Due to lack of medical knowledge and prowess in the past, life expectancy in Britain was quite low. This statistic has risen in recent years, but without the medical understanding we have grown used to today, diseases ran amok and were a formidable threat to the British population. Two of such diseases were cholera and syphilis, and while their mortality rates and the times that they were introduced to society differed, they both affected the history of Great Britain in the long run. Cholera had interesting medical responses that involved discussions about whether the disease was contagious as well as how exactly the disease spread. Syphilis had significantly different death rates than cholera, but it invaded Britain hundreds of years earlier, meaning medical knowledge was not yet advanced enough to properly deal with the disease. Their social responses drastically differed as well, due to a culmination of the time periods they invaded in and the natures of the diseases themselves. Despite cholera and syphilis taking place in completely different time periods, they both had long-lasting effects on Britain in terms of medical and social responses.
The life expectancy of an average person in Britain has changed drastically between the fifteenth and twentieth centuries. Until the mid-eighteenth century, there was no sign of any trend for life expectancy, as it normally fluctuated between 30 and 40 years. At the turn of the nineteenth century, life expectancy in Britain began to steadily increase until it almost doubled what it was two centuries prior: by 1950, life expectancy had increased to nearly 69 years. This development was anything but a coincidence, as there were many advancements and milestones that ultimately led to such a massive increase in life expectancy. Quite obviously the primary reason for the change is that it was around this time when an impressive amount of progress was made in health care and treatments. Besides this, improvements in mortality can also be attributed to the culmination of advances in education, nutrition, sanitation, income, a general desire to be healthy, and of course, medicine. Progress in these areas inevitably led to improvements in quality of life, and thus made it easier to live longer than one would have living in earlier times. While the improvement in life expectancy is unquestionably a huge achievement, there may actually be more of an explanation for the sizable discrepancy between the fifteenth-century and twentieth-century life expectancies.
Child mortality is often considered one of the main reasons for the low life expectancy prior to the twentieth century. In 1800, 43% of all newborns died before their fifth birthday; contrarily, in 1960, the child mortality rate had decreased to 18.5%. As one can see from such high child mortality rates, the life expectancy from these time periods were skewed heavily downwards by all of the untimely young deaths. Health care and medical advancements in general are to thank for this improvement, as there were less complications during births and disease crises became less destructive as medical knowledge expanded. That being said, is there more to the story? Were there really so many deaths of infants and children prior to and through the nineteenth century? It is important to mention that, while there were certainly many problems and complications that caused newborns to die within years of their births, Great Britain’s child mortality data prior to 1874 may be inaccurate to a certain extent. The Births and Deaths Act of 1874 made registering the birth of one’s newborn a legal requirement, so there may be data that is not readily available, therefore skewing the data – in which direction can only be assumed. Life expectancy is not a simple subject, so even though child mortality was a major factor in the high mortality rate, there are assuredly other aspects to examine.
The low life expectancy of the past can be attributed not just to child mortality, but also to factors such as crises and major outbreaks of diseases. With the limited medical knowledge and technology available at the time, it was much easier for diseases to spread throughout the population, and unfortunately it was more difficult to treat the infected. Cholera is a disease that spread throughout the world relatively quickly, and it certainly wreaked havoc in Britain as well. The cholera germ enters the body through the mouth, usually by consuming contaminated food or water, and infects the small intestine; symptoms tend to start appearing after an incubation period ranging from less than a day to five days, and it normally develops in three stages. According to the resources offered by The Gazette, Britain’s first identified and recorded instance of cholera was in October 1831, when William Sproat of Sunderland was infected and died just three days later. Once the disease reached London, the capital, it continued to spread at an alarmingly rapid pace. This quick spread of cholera is generally attributed to the impressive growth that London saw around this time, and subsequently the inability to develop infrastructure to deal with the ever-increasing amount of waste and sewage that the growing population produced.
Cholera was not only a problem in London, though – it was also a problem in many other relatively large cities in Britain. The first outbreak that began in October 1831 killed approximately 56,000 people total throughout the British Isles. Out of the 56,000 deceased, 21,500 people were believed to have been from England and Wales, 9,500 were from Scotland, and the remaining 25,000 victims were from Ireland. More than ten years later, John Snow reported that there were 7,466 recorded deaths from the disease in London alone from September 23rd, 1848, to August 25th, 1849 out of a total population of 1,948,369; this means that out of every 1000 inhabitants, 3.83 died of cholera in this time frame. It is also worth noting that Snow remarks that the South District of London had significantly more deaths than any other district. This disparity is due to the conditions of the South district: occupants were generally poorer and lower class, and thus had less access to benefits that other districts had. This time frame falls within the span of the second outbreak of cholera in the United Kingdom, which affected England and Wales. Overall, this outbreak was the cause of the deaths of 52,000 people over a total of two years. Unfortunately, though, cholera was not the only disease that Britain has had to deal with throughout its history.
