Regency Health and Medicine: Cholera Pandemic 1 and 2

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In 1817, the first cholera pandemic broke out Kolkata (also known as Calcutta).  Between 1817 and 1824, it spread through Southeast Asisa to the Middle East, eastern Africa, and the Mediterranean.  British soldiers were included in the death toll, which reached hundreds of thousands of people. The second cholera pandemic (1826-1837) spread from Russia, to the rest of Europe , Great Britain, and the Americas, as well as China and Japan. While cholera had been around significantly longer, the first pandemic signaled a disease of global importance and kicked off numerous rounds of cholera pandemics that would impact most of the globe.

The British newspapers had some letters to the editor, short articles, and advertisements promising quack medications and remediations for cholera.  Meanwhile, the news from India reported starkly on the realities of the disease as it ravaged the country.

During the first two cholera pandemics, it was largely believed that foul air and filth were the vehicles for spreading the disease.  There was debate in trying to isolate European compared with Asiatic cholera:

LONDON MEDICAL SOCIETY Monday October 28th 1833 concluded DIAGNOSIS OF MALIGNANT CHOLERA Mr PROCTOR this evening inquired whether members generally had found the cholera at its last irruption less fierce than at its first appearance My medical friends he observed most them tell me that either their treatment has this season been more successful or the disease has been much less severe Mr STEPHENS no one seeming to think that the severity of the disease had di minished drew attention to some of the minuter shades which distinguished the epidemic and dwelt long on the subject of troublous apprehensions and sensa tions within experienced by himself dur ing its prevalence though not amounting to an attack of the discase expressing his opinion that the world should know that feelings might exist during the epidemic creating fear of without leading to it Carefulness in diet he regarded as of the first importance on such occasions Dr WILLIAMS suspected that mental anxiety was the proper answer to the riddle Mr STEPHENS said nay but rather that the symptoms caused the mental anxiety Mr PROCTOR These remarks lead me to say that I think three distinct diseases prevailed during the epidemic One of them diarrhoea the other English cholera the third Asiatic cholera As an opinion has been promulgated that the malignant cholera existed in this country long be fore 1831 I wish to observe that I believe no two diseases to be more distinct than the English and the Asiatic cholera and I believe that the cases in the Hackney Road Orphan Asylum and those named by Dr Ayre were purely English cholera Dr JOHNSON I am not disposed to agree with Mr Proctor as to the three dis cases The diarrhea is a beginning of the epidemic cholera and that is only a greater degree of what Mr Ste phens felt Scarcely any one indeed en joyed perfect health during the season Mr PROCTOR The diarrhoea was dis tinct because it often went no further Besides just such diarrhoeas have at other than the cholerà seasons Cho lera too in the majority of cases that have seen has afforded no signs Mr HOOPER For my part I have al ways traced a preceding diarrhoea Medi cal men may often have been deceived this point because many patients afraid of medical men during the epi demic and sought no advice till the dis ease was far advanced Mr BURT And did the patient re cover Mr HEADLAND These discussions are very heterogeneous We are all still sea on the subject The advances made by us towards obtaining a knowledge the disease are not such as to raise scientific character of the profession What a mess of remedies is our treatment I attended one case in which four medical gentlemen were consulted every one whom prescribed differently malignant cholera Mr HEADLAND He did Sir Laugh ter Mr STEPHENS My experience leads me to say that Mr Proctor's three dis eases are all shades of the same malady Dr WILLIAMS What after all is How am I to know it from any other form of cholera Some say that it kills rapidly others that it takes time What is an undoubted diagnostic sign of the disease I listened with great attention to Dr Tytler's state ments but I did not gather from him sufficient distinctive marks to guide me How far are we to regard common cho lera morbus as the first grade of malignant cholera Dr UWINS I and Dr Johnson must take great credit to ourselves for having dissipated the cholera phobia when it first arose in this country The epidemic thus we understood the worthy doctor who rather bothered us for from being one the most modest he renders himself one of the most unfortunate of speakers the epidemic owed all its malignity to an in crease of malignity in the atmosphere One tenth of a grain of arsenic may do no harm two grains will kill An excessive dose of poisonous atmosphere did the mis chief I saw many cases before Asiatic cholera was said to be in this country which must be set down under the head of malignant cholera Cholera is in

