cholera, an acute diarrhoeal disease transmitted by faecal contamination of water supplies and food, and long endemic in India, escaped from Bengal in 1817 to initiate the first of several world-wide pandemics. Asiatic cholera eventually appeared in England in October 1831 in the north-east port of Sunderland, supposedly imported from Hamburg; its presence was initially denied by those with mercantile interests, but it soon arose in Newcastle, Edinburgh, and London, before reaching France and then hurdling the Atlantic. Spreading capriciously, it caused some 31,000 estimated deaths in England and Scotland, and a further 20,000 in Ireland. A second outbreak commencing in London in 1848 was even more serious, despite a stream of regulations and recommendations, and affected all sections of the population rather than the ‘destitute and reckless class’ as before, with some 65,000 deaths in England, Wales, and Scotland and 30,000 in Ireland. The last two major outbreaks of 1853–4 and 1866 were milder. Mid-century attitudes of practical concern held by an enlightened minority (such as John Snow, who famously removed the handle of the Broad Street pump in 1854) spurred some sanitary reform, but there is disagreement amongst modern commentators about the impact of cholera on political, administrative, or social history. Despite its shock value, it was surpassed by tuberculosis and the fevers as a cause of death and debility, but local government reorganization facilitated progress in public health, and few cases occurred in Britain after 1893.

A. S. Hargreaves