Cholera first came to England in 1831-32. The disease caused much fear, and invoked considerable debate and intellectual sparing in both the scientific community and general society. Yet when the disease again came to England in 1848, past issues had not been resolved and a deadly epidemic ensued. This final chapter in Morris's account of the 1832 cholera epidemic describes the debates that took place in the era of John Snow, offering an interesting account of how past lessons were addressed in the mid-nineteenth century. What is perhaps equally fascinating is how close historical debates on cholera in England parallel current debates on ways to address the HIV/AIDS pandemic (personal HIV screening and international HIV controversies), pointing out that while diseases change, human combative reactions have a constant quality.
To view the notes in Morris' Epilogue, click on the numbers (e.g., ) to go and return.
Chapter 9: Epilogue
by R. J. Morris
in Cholera 1832 -- The Social Response to An Epidemic, 1976.
The 'Lessons' of 1832
There was a wide-ranging, substantial and often violent reaction to the immediate impact of cholera. Long-term responses were not so clear. Men like Sir John Simon and Charles Creighton looked back at 1832 and saw obvious lessons in the epidemic. Cholera had demonstrated the relationship between disease and the dirty, ill-drained parts of towns and had shown the need for drainage, sewerage and filtered water supplies.  It ought to have been a spur to sanitary reform. Yet little action of this sort followed the epidemic.
1832 was one of those periodic occasions in the nineteenth century in which government and the middle classes made a shocked discovery of poverty. Charles Greville was alarmed by the information which came to him at the Privy Council, 'The awful thing is, the vast extent of misery and distress which prevails, and the evidence of the rotten foundations on which the whole fabric of this gorgeous society rests. .'  Their Lordships were alarmed by what their agents found in Sunderland, '...these poor people have an undoubted right to a larger measure of relief than appears to have been dispensed.'  This reaction was in part an old pattern of social relationships; the aristocratic government intervening to ensure that the lower orders got their 'rights' from the middle classes. It also indicated the normal lack of contact between rulers and people. This gap was nearly as great at local level. Kay noticed it in Manchester. At Bilston, the middle class and their clergy expected to find some 500 families in extreme poverty, by which they meant needing relief at least twice a week. In fact they found 1,057 families in this position.
In the winter of 1832-3, both government and people seemed to want to forget cholera as quickly as they could. The Edinburgh Medical and Surgical Journal declared they would review no more books on the subject because of 'the multitude of books which have recently issued from the press on the subject of cholera, and our determination no longer to try the patience of our readers'.  The newspaper and periodical Press dropped the subject even more rapidly than they had taken it up. Hence the work of James Kay, Gaulter and Robert Baker, which has received so much attention from historians, was largely ignored. The last letter in the Board of Health letter book showed that familiarity bred complacency:
the disease will probably be contemplated henceforth in the same sanitary light as any other dangerous malady which may become domiciled in this country, its management must be left to the prudence and good feeling of those communities where it may occasionally show itself.
Cholera played no part in social policy-making in the next decade. Although the discussion of poverty had a central place in the public and administrative reaction, the epidemic of 1832 had no place in the Poor Law Commission Report of 1834. Cholera did gain an occasional mention in the Commissioners' Local Reports to illustrate a point about surgeons' fees or to fill an item in the accounts, but the broader implications of the epidemic were ignored. The lessons of cholera had no place in the vast pamphlet literature which surrounded the Poor Law debate. Such lessons had no place in a 'reform' which was designed to reduce the amount of help which was given to the poor. Cholera had no place in the Factory Act debates. It had no mention in lesser debates, like the Select Committee on Drunkenness and the Select Committee on Public Walks, both published in 1833 and both on subjects which related to cholera as it was then understood.
There were two main reasons why the 'lessons' of cholera should have been ignored after 1832. First, the epidemic when it came was an anti-climax after the terrifying reading and speculation of 1831. British government had reacted to the approach of cholera with urgent attempts to find effective and responsible ways of stopping and treating the disease. Despite their failure these attempts were in marked contrast to the occasional pleading pamphlets which promoted smallpox vaccination. In part the initial reaction was prompted by fear of the unknown, in part by fear that the rich would be infected by the poor, though the belief that the rich would escape was equally powerful. The most important reason for taking such urgent action was the belief that cholera by its suddenness and unpredictability was capable of massive social and commercial disorganization. Experience showed that this was not so in Britain. The unsatisfactory account which medicine gave of cholera supplied a second reason for lack of action. There were no clear 'lessons'. Certainly none which would justify increases in the rates. Indeed, the religious and moral accounts of cholera were more convincing to many and evoked more reaction.
Local evidence showed two sorts of long-term response to cholera after 1832. The first was the Oxford pattern in which reforming energies were dissipated in activities which had little practical relationship to public health needs. The Oxford Board had noted the spread of cholera among the prostitutes of the New Hamel and resolved on a subscription to establish a charitable institution to help those women who wished to reform. Although the Board felt that they might take 'much higher and more comprehensive views of the subject', they closed their debate on the matter by 'entering upon the minutes the following propositions relating to the dangers to public health arising out of the profligacy, the destitution, the filthiness and the unwholesome situations of the residences of the common prostitute'.
It appears to this Board of great importance, viewing the matter in its lower instead of its higher affinities and entertaining it simply as a sanitary and precautionary measure that it would be conductive to public health and safety under the present calamity of cholerous sickness to effect some amelioration in the habits of the common prostitute -- their homes and homesteads, the localities of their residences, their destitute as well as their debased condition, and generally in their natural and statistical as well as their spiritual and eternal relations.
Although the Oxford Board saw the cholera among the prostitutes as part of the general prevalence of cholera in conditions of filth and poverty, the Board concerned themselves with that aspect of the New Hamel which attracted their attention on moral as well as public health grounds.
In Leeds the story was different. Here the strands of reform were created by the young Poor Law surgeon Robert Baker, and ran into the sands because of lack of public interest. He presented his report to the local Board of Health. It received a little notice in the local Press and council and was then forgotten.
The cholera of 1832 may be dismissed as an immediate influence on opinion regarding public health, but it was important for its influence on a number of individuals who later came to play key secondary roles in the public health campaigns after 1840. In 1839, Robert Baker returned to public notice with a statistical survey of the town which attracted a great deal of attention, which did not mention cholera, and which led to the 1842 Leeds Improvement Act. Reverend Charles Girdlestone, the Black Country parson of fervent evangelical views, took a leading part in religious and public health action against the cholera, and reappeared several years later as one of Chadwick's local informants for the 1842, Report on the Sanitary Condition of the Laboring Population of Great Britain. Baker was also amongst the local correspondents. In 1832 Duncan of Liverpool (upper center) was given special thanks by the local board of health for his work. He was appointed as the first medical officer of health in 1847. James Kay's early experience of disease and poverty was gained among the cholera cases of south Manchester. He reappeared in the 1840s at the centre of work to improve the quality of schools and teachers among the working classes. There was then a sense in which a public health and a wider movement for the improvement of the conditions of the poor were created by the epidemic of 1832.
The powerful experience of observing and dealing with cholera came at the start of the careers of a small group of men. As these men were forming their impressions and evaluations of the society and environment in which they lived, they saw cholera, which through its pain and unpredictable spread emphasized the inhumanity and danger of British society. Ten or fifteen years later when they had gained in reputation, in social experience and authority, these people were able to influence the course of social and public health reform. If the lives of Baker, Duncan, Girdlestone and Kay prove to be characteristic of the lives of others, then the cholera of 1832 will be seen to have created the early cadres of a public health movement, which then went underground, to emerge again in the 1840s.
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