Another example of a disease that the British population had to deal with is syphilis, a sexually transmitted disease, and it is a problem that was introduced centuries before cholera. Its exact origins are unknown, and actually quite controversial to this day; in fact, Marinković and Đukić argue that ‘the origin and antiquity of syphilis are among the greatest historical and scientific questions in the history of medicine.’ The reason for the controversy is that it is unknown whether Christopher Columbus and his crew brought the disease from the New World in 1493, or if syphilis had already existed in the Old World and only became prevalent around that time. Even without knowing its origin, citizens had to learn of its existence and how to avoid it. As a venereal disease, syphilis is spread by having sexual intercourse with a person that has already been infected. Somewhat understandably, the mere utterance of the phrase ‘sexually transmitted disease’ caused the public to link the spread of syphilis to sex workers, which will be further discussed later in this paper. No matter who was to blame, there is no debate: many people still became infected and some even died.
While syphilis’s mortality rates are relatively low compared to cholera’s, the real significance of the disease lies in that it was relentless. It did not come in the form of an occasional outbreak, only to eventually stop with enough improvement in sanitation and living conditions; syphilis was an ever-present threat that one had to be wary of when engaging in sexual intercourse. Acton provides data illustrating that, in the years 1864, 1865, and 1866, there was a total of 189 deaths attributed to syphilis – 111 females and 78 men. It seems as though more women died from the disease than men by quite a large percentage – 42.3% more, to be precise; however, once one considers that women outnumbered men by a sizable amount at this time in London, the difference becomes less significant. There was also a trend in the amount of cases of syphilis in England and Wales over time, as Acton again showcases: in 1855, there were 546 female deaths, while in 1866 and 1867, there were 1,046 and 1,052 female deaths respectively. Although only deaths in the female population is exhibited, this data illustrates the increase in instances of syphilis over time, and it is safe to assume that this trend applies to men as well. It is also reasonable to say that responses to syphilis and cholera differed, considering they originated in different time periods.
For the first decades after its introduction to Great Britain, the medical response to cholera was inadequate to say the least, and this was mostly due to the misunderstanding of the disease at the time. As the disease was new to the country, there was not much that was known about it, such as its properties and if it was possible to prevent it. One aspect that began to be increasingly discussed following the first outbreak in 1831 was whether or not the disease was contagious; in this case, the idea of the disease being ‘contagious’ implies that actual physical contact would be made. Some professionals, one example being Moir, were of the belief that cholera was contagious. Contrarily, others believed that the disease was not contagious. Molison was certainly of this belief, and supported it both scientifically and anecdotally. On top of this, there were some that hypothesized that the mere notion of cholera being contagious caused fear in the minds of the public. Lizars states that this fear gives rise to unamiability in the heart, even when that is out of the norm for the individual. He also seems to imply that when people are frightened by contagion, they will do whatever it takes to avoid becoming infected, even if that means severing communication with close family and friends. The entirety of this debate would remain significant for decades while cholera continued to kill thousands of unfortunate citizens. All in all, while most people believed that the disease was contagious, there was no concrete evidence that proved it actually was; whenever anyone proposed the idea, it was met with a lot of criticism from those of the opposing belief, and each time the proposal was disregarded or disproved. Luckily, after decades of debates and discussion, the medical community learned more about cholera, including the truth about the contagiousness of the disease.
