20. The legal aspects of the story are described in detail in chap. 3.
21. The classic epidemic during which the city officials fled is the yellow fever epidemic that struck Philadelphia in 1793. See John Powell, Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793 (Philadelphia: University of Pennsylvania Press, 1949); and Martin S. Pernick, “Politics, Parties, and Pestilence: Epidemic Yellow Fever in Philadelphia and the Rise of the First Party System,” William and Mary Quarterly 29 (1972): 559–86.
22. Nineteenth-century public health work can be followed best through local studies. See, for example, John Duffy, A History of Public Health in New York City, 1625–1866 (New York: Russell Sage Foundation, 1968); John Duffy, A History of Public Health in New York City, 1866–1966 (New York: Russell Sage Foundation, 1974); Judith Walzer Leavitt, The Healthiest City: Milwaukee and the Politics of Health Reform (Princeton: Princeton University Press, 1982); Stuart Galishoff, Newark, the Nations Unhealthiest City, 1832–1895 (New Brunswick, N.J.: Rutgers University Press, 1988), and his Safeguarding the Public Health: Newark, 1895–1918 (Westport, Conn.: Greenwood Press, 1975).
23. Louis P. Cain, “Raising and Watering a City: Ellis Sylvester Chesbrough and Chicago’s First Sanitation System,” Technology and Culture 13 (1972): 353–72. See also, Heman Spalding and Herman N. Bundesen, “Control of Typhoid Fever in Chicago,” American Journal of Public Health 8 (1918): 358.
24. Although some historians have seen bacteriology as a complete break with the filth theory of disease, and have treated this discovery as a paradigmatic revolution in medicine, a number of recent studies have described the “new” public health more as an integration of old and new. For example, see Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1800 (New York: Oxford University Press, 1985); John Ettling, The Germ of Laziness: Rockefeller Philanthropy and Public Health in the New South (Cambridge: Harvard University Press, 1981); Nancy Tomes, “The Private Side of Public Health: Sanitary Science, Domestic Hygiene, and the Germ Theory, 1870–1900,” Bulletin of the History of Medicine 64 (1990): 509–39; Naomi Rogers, Dirt and Disease: Polio in America before FDR (New Brunswick, N.J.: Rutgers University Press, 1992); and Barbara Bates, Bargaining for Life: A Social History of Tuberculosis, 1876–1938 (Philadelphia: University of Pennsylvania Press, 1992). For earlier studies along these lines, consult, for example, Lloyd Stevenson, “Science Down the Drain: On the Hostility of Certain Sanitarians to Animal Experimentation, Bacteriology and Immunology,” Bulletin of the History of Medicine 29 (1955): 1–26; William Rothstein, “Bacteriology and the Medical Profession,” in his American Physicians in the Nineteenth Century (Baltimore: Johns Hopkins University Press, 1972), pp. 261–81; Phyllis Allen Richmond, “American Attitudes Toward the Germ Theory of Disease (1860–1880),” Journal of the History of Medicine 9 (1954): 428–54; Howard D. Kramer, “The Germ Theory and the Early Public Health Program in the United States,” Bulletin of the History of Medicine 22 (1948): 233–47; Barbara Rosenkrantz, “Cart Before Horse: Theory, Practice, and Professional Image in American Public Health 1810–1920,” Journal of the History of Medicine and Allied Sciences 29 (1974): 55–73. See also Leavitt, “ ‘Typhoid Mary’ Strikes Back,” pp. 608–29.
25. James H. Cassedy, Charles V. Chapin and the Public Health Movement (Cambridge: Harvard University Press, 1962). Chapin served as superintendent of health for the city of Providence from 1884 through 1931. I focus on him in this section to illustrate a public health officer who represented an extreme of support for bacteriology; most health officials of the period more likely adopted some of the newer ideas alongside the older ones and saw that germ theory and filth theory had some things in common.
26. Charles V. Chapin, “Dirt, Disease and the Health Officer,” in Papers of Charles V. Chapin, M.D.: A Review of Public Health Realities, ed. Clarence L. Scamman (New York: The Commonwealth Fund, 1934), pp. 20–26; quotations from pp. 21, 22. Chapin maintained this position throughout his long career. He wrote after his retirement from public life about the changes he had witnessed during his career in public health: “When I was first drawn into public health I had to accept the teachings of our English friends as to the close dependence of disease upon dirt. I soon found that these ideas were for the most part erroneous and were so strongly entrenched in this country that they have proved to be one of the greatest hindrances to the development of public health. A large part of my own time has been occupied in getting English rubbish out of American heads. So far as I can see there is very little ‘dirt’ that is really dangerous to health.” Charles V. Chapin to George Soper, June 10, 1932, John Hay Library, Brown University, Providence, Rhode Island. Chapin continued, echoing directly words he had used before: “The removal of garbage, street cleaning and even the control of dumps are most important from an esthetic standpoint but in my opinion have practically no influence upon public health. I have never seen any evidence that they have.” Chapin died in 1941.
