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

by Charles E. Rosenberg

Cholera was the classic epidemic disease of the nineteenth century, as the plague had been for the fourteenth. Its defeat was a reflection not only of progress in medical knowledge but of enduring changes in American social thought. Rosenberg has focused his study on New York City, the most highly developed center of this new society. Carefully documented, full of descriptive detail, yet written with an urgent sense of the drama of the epidemic years, this narrative is as absorbing for general audiences as it is for the medical historian. In a new Afterword, Rosenberg discusses changes in historical method and concerns since the original publication of The Cholera Years .

"A major work of interpretation of medical and social thought . . . this volume is also to be commended for its skillful, absorbing presentation of the background and the effects of this dread disease."—I.B. Cohen, New York Times

" The Cholera Years is a masterful analysis of the moral and social interest attached to epidemic disease, providing generally applicable insights into how the connections between social change, changes in knowledge and changes in technical practice may be conceived."—Steven Shapin, Times Literary Supplement

"In a way that is all too rarely done, Rosenberg has skillfully interwoven medical, social, and intellectual history to show how medicine and society interacted and changed during the 19th century. The history of medicine here takes its rightful place in the tapestry of human history."—John B. Blake, Science

Genres: History, Nonfiction, Medicine, American History, Science, History Of Medicine, Health

276 pages, Paperback

First published September 1, 1968

Reviews

[Valorie Dalton · Rating 4 out of 5]

In the Republic era of America, people were assaulted daily by their own visions of success, failure, the expectations and weaknesses of a still developing concept of democracy, poverty, and illness. One such illness, Cholera, infected America three times during this period: 1832, 1849, and 1866. In America, “Cholera represented a constant and randomly reoccurring stimulus against which the varying reactions and systems of Americans could be judged”, and it caused gradual changes in social attitudes, government, religious thought, and medicine as people tried to understand and cope with the disease. Historians have recently given little attention to defining and then writing about the social changes brought about by cholera, both as a process and its final result. It is part of history’s recent interest in social aspects such as family and school, which medicine is a part of because the two are linked by every day life concerns.

The Cholera Years is an interesting and easy to read book. One of its strengths lies in its readability and in how it engages the reader through primary sources. Historical books that tell stories and relate true life accounts and words are more interesting than those that simply move from one fact to the next. Also, Rosenberg is very organized in his presentation of information. The sections, chopped up by cholera year, follow the same patterns as far as how information is addressed. As a result, though we are reading from one year to the next, the progressions of society and thought are easy to follow and connect together. It actually made more sense this way than if Rosenberg had approached the book topically, which would have jumped around and only confused. Unfortunately, as a weakness, Rosenberg is very repetitive. A lot of information and points are stressed repeatedly throughout the book, and in that way it sort of losses focus a few times.

Rosenberg gives an annotated bibliography at the end of his book, which lists aids, manuscripts, public documents, newspapers, printed medical documents, other printed material, and secondary sources consulted. He does make note in his section on printed material other than medical literature that he has not listed all the documents consulted because they are too numerous, but instead listed those that are most interesting or relevant, which he also does with newspapers. The primary sources include such documents as hospital reports, newspapers, Board of Health and committee minutes, and religious sermons. As such, we are provided with a lot of “from the mouth” accounts of cholera to support the progressions in thought and practice that Rosenberg takes us through from one outbreak to the next.

This book fits well into the genre of medical history, as well as cultural history because Cholera had a direct and distinct impact on life, the concept of a person, social equality, and medical care. You won’t get the sort of copious gory details that medical history books are known for, which is a shame, but you will certainly come out of reading the book understanding a bit more how America evolved into the country it is now, and how something like one disease could shape a nation.