An unfortunate belief concerning the contagiousness of cholera in the nineteenth century was the infamously dominant miasma theory. This theory held that people became infected by diseases by inhaling ‘bad air’ that had been exposed to decaying matter and was characterized by its horrid smell. This was a commonly held belief that was generally accepted throughout the medical community at the time of the cholera outbreaks, and was one of the primary misunderstandings that led to so many deaths – not just for cholera, but also for diseases such as malaria and tuberculosis. However, aforementioned John Snow, a well-known anesthetist, was one of the first people to actually dispute this terribly popular theory. Although miasma theory was more dominant by far at the time of the first outbreaks despite the concept of germ theory having already been introduced to the public, Snow was fully supportive of the newer theory. In his work, he fully developed and fleshed out germ theory, and correctly states that cholera’s mode of communication was the oral-fecal route. In his 1849 publication, he also suggested that water ought to be filtered and boiled before being used – this proposal was actually one of the first instances of germ theory being put into practice. Eventually, the public began to take this recommendation to heart and apply it in their daily lives, which can be seen in advisories directed towards inhabitants of cholera-infested areas. He also conducted research showing where clusters of cholera incidents occurred; he suggested that cholera was being spread in London through the community drinking water, which had been contaminated by the sewers being emptied into it. As previously mentioned, London’s south district had many more deaths than any other part of London, and this is because this district got its water from a polluted part of the Thames River – Snow’s discovery helped come to this conclusion. Ultimately, this proposal led to London changing the way its sewage system worked, with its long-lasting effects on public health inspiring other parts of Britain as well. Unfortunately, it wasn’t until after his death that Snow’s publications and research were given serious consideration.
The medical response to syphilis, like cholera, consisted of quite a few heated discussions and debates that eventually led to more knowledge of the disease. The first of these debates concerned the understanding of syphilis: was the disease completely new, with the first instances of the disease being brought back with Christopher Columbus in the 1940s, or was it old, remaining unnoticed in Great Britain up until that point in time? In fact, this discussion still continues through the centuries up to the modern day. The second debate, related to the first, was actually about the cause of the disease. Who was the cause of the disease – was it Columbus? What was the cause of the disease – is the New World to blame? It has been said that the reason for these debates was to gain credit, in order to boost the prestige of the new medicine of the Enlightenment, and to assign blame to whoever or whatever caused the problem. Despite the intentions of these debates, they were crucial to understanding the medical side of syphilis. By the 1520s, it was known that syphilis was a sexually transmitted disease, and it sat alongside gonorrhea as the two major venereal diseases that the public faced up to and during the eighteenth century. It was also understood that syphilis evolved in stages, becoming increasingly deadly if left untreated. Unfortunately, as a result of the state of medical knowledge and technology of the time period, as well as the disease only recently being introduced to the Old World, there was no known cure for syphilis. There were many attempts to find a solution to the problem, but a lot of them were experimental or just plain ineffective; the early remedies of syphilis were often considered worse than actually dying from the disease itself.
The early treatments for syphilis were generally not received well by the public. The earliest known remedy, guaiacum, also known as ‘holy wood’ or Legno de India, was originally documented by Francisco Delicado in 1525. Guaiacum is an evergreen tree from the Americas and its resin was made into a hot drink, and after drinking, the syphilis-infected person would take a sweat bath in the hopes of forcing the disease out of the body. Following guaiacum, mercury was the next known remedy for syphilis. When the public considered syphilis’s remedies worse than dying, this is most likely what they were referring to. At this time, mercury was used in things like ointments and oral medication; thus, even in this time period centuries ago, the public knew that mercury treatment could often prove fatal, and even if death didn’t occur, the treatment was long and excruciating. To treat syphilis, mercury was either injected into the arm or taken orally, and although it caused extreme discomfort, pain, or even death by mercury poisoning, it was the best solution that the medical community had at the time. Luckily for those living in the modern day but less so for those who were infected with the disease in the previous centuries, the widespread availability of penicillin made contracting syphilis much less daunting. After the discovery of the mold’s anti-bacterial properties in 1928, its manufacturability skyrocketed after World War II. What this meant for those afflicted with syphilis was no more inefficient or potentially deadly treatments, and the ability to get cured more easily. Essentially, the discovery of penicillin rendered the previously mentioned treatments obsolete, and even if the sufferer is allergic to penicillin, alternatives exist in amoxicillin and ceftriaxone. Beyond the medical responses to cholera and syphilis, though, there are still important social responses to consider.
Considering the massive death toll due to the multiple outbreaks of cholera throughout Great Britain in the nineteenth century, it is no wonder that the public often considered it a new plague. The social ramifications of the disease were especially evident during the first outbreak in Liverpool, which was notoriously one of England’s most overcrowded and filthy cities. By the end of May 1832, cholera had taken the lives of many residents of Liverpool; these deaths mostly occurred in the lower-class and the poor immigrant population, exemplifying the toll cholera took on lower social classes. As these people were understandably unhappy about their situation, this prompted a series of violent riots in Liverpool, with the first taking place on 29 May 1832. The cause for the riots is a culmination of problems, such as unhappiness and fear, but the most significant factor concerning the riots is the public’s general distrust of the medical professionals. Seeing family members and other loved ones die, even after religiously following the medical advice they had received from doctors, had convinced them that the people who were supposed to be helping them were actually harming them. Hundreds of people would crowd outside places such as hospitals, in order to make their voices heard. That being said, even if their reasoning was justified in their own minds, their actions were quite vile, as they called doctors words such as ‘murderer’ and ‘Burker’ and threw things like stones and mud. In total, there were eight riots that took place in Liverpool throughout May and June 1832. Another underlying cause of the public contempt causing the riots was the practice of body-snatching. Bodies would often be stolen and sold to the medical community to be used for dissection, and an infamous figure known for committing these crimes is William Burke, hence the word ‘Burker’. On the bright side, not all social impacts of the cholera pandemics were so negative.
