The Michael M. Davis Papers and Economics in Medicine

By Carrie Levinson, Reference Services & Outreach Librarian

Recently, the Academy hosted a talk between Paul Krugman and Tsung-Mei Cheng, entitled “Priced Out: The Economic and Ethical Costs of American Health Care.” This event focused on Uwe E. Reinhardt’s latest book, which discusses today’s U.S. healthcare system. Krugman and Cheng delivered lively and nuanced explanations of why our system is so expensive, especially compared with other similar countries, the morality involved in having costs so high, and some potential solutions.

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A photograph of Michael M. Davis from Michael M. Davis: A tribute, by Alice Taylor Davis and Gertrude Auerbach (1972?). NYAM Collection.

The debate about healthcare in the United States is not a new one, however. One notable medical economist whose collection is one of the most interesting in the Academy’s library, Michael Marks Davis, advocated for comprehensive medical care and national health insurance, and worked in many prominent organizations and committees throughout his career, including the Rockefeller Foundation, the Julius Rosenwald Fund, the Committee for Research in Medical Economics, and the Committee for the Nation’s Health (New York Academy of Medicine, n.d.).

Davis donated his collection of papers and reports in 1962. This collection is important because, among other things, it provides source material for studying some of the most significant historical legislative advances in the United States, as well as social trends of the 1920s through the 1960s, aspects of medicine and health in other countries, and confidential and other unpublished reports that likely are not duplicated elsewhere. Below is a short description of the kinds of material that can be found within these papers, originally compiled by Lee Ash (1967).

Series 1: Medical Economics and Medical Sociology

  • Material on medical care costs and studies by, for, and about the Committee on the Costs of Medical Care, including confidential reports; also material on state, industrial and cooperative medical plans, comprehensive group medical plans, and union health programs.

Series 2: Medical Care in the United States

  • Materials including confidential reports made for foundations in the United States; material on rural economic conditions from the 1930’s through the 1950s, and on rural health problems and programs, material on medical education, hospitals, and medical personnel.

Series 3: Legislation and Legal Aspects

  • Materials on legislation since 1950, and publications, reports, correspondence, and ephemera relevant to legislation prior to 1950, public assistance and child welfare, mental health, and state legislation, including sickness and disability insurance programs to be paid for by the state, and original texts of bills.

Series 4: Organizations

  • Samples of special reports, annual reports, and letters to and from Dr. Davis concerning the work of various organizations, grouped into the following sections: Professional Organizations, General Organizations, International Organizations, and Political Organizations.

Series 5: Medical Care in Foreign Countries

  • Public documentation and correspondence with leaders and private physicians concerned with social medicine and public health abroad; a good deal of material focusing on the National Health Service Act; published and unpublished reports from many other countries.

Series 6: Personalities

  • Correspondence, notes, comments, clippings, personality evaluations, and memorabilia to, from, and about all of the leaders Dr. Davis associated with in his work.
Article with graphs looking at illness and income

Article with graphs looking at illness and income in Volume 21 of the Michael M. Davis papers. NYAM Collection in Public Health in Modern America, 1890-1970 .

These short descriptions don’t even begin to cover the richness of the Davis collection. With over 400,000 pieces (Ash, 1967), it might seem insurmountable to researchers, but that’s not the case. We have an excellent finding aid that goes into more detail about the materials and how to find them, as well as giving detailed biographical information on Dr. Davis. Not enough for you? You may recall our blog post about our partnership with Gale to digitize material related to public health in America. Well, this entire collection can be found in Gale’s new database Public Health in Modern America, 1890-1970! If your institution doesn’t subscribe to it, you can make an appointment to view it at our library.

Conversation and arguments about healthcare costs and structure are unlikely to stop anytime soon, but with collections such as Davis’s available to those who are interested, we can understand the history of such discussions in going forward.

References

Ash, L. (1967). The Michael M. Davis Collection of Social and Economic Aspects of Medicine. Bulletin of the New York Academy of Medicine, 43(7), 598–608. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1806900/

New York Academy of Medicine (n. d.). Library of social and economic aspects of medicine of Michael M. Davis [Finding aid]. New York, NY: Author. Retrieved from https://www.nyam.org/library/collections-and-resources/archives/finding-aids/ARM-0003.html/

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

By Anne Garner, Curator, Rare Books and Manuscripts

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

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

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

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

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

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

7thward-NYHS

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

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

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

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

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Fourth Ward map, detail of Gotham Court

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

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

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Fourth Ward map, detail of the Bowery

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

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

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

References

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

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

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

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

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

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

[7] Duffy, p. 556.

