Recent events surrounding the COVID-19 pandemic serve as a reminder of how disruptive a public health crisis can be to our local Indianapolis community, and our country as a whole. Although this is not the first public health crisis experienced by Indianapolis, both at the epidemic and pandemic level. Seemingly most cited is the 1918-1920 Spanish Influenza pandemic, which may be subject of a future post. But, in the spirit of the city’s bicentennial, this post will discuss an earlier epidemic.
As has been discussed in prior posts, Indianapolis’ geographic location was not ideal for several for reasons, but it was ideal for the promotion of disease, particularly mosquito borne illness. Additionally, the numerous water sources which cut through the city, and the lack of proper sanitary precautions or the understanding of such precautions at the time, contributed to other diseases, particularly one which spread particular dread amongst many populations in the 19th century: Cholera.
Cholera in the simplest terms is severe diarrhea which causes rapid dehydration, severe shock, and death. In pre-Civil War Indianapolis, onset of the infection was often acute and would sometimes lead to death in a matter of hours. The bacteria causing cholera was spread through contact with fecal material from an infected person. Poor sanitation and water sources located too close to latrines or animal pens, and water being drawn from local waterways which were polluted with human or animal waste, contributed to the origins and spread of the disease.
Cholera was a constant threat in the 19th century, and Indianapolis experienced particularly virulent epidemics of cholera in 1832, 1849, 1866, and 1878-79. However, while these were recognized epidemics, cholera was always present to some extent, with minor breakouts and individual or isolated cases appearing in between these larger epidemics. Walter D. Daly, M.D., described this in his 2008 article, The Black Cholera Comes to the Central Valley of America, observing that the boundaries for the above referenced epidemics were “not so sharp.” These epidemics impacted the entire country (and the world), but for our purposes, I’ll only cover the 1849 epidemic in Indianapolis (which was actually spread over the years 1849-1851), or else this post would turn into a book.
Robert Brill, in his 1982 article “The Sabbath Day Summer: Madison, Indiana and the 1849 Cholera Epidemic,” described that the initial large-scale experience with the disease which swept through Indiana in 1832 was believed to have originated in southern Asia (thus its name Asiatic Cholera) and spread rapidly through Europe in 1831, before jumping the Atlantic and rampaging across North America in 1832, before fizzling out in 1834. Cholera still made occasional appearances and scattered references in post 1832 newspapers, but it wasn’t until early 1849 when another widespread epidemic commenced.
Brill noted that again, the disease which impacted Indianapolis in 1849 jumped from Europe aboard immigrant vessels, known for crowded conditions and poor sanitation, which were bound for North America, with the primary beachhead locations being New Orleans and New York. From these cities the epidemic spread via rail lines, roads, and waterways, as steamboats from New Orleans moved northward into the Ohio Valley, and roads and canals from the east coast carried the disease into the interior. Hoosier cities and towns along the Ohio River saw some of the first cases, which were then spread northward into Indiana by way of roads, and the newly completed Madison Indianapolis Railroad. From the east, cholera also travelled along the line of the Wabash & Erie Canal, north of Indianapolis.
Prior to the arrival of the disease locally, newspaper reports were often full of reports from other cities about the cholera as the epidemic moved throughout the country. One could track the movement of the disease from these reports. On January 13, 1849, the Indianapolis Locomotive (excerpt above), responding to the rumors of the epidemic, implored the Indianapolis Commn Council to take action to prevent the spread of the disease and the death of hundreds, noting that "[t]he disease is now prevailing more or less along the Ohio River, and the daily intercourse between there and this place, lay us liable to take it any day..."
The 1849 epidemic didn’t reach Indianapolis and central Indiana until middle of the year, and it persisted, with some waxing and waning, over the course of the next few years. On June 30, 1849, the Indianapolis State Sentinel reported under a headline of “Progress of the Cholera” that “[i]t is our duty to announce, that there is an increase of cholera at most of the points from which we are in receipt of regular information.” However, newspaper reports involving cholera were often focused on the disease elsewhere, including the death toll (see Sentinel excerpt below) but minimized, or outright denied the disease in and adjacent to Indianapolis. Dr. Daly noted this phenomenon in his article, stating that often, newspapers “denied cholera at home but had lengthy discussions of cholera far distant. Cholera caused panic; it was bad for business.”
