Topic 4A: Life, Death and Disease in the City

Life, Death and Disease in the City 
By Grace Owen

Disease has always been one of humanities major concerns, with plagues and epidemics historically devastating the known world – the Black Plague in 1665 killed “…between 75,000 and 100,000 of … about 460,000” (Open Collections Program, 2015). Currently, due to both vaccinations and better health and sanitation, plague and illness are less of a concern in the developed world. However, in developing countries such as India and much of Africa, there are still major concerns surrounding chronic communicable diseases. Cholera is one such example.

History of Cholera

The first global epidemic of cholera occurred in 1817, having spread from the Ganges to wider India, China, Japan and further afield (Origins of Cholera, 2015); in the time up to the 1900’s, five major pandemics were recorded of this disease, claiming hundreds of thousands of lives (Origins of Cholera, 2015). In London, the disease was primarily thought to have spread through “miasma”, or the bad smells emanating from the refuse and effluvia of the city (Halliday, 2001). As cholera outbreaks occurred, there was a massive push for a more “hygienic” city – the slums which had housed a larger number of poorer workers were demolished, or made to have better access to clean air and cesspools. Despite this, cholera continued to be an issue in the city. The various outbreaks which occurred claimed huge numbers of lives, and was a very real terror to the citizens of London and other global cities. 

John Snow was sceptical of the idea of miasmas causing cholera in the city of London. Instead, he proposed that the main cause of the disease was water, and polluted water sources from the number of old or ineffectual cesspits in the city (Challoner, 2013). In particular, he studied the spread of an outbreak of cholera from a particular water pump in Soho in 1854. He mapped out the occurrence of cholera in the surrounding area, and provided convincing enough evidence to the local council to convince them to disable the pump by breaking the handle; subsequently, there was a significant decline in the disease (Challoner, 2013). Further examination of the pump found that it had been sunk in close proximity to an old cesspit. Despite this, Snow’s theory was still not considered accurate, and had been derided by his fellow physicians.

Some years after this in 1958, after Snow’s death, London suffered a particularly intense heatwave and drought. A significant amount of effluvia at this time was being drained into the Thames and, due to the heat, an intense smells arose and covered the city. The Great Stink, as it was called, finally resulted in the government wanting to have effective sewerage out of the city, to clean the waterway which had produced such an offensive smell (The Great Stink, 2015). Balzalgette was able to introduce his comprehensive sewerage system into the city between 1859 and 1875 (Halliday, 1999). In 1866, there was another cholera outbreak, but concentrated in an area which had not yet been covered by the sewerage system. From this, an enquiry was launched, and it was determined that the East London Water Company’s water was contaminated (Halliday, 2001); Snow’s theory that cholera was spread through water was confirmed and accepted in official circles.

In 1982, Hamburg was struck by a cholera outbreak, and panic occurred in London as plans were laid to deal with the coming epidemic; no epidemic occurred in London, and the city has continued to be safe since (Halliday, 2001).

Cholera in the Modern World

As mentioned, cholera is all but eliminated in the developed world. However, there are still a number of major incidences which have been recorded in less affluent and developed countries. For example, the Centre of Disease Control (CDC) indicates that there is an ongoing cholera outbreak occurring in Haiti at the current time (Prevention, 2015). This outbreak occurred following the 2010 earthquake, which disrupted much of the country’s infrastructure and thus allowed for the infection to spread. It is interesting to note that cholera had been absent from that region for a century prior to the disaster (Robbins, 2015), but had been “…the perfect environment for a cholera epidemic” (Robbins, 2015) due to the lack of safe water and sanitation infrastructure.

Another example of the endemic nature of cholera in certain countries can be seen by this graphic from the World Health Organisation: (figure 1). The graph shows the historical occurrence of cholera determined by region from 1989. Between 2001 and 2009, 93% to 98% of cholera cases occurred in the African region; again, this relates to the lack of infrastructure in place to allow access to clean, safe drinking water and sanitation (WHO.int, 2015). In 2010, there is an obvious spike in the number of cases reported from the Americas; as mentioned previously, this relates to the Haitian outbreak, and the associated spread of the disease to surrounding areas. This map, also from the WHO, also demonstrates the spread of cholera outbreaks from 2010 to 2013: (figure 2).







In fact, the major point across all of the data around modern cholera outbreaks is the lack of clean water and infrastructure that allows the disease to continue. Cholera is an eminently preventable and treatable disease, as evidenced by its elimination in the developed world. The WHO and UNICEF have a joint monitoring programme that is focussed on the implementation and development of “improved drinking water sources” which shows how water sources across the globe have improved over the past years. The WHO and UNICEF define an improved drinking water source as “…one that, by nature of its construction or through active intervention, is protected from outside contamination, in particular from contamination with faecal matter” (Wssinfo.org, 2015); the ladder graphic below (figure 3) shows historical improvement of such water sources from 1990 to 2012. The hope is that eventually all countries will have predominantly improved water sources, and preventable diseases such as cholera, which are currently endemic in some countries, will be eliminated.




References

Challoner, J. (2013). John Snow. [electronic resource]. London : Bloomsbury Publishing, 2013. 

Choleraandthethames.co.uk,. (2015). The Great Stink. Retrieved 26 March 2015, from http://www.choleraandthethames.co.uk/cholera-in-london/the-great-stink/

Choleraandthethames.co.uk,. (2015). Origins of Cholera. Retrieved 26 March 2015, from http://www.choleraandthethames.co.uk/cholera-in-london/origins-of-cholera/

Halliday, S. (1999). The great stink of London : Sir Joseph Bazalgette and the cleansing of the Victorian metropoli. Stroud : Sutton, 1999.

Halliday, S. (2001). Death and miasma in Victorian London: an obstinate belief. BMJ, 323(7327), 1469-1471. doi:10.1136/bmj.323.7327.1469

Ocp.hul.harvard.edu,. (2015). Open Collections Program: Contagion, The Great Plague of London, 1665. Retrieved 26 March 2015, from http://ocp.hul.harvard.edu/contagion/plague.html

Prevention, C. (2015). Cholera in Haiti - Watch - Level 1, Practice Usual Precautions - Travel Health Notices | Travelers' Health | CDC. Wwwnc.cdc.gov. Retrieved 26 March 2015, from http://wwwnc.cdc.gov/travel/notices/watch/haiti-cholera

Robbins, A. (2015). Haitian Cholera Outbreak Highlights Need for Infrastructure, Not Blame | Guest Blog, Scientific American Blog Network.  

Blogs.scientificamerican.com. Retrieved 26 March 2015, from http://blogs.scientificamerican.com/guest-blog/2014/03/25/haitian-cholera-outbreak-highlights-need-for-infrastructure-not-blame/

Who.int,. (2015). WHO | Cholera. Retrieved 26 March 2015, from http://www.who.int/mediacentre/factsheets/fs107/en/

Wssinfo.org,. (2015). WHO / UNICEF Joint Monitoring Programme: Definitions & Methods. Retrieved 26 March 2015, from http://www.wssinfo.org/definitions-methods/