Cholera Epidemics

10 Key excerpts on "Cholera Epidemics"

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  Cholera

  The Victorian Plague

  • Amanda J Thomas(Author)
  • 2015(Publication Date)
  • Pen & Sword History

    (Publisher)

  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.’

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  Plagues and Epidemics

  Infected Spaces Past and Present

  • D. Ann Herring, Alan C. Swedlund, D. Ann Herring, Alan C. Swedlund(Authors)
  • 2020(Publication Date)
  • Routledge

    (Publisher)

  six Deconstructing an Epidemic Cholera in Gibraltar

  Lawrence A. Sawchuk

  A recurring theme in research on infectious diseases has been to empirically describe and capture the epidemic experience. This task has proved daunting, for it is not always easy to resolve the most fundamental question: When is an epidemic an epidemic? (Green et al. 2002). Frequently, the researcher is confronted with variations of the use of the term, with seemingly interchangeable expressions employed to describe epidemics such as plagues and outbreaks. To obfuscate the matter further, these emotionally charged terms are mutable over time and space. Clearly, the need for an unambiguous lexicon for the term epidemic is paramount for effective communication within and across discipline boundaries (Green et al. 2002: 5).

  I define an epidemic simply as a marked rise in the frequency of a specific infectious disease in a community over a limited period, beyond the frequency considered normal for the population under investigation. I readily acknowledge that this definition is insufficient in scope and detail, for as Green and co-workers (2002) pointed out, each epidemic, by its very nature, is context specific. Accordingly, steps must be taken to situate the epidemic in space, place, and time. If the goal of the investigator is to empirically assess the effects of an epidemic, then contextualization is essential.

  The first step in contextualizing the epidemic is to describe its fundamental epidemiological characteristics, using traditional methods. The second step is to define the prevailing state of mortality before and after the epidemic, ideally in empirical terms. The normal state of mortality then serves as the control period by which to gauge the effects of an exogenously derived epidemic on a population, as well as its short- and long-term consequences. This conceptual model divides the state of community well-being into four phases: the steady state of equilibrium, or the normal level of mortality; the stress period that disrupts equilibrium through an epidemic; the immediate aftermath of the epidemic; and the return to the steady state of mortality equilibrium. The third step in contextualizing an epidemic involves identifying, sourcing, and assessing the emergence of health inequalities. Collectively, these phases serve to contextualize the event, the ecosocial landscape, the processes at work, and the consequences. Such a scheme allows other researchers to frame their analytical work spaces in a way that will yield results that can be used to compare epidemics across space and time.

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  Cholera

  • W. E. van Heyningen(Author)
  • 2019(Publication Date)
  • Routledge

    (Publisher)

  I The Disease

  1. Introduction

  Few major infectious diseases have moved with the times as successfully as cholera.

  Editorial, Proceedings of the Royal Society of Medicine, May 1977

  There have been three watersheds in the history of the involvement of the Western world in cholera. The first, early in the last century, marked the end of the isolation since times immemorial of the West from cholera, when the disease erupted from India in six pandemics at intervals of one or two decades and invaded Europe five times and the Americas three times. It struck Britain with a terror such as had not been experienced since the Plague, which, to use Creighton's words, "had been the grand infective disease of Britain from the year of the Black Death, 1348-9, for more than three centuries, down to 1666" [86]. Diarrhoeal diseases (of which cholera is one) were not unknown in Europe and in fact often went under the name of "cholera" of some sort or another, such as "Cholera Nostra", but, to use Creighton's words again, the newly imported "Indian or Asiatic cholera, which first showed itself on British soil in one or more houses on the Quay of Sunderland in the month of October 1831, was a 'new disease' in a more real sense than anything in the country since the sweating sickness of 1485". But we must be wary of dramatics: "We are all the dupes of words or of their emotional colour", wrote Greenwood, comparing plague and the far more lethal disease with the "emotionally colourless [name of] influenza" [180]. Pelling has pointed out that "as a cause of death and debility in mid-nineteenth century England, cholera was surpassed among epidemic diseases by 'common continued fever' (chiefly typhoid, relapsing fever and some typhus), scarlet fever, smallpox, and measles, and accounted for only a very small proportion of the area of highest mortality, which occurred among infants and young children" [328]. She goes on to state that

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  Pandemic India

  From Cholera to Covid-19

  • David Arnold(Author)
  • 2022(Publication Date)
  • Hurst Publishers

    (Publisher)

