Yellow Fever and Quarantine in Charleston, South Carolina

During the Covid pandemic, countries, states, localities faced a stark choice: should they restrict human interaction by restricting commercial activity and risk harming the economy? Or should they allow businesses to continue to operate as normal, thus endangering people's lives?

In cities heavily reliant on commerce, epidemic diseases have long posed an agonising dilemma. Closing a city to trade through strict quarantine threatens people’s livelihoods. Leaving it open, even partially open, threatens their lives. As was the case with Covid, both options had their advocates and opponents. 

Charleston, South Carolina, provides an instructive case study of this dilemma. From its foundation in 1670, this southern port was dependent on global trade. At the time of the American War for Independence in the 1770s, South Carolina was the richest of the thirteen colonies. Its wealth derived mainly from exports of rice, indigo, and after 1800, cotton. All of these crops were grown on plantations worked by thousands of enslaved Africans. The reliance on this labour source required regular imports of human cargo. [Image: Charleston Harbor, early 19th century]

As a commercial port, Charleston received unwelcome imports of another sort: diseases from Europe, from Africa, from the Caribbean, and other North American colonies. Some of these imported diseases were highly contagious and deadly, notably smallpox. One, cholera, was transmitted mainly through contaminated water. But nasty as it was, cholera did not arrive until the 1830s and was only an occasional visitor thereafter.

Other imported diseases were transmitted by insect vectors, particularly mosquitoes. The most important were malaria and yellow fever. At least two types of malaria were imported: vivax malaria from Europe and the deadlier falciparum malaria from Africa. Malaria became endemic in South Carolina from the early days of the colony. It flared up every summer and lasted into the late autumn or early winter. Malaria was generally a greater problem in the countryside than in Charleston, especially after about 1750.

Unlike malaria, smallpox and yellow fever were epidemic diseases. They were not an annual problem, but when outbreaks occurred, they could produce widespread terror and high mortality rates. Until the early 19^th century and railroads, yellow fever was largely confined to Charleston and other coastal ports because its vector, the Aedes Aegypti mosquito is a poor flier. Smallpox, by contrast spread widely into the countryside, wherever infected humans travelled. But it came less often than yellow fever.

How to prevent or minimize the effects of epidemics was always a contentious issue for the city’s leaders. It was complicated in the case of yellow fever by difficulties of diagnosis and conflicting views of how it spread. One view was that it spread through the air, through miasmas, or bad air. Another was that it was contagious, passing from person to person. Neither view was correct. The role of mosquitoes in transmitting yellow fever was not established until 1900.

Miasmatists and contagionists differed over the best way to limit the spread of yellow fever. Miasmatists generally believed that disease-causing bad air was generated locally. Closing the port would do little to control the fever, they insisted. Contagionists viewed yellow fever as imported, mainly from Africa or the Caribbean. The best way to control it, they argued, was through quarantine measures. Ships coming from places where yellow fever was common or known to be present should be inspected by physicians. If found to be harbouring the disease, the ships should be ordered into quarantine. Crew and passengers should remain on the ships just outside the harbour or be removed to the pest house or quarantine station until they were no longer considered a danger. 

South Carolina erected the first of several pest houses on nearby Sullivan’s Island around 1707. Quarantine measures were the dominant way of controlling yellow fever, smallpox, and other epidemic diseases in the 18^th century. They were supported by most doctors.

Opposition to quarantine measures for yellow fever increased markedly after 1800. The change was undoubtedly connected to economic decline in South Carolina and Charleston’s sagging importance as a trading port. Interruptions of commerce became a more serious problem than they were in the 18^th century. Acknowledgement that yellow fever was present in a port could greatly reduce its seaborne trade and sharply curtail visitors and potential immigrants.  

Merchants, city leaders, and most doctors in Charleston became increasingly reluctant to declare the presence of yellow fever. They would first deny that a problem existed. When the problem became obvious, they denied that the disease was yellow fever but rather something less dangerous. When forced to concede that yellow fever was epidemic, they argued that quarantine measures would be ineffective, because the disease was generated locally through bad air.

