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Cholera


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Though cholera has been around for many centuries, the disease came to prominence in the 19th century, when a lethal outbreak occurred in India. There have since been numerous outbreaks and seven global pandemics of cholera. Each year, cholera infects 1.3 to 4 million people around the world, killing 21,000 to 143,000 people, according to the World Health Organization (WHO).

What Is Cholera?

Cholera is an infectious disease caused by a bacterium called Vibrio cholerae. The bacteria typically live in waters that are somewhat salty and warm, such as estuaries and waters along coastal areas. People contract V. cholerae after drinking liquids or eating foods contaminated with the bacteria, such as raw or undercooked shellfish.

There are hundreds of strains or “serogroups” of the cholera bacteria: V. cholerae serogroups O1 and O139 are the only two strains of the bacteria known to cause outbreaks and epidemics.

These strains produce the cholera toxin that cause cells lining the intestines to release increased amounts of water, leading to diarrhea and rapid loss of fluids and electrolytes (salts). A single diarrhea episode can cause a one-million-fold increase of bacterial numbers in the environment, according to the National Institute of Allergy and Infectious Diseases.

Cholera Symptoms

About 80 percent of people who contract the bacteria don’t develop cholera symptoms and the infection resolves on its own. And of the people who do develop cholera, 20 percent come down with severe symptoms, which includes severe diarrhea, vomiting, and leg cramps. These symptoms can cause dehydration, septic shock and even death within a matter of just a few hours.

People who contract non-01 or non-1039 V. cholerae can also acquire a diarrheal disease, but it is less severe than actual cholera.

Today, cholera is treated through fluid replacement and antibiotics. Cholera vaccines are available, though they only offer roughly 65% immunity, according to WHO.

Origins of Cholera

It’s unclear when, exactly, cholera first affected people.

Early texts from India (by Sushruta Samhita in the 5th century B.C.) and Greece (Hippocrates in the 4th century B.C. and Aretaeus of Cappadocia in the 1st century A.D.) describe isolated cases of cholera-like illnesses.

One of the first detailed accounts of a cholera epidemic comes from Gaspar Correa—Portuguese historian and author of Legendary India—who described an outbreak in the spring of 1543 of a disease in the Ganges Delta, which is located in the south Asia area of Bangladesh and India. The local people called the disease “moryxy,” and it reportedly killed victims within 8 hours of developing symptoms and had a fatality rate so high that locals struggled to bury all the dead.

Numerous reports of cholera manifestations along the West coast of India by Portuguese, Dutch, French and British observers followed throughout the next few centuries.

READ MORE: Pandemics That Changed History

The First Cholera Pandemic

The first cholera pandemic emerged out of the Ganges Delta with an outbreak in Jessore, India, in 1817, stemming from contaminated rice. The disease quickly spread throughout most of India, modern-day Myanmar, and modern-day Sri Lanka by traveling along trade routes established by Europeans.

By 1820, cholera had spread to Thailand, Indonesia (killing 100,000 people on the island of Java alone) and the Philippines. From Thailand and Indonesia, the disease made its way to China in 1820 and Japan in 1822 by way of infected people on ships.

It also spread beyond Asia. In 1821, British troops traveling from India to Oman brought cholera to the Persian Gulf. The disease eventually made its way to European territory, reaching modern-day Turkey, Syria and Southern Russia.

The pandemic died out 6 years after it began, likely thanks to a severe winter in 1823–1824, which may have killed the bacteria living in water supplies.

Cholera Infects Europe and the Americas

The second cholera pandemic began around 1829.

Like the one that came before it, the second pandemic is thought to have originated in India and spread along trade and military routes to Eastern and Central Asia and the Middle East.

By autumn of 1830, cholera had made it to Moscow. The spread of the disease temporarily slowed during the winter, but picked up again in spring of 1831, reaching Finland and Poland. It then passed into Hungary and Germany.

The disease subsequently spread throughout Europe, including reaching Great Britain for the first time via the port of Sunderland in late 1831 and London in spring of 1832. Britain enacted several actions to help curb the spread of the disease, including implementing quarantines and establishing local boards of health.

But the public became gripped with widespread fear of the disease and distrust of authority figures, most of all doctors. Unbalanced press reporting led people to think that more victims died in the hospital than their homes, and the public began to believe that victims taken to hospitals were killed by doctors for anatomical dissection, an outcome they referred to as “Burking.” This fear resulted in several “cholera riots” in Liverpool.

In 1832, cholera had also made it to the Americas. In June of that year, Quebec saw 1,000 deaths from the disease, which quickly spread along the St. Lawrence River and its tributaries.

Around the same time, cholera imported into the United States, appearing in New York and Philadelphia. Over the next couple of years, it would spread across the country. It reached Latin America, including Mexico and Cuba, in 1833.