  We have become accustomed to the idea of new diseases, from AIDS and SARS to Ebola and Covid-19, as resulting from radical shifts in the relationship between people and environments. Deforestation, climate change, surging populations, and an inexorable demand for food and other resources have pushed against environmental limits or overturned existing ecologies, so that infections previously confined to birds, bats, pigs, monkeys—or marine invertebrates—have spilled over into humans, who then pass them on among themselves through person-to-person transmission. 11 Cholera was an earlier iteration of this now familiar story. In deltaic Bengal an ecological frontier had been breached, a watery ecology transformed to suit human needs, a city with tens of thousands (ultimately millions) of inhabitants sited in an uncongenial swamp. A disease that for centuries may have been locally present, or sporadically epidemic across the subcontinent, now found the conditions in which to thrive and the freedom to crisscross the globe. ‘Pandemics,’ it has been said, ‘appear for a reason. And that reason is the size of the host population and the degree to which it has disturbed its environment. Upsetting the balance of nature is something the human species has done rather well.’ 12 In 1817 lower Bengal experienced ‘probably the most terrible of all Indian Cholera Epidemics.’ 13 Consternation and confusion marked the arrival of this ‘most alarming and fatal disorder.’ 14 In Jessore in the summer of 1817 an estimated 10,000 people died within two months. The disease spread to Calcutta, where 4,000 deaths were reported; then, traveling via Patna, Benares, and Allahabad, cholera pushed into northern and central India, attacking Bombay in August 1818 and Madras in October. In 1819 it began journeying overseas, crossing to Ceylon, before moving on to Mauritius, Southeast Asia, China, and, by 1822, Japan. 15 A short respite followed

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  Poverty and Sickness in Modern Europe

  Narratives of the Sick Poor, 1780-1938

  • Andreas Gestrich, Elizabeth Hurren, Steven King, Andreas Gestrich, Elizabeth Hurren, Steven King(Authors)
  • 2012(Publication Date)
  • Continuum

    (Publisher)

  5 Poverty and epidemics: Perceptions of the poor at times of Cholera in Germany and Spain, 1830s–1860s Beate Althammer Introduction

  ‘Asiatic’ cholera caused shockwaves when it first appeared on the European borders in the early 1830s. Originally this epidemic disease had only been known on the Indian subcontinent, and although it had begun to spread over large parts of Asia and the Near East in the early nineteenth century, European worries had not yet arisen. Europe, a fortress of progress and civilization, so many had believed, would not be affected by the nasty and dirty sickness from the swamps of Bengal. But when cholera broke out in Russian Poland and crossed to the eastern provinces of Prussia in 1831, public concern was enormous, even in regions much further to the west. Rumours were disseminated, public prayers held. Hundreds of books, pamphlets and newspaper articles were published on this new threat that frightened and at the same time fascinated the collective imagination. Cholera seemed to be not just another normal malady, but rather an approaching disaster, something like a new form of plague. It developed very fast and violently. The symptoms were drastic and revolting. Half of those falling sick died, often within hours. Authorities developed frantic countermeasures but were seemingly unable to stop the disease. For the medical profession it was a severe setback: none of the many propagated preventive and therapeutic remedies really helped, and – until after the bacteriological turn of the 1880s – no agreement could be achieved about causation or transmission.

  Historians have written extensively on cholera, but at least in German historiography – which has turned to the subject later than its British or French counterparts – the focus remains limited. Several studies have described the first outbreak in eastern Prussia in the summer of 1831, state policy to contain it and reactions of the population during the initial turbulent month of cholera-hysteria.1 Other studies have been devoted to the famous Hamburg epidemic of 1892, the last in Germany, during which perceptions and reactions were already strongly influenced by the new bacteriological paradigm.2 But very little attention has been paid to the period inbetween.3 Reflecting this lacunae, the picture of German, and especially Prussian, policies to control epidemic disease has been distorted. Drawing on Ackerknecht’s theory that there was an affinity between conservative regimes and contagionist disease control on the one hand, Liberal convictions and anti-contagionist explanations of epidemic disease on the other,4 Prussia is commonly presented as a classic example of poor public-health planning. Right up until the most recent contribution to German cholera history, the study of Olaf Briese,5

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  Epidemics

  The Impact of Germs and Their Power over Humanity

  • Joshua S. Loomis(Author)
  • 2018(Publication Date)
  • Praeger

    (Publisher)

  V. cholerae the day before 1,000 people drink from it, every person may come down with symptoms at the same time. Unlike host-to-host epidemics, which often have a slower lag period as the infectious agent progressively spreads through the population, common-source epidemics can seemingly arise out of nowhere and claim the lives of thousands before health officials even have time to react. Since transmission is not directly between people, quarantines are usually minimally effective as are attempts at improving personal hygiene. The only way to truly stop a common-source epidemic is to identify the contaminated source and then either remove the contaminant or prevent people from accessing it. Common-source epidemics can be prevented altogether by maintaining a clean water supply and requiring that standard food safety measures are followed.

