Typhoid SCARY!

Hi all! Ok that was a really bad pun and I apologize for it but I couldn't help myself...
In studying history I feel like their is very few times where I am completely shocked by something I had never heard of before but Judith Walzer Leavitt's "Typhoid Mary" does just that in her vivid description of the solitary life of Irish immigrant Mary Mallon. Although I had previously been aware of immigrants being quarantined or turned away I guess I had never thought about what that could have truly meant. I agree with Joseph's previous post about the chapter on the "Extraordinary and Even Arbitrary Powers" of the New York State Health Department.
Secondly to the questions "Was it the fact that she was a single working-woman, Catholic, Irish-born, or was it something that does not take such a complex lens to understand?" I think my answer, although open to interpretation was the fact the she was all of those things allowed the health department to quarantine her also factoring in the fact that she didn't really believe she was that much of a health risk. Often when discussing important topics (arguing) with my wife although one argument like the one Leavitt is trying to make seems to be a little bit of a stretch, often upon further investigation it seems to slowly turn into more of an impossible coincidence. That's not too say that she was or wasn't 100% of a victim, just that it no doubt had something to do with it and the difference between a stretch of the imagination and a lot of coincidences are small is a matter of opinion and perspective. I hope that makes sense...

Leavitt's Typhoid Mary

An old file card detailing results from tests on stool specimens from Mary Mallon gives a capsule history of her capture and quarantine.

image courtesy of: http://www.pbs.org/wgbh/nova/typhoid/mary.html

The one question I have, for you (the class) and Leavitt, is why do you think Mary Mallon is a unique case? Was it the fact that she was a single working-woman, Catholic, Irish-born, or was it something that does not take such a complex lens to understand?

Take a step back and think about the different perspectives and stories that Leavitt articulates in Typhoid Mary. Ms. Mallon was not the only "healthy carrier" in the monograph to be questioned by health officials, but she is the center of the narrative. Mallon stated that: officials had "stuck her away for a reason she couldn't accept" (p. 198).

This is what makes Mallon the unique case: she never "believed" or "agreed upon" the fact that she was a carrier of a contagious disease. In the other cases, you have people isolated, institutionalized, then let free on the notion that they would try and find some other form of employment outside of the food service industry. Some did, some did not. Mallon was also offered this idea, when she signed a document stating that she understood why she was being held and that she needed to change the types of job she did in order to protect the public health: "taking measures to protect any and all persons with whom I may come in contact from any infection…which it is possible I may cause" (p. 189).

Leavitt suggests that this was simply a scam so that Mary could get on with her life and independence. Later, she alludes that Mallon had no intention of staying out of being a cook (a skill in which she had always found labor during the past). Moreover:

"Mary Mallon denied throughout her life that she transmitted typhoid fever to people for whom she cooked. Despite working for seven or eight years in a bacteriology laboratory preparing sputum slides for physicians to use in the medical diagnoses of tuberculosis, she never came to understand the connection between the sputum that carried tuberculosis bacilli and her own gallbladder that carried typhoid bacilli. SHE DID NOT ACCEPT THAT SHE WAS DANGEROUS TO OTHERS" (emphasis added) (199-201).

She was released upon signing an agreement, but broke her parole and was reinstated at the hospital. Would you claim that any other parolee who broke their agreement and was reinstitutionalized was a victim? I feel that throughout this piece, Leavitt's viewpoint is that Mallon was a victim, not culpable for anything that she actually did.

So, when considering cases in the present, which many medical historians often like to do in concluding remarks, is to look back at history with open perspectives. In terms of this book as a historiography piece, Leavitt appears to have looked at many different angles in order to construct a history of "Typhoid Mary" that is complex and imbued with class, racial, and gender prejudices. However, when looking at the content of said history, I have arrived at a different conclusion.

So, think about Mallon, and the other cases in the narrative, and see if you have arrived at a different conclusion than Leavitt has about why Typhoid Mary is an exceptional case, and why she was an exceptional woman in a time of "thousands" of healthy carriers.

Interesting Connection ...

Sorry this is late, I had to wait and write it on a campus computer because my home laptops seem to have some kind of virus that is blocking Blogspot. Anybody know how to fix computers?

