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.
During this week in 1862, the Lincolns moved out to the Cottage for the first time. Part of their reason for coming was to find solace in the wake of their son Willie’s death earlier that year. To mark the anniversary, we’re making public our live show from March 2025!
In addition to the embedded media player below, you can find the podcast on Apple Podcasts / Spotify / Stitcher or wherever you get podcasts. You also can read below for a transcript of the episode (coming soon!)
“Was Willie’s death preventable?”
Joan Cummins: Hi everybody! During this week in 1862, the Lincolns moved out to the Cottage for the first time. Part of their reason for coming was to find solace in the wake of their son Willie’s death earlier that year. To mark the anniversary, we thought you might like to hear our live show from March: “Was Willie’s death preventable?” Enjoy! 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. So tonight we’re really honored to be having this conversation. And before we, before Joan introduces, um, our wonderful guests, I wanted to tell you a little bit about where the question came from. When Willie Lincoln died in February of 1862, we know that his death really changed the course and character of his parents’ lives forever. President Lincoln wrote to a colleague, “the blow overwhelmed me,” the blow of Willie’s death really overwhelmed me and Mary Lincoln said to a friend “after his death, everything seems a mockery.” We also know it precipitated their move out to the Cottage. The quiet and cool breezes I think really provided a, a quiet comfort for them, that the White House just couldn’t, couldn’t do. And so we’ve thought for a long time about the Cottage as a place that really nurtured the Lincoln’s broken hearts after the, the experience of, of the death of, of Willie, who actually was the second of their children who died in, in childhood. And we’ve worked hard over the last few years to try and remove some of the stigma of grief, to connect modern grieving families with the Lincolns and with each other in a shared space of, of grief and love. And as I was sharing with our, our speakers, um, earlier about where this question came from, you know, I, I said that in, in the years that we’ve been doing this work, I’ve been asked this question at least a half a dozen times and almost always by children. And, when we think about was Willie’s death preventable?, and when we’ve dug deeper into the subtext of what would make children today ask that question, the thing that kept emerging was, you know, the, the fear from young children today that if a kid my age died of this, can I die from this too? And so we decided to dig a little deeper.
JC: And we’re very excited to be joined today by three experts in things that are not Abraham Lincoln at all: Dr. Alexandra Lorde is the chair of the medicine and Science Division at the National Museum of American History and a curator of the history of medicine. Uh, she has done a bunch of work on the history of medicine, including sex education and Ellis Island and, uh, the history of suicide, and she has done considerable work as the President of the National Council on Public History, so we’re really excited for her to be bringing some of the history of medicine to this conversation. Brian Deer is a British investigative journalist best known for inquiries into the drug industry, medicine and social isss, excuse me, social issues for the Sunday Times. Um, Brian’s book, The Doctor Who Fooled the World, is an exposé on disgraced former Dr.
Andrew Wakefield and his study about the MMR vaccine that made fraudulent connections to autism. And there are, uh, other papers Brian has worked for, including The Guardian, The Daily Telegraph, and The New York Times. And Dr. Matthew Laurens is a pediatric infectious disease specialist who works on malaria, typhoid fever, and other diseases that affect people who live in resource limited settings.
So he’s, uh, at the Center for Vaccine Development at the University of Maryland, Baltimore, and works internationally on vaccinating people against typhoid and some of these other concerns. So, we’re very lucky to have these folks along with us today, and I would kind of like to kick the conversation off by thinking about what we know about the different ways we prevented childhood illness in the past and also how we prevent them in the present. So maybe Lexi, you can tell us a little bit more about the past first.
Alexandra (Lexi) Lord: If we go back into the 19th century, we’d find that people had really different ideas about disease and what caused a disease. Today we know that microorganisms, we think of that when we think of infectious disease. It’s called germ theory, and the idea of germ theory really only begins to emerge around the late
19th century. It’s a really slow process., it begins in the 1860s and then slowly, more and more people begin accepting this idea. So if we went back into the past and into the 19th century, I think the first thing that we’d find is that people had very different ideas about what caused disease, and that obviously shapes how they prevent disease as well. And there were a lot of conflicting ideas about what might cause disease, um, and then obviously how to prevent it. But if we went back, um, really to 1860, really the only disease that we’re able to prevent at this time is smallpox, through a vaccine, the smallpox vaccine. So, a very different idea about disease and disease causation, lots of, uh, theories about what might cause a disease.
JC: Were any of them even close or they’re all kind of, out of left field from a 21st century perspective?
AL: You know, it’s, it’s hard to say – the theories that they developed, they made a great deal of sense. One of the things that they often thought was that dirt caused disease.
