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Pandemics Part 3: Cholera
"The choice between plague and cholera" is the choice between two evils. Cholera is easy to treat in modern societies today, but if left untreated it often ends in death and will continue to claim thousands of victims worldwide in 2020. It is one of the diseases that caused most pandemics.
The symptoms of cholera
Cholera causes severe pain, severe vomiting and massive diarrhea - those affected lose up to 20 liters of fluid a day. They tarnish blue and lose weight extremely quickly. If left untreated, they die of dehydration and the loss of minerals that are necessary to maintain the body's functions. Without treatment, two out of three sufferers die within a week.
The cholera pathogen
Cholera comes from the Greek word chole, that means bile. Historical terms were “biliary dysentery” or “biliary disorder”. It's caused by a bacterium - Vibrio cholerae. Its poison opens the mucous membranes of the intestine and thus leads to extreme diarrhea known as the "rice water chair".
The bacteria collect in drinking water that pollute feces, which serve as food for the microbes. Rarely do people become infected with objects or food to which the pathogens adhere. They enter the gastrointestinal tract through the mouth.
How did the cholera bacteria adapt to humans?
According to historical evidence and evidence, the cholera pathogen existed on the Indian subcontinent long before the first pandemic occurred. Only settling down, farming and raising cattle can give him the opportunity to spread orally through drinking water and food contaminated with faeces.
In the cultures of mobile hunters and gatherers, such breeding grounds in water did not exist in the form that a bacterium could create an uninterrupted chain of infection. In order to establish a closed chain of infection of human excretions via drinking and washing water, masses of people had to use such water in the same place over a long period of time.
The big cities of the industrial revolution, in which many people gathered who were not connected to closed sewage systems, allowed the bacteria to spread more efficiently on site than ever before. Global shipping also carried the microbes.
The cholera pandemics
The first cholera pandemic from around 1817 to 1824 is known as "Asian cholera". It started in Jessore near Calcutta, migrated through India to China and Southeast Asia and reached Muscat, Iran and Baghdad. The second cholera pandemic from 1829 to 1851 started again in India and spread to China, Europe and America. The third cholera pandemic (1852-1860) had its center in Russia, the fourth started in Bengal in 1863 and was spread by Indian Muslims in Mecca, from where it devastated the Middle East until 1875.
The fifth pandemic from 1881 to 1896 started again in India and reached Europe, where Germany, among others, was hard hit. The sixth from 1899 to 1923 killed around 800,000 people in India alone, spreading mainly in the Middle East, Eastern Europe and North Africa. The seventh pandemic started in Indonesia in 1961 and spanned India, Russia and North Africa. It continues to this day with national epidemics.
An old plague?
Long before Christ, Greek, Indian and Chinese sources report a plague, the symptoms of which, like extreme diarrhea, resemble cholera. Hippocrates (460 to 377 BC) and Galen in Rome (129 to 216 AD) reported such an illness. However, it is doubtful that it was the pathogen that triggered the first cholera pandemic in 1817.
However, according to a paper by Robert Pollitzer, an inscription in a temple in Gujarat in western India from pre-Christian times suggests that the cholera bacterium in South Asia claimed victims thousands of years ago. This is how a disease is described, which not only wounds the brave and arises from a curse by the priests, but also turns the lips blue, the face collapse and the limbs and the body shrink. This condition clearly describes the appearance of cholera patients who are drained of fluid.
A "poison that darkens the eyes"
There is clear evidence of cholera shortly after Vasco da Gama reached the Malabar coast in 1498. As early as 1503, the Portuguese Gaspar Correa described many deaths in the army of the ruler of Calicut in his chronicle "Lendas da India", triggered, among other things, by a disease that began with sudden abdominal pain and from which a man died in eight hours. He also noted an outbreak in the spring of 1543.
According to Correa, the locals called the disease "Moryxy" and the death rate was so high that it was hardly possible to bury the victims.
