Epidemics in Uncle Tom’s Cabin: cholera, yellow fever, tuberculosis

I have been drafting annotation for Uncle Tom’s Cabin, for an edition, and last November and December I was working on the St. Clare chapters, in which two epidemic diseases are mentioned by name, cholera and yellow fever, and one disease is referred to but never named, tuberculosis. As I’ve already drafted the annotations—and as pandemic is much on the minds of everyone today–I’m going to share my annotation notes, with some suggestions for additional research and connections to the present COVID-19 moment, and with some hints about how they may inform about the United State’s long history–and present–of systemic racism. If you are teaching or reading Uncle Tom’s Cabin this academic year (I won’t be, at least not until spring), perhaps could be of interest to you as well.

When St. Clare refers to the death of Scipio during the “first cholera season,” that dates his death, to the year 1832, the first year in which the United States suffered a cholera epidemic, which would have been in the living memory of much of the audience for Stowe’s novel. And the memory might have been quite fresh, because in 1849 the U.S. suffered its second major cholera epidemic. In any case, here’s the note:

An often lethal infection, cholera targets the gastrointestinal system and causes copious and watery diarrhea, which leads to dehydration and can cause death within hours of its initial onset. A new scourge for the Occident in the 19th C., global trade networks permitted epidemics that had formerly been limited mostly to regions—cholera in Asia, for example—to spread into worldwide pandemics. At midcentury, its germ origins were not understood, and public health consensus blamed seasonal outbreaks of cholera on intemperance and on impoverished immigrants.

The global reach of the British and other less expansive European empires contributed to the spread of epidemics, but they also, as I will show below, led to the formulary of treatments. The 1849 cholera epidemic was a harrowing summer in HB Stowe’s family. Her son Samuel Charles “Charley” died, then aged about 18 months, the disease also striking her daughters Eliza and Georgina, aged 13 and 6, and her household servant Anna Smith–the other three recovering. Charley was one among the tenth of the Cincinnati’s population who perished, which was comparable to other major cities like Sandusky and St. Louis. See Joan D. Hedrick’s biography (buy it), which has a deathbed daguerreotype of Charley and describes that summer in her household. The letter that Stowe wrote to her sister-in-law, after Charley’s death, is at the Harriet Beecher Stowe Center, and they have published it here: https://nationalera.wordpress.com/harriet-beecher-stowe-to-sarah-beecher-7291849/. When she was writing her novel in 1851, that event was not long in her past.

But back from author biography to the novel: in chapter 34, the death of St. Clare’s father is dated as among the “first cholera cases” in New Orleans. That statement dates his death to around November 18, 1832, a date you could arrive at by using the chart on page 62 of G. F. Pyle’s “The Diffusion of Cholera in the United States in the Nineteenth Century.” Geographical Analysis (1969) 1: 59–75. https://doi.org/10.1111/j.1538-4632.1969.tb00605.x. I had never considered that an identifiable date–and discovered it by checking on a whim–but it occurs to me that 25 years from now for someone to say “one of the first coronavirus deaths in New Orleans” would be something that many of us will be able to identify to within weeks. To learn more about cholera in U.S. history, with additional resources, see Howard Markel, “Cholera.” In The Oxford Companion to United States History. (2004) Oxford University Press. [Oxford Reference DOI]. From that encyclopedia entry, a standard scholarly study appears to be Charles E. Rosenberg (1987), The Cholera Years: The United States in 1832, 1849, and 1866. University of Chicago Press. [Kent Library Link]. Also, if you want to know how cholera was discussed and treated in 19th-century medical literature, in Stowe’s day, see Charles Delucena Meigs, 1849. Remarks on Spasmodic Cholera. Printed, Not Published. T. K.&P. G. Collins, printers [Google Books]. Also of interest, but older, is Daniel H. Whitney (1835), The Family Physician, Or Every Man His Own Doctor: In Three Parts. N & J White. Part 3 is on the “History, Causes, Symptoms, and Treatment of Asiatic Cholera,” the last a historical (and as I shall show below, present) disease naming convention whose ideological significance should not be lost to ourselves in the U.S. during the COVID-19 era. Using the chart in Pyle, the article above, I think it would be interesting—dissertation chapter or scholarly article interesting–to trace the spread of cholera geographically, which then could be compared to newspapers in the regions as it took hold, in Chronicling America and subscription newspaper databases.

