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What does cholera teach us about the corona virus?

Cholera was to the 19th century what the corona is to us. What have we learned from the great epidemics of the past and where do we stand?

Beds for cholera patients in a hospital in Dhaka, Bangladesh. Photographer: Mark Knobil, Wikimedia.
Beds for cholera patients in a hospital in Dhaka, Bangladesh. Photographer: Mark Knobil, Wikimedia.

Cholera was to the 19th century what the corona is to us. What have we learned from the great epidemics of the past and where do we stand?

The corona of the 19th century

Cholera is a bacterial intestinal disease manifested by severe diarrhea. The patient loses about 10 liters of water every day, and in each ml of the secretion that looks like "rice water" there are up to 500 million bacteria that are transferred to the next infected person through contaminated food or water. The loss of fluids is so rapid that those caring for the victims of the outbreak invented the "cholera bed" - a bed with a drainage opening in the center so that the patient, lying on his back, poops into a bucket underneath. In the 19th century, before the era of modern sewage pipes, the distribution of such a quantity of disease agents caused mass and deadly epidemics. 5 cholera epidemics struck Europe in the 19th century, all of them started in the area of ​​the mouth of the Ganges River to the Bay of Bengal in the north of the Indian subcontinent (in the area of ​​India and Bangladesh today). The Ganges delta on the water channels used for both drinking and irrigation as well as sewage drainage for many communities was to cholera what the food markets in Wuhan are to today's corona. The Ganges River, by the way, remains polluted to this day: 1.1 billion faecal coliform bacteria per 100 ml of water were counted there in the 21st century. From India, cholera spread in waves through trade routes east to Thailand and China and west to Central Asia, the Middle East and Europe. The disease that until the discovery of the bacterium causing it by Robert Koch in 1884 was a mystery to medical science wreaked havoc on large communities and regions. The traces of the disease, the fear of it from the insights it gave to science are recognizable even in these Corona days.

Cholera and the Jews

Let's start, of course, with the Jewish people. In the path of cholera's spread from Asia to Europe, the plague struck the "Tehem Moshav" - a strip in the west of the Russian Empire where millions of Jews lived, in abject poverty, in small, crowded towns. The filth and filth accompanying poverty and overcrowding is a recurring motif in the description of life in the towns of the Moshav area. The attitude of the shtetl Jews to the luxuries of hygiene is illustrated by a story documented by Alter Droyanov in which a Jew from the town is brought before a Russian judge on the charge of building his house without a toilet so that the needs of the household members were discharged into the street. "Why do I need a bathroom?" The Jew wondered, "I am sitting among my people." The meeting between the Jews of the town "powerless, thin and emaciated, moaning and coughing" (as described by Max Nordau) and the cholera bacterium was therefore catastrophic. The communities of the moshav area were hit with high morbidity and mortality rates and "Kholra" became a common Yiddish curse to this day. One of the mystical means to contain the plague was a "black canopy" - the threatened community sent a poor orphan ("cholera bridegroom") to a poor orphan in the cemetery. The hero of Y.L. Peretz's tragic-comic story "Yossi the yeshiva boy" He is a destitute orphan who longs for the plague to come to town so he can marry one of the orphans. The custom, surprisingly, has survived to this day: Tel Aviv's first cemetery on Trumpeldor Street, built during the cholera outbreak in Jaffa, was inaugurated with a grave wedding of this kind and the outbreak of the Corona revived the custom In Israel of the 21st century.

In the Land of Israel, the cholera epidemic was a catalyst for the establishment of Jewish neighborhoods outside the walls of the Old City of Jerusalem. Moshe Montefiore financed the construction of "Mishkanim Shananim" a neighborhood that was a failed real estate project. Going outside the walls at night in the late Ottoman period was a dangerous adventure that did not attract settlers. The cholera epidemic that struck the crowded alleys of the old city turned the bowl upside down. Rather, staying in the city became more dangerous than the relative isolation of the new neighborhoods.

