The 1832 Cholera Epidemic

The 1832 Cholera Epidemic in New York State

19th Century Responses to Cholerae Vibrio

By G. William Beardslee

I. Disease and History

"New York was probably the most thoroughly scourged among the states. Each of the thriving towns along the Erie Canal suffered in its turn, despite quarantines and last minute attempts at 'purifications.' . . .Small villages, even isolated farms, were stricken. And here the disease was most terrifying; it had to be faced alone, often without friend, minister, or physician. The appearance of cholera in even the smallest hamlet was the signal for the general exodus of the inhabitants, who, in their headlong flight, spread the disease throughout he surrounding countryside^[i] The study of history has long required the application of sophisticated multi-causal analyses. Decades before "modern" historians proposed a greater sensitivity and appreciation to environmental factors and some aspects of environmental determinism, Frederick Jackson Turner wrote of the "mastering" powers of nature, the environment, and man's necessary adaptation to it. Turner's "Frontier Thesis" proposed that it was the presence of vast frontier lands which caused American history to be uniquely characterized by its individualism, nationalism, sectionalism, and self-reliant unilateralism. Despite his appreciation of the significance of the frontier's environment on history, Turner, and many other historians have curiously overlooked the impact and consequences of disease and pestilence upon American history preferring to perceive the "germ theory" with a verydifferent connotation, "All peoples show development; the germ theory of politics has been sufficiently emphasized. . . .At the Atlantic frontier one can study the germs of processes repeated at each successive frontier. We have the complex European life sharply precipitated by the wilderness into the simplicity of primitive conditions."^[ii] The influence of disease upon American history is an under appreciated historiographical component. It is true that within the last few generations of American historians, there has been a growing recognition that disease devastated native American peoples prior to and after the arrival of Europeans on the North American continent. But the influence of plagues, epidemics, pestilences, and poxes upon local, regional, and national events has been less studied. Relatively few historians, including European or world historians such as Hans Zinnser and William H. McNeill, have proposed environmentally oriented historiographical theories that highlight the analysis of disease upon global history.^[iii] In his Plagues and Peoples, William H. McNeill recognized Turner's contributions, but suggested that the "frontier" was a consequence of cultural differentiation, which itself was the result of environmental and geographical inequities. McNeill suggested that European's selective disease immunities, post-Napoleonic political equilibrium, technological changes, and a market oriented economy all propelled Western cultures toward North America and other world wide frontier communities. McNeill's global analysis synthesized an explanation for the existence of not only North America frontier experiences, but also in other locations at the forefront of European advancement. As McNeill suggests, the occurrence of disease, epidemics, and pestilence constituted a persistent and expected element of the "frontier experience." The response by several New York State communities to the 1832 invasion of Cholerae vibrio provides an poignant opportunity to view man's social and political adaptation to this component of his environment. It is also a chance to understand another of William McNeill's biological/historical theories: man and microbe are engaged in a long term relationship; disease, pestilence, and plague are examples of microbial efforts to dominate their frontier-homo sapiens. An additional benefit from an analysis of the 1832 Cholera Pandemic is that it illustrates the inextricability of regional, national and global "great events" as a part of local history. Local historians often do not give sufficient credit to their local events. Perhaps because they are seen as too common and familiar, local historians tend to perceive local history as less important, or that local history is only a part of the "great' events occurring on a national or global scale. It can be argued that it is actually the local event, particularly in the case of epidemics-the case by case occurrence of disease, that collectively creates "big history." In each of the individual community's reactions are elements of the greater response by region, nations, and hemispheres to the global catastrophe inherent in the 1832 Cholera Pandemic. Every response, whether it be in (1) rural Otsego county, (2) the Village of Cooperstown, (3) Utica or (4­) Buffalo, provides a glimpse into that community's values, culture, and character. Each will also be compared to the response of the great metropolis of New York City. Each community's response usually included the creation of some sort of public health response upon which later responses to other diseases and epidemics would be based. In many ways the 1832 local health board's responses to the Great Cholera Pandemic established the outlinesof today's public health reactions to all epidemics.

