Cholera
Less than two hundred years later both Europe and America faced a new disease—cholera—although a number of historians argue that cholera has been around since the sixteenth century. Speculation about its origin continues. A recent hypothesis argues that a relatively harmless water-borne bacterium, easily destroyed by acid in the stomach, mutated in India early in the nineteenth century, suddenly acquiring the ability to produce a powerful toxin responsible for the severe diarrhea and vomiting, resulting in an enormous loss of fluids and high death rates.[28]
Once launched, cholera spread quickly in successive epidemics affecting virtually every country in the world. Its transmission was possible because of increased and more rapid means of transportation. Moreover, the industrial revolution promoted an accelerated and poorly planned urbanization that frequently allowed the mingling of human wastes with water supplies—ideal conditions for a disease like cholera.[29]
Reports from West Bengal suggest that the first cholera pandemic originated there in 1817, spreading throughout Asia and East Africa. A second wave began in 1829, quickly moving into Russia (1830), Germany and Britain (1831), and France (1832). Having effortlessly crossed the seas and three continental landmasses, there was a justified fear that cholera would also travel to the New World, given the high volume of transatlantic traffic. Although the demographic effect of cholera's deaths was relatively small compared with the great killers of the past—nevertheless, in Britain alone about thirty thousand people died of the disease in 1831-1832—its sudden evolution and spectacular symptoms caused considerable horror and panic.[30]
In the spring of 1832, therefore, Americans warily awaited cholera's leap across the Atlantic. Even before cholera broke out in Quebec and Montreal on June 15, New Yorkers had braced themselves for the onslaught by reorganizing the city's sanitation system. Money was made available to erect hospitals should cholera strike.
Although holding infrequent meetings, the city's permanent Board of Health had been in operation since the yellow fever epidemic of 1822.[31] When cholera erupted in Europe, board members—including New York Mayor Walter Bowne and city aldermen—gathered information about the disease. By the fall of 1831 quarantine regulations went into effect for the screening of all incoming passengers and goods first from Asia and Africa, and then from southern Europe as cholera spread to that continent. By June 1832 a blanket quarantine against all European and Asian travelers went into effect. No vessel could approach within three hundred yards of the docks if suspected of carrying cholera victims. American physicians, in turn, went to Canada to observe the newly arrived disease and returned to issue recommendations for preventing the scourge. Cleanliness and temperance were considered critical.[32]
New York had a population of about 250,000 at this time. With the greatest port on the continent, the city was a thriving but densely populated commercial center. Thousands of European immigrants—especially the Irish—crowded into the humid, marshy areas of Lower Manhattan, occupying unfinished cellars and back rooms. Located near the
docks and common sewers, these slums furnished a highly favorable ecology for cholera. Horse stables as well as pens for cows and swine dotted the alleys; more than a thousand pigs roamed through the streets. Following the news from Canada about the arrival of cholera, perhaps as many as a hundred thousand inhabitants left the city. Driven by fear, people fled in stagecoaches, steamboats, carts, and even wheelbarrows.[33]
In spite of all precautions, an Irish immigrant named Fitzgerald became ill on June 26, 1832, complaining of stomach pains. His wife and two children were similarly affected, and although he recovered, they died a few days later. Perhaps there had been previous victims of cholera, hidden from authorities or deliberately unreported by officials to avoid panic. In any event, within days the news circulated that the disease had appeared in various areas of the Lower East Side, and in the notorious "Five Points" area in the Sixth Ward, Greenwich Village, and the Bellevue almshouse. Before it was over in September the epidemic killed nearly 3,500 inhabitants, claiming most of its victims—perhaps 2,000—among the poor.[34]
On July 2 the Medical Society of New York announced that nine cases of cholera had already occurred, expecting to prod the municipal authorities into greater action.[35] Although the Board of Health considered the medical declaration an "impertinent interference" in its affairs, members agreed to appoint a special medical council, composed of seven prominent physicians, to look into the matter. Like the Roman Health Congregation, this group promised to meet daily and, if necessary, to issue public health regulations. Predictably, the medical confirmation of cholera in New York merely exacerbated the exodus already in progress. "Oceans of pedestrians" were reported on roads leading out of the city. Farm and countryhouses within a thirty-mile radius quickly filled up with panic-stricken refugees.[36]
