THE MAN WHO DRANK POOP

“Oh yeah, cholera! I know cholera! That’s the one you caught on the Oregon Trail!”

Be thankful that the closest you’ve likely ever come to cholera exposure was watching your own ill-fated westward trek through the monochrome screen of an Apple II. In the real world, cholera is . . . very bad news.

If you want to get crass about it (and we always do), cholera is a vicious bacterial disease that can cause massive diarrhea. At first blush, that might sound like nothing more than a fairly yucky inconvenience, but cholera has been responsible for the deaths of millions throughout history.

HAVE BUG, WILL TRAVEL

The word “cholera” comes from the Greek word for bile, but the disease itself probably started out in India, and has been kicking around since ancient times. Throughout the centuries, this pernicious little bugger has spread influence by traveling via trade routes. Cholera has been responsible for eight epidemics throughout recorded history, the last of which was as recent as 2010, when a 7.0 earthquake decimated the infrastructure of Haiti.

Planning on getting cholera? Well, that’s a very bad idea, and frankly, we don’t know why you’re entertaining it. But you seem to be really into it, so we’ll be providing you with a step-by-step guide (see page 94).

Without a handy aid like the one we have so generously provided, historical societies had no idea why the disease was happening, or how to stop it. But they did know enough to stay away when an epidemic started.

In fact, quarantine was the only surefire method of staying healthy in many people’s minds, and a number of measures were taken to try and contain the disease. Sometime around the 17th century, for instance, it became maritime law that if cholera broke out on a ship at sea, it was required to fly a yellow flag to indicate the presence of the disease on board. Passengers and crew had to stay aboard in dock for thirty to forty days before they were allowed to come ashore once the yellow flag was flown. During an outbreak in New York City in 1832, 100,000 of the city’s 250,000 inhabitants left the city to avoid illness.

If a proportionate number of residents left the city today, we’d be talking about an exodus of 3.4 million people. To give you some perspective, that’s . . . a lot of people.

Those who didn’t flee the disease tried anything they could to fight it. In the Indian subcontinent, where cholera was endemic, traditional treatments sought to rebalance the humors, and calm intestinal spasms, largely through the use of heavy metals like mercury in the form of calomel—which was not only poisonous but also had laxative qualities, so it may not have been super helpful. Another remedy, published in an 1864 medical book, called for a tincture of brandy, peppermint, and a hefty dose of our good friend opium. Essential oils and spices were used as well, but this may have been to combat the smell as much as anything else.

Sometimes heat was the only treatment offered, in the form of baths, friction, cauterizing the heel (yeah, your guess is as good as ours on that one), or even using tourniquets on the limbs to cause redness and swelling.

Of course, bleeding was popular throughout history, only supplanted by opium later on.

One treatment account from the 19th century involved putting a paste of lemon juice, iron oxide, and alum over a man’s eyes. Here’s the account of a Dr. A.L. Cox who witnessed the treatment being administered by an Indian doctor:

“The pain it produced vexed and enraged the sick man, and he attempted to strike those around him; the vomitings became more frequent, his attendants fled to avoid his blows; he pursued them; passing by a reservoir of water, which served for the purposes of the garden, he plunged into it and drank with avidity for several moments. They surrounded him, but he remained tranquil in the water. The enormous quantity of liquid he drank, was followed by fainting. He was then removed from the reservoir and put to bed; he slept for eleven hours. When he awoke, the vomitings and dejections had ceased, but he was blind.”

Well, umm . . . win some, lose some, right? Win some . . . not vomiting, and lose some . . . sight. Seriously, I have to tell you, “win some, lose some” really loses something when you start filling in the blanks, huh?

RED FLANNEL DISEASE PREVENTION

While disease prevention is generally preferable to treatment, that only holds true when the method of prevention is based on sound science. Many people in the 1800s believed that a chilly belly could leave one open to illnesses such as cholera or dysentery. The solution: simply wrap a piece of red flannel around your middle. For many years, soldiers in the British Indian Army were issued two of these so-called “cholera belts” to wear under their uniforms. These persisted as part of standard military issue throughout the 1800s and were even used in some instances during World War I. And in fact, the concept of abdominal chilling as a cause of disease did not completely die out until the 1940s.