The pandemic would die out and reemerge throughout numerous countries for nearly two decades until it subsided around 1851.

How Scientists Studied Cholera

Between 1852 and 1923, the world would see four more cholera pandemics.

The third pandemic, stretching 1852–1859, was the deadliest. It devastated Asia, Europe, North America and Africa, killing 23,000 people in Great Britain alone in 1854, the worst single year of cholera.

In that year, British physician John Snow, who’s considered one of the fathers of modern epidemiology, carefully mapped cholera cases in the Soho area of London, allowing him to identify the source of the disease in the area: Contaminated water from a public well pump.

He convinced officials to remove the pump handle, immediately dropping the cholera cases in the area.

The fourth and fifth cholera pandemics—occurring 1863–1875 and 1881–1896, respectively—were overall less severe than previous pandemics, but had their fair share of deadly outbreaks. Between 1872 and 1873, for example, Hungary suffered 190,000 deaths from cholera. And Hamburg lost nearly 1.5 percent of its population due to cholera in the 1892 outbreak.

In 1883, German microbiologist Robert Koch, the founder of modern bacteriology, studied cholera in Egypt and Calcutta. He developed a technique allowing him to grow and describe V. cholerae, and then show that the presence of the bacterium in intestines causes cholera.

However, Italian microbiologist Filippo Pacini had actually identified the cholera bacterium—naming it cholerigenic vibrios—in 1854, though this fact wasn’t widely known (and was likely unbeknownst to Koch).

During the fifth pandemic, Great Britain and the United States were mostly safe thanks to improved water supplies and quarantine measures.

The sixth cholera pandemic (1899–1923) largely didn’t affect western Europe and North America due to advances in public health and sanitation. But the disease still ravaged India, Russia, the Middle East and northern Africa. By 1923, cholera cases had dissipated throughout much of the world, except India—it killed more than half a million people in India in both 1918 and 1919.

READ MORE: How 5 of History's Worst Pandemics Finally Ended

Cholera Today

Unlike previous pandemics, which all originated in India, the seventh and current cholera pandemic began in Indonesia in 1961. It spread across Asia and the Middle East, reaching Africa in 1971. In 1990, more than 90 percent of all cholera cases reported to WHO were from the African continent.

In 1991, cholera appeared in Peru, returning to South America after being absent for 100 years. It killed 3,000 people in Peru in this first year and subsequently spread to Ecuador, Colombia, Brazil and Chile, and then Central America and Mexico.

Though the current cholera pandemic has affected some 120 countries, it’s largely a disease of impoverished, less-developed nations.

In recent years, there have been a number of devastating outbreaks, including the Zimbabwe outbreak of 2008–2009 that affected some 97,000 people (killing 4,200) and the Haiti outbreak of 2010–2011, which followed the Haiti earthquake and would affect more than 500,000 people.

In 2017, outbreaks of cholera broke out in Somalia and Yemen. By August 2017, the Yemen outbreak affected 500,000 people and killed 2,000 people.

Sources

Cholera. World Health Organization.
What Is Cholera? Everyday Health.
Boucher et al. (2015). “The out-of-the-delta hypothesis: dense human populations in low-lying river deltas served as agents for the evolution of a deadly pathogen.” Frontiers in Microbiology.
Cholera studies. 1. History of the Disease. Bulletin of the World Health Organization.
Non-O1 and Non-O139 Vibrio cholerae Infections. Centers for Disease Control and Prevention.
Gill et al. (2001). “Fear and frustration—the Liverpool cholera riots of 1832.” The Lancet.
Kelley Lee (2001). “The Global Dimensions of Cholera.” Global Change and Human Health.
Cholera’s seven pandemics. CBC News.
Cholera count reaches 500 000 in Yemen. WHO.


Cholera: History, Causes, Symptoms and Treatment

Cholera is an acute bacterial disease caused by the bacterium Vibrio cholera. It is an infectious disease that causes watery diarrhea, which can be fatal and result in death within hours if left untreated.

Other symptoms of cholera that could occur include vomiting, sunken eyes, cold skin, decreased elasticity of the skin, Low blood pressure, and the wrinkling of the hands and feet. Water loss from dehydration can cause the skin to turn blue.

Cholera often occurs when people ingest food and water that have been contaminated with the bacterium. Symptoms can range from mild to severe, depending on the individual’s immune system.

However, most healthy people would develop diarrhea within 1-5 days of getting infected.


