Coercive Intimacy & Contagion:
Epidemiological Blindness, 1880-1940
Late nineteenth‑ and early twentieth‑century epidemics of tuberculosis, typhoid fever, yellow fever, and, by 1918, pandemic influenza unfolded in social worlds where sexual assault was widespread but rarely acknowledged in medical or public health records. Bacteriology and sanitary reform made air, water, and insects newly visible as vectors of disease. At the same time, legal and cultural regimes pushed most rapes into silence or framed them through racialized and moralized scripts that had little to do with the everyday micro‑geographies of exposure. Focusing on the United States from roughly 1880 to 1940, this article argues that the very systems that stabilized respiratory, enteric, and vector‑borne infections as objects of governance also erased a whole class of plausible exposure events: assaults that forced women and girls into close contact with infectious bodies in crowded, unsanitary environments.
Etiology and transmission, 1880–1940
The bacteriological era reshaped etiological thinking in profound ways. In 1882, Robert Koch identified the tubercle bacillus and linked it to tuberculosis. This finding, combined with sputum microscopy and sanatorium regimes, reframed TB as a communicable airborne disease. Clinicians and public health officials emphasized inhalation of droplets from coughing consumptives in shared indoor air as the key route of transmission. Campaigns against spitting, together with architectural ideals of light and ventilation and the expansion of sanatoria, made “house infection” in overcrowded dwellings and workplaces a central trope of early twentieth‑century TB control.
Typhoid fever, associated with Salmonella Typhi, was increasingly understood as an enteric disease spread by contaminated water, milk, and food. Bacteriological testing of municipal water supplies and dairies confirmed the central role of infrastructure. The case of Mary Mallon, “Typhoid Mary,” popularized the asymptomatic carrier who moved between middle‑class households as a cook. Control efforts focused on filtration and chlorination of drinking water, milk inspection, and the surveillance of food handlers and carriers.
Yellow fever, long feared in Atlantic and Gulf ports, underwent etiological redefinition at the turn of the century. Work in Cuba and U.S. Army experiments established Aedes aegypti mosquitoes as the vector. This displaced miasmatic theories and concentrated interventions on mosquito eradication, drainage of standing water, fumigation, and screening. Campaigns in cities such as New Orleans coupled these efforts with broader sanitation drives that exposed the links between urban inequality, environmental management, and disease risk.
The 1918–1919 influenza pandemic, caused by a novel H1N1 strain, brought droplet and aerosol transmission in crowds to the foreground. Public health authorities did not yet know the precise viral agent. They did, however, recognize that influenza spread rapidly through close face‑to‑face contact in public spaces and institutions. Municipalities closed schools, churches, and theaters, banned public gatherings, imposed mask ordinances, and staggered work hours to thin crowds in streetcars and factories. Retrospective analyses show that early and sustained non‑pharmaceutical interventions reduced epidemic peaks and total mortality.
Across these infections, etiological discourse focused on well‑defined mechanisms: airborne droplets and aerosols for tuberculosis and influenza, fecal–oral contamination for typhoid, and mosquito vectors for yellow fever. These diseases were not classified as venereal. That term was reserved for infections such as syphilis and gonorrhea that were explicitly linked to genital contact and were deeply entangled with moral regulation. Yet the same models that foregrounded household cohabitation, water systems, and occupational exposure could, in principle, have encompassed sexual assault as a configuration of close contact. In practice, they did not.
Coercive intimacy and exposure
Placing sexual assault in this etiological field requires close attention to bodily configuration and space. Forced sex involves prolonged, face‑to‑face proximity, heavy breathing, and often shouting or crying. It may also involve kissing or mouth‑to‑mouth contact. These acts typically occurred in small, poorly ventilated rooms in tenements, boarding houses, brothels, or institutional wards. These settings matched almost exactly the environments that TB and influenza campaigns marked as high‑risk for airborne transmission.
If an assailant was actively infectious with pulmonary tuberculosis or influenza, rape can function as an intense exposure event. The victim could not withdraw, turn away, or control the distance from the assailant’s mouth. The mechanism remains respiratory. The specificity lies in the enforced intimacy and the victim’s lack of agency in managing risk. Late nineteenth‑ and early twentieth‑century public health education warned against sharing beds or close stagnant air with consumptives. These campaigns did not extend this logic to the sexual exploitation of women and girls in crowded dwellings and workplaces, even though the underlying physics of droplets and air exchange are the same.
For typhoid and yellow fever, the connection is more ecological than mechanical. Typhoid transmission requires ingestion of contaminated food or water. Yellow fever depends on mosquito bites. Sexual assault does not create new routes for these pathogens. It does, however, often take place in environments where those routes are concentrated. Brothels, port‑side boarding houses, plantation quarters, and migrant labor camps frequently had unsafe drinking water, inadequate sewage, and high mosquito densities. Coercive movement of women and girls into sex work, domestic service, or institutional confinement thus placed them in ecological niches where enteric and vector‑borne risks were elevated, even when genital contact itself did not transmit those infections. Coercion acted as a technology of placement. It determined who slept in which bed, drew from which tap, and lived within which insect ecology. Despite this, medical and public health discourse did not treat sexual assault as epidemiologically salient for these non‑venereal infections. Sexual violence was framed, when it was discussed at all, as a moral, legal, or racial problem rather than as a configuration of exposure to air, water, or insects.
