“For I will pass through the land of Egypt this night, and will smite all the firstborn in the land of Egypt, both man and beast; and against all the gods of Egypt I will execute judgment: I am the LORD.” – Exodus 12:12

“When Jesus heard that, he said, This sickness is not unto death, but for the glory of God, that the Son of God might be glorified thereby.” – John 11:4

Introduction

In Johns Hopkins: A Silhouette (1929), family biographer Helen Hopkins Thom reported that Johns Hopkins, the founder of the eponymous university and hospital, suffered from an “attack of cholera” in late 1832 that “nearly cost him his life.” For years, little else was known about this period of Hopkins' life, and no evidence existed to corroborate Thom's statement. However, a new letter has recently been discovered, written by Johns Hopkins' mother Hannah, that mentions a medical ordeal Hopkins endured in 1832.[1] The discovery of this letter, one of a bundle of three from Hannah’s pen written in the 1830s, has prompted us to reexamine this critical moment in the life of Johns Hopkins and the city he inhabited.

Many observers, including Thom, have suggested that Hopkins’ brush with death in 1832 was the key event that inspired his future philanthropy. Indeed, we find evidence in Hannah’s letter to support the claim that contracting cholera influenced Hopkins’ decision forty years later to found the Johns Hopkins University, Hospital, and Orphan Asylum for Colored Children. But the cholera epidemic of 1832, the first health crisis of the intestinal infectious disease in the United States, had an even deeper and far-reaching impact on Johns Hopkins and Baltimore. In this essay, we revisit this early period in the city’s history to unpack how science, religion, and superstition intertwined in ways that would significantly shape public health, poor relief, sanitation infrastructure, social movements, local politics and the Black community in mid-nineteenth century Baltimore.

Baltimore in the Nineteenth Century

At the turn of the 1830s, Baltimore was the second-largest city in the United States with a population of more than 80,000 inhabitants. In every respect, it was a city on the move. The Baltimore and Ohio Railroad Company, incorporated in 1827, rapidly transformed the town - already a bustling port city - into the most important transportation hub in the Mid-Atlantic region. The city's central geographic location between the free North and slaveholding South also made Baltimore a popular destination for major national events, meetings, and conferences. In the run-up to the presidential election of 1832, for example, Baltimore hosted three national political conventions for the Jacksonian Democrat, Whig, and Anti-Masonic parties.

Given its economic dynamism, accessible port, new railroad, and proximity to the Midwest, Baltimore also became an attractive destination for immigrants in search of new opportunities in America. Droves of English, Welsh, German, Irish, and West Indian immigrants disembarked in Baltimore during the first half of the nineteenth century. Some travelers passed through the city to destinations further west, but many stayed. Those who remained joined an already diverse population of native-born Whites as well as free, indentured, and enslaved Black Americans, who made up almost a quarter of the city’s population in 1830.[2]

Baltimore's precipitous growth and rising social, economic, and political prominence during the early decades of the nineteenth century placed tremendous pressure on the town's infrastructure, especially in the area of sanitation. Although city planners had been experimenting with sewage systems since the end of the 1700s, their efforts did little to address the many complex facets of urban waste management in a rapidly expanding and densely populated entrepot. In fact, in 1830 about two-thirds of Baltimoreans still relied on wells and springs for water and sewage systems remained primitive. In Baltimore: The Building of an American City, Sherry Olson notes:

The sewage of the entire populace was disposed of either through privies draining directly into surface or groundwater, or vaults that were periodically emptied: the contents were removed to night-soil depots on the edge of town, where the untreated waste was open to flies and surface drainage.

Wealthier Baltimoreans often paid for private waste disposal, brought in fresh spring and mountain water from the countryside, and fled the city for higher ground during the city’s humid summers. Everyone else had to figure out how to survive the consistently unsanitary - and extremely foul-smelling - conditions in the Monumental City. Marginalized groups, such as Baltimore's large population of free but largely impoverished Black residents, fared the worst.

