"All Smell is Disease": Miasma, Sensory Rhetoric, and the Sanitary-Bacteriologic of Visceral Public Health.
In this essay, we interrogate the power of sensory rhetoric to craft what Jenell Johnson (2016) defines as a "visceral public": a public bound by intense, shared feeling over a perceived threat of boundary violations. We argue the visceral configuration of a public is based upon its rhetorical participation in the sensorium; what Debra Hawhee (2015), citing Joseph Dumit, defines as "the sensing package that constitutes our participation in the world" (p. 5). To advance this theoretical amplification, we situate miasmatism--the idea that environmental degeneracy produces bad smells that carry disease--as a historical disease etiology overtaken, but whose logics were never fully displaced, by the insights of germ theory. As a visual and olfactory mode of detecting circulating disease, miasmatic sensory logics were incorporated into germ discoveries to create what David Barnes (2006) names as a public "sanitary-bacteriological-synthesis," allowing miasma to retain cultural resonance despite obsolete scientific underpinnings. This transition is important because it established distinct sensory-based knowledge boundaries between public health experts and non-expert publics; the incomplete displacement of miasmatic thought dissociated germ-oriented, scientific publics from miasmatic-oriented, lay publics.
This essay proceeds as follows: we situate the development of public health practice as a constant epistemological negotiation between experts and lay publics and demonstrate how visceral publics become distinguished by unique forms of visual and olfactory sensory rhetorical engagement. We then introduce sanitary-bacteriological-synthesis by explaining why miasmatism retains resonance before presenting our comparative visual-olfactory rhetorical analysis of two journalistic representations of diseases capturing the public imagination: early 20th century images of "Typhoid Mary" Mallon and stock photography of Brazilian national Tianara Lourenco that circulated during the 2015-2016 Zika outbreak. From an epidemiological standpoint, we select these diseases because of their comparative asymptomaticity. While typhoid fever usually presents symptoms, "Typhoid Mary" Mallon famously did not (Leavitt, 1996). Similarly, when Zika is sexually transmitted, it often does so while infected persons do not display symptoms (CDC, 2017). Viscerally alerting and managing those who might be affected by such asymptomatic diseases requires rhetoric. Each disease required a public rhetorical intervention to symbolize an asymptomatic threat. Each also operated according to a raced, gendered, and classed sanitary-bacteriological-synthesis for defining the victims and perpetrators of disease and thus provoked fear based upon physical and national boundary anxieties. Both Mallon and Lourenco were framed as non-native agents of infection. Mallon operates in metonymic terms to enable Irish immigrants to obtain membership as legitimate "white" Americans, whereas Lourenco operates in synecdochal terms to shore up whiteness by excluding infected, Latinx bodies. We close our essay with a discussion about visceral publics and managing fearful threats in public health rhetoric.
Sensory Knowledge Contestation in Visceral Public Health
Circulating definitions of public health often implicate the shifting
relationship between scientific paradigms, expertise, and lay public knowledge. During the mid-1800s, public health included the spatial interventions of sanitary reform to meet the demands of explosive urban population growth. This period was also accompanied by a significant consolidation of health knowledge into the domain of professional organizations. For example, the American Medical Association legitimized itself by systematically disrupting midwives' experiential knowledge (Lay, 2000). With the development of germ theory in the 1860s, public health initiatives turned toward community health through projects such as widespread vaccination campaigns (World Health Organization [WHO], 1996). During the Progressive Era, scientific and medical experts began to enjoy unprecedented authority in the production of knowledge and administration of health policy. However, experts such as Dr. Ella Flagg Young, who needed to overcome cultural morality constraints when advocating sexual health education, often appealed to lay experience to resonate with audiences (Jensen, 2007). Instead of intervening with the environment or the community, over the course of the 20th century the third phase of public health attended to curative practices. Mid-20th-century academic hospitals privileged scientific and technological treatments of the governing elite over the widespread distribution of healthcare (WHO, 1996, p. 13). In 1996, the WHO (1996) proposed a fourth phase called "the new public health," concentrating on "equitable access to health services as well as related issues concerning the environment, political governance, and social and economic development" (p. 2).
Global public health professionals' focus on vulnerable communities has been scrutinized for its static, empirical conceptualization of community membership (Montgomery & Pool, 2017). If the promotion of collective health and mitigation of disease is a community effort, then questions of who belongs to the community are central and defining. Indeed, retaining the term "community" is problematic because "communities are assumed to preexist the research, to be timeless, and to be a whole" (Montgomery & Pool, 2017, p. 51). In that static formulation, lay knowledge from disenfranchised "communities" are often culturally stereotyped or dismissed.
Without having to rely on the pitfalls of engaging public health with a locus on a potentially exclusionary concept of "community," rhetoricians of health and medicine have theorized publics as both local and vernacular in order to expand what counts as a public as they adopt, resist, and transform expert knowledge from the ground up (Spoel, Harris, & Henwood, 2014). Rhetorical studies of health have intervened into the theory and practices of publics, drawing out the decidedly contingent, dispersed, and civic dimensions of public health. This holds important implications for how public health conceptualizes the bodies of concern and their capacity to influence recalcitrant, expert knowledge. By conceptualizing publics through a rhetorical perspective, public health stakeholders can displace simplified notions of a singular, monolithic public in favor of a more vibrant, participatory model marked by geographically dispersed and self-organized civic concerns (Keranen, 2014). Robin Jensen (2007) argues that there has long been a complex relationship between scientific experts and the public, and that "lay experiences remain crucial to understanding how health operates and how the people understand their relationship to health and the experts that generate that knowledge" (p. 219). Rhetorical scholars have adeptly accounted for how laypeople and those whose health has been positioned at the margins of society absorb, contest, and resist public health efforts (Bennett, 2015; Malkowski, 2014). When considering the bodies of public health, we must account for the mutually constitutive relationship between discursively molded bodies and specific experience of living in one's embodiment (Scott, 2014).
