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Epidemics

The health of Americans through the centuries has been shaped by the shifting nature of economic, social, and political life. In particular, epidemic diseases have been affected by such factors as the isolation of rural communities, the development of an economy based on commerce, the growth of large cities, extremes of poverty and wealth, and changing housing and work conditions.

In the seventeenth century, the relative isolation of many colonies tended to limit the impact of epidemics, in contrast to conditions in crowded European cities. But by the end of the eighteenth century, an extensive commercial economy combined with a growing, increasingly urbanized, and poor population made epidemics a much greater threat to Americans. Epidemic disease, once a local phenomenon circumscribed by the relative lack of mobility among rural communities, began to sweep through the nation along well-established trade routes. By the middle of the nineteenth century, the crowded and increasingly poor urban centers experienced death rates that were as high as those in Europe. Cholera, dysentery, tuberculosis, and other waterborne and airborne infectious conditions became endemic in such cities as New York, Boston, Philadelphia, and New Orleans.

One example of the close connection between health and geographical and social conditions is the experience of seventeenth-century colonists in Massachusetts. Studies have revealed an extraordinarily healthy population as measured by statistics on average length of life, mortality and morbidity rates, and infant mortality. Male residents of the first settlements lived into their seventies and eighties while their English counterparts were dying in their mid-thirties. Similarly, colonial women in the Massachusetts Bay Colony who escaped death during childbirth also lived long lives.

Although yellow fever and malaria, both mosquito-borne diseases, were widely reported in seventeenth-century New England, their impact on the colonists of Jamestown was far greater. The first generations of settlers in the Virginia colonies were plagued by malaria, yellow fever, and other epidemics. The prevalence there of early death, infirmity, and infertility led historian Edmund Morgan to entitle one of his essays about the region "Living with Death." The initial lack of commitment to establishing permanent colonies in Virginia helps explain both the dearth of women among the first generations of colonists and their inability to avert starvation leading to their susceptibility to epidemic diseases. (The sickle-cell trait among African-Americans is associated with greater resistance to malaria. Some have argued tenuously that this relative ability to withstand malaria helps account for the introduction of slavery in the American South.)

Smallpox, an acute viral disease that disfigures its victims, was perhaps the most fearsome illness of the colonial period. Introduced to the Americas by European colonists, the disease had an especially devastating effect on Native Americans who, because of their lack of contact with the virus, had virtually no immunity to it. While English and Spanish settlements were periodically swept by epidemics that caused varying degrees of distress, Native American populations throughout the colonies were all but wiped out. John Duffy, in Epidemics of Colonial America, quotes a letter written by a settler of South Carolina in 1699: smallpox "swept away a whole neighboring [Indian] nation, all to 5 or 6 which ran away and left their dead unburied." Duffy also reports that an "epidemic in 1738 killed one half of the Cherokee Indians" near Charleston. In a horrifying instance, some U.S. Army units in the nineteenth century gave blankets used by smallpox and measles victims to Indian tribes, thereby destroying their communities and slowing resistance to western expansion.

In some early epidemics it was observed that a technique called "variolation" practiced by African-American slaves appeared to be effective in protecting blacks from the worst ravages of the diseases. The focus of intense public and religious debate in the early eighteenth century, the technique consisted of transplanting scabs or pus of smallpox victims into open wounds of healthy individuals. These people then developed a mild set of symptoms and thereafter immunity. This technique was adopted by European-Americans and helped in the development of inoculation and vaccination as effective preventives.

Epidemics became national in character with the development of extensive coastal and river trade in the eighteenth and early nineteenth centuries. Earlier, local outbreaks had been devastating but limited geographically. But by the 1790s, linked epidemics ranged up and down the East Coast in such cities as Philadelphia, New York, and Boston. Often understood in religious or moral terms, epidemics were thought to be forms of godly retribution for sins of the individual or the community.

In the nineteenth century a number of new waterborne and airborne diseases swept through the growing cities of the nation. Cholera, a disease that caused severe dehydration through acute diarrhea, made dramatic and fearsome appearances in 1832, 1848, and 1865. In the absence of sewage systems, clean water, systematic street cleaning, pure food and milk, and effective methods for preserving or freezing meats, diphtheria and whooping cough, fevers and flu--all present to varying degrees in earlier periods--became constant threats to babies and young children in the nation's filthy urban centers. By the second half of the century, death and disease rates in American cities had climbed substantially and Americans' average length of life was now no better than that of Europeans.

Tuberculosis, perhaps the most pervasive and deadly disease in the West, became the focus of intense concern as its primary symptom, coughing and spitting, took on a seemingly dangerous aspect in the crowded, poverty-stricken urban environments of the late nineteenth century. Despite the fact that incidence of the disease probably peaked in the middle years of the century and that it declined as a major cause of mortality after the 1880s, efforts of public health professionals and charity workers to combat the illness continued for several decades.

In the twentieth century, infectious diseases still accounted for vast suffering among urban and rural populations alike. In 1918-1919, the worldwide pandemic of influenza reached the United States, causing about 400,000 deaths, by far the most devastating epidemic in American history. In the next few decades, diphtheria, whooping cough, measles, and mumps continued to exact a high toll among children. But public health attention began to turn increasingly to chronic, noninfectious illnesses such as cancer, heart disease, and stroke.

With the advent of sulfa drugs, penicillin, and antibiotics in the decades following the Great Depression, both the medical profession and the public believed that infectious diseases would soon cease to be a major threat to Americans. The polio epidemic of the 1950s was fearsome, but the promise of the new "wonder drugs" seemed to be confirmed with the vaccines developed by Jonas Salk and Albert Sabin.

Ironically, the very successes of the postwar decades in the development of technological medical innovations left the nation mostly unprepared for the new scourge of the 1980s, acquired immune deficiency syndrome, or aids. Health departments were underfunded and understaffed, and a generation of public health and medical practitioners had come of age believing that medical science and technology could protect Americans from any widespread epidemic. Also, the fact that the 1970s was marked by a fiasco in which millions of dollars were spent on the development and distribution of a vaccine for a swine flu epidemic that never materialized undermined the nation's ability to mobilize against the disease. And because aids primarily affected gay men and intravenous drug users--both subject to widespread biases--some accused government and research scientists of deliberate inaction or at least of reluctance to undertake massive programs to combat the latest American epidemic.

The nature of epidemics and the public's response to them changed greatly over time. Once simply local problems perceived to be of divine origin, epidemics became national in scope and understood in medical terms. But the reaction to a given disease was often still influenced by society's perceptions of its victims.

Bibliography:

Judith Leavitt and Ronald Numbers, eds., Sickness and Health in America, 2nd ed. (1985); Charles Rosenberg, The Cholera Years (1987); Barbara Rosenkrantz, Public Health and the State (1973).

Author:

David Rosner