Epidemics and Public Health in Boston (episode 176)

Music

Jake:
[0:05] Welcome to Hub history, where we go far beyond the Freedom Trail to share our favorite stories from the history of Boston. The Hub of the universe.
This is Episode 1 76 Epidemics in Public Health in Boston Hi, I’m Jake.
I had a different topic picked out for today’s show, but given our current cove in 19 state of emergency, I decided to switch gears instead.
I’m revisiting three classic episodes this week, which will show how Boston has suffered from past epidemics and demonstrate how medicine and public health have eventually prevailed.

[0:42] First, we’ll talk about the 1918 so called Spanish flu, the most deadly disease humanity has ever faced.

[0:50] Then we’ll visit a fairly recent show about a deadly cholera epidemic that forced Boston to confront its sanitation problems and then finally will face humanity’s ancient nightmare, the speckled monster smallpox.

[1:06] But before we talk about the scary diseases that Boston’s confronted and conquered, it’s time for this week’s Boston Book Club selection and our upcoming historical event.

[1:17] My pick for the Boston Book Club this week is the new Netflix movie, Spencer Confidential, starring Mark Wahlberg as a disgraced Boston cop on the day Spencer’s released from prison. His old nemesis, another cop, is murdered.

[1:33] The movie follows his attempt to clear his name with the help of his aspiring UFC fighter roommate, his aging boxing coach and his volatile ex wife, who never met in our She didn’t want to drop.

[1:45] Turns out his nemesis was a dirty cop, and he was embroiled in a drug trafficking scheme that also somehow involved condo developers who wanted to gentrify Southie.
Spencer and his crew are forced to take on both the cops and the mob to get to the truth.

[2:02] The movie is not very good.
I’m pretty sure that they said that Walpole Prison was up in Revere, and the dog track at Wonderland is simultaneously in South Boston and deep in some primeval forest.

[2:17] The murder dirty cop is supposed to have lived in a giant McMansion in Boston, which is too much to believe exists. Even in West Roxbury.

[2:26] About the best thing I can say about the film is that some of the aerial shots of Boston are really stunning.

[2:33] Spencer Confidential is loosely based on Spencer for Hire, a TV show that ran on ABC for three seasons in the late eighties.
I’ve never really gotten into the TV show, but I have always been a fan of the books that both it and Spencer Confidential are based on.
Robert B. Parker wrote 40 Spenser novels between 1973 and his death in 2010.

[2:57] They’re very consciously styled after the hard boiled detective novels of Daschle, Hammett and Raymond Chandler, with Spencer is an archetype of the jaded private eye with a heart of gold.

[3:07] Parker’s obituary in The Chronicle of Higher Education begins. Of the many crime writers who have tried on Raymond Chandler’s Mantle few, Ward is easily as Robert B.
Parker Parker Spencer. Books form the centerpiece of a body of work that bears Chandler’s torch through the late 20th century and into the 21st where continues to light the main roads of the hard boiled tradition.
Spencer’s written as a Korean War vet and former prizefighter, and his wisecracking banner is peppered through with obscure references from English and American literature, and he’s more likely to be portrayed whipping up a gourmet meal than pounding back scotch.
I’ll include a recipe that I adapted from Early Autumn, the seventh novel where Spencer’s unofficially adopted son, Paul is introduced, and this week’s show notes.

[3:56] After Spencer, his sidekick, the inscrutable African American hitman Hawk and the love of his life. Susan Silverman.
Boston is the most important character in the series of novels.
Before I ever moved to Boston, I felt like I knew this city through the pages of Parker’s novels from the Harbor Health Club, where Hawkins Spencer work the heavy bag to Spencer.
Shoddy office in the turn of a building at the corner of Mass Avenue, Boylston that’s now a Bank of America.
I slowly discovered the corners of the real Boston after moving here that I had imagined through Spencer’s eyes for years, especially the first few novels, or kind of a time capsule of bygone Boston.
There are written in the time before gentrification, when the South End and the Fenway we’re still in the throes of urban blight.
It was also the time of busing when Boston’s racial divide was in the spotlight and Spencer’s friendship with Hawk was seen as a radical move even in fiction.
Decades before the term toxic masculinity was coined, Parker Spencer wrestled with what it meant to be a man. In modern times, the Chronicle of higher ed continues.

[5:07] Parker taught full time for more than a decade, rising to the rank of full professor at Northeastern University.
Although he left the classroom in 1979 when his Spenser novels gained marketplace traction, he never ceased to teach.
His writing amounts to a decades long primer and the meaning of tough.
For Parker, Tough was a stance and ethos, a code in a world view all at once.
Through his characters, he acted as the crime genres professor of hard boiled studies.
For nearly 40 years, Parker consciously dismantled the stereotype of the hard boiled tough guy in all his books and then reassembled it with only the parts he liked, creating detectives to update the image for more progressive times.

[5:54] The essential Parker 10. It was that you must be tough, but also soft. The two must co exist, but tough comes first.
It means a Spencer put it in the 1995 book Thin Air, being able to control feelings so you won’t be tripping over them while you’re trying to do something useful.

[6:14] Soft, on the other hand, means that you have to know yourself fully.
Spencer’s longtime partner, Susan Silverman, admits to him that you let me see your emotions from time to time.
Parker’s tough, soft characters understand the value of home and hearth and of Children, even if they don’t have their own.
In early autumn, for example, Spencer becomes the guardian of a young child, a responsibility that he accepts and take seriously.
Tough Soft is also tolerant. Parker made Spencer ostentatiously gender and color blind, working with entrusting a diverse cast of people, particularly gay tough guys, one of whom was a police officer who appears in a number of books.
Above all, tough, soft must be principled. Spencer is so often willing to put financial motives aside that an observer marvels and small vices that having a paying client must be a nice change of pace.
In short, Parker’s detective is, ah, hardboiled humanist.

[7:17] How well is this treatment held off now, almost 50 years after Spencer was first written, we’ll include links to some of the early novels and this week’s show notes, so you can decide for yourself and for upcoming event.
This week we’re featuring nothing.
I was gonna feature a talk by past podcast guest professor Mark Peterson at the Royal House and slave Quarters in Medford, but it’s been cancelled.
Everything’s been canceled, and if there any events out there that haven’t been canceled, they probably should be.
We’re gonna hold off on promoting upcoming events until further notice.

[7:52] Events may be canceled, but raising money isn’t Before moving on, I want to pause and say, a big thank you to everyone who supports Hub history on patriotic.

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We’re better researchers now and better writers, but what really stands out to me is how much better we sound. Then we used to.
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[8:58] Now it’s time for this week’s main topic. On August 27th 1918 Boston became acquainted with the epidemic that has spooky parallels to today’s Cove.
In 19 it went down in history as the Spanish flu.
But a more accurate name for the disease outbreak might be the Boston flu, because our city is where this influence of variant mutated and first turned truly deadly.
The first cases of this new and deadly disease were reported among sailors Commonwealth Pier in South Boston.
Soon, Boston would suffer nearly 1000 deaths per week as the disease peaked.
Before it was over, up to 20% of the entire world’s population would be infected with up to 100 million people killed.
The 1918 flu was the most deadly disease in human history, but it’s also our best model for prevention and cities that quickly put social distancing protocols into place, closing theater, schools, churches and other gathering places.
The death rate was a fraction of that in cities that didn’t.

Influenza:
[10:06] In August 1918 Boston was a city on a wartime footing.
It had been about a year and 1/2 since the U. S entered World War and our factories or manufacturing arms.
Soldiers were streaming in on trains to board ships to Europe, and the Navy Yards in Charlestown in South Boston overflowed with ships and sailors.
Commonwealth Pier on the South Boston waterfront was an important naval facility, serving as the embarkation point for both sailors and soldiers who were bound for the front lines.
A huge rail yard fanned out just across the street, while rail sightings allowed trainloads of troops and supplies to be rolled right onto the pier.
Throughout the warriors, tens of thousands of sailors passed through Boston at any one time.
Thousands of sailors could be waiting for orders while living on board receiving ships. At Commonwealth Pierre, a receiving ship was an old hulk, anything from a modern ocean liner to an elegant antique clipper.
Anything that floated but was no longer seaworthy that could be converted into a giant floating barracks.
Large ocean liners would be used as is, while old sailing ships would have their masts and rigging removed and a large wooden superstructure added to house more men.

[11:28] The U. S Navy certainly had no shortage of aging ships that could be pressed into service.
Even the USS Constitution served as a receiving ship from 18 81 until restoration efforts began in 1906 For every military in history, disease has rivaled combat in its deadliness.
With so many sailors packed cheek by jowl in overflowing barracks ships.
It was unsurprising when two sailors reported to Sick Bay on August 27th 1918 complaining of flu like symptoms, coughing, aches and pains and a high fever.
The next day, eight more reported the day after that, 58 more as they got sicker.
The patients were moved from the temporary sickbay at Commonwealth Pier to the Chelsea Naval Hospital.
Nobody knew it yet, but Boston had just become ground zero for the most deadly global pandemic the world has ever seen.
This wasn’t the first flu outbreak in human history, of course. It wasn’t even the first time in 1918 that the U. S. Military had to deal with a particularly virulent strain of flu.
In January and February, a country doctor named Lauren Minor, based in Haskell County, Kansas, noticed a sudden and dramatic increase in influenza cases.

[12:50] Haskell County was sparsely populated. It was the kind of place where dugout sod houses were still common in 1918 it had relied on the beef industry until some of the larger ranches went bankrupt.
Now it was known for raising hogs out of a scattered population of just over 1700.
Dozens were suddenly stricken with a serious respiratory flu somewhere in Haskell County, a strain of the swine flu, and made the jump to infect humans,
more concerning it had mutated to be transmissible from human to human directly.

[13:26] By the time Dr Minor was able to get an article published in a public health journal, it was April.
In the meantime, Army recruits from Haskell County were reporting for duty at Camp Funston.
The local paper named three recruits in the last two weeks of February, and it’s likely that Maura followed the same path.
It was the height of World war and camp. Funston was one of the U. S. Army’s main recruit training stations.
Before long influence, it was ravaging the densely populated army post, as colorfully described by Joseph He Persico in a 1976 issue of American Heritage magazine.