[James · Rating 4 out of 5]

: Rosenberg’s text, considered a classic in Public Health history, explored the short outbreaks of cholera in the United States over the course of 34 years. Cholera was the major classical 19th century disease, replacing smallpox and malaria as both had been largely dealt with by the time of major industrialization and urbanization. It was characterized by transmission by diarrhea and vomit which were spread by infections of public water, dirty streets, and failure to deal with waste by cities. The struggle to understand the disease was underscored by its major outbreaks in 1832-34, 1848-49, and 1866, and Rosenberg concentrates on New York City, as the largest and most dominate American city. He frames the discussion of each outbreak by the reaction of religious movements/clergy, discussions of poverty (of which Irish immigrants and free blacks were the poorest), and debates within the medical profession on how to deal with the disease. Unlike previous diseases, weather did not affect cholera which further terrified urban residents.
In the first major outbreak, 1832-34, the city struggled to keep up with the death rate, as quarantines did not work, and those who could afford left the city in droves, with up to 39 deaths a day. The religious community argued that the outbreak was proof of God’s judgement, while professionals argued that the poor were to blame. Medical officials debated whether it was a atmospheric or contagion, and pushed eventually for the formation of a weak Board of Health which pushed to clean the streets, which failed to clean the water well, though only the poor drank of the water. While lacking basic medical knowledge, the outbreak enabled data gathering, though the Board of Health quickly faded in the years after the outbreak as the city failed to fund it.
In the second major outbreak, 1848-49, ideas about germs had become more popular, and earlier medical debates had largely ended. While the city was again slow to act, this time a reconstituted Board of Health acted quickly and banned open air fruit sales and experimented more with cleanliness coordinator. By this point, the water cure was becoming popular and thus clean was prioritized which helped with the outbreak. Though it was under control in NYC by the end of 1849, it continued much of the rest of the country until 1854.
Finally, in 1866, directly after the Civil War, the final outbreak of cholera struck New York. After years of medical research, fueled by Dr. John Snow of London in the 1850s in linking infection of water sources led to the formation of a powerful board of health to quickly clean the streets, remove manure from vacant lots, and disinfect privies. This board was left in place and was largely copied by cities across the United States which effectively eliminated cholera as a disease, a remarkable turnaround in a mere 34 years for dealing with deadly disease.

Key Themes and Concepts
-The popular mind was cholera hospitals were places of death to avoid if possible.
-Cleanliness culture took root as a basic function of municipal government in order to prevent further outbreaks of disease.
-Religious response and disdain for the poor was replaced by medical rationalism and widespread treatment of poverty cleanliness. It was in the interest of the city to provide sanitary conditions for all residents, which meant clean streets, clean water, and well ventilated homes.

[Harper Daisy · Rating 3 out of 5]

If you know one thing about me it’s that I’m gonna be logging my school books on Goodreads.

The Cholera Years was a decent read, something I absolutely never would have chosen on my own but was surprisingly interesting. I felt that the writing style was easy to get into and not too hard to follow.

I think this is because the epidemics were in themselves somewhat repetitive, but I felt that this book got extremely redundant sometimes; a simple point could go on for pages and pages. That being said I really liked the breadth of sources and references to real people at the time, it helped a lot to convey how people were actually thinking about the disease.

I find myself surprised at the chronological timeline of certain discoveries, that they were advancing so much in the early industrial era but didn’t discover bacteria (or the general public discovering that poverty was the cause of illness/vices and not immorality causing poverty) until less than 200 years ago.

[Mathew Powers · Rating 3 out of 5]

This book isn't bad, but I don't find it riveting. Furthermore, there are too many assumptions made about how "Americans had become.." and "most people.." when he admits most of his sources are from New York and, let's face it, are not about how people felt. There are some wildly over generalizations about the entire makeup of society.

His overall premise about a shift from bad medicine, folklore, and God's punishment shifting to germ theory, science, and pragmatic approaches to health was not bad, but not all of it was attached to Cholera. Much of the idea of cleaning water, for example, started with Haussmann (sp?) in Paris which had been studied by many. It wasn't just cholera, it was many diseases and overall health of people .. not to mention cleaning up cities for various business and political reasons.

The idea of social change in regards to helping the poor rather than admonish them is a typical story of nineteenth century study. One can find works from China to London to Chicago (a LOT in Chicago) regarding this subject.

