Monthly Archives: May 2019

Special Issue: Medicine and Disease in History


Nursing students training in the classroom, United States, 1930s. 

The 1940 Provisions of the Sanitary Code of the City of New York and Regulations Relative to Reportable Diseases and Conditions and Control of Communicable Diseases, written by the City of New York’s Department of Health, notified medical personal that “certain diseases and conditions must be reported immediately and others within twenty-four hours.” Some had to be reported in writing and some immediately “by telephone or messenger in addition to the written report.” This spring, students in History 236: Medicine and Disease in Modern Society were each assigned a disease from that list and charged to write a paper that described the biological and social experience of having that disease in the United States in the 1930s. It was not an easy assignment. Students had to really search for the primary sources that could provide them with the kind of information that they needed to be able to make a persuasive argument, but many of them wrote excellent papers and we are delighted to share some of them in this special issue.

First Typhoid Fever Inoculations.

By Andreas Van Dijck

Note: Essay 7 in a series, all from Dr. Amanda McVety’s Spring 2019 class on Medicine and Disease in Modern Society

As one of the City of New York Department of Health’s designated “reportable diseases” in 1940, typhoid fever was viewed as a serious health hazard by United States health officials, and anyone showing possible symptoms of the disease was required to report those symptoms immediately. An infectious and contagious bacterial disease that spreads via contaminated food and water[1], typhoid fever caused great suffering to those who contracted it in the 1930s due to the biological and social ramifications of contracting such a disease. Contracting typhoid fever was an arduous biological and social experience; the disease presented painful physical symptoms, and those who contracted it tended to be viewed with suspicion and contempt. In addition, outbreaks of typhoid fever disproportionately impacted poor, rural communities across North America, which exposed the growing economic divide between cities and rural areas.

            Typhoid fever symptoms are painful and physical in nature; those who suffer from the disease come down with a prolonged fever, nausea, headaches, vomiting, abdominal pain, rashes, diarrhea, and loss of appetite[2]. In the 1930s, typhoid fever was sometimes confused with other diseases that caused persistent fevers[3] such as malaria and yellow fever, thus indicating that diagnosing the disease sometimes proved difficult. Typhoid fever was still scientifically understood to be transmitted by bacteria, Salmonella Typhi, that can only be carried by humans[4]. It was also understood that the disease was primarily spread via contaminated water, and when cities such as New York City made improvements to their sewage systems and facilitated easier access to clean water, instances of typhoid fever decreased dramatically; the death rate per 100,00 people due to Typhoid Fever in the United States dropped from 35.8 in 1900 to 4.9 by 1928[5]. In addition, several treatments for people affected by typhoid fever existed, including administering calomel, saline draught, and a spoonful of hot water for hydration, with mixed results[6]

Nonetheless, cases of Typhoid fever continued to crop up across the country in the 1930s, particularly in rural and poor communities; during the 1930s, 65 percent of typhoid outbreaks in the United States and 77.5 percent of those in Canada occurred in cities with a population of less than 5,000 people[7]. Thus, rural residents who did not have ready access to sanitation and clean water most likely to be affected by typhoid fever, a fact which also highlights the economic and developmental disparities of North America in the 1930s. American cities with over one million residents were noted to have nearly eliminated the disease by 1931 due to being better funded and having modern sewage systems[8]. Rural communities did not have the resources, funds, or expertise to update their sewage systems and curb the spread of typhoid fever. In fact, a 1938 health report estimated that deaths from typhoid fever were 30 to 40 percent higher than reported in Mississippi, a state where only around 30 percent of residents had access to running water in the 1930s and where most residents lived in towns of less than 1,000 people[9].

While outbreaks of typhoid fever were more prevalent in rural towns, the disease still appeared in more affluent areas as well, as in the case of “Typhoid Mary”. Mary Mallon was a poor Irish immigrant who worked as a cook for several wealthy New York families in the early 1900s, most of whom contracted typhoid fever while employing Mary. By the 1930s, it was understood that Mary was a carrier of typhoid fever[10]; she did not present any symptoms but was still a host to the bacteria causing the disease. As a carrier, Mary could still transmit the disease by handling and then serving food or water, which is how most of the families she worked for became ill. After a series of investigations, Mary was apprehended by authorities and forcefully quarantined[11]. This incident reveals how typhoid fever could still be an isolating social experience even if one was not suffering with the disease’s physical symptoms, and it also highlights how typhoid fever is a uniquely human affliction with human carriers and transmitters; Salmonella Typhi cannot be transmitted by animals, which is unlike most other diseases[12]. In addition, the story of Mary Mallone infecting the families she worked for spiked prejudice against Irish immigrants, who were seen among some Americans as “potentially dirty and hazardous”[13]. Because Mary Mallon was one of the most notorious carriers of typhoid fever, she likely became the image of a carrier in the eyes of the public, and that image was extended to Irish immigrants as a whole. As a result, the incidence of typhoid fever and the association of carriers with Mary Mallon further exposed prejudice against Irish immigrants, which was already prevalent during this time.

While typhoid fever was a known entity by the 1930s, and officials knew how to prevent it, the disease’s presence persisted among the poorer parts of society. Considering typhoid fever’s role as a biological and social experience in the 1930s is important because the disease exposed rifts in American society; poor, rural parts of the country were much more likely to experience outbreaks of this disease than bustling metropolitan areas were, which reflected the growing divide between urban and rural prospects in the United States. Indeed, cities benefited more from the “roaring 20s” and the technological advancements of the early 20th century than places like rural Mississippi, and thus were able to limit the spread of the disease. The divide between urban and rural areas arguably still exists today in the United States, albeit in a different context, but examining how different parts of the country were impacted by typhoid fever in the 1930s helps expose the origins of that divide. Furthermore, the case of Mary Mallon also shows how the outbreak of typhoid fever was used to justify prejudices against Irish immigrants, revealing how outbreaks of infectious disease can exacerbate existing social tensions and justify biases. While typhoid fever is not a major cause for concern today, the social problems of inequality and anti-immigrant sentiment still exist in the United States.

Andreas Van Dijck is a Junior Political Science Major and History minor from the Cleveland area. 


[1] Center for Disease Control and Prevention, “Typhoid Fever”, https://wwwnc.cdc.gov/travel/diseases/typhoid

[2] World Health Organization, “Typhoid”, https://www.who.int/immunization/diseases/typhoid/en/

[3] F.F Russell, “The Prevention and Treatment of Typhoid Fever”, Boston Medical and Surgical Journal 164, no. 1 (1911), 1

[4] Ibid

[5] Abel Wolfman and Arthur E. Gorman, “Water-borne Typhoid Fever Still a Menace”, American Journal of Public Health 11, no. 2 (1931), 115

[6] James Barr, “An Address on the Treatment of Typhoid Fever”, The Lancet, 1900

[7] Wolfman and Gorman, “Water-borne Typhoid Fever Still a Menace”, 119

[8] Ibid, 120

[9] A.L Grey, “The Probably Typhoid Carrier Incidence in Mississippi”, American Journal of Public Health 28, no. 1 (1938), 1415-1416

[10] George A. Soper, “The Curious Career of Typhoid Mary”, New York Academy of Medicine Bulletin 698-710, 1939

[11] Ibid, 700

[12] Frederick P. Gay, Typhoid Fever Considered as a Problem of Scientific Medicine, (New York: Macmillan Co., 1918), 7

[13] Soper, “The Curious Career of Typhoid Mary”, 701

Medicine and Disease in History: Tetanus




Wounded Australian soldiers receiving tetanus antitoxin outside a medical dressing station. 1918, Australian War Memorial E05242, Campbell, Australia.  From: Shanks, Dennis. How World War 1 changed global attitudes to war and infectious diseases. New York: The Lancet, 2014.  

By Karley Carter

Note: Essay 6 in a series, all from Dr. Amanda McVety’s Spring 2019 class on Medicine and Disease in Modern Society

Tetanus has been a well known disease for thousands of years, with its effects becoming devastating at times when treatment was unknown.  Due to developments of the late nineteenth and early twentieth centuries, there were revolutionary improvements in the way the disease was handled.  While tetanus carried with it a lack of social stigma due to its non-communicable nature, the fear of tetanus during war time prior to the twentieth century was real.  With the discovery of both the tetanus antitoxin and toxoid, tetanus transformed from being a killer in war to something that was less than an afterthought in the minds of soldiers and the general population.  

