Beyond Typhoid Mary
The series introduced students and faculty alike to the various disciplines that had, over the course of the previous four decades, transformed the health experiences of New Yorks population. For much of the nineteenth century, public health had been largely an engineering enterprise as the City built the Croton Reservoir System and massive aqueducts to move water from Westchester County and the Catskills to Manhattan. While smallpox outbreaks had largely been contained by mass inoculation campaigns, the extension of the water supply into poor neighborhoods limited the occurrence of water-borne diseases like cholera. The draining of swamps in Queens and the Bronx was leading to declines in outbreaks of mosquito-borne diseases such as yellow fever and typhoid.
However, engineering as a means of improving the Citys health seemed to have reached its limit. This new generation of administrators, engineers, and scientists argued the need for more targeted methods for eliminating outbreaks of diseases transmitted person-to-person. They maintained that a merging of traditional environmental controls with the new science of bacteriology could make horrifying epidemics a thing of the past.
Sanitary engineering had cleaned up broad swaths of the City. Now medically trained health professionals could identify local sources of disease and infected individuals whose treatment or isolation would further reduce the spread of disease. It is sincerely to be hoped that this beginning will lead to some permanent organization upon the lines of Sanitary Science and Public Health, Dean Samuel W. Lambert said of the lecture series in the 1909 P&S annual report, adding that a special committee [has] outlined the possibilities for funding such a permanent department in connection with Columbia University.
The grand possibilities of the new merging of sanitary science and medicine had just been illustrated neatly, in 1907, through the Citys experience with Mary Mallon, a cook for some of New Yorks elite families, who would become known as Typhoid Mary. Mary Mallon was a healthy typhoid carrier, whom George Soper, an 1899 graduate of Columbias School of Mines program in engineering, had identified as the source of an outbreak of typhoid among some wealthy New Yorkers vacationing at their summer cottage in Oyster Bay, Long Island.
Soper had been called in as an engineer to track the sources of pollution that led to the outbreak of this disease usually caused by drinking water contaminated with human feces. After detailed inspections of the water supply, the oysters regularly harvested in the bay nearby, the sewer system, and other possible sources of contamination, Soper concluded that the problem was not caused by leaks or cross-contamination of sewage and drinking water. Rather the problem, he argued, was that Mary, as a cook in the house, had been passing bacteria into the food that she prepared for the family.
George Soper, an 1899 graduate of Columbias School of Mines, used the newly developed bacteriological techniques and laboratories of the Citys Department of Health to argue that the source of a typhoid outbreak was Typhoid Mary, a healthy carrier.
Such detective work showcased recent advances in bacteriology, histology, and hygiene. During the lectures, Norman Ditman, an instructor in pathology at Columbias medical school, argued that between 20,000 and 25,000 lives had been saved by the recent advances in public health, and Herman Biggs, the director of New Yorks Department of Health, made the claim that in large measure, public health is purchasable, meaning that the publics willingness to invest in a variety of public health activities, laboratories, vaccination campaigns, and the like could determine how long New Yorks population would live and how free from the ravages of infectious diseases they would remain.
The need for the inclusion of public health into some aspect of the training of physicians was clear. For many at those lectures in 1908 it was not difficult to remember the experience of mid-nineteenth-century New Yorkers, many of whom died of rampant outbreaks of infectious diseases such as cholera, typhoid, smallpox, and yellow fever. Nor was it difficult to recall the suffering of children who died of diphtheria, whooping cough, and a host of other intestinal or pulmonary diseases. Tuberculosis was a chronic and continual reminder of the dangers that attended city life.
By the mid-nineteenth century, New York had among the worst health statistics in the nation. Vital statistics gathered by the City showed that while one out of every 44 people died in 1863 in Boston and one of 44 that year in Philadelphia, New Yorks rate was one in 36. Even when compared with European centers such as London and Liverpool, New York seemed strangely unhealthy. Mortality data highlighted the Citys apparent decline.
