2. Asiatic Cholera

Question 1

Describe 18thc enlightenment. 7

Answer 1

1. Individualism
2. natural right
3. ‘the good state’
4. utilitatianism, founded by Jeremy Bentham
5. accompanied by growth of states and bureaucratic approaches
6. medical police provided order and surveillance
7. development of stats

Question 2

What is utilitarianism? 1

Answer 2

1. best moral action leads to best utility

Question 3

What was the importance of 18th century stats?4

Answer 3

1. ‘the science of the state’
2. measuring the state
3. demography - Thomas Malthus was influential here
4. compulsory registration of birth,death and marriage began

Question 4

Describe 18thC industrialization and urbanisation. 3

Answer 4

1. north west textile industry from late 1700-mid 1800s
2. shift from small workshops to giant mills
3. encourages concentration of workers in mill towns and cities

Question 5

Describe the industrial city of the 18/19th c. 4

Answer 5

1. shock cities
2. influx and expansion easily visible.
3. inhabitants lived in very close proximity
4. inadequate infrastrcutre

Question 6

What rights and reforms changed in industrial Britain? 4

Answer 6

1. Reform act of 1832 changed and rationalised electoral structure and extended franchise
2. factory acts of 18333-1834 limited hours for women and children and enforced inspections
3. Poor law amendment act/new poor law of 1834 emphasised workhouses and tried to end outdoor relief
4. local government changes gave ratepayers power and enabled property legislation

Question 7

What was the impact of cholera in the 18thc and what were the public attitudes towards it? 8

Answer 7

1. Europe and USA saw major 18th epidemics
2. 1831-32, 1848-49, 1853-54 and 1866-67
3. overall, cholera was not a huge killer - 53K deaths in 48-9, 5% deaths that year and worst year for death toll
4. People were terrified
5. Asiatic cholera in england had a rapid and visible course
6. economic consequences
7. little consensus about action
8. contagion vs anticontagion

Question 8

Describe the spread of cholera in 1832 and the use of quarantine. 6

Answer 8

1. Similar experiences with yellow fever in 1821 - gibralter
2. conflicts of quarantine vs free trade and contagion vs anticontagionism
3. 1831 - cholera moving westward across europe and boards of health established
4. Arrived in sunderland in late 1831
5. early cases described as english cholera, then identified as asiatic/indian cholera
6. Quarantine initiated against objections

Question 9

What disease theories were there surrounding cholera in 1832? 4

Answer 9

1. 2 main theories were miasmatic and contagionist
2. endpoints of a spectrum
3. debate over quarantine/isolation policy
4. most drs were contingent-contagionists, meaning they believed a bit of both

Question 10

Describe miasmatic theory of diease. 3

Answer 10

1. Caused by human/animal/plant matter
2. Diffused by air and water
3. variable disease

Question 11

Describe contagionist disease theory. 3

Answer 11

1. disease develops in body, communicated person-person
2. poison could take form of chemical, fungus or virus
3. caused specific illness

Question 12

How did the 1832 cholera outbreak influence public health? 6

Answer 12

1. BoH may be non-medical (Liverpool) or mixed medical and non medical (york)
2. BoH issued advice to citizens and established hospitals
3. cleaned streets
4. the public responded to epidemic with days of prayer and rioting
5. eg. manchester riots (anatomy act also a factor in this)
6. Position of the medical profession changed

Question 13

Describe the social investigations on cases of disease (1800s) 4

Answer 13

1. People horrified, disgusted and fascinated by slums
2. question of why epidemics were urban
3. can’t be industrial - would put doubt on economic system
4. Must be filthy environment, immorality and ignorance

Question 14

Who was Edwin Chadwick? 5

Answer 14

1. 1800-1890
2. sanitarian, lawyer, bureaucrat, and parliamentary secretary
3. 1842 - report on the sanitary conditions of the working population
4. illness was impacting economy, making it a public concern
5. urban disease had environmental causes and could be solved with technology and engineering

Question 15

What was the link between sanitation and public health in the 19thC? 3

Answer 15

1. strong smell caused disease
2. piped water, sewers and drainage could help
3. public somewhat ignored

Question 16

Who was John Snow (1813-1858)? 6

Answer 16

1. active promoter of anaesthesia
2. sceptical of miasma, published alternative theory - on the mode of communication of cholera, 1849
3. in 1854 epidemic, found cluster of cholera cases around broad street, soho
4. believed pump was source and persuaded council to remove handle
5. produced map to accompany 2nd edition of book
6. often mythologised today

