I’m sorry. But not sorry. I have about a million incredibly immature diarrhea puns and well, if you’re writing about cholera, you are decidedly going to find shit is a prominent topic.
You might know that cholera is a disease caused by the bacteria Vibrio Cholerae. This is a one celled organism and what happens is that you get an infection in your lower intestine. It is a fatal illness causing you to essentially, shit and vomit yourself to death. Ultimately, you dehydrate quickly.
The last significant outbreak here in the US was in 1911- however, you’ll note that I’m using present tense. This is because cholera actually never went anywhere. In fact, there have still been outbreaks, worldwide- and those typically involve situations where natural disaster, war or impoverished conditions have led to people living without proper sanitation and cramped quarters.
It also happens to be one of my very favorite examples of why historically speaking, people who are adamantly resistant to change do more harm than good.
Cholera in St. Louis
So, let’s talk just a minute about what happens when you’ve got bustling cities with rapidly growing populations- and horrifying sanitary conditions. We see the first recorded cases of cholera in London, right around 1831. The first epidemic here in St. Louis would hit around 1832, the second, in 1848, and a 3rd in 1866. They believe that the first epidemic struck in Jefferson Barracks, likely brought in from Quebec by soldiers there. At the time, the population was around 8000, but it killed around 20 people daily but peters out around 100-200 deaths. In 1848, the city boasted a population of roughly 63,471 and by the summer of 1849, was killing around 80 people a day. In the 1866 epidemic, though much more was known and now loosely accepted about it: this time, it came in with another disease: typhoid fever. They discovered that particular epidemic likely happened due to contaminated wells. Though more was understood about disease at this time: St. Louis’s infrastructure was absolute bullshit and really hadn’t improved all that much.
Even before cholera, the conditions were pretty gross. In the time of cholera there, boom cities started out much smaller than they are today, though the populations were growing more all the time. What you had then, was some really gross ideas about disposal of waste materials of all sorts. Today, while you may find a stroll down around Laclede’s Landing to be a fairly pleasant experience: back in the day it probably smelled pretty bad. You have to imagine a heavily congested city without all the modern trappings. So, not only do you have people who are likely not bathing that often, you’ve got livestock pens, incredibly rudimentary practices for the disposal of the dead, and frankly: people pissing and shitting and vomiting in buckets that are carted off and just dumped places. Gross.
If we look at the city’s first directory, we can get a better idea of just how things begin:
“Eight streets run parallel to the river and are intersected by twenty-three others at right angles. Streets in the old town are narrow, while those west on the hill are much wider, providing a pleasant and salubrious appearance. The lower end of Market Street is paved and it is to be hoped that soon the trustees will provide for the paving of Main and other streets. On the hill, in the center of town, is a public square donated by Judge Lucas, on which it is intended to build an elegant courthouse. Market Street is in the middle of town and is the line dividing the north part from the south. Those streets running north from Market Street have the addition of North to their names, and those running in the opposite direction, South. The houses were first numbered by the publisher of this directory (Paxton) in May, 1821.”
When you get into when cholera first begins to kill people, we’re looking at right after that: and from around 1830 through 1840, this river city was going like gangbusters. The population, which had previously been around 6,694 jumps to somewhere in the neighborhood of 16, 694.
The thing is, by 1841, the city had really only expanded by around 4 and a half square miles. The first cholera epidemic had come and gone- seeming to vanish as quickly as it had emerged: but, the sanitation issues that created a situation rife for it hadn’t improved. In fact, by this time, they’d gotten worse. (And oh my god, at some juncture I do need to write about the cadaver scandal- but, not today. Foooocus, McFly.) Now, here in the states we never really saw things get as horrible as they did in say, London: but this wasn’t due to robust innovation or differing mindsets. It was because those European cities had been experiencing those population booms for much longer and therefor, had a bunch more people creating a bunch more waste. And no matter which side of the pond you happened to be on: the ideas about how disease was spread, prevented, and otherwise was…less than well informed. Speaking of ponds…
In those earlier days, it was considered a lovely place for a family to have a picnic or just a serene location. Originally build by Taylor as a mill dam for what was then known as La Petite Riviere, it was created not long after St. Louis’s founding. In 1779, August Chouteau bought it, expanding the dam and creating a lake of roughly 100 acres. Because at that time it was out in the pretty country area, it was an idyllic spot where you could go skinny dipping and enjoy yourself.