And to the second, yellow fever. When Ophelia is urging St. Clare to complete the legal transfer of Topsy to her, he asks her whether he “exhibits symptoms of yellow fever or cholera,” and that brings us to the second fatal illness that haunts the novel, which is related to its setting in the city of New Orleans. I’ll begin with my brief explanatory note on yellow fever, and then dilate on it:

An infectious disease, transmitted by a mosquito-born virus, with symptoms that range from headache, chills, and nausea to internal hemorrhage and death. New Orleans’s close trade connections to the Caribbean, ecological transformation including deforestation wrought by sugar plantations, poor sanitation, and frequent immigration of Europeans not previously exposed to the virus led to recurring pandemic outbreaks in the city.

Again according to The Oxford Companion to United States History, the article by Margaret Humphreys, America’s first outbreak occurred in 1790s Philadelphia. (By the way, if you are thinking of a pandemic-themed class, see discussion and text of Charles Brockden Brown’s A Man at Home, which responds to that first Philadelphia yellow fever pandemic, newly released at at Just Teach One). As with cholera, origins were disputed: some blamed poor hygiene and others blamed an imported foreign virus, so public health responses included sanitation and quarantine. Some public health officials noticed that newly arrived persons, not previously exposed, were more susceptible to death. The last major outbreak in the south occurred in the 1890s, at a cost of some 10,000 lives. A recent work, which I have not yet read, associates yellow fever with ecological transformations wrought by the sugar industry and discussions of its causes with slavery, race, and ecology, Urmi Engineer Willoughby’s Yellow Fever, Race, and Ecology in Nineteenth-Century New Orleans. (2017). In the words of the press release: “She then traces the origin and spread of medical and popular beliefs about yellow fever immunity, from the early nineteenth-century contention that natives of New Orleans were protected, to the gradual emphasis on race as a determinant of immunity, reflecting social tensions over the abolition of slavery around the world.” I’ve requested my library’s copy of Willoughby’s book, (as of today, because my university library books were in quarantine until last week), so I can update my note, and you should check with your library to request or order a copy.

Finally, we turn to the most frightening disease of the nineteenth century, tuberculosis, which though technically not an epidemic was nonetheless so frightening that Stowe refers only to it as a series of symptoms, that Eva is “tired and languid,” and that her father overhears the New England nurse Miss Ophelia discussing “a cough, that all her medicaments could not cure; and even now that fervent cheek and little hand were burning with hectic fever.” That is, upon witnessing the cluster of symptoms, death is nearly assured. As today, when in fear of contagion, Ophelia watches and notes the “slight, dry cough” and the “airy buoyancy born of fever.” In choosing to annotate what cannot be named, I decided to link it (as another editor had) to the phrase “could not cure.” And this is the draft:

The unnamed disease associated with an uncurable cough is pulmonary tuberculosis, the wasting illness known as consumption, which led to a quarter of American deaths in the 19th century. An infectious but not epidemic disease, its high prevalence and fatality rates meant that great anxiety accompanied detection of its diverse symptoms: fatigue and poor appetite and weight loss; fever, chills, and night sweats; and coughing for several weeks, painful breathing, and coughing up blood. Its bacterial origin unknown, its infection rate comparatively low and onset delayed, blame was placed on various causes: overstimulation of nerves, overcrowded housing, factory working conditions, alcoholism, poor diet, race, poverty, etc.

Consumption or phthisis is the emblematic death ailment for heroes and heroines of Gothic novels or Romantic poetry, in the religious sensitivity of the sinless child, and in an admired companion in domestic fiction, who guides a young girl’s transition into womanhood (see Warner’s Wide, Wide World). But again also consult medical guides like Mayo Clinic for symptoms and The Oxford Companion to United States History, which has the article by Georgina Feldberg on “Tuberculosis.” If we understand the disease model of that day, then we can understand why Eva’s father insists on a “receipt or strengthening mixtures.” Based on medical dictionaries, this is the pharmacological brew that St. Clare is bringing home to his daughter:

receipt: a medicinal preparation or prescription, one following a formula or recipe;   strengthening mixture: a tonic, typically for tuberculosis symptoms a sweet syrup flavored with citrus peel, cinnamon, or peppermint oil, buchu leaves, cinchona or willow bark, and dilute sulphuric acid, or quinine sulfate, the preparation varying to match symptoms and taken orally in tablespoonfuls two or more times per day.

