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Cholera, as fatal as the Black Death in the Middle Ages, was the classic killer disease of the nineteenth century. Two forms of cholera were known to British doctors at this time. English cholera, sometimes called ‘autumnal diarrhoea’, was commonplace and not usually fatal.
The first British epidemic of 1831-33 reached every corner of the British Isles and killed some 60,000 people including 7,000 in London, 3,000 in Glasgow and 1,500 in Liverpool.
Britain’s death roll, however, was much lower than in the countries of Western Europe. The second epidemic, again beginning in India in 1845, reached Britain in 1848-9. It was more severe than before and half a million cases brought 130,000 deaths.
Today, we know that the cholera vibrio, a germ shaped like a tiny coma, is not caught but swallowed. It imbeds itself in the intestine and kills rapidly by dehydration. The disease is spread when water supplies become polluted by cholera excrement which in the nineteenth century often drained from privies and cesspools into nearby public wells. It spread so rapidly among the poor because in overcrowded, insanitary conditions and often without water in their houses, they rarely washed and frequently touched each other’s soiled clothing or bedding before eating.
For much of the nineteenth century doctors knew little of cholera’s causes and nothing of its cure. They were divided into contagionists and miasmatists. The former believed that cholera was spread by physical contact with the persons, clothes or bedding of the infected. The latter believed it travelled ‘on the wings of the air’. Both were agreed, however, that the best protection wa cleanliness. Because property owners resented interference with property, cleansing the insanitary streets and houses, whether in town or village, was almost impossible.
This is well illustrated by the case of Sandgate. Sandgate was a watering place which has escaped the outbreaks of 1831-33 and 1848-49. Part of it lay in the parish of Cheriton, part in the parish and part in the township of Folkestone.
In 1848 some of the Sandgate ratepayers, after a public meeting at Sandgate National School, asked the General Board of Health to set up under the Public Health Act of that year, a local Sandgate Board of Health.
A local Board of Health could lead the fight against disease by the removal of refuse and the provision of more effective drainage and pure water supplied by this would cost money and so put up the rates. In June 1849, Thomas Webster Rammell, an inspector, was sent to Sandgate to investigate and make a report to the General Board of Health in London. His report, which was published in May 1849, provides a great deal of information about Sandgate and its public health problems.
Copy of Report to the General Board of Health on a Preliminary Inquiry into the sewerage, drainage and supply of water, and the sanitary condition of the inhabitants in the Town of Sandgate available from Sandgate Library.
Asiatic or Indian cholera, also known as ‘cholera Asphysia’, ‘cholera Morbus’, the ‘Black Illness’ or the ‘Blue Vomit’ was a different matter. It struck with appalling suddenness.
The first signs were usually giddiness followed by a ‘prodigious evacuation when the whole intestines seemed to be emptied at once’. Body movement was then accompanied by violent vomiting and diarrhoea. The odourless, rice-water motions of the victim became the classic diagnostic sign. The body often lost several pints of fluid in minutes and dehydration made the patient shrivelled.
These symptoms were followed by ‘cramps’, which began with acute pains in the fingers and toes spreading upwards to the chest and stomach. The features became black or blue, breathing was difficult and violent convulsions contracted the body almost into a ball. A victim who survived the agony of the cramps could still recover but if the attack was severe he passed into final stage of collapse giving way to coma and death. In the crowded, insanitary hovels of the poor, without privacy, sanitation or water, few diseases could have been more ghastly but cholera also had an unpleasant habit of spreading to the homes of the rich.
Before 1817 cholera was known only in India and the Far East where periodic outbreaks claimed thousands of victims. In that year it began to move slowly eastward and westward from its homeland in the swamps of Bengal and the Ganges Delta reaching Britain from the European mainland, via the port of Sunderland, in October 1831 before passing on to America.