Boston in the Time of Cholera (episode 161)

Cholera is a truly horrifying disease, with severe diarrhea causing death through dehydration, while the patient remains awake and in agony.  The disease is carried by fecal bacteria, so it’s virtually unknown in highly developed countries today, because of our sophisticated sewage and drinking water systems.  Back in 1849, Boston had just begun to address its drinking water needs, with the Cochituate aqueduct opening the year before. We had not, however, even begun to deal with our sewage.  In most of Boston, raw sewage ran in open gutters down the sides of the street. When the first major cholera epidemic hit Boston in the summer of 1849, hundreds died.  There were no antibiotics or IV rehydration to treat victims with.  Instead, the city government took a public health approach that was focused on sanitation first.


Boston in the Time of Cholera

1852 map detail showing location of Half Moon Court

Boston Book Club

Public Health in the Town of Boston, 1630-1822 is an extensive study of Boston’s battle against epidemic disease in the years between English colonization and incorporation as a city that was published in 1959 by Dr. John Blake. We didn’t even know this book existed until recently, but once we discovered it, we realized we had missed out on an important book. I can’t believe that we released two different episodes about the 1721 smallpox epidemic, not to mention the Spanish flu, without consulting this volume.  It’s exhaustively researched, tying Boston’s struggles with smallpox, yellow fever, and dysentery to advances in medicine and broader historical themes.

Here’s how the Harvard University Press describes the book:

In this book, based almost exclusively on original source material, John Blake takes a detailed look at the public health history of the town of Boston. Historically, the author tells us, public health may be viewed as the science and art of preventing disease and promoting health through organized community activity. A significant part of this study is the insight it offers into the early attitudes toward disease and death as well as other basic political, social, and economic questions.

Dr. Blake outlines the development of public health practice from occasional emergency measures to a continuing program for the prevention and control of certain epidemic diseases. The introduction and increasing use of smallpox inoculation and later of vaccination are described and their importance evaluated. The book also discusses the further developments in the 1790s and the following two decades that resulted from a series of yellow-fever epidemics in northern seaports, including the establishment of a board of health and its efforts to prevent recurrence of this disease. The prevention of other endemic infectious diseases, though far more important in their effect on the community’s health, was largely neglected. Nevertheless, the principles of notification, isolation, and quarantine had been established and the need for governmental activity to protect the public health, for special public health officials, and for expenditure of tax money for public health purposes had been recognized.

This study, restricted in time to the period before Boston became a city (1630–1822), deals with the early years of the public health movement, a period that has been largely neglected. In comparing Boston’s experience with that of other colonies and England, Dr. Blake presents the European background in both the theory and practice of epidemiology and public health. The colonies themselves, whose differences caused many contemporaries to despair of their ever becoming a single nation, were yet bound by an essential homogeneity. “By and large they had the same language, the same religion, the same inheritance of British social and political ideals. And by and large they had the same diseases. Thus the history of public health in Boston becomes significant for the whole American experience.”

Upcoming Event

Back in 1773, colonists in Massachusetts were upset with Parliament, and the tax on tea had become a symbol of everything they were upset about.  Before the Boston Tea Party became a symbol for far-right anti-government extremists, before the Boston Tea Party even became a tea party, the town of Lexington had its own tea protest.  Three days before the destruction of the tea on Boston Harbor, Lexington residents brought their household tea out to the common and burned it in a giant bonfire. They issued a resolution saying that anyone in Lexington who continued to drink tea would be seen “as an enemy of this town and this country.”  It also said, “Should the State of Our Affairs require it, We shall be ready to Sacrifice our Estates, and every thing dear in Life, Yea & Life itself, in support of the common Cause.”

Modern Lexington reenacts the tea burning every December.  This year’s day-long Lexington Tea Burning will be held on December 8.  There will be musket drills, tours of Buckman Tavern, fife and drum music, and the tea will be burned at 1:30pm.  Festivities begin at 11am. The event is free and open to the public. 

Transcript

Intro Outro

Jake:
[0:04] Welcome Toe Hub history, where we go far beyond the Freedom Trail to share our favorite stories from the history of Boston. The Hub of the universe.
This is Episode 1 61 Boston In the time of cholera. Hi, I’m Jake.
This week, I’ll be talking about the deadly outbreak of cholera that happened in Boston in 18 49.
Cholera is a truly horrific disease with severe diarrhea causing death through dehydration while the patient remains awake, alert and in agony.
The disease is carried by fecal bacteria, so it’s virtually unknown in highly developed countries today because of our sophisticated sewage and drinking water systems.
Back in 18 49 Boston had just begun to address its drinking water needs, with the constituent aqueduct opening the year before.
We had not, however, even begun to deal with our sewage. In most of the town, raw sewage rented open gutters down the sides of the street.
When the first major cholera epidemic hit Boston, there were no antibiotics and no ivy rehydration to treat victims with.
Instead, the city government took a public health approach that was focused on sanitation first.
But before we talk about sewage and suffering. It’s time for this week’s Boston Book Club selection and our upcoming historical event.

