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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
community. 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 Koch’s 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
effects 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
staggering. 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 one’s 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
as follows:
1831-1832: 21,000-23,000
1848-1849: 53,000-55,200
1853-1854: 23,000-24,500
1866-1867: 14,000-14,50010
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
region18.
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 London’s East End, a notoriously poor region of the
city. The following is the weekly mortality rates during the peak period of the 1866
epidemic:
14 July: 20 11 August: 673
21 July 308 18 August: 369
28 July: 818 25 August: 198
4 August: 916 1 September: 127
8 September: 7429
Another report studies select districts in and around London in 1866. The following are
death rates from cholera per 10,000 population during that time:
London: 18 Bethnal Green: 63
Hackney: 11 Whitechapel: 76
Clerkenwell: 12 Stepney: 166
St. Giles: 10 Old Town: 64
St. Luke: 15 Poplar: 89
East London: 18 Greenwich: 20
Shoreditch: 11 St. George in-the-East: 9730
In the 1854 epidemic, approximately 11,000 Londoners died and in 1866, 5,550
Londoners died31.
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
part 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
following numbers exhibit this:
Population size per town Mortality per 1000 Mortality per 1000
(thousands) England and Wales Scotland
* 2.5 8.2 8.7
2.5-4.9 5.5 6.4
5.0-9.9 4.4 8.2
10.0-19.9 6.1 14.8
20.0-39.9 5.8 8.4
40.0-79.9 6.4 9.3
80.0+ 5.1 11.936
Finally, throughout all four epidemics, the mortality rate for those infected was around
50%37.
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
that 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
of cholera patients.
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
lived 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 Durey’s
analysis of the 1831-1832 epidemic he outlines these options for the poor and he also
outlines 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
the poor. This idea actually had some logical basis. Several laws passed by the English
Parliament in the 1830’s 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
were 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
the 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
still 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 boy’s coffin and found that
his 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 Britain’s 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
money, 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
towns62. 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 people’s 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 1830’s, 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
arrive73. 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.
The next major controversy revolved around the role that water and air had in the
spread of cholera. The first major water-born theorist was John Snow78. Snow was a
York born doctor that worked with cholera patients in Newcastle-Upon-Tyne during the
1832 epidemic79.He staunchly believed that water was the main factor in causing and
perpetuation cholera. He set out to test the Broad Street pump80, which was believed to
be the sight of origin of the 1854 epidemc80. Snow’s doctrine stated:
This doctrine is, that cholera propagates itself by a ‘morbid matter’
which, passing from one patient in his evacuations, is accidentally
swallowed by other persons as a pollution of food or water; that
an increase in the swallowed germ of the disease takes place in the
interior of the stomach and bowels, giving rise to the essential
actions of cholera81.
The temporary Board of Health in 1854 set up the Medical Council to study that years
cholera and in a way, dispute Snow’s findings82. There conclusion was that there was no
reason to adopt Snow’s cholera explanation83.
We do no find it established that the water was contaminated in the
manner alleged; nor is there before us any sufficient evidence to
show whether inhabitants of the districts drinking from that well,
suffered in proportion more than other inhabitants of the district
who
drank from other sources84
In Hampstead, there was an isolated victim of cholera who had been purchasing Broad
Street Pump water, because of better taste. This was the clinching piece of data for
Snow85. In regards to this, the Council all but ignored it86.
With Snow’s theories not being accepted by the medical community for several
reasons, several scientists and medical professionals set out to prove that the air, or things
in the air are the major cause for the arrival of cholera to particular districts. For
example, there was the cholera-fungus theory produced in 1849. Three leading scientists,
Budd, Swayne and Brittan, belonging to the Microscpical Subcommittee of Bristol,
analyzed rice water samples of recently deceased cholera victims87. All three scientists
found the same results88. On this basis, Brittan made another study isolating atmospheric
fluid of a house where five cholera patients were living89. His findings there matched the
earlier findings and he released his results90. Upon the release of the information, Budd
contended that he went further then Brittan and found a living organism of distinct
species that appeared to be a fungus91. The General Board of Health seemed to accept
these ideas more as they published reports about how to avoid the fungus in the Times92.
Another theory was in a way popularly accepted by the poor. As has been stated
there was a period of time when the poor thought that the rich were trying to ‘poison’
them with the cholera for several reasons, such as, the needs for bodies at universities for
students to study and for the desire of the rich to no longer support the poor financially
with aid. The poison theory was furthered by several scientists, including William Farr
and Justus Liebig93. Liebig was an organic chemist94 who used chemical analysis on
human blood to show that poisons were introduced to the body and through the air and
then through organic reactions manifest themselves within the blood and poison the
person95. Liebig claimed his ideas to be anticontagionist because he claimed that the
infected person could not pass on the disease, only infected air or infected blood could
effect a new victim96. Upon publishing of Liebig’s reports, employee at the General
Register’s Board, William Farr endorsed these as proper explanations and adapted them
into his own ideology97. This was beneficial to Liebig as well because Farr was a
respected member of society by both the medical community and the lay people.
