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The Names We Use to Describe Our Diseases – A Story From Colonial India

The Names We Use to Describe Our Diseases – A Story From Colonial India

A metaphorical illustration of cholera bringing death into Europe, Le Petit Journal, 1912. Photo: Le Petit Journal/Wikimedia Commons.

In the autumn of 1817, a mysterious intestinal disease that had been endemic to the rural Ganges delta arrived in Calcutta, then the East India Company’s capital and a major centre for inter-Asian trade. The malady was associated with a variety of interconnected symptoms, among them lethargy, diarrhoea, vomiting, chills and abdominal pain. It came to be known as a ‘cholera’, one of several present on the Indian subcontinent, because it resembled a host of other diseases that caused those affected to forcefully expel fluids from their bodies.

As the contagion spread further afield – to British outposts in Burma, Sri Lanka and western India – colonial officials started to differentiate it from the ‘native cholera’ and the ‘summer cholera’, both of which were thought to be milder variants of the same disease. In 1819, James Jameson, the secretary to the medical board of the East India Company, wrote that the “disorder, as it lately visited India, was new in this alone” – in the fact that, “for the first time, [it] assumed the Epidemical form”.

Indeed, several medical experts contended that this was only a more virulent strain of a well-known ailment – one identified by the ancient Greeks, among others – rather than an entirely new disease. But as time wore on, the illness spread across the Middle East and the Indian Ocean; the severity of the outbreak in Bengal also increased and the death toll in South Asia rose to six figures. Eventually, prominent colonial administrators concluded that they were dealing with an unfamiliar beast.

This decision would have a significant impact on the relationship between the disease at the heart of the 1817 pandemic – which ultimately came to be known as the one and only cholera – and those less successful relatives, such as summer cholera and native cholera, that have over the decades faded into oblivion. The story also carries lessons for epidemiologists studying the relationship between COVID-19, the disease caused by the novel coronavirus, and such noteworthy predecessors as the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS).

Unlike public health officials and medical practitioners in the present day, the employees of the East India Company were powerless before their stealthy new nemesis. Quarantines and cordons sanitaires were beyond their administrative reach. What’s more, the bureaucrats in London and Calcutta thought that the many pilgrimages to the Ganges that accelerated the disease’s inland spread were far too lucrative and religiously significant to interrupt.

Of course, most public health officials in the 19th century were flying blind. The germ theory of disease had not yet become the main explanation for the spread of infections. And scientists were still unable to isolate the bacteria and viruses that produced contagions – hence the confusion among the several choleras. To the 19th century eye, diseases were hazy and indistinct.

Seeing the unprecedented amount of death and disruption, however, Europeans’ descriptions quietly shifted to emphasise the novelty and exotic provenance of the disease associated with the 1817 Bengal outbreak. In the process, these accounts distanced the pandemic condition from more benign counterparts, such as summer cholera and native cholera.

Like the new coronavirus – which several politicians in the West have called “the Chinese virus” and which US President Donald Trump once called the “kung flu” – the disease became the ‘Asiatic cholera’ once it surfaced in Europe. Changes in the symptomatology of this contagion also accumulated as the new cholera continued its merciless advance.

If the native cholera was associated with the temperature, air pressure and weather of British India, the Asiatic cholera was linked to trade over both land and sea routes. The 1817 pandemic exposed commerce’s uncanny ability to spread illness. The term ‘Asiatic cholera’ itself highlights this dimension by calling on the association in Europeans’ minds between Asia and trade.

By the early 1820s, the intestinal disease that ravaged the Bengal Presidency had been rechristened once again. Now dubbed ‘cholera morbus,’ or ‘deadly cholera’, the illness shifted from being a product of either colonial atmospheric conditions or commerce to being a product of industrial waste and urban poverty.

As the medical geographer Tom Koch notes in Disease Maps (2011), cholera morbus was just one of the names that the ailment carried when it was finally acknowledged as a global pandemic. But it was also one of the most popular early descriptors, as it designated a disease that could come from either East or West, in the bodies and excretions of both ‘natives’ and colonists.

With Latinate roots and an official allure, cholera morbus perhaps most closely resembles the term that the WHO has approved to refer to the novel coronavirus: ‘SARS-CoV-2’. There is another similarity between cholera morbus and SARS-CoV-2: in both common parlance and official use, these two terms have largely been left behind.

After peaking in the early 1830s, ‘cholera morbus’ quickly fell into disuse. By this time, the various conditions that had once been called native or summer choleras had also been eclipsed by a singular, implacable disease: cholera, tout court.

It is, of course, ironic that a pandemic disease initially identified on the Indian subcontinent received a name that alludes to a European ‘original’ – all the more so because, in the process, this condition replaced a multiplicity of older choleras that were actually western in origin. (Picture the confusion that would arise if the state of New Jersey all of a sudden decided to call itself the one and only Jersey!) But a similar dynamic of replacement and renaming has taken place with the novel coronavirus, which many people refer to as “the coronavirus,” as if there were no others.

Historians of science cannot easily tell whether the pandemic cholera was biologically different from any of its predecessors – Asiatic, morbid, native or otherwise. It is certainly possible that the older choleras were simply digestive illnesses that are now grouped under the heading of ‘traveller’s diarrhoea’. But they may have also been less potent varieties of the cholera that, in the 19th century, claimed millions of lives around the world.

There were, in short, many different choleras, each suiting disparate political interests and corresponding to particular communities affected by the disease. Today, as epidemiologists and public health officials reflect on the mutations – in naming, if not in genes – that the novel coronavirus has undergone, they must also remain aware of the transitions that previous diseases have endured on the path from local scourge to global contagion.

After all, public health officials in the countries with the gravest outbreaks, such as Brazil, India and the US, have insufficient testing capacity and so will be flying blind, like their 19th-century forebears. Unable to chemically differentiate the novel coronavirus from the seasonal influenza, as well as any other viruses that present similar symptoms, medical practitioners must once more pay keen attention to their patients’ descriptions of the disease.

Sergio Infante is a journalist and historian. He was, until recently, an assistant editor at Foreign Affairs.

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