Last week, the World Health Organization (WHO) approved a new manufacturer to double the world supply of oral cholera vaccines. WHO leaders turned to the South Korean company after last fall’s outbreak of cholera in Iraq strained supplies of the vaccine, and meant that many who needed it could not get it. In that outbreak, the WHO dispersed oral cholera vaccines to nearly 250,000 Iraqis in high-risk populations. Over 2000 Iraqis had confirmed cases of cholera, but the actual number, according to the WHO, was much higher. Iraq wasn’t alone. In 2013—the last year with concrete numbers—there were over 125,000 confirmed cases of cholera from 47 countries. But these are just confirmed cases: the WHO estimates that 1.4 to 4.3 million people contracted cholera in 2013, causing between 28,000 and 140,000 deaths, and leaders are concerned that the warming climate will cause even more waterborne illness in the future. This isn’t just a disease infecting the other side of the planet. In the West, Haiti has regularly suffered outbreaks since the 2010 earthquake. This despite the $500 million donated by people to the Red Cross, partially to re-construct the country’s destroyed sanitation infrastructure. However, according to NPR, little of that money has made it actually to Haiti. Meanwhile hundreds of new infections occur every month.
Cholera, an acute diarrheal infection caused by bacterium in food or water, typically rears its ugly head in impoverished or war-torn regions, places where the drinking water is unsafe and the sanitation system is either collapsing or non-existent. If left untreated, cholera can kill within hours, but it’s an entirely preventable disease for those with money and infrastructure, and, even if you contract it, it is curable, usually with a regimen of oral rehydration salts.
This happy outcome is in stark contrast to the cholera pandemics that swept across the planet during the nineteenth century, killing an untold number of people, with no cure in sight. The disease was first discovered around the Ganges River near Calcutta in the early 1800s, though it may have existed for centuries. From there it headed west across Asia and into Europe in the early 1830s, decimating countries along the way. By the time cholera swept its way into England, Americans were well aware that, for the first time, they could be next.
Nowhere was this more the case than New York City in 1832. At the time, New York had a population of just over 200,000 people. Most of the city resided south of modern day 14th street, but the population was growing fast. In 1800, there were only 60,000 people in the city, most of them born in the United States. However, by 1830, there were over 17,000 foreign-born residents living in the city, the Irish being the most conspicuous. And more ships full of people arrived weekly.
Although the Atlantic Ocean before air travel might seem like a suit of armor—or an inoculation—this wasn’t the case. New York was a port town, docking ships from around the world. The city’s people were well aware of their vulnerability, but that didn’t mean they did anything about it. Historians Edwin G. Burrows and Mike Wallace in their Pulitzer Prize winning history of early New York City Gotham, write, “City authorities knew the plague might well ride the sea lanes to the Hudson, but did next to nothing with the foreknowledge.”
There were talks of preemptively quarantining the city, but the Board of Health was under pressure not to over-react by shutting down trade like they sometimes did when threatened by Yellow Fever. There’d been two deadly outbreaks of that deadly illness in living memory, one in 1794 and another in 1822. City officials routinely quarantined ships from the West Indies and the American South—the sources of Yellow Fever—but they didn’t want to do this too often because it cost money.
Moreover, the cause of cholera—and the way it was transmitted—remained a mystery. Some suggested it was airborne, while others thought it only infected the “filthy” sections of the population. Nevertheless, the Medical Society pushed the government to ready themselves by setting up hospitals and disinfecting cesspools with quicklime. Yet, even if they knew how cholera occurred, there was little they could do about it without overhauling the entire infrastructure. The city had no sewage system and little clean water. In fact, the two—drinking water and sewage—often swam in the same pool.
Moreover, much of the city’s population remained unconvinced that cleaning would do any good. New York’s clergy argued that cholera was God’s way of cleansing the city of sin, mostly Irish Catholic sin. Some physicians agreed, blaming cholera’s contraction on vice. And temperance advocates blamed alcohol consumption and encouraged the drinking of water. Oh, how wrong they were.