            Tetanus has been regarded in history all through time, with documents noting tetanus symptoms found from 1500 BC in Ancient Egypt, but are thought to have been copied from as early as 3000 BC.[1]  While there was a general understanding that the disease came from something infecting an open wound, many ideas for treatment were not beneficial, such as early Chinese physicians needling patients above the ears around 300 BC, Hippocrates’ ideas in Ancient Greece of promoting sweating through drinking strong wines and being wrapped in oil soaked cloths, and ideas in the Renaissance of covering the patient with manure.[2] The 19th century was revolutionary for tetanus research, as the disease was first replicated in 1884 through producing tetanus in animals, and pure cultures of tetanus bacillus were acquired soon after to study.[3]  These studies led to Kitasato and Emil von Behring among others discovering the tetanus antitoxin in 1891, something that greatly reduced deaths due to tetanus after being administered in World War I.[4]   In 1924, the first tetanus toxoid was developed and was given to all U.S. soldiers prior entering World War II, being eventually widely administered as the tetanus vaccine in the late 1940’s.[5]  National report of tetanus cases began in the 1940’s as well, allowing the decline in tetanus cases over the next half century to be noted.[6]

            Tetanus was relatively well understood in the early twentieth century.  With the new discoveries found between the 1880’s and 1920’s, tetanus was known to be caused by the bacteria tetanus bacillus, which is an anaerobic organism that enters the body through subsurface wounds.[7]  In addition, there was knowledge of contraction of tetanus being through contamination of the wound with soil, due to puncture wounds, wounds entering joints, or through other subsurface wounds, such as surgical incision sites, that were not properly treated.[8] 

While there was ability to destroy the bacteria through antiseptics, it was known to be unable to be destroyed in spore form, due to its ability to live through a wide range of temperatures.[9]  This information is relatively true to today, with most discrepancies between the times being small, such as many of the articles of the early to mid-twentieth century referring to tetanus as tetanus bacillus, with few calling it Clostridium tetani as it is officially referred to as today.  There is also a wider description of causes today as risks and dangers in society have changed, such as contraction due to non-sterile needles in drug use, body piercing, and tattooing.[10]  Recent articles also provide more information on the different kinds of tetanus, being general, local, cephalic, and neonatal, describing the specifics of each as well as how common each one is.[11]

            The experience of having tetanus, if acquired, is very painful and incessant.  After contraction of the disease, the incubation period is around 2-21 days, with symptoms tending to start around the seventh or eighth day.[12]  The first symptoms would be spasms in the muscles near the location of the wound, or tightness in the jaw,  in which the spasms would spread throughout the body as the bacteria travel through the bloodstream.[13]  Swallowing can become difficult and stiffness and pain may occur in the muscles of the shoulders, neck, and back, with additional spasms possibly spreading to the muscles of the arms, legs, and abdomen.[14]  There can be other symptoms too, including fever, sweating, high blood pressure, and rapid heart rate.[15]  In some cases, the spasms can be so strong that they causes fractures and muscle tears, as well as ones in the throat that cause difficulty breathing and can sometimes lead to brain damage.[16] These symptoms tend to lessen after around 17 days, but spasms can continue for three to four weeks, and in some cases a recovery can take months.[17]  The prognosis for the disease can be dire, with twenty-five percent of people with the disease dying if not properly treated, and around ten percent of people with the disease dying when properly treated, even into modern day.[18]

            The treatments for tetanus created in the early twentieth century completely altered the prevalence of the disease.  The discovery of the tetanus antitoxin completely changed its effects in war, with soldiers in battle being the primary victims to the disease prior.  In the Civil War, one of every 500 men died of tetanus by sustaining wounds during battle and then becoming infected with tetanus.[19]  In World War I, there was less than one case that occured for every 5000 wounded, due to the fact that every wounded soldier in the U.S. troops received a prophylactic injection of the tetanus antitoxin.[20]  To create the antitoxin that was distributed, a tetanus toxin was injected into horses who form antitoxins to protect themselves from the poison.[21]  The resulting antitoxins created a serum that could be obtained from the horse containing the antitoxin and be used for treatment in humans.[22]  This was the primary way to treat tetanus until the development of the tetanus toxoid in 1924.[23]  While it was not commonly used in the thirties,  the toxoid was administered to all U.S. soldiers in World War II to protect them from contracting the disease.[24]  It was then used for the vaccine that was administered to the public, most commonly together with the Diphtheria and Pertussis vaccine, which created the DTP vaccine.[25] 

Unlike many communicable diseases, tetanus did not have a strong social stigma, as it was not contagious from person to person.  Although there was no stigma, there was still a fear of tetanus in people up until the antitoxin and toxoid became widely available, for soldiers in battle, in cases of surgical procedures gone wrong, and even on the Fourth of July.[26]  Tetanus cases on the Fourth of July were extremely prevalent due to injuries by blank cartridges, firecrackers, and other Fourth of July festivities.[27]  This caused the Fourth to become nicknamed the Bloody Fourth, due to the amount of deaths it caused due to tetanus.[28]  While this was devastating in the 1800’s due to lack of treatment, articles of the 1900’s urged those injured on the Fourth to seek treatment to prevent the onset of tetanus, eventually reducing the number of deaths.[29]  In addition, there was little regulation by public health officials of tetanus due to it not being contagious.  When looking at the sanitary code from New York City in 1940, tetanus was mentioned as a communicable disease, but there were no specific regulations for it, unlike the majority of other communicable diseases.[30]  

            The discovery of the tetanus antitoxin and toxoid transformed tetanus from being devastating in war to becoming one less trepidation in the minds of soldiers and the general population.  This was tremendously helpful during both World Wars, as it greatly reduced deaths which created a better morale for both soldiers and their families.  The advancements in science during the late nineteenth and early twentieth centuries caused this disease to become something extremely uncommon in places where vaccines are easily accessible, which helped to manifest the current health system that we know today. 

Karley Carter is a freshman majoring in Architecture with a minor in History.

Bibliography

Chalian, William. “An Essay on the History of Lockjaw.”  Bulletin of the History of Medicine.

           Vol. 8, No.2. Baltimore: The Johns Hopkins University Press, 1940. JSTOR.

City of New York’s Department of Health, Provisions of the Sanitary Code of the City of New                                                                                                                                                                                                                                         York and Regulations Relative to Reportable Diseases and Conditions and Control of                  Communicable Diseases.  Washington DC, 1940.

Coleman, George E.  “Investigating Tetanus. (Lockjaw).”  The Scientific Monthly.  Vol 31,                   No. 6.  Washington DC: American Association for the Advancement of Science, 1930.

Faulkner, Amanda E. and Tejpratap S. P. Tiwar. “Manual for the Surveillance of                                                                                                                Vaccine-Preventable Diseases.” Centers for Disease Control and Prevention.  November                       17, 2017.  https://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html

Huber, John B. “Tetanus and the Glorious Fourth.” Scientific American, Vol. 101, No. 1.

New York: Scientific American, a division of Nature America, Inc., 1909.  JSTOR.

Krantz, C. John. Fighting Disease with Drugs.  Baltimore: Williams & Wilkins Co., 1931.           

Lerner, Brenda Wilmoth and K. Lee Lerner, Infectious Diseases: In Context.  Detroit: Gale,                       2008.  Gale Virtual Reference Library.

 Spaeth, Ralph.  “Tetanus.  The American Journal of Nursing, Vol. 42, No. 7.  New York:

Lippincott Williams & Wilkins, 1942.  JSTOR.

United States Surgeon General’s Office.  FM 21-10 Military Sanitation and First Aid.

Washington,1940. https://archive.org/details/FM2110/page/n121

Vyas, M. Jatin et al. “Health Information from the National Library of Medicine.” MedlinePlus,                    Accessed March 1, 2019. medlineplus.gov/.

Image:

https://marlin-prod.literatumonline.com/cms/attachment/56d4e890-8a72-4555-af18-b889930ad088/gr2_lrg.jpg

Wounded Australian soldiers receiving tetanus antitoxin outside a medical dressing station. 1918, Australian War Memorial E05242, Campbell, Australia.  From: Shanks, Dennis. How World War 1 changed global attitudes to war and infectious diseases. New York: The Lancet, 2014.  



[1] William Chalian, “An Essay on the History of Lockjaw,” Bulletin of the History of Medicine. Vol. 8, No.2 (1940): 173. JSTOR.

[2] Ibid., 175, 179, 193-194.

