BackStory; Contagion: Responding to Infectious Disease

This is backstory. I'm Brian Ballot. As a civil war ground to a halt, the journey from millions of former slaves was just beginning. A smallpox epidemic was ravishing their camps. A terrible scene made more terrible by the callous attitude of their white neighbors. Some people fall back on this popular fiction of the 19th century that black people would go extinct if freed. 40 years later, people on the margins were again dying from smallpox this time in New York, but the response was different. Doctors and police officers burst into immigrants homes to vaccinate them by force. With mothers trying to hide sick babies with men actually brawling with health officials and police to prevent them from scraping their arms and rubbing the vaccine into their arms. Today I'm backstory a history of epidemics. What has the government done and not done to stop contagious disease? Major funding for backstory is provided by the ShiaCon Foundation, the National

Endowment for the Humanities, the Joseph and Robert Cornell Memorial Foundation, and the Arthur Vining Davis Foundations. From the Virginia Foundation for the Humanities, this is backstory with the American History Guide. Welcome to backstory. I'm Peter Onuf. I'm Ed Ayers, and I'm Brian Ballot. There is growing concern tonight about the Zika virus, a mosquito-borne infection with possible links to birth defects. The head of the World Health Organization The World Health Organization says the Zika virus is spreading explosively in the Americas, especially in Brazil. These efforts are on all fronts. They're trying to come up with a vaccine against Zika, and they're also trying to get more places that can do a test for Zika because right now you have to send blood to the CDC. We figured this would be a good time to revisit an episode from our archives in which we look at the history of contagious diseases. We were especially interested in the changing patterns of the government's response to

disease. Peter Onuf started us out with a story from the time, when if I said germ theory, you'd probably think I was talking about a way to grow wheat. Here's Peter. At 1793, the dog days a summer, and we're in Philadelphia. And I want you to get a picture of Philadelphia as a city, as 50,000 people. In those days, the biggest city in the USA. And it's the country's capital, folks. It's kind of smelly, it's nasty, noise, some unhealthy. And the people live so close together that when the disease comes, it comes on strong. Yeah, what is the disease, Peter? Well, people don't know. I'm going to give you the description of poor Mrs. Parkinson and Irish woman. She had severe head and back pains, great thirst, offensive stools, red spots on her face, blindness, sore throat, and hiccuping. And after all that, she died. But as she dies, she turns a particular hue of yellow, yellow fever.

Now, you think this is the nation's capital. It's where they've got the best doctors, the most resources. They're going to mobilize an effective response. But I got to tell you 10% of the population, that would be 5,000 Philadelphia's die. And what does the government do? It leaves town. And if the people in the government had stayed, what could they have done? Well, they would have died too. I think that's the real problem here is that in early America, there is so much mystery about these epidemics. You don't know where they come from. Many Americans would think it's an act of God. It's beyond our control. You're being punished for something. It is a great mystery. So how do you respond to an outbreak? We think now you've got to send in the National Guard and you got to get the government to do stuff. But in 1793, we just don't have that kind of capacity. We barely had the capacity to make war on other

nation states and kill people. We certainly didn't have the capacity to keep people alive. Well, today on the show, we're going to take a closer look at how government response to disease epidemics has evolved since 1793 when authorities essentially threw up their hands and ran. But before we launch it to the history, let's take a minute and check in with an expert on the science. Okay. My name is Dr. Robert Gaines. I'm a physician. Dr. Gaines is an attending physician at the Atlanta VA who has spent decades working at the Centers for Disease Control and Prevention, the CDC. We called him to help us understand what some of the diseases we're talking about today actually looked and felt like. We began with one that shows up in all three of our centuries,

smallpox. This particular virus had a long period of incubation. So you would be exposed to someone and it would take almost two weeks for you to become sick. Dr. Gaines says at first, smallpox look like almost any other illness. You have a fever, fatigue. But by day four or five into the illness, a skin rash would appear. And this was a very characteristic skin rash. They began as fluid filled, raised lesions that we call vesicles. It was like really bad acne, but all over your body. And unfortunately for people who survive smallpox, they would leave permanent scars. A lot of those scars were on the face and left people looking pretty disfigured. So with that in mind, we want to take a look at how people dealt with an outbreak of smallpox in the past. We've already heard how impudent government was when disease struck in early America. But by the 20th century, the pendulum swings back. Not only have public officials decided that it's their job to protect the public from smallpox, they've also decided

