Adenoids and American School Hygiene in the Early 20th Century

Kate Mazza, today’s guest blogger, received her doctorate in US history from the Graduate Center, CUNY. Her dissertation, “The Biological Engineers: Health Creation and Promotion in the United States, 1880-1920” examines the ideas and progress of the interrelated health reforms of physical education and school hygiene. She has published an article, “Distracted At School: Aprosexia, ADHD and Adenoids in American Culture” in the Journal of American Culture.

NYTimesHeadlines_AdenoidsAs the school year came to a close in June 1906, a panic swept through New York’s Lower East Side. According to newspaper reports, hundreds of parents, mostly Eastern European immigrants, ran to about a dozen local schools believing that their children were going to be harmed or murdered by doctors. Some people broke windows, some hit school workers, many yelled and cried and all demanded to see their children. At each school, children were eventually dismissed early, and, to the great relief of the frightened parents, were unharmed. A similar course of events took place in Brownsville, Brooklyn the next day.1 These events came to be known as the “adenoid riots” because they occurred a week after students had undergone surgeries, apparently without incident, to remove enlarged adenoids at Public School 110 in the Lower East Side.

What caused the riots? Most accounts of the time blamed the immigrant population, stating that they were subject to panics, suspicious and ignorant of modern medical practice, and incensed and saddened by recent news of the Bialystok pogroms. Reporters also commented that local doctors intentionally spread rumors that children were being harmed because they saw free school and city services as a threat to their business.

Modern scholars, sympathetic to the immigrant’s perspective, have analyzed the events as a reaction against coercive means of assimilation.2 Yet while “Americanization” certainly played a role in this health initiative, school medical inspection affected children of all classes and ethnic groups in the United States and abroad. The confusion, fear, and misunderstanding of the adenoid riots was caused, in part, by erroneous beliefs about the implications of enlarged adenoids (masses in the back of the nasal cavity that can help fight infection), the methods used in NYC, and the zealousness of the hygienists to find and root out adenoids.

In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), page 4.

“Mouth breathing means adenoids; adenoids mean deadened intellects.” In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 4.

In 1887, Amsterdam physician A.A. Guye connected enlarged adenoids to aprosexia, or the inability to pay attention, along with poor memory and headaches.3 This idea laid the foundation for associating adenoids with academic failure, disobedience, and truancy. Over the years, physicians also linked enlarged adenoids to deafness, poor voices, trouble sleeping, colds, weight loss, restlessness, chest and mouth deformity, mouth breathing, ear disease, and even tuberculosis.4

By the early 1900s, many involved in the growing school hygiene movement in the United States were convinced that enlarged adenoids were a common impediment to learning. In 1905 New York City became one of the first cities to inspect students for enlarged adenoids along with ear, nose, and throat problems. This more thorough physical examination was added to examinations for contagious diseases that had taken place since the 1890s in a number of cities.

"Mouth breathers before adenoid party." In Allen, Civics and Health, 1909, p. 55.

“Mouth breathers before ‘adenoid party.'” In Allen, Civics and health, 1909, p. 55.

Chief Medical Inspector of the New York City Department of Health, Dr. John C. Cronin, spearheaded the expanded medical inspection. He claimed that at PS 110, 137 children out of 150 in a specialized class of so-called “backward,” “incorrigible,” and “truant” children had enlarged adenoids.5 As the end of the school year approached, 56 children had had them removed, with 81 remaining. Cronin arranged to have the students convalesce in the countryside with the Society of Improving the Condition of the Poor at the end of the school year. Yet Cronin also wrote later that “it was then thought justifiable to get information as to what scholastic results would be obtained if these children were operated on collectively.”6 Seemingly frustrated, he brought in three doctors from Mount Sinai hospital to perform the operations at the school, after obtaining permission slips from parents. Cronin stated that doctors performed operations on 81 children in 84 minutes.7 While it was typical to do these surgeries quickly and without anesthesia or after care, these operations were done at an exceedingly rapid pace. From various accounts, children left the schools bleeding profusely. The riots occurred a week later.

"Mouth breathers immediately after 'adenoid party.'" In Allen, Civics and Health, 1909, p. 46.

“Mouth breathers immediately after ‘adenoid party.'” In Allen, Civics and health, 1909, p. 46.