Though the Missouri Historical Society notes that the above painting was likely copied from a lithograph by JC Wild- this painting by Henry Lewis depicts what he said was his memory of a sketch of Chouteau’s Pond circa 1847. In either case, Wild’s lithograph depicted it circa 1840: so the point remains- it was a gorgeous place at the time. Until they decided that was just the place to dump their shit. Literally.
The Missouri Botanical Garden put out this great PDF a while back, which is where I got this screenshot- but, if you want a good idea of where that was, in the context of now:
That link also contains a neat and concise history of the Botanical Gardens, as well as a map of St. Louis, circa 1879 or so. The population at that time, still growing…the city, eh, a little. But not that much.
Side note, you’d probably love to imagine that dumb sanitation practices have ceased but as of 2016, yeah, no. Saint Louis still has big problems with where our waste goes. So, you know, if you’re one of those change aversive types: take heart, hardly anyone’s really learning from history so you’ll be back to those dangerous or otherwise unhealthy nostalgic conditions you cling to soon enough. 😉 For those of us who do watch these cycles- eh.
So anyway, St. Louis is growing in leaps and bounds. That first cholera epidemic was a doozy but they made it. By 1849, the city’s population was roughly 75, 000 and they still had no sewer system which meant they were dumping their waste wherever it was out of sight, essentially. One location was the cave system beneath the city- in 1842, a city engineer by the name of Kayser is looking at ideas for sanitation and going “Wow, that’s really expensive but we got all these caves, soooo…”
Essentially what happened there was, okay, any time you’re at the Edward Jones Dome, I want you to imagine that you are standing eh, maybe knee deep in raw sewage. Because that’s the location of the former Kayser’s Lake: which was where all that crap wound up when it overflowed. More or less. There’s kind of a debate but roughly that block around Biddle, 9th, 10th, and Cass.
So, we are in the early Spring months of 1849, now. You drink water that comes from streams and rivers- and, unfortunately, this is also where much of the city’s waste winds up. People are getting sick. Dr. William McPheeters diagnoses the first case that year in January and describes it as:
“Vomiting freely, with frequent and copious discharges from the bowels; at first of slight bilious character, but it soon became pure “rice water.” As the disease progressed, his patient suffered intense abdominal pain and his skin became “of a blue color and very much corrugated.”
What are they doing with this stuff? Well, they’re collecting it in buckets and dumping it where it goes right back into the drinking water. Scroll back up to that pretty scene at the pond. Because by 1860, this is what it looks like:
The reason people dumped their shitwater into places where their drinking water was also found- in spite of the fact that in 1849- the same year St. Louis is dealing with what must have seemed like the Apocalypse (The Great Fire happens this year, also, among other things.)- John Snow, an obstetrician in Britain published a paper stating that he felt cholera was transmitted this way. In fact, at that time: they thought he was completely off base or even insane because common beliefs about disease transmission even- or especially among the medical community just didn’t agree with this.
Though Pacini would continue to develop and promote the idea that this was in fact a very contagious disease spread via the intestinal mucosa and he would consistently publish material to that end: no one really listened to him. He even had an effective cure, replacing the lost fluids and electrolytes. Though he published his work from around 1865 until 1880: the medical community completely wrote it off and ignored it in exactly the same way they did Snow before him.
You know what a few things they thought caused cholera were?
Well, some in Saint Louis really felt that a newspaper, the Missouri Republican, deciding they’d publish on Sunday did it- invoking God’s wrath.
Others believed that all those dirty Germans with their sauerkraut caused it. Sort of. The thing is, cabbage is pretty easy to grow and was a staple- so, yeah, cabbage was everywhere and that must be it, right? (Do I talk about how fermented food in particular has a great deal of disease fighting properties? Nah. You know.) They did at one point freaking outlaw cabbage out of those fears.
As it began to sweep through the military, in 1832, U.S. Army General Winfield Scott, like many others believed it was due to a moral failing. So, he issues an order for the volunteer Rangers and the Regulars stationed near St. Louis at Fort Armstrong:
It is believed that all these men were of intemperate habits. The Ranger who is dead, it is known, generated this disease within himself by a fit of intoxication… Sobriety, cleanliness of person, cleanliness of camp and quarters, together with care in the preparation of the men’s messes are the great preventatives… The Commanding General… therefore peremptorily commands that every soldier or Ranger who shall be found drunk or sensibly intoxicated, after the publication of this order, be compelled, as soon as his strength will permit, to dig a grave at a suitable burying place, large enough for his own reception, as such grave cannot fail soon to be wanted for the drunken man, himself, or some drunken companion.
