Group Members

Ginni Oldner-Leader; Kelly Fisher-Assistant Leader; Misty Bass-Technical Support; Researchers: Heather Finlay, Joe Fiamoncini, Leslie Stuart, Sonya Arguijo-Frederick, Kamey Jolley, and Mabruka Yazidi



Monday, April 19, 2010

Life in the City

During the 19th century, there was a shift from country to urban city life as our nation entered in to the industrial revolution. For many, city life was synonymous with skyscrapers, lights, action, opportunity and romance . However, many of the incoming immigrants were forced to join the urban poor , living in overcrowded and unsanitary conditions . This unfortunately led to repeated outbreaks of deadly diseases such as cholera, tuberculosis, typhoid fever, influenza, malaria, yellow fever and small pox. For millions, city life meant slums, crime, poverty , disease and death. (Contributed By: Ginni O. and Kelly F.)

“The cities stank. The air stank, the rivers stank, the people stank. Although public sewers were improving, disposing of human waste was increasingly a problem.” “Trash collection had not yet been systemized. Trash was dumped in the streets or in the waterways”. “Almost 25% of babies born in late-19th century cities died before reaching the age of one.” (U.S. History)

We will be discussing a few of these diseases below, including inception, management and potential eradication. (Contributed By: Ginni O. and Kelly F.)

Tuberculosis (TB)

In 1900, one of the leading causes of death was from tuberculosis (TB). Combined with diphtheria, pneumonia and enteritis, it was responsible for over 30 percent of all deaths during this time. Of these deaths, over 40 percent were children under the age of 5. (CDC, 1999) (Contributed By: Ginni O. and Kelly F.)

Tuberculosis, also known as phthisis, scrofula, bronchitis, hectic fever, gastric fever, lupus, the great white plague or consumption, can be traced as far back to 5000 BC. It was said that Columbus brought the disease to America in 1492 (Winterer, 2007). Throughout the years it claimed many lives and was extremely hard to diagnose. The disease traveled from New England to the Midwest with the industrial revolution, and then to the west by 1880. By 1882 TB was running rampant throughout North America killing nearly one in seven people (Winterer, 2007). (Contributed By: Leslie S.)

With the discovery of the organism and the invention of the x-ray, TB was more easily identified and monitored closely. A skin test was also discovered to identify people that were infected. A sanatorium movement then began in 1886. Patients suffering from TB were placed in overcrowded long term facilities known as a sanatorium to receive better nutrition and rest (Croft, 2005). Along with better infection control, a sanatorium was the treatment of choice for TB at this time before antibiotics were discovered in 1944 (Winterer, 2007). By 1889 it was discovered that the diseased was preventable, and a committee was formed called The National Association to the Prevention of Tuberculosis (NAPT) to educate the community. Their main focuses were better nutrition, fresh air, and clean drinking water. People were also taught not to overcrowd their homes, and not to overwork (Croft, 2005). The NAPT committee soon realized that their main problem was poverty, and that was a much bigger issue to tackle. (Contributed By: Leslie S.)

An uproar began in 1892 when Dr. Herman Biggs implemented mandatory reporting of all TB cases. Dr. Biggs wished to better educate the public on the disease and properly isolate those that are infected. He wanted to analyze their sputum, and have the health department visit their homes. Many physicians thought that this violated their patient confidentiality, and did not adhere to the mandatory reporting for several years. Eventually, Dr. Biggs ideas created a platform for TB control programs (Winterer, 2007). (Contributed By: Leslie S.)

It was not until the mid 1900’s that the public became more aware of this disease. With better education, antibiotics, and the governments help to reduce poverty the number of cases began to decrease. (Contributed By: Leslie S.)

It wasn't until the Progressive Era that people actually knew TB was caused by a germ. Until then they had thought it was a hereditary disease. TB was actually declining during the progressive era but it still proved a major health risk. TB accounted for one out of every ten deaths and particularly targeted young adults. TB spread fast in the unsanitary tenements found in big cities. You'd find people cramped together, whole families living in one small room with no running water. If one person in the family had TB they'd all become carriers. (Tomes,1998) (Contributed By: Mabruka Y.)