[3] Ralph Spaeth, “Tetanus. The American Journal of Nursing, Vol. 42, No. 7, (1942), 733. JSTOR.

[4] Ibid., 733.

[5] Amanda E. Faulkner and Tejpratap S. P. Tiwar, “Manual for the Surveillance of Vaccine-Preventable Diseases,” Centers for Disease Control and Prevention.

[6] Ibid.

[7] United States Surgeon General’s Office, FM 21-10 Military Sanitation and First Aid (Washington, 1940), 115.  https://archive.org/details/FM2110/page/n119

[8] Ibid., 115.

[9] Ibid., 115.

[10] Ed. Brenda Wilmoth Lerner and K. Lee Lerner, Infectious Diseases: In Context (Detroit: Gale, 2008), 816, Gale Virtual Reference Library.

[11] Ibid., 817.

[12] Ibid., 816.

[13] Ibid., 816.

[14] Ibid., 816.

[15] Ibid., 816.

[16] Jatin M Vyas, et al. “Health Information from the National Library of Medicine.” MedlinePlus, accessed March 1, 2019, medlineplus.gov/.

[17] Lerner, Infectious Diseases: In Context, 816.

[18] Vyas, “Health Information from the National Library of Medicine.”

[19] Krantz, C. John. Fighting Disease with Drugs. (Baltimore: Williams & Wilkins Co., 1931), 107.

[20] Ibid., 107.

[21] Ibid., 103.

[22] Ibid., 103-104.

[23] Faulkner and Tiwar, “Manual for the Surveillance of Vaccine-Preventable Diseases.”

[24] Ibid.

[25] Ralph Spaeth, Tetanus, 738-739.

[26]  United States Surgeon General’s Office, FM 21-10 Military Sanitation and First Aid, 115. 

[27] John B. Huber, “Tetanus and the Glorious Fourth,” Scientific American, Vol. 101, No. 1 (1909), 8, JSTOR.

[28] Ibid.

[29] Ibid.

[30] City of New York’s Department of Health.  Provisions of the Sanitary Code of the City of New York and Regulations Relative to Reportable Diseases and Conditions and Control of Communicable Diseases. (Washington D.C., 1940).

Medicine and Disease in History: Hookworm


Hookworm treatment at the Chapel Hill School, Alabama 1923

By Matt Narbutis

Note: Essay 5 in a series, all from Dr. Amanda McVety’s Spring 2019 class on Medicine and Disease in Modern Society

Imagine yourself as being a child. You are trying to live a normal life, but a mysterious organism inside of you regularly manifests both physical and mental problems.  In addition to you, almost half of your friends and family suffer similarly, yet for the most part, no one is even talking about it, let alone trying anything to get rid of it.  You may end up free from this condition, but most likely it will be present with you until your death.  You’re not living in some sort of apocalyptic disease-ridden world, you are one of the millions of Americans that suffered from Hookworm at the turn of the 19th century.  Though having Hookworms was rarely fatal, or even significantly impactful on one’s life, the experience of having the parasitic disease in the 1930’s resulted in physical discomfort and social stigmatization, which were treated by archaic medicines and often vague preventative measures.

In the 1930’s Ancylostomiasis or, as it is still commonly known today, Hookworm, was a disease scientists and health practitioners fought and researched with regularity.  The disease was known to be an parasitic infection of the body caused by millimeters-long worms.  Throughout the first two decades of the twentieth century, some adamant scientists believed Hookworm infections were either caused by the consumption of contaminated meat or passed hereditarily.  However, by the 1930’s it was nearly universally accepted that the infection entered the body almost exclusively through skin penetration, with rare cases stemming from ingesting Hookworm contaminated food[1].       

In the 1930’s, the known history of the disease was relatively comprehensive.  The disease was first documented in 1838 when an Italian physician performed an autopsy on a peasant woman.  By the mid 1800’s, the disease had been documented across the world and known cases existed on nearly every continent.   Hookworm’s origins in the United States were thought to be in 1902, though the condition had most likely been in the country for centuries before.  Around the turn of the century, many Americans considered the disease to be nothing more than a myth.  This line of thinking however, was halted in the 1910’s when various health organizations and the federal government recognized Hookworms to be a prevalent parasitic infection within the country.  By the 1920s, the disease was thought to have disappeared for the most part from the U.S. as a result of aggressive treatment and public education.[2]         

In the United States one group suffered more from the disease than any other: rural Southerners.  Hookworm infections were so rampant in the American South that estimates concluded roughly “30 percent of the rural southern population”[3] was afflicted by the disease.  Among rural Southerners, those who had frequent interaction with soils and sand, such as farmers and children, were most likely to have the condition.       

The physical experience of having Hookworms was a tedious one.  Those suffering from the infection experienced anemia, sluggishness, “Delayed pilosity, aches, dizziness, epigastric tenderness, lassitude, insomnia, constipation, irregular menses,

[and]

frigidity.”[4]  Despite these symptoms, infections were rarely lethal with the few actual Hookworm caused deaths primarily a result of anemia in children.  This gave rise to the notion among many that Hookworms didn’t necessitate treatment, as it was perceived to be an inconvenient condition rather than a possibly life-threatening one.  

The social experiences of having Hookworms were similar to the physical ones: they ranged from uncomfortable to debilitating.  Those with Hookworms were stigmatized and often seen as impoverished, low-class, and uneducated due to the disease’s prevalence in the rural southern states.  The children who suffered from this disease were thought to be “dull, apathetic, unable to concentrate” and in extreme cases “mentally retarded” due to their infections[5].  Those who were afflicted by Hookworms and resided in the South generally had easier social experiences than sufferers in the Northern States, who were even more heavily stigmatized.  This notion makes sense give the diseases relatively rare rate of occurrence in the North compared to the South.     

Unfortunately, both the treatments given to sufferers and the preventative measures taken were relatively archaic in the 1930’s.  Carbon tetrachloride, a sweet-smelling, volatile liquid closely related to chloroform, which had previously  been used primarily as an industrial cleaner, was the standard of care in treating Hookworm infections.  Though it was effective in treating patients afflicted by the condition, it could be toxic and cause damage to the nervous system, liver, and kidneys in high dosages.  Another common treatment was Chenopodium, a flowering plant that was made into a liquid.  However, those who received this treatment often experienced lethargy and the dose had to be administered multiple times before it had any positive effect thereby drawing out the side effects[6], thus making Carbon tetrachloride, which only required one dose, the preferred choice.  The preventive measures that were recommended to combat the spread of the disease were fairly vague.  Among them were “Proper disposal of human excreta” and the recommendation to “implement sanitary measures.”[7]These non-specific recommendations make sense given the fact that Hookworms had the potential to live in nearly any soil or sand, thereby making specific preventive measures nearly impossible.                    

Public discourse regarding the disease went through a turbulent reform over time.  At the turn of the 19th century, a practitioner’s suggestion that a patient had Hookworms often resulted in the patient being offended.  This is no surprise given the negative connotations and social stigma the disease carried.  However, generous funding from the Rockefeller foundation for education and treatment of the disease resulted in a massive expansion of the discourse and the legitimacy in which people spoke of it.  Additionally, through the help of travelling Hookworm educators, who often spoke at schools, the disease was discussed within communities even more.[8]            

In the Southern United States, where the disease was the most prevalent, public health officials did not enforce specific health requirements for disease as they lacked the resources to do so.  Trying to implement specific guidelines for how cases of the disease would be reported to public health officials and managed by physicians would have been impossible, due to how frequently the condition presented.   However, in the Northern cities, such as New York City, public health officials enforced much stricter regulations, due to Hookworm’s lack of prevalence there.  Those with Hookworms were to be removed from hospitals unless they were able to be properly isolated and quarantined, and were prohibited from mobilization so that they would not spread the disease.  In addition, physicians attending to cases of the disease had to file official reports noting them or else face heavy penalties.  These regulations, combined with the prevailing environmental conditions, helped limit the prevalence of Hookworms in the North.[9]    

Both the 1930’s understandings of Hookworms scientifically and historically were quite similar to what they are understood to be today.  The developments and insights made in that era laid the foundation for the current research on the condition.   Presently, it is common knowledge that Hookworms in humans are caused by an infection with the nematode parasites Necator americanus and Ancylostoma duodenale that are transmitted through contact with contaminated soil.  The worms subsequently migrate to the lungs where productive coughing sends them into the gastrointestinal tract where they can cause intestinal blood loss and in some cases, anemia.  Historically speaking, it is now know that in the decades leading up to the 1910’s when education and treatment began to take place Hookworms were, and most likely had been for decades prior, an epidemic in the American South.  It is also accepted as fact that the treatments of the early 20th century did not nearly eradicate Hookworms as previously thought.  Though much has changed since the 1930’s, for the nearly 700 million people who suffer from Hookworm today the feelings of physical discomfort and social stigmatization they experience are akin to those experienced by Americans in the 1930’s.[10]

Matt Narbutis is a second year student majoring in History, with a co-major in premedical studies.  Outside of class he participates in cell signaling and cancer related research.   

