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Podcast Episode 55- Cholera

Cholera is a severe disease of the intestine caused by the Vibrio cholerae bacterium, which is found in food or water that have been contaminated by feces from a person infected with cholera. Cholera is closely linked to a lack of clean water and crowded, unsanitary conditions. A person with cholera may take up to five days after infection to show symptoms, which include nausea, vomiting, and severe diarrhea, resulting in dehydration and death if left untreated. In modern times, people with cholera can be treated by rehydration via intravenous, but in the 19th century there was very little that could be done to treat the disease. Cholera claimed the lives of millions globally, including around 20,000 people in Canada.  

Cholera is believed to have originated as early as 400 B.C. in the Ganges Delta, and was described by Hippocrates, Galen and Wang-Shooho in ancient times. Many cholera-like symptoms were labeled as cholera, however the first serious outbreak of cholera morbus was first truly described in 1783 on the banks of the Ganges. The disease was endemic in present-day Bangladesh and in western India, with a particularly devastating epidemic striking Lower Bengal in 1817. With the rise of global trade and ship travel, Cholera started to spread throughout the world, first through Asia, then Russia, western Europe and finally Cholera arrived in the British Isles in 1831. On October 20th, 1831, the first death attributed to cholera in Great Britain took place in Sunderland, and by February of 1832, cholera had arrived in London. People in Britain called this poorly understood disease by many names, including Indian cholera, Asiatic cholera, Cholera Morbus, the blue cholera, spasmodic cholera.  

The arrival of cholera filled many people with a sense of terror due to its severity, and its sudden and seemingly arbitrary nature. They were also horrified by the painful and rapid decline of those who were afflicted with cholera, which did not allow for a gradual or peaceful death. People were baffled by the spread of cholera, as it did not seem to follow any known model of contagion. There were two main schools of thought which offered two different scientific explanations for the spread of disease. Those who supported miasmatic theory believed that “miasmas” in the air were responsible for the spread of disease. According to miasmatic theory, disease was spread through the air, and therefore could not be stopped through quarantine. Others subscribed to contagion as the method of the spread of disease. They believed that disease was carried through human contact, and therefore supported quarantines to stop the spread of cholera. Many became skeptical and contemptuous of doctors who were unable to cure the disease. Cholera so influenced the population that “may the cholera catch you!” became a popular curse.  

Although Canada had had several epidemics throughout the 18th and early 19th centuries, including smallpox and typhus, none had ever reached the severity of the cholera epidemic that began in 1832. The authorities of Lower Canada had initially attempted to prevent cholera’s arrival by opening a quarantine station on Grosse Ile, an island on the St. Lawrence River. In 1832, Grosse Île’s sole objective was controlling the cholera epidemic that was quickly arriving by ship. European immigrants were often sailing in cramped and unhygienic conditions, which offered a perfect breeding ground for disease. All ships were required to anchor at Grosse Île and undergo an examination by a health officer, and it would be decided if the ship could continue to Québec. The ship would then be examined a second time at the Port in Quebec City before any passengers were allowed to disembark. There were many flaws in this system. Many passengers carrying cholera were asymptomatic, and some simply hid their sick family members. The island itself enforced no separation of passengers, and the close proximity of the overwhelming numbers of people provided a perfect breeding ground for asymptomatic people to infect other passengers.  

Vessels had to anchor 50 yards from shore and wait for a health officer to visit the ship. The health officer would then deem if the ship was good to dock and the passengers allowed to continue to Montreal, or quarantine. The average waiting time for ships to be anchored offshore before being visited and granted passage, was around 3 days. Vessels were asked that if they have any infected passengers, a yellow flag shall be flown from its mast. In fact, anywhere infected persons stayed flew yellow flags to signify the quarantining of those infected.  Those vessels that did have a cholera outbreak had to go into quarantine for 30 days.  

With the help of the Emigrant Society, cholera was soon spread to Upper Canada and the United States. People looked to doctors, apothecaries, and the clergy for solutions, but cholera continued to afflict growing numbers of people. In Lower Canada, the disease gave rise to the expression “avoir une peur bleue”, meaning to be scared blue, because the corpses of cholera victims turned a distinct blue colour due to extreme dehydration. Hospitals quickly became overrun with the sick, and makeshift buildings and camps were erected to house the afflicted. The busy schedules of hospitals likely contributed to a popular rumour that circulated which claimed that a young woman was put into a coffin “yet living”. Her husband demanded to see her body and he discovered she was still alive, after which he carried her home and she recovered.  