Keep in mind, we’re talking about how people have gone about treating cholera in the many centuries before antibiotics, intravenous fluids, or oral rehydration solutions. It’s still a dangerous disease today, but before the modern era, cholera was absolutely brutal. This unfathomable threat to public health demanded a few brave souls to summon up all of their courage and—

Okay, fine, we’re couching. It’s just that we’re about to tell you about a guy who did something really grody to try to crack the cholera code, and we wanted you to have the full historical context, lest you just think he’s, you know, a total grosso freakazoid, rather than a well-meaning scientist.

Historical niceties complete, we’ll just say it: This is the tale of the guy who drank poopy water. We’ll get to the details, promise. But first, we need to understand why the old dirty bird—sorry, scientist—would have done such a thing.

MEDICAL DETECTIVES

Prior to our understanding that germs cause disease, people had a lot of strange theories about illness. We already mentioned that in India, cholera was once thought to be caused by an imbalance of internal forces, or humors. The Europeans and Americans later thought it was more of a miasmatic disease, meaning that it was the result of foul air that drifted your way. They surmised it had something to do with being close to filth and waste. Which wasn’t entirely wrong.

Congratulations, old-timey doctors! You accidentally sort of got one half-right! I’m not being sarcastic either; that’s pretty darn good, considering just how dumb you’ve been about basically everything medical! Wait, that wasn’t nice either, was it? . . . Wait, wait, come back!

A far less laudable (and far more wrong) idea was that cholera transmission was somehow related to race or cultural background. It was also sometimes blamed on the sufferers engaging in immoral behavior, or perhaps just having the misfortune of being poor. It likely won’t come as much of a surprise, then, that outbreaks in the United States would often be unfairly blamed on various immigrant populations.

It was not commonly believed that you could transmit cholera from person to person, because the doctors who were caring for those stricken with the disease rarely became ill themselves. In reality, the doctors probably stayed well simply because they weren’t drinking the same contaminated water that their patients were consuming.

In the late 19th century, the growing realization that germs are responsible for at least some illnesses (the not-so-cleverly-named “germ theory of disease”) should have changed a lot of these misconceptions. Doctors and scientists were finally understanding that tiny organisms, now made visible through the power of microscopy, were actually responsible for all the unwanted pooping or puking or sneezing or what have you. Like most scientific advances, though, it didn’t catch on all at once.

Some argued that the bacteria that had been isolated and blamed for the disease were actually a result of the disease process and not the cause. Others argued that maybe the bacteria were to blame, but that not all people were equally susceptible—meaning the disease was only contagious under certain circumstances. One such scientist was Max Joseph von Pettenkofer.

MAX KEEPS IT CLEAN . . . MOSTLY

Max was born in Bavaria, and studied to become both a medical doctor and a chemist, but eventually wound up working largely as a hygienist. This meant that he was exceptionally good, for the time, at keeping things clean. He lived in Munich, where there happened to be outbreaks of cholera in the 1880s and 90s—so he decided to study them.

Robert Koch had recently discovered the bacterium that causes cholera, but as mentioned previously, Max didn’t totally buy it. He believed that the bacteria might spread the disease, but only among patients who already lived in poor conditions, and weren’t clean enough to begin with.

He had a lot of faith in his theory—we mean a whole lot of faith. So much faith in fact, that he was willing to put his money, quite literally, where his mouth was. Max considered himself a clean person, and therefore, he did not believe that he would be able to get cholera—even if the bacteria itself managed to get inside his gut.

LAST CHANCE TO BAIL:

Aww, gang, things are about to get so, so bad for the even-mildly-squeamish among you. Us. Among us. It’s bad enough that we asked Teylor to follow this next part up with just the most adorable image humanly possible. I’m sorry in advance, even if you don’t read it; I’m just sorry it’s in a book you bought or some well-meaning, horribly misguided soul bought for you. I’m just so sorry.

Max wanted to prove his point in just the worst way humanly possible, so he . . . well, there’s no delicate way of putting this: He took some diarrhea from a recently-deceased patient of his, and he mixed up history’s least appealing cocktail. Once he was satisfied with the consistency, or maybe the color, or perhaps he took a little time to create a garnish, he tossed back the foul concoction, and waited.

