“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 medical school, 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 claim. However, a new letter has recently been discovered, written by Johns Hopkins' mother, Hannah, that mentions a medical ordeal that Hopkins endured in 1832. Based on this communication, along with details from other contemporaneous accounts, new insights can be gleaned about how nineteenth century science, religion, superstition, healthcare, and public infrastructure intertwined in ways that would significantly impact Baltimore and shape Hopkins' future philanthropy, ultimately leading to the creation of the Johns Hopkins University, Hospital, and Orphan Asylum for Colored Children. Hopkins' objective in founding these institutions was to create  "a city whose walls are salvation," a personal and spiritual goal that had its origins in the devastating cholera epidemic of 1832.

Baltimore at the Beginning of the Nineteenth Century

At the turn of the 1830s, Baltimore was the second largest city in the United States with a population of over 80,000 inhabitants. In every respect, it was a city on the move. The Baltimore and Ohio Railroad Company had launched in 1827, rapidly transforming the young town into one of the most important commercial  and transportation hubs on the Eastern seaboard. The city's central location between the free North and slaveholding South also made Baltimore a popular destination for major national events. In 1831 and 1832, for example, Baltimore hosted the Jacksonian Democrat, Whig, and Anti-Masonic party conventions, which was indicative of the city's rising social, economic and political prominence.

Given its deep harbor, well-functioning railroad system, and proximity to the Midwest, Baltimore also became an attractive destination for immigrants in search of new opportunities. Droves of English, Welsh, German, Irish, and West Indian immigrants disembarked in Baltimore during the first half of the nineteenth century. Some passengers passed through the city to destinations further west, but many stayed. Those who remained joined a already diverse population of native-born Whites as well as free, indentured, and enslaved Black Americans. [cite black pop here]

Baltimore's growth 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 challenges surrounding urban waste management in a rapidly expanding port town. By 1830, about two-thirds of Baltimoreans still relied on wells and springs for water and sewage systems largely remained primitive. In Baltimore: The Building of an American City, Sherry Olson writes:

 The sewage of the entire populace was disposed of either through privies draining directly into surface or ground water, 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 and fled the city for higher ground during the city’s humid summers. Everyone else had to figure out how to survive the unsanitary - and foul-smelling - conditions in the Monumental City. Marginalized populations, such as Baltimore's very large population of free but largely impoverished Black residents, fared the worst.

Healthcare in Early National Baltimore 

Unsurprisingly, illnesses linked to Baltimore's lack of adequate sanitation were frequent, and those who became ill had few institutions in which to receive treatment. Some sought solace at Baltimore’s Almshouse (see image below), which was built in the late 18th century to combat vagrancy and began admitting patients with physical maladies in 1823.  Of 475 “inmates” in 1827, a quarter were sick adults. The demand for general healthcare was so great that the Almshouse hired Simon A. Wickes to treat Baltimoreans in home visits 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 policies of austerity that decreased costs by up to 30 percent per head in the five years leading up to the 1832 cholera epidemic. Religious organizations - such as the Sisters of Charity and the Oblate Sisters of Providence - cared for some of the remaining sick, as did Baltimore's Infirmary on Pratt Street. (Blacks were admitted to institutions like the Almshouse and some charities, like the Oblate Sisters, cared exclusively for Baltimore's African American population.)

When it came to healthcare in Early National Baltimore, the wealthy did not have many more options than the poor, whether White or Balck, free or enslaved. The rich could, of course, afford private nursing, experimental treatments, and a wider range of palliative options, but the overall quality of medical care was universally abysmal. Lack of knowledge was the most significant obstacle to improved care. At the time, doctors simple didn't know what caused communicable diseases like yellow fever, cholera or consumption. “Miasmata” was the dominant theory of the day. It posited that infection was caused when people inhaled noxious vapors released from rotting vegetable matter.  This theory would go unchallenged until the 1860s when the first germs theories of disease were put forward. (The first virus would not be discovered until 1892.)

Religious theories of disease were also widespread. Many people also believed that illness was a form of heavenly punishment for sinful behavior. These ideas stressed the behavioral causes of disease and led people to believe that only God to save an ill person from death. The observable fact that disease seemed to lower classes more frequently that others reinforced the belief that God rewarded the rich and industrious. Just like today,  wealthier patients in the early nineteenth century tended to experience milder forms of many diseases on account of higher quality diet, which in turn contributed to the presence of beneficial stomach acids and fewer cholera bacteria in their relatively cleaner food. Soch micro-infections not only caused milder disease and better outcomes but could lead to lasting acquired immunity. Thus socio-economics Thus, as Baltimore’s elite were unknowingly shielded, their moralizing solutions were implicitly validated.  For example, in the early stages of the 1832 epidemic, it was a reassuring statement to some when Alexander H. Stevens, a leading New York doctor, published that “cholera occurs more frequently among those who lead intemperate and debauched lives.” 

