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Epi Wit & Wisdom Articles
“Epidemiology is Born”: Cholera
in Paris, 1832
By David Morens, MD
“The Central Health Commission
convened yesterday in an extraordinary session at the police
prefecture... The Conseil Supérieur of Health was convened today at
the Ministry of Commerce for the same purpose... Forty-eight Bureaus
of Health are going to be set up in the 48 quarters of Paris in order
to render help to those attacked by cholera...”
So began Le Moniteur Universal
in its introduction to the “First Health Bulletin of the City of
Paris” on Friday, 30 March, 1832. Judged by its far-reaching
influence on popular imagination, art, and the birth of modern
epidemiology, the Paris cholera epidemic is among the most significant
events of human history. In a matter of months, 18,402 Parisians died,
gripping the city in terror. The epidemic was capricious and
mercurial, seeming to strike everywhere at random. Hearses, disguised
as cabs, were stationed on street corners, but so many deaths occurred
so quickly that soon desperate Parisians were looking out of shuttered
windows at parades of carts and furniture vans, piled high with
bodies, rolling through the streets. No one who remained in Paris ever
forgot the summer of 1832.
In her 1907 memoirs the Comtesse
de Boigne recalled Palm Sunday: “Mme. de Champlatreux... a girl of
20.. was taken ill on returning from a walk to the flower market and
died in the night. We were speaking of this sad event when the Marquis
de Castries entered and asked if we knew why Mme. de Montcalm was not
receiving as usual... We went to her house to inquire; she was
dead.... M. de Glandéves had been taken ill the night before, but not
seriously. Someone assured us that he had seen him that morning quite
well. Nevertheless, we went to inquire again; he was dead. We had not
recovered from the shock when M. de Pasquier was called away to see
his niece, with whom he had dined, and whom he found at the last
gasp...” (1). But this was the genteel description.
Châteaubriand, also of the
nobility, wrote in his posthumous memoirs with eloquent horror:
“Imagine a mortuary sheet flying as a flag from the heights of Notre
Dame’s towers, solitary canon blasts thundering intermittently to
drive away the imprudent traveler; a cordon of troops circling the
city, permitting no one to enter or leave, churches filled with
moaning crowds, priests chanting, day and night, prayers of perpetual
agony, the last rites taken from house to house with religious candles
and little bells, tolling funeral bells never silent, monks, with
crucifixes in hand, calling out in the intersections for people to do
penance, preaching the cholera and God’s judgement, shown by the
cadavers already fed to the fires of hell.” (2)
Although most of the privileged
fled Paris, the poet Heinrich Heine credited others with courage in
trying to allay panic, including the king and especially the queen,
who cut up and distributed bandages. The Prince d'Orléans, Casimir
Périer, and the Archbishop of Paris visited the sick at the Hotel-Dieu
and at other hospitals. Heine, who stayed in Paris throughout, even
indirectly applauded himself as being among the few who could have
fled but chose to stay, writing that “the Messieurs Rothschild,
have... quietly remained in Paris, thereby manifesting that they are
great-minded and brave.” (3) (For centuries, Jews had been accused of
starting epidemics by poisoning wells, as Heine’s readers of the day
knew well. Heine apparently could not resist a literary rebuttal to
epidemiologic anti-Semitism.)
Heine’s defensiveness was not
without reason. As the cause of cholera was then unknown, and as many
deaths occurred so quickly after onset, and were associated with so
few symptoms before terminal pallor and collapse, there soon arose a
wild rumor of mass poisoning. Organized vigilante squads began to roam
the streets and to congregate at key intersections, looking for
poisoners, searching the persons and possessions of suspicious men.
Heine saw the mob hang a supposed poisoner in the rue Saint-Denis. In
the rue Vaugirard he described the deaths of two more “poisoners.” “I
saw one of the wretches... still in his death-rattle... old women
plucked the wooden shoes from their feet and beat him on the head
until he was dead. He was naked and beaten and bruised so that his
blood flowed; they tore from him not only his clothes, but also his
hair, and cut off his lips and nose; and one blackguard... dragged
[the corpse] through the streets, crying out ‘Voilá le choléra-morbus!’