27. Chapin, “The Fetich of Disinfection,” Papers, pp. 65–75. Chapin first presented this paper as an address to the American Medical Association in Boston, June, 1906. It was first published in JAMA 47 (August 25, 1906): 574–77.
28. See, for example, Charles V. Chapin, The Sources and Modes of Infection (New York: John Wiley & Sons, 1910), pp. 93–94.
29. Charles V. Chapin, How to Avoid Infection, Harvard Health Talks (Cambridge: Harvard University Press, 1918), p. 21.
30. Ibid., pp. 60–61.
31. Chapin created a “score card” delineating the relative value of various public health activities to give his fellow workers a practical guide. On a scale with a total of city activities at 100, he rated communicable disease work 36 and sanitation 9. Charles V. Chapin, “Effective Health Work,” in Papers, pp. 37–45; the scale appears on pp. 41–42.
32. Chapin, “Dirt, Disease” p. 25.
33. Leavitt, The Healthiest City.
34. C.-E. A. Winslow, The Evolution and Significance of the Modern Public Health Campaign (New Haven: Yale University Press, 1923), p. 36. Quotation from third printing, July, 1984.
35. There are fewer than 500 sporadic cases of typhoid fever per year in the United States today. Richard C. Harruff, Pathology Facts (Philadelphia: J. B. Lippincott Co., 1994), p. 118.
36. See, for example, Michael P. McCarthy, Typhoid and the Politics of Public Health in Nineteenth-Century Philadelphia (Philadelphia: American Philosophical Society, 1987). See also Ronald K. Huch, “ ‘Typhoid’ Truelsen, Water, and Politics in Duluth, 1896–1900,” Minnesota History 47 (1981): 189–99; Reimert T. Ravenholt and Sanford P. Lehman, “History, Epidemiology, and Control of Typhoid Fever in Seattle,” Medical Times 92 (1964): 342–52; and Terra Ziporyn, “Typhoid Fever: A Disease of the Indifferent,” in Disease in the Popular American Press (Westport, Conn.: Greenwood Press, 1988), pp. 71–111. On the medical understanding of the disease, see Leonard G. Wilson, “Fevers and Science in Early Nineteenth Century Medicine,” Journal of the History of Medicine and Allied Sciences 33 (1978): 386–407; Lloyd G. Stevenson, “Exemplary Disease: The Typhoid Pattern,” ibid. 37 (1982): 159–81; and Dale C. Smith, “Gerhard’s Distinction between Typhoid and Typhus and Its Reception in America, 1833–1860,” Bulletin of the History of Medicine 54 (1980): 368–85.
37. Abram S. Benenson, ed., Control of Communicable Diseases in Man 14th ed. (Washington, D.C.: American Public Health Association, 1985), pp. 420–24.
38. The available evidence suggests to me that typhoid fever was, in fact, one of the diseases most responsive to public health sanitation projects at the end of the nineteenth century. Of twenty-one cities analyzed by George A. Johnson in 1916, twenty showed significant reduction (between 28 and 85 percent) in typhoid mortality after the introduction of water filtration systems. See his “The Typhoid Toll,” Journal of the American Water Works Association 3 (1916): 249–326, especially pp. 304–10. See also Edward Meeker, “The Improving Health of the United S
tates 1850–1915,” Explorations in Economic History 9 (1972): 353–73; and Eric Ashby, “Reflections on the Costs and Benefits of Environmental Pollution,” Perspectives in Biology and Medicine 23 (1979): 7–24. For a slightly less optimistic reading of these data, see Gerald N. Grob, “Disease and Environment in American History,” in Handbook of Health, Health Care, and the Health Professions, ed. David Mechanic (New York: Free Press, 1983), p. 18.
39. Leavitt, The Healthiest City, p. 61. In coastal cities, contaminated shellfish continued to constitute a risk even after city water works had been adequately protected.
40. Duffy, A History of Public Health in New York City, 1866–1966, passim.
41. Johnson, “The Typhoid Toll,” pp. 249–326, graph is on p. 308. See also John Duffy, The Sanitarians: A History of American Public Health (Urbana: University of Illinois Press, 1990), chap. 13, “Bacteriology Revolutionizes Public Health”; and Christopher Hamlin, A Science of Impurity: Water Analysis in Nineteenth-Century Britain (Bristol: Adam Hilger, 1990).
