Urban Epidemics

Tuberculosis has its roots deep in ancient history and has grown to be notorious for its high mortality rates and excruciating symptoms. It has taken centuries of scientific advancements to determine the bacterial origin of this disease and its contagious characteristics. It was not until relatively recently, in the twentieth century, that a vaccine for tuberculosis was developed. Until that time, large urban cities struggled with methods of prevention, control, and treatment of the contagion. The social and political contexts provided for us by these readings allow us to fully appreciate the repercussions of tuberculosis outbreaks.

A few of the readings, particularly Connolly and Freudenberg, focus specifically on tuberculosis in New York City. In New York City, the first line of action was prevention of disease through adoption of aseptic techniques, such as pasteurization developed by French scientist Louis Pasteur, a policy spearheaded by reformer Nathan Straus (Connolly). This was just one of the many things American policymakers would pick up from the Europeans. Before John Seely Ward, board member of the Association of Improving Conditions of the Poor, learned about European sanitoriums, New York City’s public health enforcement required the compliance of parents in order to treat children. Meanwhile, in France in the 1880s and 1890s, legislation was enacted allowing the state to take custody of children in impoverished, immoral, or abusive households (Connolly). Though this policy seems like an encroachment of the state on individual affairs, the government believed that “the stakes were too high” to risk (Rothman). In France, and also Germany, children with tuberculosis left their homes for sanitoriums, where they were extensively cared for by nurses, consistently well-fed, and provided with adequate fresh air that doctors believed aided in their recovery. Here we again see miasma theory being supported, and not without reason. Sanitoriums worked wonders. Not only were children cured, but they enjoyed being with each other, no longer feeling alone or shunned because of their medical condition (Rothman). Connolly provides us with stories of miraculous recoveries that inspired Ward to emulate his own version of a sanitorium, “Sea Breeze”, in New York City. Sea Breeze received tremendous support from elites and the general public, both a cause and an effect of its continual success. There was always a waitlist of hopeful patients requesting beds at Sea Breeze. Many were financially supported by the “Christmas Seal” fundraising program, an idea adapted from a Danish postmaster (Connolly). The United States Public Health system repeatedly borrowed from European ideas and wisely selected polices and programs with proven positive results.

Reading about tuberculosis, we again encounter the recurring theme of social status as a factor of disease prevalence. When the economy experienced a dip in 1975, the financial crisis had profound effects on the public health sector. Cities and states cut funding to health programs, and the skyrocketing percentages of tuberculosis patients reflect the impact of these changes (Freudenberg). The poor no longer had access to health care services and became even more susceptible to tuberculosis. Interestingly, not only did socioeconomic status impact susceptibility, but race also played a measurable role. Achard and Boyle both noted that Black Americans were more likely to develop tuberculosis even though, during times of slavery, they appeared to be resistant. Boyle disturbingly refers to this as “the white man’s burden”. He goes on to say that it is due to “shiftlessness, ignorance, and poverty” and can only be treated by “disciplinary training of his physical, mental, and moral powers.” He seems to imply that their freedom contributed towards their sickness, with outrageous conclusions that have no basis in science or research. Tuberculosis itself also became a discriminating agent; diagnosed patients would have difficulty seeking employment (Rothman).  In essence, even cured patients, and the rest of New York City, were affected by tuberculosis for life. The tragic contagion was a learning process and a milestone in the development of the city’s Public Health department which, coupled with scientific advancements, culminated into successful decrease in tuberculosis rates today.

Tuberculosis–otherwise known as the White Plague or Pott’s disease–was an inevitable ticket to death in Europe during the 1650s; the combination of a dense population and and abysmal sanitary conditions served as a breeding ground for the illness. Evading the illness became the number one goal in the seventeenth, eighteenth and nineteenth centuries, and that fear of an early death vis-a-vis high fever and coughing up blood incentivized the Children’s Preventorium – “residential institutions for children,” as Cynthia Connolly defines it. These Preventoria were the early building blocks to rising above a society encumbered by fear of tuberculosis.

