Posts tagged ‘cholera’

Aug 10, 2020

Pandemic: Cholera 1832. Part 2

Guest blog by Textor

PART 2

The way in which the financial side of the 1832 cholera pandemic crisis was handled in Aberdeen reflects something of the social and economic climate of the period. Central government established rules and guidelines to manage threats to civic and commercial life while at local government level it was left to commercial and professional classes, ratepayers of some standing, to decide how the financial demands of cholera should by managed.

cholera 3

In Aberdeen it was proposed that £4,500 would be necessary for the Board of Health to operate effectively. The question then was, how the money should be raised. Eventually it was decided against a specific compulsory local tax in favour of voluntary charitable contributions from better-off ratepayers. To this end local men-of-standing were identified and canvassed and £2,172 was raised. By the time the city came out of the crisis in May 1833 the Board of Health had £735 of this amount unspent. 

Monies were also raised in the County of Aberdeen, a portion of which was used to identify and forestall the entry of vagrants. This made some medical sense for many though not all physicians believed cholera to be contagious. Ratepayers in the County set aside £200 for constables to guard strategic points (such as the Bridge of Don) – protecting the shire from unwanted visitors. Somewhat akin to present-day migrant watches by July 1832 it was claimed 1,000 vagrants had been turned back from attempting to get into the County.
Cholera brought with it fear to communities. An incident at Skene Lane a fortnight before Aberdeen’s first case was identified demonstrates this.  Citizens on the lookout for carriers of the disease discovered a man collapsed on the roadway. He was seized, bound hand-and-foot and carried away to the infirmary at Woolmanhill where the hapless individual was diagnosed as drunk. The infirmary did not want him so the police were called and he was wheeled off in the Police Barrow: The mob cheered, the straps were firmly fixed, the cholera subject writhed and cursed, and the policeman went on with his barrow.

Not every incident connected with “mob” action had such a light-hearted (though not for the victim) tinge. Prejudice mixed with perfectly rational fears could excite communities sufficiently to result in threats of violence against those attempting to impose quarantine and other regulations. An incident at Wick found a Dr Alinson under attack and forced to seek refuge when fishermen threatened him at the quarantine hospital. He was rumoured to have been involved in scandals involving acquiring corpses for medical study and of killing patients in Edinburgh to supply the College of Surgeons with bodies for dissection. In Wick it was feared patients in the quarantine hospital faced the same outcome. Before dismissing this as irrational and blind prejudice it should be remembered that the 1832 Anatomy Act created the opportunity for surgeons to claim bodies of the poor for dissection. And who were the ones almost certain to die in quarantine? The poor. Not for them the prospect of a noble memorial stone cut in granite but the unceremonial disposal of their dismembered parts.

Before the Anatomy Act was passed, the poor or “lower classes” (as defined by the local paper) in Aberdeen hit out against the cavalier and at times illegal behaviour of the medical profession. In December 1831 the Anatomy Theatre in St Andrew’s Street was the scene of a riot when skulls, bones, and entrails were discovered on open ground. The building was attacked, wrecked and set alight while the anatomist was forced to run for his life. Nobody died. We cannot know whether the febrile atmosphere of a country threatened by the cholera epidemic helped provide an explosive edge to the “mob” but given that this was also the period of agitation for political reform and democratising of the parliamentary system the city’s streets where popular action occurred must surely have had a buzz about them we can only imagine.

Cholera visited Aberdeen very late in the day and never assumed the large epidemic proportions of elsewhere in the UK. Glasgow, for example, had thousands of deaths. Why Aberdeen had such a low number of cases is unclear. Within ten days of the first diagnosed case (27 August) at Cotton and Old Aberdeen there were a further nineteen cholera patients recorded on the register. The death rate among those affected was high – eight succumbed putting the death-rate at 40%. The spread of the disease was slow. By mid-September thirty-three cases were listed with fourteen recorded deaths. The gradual increase in numbers led Aberdeen’s physicians to conclude that while very dangerous cholera was not highly contagious, unlike scarlet fever. The editor of the Aberdeen Journal musing on the reason for so few cases in the town concluded that amongst other things it was probably the gracious interference of superior power-an interference which we shall ill-deserve, did we not gratefully endeavour to testify, as we best may, our humble acknowledgements.