Such sentiments were, of course, in the eye of the beholder. Fredrick Douglass, iconic abolitionist and Baltimore resident at the time of the epidemic, remembers in his autobiography,"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."

Johns Hopkins in 1832

By the time of the 1832 epidemic, Johns Hopkins was already a successful Baltimore businessman. He had come to Baltimore from rural Anne Arundel County to apprentice under his uncle in 1812. 12 years later, the young Quaker incorporated 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 buying into a second cousin’s business project, the B&O Railroad [name Philip E. Thomas and note him in image above]. Things were going well for the ambitious Quaker.

From about 1820 to 1833, Hopkins lived at Baltimore's swanky Beltzhoover's Indian Queen Hotel. A large establishment that could house 200 residents and included two billiard-rooms (see image below), the inn boasted a rambunctious social scene that catered to Baltimore’s resident bachelors and traveling salesmen—a fact that likely raised several eyebrows in a clannish and devout Quaker family. For whatever reason, the environment appealed to the unmarried merchant and his brothers. Johns may have been a practicing Quaker, but he often displayed 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 and his brother Mahlon were disciplined by their local Quaker Meeting in 1826 for “trading in distilled spirituous liquors." It would appear that the young Johns Hopkins’ lifestyle was not 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. In 1819, an outbreak of yellow fever killed over 2,000 city residents (cite Reese). The young financier may have been more interested in markets than healthcare during the initial stages of his career, but his rising social position and business connections with traders in Maryland and Virginia would have meant that, by 1832, Hopkins was likely positioned to have a wide-reaching awareness of any major development on the Eastern Seaboard. 

Cholera Comes to Baltimore

The wave of cholera that swept the Eastern Seaboard during the summer of 1832 began as a blip thousands of miles away, likely in the Bengal region of India in 1828. Hundreds of thousands died when Iran, Russia, and Eastern Europe were infected in the summer of 1831. Come winter of the same year, Western Europe was faring no better, with 100,000 fatalities in France and tens of thousands more in Great Britain. Any hopes North America held out for avoiding another wave were dashed when cholera was detected in Canada in late June 1832. On July X?, the New York Board of Health announced the first cases in the City. A thousand unlucky residents were dead within a fortnight. 

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 Mayor William Steuart that the disease would reach Baltimore soon. The city implemented a quarantine on July 7th but that did not stop cholera from reaching the city. By late summer, cholera was exploding down the seaboard, traveling through impoverished and marginalized spaces such as the Erie Canal construction project and the interstate slave trade. The first incident of cholera in Baltimore was detected in August X, 1832; three months later, 853 residents of the city would be dead. Thousands more became infected but survived. Some, like Johns Hopkins, would suffer the after-effects for years to come. 

The causes of and effective treatments for Cholera were unknown in 1832. Today, we know that cholera is “an acute diarrheal illness caused by infection of the intestine with Vibrio cholerae bacteria.” Infection usually occurs following the ingestion of food or water contaminated with fecal matter containing the bacteria. According to the CDC, severe symptoms - which include vomiting, thirst, restlessness, leg cramps, and the trademark symptom,“rice-water” diarrhea - are observed in about 10% of contemporary patients. Rapid dehydration and shock can cause mortality among the infected mere hours after they display initial symptoms. Epidemiologists estimate that today the disease kills anywhere between 21,000 to 143,000 people every year around the globe.

Drawing on the guidance of his connections in Europe and New York, Dr. Jameson initially warned Baltimoreans to adjust four crucial aspects of their lifestyles to best avoid the plague. First, they were told to get rid of foul odors and other possible “miasmas” around their homes. According to Thom, “some tied tarred ropes around their necks, and others lighted bon-fires at the street comers; physicians advised the burning of gun powder and many citizens resorted to the repeated firing of guns.” Residents were also instructed to limit the consumption of alcohol, which was not only a sin but—more importantly—a lower-class habit. Third, Jameson advised “they should avoid an excess of cold water, all fruits, certain vegetables, and, above all, watermelons, green corn, green apples, peaches, and crabs.” Finally, and most importantly, was moral purification. Behaving and thinking more righteously, even while sick, was seen as enough to save a life. Personifying cholera, an anonymous 19th century poet wrote: "For this-I come | That every heart-may to God be given, | And shine as gems, in the dome of Heaven."

