Volume XVI • Spring 1961 • Number 3
Asiatic Cholera in Rochester
--PHYLLIS A. RICHMOND
Asiatic cholera, popularly nicknamed "The Scourge of the Nations," was undoubtedly the outstanding epidemic disease of the nineteenth century. It had long been prevalent in India, but beginning in 1817, for reasons which are still unknown, it gradually spread westward following the trade routes, in a series of world-wide epidemics, generally called pandemics, until it burst upon Europe in 1831, reaching its full force in 1832. Asiatic cholera is a very violent intestinal disease, usually running a short course to dehydration and death, often in a matter of hours. Its very violence ensured that it would not be the type of disease which could be overlooked or treated with little concern, as, for example, was the case with tuberculosis, which undoubtedly killed many more people, but in a less dramatic fashion.
The average pandemic of cholera lasted about ten years, but scattered epidemics occurred in various countries between these worldwide sieges. The disease is disseminated through contaminated food and drink, but during pandemics, water was almost certainly the major source of infection. The water-borne nature of the disease was demonstrated by Dr. John Snow, London epidemiologist and obstetrician to Queen Victoria, who stopped an epidemic in 1853 by removing a pump handle. At that time it was not known that the specific causal factor for this disease was a microscopic organism, although Snow and some contemporaries believed that this was probably the case. Confirmation came in 1883 when Robert Koch, famous German bacteriologist, was sent to Egypt and India to study cholera. He discovered the cholera Spirillum, a comma-shaped organism, and proved its relationship to the disease. Once the specific causal factor was known, it was possible to institute preventive measures, and by the end of the nineteenth century, the disease was under control.
For most of the century, however, cholera was a terrifying menace. European medical experts had promptly identified it as a filth disease, since it struck mainly in the slums, where cleanliness in any form was rare. Steps were immediately taken to clean up the slums. In fact, the repeated pandemics of cholera did more for the advancement of sanitation and the public health movement than any previous epidemic disease.
The social and economic consequences of cholera were quite significant. Community life was completely disrupted whenever a new pandemic arrived. Usually panic gripped the populace and all persons who could leave the affected area promptly did so. The spectacular deadliness of the pandemic of 1826-37, which was the first to strike Europe and America, set up a psychological conditioning which assured that all subsequent invasions would induce panic. Normal economic and social life came to an end. Governmental activities were carried out with difficulty. Even medical and nursing services were impaired--sometimes to the extent that the sick were left untended and the dead unburied. Travellers and strangers often were treated badly. Gradually, as an epidemic waned, normal routines were resumed. Practically every community added boards of health and sanitation, which were supposed to take preventive measures against new outbreaks of cholera.
Members of the medical profession, during most of the nineteenth century, were scarcely better off in the face of cholera than laymen. In the first place, they had no idea what caused the disease. Most realized that it was contagious in some way--but the evidence did not suggest a person-to-person contagion as in smallpox, and there were too many unaccountable factors confusing other explanations. Since all infectious disease requires two things for its propagation--a pathogenic organism and a receptive host--one can see that, when the specific causal factor was unknown, the host factor, with its great variations, would not alone satisfy the requirements for a rational explanation. In the second place, physicians had no adequate means for treating cholera, relying primarily on opiates to relieve the cramp pains. The rapid depletion of fluids was recognized, but no satisfactory method of replacing them had been worked out. Modern treatment began in India in the 1905-25 period with the discovery that permanganate neutralized the toxic products of the microorganism, while large scale replacement of fluids, intravenously and otherwise, countered dehydration. Even today, cholera is a disease more easily prevented than treated.
Throughout much of the nineteenth century, there was a lively discussion among the members of the medical profession as to the causes and treatment of Asiatic cholera. A tremendous outpouring of books, tractates, essays, and articles appeared. By the mid-century, confidence in the regular medical profession had reached a low level and even laymen joined the fray, with viewpoints that varied from "scientific" observations of "cholera flies" or unusual weather conditions accompanying an epidemic to outbursts not unlike Jonathan Edwards' description of sinners in the hands of an angry God. A very fine representative collection of this medical and lay literature on cholera was given to the University of Rochester Medical Library by the late Edward G. Miner.
All of the general reactions to cholera--emotional, social, economic, political, and intellectual--which took place in Europe also occurred in the United States. Panic, cessation of business, stoppage of social activities, disruption of government, and a great increase in medical tracts on the disease were all part of the American scene in the 1830's. These not only happened on a large scale in cultural and business centers such as New York, Philadelphia and New Orleans, but also on a small scale in country towns such as Rochester.