Despite professional opinion that cholera had indeed reached the city, the Board of Health and especially the newspapers continued to question the assertion. Fearful passengers on steamboats landing in New York resented the medical announcement as "injudicious and premature" by "unauthorized and meddling doctors which have filled the nation with such groundless apprehensions."[37] No matter—the alarm had been sounded. In the eyes of one observer, the Fourth of July holiday lacked the "usual jollification." Stores were closed and the official parade was canceled, although some troops marched on their own and "the places of public amusement were filled in the evening."[38] Although the Board of Health was forced to report twenty new cases and eleven
deaths for that day, all presumed to be cholera victims, one newspaper tried to soften the impact of such tidings by explaining that festivities associated with national holidays caused fatigue and notoriously encouraged intemperance in eating and drinking. Only such preconditions, it suggested, would allow the appearance of the disease if combined with environmental pollution.[39]
Over the next few weeks the press tried to minimize the importance of the epidemic. The Board of Health required that practitioners who were reporting cases also disclose the sex, age, occupation, and former health of their patients. It not only published daily the names and addresses of new cholera victims but also the number of individuals brought to the various city hospitals suspected of having the disease. In addition, the board now included on its lists the names of the doctors reporting the cases. Reporters quickly realized that most attending physicians reporting cholera cases were not among the professional elite then practicing in the city, many of whom had obviously left with their rich clients; this created further skepticism about the seriousness of the cholera epidemic. "The alleged visitation of the Asiatic cholera seems to have brought an entirely new fry of doctors into existence as a shower of summer rains brings out a new race of frogs and toads," mused one paper.[40] The unknown doctors could not be entirely trusted, the paper suggested, to provide an accurate picture of morbidity. "We have some cholera in the city," concluded the article, "and a great deal of humbug."[41]
Although not among the elite, the physicians who cared for cholera patients took considerable risks. Theirs may not have been household names gracing the social pages, but these practitioners "who pass[ed] swiftly up and down the streets in their gigs" tried to find early cases of the disease when in their eyes treatment still had a chance to succeed. By contrast, prominent members of the medical profession who were advising the Board of Health expressed "fear of contagion," and in fact dared "not to enter the room in which a patient lies suffering from that affection which these very medical advisors deny to exist."[42]
Errors in reporting by the Board of Health continued to generate skepticism about the true impact of cholera. Alarmed neighbors found one presumed victim busily engaged over her washtub; a barber in the Bowery was quietly shaving customers when the newspaper announcing his illness was thrown through his doorway.[43] In any event, the lists chiefly disclosed "the intemperate, the dissolute, and the poor creatures who are too ignorant to know what to do, or too destitute to procure
needful attention."[44] Because most casualties indeed occurred among marginal members of society, the "causes of apprehension" concerning cholera were, according to press reports, "greatly diminished." Perhaps because of this, the authorities were slow to promote the usual public health measures. "What in the name of common sense is the reason the Corporation will not do their duty?" someone wrote in the physicians' Cholera Bulletin of July 13.[45] Indifference to the citizens' welfare was the charge; the officials were told to resign. In an utterance reminiscent of contemporary statements on AIDS, the same author wrote: "Public health is now at stake, and if prompt and efficient measures be not immediately adopted to secure it, in a short time it will be too late, for thousands of our citizens will have been consigned to the tomb."[46]
Finally, time-honored public health measures were indeed implemented, including a vigorous campaign of street cleaning. Instead of merely dampening the refuse with water, workers actually deprived many streets of knee-high manure, garbage, and dead animals—only to dump it, however, on other city roads. Cesspools were covered with quicklime, and "nuisances" around slaughterhouses were discarded. Houses that had harbored the sick were fumigated and purified using chloride of lime and sulphuric acid. Walls were whitewashed. Fire destroyed clothing and bedding belonging to cholera victims. Tar and pitch were burned to purify the atmosphere. "Let us learn from the past," stated the Cholera Bulletin , "and by improving the present, diminish the danger to the future."[47]
As one resident of Five Points—that "hotbed of contagion"—complained, such public health measures were not equally enforced in all areas of the city. In that neighborhood, rubbish continued to be thrown into the streets with impunity. At night, beds and bedding belonging to cholera victims were also burned outside. Hemmed into a crowded ward that now reported thirty to forty cases of the disease daily, residents produced enough refuse at Five Points "to feed the cholera for the next forty years." Not even the Fire Department dared send their trucks there. Referring to the slumdwellers at Five Points, one critic felt that unless some action by the authorities was forthcoming, "at the end of that time (forty years) there will be no occasion for their interference."[48] In a word, it was hoped that, if left sufficiently alone, the susceptibles would all die and the disease would burn itself out.