[1:23] Our pick for the Boston Book Club this week is Public Health in the town of Boston.
16 32 18 22 This extensive study of Boston’s battle against epidemic disease in the years between English colonization and Inc is a city was published in 1959 by Dr John Blake.
This is one of those books that I didn’t know existed until very recently, but as soon as I started reading it, I realized what I’ve been missing out on.
I can’t believe that we released two different episodes about the 17 21 smallpox epidemic, not to mention the Spanish flu without consulting this volume.
It’s exhaustively researched, tying Boston struggles with smallpox, yellow fever and dysentery to advances in medicine and broader historical themes.
Here’s how the Harvard University Press describes the book in this book, based almost exclusively on original source material.
John Blake takes a detailed look at the public health history of the town of Boston.
Historically, the author tells us, public health may be viewed as the science and art of preventing disease and promoting health through organized community activity.
A significant part of this study is the inside it offers into the early attitudes toward disease and death, as well as other basic political, social and economic questions.

[2:41] Dr Blake outlines the development of public health practice from occasional emergency measures toe a continuing program for the prevention and control of certain epidemic diseases.
The introduction and increasing use of smallpox inoculation and later of vaccination are described and their importance evaluated.
The book also discusses the further developments in the 17 nineties and the following two decades that resulted from a series of yellow fever epidemics in Northern Sea ports, including the establishment of a board of Health and its efforts to prevent recurrence of this disease.
The prevention of other endemic infectious diseases, though far more important in their effect on the community’s health, was largely neglected.
Nevertheless, the principles of notification, isolation and quarantine have been established, and the need for governmental activity to protect the public health,
for special public health officials and for expenditure of tax money for public health purposes had been recognized.

[3:40] This study, restricted in time to the period before Boston became a city 16 32 18 22 deals with the early years of the public health movement, a period that’s been largely neglected,
and comparing Boston’s experience with that of other colonies and England.
Dr Blake presents the European background in both the theory and practice of epidemiology and public health, the colonies themselves, whose differences cause many contemporaries to despair of their ever becoming a single nation, were yet bound by an essential homogeneity.
By and large, they have the same language, the same religion, the same inheritance of British social and political ideals.
And by and large, they had the same diseases.
Thus, the history of public health in Boston becomes significant for the whole American experience.
We’ll have a link to buy the book in this week’s show notes, and you’ll be hearing more from Dr Blake in this week’s main story and for our upcoming event this week, I’m shining the spotlight on the Lexington T burning coming up on December 8th.

[4:42] Back in 17 73 colonists in Massachusetts were upset with Parliament, and the tax on tea had become a symbol of everything they were upset about,
before the Boston Tea Party became a symbol for far right anti government extremists before the Boston Tea Party even became a tea party, the town of Lexington had its own T protest,
three days before the destruction of the Tian Boston Harbor, Lexington residents brought their household t out to the common and burned it in a giant bonfire.
They issued a resolution saying that anyone in Lexington who continued to drink tea would be seen as an enemy of this town and this country.
It also said, Should the state of our affairs require it, we shall be ready to sacrifice our estates and everything dear in life, YEA and life itself in support of the common cause.

[5:32] Modern Lexington reenacts this tea burning every December. This year’s day long T burning celebration will be held on December 8th.
There’ll be musket drills, tours of Buckman, Tavern, Fife and drum Music, and the tea will be burned at 1:30 p.m.
Festivities begin at 11 a.m.
If it’s free and open to the public, we’ll have a link to more information about the tea burning as well as a link to buy your copy of Public Health in the town of Boston in this week’s show.
Notes at hub history dot com slash 161 Before moving on, I just want to say a big thank you to everyone who supports the show unpatriotic.
Over the past three years, we’ve built this show from nothing to a point where thousands of people listen to hub history every week.
Your support means that we can cover our monthly costs and dream about ways of making this show better.
We have big plans for what we’d like to do to improve the show from redesigning the website to move into a different podcast hosting platform to even upgrading some of our recording hardware.
If you’re not yet supporting us, and you’d like to just go to Patriot in dot com slash hub history or visit hub history dot com and click on the Support US link.
Thanks again to all of our new and existing supporters.

