The Prevention and Treatment of Epidemic Cholera. From the holdings of Andover–Harvard Theological Library—Harvard Divinity School.
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.
Causes of Cholera
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.
The Epidemics Subside
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. For additional materials on the topic “Cholera Epidemics in the 19th Century,” click here or search the collection’s Catalog and Full Text databases.