Johnson's (2016) theory of visceral publics merges considerations of publics as constituted by both discursive bodies and contextually locatable embodiment. Describing a mid-20th-century Massachusetts fluoridation controversy, Johnson extends the definition of what counts as historical discourse and argues that the emergence of publics cannot be explained solely by ideological adherence to scientifically sanctioned knowledge. Rather, visceral publics have two pillars: "they emerge from discourse about boundaries and they cohere by means of intense feeling" (Johnson, 2016, p. 2). The human body and anxieties about its boundaries are crucial because a public's "intense feelings cannot be dismissed as a lack of scientific literacy" (p. 14). Importantly, for global public health concerns, visceral publics are relevant when considering fearful negotiations over national boundaries, wherein a "threat is usually imagined in the figure of the faceless stranger" (p. 14). Comparing the visual rhetoric of typhoid and Zika speaks to the threat of both corporeal and national boundary violations: Irish immigrant Mallon brought typhoid fever across national, racial, and class-based boundaries in her role as a cook; Zika communication often appears in airports, tourist destinations, or other porous transitional spaces that structure mobilities and ultimately shape relationships between national boundaries.
Amplifying Johnson, we foreground how sensory rhetoric constitutes a visceral public and legitimates their operative health knowledge. Public health is inherently visceral insofar as public health rhetoric appeals to a contextually situated participation in the sensorium. Hawhee (2015) encourages scholars to consider the sensorium as "a bundle of constitutive, participatory tendrils, [that] may help to [...] think about the connective, participatory dimensions of sensing" (p. 5). The shared sensory experience necessary for the visceral understanding of public health need not encompass corporeal bodies' physical proximity to one another. Rather, rhetoric can draw out and direct the sense perception of individual bodies into a larger formation of a visceral public. Metaphor, synecdoche, and metonymy amalgamate individual sensing bodies into visceral publics because they offer perspective (metaphor), present a manageable, representative experience (synecdoche), or reduce complex experiences to a perceived essence (metonymy) (Burke, 1945/1969). In comparing the early 20th-century reaction to typhoid and contemporary public reaction to Zika, we heed Hawhee and Christa Olson's (2013) call for pan-historiography, or the practice of writing histories across spatial and temporal generational confines to supplement synchronic deep dives into an important rhetorical moment.
Tracing the rhetorics equipping a visceral public with sensory knowledge can prove daunting, especially when engaging with historical materials. First, we cannot assume the sensory rhetorics galvanizing a public within our current contextual configuration would have done so in the early 20th century. Alain Corbin (2005) cautions researchers to avoid denying the historicity balancing the "configuration of the tolerable and intolerable" (p. 130). For example, bathing is a relatively recent phenomenon, rendering Western contemporary olfactory capacities less willing to find body odors tolerable (Bushman & Bushman, 1988). Second, we must also grapple with what Corbin (2005) calls the "transience of evidence," or researchers' inabilities to ever fully recreate a past sensory experience through textual description alone (p. 131). Despite our inability to fully connect a sensory experience to a larger, public emotional transformation, sensory rhetoric remains potent nonetheless; while we can never be absolutely certain whether the document or event served as the cause or "more simply the crystallization" of new visceral rhetorics, their presence nonetheless helps to shape subsequent behavior (Corbin, 2005, p. 135). This matters not only because our sensory encounters can shape our behavior, but also because they can function as affective constitutive rhetoric to viscerally mold the boundaries of a shared national identity (Gruber, 2014). The sensory dimensions of rhetoric constitute the viscerality of public health, especially when the boundaries of expertise are at stake.
This essay examines how the olfactory and visual elements of the sensorium ground what Davide Panagia (2009) calls the '"sensible,' mean[ing] both 'what makes sense' and 'what can be sensed'" (p. 3). For a visceral public uninitiated into technical health expertise, a miasmatic disease explanation largely makes sense because it can be sensed via sight and smell, specifically. Thus, representations of noxious smells and visual decay can warn of a miasmatic presence that must be avoided at the risk of infection. Therefore, although Hawhee (2015) reminds us to consider the sensorium as a totality, not mechanized into discretely intelligible senses, the majority of our investigation centers around the roles of sight and smell pervasive within miasmatic disease etiologies.
Smell has not enjoyed nearly as much scholarly attention as visuality in rhetoric and media studies, likely due to the fleeting nature of olfactory evidence that Corbin (2005) observes. Nevertheless, the human olfactory capacities hold profound power to move individual and collective bodies. Spatial theorist Yi-Fu Tuan (1977) argues, "[o]dors lend character to objects and places, making them distinctive, easier to identify and remember" (p.11). Similarly, Constance Classen, David Howes, and Anthony Synnott (1994) argue olfactory norms constitute power relationships between different social groups across the West. Specifically, olfactory disgust can reduce the sociopolitical ensemble of disease to a private visceral reaction of something to be avoided (Cloud, 2014). For example, in the aftermath of the 2010 Haiti earthquake, Oprah Winfrey implored her viewers to imagine the "smell of decomposing bodies" (Cloud, 2014, p. 48). Olfactory rhetorics are central to disease rhetoric because disgust evoked by "diseased" smells can encourage visceral publics to avoid or demonize bodies visually represented as occupying disgusting spaces.
Circulating visual rhetoric implicating smell is central to the sensory transformation of disease systems. Rhetorical theorists have long accounted for the role of visual rhetorical representation and circulation in constituting, managing, and transforming publics (Finnegan, 2010). While Laurie Gries' (2015) work on visual circulation and virality speaks specifically to a contemporary context marked by rapid circulatory power afforded by new media technologies, her framework still resonates with how historical images of disease and contagious bodies moved through divergent "spatiotemporal flows" such as journalistic representation. While circulation is crucial to understand the spatiotemporal movement of images, examining visual composition, including color, light, and spatial arrangement within images helps to understand the sensory rhetorical appeals operative in cases of epidemic disease (Finnegan, 2010).
Visual rhetorics of smell are a rich analytic reservoir for interrogating the sensorial texture of visceral public health because the visual freezes an olfactory scene. Olfactory rhetoric enthymematically instantiated in an image functions as a public health pedagogy, instructing a visceral public to engage its senses to identify "miasmatic" individuals and remain on guard for their unwelcomed "invasion" (Omaar & de Waal, 1993; Sturken, 1997). Problematic images of disease reinforce preexisting biases and forms of systemic discrimination (Omaar & de Waal, 1993; Sturken, 1997). Taken together, when analyzing visual rhetoric, a consideration of rhetorical olfaction requires a thorough understanding of the contextual anxieties about bad odors and environmental degeneracy circulating at the time.