It's not a bad study, I just find myself raising an eyebrow too often at some of his statements. All in all, though, one can't help but read this and get an idea of how the nineteenth century make up of cities *generally* existed. Cholera outbreaks do serve as a good foundation with which to tag changing industrial revolution/Victorian/Middle Class thinking to.

So, the book is, to me...average, at best.

[Timothy · Rating 4 out of 5]

I first read this book way back in the 20th century, when I was new to the history of science and medicine. I recall liking the book but my appreciation for this work which came out before I was born has only grown over time. The book is steeped in primary sources, rich with details, and perfumed with generalisation that are apt.

The book carefully peels away the social thought of Americans using the cholera epidemics if 1832, 1849 and 1866. Full of politics, religion, and the history of medicine the text tells us much about the America of the mid- nineteenth century. Those who read it during the age of Trump will see many parallels between the past and present which may help explain how we got where we are today!

Rosenberg’ book has held up well despite the fact it is nearly 60 years old! The age of the book only becomes clear when you see that Rosenberg uses the term Negro rather than Black or African American to describe a people group. Black became a common term only with the black power movement which was a few years away from the book’s original publication. African American was not common until the 1980s.

Rosenberg is, as of this writing still alive, and is married to one of my other favorite historians Drew Gilpin Faust, former President of Harvard.

[Czarny Pies · Rating 4 out of 5]

Of the four horseman of the apocalypse pestilence is the one that seems to have troubled America the least. In fact this is a myth. Before the progressive movement in municipal politics which took place in America in the second half of the nineteenth century, epidemics were quite frequent in the United States. Thus the Cholera Years does us the valuable service of reminding us how much modern sanitation laws, sewers and water systems have done to make our lives not only longer but happier.

More than 50 years after it was originally published in 1962, the Cholera Years is still one of the major books that should be read by all undergraduates who are majoring in American history.

[Shannon · Rating 2 out of 5]

Book, you disappoint me. I was really excited about reading this, I mean, cholera you guys! But the prose was dull, and the same basic ideas were repeated ad nauseum. It should've been about 100 pages shorter, with less generalizations. At one point he was talking about how clean Boston was because of its Puritan routes, but Boston in the 1800s was just as filthy as other cities, especially if you looked at the parts of the city packed with impoverished immigrants. I hope Professor Rosenberg is a better teacher than he is a writer--must be, or Harvard wouldn't have hired him, right?

[Alexandra · Rating 4 out of 5]

Whenever I read a book about epidemics I always think about the time I had to run a preschool room which included a boy with scarlet fever

[Cindy · Rating 4 out of 5]

I happened upon this book in a donated box of discarded academic titles, drawn as I am by portraits of epidemics. Instead of a medical history, it turned out to be a thoroughly researched dissertation (quite literally, as the author’s dissertation became this book!) on the social and political history surrounding the emergence of an unknown disease, in a society equipped with nothing more than archaic ideas of science and inefficacious physicians who often did more harm than good.

At first I was bothered by seeming contradictions in the author’s characterization of the abundant filth in American cities and how these dirty places dealt with problems like disease. For example, a characterization of American cities as cleaner than any European slum is followed by detailed descriptions of filth accumulating in every street. Likewise, after describing how epidemics gave rise to unofficial, temporary governments that disintegrated after they ended and left no way to cope with future epidemics, he goes on to say that New York City’s “dozen bouts with yellow fever” had prepared this city to cope with cholera. The further I got into the book, however, the more I realized that the author was simply refusing to ignore the subtleties in the complicated history of a rapidly changing society forced to deal with an unknown disease. Rather than dichotomize this history into simple cause and effect, he focuses on the subtleties inherent in understanding the science and politics of disease prevention in a time of great social and intellectual change.

