The history of cholera in Italy

Cholera is an acute diarrheal infection caused by the bacterium Vibrio cholerae. It is transmitted by the fecal-oral route, for example through the intake of contaminated food and drink, and causes intestinal disorders and, in severe cases, dangerous dehydration. Between the nineteenth and twentieth centuries, this disease struck Italy several times, with numerous epidemics that plagued certain cities in particular, particularly Naples, where cholera spread on several occasions claiming many victims.

Precarious sanitation conditions, inadequate water and sewage systems, inability of Governments to recognize the emergency and respond with the most appropriate measures, poor attention to the risks of contamination of food: these are the main causes that, at the turn of the century, led cholera to spread in our country.

The spread of cholera has gone through several stages: from the great epidemic that struck Naples in the late 19th century, to the last outbreak, recorded in Bari in the 1990s.

From India to the rest of the world: cholera becomes a global disease

Cholera can be considered the first major global disease. In the XIXth century, in fact, this infection spread several times to the rest of the world from its original area around the Ganges delta in India, killing millions of people. As reported by the Istituto Superiore di Sanità, there are6 cholera pandemics that also affected Italy during that period: they occurred in 1835-1837, 1849, 1854-1855, 1865-1867, 1884-1886 and 1893.

The circulation of this disease, both in Europe and around the world, was fostered by England's military and commercial activities on the Indian continent and the advent of steam engines that made travel more numerous, as Eugenia Tognotti recalls in her book "The Asian Monster. History of Cholera in Italy."

The spread of cholera in Italy in the nineteenth century

In the nineteenth century, the explosion of cholera in Italy was very violent mainly because of the poor sanitary conditions that characterized the whole territory. As Tognotti again reports, a parliamentary inquiry revealed that between 1885 and 1886 most municipalities in the Kingdom lacked a sewer system, less than half were equipped with latrines and, in some, excrement was deposited in public spaces. Many municipalities also did not have potable water. Also dramatic was the situation of waste disposal, which in the villages and suburbs, where there was no garbage service, accumulated in the streets.

The waste was also deposited in the streets.

In this context, characterized by extremely poor public and private hygiene, cholera found fertile ground to spread, favored also by the arrogance of medical knowledge and a general distrust of the population in official medicine. A series of measures, such as maritime sanitary cordons and quarantine days for vessels from infected areas established in territories engaged in trade with other nations, such as the Kingdom of the Two Sicilies and the Kingdom of Sardinia, were adopted to stem the epidemic. These measures failed, however, to stop the spread of cholera, which was very fierce in some cities, such as Naples.

The cholera epidemic in Naples in 1884

Between 1884 and 1886, Naples was affected by a particularly devastating cholera epidemic that causedabout 6,000 deaths, accounting for two-thirds of the total deaths in Italy, and led thousands to flee the city. This epidemic wave is remembered not only for its very heavy consequences on health and mortality, but also for the impact that the reclamation work conducted to stem it had on the city's structure.

The Depretis government launched, in fact, a vast redevelopment operation of the most degraded areas of Naples that led to the razing to the ground of entire neighborhoods. The operation focused on tearing down buildings, including historic ones, instead of focusing on their redevelopment, the construction of sewer networks, and the establishment of a public system for garbage collection, and for this it was heavily criticized. Many accused this reclamation plan of fostering only huge speculation, paving the way for the building of new residential neighborhoods in the old working-class neighborhoods expropriated from the poor, without, however, allocating them to the less affluent classes, who continued to live in dilapidated areas and in very poor hygienic conditions.

They were not able to build new housing estates in the old neighborhoods.

Cholera in Italy in the 20th century: the 1910 epidemic

During the 19th century Italy was hit by new cholera epidemics. The first occurred between 1910 and 1911 and posed a serious health threat, although it did not cause high mortality. In 1910 it remained confined to southern regions, especially Apulia and Campania, where it caused about 800 deaths. The following year, however, it had more dramatic consequences, claiming more than 6000 victims, three-quarters of them in Sicily and Campania. Because of the large number of people reaching the embarkations to emigrate abroad, in fact, the spread of cholera was particularly violent especially in port cities such as Palermo and Naples.

A epidemic long concealed, both by the Neapolitan health authorities and by the Government Giolitti then in office, as denounced by physician Henry Downes Geddings, an American officer then serving in Naples, in letters sent to his superiors in New York. As recounted by historian John Snowden, who analyzed those documents in his "Naples in the Time of Cholera, 1884-1911," the fear that news of the contagions, if leaked, would compromise Italy's trade relations with other countries led first to deny the existence of cholera in Naples, then to declare the epidemic over in 1910, when the disease was, in fact, still rampant.

The return of cholera to Naples: the 1973 epidemic

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In1973 cholera again made its appearance in Naples. This time the scale of the emergency was more contained, but the memory of previous epidemics triggered a climate of fear mixed with astonishment and disbelief: in fact, there was a widespread belief that in an industrialized country like Italy this disease could be considered definitively defeated. As the Treccani Atlas recalls, two cases of acute gastroenteritis occurred immediately after Ferragosto that caused no particular concern. However, in the following days, a few deaths raised fears, and on August 29, Il Mattino announced the existence of an epidemic that had already caused five deaths and the hospitalization of fifty infected people. To stem the spread, the authorities banned the consumption of raw fish and shellfish, which was blamed for this new wave of cholera.

The authorities also banned the consumption of raw fish and shellfish.

Unfortunately, thanks to an extraordinaryvaccination campaign, the epidemic was contained within a few weeks. Official figures speak of277 infected and 24 deaths, mostly concentrated in Naples, although cholera outbreaks occurred in other parts of Italy as well: inSardinia, Rome, Milan, Florence, Bologna, and Pescara.

Bari, 1994: the last cholera outbreak in Italy

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The last outbreak of cholera in Italy, fortunately of reduced proportions, dates back to 1994, when in Bari a dozen contagions caused by the consumption of raw fish were recorded.

Today this disease remains endemic in Africa, Asia and America, while in Italy and Europe there are very few cases each year, involving only citizens returning from countries where cholera is still present.

Sources:

Superior Institute of Health (ISS): Epicenter - Epidemiology for Public Health

ISS Health - Inform, Know, Choose

Eugenia Tognotti, The Asian Monster. History of Cholera in Italy, Editori Laterza, 2000

Odoardo Bussini, Donatella Lanari, Le ultime epidemie di cholera in Italia nel Novecento, in Per una storia della popolazione italiana nel Novecento," Forum Editrice, 2016

Frank M. Snowden, Naples in the Time of Cholera, 1884-1911, Cambridge University Press, 1995

Treccani Atlas: The Lesson of the 1973 Cholera Epidemic

University of Naples Federico II - Department of Public Health