Bibliography

“The Life-History Of The Hookworm.” The British Medical Journal Vol.1, no. 2670 (1912): 499-500. http://www.jstor.org/stable/25296276.

“The Prevention and Cure of Hookworm.” Scientific American 120, no. 14 (1919): 334-53. http://www.jstor.org/stable/26039277.

Hotez, Peter J., Simon Brooker, Jeffrey M. Bethony, Maria Elena Bottazzi, Alex Loukas, and Shuhua Xiao. “Hookworm infection.” New England Journal of Medicine 351, no. 8 (2004): 799-807.

New York (N.Y.). Department of Health. “Provisions of the Sanitary Code of the City of New York and Regulations Relative to Reportable Diseases and Conditions and Control of Communicable Diseases.” (1940): 13-42.

Nicholls, Lucius, and G. G. Hampton. “Treatment Of Human Hookworm Infection With Carbon Tetrachloride.” The British Medical Journal 2, no. 3209 (1922): 8-11. http://www.jstor.org/stable/20420412.

Power, Helen J(Jun 2001) History of Hookworm. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net

[doi: 10.1038/npg.els.0003582]

Smillie, W. G., and Cassie R. Spencer. “Mental retardation in school children infested with hookworms.” Journal of Educational Psychology 17, no. 5 (1926): 314.

Stiles, C. W. “Decrease of Hookworm Disease in the United States.” Public Health Reports (1896-1970) 45, no. 31 (1930): 1763-781.

Ch. Wardell Stiles. “Some Practical Considerations in Regard to Control of Hookworm Disease in the United States under Present Conditions.” The Journal of Parasitology 18, no. 3 (1932): 169-72.

“The Rockefeller Foundation.” The British Medical Journal 2, no. 3493 (1927): 1154-155. http://www.jstor.org/stable/25327296.


[1]Ch. Wardell Stiles. “Some Practical Considerations in Regard to Control of Hookworm Disease in the United States under Present Conditions.” The Journal of Parasitology 18, no. 3 (1932): 80.

[2] Stiles, C. W. “Decrease of Hookworm Disease in the United States.” Public Health Reports (1896-1970) 45, no. 31 (1930): 1763-781. doi:10.2307/4579737; “The Life-History Of The Hookworm.” The British Medical Journal Vol.1, no. 2670 (1912): 499-500; Stiles, CH (1932): “Some Practical Considerations in Regard to Control of Hookworm Disease in the United States under Present Conditions.”   

[3]Stiles, C. W. “Decrease of Hookworm Disease in the United States.” Public Health Reports (1896-1970) 45, no. 31 (1930): 1763.

[4] Stiles, C. W. (1930): “Decrease of Hookworm Disease in the United States,” 1770.

[5]Smillie, W. G., and Cassie R. Spencer. “Mental retardation in school children infested with hookworms.” Journal of Educational Psychology 17, no. 5 (1926): 314.

[6]Nicholls, Lucius, and G. G. Hampton. “Treatment Of Human Hookworm Infection With Carbon Tetrachloride.” The British Medical Journal 2, no. 3209 (1922): 8-9.

[7]“The Prevention and Cure of Hookworm.” Scientific American 120, no. 14 (1919): 334.

[8] “The Rockefeller Foundation.” The British Medical Journal 2, no. 3493 (1927): 1154.

[9]New York (N.Y.). Department of Health. “Provisions of the Sanitary Code of the City of New York and Regulations Relative to Reportable Diseases and Conditions and Control of Communicable Diseases.” (1940): 28.

[10] Hotez, Peter J., Simon Brooker, Jeffrey M. Bethony, Maria Elena Bottazzi, Alex Loukas, and Shuhua Xiao. “Hookworm infection.” New England Journal of Medicine 351, no. 8 (2004): 799-807; Power, Helen J(Jun 2001) History of Hookworm. In: eLS. John Wiley & Sons Ltd, Chichester.

Medicine and Disease in History: Malaria

By Lauren Schaffer

Note: Essay 4 in a series, all from Dr. Amanda McVety’s Spring 2019 class on Medicine and Disease in Modern Society

The air is warm and muggy. A faint buzzing echoes in the air, and neck hairs tingle. The acrid smell of smoke fills nostrils, as bark nests are burned in an attempt to ward off an impending illness: malaria. This is what people may have experienced in 1930s southeast America, where the disease devastated many towns near the waters where mosquitos flourished.Biologically, the disease was understood to be a cycle of chills and fevers, a parasitic infection caused by the bite of an Anopheles mosquito or the drinking of infected waters where they resided and bred. Socially, many people lived in fear because it was difficult to be sure whether or not a given mosquito or water source was infectious. There was not a classist or isolationist attitude associated with malaria, but there was a geographic or regional predisposition surrounding who contracted the disease.

            Between 1930 and 1940, the majority of what people knew about malaria came from abroad, because that was where the disease originated and primarily attacked. Africa, India, and south Asia were common places to contract malaria, and people were infected in droves, resulting in hundreds of thousands of deaths.[1] When it first reached America, the government questioned whether or not there should be a quarantine because they were unsure of its contagion capabilities.[2] Soon, doctors and citizens alike knew how the disease was spread, through the various discharges of the Anopheles mosquito, but it was difficult for the average person to differentiate between it and the common American Culex variety. Its body is much narrower and sharper, and only this species carries the parasites that cause infection.[3] People who drank water from sources where these insects mated were also at risk of contracting the disease, because the parasites can be secreted into the water during mating.

            Once bitten, a victim begins to feel chills, which the body responds to with feverishness. This sequence repeats, and often induces nausea, vomiting, and jaundice, or yellowing of the skin. The main reason people die from malaria is due to these excessive lapses outside homeostasis, which is exhaustive and cannot be maintained, as it wears out the immune system.[4] Primarily, 20th century doctors would prescribe people to bed rest for 10-15 days, which is usually how long it took to recover if survivable. Many victims, however, could face up to five years of relapse, and at the time they had no reason as to why this occurred in some cases and not others.[5] The peak mortality rate of malaria in America was 3.3 deaths per 100,000 persons, in 1933.[6] Though the death rate was not massive, it was higher than typical, and this fact combined with the imminent reality of often being outside terrified the public.

            The fact that there was no real cure did not help curb this paranoia. Treatment for malaria was fairly limited to taking quinine, a substance extracted from the bark of cinchona trees, which is also found in tonic water. It was first discovered in South America in 1820, when bark was a main source of medicinal products for varying diseases.[7] At this time, it was recommended in encapsulated pills, since it absorbed better that way versus through an injection. The recommended dosage was 30 grains per day to break chills, then 10 grains daily at bedtime to break the attack, though relapse was still possible.[8] Plasmochin was also effective for killing the parasite, but not to alleviate symptoms. It was not advised to take quinine daily to prevent, only once the disease had been contracted. Throughout the history of malaria, drugs like quinine were often abused, and used as a vaccine instead of a symptomatic relief.[9]

In order to prevent malaria before it began, many infrastructural precautions were taken in areas of the southeast, such as Tennessee, Mississippi, and Alabama, where it was most prevalent. Water reservoirs were seized by health departments and inspected, and persons living within a two-mile radius were tested regularly. Special bureaus were commissioned explicitly for the investigation and prevention of malaria, specifically by the TVA in Tennessee.[10] Mosquito nets covered many people as they went outside, and were also placed over food and other high-risk items. This became and issue, however, because the majority of malaria casualties stemmed from children, those with outdoor professions, and persons living and working in rural areas. These water treatments and net coverings did not bode well for working in such sparse areas where being among the marshes and cotton fields was their livelihood. One solution proposed at the time was to grow legume plants, such as beans and alfalfa, as it had been observed in other countries that crops such as these somehow fended off the mosquitoes.[11]

Now, scientists know about many different factors that contribute to who gets malaria, why, and how to prevent it. There are several antibiotics in place that can treat it, quinine still being one of them. Other drugs including chloroquine, doxycycline, mefloquine, and more are used to treat the disease as well, sometimes in conjunction with quinine.[12] Much of this is dependent on the type of parasite the mosquito hosts and infects the person with, as well as other illness they may have, allergies, area of contraction, etc. In addition, a much wider spread of insecticides and bug zappers are available to protect people day-to-day from these potentially deadly insects. Doctors are also aware of certain genes people hailing from Africa and parts of the Middle East carry, which mutates their blood cells in a way that immunizes them from malaria (such as sickle cell disease).[13]

Altogether, malaria is and was a lasting, horrific disease that still affects millions of people today. Even though scientists know much more about it at a molecular, chemical, and human level, it still kills and is being investigated further. No permanent treatment or vaccine exists yet, and many children and adults even now suffer immensely, especially in underfunded and underdeveloped countries. By looking at how people experienced the disease earlier in history, researchers can compare the information they have now and perhaps learn from both their mistakes and advancements, in order to try and eradicate the menace that is malaria.

