In the 19th century, the usual yearly epidemics of frequently fatal infectious diseases in Britain were eclipsed by successive waves of a frightening newcomer: Asiatic Cholera.
It first arrived in 1831. You can read about it in 'The year of the Cholera', Chapter 11 of Remarkable, but still True: the story of the Revd R J Barlow and Hutton Rudby in the time of the cholera .
There I describe how, in York, Dr Thomas Simpson and the surgeon J P Needham not only treated patients but also investigated the spread of cases. They both believed cholera was contagious and Needham wrote a monograph on the subject in 1833, after the pandemic had subsided. Dr Simpson, who thought it was an air-borne disease, published his Observations on the Asiatic Cholera: and Facts regarding the mode of its diffusion after the next pandemic, which happened seventeen years later in 1848.
In 1848, as in 1831, cholera was firmly associated with "nuisances" – sewage and filth – and it was still thought that it was the "unwholesome exhalations" and poisonous vapours from nuisances and decaying vegetable matter that spread the disease. The theory may have been erroneous but the practice was helpful, because cholera is spread through water contaminated by faeces; this was the beginning of improvements in better drainage and public health.
Cholera isn't easy to catch but without the correct treatment it is fatal in half the cases. Nowadays it is treated by rehydration – which has to be begun without delay – and sometimes with antibiotics. In the 19th century, careful nursing might pull a patient through but unfortunately doctors very often used purges and emetics on their patients, which would only have dehydrated them further.
Meanwhile, there were plenty of advertisements for patent medicines.
William Hardcastle advertised his "Cure for Asiatic Cholera" and "Grand Preventive of Cholera" extensively in the Northern press. Born in Sunderland, he had learned his trade as a chemist in Stockton-on-Tees and now had his own shop in Finkle Street – and I'm glad to say the interior of Hardcastle's is preserved at Beamish Open Air Museum (photographs here). He was a man in his late thirties and evidently very enterprising.
At this time anxiety was all the greater because diarrhoea was thought often to precede cholera – of course there was a good deal of diarrhoea around – and it was believed that stopping diarrhoea would stop cholera developing. William Hardcastle's advertisements proudly proclaimed that
having witnessed the great mortality by Cholera which took place in Stockton, 17 years ago, when about 130 persons died in a very short time, Mr H. directed his earnest attention to discover some more efficient Preventive and Cure than were at that time employed, and has succeeded in compounding the "Diarrhoea Powders" and "Cholera Drops", which has rescued many from premature graves. Their great efficacy has caused them to be so much esteemed in Stockton and the Neighbourhood, that the Proprietor has now made arrangements for extending their sale to other places.
The Drops could be sent by Post to any part of the UK on forwarding 12 Postage Stamps, and they cost a shilling and a penny halfpenny or two shillings per bottle. I expect the chief ingredient was laudanum.
More useful in preventing cholera were products such as Sir William Burnett's Patent Disinfecting Fluid, which was advertised as "a deodorizing and purifying agent" and was a chloride disinfectant.
When nothing seemed to help, the only answer was prayer:
York Herald, 22 September 1849
Cholera – The authorities of Middlesbro' have issued a notice to the inhabitants to set apart Friday, the 21st inst., as a day of humiliation and prayer to God to remove that desolating pestilence, the cholera, which has lately been so fatal in that place.
Then a third wave of cholera reached Britain in 1853. It was at this point that Dr John Snow of London (1813-58) demonstrated that cholera was a water-borne disease by removing the handle of the Broad Street pump. He published his findings in his work of 1855, which drew upon the careful observations of Dr Thomas Simpson. But it took many years for public health authorities to act to ensure a clean water supply and Snow had been long dead when the Chief Medical Officer for Health acknowledged the significance of his work.
We can see that keeping the streets clear of nuisances and encouraging better cleanliness was well established as a priority for the authorities:
York Herald, 15 October 1853
Cholera – On the 24th of Sept last, this devastating disease broke out in one of the low parts of Stockton, and since that period to the present time, 13 deaths have occurred, but all in that particular locality, which is said to be in a very indifferent state of drainage, and where many of the inhabitants are not of the most cleanly description.
In Darlington, the local board of health and the board of guardians held a joint meeting. They decided to carry out the recommendations of the medical superintending inspector of the General Board of Health to set up a system of house to house visiting as the only effectual safeguard against the spread of the epidemic. (This might remind us of recent events described in this story on the BBC News website in which Professor John Wright, Head of Bradford Institute for Health Research describes the work of the local test and trace teams, sending testers door to door in neighbourhoods with high rates of infection). They resolved to employ more scavengers to clear away the nuisances, to set up a more general distribution of disintectants such as chloride of lime, and to supply water for free to the poorer districts, "in order that greater facilities for cleanliness might be afforded".
