Recalling public health efforts in Pennsylvania

This week in North Philly Notes, Jim Higgins, author of The Health of the Commonwealth, looks back on past epidemics.

By the last half of the nineteenth century, science began to unlock the secrets of infectious disease, most importantly that bacteria and viruses were the cause. No cures for human infectious disease emerged until the 1890s, when antitoxins for diphtheria and tetanus debuted. Even without cures for most infectious disease, public health efforts made remarkable inroads at the turn of the twentieth century in Pennsylvania and across the nation. 

As The Health of the Commonwealth neared its final edits, the new coronavirus responsible for the COVID-19 pandemic was on the move. Even the barriers posed by the Atlantic and Pacific Oceans, which I suspect millions of Americans depend upon, if unconsciously, to keep a dangerous world at bay, delayed the virus by only a matter of hours once it got aboard a transoceanic passenger jet.

 

The responses of the citizenry in the midst of an epidemic varies. Many quiet people in quiet corners cooked food for neighbors, checked on friends, took care of family, and generally soothed unsteady nerves. Most of those stories went unrecorded in our history. Most go unrecorded today, too. At the same time, there has always been resistance to modern public health measures in Pennsylvania. During a smallpox vaccination effort in 1906, parents allowed their elementary school aged children to parade the streets of Waynesboro, Franklin County with an effigy of the commissioner of health, which they kicked, spat upon, and ultimately burned.  The city council of Allentown declared in late-1918 that the flu, which was just beginning to infect people in the city, was actually nothing more than a “regular” cold. Homes, they suggested, should be kept warm to avoid catching these widespread, severe colds, even as the same councilmen were preparing that day to deal with a severe coal shortage throughout the region. Many people just tried to go about life as if nothing were amiss. Just push through it, they seemed to think, through the years and through the typhoid, smallpox, polio, and HIV tragedies. If one continues to go through the motions of life, eventually the threat will pass and (provided one survives) the stout-hearted (or delusional) person who ignores the presence of an epidemic will…what?  I’ve never been able to figure that part out. I guess the best I’ve come up with is that people who ignore epidemics satisfy a psychological need for control. Or because they are terrified. Sometimes, like now, politicians can harness an epidemic as a vehicle for meeting political ends. It happened in 1918 when Pennsylvania’s response to the flu became a major political issue in the 1918 senatorial race.    

But I’ve got news for you. The way people react to widespread disease outbreaks is nothing compared to the changes that have sometimes followed in the wake of epidemics. A single typhoid outbreak in the obscure town of Plymouth, Pennsylvania in 1885 led to the creation of the state board of health. Twenty years later, another typhoid epidemic in Butler, Pennsylvania led to the creation of the state department of health. Five years after that, Pennsylvania possessed the most aggressive and powerful state health department in the nation. 

On a broader note, the standard narrative for both prohibition and women’s suffrage is that after years of agitation, both efforts finally bore fruit nationally in the period 1919-1920. The war helped accelerate both social efforts. During the First World War, many voices demonized alcohol production because it directed labor, grain, and coal away from the war effort—and because the beer industry was dominated by people with German names. We have forgotten that in late-1918, in Pennsylvania and beyond, the alcohol industry was hit with hammer blows by public health officials who closed saloons and banned alcohol sales as an anticrowd measure in the face of the epidemic of flu. In Pittsburgh, the fight over alcohol sales involved military officials and threats of a near-martial law. The alcohol industry lost a great deal of sympathy during the epidemic. In the case of women’s suffrage, a long, bitter fight for the right to vote was pushed to a quicker successful conclusion by the war. Perhaps the flu epidemic offered national sentiment a final shove. Hundreds of thousands of women volunteered in emergency hospitals during the epidemic. Many were middle class and unacquainted with blood and pus and the sounds and sights of dying. Across Pennsylvania, newspapers, politicians, and civic leaders lauded the work of the state’s women and memorialized those who died with a prominence never before seen in American history.   

I really don’t know—nobody knows—whether the video of George Floyd would have sparked the response it did in the absence of COVID-19. But if the response to systemic racism continues, we might look back on a moment, in the midst of pestilence, when certain things changed in our society. I can’t predict exactly how America will change after COVID-19 fades, but if the history of epidemics teaches us anything, then changes are afoot.    

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