Correa writes: “The cramp was so painful that it seemed as if the worst poison was working, with vomiting, accompanied by the drying out of the (body) water, as if the stomach was being flipped out, and in addition cramps in the tendons of the joints and the sole of the foot with such extreme Pain as if the sufferer were at the point of death; the eyes darkened and the hands like feet black and arched."(Gaspar Correa: The three voyages of Vasco da Gama, and his viceroyalty, Introduction, Adamant Media Corporation, 2001)
Without a doubt, Correa described the main symptoms of cholera here.
An "Indian disease"
Between these first reports by Europeans in 1503 and the first pandemic in 1817, there are various records of cholera outbreaks in India, of which at least ten can be described as epidemics.
In the 16th century, these reports were limited to Goa, as the Portuguese had their commercial center here and the rest of the subcontinent remained a terra incognita for Europeans. With the presence of the British, Dutch and French, notes from other regions of the Indian west coast also entered the European chronicles. Accordingly, cholera spread on the Surat coast in the 1670s and raged in Daman near Mumbai in 1695.
The English doctor Dr. Paisley wrote about cholera in Madras in February 1774, and this tradition was included in the medical manual "Diseases of India" in 1807. "Asian cholera" was probably considered an endemic disease, and the British colonial masters had little knowledge of large parts of their inland provinces at the end of the 18th century.
It was not until 1786 that a hospital board was set up in Madras and Calcutta, so that the British previously had no regular reports of cholera among Europeans and Indian soldiers. The scanty evidence leaves no doubt that cholera was not only widespread on the coasts of the subcontinent at the end of the 18th century, but also outside of the Indian borders in South Asia.
“Asian cholera” - the first pandemic
The first cholera pandemic raged between 1817 and 1824 with local epidemics in the years before and after. It spread across many countries in Asia and East Africa and spilled from Asia Minor to Russia, to south-east, east and then to Central Europe. The first cholera cases from Germany are documented in 1831.
How did the first cholera pandemic come about?
Cholera epidemics probably existed in ancient India today. Since then, India has been connected to Central Asia, Persia and Arabia via the Silk Road, and this through Asia Minor and the Mediterranean to North Africa and Europe. So why did a cholera wave only spread in 1817 that spread far across countries and on three continents?
Philip Alcabes, the author of “Dread. How fear and fantasy have fueled epidemics from the Black Death to Avian Flu, ”explains the first extreme spread of the cholera bacterium with upheavals on the Indian subcontinent. The pressure of the British East India Company would have broken the structures of rule in what is now India and Pakistan. Wars and famines have led to major migration movements. Living conditions had also deteriorated, and cholera would have spread from local epidemics across the subcontinent and subsequently across Asia to Russia and central Europe.
Volcanic eruption and epidemic wave
Gillen Wood, a professor of environmental history at the University of Illinois, mentions one aspect that is under-explored in the pandemic outbreak. Just as the worst plague wave in Europe in the 14th century was related to the drop in temperature in the “Little Ice Age”, Wood sees the eruption of the Tambora volcano on Sumbawa (Indonesia) in 1815 as an important trigger for the first cholera pandemic.
According to Wood, this outbreak would have led to massive climate change between 1815 and 1818. In Europe, the year of the outbreak is known as the “year without summer” - ash clouds darkened the sky, and Canada was covered in snow in June. In large parts of India, agriculture collapsed because the monsoon failed to materialize. Other researchers also suspect that this extreme climate caused the cholera bacteria that were rampant in India to mutate.
This hypothesis is strengthened because, as a result of the outbreak, other epidemics spread in Southeast Asia and pathogens found a favorable breeding ground for hunger-weakened people whose malnutrition overruled the immune system and who struggled to survive in the country.
A "tropical fever"
Seafarers had long been aware of this disease in the South Asian river deltas, and it bore the Greek name "cholera" - "Bile flow". It was considered to be one of the typical fever diseases in hot countries - no one knew the cause, the bacteria that roamed in polluted water. In the 17th century, cholera was known as serious summer diarrhea, and doctors mistakenly believed that "bad air" triggered the plague.