Question 17

Who was William Farr (1807-1883)? 5

Answer 17

1. Medically trained, became a statistician
2. believed in zymotic disease
3. saw disease as analogous to fermentation
4. putrefaction in blood from organic poisons caused by contagion or miasma
5. collected evidence about distribution of cholera in 1853 london epidemic, eg. height above thames, air quality

Question 18

Summarise the following paper:

Pioneer maps of health and disease in England, by e. gilbert, 1958

Answer 18

1. john snow, in 1855, produced a map of cholera deaths and found that deaths were people who drank from the broad street pump
2. pump handle removed and cases stopped
3. dr baker, 1833, drew a similar map based on a leeds cholera epidemic and noted that most cases were in areas of poor sanitation
4. shapter, 1832, drew a map very similar to snow, marking individual cases in exeter, along with landmarks eg. burial grounds and druggists
5. he wrote on the 1849 epidemic, and claimed the reduced number of deaths was due to better sanitation
6. petermann, 1852, released a map of cholera outbreaks that occured in 1831-3 and spotted cholera was never found in mountainous areas, which was common opinion, thought due to bigger population
7. This was followed by census map of 51-2, and it was discovered dense population meant more cholera
8. birmingham on a hill but still suffered badly

Question 19

Cholera quarantine and the english preventive system, 1850-1895. A. Hardy, 1993. What was the british approach to quarantine? 1

Answer 19

1. as a free trade island, used different methods to quarantine yet successful

Question 20

Cholera quarantine and the english preventive system, 1850-1895. A. Hardy, 1993. What was the british attitude towards coming epidemics? 4

Answer 20

1. could predict them based on course in europe
2. better sanitary conditions improved confidence in controlling outbreak
3. preventive measures were suggested
4. no consensus

Question 21

Cholera quarantine and the english preventive system, 1850-1895. A. Hardy, 1993. What lessons did britain learn from 1866 in terms of cholera? 3

Answer 21

1. the lancet were confident in ability to handle
2. cholera arrived by sea from egypt and britain began to take a broad, rather than local, preventative approach
3. clean water supplies and shipping regulations began

Question 22

Cholera quarantine and the english preventive system, 1850-1895. A. Hardy, 1993. What were the port sanitary authorities? 8

Answer 22

1. removal of ill people from boat to hospital
2. improved sanitary conditions in ports
3. boats worked around this so given more powers to disinfect, burn etc
4. the rights of mainland local authorities were extended to port medical officers of health
5. boats arriving from infected places were tracked and inspected on arrival
6. there were fears as europe and the middle east became more connected by trains
7. european countries approached cholera differently - france were secretive, belgium were open, holland openish
8. the 1885 shipping act based on f.e blaxall’s report imposed stricter conditions and person inspections

Question 23

Cholera quarantine and the english preventive system, 1850-1895. A. Hardy, 1993. How did britain become free from cholera after 1867 and how confident were the public? 8

Answer 23

1. Inspections were excellent and billed as key reason for lack of epidemics, 1892-93
2. by 92, cholera was heavily reported on so greater awareness, therefore better response to threat
3. fear of fear disruption society rather than actual disease
4. authorities took it seriously, public didn’t
5. no epidemic due to weather as it came frm hamburg too late and distance from hamburg and antwerp meant symptoms showed by time of arrival
6. there was a small outbreak in grimsby due to poor inspection staff, but the wider system was good
7. sanitary and hygiene weren’t as important
8. luck helped but policies made huge difference

Question 24

The cholera years. c. rosenberg, 1962. introduce the topoc of cholera in the usa. 4

Answer 24

1. during 19thc, public health was still catching up with urbanisation
2. reduce in importance of religion between first and last USA epidemics (1832-66) so other treatments became more important
3. cities accepted, and leaving the city no longer an option
4. more slums and worse conditions developed by second outbreak

Question 25

the cholera years. c. rosenber. 1962. describe the 1832 cholera epidemic in the USA. 12

