Cholera

The Victorian Plague

Amanda J Thomas

• Publisher: Pen & Sword History
• Year: 2015
• ISBN:
  9781473875999
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

"[A] fusion of science, social, and medical history... fascinating... the understanding of and responses to cholera are covered in detail and with sensitivity" —The Victorian Web Discover the story of the disease that devastated the Victorian population, and brought about major changes in sanitation. Drawing on the latest scientific research and a wealth of archival material, Amanda J. Thomas uses first-hand accounts, blending personal stories with an overview of the history of the disease and its devastating after-effects on British society. This fascinating history of a catastrophic disease uncovers forgotten stories from each of the major cholera outbreaks in 1831–2, 1848–9, 1853–4 and 1866. Amanda J. Thomas reveals that Victorian theories about the disease were often closer to the truth than we might assume, among them the belief that cholera was spread by miasma, or foul air. "The book acts as a complete overview of cholera in Victorian Britain, taking a new, accessible approach to a topic previously covered predominately by academic researchers." — Harpenden History

CHAPTER 1

An Ancient Disease:
The history and epidemiology of cholera

Before the discovery of antibiotics in the twentieth century, there was a general acceptance that an illness or infection might prove fatal. Epidemics of diseases such as typhoid fever, tuberculosis, measles, diphtheria and whooping cough were much feared, and despite the discovery of the smallpox vaccine at the end of the eighteenth century, its use was not widespread and many still died from the disease. Yet no single outbreak of any disease was seen in quite the same light as the Black Death of the fourteenth century, which was still vivid in the popular imagination during the nineteenth century.

The prospect of another unknown foreign disease with the ability to ravage the entire population caused considerable unrest in 1820s Britain. Cholera too was seen as a pestilence, breaking out without warning, dispatching its victims painfully and at speed. In addition, just as the plague could be identified by characteristic swellings, or buboes, so cholera left its own deadly mark, rendering sufferers emaciated, with a blue tinge to their skin.

Cholera is ancient in origin and is probably the dehydrating, diarrhoeal disease described in old Chinese and Hindu texts, and by writers such as Hippocrates and Caelius Aurelianus.¹ The pathogenic strain of cholera regarded with most dread has been known by several names. These included spasmodic cholera, Asiatic cholera and cholera morbus, which was the term used in 1629 by the Dutch physician Bontius, to describe the outbreak in Jakarta, Indonesia:

‘Besides the diseases above treated of as endemic in this country, the Cholera Morbus is extremely frequent; in the Cholera, hot bilious matter, irritating the stomach and intestines, is incessantly, and copiously discharged by the mouth and anus. It is a disorder of the most acute kind, and therefore requires immediate application. The principal cause of it, next to a hot and moist disposition of the air, is an intemperate indulgence of eating fruits; which, as they are generally green, and obnoxious to putrefaction, irritate and oppress the stomach by their superfluous humidity, and produce an æruginous bile … those who are seized with this disorder generally die, and that so quickly, as in the space of twenty-four hours at most.’²

The English physician Thomas Sydenham also observed the cholera morbus in London during the summer and autumn of 1669. His description of the symptoms sounds very similar to those of the later nineteenth century epidemics:

‘Immoderate vomiting, and a discharge of vitiated humours by stool, with great difficulty and pain … violent pain and distension of the abdomen, and intestines … heart-burn, thirst, quick pulse, heat and anxiety, and frequently a small and irregular pulse … great nausea, and sometimes colliquative [profuse] sweats … contraction of the limbs … fainting … coldness of the extremities, and other like symptoms, which greatly terrify the attendants, and often destroy the patient in twenty four hours.’⁴

If Sydenham’s observations are accurate, then it is possible that a pathogenic type of cholera, perhaps a strain of what would later become known as Asiatic cholera, may have already been present in Britain by the late 1600s. However, as the victims’ skin did not turn blue – a characteristic of Asiatic Cholera – it is more likely that Sydenham was describing severe cases of the disease known as English cholera.

Prior to the nineteenth century, outbreaks of pathogenic cholera were rare outside of India. Here outbreaks were more common but they were always localised, and often spread by pilgrims who congregated for waterside ritual gatherings.⁵ The first cholera pandemic, or widespread epidemic, began in 1817 and is thought to have started following a gathering of pilgrims at the Hindu festival of Kumbh Mela in Jessore, near Calcutta.