Just a few weeks later, on July 12, the Sentinel again reported that while Indianapolis was still disease free, “we can hear of the prevalence of cholera on all sides of us.” Reports of the disease in Boston, Richmond and Centerville were noted, all interior cities east of Indianapolis towards Ohio, and along routes from Cinncinaiti, evidencing the disease’s movement away from the Ohio River. On July 19, 1849, the Sentinel reported that the “direful scourge” had hit Washington, Indiana particularly hard, with a death rate of 5%, which the paper alleged was the worst in the nation. In advance of the 1849 epidemic, and with reports of the spreading epidemic becoming more frequent, the Indianapolis Common Council attempted to take preventative action on July 21, 1849, by requiring that the streets be cleaned of all filth. While the cause of cholera, bacterium Vibrio cholerae, would not be identified until 1883, there was some understanding that sanitation played a role in the prevention of the illness:
In addition to newspaper reports, the progress of the cholera was reported by Calvin Fletcher in his ever present diary from this time. Also in mid - July of 1849, Fletcher noted his worry about the future and the reports of cholera. He wrote that “[t]he Cholera must depress prices-cities will be deserted till it is ascertained the disease has left the country….I fear ½ million will fall by the disease this year, but it may not reach that amount.” He further noted that only one case of cholera had been reported in the city.
According to a report on the cholera epidemic n Indiana by Dr. George Sutton, published in 1853, and presented to the Indiana Medical Society's annual meeting that same year, the first cases of cholera in Indianapolis during this epidemic arose during the summer of 1849. Professor J.S. Bobbs, a physician, provided the Indianapolis information for the report. He detailed that the first cases in Indianapolis were reported on July 31, 1849 when two Irish laborers arrived in the city from Laurel, Indiana. Both were stricken with cholera that night, with one dying the next day, and the other surviving. The household where they were staying displayed not further cases. Bobbs reported that there were several other cases of cholera in the city around this time, with some fatalities, but he was not involved in the care, and had limited information. One of those cases involved a German immigrant, which the August 11 edition of the Indianapolis Locomotive reported died on July 18. 1849.
The latter part of 1849 and early 1850 saw reduced cholera activity in Indianapolis, perhaps due to the colder temperatures of winter. However, the disease increased in frequency in mid-1850. Bobbs noted the increased activity of various diarrheic diseases that year, and “as the summer advanced, more decided evidences of a sickly season were manifested…”
While many newspapers minimized the local presence of the disease, Fletcher’s diary contained entries which revealed an underlying foreboding in his references to cholera. On August 1, 1850, he wrote “[s]ome cases of Chollera[sic] with German emegrants[sic].” On August 4, he noted that he was called to attend to Charles Ferguson, a local resident, who had been sick with “direah” a few weeks prior, but had the illness get worse and was near death. Treatments were not effective and he died the next day. That same day was the funeral, and Fletcher noted the low attendance due to the fear of cholera. Cholera is not mentioned as the cause of Ferguson’s death, but considering the underlying complaint of diarrhea, it seems likely. Nor was his death reported in local papers which are available for review, although the Sentinel minimized the cholera threat:
The next day, August 6, Fletcher noted someone else died the previous night and was buried that morning, although the identity of the person and cause of death is not noted. He also noted two neighbors died with dysentery “perhaps hastened with cholera[sic].” On August 7, he recorded that a number of German immigrants were dying. The German association with the infection was continued into August 8, when Fletcher simply wrote “Germans sick,” while also noting that several families in the vicinity of the Fletcher home had left “the part of town where the sickness prevails & near us.” Unfortunately, he also noted that the deceased Mr. Ferguson’s family, his wife and children, were sick with cholera. Over the next few days Fletcher continues to note the general sickly atmosphere in their area of the city, and his efforts to visit the sick.
On August 15, Esther Ray, the wife of the late governor of Indiana, James B. Ray, who himself died of cholera while traveling in 1848, contacted Sarah Hill Fletcher, who was known for her abilities treating illness and injury) to come to her home because she was dying. Mrs. Fletcher and Elizabeth Messersmith, a bound girl (indentured servant) in the Fletcher household went to attend to Mrs. Ray. Fletcher himself also went and Mrs. Ray asked him to look after her youngest son, Johnny Ray. Fletcher agreed, but only as to the child’s property interests, citing his already crowded household (Johnny Ray would turn into a, for a lack of a better phrase, pain in the butt for Fletcher as he got older). Mrs. Ray died later that day. Fletcher opined that the cause of death was cholera with some other underlying conditions also involved. On the 16th, Fletcher recorded that the sick seemed better, and attended Mrs. Ray’s funeral with several of his children, Elizabeth Messersmith, and Myra Thompson, another bound girl who assisted Mrs. Fletcher and lived in the Fletcher house.
Afterwards, Fletcher went downtown to work in his bank. Upon his return that afternoon, he was told that Elizabeth did not feel well. Apparently after the funeral she had felt ill but believed it to be an “ordinary” illness. She rested in her room, and moved about the house, and appeared as Fletcher recorded, “cheerful,” and ate supper. At 5 pm she went outside, but Mrs. Fletcher requested she stay indoors to rest. By 7 the situation was getting out of control, and Fletcher noted she was “seriously indisposed,” and it was determined she had cholera.