The push to approach the emerging cholera outbreak as a nationwide spiritual crisis was gaining unprecedented traction. Following initial reports of the disease crossing the Atlantic Ocean in late June, Johns Hopkins’ old Beltzhoover neighbor, Senator Henry Clay, proposed a national “fast-day” measure to the House of Representatives. Being effectively written as a nonbinding, virtue-signaling call to prayer, Jacksonian Democrats took issue with the bill’s undeniable conflation of church and state affairs. "Solemn reverence and devotion is due from the creature to the Creator," wrote the Baltimore Republican, "and he who neglects it is alone answerable for it; but 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." The measure stalled on Capitol Hill, but not elsewhere. As June ended and July began, twelve states passed fast-day resolutions, including Maryland. Even with pushback, public exhibitions of moral purification were surging. Even John Ross, chief of the Cherokee during the Trail of Tears, proclaimed a fast. Nothing worked. By July 25th, there were reports of people spontaneously falling dead on the job in Norfolk, Virginia. On August 4th, 10 days later, Baltimore’s first cholera cases were documented.

Of his four recommendations, Dr. Jameson's recommendation to avoid water, fruits and vegetables probably saved some lives. But it was not enough, and the medical establishment in 1832 knew of no effective means of treating the disease. Dr. Horatio Gates Jameson, perhaps summarizing leaders’ views of the disparate impacts cholera wrought on the socioeconomic strata of Baltimore more succinctly than anyone in the next two centuries, recorded that, “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. Here then is a mortality of about one in 96; and, of persons of respectability, one, we believe, in a thousand.” In the problematic statement, one wonders how, in the course of forming his ratios, Dr. Jameson operationalized categorizations of “respectability” off-hand. Distasteful verbiage aside, the numbers remain harrowing in themselves. 1% of Baltimore died as a whole. Records from the almshouse claim that of 211 cases, 133 resulted in deaths—a case-fatality ratio of 63%. Furthermore, it would stand to reason that a substantial portion of the 211 almshouse cases represented the few among Baltimore’s poor who were treated by a healthcare provider in the first place. Whether the “care” stood to entirely benefit them is dubious. The standard "cures" for cholera - which could include consuming high doses of mercury (known as calomel), bleeding, cupping, and leaches - were often worse than the disease itself. To quote Olson, “the usual modes of treatment probably killed many who might have recovered.”  In one doctor’s notes, an Irish patient from Baltimore "rallied from cholera, [but] is now perfectly salivated and raving mad." He later died. [FN 1818 letter re Sally]

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 and even Baltimore's famous terrapin soup. Or maybe he drank water infected with chorerae vibro from one of Baltimore's public water pumps contaminated by sewage that seeped into the water supply [ref John Snow and London]. at or near the Hopkins Brothers grocery stand. The Hopkins store was located at 5 West Pratt Street in the heart of the busy, and perpetually polluted, Harbor district, where schooners carrying people and products from across the globe entered the city with great frequency. 

Luckily, Johns Hopkins' life was saved though more than 800 of his fellow citizens lost theirs. At the city Almshouse, a staggering 25 percent of the institution's residents died (see image above). [1] Less that a year after his brush with death, Hopkins moved out of the Beltzhoover and into a property on Franklin Street, perhaps in an effort to avoid further exposure to the dreaded disease. Before he left the Beltzhoover, Hopkins received a pleading letter from his mother. The letter describes a serious health scare Johns had recently experienced (but without mentioning the word cholera). 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." Hannah 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 though not relax in this all important point, the salvation of thy own soul."

[1] Little else is known about the bout of cholera he supposedly experienced, or his recovery, but his mother’s letter contributes a few implicit and explicit details worth discussing. First, the communication does not mention cholera outright, possibly illustrating how Hannah viewed the disease as a symptom of a wider illness (additionally bearing in mind that, until 1832, cholera was more widely used to describe a symptom, like a cough, rather than an illness in itself). Second, the letter implies that, to Hannah’s awareness, Johns Hopkins was still in a process of recovery two months after new cholera cases had mostly subsided in Baltimore. Later evidence claims that the financier suffered from severe lifelong insomnia exacerbated by his cholera case. Tying this information together, it may suggest that some form of “Long Cholera,” perhaps relatively analogous to a present conception of “Long COVID,” may have not only existed, but become incorporated into the dogmatic thinking of those who believed moral improvements had to precede physiological recuperation.