Deadly water over the ocean
Cholera probably spread as a pandemic in 1817 because its center, India, was now in the midst of a thriving overseas trade - in contrast to the cholera outbreaks in the centuries before, international sea routes to Europe, especially London, were now used constantly.
First, however, the epidemic spread to Asia, from Jessore near Calcutta it seeped into the slums of the Sunda Islands, from there it caused mischief in Indochina, then it raged in China, from Ceylon (today's Sri Lanka) it infected it Maskarenas until the deadly water finally reached Tehran and Baghdad in 1821.
It was easy in South and Southeast Asia. In southern China, as in India, in Ceylon and on the Sunda Islands, the monsoon did not occur in the three years after the Tambora erupted. Millions of people were hungry and lacking food lacked vitamins and minerals that would have provided some protection against infection. Spotted fever was also rampant in southern Asia.
Cholera changed the course of history in Persia, because the dead and sick of the infection weakened the power of the Quajaren shahs so much that the Russian army took over much of what is today Iran. It was a Pyrrhic victory, because tens of thousands of Russian soldiers now died of diarrhea and vomiting, loss of fluid and lack of minerals.
Iran - poverty and cholera
There is detailed work on the state of public health in Persia at the time of the Qajars (Qadjars or Kadjaren) between 1796 and 1925. Child mortality in Persia was more than 50 percent in the 19th century compared to 20 percent in Germany or France at the time. Ignorance about the contagion of diseases, catastrophic hygienic conditions, serious water shortages, bitter poverty and the associated lack of food, minerals and vitamins caused infectious epidemics to spread rapidly - including cholera.
It first raged in Bushehr and the provinces of the Persian Gulf in 1821, then appeared in Kazerun, swept through the city of Shiraz, spread to Abadeh in the province of Fars, then the number of victims in Isfahan skyrocketed, and the mass of the dead piled up in central Iran. Two years later, the bacteria had reached drinking water on the coast of the Caspian Sea and contaminated Russia.
The spread of the pandemic can be roughly reconstructed from the historical distance and knowledge of the infection from contaminated drinking and washing water and food. So the plague broke out in Iran first on the Persian Gulf - probably via ship connections. Since the pathogens survived for several days in drinking water and ships that landed on the Persian Gulf loaded their water in India, the sailors most likely carried the disease to Iran and Arabia.
Cholera probably came to Afghanistan with the caravans to Afghanistan, and possibly also from there to Iran - just as the plague had already spread across the silk roads. In Muscat, it broke out in 1821 through British troops who were suspected of being infected in India or Afghanistan - from there it moved on the routes of the Arab slave traders in northeast Africa.
The second pandemic - Asia, Africa, Europe and America
The second cholera pandemic from 1829 to 1851 started again in India and spread to China, Europe and America. The plague had already raged in India in 1826, flooded Afghanistan, reached Iran in 1829, entered Russia via the Caspian Sea and finally raged there. Russian soldiers who had stood at the Indian border were ordered to Poland to put down the November uprising there and brought the disease to the center of Europe - documented here for the first time. In the south it spread from Mecca to Egypt.
In 1830 people vomited and died of water and mineral loss in Warsaw, brought in by Russian soldiers, and on the Baltic coasts, where the bacterium had presumably reached St. Petersburg via the Baltic Sea - then it hit one country after another in Europe.
Countless living creatures quickly turned to blue bodies - in England like Germany and Austria in 1830/31, in France and the Netherlands a year later. Also in 1832, ships brought the pathogen across the Atlantic to the USA: in the summer, several dozen New Yorkers died of gallstones every day, and a total of 2,000 citizens in Vienna.
Physicists, philosophers and bacteria
On November 14, 1831, the famous German philosopher Georg Wilhelm Friedrich Hegel died at the age of 60 with the diagnosis "cholera in its most concentrated form" - it is not certain whether cholera was really the cause of death. Two days later the illness killed Major General Carl von Clausewitz, who contracted it in Poland, where the Russian soldiers spread it.