Given the societal conditions that allowed for the propagation of tuberculosis, the Children’s Preventorium, according to Connolly, “rescued” lower class children from the poor sanitary conditions in which they lived and fortressed them with “[blended] features of a hospital, sanatorium, and school, while endeavoring to imbue its patients with the values of an idealized middle-class life home” (Connolly 2). The method by which these children were secluded from the disease can be considered almost a reverse quarantine; but, instead of isolating the sick from society, the Preventorium isolated the healthy (a considerably smaller percentage of society) from the rest of the world, guaranteeing their safety and preventing an early, gruesome death. And–once again– we see in Connolly’s study that tuberculosis proliferated throughout the continent as a result of high population and poor living conditions. So, in a way, Connolly’s study echoes a common historical problem: a failure to recognize the relationship between illness and living conditions.

Similar to Connolly’s study, which centers on a particular group of people (children), J. Madison Taylor’s study focuses on the effect of tuberculosis on the African American community in the United States. His opening statement, “A rich man may get along with poor health and not suffer for essentials of life,” functions as the thesis statement for his article and paragons the recurring dilemma in our discussion of tuberculosis (160). In a way, he conflates poverty with color, and contends that “in order that the African American shall survive or even to maintain a fair measure of health, it is imperative that he shall keep out of the big cities and live in the open countries (162); thus suggesting that poor living conditions perpetuate the horrific disease. In addition to this argument, Taylor examines the traits of an African or African-American that make him or her more susceptible to the disease, such as “leaky skin” or the “wide nostril.” Taylor argues that is it necessary that the black population adapt to these weaknesses and learn how to cope with them to survive as a race. Despite Taylor’s discussion of narcotic drugs, it is striking that his implication of poor living conditions and disease parallels nearly every study we’ve examined thus far in this semester.

With that, I pose a question: Is the government entirely to blame for the proliferation of diseases such as tuberculosis? Certainly, they oversee the department of health, whose responsibility it is to ensure our safety; but, in the annals of American history, we see the department of health continually falling short of its duties to keep the population safe and the country’s citizens consequently falling victims to tragic deaths. (I realize that the United States isn’t the only country we’re examining, but for the sake of narrowing down conversation a bit, I’m gearing this question specifically toward the U.S.)

The reading that caught my attention, the most this week, was the reading about typhoid fever.  What it seems to me is that a doctor wrote it about the lack of science in public health.  William Budd writes about typhoid fever, which is a highly contagious disease cause by the Salmonella virus.  He describes his experience with typhoid fever in the introduction “How often have I seen in past days, in the single narrow chamber of the day labourer’s cottage, the father in the coffin, the mother in the sick bed in muttering delirium, and nothing to relieve the desolation of the children but the devotion of some poor neighbour who in too many cases paid the penalty of her kindness in becoming, herself, the victim of the same disorder!”  Everyone that came in contact with the disease seemed to be getting it.  After doing some research on typhoid fever, I learned that you can catch it even if symptoms have subsided, if it is not treated correctly.  So while people may have thought they beat the fever, it was still lurking.

William Budd then quotes what scientists think from the time ‘Much doubt prevails whether enteric (typhoid) fever be infectious or not, and the question really turns upon the existence of a distinct, specific poison.  Positive proof that it may be conveyed from one person to another is wanting, and certainly the majority of people affected with the disease derive it, upon the clearest evidence, from one and the same source.”  But this was clearly wrong as we now know that typhoid fever is highly contagious.  This reminds me of the previous reading dealing with the water pump, which stopped some outbreak of the disease but did not deal with the cause.

He then gives three reasons why contagion is widely ignored .

