Introduction
When people consume water or food infected with the Vibrio cholerae bacteria, they get an acute diarrheal illness known as cholera. According to Awofeso and Aldbak, “there are 1.3 million to 4 million cases of cholera” each year, and the illness accounts for 21,000 to 143,000 fatalities globally (Awofeso and Aldbak 2018, 92). Public health continues to be threatened by cholera, which also serves as a sign of inequality and a lack of social progress. Cholera was only present in India’s Bay of Bengal prior to 1817. Cholera had, however, spread worldwide by the following decades, partly as a result of migration and commerce between India and Europe. The treatment methods varied greatly due to the differences in contemporary approaches to potential cholera causes and their availability based on social stratification. In particular, the miasma theory, the germ theory, and the question of contagion were the main factors that influenced the treatment methods.
The First Outbreaks and the Miasma Theory
In light of cholera’s worldwide spread, England was not an exception. The first outbreak of cholera occurred in 1831; it was transmitted by sick sailors entering the Sunderland port (Awofeso and Aldbak 2018). The following disease spread and claimed more than 50 000 lives; however, no major sanitary actions followed it (Awofeso and Aldbak 2018). A second outbreak that occurred in 1848–1849 resulted in 53,293 fatalities (Awofeso and Aldbak 2018). Only then was the Public Health Act of 1848 passed by the government. The new law established local health boards to examine sanitary conditions nationwide, appoint clinical staff, and provide guidance on disease prevention. Nonetheless, there was frequently little to no cooperation amongst the institutions, and many urban poor people had a negative view of the medical community. The local boards could not be directed to execute action by the General Board of Health. Yet, despite the opposition of the population, the new law signaled the start of the government taking charge of public health.
According to contemporary medical field opinions, poor air quality, or so-called miasma, was what caused cholera. It was an idea that has been developed over time in the field of medicine to explain a number of significant illnesses, including cholera. Miasmas are toxic emissions that come from putrefying corpses, moldy plants, and dust inside buildings. They may be recognized by the respective foul stench common in such places. The miasma was thought to infiltrate the body and cause illnesses since Ancient Greece until the middle of the 19th century (Awofeso and Aldbak 2018). In the context of the first two cholera pandemics in England, the prevention methods, in many ways, reflected this thought. For instance, hospitals practiced quarantine measures, homes were lime-washed, and streets were washed clean.
The poor seemed to be especially susceptible to the sickness, and they were frequently advised to abstain from alcohol and eat sensibly. To halt the ongoing vomiting and diarrhea, which were the primary symptoms of cholera, people were advised to cleanse their bodies by emptying their intestines; moreover, leeches were frequently used to bleed patients (Kannadan 2018). Ultimately, these therapies did little but weaken cholera patients’ bodies and make them much more dehydrated, only increasing and accelerating mortality rates. Additional precautions included wearing woolen stockings or flannel girdles to stay warm. Apart from that, patients were commonly given camphor and mercury medications.
The cholera treatment for the middle and upper classes was different mainly because the treatment occurred at home compared to the charity hospitals available for the poor. When called, doctors would provide idiosyncratic therapies like opium or bleeding (Kannadan 2018). In addition to other eclectic therapies, homeopathic approaches were favored by the wealthier classes. Apart from that, various nutrition and hygiene regimens were advertised in books and other media, such as newspapers.
The Third Pandemic and the Germ Theory
Even if people took several measures and avoided the poor air, the miasma hypothesis could not significantly slow the spread of cholera. In this context, John Snow, a medical researcher of the 19th century, proposed the theory that poor air quality was not the primary cause of cholera spread. Conversely, he asserted that cholera might spread through food, drink, or mouth-to-mouth contact (Kannadan 2018). Snow came to the conclusion that a germ cell—not contaminated air—caused cholera. After witnessing early cases of the sickness, Dr. John Snow was certain that sewage-contaminated water was to blame for its spread. During the second epidemic, he presented this notion in a medical report. According to his research, this pathogen was spread from person to person by water consumption.
This notion opposed the miasma theory, the paragon of classic and contemporary medicine. Unfortunately, Snow was not a part of the medical elite in the 1850s, so his theory did not receive much support. At the middle of the 19th century, William Farr was the most trusted epidemiologist of the time. In Farr’s report on statistics for Great Britain in 1852, he insisted that the inverse relationship between cholera mortality and “elevation above sea level” supported the miasma as the disease’s origin (Kannadan 2018, 42). As a result, Farr managed to refute Snow’s notion, which reinforced the new theory.
In this context, only the third cholera outbreak in 1854 marked a significant advance in our knowledge of the disease’s origins. In three days, the pandemic claimed 127 lives, and 616 more perished within a month (Kannadan 2018). During this time, Snow launched further, in-depth epidemiological studies on the outbreak. By connecting instances of the disease to a specific water source in Broad Street, Soho, Snow demonstrated it in 1854 (Kannadan 2018). The pandemic subsided once the water source was banned at his recommendation.
Contagion Debate
The two mentioned theories, in many ways, were connected to the question of whether cholera was contagious. According to the miasma theory, sick people might spread the miasma; therefore, quarantine and isolation treatment methods were preferable. However, this only exacerbated the situation of the poor population, as charity hospitals displayed worse treatment outcomes compared to home treatment (Kannadan 2018). Conversely, the idea that cholera was transmitted by an independent agent contained in water indirectly promoted the anticontagious nature of the disease. In the end, as a result of debates that took place at the International Sanitary Conferences, the cholera was labelled contagious under specific circumstances (Awofeso and Aldbak 2018). Moreover, the germ theory was proved superior to its miasma predecessor, altering the treatment methods to the supply of boiled water.
Conclusion
The prevalence of specific theories in the medical community proves the differences in cholera understanding and treatment approaches. According to the miasma theory, the cholera spread was caused by foul air, which prompted the disinfection of public spaces. Conversely, germ theory stated that the disease agent was not contained in the air but in the water, highlighting the need for clean water supply management. In this context, cholera’s contagious nature was finally framed, preventing the common quarantine measures and lifting the disease burden among the poor.
References
Awofeso, Niyi, and Kefah Aldbak. “Cholera, Migration, and Global Health – A Critical Review.” International Journal of Travel Medicine and Global Health 6, no. 3 (2018): 92-99.
Kannadan, Ajesh. “History of the Miasma Theory of Disease.” Essai 16, no. 1 (2018): 40-43.