A very beautiful woman, pale with rage, with barebreasts and bloody
hands, was present, and as the corpse passed her she kicked it. She
laughed to me, and begged for a few Francs... to buy a mourning-dress,
because her mother had died a few hours before of poison.” (3)
Heine, who wrote the most famous
description of all, continued: “...It was a reign of terror far more
dreadful than the first [during the revolution], because the
executions took place so rapidly and mysteriously... there were ranged
high piled [in an open public building], one on the other, many
hundreds of white sacks containing every one a corpse... [and]... the
watchers of the dead... with a grim indifference counted out the
sacks to the men who buried them... the latter, as they piled them on
their cars, repeated the numbers in lower tones, or complained harshly
that they had received one corpse too few, over which there often
arose a strange dispute. And I remember how two small boys with
sorrowful faces stood by, and that one asked me if I could tell him in
which sack his father was.” (3)
In describing actually and
metaphorically the onset of the epidemic, on the night of 29 March at
the masked ball of the mi-carême (mid-Lent), Heine created a literary
image that is still resonant and still widely read, and which has
greatly influenced art, literature, movies, and popular conceptions of
fatal epidemics. Heine’s description of the grim costume ball, in
which death circulates undiscovered, apparently influenced Edgar Allen
Poe’s “Masque of the Red Death,” and at least three other of Poe’s
tales, while T. S. Eliot’s image of death as the “eternal footman” (in
“The Love Song of J. Alfred Prufrock.” written more than 80 years
later) also echoes a vivid image from Heine’s description.
The epidemic had an even greater
effect on public health. Paris was quickly and exhaustively organized
along both public health and clinical lines. The newspapers published
mortality figures daily, and they were widely studied: for the first
time in history, every literate person could become an armchair
epidemiologist. So many books and broadsides on cholera were published
that there was a veritable deluge of information on prevention. The
city took action. Large assemblies were prohibited (in case cholera
was transmitted by the airborne route, which few believed anyway), the
sale and distribution of used clothing was prohibited (in case the
disease was transmitted like smallpox occasionally was), markets were
removed to the city’s outskirts (in case miasmas from rotting
vegetation caused cholera), and health alert signs were posted on the
dwellings of all cholera victims until eight days after their recovery
or death.
For the most part, the public
was glad that its government was taking an active role beyond that of
any other government up to that time. The city’s several thousand
rag-pickers, however, were upset at the injunction that prevented them
from picking through garbage, which deprived them of their livelihood.
They organized themselves with huxter-wives and attempted a
“counter-revolution,” the men barricading themselves at the Porte
Saint-Denis and the women fighting on elsewhere with umbrellas. The
insurrection was put down, but cholera continued.
During the year of cholera,
epidemiology was born. The French “hygienists” studied and wrote
extensively about the epidemic, many of them using municipal vital
statistics and constantly updated disease-specific mortality figures
to plot epidemic spread, and to quantitatively characterize the
epidemic in person, place and time. The great triumvirate of
“proto-epidemiologists,” Benoiston de Châteauneuf, Parent-Duchâtelet,
and Villermé co-wrote, with non-medical and non-hygienist colleagues,
a classic epidemic report. (4) Other medical luminaries weighed in
with epidemiologic or public health studies of their own (e.g.,
Bouillaud, Caffe, Desgenettes, Moreau, and Velpeau). Prevost plotted
what appears to be among the first examples of an epidemic curve,
defending its simplicity with embarrassed defensiveness. The word
“epidemiologie” appeared in France and Germany shortly after the
epidemic, in the 1830s and 1840s, from which it was apparently
exported into the English language in December, 1849, during planning
for establishment of the London Epidemiological Society.
Published February 1998 v
References:
1. Le Borgne CLEA. Récits
d'une Tante. Mémoires de la Comtesse de Boigne, née d'Osmond, publiés
d'aprés les manuscrits original par M.C. Nicoullaud. Paris, 1907.
2. Châteaubriand F-A-R. Le
cholera (XXVII). Paris, rue d'Enfer, mai 1832. In: Châteaubriand
F-A-R. Mémoires d'outre-tombe. Paris, 1849.
3. Heine H. The cholera in
Paris. In: Heine H [translated by Leland CG]. The Works of Heinrich
Heine. French Affairs. I. Volume 14. The Citizen Kingdom in 1832
(continued). VI. New York: Crosscup and Sterling, 1900:155-185.
4. Benoiston de Châteauneuf L-F,
Chevallier, Devaux L, Millot L, Parent-Duchtelet A-J-B, Petit de
Maurienne A, Pontonnier, Trébuchet, Villermé L-R, Villot. Rapport sur
la marche et les effets du choléra-morbus dans Paris et les communes
rurales du département de la Seine, par la commission nommée par MM.
les préfets de la Seine et de police. Année 1832. Paris: Imprimerie
royale, 1832.
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