Instead of neglect, others advocated harsh measures. "The Five Points and their vicinity are inhabited by a race of beings of all colors, ages, sexes and nations, though generally of but one condition, and that be-
neath the nature almost of the vilest brute," wrote one reader.[49] The cure was easy: "Turn out the inmates of the place, ventilate and purify the beastly hovels, guard effectively against their return, fence up the streets."[50] In certain instances compulsory evacuation of the poor to makeshift shanties was actually carried out.
In the meantime, New Yorkers witnessed a rampage of vandalism in dwellings belonging to those who had left the city. Carpets were cut to pieces and furniture broken; some homes were completely ransacked from top to bottom. Lacking a sufficient security force, the authorities seemed unable to control the crime wave. In response, many homeowners quickly procured insurance against theft. "At the present crisis, those who are leaving town would find it a measure of prudence to effect an insurance," advised the New York Equitable Insurance Company.[51]
Those suspected of harboring cholera were quickly taken to makeshift hospitals for observation and treatment. Because the Medical Council had concluded that "the disease in the city is confined to the imprudent, the intemperate, and to those who injure themselves by taking improper medicines,"[52] hospitals classified their admissions "according to habit" into "temperate" and "intemperate," with an intermediate category of "irregular"; unconscious or dying patients were termed "uncertain."[53] Drunks were often reported as cholera patients. The dead were buried with indecent haste in mass graves dug at Potter's Field, robbing families of traditional wake practices. Instances of resistance to such public health measures were reported, with angry mobs attacking and beating up city officials and even some physicians.
The practices described above reflected the widely held belief in the atmospheric origin of the disease.[54] Because of cholera's erratic epidemiological patterns, the issue of direct contagion was frequently debated but generally deemphasized. In spite of repeated pronouncements that they were useless and bad for business, traditional quarantines continued to be imposed by apprehensive officials. Poisonous particles from urban decay were thought to rise from streets, cellars, and tenement houses. Such vapors were presumed to irritate both stomach and bowels but led to cholera only if the individual's constitution was already weak because of dietary deficiencies and excessive consumption of alcohol. Cholera and rum traveled together: "Short is the transition from the grog-shop to the hospital, to the grave, and to perdition."[55] Critics questioned such medical assumptions, pointing out that cholera cases frequently appeared in almshouses and jails where no liquor was available.
