The truth is that, in spite of all the scientific investigations, we know very little about the origin and progress of these epidemic disorders. — The Graphic
he following selections from the 1884 Graphic provide an interesting and perhaps surprising view of late-Victorian near-understanding of cholera, epidemics, their causes, and ways to prevent them. First of all, and most surprising, one of the writers (only identified as F.E.W.) mentions in passing Koch’s germ theory of the disease, which means that at least some educated people no longer believed that some mysterious miasma caused cholera. They understood that germs, tiny organisms, caused cholera. Most of the articles, however, concern what the various writers take to be the failure of the quarantines and fumigation employed by European countries as ways of preventing the spread of this disease. What this means, in other words, is that we here have an example of the difference between understanding the immediate cause of cholera and the means by which it spreads, the physical means that enables cholera to move from one infected person to others not yet infected.
F.E.W. correctly posits a connection between sewage-contaminated water and the spread of cholera, something that at least some of those interested in public health had recognized since John Snow's now-famous act of removing the lever of a public pump in a cholera-ridden area of London with a resultant halt to the spread of the disease. But even F.E.W. is not entirely convinced that visibly polluted water spreads the disease because he knows from his experience in India that what he takes to have been clear, clean water also caused cholera epidemics. The problem here, it would seem, lies in an inadequate appreciation of the fact that germs are microorganisms that cannot be seen without a microscope; simple visual inspection of a body of water, no matter how clean it appears, is insufficient to determine whether it contains the cholera bacillus or not. So we see that these late-Victorian writers almost have the solution in hand, but not quite. George P. Landow
Progress of the Cholera (26 July)
Thus far this has been the most genial summer which we have experienced for several years, but its enjoyment is considerably alloyed by fears of the approach of cholera. That terrible disease has got a firm hold of Toulon and Marseilles, nor has the mortality been lessened, as was hoped, by a spell of cool weather. It has appeared at Arles, and it is rumoured that it has reached Paris. In such matters it is difficult in France to get at the truth, as an official tradition prevails among our neighbours of concealing bad news as long as possible. Paris is not much farther from London than is Liverpool, inter communication is probably equally great, and therefore the disease may reasonably be expected here before long, provided it should find a favourable seed-bed. At all events, it is to be hoped that our people will not give way to the panic which has seized on the inhabitants of the South of France, and which, both directly and indirectly, intensifies the suffering produced by the epidemic. It stands to reason that when those who can afford to fly run away from a plague-stricken city the poor and helpless who remain behind are the very worst people to organise and carry out proper precautions for fighting the disease. It is satisfactory to kearn that such vexatious and useless customs as the fumigation of passengers are being abandoned, but on the other hand the grossest carelessness appears to prevail with regard to the disposal of clothing, &c., belonging to cholera patients. The interesting report of Dr. Sedgwick Saunders proves that on this side of the Channel our medical men know what are the proper preventitive measures to be adopted. Meanwhile it is worth noting how people are scared by a name. The report of a single death from undoubted Asiatic cholera in London would excite widespread alarm; yet last week no less than 533 persons died within the metropolitan area of diarrhoea and dysentery. As far as the victims are concerned, their fate is just as deplorable as if they had perished from the plague which is desolating Marseilles. [74]
The Cordon Around Gibraltar (26 July)
Humours of the cholera cordon at Gibraltar — bargaining for poultry across the cordon. [73]
Since July 2 the Spanish authorities have placed a cordon round Gibraltar, at about the middle of the Neutral Ground, on a line drawn between the two guardhouses of the Spaniards on the Eastern and Western beach, with marquees for police accommodation on either side. The cordon is a cause of great annoyance both to the inhabitants of Gibraltar, who are paying through the nose for provisions, and also to the country folk of the adjacent Spanish territory, who are dependent on the British settlement for their livelihood. But it is also a source of great amusement. Certain hours in the day are told off, when bargaining may go on ; but the bargainer and the bargainee are not allowed to approach each other, and all the money passing from one to another is first washed in a pail of vinegar. Ditto, letters! A miserable little cur belonging to a native of Gibraltar ran across the line of the cordon, and was captured and soused in the vinegar-bucket, before being kicked back to its sorrowing master.—Our engravings are from sketches by Mr. Arthur A. M. Layard, R.E.
