The First Global Cholera Pandemic and the Indonesian Volcano That Probably Started It

The Ganges delta — the substantial coastal plain across modern Bangladesh and West Bengal — had been the endemic geographic home of Vibrio cholerae for centuries before 1817. The disease was sufficiently common in Bengal to have a Bengali name (moriśona) and a substantial body of regional medical practice around its management. Until 1817 it was not a particularly notable disease outside Bengal. In August 1817 it became, for the first time in recorded human history, a global pandemic.

The proximate trigger has been progressively established over the last two decades of medical-historical research. The April 1815 eruption of Mount Tambora in the Dutch East Indies produced the Year Without a Summer of 1816 in Europe and North America. It also produced, in the year and a half following the eruption, substantially altered monsoon precipitation patterns across the northern Indian Ocean. The Bengali monsoon failed in 1816; the 1816 rice crop was a partial loss; the early 1817 monsoon was anomalously late and substantially over-heavy when it arrived. The combined effects of poor 1816 nutrition and unusually saline 1817 standing-water conditions across the lower Bengal delta produced an environment in which the endemic local Vibrio cholerae could multiply at unprecedented rate and, importantly, hybridize with related Vibrio variants in ways that produced a substantially more virulent strain.

Jessore

The first European medical observer of the outbreak was the East India Company surgeon William Tytler, posted to Jessore in the lower Ganges delta (modern Jessore District, Bangladesh) in August 1817. Tytler reported, in a dispatch dated 19 August 1817 to the Company medical office in Calcutta, an unusual outbreak of severe diarrheal illness affecting roughly half of the local British and Indian troop population at the Jessore military cantonment. The disease produced rapid dehydration, blue-grey skin discolouration, and death within twelve to thirty-six hours of onset. Approximately 7,000 people in the immediate Jessore district died in the first month.

The disease moved up the Ganges toward Calcutta over the following six weeks. By the end of October 1817 it had reached Calcutta itself. The Bengal Presidency colonial death rate over the following twelve months was approximately 1.25 million. The pre-1817 endemic Bengal cholera baseline had been perhaps 50,000-100,000 deaths annually.

The global expansion

The pandemic moved outward from Bengal along the existing British, Arab, and Asian commercial-shipping routes over the following six years.

By summer 1818 it had reached Mauritius via Indian Ocean shipping; Ceylon (Sri Lanka) by overland route; the Burmese Pegu by river trade. By 1819 it was in Siam, Java, and the Philippines — the latter via the Manila-Galleon route from the Spanish East Indies. The Dutch East Indian government in Batavia (modern Jakarta), under the brief British administration of Stamford Raffles until 1816 and the restored Dutch administration thereafter, attempted strict quarantine; the quarantine failed; an estimated 100,000 Javanese died over the following two years.

By 1820 the pandemic was in southern China (where the Qing imperial administration attempted, also without success, to seal the affected southern coastal provinces) and in Persia (where it killed perhaps 100,000 in the southern provinces over the following year). By 1821 it was in Mesopotamia and the Arabian peninsula; the Mecca pilgrimage of 1821 was substantially disrupted; perhaps 20,000 pilgrims died at Mecca or on the return routes. By 1822 it had reached Anatolia and the southern Russian frontier.

The decisive episode for the European medical-administrative consciousness of the pandemic was the cholera at Astrakhan, at the mouth of the Volga on the Caspian Sea, in autumn 1823. Astrakhan was the southern frontier of European Russia and a substantial commercial entrepôt; the arrival of cholera at Astrakhan brought the pandemic, for the first time, within continuous geographic-commercial reach of European capitals. The 1823 Russian winter coincidentally produced a hard freeze that prevented the disease from establishing itself further north along the Volga; the pandemic effectively ended in late 1823. The first global cholera pandemic had run for six years and killed somewhere between two million and ten million people.

The conservative modern estimate (R. Pollitzer’s 1959 WHO study) places the total at approximately 3 million.

What it changed

The 1817-1824 pandemic was the first global pandemic of the modern industrial-commercial era and the first in which the speed of disease propagation was substantially limited by ship-and-caravan transport rather than by walking-distance contact. The pattern would recur. The second cholera pandemic (1826-1837) would reach western Europe and the Americas. The third (1846-1860) was the pandemic during which John Snow walked the streets of Soho with his map and the Florence anatomist Filippo Pacini identified the bacterium nobody believed in. The fourth (1863-1875), the fifth (1881-1896) — during which Koch confirmed Pacini’s bacterium at Alexandria and Calcutta — and the sixth (1899-1923) would all follow the same general pattern.

The seventh, current cholera pandemic, originated in Indonesia in 1961 and is still ongoing. The pathogen has not been eradicated; modern cholera treatments (oral rehydration therapy, intravenous fluids, the WHO antibiotic protocols) are effective but require functional public-health infrastructure that is unavailable in many of the affected regions. Approximately 1.3 million to 4 million cases of cholera occur worldwide per year. Most of them are in countries with monsoonal climates and limited water-treatment infrastructure — substantially the same Bengal-East African-Caribbean geographic footprint of the first 1817 pandemic.

The Tambora eruption of April 1815 killed approximately 100,000 people directly in Indonesia. The European-Year-Without-a-Summer of 1816 killed perhaps 200,000 more through agricultural disruption. The cholera pandemic of 1817-1824 that Tambora-altered monsoon climates probably enabled killed somewhere between two and ten million across Asia, the Middle East, and the eastern Mediterranean. The volcano had global second-order effects two years after its eruption; the survivors of the first-order effects were still dying of the second-order effects in 1824.