And, you know, that kind of makes a sense. We can see, we talk about sterile environments and things like that, so you can see a parallel there. But some of the other ideas that they had, like a miasma, something like a noxious air causing disease that would be radically different from anything that we would endorse today. And all of these ideas existed, you know, sometimes people believed all of these theories at one time, they seem contradictory, but you can find evidence that people endorse multiple, sort of contradictory ideas about where a disease came from. Because they could not and did not know about the microorganisms, it’s sometimes hard for us to say exactly, this person died of typhoid, or this person died of tuberculosis. We are pretty sure that Willie Lincoln probably died of typhoid, but there’s some famous people whom we think died of typhoid, and recently people have said, maybe not – like Queen Victoria’s husband. There’s a lot of debate and discussion that maybe he didn’t die of typhoid because obviously you couldn’t test for it, in the 1860s. But evidence seems to indicate that Willie Lincoln probably did die of typhoid.
CH: So absent, you know, a vaccine or other kinds of medication, what options would there have been for taking care of Willie? Would it have, just have been about and, and may, maybe that’s, you know, something, uh, that’s outside of your, uh, expertise, but I’m, I’m really curious if it would’ve been a matter of just keeping him comfortable or how they might have gone about caring for him.
AL: Well, we don’t know exactly what they would’ve done, but um, they certainly had a fair amount of options – none of those options would’ve been effective. So I, I do wanna underscore that, but there was, for example, a patent medicine industry in America, in which many different patent medicines – they, they weren’t all patented, but they, um, usually did not expose and tell what the ingredients were – and those might have been used. Some of those, uh, medications claimed – they were herbal botanicals – they claimed to cure typhoid, so it’s possible they would’ve used that, but a lot of it would have been simply just carrying and trying to make him comfortable at this time.
JC: And I think it’s for, for me, it’s very interesting that people were like, we don’t, we don’t know what causes the disease, but we do know it’s bad if everyone is dirty and crammed together. And, you know, not clean enough, and that is like mostly true, but also a little bit not true. In terms of the “probably typhoid” designation, is that because of his constellation of symptoms or…?
AL: It’s, yeah, some of the, it’s the symptoms that were described. Contemporary people said at the time that he had typhoid, they also said he had bilious fever, which is a term that was often tied to typhoid. They also said he had intermittent fever, which is usually tied more often to malaria, but these are very vague terms in that period. So again, it would be difficult for us to really pinpoint, but contemporary evidence seems to indicate that it probably was typhoid.
JC: Okay, and Matt, maybe you can tell us a little bit more about what typhoid looks like today when people get it now, like, what happens to them and how do we know they have it or do something about it?
Matt Laurens: In terms of the clinical illness that one would expect if, if one were infected with typhoid, typhoid is mostly spread via contaminated water or contaminated food, so when you ingest that contamination, the bacteria actually make their way to your intestine and they are very adept at going right through the intestines and into the bloodstream. And from there they infect different organs of the body, uh, mostly the, what we call a reticular endothelial system. So that initial infection doesn’t have any symptoms associated with it. No – one doesn’t have fever, you don’t feel crampy, you don’t feel bad. Butit is after the infection of some of those organs, part of the reticular endothelial system, then you get what’s called a secondary bacteremia. And during that secondary bacteremia, the bacteria multiply, then they cause symptoms. And the symptoms can include fever, they can include malaise, just feeling bad, they can cause constipation, they can cause abdominal pain as well, rarely they cause diarrhea, but generally that trajectory takes about 10 to 14 days. So that is, is when you might start to feel the, the signs and symptoms of, of typhoid fever and you develop these really high fevers, which are, are, are generally starting out on the lower range and then they, they gradually would increase. So we call it a stepwise increase in the fever. So most of the time, the symptoms would prompt medical attention for a resource rich setting, but for most areas of the world where typhoid now circulates, there is very limited healthcare and limited capacity to diagnose typhoid.
Therefore it’s a real challenge to get people who are infected both tested and treated, and the treatment is with effective antibiotics. So that, that’s sort of the general trajectory for, for, for clinical typhoid.
JC: What kind of challenges do you face in your efforts to vaccinate people against it?