Fumigating Passengers at Avignon (26 July)
Fumigating Passengers from Marseilles at Avignon [73]
Those persons whom business takes to the infected districts of Southern France—for few are likely to resort thither for pleasure at the present time—will be glad to learn that the fumigation system at the Marseilles and Toulon Railway Stations has been abolished as useless and vexatious. This disagreeable ordeal was in full force at Avignon early in the month, as is shown by this sketch by Mr. E. Prioleau Warren, A.R.I.B.A., who, with other unfortunates, was exposed for a quarter of an hour to the fumes of strong carbolic acid. [158]
A Cholera Fumigating Box (26 July)
IN Geneva, according to another correspondent, Mr. Thomas Howie, still more stringent precautions are adopted. The suspected person is placed in a box which is about six feet high, and in which # stands upright, with only his head outside, a towel being wrapped round his neck. The process occupies from three to four minutes, and the disinfectants used are chloride of lime and carbolic acid. The top piece of the box is made to slide in, and is removed when the process is completed by simply pulling outwards. While the sliding board is being removed the towel comes in handily as a respirator. [158]
Quarantine at Bardonnechia, Italy (16 August 1884)
The Cholera Quarantine at Bardonnechia, on the Franco-Italian Frontier [157]
THE quarantine station at Bardonnechia is situated in a small valley hemmed in by mountains, the snow-capped Frejus and Mont Cenis bounding it on the north. Travellers coming from Switzerland, and who desire to go to Italy, are made to undergo a quarantine of five days at this station. Immediately on their leaving the train at the Italian entrance of the Mont Cenis tunnel, they are secured by gendarmes and escorted a few yards up to the camping-ground, where they pass through the fumigating room, which is filled with the fumes of burning sulphur; their luggage is also disinfected. They must then appear before the Commissionaire, who takes down their sex, name, age, country, and date of arrival. From this polite official every one is passed on to the plot of ground prepared for the new arrivals, separated from the plots of those who have put in one or more days up to the fifth day by a fence of wire and branches of trees, and no one is allowed to leave the ground until his quarantine is completed. Clean tents—the usual bell tents—are pitched to sleep in, provided with abundance of straw mattresses and rugs fresh from the magazine. The higher class of people get a tent between two, and the working-class go nine to a tent.
The Government feed the people three times a day—at six in the morning, at midday, and six in the evening. They allow coffee, half a bottle of red wine twice a day, a loaf of bread, maccaroni soup, and some meat; this costs the Government 2 francs 75 centimes per individual per day. Those who can afford it get their meals irom two restaurants on the ground, the same being very indifferent food. These restaurants are established in the abandoned houses of the workmen who pierced the Mont Cenis tunnel. The bugle sounds at nine o'clock at night for all hands to repair to their tents, no lights are allowed, and the last blast sounds at ten to enjoin silence, The Regiment of the Alps patrols day and night, and strictly prevents any one escaping. Gendarmes, also, with swords and revolvers, are constantly on the watch. In a sanitary point of view the camp is well chosen. It is 3,400 feet above the level of the sea, is very cool, and rather subject to high winds, which at night make the place very cold, necessitating winter clothing. There is a river running at the foot of the camp, and springs of pure water in every plot of ground. The sanitary arrangements are not so good as they should be, considering that there are over 700 people confined to this small space, but being mostly of the working-class of Italians it is presumed the arrangements are as good as this class is accustomed to. Certainly to the English it is felt as a very primitive and unpleasant style of sanitation. The people who come from Marseilles and Toulon are isolated far off up the side of the mountains from the rest. This enforced idleness to every one of five days and nights is a source of intense annoyance, but is a tentative measure against the introduction of cholera into Italy, which the Italian Government thinks will succeed. It is to be hoped it may.— The sketch from which our engraving is taken, and the foregoing details, were furnished by Mr. Frederick W. Moore, Brigade Surgeon, Valetta, Malta. [158]
The Cholera (6 September)
