http://www.nytimes.com/2008/04/15/science/15chol.html
How Epidemics Helped Shape the Modern Metropolis
By JOHN NOBLE WILFORD
Published: April 15, 2008
On a Sunday in July 1832, a fearful and somber
crowd of New Yorkers gathered in City Hall Park
for more bad news. The epidemic of cholera,
cause unknown and prognosis dire, had reached
its peak.
People of means were escaping to the country.
The New York Evening Post re****ted, "The roads,
in all directions, were lined with well-filled stage-
coaches, livery coaches, private vehicles and
equestrians, all panic-struck, fleeing the city, as
we may suppose the inhabitants of Pompeii fled
when the red lava showered down upon their houses."
An assistant to the painter Asher B. Durand
described the scene near the center of the outbreak.
"There is no business doing here if I except that done
by Cholera, Doctors, Undertakers, Coffinmakers, &c,"
he wrote. "Our bustling city now wears a most gloomy
& desolate aspect -- one may take a walk up & down
Broadway & scarce meet a soul."
The epidemic left 3,515 dead out of a population
of 250,000. (The equivalent death toll in today's city
of eight million would exceed 100,000.) The dreadful
time is recalled in art, maps, death tallies and other
artifacts in an exhibition, "Plague in Gotham! Cholera
in Nineteenth-Century New York," at the New-York
Historical Society. The show will run through June 28.
The outbreak, as ****trayed in the exhibition & other
do***entation, highlighted the vulnerabilities of life in
overcrowded cities in a time of deplorable sanitation
and before medical science recognized the role of
germs in disease. Cities were growing faster in
population than in understanding what it took to make
them fit places to live -- an urban problem probably
as old as the Sumerians of Mesopotamia.
The initial response to the epidemic, Kenneth T.
Jackson, a professor of history at Columbia University,
said recently, exposed more than ever the city's
divisions of class, race and religion. The disease hit
hardest in the poorest neighborhoods, particularly the
slum known as Five Points, where African-Americans
and immigrant Irish Catholics were crowded in
squalor and stench.
"Other New Yorkers looked down on the victims,"
said Dr. Jackson, editor of The Encyclopedia of
New York City. "If you got cholera, it was your own fault."
Unlike most upper-class residents, John Pintard,
the respected civic leader who was the historical
society's founder, remained in the stricken city.
His letters to one of his daughters are included
in the exhibition.
The epidemic, he wrote in an attitude typical of his
peers, "is almost exclusively confined to the lower
cl***** of intemperate dissolute & filthy people
huddled together like swine in their polluted habitations."
In another letter, his judgment was even harsher.
"Those sickened must be cured or die off, & being
chiefly of the very s*** of the city, the quicker [their]
dispatch the sooner the malady will cease."
Dr. David D. Ho, a biomedical scientist at Rockefeller
University, noted the similarities between the views
on cholera and the initial reaction to a more recent
epidemic that took science by surprise: AIDS.
When the first AIDS cases were re****ted in 1981,
the victims were almost all white gay men.
They were treated as outcasts.
"It was a repeat of the cholera experience," said
Dr. Ho, the founding chief executive of the Aaron
Diamond AIDS Research Center. "The cause of
the disease was unknown, and it affected a subset
of the population. It was easy to brand the victims
and blame the disease on their lifestyle."
Scientists moved quickly and effectively to isolate
the virus that causes AIDS, which is by no means
confined to gay men and is rampant in developing
countries, particularly in Africa.
Science and medicine advanced more slowly in
the 19th century. It was 1883 before the bacterium
Vibrio cholerae was discovered to be the agent
causing the gastrointestinal disease. But a turning
point in prevention came in 1854, when a London
physician, Dr. John Snow, established the
connection between contaminated water & cholera.
Dr. Snow tested the idea by plotting cholera cases
on a map of Soho. This showed that most of the
victims drew their water from a public pump on
Broad (now Broadwick) Street. An infected baby's
diapers had been dumped into a cesspool near
the well. A recent book, "Ghost Map," by Steven
Johnson, recounts the discovery.
The cholera research was an early application of
mapping in medical investigations, a technique
that has become widespread now that computers
facilitate the display and analysis of such data.
Historians of medicine credit Dr. Snow with
advancing the modern germ theory of disease &
laying the foundations of scientific epidemiology.
