The reaction of rural communities afflicted by this latest Ebola outbreak has shocked the world, characterised by the spread of conspiracy theories and misinformation leading to attacks on emergency response teams. But for those who know a little about the history of disease outbreaks, these reactions are all too familiar. So grab a seat dear reader, and possibly a beverage of your own choosing, and allow me to take you back to 1832, and tell you about the Liverpool Cholera Riots.
Murmurs of murder rippled through the crowd as it accumulated outside the entrance of the building, cursing the people within. They watched as helpless woman was stretchered into the building, to join the hundreds that had already died within its walls. The crowd had finally decided to put a stop to it.
History does not record who threw the first stone, or the second. The Spattering of rocks became a thundering torrent crashing against the buildings wall's, shattering windows and scattering the buildings denizens, who were chased and beaten by the angry crowd.
That building was Toxteth Park Hospital, the people being chased were Doctors and Nurses, and this event marked the start of the Liverpool Cholera Riots.
The beginning of the outbreak.
It was the age of the Industrial Revolution, Empire and Mass migration. Irish immigrants, escaping famine back home would often find themselves stuck in the overcrowded city of Liverpool whilst awaiting passage to the new world.
Like many cities of this era, Liverpool had become a haven for squalor and disease. Urine and faeces were flung freely into the streets and dribbled into the rivers from which the city drank. Tuberculosis and Typhoid rampaged through the poor and the vulnerable.
The industrialization of Europe meant more trade and faster transportation links. Textiles, coal and steel could make their way across the continent in record time.
Second hand rags from hospitals in continental Europe could be sold cheaply to farmers in Yorkshire to help them manure hops. But these rags happened to carry other passengers with them, the like of which had not been seen in England before.
It was known as "Asiatic Cholera" * at the time, and it frightened the rich and poor alike. Before the appearance of this disease, the word "Cholera" had only referred to seasonal stomach bugs and diarrhoea, and didn't actually relate to the severe disease associated with the bacterium we now refer to as Vibrio cholerae.
The month after these infected rags had been imported into Hull, the first cases of Cholera began to be recorded. Patients suffered from diarrhoea, severe cramps, followed by severe dehydration and then death, with the final symptom being the patients turning blue. It could turn a healthy person into a corpse within twenty four hours.
"A Few Fat-Bellied Magistrates"
In 1831, the epidemic devastated Sunderland, killing over 20,000 people. The outbreak spun out of control. The only medical treatments of the time consisted of brandy, bleeding and opium. When it reached Liverpool in 1832, panic was at an all time high.
A veteran medic who had experienced "Asiatic Cholera" whilst stationed in India tried his best to calm the situation, publicly stating that this "was not the case of an epidemic" like people may have heard about in Europe or Dublin. Not long after this, Cholera broke out on a vessel named the Brutus, claiming eighty-one deaths. It was clear that something needed to be done.
Liverpool's Board of Health did not have a great reputation at this time. They had been dramatically criticised as "a few fat-bellied magistrates" who had obtained their position through patronage rather than any medical expertise. Their first reaction was to deny any existence of an epidemic, and their initial sluggish response to the early reports did little to instil public confidence. But they were not the main reason for the public's distrust of the medical profession.
Thieves of the dead.
In the early half of this century, medical schools suffered from a dearth of human cadavers for students to practice on. Such knowledge would be essential if they were to fully understand the workings of the human body. Human cadavers were a prized commodity, for which medical schools were willing to pay a high price.
In Edinburgh, two enterprising gentleman by the names of Burke and Hare decided to capitalise on this need by making a few corpses of their own. They killed 16 people and made approximately £8,000 in today's money before they were caught.
The ensuing scandal written across the broadsheets of Britain uncovered the complicity of the medical establishment. This, combined with sensationalised reports of grave-robbing combined with the public's general distaste for human dissection tarnished the medical establishment and anyone associated with it.
People were fully aware of the potential price their corpse would fetch from an unscrupulous physician. A patient walking into a doctors surgery did so with the fear that they could be worth more dead than alive.
Rage, Rumours an Riots
When Cholera began to spread through Liverpool people began to refer to doctors as "Burkers", invoking the more notorious of the murderers and implying that doctors were profiting from the deaths of their patients.
The medical board in the meantime had creaked into action, defying their own unfavourable reputations. They set up new hospitals, arranged special carts to carry sufferers to these hospitals. The doctors and nurses worked hard to help their patients, but were severely hampered by the fact that none of their treatments appeared to work. In fact, it is likely that treatments like bloodletting worsened the disease.
