Cholera outbreaks and pandemics

Hand bill from the New York City Board of Health, 1832. The outdated public health advice demonstrates the lack of understanding of the diseases and its actual causative factors.

Although much is known about the mechanisms behind the spread of cholera, this has not led to a full understanding of what makes cholera outbreaks happen in some places and not others. Lack of treatment of human feces and lack of treatment of drinking water greatly facilitate its spread. Bodies of water have been found to serve as a reservoir, and seafood shipped long distances can spread the disease. Cholera did not occur in the Americas for most of the 20th century after the early 1900s in New York City. It reappeared in the Caribbean toward the end of that century and seems likely to persist.[1]

Deaths in India between 1817 and 1860, in the first three pandemics of the nineteenth century, are estimated to have exceeded 15 million people. Another 23 million died between 1865 and 1917, during the next three pandemics. Cholera deaths in the Russian Empire during a similar time period exceeded 2 million.[2]

Pandemics

First, 1816–26

Second, 1829–51

Over 15,000 people died of cholera in Mecca in 1846.[10] A two-year outbreak began in England and Wales in 1848, and claimed 52,000 lives.[11]

In 1849, a second major outbreak occurred in Paris. In London, it was the worst outbreak in the city's history, claiming 14,137 lives, over twice as many as the 1832 outbreak. Cholera hit Ireland in 1849 and killed many of the Irish Famine survivors, already weakened by starvation and fever.[12] In 1849, cholera claimed 5,308 lives in the major port city of Liverpool, England, an embarkation point for immigrants to North America, and 1,834 in Hull, England.[6]

An outbreak in North America took the life of former U.S. President James K. Polk. Cholera, believed spread from Irish immigrant ship(s) from England, spread throughout the Mississippi river system, killing over 4,500 in St. Louis[6] and over 3,000 in New Orleans.[6] Thousands died in New York, a major destination for Irish immigrants.[6] Cholera claimed 200,000 victims in Mexico.[13]

That year, cholera was transmitted along the California, Mormon and Oregon Trails as 6,000 to 12,000[14] are believed to have died on their way to the California Gold Rush, Utah and Oregon in the cholera years of 1849–1855.[6] It is believed more than 150,000 Americans died during the two pandemics between 1832 and 1849.[15][16]

In 1851, a ship coming from Cuba carried the disease to Gran Canaria.[17] It is considered that more than 6,000 people died in the island during summer,[18] out of a population of 58,000.

During this pandemic, the scientific community varied in its beliefs about the causes of cholera. In France doctors believed cholera was associated with the poverty of certain communities or poor environment. Russians believed the disease was contagious, although doctors did not understand how it spread. The United States believed that cholera was brought by recent immigrants, specifically the Irish, and epidemiologists understand they were carrying disease from British ports. Lastly, some British thought the disease might rise from divine intervention.[19]

Third, 1852–1860

1854: An outbreak of cholera in Chicago took the lives of 5.5% of the population (about 3,500 people).[6][21] In 1853–4, London's epidemic claimed 10,739 lives. The Soho outbreak in London ended after the physician John Snow identified a neighborhood Broad Street pump as contaminated and convinced officials to remove its handle.[22] His study proved contaminated water was the main agent spreading cholera, although he did not identify the contaminant. It would take many years for this message to be believed and acted upon. In Spain, over 236,000 died of cholera in the epidemic of 1854–55.[23] The disease reached South America in 1854 and 1855, with victims in Venezuela and Brazil.[13] During the third pandemic, Tunisia, which had not been affected by the two previous pandemics, thought Europeans had brought the disease. They blamed their sanitation practices. Some United States scientists began to believe that cholera was somehow associated with African Americans, as the disease was prevalent in the South in areas of black populations. Current researchers note their populations were underserved in terms of sanitation infrastructure, and health care, and they lived near the waterways by which travelers and ships carried the disease.[24]

Fourth, 1863–1875

1892 cholera outbreak in Hamburg, hospital ward
1892 cholera outbreak in Hamburg, disinfection team

The fourth cholera pandemic of the century began in the Ganges Delta of the Bengal region and traveled with Muslim pilgrims to Mecca. In its first year, the epidemic claimed 30,000 of 90,000 Mecca pilgrims.[25] Cholera spread throughout the Middle East and was carried to Russia, Europe, Africa and North America, in each case spreading from port cities and along inland waterways.

The pandemic reached Northern Africa in 1865 and spread to sub-Saharan Africa, killing 70,000 in Zanzibar in 1869–70.[26] Cholera claimed 90,000 lives in Russia in 1866.[27] The epidemic of cholera that spread with the Austro-Prussian War (1866) is estimated to have taken 165,000 lives in the Austrian Empire, including 30,000 each in Hungary and Belgium and 20,000 in the Netherlands.[28]

In London in June 1866, a localized epidemic in the East End claimed 5,596 lives, just as the city was completing construction of its major sewage and water treatment systems (see London sewerage system); the East End section was not quite complete.[29] Epidemiologist William Farr identified the East London Water Company as the source of the contamination. Farr made use of prior work by John Snow and others pointing to contaminated drinking water as the likely cause of cholera in an 1854 outbreak. Quick action prevented further deaths.[6] In the same year, the use of contaminated canal water in local water works caused a minor outbreak at Ystalyfera in South Wales. Workers associated with the company and their families were most affected, and 119 died.

In 1867, Italy lost 113,000 lives and 80,000 died of the disease in Algeria.[26] Outbreaks in North America in the 1870s killed some 50,000 Americans as cholera spread from New Orleans along the Mississippi River and to ports on its tributaries.[15]

Fifth, 1881–1896

Sixth, 1899–1923

Seventh, 1961–1975

Notable outbreaks (1991–2009)

By 12 February 2009, the number of cases of infection by cholera in sub-Saharan Africa had reached 128,548 and the number of fatalities, 4,053.

Notable outbreaks (2010–present)

False reports

A persistent urban myth states 90,000 people died in Chicago of cholera and typhoid fever in 1885, but this story has no factual basis.[82] In 1885, a torrential rainstorm flushed the Chicago River and its attendant pollutants into Lake Michigan far enough that the city's water supply was contaminated. But, as cholera was not present in the city, there were no cholera-related deaths. As a result of the pollution, the city made changes to improve its treatment of sewage and avoid similar events.

See also

References

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