In retrospect, cholera may have actually helped Great Britain in the long run. Despite all of the death and suffering that the disease caused through its many outbreaks, it caused changes in the way Britain lived life and cared for its people. Public health is something that absolutely improved, and people started to live healthier – ultimately leading to the rise in life expectancy that modern Britain is able to enjoy today. While the traditional response in Europe to invading diseases was to quarantine things such as incoming ships, this practice was ended by the invasion of cholera. It was just not feasible to contain cholera, so it spread throughout the population anyways. Years later, with John Snow’s research in mind, it was decided that London’s Thames River must be cleaned up, as it was essentially the source of all of the chaos. This famous river was used as a place to dump waste of all kinds – human, animal, industrial – making it a prime breeding ground for cholera, and a vessel for the disease to spread. Eventually, with a good idea of how cholera was spread and with the Great Stink pushing for action, the Thames river was cleaned out and refurbished, and London’s sewage system was redone. As one might expect, this helped mitigate the spread of cholera throughout London, but especially to and within the south district. This is merely one, admittedly very significant, example of the improvement of public health in Britain in the mid-nineteenth century; the Public Health Act of 1848 in England and Wales not only facilitated the reform of sanitary systems, but also held central and local governments accountable for health. The culmination of these social responses ultimately resulted in cleaner and more sanitary living conditions in Great Britain.
Just as cholera was the cause of a public health reform, the introduction of syphilis to Great Britain prompted unique and interesting social responses. As sex is something that humans are naturally predisposed to do, it is inevitable that syphilis and other venereal disease would cause a problem for society. With this in mind, who better to blame for one’s contraction of a sexual disease than prostitutes and sex workers? At least, that was a popular thought in the relevant time period between 1450 and 1750, although it still persists even up to the modern day. Beyond just blaming one individual sex worker for the contraction of one’s own infection, it is important to emphasize that the entirety of the profession was blamed for the spread of venereal diseases, and thus syphilis. Understandably, this also means that female sex workers bore the brunt not only of the blame, but also of the disease itself. Working in a profession where sex between many kinds of people occurs, without modern protection, means that contracting the disease is borderline unavoidable.
Despite their near certain contraction of venereal diseases like syphilis, this also implies that sex workers are often the first to implement preventative measures. An example of this occurring is the ever-increasing popularity of condoms in the sex-worker community, despite the massive amount of changes the condom and other forms of protection have gone through since their respective inventions. It was also quite popular for a sex worker to pretend to be a virgin to get more work. This is especially true in the times of syphilis, which caused a slow and agonizing death, so many clients potentially looking to pay for sexual acts were more inclined to want a virgin, as one would have virtually no chance of being infected. On the other end of the transaction, if a man contracts a venereal disease from a sex worker for example, he might pay a doctor for their silence on top of his treatment. This is evidently one of the reasons for the patient-doctor confidentiality that the modern world thinks of as normal today.
Diseases, their mortality rates, and how they were handled are interesting because it gives the modern historian a glimpse into the history of medicine. This paper aimed to discuss both the immediate and long-lasting impacts that cholera and syphilis had on society and the medical community in Britain. It was shown that while the mortality rates drastically differed between cholera and syphilis, they both provoked unique medical and social responses that impacted Great Britain’s future. Although misunderstood at the time, cholera caused an improvement in medical care and public health, largely due to efforts to combat the disease. Syphilis was misunderstood as well, and many deaths were caused by the inability to cure the disease, but it ultimately illustrated how sex workers were blamed for venereal disease, and it promoted healthy sex practices and even patient-doctor confidentiality. As epidemics were a large part of history, this topic is important to the modern field of medicine as well as its history. On a larger scope, a further point of discussion may be in how society dealt with the diseases themselves – quackery and the medical marketplace, for example – as well as their immediate and longstanding effects on the economy.