Wednesday, 6 May 2009

Containing epidemics: cholera, 1832

As swine flu fills the headlines, much attention is focused on limiting its spread. Modern life and science give us some strong tools such as antiviral drugs, and some new problems such as fast and frequent air travel. However, the problem of containing the spread of epidemics is not a new one. The plague which devastated London in the middle ages and returned periodically until 1665 is an obvious example.

More recently, the cholera epidemic of 1832 killed over 6,500 people in London; it would be followed by an 1849 outbreak in which more than twice as many died; an 1854 epidemic killing nearly 11,000; and a localised outbreak in the East End in 1866, which took the lives of 5,596 people. Cholera is an acute intestinal infection which causes severe diarrhoea and vomiting: the resulting dehydration is the usual cause of death.

For much of the nineteenth century, the fight against cholera was made more difficult by lack of knowledge about its transmission. Miasma theory was generally accepted: according to this, diseases were carried in miasmatic particles suspended in foul-smelling vapour. Infection was a result of breathing this polluted air. Thus there was a focus upon eliminating damp, odours and dirt - helpful actions taken for the wrong reasons. The influence of that theory is clearly apparent in this notice distributed in Deptford during the 1832 outbreak:


To be affixed and preserved in every House.

Fellow-Parishioners – For your own sakes, use the utmost care to remove from your Houses all kind of Rubbish and Filth, and Lime-white the Walls and Ceilings as often as they become discoloured.

Keep your Drains clear, and destroy all unpleasant Smells by opening the Windows of your Bed Rooms as much as possible, but not after dark; and remove all Slops the first thing in the Morning.

Wash the Floor daily, but dry it well.

Keep yourselves and your Children as clean, and as warm as you can.

Abstain from Spirits

Boil your Vegetables well, and abstain from Raw Salads and Fruits.

If attacked with looseness of the Bowels, however slight, obtain Medical aid immediately, either by application to the Dispensary, or to the nearest of the following Gentlemen:
Mr. HATFUL, in Union Street.
Mr. MITCHELL, in High Street.
Mr. DOWNING, in Broomfields
Mr. PRICE, in the New Cross Road.
Mr. ATKINS, in Union Street.
Mr. BROMLEY, in Broomfields; or
Mr. DAVIS, the Secretary, in Church Street.

When Cramps in the Arms, Legs, or Belly, are felt, in addition to looseness of the Bowels, & Medical aid is not instantly to be obtained, THREE TEA-SPOONSFULL OF MUSTARD POWDER in half-a-pint of Warm Water, or the same quantity of Warm Water with as much Common Salt as it will melt, should be taken as a Vomit; and after the Stomach has been cleared out with more Warm Water, take from 20 to 30 Drops of Laudanum in a glass of any agreeable drink; apply a warm Poultice to the Stomach made, one half of Flour of Mustard and the other of Linseed Meal, moistened with hot Vinegar. Apply also Bran made hot in bags, or Bottles of Warm Water or Heated Plates, Tiles, or Bricks to the Feet. The Patient must go into a Warm Bed.

Church Street, Deptford, Feburary 24, 1832.


One suspects that taking 'a Vomit' would only worsen matters. Indeed, today the primary treatment is oral or intravenous rehydration therapy, which restores liquids and electrolytes to the body.

Significant progress on understanding the transmission of cholera was first made in 1854, when Soho doctor John Snow demonstrated that the disease was carried in drinking water - and in the process, pioneered epidemiology. He famously removed the handle from the Broad Street pump and stopped the outbreak. However, his findings contradicted miasma theory and were not generally acted upon. Cholera epidemics finally ceased in London thanks to Bazalgette's sewage system which protected drinking water from contamination by fecal matter - the final outbreak came just before the system was completed in the East End.

Explore further: Broad Street is now Broadwick Street, where Snow is commmemorated by a pub named the John Snow (rather ironically, since he was a teetotaller). The original pump is gone, but a replica stands on the street corner.

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