Medical microbiology/Sugar in the times of cholera

Introduction
In 1995, during a clean up of the local archive at the Museo Nacional de Historia de las Ciencias in Havana, Cuba, members of the staff found a misplaced document labeled “Cólera 1833”. At the time, I used to visit the Museum almost every week, looking for information on the history of epidemics. Presented with the document, I realized that it was an original account of the effects of cholera on a sugar plantation of rural Matanzas, written by its owner, and still unpublished. During the following months I transcribed the material and managed to find some basic information about the author. Early attempts at publishing the manuscript failed for lack of institutional support, but I distributed electronics copies among several scholars doing research on the history of Cuban slavery. We all agreed that an English translation of the text, published alongside the original in a bilingual annotated edition, could make a sizable impact on the development of the field. At the time, however, we were all caught up in other research projects and the logistical difficulties involved in any collaboration between academics from the United States and their Cuban counterparts seemed insurmountable. Eventually, the idea died out.

A decade later I am giving this editorial project another try. This time I would like to approach it from a different angle. A recent article by Rosenzweig (2006) on history as open source inspired me to use collaborative strategies for editing this document online. I am posting my original transcription in wikiversity, a sister project of the famous wikipedia site, and encouraging everyone to participate in the translation and annotation of the manuscript. This experience will be, at the same time, a test of the research potential of open collaboration and a pedagogical experiment on constructive learning. I am launching this editorial project here and now because I think that scholarly conferences could function as a platform to produce and reproduce all sorts of links between new online communities of content developers and traditional academic forums. Before exploring these dimensions of the issue, however, I would like to introduce the actual document. In the following pages you will find a brief biography of its author, a short discussion on the cholera epidemic of 1833, and an outline of the actual story included in the original manuscript.

The Author
José Leopoldo Yarini Klupffel was born in Siena, Tuscany, in 1789. His mother came from a well-connected family of Austrian officers and his father worked as a prosecutor in Florence, where the boy attended elementary school. At the age of 14, Yarini was already taking classes in the local University, but the onset of the Napoleonic Wars crushed his early academic ambitions. In the aftermath of the Treaty of Lunéville (1801), the Great Duchy of Tuscany had passed from Austrian to French control. The status of his family within the city of Florence was becoming increasingly precarious, and Yarini decided to move to Livorno in 1803. He worked as a surgeon apprentice in that city for almost a year, before traveling to Barcelona. The young Italian student was already committed to leaving behind the political turmoil of Europe and making his own fortune in the Americas.

Once in Spain, Yarini managed to obtain official authorization to travel to Veracruz. In 1804, after crossing the Atlantic, bad weather forced his ship to land at Omoa, in today’s Honduras. Unable to find work and still trying to reach New Spain, Yarini sailed to Batabanó, a fishing town in Southwest Cuba. He became sick right after arriving, probably suffering from a mild attack of yellow fever. Local experts advised him to move inland in order to recover his health. Yarini found himself living in Ceiba del Agua, a minuscule village west of Havana. He worked as a schoolteacher and surgeon apprentice there for four years.

Determined to become a doctor, Yarini passed a series of practical tests under the supervision of the Protomedicato and landed himself a job as an assistant at the Royal Military Hospital in Havana. A year later he applied for a degree of Bachelor in Arts, with the endorsement of the Hospital administration. The University of Havana granted Yarini his degree in 1809, after he passed a comprehensive package of formal examinations. He was so poor that the institution waived the nominal legal fee required to issue the diploma. At the time, the practical education in surgery and anatomy provided at the Military Hospital was vastly superior to the courses offered by the Faculty of Medicine. Yarini worked and studied for another year at the Hospital before passing a new series of exams and receiving the degree of Latin surgeon in 1811. Unable to find work within the tight professional hierarchy of the capital, he decided to move to the nearby city of Matanzas. By the end of the year, Yarini was working as a surgeon at the Matanzas Military Hospital, a solid but modestly paid job that he would manage to keep for more than two decades.

Now we encounter an intriguing gap in his biography. Sometime between 1812 and 1820 Yarini became the owner of a profitable sugar mill in the fertile Guamacaro valley, a few miles East of Matanzas. How could a humble military surgeon managed to amass the kind of capital required to start a business like this? His monthly salary of 20 pesos was barely enough to cover basic living expenses and his private clientele was rather limited. In 1820 he married Josefa Torres Lima, the daughter of a local landowner connected to powerful sugar families. His wife brought with her 10 000 pesos as a dowry, but at the time of the marriage Yarini was already worth around 30 000. A foreign-born university student, unable to pay his graduation fees, had become a prosperous sugar entrepreneur in less than a decade. Without proper documentation it is hard to determine the origins of Yarini’s fortune. Only one thing seems clear, slavery and sugar are at the heart of his social and financial success.

