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importantly, it catalyzed the development of modern sanitation, which enabled huge numbers of people to live together in close quarters and remain healthy, making the modern city possible. Sanitation is also partially responsible for the human population explosion. About one billion people inhabited our planet in 1800. We’re over six billion and counting today.

Feeling blue
    For most of the nineteenth century, people didn’t know what caused cholera.
Miasmists
—followers of the ancient theories of Galen—blamed the disease on mysterious emanations: electrical currents (“the miasmic electric effluvium”), rotting garbage, foul-smelling sewers, and puzzling swamp vapors.
Contagionists
believed cholera was spread by contact with an infectious agent: bad cucumbers, bad beer, foreign food, shellfish, phosphorus, copper, sulfur, or other contaminants.

     
    Nineteenth-century industrial cities were fetid sties, mounded with garbage and human waste. Rivers served as both sewers and sources of drinking water, spreading cholera and other diseases. People died at rates rivaling those associated with the Black Death.
     
    Cures and preventatives were varied and contradictory. Several towns tried quarantines. Others experimented with noise: cannons were blasted, muskets fired, gongs banged, and shouts raised from sunrise to sunset. Several nations tried closing their borders to all travelers. Many individuals tried waist-hugging flannel cholera belts. Entrepreneurs made fortunes selling cholera brandy and cholera drops. Doctors prescribed hot poultices of salt, mustard,roasted black pepper, powdered ginger, scraped horseradish, or burnt cork. They also recommended ice-water baths, boiling-water baths, tobacco enemas, opium suppositories, and the ever-popular phlebotomy. England twice tried a National Day of Prayer and Deliverance. Nothing worked.

The price of empire
    We can blame the British for the spread of cholera. Like other empires before them, the British invaded and connected areas that had previously been isolated from one another. Cholera is endemic to India, killing unnumbered thousands in repeated epidemics since at least 400 B.C. It even has its own goddess on the subcontinent, Hulka Devi. The first cholera pandemic began in 1817, when Britain was in the process of conquering the subcontinent. British soldiers stationed near Calcutta contracted cholera and carried the disease across the Himalayas to the Nepalese and Afghans they were fighting along India’s northern border. From there, cholera was relayed overland to Burma and Thailand and by sea to Sumatra, Java, China, Japan, Malaya, the Philippines, and Arabia. Slave traders carried the disease south from Oman to Zanzibar. It also migrated up the Persian Gulf to southern Russia. In each of these regions, thousands, sometimes tens of thousands, died in a matter of days. The winter of 1823–24 halted the advance.
    The second cholera pandemic started in Bengal in 1826. By 1830, cholera had reached Moscow. By September 1831, the disease was in Islam’s holiest city, Mecca. (It became one of the established dangers of the Muslim pilgrimage, reappearing forty times between 1831 and 1912.) That same year, it reached Berlin and Hamburg.

     
    Cholera became one of the established dangers of the Muslim pilgrimage, reappearing forty times between 1831 and 1912, until strict sanitation, vaccination, and quarantine were practiced. Here, cholera victims are unloaded at the port of Jaffa.
     
    A strict quarantine might have stopped cholera there. But in England, nothing was supposed to stand in the way of the free exchange of goods and services. Businessmen thwarted an attempted quarantine to keep out ships that had visited infected German ports. Soon cholera started sickening people in the English town of Sunderland. Again, business interests argued against quarantine: it would hurt profits, it would cause unemployment. Sunderland was reopened. Cholera spread through