The disease known as Asiatic cholera first infiltrated Great Britain in 1831, with its arrival in Sunderland1. From there, it broke out in epidemic proportions through 1832. Three more epidemics would follow the 1832 outbreak, 1848, 1854, and 1866. Cholera is defined as an acute infectious disease, originated in India, characterized by profuse vomiting, cramps, etc. 2 These epidemics killed numerous Brits and effected many more. Several reasons can be seen for the continued importation and spread during these different epidemics.
Amongst the most prominent is dispute within the medical ommunity. Until Robert Koch was credited with isolating Vibrio cholerae in 18833, the community was constantly torn over the cause of disease in general and specifically cholera. Many theories came about, each seemingly disputing the previous. With these new scientific theories came arguments as to the best methods to prevent, control and deal with the cholera. Until Kochs discovery ended the dispute, there was never a general consensus as to the best method of care for cholera victims.
This paper will look at the causes and symptoms of cholera, statistics of the four outbreaks, the different ffects that cholera had on the lay people, and the differing theories and how they slowed progress towards prevention of cholera. Cholera is a disease caused by the bacteria Vibrio cholerae. Cholera is spread through water or food that has been contaminated by the feces of others infected with cholera4. Symptoms include several characteristics. Initially, the person is anxious, and nauseated as well as dizzy. This is followed by severe vomiting and diarrhea, with feces that are a grayish liquid, often called rice water.
This is soon followed by extreme muscle cramps (or even seizures) and a desire for water. This is followed by the sinking stage where the patients pulse and body temperature drops and the person becomes extremely lethargic5. This next to last stage represents the person at near death, and overt physical signs of cholera become present. Visual symptoms include sunken face, bluish lips and fingernails and the tongue is coated, resulting in a voice which can only rise to a whisper6. As is relatively obvious, prevention of contraction is much more safe for the individual then trying to cure cholera once it enters the body7.
The statistics of cholera mortality and morbidity throughout Great Britain are taggering. Exact results cannot be determined for several reasons. First off all, often times, when patients died during the early stages of outbreak, local boards report that the death was not caused by cholera, but by something else, usually cholera or typhus8. This helped to delay the truth that cholera had infiltrated ones town or city. Along similar lines, many cholera deaths were actually believed to be some other disease because of lack of medical knowledge at the time9.
These facts acted to severely deflate the actual statistics. However, the estimated statistics still leave their impression. Total deaths are This leaves the total number of dead from the four outbreaks at over 110,000 people. Each region throughout Great Britain was effected differently. For example, in the 1866 outbreak at Newcastle-Upon-Tyne, the total number of deaths was 154711, 1500 of these deaths occurred from August 31 through mid-October12, with over 100 deaths daily during the peak times. The 1866 outbreak alluded to large class differences, this is illustrated in the following statistics.
Of the 1547 deaths, 37 came from the gentry class, 254 were tradesmen, and 1174 were artisans and laborers13. 1866 was the most serious at Newcastle. In 1831, 306 deaths occurred. In 1848, which is regarded as Great Britains most severe, Newcastle escaped cholera. 14. This is largely due to drought which resulted in inadequate supplies of drinking water15. In Oxford, the first three outbreaks effected the city there. It spread along the Thames River from London into Oxford. Unsanitary conditions, overcrowding, and a general lack of public health helped to facilitate the spread into Oxford16.
In 1831-1832, 86 deaths occurred. In 1848-1849 there were 44 and in 1854, 78 deaths17. The city escaped the 1866 epidemic as a result of improved sanitary conditions throughout the In York, the 1832 epidemic effected them the most. The total population at the time of the outbreak was 23,357. During the outbreak, the total number of cases was 450 and total deaths were 18519. Of the 46 different streets which reported cases of cholera during the time, 38 of them had no drainage or defective drainage20. This city is a clear example of how the poor sanitation conditions encouraged the spread of cholera.
In 1961, Asa Briggs did a comprehensive study of death rates and effected regions throughout England during the nineteenth century. The results are as follows. In 1832 and 1848, the cotton towns of Lancashire were mostly spared. These towns include Preston, Blackburn, Bury, Rochdale, Oldham, Bolton and Halifax21. In the town of Wigan in 1831 there were no cholera cases, while in 1848 there were 500 cases22. In the town of Bilston, there were 693 deaths in 1831-1832, while in the large city of Birmingham there was a surprisingly low total of 21 deaths in 1832 and 29 in 184823.
Comparatively in the large towns of Manchester and Liverpool, there were far more cases. In Manchester the total dead was 706 and 878 for the first two epidemics and in Liverpool those numbers are 1523 and 5308 respectively24, making Liverpool the second most effected city, other then London. The small region of Portsea Island had more cholera deaths in 1866 then Birmingham in all four outbreaks combined25. Briggs also alludes to the idea that outbreaks often occur in close proximity to one another. For example, in Leith, the 1848 outbreak saw the first case occur in the same house as the first case in 183226.