[14:04] The previous March, a severe dust storm and obscured the sun. At Fort Riley, Kansas, some 9000 tons of manure were burned every month at this Prairie Cavalry Post, continuously mantle in the area and a malodorous Hayes.
The storm winds had whipped up a stinging blizzard of dust and smoke that since soldiers stumbling, coughing and choking to the refuge of the barracks.
Two days after the storm had ceased, an army cook named Albert Getchell reported to the post hospital complaining a fever, sore throat and various aches and pains.
Minutes later, another soldier checked in with the same symptoms. The count had jumped to a 107 similarly afflicted patients by midday and by week’s end, 522 before the sickness ran its course.
Five weeks later, 1127 men have been stricken.
The base surgeon diagnosis the sickness as influenza. In May of 1918 the Army’s 89th and 92nd division’s finish their training at Fort Riley and sailed for France.

[15:10] Soon after the 92nd division disembarked at Brest and son is there.
French soldiers began to fall ill with influenza British soldiers in France carried the disease back to England.
Influences spread through the Royal Navy like flames on an oil slick.
Over 10,000 British sailors were laid low, confining the fleet deport The disease rolled across France and Germany were eventually 160,000.
Berliners came down, with the flu interrupted halfway around the world, sweeping across China, India and most of Asia.
Whether carried from Europe or appearing independently, nobody knew.

[15:47] A 2000 and four article in the Journal of Translational Medicine Pigs that outbreak in Haskell County, Kansas, as the origin point of the virulent 1918 flu.
But that is just one link in a century long chain of controversial claims about where the virus first emerged.
Most of the world refers to the 1918 epidemic as the Spanish flu because the first time civilians heard about the disease was in news reports about a new form of flu that was sweeping through Spain.
Of course, by the time it got to Spain, people in Germany, France, England and the United States were already suffering from the disease.
But those countries were all at war, and wartime sensors prevented news reporting on a disease that was affecting military readiness.
In neutral Spain, journalists were free to report on the disease and the term Spanish flu was coined.

[16:44] France was briefly blamed as well, since troops returning to the U. S. From the trenches of France were soon spreading the disease through military bases around the country.
And France didn’t have a good reputation as syphilis was, of course, known as the French disease.
Later research makes it clear that the disease was actually spreading in the opposite direction and earlier than people originally thought,
it was coming from Camp Funston to the front lines in France and then back again to the United States, so France could not be the origin point for this.
Disease scrutiny has often fallen on China, where rural areas have given rise to new strains of virulent flu.
As recently as 2009 however, until recently, no link could have been made between a disease outbreak in China and the global population movements that allow the 1918 flu to spread so aggressively.

[17:41] One researcher believes he may have found that link. Historian Mark Humphries of Canada’s Memorial University of Newfoundland,
believes that the 1918 flu started as a mysterious respiratory illness in northern China in November of 1917,
and then the British empire’s use of Chinese laborers in the European Theater of War and their movement across Canada spread this mystery disease around the world.
A 2014 National Geographic article reviews his research.
Humphries reports that an outbreak of respiratory infections, which at the time were dubbed an endemic winter sickness by local health officials in villages along China’s Great Wall.
The illness spread 300 miles in six weeks time in late 1917 that first thought to be pneumonic plague, the disease killed at a far lower rate than is typical for that disease.
Humphries discovered that a British legation official in China wrote that the disease was actually influenza.
In a 1918 report, Humphries made the findings in searches of Canadian and British historical archives that contained the wartime records of the Chinese Labour Corps and the British legation in Beijing.
At the time of the outbreak, British and French officials were forming the Chinese Labour Corps, which eventually shipped some 94,000 labourers from northern China to southern England and France during the war.

[19:11] The idea was to free up soldiers to head to the front at a time when they were desperate for manpower, Humphrey says.

[19:18] Shipping the laborers around Africa was too time consuming and tied up too much shipping.
So British officials turn to shipping the laborers to Vancouver on the Canadian West coast and sending them by train the Halifax on the East coast, from which they could be sent to Europe.

[19:33] So desperate was the need for Labor that on March 2nd 1918 a ship loaded with 1899 Chinese Labour Corps men left the Chinese port of We highway for Vancouver despite quote unquote plague,
stopping the recruiting of workers there.
The Chinese laborers arrived in southern England by January 1918 and were sent to France with a Chinese hospital at Neuilly sur Mer.
Recorded 100 suffered from respiratory illness.

[20:01] From there, the already familiar pattern kicked in the virus spread among the British, French and American soldiers.
It’s spread across no man’s land of the Germans, and it traveled back across the Atlantic to North America, where began to spread among the barracks ships at Commonwealth Pier in Boston.
While in its earlier incarnations, the disease had been debilitating, spread particularly aggressively and caused some deaths.
When it returned to Boston, it entered a new phase.
The flu virus mutates quickly, which is why creating an effective seasonal flu vaccine is so difficult. Every year the disease mutates more rapidly than vaccines can be developed and produced.
In Boston, the so called Spanish flu mutated into a form that started spreading even more rapidly, and it began killing in large numbers so that it would eventually become the most deadly disease in human history.
With all the Army and Navy facilities in and around Boston, the disease move fast from those first cases at Commonwealth, Pierre, 15 were quickly transferred to Chelsea Naval Hospital.
48 hours later, three of the medical officers who treated them also fell ill.
Flu arrived at Camp Devin’s, another of the Army’s main training post outside Boston, on September 8th.
In less than two weeks, thousands of soldiers and recruits were sick.

[21:29] Colonel Victor Von, a respected epidemiologist, visited Fort Devins early in the outbreak and wrote, Every bed is full.
Yet others crowd in the face is where a bluish cast a cough brings up the bloodstained sputum.
In the morning, the dead bodies air stacked about the morgue like cordwood.

[21:53] On September 29th an army doctor at the fort wrote to a friend, also a physician, in a letter that has become famous as a record of the disease.
This epidemic started about four weeks ago and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed all assemblages of soldiers. Air taboo.
Thes men start with what appears to be an attack of the grip or influenza, and when brought to the hospital, they very rapidly developed the most viscous type of pneumonia that has ever been seen.

[22:30] Two hours after admission, they have the mahogany spots over the cheekbones,
and a few hours later you can begin to see the cyanosis extending from their ears and spreading all over their face until it’s hard to distinguish the colored men from the white.

[22:47] It’s only a matter of a few hours then until death comes and it is simply a struggle for air until they suffocate. It is horrible.
One can stand to see 12 or 20 men die.
But to see these poor devils dropping like flies sort of gets on your nerves.
We have been averaging about 100 deaths per day and still keeping it up.
There’s no doubt in my mind that there is a new mixed infection here, but what I don’t know,
my total time is taken up hunting rolls Rawls, dry or moist, sibilant or crap, a tint or any other of the 100 things that 1 may find in the chest, they all mean. But one thing here. Pneumonia.
And that means in about all cases, death.

[23:37] I don’t know what will happen to me at the end of this. We have lost an outrageous number of nurses and doctors, and the little town of air is a sight.
It takes special trains to carry away the dead. For several days.
There were no coffins, and the bodies piled up something fierce.
We used to go down to the morgue, which is just back of my ward and look at the boys laid out in long rows.
It beats any site they ever had in France after a battle.
An extra long barracks has been vacated for the use of the morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers, all dressed up and laid out in double rows.
That letter begins to hint at the grim reality of the 1918 flu.
Today we treat the flu, or at least a rough collection of symptoms that we offhandedly referred to.
Is the flu fairly casually a few days of a nasty fever, body aches, headaches, maybe a stuffy nose or a cough? Then we’re back to normal.
A few deaths were caused each year by the flu, but those were restricted to infants, the elderly and people with compromised immune systems.
The 1918 flu was a whole different story.

[24:55] Not only was it more deadly than any flew in recent memory, it also disproportionately affected people who are young and healthy.
People we would consider most resistant to a seasonal flu today were the most likely to die in 1918 the Spanish flu turn an otherwise healthy patient’s immune system against them.
The virus would stimulate white blood cell production to fight the disease, and then the white blood cells would trigger the production of proteins called cytokines.
The virus then caused the white blood cells to see the site of kings as an infection, chartering the production of more white blood cells than more cytokines until it became a self reinforcing cycle called a say taking storm.
Patients with the strongest immune systems were felled quickest as their immune systems attacked their bodies.
White blood cells attack the mucous membranes of the lungs and intestines, causing intense hemorrhaging.
These patients could literally drown in their own blood, or they could develop deadly secondary infections like bacterial pneumonia.
An article from Yankee magazine attempts to categorize the ways a young, healthy patient would begin to experience flu symptoms, then rapidly slide into a decline toward death.

[26:08] Number one in the first group. The disease began mildly, and the patients felt is there.
There would be better in a couple of days, a day or two later, there was a rise in temperature, followed by the onset of pneumonia, then Death number two.
In this group, the disease began somewhat severe. It was followed by pulmonary complications than recovery number three.
The third type began is extremely severe. Breathing became difficult.
Cyanosis set in At Devon’s, the lungs of 18 year olds were filling with fluid.
They were drowning, their faces blue from lack of oxygen.
And this type death followed in 36 to 48 hours.

[26:54] When we get a headache in a stuffy nose and complain that we might be coming down with the flu, perhaps we do well to remember the patients of 1918 who, as a doctor recalled,
died struggling to clear their airways of a blood tinged froth that sometimes gushed from their nose and mouth even as it turned deadly.
The flu outbreak at first seemed to be confined to the military bases surrounding Boston.
Nine days after the first cases at Commonwealth Pierre, the state health department was still optimistic enough to warn.
Unless precautions are taken, the disease, in all probability, will spread to the civilian population of the city.
That was September 5th. Within days, the first epidemic was beginning to spread through the civilian population rapidly enough that emergency tent hospitals were called for.

[27:48] The 1st 1 of these opened on Corey Hill in Brookline on September 9th, less than two weeks after the first documented infection,
the National Guard had completed the work in a single day under the direction of Colonel William H. Brooks.
Tent Camps served a dual purpose of relieving overcrowded hospitals and providing patients with fresh air, which was thought to reduce the rate of infection.
The Health Department would later say Boston has had the unenviable experience of being the first American city, which was called on to deal with what proved to be a pandemic of influenza of unprecedented, virulent CE.

[28:31] The first civilian death was reported in The Boston Globe on September 11th 1918.
Katherine Callahan, a nurse overtaxed by her work for our soldiers, died today.

[28:45] The story went on to note that her 19 year old sister, Mary, was hospitalized for pneumonia, as was their mother.
Soon after that story ran, Boston’s public health commissioner was quoted as saying, I believe the plateau, if not the peak of the contagion, has been reached.
There is a chance that we shall continue at the same level until the first of the week, and then a steady downward tendency may be expected.
Katherine Callahan was the first civilian casualty on September 11th.
On September 14th Boston’s immigration station on Gallops Island in Boston Harbor was opened as a quarantine hospital.
It’s 200 beds were almost immediately filled By the 16th. 19 people had died.
A week later, 334 were dead.

