Tunisia's first and lightest brush with cholera took place in 1835 during the Second Pandemic. The country suffered three major cholera epidemics thereafter, in 1849 and 1850, when 56,000 died; a less severe one in 1856, when the toll in Tunis alone was roughly 6,500; and during the Fourth Pandemic in 1867 and 1868, when as many as 20,000 perished. This chapter relies extensively on Nancy Gallagher's definitive study of medicine in nineteenth-century Tunisia. Thanks to her efforts, Tunisia offers one of the few African case studies of cholera supported by primary sources. Gallagher demonstrates that cholera as a public health issue helped discredit the local Tunisian ruling elite, and played an essential role in encouraging French imperialists to annex the country in 1881.
Nominally a dependent beylik, or province within the loosely structured Ottoman Empire, what is now most of modern Tunisia developed virtual independence in the early eighteenth century when Husayn Bey (1705–1725) established a hereditary dynasty. The Husaynis reigned until 1957; their reign survived the French protectorate from 1881 to 1956, but not Tunisian independence.
The Beys, or governors of Tunis, built a strong economy based on agriculture, trade, commerce, and, informally, privateering. Tunis was one of the major ports of the so-called Barbary pirates, who reaped profits from the seizing of European cargoes, and often their nationals, who were then held for ransom, sometimes for years.