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Cholera in the 19th Century

Cholera was not well understood in the mid-19th century, and there were many misconceptions about its causes. Some believed it was caused by "miasma" (bad air or poisonous vapours), while others thought it was related to unsanitary living conditions. Fear of contagion led to panic, and many wealthy residents fled cities when outbreaks struck.

Background

Cholera first became a major global concern during the 19th century when several devastating pandemics spread across continents. The first of these pandemics began in India in the early 1800s, and over the following decades, the disease spread to Europe, the Americas, Africa, and the Middle East. The 1849 cholera outbreak in Britain is one of the most notable events in the history of the disease, particularly because it brought about significant advancements in the understanding of disease transmission and public health.

First cholera pandemic (1817–1824)

The first recorded cholera pandemic originated in the Ganges Delta in India in 1817 and eventually spread across Asia, the Middle East, and Eastern Europe. It was a deadly disease, but its exact cause was not understood at the time.

Second cholera pandemic (1829–1851)

This pandemic was particularly devastating and spread to Europe, where it wreaked havoc in places such as London, Paris, and New York. It was during this period that the link between cholera and water sources began to be suspected, though the full understanding of its transmission would not come until later.

General Board of Health reported to Parliament on the cholera epidemic of 1848 and 1849. The report, which includes an appendix by John Grainger, includes a detailed description of the disease's migration to the UK through India (1845) to Aden, Tehran, Baghdad, Mosul and Damascus (1846), Mecca and Moscow (1847), St Petersburg and Cairo (1848) and then through Europe. The report's "Places and Dates of Attack" with anglicised, modernised place names, are as follows:

Read more about the General Board of Health

Read more about John Grainger

Cholera reached Scottish shores in October 1848, in Edinburgh, then Glasgow in November, though sporadic cases had been identified in Great Britain from September.

Read the full GBoH report

The GBoH report oficially considers the epidemic in the UK to have run from 22 Sep 1848 to 22 Dec 1849. In London, the earliest cases were identified in Bethnal Green (North East London) and Southwark (South London).

Third cholera pandemic (1852–1860)

The third cholera pandemic was also severe, particularly in Europe, where the disease spread rapidly. One of the most infamous outbreaks occurred in London, with major losses of life, particularly in the East End. During this outbreak, scientific efforts were made to understand the disease better.

The causes and spread of cholera

Cholera is an infectious disease caused by the bacterium Vibrio Cholerae, which leads to severe diarrhoea and dehydration. It is spread through contaminated water or food, particularly when sanitation is poor. In the 19th century, cholera outbreaks were frequent and devastating, often exacerbated by crowded urban conditions, poor sanitation, and limited understanding of disease transmission.

Before the discovery of germ theory, cholera was often attributed to miasma (bad air), which was thought to arise from decaying organic matter. The true cause of cholera was not understood until the late 19th century, when Robert Koch identified the Cholerae bacterium in 1883. Infected individuals can spread the disease through their stools, contaminating drinking water, food, or utensils.

Key factors in cholera transmission

John Snow and the Broad Street pump

One of the most significant figures in understanding cholera in the 19th century was John Snow, a physician who is considered the father of modern epidemiology. In 1854, Snow conducted a groundbreaking investigation into a cholera outbreak in London's Soho district. He famously mapped the cases of cholera and traced them to a contaminated water pump on Broad Street, Soho. This discovery was one of the first pieces of evidence linking waterborne transmission - not miasma - to cholera and played a key role in the eventual development of germ theory.

It is worth saying, however, that Snow's work met with significant resistance from his peers. It was only towards the end of the 19th century, after Snow had passed away, that water became widely accepted as the mechanism for transmission.

Read more about John Snow

Symptoms, treatment and prevention

Cholera’s symptoms can range from mild to severe, but the most notable signs of infection include:

Today, cholera is a treatable disease, and with proper medical care, most people recover.

Modern treatments

These modern treatments for cholera would have been unavailable in the 1840s:

Rehydration: The first and most important step in treating cholera is to replace lost fluids and electrolytes. This can be done with oral rehydration solutions (ORS), which are a mixture of salts and sugar in clean water. In severe cases, intravenous fluids may be necessary.

Antibiotics: In some cases, antibiotics are prescribed to reduce the severity and duration of symptoms, although they are not always necessary for mild cases.

Zinc supplementation: Zinc has been shown to help reduce the duration of diarrhoea and improve outcomes in children with cholera.