II. The First Cholera Pandemic: 1817-23

To be sure, a couple of spectacular examples of what can happen when an unfamiliar infection attacks a population... The Black Death of the fourteenth century was the chief example. . .and the cholera epidemics of the nineteenth century constitute a second. . .^[iv] Despite relatively scant historical acknowledgment, the periodic occurrence of pestilences, diseases, and epidemics have long been a part of American history. Almost as soon as the first Europeans arrived on the North American continent, and centuries before the Cholera Pandemic of 1832, American history was repeatedly afflicted with major and minor cycles of disease.^[v] A partial listing of those known and recorded early diseases and epidemics would include at least the following events: 1657 Boston Measles 1687 Boston Measles 1690 New York Yellow Fever 1713 Boston Measles 1729 Boston Measles 1732 World Influenza 1738 South Carolina Small pox 1739 Boston Measles 1747 New England Measles 1759 North America Measles 1761 North America Influenza 1772 North America Measles 1775 North America Unknown illness 1776 World Influenza 1783 Delaware Bilious disease 1788 Philadelphia Measles 1793 Vermont Putrid Fever 1793 Virginia Influenza 1793 Philadelphia Yellow Fever 1793 Harrisburg, Pa. Unknown 1793 Middletown, Pa. Unknown 1794 Philadelphia Yellow Fever 1796 Philadelphia Yellow Fever 1798 Philadelphia Yellow Fever 1803 New York Yellow Fever 1820 North America "Fever" Cholera had never appeared in North America or the western hemisphere prior to Second Cholera Pandemic in 1832. Although it is sometimes exceedingly difficult to determine if a prior illness and its symptoms constituted a particular disease, Cholera was probably first identified as a specific illness in the late 1700's. By the early 19th century its symptoms and peculiarities were well known and capable of differentiation from the other great fevers: Yellow Fever or Typhoid. It is generally acknowledged that cholera had long been endemic to the Indian subcontinent and particularly to its northeast regions, the Ganges Delta.^[vi] Medical historians suggest the reporting of a similar disease in ancient historical accounts. Historical reports from 1629 seem to describe a disease that at least closely resembled cholera, and in the late 19th century, Indian travelers' accounts appear to describe the classic conditions of cholera well prior to the first Pandemic of 1817; over the next several years the disease moved out of its historically affected region, and began a rapid and progressively westward movement along and over the Arab-Moslem trade/travel routes from India to the west extending to Muscat, the east coast of Arabia, Syria, and southern Russia as far as the Volga River. As suddenly as cholera had appeared, it abated by the early 1820's. This earliest outbreak and its transition from endemic to epidemic to pandemic is generally considered as the First Cholera Pandemic. Europe and the Americas were unaffected by this first pandemic. Unlike other diseases that require human transportation, Cholerae vibrio, can exist outside the human body.^[vii] It is a bacterium and under the microscope it is shaped like a comma. It only affects humans. Epidemiologists believe that it evolved in the Ganges Delta region and until the modern era, was isolated to that area. Until the arrival of Europeans and their technological transportation inventions including railroads, steamships and canals, cholera had been restricted to India.^[viii] For this reason, Cholera has been called a "disease of the 19th century," and the "Pandemic of the Industrial Revolution"; without modern methods of transportation, it is unlikely to have become more than an epidemic.^[ix] Cholerae vibrio can survive for surprisingly long periods of time in many water sources including shallow wells, cisterns, or water storage tanks. It does not require an intermediary animal host or some form of agent (vector) for dispersal.^[x] Once ingested and if it can reach the human intestines, the bacteria will there produce a toxin which inhibits the absorption of water and salts. The bacteria then effectively flushes the intestines of any competition and begins a massive replication of itself. Cholera's physiological effects on humans are not appreciably different today than in the 19th century. Individuals, then and now, were generally unaware of their illness until a sudden onset of stomach cramps, nausea, fever, and explosive-severe-voluminous diarrhea. Within hours of the disease's onset, the cholera victim expelled immense quantities of bodily fluids. Deprived of the body's necessary fluids, the cholera victim's head, hands, and extremities turned cold, bluish in color, and death like in touch. Death often occurred within hours of the first symptoms and was generally "caused" by cardiac failure precipitated by the severe electrolytic imbalances. It was an ugly, nasty, and repulsive death. Individuals often lost consciousness and it was sometimes difficult to determine if individual had actually expired. Medical records frequently reported body "twitching" for hours after an individuals apparent death. In response, many communities forbade burials sooner than 24 hours after death due to this phenomenon. Anyone having contact with the individual, his soiled bedding, clothing, or infected water sources was a potential victim and transporter of the disease. In its most virulent form, cholera's death rates were, and are, over 50% for adults and overwhelmingly fatal for the elderly, infants, and the otherwise infirmed.^[xi]

