Episode 6.3: “When was DC its unhealthiest?”

Every day at President Lincoln’s Cottage we engage with visitors in conversation on difficult topics, from grief to slavery to American identity. And occasionally, we get asked a question on a tour that stops us in our tracks – one we wish we could spend a half hour answering. Some of these questions, on their face, were innocent or simple, but on a second look they contain a level of complexity that leaves us wanting to know more.

Thanks to generous donations from our supporters, we created “Q & Abe” – a podcast that investigates real questions from visitors to the Cottage. Come on down the rabbit hole with us as we seek the answers – we always start with Lincoln and the Cottage, but we often end up in unexpected places.

For this episode, we’re talking about a question we got after telling the story of Willie Lincoln’s death from typhoid. Along the way we talk about the sanitary revolution – try washing your dishes!, equity in health resources across the city, and how to even measure what “healthy” means. Come along with us!

In addition to the embedded media player below, you can find the podcast on Apple Podcasts / Spotify /  Google Podcasts or wherever you get podcasts. You also can read below for a transcript of the episode.


6.3 – When was DC its unhealthiest?

Joan Cummins: Every day at President Lincoln’s Cottage we engage with visitors in conversation on difficult topics, from grief to slavery to American identity. Visitors, young and old alike, connect with us from next door and from around the globe.

Callie Hawkins: And occasionally, we get asked a question on a tour that stops us in our tracks, one we wish we could spend a half hour answering. Some of these questions, on their face, seem innocent or simple, but on a second look they contain a level of complexity that leaves us wanting to know more. Each episode, we’ll investigate a single real question a visitor asked us here.

JC: At President Lincoln’s Cottage, we’re storytellers, historians, and truth seekers, so we called on people whose expertise could speak to all the facets of these questions.

CH: I’m Callie Hawkins.

JC: And I’m Joan Cummins. This is Q&Abe. Come on down the rabbit hole with us!

CH: Let’s take that half hour now.

JC: For this episode, we’re exploring the question: “When was DC its unhealthiest?”

CH: Our colleague Paul got this question after telling the story of Willie Lincoln’s death in February of 1862. Both Willie and his younger brother Tad contracted typhoid fever, probably from nearby polluted water sources like the Potomac River. Tad recovered, but Willie died in the White House a few days later, at the age of 11. As part of coping with this tragedy, the family moved out to the Cottage just a few months later.

JC: Before we dig into when it was worse or better, what does it mean to say something is unhealthy anyway?

Dr. Ashesh Patel: So it’s multifaceted. So to say, what is unhealthiness? I guess the first question is, what is health? Because unhealthiness is the opposite of that, right? So, so you have to really determine what is good health and how do you find that? There’s physical health, there’s mental health, and there’s a bunch of other types of things, social health, community health…

JC: Dr. Ashesh Patel is a practicing physician in Dupont Circle and the president of the Medical Society of DC. The Society supports education, community, and advocacy among its physician members.

CH: When we asked Dr. Jim Downs what health meant during the Civil War period, he also had an answer with some unexpected facets. Dr. Downs is a professor at Gettysburg College and the author of Maladies of Empire. He said:

Jim: So that’s a really wonderful and important question because in many ways, ideas of good health were always connected to some type of morality and some type of understanding about their religious character. So, on the most basic level, a lot of times illness reflected a disconnection with God or a punishment from God. But when we think about good health in the 19th century and we think about good health in the 21st century, it’s two entirely different frontiers. So I always explain to my students, you know, in the 19th century, there was no CVS. There was no, um, Rite Aid. There was no place to deal with minor aches, pains, and illnesses and over the counter type of drugs. Of course, there was like a range of health remedies that individual people concocted either in their own home or in their community or with the assistance and help of local healers or midwives. But ultimately, my understanding is that most people accepted various forms of what we would identify as uncomfortable, ill health, pain, as just a natural part of their day.

JC: This got me curious about how the moral component of this mindset would apply to children like Willie. Would we really be saying that sick children were being punished for evil?

JD: Children is a relatively recent invention. Childhood is a recent, relatively, um, recent invention, which is to say that, of course, there were human beings that existed during a certain age frame, but the idea that children were, had a certain stage of development and were different from adults, operated on lots of different levels, but you could see – and you could think about this in terms of like poor children and poor people, and the idea that children were sort of forced to work both in agrarian labor and industrial labor at a very young age, and there wasn’t this idea that their childhood protected them from having to do hard labor at a very young age. But again, when you think of death as a natural part of life, and not as something that could be avoided or accidental or aberrant, it’s folded into a religious understanding. And I think that is applicable to both to people of all, of all ages.

