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Terry Foody: Collaboration and cooperation against epidemic threats is legacy of our global health

The United States disjointed response to the coronavirus with the corresponding spike in cases has resulted in the European Union and Canada removing the welcome mat. Previous pandemics illustrate a more cohesive approach.

In the 1800s the world was assaulted by repeated cholera epidemics that killed thousands. The collaborative efforts of politicians, physicians and the military in the fight against cholera show the way for COVID-19. These examples also reveal similar patterns as today’s response and resistance.

1832: The Cholera Bulletin. New York City physicians established a thrice weekly publication, inviting doctors to contribute. Purpose “to inform the citizens to quiet the public clamor” and hopes that non-medical men wouldn’t “resist the voice of the Profession.”

Greenwich Cholera Hospital was established for the poor in the former City Bank, with confusion regarding who was to be treated. The Bulletin filled with 1830s social media posts: “Patients laboring under cholera, others recovering from previous day’s revel.” They belied the “crowd of doctors and laymen, running from one room to another, talking and laughing.” Were they taking the epidemic seriously? Readers reacted to the lack of compassion: “Feelings of the poor should be respected, not insulted by the nonsense of Idlers. Admit no drunkards unless they have cholera.”

The opposite of stay at home, fear of cholera incited people to flee to the countryside to avoid the bad miasmic air of the city. Certain contributors admonished citizens it was “their duty to return to preserve Commercial interests from destruction.” (Rosenberg, 1972)

1875: The Cholera Epidemic of 1873 in the United States. A government report commissioned by Congress and President Grant. The Mercantile Marine sent letters to 260 physicians in affected districts seeking information on 20 detailed points including prevention methods, water closets in houses, privies, sewers, and topography. 84 physicians responded from 16 states, exposing polluting practices — railroads emptied bathroom contents on the track.

Kentucky’s 1873 Marion County Fair (included in report) was a perfect storm. Located on the Louisville and Nashville railroad, Lebanon built their privies over the Jordon stream. Two wells “both in miserable condition” served the public. With cholera present in nearby towns, doctors had the Jordan “cleaned & disinfected.” A handbill for the Fair, with signatures of M.D.s (one forged), claimed no cholera in Lebanon. However, after a “violent rainstorm filled the well”, several of the large numbers of Fair attendees fell sick and died.

This national report (1,000 pages with maps) accrued breakthrough treatments and research experiments. Suggestion was made for a national sanitary bureau to gather disease information “from all quarters of the world”. The U.S. began in 1930, CDC’s MMWR (Morbidity & Mortality Weekly Report).

The doctors lamented sanitary controls were “difficult to stop movement of people, change their habits or admit reality of disease.” (Woodworth, 1875)

1954 — SEATO: Collaboration reached a global stage with formation of the Southeast Asia Treaty Organization. President Eisenhower and Secretary of State John Foster Dulles joined by UK, France, and others. Cholera research was funded by SEATO due to officers’ requests for safety of their troops. Dr. Bradley Sack, Johns Hopkins, worked to develop IV and oral treatments.

1851: International Sanitary Conference, Paris. Twelve countries met in response to cholera pandemics. This organization continued to convene every decade, at times in Constantinople or Vienna, reporting on quarantine methods/results. In 1903 they agreed to inform each other of epidemics in their countries and established The Office of International Public Hygiene in 1907. These efforts evolved into the World Health Organization, formed by the United Nations in 1948. WHO had regulations and authority for vaccination, quarantine, and tracing with cholera.

The modern public health structure arose from devastating cholera pandemics. Collaboration and cooperation against epidemic threats is the legacy of our global health.

Terry Foody, RN, MSM, Kentucky Humanities Speakers Bureau, is a former Public Health Nurse.

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One Comment

  1. Terry Foody says:

    Find more in my book: “The Pie Seller, the Drunk and the Lady:Heroes of the 1833 Cholera Epidemic in Lexington, Kentucky with Lessons for our Global Health Today.”

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