Bibliography

Copeland, Royal S., M.D. “Guarding Your Health: Control of Malaria.” The Cincinnati Enquirer, June 27, 1931. Accessed March 1, 2019. https://search.proquest.com/docview/1882058259/1067A9A0CC8E46C4PQ/5?accountid=12434.

Evans, Dr. W. A., M.D. “How To Keep Well: Treatment for Control of Malaria.” The Washington Post (Washington, D.C.), October 29, 1932. Accessed February 28, 2019. https://search.proquest.com/hnpwashingtonpost/docview/150244363/6D227B296E294483PQ/3?accountid=12434.

Krysto, Theo. “Can the World Banish Malaria?” Scientific American, 142 (April 1930): 270-72. Accessed February 28, 2019. https://web.b.ebscohost.com/ehost/detail/detail?vid=0&sid=9c050e8e-219b-490f-a767-6a23adca6093%40pdc-v-sessmgr05&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=514363711&db=rgr

Malar, J. “Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria” US National Library of Medicine, May 24, 2011. Accessed April 19, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121651/

“Malaria: MedlinePlus Medical Encyclopedia.” MedlinePlus. January 28, 2019. Accessed March 01, 2019. https://medlineplus.gov/ency/article/000621.htm.

“Mighty Malaria.” Time Magazine, January 14, 1935. Accessed March 1, 2019. https://web.b.ebscohost.com/ehost/detail/detail?vid=11&sid=51785a60-de75-41e4-b5cf-c234fa1fdf0a@pdc-v-sessmgr01&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#AN=54805106&db=a9h.

Porter, Russell B. “Malaria Scourge Fought By the TVA.” The New York Times, April 24, 1938. https://search.proquest.com/docview/102570606/abstract/7097FAF45CDB4552PQ/1?accountid=12434.

Snowden, Frank M. The Global Challenge of Malaria: Past Lessons and Future Prospects. New Jersey: World Scientific, 2014.

U.S. Congress. Senate. Committee on Public Health and National Quarantine. Malaria and Typhoid Fever: Hearings before the United States Senate Committee on Public Health and National Quarantine, Sixty-Third Congress, Second Session, on Mar. 5, 6, 1914. 63rd Cong., 2d sess. S. Bill. Washington: U.S. G.P.O., 1914.

U.S. Public Health Service. American Red Cross. “Quinine kills malaria germs” Library of Congress, September 9, 1920. https://www.loc.gov/item/2017677870/


[1] Frank Snowden, The Global Challenge of Malaria: Past Lessons and Future Prospects (New Jersey: World Scientific, 2014), 29-30

[2] US Congress, Malaria and Typhoid Fever: Hearings before the United States Senate Committee on Public Health and National Quarantine (Washington, U.S., 1914)

[3] Theo Krysto, Can the World Banish Malaria? (Scientific American, 1930), 270-272

[4] MedlinePlus, Malaria: MedlinePlus Medical Encyclopedia (MedlinePlus, 2019)

[5] Royal Copeland, Guarding Your Health: Control of Malaria (The Cincinnati Enquirer, 1931)

[6] Snowden, 2014, 78

[7] J. Malar, Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria (US National Library of Medicine, 2011)

[8] Mighty Malaria (Time Magazine, 1935)

[9] W. A. Evans, How to Keep Well: Treatment for Control of Malaria (The Washington Post, 1932)

[10] Russell Porter, Malaria Scourge Fought by the TVA (The New York Times, 1938)

[11] Theo Krysto, 1930

[12] MedlinePlus, 2019

[13]Snowden, 2014,142-145

Medicine and Disease in History: The 1930s Plague Pandemic




Children’s ward with nurses and visitors in a nursing institute in Java

By Gretchen Blackwell

Note: Essay 3 in a series, all from Dr. Amanda McVety’s Spring 2019 class on Medicine and Disease in Modern Society

Beginning in 1894 and lasting until around 1950, a pandemic of the plague began to spread, wreaking havoc on much of the developing world. This pandemic was the third outbreak of its kind, harkening back to the days of the Plague of Justinian that occured around 541-542 AD and the Black Death that desolated much of the world between 1347 and 1500 AD, both of which killed millions and reshaped the political and social spheres of the world. When the plague spread in the early 1900s, clinicians, politicians, and researches were no more prepared for its destruction than those of outbreaks before germ theory was developed. Despite the various methods of prevention, cures, and treatment employed by public health officials, the outbreak in colonized countries, where the cities were overcrowded and unsanitary, worsened drastically. The actions of officials were met with much protest and resistance from citizens, as many did not trust any Western medical interventions. Though the third outbreak of plague ravaged the majority of the world, the rich and powerful West was unscathed. Consequently, the memory of this outbreak faded in the minds of the West; yet, its devastation marked the beginning of a clear inequality in health care in those countries affected by the plague and the developed world.

            The plague, a contagion caused by Yersinia pestis, is transmitted by rodents and their fleas. There are three types of plague- bubonic, septicemic, and pneumonic, the most deadly. A person can catch the plague from being bitten by an infected flea, handling carcases of rodents with the disease or, in the case of pneumonic plague, from Y. pestis particles transmitted person to person. The plague kills by reproducing its bacteria rapidly and overloading the immune system until the organs fail. The symptoms occur around six days after infection and have various effects depending on the type of plague.[1] In bubonic plague infections, the patient’s lymph nodes swell, and the patient experiences fever, aches, and chills. When infected with septicemic plague, the patient develops fever, chills, shock, and bleeding under the skin that causes the blackening of skin tissue, a characteristic that is typical of this type of the disease. When either bubonic or septicemic plague is left untreated, it can develop into pneumonic plague which causes pneumonia.[2] There is no vaccine available for the plague; however, if it is treated with antibiotics, the patient has an increased rate of survival.[3] If the plague is left untreated, the patient has a 50 percent survival rate.[4]

During the third outbreak of plague, no cure or treatment was known, and there was a lack of understanding of the exact mode of transmission. The theory that rats spread the plague developed during this time; however, it was accepted by many that human to human transmissions occurred in every case of the plague, some even attributed miasmic theory to the outbreak.[5] Ultimately, public health officials resorted to the methods used in past pandemics. These methods included quarantining and the burning homes and belongings of victims, forcing them to relocate, in order to stop human to human transmission, what they assumed was causing infection. Additionally, officials would roundup and poison rats in order to control the spread of disease. Further, vaccination, a method that has now been proven very dangerous, was compulsory for citizens of Senegal.[6] None of these efforts did much, however, to fight the pandemic.

Many actions taken by health officials during the third plague pandemic were met with resistance in colonized nations, as the officials were ignorant of or apathetic towards the cultural and religious traditions of the colonized people. For instance, in India, citizens reacted with violent protests when forced to conform to Western medical practices, leading “to the death of four Britons, and helped accelerate the growth of Indian nationalism.”[7] Further, in Bombay in 1936, it was reported that after objections from citizens, officials would stop the trapping of rats because of the religious beliefs.[8] The title of an article from the Sunday Times of London read “Plague Preferred”, showing a clear inconsideration of the values of the society in which Britain was occupying. In the West, it was thought that only those who were ignorant caught the plague. In fact, when there was an outbreak in Scotland, officials were embarrassed by its presence.[9] It was generally accepted that backwardness and uncleanliness would cause the plague. A medical professional in the American Journal of Public Health and the Nation’s Health in 1934 claimed that it was “ignorance and fear” that worsened the fatality of disease.[10] In India, this became “an excuse for letting the plague epidemic… burn out”.[11] Officials decided to stop intervention and let the disease run its course, resulting in 10 million deaths in the country.