The historical transition from miasma to germ disease etiologies illuminates how public health has always been visceral, awaiting activation by the sensory rhetoric circulating throughout public culture. This transformation demonstrates how the sensorium has been imbricated in collective disease definition. We next historically contextualize and explicate miasma by positioning its implication in social issues and the construction of health-related moral standing. This moral dimension is crucial to understanding how the social judgments made possible by miasmatism were never fully abdicated, but instead blended into germ theory to create what Barnes (2006) has called a "sanitary-bacteriological-synthesis."
Epidemiological Transformations: Miasma, Germ Theory, and Sanitary-Bacteriological-Synthesis
Miasma has been a part of cultural lexicon since ancient Greece. The OED traces the term to the notion of staining: "to stain, sully, defile." In Miasma: Pollution and Purification in Early Greek Religion, Robert Parker (1983) notes, the mia- prefix refers to a sense of "defilement, the impairment of a thing's form or integrity" (p. 3). Miasma referred to the following features of Greek life: "it makes a person affected ritually impure, and thus unfit to enter a temple: it is contagious: it is dangerous, and this danger is not of a familiar secular origin" (pp. 3-4). Miasma remains tethered to the notion of pollution and impurity, with its presence implying immorality and requiring social isolation for the infected.
Miasma has come to focus on how disease can spread through the olfactory capacities of humans and animals. The OED further defines miasma as "noxious vapour rising from putrescent organic matter, marshland, etc. Also in extended use, formerly believed to be the carrier of various infections." As Barnes (2006) summarizes, "the claim that foul-smelling odors caused emanations that spread disease is quintessential miasmatism" (p. 44). Edwin Chadwick's Report on the Sanitary Condition of the Labouring Population of Great Britain (1842) famously attributed cholera--which Michael McCarthy (1987) argues is a "cousin of typhoid"--to urban miasmas brought on by influences from the industrial revolution (p. 24). Chadwick wrote, "All smell is, if it be intense, immediate acute disease; and eventually we may say that by depressing the system and rendering it susceptible to the action of other causes, all smell is disease" (Halliday, 2001, p. 1469, emphasis added).
While Chadwick's aphorism "all smell is disease" circulated widely, his extended claim revealed miasmas were capable of transgressing the borders of the body, rendering them susceptible to environmental influences. This aligns both with Johnson's (2016) argument about visceral publics constituted through a perceived threat of boundary violation and Brennan's (2004) theory of affective transmission positing that unconscious olfaction "alters the biochemistry and neurology of the subject" (p. 1). Chadwick similarly described affective transmission, stating "smell is disease" because a miasma acts on the body, depresses it, and opens it up to the proximal environmental influences. Germ theory, in contrast, argued the reverse: "fermentation, putrefaction, and infectious disease were caused by specific microbes found in the air and on surfaces" (Magner, 2005, p. 310).
While germ theory began disseminating internationally after 1864, it never fully overtook theories of miasmatism. Despite a rising scientific consensus of germ theory, the two paradigms overlapped because, for lay publics, there was little meaningful difference between diseases caused by microbes and miasmas. Indeed, "for most [19th-century] observers, there was no clear and practical distinction between miasmas and microbes" as the distinction "made no apparent difference in the everyday effort to prevent or cure human disease" (Barnes, 2006, p. 45). Miasma functioned as a ubiquitous, but ephemeral rhetoric that considered threats to collective health in terms of their sensory and spatial characteristics. Miasma remained compelling for it "allowed one to work at the impasse of environmental and biological etiology" whereas "bacteriology insisted it was all just germs" (Lessy, 2008, p. 4).
Despite eventual consensus around the veracity of Pasteur's developments, germ theory has always been haunted by specters of miasmatism, as Barnes (2006) argues in his "sanitary-bacteriological-synthesis" framework:
Sanitary-bacteriological-synthesis brought the common sense cultural appeal and broad applicability of the old knowledge (for example that foul-smelling substances are bad for one's health) into harmony with the specificity and scientific mastery inherent in the new knowledge of microbes. This integration took place through the language of bacteriology, with a persistent overlay of moralizing disgust, and gave rise to a new set of meanings and practices that have shaped the understanding of disease to this day. Although it is now put to use for different diseases and in different settings, the sanitary-bacteriological-synthesis governs responses to infectious disease in the early twenty-first century even more powerfully than it did in 1900. (p. 3)
To explicate this blended theory, Barnes examines two important French public health events: The Great Stinks of 1880 and 1895 where "more than a mere annoyance, the stench that gripped [Paris] between late July and early October of 1880 represented a genuine public menace" (p. 12). While Pasteur was famous for his work with Silk Worms at the time and had inklings of what would eventually become a solidified germ theory, he had not concluded this principle with the utmost certainty. Considering the foul air was articulated to a decline in public health, miasmatic explanations of the Great Stink of 1880 were unsurprisingly the common refrain. By 1895 "all but a few hold outs" were on board with germ theory (Barnes, p. 2). Whereas almost anyone could once smell the purported danger of miasma, germ theory required the lay public to abdicate faith in their own sensory knowledge in favor of faith in the sensory equipment of scientific experts. Yet, miasmatic logics still crept into characterizations of the second Great Stink, demonstrating a more gradual and messy shift between bacteriology and sanitary imperatives.
The narrative capacity of miasmatism has enabled it to retain such a viscerally potent cultural and scholarly trace, even after the miasmatic approach to disease was fully disproven. For instance, contemporary organizational miasma theory describes "a contagious state of pollution--material, psychological, and spiritual--that afflicts all who work in certain organizations that undergo sudden and traumatic transformations" (Gabriel, 2012, p. 1137). Environmental themes also permeate Yiannis Gabriel's understanding of organizational miasma:
[Miasma] is a state of rottenness for which individuals may be responsible [...], but that infects the entire state. A fundamental property of miasma is that it is highly contagious [...]. Once unleashed, the miasma is capable of afflicting everyone. (p. 1145)
This fundamental pollution of the organizational environment cannot be fully traced back to an individual, solidifying miasma as a diffuse, yet dangerous force.