[29:40] Katherine Callahan’s plate reveals one of the greatest challenges of the epidemic. The city and state were running low on medical personnel.
Doctors and nurses have been called to serve in the Great War in France, and those who were left behind could not keep up with the ever increasing number of patients.
Governor McCall soon issued a proclamation asking every person in Massachusetts who had any medical training or experience to report for duty in fighting the disease.
An article on the website Influenza Archive outlines how Boston attempted to counter this shortage of medical personnel.

[30:19] Physicians and nurses were being overworked, and hospitals were overflowing with desperate patients.
32 nurses from Brigham Hospital were out sick with influenza themselves. Unable to care for patients.
The homeopathic hospital refused admittance to some 400 influence of patients. Temporary emergency hospitals were being set up in and around Boston to relieve some of the pressure, with the lack of doctors and nurses meant that there were precious few to take care of patients.

[30:47] To help allocate precious resource is in the most efficient manner.
Authorities established a hospital clearinghouse to keep track of daily hospital bed availability and distribute patients accordingly, and the handle appeals for nurses and doctors.
They also established a relief station in East Boston that was continually staffed with physicians and nurses.
They placed Boston’s health department nurses under the supervision of Mary Beard and the Instructive District Nursing Association, so that they could be assigned duties more efficiently.
The consumptive hospital department did the same with its nurses, as did the Baby Hygiene Association, the school committee and area nursing schools.
Many Boston and Cambridge teachers, released from their usual work through this school closures and informed that they would be paid the regular salary if engaged in relief work, volunteered that aid the city’s nurses. In combating the epidemic.
Yankee magazine describes measures taken by the Commonwealth to try to fill the ranks of doctors and nurses.

[31:46] The lieutenant governor, Calvin Coolidge, had wired Washington and received more than 1000 additional nurses, and some of the money he’d asked for doctors and nurses were still sadly needed.
All month long, the city newspapers ran front page appeals for healthy men and women to volunteer for workers, nurses, bandage, sewers, ambulance drivers, Laundress is pharmacists and messengers.
Nurses would be paid $28 a week nurse’s aides $15 and if they came to the city from a distance, their transportation fees would be reimbursed.
Henry Endicott, chairman of the state Committee on Public Safety and acting chairman of the Emergency Public Health Committee, encouraged people to step forward and show their patriotism.

[32:32] Meanwhile, life in Boston was becoming grim.
One of the nurses who was mobilized to fight the flu recalled one.
Never to be Forgotten day. At the height of the epidemic, it seemed as if all the city was dying in the homes seriously.
Illness on the streets, funeral processions As Children jumped rope in the streets, they sang a morbid new skipping song.
I Have a little bird and its name was Enza. I opened the window and influenza, With city officials finally taking the threat of flu seriously, all schools were ordered to close on September 24th.
Slides and short films, warning of the dangers of the flu, were shown before features in Boston’s movie theaters until another round of restrictions was announced on September 28th.

[33:25] The City Emergency Health Committee on Thursday ordered closed from midnight Thursday until October 6th.
All theaters, motion picture houses, dance halls and public halls of every description all other meeting places not classed as essential also come under this edict.

[33:46] On October 4th, so to Fallon’s bowling alleys and saloons were forced to shut down that same day.
Churches and Sunday schools were ordered to shut their doors.
Hotels and cabarets remained open, but with strict ordinance is implementing fines for dancing, kissing, sharing cups or spoons, sneezing, coughing or spitting in public.
Residents were urged to Onley use the telephone in case of emergency because over 850 operators were out of work with the flu.
The Boston Street wear away had over 100 and 65 Carmen out, and they were having trouble maintaining their usual schedules.
On October 7th, businesses were ordered to stagger their opening and closing times to relieve rush hour crowding.
Anything that could prevent people from packing together in close quarters and increasing transmission of the disease was fair.
Game wakes were banned on September 27th and funeral homes were prevented from bringing in extra chairs for a funeral and yet another attempt to prevent large gatherings.
At the same time, there weren’t enough coffins and grave diggers for the sudden influx of bodies.
Bodies of the indigent were taken to Mount Hope Cemetery, which bore the brunt of the pandemics burial boom after the fact, a report issued by the Boston Health Department acknowledged the grave state of the city.

[35:11] The most severe outbreak of influenza that has ever prevailed in Boston occurred during the last four months of 1918.
During September and October. It constituted a veritable epidemic, causing sickness and suffering among a large part of the population of the city.
I’m bringing death and misery into thousands of homes.

[35:30] Even his Boston teetered on the brink of collapse, and doctors, nurses and public health workers tried to contain the spread of flu.
There were researchers trying to put a stop to the epidemic.
In his 1976 American Heritage article, Joseph Persico introduces us to one of the stranger attempts on the parade ground at the naval present on Boston Harbors Deer Island.
Dr. Joseph Goldberger, a public health physician, stood before 1000 deserters in subordinates, brawlers and other delinquent sailors.
The doctor needed volunteers for an influenza experiment.
In his book, A Short History of Nearly Everything, Bill Bryson picks up the narrative.
The prisoners were promised pardons if they survived a battery of tests.
These tests were rigorous to say the least First, the subjects were injected with infected lung tissue taken from the dead and then sprayed in the eyes, nose and mouth with infectious aerosols.
If they still fail to succumb, they have their throat swab with discharge is taken from the sick and dying.
If all else failed, they were required to sit open mouth while the gravely ill victim was helped to cough in their faces.

[36:47] Out of somewhat amazingly, 300 men who volunteered, the doctors chose 62 for the tests.
None contracted the flu. Not one.
The only person who did grow ill was the ward doctor who swiftly died.
The probable explanation for this is that the epidemic had passed through the prison a few weeks earlier, and the volunteers, all of whom had survived that visitation, had a natural immunity.

[37:17] Writing in the Journal of Public Health reports, Carol Byerly outlines how quickly the flu spread through the national network of Army bases.
Influenza reached all Army training camps in a month, arriving September 8th at Camp Devin’s September 13th at Camp Upton.
September 21st at Camp Grant, September 26th at Camp Cody and then on to the West Coast, arriving October 8th at Camp Fremont, California in October 9th at Camp Lewis, Washington.

[37:51] With troops on the move across the country and around the world, the disease quickly spread.
A ship from Boston carried influenza to the Philadelphia Navy Yard.
The next day, two sailors there died. Soon Philadelphia, Baltimore and San Francisco, with their large navy facilities, were particularly hard hit.
Influenza would sweep from Nome, Alaska, to Johannesburg, South Africa, and cause record death tolls across Europe and Asia.
Even remote islands in the Pacific and tribes deep in the Amazon would not be spared.

[38:29] In the end, nothing doctors and researchers did could contain the virus.
It would eventually run its course, subsiding naturally in the late fall in winter of 1918.
Ironically, this season, when flu is normally most active,
the peak of the epidemic struck in mid October, but there were still later spikes as long as the virus lingered in the population, anything that brought groups together could cause an increase in deaths.
As this 1919 city Health Department report reveals, the disease gradually subsided, though it never died out.
The celebration of the signing of the armistice brought great crowds into the city on November 10th and 11th.
Evidently, this offered a great opportunity for the spread of the disease. As there followed a rapid increase in the number of cases and later on deaths.
The disease again subsided for a time, but the crowds gathered for Christmas again caused a recruit essence of the disease, which has continued into the end of this year.

[39:28] In the five years from 1911 to 1915. Boston average 30 deaths per year from influenza in 1917.
51 deaths were attributed to the disease in 1918.
The annual report of the city Health department puts the official death toll from influenza at 4023 with an additional 771 from pneumonia secondary to influenza.

[39:56] The health Department recorded a total of 4794 dead in Boston in 1918 which is almost certainly low.
Do the number of influenza deaths that happened before reporting was required?
They were miss reported, or when pneumonia was listed as the only cause in the state of Massachusetts.
Estimates range from 23,000 over 50,000 deaths related to the flu.
About 675,000 people died of the flu in the United States, and worldwide estimates range from 50 million toe over 100 million people dead.
The disease may have infected 20% of the world’s population and killed as many as three or 4% of the entire global population.
It killed more people in a year than the HIV AIDS epidemic hasn’t 40 and more people that the black plague did in a century.

[40:52] Doctors today have a lot more knowledge about infectious disease and a lot more pharmaceutical weapons than doctors had in 1918.
Starting in 1996 DNA was extracted from the lung tissue of Spanish flu victims, and by 2005 the complete genome was reconstructed.

[41:13] Physicians now know exactly what the mysterious virus was that swept around the world in 1918 a variant of the H one n one swine flu.
The CDC says that there is evidence that some residual immunity to the 1918 virus or a similar virus is present in at least a portion of the human population.
Since contemporary H one N one virus is circulate widely, and the current annual influenza vaccines contain an H one N one component,
a 1918 like H one N one virus would not fit the current criteria for a new pandemic strain.
Two types of antiviral drugs flew, Nadine and Tamiflu have been shown to be effective against influenza.
Virus is similar to the 1918 virus, so that must mean that we’d be okay if a similar outbreak happened today, right? not so fast.
Gerald T. Coi, SH associate dean of the BU School of Public Health, warns,
conditions are favorable for the emergence of a dangerous pandemic variant of the influenza virus and preparedness to deal with such an event remains fragmented, underfunded and weak.

[42:32] As we said at the top of the show, influenza mutates and adapts rapidly while we have strains of H one N one in every season’s flu vaccine that doesn’t guarantee protection against a newly arisen strain.
Peter police chairman and a professor in the department of microbiology at Mount Sinai School of Medicine in New York warrants that each dose of flu vaccine is created using one chicken egg.

[43:00] If a new and deadly strain of flu were to require a new vaccine, it would take three million eggs per day to produce enough vaccine to treat the most vulnerable U. S citizens within even three months of the beginning of the outbreak.
That would push our nation’s chickens to their limits.
That’s why people are justified in the stockpiling of vaccines, he says.
We’ll leave you with this happy thought from Dr Tom Ingles, be director of the Bloomberg School Center for Health Security.
What I worry about is that there could be too many people for the system to care for it.
Once very difficult choices would have to be made about how to distribute medicine and how to distribute ventilators because they are in limited supply,
at the peak of the pandemic in the US we’d have seven times more people in need of ventilation than we have ventilators and seven times the number of people needing intensive care.
Then we have intensive care beds.