The City that Columbias medical school served had emerged as the national commercial hub, the nations foremost center of trade, industry, finance, and communication. Yet, the poverty, illness, and crowding of the City appeared frightening. Infections and a host of intestinal diseases in the young and old alike accompanied the growth in poverty, population, and immigration. High death rates and pestilence now marked with shame the great City of New York, remarked the authors of Sanitary Condition of the City: Report of the Council of Hygiene and Public Health of the Citizens Association of New York, the 1866 document that spurred the creation that year of what became the Citys Department of Health.
In this report, some of New Yorks leading physicians, including many from Columbia, documented the shame of the City. Valentine Mott 1807CC, professor of surgery at P&S; surgery faculty member Willard Parker, known as the father of vascular surgery; John Griscom, author of Sanitary Condition of the Laboring Population of New York, a famous 1845 study; Stephen Smith 1850PS, soon to head New Yorks new Metropolitan Board of Health and in 1872 organizer of the American Public Health Association, all bemoaned the pestilential diseases that laid bare the impotence of the existing sanitary system. The physicians noted that outbreaks of disease paralyzed the commercial and political life of the community: The people are panic-stricken [and] the interests of commerce suffer by the insensible and certain loss of millions. It was clear that the relation of the health and vigorous life of a people to the state, or to commercial prosperity, requires no discussion. Diseasethe effects of which could be measured in dollars and centswas a liability in the developing commercial capital.
On Columbias medical school faculty from 1902 to 1914 and former City commissioner of health, Haven Emerson 1899PS led the P&S Department of Public Health Administration for nearly two decades after it opened in 1922. Quickly expanding, the department grew into what is now one of the countrys leading schools of public health, Columbias Mailman School.
Written as it was by both medical and lay people, public health physicians and moral leaders, the 1866 report incorporated moralistic as well as scientific language, reflecting the contemporary understanding of illness as a sign of depravity or sin. Calling themselves health missionaries, the authors wrote,
|Lewd but pale and sickly young women, scarcely decent in their ragged attire, were impudent and scattered everywhere in the crowd. But what numbers are made hideous by self-neglect and infirmity! . . . To walk the streets as we walked them, in those hours of conflagration and riot, was like witnessing the day of judgment, with every wicked thing revealed, every sin and sorrow blazingly glared upon, every hidden abomination laid before hells expectant fire. . . . Here disease in its most loathsome form propagates itself.|
New York streets were very filthy with accumulations of manure from the horses that traversed the area, dead dogs, cats, and rats, household and vegetable refuse that in winter accumulated to depths of three feet or more, the 1866 report also noted. Garbage boxes, rarely emptied, overflowed with offal, animal carcasses, and household waste. Pools of stagnant water collected in the carcasses of dead animals and over sewer drains that were generally clogged.
These descriptions provided a vivid understanding of the intimate relationship between social and economic forces that created a slum and ill health throughout the City.
The observation that housing, politics, morals, and health were all intertwined underscored the combined missions of public health activities for the next half-century.
Disease, debasement, and pauperism . . . are found closely allied and seriously endanger the sanitary safety of all other classes, the authors of the report concluded.
By the turn of the twentieth century, New York would emerge as preeminent in the field. Older sanitarians notions of the cause of disease as residing in filth and immorality would slowly be supplemented with newer, more scientific views that disease was caused by specific pathogens, bacteria associated with particular diseases. The isolation of diseased individuals, the vaccination of potential victims of infection, and the laboratory analysis of milk supplies slowly gained a place alongside the more traditional sanitarian focus of the public health department. The advent of the bacteriological revolution had by the end of the century provided a common ground for clinical medicine and public health. Street cleaning, the provision of pure water supplies, and the treatment of bacterial disease were all essential for the control of infections and the elimination of epidemics.