III. The Second Cholera Pandemic: 1826-37

"The abrupt onset and fearful symptoms of cholera made Americans apprehensive and reflective-as they were not by the equally deadly, but more deliberate, ravages of tuberculosis or malaria. 'To see individuals well in the morning & dead in the morning is something which is appalling to the boldest heart'."^[xii] Just as suddenly as the First Cholera Pandemic abated in the early 1820's, a new cholera cycle commenced in 1826, and soon affected all of India and much of the Far East. In the West the disease traveled the familiar trade routes into Afghanistan and into Russia by 1827.^[xiii] By 1831 cholera had infected all of Russia's major cities despite quarantines and sanitation measures. These defenses were ineffective primarily because cholera victims invariably infected nearby water supplies, including creeks, streams, and ultimately the major rivers. Russian troops carried the disease into Poland in the winter of 1831. By June of that year, it had arrived in Hungary, Austria, and Germany.^[xiv] By April of 1832, cholera reached Paris. The approach of the cholera pandemic toward Europe in the early 1830's was greeted with extraordinary public anxiety, dread, and concern in all the major cities. London and Parisian newspapers featured lengthy reports from Moscow and other cities to the east. Citizens of all the major European cities awaited the approaching pandemic in moods that can only be described as one of terror. It was the most feared of all diseases in the 19th century.^[xv] In a now famous letter dated April 9, 1832, the German poet Henirich Heine (1796-1856) graphically described the outbreak of cholera in Paris. "On March 29th, the night of mi-careme, a masked ball was in progress, the chabut in full swing. Suddenly, the gayest of the harlequins collapsed, cold in the limbs, and, underneath his mask, 'violet-blue' in the face. Laughter died out, dancing ceased, and in a short while carriage-loads of people were hurried from the redoute to the Hotel Dieu to die, and to prevent a panic among the patients, were thrust into rude graves in their dominoes. Soon the public halls were filled with dead bodies, sewed in sacks for want of coffins. Long lines of hearses stood en queue outside Pere Lachaise. Everybody wore flannel bandages. The rich gathered up their belongings and fled the town. Over 120,000 passports were issued at the Hotel de Ville."^[xvi] With great justification, Cholera was perceived as a demonic, evil and foreign force similar if not worse than smallpox or the plague. In its most virulent forms, it was a highly efficient killer and often resulted in a 50% mortality rate among its healthy adult victims.^[xvii] Deaths in India between 1817 and 1860 are generally considered to have exceeded 15,000,000 persons. Another 23,000,000 died between 1865 and 1917.^[xviii] Russian deaths during a similar time period exceeded 2,000,000.^[xix] During the late winter-early spring of 1831-32, American newspapers, apprehensively, sometimes hysterically, reported the existence of the cholera in Paris. Despite severe quarantines (cordon sanitaire) and other protective measures, cholera invaded the British Isles at Newcastle in October of 1831. Within weeks, by April of 1832, it had spread north into Scotland and across the Irish Sea into Ireland. The English response to the 1832 Cholera Pandemic is historically significant. In mid 1831 with cholera's "terror" loose on the continent and approaching the British Isles, the government established a board of health within the Royal College of Physicians. This Central Board of Health was proclaimed in June of 1831 and consisted of seven physicians, the comptroller of the navy, a deputy of the Board of Customs, director general of the army's hospitals, and several other similarly important officials. Among its first proposed recommendations, rules, and regulations, applicable to each town and village, was "there should be established a local Board of Health." Local boards were to consist of the local chief magistrate and clergymen, one of whom, would serve as a correspondent with London's Central Board of Health. Additionally, ". . .in each town or its neighborhood," temporary hospitals were to be established to which ". . .every case of the Disease as soon as detected . . ." might be removed. Finally, "The Houses from which the Sick Persons had been removed should be purified in the following manner. The wearing apparel and household furniture should be thoroughly washing and scoured, the walls and ceilings lime washed, the doors and windows of each apartment left open for many days . . ."^[xx] Eventually, over 1200 local boards of health (822 in England and Wales, and about 400 in Scotland) were established in Great Britain.^[xxi] Equally as important as the establishment of a central governmental public health authority, was the publication of the official Cholera Gazette commencing in January of 1832. It purpose was to serve as a "clearing house" of cholera communications and information to and from London's Central Board of Health. The Gazette was published bi-weekly beginning on January 14 and provided "details of cases of cholera . . ."^[xxii]

