“The Just Wrath of Heaven”: Perceptions of Cholera in Nineteenth-Century Philadelphia Marina Gonzalez A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Bachelor of Arts in History, University Honors Professor Mary Frances Giandrea, Faculty Advisor, History American University, Spring 2012 Gonzalez 1 “The Just Wrath of Heaven”: Perceptions of Cholera in Nineteenth-Century Philadelphia This study investigates the 1832 cholera epidemic and how it was perceived in the city of Philadelphia. I examine the ways in which contemporary medical and popular discourse on the nature of cholera served to enforce social power structures that marginalized the poor, ethnic and racial minorities, and women. Because cholera was a disease few Americans had encountered before 1832, little was understood about its causes or manner of transmission. As a result, medical authorities, city officials, and the public attempted to make sense of cholera by creating a narrative to explain its origin, spread, and effects. The way cholera was represented by the people of Philadelphia exposes cultural beliefs and biases of the time, as well as power relations, reflected by the groups that were determined to have introduced cholera to the city and the kinds of people who were believed to harbor the disease. I use contemporary newspapers, medical texts, sermons, and other documents to determine these how these beliefs evolved during the 1832 epidemic and in the surrounding years. Most theories portrayed cholera as a disease of the dissolute, dirty, and immoral, blaming members of society’s lowest rungs for the spread of the disease. Using the language of individual responsibility, popular media shifted the blame away from the larger structural factors that led to poverty and unsanitary urban conditions, preserving the status quo. Introduction In 1832, Americans waited in fearful anticipation as news of cholera poured in from European cities. Prior to the 1820s, cholera had existed as an endemic disease in India, but the globalization of commerce allowed it to spread through Russia, Eastern and Western Europe, and eventually the Americas by the early 1830s. Cholera seemed unstoppable; it passed through the heavily-guarded cordon sanitaire separating Western Europe from Russia and the strict quarantines of the European ports, leaving a trail of death in its wake. While it was not the greatest killer of the period, the speed and violence with which it killed made it extremely frightening.1 A seemingly healthy person could be seized without notice in the middle of an afternoon walk and be dead by night time.2 Additionally, there was little medical knowledge available to explain how cholera spread or how to cure it. As a result, people had to come up with their own explanations for how the disease behaved. Epidemic diseases like cholera 1 Erin O’Connor, Raw Material: Producing Pathology in Victorian Culture (London: Duke University Press, 2000), 32 2 Charles E Rosenberg, The Cholera Years (Chicago: University of Chicago Press, 1987), 3. Gonzalez 2 function as good markers of social beliefs because they disrupt everyday life and require a society to come up with accounts that make sense of the chaos.3 In order to make cholera logical, it was essential to assign it a narrative to explain its birth, spread, and effects. Part of the narrative-making process involved the creation and dissemination of medical knowledge on the disease. While these actions may seem value-free, both medical ‘fact’ and public opinion on cholera were molded by the cultural beliefs of American society at the time. Because of the lack of factual knowledge concerning cholera, physicians and the general public interpreted the disease through the lens of the dominant ideologies of the nineteenth century, which shaped the beliefs people held about what cholera was, where and how it originated, and how it was transmitted. These beliefs determined municipal policy intended to combat the spread of cholera, with a concrete effect on people who were considered threats to public health. Therefore it is essential to examine the accepted ideologies in American society in the period leading up to the first cholera epidemic in order to understand how cultural prejudices shaped the public’s beliefs about cholera and how these beliefs upheld dominant power structures. For much of the nineteenth century, American beliefs were based on middle class Protestant moral codes. These codes included negative conceptions of poverty as well as prejudice against African Americans, immigrants, and prostitutes, all of which helped to shape the views that public officials, medical authorities, and the public in general held about cholera. By blaming stigmatized groups for the introduction and spread of cholera, members of more privileged groups were able to reassure themselves that they were in no danger as long as they complied with moral codes. 