COVID V. CHOLERA
Dr Simon Wills reflects on the impact of the Covid-19 pandemic and how it will be viewed by posterity, and compares our experiences with those of our ancestors during the rampages of cholera in the 19th century
Dr Simon Wills looks at the impact of a deadly 19th-century disease and compares our ancestors’ situation with our own recent pandemic experiences
Perhaps like me you have wondered how our descendants will view the Covid-19 pandemic. In the future, people will probably say that it must have been frightening, and they will wonder how on earth we coped.
I think that it’s given each of us a more personal insight into how our ancestors must have felt during other pandemics in the past such as the Black Death of 1346–53, and the Spanish flu pandemic of 1918–20. Although separated by centuries, we are fellow humans and have shared the same agonies of losing loved ones, worrying if we might be next, and wondering when life will return to normal. In this article, I’d like to compare our modern experience of Covid-19 with cholera, the great pandemic of the 19th century.
I should say to begin with that there are some obvious differences. Not least is the fact that the cholera pandemic reached the UK as not one, but four waves in 1831–2, 1848–9, 1853–4 and 1866. Another contrast is that cholera is caused by bacteria, whereas Covid-19 is a viral illness. Cholera spreads mainly when people drink water contaminated with the faeces of others who have the infection, whereas Covid-19 is transmitted by droplets that contain the virus in the breath of infected people or by touching surfaces that are contaminated with it.
The arrival
Despite these and other differences, there are some interesting parallels between our human experience of Covid-19 and cholera in the UK.
One of the most palpable is the fear and anxiety that both pandemics
caused. In early 2020 we knew that Covid-19 was heading our way. On the news we had heard how it started in China, and it then began to spread across the planet. You may remember that there were big surges of cases in other nations before Covid-19 had any sizeable impact in the UK. In particular there was a dramatic outbreak in Italy, which made us realise how serious the situation might become for us.
The same fear of the disease’s arrival happened with cholera.
It was seen as a ‘foreign’ disease which did not occur in the UK, and was widely referred to at the time as ‘Asiatic cholera’. The first cholera pandemic to affect the UK began in Asia, as Covid-19 did, but in India rather than China. There was no air travel in the 19th century so the disease moved much more slowly, but by 1829 it was in eastern Europe and was a widespread problem in central Europe in 1830–31.
Our ancestors were gripped by newspaper reports of the disease gradually heading towards us. Britain was the centre of world trade so it was inevitable that ships would bring cases to our shores, in the same way that aircraft brought cases of
Covid-19 to the UK.
The UK’S first case of Covid-19 came on 29 January 2020 at York; the first case of UK cholera came on 20 October 1831 in Sunderland. In both centuries, there was a lull in reports afterwards before the number of infections accelerated.
The controls
Attempts were made in each pandemic to control our borders to prevent the arrival of infected people. In the 19th century, this screening consisted not of temperature checks but employing doctors to scrutinise ship’s crews and passengers for signs of disease as they left their vessel. The symptoms of cholera were alarming. A few people had mild alerting signs, but most were suddenly gripped without warning by dramatic diarrhoea and vomiting. In the severest cases, the loss of body fluids was sufficiently appalling that victims rapidly became dehydrated, cold, shrivelled and gaunt. Often their faces were so withered they became almost unrecognisable. Some victims developed a blue-grey skin colour; hence cholera’s other name of the ‘blue plague’. So doctors at ports and on ships were looking for any of these symptoms.
During the current pandemic, the government’s Scientific Advisory Group for Emergencies (SAGE) has played a very prominent role in advising about the measures needed to control the spread of the disease. One of its chairs is the Chief Medical Officer, Professor Chris Whitty, who has become a prominent media figure. At a more local level, management of the situation has been delegated to various regional groups. The authorities had a similar structure to deal with cholera in 1831, establishing a Central Board of Health under
Sir Henry Halford, president of the Royal College of Physicians, as well as various regional health boards.
Strange ideas
There have been many unsupported theories about the origins of Covid19, most commonly that it was
engineered in a Chinese laboratory. Others have told me confidently that the virus was designed and spread by the Russians. The strangest theory is that Covid-19 doesn’t exist at all and that it’s all part of some complex global conspiracy.
Fear is a powerful stimulus to the imagination, and when faced with the cholera pandemic our 19th century ancestors also came up with some less credible theories about its origin. They were considerably handicapped by having no knowledge of the existence of micro-organisms, of course. The prevailing medical theory for the cause of infections was bad air or ‘miasma’. This theory held that the foul smells associated with infection and dirty places were themselves the causes of disease. If you got rid of the smell, you got rid of the disease. Notwithstanding this widely held concept, there were plenty of others said to account for the cholera pandemic including that it was actually caused by fear, that it was linked to diet, or that it was triggered by particular weather patterns. Some said it was Divine Providence being meted out on those who might deserve it, especially those who drank too much alcohol.
