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CHOLERA Cholera
was a much feared affliction in England, second only to the bubonic
plague right up until the middle of the 19th century, when
its cause was discovered and began to be fully understood. This disease holds a
particular interest for me as one, and possibly two, of my paternal
ancestors in Newcastle-upon-Tyne fell victim to this horrible malady. Cholera
is an infectious condition caused by a bacterial toxin that affects the
absorption of water in the small intestine. The main symptoms are
profuse watery diarrhoea and vomiting. In severe cases, the dehydration
caused can be so acute that death will occur within two hours, if
treatment is not forthcoming. Usually, a horrible and lingering death
will occur after a couple of days, without proper treatment being
rendered. The
incubation period for the disease is around five days. When sufficient
numbers of the bacterium have built up in the body, cholera will strike
suddenly. An untreated person with cholera may produce up to 20 litres
of diarrhoea a day, and as can be imagined, this is invariably fatal due
to the dehydration and electrolyte imbalance. Whilst
poor sanitation is a major cause for the spread of cholera, it can also
live naturally in any environment and this can be transmitted to humans
via the consumption of shellfish in particular. Shellfish have a
tendency to concentrate the bacterium to dangerous levels, due to their
filter feeding. Malnutrition will make a person much more susceptible to
cholera, as will possessing the type ‘O’ blood group, a fact unknown
to most people. Today
cholera is treated with rehydration treatments and vaccines. Antibiotics
may also be used to speed along the recovery and shorten the period of
illness. Cholera is still a major problem in many third world countries,
where clean drinking water can be difficult to obtain and where water
supplies may be polluted with sewage. Cholera is not a tropical disease
but can occur wherever sanitation is deficient and housing conditions
dire. Untreated cholera has a death rate of up to 60%, but with the
right treatment given in time, the death rate can fall to as low as 1%. Cholera
was at one point lumped in with other gastric conditions that could
produce similar symptoms, and was known as ‘cholera morbus’. Since
the early 20th century this has changed and cholera is now
treated as distinct from the other ailments, collectively known as
gastroenteritis. For
the average Briton today the risk of contracting cholera is pretty much
zero. However, this lack of the disease in the UK will not prove any
protection for those travelling to exotic destinations. The disease is
rife in both Africa and Asia and there are frequent outbreaks. As
ever, avoidance is often simple common sense. Only drink boiled water or
sterilized water, hot coffee and tea are good, as are uncontaminated
bottled drinks. Remember though, that boiling water may not remove all
the bacterium that can cause digestive problems. Water purification
tablets are always a sensible additional protective measure. Avoid ice
cubes in drinks, for obvious reasons and also avoid ice cream. Only eat
hot food and avoid shellfish and raw fish. Avoid raw vegetables and
fruit that you have not peeled yourself. Avoid thin skinned fruit.
Lastly, be careful of eating food from street stalls as the preparation
may be suspect, as may be the personal hygiene habits of the food
vendor. Newcastle-upon-Tyne Newcastle-upon-Tyne
has had three severe outbreaks of Cholera, all in the early to middle 19th
century. The city grew rapidly with the onset of the industrial
revolution and this sucked in huge numbers of people from the
surrounding countryside, and from further afield. The attraction of
moving to the big city was the prospect of steady and plentiful
employment, new markets for goods and services, and opportunities for
advancement. Unfortunately,
this rapid growth led to chronic overcrowding in the poorer parts of the
city, such as All Saints, and to the kind of living conditions that can
be found in such places as the slums of Bangladesh today. Between 1801
and 1851, the population of Newcastle rose from 28,000 to 87,000. In
1832, the first outbreak of cholera occurred and 306 people died. In
1848 there was another visitation of cholera and 412 people perished.
