Cholera: Ancient Threat, Modern Tragedy

As cholera spreads through Haiti, a medical doctor looks back at cholera’s history of devastation — and solutions that ended epidemics.

Twelve suspected voodoo practitioners were secondary casualties of Haiti’s cholera epidemic when an angry mob, brandishing machetes hacked them to death, believing the outbreak to be the result of evil magic. More than 84,000 people are thought to be infected and nearly two thousand have died of the disease in this Caribbean country.

Rather than witchcraft, however, the usual way of catching cholera is by drinking contaminated water or ingesting infected food containing Vibrio cholerae, a bacillus or rod shaped bacteria which I first observed under a microscope in a West African hospital in 1971.

From one to five days after ingesting the bacteria profuse painless “rice water” diarrhea begins as well as vomiting. Losing 10 to 20 liters of stool daily rapidly results in dehydration and death unless vigorous efforts are made to rehydrate the patient, usually by intravenous.

For every symptomatic person there are three to 100 individuals who remain free of symptoms.

We tend to think of cholera as something confined to the tropics but historically it has appeared almost everywhere on the planet. In 1866 a cholera laden steamer, the SS England, pulled into Halifax Harbour, in the Canadian province of Nova Scotia. The victims were ordered confined to the vessel which anchored off McNab’s Island. Future Canadian Prime Minister Dr. Charles Tupper was the Medical Health Officer in charge of managing the outbreak. His colleague, quarantine officer Dr. John Slayter caught and succumbed to cholera in the course of the epidemic.

Although the theory of contagion was far from established and still controversial among physicians, Dr. Tupper adhered to the idea that “noxious effluvia” transmitted illness. He ordered hygienic measures which included not only isolation of cholera victims but the burning of all contaminated blankets and clothing. This effectively ended the outbreak.

Tupper was no doubt aware of the work of another physician, Dr. John Snow, active in London in the 1850’s. Snow had observed cholera to be transmitted by water. Snow’s suspicions were aroused when he observed that the only people in the Broad Street area who did not get cholera were brewery workers, who never drank water, only beer. He took the handle off the Broad Street pump, effectively ending that particular outbreak of cholera.

By 1885, Robert Koch identified the V. choerae bacillus and in 1900 Waldemar Haffkine came up with the first vaccine.

Personally, when I travel to developing countries I take a dose of Dukoral (R), an oral vaccine that is effective against both cholera and certain strains of E. coli which can induce travellers’ diarrhea.

Fortunately, due to public sanitation cholera is very rarely seen any more in developed countries except in individuals newly arrived from endemic areas. As a physician I’d like to take credit for the medical communities contributions to controlling cholera, but in reality the world owes a lot more gratitude to its plumbers than to its physicians (this goes for many other diseases as well!)

So the next time you see your plumber, shake his hand or give him a hearty pat on the back and thank him for keeping you healthy.

Photo Credit

Photo © UNICEF

About this photo: On 21 October, a woman holds her baby, who is suffering from acute diarrhoea, in St. Nicholas Hospital in Saint-Marc, a town in Artibonite Department. The illness is suspected to be cholera, a deadly infectious disease. Affected patients are receiving intravenous fluids to remedy the dangerous levels of dehydration that accompany the disease.

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