April 2021

Cholera in the time of COVID-19

Behind the Book by

Anna Lee Huber shares what it was like to write about the cholera epidemic of 1832 while the COVID-19 pandemic was affecting her own life.

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Anna Lee Huber always knew that her Lady Darby mysteries, which are set in the 1830s, would eventually reach the cholera epidemic of 1832. What she couldn’t have known was that she’d be writing A Wicked Conceit, in which sleuth Kiera Darby must solve a series of crimes in a disease-stricken Edinburgh, while the COVID-19 pandemic was affecting Huber’s own life.

Illness is nothing new, and neither are epidemics, for that matter. Yet very few of us living in the developed world have experienced a pandemic. We’ve read about them in history books, but we haven’t experienced the strain and uncertainty and immediacy of dealing with one—until now. 

When I first began writing the Lady Darby mysteries and decided to set the first book in August of 1830, I always hoped the series would last long enough for the characters to reach the year 1832. But while I was aware that my characters would eventually have to wrangle with the cholera epidemic that struck Britain beginning in late 1831, I had no idea I would be writing about it while enduring a new pandemic in our time—nor could I have predicted how my own personal experience with a pandemic would inform not only my understanding of the past but also our present predicament.

First I had to confront the methods used for controlling a pandemic and treating disease in 1832 and how they differ from those we utilize today. Our scientific and medical knowledge has progressed immensely in 188 years. For one, we now understand that viruses and infections like cholera are caused by germs and not by miasmas.

In 1832, miasma theory was the predominant medical theory held by the brightest minds of the age to explain how diseases spread. The belief was that bad, noxious air emanating from things like rotting corpses, marshy land areas and other putrid matter actually released vapors that caused people to fall ill. This “influence in the atmosphere” was also believed to afflict those who had weakened themselves by exposure to certain behaviors, places or “exciting causes.” These theories promoted the idea that only people of “irregular habits” should fear diseases like cholera. So in addition to avoiding noxious air, doctors prescribed preventatives that were supposed to keep you from contracting dreaded diseases.

One of the most useful measures was the establishment of the first Central Board of Health, which was based in London with branches in other cities throughout Britain. The World Health Organization and the Center for Disease Control are the modern equivalents of these Boards of Health. Also, much like the regular televised coronavirus briefings held in 2020, the 1832 Central Board of Health published the Cholera Gazette to disseminate information to the public in an organized manner. Broadsides were posted that advised people of what foods to eat, how to clean themselves and their homes, and how to be mindful of the weather and the suitability of their clothing. Buildings in infected areas were even cleaned and whitewashed.

Quarantine measures were rarely recommended because cholera didn’t seem to spread by contagion but by personal contact. Contagionism was a precursor to germ theory, so it conflicted with the accepted concept of miasmatism. Quarantine was unlikely to have been effective anyway because the bacteria that causes cholera is not airborne like the virus that causes COVID-19. We now know that the reason cholera outbreaks kept recurring despite all the Central Board of Health’s efforts was that they failed to address the true source of the disease: open cesspools throughout communities.

It wasn’t until 1854, when Dr. John Snow was able to trace the source of a single cholera outbreak in London to a specific water pump, followed by a decadelong fight for germ theory to overtake miasma theory, that the real cause of cholera was pinpointed and accepted. Once significant sanitation improvements were made and uncontaminated water supplies were created, cholera became largely eradicated from many parts of the world, though areas without these two crucial elements still struggle with the disease.

While writing for an audience now familiar with the masking and social distancing protocols of the COVID-19 pandemic, it was important to communicate the differences in methodology between the medical community of 1832 and today. However, the feelings of dread, fear and misgiving that people experience during such times of crisis were as present in the past as they are today. The desire to make sense of such a calamity, to understand its cause and to draw some sort of meaning from it, was just as strong. 

Some people in 1832 found healthy ways to grapple with these issues and emotions, while others responded with anger and vitriol. Pamphlets from the time railed against people’s sinful natures and called on the government to change laws to save people from their own iniquities, correlating the concept of contagion with the idea that cholera was divine punishment for intemperance and immorality. Others even blamed doctors for allowing or causing people to die of cholera so their bodies would be available for dissection in anatomy schools. This fear ultimately resulted in violent cholera riots throughout Britain and Europe. 

But not everything that can be gleaned from our study of past pandemics is dire or disheartening. In fact, there is great comfort to be found in realizing we have been through difficult times like this before, and we’ll get through them again. Chaos and uncertainty may reign for a time, but humanity will eventually prevail. Science and social understanding will be advanced. We’ll emerge with a better understanding of the past, and hopefully of ourselves and others. As an author, I now have a greater empathy for the characters who inhabit my pages and the misfortunes I inflict on them.

Anna Lee Huber

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A Wicked Conceit

A Wicked Conceit

By Anna Lee Huber
ISBN 9780593198445

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