With the spread of disease it became apparent it was the poor who suffered most. The first case occurred at a centre for textile production, at Cotton, and where textile and other workers lived. In late September cases emerged in the city, again among the poor, in the east end, where people lived cheek by jowl in crowded and at times insanitary conditions. By the end of the following month a total of ninety-two had contracted cholera with thirty-three cases fatal. In one particular week twenty-three fresh cases were diagnosed, mostly in the area of Park Street and Justice Street.

Through November reported cases fell away before more incidents emerged in Windy Wynd and the Vennel; areas that housed the poor. A description of the Vennel comes from the poet William Scott:

Vagrant Lodgers-

                                                 Wi tinklers, knaves, pig wives, and cadgers,

                                                The coarsest kind o’ Chelsea sodgers,

                                                          Like beggars dress’d,

                                                In holes and dens, like toads an badgers,

                                                          Here make their nest.

High occupancy where cleanliness was difficult to ensure increased the danger of contracting disease. The most shocking outbreak occurred in the fishing community at Fittie (Footdee)  where in November “with some virulence” fifty-six cases of cholera appeared out of a local population of about 480. It was calculated that the occupancy of each house was four persons per room. The Board of Health was particularly scathing at the state of drainage at Fittie. Aberdeen Town Council was the landlord.

By the end of the epidemic Aberdeen had 260 diagnosed cases. Mortality was high, 105 persons died which, however, was small compared with Glasgow where over 3,000 died between February and November 1832. In our current Covid-19 pandemic habits have changed. The emphasis on hand washing has been particularly important, even men, it is claimed, have taken to washing after going for a pee. Back in 1832 the Board of Health patronisingly commented that even the lower classes [resorted to] unwonted cleanliness in response to its injunctions. In 1833 the city’s charitable Dispensary reported on the impact of cholera highlighting a subsequent slackening in demand for their assistance from the poor. This they put down to three factors: cleaner housing; more fever wards at the infirmary; and “full employment” of the labouring classes, enabling them to have a marginally better standard of living, better diet, clothing and furnishing.

However, this apparent improvement in personal cleanliness among the poor was unsurprisingly not matched by significant improvements in the housing available to them. When doctors Kilgour and Galen reported on the sanitary state of Aberdeen, they described ill-ventilated properties with gutters running with all sorts of filth. People without privies (dry earth or bucket non-flush lavatories) and sewers had no option but to dump human waste. Dunghills built-up at doorways. The Gallowgate, with about 170 houses, had ten privies used by about 500-600 persons. Bad as this was at nearby North Street there was not a single privy. As for the availability of fresh water it was estimated that just under 6,000 persons lived in homes with their own water supply in a population of around 58,000 in Aberdeen at the time. All others relied on public wells distributed across the city. Attempts at cleanliness by poor tenants was further frustrated by the very high occupancy rates in accommodation. A Dr Keith reported crowding was fearful. His colleague Dr Dyce’s opinion was that with the first case of fever in a poor family came the likelihood it seldom ceases until all its members have been attacked.

As much as some local ministers considered epidemics to be a kind of divine retribution Boards of Health concentrated on the disease being a sign of an active and toxic agent which might be stopped or mitigated against by social measures such as quarantine, whitewashing walls and improvements in hygiene. The role of Christian God in sending cholera their way to chastise sinners might have occupied their private thoughts but their main preoccupation was with providing some form of active intervention.

Cholera, like Covid-19, is a product of Nature. Both are organisms capable of living in and harming the human frame. To this extent at least epidemics are “natural disasters.” But just as these harmful organisms can evolve so, too, can the human-social context within which they might find a home.

Both in 1832 and 2020 the economically vulnerable in society have suffered high infection rates. In both pandemics greater precautions could have been set in place prior to the outbreaks; there were no providential reasons why conditions could not have been other than they were. The NHS should have been better prepared for a pandemic as epidemiologists have been predicting one for decades.

