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Mapping Cholera, 19th century

Medical Topography: Mapping Cholera in the Nineteenth Century by Lauren Killingsworth

John Snow’s map of the Broad Street 1854 cholera outbreak is a common reference point for historians of cartography. Snow is often recognized as the father of epidemiology and is praised for his use of cartography to demonstrate a causal correlation between contaminated water and cholera fatalities. Snow, however, was not the first to use a thematic map of disease fatalities and environmental factors to investigate the cause of disease. In 1798, the physician Valentine Seaman mapped yellow fever fatalities and unsanitary sites side-by-side on a plan of New York City, the earliest known example of medical cartography. When cholera reached Europe in the 1830s, the field then known as “medical topography” burgeoned. The explosive, sudden outbreaks of cholera and the high mortality of the disease led to widespread panic. Miasmatic theory dominated popular opinion; most people believed that disease rose from putrid, foul-smelling matters in the air. Determining the cause of the “cholera morbus” became a chief priority.

The threat of cholera, coupled with the rising popularity of statistics and scientific mapping, led academics to turn to cartography. City plans depicting cholera fatalities and potential sources of disease became increasingly popular. The growing output of disease maps was largely fueled by the debate between two camps of academics: the contagionists (those who believed cholera could be spread between people) and the localists (or non-contagionists, those who believed that disease was incited by local, foul matters rather than infected people). Disease maps provided an ideal medium for physicians to advocate their theories.

This case examines medical cartography from 1832 to 1865, highlighting the diverse approaches used to better understand the origin of cholera and to promote specific theories. The original approach involved plotting disease fatalities (often alongside proposed sources of disease) on a city plan. Within this style, there was great variety in the data selected for display, symbols used, and use of statistics. Maps were cleverly designed to support either the contagionist or localist theory. Some mapmakers departed from the classical approach, creating innovative infographics, world maps tracing the progress of disease, and sanitary maps highlighting sewage systems. These diverse cholera maps provide important insight into the role of cartography in advancing medical science and shaping popular perceptions of disease in the nineteenth century.

“Sanitary & Topographical Map of the City and Island of New York Prepared for the Council of Hygiene and Public Health of the Citizens Association.” Egbert L. Viele New York: 1865
Miasma and sanitation theories dominated public health in nineteenth-century America. Civil engineer and cartographer Egbert Viele held the popular belief that disease was caused by the “humid miasmatic state” and “poisonous exhalations” caused by excess moisture and poor drainage. Viele argued that drainage and waterways must be considered in New York's development in order to improve sanitation, using his beautiful map of New York’s sewers, waterways, and natural landscapes to prove his point. Today, Manhattan’s engineers and city planners consult the Viele map to locate underground streams before initiating new construction projects.
Untitled map in A Plain and practical treatise on the epidemic cholera, as it prevailed in the city of New York, in the summer of 1832: including its nature, causes, treatment and prevention: designed for popular instruction: to which is added, by way of appendix, a brief essay on the medical use of ardent spirits: being an attempt to show that alcohol is as unnecessary and mischievous in sickness as in health. David Meredith Reese New York, NY: 1833
This unique plan was designed to demonstrate the “local,” “non-contagious” nature of cholera. The “local” nature refers to the belief that cholera was caused by noxious air and decaying matter in the local environment, rather than infection spread by people. In support of the non-contagious belief, the plan shows that cholera occurred in isolated nuclei in different parts of town. The bold numbers correspond to ward numbers. The faint capital letter in each circle corresponds to the text. Small black circles with white dots denote cholera hospitals.
“Course of Cholera in Boston in 1849” Boston Internal Health Department Boston: 1850
To determine the cause of the cholera epidemic that hit Boston in 1849, the Health Department plotted all fatal cases on a plan of the city, concluding that cholera was excited by unsanitary conditions in the “lower parts of the city, where the drainage is difficult and the cellars more or less invaded by the back-water."
“Plan de la ville de Rouen 1833” in Souvenirs du choléra en 1832 Honoré Daumier Paris: 1840
Like Reese, Daumier was also an advocate of the “localist” theory. Daumier plotted cholera cases on the map in red to determine the distribution of disease, noting that sailors on the Seine and neighborhoods along the river were the most severely affected. The practice of plotting individual cholera cases on a city plan became very popular in the 1830s and served as both an experimental method to test hypotheses of the cause of cholera and as a tool to communicate public health information and medical theories.
“Plan of Oxford Shewing the Parts Visited by Cholera and Fever” William P. Ormerod Oxford: 1848
The physician William P. Ormerod plotted cases of cholera and typhoid fever alongside unsanitary sites in order to determine which neighborhoods were most affected by disease and to prepare for future epidemics. Ormerod shaded neighborhoods “chiefly visited by disease,” concluding that poor drainage, “decomposing matter,” and poverty were associated with disease. Ormerod’s map received high praise among the public and academics alike, who used the map to argue for better sanitary and water systems in Oxford.
“Map of Oxford to illustrate Dr. Acland’s Report on Cholera in Oxford in 1854 showing the localities in which Cholera and Choleraic Diarrhoea occurred in 1854 and cholera in 1832 and 1849.” Henry W. Acland Oxford: 1856
The physician Henry W. Acland created this extensive map plotting cholera from Oxford’s three outbreaks, in addition to unsanitary sites, contaminated rivers and streams, and elevation. Acland, a strong proponent of the localist theory, used the map to conclude that low-lying regions were most severely affected by cholera because miasma festered at low elevations. Acland was strongly influenced by Ormerod, evidenced by Acland’s inclusion of “Parts described by Ormerod” in the key of his map, referring to the unsanitary sites that Ormerod identified.
“The geographical distribution of health and disease.” Alexander Keith Johnston 1856
The geographer Alexander Johnston investigated disease at an international scale, creating one of the most impressive world maps of disease. Johnston’s extensive map includes diseases endemic to each region of the world, routes of disease, and exhaustive statistics on disease mortality by country and value of life by country.
“Chart Shewing the Progress of the Spasmodic Cholera.” Frontispiece to A Treatise on epidemic cholera: including an historical account of its origin and progress, to the present period. Amariah Brigham Hartford, CT: 1832
The American psychiatrist Amariah Brigham illustrated the spread of cholera from India to China, Europe, and North America on this trade-route style map. The map complements Brigham's treatise, which explains that the disease originated in India. World charts of disease were used to predict future spread of disease; there are reports of patients discussing disease charts with physicians to calculate when cholera would reach their hometowns.
“Map of the 48 districts of Paris showing the respective degrees of intensity of mortality caused by Cholera in 1832” and “Plan of the 80 Rural Communes of the Saint Denis and Sceaux Circuits, and of the 48 districts of the City of Paris, according to the direction of the Winds” in Report on the cholera in Paris Commission instituée pour recueillir les faits relatifs à l'invasion et aux effets du choléra-morbus dans le départment de la Seine 1849
These two maps illustrate very unique approaches to displaying cholera incidence data. Both depart from the popular approach of plotting individual cases of cholera on city plans and instead use innovative infographic and choropleth techniques.