Epidemics, Empire, and Environments : Cholera in Madras and Quebec City, 1818-1910 [1 ed.] 9780822981046, 9780822944461

Citation preview

Epidemics, Empire, and  Environments

History of the Urban Environment Martin V. Melosi and Joel A. Tarr, Editors

Epidemics Cholera in Madras

AND

AND

Empire Environments

Quebec City, 1818–1910

Michael Zeheter

University of Pittsburgh Press

Published by the University of Pittsburgh Press, Pittsburgh, Pa., 15260 Copyright © 2015, University of Pittsburgh Press All rights reserved Manufactured in the United States of America Printed on acid-free paper 10 9 8 7 6 5 4 3 2 1 ISBN 13: 978-0-8229-4446-1 ISBN 10: 0-8229-4446-4 Cataloging-in-Publication data is available from the Library of Congress

Contents

Acknowledgments vii Introduction: Cholera and the Colonial State in Urban Environments 

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Part I. First Encounters 1. Strategies of Treatment: Madras, 1818–1833          21 2. Strategies of Control: Quebec City, 1832–1834         53 Part II. Integrating Sanitation 3. Frequent Visitations: Quebec City, 1840–1854         101 4. The Advent of Sanitarianism: Madras, 1840–1857       130 5. Sanitary Consensus at Last: Madras, 1858–1883        162 Part III. Bacteriology and the Promise of Clarity 6. Finding the Comma Bacillus: Bacteriology in Madras and Quebec City, 1865–1910               201 Conclusion: The Colonial State and the Elusive Consensus Regarding Cholera              241 Notes                         259 Bibliography                      299 Index                         315

Acknowledgments

This book has been in the making for many years. Its roots go back to an undergraduate seminar on the environmental history of Canada that I took as an exchange student at York University in Toronto. Over the course of more than a decade, the project benefited from numerous persons and institutions. To thank all of them by name would be impossible in this limited space, so I ask for forgiveness from all those who remain unmentioned. I would like to express my gratitude to all those institutions and staff whose generous support allowed me to pursue this project: the Gerda Henkel Stiftung, for providing a research grant and for tolerating my special requests; the German Academic Exchange Service (DAAD), for a promotion stipendium funding my research trip to India; the German Historical Institute London (GHIL), for both a grant and kind hospitality; and the Cluster of Excellence Cultural Foundations of Social Integration, as well as the SFB 485 Norm und Symbol, both at the Universität Konstanz, for travel funding. At home as well as on my many research trips to Canada, India, and London, I depended on the help and services provided by the many libraries and archives I consulted. Without mentioning them all by name, I would like to thank the staff of the British Library, the Wellcome Library, and the British National Archives in London, the Library Archives Canada in Ottawa, the Bibliothèque et Archives nationales du Québec and

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the Archives de ville de Québec in Quebec City, the National Archives of India in New Delhi, and the Tamil Nadu State Archives and the Chennai Corporation Record Office in Chennai, as well as the libraries at the Universität Konstanz and the Bergische Universität Wuppertal, my past academic homes. Funds, source materials, and literature are, of course, crucial preconditions for the success of such a research project, but without the advice, questions, recommendations, and practical help of many individuals, this book would not have been possible. I want to thank first and foremost Jürgen Osterhammel, a constant source of inspiration, advice, and support; Jacques Bernier, for his advice; my friends and colleagues in the Dynamics of Transnational Agency research group, including Ines Eben von Racknitz, Bernd-Stefan Grewe, Robert Heinze, Valeska Huber, Jan C. Jansen, Denise Klein, Jonas Kranzer, and Daniel Schumacher, who were a perfect sounding board for ideas and source of encouragement and who made working on this project so much fun; the other participants of the AGIG discussion group at Universität Konstanz, including Ester Andrusko, Federico Benninghoff, Wolfgang Egner, Franz Fillafer, Silke Martini, Christian Niels P. Petersson, Martin Rempe, Wolfgang Schnee, Robert Stock, and Martin Welz, for their stamina when reading and discussing my lengthy chapters; the many other friends and colleagues at Konstanz and Wuppertal, including Christian Albrecht, Boris Barth, Julian Bauer, Christof Dejung, Andreas Froese, Stefanie Gänger, Tina Heizmann, Hiroyuki Isobe, Christopher Möllmann, Wenke Nitz, Benedikt Stuchtey, Sven Trakulhun, and Tara Windsor, with whom I had so many fruitful discussions; the many scholars I met on my travels, especially H. V. Nelles, whose seminar on the environmental history of Canada provided the initial spark for this project; David Arnold, for our meeting at the British Library; Karen Brown, for welcoming me in Oxford; Indra Sengupta, for our discussions in London and Constance; and Jane Buckingham and Shahana Bhattacharya, for the entertaining conversations during the many hours in a Chennai reading room; the audiences of my talks at various conferences and colloquia; and those who invited me to present or who commented on my papers, including Logie Barrow, Iris Borowy, Harald FischerTiné, Dominik Groß, Arne Harms, Astrid M. Kirchhof, Uwe Lübken, Franz Mauelshagen, Jan-Henrik Meyer, Johannes Paulmann, Franziska Rüedi, Franziska Torma, and Jörg Vögele. Making a book out of this wide-ranging manuscript has been no small feat. I would like to thank the series editors, Martin Melosi and Joel Tarr, for accepting my book for publication, the anonymous reviewers for their

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criticism, and the staff at the University of Pittsburgh Press, especially Sandy Crooms for her constant readiness to answer the most basic questions and discuss my most mundane concerns. Finally, I would like to thank my parents, Maria and Franz Joseph Zeheter, and my sisters, Ursula and Katharina, for their unconditional support during the difficult times, the numerous lifts and pickups to and from airports and train stations, the accommodations and meals during and on my way to and from conferences or research trips, and for suffering my constant babbling about my project.

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Epidemics, Empire, and Environments

Introduction Cholera and the Colonial State in Urban Environments When did we ever know such a year like this?—when did this city, since its foundation, witness such scenes?—pestilence and horror stalking abroad in her streets—dismay in every countenance—death knocking at every door—none knowing who might next be the victim. —G. J. Mountain

For the Anglican archdeacon of Quebec, G. J. Mountain, the sermon delivered on 30 December 1832 was an opportunity to reflect on the events of the almost bygone year. It had not been a good one. During the summer and autumn an epidemic of Asiatic cholera had had the city of Quebec in its grip. Cholera had been a traumatic experience of death and suffering that had cost hundreds their lives. Thus, sorrow was the dominant theme of Mountain’s homily, although even in retrospect only God seemed to offer a plausible explanation for cholera’s behavior. The disease’s ways had been mysterious and had defied “all human sagacity and calculation”: Man can neither trace it in its course,—pronounce upon the manner of its propagation, provide against it by preventive measures, nor do more than allay its intenseness by the remedies of art; neither with respect to place nor with respect to persons, can they augur where it is likely to declare itself: at one time indeed, it seems to travel continuously along a line of communication, but as another to drop, as it were, straight down from Heaven upon a detached population, or upon the devoted head of an individual who has been scrupulously guarded from all contact with the apparent causes of danger: Seemingly capricious in its movements, and sudden, most awfully sudden, in its operation, it puts to flight all the wisdom of men; and those who have the lightest skill in the disease of this

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mortal body, either profess the most discordant opinions, or frankly own their accumulated knowledge and their recent melancholy experience, to be equally at a fault.1

If Mountain recognized in cholera an agent of God, causing havoc and overwhelming the capacities of the local medical experts, attacking “drunkards,” “profane persons,” and “jesters” more frequently than others, then there was also reason for consolation: faced with such an existential crisis, many Quebec residents had rediscovered their belief and returned to God.2 Yet, cholera’s power exceeded even its ability to kill its victims, puzzle doctors, or change the mind of individuals. It had also altered almost beyond recognition the city that was so familiar to its inhabitants: We saw in our deserted streets, more signs of death than life—hearses carrying their load . . . the constituted authorities who watched for the public safety, unceasingly upon the alert, in token danger; engaged day after day and hour after hour, in active measures and anxious deliberations, doing all that man could do to stay in part the evils of the time, and to infuse confidence into the breasts of their fellow citizens,—Physicians and Ministers of Religion traversing the streets night and day with a hurried pace . . . —fires before every house, loading the atmosphere with vapour from prepared materials supposed of purifying power—or the official [health wardens] with their badges profusely scattering lime along the range of the more suspected habitations—these were the spectacles exhibited in our city—and images of deeper horror might be added were I to carry you into the precincts of the hospital in the first burst of the calamity, when its suddenness and overpowering magnitude, far surpassing all previous calculations, could not be met by any existing provisions nor at once mastered by any possible exertions.3

Mountain’s sermon betrayed feelings of alienation and helplessness even months after the epidemic had subsided. As a cleric, he made sense of this catastrophic experience by attributing its causation to God. Through cholera, God had disrupted normalcy in Quebec, changing not only the behavior of the citizens but the space in which they lived. This metamorphosis constituted a challenge that tested individuals’ faith and also tested the local authorities. They had to care for the ill and ensure that they received the treatment they required, but they also had to fight the environmental factors causing the epidemic. They did so, for example, by attempting to purify the atmosphere and by disinfecting dwellings and streets with lime.

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Introduction

In the end, they had been unable to halt the epidemic, which apparently could be controlled only by God’s power, but they had alleviated the suffering and saved as many as possible. They had carried out their duty both as Christians and as government officials. For Mountain, cholera was merely God’s tool to effect change. Yet, even if we leave God’s role in the 1832 cholera epidemic in Quebec to the theologians, it is undeniable that cholera altered the city. It had forced a reaction by individuals as well as the authorities who ruled Quebec. They had had to counteract the disease to preserve lives as well as the public and political order. As the medical experts of the time suspected the atmosphere as well as the presence of filth in public and private places to play an important part in the disease’s causation, the public and the authorities’ attention during cholera’s presence had turned to the urban spaces in which they lived, changing their perception of their city at a time of crisis. Offensive yet daily occurrences came to signify imminent danger. To eliminate the threat posed by cholera, these nuisances in the urban environment had had to be eliminated as thoroughly as possible. To organize such a response and to actively make the city safe again by altering the local environment in a way that would mitigate the epidemic had ultimately been the government’s task. A few weeks before cholera made its first appearance in Quebec, the government of Madras had also faced an occurrence of cholera in the territory of its capital city, though it was considerably less grave. On 15 May 1832 the government of Madras had informed the Medical Board that several cases of the disease had been recorded in the “Village at the Back of MacKay’s Garden,” a paracheri, or hamlet, within the city of Madras near the Cooum River. It consisted of about two hundred huts inhabited by approximately eight hundred parayars, or lower-caste tenant-cultivators. The board assigned the superintending surgeon, S.  M. Stephenson, and the surgeon in charge of the northwest district of Madras to investigate the outbreak. Their report stated that the superintending surgeon’s office had learned of the first case by 28 April 1832 and recorded other occurrences up until 11 May. Four of the cases had been fatal, an outcome the surgeons blamed on the victims’ reluctance to consult European medical practitioners. The surgeons did not pretend to have found the definitive cause of this small outbreak, but they considered the location of the village and the lifestyle of its population to be at least partially responsible. The settlement was situated at a lower level than the adjacent gardens, was close to the river, and had a strip of land that was used as a “cloaca,” or sewer, which exposed the inhabitants to offensive “effluvia.” Near the village a

Introduction

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nullah (creekbed) discharged water into the river during the rainy season and was dry the rest of the year. Residents of the village lived in crowded, filthy huts and suffered from malnutrition. Bushes around the dwellings prevented ventilation, and the air was “particularly close and confined” at the meat bazaar in the center of the village.4 The situation gained additional urgency due to the proximity of the village to Europeans’ suburban country houses, where many of the villagers were employed as servants.5 The crisis called for comprehensive governmental action. The investigating surgeons’ recommendations were unambiguous. To clear the settlement of filth, they proposed the construction of a channel that would direct the sewage into the river. In addition, the bed of the nullah would be evened out to promote a constant flow of water and prevent the formation of puddles or pools where filth could accumulate. The bazaar would be relocated from the center to the edge of the village, while the shabby huts and the vegetation surrounding them would have to be destroyed. New huts would be constructed as far away from the river as possible, in a rectangular grid to allow for ventilation. Also, to protect the inhabitants from the “exhalations” of the river, the village would be guarded on that side by newly planted trees intended to block the presumably harmful stench. The superintendent of police would henceforth control the cleanliness of the village. With a member of the Medical Board affirming the investigating surgeons’ findings, the government ordered the collector of Madras to implement the recommendations.6 These two episodes of cholera, occurring roughly at the same time in two British colonial cities on different sides of the globe, demonstrate a sharp contrast in cholera’s appearance: a major epidemic in Quebec that dominated a whole city’s reflections on the passing year and a minor outbreak in a small village within the city of Madras, barely acknowledged by the local authorities. Yet, despite their vastly different scale and consequences for the respective cities, both local governments sprang into action. Certainly, they employed very different measures tailored to the specific circumstances. In Madras, the authorities tried to eradicate the cause of the disease and prevent future epidemics by reforming and improving the village, while the officials in Quebec tried to mitigate an epidemic that overwhelmed the city by manipulating the atmosphere and rendering filth harmless through disinfection. If the confidence of the Madras surgeons in their comprehensive plan offers a stark contrast to Mountain’s sermon, which is testament to the failure of the Quebec officials to ensure the desired outcome of their measures, it is, nonetheless, clear that in both instances the authorities focused on the local environment to achieve their goal: controlling cholera.

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Introduction

Usually starting with mild diarrhea, cholera’s onset was easily dismissed as something else. Once fully developed, however—as an individual illness or as an epidemic—cholera attracted widespread attention and proved impossible to ignore. This salience was not just because of the high mortality associated with the disease. Cholera was more than a killer; it degraded its victims. The symptoms—violent diarrhea, vomiting, and coma—violated nineteenth-century notions of decency and civilization. Cholera thus filled the imagination of millions with fear not only for their lives and those of their loved ones but also of the kind of death they would suffer. That cholera remained a medical challenge for most of the century added to its potency. Despite the best efforts of medical experts in many countries over the course of almost a century, the disease only reluctantly gave away its secrets. The long list of names and sobriquets given to the disease highlights the medical profession’s difficulties in coming to terms with cholera. After its first appearance in Bengal in 1817, cholera was considered a new disease and there was thus no specific medical experience on which to rely. With time and continued observation, cholera lost the horror of the unknown, but familiarity brought no relief. For decades medical practitioners had only limited remedies to cure or at least mitigate the symptoms of the disease, and none of them was an undisputed success. Yet, the discussions about treatment within the medical profession were almost harmonious compared to those about etiology and epidemiology. Experience showed that cholera followed certain patterns of spread—along rivers or lines of communication, as Mountain mentioned—but exceptions to those rules regularly undermined even such basic assumptions. For most of the nineteenth century the questions about cholera’s causes and transmission were among the most bitterly argued among medical experts. There was virtually no aspect of etiology everyone could agree on, except one: cholera was in all likelihood caused by some combination of environmental factors. Over the course of a century the sun and moon, the climate, the composition of atmosphere and soil, humidity, the presence of surface water, filth and its emanations, miasmas, poisons, microorganisms, and many other features of the environment were at one point or another thought to play a role in the occurrence of cholera epidemics.7 Which agent under which circumstances was the question, and it was debated with a ferocious earnestness that betrayed its potential implications: if medical treatment was generally unsuccessful, then preventing and mitigating cholera by controlling its causes and spread seemed the most promising response for medical experts and government officials alike. Achieving this goal required at least some reliable knowledge of cholera’s etiology; otherwise, no definite

Introduction

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and promising course of action could be taken. As long as such knowledge regarding the disease was insufficient, any measure taken against cholera was of questionable value. Thus, a government’s success in fighting the disease depended on medical experts. To the dismay of government officials, even if medical experts occasionally reached a temporary consensus on how to improve public health, practical results were often disappointing. Yet, despite this lack of dependable knowledge about the disease, ignoring cholera was not an option. The authorities considered it their responsibility to react to a threat or an actual outbreak of cholera and therefore depended on expert opinions no matter how unreliable they might be. The experts’ medical recommendations also had to be adjusted to local conditions. Therefore, government authorities introduced information systems that enabled them to observe the local environment, the population, and cholera’s movement in both.8 The analysis and interpretation of such data, however, were again up to medical experts, who came to widely varying conclusions. As time went by, the range of possible responses to cholera changed along with the underlying medical theories. Government authorities tested long-established practices such as purification, fumigation, quarantine, and cordons sanitaires; they disinfected certain locations; they built sanitary infrastructure, including sewers and water works; and they installed water filters and established laboratories for bacteriological analysis. These measures were an attempt at controlling the urban environment, including its residents, and officials hoped such efforts would give them the upper hand in their recurring struggles with the disease. The question of how to deal with epidemic cholera was of course not limited to the cities of Madras and Quebec. Cholera was a global disease, and outbreaks were common across the globe. Originating in India, the disease spread in a series of pandemics. Most historians analyzing them in retrospect have counted six pandemics (1817–24, 1829–51, 1852–59, 1863–79, 1881–95, and 1899–1923) during the period under consideration in this book.9 In those years, since the disease’s transmission patterns were unpredictable despite all efforts to forecast its movements, the threat of an outbreak was constantly looming in many places even if cholera was not present at most times. Medical practitioners, government officials, and the interested public tracked cholera’s every movement. Newspapers keenly reported the news of outbreaks, recounting horror stories of death, as well as the newest medical theories, and estimating the likelihood of a local outbreak. Medical experts tried to incorporate supporting as well as contra-

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Introduction

dicting evidence into their theories, while public authorities explored ways to prevent, mitigate, or fight a cholera outbreak in case it materialized.10 While government and medical authorities, as well as the general public, were aware of the disease’s global reach, cholera epidemics were local events affecting the population of a circumscribed space, usually a village, town, city, or region but rarely an entire country. This book deals with outbreaks in Quebec City and Madras. At first glance, Madras and Quebec might appear an odd comparison. There is no direct connection between them and they were—and still are—rather different cities. Nineteenth-century Madras was many times larger in terms of population and territory than Quebec, but the people of Quebec had far more influence on the political fortunes of their city. The urban spaces were also rather different. Quebec was a compact settlement while Madras featured land in intensive agricultural use close to densely populated neighborhoods and small villages next to suburban garden houses, as in the case of the village behind MacKay’s Garden, until the late nineteenth century. Upon closer examination, however, the two cities had quite a number of things in common. Both were located in British colonies; both, for most of the period under consideration here, were provincial capitals with corresponding administrations; each accommodated a garrison of British troops; both were port cities; both were founded by Europeans; both experienced population growth, the establishment of a municipal government, and considerable investment in urban infrastructure during this period; and cholera epidemics occurred there several times without the disease becoming endemic. As provincial capitals, Madras and Quebec functioned as regional centers of authority. Both southern India and the valley of the Saint Lawrence River had been conquered only a few decades before their first cholera epidemics. The colonial order was still unsettled at the beginning of the nineteenth century, and unrest challenging British rule was common. Under these conditions the colonial governments perceived their own power as fragile and constantly under threat regardless of the situation on the ground. Military superiority remained the backbone of colonial rule decades after the initial conquest, and maintaining order was seen as the key task for colonial authorities. Every disturbance was perceived as having potentially catastrophic consequences that could eventually result in the loss of the colony. Thus, colonial officials had to remain cautious and observe the societies they ruled for any possible trouble. For managing and controlling the population, colonial authorities preferred nonviolent means and considered using the army to be an option of last resort. The au-

Introduction

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thorities tried to demonstrate benevolence and administrative competence, as well as their perceived cultural and scientific superiority, thereby simultaneously avoiding unrest and strengthening their position in power.11 Caught up in this mindset, which was part of what has been termed the “colonial situation,” colonial governments perceived cholera as a tangible threat.12 Those in power also feared the disease because of its ability to disrupt social relations and to incite unrest, but the authorities in the colonial metropolis and across Europe could rely on their traditions, precedents, established public health practices, and relatively developed governmental institutions. Compared to the governments of Europe, the colonial state was weak and underdeveloped, and colonial governments were well aware of this fact. The colonial elites’ sense of their precariousness at the best of times was heightened during states of emergency, such as an epidemic, when they found themselves in a continuous state of crisis. Failure to successfully confront an epidemic, they feared, could severely damage the state’s legitimacy and lead to insurrection, high expenditures, and, ultimately, loss of the colony. Thus, cholera was regarded as a challenge that usually, but not always, called for strong official action. The colonial authorities in Madras and Quebec saw their efforts to prevent or mitigate cholera epidemics as a means of preserving the colonial order. How they achieved order will be one feature of the narrative in this book. Although both Madras and Quebec City faced the problem of epidemic cholera, the respective authorities had to confront it under rather different circumstances. Although both cities were provincial colonial capitals over most of the nineteenth century, they were in distinctly different types of colonies. Canada was a colony of white settlement that served as a destination for at least a part of the emigrant population leaving the British Isles for North America. Enjoying the rights and privileges of British citizens, the population of white settlement colonies like Canada insisted on being represented in an elected body, thus having their voices heard in the political process, while the indigenous population was marginalized. Madras was located in a prime example of a colony of exploitation.13 India was ruled by small, elite groups of British officials relying on superior military power to dominate a politically disenfranchised indigenous population and reap the economic benefits for the imperial metropolis. Unsurprisingly, the governmental institutions of these two types of colonies had to fulfill their specific functions in different ways even though both systems were based on the British model. Colonies of white settlement had to take the opinions and interests of their inhabitants into account and relied on governmental institutions similar to those in Britain, such as leg-

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Introduction

islatures with appointed upper and elected lower houses, a governor as representative of the monarch, incorporated towns, and independent courts. With the exception of the governor, none of these institutions existed in colonies of exploitation, where the colonial administration’s powers were controlled only by London and the indigenous population had at their disposal only petitions, courts, corruption, or insurrection with which to pursue their interests. If any two colonies exemplify these two types of colonies and these two developments within the British Empire, they are Canada and India.14 India was certainly Britain’s most important colony of exploitation and arguably the most prized colonial possession during that period. Its importance for Britain’s role as the dominant world power during the nineteenth century can hardly be overestimated.15 Canada could not compete with India in terms of overall relevance, yet it was more populous, economically stronger, and strategically more important than other white settlement colonies, such as Australia and New Zealand. Canada kept some of the British and Irish immigrants to North America within the realm of the British Empire, and it provided a check on the expanding and increasingly powerful United States. Canada also pioneered a slow and deliberate process of gaining independence peacefully that served as a template for other colonies of settlement, as well as for the indigenous populations of colonies of exploitation like India.16 Until now, historians have rarely attempted a comparison between these two different types of colonies. The incongruous characteristics of the colonial states and the different problems they faced have apparently discouraged such an endeavor. However, cholera pandemics, combining global reach with recurring local impact, provide an opportunity to fill this gap. In this book, I take a comparative approach to the trajectories of development and environments in the two colonial cities of Madras and Quebec to explore the question of how cities and the authorities who governed them tried to cope with repeated cholera epidemics—or at least the threat thereof—over the course of almost a century. Being located in prime examples of their respective types of colony and in colonies of paramount importance for the workings of the British Empire, Madras and Quebec are uniquely suitable for the study of epidemics over such a long period. No other city in British colonies of settlement combined comparable political importance with a recurrent exposure to cholera epidemics as did Quebec. Bombay and Calcutta exceeded Madras in terms of relevance, but cholera was soon endemic there, necessitating a fundamentally different response by the colonial state and the local population.

Introduction

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Therefore, the local colonial governments in Madras and Quebec City play a central role in this book, alongside cholera and the environments of both cities. Colonial authorities had the responsibility for putting the puzzle together and fighting the disease in ways that fit the unique local environmental as well as social, political, and cultural conditions. The response to cholera epidemics was, therefore, highly localized, which made transferring methods of prevention and mitigation to different places rather difficult. Like the tremendously diverse land masses Canada and India encompass, their populations were correspondingly diverse. Indeed, Madras and Quebec were located in regions that were in many respects quite distinct from the larger colony to which they each belonged. Therefore, extrapolating the results of this study to the larger colonial context of each city would be unwise.17 Nonetheless, the two cities were part of the political framework of colonial India and Canada, respectively, as well as the British Empire, and decisions made on the colonial level affected local reactions to cholera epidemics. It is impossible to consider Madras and Quebec City independently from the political structures in which they were embedded: the province, the colony, and the empire. Thus, an environmental history of cholera epidemics in Madras and Quebec City is not completely detached from the history of those superordinate political entities and thus offers insight into the history of the development of those two colonial states. Although these colonial states were weak and initially ill prepared to deal with cholera, they proved able to adapt. During the nineteenth century the colonial governments gradually acquired more power and established new institutions to deal with public health in general and cholera epidemics in particular. This overall process, usually called “state formation,” accelerated over the course of the century as the introduction of constitutions and professional administration gave the state sweeping authority to assert control across territories and over the people living there. The more the state monopolized power, the more it required legitimation by those it ruled or governed. More and more instruments—such as constitutions and other elements of participatory democracy—enabled the population to have some reciprocal control over the state.18 Cholera was far from being the first or the only challenge to health and well-being that drove the development of state institutions intended to support the health of citizens or subjects. The British state had relied on the services of medical experts to deal with epidemics since the plagues of the Middle Ages, and it continued to do so to an increasing degree, both at home and in the colonies.19 Cholera proved to be a potent driving force

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Introduction

in this process. Sudden outbreaks called for ad hoc measures, and over the course of the century the recurrent threat and outbreak of the disease pushed authorities to modify both the medical infrastructure and the environment in ways that offered hope for permanent improvement in the public health situation. Thus, sanitation and medicine became one of the areas in which the state’s activities expanded exponentially over the course of the nineteenth century. These progressive activities offered the authorities an opportunity to extend their reach into the private affairs of the population. By doing so they could improve the health of the people and by extension also protect linked aspects such as the economy and the military, but they also assumed responsibility for the population’s well-being. If they failed, epidemic disease could quickly turn into a political problem.20 Over the course of the nineteenth century, the governing bodies of the United Kingdom, as well as those of its colonies, created new institutions to advance medical knowledge and harness it for use according to the state’s interest. Both the nascent medical profession and the state profited from this arrangement, known as medicalization.21 It may be surprising, then, that this process caused considerable friction in colonies of exploitation, where European views of medicine clashed with traditional indigenous practices. Medicine was regarded as a “tool of empire”—something that would facilitate colonial rule—and medical practitioners were expected to contribute to the colonial project by providing solutions for problems in the colonies.22 Medical crises like cholera epidemics offered these professionals an opportunity to prove their value. The medical experts, either working permanently for governmental institutions or hired temporarily during the crisis, devised plans to prevent outbreaks or proposed measures to mitigate them. Thus, they sought to impress their superiors in the colonial hierarchy with medicine’s usefulness for the colonial state and hoped also to persuade officials to establish temporary or permanent governmental positions for the medical profession. Cholera’s role in this process was important, but not central. Other diseases, such as smallpox, also offered opportunities to promote the prowess of the medical profession, but cholera had one definite advantage over most other diseases: it attracted the attention of both the public and colonial officials. The high profile of this disease has proven extraordinarily beneficial for historians. Cholera has been a mainstay of historical research since the 1960s, when Asa Briggs and Charles E. Rosenberg wrote two pathbreaking articles.23 They and their numerous successors considered cholera more than a medical problem of the past. Through the study of the disease, historians have gained insights into the history of societies, power structures,

Introduction

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and the development of medical knowledge, as well as perceptions and cultural appropriation of the disease during the period. The latter two aspects, however, rarely include local environmental factors.24 Despite the obvious importance of these environmental aspects, historiography on cholera has, curiously, engaged the environmental aspects of cholera in a very one-sided manner. Many histories of cholera that do feature the environment prominently have attempted to reconstruct the spatial distribution and biological requirements of Vibrio cholerae, the bacterium we hold responsible for the disease today. For those who had to deal with the cholera epidemics of the nineteenth century, however, this retrospective view was irrelevant. They acted to prevent or mitigate cholera outbreaks by observing and altering the local environment according to the medical theories of their own time. Although this eyewitness perspective is not entirely missing from the existing histories of cholera, it is rarely more than a sideshow. Therefore, this book is not another study of cholera in an urban setting based on social history and urban geography but an examination of the reactions of the local authorities and medical experts in Madras and Quebec City to cholera epidemics, their perceptions of the disease and the local environment, and their attempts to prevent or mitigate epidemics by altering conditions in that environment. To achieve this goal I conceptualize cholera and the local environment not as the objects engaged by humans but as actors that usually did not behave as desired or did not react as expected by government officials. If the authorities wanted to restrict cholera’s agency and thus control the disease, they had to employ numerous other human and nonhuman actors, many of them features of the local environment, as they did in Madras when they rearranged the MacKay’s Garden village to prevent future outbreaks. This approach is indebted to Bruno Latour’s actor-network theory, although it does not attempt to fully follow his prescription or use of terminology.25 For example, I have supplemented his terms “actor” and “assembling” with others, such as “factor,” “arrange,” “agglomeration,” “conglomerate,” or “integrate,” that, I believe, fit the Latourian outlook. Since historians have to rely on preserved sources, it is at times difficult to “follow the actors” and fully assemble them for analysis.26 We have to make do with those materials we come upon, and, therefore, this book strives to emulate Latour’s inclusive perspective on society but not to follow Latour’s prescription to the letter. This approach is more than a methodological choice; it reflects the perception of cholera by contemporaries. In their accounts of epidemics, they described the disease as an independent entity beyond human control, as Archdeacon Mountain did in his sermon. Even if doing so was no more

14

Introduction

than a rhetorical device to impress the readers of newspaper articles, medical treatises, or official reports, these expressions are nonetheless revealing. They demonstrate their authors’ perception of the limits of human agency when faced with an epidemic of a deadly disease. To take contemporaries’ perspective seriously also helps to avoid some of the dichotomic pitfalls of the nature-culture divide in urban environmental history.27 In cities, “nature” is by definition in short supply. Going beyond the nature-culture divide, actor-network theory offers a fresh perspective on these urban colonial spaces: they constitute an ever-changing agglomeration of human as well nonhuman actors, into which some humans, mainly medical experts and government officials, sought to bring order.28 They tried to identify those actors that would allow them to integrate cholera into a network of actors in such a way that made the disease controllable, and they found them in a variety of characteristics of the urban space. The urban space itself was one of the most important of those nonhuman actors. The term “environment” does, after all, describe a spatial relation.29 Being produced by society, and not simply being a given, urban space was continuously being formed and transformed by human and nonhuman actions. It was not, however, a passive object of human will but proved resistant to many of those plans. Thus, analyzing space is a means for studying not only human society but the complex interactions between humans and their environment, alive or not. The notion of space as a product of society was conceived by Henri Lefebvre; his spatial “triad” is a useful means of analysis.30 It proposes that space is multidimensional, encompassing aspects of everyday practices (spatial practices), conceptualizations of space (representations of space), and meanings, imaginations, and emotions connected to space (representational spaces).31 All three aspects are present in space at any time, though not in equal measure, as one aspect might dominate in certain situations. If the production of the spaces we encounter in our lives took place in the past, then obviously this is also true for the spaces of the past that historians deal with.32 These spaces were also specific products of social interactions with the environment, and Lefebvre’s spatial triad thus enables historians to analyze those aspects of historical spaces. For environmental historians this triad can be a useful tool. It can raise awareness of the different aspects of the spaces they deal with: the spatial practices shaping the sensorially perceived environment; the representations of space in the form of concepts of the environment, which might one day effect profound change; and the imagined layer of emotions and meanings, diffused over the environment, that inform representational spaces. It connects the environment to the social, the political,

Introduction

15

and the cultural. Urban environments are thus a particularly fruitful field of historical and spatial analysis. It is certainly no accident that Lefebvre himself mainly concentrated on cities. Yet, the prominence of nonhuman actors such as cholera or urban spaces cannot hide the fact that human actors, including government officials and medical practitioners, play a dominant role in this account. They were the primary figures who attempted to maintain or form these actor networks. They tried to stop, control, or manipulate cholera, and, therefore, they attempted to recruit and integrate numerous other actors—among them cholera itself—to do so. There is, however, another reason for this focus on human actors. We can discern all these participating actors only through the human observations relayed through written records. In these documents humans dominate. My main sources are records of the colonial authorities—correspondence, memoranda, reports, and minutes—complemented by newspaper articles and medical publications. Much of this source material is unpublished, although due to the process of colonial state formation in both Canada and India the number of published reports increased considerably over time while internal communications were quite often not preserved.33 This shift in administrative and archival practices has had a discernible impact on this book. However, as it reflects a shift in the workings of the colonial authorities, it should not be perceived as a shortcoming but as a consequence of historical change. On the basis of these source materials this book explores colonial authorities’ fight against cholera, their perception of the local environment, and their attempts to change it. Part I addresses in detail the first cholera epidemics in Madras (1818–20, 1832–33) and Quebec City (1832, 1834). During the outbreaks authorities in both cities undertook measures that reveal different perceptions and kinds of knowledge—or lack thereof— about the local urban environments. Part II focuses on changes in perceptions about cholera, the local environment, and the sanitary movement. After having a considerable impact in Great Britain, ideas about sanitation reached Madras and Quebec City in the late 1840s and early 1850s. Sanitarianism was received quite differently in the two countries, yet it soon became the dominant way to deal with disease in general—and cholera in particular—in both Madras and Quebec City. The movement triggered substantial changes in urban environments, with water works being built at great cost and sewers planned, although not always constructed. Despite these efforts to control the disease, however, cholera epidemics kept returning. Part III explores the impact of bacteriology on perceptions of and measures deployed to fight cholera. Despite the fact that Robert Koch’s

16

Introduction

identification of a microorganism—the comma bacillus—as the sole cause of the disease occurred in India, the authorities there as well as in London at first refused to accept his findings and launched their own research program. Once Koch’s theory had become scientific consensus, authorities in both India and Canada invested in the new infrastructure of bacteriological laboratories intended to help control disease—an expectation foiled by Spanish influenza, one of the deadliest pandemics in history.

Introduction

17

Part I First Encounters

Figure 1. Map of Madras, based on Thomas Hill, A New and Improved Plan of Madras and Its Suburbs Executed in the Year 1837, 38 and 39 for the Use of the Justices in Sessions, 1842.

Chapter 1 Strategies of Treatment Madras, 1818–1833

Among Europeans, India—and the tropics in general—had an unflattering reputation for being unhealthy. Medical experts deemed the subcontinent’s climate to be especially harmful for Europeans, and surgeons had been warily observing the environment there ever since the British had arrived. The emergence of cholera as a recurring threat to individuals and the public during the second decade of the nineteenth century sharpened this negative view in all parts of British India. The disease forced the colonial authorities and their medical experts to turn their attention to the local environment they inhabited, as was the case in the city of Madras. Although the colonial state was weak and unprepared for such a challenge, it invested not only in the medical treatment of patients but also in the observation and analysis of the urban space. By doing so, it tried to identify the environmental features causing the disease in order to better understand the workings of cholera and possibly be in a better position to control it in future epidemics. The City of Madras Madras was the capital of a vast province that had come into being only in the last years of the eighteenth century. In the early nineteenth century, Madras was a city of contradictions. Even to call Madras a city was at this time rather controversial, as its territory comprised densely settled towns,

21

agricultural villages, fields, gardens, and water tanks. Travelers from Europe in the eighteenth and early nineteenth centuries questioned whether “city” was an appropriate name for the odd and amorphous agglomeration of settlements that was Madras.1 It was a British creation, inhabited mainly by Indians but ruled by a man whom a London-based corporation had appointed. Recently introduced European institutions coexisted with traditional Indian ones. As a port city, it was a major entrepôt where goods from Europe and Asia were exchanged, but it lacked a harbor. Madras defied all definitions save one: it was a colonial city. Founded by the East India Company (EIC) in 1639 as a trading post on a flat, sandy beach on the Coromandel Coast just north of the mouth of the Cooum River, Madras was the earliest British territorial possession in India. The East India Company chose an auspicious location for its factory, protected as it was by Fort St. George. The company’s powerful rival, the Dutch Vereenigde Oostindische Compagnie, had no establishment in the vicinity, and the British had no trouble extracting territorial, judicial, military, and trade concessions from local Indian princes. The region produced profitable trading goods such as textiles, and an intensive coastal trade made available commodities from distant places. A regional surplus in agricultural production ensured supplies for the fort and provisions for the merchant ships’ long journey back to London around the Cape of Good Hope.2 The EIC established the city of Madras in a densely settled landscape of villages, towns, hamlets, fields, and water tanks that had been shaped over centuries. With the three square miles granted by the nayak of Poonamallee, the local prince, the company received three villages, along with the rights to settle and fortify the place and to trade in exchange for a yearly payment. Thus, from the very beginning, Madras consisted of several settlements.3 The commercial opportunities soon attracted Indians who would produce trade goods and supplies for the company. They were settled in the Black Town, so named in reference to its residents’ skin color. It was located to the north of the factory, while most of the British population preferred the protection of the fort, which was then also known as White Town.4 The Black Town was the center of Indian urban life in Madras. Home to more than one hundred thousand people circa 1800, it was as diverse a place as any. Portuguese, British, Armenian, and Jewish merchants had seized the opportunity to profit from intensifying trade. Seamen from China and Malaya arrived on the East India Company’s ships, and some of them stayed. Migrants from northern India, from the Deccan Plateau in

22

Strategies of Treatment

central and southern India, and from the surrounding region settled there and often prospered. To minimize conflict among the many communities, the company directed them to settle in different streets, but otherwise it left daily administration and jurisdiction to indigenous elites. Only at the southern fringe of the Black Town, where private trading houses clustered in proximity to the fort, was there a substantial European presence. From their offices there, European independent merchants, Indian suppliers, financiers, and shopkeepers worked to profit off the East India Company’s trade and thus formed the backbone of the Black Town’s economy.5 By 1750, Madras had developed from an outpost to a colonial city-state that depended on a considerable hinterland for its supplies of labor, food, and trading goods—a hinterland that lay beyond the company’s jurisdiction. For its existence, the city relied on the cooperation of the nawab of Arcot, who ruled the Carnatic region as the mughal’s subordinate. Periods of conflict and peace alternated, but the nawab’s superior position generally remained unquestioned. It was only after the French Compagnie des Indes threatened to dominate southern India, thereby endangering the stronghold of Madras, that power relations began to shift in the East India Company’s favor. Victories in the ensuing wars between the EIC and the French and later against the rulers of Mysore, Haidar Ali and his son, Tipu Sultan, ensured English rule over south India for almost 150 years. The EIC thus gained considerable territory and indirect control over formally independent Indian states, including Mysore and Hyderabad. In 1801, the nawab of Arcot, already a dependent of the British, officially ceded the Carnatic to the company. When he gave up the remainder of his power in exchange for a yearly appanage, the EIC had finally acquired the city’s hinterland. Madras had developed from a city-state to the capital of a colonial state, or at least of its southernmost part.6 The territory of the city grew along with its political importance. By 1798, when its limits were determined for the next century, it covered more than forty square miles. Madras then consisted of the fort and the Black Town, as well as fifteen villages and numerous hamlets inhabited almost exclusively by Indians. Like the Black Town, those rural parts of Madras reflected the segmented character of the indigenous society, since the traditional rural landholding elite, the mirasdars, were concentrated in some of these villages. They derived their income from the labor of lower-caste tenant-cultivators—the parayars—who inhabited separate hamlets, or paracheris. Other, higher castes also formed their own villages. This social hierarchy was reflected in the city’s urban space, as the villages inhabited by higher-caste Indians occupied the more elevated spots of the generally

Strategies of Treatment

23

flat territory of Madras, which protected homes from inundation during the rainy season. Although the paracheris were located on the best spots of the lower-lying spaces, the occupants suffered from the consequences of living in unhealthy, swampy, and poorly drained locations.7 The population of Madras grew, both by the acquisition of new territories during the seventeenth and eighteenth centuries and through the influx of parayar and lower-caste migrants who saw better chances of making a living in Madras. Thus, three of the villages in Madras quickly developed into towns with distinct characters: Chintadrepet, Triplicane, and Mylapore–San Thomé. The company founded Chintadrepet in the early eighteenth century as a weavers’ settlement to produce textiles for export to Europe. Located to the southwest of the fort across the Cooum River, Chintadrepet profited directly from the company’s commercial activities. Triplicane and Mylapore–San Thomé both predated the British presence on the Coromandel Coast. Mylapore had been a port since ancient times and, according to tradition, was associated with the martyrdom of the apostle Thomas in the first century. This legend attracted Portuguese merchants to the location. In the sixteenth century they founded a fortified town near the holy site, naming it after the saint, and erected the San Thomé Cathedral, where supposedly some of his relics were preserved. To the west of San Thomé the Kapaleeshwarar temple and its bazaar formed the center of Mylapore. The local mirasdars were traditionally responsible for the shrine and profited from trade with the pilgrims it attracted. Triplicane’s roots, too, could be traced back to a Hindu temple, the Vaishnava Parthasarathy, but the town’s growth gained momentum only when the nawab of Arcot chose the new Chepauk Palace as his permanent residence in 1768. His courtiers, soldiers, and officials settled in adjacent Triplicane, thus making for a significant Muslim population, the largest south of Hyderabad.8 Those towns, villages, and hamlets were interspersed with land used for agriculture, with extensive gardens and water tanks for irrigating the fields and supplying the livestock with water. Over the years of Madras’s growth, the villages lost some of their agricultural character. For the mirasdar elite, the profits to be made from agriculture paled in comparison with the money to be made from wealthy Europeans who purchased land for country houses outside the increasingly crowded fort. New high roads fanning out from the fort through Madras and into the colonial and commercial hinterland connected the villages with the urban, mercantile, military, and administrative centers, giving them an increasingly suburban character. Thus, the country houses were soon regarded as garden hous-

24

Strategies of Treatment

es and became the permanent residences of most of the European elite of Madras, who then commuted to their workplaces in the fort or the Black Town.9 Garden houses became so popular that in some parts of Madras they almost completely squeezed out the Indian population and became “colonial enclaves,” to some extent reproducing in the suburbs the spatial segmentation of urban Madras into the Black Town and the White Town.10 Most Europeans and Indians lived separate lives according to their own rules in distinct spaces. The colonial government approved of this arrangement, which promised political stability by allowing the traditional Indian elites to maintain their social status and privileges. The European elites created their own distinct sphere in the fort and in the suburbs, where social events like dinners or balls took place. Only the wealthiest Indians in the company’s service could afford to imitate a European lifestyle and would be invited to such events. Europeans’ social contact with Indians and Indian culture was limited and strictly regulated, even in an occupational environment. Generally, Indians belonged to the realm of the subordinate, and the difference in status was emphasized.11 The less wealthy Europeans had to find a niche between the majority of the Indian population and the colonial elite. For most civilians, the rent for accommodation in the fort was increasingly prohibitive. They moved to the commercial parts in the south of the Black Town and along its waterfront, illustrating their orientation toward the sea and the fort. This proximity to Indian neighborhoods did not create a contact zone, however, as each community went its own way. By 1800, Fort St. George, once the location of European life and commerce in Madras, was the seat of the colonial government, and it accommodated a garrison of European troops.12 Colonial Government in Madras The East India Company in Madras—as in the rest of India—was hierarchically structured and gave all of its employees a rank that also determined their social status. Even the social positions of Europeans who were not in the company’s service—such as wives or independent merchants— depended on their relationship to the company. The governor ranked first. Appointed by the Court of Directors of the East India Company in London with consent of the Crown’s government, he was their representative and the highest official in the Madras Presidency but subordinate to the governors-general of India in Calcutta in matters concerning all of India, diplomacy, war, and peace. The governor of Madras had to report all dealings of the government to the East India House in London and also to

Strategies of Treatment

25

Fort William. The distance from Madras to Calcutta and the even greater distance from Madras to London left the governor with considerable leeway and caused friction between both capitals throughout the nineteenth century.13 With the transformation of the East India Company from an armed maritime trading enterprise to a territorial state ruling millions of Indian subjects, the Madras Presidency required a more efficient and more professional government. The conduct of successful and profitable trading operations had lost its eminence. Military activity and the sound and efficient administration of the revenues collected from Indian taxpayers, which had become the company’s main source of income, were paramount, and the governor’s role and tasks changed accordingly. Most governors no longer rose through the ranks of traders but were recruited from the metropolitan elites even if they lacked personal experience with India. For governing the presidency, the governor could rely on the Executive Council. The presidency’s highest-ranking military officer, the commander-in-chief, was second in rank while the other councilors were promoted from the covenanted service. The councilors had considerable influence and power. In cases of emergency, the governor had the executive authority to override their opinions after consultation. When it came to daily business, legislative affairs, or revenue, however, he needed a majority of councilors on his side in order to govern.14 The governor-in-council ruled the whole presidency, including the city of Madras. No institutions represented the interests of the local population—Indian or European; local affairs were simply not a major concern for the colonial government. Before the late eighteenth century—when the East India Company’s dominance over India was secured—the government had left administrative and judicial matters to the various communities of the city’s population, including the Europeans. This policy of minimal political and judicial intervention was replaced by new institutions between 1792 and 1807, when Madras developed into the capital of an enormous colonial province, giving the government greater control over the population’s affairs. The Supreme Court was now the highest level of jurisdiction, ultimately deciding all civil suits regardless of whether Indian or European residents were involved. The justices in sessions, the assembly of the justices of the peace, assumed responsibility for the municipal affairs of the Black Town in 1793, forming the first civilian administrative body for any part of Madras. The rest of the city encountered the government mainly in the person of the collector of Madras, who was from 1802 onward responsible for revenue collections, overseeing the Hindu temples,

26

Strategies of Treatment

and arbitrating caste disputes, thus acting as liaison to the indigenous communities and preserving the peace in all parts of the city.15 Essential for the success of these new governmental and administrative institutions was a new police force, which replaced the traditional indigenous office of the pedda naick in 1807. Under a superintendent of police with a staff of interpreters and writers, constables and peons patrolled the streets, kept the public peace, controlled the markets, and investigated crime.16 Thus, in less than two decades the foundation was laid for governing the presidency’s capital along the lines established in Europe. Although the introduction of new administrative institutions strengthened the colonial authorities’ grip on Madras, their knowledge of the city in general was haphazard at best. Such a seemingly basic—and for administrative purposes, essential—fact as the size of the city’s population was uncertain and highly contentious. Despite some attempts to count the number of residents, there was no trustworthy census until 1871. Estimates ranged between 275,000 and more than 1 million. The Black Town alone was believed to have between 120,000 and 800,000 inhabitants. While one accounting by the police in 1822 came to a relatively low figure, many European residents and officials believed that their daily experience of a crowded “oriental” city contradicted these numbers. They estimated a minimum population of 600,000. Only the 1871 census eventually settled the matter by calculating the population to be under 400,000 and concluding that in the early nineteenth century it had been lower than 250,000 for all of Madras and approximately 100,000 for the Black Town. This wide range of estimates reflects the weakness of the young colonial state. Much of the information on which it operated was based more on anecdotes, guesswork, and impressions by the mainly European administration than on dependable data.17 The formation of administrative institutions was of course not limited to the capital. In fact, the governor-in-council headed a differentiated and complex apparatus consisting of several departments and boards that made it possible to govern the presidency. Since the East India Company had become the dominant power in India but lost its monopolies, matters of trade had lost their central status among its operations although the administration of supply, warehouses, shipping, and the like continued. From the mid-eighteenth century on, the company’s military and revenue administrations were crucial for the survival of the colony. They constituted the heart of a bureaucracy whose character was neither clearly civilian nor military, as the colonial state’s structure regularly encompassed both aspects of government simultaneously. Compared to the Military and

Strategies of Treatment

27

Revenue Departments, however, others, such as the Judiciary or Public Departments, were less important, though also indispensable due to the responsibilities of territorial rule.18 Colonial Medicine in Madras The Madras Medical Service, the provincial unit of the Indian Medical Service (IMS), was certainly of great importance for the life of the colony. Though it could trace its roots back to ship surgeons on the first East India Company vessels that traveled to India, the Indian Medical Service was another component of the military operations that ensured the company’s dominance over India. From the 1740s on, military surgeons were hired from Europe in increasing numbers to care for the ever-growing armies employed by the company. After the conquest of Bengal, the prospect of continuing rule over a large territory required the maintenance of sizable armies, which meant that a continuous infusion of medical talent from Europe was needed to protect the troops from disease. This expansion of the need for medical care necessitated a more structured approach, and in 1763 Fort William established a medical service for Bengal. The other two presidencies soon followed suit. In the new Indian Medical Service a freshly recruited practitioner would start as an assistant surgeon and could later be promoted to surgeon and possibly end up as head surgeon. The surgeons’ main task was the medical care of both the European and the so-called Native troops. Most surgeons were assigned to garrisons and cantonments and went to other posts at regular intervals due to either a relocation of their regiment or a transfer, interrupted only by furloughs spent in Europe. The four head surgeons, however, resided in the respective capitals and took care of the local hospitals and administrative duties.19 This administrative arrangement was formalized in Madras with the establishment in 1786 of the Medical Board as the central medical bureau. Consisting of the two or three most senior surgeons, it maintained discipline and decided issues such as deployment, promotions, furloughs, or general medical policy. Military aspects had to be coordinated with the Military Department under the commander-in-chief, while the civil aspects of the medical service both in Madras city and in the hinterland lay within the responsibility of the Public Department under the governor-in-council.20 Among those civil responsibilities were the city’s medical institutions, of which the hospital was certainly the most important. Since the seventeenth century, its several incarnations had served as the primary site of medical care for the troops and the European population of Madras. Located outside the Black Town, it provided care to both soldiers and civilians

28

Strategies of Treatment

suffering from the many afflictions common in India. Its management was entrusted to one of the head surgeons who also sat on the Medical Board. He was aided by three assistant surgeons who, additionally, took care of one or several of the city’s medical, charitable, and penal institutions: the Native Infirmary (also known as Monegar Choultry), the vaccination pandal (shelter), and the jails and asylums.21 Those institutions were the result of reforms intended to expand the scope of colonial medicine to the Indian population and demonstrate the superiority of European medicine over its Indian counterpart, thus mirroring the formation of the colonial state and the increase of governmental control. The new, subordinate role of Indian medical practitioners, surgical dressers, and coolies illustrated this hierarchy. Yet, the assumed superiority of European medical knowledge within the IMS did not imply a complete disregard for Indian medicine. Many surgeons studied aspects of Islamic, Hindu, and siddha medical traditions carefully enough to gain specific knowledge of Indian diseases and materia medica. European medical materials had to be shipped from Britain and were therefore expensive. They regularly suffered damage during the voyages or were even lost. Indian medicine offered a broad variety of leaves, roots, and fruits or their extracts that could be used as alternatives. Confronted with a broad spectrum of unfamiliar diseases, European surgeons tried to identify established practices in Indian medicine and add them to their own repertoire. That all traditions—Indian, Arabic, and European—were based on a humoral theory of medicine facilitated the adaptation process.22 Openness to Indian medicine was neither unlimited nor evidence of a general acceptance, however. European surgeons saw definite reasons to claim superiority. They could rely on recently developed effective practices, like vaccination; they considered the religious connotations of ayurvedic medicine to be unscientific; and they assessed the absence of postmortem examinations as serious negligence that prevented Indian practitioners from acquiring valuable additional information on the body and its diseases. Indian medicine seemed to be static in its reliance on ancient texts and therefore lacking the ambition to improve its knowledge of anatomy.23 Yet, despite all the claims of superiority, European medicine in the early nineteenth century was itself in a state of crisis. It could neither explain most diseases uniformly and convincingly to its own adherents nor provide a cure. Medical terminology was diverse and often contradictory, medical theories were wildly disputed, and the value of medical treatments was questioned by both rival physicians and critical observers from beyond the medical profession.24

Strategies of Treatment

29

Hippocratic and Galenic medical theories, with their focus on humoral balance and environmental influences, remained the foundation of European medicine in the early nineteenth century. Early modern medicine had elaborated on and added to this relation by trying to systematize the physiological manifestations of disease and its etiology. Physicians would diagnose the disease by observing and identifying a set of symptoms, such as fever, flux, or inflammation, that then enabled them to assign the illness a place in a classification system of diseases. The diseases of a certain class distinguished themselves from others by the similarities of their manifestation, but they were only hints of the underlying environmental or individual factors that, in combination, determined both the appearance and course of the patient’s illness.25 According to the medical theories of the time, there was not a single cause for any given disease. The cause was always a sufficient combination of necessary factors. In this view, a disease originated from a volatile and variable mix of causes and sub-causes, which worked on different physiological and environmental levels. Physicians tried to clear this thicket and systematize the different causes they were able to identify. They divided them into two main categories: “proximate” and “remote” causes. The former described the characteristic physiological phenomena of the disease, such as inflammation or flux; the latter could be differentiated between “predisposing” and “exciting” causes. Of those two, the predisposing causes were generally regarded as the more important ones, as they were thought to be necessary for the emergence of disease. They consisted of external factors that affected the patient’s constitution. Some, like temperature, humidity, or light, were environmental; others involved behavior, such as food, drink, exercise, and sleep, or passions of the mind. As all of these external influences were constants of human life, it was their deficiency or excess that disturbed the balance of the body and consequently drained it of its vital energies, thereby weakening the patient’s constitution. All of these influences, however, could also be exciting causes. The difference lay mainly in the way these factors affected the body. While the predisposing causes were constantly present or represented a patient’s individual sensitivity to a certain influence, the exciting causes constituted an additional yet occasional factor that pushed the patient’s body sufficiently toward a state of disease that prompted the characteristic symptoms. Without the presence of predisposing causes, an exciting cause was not sufficient to induce disease. As some if not all of those predisposing causes were controllable or could be manipulated, they provided physicians with a starting point for

30

Strategies of Treatment

treatment and prevention. Given the number of potentially morbific factors, both prevention and therapy focused on the patient and his or her individual constitution and habits. Physicians thus had to manage both disease and patients’ dangerous—or at least potentially dangerous—behavior in a way that would ensure their survival and possibly complete recovery. This approach of constant attention accommodated wealthy patients who could afford a physician’s continuous care.26 But predisposing behavior could not explain epidemics, when many persons fell sick at one place at the same time, or how a disease became endemic to a location. The reason for those phenomena had to be external and could be both predisposing and exciting. Many physicians assumed that an invisible and odorless “poison” was responsible.27 Smallpox, measles, and venereal diseases appeared to be contagious, since their poisons could be transmitted directly from person to person. Malaria, on the other hand, did not appear to be contagious at all but propagated through the air, a mode of diffusion often called “infection.” Most diseases, however, did not clearly adhere to these extreme patterns of propagation. They seemed to be contingently contagious. Some kind of contagion seemed to take place, but they did not spread directly from person to person and they spread only when certain environmental factors were present.28 Medical practitioners considered air to be the most important environmental factor causing endemic and epidemic disease. They based their view on scientific investigations of the atmosphere, air pressure and meteorology, atmospheric electricity, and the chemical composition of air that had been in fashion for most of the seventeenth and eighteenth centuries. Analytical chemists had identified several gases that had proven to be poisonous, while others, such as oxygen, were essential to life. The indication seemed clear: the atmosphere had a decisive influence on the human constitution and had to be considered whenever epidemic or endemic disease was present.29 Studying the local climate was the easiest way of finding correlations between atmospheric conditions and the occurrence of disease. Medical practitioners could measure general physical characteristics such as temperature, humidity, air pressure, and electricity with widely available instruments, record data serially, and align their data with medical statistics. Some diseases, including malaria, appeared to share a certain annual cycle of increase and decline with the seasons, connecting atmospheric conditions and the prevalence of at least certain diseases at a locality.30 But this observation was far from being a monocausal principle. Other factors also had to be considered to explain the occurrence of most diseases. Some were

Strategies of Treatment

31

far removed from human agency, like the annual and monthly cycles of the sun and moon. Several others could be considered, avoided, or altered, such as the nature of the soil, the humidity of a location, altitude, or proximity to the sea. The specific combination of those factors determined susceptibility to certain diseases in specific locations and thus posed a complex puzzle requiring scientific inquiry. By compiling and analyzing the medical topography of a place, scientific investigators could determine the likelihood of certain diseases there. In a second step, adopting such measures as drainage or ventilation sometimes appeared to improve local conditions and make them healthier for Europeans.31 The climate of India, and of the tropics in general, was considered particularly harmful to the constitution of Europeans. As military records showed, the transportation of troops from Britain to regions closer to the equator led to massive morbidity and mortality. Three groups of diseases caused particular damage and concern: fevers, liver disease, and diarrhea. Some illnesses, including malaria, hepatitis, and dysentery, were in principle well known in Europe but occurred in particularly dangerous and grave forms in India, although not everywhere to the same degree. Bengal, for example, was dreaded for its malarial fevers, while Madras was infamous for hepatitis. To the surgeons, such variations and similarities provided an opportunity to test and advance their medical knowledge and theories. In particular, the troops provided them with sufficient cases to explore the environmental causes of disease, to try new or to refine established treatments, and to propose original explanations. The individual constitution under tropical conditions remained very much at the center of their focus. The unfamiliar climate apparently put the body under pressure, but medical advice was clearly capable of mitigating its most damaging effects. Some remedies worked mechanically, such as appropriate clothing to shield the body from unwanted atmospheric influences. Others involved changes of daily routines and behavior, such as avoiding unsuitable food and drink. The abundance of meat and alcohol that the European troops of the EIC consumed was considered detrimental to their health and one reason for the high rates of morbidity among them. Other remedies were pharmaceutical, and where European knowledge reached its limits there was a good chance that India provided its own medical knowledge and remedies. Consequently, Europeans developed a hybrid form of medicine in colonial India.32 Fighting Cholera with Limited Resources At the turn of the nineteenth century the medical infrastructure of the still young colonial state in southern India was geared toward the military. In

32

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war and peace, its prime objective was the health of the troops and, to a lesser extent, of the East India Company’s civilian officials. Although the colony did have some hospitals and infirmaries, they were not numerous enough to treat the vast majority of either the Indian or the European population. The city of Madras was comparatively privileged, however. As the capital, a garrison town, and an administrative center, the city had more European medical practitioners than were present in provincial towns. Nevertheless, the city officials and the colonial government residing there were ill prepared to prevent or mitigate a major epidemic. The authorities could, however, refer to past experiences and institutional precedents in England. There, the plague epidemics of the early modern period had served as a catalyst for the development of administrative strategies to deal with such crises. The Privy Council took a central role in adapting antiplague practices from the European continent. It issued orders for quarantine, the registration and isolation of the sick, the cleansing of streets and other public spaces, or the erection of pesthouses that local officials then had to put into place. By these means, officials tried to create or activate actors that would allow them to integrate plague into a network of control over the disease. In early modern England, those instructions were not always followed and conflicts of authority ensued. Nonetheless, the threat of plague had given the English government an opportunity to establish new powers and new institutions of public health in times of medical emergency.33 Based on familiar English precedent, the colonial government of Madras was able to improvise when under threat of an epidemic. When there were fears in 1802 that plague would come to India aboard the ships that brought back troops from the fight against Napoleon Bonaparte in Egypt, the authorities in Bombay and Madras took action and imposed a quarantine. The Madras Medical Board ordered the suspect ships to the port of Ennore, where the board had hastily set up a lazaretto. In the end, it turned out to be a false alarm and the quarantine was quickly lifted, but the brief threat demonstrated that the government was able to react when necessary. With the resources of the army at its disposal, the Medical Board could establish temporary care institutions and extend its usually limited reach.34 Plague, however, was not endemic in India. Introduced from abroad, it threatened the ports, which meant there were a limited number of entry points and thus they were relatively easy to control. An epidemic spreading across the subcontinent was a different kettle of fish, however, and would quickly overpower the institutional responses based on English experience and the capacities of the young colonial state, as a fever

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33

epidemic in four districts south of Madras showed. There, the surgeons could do little more than treat the patients who came to their stations. The government rejected a suggestion by an investigative medical committee to employ Indian practitioners in every village. Once the epidemic had subsided, the committee computed mortality figures, analyzed the extent of the disease, and compared it to the environmental features of the region. The committee recommended distributing a translation of descriptions of European treatments to Indian practitioners in case of a future epidemic.35 Epidemic disease was a frequent fact of life, and neither the medical practitioners nor the government of Madras had the knowledge or resources to change this. Defining and Preparing for Cholera When a diarrheic disease appeared at a religious festival at Jessore in Bengal in August 1817, the surgeons present at first felt little alarm. Cholera morbus was a common disease, known in Europe as well as in Asia, and to be expected at such occasions. It was rarely lethal, being in most cases a temporary inconvenience. Only after several days, when the disease had spread rapidly throughout Bengal and caused an unprecedented number of deaths, did the surgeons realize that they were dealing with a new disease that merely shared similar symptoms during its early stages. The cholera label stuck nonetheless, but was supplemented with a new sobriquet. Named after its most characteristic symptom—the severe convulsions that shook the patient’s body in its later stages—the disease became known as cholera spasmodica.36 News of this crisis quickly made its way to the colonial government at Madras and increasingly raised concerns when it became clear that the disease would not be confined to Bengal. After an initial explosive outbreak, cholera spasmodica slowly followed the common routes of communication—rivers and roads—spreading southward. It seemed almost certain that the epidemic would reach the borders of the presidency and ultimately the city of Madras itself, but there was also more than enough time to prepare for the worst. However, before the government could initiate any preparations to counter the looming threat, it needed to know what it was dealing with. It had to define cholera spasmodica, ascertain its features, and find its weaknesses in order to identify possible countermeasures. Was the precedent of plague relevant or were new actors required to halt spasmodic cholera’s progress or at least mitigate its severity? For this task colonial authorities turned to their experts on the Medical Board.

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The board regularly received reports from northern India and, once the epidemic had reached the northern districts of the Madras Presidency, from surgeons stationed with regiments there. On the basis of this information they had to assess the situation and develop a strategy that would enable them to cope with an outbreak in Madras or military cantonments elsewhere. Some information, such as descriptions of the symptoms of cholera spasmodica, was based on personal observation and largely coherent: a sudden onset of purging and vomiting; painful spasms; rapid changes in body temperature; a weak pulse; a decline of vital energies leading to the loss of consciousness; and often, after as little as ten to twenty-four hours, death. Already weakened Indian patients had shown slightly different symptoms—their cramps were less severe because their muscles lost strength so quickly—but in general this description enabled medical practitioners to diagnose the new disease and distinguish it from the common cholera morbus. After closer study, the apparently uniform spread along roads and rivers showed irregularities. Some locations were spared although they were in the epidemic’s path. At the same time, isolated outbreaks without any obvious connection to previous cases occurred. This random pattern of attack demonstrated that factors besides the atmosphere had to be involved in local outbreaks. Attention thus shifted to the disease’s causes in the local environment, its mode of propagation, and its “nature” and “character.” Here the reports remained sketchy and often contradictory. Postmortems provided no clear evidence as to exciting causes. A “morbific state of the atmosphere” depressing the individual’s “vital powers” seemed to explain the disease’s widespread appearance, while a “spasmodic effect on the nervous system” appeared to be the proximate cause of illness. With such patchy information, the Medical Board could only speculate as to the epidemic’s future course in Madras or elsewhere. The reports suggested that the country’s interior had suffered the most violent outbreaks. Coastal areas were less severely affected, since—it was thought—the sea breeze modified the atmosphere. This observation boded well, at least for Madras.37 This glimmer of hope was significant as long as spasmodic cholera’s causes remained unclear. Without better etiological knowledge, officials were left with little they could do to prevent the advance of the epidemic. Measures to stop plague epidemics that were common in Europe, such as cordons sanitaires or quarantine, were not even considered. Yet, doing nothing was not an option either. The government was eager to demonstrate to the Indian population that it was benevolent, while the Medical Board perceived an opportunity to showcase the superiority of European

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35

medicine. Under the circumstances, medical treatment after an outbreak seemed to be the only viable way of fighting the epidemic. Surgeons stationed in the north had tried numerous treatments with good success, thus establishing a protocol, and a Dr. Davis, who had already experienced a similar disease in Arcot in 1787, had then employed a useful treatment designed to “excite the languid vital energy, to correct the violent spasmodic state of the system, and to restore the natural action of the stomach and the bowels.” Quick action was apparently of utmost importance. The chances of a patient’s survival increased the sooner the first remedies were administered. With some measures—the application of calomel, laudanum, or brandy, for example—the surgeons aimed to revive the body and restore the normal function of the stomach and muscles. Others, such as bleeding and senna leaves, were intended to relieve pressure in the body and bring the humors back into balance. Hot medicated baths cleaned the soiled body while also alleviating painful cramps. All of these treatments had been used previously for diseases with similar symptoms. The surgeons regarded them as tested practices that mitigated pain, eased the severity of the symptoms, or contributed to eventual recovery. Experience showed that Indian patients responded to this treatment much better than Europeans did. However, no remedy guaranteed a positive reaction and some were regarded with ambivalence.38 The perceived effectiveness of these remedies demonstrated that surgeons and the government would not be entirely helpless in case of an outbreak. There were ways to manipulate cholera spasmodica, in the human body at least. Whether it was feasible to do the same on a larger scale and alter the environment in a way that would protect Madras or any of the larger towns of the presidency from a cholera outbreak was unclear as long the epidemic’s causes remained unknown. Therefore, in the summer of 1818, about one year after the initial appearance of spasmodic cholera in Bengal, the Medical Board advised the government to focus its efforts on providing medical treatment for the whole population of an affected location. Since the government and its officials could either fall back on military stocks for the necessary resources or acquire them in local markets, it could build a temporary medical infrastructure quite rapidly without overbearing bureaucratic involvement. Once enough cases of cholera spasmodica had occurred in a town or cantonment to indicate an outbreak, the local authorities would immediately establish an appropriate number of temporary dispensaries for up to twenty patients, and each facility would be located at a healthy distance away from any swamp. Equipped with sufficient stocks of remedies such as arrack, opium, and camphor and with

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cots, bathtubs, and four subordinate Indian practitioners and eight coolies each, the dispensaries would enable the medical officers to treat every Indian or European patient and demonstrate the beneficence of both European medicine and the colonial government. In order to make the dispensaries a success, informing the public about the disease and the available medical assistance was of utmost importance. Since treatment was most promising in the earliest stages, the sick or their families had to be able to identify the symptoms as quickly as possible and then bring the patient to the nearest dispensary. The Medical Board proposed to circulate a detailed description of the disease among European officials, Indian officers of the Native Army, and “the most respectable classes of the Civil community.” They, the board hoped, would pass on the information about spasmodic cholera to others, persuade the Indian population of the effectiveness of European treatment, and attract them to the dispensaries.39 The government welcomed these recommendations and turned them into a code of practice for all towns and stations in the presidency. On 19 August 1818 this code was sent to all superintending surgeons of the Madras Medical Service, and on 21 September the Military Board distributed fifty copies throughout the presidency. For Madras, the instruction came just in time. Reports of the first cases of the long-awaited and dreaded epidemic of cholera spasmodica reached the government of Madras on 10 October.40 Managing the Epidemic The authorities at the presidency’s capital followed their own plans swiftly, but with minor alterations. The governor-in-council delegated the measures against spasmodic cholera to the Medical Board and gave it both extensive authority over the city’s administrative resources as well as the duty to report regularly on the latest developments. The superintendent of police and the superintending engineer of Madras were directed to support the superintending surgeon and his superiors on the Medical Board. The police would lay the foundations for the success of the authorities’ measures. Since the surgeons would be restricted mainly to the dispensaries, the police would look out for cholera cases in the city and register deaths from the disease. This routine would thus establish an information system that would allow the Medical Board to monitor the course of the epidemic in all of Madras. Thus, the surgeons would have a comprehensive picture of the current situation, could deploy their resources at the right time and place, and could fulfill the role they had been assigned by

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the government. For the Medical Board, such a central position within the colonial administration at a time of crisis was unprecedented. Their knowledge, experience, and perception of the disease were now essential if the government was to turn the investment in an information system and a temporary medical infrastructure into a success. They had the resources at hand to provide medical treatment to any citizen, could rely on army stocks for equipment, and had considerable financial latitude to acquire remedies and hire Indian practitioners. Other government departments, such as the police, were under order to support their effort. The government had equipped the Medical Board with emergency authority, and given the scale of the epidemic, they needed it.41 In order to provide medical care for the whole population, the Medical Board rented houses at favorable locations in the most populous parts of Madras to serve as temporary dispensaries: one in San Thomé, two in Triplicane, one in Chintadrepet, two in Vepery, and three in the Black Town. This even distribution made the dispensaries accessible for most patients, and carts provided transportation for those too feeble to make it to a dispensary on their own. Additionally, existing medical establishments like the vaccination pandal were modified to accommodate cholera patients. The government provided tents, blankets, drugs, and further necessities from military stocks, which were the most convenient source. All surgeons at Madras—the members of the Medical Board included—without urgent commitments elsewhere were assigned to the cholera dispensaries. There they could count on the support of Indian practitioners, who performed lesser medical tasks as attendants and dressers.42 As outlined in the instructions, informing the public was a necessary precondition for the success of this temporary infrastructure. The government translated the Government Gazette Extraordinary into Tamil, Telugu, and Hindustani for general distribution, describing their measures, explaining to the sick where they could find help, and emphasizing the humanitarian character of the government’s efforts.43 The devastation caused by the epidemic was distressing for the Medical Board, and it must have been even more so for the affected population. Once reliable information reached the Medical Board, the daily statements of mortality collected by police and medical practitioners revealed that the city was firmly in the epidemic’s grip. Between 16 and 22 October, 405 fatal cases were reported, and there was no relief the following week, as 411 additional deaths were registered. Those numbers were incomplete. The government and the Medical Board were aware that diagnosing cholera could be difficult and that the police lacked the resources and exper-

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tise to identify every person who had died from spasmodic cholera, but even incomplete data were definitely more helpful than no information at all.44 Of the cases treated by Europeans in the hospitals and dispensaries the mortality rate was calculated as one in seven, while the rate reported by those Indian practitioners operating independently in the city was one in thirteen. That meant that thousands were suffering and no end was in sight. At this moment of crisis, the Medical Board was ready to take any measure that promised an improvement. In late October, a severe storm that hit Madras coincided with a further increase of the number of cholera cases. The surgeons associated this surge of deaths with dangerous gases emitted by the decaying leaves, branches, and trees that the storm had left behind, changing the state of the atmosphere in a way that threatened to worsen the epidemic. Only by removing the decomposing matter could they relieve this perilous state of the city’s environment. Therefore, the Medical Board asked the government to order the Road Committee to clean up the city. The government complied immediately.45 Despite the widespread suffering and death, most Indians rejected treatment in the government dispensaries, preferring to consult the familiar Indian practitioners of unani, ayurveda, and siddha—the Muslim, Hindu, and Tamil systems of medicine—even if they had to pay for those services (the dispensaries did not charge for treatment).46 Most of the patients who came to the dispensaries were Europeans or Indians who were either too poor to afford the services of an Indian practitioner or in a hopeless condition, thus contributing to the higher mortality among patients there. The Medical Board soon realized that the presence of dressers at the dispensaries was not enough to assure most patients that their traditions and customs would be respected. An opportunity to raise the profile of the dispensaries arose when two Indian medical practitioners, the brothers Maha Ganapady Shastry and Ramachrishna Shastry, from Kanchipuram, offered the government their advice. They claimed to know a treatment for cholera that would cure the sick and was also suitable for Brahmin patients who rejected remedies prepared with alcohol or opium for religious reasons, and they volunteered to come to Madras to discuss the subject. The government and the Medical Board saw this offer as a chance worth taking: if the proposed treatment worked, the surgeons could aid hundreds or thousands and take credit for the success; if not, they had shown their benevolence toward the indigenous population of the city and their respect for local beliefs and traditions. They also considered that a demonstration of inclusiveness would create a chance to persuade the population of the merits of European medicine.

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The board invited the Shastry brothers to its Madras office, although nothing came of the conversation.47 By the middle of November 1818, the epidemic had begun to abate, without discernible impact from the Medical Board’s actions. Toward the end of the month the number of deaths reported by the police had decreased to between zero and ten a day. The dispensaries became superfluous, as the permanent medical establishments like the Native Infirmary and the hospital were more than sufficient to handle the remaining cases. As the majority of patients continued to avoid the European medical institutions yet still required medical care, the government decided to employ the most skillful Indian practitioners to treat patients outside the dispensaries, finally doing what the medical committee had suggested during the fever epidemic of a few years earlier. Thus, the government continued to benevolently provide medical aid, if not in a way that showcased the superiority of European medicine. This reaction to the population’s rejection of the initial plan also had distinct advantages. The Indian practitioners now reported on the disease’s progress and behavior in parts of the city rarely visited by surgeons, and they distributed remedies free of charge to patients for home medication. However, the fact that the Medical Board had to adopt the indigenous medical infrastructure for its own purposes demonstrated the limited reach of its power.48 The epidemic dragged on for several weeks, with the superintendent of police reporting a few deaths each day until he successfully requested that the government stop this obligation due to a lack of cases. Nevertheless, the superintendent assured his superiors that his men would continue to look out for any resurgence.49 In mid-March 1819, approximately five months after the epidemic of spasmodic cholera began in Madras, the Medical Board officially reported that it had ended. Although there were still sporadic cases, their number did not justify maintaining emergency measures. The “epidemic influence”—the assumed underlying cause of the outbreak—had obviously ceased. The medical experts were not sure whether the sporadic, or less frequently occurring, form of cholera was the same disease as the spasmodic one. The symptoms were largely identical, but the former lacked the latter’s prominent characteristic of being epidemic. Moreover, they suspected the Indian physicians of reporting dubious cases as cholera spasmodica to prolong their employment by the government. As the epidemic had now officially ended, the services of the Indian practitioners were no longer required.50 All of these concluding measures proved to be premature. In late May 1819, both the Medical Board and the superintendent of police realized

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that cholera spasmodica had reappeared, and they informed the government of their discovery. While the police had immediately resumed their surveillance of the city and started to issue daily reports on deaths, the board had the more difficult task of recommending a course of action to the government. The soldiers of the Eighth Regiment, who were waiting in Madras for their embarkment, were particularly hard hit. The board blamed the epidemic’s resurgence on the undisciplined behavior of the troops and their accommodation in tents at an insalubrious location. For the care of the indigenous population, the board proposed the reemployment of Indian practitioners, who would be assigned to those parts of the city that were most likely to be affected. After the earlier failure to persuade Indians to come to the dispensaries, the board members suggested renting only a few small houses and equipping them with cots, cumblies (blankets), bottles of arrack, and other necessities. All patients seeking aid could be treated there until cholera, in both the spasmodic and sporadic forms, had entirely disappeared from Madras. The government accepted the proposals and ordered their implementation.51 Cholera continued to be present in Madras for more than a year. Periods of calm with only a few sporadic cases were interrupted by outbreaks that could claim many deaths in just a few days. The Medical Board continued to employ Indian practitioners in the government’s service wherever the disease appeared. The approach it had adopted in an emergency situation after the Indian population had rejected the dispensaries proved to be the longest lasting measure of the fight against the cholera epidemic, although the government became increasingly skeptical as to its necessity. Late in 1820, when another outbreak yielded a report of sixty-eight deaths in one week, it suspected overstatement or even outright fraud. The board members attributed the high number to the Indian practitioners’ “natural tendency to exaggerate . . . in Order that their Service may be called into employment as heretofore on the pay of Government.” The board conceded that cholera was still present in Madras but not to an extent that would justify the reintroduction of emergency measures.52 Observing and Interpreting Cholera’s Behavior Despite Indians’ reluctance to come to the dispensaries, the surgeons had had extensive opportunity to observe cholera spasmodica during the epidemic. Apart from the first days, before the dispensaries were established, they were for the most part confined to their assigned stations. The Medical Board’s records show that 1,401 patients were treated in the hospitals and dispensaries between 16 October and 10 December 1818. Of those, 1,267

Strategies of Treatment

41

were classified as “relieved” while 127 died there.53 The surgeons had an excellent opportunity to study the symptoms and course of the disease in individual patients, and once the epidemic started to subside they had sufficient time to analyze their experiences. Their observations confirmed the vivid descriptions, sent from the north, of cholera’s power to transform the human body. Cholera spasmodica changed the body’s temperature; purged it of liquids through relentless sweating, urinating, defecating, and vomiting; made it stink and deteriorate; drained its energies; paralyzed it; and rendered its pulse indiscernible. Within hours, cholera left behind nothing but a motionless shell drained of life. When surgeons looked beyond the limits of their dispensaries they could also observe cholera in a broader context. For their reports to the government they investigated the course of the disease in the individual before them, the living conditions of the patients, and the further development of the disease. They saw the disease affecting one person in a house or hut and spreading subsequently to the other members of the family, to the whole street, or even throughout the village. They tried to map cholera’s behavior in the urban space, as they mapped its behavior in the body. Confronted with such a powerful and enigmatic enemy, the surgeons turned to the environment—the probable cause of all the mayhem—to find explanations. Cholera seemed especially prevalent among the poor. Indians were apparently more affected than Europeans, and among them, Muslims were more affected than Hindus. Among Hindus, the low-caste parayars suffered more frequently. Living in miserable conditions, the poor were exposed to numerous predisposing causes of potentially lethal disease. Their hamlets were often located on damp ground near fetid rivers, water tanks, and swamps. Prior to the outbreak of cholera spasmodica, there had been heavy rains, and water had accumulated in the low-lying and swampy areas where the highest rates of infection occurred. These areas were occupied by the poor, and many of them also regularly came into close contact with filth due to their occupations, such as washing clothes or taking care of cows. They also could not afford sufficient food or clothing to protect themselves from the daily temperature changes and the night air, both of which were believed to be harmful. The superintending surgeon attributed—without failing to indicate that his remarks were highly speculative—the distribution of cholera spasmodica to such local predisposing causes rather than to the “morbific state of the atmosphere” affecting large parts of India. In the case of Madras, the significance of these localized predisposing causes was highlighted by the generally mitigating effect of the sea, which seemed to “modify” the “morbific” atmospheric state.54

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When the surgeons conceptualized the spatial distribution of cholera, the resulting mental maps of cholera incidence and poverty were largely congruous. Apparently, poverty and an unfavorable local environment went hand in hand in propagating the disease. Furthermore, these findings suggested a correlation between the symptoms of cholera spasmodica in the individual and conditions in the urban space. Cholera spasmodica made those people who lived in filthy conditions become sick and produce filth. Cholera caused intense changes in the temperature of those bodies that were subjected to the severe effects of the atmosphere. Persons living in humid conditions perspired clammy sweat. Incrementally, the medical practitioners established a relationship between cholera and the environment through a series of these analogies. Thus, cholera’s appearance in a particular location in Madras indicated that it was a dangerous place. The arrival of a new, if yet unknown, actor had rendered the most inconvenient and unpleasant places—those inhabited by the poor—into lethal ones. The epidemic that had killed hundreds and affected thousands was merely a symptom of this change. Its origin was not easily discernible. Therefore, surgeons had to scrutinize the predisposing causes in the urban environment and reevaluate the well-known and usually harmless features of everyday life. They believed that the local population and these normally benign features of the local environment somehow interacted, thus contributing to the disease’s disastrous spread and preference for some instead of others. The rapid change in temperature from day to night seemed to play a role; cholera appeared to favor the rainy season all over India, not just in the Madras Presidency; and, once the rains had stopped, the lingering humidity also seemed to be a contributing factor.55 Thus, regular features of the urban space gained unprecedented significance, but their familiarity and ubiquity made them at the same time impossible to comprehensively change or even control. Faced with the deadly epidemic and the enormous dimensions of the environmental conditions that caused it, the surgeons must have been acutely aware of the limited capabilities of colonial medicine and even the colonial state in Madras. This is not to say that the Medical Board and the colonial authorities did not attempt to extend medical care beyond the colonial ruling class of administration, merchants, and troops. The plan to counter the cholera epidemic with the establishment of dispensaries across the territory of Madras in order to allow medical treatment for anyone was clearly intended to expand the reach of colonial medicine beyond the European community. Even so, it spatially confined the practice of European medicine by leaving most of Madras to the Indian practitioners.

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In doing so, the colonial government acknowledged the limits of its control over the territory of its capital. The dispensaries were enclaves in the sense that they embodied the restricted reach of European medicine and because they were the expression of a certain perspective that saw much of Madras—its population and its territory—as beyond the grasp of the colonial state. Even after the expansion of the colonial state during the previous decades, the government at Fort St. George had left the handling of daily administration to traditional Indian elites and was quite content to be only minimally involved in “native” matters. Consequently, certain measures against cholera spasmodica would have been deemed extremely intrusive. Even if the government had been willing to accept such actions, it could not even consider extensive changes to the urban environment to minimize the effects of cholera spasmodica, as it lacked the knowledge as well as the personnel for such a task. The only attempt to alter the landscape of Madras was to clean up leaves, fallen trees, branches, and damaged hedges after severe weather. This was facilitated by the Road Department, whose existence was based on the military and commercial necessity of a functioning road network.56 That the clearing of all the storm damage from Madras took several months to complete demonstrates both the limited resources at hand and the enormity of the task. The limited control of the urban space was not exclusively a function of the colonial state’s weakness. It was also the result of the indigenous society’s refusal to be integrated into the colonial society and, thus, into the effort to fight the epidemic on the government’s terms. For little-known reasons, Indians consciously avoided European medicine. Thus, the dispensary system was not just a testament to a certain European perspective on the urban space of Madras. Its failure to attract Indian patients also marked a border between communities that was reinforced by the Indian population of the city. Conceptualizing Epidemic Cholera Across the Madras Presidency surgeons had experienced and observed cholera spasmodica during the epidemic, and with the disease in retreat the government, and specifically the Medical Board, did not want to let this trove of precious knowledge go to waste. The governments of Bengal and Bombay were preparing or had already published official reports on the epidemic in their respective presidencies. In July 1820, the Madras Medical Board followed suit and charged William Scot, a surgeon who served as secretary of the Medical Board, with the task of collecting and documenting the various observations, examining them scientifically, and is-

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suing a report that would redefine the disease accordingly. Scot quickly sent requests for information to all surgeons of the presidency.57 As cholera spasmodica was still present in many parts of the presidency and the final reports were not expected for a few months, Scot asked the government to provide him in the meantime with the available statistical data on the health of the troops and the weather conditions for the past five years.58 It took Scot several years to complete his report, which was published by the government of Madras in 1824. In the meantime, another surgeon of the Madras Medical Service had completed and published the first volume of his own treatise on epidemic cholera. Reginald Orton, the surgeon of the Thirty-Fourth Regiment of Foot, stationed at Bellary during the epidemic, had independently committed himself to explaining the phenomenon. For his account, he relied on his own observations, the information distributed by the government of Madras, and the official report from Bombay. On the basis of these materials he came to far-reaching conclusions regarding cholera and its causes. Following the widely accepted assumption that epidemics were caused by the atmosphere, Orton took the regularity of the monsoon wind and rains as the starting point of an inquiry into the correlation of weather patterns and epidemic occurrences of cholera. In the available reports on outbreaks in all parts of India, but especially in the Madras Presidency, Orton found evidence that cholera followed heavy downpours that coincided with unfavorable phases of the moon. Both phenomena were associated with a drop in barometric pressure, which in turn decreased the atmosphere’s capacity for electricity. Orton detected the remote cause of epidemic cholera in this atmospheric state, as it diminished electricity in the human body. Thus, Orton redefined epidemic cholera as caused by a complex interplay of many actors that connected the human body to very specific environmental factors.59 The final result of Scot’s work was a reaction to Orton’s theory and to the many others put forward in the reports sent to the Medical Board, as it assessed the varying opinions about cholera spasmodica, or as Scot preferred to call the disease, cholera asphyxia. Scot had undertaken research in various fields in order to judge the opinions and observations in the surgeons’ reports and to ultimately come to his own conclusion. He had analyzed the available medical records of the colonial government, as well as traditional Indian medical writings, for references to past diseases that could be identified as cholera asphyxia. Scot concluded, based on this historical information, that cholera asphyxia was actually not a new disease. He claimed that the initial misdiagnosis as cholera morbus had caused much

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confusion among medical practitioners, but his diligent research had unearthed ample evidence that the disease had been known for centuries. He identified a disease with similar symptoms in ancient Hindu writings and in European medical treatises going back to the Dutch physician Jacobus Bontius in the seventeenth century. Past occurrences had been recorded in all parts of India, including the south in general and the city of Madras in particular. Scot concluded that there had always been a second variety of cholera besides the common cholera morbus, that it had originated in India, and that it was present there in both sporadic and epidemic forms. What was unprecedented was an epidemic of the scale witnessed in the years after the outbreak in Bengal in 1817. Scot’s report would have to distill the many observations of symptoms, causes, and cures of the disease, as well as the reasons for the scale of the recent epidemic. This proved to be a difficult task. The reports were heterogeneous in terms of content, form, and terminology. The surgeons had approached cholera asphyxia in different settings and with different personal backgrounds. Many cases were described thoroughly, with deviations in the course or symptoms of the disease noted in minute detail; other reports were hastily written and the observations they contained were sketchy at best. Only by reviewing a great number of cases could the reporting surgeons determine the common characteristics of cholera and distinguish them from rare symptoms or complications. Though all the reports were official documents and therefore had some credibility, they varied in their adherence to scientific methods and thinking, an aspect that had to be considered in Scot’s assessment of them. Not all authors had included all relevant information, nor were all their conclusions based on the facts they had presented. Not only did different reports put forward contradictory evidence but often there were inconsistencies within a single account. Scot had to evaluate and attribute significance to the information included in the reports and systematize his own account of cholera asphyxia from these sources.60 Under these circumstances, it is perhaps unsurprising that Scot took a cautious and skeptical approach. Symptoms and diagnosis together constituted the least disputed aspect of the cholera epidemic, although individual and local variations apparently did occur. The interpretation of symptoms, however, was already becoming less straightforward. Cholera asphyxia appeared to disorder, interrupt, or suspend all natural functions of the body, but not a single one of those functions was consistently or invariably affected. This incoherent presentation rendered simplistic theories of causation obsolete. Evidence pointed to some neurotic disorder, but only a detailed

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analysis of causes could give even indications of the real situation, much less a complete picture. In terms of predisposing causes, the surgeons’ observations showed that more robust patients were less frequently attacked by the disease than the more fragile ones. Women suffered more than men, as they were believed to be more susceptible to nervous disorders in general. Therefore, cholera asphyxia shared the same disposition as other nervous and cachectic diseases. The same was true for remote and exciting causes. Diet, weather, or fatigue appeared to play their part in the disease, but the unpredictable spread of the epidemic, sparing some individuals or locations while hitting others without discernible differences in terms of such causes, demonstrated that they were insufficient to cause an epidemic outbreak on their own. Scot considered a variety of factors that had been suspected of being the specific influence responsible for the disease in both its sporadic and epidemic state: the weather, atmospheric electricity, the influence of sun and moon, the soil, food poisoning, and miasmas. None provided a satisfying or even remotely plausible explanation for the pattern of cholera outbreaks and neither did the theories of contagion and infection when it came to the disease’s spread. Cholera was apparently too complex a phenomenon, and any definite conclusions would be premature. For that, more, and more detailed, information was required.61 Scot deliberately chose an approach different from Orton’s and refrained from designing any general or comprehensive theories of cholera asphyxia, but he did discuss the diverse and contradictory theories and evidence. His report included arguments for and against almost any position and could be cited by their respective proponents to support their own opinions and attack those of others. By not taking sides, he redefined the disease as an unresolved puzzle of immense complexity. Cholera had been seen as a new disease; now it was an ancient mystery of India. Although much new knowledge had been collected, Scot offered no advice on how to fight future outbreaks. His discussion of medical treatment, including the approach taken during the recent epidemic, was also highly critical, as he noted that none of the remedies employed had had a consistently positive effect.62 By taking no clear position regarding the causes of the disease, Scot inevitably remained vague when it came to pointing out a course of action for possible future cholera epidemics. By avoiding an endorsement of any of the government’s or the board’s actions, he implicitly judged them a failure. Scot’s report neither reflected nor tried to establish a consensus among medical practitioners on which the government could rely. By highlighting the unknown, he left his superiors with all options and precedents to consider but no practical advice.

