Sunday, 3 February 2019

An Unwelcome Immigrant: Cholera Comes to Britain

At the beginning of the 1830s, Britain was in ferment. As with Brexit today, the country was badly divided over several issues: reform of Parliament and extension of the suffrage, abolition of slavery, poor law reform. In the midst of rising unrest, an unwelcome immigrant was approaching Britain. 

Doctors called it Indian or Asiatic Cholera after its alleged place of origin. It had long been known in the Indian subcontinent, much of which was now under British control. An outbreak in 1817 killed 10,000 British soldiers and hundreds of thousands of Indians.

In the following years cholera spread inexorably into Southeast Asia, the Middle East, Africa, Russia, and continental Europe. By 1830 it had reached Western Europe and was poised to cross the English Channel. 

Local authorities in Britain vowed to keep it out. The cartoon below imagines John Bull seizing the cholera, imagined as an Indian, trying to sneak through an equally imaginary protecting fence into England. The reality was far different.

Efforts to prevent cholera reaching Britain proved in vain, as no one then knew how cholera spread or what caused it. Indeed, within a few months after making landfall in Britain it had reached the Americas and become a truly global pandemic. 

In November 1831, cholera broke out in the northern English port city of Sunderland. The main effect of cholera is violent diarrhea, which produces severe dehydration and often death, within hours or a day or two. The victims' skin often turned blue, giving it the name "Blue Disease." The image below shows a woman who died at Sunderland. 

Within weeks, cholera was breaking out in many parts of the kingdom. In London and elsewhere, authorities tried to locate the source of the disease, with no success. See Looking for the Elusive Mr. Cholera on this blog.

Boards of health informed the inhabitants of cholera's symptoms and listed remedies, most of which would have had no impact on the course of the disease. Medical and health boards often emphasized temperance in eating and drinking. They advised agaist drinking cold water when the body was heated and consuming "ardent spirits." 

The connection with water was correct. The main medium through which cholera spreads is water contaminated by the intestinal evacuations of the infected. But avoiding water only when one was "heated" would have had little effect. Ardent spirits caused many health problems, but cholera was not one of them. Some doctors prescribed ardent spirits.

Medical professionals tended to favor standard remedies for most dangerous diseases: bleeding, purging, mercury, and opium. Removing fluids from a body that was already becoming dehydrated seems perverse, and did make things worse. 

A couple of physicians argued for rehydrating with saline solution and got better results. Most medical men scorned such an unorthodox therapy until the late 19th century or later. Today rehydrating is a standard procedure, often combined with antibiotics.

Critics ridiculed the advice and efforts of boards of health and doctors in the 1830s, as seen in these contemporary cartoons. 

The cartoon below shows the Central Board of Health congratluating iself with a sumptuous dinner despite the mounting death toll from cholera. At bottom right a paper has the words "while doctors differ and deny, the country bleeds and patients die."

The 1832 epidemic killed about 55,000 people in the UK. It was the first of several outbreaks to strike the country during the nineteenth century. Other diseases killed far more people during that time, but they were mostly familiar and aroused far less terror than cholera. 

In the 1850s, following a couple more severe outbreaks in Britain, London surgeon John Snow demonstrated that contaminated water was the main source of cholera infection. See London's Great Stinks, Cholera, and John Snow on this blog. 

Snow had no idea what the contaminant was. He theorized that it might be a microscopic organism. In the early 1880s, German physician Robert Koch isolated the microbe responsible: the cholera vibrio. 

The solution became obvious: avoid drinking contaminated water and you could prevent cholera. Some authorities, accepting Snow's theory, had begun to advise that precaution even before Koch's discovery, as this poster from 1866 shows. 

The first cholera vaccine came into use in the 1880s and improved versions followed. (Below: Inoculation in Calcutta 1894) 

Today, cholera is preventible and curable. But thousands of people continue to die of this dreadful disease each year from a lack of safe water and adequate medical care in Africa, Asia, and Latin America. The civil war in Yemen has unleashed an ongoing major epidemic, with hundreds of thousands of infections. (Below: cholera patients in India)

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