REVIEW: Death in Hamburg: Society and Politics in the Cholera Years by Richard J. Evans (1987)
The Legacy of Johann Kraus Lives On
Death in Hamburg is published by Penguin Books and written by Richard J. Evans, a Professor of Modern History at Cambridge University. You can find it for sale at Penguin’s website or wherever books are sold.
Most Americans probably think of cholera as some old-timey disease that killed little Timmy in the ancient computer game The Oregon Trail II. Cholera is a disease caused by a bacterial infection found in, in which many have died in horrific, agonizing fashion from explosive vomiting & violent diarrhea, causing extreme dehydration. It's most often caused by contaminated water, such as the highly polluted river Elbe, which runs through the German merchant port city of Hamburg. Death in Hamburg covers a century of the town's history and politics leading up to the 1892 cholera outbreak, killing many more than previous outbreaks just decades prior. Over 10,000 people died in just a few short weeks.
Reading 1987's Death in Hamburg is quite the experience in 2025, even though cholera & COVID-19 couldn't be two more different diseases: one being caused by water-borne bacteria and the other an airborne SARS virus. So many of the worst mistakes of the 1892 cholera outbreak, from quack cures to undercounting deaths, were repeated almost verbatim 127 years later. It seems we've learned absolutely nothing. More revealing is how wealthy interests, over a century apart, carried undue influence over the response to both of these catastrophes, to disastrous effect.
I. A Time-Traveler’s Guide to 1800s Hamburg
In the 19th century, Hamburg's politics was dominated by wealthy aristocrats, who controlled the town Senate. The overwhelming majority of the population, working class laborers who lived in unsanitary squalor, lacked any real political representation. Death in Hamburg’s first section, "The World the Merchants Made," is a hundred pages or so of setting the stage of Hamburg's politics and economics in exhaustive detail, going so far as to include the design of police uniforms, diets of the working poor which included rotting or contaminated food, and even the various alcoholic refreshments available in the Hamburg Senate.
Poverty & inequality were rampant, and the rapid expansion of Hamburg's population via industrialization compounded health threats from environmental pollution. Industry & public health found themselves in constant conflict, and is a poignant reminder of just how little progress we've made since the 19th century. "Factories aren't causing soot & smog! It's irresponsible homeowners!" - compare this to the Department of Energy of today and their newfound coal fetish. Conflict over the local water supply was even more dire:
"The salmon in particular no longer swam upstream through Hamburg's harbour because 'the evil-smelling, polluted water repels them.'... Now, however, they were losing half the catch because it was killed by the foul water in the harbour. The attitude of the Hamburg Senate to any improvement was consistently obstructionist...they merely pointed out that thousands of people still considered the water healthy enough to bathe in: the critics were exaggerating their case; Hamburg was 'one of the healthiest of cities' and there was no need at all to construct a sewage treatment plant."
Richard Evans gives us a complete macro & micro perspective of just how diseases can prosper in the nihilism of public health mismanagement. A great deal of piss & shit is left to fester in 19th century Hamburg's communal spaces, creating ripe opportunities for mass infection. Eels and other sea life were often found in the town's drinking water supply. When these issues were raised, the wealthy engaged in organized, vocal opposition to water & sewage hygiene management solutions, minimizing the potential threats while whinging about the cost of building what would turn out to be essential infrastructure.
"Hamburg's centralized but unfiltered water supply was capable by the 1880s of spreading diseases to almost every house in the city, and the dangers of the contamination of the water-supply by untreated sewage were increasing all the time."
…Gesundheit.
II. Disinformation Reincarnated
This sabotage of the public's health by the aristocratic class would be repeated here in America. Starting from early 2020, wealthy billionaires like Mark Zuckerberg & Peter Thiel, the Koch oil dynasty, the Wal-Mart corporation, and others including a neo-Confederate child labor advocate, bankrolled propaganda downplaying the threat of COVID-19. They sought to control the narrative with misleading disinformation outlets that included Brown University economist Emily Oster's fraudulent blog "ParentData", the online petition known as the "Great Barrington Declaration," and the "COVID Collaborative" which featured Trump's personal McDonald's delivery boy Chris Christie, an Exxon executive, UCSF's Monica Gandhi, and Brown University Dean of Public Health Ashish Jha, who was Biden's final COVID-19 Czar. One might doubt that safeguarding your children's health was their first priority.