Because miasma and its perceived effects are not always visible (due to asymptomatic carriers, for instance), miasmatic traits are easily inscribed onto the community spaces of which the "other" is a part. Typhoid fever and Zika offer two additional cases to examine how public health imperatives are viscerally marked by the blurring of the disciplinary boundaries between bacterial and miasmatic disease logics. Next, we illustrate how the sanitary-bacteriological-synthesis Barnes discusses is operative in the public frenzy surrounding the case of "Typhoid Mary" Mallon. We follow this section by analyzing the portrayal of Lourenco in contemporary Zika coverage. Although Zika coverage overwhelmingly features infants affected by microcephaly, our juxtaposition of Lourenco (who was frequently featured as the face of Brazilian Zika) with Mallon allows for us to illustrate how poor, ethnic women have been and continue to be understood primarily as vectors of disease transmission as opposed to victims of disease systems in their own right. By situating Mallon and Lourenco in terms of miasmas and germs, each image directs the olfactory imagination of the public toward contagion and population control. Through visual-olfactory rhetorics, Mallon and Lourenco come to viscerally represent what it means for a body and a nation to be healthy or diseased. Both women we examine, in disparate spaces and times, therefore contribute to sensorially grounded U.S. visceral publics based on their respective threats to public health.
"Typhoid Mary" Mallon: Visualizing Miasmas and Germs
Typhoid fever can be traced back to 430 BCE. Comprised of the bacteria e. Salmonili, typhoid attacks the intestines and spreads through bodily contact with infected feces (CDC, 2014). Typhoid decimated the Jamestown colonies between 1607-1624 and killed far more Civil War soldiers than combat wounds (McCarthy, 1987, pp. 53-57). With the disease's lengthy historical record, it has been unsurprisingly associated with miasmatism. Even after germ theory gained popularity in France, many insisted typhoid was of a miasmatic origin. In Bogota, "Colombian doctors showed little interest in the new theory of germ identity of typhoid during the 1880's" (Garcia, 2014, p. 29). Rather, a number of physicians offered a miasmatic explanation, consolidating attention on "besieged cities, in prisons and camps, that is, places where people accumulated" (pp. 31-32). In a true sanitary-bacteriological-synthesis, physicians "mixed the old miasma terminology with germ terminology until the end of the [19th] century" (p. 42). Even with the 1897 Bogota typhoid surge, public health officials relied upon miasmatic explanations.
Rather than assuming that cultural differences kept Colombian health officials from adopting germ theory, we can observe how public health rhetoric during France's Great Stink of 1880 elucidates the blend of miasmatism and germ theory in Pasteur's own backyard. Germs associated with typhoid around 1880 meant "'germ' in the older, more general sense--a seed of disease [...]. This early case provides a clear and straightforward example of how the new germ theory was linked with and integrated into the old etiology of filth and transgression" (Barnes, 2006, p. 203). Despite the increasing hegemony of germ theory, miasmatism retained cultural currency. There is perhaps no better case study to examine miasmatisms obstinacy than in the early 20th century U.S. case of "Typhoid Mary" Mallon.
The name "Typhoid Mary" articulates a history of public health, scientific discovery, cultural memory, racial negotiation, and epidemiology at the beginning of the 20th century. As the first reported North American "healthy" typhoid carrier, Mallon threatened distinctions between sick and healthy bodies and acted as a transitional object for negotiating the theories of germs and miasmas (Leavitt, 1996, p. 14). In transforming Mallon into Typhoid Mary, public health officials created an ethnic, gendered, and classed metonymic understanding of disease transmission. Blurring meaningful distinctions between differences, "[m]etonymy [...] allows us to use one entity to stand for another" (Lakoff & Johnson, 2003, p. 36). This makes it difficult to recognize the entity that has been replaced, as there is no longer any second entity. As such, the metonymic transformation of Mallon into Typhoid Mary threatened to subsume the ethnic, gendered, and classed essence of Irish immigrants writ large, and it operated as a visceral public health pedagogy about corporeal and national boundaries. Olfactory engagement with visual representations of Typhoid Mary enabled this operation. To illustrate this claim, we next examine Mallon's transformation into Typhoid Mary.
Born in Ireland in 1869, Mallon immigrated to the United States as a teenager. Mallon made a name for herself as a talented New York cook who served the city's elite families. By 1907, she had infected around twenty people with typhoid (Leavitt, 1996). The New York City Health Department forcibly retrieved Mallon's fecal samples and isolated her for three years in Health Department custody (Leavitt, 1996). In 1910, Mallon was released from her quarantine provided she never cook again. When health authorities found her cooking in 1915, they returned her to isolation for the rest of her life. By the time Mallon died in 1938, she had been "a special guest of the city of New York" for twenty-six years (Oliver, 1941, p. 266).
Mallon emerged at a kairotic moment in U.S. history when the emerging legitimacy of public health expertise intersected with the significant transformation of American racial politics. According to Marouf Hasian (2000), "At a time when bacteriology needed legitimation and 'public health' sought public recognition, 'Typhoid Mary' was a rhetorical vessel that invited various publics to see the importance of giving medical power to health officials" (p. 128). Simultaneously, the perception of Irish immigrants transitioned from a "looming threat to U.S. civilization and to Anglo-Saxon reproduction" to conditional members of the "American Race" (Roedigger, 2008, p. 137). Sara Josephine Baker (1939/2013), Mallon's physician, could thus view the Irish as simultaneously "incredibly shiftless, [...] wholly lacking in any ambition and dirty to an unbelievable degree" and "altogether charming in their abject helplessness" (p. 57). These exigencies--the medical community's need for public legitimation and the shifting U.S. racial politics--contextualized how Mallon gave bacteriologists the publicity they needed to legitimate themselves. For Priscilla Wald (2008), "accounts of Mallon suggest that ethnicity, class, and occupation, combined with her condition, ensured her transformation into an object of disgust and reprobation in the public-health and medical literature of the period. [....] She seems startlingly typecast for her role in the narrative" (p. 96).
Typhoid Mary's status as a transitional object for miasmatic and bacteriological logics emerged through vivid representations of her contagiousness. In the April 1, 1907 edition of The Evening World, reporters identified Mallon as a "walking typhoid fever factory." A day later, their rival the New York American described Mallon as a "Human Typhoid Germ." The original use of the term was more descriptive than pejorative because doctors and other investigators actually did not know the name of Mallon and used "Typhoid Mary" as a means to refer to a "Mary" who had typhoid. This alter ego eventually transformed Typhoid Mary into an epistemological transitional object for bacteriology (Leavitt, 1996). Typhoid Mary could then become a caricature and container of bacteriology that simultaneously localized and domesticated the germ within her (Gilman, 1988, p. 1).