As the author puts it, the appearance of cholera in the Western Hemisphere "represented as much a mystery as had the plague five centuries earlier, for the theoretical resources of the average physician in 1832 were not greatly different from those of his medieval predecessor." In these dark days of science, considering a disease to be contagious was viewed as unscientific medieval thinking, and the widespread belief was that moral failures led inevitably to both poverty and disease. But of course society changes over time, and over the course of these three cholera epidemics such ways of thinking gradually diminished, paving the way for the eventual knowledge that this disease was caused not by the wrath of Gog, but instead by a specific transmissible organism. "American physicians readily accepted the discovery of the cholera vibrio in 1883. Many had expected it for they had been brought step by step to an intellectual position that could readily assimilate it."

The author considers cholera not simply as a medical problem, but rather as a challenge of a new industrial society: "The discovery of political techniques appropriate to the ordering of this new society, and the assimilation of these techniques into the pattern of existing governmental institutions, was a task far more complex than the comparatively simple one of preventing cholera."

"Cholera could not have been conquered in 1832." At the time of the first epidemic, the tools necessary for fighting such a disease did not exist: the biological concepts of disease transmission were not yet fully understood, obtaining and analyzing statistics was not yet routine, and public health organizations did not yet exist. By 1866, however, "The culture that produced New York's slums, produced as well the disinfectants, the telegraph, the scientific insights, employed by the Metropolitan Board in its fight against cholera." This insightful book highlights the ways in which societal changes first contributed to the spread of cholera, yet later allowed the disease to be conquered, and I certainly enjoyed learning about a time and place in history that I don’t often think about.

[J. Pearce · Rating 3 out of 5]

"In the history of public health in the United States there is no date more important than 1866, no event more significant than the organization of the Metropolitan Board of Health."

Summary: Rosenberg looks at the cholera outbreaks in New York City (with some details from other places) to examine how cholera was "defeated" through prevention rather than through development of a cure. The story focuses on the eventual rise of Health Boards and their successful work to clean the US's urban centers, specifically in New York.

Doctors are examined in terms of their changing theories with regards to treatment of cholera in addition to their struggles with the reputation of the discipline as being generally useless. It also looks at the growing materialism of US culture and the decline in importance of religious leaders.

Rosenberg also looks at class (or more specifically poverty) as poorer people were far more likely to die of cholera than richer people. Initially this was argued as evidence of divine punishment of the lower classes who were less likely to be religious and more likely to be blasphemous, alcoholics, or sex workers; however, later poverty was blamed for causing cholera because of the filthy living conditions of the poor. (Previously, rich people who died of cholera were thought or found out to have a secret vice that made them susceptible to the disease.)

This work also shows how within a very short period (34 years) the attitudes of both society and medical doctors can be changed through a paradigm shift (Rosenberg doesn't use that term, it comes from Thomas Kuhn's work on history of science, but it works well here). Between 1832 and 1866, there was a lot of work done on what caused Cholera (the maps of cholera sufferers from London - Dr. John Snow) and also on hygiene. As well, the NY Metropolitan Board of Health was given vast sweeping powers of change/control over the city. With the assistance of the NY Police Department, they managed to clean as much of the city as possible. With their success in keeping cholera figures low, they set the bar for how Boards of Health would work throughout the rest of the US. (Interesting to read in concert with other books that look at boards of health, specifically Nash.)

A key factor in all of this was the growing public health movement and its success with the Board of Health in NY.

By examining cholera epidemics, Rosenberg can track the changing reactions to a randomly recurring event to the US public (through newspapers), various political elites (through the responses of Boards of Health, mayors, and presidents), and medical practitioners (through medical journals and minutes). Note that this is an important part in the rise of municipal governments. As Boards of Health grew in power, it indicated how governments were given the powers necessary to deal with the problems that urbanization caused (or was perceived to cause).

Traces changing attitudes towards poverty & vice, causes of illness (bad behaviour/moralism versus product of environment)

Key terms: cholera, epidemic, public health movement, nineteenth century, medical history, materialism, urbanization, industrialization, paradigm shift, immigration

Petty Complaint: Rosenberg gets some details of Canadian geography wrong. (This is really irrelevant to the book though.)

