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Health and Disease
Marasmus and Scrofula
On April 21, 1869, Agnes Mary Moore passed
away at the age of five months and 21 days, during the Moore Family's
brief residence in 97 Orchard Street. On her death certificate,
completed by a medical attendant named Henry Foster Topping, the
first cause of death is listed as marasmus, and the second cause
scrofula. Scientifically defined, marasmus is a form of protein-energy
malnutrition that occurs among infants, usually when they are
still weaning. Marasmus can occur among infants as a result of
either an insufficient diet - or - as a result of being weakened
by a disease. According to the World Health Organization's statistics
from 1995, annually about 10.4 million children die from marasmus,
primarily in developing nations. 50 percent of those deaths can
be attributed to undernourishment.1
In the case of Agnes Moore, it is likely that scrofula led to
her death by marasmus. Scrofula is a form of tuberculosis that
can be contracted either through person to person contact or through
what is known as non-tuberculosis mycobacterium (NTM) cervical
adenitis. In both cases of the illness, scrofula leads to an infection
and swelling of the lymph nodes in the neck, followed by open
sores and the potential spread of the tubercular bacteria to other
parts of the body. Upon falling ill to scrofula, Agnes may have
experienced difficulty swallowing from the discomfort in her neck.
Like tuberculosis, scrofula also generally weakens the system;
weight loss, fever and chills, and malaise, are common elements
of the disease.2
Until the late 19th century, however, the origins of tubercular
diseases such as scrofula were not known. In its 1868 "Report
of the Registrar of Vital Statistics", the Board of Health
categorizes pulmonary tuberculosis and scrofula as "constitutional"
diseases rather than "zymotic". Diseases classified
as being zymotic were those that the Board of Health thought to
be spread through the atmosphere. Constitutional diseases were
believed to be congenital and hereditary.
Given Agnes' age, it is likely that she contracted the NTM form
of scrofula. The NTM form of scrofula occurs naturally and could
have been present in contaminated milk, food, or even household
objects that came in contact with Agnes's mouth. In the developed
world, NTM scrofula has become extremely rare with the advent
of pasteurization and other sanitation methods used to kill bacteria,
but food and beverage contamination was common in the 19th century,
especially before the 1880s, when Koch and Pasteur's theories
on the connection between bacteria and illness led to direct methods
for ensuring the safety of consumer goods.3
Contaminated Milk
and Infant Mortality
During the late 19th century many working-class
and poor mothers throughout urban America stopped nursing and adopted
the practice of feeding their newborns cow's milk about two to three
months after birth. The most common reason offered by immigrant
mothers for the switch to cow's milk was that their own breast milk
was quantitatively and qualitatively inadequate to sustain their
babies-a perception shaped in part by the experience of resettlement
in an urban, industrial environment with its demands on many women
as laborers outside the home, its greater access to American food
products in the commercial marketplace, and its diminishing effects
on traditional knowledge about birth and child care. On the stoop
and in the streets, immigrant mothers traded infant-care advice,
talk that frequently centered on the positive reasons for feeding
babies cow's milk, specifically the fact that cow's milk seemed
at first a better source of nourishment that helped their children
gain weight and grow.4
During the mid-to-late, 19th century, the difficulties in monitoring
milk in its many stages from cow to bottle were immense, and made
even more so by the development of a national economy. Whereas in
the past a cow would have local origins and its milk produced in
smaller quantities, the advent of technology such as the railroad
made it more common for cows to originate in the hinterlands and
milk to be processed in large dairy factories.5
Clean, cheap milk was not easily procured. Watering milk was an
especially common way used to "expand" the beverage, resulting
in a "weak and unutritious [sic] mixture of milk and water."
But water was probably the most benign substance added to milk-often
a mixture of soda, ammonia, salt, and water was used. Dye and chalk
were also frequently used to whiten dirty milk.
"Swill milk," produced by cows fed distillery waste, was
also common. Urban dairy farmers frequently purchased distilleries'
by-products for use as cow feed. Cows who subsisted on this rotten
mixture lost their teeth, developed skin ulcers, running sores,
and rotted tails that fell off. Dairy cows frequently carried bovine
tuberculosis, which could infect humans who drank their milk. Before
the discovery of the tuberculosis bacillus in 1882, cows were not
tested and milk was not pasteurized. Even if milk made it to the
city unadulterated and bacteria-free, careless merchants sometimes
contributed to this public health problem. Milk was ladled from
large, uncovered vats into small containers brought by customers.