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The first scientific works on cholera that originated from the Madras Presidency tried to redefine the disease based on local experience. They systematized the observations made during the cholera epidemics and integrated them into the existing scientific knowledge by finding analogies, similarities, or connections. They assembled the factors that seemed to be in play and used them as the basis of a scientific explanation for the disease’s behavior in individual bodies and space. Maybe cholera could not be definitively explained, but what epidemic disease could? Epidemic cholera was evidently an extremely complex combination of environmental and individual conditions that connected numerous variable factors—many of which were either unknown or only superficially understood. Everything could be of decisive importance, and any detail might provide the crucial hint for deciphering this medical mystery. Scot’s collection of observations on the recent cholera epidemic and his references to prior observations by medical and scientific authorities were not intended to establish a definite theory of the disease. On the contrary, the author was well aware that the scientific basis for any theoretical account was weak—despite all assurances by those authors who had ventured into this treacherous territory. He tried to bring order to the chaos that had been cholera spasmodica by compiling evidence in a way that was accessible to future researchers. His work was open for amending and revising, and it would be revised as soon as it gained new significance. Cholera Returns to Madras Despite Scot’s indecisive account of epidemic cholera, the Medical Board and its surgeons recognized local environmental influences as the cause of cholera. During the cholera epidemic of 1818–20, the authorities had refrained from actively altering conditions to achieve a more favorable state. Considering the resources and personnel at hand, there may have been no capacity for far-reaching initiatives, and the government might have decided that providing treatment was the most comprehensive approach. Yet, when confronted with the smaller outbreak in the village behind MacKay’s Garden in 1832, the government and the Medical Board demonstrated their willingness and ability to alter the environment in order to protect the population against cholera, as described in the introduction. While the village behind MacKay’s Garden was a significant if ultimately limited outbreak, regularly occurring cases of sporadic cholera received little attention. Then, in August of that same year, the Medical Board reported an increase in cholera cases. The densely settled Black Town appeared to be the most affected part of the city, and the board assured the govern-

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ment that medical aid was available wherever required.63 With the end of this limited surge in cases, cholera was largely out of the authorities’ focus again until 15 January 1833, when the superintendent of police reported to the superintending surgeon that he had recorded sixty-eight deaths from the disease during the previous ten days. As an outbreak of this scale could indicate the beginning of a serious epidemic, the government called for the Medical Board to provide treatment “to all Classes of Inhabitants” and to “take immediate measures for preventing, as far as applicable, the spreading of the disease.”64 Triplicane appeared to be the center of this epidemic, as the sixty-eight initially reported deaths had all occurred there, while additional cholera cases had been observed elsewhere in Madras. The Native Infirmary had received many patients, but from that limited sample the superintending surgeon could not determine exactly where the disease was prevalent or if additional measures were required to provide the medical care that would be needed. This combination of initial misinformation and a lack of reliable data concerning the scale and gravity of the outbreak had the government again convinced that an information system was needed if they were to get a comprehensive picture of events. Thus, the government once again instructed the superintendent of police to publicize the fact that medical institutions like the Native Infirmary and the recently established Chintadrepet dispensary were available for cholera patients, and it ordered the police to collect the daily number of deaths for each police district and to forward that figure to the Medical Board. Again, although those mortality figures were known to be inaccurate, they did provide sufficient information to allow the authorities to act. They identified Triplicane and the nearby village of Pariamettoo as the centers of the epidemic and allowed the government to support the district surgeons with the resources necessary for the immediate relief of the sick, although once again many in the population refused their services.65 Lessons from the Epidemics of 1818–1820 and 1832–1833 The smaller cholera epidemics in 1832–33 permit a review of the epidemic of 1818–20 from a slightly different perspective. They clearly show that the colonial government and the Medical Board did not ignore the possibility of changing the environment in order to prevent or mitigate future outbreaks of cholera; they simply lacked the human and financial resources to do so. The colonial institutions of Madras, although possessing all legal authority, lacked the personnel, the financial resources, and the willingness to undertake a large-scale project to change the urban environment.

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Equally important was their lack of knowledge regarding the urban space they ruled. Some of it remained inaccessible to administrators, police, or surgeons due to Indian cultural preferences and customs, an example being the women’s quarters in Indian houses. Other areas were avoided due to the colonial relationship with the local populace. Europeans were not supposed to enter certain parts of Madras, as they had no business there. From the perspective of residents of the fort or a suburban garden house, the villages, towns, and hamlets inhabited by lower-caste or parayar Indians held no particular interest. They were not terra incognita; they were too close for that, and some official institution such as the collector or the police was present there at times. Yet, these parts of the urban space of Madras were nevertheless beyond the direct control of the colonial authorities. They were part of a different sphere, and their residents’ contact with the European colonial presence in Madras was limited. Therefore, when cholera reached Madras in 1818 and 1832, colonial authorities had to deal with not only a little known and largely ill-defined disease but also ambiguous and undescribed spaces that were barely legible to government officials. As a consequence, they had to determine the behavior of the disease both within the body of the patient and in those urban spaces that had been mostly ignored. Now they had to extend the reach of the government and colonial medicine into those spaces. Thus, the government assigned new tasks to existing institutions, including the police and—most important—the Medical Board. With the help of the police, the Medical Board had to monitor the behavior of the population and the Indian practitioners employed by the government. But the most important focus of the monitoring was the behavior of cholera. By observing the patients, the medical practitioners hoped to conceptualize the movements of the disease, determine its preferences, and identify the means that would make it possible to control it. They would help decipher the puzzle that was cholera and supply the authorities with facts that could in turn be utilized to fight the disease. If they wanted to succeed, the authorities required new institutions. With the colonial government’s establishment of the dispensaries, European experts—the surgeons—were distributed across the urban space of Madras. However, their working within these colonial medical outposts meant that their perspective remained limited to that of the European enclave. Although they were able to closely observe the behavior of cholera among some residents—seeing, touching, and smelling its presence—their rootedness in the European enclave isolated them from the environment outside and the population living there. The European surgeons could not

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define cholera in the urban space as well as they could in the body, but they could nonetheless compare the appearance of the disease in each context. Thus, they correlated some symptoms of cholera in the urban space to those in the body, for example, filth, stench, coldness, or humidity. Physical locations with these characteristics they considered the most dangerous, and these spaces were inhabited by the poorest sector of the population. In the eyes of the authorities, the poor thus became associated with the threat posed by cholera. Given the immense scale of the city and their limited knowledge of both cholera and the urban environment, the authorities believed they had few options beyond focusing on medical treatment, provided by a surgeon in a controlled environment or by an Indian practitioner beyond the confines of the enclave. The case of the paracheri by MacKay’s Garden and the adjacent suburban garden houses was different. The cholera outbreak there was confined to a limited space and affected only a small number of persons. The colonial medical institutions could grasp, define, and shape the predisposing features of the disease in that setting. The fact that Europeans lived in neighboring garden houses was certainly an incentive to be proactive and provide the necessary funds to address the environmental issues they believed led to the outbreak. It was an instance when the authorities considered themselves capable of changing a physical space for the better. They could envision themselves transforming the filthy and miserable village occupied by the parayars into one that was clean and healthy. Here, they could assemble the resources available to the colonial government of Madras in a way that allowed them to attain such comprehensive goals, and for once they acted accordingly. Thus, the cholera epidemics of 1818–20 and 1832–33 not only exposed the weaknesses of the colonial government in Madras but also indicated its transformative potential. The city was far too large, populous, and complex for a small contingent of officials to control, especially given their larger responsibility for the whole presidency. Cholera disrupted the routine of colonial rule and made necessary changes in the governmental institutions that were already in place. Their success in the fight against epidemic cholera spasmodica was limited, but for a short time the colonial state was challenged to intensify its control over the urban space and population. Cholera had, if for a limited time, contributed to the process of state formation.

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Figure 2. Map of Quebec, based on Plan of the City of Quebec for the Quebec and Levis Directory from a drawing by Paul Cousin, 1871.

Chapter 2 Strategies of Control Quebec City, 1832–1834

In 1824, in his Report on Epidemic Cholera in the Madras Presidency, William Scot had expressed his hope that Britain’s medical professionals would use his work without the urgency of an outbreak of the disease compelling them to do so.1 It took cholera only a few years to render this sentiment obsolete. The slow but steady movement of the disease, which reached Russia and then central Europe in 1830, raised alarms all over the continent and increased the demand for information on a disease European physicians considered new. Scot’s report was soon translated into German and French.2 Reginald Orton, who had not been able to publish the second volume of his treatise due to a lack of interest and had only avoided a financial loss with the first one thanks to the support of the government of Madras, was now able to publish in London a second edition of his earlier work and to include with it a new supplement. Other surgeons or physicians with experience treating cholera in India penned entirely new works. In addition to studying the existing literature on cholera, many European governments sent well-respected physicians to Russia to get firsthand reports on the epidemic there. Their task was primarily to ascertain if the disease was indeed the cholera known from India, or if the very different Russian environment had altered its character, and secondarily to gain experience stopping it.3 The physicians’ Russian experience quickly convinced them that they were dealing with Indian cholera, renamed Asiatic

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cholera, but, as was the case during the previous epidemic in the subcontinent, there was very little agreement among experts regarding the epidemic’s mode of spread and measures they might take to fight it. The Russian government had tried cordons sanitaires for cities where the disease had appeared, but their effectiveness was disputed. In some instances they appeared to halt the disease’s progress for some time but ultimately had been unable to stop it.4 In Britain, the Privy Council had been responsible for protecting the country from the introduction of epidemic disease since the plague outbreaks of the early modern period. Quarantine was a well-established practice against plague, but given cholera’s disputed mode of spread, there was no certainty that such measures would be effective.5 In June 1831, the Privy Council established the Central Board of Health, consisting of prominent members of the Royal College of Physicians and officials from various governmental institutions, to develop preventive measures against cholera. Despite daily meetings, the Central Board of Health found it difficult to define the disease. Most of its members tended toward contagionist views, but there was no consensus. In the end, the Central Board of Health decided to establish a countrywide system of local boards of health that would manage outbreaks wherever they occurred and provide them with “an authoritative account of the disease, its symptoms, treatment, [and] precautionary measures to guide medical practitioners” based on the medical literature and prior experiences of the disease.6 On the issue of quarantines, the Central Board of Health recommended imposing strict regulations. The Privy Council, however, despite formally agreeing to the recommendation that quarantines be imposed, willfully neglected to implement any law requiring such measures so as to protect trade. It was trade, of course, that was likely to bring cholera not only to Britain but to its colonies across the Atlantic. From British North America, the cholera epidemic on the European continent looked distant, but with tens of thousands of immigrants arriving every summer, the danger was only one step removed from entering the colony.7 Colonial Quebec and Lower Canada British North America in the 1830s was not a cohesive territory. Rather, it consisted of several pockets of settlement that were connected mainly by waterways. The maritime colonies of Newfoundland, Prince Edward Island, Nova Scotia, and New Brunswick were more closely connected to the Atlantic than to the continental provinces of Canada. While Upper Canada—the land between the Ottawa River and the Great Lakes—was

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still a frontier region, Lower Canada—on the banks of the Saint Lawrence River—was the most populous and prosperous part of the colony, as well as the most troublesome for the colonial government at Quebec. Politics in Colonial Lower Canada When the news of a cholera epidemic in Europe arrived in North America, the province of Lower Canada was in a state of political and constitutional crisis and had been for several years. Since the conquest of New France in 1759 and the subsequent integration of the French possessions north of the thirteen colonies into the British Empire, the colonial authorities had had to deal with a majority population of French descent whose loyalty to the Crown was questionable. A new constitution for British North America— introduced in 1791 after the loss of the thirteen colonies—had divided the conquered colony into two provinces to safeguard a majority anglophone population in at least one. Upper Canada would provide a home for immigrants from Britain and Ireland, as well as for loyalists who preferred to leave the newly founded United States, while Lower Canada comprised the valley of the Saint Lawrence, the center of French settlement for almost two hundred years. The city of Quebec remained the capital of the lower province and the residence of the governor-general, who had far-reaching authority and also functioned as commander-in-chief of the British troops stationed in the colony. This official was appointed by the imperial government in London and usually had no prior experience with the province. The governor-general’s official staff consisted mainly of military officers from the metropole, with only few positions open to persons of Canadian descent.8 However, not all power rested with the governor-general. The constitution of 1791 also provided for popular representation. Following the British model, the legislative body was split between an upper and a lower house. The governor-general appointed the fifteen members of the former, the Legislative Council. They were loyal to British rule and often anglophones from the powerful merchant class of the province’s cities. Nine of them formed the Executive Council, which served as a cabinet to the governor-general. The lower house, the Legislative Assembly, was elected by the adult male citizens of the province. The assembly’s powers were limited, as its bills had to be approved by the Legislative Council and the governor-general, but it had one important constitutional asset: the government required its consent to pass any bill, including any related to the budget.9 This prerogative proved increasingly problematic for the government as francophone deputies began to dominate the assembly. Many of them

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earned their living in the aspiring liberal professions and believed that the established political system prevented the fulfillment of their ambitions. At the same time, these assembly members used their constitutional rights and political influence to preserve their mostly rural power base, as well as their French Canadian traditions and culture. Attempts by the government to anglicize the province and abolish traditional rights had provoked a strong reaction and radicalized the politics of Lower Canada during the 1820s. In the assembly, the nationalist and reformist Patriot Party (Parti patriote) had gained an unassailable majority. It was backed by a popular movement that approved of both political resistance against the colonial government and a struggle for more constitutional rights for the people. This did not mean, however, that the Patriot Party represented francophone Canada as a whole. The radicalization of the nationalist camp estranged them from the traditional French Canadian elites, the vested gentry, and the Catholic Church. This confrontation between the political, economic, and religious elites of Lower Canada and the assembly paralyzed the province. To pressure the government, the assembly refused to approve the budget. Attempts to solve the crisis were unsuccessful, as a broad compromise could not be reached and failure further strengthened the hardliners on both sides.10 The City of Quebec Many of these constitutional and political debates took place in the city of Quebec. Founded in 1608 by the French voyageur Samuel de Champlain, it had been the capital of New France since that time, and it was also the political, economic, cultural, and religious center of the French possessions in North America. Outside the city’s fortifications, British forces had defeated the French defenders in 1759 and had taken possession of the colony. Under British rule, the city remained the capital, first of the colony of Quebec, then, from 1791, of Lower Canada. It was the seat of the government institutions and colonial administration and the residence of the governor-general. A garrison of British troops was stationed at the Citadelle on Cap Diamant and ready to protect the status quo against external and internal threats.11 But beyond hosting colonial institutions, Quebec was a stronghold of the British Party, which supported the colonial government. It represented the shipping and commercial interests that were based in the port and dominated by anglophone ship builders, ship owners, and merchants trading with Europe, the United States, and the West Indies.12 This dominance in business also translated into political power, in part due to the absence of popular representation in the local government. Until the city’s incorporation on 1 January 1833, Quebec was administered by

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a fluctuating number of justices of the peace appointed by the governorgeneral and chosen from among the local bourgeoisie and dignitaries. Usually, these justices were seigneurs—feudal lords spending most of their time in Quebec—or they were men who had achieved success in the professions or in commerce. Without democratic legitimacy, they were accountable to the government and depended financially on allocations from the provincial budget. Their tasks included the maintenance and regulation of the urban infrastructure, as well as the preservation of civil order.13 Nevertheless, by about 1830 francophone Canadians constituted the majority, if only a slight one, of the roughly twenty-eight thousand permanent residents.14 The city of Quebec had grown quickly over the preceding decades due to immigration from the United Kingdom and an influx of French Canadians from the countryside. This population increase meant that open space in the old city was running out. Topographically, Quebec was separated into the more prosperous and established Upper Town and the portside Lower Town, where the mostly francophone working and middle classes lived. As the Lower Town was squeezed between the river and the rocky bluffs on which the Upper Town stood, the city could expand only beyond the fortifications of the Upper Town. As a result, the suburbs of Saint-Jean, Saint-Louis, and Saint-Roch quickly grew to become new quarters. They provided cheap housing for workers, day laborers, and their families, leaving the Lower Town to the petit bourgeois owners of the shops and taverns, as well as various artisans. By 1832, the majority of the population already lived in the suburbs.15 Despite this shift, the Lower Town remained the commercial heart of the city. As the most important entrepôt of British North America, the Lower Town port was the city’s economic keystone. With the Saint Lawrence River providing access to the interior, Quebec became the gateway to Canada. Thousands of ships arrived every year carrying immigrants and goods to the Canadas and leaving with staples like fur, grain, and, most important, timber destined for Europe or the West Indies.16 Medicine in Lower Canada Due to Canada’s temperate climate, Europeans, and particularly Britons, generally regarded it as an extraordinarily healthy colony and as particularly fit for settlement. Epidemics were relatively rare, and Canadians usually perceived them as having been introduced by ship, making the port of Quebec in their eyes the gateway for diseases, as well as goods and passengers. Most common were epidemics of smallpox, influenza, “malignant fevers,” and typhus, which recurred regularly from the seventeenth century

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onward.17 The French and later the British colonial government did little to stop such outbreaks. Only in 1795 was the Quarantine Act passed, thus allowing the governor to detain passengers or crews of incoming ships suspected of carrying contagious diseases. Beginning in 1830, a health officer examined sick passengers and decided whether they would be admitted to one of the institutions established for the treatment of immigrants. Since 1820, the Immigrant Hospital had operated in the suburb of Saint-Jean, but not until 1830 was there a “fever hospital.” Intended to isolate a limited number of patients suffering from contagious diseases—typhus, yellow fever, scarlet fever, plague, smallpox, and rubella—it was built at PointeLévy on the right bank of the Saint Lawrence.18 This still relatively new system of quarantine was far from working perfectly, and the health officer, François-Xavier Tessier, was the first to admit this. The Fever Hospital was inadequately funded, pilots and masters of vessels ignored the provisions of the Quarantine Act, and the health officer had no authority to enforce compliance. In his report for the years 1830 and 1831, Tessier highlighted the shortcomings of the existing system by pointing to the possibility of the arrival of Asiatic cholera and the likely consequences. He was not alone in his assessment—the justices of the peace agreed that the city was ill prepared for a cholera epidemic. In a letter to the government, they demanded additional powers and funds to cope with such an event.19 Despite these warnings and the prospect of tens of thousands of immigrants arriving at the port of Quebec in the year to come, during the summer and autumn of 1831 the public regarded a cholera epidemic as unlikely. However, newspapers in Europe were reporting not only the struggle over the Reform Bill in Britain and the ramifications of revolutions in Poland and Belgium but also the spread of cholera across Europe. Still, the government of Lower Canada and some local medical experts issued reassurances that there was little to fear. Cholera was in their view just a distant curiosity that would not affect the province.20 This view was shared by the government. At the opening of the Legislative Assembly’s session for 1831–32 on 15 November, the governor, Lord Aylmer, had announced that it was unlikely cholera would arrive in Lower Canada. His declaration was based on the Central Board of Health’s compilation of medical knowledge and recommendations that had arrived from London in October 1831. In the meantime, however, American port cities, including New York, had imposed a quarantine, so the governor referred the materials sent from London to the experts on the Quebec Medical Board for a review.21

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Unlike its counterpart in Madras, the Quebec Medical Board was not part of the colonial administration but was instead the licensing board for medical practitioners in the Quebec district of Lower Canada. At the time, British North America lacked a medical school that offered a degree recognized by the government. Students from the colony wanting to go into medicine had to choose between an apprenticeship with a practitioner in Lower Canada or studying abroad. Medical schools in the United States offered the opportunity to earn a degree not far from home, but Europe, and especially Britain, was a more prestigious choice that promised a profitable private practice. Additionally, there was a considerable immigration of well-trained medical practitioners, mostly from the United Kingdom but also from France and Germany. Some stayed only temporarily, as was the case with the military surgeons who accompanied the British troops stationed in the province and did not compete with their civilian colleagues for patients. Others immigrated to Canada permanently and established themselves in the many towns and villages that had no trained practitioners. They were attracted by the opportunities offered by a quickly growing population that lacked proper medical care. Their training at prestigious universities in Britain, continental Europe, or (to a lesser degree) the United States gave them a commercial advantage over those who had stayed in the province. It was these well-educated practitioners who found prosperous clients in the cities and served on the Quebec Medical Board.22 Since the late eighteenth century, medical practice in Lower Canada had taken a path of professionalization that followed the course of European developments. During the 1820s, the medical profession tried to establish institutions such as associations or journals that would allow it to organize itself and advance its views publicly. The Quebec Medical Society and the Quebec Medical Journal, however, proved to be short-lived due to a lack of members and contributors.23 More successful were the profession’s efforts to regulate its trade. The medical practitioners lobbied the government for a licensing process based on formal education, which would thereby cut down on competition from untrained “charlatans” and “quacksalvers” who dominated medical care in rural Lower Canada; the effort succeeded in 1788, when the assembly passed the Medical Act, which created medical boards in both Quebec and Montreal. The boards were dominated by the urban medical elites of British origin with close ties to government and military, and they quickly imposed restrictions on the less educated rural practitioners.24 The Medical Act enhanced the attractiveness of the profession, and an increasing number of French Canadian practitioners with rural back-

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grounds and formal education began to apply for licenses. Politically close to the Patriot Party and therefore well represented in the assembly, they pressed for a reform of the act that would ensure medical boards elected by the profession.25 Eventually, they were successful. The revised Medical Act of March 1831 introduced elected medical boards for Montreal and Quebec. The outcome in the capital was a more diverse board, as four members practiced in rural areas. Nevertheless, the Quebec Medical Board still represented the medical establishment. Only two members of the old board were not elected to the new one. Its members were prominent in the professional and educational life of the capital or came from seigneurial families. Eight of the twelve members had been educated in Great Britain, one in the United States, and only one in the province by apprenticeship. All but two members were French Canadian, with one Anglo Canadian and one British physician each being the exceptions. This was the board the governor consulted when needing advice concerning the dangers of cholera in Lower Canada.26 The Quebec Medical Board’s first report on cholera, issued on 12 November 1831, drew a very different conclusion from the information sent from London than did the governor. Although the board acknowledged that its conclusions were based on limited information and could turn out to be preliminary if new facts presented themselves, it struck a tone of urgency. It recommended following the British example by adopting antiplague measures, with only minor adjustments. Central to the report was the proposal of a quarantine station downriver from Quebec. Every incoming ship would be required to stop at the station, where a health officer would inspect the crew, the passengers, their baggage, and the cargo. People ill with Asiatic cholera would be accommodated with their belongings in a lazaretto for a period of quarantine. The Quebec Medical Board also proposed the establishment of boards of health in both Quebec and Montreal to provide public health administration modeled on British examples.27 In the eyes of the shipping interests and anticontagionist medical physicians, these proposals were too extreme. The concerned parties pointed to previous failed attempts to stop the disease and warned against any inhibition of trade that would impoverish and thus predispose large sections of Quebec’s population to the disease. Quarantine, they argued, would make an epidemic more likely, not less. Although he was also skeptical of quarantine, the governor could not ignore the advice of the Quebec Medical Board. Since cholera was still distant and no immediate action was necessary, he put the provisions of the existing Quarantine Act of 1795 into effect and referred the whole matter to the committee of the assem-

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bly responsible for supervision of the recently established Fever Hospital at Pointe-Lévy. The committee found no evidence contradicting the governor’s assessment of the situation and recommended continuing the careful observation of events in Europe.28 Preparations for an Outbreak In early February 1832, only a few months after the governor’s confident statement that a cholera epidemic in the province was unlikely, the newspapers in Quebec reported that the disease had reached Great Britain.29 This news fundamentally changed the assessment of the situation. What had seemed a far-fetched scenario now became a palpable threat. The expected arrival of tens of thousands of potentially diseased immigrants made cholera a powerful actor in provincial affairs even before a single case had occurred in North America, and the government felt compelled to react. However, devising a strategy in order to prevent cholera’s introduction was difficult, since its etiology was hotly disputed among medical experts. Legislation for Anticholera Measures The frightening news from Britain forced the government and the assembly to consider new and more vigorous measures that would mobilize existing resources and create new institutions to prevent the introduction of cholera. Such wide-ranging and expensive actions required the cooperation of the executive and legislative branches regardless of their frequent conflicts. On 3 February 1832, Governor Aylmer addressed the assembly, acknowledging that the expected stream of immigrants made the imposition of preventive measures inevitable. He reminded his audience that radical steps to protect the population of the province, such as the establishment of a new quarantine station downriver, would have some negative consequences. The quarantine would harm commerce, do injury to those persons who had to endure detention, and require considerable funds and effort to accommodate potentially tens of thousands of passengers, to feed and clothe them, and to provide medical facilities for and treatment of the sick. Whether such an enormous project could be undertaken in time to succeed was questionable, and Aylmer made it clear that he preferred the efficient implementation of limited measures to such an extensive but probably ineffective plan. Therefore, he proposed enforcing compliance with the existing quarantine law and inspections by the health officer; masters of vessels and pilots who failed to follow the rules and regulations would face severe fines, but Aylmer left the final decision to the assembly, which referred the matter to the Fever Hospital Committee.30

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After two weeks of deliberations, on 17 February 1832 the Fever Hospital Committee suggested comprehensive regulations that were the result of a compromise. The committee proposed to pursue two preventive strategies at the same time, both based on established antiplague measures. First, quarantine would ideally contain the disease to the limited space of a station and thereby prevent it from entering the province proper. Second, cleansing the urban environment would remove possible predisposing causes, therefore depriving the disease of the conditions enabling it to thrive.31 With this proposal, the committee tried to satisfy proponents of both the contagionist and localist theories among the medical and political elites of Lower Canada. Taking one side in this debate could have endangered the passage of the bill in the assembly, alienated the government and the commercial interests, or pushed a considerable part of the medical profession into opposition, thereby undermining anticholera measures from the outset. Instead, the proposal tried to minimize objections or even a political gridlock at times of crisis, while assembling as many allies as possible. Politically, the compromise proved effective. The assembly passed the committee’s proposal without amendments on 25 February 1832 after only a week of deliberations and with only seven votes against. The new Quarantine Act would be in force until 1 February 1833, but an effective implementation of the ambitious plans required more than nominal agreement and legislation. To function as intended, the plans would necessitate broad cooperation and collaboration by numerous actors. Both strategies—quarantine and altering the urban environment—depended on new institutions. The Board of Health played a central role, as it would coordinate the administrative, sanitation, and medical efforts in the city and its suburbs and would supervise the medical personnel responsible for enforcing quarantine regulations. The urban administrators of Quebec dominated the board. By law, the justices of the peace supplied eight of the fifteen members, with the most senior magistrate serving as chairman. The other seven members were to be drawn from the local elites, while clergymen could ask to become extraordinary members with the same powers as the ordinary ones. Medical training was not a requirement for service on the board, despite its expansive powers to issue rules and regulations regarding public health in the city and its suburbs and to establish the institutions to do so. The Board of Health had the authority to hire officers and health wardens to control the urban environment. The primary target of control consisted of public spaces, but the new act also gave the board the power to order its officers to enter and inspect private property, such as buildings and lots. If the officers believed private spaces constituted a threat

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to public health, they had the power to order the cleansing and purification of buildings, vessels, boats, and rafts and to close or enclose every street to passage. The Board of Health’s tasks were not limited to the prevention of an epidemic; they included the power to undertake mitigating measures if cholera broke out, as the act obligated the board to acquire a suitable supply of remedies necessary for the treatment of the disease. The act thus granted the Board of Health and its officials broad discretionary powers in dealing with an epidemic. They would have the authority to destroy anything considered a danger to public health and to send all nonresidents infected with cholera or any other contagious or “malignant” disease to a hospital run by the government, against their will if necessary. For the implementation of the medical aspects of the act, the Board of Health was to appoint three experienced medical practitioners as commissioners of health. Two of them, as resident physicians, were to examine all sick persons reported to the board to find out if they were suffering from cholera. The third officer, the health commissioner, would assume supporting administrative duties. The health officer who had been responsible for monitoring the health of arriving passengers in the port under the old Quarantine Act was placed under the authority of the commissioners of health, and that officer’s duties and powers were expanded to include immediately visiting and inspecting all arriving vessels. The act called for a comprehensive information system to allow the authorities to keep track of the latest developments in the city. The board could hire health wardens who would patrol the urban space in order to identify and remove potential predisposing causes of disease, such as filth and standing water. Additionally, every medical practitioner in Quebec and its suburbs was required to report cases of disease to the senior magistrate or the commissioners of health. The health officer would issue to both the board and the government a detailed report on any vessel visited, while the commissioners would be required to report daily and in person to the board. Thus, the authorities would have at their disposal current information on the state of the urban environment, the population, and the course of any epidemic in Quebec or the port. But the authors of the act apparently deemed even this information system insufficient and thus also obligated persons keeping taverns or boardinghouses to report to the board or the commissioners of health any case of disease among tavern customers or lodgers. The same reporting requirement applied to ship owners or consignees who had knowledge of sickness among passengers or crew. Those who failed to comply with these regulations would be subject to prosecution and severe fines of up to one hundred pounds.32

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Preparing the city for the shipping season, however, was not enough. If cholera proved to be contagious, cleansing would not stop the disease. Therefore, the act mandated the establishment of a quarantine station downriver to keep the disease out of the city and the province. The quarantine procedure would begin with the pilots handing out a copy of the quarantine regulations to the master of every incoming vessel and guiding each to an anchorage marked by buoys off Grosse Île, a small island in the Saint Lawrence River about thirty miles from Quebec. The anchorage and the island were placed under military authority, with troops stationed there to enforce the compliance of pilots and masters of vessels if necessary. The act called for constructing on the island, before the start of the shipping season, several blockhouses to accommodate those quarantined. An additional health officer was stationed at Grosse Île to inspect all incoming vessels for cleanliness and to identify passengers and crew suffering from cholera or other unusual diseases. If the officer found nothing suspicious, he would issue a certificate of health that would allow the vessel to proceed to Quebec. Ships arriving at Quebec were required to anchor at the mouth of the Saint-Charles River, where the health officer of Quebec would examine their certificates. Vessels that had evaded inspection at Grosse Île and therefore could not produce such a document were to be forced to return to the station. Pilots and masters of vessels who violated the quarantine rules would be prosecuted and punished. To pay for all these measures, the act appropriated ten thousand pounds to the governor, raised partially by a tax on immigrants of five shillings per head.33 Thus, the new law implemented a two-pronged strategy that established several lines of defense against the introduction of cholera to Quebec and Lower Canada. It also created two sets of institutions integrating the necessary resources for making each strategy work. It defined procedures to allow or even force people to participate in a collective effort against cholera. If cholera arrived on incoming vessels and was contagious, the underlying assumptions of the act suggested that the disease would remain isolated in the confined and distant space at Grosse Île while the passengers free from it could proceed. At the port, there would be a second inspection ensuring that no further cases had appeared in the meantime. Quebec itself was supposed to be in a clean and salubrious state at the beginning of the shipping season. If cholera arose from local environmental conditions, the cleansing of the urban space would reduce the presence of potential exciting and predisposing causes. Thus, the impeccable condition of the urban space would prevent cholera from developing.

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With this act, the assembly called for a hygienic and healthy city of Quebec—an ideal that served as a template for the newly founded institutions. If cholera was noncontagious by nature, the urban space perceived by the city’s population had to become similar to the space the authorities envisioned—a space without cholera that was produced by the cooperation of the actors involved. But as cholera’s character was uncertain, the security of the city and all of Lower Canada required another space where the disease could be isolated and kept from entering the province proper: Grosse Île. The quarantine station was just a proposal when the act was passed, a vision of a space within the province that would be affected by cholera, but it would be the only such space. If cholera proved to be contagious and the quarantine project was successful, then this limited space would separate cholera from the rest of the province. Since both strategies existed only in theory, their efficacy against cholera was unproven, even though they had been tried against other diseases, including plague, many times before in England and beyond. It was in no way clear that urban cleansing and quarantine, separately or in combination, would stop the spread of cholera. Yet, as long as the enigma of cholera’s etiology was not solved, one strategy could not exist without the other if the province was to be saved from an epidemic. The two strategies were interdependent even if the operations of most institutions that were created to facilitate them were separated. Different levels of government were responsible for each strategy. The military, which was under the direct command of the governor, supervised the quarantine station and therefore enforced the most important measure against cholera according to the contagionist theory. Although the Board of Health also took an advisory role regarding the management of the Grosse Île station, it was under local authority, cooperated closely with the justices of the peace, and would mainly function under local auspices to ensure the continued removal of predisposing causes from within the city of Quebec. Despite the spatial proximity of the quarantine station and the Board of Health, only the governor administratively connected them. They operated separately and tried to achieve quite different goals by different means, but both had to alter the spaces they were responsible for as conceived in the Quarantine Act. In the remaining time until the start of the shipping season, these conceptualized spaces, which were designed to both prevent and fight cholera, had to become a reality. The act was merely a statement of intent; as none of the measures resolved was in place, many details were still to be determined, and many actors needed to be integrated. Implementation of

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the act and these measures in the city of Quebec was the task of the newly established Board of Health. The Board of Health in Action It took almost one month, until 12 March, for the new Board of Health to be established, and during its first weeks of existence its members mainly worked to make the new institutions functional. At its constituting session the board consisted of fifteen members, as envisaged in the act. Only three of them were medical practitioners, and they, like most of the medical establishment at Quebec, had predominantly localist leanings. During the legislative process, one assembly member, who was a physician himself, had regarded this meager representation of the profession as a great liability and had demanded that the board consist exclusively of medical practitioners, as they were in his view the best prepared to make the right decisions. Other deputies had disagreed, given the small number of medical practitioners in Quebec, and had warned against attaching too many of them to administrative tasks when their greatest value would be in treating patients or investigating cholera. Beyond these practical reasons, the proponents for a more diverse Board of Health argued that there should be no appearance of a conflict of interest. Controversial measures might provoke animosities if the public suspected that the board was furthering the medical profession’s economic interests rather than the common good. Medical practitioners should and would have great influence on the dealings of the board, but as an administrative body the Board of Health had to be above any suspicion of self-serving behavior.34 In its first days the board prepared itself for the tasks ahead. It began by considering the applications of ten clergy members to join the board and by hiring a secretary, an assistant secretary, and a writing clerk for internal administration, recording the minutes of sessions, writing letters, and preparing advertisements for publication. The commissioner of health was appointed the board’s treasurer.35 In addition to being the central institution for the implementation of the anticholera law in the city of Quebec, the Board of Health also advised the government on quarantine. On 13 March, the governor asked for “counsel and assistance from the Board of Health in giving effect to the provisions of the Act” and requested the board members’ expertise regarding quarantine: Should the government immediately begin the establishment of the quarantine station on Grosse Île or await further instruction from London? Which detailed measures should be taken on Grosse Île, and what type of infrastructure (such as sheds, bedding, and provisions) for those under quarantine there would be

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required? Should whole ships be put under quarantine and all persons on board landed or only sick passengers? What duration of detention would be adequate? Should Grosse Île be used for cholera only or should it be a general quarantine station? And was there another location closer to Quebec than Grosse Île that would be appropriate for a quarantine station?36 For several weeks the board answered those and similar queries from the governor in several installments, thereby shaping Lower Canada’s and Quebec’s anticholera measures. Only weeks after its establishment, the Quebec Board of Health had become the most important source of expertise on public health. The board recommended the immediate establishment of a quarantine station for cholera cases only, despite considerable practical difficulties. What infrastructure would be required at Grosse Île was difficult to determine, since winter made the island almost inaccessible and information on conditions there was uncertain. Before the beginning of navigation in the spring it would be impossible to transport to the island the necessary materials required for the construction and preparation of the quarantine station. Nonetheless, the erection of sheds, the gathering of supplies and stores, the appointment of medical attendants and servants, and the establishment of communications between the island and the city would be crucial to the operation of the quarantine facility. The board also advised the government to sanitize a ship and to land all passengers in the meantime even if only one cholera case had occurred on board. This meant that healthy passengers would be present on the island, which made constructing a lazaretto a necessity in order to isolate the sick from the healthy.37 In late March, the board recommended following the sanitary regulations of the Central Board of Health in London as far as local circumstances allowed, and it thus issued detailed suggestions for planned operations on Grosse Île. Pilots would have to hand to the master of the vessel a copy of the quarantine regulations upon boarding a ship and to inquire into its port of origin, where it had touched land during the journey, the public health situation at those ports, and if any disease or death had occurred on board during the passage. If the master of the vessel gave any indication that a health risk might exist on board or that he was not telling the truth, the pilot would be required to take the ship to the anchorage at Grosse Île. Those who were suspected of having cholera would undergo a tenday quarantine. Convalescents were to be separated from the healthy for twenty days. If the authorities at Grosse Île diagnosed a case of cholera on board a vessel, all passengers were to leave the ship and receive shelter on the island. If this proved impossible due to a lack of accommodations, some

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passengers could be allowed to remain aboard their ship if the cases had appeared early during the voyage; the sick and those suffering from cholera more recently were to be landed and quarantined while the ship was cleansed and fumigated, since they apparently would have acquired cholera on board. To cope with the expected numbers of immigrants, the board recommended providing shelter in isolation for four hundred persons. If too many affected ships were to arrive at the same time, the passengers would have to remain on board until sufficient capacities on the island became available. Ships arriving from a port infected with cholera but without a case on board during the passage were to be put under quarantine for three days; ships with no cholera cases at arrival but with cholera cases during the voyage, for fifteen days; and ships with cholera cases on board at arrival at Grosse Île, for thirty days. After inspection, ships cleared to proceed to Quebec had to anchor at the mouth of the Saint-Charles River without any shore contact and then undergo another examination by the Quebec health officer. Masters of ships were ordered to comply fully with the Quebec authorities and their rules under threat of punishment. The harbor master had to accept the authority of the medical officials and was prohibited from boarding any vessel before the health officer but was responsible for the prosecution of all those who violated the quarantine law.38 In addition to advising the governor, the board tackled the duties mandated by the Quarantine Act for weeks to come. The board formed committees of several members responsible for the delicate work of making viable proposals relating to hospitals, cleanliness, and quarantine rules and regulations among other things. If information was lacking, as in the case of the Fever Hospital and Emigrant Hospital, it assigned the health commissioner to investigate. The first perceptible results of the board’s work followed quickly. On 16 March, only four days after the board’s constitutive session, the division of the city into wards had been completed and an advertisement for fifteen health warden positions had been published.39 The hospital situation was another urgent matter. If a cholera epidemic at Quebec reached the magnitude experienced in England, the number of available hospital beds would be woefully inadequate. The hospitals of Quebec were mainly charitable institutions serving as a refuge for the poor who could not afford the services of a medical practitioner.40 Only three hundred hospital beds were available for a city of approximately thirty thousand residents plus the sixty thousand immigrants expected to arrive in 1832. After the Board of Health had been established, the commissioners of health had taken charge of the Emigrant Hospital in the Saint-Jean suburb and quickly reported that the hospital could not accommodate the

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number of patients an epidemic would likely generate. After some repairs it would be fit for seventy to seventy-five patients. Some sheds erected the year before could serve another one hundred patients but would need refurbishing, while the outbuildings and the surroundings of the hospital would require thorough cleansing. If all these buildings were utilized to capacity, the Emigrant Hospital could accommodate approximately two hundred patients, and if the board rented a house opposite the hospital there would be space for another sixty.41 The inquiry into the Fever Hospital at Pointe-Lévy took longer to complete. The responsible committee of the board suggested suspending the Fever Hospital, which was too remote from the city in the case of an epidemic, and compensating the lost capacity by renting the house opposite the Emigrant Hospital. Before the board decided on the proposal, the health commissioner had to dispel some doubts. As a medical expert, he opined that using the Fever Hospital in its current condition would be more dangerous to the public than accommodating contagious patients in the Emigrant Hospital at Quebec, as he believed cholera not to be contagious. The only advantage of the hospital at Pointe-Lévy was that its remoteness made it more agreeable to the contagionist prejudices of the general public. Contagious diseases like smallpox could be treated at the Emigrant Hospital as safely as at Pointe-Lévy and would not require the expenditure necessary to sufficiently and permanently equip the Fever Hospital. Satisfied with the commissioner’s answers, the board agreed to implement the proposal.42 The appointment and supervision of the health wardens was another issue that required the Board of Health’s immediate attention. The applicant selection process was referred to the board’s committee on rules and regulations. Another committee was established to draw up instructions for the health wardens, who would be equipped with a certificate, a sign to mark their houses and signal the authority conveyed to them by the board and the government, and a badge allowing them to identify themselves on duty. Each warden’s first task was to compile a list of houses in the ward by street name and number, the name of the owner or proprietor, the house’s tenants, the number of apartments in the house, and further details from all sources available. The wardens were to inspect their wards three times per week to ensure compliance with regulations and then to issue a regular report to the board. When the wardens observed infractions, they were allowed to enter any premises during the day, only in their function as wardens and only after identifying themselves as such. To ensure the continuous presence of wardens throughout Quebec, they were required

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to reside in their wards during the duration of their appointments. The wardens officially took up their duties on 28 April 1832.43 With the newly created institutions in place and the shipping season quickly approaching, the Board of Health turned its focus to getting the work under way and improving the condition of the city by removing every possible exciting or predisposing cause of cholera and bringing the urban space into a state of perfect cleanliness. After the long winter, Quebec needed a spring cleaning. A committee to enforce the cleanliness of the city had already been established in March.44 With the health wardens now monitoring the city and reporting nuisances, the success of the campaign for cleanliness depended on the population’s cooperation. Now the people of Quebec had to do their part—but they did not fully live up to the authorities’ expectations.45 Soon letters arrived at the Board of Health’s office complaining about nuisances. Citizens denounced their neighbors, fearing the predisposing influence of dirt and sewage in their vicinity. The wardens filed their reports, too, several times per week, stating their observations and accounting for their actions. The existing system of house numbers and street names made the information given to the board very specific, providing it with details that allowed officials to identify dangerous places and act accordingly. Proprietors and tenants of houses or lots reported as unclean or unhealthy were ordered to clean their premises immediately—under threat of eviction of all persons living there. The residents mostly complied with the board’s demands, but many times the board had to order the local warden to empty, clean, or shut up houses or apartments. To assist the wardens’ more mobile surveillance of the urban space, watchmen were stationed at ten locations in the city to look out for filth and dirt being deposited in the streets.46 Some of the nuisances were the regular side effects of certain trades, like candle making and soap boiling. Slaughterhouses were also considered offensive. The Board of Health regulated those trades and threatened severe penalties, but the threats were often met with indifference or noncompliance. The fact that the government itself was far from exemplary regarding matters of cleanliness, as a letter complaining of dirt on government property shows, certainly did not contribute to the public’s observance of the rules. Apart from these cases of noncompliance, however, open resistance was rare.47 Due to the increased attentiveness to the urban space, the perception of the city changed. Since it was unclear which parts or characteristics of the urban environment might predispose the population to cholera, even the most mundane aspects of everyday life could be significant, and thus ordi-

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nary things and events gained a deeper meaning. Pigs roaming the streets, dirt in yards, and flooded cellars received unprecedented attention because people considered them signs of looming danger. Cholera, although still far away, had already altered the perception of the urban space. Fear had forced the colonial authorities of Lower Canada and Quebec to introduce new institutions to watch out for the first indication of cholera’s arrival and to identify the places where it would most likely strike. Even before its arrival, cholera had become a means to integrate the population of the city into the collective effort against the disease. The authorities tried to use fear of the disease to help them realize their vision of a sanitary city free of cholera. Thus, the population’s and the authorities’ activities were essential to the success of their measures against an enemy that was still imagined. This fear was a precondition and justification for the intrusive measures and for comprehensively altering the urban space according to plan. When cases of sickness in the city and suburbs of Quebec were reported, they heightened the state of alarm in the city. Health wardens and commissioners of health reported deaths and cases of smallpox, fever, measles, the common cholera morbus, and other unspecified sicknesses to the board, which subsequently ordered all medical practitioners to report in writing every case of “infectious or pestilential” disease within twelve hours.48 Preparations for Quarantine on Grosse Île Things got serious with the beginning of the shipping season. The planned quarantine station on Grosse Île was a completely new infrastructure that had to be built from scratch in a very short time at a remote location. For this difficult task the government turned to the military. The garrison at Quebec was the only resource at hand that could execute the plan as envisioned by the Quarantine Act and designed by the Quebec Board of Health. One Capt. Reid, the commanding military officer at Grosse Île, along with his detachment of troops and workers and the surgeon of the regiment, a Dr. Griffin, who also served as the health officer for Grosse Île, departed on 1 May for the island. The troops seized a farmhouse and its outbuildings, the only structures on the island, and began to build a hospital and sheds for personnel and passengers. Artillery was put in place overlooking the shipping route to the port of Quebec in case vessels refused to stop for quarantine procedures.49 The commander at Grosse Île, who functioned officially as superintendent of quarantine, had a considerable staff. In addition to the health officer who inspected vessels there was a medical superintendent and assistant who were responsible for medical care on the island. Military personnel

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were in charge of the sheds and sought to maintain order there, a task that proved to be difficult later on, as the superintendent of quarantine had no judicial power to punish infractions, which had to be handled in the civilian courts; they convened in Quebec and were slow. To ensure that the station functioned, a number of nurses, clerks, and laborers were employed and lived there temporarily. Supplying and caring for both the healthy and the sick constituted an enormous logistical task. Even if the Board of Health expected immigrants with sufficient means to supply themselves with food, contractors still had to deliver provisions to Grosse Île, where they were sold at Quebec prices. Only the destitute were provided for from government stocks.50 Only a few weeks after the opening of the quarantine station, the number of incoming vessels and passengers overwhelmed the improvised establishment. The regulations worked imperfectly. Pilots and masters of vessels ignored the new rules, and ships arriving at Quebec without a certificate had to be sent back downriver. These incidents also raised questions regarding the thoroughness of the health officer and the other authorities at Grosse Île. Queries revealed that the health officer there had “certain difficulties” boarding vessels.51 Already under pressure and with the number of incoming ships still rising, he was unable to personally examine every vessel and instead had to rely on the master and the passengers for his assessment of the sanitary conditions aboard. If they lied to him, he had hardly any means of exposing their deception. Although Griffin’s commanding officer reported this attitude as negligence, the Board of Health concluded that a review of the regulations was necessary and appointed an assistant, a Dr. Fortier, to share Griffin’s workload and assist with inspections.52 Cholera in Town Most of these problems and discussions moved to the background and some even became obsolete when several deaths from a yet unknown disease were reported to the Quebec Board of Health on 9 June 1832 and, a few hours later, eight confirmed cases of Asiatic cholera were admitted to the Emigrant Hospital. Not only had the disease arrived in Lower Canada but the plan to avoid an epidemic by confining cholera to Grosse Île had failed—due to either negligence or the etiology of the disease. But the notion of cholera not being contagious could account for the failure of only one strategy. The efforts to create a clean Quebec had apparently not changed the local environment sufficiently to prevent a noncontagious cholera from existing in the city either. Here, too, negligence or the unknown nature of cholera could be blamed, although the debates about the

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failures and shortcomings of prevention were moot now. The disease was already in the city, and in the days that followed the number of new cases climbed. The Board of Health needed to change its strategy. It had to rearrange and redeploy the resources at hand to cope with the new situation. Prevention had failed; now containment and mitigation were to be the course of action. First Reactions Reports of several cases of the common cholera morbus at Grosse Île had alarmed the Quebec Board of Health before the actual outbreak. It had sent its chairman and the health commissioner to visit the station immediately in order to evaluate the situation and determine if the disease could be of the severe, Asiatic variety. The board also delivered chloride to the island for precautionary disinfection. When the health commissioner and the chairman returned to the city, they assured the board and the public that the disease at Grosse Île was not Asiatic cholera but the common form of the disease, several cases of which were also currently being treated at the Emigrant Hospital. It was not until 9 June that some practitioners on the board realized while visiting those patients at the Emigrant Hospital that they were indeed suffering from Asiatic cholera.53 Before the outbreak of cholera, about twenty-five thousand passengers had already arrived at Quebec that year and at least as many were expected before the end of the shipping season. Many of them were suffering from cholera, had traveled with sick passengers, or had come from ports where the disease was present. The station had already worked beyond capacity to process the thousands of arrivals and was now overwhelmed with healthy, sick, and dying persons. Immigrants already crowded the insufficient sheds and the hospital, but the outbreak of cholera forced the Board of Health to tighten quarantine regulations. By July, it required all steerage passengers and their baggage to be brought onto the island for washing and disinfection. This order caused a further deterioration of conditions there, as more than a thousand immigrants had to compete for limited supplies of water.54 After the first cases of Asiatic cholera in the city had been confirmed, the board had to react. The preparations for medical treatment already seemed to be insufficient, so the board decided to lease a building in the Lower Town, the neighborhood where most immigrants stayed after their arrival, and to equip and designate it as a hospital exclusively for cholera patients. But amid the chaos of the crowded Lower Town, further actions were less well defined. The board had to devise a new strategy, and for that it required reliable information about the situation. It thus ordered all med-

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ical practitioners to report probable cholera cases and deaths and to destroy or purify the soiled clothing and bedding of cholera patients or victims. As a second step the health commissioners planned to investigate all cholera cases and try to determine where they had occurred. Evidently, these were dangerous locations that the health wardens had to have cleansed and fumigated to render them safe for their occupants. It soon emerged that the cases were indeed concentrated in the Lower Town, where the mostly French Canadian lower-class population lived in proximity to recently arrived immigrants, who had found temporary accommodations in crowded taverns, boardinghouses, or rooms let by resident families until they could continue their journey to the interior.55 Although the board reacted quickly to the outbreak, its public relations work was far from effective. After issuing its first report, which acknowledged the existence of Asiatic cholera in the city, it remained silent for several days. The frightened public interpreted this quietude as a sign that matters were worse than expected. Panic spread, and many residents fled the city. The newspapers published instructions on how to avoid the disease, as well as recipes for cures. Reports on nuisances that the board had overlooked or neglected reinforced the tense atmosphere. The Quebec Mercury condemned those who fled the city for contributing to the panic and suggested that they had endangered themselves since they now were farther away from competent medical aid. Those who stayed pointed to the newspaper reports as they pressured the government to accept their petitions—against the Emigrant Hospital, for example, or the use of the shallow new Catholic burial ground for cholera victims.56 The alarm and anxieties were justified, as hundreds of people died during the epidemic’s first days.57 Cholera had chosen the poor and destitute to mark its presence in Quebec, as it had done in India and in the United Kingdom. Since cholera was a disease of the poor, to deal with the disease meant to deal with the poor and the spaces they occupied. These spaces were not difficult to identify since they showed the highest rate of cholera cases reported to the board by practitioners and commissioners and had been known before as disreputable, poor, crowded, and filthy. Prevailing opinion was that the best way to fight cholera was to bring order to these spaces. Reforming the Lower Town Imposing order to fight cholera in Quebec first and foremost meant changing the environment of the Lower Town. In the first days of the epidemic, the Quebec Board of Health targeted Cul-de-Sac, Champlain, Saint-Paul,

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and Saint-Charles Streets, where most cases appeared. It ordered the proprietors and the road surveyor to disinfect all filth there with lime for several days and then remove it, along with any rubbish. Champlain Street, where most of the cases occurred, was to be sprinkled with chloride of lime immediately. A couple of days later the board thought similar measures necessary for all the houses on Cul-de-Sac, Champlain, Saint-Charles, and Saint-Paul Streets. It ordered all residents and the wardens to thoroughly whitewash, fumigate, and scrub the houses with chloride of lime and to cover yards with common lime. This effort overburdened the health wardens in the Lower Town, and the board had to order their underemployed Upper Town colleagues to assist them.58 To the board members, the stench and filth of the Lower Town were only the result of the overcrowded conditions there. To get to the root of the problem, they had to reduce the number of people living in the Lower Town. Since distributing the immigrants among the existing population in the more respectable quarters of the city and suburbs would cause considerable backlash against a government that needed citizens’ cooperation, the only alternative was to banish the immigrants from the city. A tent camp on the Plains of Abraham outside the city walls was the most viable option. The immigrants were in no position to protest such a measure, and the tavern keepers and owners of lodging houses had no significant political backing either. With the governor supplying army tents and with troops nearby to quell potential protests, the board decided this open space would be a most convenient solution to the problem at hand. The most troublesome segment of Quebec’s population would be under military control, and a cause for concern among the permanent residents had been removed. But relieving the overcrowding in the Lower Town for the moment would not solve the problem in the longer term as long as new immigrants arrived every day and took the place of those removed to the camp. The board had to limit the influx of immigrants arriving at Quebec, and it did so by forbidding the landing of passengers in the port except for those “in a healthy condition and destined to Montreal.”59 The authorities tried to forward as many immigrants as possible directly from Grosse Île to Montreal or at least to keep them on their ships, regardless of the situation on board. This restriction would ease the situation in the Lower Town as well as lessen demand for hospital beds and personnel, for it had become clear after a few days that cholera could not be confined to the Lower Town. A considerable part of the permanent population had found refuge with relatives or friends in the countryside when cholera had first appeared, but

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there were still more than enough people left for the disease to spread to the suburbs and the respectable quarters of Quebec.60 Expanding Anticholera Efforts Cholera’s spread to the Upper Town and the suburbs further challenged the already overwhelmed makeshift public health institutions. Now all of Quebec, in terms of both space and population, had to be surveyed and, if necessary, altered, but again the authorities could not succeed by coercion. The cooperation of the population was more essential than ever, as the Quebec Board of Health was now not dealing only with immigrants or the local lower classes in a closely defined space. The board and the representatives on the ground, the commissioners and wardens, could not ensure cleansing, disinfection, or fumigation without the active help or at least tacit agreement of the wealthier and more prominent permanent residents. A centralized effort to disinfect all houses in the affected parts of the city could not be accomplished due to lack of resources. Instead, the board had the health wardens distribute chloride of lime among residents of the city. Permanent residents who could afford the disinfectant were charged eight pence for a pint while the poor and destitute received it for free, but the authorities could not control its proper use. At times the board had to resort to force in order to improve local conditions in houses where cholera had appeared. In the case of one particular house on Saint-Louis Street the board ordered the responsible health warden to remove all sick people from the house and then to purify, ventilate, and disinfect it.61 This procedure was somewhat unusual, as houses were supposed to be purified and fumigated only after a death had occurred, and the possessions of the deceased could later be returned to his or her relatives and friends after purification. Fumigation was another method of improving conditions in places where illness existed. For houses, fumigation could be used without any problems, but for a comprehensive application across the whole city they again relied on the population’s cooperation. Thus, the board required the people of Quebec to simultaneously burn tar, turpentine, sulfur, resin, and “such other anti-contagious combustibles” between six and ten o’clock in the evening from 14 June 1832 onward until further notice.62 The material for fumigation could be purchased from local merchants, and poor citizens could receive the material without charge.63 Disinfection and fumigation, however, had to be part of a regimen of scrupulous cleanliness. If filth had formerly pointed only to a potential if somewhat vague danger, it was now a clear and easily identifiable threat closely connected to actual cholera cases. Numerous complaints

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soon reached the board calling attention to crowded, filthy, and disorderly “houses of ill fame” and demanding they be shut up to eliminate these “public nuisances.”64 The board usually conveyed these complaints to the health wardens for investigation, and, if they found them to be justified, the proprietor or tenant was granted a few hours to correct the situation. If the results were not satisfactory, the house would be emptied and remain shut up until it was thoroughly cleansed and disinfected. During this procedure the residents had to stay in the camp on the Plains of Abraham. In the eyes of a panicking and sometimes skeptical public, the board’s enforcement of cleanliness was undermined by the neglect of government institutions. Complaints about the poor conditions at the artillery barracks reached the board even though it had no authority there. Since its inception the board had had to urge and plead with the military to improve the cleanliness of its premises, apparently with limited success. For example, after several requests by the board that the military clear a clogged drain, the board finally sent a rather indignant letter to the governor demanding the military’s compliance in efforts to fight the epidemic.65 The alteration of the urban environment by removing the supposed predisposing causes of cholera had been the board’s responsibility from the beginning. The longer the epidemic lasted, the clearer it became that this measure would not be enough. As in Madras, the manifestation of cholera in the urban space was increasingly correlated to its manifestation in individual patients. Thus, the filth on the bodies of the poor became associated with the filth in the streets. The destitute condition of the poor was thought to further increase their likelihood of contracting cholera, and those surviving the disease often had only soiled clothes to wear, thus endangering others by spreading potentially morbific matter. The board addressed the issue by providing funds to acquire new clothing for poor convalescents.66 The public’s predisposing behavior was less easy to control or improve. As more and more people succumbed to the epidemic, the mood in the city became a concern. It was a widely held belief among medical experts that even the fear of cholera altered the human body and mind to predispose a person to the disease. At the same time, a certain amount of civic order was considered crucial if the authorities were to successfully implement measures against cholera. A city in a permanent state of panic made efficient countermeasures impossible. This concern led the board to publish reassuring messages in the newspapers, but it also resorted to more subtle measures—it asked the parish priests of Quebec and Saint-Roch not to ring the bells for every burial so as not to alarm the public any further.67

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Yet, the effects of the epidemic on the city’s residents were difficult to ignore. Many who could afford to had left—leaving behind their jobs and positions. Their absence struck further fear into the minds of the poorer population, who felt exposed to a threat they could not escape. Many believed that cholera was contagious and so they did not go to their jobs, while many farmers of the region refused to come to the markets of Quebec. As a result, food prices rose at a time when public activity had dwindled and business had almost come to a standstill. Immigrants were especially hard hit. Many of them could neither find shelter, as the owners of boardinghouses refused to let rooms for fear of contagion, nor continue their journey to the interior because the prices for steamboat transport to Montreal had risen.68 The rising cost of living was problematic not just because of the misery it entailed. Malnutrition and the consumption of alcohol were considered to be among the predisposing causes of cholera. Clean drinking water was scarce in the city, as the number of good wells was limited and many of them were privately owned. Many residents had to resort to river water, which was considered to be of inferior quality and potentially another predisposing cause of disease. The board had to ask the owners of private wells to provide water to the population of the city, as it was not able to procure enough from other sources. The availability of clean water was especially important because the board was trying to curb the consumption of alcohol, as recommended by the medical profession. Toward that end, the board closed the taverns of the Lower Town, where most of the cholera cases occurred. Alcoholic beverages were also available at food shops, however, and many patrons now sought drinks there. The board saw itself forced to include grocers in the regulations for tavern keepers and prohibited their selling spirituous liquors. That rule merely shifted the sale of alcohol from the shops to the streets. Eventually, the board disallowed any sale of spirits, but it had failed to take into account that brandy was also used as remedy against cholera. Now protesters complained that ordinary citizens no longer had access to what was considered a valuable and effective drug. To reconcile their preventive intentions with the medical use of spirits, the board had to once again alter course and make clear that the rules targeted drunkenness but allowed the use of alcohol for medicinal purposes.69 Coordinating Treatment Although the Quebec Board of Health attempted to alter the urban space and the behavior of its inhabitants to limit the further spread of cholera, the hundreds already suffering from the disease needed medical treatment

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from the authorities. Even if no effective cure for cholera existed, it was the task of any benevolent government to take care of its subjects, and the sight of a medical practitioner treating a relative, friend, or neighbor had soothing effects on the population. During an epidemic of such destructive magnitude, the authorities tried to manage the scarce medical resources available. The sudden burst of cholera cases in the first days after the outbreak had put an immediate strain on the medical personnel of Quebec. The number of practitioners was limited to begin with, and several of them spent much of their time away from their usual practice while they served as health officers, commissioners, or secretaries to the board. Some had to attend board sessions as members or were asked for their opinion and thus lost valuable time that could have been spent with patients. The board mobilized some of the medical resources it had drawn on, assigning its assistant secretary, Dr. Leslie, to the Emigrant Hospital, where most of the cases were brought. It also decided to relieve the staff at the Emigrant Hospital by assigning some medical students not yet ready to treat patients to work as assistant apothecaries there.70 The lack of medical personnel was further aggravated when Dr. Perrault, one of the resident physicians, died of cholera. As such an important position could not remain unstaffed, the board asked the governor to name a replacement as quickly as possible. The other resident physician, Dr. Parant, also fell ill but managed to recover even after most people had already given up on him.71 Perrault’s proved to be the only death from cholera among the medical practitioners, but the workload and the conditions in the hospitals and at Grosse Île overburdened many of them.72 The hospitals bore the brunt of the epidemic. A few days into the outbreak, on 12 June, the board had brushed aside objections from the justices of the peace against the location of the planned temporary cholera hospital in the Lower Town by assuring them that the chosen spot had been thoroughly considered and would not endanger the neighborhood. With this last administrative hurdle cleared, the board resolved to open the new hospital as soon as possible with a staff of two practitioners and some servants, all under the authority of the health commissioner. It took only a few days to get the improvised hospital working. Until then the board had to manage the limited patient capacities as efficiently as possible. The mood at the existing hospitals—and the Emigrant Hospital in particular—was tense. Reports described the situation as chaotic, and the local residents were deeply alarmed by the conditions there. Some members of the board considered those protests serious enough to propose demonstrative appearances of a committee or even the complete board, led by the

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chairman, to reassure the public. The board defeated this proposal, but it highlights why most permanent residents preferred to pay for treatment at their homes instead of taking advantage of the free care available at the hospitals. The poor among them, however, did not have the means to afford medical attention, so they often remained without professional treatment. They resorted to household remedies or the services of unlicensed medical practitioners. Thus, they remained outside the scope of the official measures, eluding government control, diminishing the efficiency of its measures, and demonstrating the authorities’ limited scope of control. The board’s solution was to appoint two physicians in each quarter of the city to take care of the poor victims of cholera. Of course, these practitioners could not be everywhere at once. There were still simply too many cases for the limited number of practitioners to provide optimal attention and care. Long hours of waiting were common for patients and their relatives. The board could help those people only by providing them with remedies for self-medication distributed through the health wardens.73 With the number of cases mounting and the number of beds remaining limited, the board sought to create space elsewhere for patients suffering from diseases other than cholera. Sick sailors posed a particular problem, since they did not have local homes where they could be treated. One simplistic way of coping was to keep them away from the city, so the board encouraged masters of vessels not to allow crews to come ashore. This request had only a limited effect. Regardless of what had happened in a city, after a long voyage sailors would venture into it, and, invariably, some would contract disease. Earlier regulations demanded that they be brought to a hospital, but doing so was no longer an option during the cholera outbreak. Yet, to leave them without treatment or supervision was not acceptable either, and the board decided to allow them to be accommodated in regular boardinghouses if they could show a certificate of health from a medical practitioner stating that they did not have cholera.74 Unexpected Ramifications As if organizing medical treatment and coordinating the removal of predisposing causes from the urban environment were not enough, a number of unexpected issues related to the cholera epidemic demanded the Quebec Board of Health’s attention. One was the transportation of the sick and of corpses. All kinds of carts were used for that purpose, and as the patients were soiled with vomit and excrement, so were those vehicles. For obvious reasons, the board had to ban at least the use of meat carts for the transportation of cholera patients.75

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Even more gruesome was the question of what to do with all those bodies of cholera victims. It often was difficult to identify the corpses at the hospitals when no friends or family were available. As a result, resentment among both immigrants and permanent residents of Quebec grew, as an incorrect burial at the wrong cemetery would put salvation in doubt. The clergy members on the board took up these anxieties and insisted on rules that would ensure the proper liturgical treatment for the deceased of their congregations. To transport the coffins to the cemeteries, the board hired carters and provided vehicles with canopies. Rumors went around Quebec that carters were not particularly discriminating about their cargo, with some carters reputed to have collected and buried comatose patients. That the bodies of many immigrants and resident poor were interred in mass graves outside the consecrated cemeteries further unsettled the public. Because the gravediggers were so overwhelmed and could not excavate graves at the required rate, the board hired ten laborers and set a goal of having no bodies remaining unburied at nine o’clock each evening. Labor, however, was not the only problem, as space at the cemeteries was becoming scarce, even at the relatively recently opened Catholic cemetery. Sanitary precaution dictated that coffins had to be buried at a certain depth and that not more than two were to be put in a single grave, with some lime on top of each for disinfection.76 Given the workload and pressure, members of the Quebec Board of Health not surprisingly began to feel the strain. They had to make numerous momentous decisions about life and death at every meeting, and even two daily meetings were not enough to deal with all the problems at hand. Many board members, especially the medical practitioners among them, had various other duties to attend to that did not allow for their regular participation, and at times only a fraction of the members were present. The functioning of the board, however, was not compromised by the many absences. Decisions were made and only on rare occasions were all members summoned to deliberate on a particularly important issue. The heavy workload also offered a justification for monetary compensation. The board granted themselves a pay raise for their demanding service but also increased the allocations to hospital attendants and other people employed during the epidemic.77 The Epidemic’s Abatement and Aftereffects The first few weeks proved to constitute the epidemic’s peak. On 24 June 1832 the Quebec Board of Health published an advertisement in the local newspapers stating that the epidemic was abating. The statement re-

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ferred to a decline in cholera cases and deaths reported to the board, which was supposed to ease citizens’ fears, but the epidemic was not over and the board had plenty of work yet to do. People were still dying of cholera every day, but the decline in cases did allow the board and the institutions it had created to abandon the frantic pace of meetings and decision making that had characterized the preceding weeks. There was now time to consider important issues beyond immediate crisis management. For the board’s budget, the decline in cases came at the right time. The funds provided by the Quarantine Act were almost exhausted, and the easiest way to reduce expenditures was to release some of the board’s employees, even if doing so was inconvenient for the patients and their relatives.78 The performance of these employees and the regulations under which they operated now came under scrutiny. Since the plan to prevent an epidemic had failed, the board tried to determine what had gone wrong. The first possible culprit was the quarantine station on Grosse Île. The board quickly found out that pilots and masters of vessels had violated regulations and that customs officers had broken the law. These cases were transferred to the responsible judicial authorities for prosecution.79 Addressing complaints about the health officers at Grosse Île, Drs. Griffin and Fortier, was the board’s responsibility, as it had designed the quarantine regulations the two doctors had been assigned to uphold. Allegedly, both officials had neglected their duties. While the accusations against Griffin were more general in nature and went back to the time before the cholera epidemic, Fortier was incriminated by the master of a vessel who declared that the officer had refused to inspect the sick passengers on board. Both Griffin and Fortier were asked to defend themselves, and both stressed the difficult circumstances at the station, as well as the lack of cooperation from crew and passengers of incoming ships. They had had to bend the rules in order to achieve some kind of results. There had been no alternative. Grudgingly, the board accepted this explanation, and although it insisted on stating the health officers’ negligence, it paid them their outstanding expenses and decided not to issue a reprimand.80 The subsequent review and reissuing of quarantine regulations for the rest of the shipping season can be interpreted as the board’s confession of its own failings. The new rules reduced the role of the health officer and shifted more responsibilities to the medical superintendent on the island. Now all vessels with more than fifteen passengers on board had to land them at the quarantine station. There the passengers would have to wash themselves and their belongings and afterward undergo inspection by the medical superintendent, who would send the sick to the hospital. In the

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meantime, the vessel was cleansed, ventilated, and whitewashed. Those who were allowed to continue to Quebec could re-embark only after the medical superintendent had issued a certificate confirming the proper landing, cleansing, and medical inspection of the ship. The health officer at Grosse Île still had to visit all the ships but had no discretionary power. If met with resistance on board, the health officer was free to request military force in order to gain access. Only after the inspection and the passengers’ return with a certificate issued by the medical superintendent could the officer permit the ship to proceed to Quebec. There, all vessels still had to anchor at the mouth of the Saint-Charles River without any form of communication with anyone on the shore until they were boarded by the Quebec health officer, who then had to report to the board and was not allowed to grant pratique (withdrawal from quarantine) without explicit permission. These revised rules and regulations went into effect immediately and were conveyed to the relevant institutions.81 As Quebec’s first defense against cholera, quarantine had failed, but the same was true of the efforts to rid the city of predisposing causes. For that failure the Board of Health was directly responsible. The continuing presence of cholera in the city was proof that much was left to be done, and the board intended to keep up the pressure. Parts of the population, however, considered the abatement of the disease a signal to return to normal. Tavern keepers almost immediately asked for permission to reopen their establishments. At first the board denied their requests, but it quickly reconsidered its position. On 12 July 1832, the existing orders were rescinded under two conditions: the sale of alcohol had to stop if the customers became intoxicated, and any sale of alcohol after nine o’clock in the evening remained prohibited. The board declared that it would hold the provider of alcoholic beverages accountable if inebriated customers were found, and the health wardens were charged with enforcing the restrictions.82 Although the board was willing to loosen its controls on the sale of alcohol, it would not let go of its ambition to cleanse Quebec. Both board and wardens still dealt with seemingly petty nuisances, such as a horse being kept in unsuitable conditions, water being thrown from a window onto the street, neglected alleys, crowded and filthy houses, and a dead cow near a house. With cholera present, attention to detail was still deemed essential for fighting the disease, and such violations led the board to regularly remind city dwellers that it was still enforcing the rules. However, the decline of cholera cases over the course of the summer gave the board the opportunity to target its actions more accurately. Disinfection was increasingly used to alter the condition not of the city as a whole but of spe-

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cific spaces, such as houses where people had died of cholera. For this task the board appointed a special health warden who could react immediately. Within six hours of a death during the daytime or within ten hours of a death at night and as soon as the body had been removed from the house, this warden went to work. If a patient had survived, disinfection had to take place as soon as possible after his or her recovery or, when ordered by a commissioner, even during the illness. The other health wardens were required to report deaths or recoveries from cholera to the disinfecting warden, who would then fulfill duties of office. Proprietors of disinfected houses, vessels, or boats had to bear the expenses. If they were too poor to do so, however, the board would pay for the service.83 Many measures taken by the board constituted a severe infringement of citizens’ personal rights and privacy. The board had assumed a position of power and even used force, but the results of its actions had been questionable at best. With the pressure from cholera declining, a broad backlash was forming. At the end of August the sometimes latent, sometimes articulated dissatisfaction with the board among the population found public expression. The first to speak up were the local medical practitioners who felt unfairly treated by a board that prosecuted them for—in their opinion— minor infringements of the rules and regulations while they were—again, in their opinion—working constantly and under great strain in order to provide care for cholera patients. At a meeting of medical practitioners, fourteen attendees decided to establish a committee to collect, publish, and advocate their grievances against the board. Their critical report was released after the epidemic; they were hardly alone in their discontent.84 The citizens of Quebec were equally dissatisfied with the situation in the city and shared the practitioners’ sentiments. At a meeting on 20 August they seized the initiative and set up their own sanitary committee, following the example of the people of Montreal. The committee’s purpose was the improvement of sanitary conditions in Quebec, a task the local Board of Health had been incapable of performing satisfactorily. The chaotic burials, as well as the cleansing of houses and premises where people had died of cholera, had especially upset the citizenry. The sanitary committee was a charitable organization; within three days, it had recruited two hundred volunteers who would serve as health wardens without remuneration. Despite the public criticism of its previous efforts, the Quebec Board of Health welcomed these activities. In its reaction, it highlighted its own superior position as legitimized by the Quarantine Act. However, it also acknowledged that it had failed to protect Quebec from cholera as intended, due to a lack of cooperation by both the city’s administrators and

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the population, although it had tried its best to address the issues raised by the committee. It explicitly welcomed the sanitary committee’s proposals and granted volunteer health wardens the same rights and duties as their official colleagues. One result of the higher number of wardens was a new flood of reports to the board on nuisances such as unclean houses and apartments, a horse kept under the stairs of a house, and a sow and her piglets kept in a cellar. This increased attention also meant that the government itself did not get away with several offenses against cleanliness, such as the state of the drains under the jail or the dirty streets around the military barracks. Efforts by sanitary committee volunteers improved the surveillance of the urban space but also accelerated normalizing activities. More and more of the houses that had been shut up earlier were reopened and inhabited again.85 As the city began to return to normal, the medical community had time to systematize their observations of cholera and to come to scientifically sound insights. From the very beginning, the epidemic in Lower Canada had attracted the attention of medical experts and authorities across North America because it was the first location on the continent confronted with cholera. The mayors of port or transit cities and towns, such as New York, Troy, and Albany in the United States, sought to learn from the experience in Quebec and Montreal, since they had to deal with similar numbers of immigrants arriving or passing through every year. The Quebec Board of Health replied with the requested material, which satisfied at least one of the inquiring parties. The Sanitary Board of Philadelphia even sent a delegation of three physicians to Quebec and Montreal to investigate the disease. In their published report they compared conditions at Quebec, Montreal, and several smaller towns and villages where cholera was also prevalent on the route to the United States to find out what to expect from the disease. They stressed the various predisposing causes to which both the permanent and immigrant populations were exposed. The delegation investigated living conditions, as well as the local way of life, and it compared the inhabitants’ behaviors to the spatial behavior of cholera. It had found a correlation between the local environment, in which the poor lived, and the presence of cholera. Their reassuring conclusion was that the peculiar reasons for the outbreak of cholera in Lower Canada did not exist in Philadelphia. Therefore, an epidemic was unlikely or, if cases did appear, they would likely be confined to certain environments, such as narrow alleys or streets. To the authorities they proposed measures similar to those adopted in Quebec. For individuals, their recommendation was morality and temperance.86

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Those guests from Pennsylvania were not alone in their scientific interest in the epidemic. Within a few days of cholera’s appearance in Quebec the Board of Health had ordered the health commissioner to inquire into the origins of the outbreak. He investigated the first twenty cases with special attention to the immigrants’ port of departure and the ships on which they had traveled.87 Inquiries regarding the nature and treatment of cholera, which had been commissioned by the board, continued throughout the epidemic.88 A comprehensive evaluation of current medical opinions on both cholera and the handling of the epidemic by the board began only after the number of cholera cases had declined. But it was not the board itself that took the initiative. On 27 August members of the medical profession met and decided to devise a questionnaire to distribute to all medical practitioners of Quebec. The board was not involved in this process and learned of the effort only when Leslie, the board’s former assistant secretary, conveyed the questions and his answers. The evaluation focused on three issues: the city practitioners’ experience of cholera and the disease’s behavior, their opinion on the utility or harmfulness of the measures ordered by the board, and possible improvements of measures to be taken against cholera in the future.89 Dismantling the Anticholera Infrastructure Anticholera measures continued well into the autumn of 1832, as did the cholera epidemic itself. On 13 September the board announced “the almost total disappearance” of cholera from the city and suburbs of Quebec, with only eleven patients remaining hospitalized.90 Most of the measures against cholera had been designed to be temporary, and with the end of the shipping season approaching the Quebec Board of Health started to disassemble this infrastructure. On 1 October the dismantling of the camp on the Plains of Abraham began, its remaining inhabitants being asked to seek winter accommodations elsewhere. The cholera hospital in the Lower Town was closed as well but kept in a state of readiness by a steward.91 The board discharged the first salaried health wardens on 29 September and some more on 29 October, although there were still regular reports of environmental nuisances in the city that had to be removed. The remaining wardens had to assume responsibility for larger sections of the city, but with the decrease in cholera cases the urgency of cleanliness began to wane. While such routine tasks constituted the bulk of matters the board still had to tackle, some new challenges connected to cholera arose. When the board learned that a canal was draining the Protestant cholera burial ground into the Saint-Charles River, from which the people of Saint-Roch took their

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water, it immediately became concerned and ordered the ditch to be filled in.92 The station on Grosse Île remained in operation until the end of the shipping season on 1 November. The last few incoming ships were to be sent directly to the anchorage at the mouth of the Saint-Charles, where they would await the health officer. The subsequent procedures would remain unchanged.93 On 17 November, the Quebec Board of Health decided to meet only once per week from that day on.94 The cholera epidemic was over, and the workload for the board had declined accordingly. There were still things to be done, but the state of emergency that had characterized the preceding weeks and months had come to a close. The board did not mark this event with self-congratulatory remarks. In many respects it had failed to achieve its purposes. Despite all efforts, it had been unable to meet the high expectations of the government, the Legislative Assembly, and the population to keep cholera out of Lower Canada; it had been incapable of changing the urban environment in a way that would prevent the existence of cholera there; and it had not been able to manage cholera in a way that would have limited the number of casualties and satisfied the population. Nevertheless, the board tried to leave a positive legacy. On 22 December it passed another set of rules and regulations that were intended to make Quebec a clean city during the winter, although its authority to enforce them was about to expire.95 On 31 December 1832, the board sent its Report of the Proceedings of the Board of Health to the assembly, marking the end of its existence as the last and most important of the temporary institutions created for the fight against cholera. In this elaborate statement, the board accounted for its actions, justified or explained its shortcomings, and proposed improvements for the coming shipping season. Grosse Île received much of the attention. The board emphasized the achievements made there despite the limited time frame for preparation. The fact that quarantine had failed was not entirely the result of negligence or adverse circumstances but was attributable in part to the disease’s character, which made it difficult to detect during its early stages. The board acknowledged that some of its assumptions when designing the rules and regulations had been wrong, thus contributing to the failure to prevent the disease. Many pilots, for example, were illiterate and could not read the instructions sent to them. This, however, could not justify the numerous instances in which pilots or masters of vessels had deliberately ignored the quarantine regulations. The board recommended that better infrastructure would allow quicker and safer landing and movement of passengers on and off the island. All passengers and baggage could then be brought to the station for

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inspection and disinfection. This, in turn, would require additional accommodations and supplies, which would make a proper market on the island a necessity. When it came to the hospitals, the board was satisfied with its own measures. Its preparatory actions had been a compromise between cost control in case cholera never arrived and preparing for a worst-case scenario. It pinned its hopes for the future on the new Marine Hospital, construction of which had been approved in 1831. It was far from being complete, however, and therefore the board recommended the retention of the Cholera Hospital in the Lower Town in case the disease returned the following year. The effort to clean the urban space satisfactorily, however, had failed. The board pointed to local conditions that had hindered its efforts and hoped that the situation would improve with the imminent incorporation of the city. It recommended the reopening of the camp on the Plains of Abraham in the coming year to prevent the dangerously high population density in the poorer quarters from the outset; a limit on the sale of alcoholic beverages in taverns and elsewhere; an improvement of the drains that carried sewage out of the city; the paving of the streets, especially in the suburbs, whose condition had hampered their cleansing; and a general improvement of cleanliness in the city, which would require an effective cooperation of the different authorities and institutions of Quebec. It also suggested the establishment of a permanent Board of Health, perhaps under the authority of the soon-to-be-incorporated city. Finally, the board expressed its gratitude to its officers, especially the commissioners of health.96 Cholera Returns The disbanding of the Quebec Board of Health and the expiration of the Quarantine Act did not mean an end to the threat posed by cholera. The disease was still present in Europe and even spreading to countries yet unaffected there. With the commencement of the shipping season in the spring of 1833, tens of thousands of poor immigrants would once again begin arriving at the port of Quebec, and, as in 1832, the majority of the population would identify them as carrying the disease. The medical experts were still unsure about contagion, but they again associated the epidemic with the filthy and destitute state in which the migrants reached Lower Canada. On 1 January 1833, the political framework in which preparations for the upcoming shipping season would be made had changed. The city had been incorporated, and its new charter had established a new political order. Instead of the justices of the peace, an elected city council headed by a mayor now governed Quebec. The council had more powers than the

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previous regime had had but also more responsibilities. Now the local population and their representatives had control over the city’s finances. The municipalities could raise taxes, set up their own budgets, and decide on which services they wanted to spend the money. Popular representation did not, however, fundamentally change the local power structure. Although the council gave more power to French Canadians than had the previous regime, it was still dominated by established elites. Of the first twenty elected councilors, sixteen were of French descent. This did not mean, however, that the anglophone merchant elite had been stripped of its influence. On the contrary, its representatives held important positions in the committees that formed the backbone of municipal administration.97 Public health was among the city’s new responsibilities. On 6 May 1833, the city council established the Health Committee, comprising seven councilors who would prepare the city for the shipping season and, ideally, prevent another cholera epidemic. As a strictly municipal institution, the committee had as its main focus the cleanliness of Quebec, although the provincial government had retained authority over the Citadelle by the Plains of Abraham while Grosse Île remained under military control.98 In the winter of 1832–33, the assembly discussed a new and stronger quarantine bill that would replace the expired and ineffective act of 1832. The new legislation would provide funding for the upcoming shipping season and extend the powers of the municipalities when challenged by epidemic disease. The bill was defeated, however. The opposition within the assembly to government measures against cholera reflected the skeptical or even hostile mood of a population that had endured the intrusive practices in place in 1832 without any tangible benefits for their health. Thousands had died while government officials had infringed on their individual rights and property. The governor reacted to the legislative rejection by declining to name a new Board of Health with far-reaching authority. Instead, working under the legal basis of the old Quarantine Act of 1795, he established the new Council of Health, which had only advisory functions. This council recommended reopening the quarantine station with only minor alterations in the quarantine regulations, preparing accommodations for immigrants at a location closer to the city than the Plains of Abraham, and reusing the old Emigrant and Cholera Hospitals.99 In the end the government could decide whether it wanted to follow those proposals or not. These new political and institutional arrangements appeared to have the desired effect, as no cases of Asiatic cholera were recorded at Grosse Île in 1833. People had died of cholera aboard incoming ships, but no cholera patients arrived at the station. Accordingly, there was no outbreak there

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and no case was diagnosed at Quebec that year. Apparently, the changes at Grosse Île had worked and rendered the island less receptive to the disease. However, cholera was still present in many parts of Europe at the end of the year, so the danger of a recurrence remained. In the winter of 1833–34, the Legislative Assembly once again deliberated the issue. Additional preventive measures against cholera were again considered by both the government and the assembly, but again they could not agree on legislation to improve the existing arrangements. The one bill they could agree on—a tax on immigrants that would raise four thousand pounds for destitute cholera patients—was rejected by the imperial government in London. Without a mandate for new measures and with the shipping season approaching, the government resorted to its well-worn paths. It reopened Grosse Île under military authority, and the regulations prescribed under the Quarantine Act of 1795 strongly resembled the revised rules applied in late 1832: all passengers had to land on the island, where they would wash themselves and their baggage; ships from abroad with more than fifteen steerage passengers aboard would remain at Grosse Île for forty days or until released; ships with fewer than fifteen passengers could, if all had been found clean and healthy at inspection, proceed directly to Quebec; and vessels arriving there without undergoing quarantine procedures at Grosse Île would be sent back.100 With the arrival of immigrants in large numbers, with the same people in charge at the station—Captain Reid as commandant and Dr. Fortier as health officer—and with almost identical regulations in place, the problems at the quarantine station in 1834 proved to be similar to those of two years before. The station was soon crowded with passengers struggling to undergo the mandatory washing and cleansing. Sheds provided insufficient accommodation for those who had to stay on the island. From May 1834 onward, ships with cholera cases aboard arrived at Grosse Île. Tensions among the staff at Grosse Île appeared, just as they had in 1832, with Captain Reid accusing Dr. Fortier of negligence, just as he had Dr. Griffin two years earlier. Again the health officer had refused to enter ships for inspection and instead had only interviewed masters or pilots. Like his predecessor, Fortier claimed the inadequacies of the quarantine regulations and his heavy workload as the reason for his violation of the rules. He was supposed to treat patients ashore and inspect all incoming vessels. If cholera was contagious, he asserted, his presence aboard a diseased ship could cause him to transmit the disease to the station or healthy vessels.101 Passengers suffering from cholera soon began arriving at Grosse Île. The news quickly reached Quebec, where it caused great concern among

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the public and the local authorities even though there were no cases in the city yet. The municipality had to react, but it was institutionally inexperienced and, more important, cut off from provincial funds. It had to raise on its own the money for all preventive measures against a possible epidemic. On 30 May 1834, the Health Committee submitted a list of proposals to the city council. It called for the publication of municipal regulations regarding the cleanliness of private spaces such as yards and cellars. Reported violations would result in immediate prosecutions. Public spaces such as streets were now a municipal responsibility. As the Road Office was busy, the Health Committee asked for permission to act independently and employ carts to remove filth from public locations as well as procure lime or chloride for the disinfection of streets. The city council, however, did not have the funds to implement even these modest proposals.102 Consequently, the authorities had to rely on private initiative to find some of the required funds if they wanted to do anything in preparation for a cholera outbreak. Widespread fear of immigrants generally proved to be an incentive, as it allowed the Quebec Emigrant Society to tap these resentments, as well as the public’s generosity, to raise money for anticholera measures. As welcome as these activities were for the cash-strapped Health Committee and city council, these funds were controlled by an organization beyond its control that had for years supported those destitute immigrants who were helpless through no fault of their own. The society issued a subscription in the spring of 1834 and received two hundred pounds to reopen the cholera hospital in the Lower Town in early June.103 The preparation of the cholera hospital had been a wise decision. At the end of June, a first if somewhat dubious cholera case was reported from the Emigrant Hospital. The physician in charge was not entirely confident in his diagnosis, as the patient had arrived on a vessel reportedly unaffected by the disease. He therefore considered a case of common—and not Asiatic—cholera a possible explanation. Soon afterward, however, on 11 July 1834, several cases of Asiatic cholera were confirmed and reported by the Health Committee to the council. Now it was a fact. The dreaded disease had reappeared, and it was spreading quickly. It most affected those quarters of the city that also had shown the highest number of cases during the previous epidemic. As in 1832, at first mainly immigrants fell victim to the disease, but soon it also attacked the resident population of the Lower Town and the suburbs. The council and the mayor could not do much to mitigate the effects of the epidemic or prevent its further spread by altering the urban environment. They were without funds, and the provincial government was generally unwilling to commit resources to the city—

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although it did make some minor exceptions. A last attempt to gain the necessary resources failed when the government declined a request by the municipalities of Quebec and Montreal to put their cities under quarantine and therefore grant their councils additional powers. They had to do what they could with what little they had at hand. To avoid a panic, which in the opinion of many medical experts would further predispose the population to cholera, municipal authorities tried to hide the truth of the epidemic’s extent from the public. This worked only to a certain degree but was aided by this epidemic’s slightly less grave character. A panic as extreme as in 1832 was thus avoided, but nonetheless around one thousand people were said to have left the city.104 Because extensive measures were too costly, the hospitals had to carry the burden of the fight against cholera more or less alone. Although treatment was the only way to contain and mitigate the epidemic, this focus did not translate into better therapeutic care than what had been available two years earlier. Beds and funds were again limited, and the city council asked the provincial government to pay a subsidy that would allow the municipality to temporarily open the new Marine Hospital to cholera patients. The Marine and Emigrant Hospital was a project of the provincial government and was supposed to replace the old Emigrant and Fever Hospitals that had dealt with sick seamen and immigrants arriving in Quebec. The provincial government and the assembly had already sanctioned it during the latter’s 1830–31 session, but construction had progressed only very slowly. The building itself was in place in the early summer of 1834, but it was not yet furnished and equipped. The opening was set for 1835.105 In this instance the government reacted quickly to satisfy the council’s request, on the condition that the municipality would provide the necessary furniture, equipment, remedies, and personnel to treat cholera patients there. The council decided to accept the offer and sought a loan of one thousand pounds from a local bank to equip the hospital and ready it to admit patients as soon as possible. Later, after the epidemic, the council would ask the legislature for reimbursement. The day-to-day management of the Marine Hospital was left to the Health Committee, whose members directed the operation of the facility, hired staff, and managed the funds while the city council would take a supervisory role.106 The committee succeeded in opening the building remarkably quickly. On 19 July, less than a week after receiving the government’s permission to use the unfinished structure, the Marine Hospital was operational. A physician, an apothecary-secretary, a steward, and other staff were appointed, furniture and equipment acquired, and patients from the temporary

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cholera hospital ready for transfer to the new location. Despite some organizational difficulties and a sickness that befell both the physician and the apothecary-secretary, the committee could state in their first report to the council that the hospital was making good progress.107 As in 1832, the epidemic abated after a few weeks. Only then, in mid-August, did the committee feel confident enough to publish mortality statistics in the local newspapers. Another five weeks later, on 16 September, it reported the absence of cholera from Quebec with the exception of six recovering patients in the Marine Hospital. The decision to release all staff except the steward proved premature, as new cases appeared in October and hospital operations had to be resumed. The epidemic did not come to an end until late autumn, when the committee reported that the disease had entirely disappeared. The Health Committee then returned responsibility for the hospital to the provincial government after paying the outstanding salaries.108 Cholera and the Colonial State in Quebec, 1832 and 1834 The 1834 cholera epidemic at Quebec received less attention than the epidemic of 1832, as was intended by the authorities. Given their lack of means to impose comprehensive measures, a focus on treatment was their only way of fighting the disease. In this respect, their reaction more closely resembled the anticholera measures taken by the government of Madras in 1818–19 than the measures their predecessors had implemented two years before. Despite those similarities, some differences between both cities are obvious. The Health Committee of Quebec had established a permanent administrative body responsible for local public health. Improvisation under difficult circumstances was still necessary, but now the municipality of Quebec was equipped to work continuously for improvements. Such a municipally funded administration, answerable to an elected city council, simply did not exist in Madras. The minimal reaction to the 1834 epidemic was not due to a local lack of administrative impact or knowledge but a consequence of the failure of the ambitious and comprehensive measures taken in 1832. Despite the successes touted by the Quebec Board of Health and its attempt to shift the blame to pilots and ship captains, to the population of Quebec, or to the difficult conditions under which it had had to operate, the reaction of the board’s superiors was explicit. Neither the provincial government nor the Legislative Assembly was ready to fund another elaborate scheme as long as the medical experts could not define and explain cholera or at least demonstrate a feasible way to fight or contain it. The Board of Health had not been able to assemble and utilize the actors needed to integrate and control cholera. Created specifically for this pur-

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pose, the board had called on the many different resources available and had established new institutions to aid in the battle against the disease: hospitals, commissioners, health officers, health wardens, quarantine and trade regulations, disinfectants, and many more. Some of them were intended to avoid an outbreak, others to mitigate an epidemic once cholera had arrived. In the end, all these measures had failed. The epidemic persisted despite all the efforts to control it one way or another. The citizens of Quebec blamed the board for these failures. After the sanitary committee was formed late into the 1832 epidemic, the citizens had demonstrated their lack of confidence in the official body and created a new voluntary organization to improve the implementation of previously resolved measures. They recognized the difference between the board’s promises of a clean and healthy urban space in which cholera had no place and their everyday perception of a still filthy and unorganized city shaken by an epidemic of dramatic dimensions. These criticisms and assessments were in stark contrast to the initial intentions of the board. Facing the possible introduction of cholera during the 1832 shipping season, the colonial authorities in Lower Canada and Quebec had decided early on to pursue a comprehensive plan. They did not restrict their measures to one aim, like treatment, as their counterparts in Madras had done in 1818. There were certainly several reasons for this decision. Quebec was much smaller than Madras in terms of both territory and population, more administrative and legal institutions were in place, and some of them, like the Legislative Assembly, had a democratic legitimacy that allowed them to act independently of the colonial government or even against it. The interests of different groups had to be taken into account, and the population had opportunities to make their opinion publicly known through newspapers, petitions, or civic organizations, such as the sanitary committee. But there were also good reasons for a more minimalist approach. Quebec’s prosperity depended on trade and shipping. The immense influx of immigrants was extremely difficult to manage under the best of circumstances and even more so during an epidemic. The governor as well as the shipping interests had advocated limited measures, but they could not prevail against an alliance of medical opinion and the assembly. The result was a compromise meant to achieve a maximum level of protection against the disease. The two-pronged strategy of prevention was designed to keep cholera out regardless of what its etiological characteristics might be. This strategy included an elaborate attempt to change the urban environment and reorganize the potentially dangerous urban spaces. Doing so required the cooper-

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ation of numerous actors, and a central institution was needed to coordinate this collective effort. The Quebec Medical Board, to which the governor and the assembly first turned for medical expertise and which proposed many of the measures eventually enacted by the government and assembly, was not utilized for this purpose. Instead, the new Quarantine Act provided for a completely new governmental institution, the Board of Health, following British precedent that epitomized the integrative approach. The Board of Health assembled medical practitioners and invited the participation of those with administrative expertise, as well as the population of the city. The “principal citizens” and clergy among its members were supposed to persuade at least all permanent inhabitants that simply contributing to the collective effort would give Quebec a chance to avoid cholera if quarantine failed. Medical expertise was still central for many dealings of the board. The commissioners of health and the few medical practitioners on the board had decisive influence whenever their specific knowledge was in demand. Their position in the decision-making process was central even when, on the surface, others held the most powerful positions. The comprehensive approach to achieving a clean, healthy city required the integration of many actors into a common effort. They all had to collaborate and fulfill their commitments if the plan was to succeed. Given cholera’s unclear etiology and unpredictable behavior, there was little room for error, as any overlooked detail and any lapse might have devastating consequences. When the Board of Health and the institutions under their control could not manage to cleanse Quebec and a devastating epidemic appeared to be the result, it seemed that the colonial state had not lived up to the standards it had set itself. The cholera epidemic confronted the Board of Health with a series of failures, but, whenever a measure against cholera failed, the board proved flexible and quickly adjusted its strategy even if new resources and institutions were required: from preventive cleanliness to isolating the disease in the Lower Town to measures covering the whole urban space to specific actions targeted at seemingly dangerous locations. The authorities in Quebec were not afraid to take drastic measures to make their respective strategies work. If necessary, they claimed the right to enter houses, remove their contents, and expel their occupants for days or weeks, violating established conventions and rights to privacy. Yet, despite these extraordinary powers and flexibility, the institutions of Quebec proved to be unable to implement anticholera measures as comprehensively as the strategy had called for. The fact that cholera itself could not be integrated into these arrangements only demonstrated the board’s failure.