Even with such headlines that referenced Mallon as a bacteriological entity (for example, a walking typhoid fever factory, a human typhoid germ, a living human culture tube, etc.), newspapers described Typhoid Mary in terms of a sanitary-bacteriological-synthesis. Specifically, they framed typhoid as a miasmatic disease wafting through the city's public spaces. In Mallon's first media portrayals, New York newspapers such as The Evening World ("Woman 'typhoid factory,'" 1907) and The New York American ("Human typhoid germ," 1907) characterized typhoid--and by extension Typhoid Mary--through both miasmatic and bacteriological logics.
In June of 1909, around the same time as Mallon's first plea for release from quarantine, the New York American ("Typhoid Mary," 1909) debuted a memorable illustration of Typhoid Mary (see Figure 1). Mallon's caricature stands in light clothes and an apron as she drops small, egg-sized skulls into a dark skillet. The 1907 and 1909 newspaper articles emphasize moral ambiguity and the lack of agency in Mallon's autonomous process of breathing. In particular, The Evening World's 1907 article specifically addresses her miasmatic elements: "She is immune, though with every breath she takes she draws in and exhales a cloud of dreaded bacilli" ("Woman 'typhoid factory,'" 1907, p. 8). In this context, Mallon is unwittingly a mobile diffuser of contagion--a woman who miasmatically taints every kitchen she occupies. An olfactory representation of typhoid fever as an airborne disease also manifests in the cooking-skulls illustration through the vapors moving from the skillet to Typhoid Mary's mouth or nose (and vice versa). The fumes do not originate from a heated skillet, but from Mallon and the skulls themselves. The miasma moving between Mallon and the skulls viscerally signifies an olfactory danger to the ostensibly healthy Anglo-Saxon bodies viewing the image, reminding them that typhoid threatens the boundaries of their bodies and homes through their domestic workers.
After Mallon's first quarantine, this illustration faded from the popular press, but it resurfaced after public health authorities isolated Mallon for the second time. In the July 11, 1915 Richmond Times, the image reappeared with text vilifying Mallon's "ignorance" and inability to respect public health expertise ("Microbe Carriers," 1915, p. 42). After her second quarantine, the authors direct attention towards Mallon's agential acts of malediction. The accompanying text focuses on her hands dropping skulls into the skillet: "These 'microbe carriers, almost always perfectly healthy themselves, exist by the hundreds. They are the most dangerous when they prepare food. It is then that they unwittingly 'season' with the germs of deadly disease--dropping, indeed, death into the cooking vessels" ("Microbe Carriers," 1915, p. 42). Here, the hands, not the mouth or nose, produce contamination, foregrounding Mallon's spreading of germs. Unlike the autonomous nature of the diaphragm, the hand requires agential movements to drop or spread death. While the image of Mallon remained the same in both articles, the descriptions oscillated between foregrounding miasmas and germs as public health threats.
The endurance of the fumes within the illustration combines--rather than transitions or separates--the miasmatic and germ epidemiological paradigms. Be it through her malevolent, agential fingers or the wafting dangerous air, Mallon's disease infects the corporeal boundaries around her and is thus a threat to be sequestered. As her lifelong quarantine attests, Typhoid Mary is a diffuse contamination and a pointed contagion; she must be removed from the public to ensure collective health. Isolating her on New Brother's Island facilitates miasmatic and bacteriological responses from the visceral public that her figuration constitutes.
Although the language about typhoid transmission shifts over time to more closely align with the disease's contemporary epidemiology, the cooking-skulls illustration recirculates a visual metaphor of contagion in which typhoid contaminates the very air we breathe. The 1915 text does not describe Mallon as a miasma, but her quarantine and the circulation of the 1909 image speaks to her role as a sanitary-bacteriological object. Her synthesized epistemological function manifests through this illustration and changing in-text descriptions. The cooking skulls image presents Typhoid Mary as a transitional figure and personification of a miasmatic microorganism. Like a bacterium, she infects whatever she touches; like a miasma, she sweeps disease from kitchen to kitchen around the city. If one follows the smoke in this image, the origin of the noxious fumes is unclear. So too is the ontology of and response to typhoid fever. Is Typhoid Mary exhaling or inhaling the "bad air"?
Considering early twentieth century racial politics, such a question may not have mattered. At the time, Irish immigrants were one step removed from miasmic conditions and were themselves a miasma to white communities. The Irish were viewed as vying with "the Russian Jews [...] for the distinction of living in the most lurid squalor [...] out of a mixture of discouragement and apparent shiftlessness" (Baker, 1939/2013, p. 70). Typhoid Mary cautioned Anglo Americans and Irish Americans, the latter as conditional Americans. For although Irish immigrants were beginning to be perceived as legitimate members of the "American Race" (Roedigger, 2008), "all forms of media from the period [characterized Irish women servants as] lazy, slovenly, dirty, [and] unskilled (especially at cooking)" (Wald, 2008, p. 97). Likewise, medical description of Mallon "consistently underscores her departure from conventional norms of white femininity, as, again, is consistent with depictions of Irish women servants generally" (Wald, 2008, p. 97).
In this regard, Typhoid Mary became a visceral metonymic caricature of racial anxiety. For Anglo-Saxon Americans, Typhoid Mary served as a reminder of the kind of immigrant one should avoid; for Irish Americans, Typhoid Mary served as a warning against the kind of immigrant one should avoid becoming. Nonetheless, it is precisely because Typhoid Mary operated metonymically (as a potential type of Irish immigrant) as opposed to synecdochally (as a representation of all Irish immigrants) that popular perception remained optimistic of the Irish pulling "themselves up out of the ruck" (Baker, 1939/2013, p. 70). Not all ethnic communities are so fortunate.
Comparing typhoid and Zika illuminates the public health consequences of figuring the miasmatic as a synecdochical representation of the whole. Just as our analysis of typhoid illustrates how germ theory operates as an extension--as opposed to a replacement--of miasmatic theory, the history of Zika illustrates how the gendered, raced, and classed politics of this epidemiological extension operate in contemporary terms.