In 1821, Yarini became the father of a boy he named José de Jesús and decided to focus his efforts on the administration of the sugar mill. As a result, he was mostly away from the Military Hospital during the critical harvest months. Some of his colleagues complained to the local authorities and conspired to have him fired. Yarini was able to keep his post using the vast network of connections he had developed among the corrupt elite of Matanzas. In 1827 he even tried to get a promotion to the category of medical doctor, and an increase in his salary, on account of the extraordinary services he rendered every year during the yellow fever season. Although his petition was denied, Yarini was customarily addressed as “doctor” in many official documents. I have found no evidence that he actually earned a full medical degree. He died on April 1st 1839, six years after the events described in the manuscript.

The Epidemic
According to the World Health Organization, cholera is an acute intestinal infection caused by the bacterium Vibrio cholerae. This microorganism can enter the human digestive tract orally and after reaching the small bowel it releases a toxin that in turn increases the permeability of the cells covering the intestinal walls. As a result, large amounts of water and electrolytes are pumped from the blood into the lumen and then lost in the form of diarrhea. A severe form of dehydration develops if body fluids are not replenished in time. Main symptoms of cholera are watery diarrhea, vomit, muscular cramps, and acidosis. In its advanced stages, the disease could produce hypovolemic shock, a life-threatening condition ensuing from drastic reductions in total blood volume. This particular type of shock is distinguished by pulse and breathing alterations, profuse sweating, urine suppression, anxiety, and mental confusion.

Massive cholera epidemics are usually produced when a collective source of drinking water becomes contaminated with fecal matter containing Vibrio cholerae. For reasons that are still unclear, only about ten percent of all individuals infected during a given outbreak develop a serious form of the disease, but even asymptomatic hosts are a potential source of contaminating stools for as long as two weeks. Cholera has a relatively short incubation period (between one and five days), and some individuals can enter into a state of severe shock and die within hours of showing their first symptoms. Oral rehydration is the most common treatment, but the use of intravenous solutions and antibiotics is recommended for particularly compromised patients. The effectiveness of available cholera vaccines is low and their cost is high. Infrastructure development, popular education, and general sanitation constitute the best prophylactic measures against this reemerging disease. Today, poverty and inequality are among the most important factors affecting the geographic distribution, morbidity, and mortality rate of cholera worldwide.

By the end of the eighteenth century, several European travelers and colonial bureaucrats had reported the occurrence of seasonal epidemic outbreaks of a severe gastrointestinal disorder in the lowlands of Bengal, India. Known as “Asiatic cholera”, this disease was initially described in the West as an exotic nuisance of the tropics. It is probable that some sort of equilibrium between the acquired immunities of the Bengal inhabitants and the ecology of Vibrio cholera infections kept the disease circulating in a relatively small area. Apparently, the heavy presence of British troops around Calcutta broke this fragile balance, initiating the first modern pandemic of cholera in 1817. In several waves, the disease invaded Russia, the Arabic peninsula and the Persian Gulf. A massive outbreak among the pilgrims visiting Mecca in 1831 contributed to the spread of cholera through Northern Africa and the rest of the Muslim world. Most European cities were invaded: Moscow in 1830, Berlin and Vienna in 1831, Paris and London in 1832. The disease would eventually cross the Atlantic, carried by Irish immigrants into Canada. The east coast of the United States was severely hit in 1832. Throughout North America, cholera followed one of the most popular commercial routes: down the Mississippi to New Orleans, and from there to Mexico and Cuba.

The first cases were reported in Havana at the end of February 1833. Ten percent of its population died of cholera in three months. Hundreds of people panicked and left the city, carrying the disease with them. Almost one fifth of the slaves working in the sugar and coffee plantations of western Cuba were annihilated in less than a year. A mix of veiled criticisms aimed at the incompetence of government officials and apocalyptic calls for the modernization of the colonial infrastructure signaled the intellectual responses to the disaster. The authorities were compelled to initiate a serious reformulation of the sanitary administration system. Professional doctors and alternative healers competed furiously over the loyalty of their patients, but were unable to provide anything more than treacherous heroic remedies for the victims and meager doses of emotional comfort for their families. Despite the fact that most official responses to the epidemic followed a secular approach, many inhabitants got involved in unusual demonstrations of popular religiosity. At every level, this catastrophic event represented an enormous challenge but also an invaluable opportunity for social renovation.

