Tag Archives: typhoid

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

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by guest contributor Jacob Steere-Williams, PhD, Associate Professor of History, College of Charleston.

Join us for Steere-Williams’ talk on typhoid on September 23. 

For decades, thinking about and learning from past pandemics has largely been an academic exercise, one for historians and archivists who specialize in public health. Now, in the midst of a generation-defining pandemic, COVID-19, there has been an explosion of public interest in epidemics and epidemiology. Before 2020, few Americans outside of infectious disease specialists routinely spoke the words “contact tracing” and “case fatality,” or knew the difference between isolation and quarantine.

The recent surge in popular understandings of epidemics has centered on some familiar examples, such as the 1918–1919 influenza pandemic, the mistakenly called “Spanish Flu.”[1] As this was the most significant pandemic of the 20th century, the comparisons make sense, and the public health struggle between individual rights and community health is as apt now as it was then. Other historians, seeing the rise of xenophobia as a cultural response to COVID-19 in the West, have perceptively turned our attention to 19th-century pandemics of cholera and bubonic plague. Then, as now, a uniquely durable, yet startlingly western approach to framing pandemics has been to blame Asian people and Asian cultural practices.[2] 

At a time when the cultural mileage of past pandemics is perhaps at its height in modern history, we might fruitfully turn to the history of a relatively unexplored disease, typhoid fever, to think about our current moment.

Typhoid fever is a food- and water-borne infectious disease, the most virulent of the Salmonella family. The disease continues to wreak havoc on the Global South, killing about 200,000 people each year. In the western world typhoid was at its height in the 19th century, when it was a ubiquitous and insidious reality in North America and Western Europe. In Britain, for example, typhoid annually struck up to 150,000 people, taking the lives of 20,000 each year.

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

Typhoid’s patterns of distribution were erratic; it might spare a community for months or even years, then erupt as a local outbreak. Epidemiologists today discuss COVID-19 as a cluster disease, exploding in localized events not unlike the way that typhoid did in the past.

Interestingly, typhoid outbreaks continued after the introduction of early sanitary improvements such as toilets, pumped water, and sanitation systems. In the second half of the 19th century no infectious disease was as central to the rise of public health than typhoid. Typhoid was a model disease because the burgeoning group of public health scientists, the first to call themselves epidemiologists, saw that stopping typhoid’s different pathways—through food, water, and healthy human carriers—could transform the nation through preventive public health.[3]

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

The story of typhoid in the 19th century is one deeply tied to the emergence of modern epidemiology, which George Buchanan, Chief Medical Officer of Britain’s central public health office, called “the minute observations of particular outbreaks.”[4] Epidemiological practice does not operate in a vacuum, then or now with COVID-19; it is inherently a political exercise. Everyday people, business owners, and politicians have to be convinced about the science of disease communication, requiring complex rhetorical strategies that tell us a great deal about the inherent struggles of public health.

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

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Notes

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

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

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

[4] George Buchanan, “On the Dry Earth System of Dealing with Excrement,” Annual Report of the Medical Officer of the Privy Council for 1870. Parliamentary Papers. London: Eyre and Spottiswoode, 1871, 97.

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

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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.