CH: Dr. Downs also reminded us that our understanding of what “a doctor” is would have been very different during the Civil War period.

JD: You know, one of the things to really understand in the 19th century is that most physicians didn’t go to medical school. They were trained through apprenticeship. Those that did actually go to medical school had a very uneven notion of medical education. There wasn’t a universal curriculum where everyone was taking courses in anatomy, for example. I mean that, that – so even if they went to medical school, you couldn’t assume that a doctor in Virginia knew what another doctor who went to medical school knew. So there wasn’t really a code of medical practice, but the general practitioner was part of a larger constellation of people who practice medicine, um, everything from midwives to people who turn to homeopathic remedies to people who turn to botany…

JC: We wanted to hear from someone who DID actually go to medical school about the health problems the Lincolns and the rest of DC faced during the war. We asked Dr. Patel to explain typhoid to us in more detail.

AP: Typhoid again is food and water based. It is a, uh, bacteria, contaminates water and food, it’s called a fecal oral transmission, which basically it’s not a very pleasant way of thinking about it, but basically it’s a contaminated poop that you get in contact with either by drinking water, water that you use for washing, or food that’s contaminated. Why not now? Because of the sanitation we talked about, there’s better sanitation methods nowadays versus, uh, versus 18th and 19th centuries. So that type of disease is much less common nowadays – at least in the US, it mostly occurs from travel. The most common places in the world are South Asia – India, Pakistan, Bangladesh –  but also other parts of Asia, other parts of Africa, are places where you can get typhoid. So there’s symptoms, of course, you know, fever, weakness, headaches, diarrhea, things that obviously wouldn’t make you want to go see a doctor. And of course, you go see a doctor, you can get tested for typhoid, there’s a stool test and other tests for typhoid. And yes, absolutely, there are treatments for typhoid. It’s antibiotics, because it’s the bacteria that causes it. Mild symptoms are treated with one type of antibiotic, severe symptoms are treated with a different type of antibiotic. Sometimes hospitalization is required, but it rarely, very rarely, kills people in this country, because it can be treated easily and diagnosed quickly.

CH: When I’ve explained Willie’s death to school groups in the past, the kids often want to make sure that typhoid isn’t a danger to them. It was important to be clear that we now have medicine that helps us treat this disease.

JC: Dr. Downs said that, although folks in the Civil War period didn’t know about bacteria – germ theory was developed in the 1880s – they did understand that sanitation could affect disease transmission.

JD: And this is the point that I don’t want to miss is they underscored the importance of sanitation. Now, sanitation in lots of ways could help to improve issues like typhoid or cholera, and things like smallpox, they would engage in practices of quarantine – which if I would say quarantine in 2018 or 2017, your audience would have, really very few would have a clear idea of what quarantine is. But now that we’ve all lived through COVID, we all understand the, the significance and efficacy of isolating people who are sick. And that’s, you know, everything from standing six feet apart, like, you can see this in records in the 19th century where they’re saying, like, they actually use the same rubric of standing six feet apart, which is fascinating. Oone of the things that they do, that they do that is efficacious is they enquarantine those who are infected with a virus, and when they isolate a person with a virus, they are able to somewhat control the spread of it, and they’re able to limit infection. Now, if something is caused by bacteria, that becomes much more problematic because they haven’t sort of understood it. And some of the sanitary practices can ameliorate particular situations, but it doesn’t necessarily offer an absolute cure. By 1866, you can see records by the federal government in places like Washington, D. C., who are sending messages out to, uh, military physicians stationed throughout the United States saying, “be careful of the water.” They’ve even developed various chemicals to purify it. So clearly there’s an understanding – now they can’t see, they don’t know if cholera exists in the water or not. But the most important thing is that epidemiologists are now creating a unified set of methods to help prevent the spread of disease.

CH: Dr. Patel mentioned this work restructuring medicine too, when we asked him what about the history of the field is useful to him in his medical practice today.