Despite the rioting, Cronin publicized the efforts at PS 110 as an outright success. He held that all but four of the students had significant mental and physical improvement. He wrote: “From dullards, many of them have become the brightest among their fellows, after the operation.”8 A New Jersey doctor commented that removal of adenoids “has been followed by such wonderful improvement of the body and mind as to make recital sound like romance. The story of public school No. 110 in New York City, is almost beyond belief except to those who are familiar to it.”9 Medical and educational journals were filled with accounts of transformation through adenoid surgeries, many referencing PS 110.

As they preached their belief in transformation through surgery, these doctors and hygienists continually bolstered the idea that presence of enlarged adenoids caused poor scholarship and deviance. This association is clear when looking at hygiene statistics. When medical inspections took place in Northeastern urban centers, adenoids were found in roughly 30% of students. However, when the students were in a reformatory or a specialized class, like the students at PS 110, numbers climbed to 90%.

"Throat inspection in the Orange, N. J. schools." In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 148.

“Throat inspection in the Orange, N. J. schools.” In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 148.

Even while the “adenoid craze” was in full swing, many parents did not abide by the prescriptions of medical inspectors to have their children undergo various treatments and adenoidectomy. When “defects” were found in school medical examinations, the rate of compliance was usually less than a third, as inspectors in various cities including Cleveland, Chicago, and Bridgeport, Connecticut remarked in the 1900s and 1910s.10

During the 1910s, the faith that experts had in the radical transformation of students through adenoidectomy began to wane. Walter Cornell, a leading advocate of the surgeries, found that his study group did not succeed academically after the surgeries as was expected, and wrote in 1912 that this case “certainly explodes the theory that the removal of adenoids is the panacea for all juvenile delinquencies.”11 Others began to see similar results.

"Typical adenoid faces showing mouth breathing, flattened noses, and protruding eyes." In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 170.

“Typical adenoid faces showing mouth breathing, flattened noses, and protruding eyes.” In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 170.

Medical inspection, particularly in New York City, came under fire, as many complained that examinations were too superficial and inaccurate and that enlarged adenoids were overdiagnosed. In one investigation, for example, the same group of children was examined by two different inspectors. The first inspector found that 70 students needed adenoidectomy, the second found that 96 did, with only 49 students in common.12

For school and city authorities, adenoid surgeries were an appealing, cheap, convenient way to reform education by changing the child, rather than overhauling the educational system. It is not surprising that they were overdiagnosed or misdiagnosed. While the adenoid riots took place at the beginning of the “adenoid craze,” they illustrate a general suspicion of these new hygiene practices and of the school’s new role in public health.

References

1. “East Side Parents Storm the Schools,” New York Times, 28 June 1906, pg. 4; “Throat-Cutting Rumors Revive School Rioting,” New York Times, 29 June 1906, pg.9.

2. For an interesting view of the adenoid riots, see Alan Kraut, Silent Travelers: Germs, Genes and the Immigrant Menace (Baltimore: Johns Hopkins University Press, 1994).

3. A.A. Guye, “On Aprosexia, Being the Inability to Fix the Attention and other Allied Alterations of the Cerebral Functions caused by Nasal Disorders,” Journal of Laryngology and Rhinology 3 no.11 (December, 1889):499-506.

4. For example, see Macleod Yearsley, Adenoids (London: The Medical Times, 1901); 39-74; W.E. Casselberry, “Facial and Thoraic Deformities Incident to Obstruction by Adenoid Hypertrophy in the Naso-Pharynx,” Journal of the American Medical Association 15 no. 12(September 20, 1890): 417-420; W.L. Grant, “Some Common Conditions of the Nose and Naso-Pharynx Demanding Operative Interference,” Philadelphia Medical Journal 2 no.16(October 15, 1898):798-799; Allen T. Haight, “Naso-Pharyngeal Adenoids as a Causative Factor in Ear Diseases,” Journal of the American Medical Association 33 no. 26 (December 23, 1899): 1577-1578.

5. John J. Cronin, “The Physical Defects of School Children,” The Journal of the New York Institute of Stomatology 2 no. 4(December, 1907):280.