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

[9] Duffy, 557.

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

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

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

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

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

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

MarineHospital_StatenIsland

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

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

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“Doctor’s Examination.” From Quarantine Sketches.

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

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

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

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

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

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

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

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

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

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Red Medicine: The West Looks at the Soviet Experiment in the 1930s

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

Last month marked the 100th anniversary of the Great October Revolution, whereby the Bolsheviks in Petrograd overthrew the Russian government and took power.[1] Immediately after, the Revolution’s leader, Vladimir Lenin, consolidated his rule by suppressing competing political parties; withdrawing Russia from World War I; and fighting a bitter Civil War. By the early 1920s, the country had obtained a modicum of peace, albeit isolated from the rest of the world. Through wars and purges, technological advance and political suppression, the Bolsheviks, renamed the Communist Party, held control in Russia for almost 75 years.

In a Hospital Waiting Room, Moscow

Margaret Bourke White, “In a Hospital Waiting Room, Moscow,” 1932. Red Medicine, endpaper.

Lenin was aware of Russia’s backwardness compared with the West. He saw Communist rule as a way to make up for that deficiency. His oft-cited definition of communism made this belief explicit: “Communism is Soviet power plus the electrification of the whole country.” Soviet power meant political rule that flowed from ostensibly democratic workers’ councils (the Russian word for “council” is “soviet”), with the aim of basing governance in the working class; electrification meant providing the latest means of technological development. Soviet rule and technological development, together, would enable the country to leap-frog its capitalist neighbors and become the vanguard for humanity’s future development, both social and economic.

The socialist left hoped this vision would be realized. Early accounts were enthusiastic—sympathetic American journalist Lincoln Steffens gushed in 1919: “I have seen the future, and it works!”

By the 1930s, as the United States and Europe slid into the Great Depression, Soviet Russia was held out as a more workable and more equitable society than those in the West. In the field of medicine and public health, two observers set out to see if that were true. Sir Arthur Newsholme (1857–1943), and John Adams Kingsbury (1876–1956), a Briton and an American, traveled through the Soviet Union in August and September 1932.[2] Their account was published the following year as Red Medicine: Socialized Health in Soviet Russia.[3]

Itinerary of the authors

“Itinerary of the authors, who traveled 9,000 miles within Soviet Russia.” Red Medicine, p. 19.

Newsholme and Kingsbury travelled over 9,000 miles throughout the Soviet Union. Entering Russia from Poland, the two traveled to Moscow, took a trip up to Leningrad and back, and then headed east to Kazan, south to Samara and Stalingrad, and jogged back to Rostov-on-Don before journeying to Tiflis (Tbilisi) in Soviet Georgia. They traveled back to Moscow by way of Sochi, Sevastopol (in Crimea), and Kharkov in Ukraine, and from Moscow, they returned to Poland. Their book chronicled their trip with an overlay of commentary. It was in part a look at Soviet institutions, such as residential and non-residential treatment, physician training, maternity care, and tuberculosis sanitaria. Beyond this, the authors provided social and political observations on life in the Soviet Union, with chapters on “The Background of Russian Life,” “Stages in the Introduction of Communism,” “Women in Soviet Russia,” and “Religious and Civil Liberty and Law.”

Though clear-eyed about the authoritarian nature of the Soviet government, Newsholme (the acknowledged author of most of the work) nonetheless focused on one question:

Does the Soviet organization—including all that is implied in the unification of financial responsibilities and control of the entire resources of the country—assist to an exceptional extent a complete medical and hygienic service for the entire community? To this question we can at once give a definitely affirmative answer. [4]

Though the “civilized countries” had variously tended toward socialized medicine, he thought that the U.S.S.R. had surpassed them all, both in delivery of health care and in prevention, in social services as well as medicine more narrowly defined. As one reviewer of Red Medicine understood Newsholme’s claim:

“[In the] organization and practice of medicine . . . the present government has made truly great progress, and seems to have only fairly gotten under way. The authors clearly perceive that Russia has laid a more adequate basis for up-to-date public health than any western nation; also, that we have arrived at a stage of cultural development when medical services must be provided on a sound basis for all, regardless of ability to pay.”[5]

Traveling dental station

Soviet Photo Agency, “Traveling dental station in rural district near Moscow,” [1932]. Red Medicine, p. 223.

This level of public support was seen as the inevitable goal of social development, so much so that, as Newsholme put it, “Even if the Communist experiment fails, Russian government cannot be expected to revert entirely to capitalist conditions.”