1. The first is, that medical writers, and especially those among them who exercise the widest influence, pass the greater part of their lives in great metropolitan cities -amid conditions, that is to say, under which, for reasons that will abundantly appear in the following pages, the operation of contagion in this particular fever is not only masked and obscured, but issues in a mode of distribution of the disease, which to the superficial observer would appear to exclude the idea of contagion altogether.

People living in crowded cities find reasons that are easier to explain than contagion.  Its easy to say that there is a common source, i.e. a water pump, then the esoteric idea of contagion.

2.  The great zeal with which during  the whole  period  of its existence,  the  General  Board  of  Health, backed by an  able and energetic staff and unlimited printing power, continued to urge anticontagionist doctrines.

This seems weird because in crowded cities contagion would run even more rampant but still it was overlooked.  Who knew how many lives could have been saved if we urged contagionist theories earlier.

3. The continued prevalence of very limited views as to what constitutes  evidence  of  contagion  or  self-propagation  in the case of disease.

The theory of what contagion was, wasn’t straightforward.

Budd constantly relates stories of how all the evidence pointed to contagion, the story of a dance/ball where everyone caught the fever but it was attributed to a water source that was contaminated.

Eventually we came to the conclusion that contagion does in fact exist and is a driving force in spread of disease.  However I think that, as science became more advanced, were able to develop the correct theories.

This week’s readings focused on the cause of diseases and a change in Public Health.  In “The New Public Health,” Hill describes a shift in the approach to prevent disease.  He says that Public Health includes fostering health and preventing disease and is divided into Hygiene and Sanitation, which are interdependent.  Hygiene deals with the individual, whereas Sanitation refers to the environment.  Hill presents misconceptions about diseases and how they are spread.  General good health may protect individuals from disease, but specific cleanliness can provide protection against each individual disease.  Hill points out that disease does not only inflict the poor, who are weak and lack good hygiene because if this were true, then all of these weaklings would have been killed off throughout the years and we would have a society of strong, healthy people, free from disease.  But this is not the case.  Anyone can be inflicted with a disease if it is present in the environment, as seen in “Typhoid Fever.”  Well-off guests, who had no prior health problems, attended a ball in town where about 1/3 of them came down with Typhoid fever.  The cause was contaminated water from a well close to a receptacle that received excretions from a person with the fever a few days prior.  These people had high health and would not have come down with the fever if they were not exposed to it through the water they were drinking.  Hill says that the New Public Health is concerned with the individual rather than the environment.  In the case of the people at the ball, New Public Health officials would have isolated the man that had the fever a few days earlier and found where he was excreting and taken care of the problem, which was the source of the other people’s illness.  Hill says, “Practical modern public health recognizes that the bulk of most of the infectious diseases are derived directly, or almost directly, from infected persons, not from infected things, except recently infected water, milk, food and flies,” which supports the theory that the people at the ball became sick from the infected water.  Hill also says that “the routes by which the discharges of the sick person pass to the well person are exactly those by which the same discharges pass from the well person to the well person in ordinary life.”  For example, in “Typhoid Fever” another incident occurred in a town that had a stream running through from the top of the hill to the bottom which contained normal waste.  A father from one of the cottages at the bottom of the hill became sick with Typhoid fever after doing business out of town and had diarrhea that was dumped into the common privy through which the stream flowed.  People in the cottages toward the bottom of the hill soon became sick with the fever as well, but the people living at the top of the hill were fine and healthy.  The waste flowing in the stream from the infected man had obviously contaminated the water that flowed down to the rest of the cottages.  Normal waste hadn’t made the inhabitants sick, but the moment someone dumped infected waste into the stream, people became ill.  It is interesting to read Hill’s points of view and see the difference in focusing on the individual rather than the environment.  Sometimes we may be too concerned with finding the original source of the disease in the water or earth, rather than finding the infected person whose bodily excretions are contaminating others.

