title: Cholera

text: The primary symptoms of cholera are profuse diarrhea and vomiting of clear fluid. These symptoms usually start suddenly, half a day to five days after ingestion of the bacteria. The diarrhea is frequently described as "rice water" in nature and may have a fishy odor. An untreated person with cholera may produce of diarrhea a day. Severe cholera, without treatment, kills about half of affected individuals. If the severe diarrhea is not treated, it can result in life-threatening dehydration and electrolyte imbalances. Estimates of the ratio of asymptomatic to symptomatic infections have ranged from 3 to 100. Cholera has been nicknamed the "blue death" because a person's skin may turn bluish-gray from extreme loss of fluids.


title: Cholera

text: Fever is rare and should raise suspicion for secondary infection. Patients can be lethargic and might have sunken eyes, dry mouth, cold clammy skin, or wrinkled hands and feet. Kussmaul breathing, a deep and labored breathing pattern, can occur because of acidosis from stool bicarbonate losses and lactic acidosis associated with poor perfusion. Blood pressure drops due to dehydration, peripheral pulse is rapid and thready, and urine output decreases with time. Muscle cramping and weakness, altered consciousness, seizures, or even coma due to electrolyte imbalances are common, especially in children.


title: Cholera

text: Transmission is usually through the fecal-oral route of contaminated food or water caused by poor sanitation. Most cholera cases in developed countries are a result of transmission by food, while in developing countries it is more often water. Food transmission can occur when people harvest seafood such as oysters in waters infected with sewage, as "Vibrio cholerae" accumulates in planktonic crustaceans and the oysters eat the zooplankton.


title: Cholera

text: People infected with cholera often have diarrhea, and disease transmission may occur if this highly liquid stool, colloquially referred to as "rice-water", contaminates water used by others. A single diarrheal event can cause a one-million fold increase in numbers of "V. cholerae" in the environment. The source of the contamination is typically other people with cholera when their untreated diarrheal discharge is allowed to get into waterways, groundwater or drinking water supplies. Drinking any contaminated water and eating any foods washed in the water, as well as shellfish living in the affected waterway, can cause a person to contract an infection. Cholera is rarely spread directly from person to person.


title: Cholera

text: "V. cholerae" also exists outside the human body in natural water sources, either by itself or through interacting with phytoplankton, zooplankton, or biotic and abiotic detritus. Drinking such water can also result in the disease, even without prior contamination through fecal matter. Selective pressures exist however in the aquatic environment that may reduce the virulence of "V. cholerae". Specifically, animal models indicate that the transcriptional profile of the pathogen changes as it prepares to enter an aquatic environment. This transcriptional change results in a loss of ability of "V. cholerae" to be cultured on standard media, a phenotype referred to as 'viable but non-culturable' (VBNC) or more conservatively 'active but non-culturable' (ABNC). One study indicates that the culturability of "V. cholerae" drops 90% within 24 hours of entering the water, and furthermore that this loss in culturability is associated with a loss in virulence.


title: Cholera

text: Both toxic and non-toxic strains exist. Non-toxic strains can acquire toxicity through a temperate bacteriophage.


title: Cholera

text: About 100million bacteria must typically be ingested to cause cholera in a normal healthy adult. This dose, however, is less in those with lowered gastric acidity (for instance those using proton pump inhibitors). Children are also more susceptible, with two- to four-year-olds having the highest rates of infection. Individuals' susceptibility to cholera is also affected by their blood type, with those with type O blood being the most susceptible. Persons with lowered immunity, such as persons with AIDS or malnourished children, are more likely to develop a severe case if they become infected. Any individual, even a healthy adult in middle age, can undergo a severe case, and each person's case should be measured by the loss of fluids, preferably in consultation with a professional health care provider.


title: Cholera

text: The cystic fibrosis genetic mutation known as delta-F508 in humans has been said to maintain a selective heterozygous advantage: heterozygous carriers of the mutation (who are not affected by cystic fibrosis) are more resistant to "V. cholerae" infections. In this model, the genetic deficiency in the cystic fibrosis transmembrane conductance regulator channel proteins interferes with bacteria binding to the intestinal epithelium, thus reducing the effects of an infection.


title: Cholera

text: When consumed, most bacteria do not survive the acidic conditions of the human stomach. The few surviving bacteria conserve their energy and stored nutrients during the passage through the stomach by shutting down protein production. When the surviving bacteria exit the stomach and reach the small intestine, they must propel themselves through the thick mucus that lines the small intestine to reach the intestinal walls where they can attach and thrive.