There was no cure and the only treatment seemed to be long and expensive stays in a sanitarium, but even then most people just died. Public health department teamed with various other anti-tuberculin groups and created a major campaign to fight the disease through education and prevention. The anti-tuberculosis movement was the first big public health movement, and groups like Easter Seals and Christmas Seals led the way in campaigning. They were so successful in their campaign that other health related organizations copied them for years to come. They started with pamphlets which were common for those days. They found only TB victims and their families were really the only ones reading them. They need to find a way to reach the people living in the cramped tenements who necessarily couldn't read English that is if they could read at all. Posters were placed that promoted personal hygiene as being a major factor in preventing TB. Once film started getting big the health department hired directors to create movies about the consumptives plight in order to educate the pubic further. (Tomes, 1998) (Contributed By: Mabruka Y.)

Smallpox

Smallpox is an infectious diesease, caused by 2 virus variants-Variola major and minor. It localizes in small blood vessels of the skin and in the mouth and throat. It starts as a rash, and later becomes raised fluid-filled blisters. The mortality rate of V.major is 30-35% and V.minor is about 1%. Transmitted from person to person, usually by respiratory droplets or through direct contact with body fluids. Contaminated clothing or bedding might also transmit the virus. It’s not known to be transmitted by insects or animals. In the US during 1843-1855, first in Massachussets, then the other states, vaccines for smallpox became a requirement. By 1897, smallpox had been eliminated. (Contributed By: Heather F.)

The history of smallpox is a story of hardship leading to modern medical success. The origin of smallpox is believed to have been in Africa thousands of years ago. The first recorded smallpox epidemic was as early as 1350 BC (Brannon, 2004). The demise of smallpox began with a technique called variolation and then led to the “vaccination.” An English physician named Edward Jenner, in 1796, experimented with inoculation of an 8 year old boy with fluid removed from a cowpox pustule. The treatment was introduced after he realized that milkmaids that developed cowpox, did not develop smallpox (Brannon, 2004). The inoculation worked and Jenner called the treatment “vaccine” from the Latin word “vaca” which means cow (Brannon, 2004). (Contributed By: Sonya A.)

Vaccination against smallpox began around 1800 but mandated vaccinations did not occur until the last decade of the century. Smallpox greatly decreased in New York City in 1875 from 1200 cases to approximately 6 cases in 1909 (Engs, 2003). The vaccination mandate proved to be a success although some groups continued to oppose the vaccinations and therefore led to a few cases. (Contributed By: Sonya A.)

Interesting Facts:
Abe Lincoln was diagnosed with a mild form of smallpox in late November of 1863. Lucky Luciano contracted smallpox at the age of ten in 1907, while traveling to New York from Sicily. (Contributed By: Heather F.)

Cholera

Cholera is a disease that emerged from the filthy waters and living conditions in Calcutta, India in the 1800s. It is caused by the bacterium vibrio cholerae. The most notable characteristic of the disease is violent, watery diarrhea accompanied by vomiting. These symptoms ultimately lead to extreme dehydration, a damaging loss of electrolytes and if left untreated death is imminent. (Contributed By: Kamey J.)

Typical transmission occurs from contaminated drinking water or food; not from person to person. In today’s society with such advanced technologies and proper methods of sanitation cholera is no longer a threat except in the developing countries. The threat here can be blamed on the unsanitary living conditions and contaminated water. These factors can be attributed to the lack of technologies and sanitation procedures listed above. (Contributed By: Kamey J.)

This was the case as well in life in the city in the 19th century and early 20th century. The age of Industrialization caused many people living in the jobless rural areas in America to travel to the urban cities for jobs. Industrialization idealized America as the “land of opportunity.” This allure is what led many immigrants to travel to the cities as well. The cities soon became overpopulated with as many as 10 or more people dwelling in the already inadequate housing. (Contributed By: Kamey J.)

Waste management in those years was poor at best, but usually nonexistent. Waste would run down the middle of the streets, exposes. Once cholera was introduced into the waste system, it was easy for the drinking water systems to become cross contaminated; and once the water system was comprised, neither poor nor rich were spared. (Contributed By: Kamey J.)

In the United States alone eight cholera epidemics struck the United States between 1832 and 1873. The most deadly was an epidemic in New York City in 1848 and claimed the lives of more than 5,000 people. Epidemics and sporadic outbreaks continued into the early 20th century. (Contributed By: Kamey J.)