As the daily bulletins come in, each nation says to itself with pardonable selfishness, shall I escape? will it be my turn next? and so forth. Looking back at the records of the present outbreak, it will be observed that at first the pestilence seemed of a very stationary character, confining itself almost entirely to the towns of Marseilles and Toulon. Since then, although its force has almost abated in those two cities, it has shown a much greater tendency to spread. The surrounding towns and villages have been infected, and the disease has obtained a firm hold, first in Italy, and now in Spain. The severity of the quarantine regulations of these two countries is notorious, and their inefficacy is now pretty well proved by the fact that the cholera has broken through these artificially-imposed barriers. In Indian cities, where the dread cholera spectre may be described as a permanent and not merely a transitory guest, experience has shown that the disease is most malignant at the change of the seasons, for instance, at the beginning of the hot weather in February or March, or at the beginning of the rains in June or July. Both in Naples and Spezia a downpour of rain and fall in temperature have been followed by an increase of mortality. One might have expected that a flood of rain would wash the “cholera eggs" away, whereas it seems to give them increased vigour. The truth is that, in spite of all the scientific investigations, we know very little about the origin and progress of these epidemic disorders. About one or two practical points there is tolerable certainty. Cleanliness and temperance are greater enemies to the cholera than dirt and drunkenness. Calmness of mind, too, is better than panic. The panic-terrors which have been developed in the cholera-smitten regions of France and Italy have caused more misery than the actual pestilence. Let us hope that, if the invader should visit our shores, our countrymen will show more self-control. They certainly did so in 1849, in 1854, and 1866, and we hope they have not degenerated in this respect. [242-43]
The Cholera at Naples (20 September)
1. Women Attempting to Take their Children from the Infant Schools, Where they Feared the Police Would Poison Them.–2. On the Way to the Cemetery: Night.-3. Cardinal - San Felice, Archbishop of Naples, at the Conocchia Hospital.–4. The Ministers, Signors Brin and Grimaldi, Visiting the Patients.
Cholera and the Suez Canal (27 September)
Some interesting personal experiences on this subject will be found on page 334. It is noteworthy that the strange superstitions which are rife in some parts of Italy show that the popular mind there is little more enlightened concerning the phenomena of epidemic disease than it was in 1832. Worse still, perhaps, there are upon the Continent numbers of people far above the rank of peasants or day-labourers, who would laugh at the hideous absurdity of doctors going about disseminating “cholera powder,” but who nevertheless are firm believers in the old-fashioned quarantine doctrines, and who also seem to hold that the Suez Canal is a tube through which England (regardless of everything except commercial gain) pours choleraic infection into Europe from her Indian possessions. A few observations on each of these points may not be out of place. Confidence in the old quarantine system should surely be shaken by the experience of this summer, for Spain and Italy, where the regulations are enforced most strictly, have hitherto been the only two countries attacked. We wish that our Continental friends would be at the pains dispassionately to compare the two systems. In the English system—if we may venture so to style it—isolation is only resorted to in cases of disease, or (as on board ship), of close proximity to disease. In the Continental system, persons apparently healthy are herded together under most unsanitary conditions for many days together. If there should be any latent cholera in the crowd thus brought into involuntary contact, the average lazaretto constitutes a fine hotbed for its development. Then the severity of the treatment causes people to seek to evade it altogether, and these escapees are sometimes fresh from a cholera-tainted locality. There are Some grounds for supposing that the pestilence was in this manner introduced into Spain. Next, with regard to the Suez Canal. England is guiltless of the present epidemic which it is pretty clearly established was brought by a French troop-ship from Tonquin. And although it would at first sight seem that Europe—especially Southern Europe -must run greater risk of infection now than when vessels were purified by the long voyage round the Cape, still, as a matter of fact, Italy suffered far more often from cholera before than after the Canal was opened. This would seem to show that cholera—which is practically endemic in the Indian seaports-either breaks out on board a vessel before the Canal is reached, or does not show itself at all. At the same time, if the sensitive condition of Continental opinions can be allayed by any expedients which are in accordance with scientific data, and are not subversive of free intercourse no doubt our Government would be willing to adopt them. [314]
