The Black Cholera Comes to the Central Valley of America in the 19^th Century - 1832, 1849, and Later

Abstract

In mid-19th Century, cholera was epidemic throughout the world. Small towns of the American Midwest were not spared.

The disease was blamed on miasmas arising from local causes, so flight from affected localities were logical and common. Flight, added to mortality, caused virtual depopulation of many small towns.

Drinking water was drawn from rivers or shallow wells, often near seeping cesspools.

Local merchants tried unsuccessfully to calm panic by suppressing information. Cholera was not good for business. Business was depressed. Organized religion thrived. National and state days of prayer were appointed to appease an angry God.

During these frightening times, the people learned nothing about the infectiousness of cholera or about its prevention through sanitation. Their experiences tended to reinforce their belief in miasmas or divine retribution.

The great epidemics of mankind describe human behavior in times of unavoidable and incurable crisis. Nineteenth Century cholera experiences illustrate a people's reaction to catastrophic disease, which they believed was incurable and unpreventable.

Introduction

Much has been written about the world's experience with cholera in the 1830s, 1840s, and later 19^th Century. Little has been written about cholera's effects on small town mid-America. It was entirely new to this continent. Its appearance in North America stressed many newly developed social structures.(¹)

This was a time when cholera's infectiousness was denied by accepted authorities. In general, cholera was blamed on miasmas, filthy living conditions, especially the poor blacks and Irish. The religion of the Irish immigrants was especially troublesome. Some blamed the sinful behavior of whole population groups and the just wrath of an angry God.

Sanitation was casual. Drinking water was either dipped or pumped from shallow dug wells, rivers or lakes. Water sellers carried water drawn from wells or rivers. Sewage was deposited by individual households in streams or in cesspools which were allowed to overflow or seep into nearby sites. Water sources and sewage disposal were positioned for convenience, not safety - often so close together that the odor and taste of drinking water was a problem.

The cholera experience is often considered as separate epidemics-1832, 1849, 1866, and the late 1870s. In reality, the boundaries were not so sharp. Further, nothing had been learned about the disease, its prevention or its treatment between the 1832 and 1849 episodes. The only real differences were that by 1849 the populations were larger and transportation was more rapid and less dependent upon water routes. Thus, cholera was moved with greater ease to more people.

Orthodox cholera treatment in that period would have been recognized by Galen. Bleeding, purging, and opium were used. Astringents such as lead acetate were often prescribed. Some advocated oral salt solutions-even intravenous solutions-but the idea was not accepted, though a few reported excellent results.(²) There was no objective means of diagnosis. Physicians viewed cholera as a severe and often fatal disease. Milder diarrheas occurring in the setting of severe cholera were usually taken to be other diseases. This mistake led to even further spread of the disease and confusion about treatment.

CHOLERA IN MIDWESTERN SMALL TOWNS

The story of Midwestern cholera and its effects can no longer be found in the memories of the people now living in the towns that were affected. It has been lost from local histories or reduced to short vague paragraphs, except in a few places with a well-developed sense of the past. The most valuable sources are preserved letters and diaries, local newspapers and college archives.

Newspapers from the era are particularly valuable, but difficult to interpret. Towns of 500–1000 had a newspaper, a venture dependent upon local leaders and merchants for its life. Often these papers denied cholera at home but had lengthy discussions of cholera far distant. Cholera caused panic; it was bad for business. Only once it was well-established did most papers report the local facts.

Cholera mortality was great in the large cities. St. Louis lost 500 in 1832–35, Cincinnati 732, Detroit 322. In the 1849–51 outbreak, St. Louis lost 4,557, Cincinnati 5,969, and Detroit 700. In each outbreak, deaths totaled 5–10% of the population. Great as the losses were, the life of the larger cities went on, staggered for a while, but went on. Their business suffered, but recovered. Boards of Health were activated but lapsed after a time. After John Snow (1849) reported that drinking water was responsible for cholera in a London outbreak(³) and the 1884 discovery of the bacillus by Koch(⁴), sanitation efforts slowly became more sincere and, eventually, more successful. Not until the early 20^th Century did truly effective systems evolve.