  The central problem that arises when trying to control cholera and other waterborne illnesses like typhoid and dysentery is that individuals infected from a common source can travel to distant sites and then contaminate local sources there. Now instead of having a single area of contamination to contend with, there are possibly thousands of foci distributed over hundreds of miles. For instance, a person picking up cholera from a river in one city can deposit the bacteria in 10 other cities as they travel home with uncontrollable diarrhea. As you will see throughout the chapter, this pattern of dispersal has been critical for the success of cholera as an epidemic disease for the past 200 years.

  Origins and Overview of the Seven Pandemics

  The first use of the word cholera comes from the writings of Hippocrates who, in the fifth century BCE, used the Greek word for bile (chole¯) to describe a number of different sporadic diarrheal diseases.2 Based on his somewhat vague clinical description of these diseases, it is likely that Hippocrates never actually witnessed epidemic cholera. Similarly, there are no clear descriptions of cholera in the writings of Galen or any other ancient European medical historian, which suggests that the disease either did not arise in Europe or it did not cause any significant epidemic there during those times.

  Although no one knows exactly where, when, or how V. cholerae entered into the human population, most epidemiologists believe that it arose somewhere on the Indian subcontinent at least a couple of thousand years ago. One of the more convincing pieces of evidence that supports this theory comes from writings on ancient stone monoliths found in some Hindu temples. For instance, there is a monolith at a shrine in western India dating back to the fourth century BCE that contains the inscription, “The lips blue, the face haggard, the eyes hollow, the stomach sunk in, the limbs contracted and shrumpled as if by fire, those are the signs of the great illness which, invoked by a malediction of the priests, comes down to slay the braves.”3 While one may argue that this could have been referencing any number of diseases, symptoms like blue skin, sunken eyes, and perpetually contracted muscles are much more indicative of cholera than other diarrheal diseases like typhoid fever or dysentery. Similarly, people had been worshiping a Hindu goddess devoted to cholera (Oladevi) at a shrine near Calcutta for hundreds of years before any mention of the disease in the medical literature.4 This, combined with the fact that the first six cholera pandemics all began near the Ganges River delta in India/Bangladesh, strongly suggest that V. cholerae

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  Vaccination and Its Critics

  A Documentary and Reference Guide

  • Lisa Rosner(Author)
  • 2017(Publication Date)
  • Greenwood

    (Publisher)

  Record of the Ravages of Dysentery, which was published in the 9th month of the 5th year of Ansei, there were then in Yedo 1,775,215 houses, and a population of 7,101,318. The disease was most virulent between the 1st and the 30th of the 8th month, during which space of time the number of deaths was 12,492, as appears from the statistics of death reported to the Government daily. Besides these, 18,737 persons, whose names had not been properly registered at the ward offices, died. For the first three or four days in the beginning of the 9th month there were 50 or 60 deaths daily; after that the number gradually decreased, and at length the disease entirely disappeared, and tranquility was once more restored.

  Source: Simmons, Duane. (1880). Cholera Epidemics in Japan. Shanghai, China: Statistical Department of the Inspectorate General of Customs, 4–10.

  ANALYSIS

  Cholera had been an endemic disease in human society for millennia. It is caused by a bacteria that propagates in the human digestive tract, leading to vomiting and diarrhea and, if left untreated, death by dehydration. If contaminated feces from its victims get into the water supply, it can spread throughout the community. For much of the world’s history, it was a seasonal disease, because all human communities understand the importance of depositing human excrement far away from drinking water. In hot weather, though, the water table might drop, leading to sewage seeping into the water supply. In the Northern Hemisphere, cholera tended to appear in late summer and then disappear when the autumn rains arrived.

  The industrial revolution and the massive growth of population that accompanied it completely overwhelmed traditional sewage facilities in cities around the globe. With no knowledge of bacteria, observers could not understand where cholera came from or how it spread. It was clear that it did not spread person-to-person, like smallpox, because doctors who worked among their poor patients did not get sick. Yet, entire households could become sick and die within 36 hours of the first appearance of the disease.

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  Duel Without End

  Mankind's Battle with Microbes

  • Stig S. Frøland, John Irons, John Irons(Authors)
  • 2022(Publication Date)
  • Reaktion Books

    (Publisher)

  In the first phase of the pandemic a number of countries in East Asia were hit, but the disease also travelled westwards to India and the Middle East, and followed ‘old’ paths into the Soviet Union and from the Arabian Peninsula to East Africa. But now a number of countries in West Africa were also hard hit, via passengers arriving by air from Asia. Spain, Portugal and Italy were next in line.

