Monthly Medicine: The History of Cholera

Hi all!

Welcome to the first post in our Monthly Medicine series, in which we take a new disease every week and produce content surrounding the myths and mysteries of the history, science, and medicine of the disease! This month, as promised, we’re looking at Cholera and the history and medicine of this particularly dangerous disease. And so, without further ado, let us begin.

The first question to answer is perhaps this: What exactly is Cholera?

Cholera is an acute diarrhoeal disease that researchers have estimated causes between 28,000 and 142,000 deaths each year. Its symptoms include watery diarrhoea, stomach cramps, and vomiting, which often leads to severe dehydration of the patient due to the loss of fluids.2 The disease is often identified due to the ‘rice water’ quality of the patients diarrhoea, namely that it is white, cloudy, and milky in colour, and has been prevalent in locations where sanitary drinking water is scarce. In the most severe cases, cholera is often fatal, and the disease is passed through bacteria in infected water.

cholera1
Fig 1.

Cholera as a historical disease entity is perhaps most often associated with the mid-to-late-nineteenth century, due to the infamous outbreaks that occurred in London during the 1800s. The first ever mention of ‘cholera’ as a disease dates sometime before, as it is featured in the writings of Hippocrates in 460-377 BCE although the disease to which Hippocrates is referring is unknown: what remains is that the name survived.3 The etymology of the term ‘cholera’ is often disputed, with some believing it comes from the Greek ‘cholē’ meaning ‘bile, or ‘cholēdra’ meaning ‘gutter’.4 Believed to have originated somewhere around the Indian subcontinent, cholera spread through trade routes to Europe in the early nineteenth century, and was often prevalent anywhere that large pools of still or stagnant water could be found, due to its water-borne qualities. Cholera also was the first ever reportable disease in the United States of America, due to the dangerous effects that the disease could have if an epidemic broke out, and the danger to individual health. The discovery of the Germ Theory of disease prompted huge progression in the study of epidemiology, and produced new areas of medical study that had never before been seen.

L0011181 Water from a pump in Broad Street, Golden Square, London.
Fig 2.

Perhaps one of the most famous events in the history of cholera was the tracing back of an outbreak to a water pump on Broad Street, London, by an English Physician named John Snow (stay tuned for a Famous Faces post about him). Snow disagreed with the accepted theme of miasmatic disease, in which disease was passed through bad air or miasmas, and resolved to examine the dispersal of cholera cases in London. The discovery of the water-borne bacterial nature of cholera was a significant advance in the field of epidemiology, and shed new light on the problem of London’s sewage system. Snow as able to plot the outbreaks of cholera in a local area and trace its origins back to the contaminated water from a pump in the middle of the district. The image to the left depicts a number of microbial lifeforms that were found within the water from a pump in Broad Street, where a particularly severe outbreak was recorded in 1854.

The most recent pandemic of cholera occurred in 1961, and continues to this day, although treatment and research into the disease has greatly reduced its wide-reaching scale. Outbreaks have been recorded in Zimbabwe in 2008, Haiti in 2010, and across the African continent in 2014-2015, and the problem of cholera does continue into the modern day, although cases are becoming rarer and less prevalent.

I think it’s possibly best to wrap this up, as these are only intended as a short examination of the disease in the context of the history of medicine. I hope you enjoyed reading this post as much as I did researching it, and keep one eye on this blog for more research, writing, and interesting little facts about our monthly medicine diseases!

That’s all for now,

Dan.


IMAGE ATTRIBUTION

Fig 1. – 1849 Cholera prevention poster by the Sanatory Committee, under the sanction of the Medical Counsel, in New York City (Public Domain Image downloaded from the wikimedia commons)

Fig 2. – L0011181 Water from a pump in Broad Street, Golden Square, London. Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org General Board of Health. App. to Report. Cholera-Epidemic, 1854. Published: – Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

FOOTNOTES

  1. World Health Organisation, ‘Cholera’, found at http://www.who.int/mediacentre/factsheets/fs107/en/ 
  2. The National Health Service, ‘Cholera’, found at http://www.nhs.uk/conditions/cholera/Pages/Definition.aspx
  3. Antonis A. Kousoulis, ‘Etymology of Cholera’, Emerging Infectious Diseases,  18 (2012), p. 540, found at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309598/ 
  4. Kousoulis, ‘Eymology’, p. 540
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