[6:46] And now it’s time for this week’s main topic, when Boston was racked by an epidemic of cholera in 18 49 medicine and not yet adopted the germ theory of disease.
Instead, many doctors relied on the miasma Matic theory of disease to explain why their patients got sick.
The U. C. L. A Department of Epidemiology has a succinct description of what that meant.
Many in the early to mid 19th century felt that cholera was caused by bad air arising from decayed organic matter or miasma.
Tha miasma was believed to pass from cases too susceptible. Tze and disease is considered contagious.
Believers in the miasma theory stressed eradication of disease to the preventative approach of cleansing and scouring rather than through the pure scientific approach of microbiology.
One prominent supporter of the miasma theory was convinced that cholera was transmitted by air.
He reasoned that soil it low elevations, especially near the banks of London’s River Thames, contained much organic matter, which produces miasma data.
The concentration of such deadly miasma tha would be greater at lower elevations than in communities and the surrounding hills.

[8:01] At that time, Boston was still a fairly small peninsula, nearly entirely surrounded by title salt flats.
While there was some film banned in the former mill pond that became boffins triangle along the flats of Beacon Hill and in the area surrounding the earlier city dock, the massive landfill projects of the Back Bay, South Boston in the South Bay still lay in the future.
These tidal flats that we be later filled in were believed to be perfect incubators for disease.
A report by the city’s Committee on Internal Health from December 31st 18 49 describes the areas in Boston that were hardest hit by cholera.
It’s pretty clear that the authors were believers in the miasma theory and the inherent unhealthy nous of coastal soils.

[8:46] As is well known, most persons throughout the city were more or less affected by the cholera atmosphere.
But few cases of the actual disease and still fewer deaths occurred in any of them, or dry and airy portions of the metropolis as will be seen by the topographical map appended to the medical report.
The epidemic made its first attack and spent its force in those localities which were nearest to the level of the sea and in fact rescued from it by filling up with Doc mud, which were the least perfect and drainage that worst ventilated and the most crowded and filthy.

[9:21] We’ll have a link to that mentioned topographical map in this week’s show notes so you can see where cholera hit the hardest.
There are cases scattered across the city, with concentrations along the South Bay near today, South Street Diner and in the north End along Hanover Street in Ann Street, today’s North Street near crust.

[9:41] The committee report goes on to describe the conditions in these neighborhoods. There were at least partially built on made land.

[9:48] In all these localities, there are many streets, courts and lanes which are exceedingly contracted, ill ventilated and dirty, without any proper grade and with no or very insufficient sewerage.
This state of things is mainly owing to the fact of there, having been originally laid out by private speculators whose only object was to make a profitable investment for themselves, who paid but very slight attention to the health or comfort of those who have to reside upon them.

[10:16] Along with the marsh mud, insufficient sewerage and improper grading, the areas that were hardest hit by the 18 49 cholera outbreak tended to have one other thing in common.
They were home to many recent immigrants from Ireland.
Keep in mind that while Boston heavily identifies as an Irish city today in the mid 19th century, Irish immigrants were considered unwelcome.
They tended to be dirt poor as they were escaping literal starvation after the potato famine began in 18 45.
And they were Catholic in a city that had religious biases going back 200 years and used to celebrate Pope’s Night annually by burning effigies of the pope.
As tenements begin to multiply in the North, in the South in and other neighborhoods, old Yankee Boston reacted to this wave of immigration with some of the same ugly impulses that we see playing out in reaction to recent waves of Central American immigration.
When these Irish American neighborhoods began to suffer from cholera, many Bostonians were all too happy to blame the Irish for their own fate, seeing them as inherently filthy and immoral.
The 18 49 internal Health report on the epidemic alludes to these biases when it describes who was hardest hit by the disease.
For the most part, the temperate, the moral, the well conditioned escaped whilst the imprudent, the vicious and the poorly fed succumb to its insidious influences.

[11:42] In a November 18 49 letter to the Boston Medical and Surgical Journal, Dr James W. Stone more explicitly tied the cholera outbreak to the presence of the foreign born and to the poor living conditions they were forced to survive in.

[11:57] There can be no doubt that the mortality has been greatly increased by the crowded, an unventilated condition of houses in which foreigners are enclosed,
and by the frequent assemblage and ill constructed public halls of crowds who are often obliged to remain three hours till it’s no a lecturer concert occupying half that time.
The mercenary calculations of miserly individuals have sometimes induced them to erect low contracted tenements, scarcely more visited by lightning air than those destructive minds where some are obliged to consume the greater part of an abridged life.

[12:30] The internal health report continues, describing living conditions in the densely populated tenements around the foot of Fort Hill, which was the absolute epicenter of the 18 49 epidemic.