Jake:
[44:02] Cholera is a truly horrifying disease with severe diarrhea causing death through dehydration. Well, the patient remains awaken in agony as their extremities dry out and shrivel up.
The disease is carried by fecal bacteria, so it’s virtually unknown in highly developed countries today because of our sophisticated sewage and drinking water systems.
Back in 18 49 Boston had just begun to address its drinking water needs. We hadn’t even begun to deal with our sewage.
And most of Boston raw sewage ran an open gutters down the sides of the street.

[44:38] When the first major cholera epidemic hit Boston in the summer of 18 49 hundreds died.
With no vaccine or effective medical treatments, the city government was forced to take a public health approach that was focused on sanitation first.

Cholera:
[44:53] When Boston was racked by an epidemic of cholera in 18 49 medicine and not yet adopted the germ theory of disease.
Instead, many doctors relied on the my asthmatic theory of disease to explain why their patients got sick.
The U. C. L. A Department of Epidemiology has a succinct description of what that meant.
Many in the early to mid 19th century felt that cholera was caused by bad air arising from decayed organic matter or Maya’s mata.
My asthma was believed to pass from cases too susceptible. Tze and disease is considered contagious.
Believers in the miasma theory stressed eradication of disease to the preventative approach of cleansing and scouring rather than through the pure scientific approach of microbiology.
One prominent supporter of the miasma theory was convinced that cholera was transmitted by air.
He reasoned that soil it low elevations, especially near the banks of London’s River Thames, contained much organic matter, which produces Maya’s mata.
The concentration of such deadly Maya’s mata would be greater at lower elevations than in communities in the surrounding hills.

[46:04] At that time, Boston was still a fairly small peninsula, nearly entirely surrounded by title salt flats.
Well, there was some film banned in the former mill pond that became boffins triangle along the flats of Beacon Hill and in the area surrounding the earlier city dock.
The massive landfill projects of the Back Bay, South Boston, in the South Bay still lay in the future.
These tidal flats that we be later filled in were believed to be perfect incubators for disease.
A report by the city’s Committee on Internal Health from December 31st 18 49 describes the areas in Boston that were hardest hit by cholera.
It’s pretty clear that the authors were believers in the miasma theory and the inherent unhealthy nous of coastal soils.
As is well known, most persons throughout the city were more or less affected by the cholera atmosphere.
But few cases of the actual disease and still fewer deaths occurred in any of them, or dry and airy portions of the metropolis,
as will be seen by the topographical map appended to the medical report, the epidemic made its first attack and spent its force in those localities which were nearest to the level of the sea and in fact rescued from it by filling up with Doc mud,
which were the least perfect in drainage, that worst ventilated and the most crowded and filthy.

[47:24] We’ll have a link to that mentioned topographical map in this week’s show notes, so you can see where cholera hit the hardest.
There are cases scattered across the city, with concentrations along the South Bay near today, South Street Diner and in the North End along Hanover Street in Ann Street, today’s North Street near Cross Street.
The committee report goes on to describe the conditions in these neighborhoods. There were at least partially built on made land.
In all these localities, there are many streets, courts and lanes which are exceedingly contracted, ill ventilated and dirty, without any proper grade and with no or very insufficient sewerage.
This state of things is mainly owing to the fact of there, having been originally laid out by private speculators whose only object was to make a profitable investment for themselves, who paid but very slight attention to the health or comfort of those who have to reside upon them.

[48:19] Along with the marsh mud, insufficient sewerage and improper grading.
The areas that were hardest hit by the 18 49 cholera outbreak tended to have one other thing in common.
They were home to many recent immigrants from Ireland.
Keep in mind that while Boston heavily identifies as an Irish city today in the mid 19th century, Irish immigrants were considered unwelcome.
They tended to be dirt poor as they were escaping literal starvation after the potato famine began in 18 45.
And they were Catholic in a city that had religious biases going back 200 years and used to celebrate Pope’s Night annually by burning effigies of the pope.

[49:00] As tenements begin to multiply in the North, in the South in and other neighborhoods, old Yankee Boston reacted to this wave of immigration with some of the same ugly impulses that we see playing out in reaction to recent waves of Central American immigration.
When these Irish American neighborhoods began to suffer from cholera, many Bostonians were all too happy to blame the Irish for their own fate, seeing them as inherently filthy and immoral.
The 18 49 internal health report on the epidemic alludes to these biases when it describes who was hardest hit by the disease.
For the most part, the temperate, the moral, the well conditioned escaped whilst the imprudent, the vicious and the poorly fed succumb to its insidious influences.

[49:45] In a November 18 49 letter to the Boston Medical and Surgical Journal, Dr James W. Stone more explicitly tied the cholera outbreak to the presence of the foreign born and to the poor living conditions they were forced to survive in.

[50:00] There can be no doubt that the mortality has been greatly increased by the crowded, an unventilated condition of houses in which foreigners are enclosed,
and by the frequent assemblage and ill constructed public halls of crowds who are often obliged to remain three hours to listen to a lecture concert occupying half that time.
The mercenary calculations of miserly individuals have sometimes induced them to erect low contracted tenements, scarcely more visited by lightning air than those destructive minds where summer obliged to consume the greater part of an abridged life.

[50:33] The internal health report continues, describing living conditions in the densely populated tenements around the foot of Fort Hill, which was the absolute epicenter of the 18 49 epidemic.

[50:45] We allude to the very wretched, dirty and unhealthy condition of a great number of the dwelling houses occupied by the Irish population,
in Batterymarch Broad, Worf, Wells Bread, Oliver Hamilton, Atkinson Curve, Brighton Cove an and other streets.
Thes houses, for the most part, are not occupied by a single family or even by two or three families.
But each room, from Garrett to cellar is filled with the family, consisting of several persons and sometimes with two or more families.
The consequence is an excessive population, holy disproportion to the space or accommodations in Broad Street in all the surrounding neighborhood, including Fort Hill and the adjacent streets.
The situation of the Irish and these respects is particularly wretched.

[51:32] During their visits in the last summer, your committee, where witnesses of scenes too painful to be for gotten and yet too disgusting to be related here,
it is sufficient to say that this whole district is a perfect hive of human beings without comforts and mostly without common necessaries,
in many cases huddled together like brutes among the dehumanizing language, referring to the excessive population of Irish American brutes who live in hives.
The phrase without common necessary stands out.
At the time, necessaries was a polite euphemism for sanitary facilities that is to say, a bathroom were a privy thes tenement buildings must have been overflowing with more than just excessive population.

[52:20] In his new book, The City State of Boston, Mark Peterson makes this observation about one of the narrow alleys around Fort Hill.

[52:28] Henry Clark, the doctor heading the cholera commission, found 12 to 14 ill constructed an overflowing privies in this densely occupied alley, which also received human waste tumbling down from the Fort Hill slums Up above.

[52:42] Living conditions in the tenements around Fort Hill made a major diarrheal epidemic more or less inevitable.
Those overflowing privies were the perfect mechanism to transmit the disease from one patient to an entire neighborhood.
In a journal article called Cholera and the Pump on Broad Street, Laura Ball summarizes what cholera is and how it’s transmitted.

[53:04] Microbiology has shown that cholera comes from bacterium called vibrio cholera I that enters the body through contaminated water or possibly food.
The bacteria’s interference in the small intestine causes profuse diarrhea and vomiting.
The consequent dehydration produces several distinctive symptoms.
As the concentration of water in the bloodstream decreases, the blood becomes thick and tar like capital areas rupture, which often turns the skin blue.
The heart rate becomes irregular and dehydrated limbs begin to shrivel.
The nervous system, however, remains intact until the end, leaving the victim fully conscious of the pain.
Without treatment, death occurs within days or even hours of the first symptoms.

[53:52] With a long history of dysentery epidemics in Boston, I was curious about what makes cholera different.
They’re both disgustingly deadly diarrheal diseases. But as Laura Balls description laid out, cholera is the result of a specific bacteria vibrio cholera I.
It causes watery diarrhea that leads to death by extreme dehydration.
Dysentery, on the other hand, is a catch all term for gastrointestinal diseases that cause bloody diarrhea.
It could be the result of any number of bacterial infections or amoebas, and similarly causes death by dehydration.

[54:27] Boston faced major dysentery outbreaks throughout the 18th century, especially during the siege months of 17 75 and 17 76 when both the red coats camped out on Boston Common,
and especially the soldiers and civilians in and around the Patriot camps and Roxbury in Cambridge, where racked by,
camp fever and dysentery,
both armies were plagued by diseases of the intestine throughout the war.
With John Blake in our Boston Book Club selection this week,
crediting that experience for inspiring many of the early sanitary regulations in Boston,
with everything from disposing of the by products of butchering to grave digging to selling spoiled produce being regulated in the years between the end of the war and the adoption of the federal Constitution.

[55:11] Blake continues outlining early attempts by the Boston Board of Health to deal with human waste in a sanitary fashion.
At the turn of the 19th century, another of the board’s most important sanitary functions was regulating the removal of human excrement.
At first, special carts were provided and certain men licensed to use them, but they frequently created nuisances.
Thus, in 1800 a newspaper correspondent wanted to know,
how long the citizens of middle and fist streets and on towards Hancocks worth are to be stifled by the intolerable stench arising from the filth spilled by the carts devoted to the dirty goddess.
Almost every morning, their olfactory nerves air saluted with Ian wholesome effluvia and their health’s endangered by the carelessness or perhaps design of these nocturnal gold finders.
The Board of Health have frequently ordered them to discharge. They’re using cargo in suitable places without effect.

[56:09] The licenses were continued unsatisfactory until in 18 11 a monopoly was granted to Jeremiah Bridge, who had special equipment for the job.
Many disliked paying bridges prices, however, though there are fixed by the board others, one of the share of the business and farmers were isn’t it being cut off from this source of manure?
As a result, many citizens failed to have their vault emptied on time or had it done by unlicensed collectors without permission.
Despite frequent threats and regular prosecutions, this phase of the sanitary program remained a persistent source of trouble,
In their efforts to keep Boston sanitary, the health officials found that wastewater from pumps, households and rainfall posed another continuing problem because of their concern with paving.
The Selectmen were also interested in good drainage and following long established procedures, they continued to supervise the construction and repair of common sewers in the streets.
The Board of Health, for its part, required property owners to convey wastewater underground into the nearest sewer and from time to time ordered individuals to clean their household drains.