Asiatic cholera first reached North America through emigrant ships, arriving at Quebec and Montreal early in June, 1832, and at New York shortly thereafter. As in Europe, it promptly spread rapidly. The epidemic in Montreal was so serious that by mid-June there was considerable concern in Rochester. Reports of the ravages of the dread disease in Europe during the previous year had, of course, been published in American newspapers, and it had been noticed that the spread of cholera followed the main routes of commerce. The Rochester town trustees, fearing that the epidemic would progress up the St. Lawrence to the Great Lakes region, revived the old Board of Health, with Dr. Matthew Brown as President, and sent Dr. Anson Colman to Montreal to look over the situation there. Colman's letter to Brown, now in the University of Rochester Library, is extremely interesting as an example of the medical thinking of the day:
Montreal 27, June 1832
Dear Sir,
Without having had time to arrange & communicate the impressions which I have received from personal observations of cases of Cholera, both on my way and since I arrived in this City, I hasten to say to you that I have evry [sic] facility afforded me of investigating as far as I am qualified the objects of your Board & myself, the results of which I will communicate as early as can be--
I find that the disease although diminished considerably in the number of cases occurring, yet in its mortality remains in nearly the same ratio as in the commencement, other circumstances being equal--
I have seen about forty six cases in the whole, thirty five of which since I arrived in Montreal, and of these cases scarcely one in twenty can recover--still you must not let this statement alarm you nor take is [sic] as a criterion of the mortality with which it will be likely to invade our population-- I have not time to illustrate this declaration, but I have not the least doubt of the fact--
The medical commission sent from N. York, not finding but few
cases on the day of their arrival here went to Quebec and have just returned-- I am availing myself, both of their directions in investigating personally the disease and of their opinions in relation to its pathology & treatment.
I am to have the opportunity of making a Post mortem examination of one of the cases at one of the Emigrats [sic] hospitals at half past five this evening--
One thing only I have time to say & that you must diminish as far as possible the terrifick [sic] apprehension of it [sic] contagiousness-- I have been in evry [sic] situation where if the diseasehad been communicable I should have received it, but have remained perfectly free from the disease-- That the Atmosphere in this City is in a state extremely unfavorable to full health my own sensations fully attest, yet if I should be able to get off in a few days I shall I think escape the Cholera--
One thing more -- I should advise against treating the disease so entirely on the sedative plan should it occur in your place-- I would say more to this point but have not time--
In hase [sic] I remain
Respectfully yours
A. ColmanDr. Brown, Pres. Bd. Health
The mortality rate for cholera in Montreal is given as 95% -- "scarcely one in twenty can recover." This is a high estimate, as Colman indicates. Very careful statistics kept in Berlin and published in the Berliner Cholera-Zeitung, Sept. 24-Dec. 27, 1831, show that during the epidemic of that period, in a population of 230,000 there were 2248 cases diagnosed as cholera, with 1415 deaths, giving a mortality rate of 1 in 163 persons and a morbidity rate of 1 in 106½. The morbidity-mortality ratio affords a better idea of the deadly aspect of the disease: 61.5% of those who contracted cholera died. Although these figures are based on "raw" statistics, with no allowance made for mild or abortive cases, for immunity, for errors in diagnosis and so on, they match the mortality rate figures for India prior to the institution of modern methods of treatment in the early twentieth century. The Berlin figures suggest that the chances of getting cholera were somewhat remote, but the chances of recovering once one had the disease were only fair. Medical historians have shown that the mortality rate in Europe and America decreased with each pandemic. It is possible that the morbidity rate was also less, and this may have been a result of sanitary measures. It is more likely that some decrease in the virulence of the choleraSpirillum was involved, and the early sanitary measures were primarily of aesthetic value.
