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New York Times
How Epidemics Helped Shape the Modern Metropolis
John Noble Wilford
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 reported, "The roads, in all directions, were lined with well-filled stagecoaches, 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 portrayed in the exhibition and other documentation, 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 classes 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 scum 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 reported 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 and 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 and 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 seaport to seaport, 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 vapors 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 and 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 sentiments 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 support 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 neighborhood wells that were often polluted with human and animal waste. In 1849, the municipal government 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 epidemics 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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