[The history of cholera epidemics in Israel]

During the years 1831-1918 Israel (Palestine at that time) suffered from repeated cholera epidemics. The cholera epidemics were the major cause of severe health crisis among the population. The epidemics were transmitted by returening pilgrims returning from Mecca and, during the first world War, by the Turkish soldiers crossing the country. The disease caused panic amongst the population due to its high mortality rate. Quarantine which was the major measure taken by the government at that time was repeatedly broken by people trying to escape from the affected area. During the epidemic of 1902, patients were even reluctant to be treated by physicians as they were blamed for causing death. On the other hand, cholera was a major trigger for maintaining a better sanitation and establishing social relief systems within the communities. Most of the epidemics occurred in the old cities such as Jerusalem, Tiberia and Jaffa where infrastructure was inadequate. Cholera outbreaks were the trigger to build outside the old cities as in case of Jerusalem in which after the 1865 outbreak the city was expanded outside the walls. Since the end of the Ottoman period in Israel, cholera epidemics ceased, and except for very small occeasional small outbreaks, cholera is not seen here more.


Cholera Epidemics in the 19th Century

First appearing in Europe and North America beginning in 1831–1832 and presumed to have come from India, epidemic cholera returned and traveled around the world many times through the end of the century, killing many thousands. Causing profuse and violent cramps, vomiting and diarrhea, with dehydration so rapid and severe the blood thickens and the skin becomes deathlike and blue, cholera victims can die in a matter of hours. Because 19th-century transformations in industrial, urban, political, and cultural life were intimately connected with discussions of proper public health practices and causes of disease, attempts to explain epidemic cholera involved every part of society.

Hawthorne, George Stewart. The prevention and treatment of epidemic cholera :and its true pathological nature, in a series of letters. Cleveland : M.C. Younglove & Co., 1849. Page: (seq. 1). From the Andover-Harvard Theological Library.

For much of the century, most European and American physicians believed cholera was a locally produced miasmatic disease—an illness brought about by direct exposure to the products of filth and decay. Climate and geographic location were also factors. It was a common assumption that those who engaged in morally and physically intemperate behavior or who had inferior cultural practices were more likely to get cholera when exposed to these miasmas and environmental conditions. Observations that the poor, who lived in densely populated urban slums, suffered from cholera in greater numbers than the rich, who were much differently housed, were used as evidence for this assertion. The germ theory, developed in the later 19th century, placed less emphasis on social and environmental factors, although the issue of individual predisposition and susceptibility due to personal behavior lingered.

For most of the 19th century, most scientists, physicians and sophisticated lay people believed cholera was not contagious. The observation that a doctor could have daily contact with cholera patients without falling ill led to the conclusions that cholera was not transmitted from person to person. This was an accurate observation given that cholera is usually transmitted through contaminated drinking water, as John Snow first demonstrated in 1855.

Until Robert Koch identified the cholera bacillus in 1883, science continued to favor anticontagionism. Leading anticontagionists or contingent contagionists included Max von Pettenkofer and Southwood Smith. According to the contingent contagionist perspective, cholera could be contagious, but only under particular circumstances.

The existence of the cholera bacillus did not necessarily prove cholera’s contagiousness either some argued that the bacillus was the product of the disease, not its cause. Another issue was how to explain the existence of healthy carriers—people who had the cholera bacillus in their bodies but who were not sick. In practice, public health measures often involved a blend of contagionist and anticontagionist views.

The International Sanitary Conferences, predecessor to the World Health Organization, were first convened in Paris in 1851 to discuss cholera’s contagiousness Europe’s most important scientists and public health officials attended the meetings. Quarantine, intimately related to contagion, was another important topic at the Conferences, since it was of central concern to government officials and those involved in commerce. For if cholera was not contagious, there was no reason to submit to the significant personal and economic sacrifices involved in quarantines.

Despite the continued discussion about the cause of cholera, over the course of the 19th century the actual treatment of the disease did not change much. Patients with families were cared for at home. Physicians, when called, would use such characteristic treatments as bleeding or opium. Homeopathic methods were popular among the middle and upper classes, as were other eclectic treatments, and all manner of dietary and hygienic regimens were promoted in newspapers and books. Those without families might find themselves in charity hospitals, which could become grim places indeed during an epidemic. Preachers gave sermons on the meaning of cholera for both individuals and society. Riots ensued due to popular revolt against mass burials.

By the end of the 19th century, cholera epidemics no longer appeared in Europe and North America. The reasons for this are uncertain, but standards of living had risen and many communities had made major changes in sanitation practices and established permanent boards of health. As part of the transformation to the germ theory, medical thought had changed in many ways as well. In 1831, most physicians believed cholera to be a nonspecific, noncontagious miasmatic condition that favored the morally and physically predisposed. By the end of the 19th century, although the miasmatic interpretation still had influence, cholera was primarily understood to be a specific contagious disease caused by a particular microscopic organism.

Selected Contagion Resources

This is a partial list of digitized materials available in Contagion: Historical Views of Diseases and Epidemics. To search or browse all items digitized for the Contagion exhibit, please use the search bar in the top navigation menu or the "Limit Your Search" options in the left navigation menu (accessible from the exhibit's home page).