In 1832 the bacteria ended the life of Georges Cuvier, the founder of paleontology and probably the greatest zoologist in Europe at the time. In August of the same year, the bacteria also destroyed physicist Nicolas Léonard Sadi Carnot, the founder of thermodynamics - he was only 36 years old.
A disaster in medicine
First assumptions that drinking water is the medium of distribution did not prevail for decades because contagionists and miasmatists planted the new facts in their existing theoretical system instead of taking them as new facts and evaluating them without prejudice. Either cholera spread through human-to-human contact (contagionists) or it arose through "foul processes in the local atmosphere" (miasmatists).
The dogmatists of both camps did not notice that people in the ground floors on the street side of a mill brook fell ill in villages, but none on the other side of the street. Both camps did not see the cause of the sheer water, because they already had their solid constructs in mind.
Helmut Veil writes: “An observer who only sees the sick and not the water they have drunk cannot make sense of the bouncing cholera. That's how it was in Europe - over 50 long years. ” (Helmut Veil: Cholera. A debacle of science and politics in the 19th century, Frankfurt am Main, 2019, page 110).
Ducking away, concealing and concealing were the usual methods in Russia - out of fear of the despotic tsar, elsewhere outbreaks were kept deliberately secret so as not to show the enemy of the war naked. Politics promoted the medical debacle.
“What was there was the illusion of the contagionists to stop the cholera with quarantine and no contact, and the illusion of the miasmatists to hope the end of the epidemic through general hygiene and weather monitoring. And in between there are always half-heartedness, a little bit of contact there, smoke fire against the air pollution there and chlorine lime for disinfection. A hectic helplessness against an invisible pathogen that is understandable in the opaque situation. ” (Veil: page 8).
In addition, there were treatments that were often suitable to bring the sick to the cemetery even faster. This included the omnipresent bloodletting: additional blood loss in those who lost an extremely large amount of body fluid accelerated their way out of the world of the living.
Helmut Veil writes: "When it first penetrated from India via Russia to the borders of Central Europe in 1830, doctors (...) were confronted with a situation in which the chaotic course of cholera undermined the rules known from the plague times." (Helmut Veil: page 7)
French scientists who traveled to Russia, Austria and Prussia to investigate the plague were faced with the unsolved mystery that cholera broke out in distant locations, but left others entirely unaffected.
Without knowledge of drinking water as the source of the infection, measures remained ineffective: the clothing in which the "plague fleas" nested was almost harmless for cholera, local quarantine was no more effective than blocking off entire states as on the eastern border of Prussia. Fires to purify the air did not help against a pathogen that lived in the water. Veil writes: "Prussia's strict measures to control human and goods traffic strangled the economy, but not cholera."
Inferno in the big cities
Cholera claimed significantly more deaths (and proportionally) in the metropolises than in the villages. Social misery significantly increased the infection rate, as did the associated conditions in the homes of the poor. Horror exploded in the big cities of Europe - in St. Petersburg as in Paris, in London as in Vienna.
In Warsaw in May 1831, almost 5,000 people fell ill, in August every second person in two had fallen victim to the bacteria; in St. Petersburg, 12,540 were sick and 6,449 dead. In the cities of early industrialization, fatal diarrhea raged worse than in the countryside, where the quality of the water was generally better than in the plague hatcheries of the urban working-class districts.
Russia - corruption and murder
In Moscow, the rash orders of the tsar did not slow down the disease, but instead they fueled bribery and crimes: Dragoons who controlled the spatial separation could be paid for innumerable "exceptions" with what the farmers had; Priests exhausted people by claiming that Mother Mary, who was traveling with them, was releasing the plague. When the wave of illness subsided on its own, the vainly dilating Interior Minister Sakrewski attributed it to his personal success, although, according to Veil, he only left chaos everywhere.
St. Petersburg citizens believed that "friends of Poland" had spread a "cholera poison" and looked for these "friends of Poland" among foreign doctors and pharmacists. They killed a doctor in front of a hospital. The mob stormed hospitals, "freed" the sick and threw the doctors out of the windows.