that it's okay to use force to carry out that job. Michael Wilrich is an historian at Brandeis University. And he described one episode in particular to me. It was a 1901 night raid on an immigrant neighborhood in New York City. Smallpox had been discovered up in the Italian neighborhood on the upper east side where Italian laborers and their families were living in very, very close quarters. So they assembled the health department that has assembled a vaccine squad, as they called it, of 125 physicians accompanied by 125 police officers. And they cordoned off this city block of tenement dwellings in the middle of the night because they understood that the working people would be at home in the sleep, hopefully. And they burst through doors, demanding that everybody sort of move into corners so that they could be inspected to see if they had

scars from a previous case of smallpox or had the visible vaccine scar on their arm. And if they didn't, they had to be vaccinated at once or they would be arrested. It was just a really chaotic scene with mothers trying to hide sick babies from the health officials with men actually brawling with health officials and police to prevent them from scraping their arms and rubbing the vaccine into their arms. It was a scene of almost extraordinary violence all in the name of protecting New York City from an epidemic of smallpox. And did New York City need to be protected? I mean, what was the danger here? So smallpox was really the deadliest killer in human history as far as diseases go. It killed as many as 300 million people in the 20th century alone. Typically, well, timeout. 300 million people. That's correct. Worldwide. That's incredible. In a typical outbreak, 25 to 30% of the population afflicted would die of the disease. And this was

a very serious outbreak. About 800 people died in the city of New York. So yes, it was quite serious. And where did it actually, am I remembering this correctly that the vaccine actually came from cows, infected cows? That's where a vaccine gets its name. The vaccine material is live cowpox or vaccineeavirus that is essentially harvested from infected sores on the underbellies of calves. So yeah, this stuff was pretty disgusting to contemplate. It's attractive. Yes. It's an attractive image. The vaccine itself that was used at the turn of the century was an unregulated commercial product. That is, the government compelled people to get vaccinated during epidemics in order to serve the public good. But the government did nothing at all to

ensure that those vaccines used were safe and effective. That's an enormous contradiction. So if I'm understanding this correctly, Michael, you're saying that those people who resisted might have had some legitimate reasons for doing so or is that exactly right? Even when it worked well and was not riddled with impurities, smallpox vaccine caused people to have a fever, to have a swelling and soreness of the arm to feel seriously sick for a couple of days. Workers had good reason to fear that if they took the vaccine, they would lose their capacity to earn for a period of days or even weeks, thus depriving their family of their earnings. I'm now going to appeal to the legal historian in you, Michael. And also I should say an expert on the progressive era, that period at the beginning of the 20th century where expertise and scientific

knowledge was brought to bear on a whole host of social problems. How did this change your understanding of progressivism? And let's limit it to this police raid in New York. How did that change your understanding of what progressivism was all about? Well, I mean, compulsory vaccination is kind of an emblematically progressive intervention, right? You are asking individuals to sacrifice some part of their liberty on behalf of the general public, on behalf of the welfare of the many, employing science to do it and using science to do it, right? This is the sort of science being practically applied for the good of society, classic, classic progressive innovation. I expected there to be some resistance. I knew that there had been some lawsuits generated around smallpox vaccination at the turn of the century. Some legal challenges. I had no idea the extent of resistance. There were dozens of court cases,

legal challenges to compulsory vaccination that took place at the state, local, and ultimately the federal level. There were candidates who ran for local school board offices on a platform of resistance to compulsory vaccination. Granted, many of their arguments were sort of anti-scientific, but they were arguing for an expansive idea of their legal and constitutional rights. And we would see these kinds of arguments surface again in the 1950s and 60s in the era of the so-called rights revolution. They were arguing for bodily integrity as a fundamental right of human beings under the Constitution. They were arguing for the rights of parents to make choices for their children without interference from the state. They were arguing for religious liberty. They were arguing for bodily autonomy and medical freedom. Many of these kinds of arguments would

come to the fore again in the realm of what we now call reproductive choice. And we would label all of that very progressive today. We might. We might. And what it helped me to appreciate was the extent to which the modern administrative and welfare state, this new sort of social state that's being created in the progressive era, and that we have all benefited from was nonetheless quite controversial in its own times and involved a lot of control over ordinary people that inspired a kind of reaction. That's Michael Wilbridge, professor of history at Brandeis University. He's the author of Parks in American History. In the first part of our show, we looked at how an aggressive government response to smallpox

