THE ·OSLER·LI BRARY·NEWSLE TTER· NUMBER 100 · 2003 Osler Library of the History of Medicine, McGill University, Montréal (Québec) Canada • IN THIS ISSUE OSLER, BALTIMORE AND PUBLIC HEALTH THE LEAD ARTICLE IN THIS ollowing the Civil War, limits and adding about 40,000 new by Baltimore like other major inhabitants to the city’s rolls. While Dr. Günther number of the Osler Library Newsletter F population centres on the the expansion generated a veritable is by the eminent American historian eastern seaboard witnessed an real estate and construction boom, Risse of medicine, Dr. Günther Risse. Dr. impressive economic growth the extension of municipal services punctuated by a succession of boom strained the city’s coffers. For a Risse’s wide ranging publications and bust periods. Its history and decade, house construction soared, include major monographs on geographic location made the city an with thousands of new units built— everything from the palaeopathology ideal metropolis to assist in the an average of 3,700 per year— postwar reconstruction of the South.1 following the economic slump of the of ancient Egypt, to medical practice Baltimore’s bankers, flush with capital 1870s. The result was a vast tract of in New Spain, to the hospitals of 18th obtained from government contracts “respectable” privately owned two- for cotton, iron, and steel, provided story row houses, somewhat elevated century Edinburgh. His most recent the necessary venture money to to avoid periodic flooding from book, Mending Bodies—Saving Souls: A create a number of domestic adjacent streams. These buildings History of Hospitals, was published by industries and transportation systems with their frequently polished marble to carry their wares—from farm “front steps” and sidewalks, were Oxford University Press, in 1999. In implements to millinery—to the constructed of a reddish-pink brick 1988, the American Association for southern states. At the same time, the by well-paid bricklayers who became the History of Medicine awarded him city used its port facilities to establish world famous. Behind the town- an active international trade in houses with their yards and cesspools the William H. Welch Medal “for tobacco, wheat, and flour with particular contributions of out- Europe. Prominent among the new The well-known standing scholarly merit in the field entrepreneurs contributing to Baltimore’s development was a native cartoon of 1896 of medical history.” of Maryland, Johns Hopkins (1795- by Max Brödel 1873), a Quaker and president of the Merchants Bank. Hopkins was also in which the Dr. Risse teaches in the Department one of the directors of the Baltimore germs flee in of Anthropology, History and Social and Ohio Railroad, another Osler’s presence. Medicine at the University of important local economic player. His most enduring legacy, of course, was California, San Francisco. In this the endowment that created a essay, he explores the seamy, steamy, prominent university and hospital.2 and stinky underside of Osler’s Originally built in the early 1700s on Baltimore, and the challenges Osler low ground bordered on three sides faced in awakening professional and by marshes with flowing streams, public consciousness of public health. Baltimore quickly expanded towards higher ground through repeated annexations, following a checker- board grid of streets and buildings. The sprawl during the 1880s was especially directed towards the northwest, nearly tripling the city’s • ·1· • were labyrinths of alleys and small Frostburg. Home owners, especially July, August, September, and overcrowded shacks. in German and Bohemian neigh- October. The newly accepted cause bourhoods, had their water piped to of typhoid fever was a bacillus By 1890, the city’s cesspools had their private property but not to the discovered in 1880 by the German greatly increased in number—every shacks located in the inner alleys. scientist Carl J. Eberth (1835-1926), dwelling had its own—and they were Many of them were well-paid a finding later confirmed by the connected to old and new storm mechanics, in contrast to the cannery prominent bacteriologists Robert water sewers which discharged all labour force, that also included Poles Koch (1843-1910) and Georg Gaffky “Fortunately wastes directly into the harbor basin. but was increasingly replaced with (1850-1918). However, since Eberth’s it is now a Failure to clean them regularly and unskilled workers, as machines took causal agent still failed to fulfill Koch’s keep them closed caused a constant over production of the cans. third postulate of inoculation and great and overflow into yards, courts, and alleys reproduction of the disease in an growing producing noxious odors. To The inner city, Oldtown, and Fells experimental animal, many