succession that many of the most infamous plagues of humanity things like actual plague leprosy gonera syphilis cholera tuberculosis all of these diseases were caused by bacteria and so they forever became known as germs they became cast as villains as antagonists that we needed to destroy lest they
This is the one that interests me the most, in part because it's very deadly. Cholera kills about half of the people who get it, if they're not rapidly treated. But also because cholera is one of the most successful of our pandemic-causing pathogens.
And so what I wanted to look at is, what are the drivers that turn a microbe into a pandemic? Cholera started in the environment, which is where a lot of new microbes are coming out of today. It comes out of a place called the Sundarbans.
It shows a pretty clear picture. Cholera is coming down the Hudson River. It's coming down the Erie Canal.
Some of the famous numbers were the chest sizes of Scottish soldiers, the number of Prussian officers who were killed by kicking horses, the number of victims of cholera. And with lots of these precise numbers at their disposal, any up to date statistician rejected Bayes' rule. They preferred to judge the probability of an event by the frequency that it occurred--nine times out of ten, three out of four, and so on. And eventually they
But nonetheless, there was a big storm, lots of water. And cholera is water-borne. It's spread through water.
And your job is to wash them and to get rid of the buckets and fill it with chlorine, because chlorine neutralizes the cholera toxin. And we were building beds. We'd run out of beds.
But it wasn't true when cholera was a brand-new disease. When cholera first emerged in the 19th century, it hit some of the most advanced cities of the time-- cities like New York, which was plagued by repeated epidemics of cholera in the 1800s.
When cholera first emerged in the 19th century, it hit some of the most advanced cities of the time-- cities like New York, which was plagued by repeated epidemics of cholera in the 1800s. And not just New York City-- London, Paris, New Orleans-- all these places were plagued by this scourge.
play in disease. After decades of study and experiment on this field in his late 50s, he decided to investigate the deadly disease of cholera. He wanted to figure out how these germs operate, and what makes them so fatal. As part of his research, he injected chickens with cholera and he observed how the disease progressed.
And so yes, that's another possibility. large cholera epidemic. There's been lots of other cases.
There are, like, stories of hospitals treating wounds with ice, and then the ice makes you get a disease, and your wound isn't even the problem. - They're getting cholera, they're getting food poisoning or ice poisoning. I mean, they're getting very, very sick.
So it was founded as the Boston City Hospital in, I think, I want to say, the 1860s, in the middle of when Boston was being ravaged by a cholera epidemic. And at the time, there were other hospitals in the city, but those hospitals were really specific about who they would take care of.
So there were epidemics. There was cholera. There was typhus. There was polio, pneumonia, dysentery, all these diseases that spread rampantly.
One of the things that really got me into gut microbiome research was even through my graduate-- for over 100 years, since Snow and cholera, bacteria have been seen as a problem, disease-causing vectors that are just harmful to humans.
The huge buckets at the top left of that top left picture, they're about 200 liters of oral rehydration solution, which is if you're only a moderate case, you just need to top up. The management of cholera is to avoid dehydration. It's as simple as that.
The normal human need is 2.7, call it three, liters in a day without extra losses, so three liters, 24 hours. A severe case of cholera may need five, six, seven liters in the first two hours. You die in two hours by vomiting and diarrheaing your entire body fluids out.
And there was fear in the community. There hadn't been cholera for centuries in Haiti. And so when we were first doing transfers during the day, they were throwing rocks, burning tires.
It's hard to deal with. And then the cholera came. And I've just told you how that was hard.
Certainly some things missing. Massive outbreak of cholera, so much so that city officials believed that they would lose the city.
Chimps are terrible, terrible people. There was a cholera epidemic in Soho, and it killed a lot of people.
Chimps are terrible, terrible people. You got cholera. Everyone thought was a miasma, which is this specter of a cloud of noxious fumes.
Cholera kills about half of the people who get it, if they're not rapidly treated. But also because cholera is one of the most successful of our pandemic-causing pathogens. It hasn't caused just one or two pandemics.
And the latest one is going on right now just a few 100 miles off the coast of Florida in Haiti. So we think of cholera today as a poor person's disease. And that is basically true now.