Healthcare in Early National Baltimore 

Unsurprisingly, illnesses linked to Baltimore's inadequate sanitation system were frequent, and those who became ill had few places to turn for treatment. Some sought solace at Baltimore’s Almshouse, a public institution that opened in the late 18th century to address poverty and vagrancy. Eventually, the Almshouse became a refuge not just for the poor but also the ailing and the injured, evolving into one of Baltimore’s first municipal hospitals.[4] By 1827 a quarter of the Almshouse’s 475 “inmates” were sick adults. The demand for general healthcare was so great that the poorhouse hired Simon A. Wickes to treat Baltimoreans at home as the city’s first “Out Door Physician.” But money was tight, and the Almshouse’s board of directors, charged with managing the institution's finances, began instituting austerity policies that decreased expenses by up to 30 percent per head in the five years leading up to 1832.

When it came to healthcare in early national Baltimore, the wealthy did not have many more options than the poor, whether White or Black, free or enslaved.[5] The rich could, of course, afford private physicians, live-in nursing, experimental treatments, and a wider range of palliative options, but the overall quality of medical care was universally abysmal.[6] Often, the “cures” that were employed - such as salivating patients with high doses of mercury chloride - were far worse than the diseases themselves. Other treatments for cholera included bleeding, cupping, and leeches. To quote Olson again, “the usual modes of treatment probably killed many who might have recovered.” According to one doctor’s notes, an Irish patient from Baltimore “rallied from cholera, [but] is now perfectly salivated and raving mad.” He later died.

The most significant obstacle to improved health care during this period was lack of knowledge. Before the first germ theories of disease were put forward in the 1860s, physicians simply didn't know what caused or differentiated communicable diseases like smallpox, yellow fever, typhus or tuberculosis (known then as consumption). As a result, medical quackery flourished. In the 1830s, the “Miasma Theory,” which posited that infection occurred when people inhaled noxious vapors released from rotting vegetable matter, was the dominant explanation. The Miasma Theory was so widely accepted in the medical community that when an Italian professor named Filippo Pacini successfully isolated the bacteria that caused cholera in 1854, his discovery was largely ignored by scientists. (Pacini’s discovery was confirmed thirty years later by the German microbiologist Robert Koch.)

Religious theories of disease were also widespread. Many people believed that illness was a form of heavenly punishment for sinful behavior, and thus only God’s mercy could save a sick person from death. The observable fact that disease seemed more common and deadlier among the lower classes reinforced the belief that God penalized the poor. In other words, anyone who contracted cholera deserved it. In the early stages of the 1832 epidemic, Alexander H. Stevens, a leading New York doctor, wrote that “cholera occurs more frequently among those who lead intemperate and debauched lives.” Stevens was correct, to some degree, but not because the “intemperate and debauched” were being punished by God. Wealthier patients in the early nineteenth century tended to experience milder forms of many foodborne illnesses on account of their higher-quality diets, which in turn contributed to the presence of beneficial stomach acids and fewer bacteria in their relatively cleaner food. These micro-infections not only caused milder symptoms and better outcomes but could lead to lasting acquired immunity. In effect, as Baltimore’s elite were unknowingly shielded, their moralizing beliefs were implicitly validated. 

Johns Hopkins in 1832

By the time of the 1832 epidemic, Johns Hopkins was already a successful Baltimore businessman. He had moved to the city in 1812 from rural Anne Arundel County to apprentice under his uncle. Twelve years later, the young Quaker launched his flagship mercantile firm, Hopkins Brothers, alongside siblings Samuel Jr. and Mahlon. Eventually, Johns Hopkins began to invest in a myriad of financial ventures, most notably the Baltimore and Ohio Railroad. Johns' Quaker cousin Philip E. Thomas served as president of the B&O from 1827 to 1836.