Dr. Isaac Coe (one of the early doctors in Indianapolis and often the family’s physician of choice) was called and attempted various remedies (most which were ineffective and not curative) while the family rubbed (massaged) her. Elizabeth began to experience cramping and had, as Fletcher described it, “a continued discharge of rice water appearance.” She also had a severe thirst and was given ice water. Elizabeth survived past midnight and into the early hours of Saturday, August 17. Fletcher described that while she was not cramping, at 1 a.m. she became restless and then died a quarter to 2 in the morning, about 12 hours from when she first began feeling ill.
The death clearly had an impact on Fletcher, who wrote that her death was the first in their household in several years, and he spoke highly of her character and the help she had provided to the family and Mrs. Fletcher. Later that day Fletcher and his son, Stoughton, went to the graveyard (the future Greenlawn Cemetery) and chose a plot for Elizabeth, which was part of a section he had purchased next to his family’s section that he intended for members of the Fletcher household, but not family members. Elizabeth was to be the first to buried in this plot and Fletcher stated that “[s]he was the first to be called and I feel pleased tho’ humble she is worthy of the best place in the little plats appropriated for last remains.” Fletcher theorized that Elizabeth had become ill as a result of her tending to Mrs. Ray just a day before.
The death in the household rattled nerves. Farm hands stayed away from the house, and when Messersmith’s aunts, uncle, and siblings called on the Fletcher household, they did not come past the front gate for fear of the disease and being ostracized by their neighbors for risking catching the cholera. Elizabeth was buried that same day, and Fletcher and a few family members attended (Mrs. Fletcher did not due to her tending to other sick and her dealing with her own cholera diagnosis). Fletcher summed up the day: “We returned to our lonely house trying to forget as far as possible the great loss we have sustained.”
Deaths continued to mount. The young son of the deceased Ferguson died of what was described as dysentery, although it was very likely cholera related. Julia Hewy, the daughter of a friend of the Fletchers, also died. On the morning of Tuesday, August 20, Fletcher wrote that Mrs. Fletcher informed him that Myra, or Almyra Thompson, the second servant in the household, was ill. Fletcher immediately checked on her, finding her on a small cot in the home’s library and bathed her feet with hot water, which he thought provided some relief. Myra’s cramping was not as bad as those observed by Fletcher during Messermith’s illness, so he was hopeful she might survive.
Dr. Coe was again called, as were additional physicians for what were clearly second opinions. Myra did not improve and Fletcher “spent the long afternoon in Anguish” as he and the doctors attended to the patient. The rest of the family stayed out of the room, but by six that evening, Fletcher observed Myra’s exhaustion from the continuous “discharges of rice water,” and her pulse began to fail. Fletcher recommended a water treatment where Myra was placed in a large tub and cold water poured over her. This appeared to relieve her cramps, and Fletcher wrote that at one point she said she “felt first rate.” Myra continued to survive through the next day (Wednesday), but continued to decline and died in the early hours of Thursday, August 22. Fletcher recorded his despair over the loss of another member of household in his diary, noting that on Tuesday morning, Myra had told him she was ready to die and was going to go see Elizabeth in heaven.
As with most cholera victims, Myra was buried that same day. Fletcher recorded that no one, except a few family friends who had been assisting the Fletchers with the illness, were present at the burial. Fletcher acknowledged that no one, unless very “courageous” would have willingly come to due to the fear of cholera. Interestingly, a footnote in the diary (Vol. 4, p. 214-215) identifies several Fletcher family friends who assisted during the illnesses of Elizabeth and Myra. Apparently, Fletcher gave each a silver spoon engraved with Bible verses. The note accompanying the gifts thanked them for the help provided in dealing with the “loss of our two adopted daughters.”
But the ordeal was not over. While Fletcher noted his exhaustion, Mrs. Fletcher began to display more severe symptoms of illness, and for the next several days dealt with constant bouts of diarrhea and worsening weakness. Dr. Coe and Fletcher tended to her, with Fletcher demanding changes in treatment when he felt Coe’s efforts were not effective. Mrs. Fletcher continued to be ill for the next several days, before slowly improving near the end of the month, although she seemed more fragile and weaker in the years after the illness. Several other Fletcher family acquaintances continued to suffer, and die, from cholera or other similar maladies well into September.
