Close medical observation of the 1849 cholera epidemic in St. Louis led to important public health changes.
[Above photo: Dr. William McPheeters. Courtesy of Missouri History Museum.]
By Chris Naffziger
The year 1849 in St. Louis serves as a watershed in the city’s history. The boundless optimism of the last two decades came crashing down with the twin disasters of the cholera epidemic and the Great Fire. However, despite the death and destruction of 1849, the population climbed sharply from 35,979 recorded individuals in the 1840 census to 104,978 in the 1850 census.
1849 was the 85th year since the founding of St. Louis, and it was growing faster than the science of public health was progressing at the time. An eyewitness account of the cholera epidemic by Dr. William McPheeters provides a window into the many misconceptions of doctors and residents during the epidemic. McPheeters worked in several St. Louis hospitals, including the Invalids, City, and St. Louis hospitals, where he observed patients as they began to fill the wards, often dying less than a day after exhibiting symptoms.
Cholera is caused by the bacteria Vibro cholerae and is spread through contaminated water, often when drinking water is not segregated from human waste. Victims of the disease suffer from acute diarrhea. The gastric distress leads to dehydration, sometimes causing death within a few hours. Cholera can now be easily and quickly treated because of advances in patient hydration. Antibiotics are effective against cholera, and an oral vaccine is now available. Access to safe water, which often splits along socioeconomic lines, is the key to preventing cholera.[1] Since cholera is a water- or food-borne disease, physical contact with a person infected with the disease does not easily cause infection.[2] Advances in the scientific understanding of the disease has allowed cholera to be eradicated in developed countries.
Unaware of the role of infected water sources, doctors such as McPheeters could only speculate about the cause of the outbreak, which began in New Orleans and spread through the vital economic link of steamboat traffic up the Mississippi. The first St. Louis cholera victim died in January 1849. McPheeters carefully documented the second victim’s occupation and diet, describing him as an unemployed Irish-American boatman who was “guilty of an imprudence of diet.”[3] Modern epidemiological judgement says that the victim, due to his unemployment, probably had little financial means to live where there was a safe water source. Dr. John Snow, whose famous map of the Broad Street cholera outbreak in England would not appear until 1854, was the first epidemiologist to isolate an infected water source, a pump that drew water from a shallow well that was polluted by human waste, as the cause of cholera.[4]
A suprising aspect of the calamities of 1849 revolves around the overall mortality rate in St. Louis. For example, in the first month of the epidemic, January 1849, cholera killed 38 people, while the deaths from all diseases was 276.[5] While St. Louis was beginning to show the effects of cholera, it is also clear that infectious diseases in general were not under control. McPheeters reports that deaths from cholera dropped in February of that year to 20, but then jumped to 68 in March. In April, 131 St. Louisans died from cholera and 456 from other diseases.[6] St. Louis had more than just a cholera problem; it had a chronic poor hygiene problem.
Dangerous pond
Chouteau’s Pond stands as an example of St. Louis’s failure to control pollution. The pond dated back to 1766, when Mill Creek was dammed for a grist mill built by a French colonist. By 1849 the pond had transformed from a popular park for wealthy St. Louisans into an open sewer as industry dumped straight into its waters. Train tracks began to intrude on the pond as the railroads took advantage of the relatively slight grade of the valley that rose up from the Mississippi River. Perhaps one of the few wise decisions after the epidemic was the draining of the pond, removing the polluted water source that surely infected nearby wells.
May of 1849 saw a further spread of the disease, causing “much alarm,” but still finding itself confined to the poor and indigent of St. Louis. When a ship called the White Cloud caught fire on the St. Louis Levee, leading to the Great Fire that destroyed a large portion of the St. Louis riverfront, people actually believed that the conflagration would have the effect of “cleaning the air” of the disease. This misconception reflects a common belief at the time, the miasma theory, which erroneously attributed conditions favorable for disease-causing pests as the conditions themselves causing the disease.[7] For example, malaria takes its name from Italian for the “bad air,” the noxious fumes and rotting plants, that create the perfect environment for the actual culprit, mosquitoes.[8]
So many succumb
The cholera epidemic reached its apex in July of 1849, when deaths from cholera clearly outpaced deaths from other diseases; for example, from July 17 to July 23, 269 St. Louisans died from cholera, in comparison to 171 from other infections.[9] By the end of 1849, there were 4,559 documented cholera deaths and 4,046 deaths from other diseases. McPheeters takes city leaders to task for their seeming lack of concern about the epidemic. In particular, he criticizes city government for its inability to clean the streets of refuse and other dirt.[10]
Perhaps the greatest irony of the misunderstanding of cholera and its spread revolves around the burial and disposal of dead bodies. People believed that the bodies of cholera victims could infect people living near cemeteries. As a result, the oldest cemeteries in St. Louis were uprooted and moved out to the countryside, creating what are now beautiful cemeteries, such as Bellefontaine Cemetery. But there was really no threat from cadavers; the scientific evidence is clear that cholera does not live for long in dead bodies and that it is out-competed by hardier but safe bacteria which thrive in decomposing organic material.[11] The time would have been better spent separating potable water from pollution, not digging up bodies and moving them.
The cholera and fire calamities of 1849 spurred scientifically sound practices, such as the foundation of St. Louis’s award-winning water department and the famous law requiring brick construction. And while Dr. McPheeters made some mistakes, his thoughtful and highly detailed account of the cholera epidemic provides a fascinating window into medical history in St. Louis.
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Chris Naffziger writes about the history and architecture of St. Louis at St. Louis Magazine with an emphasis on placing the city within greater cultural and historical trends of Western Civilization. This May, his architecture blog, St. Louis Patina, celebrated its 12th anniversary. Chris is an internationally published authority on the history of brewing in St. Louis, appearing on German broadcast television in a 2018 documentary on German-American brewers. Of late, he has been investigating the founding of Anheuser-Busch and the Lemp Brewery. He has worked in several art museums, including the National Gallery of Art and the Saint Louis Art Museum. Chris teaches Italian Renaissance and ancient Greek and Roman art at Lindenwood University.
Notes
[1] World Health Organization: Cholera Facts [http://www.who.int/cholera/en]. Accessed August 31, 2017.
[2] E-mail correspondence with Centers for Disease Control, dated June 28, 2017.
[3] McPheeters, William. “History of the Cholera Epidemic in St. Louis in 1849,” in One Hundred Years of Medicine and Surgery in Missouri, ed. Max Aaron Goldstein. St. Louis: Star Publishing Company, 1900, p. 64.
[4] Snow, John. On the Mode of Communication of Cholera. London: John Churchill, 1855.
[5] McPheeters, 65.
[6] McPheeters, 65
[7] Bianucci, Raffaella and Ole Jørgen Benedictow, Gino Fornaciari, and Valentina Giuffra. “Quinto Tiberio Angelerio and New Measures for Controlling Plague in 16th-Century Alghero, Sardinia,” Emerging Infectious Diseases, Vol. 19, No. 9, (September 2013) pp. 1478-1483.
[8] Centers for Disease Control: History of Malaria [www.cdc.gov/malaria/about/history/]. Accessed August 31, 2017.
[9] McPheeters, 67.
[10] McPheeters, 68.
[11] E-mail correspondence with Centers for Disease Control, dated June 28, 2017.