Poverty and Cholera

It would of course be comforting to think that this moral obtuseness was peculiar to Englishmen. It seems, however, to have been prevalent in America as well, and the cholera epidemics of the last century bring the thing into focus.

In 1832 the first epidemic of Asiatic cholera struck the United States. It was a complete mystery; no one knew what caused it or how it was transmitted, but since it passed most rapidly through areas where water and food supplies could be contaminated—and such areas were numerous in American cities of the 1830’s— it seemed likely that cholera was a natural accompaniment of filth, misery, vice, and intemperance. Loose living, in short, brought on cholera, and the man who died of it probably had himself to blame. It attacked mostly “the very scum of the cities,” and the scum would not have caught it if its members had not consented to be part of the scum.

The case is analyzed in The Cholera Years , by Charles E. Rosenberg, a book which can properly be taken as a sort of sequel to Mrs. Woodham-Smith’s study of the Irish famine. The epidemic of 1832 was wholly incomprehensible to the people of that time, and medical science was incompetent to provide any solution. All anyone could see was that the disease raged most violently in the slums, which were full of ignorant immigrants who perversely chose to live in filth and poverty. It seemed evident that cholera struck chiefly at the sinner and the poor, who had brought it on themselves. The sinner, intemperate in all things, laid himself wide open, obviously, and the poor man usually was poor because he was intemperate, improvident, and more or less immoral, and so what happened to both was nothing less than a Godly man might have anticipated. All in all, cholera appeared to be a result of increased immigration.

So the epidemic of 1832 was dismissed as a natural result of the evil ways of ignorant people who probably ought not to have come to America in the first place. There was another outbreak in 1849, but once again “the well-nourished, the prudent, and the temperate” —that is, the people who had money enough to live in decent surroundings, and who could flee the city when the infection spread—seemed to escape; which only emphasized the fact that the epidemic must be a natural visitation on those who chose to live in slums.

The Cholera Years , by Charles E. Rosenberg. University of Chicago Press. 257 pp. $5.95.

At the same time, it began to dawn on people that there was some sort of connection between lack of public sanitation and the outbreak of cholera, and now and again right-living people who did not prefer to live in slums were stricken. It remained clear that most cholera victims had only themselves to blame, but there were exceptions, and perhaps something could be done. One journalist suggested cynically that the best way would be to bribe the New York City council to enforce regulations about sanitation; and when one residential street was at last cleared of knee-deep filth that had been there for many years, a lady looked out on the pavement which was visible for the first time in her life and asked, in bewilderment: “Where did those stones come from?”

But as Mr. Rosenberg points out, cholera was not just a blight that struck the city slums. Cholera went west, ravaging country towns like Kenosha, Wisconsin, destroying a tenth of the population in St. Louis, afflicting the idyllic Ohio town of Sandusky even worse, hitting villages and army camps, and killing ten thousand slaves in the almost excessively rural Southland. It was impossible to do anything about it, partly because even the wisest men did not know what to do and partly because of the old belief that cholera came from vice and vice came from poverty and poverty was pretty largely self-inflicted. People who chose to be poor and vicious would get cholera, and that was all there was to it.

… Not quite. Slowly but surely, the facts of life began to dawn even on people whose native insensitivity had insulated them from reality. Cholera came out of poverty, and poverty was considered a moral rather than a social phenomenon; still, cholera did jump the fence occasionally, and now and then people of the better sort were stricken, not to mention industrious artisans who resisted the temptations of evil living. Possibly society itself ought to do something about slums, filthy streets, contaminated water systems, and overcrowded housing. Possibly a society that put up with such things was going to have epidemics which would, on occasions, go out of bounds and smite down people who lived amid better surroundings. Cholera called for social reconstruction.

In 1866 there was another outbreak, and by this time medical science had learned something. It had begun to see that this was a contagious disease, and it was not simply a product of loose living, intemperance, and vice. Public sanitation was all to the good, but a scientific attack on the specific channels of infection might be even better. New York City by now had a board of health, with broad powers and a disposition to work at its job—and suddenly it developed that this new epidemic was, in comparison with the two previous ones, relatively harmless. Cholera could be controlled, not by pious criticisms of vice and poverty, but by disinfection and quarantine. It was a social problem.

Credit much of this, of course, to the simple fact that doctors knew more in 1866 than they had known in 1832. Credit some of it, though, to an increased awareness that it is good to worry about what happens to the other man, if for no better reason than the fact that what happens to him may also happen to you.