During the Victorian Era there were massive waves of contagious disease. The first was from 1831 to 1833, which included two influenza epidemics and the initial appearance of cholera. The second was from 1836 to 1842, which encompassed major epidemics of influenza, typhus, typhoid and cholera. The first outbreak of Asiatic cholera in Britain was at Sunderland on the Durham coast during the autumn of 1831. From there the disease made its way northward into Scotland and southward toward London. From its point of origin Bengal it had taken five years for the disease to cross Europe.

Whine it finally reached Durham, British doctors were well aware of its nature but not of its cause. The progress of the illness in a cholera victim was frightening. Major symptoms included diarrhea that increased in intensity and became accompanied by painful retching, thirst and dehydration, severe pain in the limbs, stomach, and abdominal muscles, a change in skin hue to a sort of bluish-gray. This illness terrified doctors as well as ordinary citizens.

Cholera subsided as enigmatically as it had flourished, but in the meantime another illness took its place. Following a particularly rainy spring, Britain was visited by the first of eight serious influenza epidemics within a period of sixteen years. In those days the disease was often fatal, and even when it did not kill, it left its victims weakened in their defenses against other diseases. Burials in London doubled during the first week of the 1833 outbreak. In one two-week period they quadrupled.

While cholera was found to have spread through water effecting mainly the poorer neighborhoods, influenza was limited by no economic or geographic boundaries. Large numbers of public officials died from it, as did many theater people. At that time the term fever encompassed a number of different diseases including cholera and influenza. In the 1830 s the ne fever, typhus, was isolated. During its worst outbreak, in 1837-38, most of the deaths from the fever in London were attributed to typhus, and new cases averaged about sixteen thousand in England throughout each of the next four years.

This coincided with one of the worst smallpox epidemics which killed tens of thousands, mainly infants and children. Scarlet fever, which was referred to in those days as scarlatina, was responsible for nearly twenty thousand deaths in 1840 alone. In the years between 1842 and 1846, there was a considerable decline in epidemics. However, in 1846, a hot and dry summer was followed by a serious outbreak of typhoid in the fall of that year. Enteric fever, as it was then called, is a water-borne disease like cholera and tends to flourish when people are not particular about the source of their drinking water. That same year, as the potato famine struck Ireland, a virulent form of typhus appeared, affecting large numbers of even well to do families.

As Irish workers moved to cities like Liverpool and Glasgow the Irish fever moved with them. By 847 the contagion, not all connected with immigration, had spread throughout England and Wales. It accounted for over thirty thousand deaths. As had happened earlier, typhus appeared simultaneously with a severe influenza epidemic. There was also widespread dysentery, and as if this was not enough, cholera returned in the autumn of 1848. It assailed especially those parts of the island hardest hit by typhus and left about as many dead as it had in 1831.

Diseases like cholera, typhoid, and influenza were more or less endemic at the time, erupting into epidemics when the right climatic conditions coincided with periods of economic distress. The frequency of concurrent epidemics gave rise to the belief that one sort of disease brought on another, and it was widely believed that influenza was an early stage of cholera. There were other contagions that yearly killed thousands without becoming epidemic. Taken together, measles and hooping cough accounted for fifty thousand deaths in England and Wales between 1838 and 1840. About one quarter of all deaths during this general period have been attributed to tuberculosis and consumption. Generally throughout the 1830 s and 1840 s trade was off and food prices were high.

The poorer classes, being underfed, were less resistant to contagion. Also, during the more catastrophic years the weather was extremely variable, with heavy rains following prolonged droughts. Population, especially in the Midlands and in some seaport cities and towns, was growing rapidly without a concurrent expansion in new housing. Crowding contributed to the relatively fast spread of disease in these places.