at the turn of the 20th century sparked a fierce battle over civil liberties. Now we're going to turn the clock back just a little to the 1860s. It's the midst of the civil war and southerners are fighting on two fronts. On the one hand, Perryville, Shiloh, Vicksburg, on the other, smallpox, an epidemic swept south from Washington DC in 1862. And for the next few years, the disease decimated military and civilian populations alike. Recently freed slaves were among the hardest hit. After emancipation, they could move freely for the first time in their lives. But as millions of freed people spread out across the south to escape the fighting, they nearly all lacked adequate food, water, shelter, and medical care. And it's hard to imagine a situation really more suited for a catastrophic outbreak of disease. I recently sat down with Jim Downs and historian at Connecticut College to talk about this little known episode in our nation's past. What I started to think about was,

what did it mean for enslaved people to actually liberate themselves from Southern plantations? And so we have this triumphant narrative that they run away. But where do they run to? And where do they sleep? And where do they eat? And how do they survive? And so oftentimes, yes, there were cases in which the Union Army offered them shelter behind Union lines. But then all of these questions developed. Where were they finding clothing and food? And the army didn't have the resources. And it wasn't because the army was a pernicious institution. It just often didn't have enough resources for the army. It wasn't milk for this purpose. It wasn't milk for this. But exactly right. And so they don't have the resources available. And so as a result, they enter into these various refugee and contraband camps where all of these men are already suffering from pneumonia and from various other epidemic problems, which is the reason why Northern reformers decide to organize the sanitary commission. So people who have not paid too much attention to civil war late might not know what a contraband camp is. Maybe you can describe that for us Jim. The contraband camp is essentially this refugee

camp that sort of develops in response to this question of these various former slaves who flood to Union lines throughout the war. And so what happens is throughout the South, in various Union camps, there are these makeshift communities that form around the perimeter of Union camps. And they're considered contrabands. This is the military's term to refer to newly emancipated slaves. In large part, it's because they really don't know what to call them at that particular moment that they refer to them with this term contraband. So if their owners are claiming that they're property, they're saying fair enough now your property of war, which is what contraband would mean, right? Right. This is the world of freedom. This is the world that emancipated slaves entered. And many of these emancipated slaves living in these camps are often forced to go from one camp to the next. And they're constantly on the move. And this form of dislocation

accelerates the spread of disease. And then also at that time, it's the mid 19th century and they're conflicting understanding about disease causation. So they have some idea that cleanliness is good, but they don't really know why, right? Right. And one of the horrific stories that you tell, maybe we could focus on a little bit now is the smallpox epidemic that emerges in this period, right after it kind of overlaps with the end of the Civil War, then extends beyond it, right? That's right. So I started to first uncover references of the smallpox epidemic in Washington, DC in the winter of 1862. By 1865, in early parts of 1866, the virus moved from the upper south into the Carolinas, into the sea islands, where it was infecting well over, I mean, these numbers are outrageous, but well over 800 people a week. Wow. The military doesn't know what to do. And some of the military officials tried to quarantine these emancipated slaves yet at the same time, there's an uncertainty on how to even quarantine, where to quarantine them. Some people fall

back on this idea that, of course, black people are dying at this moment. It began to sort of fulfill their sort of idea, this sort of popular fiction of the 19th century that black people would go extinct if freed. So there aren't efforts to sort of isolate the virus or investigate it, and it's so interesting because if one case of smallpox broke out in either a confederate or a union camp, they immediately declared there was an epidemic and they would follow their soldiers, among the soldiers, right? They would immediately declare there was an epidemic and they would try to follow either a quarantine, which is a basic form of isolating the infected person, or they would even go into anoculation or vaccination, which were two rudimentary forms of trying to prevent the virus among other susceptible people. But there was something done, and you could argue about the medical efficacy of it, but there was some policy in place. They at least tried. They at least tried. What was a person with smallpox look like? What are the symptoms, Jim?

