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There were 4912 cases of cholera in Liverpool in 1832, leading to 1523 fatalities (Old Mersey Times, 2002). There were further outbreaks in 1849, 1854 and 1866.
In June, 1832, the city of Liverpool (in common with most British towns) was in the grips of the first great cholera epidemic to attack the country. The disease was dramatic; death was rapid and mortality high. Civil unrest broke out. On June 2, 1832, the Liverpool Chronicle reported the attack on a dispensary by a mob, the first of what were to become known as the “Cholera Riots” (Gill, Burrell and Brown, 2001). Although largely caused by fear of this hitherto unknown disease and a relatively ineffectual response by the authorities, another cause was the fear of body-snatching, following the Burke and Hare episode.
In early nineteenth century England, conditions were ideal for outbreaks of cholera. Sewage and “nightsoil” were deposited freely into the streets and lanes, either to stagnate or to flow into ditches and rivers. Untreated drinking water was obtained from the same rivers and lakes into which effluent flowed.
Industrialisation and urbanisation worsened the situation, bringing intense overcrowding, deplorable sanitation, and the particular evil of “cellar dwelling”. At the time, cholera was thought to be spread by vapours and air (miasma). Its water-borne nature was not discovered until 1849, by John Snow, and his findings were not accepted generally for some time.
Living conditions in Liverpool in early Victorian times were very poor for most of the population, probably worse than most other cities. The city’s rate of growth, related to shipping and the cotton trade, had been enormous; and Irish immigration particularly exacerbated the crisis. Overcrowded cellar dwelling was the order of the day for many, and there was virtually no organised supply of water or disposal of sewage.
William Duncan, later to become Liverpool’s celebrated Medical Officer of Health (the first to be appointed in Britain), commented that: “The vicious construction of the dwellings, insufficient supply of out-offices and of receptacles for refuse and excrement, the absence of drains, deficient sewerage and overcrowding of the population is tending to increase the mortality of Liverpool.”
There was a response to this outbreak, not least because it did not only affect the poor and working people. The Liverpool Board of Health arranged for the conversion of a large house in Lime Street, in the centre of town, into a cholera hospital, staffed by a resident surgeon and nurses paid for by the Board of Health, and other local doctors on an unofficial basis. A second hospital was established in Toxteth Park and became the site of the first riot. A Cholera Bill was passed in February, 1832, to prevent the spread of “the disease called the cholera, or spasmodic, or Indian cholera”. Quarantine regulations were brought in for ships.
Most of the affected, and particularly those who died, were poor— often cellar dwellers and frequently Irish immigrants. Outside London, Liverpool’s cholera case-load was the highest in England.
In 1848 Asiatic Cholera struck Liverpool (Edwards). This time it came to Liverpool by way of Glasgow and Dumfries when on 10 December 1848 an Irish family arrived in Liverpool by steamer from Dumfries where the epidemic was at its height. On landing one of the children was found to be suffering from cholera and both parents went down with the disease on the night of their arrival in Liverpool. All three died, and on the 15th December and woman residing in the same house who had washed the bodies and bed clothes of the deceased died after twelve hours’ illness. The first case diagnosed to be of Liverpool origin was on the 16th in a crowded house in Back Portland Street in the Vauxhall area. The victim was a girl about 14 years of age. By the summer of 1849 several hundred people were dying each week.
The 1849 epidemic burned itself out, with 5308 deaths in total, and when cholera returned in 1854 its impact on Liverpool was much less severe, with only 1084 deaths. This was in no small part due to the activities of William Duncan and his sanitary inspector Thomas Fresh. They believed that epidemics were caused by the miasma - the bad air caused by rotting animal and vegetable matter. They energetically applied the theories of the time - such as closing cellar dwellings and lime-washing affected houses - but they were working to a faulty theory. Ironically many of the measures that were taken - such as ventilation and simple disinfection - were the right things to have done, but for the wrong reasons.
It was only after the Broad Street outbreak in London in 1854 that John Snow’s work received much attention (Underwood, 1947). He had suggested that cholera may be widely disseminated by the emptying of sewers into the drinking water of the community, and gave examples of cholera areas such as Dumfries, Glasgow, and certain parts of London-in which these conditions existed. He constructed his case using examples of localized outbreaks in which it could be shown that the drinking water had become polluted with sewage. He was able to obtain evidence from the Broad Street outbreak which supported his theory.
Snow investigated the relationship between cholera deaths in various London districts and the water supply to those districts. In 1854 most of London south of the Thames was supplied by two water companies; the Southwark and Vauxhall Company, which drew its water from a polluted section of the river near Battersea Fields; and the Lambeth Company, which obtained its supply from much farther up the river at Thames Ditton. In a certain area of London, the pipes of the two companies ran side by side, and the last house had a choice of two supplies. In 1854, Snow assisted by Dr. J. J. Whiting, visited every house in which a cholera death had occurred and ascertained the identity of the supply used. As a result of this survey Snow showed that, during a seven-week period, the incidence of cholera deaths in houses supplied by the Southwark Company was 315 per 10,000 houses; in those supplied by the Lambeth Company 37 per 10,000; and in the rest of London, 59 per 10,000. This is one of the earliest examples of a field investigation in epidemiology. Snow's work was marked by accurate observation, careful reasoning, and logical deduction.
Medical Officers of Health began to collate data and public pressure also began to mount, and this led to the Public Health Act of 1875 which established a coherent administrative machinery to deal locally with issues of health and sanitation. Local authorities were required to provide water, drainage and sewerage.
Bibliography
Edwards, R.F. ‘The Asia Cholera Outbreak of 1849’, Liverpool Picturebook [Online]. Available at Liverpool Picturebook (Accessed 24 January 2021).
Gill, G., Burrell, S., and Brown, J. (2001) ‘Fear and Frustration – the Liverpool Cholera Riots of 1832’, The Lancet, vol 358, pp 233-7, 2001 [Online]. Available at doi:10.1016/S0140-6736(01)05463-0 (thelancet.com) (Accessed 23 January 2021).
Old Mersey Times (2002) Liverpool and Merseyside Epidemics and Health [online]. Available at LIVERPOOL AND MERSEYSIDE EPIDEMICS AND HEALTH (old-merseytimes.co.uk) (Accessed 23 January 2021).
Underwood, E.A., (1947) ‘The History of Cholera in Great Britain’, Proceedings of the Royal Society of Medicine’, vol XLI, pp 165 – 173, 1947 [Online]. Available at The History of Cholera in Great Britain (sagepub.com) (Accessed 24 January 2021).