The 1832 Cholera Epidemic in New York State:

Cholerae vibrio can survive for surprisingly long periods of time in many water sources including shallow wells, cisterns, or water storage tanks. It does not require an intermediary animal host or some form of agent (vector) for dispersal. Once ingested and if it can reach the human intestines, the bacteria will there produce a toxin which inhibits the absorption of water and salts. The bacteria then effectively flushes the intestines of any competition and begins a massive replication of itself.

Cholera's physiological effects on humans are not appreciably different today than in the 19th century. Individuals, then and now, were generally unaware of their illness until a sudden onset of stomach cramps, nausea, fever, and explosive-severe-voluminous diarrhea. Within hours of the disease's onset, the cholera victim expelled immense quantities of bodily fluids. Deprived of the body's necessary fluids, the cholera victim's head, hands, and extremities turned cold, bluish in color, and death like in touch. Death often occurred within hours of the first symptoms and was generally "caused" by cardiac failure precipitated by the severe electrolytic imbalances. It was an ugly, nasty, and repulsive death. Individuals often lost consciousness and it was sometimes difficult to determine if individual had actually expired. Medical records frequently reported body "twitching" for hours after an individuals apparent death. In response, many communities forbade burials sooner than 24 hours after death due to this phenomenon.

With great justification, Cholera was perceived as a demonic, evil and foreign force similar if not worse than smallpox or the plague. In its most virulent forms, it was a highly efficient killer and often resulted in a 50% mortality rate among its healthy adult victims. Deaths in India between 1817 and 1860 are generally considered to have exceeded 15,000,000 persons. Another 23,000,000 died between 1865 and 1917. Russian deaths during a similar time period exceeded 2,000,000.

"On March 29th, the night of mi-careme, a masked ball was in progress, the chabut in full swing. Suddenly, the gayest of the harlequins collapsed, cold in the limbs, and, underneath his mask, 'violet-blue' in the face. Laughter died out, dancing ceased, and in a short while carriage-loads of people were hurried from the redoute to the Hotel Dieu to die, and to prevent a panic among the patients, were thrust into rude graves in their dominoes. Soon the public halls were filled with dead bodies, sewed in sacks for want of coffins. Long lines of hearses stood en queue outside Pere Lachaise. Everybody wore flannel bandages. The rich gathered up their belongings and fled the town. Over 120,000 passports were issued at the Hotel de Ville."

In all probability, most New Yorkers, if they had been asked in 1831-2 what they believed to have been cause of cholera, would have answered that cholera/disease was some form of righteous consequence which afflicted those who were least likely to be in God's grace. As further proof they would cite that Cholera most often affected those persons who lived dissolute, alcoholic, drug related, sexually excessive, and filth ridden lives; cholera's victims were simply being punished by God. It was the consequence of sin and "was the inevitable and inescapable judgment" of the Divine Power. "Cholera was a scourge not of mankind but of the sinner." And, it was a known and seemingly irrefutable fact that cholera was most commonly found in those areas of the world least populated by Christians.

In contrast to the simple purity of Christianity's rationale for cholera, medicine, physicians, and other adherents of "reason," proposed theories which also recognized that certain social groups seemed more vulnerable. Similar to those who considered cholera the product of sin, knowledgeable and scientific people agreed that it was the imprudent, the dirty, and the intemperate who were more subject to cholera's terror. Instead of God's punishment, they proposed that cholera was "an influence in the atmosphere," a miasma (poison) that afflicted only those who had weakened themselves by exposure to certain behaviors, places, or "exciting causes." Only those persons of irregular habits should fear cholera. The good, the clean, and the temperate would escape its presence. Only those persons whose systems were weakened or debilitated would contract the disease.

Further complicating an understanding of New Yorker's and American attitudes regarding the causation of cholera was a collection of other attitudes, prejudices, and philosophies characteristic of 19th century America. Social reformers, such as New York's George Henry Evans, perceived cholera not as God's retribution for sin, but rather as proof of man's inhumanity to man. Cholera was overwhelmingly a "poor man's plague," and the reason for that was rooted in America's underlying unjust social and economic systems. Social radicals were aware and incensed that on one day in July of 1832, over 100 persons died of cholera in New York City. Of that group, 95 were buried in the city's graveyard for the poor-Potter's Field.