6. Ibid., 280.

7. “Medical Attention in Public Schools,” American Gymnasia and Athletic Record 3 no. 6(February, 1907):125.

8. John J. Cronin, “The Doctor in the Public School” The American Monthly Review of Reviews 35 no. 4 (April, 1907): 438.

9. F.C. Jackson, “The Medical Supervision of Schools” The New Jersey Review of Charities and Corrections 7 no. 3 (March, 1908): 84.

10. Luther Gulick and Leonard Ayres, Medical Inspection of Schools (New York: Russell Sage, 1909, ed.), 102; Florence A. Sherman, “Medical Inspection in Bridgeport (Conn.) Public Schools,” Fourth International Congress on School Hygiene 4(August, 1913):394; Mrs. Edward W. Hooke, “To Save All Babies,” The American Club Woman 10 no. 6(December, 1915):117.

11. Walter Cornell, Health and Medical Inspection of School Children (Philadelphia: F.A. Davis Company, 1912), 278.

12. A Bureau of Child Hygiene: Co-operative Studies and Experiments by the Department of Health of the City of New York and the Bureau of Municipal Research (Bureau of Municipal Research, 261 Broadway: September, 1908): 13.

Presentations Announced for the Fifth Annual History of Medicine Night: Insights from the Early Modern Period

The New York Academy of Medicine’s Section on History of Medicine will hold the “Fifth Annual History of Medicine Night: Insights from the Early Modern Period” on March 11 from 6:00 pm–7:30 pm at NYAM, 1216 Fifth Avenue at the corner of 103rd Street. Register to attend here.
RBR shelfPresenters will address historical topics relating to medicine with a focus on the Early Modern period.  This year’s presenters are:

Barbara Chubak, MD
Urology Resident (PGY-5), Montefiore Medical Center
“Imagining Sex Change in Early Modern Europe”

Jeffrey M. Levine, MD
Assistant Clinical Professor of Medicine and Palliative Care
Icahn School of Medicine at Mount Sinai
“A Fresh Look at the Historiated Initials in the De Humani Corporis Fabrica”

John E. Jacoby, MD, MPH
Assistant Clinical Professor of Medicine and Pediatrics
Icahn School of Medicine at Mount Sinai
“On the Life of Dr. Robert Levett: The Philosophy of Primary Care”

Nina Samuel, PhD
Center for Literary and Cultural Research
University of Berlin
“The Art of Hand Surgery”

Michelle Laughran, PhD
Associate Professor of History
Saint Joseph’s College of Maine
“The Medical Renaissance among Three Plagues: Epidemic Disease, Heresy and Calumny in Sixteenth-Century Venice”

Sharon Packer, MD
Assistant Clinical Professor of Psychiatry and Behavioral Sciences
Icahn School of Medicine at Mount Sinai
“Epidemic Ergotism, Medieval Mysticism & Future Trends in Palliative Care”

Part two of this lecture series, “History of Medicine Night: 19th– and 20th-Century Stories,” will take place on May 6, 2015.

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 Doorstep of America

By Johanna Goldberg, Information Services Librarian

Ellis Island opened on January 1, 1892, a gateway to the United States for 700 immigrants on three steamships that first day.1 By its close in 1924, more than 12 million people had passed through to America.2

Landing at Ellis Island. From Quarantine Sketches. Click to enlarge.

Landing at Ellis Island. From “Quarantine Sketches.” Click to enlarge.

About 10 years after Ellis Island’s opening, The Maltine Company, a patent medicine manufacturer, released “Quarantine Sketches: Glimpses of America’s Threshold,” a pamphlet oddly juxtaposing photographs of Ellis Island with advertising for its products. The full pamphlet can be viewed online:

It begins with the text:

Hundreds of thousands—men, women, and children—pass over, or are detained at, the Doorstep of America every year. In this pamphlet are illustrated the various precautions which the Government takes to insure desirable material for future citizenship.

One such precaution described in the pamphlet was the two-day quarantine of all passengers arriving from Cuba between May 15 and October 1, an effort to prevent the spread of yellow fever in the United States. But for all other steerage passengers, the procedure was different.

The hospital at Ellis Island. From "Quarantine Sketches." Click to enlarge.

The hospital at Ellis Island. From “Quarantine Sketches.” Click to enlarge.