The cholera ships

A cholera patient receives treatment with a drug to prevent dehydration, in 1992. Photo: Public domain from Wikipedia Cholera patient being treated by oral rehydration therapy in 1992
A corona patient receives treatment with a drug that will prevent dehydration, in 1992. Photo: Public domain from Wikipedia Cholera patient being treated by oral rehydration therapy in 1992

In the Israeli media, the corona reached the headlines through the story of the Israeli vacationers about the cruise ship that was placed in isolation off the coast of Japan. The isolation of the ship was then (in the distant days of January 2020) considered an extreme and even cruel action. 128 years earlier, the fate of the passengers on board the "Moravia" which carried Jewish immigrants from Russia and Poland from the port of Hamburg to New York was much crueler. The ship was equipped with water pumped from the polluted Elbe River and in the ten days of the voyage, 22 of the passengers died, twenty of them children under the age of 10 whose bodies were hastily thrown into the water. The arrival of the ship at the port of New York aroused public fear, the passengers of the ship were placed in prolonged isolation and to them were added immigrants from other ships, the overcrowding and pollution in the isolation facilities led to additional infections that killed many. The fear provoked by Moravia helped those who sought to close the immigration gates to the USA to Eastern European Jews, the description of the danger posed by Yiddish-speaking immigrants, and the burden they put on the health and sanitation authorities in the newspapers of the time is very reminiscent of what the "infiltrators" in the South Tel Aviv neighborhoods are experiencing today. The quarantine regulations that were imposed under the pressure of public opinion were aimed more at stopping immigration than at preventing the disease and included isolation for third class passengers, that is, the poor who were pushed to the bottom of the ships, for 3 weeks, a time significantly longer than the incubation period of cholera, and released from isolation the wealthy passengers in the upper deck cabins. Such a long isolation made the transportation of the masses of refugees from the Moshav area to "Di Galdena Medina" uneconomical for the shipping companies and left many Jews in Europe.
The birth of epidemiology

The first epidemiological survey: map of the distribution of cholera patients in London.

Corona brought epidemiology, the science of epidemics, to the headlines. The decision-makers consult epidemiologists on the imposition of various types of lockdowns, and epidemiological investigations record the movements of each patient. The birth of the science of epidemiology in the cholera outbreak of 1854 in London and the father of epidemiology is considered to be Dr. John Snow who studied it. When the disease struck London, the connection between bacteria and diseases was not yet known, the accepted theory of the spread of diseases attributed them to "miasms" - infected air that harms health. Dr. Snow, who investigated the outbreak, marked the deaths on a map of London and found that there was no way to explain the cluster of patients around Broad St. to air pollution. Faced with this impasse, Snow did what no doctor before him had done: he interrogated the patients and looked for the common denominator linking them when he carried out the first epidemiological investigations. This investigation led him to the water pump on Broad Street from which all the patients drank, including a family that was far from the rest of the infected but brought the water from there because they preferred its taste. Another clue that helped Snow decipher the map was an "island of health" in the heart of the infected area: a brewery where the workers received free beer and therefore did not drink the water. Ironically, one of Snow's opponents, Rev. Henry Whitehead, provided the winning proof of his conclusions. Whitehead believed that the plague was divine punishment for London's sins and set out on his own quest to disprove Snow's heretical claims. During his investigations, Whitehead came to a woman whose son was infected even before the Broad Street outbreak and she said that after washing her sick son's diapers, she poured the water into a septic tank a few meters from the suspected pump. When Snow presented his findings to the authorities, the pump handle was removed so that water could not be extracted from it. The immediate source was neutralized but the idea that the disease passes through a fecal-oral route was, not surprisingly, difficult to digest and more fundamental lessons were not learned. It took more mass outbreaks for the sewage system to be recognized as a source of infection. The plague in Hamburg, from where the unfortunate Moravia sailed, almost 40 years later is proof of how slowly scientific insights are assimilated among decision makers. The outbreak of the corona virus in bats 20 years after the outbreak of the SARS virus from a similar source suggests that not much has improved since then. Dr. Snow's investigation not only created new science but also revived the public fear of water and laid the foundation for the still thriving industry of bottled "mineral" water. An industry that continues to flourish Even a hundred years or more after filtration and disinfection methods made tap water safe to drink.

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2 תגובות

  1. The title in the picture is wrong. The error is obvious. Just fix. Other than that, the article is interesting.

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