title: Cholera

text: Once the cholera bacteria reach the intestinal wall, they no longer need the flagella to move. The bacteria stop producing the protein flagellin to conserve energy and nutrients by changing the mix of proteins that they express in response to the changed chemical surroundings. On reaching the intestinal wall, "V. cholerae" start producing the toxic proteins that give the infected person a watery diarrhea. This carries the multiplying new generations of "V. cholerae" bacteria out into the drinking water of the next host if proper sanitation measures are not in place.


title: Cholera

text: The cholera toxin (CTX or CT) is an oligomeric complex made up of six protein subunits: a single copy of the A subunit (part A), and five copies of the B subunit (part B), connected by a disulfide bond. The five B subunits form a five-membered ring that binds to GM1 gangliosides on the surface of the intestinal epithelium cells. The A1 portion of the A subunit is an enzyme that ADP-ribosylates G proteins, while the A2 chain fits into the central pore of the B subunit ring. Upon binding, the complex is taken into the cell via receptor-mediated endocytosis. Once inside the cell, the disulfide bond is reduced, and the A1 subunit is freed to bind with a human partner protein called ADP-ribosylation factor 6 (Arf6). Binding exposes its active site, allowing it to permanently ribosylate the Gs alpha subunit of the heterotrimeric G protein. This results in constitutive cAMP production, which in turn leads to the secretion of water, sodium, potassium, and bicarbonate into the lumen of the small intestine and rapid dehydration. The gene encoding the cholera toxin was introduced into "V. cholerae" by horizontal gene transfer. Virulent strains of "V. cholerae" carry a variant of a temperate bacteriophage called CTXφ.


title: Cholera

text: Microbiologists have studied the genetic mechanisms by which the "V. cholerae" bacteria turn off the production of some proteins and turn on the production of other proteins as they respond to the series of chemical environments they encounter, passing through the stomach, through the mucous layer of the small intestine, and on to the intestinal wall. Of particular interest have been the genetic mechanisms by which cholera bacteria turn on the protein production of the toxins that interact with host cell mechanisms to pump chloride ions into the small intestine, creating an ionic pressure which prevents sodium ions from entering the cell. The chloride and sodium ions create a salt-water environment in the small intestines, which through osmosis can pull up to six liters of water per day through the intestinal cells, creating the massive amounts of diarrhea. The host can become rapidly dehydrated unless treated properly.


title: Cholera

text: By inserting separate, successive sections of "V. cholerae" DNA into the DNA of other bacteria, such as "E. coli" that would not naturally produce the protein toxins, researchers have investigated the mechanisms by which "V. cholerae" responds to the changing chemical environments of the stomach, mucous layers, and intestinal wall. Researchers have discovered a complex cascade of regulatory proteins controls expression of "V. cholerae" virulence determinants. In responding to the chemical environment at the intestinal wall, the "V. cholerae" bacteria produce the TcpP/TcpH proteins, which, together with the ToxR/ToxS proteins, activate the expression of the ToxT regulatory protein. ToxT then directly activates expression of virulence genes that produce the toxins, causing diarrhea in the infected person and allowing the bacteria to colonize the intestine. Current research aims at discovering "the signal that makes the cholera bacteria stop swimming and start to colonize (that is, adhere to the cells of) the small intestine."


title: Cholera

text: Amplified fragment length polymorphism fingerprinting of the pandemic isolates of "V. cholerae" has revealed variation in the genetic structure. Two clusters have been identified: Cluster I and Cluster II. For the most part, Cluster I consists of strains from the 1960s and 1970s, while Cluster II largely contains strains from the 1980s and 1990s, based on the change in the clone structure. This grouping of strains is best seen in the strains from the African continent.


title: Cholera

text: In many areas of the world, antibiotic resistance is increasing within cholera bacteria. In Bangladesh, for example, most cases are resistant to tetracycline, trimethoprim-sulfamethoxazole, and erythromycin. Rapid diagnostic assay methods are available for the identification of multi-drug resistant cases. New generation antimicrobials have been discovered which are effective against cholera bacteria in "in vitro" studies.


title: Cholera

text: A rapid dipstick test is available to determine the presence of "V. cholerae". In those samples that test positive, further testing should be done to determine antibiotic resistance. In epidemic situations, a clinical diagnosis may be made by taking a patient history and doing a brief examination. Treatment via hydration and over-the-counter hydration solutions can be started without or before confirmation by laboratory analysis, especially where cholera is a common problem.


title: Cholera

text: Stool and swab samples collected in the acute stage of the disease, before antibiotics have been administered, are the most useful specimens for laboratory diagnosis. If an epidemic of cholera is suspected, the most common causative agent is "V. cholerae" O1. If "V. cholerae" serogroup O1 is not isolated, the laboratory should test for "V. cholerae" O139. However, if neither of these organisms is isolated, it is necessary to send stool specimens to a reference laboratory.