[12:42] We allude to the very wretched, dirty and unhealthy condition of a great number of the dwelling houses occupied by the Irish population,
in Batterymarch Broad, Worf, Wells Bread, Oliver Hamilton, Atkinson Curve, Brighton Cove an and other streets.
Thes houses, for the most part, are not occupied by a single family or even by two or three families.
But each room, from Garrett to cellar is filled with the family, consisting of several persons and sometimes with two or more families.
The consequence is an excessive population, holy disproportion to the space or accommodations in Broad Street in all the surrounding neighborhood, including Fort Hill and the adjacent streets.
The situation of the Irish in these respects is particularly wretched.

[13:29] During their visits in the last summer, your committee, where witnesses of scenes too painful to be for gotten and yet too disgusting to be related here,
it is sufficient to say that this whole district is a perfect hive of human beings without comforts and mostly without common necessaries,
in many cases huddled together like brutes among the dehumanizing language, referring to the excessive population of Irish American brutes who live in hives.
The phrase without common necessary stands out.
At the time, necessaries was a polite euphemism for sanitary facilities, that is to say, a bathroom or a privy thes tenement buildings must have been overflowing with more than just excessive population.

[14:17] In his new book, The City State of Boston, Mark Peterson makes this observation about one of the narrow alleys around Fort Hill.

[14:25] Henry Clark, the doctor heading the cholera commission, found 12 to 14 ill constructed an overflowing privies in this densely occupied alley, which also received human waste tumbling down from the Fort Hill slums Up above.

[14:39] Living conditions in the tenements around Fort Hill made a major diarrheal epidemic more or less inevitable.
Those overflowing privies were the perfect mechanism to transmit the disease from one patient to an entire neighborhood.
In a journal article called cholera and the Pump on Broad Street, Laura Ball summarizes what cholera is and how it’s transmitted.

[15:01] Microbiology has shown that cholera comes from a bacterium called vibrio cholera I that enters the body through contaminated water or possibly food.
The bacteria’s interference in the small intestine causes profuse diarrhea and vomiting.
The consequent dehydration produces several distinctive symptoms.
As the concentration of water in the bloodstream decreases, the blood becomes thick and tar like capital areas rupture, which often turns the skin blue.
The heart rate becomes irregular and dehydrated limbs begin to shrivel.
The nervous system, however, remains intact until the end, leaving the victim fully conscious of the pain.
Without treatment, death occurs within days or even hours of the first symptom.

[15:49] With a long history of dysentery epidemics in Boston, I was curious about what makes cholera differ.
They’re both disgustingly deadly diarrheal diseases. But as Laura Balls description laid out, cholera is the result of a specific bacteria vibrio cholera.
It causes watery diarrhea that leads to death by extreme dehydration.
Dysentery, on the other hand, is a catch all term for gastrointestinal diseases that cause bloody diarrhea.
It could be the result of any number of bacterial infections or amoebas, and similarly causes death by dehydration.
Boston faced major dysentery outbreaks throughout the 18th century, especially during the siege months of 17 75 and 17 76 when both the red coats camped out on Boston Common,
and especially the soldiers and civilians in and around the Patriot camps and Roxbury in Cambridge, where racked by,
camp fever and dysentery,
both armies were plagued by diseases of the intestine throughout the war.
With John Blake in our Boston Book Club selection this week,
crediting that experience for inspiring many of the early sanitary regulations in Boston,
with everything from disposing of the by products of butchering to grave digging to selling spoiled produce being regulated in the years between the end of the war and the adoption of the federal Constitution.

[17:08] Blake continues outlining early attempts by the Boston Board of Health to deal with human waste in a sanitary fashion.
At the turn of the 19th century, another of the board’s most important sanitary functions was regulating the removal of human excrement.
At first, special carts were provided and certain men licensed to use them, but they frequently created nuisances.
Thus, in 1800 a newspaper correspondent wanted to know,
how long the citizens of middle and fish streets and on towards Hancocks worth are to be stifled by the intolerable stench arising from the filth spilled by the carts devoted to the dirty goddess.
Almost every morning, their olfactory nerves air saluted with Ian wholesome effluvia and their health’s endangered by the carelessness or perhaps design of these nocturnal gold finders, the Board of Health have frequently ordered them to discharge.
They’re using cargo in suitable places without effect.

[18:06] The licenses were continued unsatisfactory until in 18 11 a monopoly was granted to Jeremiah Bridge, who had special equipment for the job.
Many disliked paying bridges prices, however, though there are fixed by the board.
Others wanted to share the business, and farmers were isn’t it being cut off from this source of manure?
As a result, many citizens failed to have their vault emptied on time or had it done by unlicensed collectors without permission.
Despite frequent threats and regular prosecutions, this phase of the sanitary program remained a persistent source of trouble,
In their efforts to keep Boston sanitary, the health officials found that wastewater from pumps, households and rainfall posed another continuing problem because of their concern with paving.
The Selectmen were also interested in good drainage and following long established procedures, they continued to supervise the construction and repair of common sewers in the streets.
The Board of Health, for its part, required property owners to convey wastewater underground into the nearest sewer and from time to time ordered individuals to clean their household drains.

