cholera Seven pandemicspathology

Cholera became a disease of global importance in 1817. In that year a particularly lethal outbreak occurred in Jessore, India, midway between Calcutta and Dhaka (now in Bangladesh), and then spread throughout most of India, Burma (now Myanmar), and Ceylon (now Sri Lanka). By 1820 epidemics had been reported in Siam (Thailand), in Indonesia (where more than 100,000 people succumbed on the island of Java alone), and as far away as the Philippines. At Basra, Iraq, as many as 18,000 people died during a three-week period in 1821. The pandemic spread through Turkey and reached the threshold of Europe. The disease also spread along trade routes from Arabia to the eastern African and Mediterranean coasts. Over the next few years, cholera disappeared from most of the world except for its “home base” around the Bay of Bengal.

The second cholera pandemic, which was the first to reach into Europe and the Americas, began in 1829. The disease arrived in Moscow and St. Petersburg in 1830, continuing into Finland and Poland. Carried by tradesmen along shipping routes, it rapidly spread to the port of Hamburg in northern Germany and made its first appearance in England, in Sunderland, in 1831. In 1832 it arrived in the Western Hemisphere; in June more than 1,000 deaths were documented in Quebec. From Canada the disease moved quickly to the United States, disrupting life in most of the large cities along the eastern seaboard and striking hardest in New Orleans, Louisiana, where 5,000 residents died. In 1833 the pandemic reached Mexico and Cuba.

The third pandemic is generally considered to have been the most deadly. It is thought to have erupted in 1852 in India; from there it spread rapidly through Persia (present-day Iran) to Europe, the United States, and then the rest of the world. Africa was severely affected, with the disease spreading from its eastern coast into Ethiopia and Uganda. Perhaps the worst single year of cholera was 1854; 23,000 died in Great Britain alone.

The fourth and fifth cholera pandemics (beginning in 1863 and 1881, respectively) are generally considered to have been less severe than the previous ones. However, in some areas extraordinarily lethal outbreaks were documented: more than 5,000 inhabitants of Naples died in 1884, 60,000 in the provinces of Valencia and Murcia in Spain in 1885, and perhaps as many as 200,000 in Russia in 1893–94. In Hamburg, repeatedly one of the cities in Europe most severely affected by cholera, almost 1.5 percent of the population perished during the cholera outbreak of 1892. The last quarter of the 19th century saw widespread infection in China and particularly in Japan, where more than 150,000 cases and 90,000 deaths were recorded between 1877 and 1879. The disease spread throughout South America in the early 1890s.

The sixth pandemic lasted from 1899 to 1923 and was especially lethal in India, in Arabia, and along the North African coast. More than 34,000 people perished in Egypt in a three-month period, and some 4,000 Muslim pilgrims were estimated to have died in Mecca in 1902. (Mecca has been called a “relay station” for cholera in its progress from East to West; 27 epidemics were recorded during pilgrimages from the 19th century to 1930, and more than 20,000 pilgrims died of cholera during the 1907–08 hajj.) Russia was also struck severely by the sixth pandemic, with more than 500,000 people dying of cholera during the first quarter of the 20th century. The pandemic failed to reach the Americas and caused only small outbreaks in some ports of western Europe. Even so, extensive areas of Italy, Greece, Turkey, and the Balkans were severely affected. After 1923 cholera receded from most of the world, though endemic cases continued in the Indian subcontinent.

Cholera did not spread widely again until 1961, the beginning of the seventh pandemic. Unlike earlier pandemics, which began in the general area of the delta region of the Ganges River, this pandemic began on the island of Celebes in Indonesia. The seventh pandemic spread throughout Asia during the 1960s. During the next decade it spread westward to the Middle East and reached Africa, where cholera had not appeared for 70 years. The African continent is believed to have been struck harder at this time than ever before and in 1990 was the origin of more than 90 percent of all cholera cases reported to the World Health Organization. In 1991, 19 African nations reported nearly 140,000 cases in total. A particularly large outbreak occurred in 1994 among the many hundreds of thousands who fled widespread killing in Rwanda and occupied refugee camps near the city of Goma, Zaire (now Democratic Republic of the Congo). Tens of thousands perished from cholera during the first four weeks following their flight.

In 1991 cholera appeared unexpectedly and without explanation in Peru, on the western coast of South America, where it had been absent for 100 years. Cholera caused 3,000 deaths in Peru the first year, and it soon infected Ecuador, Colombia, Brazil, and Chile and leaped northward to Central America and Mexico. By 2005 cholera had been reported in nearly 120 countries. Although the seventh pandemic continued in many parts of the world, the more-industrialized countries of the world were largely spared. As the disparity between industrialized and less-developed countries grew, cholera, which previously had been a global disease, seemed to have become yet another burden to be borne by impoverished nations of the Third World. Moreover, experts predicted that this time cholera would not go away but would become endemic to many parts of the world, much as it has been for centuries to the Ganges delta.

Some health officials who monitor cholera epidemics believed that V. cholerae O139 might eventually produce an eighth pandemic. However, the ability of this strain to spread in areas affected by the V. cholerae O1 strain in the ongoing seventh pandemic appeared limited, and it remained confined to India and Bangladesh.