EPI 390 1st Edition Lecture 19Outline of Last Lecture I. Review of DSMII. An in depth look at William Halsteada. His accomplishmentsb. Halstead’s AddictionIII. Review of Reasons to Study Drug UseIV. Resources and SurveillanceOutline of Current Lecture I. The State of Disease in the 20th CenturyII. Introduction to Typhoid FeverIII. The Oyster Bay OutbreakIV. Soper on the CaseV. Introduction to “Typhoid” Mary MallonVI. Mallon’s Disbelief and her DangerVII. North Brother IslandVIII. The Threat ReturnsIX. Latter Years of Mallon’s LifeCurrent LectureI. The State of Disease in the 20th Centurya. At the beginning of the 20th century New York, the Department of Public health had gained power due to the threat of various disease epidemics.i. There is very little that the Board of Health cannot do in interfering with personal and property rights for the protection of public health.1. City slums are overrun with poor immigrants, living quality is low, and infectious disease is spreading uncontrolled.a. Children were dying of intestinal diseases, diarrhea, etc. Diseases like whooping cough and tuberculosis were endemic.II. Introduction to Typhoid Fevera. Typhoid fever was a disease associated with crowded, poor neighbourhoods, andthe slums, not with wealthy family.These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.b. The lower Eastside in NYC is the most crowded neighbourhood in the world, and notorious for the spread of infectious diseases, with its overcrowded living quarters and lack of sanitation – due to minimal connection with the city water and sewer. Infectious diseases like smallpox, diphtheria, TB, and typhoid fever killthousands each year.i. Typhoid fever was common in urban areasc. Symptomsi. Weeks of feverii. Fatigueiii. Deliriumiv. Headachev. Diarrhead. 1 of 10 die of the diseasei. There were no antibiotics at this point, so doctors could only treat the symptoms.e. The cause is no longer a mystery, though: 30 years prior, Louis Pasteur had discovered that microbes were the cause of bacteria. i. Salmonella typhi was the specific bacterium responsible for typhoid fever.f. Conditions were so filthy and unbearable that in 1895 the Department of Sanitation was created, claiming cleanliness was next to godliness. The cleanliness crusade became top priority. They recruited an army of street cleaners, The White Wings.i. At the same time, public health was shifting to bacteriology. In Public Health officials of the time, there was condescension to the poor. They believed in bacteriology, but also that immigrants were a source of infection and danger.1. 1892 – NYC set up first bacteriology lab to aid in public health – bylooking at cause of disease, treatment, and prevention.III. The Oyster Bay Outbreaka. Disease had seemed to escape Oyster Bay, Long Island, though, and those that could afford it went there for a luxurious escape from disease in the city.i. Until Typhoid fever appears in the house of a healthy banker. No one new how the disease had spread.b. August 1906, Margaret Warren is ill with Typhoid fever. i. This was the only family summering in Oyster Bay to catch the illness; 6 people in the household, both wealthy family members and their staff, came down with Typhoid Fever.IV. Soper on the Casea. When the threat of typhoid fever hit Oyster Bay, everyone started looking at the usual suspects as the source of disease; the poor, the dirty, perhaps spoiled food,i.e. milk or shellfish.i. It was known that the S. typhi was spread through food or drink. 1. Thus, the plumbing in the Warren’s summer home was expected to be at fault. Dying the sewer water to see if it contaminated the drinking water only came up with false results.2. They check the local shellfish to see if the bay is polluted; it wasn’t. Milk wasn’t the source either.b. The family that owned the house, the Thompsons, was worried if the source wasn’t found, they wouldn’t be able to rent the house again. i. They hired George Soper, a man renowned for being able to track down the source of disease.c. Not finding any hint of bacteria with the usual sources, Soper thought to ask whoelse had been in the household that he hadn’t talked to. i. This uncovered that there was a cook with the family that summer who was no longer working for them.1. The family had switched cooks during the summer; outbreaks of typhoid fever happened approximately 13 weeks after that changeoccurred.a. Originally it was thought that a person spreading the bacteria would have the bacteria on their hands while in the bathroom, and would contaminate food or drinks that way to spread it to others.b. To prevent the spread of the disease, people would scrub their hands very thoroughly and were strict about not wearing jewelry there.2. Soper also knew that the typhoid bacillus could survive on uncooked food only; during their stay that summer, there was one dessert the cook had prepared that the entire family was fond of –fresh ice cream.V. Introduction to “Typhoid” Mary Mallona. At the time of the Oyster Bay outbreak, scientists had just found that microscopicbacteria were the causes of bacteria. This knowledge, as well as investigation, ledthem to a chef, Mary Mallon, whom scientists deemed a “human culture tube”.i. She was given the nickname “Typhoid Mary,” a story that makes history and raised moral questions of how do Public Health Officials protect the public health when it means taking away the liberties of an individual human being?b. Mary Mallon was a 37-year-old Irish immigrant who worked for wealthy families in NY. c. Mallon was born 1869 in county Tyron, one of the poorest areas of Ireland. Frequently suffered from famine, and grew up eating primarily potatoes.d. She came to the US in 1883, alone as a teenager. She lived with her aunt and uncle until they died, and then she was on her own. i. Living on her own, she would have taken on many of the jobs typically associated with the poor, in a laundry, seamstress work, cleaning, and hauling coal. ii. She also would have had to learn how to manage a kitchen on her own, and how to cook well. Allegedly, she was good at what she did, because wealthy families kept hiring her.1. Cook was the highest job among servants, and Mallon was often the manager of the entire affair. The cook is typically the most trusted of household staff.VI. Mallon’s Disbelief