Publications - Causes of Cholera

  • An Account of the Rise and Progress of the Indian or Spasmodic Cholera: With a Particular Description of the Symptoms Attending the Disease: Illustrated by a Map, Showing the Route and Progress of the Disease, from Jessore, Near the Ganges, in 1817, to Great Britain, in 1831.New Haven: L.H. Young, 1832.
  • Broussais, F.J.V. Le Choléra Morbus Epidemique: Observé et Traité Selon la Méthode Physiologique. Paris: Mademoiselle Delaunay, 1832.
  • Dewey, Orville. A Sermon on the Moral Uses of the Pestilence, Denominated Asiatic Cholera: Delivered on Fast-Day, August 9, 1832. New Bedford?: 1832.
  • Hawkins, Francis Bisset. History of the Epidemic Spasmodic Cholera of Russia: Including a Copious Account of the Disease Which Has Prevailed in India, and Which Has Travelled, Under That Name, from Asia into Europe, Illustrated by Numerous Official and Other Documents, Explanatory of the Nature, Treatment, and Prevention of the Malady. London: J. Murray, 1831.
  • Koch, Robert Wasserfiltration und Cholera. Leipzig: Veit, 1893.

Publications - Was Cholera Contagious?

  • Epidemic Cholera: Its Mission and Mystery, Haunts and Havocs, Pathology and Treatment: With Remarks on the Question of Contagion, the Influence of Fear, and Hurried and Delayed Interments. New York: Carleton, 1866.
  • Great Britain. Report on Quarantine.London: Printed by W. Clowes & Sons for H.M.S.O., 1849.
  • Pettenkofer, Max von. Cholera: How to Prevent and Resist It. London: Baillière, Tindall, & Cox, 1883.
  • Pettenkofer, Max von. Zur Frage über die Verbreitungsart der Cholera: Entgegnungen und Erläuterungen zu seiner Schrift “Ueber die Verbreitungsart der Cholera.”München: Cotta, 1855
  • Snow, John. Snow on Cholera: Being a Reprint of Two Papers.New York: The Commonwealth Fund London: H. Milford, Oxford University Press, 1936.

Publications - 19th-Century Treatments

  • Graham, Sylvester. A Lecture on Epidemic Diseases Generally, and Particularly the Spasmodic Cholera: Delivered in the City of New York, March, 1832, and Repeated June, 1832, and in Albany, July 4, 1832, and in New York, June, 1833: With an Appendix, Containing Several Testimonials, and a Review of Beaumont's Experiments on the Gastric Juice.Boston: David Cambell, 1838.
  • Hawthorne, George Stewart. The Prevention and Treatment of Epidemic Cholera: and Its True Pathological Nature, in a Series of Letters. Cleveland: M.C. Younglove & Co., 1849.
  • Holt, Daniel. Cholera and Its Homœopathic Treatment: With an Account of Its Success in Europe, and America, and Remarks Upon Its Symptoms, Preventive Means, Early Management, &c, &cLowell: B.H. Penhallow, printer, 1849.
  • Shew, Joel. The Cholera, Its Causes, Prevention, and Cure: Showing the Inefficacy of Drug-Treatment, and the Superiority of the Water-Cure, in This Disease.New York: Fowlers and Wells, 1849.
  • Whittle, Ewing. The Symptomatic Treatment of Asiatic Cholera. London: John Churchill, 1850.

Archives and Manuscript Collections

See Also (Related Contagion Exhibit Pages)

The following sources were used in writing this page.

  • Ackerknecht, Erwin H. “Anticontagionism Between 1821 and 1867.” Bulletin of the History of Medicine 22 (1948): 562–593.
  • Arnold, David. “Cholera and Colonialism in British India.” Past and Present, No. 113 (Nov., 1986), pp. 118-151.
  • Baldwin, Peter. Contagion and the State in Europe, 1830-1930. Cambridge: Cambridge University Press, 1999.
  • Briggs, Asa. “Cholera and Society in the Nineteenth Century.” Past and Present, No. 19 (Apr., 1961), pp. 76-96.
  • Delaporte, Francois, trans. Arthur Goldhammer. Disease and Civilization: The Cholera in Paris, 1832. Cambridge, MA, and London: MIT Press, 1986.
  • Evans, Richard. Death in Hamburg: Society and Politics in the Cholera Years, 1830-1910. Oxford: Clarendon Press, 1987.
  • Frieden, Nancy. “The Russian Cholera Epidemic, 1892–93, and Medical Professionalization.” Journal of Social History, Vol. 10, No. 4 (Summer, 1977), pp. 538-559.
  • Howard-Jones, Norman. The Scientific Background of the International Sanitary Conferences, 1851–1938. Geneva: World Health Organization, 1975.
  • Leiker, James and Powers, Ramon. “Cholera Among the Plains Indians: Perceptions, Causes, Consequences.” The Western Historical Quarterly, Vol. 29, No. 3 (Autumn, 1998), pp. 317-340.
  • Pelling, Margaret. Cholera, Fever and English Medicine, 1825–1865. Oxford and New York: Oxford University Press, 1978.
  • Rosenberg, Charles E. The Cholera Years: The United States in 1832, 1849, and 1866. University of Chicago Press: Chicago and London, 1962, 1987.
  • Rosenberg, Charles E. Explaining Epidemics and Other Studies in the History of Medicine. Cambridge: Cambridge University Press, 1992.