ML: Sure. So in, in terms of vaccinations, it’s, it’s important to recognize that, that while we’re talking about a historical figure who was likely infected with typhoid, most of the world sort of forgot about typhoid when clean water and hygiene became prevalent in most resource rich settings. Such that, uh, typhoid fever really fell off the minds of most of the industrialized world, except for the occasional visits that some would make to the low resource settings, and that’s where you would go for travel vaccinations. And those travel vaccinations might include a typhoid vaccine to prevent it. So that’s where most of us who live in the United States in similar countries, would have encountered a need for typhoid vaccine. Places where typhoid circulates now, there is just beginning to be a use of a conjugate typhoid vaccine, which was recently recommended by the World Health Organization in 2018, and it, it was recently developed and, and made available. And so the, the challenges with getting the typhoid vaccine to the areas that need it most is that – well, there are multiple challenges. The good thing is that there is a vaccine, it’s highly effective, it only takes a single dose, it’s recommended for children down to six months of age and up to 15 years of age, so it’s heralded as a huge success and it’s highly effective. It’s at least 80% effective in the very first years after you give it. But the challenge is there are many competing health priorities in areas where typhoid exists. So we, you mentioned malaria earlier in, in the podcast, and it’s not just malaria, it’s chikungunya, we’ve heard about dengue outbreaks around the world, there is Ebola. So the areas that are affected by typhoid are resource poor, and they’re constantly hit by infectious disease threat after infectious disease threat. So, getting the political will to appropriate funding that would be necessary to get vaccines into arms is necessary. And that’s often a challenge when you have multiple health threats that you’re dealing with and trying to prioritize. In areas where typhoid circulates and parents know about it, they know that, that, there is this disease called typhoid, and they’ve experienced it or they’ve got friends or family who’ve experienced it, they are very eager to have their families and their children vaccinated to prevent this disease. And they understand the importance of vaccination. In fact, a recent campaign in Burkina Faso, just January of this year, saw children with their parents lined up at five o’clock in the morning at healthcare centers waiting for that vaccine, which is hugely encouraging and, and really says something for the, the, belief that people have in vaccines and the power of vaccines to prevent disease and illness. So those are some of the main challenges, uh, that, that, that, that we encounter. Another major challenge is that, that we often don’t know enough about what we call the “burden of disease.” So how much typhoid there is in a community. When you have so many infectious disease threats and it’s only when you know the burden, then you’ll be able to prioritize which of those burdens are you are, are you going to attack? So, maybe the, the decision makers in different countries might not understand the burden of disease because diagnosing it is so difficult, the laboratories that are needed and the diagnostics that are needed might not be present, so really just having a handle on how many cases of typhoid you have in a community will help to inform how important you prioritize that vaccination for that setting, for that country, and for that region.
JC: And I imagine the challenges – that there are a lot of intertwined challenges of being a resource poor area to begin with. Like maybe folks are worried about typhoid, but they’re also worried about getting enough food or violence or any number of other things that they have to sort through and prioritize in terms of keeping themselves and their families safe.
ML: Absolutely. There are multiple challenges that, that families deal with every day that are really aren’t on our minds in, in the resource rich settings. So, understanding how important it is to keep children healthy and safe is, is a priority for families no matter what setting you are in. And most parents will do everything they can to protect their children, but at the same time, they have to provide for the family. They might be suffering from the effects of climate change with drought and weather changes that might threaten their food security. So, as you say, there are many challenges that, that families deal with who live in areas where typhoid is endemic.
JC: Brian, based on your work, do you think that the anti-vax movement, sort of rhetoric is because people in richer countries have not experienced the disease directly, or do you think there are other things behind it?
Brian Deer: Certainly that’s one of the factors that, um, the major infectious diseases that killed a lot of children in generations past, uh, are not around so much. In large part due to the success of vaccines and also, uh, issues such as water supply and housing being, um, uh, less crowded. But yes, uh, that’s one of the major factors is that, uh, when people are trying to balance what they might see as risk between getting vaccinated or, uh, being exposed to an infectious agent, if they’ve never, never seen and no one’s ever heard of the infectious agent in, in their generation, then uh, they might be drawn towards sort of the kind of anti-vaccine messages – either the very overt ones or what we’ve actually seen in the last couple of days from the new Secretary for Health and Human Services, Secretary Kennedy who, um, was interviewed on Fox News just a couple of days ago, slyly inserting negative commentary on the MMR vaccine, suggesting that “well, it wears off” and, um, uh, “people might want to, uh, consider the risks” and that “the vaccine can cause all the same things as the, um, the virus itself, uh, causes,” which is the first time in 20 years of me looking at this subject, I’ve ever heard anyone say that. So, there are these messages out there and, um, the absence of the disease, uh, makes a big difference. But now across the United States, we are seeing this year’s, uh, crop of measles outbreaks, which as, uh, Secretary Kennedy says do occur every year, but, um, it looks like this may well be a measles year because measles fluctuates from year to year in terms of its, uh, severity and, uh, the number of cases involved. So yes, that is a factor.
JC: And do you feel like, “just think about it a little more” is a different angle than people have taken in the past in terms of work against vaccines?
Brian: Well, that ebbs and flows on a different cycle to the, uh, to the virus. It the, really, in generational terms, there’ve been major, uh, concerns over in the 1970s and 1980s – very few people around, unless they’re quite old, would remember it – there was concerns about an earlier version of the, um, well, what was called the DTP vaccine or DPT vaccine against diphtheria, tetanus, and pertussis. It’s a, it’s a vaccine, which has, uh, changed a great deal since then where, where a story went round originating in the United Kingdom that, uh, it caused brain damage in children, and this did the rounds for many years and then went away when it was, uh, realized that it, uh, wasn’t the case, uh, and that the, uh, issues were caused by other things. And then, from the 1990s, again, beginning in the UK, a scare started to surface, which is now the, the, the dominant one. That the measles component of the measles, mumps and rubella vaccine causes autism, which is really the one that grabs most attention now.