From about 1820 to 1833, Hopkins boarded in Baltimore's swanky Beltzhoover's Indian Queen Hotel. A large establishment that could house up to 200 residents and included multiple billiard rooms, the inn boasted a rambunctious social scene that catered to Baltimore’s resident bachelors and traveling salesmen—a fact that likely raised eyebrows among members of Hopkins’ devout Quaker family. For whatever reason, the environment appealed to the unmarried merchant and his younger brothers. Other noteworthy residents of the day included the politician Henry Clay and the poet Edgar Allan Poe.

Johns Hopkins may have been a practicing Quaker, but he was known to display an independent streak. According to Thom, Hopkins always “believed in enjoying the good things of life.” He “liked good wine and always had the best upon his table.” Johns’ interest in alcohol and “ardent spirits” can be traced back to 1826 when he and his brother Mahlon were disciplined by their local Quaker Meeting for “trading in distilled spirituous liquors.” It would appear that the young Johns Hopkins’ lifestyle at the time may not have been one characterized by a high degree of risk aversion.

Since arriving in Baltimore as a teenager, Hopkins repeatedly witnessed a city pushed to hysterics during yellow fever, influenza, typhus, and smallpox outbreaks. And like most people in early America, Johns Hopkins was no stranger to the precarity of life conditioned by constant and unpredictable disease. Both his grandfather and father died of consumption, and in 1819, an outbreak of yellow fever killed over 2,000 Baltimoreans. Just the year before, Johns’ sister Sally (or Sarah) had such difficulty breathing she was prescribed mercury. In Johns’ own words (written to another sister):

Balt Nov 28th 1818

Dear Eliza

I mentioned in mine to thee a few days ago that Sister Sally was very unwell - but rather mending - brother Joseph was in town yesterday - he had been up to see Doctor Hopkins - Sally having had a very alarming relapse of her difficulty of breathing the doctor sent by him medicine and instructions for her to pass through a mercurial course - the idea of being salivated is a very serious - and disagreeable one - but I strongly hope she will be much improved by it - poor girl I sympathise very much for her situation - this being the time of her life in which she should be most healthy - in order to enjoy that sprightliness which her natural disposition would incline her to - we see how uncertain our calculations are - one day all our prospects may flatter us with length of days and prosperity - another may take away our health and all is gone…

Affectionately thy brother

Johns Hopkins

Fourteen years after he wrote these words, Johns himself would face a new and deadly illness that threatened to take away all he had achieved so far in his life.[3]

Cholera Comes to Baltimore

Scholars disagree about exactly when and where cholera first appeared, but many believe that the epidemic variant emerged in India during the second decade of the nineteenth century. Eventually, cholera spread from India to the Russian Empire and Eastern Europe where hundreds of thousands were infected, sparking “Cholera Riots“ in St. Petersburg and Upper Hungary in 1831. By winter of the same year, Western Europe was faring no better, with 100,000 fatalities in France and perhaps as many as 30,000 in the United Kingdom (where more riots occurred). Cholera arrived in North America in late June 1832 when the first cases were detected in Canada. In early July, the New York Board of Health announced that cholera had entered the city; a thousand unlucky souls were dead within a fortnight.

By late summer, cholera was exploding down the seaboard, following dominant trade and transportation routes - waterways, roads, and canals.[7] Fearing the worst, Dr. Horatio Gates Jameson, chief consultant to the Board of Health for the City of Baltimore and president of the Baltimore Washington Medical College, warned a skeptical Mayor William Steuart that it was only a matter of time before the disease reached Baltimore. In July, the city reluctantly implemented a quarantine on incoming vessels, but this measure did not prevent cholera from entering the Inner Harbor.