So this is one of the questions that I have throughout writing this book, and there are no references to, I mean, there are no images of emancipated slaves with smallpox. I can't find any, and I started to realize that part of it was that the people that were in the south that were interested in helping emancipated slaves did not want to promote that image to other people in the federal government or back to the north. Right. And that black people themselves completely understood that if their family members were seen as being infected with smallpox, that this could be problematic. So they're hidden. I mean, they're hidden from people in the 19th century and they're hidden from historians today. Do you have any sense, Jim, of how many people were lost in the smallpox epidemics of the media post-war era? It's so hard because the numbers often conjured each other. The first part that I would say is that in the very early part of the war, there was no mechanism or protocol within the militaries, bureaucratic structure to even track

the mortality. So people were dying constantly and no one was keeping an actual count. I would have, I mean, my roughest, I mean, I don't even, I'm not going to force you. Yeah, no, no, no, no. It's a great, I mean, I, this is like a question that you would get when I was defending my dissertation and I always try to dance around it, but I can't, I can't, I got to like do it. So, so I don't, I don't want you to have a flashback here. No, it's, it's already, it's already there. The flashback is happening. So I would argue that over a million we know saw medical care. There is one estimate that over 60 to 70,000 died from smallpox. I actually would put it higher. I would say probably at least a quarter million. I mean, the doctors write constantly in panic that they can't even keep accurate notes. And then when they do, they report 700. And then you have to say like, how do you count 700 people? I mean, this is, I mean, there's just so many issues with this, but it definitely is a large portion. And this is the

other part that I'm trying to deal with in the book is that even for those who don't die, for those who witness the death of kin, the death of other people in their community, they're still left with the scars of the epidemic. And I think that that certainly shaped their transition into freedom, into emancipation, that even if they survived in good health, what didn't mean for them to know that family members, members of their community died in this very ironic, unexpected turn of liberation. In the first moments of freedom, in the first moments of freedom, yeah. Jim Downs is an historian at Connecticut College, an author of Sick From Freedom, African-American illness and suffering during the Civil War and Reconstruction. Well guys, this really powerful story about smallpox in the Civil War,

folks for me, well, the American Revolution. Hey, we had freed people, people escaping slavery to join the counter-revolutionary cause. And the black people who gathered well, many of them died. In fact, most of them died of smallpox. And that connection between race, gathering people together, containing them and death is very powerful. And it suggests to me too that we should not forget how dangerous war is and not just time battlefields. And it's really, if you want to know how humans have dealt with disease, well, they've been the pathogens best friends by creating the optimal conditions for the spread of disease. That's a great point, Peter, because what we see is that war in many ways is massive immediate urbanization. Not only the armies are coming together with no real capacity to contain that many people, but now in the Civil War, the contraband camps and the desperate search for freedom that grew up around those armies create a particularly lethal

environment. And that is the stop of the Civil War. I believe that goes forward even to the 20th century, doesn't it, Brian? That's right. And what we find in World War I is the very movement of the armies that fought World War I are going to be the carriers of one of the great epidemics of all history and certainly of the 20th century. That's the great Influenza epidemic of 1918, otherwise known as the Spanish flu. And guys, before we go any further, I want to bring back our friend from earlier in the show, Dr. Robert Gaines, the epidemiologist at the CDC. And numbers vary a lot on this between depending on who you talk to, 20, 40, or even 60 million people worldwide in that one year died from Influenza. And that makes it in one year the worst epidemic in human recorded history. Now, normally, the very old and the very young are hit hardest by the flu. You guys know that already. But in 1918, something strange happened.

The group hardest hit was healthy young adults. Hospital awards were full of dying 23 year olds. And that demographic anomaly matters because of what else was going on in 1918. World War I. And if you were the malevolent public health official and wanted to create an environment that would facilitate transmission of Influenza, you would create trench warfare. That was an absolutely perfect place for that virus to go. Those 23 year olds, not only were they especially susceptible to Influenza, they were being concentrated in military barracks where the disease could easily be passed from one to the next. And they were being shipped from military base to military base, both here in the states and around the world. Dr. Gaines read to us from a letter written by an army doctor describing the carnage left by the flu at a military base near Boston. We have lost an outrageous number of nurses and doctors.