CH: I wanna back up just for just a second. I am not a doctor. [laughs] I will not pretend to know anything about medicine or science really. But I will tell you, during COVID-19 pandemic, I followed the creation of the vaccine like it was the only job that I had. I had the experience of having an infant die, and was – not, not during the pandemic, but a few years before – and was pregnant during the pandemic, as they were sort of puzzling through whether it was safe for pregnant women to, to get the new COVID vaccine. And I, I treated the development of this like it was the most important thing that I had to do, and really wanted to be, uh, wanted to get one as quickly as I could. And so I’m really curious to hear from you all, Brian or, or maybe Matt or Lexi, what does it take to develop a vaccine and how do you go about distributing one?
BD: I think that must be one for Matt.
ML: I can certainly take a stab at it. Happy, happy to hear, uh, your, your additions too, Brian. But vaccine development is, is a very complicated and, and costly endeavor, and it, it’s one that can be highly successful, as we have already highlighted in this program. But it is one that can be a very long road, and one for which vaccine manufacturers might not recover all of the costs that they invest into it, particularly for diseases like typhoid, that, that no longer affect developed and, and industrialized countries. A recent example of a vaccine that was developed was for malaria, the very first malaria vaccine was recommended by the World Health Organization just four years ago in 2021 – that vaccine was about 40 years in the making. And it wasn’t because big names weren’t behind it, it was developed as a partnership between the Walter Reed Army Institute of Research and GlaxoSmithKline. So, despite, uh, many obstacles, this, this vaccine was developed, and it, it’s now being used in many malaria-endemic areas of Sub-Saharan Africa to, to save lives, and, and to promote healthy lives in, in those who are affected by malaria. So it can take quite a long time. You start by looking for a part of the germ or part of the pathogen that actually causes disease, and you use that to train the immune system, even an immune system that’s never seen the disease before, such that when they do encounter the disease, they recognize it and they develop a strong immune response to it. So it prevents the disease altogether, or it prevents the complications of the disease, the death and the disability that can then, that can subsequently occur. So after you develop a potential vaccine, then you test it, generally in, in animals to see if it does produce an immune response and potential protection,
and then you would test it in a very small number of healthy adults to see if it’s safe. And then look to see in a larger number of healthy adults, if it produces an immune response, and then again, if it’s safe and produces that immune response, then you might think about going into what we call vulnerable populations, which would include children, might include pregnant women, the target population where you really want that vaccine to work well and prevent disease and death. And so, as you can see it, it takes a very long time to go through all of these steps and even after you have a vaccine and it shows to be efficacious in that target population, you still have to test in huge numbers to make sure there’s not a very rare side effect that you don’t yet detect.
So that takes multiple years. And, even after a vaccine is licensed and marketed, there is still monitoring for these severe adverse effects. So, so it’s, it’s an ongoing process, and, and it does take investment in time and resources, but when it works, it really works well, and we can really prevent a lot of death and a lot of suffering, uh, thanks to vaccines.
BD: Yeah, I think it’s worth adding there quite a number of different technologies behind vaccines for different diseases. So for example, going back into the days of the, uh, DTP shot, the whooping cough component there was essentially a bacterium that was killed with formalin, and then using that as being the, the basis upon which a response from the immune system was, uh, generated. Then with the measles, that was a, what is called a “live virus.” The viruses are, technically, I’m sure everyone – well, uh, it’s a fact that viruses are never live. But what they mean is, it that it’s a functional virus that has been weakened, in order to include it in the vaccine that the, in this case produces an immune response. I think humans were very lucky with the SARS CoV-2 vaccines, um, in that a lot of the fundamental science was already in progress and tremendous steps forward had already been made before the pandemic was first recognized at the end of 2019 with the first reports from China. So tremendous amount of work had been done, which enabled scientists, uh, to move, uh, very, very quickly, some would, some critics would say suspiciously quickly without realizing how much preparatory work had been done on the, the basic technology involved. And the technologies are very complex and in, in another kind of vaguely related, uh, virus, again, HIV, which like SARS CoV-2 is a, is a, is an RNA based virus, it’s – the technicalities probably aren’t that important – work has been going on on that for decades with absolutely no sign of a, of a breakthrough of a, of a vaccine that would be, um, effective for large populations over a long period of time. So there’s all these different technologies. But broadly, I mean, my attitude towards, uh, vaccines, people say, well, you know, I have, you have you had your, uh, COVID shots? And yes, I have had COVID shots and, uh, I’ve reached that time in life where I have a, um, an influenza shot every year, and hope that they’ve come up with the right recipe for that year that will give the best protection. But I just, I’ve reached the point, that stage in life where I’ve come to the conclusion that, contrary to when I was very young, when I was, uh, very, uh, disparaging and mocking of doctors and spent a lot of time as a journalist investigating doctors and suggesting all sorts of malfeasance and, um, and terrible motives, I’ve come to realize as I get older that, for the most part, playing the percentages, doctors do tend to know more about these kinds of things than the average member of the public, including myself, even though I’ve spent like 25 years on and off looking at, uh, different vaccines. And so I, I broadly take the advice that that’s given. And I think that politicians nowadays would probably be better to take that attitude themselves and, and, and allow people who have spent their lives studying vaccine studies, studying the different technologies and the different opportunities to prevent disease, should pay a lot more regard to them, uh, than, um, some skeptics today seem to think.
