Monday, October 27, 2014

When history does not cooperate

Don’t you just hate when you’re doing research and what you find out leads not to answers, but more questions?  Such was my experience over the past two weekends as I dug deeper into the cholera epidemics in Buffalo.

After sitting in the damp and chilly bleachers watching my son’s football team get stomped on by a team they were supposed to beat, I ran over to the Buffalo History Museum, still clad in multiple fleece lined layers, to take a look at some municipal reports for the Erie County Poorhouse.  I was interested to see if there would be any discussion of the cholera epidemics (of 1832 and 1849) and their impact on the poorhouse.  As I have mentioned before, the Erie County Board of Supervisors Reports for this period are hand written and only available on reverse negative microfilm.  With only an hour left before the Museum’s library closed, I knew my best strategy was to quickly review the documents, identify the pages pertaining to the cholera epidemics or the poorhouse and come back at a later date for a more thorough examination.

I rushed into the Museum’s research library and went straight to the shelf that held my rolls of microfilm.  I nodded a brief greeting to the staff so that I could make the most of what little time I had left before the doors were closed for the evening.  After quickly feeding the microfilm into the machine, I realized I had loaded it upside down.  When the film was finally loaded correctly, I wasted a good bit of time fumbling with the machine trying to remember which levers controlled the quality and size of the image. 

I did not find any mention of the cholera epidemic in the Board of Supervisors report of 1832, the year of the first major pandemic.  I found that very odd because the disease had such a disastrous impact on many large cities.  The hand written reports were extremely difficult to read and there is always the possibility that I missed something important.  Also, it may be that there was no time to record any details of the epidemic, as it struck so quickly and with such ferocity.  I will examine the reports again and also take another look at the reports for 1833 in the event that the Board needed time to process the events of the previous year before they could evaluate the impact of the cholera epidemic on the city.

I scrolled carefully on to the year 1849, stopping every time I saw the shapes that I came to know spelled the words poorhouse, poor, or cholera.  Finally in a meeting dated October 8, 1849 there was some discussion of this disease.  Members of the Board of Supervisors moved to give the recently (and temporarily) established Board of Health the authority to employ nurses and procure what supplies were necessary to deal with the epidemic.  They further moved to make the Board of Health permanent and give them discretion to set quarantines where they were needed to contain the disease.  I thought that was particularly interesting because physicians were arguing at the time that cholera was not contagious and quarantines were not necessary.  Also, because of Buffalo’s strategic location on the Erie Canal, quarantines would have brought commerce to a screeching halt.  However, the impact of quarantines on economic well being of the city was not mentioned in the proceedings.

Beyond that report, there was no mention of the disease itself, how many individuals had died, or if the epidemic was abating at all.  The rest of the account focused on which municipal entity was financially responsible for the cost incurred by the Board of Health.  Some argued that the Act of 1832, which established a temporary Board of Health to deal with the cholera epidemic of that year, maintained that all expenses relating to cholera and other “malignant diseases” be paid for by the county.  Others insisted that the city of Buffalo should take on the burden of said costs. 

There was also a discussion concerning the Board of Health established in the town of Evans to contain the spread of small pox.  It was argued that Boards of Health should only be established to contain “malignant diseases”.  Small pox was considered a “contagious disease” and, it was argued, if they allowed a Board of Health to be established to contain contagious diseases, what would stop another town from establishing a Board of Health to contain other diseases such as whooping cough!  I found it very interesting that members of the Board of Supervisors were more concerned with malignant diseases (malignancy is the tendency of any medical condition to get progressively worse) than contagious diseases (those passed from one organism to another via direct or indirect contact).  I am becoming very interested in the public perception of illness during this period before the germ theory of disease was understood and accepted.

