Of Plagues and Prejudice
PANDEMICS MAKE US THINK about the plagues of the past. As we live through the time of Covid-19, we seek lessons from other moments when microorganisms caused widespread death and devastation. In the 19th century, cholera put great cities into states of fear and flight and left whole families lying dead, even as physicians debated causation and transmission, and governments wrestled with travel regulations, immigration restrictions, and mandatory quarantines.
There is a cholera vaccine now, though its efficacy is not perfect or long lasting, and the disease can be treated, but epidemic cholera remains a problem in regions blighted by poverty, war, or natural disaster. Cholera continues to kill, especially where medical resources and access to clean drinking water are limited. In 2010, a severe outbreak started in Haiti that eventually killed nearly 10,000 people. But as a pediatrician treating children in the United States, I have never seen a case of cholera.
I am interested in diseases that, though no longer a threat to my patients, have shaped human history, leaving traces of their malignant presences in memory and in literature. And at this pandemic moment, we need to remember what we have learned from past pandemics: that humans everywhere, in the 21st century as in the 19th, are more closely connected than they sometimes want to believe, and that microorganisms accompany us when we travel, thrive when we gather together, and exploit our inequalities. Cholera offers us a history of scientific and epidemiologic detection, but also a history of scientific and epidemiologic error. It reminds us of the successes and the failures of quarantines and border restrictions, and it cautions us to consider most carefully how we live with the waste that we produce.
ON JUNE 26, 1832, THE FIRST CASE of cholera in New York City broke out among members of an Irish immigrant family, the Fitzgeralds. The father was the first to get sick; he recovered, but both of his children and their mother died. The United States and Canada had been watching nervously for cholera, relying on the Atlantic Ocean to keep them safe from an epidemic raging in Europe.
Earlier in the century, cholera had emerged as an epidemic disease in Asia. No one knew the cause, but we now understand that the bacteria that cause cholera live in copepods—tiny plankton that exist in brackish water—and spilled over into humans in the Sundarbans, the mangrove swamps of Bengal. In Pandemic (2016), science journalist Sonia Shah describes how, in 1817, deforestation and agricultural practices under the auspices of the British East India Company generated a major cholera epidemic. The British blamed it not on their own colonial undertaking but on a range of Indian religious practices and lapses in hygiene. Thousands of people died in Asia, but Europeans regarded the epidemic as remote. However, by 1830, cholera had spread from Asia, across Russia, the Middle East, and into Western Europe, traveling with armies, with sick passengers aboard ships, and in the water that steamships used for ballast.
In France, 100,000 people died, and despite British quarantine efforts, the disease killed thousands in London in 1832. On June 6, 1832, cholera appeared (1962), medical historian Charles Rosenberg describes how people of means prepared to flee eastern cities for their country homes while groups of doctors set out for Montreal and Quebec to study the disease. Meanwhile, the New York City Board of Health set up quarantine policies to keep ships out, appointed health officers to disinfect the streets with chloride of lime, and required doctors to report any cases they saw.
