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.

The Right to Health (Item of the Month)

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

Does one have a “right to health”? And if so, what does that right entail? Access to healthcare? Access to all healthcare? Equality of health outcomes?

The debate in this country over passage of the Affordable Care Act brought to the fore the differing assumptions over a “right to health.” Yet since at least 1946, members of the United Nations have asserted the right to health as a fundamental global human right. The constitution of the World Health Organization “enshrines the highest attainable standard of health as a fundamental right of every human being.”1 This right was further stated in the Universal Declaration of Human Rights of 1948—framed as the right to a standard of living “adequate for health and well-being.”2 The right to health remains a formative principle in global health. For example, three of the UN’s eight Millennium Development Goals are explicitly health related, and all have a health component.3

Though this right to health reached its full flower in the mid-20th century, it originated some 50 years earlier. In the late 19th century, urban and industrial ills had pushed their way onto the political agenda across the western world. Many reformers thought that supporting political rights was not enough: social and economic rights needed to be affirmed as well. One of these thinkers was the New York City-based urban researcher William Harvey Allen. In a series of books, and most notably Civics and Health (1909), Allen laid out the reasons why health was a human right.4

“Necessary to Efficient Democracy,” the way that experience in schools and other institution is brought to the public, in William Harvey Allen, Civics and Health, 1909), p. 310.

“Necessary to Efficient Democracy,” the way that experience in schools and other institutions is brought to the public, in Allen, Civics and Health, 1909, p. 310.

Allen made granting the right to health the apex of moral development, both in the individual and the society. He placed “rights” as the last and best of the seven motivations for public health action, starting with instinct and ranging through commerce to humanitarianism.5 Indeed, to promote health Allen said one could not rely on the love of money or the joy of human sympathy: “So long as those who suffer have no other protection than the self-interest or the benevolence of those better situated, disease and hardship inevitably persist.”6 By society’s affirming the right to health, it acknowledged that the citizenry’s well being had a claim on its attention and resources, and it made itself accountable to provide it. “Health administration is incomplete until its blessings are given to men, women, and children as rights that can be enforced through courts, as can the right to free speech, the freedom of the press, and trial by jury,” wrote Allen. The political rights claimed in the eighteenth century meant little if one did not have the physical means to exercise them in the twentieth. Those “permanently incapacitated . . . cannot appreciate the privilege of pursuing happiness.”7

According to Allen, it was not that people did not know what to do to secure public health—for the most part they did. It was rather that the means were often shunted aside, a problem of enforcement—and hence his argument for health as a right! Allen looked to find the most practical way to correct health deficiencies, and as co-director of the city’s newly established Bureau of Municipal Research, he looked upon all of New York as a test site.8 Here, he turned his attention to the health of school children, “the best index to community health.”9 Determining the status of children’s health was a comprehensive way of judging the health of the whole community, as children from all ranks of the community were available to reformers, and the mechanisms were already in place to examine and collect data. Allen saw children’s health as the indicator, not just to the health of the city, but to the right to health. Much of his book was devoted to measuring as well as intervening in children’s health, in such ways as enforcing milk purity laws, quarantines for communicable diseases, and vaccination for smallpox. He was concerned with controlling germs, paying attention to eye and ear health, and promoting school play and physical education. He saw the health of teachers as crucial to that of their charges. And, as detailed in our earlier blog post, he supported removal of tonsils and adenoids.

Sample record card for school physical examination, as found in Allen, Civics and Health, 1909, p. 34. As Allen noted: “Weight, height, and measurements are needed to tell the whole story.”

Sample record card for school physical examination, as found in Allen, Civics and Health, 1909, p. 34. As Allen noted: “Weight, height, and measurements are needed to tell the whole story.”

Yet, Allen did not think that the solution lay only in better school health. Society as a whole needed to address the health of its members throughout their lives. He suggested measures such as coordinating school health with other social agencies, requiring work physicals and promoting industrial hygiene, waging war on the “white plague” of tuberculosis, providing physicians with training not just in restorative medicine but also in preventive medicine, discouraging tobacco and alcohol use, and setting up institutions for large-scale information gathering and coordination through a national bureau of health.10

Many of Allen’s practical ideas today seem commonplace in the wake of the great shifts in public health that took place in the 20th century. But one thing stands out: seeing health as a right brought it out of the realm of enlightened self-interest and humanitarian relief. Health became social, health became enforceable, health became a right. That legacy, contested though it now is in American society, remains present today.

References

1. World Health Organization, Fact Sheet No. 323, “The Right to Health,” reviewed November 2013, http://www.who.int/mediacentre/factsheets/fs323/en/#, accessed September 23, 2015.

2. United Nations, “Universal Declaration of Human Rights,” Article 25, http://www.un.org/en/documents/udhr/, accessed September 23, 2015.

3. For the UN Millennium Development Goals, see http://www.un.org/millenniumgoals/, accessed September 23, 2015; for a summary of international conventions, see Mervyn Susser, “Health as a Human Right: An Epidemiologist’s Perspective on the Public Health,” American Journal of Public Health 1993 March; 83 (3): 418–26.

4. William Harvey Allen, Civics and Health, with an introduction by William T. Sedgwick (Boston, New York, Chicago, and London: Ginn and Company, 1909). For information on Allen (1874–1963), see in addition to the Recchiuti book below: “Reminiscences of William Harvey Allen: oral history, 1950,” Columbia Center for Oral History, http://oralhistoryportal.cul.columbia.edu/document.php?id=ldpd_4072329.

5. Allen, Civics and Health, pp 11–22. The seven motivations are Instinct, Display, Commerce, Anti-Nuisance, Anti-Slum, Pro-Slum [Abatement], and Rights.

6. Allen, Civics and Health, 20.

7. Allen, Civics and Health, 20.

8. For Allen and the Bureau of Municipal Research, see John Louis Recchiuti, Civic Engagement: Social Science and Progressive-Era Reform in New York City (Philadelphia: University of Pennsylvania Press, 2006), Chapter 4, pp. 98–124.

9. The phrase comes from the title of Chapter 4, “The Best Index to Community Health is the Physical Welfare of School Children,” page 33.

10. Allen, Civics and Health, Part III, “Coöperation in Meeting Health Obligations,” and Part IV, “Official Machinery for Enforcing Health Rights.” For an earlier attempt at a national bureau of health, see Jerrold M. Michael, “The National Board of Health: 1879–1883,” Public Health Reports 2011 Jan-Feb; 126(1): 123–29.

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.