Drawing on the advice of colleagues in Europe and New York, Dr. Jameson advised Baltimoreans to take four crucial steps to avoid the approaching plague. First, they were told to rid their homes of foul odors and other possible “miasmas.” According to Thom, “some tied tarred ropes around their necks, and others lighted bon-fires at the street comers; physicians advised the burning of gunpowder and many citizens resorted to the repeated firing of guns.” Second, residents were instructed to limit the consumption of alcohol, which was considered a sinful habit of the lower classes. Third, Jameson advised residents to “avoid an excess of cold water, all fruits, certain vegetables, and, above all, watermelons, green corn, green apples, peaches, and crabs.” 

The fourth step was moral purification. Priests, pastors and politicians across the nation proposed measures to address the deep spiritual crisis they believed to be at the root of the deadly disease. Johns Hopkins’ old Beltzhoover neighbor and candidate for president in 1832, Senator Henry Clay, proposed a national “fast-day” in Congress. Clay’s day of fasting and prayer was meant to be a display of public repentance to ward off cholera, but he could not convince enough of his congressional colleagues to support the measure. The Jacksonian Democrats in particular took issue with the bill’s forced conflation of church and state, and many agreed with them. The Baltimore Republican declared: “For civil magistrates to attempt to enforce an obedience which should be voluntary, can be no more acceptable to the Almighty than the offering of swine's flesh upon the holy altar.” Clay’s bill stalled on Capitol Hill but the concept was adopted elsewhere. By July, twelve states had passed fast-day resolutions, including Maryland.

On August 4th, Baltimore’s first cholera cases were documented. Dr. Jameson's recommendation to avoid water, fruits, and vegetables may have saved some lives, but it was too little, too late. Thousands of Baltimoreans contracted the illness and more than 850 perished before the end of the year. Later, Dr. Jameson would say, “there died of cholera, during the summer of 1832, eight hundred and fifty-three persons, a very great majority of whom were the most worthless; but a few of our best citizens were its victims.” One out of every hundred Baltimoreans died as a whole, and many of those who recovered experienced lingering aftereffects. Records from the Almshouse indicate that of 211 cases, 133 resulted in death—a case-fatality ratio of 63 percent. Almost half of those who died in Baltimore were Black.

Johns Hopkins and Cholera

We do not know how Johns Hopkins contracted cholera. He may have consumed a tainted meal at the Beltzhoover Hotel. Any food item that came in contact with the bacteria could transmit the illness. This included fruits, vegetables, shellfish (especially crabs and oysters), meats, dairy products, and even Maryland's famous terrapin soup. Or maybe he drank water from one of Baltimore's public pumps that had been contaminated by sewage carrying cholera. The Hopkins Brothers store was located at 5 West Pratt Street in the very heart of the busy, perpetually-polluted Inner Harbor district, where ships carrying people and products from across the globe entered the city with great frequency.

However he caught the dreaded disease, the symptoms probably came on quickly. Today, the CDC describes cholera as “an acute diarrheal illness caused by infection of the intestine with Vibrio cholerae bacteria.” Its trademark symptom - voluminous “rice-water” diarrhea - was the surest and most unpleasant sign of the illness. Severe symptoms, observed in about 10 percent of patients, may also include violent vomiting, intense thirst, body spasms, and muscle cramps. Rapid dehydration and shock can cause sudden death mere hours after the onset of illness - the corpses of victims taking on a distinctive blue pallor. Epidemiologists estimate that the disease continues to kill anywhere between 21,000 to 143,000 people every year around the globe.

Luckily, Johns Hopkins' life was spared. Perhaps in an effort to avoid further exposure to cholera, less than a year after his brush with death Hopkins moved out of the Beltzhoover and into a property on Franklin Street. A few years later, in 1841, Hopkins purchased a mansion and 300 acres of land on the outskirts of town as a place where he could escape the city’s summer miasmas, contaminated water supplies, and infected food.

