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In the 19th century cholera became the world's first truly global disease in a series of epidemics. Festering along the Ganges River in India for centuries, the disease broke out in Calcutta in 1817 with grand-scale results. India's traditional, great Kumbh festival at Hardwar in the Upper Ganges triggered the outbreak. The festival lasts three months, drawing pilgrims from all over the country. Those from the Lower Bengal brought the disease with them as they shared the polluted water of the Ganges and the open, crowded camps on its banks. When the festival was over, pilgrims carried cholera back to their homes in other parts of India. There is no reliable evidence of how many Indians perished during that epidemic, but the British army counted 10,000 fatalities among its imperial troops. Based on those numbers, it's almost certain that at least hundreds of thousands of natives must have fallen victim across that vast land. When the festival ended, cholera raged along the trade routes to Iran, Baku and Astrakhan and up the Volga into Russia, where merchants gathered for the great autumn fair in Nijni-Novgorod. When the merchants went back to their homes in inner Russia and Europe, the disease went along with them. Cholera sailed from port to port, the germ making headway in contaminated kegs of water or in the excrement of infected victims, and transmitted by travelers. The world was getting smaller thanks to steam-powered trains and ships, but living conditions were slow to improve. By 1827 cholera had become the most feared disease of the century.
The worldwide cholera epidemic was aided by the Industrial Revolution and the accompanying growth of urban tenements and slums. An indoor toilet consisted of a small, oblong hole in the floor, without a seat - similar to toilets that prevailed in the Far East and other sections of the world even today. A vertical drain connected the toilet to a cesspool below. There was little or no provision at all for cesspools or fresh water supplies. Tenements rose several stories high, but cesspools were only on the ground floor with no clear access to sewers or indoor running water. It didn't make much difference, because until the 1840s a sewer was simply an elongated cesspool with an overflow at one end. "Night men" had to climb into the morass and shovel the filth and mire out by hand. In most cases, barrels filled with excrement were discharged outside, or contents of chamber pots flung from open windows - if there were any - to the streets below. Water hydrants or street pumps provided the only source of water, but they opened infrequently and not always as scheduled. They ran only a few minutes a day in some of the poor districts. A near riot ensued in Westminster one Sunday when a water pipe that supplied 16 packed houses was turned on for only five minutes that week. Cholera first hit England through the town of Sunderland, on October 26, 1831. One William Sproat died that day from the disease, though nobody wanted to admit it. Merchants and officials found plenty of reasons to rationalize away a prospective 40 day maritime quarantine of the ports. England was reaping the profits of the Industrial Revolution. and a quarantine of ships would be catastrophic for the textile industry. At any rate, the medical profession held that cholera wasn't contagious. Public health administration was in its infancy, and so disorganized that the leading doctor didn't know there were two infected houses only a short distance away from each other. He learned of the "coincidence" three months later.
American hygiene and sanitation were not much better, and cholera spread through immigrants from the infected countries. Life aboard an immigrant ship was appalling as ship owners crowded 500 passengers in space intended for 150. Infected passengers shared slop buckets and rancid water. The contagion spread as soon as the immigrants landed. In one month, 1,220 new arrivals were dead in Montreal. Another 2,200 died in Quebec over the summer of 1832. Detroit became another focal point of cholera. Instead of drawing fresh water from the Detroit River, people used well water. The land was low and it was much more convenient. But outhouses placed at odd locations soon contaminated those wells, and cholera spread quickly. Quarantine regulations which sought to contain towns and cities in upper New York, Vermont and along the Erie Canal met with little success. Immigrants leaped from halted canal boats and passed through locks on foot, despite the efforts by contingents of armed militia to stop them. Some doctors flatly declared that cholera was indeed epidemic in New York, but more people sided with banker John Pintard that this "officious report” was an "impertinent interference" with the Board of Health. The banker incredulously asked if the physicians had any idea what such an announcement would do to the city's business.
The eminent Dr. John Snow demonstrated how cases of cholera that broke out in a district of central London could all be traced to a single source of contaminated drinking water. But Snow's original work received little attention from the medical profession. He was attacked at the weakest point - that he could not identify the nature of the "poison" in the water. By the end of the first cholera epidemic, the relationship between disease and dirty, ill - drained parts of town was rather well established. This should have spurred sanitary reform. But little action followed. When the second cholera epidemic hit England in 1854, Snow described it as "the most terrible outbreak of cholera which ever occurred in this kingdom." At least it provided him with an opportunity to test his theory. By charting the incidence of the disease, he showed that over 500 cases occurred within 10 days over a radius of some 250 yards centered on London's Broad Street. He looked for some poison which he believed came from the excreta of cholera patients and swallowed by the new victims. A common factor was their use of water that had been polluted with sewage. Snow had traced the pipelines of various water companies and showed that one was infected by cholera. By the methodical process of elimination, he proved his point: A workhouse in that area had its own private well, and there were only 5 deaths among its 535 inmates. A brewery on Broad Street likewise never used the water from the Broad Street pump, and it had no cases among its 70 workers.
Cholera was always the worst where poor drainage and human contact came together. This of course was apt to be in crowded slums. So at first, those on top of the social heap could reassure themselves that pestilence attacked only the filthy, the hungry and the ignorant. When the cholera epidemic first hit Paris, there were so few deaths outside of the lower classes, that the poor regarded the cholera epidemic as a poison plot hatched by the aristocracy and executed by the doctors. In Milwaukee, efforts to apply basic health measures were thwarted by rag-pickers and "swill children" who saw the removal of offal and garbage from the streets as a threat to their livelihood. As one newspaper editorialized, "It is a great pity if our stomachs must suffer to save the noses of the rich." The immunity enjoyed by the wealthy was short-lived, however. The open sewers of the poor sections eventually leached into the ground and seeped into wells, or ran along channels into the rivers that supplied drinking water for whole towns and cities. Once the rich and the movers and shakers of society began to get sick, government reform began. Thus it happened that most municipal water mains and sewer systems got built in the late 19th century in America. Public health agencies got formed and funded. Building codes and ordinances got passed and enforced.
The superstitions of the ages had finally run their course. Mankind began to understand that the evil spirits causing its woes were microscopic creatures that could be defeated by implementing a public health program of purifying fresh water and treating sewage appropriately.