In Colman's letter it is notable that the cases of cholera which he saw were in the emigrants' hospitals, though natives undoubtedly contracted the disease. Emigrants, of course, brought it from Europe. Rochester's first case arrived, not from Canada, as the Board of Health had expected, but early in July by canal boat from New York. Rochester's City Historian, Blake McKelvey, in his history of the city, has shown that the impact of the disease in Rochester was similar to that elsewhere: panic, flight, and almost total disruption of normal life. There were, however, courageous souls in the town, notably members of the Board of Health and a constable, who provided care for the sick and buried the dead. Public health regulations were enacted on a rather ambitious scale, but apparently could be enforced only with difficulty. The epidemic lasted all summer. In a population of about 12,000, there were around 388 known cases, many being travellers, and 108 deaths. Even allowing a 10% margin for error, the Rochester morbidity rate of 1 in 31 is so much higher than the worst in Europe that one suspects that either there was considerable erroneous diagnosis or the transients accounted for most of the total figure. The Rochester mortality rate, based on these figures is 29%, which is much too low, lending support to the point that there must have been a large number of mistaken diagnoses. European statistics for the same pandemic, assuming a similar strain of the cholera Spirillum, suggest that the number of cases of true cholera should have been about 195, at the 60% mortality rate.
A map of the cases of cholera in Rochester in 1832, made by Donald Henderson for a thesis presented to the University of Rochester School of Medicine, shows that the cases of cholera were mostly in the vicinity of the Erie Canal and the Genesee River, as might be expected. Seepage into wells in the canal area must have occurred, since the canal was most certainly contaminated. Few outbreaks appear to have occurred in outlying regions and the thousand citizens who fled the town apparently were safe.
Colman did not believe that cholera was contagious--all evidence being against a person-to-person or thing-to-person contagion--but he did worry about the unhealthy state of the atmosphere in Montreal. At that time, it was thought that pandemics were caused by some special, altered physical condition of the air which suddenly rendered it poisonous or "noxious." Those who became ill had been exposed to this noxious air or its contents (some theories gave the air a more palpable content such as a miasma or ozone or "noxious effluvia" arising from the sick) . Those who were not exposed to the bad air escaped disease. It was believed that the exposure had to be prolonged through some uncertain period, varying with different diseases, hence Colman's trust that he would escape cholera because he was returning home in a few days.
The "sedative plan" for treatment of cholera, about which Colman was somewhat dubious, consisted in giving large doses of laudanum or other opiates. Other measures were largely palliative, such as keeping the patient warm, and supportive--getting liquids into him if possible. In a day of heroic remedies, notably bleeding, purging, and giving massive doses, treatment of cholera was relatively conservative, probably because the acute stage of the disease killed the patient faster than the "cures" would have done. The opiates at least may have made his demise a little more bearable.
Following the cholera epidemic of 1832, Rochester had a minor flurry in 1834, but public health matters received little attention, according to McKelvey, until 1848 when the threat of a visitation from the new pandemic (which lasted from 1846 to 1863), brought about a revival of interest in sanitation. The Board of Health inaugurated a general sanitary campaign. As a result, when the cholera arrived in 1849, it was greeted fairly calmly. This complacence vanished as the epidemic ran its grisly course. This time, however, more active means were taken to eliminate apparent sources of cholera, such as filthy tenement buildings, stagnant pools, and the like. Separate hospital facilities were provided. A further siege in 1852 brought additional civic action directed towards water and drainage facilities, as well as condemnation of insanitary housing.
Whenever a cholera epidemic was imminent, both medical and lay writers began to study the literature of past epidemics to see what preventive measures could be developed. On the local scene, these writers were joined by speakers, and the Livingston Republican (Geneseo, N. Y.) of February 3, 1853, quoting from the Albany Journal after the fashion of the day, describes an outspoken commentary from a Rochester pulpit:
Intemperance and cholera. -- The pastor of St. Luke's Church, Rochester, in a recent discourse, alluded to the melancholy occurrences of last Summer when so large a number of people were cut down by cholera. He stated that of the whole number of deaths, one-fifteenth were nominally of St. Luke's parish [next the Erie Canal] and of the Protestant portion of the population, one-seventh were in families connected with his congregation. In fifty days he attended fifty funerals. He adds: "Never did I more heartily deprecate the vice of drunkenness, than when on some of those sad funeral occasions. I was not only forced to think of the ghastly tenant of the coffin, as having, as it were, reeled and staggered into eternity, but was also forced to see living drunkards as my attendants to the place of burial, and so under the influence of intoxication, at the very grave, as to be unfit to render the needed aid to those who were to bury the dead. On one such occasion, I remonstrated with the only persons, four in number, who constituted the company at the grave, and all of whom were partially intoxicated; and within three days they had all died of the cholera, and were in their graves, near the spot where I had forewarned them of their danger."