“The Great Stink of Paris” showed the neglect that officials sometimes have during a Public Health issue.  In the summer of 1880 an overwhelming stench in Paris could be smelled for miles.  People complained of the disgust and discomfort they felt and some even vomited.  People wanted to know the cause and factors involved, but authorities were more concerned with other issues rather than the well being of the population.  Officials took vacations to get away, while people living there had to deal with the smell.  Newspapers put out stories about how the government was not solving the problem or taking responsibility.  When authorities began to take action, they were dismissive, defensive, and blamed one another.  There were confliction opinions, but they agreed that the foul odors were a threat to public health.  The health council formed committees  to examine the problem and report back.  Louis Pasteur was placed on one of the committees that concluded different things contributed to the Great Stink – soil, sewers, ventilation pipes, cesspits, waste dumps, and treatment plants.  The wind transported the odor throughout the city.  Some, but not all the odors were hazardous, but this was a problem that needed to be addressed.

I thought the experiment that Pasteur carried out with the sheep was revolutionary.  Healthy sheep were dying on a farm where twelve years earlier sheep that died from anthrax were buried.  Pasteur brought healthy sheep to the site, where no grass to eat was growing.  The sheep died from sniffing the ground, which proved that anthrax could live for at least twelve years and be present in the air.  Miasmatism gained some validation from this experiment.

This week’s readings all showed how complex science is and how many different theories and approaches there are to identifying, treating, and preventing diseases.

The prevailing theory during the cholera outbreak of 1854 was that infectious and contagious diseases were spread by a general miasma: a pollution of the atmosphere that became malignant when combined with the emissions of organic decomposition from the earth. The miasma theory was very appealing to English sanitary reformers. It explained why these fatal diseases were epidemic in the filthy and stinking areas inhabited by the poor. At the time, people believed in the miasma theory and protected themselves by inhaling sweet scented things. It was within this framework that Dr. John Snow was working and it would be another generation before Louis Pasteur and Robert Koch discovered that diseases were actually spread by germs.

One of the most famous landmarks in London’s medical history located on Broadwick Street is the Broad Street Pump, which was a pump in the center of the slums and rookeries in Soho in 1854. On September 8, 1854, the handle to this pump was removed on the instructions of Dr. John Snow so that water could no longer be drawn from it because Snow recognized the water from this pump was the source of the cholera epidemic in Soho.

As is often the case in medical and scientific breakthroughs, the stories created around them are not the way it was. The version of the John Snow story that we hear these days is that by removing the handle from the Broad Street pump, Snow saved countless lives in the middle of a cholera epidemic. By identifying the water in the pump as the contagion, he moved away from the original theories of miasma and air pollution to the more modern theory of germs, bacteria, and infection. Finally, that it was John Snow’s work became the main impetus for the extraordinary revolution in London’s sanitation that happened over the next decade.

What was groundbreaking about John Snow’s work was the statistical method behind it. He started plotting the locations of all the deaths in the cholera epidemic, and he discovered that nearly all clustered around water pumps, particularly around the pump on Broad Street. He then investigated the people who were living in the slums around Broad Street and found that the people least affected were the brewery workers because they were drinking beer, rather than water.

Although John’s statistical work was groundbreaking, the great moment of the pump handle removal had very little effect and it was rather largely symbolic. By the time he managed to persuade the officials to remove the pump handle, the cholera epidemic had nearly burned itself out anyway, so it is unlikely he saved any lives. In addition, the idea that his work was pivotal in the campaign to revolutionize London sanitation is unfortunately not true. Snow’s work, when he finally produced it, managed to garner little attention at the time. The supporters of the miasma theory were unconvinced by Snow’s findings due to the absence of an organism and the lack of conclusive experimental proof. While the organism (Vibrio cholerae) had been discovered in 1854 by Italian anatomist Fillipo Pacini, nearly all English scientists and physicians were unaware of his work.