[57:16] The measures outlined by Blake sound like laudable goals. But for the immigrants and desperately poor families crammed into overflowing tenements in the slums around Fort Hill, reality did not measure up.
Here’s how the 18 49 Internal Health Report describes sanitary conditions in a typical tenement.
The houses are also insufficiently provided with the necessary in and out of door conveniences, which are required in every dwelling place.
The great mass of them have been one sink opening into a contracted in ill constructed drain or, as is frequently the case, into a passageway or street.
And but one privy, usually a massive pollution for all the inhabitants, sometimes amounting to 100.
Some of them have neither drained nor privy, and the tenants are obliged to supply their necessities as best they can with human waste running an open sewers down the sides of the street.
And sometimes in the street itself, it wouldn’t take much to set off a diarrheal epidemic.
Somebody steps in the suspect puddle that gets tracked into the house.
They used their hands to pull off their soiled shoes, and then there may not even be a sink in the apartment to wash up with before preparing dinner.
That’s how countless rounds of dysentery got started over the centuries. However, Boston had never encountered cholera before the mid 19th century.

[58:34] Cholera probably first arose in South Asia many centuries ago, but it didn’t become a global pandemic until after the British subject Gatien of that region with the global nature of the British Empire came widespread travel.
And with this widespread travel came a series of epidemics.
The first, starting in 18 17 spread the disease throughout Southeast Asia, East Africa, the Middle East, Russia and parts of Europe.
A second wave in 18 26 mostly affected Europe and brought the disease to American shores of the first time.

[59:07] In his 18 92 Observations on Cholera, published in the Boston Medical and Surgical Journal, Dr J.
H. McCollum discusses the first emergence of the disease in North America in 18 32 collar across the ocean for the first time and entered this country by way of Gross Island, the quarantine station for Quebec,
from April 28th 18 32 to June 3rd, 18 32 there arrived across island four collar infected ships, namely the ship Constanta from Limerick, Ireland, which arrived April 28th.
The ship Robert from Cork, arriving May 14th the Elizabeth from Dublin, arriving May 28th.
And the Brig. Carrick from Dublin, which arrived on June 3rd.
The importation of the disease by immigrants on the’s ships was the origin of an epidemic that extended from Quebec to Montreal, up the ST Lawrence and a Long Lake Ontario, down Lake Champlain to Albany and to New York from New York.
Collar extended to Newport, Newark, Philadelphia, Baltimore, Charleston in Washington, D. C. During the months of July and August.
This epidemic spread from Chicago and ST Louis down to New Orleans at the end of the year 18 32 though the United States was free from cholera.

[1:00:26] With fears of a cholera epidemic running high in 18 32 Boston’s commissioners of health made every preparation they could to combat it.
They stage supplies and located facilities so they’d be able to sell up cholera hospitals near infected areas. Quickly, they performed inspections and find landlords who didn’t provide adequate sinks, strains and necessaries.
The commissioner’s also offered this advice on how to avoid cholera.
Observe a perfect temperance in living. Avoid exposure to all debilitating causes, especially fear,
abstained from Spiritus liquors, which not only invite the disease by the indirect ability they occasion but render the system, in susceptible of all the most valuable medicinal agents employed in its cure.
Avoid as much as possible exposure to the night air and crowded meetings in the evening.
Avoid all uncooked vegetables, salads, crude fruits and sour drinks.
The food should be substantial and generous and quality, but simple and a near it ating.
It is not well to make any great and sudden change in diet or regimen, just as the disease is expected.
But let all begin to leave off bad habits immediately.
Aqueduct, water and rain water, if tolerably pure, are better than that drawn from the wells, let all observe their customary hours for labor, refreshment and sleep and engage in all their usual innocent recreation. Zen amusements.

[1:01:51] It’s worth pointing out that of all that advice, only the bit about aqueduct water and rainwater being preferable toe well, water is actually accurate.

[1:02:00] The cholera outbreak there would finally turn deadly. In Boston, 18 49 was part of 1/3 global pandemic.
As a paper by GF Pile describes from 18 42 to 18 62 cholera raked the world,
as a pandemic originating in South Asia, latched onto pilgrimages, commercial vessels, warships and related transportation movements.
There is clear evidence that the disease entered the United States at two points within a nine day period of time.
New York was attacked on December 2nd, 18 48 and New Orleans felt the first effects on December 11th.
Pile argues that although the disease made landfall in New York City first, it actually spread faster up the Mississippi from New Orleans, quickly arriving in Louisville, Cincinnati in ST Louis.
Then, as anybody who played computer games at school from the late seventies to the early nineties knows, it found its way West with wagon trains following the Oregon Trail.
It wasn’t until almost six months later that the strain that had landed in New York City began traveling up and down the East Coast.
Census Bureau information compiled by Pile shows that collar was detected in Philadelphia and Baltimore in May and it finally arrived in Boston in June of 18 49.

[1:03:19] The 18 49 cholera season would last almost exactly four months from June to September, and during that brief window, somewhere between 607 100 people died from the disease in Boston,
the internal health report describes the course of the epidemic.

[1:03:36] The first death from the disease occurred on the third of June at number 11 Hamilton Street in the Person of an Irishman and the last on the 30th of September at the Cholera Hospital in that Oven Irish woman from Worf Street.
The whole number of deaths between these dates, with 611 of which 163 were Americans and 79 Bostonians.

[1:04:01] As terrible as a death toll of 700 might be out of a city of about 100 40,000 people. It could have been a lot worse.
Now is searching for online sources to research this story. I kept getting led astray by reports about 18 49 cholera outbreak in Boston, Boston, Indiana, that is.
After seeing so many references, I finally looked up an article about the 18 49 cholera Epidemics effect on small Midwestern towns, which was published in the Journal Transactions of the American Clinical and Climatological Association.
It included this summary of the outbreak in the other Boston, Boston, Indiana, a Crossroads village about 15 miles south of the National road, had 120 people in 18 49.
There were 53 deaths over five weeks.
Of those who became ill, only one recovered. Graves were dug by family members on their own property.
The town was abandoned except for one family. Often, there was no one left to bury the dead.

[1:05:05] The report describing the course of the epidemic in our Boston is eager to distinguish between so called Americans and the majority of sufferers who were immigrants.
As I already pointed out, people were all too willing to blame Irish immigrants for their own illnesses, pointing to their in temperate ways poor diets and habits of living packed into squalid tenement houses,
among the tenement districts, we’ve seen that the area around Fort Hill was probably the worst.
In her book Gaining Ground, recent podcast guest Nancy See Shoals describes how the Fort Hill area was the fashionable home of many wealthy merchants early in the 19th century.
But they gradually moved away to newly sheikh neighborhoods like Beacon Hill.
They’re large homes were purchased first by institutions like schools and libraries but then passed into the hands of absentee landlords, she says.
The ladder, anticipating that the encroaching business district would lead to an increase in land values, had no incentive to improve the building’s reading them at low rates and let them deteriorate,
into this declining area poured many Irish immigrants in the 18 forties,
attracted by the low rinse and the proximity of Fort held of the docks into places of employment.
The newcomers converted former mansions and warehouses, ended tenements, built ramshackle buildings on every available inch of open space and tunneled habitations into the hill itself.

[1:06:32] Of all the disgusting hobbles around Fort Hill, the tenements on a narrow alley called Half Moon Place, we’re probably the worst of all.
The 18 49 Internal Health Report describes living conditions in this wretched hive of scum and villainy.
Appended to the medical report is a sketch of Half Moon Place, which is probably the worst locality in the city.
Here, the houses are built around an area from which air is almost totally excluded by the perpendicular wall of Fort Hill on one side and the lofty buildings of Broad Street on the other.
A large part of the area is occupied by some 12 or 14 privies, constantly overflowing,
and by L constructed and worn out sinks and drains into which are hourly, thrown solid substances of all sorts, which choked them up and cause the liquid parts mixed with them to run over into the area.
There is a narrow entrance from Broad Street, whilst a steep and crazy staircase affords a passage to Humphrey Place some 50 feet above, side by side with staircase and fully exposed.
Ah, large square plank drain makes a precipitous descent conducting half hidden.
Half revealed not only the waste water of the Houses and Humphrey Place, but also the contents of its previous to the area below, which, as maybe supposed, is redolent of the fact.

[1:07:54] Back when I was a tour guide in Boston, I walk guests through the Back Bay telling a series of stories that were based in the mid 19th century, the same basic time period we’re talking about this week.
Sometimes the guests would get carried away and say how great it would be to go back to that time or ask me if I’d like to go back to that time if I could.
Reading passages like that description of Half Moon Place, with a dozen overflowing privies and an entire neighborhoods waste water flowing down a staircase onto its front stoop, my answer remains, as always, an emphatic no.

[1:08:28] By my calculations, Half Moon Place would have been located roughly behind the Broadside Pub on Broad Street downtown between Franklin and Windle streets.
We’ll include a map in the show notes this week showing where it and the warren of tiny alley surrounding it once were from 18 66 to 18 72. The hill was leveled and all the surrounding buildings were demolished.
The soil that was removed was used to create a new Atlantic Avenue, a process that’s also described in the book gaining Ground.
The newly flattened neighborhood was redeveloped as a business district.
In 18 69 the City Council recommended a change to the street cred in that area that resulted in the elimination of Half Moon Place, Hamilton Court, Hamilton Alley and Baker’s Alley, all of which show up with cholera map as the epicenter of the epidemic.
As a not so accidental side affected these changes, the squalid tenements and overflowing privies describing the committee report were also eliminated.

[1:09:28] Even as cholera was taking its toll on Boston, a British doctor named Jon Snow was conducting the research that would lead to a fuller understanding of the causes of this terrible disease.
London was in the summer of 18 49. Stricken with the same global color of pandemic is Boston.
During this period, Snow became convinced that cholera was a digestive disorder rather than a blood disorder, as many medical authorities believed at the time.
This theory let him to suspect that collar was caused by ingesting contaminated food or beverage.
So you began a careful statistical study of cholera patients to determine where they obtained their water.
During a particularly bad outbreak in the summer of 18 54 snow found that the majority of patients got their water from one of two major providers, the one that drew it from a lower, more polluted part of the Thames River.

[1:10:23] The research that would eventually convince the medical establishment the contaminated water was to blame for cholera was carried out that same year,
in the London neighborhood of Soho, snow mapped every fatal case of cholera and found that most were tied to a single public water pump.
He had the handle of the pump removed, and the epidemic soon began subsiding, at least locally.
It turned out that the well feeding the pump was contaminated by surrounding privies and cess pools.
It wasn’t, however, until after another outbreak in 18 66 that Jon Snow’s theory of cholera transmission was widely accepted.

