Russia in the Time of Cholera

Disease under Romanovs and Soviets

John P. Davis

• Publisher: I.B. Tauris
• Year: 2018
• Print ISBN:
  9781788311687
• Edition: 1
• eBook ISBN:
  9781786723659
• Topic: History
• Subtopic: Russian History
• Index: History

As the nineteenth century drew to a close and epidemics in western Europe were waning, the deadly cholera vibrio continued to wreak havoc in Russia, outlasting the Romanovs. Scholars have since argued that cholera eventually fell prey to better sanitation and strict quarantine under the Soviets, citing as evidence imperial mismanagement, a `backward' tsarist medical system and physicians' anachronistic environmental interpretations of the disease. Drawing on extensive archival research and the so-called `material turn' in historiography, however, John P. Davis here demonstrates that Romanov-era physicians' environmental approach to disease was not ill-grounded, nor a consequence of neo-liberal or populist political leanings, but born of pragmatic scientific considerations. The physicians confronted cholera in a broad and sophisticated way, essentially laying the foundations for the system of public health that the Soviets successfully used to defeat cholera during the New Economic Policy (1922-1928). By focusing for the first time on the conclusion of the cholera epoch in Russia, Davis adds an indispensable layer of nuance to the existing conception of Romanov Russia and its complicated legacy in the Soviet period.

CHAPTER 1

CHOLERA AND ITS ENVIRONS: THE CASE OF RUSSIA

The aetiology of the cholera vibrio, or how it works in nature, is effected by a number of factors. Located squarely along the lines of communication between cholera’s source in India and Western Europe, southern Russia included vulnerable ecologies and susceptible topography that was often saturated with victims of famine, on caravans, steamboats and trains, pilgrimages to Mecca or military expeditions. Southern Russia’s borders were the most vulnerable to cholera in Europe. Russian physicians’ broad scientific orientation was based on this ecological and topological diversity and drew from a range of disciplines, including chemistry, biology, physiology, botany and even psychology. These factors provided their basis for understanding cholera’s aetiology in Russia.

The cholera microbe is dynamic, capable of adaptation and evolution and has appeared in over 140 variations.¹ Throughout four modern pandemics the microbe remained a mystery. Then, in 1883, Germany’s Robert Koch discovered Vibrio cholerae 01, which is resistant to antibiotics, resilient in high alkaline levels, but subject to neutralisation by stomach acid upon oral ingestion. In some cases, the microbe enters the intestine, secretes an enterotoxin that clings to intestinal plasma cells, emits a sub-enterotoxin and flushes massive quantities of water and electrolytes from the intestines, triggering intense vomiting, dehydration and a high risk of death.² Koch’s vibrio is considered the causal agent of the fifth world cholera pandemic.

While Koch’s vibrio continued to appear, another form of cholera soon emerged. In 1905 the German, E. Gottschlich discovered V. cholera 01 El Tor at the quarantine station of the same name, on the Sinai Peninsula of Egypt. This bacterium was less lethal but more survivable than Koch’s vibrio and has been linked to the sixth modern pandemic, which this book addresses.³ Other studies indicate that non-01 cholera, which inhabits aquatic environments and is considered non-agglutinative (incapable of causing the disease), also played a role in the sixth pandemic. This form of cholera survives undetected, undernourished and dormant in many coastal waters worldwide and can cause severe stomach sicknesses.⁴ The seventh pandemic was caused by 01 El tor, but an even more survivable biotype appeared by 1993, provoking fears of an eighth pandemic. With different versions of the vibrio appearing simultaneously, varying aquatic environments and changes in the immunity of human hosts play a role in cholera’s genetic changes, influencing which variation of the microbe dominates an outbreak.⁵ Cholera is thus a diverse disease which materialises differently in various environments, depending on changes related to its genetic component.

Russian physicians in 1883–1928 were well aware of Koch’s and Gottschlich’s experiments, sometimes even making observations that were undoubtedly related to discoveries that modern epidemiologists have recently disclosed. Wrestling with the ramifications of Koch’s discovery amid burgeoning transportation networks, warfare, climatic catastrophes and human upheavals, the Russian physicians appearing in this book understood, and often emphasised, that diversity of microbes and conditions prevailed in their country and played a role in contagious outbreaks.