Hannah Hopkins Writes to Her Son

Before he left the Beltzhoover, Hopkins received a pleading letter from his mother. Writing in November of 1832, Hannah Hopkins alludes to a serious health scare Johns had recently experienced, but without mentioning cholera by name.[8] Thankful that he survived, Hannah instructs her son to “bow in humility before him who in tender mercy has spared thy precious life [and] be willing to devote the remainder of thy days to his service.” But she also places the blame for Johns' illness squarely on his own behavior, telling him:

Tho not present with thee I have remembered thy affection and tender sympathy, sincerely hoping that in this thou hast found an anchor for thy troubled mind, a savior in whom thou can trust believing that his wound to heal and that he has pleased to awaken thee to a sense of the impurity of many things thee has indulged in.

Hannah continues: “Thou has been ardent in thy pursuits, mayest thou not relax in this all important point, the salvation of thy own soul.”

Whether Johns Hopkins was truly awakened to the “impurity” of many things he may have indulged in is impossible to say, but his mother’s stern words must have had an impact on the bachelor businessman. Not only that, Hopkins experienced the repercussions of cholera for the rest of his life. According to Thom, “[Johns] did not sleep for nearly two weeks at that time, and his doctor said that if this continued he would die. Although this contingency was averted, insomnia became one of the things that he had to fight against the rest of his life.” It seems that Hopkins may have suffered from some form of “long Cholera,” analogous to the “long COVID” we are familiar with today.

Hannah also reports in this letter that her son had experienced a kind of spiritual revival on account of his ordeal. She writes, “When with tears thee expressed the resolution thee had made, never to endeavor to shake the faith of any … all that was capable of feeling within me was moved with gratitude. I rejoiced to find the tender feeling of a penitent mind.”

This remarkable letter helps to confirm that cholera was a factor that helped convince Hopkins of the urgent need for better medical instruction, more rigorous scientific research, and expanded services for the poor of all races in Baltimore. The city's encounter with the dreadful disease in 1832, and Hopkins’ firsthand experience of it, demonstrated in the most visceral way the inadequacy of public health services, poor relief, and city infrastructure. These were all areas that Hopkins sought to improve through industry and charity during the remainder of his life, perhaps as a way of tending to the moral and religious responsibilities stressed by his mother.

Baltimore’s famous financier would escape two more citywide cholera epidemics in 1849 and 1866, but he contracted the disease again near the end of his life. One of Hopkins’ obituaries notes that he “suffered from a violent attack of cholera morbus” while visiting Cape May during the summer of 1873, just months before his death, and was “not entirely well when he returned to Baltimore.” In the coming weeks, a bank run and subsequent financial crisis kept Hopkins “greatly occupied” and exacerbated his “sleeplessness.” “Against the advice of his physician, Dr. W. C. Van Bibber,” Thom reports, “[Hopkins] insisted upon getting up and going down town. As usual, he refused to wear an overcoat, or overshoes, though the weather was stormy, and the following day he became seriously ill and soon developed pneumonia.” To the very end, it seems, Hopkins was “ardent” in his pursuits. The same quality his mother called out in 1823 – that also made him a very wealthy man – would be his undoing. Johns Hopkins passed away on Christmas Eve of 1873 at his mansion on Saratoga Street. He was 78 years old.

Conclusion - The Long Shadow of the Cholera Epidemic of 1832

Writing in 1962, the Harvard historian of medicine Charles Rosenberg called cholera “the classic epidemic disease of the nineteenth century, as plague had been of the fourteenth.” “Its victims,” Rosenberg continued, “included Iowa dirt farmers and New York longshoremen, Wisconsin lead miners and Negro field hands.” And, in Maryland, they included a merchant-turned-investor-turned-philanthropist named Johns Hopkins.

There seems little doubt that Hopkins’ personal experience with deadly infectious disease influenced his ultimate bequests, in which he donated almost 90 percent of his enormous wealth to public charities designed to benefit Baltimore and the indigent sick. To quote from Hopkins’ 1873 letter to the hospital trustees: 

The indigent sick of this city and its environs, without regard to sex, age or color, who may require surgical or medical treatment, and who can be received into the Hospital without peril to the other inmates, and the poor of this city and State, of all races, who are stricken down by any casualty, shall be received into the Hospital, without charge, for such periods of time and under such regulations as you may prescribe.

