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Cholera was the classic epidemic disease of the nineteenth century, as the plague had been for the fourteenth. Its defeat was a reflection not only of progress in medical knowledge but of enduring changes in American social thought. Rosenberg has focused his study on New York City, the most highly developed center of this new society. Carefully documented, full of descriptive detail, yet written with an urgent sense of the drama of the epidemic years, this narrative is as absorbing for general audiences as it is for the medical historian. In a new Afterword, Rosenberg discusses changes in historical method and concerns since the original publication of The Cholera Years.
"A major work of interpretation of medical and social thought . . . this volume is also to be commended for its skillful, absorbing presentation of the background and the effects of this dread disease."—I.B. Cohen, New York Times
"The Cholera Years is a masterful analysis of the moral and social interest attached to epidemic disease, providing generally applicable insights into how the connections between social change, changes in knowledge and changes in technical practice may be conceived."—Steven Shapin, Times Literary Supplement
"In a way that is all too rarely done, Rosenberg has skillfully interwoven medical, social, and intellectual history to show how medicine and society interacted and changed during the 19th century. The history of medicine here takes its rightful place in the tapestry of human history."—John B. Blake, Science
THE EPIDEMIC: 1832
It had been an unhealthy winter and the dry spring promised a sickly summer. But New York, a vigorous city of almost a quarter of a million, had other concerns in the spring of 1832. She was the greatest port of the continent, one of the greatest in the world, and her leaders were busy at wharves and in counting rooms ensuring her continued eminence. It was an election year, and the readers of New York's score of newspapers were not allowed to forget the Indian troubles, the tariff controversy, or the bank question.
Like Boston, Philadelphia, and Baltimore, New York was a city which faced Europe, and there was disquieting news from across the Atlantic. Cholera had broken out in England; a cordon sanitaire—enforced by heavily armed troops—had failed to halt the spread of the disease westward from Poland and Russia. Quarantine restrictions seemed to be of no avail, and as the summer of 1831 approached, it appeared more than likely that America, like Russia, France, and England, would be visited by this newest judgment. Only the Atlantic Ocean continued to protect the United States.
This, the first invasion of Europe by cholera, had not gone unnoticed in America. Throughout the fall and winter of 1831–32, newspapers, magazines, and pamphlets reported in alarming detail its westward spread. Most dismaying, because most dispassionate, were the reports of the French and English medical commissions sent to study the disease in Russia and Poland. American medical men turned to the treatises of East India Company physicians, familiar for decades with this pestilence new to the medical world of Europe, in hopes of finding some remedy. By July of 1832, it seemed questionable whether a single periodical had appeared in the past six months without "something on this all engrossing subject."
Private citizens were not alone in their concern. On September 6, 1831, the New York City Board of Health had resolved that three of the city's most prominent physicians be requested to form a committee of correspondence to gather information. In January, Martin Van Buren, minister to the Court of St. James, began sending home reports of the epidemic which had just broken out in Sunderland. In February, the Massachusetts Medical Society appointed a committee of seven to study the history of the disease in an attempt to discover how it might best be treated and whether or not it was contagious.
Collecting information could not alone prevent disease. Stringent quarantines were immediately invoked against Europe's cholera-ridden ports. In the past, restrictions had been applied only during the summer months. But cholera, unlike yellow fever, seemed to show no preference for warm climates, and quarantine regulations were maintained in America's Atlantic ports throughout the winter of 1831–32. As early as September 17, 1831, Mayor Walter Bowne of New York announced that he had made arrangements for a special depot for quarantined goods. Boston, Philadelphia, Charleston, and Baltimore soon followed suit, quarantining all goods and passengers from infected ports in Russia and the Baltic. The British Isles were added to the interdicted areas as soon as it became known that cholera had made its appearance in England.
With the spring of 1832 and the recrudescence of the epidemic in Europe, only the most sanguine remained confident that America would continue to be spared. It was, in the words of one editor, "not only absurd but morally wrong for any man to assert" that cholera would not appear in the United States. Our exemption "would imply little less than a miracle in our behalf," for American commerce with infected ports continued unabated. Even the common folk began to sense omens. All that year, one Washingtonian recalled: "The Sun Rised and Set Red ... and two Black Spots could be discovered disstint in the Sun."
But Americans were not without consolation. Cholera did not attack all, nor did it seem to be an arbitrary imposition of God. It was subject to natural laws and acted through second causes, attacking only those who had somehow weakened or "predisposed" themselves. Filth, misery, vice, and poverty conspired to produce its unfortunate victims. Few such could be found in a land enjoying those unique blessings granted the United States. The healthy farmers and sturdy mechanics of the United States could, Americans believed, never provide such hecatombs of victims as cholera had claimed from among the pagans, Moslems, and papists of Europe and the East. America had no class to compare with the miserable slumdwellers of Paris and London or with the brutalized serfs of Nicholas'Russia. Even New England mill hands were as well fed and clothed as any class in the world, their habits perfectly regular and temperate. "With clean persons and clean consciences," Americans were prepared to meet the disease without trembling.