And the little town around here is a site. 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 and look at all the boys laid out in long rows. It beats any site they ever had in France, I'll bet. The 500-bed hospital where the doctor worked was in Camp Devons, Massachusetts. In a few weeks before he composed that letter, a train load of soldiers from Camp Devons was transferred to Philadelphia. A number of them were already infected. Backstory contributor, Catherine Moore, is going to tell us the story of what happened next. Picture the port of Philadelphia, 1918. Workers at the largest shipyard in the world are grinding out warships. Over at the Navy yard, sailors are scurrying in what would be the final months of their efforts to beat back the hunt. A few blocks away, the streets are packed. It's not just any crowd. It's a parade, a

liberty-loan parade, kicking off the government's latest effort to fill up its warkoffer. Each state must do its part to meet the country's six billion dollar goal. If you can't enlist, invest. A poster drives home the by-now familiar message that true patriots put their money where their mouth is. Every liberty bond is a shot at a U-boat. Crush the Prussian by a bond. At the parade, spectacles abound. People lean out of windows to see an aircraft hull rolling down the avenue. Warplanes fly overhead. Songs and speeches could jolt people into buying bonds. And over at Willow Grove Park, John Philip Susa strikes up his band. That was the scene on September 28th. Three weeks later, over 12,000 Philadelphia would be dead from the Spanish flu.

Let's back up. Philly's ticking time bomb really begins on September 7th when 300 soldiers from flu-stricken Boston arrive at the Philadelphia Navy Yard. By the 15th, 600 sailors here report sick. And just in case you're picturing a bunch of guys with achiness and some fever, consider that symptoms from the Spanish flu included frothing blood, brown spots, bleeding from the eyes and ears, and turning blue. So blue, in some cases, that one doctor found it hard to distinguish between his black and white patients. The naval hospital runs out of beds. Patients are sent to the civilian hospital where three quarters of the medical staff is overseas at war. Meantime, soldiers have left Philadelphia on boats and trains, criss-crossing the country. Many are gravely ill upon arrival. And all this time, Philadelphia authorities haven't done much of anything except deny that there's

a threat at all. And the press isn't exactly helping to ring the alarm bell. The news of the day was often told with a cheerful spin as editor-strain to keep up morale. In fact, the Spanish flu gets its nickname from the fact that Spain, a neutral country, didn't censor the horrors of the epidemic in its papers. Finally, on the 18th, a PR campaign is launched. A polite poster is printed. When obliged to cop or sneeze, always place a handkerchief, paper napkin, or fabric of some kind before the face. By the end of the epidemic, the signs would read, spitting equals death. There's some pressure to call off the parade, but perhaps more than disease, authorities fear public panic. A panicked country, after all, can't win a war. And so the parade goes forward, and hundreds of sailors from the flu-ravaged navy yard, rub elbows with a crowd of 200,000 that stretches for miles.

Within 72 hours, about the time it takes for the flu infection to develop, every hospital bed in the city's full, and over the next several weeks, 12,000 Philadelphiaians will die. Wagens will roam the streets, medieval style, collecting the dead. Corpuses will be stacked in tenement hallways. They will be buried in mass graves, with steam shovels. In the end, six times as many Americans would die from the flu, than on the battlefield in World War I. But when the nation wrapped up its bond drive on October 19th, at roughly the peak of the epidemic in Philadelphia, the country had met and exceeded its war bond quota. That piece comes to us from reporter Catherine Moore. You can hear more of Catherine's pieces on our website, backstoryradio.org.

Well, that's some powerful stuff, isn't it, Peter? Yeah. It sounds a lot like what we were talking about earlier in the show about the epidemic in Philadelphia back in 1793. What's changed? Well, what's striking is government could do nothing, then, and it could do nothing in World War I. But there was capacity in government. In fact, that's part of the problem, isn't it, right? I mean, they could mobilize all those people. We did. And look, we were very slow to mobilize for World War I. Let's not kid ourselves. But once that mobilization got going, it was a juggernaut. And you can hear that in Catherine's piece, six billion dollars for a bond drive, millions of Americans contributing it. So, you know, a lot has changed. But it turns out that dysfunction can be just as lethal as heading for the hills back in your days. Yeah. Well, we're talking about urbanization and density in the instant cities. In a way, public health measures had made cities safer. But this was bringing people together on the streets.