Zika: Miasmatic Bodies and Infected Innocents
Although identified in 1947, medical interest in Zika remained sporadic until 2013 when a large outbreak occurred in French Polynesia, Easter Island, the Cook Islands, and New Caledonia (Kindhauser et al., 2016). Zika did not emerge as a sustained global concern until Brazil reported the first confirmed case of Zika in the Americas (on May 7, 2015) and a notable increase in newborns with microcephaly, severely small heads, which often hinders brain development (on October 30, 2015) (Kindhauser et al., 2016). Only at this point did the WHO's epidemiological interest in Zika increase from 18 entries (1947 to April 2015) to 68 entries (May 2015 to February 2016 [last updated February 2016]) (Kindhauser et al., 2016). While this accelerated rate of global response seemingly speaks to the previously unknown epidemiological severity of Zika, its prior outbreaks were under-investigated due to its clinical similarity to and frequent co-occurrence with outbreaks of other "mild" flaviviruses, such as Dengue, Chikungunya, and Yellow Fever (Kindhauser et al., 2016). These diseases often manifest in conjunction with Zika precisely because they share the same vector: the Aedes Aegypti mosquito (Pan American Health Organization & WHO, 2015). Zika can also be sexually transmitted, implicating the relational politics of race, gender, and sexual morality into its epidemiological discussions. After Zika was associated with infant microcephaly, the WHO declared Zika to be a Public Health Emergency of International Concern (Kindhauser et al., 2016). This timeline emphasizes how concern about disease is driven by which bodies are considered victims and vectors. Similar to Typhoid Mary, a sensory-driven, sanitary-bacteriological portrait of a Brazilian national, Tianara Lourenco, configures and collapses the relationship between victim and vector, generating visceral publics fearful of Zika and the bodies marked as capable of spreading it.
Focusing on the seemingly innocuous images of Lourenco, next we demonstrate how, just as with Mallon, journalistic representations of poor, non-Western women can activate a visceral public when figured as vectors of disease transmission. Although our interest in Lourenco's images may appear odd when contrasted against the ubiquitous circulation of images of infected infants born with microcephaly, the comparative invisibility of Lourenco warrants our attention precisely because circulation indicates an image has successfully met composition, audience, and formal needs (Smith, 2012, p.84). Our analysis of Typhoid Mary illustrates that the power of modern epidemiology, when filtered through journalistic media, is in its ability to act as a sensory pedagogy for non-expert publics to detect threats. By texturing a space as a miasmatic reservoir of disease and by simultaneously defining a body, behavior, or even population as a germ of disease transmission, sensory-driven health rhetoric is capable of activating visceral public health threats. Mallon's transformation into Typhoid Mary served as a metonymic warning of a specific ethnic essence needing to be sacrificed if the Irish were to fully become members of the white race. In contrast, Lourenco's images circulated in an environment where Latinx communities have long been perceived as always-already infected (Molina, 2011). Hence, Lourenco's relatively unacknowledged circulation vis-a-vis images of microcephalic infants, and in contrast to Mallon's hypervisibility, can be explained by a visual-olfactory instantiation of Lourenco's synecdochical relationship with the problematic history of Latina representation.
Isabel Molina Guzman and Angharad Valdivia (2004) argue that "dominant representations of Latinas and African American women are predominately characterized by an emphasis on the breasts, hips, and buttocks. These body parts function as mixed signifiers of sexual desire and fertility as well as bodily waste and racial contamination" (pp. 211-212). If miasmatism has never fully departed, Latinx corporeal representation as waste clarifies the threat of their bodies spreading disease to Nations and publics anxious about porous boundaries. Each photograph of Lourenco features her wearing only a sports bra and cutoff shorts (see Figure 2).
These images are indicative of the mixed signifiers associated with Latinx representation, for a Google reverse image search (conducted on August 12, 2018) reveals Lourenco's image has circulated beyond Zika-related websites and onto several pornographic and sex trafficking websites. Without even referencing Zika, one non-pornographic website features Lourenco's image for an article on how "the sexual objectification of Brazilian women hurts" (Axelrod, 2017).
Contrasting Lourenco's images to the stock photograph in Fortune's article about a CDC Zika travel warning (Mukherjee, 2016 [see Figure 3]), some of the basic features of miasmatism emerge and deftly blend with germ logics. Unlike the cleanliness of the Fortune photograph--which features full lighting and the subject wearing laundered workplace attire, Lourenco is intricately part of the damp, musty scene (see Figure 2). The poor lighting and uneven contrast renders the space productive of a noxious olfactory atmosphere. Lourenco's body is embedded within the miasmatic environment, indivisible from the scene of abject poverty, and fully subject to the environmental decay surrounding her. Because Zika is also sexually transmitted, Lourenco's body is also intelligible as infectious to sexual partners and future generations of children. Her face, breasts, and stomach are highly contrasted, but the poor lighting casts a long shadow that blends her sexual figure with the abject background. Although no articles identify her as having Zika, Lourenco embodies a sanitary-bacteriological-synthesis engaging rhetorical olfaction to figure her body as both the victim and vector of the Zika virus. While this first image of Lourenco demonstrates the sanitary-bacteriological-synthesis, another Lourenco image amplifies viewers' miasmatic olfactory pedagogy.
On February 2, 2016, The Guardian featured a compilation of images for its article "Zika virus spreads across Americas - in pictures" (Rees-Bloor, 2016). In this photographic series, two images of Lourenco are featured among images of parents holding babies with microcephaly, pregnant women, public health workers spraying mosquito repellant, and pictures of environmental decay. In Figure 4, the long-shot image of Lourenco talking with two boys outside of a home is captioned: "Homes on stilts above the dirty water in Recife. Some of the slum's streets are flooded with sewage" (Rees-Bloor, 2016). Bowing stilts precariously support the dwellings. The dirty water and accumulated sewage below activate the olfactory dimensions of a viewer's sensorium. The opaque visibility of the space under the dwellings appears as an environmental hazard potentially containing countless threats. The anchoring caption instructs a public to be fearful of Zika and people living in the Global South because these spaces flooded with sewage can be visually assessed as smelling bad and endangering the globe.