During this time society began equating cholera with the poor, giving rise to stigmatization. Poor immigrants became associated as agents of cholera. The poor lacked medical attention and prevention of cholera, consequently also lacking the resources to better their living conditions. There became a separation between the poor and the rich. Society had a distinct “us” vs. “them” attitude. Those who escaped the disease on the ships were kept in cholera-promoting conditions quarantined in sheds with little sanitation, clean water or food. 

 It is important to remember that immigrants coming to Upper Canada at this time were often penniless fleeing their homelands for a new start. Upon arrival, even if they survived through the horrible conditions of Atlantic voyage and cholera quarantine, they were denied help and shelter, and were turned away by residents. This attitude stigmatized the immigrants and pushed them off to places of crude shelter where they were kept separate from middle- and upper-class persons. Whether it was the treatment of the poor or the treatment of immigrants, the overarching social attitudes of blame and actions at this time created a cyclical process. The Irish immigrants were especially targeted, marginalized and segregated, therefore, also hit hard with cholera.  

Many methods were tried in a desperate attempt to help the situation. In Quebec City, cannons were fired in order to dispel the harmful miasmas in the air, in Montreal artillery was fired, and people all over started to burn smudge pots to help ‘clear the air’.  Doctors also began to prescribe 1 teaspoon of brandy every hour to act as a stomach stimulant.  

Nobody knew the cause of the cholera epidemic, but authorities were beginning to see a connection between the disease and unsanitary conditions and began enforcing public health regulations with the use of wardens who would go to people’s dwellings and inspect their cleanliness. Homes were to be cleaned thoroughly and purified with chloride of lime. The authorities also implemented new rules regarding garbage, privies, animals (particularly pigs), and trades considered “offensive”, such as candle- and soap-makers. Funerals were not allowed for those who died of Cholera, as the bodies were to be buried as soon after death as possible. Laws were put in place stating that in the day victims of cholera had to be buried a maximum of 6 hours after death and within 12 hours if they died at night. Many bodies were buried on non-consecrated ground infuriating loved ones. The Saint-Louis cemetery in Quebec was established to specifically bury victims of cholera. Therefore, it became known as the Cemetery of the Choleric.  

Those with money fled the cities and decided to travel to the countryside. However, this aided in spreading the disease to places that had been previously untouched by it.  

The first wave of cholera in Lower and Upper Canada were over by the end of 1832 but was soon followed by another outbreak in 1834. Upper Canada continued to experience major cholera epidemics in 1849, 1851, 1852, and 1854.  

By the epidemic of 1849, many thought cholera was not contagious. Those who held that belief thought it was transmitted anywhere from anxiety to alcohol. Sanitation and hygiene had not improved much since the first epidemics. By the end of this run, around 1,700 deaths by cholera were recorded.  

After the return of the epidemic in 51’ and 52’, it appeared to be less severe than the previous outbreaks. By the last outbreak in 1854, the spread of the disease began to be attributed to impure drainage and impure water. An indication they started gaining a better understanding and were a step in the right direction.  

The epidemic of cholera in Canada was officially declared over by September 22, 1854. The official death toll is recorded at 3,486, though it is believed that the number is much higher.  

Here is a quote about a month before the cholera epidemic was declared over from The Weekly Dispatch, titled “Health of St. Thomas”

“Thursday August 17, 1854 

We are very happy to be able to record the continuance of the health of the inhabitants of this town. At no previous period during the memory of the oldest settlers, was the general health better. Cholera, we believe, has not made its appearance in this place during the summer, but for fear of its approach the Town Council established a Board of Health under the impression that “prevention is better than cure”. The Board having been organized issued a notice forbidding the sale of unripe fruits in the town, and directing all parties to cleanse their premises, a commendable precaution and one that should be strictly enforced in order to preserve the state of things which so happily exists. We have observed during the past fortnight, a great influx pf strangers who have temporarily removed from Hamilton, London, and other places to avoid the contagion that prevails. The cholera in these towns has, within the past few days greatly abated, and it is hoped that the coolness of the weather will banish the dreaded disease.” 

We hope you enjoyed this episode and will come back for more!