Indeed, the association of cholera and intemperance filled the pages of medical books, pamphlets, handbills, and newspapers. "It is now universally known that cholera has a most peculiar affinity for the system of a drunkard, so much so that it is a very rare thing for the intemperate to escape," wrote one physician.[56] "Well-appointed nurses" at hospitals were instructed to obtain a "correct" history from newcomers regarding their drinking habits. Even small amounts of port, brandy and water, or wine taken as cholera preventives were considered harmful.[57] Taverns ("abominable styes of pollution") and liquor stores ("visible nuclei around which the epidemic raged with unwonted fury") were especially singled out as sources for a habit that now could lead to the dread infection. Cholera victims were perceived to include "the poorest class of Irish, many of them have for years (as they themselves confessed) been almost daily intoxicated."[58]
Not coincidentally, cholera claimed most of its victims among New York's poor, those who received the lowest wages but were forced to pay high rents for the humid and filthy cellars they called home. Among the women, there were poor seamstresses driven into prostitution, their susceptibility to the disease explained by the combination of "filth, crowded rooms, irregular diet, intemperance, and the debasing vice to which they are addicted."[59] Others were "hard-working women whose constitutions had been broken by years of incessant toil."[60] When cholera broke out among "carefully conducted" middle-class people, however, physicians were perplexed. In one boardinghouse on Broad Street, stumped public health inspectors pondered the death of the respectable owner and her daughter. Finally, a "local mischief" was found: a large quantity of cattlehides and bones rotting in the cellar of an adjacent warehouse.[61]
In the eyes of most contemporaries these were "innocent" victims of cholera. Most were thought to have willfully weakened their bodies through unwholesome ways of life and were now being punished for their sins. According to religious leaders, the three prominent abominations of the time were sabbath-breaking, intemperance, and debauchery, and cholera was viewed as a disease of "mental and corporeal debility."[62] The best preventive measure was a prudent life emphasizing temperance in eating and drinking, avoidance of garden vegetables and fruits, abstention from ardent spirits, and sexual moderation.
Among practitioners there was pessimism regarding compliance among the poor. "The mass of mankind are, and there is reason to fear,
ever will be insensible to the operation of great moral principles," wrote one physician.[63] Cholera was therefore viewed as a just punishment for people who were unwilling to change their lives. For many contemporary observers cholera was a godsend: It gave the temperance movement a formidable impulse by exposing the danger of ardent spirits. Providence had brought "good out of evil" and taught a valuable lesson to civil and municipal authorities. The sacrifice of cholera victims had not been in vain!
By the end of July the worst seemed over. The number of reported cholera cases was down, ostensibly unrelated to public health measures.[64] With all the accusations of intemperance and vice in relation to cholera, criticisms were voiced about the role of "newsmongers," writers, and even newspaper readers who were accused of prolonging the terror. The press was blamed for displaying an "unruly passion for publishing this heaping of trifling matters" in response to demands by eager consumers of print, who became confused "from such a heterogenous assemblage" in blanket size, as they "devoured [it] in a constant panic."[65]
Medical professionals raised another issue: the official reporting of cases by the Board of Health. Indisposed patients reported by their attending physician could be listed twice if any of them got admitted to a hospital and appeared the next day among hospital cases. If the victim died, there was the possibility of being listed a third time. "Is this not humbugging the public and most unjustifiably magnifying our distresses?" asked one practitioner.[66] To make matters worse, the Health Board apparently never checked the truth of such reports, although physicians providing incorrect information could be fined. Because of the suspected and proved inaccuracies in reporting the epidemic, the public at large remained ambivalent about the seriousness of the epidemic, an uncertainty not conducive to allaying their fears.
By August 27 thousands of refugees returned to New York City in spite of warnings by the Special Medical Council that the streets and city air were still polluted. Those coming back were invited to "contribute in preserving the commercial and trading interests from destruction."[67] Among them were physicians "who, impelled by the desire of avoiding the unprofitable labours which such calamities impose on our profession, deserted their posts in time of danger or sought refuge from their personal fears by inglorious flight."[68] Devoid of patients, some of the cholera hospitals closed their doors. As one contemporary observed, "business has revived, the streets are lively and animated, and every-
thing seems to be resuming its wonted appearance."[69] The sky, clear because of idle factories and unused domestic fireplaces, gave way again to "the dense cloud of smoke which always lays over the city."[70]
As in the previous case of plague, the cholera epidemic of 1832 constitutes another paradigm for social responses to disease. Here again, the poor—often immigrants—were the primary victims both of the disease and of the blame. In this view, moral failings thought to be responsible for poverty and dissipation provided a fertile substratum for cholera to break out among those marginal sectors of society "different" from the hard-working, God-fearing majority. Public health measures sought to clean up the environment, thus reassuring the anxious public, but the activities were selective: Slums such as the Five Points area continued to wallow in garbage and to be without fire protection. Epidemic disease served once more as a focus for the expression of religious, political, and cultural biases within society.