Disease and the Marketplace

In mid-August 1892, Hamburg was basking in a heatwave. Workers splashed around in the River Elbe, which reached an almost unprecedented 70°F. Then people started to go down with intestinal pains, spasms, vomiting, diarrhoea. Most of them died. The death rate climbed. At the back of their minds the city’s medical officers and doctors nursed a dark fear that it was cholera: but surely that was impossible. Having spread from India and ravaged Europe in a series of terrifying epidemics from the 1830s onwards, cholera had mercifully receded, and by 1870 was but a bogey of the bad old days. How could proud and prosperous Hamburg, with its modern system of piped water and sanitation, become the hotbed of an Asiatic disease? A cholera epidemic was unthinkable: it would entail isolation, quarantine, a trade embargo, financial ruin. The doctors talked about isolated instances of vomiting, and uttered soothing noises: why create a panic? Panic would not only produce a run on the exchange but would actually render people more susceptible to the disease – whatever it was. But the number of the cases rose from tens to hundreds, and then turned to thousands. Within six weeks, ten thousand Hamburgers had died of what nobody could any longer deny was cholera. The City had pursued its policy of silence and inactivity up to the very last moment, afraid to admit the truth, petrified of having to spend money. If its Senate had required the boiling of drinking water at an early stage, as bacteriologists recommended, thousands would have been spared. But the City was proud of its water. And in any case, its medical authorities did not believe in the bacteriological doctrine that water-borne bacilli were to blame – they didn’t even believe such bacilli existed.

The epidemic had struck at a crucial juncture. Louis Pasteur in France and Robert Koch in Imperial Berlin had pioneered the germ theory of disease, which attributed lethal epidemics to invasive micro-organisms. But this new bacteriology did not enjoy an instantaneous or universal triumph. To many it seemed like a warmed-up version of the obsolete ‘contagionist’ doctrine, whose favourite recourse to quarantine had signally failed to protect Europe from earlier cholera visitations. In consequence, an alternative epidemiology had become entrenched in many quarters of 19th-century Europe: miasmatism – the view that environmental pollution produced the conditions which caused pestilence. In Britain, miasmatism was a rallying-call for activism and reform. If, as Edwin Chadwick claimed, ‘all filth is disease,’ public health programmes of filth removal would create healthy individuals in a healthy body politic. In Germany, the master of miasmatism was Max von Pettenkofer. He believed that visitations arose from local configurations of natural conditions: variations in atmosphere, soil, the water-table, climatic vagaries. Formulated in this way, the doctrine was far more fatalistic than in Chadwick’s version. Nature’s epidemics were perhaps hard to stop, but individuals could hope to safeguard themselves through healthy living: fresh air, baths, exercise, temperance.

By 1890, the new bacteriology was in the ascendancy. But Pettenkoferian miasmatism still had its strongholds, and one of them was Hamburg. For – and this is one of the powerful interpretative strategies deployed in Richard Evans’s penetrating study – the entrenched laissez-faire liberalism of Germany’s foremost international trade centre was of a piece with the theory of disease aetiology which held sway in the city. Hamburg’s ruling Senate upheld a nightwatchman model of the state which had more affinities with John Bright’s Manchester than the Kaiser’s Berlin. And Pettenkoferian miasmatism was its medical equivalent: men and miasmas met in the marketplace of the environment. Prudent individuals who took precautions would probably survive. Evans is not suggesting that Hamburg’s medical establishment clung to an exploded medical theory out of crude self-interest; nor is he postulating a Marxist notion of false consciousness: he is arguing – very convincingly – that medical conceptions are not autonomous, the sterile cultures of laboratories, but possess social roots and social functions.

Koch had shown that the cholera bacillus was water-borne. Hamburg’s miasmatists by contrast denied that cholera could have such a simple and uni-causal origin. In any case, Hamburg’s piped water system was new and efficient. (Ironically, it was this centralised mains water supply, drawn direct from the Elbe, which enabled the disease to spread faster and further than ever before.) But as the deaths mounted, Hamburg’s scandal leaked out. Unlike practically all other major cities, Hamburg, governed by parsimony and lethargy, had failed to install a proper sand-filtration system. And of all the cities in Europe, it was the only one whose population was decimated in 1892. The correlation was obvious. Berlin sent in Koch. He identified the cholera vibrio in the drinking water. Worse still, he shamed the city before the world. Pacing the riverside slums, this veteran investigator of cholera in Alexandria remarked: ‘I forget that I am in Europe.’

Miasmatism was dealt its deathblow; and so was cholera. ‘Hamburg 1892’ is thus a chapter in the saga of medical progress. Only the most diehard cognitive relativist would deny that bacteriological breakthroughs played a positive role in ensuring that the great industrial conurbations suffered less devastation from epidemics in 1900 than in 1800 or 1830. Evans tells this story well. But waving the flag for medical science has little to do with his real purpose in this epic monograph. For what primarily concerns him is the politics of the city as a totality. Hamburg’s merchant princes opted for the privatised state. Minimal investments were made in public utilities. Hamburg had little religion, no university, no public culture, patchy public education, a scanty poor law system. But if it offered little, neither did it coerce much. There was no major bureaucratic control, and its Police Force resembled a bunch of Bobbies more than the Prussian para-military. The Senators gambled on the fact that private enterprise would create wealth, and wealth jobs, and jobs enough acquiescence to ensure social stability. In any case, they could keep the hatches battened down so long as socio-economic liberalism was enforced through the city’s outrageously oligarchic governmental system. As Evans hints, Mrs Thatcher would have admired Hamburg’s minimalism at the precise moment when, in her much-vaunted ‘Victorian’ England, the roots were being put down for that publicly-funded and bureaucratically-organised welfare state she so heartily detests.

Through fine-textured topographical analysis, backed by a flotilla of maps, charts and statistics, Evans shows how 19th-century Hamburg grew both rich and increasingly inegalitarian. Widening geo-social gulfs led to Social Democratic political activism, but not to revolutionary fervour. Living in poverty amidst pollution became a way of life for the masses, yet the labour market, charities and the possibility of emigration managed to prevent fundamental social fission. Tensions flared without ever quite providing the flashpoint which would have marked the beginning of the end of Hamburg’s old regime. Then came cholera. As Evans notes, it has become a moral and literary cliché to portray plagues and pestilences as metaphors for the wrath of God, nature’s revenge on an ailing, infected social organism – a punishment and a purification. Evans abstains from that melodramatic flourish, while shrewdly stressing the fact that a society divided in itself and sunk in private greed makes the microbes’ job much easier. For when the Asiatic cholera struck, the municipal authorities could not rouse themselves to make the response necessary to save the community. After the deaths and disorders of the epidemic, Hamburg’s governing class was forced to submit to Imperial centralisation and a new – less exclusive – political regime. It submitted with bad grace and the changes, far from bringing resolution and renewal, merely exacerbated traditional tensions. As Evans suggests, the lessons should not be lost on us. Cholera yesterday, Aids today. ‘Thatcherite’ Hamburg, committed to private privilege and public penury, did not have the public spirit or political will to deal responsibly with nature’s threats to its well-being.

This is a tremendous book, the biography of a city which charts the multifarious pathways from bacilli to burgomaster. All too often, political historians, urban historians, historical demographers and medical historians go their own sweet ways. Death in Hamburg demonstrates what can be achieved when historians put their minds to seeing the whole.