The Town & the City: Lowell before and after The Civil War

Methodology for identifying cases

One of my goals for chronicling this epidemic was identifying the dates and locations of all the cholera deaths in Lowell during the course of the epidemic. There were a number of methodological problems with this, so it is impossible to know with certainty who died from cholera during the 1849 epidemic or the exact number of victims. According to one report by Nathan Allen, M. D. in 1884, there were 78 deaths in a 45-day period due specifically due to Asiatic cholera.

I used the Vital records of Lowell, Massachusetts: to the end of the year 1849 (The Essex Institute, 1930), the Superintendent of Burials records for the period (the online version was often illegible), newspaper lists of deaths ordered by the Mayor, and contemporaneous newspaper articles to establish names, addresses, causes of death, and dates of death. I also attempted to cross-reference all of these names with the City Directories, although many names of the cholera victims did not appear in them. Problems with this approach included inconsistencies between the sources, omissions, and the legibility of the burial records. In addition, there were no numbers for street addresses in Lowell at that time, so unless a house was on the corner of another street or on a named block, the location could not be pinpointed.

Given these constraints, it is impossible to determine the origin or origins of the Lowell epidemic. I do not believe that a “Patient Zero” or an original source can be determined. Given the social and economic situation of the time together with the lack of adequate public health infrastructure (e.g., clean water, sewers), an outbreak in Lowell was inevitable.

My methodology counted 127 cases of cholera in Lowell during the 1849 epidemic. All of the 1849 cholera deaths in Lowell took place during June, July, August, September, and October, with 117 of the 127 taking place in August and September. Of these 127, 78 or 61%, of the victims were born in Ireland, and 49 or 39% of the victims were born in other countries, mostly the US. I included cases of cholera morbus (6), and diarrhea (1; 7 total) in the 127, but I did not count the cases of cholera infantum (17) that were reported in the months of the epidemic. Cholera infantum was sadly endemic in this period, though some of these cases might have been related to the epidemic.

Information for the public

Two pamphlets about cholera written by Lowell physicians were published and distributed to residents. One was The Cholera. Brief Hints on the Prevention of Cholera, with a Plain Account of its Symptoms. the Proper Preventive Measures, and the Management of the Early Stages by Augustus Mason M.D. This was endorsed by the regular physicians of Lowell, and 27 members of the Massachusetts Medical Society practicing in Lowell lent their names approving the pamphlet. Unfortunately, as the real cause of the disease and its spread was not known, it spread myths about the disease and, although it did offer some good advice, offered little advice that would actually prevent or manage the disease. A second pamphlet by a Lowell physician provided the homeopathic perspective on cholera. This was titled Cholera, and its Homeopathic Treatment, with and Account of its Success in Europe and America, and Remarks upon its Symptoms, Preventive Means, Early Management, &c. &c. by Daniel Holt, M.D.

Reading these two pamphlets is a great case study in mid-19th century medicine. And although both the regular and homeopathic explanations of cholera are wrong, the Holt pamphlet is correct in making the point that cholera patients fared much better in European hospitals during earlier epidemics. This was because of the interaction between the nature of the disease and the treatments offered by both schools of thought, not because the Homeopaths had any better understanding of the causes and progression of the disease. While patients at cholera hospitals in Europe that were controlled by regulars were bled and purged further depleting crucial fluids and electrolytes, those at the Homeopathic hospitals were not bled and purged and were provided with some of the fluids they needed.      

A case in June

It is very unlikely that a death, possibly from cholera, in Lowell in June was the beginning of the epidemic in Lowell, but looking at it tells us a lot about perceptions of, and reactions to, the disease at that time. The epidemic “began” (first confirmed case) in Boston on June 4, 1849 and was raging in New York City as the weather warmed. Residents saw newspaper stories of with numbers of daily and weekly deaths in Boston, New York and other cities.

On Saturday June 16^tth the Lowell Advertiser printed a brief story with the heading “CHOLERA IN LOWELL”:

Rumor has confidently asserted that a genuine case of Asiatic cholera occurred at the Washington House, on Tuesday night last. The facts, as near as we have been able to learn them are, that a Mr Lewis Kimball of Waterloo, N.Y., arrived there on Tuesday evening last [June 12th], eat [sic] a hearty supper, chiefly of lobster and condiments, strawberries and cream, and retired to rest. In the night, he was, very naturally after such a supper, and probably having eaten no dinner, severely attacked with vomiting and purging, accompanied with cramps. Several physicians were called, and, as might have been expected, under such circumstances, we presume that there was some disagreement of opinion among them as it regarded the nature of his complaint. We understand that Drs Huntington and Perham pronounce it to be a severe case of cholera morbus.
Mr Kimball died this morning about 3 o’clock. But death from cholera morbus is not uncommon, and his dying affords no evidence that his disease was cholera more than it does that it was cholera morbus. We can see no reason for alarm, believing it to be but a severe case of cholera morbus, which any person may have by following Mr Kimball’s example in diet.

