Cholera report, 1850

Edward Higgs

Cholera, often called asiatic cholera in the nineteenth century, is a water-borne disease caused by the bacteria Vibrio cholerae. These are usually taken into the body in contaminated water, or through eating poorly cooked fish, especially shellfish. Cholera was first described scientifically by the Portuguese physician Garcia de Orta in the sixteenth century. Europe witnessed several epidemics in the nineteenth century, but the disease is now seen mostly in Third World countries, due to their poor sanitation. The symptoms of cholera include extreme watery diarrhoea, vomiting, and leg cramps, the rapid loss of body fluids leading to dehydration and shock. Without modern treatment, death can occur within hours.

Cholera was originally endemic to India, from which it spread by land and sea trade routes to Russia, then to Europe and North America. The first recorded pandemic swept across India in the period 1816 to 1826, whilst a second pandemic reached London and Paris in 1832. The disease killed thousands of people in Britain, and caused terror because of the violence of its symptoms, the speed with which it could kill, and ignorance of its causation. Because it was a water-borne disease, infection depended upon drinking contaminated water. This meant that one side of a street supplied by one water company could be severely affected, whilst the other, supplied by another company, would be unaffected. In the absence of certain knowledge of the causes of cholera, the British state fell back on traditional forms of quarantine for trading vessels but these proved ineffective (Morris). There was a third pandemic in 1852 to 1860, mainly affecting Russia, and a fourth pandemic in Europe and Africa in the years 1863 to 1875, although there were more localised epidemics in Britain in 1849 and 1854. There were later world pandemics of cholera but improved sanitation meant that these had comparably little effect in the developed world. Cholera had, however, become endemic in Europe, and continued to take a regular, but diminished, annual toll.

The spread of the disease led to the publication of a number of government reports, such as the Report of the General Board of Health on the epidemic cholera of 1848 and 1849 (1850). The General Register Office (GRO), the body responsible for the administration of births, marriages and deaths under the 1836 Registration Act, had been producing cause of death statistics, including material on deaths from cholera, from its inception. Cholera appeared in the first 'Letter to the Registrar General' that William Farr, the GRO's chief statistician from 1839 to 1879, included as an appendix to the First annual report of the Registrar General for the year ending 30 June 1838 (1839, 63–83). In the nosology (disease classification) he published there both 'cholera' ('cholera biliosa' and 'cholera infantum') and 'asiatic cholera' ('cholera epidemica') appeared under the heading 'Epidemic, endemic and contagious diseases'. In the tables appended Farr showed the numbers dying from cholera in various registration divisions. The numbers of cholera deaths were rather muted compared to those from other contagious diseases because the first cholera pandemic had abated. The incidence of deaths from cholera became a common feature of the subsequent annual reports. The Report on the cholera epidemic of 1866 in England (1867–68) was unusual in that it was a dedicated, extended text released as a stand-alone publication.

In this report William Farr attempted to bring together evidence from the previous cholera epidemics in Britain in order to come to some conclusions about the causes of the disease, its means of transmission, and possible forms of prevention. The text was divided into five main parts: a description of cholera in London; the incidence of cholera in what Farr called 'fields', areas where cholera was particularly active; the effects of variables such as elevation, population density, sewerage, occupation, wealth, etc., on the incidence of cholera; theories of causation; and possible forms of prevention.

Perhaps the most interesting part of the report was the discussion of causation, which was mainly given over to the 'zymotic' theory of disease. 'Zymot' was Farr's term for a hypothetical chemical pathogen, which was supposed to have poisoned the blood. Thus, the cause of cholera was taken to be an unknown chemical, sometimes dubbed 'cholerine', in the surroundings of the deceased. This essentially environmentalist concept of disease was linked to some extent with contemporary belief in the danger of 'miasma', but more closely with the chemical theories of Justus von Liebig (Eyler, 100–5; Higgs, 1991). The bulk of the report was given over to showing the role of sewage-contaminated water in the spread of the disease, although Farr believed that other forms of transmission were possible. His analysis of the London 'water field' placed much of the blame for the epidemic on the East London Waterworks Company. John Snow's ground-breaking work on the water-borne nature of cholera was also noted (Report on the cholera epidemic of 1866 in England, lxxix). However, Farr's still imperfect understanding of the aetiology of cholera may help to explain the rather weak section on the prevention of cholera (Report on the cholera epidemic of 1866 in England, lxxxii-xc), which mainly argued that quarantine was of little use.

In time Farr's 'zymotic' theory of disease would develop into an acceptance of modern germ theory (Eyler, 102–8) but he was still groping his way towards this in the Report on the cholera epidemic of 1866 in England. But Farr's crusade to improve the sanitation of the major cities of Victorian England, whether to remove chemical 'zymots' or the gaseous causes of 'miasma', led indirectly to improvements that helped to remove the bacteria that caused cholera and other contagious diseases.

REFERENCES

John M. Eyler, Victorian social medicine. The ideas and methods of William Farr (London, 1979).

First annual report of the Registrar General (1836) BPP 1839 XVI (187) [View this document: First annual report of the registrar-general]

Edward Higgs, 'Diseases, febrile poisons, and statistics: the census as a medical survey', Social History of Medicine, 4 (1991), 465–78.

R. J. Morris, Cholera 1832 The social response to an epidemic (London, 1976).

Report on the cholera epidemic of 1866 in England: supplement to the twenty-ninth annual report of the Registrar General, BPP 1867–68 XXXVII (C.4072). [View this document: Report on the cholera epidemic of 1866 in England: supplement to the twenty-ninth annual report of the registrar-general]

Report of the General Board of Health on the epidemic cholera of 1848 and 1849, BPP 1850 XXI.