And that was just an incubator of contagion. As we do with each of our shows, we've been inviting your comments and questions on backstory radio.org and on Facebook. Today, we're calling up a few of the folks who left us a note. We got Shavani on the line from Providence, Rhode Island. Shavani, welcome to backstory. Hi. So, what's on your mind today? So, I'm going to graduate student in health economics. So, I've taken a few epidemiology classes in the last year. And I was struck by how difficult

it can be to identify who is in the need of most health, you know, following a disaster or an epidemic. So, I was wondering if you're talking more about the process of how they allocate, who gets cared, who doesn't? Yeah. Great question. How do we allocate health care? How does that happen now? Of course, that's a current events question. We're going to try to give it some deep background. Ed, Mr. 19th century, what do you say? I think there were two criteria back in the 19th century. One, who could afford it? Yep. And two, who posed a threat to those people who did it? Yeah. Those resources. I generally try not to be cynical and generally succeed in not being cynical. But health care in the 19th century is a pretty clear example of those who have taken care of themselves and taken care of other people when they have to. Yeah, that's certainly true in the 18th century as well. It maps on pretty neatly to the social order that maybe the

great achievement of Brian's 20th century is to begin to pick that apart and to come up with new conceptions of disease and where you need to intervene. I mean, how are you going to stop the spread of a disease? In some ways, you have to go to the poor people first, right? Yeah. Well, a couple of things happen in the 20th century. Shivane, we treat people that we can get our hands on because they are in public spaces. So there are huge campaigns in the 20th century to vaccinate school kids. Why? Because it's in my century that we start requiring people to go to schools. That's where the potentially diseased people are. That's where we can access them. And it's really not until quite recently that we start getting all of these vaccinations in doctors' offices and private spaces. And the great irony is that too is changing. As you probably know, Shivane, if you're in public health, now you can get vaccinated in Walmart or CVS. The privacy of vaccination

is morphing yet again back towards these public spaces and back towards some of the things that Ed and Peter were talking about, the people who can afford to do it. Yeah, I want to throw something out for Ed. And that is the idea of the analogy of firefighting. Early firefighting the 18th and in your centuries, the big fire century, all those wood buildings and in growing cities. I mean, that's a case where you have to intervene in ways that's going to stop the spread and it doesn't matter who's in your way. I wonder if is that a model for what becomes public health delivery? Yeah, it's a healthy model, so to speak, Peter, because it reminds me that this is not necessarily that people were worse than the 19th century. As Brian was suggesting, they simply did not have the capacity of understanding the origins of disease or what they would do if they did try to minister to people. And of course, sometimes the worst thing could happen was to be minister too,

with lead to some bleeding and all that. So, you know, I think in some ways, the idea that you could actually do something for an entire population about health is a very recent information. And even now is deeply contested. So, Shivani, what do you think? Are you and your classmates filled with a sense that we've crossed some kind of bridge and now we have a sense of how to really intervene in a useful way? Well, I think you're right that there is that assumption that we do know what we're doing as public health workers. Thank goodness. And the way public health is taught, I think we still have this faith that, you know, most actions are based on evidence, you know, there's like evidence-based medicine and like, you know, most public health practices do reflect like the most current research. So, there is still that faith that when we intervene, it's like to better social welfare. Yeah, I got a question for you, Shivani, and maybe you don't want to say this on national radio. But what do public health people think about the people in general? Do they sometimes think that they're ignorant, bigoted, and reactionary?

It depends on who you talk to. I think if you are talking more in the developing world, I think there is kind of a lot of, you know, looking down at the at the masses and prescribing what we think would be best for everybody. When it's more about the developed world, it seems that people do take into account like cultural norms and education and you know. Yeah, what an upbeat characterization of the American people. I love to hear it. You're reviving my faith in democracy, Brian. Well, one of the things I love about American history, Shivani, is for much of it, we are a developing country. Right. I think so much of what Ed and Peter had to say kind of demonstrates that. Shivani, thanks for your call. It's been fun talking to you. Thanks a lot. Yeah, great. Thanks for taking my call. Bye-bye. Bye-bye. And we got Peter on the line from Montpelier Vermont. Peter, welcome to backstory. Thank you very much. So what's your question? Well, my question is the relation between disease