AP: So the history of medicine is important so far as that you have to know that the way medicine progresses is that you just don’t dismiss things out of hand. You try to, you know, through scientific knowledge, make theories, and then prove those theories scientifically, and that’s the ever-evolving process of medicine. You learn from all the mistakes that happened in the past and, yeah, I mean, I guess the evolution of medicine, the evolution of medical technology is that you see what we call bad health, which, yes, is better called mistakes, I guess, nowadays, um, and we just progressed from that. So, the Civil War was such a, so many people were, um, were injured that they had to have a mass, um, a mass plan for medicine. So the, the  modern system of hospitals kind of developed after the Civil Different fields of medicine developed, reconstructive surgery, prosthetics, ENT, neurosurgery, neuroscience, many different fields sort of came out of the Civil War experience, a more regimented system of care.

JC: As a historian focusing on epidemiology, Dr. Downs told us more about how the war helped create systems for healthcare that are still in place today.

JD: Think about what the Civil War does. The Civil War unleashes a huge bureaucracy in which the military is engaged in this task of keeping very elaborate records about the cause of disease, because this is part of their understanding of trying to keep a healthy military. But also just think about it, an epidemiological perspective. If you had a doctor in Boston and another doctor in Boston, how are these doctors communicating? Well, they could have been part of a society that could have met every now and again. They could have been reading some of the same journals, but there’s very few at this particular time. They may have written letters to each other, but even in a city like Boston or Washington, D.C. before the Civil War, there wasn’t a bureaucracy that created a network that connected these physicians. The Army does that. And so now you have all of this information flowing from military physicians throughout the United States to a central administrator in Washington, who now has a bird’s eye view of epidemics and disease patterns throughout the United States. The military creates the bureaucracy that provides doctors with an aerial view of disease. That becomes a key technology in the formation of epidemiology.

CH: He said the systems were developing this kind of birds’ eye view, but were also making a fair number of changes on the ground as medicine grew more specialized.

JD: I mean, we know this is true, for surgery and we know this is true even for emergency medicine, like all of these subfields within medicine gain lots of traction and become much more sophisticated, because the scale and scope of medical practice expands dramatically. So they, you know, they, they’re now performing, disproportionately more surgeries than they ever did in private practice, or they’re starting to perform surgeries, or they’re coming up with the most efficacious ways to triage patients during the war because of the number of injured soldiers. That then leads to more sophisticated but more efficient forms of triage after the war. We know that, and lots of historians have sort of talked about that. What I’m interested in is, thinking about what does this mean for epidemics? And what does this mean for studies of disease transmission?

JC: In looking into that question, Dr. Downs has found similar patterns in the Crimean War and other conflicts of expanding European imperialism around the same time.

CH: If you don’t know what the Crimean War is, you’ve probably heard of Florence Nightingale, whose work in nursing and sanitation during this conflict made her famous. American women were working in similar contexts.

JD: The main thing I would say is that it popularizes ideas about sanitation. I think that’s like the easiest understanding, and that’s also true for the Crimean War. It’s women who form the American Sanitary Commission, the U. S. Sanitary Commission, who realized the rates of morbidity and mortality are higher for soldiers who are not dying from battlefield wounds or injuries. And what the Sanitary Commission does is they go into these camps and they say things like, you know, your drinking water should not be the same water that you defecated. And so like boiling water becomes something that’s like a really effective way to, they can’t see the germs, but they’re like, well, we know that if we do this, it does something to the water. And so then it’s just other things like, cleaning utensils. I mean, if you think about this, I mean, especially like lots of people, I don’t know, when you’re really exhausted, do you really want to wash the dishes? And maybe you could justify not doing it and eating off a dirty plate the next day. I’m sure people do it with their coffee pots all the time. But, in the 19th century, the Sanitary Commission was in there washing the coffee pots, washing the utensils, making sure that when you had, like a dead animal corpse, like you just don’t leave it, you know, or you just don’t throw it into the water that you’re drinking from. So really kind of organizing protocols around sanitation.

JC: This seems so obvious to us now, but of course it was important that people weren’t  using the same unwashed fork as the guy who just died if we wanted them to be less likely to get sick! The Sanitary Commission workers took up thinking about these kinds of details while others were busy thinking about supply lines and battle formations and everything else there is to organize during wartime.

CH: The Civil War and its aftermath represented a time of progress for all these different fields, but there were limitations.