With his gifts to the city, and in particular the hospital – one of the first of its kind in Maryland to admit Blacks – Hopkins manifested his mother’s very words from her 1832 letter, referencing Isaiah 60:18, “Then will thee [Johns] be a way mark to others, paving the way for an inheritance in that city whose walls are salvation and whose gates are praise.”

At the same time, it is important to recognize that the cholera scourge of 1832 was but one of over three dozen epidemics that visited Baltimore during Johns Hopkins’ long life in the city. Many members of Johns’ closest family suffered, and died from, a host of diseases, disorders and accidents. Johns’ brother and business partner died suddenly of an unknown ailment in 1840, his older brother Joseph died of consumption in 1845, another brother Philip succumbed to yellow fever in 1843, and his youngest sister Mary died in 1854 from complications after giving birth to twins, who died along with her. James H. Jones, Hopkins’ long-serving coachman and waiter, lost two small children to unknown causes - a two-year-old girl in 1863 and a one-year-old boy in 1864. 

But the impact of cholera on Baltimore’s government and society was felt well beyond Hopkins’ post-Civil War philanthropy. First, the 1832 cholera crisis contributed to the improvement and professionalization of health care in Baltimore. By 1840, for example, the Almshouse, now led by Dr. William Power, had developed new and better standards of care. Physicians were required to take patients’ medical histories, perform thorough physical evaluations, and keep post-mortem examination reports. Within a few years, Dr. Power would become one of the most celebrated scientists in the world. And when another wave of cholera hit the United States in July of 1849, Almshouse doctors accurately attributed the cause to leaking sewage, six years before John Snow’s legendary map of cholera in London was published. The same Baltimore physicians who promoted gunpowder as a preventative for "miasmas" less than a generation earlier, counted themselves among the earliest supporters of Snow’s theory and sanitation reform. 

Second, cholera helped to ignite a host of social and reform movements, such as prohibition and evangelicalism. Religious revivals of many shades peaked during the years and decades following the 1832 epidemic. When the next cholera epidemic struck in 1849, Whig President Zachary Taylor “did not hesitate to recommend a day of national prayer, fasting, and humiliation” to be held on the third Friday in August. The fast may have influenced Americans’ spiritual enlightenment but, of course, it did nothing to ameliorate the consequences of epidemic cholera.

The cholera epidemic of 1832 also helped spur nativism by cementing the view among many that immigration was a primary vector of deadly infectious diseases. According to Sherry Olson, “of people admitted to the Almshouse in the 1830s, it was usual to find that a tenth had been in the city less than a week and a quarter less than six months. About 30 percent were foreign-born, mostly Irish.” Connecting the surge in immigration to the citywide burden of poverty and illness, Baltimore’s municipal government established a head tax of $1.50 on immigrants to fund the Almshouse (around $50 today). We do not know how many immigrants perished in Baltimore from cholera in 1832, though in New York City recent Irish immigrants accounted for 40% of cholera deaths.

Unlike Johns Hopkins, Baltimore’s vast underclass had no stylish hotels or private physicians to help them recuperate from illness. Most of the afflicted rode out the epidemic in alley homes, crude shacks, or rented rooms; some sought refuge in the Almshouse, which was little better. John H.B. Latrobe, inventor and B&O lawyer, once said of the Almshouse that “[a] worse location could hardly have been found from the point of view of public health, sewage disposal, and mosquito-borne illness.” Nurses were so scarce and deaths so frequent at the Almshouse that it wasn’t long before Dr. Jameson agreed with his counterparts in New York that “cholera seemed indeed to be a poor man's plague,” and that its victims “were of the most worthless sort.” During the 1850s, the American Party, better known as the Know-Nothings, would exploit the perceived connections between immigration, poverty and disease to win elected seats at the city, state and federal levels. Though he never ran for office, Johns Hopkins served as a vice president of Baltimore's American Party delegation, and his good friend, Baltimore Mayor Thomas Swann, was president.