Did the Soviet experiment work? The new system of medicine and public health was initially very successful in dealing with infectious disease and extending care more widely through the country. Nonetheless, as Newsholme had envisioned, the initial impetus could not be sustained. Fifty years after Red Medicine, the system was broken; while citizens could usually get access to health care, quality lagged. After the collapse of the Soviet system in 1989–91, the new Russian government attempted reform and adopted a mixed public-private economic model, mandating compulsory health insurance while continuing a guaranteed right to free care. Fifteen years on, though, an OECD report concluded that “Russia continues to struggle with a health and mortality crisis.”[6] One could fairly state that our country faces such as crisis today as well, and in both cases, the resolution is yet to come.

A note: Red Medicine includes several photographs by noted photojournalist Margaret Bourke-White, taken during her own 1932 trip to the Soviet Union, and provided freely to the authors for their use.[7]

Endnotes:
[1] Yes, it took place in November! In 1917, Russia still used the Julian calendar, according to which the day of the Bolshevik coup was October 25. The rest of the West, using the Gregorian calendar, called that day November 7. Most of Catholic Europe had switched to the Gregorian calendar in 1582, with the Protestant countries adopting it in the 17th century and the British domains in 1752. Russia made the change in early 1918, one of the last countries in Europe to do so.

[2] Newsholme was an eminent British public servant and advocate of state intervention in public health, while Kingsbury, a Fellow of The New York Academy of Medicine, was formerly Commissioner of Public Charities for New York City, and at that time, Executive Director of the Milbank Fund, a foundation supporting research in health policy.

See “Sir Arthur Newsholme, K.C.B., M.D. (LOND.), F.R.C.P.,” American Journal of Public Health 33(8) (August 1943): 992–94; John M. Eyler, Sir Arthur Newsholme and State Medicine, 1885–1935, Cambridge History of Medicine (Cambridge: Cambridge University Press, 1997); Arnold S. Rosenberg, “The Rise of John Adams Kingsbury,” The Pacific Northwest Quarterly 63(2) (April 1972): 55–62; “Biographical Note,” The John Adams Kingsbury Papers, Manuscript Division, Library of Congress, accessed November 7, 2017.

[3] Sir Arthur Newsholme and John Adams Kingsbury, Red Medicine: Socialized Health in Soviet Russia (Garden City, NY: Doubleday, Doran, 1933). Note that, despite the title, the work was about more than Soviet Russia. The two men’s travels took them to the Georgian and Ukrainian Soviet Republics as well.

This work was conceived as in some ways completing Newsholme’s previous three-volume survey of medical practice in Europe, which he undertook with the support of the Milbank Foundation: Medicine and the State: The Relation between the Private and Official Practice of Medicine, with Special Reference to Public Health. London, Baltimore: George Allen and Unwin, Williams and Wilkins; 1932. The Academy Library holds the third volume.

[4] Newsholme and Kingsbury, Red Medicine, “Concluding Observations” (for this and subsequent statements).

[5] Frank H. Hankins, “[Review of] Red Medicine: Socialized Health in Soviet Russia. By Sir Arthur Newsholme and John Adams Kingsbury,” Social Forces 14 (1) (1 October 1935), 155–56, accessed November 7, 2017. Hankins (1877–1970) was a prominent American sociologist.

[6] William Tompson, “Healthcare Reform in Russia: Problems and Prospects,” Organisation for Economic Co-operation and Development, Economics Department Working Papers, No. 538 (Paris, January 15, 2007), 5.

[7] Gary D. Saretzky, catalog for “Margaret Bourke-White in Print: An Exhibition at Archibald S. Alexander Library, Rutgers University, New Brunswick, New Jersey, January–June 2006,” item 23, Red Medicine, accessed November 7, 2017.

“The Politics of Infrastructure” Class Review

By Audrey Sage Lorberfeld, Digital Technical Specialist

As part of the ongoing collaboration between the Brooklyn Institute for Social Research (BISR) and The New York Academy of Medicine Library, I was able to spend the beginning of summer contemplating how material and immaterial infrastructures affect peoples’ daily lives.

Throughout the BISR course titled “The Politics of Infrastructure,” taught by one of my favorite professors, Danya Glabau, we covered everything from why park benches are a certain length (so that people don’t sleep on them), to the United States’ unique economy of technological obsolescence. We took some deep dives into theoretical texts, such as Michelle Murphy’s Sick Building Syndrome and the Problem of Uncertainty and Bruno Latour’s Science in Action: How to Follow Scientists and Engineers Through Society. We were also encouraged to apply what we read to our daily lives. During my morning commutes, I suddenly found myself wondering if an umbrella or a subway car were inherently political objects (and what this might mean for their construction and use).

