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frightening due to its association with diarrhea together with a massive loss of body fluids,

vomiting and fever, and the fact that following the first insignificant symptoms death can

result within a few hours. Those dying

presented a terrible picture of death by

shrinking increasingly looking like a living

mummy while turning black because of

bursting capillaries. Death may also be

accompanied by severe cramps because of the

loss of electrolytes. Cholera was known in

India and might also have been familiar to

people in China, but Europeans did not

recognise it as a leading threat to health until

the beginning of the 19

th

century. In the year

1826 a worldwide cholera epidemic started at

Bengal, where the disease had been known for

a long time, but it then travelled around the globe reaching Poland in 1830, and from there

travelled by boat across the Baltic Sea to England where it first seemed to have entered in

Newcastle-upon-Tyne. This was not the first epidemic of the disease to spread across

continents and was followed by numerous additional outbreaks following wars and

pilgrimages. The last very severe outbreak of cholera was recognised in 1912 in Mecca and

Medina.

The germ against the miasma theory

The rapid spread of epidemics required an explanation about its mechanism. In 1546

the Italian, Girolamo Fracastoro, had already written in his

book, ‘De contagione et contagiosis morbis eorumque

curatione’, that ‘the seeds of diseases are minute animals able

to reproduce their kind’, suggesting that the diseases are

transmitted by a contagious process. His theory did not fit well

with the fact that epidemics also occurred where a contagious

process could not be established. The explanation for this

phenomenon was that ‘a noxious form of bad air’, most likely

emitted from polluted soil, was instrumental in the spread of disease. The theory is known as

‘miasma’ theory. Diseases like malaria did fit well with this theory since the life cycle of the

agent enabled by mosquitos was not known. For some time, both theories stood in conflict

with each other. The theory of contagious agents justified quarantine measures against those

exposed to people suffering from leprosy and plague. The germ theory received a deadly blow

when yellow feve

r 2 a

nd other tropical diseases over a few months in 1802 killed almost the

entire French military force of 33.000 men shipped to Santo Doming

o 3 t

o quell a revolution

there. Given the situation in a totally overcrowded urban setting with no waste disposal,

faeces and urine spilled in the narrow streets. Without toilets and running water the smell in

such an environment must have been intolerable and certainly supported the miasma theory.

2

The viral disease is also transmitted by mosquito.

3

now the capital of the Dominican Republic