The Scourge of the Nineteenth Century: Cholera in England (Part I)
Comes, black as a porpus.
The diabolus ipse,
Call’d Cholery Morphus; Who with horns, hoofs, and tail, croaks for carrion to feed him,
Tho’ being a Devil, no one never has seed him!
Ah! then my dear honies,
There’s no cure for you.
Samuel Taylor Coleridge “Cholera Cured Beforehand” (1832)
Between 1831 and 1866, four Asiatic cholera outbreaks struck England, as part of pandemic outbreaks that affected the whole world. Caused by a bacterium spread through infected water, persons in severe cases are convulsed with pain, suffering intense vomiting and uncontrollable watery diarrhoea. Dehydration caused by these extremities can lead to hypotensive shock and death within hours.
Prior to the 1830s, the disease was still unfamiliar to most of the world beyond parts of the Indian subcontinent where it had probably been endemic since ancient times. Physicians were helpless to do anything for their terrified patients but to try remedies they thought had worked for other diseases. There was also argument among both physicians and the general public as to whether this was a distinctly new disease or merely a severer variation of traditional cholera morbus (also known as ‘summer’ or ‘English’ cholera): an epithet given for almost all acute gastrointestinal disorders before the nineteenth century and the causes of which were generally attributed to either extremes in weather or faults in the diet.
Despite being two very different maladies, the terms cholera morbus and Asiatic cholera would be used almost interchangeably during the first invasion of the 1830s.
English physician Thomas Sydenham explained that a series of hot summers was the reason for a severe period of cholera morbus between 1669 and 1672. The climate had affected the blood and humors thus ‘gripeing in the bowels became very epidemical.’ Physician John Arbuthnot’s influential essay ‘Concerning the Effects of Air on Human Bodies’, published posthumously 1751, stated that epidemical diseases such as cholera were ‘commonly effects of the temperature of the air. As the weather changed with the seasons, so particular diseases could be of often expected at stated seasons of the year,’ with their duration and symptoms seeming ‘to depend upon the alterations of the weather.’
The first text which provided laypeople with descriptions on the causes and prevention of diseases was physician William Buchan’s hugely popular ‘Domestic Medicine’, first published in 1769. He did not consider weather a particularly important cause of cholera morbus, other than through ‘cold.’ Instead, he focused on certain foods such as butter and pork, and ‘violent passions or affections of the mind’ such as fear or anger. He recommended the continued use of small doses of laudanum for some period after the worst of the disease was over, in order to prevent a relapse. A simple diarrhoea, by contrast, was not to be considered a disease at all, ‘but rather a salutary evacuation.’ Such a ‘looseness’ was generally caused by ‘obstructed perspiration,’ ‘cold,’ or ‘excess.’
Naturalist and physician John Woodward based his ’State of Physick’ (1718) on the important role of food. ‘The beginnings of all things, good or bad, to the body are in the stomach. If the stomach is well, so is the body.’
The most authoritative eighteenth-century writer on bowel disorders, however, was Sir John Pringle, physician to George III. Between Pringle’s work and the appearance of Asiatic cholera in Europe, theories on bowel disorders changed relatively little. In his ‘Observations on the Diseases of the Army’ (1752), Pringle focused on the significant influence of air in causing dysentery and fevers, and considered cleanliness an important preventative – but not for the hygienic reasons we would now understand. To keep the human body in equilibrium required the removal of excess matter, be it faeces, menstrual blood, sweat or urine.
All these interpretations duly appeared in accounts of cholera in the 1830s.
Asiatic cholera had first struck in epidemic proportions in India in 1817. Such was the devastation, it was assumed to be a brand new disease, different from what was in India called sporadic cholera morbus. Whitelaw Ainslie, a physician with nearly thirty years’ experience with the Madras Establishment of the British East India Company, recorded in 1825 that he had heard ‘from every quarter that it was an affection totally different from anything that I had ever seen in India.’ However, on subsequently examining cases of the disease himself, he drew the conclusion that ‘cholera morbus and this epidemic cholera, are bona fide the same disease’ although ‘the latter has not only every common symptom aggravated, but others of a more serious nature super induced.’
Asiatic cholera, as it became widely (though not yet universally) known, was, in Ainslie’s opinion, merely an aggravated form of traditional cholera.
In 1831, when the disease reached England, an article appeared in the Lancet by H. K. Randell, a surgeon at Rotherhithe. He admitted that though a number of recent cases were clearly English cholera, ‘the disease has been more violent in its effects than is usually the case.’ Randell believed that the cause of English cholera was ‘offending ingesta (food)’ but these worse cases had been caused by sudden changes of weather temperature.
A meeting of physicians in the North-East who saw two cases of cholera and reported that it was the common cholera of this country attended with aggravated symptoms. They maintained that the old disease was simply more virulent than usual due to the unnatural condition of the seasons in every part of Europe for the last three years and the unusual mildness of the present winter.
‘Let those who doubt our position refer to Sydenham’s Account of English Cholera in 1669, in which they will find an account of as general and as fatal a disease as the present. The spasms, lividity or blueness of the skin and oppression of the pulse, are not new symptoms; all have been frequently observed in the English disease.’
- Creighton, Charles. 2003. History of Epidemics in Britain, Vol.2. Cambridge: Cambridge University Press Reissue Edition.
- Dewhurst, Kenneth. 1966. Dr Thomas Sydenham (1624-1689). Wellcome Historical Medical Library.
- Hancock, David Boyd & Rousseau, George. 2003. ‘Coleridge’s Cholera’. Bulletin of the History of Medicine, Vol. 77, No.2.
- Morris, Robert D. 1976. Cholera 1832 – The Social Response to an Epidemic. Croom Helm.
To cite this post : Gareth Miles, “The Scourge of the Nineteenth Century: Cholera in England (Part I)”, Museum Highlights (blog on oldoperatingtheatre.com), April 28th, 2020. [On line]
Gareth Miles is a Education and Outreach Officer at the Old Operating Theatre Museum & Herb Garret. He is involved with the museum’s education programme and leads historical and medical walks around the local area.