The 1866 cholera epidemic in Antwerp and Brussels: a comparative analysis of the epidemic’s trajectory and public health responses

Traditionally, historical research into epidemics has focused on the overall impact of an outbreak (total number of victims, areas, and groups most affected), but rarely on how an epidemic develops on a daily or weekly basis. In this paper, we examine the trajectory of the severe cholera epidemic of 1866 as it unfolded in Antwerp and Brussels, then Belgium's largest cities, with 117,000 and 158,000 inhabitants respectively. Linking individual-level data from cholera case registers, cause-of-death registers, death certificates, and cadastral censuses, we can reconstruct a fairly complete picture of the epidemic’s trajectory in Antwerp and Brussels, from the first death until the last death (2960 cholera deaths in Antwerp, and 3469 in Brussels). First, we examine how the epidemic unfolded across the city. As the graph shows, the epidemic in Antwerp was shorter and evolved more rapidly compared to Brussels where the curve was flatter. Which population groups (age, sex, occupation) were affected first, last, and most, and were some houses infected repeatedly? In which neighbourhoods did the epidemic persist the longest? And did these patterns differ in Antwerp and Brussels? Second, we juxtapose our findings with the actions taken by the city governments of Antwerp and Brussels, using city, provincial, and national government reports, as well as accounts of medical commissions. Did Antwerp and Brussels differ in the timing and type of measures implemented? And did these shape the trajectories of the epidemic in both cities differently? Through this comprehensive analysis, we aim to shed better light on the interplay between an epidemic’s path and public health responses.