Cholera and the Suez Canal (27 September)
Not long ago the ship in which I was sailing to India was anchored for the night in the Bitter Lakes. To pass the time, I tried fishing over the steamer's side, but caught nothing. One of the ship's quartermasters, who was looking on, observed: “Ah! sir, you won't catch anything in this here Canal now; for why, the fishes they be overfed with all we throw overboard. I remember the time when we could catch any number, but the beggars turn up their noses at the hook now; and no wonder, with all the hoffal [sic] they get.” And, indeed, the odour from the almost stagnant water on that hot August evening was anything but sweet, and betokened just what the quartermaster said—an abundance of offal all round. I called to mind what everybody has observed in India; the seeming preference of cholera for the course of rivers, and thought to myself that here, on the Suez Canal, we have all the conditions that so successfully introduced cholera, for the first time, to the world on the banks of the Ganges, now more than half a century ago–a hot sun, nasty, foetid water, and an accumulation of garbage in water. On the Ganges the garbage was represented by the floating bodies of dead Hindus; but in the Suez Canal, if there are no corpses, there is, at all events, plenty of sewage. And this led me on to think that poor Bombay—though by no means immaculate in a sanitary sense—is unduly abused for sending infection to Europe. The truth is that Egypt is quite capable of doing this herself, and I strongly suspect that the Suez Canal is not blameless in the matter.
Later on, on the return voyage, our vessel was put into quarantine at Suez because cholera was reported in India. We had no cholera on board, and anything more absurd than the Egyptian quarantine rules I never saw. A couple of Turkish quarantine guards came on board, and would allow no one to go on shore; although contrary to their orders, these gentlemen partook freely of sardines and strong waters, and smoked cigars which were given to them by the passengers. The quarantined hoped to make the qurantiners drunk, and thus evade their vigilance; but Egyptians have strong heads if weak hearts, and my impression is that an Egyptian quarantine guard could dispose of two or three bottles of gin or whisky and as many tins of sardines, at a sitting without the slightest inconvenience to himself. Then the quarantine sheds, or lazarettos, in which they confine passengers, are far better calculated to provoke cholera than to prevent it. The whole preventive system, in short, with its pinches of sulphur, tongs, hot coals, tarred bags, is a complete farce, and about as capable keeping the cholera out of Europe as it is of destroying Dr. Koch's germs, the pretty generally admitted origin of the disease.
The Suez Canal is undoubtedly a great commercial convenience, but we must expect to pay for its convenience in the greater facility with which cholera — and possibly the Bagdad plague — can be introduced to Europe. If the Suez Canal does not actually produce cholera through its watercourse of sewage, it may, serve as a hot-bed in which dormant cholera germs from the Far East can be hatched into sudden activity. And perhaps this theory may account for the many alarms of cholera in Europe lately. In the old days, before the Suez Canal was made made, cholera was worse in India than it is now; but it only reached Europe at long intervals. This was because it had to traverse the desert, or go round by the Cape, and in either route pure air “killed it,” so to say; but now it finds a great filthy ditch ready to hand at Suez, and, according to its custom everywhere, it runs along the banks, just as lightning might fly along conductors. In India it is hardly safe to march along the banks of a large and clean river. Regiments, so marching are pretty certain to contract the disease, though why cholera should affect clean rivers I am unable to say. It may be that the annual “freshets,” or floods, turn up a lot of decaying matter from the river bed, and that the seeds of cholera are thus carried down the stream. Any way, a watercourse is always to be avoided in cholera countries; but Egypt is emphatically a cholera country, and the Suez Canal is about as dirty a watercourse as there is anywhere.
