The Cholera Years
Author: Charles Rosenberg
The Cholera Years is a detailed look at the three epidemics of cholera that swept through the United States but focusing primarily on New York City since there are more records of the effects. In 1832 the first epidemic struck. During this time there were no real government actions taken and the general 'frame' of disease was that it was caused by an individual's actions (sins) and that it was not contagious. In 1848 the next epidemic came through and more died but still the government hesitated to do anything. Society was becoming more inclined to believe that the filth caused disease but a person who was sick was still looked upon as if they had horribly sinned, and doctors were still at a loss as to cure the disease and so were regarded as quacks. By the time the final epidemic swept through the government set up the Metropolitan Board of Health which actually cleaned and quarantined New York City, the 'germ' theory was beginning to catch on with the general population, and doctors were becoming more accepted. The reason this is important is that Board was, is, and will be the basis for most other Boards of Health that followed, and during the 1866 epidemic only a few died.
Part 1: 1832
I The Epidemic: 1832-
The first part of this chapter deals with how the Americans knew that cholera was coming but many believed that since their country was better, more pious, more educated, less crowded, and cleaner, it would be spared. Besides, the Atlantic stood between them and the 'old world'. This chapter also discusses the first Board of Health that New York set up to deal with the problem. It didn't do anything except follow the merchants' demands, only posted preventative measures in the newspapers after cholera had killed hundreds, quarantined the city but never backed it up, and promoted cleanliness in the home. People did, but no one came to collect the rotting garbage. The Board also didn't announce that cholera was in the city, even though there were undeniable cases and deaths, until they could no longer hide it. When it was announced, everyone who could fled to the countryside. This caused the disease to spread like wildfire throughout the country on canals, railroads, and in the countryside. It also ran rampant in the Five Points district, a tenement area where people lived in worse conditions than the most slaves in the South. At the end of the epidemic the Board shut down again and life returned to normal. Another small point that should be made is that common people by the end of this particular epidemic believed the disease to be contagious somehow but doctors said that it was impossible.
II God's Justice?
The disease only strengthened belief in God and reinforced the idea that sin caused disease. Doctors even started supporting this idea that the United States was losing its favor with God since there were so many non-believers, Catholics, and immigrants that were sinners. They also liked to point out that mostly filthy and poor people died during the epidemic.
III Or Man's Injustice?
Others pointed out that the United States was becoming like the 'Old World' in its filth and that the country was losing itself to the immigrants especially the Catholics. They also pointed out that the poor were poor compared to the rest of the population. The only good group of "non-American Americans" were the Sisters of Charity, a Catholic order that served the dying faithfully during the epidemic.
IV The Medical Profession I
The doctors of the 1832 epidemic were mostly untrained, badly paid, and had little to no respectability awarded them. They were also prescribing such things as mercury, calomel, cayenne pepper, and powdered chalk to cholera victims, as well as bloodletting. This was the conservative treatment and the more radical treatments were likely to kill. Quacks flourished since there were few 'real' doctors and they charged extremely high rates. The public saw these "doctors" and saw unsuccessful and harmful "cures." They started regarding doctors as either cowards for running away from the epidemic, or as killers. The doctors believed that by being pious one would not become predisposed to the disease and that God could cause the disease. Those doctors that did believe in a contagion theory thought that the disease was atmospheric in origin.
V Aldermen and Cholera
The organization and money that was needed came from the Board, which had the power and had acquired the necessary men to do the tasks at hand. It founded hospitals, sent doctors to Quebec to see the disease first-hand, gave out money to different districts, and found doctors or cures for the disease. The hospitals and staff for them were the hardest to find since no one wanted to be near the disease or own property that had been used as a cholera hospital. Another thing that the Board had to fix were the cemeteries, where bodies were half-buried and lying out in the open. Furthermore was the problem of the city cleanup. Often, instead of cleaning up the years of accumulated filth, the city was covered in a "reassuring chloride of lime" which in itself could not be terribly healthy for the residents. This chapter also discusses the problem that faced smaller towns who couldn't afford such actions.
Part 2: 1849
VI The Epidemic: 1849
Once more the world was going through a cholera epidemic and still New York wasn't prepared for quarantine. The 1849 epidemic struck New York City basically the same or worse than it did in 1832. The Board had to turn to religious groups to get people to do what was needed. Trash that was picked up was thrown into the rivers where tides couldn't wash it out to sea and the remains of animal carcasses, which were more numerous than humans, were either allowed to rot in the streets or were also thrown in the rivers. The Board couldn't get people to clean their homes even after it was made law; the penalties were rarely enforced. The public itself had to volunteer in many cases to do jobs that the Board couldn't afford. In order to save money, the hospitals were just schools that had been gutted, and soon these houses of death became slaughterhouses due to the large amount of people who came in and died. And still people believed that filth and sin caused cholera.