The Story
After the birth of his second child in August of 1830, José Yarini became even more involved in plantation management. The Guamacaro valley was experiencing unprecedented levels of economic growth during those years. In 1828, the foundation of the port city of Cárdenas contributed to a sharp reduction in transportation costs for the surrounding areas. At the time there were at least a dozen sugar mills operating in Guamacaro, along with a similar amount of coffee plantations and a handful of smaller farms. A decade later, the Census (1841) listed 30 sugar mills and 73 coffee plantations in the area. Although more numerous, coffee plantations were smaller than sugar mills and employed less than half of the total labor force deployed in the region. Yarini owned 1200 acres of land strategically situated at the center of the valley and tended by some 120-130 African slaves under the supervision of four salaried employees. Known as Nuestra Señora del Rosario, this was a typical sugar plantation of modest proportions. During the harvest months, slaves cut the cane using machetes and hauled them to the mill house in two-wheeled oxen carts. The mill itself used draft animals to press the juice out of the cane. This juice was condensed at the boiling house, using a series of pots aligned over an open fire in an arrangement known as “Jamaican Train”. The resulting combination of molasses and crystallized sugar was slowly drained to let the liquid molasses out. Sugar crystals were broken apart, classified according to their degree of purity, and packaged in large boxes to be exported through nearby Matanzas. During the 1830s, this cane plantation and sugar manufacture complex was still run according to old standards established in the late eighteenth century (Moreno Fraginals, 1978 I: 78-95).

Cholera invaded Matanzas in March of 1833, two weeks after its first appearance in Havana. Unable to contain the spread of the actual disease, the local authorities tried to manage its social consequences. The official newspaper painted a rosy picture of the outbreak, insisting that the governor was taking all appropriate measures to keep the situation under control. The Military Hospital remained full for a month and Yarini kept busy at work. It was not until May 18th that he was allowed to visit his sugar mill. The story narrated in his manuscript starts with his departure from the city. It seams, however, that this is only the second part of his full testimony because he mentions the existence of a first part, describing his experiences at the Military Hospital. Unfortunately, I have been unable to find that other manuscript. The existing document is divided into 26 short chapters, and two or three more were obviously lost. The first and last pages are also missing, and some words here and there are illegible. Despite the fragmentary nature of the manuscript, following the storyline is rather easy. I will provide a brief overview of the content of each chapter, assembling them into thematic sections.

The first two chapters serve as a general introduction to the story. Yarini describes the reactions of planters and merchants gathered at a local Café in Matanzas, after receiving news of the cholera outbreak in New Orleans. Some claimed that slaves were immune to the disease, arguing that cholera was similar in that regard to yellow fever. Others said that slaves were particularly susceptible to the effects of cholera, citing letters sent from Louisiana by trustworthy eyewitnesses. Yarini sided with the latter group, after discussing the issue with a French merchant who had recently arrived from New Orleans. The third chapter is a detailed account of the first appearance of the disease in the Guamacaro valley. Revealing his professional prejudices, Yarini describes the strategies of two unlicensed healers. One of them, introduced as “a Chinese curandero born in the Philippines”, was successful in treating a couple of slaves who the other healer, an English man, had already pronounced dead. This is the first mention I have found of the healing abilities of the proverbial “Médico Chino” in nineteenth century Cuba, preceding by a decade the massive arrival of Chinese indenture servants to the island. Although claiming that the success of the Asian healer resulted from pure luck, Yarini is particularly interested in demonstrating the ignorance of his British counterpart. This “doctor Makie” is presented as an alcoholic full of grand ideas who claimed to be an expert on cholera, having fought the disease in Russia, Germany, and Poland. According to Yarini, more slaves died at the sugar mills placed under his care than those working in plantations with no medical attention of any kind.

