The Enduring Significance of the Cholera Years

Keith Wailoo

H. Daumier, “Cholera in Paris,” from Némésis médicale illustrée, 1840. Courtesy National Library of Medicine.

Charles Rosenberg’s The Cholera Years, first published in 1962 and reissued in 1987, is one of those rare works that is both an old classic and still, fifty-plus years later, still required reading in the history of medicine and public health. The reasons for its enduring significance are many. In part, it embodies the social historical turn in the history of medicine—an early exemplar of the field’s shift to situating medical ideas and discoveries in deep cultural and social context. Cholera in Rosenberg’s telling was a social event, and story focused on New York—a locus of commerce where ideas of contagion became tied to economic questions such as whether or not to close the ports, and a site of religious and moral debate over whether epidemic was God’s wrath or a commentary on poverty, filth, and the deficiencies of society. Rosenberg’s approach was also pioneering, in telling the story of three epidemics, playing out sequentially in microcosm as a tale of secularization, and an urbanizing society moving haltingly toward building a new bureaucracy. For the next half-century and more, the book has remained a model of how to write the social history of disease, by embedding the very idea of public health, in the cultural, religious, and economic debates of the early and mid-nineteenth century. Twenty years after its publication the book was acclaimed as still the most influential in the field.[i] In 1988, another reviewer noted that The Cholera Years “defined the model by which American medical historians have come to approach their craft . . .  [and] instructed and informed the subsequent quarter-century of scholarship.”[ii]

The tragic arrival of HIV/AIDS in the 1980s brought another kind of relevance for The Cholera Years, even as it continued to be an unsurpassed model for many in the history of medicine. Much of the culture of blaming, the conservative religious reactions to AIDS, the moralizing surrounding sexually transmitted disease, and the politics of the new epidemic echoed past social reactions; The Cholera Years could be read in this context as profoundly prescient, or as merely revealing recurring features of an epidemic mindset.  Recurring crises in the decades since—the “emerging epidemics” of our time like SARS, MERS, Ebola, and the novel coronavirus causing COVID-19—have also ensured the book’s enduring significance in the field, as we seek to understand how Americans struggle to make sense of such sweeping calamitous events. The enduring significance of The Cholera Years owes much to its careful study of the interplay of moral judgement, social thought, and medical and scientific ideas. “To Americans,” Rosenberg wrote, “the extent of poverty revealed by the epidemic was genuinely disturbing. . . . A Cincinnati editor observed that if the disease was caused by poor food, poor lodgings, filth, and intemperance, ‘the number of victims gives us a melancholy idea of the present state of society.’”[iii] Cholera, like COVID-19, was a judgment of some kind. But it remained open to debate what kind of judgment it was. On poverty? On the state of the city? On temperance? Or on the political and economic culture that made such pandemics possible? In opening such questions for deep analysis, the book’s relevance has expanded in the new age of pandemics. (For a discussion with Rosenberg, Nancy Tomes, and me on these themes, see the opening session of the May 2020 webinar, “Pandemic. Creating a Usable Past.”)

Cholera Broadside from New York, 1849. Courtesy National Library of Medicine.

Writing in 2008, Nancy Tomes and Jeremy Greene recalled that other features of The Cholera Years, that explain its enduring significance, are its narrative style and its implicit engagement with theory. The book, they wrote, “is full of theory: we can tease out a little Weber here, some thoughts on common sense as a cultural system there, we can apply the retrospective terms of ‘practice,’ ‘habitus,’ and ‘discourse,’ but every ounce of theory in the book is wreathed in thick and rich narrative.”[iv] In style, the book evokes the work of Richard Hofstadter with whom Rosenberg studied.  Of course, all books have gaps and limitations, but even these have produced fruitful discussion over the years. In the end, it is this rich combination—a resonant method of reading epidemics and disease; a way of seeing medical thought as an idiom of social thought; a style of writing that draws readers across generations into the drama; and close attention to the arc of social, urban, and intellectual change in the early and mid-nineteenth century—that illuminates the particulars of that time while also evoking tensions that endure and recur in American medicine and social life whenever new diseases strike.


[i]  Ronald Numbers, “The History of Medicine: A Field in Ferment,” Reviews in American History 10 (Dec. 1982), 245‒63.

[ii]  Morris J. Vogel, “Review of Charles E. Rosenberg, The Care of Strangers: The Rise of America’s Hospital System,” Bulletin of the History of Medicine 62 (1988), 283‒84.

[iii]  Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago, 1962; 1987), 58.

[iv]  Nancy Tomes and Jeremy Greene, “Is there a Rosenberg School?” Journal of the History of Medicine and Allied Sciences 63 (Oct. 2008), 463.

22 September 2020

About the Author

Keith Wailoo is Henry Putnam University Professor of History and Public Affairs at Princeton University.

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