[Anna Engel · Rating 3 out of 5]

[3.5 stars]

There's something about knowing the worst-case scenario - past, present, or potential - that I find fascinating and strangely comforting. "The Cholera Years" combines social and medical history (my favorites!) and explores the 19th century cholera epidemics in the US. With the rise of urbanization and an increasingly mobile populations, diseases like cholera had the opportunity to flourish. The medical community struggled to catch up scientifically and philosophically.

"The Cholera Years" traces more than just cholera epidemics and the political, epidemiological, and public health responses. It traces the development of a truly scientific medical profession, as concerned about effective preventative measures as with the cure.

[I did my undergrad thesis on mental illness in women during the 19th century. A similar phenomenon occurred in that sector of the medical profession also, as doctors learned to recognize and treat mental illness using science (although the term is debatable) and medicine rather than chains and opiates. But I digress.]

By the end of the third and final cholera epidemic on US soil, cities had figured out how to prevent, contain, and survive this terrifying disease.

[Emily · Rating 4 out of 5]

In this foundational text within the field of the history of medicine, Rosenberg employs cholera as a lens of analysis to capture the social changes that dramatically altered America between 1832 and 1866. Using New York City as a demonstrative case study, Rosenberg shows through successive cholera epidemics in 1832, 1849, and 1866 how this disease chronicles myriad social changes including: changes in religious thought, as materialism triumphed over evangelicalism and scientific explanations of disease causation silenced religious beliefs of disease as moral punishment; changes in scientific thought, as critical and empirical methods replaced abstract and philosophical rationalism; changes in theories of disease causation, as cholera emerged as a specific, contagious disease of known etiology rather than a vague atmospheric condition somehow related to environmental conditions; and changes in municipal responsibility, as cities continued to be derided as unnatural compared to rural living, but were increasingly viewed as spaces in which social injustice must be addressed.

[Lin · Rating 4 out of 5]

This book traces the history, a period through which Cholera transformed from a primarily individual moral dilemma into a social problem. Rosenberg did a splendid job depicting the roles of various parts of human society-religion, government, medical profession and laymen-in changing the frame of a disease.
My critique comes from two perspectives. Firstly, our good old Charles used secondary data from sermon, newspapers and journal articles. Although he provided a classical examples of work using such methodology, one issue rises: who wrote these texts? Using such "elite" data sources, Rosenberg did not take into account the experience of people most afflicted by the cholera disease. As a reader, I cannot help wondering what the poor and the immigrants had to say about the disease. Secondly, I agree with many other critiques that Charles is a little bit repetitive. Could have easily been a 150-page book instead of 250.

[Lee]

I would have enjoyed this regardless, since it's an interesting look at epidemics in history, but what made it for me were some of the Indiana sources used (including the letters of Mother Guérin and a number of local newspapers). At the time I read it, I was traveling extensively on business and had been to some of these places.

[Sawy-o · Rating 5 out of 5]

I really enjoyed this book- covers different cholera epidemics in the US and how people's perceptions of what causes disease shifted. Cholera is easier to cure when people don't believe it is caused by god's wrath. Features descriptions of quack medicine doctors used to prescribe and a look at life in New York back when pigs literally roamed in the streets.

[Bridget · Rating 5 out of 5]

A classic in the history of public health, Rosenberg's study of the role of epidemic disease (specifically cholera) in the formation of permanent boards of public health was revolutionary when it was published and stand the test of time in it's attention to social, intellectual, medical, and religious history.

[Mandrew · Rating 2 out of 5]

A good study of the 19th century Cholera outbreaks, focusing almost exclusively on New York. The book's divisions do a good job of separating its concerns and topics of discussion, but result in repetition. I would have appreciated more detail generally, as well as more background on the modern scientific understanding of the disease.

[Turtle Soup · Rating 3 out of 5]

Hey, I may have had to read this for my public health class, but it's still a book. The material is interesting, but confusing at times. Rosenberg clearly is not a natural writer, or at least does not know how to convey himself without being redundant. At least the information in it helped me get an A!

[Jessica Voloudakis · Rating 4 out of 5]

I really enjoyed this book. I could wish that it went into greater depth in some areas, but it was a great look at how the country viewed cholera over three distinct epidemics and the social evolution of the idea of public health.