Lending credence to the wealthy's demands for uninterrupted commerce in early 2020 led to a nightmarish period in New York City's storied history. The economic devastation was caused by the virus, directly aided by voices who wildly underestimated it's potential for harm. The public was never told that we had already learned the dangers of such a folly over 120 years ago:
"To have admitted openly, and straight away, that Asiatic cholera had come to Hamburg, would have meant reducing the booty of the shipowners, the coffee kings, the traders, the brokers, the speculators, the insurance agents by a few per cent; but property is holy, thrice holy."
Having faceplanted into a horrific calamity, public figures who owed us all a grave apology elected to double down instead. In early 2020, Stanford academic John Ioannidis became popular on cable news for claiming COVID-19 would only kill 10-40,000 Americans in his advocacy against public health mitigations. With both COVID-19 and cholera, minimizers have gone out of their way to undercount the torrent of human suffering they helped unleash. Early on, we learned COVID-19 deaths were being undercounted by a similar 15-30% to what Hamburg's Chief Medical Officer, Dr. Johann Caspar Theodor Kraus was doing in 1893:
"And indeed it was undeniable that Kraus and his officials were publishing grossly underestimated statistics. At noon on 6 September, for example, the Senate announced that there had so far been 6,798 cases and 2,940 deaths up to that point. A week later, these figures had been revised to show that a total of 11,424 people had caught the disease by 6 September and 4,900 had died of it. This was more than a minor adjustment. 4,626 cases, or over 40% of the total, had been omitted from the official statistics, and so too had 1,960 deaths, likewise 40% of the total."
Dr. Kraus, much like the COVID-19 disinformation artists of today, was a vocal critic of any & all measures to prevent infection and insisted upon submission to pestilence:
"His report on the cholera epidemic of 1873 revealed a pessimistic, even fatalistic attitude towards the possibility of prevention. The various measures urged on the authorities in the epidemic, declared Kraus, were of 'relatively' little value. Disinfection was useless because it was impossible to do it thoroughly enough to kill all the germs. Quarantine was futile because individuals would always manage to slip through the net...he seems to have decided that nothing could be done to prevent the outbreak of cholera."
This directly mirrors what certain “influencers” said about COVID-19. Alasdair Munro, a cheerleader for pediatric illness from the United Kingdom, repeated similar myths Kraus said about cholera in the 1890s to insist "there is no feasible engineering solution" to prevent SARS-CoV-2 transmission in 2023. Munro has zero background in engineering or aerosol physics and has compared pediatric COVID-19 to head lice, the latter of which has killed and disabled zero children. Vinay Prasad, an anti-vax academic crank at the University of California San Francisco before joining the Food & Drug Administration to attack lifesaving vaccines, insisted that “infection is inevitable” and that you should get infected as early as possible, even though COVID-19 has killed countless babies that aren’t born with “natural immunity.”
Kraus' repeated failures as Hamburg's chief medical officer got countless people killed, just as our new medical establishment will. Instead of refusing to ever repeat his mistakes, our discourse was overwhelmed by those who saw COVID-19 as an opportunity to continue Kraus’ legacy, attacking any and all mitigations to prevent the harms of SARS-CoV-2. Here at the Pandemic Accountability Index, we've documented countless instances of Kraus' scattered disciples. Instead of university administrators kicking cranks like this to the curb, many of them are now infesting the federal government, doing everything in their power to get more kids killed by other diseases as well as COVID-19.