During the “Line Inspection,” United States Public Health Service physicians reviewed each entrant as he or she walked past. According to a 1917 article, the process typically took two to three hours.3 Those who passed the initial review continued on to the Immigration Service, “who take every means to see that he is not an anarchist, bigamist, pauper, criminal, or otherwise unfit.”3 Those who did not pass the inspection, about 15–20% of immigrants in 1917, were routed to the Public Health Service.3

From Mullan EH. "Mental examination of immigrants: Administration and Line Inspection at Ellis Island." Public Health Reports. 1917; 32(20): 734.

From Mullan EH. “Mental examination of immigrants: Administration and Line Inspection at Ellis Island.” Public Health Reports. 1917; 32(20): 734. Click to enlarge.

There, physicians assessed immigrants for “speech, pupil symptoms, goiters, palsies, atrophies, scars, skin lesions, gaits, and other physical signs,” along with “signs and symptoms of mental disease.”3 Some got sent to Ellis Island’s hospital (one of the best in the country), some to a detention room for further assessment.4

Filing past the doctors. From "Quarantine Sketches." Click to enlarge.

Filing past the doctors. From “Quarantine Sketches.” Click to enlarge.

Would-be immigrants could be deported for medical reasons—in 1898, 18% of deportations were medical; this rose to 69% in 1916.4 Even so, most immigrants entered the United States: in 1914, the peak year for deportations, only 2.5% of passengers were forced to return to their country of origin.4

Detention pen for immigrants awaiting deportation. From "Quarantine Sketches." Click to enlarge.

Detention pen for immigrants awaiting deportation. From “Quarantine Sketches.” Click to enlarge.

Today, you can visit Ellis Island without going through a Line Inspection. You can even book a Hard Hat Tour to see the previously closed-to-the-public hospital complex. Can’t make the trip? Take a look at Hyperallergic’s recent Ellis Island hospital portraits.

References

1. Landed on Ellis Island – new immigration buildings opened yesterday. A rosy-cheeked Irish girl the first registered — Room enough for all arrivals — Only railroad people find fault. New York Times. http://query.nytimes.com/mem/archive-free/pdf?res=9802E3D8163BEE33A25751C0A9679C94639ED7CF. Published January 2, 1892. Accessed November 19, 2014.

2. National Parks of New York Harbor Conservancy. Ellis Island. Available at: http://www.nyharborparks.org/visit/elis-faq.html. Accessed November 24, 2014.

3. Mullan EH. Mental examination of immigrants: Administration and Line Inspection at Ellis Island. Public Health Reports. 1917;32(20):733–746. doi:10.2307/4574515. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1999723/. Accessed November 21, 2014.

4. Yew E. Medical inspection of immigrants at Ellis Island, 1891-1924. Bull N Y Acad Med. 1980;56(5):488–510. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1805119&tool=pmcentrez&rendertype=abstract. Accessed November 21, 2014.

The Cure for Panic: Ebola in Historical Perspective

This post is part of an exchange between “Books, Health, and History” at the New York Academy of Medicine and The Public’s Health, a blog of the Philadelphia Inquirer.

By David Barnes, Associate Professor of History and Sociology of Science at the University of Pennsylvania

The illness itself is scary: first the sudden aches, then the spikes of fever and chills, before the massive internal bleeding and copious vomiting and diarrhea. Death comes amid delirium and hemorrhaging from the nose, mouth, and other mucous membranes. A handful of isolated cases in the United States have been enough to spark a nationwide frenzy of fear and recrimination. Imagine what would happen if the nation’s capital lost a tenth of its population to the disease in the space of two months, and another half to panicked flight.  And imagine if it happened again in the same city a few years later, then again, and again—four times in seven years.

The time was the 1790s, and the place was Philadelphia Vice President Thomas Jefferson even called for the city to be abandoned. The disease wasn’t Ebola, but yellow fever, another of the viral hemorrhagic fevers that wreak such terrifying havoc on the body’s internal organs. Yellow fever was also known colloquially by its most distinctive symptom: “black vomit,” which occurred when large quantities of blood accumulated in the stomach. Its ravages in Philadelphia and other seaport cities in the nation’s formative years constituted a serious national crisis.