IV. Causation: Sin, Contagion, Miasma, Injustice, Ethnicity, and Race?

"We have witnessed in our days the birth of a new pestilence, which in the short space of fourteen years has desolated the fairest portions of the globe, and swept off at least fifty millions of our race. It has mastered every variety of climate, surmounted every natural barrier, conquered every people. It has not, like the simoon, blasted life, and then passed away; the cholera, like the smallpox or plague, takes root in the soil it has once passed."^[xxiii] As New Yorkers observed from afar, the fearful and inexorable westward movement of the cholea pandemic across Europe and into Great Britain, the debate as to its causation and proper treatment escalated. Fundamental to the entire discussion was the cultural non-cognizance that disease originated in a micro-biological "germ theory" world. Rudimentary modern concepts such as bacteria, toxins, personal cleanliness, and public sanitation were either unknown and largely absent from the social database. Quarantines were common and had been utilized for hundreds of years, but the scientific idea of contagion was confused and interrelated with religion, piety, sin, and "God's Justice." In all probability, most New Yorkers, if they had been asked in 1831-2 what they believed to have been cause of cholera, would have answered that cholera/disease was some form of righteous consequence which afflicted those who were least likely to be in God's grace. As further proof they would cite that Cholera most often affected those persons who lived dissolute, alcoholic, drug related, sexually excessive, and filth ridden lives; cholera's victims were simply being punished by God. It was the consequence of sin and "was the inevitable and inescapable judgment" of the Divine Power. "Cholera was a scourge not of mankind but of the sinner."^[xxiv] And, it was a known and seemingly irrefutable fact that cholera was most commonly found in those areas of the world least populated by Christians. In contrast to the simple purity of Christianity's rationale for cholera, medicine, physicians, and other adherents of "reason," proposed theories which also recognized that certain social groups seemed more vulnerable. Similar to those who considered cholera the product of sin, knowledgeable and scientific people agreed that it was the imprudent, the dirty, and the intemperate who were more subject to cholera's terror. Instead of God's punishment, they proposed that cholera was "an influence in the atmosphere," a miasma (poison) that afflicted only those who had weakened themselves by exposure to certain behaviors, places, or "exciting causes." ^[xxv] Only those persons of irregular habits should fear cholera. The good, the clean, and the temperate would escape its presence. Only those persons whose systems were weakened or debilitated would contract the disease.^[xxvi] Confounding this more rationale theory was the long standing debate between the rival schools of thoughts regarding epidemics: Contagionism or Miasmatism. Many men and women of "reason" had long proposed that epidemics only occurred as the result of a miasma in the atmosphere which if encountered by a weakened individual caused disease. This theory suggested that the miasmatic atmospheric phenomenon was generated by rotting corpses, marshy land areas, and other putrescent matter exhaling vaporous emanations. The rival theory, contagionism, was a precursor of the germ theory which would not be discovered until much later in the 19th century. In 1832, without an understanding of either microbiology or germ theory, its adherents were hard pressed and relatively few. Quarantines were the natural product of the contagion concept, but confusingly, many diseases including cholera seemed transmittable without direct personal contact. It would not be until the Third Cholera Pandemic of 1849, through the efforts of an obscure London scientist/doctor, John Snow, and his observations of cholera victims and their water sources, that the rudiments of a germ theory would be understood.^[xxvii] Finally and only in the 1870's, with the discoveries of Louis Pasteur, and the 1882 identification of the cholera bacillus by Robert Koch, would the miasmatic theory finally be rejected.^[xxviii] Only with these discoveries would the cholera bacteria's mode of transmission, primarily through the ingestion of contaminated water and foods, be fully comprehended. Further complicating an understanding of New Yorker's and American attitudes regarding the causation of cholera was a collection of other attitudes, prejudices, and philosophies characteristic of 19th century America. Social reformers, such as New York's George Henry Evans, perceived cholera not as God's retribution for sin, but rather as proof of man's inhumanity to man. Cholera was overwhelmingly a "poor man's plague," and the reason for that was rooted in America's underlying unjust social and economic systems. Social radicals were aware and incensed that on one day in July of 1832, over 100 persons died of cholera in New York City. Of that group, 95 were buried in the city's graveyard for the poor-Potter's Field.^[xxix] Others within American society saw cholera's causation as based in the unchecked immigration into the United States of foreign born persons-especially the Roman Catholic Irish. And of course, it was true that the Irish died in inordinate numbers during the 1832 epidemic. As the newest and the poorest immigrants, the Irish lived in the worst housing, under the most crowded circumstances, and were least able to afford good water, medical care, or flight from the epidemic. Last and certainly not the least in historical significance, is that some Americans perceived that cholera's causation and occurrence was further proof that African-Americans were foreordained to suffer due to their social and genetic inferiority. As one might expect from their endemic poverty, African-Americans died during the 1832 cholera epidemic at significantly higher rates compared to those of whites. "Whether free or slave, Americans believed, the Negro's innate character invited cholera. He was, with few exceptions, filthy and careless in his personal habits, lazy, and ignorant by temperament. A natural fatalist, moreover, he took no steps to protect himself from disease shared, to an exaggerated extent, the distaste of the poor for hospitals and the medical profession."^[xxx] 1832 Cholera Pandemic and its public perception was a microcosm of American social life in general. From as many facets as there were spiritual, social, political, and economic divisions within the general community, cholera was received as proof, indeed as justification of their ideas. Medicine, religion, social reformism, ethnicism, and racism all regarded cholera as evidence of their individual agendas.