So that does not sound pleasant, albeit in ingredients and dosage it seems like a recognizable fore-runner to our own sugar syrup cough medicine with bitter aftertastes. For the source of that recipe, see A Cyclopædia of Practical Receipts and Collateral Information in the Arts, Manufacturers, and Trades, Including Medicine, Pharmacy, and Domestic Economy, By Arnold James Cooley. Second Edition. 1845. John Churchill. https://books.google.com/books?id=jG4DAAAAYAAJ. But it’s interesting to note how essential the fruits of empire are for deriving treatments, which also spur medicinal chemistry, to mimic otherwise rare, expensive, and difficult-to-locate ingredients. I lack the time to sort out everything at the moment, I’ll just share my raw notes, so that you if like I are first stepping into this topic, you can learn from them to read a medical dictionary of the mid-19th-century. I learned to read them (to extent I can) mostly with the assistance of the Oxford English Dictionary.

[cinchona?] bark, for fever: ``growing in the tropical valleys of the Andes"; ``The medicinal bark of species of Cinchona, Peruvian bark; also the drug prepared from it" {OED}, (1740-1880).
buchu (or bucku), source for diosmin, [also in citrus], treatment for blood diseases
``Tonic, stimulant, and diuretic": Any of several aromatic plants native to the Cape of Good Hope, used in the past for cosmetic purposes by the Khoekhoe, and now medicinally. Formerly termed Diosma crenata {OED}, (1730-1880).

calumba root, dyspepsia [indigestion], restraining vomiting and diarrhea
The root of Jateorhiza palmata (or Coccolus palmatus) family Menospermaceæ, a plant indigenous to the forests of Mozambique, used in medicine as a mild tonic and stomachic. {OED} (1789-1883).

cascarilla, ``in debility of digestive organs, to check severe vomiting [i.e., anti-emetic]"
``The bitter aromatic bark of the plant Croton eleuteria, used as a tonic. Also called cascarilla bark. {OED} (1686--1875) Also ``Croton eluteria," native to the Caribbean.

rhatany, for blennorrhea, mucus discharge from urethra or vagina, seen in gonorrhea
``inferior quality, imported from Brazil &c," for port wine. More fully, rhatany root. The astringent root of any of several South American shrubs of the genus Krameria (family Krameriaceae), used medicinally or as an additive in making port. {OED}, from Peru and New Granada (mostly 1808-1895 for medicinal).

ammonia carbonate, ``stimulant, antacid, diaphoretic [inducing perspiration], and antispasmodic" {OED}, (1789-1855), e.g., chemical process for hartshorn.
dilute sulphuric acid, [also: spirit of vitriol], to check perspiration, to relieve itching, for dyspepsia, and to achieve relaxation No OED usage, but in medical dictionaries, early one is Abraham Rees, The Cyclopædia, Or, Universal Dictionary of Arts, Sciences (1819).
quinine sulfate, from yellow cinchona bark, as a febrifuge [reduce fever] and a stomachic [appetite or digestion]

Like John Locke and his crazy infatuation with the pineapple–the all-but indescribable pleasures of the senses help make it possible for Locke to suspect that one can know empirically, on the basis of sense experience–it is access to the fruits, literal and figurative, of European empire—Peruvian-sourced bark, South African cosmetic plants, roots from indigenous forests of Mozambique, Caribbean Croton eleuteria bark, South American rhatany (or dilute sulphuric as chemical imitations of hartshorn, quinine sulfate to imitate cinchona bark extract)—that helped to create a full 19th-century tuberculosis formulary.

Please consider: The germ origin of the tuberculosis was not understood, but that does not mean that 19th-century physicians lacked a disease model. For one, match symptom to ingredient that treats the symptom. But more importantly, the key term, which I had missed until I did the research, is “nervous affection.” When Eva has night sweats (among tuberculosis symptom), her mother Marie pooh-poohs it: “Law! I’ve had that, years and years; it’s only a nervous affection.” We the reader, I suppose, are to wonder and laugh to ourselves if we think that Marie is confusing Eva’s illness with the climacteric, but there is an entire disease model behind her term “nervous affection”:

