The Assent of Cholera in 19th Century Britain

Cholera was a disease that caused great fear and loathing in 19th century Britain. Thought to have been a problem only associated with the poorest people, cholera was a deadly illness that usually proved fatal to its victims. It caused great pain and suffering to those afflicted, and tormented those who were forced to watch their loved ones suffer in great agony. Little information was known as to the causes of the disease or to its method of transport among victims, and it was practically unheard of in Britain.

The industrial progress of the nation and the massive influx into Britain's cities by the rural populace seeking relief from the economic downturn of the time, and forced to live in squalid conditions, with inferior housing, little or no sanitation, less than pure drinking water, meagre rations of food and no real medical care. These and other conditions provided the means and mechanism for cholera to take hold, once it arrived on British shores in 1831-32. Rumours and propaganda about cholera made the citizens wary of what to believe, and there was no way to dispel the misinformation that was spreading all over the country. It was only after cholera started to claims lives that more attention was given to the disease.

The works of Edwin Chadwick, Dr. John Snow and many others contributed greatly to the reform of unsanitary and unsafe living conditions that plundered the country and that ultimately helped to stop the spread of this devastating disease.

Background to a national disaster

In the early 1800s, Britain was experiencing the full force of the Industrial Revolution. Until the late 1700s, most of what became the British industrial workforce lived in the rural areas. However, by the 1830s, the economic downturn had forced most of the rural population to migrate toward the industrialized cities, to industries such as textiles and tin making, among others. Here they were competing for low wages, long hours and horrible working conditions.

The growing population meant that the industrialized areas of Britain could not evolve fast enough to keep up with the needs generated by the influx of humanity. Housing was overcrowded, in poor repair and sometimes lacking in cleanliness. Often there were no means to deal with the sanitary needs of the families in the houses, which mostly meant the use of a chamber pot, which was dumped in a location, which was probably the most convenient to the home, as opposed to the safest. There was no collection of refuse, or a designated area to place it in, and so it was left to pile up in the street, rotting and creating a home for rats and other creatures. Human waste was left in the street or thrown in the nearest available water source, be it a river, lake, or stream; which might be a source of drinking and cooking water for a community. There was no public water supply or method of containing raw sewage in any of the industrial centres of industrial Britain.

In the 1830s, the idea of social class and the ensuing discrimination that came with it was alive and well in Britain. The poor struggled in bleak conditions simply to eke out the most meagre of an existence, literally lived hand to mouth, barely able to feed, house and clothe themselves and their families. While the rich and powerful factory owners used the toils of the labourers to line their own pockets with profits, and giving little or nothing in return to their workers. The poor did not trust their employers at all, in any sense of the word, and were locked in a cycle of poverty from which there seemed no escape. In 1798, Thomas Malthus, the noted economist, described the deplorable conditions of the poor in the cities and wrote about how the population explosion and how this phenomenon would continue to add to the burden of the poor, until it became a problem of huge proportions.

The beginnings of Cholera in Britain

In 1826, the spread of cholera began to overtake the population in India, otherwise known as a pandemic. British physicians observed the disease as it took hold and tracked it as it made its way to Russia by 1830 and into the Austro-Hungarian Empire by 1831. By 1832, cholera had a firm hold in Britain. The disease was thought to have entered Britain at the port of Sunderland, as this was where the disease was first reported. It was thought to have come to Britain via Baltic seaports such as Gdansk.

In the beginning, reports of the disease were met with distain and distaste by the upper social classes. Rumours ran rampant amongst the population. The medical establishment contended that European cholera victims tended to be from the lower classes. Conspiracy was a word that fluttered around, with various theories being proposed. Some believed that cholera was a fictitious disease, created by the medical community, with the intent of scaring the population to purchase various potions and remedies to combat cholera. Others believed that cholera did not even exist. They thought the government (in essence the wealthiest segments of the population) had decided to poison the wells of the poor in order to get rid of the 'surplus population', which Malthus had predicted. Fear of the unknown, coupled with the horrid symptoms of the disease, further exacerbated the antagonism of the strain between the classes. Many victims died rapidly after the onset of cholera, but not before experiencing terrible symptoms. Often, the victim would feel very normal one moment, and then begin to feel extremely unwell. This would be followed by the onset of more symptoms such as nausea, diarrhoea, cramps, vomiting, rapid pulse, dehydration, lethargy and dry skin, each more severe than the last, with death resulting within 2-7 days.

The theories of cholera transmission

No one understood the causes, but doctors had a plethora of theories. Some believed that it was passed though the air by the unhealthy secretions of a victim. This group was called the 'effluvyists", so named for the effluvia (outpouring of liquid from the body) of cholera victims. Another group, know as the Miasmatists, who thought that the rubbish and raw sewage that was left in the streets which was a byproduct of the cities and the overcrowded conditions, gave off a kind of deadly vapour (miasma), which when inhaled caused the victim to become infected with cholera . Other theorists felt that the unhealthy diet of the poorer classes was at fault. Still others suggested theories included unclean water, or the 'immoral drunkenness' and 'dirty habits' of the poor, or that a chemical contaminant caused the illness. And some preached that cholera was retribution from God for the sins of man, and there was nothing that halt the disease.
Cholera Returns

After the initial bout with the disease in 1831-32, cholera did not resurface to any large degree Britain until 1848. In the time that had passed between outbreaks, little had changed in regards to the cause, detection or eradication of the disease. The medical profession was still arguing over the causes of cholera and the public apprehension of the disease had not improved. The general consensus amongst the upper classes was that cholera was still a disease festered by the poor. The work of Edwin Chadwick and several others brought the fact that there was great need to provide for the greater good of all the population to the forefront of the public consciousness.