Despite the gulf in medical knowledge that exists between 1831 and 2021, a major approach to managing the pandemic has been the same – namely hygiene. Our 19th century forebears did not understand why cleanliness seemed to prevent disease, but they did know that dirty places, bad smells, and coming into close contact with infected people all seemed to increase the risk of contracting the disease. So they practised the ‘hygiene’ measures of the time, which consisted of quarantining affected households, fumigating houses or ships with burning sulphur, opening places up to fresh air, and scrubbing, washing and whitewashing.
Science & statistics
The lack of a methodical, coordinated scientific approach to understanding cholera is perhaps the single biggest difference between the two pandemics. In modern times, scientists come up with theories and test their evidence before recommending a course of action. This was an alien concept during the cholera pandemics so most people had to rely on luck, prayer, or superstition to keep them safe. In the absence of knowledge about the bacterial cause of cholera, the simple measures of improving sanitation and boiling water before you drank it was not understood and, of course, creating a vaccine was inconceivable. Even when Dr John Snow proved that cholera was caused by drinking dirty water in 1854, his careful study was not acted upon until years afterwards.
In both pandemics there were rumours about ineffective medicines that would supposedly reduce your risk of becoming infected. In 2020, for example, there were adverts on the internet for special herbal products that would stop you getting Covid-19, and even an American president
Cholera statistics reported in The Times, 1832
who advocated using a medicine called hydroxychloroquine that didn’t work. In the 19th century, drinking brandy was supposed to render you immune to cholera, as was the wearing of special clothes to keep the stomach warm. One surgeon advocated explosions of gunpowder in affected areas to blow away the miasma that caused the disease!
Media coverage
Many of us will long remember the regular media reports of Covid-19 pandemic statistics, especially the number of deaths as they escalated. A heart-breaking daily reminder of the human cost of the disease. You may be surprised to learn that similarly alarming statistics were reported in newspapers for cholera even during the first wave in 1831–2. One contemporary writer noted: ‘The daily numbers of deaths was increasing. It mounted upward from
20 to 50, 80, 100, 150 each twentyfour hours, till it seemed as if our fate were sealed and the curse of heaven was to sweep us all to the grave’.
Across the four waves of cholera, around 130,000 people died in England, Wales and Scotland at a time when the UK population was much smaller than it is today. In addition, a large number of British people died of the disease abroad particularly in India, but also seafarers, and soldiers in the Crimean War. Around the world, cholera killed tens of millions in the 19th century on every continent.
Daily life
In the 1831–2 cholera pandemic, the Rev Leigh of Bilston, Staffordshire, wrote about a scene not unfamiliar to us: ‘To describe the consternation of the people is impossible. Manufactories and workshops were closed; business completely at a stand’. He and others describe the quiet streets, the abandoned building works, the difficulty in organising funerals, and the disruption to normal everyday services. Contemporary authors mention another facet of the 19th century pandemic that is familiar to us in the 21st century, namely that people with the means to do so abandoned the cities for their country homes.
Health care
Once cholera arrived in an area, local boards of health attempted to limit its spread: initially by trying to isolate confirmed cases, and then
Fumigating to protect against cholera
by dedicating premises to house the sick – again keeping them separate from those who were not infected. Many communities had special burial grounds reserved for victims. In certain parts of the UK such as Liverpool, the population panicked and then rioted – demanding protection. Doctors were even blamed in some places for causing the disease and of using it as a means to obtain bodies for dissection.
This was an era with no NHS, so families suffering from cholera had to pay for a doctor to visit or go without
John Snow proved that cholera spread by drinking dirty water in 1854, but it took years before his advice was acted upon
medical assistance. Not that doctors could do very much to help victims. They believed the body needed to be purged of its impurities, so doctors prescribed potent laxatives and drugs that induced vomiting, to patients already exhausted by diarrhoea and sickness. They administered poisonous mercury – which could cause diarrhoea – and opium which made people vomit; while their brandy, bloodletting, and ‘hot bathing’ made the dehydration worse. Some doctors prescribed even more ludicrous treatments such as highly toxic arsenic. It’s a wonder that anyone survived their ministrations.
The role of artists
Finally, it’s interesting that artists
have played a recognised role in both pandemics: helping to hold up a mirror to society. The street artist Banksy donated a painting to the NHS entitled ‘Game Changer’ depicting a small boy who had thrown away his comic-book hero figurines and was playing with one of the real heroes of the pandemic – a nurse. During the cholera pandemic, John Leech published a famous cartoon in the popular magazine Punch called ‘A Court for King Cholera’. It correctly showed how dirtiness and overcrowding meant that impoverished urban dwellers were far more likely to contract cholera.
Like me, you may have ancestors who died from the cholera in the 19th century. Although I have studied cholera in the past, I now feel that I have more understanding of how my forebears and their families felt based on our own experiences with Covid19. I’m sure we all appreciate living in the current century, rather than enduring the sad ignorance of medical matters with which our unfortunate ancestors had to contend. Yet our anxieties and our reaction to the widespread loss of loved ones is surely very similar.
About the author
Dr Simon Wills is a genealogist and author with more than 30 years’ experience of researching his ancestors. He has a particular interest in maritime history and the natural world. His latest book is A History of Birds (White Owl). He is also author of The Wreck of the SS London, Tracing Your Seafaring Ancestors, and How Our Ancestors Died amongst others.