Baltimore in the Nineteenth Century and the State of Public Health

Incorporated in 1797, Baltimore was a relatively young city when it began to experience the booming growth that characterized the nineteenth century. By the turn of the century, the city covered approximately 850 acres with most of the population concentrated in the villages of Jones' Town, later known as Old Town, and Fell's Point, founded in 1729 and 1732 respectively. Fell's Point, in particular, grew rapidly as its reputation for excellent shipbuilding spread. Since timber, iron, and naval stores were readily accessible, the area soon flourished with shipbuilding, trade, and related activities. In addition to the shipyards, Fell's Point's neighborhoods began to grow and develop. Captains and mariners called the Point their home. Their dwellings, sandwiched between forges, ropewalks, smithshops, and boarding houses, faced a waterfront fringed with wharves. James Kent of New York, visiting the city in 1793, found the city to be "new, elegant and prosperous in every part," adding that "in 1760 there were not 10 brick houses, whereas in 1787 it had 2,000 houses . . . of which 800 were at Fell's Point . . . . The houses are newer and more handsome than in Phil[adelphia] and they all have the same defect in wood roofs." Kent also noted that the two main streets on the Point, probably Broadway and Bond, were now paved.³

Dwellings for artisans and laborers were generally of the style of Baltimore rowhouse that developed in the late eighteenth century. These structures were modest in style, arranged in simple groupings of two and four houses. Later as demand for housing increased, builders extended the groupings. Wealthier merchants and captains may own individual houses that were grander in style, but still modest in scale. The houses were generally two or three stories, usually constructed of wood or brick, with two to five windows across the facade.⁴ In 1794, Moreau de St. Mery observed:

At the Point the buildings are much more modern than those in Baltimore, and are increasing prodigiously. The reason for this is due to its situation, which is purely commercial. As the Point expands, the closer to it are the houses of Baltimore, and it won't be long before they meet. The space that separates them, like that which corresponds to it on the other shore of the bases, is still marshy, but constant work lessens this inconvenience -- at least on the side of the Point.⁵

The marshes proved to be a continual source of concern to the neighborhood for the low lying swamp land provided a prodigious breeding ground for aedes aegypti, the mosquito responsible for the transmission of yellow fever. "Baltimore is subject to the scourge of yellow fever," Moreau wrote, "which has inflicted frightful ravages almost every year since 1793, particularly in the vicinity of the Point, which is nearest to the sea and the lowest part of the town."⁶ Little was known about the cycle of the disease and the only practical treatment was to leave the city for higher ground.

In 1800, the city was once again held hostage by a yellow fever epidemic that began in August and lasted approximately sixty-five days. Scores of businesses and residents evacuated the city, resulting in a suspension of trade that brought the city to a near halt. The task of treating the ill was not helped by the fact that all but two members of the city's Board of Health also fled town and the signatures of a Board member and attending physician were required for admittance to the hospital.⁷ By the time the epidemic ended with the first frost in October, nearly 900 residents had died, with over 46% of the deaths taking place in Fell's Point.⁸

In 1819, Mayor Edward Johnson⁹ solicited the opinions of Baltimore physicians as to the causes and remedies for the annual yellow fever epidemics. Many local doctors were able to provide frightful case histories for the enlightenment of the Mayor, and most were able to count residents of the Point among the disease's victims. Dr. Samuel K. Jennings¹⁰ wrote:

In the first family to which I was called, I had eight patients, apprentices to a respectable ship-joiner on Fell's Point. For some days previous to the commencement of the fever, they were all engaged in planing a vessel at Price's Wharf, in the neighborhood of Wolf and Pitt Streets. The first of these eight cases, was likewise the first instance of attack upon any of the residence inhabitants. The fever was incorrigibly malignant and terminated fatally on the morning of the fourth day, with black vomit and stool, heomorrhage, & c. The remaining seven were immediately removed to other houses, in more healthy situations and all were preserved. It is worthy of remark, that the facility of their recovery appeared to vary with the distances to which they were removed from the water's edge, and to the elevation to which they were raised above the surface of the ground.¹¹

The young wife of James R. Sinners, a Point resident, fell victim to the fever shortly after the birth of their first child. The attending physician wrote of the case, "The people, to use her husband's words, were at this time dying all around his place of residence on the Point."¹²

Cholera was another disease well known to public officials in the nineteenth century.¹³ During the pandemic of 1832, the spread of the disease was aided by environmental conditions, including pollution of part of the water supply.¹⁴ The first cases appeared in the southeast section of the city and quickly spread, transmitted possibly through the city's wells and public springs. Believing in the relationship between "atmosphere" and disease, the city's consulting physician, Dr. Horatio Jameson,¹⁵ informed the mayor and city council that the disease was not infectious and suggested measures aimed at fighting the disease through improved sanitation rather than fighting a contagion. He promoted the cleaning of city streets, alleys, wharves, sewers, hog pens, and slaughterhouses and the removal of public nuisances, including the disposal of dead swine left in the streets. He advised dietary restrictions, including the avoidance of fresh fruit and vegetables, and advocated temperance. In spite of Jameson's suggestions, the city health officer quarantined the ship Brenda after a voyage from Liverpool in June 1832 in which cholera claimed the lives of fourteen passengers. After vaccinating the children and evacuating all passengers to the Lazaretto, the city's facility for holding immigrants, the ship's cargo and baggage were "ventilated."¹⁶ Shortly thereafter, an ordinance was passed requiring quarantine of ships departing from ports with infectious diseases and prohibiting entry of immigrants to Baltimore within fourteen days of their arrival in the country.