III. Parallels in Pestilence
Just like the unyielding typhoons of disinformation that Kraus' ideological successors unleashed upon us, Hamburg became submerged in a chaotic sea of misinformation. What is so notable is how just many of these myths we encountered over the past five years are near-identical to the lies spread in 19th century Hamburg. Just read this excerpt about vaccine mandates for smallpox:
"Accordingly, the Hamburg medical profession made a determined attempt to secure the introduction of compulsory vaccination during the 1860s. Their proposals were consistently rejected by the Citizens' Assembly, with - among other things - the argument 'that compulsory vaccination is an outrageous interference in the rights of people to freedom and liberty!'"
Smallpox would go on to cause nearly a third of Hamburg's deaths in 1871. Thankfully, nobody tried to revive this meme over a century later...
...awh. Gesundheit.
These vaccine mandates gave people freedom and liberty from deadly and disabling diseases, a fact that the quacks of our modern era willfully choose to conceal. Now these parroters of historical myth corrupt our federal public health institutions, doing their best to recreate 19th-century Hamburg's waves of unchecked pestilence. While a significant percentage of Hamburg's doctors were "miasmatists," who foolishly believed that diseases were caused by fowl-smelling air, there's no excuse for the Secretary of Health and Human Services to believe in such a ridiculous myth today:
"Miasmatists stressed the need for fresh air, while the widespread belief that cholera was an extreme form of 'the common cold' led many to urge the importance of keeping warm."
As an aside, the senior leadership of the Food & Drug Administration, Marty Makary & Vinay Prasad, believe that COVID-19 is a "common cold" virus. These are dishonest, abusive frauds that have no place in medicine or science, much less our federal public health agencies.
When tuberculosis struck Hamburg, the working poor were treated with little more than cod-liver oil - a quack cure HHS Secretary Robert F. Kennedy, Jr. attempted to treat a measles outbreak with in 2025 that led to liver damage and the deaths of children. RFK Jr. considers this a success. His handpicked yes-men, once-respected medical professionals, cowardly silenced themselves instead of doing their civic duty and condemning such obscenity.
In more mainstream circles in the early 2020s, alleged experts elected to engage in a media parade espousing what one might call "Vibes-Based Epidemiology," in which "fear" of COVID-19, after it had killed and disabled countless Americans in rapid fashion, was worse than the disease itself. We were bombarded with messaging that, again, was proven to be completely useless in 19th century Hamburg:
"The tendency to ascribe infection to moral failings or psychological disturbance in the victim was very widespread. 'Just don't be afraid!' people were advised...'Galety and a cheerful courage are well known to be the best prevention against all epidemics and infectious diseases.'"
Hey, remember back in 2021 when minimizers in the media such as UCSF’s Monica Gandhi, unchallenged by journalists, who insisted that the CDC should stop reporting COVID-19 cases? The same happened with cholera:
“The Hamburger Nachrichten proposed in June 1893 that fresh cholera cases should no longer be publicly announced, in order to prevent these recurrent and economically damaging panics…The left-liberal Berline Tageblatt, declaring that cholera was not infectious, asked why it was necessary to publish every new case: this could only lead to ‘damage to trade and transport’ and therefore had to be avoided.
Toxic positivity has yet to be proven as an effective treatment for any disease.
Conspiracy theories that doctors were killing COVID-19 patients with ventilators or vaccines or were receiving financial kickbacks for falsely assigning deaths to the SARS-CoV-2 virus have run rampant and become mainstream. Yet, this is another tired old fantasy that we saw in 19th Century Hamburg:
"...many others found symbolic expression in the belief that the disease was the product of poisoning by physicians engaged in a secret campaign to reduce the excess population. The doctors, it was said, were being paid 3 Talers for every cholera death reported to the king."
Perhaps Jay Bhattacharya should have been kicked out of Stanford University for plagiarism, years before he was given the chance to compromise the world's leading hub for medical and scientific breakthroughs.
