Taking the cure to the poor: patients' responses to New York City's tuberculosis program, 1894 to 1918

Drawing on the case files of a major charitable agency, this paper explores how poor people experienced New York City's pioneering program of tuberculosis control. Although the program provided enormous benefits, poor New Yorkers often had pressing concerns that took priority over eradicating tuberculosis. Moreover, the program imposed extreme hardships even as it promised liberation from a terrible scourge. Poor people did not protest collectively, but many individually resisted. They delayed seeking diagnosis, disobeyed the advice promulgated by the Department of Health, attended clinics irregularly, and either refused to enroll in hospitals, sanatoria, and preventoria or fled soon after arrival.

[The dawning of a new science: Bahian tropicalist medicine]

Medicine in 19th-century Brazil was a scientific field where traditional knowledge, academic teaching, and clinical care found themselves clashing with new theories of illness and medical care underpinned by pioneer disciplines like parasitology, bacteriology, and anatomopathology and an experimental clinical practice focused on tropical diseases which afflict the poor. This new set of theoretical and social references which affected public health-care policy saw its decadence when it was appropriated by an ideology that argued that the Afro-Brazilian population was racially and culturally inferior. Two new disciplines--criminal physical anthropology and legal medicine--contributed to the development of specialized knowledge within intellectual circles. At the same time, they were placed at the service of the ruling order, reinforcing principles and devices that the elite utilized to keep itself in power. This hybrid structure constitutes the legacy of barbarianism which is sundering today's civilization.

Inoculating the urban poor in the late eighteenth century

Historical accounts of the practice of smallpox inoculation in the late eighteenth century invariably made a distinction between the widespread general inoculations carried out within small rural parishes and the partial inoculations in urban centres such as London, Manchester, Newcastle and Leeds. This distinction, moreover, is generally reinforced by concluding that the rural inoculation programmes were 'highly effective' or 'successful' in contrast with the urban inoculation schemes, which are often seen as 'marginally effective' or indeed 'failing'. Success or failure tends to be judged by the impact which inoculation had upon reducing mortality from smallpox, but as a result of this demographic focus the motives behind the implementation of urban inoculation have been overlooked. My paper readjusts this balance by looking more closely at motives and by judging success in relation to aims. To achieve this I have taken a new approach towards the history of smallpox inoculation as a whole, and portray the basic idea of giving a person smallpox in order to confer subsequent immunity as being modified in the hands of different people throughout the course of the century. Hence it is possible to trace the development of inoculation from a folk practice carried out within the home with the aim of protecting individuals, to large-scale general inoculation of an entire community, which aimed to eradicate the disease altogether.

Interacting factors affecting illegitimacy in preindustrial northern England

Illegitimacy in a historic, single community at Penrith, Cumbria (1557-1812), has been studied using aggregative analysis, family reconstitution and time series analysis. This population was living under extreme conditions of hardship. Long, medium and short wavelength cycles in the rate of illegitimacy have been identified by time series analysis; each represents a different response to social and economic pressures. In a complex interaction of events, the peaks of the cycles in wheat prices were associated with rises in adult mortality which promoted an influx of migrants and a concomitant rise in illegitimacy. The association between immigration and illegitimacy was particularly noticeable after the mortality crises of the late sixteenth and early seventeenth centuries. Children of immigrant families also tended to produce illegitimate offspring. Native and immigrant families responded differently to extrinsic fluctuations, and variations in their reproductive behaviour were probably related to access to resources.

[In the footsteps of Pinel at the Salpêtrière, concerning some unedited documents]

In 1802, the government transferred the treatment of all indigent mentally ill women in the Paris region to Salpêtrière Hospice where Philippe Pinel was physician-in-chief. Four newly identified folio registers in the Paris hospital archives document how Pinel applied what he called "traitement moral" to the women under his care. He elaborated a method of supervised living and encouragement to work. The newly discovered case histories reveal that, in 3 years and 9 months - the timespan of Pinel's report to the Academy of Sciences - 265 out of 1077 patients returned to their families, but 107 women, though cured, remained under police supervision. There appears to be no follow-up study.

The New Poor Law and the County Pauper Lunatic Asylum--the Devon experience 1834-1884

In this article we examine the impact of the policies and practices of the Guardians of the New Poor Law Unions on the management of pauper lunatics in four Devon Poor Law Unions in the critical period 1834-84. The central role of the Victorian Poor Law in provision made for the insane has only recently been recognized in the research literature. Scholars have been much more concerned with the activities of professionalizing physicians and the general project of state management than they have with the micro-politics of the local Poor Law and the magistracy who were responsible for the legal disposition of the insane. In this paper we argue that not only were the Guardians of the Poor Law Unions central in the determination of the lunatic's journey through the institutional systems provided in the mid-nineteenth century, but also that there were significant variations within the Poor Law system which made for contrasting systems of disposal of lunatics as between the Unions themselves. These variations in disposal of lunatics in Devon raise important questions of ideology, policy, and practice which, if repeated elsewhere, point to a need to refine significantly our assumptions regarding the disposal of pauper lunatics in England and Wales in the fifty years following the 1834 Poor Law Amendment Act.

