Outbreaks: Major Diseases of the 20th and 21st Centuries That Influenced Societal Changes in Ontario County

Epidemic — the rapid spread of a disease that affects some or many people in a community or region at the same time.

Pandemic — an outbreak of a disease that affects large numbers of people throughout the world and spreads rapidly.

Through the course of history, disease outbreaks have ravaged humanity, however these past health crises inspired innovations in infrastructure, education, fundraising and civic debate. 

Tuberculosis

At the end of the 19th century, one in seven people around the world had died of tuberculosis, and the disease ranked as the third leading cause of death in the United States. While physicians had begun to accept German physician Robert Koch’s scientific confirmation that TB was caused by bacteria, this understanding was slow to catch on among the general public, and most people gave little attention to the behaviors that contributed to disease transmission. They didn’t understand that things they did could make them sick. In his book, Pulmonary Tuberculosis: Its Modern Prophylaxis and the Treatment in Special Institutions and at Home, S. Adolphus Knopf, an early TB specialist who practiced medicine in New York, wrote that he had once observed several of his patients sipping from the same glass as other passengers on a train, even as “they coughed and expectorated a good deal.” It was common for family members, or even strangers, to share a drinking cup.

With Knopf’s guidance, in the 1890’s the New York City Health Department launched a massive campaign to educate the public and reduce transmission. The “War on Tuberculosis” public health campaign discouraged cup-sharing and prompted states to ban spitting inside public buildings and transit and on sidewalks and other outdoor spaces—instead encouraging the use of special spittoons, to be carefully cleaned on a regular basis. Before long, spitting in public spaces came to be considered uncouth, and swigging from shared bottles was frowned upon as well. These changes in public behavior helped successfully reduce the prevalence of tuberculosis.

_{By the mid-20th century it was thought that sunlight would ward off TB – and public health officials promoted their theories through poster campaigns. (Library of Congress)}

As we are seeing with the coronavirus today, disease can profoundly impact a community—upending routines and rattling nerves as it spreads from person to person. But the effects of epidemics extend beyond the moments in which they occur. Disease can permanently alter society, and often for the best by creating better practices and habits. Crisis sparks action and response. Many infrastructure improvements and healthy behaviors we consider normal today are the result of past health campaigns that responded to devastating outbreaks.

Ontario County was the first county in New York State to have a tuberculosis sanitarium. In 1909 the Board of Supervisors appropriated $15,000 for its erection on a wooded hilltop in East Bloomfield Township.  Oakmount was opened formally in 1911.

Also through the generosity of Mary Clark Thompson, a laboratory was erected in 1906 to aid in the research and cure for the disease. It was another first for the County.  

At that time it was felt that appropriate treatment for tuberculosis was absolute quiet, much rest complete contentment and personal attention. Oakmount offered all of this. By 1930 it consisted of a main building, laundry and five cottages. This expansion was under Superintendent Dr. Selover of Canandaigua and Miss Emma Thaler, head nurse. 

Before the establishment of the Oakmount, many individuals died in their homes as noted on this 1903 Coroner’s Report (RAIMS)._{Obituary for William H. Riley as published in the Geneva Daily Times on August 21, 1903.}

In 1920 at an Ontario County Board of Supervisors meeting much discussion took place of the problem of properly caring for the tuberculous children. Dr. John H. Jewett chairman of the executive committee of the Thompson Memorial Hospital presented a resolution asking the Board of Supervisors take some definite action regarding the care of the tuberculous children now at the Memorial hospital.

With the generous help of the Canandaigua Rotary Club a “preventorium” was erected on the Thompson Memorial Hospital grounds. This was unlike a regular hospital it catered to children with tubercular contact or children who might be saved if they could be separated from their source of infection. The bungalow reflected the feelings of a cozy home like surrounding for the children. Nurses and public health staff were devoted to the care and aid and schooling of crippled children. Winter and summer sports were equally enjoyed by the small patients –those unable to participate thoroughly enjoyed the role of spectator. 

