The Cholera Years: The United States in 1832, 1849, and 1866

"The Cholera Years , which was published more than 50 years ago, is one of those rare classics that remains an important reference point in the field, still relevant to the politics of public health today. The story is centered in New York, which was a locus of commerce in 1832, in 1849, and in 1866 at the time when three waves of cholera came sweeping across the Atlantic. Then as now, theories of contagion became widely debated. Suddenly, whether you believed in contagion carried enormous economic significance. If you thought that cholera is contagious, you pressed to stop commerce and close ports. For Rosenberg, each cholera outbreak told the story of a changing society—moving from decrying the epidemic as God’s punishment or calling for a day of prayer, to developing new practices associated with the creation of public health. His book examines the moral, religious, and economic aspects of dealing with epidemic disease. These debates occurred mostly in the pre-bacteriology era, before the identification of microbes as the real enemy. But the book was pioneering in showing how the social response to these three epidemics told, in microcosm, the story of American urban change and secularization. And out of the cholera experience came the creation of the Metropolitan Board of Health in New York City and the idea, ultimately, that every city needs a permanent board of health to safeguard its population. The defeat of cholera showed that it was possible to intervene against disease without knowing its cause. One of the iconic developments in the same period was the work of John Snow in London . He discovered that people developing cholera were more likely to be getting water from pumps whose source was a particularly polluted stretch of the Thames, whereas other pumps that were getting water from upstream, where the water had not yet been polluted by human waste, had far fewer cases of cholera. Closing the Broad Street pump was a signal moment in the rise to public health. It showed studying urban processes, such as waste disposal, and understanding water and waste flow, could prevent disease. So, The Cholera Years is a US version of this UK story about the origins of modern public health."

"Well, Rosenberg’s book isn’t new, but it’s a classic of medical history, and it’s a fun read. Much like Bristow, Rosenberg devoted a lot of research into incorporating quotations from a huge range of sources. So, medical reports, but also sermons and political speeches and diaries. It fixates on one city—New York—through three different cholera epidemics, so you can see change over time. You can see cholera going from being seen as a divine punishment, a dreaded disease against which people had no defence, to something that, by the 1860s, seemed to be a signifier of inadequate public health infrastructure. He shows how it moves from a religious framing to a scientific or political one. But that’s not to say he’s suggesting people became secular by the 1860s; he shows how preachers, ministers and their sermons, started casting cholera as a problem for society and governments rather than a bolt of lightning from God. That transformation is interesting. Support Five Books Five Books interviews are expensive to produce. If you're enjoying this interview, please support us by donating a small amount . Reading Part I of that book (about the first cholera epidemic) in the time of coronavirus is especially evocative and interesting. There are a huge number of parallels. He talks about the growing popularity of this movement called Thomsonianism, which was a kind of do-it-yourself school of natural medicine that had a resonant appeal in Jacksonian America. That’s something we’re starting to see again, though without a formal doctrine this time; people are casting about for all kinds of remedies. In 1832, as now, elite figures recommended treatments that, after some thinking, sound crazy. To give you an example from Rosenberg, a New York Medical Board member suggested that victims of cholera should actually insert beeswax into their rectums to stop diarrhoea. It’s an absurd idea. But it reminded me a lot of the news recently. I think it was a Florida county commissioner who said he had been told that coronaviruses can live in nasal passages because they’re relatively cold … and so he started recommending that people take hair dryers and blow them up to their nostrils. Absurd, but I can half-understand where it’s coming from. There’s a logic behind it: everyone, from all different backgrounds, is casting about for something they can do themselves in the face of an unknown disease. Homemade prophylaxis seems very appealing! And at a time of uncertainty, the idea that there could be some easy cure seems tantalizingly possible. It’s a moment where, perhaps, the medical profession loses a bit of its prestige, because they aren’t able to give answers to clear questions like: how can I treat myself if I happen to get this disease? It’s really interesting to think of parallels for modern moral movements—the way a discourse of sin and repentance filters into any sort of big natural disaster in this way. For example, people pointing out the way in which Covid-19 seems to have spread via air travel, and air travel is a major contributor to climate change. You can say, you know, ‘this is a corrective’ to a world some argue is too accustomed to constant movement. Even in more prosaic, practical terms—the diminution of the public health infrastructure, the cutting of hospital beds, the lack of planning—all of this can be written about in a way that draws on religious or moral language."