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The last decades of the nineteenth century witnessed breakthroughs in the field of bacteriology, exemplified by the work of Louis Pasteur and Robert Koch. Between 1880 and 1898 scientists identified the organisms causing leprosy (1873), malaria (1880), tuberculosis (1882), glanders (1882), cholera (1883), streptococcus/erysipelas (1883), diphtheria (1884), typhoid (1884), staphylococcus (1884), streptococcus (1884), tetanus (1884), coli (1885), pneumococcus (1886), Malta fever (1887), soft chancre (1887), gas gangrene (1892), plague (1894), botulism (1894), and dysentery (1898).
With the revolution in bacteriology emerged a new faith in laboratory science not only among physicians but also among public health workers. Despite the different professional mandates of public health and medicine, members of both professions began to share a common faith in the significance of the disease specific germ entity in causing disease. The implications for professional and public health understanding were that the modes of bacterial transmission had to be clearly identified if an effective campaign to eliminate the sources of the disease was to be mounted. Public health policies that focussed on the sources of specific infection rather than on the general sanitary conditions of the broader city had numerous attractions. Among them was the prospect of efficiently stemming infection without disrupting existing social relationships between tenant and landlord, employer and worker, political leaders and voters. Health and wealth, it seemed, could both be attained.
Bacteriology began to shape the practice of public health in New York City in the 1890s with the rise to power of Dr. Hermann Biggs. Biggs's public health career began in New York State in 1886 when the legislature passed the Metropolitan Health Act creating the Division of Pathology, Bacteriology, and Disinfection in the New York State Department of Health. Hermann Biggs became its first Director of Laboratories. In 1892, he transferred to the directorship of the New York City laboratory-the first municipal laboratory in the nation-and would eventually serve as City's Health Commissioner. According to his long-time friend and colleague, upon taking over the city lab Biggs "for the first time in the history of the world" applied "the new science of bacteriology . . . in an organized fashion." Winslow's statement is less an exaggeration than a boast underscoring his overwhelming faith in Biggs and the new science.
Almost immediately upon taking over the laboratory, Biggs launched a campaign to control diphtheria in New York City. He quickly appointed William Park, a young American scientist who had worked to confirm the existence of the diphtheria bacillus, as Inspector and Bacteriological Diagnostician of Diphtheria to aid in the diagnosis project. The first phase of Bigg's diphtheria campaign consisted of efforts to diagnose and contain cases throughout the city. In the second, the department developed, tested, and distributed diphtheria antitoxin. Finally, the department began to test the efficacy of the antitoxin in providing immunity and eventually the laboratory began manufacturing antitoxin for sale. Beginning in 1897, Biggs sought to transform the control of TB in similar fashion when he made the disease reportable by name, sparking outrage on the part of physicians who argued that the Department of Health overstepped its professional bounds. Biggs also pursued other "targeted" interventions intended to control TB. Otisville, the municipal sanatorium, opened in 1906. Other city institutions were created to hold recalcitrant, intractable infectious patients by force, such as the hospital for the tubercular poor on Blackwell's Island in the East River and Riverside Hospital, established on North Brother Island.
Despite enthusiasm for bacteriology and a new set of targeted public health interventions that it spawned-isolation, quarantine, vaccination, name reporting-the new science did not necessarily result in a radical transformation of public health practice in the City. The relative simplicity, usefulness and cohesiveness of the germ theory of disease was incorporated into older sanitarian notions regarding the relationship between cleanliness, godliness and health. The need for a synthesis was pressed on public health leaders by a diverse group of progressive era reformers who were concerned with the plight of the urban poor in the newly emerging industrial capitalism of the city and country. They continually pressed the point that disease could not be divorced from the terrible conditions of life and work and that addressing health and social problems went hand in hand.
Charity and settlement house workers, for example, documented that nearly one out of every four dwellings in New York City in 1890 experienced a death from phthisis or tuberculosis. In the poorer neighborhoods, it was clear, the toll was much higher, leaving these communities devastated by the disease. For these reformers, phthisis was a disease of poverty as much as it was one of germs. One of the leading social welfare reformers of the time, Graham Taylor, declared that tuberculosis was a "disease of the working classes" and that "everything which makes the life of the workingman harder, everything which is attendant upon poverty, makes for the increase of this disease." Especially clear was the connection between work and tuberculosis. "Where there is dirt and grime and dust, long hours, foul air and bad pay, the community pays for what it calls cheap prices by a little money and many lives sacrificed to greed, ignorance and indifference," pointed out one labor representative in 1906. Graham Taylor saw four "characteristics of employment" that put workers at risk: "insanitary conditions," "Low rate of wages," "Fatigue," and "long and irregular hours." Under the heading of insanitary conditions, Taylor identified two major sub-categories, "hygienic surroundings which are not inherent in the trade itself and those conditions which are to a certain extent necessitated by the character of the trade."
But the 1880s are important not only because of the ways in which the conditions of the poor, working classes were being reconciled with the tenants of the new science of bacteriology. The conditions were also being put in place in which arguments about bacteriology were going to become much more important in the 1890s and have relevance for all classes in the City as it became more densely crowded and, with the opening of the Brooklyn Bridge in 1883, more accessible.
The 1880s also provided an important catalyst for changes in the built environment. With increasing crowding, the Dakota-started in 1882 and finished in 1884-would advance apartment dwelling as a new model for middle class, urban living. The Blizzard of 1888 brought the city to a standstill as electric lines came down under the weight of the snow. It stimulated the move to place electric lines underground-an innovation Lewis Mumford referred to as "the Invisible City." The blizzard underscored the problem of refuse that built up in city streets during the wintertime-the growing fashion of stoops on middle class families homes could be seen as an adaptation of wealthy urban dwellers to the problem of waste overtaking one's front door, especially during thaws and rainstorms. But by the 1880s stoops did little to ameliorate the problem of refuse in the streets. The blizzard, therefore, began to galvanize support for a regular, accountable sanitary force responsible for cleaning the city streets, which would lead to the reconceptualization of garbage as a public health threat in the next decade.
Hospital: David Rosner, A Once Charitable Enterprise: Hospitals and
Health Care in Brooklyn and New York, 1885 to 1915 (Cambridge and New
York: Cambridge University Press, 1982) and Sandra Opdycke, No One Was
Turned Away: the Role of Public Hospitals in New York City since 1900
(New York: Oxford University Press, 1999).