title: Cholera

text: Infection with "V. cholerae" O139 should be reported and handled in the same manner as that caused by "V. cholerae" O1. The associated diarrheal illness should be referred to as cholera and must be reported in the United States.


title: Cholera

text: The World Health Organization (WHO) recommends focusing on prevention, preparedness, and response to combat the spread of cholera. They also stress the importance of an effective surveillance system. Governments can play a role in all of these areas.


title: Cholera

text: Although cholera may be life-threatening, prevention of the disease is normally straightforward if proper sanitation practices are followed. In developed countries, due to their nearly universal advanced water treatment and sanitation practices, cholera is rare. For example, the last major outbreak of cholera in the United States occurred in 1910–1911. Cholera is mainly a risk in developing countries in those areas where access to WASH (water, sanitation and hygiene) infrastructure is still inadequate.


title: Cholera

text: Effective sanitation practices, if instituted and adhered to in time, are usually sufficient to stop an epidemic. There are several points along the cholera transmission path at which its spread may be halted:


title: Cholera

text: Handwashing with soap or ash after using a toilet and before handling food or eating is also recommended for cholera prevention by WHO Africa.


title: Cholera

text: Surveillance and prompt reporting allow for containing cholera epidemics rapidly. Cholera exists as a seasonal disease in many endemic countries, occurring annually mostly during rainy seasons. Surveillance systems can provide early alerts to outbreaks, therefore leading to coordinated response and assist in preparation of preparedness plans. Efficient surveillance systems can also improve the risk assessment for potential cholera outbreaks. Understanding the seasonality and location of outbreaks provides guidance for improving cholera control activities for the most vulnerable. For prevention to be effective, it is important that cases be reported to national health authorities.


title: Cholera

text: Spanish physician Jaume Ferran i Clua developed a cholera inoculation in 1885, the first to immunize humans against a bacterial disease. However, his vaccine and inoculation was rather controversial and was rejected by his peers and several investigation commissions. Russian-Jewish bacteriologist Waldemar Haffkine successfully developed the first human cholera vaccine in July 1892. He conducted a massive inoculation program in British India.


title: Cholera

text: Persons who survive an episode of cholera have long-lasting immunity for at least 3 years (the period tested.) A number of safe and effective oral vaccines for cholera are available. The World Health Organization (WHO) has three prequalified oral cholera vaccines (OCVs): Dukoral, Sanchol, and Euvichol. Dukoral, an orally administered, inactivated whole cell vaccine, has an overall efficacy of about 52% during the first year after being given and 62% in the second year, with minimal side effects. It is available in over 60 countries. However, it is not currently recommended by the Centers for Disease Control and Prevention (CDC) for most people traveling from the United States to endemic countries. The vaccine that the US Food and Drug Administration (FDA) recommends, Vaxchora, is an oral attenuated live vaccine, that is effective for adults aged 18–64 as a single dose.


title: Cholera

text: One injectable vaccine was found to be effective for two to three years. The protective efficacy was 28% lower in children less than five years old. However, , it has limited availability. Work is under way to investigate the role of mass vaccination. The WHO recommends immunization of high-risk groups, such as children and people with HIV, in countries where this disease is endemic. If people are immunized broadly, herd immunity results, with a decrease in the amount of contamination in the environment.


title: Cholera

text: WHO recommends that oral cholera vaccination be considered in areas where the disease is endemic (with seasonal peaks), as part of the response to outbreaks, or in a humanitarian crisis during which the risk of cholera is high. Oral Cholera Vaccine (OCV) has been recognized as an adjunct tool for prevention and control of cholera. The World Health Organization (WHO) has prequalified three bivalent cholera vaccines—Dukoral (SBL Vaccines), containing a non-toxic B-subunit of cholera toxin and providing protection against V. cholerae O1; and two vaccines developed using the same transfer of technology—ShanChol (Shantha Biotec) and Euvichol (EuBiologics Co.), which have bivalent O1 and O139 oral killed cholera vaccines. Oral cholera vaccination could be deployed in a diverse range of situations from cholera-endemic areas and locations of humanitarian crises, but no clear consensus exists.


title: Cholera

text: Developed for use in Bangladesh, the "sari filter" is a simple and cost-effective appropriate technology method for reducing the contamination of drinking water. Used sari cloth is preferable but other types of used cloth can be used with some effect, though the effectiveness will vary significantly. Used cloth is more effective than new cloth, as the repeated washing reduces the space between the fibers. Water collected in this way has a greatly reduced pathogen count—though it will not necessarily be perfectly safe, it is an improvement for poor people with limited options. In Bangladesh this practice was found to decrease rates of cholera by nearly half. It involves folding a "sari" four to eight times. Between uses the cloth should be rinsed in clean water and dried in the sun to kill any bacteria on it. A nylon cloth appears to work as well but is not as affordable.


