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How the coronavirus crisis echoes Europe’s 19th-century cholera pandemic

 The same divisions of opinion that played such a fateful role in Hamburg in 1892 are with us today. 

As the world struggles to come to terms with coronavirus and think about its possible consequences, not least in the long term, we might ask whether there are any lessons or warnings we can take from the previous history of pandemics. Infections such as the Black Death of the 14th century are so distant in time that it’s hard to find parallels with the present. There have been very few visitations of mass epidemics on modern societies, on capitalist economies in which most people are engaged in waged labour, and on political systems dominated by political parties and elected administrations. 

One such, however, was cholera, a disease unknown in Europe before the 19th century. Endemic in north India, it was spread westward by trade after the British conquest of the region, which opened up trading routes across Afghanistan and Persia and into Russia. UK industrialisation not only stimulated trade with the subcontinent, it also created perfect conditions for the cholera bacillus to multiply in the overcrowded, insanitary and unhygienic towns of the new industrial era. Armies brought the disease with them as they marched across Europe: it’s no coincidence that the great cholera epidemics of the century coincided with periods of revolutionary upheaval and war – the Russian suppression of the Polish uprising of 1830, revolution and counter-revolution across Europe in 1848-49, the Crimean War of 1853-56, and Bismarck’s wars of German unification in the 1860s. 

But by the late 19th century, the threat of cholera seemed to have receded. A great clean-up of European cities had improved hygiene and sanitation, and in particular the provision of fresh, properly filtrated municipal water by municipalities and urban administrations had eliminated the major means by which cholera was transmitted – dirty, unhygienic drinking water that provided the ideal growth conditions for the bacillus, especially during the summer months. 

It was all the more shocking, therefore, when in August 1892, long after it had vanished from the UK and other west European countries, cholera broke out on a huge scale in the north German seaport of Hamburg. From mid-August, when the first case was recorded, to the beginning of October, when the epidemic came to an end, around 10,000 people out of the Hamburg conurbation's population of more than 600,000 died from the effects of the disease. 

Hamburg was known in Germany and beyond as an “English” town, run by a small oligarchy of merchant families for whom the interests of trade and industry were paramount. The senate – the municipal government, elected under a complicated voting system geared to the interests of businessmen and property-owners – prioritised economic interests above everything else. State expenditure was kept to a minimum. By 1892, medical opinion in Germany had come round to the view, propagated by the bacteriologist Robert Koch, that cholera was caused by a bacillus transmitted in unclean water. 

However, the Hamburg senate, terrified of the potentially disastrous economic consequences of a trade embargo if the epidemic became known, refused to appoint any of Koch’s followers to official medical positions in the city. As a result, its approach to disease was still dominated by the old-fashioned doctrine of “miasmatism”, according to which cholera was caused by invisible vapours rising from the ground, which meant that quarantine measures were useless against it. Acting on this belief, the parsimonious city government had also refused for many years to commit taxpayers’ money to the construction of a properly sand-filtrated municipal water supply, which alone would have eliminated the possibility of infection by the cholera bacillus. Expenditure on housing improvement, sanitation and hygiene were equally minimal. State intervention was kept low. 

The result was that when thousands of emigrants brought cholera with them by train from Russia, staying in cheap, tumbledown lodgings in the city before embarking for the US, they infected the river Elbe as it flowed through the city, pushing their excreta upstream with the incoming tide until they reached the inlet into the city water supply, which promptly delivered the bacillus to every household in the city that had a connection to it. When the disease duly broke out, the city fathers reacted by trying to conceal its presence. Under their instructions, doctors deliberately misreported deaths as due to causes other than cholera. It took a week for them to admit the presence of cholera in the city, an admission that led immediately to Hamburg being quarantined by the rest of Germany and, very soon, the rest of the world. 

The economic results for the city were disastrous. Trade virtually came to a halt, and with it the processing and re-exporting industries on which most of the rest of the municipal economy depended. The city’s health services were overwhelmed, and conditions in the overcrowded hospitals were said to be “frightful”. No effective treatment was available, and the few available doctors were unable to cope. 

The Kaiser’s administration in Berlin sent in Koch and a team of bacteriologists, who forced the city government to institute a hugely expensive programme of quarantine, disinfection and isolation of victims, together with the distribution of free fresh and uncontaminated water from tankers parked in the town squares. Field hospitals were acquired from the Prussian army. The city’s medical officer, a diehard miasmatist who had failed to do anything to deal with the catastrophe because he refused to believe that anything could be done, was fired, and Koch’s team was put in effective control of the city’s medical services. Eventually the epidemic came to an end. 

Quarantine led to mass unemployment and destitution, which the senate did little to alleviate. But it did not take long for the local economy to recover. The city’s municipal budget was back in surplus by 1894, and trade benefitted from a prolonged period of German and, indeed, world economic growth, up to 1914. The political fallout from the disaster was considerable. The senate was forced to appoint, for the first time, a paid body of full-time, professional local administrators, along with a Prussian-style police force. A clean water supply was constructed, state housing and hygiene inspectorates introduced, and plans were laid for a major programme of slum clearance.