[1:11:00] Snows early thinking on cholera certainly hadn’t reached Boston by 18 49.
So the theory of my asthma’s was the best information anyone was working from.

[1:11:10] The city mobilized a major public health campaign to try to halt or contain the epidemic.
Luckily, some of the public health measures that one would take against a my asthmatic disease map fairly accurately to those one would take against an intestinal bacteria.
From the Internal Health Report of 18 49 here of the preventive measures that the city recommended at the time, the police were directed to see that houses and sellers and exposed places were whitewashed.
Large quantities of disinfecting substances were purchased and freely distributed wherever they were required.
The inhabitants were notified to cleanse their house strange with constituent water, and the common sewers are ordered to be washed.
Different periods Throughout the summer, the board directed the large tract of marshy land, constituting the Back Bay.
And remember, before the back Bay was a neighborhood. It was a title marsh, and by 18 49 it was dammed up to power title mills.
So they directed the Back Bay to be flooded from the ocean and the water to be retained as great a height as the drains flowing into it would permit by a special order.
All vessels arriving in the harbor with fruits or other objectionable substances were ordered to report themselves to the hospital physician at Deer Island, by whom they were thoroughly examined in all decayed or Della teary ISS.
Portions of their cargoes were removed a thrown overboard before a permit was granted to come up to the city.

[1:12:36] Along with this public health approach, the city also arranged a special collar a hospital.
The groundwork for this have been laid during the 18 32 epidemic, but the plan wasn’t put into action.
Until 18 49 the hospital was set up in an old warehouse with 20 beds. At first, the capacity was later expanded, his 28 10 to 40 beds.
Unfortunately, doctors had no effective means with which to treat cholera at the time, so the hospital was essentially just a clean and comfortable place where the afflicted could await their deaths.

[1:13:10] The disease, or at least a slip ality, declined in the fall months.
This might mean that the city’s preventive campaign was effective. After all, Cleaning and flushing household drains and city sewers had to mean that there was less raw sewage in the streets on a daily basis,
however, it’s just a cz likely that the epidemic was curtailed by the onset of fall weather and the cooler temperatures that are less conducive to vibrio colorize survival.

[1:13:37] That wasn’t the last time that Boston had to contend with cholera. Just five years later, the disease reared its ugly head again.
Dr. J. H. McCollum’s 18 92 Observations on cholera give a sense of how the 18 54 outbreak affected Boston.

[1:13:55] In 18 54 there was a second epidemic of cholera in Boston.
The number of deaths from this disease was 218. Although there is no published account of this epidemic, the fact that it caused considerable anxiety is evident from the report of the consulting physicians, the mayor and aldermen of City of Boston.
The text of this report is as follows to the mayor and aldermen of the City of Boston.
Gentlemen, in reply to the interrogatory, is proposed this day by the mayor to the consulting physicians of the city.
The undersigned beg leave to ST that the cholera now exists in Boston, as in most large cities in the United States, button so limited a degree as not to be considered a general epidemic.
The consulting physicians concur in the propriety of inefficient prosecution of the active sanitary precautions which air stated to be in progress in the city, and they particularly recommend, as faras possible, the filling up of stagnant pools of water with earth,
the separation of the poor who reside in overcrowded tenements and especially their removal from sellers, which are damp, foul and on wholesome,
signed George Hayward, Jacob Bigelow, Z B.
Adams and James Air Consulting physicians of Boston.

[1:15:14] The medical community was still working within the framework of the Maya asthmatic theory of disease, and the city’s response was still grounded in sanitation in public health.
Filling pools of sewer water and reducing overcrowding and tenements probably were actually effective in combating the disease.
Whatever the reason, this time around the death toll was but a fraction of the 18 49 outbreak.
The last major outbreak of cholera in the 19th century came in the summer of 18 66.
This time, a grand total of 39 infections were reported with 19 fatalities.
This time around, the committee report indicates that the medical community was beginning to get over some of those earlier prejudices.
The reports which have been received as appears by the cases which we have been given,
show beyond question that the educated and uneducated, the wealthy and the poor, the old, the young, the prudent and the imprudent, the resident and the non resident furnished victims to this disease.
They also showed that locality does not afford complete protection from this pestilence, But the majority of cases that occurred during the year 18 66 were in the most unhealthy localities.

[1:16:27] This time the supposed morals of Irish immigrants didn’t take the blame for the epidemic resulting from the poor. Municipal service is available to them.
The response again was public health based, though that would soon start to change.
The germ theory of disease would just start gaining traction in the beginning of the 20th century, as medical science developed an understanding of how cholera was spread and how to prevent it.
In his 18 92 article in the Boston Medical and Surgical Journal, Dr J.
H. McCollum shares the latest consensus on cholera from a careful study of the different authorities on this subject that general opinion seems to be one that cholera is mildly contagious.
Two. That the principle, if not the only way of infection is by the alimentary canal.
Three. That the germs of the disease are carried only a short distance if it all through the air.
Four that the great danger of infection lies and the intestinal discharges and in the vomit iss five.
That contamination of the water supply and of the food by thes discharges is the chief source of danger.
Six. That Lenin or woollen fabric soiled by cholera discharges if excluded from air and sunlight served to keep alive the germs of the disease for an indefinite period.

[1:17:53] If the foregoing conclusions are correct, it necessarily follows that in order to prevent the admission of the disease to a city and effectually to stamp it out, the following measures must be adopted.
One. The proper isolation of all cases of the disease. Mild and severe.
Two. The disinfection of all discharges from the patient by chloride of lime or carbolic acid as recommended by the International Committee of Experts at Rome in 18 85. Three.
The most careful supervision of the water supply End of food four.
The rigid observance of all laws of hygiene in their widest sense.
Five. The disinfection of all persons in whom there is thes slightest suspicion of infection by suitable bathing and of their effects by superheated steam.

[1:18:45] Even before the advent of antibiotics and truly effective disinfectants and ambitious public health campaign was able to rein in the spread of cholera and of similar diarrheal illnesses.
The next time cholera reared its head in Boston, sewage systems were able to manage Boston’s human waste.
Public health was up to the task of providing the diseases spread, and modern medicine could help sufferers survive.
In 2011 a large group from Boston attended a destination wedding in the Dominican Republic while the wedding was held an exclusive resort.
Some food, drinks and ice were provided by outside caterers within a few days to members of the party and confirmed cases of cholera, and four others were being watched closely.
Ah, 30 year old man and a younger woman were hospitalized, given aural rehydration, strong antibiotics and, after a few days of extreme discomfort, recovered,
with clean cua, been drinking water, no overflowing privy pits and access to modern antibiotics.
Today’s Boston is far less susceptible to cholera than any earlier era.
It’s a good time to be alive, and I wouldn’t go back for anything.

Jake:
[1:20:02] Although Cotton Mother is best known today for his role in the Salem witch trials, he also pioneered smallpox inoculation in North America.
Smallpox is an ancient horror that has afflicted people around the world for centuries. It causes disfiguration, blindness and death.
In this classic clip, you’ll hear how mother learned about traditional African inoculation practices from a man named Dismas who was enslaved in mother’s household.
Using this traditional knowledge, Mather and a doctor names a video. Boylston confronted one of humanity’s ancient enemies as well as their fellow Bostonians who are opposed to this dangerous experiment.
You’ll also learn how Boston survived multiple smallpox epidemics throughout its history, including a final outbreak in the 20th century.

Smallpox:
[1:20:53] As a history nerd. People are often surprised to learn that I would not take advantage of time travel should the opportunity present itself.
I like a world with indoor plumbing, abolition, suffrage and a 0% chance of contracting smallpox.
I’m not sure that there’s anything today that we fear as much as our ancestors feared smallpox, a disease with a 30% chance of death.

[1:21:20] The initial symptoms of the disease included fever and vomiting, followed by the formation of sores in the mouth and a skin rash.
Over several days, the skin rash turned into characteristic fluid filled bumps with a dent in the center.
The bumps then scabbed over and fell off, leaving scars, the highly contagious disease used to spread between people or by contaminated objects.
There are estimates that the disease was killing up to 20% of the population in Europe through the mid 17 hundreds.
And, of course, once Europeans came to the Americas, smallpox wiped out the native population and was sometimes used as a biological weapon.
Early Bostonians were no stranger to the fear of smallpox.
In the show, notes will link to a 17 23 map of Boston by John Bonner with a key showing a list of great fires and a list of smallpox outbreaks.
It lists outbreaks in 16 49 66 77 78 89 90 17 02 and 17 21.

[1:22:28] Of New England’s history with smallpox. Ted Widmer, writing for the Globe, tells us, too early New Englanders.
Smallpox was one of life’s many imponderables.
No one really knew where the disease came from.
Was it carried by bad air or sent is a form of divine retribution for personal failings.
Boston had plenty to fear on both counts. One observer described the town at low tide as a very stinking puddle.
Medical knowledge was still primitive. A learned scientist, John Winthrop Jr.
Kept what he thought was a unicorn horn in his Cabinet.
For most, the first line of defense was the prayer book.

[1:23:12] Disease was an inseparable part of the New England story. From the beginning, it arrived with the great migration of the 16 thirties aboard the very ships that brought so many families to New England.
It returned in 16 66 and again in 16 78 when an epidemic killed 340 Bostonians. A young cotton Mather wrote Boston burying places never filled so fast.
With time, local leaders began to develop crude public health policies, burying the dead quickly, flying red flags over houses affected and requiring ships with six sailors to stop its Spectacle Island in Boston Harbor.
But as Bostonians knew, the next epidemic was always just over the horizon.
In 17 21 on April 22nd the H. M s seahorse arrived from the West Indies with smallpox on board and despite precautions, a full blown epidemic started.
The sailor was quarantined to try to prevent the disease from spreading, but some of the other crew were already infected. As they moved through the city, smallpox began to spread rapidly through the population.
And as a side note, that’s almost exactly how Boston came down with the Spanish flu in 1918. Check out Episode 95 for that story.

[1:24:32] For Bostonians wth e only preventative Measure Available was prayer.
Yet in other parts of the world, a defence known as very elation had been used for centuries.
The CDC describes the practice.
One of the first methods for controlling the spread of smallpox was the use of very elation, named after the virus that causes smallpox variola virus.
Very elation is the process by which material from smallpox pustules was given to people who had never had smallpox.
This was done either by scratching the material into the arm or inhaling it through the nose with both types of very elation. People usually went on to develop the symptoms associated with smallpox, such as fever and a rash.
However, fewer people died from very elation than if they had acquired smallpox. Naturally, that’s pretty gross.