Chapter four is a description of the medical topography of the Guamacaro valley, with an emphasis on the unsanitary working conditions of the sugar mills. Chapter five, on the other hand, is a chilling characterization of the daily life of the slaves themselves. At the root of all their illnesses, Yarini claims, was the avarice and cruelty of their masters. His presentation of the pathogenic consequences of slavery is unapologetic:

“Plenty of continuous work keep them oppressed, living with no rest and very little food. Naked and exhausted they are barely allowed a short period of time to lie their tired members on the floor and sleep. Their rest is often interrupted for insignificant reasons. Any minor fault, sometimes resulting from lack of sleep, is cruelly punished. Victims of the brutal furor of those barbarians that rule over them under the name of overseers, they are often used as a source of entertainment, presented as bait during the training of watch dogs. They are exposed to chronic diseases as a result of going rapidly from excessive cold to extreme heat. Full of disgusting ulcers, they are poorly assisted when sick, despite the fact that they have acquired their illnesses at the service of their masters. Degraded and humiliated all the time, living in total abandon, theirs is a sad and laborious existence. Instead of a source of incentives, life represents for them an unbearable weight. That is the only reason why many of them commit suicide in cold blood: to put an end to their continuous pain. Many of them have shackles on their feet and walk around dragging huge masses, pale and half-dead, living their last days in excruciating agony. Only death can free them from their anguished existence.”

In chapter six, Yarini comments on the arrival of cholera to the surrounding plantations. A detailed chronicle of the events that took place at his sugar mill during the first days of the outbreak occupies the next five chapters. Yarini tell us about each of his four white employees: the mayoral or slave overseer, the boyero or oxen manager, the maestro de azúcar or sugar chemist, and the mayordomo or estate administrator. The first cases of cholera, diagnosed right after the end of a violent storm, gave the author an opportunity to explore the metaphoric connections between climatic and epidemic disturbances. His coverage of the events is very detailed. Yarini includes passages taken from his personal diary and transcriptions of actual conversations where he attempts to reproduce the popular phraseology of his employees and even the speech patterns of his slaves.

The next block of chapters, from 12 to 17, are devoted to an even more precise description of one single day. On May 26 of 1833, all four of the plantation employees died somewhere in the Guamacaro valley, after failing to outrun the disease. Yarini provides a detailed account of practically every hour, peppered with clinical observations about cholera and commentaries regarding the most intimate details of daily life in an infected sugar mill. Many slaves decide to run to the nearby hills, in an attempt to escape from the disease, but a handful of them were forced to return the next day for lack of food and drinking water. Thirty pages of the original manuscript are missing, the equivalent of two or maybe even three full chapters. One way or the other, the narration is rapidly approaching its climax. All white employees are now gone and Yarini is surrounded by sick slaves. He asks a couple of them to dig some graves. One is specially prepared for the master, under his favorite lemon tree.

Seventeen slaves died on the night of May 26th, at the peak of the epidemic outbreak. Chapters 18 to 21, chronicling these events, are among the richest in the whole manuscript. Here Yarini describes the funeral rituals performed by the slaves, complementing his observations with a transcription of actual interviews. He also includes an inventory of preventive measures taken by the slaves, transcribing their own explanations about the meaning of both funerary and prophylactic practices. On June 11, Yarini decided to restart the operation of the mill. The last weeks of the epidemic are presented in chapters 22 to 25. Many of the slaves returned from the hills and the situation seems to be going back to normal. Within a few hours, however, two dozen of them started showing symptoms of cholera. This time the invasion is mild and most of the patients recover uneventfully. The remission of cholera brings closure to the story. In less than 20 days, 38 out of 129 slaves had perished in the sugar mill. The last chapter is titled “To my slaves that died of cholera, year 1833”, and this is how Yarini said goodbye to them:

“Comfort all of you that used to be called poor Negroes. Your sad penance and your labors have come to an end. Your forced and violent slavery has ended. The mother of all living things is opening her bosom to receive you. There you will find the rest that men stole from you.”

The Proposal
Charting the development of colonial medicine in nineteenth century Cuba is very difficult. We know plenty about the most prominent figures operating within academic circles, doctors like Tomás Romay, Nicolás José Gutiérrez, or Carlos J. Finlay. What makes the Cuban case interesting, however, is the proliferation of licensed and unlicensed practitioners working at the margins of the profession, where exchanges between complementary healing strategies were more frequent and productive. Plantation healers and garrison surgeons were instrumental in the creation of vast hybrid networks of practitioners, connecting the formal sphere of academic medicine with the informal realm of healing tradition. Understanding this process of medical syncretism and hybridization requires approaching well-known figures and conventional sources from a different angle. At the same time, however, we need to unearth fresh documents to create a whole new batch of case studies.