Third, the cholera epidemic of 1832 was also a defining moment for Baltimore’s Black community as church leaders and social organizations rushed in to stem the tide of the devastating disease. Sister Mary Anthony Duchemin, for example, worked at the Almshouse along with three other members of the all-Black Oblate Sisters of Providence. A skilled nurse, Sister Anthony was called on to assist the Archbishop of Baltimore and other members of his household suffering from cholera in 1832. The Archbishop lived, but Sister Anthony caught the disease and died. In 2023, 191 years after Sister Anthony’s death, the Oblate Sisters were honored for their work in the cholera epidemic of 1832. The same year, Mother Mary Lange, Mother Superior to the Oblate Sisters of Providence during the cholera outbreak, was declared “venerable” by Pope Francis at the Vatican, a key step on the path to sainthood in the Catholic Church.

Finally, Cholera struck Baltimore on the heels of the Nat Turner Rebellion, adding fuel to the zeal among many White leaders to impose laws restricting the rights of Black citizens. Abolitionist Fredrick Douglass, who had been a resident of Baltimore at the time of the 1832 epidemic, interpreted cholera differently:

The cholera was then on its way to this country and I remember thinking that God was angry with the White people because of their slaveholding wickedness, and therefore his judgments were abroad in the land. Of course it was impossible for me not to hope much for the abolition movement when I saw it supported by the Almighty, and armed with DEATH.

Epilogue

Almost two hundred years after the epidemic of 1832 in Baltimore, cholera continues to claim victims across the globe. According to NPR, “cholera is making a comeback in 2024 – but the world's supply of vaccines can't keep up.” Despite cholera immunization techniques having been developed by three scientists within a generation of Johns Hopkins’ death in 1873, still today not enough medicine can be manufactured to keep cholera rates stable in poorer countries. Thousands of people were believed to have been killed in 17 countries by the disease last year. According to the NPR article, cholera treatments are not part of routine vaccination programs, which tend to prioritize diseases with higher risks of migrating to the global north. In 2022, the primary manufacturer of the cholera vaccine recommended providing just one dose per patient instead of the usual two.

This is why stories like the 1832 cholera pandemic are crucial in international health spaces, especially in rich countries. Ignoring not only the exploitation that brought on the disease but also the inaccessibility of effective treatments that have existed for over a century, doctors have continued to blame the continued spread of cholera on “sanitation norms” and “health beliefs.” In truth, improving access to high-quality healthcare often demands little more than a new perspective on one’s own history. In 1832, like today, leaders saw their primary responsibility to be containing, not eradicating cholera. Vague statements about social customs exonerate rich countries from their culpability in largely sustaining the poverty that generated the outbreaks in question. Still, following the death of Johns Hopkins, without a complete immunization program, without NGOs, without magically solving inequality, and with the same types of pseudoscientific misinformation dominant, America went on to dramatically reduce its cholera rates through infrastructure projects orders of magnitude larger than anything the nation had tried before. All it took was better sanitation systems.

Notes

[1] From the personal files of the late Samuel Hopkins, the founder of the Friends of Clifton Mansion.

[2] By 1830 free Blacks outnumbered enslaved Blacks by about 14,000 to 4,500. See http://slavery.msa.maryland.gov/html/research/census1830.html. 

[3] To view this letter see https://aspace.library.jhu.edu/repositories/3/archival_objects/14959. 

[4] The College of Medicine of the University of Maryland was incorporated on December 18, 1807. The first college building was built at Lombard and Greene Streets and opened for classes in 1812. See “200 YEARS OF MEDICINE IN BALTIMORE: Outstanding Contributions of University of Maryland Medical Alumni and Faculty,” University of Maryland at Baltimore School of Medicine, 1976. 