The solution, these Miasmatists believed, lay in sanitary improvements. Eliminating sources of bad odours, cleaning the streets, removing organic wastes and offal, and providing clean water. These measures could have improved health in other ways, but they would have done little to stem yellow fever. 

In any case the city’s sanitary condition did not improve much before the early 20^th century, when yellow fever had already ceased to be a problem. One reason is that sanitary improvement was expensive and often collided with personal and property rights.

A miasmatic explanation of yellow fever, combined with attempts to deny the presence of the disease, had a clear economic advantage. It reduced disruptions to seaborne commerce. Imposition of quarantine measures was delayed, limited, or altogether avoided. 

The fact that most of the victims of yellow fever were “strangers” -- visitors and immigrants, mainly Irish and German – may have made that choice more palatable. It also reduced the number of immigrants, which some locals did not much mind. Charleston's reputation as a yellow fever hotspot for foreigners is one reason why it did not receive as many immigrants as New York, Boston, and Philadelphia.

In 1840, Dr Benjamin Strobel of Charleston wrote a highly controversial essay on yellow fever. He accused commercial interests, boards of health, and the medical establishment, of endangering human lives. Worse, he charged them with "exploiting public ignorance" to rouse opposition to quarantine. The very people who would benefit from a strict quarantine were among its most vociferous opponents. [Image: Benjamin Strobel, 1803-1849]

Strobel demonstrated that yellow fever usually broke out and was heavily concentrated in areas of Charleston closest to the wharves and where sailors and immigrants lodged on arrival. He avoided the thorny issue of contagion. Instead, he argued that yellow fever was somehow transmissible. And he was sure it had been transmitted to the city from ships. He was ostracized for his efforts and left town.

In the 1850s, several lethal epidemics coincided with the opening of a steamship link with Havana, Cuba, a port notorious for endemic yellow fever. In the wake of these outbreaks, support for quarantine measures grew, with a Citadel science professor, William Hume, leading the charge. Hume had been an advocate of miasma theory, but his research convinced him that yellow fever was imported, mainly from the Caribbean. His ideas did not receive a warm welcome either. 

Yellow fever was absent from Charleston during the Civil War. Probably not coincidentally, thanks to the Union blockade, so was most seaborne trade. The last documented epidemic in the city occurred in 1877. How much the retreat of yellow fever owed to stricter quarantine is difficult to say. The decline of the port’s seaborne trade after the war may have been more important. Yellow fever continued to strike busier southern ports hard, notably New Orleans, which suffered the last epidemic in North America in 1905, and the region around Memphis, scene of the worst epidemic in the USA, in 1877. 

Yellow fever in the 19^th century South, as Margaret Humphreys has stated, “was above all, a commercial problem.” And sometimes, local authorities chose the health of commerce, as they saw it, over the health of the people. 

Further reading:

Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry (New York: Cambridge University Press, 2011)

Margaret Humphreys, Yellow Fever and the South (Baltimore and London: Johns Hopkins University Press, 1992)







  

Finding a Scapegoat for Pandemics: Black Death to Trump Virus

Ever since Donald Trump stopped calling Covid-19/coronavirus a hoax, he has been engaged in an age-old response to disease epidemics and pandemics: finding a scapegoat. Rather than accept his own incompetent response to the pandemic (impossible), he has engaged in blaming a host of nefarious villains. 

Trump's scapegoats have included everyone who "failed to warn him" or "created the virus." The list is long and grows longer by the day: Democrats, immigrants, the "Lamestream" Media, the Chinese, Obama, Hilary, and the World Health Organization (WHO), and Dr. Fauci. Trump, of course, is not alone in scapegoating. Some of his supporters blame all of the above, plus Bill Gates, libruls, commies, gays, single sex marriage, and Jews.

The word "scapegoat" derives from a practice described in the Bible (Leviticus 16). The original scapegoats were actual goats. A rabbi would symbolically load up a goat with all the sins of the community and send it into the wilderness. Goodbye sins.

In more modern times, a scapegoat is usually a person or group of persons blamed for a disaster. The disaster might be a famine, an earthquake, floods, or as in the current case, a deadly disease. Throughout history, people have tended to blame "others" for mysterious deaths, especially on a large scale. The scapegoats have included people of different religions and cultures, minorities, "witches," heretics, women, and the poor.