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Yet, there was one positive aspect of these constantly changing strategies against cholera. The authorities at Quebec established a repertoire of measures that could be employed during future cholera epidemics. Some of them, such as quarantine, hospitals, temporary boards of health, the cleansing and disinfection of troublesome locations, or the purification of the atmosphere, had been in use against plague and other diseases for centuries. Others—such as the establishment of a camp beyond the city limits or the introduction of a comprehensive information system not only for cholera cases but also for nuisances—showed the authorities’ ability to improvise and employ organizational capacities. These activities had not yet achieved the desired effect, but they could be reconsidered and improved in the future. They had now been tested, and, once cholera or a similar epidemic disease returned, they could be adapted to the circumstances and tried again. The authorities had failed to integrate cholera, yet they had demonstrated their potential and they could feel better prepared for the next emergency. Failure was a common outcome when it came to anticholera measures in India, Europe, or North America. The measures taken in Madras during its first encounter with cholera also had not had the desired effect, but there the colonial authorities had pursued a more limited strategy from the outset. Their available resources were too scarce to even attempt such a comprehensive scheme as the government of Lower Canada had tried in Quebec in 1832. Changing the urban environment, even on a smaller scale, was beyond the Madras government’s means, in terms of not only funds but also established and functioning administrative institutions. With fewer resources to begin with, it was more difficult to create the necessary means to fight an epidemic. Nonetheless, the government and the Medical Board of Madras did their best and established the dispensaries as a limited space where free medical treatment would be accessible to everyone. Existing institutions, like the Medical Board itself or the police, were assigned additional tasks or functions, but by and large the authorities in their initial response to the epidemic tried only those measures they felt would be within their means, and if their competent implementation had been the only criterion, they would have been a success. The dispensaries were functioning after a few days, patients were treated there, and the information system delivered data on the course of the epidemic in Madras. The Madras Medical Board, an institution that was in normal times marginal, had assumed a central coordinating role after the outbreak of the epidemic. Its medical expertise placed it in an unprecedented position of power, although the superiority of the governor-in-council was never

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in question. Unlike in Quebec, the failure of its anticholera measures was not due to the malfunctioning of the institutions it had created or supervised but rather to public lack of acceptance. The colonial authorities had imagined that the dispensaries would become locations where they could demonstrate the superiority of European medicine to a doubtful Indian population. Despite the almost unrestricted power of the government of Madras, it could not muster the authority to force its way into Indian houses. The seemingly omnipotent institutions of the colonial government of Madras could neither persuade nor force the city’s Indian population to accept its offer. Eventually, the opposite of what was intended happened. The Medical Board had to rely on the services of Indian practitioners for the care of the vast majority of the urban population that had rejected European medicine. Whatever the motive behind the strategies adopted to deal with cholera, they reveal that the colonial authorities in Quebec and Madras looked at their respective cities through very different lenses. The officials and surgeons in Madras observed their urban environment from the enclave of the fort or the dispensaries and had not quite grasped the entirety of the space for which they were responsible. They had institutions at hand, such as the police, that were supposed to maintain order and to report what was happening outside the confines of government buildings and offices. During the epidemic they also had an information system, maintained mainly by the police, that allowed the authorities in the fort to follow the course of the epidemic to a certain extent. But in effect only the limited spaces of the dispensaries, the hospital, and the fort were under government control when it came to cholera. The Indian practitioners who were paid by the Medical Board to look after the indigenous population of Madras were indispensable yet not fully trusted. From the perspective of the colonial enclaves, the kind of comprehensive measures implemented in Quebec were unimaginable. The government and the Board of Health at Quebec already had a system in place that facilitated their survey of the whole urban space. Thanks to preexisting street names and house numbers they could define and communicate exactly which places were dangerous and which were safe. Although confronted with an often uncooperative and sometimes even hostile population, the authorities in Quebec still had the means to conceptualize the complete urban space. Their comprehensive perspective allowed them to think big and small at the same time. They could define strategies and measures that would alter the urban environment as a whole, such as the original cleanliness campaign or the purification of the atmosphere, or in part, like the cleansing of houses or the disinfection of streets.

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The two approaches were not discrete operations; on the contrary, they were intertwined. The information system of health wardens, commissioners, tavern keepers, and medical practitioners across the city and suburbs provided anecdotal data on the entire city. Only this capability to quickly define a limited space as dangerous allowed officials to react to the challenges of a cholera epidemic and maintain their comprehensive approach even when altering their strategy due to new circumstances. Yet, even a relatively small city such as Quebec was too big for continuous surveillance solely from the administrative center. A defined, limited space was the precondition for a comprehensive approach that aimed at altering the urban environment to render it unsuitable to cholera. The case of the village behind Mackay’s Garden in Madras confirms this conclusion. There, the investigating surgeons had at hand a place with clear limits that was affected by cholera. Defined, relatively enclosed spaces allowed the surgeons to suggest a comprehensive plan—a vision that, once implemented and sustained, was intended to banish cholera altogether. Regardless of what approach the respective governments in Madras and Quebec followed, faced with a severe medical crisis they expanded the reach of the colonial state. Although this reach was considerably stronger in Lower Canada than in southern India, it was still rudimentary in terms of institutions and knowledge. Its potential to fight a massive and lethal epidemic like cholera was severely limited, and the governments had had to establish new institutions in order to cope with the challenge. Some of those institutions continued to operate after the end of the imminent threat, as the quarantine station on Grosse Île did, but most were improvised and of a temporary nature. They strengthened the colonial state for a short while and showed its potential, just as their regular failures demonstrated their own limitations, ensuring their short-lived existence, but they also lacked political backing. There was no consensus about cholera among medical experts nor was there public support to compel the authorities to finance the continued functioning of those institutions. In the aftermath of the cholera epidemics of the 1830s, a new cholera theory backed by a broad political consensus finally emerged in the United Kingdom. In the battle against disease, the sanitary movement would propose and propagate the establishment of permanent institutions and measures such as sewers and a public system to supply clean water. For the colonial governments in Quebec and Madras, this metropolitan development offered opportunities to further form the colonial state they were ruling, but it also meant the possibility that new conflicts would emerge.

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Part II Integrating Sanitation

Chapter 3 Frequent Visitations Quebec City, 1840–1854

By the 1830s, the Industrial and Agricultural Revolutions had profoundly changed Britain, but nowhere were their effects more devastatingly felt than in the cities and factory towns. Millions had moved there looking for work, though their meager wages could pay for only crowded accommodations and poor food. Social unrest and poverty were rife and so were many epidemic and endemic diseases that found numerous victims in those unhealthy conditions. Cholera was only one of these diseases, but the deadly outbreaks of the 1830s had demonstrated that the problem was in no way limited to the poor, though they had been the hardest hit. For one thing, hotbeds of disease in urban centers also put the middle class in neighboring quarters at risk; for another, diseases hit the working class hard, lowered their productivity, and endangered the rapid growth of the economy. Thus, diseases like cholera posed a threat to British prosperity and had become a political problem in urgent need of an answer. At first only a few social reformers offered what would become a much-desired solution to the problem. The central figure among the reformers was Edwin Chadwick, a bureaucrat and the primary author of the New Poor Law of 1834. A few years after its passage, the law had come under pressure due to the high costs of medical treatment, and Chadwick’s plan to both save his brainchild and improve the living conditions of the working class was not higher wages or better working conditions but the

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installation of infrastructure that would transport feces and other filth from the densely populated cities to where they could do no harm. This technocratic vision of clean and salubrious cities and towns was based on an etiological theory of disease that contradicted the predominant medical opinion. Supported and based on reports by physicians like Thomas Southwood Smith, Neil Arnott, and James Phillips Kay, Chadwick’s famous Report on the Sanitary Condition of the Labouring Population of Great Britain (1842) claimed that most or maybe even all diseases were not caused by numerous predisposing and exciting causes like malnutrition, poor working conditions, or exhaustion but exclusively by the poisonous effluvia of decaying organic matter. The more prolonged and intense the exposure to those gases, the more likely people would be to contract diseases like cholera or fevers, which were merely symptoms of the presence of decomposing filth in the environment.1 Thus, health and disease were no longer situated on a wide spectrum but a binary distinction. The consequent equation was simple: if it was possible to comprehensively change the urban environment by removing the sole cause of disease—filth—then the health, income, and living conditions of the poor would almost automatically improve alongside the productivity of the British work force.2 For Chadwick, the way to bring such a perfect state to fruition was a combined water supply and sewer system. If it were scientifically designed, gravity would transport clean drinking water to every inhabitant of a city and dangerous filth into rivers or onto sewage farms. But laying water pipes and sewer lines required massive investment that would have to be paid for by the public. Chadwick and his followers presented sanitary infrastructures as an irresistible offer to the middle class, arguing that a one-time investment was in the long run much cheaper than continuous expenditures for medical care as provided by the Poor Law. Once established, sanitation would improve the income and morals of the poor without addressing fraught political issues like pay, working hours, or political representation, thus defusing social conflict and preserving the established social order.3 Within a few years, this political project based on a fringe medical position became a widely popular movement with practical consequences for many cities and towns in Great Britain. The government, local industrialists, the professions, and municipalities agreed to work together to implement the sanitary program designed by Chadwick and his fellow campaigners. Conflicts over the realization arose locally, but by and large the advantages appeared evident. The most directly affected professionals— physicians and engineers—were especially quick to realize the potential

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gains to be made, and they supported the sanitary ideas and agenda accordingly. Engineers would be responsible for the “scientific” construction and maintenance of the new infrastructure, thus gaining access to well-paid and secure positions in municipal administrations. Physicians were also sought after, as they provided the necessary expertise concerning health and disease. That many medical practitioners did not agree with the underlying medical theory of radical localism did not reduce their enthusiasm for the political project of the sanitary movement. Even if they disagreed that filth was the only cause of many diseases, they certainly concurred that it contributed as a predisposing cause. Thus, the success of sanitarianism was based not on a common medical theory but on a political consensus among members of the British middle class. It made the source of disease and misery easy to identify, thus opening the field of public health to the layperson. Everyone with an open eye or nose could point out filth and other nuisances, thereby contributing to the movement.4 Men and women with a philanthropic streak could go one step further and actively promote change and improvement. At the same time, resistance to sanitary measures was rare. The government embraced and supported sanitary investment through the British Public Health Act of 1848 and created the General Board of Health. The sanitary movement proved highly successful not only in Britain but also abroad. It promised improvement without fundamental change; thus, it is hardly surprising that this formula would prove highly attractive to colonial authorities. Cholera in Quebec, 1840–1852 Inspired by the sanitary movement, cities of a certain size all over the “civilized” world invested in a triad of projects to elevate the living conditions of their inhabitants: gas lighting, water supply, and sewers. Quebec certainly had the necessary size, prosperity, and political importance to justify such a project, and many of its inhabitants craved the elevated status that such infrastructure implied. In Europe and the United States, gas lamps illuminated streets while aqueducts channeled clean water from an intake far from the city and sewage was banished to subterranean canals where it could not offend the eyes and noses of the public. In Quebec, on the other hand, the majority of the population had to rely on river or snowmelt water, since the number of wells was limited due to Quebec’s location on top of a rocky bluff. In theory, water was always available, but practically it often was not—such as when there was a fire to extinguish—or its quality was poor. In Great Britain and the United States, private companies often undertook the costly investment in sanitary infrastructure, calculating

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that local citizens would be glad to pay for the convenience and luxury of having a safer, healthier, and more pleasant city. The city of Quebec followed suit. In 1842, the provincial legislature granted a charter to four British businessmen and their Compagnie de l’eau et de l’éclairage au gaz de Québec that allowed them to develop a private service of water supply and gas lighting. The company sold twenty-four hundred shares worth a total of sixty thousand pounds. For the privilege of laying pipes under the city’s streets, the entrepreneurs had to install twenty hydrants across Quebec to facilitate the fight against dreaded fires. To make the business profitable, individuals and businesses would have to pay for the services offered by the new company.5 The enterprise, however, proved to be ill fated. The authorities revoked the charter in 1846 due to the company’s inactivity. The city council decided to take matters into its own hands and undertake the works with public funds. Gas lighting was the first of these services completed in Quebec. The new system was inaugurated on 1 November 1849, when the latest cholera epidemic was drawing to a close.6 Quebec between 1834 and 1849 The period between the cholera epidemics of 1834 and 1849 saw dramatic changes to the constitution of the colony and the city of Quebec. The political and constitutional tensions between the colonial government and the Legislative Assembly dominated by the Patriot Party had escalated in 1837, when armed conflict broke out. The British military easily repressed the francophone patriots’ rebellion, and the imperial government suspended the constitution for three years. In 1840, a new United Province of Canada, comprising the former provinces of Lower and Upper Canada under a new constitution, was introduced. Thus, a slight demographic majority of anglophone Canadians could check the francophone minority without denying the colony democratic representation. This new constitutional constellation changed political dynamics. In 1848, only a few years after the unification of the Canadas, the colony achieved responsible government when Lord Elgin, the governor-general, felt he could not resist the pressure of the elected representatives and had to adjust his government in a way that mirrored the majority of the assembly. The imperial government and Parliament in London were not ready to support this move, but they had to accept it despite the loss of power that resulted. Responsible government gave the Canadian settler society more power, but it did not end colonial dependence. The governor-general was still appointed by London, and the extent of self-government was a constant process of negotiation between the imperial center and the legislative and executive bodies in the colony.7

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The new constitution cost Quebec much of its political importance within the province. The assembly now met mostly at Montreal or Toronto, and, despite Quebec being still one of the governor-general’s residences, he spent most of his time elsewhere. The absence of the colonial government, however, did not herald the demise of anglophone influence in municipal affairs. The incorporation charter had expired in 1835 and had been neither renewed nor replaced, which meant that the old regime of the justices of the peace returned in 1836 and remained in place until 1840. During the rebellions of 1837–38, relations between the two language groups remained relatively calm. Nonetheless, in 1840, Governor-General Charles Poulett Thomson and his unelected Special Council imposed a new charter that was intended to ensure British control over the city. It tried to privilege the anglophone elites by reducing the number of wards from ten to six, each of which would elect three representatives. The suburbs, the Upper Town, and the Lower Town consisted of two electoral districts each, which privileged the urban neighborhoods, where the reliable and propertied anglophone minority dominated, and marginalized the mostly francophone suburbs. For the first two years of the reincorporated municipality, an appointed city council governed the city according to Thomson’s intentions. After the first elections of 1842, the plan started to unravel under pressure from both the Legislative Assembly and the underrepresented parts of the population, which resulted in the establishment of two new wards in the suburbs and the domination of municipal politics by the professions. Still, however, the number of anglophone city councilors increased, and by 1847 they held a twelve-to-eight majority.8 These changes in the political structure also reflected the continued growth of Quebec since the early 1830s in terms of both settled area and population. The port was still the center of economic activity, though the city had lost its lead in terms of economic activity and population size to Montreal. Nonetheless, Quebec’s population now totaled approximately forty-five thousand. The growth was mostly due to migration. Many of the arrivals were Irish who had settled in the city and made the Champlain ward in the Lower Town a predominantly Irish neighborhood, though the influx of francophone Canadians from rural areas was also substantial. Thus, the majority of the population remained francophone, but most members of the economic elite were still anglophone.9 The increase in population resulted in the city’s further expansion. With space in the Upper and Lower Towns limited, most of the growth took place in the suburbs. This development required a corresponding expansion of the municipal infrastructure. Roads had to be extended, paved,

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or newly built. In older parts of the city, renovation work was necessary, as international standards for urban infrastructure were rising steadily. Paved streets and other improvements had become commonplace in the cities of Europe and the United States, and the municipal authorities of Quebec wanted their city to be on par with those.10 At the same time, medicine’s process of professionalization was continuing. This advance was probably most visible in the establishment of medical training centers in the province. As a result of the Licensing Act of 1831, apprenticeships with an experienced medical practitioner declined and soon died out. They were replaced by medical schools attached to universities. Montreal developed into the center of medical training in Canada. At the Montreal Medical Institution—founded in 1823 and affiliated with McGill University in 1829—the dominant language was English, while the rival École de médecine et de chirurgie de Montréal—established in 1845—was a francophone institution. Quebec lagged behind until 1845, when several of the most prominent medical practitioners of the city decided to establish a medical school. The École de médecine de Québec was finally inaugurated in 1848 and functioned under this name until 1854, when it became the faculty of medicine of Université Laval.11 The attachment of medical training to universities resulted in the establishment of new medical journals. The first one was the Montreal Medical Gazette. Its editors were cofounders of the École de médecine et de chirurgie de Montréal, and one editor was also a founder of the Montreal Medico-Chirurgical Society. The journal existed only from 1844 to 1845 but was reestablished in 1852 with a different editorial board.12 Most new journals shared such a fate. In 1845, the British American Journal of Medical and Physical Science was introduced but lasted only five years, when it was replaced by the British American Medical and Physical Journal, which survived for another two. La Lancette canadienne gave up after half a year and the Canada Medical Journal and Monthly Record of Medical and Surgical Science, after a little more than one year. These medical journals were all published in Montreal. Their short lifespan was due to insufficient funds, subscriptions, and articles.13 This remarkable volatility is clearly a sign that the medical profession’s position was still fragile despite its growth and the creation of all those new institutions. Still, the journals spread medical knowledge from the centers of learning in Europe and the United States and circulated information on the state of the profession in British North America. They also offered local medical practitioners an opportunity to publish their observations and thus sparked an interest in medical research. The same was true for the

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universities, where students had to submit an inaugural dissertation for the degree of medical doctor. It was in the latter context that the first academic treatise on cholera was published in Lower Canada: Joseph Workman’s Dissertation on Asiatic Cholera.14 Precautions and Preparations for a New Outbreak When news of the reappearance of cholera in Great Britain reached Quebec in the autumn of 1848, the city had just overcome a typhus outbreak. The previous years had brought a spike of immigration from Ireland due to the infamous potato famine. Many of the immigrants who arrived in Canada were suffering from typhus and other diseases. In the summer of 1847, Grosse Île had been crowded with Irish immigrants. Thousands had died there, and disease had also threatened those cities and towns through which the immigrants had passed. Although the quarantine station’s function had not changed since the cholera epidemics of the 1830s, Grosse Île was now an established institution. The imperial government had granted funds in 1836 to buy Grosse Île and make it the permanent quarantine station for Lower Canada.15 In 1847, Quebec, the first city upriver from the bottleneck, had prepared itself for an outbreak by implementing much of the repertoire of precautions familiar from previous cholera epidemics, such as an emphasis on cleanliness and the hiring of a health officer and health wardens. Again a temporary Board of Health had been in charge of these efforts, but this time it functioned under the city council’s authority. In the end, the typhus outbreak had struck Quebec a light blow. Only few permanent residents fell ill, but together with the immigrants passing through the number of sick was enough to exceed the hospitals’ capacities.16 Only little more than a year had passed since the typhus crisis when the far more dreaded threat of cholera reappeared on the horizon. In a report to the city council, the Health Committee offered its assessment of the situation. By now the predominant medical opinion in the United Kingdom was that cholera was not a contagious disease, although some argued that the disease was contagious under particular circumstances. The committee welcomed this development, as it would make it easier to calm the public, reduce animosities against immigrants or municipal officials, and offer “consolation and encouragement” to those affected by the disease.17 This did not mean, however, that Quebec had nothing to fear during the coming summer. The committee found that the city was once again ill prepared in terms of cleanliness, medical infrastructure, and administration. Low-lying, ill-ventilated locations near the river were particularly in dan-

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ger. Such places, the committee insisted, were generally the most severely affected, and the Lower Town, as well as the area around the Marine Hospital at the estuary of the Saint-Charles, required thorough cleansing. Given these circumstances, the committee lamented that not much progress had been made in the last decade and that Quebec was lacking adequate sanitary regulations and infrastructure for a city of its size. Its previous urgent recommendation to improve the city’s drainage had been ignored by the council. The medical situation was also far from satisfactory, as Quebec was still without a hospital for its permanent population, so the poor who fell sick would again have to be treated at an improvised location. The committee proposed to procure two buildings for this purpose, one in Saint-Roch ward and one in Champlain ward in the Lower Town, and to establish two dispensaries in other quarters. The citizens were to pay for the expenses incurred. Because early treatment of the disease was still deemed essential, the committee recommended publishing an advertisement on the early symptoms of cholera, thereby presumably saving citizens’ lives by encouraging them to immediately seek the services of an experienced medical practitioner.18 The final recommendation was the establishment of a board of health in order to increase the medical expertise among those responsible for the prevention of a new epidemic.19 Some of the committee’s proposals and its language indicate that sanitary thinking influenced these recommendations. The cholera theory summarized at the beginning of the report shows traces of the British sanitary discourse that came to Canada in the form of the government-sponsored reports by Chadwick and others. Cleanliness had been a staple of anticholera measures for quite some time, but the committee’s report emphasized not only the importance of the population and authorities taking care of their respective private and public spaces but the urgent need for infrastructure such as an improved system of drainage following the scientific standards established in Britain. That such a task could not be completed in the coming months in order to prevent or limit a cholera epidemic was obvious, and the committee could not expect the council to move forward with that particular proposal. Nonetheless, this passage in the report hints at a change in priorities, at least among the medical experts, toward largescale, long-term, and government-sponsored infrastructure projects for the permanent improvement of public health. The committee, however, was not primarily focused on the distant future, and the council followed its recommendation by establishing in December 1848 a board of health that would consist of the committee members and six others. The board was tasked with the prevention of a cholera epidemic, as well as with the

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preparation of permanent sanitary regulations, which the council wanted to be included in a new incorporation bill that was being prepared at that time.20 The potential arrival of cholera excited the interest of the general public as well. Several physicians tried to satisfy the demand for information. A Dr. Joseph Painchaud, for example, gave a public lecture, later printed in abridged form, while Dr. G. Russell of Montreal took the opportunity to reprint his pamphlet On the Operation of Physical Agencies in the Functions of Organized Bodies, with Suggestions as to the Nature of Cholera.21 Both aimed their advice at the individual citizen. They emphasized that the population was not helpless and at cholera’s mercy. While Russell wrote mainly for medical experts and thus a limited audience in both Canadas, Painchaud addressed the general public of Quebec. His frame of reference was the previous epidemics of 1832 and 1834, and Painchaud’s objectives were twofold. As a prominent member of the medical profession, he tried to assure the population of Quebec of his powers as a healer of cholera and to calm anxieties that could eventually lead to a panic. He also tried to remind the citizens of Quebec of the importance of their cooperation in the fight against cholera. The starting point for that fight was still individual behavior. Systematic, technological solutions to epidemic disease, as the sanitary movement promoted, played no role in his lecture. This public awareness of potential danger contrasted sharply with the municipal authorities’ inactivity. The Quebec Board of Health presented a first report to the city council soon after its inauguration, but thereafter it remained inactive for several months because it felt unable to fulfill its duties under the legal framework that existed. The incorporation law did not grant the board the means to enforce the existing sanitary bylaws and regulations, and it was paralyzed by the legal insecurity regarding two new public health bills being debated in the chambers of the legislature. With cholera present in Europe and the shipping season approaching, the Legislative Assembly debated a public health bill for Canada in March 1849. The bill would grant the governor-general far-reaching powers once an epidemic was imminent. Its centerpiece was the Central Board of Health located in Montreal, funded by the provincial government and having the authority to direct local boards of health. The municipalities would no longer decide the boards’ establishment independently, for the bill required towns and cities to create boards at their own cost whenever the Public Health Act was in effect. Simply ignoring the law would not constitute a loophole, as the governor-general could establish a local board if ten tax-paying citizens of a town petitioned him. Eventually, the assem-

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bly passed the bill on 5 April 1849, though it took more than two months until the new Central Board of Health was convened for the first time.22 Long before the bill was passed the Quebec city council had intervened and conveyed its complaints to Jean Chabot, deputy to the assembly for the city of Quebec. The council found the bill unsatisfactory and inappropriate for the uniquely exposed city. It intruded into municipal affairs and transferred power to commissioners in distant Montreal. The councilors predicted that it would become the cause of dissatisfaction among the local population, which had reacted in a hostile manner to comparable attempts to override local authority.23 In the meantime, despite those legal insecurities, the Quebec Board of Health could not further delay its actions. A ship that had had seven deaths on board during passage had arrived at the port and been sent back to Grosse Île for quarantine. This incident prompted a city council resolution that recommended to the provincial government various changes, including an expanded medical staff and improved quarantine procedures. Soon there were rumors of deaths from cholera in the city that had to be officially refuted. That the arrival of cholera during the approaching shipping season was seen as likely can also be concluded from the unsolicited applications for positions that reached the board. Beginning on 7 May, when the first application for a job as health warden arrived, numerous people advertised their services. Among them were ordinary citizens and several physicians looking for employment. Alongside these applications came the first complaints of unsanitary conditions in the yards and streets of Quebec. The Board of Health was still unable to react to those complaints or take any action on its own, as it awaited passage of the second public health bill, which was still being debated in the assembly and which would affect them directly.24 On 8 June, the Board of Health published an advertisement in English and French that informed the public of Quebec that the assembly had passed “An Act to Provide for the Health of the City of Quebec.” The Quebec Board of Health thus had a new legal framework handed down from the provincial level. Combined with the local standing of its members, the new law significantly increased the powers and legitimacy of the board. It could now investigate and remove all suspected causes of disease from within the limits of Quebec based on a provincial parliamentary act rather than a municipal bylaw. Board of Health members could enter, with force if necessary, all houses, premises, or private property to investigate a threat to public health. The new legislation codified the improvised rules set up by the Board of Health or the city council and established a proce-

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dure that protected a building proprietor’s rights. If inhabitants or owners of buildings denied entry to a member of the board, that official had the right to appeal to any justice of the peace in the district of Quebec. Then, after ensuring that a majority of the board supported the inspection, the justice could order the police to assist the board member in gaining entrance to the property, thus enabling removal of the nuisance. The act also ordered the party responsible for creating any nuisance that had to be removed by the board to bear the cost of the disposal, thereby continuing an established practice and relieving the authorities of some costs.25 The new legal framework required a reconstitution of the Quebec Board of Health, which took more than a month to accomplish. In the meantime the old board was far from idle. Even with the new act already in effect, the old board assumed broader powers, filling the most important position, that of health officer, on 9 June 1849. The board chose Robert Symes, a justice of the peace. In an outbreak, his duties included keeping track of its course, collecting mortality statistics, and reporting the number of deaths to the board on a daily basis. In the meantime, the health officer became the board’s eyes and ears, its representative in the city, its spokesperson in the local newspapers, and its agent in all matters sanitary.26 Symes immediately went to work. Compared to the often incoherent compilations of anecdotal reports that characterized similar informationgathering efforts during the epidemics of the 1830s, what Symes collected was decidedly more focused and reflected his choice to use a systematic approach to collecting data. His first report to the board contained his observations of the Lower Town. He had found Champlain Street, the Cul-de-Sac, and Saint-Pierre Street in a “tolerably clean” state, with some exceptions. The proprietors of some filthy premises had promised to clean them immediately, while the road surveyor had been called on to take care of public spaces. For several other problems the solution was not so obvious. Some issues involved the keeping of domestic animals, including pigs, on the streets or in inappropriate stables, but Symes did not perceive these nuisances as an immediate danger to public health. In Sault-de-Matelot Street, however, he had encountered a more worrisome situation. The area was densely populated and dirty, which in combination was reason for concern and special attention. Again, some of the responsibility for the problems lay with the municipality, like a small lane that the road surveyor was summoned to inspect. The main nuisance there was a clogged public drain that the whole neighborhood could smell. Symes was also worried about stagnant water. Near the Marine Hospital he had come across a lot covered with “green stagnant water,” and in the vicinity of the Berthelot

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Market he found two ponds in which people regularly disposed of dead animals. The health officer’s recommendation was to do away with both nuisances: the water near the hospital would be channeled into a nearby public drain and the two ponds filled in.27 In his next report Symes dedicated his attention to the suburbs as well as the Upper Town. Again, he found the supposedly problematic suburbs in surprisingly good condition beyond some minor nuisances. Only Julie Street, in the Saint-Louis suburb, was an exception. A public drain was leaking there, and sewage and surface water ran down the street. Because the street ran along a hillside, the water accumulated on the lower side, where it seeped into cellars. As for the Upper Town, it was a surprise, albeit a negative one, as it was in worse condition than the notorious Lower Town. Many houses and yards were in an unwholesome condition. Substantial parts lacked drains, and most of the existing ones were clogged or neglected. Nonetheless, in his concluding remarks Symes could report that the city and its suburbs were in a “remarkably healthy condition.”28 The Health Officer continued to submit weekly inspection reports to the Board of Health. The problems he described remained similar to those encountered in his first tours of Quebec. Symes’s work did not offer too many surprises, and the Board of Health eventually underwent its institutional change. On 10 July 1849, the Quebec Board of Health reconstituted itself under the authority of the new provincial parliamentary act. The board now had fourteen members: the six members of the city council’s Health Committee and eight citizens chosen by the council. The president of the old board, Dr. Joseph Morrin, who had been health commissioner in 1832, was also president of the new one. Its secretary was François-Xavier Garneau, the city’s clerk and historian of French Canada. Robert Symes remained the health officer.29 Cholera in Quebec, 1849 On the day of the new Board of Health’s inaugural session, epidemic cholera had been present in Quebec for almost a week. In previous epidemics, the disease had reached Canada by sea and proceeded through the Saint Lawrence valley. In 1849, however, cholera came from the United States, and the first cases in Canada had been confirmed in Kingston on 2 June. The disease slowly traveled downstream. The first confirmed deaths from cholera in Montreal were recorded in the week between 2 and 9 July, though cases in the local garrison had been treated on 20 June and rumors of an outbreak circulated as early as 15 June. The disease officially reached Quebec around the same time it hit Montreal, when a patient was brought

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to the Marine and Emigrant Hospital on 4 July.30 The old Board of Health lost no time taking action, despite still being in a state of legal limbo and though it was still unclear if the cholera cases were of the less severe, sporadic or of the dreaded epidemic kind. Regardless of the possible severity or harmlessness of the cholera outbreak, the new board now had to do several things at once: ensure its functioning under the new legal framework, prevent a cholera epidemic, and prepare the city for the worst in case the epidemic could not be prevented. On the day of its reconstitution, the board ordered the road surveyor to “take immediate steps to have streets, lanes, thoroughfares & wharves” cleansed and to report the next day.31 The board’s attention to cleanliness was again centered primarily on the Lower Town, although the focus soon shifted to the suburbs. The health officer had reported that, given the crowded circumstances in Champlain ward during the shipping season, it was a miracle that the outbreak was not as extensive as the one in 1832. To improve the situation there, the board used its authority to set up a system of waste disposal for Champlain and Sault-de-Matelot Streets. Twice a day soil carts were to collect all the sewage and refuse and transport it to a “safe and convenient place to be procured by the Road Surveyor.”32 The local residents were ordered to collect and put all their refuse on the carts under threat of prosecution. This effort, however, was apparently insufficient. Despite the threats of punishment, the failures of the refuse collection service proved that the private spaces of houses or apartments remained beyond the board’s reach. As important as public spaces were for public health, the board realized that efforts to create a healthy environment would be futile unless private spaces were similarly clean. Thus, to prevent the further spread of disease, the interior of people’s homes had to be controlled and, if found wanting, cleansed. In 1849, the board sought a more systematic solution than the previous improvised efforts and created special offices solely for this task. It appointed domiciliary visitors to inspect every house in certain wards of the city and report their findings to the board on a daily basis.33 The new institutions the board had established did not mean different measures would be used to tackle cholera. Generally, the new board used elements of the same repertoire that had been developed in 1832. Again, the board distributed lime to the poor for disinfection. It hired workers to assist the health officer with whitewashing houses. A privy was determined to be inappropriate and consequently ordered demolished and rebuilt. The health officer required help from the police to remove pigs from the streets. Houses found to be too neglected or filthy for human habitation

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were again shut down and cleansed. Proprietors were urged to fumigate their houses with combustible substances distributed by the health officer. Again, state institutions such as the courthouse, the jail, and the military barracks proved to be less than spotlessly clean, causing the authorities some embarrassment. On 20 July the road surveyor reported to the board on the result of his latest inspections. He had found the streets of Quebec “in the highest state of salubrity,” with a few exceptions.34 Some measures deviated from the usual course, but not by much. This time the board refrained from establishing a camp to accommodate those evicted from their homes. Instead, it had taken possession of a house near the cholera burial ground in the Saint-Louis suburb for this purpose.35 Cemeteries played an even greater role in the board’s considerations and actions than they had in 1832, when the city faced a lack of space and an abundance of corpses that had to be buried. Such problems did reemerge in 1849—at one point it was reported to the board that six coffins were piled up in each grave at the cholera cemetery. The board deemed this number to be too high because of the ensuing dangers of putrefaction, and it had to (successfully) urge the trustees of all cemeteries to bury only one body in each grave.36 Despite those issues reminiscent of 1832, however, the problem with cemeteries that most concerned the board and the public in 1849 was their sanitary condition, as neighbors of burial grounds handed in petitions complaining about dangerous effluvia originating there. Indeed, very early into the epidemic the board had regulated the use of some cemeteries. It recommended to the trustees of the Protestant burial ground of the Saint-Jean suburb and the old Picoté cemetery that during the cholera outbreak only such persons who already owned a lot or vault should be interred there. This recommendation reduced the number of available cemeteries, and corpses had to be transported farther. Often this meant that they had to pass through the city. The sight and stench of them were unpleasant for those living along the main thoroughfares. They distressed the population and were regarded as detrimental to public health by many medical practitioners, since the corpses were themselves decomposing matter producing dangerous exhalations. The board therefore resolved that bodies from Champlain ward had to be transported to the cemetery without passing through the town. The proximity of the Marine Hospital, where many cholera patients were treated, to several cemeteries was also the cause of much concern.37 The board’s adherence to established practices is hardly surprising, as most circumstances had not changed. Despite the success of the sanitary movement, water supply and sewer systems had not yet been built. Cholera

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theory was still highly controversial. It was a matter discussed by medical practitioners as well as laypersons in journals and newspapers. Which measures a person supported depended on the effects they would have on the individual’s interests, and it was easy to find scientific support for one’s own opinion in the vast mass of literature on the disease published in Europe and elsewhere.38 Scientific articles on cholera were reprinted in Canadian newspapers according to their political point of view. Supporters of the mostly anglophone shipping interests, for example, still favored a decidedly anticontagionist position, as quarantine hindered their business. In their preferred newspaper, the Quebec Morning Chronicle, the editor, Charles St-Michel, frequently referred to the publications of metropolitan sanitarians, French physicians, reports from India, or local anecdotal evidence if these authorities, facts, or stories supported his opinion on the futility of quarantine. When other newspapers emphasized another position supported by contradictory evidence gathered from other European or local sources, St-Michel or like-minded contributors disputed these opinions at great length.39 The result was the Morning Chronicle’s own private theory of cholera etiology that focused on atmospheric conditions, including changes of temperature and electricity, although the connection between these factors was never thoroughly explained or exemplified. The public was generally better informed about the course of the epidemic in the city than it had been in 1832 or 1834. The board issued two reports on its actions to the press, and it supplied daily numbers of deaths to the newspapers, which scrupulously printed them. Advertisements for the Central Board of Health in Montreal or news on cholera from other cities or towns in Canada or the United States were also regularly published. These official statements were discussed by the press and certainly also by the general public.40 Alongside the improvement of the city’s sanitary conditions, care for the sick was again a major concern. To organize additional hospital beds, the board successfully lobbied the mayor to allow the use of the old customhouse in Cul-de-Sac in the Lower Town as a temporary cholera hospital. The building lacked the necessary equipment, but it was somewhat isolated in the port, in whose vicinity most cases were once again expected to occur. A committee was established to acquire furniture for the new temporary hospital and to hire staff. These plans proved to be premature. In 1832, the inhabitants of the Lower Town had grudgingly and with many complaints endured the temporary cholera hospital’s presence. In 1849, they would not. A furious mob stormed the customhouse on the evening of 11 July, damaging it to such an extent that it was of no use for the fore-

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seeable future. The board decided to use the Marine and Emigrant Hospital in Saint-Roch as a cholera hospital until the customhouse was renovated and ready to serve its intended medical purpose. During the shipping season, however, the Marine and Emigrant Hospital was usually completely occupied and therefore not equipped for an influx of additional patients. Only the inadequate outbuildings could be used to accommodate them.41 Despite all of these problems, this plan for accommodating the sick again did not go through uncontested. This time it was the medical practitioners on the board who protested, though without resorting to violence. They submitted a resolution claiming that the best site for the temporary cholera hospital would be the Champlain ward in the Lower Town, where most of the cases would probably occur. The transport of patients through the city to the Marine Hospital was deemed too perilous for people suffering from such a severe disease. They proposed the immediate renovation of the damaged customhouse to make it fit for patients as soon as possible. The physicians’ opinion was supported by a petition signed by the inhabitants of Saint-Roch, who protested against the transport of patients through their district. They demanded that the inhabitants of each ward be treated in their own neighborhood. The board met neither the physicians’ nor the petitioners’ demands. Instead, it would cover the cost of treatment for all citizens of Quebec. Additional staff for the hospital were hired and the outbuildings fitted for use as a temporary hospital. All of these efforts did not change the fact that this makeshift hospital was far from appropriate. The outbuildings were not rainproof, and the patients had to be moved to drier areas during bad weather. The neighborhood’s population did not welcome the solution either. The parish priest and the citizens of Saint-Roch, afraid for their health, again petitioned the board to stop the transport of cholera patients through their ward to the hospital.42 Just as in 1832, not all patients would come to a hospital, preferring instead to be treated in their homes. As the poor could hardly afford the services of a physician and the hospital situation was precarious, the board appointed four visiting physicians. Each was responsible for the treatment of cholera victims in one of the poorer wards of the city: Champlain, SaintPierre, Saint-Roch, and Saint-Jean. Like all other medical practitioners, the visiting physicians were required to issue a daily report on the cholera cases they had treated. As the epidemic progressed, the number of visiting physicians proved to be too low. Additional visiting physicians were appointed, and the original areas of responsibility were reapportioned. Saint-Roch was the first ward to acquire a second visiting physician, with Saint-Jean ward the next to get one. The physicians were busy and reme-

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dies were scarce. Dr. Robitaille, a visiting physician for Saint-Jean ward, asked the board for an aide to help with the distribution and preparation of remedies. His request was granted, but in the end the aide was required for only one week.43 On 17 July the board advertised that the epidemic had already abated, but the board’s activities would continue apace. In fact, it was just beginning to establish its full functionality. Also on 17 July it issued general directions to the public on how to behave during the presence of cholera in the city. These instructions were mainly of a preventive nature and addressed each individual’s responsibility for his or her own well-being. The board pointed to the importance of cleanliness, ventilation, moderation of diet, and warm clothing. They thereby referred to the mainstays of anticholera measures, which all physicians could agree upon regardless of their personal opinions on cholera etiology. Only the final recommendation dealt with the question of what to do in case of a possible outbreak. The board urged that any person thus afflicted should immediately contact the family physician or one of the visiting physicians for treatment.44 With the issuance of its general directions, the Board of Health once again tried to persuade the residents of Quebec to join its efforts to improve the health of the city and fight the encroachment of cholera. The population’s reaction was not so different from its reactions to earlier epidemics. Complaints of exhalations, slaughterhouses, or drains still reached the board, though not at the same frequency as in 1832 or even before the board’s reconstitution. At first the complaints remained sporadic. It was only after several weeks, when the number of cases and deaths declined, that the bulk of complaints and demands for action arrived.45 Without the appointment of health wardens in 1849, the health officer, the road surveyor, and their staff would have been wholly responsible for the removal of nuisances and the inspection of streets and yards. They lacked the personal ties to the neighborhoods the wardens had had when they went on inspection tours. Without roots in the local community, those officials’ authority was derived solely from the Quebec Public Health Act via the Board of Health. They were placed on a higher administrative level and had more powers than the wardens had ever had, and they had access to a more sophisticated municipal administration that—at least nominally—had to rely less on the voluntary cooperation of the population. The board had more means of coercion. This arrangement might have resulted in a more sanitary city, but as soon as the epidemic abated the local population offered up numerous complaints. This surge was possibly due to a deterioration of conditions, but it could also point to a divergence

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in the perception of the urban environment between the general public and the public health officials. Citizens were directly exposed to nuisances. They saw and smelled every one of them, and they saw the gap between the official calls for a clean city and the filth they perceived. The officials, on the other side, observed the city from a removed, bureaucratic perspective. They were looking for specific phenomena in the urban space that they deemed dangerous. Not every nuisance was equally worrisome. They had a professional outlook informed by ideas about sanitation, and they focused on what they considered the most beneficial ways to improve the environment and learn more about the disease. One issue in particular attracted the attention of public officials: the concentration of cholera cases in one house or apartment building. These locations apparently had certain characteristics that made them more prone to cholera than others, which rendered them the perfect spot to investigate the “nature” of the disease. In the first house to attract this kind of inquiry, no fewer than seventeen people had died within twelve days. The board dispatched two of its members, Dr. J. Douglas and Sheriff Sewell, as well as the two visiting physicians of the ward, to inspect the house in question, which was in Saint-Jean. They were to ascertain if there was any specific cause for the locality’s susceptibility to cholera. The report—submitted the following day—pointed to one peculiarity. The house—built directly adjacent to “un petit cap” (a little bluff) behind it—had water standing in a cellar without a window or a trapdoor at ground level to ventilate it.46 Several other houses in the vicinity had not lost residents to cholera, which pointed to a cause of the disease located within the ill-fated house. The surviving residents had been induced by its bad reputation to seek refuge in the emergency shelter at the Catholic cemetery. The board declared the house infected and ordered it closed.47 The mystery of why some houses were especially prone to cholera cases continued to preoccupy the board, as well as the public, and a related problem sparked the board’s curiosity even more: the presence of stagnant surface water.48 It had already been an issue during the typhus epidemic of 1847, but it now gained momentum as an explanation for the incidence of disease. During the following weeks, managing water and drainage moved more and more to the center of the board’s actions. Quebec had a rudimentary system of drains to channel sewage and surface water. An estimate in 1841 had guessed the length of the system to be nine to nine and a half miles. The authorities had never paid it much attention, and consequently it consisted of a relatively small number of drains that were imperfectly covered, not necessarily interconnected, and often clogged.49

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In anticipation of a cholera epidemic, some residents, such as the Ursuline nuns in their Upper Town convent, had demanded new and better drains for their neighborhood. People living near a drain filled with stagnant water in Saint-Roch offered to contribute to the construction of a proper sewer if the board would provide the materials and the sum of twelve pounds. They were not alone. After his initial survey of Quebec, the road surveyor had stated in his report to the Board of Health that drains were in poor condition or nonexistent in several instances. The drainage of surface water, as well as sewage, was a concern. The road surveyor had noticed that a flow of water in Saint-Jean ward crossed several properties, thereby washing out privy deposits and other dangerous materials. He referred the issue to the municipal Road Committee, as the board did not have the funds to dig the necessary drains. Since the connection of stagnant water and cholera seemed to be strengthened by the case of the deadly house, the issue of sewage and surface water drainage gained new urgency. In three cases, the investigating road surveyor recommended the construction of new drains.50 When the Ursulines complained a second time about the lack of proper drains in the vicinity of their convent, the board formed a committee on drainage to come up with a solution for the current situation based on the newest scientific principles. This committee of four was to investigate the status quo and handle the incoming petitions to take action, such as a spring of water in Saint-Jean potentially releasing dangerous substances in the soil or filthy or clogged drains in Saint-Roch.51 It took the committee less than a week to come up with its solution to achieve a better drainage system. Their view of the present condition of sewers in Quebec was damning, and they predicted that rectifying the defects would require “extended persevering and costly efforts,” mainly because of the topography. Most of Quebec was built on a rocky bluff, which made digging canals expensive and laborious. The benefits of a new and comprehensive system of drainage for the public health, however, would be enormous and justify the cost. The example to follow in creating a better drainage system could be found in England. There, the legislators, influenced by the sanitary movement, had recognized the importance of the issue and had passed legislation that had improved water and sewer systems in cities and towns. In doing so, these British politicians had proven that disgusting matters like sewage could be of utmost importance to “men of character of every grade, and politics” and not a subject to be ignored.52 For Quebec, the committee proposed a system that ensured the city would be “thoroughly and scientifically drained by large arterial drains which should be so deep as to receive the water from each cellar with prop-

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er gratings and openings in the street.” The “appurtenances of each house, such as privies, sinks, &c., should be made to empty in to the drains,” while the newest technology would prevent the obnoxious and dangerous effluvia from escaping to the surface. The fact that the best-drained parts of Montreal and Quebec had suffered less from cholera in the past was offered as another proof of the plan’s virtues and as a further incentive.53 Those statements trumpeting the benefits of such a system were certainly necessary, since the report also included a preliminary cost estimate calculated by the committee with the assistance of the road surveyor. The total came to more than twelve thousand pounds, a remarkable sum, though the committee planned to let proprietors pay one-third of the cost. The committee pointed to the positive consequences for the health of the city and the lives such a system would save. The citizens would recognize the importance of their proposal and happily pay “so cheap” a price for health “and perhaps immunity to some extent from one of the heaviest scourges of centuries.”54 The committee’s proposal had no immediate impact, but it did signal that the time was ripe for a comprehensive sanitary infrastructure. In the aftermath of the 1849 cholera epidemic, everyone was aware that sanitation was a matter of life and death. That a committee of the Board of Health developed a comprehensive plan indicates how seriously the matter was taken. Now it was the city council’s task to decide how to proceed. With the decline of cholera cases from mid-August onward, the board was more occupied with bringing its dealings to an orderly end than planning the future. The sanitary system was not its business anyway, as permanent institutions like the city council and its Road Committee were responsible for the funding and implementation of infrastructure of such proportions. The board had to handle the present problems. Complaints still came in regularly concerning filthy or clogged drains in several parts of Quebec or about rubbish at the Saint Paul’s Market that had to be removed. The remedying of those nuisances in public space fell under the authority of the road surveyor, but the board had to coordinate and pay for them.55 Its activities had already plunged the Board of Health into debt, and, despite attempts to lower its expenditures, it had to ask the city council for an extra five hundred pounds. That was enough to continue its operations, as the epidemic had begun to abate and it was now possible to release most of its staff.56 The final statement of expenses disclosed that the board had spent £821 5d. during the epidemic. Its task was fulfilled and the last employees could be dismissed. Thus, Robert Symes was discharged as health officer on 29 September 1849. The board’s secretary was awarded £30 for his services.

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The board composed, adopted, and published a final report on its actions before it discontinued its meetings.57 Minor Epidemics, 1851 and 1852 Cholera once again proved to be more persistent in Europe and in the United States than in Canada, so the danger of reintroduction would remain for several years. There was no cholera outbreak in Quebec in 1850, but it did appear in each of the next two years. In both instances, the Lower Town had a cluster of cases, as the transient population of immigrants and travelers passed through the area. In both years as well the first victims had been travelers arriving from the United States, and the authorities were slow to react.58 In 1851, the authorities’ efforts gathered some momentum only when the number of cases began to rise and severely affect the city’s permanent population. Only then was a board of health formed and measures beyond individual medical treatment implemented. At the end of the year, cholera had claimed eighty-four lives, the mildest epidemic since cholera’s first appearance in the city.59 In 1852, the outbreak was largely confined to the Lower Town and barely encroached on the Upper Town. Therefore, the Health Committee did not deem the establishment of a board of health necessary that year, and the committee handled the epidemic with its limited resources. The death toll proved to be even lower than in the previous year.60 Both minor epidemics failed to leave a lasting mark but served as timely reminders to the authorities that the sanitary situation in Quebec was still poor. The authorities’ measures had worked well, or so it seemed, since for once they had managed to contain the epidemics. At the same time, however, even these smaller outbreaks showed that the city had not yet reached the standards of civilization to which it aspired. Cholera was a symptom of this deficiency.61 Water and Sewers for Quebec The frequency with which epidemics struck Quebec between 1847 and 1852 changed opinions about sanitary infrastructure. A reliable water supply had been deemed merely desirable before cholera’s arrival, as the initiative of the private gas and water company had shown in the early 1840s, but the raised civic reputation and the protection from fires that a water supply system would provide had played a role at least as important as health. Now the necessity of a water and sewer system was undisputed, and the municipality was ready to fund the project. George R. Baldwin, the American civil engineer responsible for Quebec’s gas lighting, a project completed in 1849, had by 1847 investigated

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the problems and possibilities of an aqueduct that would supply the city of Quebec with water. He explicated his findings in a report to the mayor and council of Quebec in 1848. A chemical analysis had shown that the water from the wells of Quebec was impure. Baldwin concluded that the construction of an aqueduct was absolutely necessary for the public health of the city. He estimated demand to be 480,000 cubic feet of water per day. As the smaller rivers in the vicinity of Quebec froze completely during the winter months, only a larger river could supply the required amount of water year round. To further complicate matters, the elevated location of Quebec required an intake on a slightly higher level, from which the water could be directed through pipes to a reservoir near the city using the force of gravity to avoid the expense of pumps. Baldwin identified two suitable locations for such an intake: one at Lorette on the Saint-Charles River and one on the Montmorency River. In both cases the intake would be several miles away and the pipes had to cross rivers, roads, and private property. The cost for both projects was estimated by Baldwin at slightly more than US$630,000, an immense sum.62 The city of Quebec was not able to raise such an amount by increasing taxes. A bond was necessary, but the Incorporation Act and provincial laws of the time restricted the city’s ability to incur debt. Thus, the Legislative Assembly had to pass a bill in 1850 for the project to go ahead. It granted the city the authority to lay pipes from an intake located within a twentyfive-mile radius of the city as long as existing rights of property owners were observed. It also allowed the city to finance the works by selling £50,000 in bonds and to employ a superintendent to supervise the construction and maintenance of the system. The bond sale was not enough to fund the project, and over the following two years the city of Quebec again had to issue bonds, this time totaling £300,000.63 To oversee the construction work, the city council established the Water Works Committee, which employed a manager for daily administrative business and engineers for planning and implementation. For the position of chief engineer, the committee retained the services of George Baldwin, who began preparations in the autumn of 1850.64 The committee quickly decided in favor of locating the intake on the Saint-Charles River. While Baldwin surveyed the area for a possible pipeline route, the acquisition of suitable pipes and other necessary materials became a serious problem. The province of Canada had no producer of proven quality, so iron pipes and iron castings would have to be imported from the United Kingdom. As soon as the chief engineer’s surveying and planning were concluded, his estimates submitted, a route adopted by the committee, the

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location at Lorette visited, bids for pipes solicited, and a supplier identified and contracted, Baldwin was sent to Britain in November 1851 to supervise the production of the pipes.65 However, the technical issues were not the only obstacles. The corporation still required essential permissions from property owners. First and most important was permission to draw water from the Saint-Charles, which was owned by the provincial government. With the assembly having given the go-ahead for the public water works, the Crown Land Department’s permission, granted in April 1851 after a visit to Lorette and some technical clarifications, was only a formality.66 However, that permission did not cover the land required for the line between Lorette and Quebec or for a reservoir just beyond the suburbs. From February 1851 on, the Water Works Committee struggled to obtain the necessary tracts of land. Although a deed of acquisition was prepared early on, finalization of the transfer took years, as many property owners saw a chance to make a handsome profit. The construction work began only after long negotiations, many protests and complaints, requests, demands, and offers, and much metaphorical horse-trading.67 The first construction undertaken was a dam at Lorette to retain water for the intake. Then a trench was dug for the pipes along the line surveyed by the chief engineer.68 The pipes finally arrived from Scotland on three ships in the spring of 1852, and three pipe layers hired by the chief engineer during his visit to Britain disembarked a few weeks later. The committee was so eager to finally commence the work that they ordered the chief engineer to start laying the pipes using local workers even before the experts from Scotland had arrived with their equipment and tools. While work between Lorette and Quebec progressed smoothly, the more difficult construction of a distributive system began in Quebec. Each household in Quebec would have the opportunity to be supplied, as maintenance and water use would be paid by a general tax. It took until 1854 for the system to be partially ready and to guide fresh water from Lorette to the reservoir at Quebec, although its distribution within the limits of the city was still a work in progress at the time.69 Before the smaller-scale epidemics of 1851 and 1852, water availability had been considered more critical than the lack of sanitary sewers, but the recurring cholera outbreaks and recent experience of clogged and unsanitary drains had increased the urgency to develop a new, better, and comprehensive sewer system. In addition, once water was flowing from the new works, drainage of larger amounts of fouled water would become an issue. The fear of dirty surface water demanded a congruent system, as

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Mayor Jean-Ulric Tessier stated in his annual report for 1853: “[S]’il était nécessaire d’introduire une bonne eau dans chaque maison, il était aussi nécessaire d’égoutter chaque propriété pour assainir la ville.”70 Consequently, the city council decided to begin constructing sewers at the same time the water pipes were being laid.71 Sewers began to occupy the attention of the Water Works Committee in March 1853, when it faced the question of how to implement the city council’s demand for proper drainage. The committee soon agreed that earthenware pipes would be the material of choice, and a preliminary estimate put the cost at twenty-five thousand pounds. Within one day, the chief engineer prepared a report on the drains, and the committee felt ready to have the manager advertise a tender (request for bids) for stoneware or earthenware pipes.72 This quick planning soon proved to have been cursory at best, as it had missed numerous details and potential problems that emerged over the weeks and months that followed. Specifications for the pipes were required before the tender could be advertised. The characteristics of the soil and rock strata were unclear, and the chief engineer had to ask the road surveyor for advice regarding excavation work. But the most significant obstacle proved to be the unavailability of suitable drainage pipes. The company that had won the bid was unable for months to deliver even a specimen for testing. These delays also slowed the laying of the water distribution pipes. Trenches had been dug in Saint-Jean Street for both distribution and drainage pipes, but the latter had not yet been delivered. Further excavation work had to be halted for the time being.73 To circumvent this impasse, the Water Works Committee considered alternatives. It resolved in October 1853 to construct drains of stone in Glacis Street “if practicable,” while those in Sainte-Claire Street would be wooden pipes and only those in Saint-Augustine Street of earthenware pipes. The goal was to be able to close the excavations in those streets before the onset of the winter.74 The wisdom of laying wooden pipes was apparently questionable, as the chief engineer opposed their usage on a larger scale in Saint-Roch.75 All these delays and problems tried the patience of the Water Works Committee. In March 1854, before the resumption of construction after the winter break, the committee sent a letter to the chief engineer that came close to being an ultimatum. It ordered Baldwin to complete both the water works and the drainage system within that year and demanded from him a list of materials needed to achieve that goal. Fortunately for Baldwin, the earthenware pipes were at last ready, as the assistant engineer had learned during a visit to the producer’s premises, although in the end a

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considerable portion of the pipes delivered proved to be faulty.76 When the water works was officially inaugurated in late 1854, it comprised more than eight miles of newly constructed water conduits and almost five miles of sewers. Yet, the system was hardly more than rudimentary. Parts of Quebec were served by temporary pipes, and new excavation work began in January 1855, about one month before the regular service of water supply and drainage began on 27 February 1855.77 The decision to dig up many of the roads and streets of Quebec a second time within a few years for a large infrastructure project stretched the financial resources of the city to the extreme. The cost of the water works and sewers far exceeded other municipal expenditures for roads or salaries for police officers and administrators. The tax revenue and the limited debt the municipality was legally allowed to incur turned out to be woefully insufficient to fund the runaway costs of such an enormous project. Completion of the project was not even a viable option until after the city’s charter was changed in 1853 to allow the municipality to go deeper into debt and thereby make new funds accessible. However, it turned out that the city was still unable to fulfill its obligations. The dream of a civilized and healthy Quebec achieved through the availability of fresh water and functioning sewers threatened to push the municipality toward bankruptcy.78 Quebec’s Last Cholera Epidemic, 1854 In the aftermath of the minor epidemics of 1851 and 1852, the Health Committee had attributed the decline of deaths to Canadians’ improving acclimatization to the local environment, and it had predicted—prematurely—that future epidemics would be even less severe. In 1853, the city survived a cholera scare unscathed when a ship arriving at the port was sent back to Grosse Île after inspection. There had indeed been cholera cases aboard during the passage, and this time the staff of the quarantine station succeeded in containing the disease on the island.79 In 1854, however, cholera returned to Quebec, and the epidemic was far worse than the outbreaks of 1851 and 1852. Despite the fact that Quebec had been free of cholera in 1853, the danger was again present in the minds of the authorities. The public still strongly believed that the disease was coming from Europe, but the city council and the local medical practitioners disagreed. Following the dominant medical opinion in Europe, they were convinced that cholera had mainly local causes and that timely sanitary preparations for the shipping season were the appropriate way to ensure another cholera-free year. Thus, with spring and the start of the shipping season in 1854, cholera reappeared in the considerations of the

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Health Committee. It urged the city council to order the usual precautionary measures—appointing a health officer, granting the committee enhanced powers to appoint health wardens or visiting physicians and establish temporary hospitals—and to authorize the committee “à faire tout ce qui serait nécessaire, dans les circonstances, pour le bien de la santé publique.”80 After an initial delay, the city council eventually accepted the proposal in two steps. On 26 May 1854, it appointed a board of health, but it refused to install health wardens until 20 June, when the first cases of cholera were reported.81 These patients came from two ships—the Glenmanna and the John Howell. During the passage, the Glenmanna had lost several passengers to cholera. Consequently, the authorities at the quarantine station at Grosse Île had ordered all passengers to come ashore for disinfection, and at the station they had been mingled with passengers from the John Howell, which had had no cholera cases on board. After the usual procedures, both vessels had been allowed to proceed to Quebec on 17 June, having been declared free of the disease. At Quebec their passengers continued to lodge aboard their ships but were allowed to visit the city. When disease broke out on both ships on 20 June, the sick passengers were sent to the Marine Hospital.82 As during previous epidemics, the municipality tried to shift responsibilities and some of the resulting costs to the provincial government. It called for a central board of health that would be more effective than the local boards in fighting an epidemic. After all, a central board could pass regulations for the whole province of Canada, including Grosse Île, where the disease had once again slipped through or where people had been infected due to miserable sanitary conditions. The call for a central board suggested a remarkable change of heart. Only five years earlier, the city of Quebec had called for special legal treatment, as its situation was deemed incomparable to any other municipality in Canada. Municipal authorities had claimed then that a public health act for the whole province would not meet the special needs and peculiar characteristics of Quebec. As a result, the assembly had passed an act designed to let local authorities manage local conditions. Now, the city council called for a provincial central board of health to assume some of the responsibility for public health. With the disease rapidly spreading beyond Quebec, the governor-general finally heeded advice on 5 July. In the end, though, the central board played no significant role in local dealings in Quebec, though it caused less resentment among local authorities and physicians than its predecessor had in 1849. However, this step by the provincial government also required the

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establishment of a local board of health, and, on 18 July 1854, the council accepted the inevitable and created a board consisting of seven members, the mayor among them. In its first report to the committee, on 21 July, the board painted a bleak picture of the situation in Quebec. Already, 554 cases of cholera had been recorded, and 402 of the patients in the hospitals had died. The disease was now in decline, but the epidemic was far from over. On a positive note, the board could stress that the first report of the outbreak’s extent had been exaggerated and the number of cases indeed had been lower than suspected.83 Over the next several weeks the Quebec Board of Health did more or less what its predecessors had done. It received the usual complaints about unsanitary places, such as crowded houses, a tannery, a filthy yard, pigs kept behind a house, and public privies that were suspected of causing a cluster of cholera cases in their vicinity. It kept daily records on the numbers of cholera cases and deaths from the disease, collected and delivered by the health officer, and conveyed them to the central board, which tried to observe the epidemic’s course throughout the province. A second visiting physician was appointed in early August, and the local board could report to the central board that public health in Quebec had been much improved recently, with the exception of Saint-Jean.84 Despite the busy dealings of the board, there was some routine. The fourth cholera epidemic in six years had blunted the population’s sensitivity to the issue. Although the epidemic was more severe than its two immediate predecessors, it failed to provoke as strong a reaction among the city’s residents and authorities as the epidemics in 1832 and 1849 had. Cholera, Sanitary Thinking, and a Reformed City During the cholera epidemics of 1849, 1851, 1852, and 1854, the authorities gave most of the elements of their established repertoire of public health measures another try. Only a few had been permanently shelved, such as the camp outside the city or citywide purification of the atmosphere, while some were used more frequently than others. The authorities still relied mainly on quarantine and cleansing. The former, however, was firmly in the hands of the provincial government, and trust in the effectiveness of quarantine was slim. It was possible to argue that the imperfect procedures at Grosse Île were responsible for the failures of a concept that was sound in principle. Recurrent epidemics made this debate increasingly academic, however. The medical experts were almost unanimous in their opinion that cholera epidemics had mainly local causes and that the popular belief in the importation of a contagious disease by immigrants was generally

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unfounded. Of course there were still some physicians who supported a contagionist interpretation of cholera’s spread. However, they were marginalized and barely represented among the municipal decision makers. This change in attitude put more emphasis on cleansing and, as a result, there was a new focus on sanitary improvement of the city. The removal of nuisances had been considered essential as early as 1832, but the ideas about sanitation that reached Canada in the 1840s offered a more systematic perspective on cleanliness, one that was detached from the actual presence of epidemic disease in the city. This new view also furthered changes in the perception of the urban environment. First, atmospheric conditions were no longer considered as important a potential cause of disease—hence the lack of purification. Instead, water was now perceived as a significant source of danger, although clean water was at the same time considered to be the main tool for sanitary improvement. Second, minimizing potential causes for epidemic cholera helped the officials to focus their attention on specific phenomena in the urban environment, such as surface water, and ignore others. Instead of the previously almost unlimited number of factors that might or might not be causing cholera, they now had a limited number of issues on which to focus. Sanitation as a political consensus, regardless of the medical theory on which it was based, had made it easier to identify the causes of cholera in the urban environment. It had simplified cholera and thus the number of actors required to control the disease. At the same time, improvised measures to counter a temporary threat were no longer sufficient, though they were still necessary to react to an outbreak. Rather, a fundamental and sustained alteration of the local environment was required. The permanent sanitary infrastructure of water supply and sewers operated continuously and effected a perpetuation of what had previously been, at best, temporary improvements. Infrastructure for those purposes was intended to create a reformed and improved city with equal access to clean water and sewers. From now on, Quebec would be a clean space. Removing filth and nuisances would deprive cholera and other dangerous diseases of the basis of their existence. Furthermore, the new infrastructure would reform not only the urban environment but also the whole population by altering the population’s behavior. Habits that were detrimental to individual and public health would cease. Consequently, the new works would render cholera part of a successfully overcome past. The motivation for funding this infrastructure, however, was not entirely out of concern for public health. The status of Quebec as a civilized and modern city might have been the main reason behind the preliminary

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initiative to develop a reliable water supply and gas lighting. Of course, public health was among the reasons offered as justification for constructing these works, but the examples of British and American cities provided the dominant incentive to go into debt and fund an infrastructure that would make life more convenient. Sewers, which would add massively to the cost of the scheme, were not a primary focus, since a gain in prestige would materialize with just the water system in place. Only the recurrent cholera epidemics from 1849 to 1854 changed this attitude. Convenience and municipal rivalry faded as death and disease loomed, and sanitary improvement became the top priority. The presence of cholera as both a persistent threat and a recurring epidemic disease over more than five years persuaded the municipal authorities to invest heavily in overcoming the population’s unsanitary behavior, which had so disastrously haunted the city since 1832. Sanitary improvement also had several political advantages that seemed to justify its high costs. Since it added another instrument of control, a comprehensive system of sewers would make much of the urban surveillance by health officers, wardens, and visiting physicians redundant. Its convenience would almost automatically predispose the population to use it and thus ensure the removal of offensive and dangerous filth from the urban environment to a faraway location. After the completion of the scheme, it would save the municipality money, as it would prevent or minimize the impact of epidemics and, as a side effect, make the expensive improvised measures that dominated the local authorities’ response obsolete. The sanitary infrastructure also had another, less obvious political consequence. It added another layer of governmental control over the environment and population of Quebec, thereby strengthening the colonial state as a whole. Water supply and sewers were actors created not only to integrate cholera into a scheme that tried to prevent future epidemics but also to change the behavior of the population—to civilize it. However, under the conditions of a colony of settlement, with its democratic representation in an elected assembly and city council, this new level of government control was a double-edged sword, as the majority of the population was participating in the political affairs of the city, thus taking power away from the colonial and imperial governments or turning its might against fellow citizens. The way of life that sanitation was intended to promote was certainly of a bourgeois kind, and the law could be used to exclude or change the behavior of immigrants or the poor who did not fit this vision.

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Chapter 4 The Advent of Sanitarianism Madras, 1840–1857

While Quebec embraced sanitarianism quickly—at first primarily as a matter of status, then as a means of preventing epidemics—Madras faced a long road to universal acceptance of the principle. The government was extremely reluctant to invest substantial sums in infrastructure projects, fearing spiraling costs and unrest. Fundamentally opposed to this conservative position, medical practitioners and engineers within the colonial administration wanted progress. The sanitary movement provided them with an incentive to promote the already growing role of the professions within the government; implementing sanitation projects would result in not only a healthier and more civilized population but also new positions and a higher profile for themselves. There was thus a prolonged struggle within the colonial government about the scope and responsibilities of the colonial state. The Growth of Colonial Medicine Medicine was one of the areas into which the colonial state began to pour considerable resources from the 1830s onward. This infusion of governmental wherewithal was not restricted to medical care, an already established focus of government activity in that realm; it also included medical training. Through this expansion of funding, medical treatment became an increasingly contested field that was supposed to simultaneously demonstrate

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the superiority of the colonizers and prove their benevolent intentions. The higher demand for medical services required the establishment of new medical institutions by the colonial state. The government’s investment in those two areas was to the benefit of the medical profession, as it resulted in new positions and paths for recruitment, thereby strengthening and accelerating the twin processes of medicalization and professionalization.1 Most of those processes were taking place in the Madras Presidency’s capital. By 1829, the government had already decided to open a dispensary in the town of Chintadrepet. It had explained in a letter to the Court of Directors of the East India Company that this dispensary was needed due to the frequent sickness of the company’s writers, who were employees of a low rank and had nowhere to turn for medical care. The dispensary staff would treat patients “with particular attention to the observances required by their Cast[e] and Religion.” The medical officer in charge of the Black Town would give advice in case of the appearance of “severe diseases” and “exercise control and Superindendense [sic].”2 The dispensary, once operational, was well received by the Indian population of Madras, or so the government reported to London in a later letter. The company’s servants frequented the new institution, as did “a large proportion of the most respected Native Inhabitants of the Black Town, Triplicane and other Villages near Madras who until the establishment of it had no means of proceeding [sic] Medical aid for themselves or their families.”3 This success story, which stood in stark contrast to the rejection of the temporary dispensaries during the 1818–20 cholera epidemic, should be taken with more than a grain of salt, as it ignored the role of Indian medical practitioners in the care of the indigenous population. Most patients came to the dispensaries as ambulants, while only a few stayed as inpatients.4 However, the dispensary must have been deemed a success, since the government sanctioned the expansion of this service over the next few decades: one dispensary was established in the northern part of the Black Town “in connexion with the Native Infirmary” in 1837, one in the southern part of the Black Town in 1843, one in Triplicane in 1845, and one for Vepery and its surroundings in 1848. During the decades that followed, these dispensaries shouldered the main burden of spreading European medicine in Madras.5 To complement the dispensaries, the government also established a maternity hospital in 1844. Nine surgeons had seized the initiative, formed a committee, and petitioned the government to support a medical institution dedicated solely to the health of women. After some hesitation, the governor-in-council approved the plan, probably in part because private

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philanthropists had agreed to pay for the construction of the building, which was near the Cooum River. After some time, the government realized that the operating costs were considerably higher than expected, and, in 1847, it had to take over management of the facility from the committee of surgeons.6 This unexpected development was aggravated by the fact that a second maternity hospital, this one privately owned, was soon established in the Black Town. It was founded in 1850 by Dr. John Scott, who had previously run a well-known hospital for women in Colombo on the island Ceylon. Upon Scott’s arrival in Madras, his plans were widely welcomed, and he received private subscriptions and a government grant for his establishment, which soon proved to be very popular with the Indian population of the Black Town.7 This latter fact was quite a telling contrast to the government’s hospital, which clearly attracted fewer patients. When the disparity came to the notice of the Court of Directors in London, it triggered an official investigation, which led to an open dispute among Scott, the Madras Medical Board’s superintending surgeon, the governor, and several members of the council over the control of the independent hospital. In the end, Scott had to close his establishment in 1852 due to a lack of funds.8 The expansion of medical care for the Indian population required additional medical staff, who had to be trained in India. Since 1822, Calcutta had had a medical school where European and Indian medicine was taught to Indians who sought entry into the military’s medical service.9 Madras followed suit in 1835, when the Madras Medical School—and from 1850 onward, the Madras Medical College—was established. Only one year after its foundation, the school was opened to civilians. The demand for such an education proved to be nonexistent, as there were no applications for eight years. Once civilian students enrolled, the degrees awarded prepared them only for positions in the Indian Medical Service’s subordinate ranks, such as apothecaries and surgical dressers. Even from 1847 on, when the course of training was again revised and upgraded, graduates received only the degree of subassistant surgeon, which from 1855–56 on was at least recognized by the Royal College of Surgeons in London.10 As in Quebec, the establishment of institutions of medical training also boosted the creation of medical journals. The Madras Quarterly Medical Journal was edited by Samuel Rogers and issued from 1839 to 1844. It offered surgeons employed in the presidency an opportunity to publish their observations, discoveries, and theories on nosology, physiology, and therapy. The journal also passed on information published in the other presidencies, as well as in Europe, if this information appeared to be of interest to the readership. De-

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spite the early end of the publication, the concept of a local medical journal for Madras remained attractive, as several successor journals under varying editors and titles were established in the following decades.11 None of these activities involved a restructuring of the presidency’s medical authorities. The Madras Medical Board remained the central administrative body, and most of its duties and responsibilities were unchanged. Its only innovative project was the publication of a volume on medical topography in 1842 that covered the city of Madras, or, in the military’s terminology, the “Presidency Division” of the army. This book was a result of original research by the medical officers, who completed a systematic compilation of already existing records in the Medical Board office. Publication of the medical topography of Madras was initiated by order of the government of India and was the first volume of a series of ten studies that would cover all districts of the Madras Army.12 The medical topography of Madras described the characteristics of the fort, the Black Town, and the other towns and villages that made up the city, as well as the government-run medical infrastructure of hospitals, infirmaries, and dispensaries. It focused on the predisposing causes of disease in the urban environment to which both European and Indian residents were invariably exposed. It did not, however, try to establish a correlation among local geographical characteristics, the climate, and the prevalence of certain diseases but did list possibly harmful agents that might be found at certain localities and be detrimental to health. Water was of special concern, both fresh water for human consumption, which was considered to be both plentiful and of good quality, and surface water in tanks, as well as sewerage in drains. The lack of any type of sewer system particularly attracted the Madras Medical Board’s attention, as dangerous effluvia could endanger certain populated locations.13 Which diseases might result from those predisposing causes was thought to be subject to individual disposition and behavior. However, the Madras medical topography also attempted to ascertain the prevalence of certain diseases by recourse to mortality and morbidity statistics. Because such data were not compiled for the whole territory, the volume’s authors had to resort to the numbers compiled in institutions where European medical practitioners had unrestricted access to patients, such as the hospital, the dispensaries, the jail, and the army barracks. Only they provided the board with a factual basis for determining the presence or absence of certain diseases in Madras. Thus, the comprehensive approach of the Report on the Medical Topography quickly reached the limits of the scope of colonial medicine in Madras. Despite the new institutions and the corresponding expansion of medical treatment

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and training, the limited perspective of the colonial enclave still dominated. Information about public health and the medical situation in most locations remained superficial. For facts beyond casual observation, the Madras Medical Board still had to resort to the spaces under its immediate control. Of the diseases under consideration the study did not single out cholera as particularly dangerous or prevalent. It merely noted that the disease had a high mortality rate “among the poorest classes of the population” and that its preferred season was during the months of August to October.14 This slight regard for cholera shows that its novelty had worn off, at least at the administrative level. It had become a run-of-the-mill Indian disease that deserved less attention than fevers, which were endemic, supposedly caused by the decomposition of the lush vegetation, and regularly took a toll among troops and colonial officials, warranting constant measures to improve ventilation and dispose of rotting leaves.15 Cholera was considered comparatively innocuous, and even outbreaks did little to alter this perception. India was widely affected by the disease, and it is no surprise that the Madras Presidency also had cases of it. At Madras, or rather at Fort St. George, no one seemed to take notice. Sporadic reports of cholera’s attacks on troops on the march, in distant stations or, rarely, in Madras did not cause much concern among the medical or military authorities. Cholera had become an element of everyday administrative life as long as it did not affect the fort and its residents directly.16 Although the colonial authorities took little notice of cholera among the local populace, the presence of filth in the streets of Madras increasingly became a problem that the government and its administrative institutions had to address. In the years after 1849, the government and some of its officers fought a protracted battle about a relatively small issue: the southern part of the drainage system of the Black Town. Superficially, it played out as a dispute between the government and its own experts. But this conflict was about more than financial, sanitary, economic, or engineering matters, although it very much started as such. In the end, it was a conflict about the idea of colonial government and its purpose: it became a conflict between the concepts and policies of the civilizing mission and colonial nonintervention in “native” affairs.17 Drainage for the Black Town The poor state of the drains in the Black Town had attracted the government’s attention as early as 1825, when a committee appointed by a grand jury reported to the Supreme Court of Madras, which was responsible for the condition of the jail, that the drains nearby were “a serious nuisance.”

