Knowledge in the Time of Cholera

PETER: Well, today on the show, we have for you an hour we’re calling “Rinse and Repeat.” We’re going to explore some of the other strange twists and turns American thinking about cleanliness has taken over the course of our history. As always, I, Peter, will be holding down the 18th century.

ED: While I, Ed, will be speaking for the 19th century.

BRIAN: And I, Brian, will be covering the 20th century.

In a little bit, we’re going to look at how it was that Americans started washing up in the first place. But first, we’re going to step back from personal cleanliness and take a look at cleanliness on the broader social level.

ED: This next story takes place in the 1860s. It was then that people were starting to think about urban sanitation in ways that seem familiar to us today. But they were doing so for reasons that would strike us as completely alien.

PETER: February, 1866, residents of New York City received some terrible news. Cholera was showing up in several European cities. Now the upshot was clear. It would only be a matter of months before the disease made landfall in New York.

ED: And it wouldn’t be the first time. In the 1830s and 1840s, New York had suffered through two other cholera epidemics. More than 15,000 people had died, some in a matter of hours, and all in the ways that would leave a profound impression on survivors.

Victims were stricken with endless diarrhea, bluish skin, and voices that were reduced to dry, ghostly wails.

PETER: The official response to these epidemics had been meager, to say the least, which was to be expected. After all, the prevailing understanding of cholera at the time was that it particularly afflicted the disorderly, even morally dubious segments of the population.

And on the occasions when city workers had tried to act, they had been hamstrung by the cronyism and corruption that plagued Manhattan at that time.

ED: And so in 1866, with cholera looming on the horizon again, state lawmakers decided they needed to get involved.

OWEN WHOOLEY: We need to create an independent, permanent board of health, one that’s not connected or tied to local city politics.

ED: This is Owen Whooley, author of a new book about cholera in the 19th century. He points out that although germ theory hadn’t come along yet, this board did embrace a new theory about cholera’s causes. They thought that it had something to do with filth.

OWEN WHOOLEY: Now the exact relationship between cholera and filth is kind of up for grabs. Is cholera just filth? Does filth cause cholera? Does filth provide an environment for cholera? Or does filth somehow undermine individuals’ predisposition towards the disease?

PETER: Whatever that relationship was, one thing was clear. New York was a filthy place.

OWEN WHOOLEY: We’re talking cesspools in the street. We’re talking pigs and goats roaming around. We’re talking tons and tons of manure baking in the sun, no proper sewage, water is dirty, overcrowding, you name it. It was pretty, pretty horrible.

PETER: And so armed with unprecedented police powers from the state, the board went to work. Because cholera could have come from anything, in their view, they cleaned up everything.

OWEN WHOOLEY: They removed over 160,000 tons of manure from vacant lots. They cleaned over 6,000 privies. They removed inhabitants of dank cellars and relocated them. They closed down offending businesses like bone boiling, fat rendering businesses.

They condemned tenement houses, apartment buildings that would have been deemed too filthy. They picked up the garbage. They removed wandering pigs and goats. So this was a broad-scale program that naturally offended many of the people living in Lower Manhattan.

ED: In April of 1866, just over a month after the formation of the Board of Health, cholera did hit New York. And when it came, the unthinkable happened. It was contained at the ports. Mortality numbers, which people feared would be in the thousands, rose no higher than 600. And in the eyes of New Yorkers, the new Board of Health had defeated cholera.

BRIAN: So what do we think today? I mean, were they doing the right thing?

OWEN WHOOLEY: Yes, but they didn’t know it. Today we know that cholera is a waterborne disease. And so the most effective way to prevent cholera epidemics is to provide basic clean water infrastructure.

Now when these reformers go down to Lower Manhattan in 1866, that’s part of their program, is to drain cesspools, is to clean up privies, to do all these things with water. But it’s a small part of a more general program.

So even though they didn’t know that it was spread by water, they kind of unintentionally, in cleaning up the whole area, are credited with having prevented a severe outbreak of cholera during that epidemic.

And subsequently, other municipalities, other cities, other states, look upon New York as this kind of shining example of what could happen if you have an independent board of health taking care of the sanitation in the city.

PETER: It’s hard to imagine any of this would have happened if the doctors on the Board of Health had known how cholera was actually transmitted. More than a decade earlier, in London, the epidemiologist John Snow helped stem the tide of cholera, not by cleaning up every single sign of filth in the city or by stamping out government corruption, but by removing the handle from a single water pump.

ED: But American doctors, famously and even defiantly behind the curve on European medical developments, continued to operate under an older idea, that disease was caused by noxious air, or miasma.

And the result? A city widely regarded as the filthiest place in America got a little bit cleaner, both in the streets and in the halls of government. It’s not the story about knowledge and progress we might expect. But Owen Whooley says it offers an important lesson nevertheless.

OWEN WHOOLEY: The popular medical histories, especially around medical discoveries, do us a bit of disservice in that they tend to suggest that once these discoveries are made, you move from kind of ignorance to enlightenment, problems get solved.

But when you go back and look at it, you really see much more of a messy picture. In medicine, there’s no certainty in knowledge. I mean, even the best doctors will tell you this. So what do you do in absence of having complete, certain knowledge? Well, you kind of muddle along.

And so the idea that there’s kind of this linear progress in medical knowledge, it’s a bit misleading in that what you really need to start to look at is how these things play out in practice.

ED: In the case of cholera, maybe the false beliefs that inspired these practices were just as powerful in bringing about positive change as the true beliefs about germ theory would eventually be years later. Maybe they were even more so.

PETER: Helping us tell that story was Owen Whooley. He’s a sociologist at the University of New Mexico and the author of Knowledge in the Time of Cholera: The Struggle over American Medicine in the Nineteenth Century.

TEITUR: [SINGING] We’re still the same. Nothing has changed. We still drink the same water. We’re still the same. Nothing has changed. We still drink the same water.

BRIAN: It’s time for a short break. When we get back, how Americans learned to stop worrying and love soap and water.

PETER: You’re listening to BackStory. We’ll be back in a minute.