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Cholera Panic in New York City

In early 1832, citizens of New York City had known the disease might strike, as they were reading reports about deaths in London, Paris, and elsewhere. But as the disease was so poorly understood, little was done to prepare.

By the end of June, when cases were being reported in the poorer districts of the city, a prominent citizen and former mayor of New York, Philip Hone, wrote about the crisis in his diary:

Hone was not alone in assigning blame for the disease. The cholera epidemic was often blamed on immigrants, and nativist groups like the Know-Nothing Party would occasionally revive fear of disease as a reason to restrict immigration. Immigrant communities came to be blamed for the spread of the disease, yet the immigrants were really cholera's most vulnerable victims.

In New York City the fear of disease became so prevalent that many thousands of people actually fled the city. Out of a population of about 250,000 people, it is believed that at least 100,000 left the city during the summer of 1832. The steamboat line owned by Cornelius Vanderbilt made handsome profits carrying New Yorkers up the Hudson River, where they rented any available rooms in local villages.

By the end of the summer, the epidemic seemed to be over. But more than 3,000 New Yorkers had died.


History of the Cholera Vaccine

From the first cholera vaccine created in 1885 to Vaxchora (approved by the FDA in 2016), the world has a much better understanding of the disease and its epidemics. That’s why knowing how vaccination prevention works is such an important tool.

Cholera is a bacterial disease the can be transmitted in water or food contaminated with Vibrio cholerae bacteria.

Symptoms from the disease can range from mild to fatal. Cholera typically causes symptoms like diarrhea and vomiting. Both of which can lead to death due to dehydration if left untreated.

Origins of the disease trace back to approximately 500 B.C. Since then, there have been two “first” genuine discoveries of cholera’s bacteria, once in the 1850s and once in the 1880s.

The earliest original discovery of the comma-shaped Vibrio cholerae bacillus goes to Italian anatomist Filippo Pacini for his 1854 paper, “Microscopic observation and pathological deductions on cholera.” Pacini found the bacterial cause after the a bad outbreak of the disease in Italy that year. Yet, his work went completely unnoticed for a considerable time after his death.

For the next “first time” in the 1880s, cholera bacteria were found by famed scientist and physician Robert Koch. Koch also investigated important medial matters such as anthrax, microscopy and tuberculosis.

Koch and his team traveled from Germany to Egypt and India during major epidemics. There they discovered the presence of the bacteria in all the autopsies. Its signature bent look is now very recognizable.

The group did research that connected the bacteria to infected water supplies. This showed the immense need for clean water in local communities. Of course, guaranteed cleanliness was impossible for every person. Developing an effective vaccine would prove even more necessary.

Koch then made a discovery that would spark vaccine development. People infected with cholera became protected from the disease during that same outbreak.

In 1885, Spanish physician Jaime Ferrán, who studied under Koch’s rival Louis Pasteur, became the first to create a cholera vaccine. He did so after cultivating Vibrio cholerae and working with the live germs.

Ferrán became the first to do a mass-vaccination as well.

He used the vaccine to help 50,000 people in Spain during a major cholera epidemic. Later, he also created vaccinations for plague, tetanus, typhus and tuberculosis.

Two scientists, Sawtschenko and Sabolotny, and their students experimented with a killed cholera bacteria “broth” in 1893. The vaccine proved successful in in prevent cholera against exposure, but impractical. The “broth” required too many high doses to be preventive.

Further research and trials continued later in India during the early 1900s. Dried organism tablets were the focus but were not as successful as former vaccines. The cost and difficulty in their preparation was overwhelming.

Other clues about the bacteria created a gradual understanding of the disease.

Scientists isolated a new serogoup named El Tor that caused 400,000 cases. The O139 Bengal serogroup was also found in India and Bangladesh in 1992.

These findings added to the understanding and complexity of cholera. It also created a new desire and push for the vaccine throughout the 1980s and 󈨞s.

This new focus on a possible vaccine produced crucial research for the scientists.