[Lauren · Rating 3 out of 5]

A classic text from a giant in the history-of-medicine field... Focuses primarily on the epidemics in New York, but also offers useful information on theories of disease etiology and contagion in nineteenth-century medicine more broadly.

[Zeb Larson]

Couldn't finish this one. The writing style was very dated and he writes with a maddening number of assumptions and generalizations. I know it was a classic in its time, but there has to be a more up-to-date work out there.

[Helena · Rating 5 out of 5]

if you're interested in cholera in the US this is the book for you. its an amazing read if you want to know everything about it.

[Chris · Rating 3 out of 5]

A good book on the ethics of treating disease and how treatment moves from the religious sector to the medical and its causes from immorality to exposure.

[Wyatt · Rating 3 out of 5]

Not a bad book, an interesting look at change regarding views of medicine.

[Shirley · Rating 3 out of 5]

So interesting! I love medical history books!

[Sarah Catherine · Rating 3 out of 5]

Informative but it reads like a high school HOA IA.

[Robin Ray · Rating 5 out of 5]

Fantastic medical and social history of three cholera epidemics that swiped the United States in the 19th century. This book is remarkable for being as fresh today as when first published in 1962.

[Kathy · Rating 5 out of 5]

Why did I want to read about cholera epidemics? Misery loves company? I hope not; that seems quite callous in 2021. Medical curiosity? Not my area of expertise. Insomnia? No, thank goodness.

The Cholera Years by Charles E. Rosenberg was described as an analysis of the confluence of the medical, intellectual and social history of the three American cholera epidemics – 1832, 1849 and 1866. The attraction of learning about the interweaving the scientific and societal causes of a devastating disease was something I could not resist. Causes, who doesn't want to learn about the inducements and catalysts of dangerous systems?

Rosenberg chooses to focus his discussion on New York City, thus avoiding necessary repetition of explication from city to city. It was only in the populated cities of the 1830s that cholera as an epidemic struck: Boston, Charleston, Chicago, but New York was the largest and most populated at the time.

Causes – improvement in trade and transportation, industrialization; inadequate attention to humane architecture (tenements) and support services for the poor leading to slums; denial of the necessity of a Board of Health and condemnation of the medical profession's theories and warnings, Puritanical belief in the special dispensation of the pious, the temperate, the clean; lack of knowledge of fermentation and enzyme reaction and of scientific habits of mind. That's just some of it.

This is definitely worth your time, a well and clearly-written presentation which reads like a movie camera zoom into 40-some years of American life.

[Zack Loy · Rating 5 out of 5]

The Cholera years is a great reference when looking at the Covid-19 pandemic. This book shows that Cholera attacks everyone regardless of Race, Gender, Class. In the beginning of the book, only the poor were getting it. The poor were then labeled as being sinful because of this cholera outbreak. But as the book progresses we find out that it had nothing to do with virtue and everything to do sanitation. The rich who were seen as virtuous at first were not immune to this. The difference was that the rich were not living in slums that predisposed poorer people to contracting cholera. This book does a great job at showing the pros and cons of the church. At first, the church was using this as a way to point fingers at God's judgment. As new discoveries emerged that could explain how this pandemic was spreading the church altered their view of people with Cholera. By the end of the book, the church was acting in a much different capacity than at the beginning of the book. I think this shows two things, first human's ability to change and adapt. Secondly, that just cause we have always done something one way doesn't make it the right way.

[William Crump · Rating 4 out of 5]

As background for my own Healing Savannah trilogy, this book provided an important, detailed view into how different groups sought meaning in epidemics. As a physician, the medical details were well known to me, but I had a very superficial understanding of the religious and societal perspectives of earthshaking medical events. Our recent Covid experience just proved the value of this book as a guide. As I had to explain the miasma theory in my "Savannah's Hoodoo Doctor" and the differences among the enslaved Savannahians in "Savannah's Bethesda,", I referred back to this book frequently.