V. 19th Century Cholera Regimens and Therapies

"The disease may properly be divided into four stages; each of which has its own peculiar symptoms, requiring some modification in the treatment . . .first, the premonitory stage . . ., second, . . violent vomiting and purging, . . .third, . . collapse, and fourth, . . consecutive fever. Nor surprisingly much of the the medical literature written between the 1832 Second Cholera Pandemic and the Third Pandemic of 1849, manifested characteristics of all or hybridized combinations of the pietistic, miasmatic, and contagionistic causation theories. Epidemic Cholera: Its History, Causes, Pathology and Treatment, written in 1849 by Buffalo, New York's Dr. C. B. Coventry is representative of the confusion relating to the causation and treatment of cholera.^[xxxi] Written nearly thirty years before Snow's, Pasteur's, and Koch's establishment of a "germ theory," Coventry's discussion of causation, and recommendations for treatment, are painful and uncomfortable to read. The ignorance of the underlying biology, microbiology, and "germ theory" causation of cholera combined with its suggested treatments provoke enormous empathy for cholera's helpless victims. Without exaggeration, cholera's piteous must have concluded that "the cure was worse than the disease." As Coventry's treatise established, 19th century medical treatments for cholera were ultimately grounded in the tenet that "the disease may be properly be divided into four stages:" (1) Premonitory, (2) Cramps, diarrhea, and coldness, (3) Collapse, and (4) Consecutive fever.^[xxxii] For each stage he suggested a treatment plan. Despite their antiquated and baseless nature, in comparison with other non-medical, homeopathic, naturalist, or simple "medical quackery," Coventry's therapies were considered conservative, logical, and humane. For each of the identified four (4) individual stages, unique medicines and treatments were prescribed. Complicating the entire diagnosis and treatment process was the reality that 19th century physicians could not effectively differentiate between a myriad of similar illnesses. An upset stomach, food poisoning, common diarrhea, and dysentery were all considered more or less related to the 1832 Cholera. These lesser forms were typically denominated as Cholera morbus and lumped together with the more aggravated form which was usually denoted as Asiatic Cholera.^[xxxiii] Most physicians felt that cholera was particularly susceptible to medical management during its Premonitory stage. The onset of lesser stomach spasms and "painless" diarrhea was considered not part of the disease but a precursor; if prompt medical attention were received, individuals could escape, prevent, or otherwise avoid the disease. It was "not improperly termed the curable stage."^[xxxiv] The Premonitory stage, and the medical community's fixation that it could be managed, was erroneous. The "curable stage" was simply one of the many common "stomach upsets" other than cholera. The conclusion that cholera was curable was based upon a faulty premise: all similar symptoms are the same disease and were related. Treatment of the first stage (Premonitory) of cholera consisted of confining the victim to bed and the taking of some warmed mild aromatic drink such as spearmint, chamomile, or warm camphor julep. Once the individual had commenced to perspire, calomel, camphor, magnesia, and pure castor oil was administered.