They examined the idea of basic immunity after exposure to cholera. From the 󈨔s onward, many new vaccines were developed and licensed. Trials popped up all over the world. Everywhere from Sweden and Bangladesh to Peru and the Netherlands saw experiments.

These tests expanded knowledge on the theory of herd protection. Herd protection illustrated that vaccines could help both direct recipients and surrounding neighbors.

Travelers going to at-risk areas have benefited from advance protection against cholera. This is particularly necessary considering the rise in cholera outbreaks and epidemics.

While early vaccines relied on high doses, modern day immunizations are more efficient.

Vaxchora, the vaccine currently in use, only needs a single 100mL dose, protecting against the Vibrio cholerae serogroup 01. Taken 10 days or more before a trip, the immunization can reduce chances of cholera by 90 percent.

Even with modern advancements, vaccines are not the only ways to avoid cholera. Travelers should stay vigilant against contaminated food or water.

Do you have any questions about the cholera vaccine? Let us know in the comments below, or via Facebook and Twitter.

Written for Passport Health by Katherine Meikle. Katherine is a freelance writer and proud first-generation British-American living in Florida, where she was born and raised. She has a passion for travel and a love of writing, which go hand-in-hand.


Cholera: A Trail Epidemic

George Winslow Grave Marker, Fairbury Nebraska

In the early years of the California gold rush, cholera struck each spring at the thronging jumping-off towns along the Missouri River where thousands of gold seekers and Oregon-bound emigrants gathered to outfit. The deadly disease claimed many lives before the victims even had a chance to start across the prairies of Kansas or Nebraska. It claimed many more along the trail corridor to Fort Laramie, Wyoming, and in American Indian encampments and villages, as well.

Cholera is a bacterial infection that causes severe diarrhea and kills its victims through dehydration. The bacteria spread through water and food contaminated by human waste. Today cholera is treated by rehydrating the patient with salty solutions, but at that time the cause, means of transmission, and treatment of the disease were unknown.

Travelers spread the infection among the unsanitary outfitting towns and carried it west from campground to campground and waterhole to waterhole. Emigrants treated the sick with pain medications such as camphor, the oil of the Asian camphor tree, and laudanum, a bitter-tasting, addictive tincture made from opium, but victims often died within a matter of hours— healthy in the morning and dead by noon.

“For four hundred miles the road was almost a solid graveyard,” recalled George Tribble, who traveled to Oregon in 1852. “At one campground I counted seventy-one graves.” Of ten Tribble family members who started west, only five reached Oregon.

Most trailside cholera graves are unmarked, but one that is known belongs to twenty-five-year-old George Winslow, who died on June 8, 1849, near present-day Fairbury, Nebraska. Symptoms struck Winslow as his party crossed Kansas, not long after jumping off onto the trail. His company continued west, carrying George in a wagon for the next six days. He seemed to be improving but then a violent thunderstorm struck camp, chilling the sick man. He lingered another week. A companion, Bracket Lord, sadly wrote home, “George is dead— —his body lays here in the tent but his spirit has fled — Our company feel deeply this solemn providence. I never attended so solemn funeral — here we were on these plains hundreds of miles from any civilized being — and to leave one of our number was most trying.”

Winslow’s friends buried him deep on a grassy hillside, marked his grave with an inscribed sandstone slab, and sent word back to his wife and family in Connecticut. Many years later Winslow’s sons relocated the gravesite and erected a beautiful monument beside the trail swales. Owners of the family farm where it the grave lies have protected it and the swales since 1873.

Death on the Trail, from the diary of Virginia Reed, a member of the Donner Party.

Every year 3-5 million people around the world are infected with cholera and 100,000- 120,000 people die from the infectious disease, according to estimates by the World Health Organization (WHO). The disease, however, is of ancient origins, having existed in some form since the times of Lord Buddha and Hippocrates, if not earlier. The first recorded instance was in 1563 in an Indian medical report but in more modern terms, the story of the disease begins in 1817 when it spread from its ancient homeland of the Ganges Delta in India to the rest of the world. Since that time, untold millions have contracted and died from this preventable infectious disease.

Cholera is a preventable, acute diarrheal disease that leads to severe dehydration due to a massive loss of bodily fluids that can lead to sunken eyes, blue-grey skin and eventually death. 80% of cholera cases today can be prevented by the ingestion of rehydration salts. In the early nineteenth century the disease was thought to have been transmitted by a miasma or &ldquobad air,&rdquo but we now know that the disease is caused by the strand of bacterium called Vibrio cholerae, or simply V. Cholera. This bacterium flourishes in warm water and is transmitted through intake of contaminated food and water. The bacterium can turn into cholera as quickly as two hours which, according to WHO, &ldquoenhances the potentially explosive pattern of outbreaks.&rdquo

Cholera outbreaks in recorded history have indeed been explosive and the global proliferation of the disease is seen by most scholars to have occurred in six separate pandemics, with the seventh pandemic still rampant in many developing countries around the world.