In reality, COVID-19 minimizers did everything they could to encourage infections and discourage testing, falsely prescribing the virus as a mere "cold" or "flu." This did nothing to keep patients out of the hospital or prevent post-acute disability, and it also wasn't a new idea in any way. When a passenger ship departed Hamburg in the midst of the 1892 outbreak for New York, disaster inevitably struck as cholera accompanied the Normannia's passengers across the Atlantic Ocean:
"She was immediately placed under strict quarantine by the immigration authorities...The epidemic reached it's height on 7 September, when no fewer than 13 new cases were recorded, though by now the ship's medical officer, in an attempt to deceive the New York authorities as to the true nature of the sickness, had stopped calling it cholera and was recording all cases as 'vomiting and diarrhoea' or 'acute intestinal catarrh.'"
Disinformation about quack cures for COVID-19 ran rampant across cable news and social media. Droplets of bleach, ivermectin paste bought from a farming supply store, and the hydroxychloroquine that lupus patients need were just a few of the suggested "miracle treatments" that failed to prevent deaths in any way. In the chaos of the mismanagement of Hamburg's pandemic response, desperate people in dire need of real help were tragically swindled:
"Traces of medieval medical theories could be found in the belief that 'freshly-prepared, warm cow-dung broth pushes the cholera out below, because it is slimy and already digested.' ... Other writers favored infusions of gunpowder; more palatable perhaps were proposals to consume quantities of raw onions or salted herrings, Berlin 'white beer,' or even three tablespoons a day of Worcestershire sauce...running an electric current through the patient's bath...preventative measures included camphor or menthol cigarettes, gargling with camphor, putting Lysol in one's morning coffee, rubbing the body down with petroleum - or covering it in chalk - or washing it down in chlorine...Straight out of the Middle Ages came the suggestion that the City Fathers fire off cannon to set the air in motion and so kill the bacilli which the writer imagined were floating in it; or that the entire city should be covered in salt."
Misinformation of theories about cholera transmission were rampant, much as how many expert voices, including Zeynep Tufekci of the New York Times, initially downplayed the now widely understood reality that SARS-CoV-2 is a socially transmitted disease via exhaled aerosols:
"...even telephone conversations from Hamburg to Berlin to Magdeburg were broken off at the other end in the lunatic, stupid fear that people might be infected in this way."
Ah, yes. Infectious diseases transmitted via telephone, surely nobody today could possibly believe that sort of nonse...
…Frak it all!
IV. Closing Thoughts
Death in Hamburg is an exhaustive yet definitive tome about the politics of pandemics and public health that reaches far beyond the seemingly limited scope of 19th-Century Hamburg. Over thirty years after its publication, we find ourselves having repeated all of the mistakes that author Richard Evans tried to warn us about. It's easy to say that the failures of our COVID-19 response were merely a result of mere "misinformation" or “politicization” but the direct parallels between 1893 cholera in Hamburg and 2020 COVID-19 in America cannot be denied.
What is worth interrogating is just how many obscene unscientific myths, from well over a century ago, were suddenly revived without much scrutiny from our leading experts. Meanwhile, the federal government is doing everything in their power to make these incredibly dangerous unscientific myths an essential part of the education for future doctors and nurses. Come the next pandemic, will American healthcare workers be mandated to light up menthol cigarettes in quarantine wards while PPE is banned, because dying patients need to see smiles?
In the years following the horrors of 1892’s epidemic, Hamburg made significant reforms & sanitary improvements, investing in public health to ensure this never happened again. Germany passed sweeping laws to safeguard the nation from threats to the public’s health. After the turn of the century, Hamburg suffered a rather tumultuous 20th Century as part of Germany. A Great War, the 1918 Spanish influenza pandemic, the rise of Adolf Hitler and the Third Reich, the Holocaust, and the Second World War all followed.
Well, I'm sure that's totally irrelevant to the current challenges we're facing in the "post-pandemic" United States of America, which has elected to do the exact opposite of everything Hamburg did post-1892: Restricting vaccines, making disinformation official federal policy, and refusing to implement proven engineering solutions to prevent future outbreaks. This will end in tragedy.
Death in Hamburg is published by Penguin Books and written by Richard J. Evans, a Professor of Modern History at Cambridge University. You can find it for sale at Penguin’s website or wherever books are sold.
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