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Workshop 7:  Lectures & Activities


Lecture Transcript Two:
Typhoid, Polio, and Diphtheria: Science and Class Issues

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Continued…


Now, despite the dominance of the new public health, the department ended up blaming the epidemic on the irresponsible sanitary behavior of immigrants. But this began to wear thin, because this kind of explanation couldn't explain the appearance of the disease in middle-class homes. And eventually, epidemiological research would show that children in more affluent homes were in fact more at risk to polio than poor children. Poor children, in fact, were more exposed to the virus when they were very young, because the virus was very prevalent in New York City. So they were exposed at a very young age and tended to have a mild reaction, in many cases. Middle-class kids were not exposed to the virus. They're kept inside much more, shielded from contact with other children much more as infants, and so they weren't exposed at the same early period, and when they were finally exposed, the virus had more severe effects.

So as historian Naomi Rogers has noted, the 1916 polio epidemic and the campaign to contain it, we have to understand this in the context of its time. These health officials, as someone mentioned earlier, were part of a progressive reform movement, and they tried to use legislative power— that is, the laws on the books that public health officials could invoke—in the time of outbreaks of disease. They also tried to use moral persuasion to address these kinds of outbreaks and to deal with a whole host of urban problems. But one of the things that I think is an aspect of these kinds of reformers in situations like this is that they believe that the city was both an incredible place to be, but it was also a very threatening place to be. It was dirty; it sort of had a kind of immoral cast to it. And these things had to be contained, controlled, and regulated in order for the city to be a healthy place for either the poor or the middle class to live.

And these reformers believed that regulation wasn't enough. The behavior of individuals had to be altered, and that—whether that behavior could be changed through education, that was the best way, so to educate people about what to do in the face of these kinds of infectious disease outbreaks, including putting screens on their windows when it was widely believed that polio was being transmitted to humans via flies, and that meant that everybody had to defer to scientific authority. If the experts said it was time to get your window screen, you had to get your window screen, or else you were going to be stigmatized as someone who was threatening everybody else's health.

In a sense, through this education campaign and deference to the authority of scientific experts, these reformers really hoped to transform the family, home, community, and ultimately the American society as a whole. And to achieve their goal, health officials really exalted the role of medical science and supported the use of government power. Now, in this case, exalting the role of medical science in the case of polio in 1916 turned out not to be such a great idea, because the medical, the scientific knowledge about polio was very uncertain. Though the virus was identified, they couldn't figure out how it was transmitted, and they could not figure out how to stop it. A number of vaccines were promoted and failed. And in the case of the 1916 epidemic in New York City, as it got colder—you started in the summer—as the winter came along, it seemed to die out. And that's how—that's basically how it ended.

Polio continued to appear in the United States through the 1930s and well into the 1950s. And on April 12, 1955, on the 10th anniversary of the death of President Franklin Roosevelt, is when Jonas Salk announced the development of a vaccine to wide acclaim, huge acclaim. You know, this was really the conquest of something that had brought such fear and so many deaths and left such vivid memories—and real people who were crippled—around for people who had lived through this period. So in part, people were so enthusiastic and positive in their response because of the memories of the 1916 epidemic and outbreak, but also in the ones that followed, right? But this seemed as well to be a real triumph for science, conquering something that had caused so much pain and suffering.

So these two cases, "Typhoid Mary" and this polio epidemic in 1916, tells us that outbreaks of disease always engender fear, stigma, the need for government intervention. But the broader lesson is that societies can address these kinds of issues in ways that preserve certain values of equity, of justice, of community trust. Or you can address outbreaks of these diseases and institute rules that disrupt those kinds of values. And it's very interesting for historians of medicine to look at which choices are made, at which particular times, with which particular diseases, so diseases that are carrying with them an image of really irredeemable bad behavior, we can see that often societies and communities respond quite harshly. And someone mentioned earlier the AIDS epidemic. AIDS initially [was] thought of to be a disease of gay men, of drug addicts, of people engaging in various sexual, sexually deviant behavior. The response did not evoke a great deal of compassion in the initial days. Once children became infected with AIDS, you know, I think you sort of see change in people's willingness to think about ways we might contain the epidemic that were not so harsh.

After the discovery of the vaccine for polio, along with the development of other vaccines, the memories of fear and stigma associated with outbreaks of these diseases tended to fade from public view, and a kind of complacency set in. People thought, well, we've conquered all the great infectious diseases of the 19th century: tuberculosis—we know how to deal with that; syphilis, gonorrhea, typhoid, typhus, yellow fever, malaria, polio, diphtheria, all the great killers—we had really effective means of controlling them. And people thought we were now entering the golden age when we would be free of infectious diseases. And then the 1980s came, and AIDS came, and people said, "Uh-oh." Our complacency was truly shattered. The control of infectious diseases, I want to end by saying, is one of the great triumphs of public health and scientific research in this century. But I think the major point to take away is that with every success came very real challenges to the values that Americans hold dear. Thank you.


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