Today I am lucky enough to have a guest on my blog – author and historian Amanda Thomas, whose latest book Cholera – The Victorian Plague has just been published by Pen & Sword History. Here she offers a fascinating, and tragic, overview of this terrible disease, which still ravages communities in many parts of the world. My sincere thanks to Amanda and full details of how you can purchase her book are given at the end of the piece. If you have any questions or comments we would love to hear your thoughts on the subject.
I have been interested in cholera for many years and my second book on the subject, Cholera: The Victorian Plague has recently been published by Pen and Sword. I first became aware of the cholera epidemics of the nineteenth century when a distant cousin, Susan, asked me why some members of our family had disappeared in Lambeth in the late 1840s, specifically James and Anne Osmotherly, who originated from the Hoo Peninsula in Kent. James is my second cousin five times removed and Anne was the niece of Susan’s great grandmother. Susan and I visited Lambeth Archives in London and discovered that James and Anne had both died of cholera, an often fatal disease which causes severe vomiting and diarrhoea, and which is commonly thought to be caught by ingesting water tainted with sewage.
It was at Lambeth Archives that I opened for the first time a box of documents entitled The Lambeth District Sanitary Reports. These pristine papers, virtually untouched since the day they had been written, were to form the basis of many articles about the 1848 to 1849 cholera outbreak and eventually my first book on the disease, The Lambeth Cholera Outbreak of 1848-1849 (McFarland, 2010). The District Sanitary Reports were written in two or three phases in January and February 1848 and give a vivid insight into the deplorable living conditions of Lambeth’s working poor. They were produced in response to the 1847 Metropolitan Sanitary Commission to investigate whether better drainage and sanitation might improve the health of Londoners.
In the nineteenth century thousands died from cholera in Britain during the four major epidemics of 1831-2, 1848-9, 1853-4 and 1866, and in the years between when the disease was still prevalent but not so virulent. In Lambeth alone in 1848 and 1849 around 2,000 died, perhaps more, but many deaths were attributed to dysentery and, despite the introduction of civil registration in 1837, some went unrecorded. At a time when disease was little understood and the government was fearful of uprisings like those which had taken place in France and America, it was important to keep the working poor in check. Deaths from cholera in the early stages of an outbreak were kept as quiet as possible by the medical elite so as not to cause widespread panic; those most at risk of the disease were the poorest members of society and also most likely to cause unrest. The working population was concentrated in the densely populated riverside communities of conurbations which had grown up and rapidly expanded in the early days of the Industrial Revolution. Epidemic diseases such as cholera are opportunistic and will spread easily and fast in environments like these where there is a lack of sanitation and little understanding of basic hygiene.
Death from cholera is swift, painful and unpleasant, as the dehydrating effect of the disease causes the blood to thicken, affecting circulation and respiration. In a densely populated community cholera will spread voraciously once it has taken hold, killing vast numbers throughout the warm weather of summer and early autumn. During the worst epidemics gravediggers were unable to keep up with the number of burials, and the merciless nature of cholera, together with the sight of coffins piled high at cemetery gates, had a profound and lasting effect. In the nineteenth century cholera was as feared as the plague, or Black Death. Local authorities and the government knew something had to be done but the challenge was enormous and also extremely costly. In the new urban industrial areas such as Lambeth’s waterfront, houses for the working population had been erected hastily and without care. A lack of sanitation, filth, damp and poor ventilation were all factors in the spread of other potentially fatal diseases such as smallpox, tuberculosis, measles and diphtheria.
Politics and religion divided opinion and played a part in delaying social reform; ignorance and prejudice impeded scientific progress. Most believed disease was spread by miasma, or foul air, which did not help the argument for improving sanitation. Yet whilst the poor were the worst affected by cholera, the better off were not immune, and the repetitive severity of successive cholera outbreaks highlighted an urgent need to improve Britain’s sanitary infrastructure for everyone. Outbreaks of influenza and typhus in the late 1830s also had an effect, but by the middle of the century the putrid stench emanating from rivers and open sewers, scientific observation and the gathering of statistics were all catalysts for change.
The stories of Dr John Snow and the removal of the pump handle in Soho, and Joseph Bazalgette’s new system for London’s sanitation are well known. They reinforce the common understanding that cholera is not transmitted through the air in miasma, but rather, it is a waterborne micro organism, a vibrio, which spreads through water tainted by sewage. Today cholera remains a serious threat to public health but current research and the recent outbreaks, such as those in Haiti and Bangladesh, have shown that contaminated drinking water is not the whole story, which the historic record confirms.
In Bristol during the 1866 cholera outbreak Dr William Budd realised that the working population was at risk of contracting the disease not just from a contaminated water supply but because of their poor hygiene. Budd and his colleagues made local people aware of the need for cleanliness and also put in place a system for disinfecting affected houses. As a result only 29 people died in Bristol during that outbreak.
There is no doubt that the cholera epidemics during the Victorian era played a part in speeding up social reform, including effective sanitation. However, as the recent Ebola outbreak has highlighted, deadly infectious diseases are still a threat to public health in Britain. The good sanitation which we all enjoy – and the efficacy of antibiotics until recently – have created a dangerous complacency. Today most diarrheal disease in Britain is caused by an ignorance of good hygiene, particularly the importance of hand washing and careful food preparation. In the Victorian period the rapid spread of cholera through densely packed communities was not because of tainted water, but rather by hand-to-mouth (oral-faecal) contamination. At the peak of successive outbreaks, cholera spread most rapidly through the female population, the women caring for the sick and washing the garments and bedding of the dead. Cholera is a resilient bacterium and can remain dormant for long periods of time, including within dried vomit and excrement. Those handling such materials who neglected to wash their hands with soap and water afterwards caused the spread of cholera just as effectively as the tainted water supply in John Snow’s Soho. Bacteria are cunning and opportunistic and our ignorance of the importance of basic preventative measures – such as simple hand washing – means that we will always be vulnerable to diseases like cholera.
AMANDA THOMAS is an author, historian and linguist; she has previously worked in journalism, and public relations. Her books include ‘The Non-Conformist Revolution’ (Pen & Sword History, 2018), ‘Cholera – The Victorian Plague’ (Pen & Sword History, 2015), and ‘The Lambeth Cholera Outbreak of 1848-1849’ (McFarland, 2010). She has advised on the BBC’s ‘Who Do You Think You Are?’ (Series 10, 2013), ‘The One Show’ (2016) and, in collaboration with English Heritage, on ‘The Flying Archaeologist’ (2013)