Then in 1853 the largest ever outbreak occurred and 1,533 people
perished, including one of my paternal ancestors. Another died in 1857,
the suspicion being that it was cholera or another related gastric
affliction. The
printed media coverage of the time was scathing in respect to the 1853
cholera outbreak. They stated that little improvement had been made in
sanitary arrangements and overcrowding since the 1848 outbreak, and that
the authorities as such, were culpable in the cholera related deaths of
1853. Dr
John Snow Dr
Snow was born into a working class family in 1813, his father being a
Labourer. In 1827 at the age of 14, he was apprenticed to a surgeon in
Newcastle upon Tyne. These were the days when a surgeon would learn his
craft like any other apprentice. After learning his trade, John Snow
worked as a colliery surgeon. By 1836, John was ready to enrol at the
Hunterian School of Medicine in London, in order to undertake the
university education necessary to add the title ‘Doctor’ to his
name. He was finally awarded his MD in 1844. Prior to that, in 1838 he
had already become a member of the Royal College of Surgeons and a
licentiate of the Society of Apothecaries. It
was Dr Snow who was to finally prove the link between water and cholera.
Poor sanitation, appalling living conditions and drinking water polluted
with faecal matter are the hallmark of a cholera epidemic in the making.
His famous essay, ‘On the Mode of Communication of Cholera’ published in 1849, set
out his revolutionary germ theory. Up to that time, cholera was deemed
to be caused by ‘miasma’, or bad air. The understanding of the
effect of germs in disease was not fully comprehended until the
1860’s. Dr Snow however, had already realised that something other
than bad air was responsible for cholera. Dr Snow’s studies and theory
are generally deemed to be the founding event of the science of
epidemiology. Dr
Snow’s contention in respect to cholera was shown to be correct by a
severe outbreak of Cholera in Soho, London, in 1854. He proved that the
cause of the epidemic lay in the infected water from a pump in Broad
Street, and his action in insisting on the removal of the pump-handle
not only saved many lives but is a symbolic event of great historical
importance.
Doctor John Snow The
Cholera outbreaks in Newcastle upon Tyne – by Doctor John Snow The
town of Newcastle-upon-Tyne affords a remarkable instance of the
influence of the water supply on the prevalence of cholera. In 1831-32
there were no waterworks at Newcastle; it was supplied, in an
insufficient manner, with spring water, which generally had to be
carried some distance to the houses from "pants" in the
streets. The epidemic was pretty severe at this time. From November 1831
to November 1832 there were 801 deaths from cholera out of a population
of 42,760. The
disease prevailed chiefly amongst the poor, and was worst in the least
elevated parts of the town, near the river. Subsequently to 1832,
waterworks were established on the river Tyne, a little above the town;
but these were abandoned, in 1848, in favour of a supply from a rivulet
and springs at Whittle Dean, about ten miles distant. In 1849, there
were but 295 deaths from cholera in a population then increased to
71,847. In
the beginning of July 1853, two months before the reappearance of
cholera in England, the Whittle Dean Water Company found their proper
sources insufficient for the demands of the population and the various
factories, and they made use of the former waterworks, mentioned above,
to obtain water from the Tyne. The point at which they obtained water
from the river, is scarcely a mile above Newcastle, and the tide flows
for six miles above the town, carrying the contents of the sewers with
it. There
are also villages, containing several thousands of colliers and
iron-founders, on the banks of the Tyne, above the waterworks. The water
from the Tyne was mixed, without filtration, with that from Whittle
Dean, to the extent of one-third; and the mixed water, so supplied, was
discoloured, and contained the large quantity of 7.1 grains of organic
matter per gallon. In
the autumn of 1853, the cholera was prevailing extensively at Hamburg,
and in nearly all the ports of the Baltic, whence a number of ships were
arriving every day in the Tyne. The first cases of cholera commenced,
with diarrhoea, on the 27th and 28th August, at Bell Quay, on the banks
of the Tyne, three miles below Newcastle. One of the patients' from Bell
Quay was taken worse whilst on a visit to her mother at Newcastle: she
died on 2nd September. Her mother was taken ill the same evening, and
died on the following day. Other
cases occurred in Newcastle on the 1st and 2nd of September, having no
connection with these. A ship from Bremen was lying at Bell Quay,
opposite the house where the first cases occurred; but there had been no
illness on board this ship, and the precise way in which the cholera was
introduced on this occasion, is not known. The disease soon spread to an extent almost unprecedented in this country: by the 15th of September the deaths exceeded a hundred a day. In nine weeks there were 1,533 deaths from cholera in a population of 86,114, being 178 to each 10,000 inhabitants; but the greater number of these deaths occurred in a few days, as 1001 took place from the 13th to the 23rd Sept. inclusive. Below is a video about the 1854 Cholera outbreak in Soho, London |
