History of Bacteriology: The Cholera Riots

Murmurs of murder rippled through the crowd as it accumulated outside the entrance of the building, cursing the people who entered and exited it. They had watched helpless woman stretchered into the building, knowing she would soon join of the hundreds of people who had died within its walls. Whole city of Liverpool was in uproar, and had endured enough.

History does not record who threw the first stone, but soon the air was thick with them. They thudded against the buildings wall's, breaking the windows and scattering the people within. The men and women escaping the building were chased and beaten. 

The building was Toxteth Park Hospital, the people being chased were Doctors and nurses, and this was the beginning of the Liverpool Cholera Riots.

It was the age of the Industrial Revolution, Empire and Mass migration. Irish immigrants formed a major part of this migration, travelling to America to avoid the depredations back home. The primary intersection between the British Isles and America was a Liverpool. Immigrants awaiting passage to the new world would often find themselves stuck in the overcrowded city of Liverpool.

Like many cities of this era, Liverpool was transforming into a haven of squalor and disease. Urine and faeces were flung freely into the streets where they flowed into the rivers from which people drank. Tuberculosis and Typhoid ravaged the poor.  

The industrialization of Europe had meant that transport links had become much quicker, and trade had improved, but brought with it diseases. Rags from continental hospitals sold to farmers in Yorkshire to help manure hops also carried with them a disease that had not been seen in England before. It was known as "Asiatic Cholera" * at the time, and it frightened the rich and poor alike. Before its appearence, "Cholera" had only referred to seasonal stomach bugs and diarrhoea, and didn't relate to the deadly bacterium which we now refer to as Vibrio cholerae.

The month after the infected rags had been imported into Hull, the first cases of Cholera began to be recorded. Patients suffered from diarrhoea, severe cramps, followed by severe dehydration and then death, with the final symptom being the patients turning blue. It could turn a healthy person into a corpse within twenty four hours.

In 1831, an epidemic devastated Sunderland, killing over 20,000 people. The doctors could not contain the outbreak, their treatments consisting of brandy, bleeding and opium. Fear of this disease was high when it reached Liverpool in 1832.

A veteran medic who had experienced Cholera first hand whilst stationed in India tried his best to calm the situation. After the first two cases reported in Liverpool, he publicly stated that this "was not the case of an epidemic" like people may have heard about in Europe or Dublin. Not long after this, Cholera broke out on a vessel named the Brutus, claiming eighty-one deaths. Liverpool's Board of Health were slow to act, at first apparently denying the news of the outbreak within their city. At the boards very outset it was criticised as being filled with "a few fat-bellied magistrates" who had obtained their position through patronage rather than any medical expertise. Their sluggish reaction to this epidemic did not help that public perception.

The hysteria surrounding this disease was only rivalled by the scandal surrounding the whole medical profession. In the early half of this century, medical schools suffered from a dearth of human cadavers for students to practice on, and had begun to pay quite handsomely for them. In Edinburgh, two enterprising gentleman by the names of Burke and Hare decided to capitalise on this need by making a few corpses of their own, killing 16 people and making approximately £8K in today's money. The complicity of the medical establishment in this case combined with widespread reports of grave-robbing and the publics general distaste for dissection stained the medical establishment. People were now well aware of the high prices doctors would pay for a good corpse. A patient walking into a doctors surgery may have worried that they could be worth more dead than alive.

When Cholera began to spread through Liverpool people began to refer to doctors as "Burkers", invoking the more notorious of the murderers and implying that doctors were profiting from the deaths of their patients. 

The medical board in the meantime were doing their best to contain the disease, setting up new hospitals for patients to go to, and arranging carts to carry sufferers to these hospitals. The doctors and nurses worked hard to help their patients, but were severely hampered by the fact that none of their treatments appeared to work. In fact, it is likely that treatments like bloodletting made the disease a lot more dangerous.

Things however came to a head when Mr Clarke and his wife fell ill from Cholera. The doctors were jeered at by the mob when they brought the woman into the building. At this point the Liverpool Chronicle picks up the story.

“Stones and brickbats were thrown at the premises, several windows were broken, even in the room where the woman, now in a dying state, was lying, and the medical gentleman who was attending her was obliged to seek safety in flight. Several individuals were pursued and attacked by the mob and some hurt."

 The next few days saw the protests escalate. Mobs prevented doctors from carrying away their patients by any means necessary. They would halt the palanquins that were used to carry patients away, and when that didn't work they started to smash them to pieces. In one incident, people opted to hide a patient away from a surgeon tasked with treating her, and upon confronting them is chased across town to take refuge in a shop. Nightly gatherings surrounded the hospital in Toxteth Park. The police were often called in to hold back the worst excesses of the violence, but were simply overwhelmed.

But it wasn't just the fear of the doctors that motivated people. Cholera hospitals were rapidly being set up, bringing sick people to places of business. Some of those in the crowd wanted the doctors to take their grisly business elsewhere. Conspiracy theories abounded about how doctors were perpetuating the epidemic for a £10 "cholera fee" paid out by local bureaucrats. In some cities, Grocers believed doctors were advising people from staying away from certain food, leading them to be pelted with fruit.

The riots in Liverpool were solved when a threatening letter was sent to the mayor of the city. In the content of the letter, the author promised to do "wicked things" to any doctors who attempted to treat their patients. The author signed the letter off simply as "An Irishman". It was this last part of the message that suggested an alternative solution to the violence. Most of the cholera victims were the Irish Catholics crammed together within cramped underbelly of the city, and they were the loudest voices speaking out against doctors.

The Board of Health invited the Catholic clergy into a meeting to discuss solutions to the violence, and the clergy were given a message to deliver to their congregations. The speech addressed people fears about the cholera outbreak, and more importantly announced in no uncertain terms that the people who were dying were not being dissected. Furthermore, they declared that people had the right to go into the hospitals to see this for themselves, and to see the untouched bodies of their deceased before burial.

This was supported by an article published in the Liverpool journal by Dr James Collins , who also made a point of talking to people during church meetings. 

Soon, the streets of Liverpool were once again relatively quiet.

These riots occurred before anybody had a real handle on how infectious diseases spread. It was an era where the doctors had little idea of how to control a cholera outbreak, nor even what truly caused it. But the massive death toll and the incredible civil unrest spurred the government into action nonetheless. At this point, people had started to make the connection between overcrowding and poor sewerage to the spread of disease. The government would soon take steps to solving these problems, but in the process promote a troublesome theory that nearly strangled the nascent science of microbiology in its crib.

References

Burrell S. & Gill G. The Liverpool cholera epidemic of 1832 and anatomical dissection--medical mistrust and civil unrest., Journal of the history of medicine and allied sciences, PMID: 16144959

Puntis J. 1832 cholera riots., Lancet, PMID: 11597715

Gill G., Burrell S. & Brown J. Fear and frustration--the Liverpool cholera riots of 1832., Lancet, PMID: 11476860
Howie W.B. (1981). Stephen T. Anning, The history of medicine in Leeds, Leeds, W. S. Maney, 1980, 8vo, pp. ix, 218, illus., [no price stated], (paperback)., Medical History, 25 (04) 442-443. DOI: 10.1017/S002572730003502X

Further Reading

The First Spasmodic Cholera Epidemic in York, 1832, Issues 37-46 By Michael Durey

* The only doctors who had observed it were those who had been serving in the armed forces in the Empire when this disease swept through India during the Kumbh Mela, hence why it is known as Asiatic Cholera. A second pandemic had been working its way across Europe.