Others within American society saw cholera's causation as based in the unchecked immigration into the United States of foreign born persons-especially the Roman Catholic Irish. And of course, it was true that the Irish died in inordinate numbers during the 1832 epidemic. As the newest and the poorest immigrants, the Irish lived in the worst housing, under the most crowded circumstances, and were least able to afford good water, medical care, or flight from the epidemic.

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The Cholera Years

Author: Charles Rosenberg

II God's Justice?

The disease only strengthened belief in God and reinforced the idea that sin caused disease. Doctors even started supporting this idea that the United States was losing its favor with God since there were so many non-believers, Catholics, and immigrants that were sinners. They also liked to point out that mostly filthy and poor people died during the epidemic.

III Or Man's Injustice?

Others pointed out that the United States was becoming like the 'Old World' in its filth and that the country was losing itself to the immigrants especially the Catholics. They also pointed out that the poor were poor compared to the rest of the population. The only good group of "non-American Americans" were the Sisters of Charity, a Catholic order that served the dying faithfully during the epidemic.

VII Religion, Science, and Progress

As far as the faithful were concerned, cholera was caused by sin but they started to believe that filth was a form of sin. The nation actually declared a day of fast to combat the sinning and the growing atheism that people saw, but still more thought that the fast was a bad idea. Furthermore science saw no connection between God and the disease and preached better hygiene as the only safeguard.

. Another thing that came out in the 1840's was a new means of taking statistics and there was proof that tenements were breeding grounds for disease because of the overcrowding and filth. Even with this knowledge, people still believed that it was the tenement owner's fault or the drunks who "chose" to live there.

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http://www.epilepsytoronto.org/

by Lisa Francesca Andermann, MPhil, MD

epilepsy as a punishment for sin, epilepsy as bewitchment or possession, and epilepsy as a contagious disease. 4 More than one of these conceptualizations may be held simultaneously.

The belief that epilepsy is a contagious disease underlies all others in Baganda medicine, with drastic social consequences for the patient. Even a person with relatively few seizures will have to eat and sleep alone, leave school, be forbidden to play with other children, and will likely not marry, except in a downwardly mobile arrangement. Once a diagnosis of ensimbu has been made, people accept that the patient will suffer from a "spoiling of the brain." The social isolation that ensues may make this a self-fulfilling prophecy.

Beliefs about the contagious nature of epilepsy may also put the person with epilepsy in great danger. [Cooking fires are common throughout Africa as well as many parts of the developing world], and burns and scars that result from falling into the fire may occur if those nearby flee in fear. Severe burns are such a common occurrence among epilepsy patients, that they have been suggested by Gelfand and others as sufficient evidence for making a diagnosis of epilepsy. 9 For the physician, the presence of burns distinguishes epileptic convulsions from hysterical seizures, while for the traditional healer, it may be a sign that the illness has progressed beyond a certain point and is no longer curable.

A Henan study found many negative attitudes towards people with epilepsy among the general population: 87% would object to having their child marry someone with epilepsy, 57% would not let their child play with a person with epilepsy at school, and 53% believed that people with epilepsy should not do the same jobs as others. Living in a rural area with a lower level of education was associated with increased prejudice against family members either playing with or being employed with people who have epilepsy. However, the idea of a link between epilepsy and insanity was found to be more prevalent among the educated urban group. 28

While stigma, loss of face and low self-esteem are commonly encountered among patients in China as in the West, in China the moral "blame" associated with epilepsy extends beyond the individual to encompass his or her entire family. "The ruins of social relations ruin lives. Renqing, favour, the affect central to social exchange, can neither be given nor received. To lose face, to be unable to allocate renqing, to experience delegitimation means that the social course of epilepsy for patients and families is potentially a form of social death. It is not at all surprising, therefore, to what extent families will go to ward off, to resist, delegitimacy." 29

The role of ethnicity in the utilization of biomedical health care is not only an issue in developing countries. The Native North American Tewa consider breach of tabu, or any digression from the ideal way of life, to be the primary explanation for disease, followed by object intrusion, contagious magic and witchcraft. Mothers of children with epilepsy often blame themselves for having had bad thoughts or actions during the pregnancy which could have caused the illness. Among the neighbouring Navajo population, grand mal seizures are thought to be the direct consequence of sibling incest, thus representing a stigma for the entire family. 37 While these beliefs are not found among the Tewa, patients and their families still experience varying degrees of social isolation.

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