[19:13] The measures outlined by Blake sound like laudable goals, but for the immigrants and desperately poor families crammed into overflowing tenements in the slums around Fort Hill.
Reality did not measure up.
Here’s how the 18 49 Internal Health Report describes sanitary conditions in a typical tenement.
The houses are also insufficiently provided with the necessary in and out of door conveniences, which are required in every dwelling place.
The great mass of them have been one sink opening into a contracted in ill constructed drain or, as is frequently the case, into a passageway or street.
And but one privy usually a massive pollution for all the inhabitants, sometimes amounting to 100.
Some of them have neither drained nor privy, and the tenants are obliged to supply their necessities as best they can.

[20:01] With human waste running an open sewers down the sides of the street, and sometimes in the street itself, it wouldn’t take much to set off a diarrheal epidemic.
Somebody steps in the suspect puddle that gets tracked into the house.
They used their hands to pull off their soiled shoes, and then there may not even be a sink in the apartment to wash up with before preparing dinner.
That’s how countless rounds of dysentery got started over the centuries, however, Boston had never encountered cholera before the mid 19th century.

[20:31] Cholera probably first arose in South Asia many centuries ago, but it didn’t become a global pandemic until after the British subject Gatien of that region with the global nature of the British Empire came widespread travel.
And with this widespread travel came a series of epidemics.
The first, starting in 18 17 spread the disease throughout Southeast Asia, East Africa, the Middle East, Russia and parts of Europe.
A second wave in 18 26 mostly affected Europe and brought the disease to American shores for the first time.

[21:04] In his 18 92 Observations on cholera, published in the Boston Medical and Surgical Journal, Dr J.
H. McCollum discusses the first emergence of the disease in North America in 18 32 cholera across the ocean for the first time and entered this country by way of Gross Island, the quarantine station for Quebec,
from April 28th 18 32 to June 3rd. 18 32.
There arrived a gross island, four collar infected ships, namely the ship Constanta from Limerick, Ireland, which arrived April 28th.
The ship Robert from Cork, arriving May 14th the Elizabeth from Dublin, arriving May 28th and the Brig. Carrick from Dublin, which arrived on June 3rd.
The importation of the disease by immigrants on the’s ships was the origin of an epidemic that extended from Quebec to Montreal, up the ST Lawrence and a Long Lake Ontario, down Lake Champlain to Albany and to New York from New York.
Cholera extended to Newport, Newark, Philadelphia, Baltimore, Charleston in Washington, D. C. During the months of July and August.
This epidemic spread from Chicago and ST Louis down to New Orleans at the end of the year, 18 32 though the United States was free from cholera.

[22:23] With fears of a cholera epidemic running high in 18 32 Boston’s commissioners of health made every preparation they could to combat it.
They stage supplies and located facilities so they’d be able to set up cholera hospitals near infected areas. Quickly, they performed inspections and fine landlords who didn’t provide adequate sinks, strains and necessaries.
The commissioner’s also offered this advice on how to avoid cholera.
Observe a perfect temperance in living. Avoid exposure to all debilitating causes, especially fear,
abstained from Spiritus liquors, which not only invite the disease by the indirect ability they occasion but render the system, in susceptible of all the most valuable medicinal agents employed in its cure.
Avoid as much as possible exposure to the night air and crowded meetings in the evening.
Avoid all uncooked vegetables, salads, crude fruits and sour drinks.
The food should be substantial and generous and quality, but simple and a near it ating.
It is not well to make any great and sudden change in diet or regimen, just as the disease is expected.
But let all begin to leave off bad habits immediately.
Aqueduct water and rain water, if tolerably pure, are better than that. Drawn from the wells.
Let all observe their customary hours for labor, refreshment and sleep and engage in all their usual innocent recreation. Zin amusements.

[23:48] It’s worth pointing out that of all that advice, only the bit about aqueduct water and rainwater being preferable toe well, water is actually accurate.