Fear of these epidemics influenced medical scholarship and policy. The pages of the Russian Physician, the main journal of Russian ‘community’ physicians who were generally employed by the zemstvos, expanded considerably in the years when an outbreak was expected, which included 1905, 1907–8 and 1911–12. The internationally respected Soviet bacteriologist and immunologist, Lev Tarasevich, believed that the alarm prevalent prior to a cholera epidemic was desirable, due to the preparations that it precipitated. In a report to the League of Nations in 1922, he noted that the study and prevention of cholera generated more attention, energy and extraordinary measures than other diseases, particularly after 1900. Special monetary expenditures for cholera motivated more accurate reporting and over 90 per cent statistical accuracy, drawing advances to organise anti-epidemic campaigns.⁶ The vibrio selected and adapted to environments that were most conducive to its longevity and it emerges in this book as a dynamic entity, seeking to ensure its survival in natural and built environments.

Constructed and natural environments lie within what the Australian geologist, Edward Suess, called the ‘biosphere’. In the nineteenth century, two geochemists, the Russian V. I. Vernadsky and Frenchman Pierre Tielhard de Chardin, promoted this entity, which included everything from ‘Himalayan glaciers […] to bubbling seafloor vents teeming with bacteria’.⁷ Both extremes were essential to cholera epidemics, which most often originated from ocean bottoms in the estuary of the Bay of Bengal at the base of this same mountain range.

The scientific world is discovering material relationships between cholera epidemics and volcanic activity in the Pacific Ocean’s ‘ring of fire’, particularly in Indonesia’s Sunda Arc. Most of the world’s seismic and volcanic activity occurs in the ring of fire, a circle along the borders of the Pacific Ocean. Of the 3,000 volcanoes that are active worldwide at any given moment, approximately 100 are in the Sunda Arc.⁸ In 1936, Sir Gilbert Walker recognised an ‘oceanic El Niño’, sometimes referred to in this book as the El Niño Southern Oscillation (ENSO). These events involve rising atmospheric pressure in the eastern-Pacific Ocean, which generally reduces density in the ocean’s western regions. Changes in ocean temperatures in the Pacific produce increased atmospheric pressure that causes far reaching ‘teleconnections’, affecting climatic processes across the ocean. In the 1960s meteorologists discovered that these processes altered precipitation in the Asian monsoon, including intense downpours and long dry spells in Indonesia, India, the Philippines and Australia. Altered precipitation caused drought, flooding and crop failure.⁹ While the precise chronological and material relationship between ENSO events and Russian famine and cholera has not yet been discovered, they were important in that they created conditions among human populations in India, Asia and elsewhere, causing widespread flooding, dehydration and famine and cholera, often reaching into the southern Russian breadbaskets. The climate in the Southeast Steppe of Russia is susceptible to high atmospheric pressures from Asia, which results in early autumn frosts and heavy spring winds, which create soil erosion and crop failure.¹⁰ The continued reappearance of famine was most important. Symptoms appearing in patients such as nausea, bloody vomiting, diarrhoea, sharp intestinal disorders, gastroenteritis, were signs that the ‘Blue Death’, cholera, was imminent.

As climate change weakened the human organism, it simultaneously ensured that the cholera vibrio arrived in a timely manner. Warm rains caused temperature changes and variations in the salt content of estuaries and coastal waters in the Bay of Bengal, where an influx of large volumes of non-salt water created mixed or ‘brackish’ water, mobilising stored nutrients in the bottom sediments.¹¹ Some of the most dynamic environments on earth, estuaries create more organic matter than similar-size forests, grasslands and farmlands and support a unique variety of animal and plant life.¹² Fluctuations in water temperatures and tides fed the vibrio in estuaries with inorganic sources of nitrogen, carbohydrates and minerals that were specific to its requirements.¹³ The changes occurred in low oxygen ‘dead zones’, in which mobilisation of nitrogen and phosphorus prompted eutrophication, a process in which phytoplankton causes large algae blooms or zooplankton to appear near the surface.¹⁴ In 1908 the Russian bacteriologist, N. N. Klodnitskii, identified a similar place on the Volga River at the mouth of the Caspian Sea, in Astrakhan’, which he also called a dead zone. Klodnitskii was in charge of the Ministry of the Interior’s (MVD) bacteriological laboratory in Astrakhan’.¹⁵ Subject to tidal disturbances, estuaries are often still, with low oxygen or an absence of it near the ocean floor. The microbe emerged through navigation of marine and human channels of ingestion and waste, starting in shrimp-like copepods, which survive both anaerobically (without oxygen) and aerobically (with oxygen), then through the gut tracts of larger shellfish such as oysters, clams, crabs and humans.¹⁶ In 2007, the epidemiologist Alfredo Morabia observed that cholera’s activities in these waters rendered Koch’s discoveries insufficient to stop cholera in some locations.¹⁷ Southern Russia was clearly one of those places. Due to Pasteur’s influence, some Russian physcians were considering anaerobic and aerobic developments along coastal regions by the first decade of the twentieth century.