As always, there were beautiful treasures from the Academy Library that we were able to view during class, thanks to our Rare Books and Manuscripts Curator Anne Garner’s expansive knowledge of our holdings. One item she found for the class that was particularly striking was Stephen Smith’s The City That Was (1911).[1] We used this item as a complement to our unit titled “Infrastructure and Public Health,” where we read critical texts such as Paul Farmer’s “An Anthropology of Structural Violence” and Manjari Mahajan’s “Designing Epidemics: Models, Policy-Making, and Global Foreknowledge in India’s AIDS Epidemic.”

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Image from Smith’s The City That Was (1911) showing the “Region of Bone-Boiling and Swill-Milk Nuisances.”

Smith was a New Yorker who many now regard as the father of public health. He founded the American Public Health Association and was the first to attribute the spread of typhus and cholera to environmental conditions around New York City.[2] Without him, New York would likely not have advanced into the public health-conscious city it is today (at least not as quickly). In The City That Was, Smith outlines through detailed illustrations various areas of the city that were public health concerns. I hate to imagine what Nolita’s trendy residents would think of their apartments if they knew they were once next to noxious hide-curing and fat-gathering houses.

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Image from Smith’s The City That Was (1911) showing the “Region of Hide-Curing, Fat-Gathering, Fat and Soap Boiling, and Slaughter-Pens, Behind the Bowery Shopping Houses.”

While examining physical infrastructures, past and present, provided us with the tools to critique New York’s metropolitan landscape responsibly, we also learned about more cerebral types of infrastructure. One author whose work particularly struck me was Susan Leigh Star. In her article titled “Power, Technology and the Phenomenology of Conventions: On Being Allergic to Onions,” she examines the power of living in between worlds, and challenges her readers to question the idea of standardization. Of the latter, she brings attention to stoplights, writing: “The initial choice of red as a colour of traffic lights that means, ‘stop’, for example, is now a widespread convention that would be functionally impossible to change, yet it was initially arbitrary.” And it’s true — who decided that red meant stop? Why does red mean stop everywhere now, from stop signs to walk signals?

Star_DimensionsOfPower_1991

Diagram showing Star’s theory of the dimensions of power, from “Power, Technology and the Phenomenology of Conventions: On Being Allergic to Onions,” 1991.

For me, the power of Star’s scholarship really became solidified throughout her discussion of marginality, though. She writes:

“We are at once heterogeneous, split apart, multiple — and through living in multiple worlds without delegation, we have experience of a self unified only through action, work and the patchwork of collection biography . . . That is, in the case of Pasteur or any executive, much of the work is attributed back to the central figure, erasing the work of secretaries, wives, laboratory technicians, and all sorts of associates. When this invisible work . . . is recovered, a very different network is discovered as well . . . All of these ways of gaining access imply listening, rather than talking on behalf of. This often means refusing translation — resting uncomfortably but content with that which is wild to us.”[3]

As someone who works in the intersection of medicine and the social sciences, the ideas in the above quote seem especially relevant. Biological scientists hate lingering in the unknown, while social scientists get tenure by writing about it. The idea of a library whose collections reflect the chameleonic history of medicine likely exists in a space much like Star’s “multiple worlds.” And, similar to those lab technicians whose names you never read about when a team of scientists win the Nobel Prize, libraries function largely on invisible labor. Thanks to Star, I am getting more comfortable with my own brand of marginality, too.

Glabau lead us expertly down these paths and many more during my time as a BISR student in “The Politics of Infrastructure.” We are currently hosting another one of her classes (“Science, Race, and Colonialism“), so stay tuned for more synopses from the field.

References:
[1] Smith S, The City That Was. New York, NY: F. Allaben; 1911.
[2] A Short Narrative of Dr. Stephen Smith. Medph.org. Published 2016. Accessed July 10, 2017.
[3] Star S. Power, Technology and the Phenomenology of Conventions: On Being Allergic to Onions. The Sociological Review. 1991; 38(S1):26-55, p29-30.

Deafness as a Public Health Issue in the 1920s & 1930s (Part 2 of 2)

Today we have part two of a guest post written by Dr. Jaipreet Virdi-Dhesi, the 2016 Klemperer Fellow in the History of Medicine at the New York Academy of Medicine and a SSHRC Postdoctoral Fellow in the Department of History at Brock University in St. Catharines, Ontario. She is working on her first book, Hearing Happiness: Fakes, Fads, and Frauds in Deafness Cures, which examines the medical history of hearing loss and “quack cures” for deafness. Some of these cures are explored on her blog, From the Hands of Quacks. You can find her on twitter as @jaivirdi.

