholera in New York occurred in 1854, when the disease again reached epidemic proportions, killing 2,509. The Board of Health established temporary hospitals throughout the city to accommodate the large number of patients. This volume contains 27 orders for hospitalization during the epidemic of 1854, most of them hastily written on scrap paper. According to the notes, this patient, Mary Riley, delayed going to the hospital and died the following day at home.

“The Cholera and Fever Nests of New York City.” Illustrations from the Healy Collection. 1866.

"The Cholera and Fever Nests of New York City." Illustrations from the Healy Collection. 1866.

“The Cholera and Fever Nests of New York City.” Illustrations from the Healy Collection. 1866. Click to enlarge.

The Metropolitan Board of Health was established in 1866, the year these illustrations were published. The Board was instrumental in identifying sanitation problems that made the city’s poorest neighborhoods most vulnerable to cholera outbreaks. An early board publication describes these cholera nests in vivid terms: “There is such an utter neglect of ventilation and adequate means for daily scavenging and purification of the tenement blocks, that they invite and perpetuate the most pernicious infections…They are perpetual fever nests, ready to nourish and force into deadly activity any fomites or contagium that may chance to find lodgment in them.”1

Peters, Dr. John C. “Routes of Asiatic Cholera.” Harper’s Weekly [New York] 25 April 1885. Illustration from the Healy Collection.

Peters, Dr. John C. "Routes of Asiatic Cholera." Harper's Weekly [New York] 25 April 1885. Illustration from the Healy Collection.

Peters, Dr. John C. “Routes of Asiatic Cholera.” Harper’s Weekly [New York] 25 April 1885. Illustration from the Healy Collection. Click to enlarge.

New York physician John C. Peters produced several informative maps showing the movement of cholera across the globe. This map, originally published in 1873, tracks the path of cholera from its origins at the mouth of the Ganges to Europe and on to the Americas. Visible on Peters’ map are the five major 19th-century routes of the disease into New York, in the years 1832, 1849, 1854, 1866, and 1873.

Reference

1. Documents of the Assembly of the State of New York, Volume 4. Accessed December 23, 2014, at http://bit.ly/1CwL7Kd.

“The Pest at the Gate”: Typhoid, Sanitation, and Fear in NYC

By Lisa O’Sullivan, Director, Center for the History of Medicine and Public Health

The relationship between medicine and public health could be a complex one at the turn of the last century. In particular, the question of how to deal with infectious disease epidemics demanded that medical professionals and city officials grapple with sanitation and cleanliness, city infrastructure, water supplies, and garbage and sewage. Epidemics also raised questions of individual autonomy and the proper role of government. In response to these issues, Boards of Health emerged in many American cities in the second half of the 19th century. The New York Metropolitan Board of Health was the first, founded in 1866 after a campaign by Dr. Stephen Smith and The New York Academy of Medicine.

Poultney Bigelow, The Pest at Our Gates, ([New York] : Merchants’ Association of New York, [1908])

Bigelow Poultney, The Pest at Our Gates, (New York: Merchants’ Association of New York, 1908)

Relations were often fraught between the different groups responsible for the city’s health. Many physicians resented the interference of city-nominated health officials (many of whom they considered corrupt and/or incompetent) into the medical domain; health officials blamed doctors for failing to report cases of infectious diseases; and families regarded hospitals with suspicion and did their best to keep their ill relatives out of them.

The diseases most feared by New Yorkers included cholera, typhus, and typhoid fever. Between 1898 and 1907, at least 635 New Yorkers died from typhoid, with cases of the disease in the thousands.1 Typhoid spreads through water supplies contaminated with infected fecal matter. It can be transmitted via contaminated food or water, and more rarely, through direct contact with someone infected with the disease. As such, sources of the illness in late 19th-century New York were many and largely invisible, as the investigative journalist and author Poultney Bigelow described in 1908 in “The Pest at Our Gates”: typhoid sources ranged from the “placid, perilous Potomac” to “the deadly house fly,” “the fish and oyster menace” and the “perils that lurk in ice.”2 Fear of typhoid pushed public health initiatives and legislation to ensure safe water and food, adequate plumbing, and proper sewage control.

The specters of cholera, yellow fever, and smallpox recoil in fear as their way through the Port of New York is blocked by a barrier on which is written "quarantine" and by an angel holding a sword and shield on which is written "cleanliness." Courtesy of the National Library of Medicine.

Cholera, yellow fever, and smallpox recoil in fear as a quarantine barrier and an angel holding bearing a shield of cleanliness blocks their way through the Port of New York. Image courtesy of the National Library of Medicine.

Fear of infectious disease often overlapped with fears about the changing face of the city and nation. As Alan M. Kraut explores in Silent Travelers: Germs, Genes and the Immigrant Menace, the relationship between immigration and public health in the United States has historically been informed by nativist debates about the identity of the nation and its ethnic makeup, fears about the potential limitations of scientific medicine, and the public health impact of immigration.3 As the gateway to America for hundreds of thousands of new immigrants, New York City became a focus for questions of quarantine and infectious disease. Epidemics, particularly of cholera, prompted many public health reforms in the city, especially increased scrutiny of immigrant arrivals at quarantine stations, including Ellis Island, where officials assessed arriving immigrants for their physical and mental health between 1892 and 1924.

In the case of typhoid, the specter of the foreigner as the reservoir of disease came to be personified by the Irish-born Mary Mallon, so-called “Typhoid Mary.” Mallon was a cook whose employment history in the kitchens of wealthy New Yorkers matched a spate of typhoid outbreaks in those same households in 1906. Mallon was a healthy carrier of typhoid, and was put under enforced quarantine by the Board of Health, which she vigorously resisted. On her release in 1909 she took multiple aliases and continued to work as a cook until 1915, when she was again detained and kept in isolation until her death in 1932. To some, Mallon was “the most dangerous woman in America”; to others, she was a symbol of the undermining of individual liberties by the government.4

In the case of typhoid fever, a combination of new vaccine technology and improved sanitation measures (particularly water chlorination) saw cases in the United States drop dramatically in the early 20th century. However, as is the case for many preventable infectious diseases, typhoid remains a problem in parts of the world with less developed public health infrastructure. On a global scale, medical and governmental responses to public health issues continue to exist in an uneasy tension with broader political and social concerns.

References

1. John Duffy,  A history of public health in New York City (New York: Russell Sage Foundation, 1968), p566

2. Poultney Bigelow, The Pest at Our Gates, (New York: Merchants’ Association of New York, 1908)

3. Alan M. Kraut, Silent Travelers: Germs, Genes and the Immigrant Menace (New York: Basic Books, 1994), pp 1-9

4. Judith Walzer Leavitt, Typhoid Mary: captive to the public’s health (Boston: Beacon Press, 1996); Alan M. Kraut, Silent Travelers: Germs, Genes and the Immigrant Menace (Baltimore: Johns Hopkins University Press, 1995), 97-104.