By the end of the outbreak around 1950, nearly 15 million were dead, primarily in the port cities of India, China, and other Asian countries. There were many deaths in Africa, South America, and Australia as well, but, comparatively, Europe and North America experienced very few casualties. The breeding ground for plague epidemics is overcrowded and unsanitary spaces, a description of many seaports in the developing world during the early 1900s. The threat of death by the plague struck so much panic in citizens of India that two men from Calcutta were sentenced to death for the murder of a man by using “bacilli serum” containing plague microbe.[12] In comparison, the West had a developed public health system that enforced sanitary codes and prevention efforts. The New York Sanitary Code from 1940 lists the rules and regulations to be followed in the case of plague, including notifying authorities, isolating the patient and the patient’s family, and quarantining the patient’s home.[13] Ultimately, these measures led to the disparate effects of the plague pandemic.  In an article from The Science News-Letter from 1938, “the horrors of the plague of the Orient” are described as being far off and distant from the minds of Americans.[14] Further, an article from The Sunday Times discusses the public health efforts to prevent infection and how the threat of plague has been “happily” reduced in Britain because of them.[15] While the majority of the world was being ravaged by the plague, the disease was barely on the radar of Westerners.

The disparities in public health interventions that existed during the time of the third plague pandemic led to the death of millions by, as evident by the low mortality in Western countries, a preventable disease. While North America and Europe were barely touched by the disease as a result of the regulations and precautions set in place by their bureaucracies, poor and often colonized countries such as India and China experienced an unbridled pandemic that struck fear into the populations and left the countries with political and social turmoil. This sharp contrast between formally colonized countries and the Western world is still evident today. According to the World Health Organization, as of 2017 “nearly 9 million children under the age of five die every year” and “around 70% of these early child deaths are due to conditions that could be prevented or treated”.[16] Most of these deaths are concentrated in developing countries, the same regions ravaged by the plague around 100 years ago.


Gretchen Blackwell is a freshman from Huron, Ohio planning on majoring in history and political science with a minor in computer science.

Works Cited

 Centers for Disease Control and Prevention. “CDC Plague | Frequently Asked Questions (FAQ) About Plague.”

(Centers for Disease Control and Prevention, 2018). https://emergency.cdc.gov/agent/plague/faq.asp.

Echenberg, Myron. “Pestis Redux: The Initial Years of the Third Bubonic Plague Pandemic, 1894-1901.” Journal of

World History13, no. 2 (2002a): 429-49. http://www.jstor.org/stable/20078978, 435.

Echenberg, Myron J. Black Death, White Medicine: Bubonic Plague and the Politics of Health in Colonial Senegal,

1914-1945. (Oxford: James Currey, 2002b), 103.

Larkey, Sanford Vincent. “Public Health in Tudor England.” American Journal of Public Health 24 (November 1934):

1099–1102. doi:10.2105/AJPH.24.11.1099, 1102.

“Murder by Germs.” (Sunday Times 1935), p. 21. The Sunday Times Digital Archive,

http://tinyurl.galegroup.com/tinyurl/9M3dZ9. Accessed 4 Mar. 2019.

Our Agricultural Correspondent. “Plague Peril from Rats.” (Sunday Times 1937), p. 31. The Sunday Times Digital

Archive, http://tinyurl.galegroup.com/tinyurl/9M3Aq2.

Our Own Correspondent. “Indian City Not to Trap Rats.” (Sunday Times, 1936), p. 24. The Sunday Times Digital

Archive, http://tinyurl.galegroup.com/tinyurl/9Lzbq6.

“Provisions of the Sanitary Code of the City of New York and Regulations Relative to Reportable Diseases and

Conditions and Control of Communicable Diseases”(Department of Health, 1940).

Stafford, Jane. “Death Rides a Rat.” (Science News Letter, 1938), 134–35. doi:10.2307/3914747.

Unknown author “Children’s ward with nurses and visitors in a nursing institute in Java”[digital

image]. https://www.repository.cam.ac.uk/handle/1810/285241

U.S. National Library of Medicine. “Plague.” (MedlinePlus,  2018). https://medlineplus.gov/plague.html.

World Health Organization. “Child Mortality.” (World Health Organization, 2011).

https://www.who.int/pmnch/media/press_materials/fs/fs_mdg4_childmortality/en/.

[1] Echenberg, Myron. “Pestis Redux: The Initial Years of the Third Bubonic Plague Pandemic, 1894-1901.” Journal of World History13, no. 2 (2002a): 429-49. http://www.jstor.org/stable/20078978, 435.

[2] U.S. National Library of Medicine. “Plague.” (MedlinePlus,  2018). https://medlineplus.gov/plague.html.

[3] Centers for Disease Control and Prevention. “CDC Plague | Frequently Asked Questions (FAQ) About Plague.” (Centers for Disease Control and Prevention, 2018). https://emergency.cdc.gov/agent/plague/faq.asp.

[4] Echenberg 2002a, 435.

[5] Echenberg 2002a, 437.

[6] Myron J., Echenberg. Black Death, White Medicine: Bubonic Plague and the Politics of Health in Colonial Senegal, 1914-1945. (Oxford: James Currey, 2002b), 103.

[7] Echenberg 2002a, 443.

[8] Our Own Correspondent. “Indian City Not to Trap Rats.” (Sunday Times, 1936), p. 24. The Sunday Times Digital Archive, http://tinyurl.galegroup.com/tinyurl/9Lzbq6.

[9] Echenberg 2002a, 448.

[10] Sanford Vincent, Larkey. “Public Health in Tudor England.” American Journal of Public Health 24 (November 1934): 1099–1102. doi:10.2105/AJPH.24.11.1099, 1102.

[11] Echenberg 2002a, 443.

[12]  “Murder by Germs.” (Sunday Times 1935), p. 21. The Sunday Times Digital Archive, http://tinyurl.galegroup.com/tinyurl/9M3dZ9. Accessed 4 Mar. 2019.

[13] “Provisions of the Sanitary Code of the City of New York and Regulations Relative to Reportable Diseases and Conditions and Control of Communicable Diseases”(Department of Health, 1940).

[14] Jane Stafford. “Death Rides a Rat.” (Science News Letter, 1938), 134–35. doi:10.2307/3914747.

[15] Our Agricultural Correspondent. “Plague Peril from Rats.” (Sunday Times 1937), p. 31. The Sunday Times Digital Archive, http://tinyurl.galegroup.com/tinyurl/9M3Aq2.

[16] World Health Organization. “Child Mortality.” (World Health Organization, 2011). https://www.who.int/pmnch/media/press_materials/fs/fs_mdg4_childmortality/en/.

Medicine and Disease in History: Syphilis


1996 series 200 Deutsche Mark banknote featuring Dr. Paul Ehrlich

By Ashlee Mosley

Note: Essay 2 in a series, all from Dr. Amanda McVety’s Spring 2019 class on Medicine and Disease in Modern Society

In the 1930’s syphilis was known as a sexually transmitted disease.  Even then syphilis was a preventable disease, but it still caused a worldwide panic.  Syphilis has been referred to as the “third great plague”, due to its significance in affecting the population all around the world.  The symptoms have stayed the same within 90 years.  Sores or lesions all over the body which vary in size and placement, they are usually painless.  Treatment and the social stigma has changed within this time frame.  In the past 90 years, the social perception of syphilis changed due to a shift in social acceptance and scientific understanding of the disease which resulted in more effective treatment.