JC: hearing you say, Brian, that you feel like you can trust doctors because you’ve, like, you’ve done the checking, you’ve done the extra work to check their
BD: Well I’m saying on, on, on balance, having seen –
JC: Yeah…
BD: …seen my local general practitioner and consultants for one thing or another, more often than not, they’ve been right and I’ve been wrong. And that, um, Dr. Google is a pretty bad guide. Although I did have a, a couple of years ago I had a, had a doctor, I, I had a chest infection and, I went in to see my, uh, GP who, um, who said that a scan had been done and there was a shadow on my lung, and that was the end of the consultation. I went home and looked up “shadow on lung,” on Dr. Google – page after page after page of lung cancer, and I was living in terror for weeks. But uh, broadly, um, I’ve found that, um, they are better placed than I am usually to, uh, point me in the best direction. I’m not saying – I, I, I think blind trust in doctors is, is, uh, is is to be somewhat negligent. But yes, I think that, um, broadly the, the advice – and certainly that’s been true of vaccination in the UK for example, we don’t have mandatory vaccination as the, as the United States sort of broadly does with, with school admission requirements and suchlike, we don’t, don’t have those ’cause we try and leave the patient to, um, have a relationship with their doctor, and build trust that way, so when they get the advice, they broadly take it. And that’s been the way we’ve gone forward over the years, and really rather effectively.
JC: Lexi, you had something to add.
AL: I was just going to say, as a historian of medicine, I always feel that, we don’t always teach or think about the history of medicine, it’s not something you learn, uh, in high school, or even sometimes in college, but if you look at that history of medicine, then you can really see the impact of vaccination over basically 225 years really.
And you can also see what it was like for parents who were worried about their children. My favorite object in our museum is a vaccination card from 1809 that was used with smallpox. And when I originally saw the card, which lists the names of the children who were vaccinated in the town of Milton, I originally thought, well, those must have been children who were orphans, that was much more common back then than it was today, I thought these were the children who were sort of the castoffs, uh, in this society and they were testing the vaccine on them. And we did a little research and we discovered actually these were the children of the elite in the town. The people in the town were so confident in 1809 in the smallpox vaccination that they were willing to put their own children and test the vaccine on their children. And there’s a little saying at the top of the card, it’s written, “he is slain,” and it refers to smallpox. They were saying smallpox is slain. But you can see this throughout history. You see this with the polio vaccine in the United States when it was tested, 600,000 children – their parents volunteered them to be a part of the field trials because their parents feared polio, because they knew polio, and the people in – just as an 1809, they knew smallpox. We don’t know these things anymore in the United States, and that has enabled us to become somewhat careless, I think.
JC: And I really noticed that conversations in the public sphere about keeping kids safe from things or children’s health are more fraught and dramatic than conversations about what adults are doing. Do y’all have insight about – I mean, everybody loves their kids, but like, why would that be a concern more broadly, I guess?
AL: Sort of why parents are more concerned about, uh, vaccination for their child than for themselves getting like an influenza vaccine?
JC: No, like, like why would – obviously I care about my children, but why would I be so worried about children generally? And what’s happening to them, or whether they’re vaccinated or what diseases they’re vulnerable to.
ML: If I could speak to that, I think a big reason is that children have their entire lives ahead of them. So any disease or affliction that affects them early in life can really change their trajectory forever. You know, if, if they do survive the illness, if they do survive the disease, they might continue to have some type of a neurologic disability, some type of a physical disability that will change how they interact with others, how others treat them, how they’re able to function and, and survive, and how they’re able to, uh, choose an occupation and be productive in society. So I think protecting, uh, children against disease is even more imperative because, uh, not only do we see them as innocent and as parents and, and society, we want to protect them, but also that they have a much longer life ahead of them, nd if we can ensure a, a productive and, and, and healthy life from the start, then, then that’s something we should do.