It appears the cholera began to wane as the season moved towards winter. The newspaper reports from September had limited discussion about the deaths related to cholera, especially considering Fletcher’s diary detailing several deaths over the course of just a few weeks. Instead, news reports detailed how the cholera was abating in the area, or continued to focus on the impact of the disease in other cities, perhaps in an effort to skip over the worst of the disease:
Professor Bobbs, in reporting his experience with cholera in Indianapolis, described that the summer of 1850 saw a marked increase in cholera in the city. Like other reports, he makes reference to the prevalence of the disease amongst the immigrant population. He recounted one visit in early August with a woman who had recently moved to the southeast side of the city (same are as where the Fletchers resided) and was experiencing vomiting (an early symptom of cholera) and “great distress of the stomach.” She was concerned because of the presence of several German families near her home, “many of whom were said to have died, or were then ill with the cholera.” He opined that she was displaying symptoms of dysentery, which continued for several days, and she made plans to leave the city for the country to escape the sickness. However, he described that she summoned him on the morning of the August 15th, and he found her with “usual symptoms of cholera,” and she died that day. This account is similar the account given by Fletcher of Mr. Ferguson, who also had what was described as dysentery for several days before an escalation, also around the middle of the month, and his death. Since he was providing this information for a medical journal, Bobbs described his patient’s death in excruciating detail.
Bobbs explained that August 1850 saw the most dramatic increase in cholera cases, with the peak, in his opinion, being reached around the first of September. He also explained that dysentery was common during this time, and was also often fatal, although he suspected that the use of “irregular practitioners” by ill individuals resulted in confusion between cholera and dysentery, and such practitioners tended to call everything cholera.
Prof. Bobbs also noted the indifference to the cholera displayed by many of the population of Indianapolis: “Our citizens generally discredited the first reports of cholera, and up to the middle of August, its prevalence continue to be questioned. Even at present many can be found who deny that we ever had cholera here; but it is among those who never believe until they see themselves, and they will never see the cholera, unless it steps into their own dwellings.”
Statistics on deaths related to cholera in Indianapolis are difficult to identify. No newspapers I reviewed, including papers from Cincinnati, Louisville, and Madison, included any tally of the death toll in Indianapolis. This, despite the Indianapolis papers carefully tracking and detailing deaths in those cities. Bobbs recognized, this noting that “it is impracticable…to estimate the number of deaths from the disease. We should suppose, however, fifty to be a moderate estimate, nearly all of whom were among our foreign population.” He also identified that the southeast side of the city saw the worse of the disease, and “mortality was also beyond all proportion in this portion of our population.”
As the seasons changed to fall, the prevalence of cholera in the area declined. There were still the occasional case, such as one Bobb described in November, but the worse seemed to have passed. Heading into 1851 and 1852, there were still references to cholera, but these were more isolated and 1849-1850 appeared to be the peak. Fletcher’s diary reflects a few entries expressing concern about rumors of cholera. In the summer of 1851 he noted the that flux (essentially bad diarrhea) was prevalent in the area, and the child of a neighbor died as a result. His entries indicated a fear that this was cholera. This sickness continued for several weeks, and there were a few deaths. However, the direness of the situation as described in Fletcher’s diary does not reach the same level as the summer of 1850.
Generally, it appears Indianapolis's bout with cholera in 1849-52 was milder than that experienced by many southern Indiana cities, which were either on the front lines of cholera being transported along the Ohio River, or were within a short distance of the river. These towns, as well as major cities like Cincinnati and St. Louis suffered heavy losses. However, the actual losses cannot be said with complete accuracy, considering the incomplete records, perhaps deliberate misinformation about the extent of the epidemic, and the confusion with categorizing some illnesses and deaths as something other than cholera. Additionally, other similar conditions, like dysentery, seemed, at least in a few instances described above, to lead to developent of cholera as the illness progressed.
Based on the information above, it is clear that the immigrant population of Indianapolis, particularly on the southeast side of the city (Fountain Square, Fletcher Place, Irish Hill areas) suffered the worse, likely due to the impoverished conditions in which those populations lived following their relatively recent arrival in the US, and the lack of sanitation in those areas. While not carrying the epidemic themselves, these areas were susceptible to introduction of cholera as it traveled northward from the Ohio River communities.
References
Daly W. J. (2008). The black cholera comes to the central valley of America in the 19th century - 1832, 1849, and later. Transactions of the American Clinical and Climatological Association, 119, 143–153.
The Sabbath-Day Summer: Madison, Indiana, and the 1849 Cholera Epidemic, Robert Brill, Indiana Medical History Quarterly, Volume 8, Indiana Historical Society
A report to the Indiana State Medical Society, on Asiatic cholera, as it prevailed within the state of Indiana, during the years 1849, 1850, 1851 & 1852: With observations on the laws which govern its progress, George Sutton (1853)
Thornbrough, E. Diary of Calvin Fletcher. Vol. IV. Indianapolis: Indiana Historical Society; 1972.
Newspapers as noted above.