The next logical place to investigate the impact of cholera on the Erie County Poorhouse was the actual records from the institution.  There are no surviving inmate or hospital records for the year 1849, so I looked through the inmate records for 1832 in the hopes of finding some mention of the disease.  Again, my investigation yielded very little information.  Twenty eight inmates died at the ECPH that year compared to 14 in 1831 and 17 in 1833.  The number of deaths in 1832 still seems low for an epidemic year.  Cause of death was not usually listed in these records, although cholera was sometimes written in the margin as a cause of death in later years.  However, 11 of the 28 deaths (39%) occurred between May and September (warmer months when the epidemic would have been at its peak).  These mortality statistics suggest that the ECPH was not being used as a pesthouse (a place to house infected patients) during the cholera epidemic of 1832.  It also appears that the institution's remote location with respect to the rest of the city (and likely the use of a well on the property) may have offered some protection from the spread of the disease.  Clearly more research is needed.

So my investigation into the primary sources has left me with more questions than answers (what else is new?).  Where were the people infected with cholera in the city of Buffalo treated?  Why did the disease not hit the ECPH harder?  What role did the Board of Health have in managing the epidemic during either pandemic year (1832, or 1849)?  What did they learn from the epidemic in 1832 that helped in the containment of the disease in 1849?  I’ll keep digging.  Stay tuned…

Tuesday, October 14, 2014

Early nineteenth century treatments for cholera

Although I am well acquainted with early nineteenth century medicine in the United States, I am seldom able to stifle a shudder when I read about the various treatments typical of the period.  Such was my experience over the past few days when I was reading about the cholera pandemics of the mid nineteenth century.  I am particularly interested in the impact of cholera on the Erie County Poorhouse in Buffalo, New York, as the pandemic of 1849 will figure significantly into my third book of the Orphans and Inmates series.

When reading medical accounts of cholera from the mid nineteenth century it is important to remember that most of the advances we now take for granted, like the germ theory of disease, came much later in the century.  By the 1848-49 pandemic, cholera was widely thought not to be an infectious disease.  The logic being that those who treated the sick seldom became ill.  In support of this was the claim of a physician to have slept on the very cot of a man who had died of the disease just the night before.  “To these facts I may add another, namely, of a gentleman with the disease dying upon my own cot, and my having not only slept, on the following night, in the same room, but upon the cot and bedding as well…”  

There was a general belief that environmental miasma, or poisonous air resulting from poor sanitation and overcrowding was to blame (for cholera and many other infectious diseases).  Such atmospheric toxins acted to depress the nervous and vital energies of the body and, as a result, produce other symptoms of the disease (such as vomiting and diarrhea).   Although London physician Dr. John Snow suggested as early as 1849 that contaminated water was the cause of cholera, it would be years later, during the 1854 pandemic, that he obtained proof by linking afflicted individuals to a specific well in London.   
While treatments during the 1849 pandemic varied, most practitioners held that the best results were obtained if therapy began in the primary stage of the disease.   The intent was to relieve “nervous prostration and congestion”.  Treatment was aimed at freeing the body of whatever might be in excess.  Initially substances were given to encourage perspiration such as Dover’s powder (a substance made up mainly of ipecac and opium), calomel, camphor, and opium.  After several hours of sweating, a patient was given cathartics (purgatives) such as rhubarb, magnesia and castor oil. Emetics, substances used to induce vomiting, were also employed.  Some physicians thought that cholera was caused by the accumulation of acids or other substances in the blood.  “Congestion” of the blood could be relieved either by bloodletting, cupping (the process of applying cups to the skin to form suction in the attempt to bring blood or heat to the skin’s surface) or by injecting substances like saline into the veins.  The problem with treatment in the primary stage of the disease according to physicians was that few individuals acknowledged symptoms like lethargy and loss of appetite and seldom sought treatment until the more severe symptoms like vomiting and diarrhea, characteristic of the later stages, set in.  It was generally agreed that treatment in the later phases was futile and mortality was high. 