BD: I think also, uh, a purely practical thing is, I think every parent knows that children are tremendous disease magnets. They seem to catch everything all the time, um, from week to week and month to month. So if your child is going to a kindergarten school or whatever, to, uh, and surrounded by other kids, you’re hoping they’re not carrying some terrible infectious disease such as polio, um, so it’s, it makes common sense that everybody really rallies together, pulls together as a community to ensure that everyone is protected. And that’s one of the things that we are beginning to see breaking down a little bit, I think, in a, as we move through, uh, a period in history where people do seem to be becoming more selfish and more self-obsessed and out for themselves and not seeing themselves as being all in it together with, um, with other families. And I think that that tendency, which is occurring, particularly in some parts of the United States and some people tied up with, uh, all kinds of ideas about, um, conspiracy theories and, um, and suspicion, um, about institutions and, um, and doubts towards authority, which although traditionally might have been quite, um, quite a, quite a good thing, now is, um, seeing more and more children exposed to, to risk.
JC: I’m still thinking about Lexi’s point from earlier in terms of the fact that we don’t, people don’t learn a lot about the history of how we got here. Where, I’ve met one person in my entire life who had polio, and I didn’t, I met them after they were sick, right? Like, I’ve never seen a person who was sick with polio. And so I think some of that, like, I’m very biased as a historian, I think it’s important for people to learn about the past, but I think some of that cavalier-ness that you’re describing, Brian, comes from people not really, not really knowing how we got here or what they could be getting themselves into.
BD: I think it may well, some people may well be in for a surprise the way we’re going because when we had, um, our concerns in the UK about, for example, the alleged link between autism and, um, measles vaccination, when that really took off in the 1990s and early 2000s, two things that made a difference, one I’m, I’m proud to say, was a long investigation by me, which, uh, showed that the whole thing had been started off uh, the instigation of lawyers and, um, that the, the research that was done, ultimately, uh, I was able to show was fraudulent and the whole thing had been concocted from the very beginning. That was one of the factors that brought back confidence among the public, um, and particularly the involvement of lawyers. It was almost as though when we first broke that story on the front page of the Sunday Times, that, um, the whole nation suddenly thought, “h, lawyers, now we get it. Now we understand where this thing has come from.” That was one of the factors at work. But another was that we were getting major disease outbreaks and we were starting to get children dying. And that, uh, we found when one of these outbreaks – and we had much worse outbreaks than the one you’re seeing at the moment in, um, in Texas and, um, parts of New Mexico – we had outbreaks where parents were queuing round the block. They were forming up in lines round the block of their, um, of their pediatricians and their doctors to get vaccines. Um, we saw the same in Samoa. There was, um, an outbreak, which, uh, began in late 2019 and was, where 83 people died, overwhelmingly children. And there again, as soon as um, this started to rip through the community, measles started to rip through the community killing children, everybody formed lines to get their shots. And uh, when the vaccine was given out to everybody, then measles went away and the children stopped dying. So, I think, I think there is a, there is a real potential now from this resurgent anti-vaccine movement, which we are seeing across America and indeed around the world, which, as I say, began in, began in the United Kingdom in the 1990s. We are, we are potentially at risk of seeing another factor that brings people back to vaccines, which is, um, death, brain damage, and other forms of suffering of children caused by infectious diseases that needn’t be there. Because measles had already been eliminated from the United States. Um, and eliminated basically means there was no measles in the country that wasn’t coming in from outside the country. So that’s the, the, the, the step just before eradication. But, um, eradication was – in fact, there was a, there was, um, a big celebration by the United, by the WHO in New York, uh, I, I did a whole chapter from my book based around it. Where they were celebrating the great victory, uh, against measles. And, um, within weeks, the anti-vaccine movement had succeeded in, in setting off an outbreak in the Minnesota area. So these diseases will come back unless, um, parents can be, uh, informed and encouraged and led to trust in vaccination, which overall ha, uh, has been, um, a very safe and effective, uh, response to disease.
JC: I have asked our audience members to share some of their questions and they have questions about Willie. I think there’s two components that I want to start with, which is, Lexi, what do we know about Willie that makes us think he had typhoid, and what would they have tried to do about it then? And then, Matt, maybe you can tell us more about what we do about typhoid now.
AL: Right. So there are a lot of reasons why we think Willie had typhoid. As I’ve said, that’s one of the things, one of the descriptions that they said, he seemed to, um, express symptoms. There was at that time a little bit of a better understanding, emerging about what typhoid was. They did not understand really what caused it, at this time, but there’s a growing belief that it’s transmitted by water during this period, slow emergence of this. You can also see evidence of typhoid outbreaks in the army that’s around DC during this area, in the different camps, there are typhoid outbreaks which make it likely that there’s typhoid in the city and in that area. And in the district at the time we think of typhoid. Um, and one of the things that happens, DC actually was a leader in many ways in eradicating typhoid in the early 20th century when they built this wonderful sand filtration plant here for their water system. But toy, typhoid was a common disease in 19th century Washington, DC. IIt also tended to, you know, just rip across the city, going back to the point that someone was making about communities, this impacted rich and poor as well. And I’m sorry there, someone just asked a question, which I think I could answer, but I didn’t see what it was, what was the last question there? That was just flashed across the screen. Sorry.