The small towns in the Midwest were more severely affected than the cities. In general, relative to the population, losses were similar, but the panic and flight were more destructive. Reporting of deaths for a given year does not reflect the real terror created in these towns. Most deaths occurred in a few days or weeks, so the effect was magnified. In some cases, the early death rate, extrapolated for a year, would have exceeded the local population. Information about some representative towns is available.

Aurora, Indiana, is a river town about 25 miles downstream from Cincinnati. In 1832, 20–30 people died from a population of a few hundred. By 1849, the population was 2,000. On June 14, there were 14 deaths despite great efforts to purify the air by fires burning at street crossings and a canon fired every 25 minutes for 4–5 hours. Fifty-one more died over the next three weeks. Sixteen hundred of the 2,000 residents fled the town. Fright must have been the chief cause of flight. Perhaps they were driven out by the fear that it was the local air that carried the disease. One hundred twenty-two died in the town; there were 13 deaths among the 1,600 who fled. Four county physicians died during that epidemic. Leaving was a good idea, but they carried the cholera with them.(^5,6) After the epidemic passed, people returned and growth continued.

Boston, Indiana, a crossroads village about 15 miles south of the National Road had 120 people in 1849. There were 53 deaths over five weeks. Of those who became ill, only one recovered. Graves were dug by family members on their own property. The town was abandoned except for one family. Often there was no one left to bury the dead.(^7,8)

The Indiana College was along the stagecoach route south from Indianapolis. In 1833, cholera broke out in town and the college. There were three deaths among the students and eleven in town. The college was closed, and students were sent home. Many had no way to travel except to walk home. Some of those walkers died along the road.(^9,10)

In 1832 in Rising Sun, Indiana, another small river town just downstream from Aurora, William Lewis, a Presbyterian minister, wrote to his sister “I have made arrangements in case of my sudden death to secure to my dear wife all her property. She feels solemn, as we all do, and that it is not improbable that this awful calamity should visit usthat she and I will be numbered among its victims. Still we pursue our ordinary affairs, as usual, committing ourselves to the hand of our Heavenly Father.”(¹¹)

A bit further downriver, Madison's 1849–50 problems were worse than they had been in 1832. On January 25, 1849, Madison created a Board of Health with quarantine and data-gathering powers. It also had the power to impose fines of $500 on those who brought the disease into the city.(¹²) Within 5 years, those requirements were forgotten. The County Council required the sexton of the town cemetery to maintain a list of all burials, citing name, age, origin and cause of death.(¹³) In and around Madison, 163 died of cholera during the worst of the epidemic.(¹⁴) On July 12, 1849, Judge Jeremiah Sullivan wrote to his son Algernon: “We have cholera here also (in Madison). Every day one or more deaths.” On June 26, 1850, to Algernon, then in Cincinnati: “We are anxious about you; we hear cholera in Cincinnati is worse than the papers admit. Are you careful to avoid fruits and vegetables? Avoid the night air and damp places.”(¹⁵) On June 19, 1849, John L. King of Madison wrote in his diary: “Each morning the first inquiry is about cholera. Each one approaches somebody else with grave face and each asks the other about deaths during the night. No one knows whether his friend whom he left at night in the fullness of life may not in the morning be either a corpse or prostrated in the last stages of collapse.” On July 14, 1849, he wrote, “I wake for breakfast to find panic because of cholera.”(¹⁶)

In July 1849, cholera came to the hamlet of Hanover (pop. 400), just downstream from Madison. Among the deaths was Sylvester Scovel, President of Hanover College, and three students. After Scovel's death, the college closed for several weeks. More than 14 deaths occurred in the town.(¹⁷)

The diary of Dr. Asahel Clapp of New Albany, Indiana (further downstream), records that he cared for 34 patients who died of cholera between June and September, 1849. There were nine more in 1850.(¹⁸) Yet, the daily New Albany Democrat, during the same time, focused attention elsewhere. It reported that 500 had fallen victim to the disease in San Antonio, and fatalities in New Orleans, Louisville, Lexington, Kentucky and Nashville, Tennessee were reported.(¹⁹) On July 6, Clapp's diary reported that he had ten cholera deaths among his patients that week. During the same period, the newspaper reported deaths in Madison, Corydon and Aurora and only one in New Albany.

On July 14, 1849, the New Albany Democrat reported 50 deaths in Washington, Indiana (pop. 1000). On July 17, the paper said that only five families were left in Washington. The rest were dead or fled. On July 19, the Evansville Weekly Journal reported “that Washington had had 12 deaths between 6:00 a.m. to 8:00 p.m. People were fleeing.”