This is a very extraordinary revelation. Coming as it does from the pastor of St. Luke's Church, at Rochester, we are bound to give it full credence. Assuming therefore the truth of the statement, it is evident that Cholera seeks and finds its victims among the victims of Intemperance. But we are surprised to learn that this habit prevailed so extensively in a Christian congregation at Rochester, and especially in a congregation so respectable as that referred to. When the pastor of an Episcopal church in Rochester is called to officiate at the funerals of fifty persons who have "staggered into eternity in fifty days," we find an overwhelming argument in favor of Temperance. When four intoxicated who attend the funeral of an associate are themselves swept off by Cholera, in three days afterwards, it seems needless to look further for the causes of Cholera.
This type of utterance was one of the more popular explanations for the sudden devastating pestilence. The malicious thought presents itself: if the inebriates had been sufficiently sober to avoid drinking water they might have survived.
Another explanation of this general type was that which ascribed epidemic disease to Divine Wrath. Since the Scientific Revolution, however, interpretations of a more earthly and less personal nature have been sought and found in case after case. Richard Shryock, in his Development of Modern Medicine (2nd ed., New York, Knopf, 1947), writes that "the connection between bad living conditions and cholera was too obvious and too dramatic to be overlooked. After 1831 there was a sudden increase of interest throughout Europe and America in the whole problem of public hygiene. Fear now combined with humanitarianism to demand investigations, cleanups, and general sanitary reform, as these things had never been demanded before. Whenever enthusiasm waned, further invasions of cholera, supplemented by occasional outbreaks of yellow fever, typhoid, typhus and smallpox, terrified authorities into renewed activity." The net result was an effective system of sanitary regulation.
Rochester did not have an invasion of cholera after 1852, though the next pandemic (1865-75) struck twice in the United States, affecting New York City, the South and Middle West in 1866, and a wide central region from New Orleans to the Canadian border in 1873. Good quarantine and isolation measures localized the New York outbreak and, of other cities in the East, only Philadelphia suffered seriously. Rochester's escape may be attributed to lack of exposure to infection rather than to any superlative public health situation, though this had improved greatly since the 1832 epidemic.
The Rochester Board of Health was seriously hampered in the mid-century by lack of funds, reflecting public apathy in non-epidemic periods. When cholera threatened in 1873, the Board received more support, and its activities gradually expanded. Able leadership provided efficient service. By 1890, census figures revealed that Rochester had one of the lowest death rates in the United States, and the lowest in the eastern part of the country.
The value of health to a city is very great, though not always fully appreciated. Rochester's rapid growth and increasing prosperity since 1890 partially reflect the good public-health situation. And the hardworking Board of Health owed its influence, in no small degree, to the ominous presence of Asiatic cholera, which literally scared people into taking adequate steps for their own protection.
THE ROCHESTER GEM.
EDITOR'S TABLE.--JULY 21, 1832.
CHOLERA.
We embody each day the new cases of cholera, and notice its appearance in different places.
Rochester.--July 14. The Board of Health of this village, reported 2 new cases. One is since dead, the other convalescent. No new cases since.
New York.--July 11. 129 cases, 50 dead. July 12. 119 cases, 51 deaths. July 13.- 101 cases, 49 deaths. July 14. 27 cases, 6 deaths.
The disease is increasing fearfully. July 15. New cases 133, deaths 74. July 16. New cases 163, deaths 94.
Albany. -July 11. 28 cases, 9 deaths.-- July 12. 10 cases, 3 deaths. July 13. 28 cases, 7 deaths. Ju1y 14. 17 cases, 6 deaths. July 16. New cases 29, deaths 7.
Buffalo.--One case has occurred, and proved fatal. The man had 3 pounds 10 ounces cherries, currants, &c. in his stomach! July 13. 7 new cases reported. July 15. The board report 1 new case, that of a drunkard who died in 8 hours.
Ogdensburgh.--July 10. 13 cases, 5 de'ths.
Detroit.--On the 9th, 16 cases--9 among the soldiers, 5 of whom died. 8 among the citizens, 4 of whom died. July 10. 2 new cases.
N. Haven, Ct.-- Two cases have occurred in this city.
Kingston, U. C.--July 6, whole number of cases 152, deaths 48.
Hallowell. July 5--17 cases, 5 deaths.
Montreal and Quebec. The cholera has nearly disappeared.
Prescott.--July 9, there had been 81 cases,. and 33 deaths.