The cholera menace thus prompted cities to begin
cleaning up their fouled nests. This came too late
for victims of the 1832 epidemic in New York, or
one that followed in 1849. By then, the city's
population had doubled, to 500,000, and deaths
by cholera rose to 5,071.
The city in 1832 had expanded as far north as
14th Street. People were squeezed out of the
lower wards by the influx of immigrants. Some,
escaping earlier outbreaks of malaria and yellow
fever, had sought a haven in the clean air and
open land of the village called Greenwich.
Walking in Greenwich Village today, one is
struck by the number of small brick houses
bearing markers with dates immediately after
1832. It may be no coincidence that John Blauvelt,
a carter working the piers, built his on West 10th
Street (then Amos Street) the year after the
cholera epidemic.
New Yorkers should have suspected that the
scourge was on its way. Cholera, originally
confined to South Asia, had started spreading
in 1817 from sea****t to sea****t, presumably
carried by infected sailors. The disease struck
London in 1831 and reached New York the next
June.
No one was prepared, not even doctors. They
generally believed that miasmas, the noxious
va****s from rotting organic matter, carried
infections, an idea inspiring literature of death
in Rome and Venice. The cholera in Five Points
seemed to bear out the hypothesis.
Five Points was a slum that had metastasized
from an intersection of five streets north of City
Hall through the area that is now Foley Square
and Chinatown. "All that is loathsome, drooping
and decayed is here," Charles Dickens wrote
after a visit. Martin Scorsese's movie "Gangs of
New York" captures the lowlife there later in the
19th century, when it was still an urban sinkhole.
The exhibition includes illustrations of the thugs
and gamblers, the stray dogs and pigs that
inhabited the streets of mud and manure. The
pigs at least were useful as garbage collectors
and sources of food.
For victims, the onset of cholera was sudden:
an attack of diarrhea and vomiting, followed by
abdominal cramps and then acute shock,
signaling the collapse of the circulatory system.
Some survived the illness, despite the lack of
effective remedies.
Posters from the time described recommended
treatments, including laudanum (morphine),
calomel (mercury) as a binding laxative, and
camphor as an anesthetic. High doses sometimes
did more harm than good. Poultices of mustard,
cayenne pepper and hot vinegar were also applied,
as well as opium suppositories & tobacco enemas.
Many victims, nearly half the cases at one hospital,
died within a day of admission. After private
hospitals began turning away patients, the city
set up emergency public hospitals in schools and
other buildings. One, on Rivington Street, bore the
brunt, and sketches of its patients' faces contorted
in the throes of death look down from the exhibition
walls.
In stark contrast, Asher Durand, who had escaped
with his family to their country home in New Jersey,
painted his children happily eating apples in a
sunny orchard. The idyllic canvas hangs a few feet,
and a world, away from the scenes of Five Points.
While many Protestants sat out the epidemic at
safe distances, the city's Catholics, many of whom
were poor immigrants, mostly Irish, had no choice
but to stay. Their nuns and priests also remained
to offer comfort and some help, and they emerged
as the few heroes in the ordeal. "The Sisters of
Charity performed heroic service, and many of
them died," said Stephen R. Edidin, co-curator
of the exhibition, with Joseph Ditta. "As a result,
there was some reduction of anti-Catholic senti-
ments and a new respect for the Catholic clergy,
who risked their lives in the epidemic. The feeling
didn't last, of course."
Despite the epidemics of '32 and '49, people
still flocked to New York and other teeming cities.
But the first outbreak bolstered sup****t for the
Croton Aqueduct system to bring clean upstate
water to the city, a project, completed in 1842,
that led to the phasing out of private and neighbor-
hood wells that were often polluted with human
and animal waste. In 1849, the municipal govern-
ment banished more than 20,000 pigs to the outer
reaches of the city. A similar effort in previous
years had provoked riots, but this time a public
chastened by epidemic complied.
Finally, after the work of Dr. Snow in London
and a lesser cholera outbreak in New York in
1866, the Metropolitan Board of Health was
established with doctors in commanding roles
and broad powers to clean up the city. Inspectors
went to houses and burned clothing of people
who had just died. They cleared the filth, spread
lime and instructed survivors in proper sanitation.
Cities had learned, or should have, that epi-
demics as a consequence of urbanization were
their responsibility to prevent and control.
Cholera is still a threat wherever drinking water
is polluted. But Dr. Ho says that people should
no longer die of it, if they are treated promptly
and properly with rehydration fluids to restore
their ravaged bodies.
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