Although cholera was a public health problem in the United States and Europe a hundred years ago, modern sanitation and the treatment of drinking water have virtually eliminated the disease in developed countries (MedicineNet.Com, 2005). During the late 1800’s, the link was made between filthy water and illness, such as cholera. During the industrial revolution and the Progressive Era, more and more people crowded into the cities of America in search of work; subsequently, the accumulation of human and animal waste contaminated the water supply. The large cities began creating ways to make their water cleaner (New York City Department of Environmental Protection, n.d.). (Contributed By: Joe F.)

In 1892, the New York City Department of Health opened up a laboratory that dealt with different bacteria. This was led by Hermann Biggs (who was one of the scientists who isolated the cholera bacteria), and became the first city run laboratory in the world to diagnose disease as one of its main purposes. In 1892, that laboratory used scientific method to recognize cholera on a ship carrying immigrants to the New York harbor. This helped the city to take preventative measures to quarantine the immigrants and stop another cholera epidemic in the city (New York City Department of Health, p. 21). (Contributed By: Joe F.)

One of the reforms of the Progressive era that specifically helped the living conditions of the working poor in New York was the 1901 Tenement House Act. This was the most extensive of the Tenement House Act (Dolkart, Part 1), requiring improvements in ventilation and light and requiring indoor toilet facilities (and the removal of all outhouses from the tenement yards) (Dolkart, part 6). It required changes not only to new housing built, but also to already existing buildings. Of course, landlords were not happy about having to take on the costs of the remodeling, so eventually some compromises were made (Dolkart, Part 2). Among them was the legalization of “second interior rooms as long as they had sash windows cut into the partitions,” no longer requiring a costly air shaft to be constructed. These changes occurred after an amendment to the act was passed in 1903 (Dolkart, Part 5). (Contributed By: Joe F.)

The efforts of Jacob Riis must be acknowledged in his exposure of the state of the New York's water supply. Below is a quote from his story “Some Things We Drink" that was published on August 2, 1891 in the New York Evening Sun, including six photographs that have since been lost. (U.S. History) (Contributed By: Kelly F.)


“I took my camera and went up in the watershed photographing my evidence wherever I found it. Populous towns sewered directly into our drinking water. I went to the doctors and asked how many days a vigorous cholera bacillus may live and multiply in running water. About seven, said they. My case was made.” (U.S. History) (Contributed By: Kelly F.)


In 1900, Chicago finished a canal, controlled by locks, to dispose of Chicago’s waste waters. Over the next 10 years, engineers extended canals to remove the wastewater filth of the surrounding Chicago suburbs (Chicago River History, n.d). (Contributed By: Joe F.)

In 1904, New York City created the Metropolitan Sewerage Commission. The commission made studies of the city’s water supplies, as well as the harbor’s “natural flushing action”, in order to create a plan for wastewater treatment plants (New York City Department of Environmental Protection, n.d.). One of the first was the Jamaica Bay plant (in Queens, NY), first operated in 1903. A much more recent photograph of the Jamaica Bay plant is shown here (New York City Department of Environmental Protection, n.d.). (Contributed By: Joe F.)

The interest in containing cholera was not just held by city officials. Here is a picture of a magazine that not only publishes poetry, but also the latest social interests of the day, including cholera (The cosmopolitan, 1893). (Contributed By: Joe F.)

In conclusion:

In the 20th Century, infectious diseases declined tremendously. It is important to remember that this was in direct relation to the 19th century discovery of microorganisms that caused many of these diseases, such as tuberculosis and cholera. The discovery of antibiotics, vaccinations, along with improved water and sanitation systems played a huge role in disease control. (Contributed By: Ginni O. and Kelly F.)

The accomplishments of the 19th and 20th century have formed the foundation of our current disease surveillance and disease control in our nation today. (CDC, 1999) (Contributed By: Ginni O. and Kelly F.)

References:

CDC (July 1999), Achievements in Public health, 1900-1999: control of infectious diseases, retrieved online April 4, 2010 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829al.htm

CDC (July 2009), Achievements in Public health, 1900-1999: control of infectious diseases, retrieved online April 4, 2010 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829al.htm

Winterer, Kerry T. "History of Tuberculosis." Nebraska Department of Health and Human Services. http://www.dhhs.ne.gov/cod/Tuberculosis/TBHistory.htm (accessed April 2, 2010).

Croft, Neil, and Janet Croft. "The History of Tuberculosis." Welcome to Micklebring. http://www.micklebring.com/oakwood/ch18.htm (accessed April 2, 2010).

Brannon, M.D., Heather (2004). The History of Smallpox: The Rise and Fall of a Disease. About.com. Dermatology. Retrieved April 8, 2010, from http://dermatology.about.com/cs/smallpox/a/smallpoxhx.htm

Engs, Ruth C. (2003). The progressive era’s health reform movement: a historical dictionary. Connecticut: Praeger Publishers. http://www.upmcbiosecurity.org/website/focus/agents_diseases/fact_sheets/smallpox.hml

http://www.bt.cdc.gov/agent/smallpox/overview/disease-facts.asp

“Cholera: Tracking the First Truly Global Disease.” National Geographic News. 8 April 2010 http://news.nationalgeographic.com/news/2004/06/0614_040614_tvcholera.html

Dolkart, A. (n.d.). The 1901 tenement house act. (Parts 1-6). Retrieved April 13, 2010 from, http://www.tenement.org/features_dolkart.html

“King Cholera.” USGenNet. 8 April 2010. http://www.tngenweb.org/darkside/cholera.html

U.S. History, The Underside of Urban Life, retrieved April 2, 2010 from http://ugh-ms1/exchweb/bin/redir.asp?URL=http://www.ushistory.org/us/38b.asp

How the Progressive Era Cities Adopted to the Needs of its Residents Chicago River History. Retrieved April 9, 2010 at http://www.inficad.com/~ksup/chiriver.html

New York City Department of Environmental Protection. (n.d.). Cleaning the water we use: Protecting the environment we live in New York City’s wastewater. http://www.nyc.gov/html/dep/pdf/wwsystem.pdf

New York City Department of Health. ( n.d) Protecting public health in New York City: 200 years of leadership. Retrieved April 10, 2010 from, http://www.nyc.gov/html/doh/downloads/pdf/bicentennial/historical-booklet.pdf

MedicineNet.Com (2005, August 31). Cholera. Retrieved on April 4, 2010, from http://www.medicinenet.com/cholera/article.htm

The Cosmopolitan: An illustrated monthly magazine. (1893, August). Contents: How to make a city cholera proof. Retrieved April 8, 2010, from http://www.nlm.nih.gov/exhibition/cholera/images/101164357.jpg

Tomes, Nancy, 1998 The gospel of germs : men, women, and the microbe in American life / Nancy Tomes Harvard University Press, Cambridge, Mass. :

Images:

http://theboweryboys.blogspot.com/2009/12/jacob-riis-not-so-rockin-sane-new-years.html

http://www.hsl.virginia.edu/historical/medical_history/alav/assets/car_dontspit.jpg

https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjE0xTtbxt7-uZEJK722S4DruYIXnlXDq8OX4RUFYZ5CmfV39-bqaRYC2XiPiiNA81oCVaw2-nqt5wZv37nddXQ-s3-UEhxkEBppkgo2txVJgspsjDKitnUYokSu45IvnhypBRhNEPQW0xK/s1600-h/blog+xmas+seals+1934.JPG

http://www.clinicalcorrelations.org/wp-content/uploads/385px-TB_poster.jpeg

http://www.timbratcher.com/IMAGES_HAZELIP/PLACES/PL-WAVERLEY-HILLS-SANATORIUM-PATIENTS.jpg

http://www.hsl.virginia.edu/historical/medical_history/alav/assets/Biggs.jpg

http://www.logicalimages.com/publicHealthResources/smallpox.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/

http://people.virginia.edu/~sfr/enam312/1890pic.jpg

http://www.freewebs.com/mpb1/Hester%20street%201900.jpg

http://www.schoolshistory.org.uk/IndustrialRevolution/images/Street1a.jpg

http://www.cbc.ca/gfx/images/news/photos/2008/05/09/cholera-cp-2031106.jpg

http://lgimages.s3.amazonaws.com/data/imagemanager/8936/cholera1873.jpg

https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEmdauqwu0oZpqpof-x1ZAtjX40fZpPbkTqHufYjptOwBTWU8f1Wn218mKbQHRCYnNkgJdcrpJTacG1Sv454eGaoDw3wLBUA4lA4hJDTm3HFC2SD43yv_Lfqi7EOy7Lfad7Wpzej_iuw4/s1600/cholera-717999.bmp

http://www.nyc.gov/html/dep/pdf/wwsystem.pdf

http://www.nlm.nih.gov/exhibition/cholera/images/101164357.jpg