European Christians often blamed Jews for epidemics, notably during the Black Death of the 14th century. Then and in later outbreaks, Christians claimed the Jews had poisoned the wells. Mobs killed thousands of Jews. Yet the plague was never called the Jewish Disease. 

Nor was it called the Chinese Disease. The plague probably originated in China, but few Europeans were aware of that in the 14th century. In more recent times, Westerners have accused the Chinese (and Asians more generally) for epidemics and pandemics. The 1890s cartoon below, from a San Francisco newspaper, condemns the city's Chinatown and Chinese immigrants as the source of malaria, smallpox, and leprosy. 

  
In 1900, whites in Honolulu and San Francisco blamed the Chinese community for an outbreak of plague in their cities, the first ever in the United States. The entire Chinese population of the two cities was quarantined and demonized. In Honolulu, an attempt to use fires to purify the air and burn out the plague resulted in wildfires and the destruction of 7000 homes in Chinatown. (Below: Quarantine line around Chinatown, Honolulu and fire there, Jan. 1, 1900)

In the USA, many people blamed Jews for the 1892 cholera epidemic, which coincided with the arrival of a large Jewish migration from Russia. Americans also blamed Irish immigrants arriving in the 1830s and 1840s for cholera and other diseases.

In the 1980s, many people blamed gays for the AIDS epidemic. The original name for the disease, GRID (Gay Related Immune Deficiency) did not help. Later, many Americans accused Haitians as the source.

The disease for which blame has been most shared is syphilis, which first broke out in Europe around 1500. The Spanish, who appear to have been the first to experience it, blamed Native Americans, and that remains a common view. Tahitians called it the British disease after Captain Cook's visit in 1769.

The English called it the French Disease, the French called it the Italian Disease, and the Italians reciprocated. The Dutch called it the Spanish Disease, For the Russians, syphilis was the Polish Disease.Turks called it the Christian Disease, the Japanese the Portuguese Disease. 

After the Civil War and emancipation of the enslaved, many Americans viewed syphilis as a black disease. Nearly everybody blamed "loose women" but rarely did anyone blame loose men. Everybody knew that most human troubles originated with Eve and Pandora.

Scientists (especially the mad kind) are another favorite scapegoat for diseases. They have often been accused of producing killer microbes in their labs, then releasing them on the world either intentionally or from absent-minded carelessness. Americans accused Chinese scientists of cooking up the Covid-19 virus. The Chinese government accused American scientists of the same thing. 

A popular explanation among conspiracy theorists, mainly in the US, is that the Chinese 5G network is the culprit. Another is that Bill Gates created it.

Trump Virus or Kung Flu? Naming Pandemics in History

Last year, Chinese officials and many others accused Donald Trump of racism because he referred to Covid-19, or coronavirus, the "Chinese virus." At his Tulsa rally, he called it "Kung Flu."  "Trump Virus" may be the most accurate name, because he has done more than anyone on the planet to spread it. His rhetoric has also contributed to an upsurge on attacks on Asian Americans. 

Racist or not, and it often is, naming pandemic diseases after their alleged place of origin is an old practice. In 1957 and 1968, two deadly flu pandemics were named the "Asian Flu" and the "Hong Kong Flu." A pandemic flu first reported in St. Petersburg in 1889 was denoted the "Russian Flu." It was later called "Asiatic Flu," although St. Petersburg is a long way from Asia.

When pandemic cholera first made its way from India to the UK in the early 19th century, people called it the "Indian Cholera," as in the broadsheet below from 1831. One reason for adding the adjective "Indian" was to distinguish this new, mysterious disease from an old, familiar one: "cholera infantum," a type of childhood diarrhea. but the name led to Indians being blamed for the disease.

In the cartoon below, also from 1832, the cholera is dressed in Indian garb, trying to enter England, but caught by stout John Bull. The reality was far different for England and the world. A series of cholera pandemics during the 19th and early 20th century killed millions in Asia, Africa, Europe and North America, more than 30 million in India alone.