or public health and immigration through our history? Well, you have hit the big one Peter that is disease and immigration. Many people throughout American history would have said it's the same thing. That's right. Yeah. Well, let's go back to the beginning. Yeah, okay. Let's think about 17th century Virginia. Goodness gracious to be immigrant was to be dead basically. Yeah. And of course, but then it was clear because of course the immigrants were the settlers, the slaveholders, the Indian killers, but they didn't bring disease. They got hit by the diseases when they arrived. You know, the big story of early American history is that immunities for small pox and other contagious diseases which Europeans had earned over the millennia. They didn't have been Native America. And so you had a vast killing off of Native populations up to 90 percent of New World population. So in some ways, it's the locals who are killed by the immigrants in the

early period. But that idea lingers on in many ways. And of course, once a population is established the European population that is the largely northern European, if not British population is established, then there's great concern about foreigners bringing in not only their nasty habits, their foreign ideologies, but also diseases. You're right. In the 19th century was the great century of massive immigration from the Irish coming in who were seen as diseased and bringing sort of not just unhealthy bodies, but unhealthy habits and neighborhoods with them wherever they came, they created places where diseases would flourish. And so on the other coast, the Chinese coming in were seen as especially dangerous. I mean, European Americans were at least European at one time. But Chinese immigrants were bringing these kind of Asian diseases that seemed especially frightening. In fact, at the turn of the century, the plague comes to San Francisco and is seen

as the great warning of what happens if we don't curtail immigration from Asia. So, you know, all the way from the Irish in the early 19th century to the Chinese at the end of the century, it's perceived that the immigrants are just bringing one wave after another of health problems. Yeah. And what I would add to that in the 20th century is that we begin to use this very long standing association between immigrants and disease as a substantive basis to cut off systematically the flow of immigrants into the United States. One of the arguments behind the Immigration Restriction Acts of the 1920s is that these immigrants are bringing diseases epidemics and what we would call today more genetically defined diseases such as imbacility, that kind of thing. Mental retardation we would would have called it in the 1950s. And the other thing that happens in the

20th century is that we target immigrant neighborhoods for the eradication of disease. So, they're here, but when there's an outbreak of an epidemic, it's usually the immigrant neighborhoods that are targeted. But I think it's important to suggest that the very fact that government gets involved the way Brian suggests as a response to immigration and the pathologies associated with it means that that's the threshold of a genuine substantive exploration of public health issues. So in some ways you've got to start with these less than honorable passions and concerns and reflexes. And that's the energy that's channeled toward real improvement. I think that's the maybe the upbeat way to formulate that. So what do you think Peter, have we begun to address some of your curiosity? You have, it's very helpful. You know, it plays into the politics, it plays into the reality of both the 18th, 19th century American science and what we knew about

public health at the time right up to the present. It has a moral aspect to it as well as a political one. Yeah, Peter, thanks. Thanks Peter. I appreciate it. Thanks a lot. Thank you. Our last caller today is going to be John Avis. She's in St. Petersburg, Florida. John Avis, welcome to the program. Thank you, professors. Hey, well, we like those honorific titles. They make us feel really important. So John Avis, who we're talking about disease share with us. I am really excited about today's topic, not not going to make sense about disease, but my family, my father has been fighting cancer for the past eight years. And I started an on-profit called the War on Cancer Foundation. And a lot of thought went into what name we wanted to use. It was a root, a root choice. And I know why we use specific language. But given today's topic, I would love to share from you about the history of language in disgusting sickness over the years as a war or a race. Yeah, yeah. John Avis, a wonderful question that is the use of language

to shape perceptions. Ways we think about disease as a conquering host that we need to resist and in a way, the response to disease even back in my benighted period was that the state had to step up and exercise what were then called police powers to maintain public health by keeping diseases out. They didn't know how they traveled, but they knew they were coming, for instance, the yellow fever. That came from the Caribbean. So you're going to have to block trade because somehow or another, this disease comes with that lucrative trade to the Caribbean. So war has been the trope of choice throughout American history. And we can see in that historic context why you would call your organization a war against cancer. Yeah, John Avis, there's a very noble tradition of wars on cancer that go back to the early 1950s. This is Eisenhower and some of his advisors who in the wake of the tremendous success of World War II decided to use that war time metaphor

to take on your topic, to take on cancer. And they called it a war on cancer and they invoked the success of the Manhattan Project and mobilizing federal research and development to defeat an implacable enemy and to do it with one clean sweep as many felt the bomb had done to the Japanese. Now, of course, World War II and its ending was much more complicated than that. And as you know better than anybody, John Avis, the war against cancer has turned out to be pretty complicated. But this clean metaphor and emotional metaphor of mobilizing the entire nation against this dread disease was very effective going back to the 1950s. It's interesting, Brian, to think about in the post-World War II era, how widespread this language becomes because we have not only a war on cancer, we also have a war on poverty and then later a war on drugs.