The public discourse surrounding the ongoing Ebola epidemic has been singularly unedifying. In the United States, news media outlets have eagerly stoked groundless fears, which public officials have rushed to appease with policy responses that will do nothing to stop the disease’s spread. Meanwhile, help has been slow to arrive where it is desperately needed, in Guinea, Sierra Leone, and Liberia. Rural health centers there turn away patients for lack of staff and equipment, while well-funded American hospitals prepare for an influx of patients that may never come.

>>Read the full post at The Public’s Health.

“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.

 

School Breakfast Week: “Take Time for School Breakfast”

By Danielle Aloia, Special Projects Librarian

Starting the day with a hearty, healthy breakfast allows your body to maintain the physical and mental agility needed to function without fatigue during the course of the day. Today, the Food Research and Action Center recognizes that “school breakfast participation is linked with increased food security, improved health outcomes, and numerous educational benefits, particularly for low-income children.”1

In 1790, Germany began the first school feeding program on record. In the early 1900s, the U.K. and several other European countries passed bills to enact school lunch programs. The following table shows the nutrition requirements for school children in Switzerland, Germany, and England circa 1900:2

Recommended nutritional requirements.2 Click to enlarge.

Recommended nutritional requirements.2 Click to enlarge.

The U.S. was late to follow, not passing legislation for a school lunch program until the 1940s. However, U.S. researchers had previously looked at the nutrition status of school aged children. In 1906, a Dr. Lechstecker in New York City examined 10,707 children and found that 439 had no breakfast and 998 had just coffee or coffee and bread. In 1908, of 10,090 children studied in Chicago, 825 suffered from malnutrition.2

In the 1940s, West Virginia surveyed students from various cities about their eating habits. They found that poor breakfasts were the biggest problem. By 1947 the state established the Good Breakfast for Every Man, Woman, and Child program with the slogan “Start the Day the Good Breakfast Way.”3

Some of the findings reported by West Virginia School Children’s Diet Study.3 Click to enlarge.

Some of the findings reported by West Virginia State Nutrition Committee.3 Click to enlarge.

In 1966, the Child Nutrition Act enacted The School Breakfast Program (SBP) as a pilot project. “During the first year of operation, the SBP served about 80,000 children at a federal cost of $573,000.”4 In fiscal year 2007, “the participating schools served . . . 1.7 billion breakfasts at a federal cost of $2.2 billion.”5 Current research shows that “10.8 million low-income children participated in the School Breakfast Program on an average day in school year 2012-2013, an increase of more than 310,000 children from the previous year.”6 And “for Fiscal Year 2012, the School Breakfast Program cost $3.3 billion, up from $1.9 billion in Fiscal Year 2005.”1

Today’s programs must meet the U.S. Dietary Guidelines for Americans, 2010, which provide evidence-based nutrition standards. The government will implement new guidelines in 2015 under the Federal Rule Nutrition Standards in the National School Lunch and School Breakfast Program. “This rule requires most schools to increase the availability of fruits, vegetables, whole grains, and fat- free and low-fat fluid milk in school meals; reduce the levels of sodium, saturated fat and trans-fat in meals; and meet the nutrition needs of school children within their calorie requirements.”7

ChooseMyPlateChoose MyPlate is an easy way for people to adhere to the dietary guidelines set out by the U.S. Dept. of Health and Human Services and the Dept. of Agriculture.

Breakfast is not just for school children. Remember to take time for breakfast no matter your age.

References

1. Hewins J, Burke, Mike. School Breakfast Scorecard: 2012-2013 School Year. Washington, DC: Food Research and Action Center (FRAC); 2014. http://frac.org/pdf/School_Breakfast_Scorecard_SY_2012_2013.pdf. Accessed January 31, 2014.

2. Bryant, Louise Stevens. School Feeding; Its History and Practice at Home and Abroad. Philadelphia: J. B. Lippincott Company; 1913. Access at: https://ia700505.us.archive.org/3/items/schoolfeedingits01brya/schoolfeedingits01brya.pdf

3. State of West Virginia. Start the Day the Good Breakfast Way: A Statewide Nutrition Program Sponsored by The West Virginia State Nutrition Committee September 1947-August 1948. State of West Virginia; 1948.

