The 1866 Cholera Epidemic

Epidemic diseases are a common trend in human history; the black plague, smallpox, Spanish Flu, and currently, COVID-19. Cholera used to be one of those diseases that would spread at epidemic levels throughout the colonial era and the 19th century. While cholera was a nasty disease, an outbreak in London gave birth to some of the earliest epidemiological methods. In 1854, a cholera outbreak began in the crowded Soho neighborhood of London. Over 600 people died during that outbreak. The medical rationale for the spread of disease, for the most part, was still dominated by miasma theory, or the spread of disease from “bad air.” In 1854, Soho was a  poor community, and it was very crowded. People would throw their waste into cesspools outside of their homes, and trash and refuse covered the streets–needless to say, sanitation was not a priority. Eventually, some of that waste sitting in the cesspools leaked into the local water supply causing cholera to form and spread from the pump.^[1]

At the beginning of the outbreak, when cases began to be reported,  Dr. John Snow went into Soho to track the cases to find where the epidemic began. In his research, Dr. Snow noticed a trend in the cases: all of the people who became sick with cholera got their water from the same pump on Broad Street. John Snow’s epidemiological map of the 1854-55 cholera outbreak became one of the early examples of contact tracing in order to make conclusions about an epidemic and try to make plans for the prevention of future outbreaks.^[2] In his study of the Soho outbreak, Snow concluded that cholera did not come from “bad air,” rather, it came from contaminated water sources such as that of the Broad Street pump. Dr. Snow challenged the entire medical community with his conclusions about cholera and was met with  heavy resistance

Due to the increasing global connectivity of the world and the transmissibility of cholera, outbreaks were  common worldwide in the 19th century. In the United States, there were major epidemics of cholera in 1832, 1849, and 1866 with each epidemic showing a change in medical techniques and the role of government in public health. The 1866 cholera epidemic was the best handled from a medical and sanitary standpoint. This is best exemplified in the creation and execution of the roles of the Metropolitan Board of Health in New York City. Formally established in February of 1866, the Metropolitan Board of Health sought to improve sanitary conditions throughout the city.^[3] The Civil War proved the importance of keeping public spaces and hospitals as clean as possible to increase the overall health of the surrounding population.

The 19th century saw a demographic shift among New York City inhabitants. People from Ireland made up the largest portion of immigration to the United States. It is estimated that from 1820 to 1860, the Irish represented no less than one third of immigrants coming into the country.^[4] Previous epidemics and disease outbreaks would be blamed on these immigrant populations as they would most likely be living in some of the slums of the city in very unsanitary conditions causing disease to spread rapidly. This occurrence would also further the justification used by members of “respectable” areas to look down on those populations.

Much of that changed with the establishment of the Metropolitan Board of Health in 1866. One of the first acts of the board was to fix the hospital system in New York and make it resemble the style of hospital used in the Civil War. Sanitation was more understood but not fully embraced until after the work of Dr. Joseph Lister in 1867 and Dr. Robert Koch in 1881. While hospitals were of concern to the board, general sanitation within the city streets were of greater concern. Hospital sanitation was mostly the job of those in charge of the hospital, however, in the 19th century, there was no real public health organization to advocate for general sanitation of the city. That is, until the Metropolitan Board of Health was formed in February of 1866, and “By April, it had issued seven thousand orders to remove piled horse manure, rotting animal carcasses, and mountains of refuse. With the help of local police, the board forced residents to clean their yards, and tried to compel ward bosses to actually use the funds they had been given by the city to clean streets.”^[5]

These orders at first were met with resistance from store owners and politicians, some were even fought over in the courtroom. Despite the resistance to the board’s recommendations and guidelines, the city had become much cleaner than it was before the board intervened. The organization had managed to clean up the city just in time for the beginning of the 1866 cholera epidemic about to hit New York city later that same summer.

Doctors and public health officials were armed with the tools and experience from both the research conducted by Dr. John Snow and from dealing with the health crisis of the Civil War. The 1866 cholera outbreak was handled remarkably better than those of 1832 which claimed the lives of roughly 3,000 New Yorkers, and 1849, which killed over 5,000 people.^[6] By 1866, the members of the Metropolitan Board of Health was readily equipped in sanitary methods of the time to combat the epidemic which was spreading throughout the city and not isolated to the poor, immigrant neighborhoods. As the epidemic wound down a few months later, it had claimed the lives of over 1,100 New Yorkers, however, given the population size of the city at the time and the quick actions of the Board of Health, the mortality rate was much lower than expected.

For the past two years, the COVID-19 pandemic has greatly impacted the lives and economies of the world. The world was at a standstill for some time and millions are still dealing with the aftermath of the pandemic. Public health entities across the world used lessons learned from previous pandemics in an attempt to slow the spread of COVID. In studying the past, we are able to learn how to better equip ourselves to fight future pandemic diseases, just as they did with the creation of the Metropolitan Board of Health.

About the Author

Michael Mahr is the Education Specialist at the National Museum of Civil War Medicine. He is a graduate of Gettysburg College Class of 2022 with a degree in History and double minor in Public History and Civil War Era Studies. He was the Brian C. Pohanka intern as part of the Gettysburg College Civil War Institute for the museum in the summer of 2021. He is currently pursuing a Masters in American History from Gettysburg College and the Gilder Lehrman Institute.

Sources

^[1] John Snow and the 1854 Broad Street Cholera Outbreak. YouTube. HarvardX, 2017. https://www.youtube.com/watch?v=lNjrAXGRda4.

^[2] Rogers, Simon. “John Snow’s Cholera Map of London Recreated.” The Guardian. Guardian News and Media, March 15, 2013. https://www.theguardian.com/news/datablog/interactive/2013/mar/15/cholera-map-john-snow-recreated.

^[3] “The Metropolitan Board of Health.” Cholera in Nineteenth Century New York, n.d. https://virtualny.ashp.cuny.edu/cholera/1866/cholera_1866_set.html.

^[4] “Irish-Catholic Immigration to America.” The Library of Congress, n.d. https://www.loc.gov/classroom-materials/immigration/irish/irish-catholic-immigration-to-america/.

^[5] “The Metropolitan Board of Health.” Cholera in Nineteenth Century New York, n.d. https://virtualny.ashp.cuny.edu/cholera/1866/cholera_1866_set.html.

^[6] Wiszniewski, Greg. “A History of Cholera in New York City.” https://www.bbcleaningservice.com/history-cholera-new-york-city.html.