Napoleon, Indiana, in 1849, was a thriving transfer center for a number of stagecoach routes - principally between Indianapolis and Cincinnati and Indianapolis and Madison. As a transportation hub, Napoleon brought together affected and non-affected communities, and thus, distributed cholera more widely. Thirty-five of its own 250 people died of cholera in 1849.(^20,21)

In 1849, cholera was in Vincennes, Indiana, again. It was an important commercial site on the Wabash River, part of the canal system between Lake Erie and the Ohio River. Cholera was there again in 1849 and, again, businessmen attempted to suppress its recognition. The doctor who diagnosed cholera in 1849 was forced to leave the town.(^22,23) By August 1, 1850, the Vincennes Gazette admitted there had been seven deaths in Vincennes. The Gazette stated that numbers had been exaggerated and one should not believe rumors. On August 8, 1850, the Gazette reported that the disease was subsiding. It noted with considerable pride that deaths in Vincennes had averaged 11/2 per day. This, it said, was “the best in the United States where cholera had existed.”(²⁴)

Lafayette, Indiana, also a Wabash river town, attempted to hide the cholera problem in 1849. On August 15, 1849, Millicent Ann Stratton of New London in Howard County wrote: “The cholera is in Lafayette, about 10 miles distant. It has not reached our settlement yet, but we do not know how soon it may please our Heavenly Father to send it over our land and call us from this unfriendly world to appear before our final judge. We have heard about Salem and the little town of Boston that have suffered greatly.”(²⁵) The cholera survey conducted by the Indiana Medical Association (1853) reported 300 deaths in Lafayette in 1849 from “diarrheal diseases.”(²⁶)

Salem, Indiana, an inland village, on a stagecoach route, about 25 miles from the Ohio River and New Albany, was one of the most severely affected towns. In July and August, 1833, there were 113 deaths in and around the town. Its population was a few hundred. The newspaper stopped publication. Most individuals fled. A local minister later wrote that all fled the town except “a donkey and a drunken grocery keeper.”(^27–30)

Among the ideas about the cause of cholera was electrical disturbances in the atmosphere. This seemed confirmed in Randolph County, Indiana, near the village of Lynn. John Lister drove a wagon along a country road and observed a lightning strike, followed by a sulfurous odor. John and his son died of cholera the next day and 27 others in a few days.(³¹)

Elizabethtown in Bartholomew County was a stop on the Madison to Indianapolis stagecoach route. Eighteen to 20 people died there during July 1849. They were buried about a mile east of town, hauled there in a wagon, four at a time.(³²)

In 1851, cholera was in Greene County, Indiana. Four doctors died during a period of four days. There were none left in the county. One fourth of the people in Old Point Comfort died. The rest fled.(³³)

New Elizabeth (later Lizton) was on the railroad line west from Indianapolis in 1873. Most Indiana towns had no diagnosed cholera that year, but New Elizabeth was not so fortunate. Fannie Davis, newly married, moved to town and became ill, almost at once, during the night of August 22. Cholera was recognized by Dr. John A. Dicks, a newly graduated physician who had just moved to town. Mrs. Davis died at 5:00 p.m. the next day. Her neighbors had taken turns caring for her. Over the next few days, Dr. Dicks and 10 percent of the population (200) died. Death or flight took all but five of the 75 families from the town.

After Dr. Dick's death, his family wanted him buried in Filmore, down the railroad in the next county and his original home. His coffin was loaded on a railroad train, but armed men prevented its removal at his hometown. A doctor there, one of Dick's friends, opened the coffin to rearrange his clothing. He, too, died of cholera and introduced the disease to the second town.(³⁴)

In 1850, a Constitutional Convention had been convened in Indianapolis to rewrite the Indiana constitution. Delegates lived in boarding houses in Indianapolis. Many were ill with diarrhea. One, John VanBenthusen, died of cholera - delaying the deliberations of the convention.(^35,36)

BUSINESS

Through these cholera waves, the Indiana economy was badly affected. Business was not active in towns where people were afraid of dying. Certainly, the economic effects of flight must have been large. Hog prices were depressed in Madison and Cincinnati. On July 16, 1849, Calvin Fletchter of Indianapolis wrote in his diary, “I will not keep as many cattle to fatten; I will sell them; I fear the future. The cholera must depress prices. Cities will be closed until it is understood that the disease has left the county.”(³⁷) In 1850, the railroad between Madison and Indianapolis stopped running because of cholera. This was the only railroad in Indiana.