 A second short article appeared in the Advertiser on the following Tuesday, June 19th:

 Dr. Burnham, we learn from the Courier, states that the disease of which Mr Kimball died at the Washington House was, in the opinion of all the attending physicians, Asiatic Cholera and not Cholera Morbus. Now Dr. Burnham would do a great service if, before he pronounces a disease Asiatic Cholera and not Cholera Morbus, he would inform the public by what symptoms he judges that Mr Kimball had the Cholera and not Cholera Morbus. We have found no one who heard of any symptoms in the case of Mr K, not common in cases of Cholera Morbus when fatal. Will Dr. Burnham, or any other of the attending physicians, tell us why he pronounces it Cholera instead of Cholera Morbus.
We understand all the attending physicians by no means agree that Mr K.’s disease was the Asiatic Cholera.

We can feel the newspaper writer’s consternation in these articles, which would certainly be felt by the public as a whole. Cholera morbus could be rationalized as the result of one poor soul eating too much lobster and strawberries, while Asiatic cholera meant that a possible epidemic was looming with fatal consequences for unknown numbers of people. The lack of confidence in the medical profession during this period, discussed in the previous section, is perceptible as well. The difficulties of not knowing causes, diagnoses based on symptoms, and lacking a reliable test to identify a specific pathogen led to a diagnosis by consensus, leaving the public with wishful thinking as the best response.  

The course of the epidemic in Lowell

On the following calendars, the red number next to the date is the number of cholera deaths on that date, the words in blue are a listed cause of death other than cholera (sometimes inconsistent between sources), the green numbers in parentheses are the victims who were born in Ireland, and the street names are the places of death (often inconsistent or incomplete).

My methodology counts four cholera deaths in Lowell in the month of July 1849. The first was a non-resident, William Wood, who came to Lowell from England via New York and Boston. The second and third cases were listed as cholera morbus and the fourth case was “supposed” cholera for a man who was born in Ireland and whose place of death was Dummer St.

4 cases total

2 c. morbus &c

1 born in Ireland

51 total cases

2 c. morbus &c

30 born in Ireland

While Lowell was experiencing isolated cases of cholera in July, the disease was spreading rapidly around the US via railroads and steamboats. The faster humans could travel, the faster the disease could travel. And the more cities grew the more the bacteria could thrive, especially as the population outpaced the growth of the public health infrastructure. On July 3, 1849, President Zachary Taylor proclaimed a National Day of Fasting, Humiliation, and Prayer for the first Friday in August in response to the epidemics.

Between August 1 and August 16 there were four cholera deaths recorded in Lowell. Then on August 17 the local epidemic began with daily fatalities and continued to September 26. There were 111 total deaths in this 42-day period with only 3 days, all Sundays, without a reported death. After September 26 there would still be seven more deaths before the cold weather killed off the bacteria.

66 total cases  

3 c. morbus &c.

 42 born in Ireland

5 total cases  

0 c. morbus &c.

 4 born in Ireland

The source of the outbreak

As mentioned above, there were no house numbers in Lowell in 1849. Sometimes the street corner was mentioned or a block named, but usually the exact location on the street where a death from cholera occurred could not be determined. While there is also no evidence that there was just one source of cholera there is no doubt that there was an epicenter was somewhere in the Acre. There were cases and deaths outside the Acre, but other than the Almshouse (more on this below) there were no clusters of fatalities other than the Acre.

With what we know now, cholera was not transmitted by miasmas or effluvia or caused by intemperance, but by the human waste of an infected person being ingested orally by another. Looking at the maps and places of death it seems like the Western Canal might have played a role in the spread. Because of the crowded conditions in the Acre and a lack of any pre-existing water or sewer infrastructure, it seems inevitable that human waste would find its way into the Western Canal. In the warm summer water of the canal, bacteria could easily make its way into the wells around the canal, in addition to the possibility that the canal water was being used directly for various purposes including drinking and washing.     

While the maps available for that period do not include the locations of wells, an unrelated document from 1869 reveals a possible source. In 1869, Lowell was looking for a source of pure water, this was controversial and will be discussed in a later section. The Report of the Joint Special Committee on a Supply of Water for the City of Lowell, September, 1869 contained a series of reports written to identify the best water source for the city. A report by Mr. L. S. Burbank of the Lowell High School reveals what might have been the source, or one of the sources, of the cholera epidemic. Mr. Burbank tested samples from 15 pumps “standing in or near public streets, and in close proximity to uncemented drains and sewers.” He wrote that “the worst example of this class” that he examined was on the corner of Lowell (now Market) and Dummer Streets:

This well is evidently supplied mainly from the washings of the streets and the drainage of sewers, filtered through a few feet of earth. . . I am informed by old residents of this city, that thirty years ago [1839], this well, known as Dummer’s well, was famous for the excellence and purity of the water, and was, on this account, resorted to from a considerable distance by the inhabitants of the neighborhood.

