Childhood's Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880-1930 (review)

Childhood's Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880-1930. By Evelynn Maxine Hammonds (Baltimore, Johns Hopkins University Press, 1999) 312 pp. $39.95

As infectious diseases have returned to the forefront of medical and public attention in the last two decades, books on the history of such diseases have also gained in popularity. Yet, a large part of the battles of the late nineteenth and early twentieth century to apply knowledge of the bacterial world to the prevention and control of epidemic diseases remains underexplored by historians. The effectiveness of vaccines and antibiotics against many scourges has, in a sense, clouded our vision of what the disease landscape was like before World War II, and of what new challenges confronted physicians and public health officials as their understanding of microbiology increased. Readers will find that Hammonds' Childhood's Deadly Scourge not only examines the scientific, public health, and logistical complexities of fighting diphtheria in the period from 1880 to 1930, when it was a major cause of childhood mortality and family suffering, but also illuminates a critical phase in changing perceptions of the capabilities of medicine.

Hammonds chose New York City for her analysis because its health department was the first in the United States to apply bacteriology to the control of diphtheria. The city also offers substantial documentation on which to base her examination. But, as her book amply demonstrates, the reduction of diphtheria morbidity and mortality in New York, and the virtual disappearance of the disease from the spectrum of childhood infectious ailments by mid-century, should not be depicted as a simple story of scientific progress. Contrary to more triumphalist claims, laboratory knowledge did not quickly or easily change clinical and public health practice.

Hammonds' narrative is structured around four themes. The first focuses on the re-definition of diphtheria as a clinical entity and on the possibilities for control of this highly prevalent disease, especially in New York City's overcrowded immigrant neighborhoods, wrought by bacteriological diagnosis in the 1880s and 1890s. Hammonds offers new insights about the role of diphtheria in the establishment of bacteriological laboratories in New York and about how the new laboratory knowledge shifted the balance in relationships between public health and other practitioners. She then turns her attention to the highly publicized introduction of diphtheria antitoxin in the 1890s, frequently claimed as one of the earliest successful products of laboratory medicine. Hammonds examines both the media campaign to persuade the public and municipal politicians of the merits of the new innovation of artificial immunization for diphtheria and also the factors governing medical acceptance of this practice.

A third and shorter section looks at the issues for public health policy on surveillance and isolation raised by the existence of large numbers of carriers of diphtheria. The book is completed by an analysis of how earlier developments enabled a broadscale program of active immunization during the 1920s in New York City with the goal of preventing outbreaks of diphtheria altogether. A coda to the story is a commentary, now almost obligatory for books about the history of infectious disease, on whether this earlier campaign against diphtheria has any lessons for the contemporary endeavor to control aids.

Hammonds' book deftly weaves together many threads in the tapestry of the New York City campaign to control diphtheria. It offers a sophisticated account of the complex ways in which bacteriology altered medical and public health practice. The author's strength is her ability both to explain the science and to appraise how public health measures are constrained by social and political context. The book has value beyond the history of health and medicine by illuminating important issues relating to the history of immigration in New York City and the larger topic of the history of childhood.

Caroline Hannaway
Baltimore, Maryland

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