Several years ago, I wrote a senior thesis at my undergrad, Wells College, about soldier's motivations for enlisting and fighting in the Civil War, and one of the soldiers that I focused on was very similar to the young New England men that Rothman uses in the first section of her book. His name was Charles Russell Lowell, and he was considered a "Boston Brahmin," a member of the well-educated, wealthy elite of Boston society. Lowell came to mind while I was reading this book because he always seemed not to totally fit in with his peers: he did go to college, but after graduation, when his friends and cousins were becoming lawyers and ministers, Lowell decided to pursue business and led a relatively physically active life working in iron mills and foundries. He also spent two years traveling through Europe. I always wondered why he chose a labor intensive career instead of studying, like so many other Boston Brahmin seemed to do. While reading Rothman, it occurred to me that much of his letters and diaries are concerned with his health. He often wrote to his mother to reassure her that he wasn't studying too much, that he was getting outside often, or to tell her about how when he did study too much, he felt very ill. He was always sick, or avoiding being sick, and was very preoccupied with always leading a health, balanced life. Perhaps he pursued his travels and more labor intensive career because of (as Rothman argues) this idea that physical labor or activity was more healthful for peope struggling with disease. I would have to do more research to see what the nautre of his illness was, but it seems possible that it could have been consumption.

I'm sure I have now thoroughly bored you all. See you next week!

Living in the Shadow of Death

Living in the Shadow of Death is a tremendous look at the harsh realities of Tuberculosis and the experiences of people in the early 19th century. What made her book so great to read was her extensive look into the primary sources she used to solidify her argument and theme. I was impressed with her use of manuscripts, letters, diaries, medical papers, books, etc. She shows Tuberculosis at the height of the epidemic in which it was at its deadliest. Her emphasis of the "invalid" in New England was particularly interesting. In this part of her narrative, Rothman does an incredible job at explaining and blending history, sociology, ethics and medical science. I found it incredibly interesting to see the experience of the patient as it practiced back in the past and with the medical situation it faced. As we have discussed in previous weeks, it is incredible to see the pain and suffering the patients went through. They did not have the benefit of painkillers or modern practices of medicine that we have today. Medical practice in the early 19th century was something of trial and error and unfortunately these patients were faced with being the "guinea pigs" of medical advancement. It is an amazing story of progress and hope.

Living in the Shadow- Moving Out West

I've been thinking about the section of the book on people moving west in the hopes of curing their afflictions. The author states that the main reasons the myth of the west persisted are because people had financial and emotional investments in it. The emotional part makes sense. People suffering from a terminal illness want to believe that they can be cured. They may be willing to suspend their skepticism of an idea, such as moving west, to keep their hope alive. Many people moved west before anyone made financial investments in the movement. I believe the westward movement probably would have flourished even if nobody had a financial investment in it.

The book mentioned that some of the sick moved into cities, or the towns they settled eventually grew into cities. I wish the author hald delved into this point further. For example, did anyone ever write about the illogic of moving into a western city when one of the points of moving west was to escape the impurities of the city? She also did not discuss who ran the businesses in the cities- were they run by the sickly, or their healthy counterparts? It would be interesting to find out the ratio of sick tuberculosis patients to healthy people in the settled lands, and what their relationships to each other were. The author also mentioned that people went westward to help cure other ailments they suffered besides TB, but she did not indicate how commonly this took place. I wish too that she had focused more in the experiences of people moving westward before the railroads were built.

The topic of the westward movement is intriguing; however, the section could have been more enjoyable if the author had gone into greater depth on some issues.

Shadow of Death

Despite other comments so far, I believe Rothman's Living in the Shadow of Death truly creates a vivid picture from multiple perspectives on the terrible conditions of living with TB.  From the patients point of view Rothman clearly shows the shame, anger, confusion, and overall terror caused by the disease.  Furthermore I believe even in our current society we still see signs of the past terror.  Most places that I've gone to work at, or gone for schooling still require proof of TB immunizations.  I'm not a doctor, but with all the infectious diseases out there is it really still necessary for that to be required of everyone or is it just an easy test?  Do other modernized countries still require TB tests from everyone or does it just have to do with our history?

