After escaping its original home in India in 1817, cholera began a global migration; by 1820 it had advanced into China and shortly afterward into Korea and Japan as well. According to Korean records, the first major cholera epidemic occurred in 1821, and observers were sure that the devastating disease, which reached P'yongyang by the end of July 1821, had begun in China. Within 10 days more than 1,000 people had died. The epidemic reached Seoul in August, and by the end of September was in the southern part of the peninsula and all the cities of Kyongsang Province.

Physicians could neither cure nor prevent the spread of this disease, which terrified observers claimed would kill 9 out of every 10 people stricken. Once the first cases of cholera developed, it appeared to spread instantly to surrounding areas, killing countless numbers of people. Stunned by its virulence, the King appealed to the gods, and the people held feasts and ceremonies to propitiate disease devils. Gradually as winter arrived, cholera seemed to disappear, but in April of the following year it reappeared around Seoul and once again spread throughout the country. By mid-August, the epidemic had reached Japan (Miki 1962).

Between 1822 and the 1870s, epidemic cholera made several more invasions, but the records are not precise. There are indications of several cholera interchanges between Korea and Japan during this period, and sometimes the disease spread from Japan to Korea; however, it usually followed the northern land route from Manchuria along the western coast or across the Yellow Sea. Following the 1870s, cholera epidemics were recorded for the years 1881, 1885, 1886, 1890, and 1891.

Modern cholera prevention practices began in 1880 when the illness spread from Japan to Pusan. Emergency policies included established of Disinfection Stations and Cholera Refugee Hospitals. In 1895, during the Sino-Japanese War, cholera broke out in Manchuria. The epidemic slowly but inexorably crept into Korea, finally attacking Seoul with great virulence: At the peak of the epidemic, over 300 were dying per day. During the 6 weeks of the epidemic, over 5,000 deaths in Seoul and vicinity were counted out of a population of about 220,000. The exact number of cases throughout the country is unknown, but it is estimated that some 300,000 people died (Clark 1979). The first cholera hospital organized by Avison in Seoul was closed after the mortality rate of the first 135 patients reached 75 percent.

A second hospital treated 173 cases with a mortality rate of 35 percent (Avison 1895).

In 1902 when cholera epidemics were reported on the continent, all the harbor towns in Korea established Quarantine Stations; nevertheless, epidemic cholera once again attacked Seoul, and deaths reached about 10,000. In 1907 it claimed hundreds of victims in outbreaks around Seoul, Pusan, Inchon, and P'yangyong. It appeared again in 1908, and in 1909 reached Seoul and Inchon from Manchuria. In the latter epidemic, 1,775 contracted cholera and 137 died. During still another outbreak in 1910, which also seems to have originated in China, 456 Koreans contracted the disease and 367 died, along with 722 Japanese in the country who suffered from the illness (Miki 1962). During the epidemic of 1919-20 there were some 44,000 cases, and then for several years no cases were reported. In 1929, only 18 cases were reported, but 15 were fatal, and in 1933, 70 cases were reported with 37 deaths.

One must consider that official reports may have underestimated or deliberately concealed cholera outbreaks. For example, the League of Nations listed Korea as a country in which cholera was epidemic in 1937, while the official reports noted only one case (Simmons et al. 1944). Indeed, some claimed that cholera was never endemic in Korea and always came from outside the country, but this was disputed by other authorities.

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