4. USDA Food and Nutrition Service website. http://www.fns.usda.gov/sbp/school-breakfast-program. Accessed February 10, 2014.

5. National Research Council. School Meals: Building Blocks for Healthy Children. Washington, DC: The National Academies Press; 2010. http://www.nap.edu/openbook.php?record_id=12751&page=1. Accessed on: January 31, 2014.

6. The School Breakfast Program:  Fact Sheet. Washington, DC:  USDA Food and Nutrition Service; http://www.fns.usda.gov/sites/default/files/SBPfactsheet.pdf. Accessed February 11, 2014.

7. Nutrition Standards in the National School Lunch and School Breakfast Programs. Fed Regist. 2012;77(17):4088-4167. To be codified at 7 CFR §210 and 220. http://www.gpo.gov/fdsys/pkg/FR-2012-01-26/pdf/2012-1010.pdf. Accessed on: January 31, 2014.

History Night Presentations Announced

The New York Academy of Medicine’s Section on History of Medicine will hold the “Fourth Annual History of Medicine Night – Part One: Spotlight on New York” on February 6 from 6:00 pm–7:30 pm at NYAM, 1216 Fifth Avenue at the corner of 103rd Street. Register to attend here. A second evening of presentations is being planned for spring.

RBR deskThe night will feature the following presentations, as described by the speakers:

“Psychiatric Criminology in the Eugenic Era: The New York Police Psychopathic Laboratory, 1915-1929”
Sara Bergstresser, M.P.H., Ph.D., Columbia University, Bioethics

“First, I explore the historical background of North American and European psychiatry, criminology, and eugenics in the nineteenth century, including threads of early convergence. Next, I examine the development of eugenic psychiatry and its intersections with eugenic criminology, with a particular emphasis on New York State in the early twentieth century. I then present a case study from that time period, which is based primarily on materials from the archives of the New York Police Psychopathic Laboratory. I go on to argue that in this case the workings of psychiatric criminology were more eclectic and uncertain than they may otherwise appear based on broad descriptions of the eugenic era.”

“Not for Self but Others: The Presbyterian Hospital Goes to War”
Pascal J. de Caprariis, M.D., Lutheran Medical Center

“On March 11, 1940 the U.S. Surgeon General reached out to Presbyterian Hospital’s medical board president to develop a military hospital to support US troops in an eventual war. Structured to receive patients from combat areas and follow American troops throughout war, it was to provide complex medical and surgical care over the course of three years and two months abroad.”

“The Cancer Education Campaigns in Progressive Era New York City: The Role of Women”
Elaine Schattner, M.A., M.D., F.A.C.P., Weill Cornell Medical College

“At the start of the 20th century, myths about cancer’s causes and treatments were widespread. Fear of the disease—and of inept surgeons—was rampant. Many afflicted fell prey to hoaxers selling bogus salves, patent medicines and painless “cures.” In April 1913, a prominent New York City surgeon and gynecologist, Dr. Clement Cleveland, invited a group of well-to-do ladies, bankers and physicians to his home. They heard from statisticians and public health specialists, and considered what might be done to reduce cancer’s mounting toll. The group met formally again in June 1913 at the Harvard Club in New York City. They formed the American Society for the Control of Cancer (ASCC), which three decades later became the American Cancer Society.”

“A Diagnosis of Philanthropy: Carnegie and Rockefeller and the Medical Profession”
Catherine (Katia) Sokoloff, Sarah Lawrence College

“Through exploring the evolving interests of Andrew Carnegie and John D. Rockefeller during the Progressive Era, this paper unearths how these philanthropists and their advisers facilitated and funded the writing of the infamous Flexner Report in 1910. The report, also called Bulletin Number Four, exposed the inadequacies of medical schools and catalyzed dramatic education reforms.”

“Organizing Orthopaedic Societies in New York City in the 1880s: The New York Orthopaedic Society, the New York Academy of Medicine Section of Orthopaedic Surgery and the American Orthopaedic Association”
Jonathan B. Ticker, M.D., College of Physicians and Surgeons, Columbia University

“After the seventh general meeting of the New York Orthopaedic Society (NYOS) on January 4, 1886, steps were taken to merge NYOS into a section of the New York Academy of Medicine (NYAM). Thus, on January 29, 1886, NYOS adjourned and the NYAM Section of Orthopaedic Surgery began. On January 29th, 1887, the chairman of the Section and 15 others “[met] and [discussed] the organization of a national orthopaedic society.” This led to the founding of the American Orthopaedic Association (AOA).”