Despite what Bob Dylan might say about the loss of lives on the Titanic there is understanding of pandemics, whether the one in 1832 or 2020. Grounded in the appearance of a harmful organism does not mean they are Acts of Nature. The way in which these organisms hit populations is dependent upon the state of scientific knowledge and divisions of wealth and power across society. The poor of Aberdeen occupied insanitary housing because of such divisions not because a God so decided. Equally the way in which the NHS found itself ill-prepared for pandemic despite decades of warnings speaks of economic and ideological priorities rather than an act of nature. Dylan’s song Tempest is wrong. We can understand and we can change things.

Aug 8, 2020

Pandemic: Cholera 1832

Guest post by Textor

PART 1

On the 27 August 1832 cholera arrived in Aberdeen; its first case from a pandemic that had been moving westward from Asia since the 1820s. Cholera was and is a killer disease – currently afflicting war-torn Yemen with mass infections and death – as Yemen’s civilian populations suffer the consequences of murderous rivalries for control and regional domination.

Saudi Arabia, a friend and ally of the arms-supplying British state, has played no small role in creating the conditions for cholera to thrive: poverty, hunger and destruction of the country’s sanitary and healthcare infrastructure which are vital to prevent the spread of infectious-contagious diseases. The scale of the tragedy in Yemen, to coin an historical anachronism, is of Biblical proportions. According to the European Centre for Disease Prevention and Control between 2017 and February 2020 there were 2.3 million suspected cases of cholera with close on 4,000 deaths; children being particularly vulnerable. (https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly )

Cholera is a water-borne disease so disruption to supplies of clean water make spread largely unavoidable. Add to this poor sanitation and a population becomes highly vulnerable. The bacterium Vibrio cholerae, to be anthropomorphic, is the guilty party (but nowhere near as guilty as those responsible for bombing Yemen.) The comma-shaped organism was first isolated in 1854 by Fillipo Pacini. His work was little known within the scientific community and it took another thirty years and the research of Robert Koch to more firmly and widely establish the bacterium as the cause of cholera. Also in 1854 the physician John Snow satisfied to his own, if not other medics’ satisfaction, that an outbreak of cholera centred on Broad Street in London’s Soho district was related to the local water supply; hence his removal of the water pump handle so potentially hindering the spread of the disease.

Patrick Manson, physician, born in Oldmeldrum, Aberdeenshire provided detailed descriptions of the disease in his seminal work of 1898, Tropical Diseases. He outlined its cause, history, means of spread and containment along with how it manifested itself in patients. Manson described it characterised by profuse purging and vomiting of a colourless serous material, muscular cramps. “Serous material” is watery fluid often likened to “rice water” – in plain language more solid and normal faecal waste becomes liquid. The accompanying cramps of an agonising character attacks the extremities and the abdomen. Of course, the fluids being expelled by the poor suffering patient contain virulent bacterium. In addition, such massive loss of liquid profoundly dehydrates a sick person, damaging the intestines and threatening organ collapse and eventual death. 

With Vibrio cholerae in the community, the break-down of sanitation, the destruction of clean water supplies in areas of high-density populations, such as in Yemen, mean an epidemic is almost inevitable. A product of war – collateral damage used to be the term, and for the barbarous perpetrators of conflict an additional source of fear and terror suffered by civilians which, if pushed far enough, can lead to the collapse of civil society.

When a cholera pandemic (often labelled Cholera Morbus) arrived in Aberdeen in 1832 its cause was unknown. The contagion originated in Asia and moved westward, carried along trading routes – as Patrick Manson observed cholera follows the great routes of human intercourse. Traders, whether overland or sea-going, might carry more than recipient nations bargained for. In much the same way the 2020 pandemic Covid-19 was carried country to country on motor vehicles, cruise ships and aircrafts transporting thousands of passengers across boundaries. Global movement of people and commodities existed long before the modern period but by the 19th century the reach, density and speed of travel accelerated substantially.