A catch-all medical diagnosis for any affliction or disease that targets mucous membranes and internal organs, those involved in breathing, circulation, digestion, and reproduction: nerve pain in the face and head (neuralgia), indigestion (dyspepsia), vomiting, diarrhea, abdominal cramping and spasms, urinary tract infections, chills and fever or night sweats, weight loss, pains during menstruation, impotence or sterility, and lung and heart ailments. The explanatory model was that bodies have a limited store of vital energy (i.e., nervous affection), which differs by gender, class, and individual constitution. All types of activity–study, entertainment or excitements, physically taxing work, drunkenness or gluttony, sexuality, etc.–expend nervous energy, which might be restored with rest and curtailment of activities. Before the germ model identified certain disease origins, both acute diseases like tuberculosis and various chronic conditions were suspected to originate in depletion of nervous energy, which rendered the body unable to heal or restore itself.

You can learn more about this battery-like model of nervous energy–and it is related to the galvanic battery, the late-18th century discovery of the voltaic cell–by consulting the British and Foreign Medico-Chirurgical Review (1850), by Samuel Highley at, https://books.google.com/books?id=rzIBAAAAYAAJ, or Charles Delucena Meigs (1849) Remarks on Spasmodic Cholera, Printed, Not Published. T. K. & P. G. Collins, printers. [Google Books].

I am not a medical historian but rather a scholar of literature and culture, who is trying to annotate disease references in a mid-19th-century novel. And I of course welcome corrections to my amateur effort in another discipline. But upon thinking about how we in the present look back upon pandemic disease, it is interesting to me that Library of Congress topic Epidemics has a sub-heading for both the Black Death and for the Influenza Epidemic, 1918-1919, and my general sense is that these are the historical models invoked most frequently for discussions of Covid-19. By contrast, 19th-century epidemics like cholera or yellow fever are not similarly invoked. Cholera (alternate name, Asiatic cholera: and hey, LOC subject heading librarians, you might think about that label some more) is a subject heading, but it not a subheading under pandemic. And nor is yellow fever beneath pandemic. Cholera seems like it definitely ought to qualify, although it was eventually held at bay by improved sanitation–and perhaps has not received the attention from historians and scholars that it deserves. The cholera article by Pyle, above, is as old as I am. Yellow fever is epidemic but regional–and in a warming world with ecological devastations may spread more broadly. Tuberculosis is not identified as epidemic, though infectious, because people could be symptomless carriers, or an infection could remain latent for years. Still, tuberculosis is estimated to have “accounted for almost a quarter of all North American deaths” and a leading cause of death “for as long as records have been kept” (Feldberg). I am not really trying to make a larger point about how we discuss COVID-19, except to note how the language of blame (“Asiatick cholera,” like Trump’s obscene term “China flu”) invokes the foreign threat. Blame for pandemic spread seems not often to fall where it also should, on global trade, on the elite who travel almost effortlessly its well-established routes ship-board or in airplanes–and upon environmental degradation. Instead, racists imply that the deserving are dying at higher rates, as a biological accident rather than as the result of systemic oppression.

More directly pertinent, though, I had never really thought of Stowe’s novel as possessing an epidemic or pandemic sensibility, and had sensed (but only dimly) the presence of acute fear of contracting a horrific, nameless illness. Doubtless Covid-19 is to be blamed for that aspect rising into my awareness. I had not previously been arrested by the mentions of yellow fever or cholera in the Uncle Tom’s Cabin, but the systematic work at annotating (and our COVID-19 moment) has changed me as a reader. And also, now knowing the historical disease model better, it makes sense to me–as it had not previously–why tuberculosis haunts haunts everyone who feels too intensely. Stowe’s novel ends with the following line:

Not by combining together, to protect injustice and cruelty, and making a common capital of sin, is this Union to be saved,—but by repentance, justice and mercy; for, not surer is the eternal law by which the millstone sinks in the ocean, than that stronger law, by which injustice and cruelty shall bring on nations the wrath of Almighty God!

I think the accident of history and our present historical understanding will cause most readers of my generation to associate the invocation of “wrath” with the Civil War, but I am now capable of imagining a newer generation of readers sensitized to the horror of pandemic, for whom Covid-19 and the Spanish Influenza Epidemic reverberate with links to the prior generations’ cholera and yellow fever epidemics, which I now sense alongside pulmonary tuberculosis as palpable strands of fear and dread coursing through the middle chapters of the novel.

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