The spread of cholera out of India may have been the result of a combination of circumstances, just as is believed to have been the case with the plague, (as discussed in the Introduction). The eruption of Indonesia’s Mount Tambora in April 1815, combined with low solar activity, caused climate cooling and harvest failure. India’s population was already weakened by famine and it is possible that cholera initially spread through the consumption of rice cooked in tainted water.

An additional trigger for the outbreak has been proposed by epidemiologist Professor Ralph Frerichs, who suggests that changes to India’s irrigation system may have also been a factor in the spread of the disease. From 1801, under British rule, successive and extensive excavations were undertaken in India to free up silted rivers and stimulate agricultural production.⁶ The disruption of river sediment, the change of soil composition, and climate changes affecting air and water temperatures could all have played a part in triggering an alteration in the behaviour of Vibrio cholerae, the cholera bacteria native to India’s water systems which may even have been present within the soil.

The spread of cholera out of India was facilitated by the movement of people, in particular the military, and an increase in trade across both land and sea. By 1820 the first cholera pandemic had spread from Jessore to Nepal, Surat, Bombay and China. It then moved on to Astrakhan near the Caspian Sea, where the severely cold temperatures during the winter of 1823 prevented it from spreading further. Then, in 1826, a second pandemic started in Bengal which took three years to spread to Persia and Afghanistan.

Cholera then followed the caravan routes to Orenburg in the southeastern corner of European Russia, where there was a pause in its dispersal throughout the winter. Unlike the winter of 1823, temperatures were not low enough to entirely halt further outbreaks. Cholera reappeared again in the spring of 1830 and began to spread throughout Eastern Europe, Austria, Germany, France, the Americas, East and North Africa, and Britain.⁷

In 1832, writing in the Medico-Chirurgical Review, the editor and proprietor, physician Dr James Johnson, described the spread of the disease:

‘We are rather at a loss for a simile or example to illustrate the journeys of this scourge, which was to go faster than a steam-carriage. It crept, like a skulking hyena, from one dirty lane to another, seizing chiefly on those who were half in the grave already, or who, from terror, were flying before the enemy. It rarely or never attacked those who boldly faced the foe.’⁸

Britain’s extensive influence across the globe during this period meant that the outbreak of any epidemic disease abroad was usually swiftly communicated to the British medical authorities. Cholera was fearfully anticipated, and the rapid pace with which the disease spread caused considerable unease. In November 1831, when cholera had already broken out in the north-east of England, Dr J. Sanders wrote to the President of the Board of Health in London, Sir Henry Halford:

‘When the disease misnamed Cholera Morbus was confined within our east Indian dominions, it concerned us only as a remote evil – but now that it has traversed Asia, invaded Europe, and advanced to the shores of the Northern Ocean, we awake from our dream of security … the present epidemic reminds us of one which took a course not dissimilar in the reign of Edward III, anno 1349.’⁹

The way in which cholera had spread so rapidly, and the devastation it had caused, reminded doctors of the way in which the plague had swept across Europe and into Britain in the fourteenth century. Cholera was an unknown foreign disease which was poorly understood and for which there was no cure; moreover Britain was as vulnerable to cholera as it had been to the plague. The country’s working population was, in general, poorly nourished, worn down by a raft of other infectious diseases and living in densely packed housing, with little or no sanitation.

An outbreak of cholera was a deeply worrying prospect, as expressed by Dr W. Macmichael in another letter to Sir Henry Halford, which was published by the London Quarterly Review:

‘This pestilence has, in the short space of fourteen years, desolated the fairest portions of the globe and swept off at least FIFTY MILLIONS of our race. It has mastered every variety of climate, surmounted every natural barrier, and conquered every people … the cholera like the small pox or plague, takes root in the soil which it once possessed … Great debility, extinction of the circulation, and sudden cooling of the body are the three striking characteristics of the Indian cholera; these, in the majority of cases, are accompanied by exhausting evacuations of a peculiar character, intense thirst, cold blue clammy skin, suffused filmy half-closed eyes, cramps of the limbs, extending to the muscles of respiration, and by an unimpaired intellect. It is no wonder that the approach of such a pestilence has struck the deepest terror into every community.’¹⁰