Dr. Ayanna Bennett: I will say you, the topic of this podcast did make me think a little bit about the history. Just so many things have happened, and if we had equally distributed those benefits, we would be in a very different place. The sanitary revolution that cleaned up so many places – trust me, cleaned up places where black and brown people lived quite a lot less than it did other places. You know, the nutritional changes, we used to have quite significant malnutrition and starvation in this country and we did a lot to help people understand what to eat. And that did not benefit places where they had really poor access to food, which, frankly, were poor neighborhoods and, and neighborhoods of color. So the benefits aren’t evenly distributed over the decades. So we’ve had 100-plus years of progress that just missed some areas in many ways. So we, we have a lot to do to correct that, and it took us quite a lot to get here.

CH: That’s Dr Ayanna Bennett, who runs DC Health, the contemporary organization responsible for overseeing the city’s health landscape. She described the work her team does like this:

AB: DC Health is the public health department for the city of D.C. It is also the state health department for the state of D.C. So, we are a combination of the functions that both the state and local health departments do in other states. So, that means, um, stuff on the ground, like, getting rid of rats and inspecting restaurants, as well as state level things like, overseeing hospitals and things like that. So we are the conduit of major federal programs that are addressing broad health issues. So the WIC program, for example, which works with pregnant women and young children is run through the Department of Health. The other things we do are more around healthcare access – we provide the school nurses, we help with the health standards and other, other health related things in the school district. We are the quality assurance arm of our hospital oversight, so CMS is the agency that runs Medicaid and Medicare, and we represent them, locally, and we also represent our local laws about healthcare quality.

CH: So, DC Health is managing some of the same concerns as during the Civil War, but there’s also plenty of things that are different now.

JC: Dr. Patel explained what he sees in his contemporary patients, if it’s not typhoid and malaria and gangrene and all that.

AP: Yeah, they’re more chronic, right? So diabetes, obesity, hypertension, cholesterol, I mean, these are things that are lifestyle-based. I mean, there are medications that can help with these things, but it’s generally better diet, better exercise, better sleep can help with these things. Yeah, those are more of a chronic condition. And of course, there’s heart disease and cancer, which are much more harder to deal with, obviously… So, yeah, those are more intransigent, uh, types of things to treat, uh, it’s very difficult to treat those things, whereas infections, assuming you get it diagnosed, and trea –  well yeah, diagnosed quickly enough, yeah, you should be able to fix that. In the chronic disease sphere of illnesses, which we currently are, are having, there’s genetic factors, things you’re born with or things you get from your, your family. And then, yes, lifestyle things that, things that you do that can affect your, your health. And they both play a role.

CH: Dr Bennett thinks about it like this:

AB:  Well, I come from an equity perspective always, and so I don’t spend a lot of time in the average. Lots of places are healthy on average, because they discount the people who are, are not there. And if the gap is wide enough, but the healthy group is big enough, it is very easy to make invisible the problems that exist. So D.C. has many ways in which it needs to be healthier, but my goal for its health is that people have longevity, so long lives of active living, and that that longevity is shared by everyone and that those are healthy years in which people can actually participate in their families, do the things they want to do. So that means, not dying of violence or diseases when you’re young and it means not having chronic diseases to a level that is debilitating when you’re older, or don’t get to be older because of that – so equally long healthy life for everybody. The rates of heart disease are quite a lot higher among African Americans and those deaths are much younger. So we have a life expectancy death as much as you know, 15, 17 years between neighborhoods. And a lot of that is driven by chronic disease differences. People get it younger and worse. African Americans, and to a lesser degree, Latinos are the top of the group, they have it worse than everyone else, even when they do not have that illness in greater numbers.

JC: I wanted to know, was it that we just didn’t have enough resources to help everyone?

AB: We’re a pretty resource-rich area. So it is not all that often supply, but it’s distribution. Our history of segregation, just like everybody else, has determined where resources are. It is very hard to pick up infrastructure and put it somewhere else. And so, we didn’t, for the most part, and so where you have freeways and exposure to toxins is not in Friendship Heights, right? So you just have an infrastructure that, because we’ve concentrated folks with similar problems, we have higher unemployment. For lots of reasons, one of them being quite clearly racism, and if you’ve ever read any research on this, it is really not that debatable anymore. We’ve concentrated all those people in one area, or at least we concentrated their great grandparents, and they’re still there. And so by doing that, we’ve made the people who have the least access to work also have the least access to a grocery store, because it sort of depends on a mixed-income community to support its work. And that is the same as where we decided to put transportation and lots of other things. So there have been many attempts to correct, my agency being in Anacostia for the last week and going forward is one of those attempts to correct. You cannot put, there are not enough programs in the world to get opportunity that an economic base would give you. So, having people go out to lunch and understand the area and all of those things is an economic intervention, which I consider a health intervention frankly. So we, we have some things that we can do. A lot of what is impacting health is not in my hands. So, transportation, pollution, access to food in terms of a grocery store getting built somewhere, all of those things lie in other parts of government or in the private sector. And so getting all those people on board for their role in health and health equity has been, I think, a project of decades at this point, and we’ve had much more movement in the last I would say 5 years, than we’ve had any time before then.