^[xxxv] If the cholera victim had recently consumed food, an emetic such as ipecacuanha or sulfate of zinc was given. It was also recommended that bleeding of the victim be performed. "The object of the bleeding is to relieve the internal congestion," and should be discontinued if the victim faints.^[xxxvi] During the second stage, which 19th century medical professionals considered the actual onset of cholera, treatments were intensified. During this stage, as cholera's victims suffered excruciating nausea, massive diarrhea, cramps, physical collapse, cold clammy extremities, and a feeble pulse, medical therapies included, "put the feet and legs in water as warm as could be born, with the addition of mustard and common salt to the water; open a vein in the arm, and bleed from five, to sixteen to twenty ounces . . apply a large mustard cataplasm over the stomach and give . . .calomel, opium, an camphor, every half hour." If the patient continued to deteriorate, and was there any reason to think he would not, "Sulphuric ether in small doses should be given . . .at the same time an enema of a pint of chicken tea, with a table spoonful of salt . . .should be thrown into the bowels . . ."^[xxxvii] Few persons survived cholera's third stage which was sometimes called the "stage of asphyxia." The principle of treatment during this portion of the illness was to "arouse the dormant energies of the system." Larger doses of calomel and camphor were recommended; in addition, quinine and morphine were to be administered every half hour, and "a cholera patient . . . should never be left a moment without the presence of an intelligent nurse."^[xxxviii] If the patient survived the treatments prescribed for the third stage, further bleeding or the attachment of leeches was recommended for the fourth stage. More calomel, magnesia, camphor, opium, and morphine pills were given, and if during this stage of cholera, "consecutive fever" or typhoid appeared, "it may be necessary to resort to tonics and stimulants such as sul. quinine, serpentaria, carb. of ammonia, wine whey, oil of turpentine, etc."^[xxxix] Variations upon these therapies were as numerous as there were physicians. Some treatments emphasized exterior stimulants to the system, in hopes of energizing the collapsing patient, by rubbing the victim's body with rebefacients, the most common being combinations of mustard, oils of turpentine, and cayenne pepper.^[xl] Other physicians routinely recommended immense dosages of calomel, a chalky mercury compound, until the victim's gums stared bleeding. The most common, and considered as conservative therapies, always included some combination of calomel, opium (laudanum), and bleedings. More exotic and radical treatments abounded: tobacco smoke enemas, electric shock therapy, beeswax/oilcloth plugs forced into the victim's rectum to stop the diarrhea were among the most distressing encountered.^[xli] Curiously, at least one physician, New York City's Dr. W. Rhinelander, located at 342 Broadway, suggested in July of 1832 that cholera could be treated by the infusion of saline solutions into the victim's veins.^[xlii] Such a treatment along with a regimen of attendant antibiotics is the preferred therapy for modern cholera victims. When treated early the fatality rate is very low.

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End Notes