Thread by @AlexPetrovnia

In year three of the pandemic, I see many people mourning not only death around us, but a loss of public trust in institutions, spread of misinformation, and governmental instability. For today, I want to talk about something else. I want to talk about cholera. 🧵

Cholera, as many of you likely know, is a bacterial illness spread by fecal-oral routes due to contaminated food or drinking water. It almost universally exists where sanitation infrastructure is low or nonexistent.

Cholera is particularly interesting because it is a disease that emerged very suddenly. Cholera (of the highly infectious variety) didn't evolve until the 1800s. Specifically, it broke out in 1817, two years after the Tambora volcanic eruption that caused acute climactic change.

This Tambora eruption was so powerful that it clouded much of Europe and North America in "a year without a summer", caused widespread famines and sickness, and made it snow in August.
In southern Asia, it strengthened the monsoon.

For two years, monsoons struck the Ganges River Delta region of India so strongly that the entire region became swampy marshland. There was no possible way to avoid contaminated water, because all water was mixing constantly.
And here, in 1817, the first cholera outbreak began.

Cholera is a very interesting illness. In most people, it causes no effects whatsoever. But in about 1/10th of people infected, it causes the body to lose fluids at such a rate that people can die within a day, blue with dehydration.

Cholera is completely curable, as it kills through dehydration. If someone afflicted with cholera is given oral rehydration solutions (or even enough uncontaminated water, in many cases), they will almost certainly survive.

Cholera is a disease of extremes; harmless only within the very conditions that would prevent it, devastatingly deadly without them.

The first cholera pandemic infected much of the middle east, southeast Asia and central Eurasia. It killed with devastating swiftness. This new disease was like nothing seen before.

Eventually, however, the first pandemic subsided. The second spread even further, especially to Europe and the Americas.

Some of you may have heard much of this story before. But I want to talk about something rarely discussed in the conversation around cholera; cholera riots.
In many places, it was obvious that more poor people were dying of cholera than rich people.

Germ theory hadn't caught on yet. The importance of sanitation was not understood.
In the absence of scientific explanations, paranoia blossomed.

Particularly in Europe, rumors spread. There were those who accused the government of creating the disease to rid their cities of the urban poor. There were outcries against this "Oriental" disease. The press often contributed, with op-eds spurring on these vitriolic claims.

In 1830-1832, all hell broke loose. Violence rose against the rich, against the classed gentry, against doctors, against patients, against foreigners.
In Russia, protestors specifically organized against measures taken to slow the spread of cholera.

The Russian poor saw quarantines and other measures taken against cholera as a means through which the upper classes were oppressing the poor. They called for the death of all doctors in the city, claiming they had poisoned the wells of the poor.

The riot only stopped when the Czar himself intervened, appearing in the main square and calling for protestors to kneel in deference to him.

Street riots took hold in England as well. There, people accused doctors of manufacturing cholera deaths in order to steal bodies for medical students to experiment on.

In France, cholera tensions against the aristocracy were so intense that they were instrumental in the buildup to the 1832 June Rebellion (the inspiration for Les Mis) against the aristocracy.

But cholera's impacts didn't end there. The third cholera pandemic swept through the world in the 1850s, bringing hundreds of thousands of deaths in its wake. Here it was nicknamed the "blue death".

This is the part of the story where doctor John Snow, the so called father of epidemiology, comes in, and humans get an edge against cholera. In London, the general scientific consensus at the time was focused on miasma theory.

Miasma theory was the idea that disease was caused by bad smells - particularly those of rotting corpses, human or animal waste, or spoiled foods. It was so very close to the truth in many ways.

Catastrophically, London had invested in a huge public infrastructure project making it so that public waste left in the streets would be drained efficiently into the River Thames, efficiently polluting the water supply. According to miasma theory, this was sound practice.

With the best of intentions, a lack of knowledge of this new disease had led to resources being utilized in the worst way possible. A scientific body unwilling to consider new ideas ignored the previous findings of one Dr. John Snow, who had a theory that cholera was waterborne.

During the third cholera pandemic, Dr. John Snow meticulously recorded cholera deaths in one of the hardest-hit neighborhoods in London. And, like a vision, they all centered on one singular water pump utilized by residents of the city.

The Broad Street Pump, now famous, had been utilized by residents of this district, and others outside who sought the water out, liking the taste of the Broad Street water specifically. Dr. Snow interviewed residents about cholera deaths, where they got their water, and more.

Finally, after presenting his evidence down to the exact household where the cholera took root, city officials allowed Dr. Snow to shut down the Broad Street Pump.
The deaths almost immediately stopped. But cholera was far from done.

Cholera is still ongoing, and our fight against it, now armed with the knowledge of sanitation, is still ongoing. We are currently in the midst of the seventh cholera pandemic.

Cholera pandemics are now relegated to only the poorest and most exploited nations, particularly in sub-Saharan Africa. This disease of the poor has become a disease of the global poor.

In a just world, where the sharing of technology and science was done with egalitarianism, this would not be the case. In a just world, where lives and a reduction of suffering mattered more than manufactured scarcity, this would not be the case.

The mistakes of COVID may seem like new mistakes, but there is always much to be learned from the past. We can especially learn from the lessons of cholera, where we seem to be eerily retracing our steps. We can do better. We must do better. For a kinder world.

If you are interested in learning more about modern cholera and what you may be able to do to help, please visit this link. washmatters.wateraid.org/publications/t…

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