Later in the 19th century, cholera was often referred to as "Asiatic Cholera."

In 1918-1919, a virulent form of influenza became pandemic, and ultimately killed 50-100 million people worldwide. It quickly became known as the "Spanish Flu," although it probably originated in the USA. But the USA was engaged in World War I and sending thousands of troops to Europe. The press was instructed not to report about the epidemic, lest it lead to demands to stop troop shipments -- the overcrowded ships were excellent incubators for such a disease. 

Most European countries involved in the war similarly kept quiet at first, to avoid hurting morale. Spain, however, was neutral, and its press reported on the outbreak. Spain's reward was to have one of the worst pandemics in history named after it. 

It was also called "Flanders Grippe" in Britain, "Bolshevik Disease" in Poland, "Too much inside sickness" in Hong Kong.

Today, it is usually called the "Great Influenza." Perhaps it should be called the "American Flu."

Interestingly, the greatest and most famous pandemic in world history was not named for a place or nation. That was the pandemic of plague that ravaged Eurasia during the 1340s, killing between 75 and 200 million, It wiped out perhaps as much as 60 percent of the European population. It probably originated in Central or East Asia and traveled west along the Silk Road to the Middle East, Europe, and North Africa. 

The 14th century pandemic is best known today as the Black Death, but that name was not applied to it at the time. Other names for it include, Plague, Great Plague, Black Plague, and Pestilence (La Peste). Before the pandemic, plague and pestilence simply meant a deadly epidemic disease. (Below: The Dance of Death, or Danse Macabre, late medieval, Nuremberg Chronicles).

Syphilis, which struck Europe in pandemic form after 1500, was generally named after other, often disliked, countries. The English called it the French Disease. The French called it the Italian Disease. The Italians returned the compliment. The Dutch called it the Spanish Disease. Russians called it the Polish Disease. Turks called it the Christian Disease. The Japanese called it the Portuguese Disease because Portuguese traders brought it from Europe.  

Coronavirus, Quarantine, and Contagion: A Historical Perspective

The spread of Covid-19, or coronavirus, has led many countries and localities to resort to quarantine as a mechanism to contain this new disease. Medical isolation, as quarantine is often called today, has a long history, and its use owes little to modern medical science. 

Examples of isolation of the sick can be found in the Bible, in the Islamic World from the 7th century, and in medieval Europe. Interestingly, most of the quarantine measures currently being used to contain or delay the spread of coronavirus have been used for centuries or longer.

The practice of isolating people with diseases in the past, as today, was based on the belief that the sick were contagious: that they could infect the healthy. That was correct for some diseases, but not others. Even among those that were contagious, some were much less contagious than others. For this reason, contagion theory was controversial until the role of microbes in many diseases was firmly established in the late 19th century. Before then, contagionists could seldom demonstrate how diseases could be transmitted from person to person (or animal to animal).

Diseases transmitted by mosquitoes, like yellow fever, or by contaminated water, like cholera, complicated things for contagion theory. Opponents of contagionism pointed out that people in close contact with the ill often remained healthy, while people who had no such contact contracted yellow fever or cholera.

Contagionism's main competitor until the establishment of germ theory was the miasmatic theory. Miasmatists believed that most diseases were conveyed in the air, through miasmas, or "bad air" ("mal aria" in Italian). Marshes and swamps were considered to be major sources of miasmas, as was rotting organic matter, including human and animal wastes. In the late 18th and 19th centuries, the miasma theory gained many adherents, partly because the growing, unsanitary, and often polluted urban areas produced powerful, obnoxious odors. The miasma theory was wrong but it often led to draining of marshes and the implementation of sanitary reforms that reduced disease mortality.

In the 19th century, however, many traders used miasma theory to oppose quarantine, which could literally shut down ports for weeks or months. They argued that the source of the disease was not incoming ships or people, but miasmas generated locally by unsanitary conditions. 