Also, in Pollokshaws the first victim of the 1848 epidemic lived in the same room and actually the same bed as the first victim of the 1832 epidemic27. Several journal articles and monographs have studied the effects of cholera in London. In London, numerous studies have shown that the poor were hit the hardest, being drastically more effected then the well off. In London 1848 and 1854, the poor regions had six to twelve times higher mortality rates then the better off regions of the city28. Another study centers around Londons East End, a notoriously poor region of the city.
The following is the weekly mortality rates during the peak period of the 1866 Another report studies select districts in and around London in 1866. The following are eath rates from cholera per 10,000 population during that time: Shoreditch: 11St. George in-the-East: 9730 In the 1854 epidemic, approximately 11,000 Londoners died and in 1866, 5,550 In 1979, Michael Durey published a historical monograph based on the first English outbreak in 1831-1832. Cholera first reached the town of Sunderland in October of 183132. Warnings came from several sources about protecting yourself from cholera33, although nobody really knew how.
By the end of February, nearly every town in Northeast England had been infected, including London. Cholera remained for the most art stable until the weather warmed around May and June and increased travel resulted. This helped to spread the cholera to the rest of England34. The summer months of July, August, and September saw the peak of cholera, with 217 towns and cities experiencing confirmed cases of cholera35. During this time, the disease also spread to Wales and Scotland, effecting Scotland the worst of the three countries proportionally.
The Population size per town Mortality per 1000 Mortality per 1000 (thousands)England and Wales Scotland Finally, throughout all four epidemics, the mortality rate for those infected was around Cholera has also effected different people in different ways. The well-to-do had several choices in dealing with the disease, and the poor also had several choices, although the choices were often quite different. In examining the reactions of the lay people, class distinctions must be made in order to simplify comprehension of the different choices that each group had.
Cholera most definitely effected the poor the most. The poor in general resented cholera, the medical community and the upper class for two main reasons during the epidemics. The first reason was that the poor believed hat the upper class was exposing them to cholera in an attempt to kill them for several reasons. The second reason for poor resentment towards the rich was disposal of bodies Cholera had several reasons for effecting the poor the most. Richard J. Evans wrote an in-depth article, partly outlining the class discrepancies caused by cholera and the reasons why cholera effected the poor so much.
As a result of Koch showing the V. cholerae existed in contaminated water, it is important to analyze the close proximity in which the poor lived to dirty water. Evans points out that more often then not, the poor ived near and consumed contaminated water38, thus assisting the spread of cholera to the poor. Manual laborers, sailors and boatsmen all lived in close relation to the water39, and often this water was contaminated. The poor were effected as well because of the overcrowded conditions in which they lived and the unsanitary lifestyle40 that they dedicated themselves to, often not bathing and living in their own feces.
Also, it is pointed out that cholera effected the poor for one major reason aside from any other. The rich had the option to flee their lands and homes in order to avoid cholera. The poor did not have this option41. The poor had to live near where they were employed and if they fled when cholera broke out, they left their jobs and any possible money that they were earning. Also, the spread of cholera was often facilitated by acts by the poor, thus inflicting themselves more. For example, famine and deprivation caused many rural poor to flee into the cities42, causing more overcrowdedness.
The arrival of cholera left the poor with a few options. In Michael Dureys analysis of the 1831-1832 epidemic he outlines these options for the poor and he also utlines how they often reacted violently in isolated incidents. He points out that the poor can deny cholera, acceptance its presence and try to help with care, or they could blame the arrival on someone or something else43. Often, when cholera arrived in poor districts, so did local boards of health and medical proffessionals44. This provided the poor with a chance to blame the well-off for importing cholera into their towns and attempting to kill them.
Numerous journals and monographs point to the idea that the poor believed cholera to be a poison introduced to them by the rich in order to kill off he poor. This idea actually had some logical basis. Several laws passed by the English Parliament in the 1830s led to this conclusion. The first law was the Anatomy Bill of 1832. The attempt was to end the burking process or murder of individuals by leaving as few or no marks on their body so that they can be sold to science schools and used for anatomy purposes45.
The Anatomy Bill brought into law the idea that any dead body at public venues (such as a hospital) not officially claimed could be sold to science46. The other law revolved around the creation of the local boards of health. The local boards ere given governmental control over few things, but one of the items that they could control was where to dispose of the bodies47. It is an obvious fact that most of the make-up of the local boards was people with money or property and not the poor. This meant that the elites had the final say in when and how the bodies of the cholera victims (most often poor people) were disposed of.