[1:25:23] The Chinese practice the oldest documented use of very elation dating back to the 15th century.
They implemented a method of nasal insulation administered by blowing powdered smallpox material usually scabs up the nostrils.
Various insulation techniques were recorded throughout the 16th and 17th centuries in China.
Mild smallpox cases were selected his donors in order to prevent serious attack.
The technique used scabs that have been left out to dry for some time as fresh scabs were more likely to lead to a full blown infection.

[1:25:57] Three or four scabs were ground into powder or mixed with grain of musk and bound in cotton.
Infected material was then packed into a pipe and puffed up the patient’s nostril. The right nostril was used for boys and the left for girls.

[1:26:11] Two reports on the Chinese practice were received by the Royal Society in London and 1700 one by Dr Martin Lister, who received a report by an employee of the East India Company station in China and another by Clapton Havers.
But no action was taken to Similar methods were described in Sudan during the late 18th and early 19th centuries.
In one practice, ah, Mother oven unprotected child would visit the home of a newly infected child and tie a cotton cloth around the ailing child’s arm.
She would then haggle with the child’s mother over the cost of eats push tool.
When a bargain was struck, the woman would return home and tie the cloth around her own child’s arm.
In the second method, similar to that used in turkey, fluid was collected from a smallpox postural and rubbed into a cut made into the patient’s skin.
This practice spread more widely through Africa before making its way to Boston with unlikely endorsement of Cotton.
Mather Mother was born in Boston, the son of Maria caught in an increase Mather and grandson of both John Cotton and Richard Mother, all prominent Puritan ministers.
Mother was named after his maternal grandfather, John Cotton.
He attended Boston Latin School and graduated from Harvard in 16 78 at age 15.

[1:27:36] After completing his postgraduate work, he joined his father as assistant pastor of Boston’s Original North Church, where he assumed full responsibilities as pastor of the church in 16 85.
Coffin Mother is most remembered for his role in the Salem Witch trials.
In 16 89 Mather published Memorable Providence is detail ing the supposed afflictions of several Children in the Goodwin family in Boston, Catholic washerwoman Goody Glover was convicted of witchcraft and executed.
In this case, Mather had a prominent role.
Besides praying for the Children, which also included fasting and meditation, he observed and recorded their activities.
The Children were subject to hysterical fits, which he detailed in memorable. Providence is in the book.
Mother argued that since there are witches and devils, there are immortal souls.
He also claimed that witches would appear Spectra Lee as themselves. Basically, he wrote Witchcraft for Dummies.

[1:28:41] 19th century historian Charles Wentworth up, Um, asserted that they afflicted in Salem were imitating the Goodwin Children, but he put the blame on both Cotton and his father. Increase Mather.
They are answerable more than almost any other men have been for the opinions of their time.
It was indeed a superstitious age, but made much more so by their operations, influence and writings, beginning with increased Mathers movement at the Assembly of Ministers and 16 81 and ending with Cotton Mather’s dealings with the Goodwin Children,
and the account there, of which he printed and circulated far and wide.
For this reason than in the first place, I hold those two men responsible for what is called Salem Witchcraft.

[1:29:23] Mather wrote more than 450 books and pamphlets, and his ubiquitous literary works made him one of the most influential religious leaders in the colonies.
He set the moral tone and sounded the call for second and third generation Puritans to return to the theological roots of Puritanism.
The most important of these was the Magnolia Christie Americana in 17 02 which comprises seven distinct books, many of which depict biographical and historical narratives.
Mother also influenced early American science. In 17 16 he conducted one of the first recorded experiments with plant hybridization because of observations of corn varieties.
This observation was memorialized in a letter to his friend James Pet Ever.
First, my friend planted a row of Indian corn that was colored red and blue, the rest of the field being planted with corn of the yellow, which is the most usual color to the windward side.
This red and blue rose so infected three or four whole rose as to communicate the same color onto them and part of the fifth in some of the sixth.
But to the leeward side, no less than seven or eight rows had the same color communicated under them, and some small impressions were made on those that were yet further off common Mother also emerged as the face of the vaccination movement.
Winner explains how he learned the methodology from anus, emus and enslaved person in his household.

[1:30:50] Mother had come close to choosing a career in medicine and devoured the scientific publications of the Royal Society in London.
As the society began to turn its attention to inoculation practices around the world, Mather realized that he had an extraordinary expert living in his household.

[1:31:09] Onus. Imus was a pretty intelligent fellow. It had become clear to him when asked if he’d ever had smallpox.
Onus Imus answered yes and no, explaining that he had been inoculated with a small amount of smallpox, which had left him immune to the disease.
Fascinated Mother asked for details which onus Imus provided and showed him a scar.
We can almost hear Anissa missed speaking, and Mother’s accounts for Mather took the unusual step of writing out. His words with the African accent included the key phrase Waas.
People take juice of smallpox and cutie skin and put in a drop.

[1:31:50] Returning to the arrival of the Mhsc horse in April of 17 21 and account of actions taken is given by James Blake in a New England quarterly article on April 22nd 17 21.
Among several ships arriving from the West Indies was Hmm, a seahorse, which brought the smallpox.

[1:32:11] Not until May 8th, however, did the Selectmen learn that a black sailor who came on the naval vessel was in town with the disease.
When they heard of another case that Captain Wentworth, Pakistan’s house, they ordered two men to stand guard there and let no one in or out without their permission.
A few days later, at the request of the town, the governor and council ordered the seahorse down to Bird Island to prevent further infection from this source,
but not until after several other sick members of the company had come ashore As late as May 20th the Selectmen could find no more cases.
But two days later, the town nevertheless instructed its representatives to seek further legislation to enable the Selectmen to prevent the spread of infectious sickness.
On the 24th the Selectmen set 26 free black men toe work cleaning the streets as a preventative measure but without avail.
On May 27th there were eight known cases, and by the middle of June the disease was in so many houses that the Selectmen abandoned the system of guards.

[1:33:18] As this new wave of smallpox hit the area and continued to spread, many residents fled the outlying rural settlements.
The combination of exodus, quarantine and fear of outsiders disrupted business. For weeks, guards were stationed at the House of Representatives to keep Bostonians from entering without special permission.
The death toll reached 101 in September, and legislators delegated £1000 from the treasury to help the people who under these conditions could no longer support their families.

[1:33:49] But back on June 6th, 17 21 mother sent an abstract of reports on inoculation by Timoney Ous and Jacobs Pyla anus to local physicians, urging them to consult about the matter.
He received no response.
Next mother pleaded this case to Dr Zab Deal Boylston, who tried the procedure on his youngest son and to enslave people.
One grown and one a boy, all recovered in about a week, and yet the people were willing to completely ignore the objective evidence before them for the sake of religion and superstition.
Apparently, climate change is the new smallpox.

[1:34:28] The newly formed New England Courant published writers who opposed the practice.
The editorial stance was that the Boston populist feared that inoculations spread rather than prevented the disease.
Editor in Chief James Franklin, a brother of Benjamin Franklin, led the attacks on Mather and Boylston.
Several opponents of smallpox inoculation stated that there were only two laws of medicine, sympathy and antipathy.
The opposition stated that inoculation was neither a sympathy toward a wound or disease nor an antipathy toward one but the creation of one.
For this reason, it’s practice violated the natural laws of medicine, transforming health care practitioners into those who harmed rather than hell.
Puritan beliefs were enmeshed in every aspect of life, and anti inoculation doctors used the Bible to make a case.
In Matthew, Chapter nine, Verse 12 Jesus said it is not the healthy who need a doctor, but the sick.
Dr. William Douglas proposed a more secular argument against inoculation, stressing the importance of reason over passion and urging the public to be pragmatic in their choices.
In addition, he demanded that ministers leave the practice of medicine to physicians and not meddle in areas where they lacked expertise now to be clear.
That is some serious shade to Cotton Mather.

[1:35:53] According to Douglas, smallpox inoculation was a medical experiment of consequence, one not to be undertaken lightly.
He believed that not all learned individuals were qualified to Dr Others.
And while ministers took on several roles in the early years of the colony, including that of caring for the sick, they were now expected to stay out of state and civil affairs.
Douglas felt that inoculation caused more deaths than it prevented.
The only reason Mother had had success in it, he said, was because mother had used it on Children, who are naturally more resilient.
Douglas and mother took shots at each other in their writings, pretty much for the rest of their lives.

[1:36:38] But Cotton Mather was not the only minister in favor of inoculation.
Generally, Puritan pastors favored the inoculation experiments increase. Mather Cotton’s father was joined by prominent pastors Benjamin Coleman and William Cooper in openly propagating the use of inoculation.
Nevertheless, opponents believe that smallpox was a peculiar act of God, not understood by man and not meant to be fought against,
if smallpox was a punishment for sin, that inoculation was to reject God’s will and provoke something even worse.

[1:37:17] Opponents also grappled with adhering to the 10 Commandments and the apparent contradiction between harming or murdering a neighbor through inoculation and the sixth Commandment Thou Shall Not Kill stood is one of the main objections against the procedure.

[1:37:33] The subject of inoculation could not be found in the Bible and with the Bible as the Puritans source for all decision making.
Lack of scriptural evidence concerned many Mather was scorned for not being able to reference an inoculation edict directly from the source.
With the smallpox epidemic catching speed and racking up a staggering death toll, a solution of the crisis was becoming more urgently needed by the day.
The use of quarantine and various other effects such as balancing the body’s humors did not slow the spread of the disease.
As news rolled in from town to town and correspondents arrived overseas, reports of horrific stories of suffering and loss due to smallpox stirred mass panic among the people.
Mather strongly challenged the perception that inoculation was against the will of God and argued that the procedure was not outside of Puritan principles.
He wrote that whether a Christian may not employ this medicine,
let the matter of it be what it will and humbly give thanks to God’s good providence in discovering of it to a miserable world and humbly look up to his good providence as we do in the use of any other medicine.
It may seem strange that any wise Christian cannot answer it and how strangely demand that call themselves physicians betrayed their anatomy and their philosophy as well as their divinity and their invectives. Against this practice.

[1:38:55] The Puritan minister began to embrace the cinema, that smallpox was an inevitability for anyone, both the good and the wicked.
Yet God had provided them with the means to save themselves, Just like today.
In 17 21 domestic terrorism was used to fight progress.
In November, a small bomb was hurled through Cotton Mather’s window at his home in North Square.
Attached to this explosive was a note that read, Cotton Mather, You dog, Damn you, I’ll inoculate you with this with a pox to you.

