Outbreak of 1848

The second major epidemic of cholera in the British Isles originated in Scotland in October 1848, but did not establish itself in London until February 1849.  This major epidemic proved to be the most deadly outbreak of the 19th century, with records showing 53,000 deaths in England.  By contrast, the outbreak in the years of 1831-1832 caused 20,000 deaths in England.

L0039174 Map of England showing prevalence of cholera, 1849
Map of England showing prevalence of cholera, 1849 Credit: Wellcome Library, London.

The outbreak of cholera showed certain patterns of attack that depended on specific factors such as time of the day and age.  In one report, there were 225 cases observed.  Out of the 225 cases of attacks, 118 of the 225 died.  The report observed the time of attack of cholera on the individuals.  From the times of 8 a.m. to 12 p.m., there were 35 cases of attacks and 26 of the 35 died.  From 12 p.m. to 4 p.m., there were 18 cases of cholera attacks observed and 8 of them died.  From 4 p.m. to 8 p.m. there were 33 cases observed and 18 died.  Midnight to 4 a.m. showed the highest number of cases of attacks at 56 and out of the 56 there were 20 individuals that died.  From the time of 4 a.m. to 8 a.m. the number of cases of cholera attacks was less than midnight to 4 a.m. showing only 51 cases of attacks, but this time period recorded the highest number of deaths at 27.  These recorded cases showed that most of the attacks and deaths occurred between the times of midnight to 8 in the morning.

Age also proved to be a factor on the frequency of attacks and deaths.  2322 cases of cholera attacks were observed for this study, and out of the 2322 cases there were 1058 deaths.  91 of those deaths occurred in individuals under the age of 10 out of 192 cases.  Nearly double the amount of cases between the ages of 10 and 20, there were 315 recorded cases with 113 of them dying.  The bulk of the cases occurred between the ages of 20 and 30 with 616 cases and 30 to 40 with 532 cases.  Out of the 616 cases, 269 individuals died and 234 of the 532 cases died.  There were also a lot of recorded cases between the ages of 40 to 50 with 415 cases and 195 deaths.  The number of cases and deaths dropped as age goes up with only 138 cases and 77 deaths for individuals aged 50 to 60, 93 cases and 65 deaths for 60 to 70, and 21 cases and 14 deaths for 70 to 80.

Unsanitary Conditions

Throughout the epidemic there were different theories of causes of the cholera outbreak, but there was one cause that was unanimous and that was the unsanitary water-supply.  Most of the citizens obtained water from wells, and the contents of sewers and drainage from graveyards had leaked into the water supply.  Many people did not notice that the water was necessarily dangerous and unsanitary at first, except the occasional bad smell or muddiness.  After some time, residents who used well water started to complain about the supply.  Some were quoted as saying, “The Water looks rather muddy, and has not been clean since the pump was mended” and others spoke of residue on their pans like soapsuds.   John Snow was thoroughly convinced that the spread of cholera was through contaminated and unsanitary water.  He had gathered a lot of evidence and in 1849 during the second year of the outbreak he published a pamphlet titled On the Mode of Communication of Cholera that contained the necessary information to support his theory.  He believed that unsanitary conditions existed in many neighborhoods and that the contaminated water can spread to the clean water.  He believed that wells and water pipes had to be kept isolated from drains, cesspools, and sewers if people ever wanted to stop cholera epidemics.

Cramped living quarters were another major reason that the disease spread so much so fast.  One of the first outbreaks in Bristol happened in the three courts of Wellington and Gloucester.  The area was not that large, spanning only 1850 square yards.  The area was bordered by an overcrowded graveyard, where the drainage caused unfavorable conditions for the residents.  Due to the small living space and unsanitary conditions, once one person caught the disease it did not take long until others did too.  There was little to no ventilation and the houses were all too close to each other to avoid catching the disease.

Progress for the Future

The outbreak started in 1848 and did not arrive in England until 1849, but it made a huge impact.  One of the worst, if not the worst, cholera outbreak in the history of England, many lives were lost.  However, there were a lot of doors opened during the epidemic.  People were becoming more aware of cholera and the causes as well as how to treat it.  With each outbreak comes new knowledge to treat, prevent, and contain the disease.

Written by Andre Vuong


Father of Modern Epidemiology. Accessed April 07, 2016.

Snow, Stephanie J. “Commentary: Sutherland, Snow and Water: The Transmission of Cholera in the Nineteenth Century.” International Journal of Epidemiology 31, no. 5 (2002): 908-11.

Sutherland, Dr. “Extracts from Appendix (A) to the Report of the General Board of Health on the Epidemic Cholera of 1848 & 1849a.” International Journal of Epidemiology 31, no. 5 (1850): 900-07.