VII Religion, Science, and Progress
As far as the faithful were concerned, cholera was caused by sin but they started to believe that filth was a form of sin. The nation actually declared a day of fast to combat the sinning and the growing atheism that people saw, but still more thought that the fast was a bad idea. Furthermore science saw no connection between God and the disease and preached better hygiene as the only safeguard.
VIII The Nature of Poverty and The Prevention of Disease
In 1832, there were to many people, two classes of poor, the proud and hardworking laborers, and the destitute drunks who deserved to get cholera since they chose to be poor. Then in the 1840's the famine in Ireland sent thousands of Irish to America where "Americans" thought of them as scum and disease ridden. They devalued American beliefs and society since they were mostly drunks and by 1849, the Irish immigrants were hated by most Americans. Many Irish died from cholera and this just reinforced the belief that they were all filth ridden and uneducated. Meanwhile Irish Catholics pointed out that the Protestant priests had run away during the epidemic. Another thing that came out in the 1840's was a new means of taking statistics and there was proof that tenements were breeding grounds for disease because of the overcrowding and filth. Even with this knowledge, people still believed that it was the tenement owner's fault or the drunks who "chose" to live there. The last part of the chapter talks about how America was becoming like the "Old World" and soon insanity would abound because of people living in overcrowded cities, and how life expectancy was going down.
IX The Medical Profession II
The medical profession was still at a loss as to how to cure cholera except what they had done in 1832, only more "heroic". An example of this is one physician who had cholera who drew 16 ounces of blood from his arm, dosed himself with castor oil and calomel. The only problem with this was that people knew it wouldn't work, they refused to take calomel, and doctors turned to such things as strychnine, morphine, or aconite. The status that the medical profession held was falling further in the 2nd epidemic because of the rapid changes that society was undergoing; more people were realizing how dumbfounded the doctors were by the disease. Fortunately though, the "germ theory" was rapidly catching on due to the work on fermentation and finding microscopic fungi cells. This theory was supported by the anticontagionists theory that the disease spread through the air.
Part 3: 1866
X America After the War
After the Civil War many Americans once more looked at their country and saw the tenements as sinful atheist cesspools. These places were struck the hardest by disease. Immigrants, especially the Irish, were seen as potentially evil. In the winter of 1865, the first ship carrying cholera docked at New York, it was quarantined, and the disease didn't spread. Due to fear and desperation, legislature passed a bill that created the basis for modern Boards of Health. The "Metropolitan Sanitary District and Board of Health" was given powers to take complete control of the entire city in a state of emergency.
XI The Metropolitan Board of Health
It had from spring to summer to clean, survey, and prepare a city of about a million people for a cholera epidemic. Fortunately for the entire country, most doctors now believed that the cause of cholera was easily carried by water and in the vomit and excrement of cholera victims. Another thing that was in the Board's favor was that New York City had a quarantine hospital. Contagionism was respected along with the germ theory. This belief helped to support the drive for the cleanup of New York. When cholera would put in an appearance, the building of the contaminated person was evacuated and the people therein were put in a quarantine-tent city. The building was then decontaminated by dumping lots of chloride of lime. This stopped the outbreaks from spreading and the epidemic itself only claimed a few lives.
XII The Gospel of Public Health
It was now proven to everyone that sanitary measures were needed and so many places started developing government departments to deal with these measures. The rest of the chapter basically goes on to discuss how people's beliefs were slowly changing and how some still preached that the poor deserved to be victims of disease because of the filth they lived in. Moreover the chapter reviews the accomplishments of the medical profession up until 1866.
XIII Conclusion: The Way We Live Now
This chapter begins by describing how cholera affected the Western Hemisphere and when it appeared. The rest of this chapter deals with the changes that occurred in the United States between 1832 and 1866 and reviews everything that Rosenberg had already written. The last part is about how America made it through all these epidemics politically and was continuing to change socially.
We felt the book was good at giving an accurate account of the time period and how several different factors could influence an entire society. What we didn't like was the way that Rosenberg would repeat everything a least a couple of times too many. Also, he went into WAY too much detail about how the Board carried out its missions to save the city, most of which were failures. Also, we will put it this way: weíve all had to read Rosenberg. To get a feeling of what it was like to read this book, imagine one of his essays, and then imagine it being two hundred and thirty three pages long!
1.Why do you think the Board was so important and original?
2. Do you think we are still at risk from cholera?
3. What were the most important changes that occurred between the 1830's and 1860's?