Author: Thomas C. Rosenthal MD
A headline like this appeared in the Aurora Standard on December 27, 1837 along with a letter signed by Drs Jabez Allen, Jonathan Hoyt, Erastus Wallis and C.H. Lapham. After a month of tracking down each patient’s friends and family members, the doctors confidently reported no new cases and encouraged everyone to get Jenner’s milkmaid vaccine (Latin: vacca meaning cow). These four doctors were graduates of medical colleges that taught bloodletting and intestinal purging, the ‘remedies’ used to treat George Washington’s sore throat in 1799. But nineteenth century medical practice was giving way to more modern methods of quarantine (social isolation), contact tracing, and vaccination some 180 years before COVID.
In 1843, the same Dr. Allen requested help from Dr. Austin Flint, Buffalo’s newly appointed Director of Public Health. Allen was investigating a pandemic of typhoid that had claimed 10 of the 43 persons living in the hamlet of North Boston, NY. With Dr. Flint’s help, the doctors mapped every case and visited every home in the hamlet.
The first case was a man from Warwick, Massachusetts traveling by stagecoach. Feeling unwell, he decided to stay overnight in North Boston’s Fuller Tavern and died the next day. Two families with their own outhouses and water supplies were unaffected. One family, the Stearns, had a long-standing feud with the Fullers. The Fullers accused the Stearns of poisoning their well. The Stearns later sued for slander and won a $100 settlement.
Letters from a Warwick clergyman revealed Warwick had several typhoid cases prior to the man’s departure. Mapping proved that every North Boston affected patient had contact with an ill person or their emissions, but it was the intemperate, poorly nourished, and those younger than 25 who suffered the most. The doctors concluded that the agent was a typhoid specific miasma (bad air) emanating from the discharges of sick patients.
Flint eventually published three scientific papers about the North Boston pandemic, first in the 1845 American Journal of the Medical Sciences, a second in Clinical Reports in Continued Fever in 1855 and the third in proceedings of the American Public Health Association in 1873. Each successive paper made corrections based on expanding knowledge about germs and contagions. When John Snow wrote his landmark 1855 treatise describing the spread of cholera from a London well, he cited Dr. Flint’s contact tracing in North Boston, NY as the basis for his London investigation.
It was cholera that finally matured American doctors’ understanding of pandemics, contagions, and germs, beginning with the first American cholera epidemic of 1832. Long known in Asia, cholera spread across Europe and entered New York’s back door, moving down the Saint Lawrence River from Montreal, to Lake Champlain; then splitting at the Hudson headwaters to course along the Erie Canal to Buffalo and down the Hudson to New York City. Cholera spread at the speed of human travel and killed 10-30 percent of its victims. The New York State legislature empowered municipalities to establish health boards and governor Enos Throop proclaimed, “an infinitely wise and just God has seen fit to employ pestilence as one means of scourging the human race for its sins.” Village doctors supported health boards, but generally held to the conviction that any water a horse would drink was safe for humans. By 1834 cholera seemed to disappear.
When cholera returned in 1849, Buffalo’s newly opened hospitals initially echoed the 1832 treatments by purging patient bowels with hourly doses of calomel (mercury and rhubarb) and attempted to mitigate fever by bloodletting. Thirty percent of hospitalized patients died. Soon magazines and itinerate salesmen hawked specious preventives including camphor amulets, sulphur pills, and Old Jacob Townsend’s sarsaparilla. Villages burned pitch to neutralize cholera’s miasmic taint. Five Buffalo doctors died, including Dr. Allen’s brother, James Allen who practiced in Hamburg, NY. Doctors who survived were accused of withholding secret tonics from their patients. Tuberculosis killed more people, but the sudden death of cholera terrorized everyone.
Ex-president Millard Fillmore’s daughter, Mary Abigail “Abbie” Powers Fillmore, was college educated and conversant in five languages. Until Zachary Taylor’s death promoted her father to the presidency, Abbie taught in Buffalo’s public schools. In the White House she became the darling of newspapers around the world by entertaining dignitaries with impromptu performances on the piano, harp, and guitar. When antipathy for the Fugitive Slave Act denied Fillmore the Whig nomination in 1852, the family returned to Buffalo.
On July 25, 1854, the twenty-two-year-old Abbie boarded an afternoon stagecoach intending to help her grandfather, Nathaniel Fillmore and his wife Eunice, settle into their new home next to Dr. Allen in East Aurora. On arrival, Abbie purchased peppermints at the Allen drugstore (today’s Larwood Pharmacy) to settle an upset stomach. She awoke before midnight with diarrhea and vomiting. Shortly after midnight Dr. Allen was summoned.
Abbie’s suffering was acute. Retching, rice water diarrhea and painful muscle cramps left little doubt she was in the grasp of cholera. A messenger dispatched to Buffalo summoned the Ex-President. Every hour Dr. Allen administered repeated doses of bicarbonate of soda and laudanum and refreshed a poultice of powdered black mustard over her liver area.
Former President Fillmore arrived mid-morning. Abbie passed at 11 am on Wednesday July 26, 1854. Her grave in the family plot in Buffalo’s Forest Lawn Cemetery is marked only with her initials. Dr. Allen sent no bill. Some months later, Millard Fillmore presented the Allens with a silver teapot now on display in East Aurora’s Millard Fillmore House and Museum.
Cholera plagued troops throughout the Civil War, though measles killed more soldiers. Cholera returned to Buffalo with soldiers discharged after the war, but by 1866 the City of Buffalo began laying sewage lines to separate water supplies from human discharges. Finally, in 1883, fifty years after the first cholera pandemic, Robert Koch identified the Vibrio cholerae bacillus.
Today humans move much faster than stagecoaches or canal boats. In the worst pandemic of our generation the coronavirus and its variants have spread farther and faster than any nineteenth century doctor could have imagined. Today’s basic medical science required only weeks to verify the viral cause of COVID and only a year to begin protecting our communities with vaccines. Essential public health measures like social isolation and masking softened the pandemic’s impact, but came with a huge economic burden.
The push for vaccinations began over 180 years ago. Thankfully, twenty-first century immunizations are much safer, and more effective, than Jenner’s smallpox vaccine. Vaccines remain the most effective strategy in every family’s arsenal for maintaining and preserving wellness in a germ filled world.
Thomas Rosenthal MD is the author of: Bloodletting and Germs: A Doctor in Nineteenth Century Rural New York (2020) and a UB Emeritus Professor of Family Medicine.