Can’t Boil, Won’t Boil: Material Inequality, Information, and Disease Avoidance during a Typhoid Epidemic in Tampere, Finland, in 1916

Abstract

Historical research on urban epidemics has focused on the interaction of diseases with social and spatial gradients, such as class, ethnicity, or neighborhood. Even sophisticated historical studies usually lack data on health-related behavior or health-related perceptions, which modern analysts tend to emphasize. With detailed source material from the Finnish city of Tampere during a typhoid epidemic in 1916, we are able to combine both dimensions and look at how material and social constraints interacted with behavior and knowledge to produce unequal outcomes. We use data on socioeconomic status, location, and physical habitat as well as the self-reported behavior and expressed understandings of transmission mechanisms of the infected people to identify the determinants of some falling ill earlier or later than others. Applying survival analysis to approximately 2,500 cases, we show that disease avoidance behavior was deficient and constrained by physical habitat, regardless of considerable public health campaigning. Behavioral guidelines issued by authorities were sub-optimally communicated, unrealistic, and inadequately followed. Boiling water was hampered by shared kitchens, and access to laundry houses for additional hygiene was uneven. Centralized chemical water purification finally leveled the playing field by socializing the cost of prevention and eliminating key sources of unequal risk.