The rapid modernization associated with the Industrial Revolution of the mid-19th century propelled the spread of the disease from its ancient homeland around the Ganges River. The first pandemic occurred in 1817 hitting India, China, Japan, parts of Southeast Asia, much of the Middle East, and Madagascar and the East African Coast opposite Zanzibar however, it died down in 1823 in Anatolia and the Caucuses before it reached Europe. As contact with India increased through trade and colonial endeavors&mdashnamely the creation of the British Raj&mdashthe disease began to spread along trade routes. The second pandemic of 1826-1837 swept across Europe&mdashstarting in Russia, then moving to Poland and subsequently the rest of Europe, North Africa and the eastern seaboard of North America&mdashcarried along shipping routes by merchants.

The disease hit Britain in October of 1831 reaching London in 1832 with subsequent major outbreaks in 1841,1854 and 1866. It was through these London cases Cholera has always been associated with the sea, with all of its recorded initial instances being at a seaside location. Thus, the increased speed and ease of travel allowed by the industrial revolution, particularly the opening of the Suez Canal and the invention of the steamboat in 1869, led to more rapid spread of the disease. Not only did the Industrial Revolution accelerate the disbursement of the disease around the world, but it also allowed for more rapid and devastating outbreaks when it reached Europe. Once in continental Europe, cholera quickly spread along major waterways and later railways. The disease subsequently reached the large and quickly growing industrial European cities and rapidly spread with the aid of the crowded and unsanitary housing conditions and unhygienic water sources.

The more widespread third pandemic of 1841-59 attacked the same regions as the second along with parts of south and central Europe. Subsequently, there was another massive outbreak from 1863-75 across the whole of Europe, large parts of northeastern, South and Central America, Africa, China, Japan and Southeast Asia. The world continued to suffer the effects of cholera with a fifth pandemic in many parts of continental Europe, the whole of the North African coast and various areas in Asia and the Americas form 1881-96. London was to escape the ravages of cholera during this pandemic because its water supply had been transformed by the building of Joseph Bazalgette&rsquos sewage system. It was only when the Europe&rsquos other industrialized cities followed London&rsquos lead that Europe avoided further pandemics, however the rest of the world was not so fortunate. Asia suffered immensely from a large outbreak from 1899-1923 and currently many developing nations in Africa, the Caribbean and Asia suffer in the seventh pandemic of cholera. This current pandemic began in South Asia in 1961, touched Africa in 1971 and then the Americas in 1991.

Both historically and presently Cholera has caused devastation across the globe. Cholera is, and has always been a preventable disease. It has spread around the world, starting at the Ganges River, through contaminated food and drink. While access to clean drinking water might not be an issue that many of us face, millions around the world still lack this resource. The migration of cholera throughout history is a testament to the widespread and universal problem of unclean drinking water that spans time and space.

Copyright © 2021 Cholera and the Thames, All rights reserved.

This project is generously funded by the Heritage Lottery Fund. The lead partners are Westminster City Archives the project is supported by Thames Water, WaterAid, The John Snow Society and the London City Mission. Much of the content has been produced by volunteers and interns.


The Fastest Killer in the Old West The cholera epidemic of 1873 struck fear on the frontier.

The cholera epidemic of 1873 struck fear on the frontier.

In August 1873, Dr. J.B. Van Velson, city physician for Yankton, capital of Dakota Territory, reported upon the arrival of some Russian emigrants who came directly from their port of entrance in New York City to settle temporarily in unoccupied buildings throughout the town.

These Russians were to be located “upon the farms in the territory that had been selected for them,” he wrote. The large majority of these emigrants “were of the lower classes, filthy in persons and habits” and “in the majority of instances, it was impossible to compel them to adopt any sanitary precautions in their lives the utmost repugnance was shown to the use of privies, both sexes preferring to urinate and defecate immediately around the building in which they were located.”

Dr. Van Velson then described the multiple deaths from cholera among these people and others in Yankton, sometimes occurring after only a few hours illness. His theory, widely held by other physicians at the time, was that cholera was brought by immigrants in this country from endemic areas overseas.

The 1873 cholera epidemic in Yankton was only a small part of a greater epidemic that affected at least 18 states and territories, including the state of Texas and the Territory of Utah. The epidemic was so severe that it led to a joint resolution of Congress on March 25, 1874, authorizing an “inquiry into and report upon the causes” of this disaster. President Ulysses S. Grant submitted the 1,144-page report, authored by Dr. John M. Woodworth (supervising surgeon, U.S. Merchant Marine Hospital Service), to Congress on January 12, 1875. The more than 7,000 cases and hundreds of deaths described in this report were probably only a small fraction of the actual morbidity and mortality of this epidemic.