In hindsight, John Snow’s work has been recognized as a very important contribution to a public health movement that had been growing in London since cholera had arrived in the early 30’s. The real significance of John Snow story is that it is the birth of epidemiology and statistical analysis, and it shows how many lives you could potentially save and how you can improve conditions with proper statistical surveys. Of course this is something we recognized clearly now but was not recognized at the time. Therefore, although John Snow went on to make other medical discoveries, he never really lived to see his work on the Broad Street pump come to any practical fruition.

London provides an example of how useful a wrong theory (miasma) can be for addressing an epidemic (improvement of air, solid waste and water supplies). While the sanitary reforms following the miasma theory were effective at containing cholera, full acceptance of the scientifically valid germ theory would have saved even more lives.

Chhada Nathan Kabariti

Frederick Engels’ life has some connection to his writing. As a young teenager, his father pushed him to join the business world and to reject the political ideas Engels kept thinking and writing most of his articles about. Instead, Engels continued writing and publishing articles and opinions over time despite what his parents wanted. There was even a letter sent by his mom begging him to stop his continued publications and return to the business world his father wanted him to join all this time. However, Engels was quick to reject that world and rebel against his parents’ wishes. I believe he identified with the working class’ oppression by the bourgeoisie mentally, physically, and morally.

In the selected text for this homework, Engels describes the environment the working class had to endure. The feces that were not properly disposed of were thrown on the streets, piling up to the point where they were disease breeding grounds. The cramped rooms with a dozen living in one room also led to perfect places for diseases to be rampant and spread. He also cites various medical physicians and sources that strengthen his argument that the poorly ventilated air led to many lung diseases for the working class. He continues to describe other diseases like scurvy and rickets that he shows to be linked to the malnutrition and food deprivation most kids were prone to.

Mainly, he pushes for the idea that the upper class, or property owning class, can be held responsible for many of the ailments and diseases that are rampant among the working class. Were it the steady loss of hope, their unfortunate child death accidents, their resorting to stealing or suicide, or their resorting to liquor for consolation, the upper class are to blame for their choice of how to educate the working class, how to set up the homes and infrastructure, and the amount of work they place on the working class.
Engels once said “To get the most out of life you must be active, you must live and you must have the courage to taste the thrill of being young … ” (1840), and I believe he spoke up for the working class because he felt they weren’t being allowed to get the most out of life. Their opportunities to taste the thrill of being young were being prohibited by the property-owning class. Engels spoke up for others most of his life and fought for revisions for the sake of public health. It is therefore unfortunately ironic that he passed away from throat cancer.

Chhada Nathan Kabariti

During the 19^th century, several chemists/biologists contributed a great deal to the advancement of modern day medicine. The basis for the advancement of medicine lies primarily in the discovery of the causation of disease. The contagion theory stipulated that disease spread through contact and was largely active in dense populations. Similarly to most nascent theories, the contagion theory had very little to no support of its stipulation. In A History of Public Health, Rosen states that the first discovery of support of the Contagion theory involved silkworms.

Agostiono Bassi and his work involving silkworms truthfully demonstrated the cause of the silkworm disease. He was able to successfully identify a fungus as the disease -causing agent. This discovery further bolstered the validity of the Contagion theory. Bassi was able to make significant conclusions in the causations of smallpox, cholera, and other deadly diseases. There were many other experiments that involved the presence of microorganisms and deadly diseases. One of these cases involved anthrax and animals. One of the leading figures in this discovery was Casimir Davine. It was through his insistence and experiments that the cause of anthrax was focused on to rod- shaped bodies, bacteria.

At the same time, the germ theory was not a widely accepted hypothesis. The theory could not explain the origin of many known diseases and was thus seen as a dead hypothesis. Discoveries made by Louis Pasteur concerning fermentation and spontaneous generation served as an impetus for the recrudescence of the germ theory. Louis Pasteur was able to disprove spontaneous generation through his studies of rotten meats and fermentation. He was able to show that the presence of certain organisms could account for the disruption of proper fermentation processes. Pasteur demonstrated that organisms did not spontaneously arise from the air but from other organisms as seedlings.