After the publication of the Report on the Sanitary Condition of the Labouring Classes of Great Britain, in which Chadwick noted the abysmal conditions and the areas that needed to be improved upon, the government was starting to take some measures to try to prevent the spread of cholera. Measures that the government implemented, in part were:

• Establishment of Cholera hospitals
• Quarantine of ships coming into British ports
• The passage of the 1848 Public Health Bill, which ensured that potable water and proper drainage was available to new homes
• The building of public baths and wash-houses
• Piped water
• Paved roads

It was during this time that Dr. John Snow, a prominent British surgeon, began to study cholera in earnest. A radical new idea was being passed around certain segments of the medical community. Although at this time an unproven theory, it was thought that some diseases could possibly be caused by an infection by certain microbes. This concept had been around since the 17th century, but was not widely circulated by the traditional medical establishment. Snow knew of this idea, and thought it might be applied to the study of cholera.
The work of Dr. John Snow

In 1849, a particularly terrible outbreak occurred along Broad Street in London, and this was to prove to be the time that all of Snow's years of research was to come to fruition. Over a 10-day period, almost 500 people died within a 250-yard radius of the intersection of Broad and Cambridge Streets. In this area was a well-used public water pump. Snow was certain to a high degree that cholera was transmitted via a water supply. He believed that the water at the Broad street pump was contaminated with cholera-laced microbes.

To prove his point, he set about conducting an experiment. He went to the London General Register Office to obtain the names and address of 83 people who had died of cholera from suspected usage of the Broad Street pump. He then conducted a survey of the residents to get information about the habits of the cholera victims. He ascertained that of the 73 victims that lived near the pump 61 were known to have drunk the water. Of the remaining 13 victims, eight were among family members that were sent to get water from the pump or children that attended the school nearby. The data strongly correlated with Snow's theory that the pump was contaminated. Because of his efforts and work, the handle of the Broad Street pump was removed. At this time, the epidemic was in its last throes, and there fore the removal of the pump could not be viewed as the moment that ended the epidemic. However, the removal was viewed as a response to a theory that was being taken seriously.

During the epidemic of 1853-54, Snow set out to find lasting proof of his theory's validity. In his book, published in 1849 called On the Mode of Transmission of Cholera, Snow had introduced the contaminated water theory. He argued that since the major symptoms of cholera were concentrated in the intestines, water had to be a leading component in the transmission of the disease . There was still no public water supply available to the mass population. However, water was being marketed to residents and sold by the bottle, while other companies were running pipes in some areas and allowing the purchase of water from these pipes, which then would be hooked into the residence. This constituted a major part of Snow's studies in this period, as his studies indicated that the water being sold was the contaminated water from the River Thames.

There was great competition between the Lambeth Company and the Southwark & Vauxhall Company to sell their water. Snow compared the data of cholera victims to what water supplier they used and found that Southwark and Vauxhall Company users had over 1200 deaths from cholera as opposed to just fewer than 100 for the customers of the Lambeth Company. The Lambeth Company had moved its intake pipes upstream on the River Thames after the outbreak in 1832, while Southwark & Vauxhall continued to pipe from the area where London sewage entered the river , and this provided substantial validity for the theories of John Snow on cholera and its links to water contamination.

The End of the Epidemics

Once that there was sufficient evidence that had been established to link the disease and contaminated drinking water, and with untreated sewage, there was a great deal of pressure brought to bear on the national government and local municipalities. They were forced to begin to address and to provide the basic mechanisms for an infrastructure to ensure a safe water supply for the populace and to deal with the problems of sewage treatment and waste disposal problems. Measures such as the passage of the Public Health Bill and the Nuisances Removal Bill (also know as the Cholera Bill) will sought to begin to implement such things as paved roads, better housing, piped water and new sewers for the entire population, rather than just benefit the wealthy.

The cholera epidemics that had scarred the population during the early and mid 19th century began to recede in memory with the advent of these new concepts. Edwin Chadwick and his colleagues had begun to make inroads into the poor economic and social conditions that the poorer classes were faced with. They had highlighted the squalor and poverty the people were forced to endure, and to eradicate the idea that the poor were filthy, ill-kept and immoral beings, but rather were a group, which had been preyed upon by those in power to provide cheap labour to fund maximum profit of the wealthy business owners. And, in addition, to impart the notions that the poor were victims of cholera, as opposed to the purveyors of this wretched disease. The so called Chadwick report made the government take notice and provide the lower classes with reforms that not only provide for their medical wellbeing, but also for their physical and mental wellbeing. It should be noted that this change of events could be viewed as a point from which the class divides may have been started to inch closer to closing the enormous gap that had for so long separate the very differing segments of British society.

The work of Dr John Snow proved invaluable in the effort to dissect and contain the cholera epidemics. His work no doubt led to the saving of thousands of lives in the latter half of the 19th century and led to a better understanding of the epidemiology of cholera. His painstaking investigations of the Broad Street pump contamination and later the usage of contaminated water from the River Thames provided invaluable evidence for the medial community to finally accept his theories and to begin to make inroads into halting the progression of the disease. His insistence of the removal of the handle of the Broad Street pump to prevent its usage no doubt helped to bring the epidemic to an end in that area. Nevertheless, he has gone down in medical history more so for his efforts in tracing the causes of cholera and how the disease was transmitted to the population.