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.
I do agree that the “lack of science in public health” at the time can be attributed to the distracting elements of urban life and the multitude of seemingly reputable causes of disease, namely the filth of the environment. That was why the miasmatic theory was held to such a huge regard: people saw that the ill, which was mostly the urban poor, lived in squalid and filthy tenements, and thus put two and two together. That does not necessarily mean the assumption was correct.
The fact that US public health was localized led to inadequate health boards across the nation, which received little funding. Only during emergencies or annual “cleanups” did these boards actually performed. It wasn’t until after the American Civil War that there was a push to centralize and introduce the scientific method to public health through the Progressive reform. Ultimately, the American Progressive reform led to the popularization of the bacteriology theory of disease causation, starting with the stressing of “universal standards of hygiene” (Porter 156).
Sorry – I could not sign in because of my internet so I had to post anonymously.
While William Budd doesn’t necessarily offer any solutions to the spread of disease, he poses a valuable point in terms of the effect contagion has on the proliferation of disease. He reminds his audience that “of the permanent sanitary works, by which the spread of typhoid fever may be hindered, this is not the place to speak” (611). Despite this inability to offer a solid solution to the spread of disease, knowing its origin is a big step forward. Its origin is the kicking-off point for the creation of a cure/vaccination. Bearing in mind that typhoid fever may very well have spread from cess pools, sewers, feces, air and the drinking water, the health department can prioritize themselves with clearing the drinking water of this disease. Like Sam argues, Budd’s work is an unmistakable step toward public health; it unravels the cause of a disease and informs the health department where the source is so that they can work on eliminating it.
To respond to both Alex and Sam, I think the most interesting thing about this week’s readings is the fact that Public Health concerns are finally being intensely studied by government officials and the public. As the contagion theory evolved in these readings, we also learn that the importance of public health becomes stressed in society. In the Barnes reading about the Great Stink of Paris, we learn that the people finally became concerned after an overwhelming smell surrounded their homes. This smell was generated by a combination of chemicals from a nearby waste plant and from waste in the streets. While the people believed that the smell was deadly due to the Miasma theory, they were not fully wrong. The smell was actually a combination of harmful chemicals with the potential to kill. Unfortunately the government was initially reluctant to do anything about the problem and the business owners and “scientists” argued that the odor was not harmful. Even though it may seem like this stonewalling was harmful, many committees in public health were created to research the epidemic and to discuss if it was harmful or not.
In the typhoid fever article, we learn research was performed on the spread of a contaminant. Scientists and researchers wanted to understand how typhoid fever spread through the population and categorized its journey by taking down case studies and data. It is through the epidemic of typhoid fever that the contagion theory truly evolves. Researchers studied the disease intently and compared it to other outbreaks such as smallpox to see whether it was truly a contagion. After researching how it can be transmitted, they then pinpointed which media forms it used to reach its victims (bed sheets, linen, etc).
It is through these articles that we learn the systematic approach scientists and researchers adopted to handle the spread of epidemics. Public health was now a necessary institution in society and was evolving rapidly as the needs of the people grew.
Like Sam, I was particularly intrigued by William Budd’s “Typhoid Fever: Its Nature, Mode of Spreading and Prevention.” In the introduction of his work, Budd poses the question, “If it be true of diseases in general, that all prevention must be based on an intimate knowledge of their causes, how much more true must it be of that great group of diseases which is the work of definite and specific agents, having not only the power of breeding within the body, but capable, for limited periods at least, of existing externally to it?” (3). The beginning of the question struck me immediately because it was referring to etiology. Like last week’s readings showed, prevention and treatment of a disease requires knowing the cause of the disease (the etiology). As Budd points out, typhoid fever is certainly part of this group of diseases in that it does exist outside of the body and is contagious.
Later on in Chapter IV of Budd’s work, etiology is discussed yet again. He brings up the idea of typhoid fever being caused by poison and toxins carried in sewer systems. The outbreak examples mentioned were all traced back to tainted drinking water, which was why it was thought to be the cause. If this was the case, then that was what they were going to focus on fixing in their treatment/prevention. In my opinion, this work is yet another example of how important etiology is in trying to prevent the spread of disease and ultimately save lives. It doesn’t matter what disease is being looked at – whether it be typhoid fever, cholera, or even childbed fever, all individuals thus far have been tracing the disease back to its causes in order to find solutions. It is interesting to see that as public health changes to match the time period as well as the people living in that time period, one thing that has stayed the same is the importance of etiology.
We’ve discussed in class many times the power of ideas. Ideas spread as far and wide as a contagion spreads, and similar to typhoid fever, leave a trace of themselves behind that can be reactivated.
In chapter V of Dr. Budd’s analysis of typhoid fever, he rationally deduces from existing information that typhoid fever does not acquire any new powers from external factors when expelled from the body. Rather, he says, something in it becomes activated giving it new powers.
He continuos to say that typhoid fever is similar to a seed in that it is expelled from the body, undergoes a change, and brings out something from within that can then be separated into fine minute particles that can spread through the air. Although Dr. Budd subscribes to the germ theory, he still refers to the germ’s likely path of air where many victims can be infected, albeit slower than other mediums, similar to when public health believed in the miasma theory and the general poor air of unsanitary neighborhoods. The idea of the miasma theory remained during the germ theory days, and became a medium for germs.
The scientific article, “Periodontal Infections and Coronary Heart Disease” by Spahr A et al, was placed among the other readings to provide a contrast between, say, the thorough analysis of typhoid fever by Dr. Budd and the extensive experiment aimed to find a correlation between periodontal infection and CHD. Dr. Budd’s analysis, though quaint, pales in comparison with the Spahr A et al article’s use of statistics, scale of experiment, control of variables, control group, number of participants etc. Spahr’s article even uses a different theory, risk factors, to investigate their correlation.
But this is not a bad thing; rather it just goes to show how much public health has changed and how complex the scientific analysis used in public health investigations has become.
-Chhada Nathan Kabariti
It’s interesting to see that contagion was a largely ignored concept in discussing the spread of disease. Now it seems common knowledge that there are certain contagious diseases, but back then that wasn’t always the case. William Budd was ahead of his time with his contagion theory, writing in a time when the miasma theory was still enormously popular. As Alex said, even though Budd did not present any solutions to the problem of the spread of disease, it is important to discover how diseases spread in order to come up with a proper solution.