Robert Koch was another important contributor to the development and acceptance of the germ theory. His experiments with anthrax and the blood of sick cattle proved the transmissibility of the disease. Furthermore, he was able to observe the growth and development of the bacteria in infected organisms.

Along with these epidemiologists, Ignaz Semmelweis made important contributions to the development of modern day medicine. Semmelweis studied childbed fever. His interest in childbed fever was due to inexplicable patterns he observed in two different maternity hospitals. One of the two clinics had a much higher death rate then the other clinic. There were several hypothesized causes of this but all were disproved because these factors were present in both clinics. Semmelweis noted important facts surrounding childbed fever. He was able to point out that women who delivered on streets were less likely to die from childbed fever than those who delivered in the clinics. It was through the death of an influential figure in Semmelweis’ life that he was able to pin point the direct cause of childbed fever. Semmelweis realized that the cause of childbed fever was due to the presence of cadaverous particles on examiner’s hands. The disease would be transmitted during examination of a women’s genital area. He was able to eradicate these particles by requiring the examiners to wash their hands with a chlorinated solution. This would prevent the transmission of the particles to the women during examinations. Semmelweis was also able to explain differences in mortality rates of women who entered the clinic after giving birth, and those who were in labor. The discrepancy in the mortality rate is caused by the lack of examinations of women who already went through labor.

Ultimately, many epidemiologists can be accredited for the rise of the germ theory and the revision of the contagion theory. Bacteriology provided the means of improving the understanding of disease and its causation. This enhancement led to the development of modern day medicine.

This seminar is meant to teach us about the shaping of public health in NYC and other places in the world. The more assigned readings I read, the more I realize how significant the public is in the shaping of its health.

This week’s readings discussed the cholera epidemic that started in India and left a trail of buried people as it crossed borders around the globe. The readings explained how the epidemic killed so many.

In 1832, NYC was a booming city with immigrants from all over the world. The immigrants often lived in crowded neighborhoods with very poor sanitation and animals walking in the streets. One person would drink water that another had used to wash clothes which another had used to relieve himself. Human and animal waste was left to pile up in privies/outhouses which were right near the tiny rookeries people inhabited. Suffice it to say, I wouldn’t wish the living conditions upon my worst enemy. The poor immigrants and blacks could not do anything to escape the overcrowding of the inhabitable cities. On the other hand, the upper class found it easier to move out to the open rural areas where they was a cleaner atmosphere and they were less susceptible to disease. The point is, however, that the living conditions in NYC were not any better than the conditions, the location the film “Cholera Can be Conquered” identified as the source of the cholera bacterium.

To make matters worse, some Americans during the Era of the Common Man believed they wouldn’t contract cholera because it was a punishment for the dirty poor people who led immoral lives. The Many Meanings of Cholera shows that people believed cholera was attracted to the evil in these people’s bodies and it could never harm the pious moral individuals. This explanation was favored because it established moral superiority and even led some to promise relief from cholera if one was converted. Others viewed cholera as a display of God’s power over man and regarded the epidemic as a humbling experience. Still, others blamed the politicians and city leaders for allowing an unequal society to emerge.

Surprisingly, many physicians at the time did not believe that the acute symptoms of cholera which included: sunken eyes and cheeks, body tremors, dehydration, wrinkling of the hands and feet, excessive vomiting, violent diarrhea, and death were caused by a single biological entity. They did not attempt to think of a scientific explanation for the epidemic. Rather, they believed the city’s poor atmosphere along with preexistent individual factors was what caused many people to feel healthy at breakfast but be buried before dinner. Many physicians really believed cholera was meant to cleanse evil that they even rejected the notion that they could get infected and dove straight into cholera nests with many different treatment plans designed to rid the cholera patient of his/her impurities that the cholera found so attractive. Obviously, many physicians then became infected and lost their lives.

