Cholera Outbreaks and Pandemics since 1817
Curated/Reviewed by Matthew A. McIntosh
Seven cholera pandemics have occurred in the past 200 years, with the first pandemic originating in India in 1817. Additionally, there have been many documented cholera outbreaks, such as a 1991–1994 outbreak in South America and, more recently, the 2016–20 Yemen cholera outbreak.
Although much is known about the mechanisms behind the spread of cholera, this has not led to a full understanding of what makes cholera outbreaks happen in some places and not others. Lack of treatment of human feces and lack of treatment of drinking water greatly facilitate its spread. Bodies of water have been found to serve as a reservoir, and seafood shipped long distances can spread the disease.
Between 1816 and 1923, the first six cholera pandemics occurred consecutively and continuously over time. Increased commerce, migration, and pilgrimage are credited for its transmission. Late in this period (particularly 1879-1883), major scientific breakthroughs towards the treatment of cholera develop: the first immunization by Pasteur, the development of the first cholera vaccine, and the identification of the bacterium Vibrio cholerae by Filippo Pacini and Robert Koch. After a long hiatus, the seventh cholera pandemic spread in 1961. The pandemic subsided in 1970s, but continued on a smaller scale, with outbreaks across the developing world to the current day. Epidemics occurred after wars, civil unrest, or natural disasters, when water and food supplies become contaminated with Vibrio cholerae, and also due to crowded living conditions and poor sanitation.
Deaths in India between 1817 and 1860, in the first three pandemics of the nineteenth century, are estimated to have exceeded 15 million people. Another 23 million died between 1865 and 1917, during the next three pandemics. Cholera deaths in the Russian Empire during a similar time period exceeded 2 million.
The first cholera pandemic occurred in the Bengal region of India, near Calcutta starting in 1817 through 1824. The disease dispersed from India to Southeast Asia, the Middle East, Europe, and Eastern Africa through trade routes. The second pandemic lasted from 1826 to 1837 and particularly affected North America and Europe due to the result of advancements in transportation and global trade, and increased human migration, including soldiers. The third pandemic erupted in 1846, persisted until 1860, extended to North Africa, and reached South America, for the first time specifically affecting Brazil. The fourth pandemic lasted from 1863 to 1875 spread from India to Naples and Spain. The fifth pandemic was from 1881–1896 and started in India and spread to Europe, Asia, and South America. The sixth pandemic started in India and was from 1899–1923. These epidemics were less fatal due to a greater understanding of the cholera bacteria. Egypt, the Arabian peninsula, Persia, India, and the Philippines were hit hardest during these epidemics, while other areas, like Germany in 1892 and Naples from 1910–1911, also experienced severe outbreaks. The seventh pandemic originated in 1961 in Indonesia and is marked by the emergence of a new strain, nicknamed El Tor, which still persists (as of 2019) in developing countries.
Cholera did not occur in the Americas for most of the 20th century after the early 1900s in New York City. It reappeared in the Caribbean toward the end of that century and seems likely to persist.
The first cholera pandemic, though previously restricted, began in Bengal, and then spread across India by 1820. Hundreds of thousands of Indians and ten thousand British troops died during this pandemic. The cholera outbreak extended as far as China, Indonesia (where more than 100,000 people succumbed on the island of Java alone) and the Caspian Sea in Europe, before receding.
A second cholera pandemic reached Russia (see Cholera Riots), Hungary (about 100,000 deaths) and Germany in 1831; it killed 130,000 people in Egypt that year. In 1832 it reached London and the United Kingdom (where more than 55,000 people died) and Paris. In London, the disease claimed 6,536 victims and came to be known as “King Cholera”; in Paris, 20,000 died (of a population of 650,000), and total deaths in France amounted to 100,000. In 1833, a cholera epidemic killed many Pomo people which were a Native American tribe. The epidemic reached Quebec, Ontario, Nova Scotia and New York in the same year, and the Pacific coast of North America by 1834. In the center of the country, it spread through the cities linked by the rivers and steamboat traffic.
Similarly, in Washington DC (where there are no reliable mortality figures), Michael Shiner, an enslaved laborer at the Washington Navy Yard recorded, “The time the colery [cholera] broke out in about June and July August and September 1832 it Raged in the City of Washington and every day they wher [were] twelve or 13 carried out to they [their] graves a day.” By late July 1832 cholera had spread to Virginia and on 7 August 1832, Commodore Lewis Warrington confirmed to the Secretary of the Navy Levi Woodbury cholera was at the Gosport Navy Yard, “Between noon of that day, [1 August] and the morning of Friday [3 August], when all work on board her USS Fairfield stopped, several deaths by cholera occurred and fifteen or sixteen cases (of less violence) were reported.”