title: Cholera

text: Continued eating speeds the recovery of normal intestinal function. The WHO recommends this generally for cases of diarrhea no matter what the underlying cause. A CDC training manual specifically for cholera states: "Continue to breastfeed your baby if the baby has watery diarrhea, even when traveling to get treatment. Adults and older children should continue to eat frequently."


title: Cholera

text: and volume of fluids required. In most cases, cholera can be successfully treated with oral rehydration therapy (ORT), which is highly effective, safe, and simple to administer. Rice-based solutions are preferred to glucose-based ones due to greater efficiency. In severe cases with significant dehydration, intravenous rehydration may be necessary. Ringer's lactate is the preferred solution, often with added potassium. Large volumes and continued replacement until diarrhea has subsided may be needed. Ten percent of a person's body weight in fluid may need to be given in the first two to four hours. This method was first tried on a mass scale during the Bangladesh Liberation War, and was found to have much success. Despite widespread beliefs, fruit juices and commercial fizzy drinks like cola are not ideal for rehydration of people with serious infections of the intestines, and their excessive sugar content may even harm water uptake.


title: Cholera

text: If commercially produced oral rehydration solutions are too expensive or difficult to obtain, solutions can be made. One such recipe calls for 1 liter of boiled water, 1/2 teaspoon of salt, 6 teaspoons of sugar, and added mashed banana for potassium and to improve taste.


title: Cholera

text: As there frequently is initially acidosis, the potassium level may be normal, even though large losses have occurred. As the dehydration is corrected, potassium levels may decrease rapidly, and thus need to be replaced. This may be done by consuming foods high in potassium, like bananas or coconut water.


title: Cholera

text: Antibiotic treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms. Use of antibiotics also reduces fluid requirements. People will recover without them, however, if sufficient hydration is maintained. The WHO only recommends antibiotics in those with severe dehydration.


title: Cholera

text: Doxycycline is typically used first line, although some strains of "V. cholerae" have shown resistance. Testing for resistance during an outbreak can help determine appropriate future choices. Other antibiotics proven to be effective include cotrimoxazole, erythromycin, tetracycline, chloramphenicol, and furazolidone. Fluoroquinolones, such as ciprofloxacin, also may be used, but resistance has been reported.


title: Cholera

text: Antibiotics improve outcomes in those who are both severely and not severely dehydrated. Azithromycin and tetracycline may work better than doxycycline or ciprofloxacin.


title: Cholera

text: In Bangladesh zinc supplementation reduced the duration and severity of diarrhea in children with cholera when given with antibiotics and rehydration therapy as needed. It reduced the length of disease by eight hours and the amount of diarrhea stool by 10%. Supplementation appears to be also effective in both treating and preventing infectious diarrhea due to other causes among children in the developing world.


title: Cholera

text: If people with cholera are treated quickly and properly, the mortality rate is less than 1%; however, with untreated cholera, the mortality rate rises to 50–60%.


title: Cholera

text: For certain genetic strains of cholera, such as the one present during the 2010 epidemic in Haiti and the 2004 outbreak in India, death can occur within two hours of becoming ill.


title: Cholera

text: Cholera affects an estimated 2.8 million people worldwide, and causes approximately 95,000 deaths a year (uncertainty range: 21,000–143,000) . This occurs mainly in the developing world.


title: Cholera

text: In the early 1980s, death rates are believed to have still been higher than three million a year. It is difficult to calculate exact numbers of cases, as many go unreported due to concerns that an outbreak may have a negative impact on the tourism of a country. As of 2004, cholera remained both epidemic and endemic in many areas of the world.


title: Cholera

text: Recent major outbreaks are the 2010s Haiti cholera outbreak and the 2016–2021 Yemen cholera outbreak. In October 2016, an outbreak of cholera began in war-ravaged Yemen. WHO called it "the worst cholera outbreak in the world". In 2019, 93% of the reported 923,037 cholera cases were from Yemen (with 1911 deaths reported). Between September 2019 and September 2020, a global total of over 450,000 cases and over 900 deaths was reported; however, the accuracy of these numbers suffer from over-reporting from countries that report suspected cases (and not laboratory confirmed cases), as well as under-reporting from countries that do not report official cases (such as Bangladesh, India and Philippines).


title: Cholera

text: Although much is known about the mechanisms behind the spread of cholera, researchers still do not have a full understanding of what makes cholera outbreaks happen in some places and not others. Lack of treatment of human feces and lack of treatment of drinking water greatly facilitate its spread. Bodies of water have been found to serve as a reservoir of infection, and seafood shipped long distances can spread the disease.