Spanish Flu

It was called Spanish Flu because it swept across Europe at the time of World War I. All countries involved in the war controlled the flow of news and didn’t want anything to weaken the morale of their people. Spain, which was neutral, openly reported on the disease causing disruption in their country, including their king becoming gravely ill. People assumed the “flu” originated there, but it was later determined to have started on an army base in Kansas in March of 1918.

Carried to Europe by U.S. soldiers, the flu ravaged the trenches in Belgium and France through the summer of that year, affecting all armies. It was suspected to be biological warfare introduced by the Germans or a side effect of mustard gas. From Europe it spread around the globe, including the islands of the Pacific and the Arctic. The virus was brought back to the U.S. by our troops returning from Europe.

Although some researchers argue that the 1918 pandemic began elsewhere, in France in 1916 or China and Vietnam in 1917, many other studies indicate a U.S. origin. The Australian immunologist and Nobel laureate Macfarlane Burnet, who spent most of his career studying influenza, concluded the evidence was “strongly suggestive” that the disease started in the United States and spread to France with “the arrival of American troops.”

Wherever it began, the pandemic lasted just 15 months but was the deadliest disease outbreak in human history, killing between 50 million and 100 million people worldwide, according to the most widely cited analysis. An exact global number is unlikely ever to be determined, given the lack of suitable records in much of the world at that time. But it’s clear the pandemic killed more people in a year than AIDS has killed in 40 years, more than the bubonic plague killed in a century. (https://www.smithsonianmag.com/history/journal)

Starting in Boston and New York City in September, it swept across the country in a matter of weeks, killing nearly 700,000 Americans. The peak month was October, when more than 200,000 Americans died from the flu. Globally, an estimated 50 million died from influenza in 1918-1919. Some experts put the number as high as 100 million. Unlike common influenza, it most affected people between the ages of 20 and 40. In some people it struck very quickly. One anecdote told of four women playing bridge in the evening; three were dead from influenza by the next morning. In the worst cases, the flu turned quickly into an aggressive pneumonia and people died from the buildup of fluid in the lungs.

While the 1918 H1N1 virus has been synthesized and evaluated, the properties that made it so devastating are not well understood. With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.

The pandemic affected everyone. With one-quarter of the US and one-fifth of the world infected with the influenza, it was impossible to escape from the illness. Those who were lucky enough to avoid infection had to deal with the public health ordinances to restrain the spread of the disease. The public health departments distributed gauze masks to be worn in public. Stores could not hold sales; funerals were limited to 15 minutes. Some towns required a signed certificate to enter and railroads would not accept passengers without them. Those who ignored the flu ordinances had to pay steep fines enforced by extra officers. Bodies piled up as the massive deaths of the epidemic ensued. Besides the lack of health care workers and medical supplies, there was a shortage of coffins, morticians and gravediggers. (https://virus.stanford.edu/uda/)

_{The Buffalo Times. Buffalo, New York. 17 Oct 1918 Page 15}

_{Democrat and Chronicle. Rochester, New York. 20 Oct 1918, Page 32}

_{Policemen in Seattle wearing masks made by the Red Cross during the influenza epidemic December 1918.} 

When the influenza virus pandemic took hold in the United States in 1918, emergency hospitals were started in schools, halls, and large private houses and open-air hospitals were being “thrown up” all over the country. (Crosby AW, America’s Forgotten Pandemic: The Influenza of 1918. 2nd ed. Cambridge, England: Cambridge University Press; 2003)

_{Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp Funston (Otis Historical Archives, National Museum of Health and Medicine)}

The one factor that facilitated the transmission of the disease was crowded conditions. In urban areas, people were moving to cities so that they could find jobs and assist with the war efforts. People were living in very close quarters; sharing beds and bathroom facilities. Soldiers were also in crowded situations. Young men moved from towns to training bases and then to Europe which allowed the infection to move from camp to camp and then globally.

