View Full Version : Cholera in the 1800s

12-05-2008, 08:23 PM
What kind of preventative measures would have been taken in the late 1800s during a cholera outbreak? (ie: people wearing cloths over their noses & mouths, etc.) I don't know how much they knew about the disease back then, and how effective/accurate their methods would have been to try and contain an outbreak.

12-05-2008, 09:22 PM
Quarantine was the mainstay. Once in a while there were people who understood the problems associated with poor sanitation. Unfortunately a lot of them went unheeded.

12-05-2008, 09:40 PM
Also, rat-catchers may paid a bounty by the local politicians if there was an outbreak either in progress or threatening...


12-05-2008, 09:47 PM
A very famous case in epidemiology and cholera:


The English response to the 1832 Cholera Pandemic is historically significant. In mid 1831 with cholera's "terror" loose on the continent and approaching the British Isles, the government established a board of health within the Royal College of Physicians. This Central Board of Health was proclaimed in June of 1831 and consisted of seven physicians, the comptroller of the navy, a deputy of the Board of Customs, director general of the army's hospitals, and several other similarly important officials. Among its first proposed recommendations, rules, and regulations, applicable to each town and village, was "there should be established a local Board of Health." Local boards were to consist of the local chief magistrate and clergymen, one of whom, would serve as a correspondent with London's Central Board of Health. Additionally, ". . .in each town or its neighborhood," temporary hospitals were to be established to which ". . .every case of the Disease as soon as detected . . ." might be removed. Finally, "The Houses from which the Sick Persons had been removed should be purified in the following manner. The wearing apparel and household furniture should be thoroughly washing and scoured, the walls and ceilings lime washed, the doors and windows of each apartment left open for many days . . ."[xx] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn20) Eventually, over 1200 local boards of health (822 in England and Wales, and about 400 in Scotland) were established in Great Britain.[xxi] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn21)

Most physicians felt that cholera was particularly susceptible to medical management during its Premonitory stage. The onset of lesser stomach spasms and "painless" diarrhea was considered not part of the disease but a precursor; if prompt medical attention were received, individuals could escape, prevent, or otherwise avoid the disease. It was "not improperly termed the curable stage."[xxxiv] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn34) The Premonitory stage, and the medical community's fixation that it could be managed, was erroneous. The "curable stage" was simply one of the many common "stomach upsets" other than cholera. The conclusion that cholera was curable was based upon a faulty premise: all similar symptoms are the same disease and were related.
Treatment of the first stage (Premonitory) of cholera consisted of confining the victim to bed and the taking of some warmed mild aromatic drink such as spearmint, chamomile, or warm camphor julep. Once the individual had commenced to perspire, calomel, camphor, magnesia, and pure castor oil was administered.[xxxv] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn35) If the cholera victim had recently consumed food, an emetic such as ipecacuanha or sulfate of zinc was given. It was also recommended that bleeding of the victim be performed. "The object of the bleeding is to relieve the internal congestion," and should be discontinued if the victim faints.[xxxvi] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn36)
During the second stage, which 19th century medical professionals considered the actual onset of cholera, treatments were intensified. During this stage, as cholera's victims suffered excruciating nausea, massive diarrhea, cramps, physical collapse, cold clammy extremities, and a feeble pulse, medical therapies included, "put the feet and legs in water as warm as could be born, with the addition of mustard and common salt to the water; open a vein in the arm, and bleed from five, to sixteen to twenty ounces . . apply a large mustard cataplasm over the stomach and give . . .calomel, opium, an camphor, every half hour." If the patient continued to deteriorate, and was there any reason to think he would not, "Sulphuric ether in small doses should be given . . .at the same time an enema of a pint of chicken tea, with a table spoonful of salt . . .should be thrown into the bowels . . ."[xxxvii] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn37)
Few persons survived cholera's third stage which was sometimes called the "stage of asphyxia." The principle of treatment during this portion of the illness was to "arouse the dormant energies of the system." Larger doses of calomel and camphor were recommended; in addition, quinine and morphine were to be administered every half hour, and "a cholera patient . . . should never be left a moment without the presence of an intelligent nurse."[xxxviii] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn38)
If the patient survived the treatments prescribed for the third stage, further bleeding or the attachment of leeches was recommended for the fourth stage. More calomel, magnesia, camphor, opium, and morphine pills were given, and if during this stage of cholera, "consecutive fever" or typhoid appeared, "it may be necessary to resort to tonics and stimulants such as sul. quinine, serpentaria, carb. of ammonia, wine whey, oil of turpentine, etc."[xxxix] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn39)
Variations upon these therapies were as numerous as there were physicians. Some treatments emphasized exterior stimulants to the system, in hopes of energizing the collapsing patient, by rubbing the victim's body with rebefacients, the most common being combinations of mustard, oils of turpentine, and cayenne pepper.[xl] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn40) Other physicians routinely recommended immense dosages of calomel, a chalky mercury compound, until the victim's gums stared bleeding. The most common, and considered as conservative therapies, always included some combination of calomel, opium (laudanum), and bleedings.
More exotic and radical treatments abounded: tobacco smoke enemas, electric shock therapy, beeswax/oilcloth plugs forced into the victim's rectum to stop the diarrhea were among the most distressing encountered.[xli] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn41) Curiously, at least one physician, New York City's Dr. W. Rhinelander, located at 342 Broadway, suggested in July of 1832 that cholera could be treated by the infusion of saline solutions into the victim's veins.[xlii] (http://www.earlyamerica.com/review/2000_fall/1832_cholera_part1.html#_edn42) Such a treatment along with a regimen of attendant antibiotics is the preferred therapy for modern cholera victims. When treated early the fatality rate is very low.