18th century treatments

Judge for yourself how effective these treatments would have been:

Blood-letting: This was a common treatment for many ailments at the time, including cholera. It was believed that removing blood could balance the "humours" in the body (a concept dating back to Hippocrates of Ancient Greece) and help "expel the poison" causing illness. Doctors would use leeches (a treatment used in Ancient Egypt and later by Hippocrates) or cut veins to remove blood.

Purging: Patients were often given powerful purgatives, such as calomel (mercury chloride) or tartar emetic, which induced vomiting and diarrhoea. The idea was to expel the disease from the body by causing purging, but this often led to severe dehydration, exacerbating the illness.

Opium and other narcotics: Opium was frequently used to manage the symptoms of cholera, especially diarrhoea and abdominal pain. It was believed to help calm the stomach and prevent fluid loss. Other narcotics, such as laudanum (a tincture of opium), were often prescribed to ease the pain and discomfort caused by cholera.

Antiseptic and herbal remedies: Although antiseptic treatments were not widely recognized yet, some herbal remedies were employed to treat cholera. Peppermint, ginger, camphor, and rhubarb were believed to have therapeutic effects on digestion and were sometimes used in attempts to alleviate symptoms. Paregoric, a tincture made from opium and other ingredients, was sometimes given to calm the digestive system.

Rehydration attempts: There were some attempts at rehydration, but these were rudimentary by modern standards. Patients were sometimes given saline solutions, but the idea of oral rehydration therapy (as we know it today) had not yet been developed. Hot drinks like herbal teas or broths were often given to patients in the hope of keeping them hydrated, though this was not always effective.

Application of heat: Heat was used as a therapeutic method in the form of hot compresses or mustard plasters. These were applied to the abdomen, chest, or limbs in the belief that they could stimulate circulation and expel toxins. Hot baths were also used in an attempt to soothe the body and relieve cramps, though they were not effective in treating the root causes of cholera.

Quarantining and isolation: In some areas, particularly urban areas where cholera outbreaks were most severe, quarantines and isolation were implemented in an attempt to contain the disease. The idea was to isolate affected individuals from the healthy population to prevent the spread of the illness. However, this was based on the miasma theory and not on an understanding of how cholera is transmitted (through contaminated water). Families and communities were sometimes confined to their homes, and the sick were isolated, though there were no systematic public health measures in place at the time.

Cleansing and fumigation: People believed that cholera was caused by "bad air" or miasma, so they tried to purify the air by fumigating homes with aromatic herbs, burning tar or incense, or using strong-smelling substances like vinegar to "clear" the atmosphere. Cleansing rituals were sometimes performed on patients or their clothing in an effort to remove the "poisonous vapours" that were thought to be the cause of disease.

Dietary restrictions and support: Patients were often told to follow strict dietary restrictions, with some being advised to drink only clear broths or water, while others were encouraged to drink liquid preparations of sugar and salt to help balance electrolytes. However, these were typically ineffective in managing the dehydration caused by cholera.

Supportive care: If a patient was in the final stages of cholera, doctors would often provide palliative care, offering comfort and pain relief, but there were few treatments available to save lives. This was a common practice for conditions that were considered fatal during this period.

Quinine: Effective in treating malaria, quinine was sometimes used in the belief that it could help with the fever and symptoms of cholera, even though it had no impact on the disease's progression.

Cholera hospitals: In some cities, special cholera hospitals or isolation units were set up to treat patients. These were often rudimentary and overcrowded.

Water and sanitation: Although the link between contaminated water and cholera transmission was not fully understood at the time, some early public health measures were being discussed. However, systematic improvements in sanitation and water infrastructure, such as the development of clean water supplies and sewer systems, would not come until later in the century.

Modern preventative measures

Cholera today

While cholera is largely under control in developed countries, it still poses a significant threat in many parts of the developing world, particularly in Africa, Asia, and Latin America. In regions with poor sanitation and limited access to clean drinking water, cholera outbreaks continue to occur, often in the wake of natural disasters, armed conflicts, or other disruptions to public health infrastructure.

The disease remains a public health concern in countries with limited access to clean water and sanitation, and efforts to prevent cholera focus on improving water quality, sanitation infrastructure, and access to healthcare.

Conclusion

Cholera is a serious infectious disease with a long history of causing widespread illness and death, particularly during major outbreaks in the 19th century. While modern treatments and sanitation have greatly reduced its impact in many parts of the world, cholera remains a significant health risk in regions with poor access to clean water and sanitation. The advances made in understanding cholera in the 19th century, particularly by John Snow, laid the foundation for modern epidemiology and public health, leading to significant improvements in the control of infectious diseases worldwide.