*Post written by Mona Meyer, Archives and Special Collections Metadata Librarian.
… comes around. As we deal with the COVID-19 pandemic, it might be instructive to look to the past to see how others dealt with such disasters. One such example was the 1918 Spanish flu pandemic. Page forward, the library’s newsletter, had an article on this in the Fall 2018 issue. In the mid to late 1800s there were cholera outbreaks worldwide, including here in Indiana.
Just what is cholera? According to the CDC, or Centers for Disease Control and Prevention, “Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. An estimated 2.9 million cases and 95,000 deaths occur each year around the world. The infection is often mild or without symptoms, but can sometimes be severe. Approximately one in 10 (10%) infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.” Here’s an image of the beast itself, the bacterium Vibrio cholerae.
Cholera transmission is the result of poor sanitation and hygiene, particularly inadequate water treatment. ”A person can get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person that contaminates water and/or food. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill.” Cholera is very rare in the United States, but there is a vaccine for travelers who travel to parts of the globe where it is still rampant, parts of Africa, parts of southeast Asia, and Haiti. Treatment largely consists of rehydration to combat the effects of diarrhea and vomiting. Antibiotics can diminish the severity of symptoms, but replacement of fluid loss is the key. According to the CDC, “With prompt appropriate rehydration, fewer than 1% of cholera patients die.”
Cholera has probably been around since ancient times, but the first major pandemic began in India in 1817 and spread via trade routes by 1821 it had reached parts of southeastern Europe. A second pandemic began in 1829 and by 1832 it appeared in the United States. The biggest enemy was not the cholera, but complete ignorance. In Great Britain, “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.”
The most common, widespread belief of how cholera spread was the miasma theory. In June 1837, a doctor by the name of David King, Jr. won the Fiske Fund Prize from the Rhode Island Medical Society for his dissertation entitled Cholera Infantum: Causes and Treatment. In it, he proclaimed, “In the first place, this disease has a specific miasmatic cause. Most endemic maladies, probably, arise from some emanation from the soil, owing to the dissolution of animal and vegetable matter. We know not the nature of these miasms, because they are beyond the reach of our senses and the analyzing processes of art.” Furthermore, ”The impure air of cities, independent of the specific miasm, predisposes the system to the disease. It acts through the medium of respiration, contaminating the blood, and lowering the general tone of the system. In the narrow lanes and alleys, and in the filthy and crowded habitations, of our large cities, the morbid agency of impure air is seen in the great prevalence of this disease.” Dr. King goes on to recommend that children should spend their summers in the country where the air is better, or at least sleep at night in the country during the summer because the threat of infection was greater at night due to the inactivity of sleep. If this was not possible, then the child should sleep in the upper stories of a house, because it was believed that the miasma would not rise that high, or at least its virulence would be lessened as it rose. In other words, it’s in the air. It’s no wonder that the cholera outbreaks of the 19th century caused hysteria and mass evacuation. In New York 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.”
There were at least 4 pandemics–1832, 1849, 1866, and then 1873, with outbreaks in between. Although big cities were devastated by cholera, “Small towns got hit even worse. These small towns are built off of farming and when cholera came in and started raising death tolls, the economy struggled because a decrease in population means a decrease in labor to work on the farms.” Cholera in small, rural settings certainly raises doubt about Dr. King’s theories about the impure air of cities. The deadly foe arrived in Indianapolis on July 24, 1873 and spread around the city. “One of the most important small towns it hit next, due to its position on the railroad line, is the city of Cumberland, Indiana. The first case in Cumberland occurred on August 8th, 1873 and was unfortunately fatal. It took the life of a German mother of four who had only contracted the disease 12 hours prior to her death. Only five days after the first case, 15 more cases were found and eight of them had quickly passed away. In only five weeks there were 80 cases of Cholera in Cumberland alone and 32 were fatal. Because Cumberland and Indianapolis were key railroad cities, the economy had been severely affected. No one wanted to take a train through these cities in fear of contracting the disease and even if they did, the population of people who could actually work the railroads were decreasing either by sickness or by people fleeing the city to find somewhere Cholera had not reached yet.”