  In 1991, thirty years after the pandemic had begun, the cholera bacterium struck with violent force in Latin America, first in Peru, but then spreading to several other countries. By the end of the year there were 391,000 cases in Latin America, equivalent to two thirds of all the cholera cases in the world.

  This latest pandemic also differed from earlier ones in that there was now far greater knowledge about cholera, particularly when it comes to prevention and treatment.126 We now know that simply administering a large amount of fluid has a striking effect on recovery from this intestinal infection. For that reason, the case fatality rate from cholera is now far lower, perhaps 2 or 3 per cent as against 50 per cent in earlier times. Even so, cholera has a firm stronghold in many places around the world outside India: it has become what is called endemic. More or less widespread local epidemics break out at regular intervals at various places in the world whenever the now well-known ecological and environmental factors are favourable.127 Examples are Haiti, where cholera broke out in 2010 after the destruction caused by the earthquake, and Yemen, which has an ongoing epidemic in the wake of the war there.

  Miasmas or contagion from person to person?

  When the cholera bacterium arrived in Europe and North America at the beginning of the nineteenth century, it came, so to speak, to a table ready laid. The sanitary conditions in the towns, which since the early Middle Ages had been extremely poor, became even worse during the Industrial Revolution.128

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  Investigating Cholera in Broad Street: A History in Documents

  (From the Broadview Sources Series)

  • Peter Vinten-Johansen(Author)
  • 2020(Publication Date)
  • Broadview Press

    (Publisher)

  It is impossible to attempt an accurate calculation of the number of persons actually attacked by the late epidemic in London…. It is, for example, most difficult to assign any limits which would be universally acceded to by medical practitioners between cholera and diarrhoea. The fact is that the latter runs so insensibly into the former in a large number of cases as to defy rigid separation. To which category, for instance, are those numerous cases of rice-water purging without collapse to be referred? Are they cases of cholera or diarrhoea? … During the last, as in the preceding epidemic of 1832, there was the greatest discrepancy of opinion among medical men in all parts of London. Some applied the term, cholera, to attacks which others called diarrhoea…. In all its proceedings and documents, the General Board of Health reported those only to be cases of cholera in which there was actual collapse—that is to say, where the pulse was either extremely weak or entirely lost, … great prostration of strength, shrunken features, coldness of the surface, a marked diminution or total suppression of the urinary secretion, and the characteristic rice-water evacuations. Although pathologically all cases of choleraic diarrhoea, and even many other forms of disturbance of both the alimentary canal and other organs, are … part and parcel of the epidemic, … some arbitrary limit must … be assumed. The [Board of Health] definition, resting on a marked and easily recognized stage of the disease, appears to be sufficient for all practical purposes.

  The progress of the late epidemic through Europe, when carefully studied, has demonstrated that the principal determining cause of the spread of the disease—I do not here speak of the efficient cause

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  Epidemics and War

  The Impact of Disease on Major Conflicts in History

  • Rebecca M. Seaman, Rebecca M. Seaman, Rebecca M. Seaman(Authors)
  • 2018(Publication Date)
  • ABC-CLIO

    (Publisher)

  10

  The third major pandemic started in India in 1840, and by 1844, it had emerged from the subcontinent along the overland trade routes to Persia, Arabia, the Caucasus, and then into Europe. In the spring of 1848, in conjunction with the Revolution of 1848, the cholera epidemic added to the social and political upheaval in Prussia and elsewhere on the European subcontinent. Britain again felt the impact of cholera, with every county in England experiencing deaths from the outbreak. New York also experienced a new epidemic, despite efforts to quarantine infected passengers on board their ships. The cholera pandemic rapidly spread from this center of trade and immigrated across the continent and along the coastline, following the trail of the California gold rush of 1849. Even the West Indies, until then isolated from the contagion, experienced this third pandemic of cholera from 1850 to 1855.11 Not surprisingly, the presence of cholera during this pandemic throughout the British Empire and other imperializing nations led to the eventual presence of the disease from 1854 to 1856 at the site of the disastrous war for empire in the Crimea.

  The Crimean War was one of the worst such military/epidemic incidents, with numerous competing powers coalescing on a poorly drained piece of land jutting into the Black Sea, the Crimea. Surrounded by the Black Sea and marshlands, the Crimean Peninsula was hard for the invading powers to provision, as the two straits leading into the sea curtailed the shipment of goods during periods of war. The involved parties initially included Britain, France, Russia, and the Ottoman Empire. Other nations joined in the fray, either compelled by alliances or lured by hopes of increased power and influence. The pandemic of cholera did not contain itself to one side of the conflict on the Crimean Peninsula. It was an equal opportunity aggressor, infecting the defeated and victorious armies.

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