Huber the Tuber, Corky the Killer, and The Mind

By Danielle Aloia, Special Projects Librarian

Harry A. Wilmer (1916-2005) was a well-known psychiatrist, writer, Jungian analyst, and founder of the Institute for the Humanities at Salado (you can learn more about his achievements at the Salado Institute website). Among his publications—most written or edited with professional psychiatrists in mind—are three health information books for children: The Lives and Loves of Huber the Tuber, Corky the Killer: A Story of Syphilis, and The Mind: First Steps.

In Huber the Tuber, Wilmer gives life to the tiny tubercle bacillus, Huber, and his friends as they embark on the invasion of Lungland. A 1943 book review by Sally Lucas Jean describes the book as “A riotously gay tale of a tuberculosis bacillus and his friends. The entire gang is so personalized as to become real creatures battling against Monosights.”1 The Monosights are the good guys in the story, trying to subdue the tubercle from invading their land (in biology, monocytes are white blood cells that react to infections).

Huber the Tuber invades Lungland. Click to Enlarge.

Huber the Tuber invades Lungland. Click to Enlarge.

In Corky the Killer, “an articulate microbe of the Treponema pallidum tribe describes what goes on from the start of a syphilitic infection and what may happen if proper treatment is not given.”2 Corky and friends invade the body using the Whirling Dervish Dance of the Spirochetes (a type of bacteria) to spiral through the skin and invade the blood.

The Whirling Dervish Dance of the Spirochetes. Click to Enlarge.

The Whirling Dervish Dance of the Spirochetes. Click to Enlarge.

These two books are great examples of how public health concerns can be brought to public attention in new and dramatic ways in order to curb the spread of disease. Hidden Treasure: The National Library of Medicine devotes a chapter to them, describing them as having “a bit of magic in them: the health message is subordinated to the sheer joy of visual storytelling.”3 This joyful storytelling can be seen in a YouTube video of a young girl reading Huber the Tuber.

"The Author's Imaginative Model of the Inside World of the Mind." Click to enlarge.

“The Author’s Imaginative Model of the Inside World of the Mind.” Click to enlarge.

In The Mind, Wilmer describes perception, emotion, action, and all the functions of the mind in between through the example of a fire engine. When you see a fire engine you perceive a red moving object. Then you classify that image as a warning signal. Anxiety begins to rise and you prepare for fight or flight. Your conscious mind and your conscience work together with your unconscious mind to determine your thought process. Because you have experience with what a fire engine means you know there may be a fire happening somewhere and you determine how it may affect you. A 1965 book review says “All in all, a charming book with unusual ideas.”4

These books remain excellent examples of how an author can present seemingly dense scientific information through illustrations and comic relief.


1. Jean, Sally Lucas. 1943. Book Review. Am J Public Health Nations Health 33(4): 445–446.

2. Doppler, William. 1946. Book Review. Am J Public Health Nations Health 36(9): 1068–1069.

3. Sappol, Michael. 2012. Hidden Treasure: The National Library of Medicine. New York: Blast Books.

4. Book Review. 1965. The American Biology Teacher. 27(2): 565.

Smoking and Health, 50 Years Later

By Johanna Goldberg, Information Services Librarian

On Saturday, January 11, 1964, fifty years ago this past Saturday, the U.S. Surgeon General released a report that took the country by storm: Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service.

While surgeons general had made statements regarding cigarette dangers as early as the 1920s,1 this report marked the beginning of the Office of the Surgeon General’s practice of releasing “authoritative scientific statements,”2 which continues to this day. It also marked the first time a surgeon general report received enormous media attention.1

"Percentage of persons who have never smoked by sex and age, United States, 1955." A chart from Smoking and Health. Click to enlarge.

“Percentage of persons who have never smoked by sex and age, United States, 1955.” A chart from Smoking and Health. Click to enlarge.