Promotional photo by the New York League for the Hard of Hearing and its hearing clinic for testing and examination (The Bulletin, Dec. 1935)

Promotional photo by the New York League for the Hard of Hearing and its hearing clinic for testing and examination (The Bulletin, Dec. 1935)

The New York League for the Hard of Hearing launched several campaigns during the 1930s addressing the “psychological aspect” of acquired deafness mentioned by Wendell C. Phillips. Since deafness is an invisible affliction, Phillips emphasized the deafened person often feels isolated and unable to adjust to the sensory change, especially if the hearing loss occurred suddenly. Other otologists agreed as many patients narrated similar stories: their hearing was perfectly fine and normal, then one day something happened and they became deaf, and the process of coming to terms to the newfound deafened state was a difficult one. Illness such as influenza, pneumonia, meningitis, diphtheria, scarlet fever, measles, or ear abscesses were usually the culprit. So too were heard injuries, age-onset deafness in the elderly, misuse of drugs such as quinine, a poor diet (including too much sugar), and other ordinary factors:

“It is well to bear in mind the effects of hair-dyes, excessive smoking or drinking, and indeed, improper underwater swimming and diving. Vigorous blowing of the nose is also frequent causes of hearing impairment.”[1] 

Otologists claimed individuals needed to take responsibility for their hearing—to conserve what hearing one had, through proper diet, lifestyle, and hygiene, before it disintegrated. This was a remarkable shift from the 1920s “prevention of deafness” campaigns that concentrated on a screening program of early detection and medical care. While constant surveillance was still promoted, the late-1930s campaigns transformed hearing loss into an affliction that could easily be treated or managed by good habits.

Pamphlets reveal how parents were encouraged to become more “ear-minded” toward their children, that is, to pay attention if their child exhibits any signs of hearing loss, to avoid a circumstance in which a neglected hearing issue ends up turning a deafened child into a problem.

Advertisement for the New York League Hard of Hearing (The Bulletin, 1934).

Advertisement for the New York League Hard of Hearing (The Bulletin, 1934).

Image 6b

Advertisement for the New York League for the Hard of Hearing (The [Hearing] News, October 1935)

 

 

 

 

 

 

 

 

 

 

In other words, the “problem of deafness” became less about the triumphs of medical cures for hearing loss or social organizations providing communication services, but more about conserving one’s hearing before it was gradually diminished. Themes for “Better Hearing Week” especially reflect this: the 1937 theme was “It’s Sound Sense to Conserve Hearing,” while the 1938 was “Help Conserve Hearing.”

Front page of the October 1937 issue of The Bulletin magazine, promoting the National Hearing Week, with reprints of letters from FDR.

Front page of the October 1937 issue of The Bulletin magazine, promoting the National Hearing Week, with reprints of letters from FDR

The American Society for the Hard of Hearing also launched their own campaigns. In 1937, the organization listed a four-point program publicizing their mandates: the prevention of deafness, the conservation of hearing, the alleviation of social conditions affecting the hard of hearing, and rehabilitation. In addition to popular radio broadcasts on the National Broadcasting System, 327 feature articles and 189 editorials were released in over 1600 newspapers.

“Hearing through Life,” a national campaign launched by the ASHH (Hygeia, October 1937).

“Hearing through Life,” a national campaign launched by the ASHH (Hygeia, October 1937).

The publicity campaigns of the 1920s and 1930s were really about transforming public perceptions of the hard of hearing and deafened as handicapped persons, rather than as “defectives”—an important observation in light of the eugenicist concerns of the period. But they were also about addressing hearing impairment not as a social or educational issue, but as a public health issue, one that required cooperation between different levels of civic infrastructures. As otologist Edmund Prince Fowler noted in 1940, the hearing impaired “should never be dismissed with the thought, “Nothing can be done.”[2]

Promotional photo for the League’s “Children’s Auditory Training Project” campaign of the 1940s (The Bulletin, Nov-Dec, 1949)

Promotional photo for the League’s “Children’s Auditory Training Project” campaign of the 1940s (The Bulletin, Nov-Dec, 1949)

Special thanks are owed to Arlene Shaner at the NYAM Library for her generous research assistance and lively conversations.

References

[1] Samuel Zwerling, “Problems of the Hard of Hearing,” Hearing News (January 1938).

[2] Bulletin of the New York League for the Hard of Hearing, 18.7 (November 1940).

Deafness as a Public Health Issue in the 1920s & 1930s (Part 1 of 2)

Today we have part one of a guest post written by Dr. Jaipreet Virdi-Dhesi, the 2016 Klemperer Fellow in the History of Medicine at the New York Academy of Medicine and a SSHRC Postdoctoral Fellow in the Department of History at Brock University in St. Catharines, Ontario. She is working on her first book, Hearing Happiness: Fakes, Fads, and Frauds in Deafness Cures, which examines the medical history of hearing loss and “quack cures” for deafness. Some of these cures are explored on her blog, From the Hands of Quacks. You can find her on twitter as @jaivirdi.

In 1935, physician Francis L. Rogers of Long Beach read a paper addressing the worrisome statistics of deafness. One study discovered nearly thirty-five thousand Americans were deaf. Another found that out of a million people tested for their hearing, 6% had significant hearing impairment. Yet another study reported three million people had some kind of hearing impairment. This “problem of deafness,” Rogers emphasized, “is primarily of public health and public welfare.” Not only were there too many people failing to adequately care for their hearing, but many cities, schools, and governments lacked the proper infrastructure to educate the public on the importance of hearing preservation. Indeed, as Rogers stressed: “Today the three great public health problems confronting the world are heart disease, cancer, and deafness.”[1]

Image 1

A window display in Detroit (Hearing News, June 1942)

The notion of deafness being statistically worrying as a public health issue actually dates to the late nineteenth century, especially to the work of otologist James Kerr Love of Glasgow. Love conducted several statistical studies of the ears of deaf schoolchildren, discovering that the majority of them were not completely deaf, but had some level of “residual” hearing. With proper medical treatment, the hearing could be intensified enough to warrant a “cure.” For other cases, children could be taught to make use of that residual hearing through invasive training using acoustic aids and other kinds of hearing technologies.

Love’s research concluded that many deafness cases could actually be relieved if the ears of children were examined early and frequently—that is, deafness could be prevented. His “prevention of deafness” concept was influential for the new generation of otologists in America, especially those who were members of the New York Academy of Medicine’s Section of Otology during the first three decades of the twentieth century.

To raise awareness on the necessity of proper medical examinations and frequent hearing tests, these otologists collaborated with social organizations such as the New York League for the Hard of Hearing, which was established in 1910. The League was a progressive group catering to the needs of hard of hearing or deafened persons who were raised in a hearing society rather than in a D/deaf community and communicated primarily with speech and lip-reading rather than sign language. Composed mostly of white, middle-class, and educated members who lost their hearing from illness, injury, or progressive deafness, the League strove to construct hearing impairment as a medical issue. They argued hearing impairment was not an issue of education or communication, but rather a handicap.

Image 2

An otologist examining a young patient’s ear (Hygeia, June 1923)

The collaboration between New York otologists and the League eventually created a national network of experts, social services, teachers, physicians, and volunteers who banded together to address the so-called “problem of deafness.” That is, the problem of how to best integrate the hard of hearing, the deafened, and to some extent, even the deaf-mutes, into society. One key achievement of the League was the establishment of hearing clinics to properly assess hearing impairment, especially in children, to ensure medical care could be provided before it was too late. This project was primarily spearheaded by Harold M. Hays (1880-1940), who was recruited as president of the League in 1913, becoming the first active otologist collaborating with the League. After the First World War, Hays set up a clinic for treating hearing loss in children at the Manhattan Eye, Ear, and Throat Hospital.

Image 3

Group hearing tests of schoolchildren, using an audiometer. Headphones are used first on the right ear, then the left. (Hygeia, February 1928)

Hays claimed that hearing impairment might be a handicap, but “the sad part of it is that 90 percent of all hearing troubles could be corrected if they were treated at the proper time.” With regular hearing tests, this was possible. Yet, as Hays argued, regular hearing tests were not considered on par with other hygienic measures under public health services:

We are saving the child’s eyes! We are saving the child’s teeth! Is it not worth while to save the child’s ears?”[2]

During the 1920s, Hays’ activism for regular hearing tests was so instrumental that in 1922, the League’s newsletter, The Chronicle, told its readers “we believe that the League would justify its existence if it did no other work than to prevent as much deafness as possible.”  To achieve this mandate, the League launched a large public campaign to raise awareness on the importance of medical care. Indeed, in one report for the League, Hays remarked that with the increased publicity, there were 10,000 calls to the League in 1918 alone inquiring about aural examinations. A steady increase in patients would follow: 17 clinic patients in 1924, 326 in 1926, and then 1,531 in 1934.