On July 7, 1833, Arthur St. Clair of Indianapolis felt forced to travel to Cincinnati on business. He wrote his will before he left, noting that cholera “raged” there and he wanted his wife's inheritance protected.(³⁸)

THE CHURCHES SPOKE OUT

In 1835, the Standard, a newspaper published by the Theology Department of Hanover College, reflecting Old School Presbyterian beliefs, noted “We regard cholera as the judgment of God upon a sinful nation, an intemperate, ungrateful Sabbath-breaking nationa nation which has robbed and spoiled the Indian and withheld that which is just and right from the enslaved African. Cholera will go where it is sent. Best advice: Be ready for death. Death stands at your door. Repent of your sins.”(³⁹)

In 1833, John Arnold of Rush County, Indiana, was a student at Miami University, Oxford, Ohio. On July 20, 1833, he wrote home to his father - “Many students have suffered severe attacks of diarrhea. There is fear of cholera, which the black-coated gentry are endeavoring to turn to their advantage - prayer meeting every few days. They are striving with all their might to frighten people into their hands. Thus, it is that they reap a rich harvest amid the miseries of the rest of mankind.”(⁴⁰)

Among the many cholera sermons delivered during the epidemics, two were especially noteworthy: On August 3, 1849, Joseph G. Wilson of the Presbyterian Church in Lafayette, Indiana, said: “Twenty million free men in the person of their elected representatives defile the judgment of Heaven by a protracted Sabbath morning session, an act of impiety and audacity against which the convention of public morals (and) the editors of the secular press have lisped scarcely a whisper. Now panicked, stricken, humbled and penitent, they are assembled at the call of the chief magistrate to pray for lifting the cholera plague. It came as a Divine Volition. The natural history of cholera shows that it is in modern times the appointed scourge of the human race. At the root are avarice, superstition and intemperance. For the weeks of July 2-August 27, 155 cholera deaths occurred in Lafayette. Of this number, two were Freemasons, and two were Presbyterians of a population of 4,000.”(⁴¹)

During the 1832 episode, John Palfrey of the Brattle Square Church in Boston had delivered a less strident sermon on a similar theme - “A merciful God using cholera to straighten the world out.”(⁴²)

In 1832 and again in 1849, many state governors established days of prayer. Churches held their own prayer meetings. President Jackson had refused to recommend a national day of prayer in 1832. He said he had no constitutional authority. In 1849, President Taylor recommended a national day of prayer, fasting, and humiliation.(⁴³)

SUMMARY

These stories are samples of what happened when cholera came to Midwestern small towns. This is how they reacted.

It is possible that their responses were specific to time and place, yet through the centuries similar disasters have evoked similar reactions. There may be in them glimpses of fundamental human reactions to crisis.

The real question is what happens when another fatal disease, seemingly unpreventable and untreatable appears at the door. The 1918 influenza epidemic can be seen as another lesson - similar but even more disastrous. Then, Victor Vaughan had written in Collier's “If the epidemic continues its mathematical rate of acceleration, civilization could easily disappear from the face of the earth within a matter of a few more weeks.”(⁴⁴)

There was an important difference in public attitude about the two epidemics, 19^th Century cholera in the Midwest and 1918 influenza: in the case of cholera, the people believed the local atmosphere was at fault, consequently flight was attractive. In 1918, they knew the disease was contagious, whatever it was; they knew it was everywhere; flight would not be successful. Nevertheless, some fled.

Since mid-19^th Century, the people have moved ahead. Public opinion is still influenced by business interests and the editors of news distributors. Certainly, they expect more of medical science than did their ancestors. Yet some reactions are probably imbedded in human behavior: to seek explanations and accept unworldly ones if others do not satisfy, to blame strangers among us, to flee if a safer place might be available, to postpone action, and then to forget rather than to learn from it, once the disaster is past.