To produce Smoking and Health, Surgeon General Dr. Luther L. Terry assembled a committee of 10 doctors from a variety of disciplines, none of whom who had previously spoken publicly about tobacco use, to review more than 7,000 publications, including articles, reports, statements from tobacco companies, and conference proceedings. The committee did not carry out original research, instead performing a thorough review of the literature, completed in just over two years.3

"Trends in Age-Adjusted Mortality Rates for Cancer by Sex." A chart from Smoking and Health. Click to enlarge

“Trends in Age-Adjusted Mortality Rates for Cancer by Sex.” A chart from Smoking and Health. Click to enlarge

The 387-page report made some dire conclusions:

  • Smokers are 70% more likely than non-smokers to die of coronary artery disease; 500% more likely than non-smokers to die of emphysema and chronic bronchitis; and 1,000% more likely to die of lung cancer.
  • Male cigarette smokers have a “9- 10-fold risk of developing lung cancer.” That risk rises to 20-fold for heavy smokers.
  • Cigarette smokers have a 70% higher mortality rate than non-smokers.3

On Sunday, January 12, newspaper front pages and other media sources  around the country featured the report.4 The New York Times alone published 10 articles mentioning the report that day,5 with one on reporters and government employees (including the surgeon general’s assistant for information) smoking in front of the nine no-smoking signs outside the news conference auditorium.6

The report had an immediate impact. In New York, the cigarette tax revenue was 5% lower in January 1964 than the previous year, and 18% lower in February. Cigarette consumption dropped 3.5% nationwide; while it rose in coming years, it never again reached its 1963 peak. One week after the report’s debut, the Federal Trade Commission (FTC) released plans to require health warnings in cigarette advertisements and packaging. In place of the FTC’s plans, Congress passed the Cigarette Labeling and Advertising Act of 1965, followed by additional labeling laws.7

"Mortality from Cancer (All Sites), U.S. Death Registration Area of 1900, 1900-1960," a chart from Smoking and Health.

“Mortality from Cancer (All Sites), U.S. Death Registration Area of 1900, 1900-1960,” a chart from Smoking and Health.

How far have we come? In 2011 (the most recent year available from the CDC),  about 19% of adults in America smoked, compared to the approximately 40.3% in 1964.8,9 Looking for information on how to quit smoking and reduce this percentage further? Visit smokefree.gov.

References

1.The Reports of the Surgeon General: Brief history. (n.d.). Retrieved January 7, 2014, from http://profiles.nlm.nih.gov/ps/retrieve/Narrative/NN/p-nid/58.

2. The Reports of the Surgeon General: Changing conceptions of public health. (n.d.). Retrieved January 7, 2014, from http://profiles.nlm.nih.gov/ps/retrieve/Narrative/NN/p-nid/59.

3. United States Surgeon General’s Advisory Committee on Smoking and Health. (1964). Smoking and health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington, D.C.: U.S. Department of Health, Education, and Welfare. Public Health Service. Accessible in full online at http://profiles.nlm.nih.gov/NN/B/B/M/Q/.

4. Housman, M. (2001). Smoking and health: The 1964 U.S. Surgeon General’s Report as a turning point in the anti-smoking movement. Health Policy Review, 2(1). Retrieved from http://www.hcs.harvard.edu/~epihc/currentissue/spring2001/housman.html.

5. NYTimes.com search. (n.d.). Retrieved January 7, 2014, from http://query.nytimes.com/search/sitesearch/#/surgeon+general/from19640112to19640112/.

6. Hunter, M. (1964, January 12). Smoking banned at news parley. But some reporters puff sheepishly in corridors. New York Times. Retrieved from http://legacy.library.ucsf.edu/tid/zbg90c00/pdf.

7. Sullum, J. (1998). For your own good: The anti-smoking crusade and the tyranny of public health. New York: Free Press.

8. CDC’s Office on Smoking and Health. (2013, June 5). Smoking and tobacco use fact sheet: Adult cigarette smoking in the United States. Retrieved January 7, 2014, from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/.

9. United States Public Health Service Office of the Assistant Secretary for Health Office on Smoking and Health, & United States Public Health Service Office of the Surgeon General. (1979). Smoking and health: A report of the Surgeon General. Appendix: Cigarette smoking in the United States, 1950-1978 (pages A-1 through A-29) (Official reports). Retrieved from http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBCPH.