Largewavesofimmigrationinthenineteenthcentury,madeNewYorkCityAmericaslargest

andmostdiversecity,butalsoitsmostunhealthy,asthelargespikeinpopulationmadeit
moresusceptibletodisease.((FilthyCitiesIndustrialNewYork(video):
http://www.youtube.com/watch?v=Wy_ynQtguvY
))Comparedtootherlargeurbanareas,
suchasBostonorPhiladelphia,NewYorksdeathrateduetodiseasewasconsiderably
higher.((EvelynnHammonds,InfectiousDiseasesinthe19thCenturyCity,
Workshopsin
AmericanHistory:DiseaseandHistory
.AnnenbergFoundation,2001))Itwasnotuntilthe
middleofthecenturythatNewYorkersrealizedthattheirpoorlivingconditionsmightbethe
causeofthecityspoorhealth.Bythe1840shighratesofdiseasewereascribedtothe
housingmanyofNewYorkspovertystrickenimmigrantslivedin.Fearspreadthatwhile
diseasewasrootedinthepollutedlivingconditionsofNewYorkspoorercommunities,
diseasecouldeasilyspreadtothemorewelloffcitizenstoo.Publichealthofficialsrealized
thatthecityssoiledstreetsandpollutedsewerswereahealthrisktoallNewYorkers.
((Hammonds,InfectiousDiseasesinthe19thCenturyCity))Inthemidnineteenthcentury,
NewYorkpossessedaprimitivesewagesystem.Poorlyplannedsewersspannedthecity,but
mostcitizenshomesdidnotconnecttothesepipes.Instead,mostNewYorkersreliedon
outdoorouthousesandprivies.Theseouthouseswereusuallypoorlymaintainedandcovered
infilth.Poorerfamiliesdidnotevenhavetheluxuryofanouthouse.Theysimplydugasmall
trenchintothegroundoutsideoftheirhomes.Trenchesandouthouseswerebothunsavory
solutionsaswastewasrarelyremovedfromthemandfrequentlyflowedintothestreetsofthe
city.((
ibid
.))
Becauseofthehighlevelsofunmanagedwaste,epidemicsofinfectiousdiseaseswere
commonplaceinNewYork.((IndustrialRevolutionAgeHospital
(photo):
http://cdn.dipity.com/uploads/events/28bcea9c15f6687892f22d05bd2365bf_1M.png
))

Thecitybattledoutbreaksofsmallpox,typhoid,malaria,yellowfever,cholera,and
tuberculosis.In1849,arashofcholerastruckthecity,killingmorethanfivethousand
people.Awaveoftyphoidinthemid1860sresultedinasimilaramountofdeaths.
((Hammonds,InfectiousDiseasesinthe19thCenturyCity))Portcitiesandtransportation
hubs,likeNewYork,wereespeciallypronetooutburstsofinfectiousdiseasesbecauseofthe
highvolumeoftravelersthatpassedthroughthecity.Cholera,forinstance,wasnevera
probleminNewYorkuntiltheoverseasshipmentofgoodsandpersonsbetweenAsiaand
NewYorkdrasticallyincreasedinthemidnineteenthcentury.((
ibid
.))

Theseepidemicswereparticularlydeadlytochildren.In1840,almosttwopercentofNew
Yorksnewbornsfailedtoreachtheirfirstbirthday.Especiallyinthesummermonths,infants

andchildrenwereextremelysusceptibletodiarrhealdiseases.Theseinfectionsledtosevere
dehydrationandfrequentlydeath.((
ibid
.))Youngadultsalsofacedmanyhealthrisks.
Between1840and1870,nearlytwentyfivepercentoftwentyyearoldsdidnotmakeittothe
ageofthirty.Peopleintheirtwentieswereoftenthemostexposedtoinfectiousdiseases
becauseofthelonghoursanddirtyconditionstheywereexpectedtoworkin.((
ibid
.))The
highdeathrateforchildrenandyoungadultsalsohadanimpactonhownineteenthcentury
parentsplannedtheirfamilies.Urbanfamiliesrealizedthatmostlikelyatleastoneoftheir
childrenwouldnotreachtheageoffive.Itwasevenmoreunlikelythatparentswouldhave
mostoftheirchildrensurvivetheirtwentiestohavechildrenoftheirown.Asaresult,many
workingclassfamiliesadoptedasenseoffatalismandplannedonhavinglargefamiliesso
thatatleastsomeoftheirchildrenwouldsurvive.((
ibid
.))

ThisfatalistattitudewaslargelycausedbythefactthatAmericansrealizedthattheywere
contractinganddyingfrominfectiousdiseasesatanalarmingrate,butwerententirelysureof
whyorhow.Theanswerstothesequestionscamelaterinthenineteenthcenturywiththe
emergenceofgermtheory.

Towardstheendofthenineteenthcentury,peoplesoughttobetterunderstandandmanage
infectiousdiseases.Alargepartofthisprocesswasthewidespreadacceptanceofgerm
theory.((TheGermTheoryofDisease(video):
http://www.youtube.com/watch?v=VQy0tJ1yu9w
))Itwasevidentthatpoorliving
conditionspollutedwater,overcrowding,spoiledfood,etc.werecontributingtothespread
ofdisease,butthesciencebehindthiscouldnotbeexplained.Itseemedthattheonlywayto
solveNewYorkshealthproblemswasamassiveinvestmentinsocialprogramsforbetter
housingandsewagesystems,butalsoanexpressedemphasisonpersonalhygiene.By
stressingpersonalhygiene,however,responsibilityforsicknesswasplacedontheindividual.
Thiscausedmanypeopletoblamethepoorandinfectedforspreadingtheirdiseases.
((Hammonds,InfectiousDiseasesinthe19thCenturyCity))
Itwasnotuntilthe1870sand1880sthatAmericansbegantorealizethatanindividualwas
notentirelytoblameforthespreadofadisease.Asscientistsanalyzedtransmissionpatterns
ofinfectiousdiseases,theybegantounderstandhowspecificpathogenswerethecausesof
specificdiseases.Atfirst,manydoctorsdoubtedthatsomethingassmallasasingle
bacteriumcouldcausesuchdeadlydiseases.However,bytheendofthenineteenthcentury,
germtheorygainedwidespreadacceptanceinthemedicalcommunity.Theworkofscientists
suchasLouisPasteurandRobertKochhelpedconvincedoctorsandthepublicthattheideas
proposedbygermtheorywereinfacttrue.Theirworkfocusedontestingthespawningof

infectionsfrombacteria,provingthatspecificpathogenswerethecausesofspecificdiseases.
Convincedofthesciencebehindgermtheory,doctorsandpublichealthofficialsbegan
testingwater,food,andbloodsamplesfortracesofspecificdiseases.Usingthisdata,
governmentofficialsscrappedtheoldplanthatemphasizedsimplyriddingcitiesofwasterand
introducedanewstrategybasedongermtheory.Highlightingthatdiseaseswereoften
spreadbyindividualcontact,thenewpublichealthstrategyfocusedoneducatingpeopleon
howtheycouldpreventthetransmissionofdiseases.((
ibid
.))Thesepracticesincluded
recommendationsassimpleasfrequenthandwashingandensuringthatfoodwasfully
cookedbeforeserving.Theintroductionofgermtheoryshiftedthefocusofpublichealthand
diseasepreventionawayfromcitywidewastecontroltowardsanemphasisonpersonal
contactandtheindividualspreadofdisease.

TyphoidMary
ThemostinfamouscaseofgermtheoryatworkisthestoryofTyphoidMary.Typhoidfever
wasacommonprobleminmanynineteenthcenturyurbanareas.Awaterandfoodborne
bacteria,thediseasespreadeasilyandcausedaboutatenpercentfatalityrate.Typhoid
typicallystruckhardestincitieswithoutproperwatersanitationsystems,suchasNewYork.
However,bytheendofthenineteenthcentury,whenmostAmericancitieshadbuiltwater
treatmentfacilities,typhoidfeverwasstillanissueandpublichealthofficialsdidnot
understandwhy.Theanswerwasthatmanypeopleremainedtyphoidcarriers,without
showingsymptomsofthedisease.Carriersofthediseaseshowednosignsofillness
themselves,butwerehosttothetyphoidbacteriaandcouldspreadthediseasetoothers.
((
ibid
.))
MaryMallon,otherwiseknownasTyphoidMary,isthemostfamousofthesecarriers.An
IrishimmigrantcooklivinginNewYorkCity,Marywasthefirstrecordedcarrieroftyphoid
fever.Asacook,Maryunknowinglyspreadthediseasetomanyofthewealthyfamiliesshe
workedforacrossthecity.In1906,MarybeganworkinginasummerrentalhomeforaNew
Yorkbanker.Overthesummertyphoidfeverstruckoverhalfthepersonslivinginthehome
andthebankerbecameworriedthathewouldnotbeabletorentoutthehouseagainuntilhe
foundthesourceofthedisease.ThebankerhiredGeorgeSopertoinvestigatetheoutbreak.
((EvelynnHammonds,InfectiousDiseasesinthe19thCenturyCity))Soperdeterminedthat
noneofthefoodorwaterwascontaminatedsoitmusthavebeenacookwhospreadthe
disease.AftertracingMarysworkrecordsallthewaybackto1900,SoperrealizedthatMary
notonlyinfectedthisfamily,butmanyothersaswell.((JudithWalzerLeavitt,
TyphoidMary:
CaptivetoPublicsHealth
.Boston:BeaconPress,1996:1617.))Soperattemptedtoexplain
thesituationtoMary,butsherefusedtobelievehim.In1907,Soperturnedoverhisfindings

totheNewYorkCityhealthdepartment.Thehealthdepartmentproceededtoapprehend
Maryandquarantineherinahospital.Bythispoint,Marywasextremelyuntrustingofany
healthofficialsandfrequentlyactedaggressivelytowardsthem.((Leavitt,
TyphoidMary
,46))
TestsperformedonMaryconfirmedtheassumptionthatshewasacarrier.Forthreeyears
Marywasforciblyheldinhealthdepartmentcustodysothatshecouldnotspreadthedisease
anyfurther.Marywaseventuallyreleasedundertheconditionthatshenevercookagain.
((Leavitt,
TyphoidMary
,188))However,shewasrecapturedshortlythereafterwhenanother
outbreakoftyphoidwastracedtoherkitchen.Marylivedinforcedisolationfortherestofher
life,untilherdeathin1938.((Hammonds,InfectiousDiseasesinthe19thCenturyCity))

ThestoryofTyphoidMaryhasremainedpopulartothisday,notbecauseMaryMallonwas
terriblyuniqueasacarrieroftyphoidfever,butbecausehertaleepitomizesanentireera.
Mallonwasthefirstknownhealthycarrieroftyphoidfever,butdefinitelynotthelast.Atthe
beginningofthetwentiethcentury,approximatelyonehundredNewYorkersbecamecarriers
ofthediseaseeachyear.Also,Mallonwasneitherthemostdeadlycarriernortheonlycarrier
todisobeythehealthdepartmentsguidelines.Anothercarrier,TonyLabella,isattributedwith
spreadingtyphoidfevertoalmostthreetimesasmanypeopleasMaryandAlphonseCotils,a
bakeryownerandtyphoidcarrier,crossedthehealthdepartmentandcontinuedtooperatehis
bakeryagainsttheirwill.((Leavitt,
TyphoidMary
,96125))TyphoidMary,though,hasfound
aprominentplaceinAmericashistorybooksbecauseherstoryisthesamestoryof
thousandsofothersinthelatenineteenthcentury.MallonimmigratedacrosstheAtlanticto
Americaslargestcityinsearchofabetterlife.Whatshefoundwasadirtyandcrowdedcity
thatofferedworkthatcamewithlowpayandlonghours.Maryscontractionandsubsequent
spreadoftyphoidfeveristheperfectexampleofthecrampedlivingquarters,poorworking
conditions,andpoorhygienethatmanylatenineteenthcenturyimmigrantsfaced.