The epidemic of cholera, cause unknown and prognosis dire, had reached its peak. Cholera afflicted Mexico’s populations in 1833 and 1850, prompting officials to quarantine some populations and fumigate buildings, particularly in major urban centers, but nonetheless the epidemics were disastrous.
During this pandemic, the scientific community varied in its beliefs about the causes of cholera. In France doctors believed cholera was associated with the poverty of certain communities or poor environment. Russians believed the disease was contagious, although doctors did not understand how it spread. The United States believed that cholera was brought by recent immigrants, specifically the Irish, and epidemiologists understand they were carrying disease from British ports. Lastly, some British thought the disease might rise from divine intervention.
The social importance of the government having a direct role in the development and application of science was demonstrated through the U.S. Government’s support of efforts to control the epidemic.
The third cholera pandemic deeply affected Russia, with over one million deaths. Over 15,000 people died of cholera in Mecca in 1846. A two-year outbreak began in England and Wales in 1848, and claimed 52,000 lives.
In 1849, a second major outbreak occurred in France. In London, it was the worst outbreak in the city’s history, claiming 14,137 lives, over twice as many as the 1832 outbreak. Cholera hit Ireland in 1849 and killed many of the Irish Famine survivors, already weakened by starvation and fever. In 1849, cholera claimed 5,308 lives in the major port city of Liverpool, England, an embarkation point for immigrants to North America, and 1,834 in Hull, England.
An outbreak in North America took the life of former U.S. President James K. Polk. Cholera, believed spread from Irish immigrant ships from England, spread throughout the Mississippi river system, killing over 4,500 in St. Louis and over 3,000 in New Orleans. Thousands died in New York, a major destination for Irish immigrants. Cholera claimed 200,000 victims in Mexico.
That year, cholera was transmitted along the California, Mormon and Oregon Trails as 6,000 to 12,000 are believed to have died on their way to the California Gold Rush, Utah and Oregon in the cholera years of 1849–1855. It is believed more than 150,000 Americans died during the two pandemics between 1832 and 1849.
In 1851, a ship coming from Cuba carried the disease to Gran Canaria. It is considered that more than 6,000 people died in the island during summer, out of a population of 58,000.
In 1852, cholera spread east to Indonesia, and later was carried to Indonesia and Japan in 1854. The Philippines were infected in 1858 and Korea in 1859. In 1859, an outbreak in Bengal contributed to transmission of the disease by travelers and troops to Iran, Iraq, Arabia and Russia. Japan suffered at least seven major outbreaks of cholera between 1858 and 1902. Between 100,000 and 200,000 people died of cholera in Tokyo in an outbreak in 1858–60.
In 1854, an outbreak of cholera in Chicago took the lives of 5.5 percent of the population (about 3,500 people). Providence, Rhode Island suffered an outbreak so widespread that for the next thirty years, 1854 was known there as “The Year of Cholera.” In 1853–54, London’s epidemic claimed 10,739 lives. The 1854 Broad Street Cholera outbreak in London ended after the physician John Snow identified a neighborhood Broad Street pump as contaminated and convinced officials to remove its handle. His study proved contaminated water was the main agent spreading cholera, although he did not identify the contaminant. It would take many years for this message to be believed and fully acted upon. In Spain, over 236,000 died of cholera in the epidemic of 1854–55. The disease reached South America in 1854 and 1855, with victims in Venezuela and Brazil. During the third pandemic, Tunisia, which had not been affected by the two previous pandemics, thought Europeans had brought the disease. They blamed their sanitation practices. Some United States scientists began to believe that cholera was somehow associated with African Americans, as the disease was prevalent in the South in areas of black populations. Current researchers note their populations were underserved in terms of sanitation infrastructure, and health care, and they lived near the waterways by which travelers and ships carried the disease.
From November 10, 1855 to December 1856 the disease spread through Puerto Rico claiming 25,820 victims. Cemeteries were expanded to allow for the burial of victims of cholera.
The fourth cholera pandemic of the century began in the Ganges Delta of the Bengal region and traveled with Muslim pilgrims to Mecca. In its first year, the epidemic claimed 30,000 of 90,000 Mecca pilgrims. Cholera spread throughout the Middle East and was carried to Russia, Europe, Africa and North America, in each case spreading from port cities and along inland waterways.
The pandemic reached Northern Africa in 1865 and spread to sub-Saharan Africa, killing 70,000 in Zanzibar in 1869–70. Cholera claimed 90,000 lives in Russia in 1866. The epidemic of cholera that spread with the Austro-Prussian War (1866) is estimated to have taken 165,000 lives in the Austrian Empire, including 30,000 each in Hungary and Belgium and 20,000 in the Netherlands. Other deaths from cholera at the time included 115,000 in Germany,90,000 in Russia and 30,000 in Belgium.