Paris - The Blue Fear
In France, the disease was called "peur bleue", the blue fear, after the blushed bodies of the emaciated patients. The Parisian bourgeoisie had not taken cholera seriously just a few months earlier - out of arrogance: cholera was considered "typical" for "barbaric countries" like Russia or Poland, and "civilized Paris" had nothing to do with it.
But cholera bacteria also found a paradise in Paris: the drinking water came from the Seine, which was filled with faeces and garbage, and from wells that were also contaminated - the foul dirt flowed through the gutters of the streets, and with it the disease.
On April 14, 1832, the authorities counted 13,000 sick and 7,000 dead, and 12,800 died at the end of April. Panic now replaced arrogance. The Parisians went through a collective psychosis, the drinking water was soaked in bacteria, the atmosphere saturated with conspiracy fantasies; Republicans believed in monarchist poisoning, a mob threatened doctors, and looted pharmacies.
The authorities confiscated horse buses, goods carts and all sorts of other companions; soon the bodies were brought to mass graves on wheelbarrows, separated only by lime.
Heinrich Heine experienced the epidemic in Paris at its peak and depicts a picture like from the fever dreams of the Middle Ages of hell: "It was disgusting to look at when the big furniture wagons (...) now drove around as mortuary buses, as omnibus mortis (...)."
At the Père Lachaise cemetery “Saw (Heine) nothing but heaven and coffins. I got under a few hundred hearses (...) and in this black environment (...) I had to endure a few hours. ", in which "Some cars overturned, the coffins fell apart, the corpses came out ...".
On April 14, 1832, around 7,000 people died of cholera in Paris alone, up to the end of September 18,402 out of 785,000 citizens. The situation was no better in Marseille and Toulon, where the disease had come from the Mediterranean through the Mediterranean.
The third pandemic - bacteria under the microscope
Speculation about the cause of cholera and its treatment was as presumptuous as it was helpless. The "Cholera-Zeitung" (the only disease cholera had its own magazine) mentioned more than 100 times in 1831/32 the term miasma as an "abnormal atmospheric process". This "miasma" had to remain approximate - since this "miasma" does not exist. In the 1830s, no medical practitioner tried to detect germs under the microscope.
This changed after the shock of the 1830 cholera pandemic, which left Europe vulnerable: three doctors from Bristol examined excretions of patients from the second epidemic in London as well as air and drinking water from cholera rooms under the microscope. William Budd (1811 to 1880), Joseph Griffin Swayne (1819 to 1903) and Frederick Brittan (1823 to 1891) found what they thought were "cholera cells" at 420 times magnification. However, it was not the hook-shaped cholera vibrions, although they depicted them, but much larger spherical cells.
In fact, according to Veil, there was still no way to isolate bacteria in this early phase of microscopy and thus to determine pathogens with a high degree of probability: the lenses were the less accurate the more they enlarged, and the scientists saw different living beings, all of them the germs could be.
Until the end of the century, up to Robert Koch, the traditional trench warfare between miasmatists and contagionists and their theories dominated the field, theories that from today's perspective were nothing more than systematically ordered speculations. Sometimes the wrong assumptions, such as that cholera is caused by a miasma in the air or by rotting in the earth, lead to sensible hygiene regulations that contain the cholera selectively.
It had long been clear to “non-scientists” that there was a connection between cholera and the “shitwater” that was directed into the Thames. Already in 1831 George Cruikshank (1792 to 1878) caricatured the Southwark Water Company, which took its water from the river, exactly where the waste water ran in. The Spottvers read: "Give us clean water. We shall all have the cholera. ”Obviously, the“ normal ”people who were exposed to cholera assessed the situation more realistically than the miasmatists and contagionists caught in their dogmas, said Veil.
John Snow and Filippo Pacini - water and parasites
It must have become clear that cholera spread particularly where there was putrid water, and that other diarrheal diseases were rampant there - and that during the devastating cholera epidemic in London, which killed 15,000 people in 1848/49, impartial viewers were accurate can see that.