The City’s Response explains that NYC’s legislative branch, the Common Council, created the Board of Health in 1805 after the yellow fever epidemic to report on public health. The problem was that the Board of Health was nearly inactive until the cholera epidemic. Most of its quarantines were removed or breached due to pressure by the city’s merchants. The board did not even consist of doctors who could help in the public health decisions. A different council called the Special Medical Council was created to fulfill that purpose but it only consisted of seven physicians. To aid the city cleaning, the board attempted to house the poor but these homes were not any better, and sometimes worse, than the city’s rookeries. As the epidemic worsened, the Board of Health specified a method for the disposal of corpses, and tried to raise money to open more than just five hospitals.

Before the epidemic, the Board did not accomplish much after the yellow fever epidemic subsided. During the epidemic, the Board was still not used to its full potential by the city leaders and physicians. After the 1832 epidemic, the Board’s activities returned to the minimum level they were before and it wasn’t active again until cholera reappeared in the epidemic of 1849.

The lesson from the cholera story is that if city leaders and physicians accept a public health problem, it ends up affecting people much worse than if they were to work together to form a solution. In the reading, Cholera and Medicine, it says “Due to a lack of understanding, medical knowledge could do little to limit the impact of cholera in 1832”, but I believe it should say “Due to physicians’ bias, medical knowledge…” because physicians did not approach the cholera epidemic with the correct mentality. Instead, they attached social meanings to the cholera epidemic that supported their own pre-existing beliefs while ignoring alternate explanations until it was too little, too late. That’s just sad.

Chhada Nathan Kabariti

The individual is dehydrated, has sunken eyes and cheeks, wrinkled hands and skin, body tremors, nausea, cramps, and projectile vomiting, and he or she ultimately dies in about twenty-four hours or less.

What exactly was the disease that caused in humans all of these and more? In the 1830’s New York City was forced to face public health’s worst nightmare – cholera. In the U.S. Navy’s brief film Cholera Can Be Conquered, we learn that cholera is a contagious disease that originated in India, which comes as no surprise. Overpopulation, squalor, and filth plagued the country long before the 1800’s, and the same water was used for drinking, bathing, and getting rid of waste. The water was then pumped back into the streets of the cities, where food was sold daily. India created a prime environment for cholera to not only plant its roots but also to continue to spread. Countries such as France and the United States (New York City specifically) were hit hard with the cholera epidemic and thousands died as a result.

In France, public health in the early to mid 1800’s was largely influenced by Louis René Villermé, a French hygienist who initially served as an army surgeon. Villermé studied what Coleman in Death is a Social Disease: Public Health and Political Economy in Early Industrial France called “social diagnosis,” meaning that he often did numerical work and wrote a lot about issues in society. One of his works in particular deals with the cholera epidemic of 1832. In it, he explored the disease as it occurred in both the luxurious lodging houses and the slums of France, for it was believed that the likelihood of becoming ill with cholera had to do with one’s economic status (link between poverty and disease). In other words, the poorest individuals who lived in the filthiest of conditions were the ones who suffered from cholera the most. Nevertheless, hundreds of French citizens were dying everyday.

Like France, New York City also lost many of its citizens to cholera. During the 1830’s, the city was overcrowded and flooded with immigrants. Many lived in dirty, dimly lit apartments that reeked of horrible odors. The outhouses, called privies, were shared by several families and were places for the waste to be collected…and hardly ever emptied. In The Cholera Years: The United States in 1832, 1849, and 1886, Rosenberg notes that pigs, goats, and dogs were found running in the streets and were the cities own personal street cleaners. Also like France, cholera tended to strike New York City’s poor and working class neighborhoods the most. Efforts were taken to try and control the epidemic, such as quarantine and attempts to purify the city that came a little too late, but the disease continued to harm all in its path.