Conclusion

Johns suffered the repercussions of cholera the rest of life. The illness left him with chronic insomnia. According to Thom, “He 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.” On the flip side, cholera may have been the spark that convinced Hopkins of the urgent need for improved healthcare, better medical instruction, more rigorous scientific research, and expanded services for the poor of all races. Indeed, cholera may have "[paved] the way for an inheritance in that city whose walls are salvation and whose gates are praise, which needeth not the light of the moon, nor the light of the sun, for the lord God and the lamb is the light thereof.” Perhaps it is not what Hannah meant directly, but what more could an 1800s public hospital represent, one might ask, than a “city whose walls are salvation?”

Baltimore’s greatest financier would survive two more citywide epidemics in the 1840s and 1860s, likely contracting a case on the tail end of the latter. Hopkins’ obituary mentions that he came down with cholera while visiting Cape May during the summer of 1873, months before his death. Dr. Van Bibber, Johns Hopkins’ physician, was away on business. Though he recovered, the financier was “not entirely well when he returned to Baltimore.” In the coming weeks, a bank run and the ensuing financial crisis that occurred, remembered as the Panic of 1873, kept Hopkins “greatly occupied” and exacerbated his “sleeplessness.” His obituary blamed the death of Johns Hopkins that winter on a “hurtful draft” caused by the “construction of a venetian door that opened upon his bed and communicated with an unheated hall that was lined and floored with marble.” To the very end, Hopkins would slow his life for no man. The very same lack of risk aversion that characterized the up-and-coming banker in 1832, the same qualities his own mother had to call out in fear for his place in Heaven, the same qualities, indeed, that likely made him rich, would be his undoing. Johns Hopkins passed away on Christmas Eve of 1873. He was 78.

_______

[1] Little else is known about the bout of cholera he supposedly experienced, or his recovery, but his mother’s letter contributes a few implicit and explicit details worth discussing. First, the communication does not mention cholera outright, possibly illustrating how Hannah viewed the disease as a symptom of a wider illness (additionally bearing in mind that, until 1832, cholera was more widely used to describe a symptom, like a cough, rather than an illness in itself). Second, the letter implies that, to Hannah’s awareness, Johns Hopkins was still in a process of recovery two months after new cholera cases had mostly subsided in Baltimore. Later evidence claims that the financier suffered from severe lifelong insomnia exacerbated by his cholera case. Tying this information together, it may suggest that some form of “Long Cholera,” perhaps relatively analogous to a present conception of “Long COVID,” may have not only existed, but become incorporated into the dogmatic thinking of those who believed moral improvements had to precede physiological recuperation.

Epilogue - the long shadow of the 1832 Cholera Epidemic

Dr. Horatio Gates Jameson, perhaps summarizing leaders’ views of the disparate impacts cholera wrought on the socioeconomic strata of Baltimore more succinctly than anyone in the next two centuries, recorded that, “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. Here then is a mortality of about one in 96; and, of persons of respectability, one, we believe, in a thousand.” In the problematic statement, one wonders how, in the course of forming his ratios, Dr. Jameson operationalized categorizations of “respectability” off-hand. Distasteful verbiage aside, the numbers remain harrowing in themselves. 1% of Baltimore died as a whole. Records from the almshouse claim that of 211 cases, 133 resulted in deaths—a case-fatality ratio of 63%. Furthermore, it would stand to reason that a substantial portion of the 211 almshouse cases represented the few among Baltimore’s poor who were treated by a healthcare provider in the first place. Whether the “care” stood to entirely benefit them is dubious. To quote Olson, “The usual modes of treatment probably killed many who might have recovered.”

While Dr. Jameson’s work navigating Baltimore’s public health approach to cholera in 1832 would garner him repute in the scientific community, to his bosses, things could have been handled better. Dr. Jameson had to write a letter in 1833 apologizing for the increased costs incurred by the almshouse during the recent outbreak, explaining, “The rate of mortality is larger than before but that is because for an entire month, a new and deadly pestilence never before present in this institution raged incessantly with extreme and irresistible virulence in the almshouse.” Cholera patients themselves were not mentioned until the last 10 lines of Jameson’s 3-page-long report. In some ways, the document is one of the few strong connections so far mentioned in this narrative between the state of American medical systems in the 1830s and the hyper-monetized ones that exist today. Dr. Jameson, like modern public health experts, was asked to save lives on a budget. The medical systemization and institutionalization that began in the almshouse would only expand from there. 

By 1840, now led by Dr. William Power, the almshouse took patients’ medical histories, developed standards for physical evaluations, and kept post-mortem examination reports of its dead. That decade, Dr. Power would become one of the most celebrated scientists in the world. When another wave of cholera hit the United States in July of 1849, almshouse doctors successfully attributed the cause to leaking sewerage. John Snow’s legendary map of a cholera outbreak in London was published 6 years later. Baltimore physicians, the same lot that marketed gunpower as a preventative for cholera less than a generation prior, counted themselves among the earliest supporters of Snow’s theory.