42. C. L. Overlander, “The Transmission of Typhoid Fever,” Interstate Medical Journal 21 (1914): 133–144.
43. The first to document the carrier state, with regard to bacteria in his own saliva, was George M. Sternberg in 1881. See his “A Fatal Form of Septicaemia in the Rabbit Produced by the Subcutaneous Injection of Human Saliva,” Special Report to the National Board of Health (Baltimore: John Murphy & Co., 1881), first published in the National Board of Health Bulletin 2 (1881): 781–83. I am grateful to Robert J. T. Joy for alerting me to this reference. In 1884 Fredrich Loeffler, the German bacteriologist, posited the concept of a healthy carrier of disease for diphtheria, and in 1893 Robert Koch did the same for cholera. In New York City, Hermann M. Biggs, William H. Park, and A. L. Beebe convincingly established the carrier principle in cases of diphtheria in 1893, finding virulent diphtheria bacilli in about 1 percent of the healthy throats in New York. Hermann M. Biggs, William H. Park, and Alfred L. Beebe, Report on Bacteriological Investigations and Diagnosis of Diphtheria From May 4, 1893 to May 4, 1894, Scientific Bulletin No. 1, Health Department, City of New York, From the Bacteriological Laboratory (New York: Martin B. Brown, 1895); available in Arno Press Reprint, The Carrier State (New York, 1977). Some 1890s studies uncovered typhoid bacilli in convalescent typhoid patients, sometimes years after initial infection, and by 1900 studies revealed that typhoid fever, too, could be transmitted by healthy recovered persons. See Reed, Vaughn, and Shakespeare, Abstract of Report, pp. 178–79. In 1902, Robert Koch published a paper on the subject, and during subsequent years a few typhoid carriers were discovered and described in Europe. See, for example, D. S. Davies and I. Walker Hall, “Typhoid Carriers, with an account of Two Institution Outbreaks traced to the same ‘Carrier,’ ” Proceedings of the Royal Society of Medicine, 1907–8, pp. 175–91; and Alex Ledingham and J. C. G. Ledingham, “Typhoid Carriers,” British Medical Journal 1 (January 4, 1908): 15–17. The most succinct account of the work on healthy carriers is C.-E. A. Winslow, The Conquest of Epidemic Disease (Madison: University of Wisconsin Press, 1980), pp. 337–46. The book was first published in 1943 by Princeton University Press. For specific carriers, see for example, Charles Bolduan and W. Carey Noble, “A Typhoid Bacillus-Carrier of Forty-Six Years’ Standing, and a Large Outbreak of Milk-Borne Typhoid Fever Traced to This Source,” JAMA 58 (1912): 7–9; C. W. Gould and G. L. Quails, “A Study of the Convalescent Carriers of Typhoid,” JAMA 58 (1912): 542–46; Frederick G. Novy, “Disease Carriers,” Science n.s. 36 (July 5, 1912): 1–10; and C. L. Overlander, “The Typhoid Carrier Problem,” Boston Medical and Surgical Journal 169 (1913): 37–40. See also Mazyck Ravenel, “History of a Typhoid Carrier,” JAMA 62 (1914): 2029–30; O. McDaniel and E. M. Wade, “The Significance of Typhoid Carriers in Community Life, with a Practical Method of Detecting Them,” American Journal of Public Health 5 (1915): 764–65; F. M. Meader, “The Detection and Control of Typhoid Carriers of Disease,” Medical Times, September, 1916, p. 278; and A. J. Chesley et al., “Three Years’ Experience in the Search for Typhoid Carriers in Minnesota,” JAMA 68 (1917): 1882–85. For a lengthy exploration of the early work on healthy carriers, see John Andrew Mendelsohn, “Typhoid Mary: Medical Science, the State, and the ‘Germ Carrier,’ ” undergraduate thesis, Harvard University, 1988. I thank Mr. Mendelsohn for his permission (granted through his advisor, Barbara Gutmann Rosenkrantz) for me to read this paper.
New diagnostic techniques aided in the discovery of people who had typhoid and ultimately of those who, although symptomless, could transmit the disease. In 1896, with the help of the newly developed Widal agglutination reaction test, a bacteriological assay for typhoid bacilli in the blood, New York City began offering free diagnoses for New Yorkers in health centers around the city. See Duffy, A History of Public Health in New York City, 1866–1966, pp. 105, 247. See also, for example, Thomas G. Hull, “The Widal Test as Carried Out in Public Health Laboratories,” American Journal of Public Health 16 (1926): 901–4.