Answer 25

1. usa quaratine enforced 31-32
2. americans believed cholera would come but they could handle it due to education and christianity
3. thought would get some protection from ruralness
4. water supply in nyc very dirt and avoided
5. boh meetings were infrequent and quarantine based after yellow fever experiences
6. boh made of laymen and slow to take medical advice. heavily criticised for late and feeble action
7. some sanitary measures put in place before arrival, and hospitals orded on news of quebec and montreal
8. cleanliness, calmness and temperance encouraged
9. everyone left nyc out of fear when cholera arrived
   10 residents warned of immoral behaviour
10. epidemic declined in august ‘32
11. laypeople believed it was contagious

Question 26

the cholera years. c. rosenberg. 1962. why did some people believe cholera was a form of justice from god in the usa? 7

Answer 26

1. drs believed intemperate, immoral and dirty most vulnerable
2. cholera affected those exposed who haad weakened themselves
3. those respected who did were thought to have secret weaknesses
4. believed cholera was to encourage social change and remove sinners
5. some others believed in natural rather than spiritual causes
6. days of fasting and prayer were common
7. some thought it was a saviour against atheism

Question 27

the cholera years, c. rosenberg. 1692. why did some people believe cholera was the fault of man? 4

Answer 27

1. many sufferers were poor - poor housing, overcrowding and unable to leave
2. in nyc, poor had to drink terrible city water
3. some believed it the fault of man for not helping enough
4. fear that immigrants may be carriers

Question 28

the cholera years. c. rosenberg. 1962. how did medical professionals respond to the usa cholera epidemics? 5

Answer 28

1. physicians told that cholera could be treated if caught early
2. lack of truly effective cure didn’t helpt
3. marhsland and ill vemtilation seen as bad
4. miasmatic theory partly accepted due to lack of alternatives
5. contagion was impractical, cities would be totally abandoned

Question 29

Summarise the following paper:

the history of asiatic cholera in the usa. j. duffy. 1971. 8

Answer 29

1. urbanization that had occurred in europe later occurred in USA
2. a ny medical society created a committee to advise on cholera prevention: sanitation, hygiene, and morality and temperance
3. 1832 outbreak was short but intense, creating burial problems
4. cholera moved down east coast from ny to new orleans
5. 1848 - conditions were still bad
6. places with transient residents suffered badly
7. by 1866, sanitary improvement was taking place, which reduce impact of later epidemic
8. bad time for medicine, still a lot of uncertainty

Question 30

What caused cholera - germs, poverty of global trade? essay plan. 18

Answer 30

1. scientifically speaking, germs were the direct cause of cholera
2. however, not everyone believed this
3. john snow did
4. many found it difficult to believe in invisible agents that were causing disease
5. poverty had a huge impact on cholera spread
6. in europe and usa, cholera disproportionately affected the poor
7. they lived in cramped conditions which enabled spread
8. poor sanitation - sewage everywhere - could catch it
9. shared water supplies that could be contaminated by waste water. in usa, only those with no choice drank such dangerous water, even though it was not known to cause cholera until 1854
10. at the time, it was believed that immoral ppl were predisposed to cholera and also believed immorality, intemperance and cholera fed into each other
11. those in poverty could not leave so easily when the disease arrived
12. refuse and filth led to miasma which caused cholera
13. global trade had a huge impact in determining the spread of cholera
14. cholera traveled westwards across europe from east asia, like trade
15. epidemics in britain/europe were usually followed by epidemics in north america
16. it was thought that, in britain, the implementation of quarantine and port sanitary authorities, who carried out inspections on incoming ships, contributed to the end of cholera in britain eg, britain was spared the 1892-3 european outbreak
17. this suggests epidemics were carried by trade
18. mixture, but especially poverty

Question 31

according to primary sources, what did physicians in 19thc believe caused cholera? 8

Answer 31

1. air - poisoned gases
2. mixed with poor lifestyle before contamination
3. weather influences spread
4. public discussion - scientists wrote in scientific journals that could/would be read by laypeople
5. oxygen importance discovered in late 18thc so oxygen mentioned a lot
6. some believed bronchioles constricted so oxygen couldn’t enter and poisonous gases couldn’t leave
7. miasmatic theories existed within humoural framework
8. moral issues eg. gluttony, intemperance and irish migration

Question 32

What preventatives/treatments were offered for cholera in the 19thc? 9

Answer 32

1. Calomel
2. laudunum
3. brandy/port
4. enemas
5. ventilation/sanitation
6. tartar emetic
7. acidic baths, boiling water or friction
8. blood letting
9. advice on how to behave in moral fashion