Knowledge in the Time of Cholera (33 page)

In the end, the ownership of Koch was not inherent in his ideas. Koch's “discovery” was not created in India but rather downstream in the way in which American advocates struggled to claim it, to transform it into a discovery, and to link the discovery via networks to a more general system of intellectual reform. Allopathic reformers still had work to do to realize the
future
promise that they claimed the laboratory held. This future would be expensive, and reformers still had to figure out how to raise the requisite funds for their reforms. But once completed, after the laboratory was institutionalized and regulars had achieved epistemic closure through bacteriology, Koch's research would finally become what it is now remembered as—a textbook discovery.

5

CAPTURING CHOLERA, AND EPISTEMIC AUTHORITY, IN THE LABORATORY

By the final U.S. cholera epidemic in 1892, bacteriological reformers had gained an important foothold in municipal and state boards of health. The allure of the boards for allopaths, previously spoiled by their intellectual ecumenism, was reinvigorated by Koch's discovery. Many bacteriological reformers viewed municipal laboratories as
the
way in which regulars would finally capture control of the boards, defeat cholera, secure the exclusive right to define it, and ultimately wrest epistemic authority from homeopaths and sanitarians. Even though the boards had long been under the control of a diverse group of sanitarians, allopathic physicians had maintained a healthy presence on them and were able to divert some resources to establish municipal laboratories. Thus, the stakes for the 1892 epidemic were high, as it would test these municipal laboratories, which, if successful, would validate bacteriology and, in turn, allopathy.

The early efforts to integrate laboratory analysis into public health were part of a new strategy to combat cholera, and other infectious diseases—a strategy that boasted some government support. In the wake of Koch's discovery, the U.S. government wanted to clarify the “conflict of opinion” (Shakespeare 1890, 2) over the germ theory between Koch and the British government, which had vocally denounced his findings. By executive order President Grover Cleveland sent Edward O. Shakespeare to evaluate bacteriology in action during a European outbreak of cholera. In the autumn of 1885, Shakespeare, a bacteriologist himself, assembled a “traveling laboratory” and arrived in Europe. He met with Koch, along with other European bacteriological luminaries, and traveled to Spain to evaluate Dr. Jaime Fer-ran's anticholera inoculations. In 1890, he published his thousand-page
Report on Cholera in Europe and India
, a tome that served as a clarion call for a bacteriological approach to cholera in the United States. Arguing that “nearly every studious physician of experience” (Shakespeare 1890, 447)
believed
that cholera was a microbe, Shakespeare laid out a blueprint for a bacteriological attack on the disease that included a national system of maritime quarantine and interventions based on laboratory science. Public health needed to move beyond broad sanitation efforts to a focused program that targeted specific germs, for it was “folly” (Shakespeare 1890, 854) to continue to approach diseases as if they were noninfectious.

Shakespeare's blueprint focused on three potential benefits of the laboratory. First, the bedrock of the new program was the promise the germ theory held for diagnosis. Diagnosing contagious diseases in an era before laboratory culture methods was fraught with difficulty, as physicians had to “rely on empiric observations and broad experience” (Markel 1997, 41). It was an exercise in intuitive clinical judgment, and predictably, conflicts often arose that stalled interventions. While laboratory methods were not foolproof and only a few physicians were skilled enough to perform them, Shakespeare believed that they promised immediate and accurate knowledge of the disease's arrival. This
perception
of their certainty allowed reformers to claim that “the only absolutely positive means of diagnosis of Asiatic cholera” (Welch 1893, 4) was to “see” the microbe. Second, Shakespeare lauded the prophylactic potential of laboratory analysis, albeit with reserve (even though Ferran's data on his inoculations showed inconsistencies, Shakespeare remained bullish about its prospects). Finally, municipal laboratories could perform an invaluable educational service. If a lab were established “in every city of any size,” all physicians would be exposed to the new sciences and become “acquainted with the results of modern laboratory investigation” (Chapin 1934a, 90–91).