The case for the scientific community could likely not be more different than what the next twenty years had in store for American society as a whole. The brutality and rampant dogma that characterized the 1832 cholera epidemic ignited what historians now call “The Second Great Awakening,” a national period of religious revival especially remembered for the decentralization of religious authority, shrinking the gap between church and state matters, as well as setting the backdrop of defining social movements like abolition, temperance, nativism, and westward expansion. To provide one example of a seismic shift in American political culture, with effectively none of the resistance seen in 1832, President Zachary Taylor unilaterally declared a “fast-day” during the cholera epidemic of 1849. Kathleen S. Murphy asserts in her book, 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.”

Looking more directly at Baltimore, the 1832 outbreak remains at the core of many unseen forces influencing the legacy of the city. For instance, it was a defining moment of leadership for Black residents. Anthony Duchemin of the all-Black Oblate Sisters of Providence died in 1832 of cholera as one of the most famous people in Maryland after single-handedly nursing Baltimore’s (White) archbishop back to health. In her tradition followed generations of Black women in Baltimore who would come to serve as the thankless bedrock foundation of a local nursing industry, including at Johns Hopkins Medical, for over a century. In 2023, or 191 years after Duchemin’s death, the Oblate Sisters were honored for their work in the cholera epidemic of 1832. The same year, the Mother Mary Lange, Mother Superior to the Oblate Sisters of Providence during the cholera outbreak, was declared “venerable,” by Pope Francis at the Vatican, representing a key step on the way to sainthood. Perhaps none of Dr. Jameson’s analyses and none of Johns Hopkins’ future endowments amount to the influence the Oblate Sisters held over the fate of Baltimore’s healthcare landscape for its most marginalized in the mid-19th-century.

Effects on the Poor

The vast majority of Americans had no stylish hotels or Gardens of Cuba in which to safely ride out their illnesses. John H.B. Latrobe,  inventor, lawyer, and Baltimore legend, once said of the almshouse where poor residents were treated for cholera, “A worse location could hardly have been found from the point of view of public health, sewage disposal, and mosquito-borne illness.” Helen Hopkins Thom refrains from even labeling it as an almshouse, instead, “a camp hastily provided in the suburbs.” 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.” Among poor Whites in Baltimore, immigrants had it especially tough. Mostly on account of the high level of immigration that had occurred in recent decades, for many born in the U.S. or in the preceding colonies, the cholera epidemic of 1832 entrenched the view of immigration as a breeding ground for 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). While no data is available calculating the exact share of mortality incurred by Baltimore’s immigrants in 1832, the literature describes the potential figure as sizable. For reference, recent Irish immigrants accounted for 40% of cholera deaths in New York City.

Long Cholera

 Later evidence claims that the financier suffered from severe lifelong insomnia exacerbated by his cholera case. Tying this information together, it may suggest that some form of “Long Cholera,” perhaps relatively analogous to a present conception of “Long COVID,” may have not only existed, but become incorporated into the dogmatic thinking of those who believed moral improvements had to precede physiological recuperation.

Hardy's Conclusion

A March 8th, 2024 article by NPR reminds us that “cholera is making a comeback in 2024 – but the world's supply of vaccines can't keep up.” Indeed, despite cholera immunization techniques being developed by—not one—but three different scientists within a generation of Johns Hopkins’ 1873 demise, enough vaccines cannot be manufactured to keep cholera rates stable in the Global South 151 years later. 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 conveniently prioritize diseases with higher risks of geographically migrating to the Global North. In 2022, rather than ramping up production, 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. Today, conversations about cholera are all too often framed around the “sanitation norms” and the “health beliefs” of impoverished people, ignoring not only the violence and exploitation that brought on their conditions, but also several avenues of biological and material solutions that have existed for over a century to improve them. In truth, the “grunt work” of decolonizing public health 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 deflected and deflect the Global North from its culpability in largely causing and sustaining the poverty that generated the very 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 abound, America went on to decimate its cholera rates through infrastructure projects several orders of magnitude larger spatially than most countries on Earth. This country does not just have the “responsibility” of ending cholera in underserved communities worldwide, but, with the right interpretation of history, the experience and capability as well.

Sources

• Medicine in Maryland, 1752-1920: https://mdhistoryonline.net/ 

• Sherry Olson, Baltimore: The Building of an American City, Baltimore: The Building of an American City, Sherry Olson writes:

• Thomas Hepburn Buckler, 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.

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

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

• Seth Rockman, Scraping By 

• Christopher Phillips, Freedom's Port