Diseases and epidemics of the 19th century included long-standing epidemic threats such as smallpox, typhus, yellow fever, and scarlet fever. In addition, cholera emerged as an epidemic threat and spread worldwide in six pandemics in the nineteenth century.
Medical responses
Medicine in the 19th century Epidemics of the 19th century were faced without the medical advances that made 20th-century epidemics much rarer and less lethal. Micro-organisms (viruses and bacteria) had been discovered in the 18th century, but it was not until the late 19th century that the experiments of Lazzaro Spallanzani and Louis Pasteur disproved spontaneous generation conclusively, allowing germ theory and Robert Koch's discovery of micro-organisms as the cause of disease transmission. Thus throughout the majority of the 19th century, there was only the most basic, common-sense understanding of the causes, amelioration, and treatment of epidemic disease.
The 19th century did, however, mark a transformation period in medicine. This included the first uses of chloroform and nitrous dioxides as anesthesia, important discoveries in regards of pathology and the perfection of the autopsy, and advances in our understanding of the human body. Medical institutions were also transitioning to new hospital styles to try to prevent the spread of disease and stop over crowding with the mixing of the poor and the sick which had been a common practice. With the increasing rise in urban population, disease and epidemic crisis became much more prevalent and was seen as a consequence of urban living. Problems arose as both governments and the medical professionals at the time tried to get a handle on the spread of disease. They had yet to figure out what actually causes disease. So as those in authority scrambled to make leaps and bounds in science and track down what may be the cause of these epidemics, entire communities would be lost to the grips of terrible ailments.
Exploring potential cures During these many outbreaks, members of the medical profession rapidly began trying different cures to treat their patients. During the cholera epidemic of 1832, a doctor in London, Thomas Latta, discovered that he could greatly increase the survival rate of his patients by injecting saline solutions into their arms. However, due to the wide range of medicines being touted as cures and treatments, his technique failed to gain widespread adoption. Many other medical discoveries made in the 19th century failed to gain traction for similar reasons. With the increasing circulation of mass media and little content review in medical journals, almost anyone with or without proper education could publish a potential cure for disease. Actual practicing medical professionals also had to compete with the ever expanding pharmacy companies that were all too ready to provide new elixirs and promising treatments for the epidemics of the time.
Emerging from the medical chaos were legitimate and life changing treatments. The late 19th century was the beginning of widespread use of vaccines.Baxby, Derrick (1999). "Edward Jenner's Inquiry; a bicentenary analysis". Vaccine 17 (4): 301–307 The cholera bacterium was isolated in 1854 by Italian anatomist Filippo Pacini,See: Fillipo Pacini (1854) "Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico" (Microscopic observations and pathological deductions on Asiatic cholera), Gazzetta Medica Italiana: Toscana, 2nd series, 4 (50) : 397–401; 4 (51) : 405–412. Reprinted (more legibily) as a pamphlet. and a vaccine, the first to immunize humans against a bacterial disease, was developed by Spanish physician Jaume Ferran i Clua in 1885,onlinelibrary.wiley.com and by Russian–Jewish bacteriologist Waldemar Haffkine in July 1892.haffkineinstitute.org
Antibiotic drugs did not appear until the middle of the 20th century. Sulfonamides did not appear until 1935, and penicillin, discovered in 1928, was not able to be purified in large quantities until 1940 and was first used to treat a patient in 1941.
A big response and potential cure to these epidemics were better sanitation in the cities. Sanitation prior to this was very poor and sometimes attempts to get better sanitation often exacerbated the diseases, especially during the cholera epidemics because their understanding of diseases relied on the miasma (bad air) theory. During the first cholera epidemic, Edwin Chadwick made an inquiry into sanitation and used quantitative data to link poor living conditions and disease and low life expectancy. As a result, the Board of Health in London took measure to improve drainage and ventilation around the city. Unfortunately, the measures helped clean the city but it further contaminated the River Thames (the primary drinking water for the city) and the epidemic got worse.
Beliefs about the causes
During the second cholera pandemic of 1826–1837, the scientific community varied in its beliefs about its causes. In France, doctors believed cholera was associated with the poverty of certain communities or poor environment. Russians believed the disease was contagious and quarantined their citizens. The United States believed that cholera was brought by recent immigrants, specifically the Irish. Lastly, some British thought the disease might arise from divine intervention.
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. The prevalence of the disease in the South in areas of black populations convinced United States scientists that cholera was associated with African Americans. Current researchers note they lived near the waterways by which travelers and ships carried the disease and their populations were underserved with sanitation infrastructure and health care.