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Although the prison itself was in an exemplary condition, as the grand jury stated, the health of the inmates was endangered by “the filth and Ordure continually deposited” in its proximity. The justices on the Supreme Court asked the government to order the justices in sessions to remove the nuisance, and they complied.18 The problem with the drains near the jail was not an isolated case. As the Report on the Medical Topography would note a few years later, the drains in the main streets of the Black Town and some of the other towns and villages were open sewers. They were often clogged, and, to keep them clear, conservancy officials employed Indian scavengers who emptied the drains regularly and transported the sewage out of town, an occupation thought to be decidedly unhealthy.19 This pitiful state of the sewers contributed to the perception of the Black Town by Europeans as congested, poor, and filthy. It epitomized an unhealthy location that should be avoided, and the prevailing stench was both proof and reminder of the dangers present there.20 From the early 1840s on, the authorities tried to solve this problem comprehensively. The existing main drain was a partially open ditch with a paved bed that was supposed to carry filth, refuse, feces, and rainwater through the narrow and curved streets of the Black Town southward to an outlet at the northeast corner of Fort St. George. However, due to the drain’s many course changes and lack of cover, filth as well as sand and dirt from the streets accumulated at certain spots and emitted a foul odor that troubled the neighborhood. The European residents of the Black Town lobbied the authorities to rectify such nuisances. They claimed that the neglect of the existing sewers made the town unhealthy, but at a public meeting a surgeon dispatched by the Medical Board tried to assuage their fears. He pointed to the general absence of severe cholera epidemics in the Black Town as evidence of its healthiness, although he granted that the normal— for India—“occasional visitations” did occur. Through this emissary the Medical Board conceded that the stench emanating from the drains was an inconvenience for the population, but it considered the Black Town to be one of the cleanest and healthiest “Native Towns” in southern India. Thus, the medical experts in Madras denied a direct connection between stench and disease. Thus, if no such connection existed, then the poor drainage was a mere inconvenience and lacked any urgency.21 The justices in sessions were responsible for the infrastructure of the Black Town, and although they intended to improve the situation there, they lacked the necessary funds. Following a plan designed by a committee of engineers, who had recommended some changes as early as 1836, the

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justices asked the government to support their effort, but only after having already engaged contractors to work on the drainage project. The government was not pleased but agreed that the improvements were necessary and referred the matter to the Court of Directors for a final decision.22 London was generally supportive of measures to improve the drainage of the Black Town and thereby improve its wholesomeness. It agreed to use government funds to support the justices in sessions as long as they refrained in the future from undertaking such works without proper funding. However, the directors felt that they lacked sufficient information on the plans in question and asked for more details and the opinions of the “principal Engineers at the Presidency.”23 The court’s reaction to the detailed plans sent in response was damning. They found them piecemeal and wanting, especially when compared to the newest knowledge on the matter in England, where “many eminent engineers and architects” had focused their attention on the drainage of London. The plan for the Black Town violated several of their principles: a proper sewer had to be an oval tunnel with a diameter large enough for a man to pass through for cleaning and repair; it had to be as straight as possible, with no right angles in its course, and any change of direction had to be in a curve as large as possible; it had to run along the middle of the street; its incline had to be at least a quarter of an inch for every ten feet (curved sewers required a much greater fall); and deposits in the drain had to be cleared by flushes. The plan for the Black Town drain did not meet these requirements. Although the elevation from its starting point at the northern end of the Black Town to the outlet into the sea was sufficient for a straight line, it had many curves and several times broke at right angles. Its bed was uneven and featured several stagnant pools of sewage during the hot season. To improve some problematic sections, as the plan suggested, would not eliminate the fundamental flaws of the current drain. A bold, new, and comprehensive approach that followed the most recent principles was necessary. Thus, the court sent two copies of the Report of the Surveyor of the Holborn and Finsbury Division of Sewers from 1843 and Chadwick’s Sanitary Report of the Poor Law Commissioners from 1842 in order to convey “the most recent information on the construction and management of Sewers in London, and on the preservation of health in large Cities.”24 The government passed the reports and the requirements on to the justices with the request to reconsider all plans and suspend the current construction work. The justices charged their civil engineer with the design of a new plan that would reflect the court’s criticism and adhere to the principles that had apparently yielded success in London.25

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Once the court’s letter had been reviewed, the justices replied to the government that the construction work had already progressed too far to suspend. However, the civil engineer, a Capt. John Thomas Smith, had already altered the plans in a way that had anticipated much of the court’s criticism. He had independently developed the comprehensive plan the court had demanded, although with some deviations from the principles the court had conveyed, due to local circumstances. His plan provided for the construction of a completely new and straighter drain with two outlets: the existing one to the south of the Black Town and a new one to the north of it. However, he was willing to accept the advice of the court and consider changes to his plan that would improve the design and make it unnecessary to undertake a complete overhaul of the recent construction work.26 The government charged its chief engineer, Col. Duncan Sim, with investigating the already completed work and finding a solution. In his report he explained the topographical situation that made constructing an efficient drainage system so difficult. The current sewer lay in a small depression running parallel to the coastline from north to south and discharged into the sea at both ends of the Black Town. Its incline, Sim discovered, was only 2 feet, 8 inches, over a length of 4,785 feet. Although the main drain in the Black Town had been recently reconstructed, that effort had been only a partial success. Smaller secondary drains in cross streets emptied into it, leaving deposits that further hindered runoff. While the current was strong enough to carry off refuse during the monsoon rains, at other times of the year it was unable to do so. Since sand and filth from the road were washed into the drain, they accumulated there and obstructed the runoff of sewage at several points. The material had to be removed manually, thus generating additional expenses.27 Additionally, the drain lacked a proper outlet into the sea. Only an untended canal, in which sewage stagnated for months, connected the southern half of the Black Town drain with the shore. On its way from the limits of the Black Town to the sea it crossed the northern esplanade of the fort, a largely unused open space under the government’s authority. The government’s approval would be required for any construction work on the esplanade. Sim proposed an extension of the reconstructed southern main drain. His design would follow the line of the existing drain that discharged in proximity to the northeastern corner of the fort. However, on this path the existing drain had no continuous natural incline and the “filthiest Sewerage of the Town consisting of putrid animal and Vegetable matter . . . in a state of fermentation” accumulated on the esplanade in the

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Figure 3. Drawing of the Black Town main drain, c. 1840, © The British Library Board, opposite p. 248, in IOR/L/E/4/960.

immediate vicinity of the fort. The canal was open to the tides, so when the sewage-seawater mixture flowed into the sea during low tide “the exhalation from that portion that escapes is most offensive to the inhabitants of the Fort when the wind is from the North ward.” However, it was only the “lighter and fluid parts that escape to the sea, the heavier portion falls to the bottom and continues stagnant; till stirred up by floods during the heavy rains, when the smell of the putrid mass is almost intolerable. This part of the sewer is cleaned as well as practicable yearly, during the hot weather by manual labor but the operation is necessarily very imperfect, and the filthy stagnant sewerage cannot be removed.”28 In the eyes of the authorities, the outlet across the esplanade had become more than an inconvenience. It now was a nuisance that made action necessary to preserve the health of the fort’s residents. Unfortunately, it was in no way clear how these obstacles might be circumvented.29 In his review Colonel Sim proposed a slight alteration to the existing plan: a relocation of the drain’s outlet seven hundred yards to the north and thus closer to the Black Town. The technical problems of drainage would remain unresolved, but it would relieve the fort of most of the nuisances its inhabitants had to endure by shifting the problem toward the civilian population in the southern part of the Black Town. Yet, the matter was not that simple. Sim’s plan would require the acquisition of land and infringe upon the property rights of individuals. Legal matters arose that would have to be resolved, and approval for the change would have to be ob-

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tained from London before construction could resume. After a long period of tense waiting, which had prompted several letters to London urging a decision on the matter, the Court of Directors rejected the proposal and ordered the government to proceed with the original plan despite its flaws.30 In the years after Sim had issued his report, the reform of the northern part of the Black Town’s main drain, including its outlet, was completed and the reconstruction of the southern part continued under the authority of the justices and according to the original plan. Still missing by 1847 was the outlet of the southern drain into the sea. None of the technical defects discovered by Sim and the resulting open questions had been addressed, although given the severity of the nuisance caused by the stagnant sewage lying between the Black Town and the fort, both the justices and the government found them hard to ignore. Still, their only hope for a solution lay with the expertise of the engineers. The authorities asked Capt. John Carne Boulderson, the civil engineer, and a Major Smith, of the army engineers, to explore ways of making the existing system work better and to reassess it in general in light of recent scientific progress in England. In his report, issued in 1848, Boulderson pointed out that the situation had not changed since Sim’s review. The runoff within the Black Town was problematic due to the deficient state of the secondary drains and the canal that directed the sewage to the sea. Smith refused to evaluate the working of the sewers in detail without a comprehensive investigation but offered his opinion on the ways to procure water to flush them. He considered a supply of fresh water from the Red Hills, as well as using a steam engine to pump seawater into the drains. The latter plan, he reckoned, would incur lower initial expenses but require continuous funds for maintenance and operation. A supply of fresh water would certainly necessitate a higher initial investment, but once the infrastructure was in place it would run almost for free and provide the residents of the Black Town with fresh drinking water, thereby improving their health and well-being. Smith did not consider himself to be in a position to estimate which solution would in the end be more economical or even how much those plans might cost. Both would exceed the financial means of the justices’ budget and thus require assistance from the government. Smith therefore restricted himself to suggesting issues that had to be addressed if such a major project was to be undertaken: the viability of water tanks in the vicinity of Madras to serve as a freshwater reservoir during the dry season, the negative effects of such a project on the local population and the cost involved if agriculture should be harmed, and the cost for transporting or conducting water to the Black Town and the annual expenses that would be involved.31

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Over the months that followed Boulderson developed a plan that envisaged a steam engine pumping seawater into the secondary drains of the Black Town, thereby flushing the accumulated sewage into the sea and solving the persistent problems once and for all. As the government would have to pay for the scheme, it established a committee of three army engineers, Major Smith among them, to obtain a second opinion on the scheme’s practicability. Their report on Boulderson’s plan, submitted in February 1852, was scathing. They considered it impracticable, as it would not address the underlying problem that caused the clogging of the main drain in the first place: the lack of incline. To rush a greater amount of water through the sewers on a daily basis, as Boulderson proposed, would only disturb the deposited filth and mix it with the water. The result, the committee feared, would be an extension of the “nuisance of decomposition and the generation of noxious gases” over the whole extent of the drain network instead of the limited section on the esplanade.32 To support their claims, the committee referred to the comparable experience of flat sections of London, where low-lying areas in Surrey and Kent had encountered a similar problem when sewers had been laid out. There, too, the sewers’ incline had proven insufficient for natural runoff, and water from the Thames was used to wash the refuse out once the defect had become apparent. The result had been not a clean runoff of the sewage but the neighborhood’s increased exposure to dangerous exhalations. The implications of this practice had been grave despite the advantage of the comparatively cold climate there.33 Since Smith’s first report on the matter, he and his colleagues had had sufficient time to investigate the subject and design a better solution. In their opinion, only a steeper incline of the main drain from its beginning to its outlet would guarantee success. To achieve this goal, they would have to replace the existing canal by laying the sort of pipes that had proven their capability in England. They were smooth and offered little resistance to the flow of sewage. Sand and dirt from the surface would not be able to cling to any uneven seams between bricks. The sewage would run off steadily into a cesspool lying below sea level, which would thus provide enough of a differential in elevation. Steam power would then pump the sewage into the sea. The engine would have to be strong enough to overcome the force of the surf so that sewage would not wash back into the canal or onto the beach. The engineers on the committee knew that their plan was ambitious and that it exceeded the limited expectations of both the government and the justices. They justified their scheme on the basis of the new technical knowledge on which their plan was based. Only

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recently they had had the opportunity to study the Report of the General Board of Health in England, which had compiled the investigations, experiences, and knowledge of sanitary commissioners all over the country. The same report also offered ideas that might be followed in making further improvements to the situation in Madras, as it stressed the importance of a combined system of drainage and water supply for a city, especially one of Madras’s size. In addition to fostering the health of the city, a better water supply would also enhance drainage, as it would provide a continuous flow of water in the sewer lines. Thus, the committee urged the government to launch a “full and careful enquiry” into the best means of procuring fresh water and to compare such a system to the existing water supply from wells. They also suggested potential sources for a water supply, such as the nearby Palar and Adyar Rivers.34 The committee was well aware that its proposal sounded grandiose and would be very expensive. Hence, it particularly stressed mitigating factors that would anticipate the objections of their superiors who would—in all likelihood—be skeptical or even hostile. First, the work on the sewer had been completed for some time, and the government and the justices agreed that the results were unsatisfactory. What good, then, would Boulderson’s remedial work do if the outcome again was insufficient? Would the money spent on such an effort not be wasted? Thus, the committee tried to promote its proposal as simply an extension and improvement of the existing officially approved efforts. It was, like Boulderson’s plan, just a way to make an already-commenced but flawed project function properly.35 Second, the proposed scheme would be comprehensive. Boulderson’s proposal would clean out only one-quarter of the drains while a constant supply of fresh water would be distributed over all of the Black Town and consequently also run through all the sewers leading to the main drain. When taking all of Madras into consideration, Boulderson’s plan appeared even more suspect. It affected only one-third of Madras’s population. For those living outside the Black Town, it brought no improvement. The committee’s proposal, however, would supply fresh water to most of the people living in the city, if not all.36 The last argument was the recommendation not to take on the whole project at once. In several places it called for further study of the matter and the employment of an engineer responsible solely for this investigation and for the implementation of two small measures that would immediately improve the situation and simultaneously serve as first steps for the full project. The first was to fill in a ditch designed to carry seasonal stormwater from the southern Black Town drain, across the western esplanade,

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and to the Cooum River. Like the canal across the northern esplanade, this ditch served as an unintended cesspool running along the western side of the fort. Filling it in would improve the condition of the fort with only a small expenditure. Second, the committee suggested creating a sharper incline of the sewer line on the esplanade to allow its runoff to flow into the sea without a complete reconstruction of the sewer system. Therefore, the floor of the existing canal across the northern esplanade had to be raised between a cesspool at the end of the southern Black Town main drain and the sea. The sewage would be pumped into the raised canal and then flow into the sea.37 The governor and the members of the Executive Council were not pleased with the committee’s report. In addition to rendering Boulderson’s plan useless, it also offered unsolicited advice, and the government was not in a position to take sides in a dispute among experts. The governor, Sir Henry Pottinger, was particularly scathing in his assessment. In a first reaction he made no secret about his disappointment that the experts deemed Boulderson’s plan impracticable and that their proposal did not seem as straightforward as they had claimed. When reviewing their considerations, he spotted inconsistencies. Some of the recommendations, he figured, would be against the law.38 In a second statement issued several weeks later, Pottinger commented again on the subject. He had now had plenty of time to carefully study the report and to form an opinion on more solid ground. He denounced the committee’s effort as “speculative” and far exceeding the scope of works deliberated by the government. He did not deny that a full implementation of the scheme could bring considerable improvements for Madras, although his doubts about the project’s practicability remained. But his main misgivings were that the report did not offer what the government had asked for. It wanted the simplest and cheapest feasible solution for a local problem and not a massive infrastructure project. If the committee held the opinion that Boulderson’s plan was not feasible, he had to accept their conclusion. However, he was not prepared to subscribe to any megalomaniacal scheme that would offer no quick remedy for the existing problems but require massive funding that would have to be provided by the government.39 John Fryer Thomas, another member of the Executive Council, expressed a similar sentiment. He concentrated his objections on the fact that the committee had not included an estimate of the costs to be incurred in its scheme. He also went further than Pottinger by doubting that such a plan was necessary at all under the circumstances that prevailed in Madras.

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While in Europe and particularly Britain the majority of the population lived in crowded lanes and alleys where cleanliness was rare and health in constant danger, Madras offered its inhabitants an abundance of space. Large parts of its territory between the several centers of settlement were uninhabited and used for agricultural purposes. In addition, the climate of Madras was “naturally pure and dry to a remarkable degree.” The intensity of the sun dried the “putrid and offensive” matters and thus removed the “noxious exhalations.” As the constant sea breeze blew away any malaria and good well water was available to the population in abundance, Thomas fancied Madras to be a place of exemplary health and therefore not in need of any expensive, large-scale infrastructure project to improve its condition. Nonetheless, something had to be done about the main drain that affected the fort, and with Boulderson’s plan deemed impracticable, Thomas approved of the scheme to increase the sewer’s incline and pump the sewage from a cesspool into the sea.40 Sir Daniel Elliot, a third member of the Executive Council, struck a more appreciative tone. He did accept the topographical similarities between those low-lying parts of London and the Black Town referred to by the committee and their implications for any technical solution. But, like Pottinger, he pointed to open questions regarding the few practical recommendations in the report. This left the council at an impasse. It had one plan that was considered impracticable by one expert who had been asked to review it and another ambitious but not very detailed proposal that the council rejected on several grounds and that—even if adopted—would take years to complete. Its only option was to let the extensive plan as a whole rest and instead sanction some of the smaller suggestions included in the committee’s report. In the end, the council resolved to fill in the ditch across the western esplanade and to raise the floor of the main sewer on the esplanade to enhance runoff into the sea.41 Foundations of the Sanitary Infrastructure Conflict The Executive Council’s resolution left unsettled the main problems with regard to both the practical terms of drainage and the conflict concerning the scope of the measures. The engineers and the government had very different opinions about what kind of sanitary infrastructure a city like Madras should have. For the engineers, the point of reference was Britain. They tried to emulate the standards set there in terms of scientific expertise, the scope of the projects, and the enhanced political importance of their profession. What better way to prove their value than with a large-scale project conducted in the most sophisticated manner? The government and

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Governor Pottinger in particular had a very different perspective. They strongly believed that European standards did not apply to India. They considered not only British living standards and political rights but also the role of government more generally to be inapplicable to the colonial setting. For Pottinger, it was simply not the government’s business to intrude into the lives of hundreds or thousands of people, to tax them, and maybe even destroy their livelihood for a fancy project of questionable value. If intrusion was necessary, it was for the maintenance of the East India Company’s rule over India and the defense of its interests. Since the company ruled the subcontinent, it could exploit the privileges of power. Yet, as it claimed to have replaced the “despotism” of its “oriental” predecessors, it had to restrain itself both to avoid their fate of decadent decline and to minimize indigenous resistance to its rule. The exploitation of the Indian population of Madras by taxation was both a necessity and a temptation. The first had to be fulfilled responsibly, while the second had to be resisted.42 Henry Pottinger was an old East India hand who had joined the East India Company’s service at a young age and risen through its ranks. The scion of a wealthy Ulster family that had for generations sent sons to India to make a career, he had distinguished himself first in military service in the wars of the early decades of the nineteenth century and later served in the civil administration as a collector in the Bombay Presidency. He had established good personal relationships with his superiors, especially Mountstuart Elphinstone, the governor of Bombay at the time, who had assigned him to important posts in Sind. During a leave to England he had been recruited by the foreign secretary, Lord Palmerston, to go to China as the sole plenipotentiary and chief superintendent during the first Opium War. His task had been to force the Chinese emperor to agree to a favorable peace treaty that would open several ports for British trade or even cede a small island in the mouth of the Pearl River—Hong Kong. After several victorious battles, his negotiations for a peace treaty had been successful, and in 1842 Pottinger had become for a few months the first governor of Hong Kong. Back in Britain he had again been asked to accept a colonial assignment, this time as governor of the Cape Colony. Pottinger had made use of the opportunity, and after several years in South Africa he had been directly promoted to the governorship of Madras. While many of his contemporaries saw it as their task to improve the lot of the Indian population and advance progress through education, Pottinger believed in minimal involvement with Indian life. During his long career he had served in many different capacities, but his understanding of government

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was most profoundly shaped by his time as a soldier and political agent. He saw himself as the EIC’s representative, subordinate to decisions made in London or Calcutta, and he did not consider taking the initiative on a large-scale infrastructure project to be part of his job.43 The engineers conformed to an entirely different ideal of colonial government: the civilizing mission. They believed that it was the colonial power’s task to guide the colonized population to a higher, more civilized form of life. In India the dominant means of civilizing the population had been education. The belief was that if the indigenous people would abandon their ancient and obsolete traditions and embrace Western knowledge it would be the first rung on a ladder toward a more sophisticated and civilized existence. British sanitarianism was a new arrival in India, aimed at changing the environment and not the mind, but it shared several characteristics with the civilizing mission. In fact, one can categorize sanitary thinking as another, internal form of the civilizing mission, one that was designed to improve not colonized populations but the working-class residents of Britain or Europe. These parallel missions allowed the engineers to transfer sanitary practices and techniques to India right along with the moral impetus and rhetoric of the British sanitary movement. They could promote their proposal in a language that referred to higher values and went beyond the self-interest of their profession.44 In India, as in Canada and Europe, sanitarianism was not conceived as a charitable and altruistic project to help the poor. It was a technocratically designed and coercive system, one that would, if completely implemented, almost automatically train a city’s population to adopt a healthier and more civilized lifestyle. The Indians could avoid the practice of European medicine, but by having better water available and connecting their mostly off-limits homes to functioning sewers everyone would use the new infrastructure on a daily basis. This change would make the old and potentially dangerous means of water supply and drainage superfluous and have the additional effect of allowing police officers or neighbors to more easily identify those who refused to utilize the new system. Sanitation would alter the unhygienic practices of the Indian population, pull them out of their seemingly eternal fatalism, and put them on a path toward civilization. The view was that Indians would eventually recognize the improvement and learn to appreciate British rule, and thus a sanitary infrastructure would not only improve public health in Madras but also strengthen colonial control. That the sanitary movement was relatively new and scientific and that it originated in Britain made it especially attractive for the engineers, as it confirmed the United Kingdom’s position as the world’s

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supreme civilization. Indians’ acceptance of and support for the new approach would demonstrate the indispensable modernity of the engineers’ profession, their shared contribution to Britain’s role in the world, and, on a local level, the benevolence of the colonial government toward its indigenous subjects. The committee’s scheme would be a government measure that—if conducted properly and comprehensively—would almost automatically ensure success on several levels. That the Executive Council did not take this same position resulted in a prolonged conflict within the colonial administration of Madras. This clash of worldviews and intentions remained unresolved when Pottinger put the committee’s proposal aside. He had not entirely dismissed it and thus ensured that the conflict would go on as long as the underlying problems—the inadequate main drain and the different notions of the role of government—remained. For the engineers, this indecisiveness left an opening to continue pursuing their goal: sanitation not just for the Black Town but for the whole of Madras.45 The Military Board’s Proposal The rejection of their plans and ambitions did not deter the engineers for long. They still had to complete the reconstruction of the outlet, and they could rely on allies within the government in their pursuit of comprehensive sanitation. In August 1852, the Military Board, under whose authority the engineers responsible for the work were placed, reported to the Executive Council that the construction work on the main drain outlet was about to begin since the deed of covenant with the contractor was ready to be signed. Yet, the matter was still stalled when a new chief engineer was appointed, Col. Arthur Cotton, who decided to review not simply the plans already approved by the government but the whole question of drainage and water supply. After lengthy inquiries, he prepared a report that further delayed the start of construction and defied the orders of his superiors and the justices who wanted the work to begin immediately.46 When Cotton finally submitted the Military Board’s report on 26 April 1853, it must have come as a shock to Pottinger and the other councilors for its uncompromising tone and insubordinate content. First, the Military Board and its chief engineer had discarded yet another plan to solve the main drain problem. Cotton and the board questioned the wisdom of raising the floor of the drain and asked what was to be done with the sewage during the eighteen months that project was under construction. In their view, the open ditch that connected the canal to the Cooum River would become the default sewer—except that the orders indicated the ditch was

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to be filled in. The sewage of the Black Town would, one way or another, flow alongside the fort and “independently of the stench which would be insufferably offensive throughout the fort, the town, and all Madras, it cannot be doubted that the effect on the health of a locality so thickly peopled would be exceedingly prejudicial, and lasting for so long a time it might very likely give use to destructive epidemic [sic].”47 The only way to avoid this danger was the construction of a completely new tunnel parallel to the old one, a project that would incur even higher costs. The sanctioned scheme had such obvious flaws in several interconnected respects that the chief engineer reviewed all of the existing plans. His own proposal was the result of these efforts, and it tried to combine several worthy objectives that had previously come up: supplying all of the (estimated) seven hundred thousand citizens of Madras with drinking water; draining the sewage of the Black Town, as well as of Triplicane and all other towns and villages, without polluting the Adyar and Cooum Rivers; supplying irrigation water to the whole territory of Madras; enabling navigation on the existing canals and water tanks during all seasons; and allowing for the construction of a new canal that would connect the fort with the Adyar, which would facilitate the transport of troops and heavy goods. This new proposal obviously exceeded the scale of the committee of engineers’ earlier suggestions, and of course the authors knew the fate of their predecessors’ plans. Thus, they had prepared a series of arguments to support their case. First, the scheme, if realized, would amortize in the long run, as the improved irrigation would produce higher yields, and toll stations along the new canal would generate additional income for the government. A second argument tried to highlight the enormous improvements that the implementation of the proposal would entail. The Military Board had approached the heads of several government institutions, such as the superintendents of the gunpowder and gun carriage manufactories, as well as the chairmen of the Marine and Medical Boards, all of whom had stated their support. Of those, the Medical Board was the most important, as sanitary concepts of health and disease very much formed the basis of the whole plan. The Military Board and the engineers had no expertise in this matter, so they relied on the medical experts’ assessment. The surgeons’ reply was extremely supportive. They affirmed the Military Board’s assumption that avoidable disease was rife in Madras. To prove their point, they attached six reports of surgeons who complained of the dismal sanitary circumstances of the city’s indigenous population and frequently referred to the unacceptable state of the sewers and the lack of fresh water not only in the Black Town but in all of Madras.

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This affirmative statement by the Medical Board strongly contradicted the calming address delivered a few years earlier to the European inhabitants of the Black Town demanding better drainage. At that time, the board had stressed the health of Madras and the limited effect the defective sewers had on the population. This divergence indicates a shift toward sanitary thinking among the surgeons as well as the engineers. Like the engineers, many medical practitioners in Britain had embraced the sanitary movement as a means of improving the public profile and influence of their profession. With their positive assessment of the Military Board’s proposed scheme, this alignment of interests also manifested itself in Madras. To preempt anticipated criticism, the Military Board’s report also included “arguments against supposed objections to the project” and delivered detailed analyses of the necessary works and costs. This strategy led the Military Board to conclude that their case was “unanswerable.” In the engineers’ view, the implementation of the project would serve three objectives: “first sanitary improvement, secondly social physical improvement, which will be effected at once by the work itself, and thirdly, similar improvement, of which it will be the instrumental means, but less immediately.” The sanitary improvement of Madras would be ensured through the abundant presence of good water. It was seen as the key to preserving the health of the city’s residents. It would be used “for drinking and culinary purposes as well as for bathing, the constant cleansing of all the drains and sewers, and consequent removal of the present causes of disease; and the keeping of the Cooum always full of sweet water in place of the fetid and offensive mud and muddy water, of which it now consists during a considerable part of the year.” This assessment, the Military Board claimed, was not the unfounded opinion of some engineers but of the most experienced engineers of the presidency, and they had proven “fully that the project is not only feasible, but would be singularly easy and cheap.” The surgeons of the Medical Board had wholeheartedly supported them with their reports and put the matter beyond doubt: the nuisances that the plan sought to remove were a “powerful cause of disease and mortality” in the most populous part of Madras, and only a good water supply could improve the situation there. Next was the “social improvement” triggered by the planned canal that would connect the reservoir with the city. It would make possible inland water transport, connect the city to its hinterland, and boost the economy of Madras due to increased commerce, industry, and agriculture. Goods could be brought to the city more cheaply. Prices for “commodities of dai-

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ly and universal consumption, grain, firewood, straw, &c.” would fall, and heavy goods such as granite, which could be used for paving streets, would be available for construction purposes. The canal’s capacity for transport would not be a direct consequence of the plan’s implementation but require further investments that would further improve Madras. One possible use of the canal would be the transport of granite for the construction of a pier and a breakwater on the beach. “[F]our European Vessels, and thirteen Native craft” and their cargo had only recently been lost in a storm. The board thus claimed that twice the capital that would be required for the construction of a breakwater had been wasted. The advantages of another potential use of the canal were similar. Two Indian regiments were stationed at the fort, and the soldiers of those regiments lived “in lines,” or designated areas where they could build their own huts. As they had to march from the lines to the fort for duty twice a day, the residential area had to be near the fort and the Military Board was negotiating to acquire land in the village of Vepery for that purpose at a price of more than one hundred thousand rupees. However, with the construction of the canal, troops could be stationed farther away, at the old cantonment of Pallaveram, which had recently been abandoned because it was too far from the fort. With the canal in place, those troops on guard duty could be brought daily to the fort by steamer while the rest remained in their cantonment, which was considered particularly healthy and almost completely free of cholera. After this lengthy explanation of the project’s benefits and interspersed with several allusions to the great benefits of the proposal, the Military Board came to the financial aspects of its scheme. It openly conceded “that the proposed outlay differs entirely from the expenditures first mentioned as sanctioned or about to be incurred by Government for objects connected with the drainage.” However, their project “would not like all those expenditures be a mere sinking of Capital without return.” On the contrary, their proposal “would be capable of yielding an ample return, sufficient not simply to pay the interest of the Capital invested, but to afford a large profit if it should be deemed expedient to require it.” Against this backdrop and considering the undisputable improvement of the well-being of an estimated seven hundred thousand human beings crowded in a narrow strip of land at a density rarely found in Europe or even Asia, the cost would not seem so very high. “It is nothing less than to provide a dense, poor and ignorant population with an adequate supply of the first necessary of healthy existence, and thus deliver them from a large amount of actual

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suffering and prolong their lives. And what after all, is it that we ask for the noble object of delivering from the dominion of disease, and death this destitute population of 700 000 persons, and giving the means of gaining increased wealth and increased comfort.” Even “twenty, thirty, or say even one hundred thousand pounds Sterling” would be a reasonable investment. In England or America “hundreds of thousands of Pounds have repeatedly been spent on the mere object of providing good water for a population equal [to] only a fifth or a tenth” of that of Madras. A comparable project for Calcutta was under consideration, although its population amounted to only one-third that of Madras and the government of Bengal was willing to spend “67 lacs [lakh] of rupees with an annual expedition of 5 ½ lacs for working expenses.” Compared to this sum, the Military Board’s estimated cost of its complete project was judged probably a mere three lakh rupees (three thousand pounds) but not more than six lakh rupees (six thousand pounds).48 Did this sales pitch work? At first glance, a letter by the justices in session to the government appeared to support a grand scheme. In fact, it was another expression of their frustration that no progress had been made. The justices agreed with the Military Board and regarded the minor construction works sanctioned by the government as insufficient. In their reasoning they were clearly influenced by the engineers’ assessment. In all likelihood the projects sanctioned by government would not solve the existing problems, which would in turn continue to bother the population of the Black Town even after almost six years of considerations. Thus, they could only urge the government to adopt at least those parts of the engineers’ suggestions that called for a completely new drain across the esplanade, which would allow for a working outlet and enable construction to begin immediately.49 Pottinger was the first member of government to respond, and his reaction was far less favorable. First and foremost he questioned the project’s feasibility. He called the report “altogether one sided and partial whilst blinking all the difficulties and obstacle[s]” that were inevitable for a scheme of such a scale. As he could hardly judge the engineers’ expertise in their field and certainly not deny that the intended improvements would change Madras for the better, he attacked their plan on more familiar grounds. He claimed that such a project would cost the government six or even eight times the amount stated in the plan. Such a proposal could not be decided by the government without orders by the Court of Directors; even if the court should approve, Pottinger claimed, it would require a more detailed survey before any construction work could begin. After having stated his

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general objections, Pottinger continued by raising points in the plan that seemed dubious or questionable, thereby foiling the Military Board’s optimistic claim that their report was “unanswerable.” Many of his criticisms were practical and derived from his knowledge of the local topography. In the governor’s view, the plan did not explain sufficiently how to overcome the difficulties caused by the physical characteristics of Madras and its environs. Another point of disapproval was the authors’ lack of attention to the consequences for those among the indigenous population who would lose their property or even their livelihood when a reservoir or a new canal flooded their land. They would protest and never voluntarily accept their tangible loss for such a “far-fetched and questionable” project. Pottinger concluded his comment with an expression of his surprise that the Military Board had mixed up the technical and practical issues in question—the area of their expertise—with a lengthy medical and sanitary excursion, which, to add insult to injury, appeared to contradict itself. Either the medical authorities agreed with the Executive Council that Madras was a comparably healthy location, as was stated by a surgeon in one of the attached reports, or the city was predisposing its people to disease, as was claimed by the Medical Board in their statement of support. Pottinger’s position on this matter was clear: Madras was “the very healthiest town in India, if not . . . the world.” Considering the endorsements of the plan by several colonial officials in important positions, he was left “with a certain portion of surprize [sic] and humiliation,” as these “sensible and well informed men” had not protested such a scheme, as would have been their task. For Pottinger, the Military Board’s report constituted a failure of the colonial government. Several institutions had clearly violated their limits of competence and contributed to a report that was a direct challenge to his authority. If the result had been correct and accurate, there might have been some practical value to it, but Pottinger clearly felt that much time and effort had again been wasted on a flawed proposal that only replaced one defective plan with another.50 Pottinger’s fellow council member Daniel Elliot more or less agreed with the governor’s objections. However, he called for an immediate cost estimate for both the new canal across the esplanade and the filling of the open ditch, as those two proposals appeared to solve one of the most pressing problems if the original plan sanctioned by the government was impracticable. As long as the financial matters remained unclear, the plan originally put forward by the justices was not an option. He also pointed to the indecisiveness among the engineers, who had declared that they were ready to sign a deed of covenant for the sanctioned construction work,

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thus indicating that the project was sound, only to declare it impracticable a short time later. Elliot did not go so far as to question the engineers’ expertise by calling the feasibility of the project as a whole into doubt, and he agreed that it would in theory have positive effects for Madras. What he doubted, however, were their financial estimates, as he feared runaway costs. Given the length of time required for the approval of the project, Elliot proposed to ignore the scheme for the time being and order the immediate implementation of the already-sanctioned plan, aided by an additional drain that would carry off the sewage into the Cooum while the old sewer was being reconstructed. Thus, the government would save money for a completely new canal by utilizing the existing ditch.51 Pottinger agreed. The consequent resolution of the Executive Council approved Elliot’s proposal and called for an immediate plan for the temporary sewer and an estimate of its cost. The other already-sanctioned measures were confirmed, and the Military Board was reminded to start the necessary work immediately. These orders would be final, although they did not offer an ultimate judgment on the chief engineer’s grand scheme, which would be referred to London.52 The Executive Council’s Decision The Military Board had to accept the Executive Council’s orders, but it could not avoid pointing out once again that the plan it had to implement was flawed and that it would have sanitary implications for the inhabitants of the fort, who would literally be surrounded by sewage. The only responsible way to proceed with the order would be to construct a completely new drain for about double the allotted funds. If the Military Board accepted the council’s order despite knowing its potentially grave consequences, it would be partially responsible if the outcome did not meet the requirements for the new design, enumerated in the very same orders that called for its construction.53 The Executive Council was not impressed by this new twist. It conceded that “some inconvenience to some persons residing in the immediate neighbourhood of the Channel” would follow, but it did not believe that the consequences would be as dire as the Military Board predicted. As they were not experts on the matter, they referred the question to the Medical Board for examination, thereby causing yet another delay.54 Unsurprisingly, the Medical Board shared the engineers’ apprehensions and declared the proposed diversion of sewage into the Cooum as “so fraught with danger to the public health, that they earnestly recommend its not being carried into effect, since the effluvia from an open surface of such

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extent loaded with putrid animal matters would undoubtedly be productive of disease of a severe character (Fever, cholera, and bowel complaints).” As an alternative, the Medical Board proposed the construction of a covered cesspool as a receptacle for the Black Town’s sewage while the drain was undergoing reconstruction. It could be emptied into the drain during the monsoon month when construction work would be interrupted anyway. This solution would not improve the old and well-known problem of the path of the existing drain, which ran across the northern esplanade and discharged into the sea at the northeastern corner of the fort. As discussed many times before, this design conveyed all the sewage of the southern Black Town to the vicinity of the fort where troops were stationed. A new canal running alongside the southern limit of the Black Town would be preferable. The Medical Board concluded its letter by pointing to the advantages of the board’s grand scheme, endorsing it once again for all of the positive effects it would have on public health.55 The justices in session shared the Military and Medical Boards’ assessment that the Executive Council’s decision was “prejudicial to the public health” and it would “not only effect [sic] those persons residing in the immediate neighborhood of the channel and others passing that way” but also part of the Black Town, as the ditch proposed as a temporary sewer would allow an even worse runoff of sewage and cause a backwater of stagnant filth, thereby worsening the “evils” of the present system. To circumvent these problems, the justices referred to their earlier proposal to construct a completely new canal parallel to the existing one, so that the old one could be used during the construction process. The cost for this venture, according to the justices, would be far lower than expected by the engineers, since their estimate was based on the original investigation Colonel Sim had conducted many years earlier. Since then, the justices had already completed parts of Sim’s plan without government involvement. Thus, their proposal would not go far beyond the scope of funds sanctioned by the government. They reckoned with an expense of thirty thousand to thirtyfive thousand rupees, which exceeded the approved funds only by 10 to 15 percent. This would make it possible to implement the Medical Board’s recommendation to alter the route of the new drain in order to avoid the immediate vicinity of the fort.56 The Executive Council welcomed these constructive recommendations. Now, finally, progress was palpable. It adopted the justices’ suggestion and even decided to enhance it by seizing on an old proposal by Boulderson, the former chief engineer, who had proposed a new, broader drain that would be capable of carrying all rainwater runoff, even during the

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most severe monsoon. Thus, a connection with the Cooum River through the existing ditch was unnecessary and the latter could finally be filled in. As some practical problems had to be solved and an estimate for the necessary expenditure for some of the measures had to be compiled, the Executive Council could not decide immediately.57 This delay left the door open for members of the Military Board to once again promote their concerns. They had only minor objections to the latest plan, but they again pointed out that their grand scheme was not obsolete. They still strongly favored a water supply for all of Madras, since only a comprehensive plan would ensure the proper runoff of filth into the Black Town’s sewers and prevent the continuous accumulation of refuse in the drains. The Medical Board’s support for the plan was still on record. The engineers still thought it feasible. The only thing lacking, at least from their point of view, was the political will and commitment of the government.58 That the government was not ready to subscribe to the engineers’ vision should have been obvious for a long time, and thus the Executive Council’s reaction was pure annoyance. Pottinger complained of the Military Board’s stubborn persistence, the length of its remarks, its failure to accept that a decision had been made, and its refusal to comment in detail on the plan at hand. Thomas wanted to avoid any further discussion and proceed as quickly as possible with the present plan, as too much time had been lost. The government adopted the justices’ plan and charged them with its execution, although the esplanade lay beyond the territorial limits of their responsibility, thus avoiding any further involvement of the Military Board.59 Colonialism and the Reasons for Rejection With this decision, Pottinger’s dealings with the main drain ended. The construction was under way when a new governor took office in April 1854. A changed Executive Council found the time in June 1854 to reconsider the grand scheme still advocated by the Military and Medical Boards. Lord Harris, Pottinger’s successor as governor of the Madras Presidency, was not as decidedly opposed. He also considered the plan insufficiently detailed but saw enough ground for “further scientific inquiry,” which would include a survey of the area in question by an engineer, Lt. P. P. O’Connell, who was assigned exclusively to this task.60 O’Connell succeeded in producing a plan that appeared to eliminate several of the weaknesses that had made Cotton’s proposal an easy target. First, it was far more detailed regarding the survey of the present condi-

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tions, the planning of construction work, and the estimates for costs involved. However, the scope of the project was not much smaller than the one Cotton had envisioned. O’Connell’s plan provided for a water supply as well as sewers for all of Madras, but the water would be used only for domestic purposes and the necessary flushing of the sewers. He also emphasized that his proposal consisted of three parts that were feasible and would offer palpable benefits if undertaken separately but, if realized together, would form the comprehensive system the engineers had called for from the beginning. Fancy additional projects, like navigable canals and irrigation, were not part of it, as it focused on the basics of public health.61 Although the report was well received by both the government and the Court of Directors, the project did not advance, as it was still considered too costly.62 Madras had to wait another seventeen years for a functioning water supply system, while the drainage problems of the Black Town would remain unresolved even longer. However, the lengthy discussions, the engineers’ persistence, and the alliance between the Military and Medical Boards signaled the arrival of the sanitary movement in Madras. The engineers’ stubborn and defiant defense of their ever more complex schemes against their superiors’ opposition can be explained only by their confidence in their professions’ progress based on scientific knowledge. They were fighting for a good and justified cause—progress and public health. Like engineers in Europe, those in India had been in a marginalized position, in both the military and the colonial order as a whole. The sanitary movement and the scientific knowledge it generated allowed them to gain respectability. It had moved them into a more prominent position in Britain and had given them considerable power. There, engineers controlled the spending of large sums of money for publicly funded projects. The maintenance of water supply or sewers created well-paid and respectable jobs within municipal administrations. In India, their counterparts believed that such development—which from their point of view was indispensable and inevitable—was lagging behind. The variance between Europe and India encouraged their persistence. Surprisingly, they were able to persuade the Military Board to support their concern unconditionally. Certainly, the engineers were military officers and thus part of the presidency’s military establishment. The chief engineer was even a member of the board. But the engineers were still marginalized within the military and the whole colonial administration. That sanitary awareness was not yet higher in the military than in the colonial government is amply proven by the high mortality due to avoidable disease among British troops during the Crimean War that shook the

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British public and set off a fundamental reform of the army. Whatever the exact motivation behind the Military Board’s support for the engineers might have been, it was persistent and apparently did not depend on only one or two members being in favor of the sanitation effort. The Medical Board’s approval was motivated by considerations much like those of the engineers. When there was no epidemic to fight, the surgeons were marginalized in much the same way as the engineers. The sanitary movement prompted permanent societal and governmental appreciation for the surgeons’ work, and that appreciation would translate into paid positions and political influence. That the engineers’ attempt to gain more influence had been rejected repeatedly and vehemently by the government might have been attributable to Henry Pottinger, but other members of the council also generally supported the governor’s objections. Thus, the whole conflict can be interpreted as a gulf between two generations. The engineers were advocates of a new set of ideas originating from Europe, and the old India hands Pottinger, Thomas, and Elliot had encountered such newfangled notions only recently, in various writings or during visits to Britain. They were proponents of a more conservative philosophy that emphasized minimal involvement with the colonized population. In their view, sanitation was for Europe and not for India. If a colonial city like Quebec funded a waterworks that threatened to ruin the municipality because it aspired to European levels of civilization, that was Quebec’s business. The moral arguments for improvement there did not apply to Madras, as it was not a civilized city and therefore could be held to a different standard. Minor improvements were acceptable, as long as the results of such efforts remained predictable. More extensive construction work, however, would disturb the peace and damage the East India Company’s revenues. Despite Pottinger’s past as a former protégé of Mountstuart Elphinstone, one of the great liberal proponents of the civilizing mission in India during the first half of the nineteenth century, he himself was very reluctant to interfere to achieve gains that were so speculative. Pottinger’s rejection of a comprehensive sanitation infrastructure arose from the same colonial perspective that resulted in only limited measures being taken to fight cholera epidemics. During the epidemics, European medicine had been confined to certain spaces because the government could not provide it for the whole population and did not even see the need to do so. Modern sanitation, achieved through a new, comprehensive system of water supply and sewers, meant intruding into a world the government considered to be best left alone. Government officials did not believe

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that the Indian population wanted the intrusion of new infrastructure and by extension the colonial state, indicating that the public had rejected or refused such interference before. The engineers’ perspective was unfettered by such views. Instead of preserving the existing order, they intended to bring change to the whole territory of Madras. In their plans they conceptualized a space unified by a comprehensive system of sanitation despite the differences in ethnicity, religion, class, caste, jurisdiction, and power that segmented Madras. Sanitation would create a new common category for the description of Madras: healthy. Engineers thus reduced the complexity of the spatial order of Madras to one aspect or concept, a move Pottinger and his fellow councilors were not prepared to follow. Being the governing body, the Executive Council held the political reins in Madras and thus had to keep the complexities of reality in mind and could not simply act as they might wish.63 The concept of Madras being unified by sanitation was at the time nothing more than a vision for a better future. For the engineers, this hopeful vision rested on a reliable foundation, as it was based on the scientificity of their training. They had mastered ways of altering the environment and could thus project possible outcomes transcending the present urban space. Eventually, they would overcome the difficulties of realizing their visions. From their very first plans for a new main drain for the Black Town, the engineers had to negotiate the divide between the spatial characteristics of the present and their vision of a healthy urban space in the future. Further complicating their task were their superiors’ expectations of a limited scheme. Ultimately, the engineers brought forward plans that utilized different elements to bridge the problematic divide: reworked sewers, steam-powered pumps, and water pipes. In the end, none of their plans gained acceptance. Either the government or other engineers opposed the overall concept—albeit for different reasons. The government’s objections were usually based on the notion that the proposals were too complex and therefore too expensive, while the engineers criticized overly simplistic designs that would not address the problems posed by the topography. The engineers’ reaction to this failure of their plans was to increase the technical complexity and comprehensiveness of their plans. The conceptualized space they envisioned had to integrate more features of the perceived space to function properly and prevent disease in Madras. Even for the engineers and their allies, the surgeons, comprehensive sanitation was not a panacea. Disease would not cease to exist no matter what sanitary efforts were undertaken, and some locations would remain more dangerous to a person’s health than others. An individual’s behavior

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could still predispose him or her to cholera, fever, and other diseases. But having a safe, reliable water supply and efficient drainage would instill a new standard of behavior that would eliminate some of the most harmful practices among the population. In order for Madras to become a healthier space, everyone had to participate in preserving public health, and sanitation would force the population to do so. This notion of integrating the population into a collective effort for a healthier city did not pose a challenge to colonial rule. It was not an attempt to emancipate the Indian population but to subject them to a new regimen of cleanliness that would not allow for different sectors of Madras to behave differently from others. The perspective of the colonial enclave that found its expression in dispensaries and Pottinger’s rejection was also a result of the indigenous population’s previous refusal to seek medical treatment from practitioners of European medicine. They wanted to keep and guard their own spaces, be they houses, villages, or towns. The engineers’ comprehensive plan for a sanitary Madras was intended to overcome this insularity and replace it with an integrated city, at least in this one respect. That the engineers were not allowed to implement their vision was only partially due to the Executive Council’s resistance. Their inability to unite behind one proposal with a clear perspective certainly hindered the engineers’ cause. The success of the sanitary movement in Britain was based on using a technological solution to solve an array of social problems. The engineers’ failure to accomplish the same thing in Madras occurred in part because the engineers lacked allies besides the surgeons on the Medical Board. The constant reviews, revisions, and criticism left the government in something of a muddle. If the experts could not agree on a solution, then how could the Executive Council sanction such an enormous expenditure for a project whose positive effects lay in the distant future and might cause more social problems than it would solve? With Pottinger’s rejection of the grand scheme and despite Governor Harris’s referral of the matter to an engineer for further inquiry, the first attempt to implement concepts of the sanitary movement at Madras had failed. The engineers were able to delay their defeat by the government for years because their expertise could not be disputed no matter how questionable it sometimes seemed. Only they could decide if a project was feasible, and the government needed their knowledge to achieve any success. The result was a compromise. The government had to spend more than it had initially intended to finally put the issue to rest. Sanitarianism had thus arrived in Madras in the late 1840s and early 1850s even if it had not yet succeeded. The engineers, on the other hand, had to abandon their grand

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schemes and settle for the limited measures adopted by the government, at least temporarily. That Governor Harris was more amenable to the sanitation effort was a sign that Pottinger’s refusal to consider large-scale sanitation plans would not be a lasting attitude among colonial officials. With the success of the sanitary movement in Britain, its time in India would come. The whole conflict surrounding the Black Town drain and the disagreements concerning sanitary conditions in Madras had another practical result directly linked to sanitary thinking: the government recorded the first mortuary statistics for Madras, which later spawned the gathering of comprehensive vital statistics for the whole presidency. Statistical data had for some time been employed in Europe and elsewhere to determine the presence of disease and poverty in a given group of people and to make available reliable information that could be used for governance. The dispute between the Medical Board and the government regarding the health of Madras had demonstrated how little was actually known about the prevalence of disease in the city. This situation gradually changed in the years following the main drain controversy. From 1 January 1855 onward, the Medical Board supplied medical practitioners and the police in Madras with forms to be filled out and returned for the compilation of statistics. It was not supposed that these statistics were perfectly accurate, but they offered approximate information on the number and causes of deaths within the limits of the city. As deficient as the results might have been, the Madras mortuary statistics—published in subsequent years under the telling title Deaths in Madras—represented the first attempt by the government of Madras to establish a permanent information system in order to measure the sanitary state of the whole city.64 Conflicting Perspectives on the Urban Environment of Madras The confrontation between the engineers and the government, and Governor Pottinger in particular, was a clash of two views on the urban space of Madras. The government held on to the established views that were characteristic of the colonial enclave, from the perspective of places like Fort St. George and the cantonment of St. Thomas Mount to the south of the city. The government’s intention was to keep the peace by letting the Indians determine how to live their lives as long as they paid their taxes and did not try to overthrow the East India Company’s rule. This meant a fractured conceptualization of the urban space reflecting the political and social heterogeneity of Madras.65 The ways of the Indian population, which the government deemed to be traditions, ensured a stability that would allow colonial rule to continue as long as the government stayed in

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its enclave and did not provoke a reaction that could prove detrimental to its interests. “Improvement” was most certainly a recipe for trouble if it extended beyond the limits of the enclave. The engineers and their supporters on the Medical Board had a different perspective on Madras. They conceptualized it as a whole, to be managed by a comprehensive system of water supply, sewers, and canals inspired by the British sanitary movement and intended to improve the city’s economic situation as well as the health of its population. The opinions and rights of the Indian population were of minor concern to them. They believed they knew what was best for the people, and only by conducting such an ambitious project would the Indian population eventually be able to appreciate the benefits of sanitation. The public’s rejection of the engineers’ attempts to improve their lot would itself be evidence that improvement was necessary. The civilizing mission would not be stopped by the prejudices of the population. However, stopped it was—though not by the people of Madras. The proposed project did not even get far enough to be rejected by the public, since the government had already effectively quashed it. Government opposition to the varying projects put forward by the engineers was based on financial considerations as well as the perspective of the enclave. But the engineers’ contradictory plans did not encourage trust in their vision of an improved future Madras. Their remarks on earlier plans were often harsh and their criticism scathing. They were scarcely able to agree on even the most fundamental things. The engineers’ widely divergent plans and disagreements arose from a profound divergence of theory and practical experience. None of the engineers had actually constructed such a complex and comprehensive system of sewers and water supply as they proposed. Their training at the East India Company’s military seminary at Addiscombe had prepared them for the tasks awaiting a military engineer, such as building a pontoon bridge or mining.66 Civil engineering was low on the list of priorities there. In Madras they had received the newest writings on public health engineering inspired by sanitary ideas. But there had not yet been an opportunity to put this new theoretical knowledge to the test. Therefore, they could not point to similar successfully completed projects in India to support their claims. The lack of practical experience regarding sanitary engineering is especially obvious in Col. Arthur Cotton’s Public Works in India: Their Importance, with Suggestions for Their Extension and Improvement. This treatise reported on the successes of civil engineering in India. However, it focused mainly on communications and irrigation. Even the tenth chapter,

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which bears the title “Water,” only deals with its importance for irrigation and navigation. There were apparently no sanitary improvements worth noting. Thus, the engineers had only theoretical expertise, including their most fundamental assumption: Madras needed a better and more comprehensive system of water supply and drainage.67 To this lack of practical experience was added the difficulties posed by the topography of Madras. The flatness of the terrain and the heavy if irregular precipitation made it even harder to come up with a plan intended to service a vast territory efficiently. All these circumstances prevented any practical consensus among the engineers that would allow them to impress the government. Thus, an already reluctant government was increasingly irritated by the engineers’ attempts to promote their agenda of improvement while ignoring their superiors’ ever more urgent orders to fulfill their assignment. In this conflict the sanitary ideas on which the engineers’ plans were based could not take hold. However, it would not be long until they were the foundation of measures far more extensive than the local reconstruction of a sewer.

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Chapter 5 Sanitary Consensus at Last Madras, 1858–1883

After the departure of Governor Pottinger, the Madras government’s opposition to sanitary concepts began to crumble and the ideology of the civilizing mission gained momentum. This shift was not due to internal administrative developments, scientific advances, or improved engineering techniques but to external events. The sanitary movement had become the leading voice on public health in Britain, and the British campaign in the Crimean War had highlighted the disastrous results of poor hygiene practices in the army. In addition, after the Great Mutiny of 1857–58, when a considerable number of the Indian regiments of the army rebelled, the governments in London, Calcutta, and Madras had to radically rethink their approach to colonial rule. Officials had to reconsider the role of medicine and especially sanitary improvement, which was seen as a precondition for the continued British presence on the subcontinent. The implication of this shift in priorities was that there would be profound structural changes in the way the colonial government in Madras ran its business. Those changes amounted to a considerable expansion of the colonial state. The colonial governments of India assumed new responsibilities that required greater administrative capabilities and additional funds. Public health was among those responsibilities, but implementing technological improvements such as sewers and water works was not enough to achieve the desired results. The colonial authorities also had to

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change their perspective on environment and disease. They could no longer regard cholera as a temporary crisis that improvised short-term measures could manage. Cholera was a symptom of a structural problem that needed constant attention, both locally, through alteration of the physical environment, and institutionally. Thus, the government now required a sanitary administration with the task of continuously observing the local space and improving it, if necessary, in a way that would allow the colonial authorities to control cholera. This change in perspective, however, was not limited to India. In the 1860s, cholera was increasingly perceived as a global issue that called for an international solution. The Suez Canal and faster steamships moved India closer to Europe in terms of travel time. Especially after the cholera epidemics of the mid-1860s, many European governments felt threatened and placed cholera on their diplomatic agendas, thus putting the government of India increasingly under pressure to contain the disease and thus protect Europe and the rest of the world from it. Mutiny and Sanitary Reform By the mid- to late 1850s, the sanitary movement was dominating the discourse on public health in Great Britain. In Florence Nightingale, the movement had found an immensely popular and politically influential icon. Nightingale famously came to public notice as a nurse in the Crimean War. Reports of the miserable sanitary and medical conditions in the battlefield, as well as her and her fellow nurses’ efforts to provide care for thousands of soldiers dying of preventable diseases, popularized the demand for better medical care and public health in the British military.1 Public pressure resulted in the Royal Commission Appointed to Inquire into the Sanitary Condition of the Army. Nightingale was not a member of the commission, but she gave evidence and contributed both an account of her experiences and various recommendations to the commission’s published report. The report identified an increased death rate among troops stationed in Britain compared to the civilian population of the same age and sex. The death rate was highest among the “White Troops” stationed overseas, with rates in the three Indian presidencies being the highest overall. The commission identified four predisposing causes for the higher mortality: night duty, idleness, unhealthy behavior, and unsanitary conditions.2 For two of those problems, the sanitary movement offered a solution. However, as the commission was responsible for the army alone, it had only limited influence on the East India Company. Yet, by the time the commission completed its final report, that situation was about to change profoundly.

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In May 1857, a revolt of Indian troops in the cantonment of Meerut near Delhi shook the foundations of the East India Company’s rule over India. The rebellion quickly spread through much of northern India. Cholera proved to be an ally of the rebellious sepoys, as many of the beleaguered British soldiers succumbed to the disease. The revolt was quelled with a combination of determination, luck, and the assistance of troops from the Madras and Bombay Presidencies. As a direct result of these events, the East India Company lost its Indian possessions. On 1 January 1858, India became a Crown colony under a governorgeneral appointed by the imperial government and residing in Calcutta. The EIC Court of Directors in London was thus obsolete, and control of India was transferred to the newly established India Office, which had a cabinet minister at its head. The Mutiny, as the events of 1857–58 became generally known, forced the British to reconsider the foundations of their domination of India. Since the beginning of the East India Company’s territorial rule and its conflicts with Indian states and colonial competitors, it had overwhelmingly relied on Indian troops. British troops raised by the company or regular regiments stationed in India for some time provided only around onesixth of the overall number of soldiers under the company’s command, the rest being recruited within India. A substantial number of these sepoys had defied British authority in the Mutiny. However, Britain could not raise enough troops in the home countries to control the subcontinent, so Indian soldiers were still essential.3 The solution to the crisis lay in changing the proportion of British to Indian troops. Under the new plan, one-third of all troops stationed in India were supposed to be British. This equation factored in the assumed higher value of British troops in combat, which in turn was thought to be based on their racial superiority. As a consequence, the number of sepoys in the army had to be reduced while more British regiments had to be deployed to India. Yet, the aforementioned Royal Commission investigating sanitation in the British army had discovered that mortality rates among British troops in India were unacceptably high and that the premature deaths due to preventable diseases generated intolerable costs.4 Public outrage over the Crimean War also threatened to damage the new colonial regime, as Florence Nightingale and Edwin Chadwick among others tried to raise awareness of the dismal sanitary situation in India. To justify the additional employment of British troops, the government thus had to lower mortality rates. As no comprehensive knowledge on the sanitary conditions in India was available and no plan to reach that goal was circulating,

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London decided that another royal commission specifically dedicated to the army in India was the way to go. It started its work in 1859.5 The Royal Commission on the Sanitary State of the Army in India Florence Nightingale was a member of this second Royal Commission along with other well-known sanitarians, including William Farr, the statistician and epidemiologist, and John Sutherland, the sanitary commissioner for London, who took a leading role in the commission’s proceedings. The Royal Commission never left Britain. To acquire the necessary information, it sent questionnaires to all military stations in India and requested comprehensive answers. It also summoned witnesses who had spent time in India or had other valuable expertise to answer the commissioners’ remaining questions. Among those questioned were surgeons, physicians, engineers, military officers, sanitary experts, and colonial officials.6 One colonial official interviewed was Charles Trevelyan, Lord Harris’s successor as governor, whose evidence on the conditions in Madras and Fort St. George was damning. He claimed it was not the location, the topographical characteristics, or the layout of either city or fort in general that were to blame for the high mortality rate among troops there but the poor sanitary situation. Both the barracks and the hospital lacked proper ventilation, the fortifications obstructed the healthy sea breeze, the drainage was poor and causing dangerous emanations, the hospital was close to the polluted Cooum River, and fresh water of good quality was scarce. Trevelyan had tried to mitigate some of these shortcomings. He had lowered the fort’s sea-facing walls by six feet and had a small seawater reservoir constructed on an elevated location to flush the fort’s drains. Both measures, he claimed, had had a positive effect not only on those inhabiting the barracks but also on the whole population of the fort.7 The success of such improvements, Trevelyan conceded, could only be partial as long as the sanitary situation of Madras as a whole was not addressed. The British troops could not be kept within the confines of the fort all the time. They wandered around Madras to go to bazaars, thereby coming in contact with unsanitary conditions. The Indian troops, however, were traditionally accommodated in the city in separate settlements known as the lines, where they were exposed to the same environmental conditions as the general population. Thus, to limit the loss of life among the army in Madras, the sanitary condition of the whole city would have to be improved.8 For Trevelyan, the Cooum River, which he regarded as little more than a clogged sewer, had to be the starting point of any improvement.

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He proposed to embank the river in order to promote the steady runoff of sewage, but even that was little more than a first step. It was impossible to know how the condition of Madras affected the population, as reliable information was not available. The police collected vital statistics, but such data had been of little interest to Trevelyan when he served as governor. The number of people in the city and the extent of in-migration remained unknown. Sewers had not improved much since Pottinger’s time. Trevelyan and the justices in sessions had implemented an altered version of Boulderson’s plan that called for flushing the drains of the Black Town with seawater, but, as predicted at the time by rival engineers, the effort apparently had little impact. The main deficiency was still the lack of a comprehensive system of water supply and drains or sewers. Trevelyan had supported such a scheme, but an actual plan had not been submitted until after he had left Madras.9 The Madras officials’ reply to the Royal Commission questionnaire on sanitation appeared to support Trevelyan’s testimony. It confirmed the negative influence of the Cooum. Drainage, “in the proper sense,” could not be said to exist. The present system was “worse than useless.” The air of the Black Town and Triplicane was “loaded with mephitic effluvia at night.” The “very pure” fresh water for the fort had to be piped from the Seven Wells water works two miles away and was stored in a covered cistern in the fort. The water used by the Indian population came from wells and tanks, some of it being “brackish, especially in [the] Black Town.” Almost all water from tanks had a “disagreeable smell.” Its quality was thought to be “good,” though no chemical analysis had been undertaken.10 The Royal Commission’s questionnaire covered a whole range of issues that were important to the troops’ health in India: statistics on mortality rates and prevalent diseases; the soldiers’ duties; their behavior, including diet, intemperance, and exercise; their dress; environmental conditions such as topography, climate, drainage, and water supply; the construction of barracks and officers’ quarters; the existence and condition of latrines and urinals, libraries, and hospitals; and the sanitary conditions outside the cantonments. All these factors determining the health of the troops had been under investigation before but never comprehensively. As a consequence, the commissioners discovered that problems like those Trevelyan had described in Madras existed all over India and at an unacceptable scale. Diseases like fever, diarrhea, dysentery, and cholera forced soldiers out of duty and raised mortality to a crisis level, which implied unsustainably high health-care costs, an increased number of troops to maintain combat readiness, and a steady supply of recruits to replace their deceased or

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incapacitated predecessors. Sepoys, however, were found to be considerably healthier than British soldiers. The commission deduced that this circumstance was not due to the superior acclimatization of the sepoys but to their accommodations in the lines. The conclusion was clear: the sanitary conditions inside the stations inhabited by British soldiers were worse than those of the Indian population outside. Thus, an investment in the sanitary improvement of the living conditions of British troops was an absolute necessity.11 The Royal Commission gave no specific advice on how to proceed and succeed in certain locations. Instead, it recommended general practices to be pursued in India: changes in the soldiers’ personal hygiene and behavior, the distribution of cholera belts (strips of flannel or wool that were supposed to protect the susceptible bowels from changes in temperature and thus from the disease) as standard equipment, the relocation of troops to hill stations, the establishment of sanitaria, the improvement of hospitals for Indian troops, and—most important—the establishment of a sanitary administration in all three presidencies. If the sanitary situation in Madras was bad, it was no better in Bombay or Calcutta. The responsibility for sanitary matters was divided among different institutions, and the local authorities in charge generally lacked sanitary expertise. The Royal Commission recommended the introduction of identical procedures and institutions in all three presidencies, with a health commission at each presidency’s capital representing all the various military, civil, engineering, sanitary, and medical institutions. These health commissions would advise their respective governments on the basis of the most recent sanitary developments in Europe, review proposals, and make their own suggestions. Implementation, however, would remain the task of the presidencies’ public works departments.12 Many of the Royal Commission’s suggestions were neither original nor contentious. Medical officers had advocated most of them for years but had been ignored by the authorities. What had changed in the wake of the Crimean campaign and the Mutiny was public pressure on British politicians. The fate of the troops and European civilians in India had attracted the attention of the British public, which was no longer ready to accept the death of so many due to preventable diseases. With Florence Nightingale as its popular figurehead, the sanitary movement in India had found a lever against the resistant authorities in the colony that earlier proponents had lacked. As a result, the government’s priorities shifted toward comprehensive sanitary improvement.13

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Sanitation in Madras, 1857–1864 In the years between the Mutiny and the report of the Royal Commission, the sanitary situation in the city of Madras was largely unchanged. A lack of funds (or at least the government’s unwillingness to spend the required sums) and the unsuitably flat topography of Madras hindered progress. Sand and rubbish from the streets still clogged the sewers, causing offensive odors, tides and surf prevented the outflow into the sea, and during the dry season there was not enough water in the drains to carry the more solid sewage away. Again and again engineers had provided plans to improve the situation, and again and again their proposals were picked to pieces by their colleagues for alleged practical flaws or, when implemented, for delivering less than originally promised.14 What had changed since Pottinger’s departure was the government’s attitude toward sanitary concepts. Lord Harris had already signaled an open-minded approach. His and his successors’ governments no longer questioned the necessity of comprehensive sanitary improvement or the general applicability of sanitarianism to India. In its resolutions, the Executive Council acknowledged the validity of sanitary ideas and their implications for the council’s responsibilities toward both the European and the indigenous population of Madras. The government accepted that preventive measures were a good and necessary investment, and it was willing to provide substantial, though ultimately limited, funds for their execution. Thus, the fundamental debates ceased, and practical issues began to dominate the proposals and considerations of engineers and officials. In other areas, the influence of sanitary movement concepts showed tangible results. The ever more reliable mortuary statistics of Madras, which had been collected and published since 1855, had set knowledge regarding the local prevalence of cholera and other diseases on a new footing. Long-held assumptions could now be confirmed or disregarded as false. As the statistics provided reliable numbers of deaths in a given year, the size of the city’s population could be extrapolated, proving that most estimates regarding the size of Madras had been too high and putting an end to the assertion that Madras was one of the healthiest cities in the world. The statistics also demonstrated that the presence of cholera and other diseases depended on the locality. Since the statistics listed the various causes of death in the villages and towns of Madras, the surgeons who analyzed the statistics could compare local to general prevalence and so determine the relative health of the residents in particular locations. These results supported the surgeons’ demands for improved sanitation. They could point

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to local nuisances as the cause of mortality and propose limited measures to eliminate them.15 The events of the Mutiny, the ensuing higher priority of public health, and the acceptance of sanitary thinking put cholera in the spotlight again. The disease had attracted only limited attention in the 1840s, but now it once again acted as an important indicator for unhealthy localities whether it was currently making people sick or not. The idea of a cholera epidemic as a result of unsanitary conditions was worrying enough to force the authorities to act. In the summer of 1859, when the disease approached Madras once again, the superintending surgeon considered it necessary to let one of his surgeons, William R. Cornish, draft a report on the present sanitary condition of Madras. Cornish focused on the issues that could be remedied by the government in the limited time left before the probable arrival of the disease, thus largely ignoring the lack of drainage and water supply systems. Instead, he concentrated on the cleanliness of Madras, or rather the lack thereof, and called for all kinds of improvements, a response evoking Quebec’s approach in the 1830s and 1840s.16 When cholera did reappear in 1861, the Madras government could rely on the permanent dispensaries and did not have to improvise to provide medical treatment, as was the case in 1818–20 and 1832–33. On the basis of this medical infrastructure, the government could go beyond medical care and investigate the circumstances of the outbreak. Several cases had appeared in a house in the town of Persewaukum, where an indigenous government official lived. Alarmed by this outbreak, the government urged the medical authorities to investigate.17 As the surgeon in charge of the inquiry remarked in his report, the neighborhood where the house was located suffered from the influence of a dumping ground for the city’s garbage. Such dumps were a widespread phenomenon that apparently contributed to the accumulation of cholera cases in many neighborhoods. To solve the problem, the investigating surgeon asked the government to find another place for the disposal of refuse, one that would be distant from any settlement.18 Slowly, sanitarianism also began to make an impression on the population. The European residents of Madras, at least, became increasingly aware of the deficiencies in public health and the means to correct them. Their protests regarding sanitary problems were nothing new, but now they conveyed more than simply a certain discontent regarding tangible nuisances. The sanitary movement had turned residents’ perceptions of these problems from inconveniences into hazards and, at the same time, had delivered a standard to which citizens were able to hold the govern-

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ment. They no longer politely asked but expected the government to rectify the most outrageous shortcomings. Since it did not seem willing to do so, they held a public meeting at which they formed the Madras Sanitary Committee to serve as a pressure group. The committee demanded a better system of drainage and water supply, the levy of a general property tax to pay for construction of same, and the incorporation of Madras following the English model. To promote and eventually achieve their goals, they set up the Sanitary Reform Fund. With this catalog of demands, the Europeans of Madras clearly tried to take matters into their own hands, stating their ambition to guide municipal affairs in the future. However, the overwhelming majority of the indigenous population would not be represented in the elected council of an incorporated Madras population but would be made to pay for the ambitious infrastructure projects regardless. The government reacted to the initiative with mixed feelings. On the one hand the commitment of the committee was welcome, as the government assured the members of its support and promised to make the expertise of the Public Works Department available to them. On the other hand, it could not agree to the political proposals. It found a way to dismiss the issue by pointing to the vague nature of the committee’s request. Yet, in the end, the government made it quite clear that it was not willing to transfer more power to the inhabitants.19 The Sanitary Commission at Work With the Military Cantonment Act of 1864, the India Office followed the Royal Commission’s recommendations. That law required the reconstruction of barracks to fit the new requirements and initiated the establishment of a sanitary administration in each presidency that would be responsible for both military and civilian aspects of public health. In Madras, the Sanitary Commission, consisting of a president and four members with medical and engineering expertise, commenced its work in April 1864. The commission’s responsibilities were investigative as well as advisory and covered the whole presidency, including the military stations of the Madras Army in Indian states. Although its early focus was clearly on the military, the civil sphere was equally within the commission’s scope, especially with the compilation of morbidity and vital statistics for the whole presidency being among its tasks.20 As a completely new administrative body without precursor, the Sanitary Commission had to establish its own functionality first. During the first years of its existence it concentrated on the establishment of an administrative infrastructure so that it could perform the tasks set by the colonial

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authorities.21 Before it could make any recommendations, the commission had to assess the local conditions and determine a starting point for any future improvements. This assessment necessitated a broad range of activities: visits at stations, cantonments, and government-run prisons in the presidency and the Indian states controlled from Madras; the introduction of a more accurate and comprehensive system for gathering vital statistics that would make it possible to monitor certain diseases across the whole Madras Presidency; the training of medical officers in hygiene and public health; the draft of sanitary rules of conduct for the troops to reduce their exposure to disease both within stations and on the march; and the raising of awareness for the importance of sanitary measures and individual behavior among military officers and civilian officials.22 Cholera’s high profile ensured the commission’s attention. It was the most prominent disease in the commission’s annual reports, partly due to the traditionally intense reaction to the disease and partly to the high cholera mortality rate among the troops. To some degree this high rate could be ascribed to cholera epidemics in urban centers, which occasionally encroached on the local garrisons, but the disease took an especially high toll among troops on the march. The vulnerability of troops outside their station had been a well-known phenomenon for almost as long as cholera itself. Now, following the release of the Royal Commission’s Report of the Commissioners, the Sanitary Commission had to find the cause of those outbreaks and, if possible, develop practices to prevent and avoid or at least limit them.23 Thus, the Report of the Commissioners had precipitated a shift in anticholera strategy. The selective reactive approach focusing on medical relief for troops and the civil population in times of crisis, which had guided governments and medical officials for decades, was now officially replaced by a comprehensive preventive approach that was intended to avert outbreaks of disease altogether. Some preventive measures had of course been taken before, though only on the limited scale of a village or a cantonment. Sanitary projects like the reformation of the Black Town main drain system aimed equally at mitigation of inconveniences and the prevention of disease. The official endorsement of the sanitary movement changed this pattern. Because there was no reliable cure for cholera, as well as a number of other epidemic diseases, any comprehensive attempt to lower mortality among soldiers had to embrace prevention without abandoning emergency measures during an outbreak. The Sanitary Commission set a precedent that was followed by the Sanitary Commissioners who succeeded it in 1866. The commissioners

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were Indian Medical Service surgeons and served as liaisons between the military and the colonial administration. Although the commissioners’ role was strictly advisory, they bridged the divide between the sanitary needs of the military and those of the Indian communities surrounding stations and cantonments. They had to investigate both types of environment and identify the factors that connected the health of the troops to the world outside the colonial enclaves.24 With the Sanitary Commission(er)s, the sanitary movement had gained a permanent foothold in the Madras Presidency’s administration. The aims and methods of the movement had been officially recognized and comprehensive solutions to existing problems accepted. The colonial government of India was not entirely happy with this development, however. Now it had to juggle contradictory demands—higher expenditures for sanitary improvement and a balanced budget. In the end, it followed the British example and shifted the cost and responsibility for sanitary measures to the provincial and municipal levels. Both London and public figures like Florence Nightingale always suspected that Calcutta authorities were attempting to shirk responsibilities for public health. To maintain pressure on the government of India, the Army Sanitary Commission, based in London, observed the sanitary progress and admonished authorities when their efforts fell short.25 Debating Theories and Facts on Cholera’s Etiology The sanitary movement in general and the work of the Sanitary Commissioners in India made new and reliable information available to researchers interested in cholera etiology, thus invigorating scientific discussions about the disease. These disputes were not academic, no matter how arcane they appear to us today; they were framing actions. They shaped and promoted some agendas while stifling others. They had implications for medicine, as well as for the political sphere. In Europe as in India, the observation of cholera had been instigated by alarming outbreaks or the circumstantial presence of a surgeon. Research on the disease had thus been haphazard at best until the comprehensive registration of cholera cases began. The new collection of data by surgeons and other officials stationed across India for the new sanitary administrations allowed for a more systematic approach to analyzing patterns of cholera’s occurrence, not just in certain locations but on the scale of districts or even an entire presidency. Data gathering enabled the Sanitary Commissioners and medical authorities to map cholera in southern India. Beginning in 1875, the annual Madras Sanitary Report included cholera maps that showed the

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prevalence of the disease in the presidency’s districts. When analyzing data from several consecutive years, a sanitary commissioner or surgeon with an interest in the matter could seek out patterns in the appearance and disappearance of cholera in certain districts or regions, thereby trying to answer the old question of the connection between environment and cholera.26 Apparently cholera’s prevalence was subject to a complex, repetitive cycle of gestation and decline, of movement and continuity.27 Certain locations appeared to be especially prone to the disease and generated a new epidemic every few years. Other areas were not subject to regular outbreaks but seemed to experience cholera as the result of its introduction from adjacent regions. Despite the stability of these recurring outbreaks over years or even decades, they did not easily reveal the natural laws of cholera. Dozens of factors had to be considered in order to understand the complex sequences: local weather and climate, the health of the local population, food prices and famine, migration due to religious festivals or drought, the presence of other possibly related diseases, and the topography of these locations. Consequently, all these phenomena were addressed in the annual sanitary reports. Of course all the information had value in its own right and was collected for reasons independent of cholera, but it allowed those with an interest in the disease to recognize the complexity of cholera’s movements in space. This was true for Madras as well as the other two presidencies. They, too, had established Sanitary Commission(er)s, and in Bengal the government of India had delegated responsibility for sanitation to the provincial level. There, under the supervision of the sanitary commissioner to the government of India, each province had its own subordinate commissioner working to improve the sanitary situation in stations and reporting on his progress.28 Given the differences in geography, climate, and other aspects between and even within the different presidencies, it is hardly astonishing that the experts developed diverging opinions. Around the same time, new cholera theories based on statistics and recent observations arrived in India. In Europe, the cholera epidemics between 1848 and 1854 had rekindled the attention of physicians, who subsequently offered a variety of new explanations for the behavior of the disease in time and space. Statistical as well as geographical data had informed John Snow’s theory that the illness was waterborne, thus challenging the predominant view among sanitarians that cholera was caused by miasmas. Justus von Liebig, the influential German chemist, proposed a new etiology of disease as a result of his research on fermentation and putrefaction. He assumed that certain diseases, such as cholera, and fermenta-

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tion were caused by a similar chemical process, which he called “zymosis.” His theory gained widespread acceptance in Britain and beyond, as it fit sanitarian priorities.29 The innovative theories coming from Europe and the abundance of collected data recomplicated cholera, provoking debates and conflicts among physicians. Since the sanitarians had with some success promoted a theory of disease that focused on just one cause—emanations from decaying organic matter—this theory formed the foundation on which the sanitary agenda could be built. Far from being universally undisputed within the medical profession, this simplification of cholera’s etiology had helped facilitate sanitary improvement. Sanitation had become a political consensus, at least among the established sections of British society. From the 1850s on, the medical foundations of this consensus increasingly came under pressure. Snow’s and Liebig’s contributions to cholera theory, for example, stated that cholera was at least contingently contagious, thus contradicting the orthodox fever theory promoted by the sanitarians and provoking mixed reactions. In the end, their views did not threaten the sanitarian consensus in Europe or elsewhere, as it was not a medical but a political consensus. In fact, Snow’s and Liebig’s views strengthened it with the insistence on water works and sewers and a more broadly accepted scientific foundation. Sanitary improvements were still regarded as the most useful tool in the fight against preventable diseases.30 In India, the reinvigorated debate found fertile ground. James L. Bryden, the first statistical officer to the new Sanitary Department of the government of India, enthusiastically embraced a statistical approach to cholera, which promised more useful analysis than the investigation of individual occurrences that had dominated Indian cholera investigations from 1817 on. As the other presidencies had to accept the precedent set by Calcutta, Bryden’s preference for the zymotic theory of disease became the standard classification for more than twenty years.31 Snow’s findings on the waterborne character of the disease were ignored by the Indian medical authorities for the time being.32 If the midcentury cholera epidemics had reinvigorated scientific discussions about the disease, the outbreaks of the mid-1860s instigated its entrance into the diplomatic arena. It was in that decade that cholera first reached Europe by ship via the Red Sea and the Mediterranean, and the growing traffic in steamships as well as the planned opening of the Suez Canal foreshadowed worse to come. The yearly hajj to Mecca and Medina was identified as a massive problem by European medical experts, who suspected that pilgrims from India, where cholera was endemic, would

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regularly bring the disease to the Red Sea region. From there, they feared, returning hajjis would introduce the disease to the Mediterranean region and Europe, causing yearly epidemics. The presence of cholera in Egypt in 1865 seemed to confirm the worst fears, and, to solve an issue of this potential magnitude, an international approach was required. The appropriate and established forum in which to negotiate a functioning control regimen was an international sanitary conference.33 The view that cholera was a continuous threat was based on the assumption that the disease was contagious and implied that it arose solely from an origin in India. If this opinion were widely accepted, the consequences for the governments of Britain and India appeared to be nearly unmanageable. They would have to prevent the spread of the disease from India in the future and bear the ultimate responsibility for outbreaks, no matter where they occurred. At the same time, European powers could legitimately install quarantine regimens in order to control traffic from India via, for example, transports of troops. For London and Calcutta, this turn of events endangered the principle of free trade and hindered communications within the British Empire, and it also threatened to inhibit the hajj itself, thereby alienating the Muslim elites on which the government of India increasingly relied to keep in check the political demands of the Hindu middle class. Yet, the British could not refuse to participate in an international effort to contain a deadly disease. Thus, when the delegates to an international sanitary conference assembled in Constantinople in February 1866, the stakes were high for the governments of Britain and India.34 The majority of delegates followed France’s lead. Claiming that cholera was not endemic in the Hejaz region along the eastern shore of the Red Sea, in Egypt, or in Europe but was always imported from India by transmission between humans or cargo, the French demanded quarantines for pilgrims and cordons sanitaires around infected locations. Britain, Russia, and the Ottoman Empire disagreed on political grounds but had no scientifically supported answer to argue that the recent jump from India to Arabia could not be explained by aerial propagation or that cholera was not endemic outside India. The British, Russians, and Ottomans thus suffered a defeat in the final vote on compulsory measures. In the diplomatic arena, cholera was now officially a transmittable disease, maritime quarantine was accepted as an effective means to prevent its spread, and Britain was responsible for regulating the hajj from India. There was now an epidemiological consensus on cholera, and Britain was bound to enforce the implementation of its practical consequences if it wanted to avoid affronting the other European powers.35

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The failure of the British delegation to prevail at the conference was to a large extent due to a lack of credible evidence to support their scientific and medical claims. They could only point to open questions and contradictory phenomena. The Indian Medical Service did not encourage its surgeons to conduct research, and there was no established and internationally recognized medical journal in India, although the Indian Medical Gazette was about to be launched; the first issue was published in 1866. If London and Calcutta wanted to challenge the new epidemiological consensus, they needed credible evidence quickly, and only the new and still untried sanitary administrations constituted a basic infrastructure that could procure it. Orthodoxy and Heresy in Indian Cholera Research The government of India faced the need to investigate the epidemiological consensus on the subcontinent. If it was possible to prove that cholera behaved differently there than in the rest of the world, that it was in effect a different disease, then exempting India from the provisions of the Constantinople conference could be justified. In order to appeal for an exemption, however, the Indian government needed IMS surgeons to do scientific research that conformed to international standards. The problem was not so much the general qualification of the surgeons but their lack of experience in skills like microscopy, which had gained more and more prominence in medical research.36 To correct this defect, the government of India sent two promising young surgeons on a research tour in 1869. Timothy Richards Lewis was in the British Army Medical Service, while David Douglas Cunningham was an IMS officer. They visited eminent professors in Germany to study the most advanced methods of laboratory research and cholera theory. Among the German academics they visited was Ernst Hallier, a professor of botany at the University of Jena who claimed to have identified a microorganism responsible for cholera, a claim disputed by other scientists. One of those critics was the rising star of German cholera research, Max Pettenkofer, of Munich, who left a lasting impression on his two visitors.37 Pettenkofer claimed that a certain coincidence of environmental factors was a precondition for cholera outbreaks. His influential model of cholera causation was the xyz theory. According to the theory, cholera’s presence at a certain location did not depend on one single factor, such as the presence of a cholera poison or some atmospheric condition, but on the combination of a specific, and in other circumstances innocuous, agent x and a set of contributing conditions y, which would together create the deadly cholera

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poison z. Pettenkofer’s research focused on the y, particularly on soil conditions such as organic composition, porosity, temperature, and moisture, since the soil was thought to emit the cholera poison. The disease broke out among a predisposed population, Pettenkofer claimed, if in a given soil with x present the groundwater level fell and the organic matter in the soil dried out.38 Upon their return from the continent, Cunningham and Lewis began an extended project of cholera research that was intended to establish the basic facts of cholera’s nature in India. Their approach was two-pronged: microscopic laboratory research was supposed to test Hallier’s microbiological cholera theory while broad investigations of the environmental factors present at certain localities would be conducted in the field. The Orthodoxy of a Specific, Indian Cholera While Cunningham and Lewis conducted their research, James McNabb Cuningham, the sanitary commissioner for Bengal from 1866 to 1869 and for the government of India from 1869 to 1884, promoted cholera analysis based on the available statistical data. The aforementioned J. L. Bryden, the statistical officer in Cuningham’s department and an avid follower of Farr’s epidemiological methods and theories, tried in particular to prove the dominant role of the atmosphere in the propagation of cholera and from 1869 on published reports on the disease. He focused on the monsoon winds that, as he claimed, dispersed a cholera miasma emitted by the soil in certain locations, mainly in Bengal. In his statistics he discovered some regular patterns of cholera epidemics in northern India. Cholera appeared to leave its endemic home in Bengal at the same time as the northeast monsoon winds reached that region. From there, Bryden had found, the disease followed roughly the direction of the wind. The questions that his findings raised were obvious. If cholera was airborne and could reach Arabia or even Europe that way, how would quarantines, cordons sanitaires, or the control of migration in India have any effect? The government of India was apparently powerless to stop cholera’s spread. Only the local authorities could prevent the outbreak of epidemics by introducing sanitary measures at affected places, thus conveniently absolving the colonial government of any responsibility. It is hardly surprising, then, that the Army Sanitary Commission perceived Bryden’s research as an attempt to delay essential sanitary work.39 Bryden’s research perfectly fit the political expectations of the government of India by localizing the disease in two different ways. First, he tried to remove cholera from the international agenda. Although Bryden

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accepted that cholera originated in Bengal and moved from there, he believed that controlling its spread was not humanly possible. Cholera, he claimed, was a natural phenomenon that could only be fought locally and therefore was not an international issue. Second, he attempted to open up the possibility that cholera in India was a distinct form of the disease. Bryden did not investigate cholera elsewhere. He did not try to deny the claims brought forward at Constantinople regarding cholera’s contagious “nature” in Europe or the Middle East. Instead, he focused on cholera in India and created his own theory that applied only to that country and could only be disproved there. By juxtaposing those two contradictory theories of cholera he implied that there were different kinds of the disease. This theory underscored the British claim at the sanitary conference that not all cholera epidemics originated in India. If cholera was different in India, then different measures had to be taken there to fight the disease, and who else would decide on these but those with experience of the local conditions? Drs. Cunningham and Lewis were Cuningham’s other scientific warrantors. They were convinced that they could experimentally prove Pettenkofer’s subsoil water theory in India. First they examined the blood of cholera patients and victims but found no evidence of the presence of bacteria or “fungal elements” there, thus discounting Hallier’s theory. However, they observed a process of decomposition and transformation that was unlike what was seen in the blood samples taken from healthy persons or from patients suffering from other diseases. In order to recheck the potential effects of microorganisms, they injected dogs with different preparations taken from cholera excreta, recording the animals’ reaction and later dissecting their nerves. The authors refrained from drawing conclusions regarding cholera theory, but the implications of their findings were clear: there was no evidence that cholera was contagious. No poison had been identified, but the decomposition of the blood pointed to a zymotic presence.40 Their third report followed the second line of investigation and focused on environmental conditions, especially the atmosphere and soil, mainly in Bengal. The results were based on observations of subsoil water levels made by medical officers in different locations from 1870 onward, as well as accessible meteorological data. In their report, Lewis and Cunningham compared this information to the prevalence of cholera at the same location, as provided by mortality statistics. By correlating those data sets they hoped to decode the complicated environmental factors that, as Pettenkofer had assumed, produced the cholera poison. Their results were ambig-

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uous. They could not establish a direct causal relationship between a single environmental factor and the prevalence of cholera, but the occurrence of cholera seemed nonetheless to coincide with the seasonal cycle of certain environmental factors of which the water level and soil ventilation seemed to be the most important variables. They seemed to explain different patterns of cholera prevalence—“endemic” and “non-endemic”—between stations by local geological characteristics and variations in climate. This result fit neatly with Pettenkofer’s theory, while objections based on other theories were discarded. Their results indicated to Lewis and Cunningham that there was reason enough to call for more extensive research.41 Although the results of Bryden’s and Lewis and Cunningham’s research were met with skepticism outside India, they ostensibly achieved one of their principal goals: they raised the scientific profile of Indian cholera research internationally, at least in some quarters. That Pettenkofer and his disciples found their results interesting should not come as a surprise. In 1871, Pettenkofer published a treatise, Verbreitungsart der Cholera in Indien, in which he evaluated many of the recent publications on cholera, including Bryden’s and Lewis and Cunningham’s. One year later an editorial in the Zeitschrift für Biologie, a journal coedited by Pettenkofer, included an enthusiastic reaction to preliminary results of subsoil water research in the Madras Presidency, which had been published by Cunningham in a Report on Cholera in 1871.42 Despite its increasing prominence, the standing of Indian cholera research was still largely dependent on Pettenkofer’s reputation. The fragility of this relation was highlighted by the translator’s introduction to the English version of Pettenkofer’s public address, Cholera: How to Prevent and Resist It. He pointed out Pettenkofer’s achievements while lamenting that his work and theory were virtually unknown in Britain. By choosing to translate a more popular text, he hoped to make the general public aware of an internationally accepted authority on cholera.43 Thus, the government of India tied its cholera research policy to one international authority with little to no academic and professional support in Britain. This left Calcutta and its medical administration open to severe criticism. The Heterodoxy of a Contagious Cholera The medical orthodoxy promoted politically by Cuningham and scientifically supported by Bryden and Cunningham and Lewis was not unopposed within the IMS. A. C. DeRenzy, for instance, the sanitary commissioner for Punjab and hence directly subordinate to Cuningham, first attracted his superior’s attention in 1870 when criticizing Bryden’s first cholera re-

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port. In the years that followed, DeRenzy frequently questioned Bryden’s cholera theory by pointing to local evidence as well as metropolitan authorities. His opinion on Lewis and Cunningham’s research regarding subsoil water levels was particularly damning. He favored Snow’s waterborne theory and consequently advocated greater investment in sanitary infrastructure, particularly fresh water supply. His attacks on Bryden and his opposition to the official cholera agenda did little to endear him to his superiors. Cuningham filed several complaints, and DeRenzy was ordered to “adhere strictly to the orders of the government of India in the presentation of future reports.” When he ignored this warning, he was transferred to a remote station in Assam.44 William R. Cornish, the sanitary commissioner for Madras from 1870 to 1875 and 1876 to 1879, argued along similar lines, but from a politically secure position. As an advocate of Snow’s waterborne theory, he found Bryden’s work unconvincing and in 1870 and 1871 published his own reports on cholera in the Madras Presidency as a direct reply. Employing similar methods of statistical analysis, he had different results and conclusions regarding cholera in southern India. His more detailed second report, which covered the history of cholera in the presidency from 1818 to the recent epidemics from 1859 onward, as well as pilgrimages, the sanitary conditions of stations and cantonments, and recent statistics on morbidity and mortality, questioned how Bryden could come to his conclusions. How could Bryden exclude the possibility of cholera being spread by contaminated water, given the deficient state of the water supply in all the stations in India? Had Bryden proved that cholera did not spread against the monsoon winds if Scot had demonstrated that it did as early as 1824 and if similar observations had been recorded during more recent epidemics? Why did cholera not spread epidemically with the same speed as the monsoon winds? How could Bryden claim a cholera theory for India if his results were based only on data from the Bengal Presidency? In the south, where the monsoon pattern was basically the same in terms of wind direction, cholera had moved against the wind.45 In his reports Cornish did not develop an original hypothesis regarding the spread of cholera. Confronted with the complexities of cholera, he contented himself with pointing out the contradictions in the theories of others and calling for further research. He promoted an investigation of those places that seemed immune to cholera, not those where it appeared most frequently, thus following a line of argument that had already been put forward in 1856 by Edward Balfour, a surgeon of the Madras Army.46 Yet, like Bryden, Cornish also had a political agenda. He was fighting for his

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and his predecessors’ standing as sanitary commissioner within the presidency’s administration. Following the official line indicated by Calcutta would make it difficult to pressure the government of Madras for additional funds. By pointing out his differences of opinion with the sanitary and medical authorities in Calcutta, Cornish played to the traditional rivalry between the governments of India and Madras. In the end he pursued a strategy similar to Bryden’s, yet with a different aim, by conceiving of the Madras Presidency as a space where cholera was distinctly different than it was in the rest of India while at the same time behaving just as it did in the rest of the world. Even if DeRenzy and Cornish had been the only heretics within the IMS, they would have found like-minded authors in Britain. The Lancet criticized Bryden’s theory as early as 1870 and subsequently supported DeRenzy. A report on cholera by Cuningham published in 1872 received the same dismissive treatment. A gulf was appearing between epidemiological opinions in India and Britain that resulted in a further isolation of the medical authorities in Calcutta. When Cuningham addressed the Royal Medical and Surgical Society in London in 1874, he could maintain his stance only by dismissing all cholera research done outside India as irrelevant for the Indian case. The Indian cholera orthodoxy had become a heterodoxy in the rest of the world. In the end, the government of India’s research program was a failure and it was stopped by the late 1870s. Bryden published his last report on cholera epidemics in 1874, and the investigation of subsoil water levels conducted by Lewis and Cunningham was halted by direct order from London in 1879 when it became obvious that it was going nowhere, and Lewis subsequently left India. Despite the failure of his collaborative research with Lewis, Cunningham had become the foremost authority on cholera in India, and it was in that capacity that he periodically was called on by J. M. Cuningham whenever the sanitary commissioner needed him to quell heretics within the IMS.47 Cholera, Quarantine, and Commissions The establishment of an internationally accepted Indian cholera theory that served the colonial government’s interests was conceived as a long-term project. Until such a theory could serve its purpose, the authorities had to yield to international pressure and find ways of implementing the sanitary conference’s resolutions without causing too much damage to their own agenda. Since the colonial governments and their sanitary authorities had to adhere to the conference’s guidelines for sanitation, they had to establish where changes to established policies were necessary, where new ar-

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rangements were required, and where assumptions by the conference were clearly contradictory to local evidence or ineffective under local circumstances. The Madras government established its own Cholera Committee, led by the sanitary commissioner. It was supposed to evaluate the conclusions and the consequences of the recent sanitary conference for the presidency. However, it did not start from scratch, as the committee members could rely on recently compiled topographic information.48 In its report, published in 1868, the committee first confirmed the applicability of the conference’s conclusions and recommended measures, such as cordons sanitaires, that would probably prove effective in ending the recurrent epidemics originating at religious festivals. However, some statements made at the conference regarding the endemicity of cholera in the presidency seemed to contradict the locally assembled data. The delegates at Constantinople had established that cholera was endemic in only a few places in India, most of them in the north. Arcot was the only such location in the Madras Presidency. Further, the conference had declared that annual outbreaks occurred in Madras and several places nearby, such as Kanchipuram. The committee could not confirm these assertions, as they contradicted the recent data collected by the sanitary commissioner. Cholera was evidently not endemic in the presidency, the committee insisted, and the annual outbreaks at Madras were not “due, either to any inherent property in the soil or to any personal habits or peculiarities of constitution on the part of the permanent residents of the town.” Cholera in Madras was apparently always imported from elsewhere, usually the north, by migrants, many of whom were pilgrims.49 If the Madras government was to follow the conference’s suggestions, it had to stop the influx of cholera by controlling pilgrimages, the primary means of the disease’s spread. Religious fairs and festivals, most of them Hindu, attracted millions of believers. The pilgrims gathered under circumstances that were often only superficially controlled by the colonial authorities, who feared a hostile reaction if they disturbed ancient practices. The sanitary conditions at those fairs were often appalling to the British officials present, and the outbreak of cholera at these events was all too common. Since the issue of pilgrimage had gained such a high international profile at the Constantinople sanitary conference, the problem could no longer be ignored or neglected by the different levels of government; it had to be handled delicately, as it touched a sensitive issue. The sanitary commissioner to the government of India submitted to the provincial governments a catalog of questions. Those officials would discuss the matter with the local Indian elites in order to determine how preventive measures

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could be safely introduced to protect both the pilgrims and the inhabitants of the places they passed through. At this point, the Madras sanitary commissioner had already published a report on the pilgrim situation in the presidency.50 Much of the report referred to an investigation of the Haridwar fairs in northern India, the largest gathering of pilgrims in India. The smaller festivals in the Madras Presidency appeared to be equally problematic, however, if on a smaller scale. For the city of Madras, the Cholera Committee established a direct connection between the religious festival at Kanchipuram and cholera outbreaks in the city. On the question of how this recurring spread of disease by returning pilgrims could be prevented, the committee focused on taking more sanitary precautions at the site of the festival. The government was not ready to bear the cost of these measures, however, and sought a way to have the pilgrims pay, thereby decreasing the number of persons concentrated there and generating the desired income for sanitary measures.51 The Cholera Committee’s report had a wider focus, as the disease did not occur exclusively at festivals but also in cantonments, towns, jails, and villages. Despite the sanitary conference’s declaration that cholera was contagious, that it could spread from person to person, and that it traveled with the speed of human migration, the Cholera Committee considered local conditions to be crucial factors in creating a suitable environment for contagion. Thus, it would be the government’s task to change critical environmental factors in a way that would prevent the spread from an infected person to a healthy one at a certain location. By removing organic matter and the dangerous by-products of its decomposition, the result would be an improvement in soil, water, and air.52 Different circumstances, however, required adequate measures designed for the specific characteristics of a location. Towns and villages would need different treatment than military cantonments or jails. The committee’s report detailed the different measures to be adopted in each type of space. While the removal of cattle from the streets and the disinfection of houses were among the means of avoiding cholera in cities, towns, and villages, military cantonments required the separation of people affected by cholera and thus the establishment of cholera camps. The Cholera Committee, despite detailing possible measures at great length, refrained from making suggestions on how to implement them. There were no recommendations to the government regarding new or better sanitary institutions or investments in public health that would have the desired effect.53 Besides improving sanitary conditions at religious festivals, the government of India had to satisfy the international sanitary conference’s demand