Yarini´s testimony is a perfect example of the kind of material we need. This remarkable document can illuminate many obscure corners of the complex interaction between slavery and medicine during a key period of institutional and intellectual renovation. In purely ethnographic terms, its value remains unmatched. As a window into the ideology and worldview of a slave holding “doctor”, this testimony constitutes one of the most useful pieces of evidence we have. Yarini was at the same time, an insider and an outsider. He combined the familiarity of a long term resident of rural Cuba with the critical outlook of a foreigner. While owning slaves and profiting from their work, he was also a critic of the institution of slavery. More than just a “contradiction” this duality was in fact essential in the construction of professional and medical identities within plantation medicine. Only a handful of physicians owned sugar mills in nineteenth century Cuba, but many practitioners found employment in plantation infirmaries. There, as in the hospital of Paris, colonial healers had easy access to the open bodies of their patients. In the infirmaries, however, they were also exposed to complex bodies of traditional medical knowledge. Plantation infirmaries only reveal their full potential when understood as nodes within vast networks of epistemic and professional exchanges.

We are merely starting to appreciate the historical significance of these exchanges. The scope and depth of the research required to reconstruct them place this type of study out of the reach of individual scholars. Personally, I think that it takes a network to understand a network. That is why I want to translate, annotate, and edit Yarini’s manuscript online, using a collaborative strategy. As the development of wikipedia shows, running an actual editorial experiment is the best way to organize a team of scholars, students, and general readers around this type of work. That site, however, has a clear policy against what its editors define as “original research”. It is obvious that translating and editing poorly known primary sources falls out of the scope of an online encyclopedia. Fortunately, the Wikimedia Foundation also host a sister project of wikipedia, known as wikiversity, that could provide an ideal home for this kind of experiment.

Inaugurated a few weeks ago, the wikiversity project is positioning itself as a space to promote the integration of physical and virtual learning communities. I am interested in this experience because I believe that academic resources in the humanities and social sciences could be allocated more efficiently through a radical integration of research, teaching, and public outreach. Rather than treating each of them as separate activities competing for funding and time, we should aim for the articulation of scholarly, pedagogical, and publishing endeavors into dynamic productive clusters. Classrooms ought to be transformed into networked workshops. Instead of a one way road for the transmission of fixed knowledge from full professors to empty students, we need to redesign the classroom environment so it can serve primarily as a coordinating hub for small teams of students committed to the production and dissemination of new scholarly resources and instructional materials. Within such a workshop, each assignment would arise from valid research needs and their outcomes would be treated as authentic academic contributions. Instead of being passive consumers of prepackaged information in the form of overpriced standard textbooks, students would be able to participate in the production of useful bits of real knowledge. Under this paradigm, static textbooks could eventually be replaced with free dynamic repositories of instructional multimedia resources manufactured for students and by students.

Students would be the main beneficiaries of this transition from static classrooms into networked workshops. Instructors, however, could also increase their productivity under the new paradigm. Our current model of academic production is centered on individual scholars crafting their articles and monographs in relative isolation. Intellectual credit and professional promotions are distributed under the assumption that academic authors operate as discrete creative units. Under this model, sharing resources is seldom encouraged, extreme specialization becomes enshrined, and open forms of collaboration are usually avoided. While exchanges among discipline and across institutions are officially promoted everywhere, the reality of academic life precludes authentic forms of teamwork from developing even within single fields or departments.

Transforming this landscape would require the emergence of a legitimate model of intellectual production running parallel to the one we already have. Only sustainable public displays of the raw power of collaboration could change the outlook of academic administrators and draw the interest of young scholars. For most of them, dealing with cumbersome tenure requirements is hard enough already. They are expected to publish, to teach large amounts of introductory courses, and to serve their departments in several other capacities. Under these circumstances, a synergy between teaching and research could be particularly useful for entry level professors. As facilitators of networked workshops, young academics could contribute to the creation of sizable online repositories in which their own authorship would be diluted but still recognizable. This could, in turn, demonstrate the viability of collaborative research models while accelerating a most needed transition from static to dynamic forms of scholarly publishing.

That is why I am inviting you all to join this editorial experiment at wikiversity. Following this link you will find a full transcription of Yarini’s manuscript in Spanish. Maybe you can contribute to the translation effort, or maybe you feel more comfortable working on annotations or commentaries. Whatever your field of expertise is, we will find something useful for you to do.