The Soho outbreak in London in 1854 ended after the physician John Snow identified a neighborhood Broad Street pump as contaminated and convinced officials to remove its handle. Snow believed that germ-contaminated water was the source of cholera, rather than particles in the air (referred to as "miasmata"). His study proved contaminated water was the main agent spreading cholera, although he did not identify the contaminant. Though Filippo Pacini had isolated Vibrio cholerae as the causative agent for cholera that year, it would be many years before miasma theory would fall out of favor.
In London, in June 1866Johnson, S: The Ghost Map(), 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. William Farr, using the work of John Snow, et al., as to contaminated drinking water being the likely source of the disease, relatively quickly identified the East London Water Company as the source of the contaminated water. Quick action prevented further deaths.
During the fifth cholera pandemic, Robert Koch isolated Vibrio cholerae and proposed postulates to explain how bacteria caused disease. His work helped to establish the germ theory of disease. Prior to this time, many physicians believed that microorganisms were spontaneously generated, and disease was caused by direct exposure to filth and decay. Koch helped establish that the disease was more specifically contagious and was transmittable through the contaminated water supply. The fifth was the last serious European cholera outbreak, as cities improved their sanitation and water systems.
Cholera
Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. Cholera is transmitted primarily by drinking water or eating food that has been contaminated by the cholera bacterium. The bacteria multiply in the small intestine; the feces (waste product) of an infected person, including one with no apparent symptoms, can pass on the disease if it contacts the water supply by any means.
History does not recount any incidents of cholera until the 19th century. Cholera came in seven waves, the last two of which occurred in the 20th century.
The first cholera pandemic started in 1816, spread across India by 1820, and extended to Southeast Asia and Central Europe, lasting until 1826.
A second cholera pandemic began in 1829, reached Russia, causing the Cholera riots. It spread to Hungary, Germany and Egypt in 1831,Cholera Epidemic in Egypt (1947) . and London, Paris, Quebec, Ontario and New York City the following year.Asiatic Cholera Pandemic of 1826–37 Cholera reached the Pacific coast of North America by 1834, reaching into the center of the country by steamboat and other river traffic.
The third cholera pandemic began in 1846 and lasted until 1860. It hit Russia hardest, with over one million deaths. In 1846, cholera struck Mecca, killing over 15,000.Asiatic Cholera Pandemic of 1846–63. UCLA School of Public Health. A two-year outbreak began in England and Wales in 1848, and claimed 52,000 lives.Cholera's seven pandemics, cbc.ca, 2 December 2008. In 1849, outbreak occurred again in Paris, and in London, killing 14,137, 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. Cholera spread throughout the Mississippi River system. Thousands died in New York City, a major destination for Irish immigrants. Cholera killed 200,000 people in Mexico. That year, cholera was transmitted along the California, Mormon and Oregon Trails, killing people that are believed to have died on their way to the California Gold Rush, Utah and Oregon in the cholera years of 1849–55. In 1851, a ship coming from Cuba carried the disease to Gran Canaria,http://coloquioscanariasamerica.casadecolon.com/index.php/CHCA/article/viewFile/9072/8523 p. 626 killing up to 6,000 people.mdc.ulpgc.es/cdm/ref/collection/MDC/id/44370 pp. 545–546
The pandemic spread east to Indonesia by 1852, and China and 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. The Ansei outbreak of 1858–60, for example, is believed to have killed between 100,000 and 200,000 people in Tokyo alone.Kaoru Sugihara, Peter Robb, Haruka Yanagisawa, Local Agrarian Societies in Colonial India: Japanese Perspectives, (1996), p. 313. An outbreak of cholera in Chicago in 1854 took the lives of 5.5% of the population (about 3,500 people).Chicago Daily Tribune , 12 July 1854 In 1853–54, London's epidemic claimed 10,738 lives. Throughout Spain, cholera caused more than 236,000 deaths in 1854–55. In 1854, it entered Venezuela; Brazil also suffered in 1855.
The fourth cholera pandemic (1863–1875) spread mostly in Europe and Africa. At least 30,000 of the 90,000 Mecca pilgrims died from the disease. Cholera ravaged northern Africa in 1865 and southeastward to Zanzibar, killing 70,000 in 1869–70. Cholera claimed 90,000 lives in Russia in 1866.Eastern European Plagues and Epidemics 1300–1918 . The epidemic of cholera that spread with the Austro-Prussian War (1866) is estimated to have killed 165,000 people in the Austrian Empire.Matthew R. Smallman-Raynor PhD and Andrew D. Cliff DSc, Impact of Infectious Diseases on War. . In 1867, 113,000 died from cholera in Italy.Vibrio Cholerae and Cholera – The History and Global Impact . and 80,000 in Algeria.