Warmer Climates

The first section of Living in the Shadow of Death discusses consumption during the 19th century. One of the prescribed treatments was taking finding a more suitable climate. One that was warm and more moist (as opposed to cold and unforgiving).

I mention this small part of the book because this is one of my mother's and grandmother's go to cure suggestions. Every winter I usually end up receiving a terrible sinus infection that refuses to leave me alone (thankfully not consumption) and every year my mother (grandmother) tells me that I need to head south. This year I was fortunate enough to be able to head south, and yes when I got there I did feel immediately better (the sun was shining and there wasn't mountains of crusted over black snow everywhere).

I find it interesting how even today these ideas remain with us.

Womanly Roles vs. Consumption

From the introduction on, Rothman highlights the point that women as opposed to men choose to stay at home when they are diagnosed with consumption. In chapter 5, this is elaborated on. I found it very interesting how men would go and travel to treat their illness but women felt that it was their duty to stay and take care of the home. In chapter 5, we get a real sense of community. When a mother gets sick, the women in the community help raise her children. Women came together to assist each other when they needed it the most. When we meet Deborah in this chapter, we get a sense that even though she gets to travel and is sick, she still takes a responsibility to keep things neat and clean up after others. This disease did not mean that women could try and rest and get better. It seems that no matter what their chosen "cure" was (traveling or staying home) they always had the responsibility of taking care of others and displaying a proper outward appearance. They did not have the luxury of truly being sick and trying to fight the disease. Even further in the chapter, after being ill, Deborah gets pregnant twice at risk to her own health. I found it interesting how the proper duties of a family did not truly change with consumption, but perhaps one did need to continue living for as long as they ha left?

Living in the Shadow of Death

I've just finished plugging through Rothman's account of the social experience of Tuberculosis in American history, and I have to admit this book leaves a lot to be desired. Although the author claims in the introduction that this "does not pretend to tell the story of all Americans who contracted tuberculosis", the segments of society it does reference do not seem to be a fair cross section of society at this point in history. We are led to believe that a great deal of the population affected were poor, minority immigrants, yet the personal accounts referenced appear to be generated from the middle to upper class. Perhaps this is a result of the types of narratives available.

That being said, Part IV : Becoming a Patient 1882-1940 proved to be the most interesting and enlightening source in my opinion. A significant part of the social experience involves how the various authorities and institutions approached consumption and TB. The threat of any sort of epidemic was very real at that time, and the same holds true today. The manner in which the disease was stigmatized and addressed is echoed in modern times with regard to HIV. Rothman alludes to this connection briefly throughout the book and in the epilogue, but I wish she would have expanded on this a bit. I truly do not mean to downplay the author's research and insight into this significant time in American history. Perhaps I am just searching for a more comprehensive look at the 'Social Experience' that comprises a greater population of society at that time.

Conduct Unbecoming a Woman

Morantz-Sanchez provides a great look into the details and story-telling ability to provide a story that really gave the reader a complete look into the medecine of the turn of the century in the United States. One of my favorite parts of her story comes toward the end of the book when she discusses the "anxiety" over the meaning of femininity and masculinity. It was interesting to see the differences in the courtroom procedures and emotional environment between men and women. The discussion of the various crimes of passion that these women were accussed of shows how the world of medecine and society viewed women at this time. As I read through some of the discussion and details of Mary Dixon Jones, I was able to get a better feel and understanding of the differing gender issues and perspectives. It was very interesting to see how self-promotion was considered a very serious violation of accepted medical professionalism. It was the conflicting struggle for women to prove themselves in a field and time dominated by men. It was exciting and interesting to see how Morantz-Sanchez used her ability to write and stroy-tell to provide an experience beyond something I was ever aware of. The detail of the writing and the approach in which Morantz-Sanchez chose to write in was very important to her argument and description of medecine.

A Great Read!