With the revolution in bacteriology that followed the discoveries of Louis Pasteur, Joseph Lister, and Robert Koch in the mid-nineteenth century, a new faith in laboratory science emerged not only among physicians but also among public health workers. Bacteriology became an ideological marker, sharply differentiating the old public health, the province of untrained amateurs, from the new public health, which belonged to scientifically trained professionals, points out public health historian Elizabeth Fee, author of Disease and Discovery: A History of the Johns Hopkins School of Hygiene and Public Health, 19161939 (1987). A revolution in ideology overtook the field in the 1880s, as William Sedgwick, one of the first to speak at the 1908 lecture series at Columbias medical school, would remember: Before 1880 we knew nothing; after 1890 we knew it all; it was a glorious ten years. A new model was gaining greater acceptance: A bacillus made people sick and diseases like tuberculosis were caused by germs. Dirty, crowded public spaces or unclean homes with moist, warm, and stagnant air were seen as the conduits for disease.
By 1906, it had become apparent that some sort of alliance between medicine and public health was necessary and that P&S was the perfect place for the new practitioners in both disciplines to forge a common ground.
In the early years of the new century, the very successes of the reforms had led to the emergence of changing patterns of death in the City. Diseases of old age, the very welcome result of improved urban health, began to replace dying children and epidemics as a major concern. Cancer, heart disease, and pneumonia were claiming larger numbers of elderly. The data showed in an unmistakable manner the success of public sanitary administration which has heretofore directed its efforts almost entirely against infectious diseases, according to the 1912 annual report of the New York City Department of Health. On the other hand, the report point[ed] with equal clearness toward the field in which public hygiene must [focus] in the future, namely, the reduction of mortality from the diseases of middle and old age. What techniques could be employed to address these new challenges? Were the traditional tools of environmental cleanup or the newer techniques of vaccination and medical interventions adequate?
No longer would public health be limited to environmental engineering and food inspection. In future years, on the one hand, public health would find itself coming into conflict with providers of medical care as prevention of disease through inoculation and vaccination, prenatal and well-baby care, factory inspection, and occupational disease prevention as well as treatment of communicable diseases such as syphilis and gonorrhea would force those in the field to venture into areas previously the preserve of the clinician. On the other hand, it would lead to a greater coherence and sympathy with medical science.
At Columbia, Dr. Walter Bensel of the medical school gave the first regular course of instruction on the important subject of public health and sanitation, according to Dean Lambert in the 1911 P&S annual report. One of the schools projects then was a milk station peopled by P&S personnel that guaranteed the bacterial safety of milk provided to the Citys school children. By 1916, Dean Lambert noted that the proposed development of a School of Hygiene and Sanitary Science was delayed by a lack of funds. The hope was that with the anticipated early 1920s opening of the new campus at 168th Street, there would be space for the new school.
However, the 168th Street campus did not open until 1928, and by 1922 the urgent need for providing some sort of public health education to the health officers of the City, the students at P&S, and faculty at other schools had led to the opening of the Department of Public Health Administration as a unit of P&S. This collaboration was made possible with the help of a modest endowment from Joseph DeLamar, a Dutch sea captain who made his fortune in this country in mining and chemicals, and who left his wealth to Columbia (as well as to Harvard and Johns Hopkins).
Dr. Haven Emerson 1899PS, on the medical school faculty from 1902 to 1914 and former commissioner of health for the City, took over as head of the newly created department during its first year and led it for nearly two decades, until 1940. The author of numerous classics, including eight editions of Communicable Diseases of Man, Emerson expanded the scope of the department, and by the 1930s it had emerged as a school, teaching courses in epidemiology, public health administration, and the use of mass inoculation in the prevention of disease outbreaks.
In its first few years, the new school within a school organized courses on preventable disease and public health administration for fourth-year medical students and graduate nurses at Teachers College. New courses were added on communicable and occupational diseases, mental health, administration of public and private agencies, infant health service, prenatal supervision, and health examination of the preschool child, among others.
Initially, the new public health program was devoted to the education of the lay public in matters of preventive medicine and particularly in matters of diet and the use of food, as Dean William Darrach reported in 1923. But it soon grew, becoming today Columbias Mailman School, one of the nations leading schools of public health.
Photo credit: Living Legacies photos courtesy University Archives, Columbiana Library, Columbia University, except as noted. Little Mothers' League: Courtesy New York City Municipal Archives; Orchard Street: Courtesy New York City Municipal Archives; and Baxter Street: Courtesy Museum of the City of New York, Jacob A. Riis Collection.