From miasma to waterborne disease

PanARMENIAN.Net - Although much is known about the mechanisms behind the spread of cholera, this has not led to a full understanding of what makes cholera outbreaks happen some places and not others. Lack of treatment of human feces and lack of treatment of drinking water greatly facilitate its spread.

Deaths in India between 1817 and 1860, in the first three pandemics of the nineteenth century, are estimated to have exceeded 15 million people. Another 23 million died between 1865 and 1917, during the next three pandemics. Cholera deaths in the Russian Empire during a similar time period exceeded 2 million.

The first incidence of cholera in England occurred in Sunderland in October 1831 when a ship, carrying sailors who had the disease, docked at the port. The ship was allowed to dock because the port authorities objected to, and therefore ignored, instructions from the government to quarantine all ships coming from the Baltic states. From Sunderland, the disease made its way northwards into Scotland and southwards toward London, killing an estimated 55,000 people.

British doctors were well aware of what cholera did but no one knew how to prevent the development or spread of the disease. Even worse, no doctors knew how to treat cholera patients.

There were two medical theories related to the spread of disease in the 1830s. One was that disease was transmitted by touch (contagion) so doctors wanted to isolate patients. The other theory was the miasmic theory, which taught that disease was spread by bad smells, bad air or 'poisonous miasma'. In the later 1820s, doctors had connected dirt with disease but they believed that disease was carried by the smell; Consequently, orders were issued for the lime-washing of houses to try to clean them up. Barrels of tar and vinegar were burned in the streets to try to remove the bad smells. None of these efforts had any effect whatsoever. The symptoms were vomiting, diarrhea and sweating. Death occurred within hours of the first symptoms showing.

Physician John Snow was not a supporter of the main theories. He believed he had enough evidence to put forward an alternative theory; that cholera was a waterborne disease. Snow published ‘On the Mode of Communication of Cholera’ in 1849. His theory being that cholera was caused by the contamination of drinking water and “always commences with disturbances of the functions of the alimentary canal.” (The ‘pipes’ in the body that takes food from mouth to anus). This theory went largely ignored by the medical establishment and authorities and was opposed by a local water company near one London outbreak.

A plaque and a handle-less pump now stand as a monument to Snow near the site of the original pump in Soho

Snow lived in the district and interviewed the victims’ families. His research showed that virtually all of them lived near the water pump on Broad Street, but that Soho streets closer to another pump had fewer fatalities. He examined a water sample from the Broad Street pump under a microscope and found “white, flocculent particles.” He went to the Board of Guardians of St. James’ Parish and asked them to remove the handle and disable their pump. They weren’t convinced their water was polluted, but with little else to do and the city in turmoil, they agreed. The handle was removed and the water pump no longer used by local people as a source of drinking or washing water and cases dropped almost immediately.

The first cholera pandemic, though previously restricted, began in Bengal, and then spread across India by 1820. Hundreds of thousands of Indians and ten thousand British troops died during this pandemic. The cholera outbreak extended as far as China, Indonesia (where more than 100,000 people succumbed on the island of Java alone) and the Caspian Sea in Europe, before receding.

The second cholera pandemic reached Russia, Hungary (about 100,000 deaths) and Germany in 1831; it killed 130,000 people in Egypt that year. In 1832 it reached London and the United Kingdom (where more than 55,000 people died) and Paris. In London, the disease claimed 6,536 victims and came to be known as "King Cholera"; in Paris, 20,000 died (of a population of 650,000), and total deaths in France amounted to 100,000. The epidemic reached Quebec, Ontario, Nova Scotia and New York in the same year, and the Pacific coast of North America by 1834. Cholera afflicted Mexico's populations in 1833 and 1850, prompting officials to quarantine some populations and fumigate buildings, particularly in major urban centers, but nonetheless the epidemics were disastrous. Over 15,000 people died of cholera in Mecca in 1846. An outbreak in North America took the life of former U.S. President James K. Polk and killed over 4,500 in St. Louisand over 3,000 in New Orleans. Thousands died in New York, a major destination for Irish immigrants. Cholera claimed 200,000 victims in Mexico.

The third cholera pandemic mainly affected Russia, with over one million deaths. In 1852, cholera spread east to Indonesia, and later was carried to China and Japan in 1854. The Philippines were infected in 1858 and Korea in 1859. In 1859, an outbreak in Bengal contributed to transmission of the disease by travelers and troops to Iran, Iraq, Arabia and Russia. Japan suffered at least seven major outbreaks of cholera between 1858 and 1902. Between 100,000 and 200,000 people died of cholera in Tokyo in an outbreak in 1858-60. In Spain, over 236,000 died of cholera in the epidemic of 1854–55. The disease reached South America in 1854 and 1855, with victims in Venezuela and Brazil.

The fourth cholera pandemic of the century began in the Ganges Delta of the Bengal region and traveled with Muslim pilgrims to Mecca. In its first year, the epidemic claimed 30,000 of 90,000 Mecca pilgrims. Cholera spread throughout the Middle East and was carried to Russia, Europe, Africa and North America, in each case spreading from port cities and along inland waterways.

The fifth cholera pandemic cost 250,000 lives in Europe and at least 50,000 in the Americas. Cholera claimed 267,890 lives in Russia (1892);[ 120,000 in Spain; 90,000 in Japan and over 60,000 in Persia. In Egypt, cholera claimed more than 58,000 lives. The 1892 outbreak in Hamburg killed 8,600 people.

The sixth cholera pandemic had little effect in western Europe because of advances in public health, but major Russian cities and the Ottoman Empire were particularly hard hit by cholera deaths. More than 500,000 people died of cholera in Russia from 1900 to 1925, which was also a time of social disruption because of revolution and warfare.