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for quarantine. However, any measure that would inhibit the hajj threatened to alienate a substantial proportion of the Indian population. Instead of making a decision, the government bided its time. An amendment to the Native Passenger Ship Act, issued in 1870, which required vessels to observe certain sanitary standards before leaving an Indian port, proved inconsequential. With that amendment the authorities had hoped to pacify the European powers without disturbing the Muslim elites, but it achieved neither goal. From the Muslim elites’ point of view, the disastrous demand for quarantine measures made at the Constantinople conference had come about because the government had been ignoring sanitation problems both in port cities and on ships. If the colonial authorities had acted earlier, the demands for quarantine would have gained no traction at the conference.54 A subsequent international sanitary conference, held in Vienna in 1874, showed that this minor alteration of the Native Passenger Ship Act had not alleviated international pressure. Moreover, it became obvious that the interests of the India Office and the government of India were no longer aligned. After the 1866 cholera epidemic, the British government had introduced a system of sanitary control for ports and shipping in general. This change in policy had also altered London’s perspective on possible concessions at the Vienna conference. If shipping regulations were needed to keep the Suez Canal open for the transport of troops, the India Office was ready to accept such rules. The authorities in Calcutta, however, could not simply follow the British example, as they had to keep the domestic situation in mind. They had to navigate both international and British public opinion, but especially the interests of Indian Muslims. Thus, when the secretary of state for India, Lord Salisbury, agreed in Vienna to stricter sanitary standards on ships leaving Indian ports and conceded that ships from ports affected by cholera would be subject to quarantine measures in the Red Sea, the government of India was left protesting without effecting any change.55 Cholera and Sanitation at Madras, 1864–1883 Amid all the scientific disputes, the diplomatic negotiations, and the committee investigations, the continuing struggle for the sanitary improvement of the city of Madras seemed to be only a small detail. From the local perspective, however, the government’s acceptance of the sanitary movement, as well as international pressure, marked the beginning of palpable change. There was comprehensive change in the environment, mostly in the fort but in the city as well. For the first time, sanitary measures were a priority, which meant that getting sufficient funds for improvements

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would be possible. As recommended, the colonial authorities’ first priority was improvement of sanitary conditions in the military stations of the whole Madras Presidency in order to decrease mortality among the troops. What exactly was necessary was an open question and required investigation. The Royal Commission had delivered only “principles” on the basis of which the barracks, the troops’ diet, and other circumstances of daily life had to be changed.56 The investigation into the local circumstances at Madras again highlighted some of the well-known problems. Many of the problem areas lay outside the limits of the fort but still fell within the responsibilities of the government, such as the perennial stench from the drain across the esplanade or the stagnant water in the moat surrounding the fort. These nuisances could not be removed if they were considered separate from the general sanitary improvement of the city, but at the same time they did not appear to threaten the viability of the fort as a garrison for European troops if properly addressed.57 Some problems could be tackled on an improvised basis until a comprehensive solution for all of Madras was in place. Water, for example, was still taken from the Seven Wells in the most northern part of the Black Town, a couple of miles from the fort. The government had for decades considered this source reasonably good and certainly superior to the water taken from the tanks by the Indian population, but this assessment now came under pressure. By British standards, the water from Seven Wells was impure and unfit for drinking. Following the recommendation of the sanitary commissioner, the government ordered a filtering cistern, which went into operation in 1867.58 Given the many problems connected to drainage, a system of dry earth conservancy was installed in all stations of the presidency. This method, which involved mixing waste with dry materials like ashes, charcoal, or clay, was supposed to prevent the further decomposition of the refuse and thus prevent exhalations of poisonous gases. The solid mix could then be easily and innocuously transported to a dumping ground or used as fertilizer. Dry earth conservancy was considered a viable alternative to sewers wherever water was scarce, but it was labor intensive, which made it difficult for whole cities to employ. For garrisons and cantonments, however, the sanitary commissioners highly recommended and advocated its implementation. In the end, the results of the measures appeared positive.59 From 1864 on, the troops stationed at Fort St. George largely escaped the regular outbreaks of cholera that gripped the city. Cases were rare among both European and Indian troops, and, if an outbreak occurred, it was not linked to the epidemics prevailing in the city.60

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In the rest of Madras, the existing sanitary problems remained unchanged: good drinking water was scarce, and the drainage system was still defective. A practical solution still had not come to light, and the conflicts over matters of design, cost, and implementation were still unresolved. Again the response was to charge engineers with finding a technical solution as simple and affordable as possible and to execute it with the consent of—and funds provided by—the government of Madras, the government of India, and the India Office. Yet, after the transfer of more administrative tasks to the local level through the municipal acts of the 1860s, the responsibility for these improvements no longer lay solely with the government. To achieve any improvement, the sanitary commissioner had to deal with an additional administrative actor: the Municipal Commission for Madras. It had the authority to levy and collect municipal taxes, and it decided how much money was available for sanitary improvements mandated by the same law that had created the commission. The municipal commissioners were not particularly generous; they were members of the wealthy elite of the city and had been nominated by the government to serve on the commission. Even from 1878 on, when half of the commissioners were elected, little changed since only those who owned considerable property were allowed to vote, thus ensuring that only the elite were represented. Once in office, the commissioners tried to foist the tax burden onto the poorer classes but took care that sanitary measures improved the more prosperous neighborhoods. Since Madras lacked wealthy philanthropists, the sanitary commissioner had no one else to turn to for funds.61 Although the budget for sanitary improvement had grown since the establishment of the Sanitary Commission in 1864, it could barely keep up with the effects of population growth. The exact size of the population of Madras was finally determined with the introduction of a general census in 1871. In the first census of the city of Madras, the sanitary commissioner, who was in charge of its execution, declared that 397,552 persons lived there.62 This figure was considerably lower than most of the previous estimates. The subsequent tallies demonstrated that the population was growing. Under those circumstances, the cost for providing a sanitary infrastructure for all citizens was also rising. The first major sanitary project undertaken for Madras since the official adoption of sanitarianism was a system to supply fresh water. The importance of fresh water for the health of the city was no longer disputed, and the cost of providing it was not thought to be prohibitive. Procuring a good water supply had become a priority, and the British precedent in engineering, expenditure, and water quality now served as an example to

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be followed. Since 1866, the sanitary commissioner, who was a surgeon, and the engineers agreed that only a reservoir farther away from Madras could hold and provide the necessary amount of good water. The best source appeared to be the Red Hills to the northwest of Madras, where water could be diverted from the Korttalaiyar River. From this elevated point, the water would run downhill for six miles through an open canal toward Madras. The distribution of water in Madras and its preferred use was contentious among the experts: should it be reserved for domestic use or also provided for agricultural purposes? Colonel O’Connell, who as a young lieutenant had written the previous drainage plan for the Black Town, advocated the equal distribution of water for irrigation and domestic purposes, while Mr. Fraser, the municipality’s civil engineer, saw agriculture as a secondary priority and proposed alterations to the plan to prioritize domestic use. The government of Madras agreed with Fraser’s modifications and approved the revised plan, and the government of India promised to contribute to the implied additional expenditure. As the cost for the whole scheme was shared among the different levels of the colonial state, the responsibilities would also be divided. Once the water works construction was complete, the government of Madras would maintain the reservoir. The system of water distribution from the outlet at the reservoir to the fountains spread over Madras, however, would be the municipality’s responsibility. As the latter was not able to pay for the considerable infrastructure of canals, pipes, and fountains required by Fraser’s plan, it still relied on government money. But the higher authorities granted only portions of the already sanctioned funds. A drought-induced famine in 1866 further delayed the beginning of construction, as did Fraser’s ongoing work to hammer out the details of the plan. With the civil engineer occupied, the municipality lacked the necessary engineering capacity to begin the portion of the work unaffected by his modifications, and the government reluctantly ordered an assistant engineer to support the municipality for the time being.63 According to the plans, the water would be stored in reservoirs around the city and distributed to 137 fountains, where the local population would be able to obtain their share. Yet, water would not be provided for free. In a report by the committee on the water distribution project, the responsible engineer, a Colonel Silver, discussed the available options for charging the public for water. Silver emphasized that a general levy would be unjust, as not all parts of Madras would benefit equally from the new supply and to require the poor to pay as much as the wealthy residents would force the former to resort to the tanks—a dangerous practice that the new sup-

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ply was supposed to render unnecessary. The alternative, however, was to provide free water to paracheris, poor neighborhoods, and persons with houses worth less than fourteen rupees and to charge wealthier persons for water, but this strategy would generate high administrative expenses. Colonel Silver argued that the total annual cost of providing water to poor households, an estimated 8,00,000 to 10,00,000 (i.e., 8 to 10 lakh) rupees, could be covered in the government’s regular budget, but the government of India was reluctant to pay for the scheme if there would be no financial return and insisted on a charge of one rupee for one thousand cubic yards of water supplied from the reservoir.64 Problems during construction and the loss of materials from a ship sailing from England further delayed the completion of the water supply system. Eventually, in 1872, the water works of Madras was complete. Its effects were positive. Many, though certainly not all, citizens used the better water, and the result showed in the vital statistics: the years 1872 to 1874 saw a sharp drop in cholera mortality in Madras. During those three years, only eleven deaths from the disease were recorded, and the sanitary commissioner highlighted the link between those numbers and the recent improvement in water supply. However, several defects of the new scheme soon became apparent: the outlet of the reservoir was situated too high, so that much of the water held there could not be utilized; the canal was open and thus vulnerable to loss due to evaporation and to pollution; and the system lacked filters.65 Although the new water supply lowered cholera mortality, it also increased the city’s vulnerability to the disease whenever the system failed, as during the disastrous famine and epidemic of 1875–76 that left 350,000 dead in the presidency and more than 8,000 in the city of Madras. Due to a long drought in southern India, the waterline at the Red Hills reservoir fell below the outlet, thus cutting off the water supply until a steam engine–driven pump was installed. For seven months Madras had to rely on the pumped water, the quantity of which was less than required and the quality of which was very poor. In their distress people resorted to the old sources, such as tanks or wells, which were also affected by the drought and in poor condition, as they were out of regular use. The sanitary commissioner thought the water quality to be the worst he had experienced since his arrival at Madras, and the government’s attempts to improve the situation by deepening wells or doing other maintenance work had no positive effect.66 The system also showed deficiencies under less extreme circumstances. Many residents had no access to the water, as the fountains were located too far from their homes, but the municipality only gradu-

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ally extended the distribution system to these areas. Where the water was available, it was often discolored. Wire screens put in place to remove larger objects from the water system failed to filter out fish eggs, so fish were found living in the pipes and sometimes caused blockages.67 With the long-desired water supply in place, the engineers had to tackle the perennial problem of drainage. Again the government charged an engineer, Capt. Hector Tulloch, with the task, and he quickly provided a plan. However, the problems posed by the unfavorable terrain and the difficulty of the discharge into the sea remained unsolved. Tulloch first discussed two concepts from Europe that appeared to provide a quick and cheap solution to the existing problems: the aforementioned dry earth conservancy and sewage farming. Advocates of the former pointed to the successes of small-scale systems and the precedent of London. It would also allow for the utilization of sewage as fertilizer as a transitional solution until a combination of water supply and proper sewage could be provided. Tulloch was rather skeptical about the viability of such a project for all of Madras, however. New latrines would have to be built all over the city, at a high cost. Once in operation they would require constant supervision and maintenance to remain effective, the rainy season would make it difficult to obtain adequate amounts of dry materials, and all manure would have to be carted away by scavengers. Tulloch estimated the cost involved to be more than seventy-five lakh rupees and thus anything but cheap.68 Sewage farming would deliver the liquid refuse to a field outside the city limits where grain or grass could be grown. It would irrigate and fertilize the fields, producing higher yields. Thus, former wastelands unsuitable for agriculture could be transformed into financial assets, as the produce could replace fodder or food that currently had to be bought. The precedent in England promised a lucrative scheme, and the adaptation of sewage farming to India seemed to be manageable.69 The viability of sewage farming facilitated Tulloch’s preference for a truly comprehensive system of sewers. He disputed opinions claiming that a general scarcity of water in southern India would make a system requiring flushing unfeasible. On the contrary, he maintained, a state-of-the-art system of sewers had not yet been tested in India, so a final judgment on the matter could not be made. Some of the shortcomings of the existing sewers could be avoided. Sewage farming could also eliminate the need for an outlet into the sea and thus eliminate one of the main problems that had prevented the implementation of earlier plans.70 Tulloch’s scheme was the first to propose an integrated system of sewers for all towns and villages of Madras. The plan’s most important feature

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was the collection of sewage in one spot to the north of the city. No sewage would be drained into the Cooum River, tanks, or the sea near Madras. A long main sewer leading from Mylapore in the south through the more populous towns of Triplicane and Chintadrepet and along the Black Town would collect the sewage fed into it by numerous secondary drains that would connect it with more distant villages and towns. The main drain would end at a cesspool from which the sewage would be pumped into the sea at a safe distance from Madras. This proposal would also deal with the already well-known problems of Madras’s flat topography. Tulloch suggested avoiding the difficulty by creating a subterranean canal, which would create the necessary incline. Thus, it would be built at steadily increasing depths and safely pass beneath critical points like the bottom of the Cooum and various canals and ditches. Completely new sewer pipes would have to be constructed to make use of the constructed slope. A system of reservoirs would allow for flushing of the drains, and, in case of a blockage, several access holes would allow workers to enter the line and clear it.71 The main difficulty of Tulloch’s scheme was its cost. He estimated the expenditure for construction, maintenance, and repairs to be 39,50,000 (39.5 lakh) rupees. This total, he asserted, was less than a comparable scheme of dry earth conservancy, but all comprehensive systems would be costly. The government’s decades-old expectation that there could be a quick and cheap solution was not only wrong, Tulloch claimed, it was absurd.72 This recognition of financial reality did not lead to more generous funding. In order to gain some time and ensure the quality of the scheme, the government sent Tulloch to Europe to study the most recent developments in drainage. Sanitary and engineering knowledge had been transmitted from Britain to India for some time; what was lacking when it came to implementation had been practical experience. Tulloch’s visit to Europe was supposed to rectify this deficit, and upon his return he was supposed to submit a final, feasible plan.73 The result, however, issued in 1869, did not meet with enthusiasm. It still exceeded the financial means of the municipality, and the governments of Madras and India were unwilling to spend such large sums for the local infrastructure. Consequently, little progress was made toward a comprehensive scheme or local improvements during the following years, while the municipal authorities struggled to maintain the existing sewers with the limited funds at their disposal. Municipal engineers designed new plans in hope of finding a cheap solution for the Black Town main drain, but they encountered exactly the same problems their predecessors had. When reviewing the various proposals submitted by committees, boards, and engineers assigned to the issue by the government,

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the municipality’s executive engineer did not come up with new ideas. His recommendations incorporated proposals previously discussed in numerous reports. Attempts to employ European innovations failed, too.74 An exception to all these failures was sewage farming, which was first tried on an experimental scale in 1869, with mixed results. During the wet season, the growth of guinea grass was good, but once the weather turned hot and dry the brackish Madras sewage proved too salty for the plants.75 Nonetheless, the experiment was deemed a success and expanded over the following years. The authorities acquired wastelands near insalubrious locations or transformed former cesspools for this purpose. Several farms produced grass, which was sold as horse fodder, though the revenue did not recover all the costs involved in the scheme. However, it proved to be an inexpensive way to locally sanitize areas heavily affected by deficient drainage and therefore led to an improvement of public health.76 Still, the general lack of progress in terms of drainage put the municipality of Madras in an awkward position when the government began to press the issue again in 1874. The local authorities had little to show for the time they had been in charge of sanitation, and, with the introduction of a water supply system, one well-established and often mentioned obstacle to a better drainage system had been removed. A lack of water was not the problem anymore, and new approaches to the old and contentious problem of drainage could be expected. However, there were none. New plans discussed in 1878 and 1879 would offer only gradual improvements and were far from detailed enough to make their outcome predictable. The municipality hesitated to invest substantial sums, as eventual success was questionable. The failing drainage system of Calcutta was a warning.77 Despite these adversities, the municipality agreed to implement a new scheme for the Black Town, if only on an experimental scale. The project involved construction of new sewers running along the streets and a separation of solid from liquid sewage by a rubber tool. Scavengers would cart solid matter away, while the liquid would be flushed away and later pumped into the sea. When the first experimental stage was complete within one year, both the governor-general and the governor of Madras visited, inspected, and approved it. The cost of the expansion over the whole of the Black Town amounted to a comparatively low 8,00,000 (8 lakh) rupees, for which a government loan seemed justified. As usual, the government was less enthusiastic and took its time to grant the necessary funds, even after it had sanctioned the scheme and the municipality had had to obtain a loan of 1,00,000 (1 lakh) rupees. The first portion of the system would be operational in 1884.78

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Compared to the sanitary improvements that were intended to alter the environment, the observation and analysis of cholera through the compilation of statistics worked smoothly. As in other parts of India, the sanitary commissioner was soon able to serialize the annually recorded data in order to illustrate the presence as well as the movement of cholera in the presidency. Apparently, cholera occurred in epidemic waves stretching over three or four years before an intermittent period of calm, when only sporadic cholera deaths were recorded. Despite these fluctuations, however, the medical experts felt sure they had discovered an epidemiological pattern for southern India, including Madras, that was linked to the spread of the disease from Bengal, where all waves seemed to originate. These patterns indicated the rise and fall of cholera epidemics. Of course, cholera did not observe the calendar, and often one epidemic straddled two years. Nonetheless, the statistics allowed the sanitary commissioners to identify epidemics and evaluate their extent.79 But how could these variations in the prevalence of cholera across southern India be explained? Were changes in the local environment responsible or were the differences inherent in cholera’s “nature”? And what was the connection between the broader picture, which clearly indicated a complex interaction of epidemic waves originating in Bengal with regional patterns of diffusion throughout the Madras Presidency, and the local epidemics in Madras and other urban centers? The general epidemic presence of the disease was thought to be a decisive factor. If an epidemic reached the Madras Presidency from Bengal, the city of Madras would definitely be affected. It was rather easy to explain the high mortality rates of 1875–76. As mentioned above, that cholera epidemic was concurrent with a severe famine caused by a persistent drought. Yet, cholera was apparently not a direct consequence of famine. Previous epidemics had shown that the disease was also prevalent when food and water were plentiful. However, hunger forced many people to leave their villages to seek relief. Water was especially difficult to come by for drought refugees, and many of the existing sources were believed to be contaminated with cholera poison. As bad water was often the only water available, many had no choice but to drink it or perish. The cholera epidemic only subsided when the monsoon finally brought rain at the end of the year. In regions that had to wait for precipitation, cholera persisted longer.80 Many hungry migrants came to Madras, where they hoped to receive government relief. In the opinion of the sanitary commissioner, this influx of refugees was the main reason for the exceptionally high death toll in the city during famine epidemics in general. He estimated that there had been

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a temporary increase in the population of about one-third, from a total of about four hundred thousand to around six hundred thousand. Most of those migrants arrived in abject poverty. They lacked proper accommodation and rarely received the food they were hoping for. Good water was also scarce in Madras, further complicating the situation. Their refuse overwhelmed the scavenger system of removal so that filth accumulated in the streets. The drains were in poor condition, as usual, and the lack of water further aggravated the problem. This desperate situation led the sanitary commissioner to conclude in a report to the government that the “general sanitary condition of the town is worse than I have ever known it (and my acquaintance with Madras dates back from the year 1858).”81 To cope with this influx of destitute people, the government established several relief camps within the city limits, and cholera was relatively rare in them. The sanitary commissioner attributed this positive circumstance to the sanitary regulations; those who left the camps to work came down with cholera when they entered infected localities. With its limited resources, the government had little choice but to wait for an end to the drought. When the monsoon brought a sufficient supply of good water, the number of cholera cases in the city decreased.82 The government’s improvised reaction to major epidemics in terms of medical treatment was not too different from earlier ones. During an outbreak of cholera in 1869, the government set up a cholera hospital at a house in Vepery, where most of the cases occurred. When the epidemic began to encroach on the neighboring Black Town, however, the Vepery hospital proved to be too far away to be accessible for the Black Town patients so the beds remained empty. The medical authorities and the government quickly closed the cholera hospital, and the responsible medical official recommended a more decentralized approach for the next epidemic.83 In the summer of 1875, when another epidemic loomed, the government heeded that advice. It ordered the erection of cholera sheds at accessible locations, each equipped with army supplies and staffed with “Medical subordinates.” Medical relief was also made available in the different hospitals and dispensaries of the city. As during previous epidemics, the acceptance of Western medicine by the Indian population was limited. The vast majority certainly did not flock to the colonial institutions to receive treatment there but trusted the practitioners of Indian medicine. Thus, the sheds were quickly removed.84 Massive epidemics remained the exception, but they continued to demonstrate the limitations of a colonial perspective that was still dominated by the enclave. Of course, colonial establishments still received more

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and better resources than other parts of Madras, but the patterns of cholera in southern India showed that even the sanitary improvement of the cities close to cantonments and administrative centers could not protect the colonial government from the threat that epidemic and endemic disease posed to their lives, the lives of the troops, and the stability of their rule. Further sanitary measures were necessary, not only in the cities, and especially in Madras, but also in the countryside to protect the foundations of colonial control. Cholera’s Impact on Colonial Infrastructure The years between 1857 and 1863 marked a watershed in the history of India that extended beyond politics, the military, and administration of the colony. Public health became a colonial ambition, because it was seen as an essential precondition for British rule over India under the new, postMutiny conditions. The value attached to lives—primarily European lives—had increased considerably, and if a small number of foreigners wanted to maintain their dominance over a population of proven or potential enemies, then waste due to avoidable diseases could no longer be tolerated. Sanitation was the accepted means of improving public health in Britain, Europe, and elsewhere. Sanitary measures had to be introduced to India, and the first step was the establishment of a sanitary administration to observe the environment, report nuisances, and propose solutions. Cost did still matter and was frequently used as an argument against sanitary projects, but the government had to accept higher expenditures for infrastructure measures, since reducing mortality among the troops was now of paramount importance. For once, lives somewhat outweighed financial considerations. The Indian population would also benefit from these improvements, but the impact on their lives would be merely a side effect. Most of the government funds and efforts were directed at improving the health of troops and colonial officials, and the separation of European from Indian civilian life by means of cantonments and hill stations became a principle that was pursued more consistently than ever before. Of course, this segregation could not be implemented to the same extent everywhere. Troops and officials had to leave their enclaves once in a while and pass through the dangerous lands that were beyond their complete control. Some stations posed a different kind of problem, as they were located in cities, like Madras. Here, too, sanitary measures were focused on the fort, but not all public health measures could be designed specifically to benefit only Europeans. The Indian city was close by, and many Europeans lived outside the fort. The structural changes to the environment, which were necessary

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to integrate and control cholera in Madras, had to be applied to the whole city to be successful, which resulted in a somewhat paradoxical situation. The retreat of the Europeans to cantonments and hill stations appeared to be founded on a renewed and reinforced belief in the necessity of the enclave. The land outside was perceived as dangerous, as both the Mutiny and the medical statistics assembled by the royal commissions had so strikingly demonstrated. The efforts to improve the health of those enclaves by sanitary means were clearly targeted at widening the gulf between the diseased spaces outside and healthy spaces inside. However, there was simultaneously an unprecedented interest in the outside world and its workings, partly as a result of international pressure. The Constantinople sanitary conference had put the blame for past and future cholera epidemics on the governments of Britain and India, and it had forced them to pay more attention to matters of public health. Medical research was one field in which a lack of official support had backfired politically. For too long medical authorities had relied on established assumptions about cholera in India and ignored foreign developments. The official attempt to define Indian cholera as simultaneously unique (Indian knowledge of the disease had to be considered as superior while knowledge gathered outside India could not be applied to Indian conditions) and ordinary (India was not the sole origin of cholera epidemics) was weak and could not be supported with methodologically sound, recent research. The Indian government’s answer was to send two surgeons to Europe, where they could acquire the necessary skills on which research boosting colonial and imperial interests could be based. The diplomatic defeat at Constantinople called for a pragmatic response. The combined demands of the sanitary conference and the Royal Commission made the expansion of the colonial state a prerequisite for any adequate response. Which action to take, however, was unclear. The cholera commissions were installed to gauge the required measures and their future effects, as Britain and India had to adhere to the conference’s resolutions, while the colonial government could demonstrate that it was taking the issue seriously. The commissions investigated the status quo and tried to identify potential improvements that would satisfy the foreign powers without being too costly. They also considered interventions that would affect Indian traditions, like pilgrimages, and extend colonial control to people and occasions that were at some distance from any cantonment or hill station. Statistics increasingly confirmed cholera’s—and other diseases’—presence outside the enclaves. The new sanitary administration installed an

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elaborate information system that gathered ever more reliable data for analytical purposes. One result was maps that showed the distribution of cholera mortality in time and space; others were graphs and statistical series. Thus, the surgeons tried to establish patterns of cholera’s spread that would help to clarify the nature of the disease, while the Indian government hoped that they would further their political agenda by discrediting some epidemiological assumptions that informed the international consensus about the disease. However, the method left cholera theory wide open for contradictory interpretations that could not always be controlled by the government. Although the statistical approach failed in the end to unlock the secret of cholera’s spread, it still emphasized observation of cholera outside the enclaves and highlighted the importance of the sanitary administration that delivered the data for statistical analysis. All those activities triggered by the Mutiny and the diplomatic defeat at the Constantinople conference directed the sanitary focus to the areas outside the colonial enclaves, but they still did not alter the colonial attitudes that pervaded the enclave. Much of the statistical work could be administered from within Fort St. George by relying primarily on Indians to collect the data in remote districts, towns, and villages. Sanitary interventions in those areas were still selective and were not intended to change the local environment in a way that would make the outbreak of cholera and other diseases less likely. The strategy of profound and comprehensive environmental change for sanitation purposes was applied mainly in and near the colonial enclaves. According to statistics on the health of the troops, compiled for the annual sanitary reports, these measures had some success for both Indian and European soldiers.85 Though the new sanitary policy was aimed primarily at improving the health of the enclave by isolating it from the outside world, it had to overcome the perspective of the enclave to make improvements that would secondarily benefit the population outside the enclave. Where physical and spatial separation was impossible, as in Madras, the sanitary authorities had to treat the city as a single entity if they wanted to ensure positive results. The emphasis was still on the health of the troops and Europeans, but with the acceptance of sanitarianism as the guiding principle, the underlying civilizing mission could not be excluded. Thus, sanitary projects had to be comprehensive and could not exclude parts of the population. The water works was an expression of this view. As in Quebec, a water supply system was easier to put in place than a drainage system. Due to high costs, a system providing both fresh water and drainage was more difficult to complete, and the old pecuniary reservations in the govern-

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ment prevailed. Experimental schemes were tried with success on a smaller scale, but the core issue of drainage remained unresolved. In Quebec, the situation was quite different because there had been no prolonged fight over the question of whether comprehensive sanitary measures were necessary or adequate. The municipal authorities were convinced that their city deserved water works as well as a sewer system, and the provincial government supported them. The problems were mainly financial in nature. It turned out that the costs involved in the schemes exceeded the financial means of a city of Quebec’s size and economic potential. The acquisition of a sanitary infrastructure, which was in part intended to demonstrate that Quebec was indeed a “civilized” city, almost bankrupted the municipality. These sanitary projects altered the urban environments of Madras and Quebec profoundly, although the change was not visible at first glance. Much of the new infrastructure was subterranean and therefore out of sight, just as intended. Surface water was channeled to a different dimension, deep in the ground. Odors no longer bothered the inhabitants, as refuse was banished from street level, into tunnels designed to carry it away to a safe location. Thus, the sanitary infrastructures had integrated many actors that were thought to cause cholera into a system that enabled the authorities to control the disease. People who had previously thrown their sewage from the window into the street had had their behavior changed; they began to use toilets and latrines that carried sewage directly to this underground world where the dangerous disease-causing substances belonged. Fresh water came out of the ground at pumps or fountains that were connected by pipes to distant reservoirs. Ancient water tanks, wells, and even the mighty Saint Lawrence River had lost the important function of supplying water for the cities and their citizens. Sanitary changes to the environment were more complete in Quebec than in Madras. Nonetheless, in both cities sanitary thinking had altered the perception of the urban environment among the authorities. Additionally, the urban spaces could now be conceptualized as unified. Boundaries between neighborhoods, classes, and races did not cease to exist, but sanitary infrastructures serving the whole city required a comprehensive approach that connected each house to the system. The new systems required the authorities to look continuously at places that they had previously ignored at most times. Cholera had forced the colonial state to make structural changes, both to the environment and to itself. Cholera thus became a subject of continuous importance to a specialized bureaucracy instead of to temporary and improvised institutions at times of crisis. Previously,

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when cholera had threatened to make an appearance, those unappreciated locations and spaces had gained attention, though only intermittently. Now the authorities observed and serviced them continuously. Thus, their knowledge of Madras and Quebec grew alongside their control over these spaces. Once those sanitary infrastructures were in place, however, their success in terms of cholera prevention was only of a limited nature. In Madras, the decline in cholera mortality rates during the first years after the introduction of a water supply from the Red Hills reservoir was impressive, but it could not be sustained. Time exposed the system’s weaknesses, and especially during drought the centralized water supply increased the city’s vulnerability to cholera. Thus, the disease remained present in the city and took its toll of lives. The threat of cholera thus remained, but mostly for the population of Madras outside Fort St. George. The troops and the officials residing in the fort were effectively removed from cholera. Fort St. George became a healthy space with its own sanitary infrastructure, in contrast to the state of the rest of Madras, despite all efforts there. Nonetheless, cholera remained a problem for the colonial state as long as the disease threatened the rest of the city. Sanitation had come too late for the cholera epidemics in Quebec between 1849 and 1854, though they provided the impetus to undertake sanitary improvements. Quebec did not experience another cholera epidemic thereafter, but not because of this achievement. The potential for a cholera crisis remained present, as the deliberations at the sanitary conferences after 1866 demonstrated. It could arrive in Canada almost as soon as it appeared on the other side of the Atlantic.

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Part III Bacteriology and the Promise of Clarity

Chapter 6 Finding the Comma Bacillus Bacteriology in Madras and Quebec City, 1865–1910

By the 1870s, sanitary thinking had been accepted in Madras, the government and the municipality had instigated some profound changes to the urban environment, and cholera had tested the weaknesses of these first improvements. In Quebec, the shift in priorities toward a permanent structural alteration of the urban environment had been accepted more readily, but from the mid-1850s onward cholera was absent from Canada, so its effectiveness was still in doubt. Yet, as long as the disease was present in Europe or in the United States, the threat of another outbreak of cholera loomed over the city of Quebec, its sanitary authorities, and the various governments of British North America. The officials responsible for quarantine paid especially close attention to the movements of cholera around the world, while the municipal authorities became involved only when the reappearance of cholera seemed imminent. The underlying anxieties about a return of the disease remained a strong impetus for the authorities to take preventive measures. This fear also provided an opportunity for enterprising public health officials to vigorously pressure their superiors for improvements in quarantine and sanitation. Cholera, despite being absent in epidemic form, was still useful for officials who wanted their government’s attention.

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Cholera Scares in Quebec, 1865–1884 The 1865 cholera epidemic in Egypt that had alarmed the public and governments of Europe did not go unnoticed in Canada. Despite recent innovations in naval transport technology that made possible the introduction of the disease into New World ports such as Quebec direct from Egypt, the presence of the disease in the Middle East did little to stimulate the public’s imagination.1 As during previous epidemics, cholera was perceived to be an immediate danger by the authorities and the population of British North America only when it had reached Britain. Cholera news from France, Germany, and Russia again had featured prominently in the newspapers, but the United Kingdom had played the role of distant cholera detector. As long as cholera was absent from Britain, British North America felt safe. If Britain was threatened by cholera’s presence on the European continent, British North America was still one step removed. That cholera had apparently traveled directly from India to Egypt across an ocean had not changed this perception. Cholera began to cause some concern among immigration officials in Ottawa only when it reached European ports later in the year. By the autumn of 1865, the disease was present in British ports, cases had occurred on the steamer Atlanta traveling from London to New York, and it appeared that the apprehensions of the government were becoming a reality. The first outbreaks in the Americas occurred in the early months of 1866, though only on the distant Caribbean islands of Guadeloupe and Martinique. A new cholera epidemic in British North America at this point seemed to be only a matter of time.2 The imperial government in London had officially informed Canadian authorities of the developments in Egypt and Britain by transmitting a circular letter from the Privy Council to the “principal towns and cities” of the United Kingdom and its overseas possessions.3 In Quebec, the Health Committee deliberated on this information on 8 September and subsequently sent a report on the matter to the city council recommending the publication of precautionary advice and proposing to order the chief of police to monitor and enforce the existing regulations regarding cleanliness.4 Precautions on the Provincial and Municipal Levels In the eleven years since the previous epidemic, cholera had lost little of the terror it held for the public. It was still one of the most dreaded diseases in the popular imagination. Given the proximity of the disease and the speed with which it could travel, not only Quebec but other cities, including Toronto, Hamilton, Kingston, and Montreal, felt at risk, and residents there

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consequently demanded a proclamation of the Public Health Act of 1849 by the provincial government, which would allow them to set up local boards of health. This unanimous cry for help gave the provincial government an opportunity to shape a uniform anticholera policy.5 At a meeting on 20 February 1866, the provincial cabinet established the new Central Board of Health to coordinate the efforts. Thomas D’Arcy McGee, the minister of agriculture and statistics, which was the government department that had been responsible for quarantine since 1857, had already pressed for quarantine restrictions to be imposed, and he was determined to do more, proposing the acquisition of ten thousand pounds of lime for the disinfection of government-run medical facilities such as the Quebec Marine Hospital and for general distribution by the Central Board of Health. In March, his department convened a ten-day conference of physicians to discuss a draft by Joseph-Charles Taché, the deputy minister, for a memorandum on cholera. At the conference, Taché, who was a physician, tried to compile a cholera manual for municipal authorities as well as concerned individuals. He faced the well-known problem of a diversity of opinions among medical experts regarding the nature of the disease.6 There was only a consensus among the participants regarding the history of cholera’s movements inside and outside of Canada and the superiority of medical care by physicians compared to self-treatment at home. Beyond that, they could only agree to disagree. Not all views were represented at the conference. A contagionist voice was missing, although prominent contagionist opinions were not totally ignored. As the conference “reporter,” Taché was entrusted with compiling and publishing a memorandum into which he tried to integrate the different etiological theories without taking a position. The result proposed practical measures based on the sanitary consensus, thus avoiding theoretical disagreements. It called for tested sanitary measures, such as cleansing or ventilation, but also more contagionist-inspired practices, such as the continuation of quarantine and the isolation of the sick. Beyond those public health measures, the memorandum focused on citizens’ individual responsibilities. In times of cholera it was everyone’s duty to avoid anything that would endanger his or her own life as well as those of their neighbors. This was not simply a matter of self-preservation but a moral obligation to society. The government could try its best to fight an epidemic, but without the cooperation of every single citizen much of the effort would be in vain.7 Such appeals to individual responsibility and moral conscience were as old as cholera prevention policies in Quebec. They were often based on religious notions of morality that damned indulgence or gluttony and pro-

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moted temperance. Cholera was an occasion to point to the shortcomings and failings of society and an opportunity for change and repentance for individuals and communities. These suggestions gained significance due to the timing of the publication of Taché’s memorandum. In the winter of 1865–66, Canada was preparing for the eventual confederation of the provinces of Canada, Nova Scotia, and New Brunswick. Since the Charlottetown conference of 1864, representatives of the five provinces of British North America had negotiated the creation of a federal colonial state. Taché was an ardent supporter of the Confederation. With the memorandum, he tried to strengthen the position of the provincial government and stop the moral decay of the population at a time of social and political change. By proposing a particular set of centralized recommendations for officials, as well as for every concerned individual, Taché tried to extend the reach of the government into areas that had hitherto been considered private. Such intrusions had occurred before in emergency situations. Local authorities, including those in Quebec, had granted themselves the power of entrance to premises and the destruction of private property at times of crisis for the greater good of cholera prevention. Taché’s memorandum, combining medical expertise with administrative intent, took up this precedent and elevated it to the provincial level. It called for the government to compile reliable and comprehensive statistics on the prevalence of cholera in case of an epidemic, thus instituting a provincewide information system for the first time. This move would make information about the disease available to medical experts and government officials studying cholera and would strengthen the provincial government’s position.8 The memorandum was not the Department of Agriculture’s last effort to prevent the reintroduction of cholera. McGee himself supervised the draft of new quarantine regulations for Grosse Île, which the cabinet approved in April 1866. The new rules were designed to close loopholes in the existing ones and to extend the powers of the authorities to the port of Quebec by requiring comprehensive records on vessels, their masters, cargo, and passengers. The Department of Agriculture and Taché in particular insisted on the thorough implementation of those stricter rules despite the protests of some ship owners who lobbied for exemptions.9 While the provincial government tried to design a uniform response to cholera, the municipal sanitary authorities in Quebec had more practical things to worry about, such as the management and improvement of the sanitary infrastructure. Water works and drainage had lifted Quebec to civilized parity with British or American cities, enhancing its prestige. The process of sanitary amelioration, however, was not complete, as the

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Health Committee never tired of pointing out. In May 1865, for example, it had emphasized the unsanitary woodblock linings of some streets and demanded sturdier paving.10 The news of the arrival of the Atlanta in New York also marked the beginning of the latest cholera crisis on the local level, as the city council reacted immediately. In a letter to the provincial government in Ottawa, the council lamented that the quarantine station at Grosse Île had been prematurely closed for the year. Late arrivals could now start an epidemic, for which the city and the colony would be utterly unprepared. Therefore, the council asked for instructions from the provincial government on how to proceed in such a case, yet it did not wait for a response to take the first precautionary actions. It strengthened the Health Committee, adding eight councilors and six physicians as temporary members. This enlarged committee, supported by ten policemen and a budget of five hundred dollars, was to investigate the current sanitary conditions of Quebec and to propose adequate measures against a possible epidemic during the upcoming shipping season.11 Thus, the city council had once again created an institution charged with the coordination of the anticholera effort that integrated medical and administrative expertise. Since it operated under the Quebec City Health Act of 1849, the municipality could act independently from the provincial government. It did not establish a board of health but gave the expanded Health Committee more responsibilities. It could now make decisions without continuously negotiating measures with the city council but still had to report regularly on its actions. The Health Committee appointed eight health officers, one for each of the city’s wards. As had been the case during the preparations before the epidemics of 1849 and 1854, they were responsible for maintaining the city’s cleanliness and began their work in advance of the shipping season on 21 March. Once they had taken up their duties, the municipal authorities could do little but wait and hope that quarantine would protect them.12 The quarantine station on Grosse Île opened in the last week of April. Its superintendent, Dr. Anthony von Iffland, had requested additional medical personnel, as he expected the arrival of up to 150 vessels on the busiest days. The government granted his request, dispatching two young physicians, Drs. Lachine and Montizambert. Iffland’s worries proved to be exaggerated, as only 124 ships arrived at the station in the first three weeks of navigation, all without a sign of cholera, although other dangerous diseases, including typhus, smallpox, and measles, were discovered. Cholera remained a concern throughout the summer, but when the station closed in the first week of November 1866, no less than 956 vessels had been in-

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spected and 28,648 passengers had landed in Quebec, but there had been no cases of cholera among them.13 The Quebec Health Committee had reacted to the reassuring news from Grosse Île early and reduced the number of health officers to five on 1 June. This arrangement remained unchanged for the rest of the year. However, ships arriving from Europe were not the only possible route for the introduction of cholera. As during previous epidemics, the disease could also cross the southern border. From May 1866 on, cholera spread from New York as far as Kansas, apparently via the railway network. The disease did not enter Canadian territory from the south, however, and the winter of 1866–67 brought the outbreak in the United States to a halt. When the shipping season, and with it the annual threat of cholera, began in the spring of 1867, the usual cleansing supervised by the health officers, as well as the publication of advice for the general public, followed. At the same time, cholera again spread in the United States, though only to a limited extent. No cholera cases appeared at Quebec that spring, and the health officers were finally discharged on 30 June 1867.14 The summer of 1867 marked the end of the cholera scare, but the quarantine officials stayed vigilant, since the disease was still present in the Mediterranean region.15 The Confederation of Canada on 1 July 1867 brought some changes in the political responsibilities for medicine, public health, and quarantine. As article 92 of the British North America Act stated, public health and social well-being were henceforth provincial responsibilities. Quarantine, however, was now administered by the federal government in Ottawa. Over the years that followed, the government passed three federal acts reforming and specifying quarantine rules and regulations. Cholera was one reason for these new laws, as authorities still considered it a looming threat. The specter of the disease faded from public awareness, however. Canadians remained calm and disinterested when an epidemic swept the United States in 1873, although the authorities watched the developments south of the border carefully and imposed quarantine in January 1873. The public’s equanimity might be explained by the fact that the epidemic originated in distant New Orleans and moved northward at a relatively slow pace. With the exception of Chicago, it failed to reach the Great Lakes region. However, cholera was present in Ohio and Pennsylvania, which meant that it could travel to Canada by train in a matter of days.16 Quebec City, 1854–1910 Confederation had fundamental implications for the city of Quebec. It once again became a seat of government, albeit only the provincial one.

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With the passage of the British North America Act, the United Province of Canada was split up into its original parts, which received new names. Quebec became a province of the Dominion of Canada, and the city of Quebec was the provincial capital once again, as it had been before 1840. For the citizens of Quebec City, this development was welcome, as the local economy had endured hard times since the 1850s. The main sectors of industry—timber and ship building—had run into trouble since ironclad steamships had begun to replace wooden sailing ships. As neither Quebec nor Canada had a noteworthy iron or steel industry, the shipyards could no longer compete with their American and European rivals. Workers of British or Irish descent were ready to leave Quebec City for Montreal, Ontario, or the United States, and many did, leading to a decline in the local anglophone population. For the anglophone community in Quebec City, this exodus was a shock and had lasting consequences.17 Another blow for the local economy was the withdrawal of the British garrison in 1871. The British military presence had accounted for three thousand salaries paid by London but spent in the city, and local merchants, artisans, and tavern keepers dearly missed this source of income.18 Yet, despite the relative economic decline, the population of Quebec City continued to grow, although not at the same rate as in Toronto or Montreal. The proportion of francophone citizens rose due to both natural growth and migration from rural Quebec. In 1871, Quebec City had almost sixty thousand residents, and it grew further, to more than seventyeight thousand in 1911. This increase was not distributed evenly over the city’s territory. The old working-class neighborhoods in the Lower Town and in the suburbs were stagnating or even losing inhabitants, as was the prestigious Upper Town. The old Champlain quarter in the Lower Town lost 70 percent of its population in a half century. As the population density in those quarters decreased, it eliminated the sanitation problems due to overcrowding that had worried the authorities for decades. Instead, people were moving to rapidly expanding newer suburbs that quintupled the city’s territory between 1889 and 1914.19 Servicing these newly settled areas with drinking water and sewers was a high priority for the municipality. As the water works had to supply more people dispersed over a larger space, more water had to be taken from the intake on the Saint-Charles River—where it had been filtered from 1870 onward—and it passed through a new stretch of pipe alongside the existing route.20 The Cholera Scare of 1883 In the years following the 1866 cholera scare, the disease was not an issue

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for the municipal, provincial, and federal authorities concerned with public health—until it spread for a fifth time westward from India, reaching Egypt in 1883. The Canadian government began to pay attention in July 1883 when Parliament in London discussed measures to protect Britain against another outbreak. The renewed threat alarmed the authorities at Grosse Île, where Frederick Montizambert had taken over as medical superintendent in 1869 after Iffland’s retirement. Montizambert deemed it “not improbable” that cholera could migrate directly from the Mediterranean region. Grosse Île, however, was unprepared for the arrival of the disease.21 The infrastructure there had been neglected or was no longer up to scratch, and if works were delayed until the next year they might be completed too late to be of any use.22 Since the early 1880s, Montizambert had demanded an overhaul of the quarantine regulations and procedures. He thought that both a change in the legal framework and an improvement of the facilities on the island were necessary. Yet, despite his efforts, quarantine was on the brink of becoming obsolete. In 1882, no incoming ships had stopped at Grosse Île. They avoided quarantine by passing at nighttime or blatantly ignoring the station. Given the improved sanitary conditions on the faster transatlantic steamers, Montizambert recommended a more specific approach to quarantine. He called for the disinfection of passengers and ships only if dangerous diseases such as cholera, yellow fever, typhus, or smallpox had occurred on board.23 During the winter and spring of 1883, the Canadian authorities watched and discussed the developments in London, but they also acted on their own. On 21 July 1883, the federal government proclaimed quarantine for all vessels arriving in Canada from Mediterranean ports. The act of proclamation itself, however, did not enable the medical superintendent at Grosse Île to stop vessels. Consequently, Montizambert complained to the minister of agriculture about his lack of authority to direct the pilots to the station and requested an order to that effect, otherwise quarantine would remain “inoperative.” He wanted the same authority with regard to cargo ships carrying rags from the Mediterranean region, which he deemed a particular danger as they could contain soiled bed linen or clothing.24 His concerns mirrored those of the Quebec city council. In a letter to the minister of agriculture, the mayor of Quebec reported the widespread suspicions among the population that the port physician, who served under federal authority, was neglecting his duties, inspecting passenger ships only superficially and thereby endangering public health. In light of these rumors, the mayor warned the federal government that “there is an im-

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pression existing that the quarantine station is only kept to throw dust in the eyes of the public, and that the great steam ship companies have succeeded in making it a dead letter,” and he urged the government to take action if only to regain public confidence.25 The remainder of the shipping season brought no cholera cases, but no one could be sure what the next spring would bring, as Montizambert was quick to remind his superiors in November 1883. The threat was not over, and the worst-case scenario—a major epidemic affecting the city, the province, and the whole country—was still possible if not probable. Montizambert regarded the situation as precarious enough to “demand” a catalog of measures to fend off a possible disaster: a reform of the quarantine regulations; the implementation of several long-awaited improvements, such as a telegraphic or telephonic connection from Grosse Île to Quebec or an extension of the pier; and repairs to the buildings on the island.26 In 1884, the fears and warnings again proved to be baseless. Cholera failed to make a comeback at the start of the shipping season, and the constant vigilance of the authorities at Ottawa and Grosse Île resulted in little more than an extension of quarantine to ships coming from the French ports of Marseille and Toulon in July and from all ports outside Canada in August 1884. Amid the limited government measures, the admonitions of Montizambert and the Quebec city council’s warning of a still-present danger were left more or less unheard.27 Bacteriological Inquiries in Egypt and India, 1883–1885 The cholera epidemic that reached Egypt in 1883 and revived old anxieties in Canada proved to be the catalyst for a new round of state-sponsored research. Encouraged by recent successes in the new science of bacteriology, which had established that at least some diseases were caused by specific microorganisms, the French and German governments sent scientific commissions to Alexandria to investigate the occurrence of the disease there and, if possible, to finally discover not only its true cause but also the means to effectively prevent its spread. Bacteriology relied on a specific arrangement of actors. First was the laboratory: a space of control, experiment, and observation, a space in which the number of factors that influenced the object under investigation—and, in consequence, the object under investigation itself—could be reduced in complexity or number and manipulated at will. In the laboratory, a bacteriologist could gain a level of control over the cause of disease that generations of physicians, engineers, and sanitarians had failed to achieve in the outside world despite the most costly or audacious efforts.

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A range of instruments, such as microscopes and stains for observation, dishes and culture media in which to grow the microbe, ovens to guarantee a stable temperature, and test animals, made this special space possible, allowing the alteration of environmental conditions at will for research purposes.28 The power to change and control those environmental factors required a standardization of the bacteriologists’ practices. Every minimal deviation in conditions or procedure could spoil the experiment. Thus, the laboratory demanded the practical training of scientists in certain methods and meticulous work in teams or by an individual to both produce knowledge and reproduce other bacteriologists’ results. Following procedures described in handbooks and manuals was not enough to become a bacteriologist.29 Previous research on cholera’s etiology had had to overcome the problem of the infinite number of factors present in the environment in which diseases occurred. Any one or any combination of them could be the decisive cause of disease in a certain location. The laboratory allowed scientists to investigate each of these actors independently or in connection with a limited number of others, thus allowing them to exert a level of control over the cause of a disease that was impossible to achieve outside the laboratory. This control did not necessarily mean, however, that the lab results would be transferable to an infinitely more complex environment outside. The environmental factors outside the laboratory had to be simulated inside as closely as possible to allow scientists to make valid conclusions. Only then could the environment outside be changed in a way that would allow scientists to control the pathogen. The public demonstration of this second step, as in Louis Pasteur’s famous trial of the anthrax vaccine at Pouilly-le-Fort, excited the imagination of their contemporaries, making scientists like Pasteur or Robert Koch national heroes and giving them considerable political influence.30 The reaction among medical professionals was at first more cautious than the public’s. That a single microorganism transferred from one person to another was the sole reason for a certain disease challenged medical tradition. The proponents of localist theories expressed their doubts, while contagionists were thrilled that the elusive contagium had been revealed. For the sanitary movement, however, bacteriology offered a solution to two of its most pressing problems. First, despite the political success of the movement, it had failed to make good on its promise that spaces with a sanitary infrastructure would be free of preventable diseases. Second, this failure had undermined the medical foundations of the movement’s agenda, as a multitude of environmental factors were deemed possible explanations for

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the continued presence of disease. The simplicity of localist medical theory had again given way to a complex aggregation of causes, which sanitary measures had to control. Bacteriology offered a chance to improve existing and future infrastructure by identifying certain points of passage through which a germ had to travel if it was to affect a human being or a certain space.31 By figuring out the ways and means through which the intruder entered the environment (e.g., drinking water, food, migrants, etc.), the bacteriologists allowed the sanitarians to focus their attention on the places where germs could be fought most effectively. The scientists could then evaluate their efforts using laboratory tests.32 Anticontagionist medical practitioners were at first skeptical of bacteriology, and the same was true for some governments. When it came to many epidemic diseases, especially cholera, the British government had stressed that such diseases were not contagious; by making this proclamation, the government was thereby protecting trade and the quick transfer of troops from the home country to the colonies, especially India. The anticontagionist theory also undergirded the government’s opposition to quarantine, particularly at the Suez Canal, and its preference for sanitary improvements in its colonial outposts and control of ships in ports. The cholera epidemic in 1883 also gave the British government the opportunity to send its own scientific commission to Egypt. However, its task was not bacteriological research, as was the case for the rival French and German scientists, but to look for evidence that the disease was not caused by a microorganism and, if possible, to confirm the local origin of cholera outside the regions of India where the disease was endemic. The British commission arrived in Egypt in July 1883, but its efforts were soon eclipsed by those of their French and German counterparts, who had a considerably higher scientific profile. Émile Roux, one of Pasteur’s most important collaborators, led the French scientists, who arrived at Alexandria in August. The German commission, led by Koch himself, was last on the scene. Both the French and German commissions brought their own instruments and test animals, but the cholera epidemic they had come to study was already in decline, and it became increasingly difficult to obtain recently deceased bodies. When a member of the French commission died of cholera and there was still no breakthrough on the horizon, Roux and his companions left Egypt, in October 1883. Koch and his team felt that they were on the right track, however. They had identified a comma-shaped bacillus that appeared in the intestines of cholera victims in great numbers and was seemingly connected to the occurrence of cholera. However, it was in no way clear if the microbe was the cause or a conse-

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quence of the disease. To complete their study, they proceeded to Calcutta, where the disease was endemic and where a sufficient supply of bodies of cholera victims was ensured.33 Koch and his team arrived in Bengal on 11 December. J. M. Cuningham, still the sanitary commissioner of India, personally welcomed the Germans and placed the second floor of the Medical College hospital at their disposal. Koch and colleagues set up a laboratory there and soon discovered that the comma bacillus they had observed in the intestines of Egyptian cholera victims also occurred in Indian ones. Koch’s team quickly managed to produce a pure culture of the microbe but failed to generate any symptoms in test animals. However, when the German commission found comma bacilli in a water tank from which Indian inhabitants of a cholera-plagued area took their drinking water, Koch was certain he had substantiated a chain of transmission from the feces of cholera patients into the drinking water. For him, the enigma of cholera that had puzzled medical practitioners for decades was solved, and in his last report to Berlin, issued in February 1884, he proclaimed his expedition a success.34 The British and Indian governments were caught off balance by this inconvenient news. A claim by one of the world’s most eminent scientists to have found proof of the contagious nature of cholera put them in an awkward position. If Koch’s argument could not be countered, decades of research and scientific work, as well as the reputation of the IMS, would be devalued by the results of a few months’ laboratory work in Egypt and India. The international diplomatic pressure to employ stricter quarantine procedures at Suez would increase. As in the aftermath of the Constantinople sanitary conference of 1866, the India Office once again charged a scientific commission with investigating the disease in order to raise doubts, this time about the scientific credibility of Koch’s findings. The commission would have to be staffed by scientists who could stand up to Koch in prestige and methodology. In the spring of 1884, the India Office selected two young physicians for this task.35 Edward Klein was one of the most internationally respected British bacteriologists and probably the only one with sufficient prestige to challenge Koch’s conclusions. Heneage Gibbes was chosen as Klein’s assistant due to his experience in foreign countries, notably China, where he had traveled as a sailor before training in medicine. The two men appeared to be the best choice to save the honor of AngloIndian medical research, as well as the free passage through the Suez Canal, the most important line of communication between India and London, as the diplomatic stakes continued to rise. Cholera had broken out in southern France, and Koch had found the same bacterium in victims there as

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in those in India and Egypt. The British government’s intransigence on quarantine seemed to be responsible for the spread of the disease from its colonies to Europe, and, at a conference on Egypt’s finances held in London from June to August 1884, the German plenipotentiary had raised the issue of quarantine at Suez. London and Calcutta needed a scientific success to stave off the demands for quarantine, and for that to happen Klein and Gibbes had to beat Koch at his own game. In India they would travel to and investigate more locations than Koch had. The sanitary commissioner for India, J. M. Cuningham, along with D. D. Cunningham, who was still the IMS surgeon most qualified in microscopic research, would support them and supply them with the means and resources required for a successful investigation. However, neither of them was supposed to interfere so as to ensure the commission’s independence.36 After their arrival in India in September 1884, Klein and Gibbes conducted research in Bombay and Calcutta. Klein chose an obvious weakness of Koch’s argument as his starting point. Koch had not been able to demonstrate that the comma bacillus was capable of producing symptoms of the disease in test animals. Therefore, Koch was incapable of experimentally fulfilling the requirements that he himself had established with his three famous postulates for the identification of the bacterial causation of a disease.37 Klein doubted that the comma bacillus could be the cause of cholera, as cases of direct contagion, from patient to physician or nurse, for example, were too rare. He rather suspected the microbe to be an epiphenomenon. Klein and Gibbes tried to substantiate this position with an examination of water tanks. Like Koch, they found the comma bacillus in such tanks, yet many of the Indians who drank the water did not fall ill with cholera. Thus, in their report submitted to the secretary of state for India in March 1885, Klein and Gibbes could state that at least some aspects of Koch’s theory had been refuted. They claimed that the burden of proof was still on Koch. If he could not induce symptoms in test animals, his results were nothing more than speculation. The comma bacilli profusion seen in victims could be a consequence of cholera and not the disease’s cause. However, they could not propose a superior theory, and they felt the circumstances were to blame for that. Both had found the working conditions in India wanting, and the time allotted for their research had been too short. Eventually, they had had to leave with their investigations incomplete.38 Since Klein and Gibbes had merely questioned Koch’s theory and pointed to weaknesses in his results, they had not been able to disprove it. In light of Koch’s reputation, large parts of the international public

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were giving him the benefit of the doubt. At international conferences on cholera and sanitation in Berlin and Rome, respectively, in the spring of 1885 and in the scientific discourse generally, Klein and Gibbes’s line of argument proved ineffective, thus handing the British another diplomatic defeat. Koch’s theory had gained considerable momentum and served as the basis for attacks on the lifeline of the British Empire. In order to turn things around, the India Office convened a commission of thirteen eminent British medical authorities to review Klein and Gibbes’s report and to compose a refutation of Koch’s cholera theory. However, the commission had no new facts at hand. So it changed the tone and toughened the language Klein and Gibbes had used, reiterating their findings and emphasizing their belief that cholera was not contagious and that cordons sanitaires were futile. Their result was published in a minor journal, the Quarterly Journal of Microscopical Science, under the title “The Official Refutation of Dr. Robert Koch’s Theory of Cholera and Commas,” avoiding more widely circulated journals, such as the British Medical Journal or Nature, which had published articles favorable to Koch’s theory. This review became the official position of the India Office, which willfully ignored those scientific voices from Britain that had either supported Koch’s conclusions or expressed criticism of Klein and Gibbes’s findings.39 Disputing the Comma Bacillus, 1884–1894 Following Koch’s identification of the comma bacillus as the sole cause of the disease, cholera theory was in a state of limbo for a decade. Koch had found much acclaim, and the German public was especially united in its support, but even among German scientists there was still a considerable amount of doubt. Especially bitter was Koch’s debate with his eminent and recently ennobled German rival, Max von Pettenkofer, who vehemently attacked Koch’s claim that the comma bacillus was the sole cause and only sufficient precondition for cholera. Pettenkofer was open to the possibility that a microbiological germ was the missing cholera poison, but he could not accept Koch’s increasingly reductionist interpretation of the comma bacilli’s powers to induce the disease. Koch dismissed Pettenkofer’s complex combination of factors influencing and causing cholera in an environment and focused on only one, the comma bacillus. For Pettenkofer, it was a challenge to a lifetime of research, and the two men clashed on several occasions. Throughout those debates, both positions became more radical. Koch’s theory gained further ground when the physiologists Nicati and Reitsch succeeded in inducing symptoms of cholera in test animals. However, the debate was not decided, and both sides continued the battle.40

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The debate was not settled in Koch’s favor until 1893, when an inquiry regarding a severe cholera epidemic that had affected the city of Hamburg in the previous year had yielded results confirming Koch’s hypothesis on cholera’s etiology. Koch and his collaborators were able to determine why Hamburg had been severely affected by a cholera epidemic in 1892–93 while the suburb of Altona went unscathed. Localists like Pettenkofer were unable to explain why two adjacent towns had such a different experience of the disease. Koch realized that the two municipalities had different water supply systems. Altona had relied on a filter and therefore escaped the disease, while Hamburg had distributed contaminated water from the river Elbe. When one of Altona’s filters failed, cholera spread there, too. In their Hamburg investigation, Koch and his collaborators had proven themselves to be bacteriologists as well as epidemiologists. They had managed to transfer the results of their laboratory research to the outside world.41 The following year, the Russian bacteriologist E. Metchnikoff, who worked in Paris at the Pasteur Institute, reported that he had succeeded in inducing cholera symptoms in test animals and in himself, while in India another Pasteurian and Metchnikoff’s student, Woldemar Haffkine, claimed to have developed an anticholera vaccine. Thus, one of the last weaknesses in the bacteriological cholera theory appeared to have been eliminated. The scientific community, the public, and governments accepted that the comma bacillus was the sole cause of cholera.42 During the decade between Koch’s identification of the comma bacillus as cholera’s sole cause and the confirmation of his results in Hamburg, the sanitary authorities in India tried to fend off this claim and to counter the implications of this theory. The government of India and especially J. M. Cuningham, as its most senior sanitary official, had invested heavily in their localist cholera theory, suppressed contagionist voices like A. C. DeRenzy’s, and sponsored cholera research that would support its needs. Coming to the end of his career in 1884, Cuningham was faced with Koch’s comma bacillus theory, which threatened to devalue his life’s work. The conferences in Berlin and Rome and the widespread international acceptance of Koch’s theory demonstrated that the old method of raising doubts based on statistical epidemiology and inconsistencies had run out of steam. Koch’s claims based on bacteriological science had proven to be too strong and too convincing. Klein and Gibbes had tried to counter Koch with bacteriological methods, but their resources had been insufficient. To discredit Koch’s theory, short investigative visits were not enough. The only way to save the government of India’s cholera policies was to conduct sustained bacteriological research in India.43

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Yet, there was no proper, state-of-the-art laboratory and no internationally respected scientific journals or scientists with adequate knowledge of techniques and methods in India. The government had to catch up in all three areas. A first step was the establishment of a medical laboratory. Located in Calcutta, the new facility was attached to the Medical College. The government appointed D. D. Cunningham as its first director, taking over J. M. Cuningham’s mantle as the primary defender of localist cholera theory. Although he was not a bona fide bacteriologist, D. D. Cunningham was still the most qualified candidate in the IMS due to his experience as a microscopist. He was also still close to Pettenkofer, who was a well-respected authority in the field of hygiene. At the time of his appointment, Cunningham was professor of pathology at the Calcutta Medical College and had steadily published on cholera. However, his microscopy training in Europe had preceded the breakthrough of bacteriology and could be judged by European authorities as outdated.44 A journal to publish Cunningham’s results was quickly established: the Scientific Memoirs by Medical Officers of the Army of India. Conveniently, its first editor was Surgeon-General Benjamin Simpson, who had succeeded J. M. Cuningham as sanitary commissioner for India in 1884. The new journal presented Cunningham with a platform on which to stage his attacks on Koch’s theory, an opportunity he used regularly. He was the author of the only two articles in the first issue and continued to contribute to subsequent issues. In several articles published over the course of the following decade, Cunningham tried to shake or discredit Koch’s theory.45 He did not go as far as denying that the comma bacillus played any role in cholera but highlighted ambiguous results of his own experiments and interpreted them in localist terms, thus trying once again to bring the specifics of the Indian environment into the bacteriological equation. Laboratory experiments, Cunningham claimed, had to reflect the peculiarities of the Indian environment. Koch’s assumption that cholera, and the comma bacillus, worked the same way in India, Egypt, Europe, and in the laboratory had to be considered unproven. Therefore, Cunningham investigated the ecology of the cholera bacillus in the Indian environment, its presence in soil and water, and its influence on cholera epidemiology. He found in cholera victims new species of comma bacilli thriving under different conditions, which challenged Koch’s notion that only one species of bacterium was responsible for the disease. Thus, he was able to reintroduce locality and individual predisposition into his bacteriological analysis. In addition, though, Cunningham also demanded a thorough investigation of comma bacilli in other parts of the world in order to find out if they were native there.

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In short, Cunningham’s strategy was to add characteristics to the bacillus, redefine it, and complicate cholera theory where Koch had simplified it. Thus, he and the Indian government both won time and forced the contagionists to challenge Cunningham on his terrain. Cunningham continued his attacks on Koch’s theory until 1897, when he retired. Over the years he made some concessions to the shift of scientific opinion in Koch’s favor, although he remained a committed localist who represented the political interests of the government of India in the scientific world of bacteriology.46 Cunningham, however, was not the only scientific voice on cholera in India. The Indian Medical Gazette and its editor, K. MacLeod, were more open to Koch’s theory than the government was, despite some reservations, and MacLeod made the journal a forum for discussion. It published a translation of Koch’s final report and discussed Koch’s theory in two critical editorials that reiterated the official response. Over the years that followed, the Indian Medical Gazette printed some editorials that referred to articles by scientific voices in Britain and India that supported Koch’s theory, although the majority of the pieces were opposed to it.47 Among the former was an address by William Cornish, the former sanitary commissioner for Madras and staunch contagionist, to the southern India branch of the British Medical Association, of which he was the president. In his speech, Cornish carefully avoided taking a position in the dispute. But his criticism of J. M. Cuningham and the localist thinking in the Indian government gave away his sympathies. To settle the matter he proposed letting prisoners sentenced to death volunteer to undergo an infection with comma bacilli. Whether they succumbed to cholera in sufficient numbers or showed no symptoms of the disease at all, the result would clearly indicate whether the germ identified by Koch was capable of inducing the disease.48 Most articles, however, were highly critical of Koch. Their authors argued on epidemiological grounds, and most highlighted the spread of the disease by contaminated water and the importance of a good water supply for the prevention of cholera. On the question of cholera’s cause, however, they were rarely ready to commit themselves. Koch’s comma bacillus theory was considered but rejected. These authors, like Cunningham, felt that their experience of cholera in the Indian environment could not be explained sufficiently by Koch’s theory.49 Around 1894–95 a change in attitude is apparent in the published articles. This shift coincided with Haffkine’s presence in India. His cholera vaccine was not only of considerable practical value, it also discredited the official position of the medical authorities as represented by Cunningham, who had predicted that a vaccine based on the comma bacillus would be of

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only limited use, since it would prevent only the harmful epiphenomena caused by the bacterium and not the original cause of the disease. Cunningham’s position also increasingly came under pressure from within the IMS due to the arrival of a new crop of surgeons, such as Ernest H. Hankin, who had received bacteriological training in Europe before his service in India and had published a critical article. These scientific and generational changes coincided with Koch’s public declaration that he did not support more restrictive quarantine measures against cholera, which he considered ineffective, thus decreasing the diplomatic pressure on the governments in London and Calcutta.50 Bacteriological Theory and Its Effects in Madras, 1883–1896 The Madras medical establishment received Koch’s discovery of an infectious microbe more favorably than did the authorities in Calcutta. In his sanitary report for 1883, the sanitary commissioner M. C. Furnell was enthusiastic when discussing Koch’s reports from Bengal. He saw no reason to doubt Koch’s findings. For some surgeons of the Madras Medical Service, it confirmed the assumption that cholera was contagious and that water had an important role to play in its propagation. The role of water tanks appeared to be particularly convincing: Koch attributed local cholera epidemics to Indians’ unsanitary behaviors—habits that sanitary officials had often witnessed and criticized. In the eyes of the sanitary commissioner, Koch’s findings fit into his perception of cholera, confirming long-held beliefs regarding the disease’s causation. Koch’s results and his prestige could be used to reinforce the demand for sanitary measures that the government had neglected for too long. Therefore, it is hardly surprising that the sanitary commissioner extensively quoted his own previous experiences, recommendations, and demands regarding the drinking water supply at Madras and in other towns throughout the presidency, and he reminded the government of its legal obligation to secure a proper supply of drinking water for the municipalities.51 The sanitary commissioner’s report was published shortly after Koch’s announcement of his success in identifying the bacillus in February 1884 and before London’s and Calcutta’s negative responses. Once Klein and Gibbes had completed their investigation and the official refutation of Koch’s theory was published, the comma bacillus disappeared from the Madras Sanitary Report for almost a decade. However, when describing grievances concerning the water supply in the city of Madras and all over the presidency, the sanitary commissioner regularly referred to the same unsanitary practices that had been featured in Koch’s account of cholera

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etiology. Mentioned with particular prominence was washing the soiled linen and clothes of cholera patients. Although neither the commissioner nor his sanitary officers conducted bacteriological investigations of the drinking water, they took samples to highlight the impurity of the water, which could be interpreted as being contaminated with bacteria.52 Such passages in their reports appear to be deliberately ambiguous. They could be understood in terms of either prebacteriological epidemiology and sanitation, influenced by Snow’s theory of waterborne contagion, or Koch’s theory of dissemination of a germ excreted by cholera victims and ingested with drinking water from an unsafe supply. It was not necessary for the officers to mention Koch or his comma bacillus in order to make a statement in favor of sanitary improvements and, at the same time, implicitly challenge the government of India’s official position. Koch’s identification of the comma bacillus did little to change the sanitary commissioners’ practical view of cholera, and no modification of the measures taken to counter the frequent epidemics ensued. The instruments and practical knowledge for bacteriological investigations of outbreaks did not exist. Thus, sanitation remained paramount, and procuring drinking water had the highest priority. Madras had demonstrated the potential success of such projects after the introduction of a central water supply from the Red Hills, but it had also highlighted the practical problems caused by the municipality’s limited financial resources. Koch’s theory could not be used to demand higher expenditures from the colonial government, as it had been rejected by the authorities in Calcutta. Ultimately, the presidency’s sanitary authorities were no longer responsible for sanitary improvements for a large part of its population anyway, since the government of India under Lord Ripon had transferred additional authority for many aspects of public life to the municipalities in 1882.53 For Madras, this administrative change resulted in a new municipality act passed by the government of Madras in 1884. The act put more political power into the hands of the people, though only a very small part of the population had the vote. The following decades saw an expansion of municipal responsibilities, as well as a rise in population and, subsequently, an increase in the municipal budget. The municipality of Madras also invested in tramways and lighting, but the sanitary infrastructure still did not extend to most of the city.54 The new drainage system of the Black Town was finally completed in 1888–89, yet good water from the Red Hills reservoir was increasingly scarce and provided an incentive to begin planning for a new water scheme. However, as no funds for such an extensive investment in public health were available, no planning took place. On the contrary, the municipal sanitary .

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officer apparently struggled even to preserve the precious improvements of the previous decades. In an assessment of the sanitary defects of Madras, which he included in his report for 1892–93, he lamented the deficient drains and sewers, the insufficient supply of water from the Red Hills in dry years, and the soil that had been polluted through decomposition.55 This negative review of Madras’s sanitary condition was prompted by a cholera epidemic that had gained momentum over several years and peaked in 1891 with a death toll of 1,806 in the city of Madras and 98,773 in the presidency. The epidemic declined over the next few years, but the disease had once again made an impression. The epidemic in Madras more or less coincided with the 1892–93 epidemic in Europe, which had provided Koch with the opportunity to investigate the disease in Hamburg and Altona, once again confirming his previous findings in Egypt and India. Koch’s success apparently caused the Madras sanitary commissioner to reflect the etiological state of affairs in his report for 1893. There was a hint of weariness in his account. India had always been a graveyard of cholera theories. He considered Snow’s theory of waterborne contagion as proven and acknowledged the acceptance of Koch’s bacteriological theory in Europe. Yet, he claimed that in India cholera was more complex, and elaborate theories had not matched the facts detailed in the cholera statistics compiled by the sanitary officers. Some of the epidemiological phenomena observed and described by sanitary or medical officers, especially in the context of mass migration due to pilgrimages and religious festivals, seemingly contradicted Koch’s and Snow’s theories and still posed a scientific puzzle that remained to be solved. The spread of new technologies such as railways and telegraphs, however, would provide the authorities with the means to receive news of outbreaks and movements of the disease almost immediately, even from the most remote areas of the presidency. Of course, the local informers would have to be reliable and diligent, but such statistics would be vastly superior to the established monthly or yearly figures.56 The sanitary commissioner’s general acceptance of Koch’s comma bacillus theory in connection with Snow’s established waterborne theory marked a redefinition of cholera prevention in Madras, even without the necessary laboratories for actual bacteriological testing. The sanitarians had always believed that cholera could be prevented by comprehensively changing the environment. This approach had resulted in some successes, as the vital statistics had proven, but cholera and other diseases were still present in the urban space of Madras, as well as in the rest of the presidency. Sanitation had brought improvements but had not been able to keep its promise of banishing preventable disease from the city. The urban space

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had been too complex and varied and thus had combined with the still unclear “nature” of cholera to thwart the efforts of the colonial state’s institutions. The germ theory of cholera specified what caused the disease, thus changing the perception of the local environment. With the comma bacillus’s points of passage known, the most vulnerable spots in the sanitary infrastructure, as well as in the lives of the population, could be easily identified. The germ theory of cholera narrowed the spaces requiring special attention and replaced a complex web of environmental features with a more selective perception of urban space. Therefore, preventive measures, not just in bigger towns and cities but also in smaller villages, could be fine-tuned both as preventive action and in reaction to an outbreak. The scarce funds could be targeted where they would be most effective.57 Cholera versus Plague in Madras, 1896–1910 In the years between 1883 and 1896, cholera ceased to inspire the kind of horror it once had. By the end of the century, Koch’s comma bacillus theory of cholera was widely accepted, all but ending the etiological debates. It provided a new foundation for sanitary improvement, and Haffkine’s vaccine allowed for the inoculation of troops and the population in case of an epidemic. Although the combination of sanitation and vaccination did not provide complete protection, it managed to further decrease morbidity and mortality. Science had demystified cholera (or so it seemed), identified and integrated the responsible actors, and made the disease controllable, at least to a certain degree. There was still no effective treatment once the first symptoms had appeared. Yet, in the perception and imagination of the scientific community, the colonial authorities, and the public, cholera had lost much of its power and terror, and the new clarity about causation had defused the diplomatic conflicts over quarantine among Germany, France, and Great Britain. Although cholera remained an international issue after Koch’s statement against quarantine, it was far less contentious.58 The attention cholera attracted further decreased when another, even more dreaded disease appeared to become epidemic in India. In 1896, bubonic plague, spreading from southern China, had reached Hong Kong. From there it spread quickly to Bombay by ship. There, the disease found its victims among the port workers, while the authorities quarreled for several weeks over the correct diagnosis and concerns over possible trade restrictions. Plague was rare in India, and only a few IMS surgeons had practical experience with it. The disease had not yet attracted the scrutiny of bacteriologists, and its etiology was still in doubt. In addition, the very idea of plague evoked a terrifying history that reverberated in the imagi-

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nations of the authorities and the public. Plague was the disease of the medieval Black Death and the infamous 1665–66 London epidemic. It was a killer, leaving few survivors, and there was no proven remedy. Its behavior in any given space was unpredictable, and where it was endemic there were frequent outbreaks. If there was a disease with horrors that exceeded those of cholera, it was plague.59 Thus, the medical, sanitary, and political authorities thrust cholera to the margins. Fighting plague became a justification for colonial rule in India in the face of an emergent and increasingly assertive movement for independence. Over the years that followed, antiplague measures in India reached a level of intrusiveness that previously would have been unimaginable. Long-established taboos and considerations were put aside to ensure that the preventive measures would be effective. Women were no longer “untouchable” by male European medical practitioners; sanitary officers were allowed to enter houses for disinfection without the permission of occupants; the government ordered railway companies to medically inspect and hospitalize passengers, with force if necessary; the sick were segregated from the healthy; infected villages were isolated; and cordons sanitaires were established to stop the spread of plague in rural areas. All those measures had also been contemplated to fight cholera but had either never been dared or had been tested on only a small scale. The gigantic efforts that the government put into its antiplague campaign clearly overshadowed those earlier attempts to prevent or mitigate cholera. When it came to fighting plague, the government of India demonstrated the capabilities—and, by extension, the development—of the colonial state. The Indian backlash against these intrusive measures showed that the careful approach of the preceding decades had been sensible. The vast majority of the indigenous population was not ready to accept massive incursions into their daily life and culture. The ensuing conflicts only pushed cholera farther aside.60 The strong reaction to the plague epidemic allowed the medical profession in India to improve its position. Cholera had had a major impact; it had triggered short-term emergency measures, contributed to expensive infrastructure projects, and led to the establishment of a sanitary administration. Plague, however, was a more powerful actor. In combination with the new bacteriological and microbiological knowledge, the disease gave the IMS and its surgeons the leverage to elevate the institutional status of their specialty: tropical medicine. It also allowed IMS surgeons to acquire funds for research, therapy, and training on an unprecedented scale.61 Tropical medicine had existed since the mid-eighteenth century, but it was not a discipline with a well-defined subject, institutions, research agenda,

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or curriculum. Rather, it referred to the study of connections between a certain type of climate and its diseases, which few medical practitioners pursued in depth.62 The new tropical medicine, which arose in the late nineteenth century, combined this interest in diseases in distant and exotic countries with the sanitary and colonial civilizing missions, bacteriological and microbiological methods, and colonial political interests. Medical research would thus support the survival of European (and American) colonial empires and legitimize them by promoting efforts to alter the colonies for the good of the public health. To achieve this goal, schools of tropical medicine were established in imperial centers and increasingly in the colonies.63 In the late 1890s, medical research in India meant mainly plague research. The epidemic attracted research commissions from France, Germany, Russia, and Egypt. Their work once again exposed the lack of stateof-the-art laboratory facilities in India. An Indian plague commission established in 1898 that did no laboratory research but toured the colony for two years recommended a network of medical laboratories. Although this proposal was only partially implemented, the government of India was ready to spend more money for medical research in general and specifically to establish the Indian Research Fund Association in 1911. One result was the founding in Punjab of the Central Research Institute in Kasauli and the establishment of a regional research laboratory in Bombay and another in Guindy, just outside Madras. In order to staff these facilities, the government in 1905 established a bacteriology department in which medical officers received special training. Plague research was not the only area to profit from these new funds and open-mindedness; physicians working on malaria, kala-azar (leishmaniasis), and—to a lesser degree—cholera did as well.64 Bacteriology had given sanitary and medical authorities some new instruments to use in limiting the spread of cholera. The efficacy of wellestablished sanitary measures such as a safe water supply and good drainage could now be easily determined. The same was true regarding the introduction of cholera by migrants. The presence of cholera in the disease’s early stages had been a difficult diagnostic question for decades, but it was no longer a matter of guesswork and experience. With a rudimentary laboratory equipped with a microscope and some other materials, a scientist or surgeon could make the causative microorganism visible. That Leonard Rogers’s experiments with intravenous infusions made cholera a curable disease in 1908 further contributed to cholera’s diminished public profile. Ambivalence—confusion between epidemic and sporadic, common or Asi-

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atic cholera—had given way to clarity. Pilgrims could be vaccinated before they left home or after their arrival at the holy site. In case of an outbreak, wells, latrines, and sewers could be disinfected. Patients received intravenous saline solution and usually recovered. Thus, in the space of a decade or two, cholera had lost its century-old identity as a dreaded scourge.65 Cholera Persists in Madras, 1896–1910 What was true for India as a whole was also true for the city of Madras. Plague replaced cholera as the first disease to be discussed in the regularly released Sanitary Report, attracting the attention of the sanitary, municipal, and medical authorities to its mysterious etiology, its threat to trade, and its terrifying course. Yet, this shift did not indicate cholera’s absence from Madras from 1896 on. Continued Epidemics Between plague’s appearance and 1910 there were three years during which cholera took more than one thousand lives in the city of Madras. The worst year was 1905, when more than thirty-five hundred persons died of the disease, the most severe epidemic since 1875–76. Cholera was not restricted to those major epidemics, however. There were cholera cases every year. Many of them were isolated or clearly imported by migrants from the surrounding rural areas and provincial towns, but most years did not pass without an outbreak taking dozens or even several hundred lives.66 When it came to epidemics, quick action was still of utmost importance. Sometimes the medical personnel encountered the same problems their predecessors had four, six, or eight decades earlier. In 1901, they found themselves understaffed for the task of treating the sick and consequently overwhelmed. Cholera epidemics were thus still demanding times for the government and its medical staff, despite the improvements to medical infrastructure and a higher number of physicians practicing in the city. The existence of hospitals was a clear advantage, since they could be rededicated as exclusive cholera hospitals without much effort, as happened in 1905. The time of temporary hospitals was definitely past.67 Koch’s cholera theory was widely accepted in Madras by 1897, and the sanitary authorities were able to limit smaller outbreaks by disinfecting the water supply.68 The further spread of the disease could usually be restricted and thus a larger, more severe epidemic avoided. Bacteriological experiments by Koch and others had confirmed time and again that the comma bacillus was very sensitive to disinfectants under laboratory conditions, and the use of disinfection agents gradually became a standard practice.

