Commentary: Sutherland, Snow and water: the transmission of cholera in the nineteenth century.

The first confirmed case of cholera in Britain occurred in September 1831 when William Sproat of Sunderland contracted the disease. Over the next 30 years or so, Britain was invaded by four of the pandemics of cholera that had spread from Bengal since the early 19th century and suffered epidemics in 1831–1832, 1848–1849, 1853–1854 and 1866. Cholera was not as persistent or as frequent in its attacks as other infectious diseases but was remarkable for its high mortality rate and the speed at which it could kill. In terms of overall number of deaths for example, cholera claimed only 6% of the total for 1832. This put it no higher than third in the table of leading causes of death— behind consumption and convulsions and not far ahead of typhus, pneumonia, smallpox and dropsy.1 By 1831, Britain had known for some time that cholera was moving towards its national boundaries. Both the public and medical practitioners reacted to the arrival of cholera with sheer panic. The Lancet set a tone of alarm through its editorials which spoke of cholera raging with ‘unabated virulence’, and the same sentiments reverberated through the popular press.2 It was common knowledge that medicine could offer no cure for cholera and medical society debates highlighted the disagreement over the nature of the disease and its transmission.3 It is no surprise that this ‘new’ disease, which had no antidote and which could kill its victims in 12 hours, created ripples of fear throughout Britain. The second major epidemic of cholera began in Scotland in October 1848 but did not establish itself in London until February 1849.4 In relation to the number of fatalities, this was the most serious of all 19th-century epidemics and around 53 000 deaths were registered for England and Wales compared to around 20 000 for the 1831–1832 epidemic.5 Between 1845 and 1856 over 700 individual works were published in London © International Epidemiological Association 2002 Printed in Great Britain