CH: Dr. Patel agreed that access was an issue even with his patients in Dupont Circle, which is one of the more affluent neighborhoods in Washington, DC.

AP: That is a very big topic in the field of medicine, absolutely. And that’s a very big topic in health care policy nowadays, actually, is access to care. Like, how do we get patients who need the care get the access to it? Like if they’re too poor to get it, how do we get them to go places where they can get it? Or how do we get the people who give the care to go to the places where they live to give the care?  Absolutely. If they don’t have good access to food, good access to good water, good access to healthcare, then their health actually suffers greatly for sure.

CH: Yeah. And I guess access to insurance is another part of that.

AP: Yep, absolutely, yep. I have lots of patients in this category. They pay for health insurance, of course, either self-insurance or employer based. They pay a premium, obviously. But what is the insurance? It’s, they have a copay. Okay, fine, they have a copay, it’s 10 bucks, 20 bucks, that’s no big deal. But then they have a deductible, and the deductible can be like 5000 bucks. So that means if they have to see any doctor anytime during that year, they have to hit 5000 dollars before the insurance kicks in and pays anything else on top of that 5000. So, that’s not great access. I mean, you have insurance, but how good is that insurance if you’re paying for everything up until you hit 5000? So even with insured patients it’s not like they have great access potentially. But, yes, that is a political question, unfortunately, and the health care system and insurance wise in this country is potentially not as good as other countries.

JC: We’ve been talking about external factors that can change a person’s health – but there’s also important internal ones. Even amid political questions like insurance access or Covid regulations by local governments, my experience was that people had very strong feelings about their health and how they wanted to handle it.

CH: We asked Dr. Patel if emotion ever impacts his work with his patients today.

AP: Absolutely, of course. I mean, you tell someone they have diabetes, they don’t want to hear that. Or you tell them they’re obese, they don’t like to hear that. And so, people can get depressed or anxious about certain conditions that they have. And that anxiety or that, that mood can potentially negatively affect the way they treat themselves or how you can treat them or how they care for themselves. So, of course, you want to, if their mood really is negatively affecting their physical health, you want to help with that and address that.

CH: What people are worried about and afraid of changes over time – what do you think would be the worst news you could receive about your health? It’s probably not typhoid.

JC: Dr. Downs talked about what kinds of health problems were “the worst” or the most stigmatized in the 19th century.

JD: The stigma is culturally constructed. So, it would really just depend on the community and that culture. I mean, being pregnant could be stigmatized, you know, having a sexually transmitted infection could be stigmatized. These are all things that are stigmatized in various ways. I mean, there’s a whole history, poignant and depressing history around suicide, which is that, before suicide was seen as a medical illness, it was seen as a result of demonic forces, etc. But then it was also considered a crime. In England in the 17th, 18th century, it was considered a crime in which if the person committed suicide, the family was then considered liable to the state and all of these things. And so that’s a notion of stigma that’s very particular to a specific social context.

CH: He gave us the specific example of smallpox, which leaves your face and skin covered in small, pocked scars.

JD: Like when I was doing my – because I did a lot of research on smallpox during the Civil War, when I was doing – you know, I was like kind of seeing representations in newspaper articles about people who suffer from smallpox and still have the scars on their face. And it operated in two ways. Like, you could look at that from the vantage point of a 19th, you know, from a 21st century person, like, ugh. That’s kind of like, to see someone’s face cover with these kind of pock marks. But then that meant immunity in the 19th century. So actually, the one paper said we would soon have a pitted or poxed aristocracy or something like this. And it was this idea that if you had it, then you had immunity. So we would look at that and say, Oh my gosh, they must have been stigmatized for how they looked. I mean, the, because of all of these, you know, marks on their face, but no, that’s – it was the opposite. Something similar is going on with the hiring of laborers. Like, if you could prove that you, and you can visually prove that you had smallpox, that you had a better chance of getting employed because the argument was, you were then immune to it.