The Registrar General reported in 1841 that while mean life expectancy was forty-five years, it was only thirty-seven in London and twenty-six in Liverpool. The average age of laborers, mechanics, and servants at times of death was only fifteen. Mortality figures for crowded districts like Shoreditch, Whitechapel, and Bermondsey were typically twice as high as those for middle-class areas of London. These kinds of statistics made the people of Britain aware of the magnitude of diseases in their own time and it also served as effective weapons for sanitary reformers when they brought their case before Parliament. Two reports by the Poor Law Commission in 1838, one by Dr. Southwood Smith and the other by Drs.

Neil Arnott and J. P. Kay, outlined causes and probable means of preventing communicable diseases in poverty areas like London s Bethnal Green and Whitechapel. Edwin Chadwick s report broadened the scope of inquiry geographically, as did a Royal Commission document in 1845 on the Health of Towns and Populous Places. What we learned from these and other sources gives a depressing picture of early Victorian Hygiene. During the first years of Queen Victoria s reign, baths were virtually unknown in the poorer districts and uncommon anywhere.

Most households of all economic classes still used privy-pails and water closets were rare. Sewers had flat bottoms, and because drains were made out of stone, seepage was considerable. If, as was often the case in towns, streets were unpaved, they might remain ankle-deep in mud for weeks. For new middle class homes in the growing manufacturing towns, elevated sites were usually chosen, with the result that sewage filtered down into the lower areas where the laboring populations dwelt. Some towns had special drainage problems. In Leeds the Aire River, fouled by the town s refuse, flooded periodically, sending noxious waters into the ground floors and basements of low-lying houses.

In his report, Chadwick later recalled, the new dwellings of the middle class families were scarcely healthier, for the bricks tended to preserve moisture. Even picturesque old country houses often had a dongeonlike dampness. Chadwick quotes what a visitor might observe, If he enters the house he finds the basement steaming with water-vapor, walls constantly bedewed with moisture, cellars coated with fungus am = nd mould; drawing rooms and dining rooms always, except in the very heat of summer, oppressive from moisture; bedrooms, the windows which are, in winter, so frosted on their inner surface, from condensation of water in the air of the room, that all day they are coated with ice. In some districts of London and other great towns, the supply of water was irregular. Type 8 cally a neighborhood of twenty or thirty families on a particular square or street would draw their water from a singly pump two or three times a week. Sometimes, finding the pump not working, they were forced to reuse the same water.

When the local supply became contaminated the results could be disastrous. In Soho s St. Anne s parish, for example, the feces of an infant stricken with cholera washed down into the water reserve from which the local pump drew, and almost all thos using the pump were infected. Contaminated London Drinking water containing various microorganisms, refuse, and more. The Public Health Bill, passed in 1848 because of the efforts of reformers like Smith and Chadwick, empowered a central authority to set up local boards whose duty it was to see that new homes had proper drainage and that local water supplies were dependable.

The boards were also authorized to regulate the disposal of wastes and to supervise the construction of burial grounds. Simply bringing this last problem to public attention was a great service. The New Bun hill Fields burying ground in the Borough less than an acre in size, was at the time the depository of over fifteen hundred bodies a year, though Chadwick estimated that only one hundred and ten could be neutralized per acre of ground. When more room was needed, the older skeletons and coffins were incinerated. The graveyard of ST. Martin s, Ligate.

Had long since filled and hundreds more were interred in church vaults, the resulting stench drove the regular worshippers from service. Since it was widely believed that disease was generated spontaneously from filth and transmitted by noxious invisible gas or miasma, there was much alarm over the Greta Stink of 1858 and 1859. The Thames had become so polluted with waste as to be almost unbearable during summer months. People refused to use the river-steamers and would walk miles to avoid crossing on of the city bridges. Parliament could carry on its business only by hanging disinfectant-soaked cloths over the windows. It should have been a blow to the theory of pathogenesis when no outbreak of fever ensued from this monstrous stench.

