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.