This order is given as well to serve for the punishment of drunkenness as to spare good and temperate men the labor or digging graves for their worthless companions.
The biggest reason they start to drain these sinkholes and ponds, however- comes from the most prominent reason of all: the miasma theory. While yes, it absolutely was a step in the right direction- they didn’t do it because they realized John Snow was right: they did it because they thought stink caused disease. The doctor I quoted above believed, as most did that Snow was ridiculous. It had to be the stench because stench causes all sorts of diseases from gonorrhea to the plague. Change is haaaard, ya’ll. So hard.
Basically, miasma theory states that there is a funky cloud that looms over us all and that is where diseases come from. Though they believed it was created by rotting organic material such as waste or bodies, they thought that it was the cloud itself that caused disease- not the biohazard that was freaking everywhere.
Of course, though, not everyone believed that, either. Oh no. See, cholera hit the poorest parts of the cities first: so, there were many who believed that God was punishing them. Confirmation bias in action because a lot of people held dim views of the poor Irish and German immigrants flooding the city. In those areas they deemed slums, the bodies of the dead were often buried in shallow ditches. Most people believed that poor black people and Irish were to blame for the catastrophes they were seeing. Nationwide, the epidemic begins to spawn some horrifying levels of fear and ignorance that in all honesty: probably was based on existing bullshit those people already believed.
Once the churches begin to get involved, it gets interesting- you might think you’d see some horrifying shit come out of the pulpits and you definitely won’t be let down there- but, you’d be surprised by some of the more progressive attitudes that were also out in force. In an 1835 edition of The Standard, the then very Presbyterian Hanover college announces:
“We regard cholera as the judgment of God upon a sinful nation, an intemperate, ungrateful Sabbath-breaking nation. A 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.”
While the statement is valid in pointing out injustices, it does unfortunately still cite divine retribution as causal. Unfortunately, many more churches would state that cholera was God’s way of wiping the slate clean on an avarice stricken world beset by vice, sin and laziness.
So, May of 1849, the city takes control of Arsenal Island and if you wanted to get in, you had to stop here. They build makeshift shelters and a hospital where, if they thought you had cholera- you stayed until you either got better or died. By 1860, the graves of those that did would already go into the river. Meanwhile, in the city, people are still dumping their waste down into the cave systems and it’s around this same time that the overflow I mentioned around the current Dome happens. It creates this big lake of shitwater, essentially and people are understandably pissed off by that.
While a variety of interesting “cures” pop up, they cannot quite defeat the fact that people are in essence: dumping the disease into the drinking water time and time again while blaming all manner of things that have nothing to do with the spread.
At this point, they have been dumping industrial and slaughter waste into Chouteau’s Pond, it’s already nasty.
The committee decrees that the best thing to do is to send carts around to pick up waste, slop and other grossness. They would then take that and dump it into the pond. Cabbage and other fresh vegetables are banned and they set up burn barrels filled with tar, coal, and sulfur in the streets. What you did, then, was, you would collect your waste in big piles or buckets and simply set it out in the street for them to pick up.
Additionally, they held a special day that summer meant for supplicating the clearly angry God. You would engage in prayer, fasting, and humiliation- and all the businesses would be closed.
You know what they did not do?
Fix the damn infrastructure. Implement an effective sewage or sanitation system.
Though by 1854, John Snow’s already mapping out the wells that he believes originated the contaminated water, his theory is only very slowly gaining steam.
In fact, in 1855, in spite of everything: famed physician William Farr was still stating,
“In explanation of the remarkable intensity of this outbreak [Broad Street Pump outbreak] within very definite limits, it has been suggested by Dr. Snow, that the real cause of whatever was peculiar in the case lay in the use of one particular well, situated at Broad Street in the middle of the district, and having (it was imagined) its waters contaminated with the rice-water evacuations of cholera patients. After careful inquiry, we see no reason to adopt this belief. We do not feel it established that the water was contaminated in the manner alleged; nor is there before us any sufficient evidence to show whether inhabitants of that district, drinking from that well, suffered in proportion more than other inhabitants of the district who drank from other sources.”