The English doctor John Snow did not allow himself to be deterred by the dogmas in 1849. He had noticed that miners suffered from cholera very often and came to the conclusion that people got sick exactly where they lived together in a confined space and where food and drinking water came into contact with the excretions of the cholera patients.
In 1855 he read his text, which belongs to the history of medicine, with the title "On the communication of cholera through the medium of water". There was no mysterious miasma for him, but the disease was limited to the intestinal tract, where it could only have gotten through food and water.
Not only did John Snow have the right idea, he also proved that it was true: the doctor had the water pump shut down on a cholera-infested street in London and provided people there with clean water from tankers. The result was clear. In this street the new cases of cholera dropped rapidly. Even without knowing the pathogen, he had proven the route of infection of the diarrhea. But that did not lead to rethinking among the leading medical professionals - and three years later Snow died of a stroke.
His proof of the infection path through water exchange can be described as the beginning of modern epidemiology, in which scientific evidence replaced the exaggerated but ultimately speculative theories.
In 1854 the Florentine Filippo Pacini (1812 to 1883) identified the vibrions that cause cholera. He found them in bulk between the mucus and epithelial cells of the intestine of cholera corpses, i.e. exactly where the disease was destructive: the cholera vibrions produce a poison that makes the membranes permeable, which leads to extreme water and mineral loss and leads to death.
In 1854/55, two doctors, one in London and one in Italy, had first recognized the path of cholera in the intestinal tract through water contaminated by faeces and secondly the deadly effect of a pathogen on the intestinal membranes.
Cholera continued to kill unrestrictedly: in the Crimean War, between 1853 and 1856 more soldiers died from the disease than from the human enemy. But it took more than 30 years for science and politics to draw conclusions - and that had both scientific, political and economic causes.
John Snow had the necessary bite to defend his real knowledge, but the general practitioner was not one of the major universities, and the miasmatists and contagionists based there continued to write tons of speculative writings that fit their theories.
Pacini held back, which at first glance seems unusual for a professor who had found valid evidence of the cholera pathogen and its effects under the microscope.
But to bring his conclusion about vibrions to the public would have been to dismantle a mountain of theory, similar to what Charles Darwin had said with his dictum that species are changeable: the early scientific physicians in the modern sense found whole universes under the microscope of previously unknown organisms, but before the establishment of bacterial strains in nutrient solutions they had no proof that and how unicellular organisms reproduced.
This contrasted with the idea of primal production that had been established since antiquity, according to which microorganisms spontaneously formed on a suitable substrate. The Italian professor had good reasons not to go ahead if he didn't want to lose his reputation as a scientist.
The fourth pandemic
In the Prussian army the disease broke out in full force in 1866 and killed 3,139 soldiers, the military brought it to Austria, and in August a full-blown epidemic raged there that killed almost 2,000 people until late autumn, and twice as many in the surrounding area. Around 8,000 people died in Lower Austria, around 1,000 and half as many in Zurich in Erfurt.
The fifth and sixth pandemic
The fifth cholera, which flowed across the continents from 1883 to 1896, had its origin in the "old homeland": it spilled from India to Afghanistan, from there to Russia. In 1892 it raged in Hamburg - there alone more than 8,600 dead were killed. Die sechste Cholerapandemie begann 1899 in Zentralasien, verbreitete sich von dort in Russland und brach dann in Mittel- und Westeuropa aus.
