Denial and Tragedy in the Age of Cholera

How ignorance, quacks, and skeptics made a pandemic worse

Mar 09, 2025

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No disease symbolized the changes of the early nineteenth century quite like cholera. A French journal wrote of an outbreak in 1832 that

It was a strange Paris, that one. You do remember it: cholera was everything; it had absorbed everything, politics, uprisings, theater, intrigues. It was the whole of society, morality, belief, the end goal of every thought, the center of all activities.

And who could blame people for being obsessed with the disease? It sounds like a terrible way to go. One nineteenth-century writer described the course of the illness this way:

The sick person is overtaken simultaneously by vertigo, retching, and diarrhea, painful cramps in the limbs, and a sudden coldness of the body, which soon assumes a cadaverous look, resulting especially from the deep hollowing of the eyes and from the frightful alteration of the features. The pulse slows down... and disappears within a few hours.... The nails and fingertips turn a blue color, which gradually spreads to the lips, the area around the eyes, and, with varied nuances, on the whole surface of the body.... Breathing is short, quick, panting, breath is cold; and all these symptoms of suffocation conclude with the extinction of life

The onset of the disease was sudden, and a person could be dead within hours of first feeling symptoms. Heinrich Heine, who happened to witness the 1832 epidemic in Paris, described how things could go from frivolous to serious in an instant:

[Cholera’s] arrival was officially announced on the 29th of March; and as this was the Mi-careme [mid-Lent], and a bright and sunny day, the Parisians swarmed more gaily than ever on the Boulevards, where masks were even seen mocking the fear of the cholera and the disease itself in off-color and misshapen caricature. That night, the balls were more crowded than ever; hilarious laughter all but drowned the louder music; one grew hot in the chahut, a fairly unequivocal dance, and gulped all kinds of ices and other cold drinks-when suddenly the merriest of the harlequins felt a chill in his legs, took off his mask, and to the amazement of all revealed a violet-blue face. It was soon discovered that this was no joke; the laughter died, and several wagon-loads were driven directly from the ball to the Hotel-Dieu, the main hospital, where they arrived in their gaudy fancy dress and promptly died, too.... [T]hose dead were said to have been buried so fast that not even their checkered fool's clothes were taken off them; and merrily as they lived they now lie in their graves.

This event, or one very similar to it, was depicted in a print 20 years later — here, death plays his tune as revelers at a masked ball flee or succumb to the disease:

Cholera was not new in the nineteenth century, but its global spread was certainly novel. It was caused by the bacterium Vibrio cholerae, which seems to have existed for a long time in the lower Ganges River, near where it flows into the Bay of Bengal. As cholera spreads through oral-fecal contact (i.e., you drink some water that has somebody else’s feces in it), there were outbreaks of the disease in this region from time to time.

But the historical developments of the nineteenth century changed all that. The region where the cholera bacteria thrived came under the control of the industrializing British Empire. Now the bacteria could hitch a ride on the empire’s ships and travel the world, infecting new populations and water supplies.

This once-local disease spread through the world’s trade networks several times during the century: the first cholera pandemic took place between 1817 and 1824, followed by five others: 1826-37, 1846-60, 1863-75, 1881-96, and 1899-1923. At any moment in the nineteenth century, people were more likely to be living through some portion of a global cholera pandemic — either seeing the dread effects of the disease in their own city or hearing ominous reports of its movements — than not.

When cholera hit, it was devastating. This map, compiled in 1849, tallies the toll of the 1832 outbreak in Exeter with red marks:

This map shows the 1832 epidemic in New York, emphasizing the “filthy state” of the epicenters of contagion along with the “intemperate, dissolute, and abandoned habits” and the “filth of the streets, as well as the houses, in most of these locations.”

Until the later part of the nineteenth century, people didn’t understand the mechanism by which the disease spread (discovered by John Snow in London in 1854, although his ideas were ridiculed by the medical establishment for years afterward) or the organism that caused the disease (the link was first made by Robert Koch in 1883). For most of the century, cholera was a mysterious killer, inflicting terrible suffering through mechanisms and for reasons that no one understood.

It was during the second pandemic — the first truly global one, as the disease broke out of Asia, crossing continents and even oceans — that people around the world began to really reckon with the disease. They saw it as a cause, effect, and symbol of the rapid changes that were happening in society. It was, depending on the perspective of the beholder, a punishment from God; for others, a consequence of urbanization, an excuse to scapegoat your enemies, the just desserts of the filthy lower classes, or an exaggerated threat cooked up by the authorities for political purposes.