I got the above from:

Cholera is particularly interesting in that it hit the North America and Britain at a time when they were poised for action by science and public health organizations rather than by individuals.

Hope this helps.

12-05-2008, 11:07 PM
This helps a lot guys, thanks! (the bizarre things we find ourselves researching in the name of fiction and entertainment. ;) )

12-06-2008, 12:26 AM
I strongly recommend that you read the book The Ghost Map (http://www.theghostmap.com/), by Steven Johnson, which is an engagingly written, well researched book for the average reader on how a cholera outbreak sparked the beginning of modern epidemiology.

It's a great read, and will give you lots of useful details.

12-06-2008, 12:59 AM
It really depends on *where* you were at. Some cities had it all figured out, and knew the problem was contaminated water or food, and would take fairly appropriate measures. And some places were a lot better at treating the sick than others, too.

On the other hand ... some places still don't have it figured out, or if they do, they don't have the resources to fight it. See: Zimbabwe.

-- Leva

12-06-2008, 01:12 AM
...or Latin America, where after being free of the disease for 100 years since the 1890s, now has periodic epidemics, and strains resistant to antibiotics are appearing.

Another note: I know that in the 1970s, there was cholera in the river in (what was then) Leningrad, now St. Petersburg. I don't know what the situation is now.

12-06-2008, 01:14 AM
I'm setting this in the late 1870s, probably in Kansas/Missouri. Most likely a small town along the budding railroad line.

12-06-2008, 02:23 AM
I'm setting this in the late 1870s, probably in Kansas/Missouri. Most likely a small town along the budding railroad line.

I'm thinking an outbreak of cholera would be fairly self-limiting in a small town, particularly if they had multiple sources of water and/or the water wasn't the source of the contagion. (i.e., multiple wells or springs.) However, I'm sure you've read up on how it's spread, so you could plausibly make it work.

In 1870 in the US housewives would probably go on a frantic cleaning spree, they might shut down food vendors, you might get the local doctor doing epidemiological studies to figure out the source (i.e., did everyone who got sick in the first wave drink from the same spring or eat at the same inn?) depending on how well read he was, and they'd probably be some pretty vigorous debates on what quack or home grown remedy was the best preventative.

They weren't completely clueless in 1870 in the US.

-- Leva

Tsu Dho Nimh
12-06-2008, 05:58 AM
What kind of preventative measures would have been taken in the late 1800s during a cholera outbreak? (ie: people wearing cloths over their noses & mouths, etc.) I don't know how much they knew about the disease back then, and how effective/accurate their methods would have been to try and contain an outbreak.


By the late 1800s, people had grasped the connection between sewage and cholera, thanks to John Snow and Florence Nightingale. By 1885, Koch had isolated the bacteria responsible

To contain an outbreak, quarantine of all infected persons and their households was

Keep in mind that it's a fast disease, and a short quarantine is enough to break the chain of transmission.

http://books.google.com/books?id=HwwPAAAAYAAJ&pg=RA1-PA1016&dq=cholera+treatment+date:0-1900&lr=&as_brr=1 has some interesting reading for you. The US epidemic of 1873.

Sandi LeFaucheur
12-07-2008, 01:15 AM
Here is a link to a historical fiction piece I wrote for the Region of Peel in Canada. http://www.region.peel.on.ca/pw/waterstory/pdf/cholera-pws.pdf Although the main story itself is fictional, it is firmly based on fact.

Unless I'm mistaken, I believe Florence Nightingale believed that cholera was caused by miasma, not drinking foul water. I might have that wrong, though, since I wrote the story (and hence did the research) 4 years ago.

John Snow's "Mode of Communication of Cholera" is online in its entirety. (Or it was in 2004; I imagine it still is.)

12-07-2008, 10:52 PM
What did we do before Google. Here it is http://www.ph.ucla.edu/EPI/snow/snowbook.html

Linda Adams
12-07-2008, 11:38 PM
I just found a book in the library's withdrawn section called Invisible Enemies: Stories of Infectious Disease (http://www.amazon.com/Invisible-Enemies-Revised-Stories-Infectious/dp/0374336075/ref=sr_1_1?ie=UTF8&s=books&qid=1228678639&sr=8-1)by Jeanette Farrell. It talks about the New York cholera epidemic in 1832 and how people reacted.

12-08-2008, 03:19 AM
1800s a broad span, relatively speaking. Where is your story set and does it actually span the full 100 years? In the mid 1800s in eastern NA, folks did not understand it. For ex, Confederates tried to give it to the North via blankets that had been on cholera vics..and then there was a cholera outbreak and the North heard the Confederates had tried to give it to them and believed it had been accomplished.
But cholera isn't spread this way.
Their so-called Health dept advised folks temperance in food and drink, (when folks ought to drink and eat all the clean healthy food and water they can) thus helping to kill folks who might have survived the disease, a la bleeding ill people.

12-08-2008, 06:24 PM
This is all great info. Thanks for the links! You guys are awesome.