Kathmandu in the time of cholera

Patan Darbar Square Photograph taken by Bourne and Sheperd in 1870. Photo: The British Library

Kathmandu in the 1880s was a small place, about 1.5 km across and with 50,000 people living in its dense core area. In-migration after 1768 and new Rana palaces after 1846 had started expanding the city. Sanitation was poor, and conditions in Kathmandu were ripe for another disease outbreak.

The doctor at the British Residency in Lainchaur, G H Gimlette, did not pull punches in describing Kathmandu's poor hygenic conditions: ‘The filth of the city is indescribable; along each side of the narrow lanes and streets run deep gutters, a foot to eighteen inches wide, filled with a stagnant mass of black stinking mud, into which fecal matter and every sort of refuse find their way. The stench of the thoroughfares is at all times bad enough, but, on a warm morning in the rains, it becomes sickening. (The houses) are generally overcrowded and ill-ventilated.’

Cholera had struck before -- in 1823, 1831, 1843, 1856, 1862, 1867, 1872, 1874, and 1875. The 1856 and 1872 outbreaks killed large numbers. In 1872, 200 to 250 people perished each day.

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The dreaded disease which brought on dysentery and vomiting killed half of those who got it. People were just beginning to understand how to contain outbreaks. Health knowledge was needed, but also smart, concerted government action. Kathmandu had little of either.

The city strained to feed itself. ‘Every scrap of available ground in the valley of Nepal is cultivated to exhaustion,’ an 1880s visitor noted, ‘to yield its utmost to support a population already too large for its limited area.’

The most common ailments at the time were typhoid fever  chronic dyspepsia, goitre, and syphilis. With syphilis, the chronicler noted, it was ‘rather the rule than the exception for a man to be infected at some period of his life’.

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Gimlette also worried about Nepali superstitions about cholera. One early outbreak had been blamed, he wrote, on the position of Saturn in the sky, another on the unluckiness of the king's 18th birthday coming in the Nepali year 1888.

He had a point, but was also displaying some colonial self-congratulation. It had not been many years since John Snow had identified dirty water taps as the source of London's cholera outbreak in 1849. Before this, and afterwards, many westerners advanced their own quirky, unscientific explanations for disease.

In 1885 Nepal had seen lots of rain and extremely hot weather. The city's ‘sultry and oppressive’ air, Gimlette noted, ‘was undisturbed by the slightest breeze’.

The first ugly symptoms of cholera manifested themselves in mid May. Soon, five or six people were dying each day. By the end of May 10-12 people were dying. The British doctor tried to spur the palace into action, making ‘frequent and urgent’ calls for temporary clinics to treat the sick. But his pleas went ‘entirely disregarded’ by the Rana rulers at the time.

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Eventually the government gave a space for a small dispensary, but that fell far short of the what Gimlette really wanted -- a ‘place into which patients could be admitted and treated continuously’.

Another poor decision added fuel to the fire. Over 15,000 troops were gathered in Kathmandu for a possible deployment in India. Some soldiers got sick, and others were not dispatched home immediately. Only after a colorful parade two weeks later on 1 June 1885 were soldiers sent home. But it was too late.

The disease followed them around the country. Kathmandu saw ‘a sudden increase’ in cases, the death rate now topping 50 per day. Cases appeared in Patan and then Bhaktapur. Cholera spread into the mountains.

Meanwhile, the troops at the British Residency remained healthy, despite cases nearby. Gimlette credited good hygiene and a limited quarantine -- soldiers were not allowed into the city, then a slight distance away.

By 14 June, cholera had invaded the palace. Of the over 300 people who lived there, 25 were dead by evening, chiefly slave-girls and servants.

‘A panic ensued, and the Durbar was quickly emptied,’ Gimlette wrote. The dying were rushed to Pashupati. Others fled to the palaces of Patan and Bhaktapur which themselves soon grew into ‘fresh centres of the disease’.

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On June 29th, after alternating days of heavy rain and high temperatures, the daily death toll climbed over 100, its highest yet, and stayed there for several days. Gimlette made house calls, and visited the ghats daily. He observed a society struggling to maintain its humanity.

He described the cremation ghats as ‘crowded with sick, dying, and dead. Many unfortunate wretches were simply, when attacked, brought to the edge of stream and there abandoned’.

The scene was gruesome. The better off could afford to burn their dead, but ‘the bodies of the poor and low castes were thrown into the middle of the shallow stream by hundreds, to be pulled again piecemeal to the banks by the dogs, jackals, and vultures, who feasted on them’.

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Cooler temperatures in July gave the city a short respite. But the disease soon roared back ‘as bad as ever’. This time it devastated the city's lower quarters. Only in August did the death rate significantly drop, the outbreak finally coming to an end in early September.

Over 9,000 people in Kathmandu Valley had died, the Darbar announced. Gimlette thought this estimate high, but agreed that the loss of life ‘must have been very great’. The city's population, before the outbreak, was approximately 50,000.

G H Gimlette worried that poor hygiene and government indifference would yield yet more killer epidemics. ‘The disgustingly insanitary condition of Katmandu and other towns,’ he wrote, ‘is quite certain to breed epidemics in future. No efforts to remedy it are in the least likely to be made by the Durbar, nor would anything much short of burning the city to the ground suffice. The foundations are saturated with filth, and the air is almost thick with stenches.’

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Tom Robertson, PhD, is researching the environmental history of the Kathmandu Valley.

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