The 1892 cholera epidemic presented an opportunity to put Shakespeare's vision to work. Once again New York was at the center of the drama, as its bustling port was the place most threatened by the disease. The infrastructure was more or less in place, as the city had experienced a cholera scare in 1887. When cholera failed to materialize that year, Hermann Biggs, the resident bacteriologist of the New York Department of Health, claimed it as a victory for bacteriology (Fee and Hammonds 1995) and parlayed it into ten thousand dollars' worth of municipal funding to create the world's first municipal diagnostic bacteriological laboratory. This laboratory became the center of New York City's public health efforts and the place through which all actions pertaining to cholera had to pass.

As cholera approached in 1892, the focus was on establishing an effective quarantine system based on laboratory science. The preferred preven
tive
measure in the early 1800s, quarantine had fallen into disfavor during the nineteenth century, as cholera continuously evaded its grasp and public health officials, operating under the idea that cholera was filth, concentrated on basic sanitation. Bacteriology redirected attention back toward quarantine. According to Shakespeare's vision, bacteriological methods would prevent the cholera microbe from gaining entry into the city. A ship believed to be infected would be held up in the port. The lab would then test passengers to see if the comma bacillus was present. If the ship received a clean bill of health, it could dock. If not, the passengers would be removed to quarantine stations where they would be detained until the incubation period of the microbe was over and cholera could no longer be detected. Under this system, bacteriologists were poised to determine quarantine policies, as they were the only ones who could definitively identify cholera aboard ships and understood the life cycle of the bacteria that determined the length of the quarantine. Such was the logic of the new bacteriological regime.

Thus, the board of health, armed with its new laboratory, sought to contain cholera in quarantine and, in turn, tame the disease once and for all. However, instead of a crowning success, the 1892 epidemic became an unmitigated public relations disaster for city officials, the New York Department of Health, and by association, bacteriologists. Once again, bacteriologists came up against the very problem allopaths had faced in public institutions throughout the course of the epistemic contest—outside interference. During the epidemic, bacteriological recommendations regarding the quarantine were routinely ignored and rejected (Markel 1997). Rather than serving as a rational application of bacteriological principles to sanitary science, by which “the exact replaced the conjectural in this branch of medicine” (Osler in Thayer 1969, 128), quarantine policies were ineffectively jerry-rigged out of xenophobia and political squabbling between local, state, and national authorities (Markel 1997). The results were embarrassing, and quite publicly so. In the end, despite the promise of bacteriology, what reformers got was a political farce that forced them to rethink their professionalization strategy, to look for a way to avoid the state altogether in order to achieve epistemic authority.

On August 30, 1892, cholera arrived in port aboard the SS
Moravia
, a passenger ship from Hamburg. The
Moravia
had lost twenty-two passengers to the disease, whose presence was confirmed by laboratory analyses. Unconcerned, bacteriologists expressed confidence that the disease would
not
jump the quarantine (e.g., “With our present knowledge of the comma bacillus, and how to destroy it, we can act with intelligence and effect in our efforts to ward off the coming pestilence” [
Medical and Surgical Reporter
1893, 421]), provided that protocol was heeded. It wasn't. Rather than identifying and separating infected passengers according to bacteriological principles, Port Officer William T. Jenkins chose to keep all passengers aboard the ship for two weeks, unnecessarily exposing healthy passengers to cholera. Unsatisfied with Jenkins's handling of the quarantine, President William Harrison jumped into the fray, declaring a twenty-day quarantine of all ships arriving in American ports. The length of the federal quarantine was determined by an economic, not bacteriological, rationale, as twenty days was a period long enough to make transport too expensive for shipping companies to bear, effectively putting a halt to all trade (Markel 1997, 98). Despite the fact that the economic logic behind the quarantine length contradicted bacteriological science, it was fortunately wrong in the right direction, as it was actually longer than bacteriologists recommended based on the incubation period of cholera.

The real problems arose when Jenkins refused to comply with the federal mandate. Despite seeking the advice of “four of the most eminent bacteriologists in the nation” (Biggs, Welch, T. Mitchell Prudden, and George Sternberg), Jenkins ignored their advice to coordinate his activities with the federal government, balking at what he perceived as undue federal meddling. Jenkins's rejection of federal oversight took a darkly comedic turn with the unfortunate handling of another cholera ship, the SS
City of Berlin
. Unlike the
Moravia
, this ship from Antwerp was determined to be free of cholera. Defying President Harrison's twenty-day quarantine, Jenkins gave the ship permission to dock. The U.S. Collector of the Port of New York, however, refused to grant entry to the
City of Berlin
. What followed was a “dramatic illustration of the confrontation between state and federal rights culminating in an almost comic sending of the unfortunate steamship up and down the bay between the quarantine station and the port collector, as each official refused to recognize the authority of the other” (Markel 1997, 99). Passengers were needlessly confined to the ship, as it yo-yoed up and down the port. Ignored during this entire squabble were the negative laboratory findings. Federal and local officials not only refused to recognize each other's authority; they failed to recognize the authority of the lab.