There are numerous other theories, reports and conclusions, including the small
pox analogy claiming that cholera is breathed in like small pox98, making it a contagious
disease. All of these theories, if they were accepted, helped to further the careers of
many medical men. Often, these men had thriving practices or they turned to writing
about epidemic diseases such as cholera as a result of their success. However, these
competing theories acted to slow severely the progress of public health. Some people
claimed that water needed to be cleaned, some thought that the air needed to be clean,
some thought both. Some people believed that cholera victims should be quarantined
because they were contagious to others, while some medical men believed that cholera
only spread as a result of local environmental conditions which help to manifest cholera.
Eventually, it was proven that there is only one cause for cholera, and with this discovery
came final sanitation reforms and cholera vaccines, helping to avoid any further
epidemics.
In conclusion, cholera is a disease that ran rampant through much of Europe and
Asia during the nineteenth century. Many hundreds of thousands of people died and
nearly an equal number more people suffered with cholera but survived99. In Great
Britain, cholera effected them during four epidemics: 1832, 1848, 1854, and 1866, with
the most severe being in 1848. It took the country around 35 years to improve sanitary
and environmental conditions enough so that later epidemics did not effect them. This
long period of time that sanitary improvement required was based on several reasons.
One of these reasons is the fact that the medical community could not agree on the
causes of cholera. There were numerous theories about contagion and anti-contagion,
water-born and air-born, miasmas, poisons and theories relating to fungi and blood
infection. All of these differing opinions slowed the growth of knowledge as to the cause
and preventive measures of diseases. Another stumbling point with sanitation progress
was that sanitation improvements first came to large cities that had the money to improve
pipes, drains and sewers, and not necessarily to the overcrowded, impoverished cities that
needed the water sanitation the most. This meant that cities, such as Birmingham, that
were not severely hit during the four epidemics saw the first sanitary reform measures,
while cities, such as Wigan, saw sanitary measures much later in the century.
As a result of the scientific community finally reaching a consensus as to the
cause of diseases, and their acceptance of ideas such as the germ theory, two positive
results came about. Naturally, sanitation reform followed and England has seen only
extremely rare and isolated cases of cholera in the twentieth century. Another positive
aspect of medical improvement is faith from the lay people in the medical community as
a whole. As was shown earlier, during these epidemics, the lay people criticized the
medical community more then any group because the lay people believed that all of the
cholera and disease was in some way caused by the medical community. With
improvements in medical knowledge came increased government financial and political
support to continue with further studies to find more answers about diseases.
Finally, with modern enhancements cholera has nearly been eradicated in most
first world countries throughout the world, including Great Britain. The lay people now
have indoor plumbing and no longer live in direct contact with their own feces. The
overcrowding that many industrialized cities faced during the early Industrial Revolution
has been reduced greatly. People now enjoy a greater standard of living and no longer
face the daily threat of epidemic diseases such as cholera.
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70. Pelling, Cholera, fever, p. 3.
71. Mitchell, Victorian Britain, p. 149.
72. Pelling, Cholera, fever, p. 24.
73. Pelling, Cholera, fever, p. 24.
74. Pelling, Cholera, fever, p. 25.
75. Pelling, Cholera, fever, p. 27.
76. Christopher Hamlin, Public Health and social justice in the age of Chadwick (NY:
Cambridge University Press, 1998), p. 189.
77. Hamlin, Public health, p. 192.
78. Cannon, Oxford Companion, p. 203.
79. Watts, Epidemics and history, p. 169.
80. Paneth, “Public health then and now,” p. 1549.
81. Pelling, Cholera, fever, p. 204.
82. Pelling, Cholera, fever, p. 222.
83. Pelling, Cholera, fever, p. 224.
84. Pelling, Cholera, fever, p. 224.
85. Michael Sigsworth, “The public’s view of public health in mid-Victorian Britain,”
Urban History, vol 21(1994), p. 243.
86. Sigsworth, “The public’s view,” p. 249.
87. Pelling, Cholera, fever, p. 163.
88. Pelling, Cholera, fever, p. 163.
89. Pelling, Cholera, fever, p. 165.
90. Pelling, Cholera, fever, p. 165.
91. Pelling, Cholera, fever, p. 170.
92. The London Times, “General Board of Health Directions and Regulations,” 06
November 1848.
93. Pelling, Cholera, fever, p. 113.
94. Pelling, Cholera, fever, p. 120.
95. Pelling, Cholera, fever, p. 121.
96. Pelling, Cholera, fever, p. 121.
97. Pelling, Cholera, fever, p. 144.
98. Pelling, Cholera, fever, p. 250.
Word Count: 4427
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