JC: If everything from the environment to your genes to the social pressures around you can change your health, there are so many components and so many different things that can go wrong, how can we be hopeful about approaching this set of challenges?

CH: Dr Bennett says thinking about the history can help. Here’s what she said when we asked her whether things were more unhealthy then or now.

AB: Oh, definitely then. I’m really dedicated to people all getting to be 80 or 90 years old, as many people alive right now will get to do. But at the same time, if you can have three children and not have two of them die, you’re in better shape. So things were very, very bad. So you’ve got poor rural people, poor city people, black people of every income level, all of whom were more subject to the unsanitary conditions that were killing people left and right. More subject to an unsanitary food, so things were violent and dangerous and people got killed at work because things weren’t safe for them. They died in childhood from infections, because the world was not safe and you cut your finger on stuff – so little, little things that would not be – we don’t notice the lack of them now, were really quite dangerous. Lots of infections that almost don’t exist killed scores of people, and the likelihood that you would be able to have a long and healthy adulthood surrounded by other people in your family who did the same was pretty low. It’s still better.

CH: I told Dr. Patel that after our conversation I felt like I could hold my own in a cocktail party full of doctors. Dr. Downs reminded us, though, that it’s not just doctors who advance medical knowledge.

JD: But I think it’s more about the fact that the origin of so much medical knowledge can be pinpointed to this period, and more to the point, we have to think about how that knowledge developed. And that’s what my work is basically saying, it’s that, you know, it often develops as a result of people who are the most marginalized in communities, the most dispossessed, the most subjugated, whose health then provides the opportunity for doctors to study and to advance knowledge. And yet what we end up doing is we elevate the doctor as the sort of key figure and we forget about the other people.

JC: It’s true, they usually name the disease after the doctor who described it and not the people who had it or who helped the doctor figure out its cure.

CH: Dr. Downs had a fascinating example of how this process can work from the history of epidemiology.

JD: What you end up seeing in 1750 is how chemistry helps to inform public health, with the idea that scientists in, throughout Europe are understanding oxygen, they’re discovering oxygen in their laboratories. Now, people since Aristotle, since the beginning of time, understood air was necessary for human survival. But what happens when air – how does air change its quality? The studies of air within laboratories are basically abstract. What’s happening in the 1750s outside of European laboratories? It’s the rise of the transatlantic slave trade. So while European doctors were seeing how air changes quality in laboratories, the violent, sort of brutal treatment of enslaved Africans at the bottom of ships alerted both the surgeons and medical crew on those ships as well as the captains that something was happening to the air at the bottom of the ships. And this is prior to the understanding of ventilation. So all of these people, enslaved Africans, were placed and crammed in the bottom of ships and many of them were suffocating and dying. So what I mentioned in my book, I describe in more detail, is that these physicians returned to London, they reported the fact that air is changing its quality. It then provided the human evidence of what happens to enslaved people. So, slavery then, like war, creates a laboratory on the ships that makes oxygen visible. I mean, this is the part that literally blew my mind – Stephen Hales, a major chemist, begins using data from slave ships in order to prove that his new invention the ventilator works. And so in order to say that it’s actually leading to the promotion and circulation of air, he says… You would have, before, two thirds of people that went from Africa to Charleston would die. This is the one doctor was reporting this in the 1740s, he said, but once they use the ventilator, you could have 360, and when you arrive in Charleston, you would have 357. So they’re using the experience of enslaved Africans to point to the fact that ventilation is necessary because something’s happening in the cramped quarters – and also like, think about it in the 18th and 19th century, where are you getting crowded spaces? You’re getting them in certain poor neighborhoods, you’re getting them in certain hospitals and prisons, but these are dispossessed populations, no one cares. Now that it’s connected to capital, that the enslaved bodies have been commodified, now there’s a concern about that. But then more to the point, and this is the chilling aspect of it. Many of these doctors will write to Hales. Hales will then record this in his treatise to convince his colleagues. They will write the testimonies of enslaved Africans and say, the enslaved Africans rejoice when we turn the ventilators on. The enslaved Africans talk about and appreciate the fact that we can do this. So now the voices of enslaved Africans are being used to promote this technological innovation. And yet when we think about the history of technology, we think about the history of science, they’re often not there. And their bodies, their experiences, their gasping for air actually leads to this major scientific invention. Ventilation is a key protocol in helping to control the spread of infectious disease that originates on slave ships.