[23:57] The cholera outbreak there would finally turn deadly. In Boston, 18 49 was part of 1/3 global pandemic.
As a paper by GF Pile describes from 18 42 to 18 62 cholera raked the world,
as a pandemic originating in South Asia, latched onto pilgrimages, commercial vessels, warships and related transportation movements.
There is clear evidence that the disease entered the United States at two points within a nine day period of time.
New York was attacked on December 2nd, 18 48 and New Orleans felt the first effects on December 11th.
Pile argues that although the disease made landfall in New York City first, it actually spread faster up the Mississippi from New Orleans, quickly arriving in Louisville, Cincinnati in ST Louis.
Then, as anybody who played computer games at school from the late seventies to the early nineties knows, it found its way West with wagon trains following the Oregon Trail.
It wasn’t until almost six months later that the strain that had landed in New York City began traveling up and down the East Coast.
Census Bureau information compiled by Pile shows that collar was detected in Philadelphia and Baltimore in May and it finally arrived in Boston in June of 18 49.

[25:15] The 18 49 cholera season would last almost exactly four months from June to September, and during that brief window, somewhere between 607 100 people died from the disease in Boston,
the internal health report describes the course of the epidemic.

[25:33] The first death from the disease occurred on the third of June at number 11 Hamilton Street in the Person of an Irishman and the last on the 30th of September at the cholera Hospital in that Oven Irish woman from Worf Street.
The whole number of deaths between these dates, with 611 of which 163 were Americans and 79 Bostonians,
as terrible as a death toll of 700 might be out of a city of about 100 40,000 people. It could have been a lot worse.
Now is searching for online sources to research this story. I kept getting led astray by reports about 18 49 cholera outbreak in Boston, Boston, Indiana, that is.
After seeing so many references, I finally looked up an article about the 18 49 cholera Epidemics effect on small Midwestern towns, which was published in the Journal Transactions of the American Clinical and Climatological Association.
It included this summary of the outbreak in the other Boston, Boston, Indiana, a Crossroads village about 15 miles south of the National road, had 120 people in 18 49.
There were 53 deaths over five weeks. Of those who became ill, only one recover.
Graves were dug by family members on their own property. The town was abandoned except for one family.
Often, there was no one left to bury the dead.

[27:02] The report describing the course of the epidemic in our Boston is eager to distinguish between so called Americans and the majority of sufferers who were immigrants.
As I already pointed out, people were all too willing to blame Irish immigrants for their own illnesses,
pointing to their in temperate ways poor diets and habits of living packed into squalid tenement houses among the tenement districts, we’ve seen that the area around Fort Hill was probably the worst.
In her book Gaining Ground, recent podcast guest Nancy See Shoals describes how the Fort Hill area was the fashionable home of many wealthy merchants early in the 19th century.
But they gradually moved away to newly sheikh neighborhoods like Beacon Hill.
They’re large homes were purchased first by institutions like schools and libraries but then passed into the hands of absentee landlords, she says.
The ladder, anticipating that the encroaching business district would lead to an increase in land values, had no incentive to improve the buildings, one of them at low rates and let them deteriorate,
into this declining area poured many Irish immigrants in the 18 forties,
attracted by the low rinse and the proximity of fort held of the docks into places of employment.
The newcomers converted former mansions and warehouses, ended tenements, built ramshackle buildings on every available inch of open space and tunneled habitations into the hill itself.

[28:29] Of all the disgusting hobbles around Fort Hill, the tenements on a narrow alley called Half Moon Place, we’re probably the worst of all.
The 18 49 Internal Health Report describes living conditions in this wretched hive of scum and villainy.
Appended to the medical report is a sketch of Half Moon Place, which is probably the worst locality in the city.
Here the houses are built around an area from which air is almost totally excluded by the perpendicular wall of Fort Hill on one side and the lofty buildings of Broad Street on the other.
Ah, large part of the area is occupied by some 12 or 14 privies, constantly overflowing,
and by ill constructed and worn out sinks and drains into which are hourly, thrown solid substances of all sorts, which choked them up and cause the liquid parts mixed with them to run over into the area.
There is a narrow entrance from Broad Street lost.
A steep and crazy staircase affords a passage to Humphrey Place, some 50 feet above, side by side with staircase and fully exposed.
Ah, large square plank drain makes a precipitous descent conducting half hidden.
Half revealed not only the waste water of the Houses and Humphrey Place, but also the contents of its previous to the area below, which, as maybe supposed, is redolent of the fact.

[29:51] Back when I was a tour guide in Boston, I walk guests through the Back Bay telling a series of stories that were based in the mid 19th century, the same basic time period we’re talking about this week.
Sometimes the guests would get carried away and say how great it would be to go back to that time or ask me if I’d like to go back to that time if I could.
Reading passages like that description of Half Moon Place, with a dozen overflowing privies and an entire neighborhoods waste water flowing down a staircase onto its front stoop, my answer remains, as always, an emphatic no.

