History: 1832, cholera arrives in France

From March to September 1832, the infection (a bacterium) causes the death of 18,400 people in Paris, increasing the number of deaths recorded annually from 25,500 to more than 44,000. On the whole of the French territory, more than 100,000 people are mowed down by the cholera. The pandemic which has its origin in Bengal (under the administration of the British crown), moved away from France in 1834, after causing havoc in the south of the country, particularly in Provence.

In 1846, a new home ofepidemic world declares itself in China : cholera arrives in Europe by theEngland and in France, by the port of Dunkirk in November 1848. The “cholera vibrio” which has not yet been discovered, spreads through the departments of Pas-de-Calais, Somme and Nord. It is soldiers already affected and moved from Lille to Paris, who bring the contagion to the Paris region.

Cholera devastates the capital

Cholera quickly affected the northern suburbs of the capital: the first death was officially recorded in Paris on March 7, 1849. Death, which occurred in half of the cases, was observed within forty-eight hours of the appearance of the first symptoms. Mortality intensifies sharply in May, peaks in June at the time of large heat ; the epidemic ceases during the month of October. In Paris, there are 19,184 deaths due to cholera, including 10,950 at home; people affected represent approximately 3.5% of the Parisian population. As in 1832, all age groups are concerned, but young children and the elderly are at greater risk. The medicine is unable to stop the progression of the disease and limit its effects.

In Paris, but this remains valid wherever cholera strikes, the social nature of the epidemic seems obvious: the counting of deaths by neighborhood indicates significantly higher mortality rates in working-class neighborhoods than in wealthy sectors. Same observation as in 1832: studies on the ravages of the epidemic show that the poor die more than the rich; the geography of cholera merges with that of poverty. In 1832, the social classes accuse each other: the bourgeois denounce a disease of the people which threatens them by contagion and the workers accuse the authorities and the government of attempted poisoning aimed at eliminating them. In 1849, the epidemic aspect of the disease, which is raging worldwide, is no longer disputed and it is accepted that it can affect everyone, escaping all human manipulation.

Contagion or infection?

Since 1832, a debate has agitated doctors and the French administration: is cholera a contagious disease or an infection? The importance of the question is such that beyond the medical aspect, the discussion has political implications. Major deadly epidemics have not affected France since that of the plague in 1720, but the principle of contagion imposed itself from the Middle Ages. As soon as an epidemic is reported abroad and can enter French territory, protective measures are taken to isolate those affected in order to prevent the spread. The cholera pandemic which spreads from 1830, causes a controversy among doctors about the contagion or infection. The retained idea of ​​”miasmas” proliferating in the air and contaminating subjects predisposed to contracting cholera, will develop rapidly. The debate is all the more lively as the new theory, which lacks scientific credibility, makes it possible to lift all the protectionist measures (in particular at the borders) which hinder the trade international. It also makes it possible to avoid any segregation between wealthy and poor classes.

Unsanitary conditions, cause of infection?

During the epidemic of 1832, the statistics relating to cholera in Paris reveal a real geography of the disease and affirm the link between misery and death. These findings are in line with the fears of “hygienist” doctors about the unsanitary conditions of homes. The French doctor Louis Villermé recognizes as a majority of his colleagues, that the spread of “miasmas” is favored by the lack of hygiene (existence of slums) and overcrowding. The good health of populations therefore depends on a healthy lifestyle in sufficiently ventilated housing, where bodily cleanliness must be the rule, as well as sufficient and healthy food. Such living conditions presuppose an ease and an education which are precisely lacking in slums!

the diagnostic seems posed and the demands for a political response are becoming urgent; doctors denounce the threat of slums but thesanitation authority of entire neighborhoods is not feasible. Many surveys are carried out on workers’ housing on the initiative of hygienist doctors who visit the major French cities. Louis Villermé (in his Table of the physical and moral state of workers employed in cotton, wool and silk factories, published in 1840) will leave powerful testimonies on the living conditions of the workers. Their tragic situation, which private charities are trying to remedy, is a revelation for the wealthy population. In 1849, this state of affairs was no longer ignored.

1849: cholera and law on the sanitation of housing

From the entry of cholera on French territory, the authorities remind that there is no risk of contagion even if many doctors doubt; the Academy of Medicine specifies that if cholera proves contagious, the duty would be not to say it! In January 1849, doctors from Nord and Pas-de-Calais insisted on the development of the disease in slums. In Paris, the highest mortality rates are found, as in 1832, in the most disadvantaged neighborhoods in terms of hygiene.

Social surveys confirm the importance of the environment and in particular of housing on health. With the approach of the second cholera epidemic in 1849, we are interested in the populations crammed into unsanitary housing in order to slow down the spread of the epidemic as much as possible. It is urgent to legislate: the law voted in April 1850, recognizes the principle of insalubrity and encourages measures of installation which lead to the destruction of hearths of infection (demolition of old slums).

Alongside the contagion/infection debate, the notion of public hygiene triumphs, with the idea that “miasmas” can be propagating agents of cholera and that they circulate particularly in unhealthy places. The controversy between defenders of contagion and those who believe that the disease results from an infection, is not yet based on any scientific basis. Practitioners already mentioned at the beginning of the 19th century, the possible existence of microorganisms cause of cholera disease. The bacteria responsible for cholera (the Vibrio Cholera), was discovered in 1854 by the Italian anatomist Filippo Pacini and isolated in 1884 by the German physician Robert Koch which demonstrates the role of water as a disease-transmitting agent.