Knowledge in the Time of Cholera (7 page)

Focusing on the epistemic contest over medicine as determinative in the professionalization of U.S. medicine opens an analytical space for understanding the nature of the ascendancy of the bacteriological model and the triumph of allopathic medicine over other alternative medical sects. The history of this epistemic contest yields a surprising, and disconcerting, finding, namely that the genesis of the U.S. medical system involved a repudiation of democratic principles. It also serves as an example of what the sociol
ogy
of epistemologies (Abend 2006, 3) can achieve, what an empirical focus on epistemology can tell us about the power/knowledge nexus (Foucault 1980). By taking a quixotic journey into the history of American cholera, we gain insight not only into the strange world of professionalization of U.S. medicine but also into the general politics of knowledge and the everyday practices of epistemology in democratic cultures.

1

CHOLERIC CONFUSION

When cholera first attacked Europe in 1831, physicians were caught so unprepared that they struggled to even name the new malady, much less prevent its spread.
¹
Among the names suggested were “cholera asphyxia,” “spasmodic cholera,” “malignant cholera,” “bilious cholera,” “convulsive nerve cholera,” “hyperanthraxis,” and the particularly poetic “blue vomit” (Longmate 1966, 66). Eventually, the disease was anointed “cholera,” a curiously misleading choice, given the amount of baggage the term bore. Under the centuries-old Hippocratic system, cholera referred to an excess of yellow bile (Hamlin 2009, 19). Over time this humoral definition morphed into a more generic stand-in for milder diarrheal diseases. Now, in the panicked days of the first pandemic, cholera underwent another definitional transformation—from “a transitory state of one's constitution” to “a relentless and deadly invader” (Hamlin 2009, 20). This hasty christening caused much confusion among physicians and officials. The victimized poor, on the other hand, suffered no such appellative confusion; to them the new disease was known simply as “the pestilence.”

Whatever its name, the new disease killed in a dramatic fashion. Doctors marveled at the speed at which cholera claimed those in their prime (Rosenberg 1987b). According to Dr. M. Magendie (1832, 6), of Sunderland, cholera “cadaverizes
in an instant the person whom it attacks
.” Victims purged an abundant amount of “rice water” diarrhea. A “loose and relaxed state of the bowels” was attended “by frequent loose or watery discharges” (Atkins 1832, 65) with up to 10 percent of a person's weight lost within hours. But cholera's most macabre symptoms were the “cholera voice” and the surreal color of its victims. Patients took on an eerie bluish pallor just before dying, a ghastly visage of impending death. And the blue victims emitted strange sounds. One haunted doctor reported in the
Boston Medical and Surgical Journal
(
BMSJ
), “In the most deadly form of cholera there is a tone of voice, a wail, which once heard, can never be mistaken; by him, upon whose ear
it
has fallen in the accents of anguish, it can never be forgotten” (“Cholera Voice,” 1832, 148). More than the number dead, it was the nature of cholera that caused it to loom large in the popular imagination (Humphreys 2002).

Cholera plunged Europe into turmoil. Hungary and France each lost over one hundred thousand people to the disease. Cholera claimed another fifty-five thousand in England. These raw mortality counts only hinted at the horrors on the ground. Europe's inadequate infrastructure of charitable organizations and government institutions was overwhelmed. Churches were converted into makeshift hospitals, while their cemeteries swelled. A report from Paris described the deteriorating scene: “The deaths are so numerous every day that hearses have become altogether inadequate to the purposes for which they are ordinarily used, and the dead are carried to their burial places in large wagons” (
BMSJ
1832b, 254). Cholera killed its victims quicker than communities could bury them (Grob 2002, 108). Wherever it touched, cholera produced a type of “epidemic psychology” (Strong 1990) of suspicion, fear, and stigmatization. The feeble actions adopted by European governments heightened tensions, often resulting in riots fueled by rumors of physician-led conspiracies against the poor (Briggs 1961; Burrell and Gill 2005; Durey 1979; Morris 1976). Faced with the breakdown of the social fabric, many looked to the heavens, conjuring up supernatural explanations for cholera. Seizing this opportunity, shrewd religious leaders used the scourge to admonish their flocks for their moral laxity.

Anticipating cholera jumping the Atlantic, American physicians scoured reports from Europe for any useful information on the disease. The editors at the
Boston Medical and Surgical Journal
(1831a, 5) instructed every American physician “to watch with eagle eye the progress of this dreadful malady, and to treasure up in his mind every incident in its history which may aid in forming philosophical views with regard to its treatment.” But the profuse reporting offered scant medical intelligence (Hamlin 2009, 110). Measured analyses were difficult given the circumstances. Helpless in the face of “King Cholera,” European doctors could not agree on the most basic details of the disease. Was it a new disease or a more virulent form of an old one? What was its cause? Did it prey on the weak and immoral or kill indiscriminately? Which treatments were most effective? As doctors impotently mulled these questions, deaths accumulated. Hope dwindled. Having tried “every means sanctioned by recorded experience,” a London physician voiced the futility felt by many European doctors: “To our patient, laboring under a violent and advanced attack of Spasmodic Cholera, no solid expectation of recovery
could
be extended” (
BMSJ
1831a, 8). Eventually, American physicians gave up on gaining any insight from abroad. An anonymous letter to the
BMSJ
(1832a, 189–190) summed up the situation:

We have nothing, therefore, to learn from the practice of the most distinguished physicians in Europe, except to notice their errors, and to avoid the rocks and shoals upon which they have made shipwreck. Let us turn these scenes of horror to the writers of our own country. . . . Seeing the utter failure of the European physicians, in their treatment of the present epidemic, it behooves our practitioners to make themselves masters of all principal writers of their own country, who have been familiar with cold, sinking febrile disease.