Aurora, Indiana is a small town on the Ohio River, some 25 miles from Cincinnati. In an 1832 cholera outbreak, it lost some 30 people out of a population of only a few hundred. By the time the 1849 pandemic came, its population had risen to 2,000. “On June 14, there were 14 deaths despite great efforts to purify the air by fires burning at street crossings and a canon fired every 25 minutes for 4–5 hours. Fifty-one more died over the next three weeks. Sixteen hundred of the 2,000 residents fled the town. … One hundred twenty-two died in the town; there were 13 deaths among the 1,600 who fled. Four county physicians died during that epidemic.”
In his history of Indiana University (at the time of the events described below, it was Indiana College), David Banta notes that after the 1832 outbreak ceased, some breathed a sigh of relief, only to gasp in horror again as it arrived again in the Hoosier state mid-1833.
“Two centers of attack were made, one in the eastern part of the state and the other in the southern. At Greensburg, a small village of a few hundred inhabitants, 30 deaths occurred in a few hours. Out of a population of 150 in New Castle, 16 fell victims. The mortality was less at Richmond. In the south, the severest sufferer was Salem. Here the mortality was appalling. In the town 65 died and 48 in the country round about, II3 in all. From Salem it marched to Paoli; it is next heard of at Bedford, and thence it passed on to Bloomington. On Saturday morning, August 10, as certain ten-o’clock church-goers passed the residence of Mr. George Johnson, on the southwest corner of the square, on the lot now occupied by the First National Bank, Anneka, the colored family servant, was seen gathering fuel to start the dinner fire. At two o’clock, the same churchgoers, and other persons, were giving her a hasty burial. Between the hours of 10 a.m. and 2 p.m. she had been stricken and had died of cholera, and her very hurried funeral testifies to the extreme alarm that had possession of the town. The same afternoon a student by the name of Huntington, from Indianapolis, was attacked and died during the night. He was buried early the next morning, the faculty and most of the students attending the funeral. Mr. William McCollough, a prominent citizen, died about the same time, and others followed in quick succession. All was now alarm and confusion. A few families fled the town, one in particular seeking safety at Ellett’s tavern on the road to Gosport. When the students reached the place, the landlord and his wife were both found in the agonies of death from the dread disease. All College work now ceased, and the great majority of the students left at once for their homes. Says the venerable Judge Roache, who was here as a student at the time, “Those who were able to secure conveyances or horses went in that way, but my recollection is that the great majority could not secure any sort of conveyance, and in their wild hurry to escape from the pestilence left town on foot.”“
In July 1849, cholera came to Hanover, Indiana, where at least 14 deaths occurred. The president of Hanover College, Sylvester Scovel, and 3 students died, with the college closing for several weeks.
“On July 14, 1849, the New Albany Democrat reported 50 deaths in Washington, Indiana (pop. 1000). On July 17, the paper said that only five families were left in Washington. The rest were dead or fled. On July 19, the Evansville Weekly Journal reported “that Washington had had 12 deaths between 6:00 a.m. to 8:00 p.m. People were fleeing.””
Closer to home, “The second visitation of cholera in Gibson County occurred in the summer of 1873. … A small epidemic had occurred in the Eastern states in 1865, but in 1873 cholera again got a firm foothold in the South and traveled up the Mississippi valley. It became epidemic in Evansville and Mt. Vernon. Indiana. Cairo and Carmi, Illinois. Paducah. Kentucky, and many deaths occurred, and it is from one of these infected places that it is believed to have spread Princeton. … The known total of deaths in Gibson county during the cholera epidemic of 1873 is twenty, but it is very probable that there were a few more. It was by far the worst epidemic of any disease which ever visited the county. … In 1873 Gibson county was not the only locality to suffer greatly from the disease. At Mt. Vernon and throughout Posey county the epidemic was prevalent. Hundreds fled to higher points away from the river. Albion, Illinois, was a refuge for a great number and they remained until the scourge had spent its fury. Other cities along the Ohio river also suffered greatly, including Cairo, Illinois, Paducah and Henderson. Kentucky, and Evansville. At the latter place, however, the death ratio was not large.”
