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