DISCUSSION

Billings, Baton Rouge: Along with the idea of protecting commerce, almost every summer I read in the Morbidity and Mortality that there is Vibrio cholera in the oysters around the gulf, but we never seem to have actual outbreaks of cholera. Do they just go unreported or are we not having quite an infectious organism?

Daly, Indianapolis: Well, there are others who would know more about that than I do, but I have read some of the same reports. There have been outbreaks of cholera along the gulf area, not in the last 20 years I suppose. There has been cholera in Indiana in the last 25 years. However, it was imported by food brought in from Ecuador by a Hispanic family. There was a nice cholera epidemic transported into the country by an airplane on the west coast when seafood salad was put on the plane in a Central American country, and cholera broke out here after the people had disseminated over the west coast. It does happen, and I have read the same things about the oysters but more particularly, the crabs, undercooked seafood, shellfish as being a problem. Thank you.

Billings, Baton Rouge: Well the people of Louisiana are absolutely certain that those shellfish that have cholera in them have come from the Chesapeake Bay and were brought down, in part, to infect our waters to avoid the competition.

DuPont, Houston: I just want to respond to the issue of cholera current in the United States. There has been a small focus of E1 Tor cholera along the gulf coast area since 1971, with a few cases every year. However, mind members of the Association, that cholera is really a disease of people with abnormal gastric physiology. It is very hard to produce cholera in a healthy person without absolutely paralyzing their parietal cells. I think that the reason why cholera is endemic in many parts of the world is because of undernutrition and achlorhydria and hypochlorhydria. It is a disease of the disadvantaged. It is a disease of the poorly nourished. One of the major reasons we don't see more cholera in this country is because of the state of nutrition. Now if we get everybody on proton pump inhibitors, which some people are interested in, we will not only have hip fractures, vitamin B12 deficiency, but we may see a resurgence of cholera.

Daly, Indianapolis: That issue is, of course, important. After the organism was described, I believe in the mid 1870s, there was considerable argument about whether it was really a valid discovery. A Munich Professor of Medicine attempted to disprove the importance of the organism by drinking a culture of cholera bacillus and did not get cholera. Interestingly, there was considerable diagnostic variability at that time and there was argument about whether mild diarrheas in the setting of severe cholera were cholera or not. He did get diarrhea from drinking it.

Ross, Baltimore: Walter, I appreciate that very much. Lovely talk. As a fellow Hoosier, I recognize that most of the towns you mentioned are clustered in southern Indiana near the Ohio River. Now I know the state was settled by people coming up from the river, but is there something else the river has to do with the disease, other than the fact that that is where the people were?

Daly, Indianapolis: The river was the principle mode of easy transportation at that time. The transportation was of people as well as goods. People came either down the river from Pittsburgh or more importantly, up the river from New Orleans, and the trip up the river from New Orleans was particularly dangerous. There are records which reflect the mortality on riverboats, steamboats. The steamboat was a villain in the cholera epidemic. There was one carrying 400 German immigrants on their way to Cincinnati, and something like 50 of them from New Orleans died on the way. Of course the Great Lakes in 1833 were a major transportation source for cholera. In the case of General, who was it, Taylor?…General Scott and the Black Hawk War around Chicago. He lost several hundreds of soldiers due to cholera on the way there. Water transportation was terribly easy and important in those days.

Wenzel, Richmond: Wonderful talk. I would like to come back to why we don't see so much cholera. We know a lot about infecting dose. The infecting dose for shigella is only about 10 organisms, for salmonella, 10 to the 4^th or 5^th, for cholera, 10 to the 9^th. As Bert says, if you give somebody 2 grams of bicarbonate, as we did in our fellowship, you can lower that infecting dose down to about 10 to the 4^th. So, the real truth hit me when I was in Bangladesh as a resident taking care of cholera patients. As you know, these patients are on a cholera cot. There is a hole in the cot for the buttock to rest over, and underneath, you have a bucket. Then you come around and basically have a dipstick. If they have 4 liters out, you put 4 liters in as fast as you can. So it was a very hot day. I wore dark-rimmed glasses at the time, my face was moist and I was pulling the bucket out. I bent over, my glasses fell into the cholera bucket. My first impulse was, you know, “Hell, I see pretty well without them”, but I did recall that I had studied the infecting dose at ten to the 9^th, pulled my glasses out, and using common sense, washed them off. I never got cholera.