In all, 853 Baltimoreans died during the 1832 cholera pandemic, with deaths peaking between the weeks of August 27 and September 17. In addition, 133 inmates of the Baltimore Almshouse also died from the disease.¹⁷ In 1849, a serious outbreak of cholera occurred in the Baltimore Almshouse, probably transmitted by flies attracted to the cesspool on the north side of the institution. The disease did not spread to the city since the cesspool drained into Rutter's Run, a tributary of the Gwynn's Falls, not the Jones Falls.¹⁸ In 1854, only two official cases of cholera were reported, but there were higher incidents of deaths from diarrhea and cramp colic which may have been misdiagnosed cases of cholera.

3	Raphael Semmes, Baltimore As Seen By Visitors 1783-1860 (Baltimore: Maryland Historical Society, 1953), pp. 26-27.
4	Rodris Roth, "Interior Decoration of City Houses in Baltimore: The Federal Period" Winterthur Portfolio 5 (1969): 59-86.
5	Kenneth Roberts and Anna M. Roberts, eds. Moreau de St. Mery's American Journal [1793-1798] (New York: Doubleday & Co., 1947), p. 47.
6	Roberts, Moreau de St. Mery, p. 8.
7	Douglas F. Stickle, "Death and Class in Baltimore: The Yellow Fever Epidemic of 1800" Maryland Historical Magazine 74 (1979): 286.
8	Stickle, "Death and Class in Baltimore ," p. 294.
9	Edward Johnson (1767-1829) also served as a member of the Baltimore City Council, 1797; Judge of the Orphan's Court and Associated Judge of the Baltimore City Court, 1804-1805; presidential elector for Jefferson, Madison, and Monroe, 1805, 1809, 1813; and chairman of the Committee of Vigilance and Safety of Baltimore 1809, 1819, and 1823. He studied under Dr. Allen and began his career as an attending physician of the Baltimore Almshouse, 1789. He was the author of A Series of Letters and Other Documents Relating to Yellow Fever, Baltimore, 1820. He served as the President of the Medical Society of Baltimore, 1789, and with James McHenry, George Roberts and James McCullough, organized the House of Industry (later the House of Refuge).
10	Dr. Samuel Kennedy Jennings (1771-1854) was educated at Rutgers College and studied medicine under his father, Dr. Jacob Jennings. Ordained a minister in the Methodist Episcopal Church, Jennings served as President of Asbury College, Baltimore, 1817-18 and was a founder of Washington Medical College, Baltimore, where he served as profession of Materia Medica 1827-1839 and Professor of Obstetrics, 1839-42. He was the author of A Plain, Elementary Explanation of the Natural Cure of Disease…, 1814, Letters on the Patent Warm and Hot Bath…., 1816, The Married Lady's Companion, and A Compendium of Medical Science, or Fifty Years Experience in the Art of Healing…, 1847.
11	A Series of Letters and Other Documents Relating to the Late Epidemic or Yellow Fever; Comprising the Correspondence of the Mayor of the City, the Board of Health, the Executive of the State of Maryland, and the Reports of the Faculty and District Use of the Medical Society of Baltimore, Also the Essays of the Physicians in Answer to the Mayor's Circular Requesting Information for the City Council in Relation to the Causes Which Gave Origin to This Disease -- To Which is Added, the Late Ordinance Re-Organizing the Board of Health (Baltimore: William Warner, 1820), p. 15. When the City Council refused to pay for the cost of printing the report, Mayor Edward Johnson contributed $150 for its publication.
12	A Series of Letters and Other Documents Relating to the Late Epidemic or Yellow Fever …, p. 47.
13	Outbreaks of the disease occurred in the city in 1832, 1834, 1845, 1866, 1877, and 1879.
14	William Travis Howard, Public Health Administration and the Natural History of Disease in Baltimore, Maryland 1797-1920 (Washington, DC: Carnegie Institute of Washington, 1924), p. 257.
15	Horatio Gates Jameson (1778-1855) studied medicine under his father, Dr. David Jameson, and began practice in 1795. He settled in Baltimore ca. 1810, receiving his medical degree from the University of Maryland in 1813. Among other offices, Jameson served as surgeon at the Baltimore Hospital, 1814-1835, consulting physician, Board of Health, 1821-1835. He was a founder and president of Washington Medical College, Baltimore and served as Professor of Surgery 1827-35. He was the editor of Maryland Medical Recorder, 1829-1833 and author of Lectures on Fevers, 1817, American Domestic Medicine, 1817, Yellow Fever, 1824, and Treatise on Cholera, 1854.
16	Baltimore, Board of Health, Report of the Health Officer 1832 in Baltimore City Health Department, The First Thirty-Five Annual Reports 1815-1849 (Baltimore, 1953).
17	Since the Almshouse was outside the city limits, these deaths were not included in the city figures.
18	Howard, Public Health Administration, p. 254.