Cholera

By 1832, when the first cholera epidemic struck the United States, enlightened physicians were much more in Rush's camp than in that of the contagionists. In fact, anticontagionism had become a mark of the educated physician, although the populace continued to hold the unsophisticated view that diseases such as cholera were transmittable from one person to another. Indeed, cities did declare quarantines, over the objections of physicians. The president of New York City's Special Medical Council, Dr. Alexander H. Stephens, privately characterized the quarantine he was supposed to help enforce as a "useless embarrassment to commerce." Politically, however, not to have enforced quarantines would have been "suicidal," according to Charles E. Rosenberg, author of the chapter on disease and social order in this book. Still, cities that did not impose a quarantine had a commercial advantage over those that turned away or detained ships seeking to enter their

ports. Agitation within a city would increase if potential victims could not flee to a countryside believed to be more safe.

The first cases appeared in New York City in late June, and the epidemic was upon the city for the remainder of the summer. The Board of Health was greatly criticized for its efforts: The job of cleaning the city was too big to accomplish in such short order, the cholera hospitals were overcrowded, and it was not easy to find caretakers for the sick and dying. The public had demanded protection, and the response of government at the state and local level was quick and authoritarian. The natural response of the populace was to cordon off the healthy or to confine the sick; a show of support for the creation of boundaries overwhelmed the medical experts' assurances that the disease was not contagious and that quarantine was an expensive and useless weapon.

Cholera, as we saw in the chapter by Guenter B. Risse, was associated with the poor and the immoral. About two weeks into the epidemic the Special Medical Council stated that the disease was "confined to the imprudent, the intemperate and to those who injure themselves by taking improper medicines."^[9] The highest incidence of cholera occurred in the red-light district, which the New York Evening Post reported to be populated by the vilest brutes whose breath would contaminate and infect the atmosphere with disease, even "be the air pure from Heaven."^[10] Cholera arrived in the 1830s, and the social reaction to the ensuing epidemic was greatly complicated by the emotionally charged atmosphere of an active temperance movement in which moralizing was common. Advice for resisting the disease frequently included warnings against ardent spirits. One of the first and most prominent of American psychiatrists, Dr. Amariah Brigham, advocated in 1832 that boards of health be given "the power to change the habits of the sensual , the vicious , the intemperate ."^[11] The link between illness and morality has maintained a long and strong tradition. When an epidemic illness hits hardest at the lowest social classes or other fringe groups, it provides that grain of sand on which the pearl of moralism can form. Such was the case with a disease that has elicited alarmed calls more recently for isolation: tuberculosis.