Milk delivered directly to homes was endangered by milkmen who re-used
dirty bottles from one customer, ladled new milk into it, and sold
it to another. Diseases such as tuberculosis, diphtheria, and other
communicable diseases were spread in this manner.6
Prior to the late-1860s, women who could not breast feed and could
not or did not want to hire a wet nurse, usually fed their children
straight cow's milk or formulas they put together in their homes
based on cultural assumptions of what constituted a healthy diet
for infants. The process of producing condensed milk was patented
in 1856 and it was also used as a formula when "fresh"
milk was not available. Two types of condensed milk were available
in cans, plain condensed milk and preserved condensed milk, which
had sugar added and kept longer. Aware that the high sugar content
of preserved condensed milk reduced its protein values, physicians
recommended that cod liver oil or meat broth be added to it as a
way of rectifying the problem.7
Infant formulas prepared outside the home first became readily available
in the United States in the late-1860s, but by the end of the century,
represented a vibrant industry that included processing centers
and other distribution networks that provided "fresh"
formulas to mothers in an era when refrigeration was not readily
available to most families. In marketing infant formula, "two
important themes dominated infant-formula advertising: fear for
the health of the child and faith in science." Companies selling
infant formula manipulated science and its presumed authority to
attempt to convince mothers that formulas were calculated in meticulous
detail by doctors who had a strong grasp on what nutritional combinations
were best for infants. Infant formulas were touted for the consistent
ratio of their ingredients, which had been determined by professional
scientists in a process that could not be replicated by mothers
in the home. (Later in the century, when medical doctors would actually
get involved in studying infant formula, many criticized the brands
on the market for being to farinaceous in their composition. It
was not until 1920, that doctors linked the high prevalence of rickets
among Americans to vitamin deficiency, which was another legacy
of the fiber-heavy diet most infants were fed.) Infant formula companies
contrasted their products as being safer then the alternative: wet
nurses. Wet nurses were considered liabilities in that it was believed
that not only sickness and disease could be passed along to the
child through contaminated breast milk, but also racial and moral
deficiencies. Given that most of the wet nurses who offered their
services were immigrants, middle-class women especially feared the
consequences of hiring unknown characters of a different "race."8
Prior to the creation of the Metropolitan Board of Health in 1866,
food and beverage manufacturers were virtually free of sanitary
regulations - even in cases where the city government knew of factories
selling tainted products, the blind eye of political reform in the
time period resulted in limited punishment. In his 1861 address
before the New York Sanitary Association, in espousing for the creation
of professional Health Board, John H. Griscom specifically cites
a number of swill milk factories that the existing health commissioners
refused to close because their owners were supporters of Tammany
Hall.9
In 1869, the Metropolitan Board of Health was conscious of the risks
that contaminated food and beverages presented, as well as the risks
of refuse from slaughterhouses poisoning water in congested urban
areas. In its Code of Sanitary Ordinances, Section 40 explicitly
prohibited the sale of food or beverages that are known to be contaminated.
Section 45 banned the presence and slaughter of livestock south
of 40th Street in Manhattan. Section 47 empowered Board of Health
inspectors and police officers in their employ to inspect butchers
and milk dealers to make sure they were adhering to the numerous
sanitary provisions regarding their professions. (Manual of the
Board of Health of the Health Department of the City of New York,
1869) A sanitary inspector with the Metropolitan Board of Health
would have worked to ensure that dairies processing milk be clean
and the milk produced be unadulterated. Nevertheless, as the Board
of Health itself would readily admit, it was limited in the amount
of inspections it could make and did not possess sufficient manpower
to monitor the entirety of the vast city. Political corruption at
the hands of Tammany Hall also played a role in limiting the Board's
effectiveness in addressing the threat posed by contaminated food.10
Until the late 19th century, however, the origins of tubercular
diseases such as scrofula were not known. Despite their best efforts,
no matter how aware municipal health authorities were about the
dangers contaminated milk posed to infants little could be done
to ensure the purity and safety of this vital substance. Indeed,
even if the milk and the dairy in which it was produced appeared
clean and unspoiled to the eye of the inspector, without the scientific
knowledge and ability to test the milk for bacteria, public health
efforts fell short of arresting disease spread by contaminated food. 11
See also: Meehan-Moore
Family
1 Sanitary legislation, past and future,The
value of sanitary reform, and the true principles for its attainment.
Parts of two essays read before the New York Sanitary Association
, October 3d and November 14th, 1861; www.emedicine.com.
2 Ibid.
3 Ibid.
4 Jacqueline Wolf, Don't Kill Your Baby: Public Health and the Decline
of Breastfeeding in the 19th and 20th Centuries (Columbus: Ohio
University Press, 2001).
5 Ibid.
6 Ibid.
7 Rima Apple, "'Advertised by our loving friends': The Infant Formula
Industry and the Creation of New Pharmaceutical Markets, 1870-1910,"
in The Journal of the History of Medicine (Vol. 41, January 1986);
Janet Golden, A Social History of Wet Nursing in America (New York:
Cambridge University Press, 1996); Dorothy L. Jefferson, "Child
Feeing in the United States in the 19th Century," and Alice L. Wood,
"The History of Artificial Feeding of Infants" in Lydia J. Roberts
Award Essays: A Compilation of Essays (Chicago: American Dietetic
Association, 1968).
8 Ibid.
9 John Duffy, A History of Public Health in New York City (New York:
Russell Sage Foundation, 1968).
10 Ibid.
11 Ibid.
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