Another publicity campaign spearheaded by the League was the establishment of “Better Hearing Week” in 1926, a week-long awareness program (later renamed “National Hearing Week”). Held in October, the campaign included symposium discussions on the “Problems of the Hard of Hearing,” including topics on the relationship between the physician and his deafened patient, how the deafened could build their lives, and even on newest technological developments in hearing aids. October issues of The Bulletin (the renamed League newsletter) and the Hearing News, the newsletter of the American Society for the Hard of Hearing (ASHH) included reprints of letters from prominent leaders supporting the mandates of “Better Hearing Week,” including letters from President Roosevelt and New York Mayor LaGuardia.

Image 4

Advertisement for Western Electric Hearing Aid, the “Audiophone.” These before-and-after shots were powerful for demonstrating the effects of “normal” hearing, sending the message that outward signs of deafness, such as the “confused face,” could easily disappear once being fitted properly with a hearing aid. (Hearing News, December 1936)

The 1920s publicity campaigns were primarily focused on fostering ties between otologists and the League, in cooperation with hospitals and schools. In 1927, the League purchased audiometers and offered invitations to conduct hearing tests in schools across New York, so children with hearing impairment could be assessed accordingly. Two years later, the League worked with Bell Laboratories to further substantiate the conviction that deafness was a serious problem amongst schoolchildren and that something needed to be done.

At the same time otologists across America established joint ventures between organizations like the America Medical Association and the American Otological Society. They formed committees to write reports to the White House on the national importance of addressing the “prevention of deafness.” Wendell C. Phillips (1857-1934), another president of the League and the founder of ASHH, particularly emphasized the need to address the “psychologic conditions and mental reactions” of the deafened patient, for the tragedy of acquired deafness meant it is a “disability without outward signs, for the deafened person uses no crutch, no black goggles, no tapping staff.”[3] It was an invisible handicap that needed to be made visible if it was to be prevented, if not cured.

References

[1] The Federation News, August 1935.

[2] Harold M. Hays, “Do Your Ears Hear?” Hygeia (April 1925).

[3] Wendell C. Phillips, “Reminiscences of an Otologist,” Hygeia (October 1930).

Presenting Grey Literature at the 13th International Conference on Urban Health

By Danielle Aloia, Special Projects Librarian, and Robin Naughton, Digital Systems Manager

Danielle Aloia, Special Projects Librarian, and Robin Naughton, Digital Systems Manager, presented Hidden Urban Health: Exploring the Possibilities of Grey Literature on the Academy’s Grey Literature Report (GreyLit Report) in two sessions at the recent International Conference on Urban Health in San Francisco, April 1-4, 2016. The conference focused on Place and Health and included a joint program with the American Association of Geographers. Combining data from geography with health data is one way to develop better models for urban and population health, and those involved in fields as diverse as urban planning, transportation, housing, and education all need to be at the table.

Themes of the ICUH 2016 opening ceremony. Photo by Danielle Aloia.

Themes of the ICUH 2016 opening ceremony. Photo by Danielle Aloia.

During the conference, two themes particularly relevant to the GreyLit Report emerged: the need for a better definition of urban health and the importance of interdisciplinary research. These are important concepts for the GreyLit Report when collecting and providing access to urban health resources, helping us to identify and understand topics that cross disciplines.

We had an opportunity to appeal to the cross-disciplinary audience of researchers during two conference sessions, providing a brief explanation of what grey literature is and ways to search for it beyond traditional databases. In brief, grey literature is produced by think tanks, university centers, government agencies, and other organizations. It can be published as reports, fact sheets, data sets, white papers, and more. It provides current research on trending topics and is used to communicate findings to stakeholders and policy-makers.

Robin Naughton and Danielle Aloia before the Hidden Urban Health: Exploring the Possibilities of Grey Literature session. Photo courtesy of ICUH.

Robin Naughton and Danielle Aloia before a Hidden Urban Health: Exploring the Possibilities of Grey Literature session. Photo courtesy of ICUH.

Some forms of grey literature can be found in traditional databases, such as PubMed or Web of Science, but the majority is not indexed or organized in systematic ways. To help solve this problem, the Academy Library developed the GreyLit Report in 1999 to collect these reports and make them accessible. During the presentations, we emphasized the importance the GreyLit Report places on interdisciplinary research. We collect reports related to public health in all sectors, to truly make a one-stop-shop for urban health.