The problematic handling of the SS
Moravia
and the SS
City of Berlin
was only a prelude to the farce involving another cholera-infected ship, the
Nor
mannia
, on September 3, 1892. Because the ship's passenger manifest contained a number of luminaries, including the famous British entertainer Lottie Collins, U.S. senator John McPherson of New Jersey, and newspaper editor E. L. Godkin, the press took a special interest in it, scrutinizing the intensifying conflict between Jenkins and federal officials. This created a circus-like media atmosphere. Reporters, not allowed to board the infected ship, commandeered small boats and conducted interviews with passengers by screaming across the water (Markel 1997). Godkin himself wrote a number of widely circulated letters that documented and condemned conditions on the ship.

Jenkins decided to keep the
Normannia
passengers aboard until a quarantine hospital could be procured. Once again healthy passengers were unnecessarily exposed to cholera. Furthermore, ignoring bacteriological advice, the port failed to provide clean water to the passengers, enabling the spread of the disease. Describing the scene on the ship,
Harper's Weekly
reported,

In the mean time the
Normannia
's 600 passengers were penned up in the ship with death lurking on every side of them; no water, save that from the polluted Elbe, until the second or third day of their detention; and almost every hour bringing from the steerage its story of a “new case.” And those steerage passengers, unclean cholera-trafficking wretches that they are—heavens! what must have been the torture of the uninfected—huddled together in quarters reeking in filth, where sleep was impossible and the moments agonizing in expectation of the plague? (Whitney 1892, 920)

The magazine damned the quarantine as “utterly unnecessary and barbarous to a degree bordering on the fiendish” (Whitney 1892, 919). The
New York Times
(September 9, 1892, 1) described the sentiments of the passengers: “It is a game of life and death to them, and they cannot understand why the authorities should be so tardy in removing them from what they regard as an imminent source of danger—enforced existence where they now are.” When the city finally designated a hotel on Fire Island as a site for a cholera hospital, the decision immediately set off explosive local resistance by the island's inhabitants. Local fishermen formed a mob, dubbed the “Clam Diggers” by the press, and threatened to burn down the hotel/cholera hospital. The Clam Diggers refused to let the ship dock, threatening riots and violence should cholera be brought ashore. Governor Roswell Flower had to call in the National Guard and the Naval Reserve to force the
mob
to back down. Even after officials secured their cholera hospital, they failed to heed the advice of bacteriologists. The hospital might have done more harm than good, as sanitary conditions in the hotel were filthy, especially the water supply. Once again, healthy passengers were exposed to an environment that only cholera could love—an environment not so different from that aboard the
Normannia
.

Throughout the 1892 cholera scare, bacteriological knowledge was continuously ignored, resulting in ineffective policies that were universally repudiated by the local and national press. Officials inconsistently applied quarantine and sanitary measures to different groups throughout the ordeal. Cabin-class passengers were given preferential treatment in deference to their class status; steerage passengers were not afforded the same level of concern (Markel 1997). Moreover, the debates over cholera took on an increasingly racial tone.
¹
The link between race and disease was joined with nativist fears to produce a lethal public backlash against the Russian Jewish immigrants who were blamed for bringing cholera to the States (Markel 1997). Despite repeated proclamations from bacteriologists that the disease was not in any way related to race or nationality, sanitary efforts targeted Russian Jewish immigrants, deemed the “scum of invalided Europe” (Whitney 1892, 920). Once tied to place, cholera now was written over with ethnicity (Markel 1997).
²
In fact, the primary effects of the 1892 epidemic were felt, not in public health, but in immigration reforms; fear of disease provided justification for the restrictive anti-immigration policies of the early twentieth century (Markel and Stern 2002).