"Why do they hate me so much?" A history of welfare and its abandonment in the United States

Acceptance of the need for government-sponsored welfare programs has declined radically in the past 15 years. The history of welfare initiatives is traced, from their inception as a buffer to inherent inequities of a capitalist economy to their recent demonizing as corruptive influences on recipients of benefits. The political shifts that have permitted this change, along with its effects on the lives of poor people, particularly women, are discussed.

[Access to care, precariousness and misery conditions]

Fraternity among humans is a social trait as old as the world. Among primitive men and in antiquity the most favoured came to the aid of the least favoured. Through the ages, this assistance has taken on various forms: food, money, and free medical care. With the Christian era, such aid became a charitable duty. The throne also came to the assistance of the poor, but here such actions alternated with those of the police, for poverty, engendered delinquency. The French Revolution opened a new era. Thereafter, the poor had certain rights upon society. This immense change led to our present social legislation.

Invisible labours: mill work and motherhood in the American South

With an almost total lack of access to contraceptive information before the mid 1930s, a high percentage of married women working in the textile mills of the American south were or rapidly became mothers. Without the financial resources to provide their families with wholesome food, medical care, and adult supervision, these women, who bore many children and shouldered most domestic duties in addition to their mill jobs, presumably had particular health care needs. This essay intially questions the usefulness of traditional categories that label physical ailments and accidents as either job-related or lifestyle-related. A group of female physicians in Greenville and Spartanburg Counties in South Carolina, all of them southern natives, worked during the 1930s to address some of the most immediate medical needs of the region's working women. These physicians had no appreciable effect, however, on workplace conditions and did not question the social and economic relationships that led so many working mothers to depend on their services. This essay also provides a partial analysis of public health services available to working mothers in Carolina mill villages during the Depression decade and explores reasons why the region's female medical professionals failed to challenge a form of social organization that left working mothers' particular health care needs unaddressed.

To pauperize or empower: public health nursing at the turn of the 20th and 21st centuries

From its inception, public health nursing has provided health care and teaching to all people including those who are disadvantaged and impoverished. Based on the work and beliefs of Florence Nightingale and Lillian Wald, public health nurses developed positive relationships with people which resulted in healthier environments and lifestyles among diverse families and communities. And, despite societal concern that nursing care for the poor would pauperize them, it did not. It empowered them. A review of concepts of poverty and comparisons of issues and circumstances at the turn of the 20th and 21st centuries underscores the values inherent in these early initiatives and their continuing relevance to public health nursing practice that can empower, rather than pauperize, those who are disadvantaged or living in poverty.

Hay Bilharzia!, by Klock, Ildefonso, and Mateo-Serrano: medical images of poverty and development in Puerto Rico in the 1950s

From 1940 to 1970 Puerto Rico underwent a dramatic change in its economic, social, political, and medical characteristics. Schistosomiasis (known locally as bilharzia) persisted throughout this period as a nearly intractable problem. In 1954, staff from the Puerto Rico Department of Health, and the Puerto Rico Field Station of the U.S. Communicable Disease Center (now San Juan Laboratories, Centers for Disease Control and Prevention) created a set of black and white 35 mm slides as a tool for community education. The presentation, titled "Hay Bilharzia!" ("There is schistosomiasis here!") is organized in four major sections (Introduction, Disease Cycle, Disease Prevention, Treatment). Each section consists of two to four sub-themes, with three to eight slides each. The slides were used extensively in public schools and community lectures. This set of slides is worthy of preservation as evidence of the bilharzia control efforts and the dismal living conditions widely prevalent in Puerto Rico in the 1950s. It is also an example of the educational programs that were produced at the time to stimulate community development and health.

Perils and pitfalls on the path to normal potential: the role of impaired attention. Homage to Herbert G. Birch

The research of Herbert Birch and colleagues, conducted 30 years ago in a rural area of Guatemala, called attention to the permanent noxious effects on cognitive development associated with conditions of poverty. Half of the world's population, including millions of persons in the United States, are still afflicted by these conditions. Included among these are malnutrition, disease, toxic agents, perinatal injury, and lack of intellectual/social stimulation. Recent research findings on the cognitive effects of these poverty-related variables are presented; the effects appear to be expressed in a reduction of the brain's capacity to engage in attentive behavior. Neuropsychologists, by virtue of their interests and training, are in a position to develop methods of assessing and correcting these deficits, and must become advocates of improved conditions to foster better brain development for all of the world's children.

Britain's regional mortality: a legacy from disaster in the Celtic periphery?