Things however came to a head when Mr Clarke and his wife fell ill from Cholera. The doctors were jeered at by the mob when they brought the sick woman into the building. At this point the Liverpool Chronicle picks up the story.
"Stones and brickbats were thrown at the premises, several windows were broken, even in the room where the woman, now in a dying state, was lying, and the medical gentleman who was attending her was obliged to seek safety in flight. Several individuals were pursued and attacked by the mob and some hurt."
The next few days saw the protests escalate. Mobs prevented doctors from carrying away their patients by any means necessary. They would halt the stretchers used to carry patients away, and when that didn't work they smashed them to pieces. In one incident, people opted to hide a patient away from a surgeon tasked with treating her, and upon confronting them is chased across town an forced to take refuge in a shop. Nightly gatherings surrounded the hospital in Toxteth Park. The police were often called in to hold back the worst excesses of the violence, but found themselves simply overwhelmed.
But it wasn't just the fear of the doctors that motivated people. Cholera hospitals were rapidly being set up, bringing sick people to places of business. Some of those in the crowd wanted the doctors to take their grisly business elsewhere. Conspiracy theories abounded about how doctors were perpetuating the epidemic for a £10 "cholera fee" paid out by local bureaucrats.
The Death Threat that stopped the riots
The medical boards response to the outbreak completely changed when a threatening letter was sent to the city's Mayor. In the content of the letter, the author promised to do "wicked things" to any doctors who attempted to treat the sick, signed "An Irishman". The author of this letter, without knowing it, gave the medical board the vital clue that helped them see the true victims of this outbreak.
Liverpool had probably the strongest Irish community of any English city. Many Irish Catholics picked up jobs on the dockyards of Liverpool, and found themselves and their families crammed together within the cities underbelly. They suffered more from this outbreak than any other community. It was no coincidence that theirs were the loudest voices arrayed against the dreaded doctors.
The Board of Health had to find a way to reach these communities. So they invited the Catholic clergy to a meeting to discuss the fears of their congregations, and solutions to the violence. Clergy were given a speech to deliver from their pulpits across the city
This speech addressed fears about the cholera outbreak, and announced in no uncertain terms that the people who were dying were not being dissected. Furthermore, it was declared that people had the right to go into the hospitals to see this all for themselves, to see the untouched bodies of their deceased before burial. The newspapers published the speech and its contents as well, and some doctors made a point of talking about it to people during church meetings. Peace soon broke out across the streets of Liverpool. The riots had been contained, so the process of controlling the disease could begin.
What can we learn from these riots ?
When we examine all of the attacks, riots and panic surrounding this latest Ebola outbreak, its hard not to see the echoes of history being re-enacted. The rumours passing within isolated communities, the suspicion of the authorities who are tasked with helping them that turns to anger when those same authorities take their loved ones away from them.
But in this story, we can also see the shadow of a solution, one that is already animating Muslim and Christian clerics in Sierra Leone. They are demanding better measures be taken to educate their congregations of the threat of the Ebola outbreak, so that they will be better prepared to accept the extreme measures needed to be placed on their communities.
What the Liverpool Cholera Riot teaches us is the importance of educating and informing the public. Those "fat-bellied magistrates" of the Liverpool Health Board figure out that the key to education is not just the message, but the medium by which its delivered. By winning over trusted members of the local community, and getting them to spread the truth about the outbreak, they could put an end to those riots. If this latest Ebola outbreak is to be brought under control, the people in charge will need to implement a similar strategy.
* The only doctors who had observed it were those who had been serving in the armed forces of the British Empire when this disease swept through India during the Kumbh Mela, hence why it is known as Asiatic Cholera.
Burrell S. & Gill G. The Liverpool cholera epidemic of 1832 and anatomical dissection—medical mistrust and civil unrest., Journal of the history of medicine and allied sciences, PMID: 16144959
Puntis J. 1832 cholera riots., Lancet, PMID: 11597715
Gill G., Burrell S. & Brown J. Fear and frustration—the Liverpool cholera riots of 1832., Lancet, PMID: 11476860
Howie W.B. (1981). Stephen T. Anning, The history of medicine in Leeds, Leeds, W. S. Maney, 1980, 8vo, pp. ix, 218, illus., [no price stated], (paperback)., Medical History, 25 (04) 442-443. DOI: 10.1017/S002572730003502X
Re-blogged from my other website at: http://defectivebrain.fieldofscience.com/2013/11/histor…