Origins of Cholera

Every year 3-5 million people around the world are infected with cholera and 100,000- 120,000 people die from the infectious disease, according to estimates by the World Health Organization (WHO). The disease, however, is of ancient origins, having existed in some form since the times of Lord Buddha and Hippocrates, if not earlier. The first recorded instance was in 1563 in an Indian medical report but in more modern terms, the story of the disease begins in 1817 when it spread from its ancient homeland of the Ganges Delta in India to the rest of the world. Since that time, untold millions have contracted and died from this preventable infectious disease.

Cholera is a preventable, acute diarrheal disease that leads to severe dehydration due to a massive loss of bodily fluids that can lead to sunken eyes, blue-grey skin and eventually death. 80% of cholera cases today can be prevented by the ingestion of rehydration salts. In the early nineteenth century the disease was thought to have been transmitted by a miasma or “bad air,” but we now know that the disease is caused by the strand of bacterium called Vibrio cholerae, or simply V. Cholera. This bacterium flourishes in warm water and is transmitted through intake of contaminated food and water. The bacterium can turn into cholera as quickly as two hours which, according to WHO, “enhances the potentially explosive pattern of outbreaks.”

Cholera outbreaks in recorded history have indeed been explosive and the global proliferation of the disease is seen by most scholars to have occurred in six separate pandemics, with the seventh pandemic still rampant in many developing countries around the world.

The rapid modernization associated with the Industrial Revolution of the mid-19th century propelled the spread of the disease from its ancient homeland around the Ganges River. The first pandemic occurred in 1817 hitting India, China, Japan, parts of Southeast Asia, much of the Middle East, and Madagascar and the East African Coast opposite Zanzibar; however, it died down in 1823 in Anatolia and the Caucuses before it reached Europe. As contact with India increased through trade and colonial endeavors—namely the creation of the British Raj—the disease began to spread along trade routes. The second pandemic of 1826-1837 swept across Europe—starting in Russia, then moving to Poland and subsequently the rest of Europe, North Africa and the eastern seaboard of North America—carried along shipping routes by merchants.

The disease hit Britain in October of 1831 reaching London in 1832 with subsequent major outbreaks in 1841,1854 and 1866. It was through these London cases Cholera has always been associated with the sea, with all of its recorded initial instances being at a seaside location. Thus, the increased speed and ease of travel allowed by the industrial revolution, particularly the opening of the Suez Canal and the invention of the steamboat in 1869, led to more rapid spread of the disease. Not only did the Industrial Revolution accelerate the disbursement of the disease around the world, but it also allowed for more rapid and devastating outbreaks when it reached Europe. Once in continental Europe, cholera quickly spread along major waterways and later railways. The disease subsequently reached the large and quickly growing industrial European cities and rapidly spread with the aid of the crowded and unsanitary housing conditions and unhygienic water sources.

The more widespread third pandemic of 1841-59 attacked the same regions as the second along with parts of south and central Europe. Subsequently, there was another massive outbreak from 1863-75 across the whole of Europe, large parts of northeastern, South and Central America, Africa, China, Japan and Southeast Asia. The world continued to suffer the effects of cholera with a fifth pandemic in many parts of continental Europe, the whole of the North African coast and various areas in Asia and the Americas form 1881-96. London was to escape the ravages of cholera during this pandemic because its water supply had been transformed by the building of Joseph Bazalgette’s sewage system. It was only when the Europe’s other industrialized cities followed London’s lead that Europe avoided further pandemics, however the rest of the world was not so fortunate. Asia suffered immensely from a large outbreak from 1899-1923 and currently many developing nations in Africa, the Caribbean and Asia suffer in the seventh pandemic of cholera. This current pandemic began in South Asia in 1961, touched Africa in 1971 and then the Americas in 1991.

Both historically and presently Cholera has caused devastation across the globe. Cholera is, and has always been a preventable disease. It has spread around the world, starting at the Ganges River, through contaminated food and drink. While access to clean drinking water might not be an issue that many of us face, millions around the world still lack this resource. The migration of cholera throughout history is a testament to the widespread and universal problem of unclean drinking water that spans time and space.