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135 Seven Cholera and Sanitation Cholera occupies a somewhat anomalous position in the history of diseases that have affected Western civilization. It shares many of the characteristics of plague: its suddenness of onset, its horrible symptoms, its high rate of mortality, and its apparent inexorability. For many nineteenth-century people cholera seemed as much a visitation from a vengeful God as plague had seemed to Europeans in 1348. And as they had in 1348 Europeans took flight when they could; as in 1348, they searched for the sinful who had brought on the disease and made scapegoats of them. Social turmoil followed in cholera’s wake. But cholera also appeared at a time when science was making more extensive claims of explanation, and when many societies were groping toward the control of disease through social and political action. Cholera’s victims might be as helpless as plague’s had been, but nineteenth-century thinkers were hardly resigned to that fact. Cholera’s position in historical writing has also been anomalous. For some it qualifies as the great disease drama of the nineteenth century, one that moreover focused attention on the environmental evils of early industrial urbanization . But much recent scholarship has discounted the importance of cholera in either the evolution of etiological theory or the development of sanitary practice , and we have recognized that its demographic impact was slight. It is as though cholera represented the last gasp of an earlier period of disease history . Nineteenth-century thinkers recognized its horrors, but were more concerned with an agenda determined by endemic complaints such as tuberculosis and “fevers,” an agenda in which this violent Asian visitor did not find a clear place. Cholera in 1831 The shock value of the disease came in part from its newness on the Western scene. Cholera had been at home on the Indian subcontinent for centuries . In warm river waters the causative microorganism (Cholera vibrio) flourished , reaching humans most often through water, but also carried on infected food or from hand to mouth. Microorganisms passed through digestive tracts and reentered water supplies through excreta. The growth of commerce and communication between India and Europe increased the likelihood of its importation from its Bengal home, and the imposition of British authority on the subcontinent increased the human (and disease) interchanges among regions of India itself. A major cholera epidemic began in India in 1817; from India the disease spread to Afghanistan and Persia and thence into Russia, appearing at Orenburg in 1829. From Orenburg it traveled into the West with remarkable rapidity, considering that the age of steam travel had scarcely begun. Cholera reached the major cities of Russia in 1830, spread to the Baltic in 1831, and by that autumn jumped into England. Northern Europe felt the disease in 1832, as did North America; cholera reached southern Europe, as well as Central and South America, in 1833. As railroads and steamships appeared in subsequent years, later episodes of cholera moved with even greater speed, with especially severe epidemics in 1848–49, 1853–54, the middle 1860s, and the early 1870s. One of the most serious outbreaks occurred as late as 1911, in Naples. Europeans took fright at cholera’s virulence, and with reason. Mortality rates from cholera approached those of plague, for roughly half of its victims died. It is worth noticing, however, that cholera’s morbidity rate fell far below that found in the great plague epidemics, and even below that customarily maintained by nineteenth-century tuberculosis. Cholera affected about 35,000 people in Paris in 1832 (in a population of 785,000), for example, and about 17,000 people in Hamburg in 1892 (in a population of 620,000).1 Cholera is not particularly easy to catch. Although the microorganisms must have been plentiful during the nineteenth-century epidemics, many people probably ingested them without harm, for human stomach acids often kill the organisms before they reach the intestines where the trouble starts. That trouble could devastate the victim. Cholera came as a sudden, overwhelming attack, most notably of dehydration marked by vomiting and profuse, uncontrollable excretion. The drastic loss of body fluids collapsed the tissues; coagulated blood ceased to flow, the skin turned alarmingly blue, and the heart (or the kidneys) failed, often within a few hours. People perfectly healthy in the morning died by nightfall, having undergone some hours of great agony. And the bourgeois of the nineteenth century found such a death particularly repugnant , for his sensibilities about the...

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