In London in June 1866, a localized epidemic in the East End claimed 5,596 lives, just as the city was completing construction of its major sewage and water treatment systems; the East End section was not quite complete. Epidemiologist William Farr identified the East London Water Company as the source of the contamination. Farr made use of prior work by John Snow and others pointing to contaminated drinking water as the likely cause of cholera in an 1854 outbreak. Quick action prevented further deaths. In the same year, the use of contaminated canal water in local water works caused a minor outbreak at Ystalyfera in South Wales. Workers associated with the company and their families were most affected, and 119 died.
In 1867, Italy lost 113,000 lives and 80,000 died of the disease in Algeria. Outbreaks in North America in the 1870s killed some 50,000 Americans as cholera spread from New Orleans to other ports along the Mississippi River and its tributaries. None of the cities had adequate sanitation systems, and cholera spread through the water supply and contact.
The fifth cholera pandemic, according to Dr A. J. Wall, the 1883–1887 part of the epidemic cost 250,000 lives in Europe and at least 50,000 in the Americas. Cholera claimed 267,890 lives in Russia (1892); 120,000 in Spain; 90,000 in Japan and over 60,000 in Persia. In Egypt, cholera claimed more than 58,000 lives. The 1892 outbreak in Hamburg killed 8,600 people. Although the city government was generally held responsible for the virulence of the epidemic, it went largely unchanged. This was the last serious European cholera outbreak, as cities improved their sanitation and water systems.
The sixth cholera pandemic had little effect in western Europe because of advances in public health, but major Russian cities and the Ottoman Empire were particularly hard hit by cholera deaths. More than 500,000 people died of cholera in Russia from 1900 to 1925, which was also a time of social disruption because of revolution and warfare.
The 1902–1904 cholera epidemic claimed 200,000 lives in the Philippines including their revolutionary hero and first prime minister Apolinario Mabini. Cholera broke out 27 times during the hajj at Mecca from the 19th century to 1930. The sixth pandemic killed more than 800,000 in India.
The last outbreak in the United States was in 1910–1911, when the steamship Moltke brought infected people from Naples to New York City. Vigilant health authorities isolated the infected in quarantine on Swinburne Island. Eleven people died, including a health care worker at the hospital on the island.
In this time period, because immigrants and travelers often carried cholera from infected locales, the disease became associated with outsiders in each society. The Italians blamed the Jews and gypsies, the British who were in India accused the “dirty natives”, and the Americans thought the disease came from the Philippines.
The seventh cholera pandemic began in Indonesia, called El Tor after the strain, and reached East Pakistan (now Bangladesh) in 1963, India in 1964, and the Soviet Union in 1966. From North Africa, it spread into Italy by 1973. In the late 1970s, there were small outbreaks in Japan and in the South Pacific. There was an outbreak in Odessa in July 1970 and there were also many reports of a cholera outbreak near Baku in 1972, but information about it was suppressed in the Soviet Union. In 1970, a cholera outbreak struck the Sağmalcılar district of Istanbul, then an impoverished slum, claiming more than 50 lives; eventually the notoriety of the incident led to the renaming of the district as Bayrampaşa. Also in 1970, a few cases were reported in Jerusalem in August.
- Aberth, John (2011). Plagues in World History. Lanham, MD: Rowman & Littlefield. p. 102.
- Echenberg, Myron (2011-02-28). Africa in the Time of Cholera.
- Hayes, J.N. (2005). Epidemics and Pandemics: Their Impacts on Human History. Santa Barbara, CA: ABC-CLIO. pp. 214–219.
- Johnson, Steven (2006). The ghost map : the story of London’s most terrifying epidemic—and how it changed science, cities, and the modern world. New York: Riverhead Books.
- Kohn, George C. (2008). Encyclopedia of Plague and Pestilence: from Ancient Times to the Present.
- McNeil J. Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).
- Rosenberg, Charles E. (1987). The cholera years: the United States in 1832, 1849 and 1866. Chicago: University of Chicago Press.
- Snow, John (1855). On the Mode of Communication of Cholera.
- Snowden, Frank M. (2019). Epidemics and Society: From the Black Death to the Present. New Haven, Connecticut: Yale University Press. pp. 239–240.
- Unruh, John David (1993). The plains across: the overland emigrants and the trans-Mississippi West, 1840–60. Urbana, IL: University of Illinois Press. pp. 408–10.
Originally published by Wikipedia, 12.19.2010, under a Creative Commons Attribution-ShareAlike 3.0 Unported license.