Professor Hammonds: I think that there are some interesting tensions there in what happened in the courtroom. My reading of that has to do with the authority of the scientific evidence and the way in which the court deferred to that as the bottom-line explanation, and I also think because they don't put Mary in jail, for example, that she is isolated in a cottage and that there are ways in which I think people might see that as a fairly benign kind of "punishment." My reading of the case sees it—I think those factors play in as well, but I think the key of it is that the bacteriological evidence that the health department presents and the stature of the health department at that time carries the day in the court.
I also want to say that outbreaks of infectious disease raise a whole host of issues beyond simply ones about individual rights versus the public's health. And I want to turn to another epidemic—the outbreak of polio in New York City in 1916—as a good example to look at some of the other issues that emerge. Poliomyelitis is a viral disease, characterized by fever, headache, and sometimes stiffness of the neck and back. In paralytic cases, the virus attacks the motor nerve cells in the spinal cord, which governs your muscles, and if the muscles needed for breathing or swallowing are affected, the patient may die. Now, unless weakness or paralysis of the muscles in the limbs is minor or improves after the acute attack, most victims of polio will be crippled for life. In 1916, a national epidemic of polio emerged with 27,000 cases in 26 states, with 6,000 deaths. In June 1916, New York City had the largest single incidence of the disease, with over 8,900 cases and 2,400 deaths, and a mortality rate of more than one child in four.
So again, we've just talked about typhoid in New York City. This is coterminous with typhoid. So you have outbreaks of typhoid in New York City; you have outbreaks of diphtheria; you have this huge outbreak of polio. Again, look at the landscape of the city at this point in time. This is not a healthy place in many respects.
New York City remained a center for polio epidemics for the next four decades. And initially it was seen, as many infectious diseases were, as a disease of unsanitary living conditions and of the immigrants—the immigrants' bad behaviors. But polio slowly became more associated with the middle classes by the 1930s, and then was considered as a danger to all. The agent, the pathogen that causes polio was identified in 1908 as a filterable virus, but the 1916 epidemic generated enormous fear in the public. Health officials had to deal with families fleeing the center of the disease, and they also had to deal with people who stayed behind. The officials tried to restrict people's movement; they tried to identify the sick; they tried to placard people's houses where the sick were. They also tried to calm public fears, though they weren't quite successful with that. And in New York City, as people, many people, just, again, tried to leave, you know, it's like, time to leave, take the kids, get out of the city.
To identify those free of the disease, the city's health commissioner introduced a system of health certificates, in part because neighboring towns were restricting entry to people from New York City who didn't have a certificate certifying that their children were free of the disease. These certificates gave communities outside New York City one way to assess whether a child was free of infection. By the end of the epidemic—that is, it went into the early fall—68,000 certificates had been issued. Even so, New York children were frequently refused entrance to neighboring towns, are threatened with quarantines that lasted as long as four weeks. In a few cases, like the city of Paterson, New Jersey, they said until further notice, no nonresidents will be allowed to enter the city. And a city on Long Island just put big red signs up on the main road entering the town that all children who lived outside of the town would not be allowed to enter it.
Placards identifying housing where there were many cases of the disease were placed outside tenement buildings, but these placards were never placed outside of middle-class homes, because it was at—In one sense, the health officials believed that the disease was less dangerous in middle-class communities than it was in the immigrant communities, so you see constantly the ways in which the fear of the immigrant classes and their threats to the city get pretty wrapped up in public health policies, even after the introduction of bacteriology and more scientific-based public health.
The other thing that happened to poor parents is they were faced with the prospect of their children being removed from their homes and taken to the contagious disease hospital if health officials felt that they couldn't provide adequate care for the children inside of their homes. All manners of public gatherings were cancelled during the epidemic. Theaters... The health commission instructed all motion picture theaters to bar entry to children under 16. And even though the theater owners protested and said they were losing money, the city maintained the closure of the theaters. Playgrounds were closed. Sand piles were disinfected. Children's reading rooms in public libraries were closed. And parents were also urged to guard the behavior of their children. One official told parents to avoid caressing or kissing children, to forbid children from buying fruit or other exposed foods from street vendors, and to keep them from exchanging toys, marbles, candy, or chewing gum with other children.