[30:25] By my calculations, Half Moon Place would have been located roughly behind the Broadside Pub on Broad Street downtown between Franklin and Windle streets.
We’ll include a map in the show notes this week showing where it and the warren of tiny alley surrounding it once were from 18 66 to 18 72. The hill was leveled and all the surrounding buildings were demolished.
The soil that was removed was used to create a new Atlantic Avenue, a process that’s also described in the book gaining Ground.
The newly flattened neighborhood was redeveloped as a business district.
In 18 69 the City Council recommended a change to the street cred in that area that resulted in the elimination of Half Moon Place, Hamilton Court, Hamilton Alley and Baker’s Alley, all of which show up with cholera map as the epicenter of the epidemic,
as a not so accidental side affected these changes the squalid tenements and overflowing privies, describing the committee report, we’re also eliminated.

[31:25] Even as cholera was taking its toll on Boston, British doctor named Jon Snow was conducting the research that would lead to a fuller understanding of the causes of this terrible disease.
London was in the summer of 18 49. Stricken with the same global cholera pandemic is Boston.
During this period, Snow became convinced that cholera was a digestive disorder rather than a blood disorder, as many medical authorities believed at the time.

[31:53] This theory let him to suspect that cholera was caused by ingesting contaminated food or beverage.
So you began a careful statistical study of cholera patients to determine where the obtained their water.
During a particularly bad outbreak in the summer of 18 54 snow found that the majority of patients got their water from one of two major providers, the one that drew it from a lower, more polluted part of the Thames River.

[32:20] The research that would eventually convince the medical establishment the contaminated water was to blame for cholera was carried out that same year,
in the London neighborhood of Soho, Snow mapped every fatal case of cholera and found that most were tied to a single public water pump,
he had the handle of the pump removed and the epidemic soon began subsiding, at least locally.
It turned out that the well feeding the pump was contaminated by surrounding privies and cess pools.
It wasn’t, however, until after another outbreak in 18 66 that Jon Snow’s theory of cholera transmission was widely accepted.

[32:57] Snows early thinking on cholera certainly hadn’t reached Boston by 18 49.
So the theory of my asthma’s was the best information anyone was working from.

[33:07] The city mobilized a major public health campaign to try to halt or contain the epidemic.
Luckily, some of the public health measures that one would take against a miasma attic disease map fairly accurately to those one would take against an intestinal bacteria.
From the Internal Health Report of 18 49 here of the preventive measures that the city recommended at the time, the police were directed to see that houses and sellers and exposed places were whitewashed.
Large quantities of disinfecting substances were purchased and freely distributed wherever they were required.
The inhabitants were notified to cleanse their house trains with constituent water and the common sewers are ordered to be washed different periods throughout the summer, the board directed the large tract of marshy land constituting the Back Bay.
And remember, before the back Bay was a neighborhood. It was a title marsh, and by 18 49 it was dammed up to power title mills.
So they directed the Back Bay to be flooded from the ocean and the water to be retained as great a height as the drains flowing into it would permit by a special order.
All vessels arriving in the harbor with fruits or other objectionable substances were ordered to report themselves to the hospital physician at Deer Island, by whom they were thoroughly examined in all decayed or Della teary ISS.
Portions of their cargoes were removed a thrown overboard before a permit was granted to come up to the city.

[34:33] Along with this public health approach, the city also arranged a special cholera hospital.
The groundwork for this have been laid during the 18 32 epidemic, but the plan wasn’t put into action until 18 49 the hospital was set up in an old warehouse with 20 beds.
At first, the capacity was later expanded, his 28 10 to 40 beds.
Unfortunately, doctors had no effective means with which to treat cholera at the time, so the hospital was essentially just a clean and comfortable place where the afflicted could await their deaths.

[35:07] The disease, or at least a slip ality, declined in the fall months.
This might mean that the city’s preventive campaign was effective. After all, Cleaning and flushing household drains and city sewers had to mean that there was less raw sewage in the streets on a daily basis,
however, it’s just a cz likely that the epidemic was curtailed by the onset of fall weather and the cooler temperatures that are less conducive to vibrio colorize survival.

[35:34] That wasn’t the last time that Boston had to contend with cholera. Just five years later, the disease reared its ugly head again.
Dr. J. H. McCollum’s 18 92 observations on cholera give a sense of how the 18 54 outbreak affected Boston.

[35:52] In 18 54 there was a second epidemic of cholera in Boston.
The number of deaths from this disease was 218. Although there is no published account of this epidemic, the fact that it caused considerable anxiety is evident from the report of the consulting physicians, the mayor and aldermen of City of Boston.
The text of this report is as follows to the mayor and aldermen of the City of Boston.
Gentlemen, in reply to the interrogatory, is proposed this day by the mayor to the consulting physicians of the city.
The undersigned beg leave to ST that the cholera now exists in Boston, as in most large cities in the United States, button so limited a degree as not to be considered a general epidemic.
The consulting physicians concurred in the propriety of an efficient prosecution of the active sanitary precautions which air stated to be in progress in the city, and they particularly recommend, as faras possible, the filling up of stagnant pools of water with earth,
the separation of the poor who reside in overcrowded tenements,
and especially their removal from sellers, which are damp, fowl and unwholesome.
Signed George Hayward, Jacob Bigelow, Z B. Adams and James Air Consulting physicians of Boston.