fact nothing more than a locked up state of the secretions and it is our business to unlock them without plaguing ourselves about names Dr NEGRIS I cannot coincide in these statements The distinction between English and Asiatic cholera is quite plain In the former when the diarrhoea ceases the patient is cured In the latter when it ceases the patient is worse he is then near dying The signs also of the diar rhoea in the latter are very marked When a patient is afflicted with the diarrhoea of Asiatic cholera he presents a peculiar throbbing pulse as though there had been much hemorrhage or some affection of the heart such a pulse as diarrhoea does not present under other circumstances a rather vivid and triflingly bloodshot eye and an anxiety of countenance which is not common to simple diarrhoea These with the pathological characters detect able when the disease terminates fatally render malignant cholera clearly distin guishable from the affections with which it is sometimes confounded Dr SHEARMAN Till this point is fairly settled all discussion on the disease is a waste of time The distinctive marks between Asiatic and English cholera ought to be at once clearly pronounced or the presumed distinction entirely waved For my part I believe them to be two diseases candidly confessing that during my experience of thirty or forty years I never saw such a disease as that of 1831 before that time Let us blindly wander from point to point no longer Dr WALSHAM If the symptoms be the same and such I consider them why should the diseases be different During the epidemic the symptoms may be more violent than at other times but that is all The same principles of treatment do for both dilution of the contents of the stomach with chicken broth for instance and the use of purgatives though to be sure when collapse arrives you can do nothing The PRESIDENT I dispute the position of Dr SHEARMAN for if we discuss none of the many questions that arise in this disease until our minds are satisfied on such and such points we shall effect no good as a society Gentlemen must in the absence of certain preliminary infor mation tell each other to the best of their ability what they have seen and the im pressions made on their minds no matter what views they support We cannot conduct our discussion with strict regu larity and mathematical order The re marks of Dr Negris Gentlemen are highly important The distinction he has laid down and the stage of the disease at which he fixes a distinction have never before that I am aware been remarked by any gentleman If the signs he has named be present in some instances diarrhea and not in others and if you often find that the diarrhea in one case leads to malignant cholera a most im portant point is decided Gentlemen the hour of adjournment has now arrived The Lancet: A Journal of British and Foreign Medicine, Surgery, Obstetrics, Physiology, Pathology, Pharmacology, Public Health and News. (1834). United Kingdom: Lancet, Limited.

During the third wave of cholera, including an outbreak in England and Wales in 1848, the link between cholera and the water supply was beginning to be noted. It was during the two year outbreak that London Dr. John Snow began to test a theory of cholera being spread by polluted water. Through investigation, he narrowed down the Soho contamination to a hot spot and learned most got their water from the Broad Street pump. He was able to develop a map of the outbreak in relation to the pump, and therefore convince the local council to remove the pump handle which subsequently eliminated the outbreak. (https://librarycompany.org/2020/05/21/pandemic-reading-cholera-john-snows-map-and-poes-red-death/).

Here is an excerpt from a publication by the good Dr:

The views here explained open up to consideration a most important way in which the cholera may be widely disseminated viz by the emptying of sewers into the drinking water of the community and as far as the writer's inquiries have extended he has found that in most towns in which the malady has prevailed to an unusual extent this means of its communication has existed The joint town of Dumfries and Max well town not usually an unhealthy place has been visited by the cholera both in 1832 and at the close of last year with extreme severity On the last occasion the deaths were 317 in Dumfries and 114 in Maxwell town being 431 in a population of 14,000 The in habitants drink the water of the Nith a river into which the sewers empty themselves their contents floating afterwards to and fro with the tide Glasgow which has been visited so severely with the malady is supplied as I understand with water from the Clyde by means of an establishment situated a little way from the town and higher up the stream and the water is professed to be filtered but as the Clyde is a tidal river in that part of its course the contents of the sewers must be washed up the stream and whatever care may be taken to get the supply of water when the tide is down it cannot be altogether free from contamination In
the epidemic of seventeen years ago the cholera was much more prevalent in the south and east districts of London which are supplied with water from the Thames and the Lea where these rivers are much con taminated by the sewers than in the other parts of the metropolis differently supplied And this is precisely what has occurred again as will be shewn further on

The seventh wave or pandemic of cholera began in 1961 until present day, with WHO identifying cholera as endemic in many countries. This wave began in Indonesia, and spread to Bangladesh, India, and the Soviet Union until reaching from South America to Italy in the 1960s and 70s. We are now well aware of its waterborne transmission and poor sanitation systems. As European and many American places worked to improve water and sanitation, the spread of cholera would be limited by the late 19th century.

 

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