Lourenco's figuration as synecdoche intertwines with the sanitary-bacteriological-synthesis framework to problematically figure her and other Latinx women of childbearing capacity akin to a miasma of infectious, Zika carrying mosquitos. Zika's asymptomaticity and capacity for unwitting sexual transmission positions women as infectious germs. When brought into conversation with issues of mosquito control in miasmatic environments, the collapse between woman and mosquito is then capable of being projected onto all Latinx women. National Geographic published an article featuring Lourenco's image, which notably reads "Like many of Brazil's estimated 400,000 pregnant women, Tainara Lourenco of Recife can't afford mosquito repellent" (Howard, 2016). If readers missed the significance of this synecdochical collapse, the article clarifies:
The Zika virus is spreading "explosively" across Latin America and the Caribbean, and the city of Recife in northeastern Brazil remains a hotbed. [....] About 80 percent of Zika victims show no symptoms at all, but that's little consolation for Brazil's estimated 400,000 pregnant women. (emphasis added, Howard, 2016, paras. 1-2).
For non-Latinx readers, it would be difficult not to perceive these 400,000 pregnant women--of which Lourenco has become the synecdochical public face--as Zika-infected miasmas emerging from the city of Recife.
Images ostensibly taken to emphasize the medical plight of poor Brazilian women positions them as both victims and vectors. This boundary matters, for the fear of disease often translates to the fear of the diseased. The difference between victim and vector classification is contingent upon racial, sexual, and classed assumptions. Of these, race transforms the "unfortunate victims of a serious disease into active transmitters of deadly germs, thus adding a medicalized dimension to existing nativism" (Molina, 2011, p. 1026). Just as not everyone who is afflicted is infected, so too is the corollary true: not everyone who is unafflicted is uninfected.
Featuring Lourenco's body to represent an infected body (politic) operates as a sanitary-bacteriological-synthesis because she is framed as infected by the stagnant, humid atmosphere conducive to mosquito proliferation. Simultaneously, she is always already infecting due to the combination of her sexualized appearance and her capacity to sexually transmit Zika to others. While viewers cannot smell, taste, or touch the scene, the harsh lighting, uneven contrast, sharp focus, and off-kilter angle of Lourenco's portraits combined with the scenic shots of Lourenco's house and floodwater creates a disconcerting scene and scent of poverty of which Lourenco is the center. Viewers are positioned in a relationship of disgust towards the subject of this visceral spectacle, and consequently the "captured" subject is reduced to a "non-agentive body" (Cloud, 2014, p. 49). The viewer is repositioned as the true victim of the representation (Chouliaraki, 2006).
The disconcerting features of Lourenco's images are not inherent in Lourenco herself nor the scene but rather are byproducts of the photographic framing. As Rakiya Omaar and Alex de Waal (1993) argue in their discussion on the pornography of disaster: "anyone who has watched a Western film crew [...] will know just how much effort it takes to compose the 'right' image." Indeed, Omaar and de Waal's (1993) term "disaster pornography" for understanding the spectacle of suffering is perhaps too appropriate as it pertains to the imagery of Lourenco: a Bing reverse image search for Lourenco standing in her doorway (see Figure 2) produces only pornographic photos as "similar images" (see Figure 5). This is not an accident but rather a byproduct of design: choices about lighting, pose, and framing. (1) So although this representation is real, insofar as the photograph is taken outside of Lourenco's home (Barchfield & Savarese, 2016), the aestheticization of disaster reinforce the themes of tropicalism that haunt Latinx representation (see Molina Guzman & Valdivia, 2004).
If Typhoid Mary served as the archetypal "healthy carrier," Lourenco and Latinx women operate as the archetypal always already infected healthy carrier: 80% may show no symptoms, but their racial, classed, and gendered configuration intersects with sensory rhetoric enough that 100% show sanitary-bacteriological symptoms. Indeed, a February 9, 2016 article by CNN titled "Zika virus: What are the chances I'll get it (and other Q&As)" features images of slums, Lourenco, and other Latinx victims alongside images of the Aedes Aegypti mosquito, the virus, and public health officials attempting to contain the virus's spread (Tinker & LaMotte, 2016). Amongst the 29 photos is one of a woman (not Lourenco) surrounded in mist as "health ministry employees fumigate" the area (Tinker & LaMotte, 2016). No mosquitos are visible--only the woman and the repellant. The sanitary-bacteriological-s ynthesis is complete. Eight-months later, Lourenco's image is used without attribution (on September 8, 2016), for an article by Breitbart News refuting the link between microcephaly and Zika (Berry, 2016). Lacking context, the decision to feature Lourenco's image is puzzling, as the article is primarily about the Zika virus. From the larger perspective of the image's rhetorical circulation, however, it unfortunately makes sense: within the contexts of a sanitary-bacteriological-synthesis, even when the bacteriological threat of disease is minimized, the sanitary threat of the body remains.
Germ theory incompletely displaced miasmic theory not because germ theory rid epidemiology of the socio-symbolic "taint" characteristic of miasma, but rather because sensory rhetorics translate this miasmatic spatial pollution into a public, visceral relationship to the contagion. A sensorially acquired disgust thus becomes socially and epidemiologically justified because the disease is routed through biologics. Modern societies can be at peace with their discrimination because this intolerance is towards the germ, and not the person--except, as our analysis illustrates, the germ both symbolically and biologically replaces the person. Germ theory treats (some) infected individuals as a proxy of disease by discussing these infected outcasts primarily as vectors of disease transmission (Sturken, 1997). Which individuals are portrayed as victims and which are portrayed as vectors is contingent upon the treatment of race, class, gender, and other identity markers in miasmatic terms. This is not because socio-symbolic biases continue to plague modern epidemiology; rather, the success of modern epidemiology is due precisely to this merger of the socio-symbolic with the biologic. Because infection is no longer confined to a particular place (miasma), the "bio-logic" of germ theory necessitates the sociological analysis of the vector: "a living intermediary that carries an agent from a reservoir to a susceptible host" (CDC, 2012, p. 22 [glossary]). Reservoir, vector, host, mode of transmission, susceptibility, each of these fundamental epidemiological terms are as much socio-symbolic as they are biological (cf. CDC, 2012).