Let’s start with this “cholera humbug” — the belief that cholera wasn’t really all that bad, and that the government was overplaying the threat. These attitudes were especially prominent in England and the United States, which had never experienced a cholera outbreak before.

A lot of people were understandably terrified of catching cholera and took extraordinary measures to avoid getting sick. But, since nobody knew what caused the disease, all sorts of remedies proliferated, some scientific and others less so. The anti-cholera actions people took included:

Various efforts at cleanliness (most people believed that cholera spread through “bad air,” so the cleaning was aimed at removing unpleasant smells)
Ventilating homes and offices (not a bad idea for an airborne illness, but pointless against a water-borne one)
Avoiding overindulgence — too much food or alcohol was believed to make you vulnerable to disease
Avoiding specific foods, including shellfish, pork, onions, cucumbers, and melons
Quarantining the sick and limiting the movement of people in cities
Fasting to atone for the sins of humanity and beg for God’s mercy, or declaring national days of prayer
And injecting saline water into the bloodstream to combat dehydration (this actually worked!)

We can see some of this public health advice in handbills:

The women in this illustration are smoking cheroot cigars which, we’re told, is an “elegant preventative of the cholera.”

And this strange little cartoon shows leech-doctors prescribing bleeding to an ailing grasshopper:

Meanwhile, business owners — understanding that fear of disease was bad for business — worked hard to suppress information about the pandemic. This cartoon represents some of the economic fears around cholera — it shows Mercury, the god of trade, lying unconscious while government ministers try to revive him:

Just as we saw during the Covid pandemic, people who thought the threat was overblown mocked those who worried about infection. During the 1830s, a number of satirical drawings appeared, making fun of the folk remedies and superstitions that people supposedly employed.

This guy’s encased himself in rubber, hung a cup of vinegar in front of his nose, dangled pitchers of water from his legs, and is toting around a wagon full of brushes. Oh, and he’s got soup in his hat for some reason:

This woman is similarly overdoing it, with a little air-cleaning windmill atop her head, a necklace made of peppercorns, and a virtual garden hanging from her skirts:

And this fellow has built himself a little pharmacy containing all of the folk cures, including spices like cinnamon, sage, and calamus.

One artist even depicted a monkey all dressed up to prevent cholera, although I’m not sure I get the joke here:

Other satirical cartoons made fun of the authorities who were trying to deal with the pandemic. Again, the parallels with our recent experience are pretty clear; it seems like a common reflex in times of medical crisis to question the medical establishment that’s trying to keep people safe.

Some people accused the British government of publicizing cholera as a way of distracting from unpopular reforms or the poor economy. Parliament passed a law empowering boards of health, but not everyone thought this was a good idea. Some saw the anti-cholera campaigns as make-work for officials:

And seemed to believe that the medical establishment — here portrayed as a bunch of fat cats with bloated money-purses hanging from their pockets — was making out like bandits while “the country bleeds and patients die:”

This cartoon shows doctors carrying a skeleton through town to terrify the public — one doctor shouts, “contagious to all but doctors!”

And this one makes the argument that the real threat to public health and happiness is the police (the “collarer,” get it?):

Though there were a lot of satirical images circulating about the pandemic during the 1830s, people made a lot of deadly serious art as well. This lithograph shows morticians loading a cholera victim into a hearse:

And this drawing shows the odd blue pallor of the victims, caused by extreme dehydration:

Here we see the dead outnumbering the living:

In many parts of the world, cholera was seen as just one of an overwhelming set of afflictions to be guarded against. This book advertisement promises to tell the tale of women who survived cholera only to be taken prisoner by “merciless savages.”

While this lithograph shows war (in this case, between Russia and the Poles) causing havoc, with cholera close behind:

The cholera pandemic of the 1820s and 1830s burned its way through India, the Middle East, Europe, the Americas, and East Asia. It killed hundreds of thousands of people and terrified millions more. As I was looking for images to illustrate the pandemic, I found two especially moving, so I will leave you with them. First, a drawing by Robert Seymour, showing that no one was safe from the dread disease:

And this marker over the “cholera pit” in Dumfries, Scotland, where people died so quickly there was no time for a proper burial:

Over time, scientists figured out the causes and cures for cholera. It’s now much less likely to cause large outbreaks, and antibiotics and rehydration have allowed doctors to keep far more cholera patients alive than they could two centuries ago. But, though medical technology has changed, it seems that the way that people react to new diseases and the people who try to fight them hasn’t.

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Looking Through the Past

Denial and Tragedy in the Age of Cholera

How ignorance, quacks, and skeptics made a pandemic worse

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