[1:39:27] The bomber was better insults than he or she wasn’t explosives. The device did not detonate.
While Mother was experimenting with the procedure, pastors Coleman and Cooper expressed public and theological support for it.
The practice of smallpox inoculation was eventually accepted by the general population due to firsthand experiences and personal relationships.
Although many were initially wary of the concept, it was because people were able to witness the procedures consistently positive results within their own community of ordinary citizens that it became widely utilized and supported.

[1:40:07] The epidemic peaked in October of 17 21 with 411 deaths,
in total, 5889 cases were identified with 844 deaths, more than 3/4 of all the deaths in Boston during 17 21.

[1:40:25] In a 2014 article, Matthew Niedere Huber provides a modern take on the inoculation debate and reviews the data by modern standards.
This argument against inoculation seems highly sensible.
The use of a poorly researched medical technique, particularly one as potentially hazardous as intentionally exposing healthy people, including Children to smallpox would be highly unethical.
Today, too many professional Boston physicians inoculation must have appeared as unscientific as other contemporary treatments, such as bleeding and purging, which were still common practice during the early 18th century.
But as the epidemic began to diminish in early 17 22 Mother and Boylston had collected surprisingly thorough data that made a clear argument for the effectiveness of inoculation.
Boylston, who had personally inoculated some 287 people, recorded that of those inoculated Onley, 2% had died.
In comparison, the mortality rate of the naturally occurring disease during that year was 14.8%.
By February of 17 22 Boston was again free from the smallpox.
In his Globe article winner shares a surprising anecdote about the impact of this ordeal on young Benjamin Franklin.

[1:41:49] An important witness to the debate over inoculation was a 15 year old boy, the younger brother of Cotton Mather’s chief tormentor in the Koran.

[1:41:57] Perhaps the most famous Bostonian of all time. Benjamin Franklin, made his fortune, of course, by fleeing the city and its theological disputes for Philadelphia,
as an adult, possibly with some acknowledgement that he and James had been too quick to ridicule and elderly minister trying to use science on behalf of humanity,
Franklin will become an important advocate of inoculation, especially after his own son died of smallpox.
Franklin also had a personal encounter with SAB Deal Boylston in London, not long after the smallpox crisis that changed his life.
The young Franklin had run out of money and options, and Boylston helped him with a crucial loan of 20 Guineas, despite the fact that Franklin and his brother had attacked his medical efforts.
Throughout 17 21 as an old man in Paris, Franklin met a young relative of Boylston Tze and told him that he could never repay what that loan and meant to him in a low moment.
I owe everything I am to him, he confided before asking the young man what he could do for him.
Obviously, science has continued to advance because we don’t get inoculated with live viruses. Today we get vaccines.
A vaccine typically contains an agent that resembles a disease causing micro organism and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins.
The first vaccine was used to prevent you guessed it smallpox.

[1:43:20] Sometime during the late 17 sixties, while serving his apprenticeship as a surgeon in Apothecary, an Englishman named Edward Jenner learned of the rumor that dairy workers never contracted smallpox.
Instead, they would contract cowpox, which has a very mild effect in humans.
In 17 96 Jenner took Puss from the hand of a milkmaid with cowpox, scratched it into the arm of an eight year old boy, James Phipps, and six weeks later inoculated the boy with smallpox.
Afterwards, observing that he did not catch it,
Jenner extended his studies and in 17 98 reported that his procedure was safe and Children and adults and could be transferred from arm to arm, reducing reliance on uncertain supplies from infected cows.
Vodka is the Latin word for cow and Thus, vaccinations were born, and P s, the milkmaid who rendered the initial puss got cowpox from a cow named blossom blossoms.
Hide is now mounted on the wall of the Library of ST George’s Medical School in England.

[1:44:30] In 1900 starting in New York City, smallpox reared its head once again and started a socio political battle with lines drawn across race and class in populations of railroad and migrant workers who traveled from city to city.
The disease had reached an endemic low boil.
This fact did not bother the government at the time, nor did it spur them to action.
Despite the general acceptance of the germ theory of disease pioneered by Jon Snow in 18 49 smallpox was still thought to be mostly a malady that followed the less distinct guidelines of a filthy disease,
and therefore would only affect the lower classes.

[1:45:10] The last major smallpox epidemic in the United States occurred, of course, here in Boston from 1901 to 1903 During this three year period, 1596 cases of the disease occurred throughout the city.
Of those cases, nearly 300 people died as a whole. The epidemic had a 17% fatality rate,
those who are infected with the disease were detained in quarantine facilities in the hopes of protecting others from getting sick.
Thes quarantine facilities or pest houses are mostly located on Southampton Street.
As the outbreak worsened, men were also moved to hospitals on Gallops Island. Well, women and Children were primarily sent to South Hampton Street.
Smallpox patients were not allowed in regular hospitals across the city for fear that the sickness would spread among the already sick.

[1:46:02] In a reflection of the previous outbreak that occurred in New York, the poor and homeless were blamed for spreading the disease.
In response to this belief, the city instructed teams of physicians to vaccinate anyone living an inexpensive housing.
In an effort to control the outbreak, the Boston Board of Health began voluntary vaccination programs.
Individuals could receive free vaccines at their workplaces or a different station set up throughout the city,
by the end of 1901 Some 40,000 of the city’s residents had received a smallpox vaccine, yet the disease continued to spread,
A New England Journal of Medicine article tells us.
Continued reports of smallpox cases led the Boston Board of Health to order that all inhabitants of the city who have not been successfully vaccinated since January 1st 18 97 be vaccinated or re vaccinated forthwith.

[1:46:59] A program of house to house vaccination was initiated in January with physician sent to the most affected areas of the city,
East Boston, South Boston, Charlestown, the North End, the West End and parts of Roxbury and Dorchester.
The instructions given to the physicians were as follows. Vaccinate all who are willing and not too ill.
No force to be used. Makes skin clean before vaccinating.
Make to score. If vacations make no score ification more than 1/4 inch in diameter.
Do not make the blood flow rubbed the lymph well into the wound and secure it’s drying, cautioned the patient carefully against breaking the vesicles or doing other injury.
Persons who refuse vaccination were subject to a $5 fine or a 15 day jail sentence.

[1:47:53] The article continues, the homeless were blamed for spreading smallpox.
A 1904 editorial in The Lancet stated.
What a potent factor in maintaining the prevalence of smallpox is that unemployed and largely unemployable degenerate.
The fact that this parasite upon the charity and good nature of the community isn’t his turn a vehicle for the spread of other parasites, both animal and vegetable, is common knowledge.
But practically no compulsory steps have been taken to curtail seriously the vagrants movements.
In November of 1901 the Boston Board of Health ordered virus squads to vaccinate men living an inexpensive rooming houses.

[1:48:38] A reporter for The Boston Globe accompanied a squad one night and described the scene every imaginable threat, from civil suits to cold blooded murder.
When they got an opportunity to commit, it was made by the writhing, cursing, struggling tramps who were operated upon.
And a lot of them had to be held down in their cots. One big policeman sitting on their legs and another on their heads, while the third held the arms paired for the doctors.
One fighting tramp who went down in a heap on the floor from the blow of a policeman’s club received both vaccination and suit a ring of his scalp.
In hearings on compulsory vaccination, opponents alleged that in Massachusetts, boards of health in many cases had acted with autocratic power and forcibly assaulted persons to vaccinate them.
The door to door program met with resistance as some individuals feared the vaccines to be unsafe and ineffective.
Others felt compulsory vaccination in itself was a problem that violated an individual’s civil liberties.

[1:49:42] This program of compulsory vaccination eventually led to the case, Jacobson v. Massachusetts.
This case was the result of a Cambridge residents refusal to be vaccinated.
Handing Jacobson, a Swedish immigrant, refused vaccination out of fear because of illness.
He claimed a previous smallpox vaccine and made him sick as a child.
Rather than pay the $5 fine, he challenged the state’s authority on forcing people to receive vaccination.
His case was lost at the state level, but Jacobson appealed the ruling, and the case was taken up by the U. S Supreme Court.
In 1905 the Supreme Court upheld the Massachusetts law. It was ruled that Jacobson could not refuse the mandatory vaccination.
Justice John Marshall Harlan delivered the majority decision He rejected Jacobsen’s claim that the 14th Amendment gave him the right to refuse vaccination.
Harlan deemed the Massachusetts state punishment of a fine or imprisonment on those who refuse vaccines acceptable, but those individuals could not be forcibly vaccinated at the end of his decision.
He acknowledged that for certain individuals, the requirement of vaccination would be cruel and inhumane, and therefore an overreach of government power that created a medical exemption for adults under the Massachusetts Health law.
But Harlan denied that Jacobs and deserved exemption.

[1:51:03] The anti vaccine movement mobilized following the decision. The Anti vaccination League of America was founded three years later in Philadelphia to promote the principle that,
health is nature’s greatest safeguard against disease and that therefore no state has the right to demand of anyone the impairment of his or her health.

[1:51:23] The league warned about what it believed to be the dangers of vaccination and the dangers of allowing the intrusion of government in science into private life.
The league asked. We have repudiated religious tyranny.
We have rejected political tyranny. Shall we now submit to medical tyranny?
Fortunately, the Supreme Court reaffirmed its Jacobson decision in Zurich the king in 1922 which held that a school system could refuse admission to a student who failed to receive a required vaccination.
We’ve said it before, and, to be honest, will probably say it again. Vaccinate your kids people.
And we also want to say that well, Cotton Mather comes off is a hero in this story.
He was a pretty insufferable person in real life who’s intolerances led to the persecution and death of money, probably don’t want to get yourself a Team Mather T shirt, although I do have a Team Mather sticker on my laptop for shame.

Jake:
[1:52:22] Well, that about wraps it up for this week to learn more about smallpox, cholera or the 1918 flu, check out this week’s show notes at hub history dot com slash 176,
We’ll have links to all the primary sources we used in preparing these segments.
And, of course, we’ll have links to information about Robert B. Parker’s Spenser, this week’s Boston Book Club pick.

[1:52:46] If you’d like to get in touch with us, you can email us at podcast in um history dot com were hub history on Twitter, Facebook and Instagram or a Goto hub history dot com and click on the Contact US link,
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Music

Jake:
[1:53:16] That’s all for now. Stay safe out there, listeners.