_{American Soldiers arrive in France.}

Many of the Ontario County war heroes died because of the spread of the disease:

During this time there was much fear and uncertainty. The country was at war in Europe and their loved ones worried about the young soldiers being struck down by the enemy or by the illness. The families at home were also fighting against this disease and many, many of them did not win. Help and aid was initiated by the Federal Government through the work of the Red Cross.

Within weeks of the outbreak of World War I, the Red Cross dispatched a “Mercy Ship” with medical supplies, doctors and 125 nurses to aid military and civilian victims of the conflict. When the United States entered the war, they recruited more than 23,000 nurses to serve at home and overseas.To help overworked nurses care for returning veterans and to sustain ongoing, domestic nursing programs, the Red Cross introduced the Volunteer Nurses’ Aide Service in 1918.The American Red Cross recruited more than 15,000 women, including nurses and others who had taken home nursing classes, to help care for flu victims in the United States. They continued their work by setting up hundreds of health center and child welfare station.

They increased civilian services by providing new courses in first aid and nutrition for homemakers; expanded rural nursing programs; a special fund to train public health services nurses and emergency relief following natural disasters, as well as to social problems caused by the Great Depression.

American Polio

A polio epidemic that started in New York City caused 27,000 cases and 6,000 deaths in the United States. The disease mainly affects children and sometimes leaves survivors with permanent disabilities. Polio was one of the most feared diseases of the 20th century.  In the late 1940’s, polio outbreaks in the US increased in frequency and size, crippling an average of more than 35,000 people each year. Parents were frightened to let their children go outside, especially in the summer when the virus seemed to peak. Travel and commerce between affected cities were sometimes restricted. Public health officials imposed quarantines (used to separate and restrict movement of well people who may have been exposed to contagious disease to see if they become ill) on homes and towns where polio cases were diagnosed.  Before a vaccine was developed, the poliovirus afflicted millions of children and adults (including President Franklin Delano Roosevelt), sometimes causing lifelong paralysis and breathing difficulties. But by mid-century, Jonas Salk and Albert Sabin had developed vaccines against the brutal disease. The National Foundation for Infantile Paralysis, or the March of Dimes, led the effort to vaccinate millions of children, helping to eradicate the disease in the United States.   As the vaccine became widely available, cases in the United States declined. The last polio case in the United States was reported in 1979. Worldwide vaccination efforts have greatly reduced the disease, although it is not yet completely eradicated.

Polio: The Virus and its Effect

The poliovirus, in its worse form, infects and incapacitates the anterior horn cells within the gray matter of the spinal cord, as well as motor nuclei in the brain stem. The tern polio is short for poliomyelitis, a term derived from Greek meaning “inflammation of the gray matter.”  Polio was originally referred to as infantile paralysis, based on its propensity to infect children. This name, although appropriate in the early days of the epidemic, inaccurately reflected the true demographics of the disease as untold; adults were also stricken by the virus.

In 1927, when Philip Drinker and Louis Agassiz Shaw at Harvard University devised a version of a tank respirator that could maintain respiration artificially until a person could breathe independently, usually after one or two weeks. The machine was powered by an electric motor with two vacuum cleaners. The pump changed the pressure inside a rectangular, airtight metal box, pulling air in and out of the lungs.

 _{Democrat and Chronicle. 24 September 1955}

March of Dimes

In 1938 President Roosevelt created the National Foundation for Infantile Paralysis. He had already been active in assisting victims of polio through the Georgia Warm Springs Foundation, a spa he had often visited to ease his symptoms and that he had purchased in 1926. Roosevelt raised money for this foundation through a series of balls held on his birthday. The first Birthday Ball in 1934 had 4,376 communities joining in 600 separate celebrations, and raised over a million dollars.

But the National Foundation for Infantile Paralysis was funded in a different way. In 1938, radio personality Eddie Cantor encouraged Americans to give their loose change to the cause, urging listeners to create “a march of dimes to reach all the way to the White House.”