Sexual assault, race, and narrative selection
In the United States between 1900 and 1940, the disjunction between everyday sexual violence and its representation in public discourse was stark. Scholarship on this period shows that most assaults involved known men—fathers, husbands, neighbors, bosses, boarders—who acted in domestic or quasi‑domestic spaces. These ordinary rapes rarely appeared in newspapers or court records. Instead, national attention clustered around sensational cases that affirmed racial and gender hierarchies. Myths of Black men as rapists of white women, melodramatic “white slavery” narratives, and scandals involving elites and showgirls dominated the public imagination.
The “unwritten law” held that white men had a right to avenge the “defilement” of their wives and daughters. That notion supported both individual homicides and collective lynchings, especially in the South. Over time, high‑profile trials from New York to Indianapolis and Honolulu, together with mass‑circulation films and novels, shifted the script. Narratives increasingly questioned women’s credibility and emphasized their alleged culpability for stepping outside prescribed roles. The cultural focus moved from avenging male honor to policing female behavior.
The 1926 case of Italian immigrant teenager Catherine “Kate” De Ninno illustrates how one assault could cross the threshold into visibility while most remained unseen. As a child in a Manhattan apartment, Kate was raped by a boarder, Luigi Fino, when her mother was out. The attack left her unconscious. Her mother expelled Fino but did not report the crime, fearing that a public complaint would ruin her daughter’s reputation. Kate remained silent, even when the rape resulted in pregnancy and childbirth. According to contemporary coverage, a couple adopted the baby, and Kate believed the child had died.
At sixteen, Kate married Rocco De Ninno and moved to Illinois. Fino later sent letters threatening to expose the assault unless the couple paid him. Rocco responded by asking his wife to leave. Kate travelled to Chicago, acquired a gun, returned to New York, and shot Fino on a Bronx street. The case drew national attention. Press coverage framed Kate as a “girl” who killed the man who had “betrayed” her. Prominent figures, including Harry Thaw and Margaret Wilson, supported her. The judge imposed no jail time, stating that the trial itself was punishment enough.
This case condenses many dynamics at the center of this article. The assault involved a known man in a crowded immigrant household. Family silence and reputational fear prevented legal redress. Economic precarity and blackmail shaped Kate’s movement between city and suburb. Public sympathy hinged on scripts of white, youthful, working‑class innocence. And the entire narrative is accessible now primarily because lawyer Dorothy Frooks preserved clippings, photographs, and letters in her own papers, which archivists later processed. The story entered the archive as a by‑product of a lawyer’s self‑documentation, not as a deliberate medical or epidemiological record.
From an epidemiological standpoint, both the ordinary assault and the later actions involved classic TB and influenza risk settings: a crowded tenement apartment with a boarder and interstate travel during an era of dense train and bus networks. Yet none of the coverage or surviving documentation treats the assault as an exposure context for respiratory or enteric disease. The case comes into view as a problem of law, morality, and identity, not as part of the history of contagion.
Record‑keeping and structural invisibility
Medical and public health record‑keeping between 1880 and 1940 expanded dramatically. Hospital case histories, dispensary registers, and sanatorium files adopted standardized formats with fields for diagnosis, symptoms, physical findings, laboratory results, occupation, and address. Narrative elements were brief and aimed to convey “objective” clinical facts. Sexual histories and domestic conflicts appeared only sporadically. When they did, they often used moralizing language such as “immorality,” “vice,” or “prostitution,” which blurred distinctions between consent and coercion.
Public health surveillance systems were designed around infrastructure, environment, and aggregates. Tuberculosis notification laws produced registers that mapped “tuberculous districts” and guided home inspections and sanatorium referrals. Typhoid surveillance traced outbreaks to specific water mains, wells, and dairies. Yellow fever programs tracked ship movements, rainfall, and mosquito indices. Influenza monitoring in 1918–1919 generated weekly death counts, age and sex breakdowns, and time‑series data linked to the timing of school closures and gathering bans.
These apparatuses transformed sickness and death into evidence for waterworks, drainage, mosquito control, and crowd management. They did not include a category for infection likely acquired during rape, nor did they treat sexual coercion as a relevant variable for non‑venereal infections. A young woman who developed tuberculosis after repeated assault by a coughing landlord would appear as a case from a “tuberculous household” or an “overcrowded tenement.” A girl who contracted typhoid while forced into sex work in a brothel with contaminated water would be recorded as one case in a neighborhood cluster traced to a polluted source. A sex worker who died in the 1918 pandemic would register only as a young adult female death in a particular ward.