As is the case today, a concern for health competed with a concern for the economy. As Benjamin Strobel, a Charleston, South Carolina doctor, wrote in 1840: "Truth and justice have been too often sacrificed to expediency and policy, and never more so than in reference to yellow fever. Has it not occurred, when the disease actually invaded us, that there were men who, regardless of the lives of others, and listening only to the sordid suggestions of avarice, have endeavored to conceal the fact?" (Benjamin B. Strobel, An Essay on the Subject of Yellow Fever, Intended to Prove its Transmissibility, Charleston, 1840, p. 9).

The term "quarantine" derives from the Italian phrase, quaranta giorni, meaning forty days. From the time of the Black Death in the 1340s, the Italian city-states took the lead in what we would call public health. 

During plague epidemics, 15th century Venice began to enforce forty days' isolation on ships entering the port. Passengers and crew could not disembark until that period had ended with no cases appearing. Passengers stranded on cruise ships where coronavirus has broken out will understand what a terrible prospect that was. And modern cruise ships are far more comfortable and clean than ships of the past.

Other ports imitated Venice, and quarantine was later applied to other diseases such as smallpox, yellow fever, and cholera (from the 1830s). The length of quarantine then and since has varied, and is usually shorter than 40 days.

From the 15th century on, many ports created quarantine stations for isolation. These were sometimes on ships, on islands in or near the harbor, or on the mainland at a distance from highly populated areas. Some were old leper hospitals, often know as lazar houses, after the biblical parable of the beggar Lazarus. The stations established to quarantine for plague were often called lazarettos or pest houses -- "pest" coming from the French for plague, la peste. Venice established the first lazaretto in 1403 on one of the nearby islands. (Below: one of Venice's lazarettos and that in Ancona, also in Italy).

The oldest surviving quarantine station in the United States dates from 1799. and is near Philadelphia (below). American ports began establishing pest houses about a century earlier.

Inland localities have often used a cordon sanitaire to restrict movement of people in and out of a town or region, where an epidemic was underway. The authorities close off the access points to and from the place to prevent infected people from spreading the disease. In effect, the whole population inside the cordon was quarantined.

Sanitary cordons were a common measure used to prevent the spread of cholera in the 19th century, and are being used again to curb or slow the spread of the coronavirus. China has used them in the city of Wuhan and Province of Hubei during the current coronavirus outbreak. Italy has cordoned off some towns in the North ("lockdown"), then the North as a whole, and now the entire country.

In most cases where a cordon sanitaire has been used, communities have been isolated against their will. But in at least one famous case, in 1665, the inhabitants of a village agreed to cordon themselves off to protect neighboring towns and villages. In that case, the disease was plague. The village was Eyam in Derbyshire, England. The isolation lasted more than a year and killed at least 260 people, possibly more than half the residents who remained. But the disease did not spread beyond the parish boundaries.

During major epidemics, public facilities for quarantining and caring for the infected often became overwhelmed. Authorities often commandeered private houses or other buildings as temporary pest houses or hospitals for the specific disease, such as plague, smallpox, yellow fever, etc. The image below is of a pest house and plague pit in London's Finsbury Fields. The image dates from 1865 but depicts an earlier period, probably the Great Plague of London in 1665. The plague pit next to the pest house can hardly have been reassuring, but the case mortality rate from plague ranged from about 60-90 percent.

Today, many countries are trying to combat the spread of coronavirus by urging people who think they may be infected or are especially vulnerable, to self-isolate at home. Authorities did the same in earlier times, especially during plague epidemics from the 14th century. The isolation was seldom voluntary. Families were often forcibly shut up when one or more became infected. This could be a death sentence for all of them. Daniel Defoe provides a harrowing description of their suffering in A Journal of the Plague Year (1721), a fictionalized account of the Great Plague of London in 1665.

In conclusion, most of the quarantine measures used today have historical parallels. Just as in the past, quarantine may prove more successful in some places than others. We may have the advantage of a better understanding than our ancestors of how many contagious diseases spread, but in the case of coronavirus, we are battling a microbe that is new and somewhat mysterious.

"I'm Alive!" Taphophobia: the Fear of Premature Burial

Taphophobia, or the fear of being buried alive, has a long history. Tales of people being buried prematurely have been related for centuries, and at least some are well documented. The fear of such a fate seems to have increased, in Europe and America at least, from the late 18th century. 