44. This history is pieced together from the sources cited in n. 43. See also, “Typhoid Bacillus Carriers: Their Importance and Management,” JAMA 52 (May 8, 1909): 1501; and “Typhoid Carriers,” JAMA 50 (June 13, 1908): 1986–87. Other factors that led to a better understanding of typhoid emerged by the 1940s. For example, while early investigators noted the predominance of women carriers, health officers usually attributed this to the fact that more women than men handled food (Chesley et al., “Three Years’ Experience,” p. 1884). In the 1940s studies began to document more women carriers in the population at large, not just among those found in food-handling jobs, as transmitting the disease. In a New York state study published in 1945, the investigators concluded, “The rate of development of the carrier state at all ages is almost twice as high for females as for males.” The most striking sex difference found in that study occurred in the group aged forty to forty-nine, in which 16 percent of female cases and only 3.5 percent of male cases resulted in the chronic carrier state. Wendell R. Ames and Morton Robins, “Age and Sex as Factors in the Development of the Typhoid Carrier State, and a Method for Estimating Carrier Prevalence,” American Journal of Public Health 33 (1943): 223. Medical science in 1990 acknowledges similar sex and age differentials. I want to thank Dennis Maki, Head of the Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, and Herbert Dupont, Chief of Infectious Diseases at the University of Texas, Houston, for consulting with me on this issue.
45. On Hermann Biggs and the New York City laboratory, see C.-E. A. Winslow, The Life of Hermann M. Biggs, M.D., D.Sc, LL.D.: Physician and Statesman of the Public Health (Philadelphia: Lea & Febiger, 1929); David A. Blancher, “Workshops of the Bacteriological Revolution: A History of the Laboratories of the New York City Department of Health,” unpublished Ph.D. thesis, City University of New York, 1979; and Evelynn Maxine Hammonds, “The Search for Perfect Control: A Social History of Diphtheria, 1880–1930,” unpublished Ph.D. thesis, Harvard University, 1993.
46. Chapin, quoted in Winslow, Conquest, p. 340.
47. On William Park, see W. W. Oliver, The Man Who Lived for Tomorrow: A Biography of William Hallock Park, M.D. (New York: E. P. Dutton & Co., 1941); Winslow, Conquest; Winslow, The Life of Hermann M. Biggs (Philadelphia: Lea & Febiger, 1929); and Hans Zinsser, “William Hallock Park, 1863–1939,” Journal of Bacteriology 38 (1939): 1–3. For more on the significance of the laboratory, see Jon M. Harkness, “The Reception of Pasteur’s Rabies Vaccine in America: An Episode in the Application of the Germ Theory of Disease,” unpublished M.A. paper, History of Science Department, University of Wisconsin, 1987; and John Harley Warner, “The Fall and Rise of Professional Mystery: Epistemology, Authority, and the Emergence of Laboratory Medicine in Nineteenth-Century America,” in The Laboratory Revolution in Medicine, ed. Andrew Cunningham and Perry Williams (Cambridge: Cambridge University Press, 1992). On Park’s laboratory-based contributions to typhoid fever investigations, see, for exam
ple: “The Bacteriology of Typhoid Fever,” Medical News 75 (December 16, 1899): 792–96; “Typhoid Bacilli Carriers,” JAMA 51 (1908): 981–82; and “The Importance of Ice in the Production of Typhoid Fever,” JAMA 49 (1907): 731–32.
48. Charles F. Bolduan is quoted in the William Hallock Park Papers, “Miscellaneous Information” file at the Public Health Research Institute, New York City. I am grateful to Shirley Chapin, the Institute Librarian, for her help in locating this material. Of course, New York City followed other carriers, and used the data they provided as well. See, for example, Bolduan and Noble, “A Typhoid Bacillus-Carrier of Forty-Six Years’ Standing.”
49. All the laboratory reports are filed with In the Matter of . . . Mary Mallon (1909).
50. Mary Mallon’s letter, no date, in her own hand, is filed with ibid.
51. Soper, “Curious Career,” p. 706.
52. Mr. Briehof (once spelled Nriehof) was the man Soper visited in his efforts to learn more about Mary Mallon. See chaps. 2 and 4.
53. George Ferguson to Mary Mallon, April 30, 1909, In the Matter of . . . Mary Mallon (1909), laboratory reports.
54. On laboratories and typhoid diagnoses, see Thomas G. Hull, “The Widal Test as Carried Out in Public Health Laboratories,” American Journal of Public Health 16 (1926): 901–4; Fred Berry and R. E. Daniels, “Comparative Studies in Typhoid Stool Examinations,” ibid. 18 (1928): 883–92; Marion B. Coleman, “Serological and Bacteriological Procedures in the Diagnosis of Enteric Fevers,” ibid. 25 supplement (1935): 147–51; and T. F. Sellers, “Practical Procedures in the Laboratory Diagnosis of Typhoid and Clinically Related Fevers,” ibid. 27 (1937): 659–66. On transporting fecal specimens to the laboratory, see Th. M. Vogelsang, Typhoid and Paratyphoid B Carriers and Their Treatment: Experiences from Western Norway (Arbok: Universitetet I. Bergen, 1950), pp. 81–82. The legal issues in the case are discussed in greater detail in chap. 3.
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