By 1866, doctors in St. Louis were still stumped in terms of how to treat it. One speculates in a medical journal that because men who work in the various stables here and there never get it- drinking horse urine probably cures it. He figures, well, they’re around the ammonia smell all day so, ingesting the piss should do the trick. I don’t know about you, but even thinking Pacini was ridiculous: wouldn’t you rather hydrate and replace electrolytes than drink horse piss? Apparently not. Never mind that he was right.
So here in St. Louis they decide they’d better drain those ponds and cesspools: because the smell is clearly making people ill. Fortunately, this also necessitates a much more sanitary sewer system in the process. Cemeteries were also founded outside of city limits, and sanitation did improve.
By 1949, it began to subside. Still, in 1874, at an international conference, the Miasma Theory persisted. People representing worldwide governments of 21 nations unanimously voted that cholera was airborne and caused by “ambient air”.
Several decades after what seemed to people as the insane rantings of Snow and Pacini, Robert Koch would win a Nobel Prize for Physiology or Medicine. He had previously discovered the tubercle bacillus responsible for tuberculosis in 1882, then in 84, discovers vibrio cholerae.
He’d gone to Egypt with a bunch of other physicians during the 1883 cholera epidemic there. By all accounts, he has no idea about Pacini’s findings, very few people did.
They perform necropsies on the dead and discover the bacillus in their intestinal mucosa. If someone died of other causes, they noticed, this little weird wormy looking dude wasn’t there. So, Koch begins to speculate that if he could just isolate the bacillus and grow it, he could figure this out. He tests his theory on animals but is incapable of creating any kind of pure culture and fails to induce cholera in animals. The Egyptian outbreak subsiding, he then travels to India where he and his team are finally able to isolate it in a pure culture. He still cannot infect animals with it so he speculates that they are simply not susceptible to it. He notes that the bacillus is capable of rapid growth within dampened earth and soiled linens but when hit with a weak acid solution or dried out, died. He does finally note that this is only found in those who died of cholera but not other forms of disease induced diarrhea. Basically, they’d find a lot of the bacillus in the shitwater of cholera patients but not others.
Even as Pacini had shown otherwise before him, and Koch now had evidence to back that up: The English, The French, and others in the scientific community blocked Koch’s findings and discussions on the grounds that miasmata caused cholera in 1885. Though even Farr had gone back on miasma in favor of this in 1866- the world simply wasn’t ready to hear that stinky air didn’t cause disease.
Snow hadn’t been aware of what the bacterium was, but, he did in fact earlier show that it was, as Koch said: spread by unsanitary conditions. Snow proving that earlier was pure luck of confronting one egotistical asshole- the good Reverend Harry Whitehead, who had a vested interest in making people believe cholera was God’s punishment. What’s hilarious is, he believed that so staunchly that he decides he’ll prove Snow wrong. In the process of attempting this- he completely validates the theory that it was a result of contaminated drinking water instead of proving God got pissed off. Unfortunately, that still wasn’t enough for most to take it seriously and even Koch’s findings wouldn’t really begin to gain credibility and use until sometime in the early 20th century.
Of course, eventually that changed and things got better from a medical and scientific stand point- but, the resistance to change here likely resulted in untold deaths. Why the resistance? Well, of course, a great deal had to do with simply being ignorant of science at the time. It was still developing as were our understandings. However, in St. Louis, like many of the cities impacted- the media had a big hand in things and so did business. You didn’t want to create a panic. Or you did, but you’d direct that at your political or business rivals. Meanwhile, a trusting public which is just scared shitless at those points- look to those things as sources. More often than not, those sources would use these fears to validate existing prejudices, mentalities or otherwise which actually benefited them- rather than the public. (As I said, has much really changed?)
There is this tendency when things are terrifying to rely on belief or other things rather than science. The cholera outbreaks should be seen as a stark reminder of how detrimental this truly is. Though there were repeated epidemics in the 19th century, though others would try to prove otherwise: it was simply easier to believe that miasma or some sort of pissed off deity or moral failings caused the problem because it confirmed biases they already held.
Though we often write about the epidemics as separate, you know ranging from around 1832, 49, 66 all the way into the 1870s, the fact is- really due to people’s resistance there: it just slowed down, but never actually went away. Right around the mid 19th century, yes, people began to move forward and change things tremendously. However, you can’t help but notice how public opinion is still very much easily swayed by those with vested interests. As it was, then, business and media pluck the sicker chords of human behavior creating tendencies towards blaming those we don’t agree with and doing all we can to avoid actively taking part in any sort of change that might upset those interests.