Hey, look—and I’m sorry to interrupt again so soon—can we just address the fact that, because of this goofus, Syd and I had to coin the phrase “took some diarrhea”? Why does that have to exist? Like, diarrhea should never be “took.” It’s a linguistic impossibility, really, and yet here we are.

You better sit down for this one: Max got kinda sick. Hard as it may be to believe, his fecal frappé did not fill him with vim and vigor. On the other hand, Max didn’t get really sick: some diarrhea, a little bit of cramping, but nothing like the more dire cases of cholera he had witnessed. He certainly didn’t pass away as his donor patient had done. This was good enough for his scientific mind to prove that he didn’t really get the disease, and he proclaimed it a success. Max had hypothesized that his cleanliness and socioeconomic stability would protect him, and as far as he was concerned, his theory was borne out. In reality, he probably just got a mild case, since we know that your bank account and whether or not you wash behind your ears has absolutely no impact on whether or not you get cholera. Despite this, Max is remembered as a pioneer in the field of hygiene and, in 1968, he was put on a postage stamp by East Germany.

So, that’s what you get if you drink poopy water: A stamp.

DR. JOHN SNOW KNEW SOMETHING

When it came to waste disposal, 19th-century London was . . . less than ideal. Many people and businesses just dumped raw sewage into the Thames River at will—and yes, that was the same Thames River which eventually fed into public wells and water pumps. In 1854, a particularly bad outbreak of cholera was ravaging the city, and people still only had a vague understanding of how and why it was spreading.

In one of the earliest known examples of epidemiology, Dr. John Snow set out to crack the case. (Perhaps he realized that Ygritte was right; he did know nothing? No, no, this wasn’t the Game of Thrones Jon Snow; we’re just having some fun. This John Snow had an “H” in his first name, and was only kind of great with a sword.)

The miasma theory was still pretty popular among medical professionals of the time, but Snow was pretty sure that contaminated water was the culprit. To prove this theory, he mapped out the spread of cholera throughout the city. And indeed, he noticed a common link between many cases. The illness seemed to be clustered around a single public water pump on Broad Street. He removed the handle from the pump and cases began to decrease.

One lady almost ruined the whole thing. She lived outside the range of the pump; her niece (who also fell victim) lived even further. This really threw a wrench into his theory. However, Dr. Snow interviewed the lady’s nephew, and learned that the woman had previously lived near the pump, and still preferred the taste of Broad Street water (thanks to all that tasty raw sewage, one can only surmise). So greatly did she like this robust, earthy flavor, she’d had the water bottled and brought to her by visiting family and friends on a regular basis. The niece who had fallen ill had come to visit, and the two had popped open a bottle of Cholera Water to celebrate.

Despite all this evidence, many Londoners still doubted that tainted water could have been the cause. One Reverend Whitehead set out to prove Snow wrong, based on a slightly different theory of his own. He believed that cholera was a punishment from God. He interviewed victims and published his accounts to try and contradict Dr. Snow anyway he could. Unfortunately for the Reverend, these interviews would actually reveal the cause of the initial outbreak, and further cement Snow’s theory. One woman who lived on Broad Street told the good Reverend that her infant had gotten cholera before the outbreak occurred. This resulted in quite a few dirty diapers and many washings. She explained that she had been washing her baby’s diapers in water that she then dumped into a cesspool . . . which was located about three feet from the Broad Street pump.

IS THIS STILL A PROBLEM TODAY?

Tragically, yes.

It wasn’t until the end of the 19th century, with most of the major epidemics at last subsiding, that doctors truly began to embrace the bacteria theory. The decreasing number of outbreaks was probably related to better sanitation methods that were arising at the time. That said, currently, there are still three to five million cases of cholera each year and 100,000 to 200,000 deaths. These occur mainly in developing nations, or areas with poor sanitation or some reason for social upheaval, such as war zones, refugee camps, natural disasters, and so on.

Most heartbreakingly of all, medical advancement along with economic disparity have both made Max Joseph von Pettenkofer’s theorizing about the connection between social status and cholera right—for all the wrong reasons.