According to C.B. Coventry, MD, a professor at both The Medical Institution of Geneva College and the Medical Department of the University of Buffalo in 1849, cholera came back to the United States aboard the packet ship called New York.  The ship left France in November of 1848 with over 300 steerage passengers, mostly from Germany, bound for New York.  At the time there was no cholera reported in Paris, or Havre, where the ship departed.  However, on November 25th, a single passenger became ill with a “severe bowel complaint”.  The disease spread and when the ship arrived in New York those who had not died were transferred to a quarantine hospital.  Although there were other passengers on that ship, only the Germans were afflicted with the disease.  Ninety one people were stricken by cholera in New York City as of January 1, 1849.  Of those, 47 died.  The disease would make its way via the Erie Canal to Buffalo, where over 900 people would lose their lives.  

Sadly, there are no surviving inmate records or hospital records from the Erie County Poorhouse for this period.  It is my hope that some mention of how the 1849 cholera epidemic in Buffalo impacted the poorhouse will be mentioned in the Keeper's Report, contained within the Erie County Board of Supervisors Report.  A trip to the Buffalo History Museum's research library is on the books for the upcoming weekend.  Wish me luck!!

Monday, October 6, 2014

The fate of the unclaimed dead

Because the burial procedures at the Erie County Poorhouse have figured prominently in both my research and my novels, I thought it might be interesting to share what I have learned.  The mortality ledgers from the Erie County Hospital (the hospital associated with the Erie County Poorhouse) were perhaps the most important primary sources of data.  These musty old leather bound volumes recorded the details of every person who died at the hospital.  While this medical facility served in one form or another throughout most of the second half of the nineteenth century, I have only examined the records between 1880-1913 (if there are others, I do not know where they are located). 

It is important to be clear that the majority of those who sought medical care at the ECH were not residents of the poorhouse, although inmates were treated there when they became sick or injured.  Most of the folks who came to this hospital lived in the city of Buffalo but could not afford alternative health care.  The records also indicated that the Erie County Hospital may not only have served the poor.  An examination of the occupations listed for patients revealed many skilled professions.  There were jewelers, musicians, confectioners, and book keepers mixed in with the many general laborers that were seen there.  There was even an evangelist.

Regardless of their occupation, these people came to the hospital because they were in need of medical attention.  Unfortunately, many of the patients who were treated at the hospital also died there.  The records were often very detailed regarding the interment of those who took their last breath at the ECH.  Because the county wanted to contain the ever growing costs associated with the poorhouse, great efforts were taken to locate the family members or friends of the deceased so that they could make proper arrangements for burial (thus saving the county of the expense).  Nearly half of the people who died at the hospital were claimed by family or friends.  

Most of the individuals (over 40%) who were not claimed were buried in the poorhouse cemetery. A numbered wooden stake marked their burial location in the event someone might come along and claim them afterall.  In the interest of thrift, the stakes that marked the places of individual burial in the poorhouse cemetery were pulled up each year to be used again, leaving the person interred below all but forgotten  The corresponding grave number in the ledgers indicated the individual's name, age, cause of death, date of death, nativity, occupation and, in later years, the time of death.  I recall collecting data from these records late one night and feeling the crushing sadness as several patients all died within hours (sometimes even minutes) of each other in a single evening.  

There was a small group of individuals in the later decades of the nineteenth century and into the early twentieth century who were unclaimed by family or friends and were transferred to area medical schools for dissection.  In 1854 New York passed the Bone Bill and it became legal to transfer the unclaimed dead from poorhouses, prisons and morgues for medical education.  Between 1897 and 1913 over 450 unclaimed individuals listed in the mortality ledgers were transferred for use in medical schools.  Who were these people in life?  Was their socioeconomic status a factor in why they were chosen for transfer?  What about their deaths made them likely candidates for dissection?  Was the cause of death important, or was it the time of year the death occurred? The mortality records along with other documentary sources will be critical in helping to find answers to these questions. Stay tuned!