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The availability of generally effective disinfectants, however, did not guarantee safe water either in the countryside or at Madras, as these disinfectants were only in use when cholera cases had already appeared. Even in the more important towns of the presidency many people still relied on wells that were easily contaminated, and minor epidemics could thus appear before the sanitary authorities could intervene. Even in the city of Madras such outbreaks occurred whenever water from the Red Hills reservoir was scarce. Then people were forced to resort to otherwise unused wells and tanks whose water was not monitored. The municipal authorities of Madras tried to limit the number of wells by closing off or filling in those that were not permanently in use.69 Bacteriological knowledge had changed the authorities’ perspective on epidemic cholera. Previous measures had focused on either treatment or prevention by altering the character of urban spaces, building sanitary infrastructure, and providing medical treatment. All of these approaches were still in use and, as in the case of disinfection, could be improved according to the most recent knowledge.70 But the authorities’ approach to fighting disease shifted to a focus on the general public. This shift encouraged the municipal authorities to give formerly discredited measures a second chance to fight cholera epidemics. Thus, they began to isolate the sick and establish “contact camps” for migrants coming into the city from areas where the disease was prevalent. These measures had been reintroduced to fight plague and had consequently gained official acceptance. They appeared to be an effective means of intercepting carriers of cholera germs. Koch’s theory had provided the necessary criteria to explain the epidemiology of the disease and identify how it had entered the city. If the water or cargo coming from outside was not contaminated, it had to be people transporting the comma bacillus to Madras, where the disease was not considered to be endemic. Cholera had to come from elsewhere, and, as its incubation time was rather short, isolation and segregation appeared to be effective means of protecting the permanent population from carriers. Ideally, every case of cholera called for investigation so that officials could identify the origin of the contamination. This did not mean that every sporadic case or minor outbreak could be fully reconstructed, but for the more severe epidemics the municipal authorities were confident they could find the source of the disease. In both 1901 and 1905, cholera came to Madras with migrants arriving in the city to seek work, food, or medical treatment. Within the city limits, the disease spread because of contacts between those migrants and the permanent population. In the case of the 1905 epidemic, the Native Infirmary to the north of the Black

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Town became the center of the epidemic; food was distributed there and the homeless flocked to the charitable institution. Apparently, the disease had spread from there. This pattern was deemed so obvious that in 1906 the municipal authorities urged the government not only to improve the sanitary infrastructure but to prevent the starving poor from coming to the city, as they were determined to be a serious threat to the permanent population.71 Sanitary Improvement at the Turn of the Century Given the regular occurrence of cholera and other preventable diseases, the sanitary infrastructure remained the most important responsibility of the sanitary officials at both the presidency and municipal levels. Between 1896 and 1910, drainage was expanded considerably. Mylapore was finally equipped with a system of sewers in 1899, and at the same time the municipality prepared an expansion to other towns. By 1905, southern Triplicane, Egmore, Chintadrepet, and Pariamettoo had state-of-the-art sewers. A renovation of the always contentious Black Town drainage system that had replaced the old canals with new concrete sewers was under consideration in 1900. Despite the extension of the system, the question of what to do with the sewage remained and the system of sewage farms was reformed. Those facilities located within the city limits were closed in 1905 and replaced by an extension of the existing farm at Cassimode. Despite the expansion of sewers, not all of Madras was properly drained. Much of the refuse still flowed into the Cooum or the water tanks. In 1902, two bacterial filters were installed to clean the discharge running into the river, but they hardly processed all of the filth.72 Despite the progress in drainage improvements, water supply upgrades were of paramount importance. The sanitary commissioners constantly tried to muster support from the government for an improved system. Of all the weak spots in the water supply system, the reservoir was the most blatant. It was too small to permanently supply Madras with sufficient water, while at the same time it was too large for permanent control and thus its contamination would endanger the whole city. After a thorough assessment of the situation in 1894, the government refused to provide the requested annual budget of 4,00,000 rupees (4 lakh rupees) for permanent improvement of water quality but did at least sanction 6,00,000 rupees (6 lakh rupees) for the removal of villages surrounding the Red Hills reservoir. Removing the villages would permit an increase in the water level while decreasing exposure to human sewage. Despite these efforts, cholera cases in the vicinity of the reservoir remained a concern. When

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an outbreak was reported from villages in the Red Hills region in 1900, “effective measures were promptly adopted to combat the epidemic and thus protect the Madras water-supply from contamination.” Even in the absence of actual disease outbreaks, water quality was always in question, as a municipal laboratory for a proper and constant bacteriological investigation was lacking until 1899. A contamination could be determined only once an epidemic had started, as an infestation of a water pipe with cholera bacilli proved in 1907. In this case, the consequence was only a minor outbreak, but the potential of a massive epidemic spread by the water supply was always a possibility.73 During the year 1901, Madras saw a cholera epidemic with more than eleven hundred casualties. This outbreak of a controllable disease once again triggered a complaint by a sanitary commissioner, who lamented the municipalities’ reluctance to spend the funds necessary for sanitary improvements all across the presidency. As the government did not compel the municipal commissioners to improve the infrastructure for the good of their citizens, they did “not think of appointing staffs until cholera is in their midst, and even then (in the interests of so-called economy), they allow these to be incomplete.” This neglect endangered the population, and Madras in particular had been lucky to have escaped a graver fate.74 Of course, such language had a long tradition among sanitarians at Madras. Criticism of government neglect and delay was as old as the idea of sanitation, and the urgent calls for reform had never really stopped. However, a new sense of frustration was palpable in such statements after Koch’s comma bacillus theory had been widely accepted by the Indian authorities. A long period of insecurity had been overcome and new means were available to finally achieve a satisfactory level of public health. Previous measures had brought some improvements, and a supply of clean water was the most successful one. Yet, only methods addressing bacteriological contamination promised cities free of contagious diseases. The germ theory had made more precise efforts possible, and progress seemed to be no longer a matter of decades but of years or months—if only the appropriate resources would be provided. The goal should have been within the municipal sanitary authorities’ reach, yet it still appeared to be beyond their grasp, as cholera continued to be present in the city. Bacteriology and Quarantine, Quebec 1885–1918 While cholera was, despite its lower profile, a regular occurrence in Madras that still posed a formidable challenge to public health officials, in Quebec it was a quickly fading memory of past disasters. With a sanitary infra-

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structure in place, the city could expect a future free of the dreaded disease, were it not for the yearly arrival of emigrants who increasingly came not from the British Isles but from Eastern Europe and the Mediterranean region—areas that had a reputation for unsanitary lifestyles and were prone to cholera. For most residents of Quebec, that notoriety was little more than a recurring xenophobic resentment shared with other Canadians, but for quarantine officials it was a practical problem and a tangible threat. Improving Quarantine Practices, 1885–1890 As the 1883 cholera epidemic in Egypt passed without spreading to Britain, so did the attentiveness of the Canadian public. However, at least one man continued to follow the news on cholera that still came from Europe: Frederick Montizambert, the medical superintendent of the Grosse Île quarantine station. Even after the cholera-free shipping season of 1884, he was well aware that the disease was still present in Europe, especially on the shores of the Mediterranean. Thus, he once again conveyed his suggestions for how to improve the quarantine procedures at Grosse Île to the government at Ottawa, which reacted by proclaiming quarantine for all ships coming from the Mediterranean, Spain, and London. To be able to react to a further spread of the disease, the Department of Agriculture urged the Colonial Office in London to order its consuls around the world to report local cholera epidemics by telegraph to Ottawa. But apparently even the resources of the British Empire did not suffice to establish a global information system for cholera news. With the rise in railway traffic, epidemic diseases south of the border became an ever-increasing threat. Cholera could land at New York or other American ports on the East Coast and travel to Canada in a matter of hours. The government introduced a cooperative effort with the “United States Health Authorities for immediate mutual communication respecting any outbreak of cholera in any part of the United States of America or the Dominion of Canada respectively.”75 However, even more interesting for Montizambert than the persistence of cholera in Europe was Koch’s announcement that he had identified a germ responsible for the disease. Now Montizambert knew what he was looking for, and he could pressure the government for further improvements.76 The Canadian government still relied on the memorandum on cholera from 1866 as the foundation of its policy. For Montizambert, it was the starting point from which he would work to change the federal government’s attitude toward the disease. Montizambert began by sending a presentment on cholera precautions to a grand jury in Quebec in June 1885, only a few days after quarantine

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had again been declared due to cholera’s presence in Spain. In his document, Montizambert expressed wholehearted support for Koch’s germ theory of cholera causation; he did not allow even the possibility that Koch’s conclusions could have been premature. He did not mention any official British refutation of the theory. On the contrary, he did not allude to British political interests at all. Montizambert’s only point of reference for his presentment was the results of the National Health Conference in Washington and unspecified “other sanitary boards,” which he reported in their entirety.77 Montizambert’s recommendations went beyond his own responsibility for quarantine at Grosse Île, also covering the precautions to be undertaken by municipalities and individuals. He emphasized the importance of securing the water supply and ensuring the proper functioning of sewers as well as privy vaults. Only then would it be possible to disinfect the water supply effectively when cholera was present. Accompanying measures would prevent the accumulation of filth and garbage or ensure their removal, survey the food brought to markets, promote personal cleanliness, and immediately inform the responsible authorities of every cholera case. Although the influence of germ theory on the development of sanitary measures concerning water and sewage is discernible, the new approach for preventing cholera’s further spread privileged disinfectants. The proposed disinfectants, bichloride of mercury and permanganate of potash for water and “sulfurous acid gas” for fumigation, had been tested in a laboratory by experts in bacteriology (two professors from Baltimore and the health commissioner of Brooklyn) and found to act as “an efficient germicide.” If bacteriological knowledge had reinforced some of the established practices concerning the use of disinfectants, it had reinvigorated an old field of sanitary thinking. Disinfection had been a popular measure in Quebec in the 1830s and 1840s, yet it had lost most of its appeal with the introduction of water supply and sewage systems. Its effectiveness had been tied to the presence of filth in the streets and the prevalence of cholera at certain places. Due to modern laboratory experiments, its practical use could be expanded and the most efficient disinfectants could be scientifically identified.78 Montizambert’s belief in the germ theory of cholera and other diseases was further strengthened when he accompanied the minister of agriculture to the annual congress of the American Public Health Association (APHA) in Washington. There he listened to presentations about quarantine based on a bacteriological understanding of “maritime sanitation.” Disinfection would become the main means of preventing contagion, not isolation and

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detention. American public health authorities had long been skeptical about the Canadian quarantine efforts at Grosse Île and elsewhere. This criticism was expressed again at the APHA conference, yet Montizambert could not endorse it despite his own misgivings, as he was there in an official capacity. However, his subsequent recommendations on how to improve quarantine at Grosse Île closely followed the proposals made at the conference.79 Montizambert’s criticism of quarantine was not a lone voice in Canada. Many concerned physicians there were also members of the APHA, as no comparable organization existed in their own country. The arrival of bacteriology in Canada occurred at a time when public health was gaining more traction. Several provinces, including Ontario, had passed strict public health laws, and medical schools began to offer degrees in public health. The pressure on the Canadian government from the United States and from within Canada began to mount, as municipalities and provinces increasingly created posts for young physicians with an education in public health. Thus, Montizambert’s proposal to reform quarantine procedures and regulations reflected the new pressures being exerted by this emerging profession. Montizambert’s cause was also strengthened by a severe epidemic of smallpox in Montreal that alarmed the federal government. In August 1886, new quarantine regulations were passed that required the inspection of all incoming vessels and the vaccination of all passengers and crew members. During the following years the quarantine infrastructure at Grosse Île was adapted to meet these new requirements. A hospital with a hundred beds, as well as separate sheds for smallpox and cholera cases, was in operation by 1892. The station provided accommodation for up to two thousand healthy passengers and was equipped with bathhouses, hot-air forges, fumigating rooms, and a steam-disinfecting house. A steam yacht, the Hygeia, was acquired to both facilitate inspection and to disinfect the interior of ships with hot steam. These improvements earned Montizambert the respect of public health experts in Europe and North America and propelled him to the presidency of the APHA in 1891.80 While cholera had helped draw attention to public health at the federal level during the 1880s, the local sanitary authorities in Quebec City hardly gave it a thought. The reforms affecting local public health during the decade, including the creation of a new board of health and the employment of a health officer, were unrelated to cholera.81 When J. M. MacKay, a physician and chemist, offered to supply the city with the best disinfectants and then invoked the terror of the present cholera epidemic in Spain and Austria, as well as the proven effectiveness of the chemicals used in

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Indian cities and towns such as Bombay and Kanchipuram, his proposal was ignored.82 Among the public health issues of concern to Quebec City officials, cholera no longer made the cut. Introducing Bacteriology Despite Montizambert’s openness to bacteriological theories, the new discipline took some time to gain a foothold in Quebec. In order to acquire practical skills for studying bacteria, physicians had to travel to Europe. From the 1890s on, young physicians took opportunities to complete their education with training in bacteriology. Francophone Quebecois tended to go to Paris and take courses at the famous Pasteur Institute, while anglophones preferred Britain or Germany for their studies. Upon their return to Canada, many of them put their training to good use by working in the few existing laboratories or by establishing new ones. Most of these institutions were attached to the province’s medical schools, which quickly introduced bacteriological training. Yet, the arrival of bacteriology was not unopposed. Like elsewhere, medicine conducted mainly in the laboratory found its detractors among the established members of the profession, who emphasized the importance of the relationship to the patient. Nonetheless, bacteriology quickly became an indispensable aspect of medicine in Quebec. This was due in no small part to the prophylactic and diagnostic successes of efforts based on bacteriology. The sera against such diseases as diphtheria or tetanus were in high demand and had to be produced in local laboratories, while blood tests and other forms of bacteriological analysis were introduced in the province’s hospitals. The more important ones established their own laboratories from 1900 on, as did the municipalities of Montreal and Quebec City.83 Since cholera was not present in Quebec, it played no role in the institutionalization of bacteriology in the province, but it allowed those responsible for quarantine to keep better track of the disease and to press for the improvement of quarantine procedures. While the authorities at Quebec were confident enough to neglect cholera’s movements around the world, the ever-vigilant Frederick Montizambert informed his superiors at the Department of Agriculture whenever he felt that cholera had reached striking distance. He received the news of the disease’s appearances not exclusively from London or through other imperial channels but also from the United States, where he was well connected. When the American authorities were preparing for a possible introduction of cholera in 1890, he also alerted Ottawa. Increasingly, news of American efforts to fend off another invasion of the disease became a useful means for Montizambert

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and others in Canada to keep quarantine in the minds of the federal government. As American states on the Great Lakes such as Michigan and Illinois threatened land quarantine against people and goods coming from Canada in case cholera appeared north of the border, there was also an economic incentive to increase the capabilities of quarantine at Grosse Île and elsewhere.84 Generally, however, the federal government was not too concerned. Public health was not one of its primary responsibilities, and even within the Department of Agriculture it was only a marginal issue. The officials there were satisfied with the reforms of the previous decade and quickly turned to Montizambert to counter any public criticism of the existing conditions at Grosse Île despite his internal misgivings.85 Because the federal government was rather uninterested and the jurisdiction of local boards of health was limited, it was the provincial government’s opportunity to provide for a permanent sanitation infrastructure. After a devastating smallpox epidemic in 1885, the provincial government established the permanent Provincial Board of Health one year later. Its main purpose was the prevention of epidemics, and from 1888 onward it had the power to enforce the establishment of local boards of health even against the wishes of a municipality. However, the main responsibility for public health remained at the local level. The provincial board provided public health standards, and it controlled and advised the local boards, which had to implement the standards.86 If the local authorities failed to satisfy the expectations of the provincial authorities, the latter could exert pressure to force an investigation, as was the case between 1889 and 1891 in Quebec City, when a typhoid epidemic exposed sanitary deficiencies. The local boards reported locally collected vital statistics as well as outbreaks of epidemic disease to the provincial board, forming a permanent information system dedicated to detecting the presence of epidemic disease in the province.87 It is hardly surprising that in July 1892, when cholera was ravaging Europe and rumors were swirling around that it had already spread to Michigan and even British Columbia, the Provincial Board of Health weighed in. However, it was not the only board to do so. The Quebec City Board of Trade also urged the federal authorities to enforce stricter quarantine and sanitary measures in order to avoid an epidemic that would in the end be far more expensive than the mere thousands of dollars necessary for improvements at Grosse Île. Remarkably, the disturbance of trade that would invariably ensue from stricter quarantine was not an issue in the request.88 The Board of Trade apparently regarded a cholera epidemic as very likely, and at this point its probable consequences in terms of higher taxes or

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levies and possibly delays due to quarantine inspections were clearly less important than the consequences of an outbreak. If American public health authorities closed the borders completely, the result would apparently be considered more harmful than bothersome preventive measures. The Provincial Board of Health called for the same quarantine and sanitary measures. In July, it urged the Department of Agriculture to enhance its quarantine efforts at Grosse Île in order to appropriately protect the province. It did not regard the introduction of cholera from abroad as a distant possibility but assumed that cholera would in all likelihood reach Canada. The Board of Health called for a thorough investigation of incoming vessels, cargo, passengers, and their luggage in order to stop the disease at Grosse Île. Before the government issued an official reply, it received news on 27 August that the president of the United States had stopped all immigration for as long as cholera was present in Europe. This move prompted a strong reaction from the Provincial Board of Health. It issued a list of demands that included an eight-day quarantine for all ships coming from infected ports, a twenty-day quarantine for ships with cholera on board during passage, the distribution of the names of all passengers who arrived on cholera ships, and the appointment of a medical officer for the ports of Montreal and Quebec City.89 Only two days earlier the government had learned that cholera had broken out at Hamburg, one of the most important ports of departure for immigrants coming to Canada from central Europe. Cholera thus began to receive more than casual attention. While the quarantine officer at Grosse Île and the Provincial Board of Health were observing the United States’ reaction to the renewed threat, the federal government was still awaiting directions from London and, in the meantime, studying newspaper clippings covering the correspondence of the British government with the Royal College of Physicians.90 It was not until cholera was reported to have reached New York that the government finally took action by extending quarantine to the inland border and making customs officers responsible for its implementation.91 This makeshift arrangement was little more than window dressing, and it was certainly perceived as such by the provincial and local institutions responsible for the maintenance of public health. The Provincial Board of Health was certainly more concerned and active than the federal government, although it could do little more than urge others to act. As soon as the news of the cholera outbreak had reached the board, its secretary, Elzéar Pelletier, sent a barrage of letters to those concerned. He immediately informed the federal government that the board considered the quarantine station on Grosse Île insufficient to pro-

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tect the province from an invasion of cholera. Pelletier also asked the municipal physician of Quebec to pressure the federal government to appoint a properly qualified port physician. Two days later he sent to the municipal physicians of Quebec, Montreal, and Trois Rivières a list of criteria that would help those municipal officials to determine whether their towns were prepared for a cholera epidemic. The items on the list included an ambulance for quick transport of patients, a location for isolating patients, a means of disinfecting luggage, and a clean, hygienic urban space. To underscore the urgency of his request, Pelletier stressed the imminence of a cholera outbreak.92 After the Provincial Board of Health had taken care of the municipalities, it turned its attention to quarantine and immigration. As both areas fell under the federal government’s area of responsibilities, the board had to address the provincial authorities to convey its demands and recommendations. Among them were the already mentioned stricter quarantine regulations and a moratorium on immigration and the import of rags from European, African, or Asian countries. There were only a few things the provincial board could do without interfering with other administrative bodies’ responsibilities. It issued a pamphlet titled How to Prevent and Oppose Cholera and distributed them to municipalities and newspapers in order to inform and prepare the public. It also ordered those municipalities that had not yet established a board of health to do so. These steps were all the board could do beyond hoping that the offices at the federal and local levels would do what had been recommended.93 The federal government, however, chose by and large to ignore the urgent appeals by the Provincial Board of Health. As the constitutional responsibility for public health was split between the provincial and the federal levels, the board felt emboldened by this inactivity and set out to test those boundaries. In fact, the British North America Act had clearly put only quarantine and marine hospitals in the domain of the federal government. All other aspects, as well as the promotion of immigration, were in the purview of the provincial government. This constitutional authority gave the Provincial Board of Health the confidence to act without the consent of the federal government, as long as there was a connection to the issues of general public health and immigration. The board followed the American precedent and imposed a moratorium on immigration, arguing that whenever cholera was raging in Europe the influx of immigrants represented a threat to public health. The board’s actions triggered a clash between the provincial and federal governments over the constitutional relations between the two levels of government.94

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However, a ban on immigration, as well as other anticholera measures, had to be enforced at the local level, and the provincial board lacked the necessary resources to do so. It had to look for allies elsewhere, and it found them in the city of Quebec. There, the still rather newly reconstituted Board of Health was the agency primarily involved in dealing with cholera, which was now perceived as a credible threat. As the municipality of Quebec was not responsible for enforcing quarantine, there was little it could do on its own to prevent the disease from coming into the city. As usual, city officials immediately focused on improvement of the sanitary condition of the city. The markets in particular were not as sanitary as they were supposed to be. Since the sole health officer claimed to be overburdened and therefore incapable of ensuring the pristine condition of the markets, the Quebec City Board of Health recommended employing a second officer. But there were also some minor defects in the sanitary infrastructure, like the sewers, that deserved the officials’ attention.95 These preventive measures were put into effect along with one fundamental improvement in the medical infrastructure. Since 1891, the municipality had maintained in the Palais neighborhood a civic hospital, with twenty beds, that was primarily intended for the isolation and treatment of diphtheria patients. Previous attempts by the federal Marine Department to sell the old Marine Hospital to the municipality for this purpose had failed due to the high price and the poor condition of the building. In the end the Marine Hospital was acquired by the religious order of the Daughters of Charity, which turned it into a hospice. The municipality bought an old, inadequate building that was next to the morgue and required additional funds of ten thousand dollars for repairs before it could be used as the new Civic Hospital. The Civic Hospital was an improvement over the previous situation, as there had been no publicly funded hospital for the permanent population. It was relatively well equipped and could easily be turned into a cholera hospital if necessary.96 Nonetheless, the means of the municipal authorities remained limited. In cooperation with the provincial board, however, there were more opportunities to act and overcome the inaction of the federal authorities. Both the provincial and the local health boards set up a provisional quarantine station on the Louise pier in the port to screen suspected cases of disease and send affected ships back to Grosse Île.97 Cholera did not come to Canada in 1892, but it remained a threat. The federal government remained torn between the British and American approaches to anticholera measures, as it kept receiving and reviewing the regulations employed in those countries. In February 1893, news of Haffkine’s cholera vaccine

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came in without much of a reaction. The municipality of Quebec, however, invested in its own capability to fend off epidemic disease.98 In January 1893, the local Board of Health considered an expansion of the Civic Hospital and the acquisition of a steam disinfector. Similar disinfectors run by the federal quarantine authorities were in operation at Grosse Île and in the port. The city’s civil engineer had designed plans for a stationary apparatus that would use steam to kill germs in luggage and clothing. The board published in several newspapers a request for bids to build the disinfector in February 1893 and received several offers. In the end the contract was awarded to the company that had already built the apparatuses in operation at Grosse Île and in the port. Construction proceeded slowly, and the disinfector would not be put into operation until the summer of 1894, a year too late for the 1893 shipping season.99 In May 1893, just after the seasonal start of navigation to and from Quebec City, the mayor once again tried to mobilize the public in an effort to bring the urban space into a sufficiently sanitary condition. Once again, everyone had to contribute by personally observing the bylaws on public health.100 This public appeal to fend off cholera was the last of its kind. Although there was a small alarm in 1910 initiated by a cautionary report of the Health Committee, cholera ceased to be perceived as a credible threat to public health.101 In retrospect, Canada seemed to have moved away from the disease, as if the Atlantic Ocean, that unreliable barrier, had widened. To some extent this was true. Cholera rarely appeared in Europe and the Mediterranean region after 1900. Yet, this drop in the number of cases did not mean that cholera had disappeared from the face of the earth. It continued to beset India, causing death and despair. From there the disease still spread to East and Southeast Asia, to East Africa and the Middle East, despite all sanitary and medical efforts. Cholera’s Legacy in Quebec and Madras Bacteriology comprehensively changed the understanding of cholera. After Koch’s theory was generally accepted in 1894, the disease had lost most of its power to effect change. The age of cholera pandemics was not over, however, and the disease remains a threat to the poor of some parts of the world to this day. Still, cholera no longer haunted the imagination as it had when millions saw it as an immense threat to their lives and dignity. Cholera had lost its terrifying air of mystery. An identifiable microorganism had replaced the invisible miasmas, the enigmatic emanations, the complex combinations of environmental influences, and the deadly poisons that had been suspected as the cause of the disease. The comma bacillus could be ob-

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served, even if only with the help of a microscope. Environmental proxies for the mysterious disease, such as filth, stench, and the condition of soil and atmosphere, lost their significance as markers heralding the impending outbreak of disease. This new knowledge about cholera’s etiology was at first slow to affect the approaches used to fight the disease. Bacteriology promised control both by enabling the development of a vaccine and by allowing the sanitarians to fine-tune their methods according to the characteristics of the comma bacillus. In order to fulfill this promise, new infrastructure was necessary, and both in Madras and in Quebec City authorities were slow to provide it. To become experienced in bacteriology required practical training in an existing laboratory under the supervision of an experienced scientist. It took time for prospective bacteriologists to go to Europe, acquire the necessary skills, and find the funds to set up a laboratory. The effects of bacteriology on the fight against cholera in Madras and in Quebec were quite different. For Quebec, both sanitation and bacteriology came too late for the outbreaks that occurred there. No cholera epidemics struck the city after 1854, so the usefulness of those new tools for fighting this particular disease could not be proven. Nevertheless, the disease remained a recurring threat. Whenever cholera was present in Europe, a reintroduction in Quebec was a realistic possibility. The central means to prevent such an event was the quarantine station on Grosse Île. As the station was under the authority of the Canadian federal government from 1867 on, the responsibility for the fight against cholera shifted from the municipal and provincial levels to the federal level. If cholera was observed in distant parts of the world, then local officials had to anticipate the possibility of an epidemic. The Canadian authorities used the British Empire as an information system to relate news of cholera cases elsewhere. This source of data was increasingly complemented by information from quarantine officers who had personal contacts in the United States, which slowly replaced Britain as the reference point regarding public health. At the time of the last significant cholera scare, in 1893–94, bacteriology had barely arrived in the province. There was no laboratory on Grosse Île to examine the incoming ships and their passengers or cargo. If cholera had come then, the authorities at the quarantine station would have known that a microorganism caused the disease but would have had no means to identify it. Their position was not much different than it had been in previous epidemics. As they could not have identified carriers of the disease, quarantine would have been conducted along established lines: isolation of the sick, detention of new arrivals for a certain time, and disinfection of

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bodies, clothes, luggage, cargo, and ships. Bacteriology would have contributed only to the last of these measures, as the efficacy of disinfectants had been tested in laboratories elsewhere. In Madras, cholera remained a constant presence regardless of bacteriological knowledge. Epidemics continued to occur, and while their scale was not much smaller than in previous decades they were no longer perceived as a threat to British rule over India. Cholera had not been defeated, but it had been tamed. Whenever necessary, it could be controlled, either through the vaccination of colonial officials, troops, and pilgrims or by making sources of drinking water safe through disinfection. With bacteriology, Western medicine had gained a definitive advantage over Indian medicine in the eyes of the colonial authorities. The new science had explained an old mystery. Claims of scientific superiority had finally been substantiated. The anticholera measures derived from bacteriological research had demonstrated this scientific advantage to the colonial public, allowing the control of cholera outbreaks and limiting the scope of epidemics. Fewer people would be affected, the potential for panic would be curtailed, less misery would ensue, and people would have fewer grievances against the colonial government. Although there were many instances when the Indian population resisted the implementation of anticholera measures, there appeared to be little threat to British rule in the short term, and colonial officials believed that over the long run the benefits of such measures would be obvious to everyone. By demonstrating the advantages of colonial rule, bacteriology became an agent for the civilizing mission, just as sanitarianism had been before. Thus, bacteriology had profoundly changed attitudes toward cholera and altered the configuration of the urban space, as well as the importance of the actors required to control it. Building on the comprehensive alteration of the environment through sanitary infrastructure, bacteriology eliminated the underlying uncertainties regarding the causative or predisposing environmental features. Despite Edwin Chadwick and Thomas Southwood Smith’s attempt to define the emanations of filth as the sole cause of cholera and many other diseases, this assumption never gained universal acceptance and in time lost its credibility. Because bacteriology had identified microorganisms as the specific cause of diseases, it gave the sanitary movement a new direction in which to pursue its old purpose. With the identification of pathogenic bacteria, only one characteristic of the environment had been tied to the presence of certain diseases. Each germ had a certain habitat that could be limited or even destroyed. Hence, sanitary measures could be designed to do exactly

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that. Heat and disinfectants featured prominently for spaces outside the human body, and immunization for the spaces inside. The knowledge of the specific germ as the cause of a disease allowed bacteriologists to identify and develop new actors that would control disease. These measures could and sometimes had to be as specific as the microorganisms that caused disease. What allowed bacteriology to be so specific was the laboratory. It was a confined space that could reproduce different environments. The sanitarians had to observe the whole city in all its complexity to find clues about cholera’s character. The bacteriologists could exclude certain environmental factors and manipulate others in their laboratories. They could observe the microorganisms under environmental conditions that allowed them to flourish as well as under those that killed them. The laboratory allowed scientists to redefine what cholera was by deciphering the life cycle, strengths, and weaknesses of the comma bacillus and consequently those of the disease. Thus, the laboratory became a new kind of enclave. As a special environment for research, it was separate from the outside world. It was a place of observation, like the dispensaries had been in Madras during the 1818–19 epidemic, yet the methods had changed. The dispensaries had been outposts of European medicine in Indian neighborhoods. There the surgeons could learn more about cholera in Indian bodies and the Indian parts of the city. The dispensaries had been colonial enclaves, which represented the colonial hierarchy, but they were to some extent permeable for Indians. The laboratory was no less a colonial enclave than the dispensary had been eight or nine decades before. It was a confined space in which European superiority was ensured and demonstrated. In the laboratory, the colony and its environment could be dissected and manipulated. Its complexity could be reduced by dividing it into small pieces that were studied bit by bit. The laboratory allowed the scientists to widen the gulf of power between the authorities and those in the outside world. The colonial enclave of the laboratory served the analysis and control of the colonial environment. Equipped with their new knowledge of cholera, the bacteriologists could then leave the laboratory and demonstrate the benefits of their research to the outside world. Once an environment was free of the disease, only a new invasion could reintroduce it. This did not require changing the whole urban environment but finding those specific points of passage where the microorganisms were most vulnerable. By means of filters, disinfectants, and quarantine for migrants, the influx of cholera germs could be controlled. Thus, bacteriological measures against cholera involved environmental alteration—the same approach used by sanitarians. The com-

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ma bacilli that caused cholera were a feature of the local environment just like the miasmas and emanations that the sanitarians believed were responsible for disease. Thus, the reason for cholera epidemics could still be found in the environment. What had changed was the perspective on the urban environment and the approach to altering it. Both had become specific instead of holistic. The urban environment was still the place where cholera epidemics were fought and prevented, yet it was unnecessary to change the environment comprehensively for a second time. If a sanitary infrastructure was in place, as it was in Quebec City and to some extent in Madras, only minor interventions were necessary at certain and well-chosen places in order to control cholera. Thus, quarantine for migrants was introduced for the first time in Madras, and it was reinvigorated in Quebec due to the efforts of Montizambert. Filters were installed in the water supply systems of both cities to ensure the purity of the water, and disinfection became a continuous and effective means of dealing with pathogenic microorganisms of all kinds. The arrival of bacteriology coincided with a general expansion of medical services in both Madras and Quebec City, reinforcing the processes of medicalization and professionalization. One result was an increase in the number of physicians and medical institutions, including hospitals. In consequence, medical care became more accessible for patients, while medical practitioners also had access to more people. Bacteriology was not the cause of this expansion, but it did accelerate the process. Medicine as a profession gained unprecedented prestige due to the discovery of pathogenic microorganisms and new vaccines. If the profession wanted to reap the benefits of its new prestige, it had to be quick to do so, and it did. Since the use of bacteriology to fight disease did not require comprehensive changes but only efforts at certain passage points, local populations became a focus in the battle against disease. Physicians had to test blood, urine, milk, and other fluids to see if evidence of disease was clearly discernible and to determine whether symptoms would appear in the near future. The advent of bacteriology meant that officials no longer tried to change the population’s behavior to make it suitable for a sanitarily improved yet still dangerous environment. Instead, the authorities tried to make the environment safe by intervening on a microscopic level, thus taking the behavior of the population out of the equation that determined health and disease.

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Conclusion The Colonial State and the Elusive Consensus Regarding Cholera

The Spanish influenza epidemic of 1918–19 put an end to the bacteriological promise of control over infectious disease. Spreading across the globe in three waves, the second being the most deadly, it turned out to be one of the most lethal pandemics in history. Millions succumbed, if not to influenza itself then to complications like pneumonia; many more were infected but eventually recovered.1 Physicians and public health officials were confronted with an enormous number of cases of a normally rather benign disease that had now appeared in an extraordinarily deadly form. Medical treatment focused mainly on alleviating the symptoms and keeping the patient well fed and hydrated. The German bacteriologist Richard Pfeiffer had declared in 1893 that he had identified a bacillus that caused influenza, and, despite some doubts, Pfeiffer’s bacillus quickly became widely regarded as the sole cause of influenza, thus prompting scientists to hope they could develop a vaccine. Spanish influenza hastened these efforts, although without any discernible success. The first wave of influenza reached both Madras and Quebec in July 1918, resulting in a spike of cases without drawing the public’s attention. Only the arrival of the second wave, beginning in Madras in late September and in Quebec City in early October 1918, and the rapidly climbing numbers of cases and deaths prompted public health authorities to spring into action. In both cities, the crisis forced officials to improvise and resort

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to measures that resembled those employed during earlier cholera epidemics. They informed the public about the symptoms of the disease, expanded the capacities for treatment by opening temporary hospitals and sending medical students or nurses to the homes of patients in order to distribute remedies, and registered cases and deaths. None of these efforts appeared to be to any avail, as influenza left as quickly as it had come. By early November, the epidemics in both cities were in steep decline. Medicine had once again been more or less helpless, and even the new and promising bacteriology-based methods such as immunization and disinfection seemed to have had no discernible effect. In the city of Madras, officials recorded 3,417 deaths, although the sanitary commissioner remarked that deaths from influenza had also been registered under “fever,” “respiratory diseases,” or “other causes.” Thus, the actual number of cases was likely to be considerably higher. Quebec City had suffered less, counting 481 lives lost to the disease.2 As ephemeral—and formidable—as the 1918–19 influenza epidemic turned out to be, it raised the same questions for the local authorities that cholera had during the first epidemics in Madras and Quebec City. Despite a century of adjustments, investments, and research that had been perceived as unqualified progress, influenza had overwhelmed the medical infrastructure and had posed questions that medical science had been unable to answer. The challenge of influenza was perhaps even more devastating, despite the brevity of the pandemic, as it had foiled the optimism fostered by the successes of bacteriology. Science had promised if not to end all disease then at least to demystify it and propose ways of preventing it, either by means of immunization or by practical advice. Influenza, however, had blatantly defied all these efforts. It appeared to run its course despite all countermeasures, reaching its peak and abating according to its own rules and not those of the medical and public health experts who had tried to restrain it by isolation, disinfection, or vaccination. Sanitation and bacteriology had been lauded for containing and demystifying cholera. Despite all the open questions that remained, especially in India, where the disease continued to resist all efforts at complete control, medicine had succeeded in banishing cholera to the margins, and the loss of public attention to its whereabouts was a testament to this change. The problem of cholera appeared to have been solved. Influenza, however, was a powerful reminder of how fragile these past successes were, how quickly the newly won certainty of sustained public health was lost, and how little had changed. In the wake of Spanish influenza—after bacteriology’s failure to stop or

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COnclusion

even explain the pandemic—the complexities of the environment returned as an explanation of epidemic disease. This revisiting of the environmental focus was not entirely due to the deadly influenza. Other epidemic diseases, such as cerebrospinal meningitis, poliomyelitis, and encephalitis lethargica, contributed to this development. None of these illnesses could be explained by bacteriological methods, and the classic means of sanitary improvement—sewers and water works—did nothing to prevent them. It had been impossible to identify pathogenic microorganisms that caused those diseases, and the pattern of their epidemics did not fit the bacteriological theory of disease. This discrepancy gave a boost to epidemiologists who had been skeptical of bacteriology’s explanations and promises but felt overwhelmed by its successes. They reintroduced the concept of multicausality that Robert Koch had fought against so ferociously. Apparently, more factors than the presence of a pathogenic microorganism with sufficient strength were necessary to start an epidemic. Although multicausality did not make a straightforward comeback, it helped shape the concept of an equilibrium between pathogen and host as a compromise between bacteriologists and epidemiologists. If this equilibrium was off balance, epidemics broke out. The factors that could cause an epidemic were manifold, and thus the etiologies of disease again became complex conglomerates. Each pathogen had its own ecology and depended on a multitude of environmental factors. In order to understand the outbreak of epidemic disease, scientists no longer had to look out for an invasion of germs but to notice changes in the local pathogenic ecology.3 This shift is evident in Clifford Allchin Gill’s The Genesis of Epidemics and the Natural History of Disease, published in 1928, which featured a chapter on the recent influenza epidemic and used Punjab as a case study.4 His account of the epidemic focused mainly on environmental and social factors, such as atmospheric temperature, altitude, population size and density, and economic conditions, although race was also taken into consideration. He concluded that influenza had cost more lives in rural than in urban Punjab. Race, social factors, and economic conditions could not explain this result. He concluded “that the atmospheric conditions prevailing in the heart of great cities, by reason of their unfavourable influence upon the transmission of infection, may be the paramount factor in determining the relatively low influenza death rate of urban areas. . . . May it not be . . . that the artificial conditions created by an urban environment, under the climatic conditions prevailing in the Punjab, are associated with atmospheric states which are relatively unfavourable to the transmission of infection?”5 This passage sounds astonishingly similar to treatises on cholera written in

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the mid-nineteenth century, although the effects of the urban environment had been reversed. One hundred years after the first cholera pandemic, and forty-five years after Koch’s monocausal bacteriological theory, epidemics were again seen as the products of complex environmental phenomena. Despite the enormous magnitude of influenza’s mortality and morbidity and although the disease had caused much more death and sorrow than the cholera pandemics of the first half of the nineteenth century, the influenza pandemic was quickly forgotten. Influenza had left its mark in burial grounds around the world but not in the minds of the people who survived it. Whatever the reason for this collective amnesia might be, the pandemic’s feeble resonance among people of the time is nonetheless remarkable. Cholera’s impact was the opposite. Although mortality from cholera had been substantial throughout the century, it did not exceed that of other epidemic diseases, yet it took hold of the public imagination. Its symptoms were as dreaded as its high mortality rate, because cholera not only killed but degraded its victim. For almost a century it had been a powerful actor that triggered or even enforced change. Cholera did not even have to be present in a certain location to prompt change; just the possibility of its appearance was enough to set off the alarms and for the authorities to spring into action. This phenomenon can be observed most clearly in the Quebec City cholera scares when the presence of cholera in Britain or even the Mediterranean region was enough to cause grave concern among the responsible authorities in Ottawa, Quebec City, and Grosse Île. In those situations, the authorities were looking for solutions to a problem that might not occur and, indeed, did not materialize, but previous cholera epidemics had shown that precautions were warranted. Cholera’s hold over the public’s imagination found many expressions. It had the power to alter the spaces in which it was present, as well as observers’ perception of them. Daily occurrences suddenly turned into palpable and potentially lethal threats and therefore became public matters. Certain neighborhoods, streets, or houses were singled out as dangerous. Residents’ mental map of their cities changed. The authorities instigated, supported, and had to deal with the consequences of these changed perceptions. They had stimulated public imagination with their vivid accounts of cholera’s horrific symptoms and mysterious origin when they informed the population of impending cholera epidemics, partly to raise awareness, partly to motivate residents to cooperate in the fight against the disease. Once the threat materialized, the authorities had identified harmful locations, thus singling out and stigmatizing mostly spaces that were inhabited by the poor. To limit the ensuing panic, they then had to calm the public

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by, for example, pointing to the predisposing effects of fear. For all these measures, the authorities relied on medical experts. During an outbreak, the medical profession was quickly overwhelmed by the challenge, and not just because of the number of patients seeking care. Medical practitioners in India, Canada, Europe, and elsewhere offered up a cacophony of opinions, theories, and practices. Cholera was the subject of a seemingly infinite number of treatises, leaflets, advertisements, memoranda, and other texts that tried to explain and define what cholera, in its numerous permutations, really was, but in the minds of contemporary officials, medical experts, or the population it nevertheless remained poorly defined, unpredictable, and mysterious. With the attempts to decipher the “character” of the disease, all efforts to develop a reliable treatment and prophylaxis failed sooner or later for almost a century, though some were more successful than others. The sanitary movement, the sanitary conferences, and bacteriology each achieved some degree of general agreement regarding cholera on which an official response to the disease could be based. Yet, what made such efforts more effective in prompting change was not inherent scientific or medical superiority. Eventually, all the medical theories of cholera that informed those three areas of consensus came under pressure. What enabled them to effect change and made them stand out amid the confusing chaos of opinions on cholera was the agreement on a cholera theory that itself reduced cholera’s complexity and presented an attractive agenda that might feasibly be implemented. The medical theory on which sanitarianism was based was so simplistic that most medical practitioners of the time rejected it outright. That most diseases could have only one cause—miasmas—seemed to contradict both tradition and experience. Yet, this simplistic, monocausal theory became the foundation of a social movement that effected change in many parts of the world for decades. This movement was possible because the first sanitarians proposed not a medical but a technical solution to social problems, which were the result of industrialization, urbanization, and population growth. They forged a political consensus that was supposed to alter the urban environment comprehensively without changing the political status quo. The simplicity of the sanitarians’ cholera theory allowed laypersons to get involved with the sanitary movement and also gave a permanent role to experts, including medical practitioners and engineers. Most governments proved to be quite willing to invest in sanitary infrastructures for humanitarian or long-term economic reasons, as well as to reform their most troublesome subjects. The epidemiological consensus that informed the decisions of the sanitary conferences of the 1860s and 1870s worked in a

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similar way. Most European powers came to agree that cholera had become a problem that could be solved only on an international level. Thus, they forced Great Britain to accept an international regimen that was based on the common epidemiological assumption that cholera originated in India and that it was contagious under some circumstances. The governments in London and Calcutta would be held accountable for the spread of cholera beyond the borders of British India. Of course, this strategy implied not a direct intervention in British colonial affairs but an international control regimen at Suez and in the Red Sea region that threatened British strategic interests. The British could not counter the epidemiological consensus with credible scientific evidence and consequently had to accept and comply, at least officially, with the decisions of the sanitary conferences. Only after Robert Koch’s investigation of the 1892 cholera epidemics in Hamburg and Altona were the medical experts more or less unified when it came to cholera theory. The proponents of a cholera etiology based on complex environmental conditions had apparently lost the battle. For the first time, cholera was clearly defined as solely caused by the comma bacillus. There was finally a scientific consensus regarding the etiology of the disease. All these instances of consensus originated and spread from Europe, as did the control measures that the proponents of each consensus supported. In Europe it was at times difficult enough to overcome the practical difficulties of enacting those measures, but in the colonies the simplistic assumptions of the consensus came up against the complexities of the colonial situation. The authorities had to adapt the ideas and proposals coming from Europe to the local circumstances, which included, in addition to environment, geography, and climate, the politics of class, race, gender, language, commerce, resources, and colonial ideology. Despite all those potential and actual problems connected with anticholera measures, the incentives to tackle them were equally manifest. They could save the lives of colonial officials and troops and were also attractive as a means of colonial control, a symbol of civilization and of European superiority. Under these circumstances, an understanding of the “nature” of cholera was a precondition for comprehensive and permanent measures to prevent or mitigate epidemic cholera in Madras and Quebec City. Since resources were scarce even in these provincial capitals and negative repercussions likely, a positive outcome had to be all but certain to justify the investment. Only then could the authorities hope to assemble all the actors for a proactive and long-term approach to fighting the disease. This cautious strategy explains why theories that simplified cholera’s etiology and epidemiology proved to be attractive and potent, even if they all had to overcome dogged

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resistance at first. With regard to sanitation and bacteriology, a continuous and preventive anticholera strategy required the observation and alteration of the local environment. With regard to the international epidemiological approach, control of migrants was the answer. For each strategy of fighting cholera—via sanitation, bacteriology, or international controls—numerous actors came into play, requiring officials and experts to identify, analyze, and assemble them in order to achieve the ultimate goal: integrating cholera into a system of control that would neutralize the disease and prevent future epidemics. In order to identify those actors, people needed cholera to be clearly defined. In all three approaches a definition of the disease was implied. The sanitary movement identified environmental factors such as filth and the ensuing miasmas as the causes of the disease and thus improved water supply, as well as sewers, as the means to abolish cholera. For proponents of the epidemiological view that cholera was contagious, migrants who carried the disease from India to the Middle East and from there to Europe and North Africa were the problem. In order to interrupt this route—and thus cholera’s spread—quarantine, isolation, and inspections were necessary at several points: the port of departure, as well as the Red Sea bottleneck between Aden and Suez. Bacteriologists claimed that there was only one actor responsible for cholera: the comma bacillus. Yet, to control it, a sophisticated infrastructure of laboratories, as well as practical training for those who would use laboratory instruments, was required to make the pathogenic microorganism visible. Only when these conditions were met could its points of passage be identified and blocked and the bacterium neutralized. Experience soon proved that the simplistic underlying theories and the measures derived from them were insufficient to control cholera no matter which of the three views one espoused. The disease stubbornly refused definition. Sanitarians had to deal with the fact that water supply and sewers did not necessarily abolish all “preventable” disease in all spaces that were supplied and drained by a sanitary infrastructure. Cholera epidemics returned to cities that had proper and scientifically planned sewers and water works. The control of migrants did not stop cholera despite all efforts to isolate, in designated and separated spaces, those people who came from regions that were affected by the disease. Bacteriology did not manage to block the points of passage and create those promised spaces free of contagious disease, as the influenza pandemic of 1918–19 demonstrated. These prominent failures to define cholera as monocausal and to exploit this simple characteristic gave impetus to those who believed that cholera could be defined only by acknowledging the phenomenon’s complexity.

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From the first cholera pandemic of 1817 on, such persons collected all kinds of facts about the disease, its symptoms, behavior in space, and reaction to treatment. They observed both the body of the patient and the environment in order to find more and better clues regarding cholera’s nature. The result was an astonishing compilation of facts regarding the disease—a tangled mess of details, observations, conclusions, and projections. Much of this knowledge on cholera was contradictory. Experts who agreed on an etiological interpretation of cholera’s symptoms in every detail were exceedingly rare. It seemed impossible to grasp cholera’s essence through this web of information. Every failed attempt to define cholera reinforced this fact. On this basis, the formation of a consensus and the recruitment of allies outside the medical profession proved difficult. Costly long-term measures against the disease could always be dismissed as premature, as each newly discovered factor might finally bring the much-desired solving of the equation. Thus, the addition of complexity rarely had a decisive and permanent effect on the local environment. It encouraged observation, the collection of information in medical topographies, and other descriptive works, which could be put to good use by others. Direct action was usually not an outcome of the addition of complexity, but it did offer a useful tool of obfuscation in political contexts. As the Indian medical and sanitary authorities demonstrated with their reaction to the sanitary, international, and epidemiological views of cholera, the addition of new facts could stall the implementation of unwelcome obligations. They tried the same tactic when confronted with Koch’s identification of the comma bacillus. In the end, they failed. In most instances, however, complication was a chaotic process and devoid of any overarching strategy. Thus, for a century, two interdependent ways of conceptualizing cholera were at work: the reduction of complexity and its increase, both of which shaped the cholera debates among medical experts. Simplifiers like Thomas Southwood Smith and Robert Koch singled out one factor as essential for cholera, while complicators like D. D. Cunningham and Max Pettenkofer tried to reproduce the complexity of the cholera experience in one theory. The two ways of conceptualizing cholera did not operate independently but reacted to the other’s failings. Complicators tried to improve a simplistic cholera theory when the experience of the disease and the promise of its control did not fit. Simplifiers tried to guide experts and authorities toward the exit of the confusing labyrinth of cholera facts. The two conceptualizations were not necessarily antagonistic or obstructionist in the realm of public health policy. Pettenkofer’s additions to the miasma theory, for example, were not intended to undo the political consen-

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sus that had facilitated sanitary improvements. On the contrary, he tried to strengthen the consensus by adjusting the underlying medical theory, which had become fragile due to the efforts of the complicators and cholera’s continuing presence despite all sanitary improvements. He did so by adding only a few factors, mainly those that connected groundwater to the miasmatic theory. Thus, the political consensus remained intact and Pettenkofer could point to the many sanitary improvements instigated as a result of his research. He had preserved the sanitary consensus by shifting attention from controlling to managing disease. For bacteriologists like Koch, this was not enough. Their focus on microorganisms like the cholera bacillus enabled them to again envision the elimination of the disease. In the end, simplifiers and complicators could not come to terms with cholera. The fate of their theories and the measures they informed were not decided in laboratories or studies but in the real-world environment, where the validity of theories and the effectiveness of measures were on view. Only if the views of both were treated with the same respect and attention could cholera be explained. Then, future epidemics could be avoided by neutralizing the pathogenic constellation of factors. It seemed more productive to view the environment as an interconnected whole rather than trying to dissect it. Given the divergence between simplifiers and complicators, it might seem curious that it was the former who aspired to change the environment comprehensively. The spaces free of cholera that they conceived encompassed coherent areas that varied from their surroundings. Sewers and water supply were large-scale projects that pushed the limits of local government. They were part of the coming sanitary world that would be free from avoidable disease. The same was true for the bacteriologists’ dream of a world without disease. Complicators, however, despite their holistic perspective, preferred punctual change adapted to local environmental circumstances. There was an overlap between these ways of conceptualizing cholera when it came to actual projects. Simplifiers and complicators could agree on the benefits of certain sanitary infrastructures, yet their assessment of the limits of their effectiveness was quite different. In the early twentieth century, the reduction of complexity with regard to the environment and cholera theory appeared to have prevailed. Bacteriological theory was widely accepted as the foundation of public health policy by most but not all medical experts, political elites, and the public. Cholera was absent from most parts of Europe and from North America from the 1890s onward, and bacteriology could claim at least partial responsibility for this situation. In India and many other parts of the world,

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however, the disease was as destructive as ever. In India, in particular, the emergence of plague as a powerful competitor for authorities’ attention meant that cholera remained a deadly scourge but could hardly keep up with the horror and dread that plague had evoked for centuries. In the minds of the Indian medical and sanitary authorities, cholera’s loss of its previous profile robbed them of the power to effect change. The disease was no longer an actor with the potential to strike terror in the authorities’ hearts and a subject on which ambitious experts could hope to advance their careers. It had become a disease among others. Spanish influenza did not reverse this decline, but it raised questions about the bacteriological consensus and reopened debate about the complexity of epidemic disease. The contrast between the weakened grip that cholera held on the public imagination in the 1900s and its looming menace during the first epidemics at Madras and Quebec City could not be more striking. Initially, little had been known about the “new” disease. The disease’s power was derived from its ability to alter bodies, to drain them of fluids and life. Medical practitioners, in their search to find the cause(s) of the disease, came to believe that some patients had contributed to their own predisposition toward the disease by behaving unwisely. Yet, it was broadly agreed that some factors responsible for cholera came from the surroundings and were not subject to human control. People apparently acquired the disease by interacting with their environment. Thus, it was hardly possible to separate the body from the environment when it came to prevention. In the debates about cholera, the body was considered a part of the environment. The aim was to separate the body from those environmental influences that caused cholera. This, it was thought, could be achieved by changing the body through adequate medical treatment or proper behavior. Medical experts and government officials tried to distribute the prerequisite knowledge to the public by means of declarations, manuals, lectures, medical training, and individual advice. The application of this information was the responsibility of the individual citizen and thus out of the professionals’ hands. A second approach was to change the local environment in a way that would eliminate cholera from a certain inhabited space and positively affect as many people as possible at once. This strategy was troublesome and expensive but more promising for the authorities and experts. They could demonstrate their abilities and at the same time establish a system of control that, ideally, no one could sidestep. Several strategies to isolate people from cholera’s as yet undetermined causative factors were tried over the years in Madras and Quebec City: quarantine, disinfection, purification, cleansing, camps, water supply, sew-

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ers, and filters. These strategies operated on different scales. Some were comprehensive schemes intended to keep large spaces free from the disease. Others focused on clearly defined and confined localities such as streets and houses. On both levels, however, what was done had to be adjusted to the local circumstances. There was no universal remedy against the disease despite all the promises of sanitation and bacteriology. Even the epidemiological consensus of the sanitary conferences assumed that cholera had to be fought locally. In practice, the approaches taken to prevent or limit cholera epidemics were significantly different in Madras and Quebec City. It was far easier to devise comprehensive measures for the relatively small and welldescribed urban spaces of Quebec City than for Madras. Fewer actors had to be integrated, which reduced costs as well as technical difficulties. There was also, for most of the time, an implicit assumption that cholera came to Canada on ships from Europe. Despite its temporary presence in the local environment, cholera was thus seen as fundamentally foreign, even in those instances when cholera arrived from the United States. Since the border was quite far from Quebec City, it was the concern of others: the provincial government, as well as the local authorities of cities to the south. Nevertheless, the number of ways the disease could enter the city was limited. With the quarantine operation, Grosse Île served as a limited space where cholera could run its course and take its toll until it ran out of steam. Although this approach did not work very well, it demonstrated that in Quebec City devising comprehensive schemes to hold cholera at bay was a straightforward process. To do the same for Madras was far more difficult. The possible causes of cholera could not be controlled so easily there, as experts grappled with the question of what those causes were. If cholera in Quebec quite obviously came from somewhere else, its origin was not so clear in Madras. Migration was one possible explanation for cholera’s movements, but the atmosphere was also regularly deemed responsible. Neither could be effectively controlled. The urban environment of Madras was too densely populated, too diverse, too large, and too interconnected with its surroundings for there to be an effective way to contain cholera once it had broken out. For a long time, even supposedly comprehensive infrastructure projects such as a system of sewers covered only parts of the heterogeneous spaces of the city. The complexities of Madras seemed to ensure that there would be only partial solutions, which always implied a choice to be made: which locations were to be covered and which to be neglected? Sewers, for example, were at first constructed for the fort or the Black Town and not the

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outlying villages and towns. The same type of choice faced the authorities of Quebec: should those parts of the city that cholera appeared to prefer be cleansed or disinfected or was it better to protect those who could articulate their concern? More often than not the choice between options was based on class. From the first epidemics in Madras and Quebec City, cholera was closely associated with the poor and the spaces they occupied. They were more likely to fall victim to the disease because they did not have the means to protect themselves from factors that were thought to make them predisposed to it. To focus on the hotspots of disease would mean spending resources on unattended parts of the urban environment and population. Neglecting them would also put the wealthier inhabitants at risk, however, since they sometimes had to come into contact with lowerclass people or their spaces. Cholera was both a challenge and an opportunity for the local authorities. In most instances they felt compelled to act, and only rarely could cholera be ignored, as in Madras during the late 1840s. Cholera was capable of overwhelming the capacity of authorities to care for patients, and their capacity to react to the first cholera epidemics in Madras and Quebec invariably required the improvised creation of new institutions or the rededication of existing ones, such as boards and committees. They regularly became the organizational nexus of the official response to epidemic cholera. Situated at a mid-level position between the government and front-line workers, the Medical Board of Madras and the Quebec Board(s) of Health coordinated the collective effort against the first cholera epidemics, which required the cooperation of authorities, physicians, and the population. The boards had to connect themselves to these actors. Their relation to the government or the local authorities was always close, as funding came from government entities. Medical practitioners also had to maintain ties with all actors. In Quebec they were only a minority on the various boards, but they were nevertheless very influential as experts. No decision could be made without their opinion being heard. In Madras, by contrast, the medical boards consisted exclusively of surgeons, and their main problem was connecting with the public. It was never easy to distribute advice, advertise the efforts of the authorities, and persuade residents of Madras of the benevolence of the colonial government. Direct communication with the Indian population was rare; most of it was conducted through the police. In Quebec, the elites and the middle class were well represented on the health boards, which employed health wardens to communicate with permanent residents and recently arrived immigrants.

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The Madras police and the Quebec health wardens also collected information on cholera’s movement in the local environment and on factors that rendered certain locations dangerous. They were the eyes, ears, and noses of the boards and provided them with a local information system that was critical to the boards’ reactions. They effectively gave the authorities more power over the urban population and the urban environment. The authorities could in turn use the information wardens provided to conceive urban space and consequently tighten control. Thus, the first cholera epidemics contributed to the process of state formation, though only temporarily, by strengthening the position of the local authorities in Madras and Quebec City. Previously marginal institutions such as the Madras Medical Board and the Madras police gained importance through their role in the fight against cholera. Improvised new institutions such as the Quebec Board of Health and the health wardens were dissolved after epidemics. Permanent effects were therefore rare. Only the quarantine station on Grosse Île was an exception in this respect, but it had a direct effect only on immigrants. The sanitary impulse that spread from Europe in the 1840s changed this pattern of temporary measures. In hindsight, it proved to be a watershed for public health. With the introduction of sanitary ideas and infrastructure in Madras and Quebec, the number of permanent institutions rose. They targeted all kinds of diseases considered preventable by sanitary means, although cholera was clearly prominent in the minds of the authorities. Those permanent institutions were intended to make the cities safe from epidemic disease by comprehensively altering the urban environment. The sanitary commissioners of Madras made it their task to survey and improve the urban space. In Quebec City, the municipality introduced the Health Committee for this purpose. As a consequence, the authorities could feel better prepared for epidemic disease. They employed specialists who observed the urban spaces and population constantly for signs of present and future danger. The sanitary commissioners in Madras and the Health Committee in Quebec employed an assortment of means; vital statistics and censuses provided them with more or less accurate data on population numbers, annual births, and mortality figures, as well as causes of death. Surveyors, scavengers, and ordinary neighbors informed them of nuisances. Medical practitioners notified them of the presence of dangerous diseases. Thus, the Health Committee and the sanitary commissioners fulfilled the same role as the medical and health boards, but permanently. They became coordinating institutions during epidemics but also for most aspects of public health. For the government, as well as the local authorities, this coordinating role meant

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an increase in power and control over both the environment and the local population. Cholera’s potential to threaten their rule was diminished. Thus, public health continuously and permanently contributed to the formation of the state and the stabilization of colonial rule in both Madras and Quebec. The strengthening of the state and government institutions due to the improvement of public health also had its downside for the authorities, who indeed gained but also found that the population expected better services and exerted more influence over the government. For their taxes and inconvenient government intrusions they expected results, and government increasingly found itself responsible for public well-being. In Quebec, public expectations played out as political participation; democratic representation gave the citizens a voice on the provincial, municipal, and ultimately the federal level. Since those elected bodies controlled the budgets for public health, citizens could have a hand in deciding on which measures public money would be spent. The disastrous debts incurred by the water works and drainage projects showed that their ambitions could be at odds with the financial means at their disposal, but the elected provincial assembly as well as the city council had agreed to the plan and thus given it the necessary legitimacy. In Madras there was no avenue by which to gain popular consent for public works projects. There was no body elected by a broad franchise to control the government. Attempts by the European population of Madras to initiate an improvement of public health had no discernible impact. Yet, officials were sensitive to what they perceived to be the opinion of Indians, as was the case in 1818 when the Shastry brothers, both medical practitioners, had offered the government their assistance. For the authorities, accepting such help was a way to demonstrate their openness, but it was also a reaction to the rejection of the dispensaries by the Indian population. Later, Sir Henry Pottinger’s resistance to sanitary improvement was based on not solely the project’s supposed redundancy but the perception that it would unduly interfere with the lives and spaces of the indigenous population. Although residents’ voices had not been heard directly, the authorities assumed that taking comprehensive sanitary action in the densely settled Black Town would trigger a negative response. The fact that the population accepted the supply of fresh water from the Red Hills reservoir years later was interpreted as a success. Thus, there was clearly communication between the population and the authorities, and it intensified at the end of the nineteenth and during the first decades of the twentieth century as newspapers published by Indians could claim to represent indigenous public opinion.

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The authorities in Madras clearly felt that they had to respect what they perceived to be Indian public opinion. This type of caution hindered their fight against epidemic cholera. Some spaces of the city, such as the women’s quarters of houses, were considered taboo and off limits. Officers could not simply enter the premises to inspect and remove nuisances. In addition, the authorities did not want to raise taxes because they feared a possible backlash. The reluctance to trouble the majority of the population was due to the weakness of the colonial state in Madras. It lacked the institutions to conduct intrusive measures on a grand scale, but this weakness was not the only obstacle; the authorities also felt that they did not have the necessary information to judge the situation with any confidence. The colonial enclave embodied more than just a perspective; it was also a result of the Indian population’s rejection of the colonial state. Officials thus feared the consequences of intrusive actions and the possibility that the fragility of the colonial state might be exposed. Therefore, it was better to take a conservative route during epidemics and focus on treatment. This conservative stance about the colonial government interfering in the lives of the Indian population was dominant until the mid-nineteenth century, as shown by the conflict between Governor Pottinger and the sanitarian engineers. It took the seismic shift of the Mutiny for sanitarianism to find general acceptance and justify intrusive measures like the construction of the new water supply and sewers in the Black Town. This bolder approach was intensified during the plague epidemic of the 1890s, which triggered a coordinated and widespread reaction by the emerging Indian public sphere. At that point, the colonial state emerged from its isolation in the enclave, yet it could not overcome the perspective of the enclave when observing the local environment. The laboratory may have replaced the office in importance, but the medical officers still looked outward to a dangerous and chaotic world they had to alter and control in order to make their own surroundings safe and healthy. In terms of intrusiveness, the measures against plague taken by the colonial government of Madras did not go further than those the authorities in Quebec City had adopted in 1832. In this North American colonial city, dwellings were never off limits for the authorities if their proprietors or inhabitants refused to comply with the official requirements for cleanliness. Apparently, there was no backlash against the authorities at the time, even if those who had to leave their houses were accommodated in a makeshift camp outside the city limits. When Quebec residents reacted to the epidemic, they did so with regard to the perceived feebleness and ineffectiveness of the Board of Health’s measures or the authorities’ disregard

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for popular notions of contagion. The residents’ own sanitary committee provided the board with volunteers who acted as health wardens and thus allowed for a more complete surveillance of the urban environment. This difference between the Madras and Quebec officials’ respect for the local population seems counterintuitive at first. Usually it is assumed that governments of colonies of exploitation could afford a harsher and more violent treatment of their subjects than could governments of white settlement colonies, since the subjects of the former had little political influence. The colonial government answered to the imperial government and was not responsible for the welfare of the colonized. Coercion is generally considered to have played a prominent role in maintaining order, yet coercive and intrusive measures against epidemics and for the improvement of public health were common only in the last decades of the nineteenth century. Colonies of white settlement, on the other hand, are characterized quite differently—as places where the rule of law prevailed and the rights of the inhabitants were respected. It is assumed that the elected bodies and courts guarded those rights against the interference of the colonial government. This picture is far too rosy, yet the assumption that the governments of colonies of white settlement were more benign than those of colonies of exploitation is implicit in many accounts of colonial history.6 In the history of cholera epidemics at least, this view appears to be incorrect. The weakness and perceived fragility of the colonial state in Madras made the government there far more cautious than its counterpart in Quebec City. The authorities in colonies of settlement ruled by subtler but no less effective means: gathering knowledge about the population and environment and asserting the legitimacy of the government. Canada and India were very different types of colonies during the period under consideration. Despite some similarities, they followed distinct trajectories that rarely intersected. However, both were in a colonial situation during the period under consideration. The complexities of colonial rule as well as the perception of its fragility were present in both. Nonetheless, state formation put the two colonies on different paths. In Canada, and implicitly also Quebec City, the stronger government was increasingly subject to control by the population. Responsible government, dominion status, and, eventually, independence can be interpreted as a consequence of stronger governmental institutions that were increasingly under the control of the local population. In India, state formation secured the British Empire’s grip on the colonized. Freedoms were restricted and control tightened. In both cases, though, the limits and capabilities of the colonial state changed during the age of pandemics. With the development

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of the colonial state in Madras and Quebec, the practical meaning of “colonialism” also evolved. The fight against epidemic disease—and cholera in particular—was only a small part of this process but certainly not an insignificant one.

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Notes

List of Abbreviations Used in Notes AvQ  Archives de la ville de Québec BAnQ-Q  Bibliothèque et Archives nationales du Québec, Quebec City BNA  British National Archives IOR  India Office Records, British Library LAC  Library Archives Canada NAI  National Archives of India PP  Public Proceedings Pub. Cons.  Public Consultations PWDR  Public Works Department Records SGR  Surgeon General’s Records TNSA  Tamil Nadu State Archives

Introduction: Cholera and the Colonial State in Urban Environments Epigraph: G. J. Mountain, A Retrospect of the Summer and Autumn of 1832, Being a Sermon Delivered in the Cathedral Church of Quebec, on Sunday, the 30th December of that Year (Quebec: Thomas Carey, 1833), 5–6. 1. Ibid., 9–10. 2. Ibid., 7, 13 (quotes). 3. Ibid., 13.

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4. Government to Medical Board, 15 May 1832, TNSA PP, 15 May 1832, no. 14; Medical Board to Government, 28 May 1832; Report of Superintending Surgeon, 23 May 1832 (quotes), Government Order, 28 May 1832, all in TNSA PP, 5 June 1832, no. 14. 5. Susan Neild, “Madras: Growth of a Colonial City in India, 1780–1840” (PhD diss., Univ. of Chicago, 1977), 339n1. 6. Medical Board to Government, 28 May 1832; Report of Superintending Surgeon, 23 May 1832 (quote); Government Order, 28 May 1832, all in TNSA PP, 5 June 1832, nos. 14–15. 7. Those medical aspects as well as the etiological and epidemiological disputes are expertly dealt with in Christopher Hamlin, Cholera: The Biography (Oxford: Oxford Univ. Press, 2009). 8. C. A. Bayly, “Knowing the Country: Empire and Information in India,” Modern Asian Studies 27 (1993); C. A. Bayly, Empire and Information: Intelligence Gathering and Social Communication in India, 1780–1870 (Cambridge: Cambridge Univ. Press, 1996). 9. The authority on the issue is still R. Pollitzer, Cholera (Geneva: World Health Organization, 1959), 17–45. 10. The historical literature reflects the widespread concern about the disease: Geoffrey Bilson, A Darkened House: Cholera in Nineteenth-Century Canada (Toronto: Univ. of Toronto Press, 1980); Richard J. Evans, Death in Hamburg: Society and Politics in the Cholera Years (Oxford: Clarendon, 1987); Frank M. Snowden, Naples in the Time of Cholera, 1884–1911 (Cambridge: Cambridge Univ. Press, 1995); Peter Baldwin, Contagion and the State in Europe, 1830–1930 (Cambridge: Cambridge Univ. Press, 2005). 11. David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: Univ. of California Press, 1993), esp. 15–23 and chap. 6. 12. The phrase “colonial situation” was coined by Georges Balandier in his seminal article “La situation coloniale: Approche théorétique,” Cahiers internationaux de sociologie 11 (1951), esp. 48–49. 13. Jürgen Osterhammel, Colonialism: A Theoretical Overview (Princeton, NJ: Markus Wiener Publishers, 1997), 10–11; Wolfgang Reinhard, Kleine Geschichte des Kolonialismus, 2nd ed. (Stuttgart: Kröner, 2008), 4–5. 14. Allan Greer and Ian Radforth, eds., Colonial Leviathan: State Formation in Mid-Nineteenth-Century Canada (Toronto: Univ. of Toronto Press, 1992); Bruce Curtis, The Politics of Population: State Formation, Statistics, and the Census of Canada, 1840–1875 (Toronto: Univ. of Toronto Press, 2001); Burton Stein, “State Formation and Economy Reconsidered: Part One,” Modern Asian Studies 19 (1985); Frank Perlin, “State Formation Reconsidered: Part Two,” Modern Asian Studies 19 (1985); Jon

260

Notes to pages 6–11

E. Wilson, The Domination of Strangers: Modern Governance in Eastern India, 1780–1835 (Basingstoke: Palgrave Macmillan, 2008). 15. On India’s role relative to the emergence of the second British Empire, see C. A. Bayly, Indian Society and the Making of the British Empire (Cambridge: Cambridge Univ. Press, 1988). 16. On the importance of Canada’s role in the British Empire, see the essays in Phillip Buckner, ed., Canada and the British Empire (Oxford: Oxford Univ. Press, 2008). 17. It is a common but nonetheless bothersome feature of many historical studies of India that results derived from the investigation of one location (usually in northern India) are assumed to be representative of the whole colony. The regional specificities of the subcontinent, especially of the south, are often neglected, as pointed out in David Washbrook, “South India 1770–1840: The Colonial Transition,” Modern Asian Studies 38 (2004). Ronald Rudin, Making History in Twentieth Century Quebec (Toronto: Univ. of Toronto Press, 1997), discusses at length the debates among Quebecois historians on how different the province of Quebec was (and is) from the rest of Canada. 18. Wolfgang Reinhard, Geschichte des modernen Staates (Munich: Beck, 2007). 19. Paul Slack, The Impact of Plague in Tudor and Stuart England (Oxford: Clarendon, 1990), esp. chap. 8; Slack, “Responses to Plague in Early Modern Europe: The Implications of Public Health,” Social Research 55 (1988). 20. Ute Frevert, Krankheit als politisches Problem, 1770–1880: Soziale Unterschichten in Preußen zwischen medizinischer Polizei und staatlicher Sozialversicherung (Göttingen: Vandenhoeck & Ruprecht, 1984). 21. A concise definition of medicalization can be found in Wolfgang U. Eckart and Robert Jütte, Medizingeschichte: Eine Einführung (Cologne: Böhlau, 2007), 312–13. Also offering a groundbreaking discussion of the concept are Frevert, Krankheit als politisches Problem; and Jean-Pierre Goubert, ed., La médicalisation de la société française, 1770–1830 (Waterloo, ON: Historical Reflections Press, 1982). Francisca Loetz, Vom Kranken zum Patienten: “Medikalisierung” und medizinische Vergesellschaftung am Beispiel Badens 1750–1850 (Stuttgart: Steiner, 1993), provides a detailed discussion of the concept and its history. 22. Daniel R. Headrick, The Tools of Empire: Technology and European Imperialism in the Nineteenth Century (New York: Oxford Univ. Press, 1981). 23. Asa Briggs, “Cholera and Society in the Nineteenth Century,” Past and Present 19 (1961); Charles E. Rosenberg, “Cholera in Nineteenth-Century Europe: A Tool for Social and Economic Analysis,” Comparative Studies in Society and History 8 (1965–66). 24. One example of an examination of contemporary views is Projit Bihari Mukharji, “The ‘Cholera Cloud’ in the Nineteenth-Century ‘British World’: History of an Object-without-an-Essence,” Bulletin of the History of Medicine 86 (2012). 25. Bruno Latour, We Have Never Been Modern (Cambridge, MA: Harvard Univ.

Notes to pages 11–14

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Press, 1993); Latour, Reassembling the Social: An Introduction to Actor-Network-Theory (Oxford: Oxford Univ. Press, 2005); John Law, ed., Actor Network Theory and After (Oxford: Blackwell, 1999). 26. Latour, Reassembling the Social, 12. 27. Kristin Asdal, “The Problematic Nature of Nature: The Post-Constructivist Challenge to Environmental History,” History and Theory 44 (2003). 28. Latour himself has highlighted the connection between actor-network theory and environmental history by declaring two eminent works of the latter field— William H. McNeill, Plagues and Peoples (Garden City, NY: Anchor Press, 1976), and William Cronon, Nature’s Metropolis: Chicago and the Great West (New York: Norton, 1992)—to be actor-network descriptions avant la lettre. Latour, Reassembling the Social, 11. 29. Although this is quite obvious and despite the “spatial turn,” little has been written about the connection between spatial theory and environmental history. See Matthew W. Klingle, “Spaces of Consumption in Environmental History,” History and Theory 42 (2003). 30. Henri Lefebvre, The Production of Space (Malden, MA: Blackwell, 1991), 33. 31. Ibid., 31–46. My interpretation of Lefebvre’s spatial theory is heavily indebted to Christian Schmid, Stadt, Raum und Gesellschaft: Henri Lefebvre und die Theorie der Produktion des Raumes (Stuttgart: Steiner, 2005); and Andy Merrifield, “Henri Lefebvre: A Socialist in Space,” in Thinking Space, ed. Mike Crang and Nigel Thrift (London: Routledge, 2000), 167–82. I am aware that I outline a quite eclectic interpretation of Lefebvre’s theory. Central aspects of his theory, like his Marxism, play no role in my account and later use of Lefebvre’s theory. Nonetheless, I hope that I do justice to Lefebvre and his work. 32. This point is also made by Lefebvre, Production of Space, 46–53. 33. For this book I used records of the following archives: the India Office Records of the British Library in London (IOR); the British National Archives in Kew (BNA); the National Archives of India in New Delhi (NAI); the Tamil Nadu State Archives in Chennai (TNSA); the Library Archives Canada in Ottawa (LAC); the Bibliothèque et Archives nationales de Québec in Quebec City (BAnQ-Q); and the Archives de la ville de Québec (AvQ).

Chapter 1. Strategies of Treatment: Madras, 1818–1833 1. Susan Neild-Basu, “Madras in 1800: Perceiving the City,” in Urban Form and Meaning in South Asia: The Shaping of Cities from Prehistoric to Precolonial Times, ed. Howard Spodek and Meth Srinivasan (Hanover, NH: Univ. Press of New England, 1993), 227–28. 2. C. S. Srinivasachari, History of the City of Madras (Madras: P. Varadachari, 1939), 1–14; M. Atchi Reddy, Trade and Commerce of the English East India Company in India

262

Notes to pages 14–22

(Madras) (Ambala: Associated Publishers, 2006), 1:1–22; Robert Eric Frykenburg, “The Socio-Political Morphology of Madras: An Historical Interpretation,” IndoBritish Review 11 (1985): 10–12. 3. Frykenburg, “Socio-Political Morphology of Madras”: 10–12; M. Reddy, Trade and Commerce of the English East India Company, 1:1–22; Srinivasachari, History of the City of Madras, 1–14. 4. M. Reddy, Trade and Commerce of the English East India Company, 1:430–38; Susan Neild, “Madras: The Growth of a Colonial City in India, 1780–1840” (PhD diss., Univ. of Chicago, 1977), 129. 5. Neild, “Madras: Growth of a Colonial City,” 129–72; M. Reddy, Trade and Commerce of the English East India Company, 2:29–59. 6. C. A. Bayly, Indian Society and the Making of the British Empire (Cambridge: Cambridge Univ. Press, 1988), chaps. 2–3; C. S. Srinivasachari, “The Nawabs of the Carnatic,” in The Politics of the British Annexation of India, 1757–1857, ed. Michael H. Fisher (Delhi: Oxford Univ. Press, 1996). 7. Neild, “Madras: Growth of a Colonial City,” 17–22. On the parayars, or paraiyan, see Susan Bayly, Caste, Society and Politics in India from the Eighteenth Century to the Modern Age (Cambridge: Cambridge Univ. Press, 1999), 193. 8. M. Reddy, Trade and Commerce of the English East India Company, 3:1–10, 29–76; Neild, “Madras: Growth of a Colonial City,” 244–71; Srinivasachari, History of the City of Madras, 68–74, 148–51, 181; Frykenberg, “Socio-Political Morphology of Madras,” 11; Susan Bayly, Saints, Goddesses and Kings: Muslims and Christians in South Indian Society, 1700–1900 (Cambridge: Cambridge Univ. Press, 1989), chap. 3 and 260–62. 9. Susan Neild, “Colonial Urbanism: The Development of Madras in Eighteenth and Nineteenth Centuries,” Modern Asian Studies 13 (1979); Neild, “Madras: Growth of a Colonial City,” 305; M. Reddy, Trade and Commerce of the English East India Company, 3:1–28. 10. Neild, “Madras: Growth of a Colonial City,” 322. 11. Ibid., 321–22, 353; Meera Kosambi and John E. Brush, “Early European Suburbanization in the Indo-British Port Cities,” in Asian Urbanization: Problems and Processes, ed. Frank J. Costa (Berlin: Borntraeger, 1988); John E. Brush, “The Growth of the Presidency Towns,” in Urban Society, Space and Image: Papers Presented at a Symposium Held at Duke University, ed. Richard G. Fox (Durham, NC: Duke Univ., 1970). 12. M. Reddy, Trade and Commerce of the English East India Company, 1:281–302, 430–54; Neild, “Madras: Growth of a Colonial City,” 155–72. 13. B. B. Misra, The Central Administration of the East India Company, 1773–1834 (Manchester: Manchester Univ. Press, 1959), 31–32; C. Bayly, Indian Society and the Making of the British Empire, 76; David Washbrook, The Emergence of Provincial Politics: The Madras Presidency 1870–1920 (Cambridge: Cambridge Univ. Press, 1982), 24. 14. Philip Lawson, The East India Company: A History (London: Longman, 1997),

Notes to pages 22–26

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128–39; Douglas M. Peers, Between Mars and Mammon: Colonial Armies and the Garrison State in India, 1819–1835 (London: Tauris Academic Studies, 1995), 29–35; Misra, Central Administration of the East India Company, 30–33. 15. The Europeans of the Black Town enjoyed the privileges of the chartered corporation of Madras, which had mainly judicial rights. C. S. Srinivasachari, “A History of the Mayoralty of Madras,” in Madras Tercentenary Memorial Volume, ed. Madras Tercentenary Commemoration Committee (London: Oxford Univ. Press, 1939); Neild, “Madras: Growth of a Colonial City,” 280–81. 16. Inspector General of Police, The History of the Madras Police (Madras: B.N.K. Press, 1959), chaps. 3–4; Neild, “Madras: Growth of a Colonial City,” 145–46, 281, 364–65. 17. George Kuriyan, “The Distribution of Population in the City of Madras,” Indian Geographic Journal 16 (1941); Brush, “Growth of the Presidency Towns.” 18. Lawson, East India Company, 137–43. On the duality of the military and civilian aspects of the colonial government, see Peers, Between Mars and Mammon, 65–67; and Neild, “Madras: Growth of a Colonial City,” 278. Unfortunately, there is no comprehensive historical account of the workings of the colonial government and administration at Fort St. George. From the internal administrative correspondence that is accessible in the Government Proceedings, the comparative importance of the Military and Revenue Departments seems quite obvious. Washbrook, Emergence of Provincial Politics, 26, hints at the Revenue Department’s influence even before the period covered in that book. 19. D. G. Crawford, A History of the Indian Medical Service 1600–1913 (London: Thacker, 1913), 1:197–98; Pratik Chakrabarti, “‘Neither of Meate nor Drinke, but What the Doctor Alloweth’: Medicine amidst War and Commerce in Eighteenth Century Madras,” Bulletin of the History of Medicine 80 (2006): 29; Chakrabarti, Materials and Medicine: Trade, Conquest and Therapeutics in the Eighteenth Century (Manchester: Manchester Univ. Press, 2010), 83–89, 100–103; Anil Kumar, Medicine and the Raj: British Medical Policy in India, 1835–1911 (New Delhi: SAGE, 1998), 129. 20. Chakrabarti, “’Neither of Meate nor Drinke,’” 30–31; Crawford, History of the Indian Medical Service, 2:14. 21. Chakrabarti, “‘Neither of Meate nor Drinke,’” 4–5; Chakrabarti, Materials and Medicine, 89–95; Crawford, History of the Indian Medical Service, 2:411–12. 22. Chakrabarti, “‘Neither of Meate nor Drinke,’” 6–19; I. Conrad Lawrence, “Arab-Islamic Medicine,” in Companion Encyclopedia of the History of Medicine, ed. William F. Bynum and Roy Porter (London: Routledge, 1993); Dominik Wujastyk, “Indian Medicine,” in Companion Encyclopedia of the History of Medicine, ed. Bynum and Porter; David Arnold, Science, Technology and Medicine in Colonial India (Cambridge: Cambridge Univ. Press, 2000), 65; Arnold, “Cholera and Colonialism in British India,” Past and Present 113 (1986): 135–38.

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Notes to pages 27–29

23. Arnold, Science, Technology and Medicine in Colonial India, 54–58. 24. Roy Porter, Bodies Politic: Disease, Death and Doctors in Britain, 1650–1900 (London: Reaktion Books, 2001), chap. 8. 25. James C. Riley, The Eighteenth Century Campaign to Avoid Disease (Basingstoke: Macmillan, 1987), chap. 1. 26. Christopher Hamlin, “Predisposing Causes and Public Health in Early Nineteenth Century Medical Thought,” Social History of Medicine 5 (1992): 44–59. 27. Ibid., 55–56. 28. Margaret Pelling, Cholera, Fever and English Medicine (Oxford: Oxford Univ. Press, 1978), 16–18; Riley, Eighteenth Century Campaign to Avoid Disease, 1–19. On the concept of contagion, see Alison Bashford and Claire Hooker, eds., Contagion: Historical and Cultural Studies (London: Routledge, 2001). 29. Hamlin, “Predisposing Causes and Public Health,” 55–56; Riley, Eighteenth Century Campaign to Avoid Disease, chap. 1, 45–48. 30. Riley, Eighteenth Century Campaign to Avoid Disease, 18. 31. Mark Harrison, Climates and Constitutions: Health, Race, Environment and British Imperialism in India 1600–1850 (New Delhi: Oxford Univ. Press, 1999), 73–80, chap. 3. On Europe, see Riley, Eighteenth Century Campaign to Avoid Disease, chap. 2. 32. Hamlin, “Predisposing Causes and Public Health,” 59–62; M. Harrison, Climates and Constitutions, 80–88; Chakrabarti, “‘Neither of Meate nor Drinke,’” 9–10, 15–19. See also Chakrabarti, Materials and Medicine; and Mark Harrison, Medicine in an Age of Commerce: Britain and Its Tropical Colonies, 1660–1830 (Oxford: Oxford Univ. Press, 2010). 33. Paul Slack, The Impact of Plague in Tudor and Stuart England (Oxford: Clarendon, 1990), esp. chap. 8; Slack, “Responses to Plague in Early Modern Europe: The Implications of Public Health,” Social Research 55 (1988). 34. Arana Nair, “An Egyptian Infection: War, Plague and the Quarantines of the English East India Company at Madras and Bombay, 1802,” Hygiea Internationalis 8 (2009). 35. William Ainslie, A. Smith, and M. Christy, Report of a Committee Appointed by the Madras Government to Inquire into the Causes of the Epidemic Fever Which Prevailed in the Provinces of Coimbatore, Madura, Dindigul, & Tinnivelly, during the Years 1809, 1810, and 1811 (London: Black, Parbury, and Allen, 1816); Niels Brimnes, “Coming to Terms with the Native Practitioner: Indigenous Doctors in Colonial Service in South India, 1800–1825,” Indian Economic and Social History Review 50 (2013): 97–99. 36. Circular Letter, 3 Aug. 1818, TNSA PP, 29 Sept. 1818, no. 34; R. Pollitzer, Cholera (Geneva: World Health Organization, 1959), 17–18; Arnold, “Cholera and Colonialism,” 120–21. 37. Circular Letter, 3 Aug. 1818, TNSA PP, 29 Sept. 1818, no. 34; Medical Board to Governor-in-Council, 6 Aug. 1818, TNSA SGR, 6 Aug. 1818, no. 12460.

Notes to pages 29–35

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38. Circular Letter, 3 Aug. 1818, TNSA PP, 29 Sept. 1818, no. 34; David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: Univ. of California Press, 1993), 179–81; Christopher Hamlin, Cholera: The Biography (Oxford: Oxford Univ. Press, 2009), 28–34. For a Whiggish history of cholera treatment, see Norman Howard-Jones, “Cholera Therapy in the Nineteenth Century,” Journal of the History of Medicine and Allied Sciences 27 (1972). 39. Circular Letter, 3 Aug. 1818, TNSA PP, 29 Sept. 1818, no. 34. 40. Medical Board to Military Department, 21 Sept. 1818, TNSA PP, 20 Sept. 1818, no. 34; Superintending Surgeon, Central Division, to Government, 10 Oct. 1818, TNSA PP, 13 Oct. 1818, no. 9. 41. Government to Medical Board, 10 Oct. 1818, TNSA PP, 13 Oct. 1818, no. 10; Medical Board to Governor-in-Council, 15 Oct. 1818, TNSA PP, 20 Oct. 1818, no. 24; Medical Board to Government, 11 Nov. 1818; and Government to Medical Board, 24 Nov. 1818, both in TNSA PP, 24 Nov. 1818, nos. 18–19; Medical Board to Governor-in-Council, 26 Nov. 1818; and Government to Medical Board, 2 Dec. 1818, both in TNSA PP, 2 Dec. 1818, nos. 47–48. 42. Medical Board to Governor-in-Council, 15 Oct. 1818, TNSA PP, 20 Oct. 1818, no. 24. 43. Ibid.; Government to Medical Board, 10 Oct. 1818, TNSA PP, 13 Oct. 1818, no. 10; Medical Board to Government, 19 Oct. 1818, TNSA PP, 20 Oct. 1818, no. 25; Government Order, 22 Oct. 1818, TNSA PP, 27 Oct. 1818, no. 7. 44. Weekly Report of Medical Board, 27 Oct. 1818, TNSA PP, 3 Nov. 1818, no. 10; Superintendent of Police to Government, 26 Oct. 1818, TNSA PP, 3 Nov. 1818, nos. 51–55; Weekly Report of Medical Board, 31 Oct. 1818, TNSA PP, 10 Nov. 1818, no. 5. 45. Medical Board to Governor-in-Council, 26 Oct. 1818, TNSA PP, 27 Oct. 1818, no. 40; Government to Road Committee, 27 Oct. 1818, TNSA PP, 27 Oct. 1818, no. 41. 46. Superintending Surgeon to Medical Board, 15 Oct. 1818, TNSA PP, 20 Oct. 1818, no. 24; Advertisement by Medical Board, 19 Oct. 1818, TNSA SGR, no. 12461; Wujastyk, “Indian Medicine”; Jane Buckingham, Leprosy in Colonial South India: Medicine and Confinement (Basingstoke: Palgrave, 2002), chap. 3. 47. Superintending Surgeon to Medical Board, 15 Oct. 1818, TNSA PP, 20 Oct. 1818, no. 24; Maha Ganapady Shastry and Ramachrishna Shastry to Government, n.d., TNSA PP, 10 Nov. 1818, no. 6; Government to Medical Board, 5 Nov. 1818, TNSA PP, 10 Nov. 1818, no. 7; Medical Board to Government, 6 Nov. 1818, TNSA PP, 10 Nov. 1818, no. 13. 48. Superintending Surgeon to Medical Board, 15 Oct. 1818, TNSA PP, 20 Oct. 1818, no. 24; Medical Board to Governor-in-Council, 26 Nov. 1818, TNSA PP, 1 Dec. 1818, no. 46; Government to Medical Board, 2 Dec. 1818, TNSA PP, 2 Dec.

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Notes to pages 36–40

1818, no. 47; Government to Governor-in-Council, 2 Dec. 1818, TNSA PP, 2 Dec. 1818, no. 48; Medical Board to Commander-in-Chief, 9 Dec. 1818, TNSA SGR, no. 12461. On the role of “native practitioners” employed by the government of Madras during the early nineteenth century, see Brimnes, “Coming to Terms with the Native Practitioner.” 49. Superintendent of Police to Government, 11 Feb. 1819, TNSA PP, 22 Feb. 1819, no. 63. 50. Medical Board to Governor-in-Council, 8 Mar. 1819, TNSA PP, 16 Mar. 1819, no. 15. 51. Medical Board to Governor-in-Council, 31 May 1819, TNSA PP, 11 June 1819, no. 34; Government to Medical Board, 3 June 1819, TNSA PP, 8 June 1819, no. 6; Government to Medical Board, 4 June 1819, TNSA PP, 11 June 1819, no. 35. 52. The temporary dispensaries were abolished for the second time on 31 Aug. 1820. Medical Board to Government, 28 Sept. 1820, TNSA PP, 13 Oct. 1820, no. 20; Medical Board to Government, 20 Nov. 1820, TNSA PP, 1 Dec. 1820, no. 5 (quote). 53. For the reports on which those figures are based, see TNSA PP, 3 Nov. 1819, no. 10; 10 Nov. 1819, no. 5; 17 Nov. 1819, no. 3; 2 Dec. 1819, nos. 4–5, 10; and 8 Dec. 1819, no. 2. 54. Medical Board to Governor-in-Council, 15 Oct. 1818, TNSA PP, 20 Oct. 1818, no. 24; William Scot, Report on Epidemic Cholera as It Has Appeared in the Territories Subject to the Presidency of Fort St. George (Madras: Asylum Press, 1824), 49. On the perceived dangerousness of the night air, though in an American context, see Peter Baldwin, “How Night Air Became Good Air, 1776–1930,” Environmental History 8 (2003). 55. Medical Board to Governor-in-Council, 15 Oct. 1818, TNSA PP, 20 Oct. 1818, no. 24. 56. Road Committee to Government, 17 Dec. 1818, TNSA PP, 1 Jan. 1819, no. 20. 57. Medical Board to Government, 29 Mar. 1819; and Government to Medical Board, 8 Apr. 1819, both in TNSA PP, 8 Apr. 1819, nos. 38–39; Medical Board to Governor-in-Council, 15 July 1819; and Government to Medical Board, 17 July 1819, both in TNSA PP, 17 July 1819, nos. 8, 85; Fort William to Government, 13 May 1820, TNSA PP, 25 Aug. 1820, no. 2. The reports are: Robert Steuart, Reports on the Epidemic Cholera Which Has Raged throughout Hindostan and the Peninsula of India since August 1817 (Bombay: De Jesus, 1819); and James Jameson, Report on the Epidemick Cholera Morbus, as It Visited the Territories Subject to the Presidency of Bengal, in the Years 1817, 1818 and 1819 (Calcutta: Government Gazette Press, 1820). 58. Scot to Government, 24 July 1820, TNSA PP, 8 Aug. 1820, no. 21. 59. Reginald Orton, An Essay on the Epidemic Cholera of India, 2nd ed., with a suppl. (London: Burgess and Hill, 1831), esp. chaps. 6, 8, and 9.

Notes to pages 40–45

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60. Scot, Report on Epidemic Cholera, i–xvii. 61. Ibid., xviii–xlv. 62. Ibid., liv–lxviii. 63. Government to Medical Board, 8 Aug. 1832, TNSA PP, 3 Aug. 1832, no. 21; Medical Board to Governor-in-Council, 2 Aug. 1832, TNSA PP, 14 Aug. 1832, no. 7; Extract Letter to Superintending Surgeon, Presidency Division, 4 Aug. 1832; and Medical Board to Superintending Surgeon, Presidency Division, 9 Aug. 1832, both in TNSA PP, 18 Jan. 1832, no. 19. 64. Government to Medical Board, 16 Jan. 1833, TNSA PP, 18 Jan. 1833, no. 3A. 65. Government to Medical Board, 16 Jan. 1833, TNSA PP, 18 Jan. 1833, no. 3A; Medical Board to Governor-in-Council, 17 Jan. 1833; Superintending Surgeon Presidency to Medical Board, 16 Jan. 1833; Superintendent of Police to Superintending Surgeon, 15 Jan. 1833; and Government to Medical Board, 18 Jan. 1833, all in TNSA PP, 18 Jan. 1833, nos. 19–20; Medical Board to Governor-in-Council, 11 Feb. 1833; Medical Board to Superintendent of Police, 24 Jan. 1833; Superintendent of Police to Medical Board, 26 Jan. 1833; Medical Board to Superintendent of Police, 31 Jan. 1833; Superintendent of Police to Medical Board, 4 Feb. 1833; and Resolution, 11 Feb. 1833, all in TNSA PP, 19 Feb. 1833, nos. 10–11.