Louisa Wells Aikman, in a narrative she wrote in 1779, mentions the case of George Woodrop of Charleston, South Carolina, a young man in his early twenties who had died in 1770. The burial had been unusually quick. Woodrop was pronounced dead in the evening and was buried the next morning at 11:00. His uncle, Andrew Robertson, insisted on dispensing with the traditional practice of "laying out" the body in the house for a time before interment. 

Louisa's father Robert Wells had been a mourner at the funeral. He had "expressed great uneasiness, and said that the body did not appear like a dead corpse, there seemed to be a bloom on the countenance!" Wells asked the reason for the hurry in burying Woodrop. Mr. Robertson replied, "Mrs. Robertson could not bear to have the deceased in the house as she had so many young children."

About two years later, rumors spread around Charleston that Woodrop had been buried alive. During her voyage to London in 1778, the church sexton John Mills, told Louisa and other passengers that the rumors were true. Mills said that he had kept silent on the matter until that time because he had promised the Robertsons that he would not speak to anyone about the subject. But the Robertsons were now dead and he felt released form that promise. 

One night Mills was preparing a grave to bury someone the next morning, assisted by "two black boys." While they were digging, the shovel hit and broke off part of a coffin. Mills went down into the grave and discovered "the backbone of a human skeleton." 

The posture of the body seemed unusual. Aided by the boys, Mills "opened the grave, uncovered the lid of the coffin, and found the deceased lying on its side, with the cheekbone in the palm of the hand!" The coffin cover bore the words "George Woodrop died 1770." We may not be convinced by this evidence, but Louisa Aikman certainly was, and perhaps others as well.

One of them may have been another Charleston resident, Henry Laurens. He stipulated in his will that his head should be severed and his body burned after death. Laurens believed that his infant daughter Martha had narrowly escaped being buried alive. It is possible that he was aware of the Woodrop case as well because he knew the Wells family. In 1792 Laurens' body was burned on a pyre at his plantation, Mepkin. It was the first documented case of cremation in the United States. 

In an appendix to her narrative, Louisa Aiken wrote that the Woodrop case had affected her mind so much that she "never forsook the apparently dead or dying until interment." During the twenty years she lived in Jamaica (1782-1801) she reckoned that her watchfulness had prevented eighteen people from being "sent to an untimely grave." 

She mentioned in particular the case of fourteen year old James Haughton, from 1785. He seems to have been suffering from yellow fever -- Louisa mentions "a constant bleeding at the nose." For several hours "Animation was suspended." Doctors declared him dead.  His mother agreed and with a lack of emotion went off to dress for his funeral. 

Louisa persevered in trying to save him. With the help of "slaves" she applied the method recommended by the Humane Society, and he revived. When his "unnatural parent" returned, "curled and powdered" and dressed in a black silk dress, her son was sitting up "eating sago from my hands." Fifteen years later he was still alive, had married twice and had several children. [Image: Louisa Wells Aikman]

Concerns about premature burial seem to have increased during the Victorian Age. The suffragette and anti-vivisectionist Frances Power Cobbe is one of many people who feared being buried alive. It had nearly happened to her great grandmother, according to family tradition. Her ancestor was believed dead and being prepared for burial when she woke up. She went on to have twenty-two children. (Maybe it would have been better to be buried alive).

Cobbe was particularly worried about the effects of a stroke or seizure which might render her unconscious for enough time for people to think she was dead and bury her. She left behind explicit instructions about the measures she wanted performed to prevent such an outcome. In a note next to her bed she ordered a doctor to sever the arteries and windpipe on her neck, virtually cutting off her head, "to render any revival in the grave absolutely impossible." 

Interestingly, she also ordered that her burial be as natural and inexpensive as possible. She stipulated that her coffin be made of wicker that would decompose quickly, that the coffin would not be carried by six men but taken in her carriage by her coachman, who would deposit it in the grave. She also forbade attendees to wear mourning attire.

The increase in fear of premature burial during the Victorian era was due in part to the massive growth of the urban population. The crowded and unsanitary conditions rapid urbanization created fostered epidemics of cholera, typhoid and other diseases. 