Ein Ärzteteam rund um den 40-jährigen Mediziner und Mikrobiologen Robert Koch untersuchte die Seuche, als sie in Indien ihren Lauf nahm. Koch erkannte, dass die „Kommabazillen“ (die Form des Erregers erinnert an ein Kommazeichen) in Nässe gedeihen, und erklärte damit, dass Wäscherinnen oft erkrankten und schloss, dass die Verschmutzung des Wassers die Cholera begünstigte:
„Von den Hütten her ergießen sich flüssige Abfallstoffe jeder Art gemischt mit menschlichen Dejektionen in diese Wasserbehälter hinein, welche (…) als Badeplatz und Waschanstalt dienen und ihnen das Trink- und das sämtliche Gebrauchswasser liefern.“
Koch beobachtete, dass die Cholera versiegte, wenn neue Wasserleitungen den Menschen frisches Wasser brachten, und umso schlimmer grassierte, je verschmutzter das Wasser war. Im Februar 1884 entdeckte Koch dann schließlich die „Kommabazillen“ in der Nähe von Kalkutta außerhalb des menschlichen Körpers.
Koch hatte in seinen Augen klar das Mysterium der Cholera gelüftet: Er hatte den Erreger erkannt, belegt, wie sich dieser verbreitete, und auch den Weg gefunden, die Seuche zu verhindern – durch das Filtern von Wasser.
In Hamburg übernahm der Senat die von Koch vorgeschlagenen Maßnahmen, um der Epidemie Herr zu werden: Fasswagen lieferten sauberes Wasser, die Hamburger wurden aufgefordert, Wasser vor Gebrauch abzukochen. Vermutlich verhinderte das diverse Tote, doch nur ein Kanalisationssystem, aus dem alle Hamburger angeschlossen gewesen wären, hätte die Seuche beenden können – in Altona, wo es eine Kanalisation gab, starb niemand.
Die Hamburger Bourgeoisie ließ zwar gönnerhaft einige Wasserwagen durchgehen, doch eine kostspielige Reform der Wasserversorgung der ärmeren Teile der Bevölkerung war im Denken der „Pfeffersäcke“ ebenso wenig vorgesehen wie bei der Kolonialelite in London.
Medizinische Fakten stören das Geschäft
Hoch gestochene Miasmatheorien verhinderten wirksame Maßnahmen, weil Snows Nachweis, wie sich Erkrankungen verhindern ließen, nicht in die Konstrukte passte. Britische Schiffseigner und hanseatische Global Player hatten kein Interesse am Nachweis eines Erregers, der ihre Geschäfte beeinträchtigte – besser eine „unklare Beweislage“, so Veil, als der Beweis, dass Seeleute mit ihren Ausscheidungen die Seuche verbreiteten, was zu Beschränkungen im Seehandel geführt hätte.
Die Britische Regierung schickte sogar eine Kommission nach Ägypten, die aus Miasmatikern bestand, wohl wissend, dass diese Kochs Erkenntnisse in Frage stellten: Das UK kontrollierte 80 Prozent des Handels im Suezkanal, und allein der Verdacht, dass englische Schiffe die Cholera von dort nach Europa gebracht hätten, wäre sehr „bad for business“ gewesen.
Die Konstrukte der Kontagionisten und Miasmatiker waren bei dem Choleraausbruch in den 1830ern ein „unschuldiges“ wissenschaftliches Problem, so Veil. Gegen Ende des Jahrhunderts wurden die althergebrachten Dogmen jedoch Instrument politischer Propaganda von Reedern, Eigentümern, Wasserversorgern und Kolonialregierungen, die sich so davor drückten, teure Hygienesysteme in den Städten zu schaffen und den Seehandel einzuschränken. Mit Miasmatikern als Feigenblatt blieben so die stinkenden Kloaken in den Vierteln der Habenichtse erhalten: Die tödliche Cholera traf die am stärksten, die bereits im Elend lebten.
Alte Krankheit, moderne Verkehrswege
Es ist kein Zufall, dass die in Indien seit Jahrhunderten bekannte Cholera ab dem 19. Jahrhundert auf die Kontinente überschwappte. Bei der ersten Pandemie in den 1830ern hatten die Dampfschiffe in ganz Europa die Flüsse eingenommen, und es bestand ein dichtes Netzwerk in Nord- und Ostsee – der Weg von St. Petersburg nach Mitteleuropa war geschrumpft. In den 1850ern hatte die Eisenbahn in Europa Einzug gehalten, und Dampfschiffe fuhren regulär von Hamburg und London nach New York. Gegen 1890 dauerte die Fahrt über den Atlantik nur noch sechs Tage.