Fear is perpetuated by ignorance, and in the case of cholera the dearth of knowledge about disease was extreme. In the early years of the nineteenth century, many physicians still went along with the ancient view that disease was caused by an imbalance of humours in the body; others considered diseases to be a type of fever.¹¹ A choleric humour, historian Christopher Hamlin explains, was ‘biliousness … associated with “a fierce and Wrathful Disposition.” That already linked cholera with the tropics, where barbarity reigned and disease was more intense, and with hot and sultry tropical weather that could visit temperate latitudes.’¹²

The Medico-Chirurgical Review, reported that some physicians, like Dr George Gregory, thought cholera had been sent by Divine Providence as a scourge, and it was suggested that if this were the case, then the disease might rid society of ‘the drunken, the debauched, and the profligate.’¹³ Others, such as the French physician François Gabriel Boisseau, believed cholera was caused by:

‘The excess at table, abuse of indigestible viands, crustacea, leeks, onions, lettuce, cabbage, pastry, greasy, oily ailments, fruits, cucumbers, melons, farinaceous substances, warm water, wine mixed with milk, old aromatic wine, acrid purgatives and emetics, irritating, acrid, corrosive, vegetable poisons, acids and minerals, the sojourn on board of a vessel at sea; anger and solitude; heat of summer, particularly towards the end of the season; the humidity of autumn at its commencement; the winter season; cold night succeeding hot days; youth and vigour.’¹⁴

Doctors were deeply divided in their opinions as to the cause of disease. Some believed infections were fungoid, because of fungi found in tainted food and water, others, known as miasmatists, thought they originated in miasma, tiny particles spread on the wind in foul smells and odours. Other popular theories were organic, caused by a lack of ozone; electric, a result of static electricity; and telluric, due to poison exhaled by the earth.¹⁵

In the late 1830s, during the early years of his career, the doctor, statistician, and confirmed miasmatist, Dr William Farr, described the way in which disease worked as zymosis, while its epidemic, endemic and contagious forms were zymotic, from the Greek word meaning to ferment. He did not think that infections worked in exactly the same way as fermentation, but argued that the two processes were similar.¹⁶ Farr believed that non-living zymotic materials were abundant in the urban environment, produced by a chemical process on organic material, and capable of entering the body through the lungs and then infecting the blood, ‘the principal site of disease activity.’¹⁷

In Farr’s view, zymotic materials were non-organic but derived from living matter; he theorised that something happened to these particles, particularly in an unhealthy environment, when they were inhaled. He also believed that the characteristics of the zymotic matter changed during an epidemic period, and that miasma could perhaps even generate zymotic material, or non-living organic poisons. Farr identified these most specifically. Smallpox was caused by varioline, syphilis by syphiline, typhus by typhine, and cholera by cholerine or cholrine.¹⁸

At the time, the medical world understood that disease was caused by something. The work on inoculation by scientists such as Edward Jenner had demonstrated that disease could be passed from one person to another and was therefore contagious. However, an infection that could be spread in this way was seen as distinct from an epidemic disease, which did not spread out like ripples in a pond and appeared to be confined to certain locations. William Farr’s zymotic theory bridged the gap between the old miasmatic idea and bacteriology, which began to be accepted in the 1880s.

Even before the discovery of micro-organisms, the theories of some nineteenth century physicians were remarkably close to the truth. Observers such as Farr could see there was an important relationship between environmental conditions and disease. Cholera was most virulent in the lat...

Table of contents

• Cover
• Dedication
• Title Page
• Copyright
• Contents
• Acknowledgements
• Preface
• Introduction
• Chapter 1: An Ancient Disease: The history and epidemiology of cholera
• Chapter 2: Brandy is the Cure: The 1831-2 cholera outbreak
• Chapter 3: The Wretched State of the Poor: The influence of politics and philosophy on the living and sanitary conditions of the poor
• Chapter 4: Cholera and Tooting’s Pauper Paradise: Workhouse conditions and how cholera devastated a children’s institution
• Chapter 5: Births, Marriages and Deaths: The General Register Office and the work of William Farr
• Chapter 6: The Graveyards Overflow: The effect of population growth and cholera on traditional burial practices
• Chapter 7: Dr John Snow and the Broad Street Pump: The emerging theory that cholera is a waterborne disease and the modern myth of Dr John Snow
• Chapter 8: The Stink of Cholera: The improvement of London’s sewage system and Sir Joseph Bazalgette
• Chapter 9: Cholera Returns: The 1866 East End cholera outbreak and the Princess Alice disaster
• Chapter 10: A Modern Disease: Genetics, vaccines and new theories
• Notes
• Bibliography