Dummer’s well is No. 15 in Tables II and III in Mr. Burbank’s report. In Table II, well no. 15 is by far the highest in organic and volatile residue (column 5). According to the report, this is the indicator of “the amount of contamination by refuse animal and vegetable substances.”       

            Again, in Table III well no. 15 presents other serious problems. According to the report, Nitric Acid (Column 4) “in wells is believed to be wholly derived from the decomposition of matters of animal origin.” In terms of other prominent impurities, Dummer’s well water also contained Ammonia, Nitrous Acid, and Inoxidized Organic Matter.

            While none of these impurities would lead to a cholera outbreak, it is strong evidence that this well’s “standing in or near public streets, and in close proximity to uncemented drains and sewers” probably was not protected by enough earth for good filtration and would have been susceptible to an invasion of cholera germs 20 years earlier

The Almshouse

While the area discussed above seems to have been close to the epicenter of the epidemic, there were deaths outside this immediate area.   The Almshouse was, by design, outside the city center in a rural area on the border with Chelmsford about three miles away from the proposed source. There were six cholera deaths at the Almshouse spread out in time from August 25th to October 15th with three cases between the 1st and 7th of September. In the absence of the “heaped together” filth decried by the Lowell Advertiser, and far from my proposed epicenter, why did these deaths occur at the Almshouse?

Was one or more people taken to the Almshouse as paupers infected with the virus but asymptomatic? If so, why weren’t more residents and employees infected after the infected people arrived? Why were the deaths at the Almshouse spread out over time and not more concentrated?

Was the Almshouse being used as a contagious hospital people with cholera symptoms? If so, why weren’t more people taken there? Why wasn’t the Corporation Hospital used for more than the one case in early July?    

Unfortunately, I did not find the answers to these questions, and any attempts at answers would be speculation at this point. If the answers are out there somewhere, I am sure they would make sad but revealing stories. I did find two notices with identical wording in the Lowell Advertiser on September 11th and 13th that mentioned a Cholera Hospital:

NOTICE. We understand that arrangements have been made to convey patients to the Cholera Hospital at any hour of the day till nine o’clock in the evening. Hacks will be in readiness at the Mayor’s office, and physicians are requested to report at that place all cases in which removal to the Hospital is advisable. – A physician will be in constant attendance at the Cholera Hospital.
Lowell Advertiser, September 11 and 13  

So, there was an established hospital for cholera patient, but because I could not find any evidence of where it was where it was, or how many patients were admitted, it does not seem that it was utilized or perceived as a good resource. If it was a building near or connected with the Almshouse, it seems to have had limited use and little benefit for the patients. Fortunately, if this movement of patients did take place, the Almshouse never became a second epicenter.

Conclusion

Cholera was the cause of many deaths in Lowell in 1849, and it disproportionately impacted the poorest citizens many of whom were recent Irish immigrants. It could be argued the Lowell avoided what could have been a greater disaster, as there were 611 cholera deaths in Boston, 5,071 in New York City, 4,557 in St. Louis, and 5,969 in Cincinnati during the same period. While the Irish, other recent immigrants, and the poor in general were scapegoated for cholera, and other epidemics, in Lowell and across the US, it was usually the crucial act of drawing water from a public source that spread the disease.

Dummer’s well at the corner of Lowell and Dummer Streets, might have been a source or the source of the 1849 epidemic, though we will never know for sure. Though it would be decades before Lowell would provide all its citizens with an adequate supply of clean water, it seems that Lowell was fortunate to have enough water from enough good and protected sources to avoid an even greater scourge.

[Please note: I have lists with names, ages, parentage, and other information that I did not include here in this report, which I will share with any interested researchers. Please contact me if you are interested in these resources.]

            Documents

• The Cholera. Brief Hints on the Prevention of Cholera, with a Plain Account of its Symptoms. the Proper Preventive Measures, and the Management of the Early Stages by Augustus Mason M.D.

   
• Cholera, and its Homeopathic Treatment, with and Account of its Success in Europe and America, and Remarks upon its Symptoms, Preventive Means, Early Management, &c. &c. by Daniel Holt, M.D.

Vital records of Lowell, Massachusetts: to the end of the year 1849 (The Essex Institute, 1930)