My favorite part of "Conduct Unbecoming a Woman" is the expert storytelling skills and extensive details, side stories, and flat out lies exposed by the author. While painting a vivid cultural and historical background about the case of Dr. Mary Dixon Jones, although not completely unbiased Morantz-Sanchez really allows the evidence to speak for itself and the reader to make their own conclusions from the very beginning. While the stories described in the book are vivid and page turning, the points being made about the social aspects of Brooklynn in late 1800's are clear (although somewhat lengthy) as well. Overall this has been an exciting read and supports everything we previously read by Starr just further extending into the field of female physicians.

conduct

I thought Morantz-Sanchez's book served as a good supplement to Starr's work. While she focused on a specific case and therefore was able to provide in-depth analysis where Starr's work necessarily required a lot of general information, the two books have a lot in common. For example, I found her discussion of Brooklyn's struggle to define itself outside of the parameters of New York both enlightening and in line with Starr's argument for the societal components of the development of medicine. While the public/private debate of this era was certainly not exclusive to Brooklyn, focusing on a small area helps expose some of the debate's complexities. As Morantz-Sanchez states "as a woman surgeon, Dixon Jones appeared to be doubly out of bounds" (60). Morantz-Sanchez's conveyance of the tension between competeing newspapers, physicians and specialists who both supported and denounced Dixon Jones, the reading public, and her various patients demonstrates the utter complexity of an evolving medical profession within an increasingly confused and suspicious society. Although, at times, a bit tedious, in terms of the medical discussion, Morantz-Sanchez does an excellant job of balancing issues of race, gender, power, and the sociological aspects of medicine.

Changing perception

I thought The Social Transformation of American Medicine very comprehensively described how the medicine has changed in the past two hundred years. I found it particularly interesting how the prestige placed on doctors has grown over the years, just as our understanding of medicine has significantly increased. I was surprised how William Buchan in 1769 tried to promote medicine as something that anyone can practice simply and successfully, stating that his readers “trust too little to their own endeavors (33).” This remark I find particularly interesting when compared to the journal entry of a medical student who in the 1950s wrote that “Medicine is so large not that a doctor doesn’t feel confident unless he knows at least one field extremely well, rather than a little about all subjects (355).” As the understanding of medicine became more complex the prestige of those who practiced it increased.

DIY Medicine

I thought that Starr's discussion of the development of Medicine in a Democratic Culture (chapter 1) brought to mind the many modern day issues that are very similar to the issues of the past. The Thomasonian view of medicine (which was ultimately discredited) and other movements like this that stressed a DIY method of medicine were of particular interest to me. Starr writes that it was eventually decided (and agreed upon) that it was not the case that medicine was a simple science that everyone could perform (59).

This whole discussion reminded me of todays popular website WebMD. The website enables people to "self-diagnose" their symptoms and receive advice about what it is that they potentially have. You are immediately given advice from the site, be it take an Advil or go to the emergency room. This is not strictly DIY medicine, but it does show how the average person today does have the ability to feel like they know how to handle their symptoms and does not have to call their doctor in all cases.

I guess I found it interesting how Starr's opening discussion and overall discussion of power and authority concerning the medical field have today. It also reminded me of the "House" episode "Epic Fail" where House's patient attempts to undermine House's authority and knowledge of rare diseases by posting his symptoms online and continually challenge House with his internet found knowledge.

School for them, School for us

In chapter one, Starr explains how the medical profession changed in terms of the kind of schooling one need in order to become a professional. The problems faced by institutions trying to produce the best graduates is something that has not changed much today. Schools are still completing against one another but not there is a higher volume of schools. The idea that the boundaries of the medical profession were drawn on lines such as "graduates versus nongraduates of medical schools; members versus nonmembers of medical societies; licensed versus unlicensed practitioners" (46) is one that boggles the mind today when to become a doctor you have to go through not only undergrad, but also med school as well plus rotations and many other challenges. As the chapter continued, I found myself thinking about us as students and how many of us have to be licensed to do what we want as well. Teaching for example is something you have to be licensed for at any level (or have a Ph. D). I was also struck by the fact that it was so easy for anyone to practice medicine. It makes sense that before medicine was truly "practiced" anyone could be a doctor of sorts. If you had a cure to a common ailment that could set you on the path to the profession of doctor. Finally, I found it very interesting that women seemed to be the primary medical practitioners. In some ways it makes sense due to the fact that the woman is supposed to be the caregiver, but the fact that they were allowed to take such a prominent role was something I found surprising.

From the UK

The following link is an Article from the Telegraph in the UK...do not know if it really pertains overall, maybe later on in the semester, but interesting nonetheless.

Article