Americans began emptying their pockets, and little bits of money soon added up. In 1945 the annual March of Dimes campaign raised $18.9 million for National Foundation for Infantile Paralysis.

When Salk’s vaccine was declared safe and effective in 1955, church bells were rung, and the nation celebrated. By 1957 the incidence of polio in the United Sates had dropped by 90 percent. It was too late for FDR, but it was a life-saving breakthrough for Americans and children around the world.

_{FDR pictured receiving a birthday cake decorated with checks for the National Foundation for Infantile Paralysis. January 1942. FDR Library NPx. 48-49:315}

FDR: Living with Disability

Franklin D. Roosevelt was the 32nd President of the United States. Not only did he serve an unprecedented four terms in office, but he was also the first president with a significant physical disability. FDR was diagnosed with infantile paralysis, better known as polio, in 1921, at the age of 39. Although dealing with this crippling disease was difficult, many believe that his personal struggles helped shape FDR, both as a man and as a president

 Roosevelt’s struggle against polio — the mysterious virus that swept through the country in epidemics that terrified Americans in a manner not unlike the fear generated by the coronavirus today — is perhaps more relevant to the current battle against Covid-19 than his presidential tenure. It was out of this experience that Roosevelt gained a deep appreciation for the science of medicine, and the important role that the federal government can and must play in the promotion of public health.

Though paralyzed from the waist down, Roosevelt never lost hope that he might recover the use of his legs. In 1924 he read about a young man who appeared to have regained his ability to walk by swimming in the warm waters of a resort in Warm Springs, Ga. Inspired by this story, Roosevelt traveled to Warm Springs, “took the waters” and became so convinced of the springs’ restorative qualities that he not only bought the resort, but also soon turned it into the nation’s first major center for rehabilitative therapy. To support this facility and help foster a greater public awareness of how modern medicine could assist his fellow polio sufferers, Roosevelt established a nonprofit organization called the Georgia Warm Springs Foundation.

Roosevelt’s return to politics in 1928 — a successful bid to become governor of New York — provided another opportunity for him to encourage public support for what was called “aftercare” therapy. By frequently appearing in public supported by steel braces carefully concealed under his pant legs, he was able to “stand” behind a lectern, or “walk” a few short paces, swinging each braced leg forward one at a time, steadied by a cane and the arm of one of his sons or an aide, head up, smiling and laughing as if he were out for a leisurely stroll.

This “splendid deception” helped create the impression that Roosevelt had largely recovered from polio. It also helped lessen the public’s fear of the disease and reduce the stigma associated with it. The truth, of course, was that this “walk” took tremendous effort and concentration. But it also boosted Roosevelt’s political career. As his opponents’ attacks on his health and fitness for office during the 1932 campaign revealed, the public was not ready to elect a president who used a wheelchair.

Having confronted his own paralysis, Roosevelt assumed the presidency in 1933 confident that he could help lift a paralyzed nation out of the depths of the Great Depression. For the next 12 years, this man of action — who was frequently depicted as running and jumping in editorial cartoons — would transform the relationship between the American people and their government and between the United States and the rest of the world.

After the successful 1934 launch of annual fundraising “Birthday Balls” with the slogan “to dance so that others may walk,” Roosevelt helped orchestrate the establishment of the National Foundation for Infantile Paralysis in 1937 “to lead, direct and unify the fight against every phase of this sickness.” The organization launched the famous “March of Dimes” fundraising campaign in mid-January 1938, which by the end of that month had flooded the White House mail room with 2,680,000 dimes.

_{FDR leg braces displayed at the FDR Memorial (County Historian files)}

Inspired by the progress that was being accomplished in the treatment of polio, Roosevelt also took great interest in the expansion of the federal government’s role in advancing the science of public health. It was Roosevelt who secured the funding, selected the site and provided the initial design of the massive Bethesda Naval Hospital that opened in 1942.