Are the differences in Britain's contemporary regional mortality partly a legacy from the disasters which befell nineteenth-century peasant populations? The rise of Britain's industrial cities was linked with recruitment from populous but vulnerable peasant economies in the (largely Celtic) north and west of the British Isles, and in Glasgow this was linked with exceptionally high mortality. Three ways of accounting for the first of these linkages, between industrial cities and peasant migration, are considered, drawing on analyses of rural Malthusian pressures, of the industrial labour market, and of cultural divisions on the Celtic periphery. These accounts all predict a particular urban and regional geography of mortality which is confirmed in nineteenth-century data. Different accounts also suggest somewhat different durations for this pattern, and preliminary exploration of readily available data on secular change in relevant areas up to 1971 show that Malthusian explanations are unlikely to account for much of the effect, while the economic and cultural structures described are worth exploring further. Alternative explanations of regional or ethnic mortality cannot all be ruled out at this stage but discussions of contemporary regional mortality differences need to take into account the history of the peasant populations in the former British Isles as a whole.

[Charity. Poor welfare as care for the elderly in the 2nd half of the 19th century]

In the second half of the nineteenth century poor relief of the church was especially directed at the elderly. Firstly, this is clear from the existence of almshouses and the so-called old people's homes. Secondly, in allocating poor relief age played an important role. Permanent outdoor relief was supplied from the age of fifty. This article will portray this nineteenth century permanent outdoor relief. A group of 239 permanently endowed people will be analyzed on the basis of parish registers of the Evangelical-Lutheran church in Amsterdam. This specific group (orphanages, almshouses, old people's homes and boarders will not be considered) consisted largely of elderly people.

Youth, race, and labor: working kids and historical ambivalence in twentieth century America

As a society, we share assumptions that exhibit a profound historical ambivalence regarding young people at work. On the one hand, we all acknowledge that there is something socially and morally reprehensible about forcing children to toil. Many of us see child labor as a vestigial remnant of the harshest aspects of the Industrial Revolution. On the other hand, we also continue to see work as a sign of the moral and social health of a community and hence, we see employment among the young as a stabilizing and redemptive activity. Especially when addressing the nation's poor, urban and African-American populations, youth unemployment is almost universally understood as a root cause of social unrest and community breakdown. This paper outlines some of the historical arguments about children in the work force and raises the question about the national resolve to seriously address this issue.

'Through privation to knowledge': unknown documents from Freud's university years

The paper is centred on three hitherto unknown grants, two of them donated by different Jewish Foundations to the medical student Freud shortly before the end of his studies. It furthermore turned out that Freud's salary as a demonstrator in Brücke's Laboratory had been a grant too, donated by the University of Vienna. Aspects of the contemporary background by means of the private foundations and their donors as well as of the aspiring tendencies at the University of Vienna are described. Documentary evidence demonstrates that Brücke promoted Sigmund Freud continuously, more than hitherto known in the biography. The significance of Brücke and Charcot as identification-figures, on the one hand, and for Freud's development as a scientist, on the other, is elaborated. Contemporary quotations shed light on Freud's poverty in his youth as well as the arising anti-Semitism at the University of Vienna.

Enamel hypoplasias in a 19th century population from northern Italy

In a sample from northern Italy of the second half of the 19th century hypoplasias in maxillary and mandibular anterior teeth was examined. The maxillary canine is the most frequently affected tooth. Frequencies of hypoplasias show slightly lower figures than other 19th century skeletal populations. The age interval most affected was between 2 and 4 years and suggests an association with stress at weaning and immediately thereafter.

[Surgical intervention against overpopulation: Professor Weinhold's foreskin infibulation]

One of the most bizarre and forgotten suggestions to have developed from the discussion of pauperism in the 19th century was the infibulation of the impoverished men. A communication in 1827 from the Halle professor of surgery, Carl August Weinhold (1782-1829), raised indignation and caused ironic as well as angry reactions. Despite such a heated response, Weinhold's proposed method of population control soon fell into oblivion, a fate considered by this contemporaries as "highly desirable".

Field of blood, field of the forgotten. The Potter's Field of Milwaukee County

A recent discovery of a forgotten pauper cemetery at the Milwaukee County Medical Center has profound and far-reaching ramifications. More than 5,000 are buried in this graveyard, compelling an investigation into the circumstances surrounding its loss. That the cemetery lies beneath county buildings without official knowledge is a disgrace. The proper dignity of a marked and undisturbed grave was denied to these former county residents because of their poverty. How this discovery is managed will reflect our commitment to both high ideals and the law. This project endeavors to reconstruct the origins of the pauper cemetery, containing a brief history of the poor in Milwaukee County, and an examination of the Almshouse, Milwaukee County's first medical institution. Finally, a postscript offers a parallel between the writings of Charles Dickens and the pauper cemetery.