The frequent epidemics helped to change the conditions but also customary burial practices. The tradition in many countries was to lay the body out for several days before burial, at which point it would normally exhibit clear visual and olfactory signs of mortality. 

During deadly epidemics, burials often took place as quickly as possible in hopes of preventing the spread of disease. Rapid burials increased fears that some people were being entombed before death. 

Art and literature also contributed to the growing sense of alarm. During a cholera epidemic in 1854, Belgian artist Antoine Wiertz painted "The Premature Burial." The painting depicts a cholera victim awakening after being placed in a coffin. 

Writers also addressed the subject, notably Edgar Allen Poe in his story of the same name. In the 19th century estimates of the number of people buried prematurely varied from occasional cases to a preposterous one-third of those buried.  

Whatever the reality regarding premature burials, fear of it was common enough to inspire Victorian entrepreneurs to devise means of prevention. They designed "safety" coffins with various escape mechanisms or means by which prematurely buried persons could signal that they were alive.

An early safety coffin, patented in the USA in 1843, contained springs and levers that would open the lid with slightest movement inside, or so the inventor claimed.

Many safety coffins featured a bell on the lid from which a rope was attached. The rope was inserted into a hole in the lid and placed in the hands of the coffin's occupant. If they revived they could pull the rope to announce the fact. The one below, patented in the 1860s, added an escape hatch and a ladder as well. Michael Crichton, in his novel The Great Train Robbery, includes a scene in which one of the robbers is placed in such a coffin to fool railway guards.

Other safety coffins were fitted with glass panes, breathing pipes, and/or flags. J. G. Krichbaum's 1882 model included a periscope-like pipe that supplied air and could be rotated or pushed by the interred person, alerting anyone nearby that they were alive.

All such contraptions, of course, relied on another person being near enough to hear or see the signal. Someone needed to keep a watch on the grave for a few days, just in case. Families sometimes hired people for this task. The watchers could also help prevent the body being carried off by "resurrection men" or body snatchers, for dissection in anatomy schools. 

The inventor of the vault below, from about 1890, found a way to solve that problem, and declared that it rendered premature burial "impossible." Each of the chambers was fitted with an escape hatch, a handwheel on the door. The vault was supplied with air and lined with felt to prevent injury. The body was removed from the coffin before being placed in the chamber.

Alas, despite the claims of inventors, there is no documented evidence that any of these safety features saved anyone from premature burial.

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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)

London's Great Stinks, Cholera, and John Snow

Between 1800 and 1860, London's population grew from 1 to 3 million. Sanitation lagged far behind growth. Wells were contaminated by overflowing and leaking privies. Streets were full of human and animal wastes. 

The River Thames was a giant sewer, fed by the smaller sewers under the streets. It was also the major source of drinking water, as illustrated in George Cruikshank's cartoon of 1832.

By mid-century, the river had become so, pardon me, shitty, that summers were often marked by what were called "Great Stinks." The stinks sometimes coincided with severe cholera oor typhoid epidemics. 

During the cholera epidemic of 1849, surgeon John Snow argued that cholera was spread through foul drinking water. In 1855, he demonstrated it through a pioneering epidemiological investigation of cholera deaths in one neighborhood in Soho, where most victims had drunk water from a pump on Broad (now Broadwick) St. 

(Image: John Snow)

Few people paid much attention to Snow's work at the time but lots noticed the evil stink of the Thames. Scientist Michael Faraday, wrote to the  Times pointing out the necessity of cleaning up the river. The whole of the river, he said, was an opaque brown fluid, a "fermenting feculent sewer." 

The satirical magazine Punch published the cartoon below of Faraday introducing himself to a crap-covered god of the river, Father Thames.

  

Nothing happened then, but three years later, in the summer of 1858, another Great Stink aroused Parliament to action. The parliament building was right next to the river and the MPs found the smell intolerable. They passed an act to lay a new sewer system dumping wastes in the country instead of the river. 

Within a few years the Thames was much cleaner, and the health of London's population improved. Punch saluted the improvement with a cartoon of Father Thames cleaned up, robust, and dressed as a Beefeater, being greeted by Prince Albert.