_{FDR’s concept of Bethesda Naval Hospital (Naval Bureau of Medicine and Surgery Library & Archives)}

_{Bethesda Naval Hospital}

Roosevelt also vastly expanded the facilities of the National Institutes of Health. In dedicating the new $4 million facility that would house the National Cancer Institute in October 1940 — roughly a year after the outbreak of the Second World War — the president proclaimed that, in addition to the acquisition of “airplanes, ships, guns and bombs,” the security of the United States required the application of medical knowledge and science because “we cannot be a strong nation unless we are a healthy nation.”

Realizing the U.S. was but a day or two by plane from the “yellow fever of South America” or “the sleeping sickness of equatorial Africa” Roosevelt established a Health and Medical Committee within the Department of Defense “to coordinate the health and medical aspects of national preparedness.” While NIH had done good work, Roosevelt insisted the federal government could do “infinitely more” because “disease disregards state lines as well as national” and among the states “there is inequality of opportunity for health.”(Washington Post April 28, 2020)

                          _{Robert Graham created this present statue, dedicated in January 2001 to set an inspiring example for others who struggled with disability.                                                     (FDR Memorial County Historian files)}

COVID-19 

As now we are in the midst of the COVID-19 pandemic we look to lessons learned in the past. Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China. The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

In just 6 short months, the world has become a very different place as coronavirus disease 2019 (COVID-19) has brought countries to a standstill, pushed hospital systems to the brink, and dragged the global economy into what may be the worst recession since World War II. At the end of June, the global death toll had reached 511,251, with 25% (127,251) from the United States alone. The number of global cases reached 10,475,817, and again, the United States accounted for 25% (2,627,584) of the total global number.

Signs and symptoms of COVID -may include fever cough and tiredness. Other symptoms may include shortness of breath, muscle aches, child sore throat, runny nose, headache, and chest pain. The severity of COVID-19 symptoms can range from very mild to severe. Some people may have only a few symptoms, and some people may have no symptoms at all. Some people may experience worsened symptoms, such as worsened shortness of breath and pneumonia, about a week after symptoms start.

People who are older have a higher risk of serious illness from COVID-19, and the risk increases with age. People who have existing chronic medical conditions also may have a higher risk of serious illness.

Throughout the time span of this pandemic we have seen uncertainty and contrasting directives, people stock piling items that lead to a shortage of toilet paper and hand sanitizer; older people being the most at risk especially in nursing homes. By March 16 President Trump issued new guidelines urging people to avoid social gatherings of more than ten people and to restrict discretionary travel. He stopped short of ordering a quarantine or a curfew, but he said restrictions may last until July or August. He acknowledged that the country may be headed for a recession. Despite the fact that the Federal Reserve Bank lowered interest rates the day prior, the stock market fell once again. New York was especially restrictive most likely due to the great population of New York City and their close living conditions and mass transportation system. 

Due to data collection differences, the City’s reported total of confirmed deaths for any given day is usually different than the State’s data about NYC deaths. 

In Ontario County, resident’s have worked hard to "slow the spread". As of July 16, 2020, there has been 315 positive cases and a total of 34 deaths.

For the latest information regarding the COVID-19 coronavirus in Ontario County, visit the Ontario County Department of Public Health’s Coronavirus web page along with current data, accessible from the main Public Health page.  

We will move forward because we have seen the signs “New York Tough” and as we have found in the past the following habits have proved to help the spread of the disease:

• Keep a mask handy. Wear a mask in enclosed spaces, when you shop or go to the office and anytime you are in close contact with people outside your household.
• Practice social distancing — staying six feet apart — when you are with people who live outside your household. Keep social activities outdoors.
• Wash hands frequently, and be mindful about touching public surfaces (elevator buttons, hand rails, subway poles, and other high-touch areas)
• Adopt stricter quarantine practices if you or someone in your circle is at higher risk.