This pattern reflects structural design rather than random omission. Health institutions were constituted to see certain exposure pathways—crowding, bad water, mosquitoes, factory air—and not others. Sexual assault was relegated to courts, lynch mobs, gossip columns, and private memory. Even when clinicians or inspectors suspected violence behind a woman’s living conditions or symptoms, they had little institutional space and many social disincentives to record that suspicion in official documents.
Reading the archive against its grain
For historians and theorists of disease, this structural invisibility has significant methodological implications. The near absence of explicit case reports linking sexual assault to tuberculosis, typhoid, yellow fever, or influenza infection does not imply that such chains of events were rare. It indicates that record‑keeping conventions and moral regimes made them difficult to name. Reconstructing these intersections requires reading the archive against its grain.
One strategy is to treat social descriptors as markers of placement in gendered risk ecologies. Terms such as “boarder,” “domestic servant,” “factory girl,” or “prostitute” signal positions where sexual exploitation was common but unspoken. Another strategy is to juxtapose clinical and epidemiological sources with legal cases, reform literature, and popular media. This juxtaposition shows how only certain forms of sexual violence were narratable and how those narratives often reinforced racial and gender hierarchies. The De Ninno case is instructive in this regard. It entered the record through press sensationalism and a lawyer’s scrapbook, not through systematic surveillance.
A further layer involves attending to victims’ own etiologies where they survive. Letters, testimonies, and social work notes sometimes link illness and violation in ways that do not map neatly onto bacteriological categories. These accounts nonetheless reflect lived understandings of exposure and harm. They are not substitutes for microbial models. They are, however, crucial for understanding how people in this era experienced the entanglement of coercive intimacy and disease.
Conclusion
Between 1880 and 1940, U.S. public health built powerful tools for seeing and acting on tuberculosis, typhoid fever, yellow fever, and influenza as problems of air, water, insects, and crowds. Those tools were effective on their own terms, yet also selective. By design, they made certain vectors hyper-visible and relegated others—above all, sexual assault—to moral discourse, sensational trial reporting, and structural silence. Ordinary rapes that forced women and girls into intense, repeated proximity with infectious bodies in crowded, unsanitary spaces remained epidemiologically unintelligible. Recognizing this disjuncture does more than add "one more context” to disease history. It invites a rethinking of causality in the history of medicine and the humanities. To understand how non‑sexually transmitted infections moved through late nineteenth ‑ and early twentieth‑century - social worlds, it is necessary to consider not only air, water, and insects; but to consider the coercive intimacies that determined who shared spatial commodities and under what conditions.
The foregoing analysis traces how late nineteenth‑ and early twentieth‑century public health made certain modes of exposure hyper-visible while rendering others effectively unintelligible. It situates tuberculosis, typhoid fever, yellow fever, and pandemic influenza within the bacteriological and infrastructural frameworks that defined “legible” risk—air, water, insects, and crowds—and then asks what happens when sexual assault is treated not as a purely moral or legal problem but as a configuration of coercive intimacy and spatial placement. By reading medical records, epidemiological practices, and sensational trial narratives alongside one another, the discussion argues that ordinary rapes in crowded, unsanitary environments constituted plausible exposure events that existing regimes of etiology were not equipped, or willing, to see.
Questions For Reflection
- How would you map the exposure pathways in one of the four infections discussed (tuberculosis, typhoid, yellow fever, or influenza) if you treated sexual assault as epidemiologically salient rather than morally peripheral? What categories or variables would current, or historical surveillance systems need to add?
- In the De Ninno case, which elements made the assault narratable in the press when most assaults remained invisible? How did race, class, age, and archival contingency shape the fact that we can read this case at all?
- When you encounter standardized medical or public health records from 1880–1940, what kinds of violence or coercion might be present but unnamed? How could you read terms like “immorality,” “vice,” or “prostitution” as possible markers of coercive placement rather than only as moral judgments?
- How does your own understanding of “risk factors” in contemporary epidemics reflect inherited blind spots about gendered violence and coercive intimacy? What would it mean, in present practice, to design data systems that do not treat sexual assault as epidemiologically irrelevant unless an infection is explicitly classified as sexually transmitted?
Further Reading:
Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (1998).
Judith Walzer Leavitt, Typhoid Mary: Captive to the Public’s Health (1996).
Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease
in the United States Since 1880 (1985).
Barron H. Lerner, Contagion and Confinement:
Controlling Tuberculosis along the Skid Road (1998).
Emily K. Abel, Tuberculosis and the Politics of Exclusion:
A History of Public Health and Migration to Los Angeles (2007).
Emily A. K. Cain, “Intimate Invasions: Rape, Public Health,
and the Politics of Venereal Disease in the Early Twentieth Century,”
Journal of the History of Sexuality 23, no. 1 (2014).
Danielle L. McGuire, At the Dark End of the Street:
Black Women, Rape, and Resistance (2010).
Estelle B. Freedman, Redefining Rape:
Sexual Violence in the Era of Suffrage and Segregation (2013).
Samuel K. Roberts Jr., Infectious Fear:
Politics, Disease, and the Health Effects of Segregation (2009).
Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race,
and Hygiene in the Philippines (2006).