None of this stopped the Social Democrats, representing the city’s large and growing working class, from sweeping the board in Hamburg in the Reichstag elections of 1893, which were based on universal male suffrage. The city was also forced to introduce a more democratic element into the municipal electoral system as a result of criticism of its handling of the epidemic. But the resulting growth in representation of the Social Democrats, endangering the hegemony of the merchant elite, led to the reversal of this reform in 1906. Slum clearance plans were only put into operation four years after the epidemic, prompted by a huge dock workers’ strike centred on the waterfront districts, which were swept away, to be replaced by offices and shops. 

In the longer run, however, the power of the merchant elite was seriously weakened, and Hamburg, though remaining a bastion of liberalism and the left in national terms, even in the 1920s and early 1930s, became less “English” and more “Prussian”.

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Can we learn anything from this catastrophe for our current predicament? While the differences between 1892 and 2020 are obvious, there are also some striking parallels. One of the most obvious lies in the nature of medical expertise. When we look at the disputes between miasmatism and contagionism in the mid-to-late 19th century we should not allow ourselves to feel complacent. True, medical science has made astonishing advances since then. Now, we confidently expect an effective vaccine for coronavirus to be devised, tested and applied in a year or so; in the 19th century, finding medical ways of preventing and treating diseases far more devastating in their impact took decades.

Yet the same kind of division of opinion that played such a fateful role in Hamburg in 1892 is also with us today. Influential voices, especially on the political right, advocated a laissez-faire policy of allowing around 60 per cent of the British population to acquire “herd immunity” through experiencing mild symptoms of the coronavirus, so that the spread of the disease would be effectively stopped. Others, above all in the medical profession, condemned this policy as unacceptably risky, and, backed by the media and public opinion, successfully pressed for a more active, more interventionist policy (albeit delayed). How many lives this has cost will only become apparent once the epidemic is over and the inevitable inquiry is opened. 

Both cases witnessed the astonishing spectacle of a liberal government inclined to minimise the state’s role in society being forced, after an initial period of reluctance, to intervene to an extent that would previously have seemed impossible. Who would have thought in July 1892 that the Hamburg senate would have to organise such interventions in people’s daily lives as the free distribution of water, the disinfection of houses and apartment blocks, or the inculcation of habits of cleanliness, hammering into people’s minds the need to wash their hands after going to the bathroom? 

Who would have imagined, even a couple of months ago, that Boris Johnson would launch a similar campaign to get people to clean and disinfect their hands for 20 seconds at a time, again and again? Or that this would be followed by the enforcement of far more radical measures of “social distancing” and “self-isolation”? Or that a Conservative government would preside over the effective renationalisation of the railways, the state payment of wages and income support on a vast scale, or increases in state expenditure amounting to £60bn to rescue people from economic ruin?

Whether these measures will have any long-term effect is another matter altogether. As local authorities scramble to house rough sleepers in hotels and hostels, the inevitable question arises of what will happen to these people once the epidemic is over. After all, if the homeless can be provided with accommodation in the space of a few days, then why hasn’t this been done before? Will they be summarily decanted on to the streets once the epidemic is over? If the example of Hamburg in 1892 is anything to go by, emergency social measures will be dismantled as soon as it is safe to do so, unless some other, equally compelling reason for maintaining them presents itself. Peter Hennessy has said that the epidemic will change everything, and future historians will come to divide the 21st century into two periods – BC, before coronavirus, and AC, after coronavirus. I’m not so sure. 

Despite some criticism, Johnson has not lost popularity since the epidemic began, and more people approve of his handling of the crisis than disapprove, especially since the lockdown was imposed. Few seem to believe that a major overhaul of the UK’s institutions is called for. 

In 2020, the great majority put their trust in medical experts, rather than politicians, as was the case in Hamburg in 1892, when Koch was trusted far more than the Hamburg senators. Not so long ago, Michael Gove was telling us that “people in this country have had enough of experts”. Now we’re all following their advice. Perhaps coronavirus will push politicians towards listening to experts more carefully in dealing with the many urgent problems confronting society today, from poverty to climate change, transport to education, and perhaps even relations with our neighbours on the European continent.

And there’s another reason for hope, too. A period of dramatic state intervention in society, state subsidy of welfare provisions, and higher spending on the NHS, will surely make it easier for any incoming Labour government, if and when one is formed, to implement a socialist agenda without running into alarmist denunciations from the political right. If Johnson can do it, then surely it can be done by whoever succeeds Jeremy Corbyn as Labour leader.

Richard J Evans is regius professor emeritus of history at Cambridge University, and the author of The Third Reich in History and Memory (Abacus)