title: Cholera

text: Cholera had disappeared from the Americas for most of the 20th century, but it reappeared toward the end of that century, beginning with a severe outbreak in Peru. Following the end of the 2010s Haiti cholera outbreak, there have not been any cholera cases in the Americas since February 2019. the disease is endemic in Africa and some areas of eastern and western Asia (Bangladesh, India and Yemen). Cholera is not endemic in Europe; all reported cases had a travel history to endemic areas.


title: Cholera

text: The word cholera is from "kholera" from χολή "kholē" "bile". Cholera likely has its origins in the Indian subcontinent as evidenced by its prevalence in the region for centuries.


title: Cholera

text: References to cholera appear in the European literature as early as 1642, from the Dutch physician Jakob de Bondt's description in his De Medicina Indorum. (The "Indorum" of the title refers to the East Indies. He also gave first European descriptions of other diseases.) But at the time, the word "cholera" was historically used by European physicians to refer to any gastrointestinal upset resulting in yellow diarrhea. De Bondt thus used a common word already in regular use to describe the new disease. This was a frequent practice of the time. It was not until the 1830s that the name for severe yellow diarrhea changed in English from "cholera" to "cholera morbus" to differentiate it from what was then known as "Asiatic cholera", or that associated with origins in India and the East.


title: Cholera

text: Early outbreaks in the Indian subcontinent are believed to have been the result of crowded, poor living conditions, as well as the presence of pools of still water, both of which provide ideal conditions for cholera to thrive. The disease first spread by travelers along trade routes (land and sea) to Russia in 1817, later to the rest of Europe, and from Europe to North America and the rest of the world, (hence the name "Asiatic cholera"). Seven cholera pandemics have occurred since the early 19th century; the first one did not reach the Americas. The seventh pandemic originated in Indonesia in 1961.


title: Cholera

text: The first cholera pandemic occurred in the Bengal region of India, near Calcutta starting in 1817 through 1824. The disease dispersed from India to Southeast Asia, the Middle East, Europe, and Eastern Africa. The movement of British Army and Navy ships and personnel is believed to have contributed to the range of the pandemic, since the ships carried people with the disease to the shores of the Indian Ocean, from Africa to Indonesia, and north to China and Japan.


title: Cholera

text: The second pandemic lasted from 1826 to 1837 and particularly affected North America and Europe. Advancements in transportation and global trade, and increased human migration, including soldiers, meant that more people were carrying the disease more widely. The third pandemic erupted in 1846, persisted until 1860, extended to North Africa, and reached North and South America. It was introduced to North America at Quebec, Canada, via Irish immigrants from the Great Famine. In this pandemic, Brazil was affected for the first time. The fourth pandemic lasted from 1863 to 1875, spreading from India to Naples and Spain, and reaching the United States at New Orleans, Louisiana in 1873. It spread throughout the Mississippi River system on the continent.


title: Cholera

text: The fifth pandemic was from 1881 to 1896. It started in India and spread to Europe, Asia, and South America. The sixth pandemic ran from 1899 to 1923. These epidemics had a lower number of fatalities because physicians and researchers had a greater understanding of the cholera bacteria. Egypt, the Arabian peninsula, Persia, India, and the Philippines were hit hardest during these epidemics. Other areas, such as Germany in 1892 (primarily the city of Hamburg, where more than 8.600 people died) and Naples from 1910 to 1911, also had severe outbreaks.


title: Cholera

text: The seventh pandemic originated in 1961 in Indonesia and is marked by the emergence of a new strain, nicknamed "El Tor", which still persists () in developing countries. This pandemic had initially subsided about 1975 and was thought to have ended, but, as noted, it has persisted. There were a rise in cases in the 1990s and since.


title: Cholera

text: Cholera became widespread in the 19th century. Since then it has killed tens of millions of people. In Russia alone, between 1847 and 1851, more than one million people died from the disease. It killed 150,000 Americans during the second pandemic. Between 1900 and 1920, perhaps eight million people died of cholera in India. Cholera officially became the first reportable disease in the United States due to the significant effects it had on health. John Snow, in England, in 1854 was the first to identify the importance of contaminated water as its source of transmission. Cholera is now no longer considered a pressing health threat in Europe and North America due to filtering and chlorination of water supplies, but it still strongly affects populations in developing countries.


title: Cholera

text: In the past, vessels flew a yellow quarantine flag if any crew members or passengers had cholera. No one aboard a vessel flying a yellow flag would be allowed ashore for an extended period, typically 30 to 40 days.


title: Cholera

text: Historically many different claimed remedies have existed in folklore. Many of the older remedies were based on the miasma theory, that the disease was transmitted by bad air. Some believed that abdominal chilling made one more susceptible, and flannel and cholera belts were included in army kits. In the 1854–1855 outbreak in Naples, homeopathic camphor was used according to Hahnemann. T. J. Ritter's "Mother's Remedies" book lists tomato syrup as a home remedy from northern America. Elecampane was recommended in the United Kingdom, according to William Thomas Fernie. The first effective human vaccine was developed in 1885, and the first effective antibiotic was developed in 1948.


