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  I Came From the Water Vanita Oelschlager, author Mike Blanc, illustrator 4 Stars ………………………………….. I Came from Water (subtitled), One Haitian Boy’s Incredible Tale of Survival, is a story based on true events, told from the viewpoint of a surviving child. Moses was an infant when floods destroyed his hometown killing many people, including his [...]

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By Christopher Hamlin

The recent Cholera outbreak in Haiti reminds us that this is not simply a disease of the distant and unsanitary past. The current outbreak is both unique and typical. Caused by a disease that has a long and devastating history, this Haiti outbreak has much in common with the outbreaks of the nineteenth century and twentieth century. History helps us keep in mind five key factors:

The Role of Media Coverage in our awareness of cholera: In our current age, as well as in the past, the combination of rapidity and deadliness has made cholera epidemics into media events. In fact, much of the tragedy of global diarrheal disease happens beyond the public gaze. Vibrio cholerae accounts for only a small fraction of global diarrhea deaths. The microbe is widely distributed around the world. Most cholera cases are mild, often they will be unnoticed.   Unfortunately these, and particularly those many diarrhea deaths, have become part of our normal.

Epidemiological Monroe Doctrinism: In the months preceding the Haiti outbreak there were outbreaks in Pakistan (following floods) and in parts of Africa. Western hemisphere outbreaks are news because they seem to threaten the sanitary sanctity of the U.S. Some reporters ask outright whether cholera will come to us; others hint. But how serious a problem cholera is conceived to be usually depends more on where the outbreaks are than how many are affected.

“Withering Othering”: This is a phrase I used in the book to indicate the ease, which came to prominence in the nineteenth century, with which we use presumed sanitary status to group human populations. Cholera epidemics are occasions for magnifying distance between a clean “we” and a dirty “they.” Cholera is rightly associated with poor sanitation, along with the host of social, economic, political, and cultural factors that contribute to its spread. But often, blaming unsanitary conditions is an excuse to lose sight of that bigger story. Haiti has often served as default abjectness for the western hemisphere. When something bad happens, we shrug and say “Well, it is Haiti.” Cholera reinforces that abject ahistorical identity. I have taught a bit of Haitian history, am an admirer and minor collector of Haitian art, but certainly no expert. But the historian’s business is to explain both the perception of abjectness and the complicated antecedents of this cholera. Earthquake destruction is part of that latter story, but diarrheal disease was high in Haiti even before that. Haiti is a poor country, with a difficult political past.    All this is coming to bear tragically in a large number of individual lives.

Pretense of Order: As an outside observer, most of the information I get is though press conference statements. In these, whatever has happened and however many have just died, is equalized as grey fact. Nothing ruffles bureaucratic prose, well organized web-sites, or well-dressed spokespersons. Effective response, it seems, requires emotional control, and, somehow, an overlooking of tragedy. This is not new – historians of epidemics will have often been struck by the disparity between the chaos of mass disease and the need to project that those in charge have things in hand — but I was shocked to see it happening. The cholera riots in Haiti too are wholly typical – people in cholera-stricken cities have rioted throughout the world both in the nineteenth and the twentieth centuries.   Often, in various ways, the pretense of normal seems to be at the root of their anger.

Preparation and Distribution of Resources: Cholera’s status in

Joanna Ng, Intern

Christopher Hamlin is Professor of History and of History and Philosophy of Science at the University of Notre Dame, and Honorary Professor at the London School of Hygiene and Tropical Medicine. His book, Cholera: The Biography, is a volume in our series Biographies of Disease, which we will continue to explore after the new year (read previous posts in the series here). Each volume in the series tells the story of a disease in its historical and cultural context – the varying attitudes of society to its sufferers, the growing understanding of its causes, and the changing approaches to its treatment. In the excerpt below, Hamlin compares European and Asian cholera therapies.

When East India Company surgeons began in the eighteenth century to practice their craft among the troops and traders in South Asia, they encountered new diseases, some of which affected delicate Europeans differently from locals – though that was hard to gauge, since their practice among these others was occasional and unrepresentative. Within the dominant Hippocratic framework, it was assumed that place modified bodily processes; it made sense to think that local practitioners knew best how to respond. Throughout the eighteenth and well into the first half of the nineteenth century European practitioners, French as well as English, would seek local knowledge of cures. They found multiple communities of healers, Muslim and Hindu, familiar with a disease that was most commonly known in Arabic as haiza, or as mordesheen in Mahrattan. (The latter term evolved into mort du chien, though it had nothing to do with dying dogs, and even into Merde chi – it certainly did have to do with merde.) In many cases, their techniques, and the principles that apparently underlay them, were similar to European therapies for cholera morbus. Calomel, the “Sampson of medicine,” that would become the mainstay of mid-nineteenth-century cholera cures (”the only remedy that can cope with that enemy of life”) was already well established in India. And hardly surprisingly. The familiar humoral framework, the uses of mercurials and other heavy metals, reflected millennia of medical syncretism, of both theory and technique, from south-eastern Europe across most of Asia, and including China, a topic that would fascinate the cadre of late-nineteenth-century German philologists.

Strategies to redress the balance of humors, stop spasms, and support recovery were also similar. Tastes and smells were more central in Indian than in European medicine, evident in the use of spices and camphor. Essential oils were also much used, and seemed strikingly effective as specifics. They would be studied in twentieth-century clinical reviews but dismissed: their effectiveness seemed impossible to square with a bacteriological paradigm. External treatments to restore heat and ease spasms were also prominent. Mainly these were warm baths and friction, but they also included cauterizing the callused heel and ligating the limbs. That therapeutic theme would continue to be expressed in the issuing of flannel cholera belts to British Indian army. To promote recovery, Indian healers gave acidic dri