In India’s Bay of Bengal these processes initiated the larger cholera epidemics of the nineteenth and early twentieth centuries. The southern end of the Bay was formed by alluvium flowing south with water from the Himalayan Mountains into the Ganges river basin, creating a plain of old and new deposits. The western plateau rested less than 100 feet above sea level and was vulnerable to cholera bacteria flowing from rivers above the plains.¹⁸ In 1908 one of Russia’s foremost hygienists, G. V. Khlopin, cited ‘high streams and river channels’ as ‘the most harmful features affecting the health of the people’ in the city of Astrakhan’, which was located on the Caspian Sea at the mouth of the Volga River.¹⁹ By 1900, the year after India’s Great Famine, 100 million residents in the Ganges valley were exposed to approximately one-fourth of India’s drainage. Millions of sick, starving and dying humans flocked to the area on religious pilgrimages. Human sewage spread the microbe, creating oxygen deficits and destroying marine life.²⁰ The abundance of underfed human hosts and natural processes to ensure its reproduction permitted the vibrio to cause the deaths of approximately 10.7 million Indians, during the sixth pandemic in 1896–1925.²¹

The almost universal appearance of food crises before cholera’s mobilisation caused further complications that made response to epidemics difficult. The World Health Organization (WHO) recognises famine as a predisposing factor to cholera and other epidemic diseases due to physical weakness and decreased human immunity to the vibrio, increases in foraging, social upheaval and factors related to demographic movements between cholera reservoirs. Disruption of service infrastructures, respiratory ailments and increased diarrhoeal diseases related to famine all help the microbe defeat sanitary defenses. Flooding creates the same health hazard whether it is caused by climate change or other means.²² Causing crop failure and famine, flooding spreads the bacterium through an overflow of brackish and polluted waters into interior water sources. Drought destroys crops and causes heightened bacterial concentrations in water sources, resulting in reckless human consumption due to dehydration.

Famine due to climate events is likely to result in an epidemic due to the simultaneous mobilisation of nutrients and microbes in the estuaries discussed above, but the connection between the two was not always immediately evident. Socio-economic issues and agricultural deficits accumulated over several years, creating long-term stress that later caused collapse in food supplies due to another catalyst. Such accumulations occurred in the years prior to the 1891 famine and between 1918 and 1921 during the Civil War.²³ The rural physician Andrei Shingarev, the Minister of Agriculture in the Provisional Government in 1917, commented that only about one out of ten Russian peasant farmers in the nineteenth century produced sufficient grain to subsist between harvests. Rural residents survived winters by consuming ‘famine bread’, a mixture of goosefoot, nettles and other weeds ground with rye husks, dried potato peelings, bark or any remotely edible substance.²⁴ Famine reduced human immunity to disease. Moreover, recent studies in epigenetics have concluded that traits associated with recurring famine can change metabolic rates and render successive generations prone to certain diseases.²⁵ Whether Russia’s repeated exposures to hunger caused an acquired vulnerability to cholera is speculative, but famine certainly lowered immunity and predisposed Russians to cholera each time it appeared.

Famine eternally preceded cholera in Russia and any effort against it was a de facto anti-cholera measure. Starvation forged a path for cholera in 1822, 1834, 1840, 1848, 1853, most of the 1860s, 1871–2, for plague in 1877 and again for cholera in 1890–1, 1896–1902, 1905–8, 1911–12 and 1921.²⁶ The famines in 1822, 1871, 1877, 1890–1, 1896–1901, 1905–8 a...

Table of contents

• Front Cover
• Title Page
• Copyright
• Dedication
• Contents
• List of Illustrations
• Acknowledgements
• Introduction
• 1. Cholera and its Environs: The Case of Russia
• 2. Tsarist Russia and the First Five Pandemics, 1817–94
• 3. The Sixth Pandemic Enters Russia, 1902–7
• 4. Cholera Returns to Russia, 1907–13
• 5. The Troubles Continue: World War I, 1914–17
• 6. The Revolutions, Civil War and War Communism, 1917–21
• 7. The New Economic Policy (NEP), 1921–8
• 8. The End of ‘Classical’ Cholera Epidemics in the Soviet Union
• Conclusion
• Glossary of Terms and Organisations
• Notes
• Bibliography