title: Cholera

text: Cholera cases are much less frequent in developed countries where governments have helped to establish water sanitation practices and effective medical treatments. In the 19th century the United States, for example, had a severe cholera problem similar to those in some developing countries. It had three large cholera outbreaks in the 1800s, which can be attributed to "Vibrio cholerae" spread through interior waterways such as the Erie Canal and the extensive Mississippi River valley system, as well as the major ports along the Eastern Seaboard and their cities upriver. The island of Manhattan in New York City touches the Atlantic Ocean, where cholera collected from river waters and ship discharges just off the coast. At this time, New York City did not have as effective a sanitation system as it developed in the later 20th century, so cholera spread through the city's water supply.


title: Cholera

text: Cholera morbus is a historical term that was used to refer to gastroenteritis rather than specifically to what is now defined as the disease of cholera.


title: Cholera

text: One of the major contributions to fighting cholera was made by the physician and pioneer medical scientist John Snow (1813–1858), who in 1854 found a link between cholera and contaminated drinking water. Dr. Snow proposed a microbial origin for epidemic cholera in 1849. In his major "state of the art" review of 1855, he proposed a substantially complete and correct model for the cause of the disease. In two pioneering epidemiological field studies, he was able to demonstrate human sewage contamination was the most probable disease vector in two major epidemics in London in 1854. His model was not immediately accepted, but it was increasingly seen as plausible as medical microbiology developed over the next 30 years or so. For his work on cholera, John Snow is often regarded as the "Father of Epidemiology".


title: Cholera

text: The bacterium was isolated in 1854 by Italian anatomist Filippo Pacini, but its exact nature and his results were not widely known. In the same year, the Catalan Joaquim Balcells i Pascual discovered the bacterium. In 1856 António Augusto da Costa Simões and José Ferreira de Macedo Pinto, two Portuguese researchers, are believed to have done the same.


title: Cholera

text: Between the mid-1850s and the 1900s, cities in developed nations made massive investment in clean water supply and well-separated sewage treatment infrastructures. This eliminated the threat of cholera epidemics from the major developed cities in the world. In 1883, Robert Koch identified "V. cholerae" with a microscope as the bacillus causing the disease.


title: Cholera

text: Hemendra Nath Chatterjee, a Bengali scientist, was the first to formulate and demonstrate the effectiveness of oral rehydration salt (ORS) to treat diarrhea. In his 1953 paper, published in "The Lancet", he states that promethazine can stop vomiting during cholera and then oral rehydration is possible. The formulation of the fluid replacement solution was 4 g of sodium chloride, 25 g of glucose and 1000 ml of water.


title: Cholera

text: Indian medical scientist Sambhu Nath De discovered the cholera toxin, the "animal model of cholera", and successfully demonstrated the method of transmission of cholera pathogen "Vibrio cholerae".


title: Cholera

text: Robert Allan Phillips, working at US Naval Medical Research Unit Two in Southeast Asia, evaluated the pathophysiology of the disease using modern laboratory chemistry techniques. He developed a protocol for rehydration. His research led the Lasker Foundation to award him its prize in 1967.


title: Cholera

text: More recently, in 2002, Alam, "et al.", studied stool samples from patients at the International Centre for Diarrhoeal Disease in Dhaka, Bangladesh. From the various experiments they conducted, the researchers found a correlation between the passage of "V. cholerae" through the human digestive system and an increased infectivity state. Furthermore, the researchers found the bacterium creates a hyperinfected state where genes that control biosynthesis of amino acids, iron uptake systems, and formation of periplasmic nitrate reductase complexes were induced just before defecation. These induced characteristics allow the cholera vibrios to survive in the "rice water" stools, an environment of limited oxygen and iron, of patients with a cholera infection.


title: Cholera

text: In 2017, the WHO launched the "Ending Cholera: a global roadmap to 2030" strategy which aims to reduce cholera deaths by 90% by 2030. The strategy was developed by the Global Task Force on Cholera Control (GTFCC) which develops country-specific plans and monitors progress. The approach to achieve this goal combines surveillance, water sanitation, rehydration treatment and oral vaccines. Specifically, the control strategy focuses on three approaches: i) early detection and response to outbreaks to contain outbreaks, ii) stopping cholera transmission through improved sanitation and vaccines in hotspots, and iii) a global framework for cholera control through the GTFCC.