The association between unsanitary conditions—especially drinking water contaminated with infected human feces—and the development of cholera was basically understood in 1873 America. Physicians also realized that contact with the “cholera poison” coming from an infected patient’s vomit or diarrhea could lead to the spread of the disease. The importance of hygiene was underscored by Dr. Woodworth’s conclusion: “What vaccination is to small-pox, disinfection is to cholera.”

We know today that cholera is caused by an enteric (fecal) bacterial organism called the Vibrio cholerae. In its severe form, the disease is characterized by the sudden onset of painless, profuse, explosive, “rice water” diarrhea with nausea and vomiting. Untreated cases lead to rapid dehydration, electrolyte imbalances, kidney failure and shock (circulatory collapse) culminating in death, sometimes within a few hours. The descriptions of untreated cholera patients are among the most disturbing in the medical literature. While losing fluids from both ends of the digestive tract, the patient is afflicted with an insane thirst in a matter of hours, his skin shrivels and ages from dehydration.

Very often, on the frontier, cholera patients suffered and died quickly without any medical attention. A cholera epidemic could wipe out 50 to 60 percent of the population of a wagon train or small settlement. Consequently, quarantine was one method widely used on the frontier to limit the spread of the disease.

The modern treatment for cholera is centered upon the immediate replenishment of fluids and electrolytes either orally, intravenously or both. Often antibiotics are administered in conjunction with rehydration therapy. Early medical treatments varied widely. Some included the administration of laudanum (opium), sulphur, sulphuric acid, spirits of camphor, turpentine, acetate of lead and even mustard plasters placed over the stomach and bowels. Some early remedies correctly included the replenishment of fluids by the ingestion of salt and sugar or even lemonade.

Compared with many other diseases, the treatment for cholera is fairly simple and effective. In this column, I usually write from the comfort of the 21st century about often obsolete and misunderstood medical problems that afflicted our predecessors in the Old West. How is it, then, that, as I write this article, the number of cholera cases in the current outbreak in Zimbabwe Africa is greater than 12,700 and the death toll stands at more than 1,100? Dr. Woodworth, where art thou?

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Cholera

Cholera, caused by the bacterium Vibrio cholerae, is very rare in the U.S. Cholera was common domestically in the 1800s but water-related spread has been eliminated by modern water and sewage treatment systems.

Nearly all cholera cases reported in U.S. are acquired during international travel. U.S. travelers to areas with cholera (for example, parts of Africa, Southeast Asia, or Haiti) may be exposed to Vibrio cholerae.

During outbreaks in countries near the U.S., such as Haiti in 2010 and Latin America in the 1990s, cholera cases reported domestically increased. In addition, contaminated seafood brought into the U.S. has caused cholera infections.

Surveillance

CDC, through collaborative efforts among state health departments, provides a comprehensive list of diseases that occur in the U.S. Any cholera case is reported nationally through the CDC and internationally in compliance with the World Health Organization&rsquos external icon International Health Regulations.

There are several systems at the CDC that conducts surveillance for Vibrio infection:

Cholera and Other Vibrio Illness Surveillance System (COVIS)

The Cholera and Other Vibrio Illness Surveillance System (COVIS) was initiated by CDC, FDA, external icon and the Gulf Coast states (Alabama, Florida, Louisiana, and Texas) in 1988. CDC maintains COVIS to obtain reliable information on illnesses associated with a species in the family Vibrionaceae COVIS provides this information, which includes risk groups, risk exposures, and trends to regulatory and to other prevention agencies. COVIS is part of the National Surveillance Team of the Enteric Diseases Epidemiology Branch.

Foodborne Diseases Active Surveillance Network (FoodNet)

The Foodborne Diseases Active Surveillance Network (FoodNet) conducts active, population-based surveillance at 10 U.S. sites for laboratory-confirmed infections of selected bacterial and parasitic pathogens transmitted commonly through food, including Vibrio.

The National Notifiable Diseases System (NNDSS)

The National Notifiable Diseases System (NNDSS) collects and compiles reports of nationally notifiable infectious diseases, including cholera and vibriosis. NNDSS collects data from states on both laboratory-confirmed and probable cases of infection.

The National Antimicrobial Resistance Monitoring System (NARMS)

The National Antimicrobial Resistance Monitoring System (NARMS) monitors antimicrobial resistance among enteric bacteria (including Vibrio) from humans. Since 2009, NARMS has requested submission of all Vibrio isolates from participating laboratories for antimicrobial susceptibility testing.

The National Outbreak Reporting System (NORS)

The National Outbreak Reporting System (NORS) collects reports of foodborne, waterborne, person-to-person, and animal contact-associated disease outbreaks from local, state and territorial public health agencies.



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