Americans, as they readily acknowledged, were the best educated, the freest, and the most pious of people. No established clergy battened upon them; here, "where reason is free to combat error," the printed word enjoyed its greatest influence. Americans would never lose heart, they reassured themselves, become panic stricken, and like the Paris mob, loot and murder when assailed by the disease. English by inheritance, North Americans could be expected to behave calmly and with valor. An unwavering faith in Christ was a bulwark even more secure. The history of cholera seemed to demonstrate clearly that those countries with fewest Christians had been scourged most severely. America's chastisement would certainly be light, the pious hopefully predicted, for fully one half of the world's evangelical Christians lived within her boundaries.
It did not seem, moreover, that a nation predominately rural could be severely tried. Only in the densely populated cities of the Old World had cholera raged uncontrolled. Rural communities were assured that their pure atmosphere, uncrowded streets, and isolation guaranteed exemption from the disease. Even America's great eastern cities seemed cleaner and their inhabitants of better character than their counterparts in Europe. Boston, in particular, prided herself on the cleanliness, the virtue, the regularity and morality of her citizens. Where, as a Congregational sermonist put it, "on the wide earth is there another to be compared with it in point of cleanliness, health, comfort, intelligence, morals, and most of those things which minister to human happiness and improvement."
Nevertheless, few pious Americans dared deny that their nation, despite the great favors granted it by the Lord, still harbored a great many of the sinful and vicious—more than enough to provoke divine judgment. New York seemed especially vulnerable, the largest and filthiest, the most crowded and vice-disfigured of American cities.
Apprehensive New Yorkers took stock of their city and were not reassured by what they saw and smelled. New York was dirty, and dirt seemed to breed disease—not only cholera, but yellow fever, malaria, and every other sort of pestilence. Boston and Philadelphia seemed immaculate country villages by comparison.
The thousands of swine that roamed its streets were the city's shame, but, nevertheless, its only efficient scavengers. The indifference of the Common Council to the problem of sanitation almost necessitated the lenience, if not affection, with which the pigs were treated. Ordinances to control them were passed from time to time, but never enforced. Respectable folk were continually exasperated by the sight of the beasts, some even threatening to shoot them on sight.
Pigs, goats, and dogs did not provide the only street cleaning apparatus. Citizens were required by law to sweep in front of their houses on certain specified days. Dust and rubbish were to be gathered into a pile in the middle of the gutter from which place they were to be collected by the municipality. An item of Tammany graft or inefficiency, this collection was usually neglected; and appropriately, the decomposing mass of filth which adorned the middle of the streets was called "corporation pie" (New Yorkers, it should be noted, ordinarily referred to their municipal government as the Corporation). In any case, most informed citizens agreed, the streets could never be cleaned properly unless an adequate supply of water was introduced into the city.
Four decades of agitation for a municipal water system had failed to bring results. Few travelers failed to comment on the poor quality of New York water. A standing joke maintained that city water was far better than any other, since it served as a purgative as well as for washing and cooking. Most people were sensible enough not to drink it, except when forced by poverty or betrayed through inadvertence. Only the poor used the city pumps. Those who could afford the expense had their water supplied in hogsheads from the "pure" springs and wells of the countryside.
Foreigners regarded dyspepsia as America's national malady, and an American dinner could easily be an unnerving experience. Filthy and adulterated food was prepared with little care or cleanliness in kitchens swarming with flies and then bolted as rapidly as possible—perhaps in self-defense. Although cleanliness was appreciated as an abstract virtue, its observance in practice left much to be desired. A New England physician remarked that not one in five of his patients bathed or washed their bodies in water once a year. And this was the wholesome New England countryside. For the city poor, maintaining any kind of cleanliness was almost impossible. Most lived in tiny unventilated apartments, often with whole families—and perhaps a few boarders—occupying the same room, a condition deplored by physicians and moralists alike. The most miserable and degraded lived in unfinished cellars, their walls a mat of slime, sewage, and moisture after every rain. Houses adjoined stables, abattoirs, and soap factories; their front yards were the meeting place of dogs, swine, chickens, and horses.
Their city a seemingly foreordained stopping place for cholera, New Yorkers naturally questioned the powers which their municipal government would be able to call upon should there be an epidemic. The experience of the city in a series of yellow fever epidemics had provided the administrative framework of a public health organization. The temporary health committees of the 1790's had, by 1832, evolved into a permanent Board of Health with accepted powers and duties, which was, however, almost always quiescent unless an epidemic was actually in progress. (The Board of Health consisted of the aldermen meeting with the recorder and mayor, the mayor acting as president of the board and exercising its powers when it was not in session.) In the ten years after the yellow fever epidemic of 1822, the board met at stated but infrequent intervals, although interest was so slight that the necessary quorum was often unobtainable. The Board of Health was charged with the administration and enforcement of the city's public health regulations, which, in practice, consisted almost entirely of enforcing quarantine. The connection between yellow fever in the West Indies or the South and New York's outbreaks of the disease was too obvious to have been ignored. Thus, almost all of the board's stated meetings took place during the summer, when there was danger from the South. The day-to-day business of keeping a city of a quarter of a million healthy was the responsibility of only three men, the health officer of the port, the resident physician, and the city inspector.
