History of cholera
Seven cholera pandemics have occurred in the past 200 years, with the first pandemic originating in India in 1817. The seventh cholera pandemic is officially a current pandemic and has been ongoing since 1961, according to a World Health Organization factsheet in March 2022. Additionally, there have been many documented major local cholera outbreaks, such as a 1991–1994 outbreak in South America and, more recently, the 2016–2021 Yemen cholera outbreak.
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.
Between 1816 and 1923, the first six cholera pandemics occurred consecutively and continuously over time. Increased commerce, migration, and pilgrimage are credited for its transmission. Late in this period, major scientific breakthroughs toward the treatment of cholera develop: the first immunization by Pasteur, the development of the first cholera vaccine, and identification of the bacterium Vibrio cholerae by Filippo Pacini and Robert Koch. After a long hiatus, a seventh cholera pandemic spread in 1961. The pandemic subsided in the 1970s, but continued on a smaller scale. Outbreaks occur across the developing world to the current day. Epidemics occurred after wars, civil unrest, or natural disasters, when water and food supplies had become contaminated with Vibrio cholerae, and also due to crowded living conditions and poor sanitation.
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.
Pandemics
The first cholera pandemic occurred in the Bengal region of India, near Calcutta, starting in 1817 through 1824. The disease dispersed from India to Southeast Asia, the Middle East, Europe, and Eastern Africa through trade routes. The second pandemic lasted from 1826 to 1837 and particularly affected North America and Europe, due to the result of advancements in transportation and global trade, and increased human migration, including soldiers. The third pandemic erupted in 1846, persisted until 1860, extended to North Africa, and reached South America, for the first time specifically affecting Brazil. The fourth pandemic lasted from 1863 to 1875, and spread from India to Naples and Spain, and to the United States in 1873. The fifth pandemic was from 1881 to 1896 and started in India and spread to Europe, Asia, and South America. The sixth pandemic started in India and lasted from 1899 to 1923. These epidemics were less fatal due to a greater understanding of the cholera bacteria. Egypt, the Arabian peninsula, Persia, India, and the Philippines were hit hardest during these epidemics, while other areas, such as Germany in 1892 and Naples from 1910 to 1911, also suffered severe outbreaks. The seventh pandemic originated in 1961 in Indonesia and is marked by the emergence of a new strain, nicknamed El Tor, which still persists in developing countries.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.
First, 1817–1824
The first cholera pandemic, though previously restricted, began in Bengal, and then spread across India by 1820. Hundreds of thousands of Indians and ten thousand British troops died during this pandemic. The cholera outbreak extended as far as China, Indonesia and the Caspian Sea in Europe, before receding. In 1821, it is estimated that up to 100,000 deaths occurred in Korea.Second, 1826–1837
A second cholera pandemic reached Russia, Hungary and Germany in 1831; it killed 130,000 people in Egypt that year. In 1832 it reached London and the United Kingdom and Paris. In London, the disease claimed 6,536 victims and came to be known as "King Cholera"; in Paris, 20,000 died, and total deaths in France amounted to 100,000. In 1833, a cholera epidemic killed many Pomo, which are a Native American tribe. The epidemic reached Quebec, Ontario, Nova Scotia, and New York in the same year, and the Pacific coast of North America by 1834. In the center of the country, it spread through the cities linked by the rivers and steamboat traffic.In Washington D.C. Michael Shiner, an enslaved laborer at the Washington Navy Yard recorded, "The time the colery broke out in about June and July August and September 1832 it Raged in the City of Washington and every day they wher twelve or 13 carried out to they graves a day." By late July 1832, cholera had spread to Virginia and on 7 August 1832, Commodore Lewis Warrington confirmed to the Secretary of the Navy Levi Woodbury cholera was at the Gosport Navy Yard, "Between noon of that day, and the morning of Friday , when all work on board her USS Fairchild stopped, several deaths by cholera occurred and fifteen or sixteen cases were reported."
The epidemic of cholera, cause unknown and prognosis dire, had reached its peak. Cholera afflicted Mexico's populations in 1833 and 1850, prompting officials to quarantine some populations and fumigate buildings, particularly in major urban centers, but nonetheless the epidemics were disastrous.
In response to the second cholera pandemic, the Ottoman Empire and Egypt reformed their quarantine systems, following the western Mediterranean model. In 1831, the Egyptian Quarantine Board was established. It constructed Egypt's first modern lazaretto in Alexandria in 1833. In 1831, the Ottoman government set up the first permanent quarantine complex in Istanbul. In 1838, the Ottoman government established the Supreme Council of Health, which oversaw 59 quarantines. While largely useless against cholera, these quarantines shored up the two countries' epidemiological defenses against bubonic plague.
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.
Third, 1846–1860
The third cholera pandemic deeply affected Russia, with over one million deaths. Over 15,000 people died of cholera in Mecca in 1846. A two-year outbreak began in England and Wales in 1848, and claimed 52,000 lives.In 1849, a second major outbreak occurred in France. 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. 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. In Vietnam and Cambodia, cholera hit in summer 1849, killing approximately 589,000 to 800,000 people within one year, along with its consequential famine.
An outbreak in North America took the life of former U.S. President James K. Polk. Cholera, believed spread from Irish immigrant ships from England, spread throughout the Mississippi river system, killing over 4,500 in St. Louis and over 3,000 in New Orleans. Thousands died in New York, a major destination for Irish immigrants. Cholera claimed 200,000 victims in Mexico.
That year, cholera was transmitted along the California, Mormon, and Oregon Trails as 6,000 to 12,000 are believed to have died on their way to the California Gold Rush, Utah and Oregon in the cholera years of 1849–1855. It is believed more than 150,000 Americans died during the two pandemics between 1832 and 1849.
In 1851, a ship coming from Cuba carried the disease to Gran Canaria. It is considered that more than 6,000 people died in the island during summer, out of a population of 58,000.
In 1852, cholera spread east to the Dutch East Indies and later was carried to Japan in 1854. The Philippines were infected in 1858 and Korea in 1859. In 1859, an outbreak in Bengal contributed to transmission of the disease by travelers and troops to Iran, Iraq, Arabia, and Russia. Japan suffered at least seven major outbreaks of cholera between 1858 and 1902. Between 100,000 and 200,000 people died of cholera in Tokyo in an outbreak in 1858–1860.
In 1854, an outbreak of cholera in Chicago took the lives of 5.5 percent of the population. Providence, Rhode Island, suffered an outbreak so widespread that for the next thirty years, 1854 was known there as "The Year of Cholera." In 1853–1854, London's epidemic claimed 10,739 lives. The 1854 Broad Street Cholera outbreak in London ended after the physician John Snow identified a neighborhood Broad Street pump as contaminated and convinced officials to remove its handle to prevent people from drawing water there. 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 fully acted upon. In Spain, over 236,000 died of cholera in the epidemic of 1854–1855. The disease reached South America in 1854 and 1855, with victims in Venezuela and Brazil. During the third pandemic, residents of 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.
From November 10, 1855, to December 1856, the disease spread through Puerto Rico, claiming 25,820 victims. Cemeteries were expanded to allow for the burial of victims of cholera. In Arecibo, a large municipality of Puerto Rico, the number of people dying in the streets was so great that the city could not keep up. A man named Ulanga made it his responsibility to collect and carry the dead to the provisional Cementerio de los Coléricos.