On June 15th, 1832 news reached the city that cholera had reached Quebec, and then on the 18th it arrived in Ogdensburg, a town on the northern edge of New York State. New York City Mayor Walter Brown put the city under quarantine: ships had to stay 300 yards offshore and no vehicles could enter the city.
Yet, it did no good. Eight days later, an Irish immigrant, only known as “Fitzgerald,” came down with it. He lived, but two of his children died. While it’s unclear where the family lived, most Irish were squashed into the notorious Five Points neighborhood, a part of town Charles Dickens would later describe as “ruined houses, open to the street, whence, through wide gaps in the walls, other ruins loom upon the eye, as though the world of vice and misery had nothing else to show.”
City officials tried to ignore the Fitzgeralds’ case, calling it an isolated case of diarrhea, but on July 2 the Medical Society identified the cause of the Fitzgeralds’ death as cholera. Those who had the money and wherewithal to run ran, leaving the poor and a few nuns and doctors to fight the virulent disease alone. By August 3rd, half the city’s population—more than 100,000 people—had fled the city.
But there were stragglers. One wealthy man who stayed to witness the epidemic was former New York City Mayor Philip Hone. In his diary he wrote that he lamented the absence of Independence Day celebrations. “The alarm about the cholera has prevented all the usual jollification under the public authority,” Hone said. “There are no booths in Broadway, the parade which was ordered here has been countermanded, no corporation dinner, and no ringing of bells.”
Hone did contract the disease, or at least a mild case of it, but he seemed far more upset by the restrictions placed on his diet. “Beef and mutton are allowed,” Hone wrote, “but vegetables and fruit are strictly interdicted. The peaches and melons in vain throw their fragrance around; we look at them, we sigh for their enjoyment—but we don’t touch them. I am well of my diarrhea, and I find it exceedingly difficult to resist the temptation. It is too much frailty of human nature and I am off to the Springs tomorrow to get out of the way.”
Most of those remaining in the city had more pressing concerns than a hankering for peaches. More than 3500 people died of cholera that summer in New York. The board of health, unsure of how to treat the disease, burned the clothes and beds of the poor. Five Points was ravaged. And there wasn’t much help coming to the disease’s victims. The Board of Trustees of New York Hospital, a private facility, refused cholera patients. One of their Trustees was Hone.
Only public Bellevue Hospital, filthy and overcrowded, took them in.
By early August, the epidemic had dissipated. The rich returned to the city and doctors and government officials began working on preventing the next outbreak. Their efforts didn’t do much good. Cholera returned in 1848, claiming more than 5000 victims. “Bodies lay in the streets for days,” Burrows and Wallace wrote. “Eventually they were rowed over to Randall’s Island and dumped in an open trench, at which point a gruesome public health device came into play as thousands of rats swam over and gnawed the flesh from the carcasses before they rotted.”
After this epidemic, the city’s attitude toward cholera-prevention changed. It wasn’t enough for the rich simply to abandon the city and leave the poor to suffer. If New York was going to be a world-class metropolis, something had to transform. City leaders poured money into constructing sewers. In 1857, only a third of the city’s residents—almost all wealthy—had access to sewers. By 1900, nearly every residence was hooked up. In addition, when the disease returned, no longer would city officials sit by idly waiting for the Irish to die. When cholera loomed in 1866, the state government of New York granted the newly formed and politically independent Metropolitan Board of Health sweeping powers, powers they used to clean the city of “filth,” quarantine the sick, and threaten owners and landlords of unclean premises with demolition. The new measures worked. Out of the city’s 800,000 residents, only 600 died.
Although cholera popped up every once in a while over the next few decades, it was never again in New York City the great killer of yore. Fixing it wasn’t magic: it just took money, infrastructure, strong leadership, and empathy for the poor.
Today, the disease is entirely preventable. Just not eradicated.