title: Cholera

text: The WHO and the GTFCC do not consider global cholera eradication a viable goal. Even though humans are the only host of cholera, the bacterium can persist in the environment without a human host. While global eradication is not possible, elimination of human to human transmission may be possible. Local elimination is possible, which has been underway most recently during the 2010s Haiti cholera outbreak. Haiti aims to achieve certification of elimination by 2022.


title: Cholera

text: In many developing countries, cholera still reaches its victims through contaminated water sources, and countries without proper sanitation techniques have greater incidence of the disease. Governments can play a role in this. In 2008, for example, the Zimbabwean cholera outbreak was due partly to the government's role, according to a report from the James Baker Institute. The Haitian government's inability to provide safe drinking water after the 2010 earthquake led to an increase in cholera cases as well.


title: Cholera

text: Similarly, South Africa's cholera outbreak was exacerbated by the government's policy of privatizing water programs. The wealthy elite of the country were able to afford safe water while others had to use water from cholera-infected rivers.


title: Cholera

text: According to Rita R. Colwell of the James Baker Institute, if cholera does begin to spread, government preparedness is crucial. A government's ability to contain the disease before it extends to other areas can prevent a high death toll and the development of an epidemic or even pandemic. Effective disease surveillance can ensure that cholera outbreaks are recognized as soon as possible and dealt with appropriately. Oftentimes, this will allow public health programs to determine and control the cause of the cases, whether it is unsanitary water or seafood that have accumulated a lot of "Vibrio cholerae" specimens. Having an effective surveillance program contributes to a government's ability to prevent cholera from spreading. In the year 2000 in the state of Kerala in India, the Kottayam district was determined to be "Cholera-affected"; this pronouncement led to task forces that concentrated on educating citizens with 13,670 information sessions about human health. These task forces promoted the boiling of water to obtain safe water, and provided chlorine and oral rehydration salts. Ultimately, this helped to control the spread of the disease to other areas and minimize deaths. On the other hand, researchers have shown that most of the citizens infected during the 1991 cholera outbreak in Bangladesh lived in rural areas, and were not recognized by the government's surveillance program. This inhibited physicians' abilities to detect cholera cases early.


title: Cholera

text: According to Colwell, the quality and inclusiveness of a country's health care system affects the control of cholera, as it did in the Zimbabwean cholera outbreak. While sanitation practices are important, when governments respond quickly and have readily available vaccines, the country will have a lower cholera death toll. Affordability of vaccines can be a problem; if the governments do not provide vaccinations, only the wealthy may be able to afford them and there will be a greater toll on the country's poor. The speed with which government leaders respond to cholera outbreaks is important.


title: Cholera

text: Besides contributing to an effective or declining public health care system and water sanitation treatments, government can have indirect effects on cholera control and the effectiveness of a response to cholera. A country's government can impact its ability to prevent disease and control its spread. A speedy government response backed by a fully functioning health care system and financial resources can prevent cholera's spread. This limits cholera's ability to cause death, or at the very least a decline in education, as children are kept out of school to minimize the risk of infection.


title: Cholera

text: Unlike tuberculosis ("consumption") which in literature and the arts was often romanticized as a disease of denizens of the demimonde or those with an artistic temperament, cholera is a disease which almost entirely affects the lower-classes living in filth and poverty. This, and the unpleasant course of the disease – which includes voluminous "rice-water" diarrhea, the hemorrhaging of liquids from the mouth, and violent muscle contractions which continue even after death – has discouraged the disease from being romanticized, or even being factually presented in popular culture.


title: Cholera

text: In Zambia, widespread cholera outbreaks have occurred since 1977, most commonly in the capital city of Lusaka. In 2017, an outbreak of cholera was declared in Zambia after laboratory confirmation of "Vibrio cholerae" O1, biotype El Tor, serotype Ogawa, from stool samples from two patients with acute watery diarrhea. There was a rapid increase in the number of cases from several hundred cases in early December 2017 to approximately 2,000 by early January 2018. With intensification of the rains, new cases increased on a daily basis reaching a peak on the first week of January 2018 with over 700 cases reported.


title: Cholera

text: In collaboration with partners, the Zambia Ministry of Health (MoH) launched a multifaceted public health response that included increased chlorination of the Lusaka municipal water supply, provision of emergency water supplies, water quality monitoring and testing, enhanced surveillance, epidemiologic investigations, a cholera vaccination campaign, aggressive case management and health care worker training, and laboratory testing of clinical samples.


title: Cholera

text: The Zambian Ministry of Health implemented a reactive one-dose Oral Cholera Vaccine (OCV) campaign in April 2016 in three Lusaka compounds, followed by a pre-emptive second-round in December.