In much the same way as the coronavirus has caused economic hardships, the same was true in the 19th century cholera outbreaks. “Through these cholera waves, the Indiana economy was badly affected. Business was not active in towns where people were afraid of dying. Certainly, the economic effects of flight must have been large. Hog prices were depressed in Madison and Cincinnati. On July 16, 1849, Calvin Fletchter of Indianapolis wrote in his diary, “I will not keep as many cattle to fatten; I will sell them; I fear the future. The cholera must depress prices. Cities will be closed until it is understood that the disease has left the county.” In 1850, the railroad between Madison and Indianapolis stopped running because of cholera. This was the only railroad in Indiana.”
One difference between the cholera outbreaks and today’s coronavirus pandemic is the amount of information available to the public. “In 1849, cholera was in Vincennes, Indiana, again. It was an important commercial site on the Wabash River, part of the canal system between Lake Erie and the Ohio River. Cholera was there again in 1849 and, again, businessmen attempted to suppress its recognition. The doctor who diagnosed cholera in 1849 was forced to leave the town. By August 1, 1850, the Vincennes Gazette admitted there had been seven deaths in Vincennes. The Gazette stated that numbers had been exaggerated and one should not believe rumors. On August 8, 1850, the Gazette reported that the disease was subsiding. It noted with considerable pride that deaths in Vincennes had averaged 1 1/2 per day. This, it said, was “the best in the United States where cholera had existed.”” In Lafayette, newspapers reported the first few cases of cholera in June 1849, but “as the disease spread through the town, the newspapers and the board fell silent, not wanting to broadcast the town’s plight.” And the plight was real—somewhere between 300-800 died in Lafayette that summer.
Finally, back to the cause of cholera and the dangers of ignorance. Filippo Pacini (1812-1883) was an Italian whose parents had destined him for the priesthood. At the age of 28, he turned his back on that career and attended medical school, becoming particularly adept at dissection and the use of the microscope. He accepted a position at the University of Florence, where he spent the rest of his life. Cholera arrived in Florence in 1854. “Pacini became very interested in the disease. Immediately following the death of cholera patients, he performed an autopsy and with his microscope, conducted histological examinations of the intestinal mucosa. During such studies, Pacini first discovered a comma-shaped bacillus which he described as a Vibrio. He published a paper in 1854 entitled, “Microscopical observations and pathological deductions on cholera” in which he described the organism and its relation to the disease. His microscopic slides of the organism were clearly labeled, identifying the date and nature of his investigations.” Pacini’s work, unfortunately, was completely ignored by the scientific community. A German physician by the name of Robert Koch (1843-1910) was better known. In 1882 he identified the tuberculosis bacillus and in 1884 the cholera bacillus. This was 30 years after Pacini, so this was a re-discovery. To be fair, Koch was unaware of Pacini’s work when he was credited with this discovery. It took 82 years for Pacini to finally receive his due, when, in 1965, the international committee on nomenclature finally adopted Vibrio cholerae Pacini 1854 as the official name of the cholera bacillus.
Also, in 1854, a London physician, John Snow, conducted what today would be called a crime scene investigation, enabling him to pinpoint to source of transmission of the deadly disease. He believed that contaminated water was the key. No one had running water or indoor plumbing in those days. Water came from communal wells or pumps, and sewage was often dumped directly into the Thames. Water companies then turned around and bottled the water from the Thames and sold it. The following quote is rather long, but it tells a fascinating story.