While few doctors clung to the hope that cholera would not reach the United States or that the country's salubrious environment would limit its spread, most resigned themselves to the fact that they would get the chance to see the disease for themselves, as the Atlantic Ocean was no longer an insurmountable barrier for Europe's problems given advances in sea travel.

On June 26, 1832, the inevitable occurred. Cholera arrived in New York City, by way of Canada. An Irish immigrant named Fitzgerald came down with a strange intestinal illness. Dr. Cameron, a New York physician,

found him [Fitzgerald] violently affected with vomiting, purging, and most convulsive spasms; the features sunken and the eyes staring; the pulse insensible at the wrist, and the surface cold, and covered with clammy sweat; the countenance black and terrific; tongue of a dark purple during spasms, becoming opalescent as the spasmodic action abated; the fluid rejected was watery, consisting probably of the liquids he was permitted to drink; his dejection resembled rice water, of the consistence of cream. (
BMSJ
1832d, 354)

Undoubtedly a case of cholera. Fitzgerald recovered, but his wife and children contracted the disease and died. Cholera quickly spread through the poorest districts of the city, with the infamous Five Points neighborhood—a place that Charles Dickens (2000,101) described as encompassing “all that is loathsome, drooping, and decayed”—suffering the brunt of the attack (Grob 2002, 105). Initially, city officials debated whether or not to announce cholera's arrival. The stakes in such a decision were high. Officials, worried
about
the economic, political, and social ramifications of such an announcement, dawdled (Duffy 1968). In response, the city's medical society accused the board of health of being unconscionably slow in alerting the public, resulting in unpreparedness and unnecessary death. This spat fueled panic among the public, as it appeared that officials could not agree on even the most basic of issues—whether or not cholera had reached the city. No one seemed to know what they were talking about. Dr. David Meredith Reese (1833, 3) recalled,

The great ignorance of the unprofessional portion of our population on the subject [cholera] was obviously the prolific source of much imprudence, and threw the timid into a consternation and terror which prevented the adoption of any uniform and rational mode of prevention; while, at the time, the vague as well as contradictory opinions which have found their way into the public press, upon the subject of the causes, prevention, and cure of Cholera, have been very far from inspiring confidence in the members of our profession; and in such perilous times, this confidence is more than ever necessary and important.

Cooler heads were failing to prevail.

While officials argued, many abandoned the city to cholera's chaos. John Pintard, a successful merchant, respected philanthropist and former secretary of the New York Chamber of Commerce, documented the deteriorating scene in letters to his daughter. Early in the epidemic, on July 3, Pintard expressed skepticism toward the “unnecessarily alarmed” doctors, opining that “at best we are likely to have a sickly season but we are not timid & shall stand our ground” (Pintard 1832, 66). Steeled by his military pedigree and strong Huguenot faith, Pintard refused to flee the city, unlike many of his fellow New Yorkers. Independence Day celebrations were canceled. Only churches remained open for mourners to pray for their victims, thus transforming the celebratory holiday into a somber occasion of fasting and prayer. By July 8, Pintard (1832, 69) observed, “The city is much deserted & the panic prevails.” Still Pintard stood fast, comforted in the belief that cholera only attacked “intemperate dissolute & filthy people” (Pintard 1832, 72). By the end of the month, however, even this false hope was dashed, as he reported the deaths of a friendly neighbor, a “hard-working” mechanic, and three physicians. Faced with the magnitude of the epidemic, Pintard, like many, turned to religion. Although President Andrew Jackson refused
to
proclaim a national day of prayer and fasting, state governments did, and Pintard abided by New Jersey's July 26 day of fasting.

Faces of cholera, from Horatio Bartley,
Illustrations of Cholera Asphyxia in Its Different Stages, Selected from Cases Treated at the Cholera Hospital, Rivington Street
(New York: S. H. Jackson, 1832). Collection of the New York Historical Society.

While Pintard captured the panic among the living, an apothecary named Horatio Bartley (1832) memorialized the dead, sketching haunting images of cholera victims from the Rivington Street Hospital. His sketches show blue-hued, skeletal faces, writhing in pain. The victims' sunken eyes betray no awareness, revealing another of cholera's more unnerving symptoms—“the entire loss of all consent, sympathy, or catenation . . . between the brain and the nervous system, and the heart and the sanguiferous system” (
BMSJ
1833a, 271). Victims were literally severed from their corporeality, assuming a ghostly countenance.

As summer went on, the blue visages of cholera became a common sight throughout the United States. By the end of the epidemic in New York City, where cholera deaths reached their peak on July 19, 3,515 people had died out of a population of 250,000. With riverboats its chief mode of transportation (Chambers 1938), cholera spread south, first toward Philadelphia and reaching the South in late August. By late September cholera had “extended as far south as Edenton, North Carolina, and westward to St. Louis” (
BMSJ
1832e, 253), with New Orleans suffering the brunt of the outbreak. It also traveled
westward
via the Erie Canal and the Cumberland Road (Grob 2002, 105). Local attempts to pull together ad hoc medical committees to mount a defense were unsuccessful. Towns employed a variety of measures to prevent the epidemic to no avail, constructing roadblocks, imposing quarantines, even shooting cannons into the air in an effort to alter the poisonous atmosphere. Wheeling, West Virginia, undertook one of the more unusual plans:

To test the virtue of coal smoke and heat in staying the epidemic, cart loads of coal were deposited at intervals of fifty yards along each side of the principal streets and fired; the volumes of dense black smoke enshrouding the town—deserted streets, except by the frequent funeral train—sorrow and alarm depicted on every face, formed a scene more easily imagined than described; its impressions are still very vivid in my mind. (Hildreth 1868, 228)