            In the 1930s syphilis was STD that was caused by an organism called spirochete or treponeme.  It was long debated to decide which one caused syphilis.  Schaudinn was unable to determine the membrane which characterized spirochete, then suggested the name Terponema pallidum.   Though, it was also called Spirochaeta pallida during this time.  This organism is delicate and can be killed by the mildest of antiseptics and drying.[1]  During this time people did know that syphilis was preventable and curable if handled and caught in time.[2] 

Syphilis today is a systemic disease caused by spirichaete, Treponema pallidum. This can be transmitted the same way in 1930s, sexual acts, blood transfusion, or from mother to fetus in utero.  Syphilis has four different stages that it is broken up into.  There is primary, secondary, and early latent which are the early stages of syphilis and then there is late latent syphilis.  To put people into groups, anyone less than two years is early latent and more than two years without clinical evidence is referred to as late syphilis.[3]

It was known to be contracted not just from sexual acts but in other innocent ways.  People thought that by using contaminated and dirty dishes and utensils they would contract syphilis.  Infected money and simple kissing was thought to spread syphilis.[4]  In other works, it was said that prostitution was a main reason for the spread of syphilis.  Since prostitution was such a big thing, people believed that everyone who was a prostitute or was with a prostitute had syphilis. Everyone was at risk for syphilis, men, women, children, and even a fetus still in utero.  Children that are born with syphilis are more likely to be handicapped for the rest of their lives, physically and mentally.[5] 

To determine if one was to have syphilis they would administer blood test.  Treatment for syphilis was only handled at home until Dr. Ehrlich came up with “bullets”.  Patients can be discharged after a week in the hospital.  The new treatment does require treatment from a trained professional at the hospital.  The treatment was to take Dr. Ehrlich’s “bullets” and use an IV to get the medicine.  For poorer, malnutrition patients they would gain up to ten pounds during the week of care.  They would be on a continuous drip for five days and it was about ten quarts of the solution.[6]  Another type of treatment was the use of arsenic, bismuth and mercury which are nephrotoxic drugs but they can cause irritation to the kidneys.  Also the use of arsphenamines which causes severe damage to the liver.[7] 

            Today, to determine if someone has syphilis they would administer a blood test or test the cerebral spinal fluid.  The treatment for syphilis today is a single dose of penicillin if caught early.  In all cases, syphilis is curable if caught in time.  The penicillin will stop the sextually transmitted disease from progressing.  This works for people that have been infected for less than a year.  If pregnant, the doctor will only recommend penicillin.  The newborn child must receive antibiotic treatment as well.  Follow up treatment is to have periodic blood test to make sure the patient is responding well to the dosage of penicillin the doctor prescribed.  People should avoid sex until their sores have healed.  Still with this, they should always use condoms when engaging in sexual activity.  Even though cured, they can still get syphilis again.  [8]  Though syphilis can be cured, it cannot reverse any damage that has been done. 

            The public health officials proposed some action to help with the spread of syphilis.  They wanted to more control prostitution.  Control the marriage of someone who has syphilis and is not receiving treatment.  The officials also said they will punish people who do not receive treatment.  Start giving good treatment at the expensive of the state.  They want to work on earlier detection of syphilis and reporting all causes of sexual disease.2

            The social stigma around syphilis has changed in the way that is more accepted.  In the 1930s, Kaempffert wrote, “Nice people don’t have syphilis, nice people don’t have syphilis and nice people shouldn’t do anything about having syphilis.”4  Works about this disease are only for professionals.  They were published and put into libraries until many people were reading and talking about it.  During this time, if someone was to get syphilis it was as if they “deserved it.”  In the Third Great Plague, Stokes raised the question of why other sexually transmitted diseases were not seen as a sign of shame. Other STDs were not seen as bad or for bad people. Today, people today see syphilis as a risk.  Syphilis is not something that happens due to bad behavior or a bad person.  STDs in general is something that everyone has a risk of if they engage in sexual activity.  People are now trying not to brand people and make them feel bad for having a sexually transmitted disease.  This will cause people not to get tested and for them to spread this others without knowing. If people are not being safe or not getting tested then many more people are at risk for syphilis. 

            The social stigma of syphilis has changed for the better.  There are still going to be people that see it as the person is bad.  From the new understanding, this is just not the case.  The new treatment that has been developed has also helped with the social stigma.  Since it is easier to cure, it is not such a scary topic to talk about.  People are not ashamed to have syphilis anymore because it is not a bad thing.  Anyone is at risk for this anytime they engage in sexual activity. Within the past 90 years, the stigma has changed because of the new treatments and the moral understanding of what the disease is.

References

Kaempffert, Waldemar. “The Battle Against Syphilis: Dr. Parran’s “Shadow on the Land” Is A…” New York Times, August 1, 1937.

Kazanjian, Kaiden. “5 Day Treatment for Syphilis.” New York Times, April 13, 1940.

Lehman. “Lehman Urges War against Syphilis.” New York Times, February 5, 1937.

Moulton, Forest Ray. Syphilis: Presented by the Section on the Medical Sciences. American Association for the Advancement of Science by THE SCIENCE PRESS, 1938.

Nelson, Nels A., and Gladys L. Crain. Syphilis, Gonorrhea and the Public Health. New York: Macmillan Company, 1938.

Stokes, John H. The Third Great Plague: A Discussion of Syphilis for Everyday People. W.B. Saunders Company, 1917.

“Syphilis.” Mayo Clinic. January 16, 2019. Accessed March 05, 2019. https://www.mayoclinic.org/diseases-conditions/syphilis/symptoms-causes/syc-20351756

The WHO. “GUIDELINES FOR THE MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS.” The WHO.

https://www.who.int/reproductivehealth/topics/rtis/treatment_syphilis.pdf.

[1] Nelson, Nels A., and Gladys L. Crain. Syphilis, Gonorrhea and the Public Health. New York: Macmillan Company, 1938.

[2] Stokes, John H. The Third Great Plague: A Discussion of Syphilis for Everyday People. W.B. Saunders Company, 1917.

[3] The WHO. “GUIDELINES FOR THE MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS.” The WHO.

https://www.who.int/reproductivehealth/topics/rtis/treatment_syphilis.pdf.

[4] Kaempffert, Waldemar. “The Battle Against Syphilis: Dr. Parran’s “Shadow on the Land” Is A…” New York Times, August 1, 1937.

[5]  Lehman. “Lehman Urges War against Syphilis.” New York Times, February 5, 1937.

[6] Kazanjian, Kaiden. “5 Day Treatment for Syphilis.” New York Times, April 13, 1940.

[7] Moulton, Forest Ray. Syphilis: Presented by the Section on the Medical Sciences. American Association for the Advancement of Science by THE SCIENCE PRESS, 1938.

[8] “Syphilis.” Mayo Clinic. January 16, 2019. Accessed March 05, 2019. https://www.mayoclinic.org/diseases-conditions/syphilis/symptoms-causes/syc-20351756.

Medicine and Disease in History: Bubonic Plague


Rat Collecting Station. Shortly after 1900. Philadelphia. 

By Alex Gregory

Note: Essay 1 in a series, all from Dr. Amanda McVety’s Spring 2019 class on Medicine and Disease in Modern Society

The bubonic plague ravaged Asia and Europe during the 14th century and resulted in major economic and social paradigm shifts. Fear and a poor understanding about how the disease was spread resulted in epidemics occurring for the next five centuries. The invention of faster transportation, increased levels of immigration, and worldwide trading lead to a fifty-one-year outbreak of the Bubonic Plague throughout the world. Particularly in port cities, such as San Francisco, New Orleans, and Honolulu, the plague proved to be a dangerous and isolating experience for the population. Denial, racial tensions, and attempts at quarantine from the outbreaks between 1901-1910 affected the social understanding and regulations that were implemented around the bubonic plague. Throughout the 1920s and 1930s the scientific understanding of the bubonic plague developed, with the discovery of Bacillus pestis and a link being drawn between historical black death and the outbreaks in the 19th and 20th centuries.

During the 1930s it was understood that the bacteria that cause the plague was Bacillus pestis, but the ways in which the disease entered the body were still being debated[1]. Known as a disease of rats[2], the bubonic plague was thought to contaminate food and water, which would be appropriate with the limited knowledge of how bacteria and viruses were spread in the early 20th century[3]. With the adoption of germ theory and the discovery of Bacillus pestis, it is now known that plague is spread through bodily fluids and vectors, such as fleas, rats, and other small rodents. The 1900-1924 outbreak in India and China allowed scientist to diagnose the Black Death of the medieval period[4], and give reasons behind a long history of fear and death. With the lack of knowledge that preceded the Chinese and Indian outbreaks, several government laboratories were established in these countries, and lead to bacteriologists discovering essential information about the plague[5]. Even though the plague was almost nonexistent during the 1930s in the United States, the history of massive graves and quick deaths allowed fear to persist and lead to the plague still being on the report list for the City of New York.