[37:11] The medical community was still working within the framework of the miasma attic theory of disease, and the city’s response was still grounded in sanitation in public health.
Filling pools of sewer water and reducing overcrowding and tenements probably were actually effective in combating the disease.
Whatever the reason, this time around the death toll was but a fraction of the 18 49 outbreak.
The last major outbreak of cholera in the 19th century came in the summer of 18 66.
This time, a grand total of 39 infections were reported with 19 fatalities.
This time around, the committee report indicates that the medical community was beginning to get over some of those earlier prejudices.
The reports which have been received as appears by the cases which we have been given,
show beyond question that the educated and uneducated, the wealthy and the poor, the old, the young, the prudent and the imprudent, the resident and the non resident furnished victims to this disease.
They also showed that locality does not afford complete protection from this pestilence, But the majority of cases that occurred during the year 18 66 were in the most unhealthy localities.

[38:24] This time the supposed morals of Irish immigrants didn’t take the blame for the epidemic resulting from the poor. Municipal service is available to them.
The response again was public health based, though that would soon start to change.
The germ theory of disease would just start gaining traction in the beginning of the 20th century, as medical science developed an understanding of how cholera was spread and how to prevent it.
In his 18 92 article in the Boston Medical and Surgical Journal, Dr J.
H. McCollum shares the latest consensus on cholera from a careful study of the different authorities on this subject that general opinion seems to be one that cholera is mildly contagious.
Two. That the principle, if not the only way of infection is by the alimentary canal.
Three. That the germs of the disease are carried only a short distance if it all through the air.
Four that the great danger of infection lies and the intestinal discharges and in the vomit iss five.
That contamination of the water supply and of the food by thes discharges is the chief source of danger.
Six. That Lenin or woolen fabric soiled by cholera discharges if excluded from air and sunlight served to keep alive the germs of the disease for an indefinite period.

[39:50] If the foregoing conclusions are correct, it necessarily follows that in order to prevent the admission of the disease to a city and effectually to stamp it out, the following measures must be adopted.
One. The proper isolation of all cases of the disease. Mild and severe.
Two. The disinfection of all discharges from the patient by chloride of lime or carbolic acid as recommended by the International Committee of Experts at Rome in 18 85. Three.
The most careful supervision of the water supply and the food four.
The rigid observance of all laws of hygiene in their widest sense.
Five. The disinfection of all persons in whom there is thes slightest suspicion of infection by suitable bathing and of their effects by superheated steam.

[40:42] Even before the advent of antibiotics and truly effective disinfectants and ambitious public health campaign was able to rein in the spread of cholera and of similar diarrheal illnesses.
The next time cholera reared its head in Boston, sewage systems were able to manage Boston’s human waste.
Public health was up to the task of providing the diseases spread, and modern medicine could help sufferers survive.
In 2011 a large group from Boston attended a destination wedding in the Dominican Republic while the wedding was held and an exclusive resort.
Some food, drinks and ice were provided by outside caterers within a few days to members of the party and confirmed cases of cholera, and four others were being watched closely.

[41:31] A 30 year old man and a younger woman were hospitalized, given aural rehydration, strong antibiotics and, after a few days of extreme discomfort, recovered,
with clean Quabbin drinking water, no overflowing privy pits and access to modern antibiotics, today’s Boston is far less susceptible to cholera than any earlier era.
It’s a good time to be alive, and I wouldn’t go back for anything toe Learn more about the 18 49 cholera epidemic.
Check out this week’s show notes at hub history dot com slash 161 We’ll have a copy of the 18 49 Internal Health Report about the epidemic.
The map showing three concentrations of infection and Board of Health reports documenting fears of an epidemic in 18 32,
for context will include links to Laura Balls, article cholera and the Pump on Broad Street, as well as GF piles overview of 19th century cholera outbreaks.
We’ll also have several articles from the Boston Medical and Surgical Journal, a predecessor of today’s New England Journal of Medicine, and, of course, leveling store information about our upcoming event and public health in the town of Boston, this week’s Boston Book Club pick.

[42:45] If you’d like to get in touch with us, you can email us at podcast at hub history dot com.
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Intro Outro

Jake:
[43:20] That’s all for now. We’ll be back next week.