As late as 1873, however, William Budd could reluctantly report in his book on typhoid that organic matter, and especially sewage in a state of decomposition, without any relation to antecedent fever, is still generally supposed to be the most fertile source. No doubt the resistance to the theory of polluted water as a source of infection contributed to the steady prevalence of typhoid in the second half of the century as well as to the high mortality rates from cholera in epidemics as late as 1854 or 1865-66. The general cleaning up of the cities and towns, however, produced a marked reduction in deaths from typhus, a disease we now know to be transmitted by lice. Although a systematic control of contagious disease had to await the introduction of preventive inoculation in the eighties and nineties, after mid-century the general health of the country measurably improved. In the 1850 s and 1860 s there came into common use such diagnostic aids as the stethoscope, the ophthamlaoscope, and short clinical thermometer.

Meanwhile the employment of general anesthesia and antiseptic surgery was reducing considerably the number of hospital deaths. Improved hygiene, diagnosis, and treatment in the past century have given people a certain emotional security even in the face of serious disease. Throughout much of the Victorian period, with both the causes and the patterns of disease very much matters of speculation, it was difficult ever to feel comfortable about one s state of health. The behavior of the sever contagions of the time had a special way of intensifying anxiety. They would appear, then subside for a month or two, only to reappear in the same locality or somewhere else.

Also, the individual sufferer had no way of predicting the outcome of the disease in his own case. Influenza patients, observed the London Medical Gazette during the 1833 epidemic, might linger for the space of two or three weeks and then get up well, or they might die in the same number of days. Just as frightening was the uncertain progress of typhoid. For the first week the victim would feel listless and suffer headaches, insomnia, and feverishness.

His temperature would gradually increase over this period, though fluctuating between morning and evening hours. His stomach would be painful and distended. Probably he would have diarrhea and perhaps red patches on his skin. Typically there would be an intensification of these symptoms for a few weeks. In most cases the patient would recover, but convalescence might take additional weeks. Depending on the severity of the attack, however, and the patient s ability to resist, he might die from exhaustion, internal hemorrhaging, or ulceration of the intestine.

The beginnings f such a disease as typhoid were so mild and gradual as to be subjectively indistinguishable from a cold, and a moderate case of influenza from any number of nonfatal complaints. Deficiency diseases, both glandular and dietary, were but dimly understood in those days. Proper diagnosis and effective treatment of goiter, diabetes, and the various vitamin deficiencies belong to the twentieth century, as is true with allergies, many of which must also have imitated the early symptoms of acute diseases. Thousands of sufferers from eczema, hives, or asthma not only were given superficial relief but also were ignorant of the nature of their maladies. The number of unknowing victims of chronic food poisoning must also have been great. Mineral poisons were often introduced into food and water from bottle stoppers, water pipes, wall paints, or equipment used to process food and beverages.

Moreover, the deliberate adulteration of food was a common and, until 1860, virtually unrestricted practice. For example, because of Englishman s dislike for brown bread, bakers regularly whitened their flour with alum. Conditions for the processing and sale of foods were unsanitary. An 1863 report to the Privy Council stated that one-fifth of the meat sold came from diseased cattle. In 1860 the first pure-food act was passed, but, as was often the case in these early regulatory measures, it provided no mandatory system of enforcement. In 1872 another act was passed, this time considerably strengthening penalties and inspection procedures.

But in the meantime, and throughout most of the nineteenth century, British citizens had little protection against unwholesome food and drink. We can only guess how many tons of adulterated tea, rancid butter, and polluted meat were sold and consumed monthly throughout the kingdom. BIBLIOGRAPHY Haley, Bruce. , The Healthy Body and Victorian Culture. Cambridge, Mass. : Harvard University Press, 1978 Mitchell, Sally.

"Medical Practice" in Victorian Britain: an Encyclopedia Newman, Charles. The Evolution of Medical Education in the Nineteenth Century (1957). Porter, Dale H. , The Thames Embankment: Environment, Technology, and Society in Victorian London. Akron, Ohio: University of Akron Press, 1998 Wohl, Anthony S. , Endangered Lives: Public Health in Victoria Britain.