And, then as now, there were plenty of conspiracy theories. In some countries, the swiftness with which the disease spread led the people to think their water supply had been poisoned:
Huddersfield Chronicle, 2 September 1854
News has arrived in Palermo of the appearance of cholera in that city. The Sicilians, it seems, are under the impression that the cholera is a poison which has been communicated by human means. The people have surrounded the Governor's palace, and shouted "We will not have the cholera here!" The Lord Lieutenant immediately issued orders prohibiting the people to speak of poison. The city is in a very excited state.
In 1865 the cholera returned yet again to Britain.
It reached Yarm on 8 October 1866 and when doctors Robert and Christopher Young, the town's medical officers, made their report on 13 November, they hoped they had seen the back of it. There had been 23 cases of cholera, 12 of which were fatal, and 5 cases "approaching cholera", of which 2 were fatal. In the same period they had seen 87 cases of diarrhoea.
A few days before cholera came to Yarm, it had already reached Hutton Rudby and Potto – but luckily not with the virulence of the 1832 outbreak, when there were 45 cases and 23 deaths at the east end of the village green:
York Herald, 6 October 1866
The Cholera – We regret to state that a fatal case of Asiatic cholera has just occurred at the small rustic hamlet of Potto, in the parish of Whorlton, near Stokesley. Elizabeth Mary Cawthorn, the wife of a brickmaker, was attacked on Saturday afternoon last, and was visited the same night by Mr A A Boyle, assistant to Mr J H Handyside, surgeon, Stokesley, and he at once perceived that she was prostrated by a malignant attack of cholera. Mr Handyside attended on the following morning, and Mr Boyle was present when she died on Sunday night, medical skill being of no avail.
Richmond & Ripon Chronicle, 13 October 1866
Thompson - On the 6th inst., at Hutton Rudby, Cleveland, of Asiatic cholera, aged 60 years, Mr George Thompson, brickmaker
Nearly twenty years and many cholera deaths later, people across the world were electrified to hear that the German scientist Dr Robert Koch and his team had discovered the "cholera germ".
Dr Koch had carried out his researches in India. This fact spurred Professor Edwin Ray Lankester (1847-1929) to write a trenchant criticism of the British government's approach to scientific research that appeared in, among other papers, the Pall Mall Gazette of 2 November 1883. He was the son of Edwin Lankester (1814-74), surgeon, naturalist, the first public analyst in Britain, the first medically qualified coroner for Central Middlesex, a man who made a major contribution to the control of cholera in London. So his son had, in a way, a family interest in the fight against the disease.
He deplored the fact that
when a dire disease broke out in a country occupied by British troops, and, for the time being, controlled by the English Government, no steps were taken by that Government to initiate a thorough study of the disease in the light of modern science, but that, on the other hand, independent Commissions were sent to the plague-stricken country by the Governments of France and Germany for the express purpose of making the investigations which the English Government had omitted to set on foot.
The French and German scientists were from
the State-supported laboratory of M Pasteur; they were his assistants and pupils. The German Commissioners came from the Imperial Sanitary Institute of Berlin, the workers in which are drawn from the twenty-two State-supported laboratories of pathology which are scattered throughout the German Empire
Britain should be following the examples of France and Germany in training scientists and funding research bodies and laboratories like those in France and Germany.
By July 1884 the "discoverer of the cholera germ" Dr Robert Koch was known to everyone and admired by all. The Pall Mall Gazette of 11 July 1884 noted that "in the last five years he has succeeded in identifying the germs of cattle disease, of consumption, and of cholera" – he was the benefactor of humanity.
Two years later, the Sanitary Congress – the annual meeting of the Sanitary Institute of Great Britain, founded in 1876 – was held in the Museum in York (now the Yorkshire Museum).
The Leeds Mercury of 25 September 1886 carried a report of the proceedings. The president, Mr William Whitaker, read a paper about water-supply in which he said two of the chief problems in sanitary matters were getting good water and getting rid of bad water. Percy F Frankland, associate of the Royal School of Mines, spoke on the filtration of water. They had known for many years that the real danger in sewage-contaminated water lay not in the organic matter to be found by analysis but in "the presence of minute living organisms, capable of producing zymotic disease". Largely thanks to the genius of Robert Koch they now had "beautiful methods of bacteriological investigation" and this had enabled the great advance made in water purification. Surgeon-Major Pringle described his system of collecting and storing rain and drinking water. Another debate clearly centred on the role of government. Enforcement or education? The West Riding County Surveyor, J Vickers Edwards, took what might now be called the libertarian approach to achieving "a healthy house", arguing that sanitary science would not progress through the actions of local authorities nor by legislation, but by educating people to act for themselves.
Over the next fifty years the Sanitary Institute was to become the leading public health organisation in the UK, with a world-wide reputation. It is now the Royal Society for Public Health.
Public health reform was truly on its way.
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