Overtime, effective treatment methods for cholera have been found (the injection of blood plasma, for example), and there has not been a case of cholera in years. While public health has put that issue to rest, there have been many others to deal with since then. In Chapter 2 of Colgrove’s Epidemic City entitled “Public Health and the People,” three issues that New York City faced in the 1960’s and 1970’s were the poisoning of children due to lead based paint, the increasing heroin addiction associated with crime and theft, and NYC’s switch from a rigid to a more liberal stance on abortion. The issues are different from cholera in 1832 in that they are representative of a different, more modern society. However, they are the same because the link between poverty and disease is still present. Children who are eating the paint off the walls and are falling out of windows and fire escapes more often than not come from lower class families. Most of the individuals addicted to heroin were poor males who constantly committed crimes to fund their addiction. Whether it is cholera in 1832, the problems faced in the 1970’s, or the issues of the future, public health will always be needed in order to promote the overall health and well being of society.

News of a rampant disease was spreading from country to country, issuing a state of disbelief and worry. A chain of questions and answers spiraled out of cholera, and it alerted places worldwide that public health needed greater attention.

Cholera could not be restrained, being that it could attack in any season whether cold or hot. Industrialization had been under way, and public health had not yet accommodated for this new change in society; thereby leaving the perfect, filthy environment for cholera to spread its deathly wings. Its victims would be laid to rest within 24 hours, sometimes less. People worldwide were desperate to know whom this disease would claim as its prey, and how they could best protect themselves.

The Cholera Years by Rosenberg provides a number of theories that developed in New York alone, before and after cholera had even struck. Americans were rather confident that they would be impervious to the disease. They believed that none of its people were as inclined to get ill in comparison to those residing in the slums of Europe. America was a democracy populated with the freest people across the globe, and therefore, they were also supposedly the freest from disease. However, New Yorkers all agreed that the city was filthy, and they were in dire need of a substantial water supply to clean it up. The Atlantic would provide enough time for them to make a cleanly and unlivable environment for cholera’s arrival, or so they thought. Quarantine was issued and the streets were cleaned, similar to the measures taken by France to prevent the outbreak of cholera. And like France, this wasn’t enough to keep cholera from targeting America.

People now said that God deliberately plagued sinners, in an attempt to rid the human population of these people in particular. Authorities were recommending that people engage in prayer to prevent cholera, so this would inevitably bring up the political issue of separation of church and state. However, why would God help those who only sought him when they were in need? This reflects the lack of preventative measures in society, which in turn drew people without true faith to the “highest” power for any sort of help. In addition, the poor and the immigrants were deemed more likely to get ill. Statistics would prove this theory true, but it wasn’t those peoples’ natural tendency to get ill, but it was the poor conditions in which they were living. Filthy, crowded, and unable to run to rural areas, the odds were against the poor and the immigrants.

After all the struggle and devastation presented by Rosenberg’s narrative, Cholera Can Be Conquered progressively illustrates the movement toward the cure of cholera. For the first time ever, blood plasma was injected into humans. In addition to the discovery of the beneficial effect of sulfadiazine in terms of the disease, cholera was finally, after ten years, no longer a threat to America.

Cholera was an epidemic that revisited more than once in the nineteenth century, and medical professionals along with average people endlessly searched for a cure, some-one/thing to blame, preventative methods, anything. In contrast, Colgrove in Epidemic City offers a description of the new “cure” for narcotic abuse, methadone, and all the controversy that emerged from it in the 1960’s. So decades later, we have the solution to a problem and yet we still have more conflicts to solve. The main problem was whether drug abuse should be considered a crime or an illness. The government did not know how to adequately address this issue without first deciphering how to categorize it. Communities feared that Newman’s expansion of the methadone programs would promote drug use even more, and that their neighborhoods would suffer from it. In essence, whether we’re talking about the past or the present, or about an intestinal disease or an addiction, it all comes down to the fact that public health issues affect everything: politics, lifestyles, mentalities, and people.