Today’s understanding of the Bubonic Plague divides the illness into three categories: bubonic, septicemic, and pneumonic. Bubonic is the most common, with approximately ¾ of all cases from the 1900-1924 Chinese/Indian outbreaks falling into this category[6]. Septicemic and pneumonic forms of plague are the deadliest and have the most serious side effects. Septicemic is a form of plague which infects the blood stream and causes death within 24-72 hours. Pneumonic plague can spread directly, quickly, and efficiently from one individual to another, through coughing and other bodily fluids[7]. Early 20th century societies knew that the plague was common among small mammals, but now it is understood to be difficult to eradicate because of its ability to survive indefinitely in its host and the wild population inability to be inoculated[8].

Outbreaks that occurred between 1900-1924 in California[9] gave rise to racism and anti-immigrant attitudes, which carried on into the 1930s and 40s. Today it is known that the plague arrived on a steam ship from Hong Kong and was carried by the rats on board, but those in the United States blamed the Chinese immigrants for bringing the disease to North America. Japanese internment camps during World War II were preceded by the quarantining and unfair treatment of the Chinese during the plague outbreak. Immigrants, the homeless, and those in the lower class were the primary sufferers of the plague, and the denial of San Francisco’s Mayor did not assist in reducing the plague or helping those who suffered. These outbreaks also revealed the staggering differences between the upper and lower classes access to public health initiatives and how indifference of the upper class can cause devastation in the lower class. Even after the surgeon general of the US Public Health Service attempted to implement anti-plague regulations, there was a concern of causing alarm about the disease.

Common preventative measures included rodent control, incineration, isolation, and inoculation. Incineration was a highly used method in Honolulu, resulting in approximately 171,950 dollars of compensation being paid out to insurance companies in 1926 by the U.S government, from the fire suppression methods that were used during the 1899-1900 outbreak of plague[10]. An attempt at quarantining Chinatown grew from the racism and anti-Chinese sentiments that were common during the time. Immigrants were forced to stay in Chinatown, while white individuals could move freely throughout the city. Although rodent control had the ability to be the most effective method of containment, the disinfection campaigns failed in the immediate eradication of the disease. By pouring carbolic acid into the sewers in an attempt to kill the bacteria, the rats fled and began to live among the homeless and those in poor living conditions[11]. Because of the disinfection campaign’s failure, lower classes became even more impacted by the disease, since rodents were the primary carriers of plague. In the late 19th century a plague vaccine was created, but the effectiveness has never been fully studied[12]. In the United States there is not a current plague vaccine accepted by the government.

Hawaii is the only state in the United States to have plague in human victims during the 1930s. Between 1931-1932 there were five instances of plague on the island of Maui, with four of the victims dying; following these cases there was instance of plague in humans in the United States thru the 1930s[13]. During the 1930s there were countless occurrences of rats and small rodents being infected by the plague[14]. Various maps included in the United States Health Service report of 1936 reveal the extent of infected rats across three Hawaiian Islands. The cases are concentrated around waterways and main roads[15], leading to the belief that the plague was being spread through the transportation vehicles that were used. Rats, fleas, or other small mammals would have been stowaways on these vehicles, allowing the disease to spread to other populations.

Although the disease had similar symptoms to past epidemics: high fevers, convulsions, vomiting, pain in the limbs, and appearance of buboes, the social experience of having the disease changed. Attempts at Cartoons, newspapers, and caricatures were used to target the Chinese and other immigrants[16]. Written in Chinese, a poster showing a Chinese immigrant injecting ‘common sense serum’ into a government officials head[17] reveals that the methods being implemented by the government, or white man, were clearly not effective. It is also understood from this image that the targeted groups, particularly the Chinese, were not passive bystanders in this hazardous environment of illness, racism, and denial. By showing how the lower-class citizens understood what was happening to them and around them, the artist of this poster makes a statement about the poor and ignorant treatment of the immigrant population. “Plague phobia”[18] resulted in other illnesses being left untreated, such as appendicitis, because of the fear that the plague would spread if contact occurred between the sick and the healthy. Some individuals claimed that the plague was a “distant, tropical, exotic disease”[19] that should not be worried about, which was a sharp contrast to those individuals who compared the disease to Bolshevism[20]. Having these highly variable views of the plague is a result of the denial and coverups that occurred in California in the early 20th century.

Most diseases come with social, economic, or scientific influences, but the racial tensions left by the bubonic plague were evident for decades and impacted the experience of Asian-Americans/ Asian-immigrants during World War II. Lack of understanding about how the disease was spread lead to blaming the outbreaks on a specific racial group, the Chinese. Even though the plague was not an active epidemic in 1930s, the fear of past epidemics resulted in mandatory reporting and extreme measures to be taken if a case was to appear.

Alex Gregory is double majoring in English Literature and History with double minors in Archaeology and Museum Studies. A native of Liberty Twp., Ohio, she hopes to attend graduate school and study public history or museum studies. 

Bibliography

Chase, Marilyn. The Barbary Plague: The Black Death in Victorian San Francisco. New York:            Random House, 2003.

U.S. Congress, Senate, Committee on the District of Columbia. Experiments on Living Dogs. Washington, DC: GPO, 1930

Bollet, Alfred. Plagues and Poxes: The Impact of Human History on Epidemic Disease. New York:           Demos Medical Publishing Inc., 2004

Herlihy, David. The Black Death and the Transformation of the West. Cambridge, Ma: Harvard        University Press, 1997.

California State Board of Health. Ground Squirrel Eradication. Sacramento, California, 1911

Center for Disease Control. “Plague Vaccine,” CDC.org              https://www.cdc.gov/mmwr/preview/mmwrhtml/00041848.htm. (accessed March 2,     2019).

The United States Public Health Service, United States Treasury Department. Public Health     Reports. Washington, DC, 1936. Pp 1537

Kellogg, Williams and Simpson (1920). Present Status of Plague. American Journal of Public   Health, 11, p.844.

U.S Congress, House, Special Committee to Investigate Communist Activities in the United           States. Investigation of Communist Propaganda. Chicago, Il., 1930.


[1] Marilyn Chase, The Barbary Plague: The Black Death in Victorian San Francisco (New York: Random House, 2003), 44

[2] U.S Congress, Senate, Committee on the District of Columbia, Experiments on Living Dogs (Washington, DC: GPO, 1930), 174

[3] Alfred Bollet, Plagues and Poxes: The Impact of Human History on Epidemic Disease (New York: Demos Medical Publishing Inc.: 2004), 25

[4] David Herlihy, The Black Death and the Transformation of the West (Cambridge, Ma: Harvard University Press, 1997), 20

[5] California State Board of Health, Ground Squirrel Eradication, (Sacramento, California: 1911), 513

[6] David Herlihy, The Black Death and the Transformation of the West (Cambridge, Ma: Harvard University Press, 1997), 21

[7] David Herlihy, The Black Death and the Transformation of the West (Cambridge, Ma: Harvard University Press, 1997), 21

[8] David Herlihy, The Black Death and the Transformation of the West (Cambridge, Ma: Harvard University Press, 1997), 21

[9] Alfred Bollet, Plagues and Poxes: The Impact of Human History on Epidemic Disease (New York: Demos Medical Publishing Inc.: 2004), 25

[10] U.S Congress, Senate, Committee on the District of Columbia, Experiments on Living Dogs (Washington, DC: GPO, 1930), 174

[11] Alfred Bollet, Plagues and Poxes: The Impact of Human History on Epidemic Disease (New York: Demos Medical Publishing Inc.: 2004), 25

[12] Center for Disease Control, “Plague Vaccine,” CDC.org  https://www.cdc.gov/mmwr/preview/mmwrhtml/00041848.htm, (accessed March 2, 2019)

[13] The United States Public Health Service, United States Treasury Department, Public Health Reports (Washington, DC: 1936), 1537

[14] The United States Public Health Service, United States Treasury Department, Public Health Reports (Washington, DC: 1936), 1537

[15] The United States Public Health Service, United States Treasury Department, Public Health Reports (Washington, DC: 1936), 1537

[16] Marilyn Chase, The Barbary Plague: The Black Death in Victorian San Francisco (New York: Random House, 2003), 46

[17] Dr. Kellogg, Dr. Williams, and Dr. Simpson, “Present Status of Plague,” American Journal of Public Health 11 (1920): 844

[18] Marilyn Chase, The Barbary Plague: The Black Death in Victorian San Francisco (New York: Random House, 2003), 50-51

[19] U.S Congress, Senate, Committee on the District of Columbia, Experiments on Living Dogs (Washington, DC: GPO, 1930), 174

[20] U.S Congress, House, Special Committee to Investigate Communist Activities in the United States, Investigation of Communist Propaganda (Chicago, Illinois: 1930), 89