This caused numerous problems throughout many of the towns and cities from the rural countryside to the large city of London. For example, in York, bodies were forbidden to be taken into the church48, this was seen by he poor as a violation of their religious beliefs and practices. Also in York, the new burial grounds set aside for during the 1832 epidemic was down-wind from the city and the more well -to-do complained of the foul odors emanating from the grave sites49. Often times, hospitals buried cholera victims in their own burial grounds behind the hospital in order to quickly dispose of the bodies.
One occasion of this action led to the infamous Swan Street outburst in Manchester in September of 1832. Although riots like this one occurred on a small scale, involving few people and were quickly quelled, it is till worth mentioning because of the sheer numbers of outbursts that did occur during cholera times, especially in 1832. Several monographs give a description of this particular riot. On March 24 of 1832, a laborer went to a cholera hospital to visit his grandson (the boys parents had both died of cholera previously47).
The hospital informed the man that the boy was recovering and would be released the next day50. The next day the grandfather returned to the hospital only to find that the boy was dead. The grandfather and a crowd of local women went and dug up the boys coffin and found that is head had been removed and replaced by a brick. Rumor spread locally and approximately 3,000 rioters stormed the cholera hospital51. The hospital was torn to the ground and a total of twelve rioters were arrested, including three that had been marching towards Piccadilly with the boys coffin over head52.
As previously stated, although these riots often included only a few people with little acts of violence or the like, they were somewhat common among the poor towards the medical community mainly. There were numerous portraits of options that the rich had when encountered with the cholera. Again Michael Durey paints the best picture. He dedicates an entire chapter in his monograph about the 1832 epidemic to the options that the propertied class53 had. The first option available was flight54. For example, many of the propertied in the Northeast fled their homes upon first arrival in 183155.
This flight pattern explains why local boards of health seemed to disappear to a degree when cholera reached each city, as the members of the boards often fled to safer areas. However, flight was not the most preferred option56. Another very common response by this group was denial of existence. Numerous journals and monographs point to the fact that initial cases of cholera were covered up upon arrival to towns. This appears to have been done for several reasons. First, Great Britains economy thrived on mercantilist ventures, mainly waterway trading57.
If port cities admitted that cholera was present, trade would be reduced and the economy would suffer. Secondly, the rich feared that the poor would break out into riots and revolt if the cholera arrived in their city58. Also, the local boards were required to assist in care and treatment of cholera patients59, costing large sums of oney, this put a natural strain on local governments. If they can blame death on English fever (diarrhea) or typhus, or some other disease of the such, this would delay their need to fund cholera victims.
The final option open to the propertied class was assistance60. This is the option that many of the people in this class chose to pursue. The rich often were seen whitewashing homes of the poor and liming the streets in order to disinfect the areas61. The propertied class also made large charitable donations towards group that would feed and shelter the afflicted and to groups that aided in the clean-up of cities and owns62. In a way, this acted to ease the conscious of the rich and also helped to control, to a degree, the spread of the cholera.
However important that the actions of the rich and poor were during the time once cholera arrived, the most important actions and pursuits were those by the medical field. To a degree, they held the fate of the country in their ideals. Throughout the century, the medical profession advanced and with that advancement came changes in ideology and doctrine. With these changes came more correct answers and more improvements in peoples lives, in this case in improved sanitation. However, with these changes came jealousy and aggression.
Each scientist seemed to be working for the good of the career and not the good of the country. With each new idea as to the cause of and the spread of disease, came a new test that proved the theory to be invalid. Not until Koch made his discoveries and they were tested and verified numerous time was there a general agreement as to the cause and effects of disease. The first centers around the idea of contagion versus non-contagion. The idea of contagion centers around the principle that cholera is exchanged person to person63. On the other hand, anti-contagionist believe the opposite idea.
For example the anticontagionist say cholera is a result of decaying organic matter and their odors, or miasma64. Early on, the medical community was predominantly contagionist65. This can be seen in that the first epidemic,when the medical community tended towards contagion, much quarantine was initiated to isolate cholera patients66 and not allow them to spread the disease. However, these quarantines failed dramatically67. These quarantine failure helped to lead to international attempts to limit disease68, with Great Britain in the lead69.
As a result of the failed quarantines, the medical community shifted their ideology from contagion to anticontagion. This is when the numerous theories of disease began to come about. For example, by the late 1830s, Chadwick and Southwood Smith had given Great Britain official doctriine70. Chadwick and Smith promoted the miasma theory of disease71. Smith took a vested interest in discovering the origins of disease72. He argued that local conditions create disease, and since disease is noncontagion, the same local conditions must be present elsewhere for the disease to rrive73.
Therefore, Smith concluded that if air was cleaner and more pure, then disease would not have the proper conditions to appear there74. Smith and Chadwick still dominated public health and continued to press parliament for legislation on public health75. The first Public Health Act was created in 1848, setting up local boards of health76. These boards were mainly created to monitor local conditions and keep the town neat and free of disease77. This goes further to show that Smith and Chadwick were subscribing to the local conditions, anticontagionist theory.