JC: Um, did others in the White House have typhoid symptoms at the time?
AL: Yeah. One of the reasons that we definitely don’t think that, you know, he had malaria was because his brother seemed to have similar, similar disease and that’s unlikely with malaria, that they would both, um, have an experience, and be expressing symptoms at the same time if it was malaria. So typhoid seems pretty likely, we know it was in the city. Uh, we know it was in the city at that specific time, right down to the months, the descriptions seems to indicate this, and we know that sewage and water systems in the district at this time were really, really poor. So all of those things make it pretty likely that Willie had typhoid. We can’t say it exactly, and as a historian of medicine, I’ve always been taught never go back and diagnose people because you’re not a doctor and you don’t, aren’t doing the tests to confirm that this is typhoid. Matt,
you would probably say yes, you, you don’t really know for sure. But, it does seem highly likely that this is what that was.
ML: Thanks. And the, and the treatments for typhoid are, are, in addition to the supportive care that, that, that Willie likely received, we often, we would give antibiotics. And the appropriate antibiotic therapies are, are many for typhoid fever. So Willie unfortunately was an unusual case in that he died of typhoid. Typhoid, generally, we think, kills about 1% of people who are infected with it. So it’s a very small percentage who actually would die of typhoid. You, you can still suffer from fever and, and recover on your own without antibiotics, but with antibiotics you can completely cure typhoid. There are problems with antibiotics, as many of you have seen in the headlines these days. We, we have multiple antibiotics, many of which would not work for typhoid in areas where it circulates now because of resistance. And the problem of worldwide spread of resistant antimicrobials, uh, or resistant bacteria to antimicrobials is an issue. And it’s further complicated by issues like climate change, by overuse of antibiotics. So things that we can actually affect, and also the fact that very few antibiotics are currently being developed to treat diseases like typhoid because again, they affect resource poor settings in areas where drug companies might not be able to recover the, the funds that they invest in that. So a, a simple course of antibiotics, uh, generally it can be given orally if a patient can’t tolerate antibiotics by mouth, and you can give injections with very common antimicrobials. But again, you would need to know what antibiotics would work best and, and, and that would require testing and characterization of the typhoid that’s circulating in a particular area.
AL: And just to build on what Matt said about like, the fatality rate of, of typhoid, I mean, many of the people that we think about in the 19th century, I think, uh, Louisa May Alcott for example, um, had typhoid and recovered, so there are many people who experienced typhoid and recovered. Willie Lincoln was simply one of the unfortunate individuals. And it, and I think what’s fascinating to me as a historian of medicine about Willie’s death is – who’s more elite than Willie Lincoln? You know, we tend to think of disease as being associated often with, you know, poor people in America.
Willie Lincoln’s getting the best treatment possible. He is living in the best place possible, the White House, you’d think of all places that would be safe, um, it would be the White House. Um, the fact that it’s jumping, as I always say, jumping the class, racial barriers, it, it impacts everyone.
JC: and Tad Lincoln is an example of one of those folks who we, again, we think had typhoid, but who recovered. And I’m sure that complicated how his whole family felt about the situation.
AL: Yeah, I think one of the things that is so powerful and so difficult for us to think about when we think about the 19th century, even more than the 18th century, and obviously more than the 20th century, is so many families would’ve experienced the death of a child. Those of us on this call, many of us would’ve seen a childhood friend or a sibling, um, die. It would’ve been much more common experience for us. And I think that creates a really different society. I think the 19th century understood grief in a way that we have tended not to understand it, as a result, and the complicated feelings that you have when one child dies and another survives.
CH: Lexi, I think that’s such a good point, and it’s a point that we try to make in our, in our grief exhibit, is that, you know, no matter how much more common it was, it does not, that is not indicative of how these people grieved. Um, and I, I think that one of the things that, you know, until I had personal experience and until I really looked deeply at the, at the Lincoln’s experience, did I recognize, you know, I think in many ways how much, uh, better equipped society was then to provide support for grieving people because it was such a common experience. And you know, I think a lot of what we see today is that it’s, you know, grief is incredibly isolating and it’s very, it’s a very lonely experience, because there’s such stigma attached because, especially death in in children, it’s just not something we think should happen today. Um, and I think that that is, you know, is in many, in many senses, a, a privilege that we have come to, you know, sort of live in a, a society or a time when, you know, it’s not as common, and yet it happens all the time.
AL: It happens all the time, and it’s hidden right in the 19th century, we always point to Queen Victoria, oh goodness, you know, she’s always wearing black and mourning and things like that, but there were a series of rituals that helped families to deal with this because it was a common experience and because it was a common experience, people knew, you know, your neighbor suffers the loss of a child, but you, you know, 15 years before, had the same experience, and so you help them through these rituals.