physi- compound the problem, Baltimore’s Point, as well as areas located west cians continued to question the role function of water pipes were made from hemlock and south of Camden Station of this particular microorganism in the medical logs. Cracks and joints in these log obtained their water through free the pathogenesis of the disease.8 Two pipes allowed seepage from public fountains from shallow wells, distinct contemporary paradigms profession to contaminated soils near privies and vulnerable to pollution from privies competed for the attention of search out the stables, a situation that created a and street drainage. Attracted by the physicians concerned with public perennial contamination of water city’s demands for labourers and health. One was the ground-water laws about supplies coming from Jones Falls and domestic servants, newly freed Blacks hypothesis proposed by the German epidemics and the Gunpowder River reservoir had migrated there after 1870 from sanitarian Max J. Pettenkoffer (1818- outside the city. Lack of a chemical Virginia, North Carolina, and 1901) of Munich, who postulated these outside and bacteriological laboratory at the Georgia, and by 1891 made up about that particular soil conditions were Health Department, in turn, 15% of Baltimore’s population. They responsible for drainage, and that enemies of hindered periodic analyses of this mainly lived near the waterfront and epidemics spread because of man, and to water so that its actual impurity was in the segregated ghetto in South alterations in the soil caused by never suspected until 1892.3 Milk Baltimore named “Pigtown,” and their fluctuations in levels of ground teach you, supplies, lacking refrigeration and mortality rates were twice that of the water.9 The other theory was the public— exposed to flies and urban dust, were city’s white population.5 Many Black supported by the new bacteriologists equally contaminated. There was no females were part of a contingent of including Koch who attributed these dull, stupid inspection of dairies. 20,000 domestics employed in the outbreaks to the contamination of pupils you city. In Oldtown and Fells Point, water supplies. Infection occurred The major obstacles to an improved similar unhealthy conditions pre- when such water, containing Eberth’s are too as a public health in Baltimore were vailed among the nearly 16,000 bacillus, were ingested.10 Although rule—the linked to its rapid and unprecedented overworked and underpaid garment the causal agent had been cultured growth. Fueled by an influx of workers, many of them Jewish. They from the blood and stool of typhoid way of immigrants, Baltimore’s modest were mostly women and children, fever victims, it was still difficult to nature that infrastructure was quickly over- among them immigrants from Italy, identify and isolate the bacteria in the whelmed by new settlements that Lithuania, Bohemia, and Russia who water. Recent evidence from typhoid you may outstripped existing water supplies, worked twelve hours a day in small, fever outbreaks in Hamburg and walk therein dwellings, pavement, sewerage, and ill-ventilated sweatshops of East Berlin, as well as Boston, Plymouth, garbage removal, thus creating Baltimore, part of a clothing industry and Pennsylvania, however, pointed and prosper.” significant hazards to the city’s public facing increasingly acute compe- to a lack or failure of water filters, an health.4 Indeed, the land additions of tition. Indeed, following the Civil indirect confirmation of this 1888 had provided vast housing War, Baltimore had become “the city hypothesis.11 tracts with quite primitive sanitary that tries to suit everybody.”6 conditions, especially large numbers Under the circumstances, Baltimore’s of polluted wells. Garbage removal Discussions concerning Baltimore’s Health Department, devoid of both became deficient, with an abundance impure water supply and its links to adequate funding and expertise, of refuse from slaughterhouses and epidemics of typhoid and cholera remained a passive spectator in the packing plants rotting on streets. A were already common in the late battle against contagious diseases, large and sustained German im- 1880s. The British Public Health Act and considered them nuisances to be migration, especially from 1860 of 1875, based on the ideas of the blamed, in the traditional manner, on onwards, now made up a third of English physician William Budd foul “miasma.” Even Daniel C. Baltimore’s population. Many of them (1811-1880), had already accepted Gilman, president of the Johns participated in the city’s various the view that typhoid fever was Hopkins University and interim industries, as furniture makers and spread by means of water and food.7 director of the Hospital, questioned