“In August of 1854 Soho, a suburb of London, was hit hard by a terrible outbreak of cholera. Dr. Snow himself lived near Soho, and immediately went to work to prove his theory that contaminated water was the cause of the outbreak. “Within 250 yards of the spot where Cambridge Street joins Broad Street there were upwards of 500 fatal attacks of cholera in 10 days,” Dr. Snow wrote “As soon as I became acquainted with the situation and extent of this irruption (sic) of cholera, I suspected some contamination of the water of the much-frequented street-pump in Broad Street.” Dr. Snow worked around the clock to track down information from hospital and public records on when the outbreak began and whether the victims drank water from the Broad Street pump. Snow suspected that those who lived or worked near the pump were the most likely to use the pump and thus, contract cholera. His pioneering medical research paid off. By using a geographical grid to chart deaths from the outbreak and investigating each case to determine access to the pump water, Snow developed what he considered positive proof the pump was the source of the epidemic. Besides those who lived near the pump, Snow tracked hundreds of cases of cholera to nearby schools, restaurants, businesses and pubs. According to Snow’s records, the keeper of one coffee shop in the neighborhood who served glasses of water from the Broad Street pump along with meals said she knew of nine of her customers who had contracted cholera. … Snow also investigated groups of people who did not get cholera and tracked down whether they drank pump water. That information was important because it helped Snow rule out other possible sources of the epidemic besides pump water. He found several important examples. A workhouse, or prison, near Soho had 535 inmates but almost no cases of cholera. Snow discovered the workhouse had its own well and bought water from the Grand Junction Water Works. The men who worked in a brewery on Broad Street which made malt liquor also escaped getting cholera. The proprietor of the brewery, Mr. Huggins, told Snow that the men drank the liquor they made or water from the brewery’s own well and not water from the Broad Street pump. None of the men contracted cholera. A factory near the pump, at 37 Broad Street, wasn’t so lucky. The factory kept two tubs of water from the pump on hand for employees to drink and 16 of the workers died from cholera. The cases of two women, a niece and her aunt, who died of cholera puzzled Snow. The aunt lived some distance from Soho, as did her niece, and Snow could make no connection to the pump. The mystery was cleared up when he talked to the woman’s son. He told Snow that his mother had lived in the Broad Street area at one time and liked the taste of the water from the pump so much that she had bottles of it brought to her regularly. Water drawn from the pump on 31 August, the day of the outbreak, was delivered to her. As was her custom, she and her visiting niece took a glass of the pump water for refreshment, and according to Snow’s records, both died of cholera the following day. Snow was able to prove that the cholera was not a problem in Soho except among people who were in the habit of drinking water from the Broad Street pump. He also studied samples of water from the pump and found white flecks floating in it, which he believed were the source of contamination. On 7 September 1854, Snow took his research to the town officials and convinced them to take the handle off the pump, making it impossible to draw water. The officials were reluctant to believe him, but took the handle off as a trial only to find the outbreak of cholera almost immediately trickled to a stop.“
As it turned out, the source of this contagion proved to be a woman who washed diapers and dumped the water in a cesspool very near the Broad Street pump, leading to 616 deaths. To read the full story of Snow’s work, check out The Ghost Map: The Story of London’s Most Terrifying Epidemic—then How it Changed Science, Cities, and the Modern World, by Steven Johnson. It is available in the Rice Library, General Collection RC133.G6 J64 2006.
Granted, there are a lot of differences between cholera and COVID-19. Cholera is spread by waterborne bacteria, COVID-19 by a respiratory virus. Cholera is not contagious, COVID-19 is. The role of sanitation and hygiene in maintaining good health is far better understood today. Scientists and doctors are still learning about COVID-19, but with resources and knowledge far superior to that of the 19th century. Still, both diseases are worldwide. Both diseases caused/are causing an economic impact, cholera due to panicked mass evacuations and large numbers of deaths within a small area, COVID-19 due to the need for social distancing and self-isolation. As of June 4, 2020, the CDC reported 1,842,101 total cases in the U. S. and 107,029 total deaths. (For more information, look at the CDC to find the up to date figures for today.) It’s difficult to compare that with cholera—it would be an apples to oranges comparison given that COVID-19 is contagious, travel is far simpler today, and the population higher. But we, like our 19th century compatriots, face a lot of unknowns and disruptions to our way of life. Maybe we should heed the advice of mothers everywhere: Cover your mouth! Wash your hands!
Daly W. J. (2008). The black cholera comes to the central valley of America in the 19th century – 1832, 1849, and later. Transactions of the American Clinical and Climatological Association, 119, 143–153.