Cholera, a disease with origins in South Asia, was the biggest medical and political concern of the British in the nineteenth century. Called the “scourge of India,” it killed nearly forty million people across British India from 1817 to 1947.

Cholera’s onset was usually sudden and its symptoms literally chilling. A medical journal in 1831, quoted by David Arnold, stated: “within the annals of medicine there are few, if indeed any, diseases which are attended with such a frightful array of symptoms, or which destroy their unfortunate victims with such relentless fury, as the pestilential cholera.” With no remedy in sight for decades, cholera boggled the minds of Indians and British alike.

There were several outbreaks of cholera in British India over the course of the nineteenth century with the 1817-21, being the deadliest. The impact of cholera on British soldiers was significant as disease, more than actual combat, was the overwhelming reason for the death of British soldiers in India. For example, out of the 9,467 losses during the Rebellion of 1857-8, only 586 troops were actually killed in combat or died because of their wounds.

Most of the rest died due to disease, with a significant number dying of cholera. Also, statistics from the Bengal Army between 1818 and 1854 show that British soldiers were twice as likely as Indian sepoys to be admitted to hospital and their death rate was several-fold higher than their Indian counterparts.

Only British officers fared well, but even there their admission and death rate was still higher than Indian soldiers. The difference in numbers among European officer and soldiers was explained by the sanitary and material conditions, where European soldiers lived in less ventilated, over crowded, and unsanitary barracks, and European officers afforded a much more spacious and hygienic existence. Thus, as David Arnold notes, “At a time when medicine could claim few therapeutic triumphs of its own, sanitation seemed to hold the key to improved military health and hygiene.”

Even as the Royal Commission on the Sanitary State of the Indian Army was deliberating its findings, the 1861 cholera epidemic killed over 61 percent of the infected British troops stationed at the Mian Meer cantonment at Lahore, highlighting the seriousness of the disease. Earlier the governor of Madras, Sir Thomas Munro, had died of the disease in 1827, while the commander in chief of the Bengal Army had succumbed to it during the early stages of the 1857 Revolt.

After the publication of the Royal Commission’s report in 1863, the Indian Medical Service was overhauled and sanitary conditions were markedly improved, resulting in a measurable decline in the death of British soldiers due to diseases, especially cholera. However, while the incidence of disease for British soldiers came down and was almost the same as Indian soldiers by the outbreak of World War I, no corresponding efforts were made to lower mortality rates for Indian ranks, and for the civilian population. Of course, the number of British soldiers in India was always small, and so manageable, but it was also thought that prevalence of disease in India, had religious and cultural connotations.

While cholera did not have a particular deity associated with it, as with smallpox, very quickly it became associated with large religious festivals in India, especially Hindu fairs and gatherings. Just like army movements spread cholera throughout the country, it was believed that Hindu festivals which involved communal bathing and sipping of holy water, like the twelve yearly Kumbh Mela at Hardwar and Allahabad, led to not only the spread of cholera among the pilgrims, but through them the contagion to their local communities as they returned home, thus created havoc.

Since Christian missionaries had been allowed in India from 1813, attacks on Hindu pilgrimages became an important element for exhibiting that the Hindu religion was unsanitary and caused spread of disease. As quoted by Arnold, a missionary wrote in 1828 about the Puri pilgrimage that, “Probably no spot on earth represents, within so small a compass, such complicated scenes of misery, cruelty, and vice, as are presented to view round the temple of Juggernaut.”

Cholera continued to remain a widespread rural phenomenon, despite some improvement in sanitation. It only increased in cities when in years of famine rural populations flocked to the urban centres.

These and other attacks on pilgrimages, made pilgrim into a “dangerous class” which had to be regulated. (In time, the Hajj pilgrimage would be similarly regulated on sanitary grounds.) However, the state was not ready to intervene and stop such pilgrimages for fear of causing yet another revolt. Even Hunter who noted in 1872 that nothing less than a “total prohibition” of the pilgrimages would control outbreaks of cholera, noted that doing so “would be an outrage upon the religious feelings of the people and cause great resentment”. But all medical officers also did not subscribe to this ‘pilgrim theory’, and JM Cunningham, the Sanitary Commissioner of the Government of India, dismissed it altogether.