CH: I’ll be honest, I have not stopped thinking about this since I first heard if from Dr. Downs. This is a story of incredible impact on how we’re able to safely live our lives today, and it’s a story of erasure and agency. I’ll be thinking about this one for a long time to come.

JC: In our conversation with Dr Bennett, we noted that in some ways, if she and her team have done their best work possible, that work becomes invisible.

AB: You don’t get credit for things that didn’t happen, but that is in fact our job. It is our job to make things not happen. So, um, all the people who did not get COVID don’t have the same sense of miraculousness that, that happened during COVID because they didn’t get it. It wasn’t, I got it and you saved me. That’s what medicine does. On the public health side, fifty things made you not get it, but it doesn’t occur to you – or fifty really hard things had to happen for you to get it in 2022 when there was treatment and a vaccine, and hospitals kind of knew what to do at that point, and not 2020 when nobody knew what the proper care was, there was no kind of medicine and no vaccine, and your chances of dying were a lot higher. So people don’t necessarily go, thank you, public health for that. I tell my staff that our product is trust, so you just trust the world to mostly be a safe place to be. You trust that traffic lights will work and that the cars will stay, but you also trust that the pool is not going to infect you that, if there’s some place where you can get to the water, then it’s not horribly dangerous to touch the water, or if so, they would have put a sign – you trust that we’ve circled you in protections and, you know, those are not without effort. There are many, many places where they don’t have them. And if we suddenly went away, I don’t know that we’d keep all of them.

JC: We were left wondering: what can an ordinary person do to influence the intricate web of interactions that affects public health?

AB: I think that there is a role for almost everyone, there’s a giant role for philanthropy. So anybody who is a donor to anything, the degree to which you get that organization to consider equity in it’s giving and consider health in it’s giving –  you can consider health and still be doing early childhood education or whatever your, your thing is, because there is a health element there and there is an equity element there. I also think that lots of people in this particular town have actual power to do anything. So they are administrators or regulators are in charge of something or advise somebody in charge of something. So the degree to which we focus on health in everything else, we call that a health in all policies approach, that means that considering the impact that your decisions have on the health of people and that may mean where we put the freeway or what we do with the park, eliminating it to create something. Well, maybe that decreases green space in an area where it is not prevalent, that kind of thing.  When I used to give all of these health equity talks around San Francisco, someone at some point would stand up and say, yes, yes, but shouldn’t we really fix poverty or, you know, multi generational problem that no one’s ever fixed. And my answer has always been, Absolutely, you should do that on Saturday. On Monday, you should do whatever is possible in your job, which is something, even if it’s just you ensure that there’s no bias at the front desk and people don’t feel like they’re not welcome, which is 100% health relevant. People don’t use services where they know they’re going to be treated badly and the front desk of many a clinic has probably impacted people’s health in a negative way, but the front desk at other resources, same thing. So it, I really don’t think there’s a role too minor or too distant that doesn’t have some impact. And so I think thinking about what it could be and using your imagination a little bit would be really helpful to all of us.

CH: The very complexity of our society that affects public health problems can also be directed towards their solutions.

JC: I for one found myself exceedingly grateful to Dr. Bennett and her team for the work they do. There are so many things the Lincolns had to worry about that just aren’t even on my radar most of the time.

CH: We want to encourage you to think about: what small action can you take to improve the health of the people around you? How can you lead with compassion and recognize the ways you are interconnected with them?

JC: This episode was produced by me, Joan Cummins, with Callie Hawkins and additional support from the President Lincoln’s Cottage team. Music for Q&Abe was written, performed, and is copyrighted by, Clancy Newman.

CH: Q&Abe is made possible by listeners like you. You can support the show by joining Team Lincoln at lincolncottage.org, where you can also check out our other online and in person programming. If you learned something interesting today, please share this episode with a friend!

JC: To the visitor who asked this question, thanks for helping us think about not only Willie Lincoln but also all the other people who got sick around him.

CH: Comments? Questions?  Write to us at [email protected].

JC: President Lincoln’s Cottage is a home for brave ideas. Stay curious!