First Edition of The Cholera Years. Courtesy of the author.

It seems odd to be revisiting a project I began more than a half-century ago, the history of a novel and frightening nineteenth-century pestilence.[1] And at a moment when the world is consumed by our newest pandemic. As a beginning student of American history I stumbled accidentally into a world of subject matter very different from the mainstream problems tackled by my peers in graduate school.  A subject like cholera was marginal to the politics and policy interests of most historians, and it was well before the availability of digital databases and electronic messaging. Terms like social determinants of health, climate change, globalization, risk management, and postcolonial had not yet become everyday usages in academic writing. Morbidity and mortality were the province of doctors and demographers, and medicine’s history was dominated by curiosity-driven physicians in their spare time.

Although friends warned me against wasting my time with such a marginal subject, contemporary documentation—the newspapers, sermons, diaries, and letters from 1832—fascinated me, and I wrote an undergraduate term paper on 1832 epidemic. It evolved into a PhD thesis and then book, The Cholera Years.

Disease has always been elusive; only recently in historical terms have we subjected the world of individual sickness to the bureaucratic discipline of discrete categories and mechanism-legitimated laboratory definitions. When Asiatic cholera arrived in North America in 1832 there was no International Classification of Disease and no American Psychiatric Association to endorse a Diagnostic and Statistical Manual. But men and women and men still had to deal with endemic and omnipresent fevers and diarrheas, with pain and disability. Such symptoms were a recurring aspect of everyday life—noise, not signal. Some ills, however, are different, perceived as somehow discrete and threatening, entities that demand a general response transcending the experience of individuals and families. They are necessarily signal, not noise. I am referring to such ills as plague in the fourteenth century, pandemic flu in 1918‒19, or more recently, AIDS and Ebola, SARS, and now CoVid-19. It is not the absolute numbers they have killed, but their social visibility, what might be called their performance, that demands attention, explanation, response. Cholera certainly fit this into this category in nineteenth-century Europe; it was not endemic and its dramatic symptoms and frightening mortality rate made certain that it would not be confused with the familiar spectrum of diarrheal diseases.

It is these characteristics that make the nineteenth century’s recurring cholera epidemics ideal sampling devices for the historian or social scientist.  For they elicit a general response, an occasion for cultural framing and collective policy action. They are necessarily stress tests as well as sampling opportunities. I hadn’t thought in quite these terms when, as an undergraduate, I stumbled across references to America’s nineteenth-century cholera epidemics, but I soon found how rich and diverse the surviving sources were. Every source of cultural and political authority was forced to respond, churches and benevolent societies as well as newspapers and local governments. Medical journals were filled with observations, opinions, and hopeful treatments. Diaries and letters reflected the personal experience and perceptions of individual men and women. In an era before digitization and word searches, sources both printed and manuscript were necessarily contextualized for the historian.

In retrospect, Cholera Years seems to me to read a bit too neatly as a Whiggish story of modernization, of secularization, of urbanization and necessary innovations in governance, of global economic development. A developing understanding of the disease as a specific, mechanism-based entity paralleled and in part constituted an aspect of these more general changes in world view and material culture. It is only at the very end of the book that I signal some discomfort—the downside risk—in this narrative of scientific and societal progress. I refer to the book’s final sentence and its invocation of 1945. (A reference of course to atomic warfare so obvious to me in 1960 that I assumed it needed no elaboration. In my experience it is obscure to contemporary students, concerned more about climate change than the Cold War anxieties so omnipresent in my student days.)

Since the 1960s we have experienced and are still experiencing AIDS and have managed potential brushes with Ebola, SARS, and a number of other novel entities. Today we are combating a novel viral disease, another de facto sampling device and stress test—with the final outcome still obscure. Each pandemic has its own biological and sociocultural profile, its own perceived and uniquely configured performance. We have already learned a great about our society with the help of Covid 19—about inequalities social and spatial, about the peculiarities of America’s system of Federalism and the management of conflict—background noise becoming urgent and unavoidable signal.

Endnotes

[1] Cholera Years was a slightly revised 1961 Columbia University dissertation. For additional background, see Charles Rosenberg, “Erwin H. Ackerknecht: Social Medicine and the History of Medicine,“ Bulletin of the History of Medicine 81 (Summer 2007), 511‒32;  Ibid., “Epilogue: Airs, Waters, Places.  A Status Report,” Bulletin of the History of Medicine 86 (Winter 2012), 661‒70; “Disease in History, History in Disease: An Interview with Charles Rosenberg,” (with Chloe Silverman) Biosocieties 8 (2013), 360‒63.