Conclusion: Miasmatic Expectations
Miasmatism remains central to the visceral formation of public health practices, even within disparate historical contexts. This argument holds implications for both health historians and contemporary public health practitioners. To define a disease necessitates first considering what causes physical and visceral disease. Because a (fear of) disease is inherently visceral, rhetoric is crucial to any public management of disease. This does not mean historical or modern medicine is mere rhetoric--as if rhetoric was any mere thing--but rather rhetoric is a fundamental part of medicine's method of inquiry and implementation. As Latour (1993) argues, the myth of modernity is predicated on the arbitrary division of the world into human and nonhuman arenas. Medical science portrays racism, sexism, and classism as ideological impurities--socio-symbolic breaches into the scientific system--as opposed to mutually constitutive tendrils of experts and lay publics negotiating the meanings and fears of disease.
In contrast, we have argued that racism, sexism, and classism are embedded within public health practices through visceral sensory engagements with disease rhetoric. Because diseases are biological counterparts to sociological unease, operating on one necessarily means operating on the other. Intensely visceral reactions of disgust can appear to gain scientific legitimacy as rhetoric connects miasma to the threat of contagious ethnic, non-natives, such as Mallon or Lourenco. Hence, modern medicine's desire to illustrate the efficacy of germ theory further inscribes fears rooted in racism, sexism, and classism within the understanding of disease itself. By transfiguring Mallon from person to disease, public health experts, with the assistance of a journalistic medium, flexed biological and sociological power. Mallon embodied the public's fear: a poor, immigrant woman capable of silently infecting upper-class Anglo-Saxon families. Consistent with germ theory, Mallon was figured as a foreign infection. Indeed, Mallon was detrimental to the health of the nation, as germs were detrimental to the health of the body. This metonymic interplay between the two--Mallon as germ, germ as Mallon--meant public health rhetoric raced, classed, and gendered the germ.
The influence of this "socio-logic" of disease continues with the public representation of Zika. If Mallon illustrated how public health was prefigured with miasmatic suspicion of the vector--the raced, classed, and gendered reservoir of disease, whether healthy in appearance or otherwise--Lourenco illustrates the consequences of this miasmatic suspicion. While identification and subsequent policing of Mallon's body was hailed as a victory of modern public health, the miasmatic suspicion governing Lourenco's body illustrates a failure of contemporary public health. Because germ theory translates miasmatic logic from the language of exposure into the language of contagion, disease becomes mobile, intentional, imagined through the senses, and deeply visceral. Mallon's transfiguration resulted in quarantine and was considered a public health success; the germ was extracted from the public body. Lourenco, however, was never "here," and thus no "public" is threatened by her absent presence.
When discourse equates some bodies as vectors of disease transmission, then positioning these individuals vis-a-vis public interests functionally removes their well-being from public health concerns. Mallon was quarantined due to this logic. In contrast, Lourenco was never defined as a part of the public; much like the dangerous vapors of miasma, she is transitory and forgotten. Ironically, Lourenco herself should be included as an in-group member of a visceral public fearful of Zika, as it is never clear if Lourenco is actually infected with Zika; Natasha Rees-Bloor's (2016) report in The Guardian, suggests Lourenco did not have Zika: "she became pregnant at the start of the outbreak and fears catching the virus." Instead, she is positioned as a threat from the Global South. Consistent with the historical representation of "infectious foreigners" (Molina, 2011), the designation excludes her from the range of feeling and resources afforded to those who are constituted as a legitimate member of a visceral public of concerned future parents. Whereas typhoid was controlled at the cost of Mallon, Zika has been forgotten at the cost of Lourenco. Forgetting Lourenco is not a public health accident; Lourenco was always meant to be forgotten, as from the beginning she was meant to serve as an extra operating in the shadows of public health--close enough to serve as a fearful resource of disease, far enough to not prove any real threat of disease transmission. With our memory of Lourenco fading, public health efforts suffer. For example, Zika vaccine trials are at risk due to the decline of public interest (and corresponding funding) (Chen, 2018).
Finally, this essay throws into sharp relief the tensions that have historically existed between public health experts and the lay publics upon which they seek to intervene. As our analysis demonstrates, lay publics have historically and will continue to engage their sensory equipment to make sense of disease and fortify their own corporeal, affiliative, and national boundaries in response. Moreover, media outlets have continued to utilize the sensory rhetoric of miasmatism well after its epidemiological decline. Public health officials should be well aware of how popular journalistic outlets can sustain visceral publics and antiquated disease etiologies like miasmatism through vivid sensory descriptors. While miasmatism is able to intervene in the spatial context within which bodies move, it may also direct sensory perception to regressive public ends. Ultimately, rather than draw a firm boundary between public health experts and the lay publics they serve, experts should take stock of the complex visceral weave--rooted in the human body's sensory capacity--constituting public health strategy and outreach.
EMILY WINDERMAN is assistant professor of Communication Studies at the University of Minnesota, Twin Cities. Her research examines how reproductive health concerns are negotiated through rhetorics of public emotion. Her work has been published in Rhetoric & Public Affairs, International Journal of Communication, Feminist Media Studies, and Communication Quarterly, among others.
ROBERT MEJIA is assistant professor of Communication at North Dakota State University. He researches how the political, economic, social, and cultural logics of race, gender, and class are embedded within and operate through communication technologies. His work has been published in Communication and Critical/Cultural Studies, Critical Studies in Media Communication, New Philosopher, and other outlets.
BRANDON ROGERS is a Ph.D. student in the Communication, Rhetoric, and Digital Media (CRDM) program at North Carolina State University. His research primarily intertwines media studies with critical health studies. In particular, he focuses on how popular media mediate masculinity to the benefit or detriment of men's health.
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(1) We exclude clothing from this equation as a reverse image search of other women photographed in similar clothing but under different conditions (for example, brighter lighting) results in non-pornographic images of women in bathing suits or swimming. Hence, that a Bing reverse image search of Lourenco's image returns only pornographic results is not due to any inherent attribute within Lourenco herself (for example, her choice of clothing) but rather a direct result of the choices made by the photographer (for example, lighting, pose, and framing).
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|Author:||Winderman, Emily; Mejia, Robert; Rogers, Brandon|
|Publication:||Rhetoric of Health & Medicine|
|Date:||Mar 22, 2019|
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