As noted by Arnold, even after cholera broke out during the Hardwar festival in 1879, Cunningham held that “unless much stronger evidence can be adduced in favour of the pilgrim theory than has as yet been brought forward, such a measure as stopping the fair would certainly be an unwarrantable interference with the liberty and religious observances of the people.”

Towards the end of the nineteenth century it was largely believed that while cholera might be spread during a certain festival, the key was not to ban the fair itself, but as the Government of India explained to the rather eager Government of Bombay, the “best protection against an outbreak of cholera at large assemblies is to be found not in interference with the movements of the people, but in good sanitary arrangements both at the fair itself and on the routes taken by the pilgrims.” Thus, like with their primary army interest, the key for the British Indian government lay in sanitation over and above everything else.

David Arnold argues that cholera exhibited a ‘disorder’ in the system and as such proved to be a greater menace to both Indian and British sensibilities than any other disease. Where smallpox could be controlled by invoking Sitala devi, and by the ritual of variolation, there was no equivalent god or vaccine for the disease. Most importantly, there was no cure for the disease, either in Indian or Western medicine.

Thus, where vaccination for smallpox could show the superiority of Western medicine over Ayurveda and Unani medicine, Western science could not claim any victory here. In fact, often enough Western doctors employed Indian medicines in trying to cure cholera, hoping that since it had an Indian origin, local medicines might prove to be more effective. For example, in 1817, the Bengal Medical Board, recommended almost the same medicines as the local vaidyas and hakims in dealing with cholera, with the use of calomel, epsom, black pepper or senna. Thus, as Arnold concludes, “The distinction between ‘Europe’ and ‘Native’ medicine, in terms of its practice and practitioners, cannot, therefore, have appeared very great.”

Despite the lack of a clear cholera goddess (Ola Devi was at times invoked, but it seems that her remit was much larger than just one disease), there were several local responses to cholera. In some places, cholera was seen as result of divine wrath like in Bundlekand where its outbreak in 1817 was reasoned to be the result of the British troops eating beef and defiling the sacred grove of Hurdou Lal, the son of a local raja. Subsequently, Hurdou Lal was worshipped as a local deity.

In other places varied local religious explanations were sought, and in northern Konkan even Christians developed some local ritual, much to the chagrin of their local Catholic priest who saw idolatry in it. In some parts of northern India, some human ‘scapegoat,’ like a chamar or prostitute was also cast out of the village in order to placate deities and as a protection against the disease.

In terms of medical help, with the absence of a clear cure, Indian preferred their own methods than any recourse to Western medicine. In Madras for example, the several temporary hospitals set up by the government in 1819 went empty because, as noted by the Medical Board, locals ”evinced a great reluctance to reside in them even for a day.” In the Punjab, it was noted that a lot of people hid the incidence of cholera within their families for fear of being quarantined.

Cholera eventually declined in British India, though mainly in the cities, due to the introduction of better sanitary conditions. In cities like Calcutta where between 1841 and 1865 there were anywhere between 2,000-7,000 deaths per year due to cholera, after the introduction of a new sewage system and piped water in 1869, deaths only crossed 3,000 once till 1900.

Similarly, in the Punjab several measures were taken to improve sanitation leading to a much-reduced death rate. For example, in 1875 bathing on wells was prohibited, while in 1879 the Punjab Sanitary Commissioner directed local officials to keep city wells and tanks lined and clean. By 1908, people were being actively encouraged to drink boiled water.

But cholera continued to remain a widespread rural phenomenon, despite some improvement in sanitation. It only increased in cities when in years of famine rural populations flocked to the urban centres. In fact, in India, cholera often spiked during famine due to not just unsanitary conditions but also malnutrition and general weak health. This strong connection between disease and social disruptions, sadly, still remains a major cause of its prevalence in South Asia.

(To be concluded)