3 Philip Alcabes, Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Death to Avian Flu (New York: PublicAffairs, 2009), 5. Gonzalez 3 In essence, my research question is: how did the beliefs that medical authorities and the public in general held about the poor, immigrants, African Americans, and prostitutes influence their conceptions of cholera, and what effect did this have on public health policy? The Cholera Context Cholera is caused by the Vibrio cholerae bacterium, which is transmitted in humans via the ingestion of food or water contaminated with infected excretions. Infection is most common in countries with poor sanitation systems, because in these places the contaminated substances are more easily able to enter waterways and drinking water supplies. While a majority of people who are exposed to the bacterium remain asymptomatic, the disease has debilitating consequences on those it does affect.4 The cholera bacteria infest the person’s digestive system and give off a toxin that disrupts the normal transport of water and salt in the lumen of the small intestine.5 This is the section of the intestine through which food passes so that nutrients and water may be absorbed, and the disruption caused by the cholera toxin wreaks havoc on the absorption process. The toxin reverses the absorption process, causing the cells lining the intestine to pull water from body tissue and eject it into the lumen, from which it is excreted with great force.6 The massive quantity of watery diarrhea produced combines with near-constant vomiting to dehydrate the patient to fatal levels within a few hours. If left untreated, death occurs in about fifty percent of cases.7 The treatment for cholera, however, is relatively simple and highly effective. Antibiotics may be administered, but oral rehydration therapy is equally 4 Aaron A. King, Edward L. Ionides, Mercedes Pascual, and Menno J. Bouma, “Inapparent Infections and Cholera Dynamics,” Nature 454 (14 August 2008): 877. 5 Alcabes, Dread, 57. 6 Alcabes, Dread, 57. 7 Alcabes, Dread, 57. Gonzalez 4 successful. This method was officially developed in the 1960s, but simple forms of it existed as early as the 1820s.8 Cholera originated in the Indian subcontinent, circulating there for centuries as what was likely a mild form in equilibrium with the human population.9 The entrance of the British into India, with the resulting increase in population density and introduction of faster means of transportation, created an environment that allowed the disease to spread and become more virulent. The first colony-wide outbreak began simultaneously in Jessore and other cities of the Bengal province in 1817.10 From there, cholera followed British troops and trade routes to reach Asia and the Middle East by the mid-1820s. It traveled with the Russian army from Turkey to Moscow in 1829 and then to Poland the following year.11 From Russia and Poland, cholera made its first trip into Western Europe, reaching the United States by 1832. In total three epidemics would reach Philadelphia: one in 1832, a second in 1849, and the last in 1866. Cholera passed through Philadelphia several times between these three epidemic years but did not cause the same level of devastation on those trips. In each case, cholera first visited Europe and then struck the United States in the summer of the following year. As a result, Philadelphians could read about cholera’s path of destruction for months before the disease crossed the Atlantic. The early notice allowed the city to make preparations in order to reduce the number of cases, such as setting up quarantines, performing street cleaning, and establishing temporary hospitals. Physicians used the grace period to communicate with their peers in cholera-stricken countries and to come up with new explanations and cures for the disease. The educated public participated in the medical debate to a large degree, consuming news and writing in to 8 Alcabes, Dread, 58. 9 Alcabes, Dread, 59. 10 The Cholera Gazette (Philadelphia: Carey, Lea, & Blanchard, 1832), 17. 11 Alcabes, Dread, 59. Gonzalez 5 newspapers themselves. Specialized cholera-themed papers, such as Philadelphia’s Cholera Gazette, were printed in several cities throughout 1832 and could barely print enough issues to fulfill public demand.12 . Physicians endlessly debated cholera’s means of transmission and whether it was a contagious or non-contagious disease. At this time, doctors accepted that some diseases, like smallpox, could be communicated between people. Supporters of the contagion model for cholera argued that the disease