The health officer, appointed by the state and working in conjunction with the Board of Health, was responsible for enforcing the quarantine regulations. The duty of the resident physician, a municipal appointee, was to diagnose and report any communicable diseases which might exist in the city. This was a peculiarly vulnerable position, for premature diagnosis of an epidemic disease would mean severe loss to the city's business. The resident physician in 1819 who had had the temerity to diagnose a case of yellow fever was bestowed with "every abusive epithet which could degrade or disgrace" and threatened with personal injury. (The board itself was, as William Dunlap remarked to his friend Dr. John W. Francis, "more afraid of the merchants than of lying.") The city inspector, another municipal officer, was more strictly an administrator, charged with the keeping of vital statistics and the enforcement of sanitary regulations.
The weaknesses of the board were apparent to even the most casual observer. Composed of laymen, it was dependent for advice upon the city's physicians, while as an executive committee, it was dependent upon the Board of Assistant Aldermen for financial and legislative support. The board had only three regular employees, a secretary and two assistants. It had no office, no dispensary, not even a library. It hibernated each winter. Its membership was undistinguished, and as events were to show, slow to act on professional advice when it seemed to endanger the financial well-being of the city.
As spring warmed into summer, the inactivity of the Corporation began to provoke more and more criticism. Nothing, it seemed, had been done to protect the city. Cholera would rage uncontrollably should it arrive "at this moment," one critic warned early in June, "in the midst of the filth and stench with which our streets are filled." But the authorities had not been completely supine. Walter Bowne, the mayor, had hastened to proclaim a blanket quarantine against almost all of Europe and Asia. On June 4, a new act to regulate the cleaning of the city's streets was introduced into the Board of Assistants. The act, which was signed by the Mayor on Wednesday, June 13, completely reorganized New York's sanitation system.
Two days later, on the fifteenth, the threat became more real and more imminent. The Albany steamboat which docked that Friday afternoon brought word that cholera had broken out in Quebec and Montreal. The Atlantic had been forded—America's last great defense had failed, and it hardly seemed possible that she could be spared.
New York was not a large city. By Saturday morning, June 16, nearly everyone had heard the news from Canada. Philip Hone, the usually imperturbable ex-mayor, did not see how New York could escape. He could not think of a European city as dirty as New York; certainly neither Quebec nor Montreal was dirtier. Miasma arising from the filth rotting in the streets, yards, and cellars was quite capable of producing sickness without the added influence of cholera in the atmosphere.
The members of the Common Council were equally conscious of the sights and smells; self-preservation as well as political expendiency demanded their immediate action. On Saturday morning, the Board of Assistants held a special meeting and voted $25,000 to the Board of Health for "the erection of hospitals and other means to alleviate and prevent the cholera." The board was also urged to send a suitable observer to report on the epidemic in Canada. Skilled observation would provide insight and understanding, perhaps even a cure or preventive for the disease.
The news from Canada was uniformly discouraging. The mortality rate in Quebec and Montreal had not been surpassed in any part of the world, and there was little dissent when Mayor Bowne proclaimed an unprecedentedly severe quarantine. Without the permission of the Board of Health, no ship could approach closer than three hundred yards to the city; no vehicle closer than a mile and a half.
It seemed on Sunday that every minister in the city had chosen cholera as his text. "The consternation in the city is universal," a young artist noted in his journal, "Wall Street and the Exchange are crowded with eager groups waiting for the latest intelligence." The Sabbath was profaned by the Courier and Enquirer, which printed a cholera extra of ten thousand copies. The Standard also issued an extra, while hopeful apothecaries circulated and posted handbills for opium, camphor, and laudanum-all sovereign remedies and preventives for cholera. The price of camphor doubled immediately.
The medical profession was particularly conscious of the danger and of its responsibility should there be an epidemic. Accordingly, the Medical Society, which represented two-thirds of the city's licensed physicians, formed a special committee of fifteen to study the problem. At their first meeting, this committee formulated a program of public and individual hygiene for the days ahead. It was most important, they urged, that the streets be kept clean throughout the coming summer. To help accomplish this, and to purify the atmosphere, water should be run from the hydrants several times a week. The streets themselves, as well as private sinks, yards, and cesspools should be disinfected with chloride of lime or quicklime. Individuals were urged to be calm, to be temperate in dining and drinking, and to be especially scrupulous in washing. Learned in a generation of yellow fever epidemics and gleaned from accounts of cholera in Europe, these recommendations represented the best medical opinion of the time.
Excerpted from The Cholera Years by Charles E. Rosenberg. Copyright © 1987 The University of Chicago. Excerpted by permission of The University of Chicago Press.
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Part 1: 1832
I. The Epidemic: 1832
II. God's Justice?
III. Or Man's Injustice?
IV. The Medical Profession I
V. Aldermen and Cholera
Part 2: 1849
VI. The Epidemic: 1849
VII. Religion, Science, and Progress
VIII. The Nature of Poverty and the Prevention of Disease
IX. The Medical Profession II
Part 3: 1866
X. America After the War
XI. The Metropolitan Board of Health
XII. The Gospel of Public Health
XIII. Conclusion: The Way We Live Now