During the presentation, participants learned about Google Custom Search (using Google to search specific websites and document types), Twitter, and the GreyLit Report as three resources relevant to finding grey literature. Still, depending on the resource used for search, altering keywords may be necessary to get relevant results. What terms one discipline uses may be defined differently in another. For example, the word mobility can have multiple meanings. In urban health, it usually means how people get from place to place, but when searching Google or Twitter one can get results for mobile technologies and physical disabilities. We clarified that the terms used in searching are very important to the relevance of the results. Often, searches in Google and Twitter need to be weeded through to find relevant results. We also presented some criteria for evaluating such results: authority, credibility, affiliation, purpose, and conflict of interest.

Danielle Aloia presenting at ICUH. Photo by Robin Naughton.

Danielle Aloia presenting at ICUH. Photo by Robin Naughton.

The GreyLit Report is much easier to search than Google or Twitter. Because we collect, archive, and index reports from all sectors, its focus limits irrelevant results. Users do not have to wade through millions of results, but have a credible, authoritative selection from which to choose.

At the end of each session, we opened up a conversation with participants to see what their concerns were in regard to grey literature and how the GreyLit Report may help them in their research. This produced an intimate, lively discussion. Participant concerns about grey literature included how to promote their own grey literature and ideas to enhance the Report. One idea is to add canned (one-click) searches on specific urban health topics.  Another idea is to add the United Nations’ 17 Sustainable Development Goals with links to reports in those areas so that users can easily find grey literature for specific sustainable development goals in urban health. We will work on enhancing the GreyLit Report website, and more importantly, we will think about ways to help promote this growing body of research for users.

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.

What a Boy Scout Merit Badge Tells Us About the History of Public Health

By Johanna Goldberg, Information Services Librarian

This month, the Boy Scouts of America celebrated its 106th birthday. To mark the occasion, we are featuring at a pamphlet from our collection, called simply Public Health.

In 1922, the Boy Scouts published the pamphlet as one of a series designed for scouts to study in order to receive merit badges. Though as the pamphlet states:

“It would defeat one of the purposes of these merit badge tests if any attempt were made in a pamphlet of this character to so completely cover the requirements as to remove the necessity for the boy to use his own initiative and show his resourcefulness in seeking sufficiently complete information and practical experience to enable him to successfully pass the test.”1

What was on the test? The cover explains:

The cover and inside cover of Public Health, 1922.

The cover and inside cover of Public Health, 1922. Click to enlarge.

We can’t resist a close up of the cartoon at the bottom of the cover, showing how boy scouts with knowledge of public health best practices chase away causes of disease, from bad sanitation and drainage to flies and mosquitoes to “general disorder and filth.”1

A close-up of the cartoon on the cover of Public Health, 1922.

A close-up of the cartoon on the cover of Public Health, 1922.

The Boy Scouts of America still offer a merit badge in public health. Interestingly, many of the requirements are strikingly similar to their 1922 counterparts. Today’s scouts must explain disease transmission (though diseases have changed from tuberculosis, typhoid, and malaria to E. coli, tetanus, AIDS, encephalitis, salmonellosis, and Lyme disease). Instead of drawing a house-fly and showing how it carries disease, boy scouts today have to discuss how to control insects and rodents to prevent them from introducing pathogens.2

The major difference between today’s test and that of 1922 is the addition of a question about immunization. Today’s scouts must define the term and discuss diseases that can and cannot be prevented through immunization. In 1920, 7,575 Americans died of measles, 13,170 died of diphtheria, and 5,099 died of pertussis.3 In 1922, the only vaccine recommended for universal use in children was smallpox. By the end of the 1920s, diphtheria, pertussis, and tetanus joined that list, followed by polio, measles, mumps, and rubella in the 1960s and 70s.3 Today, there are 15 vaccine-preventable childhood diseases.4

While many of the same public health issues have remained at the forefront since 1922, our means of responding to them have progressed. If there is still a test for a public health merit badge in another 94 years, one hopes that the questions will reflect even more advances in prevention and control of disease.

References

1. Public Health. Boy Scouts of America; 1922.

2. Public Health. Available at: http://www.scouting.org/Home/BoyScouts/AdvancementandAwards/MeritBadges/mb-PUBH.aspx. Accessed February 10, 2016.

3. Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children — United States, 1990-1998. MMWR Wkly. 1999;48(12):243–248. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00056803.htm#00003752.htm. Accessed February 10, 2016.

4. Vaccines: VPD-VAC/Childhood VPD. Available at: http://www.cdc.gov/vaccines/vpd-vac/child-vpd.htm. Accessed February 10, 2016.