Die Cholera heute
Seit den 1960ern kommt es regelmäßig zu Cholera-Epidemien, die sich auch als Aufflackern einer einzigen Pandemie bezeichnen lassen. Eine gesundheitliche Infrastruktur vorausgesetzt ließen sie sich bekämpfen: Sauberes Trinkwasser, getrennte Trink- und Abwasserleitungen geben dem Bakterium wenig Chancen. Gegen die Cholera gibt es zudem Impfstoffe. Überall da, wo diese Voraussetzung nicht gegeben ist, tobt die Seuche, zum Beispiel im Jemen, immer wieder aber auch in Indien.
Ist ein Mensch an Cholera erkrankt, helfen Antibiotika wie Ciprofloxacin und Azithromycin. Wichtiger ist jedoch die massive Zufuhr von sauberem Trinkwasser, Zuckern und Mineralstoffen, um dem tödlichen Wasser- und Salzverlust entgegenzuwirken. Von der WHO wird eine Salz- und Glucoselösung in Wasser mit Traubenzucker, Natriumcitrat, Kochsalz und Kaliumchlorid empfohlen. Eine zeitnahe Behandlung senkt die Sterblichkeit bei Erkrankten auf unter ein Prozent.
Wie in den Elendsquartieren in London, Hamburg oder St. Petersburg im 19. Jahrhundert ist aber das Kernproblem, dass dort, wo die Cholera grassiert, weder die Möglichkeit zur Prävention noch zur Behandlung besteht: So brach 2010 in Haiti die hygienische Versorgung zusammen, 500.000 Menschen erkrankten, und mehrere Tausend starben an der Seuche. Rund 800 Millionen Menschen, besonders in Ländern Afrikas und Südostasiens, leben unter Bedingungen, die nur mangelhaften Schutz vor der Cholera bieten.
Veil entwirft nicht nur einen Überblick über die Cholera-Pandemien des 19. Jahrhunderts, sondern gibt wertvolle Einblicke, wie wissenschaftliche Dogmen ohne valide Basis zum Instrument politischer Interessen wurden und so Jahrzehnte vergingen, in denen die Seuche unzählige Menschen tötete, ohne dass bestehende Erkenntnisse über ihre Ausbreitung und ihren Erreger umgesetzt worden wären.
Zudem zeigt er, wie die Cholera-Pandemien eine Folge der modernen Verkehrswege waren – Dampfschiff und Eisenbahn, Kolonial- und Überseehandel brachten nicht nur Gewürze und Südfrüchte nach Europa, sondern auch das Bakterium.
So liefert Veil unausgesprochen Hinweise für den heutigen Umgang mit Pandemien: Das Coronavirus überträgt sich über die Atemwege, nicht durch den Darm, und die Flugzeuge brachten es schneller um die Welt als die Ausscheidungen der Seeleute des kolonialen Zeitalters. Auch heute ignorieren Regierungen wie Trump in den USA oder Bolsonaro in Brasilien Fakten über einen Pandemieerreger und lassen für Profitinteressen und Selbstdarstellung unzählige Menschen sterben.
Bei der Cholera setzte sich schließlich die wissenschaftliche Realität gegen die imperiale Konkurrenz und die Interessen der kolonialen Kapitaleigner ebenso durch wie gegen die professoralen Gralshüter überkommener spekulativer Theorien.
Leider zeigt das Debakel der Medizin und Politik hinsichtlich der Cholera im 19. Jahrhundert auch, dass die Möglichkeit, die Fakten zu kennen, längst nicht dazu führen muss, auch nach ihnen zu handeln. Wer Veils Einsicht in die politische Medizingeschichte der Cholera gründlich liest, wird über heutige Probleme im Umgang mit dem Coronavirus nachdenken. Das ist weit mehr als man bei einem medizinhistorischen Buch vermuten würde. (Dr. Utz Anhalt)
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This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
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