Um, and the rituals were very codified, especially during the 1860s, they go back and for, but during the 1860s, 1870s, very codified rituals of how you deal with the death of a child, a spouse, and at a premature age or anything like that, and I think that’s really different from our society today.
JC: I am thinking a lot about the Lincolns in the White House, worried about an outbreak of disease, living in the chaos of the war and just trying to be themselves all at the same time. And I am, again and again, reminded that, about how glad I am that they had a place like the Cottage to come and take a deep breath sometimes, um, and talk to each other and deal with their experiences and to have a chance to be the people that they were busy being during that time. We always hope that other people who connect with the Cottage also have a moment to themselves to find some respite amid whatever’s happening to them, whether it’s a very personal experience or whether it’s, you know, the, everything of everything that you are working to, uh, manage for yourself.
AL: Yeah, someone was saying Mary Lincoln gets a very bad rap. Um, and I, I think that’s true. I think Victoria does too. I mentioned her husband and the question of whether he died of typhoid or not, but, you know, 10 years to the day that her husband died, her son – and he did have typhoid, clearly – he went, he experienced typhoid, he passed through a crisis the same night that her husband had died. So 10 years to the day, she’s at another deathbed, potential deathbed of a, one of her children now from typhoid. We can’t imagine what that’s like today. We, we’re, many of us are so fortunate not to have these kinds of experiences, um, and they do have a very dramatic impact on your mental health. So yeah, I, I think sometimes when, yes, Mary Lincoln is a perfect example, Queen Victoria is a perfect example, when you look at their lives, I think it’s really difficult to understand what they were experiencing.
JC : I think we have one more question from Roberta that’s sort of a factual question, nd then I know Callie, you have some questions for everybody. Roberta would like to know whether Willie might have had a secondary infection as well as typhoid.
AL: I think Matt could answer that better…
ML: Thanks. You might be able to provide some historical input as well, uh Lexi. Um, so yes, it’s possible to have a secondary infection from typhoid. One of the severe consequences of typhoid that often is a cause for death in, in cases where death does occur, is typhoid intestinal perforation. And that’s where you get such intense inflammation at the end of your small intestines that the intestinal contents actually burst inside of your abdomen. And then the bacteria that are normally closed off from the rest of your body by your intestines now can invade your bloodstream and cause secondary infections. And that’s what actually is happening in, in many typhoid endemic areas of the world because typhoid isn’t recognized, it’s not diagnosed, it’s not treated with antibiotics. And these secondary complications develop and, and children, if they do survive then and they do make it to surgery, then they often, uh, have severe consequences. So yes, secondary infection is a possibility.
CH: Thank you and thank you all as, as we’re sort of moving to the end of the program, I just wanted to ask our guests if there’s anything that you’d like to contribute to this question that we didn’t ask you. As we’re, as we’re thinking about sort of making sense of, of the question, both historically and, and in our own lives.
AL: I think what’s, to me fascinating about this question when you asked it is, you know, you think to yourself, well, the answer, it really depends on when Willie Lincoln was living. You know, this question of was, was his death preventable? And in some ways, it’s, it’s 1905 that DC opens the, um, water filtration plant that makes the water in DC um, much safer, but they actually had a typhoid outbreak in 1906 and 1907 –
it was not related to water, it was related to milk, contaminated milk – but you, so you think to yourself, well, if Willie had just been living, you know, 50 years later, his story would’ve been very, very different.
ML: Thanks. Just to add to that and, and, and to bring the, the context of, of today, uh, what, what Willie can bring to it for all of us. And when we think about health equity and think about families around the world that are still at risk of losing a child from typhoid, this is still very real in many of these communities. And while it’s not in our communities here, thanks to safe water and safe food supply, these communities still suffer. And if we have ways that we can address health equity, whether it’s through activities, uh, to combat the effects of climate change, to help with appropriate antimicrobial use in areas where typhoid exists and to completely prevent typhoid through vaccination, these are all activities that, that we can think about, to prevent, uh, uh, recurrence of, of what happened to Willie to other families.
CH: Thank you. If you’re new to, to Q&Abe, uh, to our podcast, we like to close, uh, each episode with some community questions. And so we, this evening would like to encourage you to think about what is your responsibility to the health of your community? What makes a community healthy in the first place? And what problem do you want to consign to the history books?
JC: Again, if you would like to hear more from the show, you can find that on our website at lincolncottage.org. I want to shout out the sm, the small children who have asked us this question for prompting this incredible discussion, and I want to thank Lexi and Brian and Matt once more for bringing their expertise and helping us understand it a little more deeply.
CH: You can support us by becoming a member, by visiting the Cottage, and I highly encourage you all if you haven’t to come and see, uh, our exhibit called Reflections on Grief and Child Loss that’s open in our Visitor Education Center.
JC: President Lincoln’s Cottage is a home for brave ideas. Stay curious!