Chapter 2. Strategies of Control: Quebec City, 1832–1834 1. William Scot, Report on Epidemic Cholera as It Has Appeared in the Territories Subject to the Presidency of Fort St. George (Madras: Asylum Press, 1824), ii. 2. Scot’s report was translated into French (1831) and German (1832). The official report on the outbreak in the Bengal Presidency, James Jameson’s Report on the Epidemick Cholera Morbus, as It Visited the Territories Subject to the Presidency of Bengal, in the Years 1817, 1818 and 1819 (Calcutta: Government Gazette Press, 1820), was also translated into German (1832). 3. Peter Baldwin, Contagion and the State in Europe, 1830–1930 (Cambridge: Cambridge Univ. Press, 1999), 105–6; Roderick E. McGrew, “The First Cholera Epidemic and Social History,” Bulletin of the History of Medicine 34 (1960): 62. 4. Reports, letters, and statements from Russia, Prussia, and Scandinavia, and Drs. Russell and Barry, “Report on the Cholera,” St. Petersburg, 6 July 1831, BNA PC 1/106, 4395. 5. J. C. McDonald, “The History of Quarantine in Britain during the 19th Century,” Bulletin of the History of Medicine 25 (1951): 23. 6. Fraser Brockington, “Public Health and the Privy Council, 1831–1834,” Journal of the History of Medicine and Allied Sciences 16 (1961): 161–69 (quote, 169). 7. Baldwin, Contagion and the State in Europe, 99–104. 8. Jean Hamelin, Histoire du Québec (Toulouse: Privat, 1976), 272–74; John Dick-

268

Notes to pages 46–55

inson and Brian Young, A Short History of Quebec, 4th ed. (Montreal and Kingston: McGill-Queen’s Univ. Press, 2008), 58. 9. Hamelin, Histoire du Québec, 272–74; Dickinson and Young, Short History of Quebec, 58–59; Henri Brun, La formation des institutions parlementaires québécoises, 1791–1838 (Quebec: Presses de l’Université Laval, 1970). On representative elements in British colonies of settlement and especially in Canada, see Peter Burroughs, “Colonial Self-Government,” in British Imperialism in the Nineteenth Century, ed. C. C. Eldridge (London: Macmillan, 1984). On the contradictions and conflicts caused by the constitution of 1791, see Phillip A. Buckner, The Transition to Responsible Government: British Policy in British North America, 1815–1850 (Westport, CT: Greenwood Press, 1985). 10. Alan Greer, The Patriots and the People (Toronto: Univ. of Toronto Press, 2003), 120–36; Hamelin, Histoire du Québec, 324–31; Dickinson and Young, History of Quebec, 59–63, 158–63. 11. An annual average of nineteen hundred men were stationed at Quebec between 1814 and 1840. Brian Young, “Patrician Elites and Power in Nineteenth-Century Montreal and Quebec City,” in Who Ran the Cities? City Elites and Urban Power Structures in Europe and North America, 1750–1940, ed. Ralf Roth and Robert Beachey (Aldershot: Ashgate, 2007), 236. 12. David-Thiery Ruddel and Marc Lafrance, “Québec, 1785–1840: Problèmes de croissance d’une ville coloniale,” Histoire sociale / Social History 18 (1985): 317–18. 13. David-Thiery Ruddel, Québec City, 1765–1832: The Evolution of a Colonial Town (Hull, QC: Canadian Museum of Civilization, 1991), 162–68; Antonio Drolet, Régime anglais, avant 1833, vol. 2 of La ville de Québec: Histoire municipale, ed. Société historique de Québec (Quebec: Société historique de Québec, 1965), 24–38. 14. Fernand Ouellet, Éléments d’histoire sociale du Bas-Canada (Montreal: Hurtubise, 1972), 181; Ruddel, Québec City, table VIII, 256. 15. John Hare, Marc Lafrance, and David-Thiery Ruddel, Histoire de la ville de Québec (Montreal: Boréal, 1987), 154–57; Ruddel and Lafrance, “Québec, 1785–1840,” 321; Marc Lafrance and Thiery Ruddel, “Elements de l’urbanisation de la ville de Québec,” Urban History Review / Revue d’histoire urbaine 1, no. 4 (1975): 30; Christian Duperron, “Le choléra à Québec en 1832: Entre contagion et infection” (MA thesis, Univ. Laval, 2006), 40. 16. Ruddel and Lafrance, “Quebec 1785–1840,” 317–18; Hare, Lafrance and Ruddel, Histoire de la ville de Québec, 181–87; Gilles Pacquet and Jean-Pierre Wallot, Un Québec moderne, 1760–1840: Essai d’histoire économique et sociale (Montreal: Hurtubise, 2007), chap. 6. 17. On the healthiness of Canada and its climate for settlers, see Andrew Wear, “The Prospective Colonists,” in Cultivating the Colonies: Colonial States and Their Environmental Legacies, ed. Christina Folke Ax, Niels Brimnes, and Niklas Thode Jensen

Notes to pages 55–58

269

(Athens: Ohio Univ. Press, 2011), 23–25; A. C. Buchanan, Advice to Emigrants (Quebec: Thomas Cary, 1832), 5. 18. Denis Goulet and André Paradis, Trois siècles d’histoire médicale au Québec: Chronologie des institutions et des pratiques (1639–1919) (Montreal: VLB, 1992), 175–204. 19. Report from Officer of Health, Journal of the House of Assembly, Lower Canada, 14 Jan. 1832; Petition from Justices of Peace, Quebec, Journal of the House of Assembly, Lower Canada, 27 Jan. 1832 (available at Library Archives Canada, Ottawa). 20. James Douglas, Journals and Reminiscences of James Douglas, M.D. (New York: privately printed, 1910), 133–34; Quebec Mercury, 20, 27 Oct. 1831. 21. Duperron, “Le choléra à Québec en 1832,” 33. 22. Barbara Tunis, “The Medical Profession in Lower Canada: Its Evolution as a Social Group, 1788–1838” (BA thesis, Carleton Univ., 1979), 16–18. 23. Othmar Keel and Peter Keating, “Autour du Journal de Médecine de Québec/Quebec Medical Journal (1826–1827): Programme scientifique et programme de médicalisation,” in Critical Issues in the History of Canadian Science, Technology and Medicine, ed. Richard A. Jarrell and Arnold E. Roos (Thornhill, ON: HSTC Publications, 1983); C.-A. Gauthier, “Histoire de la Société Médicale de Québec,” Laval médical 8 (1943); John J. Heagerty, Four Centuries of Medical History in Canada and a Sketch of the Medical History of Newfoundland (Toronto: Macmillan, 1928), 1:276–77; André Beaulieu and Jean Hamelin, La presse québécoise des origines à nos jours (Quebec: Presses de l’Université Laval, 1973), 1:53–54. 24. Tunis, “Medical Profession in Lower Canada,” 41–60; Jacques Bernier, La médecine au Québec: Naissance et évolution d’une profession (Quebec: Presses de l’Université Laval, 1989), 33–36. 25. Marcel J. Rheault and Georges Aubin, Médecins et patriotes, 1837–1838 (Quebec: Septentrion, 2006), 45–50. 26. Tunis, “Medical Profession in Lower Canada,” 117–18; Ronald Hamowy, Canadian Medicine: A Study in Restricted Entry (Vancouver: Fraser Institute, 1984), 31–32; Bernier, La médecine au Québec, 43–49. 27. Report of the Medical Board, 12 Nov. 1831, Journal of the House of Assembly, Lower Canada, app. NNN; Speech of Lord Aylmer, Journal of the House of Assembly, Lower Canada, 15 Nov. 1831. 28. Journal of the House of Assembly, Lower Canada, Order, 30 Nov. 1831; Report of Committee, 2 Dec. 1831; Roberts, letter to Medical Board, 27 Oct. 1831; Roberts, letter to Government, 30 Nov. 1831, all in Journal of the House of Assembly, Lower Canada, app. NNN. 29. Geoffrey Bilson, A Darkened House: Cholera in Nineteenth-Century Canada (Toronto: Univ. of Toronto Press, 1980), 5. 30. Speech of Lord Aylmer, Journal of the House of Assembly, Lower Canada, 3 Feb. 1832.

270

Notes to pages 58–61

31. Resolution of the Fever Hospital Committee, Journal of the House of Assembly, Lower Canada, 17 Feb. 1832. 32. Ibid. 33. Ibid. 34. Duperron, “Le choléra à Québec en 1832,” 64–65, 81–83. 35. The secretary, Thomas Ainsley Young, was a physician, assemblyman, and member of the Fever Hospital Committee. Board of Health Minutes, 12, 14, 16 Mar. 1832, AvQ B1, vol. 4; Duperron, “Le choléra à Québec en 1832,” 58. 36. Board of Health Minutes, 14 Mar. 1832, AvQ B1, vol. 4. 37. Board of Health Minutes, 24 Mar. 1832; AvQ B1, vol. 4. 38. Board of Health Minutes, 30 Mar. 1832, AvQ B1, vol. 4; Bilson, Darkened House, 9. 39. Board of Health Minutes, 16 Mar. 1832, AvQ B1, vol. 4. 40. Since the times of the French regime, Quebec had had an hôtel-Dieu and a general hospital as medical institutions for the permanent population. Both were run by the Catholic Church. While the former treated mainly poor patients, the latter was reserved for the accommodation and correction of mendicants, invalids, or the insane. François Guérard, Histoire de la santé au Québec (Montreal: Boréal, 1996), 16–17. 41. Guérard, Histoire de la santé au Québec, 16–17; Bilson, Darkened House, 14. 42. Board of Health Minutes, 17 Apr. 1832, AvQ B1, vol. 4. 43. Board of Health Minutes, 5, 9, 12, 15, 28 Apr. 1832, AvQ B1, vol. 4. 44. Board of Health Minutes, 14 Mar. 1832, 30 Apr. 1832, AvQ B1, vol. 4. 45. Board of Health Minutes, 25 Apr. 1832, 5 May 1832, AvQ B1, vol. 4. 46. Board of Health Minutes, 11, 14, 18, 19, 22, 26 May 1832; AvQ B1, vol. 4. 47. Residents living near the Emigrant Hospital petitioned the government to close it down because they feared for the safety of their families. Their effort was without success. Board of Health Minutes, 22 May 1832, AvQ B1, vol. 4; Bilson, Darkened House, 17–18. 48. Board of Health Minutes, 18–22, 24–26, 31 (quote) May 1832, AvQ B1, vol. 4. 49. Marianna O’Gallagher, Grosse Île: Gateway to Canada, 1832–1937 (Quebec: Carraig, 1984), 21–22; Heagerty, Four Centuries of Medical History in Canada, 1:180–81; Goulet and Paradis, Trois siècles d’histoire médicale au Québec, 210. 50. Bilson, Darkened House, 10; Military Secretary to Superintendent Quarantine, 26 Aug. 1832, Journal of the House of Assembly, Lower Canada, app. D, 25 Jan. 1833. 51. Board of Health Minutes, 17 May 1832, AvQ B1, vol. 4. 52. Board of Health Minutes, 2, 9, 17 May 1832, AvQ B1, vol. 4; Military Secretary to Superintendent of Quarantine, 6 June 1832, Journal of the House of Assembly, Lower Canada, app. D, 18 Jan. 1833; Bilson, Darkened House, 10–11. 53. Board of Health Minutes, 6, 8 June 1832, AvQ B1, vol. 4; Bilson, Darkened House, 22–23.

Notes to pages 62–73

271

54. O’Gallagher, Grosse Île, 25; Bilson, Darkened House, 9. 55. Board of Health Minutes, 9–11 June 1832, AvQ B1, vol. 4; Bilson, Darkened House, 33. 56. Bilson, Darkened House, 23–24; Quebec Mercury, 12, 14 Feb. 1832. 57. According to official statements by the Board of Health published in the local newspapers, 403 persons died in hospitals between 8 June and 22 June. This figure excludes all those who died in their homes. Quebec Mercury, 12–26 June 1832. 58. Board of Health Minutes, 11, 13 June 1832, AvQ B1, vol. 4. Chloride of lime has been used as a disinfectant since the eighteenth century. Alain Corbin, Le miasme et la jonquille: L’odorat et l’imaginaire social XVIIIe–XIXe siècles (Paris: Flammarion, 2008), 180–82. Its effectiveness was also an issue investigated by the British Central Board of Health. BNA PC 1/106. 59. Board of Health Minutes, 15 June 1832, AvQ B1, vol. 4. 60. Board of Health Minutes, 14–16 June 1832, AvQ B1, vol. 4; Bilson, Darkened House, 25. 61. Board of Health Minutes, 12 June 1832, AvQ B1, vol. 4. 62. Ibid. 63. Board of Health Minutes, 14 June 1832, AvQ B1, vol. 4; Board of Health Minutes, 19 June 1832, AvQ B1, vol. 9. 64. Board of Health Minutes, 15 June 1832, AvQ B1, vol. 4. 65. Board of Health Minutes, 9 Apr. 1832, 13 June 1832, AvQ B1, vol. 4. 66. Board of Health Minutes, 23 June 1832, AvQ B1, vol. 9. 67. Board of Health Minutes, 14 June 1832, AvQ B1, vol. 4. 68. Bilson, Darkened House, 25–26; Quebec Mercury, 19, 28 June 1832. 69. Board of Health Minutes, 16 June 1832, AvQ B1, vol. 4; Board of Health Minutes, 20, 23 June 1832, 3, 4 July 1832, AvQ B1, vol. 9. 70. Board of Health Minutes, 16 June 1832, AvQ B1, vol. 4; Board of Health Minutes, 20, 23 June 1832, 3, 4 July 1832, AvQ B1, vol. 9. 71. Board of Health Minutes, 17 June 1832, AvQ B1, vol. 4. 72. Board of Health Minutes, 19 June 1832, AvQ B1, vol. 9; O’Gallagher, Grosse Île, 26. 73. Board of Health Minutes, 12, 14, 15 June 1832, AvQ B1, vol. 4; Board of Health Minutes, 21 June 1832, AvQ B1, vol. 9. 74. Board of Health Minutes, 12 June 1832, AvQ B1, vol. 4. 75. Board of Health Minutes, 11 June 1832, AvQ B1, vol. 4. 76. Board of Health Minutes, 18 June 1832, AvQ B1, vol. 4; Board of Health Minutes, 19, 20, 23, 25, 27 June 1832, AvQ B1, vol. 9; Bilson, Darkened House, 35–36. 77. Board of Health Minutes, 12, 13, 18 June 1832, AvQ B1, vol. 4. 78. Board of Health Minutes, 24, 25 June 1832, 3, 5–7, 11, 13, 31 July 1832, AvQ B1, vol. 9.

272

Notes to pages 73–82

79. Board of Health Minutes, 22 June 1832, 13 July 1832, AvQ B1 vol. 9. The master and the mate of one of the vessels concerned ultimately received no punishment. Since the solicitor general was absent from Quebec, the whole process would have become overly expensive. Board of Health Minutes, 9 Aug. 1832, AvQ B1, vol. 9. 80. Board of Health Minutes, 14, 19, 20, 27 July 1832, AvQ B1, vol. 9. 81. Board of Health Minutes, 23, 24, 31 July 1832, 11 Aug. 1832, AvQ B1, vol. 9. 82. Board of Health Minutes, 27 June 1832, 12, 17 July 1832, AvQ B1, vol. 9. 83. Board of Health Minutes, 7, 10, 14, 20, 21, 24, 27 July 1832, 20, 26 Aug. 1832, AvQ B1, vol. 9. 84. Bilson, Darkened House, 39–40. 85. Bilson, Darkened House, 43; Board of Health Minutes, 22, 24, 25, 28, 30 Aug. 1832, 1, 4, 6 Sept. 1832, AvQ B1, vol. 9. 86. Board of Health Minutes, 23, 30 June 1832, AvQ B1, vol. 9; Samuel Jackson, Charles D. Meigs, and Richard Harlan, Report of the Commission Appointed by the Sanitary Board of the Crisis Council, to Visit Canada, for the Investigation of the Epidemic Cholera, Prevailing in Montreal and Quebec (Philadelphia: Mifflin & Parry, 1832), 5–18. 87. Board of Health Minutes, 12 June 1832, AvQ B1, vol. 4. 88. Board of Health Minutes, 24 June 1832, AvQ B1, vol. 9. 89. Board of Health Minutes, 29 Sept. 1832, AvQ B1, vol. 10. 90. Board of Health Minutes, 13 Sept. 1832, AvQ B1, vol. 9. 91. Board of Health Minutes, 13, 22 Sept. 1832, AvQ B1, vol. 9; Board of Health Minutes, 29 Sept. 1832, 6 Oct. 1832, AvQ B1, vol. 10. 92. Board of Health Minutes, 29 Sept. 1832, 9, 13, 27, 29 Oct. 1832, AvQ B1, vol. 10. 93. Board of Health Minutes, 9 Oct. 1832, 3, 6 Nov. 1832, AvQ B1, vol. 10. 94. Board of Health Minutes, 17 Nov. 1832, AvQ B1, vol. 10. 95. Duperron, “Le choléra à Québec en 1832,” 88. 96. Report of the Board of Health, 31 Dec. 1832, Journal of the House of Assembly, Lower Canada, app. D, 25 Jan. 1833. 97. Antonio Drolet, De l’incorporation à la Confédération, vol. 3 of La ville de Québec: Histoire municipale, ed. Société historique de Québec (Quebec: Société historique de Québec, 1983), 9; Ruddel, Quebec City, 233–38. 98. Drolet, De l’incorporation à la Confédération, 70; Goulet and Paradis, Trois siècles d’histoire médicale au Québec, 214. 99. Bilson, Darkened House, 65–66; Drolet, De l’incorporation à la Confédération, 70; O’Gallagher, Grosse Île, 35–39. 100. Report of the Standing Committee on Public Accounts, Journal of the House of Assembly, Lower Canada, 11 Feb. 1834; Governor-in-Chief to Colonial Secretary, 1 July 1834, BNA CO 42/252.

Notes to pages 82–90

273

101. City Council Minutes, 30 May 1834, AvQ QP1-1/pv.1671; City Council to Government, 5 June 1834, AvQ QP1-1/corr.; Bilson, Darkened House, 67–68. 102. City Council Minutes, 30 May 1834, AvQ QP1-1/pv.1671; City Council to Government, 5 June 1834, AvQ QP1-1/corr. 103. Bilson, Darkened House, 69. 104. City Council Minutes, 11 July 1834, AvQ QP1-1/pv.1774; City Council to Mayor of New York, 24 July 1834, AvQ QP1-1/corr; Bilson, Darkened House, 69–72. 105. City Council Minutes, 11 July 1834, AvQ QP1-1/pv.1774; Sylvio LeBlond, “L’hôpital de la Marine,” Union médicale du Canada 80 (1951); Antonio Drolet, “Un hôpital municipal à Québec en 1834,” in Trois siècles de médecine québécoise, ed. Yolande Bonenfont et al. (Quebec: Société historique de Québec, 1970), 66–69; Goulet and Paradis, Trois siècles d’histoire medicale au Québec, 80–81. 106. City Council Minutes, 14, 15 July 1834, AvQ QP1-1/pv.1782–83; City Council to Government, 15 July 1834, AvQ QP1-1/corr. 107. City Council to Government, 19 July 1834, AvQ QP1-1/corr; City Council Minutes, 1 Aug. 1834, AvQ QP1-1/pv.1807. 108. City Council Minutes, 1 Aug. 1834, AvQ QP1-1/pv.1807–8; 15 Aug. 1834, AvQ QP1-1/pv.1838; 26 Sept. 1834, AvQ QP1-1/pv.1919–20; 30 Oct. 1834, AvQ QP1-1/pv.39–41; 18 Nov. 1834, AvQ QP1-1/pv.75–76.

Chapter 3. Frequent Visitations: Quebec City, 1840–1854 1. Christopher Hamlin, Public Health and Social Justice in the Age of Chadwick: Britain, 1800–1854 (Cambridge: Cambridge Univ. Press, 1998), chaps. 1–4; Hamlin, “Edwin Chadwick, ‘Mutton Medicine,’ and the Fever Question,” Bulletin of the History of Medicine 70 (1996). 2. John V. Pickstone, “Dearth, Dirt and Fever Epidemics: Rewriting the History of British ‘Public Health,’ 1780–1850,” in Epidemics and Ideas: Essays on the Historical Perception of Pestilence, ed. Terence Ranger and Paul Slack (Cambridge: Cambridge Univ. Press, 1992). 3. Hamlin, Public Health and Social Justice, chaps. 7–10. 4. Perry Williams, “The Laws of Health: Women, Medicine and Sanitary Reform, 1850–1890,” in Science and Sensibility: Gender and Scientific Enquiry, 1780–1945, ed. Marina Benjamin (Oxford: Basil Blackwell, 1991). 5. John Hare, Marc Lafrance, and David-Thiery Ruddel, Histoire de la ville de Québec (Montreal: Boréal, 1987), 294–95; Antonio Drolet, De l’incorporation à la Confédération, vol. 3 of La ville de Québec: Histoire municipale, ed. Société historique de Québec (Quebec: Société historique de Québec, 1983), 27; Michael Ernest McCulloch, “The Defeat of Imperial Urbanism in Quebec City, 1840–1855,” Urban History Review 22 (1993): 20.

274

Notes to pages 90–104

6. Hare, Lafrance, and Ruddel, Histoire de la ville de Québec, 295–96; Drolet, De l’incorporation à la Confédération, 31–33. 7. Alan Greer, The Patriots and the People (Toronto: Univ. Toronto Press, 2003), chaps. 10–11; Jean Hamelin, Histoire du Québec (Toulouse: Privat, 1976), 331–53; Yves Lamonde, Histoire sociale des idées, au Québec (Montreal: Fides, 2000), vol. 1, chaps. 4 and 7. For a comprehensive account of the development toward responsible government in British North America as well as in Britain, see Phillip A. Buckner, The Transition to Responsible Government: British Policy in British North America, 1815–1850 (Westport, CT: Greenwood Press, 1985). 8. Hare, Lafrance, and Ruddel, Histoire de la ville de Québec, 235–38, 240–42; McCulloch, “Defeat of Imperial Urbanism.” 9. Hare, Lafrance, and Ruddel, Histoire de la ville de Québec, 192–99; Robert J. Grace, “Irish Immigration and Settlement in a Catholic City: Quebec, 1842–1861,” Canadian Historical Review 84 (2003). 10. Hare, Lafrance, and Ruddel, Histoire de la ville de Québec, 222–28; Drolet, De l’incorporation à la Confédération, 35–37. 11. Denis Goulet and André Paradis, Trois siècles d’histoire médicale au Québec: Chronologie des institutions et des pratiques (1639–1919) (Montreal: VLB, 1992), 396–403; Charles-Marie Boissonault, “Création de deux écoles de médecine au Québec,” in Trois siècles de médecine québécoise, ed. Yolande Bonenfont et al., 70–74 (Quebec: Société historique de Québec, 1970); H. E. Macdermot, One Hundred Years of Medicine in Canada, 1867–1967 (Toronto: McClelland and Stewart, 1967), 97–99. 12. Goulet and Paradis, Trois siècles d’histoire médicale au Québec, 317. 13. Ibid., 318, 323; Jacques Bernier, La médecine au Québec: Naissance et évolution d’une profession (Quebec: Presses de l’Université Laval, 1989), 85–86. 14. Bernier, La médecine au Québec, 86; Joseph Workman, Medical Inaugural Dissertation on Asiatic Cholera (Montreal: Andrew H. Armour, 1835). 15. Michael Quigley, “Grosse Ile,” Eire—Ireland 32 (1997); Marianna O’Gallagher, Grosse Île: Gateway to Canada, 1832–1937 (Quebec: Carraig, 1984), 50–58; Goulet and Paradis, Trois siècles d’histoire médicale au Québec, 218. 16. Bye-Law to Establish a Board of Health in the City of Quebec and to Provide Sanitary Measures therein, 24 May 1847; and Board of Health to City Council, 27 Aug. 1847, both in AvQ QP1-4/63_3; Secretary, Quebec Board of Health, to Mayor of Quebec, 27 May 1847; and Government Emigration Office to Quebec Board of Health, 18, 28 June 1847, both in AvQ QC3/2G-559/1. 17. Report of the Health Committee, 1848, AvQ QP1-4/31_5. 18. Ibid. 19. Board of Health Minutes, 15 Dec. 1848, 10 Jan. 1849, AvQ QC3/2A-547. 20. Report Health Committee, 1848, QP1-4/31_5.

Notes to pages 104–109

275

21. Joseph Painchaud, Extrait d’une lecture sur le choléra asiatique (Quebec: Imprimerie du “Canadien,” 1849); G. Russell, On the Operation of Physical Agencies in the Functions of Organized Bodies, with Suggestions as to the Nature of Cholera, 2nd ed. (Montreal: J. C. Becket, 1849). 22. Report of the Board of Health, 15 Jan. 1849, AvQ QP1-4/63_3; Journal of the Legislative Assembly of the Province of Canada, 5 Apr. 1849 (available at Library Archives Canada, Ottawa); Geoffrey Bilson, A Darkened House: Cholera in Nineteenth-Century Canada (Toronto: Univ. of Toronto Press, 1980), 115–16. 23. City Council to Jean Chabot, MPP, 2 Apr. 1849, AvQ QP1-1/corr. 24. Board of Health Minutes, 7, 10, 16, 24 May 1849, 2 June 1849, AvQ QC3/2A-547; Bilson, Darkened House, 126; Drolet, De l’incorporation à la Confédération, 72–73. 25. Advertisement, 8 June 1849, AvQ QC3/2A-547; Drolet, De l’incorporation à la Confédération, 73. 26. City Council to R. Symes, 9 June 1849, AvQ QP1-1/corr. 27. Report of the Health Officer, 14 June 1849, AvQ QP1-4/63_3. 28. Report of the Health Officer, 21 June 1849, AvQ QP1-4/63_3. 29. Board of Health Minutes, 10, 11 July 1849, AvQ QC3/2A-547; City Council to R. Symes, 9 June 1849, AvQ QP1-1/corr; City Council to Members of the Quebec Board of Health, 10 July 1849, AvQ QP1-1/corr; Board of Health to City Council, 6 July 1849, AvQ QP1-4/63_3; Quebec Morning Chronicle, 16 July 1849. 30. Bilson, Darkened House, 126–27. The 1849 cholera epidemic has been described in Sylvio LeBlond, “Le cholera à Québec en 1849,” Canadian Medical Association Journal 71 (1954). 31. Board of Health Minutes, 10 July 1849, AvQ QC3/2A-547. 32. Board of Health Minutes, 11 July 1849, 17 Aug. 1849, AvQ QC3/2A-547. 33. Board of Health Minutes, 10, 11, 13 July 1849, 10, 25 Aug. 1849, 6 Sept. 1849, AvQ QC3/2A-547; Board of Health to City Council, 13 July 1849, AvQ QP1-1/corr. 34. Report of the Road Surveyor to Board of Health, 20 July 1849, AvQ QC3/2G-559/4. 35. Board of Health Minutes, 17, 19, 22, 24, 31 July 1849, 1 Aug. 1849, AvQ QC3/2A-547; Report of the Road Surveyor to Board of Health, 20 Aug. 1849; Report of the Health Officer to Board of Health, 1 Aug. 1849; and Petition of Inhabitants of Saint-Valier and Saint-Pierre Wards, n.d., all in AvQ QC3/2G-559/4. 36. Board of Health Minutes, 2, 14, 17, 18 Aug. 1849, AvQ QC3/2A-547. 37. Board of Health Minutes, 14, 24 July 1849, 7, 14 Aug. 1849, AvQ QC3/2A-547. 38. The classical analysis of the connection between anticontagionism and political or commercial interests is Erwin H. Ackerknecht, “Anticontagionism between 1821 and 1867,” Bulletin of the History of Medicine 22 (1948). This seminal article is dis-

276

Notes to pages 109–115

cussed in Roger Cooter, “Anticontagionism and History’s Medical Record,” in The Problem of Medical Knowledge: Examining the Social Construction of Medicine, ed. Peter Wright and Andrew Teacher (Edinburgh: Edinburgh Univ. Press, 1982), 87–108. For recent views on Ackerknecht’s hypothesis, see Peter Baldwin, Contagion and the State in Europe, 1830–1930 (Cambridge: Cambridge Univ. Press, 1999), chap. 1; and Christopher Hamlin, “Ackerknecht and ‘Anticontagionism’: A Tale of Two Dichotomies,” International Journal of Epidemiology 38 (2009). 39. The references in the Quebec Morning Chronicle to diverse European publications on cholera are frequent. If their argument supported the editor’s claims, he also quoted experts who in the British context would figure as opponents to Chadwick’s brand of sanitary reform. Quebec Morning Chronicle, 4, 13, 16, 20, 23, 27, 30 July 1849, 14 Aug. 1849, 4 Sept. 1849. On the Quebec Morning Chronicle, see André Beaulieu and Jean Hamelin, La presse québécoise des origines à nos jours (Quebec: Presses de l’Université Laval, 1973–90), 1:153–57. 40. Board of Health Minutes, 19 July 1849, AvQ QC3/2A-547. 41. Board of Health Minutes, 11, 12, 13 July 1849, AvQ QC3/2A-547; Bilson, Darkened House, 125–26. 42. Board of Health Minutes, 11, 12, 14, 18, 21 July 1849, 12 Aug. 1849, AvQ QC3/2A-547; Petition of Inhabitants of St. Roch to Board of Health, 17 July 1849, AvQ QC3/2G-559/4. 43. Board of Health Minutes, 11, 13, 21, 22, 27 July 1849, AvQ QC3/2A-547. House-to-house visitations had been in use in France previously but were practiced in Britain only during the 1848 cholera epidemic. Baldwin, Contagion and the State, 137–38. 44. Board of Health Minutes, 17, 23, 29 July 1849, AvQ QC3/2A-547. 45. In the month following the reconstitution of the board, when the epidemic was at its height, only six complaints reached the board. Board of Health Minutes, 13, 19, 14 July 1849, 3, 7, 8 Aug. 1849, AvQ QC3/2A-547. 46. Board of Health Minutes, 1 Aug. 1849, AvQ QC3/2A-547. 47. Board of Health Minutes, 31 July1849, 1 Aug. 1849, AvQ QC3/2A-547. 48. Another house in Saint-Roch received similar attention. Board of Health Minutes, 4, 6 Aug. 1849, AvQ QC3/2A-547. 49. Board of Health Minutes, 14 Aug. 1849, AvQ QC3/2A-547; George Baldwin, Report on Supplying the City of Quebec with Pure Water: Made for the City Council by Order of George Okill Stuart, Esq., Mayor of Quebec (Boston: Charles C. Little and James Brown, 1848), 29. 50. Board of Health Minutes, 30 July 1849, 3, 4, 6, 8 Aug. 1849, AvQ QC3/2A-547; Report of the Road Surveyor to Board of Health, 20, 30 July 1849, AvQ QC3/2G-559/4.

Notes to pages 115–119

277

51. Board of Health Minutes, 8, 10, 11, 13 Aug. 1849, AvQ QC3/2A-547. 52. “Report of Special Committee of the Board of Health on a Better System of Drainage for the City of Quebec,” Quebec Morning Chronicle, 17 Aug. 1849. 53. Ibid. 54. Ibid. 55. Board of Health Minutes, 15, 17, 21 Aug. 1849, AvQ QC3/2A-547; Board of Health to Drs. Seguin and Rinfret, 29 Aug. 1849; and Board of Health to Drs. Bardy, Carrier, and Robitaille, 8 Sept. 1849, both in AvQ QP1-1/corr. 56. Board of Health Minutes, 10, 14, 23, 24, 27 Aug. 1849, 7, 8 Sept. 1849, AvQ QC3/2A-547; Board of Health to McCaffry, 8 Sept. 1849, AvQ QP1-1/corr. 57. Board of Health Minutes, 11, 19 Sept. 1849, AvQ QC3/2A-547; Board of Health to Health Officer, 29 Sept. 1849, AvQ QP1-1/corr. 58. Health Committee Minutes, 26 Aug.–10 Sept. 1851, AvQ QP1-3/3F-1639. 59. Health Committee Minutes, 11 Sept. 1849–7 Nov. 1851, AvQ QP1-3/3F-1639; Board of Health Minutes, 12–15 Sept. 1851, AvQ QC3/2A-547; City Council Minutes, 21 May 1852, AvQ QP1-1/pv; City Council to Russell, 5 July 1852, AvQ QP11/corr. 60. Health Committee Minutes, 29 Sept.–2 Oct. 1852, AvQ QP1–3/3F-1639; Report of the Health Committee, 23 Nov. 1852, AvQ QP1-4/31_5. 61. Gérald Gagnon, Histoire du service de police de la ville de Québec (Quebec: Publications du Québec, 1998), 38–40; John J. Heagerty, Four Centuries of Medical History in Canada and a Sketch of the Medical History of Newfoundland (Toronto: Macmillan, 1928), 1:202–3. 62. Baldwin, Report on Supplying the City of Quebec; Hare, Lafrance, and Ruddel, Histoire de la ville de Québec, 295–96; Drolet, De l’incorporation à la Confédération, 29. 63. Much of the capital for the project was acquired in London, where an agent and Baring Brothers raised the money for the Corporation of Quebec. Water Works Committee, 26 Mar. 1851, 18 Nov. 1851, 30 Jan. 1852, and several other occasions, AvQ QD2-01/1091; Hare, Lafrance, and Ruddel, Histoire de la ville de Québec, 296; Drolet, De l’incorporation à la Confédération, 29. Montreal also invested in water works at this time; see François Guérard, Histoire de la santé au Québec (Montreal: Boréal, 1996), 29. 64. Water Works Committee Minutes, 2, 10, 16 Nov. 1850, AvQ QD2-01/1091. 65. Water Works Committee Minutes, 23 Nov. 1850, 2, 5, 17 Dec. 1850, 27 Mar. 1851, 30 Apr. 1851, 27 May 1851, 27 Sept. 1851, 4, 18 Nov. 1851, 13 Jan. 1852, 2 Mar. 1852, AvQ QD2-01/1091. 66. Water Works Committee Minutes, 14 Dec. 1850, 19, 27 Feb. 1851, 8 Apr. 1851, AvQ QD2-01/1091. 67. A few early examples of the land-acquisition efforts include the following:

278

Notes to pages 119–123

Water Works Committee Minutes, 27 Feb. 1851, 1, 16, 22 Apr. 1851, 21 June 1851, AvQ QD2-01/1091. 68. Water Works Committee Minutes, 27 May 1851, 14 July 1851, 1 June 1852, AvQ QD2-01/1091. 69. Water Works Committee Minutes, 18, 27 May 1852, 1 June 1852, AvQ QD201/1091; Quebec Morning Chronicle, 13 May 1852; Hare, Lafrance, and Ruddel, Histoire de la ville de Québec, 296; Drolet, De l’incorporation à la Confédération, 29. 70. “If it was necessary to introduce good water into every house, it was also necessary to drain each property to keep the city clean.” Tessier quoted in Hare, Lafrance, and Ruddel, Histoire de la ville de Québec, 296. 71. Hare, Lafrance, and Ruddel, Histoire de la ville de Québec, 296; Drolet, De l’incorporation à la Confédération, 29. 72. Water Works Committee Minutes, 15, 16 Mar. 1853, AvQ QD2-01/1091. 73. Water Works Committee Minutes, 28 June 1853, AvQ QD2-01/1091; Manager of Water Works to Road Surveyor, 20 May 1853; and Manager to W. & D. Bell, 6 July 1853, 23 Aug. 1853, all in AvQ QD2-03-A/1102. 74. Water Works Committee Minutes, 18 Oct. 1853, AvQ QD2-01/1091. 75. Water Works Committee Minutes, 18 Oct. 1853, 15 Nov. 1853, AvQ QD201/1091; Manager of Water Works to Road Surveyor, 19 Oct. 1853, AvQ QD203-A/1102. 76. Water Works Committee Minutes, 29 Aug. 1854, AvQ QD2-01/1091; Manager of Water Works to Assistant Engineer, 21 Dec. 1853; and Manager to Chief Engineer, 7 Mar. 1854, both in AvQ QD2–03-A/1102. 77. Water Works Committee Minutes, 14 Nov. 1854, 30 Jan. 1855, 20 Feb. 1855, AvQ QD2-01/1091; Drolet, De l’incorporation à la Confédération, 29. 78. Drolet, De l’incorporation à la Confédération, 22–24, 28. 79. Report of the Health Committee, 23 Nov. 1852, AvQ QP1-4/31_5; Heagerty, Four Centuries of Medical History in Canada, 1:203. 80. “ . . . to do everything that would be necessary, in these circumstances, for the good of the public health.” Board of Health to City Council, 6 May 1854, AvQ QP1-4/31_5. The thinking of the municipal authorities is apparent in Wolfred Nelson, Practical Views on Cholera, and on the Sanitary, Preventive and Curative Measures to Be Adopted in the Event of a Visitation of the Epidemic (Montreal: B. Dawson, 1854). Dr. Nelson was at the time mayor of Montreal, and his pamphlet was published under the auspices of the Board of Health to advise the city’s population. 81. City Council Minutes, 19 May 1854, AvQ QP1-1/pv.100; City Council Minutes, 26 May 1854, AvQ QP1-1/pv.112; City Council Minutes, 7 June 1854, AvQ QP1-1/pv.156; City Council Minutes, 9 June 1854, AvQ QP1-1/pv.169; Bilson, Darkened House, 132.

Notes to pages 123–126

279

82. Bilson, Darkened House, 132. 83. City Council Minutes, 30 June 1854, AvQ QP1-1/pv.203; City Council Minutes, 18 July 1854, AvQ QP1-1/pv.209; Report of the Board of Health, 21 July 1854, AvQ QP1-4/31_5; Bilson, Darkened House, 132–33. 84. Board of Health Minutes, 20 July 1854–22 Sept. 1854, AvQ QC3/2A-547.

Chapter 4. The Advent of Sanitarianism: Madras, 1840–1857 1. David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: Univ. of California Press, 1993), 246–54. 2. Government to Court of Directors, 9 Aug. 1831, IOR/L/P&J/3/713. 3. Government to Court of Directors, 18 May 1832, IOR/L/P&J/3/714. 4. Arnold, Colonizing the Body, 248. 5. Government to Court of Directors, 30 May 1837, IOR/L/P&J/3/718; Government to Court of Directors, 18 Nov. 1843, IOR/L/P&J/3/723; Government’s reply to Court of Directors, 19 Feb. 1845, IOR/L/P&J/3/725; Government to Court of Directors, 22 Sept. 1848, IOR/L/P&J/3/728; Arnold, Colonizing the Body, 248. 6. Seán Lang, “Obstetrics and Obstruction: Maternity Provision in Madras, 1840–1852,” in From Western Medicine to Global Medicine: The Hospital beyond the West, ed. Mark Harrison, Margaret Jones, and Helen Sweet (Hyderabad: Orient BlackSwan, 2009), 108–9, 116–17. 7. Ibid., 120–22. 8. The dispute over the independent maternity hospital is retold in all its intricacies in ibid., 122–38. 9. Government to Court of Directors, 9 June 1845, IOR/L/P&J/3/725; Anil Kumar, Medicine and the Raj: British Medical Policy in India, 1835–1911 (New Delhi: SAGE, 1998), 19–20; Mel Gorman, “Introduction of Western Science into Colonial India: Role of the Calcutta Medical College,” Proceedings of the American Philosophical Society 132 (1988). 10. D. G. Crawford, A History of the Indian Medical Service 1600–1913 (London: Thacker, 1913), 2:446–48; Kumar, Medicine and the Raj, 37. 11. Crawford, History of the Indian Medical Service, 2:456–7. Contrary to Crawford’s claim, the publication of the Madras Quarterly Medical Journal continued at least until 1844. The successor publications were the Madras Journal of Medical Science (1851– 54), the Madras Quarterly Journal of Medical Science (1860–69), and the Madras Monthly Journal of Medical Science (1869–73). 12. Madras Medical Board, Report on the Medical Topography and Statistics of the Presidency Division of the Madras Army, including Fort St. George and Its Dependencies, within the Limits of the Supreme Court, Compiled from the Records of the Medical Board Office (Madras: Vepery Mission Press, 1842), i–iii. 13. Ibid., 3–9.

280

Notes to pages 126–133

14. Ibid., 17. 15. Medical Board to Government, 1 Nov. 1836; and Resolution of Government, 1 Nov. 1836, both in IOR/P/247/9, Pub. Cons., 1 Nov. 1836, nos. 32–33. 16. For a compilation of reports on cholera attacking the Madras Army, see Samuel Rogers, Reports on Asiatic Cholera in Regiments of the Madras Army from 1828 to 1844, with Introductory Remarks on Its Mode of Diffusion and Prevention, and Summary of the General Method of Treatment in India (London: Pelham Richardson and Samuel Highley, 1848). 17. On the civilizing mission, see Catherine Hall, Civilising Subjects: Metropole and Colony in the English Imagination, 1830–1867 (Cambridge: Polity, 2002); Boris Barth and Jürgen Osterhammel, eds., Zivilisierungsmissionen: Imperiale Weltverbesserung seit dem 18. Jahrhundert (Constance: UVK, 2005); Jürgen Osterhammel, Approaches to Global History and the Question of the “Civilizing Mission” (Osaka: Global History and Maritime Asia Working and Discussion Paper Series, 2006). On the civilizing mission with particular reference to India, see Harald Fischer-Tiné and Michael Mann, eds., Colonialism as Civilizing Mission: Cultural Ideology in British India (London: Anthem, 2004). 18. Grand Jury to Supreme Court, 29 Apr. 1825; Supreme Court to Governor in Council, 10 May 1825; Government to Justices in Sessions, 10 May 1825, all in IOR/P/245/64, 10 May 1825, nos. 4–6. 19. Madras Medical Board, Report on the Medical Topography, 3–4; Susan Neild, “Madras: Growth of a Colonial City in India, 1780–1840” (PhD diss., Univ. of Chicago, 1977), 134. 20. Neild, “Madras: Growth of a Colonial City,” 151, 305–7. 21. Government to Court of Directors, 8 June 1841, IOR/L/E/4/383. 22. Government to Public Department, London, 21 Jan. 1840, IOR/L/P&J/3/720. 23. Quoted in Court of Directors to Government, 21 Sept. 1842, IOR/L/E/4/958; Court of Directors to Government, 30 May 1843, IOR/L/E/4/959. 24. Court of Directors to Government, 18 July 1843, IOR/L/E/4/960. 25. Government to Court of Directors, 14 Nov. 1843, IOR/L/E/4/390. 26. Government to Public Department, London, 13 Feb. 1844, IOR/L/P&J/3/ 724; Government to Court of Directors, 13 May 1845, IOR/L/E/4/395. 27. Chief Engineer Boulderson to Justices in Session, 25 Aug. 1848; and Clerk of Peace to Government, 10 Nov. 1848, both in TNSA PP, 9 Jan. 1849, no. 10; Government to Public Department, London, 19 Feb. 1845, IOR/L/P&J/3/725; Government to Court of Directors, 13 Feb. 1849, IOR/L/E/4/409. 28. Quoted in Chief Engineer Boulderson to Justices in Session, 25 Aug. 1848, TNSA PP, 9 Jan. 1849, no. 10. 29. Chief Engineer Boulderson to Justices in Session, 25 Aug. 1848, TNSA PP, 9 Jan. 1849, no. 10; Government to Public Department, London, 29 June 1847, IOR/ L/P&J/3/727.

Notes to pages 134–138

281

30. Government to Public Department, London, 13 Feb. 1849, IOR/L/ P&J/3/729; Government to Public Department, London, 12 Aug. 1850, 11 Dec. 1850, IOR/L/P&J/3/730; Government to Public Department and answer, 1 Oct. 1851, IOR/L/P&J/3/731. 31. Major Smith to Justices in Session, 21 Aug. 1848; and Captain Boulderson to Justices in Session, 25 Aug. 1848, both in TNSA PP, 9 Jan. 1849, no. 10. 32. Committee to Examine the Plan of Capt. Boulderson to Government, 9 Feb. 1852, TNSA PP, 6 Apr. 1852, no. 25. 33. Ibid.; Court of Directors to Public Department, Madras, 1 Dec. 1851, IOR/ L/E/4/975; Court of Directors to Government, 14 Sept. 1853, IOR/L/E/4/979. 34. Committee to Examine the Plan of Capt. Boulderson to Government, 9 Feb. 1852, TNSA PP, 6 Apr. 1852, no. 25. 35. Ibid. 36. Ibid. 37. Ibid. 38. Memorandum of Pottinger, 16 Feb. 1852, TNSA PP, 6 Apr. 1852, no. 26. 39. Minute of Pottinger, 8 Mar. 1852, TNSA PP, 6 Apr. 1852, no. 29. 40. Minute of Thomas, 26 Feb. 1852, TNSA PP, 6 Apr. 1852, no. 27. 41. Minute of Elliot, 26 Feb. 1852, TNSA PP, 6 Apr. 1852, no. 28; Resolution of the Executive Council, n.d., TNSA PP, 6 Apr. 1852, no. 30. 42. Pottinger was not alone in this regard. Reluctance to interfere in Indian affairs was widespread among EIC officials and aided by the reluctance of Indians to pay for sanitary improvements by taxation if the authorities were eager for reform. Mark Harrison, “Public Health and Medicine in British India: An Assessment of the British Contribution,” Medical Historian 10 (1998): 36. 43. For Pottinger’s biography, see George Pottinger, Sir Henry Pottinger: The First Governor of Hong Kong (Stroud: Sutton, 1997). 44. Chadwick himself had promoted the civilizing power of sanitation for the British colonies; see Anthony Brundage, England’s “Prussian Minister”: Edwin Chadwick and the Politics of Government Growth, 1832–1854 (University Park: Pennsylvania State Univ. Press, 1988), 105. 45. My description of these views is based on Thomas R. Metcalf, Ideologies of the Raj (Cambridge: Cambridge Univ. Press, 1994), esp. chap. 2. 46. Military Board to Governor, 4 Aug. 1852, TNSA PP, 17 Aug. 1852, no. 5; Military Board to Governor, 8 Dec. 1852, TNSA PP, 7 Jan. 1853, no. 76; Military Board to Government, 24 Feb. 1853, TNSA PP, 15 Apr. 1853, no. 31; Clerk of the Peace to Government, 1 Mar. 1843, TNSA PP, 15 Apr. 1853, no. 32; Resolution of the Executive Council, 9 Apr. 1853, TNSA PP, 15 Apr. 1853, no. 53; Military Board to Government, 14 Apr. 1853, TNSA PP, 14 June 1853, no. 6. Cotton’s report, as well as other documents related to it, can be found in Report of a Committee on a Plan for Cleans-

282

Notes to pages 139–146

ing the Drains of Black Town (Madras: Asylum, 1856), IOR/V/23/147. 47. Military Board to Governor, 26 Apr. 1853, TNSA PP, 14 June 1853, no. 7. All subsequent quotations from the Military Board’s report come from this source. 48. One lakh is the equivalent of one hundred thousand. 49. Clerk of Peace to Government, 26 Apr. 1853, TNSA PP, 14 June 1853, no. 10. 50. Minute of Pottinger, 16 May 1853, TNSA PP, 14 June 1853, no. 9. 51. Minute of Elliot, 17 May 1853, TNSA PP, 14 June 1853, no. 10. 52. Minute of Pottinger, 23 May 1853, no. 11; Resolution Executive Council, n.d., TNSA PP, 14 June 1853, no. 26. 53. Military Board to Government, 1 July 1853, TNSA PP, 26 July 1853, no. 42. 54. Resolution of the Executive Council, n.d., TNSA PP, 26 July 1853, no. 43. 55. Medical Board to Government, 26 Aug. 1853, TNSA PP, 13 Sept. 1853, no. 26. 56. Clerk of Peace to Government, 27 Aug. 1853, TNSA PP, 13 Sept. 1853, no. 27. 57. Resolution of the Executive Council, 13 Sept. 1853, TNSA PP, 13 Sept. 1853, no. 28. 58. Military Board to Government, 31 Jan. 1854, TNSA PP, 7 Feb. 1854, no. 17. 59. Minute of Pottinger, 2 Feb. 1854; Minute of Thomas, n.d.; Resolution of the Executive Council, n.d., all in TNSA PP, 7 Feb. 1854, nos. 18–20. 60. Minute of Harris, 14 June 1854, TNSA PP, 27 June 1854, no. 28 (quote); Resolution of the Executive Council, 24 June 1854, TNSA PP, 27 June 1854, no. 29; Government to Public Department, 23 Oct. 1854, IOR/L/P&J/3/734. 61. P. P. O’Connell, Papers Connected with the Better Supply of Madras with Water, and the Improvement of the Drainage and Sewerage of Black Town (Madras: H. Smith, 1855), IOR/V/23/141. 62. Government to Court of Directors, 6 July 1855, IOR/L/E/4/434; Court of Directors to Government, 16 Sept. 1857, IOR/L/E/4/988. 63. The Chadwickian comprehensive system of integrated water supply and sewer lines came under attack in Britain at the same time the engineers in Madras were fighting for such a project. Ironically, in Britain the roles were reversed from what they were in India. In Britain many prominent civil engineers opposed Chadwick’s centralized schemes because they were based on theoretical considerations and unsupported claims of scientificity. The British engineers proposed local improvements based on the advantages and disadvantages of certain options under local circumstances. Debate over the superiority of pipes versus brick sewers was particularly intense. That the engineers in Madras took Chadwick’s position was probably due to their sources of sanitary knowledge (i.e., official reports written under Chadwick’s supervision) and their political situation. They were not independent entrepreneurs competing in a market but officers serving a powerful government that was the only possible source for such an assignment. See Christopher Hamlin, “Edwin Chadwick

Notes to pages 147–157

283

and the Engineers, 1842–1854: Systems and Antisystems in the Pipe-and-Brick Sewers War,” Technology and Culture 33 (1992). 64. Madras Medical Board, Deaths in Madras during 1855 (Madras: Fort St. George Press, 1858), v–ix; Government to Public Department, London, 7 June 1853, IOR/ L/P&J/3/733. 65. This might be true particularly for the Black Town; see Neild, “Madras: Growth of a Colonial City,” 148. 66. J. M. Bourne, “The East India Company’s Military Seminary, Addiscombe, 1809–1858,” Journal of the Society for the Army Historical Research 57 (1979). 67. Arthur Cotton, Public Works in India: Their Importance, With Suggestions for Their Extension and Improvement, 2nd ed. (London: Richardson Brothers, 1854).

Chapter 5. Sanitary Consensus at Last: Madras, 1858–1883 1. Jharna Gourlay, Florence Nightingale and the Health of the Raj (Aldershot: Ashgate, 2003), 24–27. 2. Royal Commission on the Sanitary Condition of the Army, Report of the Commissioners Appointed to Inquire into the Regulations Affecting the Sanitary Condition of the Army, the Organization of Military Hospitals, and the Treatment of the Sick and Wounded, with Evidence and Appendix (London: Eyre and Spottiswoode, 1858). 3. Robin J. Moore, “Imperial India, 1858–1914,” in The Nineteenth Century, vol. 3 of The Oxford History of the British Empire, ed. Andrew Porter (Oxford: Oxford Univ. Press, 1999), 427–49. 4. Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859–1914 (Cambridge: Cambridge Univ. Press, 1994), 60–61; Radhika Ramasubban, “Imperial Health in British India, 1857–1900,” in Disease, Medicine, and Empire: Perspectives on Western Medicine and the Experience of European Expansion, ed. Roy MacLeod and Milton Lewis (London: Routledge, 1988), 39–40. 5. Gourlay, Florence Nightingale and the Health of the Raj, 28–45. 6. Royal Commission on the Sanitary State of the Army in India, Report of the Commissioners, 2 vols. (London: Eyre and Spottiswoode, 1863). 7. Royal Commission on the Sanitary State of the Army in India, Report of the Commissioners, 1:290–95. 8. Ibid., 1:295; Harrison, Public Health in British India, 66. 9. Royal Commission on the Sanitary State of the Army in India, Report of the Commissioners, 1:293–95, 2:301–3. How a narrowed and embanked Cooum River would have coped with the monsoon flooding will remain Trevelyan’s secret. 10. Royal Commission on the Sanitary State of the Army in India, Report of the Commissioners, 1:416, 420–21. 11. Ibid., 1:v–lxx; Mark Harrison, “The ‘Tender Frame of Man’: Disease, Cli-

284

Notes to pages 159–167

mate, and Racial Difference in India and the West Indies, 1760–1860,” Bulletin of the History of Medicine 70 (1996): 88–89. 12. Royal Commission on the Sanitary State of the Army in India, Report of the Commissioners, 1:lxx–lxxix. Regarding contemporary considerations on acclimatization and its limits for Europeans, see Harrison, Public Health in British India, 49–51, 61–65. 13. Harrison, Public Health in British India, 65. Nightingale remained interested in sanitation in India and lobbied for investment in sanitary infrastructure. She later published the dramatically titled treatise Life and Death in India (London: Spottiswoode, 1874). 14. Justices in Sessions to Government, 7 Feb. 1856; and Resolution, 2 Apr. 1856, Pub. Cons., 8 Apr. 1856, both in nos. 7–8, IOR/P/249/52; Justices in Sessions to Government, 10 July 1856, Pub. Cons., 22 July 1856, no. 48, IOR/P/249/55; Municipal Commissioners to Government, June 1858; and Government Order, 9 July 1858, Pub. Cons., 13 July 1858, all in nos. 35–36, IOR/P/249/67. 15. William R. Cornish, “Fifth Annual Report on the Cause of Death in Madras during the Year 1859,” Madras Quarterly Journal of Medical Science 3 (1961). 16. Report of Cornish, 27 June 1859, Pub. Cons., 15 July 1859, no. 5, IOR/P/249/69. 17. Government Order, 22 Aug. 1861, Pub. Cons., 22 Aug. 1861, no. 166, IOR/P/249/76; Medical Department to Government, 23 Aug. 1861; and Government Order, 5 Sept. 1861, both in Pub. Cons., 5 Sept. 1861, nos. 15–16, IOR/P/249/76. 18. Medical Department, 26 Sept. 1861; and Government Order, 1 Nov. 1861, both in Pub. Cons., 1 Nov. 1861, nos. 8–9, IOR/P/249/76. 19. Madras Sanitary Committee, 2 June 1860; and Order, 22 June 1860, both in Pub. Cons., 22 June 1860, nos. 194–95, IOR/P/249/74. 20. Madras Sanitary Report, 1865, 1–5; Ramasubban, “Imperial Health in British India,” 42–43, 65–66. 21. The administrative changes can be easily traced in the annual reports of the Sanitary Commission or later the Sanitary Commissioners. See Madras Sanitary Report, 1864–1910. 22. Commissioner of Police to Governor, 3 Jan. 1866; and Government Order, 24 Apr. 1866, both in TNSA PP, 24 Apr. 1866, nos. 88–89; Madras Sanitary Report, 1865, 1866; Harrison, Public Health in British India, chap. 3. 23. An extensive preliminary set of “Rules to Be Observed in Outbreaks of Cholera” can be found in Madras Sanitary Report, 1867, 66–70. 24. Ramasubban, “Imperial Health in British India,” 43; Harrison, Public Health in British India, 8–9. 25. The Army Sanitary Commission’s memoranda were analyses of the annual

Notes to pages 167–172

285

Sanitary Report. The commission members, many of them renowned sanitarians, evaluated in detail the work done during the previous year. Whenever the commission spotted negligence or delay, the judgment was harsh. It then offered advice on how to improve practice in the future. Harrison, Public Health in British India, 105. For an early example regarding Madras, see Army Sanitary Commission to India Office, 1 Mar. 1871, IOR/L/E/2/93. 26. Harrison, Public Health in British India, 78; Madras Sanitary Report, 1875–83. 27. In the Sanitary Report for 1877, the Sanitary Commissioner reflected on this cycle when confronted with the most severe epidemic in decades. Madras Sanitary Report, 1877, 84–87. 28. Ramasubban, “Imperial Health in British India,” 42–43. 29. Harrison, Public Health in British India, 51–52; Christopher Hamlin, “Providence and Putrefaction: Victorian Sanitarians and the Natural Theology of Health and Disease,” in Energy and Entropy: Science and Culture in Victorian Britain, ed. Patrick Brantlinger (Bloomington: Indiana Univ. Press, 1989), 96–102; Hamlin, Cholera: The Biography (Oxford: Oxford Univ. Press, 2009), 179–99. 30. This was at least the opinion of W. R. Cornish in his mortality report for the year 1859. Cornish, “Fifth Annual Report on the Cause of Death in Madras during the Year 1859,” 80–81. 31. Harrison, Public Health in British India, 100–101. Cholera was classified as a zymotic disease alongside fevers, smallpox, dysentery, and diarrhea. See Cornish, “Fifth Annual Report on the Cause of Death in Madras during the Year 1859,” 76. 32. Harrison, Public Health in British India, 52–54. 33. Norman Howard-Jones, The Scientific Background of the International Sanitary Conferences 1851–1938 (Geneva: World Health Organization, 1975); Valeska Huber, “The Unification of the Globe by Disease? The International Sanitary Conferences on Cholera, 1851–1894,” Historical Journal 49 (2006). 34. Harrison, Public Health in British India, 117–18. 35. Howard-Jones, Scientific Background of the International Sanitary Conferences, 3–34; Huber, “Unification of the Globe by Disease?,” 462–64; A. H. Leith, ed., Abstract of the Proceedings and Reports of the International Sanitary Conference of 1866 (Bombay: Revenue Office, 1867), 93–106. 36. Howard-Jones, Scientific Background of the International Sanitary Conferences, 31; Hamlin, Cholera, 204–8; Harrison, Public Health in British India, 15–35. 37. Editorial, Indian Medical Gazette 4 (1969): 56–57; Memorandum, Army Sanitary Commission, 12 Apr. 1869, IOR/L/E/3/174; Jeremy D. Isaacs, “D D Cunningham and the Aetiology of Cholera in British India, 1869–1897,” Medical History 42 (1998): 281–85. 38. Hamlin, Cholera, 199–201; Peter Baldwin, Contagion and the State in Europe, 1830–1930 (Cambridge: Cambridge Univ. Press, 1999), 143–46. Pettenkofer’s chol-

286

Notes to pages 173–177

era theory has not received much attention among historians, despite its importance during his lifetime and its ubiquity in histories of cholera. Martin Weyer–von Schoultz, Max von Pettenkofer (1818–1901): Die Entstehung der modernen Hygiene aus den empirischen Studien menschlicher Lebensgrundlagen (Frankfurt: Peter Lang, 2006) attempts a rehabilitation. 39. Army Sanitary Commission to India Office, 18 May 1871, IOR/L/E/2/93; Harrison, Public Health in British India, 100–102, 105–8; Ira Klein, “Cholera: Theory and Treatment in Nineteenth Century India,” Journal of Indian History 58 (1980): 38–39. Bryden formulated his research program before he became the statistical officer to the Sanitary Commissioner in front of a “Professional Conference” at Simla; it was later published as James L. Bryden, “Suggestions for the Systematic Study of the History and Relations of Cholera,” Indian Medical Gazette 1 (1866). Some of Bryden’s reports are compiled in James L. Bryden, Cholera Epidemics of Recent Years Viewed in Relation to Former Epidemics: A Record of Cholera in the Bengal Presidency from 1817 to 1872 (Calcutta: Superintendent of Government Printing, 1874). 40. Timothy Richards Lewis and David Douglas Cunningham, A Report on Microscopical and Physiological Researches into the Nature of the Agent or Agents Producing Cholera (Calcutta: Office of the Superintendent of Government Printing, 1872); Lewis and Cunningham, A Report on Microscopical and Physiological Researches into the Nature of the Agent or Agents Producing Cholera (Second Series) (Calcutta: Office of the Superintendent of Government Printing, 1874). 41. Timothy Richards Lewis and David Douglas Cunningham, Cholera in Relation to Certain Physical Phenomena: A Contribution towards the Special Enquiry Sanctioned by the Right Hon. the Secretaries of State, for War, and for India (Calcutta: Office of the Superintendent of Government Printing, 1878), 1–6, 97–115 (quote, 97). 42. Max Pettenkofer, Verbreitungsart der Cholera in Indien: Ergebnisse der neuesten aetiologischen Untersuchungen in Indien (Braunschweig: Vieweg, 1871); “Dr. Douglas Cunningham’s Untersuchungen über Pettenkofer’s Theorie auf Madras angewendet” (editorial), Zeitschrift für Biologie 8 (1972); Isaacs, “D D Cunningham and the Aetiology of Cholera,” 287. 43. Thomas W. Hime, introduction to Cholera: How to Prevent and Resist It, by Max von Pettenkofer (London: Ballière, Tindall and Cox, 1875), 5–7; Isaacs, “D D Cunningham and the Aetiology of Cholera,” 288–90. 44. John Chandler Hume Jr., “Colonialism and Sanitary Medicine: The Development of Preventive Health Policy in the Punjab, 1860 to 1900,” Modern Asian Studies 20 (1986): 710–17; Harrison, Public Health in British India, 102–5, 109 (quote, 103). 45. William R. Cornish, Report on the Cholera in South India for the Year 1869 (Madras: Sanitary Commissioner, 1870), esp. 141–43; Cornish, Cholera in South India: A Record on the Progress of Cholera in 1870 and Résumé of the Records on Former Epidemic Invasions of the Madras Presidency (Madras: Government Gazette Press, 1871), chaps. 1–6.

Notes to pages 177–180

287

46. Edward Balfour, The Localities in India, Exempt from Cholera (Madras: Athenaeum Press, 1856). 47. Harrison, Public Health in British India, 104–11; Isaacs, “D D Cunningham and the Aetiology of Cholera,” 290. 48. Sanitary Commissioner Madras to Government, 25 Jan. 1867; and Government Order, 27 Feb. 1867, both in TNSA PP, 27 Feb. 1867, nos. 152–53; Inspector General, Indian Medical Dept., to Government, 19 July 1867; and Government Order, 24 July 1867, both in TNSA PP, 24 July 1867, nos. 242–43. 49. Cholera Committee, Report of Cholera Committee Ordered under G.O. No. 216 of 27th February 1867, to Report upon the Arrangements Which Should Be Made to Give Practical Effect in the Madras Presidency to the Recommendations and Suggestions of the International Sanitary Conference (Madras: Gantz, 1868), 1–23 (quote, 23). 50. Government of India to Government of Madras, 21 Aug. 1867; and Government Order, 9 Sept. 1867, both in TNSA PP, 9 Sept. 1867, 95. 51. Government of Madras, Report and Order of the Madras Government, Regarding the Control of Pilgrimages, in the Madras Presidency (Madras: Gantz, 1868); Ira Klein, “Imperialism, Ecology and Disease: Cholera in India, 1850–1950,” Indian Economic and Social History Review 31 (1994): 500–505. The connection between pilgrimage and cholera was not a new insight; see David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley: Univ. of California Press, 1993), 184–86. 52. Cholera Committee, Report of Cholera Committee Ordered under G.O. No. 216, 23–26. 53. Ibid., 23–52. 54. Minute Paper, Public Dept., India Office, 26 Mar. 1866, IOR/L/E/2/90; Harrison, Public Health in British India, 118–19. 55. On the development of sanitary controls for ports and shipping in Britain, see Anne Hardy, “Cholera, Quarantine and the English Preventive System, 1850–1895,” Medical History 37 (1993); Baldwin, Contagion and the State in Europe, 149–55; Howard-Jones, Scientific Background of the International Sanitary Conferences, 35–41; and Harrison, Public Health in British India, 119–21. 56. The Royal Commission’s “principles”—general guidelines and suitable projects for sanitary improvement in the presidency—were stated in the first sanitary report: Madras Sanitary Report, 1865, 1–19. 57. Madras Sanitary Report, 1867, 17–18. 58. Madras Sanitary Report, 1866, 210–11; Madras Sanitary Report, 1867, 120. 59. Hector Tulloch, Report on a Project for the Drainage of the Town of Madras (Madras: Gantz, 1865), 19–20. 60. The rare occurrences of cholera cases were recorded in the annual Madras Sanitary Report.

288

Notes to pages 180–185

61. David Washbrook, The Emergence of Provincial Politics: The Madras Presidency 1870–1920 (Cambridge: Cambridge Univ. Press, 1982), 201; C. S. Srinivasachari, History of the City of Madras (Madras: P. Varadachari, 1939), 281–83; Susan J. Lewandowski, “Urban Growth and Municipal Development in the Colonial City of Madras, 1860–1900,” Journal of Asian Studies 34 (1975): 356–59. 62. Census of the Town of Madras (Madras: Fort St. George Gazette Press, 1873), 1–16. 63. Madras Sanitary Report, 1866, 211; Madras Municipal Report, 1867, 19; Madras Municipal Report, 1868, 164; Madras Municipal Report, 1869, 61; Madras Municipal Report, 1870, 85–86; Srinivasachari, History of the City of Madras, 283–84. 64. Madras Sanitary Report, 1867, 170–74; Madras Municipal Report, 1868, 164; Madras Municipal Report, 1869, 61. The Indian currency expression 1,00,000 rupees (1 lakh rupees) equals, in Western numerical terms, 100,000 rupees. 65. Madras Sanitary Report, 1870, 128; Madras Sanitary Report, 1872, 17; Madras Sanitary Report, 1873, 18; Corporation of Madras, Madras City Water Supply: 1870– 1955 (Madras: Corporation of Madras, 1955), 2. 66. Madras Sanitary Report, 1877, 84; Madras Municipal Report, 1876–77, 24–25, app. III, 9–10. 67. Madras Sanitary Report, 1873, 18; Madras Municipal Reports, 1873–83, esp. 1882, 8. 68. Tulloch, Report on a Project for the Drainage of the Town of Madras, 19–42. 69. Madras Sanitary Report, 1866, 203–7. Sewage farming was, like the zymotic disease theory, based on Liebig’s chemistry; see Hamlin, “Providence and Putrefaction,” 104–12. 70. Tulloch, Report on a Project for the Drainage of the Town of Madras, 43–73. 71. Ibid., 75–100. 72. Ibid., 111–20. 73. Secretary of State for India to Government, 31 May 1867; Minute of Governor Napier, 16 Feb. 1867; Minute of T. Pycroft, 23 Mar. 1867; Minute of H. D. Phillips, all in TNSA PWDR, 5 July 1867, no. 131. 74. Madras Sanitary Report, 1868, 137; Madras Municipal Report, 1868, 164; Madras Municipal Report, 1869, 61, 97–103; Madras Sanitary Report, 1869, 98; Madras Sanitary Report, 1872, 158; Madras Municipal Report, 1874–75, 32–36; Madras Municipal Report, 1877–78. 75. Madras Sanitary Report, 1869, 98–99; Madras Municipal Report, 1869, 60. 76. Madras Municipal Report, 1876–77, 22–23, app. III, 25–27. 77. Madras Municipal Report, 1879, app. IV, 88–90. 78. Madras Municipal Report, 1880, 7–8, 71–74; Madras Municipal Report, 1881, 8–9, 102–3; Madras Municipal Report, 1884, 87–88. 79. See statistics in Madras Sanitary Report, 1865–83.

Notes to pages 186–192

289

80. Madras Sanitary Report, 1877, 87. On the connection between famine, epidemic disease, and colonial policies, with special emphasis on the 1877 Madras famine, see David Arnold, “Social Crisis and Epidemic Disease in the Famines of Nineteenth-Century India,” Social History of Medicine 6 (1993). 81. Madras Sanitary Report, 1877, 181. 82. Ibid., 84–87, 103, 178–82. 83. Sanitary Commissioner to Government, 2 Aug. 1869, TNSA PP, 13 Aug. 1869, no. 93; Inspector General of the Indian Medical Department to Government, 7 Sept. 1869; and Government Order, 18 Sept. 1869, both in TNSA PP, 18 Sept. 1869, nos. 123–24; Inspector General of the Indian Medical Department to Government, 13 May 1869; and Government Order, 31 May 1869, both in IOR/L/E/3/174; Inspector General of the Indian Medical Department to Government, 11 Oct. 1869; and Government Order, 15 Nov 1869, both in TNSA PP, 15 Nov. 1869, nos. 93–94. 84. Madras Municipal Report, 1876, 34–35. 85. Sumit Guha, “Nutrition, Sanitation, Hygiene, and the Likelihood of Death: The British Army in India c. 1870–1920,” Population Studies 47 (1993). The same point had already been made in 1869 by the Inspector General of Hospitals, Indian Medical Department, in a letter to the Government of India, which was printed in the Report on the Measures Adopted for Sanitary Improvements in India, from June 1871 to July 1872 together with Abstract of the Proceedings of the Sanitary Commissioner with the Government of India for 1870 (London: Eyre and Spottiswoode, 1872), 187, and in “Sanitary Progress” (editorial), Indian Medical Gazette 6 (1871).

Chapter 6. Finding the Comma Bacillus: Bacteriology in Madras and Quebec City, 1865–1910 1. The Quebec Morning Chronicle, for example, published only a short notice on the cholera outbreak in Egypt. Quebec Morning Chronicle, 1 Aug. 1865. 2. City of Quebec to Minister of Agriculture, 4 Nov. 1865, LAC RG17, vol. 6, file 428; Bruce Curtis, “Social Investment in Medical Forms: The 1866 Cholera Scare and Beyond,” Canadian Historical Review 81 (2000): 356–59. 3. Quebec Health Committee Minutes, 8 Sept. 1865, AvQ QP1-3/3F-1642. 4. Quebec City Council Minutes, 8 Sept. 1865, AvQ QP1-1/p-v, no. 428; Report of the Health Committee, 8 Sept. 1865, AvQ QP1-4/31_5; Quebec Health Committee Minutes, 8 Sept. 1865, AvQ QP1-3/3F-1642. 5. Curtis, “Social Investment in Medical Forms,” 354–59. 6. Bruce Curtis, “La morale miasmatique: Le Mémoire sur le choléra de Joseph-Charles Taché,” Canadian Bulletin of Medical History 16 (1999): 324–26. 7. Joseph-Charles Taché, Memorandum on Cholera (Ottawa: Bureau of Agriculture, 1866); Curtis, “La morale miasmatique,” 323–31. 8. Curtis, “La morale miasmatique,” 331–37.

290

Notes to pages 192–204

9. Curtis, “Social Investment in Medical Forms,” 360–66. 10. Quebec Health Committee Minutes, 5 May 1865, AvQ QP1-3/3F-1642. 11. City of Quebec to Minister of Agriculture, 4 Nov. 1865, LAC RG17, vol. 6, file 428; City Council Minutes, 8 Nov. 1865, AvQ QP1-1/-p-v, nos. 601–5. 12. Central Board of Health to Department of Agriculture, 27 July 1866, LAC RG17, vol. 11, file 847; Curtis, “Social Investment in Medical Forms,” 366–68. 13. Central Board of Health to Department of Agriculture, 27 July 1866, LAC RG17, vol. 11, file 847; Curtis, “Social Investment in Medical Forms,” 366–68. 14. Quebec Health Commission Minutes, 1 June 1866, 7 Sept. 1866, 21 Mar. 1867, 22 Apr. 1867, 31 May 1867, AvQ QP1-3/3F-1642; R. Pollitzer, Cholera (Geneva: World Health Organization, 1959), 35. 15. L. J. Roy to Secretary of State, 28 Sept. 1867, LAC RG17, vol. 17, file 1426; Iffland to Minister of Agriculture, 7 Oct. 1867, LAC RG17, vol. 17, file 1247. 16. John M. Woodworth, The Cholera Epidemic of 1873 in the United States: The Introduction of Epidemic Cholera through the Agency of the Mercantile Marine; Suggestions of Measures of Prevention (Washington, DC: Government Printing Office, 1875), 91; Denis Goulet and André Paradis, Trois siècles d’histoire médicale au Québec: Chronologie des institutions et des pratiques (1639–1919) (Montreal: VLB, 1992), 238. 17. John Hare, Marc Lafrance, and David-Thiery Ruddel, Histoire de la ville de Québec (Montreal: Boréal, 1987), 263–65; Alyne Lebel, “Les facteurs du développement urbain,” in De la Confédération à la charte de 1929, ed. George-Henri Dagneau, vol. 4 of La ville de Québec: Histoire municipale, ed. Société historique de Québec (Quebec: Société historique de Québec, 1983), 34–35; Ronald Rudin, The Forgotten Quebecers: A History of English-Speaking Quebec, 1759–1980 (Quebec City: Institut québécois de recherche sur la culture, 1985), 180–81. 18. Lebel, “Les facteurs du développement urbain,” 35. 19. Ibid., 34, 38–46. 20. Ginette Noël, “Les travaux publics,” in De la Confédération à la charte de 1929, ed. George-Henri Dagneau, vol. 4 of La ville de Québec: Histoire municipale, ed. Société historique de Québec (Quebec: Société historique de Québec, 1983). 21. Montizambert to Minister of Agriculture, 23 July 1883, LAC RG17, vol. 376, file 40527. 22. Canadian High Commissioner, London, to Minister of Agriculture, 21 July 1883, LAC RG17, vol. 377, file 40645; Montizambert to Minister of Agriculture, 23 July 1883, LAC RG17, vol. 376, file 40527. 23. Geoffrey Bilson, “Dr. Frederick Montizambert (1843–1929): Canada’s First Director General of Public Health,” Medical History 29 (1985): 389; Martin Tétreault, “Frederick Montizambert et la quarantaine de Grosse Île, 1869–1899,” Scientia canadensis 19 (1995): 13–14.

Notes to pages 204–208

291

24. Montizambert to Minister of Agriculture, 1 Aug. 1883, LAC RG17, vol. 378, file 40691 (quote); Montizambert to Minister of Agriculture, 9 Aug. 1883, LAC RG17, vol. 378, file 40758. 25. Mayor of Quebec to Minister of Agriculture, 7 Aug. 1883, LAC RG17, vol. 378, file 40743. 26. Montizambert to Minister of Agriculture, 12 Nov. 1883, LAC RG17, vol. 387, file 41697. 27. Proclamation of Quarantine, 28 June 1884, LAC RG17, vol. 409, file 44313, and LAC RG17, vol. 410, file 44379; Proclamation of Quarantine, 2 Aug. 1884, LAC RG17, vol. 413, file 44951, and LAC RG17, vol. 420, file 45839; Quebec City Council to Minister of Agriculture, 24 July 1884, LAC RG17, vol. 411, file 44783; Montizambert to Minister of Agriculture, 18 Nov. 1884, LAC RG17, vol. 422, file 46080. 28. On the development of laboratory research in medicine, see the contributions to Andrew Cunningham and Perry Williams, eds., The Laboratory Revolution in Medicine (Cambridge: Cambridge Univ. Press, 1992). 29. Ludwik Fleck, Entstehung und Entwicklung einer wissenschaftlichen Tatsache: Einführung in die Lehre vom Denkstil und Denkkollektiv (Frankfurt: Suhrkamp, 1980). 30. Bruno Latour, The Pasteurization of France (Cambridge, MA: Harvard Univ. Press, 1988), 72–93; Silvia Berger, Bakterien in Krieg und Frieden: Eine Geschichte der medizinischen Bakteriologie in Deutschland, 1890–1933 (Göttingen: Wallstein, 2009), 77–90. 31. “Point of passage” is a technical term of actor-network theory. It describes a point where all actors come together in order to form a network. See Michel Callon, “Some Elements of a Sociology of Translation: Domestication of the Scallops and the Fishermen of St Brieuc Bay,” in Power, Action and Belief: A New Sociology of Knowledge?, ed. John Law (London: Routledge, 1986), 205–6. 32. Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900 (Cambridge: Cambridge Univ. Press), chap. 4, esp. 127–29; Latour, Pasteurization of France, 13–58; Berger, Bakterien in Krieg und Frieden, 59–64. 33. Mariko Ogawa, “Uneasy Bedfellows: Science and Politics in the Refutation of Koch’s Bacterial Theory of Cholera,” Bulletin of the History of Medicine 74 (2000): 674– 85; William Coleman, “Koch’s Comma Bacillus: The First Year,” Bulletin of the History of Medicine 61 (1987): 317–26; Christoph Gradmann, “Das reisende Labor: Robert Koch erforscht die Cholera 1883/84,” Medizinhistorisches Journal 38 (2003): 38–44. 34. Ogawa, “Uneasy Bedfellows,” 685–86; Coleman, “Koch’s Comma Bacillus,” 326–35; Gradmann, “Das reisende Labor,” 44–50; Christopher Hamlin, Cholera: The Biography (Oxford: Oxford Univ. Press, 2009), 213–23. 35. Secretary of State for India to Governor General of India, 19 July 1884; Government of Bengal to Secretary of State for India, 30 July 1884; India Office to Governor General of India, 7 Aug. 1884; Fayrer to Under-Secretary of State for India, 19

292

Notes to pages 208–212

May 1884; Memorandum of Fayrer, 19 July 1884, all in NAI Home Dept., Sanitary Branch, Proceedings Oct. 1884, nos. 16–24. 36. Ogawa, “Uneasy Bedfellows,” 686–94; Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859–1914 (Cambridge: Cambridge Univ. Press, 1994), 111–12. 37. On Koch’s famous postulates regarding the causation of a disease by a microorganism, see Thomas D. Brock, Robert Koch: A Life in Bacteriology and Medicine (Madison, WI: Science Tech Publishers, 1988), 180–82; and K. Codell Carter, “Koch’s Postulates in Relation to the Work of Jacob Henle and Edwin Klebs,” Medical History 29 (1985). 38. Ogawa, “Uneasy Bedfellows,” 694–97; Harrison, Public Health in British India, 112. 39. Ogawa, “Uneasy Bedfellows,” 694–702; Hamlin, Cholera, 223–30. 40. Hamlin, Cholera, 213–23; Coleman, “Koch’s Cholera Bacillus,” 336. 41. Richard J. Evans, Death in Hamburg: Society and Politics in the Cholera Years (Oxford: Clarendon, 1987). 42. Harrison, Public Health in British India, 114–15; Ilana Löwy, “From Guinea Pig to Man: The Development of Haffkine’s Anticholera Vaccine,” Journal of the History of Medicine and Allied Sciences 47 (1992). Haffkine’s authorship of cholera vaccination is not undisputed; see George H. Bornside, “Waldemar Haffkine and the Ferran-Haffkine Priority Dispute,” Journal of the History of Medicine and Allied Sciences 37 (1982); and Hamlin, Cholera, 234–42. 43. Harrison, Public Health in British India, 111–13, Jeremy D. Isaacs, “D D Cunningham and the Aetiology of Cholera in British India, 1869–1897,” Medical History 42 (1998): 292. 44. Harrison, Public Health in British India, 113. 45. Among the articles on cholera published in the Scientific Memoirs by Medical Officers of the Army of India by D. D. Cunningham are: “On the Relation of Cholera to Schizomycete Organisms,” 1 (1884); “On the Effects Sometimes Following Injection of Choleraic Comma-Bacilli into the Subcutaneous Tissues in Guinea-Pigs,” 2 (1886); and “Are Choleraic Comma-Bacilli, even Granting That They Are the Proximate Cause of Choleraic Symptoms, Really Efficient in Determining the Epidemic Diffusion of Cholera?,” 4 (1889). 46. Isaacs, “D D Cunningham and the Aetiology of Cholera,” 294–304. 47. “The Cholera Bacillus” (editorial), Indian Medical Gazette 19 (1884); “The Cholera Germ” (editorial), Indian Medical Gazette 19 (1884); “The Aetiology of Cholera” (editorial), Indian Medical Gazette 20 (1885). 48. William R. Cornish, “An Address on Cholera Enquiry,” Indian Medical Gazette 20 (1885). 49. Patrick Hehir, “The Etiology of Cholera,” Indian Medical Gazette 24 (1889); W.

Notes to pages 213–217

293

J. Simpson, “Cholera in Europe and India,” Indian Medical Gazette 28 (1893); Simpson, “A Resumé of Some of the More Important Facts Relating to Indian Cholera,” Indian Medical Gazette, parts 1–3, 28 (1893), and part 4, 29 (1894). 50. Ernest H. Hankin, “Observations on Cholera in India,” Indian Medical Gazette 30 (1895); “Professor Haffkine’s Inoculation against Cholera” (editorial), Indian Medical Gazette 29 (1894); W. J. Simpson, “Memorandum on Cholera and Professor Haffkine’s Anti-Choleraic Vaccination,” Indian Medical Gazette 29 (1894); Woldemar M. Haffkine and W. J. Simpson, “A Contribution to the Etiology of Cholera,” Indian Medical Gazette 30 (1895); Mark Harrison, “Towards a Sanitary Utopia? Professional Visions and Public Health in India, 1880–1914,” South Asia Research 10 (1990): 26; Isaacs, “D D Cunningham and the Aetiology of Cholera,” 298–89. 51. Madras Sanitary Report, 1883, 97–100. 52. Madras Sanitary Report, 1884, 15–16; Madras Sanitary Report, 1891, 18. 53. B. B. Misra, The Administrative History of India, 1834–1947: General Administration (London: Oxford Univ. Press, 1970), 601–12; Harrison, Public Health in British India, 166–67, 170–76. 54. C. Venkata Rama Reddy, ed., City of Madras: Official Handbook (Madras: Corporation of Madras, 1950), 205; David Washbrook, The Emergence of Provincial Politics: The Madras Presidency 1870–1920 (Cambridge: Cambridge Univ. Press, 1982), 201. 55. Madras Municipal Report, 1887–88, 17–19; Madras Municipal Report, 1892–93; J. A. Jones, “Report on the Condition of the Madras Municipal Water-Works, with Schemes for Their Improvement,” in Papers Relating to Water-Supply Schemes in India, Part 1: Major Works, ed. Government of India (Calcutta: Superintendent of Government Printing, 1889), 1–44. 56. Madras Sanitary Report, 1893, 61–62. 57. Madras Sanitary Report, 1894, 31–32. 58. Norman Howard-Jones, The Scientific Background of the International Sanitary Conferences 1851–1938 (Geneva: World Health Organization, 1975), 76; Peter Baldwin, Contagion and the State in Europe, 1830–1930 (Cambridge: Cambridge Univ. Press, 1999), 167. 59. Harrison, Public Health in British India, 139–40; David Arnold, Colonizing the Body: State Medicine and the Epidemic Disease in Nineteenth-Century India (Berkeley: Univ. of California Press), chap. 5. 60. Arnold, Colonizing the Body, 218–36; Ira Klein, “Plague, Policy and Popular Unrest in British India,” Modern Asian Studies 22 (1988): 749–52. 61. Harrison, Public Health in British India, 150–52. 62. David Arnold, “Introduction: Tropical Medicine before Manson,” in Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500–1900, ed. David Arnold (Amsterdam: Rodopi, 1996); Arnold, “The Place of the ‘Tropics’ in Western Medical Ideas since 1750,” Tropical Medicine and International Health 2 (1997). On India

294

Notes to pages 218–223

specifically, see Arnold, “India’s Place in the Tropical World,” Journal of Imperial and Commonwealth History 26 (1998). 63. Michael Worboys, “The Emergence of Tropical Medicine: A Study in the Establishment of a Scientific Specialty,” in Perspectives on the Emergence of Scientific Disciplines, ed. Gerard Lemain et al. (The Hague: Mouton, 1976); Harrison, Public Health in British India, 156. 64. David Arnold, “Colonial Medicine in Transition: Medical Research in India, 1910–1947,” South Asia Research 14 (1994): 12–14. 65. The sense that cholera had been tamed is well expressed in Leonard Rogers, “The Forecasting and Control of Cholera Epidemics in India,” Journal of the Army Medical Corps 49 (1927). On the cure of cholera, see Rogers, Cholera and Its Treatment (London: Oxford Univ. Press, 1911); and Hamlin, Cholera, 242–47. 66. For statistics, see issues of the Madras Sanitary Report, 1896–1910. 67. Madras Municipal Report, 1901–2, 22–24; Madras Municipal Report, 1905–6, 28–30. The preceding decades had witnessed a further expansion of hospital capacity in the city of Madras as well as in the rest of the presidency; see Anil Kumar, Medicine and the Raj: British Medical Policy in India, 1835–1911 (New Delhi: SAGE, 1998), 92. 68. Although Koch’s success in Hamburg had silenced most of his detractors, in an article published in 1897 D. D. Cunningham still maintained that the comma bacillus was not the sole cause of cholera. It was his last intervention in this debate; see Isaacs, “D D Cunningham and the Aetiology of Cholera,” 299–301. 69. Madras Sanitary Report, 1897, 42; Madras Sanitary Report, 1902, 12; Madras Sanitary Report, 1905, 11; Madras Municipal Report, 1903–4, 28; Madras Municipal Report, 1907–8, 40. 70. On disinfection before and after Koch’s cholera theory, see Baldwin, Contagion and the State in Europe, 165–66. 71. Madras Municipal Report, 1901–2, 22–24; Madras Municipal Report, 1903–4, 25; Madras Municipal Report, 1905–6, 28–30. 72. Madras Municipal Report, 1898–99, 52–56; Madras Municipal Report, 1899–1900, 63–65; Madras Municipal Report, 1900–1901, 59–65; Madras Municipal Report, 1902–3, 27; Madras Municipal Report, 1904–5, 30; Madras Municipal Report, 1905–6, 37. 73. Madras Sanitary Report, 1894–95, 60–61; Madras Municipal Report, 1898–99, 52–56; Madras Sanitary Report, 1900, 29 (quote); Madras Municipal Report, 1907–8, 33. 74. Madras Sanitary Report, 1901, 12. 75. Montizambert to Minister of Agriculture, 5 Mar. 1885, LAC RG17, vol. 433, file 47189; Montizambert to Minister of Agriculture, 18 Apr. 1885, LAC RG17, vol. 437, file 47683; Communication on Proclamation of Quarantine, 20 Apr. 1885, LAC RG6 A-1, vol. 59, file 6099; Proclamation of Quarantine, 17 June 1885, LAC RG17, vol. 444, file 48459; Order on Cooperation with US and British Consuls, 20 Apr. 1885, LAC RG17, vol. 437, file 47702 (quote).

Notes to pages 223–228

295

76. Montizambert to Minister of Agriculture, 18 Apr. 1885, LAC RG17, vol. 437, file 47683. 77. Presentment of Montizambert, 27 June 1885, LAC RG17, vol. 555, file 48494; Goulet and Paradis, Trois siècles d’histoire médicale au Québec, 246. 78. Presentment of Montizambert, 27 June 1885, LAC RG17, vol. 555, file 48494. 79. Tétreault, “Frederick Montizambert et la quarantaine de Grosse Île,” 14–17. 80. Geoffrey Bilson, “Science, Technology and 100 Years of Canadian Quarantine,” in Critical Issues in the History of Canadian Science, Technology and Medicine, ed. Richard A. Jarrell and Arnold E. Roos (Thornhill, ON: HSTC Publications, 1983), 96–97; Bilson, “Dr. Frederick Montizambert,” 388–90; Tétreault, “Frederick Montizambert et la quarantaine de Grosse Île,” 16–17. 81. City Council Resolution, 25 Jan. 1884, AvQ, QC3/1A-537/4; City Council Resolution, 2 Oct. 1885, AvQ QP1-4/63_3; Department of Agriculture to Quebec Treasurer, 31 July 1886, AvQ QP1-4/63_3; City Council Resolution, 5 Oct. 1888, AvQ QC3/1A-537/7; Report of the Health Officer, 2 Sept. 1889, AvQ QC3/2G-560/2; Goulet and Paradis, Trois siècles d’histoire médicale au Québec, 245. 82. MacKay to Quebec Sanitary Committee, 31 Aug. 1885, 1 Oct. 1885, AvQ QC3/2G-560/2; Department of Agriculture to Mayor of Quebec, 4 July 1884, AvQ QC3/2G-560/1. 83. Denis Goulet and Othmar Keel, “Les hommes-relais de la bactériologie en territoire québécois et l’introduction de nouvelles pratiques diagnostiques et thérapeutiques (1890–1920),” Revue historique de l’Amérique française 46 (1993); Goulet and Keel, “L’introduction de la médecine pasteurienne au Québec,” in Proceedings of the 31st International Congress on the History of Medicine, ed. Raffaele A. Bernabeo (Bologna: Monduzzi, 1988); Georges Desrosiers, Benoît Gaumer, and Othmar Keel, “L’évolution des structures de l’enseignement universitaire spécialisé de santé publique au Québec: 1899–1970,” Canadian Bulletin of the History of Medicine 6 (1989): 3–6. 84. Montizambert to Minister of Agriculture, 20 June 1890, LAC RG17, vol. 646, file 73523; Montizambert to Minister of Agriculture, 17 June 1890, LAC RG17, vol. 653, file 79340. 85. Bilson, “Dr. Frederick Montizambert,” 392–93. 86. Denis Goulet, Gilles Lemire, and Denis Gauvreau, “Des bureaux d’hygiène municipaux aux unités sanitaires: Le Conseil d’Hygiène de la Province de Québec et la structuration d’un système de santé publique, 1886–1926,” Revue historique de l’Amérique française 49 (1999); John J. Heagerty, Four Centuries of Medical History in Canada and a Sketch of the Medical History of Newfoundland (Toronto: Macmillan, 1928), 1:343–47. 87. Goulet et Paradis, Trois siècles d’histoire médicale au Québec, 249–52; Réjean Lemoine, “La santé publique: De l’inertie municipale à l’offensive hygièniste,” in De la Confédération à la charte de 1929, ed. George-Henri Dagneau, vol. 4 of La ville de Qué-

296

Notes to pages 228–232

bec: Histoire municipale, ed. Société historique de Québec (Quebec: Société historique de Québec, 1983), 160–64. 88. Quebec City Board of Trade to Minister of Agriculture, 6 Aug. 1892, LAC RG17, vol. 731, file 84217. 89. Province of Quebec Board of Health to Minister of Agriculture, 16 July 1892, LAC RG6 A-1, vol. 80, file 3755; Province of Quebec Board of Health to Minister of Agriculture, 27 Aug. 1892, RG6 A-1, vol. 81, file 4430. Apparently, the federal government did not fulfill the request to appoint a port physician for Quebec, since the city council had to ask again in 1893. City Council Minutes, 10 Mar. 1893, AvQ QP-1/p-v 1064. 90. Newspaper clippings on cholera at Hamburg from LAC RG17, vol. 733, file 84562; Interior Minister to Minister of Agriculture, 25 Aug. 1892, LAC RG17, vol. 733, file 84569; various clippings of the Times of London reporting correspondence of the Royal College of Physicians to Local Government Board, LAC RG17, vol. 736, file 84834. 91. Order of the Privy Council, 17 Sept. 1892, LAC RG17, vol. 735, file 84733. 92. Provincial Board of Health to Municipal Physician of Quebec City, 24 Aug. 1892; Provincial Board of Health to Municipal Physicians of Quebec City, Montreal, and Trois Rivières, 26 Aug. 1892, both in BAnQ-Q E 88 1971-07-03/2. 93. Quebec Provincial Board of Health to Provincial Secretary of Quebec, 27 Aug. 1892; Summary of the Quebec Provincial Board of Health’s work regarding cholera, undated, both in BAnQ-Q E 88 1971-07-03/2. 94. Lemoine, “La santé publique,” 156; Bilson, “Dr. Frederick Montizambert,” 388. 95. Minutes of the Quebec City Board of Health, 7 July 1892, 31 Aug. 1892, AvQ QC3/1B-538. 96. Lemoine, “La santé publique,” 164–66; Goulet and Paradis, Trois siècles d’histoire médicale au Québec, 121–22. 97. Goulet and Paradis, Trois siècles d’histoire médicale au Québec, 257. 98. Memorandum of Hubert Neilson on cholera vaccination, 3 Feb 1893, LAC RG17, vol. 747, file 86202; US quarantine regulations, 4 Apr. 1893, LAC RG17, vol. 733, file 87402; British quarantine regulations, 13 July 1892, LAC RG17, vol. 748, file 86421; Lemoine, “La santé publique,” 165–66. 99. Correspondence regarding the disinfector in AvQ QC3/2G-624/3 and 5; Minutes of the Quebec Board of Health, 18 Jan. 1893, 2 Mar. 1893, AvQ QC3/1B-538; L. Catellier, Report of the Work Done by the Board of Health of the City of Quebec during the Year 1892 (Quebec: City Printer, 1892), 14. 100. Proclamation of the Mayor of Quebec, 1 May 1893, AvQ QC3/6B-624/3. 101. Report of the Health Committee, 5 Oct. 1910, AvQ QP1-4/31_5.