[5] Religious organizations - such as the Sisters of Charity and the Oblate Sisters of Providence - cared for some of the remaining poorer residents, as did Baltimore's Infirmary on Pratt Street. Temporary hospitals and dispensaries were also erected across the city. African Americans were admitted to these hospitals as well as institutions like the Almshouse, and some charities, for example the Oblate Sisters, cared exclusively for Baltimore's Black population.

[6] While it is unknown where and how Johns Hopkins received medical care in 1832, he would entrust his health to a private physician named William Chew Van Bibber later in life. In the financier’s 1873 obituary, Dr. Van Bibber’s absence when Hopkins fell ill on vacation was implied to be among the causes of his death months later. 

[7] Cholera also impacted impoverished spaces like the Erie Canal construction project, the interstate slave trade, and the caravans of indigenous Americans displaced by the Jackson Administration. In the specific context of the 1832 outbreak, more information can be found in Kelton’s article, "Pandemic Injustice: Irish Immigrant, Enslaved African American, and Choctaw Experiences with Cholera in 1832."

[8] Because cholera presented with a number of symptoms and could not be microscopically differentiated from other illnesses, such as typhus or yellow fever, cholera was sometimes described as a syndrome rather than a particular disease. 

[9] Kathleen S. Murphy notes in Prodigies and Portents: Providentialism in the Eighteenth Century Chesapeake that “by 1866, the third major cholera epidemic of the nineteenth century gave rise to no fast-days, reflecting a growing confidence in science rather than providence to explain and prevent such epidemics.” Interestingly, this is precisely the period during which Johns Hopkins began to draft his will.

Sources

• Baker, Jean H., Ambivalent Americans: The Know-Nothing Party in Maryland, Johns Hopkins University Press, 1977.

• Buckler, Thomas Hepburn, A History of Epidemic Cholera: As It Appeared at the Baltimore City and County Alms-House, in the Summer of 1849, With Some Remarks on the Medical Topography and Diseases of This Region, Baltimore: James Lucas Printers, 1851.

• Cordell, Eugene Fauntleroy, The Medical Annals of Maryland, 1799-1899: Prepared for the Centennial of the Medical and Chirurgical Faculty, Williams & Wilkins Co., 1903.

• Grauer, Neil, Leading the Way: A History of Johns Hopkins Medicine, Johns Hopkins Medicine, 2012.

• "History of Baltimore," https://www.baltimorecity.gov/sites/default/files/5_History.pdf. 

• Jameson, Horatio Gates, A Treatise on Epidemic Cholera, 1855. 

• Kelton, Paul, "Pandemic Injustice: Irish Immigrant, Enslaved African American, and Choctaw Experiences with Cholera in 1832," Journal of Southern History, vol. 88 no. 1, 2022, p. 73-110. 

• Kerson, Toba Schwaber, "Almshouse to Municipal hospital: the Baltimore Experience," Bulletin of the History of Medicine 55.2 (1981): 203-220. 

• Olson, Sherry, Baltimore: The Building of an American City, Johns Hopkins University Press, 1980.

• Phillips, Christopher, Freedom's Port: the African American Community of Baltimore, 1790-1860, University of Illinois Press, 1997.

• Pietila, Antero, The Ghosts of Johns Hopkins: The Life and Legacy that Shaped an American City, Rowman & Littlefield, 2018.

• Reese, David M., Observations On the Epidemic of 1819, as it prevailed in a part of the city of Baltimore, Toy, John D., printer, 1819.

• Rockman, Seth, Scraping By: Wage Labor, Slavery, and Survival in Early Baltimore, Johns Hopkins University Press, 2009.

• Rosenberg, Charles E., The Cholera Years: The United States in 1832, 1849, and 1866, 2nd Edition, University of Chicago Press, 1987.

• Sheads, Nancy B., Medicine in Maryland, 1752-1920, see https://mdhistoryonline.net/, 2009.