Aberdeen of 1832 was one thread in the web of global trade. Without any railway connection to the rest of Britain and with a very rudimentary national highway network it was the city’s port that was the main point of entry for infectious diseases. Imports and exports, particularly to and from the Low Countries and the Baltic along with coastal trading were Aberdeen’s main commercial arteries. Consequently, when cholera moved east into Russia and onto the Baltic ports an infectious line of transmission was established. Similarly with coastal trading the movement of people within Britain provided further points for potential cross-infection. In the event the first appearance of cholera locally was not in the city as such where it might have been expected but to its northern outskirts, at Cotton and Old Aberdeen.

Cholera had been “raging” in Russian territory since the summer of 1831 but like many contagions it moved in waves. The master of an Aberdeen merchant vessel berthed in Riga wrote home in July that year that the cholera morbus is much abated here . . . We are obliged to lay off work at 11o’clock a.m. Until 3 p.m. No sort of out work is allowed to be carried on in Riga, or on board ships during that time. This partial “lockdown” presented little defence to transmission of the disease but because it was thought disease was present in a miasma of bad air which could easily be transmitted from infected persons to others, the health measure made some sense.

Equally sensible for a Christian nation which believed in sin, retribution and atonement was the response of the Scottish clergy, ministering to coastal communities, who humbly called on God to forgive transgressions and stop this great calamity from our country. By late 1831 cholera was present in Sunderland and spreading. The Presbytery of Aberdeen petitioned for a day of national fasting and humiliation to be held. The call repeated in February 1832 for a measure more likely to induce the Divine Disposer to avert or mitigate the calamity with which we are threatened. Such spiritual pleas might boost moral but provided no barrier to the yet unidentified bacterium. Aberdeen’s weaver poet William Anderson wrote “The Cholera” in which he gave quietistic voice to the Christian vision: Our hope is not in man, nor in man’s aid;/In Heaven we put our trust, and shall not be dismay’d.

More effective and practical were the actions of the British government which set about establishing Boards of Health across the nations with the Central Board in London publishing guidelines for managing the spread of cholera and ways of caring for patients. Using the experience of previous epidemics quarantine became a key approach: identify and isolate those carrying the disease and at the same secure property, including clothing and furnishings, which might harbour cholera. Quarantine was also applied to shipping. Cromarty Bay to the north of Inverness, became a holding point for Baltic trade ships flying the yellow flag of infection aboard. Fear stalked the area’s byways. The Cromarty geologist and writer, Hugh Miller, records a decline in local trade, Occasionally, however, a few of the more courageous housewives might be seen creeping warily along our streets; but, in coming . . along the edge of the bay . . . struck up the hill if the wind blew from off the quarantine vessels.

Further south one of Aberdeen’s vessels, Thistle, sailing from Newcastle with a cargo of coals discovered a crew member displaying symptoms of cholera. By the time the ship reached North Berwick the unfortunate seaman was dead, leaving the master with the problem of disposing of the body. Signalling a local pilot he asked permission to bury the man on a local island. Permission was refused and he was instructed to bury the body at sea. In the event the master seems to have simply laid the seaman to rest in waters close by the shore.

In February 1832 Aberdeen’s Board of Health advertised for Active Men and Women [to become attendants on the sick] either in hospitals, or where they may be required. Reminiscent of recent events surrounding Covid-19 Aberdeen’s General Dispensary which gave aid to the city’s poor, warned that its facilities and finances, should cholera appear, were likely to be overwhelmed as the poor were expected to become the first and overwhelming victims of the disease.

The Central Board of Health provided guidance in November 1831 based on its observation that the poor ill-fed part of the population was most at risk also offered a moral judgement that this section of the population was most likely to be beset by the sin of intemperance, addicted to drink and spirituous liquors. Their weakened constitutions would do nothing to help the poor in tackling the pandemic but perhaps it was drinking water (contaminated) that posed the bigger threat of disease transmission than alcohol. Still, as has been found with the easing of the Covid-19 lockdown bars and conviviality weaken links in chains of quarantine.

Part 2 to follow.