For example, in 1832, the Governor of New York actually sent a doctor up to upstate New York and Canada to see what was happening-- to do surveillance, see if cholera is going to threaten the City of New York. And this is the data that that doctor collected in 1832, which we've mapped.
But they didn't, because private interests decided that that would be far too disruptive to trade. And so cholera was allowed to come down these waterways again and again. In fact, there were companies that were making money selling cholera-contaminated water to the people of New York.
Like I said, his kids now are going to have to fight for a place at primary school. There's cholera. It's not a good situation. I recently checked Guled's Facebook profile.
And this, he said, was connected to the fact that they would sooner grow beards, they would be naturally quick-witted, they would be courageous and have strong appetites. Unfortunately for choleric men, they're also liable to be arrogant, graceless, quarrelsome, fraudulent, and constant and crafty. Whereas, he says, phlegmatic men-- and I'm sure I don't need to explain what phlegm is.
and drink is not going to kill you? That doesn't contain cholera, or typhoid, or any other number of waterborne diseases which have been the scourge of humanity throughout history? And again, if you're scavenging through the abandoned supermarkets and dead cities, you could get things like kitchen bleach.
And they began to suffer from cholera.
And on the way out to go to the car park, we had situated a pre-triage area. You don't want any patient with cholera to be able to enter the hospital. It's highly infectious. And we had pediatrics and obstetrics.
Dehydration that's caused from diarrhea and cholera was one of the primary killers of child under five in Bangladesh.
had been subject to several cholera epidemics that were believed to have been caused, very likely correctly,
And that is basically true now. But it wasn't true when cholera was a brand-new disease. When cholera first emerged in the 19th century, it hit some of the most advanced cities of the time-- cities like New York, which was plagued by repeated epidemics
And what had happened there is, in 1832, a bunch of Irish immigrants were working on a stretch of railway track. And there had been a cholera outbreak. And the local community quarantined the valley that the Irish workers are staying in.
It's quite warm. It's quite alkaline. And the bacteria that causes cholera actually lives naturally in this environment, and in similar environments around the world. It lives in conjunction with zooplankton.
In fact, a person infected with cholera can lose 15 liters of fluid a day. And that's what kills you from cholera. You basically just dehydrate to death.
You desiccate. It can happen in a matter of hours. So the first pandemic of cholera began in the Sundarbans in 1817. It started traveling up into Russia, out into this newly industrializing cities of the Old World.
It's like a highway system. And it was perfect for cholera to come over from London to Paris, over the Atlantic into Canada, and thence filter throughout the interior of North America. And of course, at this time we were urbanizing really rapidly.
into the groundwater. The typical 19th century New Yorker was ingesting about two teaspoons of fecal matter every day. So you can imagine when cholera came into a city like that, it just exploded. And this happened time and time again.
In fact, there were companies that were making money selling cholera-contaminated water to the people of New York. The epicenter of a lot of the cholera epidemics happened in a slum called Five Points, which is pictured here. If you've ever seen the movie "Gangs of New York," the Martin Scorsese movie, that's actually about Five Points.
So everybody pretty much drowns in water. And at the moment there is a cholera epidemic in the camp, because every rainy season without the sanitation, the disease just licks through the camp like wildfire. The way that people survive in the camp is through food rations, which all of us, through our tax dollars contribute to the United
If it didn't have cholera in it, and cholera smacks Haiti, you'd better change the plan.
He needed to abandon work on these experiments over one summer, but when he came back to his lab he resumed them. And he once again injected some cholera into a group of chickens, which we shall call group A chickens. These chickens fell ill, but to Pasteur's surprise, all of them survived.
These chickens fell ill, but to Pasteur's surprise, all of them survived. He surmised that the batch of cholera that he had injected into them had become weakened over the summer months. And so he ordered a new, fresh batch of cholera and he proceeded to inject it once again into the group A
Ghost Map" is a story about a cholera epidemic in London, in the 1850s. And I got interested
New Zealand I've dealt with a cholera epidemic in the 1850s in London all the
They were lacking clean water and suffering from cholera.
He removed the handle on that pump and lo and behold cholera was declining.
And in fact, Haiti was the first time Google got together with MSF. You helped with some mapping of the disease of cholera when it struck the country later in the year, in October time. And I'll come on to a little bit of the cholera experience there.