Familiarity with cholera breeds contempt of it, and so the Indian journals have been making merry over the panic shown in Europe lately. But serious visitations of cholera-in the epidemic form — are fortunately not very common in India now, and when they do occur despair, if not panic, seems to seize on every one. At the great outbreak of cholera at Kurrachee, in Scinde, many years ago, a singular phenomenon was noticed. The sky suddenly became lurid, and threatening in the last degree. There was no hurricane, as was expected, but cholera in the most dreadful form immediately appeared. And I think that it is not unusual for outbreaks of cholera to be preceded by weather indicating thunderstorms; that is to say, yellow clouds, and a close “muggy” atmosphere. In India we have been laughing, too, at the preposterous precautions recommended for the warding off of cholera, though Indian specifics are often ridiculous enough. I remember when a subcutaneous injection of quinine was thought to be a certain cure. Also, enormous doses of castor oil and laudanum taken alternately. Also, champagne—a much pleasanter remedy—and, of course, brandy. I rather think that the man—a shikarree probably—who first mixed brandy with the water he took from a roadside tank or well, forestalled Dr. Koch in his ideas of the disease. The alcohol was calculated to destroy the germs in the water, and I believe myself that it is a wholesome rule to colour doubtful water with good brandy or whisky. That is to say, when travelling, for it is a man's own fault, or his filter's, if he cannot have pure water in his own bungalow. Cholera, however, is a very curious, and seemingly capricious disease. Strong men are just as liable to be seized as weak men, and for cures, I have known a patient to be almost suddenly cured by a bottle of plain soda water when his case was given up as hopeless.
But these are digressions from the main contention—that the Suez Canal is a conductor of cholera to Europe. Though one has only to think of the vast number of huge steamers, crowded with passengers or troops, passing annually through the Canal—there may be twenty such vessels in the Canal on a single day—to feel convinced that M. De Lesseps splendid work must be fast becoming a great open sewer. The very fishes seem to know this, and so do the birds. A few years ago one might travel all through the Canal without seeing a bird, save only the wild fowl on Lake Menzaleh; but now every steamer is accompanied by numbers of beautiful white seagulls, which fare sumptuously on the pieces of meat, &c., thrown over from the cook's galley. I have heard that gulls also accompany the great Cunarders across the Atlantic, taking a return steamer from New York as regularly as possible; and in the the Suez Canal they must be useful as scavengers—though, of course, only to a limited extent, considering the immense quantity of sewage that must now enter it. The question is, how to cleanse the Canal and to keep it clean. And that is a question not easily answered. The tide or current does not run more than perhaps two knots an hour, and so could not possibly scour the canal; and, considering the time often taken for the passage from Suez to Port Said - generally twenty-four hours, if not more — it would be difficult to enforce any rules upon ships to prevent their discharging their filth into the Canal. If the water-way were wider and deeper, and if a vessel could make the passage of eighty-four miles at full speed in, say, seven hours, such a law might be enforced. And if the Suez Canal is not widened and deepened, so that something of the kind might be done, it will probably come to this: that the present ditch will be choked with sewage, and positively dangerous to sail on in very hot weather. I don't believe myself that cholera is ever carried from India to Suez unless in very rare cases, because the fortnight's passage over the Ocean and up the Red Sea, with all the pure sea air of the passage, would generally dispel it; but I think that cholera often comes on board at Suez, or in the Canal, and this accounts for it breaking out in the Mediterranean. The whole matter is one of considerable importance to Europe, because there is involved in it the question whether we shall have frequent appearances of cholera "Europe, or only its appearance at long intervals, as before. F. E. W. [334-35]
All the passages above appeared articles in volume 30 of The Graphic, which I have read in the Hathi Trust online version of a copy New York Public Library. Web. 22 July 2021.
[You may use the images from them without prior permission for any scholarly or educational purpose as long as you (1) credit the Hathi Trust Digital Library and the New York Public Library and (2) link your document to this URL in a web document or cite the Victorian Web in a print one. — George P. Landow]
Bibliography
“Cholera and the Suez Canal” (27 September 1884): 315, 334-35.
“The Cholera at Naples” (20 September): 300.
“The Cholera: The Cordon round Gibraltar” (26 July 1884): 78.
“Cholera Fumigating Box” (26 July 1884): 78.
“Fumigating Passengers at Avignon” (26 July 1884): 78.
“Quarantine at Bardonnechia, Italy (16 August 1884): 157-58.
Created 26 July 2021