Notes to pages 232–236

297

Conclusion: The Colonial State and the Elusive Consensus Regarding Cholera 1. Estimates of the death toll range from twenty-one million, according to Alfred W. Crosby, “Influenza,” in The Cambridge World History of Human Diseases, ed. Kenneth F. Kiple (Cambridge: Cambridge Univ. Press), 810, to between fifty million and one hundred million people, according to Niall Johnson, “The Overshadowed Killer: Influenza in Britain in 1918–19,” in The Spanish Influenza Pandemic of 1918–19: New Perspectives, ed. Howard Phillips and David Killingray (London: Routledge, 2003), 132. 2. Report of the Health Officer for Madras, 1918, 1, 9–11; “Statement[,] Acting Health Officer,” New India, 11 Oct. 1918; C. R. Paquin, Rapport sur l’état de la cité de Québec et sur les opérations du département d’hygiène pour l’année 1918–1919 (Quebec: Imprimerie Vincent, 1919); Antonio Drolet, “L’épidémie de grippe espagnole à Québec en 1918,” Laval médical 27 (1959): 653; Réjean Lemoine, “La santé publique: De l’inertie municipale à l’offensive hygièniste,” in De la Confédération à la charte de 1929, ed. George-Henri Dagneau, vol. 4 of La ville de Québec: Histoire municipale, ed. Société historique de Québec (Quebec: Société historique de Québec, 1983), 175; L’Événement, 8 Nov. 1918; Minutes of the Provincial Board of Health, 5 Dec. 1918, BAnQ-Q E88 1971-07003/1; Minutes of the Quebec Health Committee, 26 Nov. 1918, AvQ QC3/1B-540; Correspondence, 1–17 Feb. 1919, LAC RG25 A-3-a, vol. 1225, file 1918-845. 3. John Andrew Mendelsohn, “From Eradication to Equilibrium: How Epidemics Became Complex after World War I,” in Greater Than the Parts: Holism in Biomedicine, 1920–1950, ed. Christopher Lawrence and George Weisz (New York: Oxford Univ. Press, 1998), 310–19. 4. Clifford Allchin Gill, The Genesis of Epidemics and the Natural History of Disease: An Introduction to the Science of Epidemiology Based upon the Study of Epidemics of Malaria, Influenza, & Plague (London: Baillière, Tindall and Cox, 1928). 5. Ibid., 251–88 (quote, 286; emphasis in original). 6. It is quite astonishing how little colonies of white settlement feature in the overviews on colonialism when it comes to state formation and coercive practices. Frederick Cooper, in Colonialism in Question: Theory, Knowledge, History (Berkeley: Univ. of California Press, 2006), mentions them briefly several times but never discusses them at length. Jürgen Osterhammel, in Colonialism: A Theoretical Overview (Princeton, NJ: Markus Wiener Publishers, 1997), 11–12, provides a definition of colonies of white settlement but rarely deals with the phenomenon in his various chapters on aspects of colonialism. One could infer that this lack of discussion means that the coercion described by these authors did not exist in colonies of settlement.

298

Notes to pages 241–256

Bibliography

Archival Sources Archives de la ville de Québec (AvQ)  B1  QC3  QD2  QP1-1  QP1-3  QP1-4 Bibliothèque et Archives nationales du Québec, Quebec City (BanQ-Q)  E88 British National Archives, Kew (BNA)   CO 42   PC 1 India Office Records, British Library, London (IOR)  IOR/L/E/2  IOR/L/E/3  IOR/L/E/4  IOR/L/P&J  IOR/P  IOR/V/23

299

Library Archives Canada, Ottawa (LAC)   RG6 A-1  RG17   RG25 A-3-a National Archives of India, New Delhi (NAI)   Home Dept., Sanitary Branch Tamil Nadu State Archives, Chennai (TNSA)   Public Proceedings (PP)   Public Works Department Records (PWDR)   Surgeon General’s Records (SGR)

Published Works Ackerknecht, Erwin H. “Anticontagionism between 1821 and 1867.” Bulletin of the History of Medicine 22 (1948): 562–93. “The Aetiology of Cholera” (editorial). Indian Medical Gazette 20 (1885): 151–53. Afkhami, Amir A. “Disease and Water Supply: The Case of Cholera in 19th Century Iran.” In Transformations of Middle Eastern Natural Environments: Legacies and Lessons, edited by Jeff Albert, Magnus Bernhardsson, and Roger Kenna, 206–20. New Haven, CT: Yale University, 1998. Ainslie, William, A. Smith, and M. Christy. Report of a Committee Appointed by the Madras Government to Inquire into the Causes of the Epidemic Fever Which Prevailed in the Provinces of Coimbatore, Madura, Dindigul, & Tinnivelly, during the Years 1809, 1810, and 1811. London: Black, Parbury, and Allen, 1816. Arnold, David, ed. Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500–1900. Amsterdam: Rodopi, 1996. Arnold, David. “Cholera and Colonialism in British India.” Past and Present 113 (1986): 118–51. Arnold, David. “Colonial Medicine in Transition: Medical Research in India, 1910– 1947.” South Asia Research 14 (1994): 10–35. Arnold, David. Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India. Berkeley: University of California Press, 1993. Arnold, David. “India’s Place in the Tropical World, 1770–1930.” Journal of Imperial and Commonwealth History 26 (1998): 1–21. Arnold, David. “Introduction: Tropical Medicine before Manson.” In Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500–1900, edited by David Arnold, 1–19. Amsterdam: Rodopi, 1996. Arnold, David. “The Place of the ‘Tropics’ in Western Medical Ideas since 1750.” Tropical Medicine and International Health 2 (1997): 303–13. Arnold, David. Science, Technology and Medicine in Colonial India. Cambridge: University Press, 2000. Arnold, David. “Social Crisis and Epidemic Disease in the Famines of Nineteenth-Century India.” Social History of Medicine 6 (1993): 385–404.

300

Bibliography

Asdal, Kristin. “The Problematic Nature of Nature: The Post-Constructivist Challenge to Environmental History.” History and Theory 44 (2003): 60–74. Balandier, Georges. “La situation coloniale: Approche théorétique.” Cahiers internationaux de sociologie 11 (1951): 44–79. Baldwin, George R. Report on Supplying the City of Quebec with Pure Water: Made for the City Council by Order of George Okill Stuart, Esq., Mayor of Quebec. Boston: Charles C. Little and James Brown, 1848. Baldwin, Peter. Contagion and the State in Europe, 1830–1930. Cambridge: Cambridge University Press, 1999. Baldwin, Peter. “How Night Air Became Good Air, 1776–1930.” Environmental History 8 (2003): 412–29. Balfour, Edward. The Localities in India, Exempt from Cholera. Madras: Athenaeum Press, 1856. Barth, Boris, and Jürgen Osterhammel, eds. Zivilisierungsmissionen: Imperiale Weltverbesserung seit dem 18. Jahrhundert. Constance: UVK, 2005. Bashford, Alison, and Claire Hooker, eds. Contagion: Historical and Cultural Studies. London: Routledge, 2001. Bayly, C. A. Empire and Information: Intelligence Gathering and Social Communication in India, 1780–1870. Cambridge: Cambridge University Press, 1996. Bayly, C. A. Indian Society and the Making of the British Empire. Cambridge: Cambridge University Press, 1988. Bayly, C. A., “Knowing the Country: Empire and Information in India.” Modern Asian Studies 27 (1993): 3–43. Bayly, Susan. Caste, Society and Politics in India from the Eighteenth Century to the Modern Age. Cambridge: Cambridge University Press, 1999. Bayly, Susan. Saints, Goddesses and Kings: Muslims and Christians in South Indian Society, 1700–1900. Cambridge: Cambridge University Press, 1989. Beaulieu, André, and Jean Hamelin. La presse québécoise des origines à nos jours. 2nd ed. 10 vols. Quebec: Presses de l’Université Laval, 1973–90. Berger, Silvia. Bakterien in Krieg und Frieden: Eine Geschichte der medizinischen Bakteriologie in Deutschland, 1890–1933. Göttingen: Wallstein, 2009. Bernier, Jacques. La médecine au Québec: Naissance et évolution d’une profession. Quebec: Presses de l’Université Laval, 1989. Bilson, Geoffrey. A Darkened House: Cholera in Nineteenth-Century Canada. Toronto: University of Toronto Press, 1980. Bilson, Geoffrey. “Dr. Frederick Montizambert (1843–1929): Canada’s First Director General of Public Health.” Medical History 29 (1985): 386–400. Bilson, Geoffrey. “Science, Technology and 100 Years of Canadian Quarantine.” In Critical Issues in the History of Canadian Science, Technology and Medicine, edited by Richard A. Jarrell and Arnold E. Roos, 89–100. Thornhill, ON: HSTC Publications, 1983.

Bibliography

301

Boissonault, Charles-Marie. “Création de deux écoles de médecine au Québec.” In Trois siècles de médecine québécoise, edited by Yolande Bonenfont et al., 70–74. Quebec: Société historique de Québec, 1970. Bonenfont, Yolande, et al., eds. Trois siècles de médecine québécoise. Quebec: Société historique de Québec, 1970. Bornside, George H. “Waldemar Haffkine and the Ferran-Haffkine Priority Dispute.” Journal of the History of Medicine and Allied Sciences 37 (1982): 399–422. Bourne, J. M. “The East India Company’s Military Seminary, Addiscombe, 1809– 1858.” Journal of the Society for Army Historical Research 57 (1979): 200–222. Briggs, Asa. “Cholera and Society in the Nineteenth Century.” Past and Present 19 (April 1961): 76–96. Brimnes, Niels. “Coming to Terms with the Native Practitioner: Indigenous Doctors in Colonial Service in South India, 1800–1825.” Indian Economic and Social History Review 50 (2013): 77–109. Brock, Thomas D. Robert Koch: A Life in Bacteriology and Medicine. Madison, WI: Science Tech Publishers, 1988. Brockington, Fraser. “Public Health and the Privy Council, 1831–1834.” Journal of the History of Medicine and Allied Sciences 16 (1961): 161–85. Brun, Henri. La formation des institutions parlementaires québécoises, 1791–1838. Quebec: Presses de l’Université Laval, 1970. Brundage, Anthony. England’s “Prussian Minister”: Edwin Chadwick and the Politics of Government Growth, 1832–1854. University Park: Pennsylvania State University Press, 1988. Brush, John E. “The Growth of the Presidency Towns.” In Urban Society, Space, and Image: Papers Presented at a Symposium Held at Duke University, edited by Richard G. Fox, 91–105. Durham, NC: Duke University, 1970. Bryden, James L. Cholera Epidemics of Recent Years Viewed in Relation to Former Epidemics: A Record of Cholera in the Bengal Presidency from 1817 to 1872. Calcutta: Superintendent of Government Printing, 1874. Bryden, James L. “Suggestions for the Systematic Study of the History and Relations of Cholera.” Indian Medical Gazette 1 (1866): 283–87. Buchanan, A. C. Advice to Emigrants. Quebec: Thomas Cary, 1832. Buckingham, Jane. Leprosy in Colonial South India: Medicine and Confinement. Basingstoke: Palgrave, 2002. Buckner, Phillip A. The Transition to Responsible Government: British Policy in British North America, 1815–1850. Westport, CT: Greenwood Press, 1985. Buckner, Phillip A., ed. Canada and the British Empire. Oxford: Oxford University Press, 2008. Burroughs, Peter. “Colonial Self-Government.” In British Imperialism in the Nineteenth Century, edited by C. C. Eldridge, 39–63. London: Macmillan, 1984. Bynum, William F., and Roy Porter, eds. Companion Encyclopedia of the History of Medicine. London: Routledge, 1993.

302

Bibliography

Callon, Michel. “Some Elements of a Sociology of Translation: Domestication of the Scallops and the Fishermen of St Brieuc Bay.” In Power, Action and Belief: A New Sociology of Knowledge?, edited by John Law, 196–233. London: Routledge, 1986. Carter, K. Codell. “Koch’s Postulates in Relation to the Work of Jacob Henle and Edwin Klebs.” Medical History 29 (1985): 353–74. Catellier, L. Report of the Work Done by the Board of Health of the City of Quebec during the Year 1892. Quebec: City Printer, 1892. Census of the Town of Madras. Madras: Fort St. George Gazette Press, 1873. Chakrabarti, Pratik. Materials and Medicine: Trade, Conquest and Therapeutics in the Eighteenth Century. Manchester: Manchester University Press, 2010. Chakrabarti, Pratik. “‘Neither of Meate nor Drinke, but What the Doctor Alloweth’: Medicine amidst War and Commerce in Eighteenth-Century Madras.” Bulletin of the History of Medicine 80 (2006): 1–38. “The Cholera Bacillus” (editorial). Indian Medical Gazette 19 (1884): 141–45. Cholera Committee. Report of Cholera Committee Ordered under G.O. No. 216 of 27th February 1867, to Report upon the Arrangements Which Should Be Made to Give Practical Effect in the Madras Presidency to the Recommendations and Suggestions of the International Sanitary Conference. Madras: Gantz, 1868. “The Cholera Germ” (editorial). Indian Medical Gazette 19 (1884): 232–34. Coleman, William. “Koch’s Comma Bacillus: The First Year.” Bulletin of the History of Medicine 61 (1987): 315–42. Cooper, Frederick. Colonialism in Question: Theory, Knowledge, History. Berkeley: University of California Press, 2006. Cooter, Roger. “Anticontagionism and History’s Medical Record.” In The Problem of Medical Knowledge: Examining the Social Construction of Medicine, edited by Peter Wright and Andrew Teacher, 87–108. Edinburgh: Edinburgh University Press, 1982. Corbin, Alain. Le miasme et la jonquille: L’odorat et l’imaginaire social XVIIIe–XIXe siècles. Paris: Flammarion, 2008. Cornish, William R. “An Address on Cholera Enquiry.” Indian Medical Gazette 20 (1885): 169–72. Cornish, William R. Cholera in South India: A Record on the Progress of Cholera in 1870 and Résumé of the Records on Former Epidemic Invasions of the Madras Presidency. Madras: Government Gazette Press, 1871. Cornish, William R. “Fifth Annual Report on the Cause of Death in Madras during the Year 1859.” Madras Quarterly Journal of Medical Science 3 (1961): 76–108. Cornish, William R. Report on the Cholera in South India for the Year 1869. Madras: Sanitary Commissioner, 1870. Corporation of Madras. Madras City Water Supply: 1870–1955. Madras: Corporation of Madras, 1955. Cotton, Arthur. Public Works in India: Their Importance, with Suggestions for Their Extension and Improvement. 2nd ed. London: Richardson Brothers, 1854.

Bibliography

303

Crawford, D. G. A History of the Indian Medical Service 1600–1913. 2 vols. London: Thacker, 1913. Cronon, William. Nature’s Metropolis: Chicago and the Great West. New York: Norton, 1992. Crosby, Alfred W. “Influenza.” In The Cambridge World History of Human Diseases, edited by Kenneth F. Kiple, 807–11. Cambridge: Cambridge University Press, 1993. Cunningham, Andrew, and Perry Williams, eds. The Laboratory Revolution in Medicine. Cambridge: Cambridge University Press, 1992. Cunningham, David Douglas. “Are Choleraic Comma-Bacilli, even Granting That They Are the Proximate Cause of Choleraic Symptoms, Really Efficient in Determining the Epidemic Diffusion of Cholera?” Scientific Memoirs by Medical Officers of the Army of India 4 (1889): 1–20. Cunningham, David Douglas. “On the Effects Sometimes Following Injection of Choleraic Comma-Bacilli into the Subcutaneous Tissues in Guinea-Pigs.” Scientific Memoirs by Medical Officers of the Army of India 2 (1886): 1–14. Cunningham, David Douglas. “On the Relation of Cholera to Schizomycete Organisms.” Scientific Memoirs by Medical Officers of the Army of India 1 (1884): 1–20. Curtis, Bruce. “La morale miasmatique: Le Mémoire sur le choléra de Joseph-Charles Taché.” Canadian Bulletin of Medical History 16 (1999): 317–39. Curtis, Bruce. The Politics of Population: State Formation, Statistics, and the Census of Canada, 1840–1875. Toronto: University of Toronto Press, 2001. Curtis, Bruce. “Social Investment in Medical Forms: The 1866 Cholera Scare and Beyond.” Canadian Historical Review 81 (2000): 347–79. Dagneau, George-Henri, ed. De la Confédération à la charte de 1929. Volume 4 of La ville de Québec: Histoire municipale, edited by Société historique de Québec. Quebec: Société historique de Québec, 1983. Desrosiers, Georges, Benoît Gaumer, and Othmar Keel. “L’évolution des structures de l’enseignement universitaire spécialisé de santé publique au Québec: 1899– 1970.” Canadian Bulletin of Medical History 6 (1989): 3–26. Dickinson, John, and Brian Young. A Short History of Quebec. 4th ed. Montreal and Kingston: McGill-Queen’s University Press, 2008. Douglas, James. Journals and Reminiscences of James Douglas, M.D. New York: privately printed, 1910. “Dr. Douglas Cunningham’s Untersuchungen über Pettenkofer’s Theorie auf Madras angewendet” (editorial). Zeitschrift für Biologie 8 (1872): 367–93. Drolet, Antonio. De l’incorporation à la Confédération. Volume 3 of La ville de Québec: Histoire municipale, edited by Société historique de Québec. Quebec: Société historique de Québec, 1983. Drolet, Antonio. “L’épidémie de grippe espagnole à Québec en 1918.” Laval médical 27 (1959): 647–55. Drolet, Antonio. Régime anglais, avant 1833. Volume 2 of La ville de Québec: Histoire municipale, edited by Société historique de Québec. Quebec: Société historique de Québec, 1965.

304

Bibliography

Drolet, Antonio. “Un hôpital municipal à Québec en 1834.” In Trois siècles de médecine québécoise, edited by Yolande Bonenfont et al., 66–69. Quebec: Société historique de Québec, 1970. Duperron, Christian. “Le choléra à Québec en 1832: Entre contagion et infection.” MA thesis, Université Laval, 2006. Eckart, Wolfgang U., and Robert Jütte. Medizingeschichte: Eine Einführung. Cologne: Böhlau, 2007. Evans, Richard J. Death in Hamburg: Society and Politics in the Cholera Years. Oxford: Clarendon, 1987. Fischer-Tiné, Harald, and Michael Mann, eds. Colonialism as Civilizing Mission: Cultural Ideology in British India. London: Anthem Press, 2004. Fleck, Ludwik. Entstehung und Entwicklung einer wissenschaftlichen Tatsache: Einführung in die Lehre vom Denkstil und Denkkollektiv. Frankfurt: Suhrkamp, 1980. Frevert, Ute. Krankheit als politisches Problem, 1770–1880: Soziale Unterschichten in Preußen zwischen medizinischer Polizei und staatlicher Sozialversicherung. Göttingen: Vandenhoeck & Ruprecht, 1984. Frykenburg, Robert Eric. “The Socio-Political Morphology of Madras: An Historical Interpretation.” Indo-British Review 11 (1985): 5–37. Gagnon, Gérald. Histoire du service de police de la ville de Québec. Quebec: Publications du Québec, 1998. Gauthier, C.-A. “Histoire de la Société Médicale de Québec.” Laval médical 8 (1943): 62–121. Gill, Clifford Allchin. The Genesis of Epidemics and the Natural History of Disease: An Introduction to the Science of Epidemiology Based upon the Study of Epidemics of Malaria, Influenza, & Plague. London: Baillière, Tindall and Cox, 1928. Gorman, Mel. “Introduction of Western Science into Colonial India: Role of the Calcutta Medical College.” Proceedings of the American Philosophical Society 132 (1988): 276–98. Goubert, Jean-Pierre, ed. La médicalisation de la société française, 1770–1830. Waterloo, ON: Historical Reflections Press, 1982. Goulet, Denis, and Othmar Keel. “Les hommes-relais de la bactériologie en territoire québécois et l’introduction de nouvelles pratiques diagnostiques et thérapeutiques (1890–1920).” Revue historique de l’Amérique française 46 (1993): 417–42. Goulet, Denis, and Othmar Keel. “L’introduction de la médecine pasteurienne au Québec.” In Proceedings of the 31st International Congress on the History of Medicine, edited by Raffaele A. Bernabeo, 823–28. Bologna: Monduzzi, 1988. Goulet, Denis, Gilles Lemire, and Denis Gauvreau. “Des bureaux d’hygiène municipaux aux unités sanitaires: le Conseil d’Hygiène de la Province de Québec et la structuration d’un système de santé publique, 1886–1926.” Revue historique de l’Amérique française 49 (1999): 491–520. Goulet, Denis, and André Paradis. Trois siècles d’histoire médicale au Québec: Chronologie des institutions et des pratiques (1639–1919). Montreal: VLB, 1992.

Bibliography

305

Gourlay, Jharna. Florence Nightingale and the Health of the Raj. Aldershot: Ashgate, 2003. Government of Madras. Report and Order of the Madras Government, Regarding the Control of Pilgrimages, in the Madras Presidency. Madras: Gantz, 1868. Grace, Robert J. “Irish Immigration and Settlement in a Catholic City: Quebec, 1842–61.” Canadian Historical Review 84 (2003): 217–51. Gradmann, Christoph. “Das reisende Labor: Robert Koch erforscht die Cholera 1883/84.” Medizinhistorisches Journal 38 (2003): 35–56. Gradmann, Christoph. Krankheit im Labor: Robert Koch und die medizinische Bakteriologie. Göttingen: Wallstein, 2005. Greer, Alan. The Patriots and the People. Toronto: University of Toronto Press, 2003. Greer, Alan, and Ian Radforth, eds. Colonial Leviathan: State Formation in Mid-Nineteenth-Century Canada. Toronto: University of Toronto Press, 1992. Guérard, François. Histoire de la santé au Québec. Montreal: Boréal, 1996. Guha, Sumit. “Nutrition, Sanitation, Hygiene, and the Likelihood of Death: The British Army in India c. 1870–1920.” Population Studies 47 (1993): 385–401. Haffkine, Woldemar M., and W. J. Simpson. “A Contribution to the Etiology of Cholera.” Indian Medical Gazette 30 (1895): 89–92. Hall, Catherine. Civilising Subjects: Metropole and Colony in the English Imagination, 1830–1867. Cambridge: Polity, 2002. Hamelin, Jean. Histoire du Québec. Toulouse: Privat, 1976. Hamlin, Christopher. “Ackerknecht and ‘Anticontagionism’: A Tale of Two Dichotomies.” International Journal of Epidemiology 38 (2009): 22–27. Hamlin, Christopher. Cholera: The Biography. Oxford: Oxford University Press, 2009. Hamlin, Christopher. “Edwin Chadwick and the Engineers, 1842–1854: Systems and Antisystems in the Pipe-and-Brick Sewers War.” Technology and Culture 33 (1992): 680–709. Hamlin, Christopher. “Edwin Chadwick, ‘Mutton Medicine,’ and the Fever Question.” Bulletin of the History of Medicine 70 (1996): 233–65. Hamlin, Christopher. “Predisposing Causes and Public Health in Early Nineteenth-Century Medical Thought.” Social History of Memory 5 (1992): 43–70. Hamlin, Christopher. “Providence and Putrefaction: Victorian Sanitarians and the Natural Theology of Health and Disease.” In Energy and Entropy: Science and Culture in Victorian Britain, edited by Patrick Brantlinger, 93–123. Bloomington: Indiana University Press, 1989. Hamlin, Christopher. Public Health and Social Justice in the Age of Chadwick: Britain, 1800–1854. Cambridge: Cambridge University Press, 1998. Hamowy, Ronald. Canadian Medicine: A Study in Restricted Entry. Vancouver: Fraser Institute, 1984. Hankin, Ernest H. “Observations on Cholera in India.” Indian Medical Gazette 30 (1895): 92–97. Hardy, Anne. “Cholera, Quarantine and the English Preventive System, 1850–1895.” Medical History 37 (1993): 250–69.

306

Bibliography

Hare, John, Marc Lafrance, and David-Thiery Ruddel. Histoire de la ville de Québec. Montreal: Boréal, 1987. Harrison, Mark. Climates and Constitutions: Health, Race, Environment and British Imperialism in India 1600–1850. New Delhi: Oxford University Press, 1999. Harrison, Mark. “Public Health and Medicine in British India: An Assessment of the British Contribution.” Medical Historian 10 (1998): 32–48. Harrison, Mark. Public Health in British India: Anglo-Indian Preventive Medicine 1859– 1914. Cambridge: Cambridge University Press, 1994. Harrison, Mark. “‘The Tender Frame of Man’: Disease, Climate, and Racial Difference in India and the West Indies, 1760–1860.” Bulletin of the History of Medicine 70 (1996): 68–93. Harrison, Mark. “Towards a Sanitary Utopia? Professional Visions and Public Health in India, 1880–1914.” South Asia Research 10 (1990): 19–40. Headrick, Daniel R. The Tools of Empire: Technology and European Imperialism in the Nineteenth Century. New York: Oxford University Press, 1981. Heagerty, John J. Four Centuries of Medical History in Canada and a Sketch of the Medical History of Newfoundland. 2 vols. Toronto: Macmillan, 1928. Hehir, Patrick. “The Etiology of Cholera.” Indian Medical Gazette 24 (1889): 353–55. Hime, Thomas W. Introduction to Cholera: How to Prevent and Resist It, by Max von Pettenkofer, 5–24. London: Ballière, Tindall and Cox, 1875. Howard-Jones, Norman. “Cholera Therapy in the Nineteenth Century.” Journal of the History of Medicine and Allied Sciences 27 (1972): 373–95. Howard-Jones, Norman. The Scientific Background of the International Sanitary Conferences 1851–1938. Geneva: World Health Organization, 1975. Huber, Valeska. “The Unification of the Globe by Disease? The International Sanitary Conferences on Cholera, 1851–1894.” Historical Journal 49 (2006): 453–76. Hume, John Chandler, Jr. “Colonialism and Sanitary Medicine: The Development of Preventive Health Policy in the Punjab, 1860 to 1900.” Modern Asian Studies 20 (1986): 703–24. Inspector General of Police. The History of the Madras Police. Madras: B.N.K. Press, 1959. Isaacs, Jeremy D. “D D Cunningham and the Aetiology of Cholera in British India, 1869–1897.” Medical History 42 (1998): 279–305. Jackson, Samuel, Charles D. Meigs, and Richard Harlan. Report of the Commission Appointed by the Sanitary Board of the Crisis Council, to Visit Canada, for the Investigation of the Epidemic Cholera, Prevailing in Montreal and Quebec. Philadelphia: Mifflin & Parry, 1832. Jameson, James. Report on the Epidemick Cholera Morbus, as It Visited the Territories Subject to the Presidency of Bengal, in the Years 1817, 1818 and 1819. Calcutta: Government Gazette Press, 1820. Jarrell, Richard A., and Arnold E. Roos, eds. Critical Issues in the History of Canadian Science, Technology and Medicine. Thornhill, ON: HSTC Publications, 1983. Johnson, Niall. “The Overshadowed Killer: Influenza in Britain in 1918–19.” In The Spanish Influenza Pandemic of 1918–19: New Perspectives, edited by Howard Phillips

Bibliography

307

and David Killingray, 132–55. London: Routledge, 2003. Jones, J. A. “Report on the Condition of the Madras Municipal Water-Works, with Schemes for Their Improvement.” In Papers Relating to Water-Supply Schemes in India, Part 1: Major Works, edited by Government of India, 1–44. Calcutta: Superintendent of Government Printing, 1889. Journal of the House of Assembly, Lower Canada, 1831–34. Journal of the Legislative Assembly of the Province of Canada, 1849. Keel, Othmar, and Peter Keating. “Autour du Journal de Médecine de Québec/Quebec Medical Journal (1826–1827): Programme scientifique et programme de medicalisation.” In Critical Issues in the History of Canadian Science, Technology and Medicine, edited by Richard A. Jarrell and Arnold E. Roos, 101–34. Thornhill, ON: HSTC Publications, 1983. Killingray, David. “A New ‘Imperial Disease’: The Influenza Pandemic of 1818–9 and Its Impact on the British Empire.” Caribbean Quarterly 49, no. 4 (2003): 30–49. Kiple, Kenneth F., ed. The Cambridge World History of Human Disease. Cambridge: Cambridge University Press, 1993. Klein, Ira. “Cholera: Theory and Treatment in Nineteenth Century India.” Journal of Indian History 58 (1980): 35–51. Klein, Ira. “Imperialism, Ecology and Disease: Cholera in India, 1850–1950.” Indian Economic and Social History Review 31 (1994): 491–518. Klein, Ira. “Plague, Policy and Popular Unrest in British India.” Modern Asian Studies 22 (1988): 723–55. Klingle, Matthew W. “Spaces of Consumption in Environmental History.” History and Theory 42 (2003): 94–110. Kosambi, Meera, and John E. Brush. “Early European Suburbanization in the IndoBritish Port Cities.” In Asian Urbanization: Problems and Processes, edited by Frank J. Costa, 9–23. Berlin: Borntraeger, 1988. Kumar, Anil. Medicine and the Raj: British Medical Policy in India, 1835–1911. New Delhi: SAGE, 1998. Kuriyan, George. “The Distribution of Population in the City of Madras.” Indian Geographic Journal 16 (1941): 58–70. Lafrance, Marc, and Thiery Ruddel. “Éléments de l’urbanisation de la ville de Québec.” Urban History Review / Revue d’histoire urbaine 1, no. 4 (1975): 22–30. Lamonde, Yves. Histoire sociale des idées au Québec. 2 vols. Montreal: Fides, 2000. Lang, Seán. “Obstetrics and Obstruction: Maternity Provision in Madras, 1840– 1852.” In From Western Medicine to Global Medicine: The Hospital beyond the West, edited by Mark Harrison, Margaret Jones, and Helen Sweet, 108–41. Hyderabad: Orient BlackSwan, 2009. Latour, Bruno. The Pasteurization of France. Cambridge, MA: Harvard University Press, 1988. Latour, Bruno. Reassembling the Social: An Introduction to Actor-Network-Theory. Oxford: Oxford University Press, 2005.

308

Bibliography

Latour, Bruno. We Have Never Been Modern. Cambridge, MA: Harvard University Press, 1993. Law, John, ed. Actor Network Theory and After. Oxford: Blackwell, 1999. Lawrence, I. Conrad. “Arab-Islamic Medicine.” In Companion Encyclopedia of the History of Medicine, edited by William F. Bynum and Roy Porter, 676–727. London: Routledge, 1993. Lawson, Philip. The East India Company: A History. London: Longman, 1997. Lebel, Alyne. “Les facteurs du développement urbain.” In De la Confédération à la charte de 1929, edited by George-Henri Dagneau, 31–47. Volume 4 of La ville de Québec: Histoire municipale, edited by Société historique de Québec. Quebec: Société historique de Québec, 1983. LeBlond, Sylvio. “Le choléra à Québec en 1849.” Canadian Medical Association Journal 71 (1954): 292–96. LeBlond, Sylvio. “L’hôpital de la Marine de Québec.” Union médicale du Canada 80 (1951): 616–26. Lefebvre, Henri. The Production of Space. Malden, MA: Blackwell, 1991. Leith, A. H., ed. Abstract of the Proceedings and Reports of the International Sanitary Conference of 1866. Bombay: Revenue Office, 1867. Lemoine, Réjean. “La santé publique: De l’inertie municipale à l’offensive hygièniste.” In De la Confédération à la charte de 1929, edited by George-Henri Dagneau, 153–80. Volume 4 of La ville de Québec: Histoire municipale, edited by Société historique de Québec. Quebec: Société historique de Québec, 1983. Lewandowski, Susan J. “Urban Growth and Municipal Development in the Colonial City of Madras, 1860–1900.” Journal of Asian Studies 34 (1975): 341–60. Lewis, Timothy Richards, and David Douglas Cunningham. Cholera in Relation to Certain Physical Phenomena: A Contribution towards the Special Enquiry Sanctioned by the Right Hon. the Secretaries of State, for War, and for India. Calcutta: Office of the Superintendent of Government Printing, 1878. Lewis, Timothy Richards, and David Douglas Cunningham. A Report on Microscopical and Physiological Researches into the Nature of the Agent or Agents Producing Cholera. Calcutta: Office of the Superintendent of Government Printing, 1872. Lewis, Timothy Richards, and David Douglas Cunningham. A Report on Microscopical and Physiological Researches into the Nature of the Agent or Agents Producing Cholera (Second Series). Calcutta: Office of the Superintendent of Government Printing, 1874. Loetz, Francisca. Vom Kranken zum Patientien: “Medikalisierung” und medizinische Vergesellschaftung am Beispiel Badens 1750–1850. Stuttgart: Steiner, 1993. Löwy, Ilana. “From Guinea Pig to Man: The Development of Haffkine’s Anticholera Vaccine.” Journal of the History of Medicine and Allied Sciences 47 (1992): 270–309. MacDermot, H. E. One Hundred Years of Medicine in Canada, 1867–1967. Toronto: McClelland and Stewart, 1967. MacLeod, Roy, and Milton Lewis, eds. Disease, Medicine, and Empire: Perspectives on Western Medicine and the Experience of European Expansion. London: Routledge, 1988.

Bibliography

309

Madras Health Officer Report, 1918. Madras Medical Board. Deaths in Madras during 1855. Madras: Fort St. George Press, 1858. Madras Medical Board. Report on the Medical Topography and Statistics of the Presidency Division of the Madras Army, Including Fort St. George and Its Dependencies, within the Limits of the Supreme Court, Compiled from the Records of the Medical Board Office. Madras: Vepery Mission Press, 1842. Madras Municipal Report, 1867–1910. Madras Sanitary Report, 1865–1910. Madras Tercentenary Memorial Committee, ed. Madras Tercentenary Memorial Volume. London: Oxford University Press, 1939. McCulloch, Michael Ernest. “The Defeat of Imperial Urbanism in Québec City, 1840–1855.” Urban History Review 22 (1993): 17–29. McDonald, J. C. “The History of Quarantine in Britain during the 19th Century.” Bulletin of the History of Medicine 25 (1951): 22–44. McGrew, Roderick. E. “The First Cholera Epidemic and Social History.” Bulletin of the History of Medicine 34 (1960): 61–73. McNeill, William H. Plagues and Peoples. Garden City, NY: Anchor Press, 1976. Mendelsohn, John Andrew. “From Eradication to Equilibrium: How Epidemics Became Complex after World War I.” In Greater Than the Parts: Holism in Biomedicine, 1920–1950, edited by Christopher Lawrence and George Weisz, 303–31. New York: Oxford University Press, 1998. Merrifield, Andy. “Henri Lefebvre: A Socialist in Space.” In Thinking Space, edited by Mike Crang and Nigel Thrift, 167–82. London: Routledge, 2000. Metcalf, Thomas R. Ideologies of the Raj. Cambridge: Cambridge University Press, 1994. Misra, B. B. The Administrative History of India, 1834–1947: General Administration. London: Oxford University Press, 1970. Misra, B. B. The Central Administration of the East India Company, 1773–1834. Manchester: Manchester University Press, 1959. Moore, Robin J. “Imperial India, 1858–1914.” In The Nineteenth Century, edited by Andrew Porter, 422–46. Volume 3 of The Oxford History of the British Empire. Oxford: Oxford University Press, 1999. Mountain, G. J. A Retrospect of the Summer and Autumn of 1832, Being a Sermon Delivered in the Cathedral Church of Quebec, on Sunday, the 30th December of that Year. Quebec: Thomas Carey, 1832. Mukharji, Projit Bihari. “The ‘Cholera Cloud’ in the Nineteenth-Century ‘British World’: History of an Object-without-an-Essence.” Bulletin of the History of Medicine 86 (2012): 303–32. Nair, Arana. “An Egyptian Infection: War, Plague and the Quarantines of the English East India Company at Madras and Bombay, 1802.” Hygiea Internationalis 8 (2009): 7–29.

310

Bibliography

Neild, Susan. “Colonial Urbanism: The Development of Madras in the Eighteenth and Nineteenth Centuries.” Modern Asian Studies 13 (1979): 217–46. Neild, Susan. “Madras: The Growth of a Colonial City in India, 1780–1840.” PhD dissertation, University of Chicago, 1977. Neild-Basu, Susan. “Madras in 1800: Perceiving the City.” In Urban Form and Meaning in South Asia: The Shaping of Cities from Prehistoric to Precolonial Times, edited by Howard Spodek and Meth Srinivasan, 221–40. Hanover, NH: University Press of New England, 1993. Nelson, Wolfred. Practical Views on Cholera, and on the Sanitary, Preventive and Curative Measures to Be Adopted in the Event of a Visitation of the Epidemic. Montreal: B. Dawson, 1854. Nightingale, Florence. Life and Death in India. London: Spottiswoode, 1874. Noël, Ginette. “Les travaux publics.” In De la Confédération à la charte de 1929, edited by George-Henri Dagneau, 106–14. Volume 4 of La ville de Québec: Histoire municipale, edited by Société historique de Québec. Quebec: Société historique de Québec, 1983. O’Connell, P. P. Papers Connected with the Better Supply of Madras with Water, and the Improvement of the Drainage and Sewerage of Black Town. Madras: H. Smith, 1855. O’Gallagher, Marianna. Grosse Île: Gateway to Canada, 1832–1937. Quebec: Carraig, 1984. Ogawa, Mariko. “Uneasy Bedfellows: Science and Politics in the Refutation of Koch’s Bacterial Theory of Cholera.” Bulletin of the History of Medicine 74 (2000): 671–707. Orton, Reginald. An Essay on the Epidemic Cholera of India. 2nd ed., with a suppl. London: Burgess and Hill, 1831. Osterhammel, Jürgen. Approaches to Global History and the Question of the “Civilizing Mission.” Osaka: Global History and Maritime Asia Working and Discussion Paper Series, 2006. Osterhammel, Jürgen. Colonialism: A Theoretical Overview. Princeton, NJ: Markus Wiener Publishers, 1997. Ouellet, Fernand. Éléments d’histoire sociale du Bas-Canada. Montreal: Hurtubise, 1972. Pacquet, Gilles, and Jean-Pierre Wallot. Un Québec moderne, 1760–1840: Essai d’histoire économique et sociale. Montreal: Hurtubise, 2007. Painchaud, Joseph. Extrait d’une lecture sur le choléra asiatique. Quebec: Imprimerie du “Canadien,” 1849. Paquin, C. R. Rapport sur l’état de la cité de Québec et sur les opérations du département d’hygiène pour l’année 1918–1919. Quebec: Imprimerie Vincent, 1919. Peers, Douglas M. Between Mars and Mammon: Colonial Armies and the Garrison State in India, 1819–1835. London: Tauris Academic Studies, 1995. Pelling, Margaret. Cholera, Fever and English Medicine. Oxford: Oxford University Press, 1978. Perlin, Frank. “State Formation Reconsidered: Part Two.” Modern Asian Studies 19 (1985): 415–80.

Bibliography

311

Pettenkofer, Max. Verbreitungsart der Cholera in Indien: Ergebnisse der neuesten aetiologischen Untersuchungen in Indien. Braunschweig: Vieweg, 1871. Pickstone, John V. “Dearth, Dirt and Fever Epidemics: Rewriting the History of British ‘Public Health’ 1780–1850.” In Epidemics and Ideas: Essays on the Historical Perception of Pestilence, edited by Terence Ranger and Paul Slack, 125–48. Cambridge: Cambridge University Press, 1992. Pollitzer, R. Cholera. Geneva: World Health Organization, 1959. Porter, Roy. Bodies Politic: Disease, Death and Doctors in Britain, 1650–1900. London: Reaktion Books, 2001. Pottinger, George. Sir Henry Pottinger: The First Governor of Hong Kong. Stroud: Sutton, 1997. “Professor Haffkine’s Inoculation against Cholera” (editorial). Indian Medical Gazette 29 (1894): 137–38. Quigley, Michael. “Grosse Ile.” Eire—Ireland 32 (1997): 20–40. Ramasubban, Radhika. “Imperial Health in British India, 1857–1900.” In Disease, Medicine, and Empire: Perspectives on Western Medicine and the Experience of European Expansion, edited by Roy MacLeod and Milton Lewis, 38–60. London: Routledge, 1988. Ranger, Terence, and Paul Slack, eds. Epidemics and Ideas: Essays on the Historical Perception of Pestilence. Cambridge: Cambridge University Press, 1992. Reddy, C. Venkata Rama, ed. City of Madras: Official Handbook. Madras: Corporation of Madras, 1950. Reddy, M. Atchi. Trade and Commerce of the English East India Company in India (Madras). 3 vols. Ambala: Associated Publishers, 2006. Reinhard, Wolfgang. Geschichte des modernen Staates. Munich: Beck, 2007. Reinhard, Wolfgang. Kleine Geschichte des Kolonialismus. 2nd ed. Stuttgart: Kröner, 2008. Rheault, Marcel J., and Georges Aubi. Médecins et patriotes, 1837–1838. Quebec: Septentrion, 2006. Riley, James C. The Eighteenth-Century Campaign to Avoid Disease. Basingstoke: Macmillan, 1987. Rogers, Leonard. Cholera and Its Treatment. London: Oxford University Press, 1911. Rogers, Leonard. “The Forecasting and Control of Cholera Epidemics in India.” Journal of the Army Medical Corps 49 (1927): part 1, 182–92, and part 2, 261–78. Rogers, Samuel. Reports on Asiatic Cholera in Regiments of the Madras Army from 1828 to 1844, with Introductory Remarks on Its Mode of Diffusion and Prevention, and Summary of the General Method of Treatment in India. London: Pelham Richardson and Samuel Highley, 1848. Rosenberg, Charles E. “Cholera in Nineteenth-Century Europe: A Tool for Social and Economic Analysis.” Comparative Studies of Society and History 8 (1965–66): 452–63. Royal Commission on the Sanitary Condition of the Army. Report of the Commissioners Appointed to Inquire into the Regulations Affecting the Sanitary Condition of the Army,

312

Bibliography

the Organization of Military Hospitals, and the Treatment of the Sick and Wounded, with Evidence and Appendix. London: Eyre and Spottiswoode, 1858. Royal Commission on the Sanitary State of the Army in India. Report of the Commissioners. 2 vols. London: Eyre and Spottiswoode, 1863. Ruddel, David-Thiery. Québec City, 1765–1832: The Evolution of a Colonial Town. Hull, QC: Canadian Museum of Civilization, 1991. Ruddel, David-Thiery, and Marc Lafrance. “Québec, 1785–1840: Problèmes de croissance d’une ville coloniale.” Histoire sociale / Social History 18 (1985): 315–33. Rudin, Ronald. The Forgotten Quebecers: A History of English-Speaking Quebec, 1759– 1980. Quebec City: Institut québécois de recherche sur la culture, 1985. Rudin, Ronald. Making History in Twentieth Century Quebec. Toronto: University of Toronto Press, 1997. Russell, G. On the Operation of Physical Agencies in the Functions of Organized Bodies, with Suggestions as to the Nature of Cholera. 2nd ed. Montreal: J. C. Becket, 1849. “Sanitary Progress” (editorial). Indian Medical Gazette 6 (1871): 214–15. Schmid, Christian. Stadt, Raum und Gesellschaft: Henri Lefebvre und die Theorie der Produktion des Raumes. Stuttgart: Steiner, 2005. Scot, William. Report on Epidemic Cholera as It Has Appeared in the Territories Subject to the Presidency of Fort St. George. Madras: Asylum Press, 1824. Simpson, W. J. “Cholera in Europe and India.” Indian Medical Gazette 28 (1893): 43– 44. Simpson, W. J. “Memorandum on Cholera and Professor Haffkine’s Anti-Choleraic Vaccination.” Indian Medical Gazette 29 (1894): 235–38. Simpson, W. J. “A Resumé of Some of the More Important Facts Relating to Indian Cholera.” Indian Medical Gazette, parts 1–3, 28 (1893): 129–35, 177–81, 364–69; and part 4, 9 (1894): 161–68. Slack, Paul. The Impact of Plague in Tudor and Stuart England. Oxford: Clarendon, 1990. Slack, Paul. “Responses to Plague in Early Modern Europe: The Implications of Public Health.” Social Research 55 (1988): 433–53. Snowden, Frank M. Naples in the Time of Cholera, 1884–1911. Cambridge: Cambridge University Press, 1995. Srinivasachari, C. S. History of the City of Madras. Madras: P. Varadachari, 1939. Srinivasachari, C. S. “A History of the Mayoralty of Madras.” In Madras Tercentenary Memorial Volume, edited by Madras Tercentenary Commemoration Committee, 181–93. London: Oxford University Press, 1939. Srinivasachari, C. S. “The Nawabs of the Carnatic.” In The Politics of the British Annexation of India, 1757–1857, edited by Michael H. Fisher, 98–120. Delhi: Oxford University Press, 1996. Stein, Burton. “State Formation and Economy Reconsidered: Part One.” Modern Asian Studies 19 (1985): 387–413. Steuart, Robert. Reports on the Epidemic Cholera Which Has Raged throughout Hindostan and the Peninsula of India since August 1817. Bombay: De Jesus, 1819.

Bibliography

313

Taché, Joseph-Charles. Memorandum on Cholera. Ottawa: Bureau of Agriculture, 1866. Tarr, Joel A. “Sewerage and the Development of the Networked City in the United States, 1850–1930.” In Technology and the Rise of the Networked City in Europe and America, edited by Joel A. Tarr and Gabriel Dupuy, 159–85. Philadelphia: Temple University Press, 1988. Tétreault, Martin. “Frederick Montizambert et la quarantaine de Grosse Île, 1869– 1899.” Scientia canadensis 19 (1995): 5–28. Tulloch, Hector. Report on a Project for the Drainage of the Town of Madras. Madras: Gantz, 1865. Tunis, Barbara R. “The Medical Profession in Lower Canada: Its Evolution as a Social Group, 1788–1838.” BA thesis, Carleton University, 1979. Washbrook, David. The Emergence of Provincial Politics: The Madras Presidency 1870– 1920. Cambridge: Cambridge University Press, 1982. Washbrook, David. “South India 1770–1840: The Colonial Transition.” Modern Asian Studies 38 (2004): 479–516. Wear, Andrew. “The Prospective Colonists.” In Cultivating the Colonies: Colonial States and Their Environmental Legacies, edited by Christina Folke Ax, Niels Brimnes, and Niklas Thode Jensen, 19–46. Athens: Ohio University Press, 2011. Weyer–von Schoultz, Martin. Max von Pettenkofer (1818–1901): Die Entstehung der modernen Hygiene aus den empirischen Studien menschlicher Lebensgrundlagen. Frankfurt: Peter Lang, 2006. Williams, Perry. “The Laws of Health: Women, Medicine and Sanitary Reform, 1850–1890.” In Science and Sensibility: Gender and Scientific Enquiry, 1780–1945, edited by Marina Benjamin, 60–88. Oxford: Basil Blackwell, 1991. Wilson, Jon E. The Domination of Strangers: Modern Governance in Eastern India, 1780– 1835. Basingstoke: Palgrave Macmillan, 2008. Woodworth, John M. The Cholera Epidemic of 1873 in the United States: The Introduction of Epidemic Cholera through the Agency of the Mercantile Marine; Suggestions of Measures of Prevention. Washington, DC: Government Printing Office, 1875. Worboys, Michael. “The Emergence of Tropical Medicine: A Study in the Establishment of a Scientific Specialty.” In Perspectives on the Emergence of Scientific Disciplines, edited by Gerard Lemain et al., 75–98. The Hague: Mouton, 1976. Worboys, Michael. Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900. Cambridge: Cambridge University Press, 2000. Workman, Joseph. Medical Inaugural Dissertation on Asiatic Cholera. Montreal: Andrew H. Armour, 1835. Wujastyk, Dominik. “Indian Medicine.” In Companion Encyclopedia of the History of Medicine, edited by William F. Bynum and Roy Porter, 755–78. London: Routledge, 1993. Young, Brian. “Patrician Elites and Power in Nineteenth-Century Montreal and Quebec City.” In Who Ran the Cities? City Elites and Urban Power Structures in Europe and North America, 1750–1940, edited by Ralf Roth and Robert Beachey, 229–46. Aldershot: Ashgate, 2007. 314

Bibliography

Index

abatement: of epidemic cholera, 4, 34, 40, 42, 81–86, 93, 117, 120, 127, 192, 211, 220; of epidemic influenza, 242 acclimatization, 125, 167. See also climate accommodation, 25, 86, 101, 114, 118, 193, 255; for immigrants, 61, 74, 78, 89; for patients, 38, 41, 165, 167; on Grosse Île, 60, 64, 67–68, 88, 90, 230 acquisition, 77, 122, 189, 235; of equipment, 36, 92, 115, 203, 236; of land, 107, 123, 138, 149, 191; of remedies, 38, 63 administration, 9–12, 26–28, 65; sanitary, 167, 170, 194–96 advertisement, 110, 115, 124, 252; for positions, 66, 68, 110; on cholera, 38, 81, 108, 117, 245 Adyar River, 141, 147 Africa, 144, 234, 236, 247 agriculture, 9, 22, 24, 139, 143, 148, 187. See also sewage farming alcohol, 32, 78, 83, 88; as remedy, 36, 39, 41, 78 Alexandria, 209, 211 Altona, 215, 220, 246 American Public Health Association (APHA), 229–30

analysis, 42, 47, 148, 247; bacteriological, 8, 211, 216, 220, 229, 231, 238–40; of records, 8, 34, 45, 168, 172–73, 174, 177, 180, 192, 196; spatial, 15-16, 21 anchorage, 64, 67, 87 anglophone, 55, 104, 106, 207, 231; elites, 55–56, 105, 115 Arabia, 174, 175, 177 Arcot, 23, 24, 36, 182 army, 64, 71, 153, 156, 162–67, 194, 198; British, 9, 12, 25, 28, 32, 41, 55, 56, 59, 155, 163–67, 185, 196; health of, 28, 33, 41, 45, 134, 162, 164–67, 171–72, 185, 194, 196, 221, 238, 246; Native, 28, 37, 149, 162, 164, 167, 185, 196; stocks, 33, 38, 75, 193 Army Sanitary Commission, 172, 177 Atlanta (ship), 202, 205 Atlantic, 54, 198, 208, 236 atmosphere, 4–6, 31, 173, 237, 251; composition of, 7, 31; condition of, 31, 35, 39, 42, 45, 115, 128, 176, 243; electricity of, 31, 45, 47, 115; influence of, 31–32, 35, 43, 45, 177; pressure of, 31, 45; purification of, 4, 6, 96, 97, 127. See also temperature, atmosphere

315

Aylmer, Lord, 58, 60, 61, 64–68, 75, 77, 79, 89, 94, 95 bacteriology, 209–11, 215–18, 222–23, 229–30, 231, 236–40, 242–43, 247; methods 215, 223, 242, 243; training, 210, 215, 218, 231. See also analysis; consensus; medical theory; research baggage, 60, 73, 87, 90, 233–34, 236, 238 Baldwin, George R., 121–24 barracks, 85, 114, 133, 165–66, 170, 185; lines, 149, 165, 167 bath, 36, 37, 82, 90, 148, 230 bazaar. See market bedding, 38, 41, 66, 74, 208, 219 behavior, 109, 167, 171, 197, 218, 222, 228; of cholera, 3, 40, 42, 48, 50, 85, 86, 95, 173, 248; of population, 4, 5, 50, 78, 128–29, 182, 240; predisposing, 30–31, 32, 41, 77, 128, 133, 157–58, 163, 166 benevolence, 10, 35, 37–40, 79, 131, 146, 245, 252 Bengal, 28, 32, 212, 218; as origin of cholera, 7, 34, 36, 46, 177–78, 192; Presidency, 180 bid, 123, 124, 236 Black Town, 22–23, 25, 26, 48, 131–32, 143, 166, 193; drainage, 134–43, 146– 47, 153–54, 155, 157, 159, 166, 171, 187, 190–91, 219, 226, 251, 255; water supply, 139, 141, 147, 166 Board of Health, 54, 96, 108, 126, 202–3, 232; Central (Canada) 108–9, 115, 126, 127, 203; Central (London), 54, 58, 67; General, 103, 141; Montreal, 60, 202–3; Provincial, 232–35; Quebec City, 60, 62–63, 65–88, 89, 93–95, 97, 107–8, 110–25, 126–27, 205, 230, 235, 236, 252–53, 255–56 boardinghouse, 63, 74, 78, 80 body, 4, 32, 45, 46, 77, 239, 450; of patient, 29, 30, 34, 36, 42, 50, 51, 248. See also constitution (body); temperature, body

316

Bombay, 11, 167, 213, 221, 223, 231; Presidency, 144, 164. See also government, of Bombay Boulderson, John Carne, 139–40, 141–43, 153, 166 bowels, 36, 167, 211–12 Britain. See United Kingdom British Army Medical Service, 176 British Empire, 11–12, 55, 175, 202, 214, 228, 237, 256 British Isles. See United Kingdom British North America, 54–55, 57, 59, 106, 201, 202, 204. See also Canada (province) British North America Act, 206–7, 234. See also constitution (law) Bryden, James L., 174, 177–81 budget, 89, 172, 186, 188, 219, 226, 254; provincial, 55–56, 57 burial, 77, 81, 84, 114 Calcutta, 11, 25–26, 132, 164, 167, 212, 213, 216; drainage, 150, 191 camp, 114, 127, 183, 193, 225, 250; on the Plains of Abraham, 75, 77, 86, 88–89, 96, 255 Canada (dominion), 10–12, 206–9, 228, 230–3, 235, 236, 251; as colony, 10– 12, 256. See also British North America; government, federal Canada (province), 104, 106–9, 112, 115, 121, 122, 128, 145, 198, 201–4. See also Lower Canada; Ontario; Quebec (province); Upper Canada canal, 147–49, 151, 155, 160; Suez, 163, 174, 184, 211, 212, 213, 246, 247 cantonment, 28, 35, 36, 170–72, 180, 183, 194–95; Meerut, 164; Pelaveram, 149; St. Thomas Mount, 159. See also garrison capital city, 26, 28; provincial, 9–10, 21, 23, 26, 55, 56, 207, 246 cargo, 60, 81, 149, 175, 204, 208, 225, 233, 237, 238

Index

cart, 28, 80–81, 91, 113, 189 caste, 27, 39, 131, 157; lower, 5, 23–24, 42, 50. See also parayar Catholic Church, 56, 119, 235. See also clergy; religion cause, 30–31; environmental, 30–32; exciting, 30–31; predisposing, 30–32; proximate, 30; remote, 30. See also etiology; medical theory cellar, 71, 85, 91, 112, 118, 119 cemetery, 74, 81, 86, 114, 118, 244 census, 27, 186, 253 certificate of health, 64, 72, 80, 83 cesspool, 140, 142–43, 153, 190, 191 Chadwick, Edwin, 101–2, 108, 136, 164, 238 Champlain Street, 74–75, 111, 113 charity, 29, 68, 84, 145, 226 chemistry, 31, 122, 166, 173–74, 230 China, 22, 144, 212, 221, 236 Chintadrepet, 24, 38, 49, 131, 190, 226 chloride, 73, 91; of lime, 75–76 cholera, 6–11; Asiatic, 53; asphyxia, 46– 47; spasmodica, 34; sporadic, 40–41 Cholera Committee, 182–83 cholera literature, 45–48, 53–54, 107, 115, 179; pamphlet, 109, 234 cholera morbus, 34, 35, 45–46, 71, 73, 91, 223 Citadelle, 56, 89. See also fortification, Quebec City Council, 88, 93, 105 civilizing mission, 134, 145, 156, 160, 162, 196, 223, 238 cleansing, 62–65, 70, 76–77 clergy, 3–4, 62, 66, 77, 81, 95, 116. See also Catholic Church; religion climate, 7, 31, 133, 143, 223, 246; of Canada, 57; of India, 21, 32, 166, 173, 179. See also acclimatization clothes; 32, 61, 117, 166, 236, 238; soiled, 74, 77, 208, 219; washing, 42, 82, 219 coercion, 64–65, 76, 83–84, 97, 117, 146, 256

collector, 6, 26, 50, 144 colonial city, 6, 11, 22, 156 colonial situation, 10, 246, 256 colonial state, 11–12, 255–56; formation, 29, 98, 129, 157, 162, 195; weakness of, 10, 21, 27, 44, 255–56 colony, 10–12; crown, 164; of exploitation, 10–11, 13, 256; of white settlement, 10–11, 256 coma, 7, 35, 42, 81 comma bacillus, 211–21, 224, 225, 227, 236–37, 239, 246–48 commander-in-chief: Madras, 26, 28; Quebec, 55 commissioners of health, 63, 66–74, 79, 84, 86, 94–95 complaint, 78, 82, 115, 119, 123; about nuisances, 70, 76–77, 110, 114, 120 complexity, 209–10, 239, 243–44, 248– 49, 256; of cholera, 32, 45, 47–48, 173, 180, 192, 211, 214, 220–21, 236, 245, 247; of Madras, 51, 157, 251; of scheme, 155, 157, 160 complicator, 248–49 consensus, 8, 47, 54, 98, 161, 203, 248; bacteriological, 17, 245–46, 250; epidemiological, 175–76, 196, 245–46, 251; political, 98, 103, 128, 174, 245–46, 249 constitution (body), 30–32, 182. See also body constitution (law), 12, 55–56, 104–5, 234. See also British North America Act control, 29, 241; of cholera, 6–7, 14–17, 21, 50, 93, 94, 128, 163, 178, 195, 197, 211, 238–40, 247; of environment, 8, 43, 62, 129, 209–10, 250–51, 254; of migration, 175, 177, 182, 184, 211, 246–47; of population, 9, 26, 77, 80, 254; of space, 44, 50–51, 134, 194, 198 cooperation, 23, 61, 82, 252; of authorities, 65, 88, 228, 235; of population, 70, 75, 76, 84–85, 97, 109, 117, 203, 244

Index

317

Cooum River, 5, 22, 24, 132, 142, 154; pollution of, 146–47, 152, 165–66, 190, 226 cordon sanitaire, 8, 35, 54, 175, 182, 214, 222 Cornish, William R., 169, 180–181, 217 corpse, 80–81, 114, 211–12 cost, 16, 120, 166; construction, 103, 119– 25, 148–52, 188–91; of medical treatment, 101, 102, 116 cots, 37–41 Cotton, Arthur, 146, 154–55, 160 Council of Health, 89 court, 11, 72, 82, 114, 256; Supreme, 26, 134–35 Court of Directors, 25, 131–37, 139, 150, 155, 165. See also East India Company crew, 58, 60, 63–64, 80, 82, 92, 230 Crimean War, 155, 162, 163–64, 167 crisis, 10, 26, 29, 62, 107; cholera epidemics as, 4–6, 34, 87, 96, 163, 198, 205; management, 13, 38–41, 82, 98, 171, 197, 204, 222, 241; political, 10, 55–56 crowding, 27, 90, 107, 143, 149, 207; house, 6, 77, 83, 127; Lower Town, 73–75, 111, 113, 207 Cul-de-Sac, 74–75, 111, 115 Cuningham, James McNabb, 177–81, 212– 13, 215–17 Cunningham, David Douglas, 176–81, 213, 216–18, 248 customhouse, 115–16 customs officer, 82, 233 debt, 92, 120, 122, 125, 129, 191, 197, 254 decomposition, 173, 178, 220; of organic matter, 39, 102, 114, 134, 174, 183; of sewage, 102, 140, 185 delegation, 85, 175–76, 182 democratic representation, 10–12, 55–56, 89, 104, 254 Department of Agriculture and Statistics, 203–4, 228, 231–33; minister, 203, 208, 229

318

DeRenzy, A. C., 179–81, 215 diagnosis, 30, 221, 231; of cholera, 35, 37, 38, 45–46, 64, 67, 90, 91, 223 diarrhea, 7, 32, 34, 35, 153, 166 diet. See also food diphtheria, 231, 235 diplomacy, 25, 163, 174–75, 184, 212, 218, 221; defeat, 195–96, 214 discontent, 75, 84, 116, 123, 204; among population, 78, 79, 84, 110, 116, 151, 169, 238 disease, 13, 16, 30–31, 101–3, 209, 243; Indian, 29, 32 disinfection, 8, 76, 96, 113, 203, 229–30, 237, 240, 242, 250; of filth, 6, 75; of houses, 4, 76–77, 84, 183, 222; of passengers, 73, 88, 126, 208; of streets, 91, 97; of water supply, 224–25, 229, 238; with steam, 230, 236 dispensary, 33, 49, 131, 133, 158, 169, 193; temporary, 36–44, 50, 96–97, 108, 239, 254. See also hospital ditch, 87, 141–43, 146, 151–54, 190 drink, 30, 32, 78 drought, 173, 187–88, 192–93, 198 dry earth conservancy, 185, 189, 190 dysentery, 32, 166. See also diarrhea East India Company (EIC), 22–23, 25–28, 156, 164. See also Court of Directors Egypt, 33, 211–12, 213, 216, 220, 223; cholera in, 175, 202, 208–9, 228 elites, 26, 59, 62, 186, 249, 252; anglophone, 89, 105; colonial, 10, 25; francophone, 56; Indian, 23–24, 25, 44, 175, 182, 184 Elliot, Sir Daniel, 143, 151–52, 156 Elphinstone, Mountstuart, 144, 156 emigrants. See immigrants employment, 28, 123, 141, 230; of Indian medical practitioners, 38, 40–41; of staff, 62–63, 67, 92, 110, 113, 115–16 enclave, 25, 50–51, 172, 194–96, 239, 255; perspective of, 97, 134, 158, 159–60, 193, 255

Index

endemic, 31, 33, 194; cholera, 174–75, 177, 179, 182, 211–12, 225 engineer, 102–3, 130, 135–37, 143–61, 189– 91, 245, 255; chief, 122–24, 153; civil, 121, 139, 187, 239; military, 139–40; super-intending, 37 England, 33, 65, 119, 139, 150, 189 environment, 8, 12–16 epidemic, 16–18, 31 epidemiology, 7, 192, 196, 215–17, 219– 20, 225, 246–48; methods, 177, 215. See also medical theory equipment, 123, 167, 223, 230; of dispensary, 36, 38, 41, 193; of hospital 69, 73, 92, 115, 235 etiology, 7, 30; monocausal, 27, 30–31, 102, 176, 179, 210, 214–15, 238, 241, 245–248; multi-causal, 243. See also cause; medical theory Executive Council: Madras, 26, 142–43, 146, 152–54, 157–58, 168; Quebec, 55 exhaustion, 47, 79, 81, 82, 84, 102 famine, 107, 173, 187–88, 192 Farr, William, 165, 177 fear, 70, 91, 175, 255; of cholera, 10, 71, 74, 77–78, 201; predisposing, 77, 245 feces, 80, 102, 119, 135, 178, 212 festival, 34, 173, 182–83, 220 fever, 57, 71, 102, 134, 153, 158, 166, 242; epidemic, 34, 40; as symptom, 30 filter, 8, 185, 188–89, 207, 215, 226, 239– 40, 251 filth, 7, 102–3, 238, 247 fine, 61, 63, 70 fire, 103–4, 212 flood, 24, 71, 138, 151 flushes, 136, 139–40, 155, 165–66, 189–91 food, 23, 72, 78, 173, 192–93, 211, 225–26, 229. See also diet Fortier, Dr., 72, 82, 90 fortification: Madras, 22, 24, 165; Quebec, 56, 57, 75. See also Citadelle; Fort St. George

Fort St. George, 22–25, 97; esplanade, 137–43, 150–54, 185; sanitary condition, 133–149, 152–53, 165–66, 184– 85, 194, 198, 251. See also fortification, Madras fountain, 104, 187–88, 197 fragility, 9, 106, 255–56 France, 23, 115, 175, 202, 209, 211–12, 221, 223 francophone, 56–57, 59–60, 74, 89, 104–5, 207, 231 fumigation, 8, 68, 76, 229, 230 funds, 77, 223–24, 235, 254; for quarantine, 61, 107; for sanitary measures, 104, 119, 125, 135–36, 152, 153, 168, 184, 186–87, 191, 219, 227 garrison, 9, 25, 28, 56, 112, 171, 185, 207 gas lighting, 103–4, 121, 129 gentry, 56–57, 60 Germany, 176, 202, 209, 211–14, 221, 223, 231 Gibbes, Heanege, 212–15, 218 government, 7–16, 245, 249–56; British, 55, 104, 164–65, 175–76, 184, 211, 228; federal; 206, 208, 232–34; of Bombay, 33, 44; of India, 26, 28, 44, 145, 150, 162, 164, 175–76, 195–96, 212–13, 217, 246; of Lower Canada, 58, 93, 96; of Madras Presidency, 25–28, 136–59, 186–87, 219; of Quebec (province), 92, 109, 203–5, 232; responsible, 104, 256 governor, 11, of Madras, 25–26, 144, 154, 191 governor-general: of British North America, 55, 104–5, 109, 126; of India, 164, 191 Great Britain. See United Kingdom Great Lakes, 54, 206, 232 Griffin, Dr., 71, 72, 82, 90 Grosse Île, 64–68, 71–73, 107, 230, 251, 253 Haffkine, Woldemar, 215, 217, 221, 235

Index

319

Hamburg, 215, 220, 233, 246 Harris, Lord, 154, 158–59, 168 health commissioner. See commissioner of health Health Committee, 8, 91–93, 107, 112, 125–26, 205–6, 253 health officer: Grosse Ile, 60–61, 64, 71– 72, 82–83, 90; Quebec, 58, 63–64, 68, 87, 107, 111–14, 117, 205–6 health warden, 62–63, 68–71, 107, 126, 252 hill station, 167, 194–95 Hindu, 42, 46, 175, 182. See also pilgrim; religion; temple Hong Kong, 144, 221 hospital, 94, 96, 97, 166–67, 231, 242; Cholera, 73, 79, 86, 88–89, 91–93, 115–16, 193; Civic, 235–36; Emigrant, 58, 68–69, 72–74, 79, 89, 91–92; Fever, 58, 61, 68–69, 92; Grosse Île, 71, 73, 82, 230; Madras, 28, 40, 133, 165; Marine and Emigrant, 88, 92–93, 108, 113, 114, 116, 126, 203, 235; maternity, 131–32. See also dispensary house, 38, 41, 69, 113, 193; deadly, 42, 76, 84, 118, 119, 169, 244; garden, 6, 9, 24–25, 50, 51; number, 69, 70, 97; owner, 69, 70, 77, 111; tenant, 69, 70, 77 humidity, 43, 177; predisposing, 7, 24, 30–32, 43, 51 hut, 5–6, 42, 149, hygiene, 162, 167, 171, 216 Iffland, Anthony von, 205, 208 immigrants, 54–55, 58, 73–74, 90, 107, 233–35, 252; destitute, 72, 88, 91; sick, 127 inclination, 136–43, 190 incorporation, 56, 88, 105, 170; law, 88, 105, 109, 122, 125 India, 10–12, 25, 175; northern, 164, 177; southern, 9, 172, 180, 188–89, 192. See also government, of India

320

Indian Medical Gazette, 176, 217 Indian Medical Service, 28–29, 132, 176, 181, 212–18, 221–22; in Madras, 28, 37, 45, 218 Indian prince, 22, 164, 170–71; Haidar Ali, 23; Nawab of Arcot, 23–24; Nayak of Poonamallee; 22; Tipu Sultan, 23 India Office, 164, 170, 184, 186, 212–14. See also secretary of state for India influenza, 57, 241–44, 247, 250 information system, 8, 37–38, 63, 96–98, 159, 196, 253 inspection, 69, 112, 114, 117, 191, 222, 233; of houses, 62, 111, 113, 118, 255; of ships, 60–64, 68, 71–72, 82–83, 90, 125, 208, 230 intake, 103, 122–23, 187–88, 207. See also reservoir international cholera conference, Berlin (1885), 214 international sanitary conference, 175, 198, 245–46, 251; Constantinople (1866), 175, 178, 181–83, 195, 212; Rome (1885), 214–15; Vienna (1874), 184 intrusion, 44, 71, 144, 204, 222, 254–55; of private space, 62, 69, 84, 89, 110 Ireland, 107, 144 irrigation, 24, 147, 155, 160–61, 187, 189 isolation, 50, 196, 242, 247, 255; of cholera, 64–65, 95, 222; of sick, 33, 58, 67–68, 183, 203, 222, 225, 234, 237, 247, 250 jail, 29, 85, 114, 133–35, 171, 183 justices in sessions, 26, 135–41, 146, 150– 56, 166 justices of the peace, Madras, 26; Quebec, 57–58, 62–63, 65, 79, 88, 105 Kanchipuram, 93, 182–83, 231 Kingston, 112, 202 Klein, Edward, 212–15, 218 Koch, Robert, 210–21, 224–25, 227–29, 243–49

Index

laboratory, 176–77, 209–12, 215–16, 220, 223–24, 227, 231–39 latrines, 113, 119, 166, 189, 197, 224, 229 laudanum, 36, 39 Legislative Assembly, 254, of Canada (province), 104–5, 109–10, 122–23, 126, 129; of Lower Canada, 55–66, 87, 89–90, 92–95, 104 legitimacy, 10, 12, 57, 94, 110, 175, 254–56 Leslie, Dr., 79, 86 Lewis, Timothy Richard, 176–81 Liebig, Justus von, 173–74 lime, 4, 75–76, 81, 113, 203. See also chloride, of lime livestock, 24; cattle, 42, 83, 183; horse, 83, 85; pig, 71, 85, 111, 113, 127 living conditions, 42, 85, 101–2, 167 location, 31–32, 157, 213; exempt, 35, 47, 180; healthy, 38, 151, 168; unhealthy, 5, 24, 41, 43, 47, 74, 95, 107, 118, 135, 173, 191, 244, 253 London, 22, 53, 136, 140, 143, 189, 213 lot, 62, 71, 75, 91, 110–12, 117, 127 Lower Canada, 55–56, 104. See also Canada (province); government, of Lower Canada; Quebec (province) Lower Town, 57, 73–75, 95, 111–16, 121, 227 Madras (city), 8–9, 21–25, 186, 216 Madras Presidency, 25–27. See also government, of Madras Presidency Madras Sanitary Report, 172, 173, 193, 218, 224 malaria, 31–32, 143, 223 map, 42–43, 172, 196, 244 market, 36, 129; in Madras, 6, 24, 27, 165; in Quebec, 78, 88, 112, 120, 235 master of vessel, 58, 61, 64, 67–68, 72, 90, 204; violating quarantine, 82, 87 mayor, 88, 91, 115, 124, 127, 208, 236 McGee, Thomas D’Arcy, 203–4 measles, 31, 71, 205 meat, 6, 32, 80

Medical Act, 59–60 medical association, 37, 59, 217 Medical Board; Madras, 28–29, 33–50, 132–35, 147–48, 151–60, 252–53; Montreal, 59–60; Quebec, 58–60 Medical College: Calcutta, 132, 212, 216; Madras, 132. See also medical school medicalization, 13, 131, 240 medical journal, 59, 106, 132–33, 176, 214 medical practitioner, 59, 109, 148; European, 33, 132; Indian, 29, 39–41, 193; unlicensed, 59, 80. See also surgeon medical school, 59, 106, 230, 231. See also Medical College medical staff, 110, 132, 224; attendant, 38, 67, 81; nurse, 72, 219, 242; servant, 67, 79; steward, 86, 92–93 medical student, 59, 106, 230, 242 medical superintendent, 71, 82–83, 205, 208, 228 medical theory, 45, 115; bacteriological, 213–21, 224–27, 229, 243–44; contagionist, 54, 65, 128, 203; localist, 62, 102–3, 180–81, 211, 215–16, 245, 248–49; subsoil water theory, 176, 178–80; waterborne, 173–74, 180, 219, 220; zymotic, 173–74. See also cause; etiology; epidemiology medical topography, 32, 133, 135, 248 medical treatment, 36–39, 78–80, 92, 116– 17, 169, 193, 223 medicine, 13, 206; colonial, 28–32, 43, 50, 130–3; European, 39, 44, 145, 158, 193, 238; Indian, 29, 39, 45, 131, 132, 193, 238; tropical, 222–23 Mediterranean, 174–75, 206, 208, 228, 236, 244 Memorandum on Cholera, 203–4, 228 merchant, 22–23, 43, 55–56, 89, 207 miasma, 117, 165–66, 177, 236, 240, 245– 49; originating of filth, 102, 114, 120, 135, 138, 140, 143, 174, 185, 238 microorganism, 176, 178, 209–12, 238– 40, 247–49

Index

321

microscope, 176–77, 210, 216, 216, 223, 237 Military Board, 37, 146–55 mirasdar, 23, 24 mitigation, 33, 42, 49, 63, 91–94, 222, 246 monsoon: rains, 24, 43, 45, 137, 153, 154, 191–93; wind, 45, 177, 180 Montizambert, Frederick, 205, 208–9, 228–32, 240 Montreal, 60, 84, 105, 106, 112, 202, 230 moon, 7, 32, 45, 47 morality, 85, 102, 145, 203–4 Mountain, G. J., 3–7, 14 Municipal Commission, 186, 227 Muslim, 24, 42, 175, 184. See also pilgrim; religion Mutiny, 162, 164, 167, 169, 255 Mylapore-San Thomé, 24, 38, 190, 226 Native Infirmary, 29, 40, 49, 191, 225 negligence, 72, 82, 90 nervous system, 178, disorder of, 35, 46– 47 New France, 55–56 New Poor Law, 101–2 newspaper, 74, 77, 81, 93, 94, 115, 234; reports of cholera, 58, 61, 202 New York, 58, 85, 202, 205–6, 228, 233 night, 43, 84; air, 42, 166; duty, 163 Nightingale, Florence, 163–65, 167, 172 observation: of the body, 30, 42, 46–47, 50; of the environment; 70, 97, 129, 163, 194, 239, 255–59 O’Connell, P. P., 154–55, 187 Ontario, 207, 230. See also Canada (province); Upper Canada order, 48, 72, 74, 97, 256; colonial 9–10, 155, 157; political, 5, 88; public 5, 57, 77; social, 102 Orton, Reginald, 45, 47, 53 outbuilding, 69, 71, 116 outlet: northern, 137, 139; southern, 135– 40, 146, 150, 189

322

pandemic, 8, 11, 17, 236, 241–43, 244, 247–48 paracheri, 5, 22–24, 42, 50–51, 188. See also Village at the back of MacKay’s Garden parayar, 5, 23–24, 42, 50, 51 Pariamettoo, 49, 226 Parliament, 104, 208 Pasteur Institute, 215, 231 Pasteur, Louis, 210–11, 215 patient, 30–31, 36–42, 66–69, 91–93, 116 Patriot Party, 56, 60, 104 pavement, 88, 105–6, 149, 205 Pelletier, Elzéar, 233–34 Pennsylvania, 86, 206 perception, 9–10, 57, 94, 195; of cholera, 38, 134, 202, 218, 236; of the urban environment, 65, 70–71, 118, 128, 169, 197, 221 petition, 11, 74, 94, 109, 114, 116, 119, 131 Pettenkofer, Max (von), 176–77, 178–79, 214–16, 248–49 philanthropy, 103, 132, 186 pilgrim, 24, 180, 182, 238; to Mecca, 174– 75, 184; to festivals, 182–83, 195, 220, 224 pilot, 58, 64, 67, 87, 90, 93, 208; violating quarantine, 61, 64, 72, 82, 87 plague, 12, 33–35, 58; epidemic of 1896, 221–25, 250, 255 Pointe-Lévy, 58, 61, 69 poison, 7, 31, 176–77, 178, 192, 214, 236 police, 27, 37–38, 40–41, 49–50, 96–97, 145, 166, 252–53; superintendent of, 37, 49 poor, 42–43, 51, 74, 77, 85, 244, 252 population: growth, 24, 57, 105, 186, 193, 207, 219; indigenous, 10–11; size, 27, 57, 105, 150, 168, 186, 207 port, 9, 33, 58, 184; of Madras, 22; of origin; 67–68, 86, 247; of Quebec, 56– 58, 63–64, 71, 85, 105, 204, 235–36 postmortem, 29, 35 Pottinger, Sir Henry, 142–46, 150–57, 189, 162, 255

Index

precaution, 54, 73, 107, 126, 183, 205, 228–29 preparation, 34, 61–72, 91, 107–12, 234 prevention, 7–14, 242–53 Privy Council, 33, 54, 202 profession, 56, 57, 102–3, 105, 230; engineering, 143, 145–46, 148, 155; medical, 29, 59–60, 106, 131, 174, 222, 240, 245, 248 professionalization, 59, 106, 131, 240 Public Health Act: Britain (1848), 103; Canada (1849), 109, 126, 203; Quebec City (1849), 117 pump, 122, 139–43, 157, 188, 190–91, 197 punishment, 63–64, 68, 72, 82, 84, 91, 113 Punjab, 179, 223, 243 quarantine, 33, 60–68, 71–73, 175–77, 203–6, 228–36; regulations, 62, 64, 67–68, 82–83, 89–92, 204, 208–9, 230; superintendent of, 71–72 Quarantine Act bill: of 1795, 58, 60, 89, 90; of 1832, 62, 63, 65, 68, 71, 82, 84, 95; of 1832–33, 89 Quebec (province), 104; 204–6. See also Canada (province); government, of Quebec, Province; Lower Canada Quebec City, 9–12, 55–57, 103–5, 121–25, 206–7 Quebec sanitary committee, 84–85, 94 questionnaire, 86, 165–66 race, 164, 197, 243, 246 railway, 206, 220, 222, 228 rain, 42, 43, 45, 161, 192. See also monsoon, rain recovery, 36, 67, 77, 84, 93, 224, 241 Red Sea, 174–75, 184, 246, 247 reform, 56, 156, 206, 209, 226, 230, 232; medical, 29, 60; sanitary, 101–2, 128, 139, 171, 227 Reid, Captain, 71, 90

religion, 29, 39, 56, 131, 157, 203. See also Catholic Church; clergy, Hindu; Muslim, pilgrim; temple remedy, 32, 36, 39, 223, 251; distribution of, 40, 63, 80, 203 repertoire, 29, 96, 107, 113, 127 report, 111–12, 122; of abatement, 40, 93; of outbreak, 35, 37, 72–73, 127, 134; on cholera, 46–47, 60, 177–81, 183, 213–14 research, 45–46, 133; bacteriological, 209– 12, 213, 215, 239; medical, 106, 195, 212, 222–23; scientific, 173, 176–80 reservoir, 123, 139, 148, 151, 165, 190; Lorette, 122–23, 207; Red Hills, 139, 187–88, 198, 219–20, 225–27, 254. See also intake; water supply resident physician, 63, 79 resistance, 44, 79, 115–16, 255; against measures, 20, 103, 157, 160, 238; against treatment, 39–41, 49, 97, 131, 158, 254 road, 24, 34–35, 44, 105, 122, 125, 137 Road Committee, 39, 119, 120 road surveyor, 75, 111, 113–14, 117, 119– 20, 124 Royal College of Physicians, 54, 233 Royal Commission, 163–67, 170–71, 185, 195 Russia, 53–54, 175, 202, 223 Saint Lawrence River, 55, 57, 60, 61, 64, 197 Saint-Charles River, 64, 68, 83, 86–87, 108, 122–23, 207 sanitarian, 115, 165, 173–74, 209, 211, 220, 237 sanitary commission, 167, 170–72, 173, 186 sanitary commissioner, 141; Bengal, 173, 177; government of India, 173, 177, 181, 182, 212–13, 216; London, 165; Madras, 171–73, 180–81, 182–83, 185–88, 192–93, 218–20, 226, 253; Punjab, 179

Index

323

sanitary movement, 102–3, 114, 145, 155– 61, 163–72, 210, 245–47 sanitary regulations, 67, 108–10, 117, 193, 236 Sault-de-Matelot Street, 111, 113 scavenging, 75, 113, 135, 169, 189, 191, 193, 229 scientific commission, 209, 211–12, 223 Scot, William, 44–48, 53, 180 sea breeze, 35, 143, 165 season, 31, 134, 147, 179; dry, 136, 139, 168. See also monsoon secretary of state for India, 184, 213. See also India Office sewage, 118–19, 140–43, 152–53, 168, 190, 226; stagnant, 136–39 sewage farm, 102, 189, 191, 226 sewer, 102–3, 118–25, 135–54, 165–66, 189–91, 226; clogged, 77, 111–12, 118–19, 123, 135, 168; pipe, 124–25, 140, 190; secondary, 137, 139–40, 190; subterranean, 103, 190, 197 Shastri, Maha Ganapadi and Ramachrishnan, 39–40, 254 shed, 66–67, 69, 71–73, 90, 193, 230 ship, 60–68, 126, 174, 184, 205–6, 208–9, 233; steam, 78, 149, 163, 174, 202, 207, 208, 230 ship building, 56, 207 ship owner, 56, 60, 63, 94, 115, 204, 209 shipping, 104, 184, 202 shopkeeper, 23, 57, 78 Silver, Colonel, 187–88 Sim, Duncan, 137–39, 153 simplification, 128, 174, 209, 214, 217, 239, 246–49 simplifier, 248–49 slaughterhouse, 70, 117 smallpox, 31, 57–58, 69, 71, 205, 208, 230–32 Smith, Major, 139–40 soil, 32, 47, 124, 177, 182–83 Southwood Smith, Thomas, 102, 135, 238

324

space, 14–15, 48; defined, 51, 62, 65, 76, 84, 98, 221; European, 25, 43; Indian, 25, 58; private, 62, 91, 108, 113; public, 62, 91, 108, 111, 120; urban, 23, 42–44, 70–71, 157–58 spasm, 34–36 spread, 54, 175; aerial, 175, 177–78; along rivers and roads, 7, 34–35; pattern of, 31, 35, 47, 172–73, 177, 179, 192, 196, 243 statistics, 165, 173, 177, 180, 192; morbidity, 31, 45, 133, 166, 170, 180, 195–96, 204, 220; mortality, 34, 38, 49, 93, 111, 159, 166, 168, 178, 180; vital, 159, 166, 170–71, 180, 232, 253 status, 25, 103, 121, 128, 130 steam engine, 139–40, 157, 188 stench, 50, 75, 111, 118, 166, 168, 185; predisposing, 51, 114, 135, 138, 147, 237 storm, 39, 44, 149 strategy, 35, 61, 64–65, 72–73, 94–95, 171, 217 street, 27, 91, 113–14, 117; filthy, 70–71, 74–75, 77, 110, 134, 229, 244; name, 70, 97 suburb, 62–63, 71, 75, 76, 88, 105, 112–13, 207; Madras, 6, 9, 24–25, 50–51; SaintJean, 57, 58, 68, 114, 116–18, 119, 124, 127; Saint-Louis, 57, 112, 114; SaintRoch, 57, 77, 86, 108, 116, 119, 124 sun, 7, 32, 47, 143 superiority, 131, 167, 239, 246; medical, 29, 35–36, 40, 96, 195, 203, 245; military, 9, 10; racial, 164; scientific, 10, 238, 245 supplies, 22–23, 66–67, 72, 88 surgeon, 28–32, 71, 131–32; superintending, 5, 37, 42, 49, 132, 169. See also medical practitioner Symes, Robert, 111–12, 120 symptoms, 7, 30, 34–37, 51, 212–14, 248 Taché, Joseph-Charles, 203–4

Index

tavern, 57, 74, 78, 88; keeper, 63, 75, 78, 83, 98, 207 taxation, 89, 122, 123, 125, 144, 170, 186, 232; on immigrants, 64, 90 technocracy, 102, 145 telegraph, 209, 220, 228 temperance, 85, 117, 204 temperature, 210; atmospheric, 30–31, 42, 43, 51, 115, 167, 177, 243; body, 35, 42, 43 temple, 24, 36 tent, 38, 41, 75, 77 test animal, 210–15 Thomas, John Fryer, 142–43, 154, 156 threat of epidemic, 33, 107, 194; cholera, 8–13, 34, 61, 88, 107, 175 Toronto, 105, 202, 207 trade, 22, 23, 54, 60, 94, 211, 232 translation, 34, 38, 53, 179, 217 transport, 38, 78, 114, 225; of patients, 38, 80–81, 116, 234; of troops, 147, 175, 184 Trevelyan, Charles, 165–66 Triplicane, 24, 38, 49, 131, 147, 166, 190, 226 Tulloch, Hector, 189–90 typhus, 57–58, 107, 118, 205, 208 United Kingdom, 54, 101–3, 145, 158–59, 163–65, 237. See also government, British United States, 55, 59–60, 85, 231; cholera in, 112, 121, 201, 206, 251 university, 59, 106–7, 176 unrest, 9–11, 101, 104–5, 115

Upper Canada, 54–55, 104. See also Canada (province); Ontario Upper Town, 57, 75–76, 105, 112, 119, 121, 207, 235 vaccination, 29, 210, 230, 237, 240–42; anticholera, 215, 217, 221, 224, 235, 238; pandal, 29, 38 vegetation, 6, 39, 44, 134 ventilation, 6, 32, 76, 83, 117–18, 134, 203 Vepery, 38, 131, 149, 193 Village at the back of MacKay’s Garden, 5–6, 9, 14, 48, 98. See also paracheri visiting physician, 116–18, 126, 127, 129 vital energy, 35–36, 42 vomit, 7, 35, 42, 80 water: contamination of, 180, 192, 215, 217, 219, 225–27; quality, 78, 103, 122, 133, 165–66, 185–86, 188–89, 226–27; standing, 63, 11, 118–19, 185; surface, 7, 112, 118–19, 123, 128, 133, 197 water pipe, 102, 122–25, 157, 166, 187, 189, 197, 207, 227 water supply, 102, 215; in Madras, 139–41, 147–48, 154–61, 186–89, 218–20, 226–27; in Quebec, 103–4, 121–25; Seven Wells, 166, 185 water tank, 22, 24, 42, 139, 147, 197, 212– 13, 218, 226 West Indies, 56, 57, 202 writer, 27, 131 yellow fever, 58, 208

Index

325