And crime. Don't leave crime. And crime. Exactly. In the 19th century, which I specialize, we weren't confident enough to wage war on any disease. Basically, there's a sense of, oh my god, here it is. What are we going to do? I think the metaphor is much more like a fire department than it is an army. You know, here is something that has emerged in our midst that we need to mobilize ourselves all across the usual class boundaries and racial boundaries and try to extinguish it for the greater good. But then our goal is to get back to normality as quickly as we can. I have one thing about Brian's century that I think might complicate a little bit, and that is the Cold War. That's the big war. And you could have said for many years, hey, that's never going to end. And it didn't seem like it was going to. But that was a war that continued to energize and mobilize for good reasons and bad, paranoid and progressive, and ultimately, well, it was over. So sometimes they work, sometimes the trope does too much work

and people become cynical. Too many wars. Great point. So John, you said you'd really thought this through for your own purposes. What led you to go ahead and use that language? Well, I think I was 16 when my dad was diagnosed. So for the past eight years, essentially a third of my life, this has been a highly impactful element of my life. And when you mentioned the Cold War, for example, I think that is a great analogy for what cancer is for so many people. People sort of coming in and out of these hot periods, whether they go into remission or the disease comes back. And one of the huge elements in naming the foundations, the war on cancer foundation, was the fact that for individuals or their families, it is so damaging and not just in the physical or the clinical sense, but what we at the foundation have come to call collateral damage. That's right. Yeah. What was funny, as you had mentioned, the use of the

war can have positive and negative connotations and effects, like with the war on drugs. But we actually got overwhelmingly positive responses from caregivers and especially women when using burbiage like the war on cancer foundation because it sort of gave testament to the experience that they're having. It's just this daily war with the disease and then especially the all the collateral damage that comes with the result of it. We have so many combatants and we have so many veterans. I mean, I think all of us have good friends who've had bouts with cancer and it's personal triumphs and there are triumphs on various fronts of particular cancers that we seem to have under control. But the metaphor of war is one that does organize our holistic sense of the evil empire that we're trying to overcome. And I think one thing that resonated with me especially was the fact that when you're fighting something, I think we tend to think of war as the active period of fighting. But then there's

also the period of recovering and rebuilding. There's winning the peace. Exactly. And I think for a lot of people, even if they get through the cancer, then it's a matter of sort of that rebuilding and reconstituting a semblance of normalcy in their lives. How do you get back to even having a job to put food on your table and keep a roof over your head? There's so much rebuilding that goes on. And I think for us, one of our goals is not only in addressing this collateral damage, it's doing a lot to provide support to the caregivers and the families as opposed to just the patients. And in that sense, that's where we really see this notion of a war being so far reaching. You know, John, if you think it's for your call. Thank you all very much. Good luck. Bye-bye. Bye. That's going to do it for us this week. You can find us at Facebook, Tumblr, and on Twitter,

at Backstory Radio. You can also download all of our past shows, virus-free, which is important after hearing this one, at our website, BackstoryRadio.org. Remember a little backstory every day helps keep the doctor away. Thanks for listening and don't be a stranger. Today's episode of Backstory was produced by Tony Field, Jess Angabrettson, Eric Mennell, and Anna Pinkert, with help from Neil Bechinstein and Alison Quartz. Jamal Milner mixed the show. Backstory is produced at the Virginia Foundation for the Humanities. Major support is provided by the ShiaCon Foundation, the National Endowment for the Humanities, the Joseph and Robert Cornell Memorial Foundation, and the Arthur Vining Davis Foundations. Additional funding is provided by the tomato farm, called to vetting fresh ideas in the arts, the humanities, and environment, and by history channel. History made every day. Brian Ballot is professor of history at the University of Virginia. Peter Ones is professor

of history emeritus at UVA and senior research fellow at Monticello. At heirs is professor of the humanities and president emeritus at the University of Richmond. Backstory was created by Andrew Wyndham for the Virginia Foundation for the Humanities. Backstory is distributed by PRX, the public radio exchange.