title: Cholera

text: The city of Kolkata, India in the state of West Bengal in the Ganges delta has been described as the "homeland of cholera", with regular outbreaks and pronounced seasonality. In India, where the disease is endemic, cholera outbreaks occur every year between dry seasons and rainy seasons. India is also characterized by high population density, unsafe drinking water, open drains, and poor sanitation which provide an optimal niche for survival, sustenance and transmission of "Vibrio cholerae".


title: Cholera

text: In Goma in the Democratic Republic of Congo, cholera has left an enduring mark on human and medical history. Cholera pandemics in the 19th and 20th centuries led to the growth of epidemiology as a science and in recent years it has continued to press advances in the concepts of disease ecology, basic membrane biology, and transmembrane signaling and in the use of scientific information and treatment design.


title: Clive Owen

text: Clive Owen (born 3 October 1964) is an English actor. He first gained recognition in the United Kingdom for playing the lead role in the ITV series "Chancer" from 1990 to 1991. He received critical acclaim for his work in the film "Close My Eyes" (1991) before earning international attention for his performance as a struggling writer in "Croupier" (1998). In 2005, he won a Golden Globe and a BAFTA Award and was nominated for an Academy Award for his performance in the drama "Closer" (2004).


title: Clive Owen

text: Owen has played leading roles in films such as "Sin City" (2005), "Derailed" (2005), "Inside Man" (2006), "Children of Men" (2006), and "The International" (2009). In 2012, he earned his first Primetime Emmy Award nomination for Outstanding Lead Actor in a Miniseries or a Movie for his role in "Hemingway & Gellhorn". He played Dr. John W. Thackery on the Cinemax medical drama series "The Knick", for which he received a Golden Globe Award for Best Actor – Television Series Drama nomination. In 2021, he starred in a psychological romance horror miniseries "Lisey's Story" and also portrayed President Bill Clinton in the third season of "American Crime Story".


title: Clive Owen

text: Clive Owen was born on 3 October 1964 in Keresley, Coventry (then in Warwickshire), the fourth of five sons born to Pamela ( Cotton) and Jess Owen. His father, a country and western singer, left the family when Owen was three years old, and despite a brief reconciliation when Owen was 19, the two have remained estranged. He has described his childhood as "rough".


title: Clive Owen

text: While initially opposed to drama school, he changed his mind in 1984, after a long and fruitless period of searching for work. Owen graduated from the Royal Academy of Dramatic Art. After graduation, he worked at the Young Vic, performing in several Shakespearean plays.


title: Clive Owen

text: Initially, Owen's career was in television. In 1988, he starred as Gideon Sarn in a BBC production of "Precious Bane" and the Channel 4 film "Vroom" before the 1990s saw him become a regular on stage and television in the UK, notably his lead role in the ITV series "Chancer", followed by an appearance in the Thames Television production of "Lorna Doone".


title: Clive Owen

text: He won critical acclaim for his performances in the Stephen Poliakoff film "Close My Eyes" (1991) about a brother and sister who embark on an incestuous love affair. He subsequently appeared in "The Magician", "Class of '61", "Century", "Nobody's Children", "An Evening with Gary Lineker", "Doomsday Gun", "Return of the Native" and a Carlton production called "Sharman", about a private detective. In 1996, he appeared in his first major Hollywood film "The Rich Man's Wife" alongside Halle Berry before finding international acclaim in a Channel 4 film directed by Mike Hodges called "Croupier" (1998). In "Croupier", he played the title role of a struggling writer who takes a job in a London casino as inspiration for his work, only to get caught up in a robbery scheme. In 1999, he appeared as an accident-prone driver in "Split Second", his first BBC production in about a decade.


title: Clive Owen

text: Owen starred in "The Echo", a BBC1 drama, before starring in the film "Greenfingers", about a criminal who goes to work in a garden. He appeared in the BBC1 mystery series "Second Sight". In 2001, he provided the voice-over for "Walk On By", a BBC2 documentary about popular music, as well as starring in a highly acclaimed theatre revival of Peter Nichols' play "A Day in the Death of Joe Egg", about a couple with a severely handicapped daughter.


title: Clive Owen

text: Owen became known to North American audiences in the summer of 2001 after starring as "The Driver" in "The Hire", a series of short films sponsored by BMW and made by prominent directors. He appeared in Robert Altman's "Gosford Park". He appeared in the 2002 film "The Bourne Identity". In 2003, he reteamed with director Mike Hodges in "I'll Sleep When I'm Dead". He starred in "Beyond Borders" as well as King Arthur in "King Arthur", for which he learned to ride a horse.


title: Clive Owen

text: He appeared in the Royal National Theatre debut of the hit play "Closer", by Patrick Marber, which was produced as a film in 2004. He played Dan in the play, and played Larry in the film version. His portrayal of Larry in the film received very favourable reviews, as well as the Golden Globe and BAFTA awards, and an Academy Award nomination for Best Supporting Actor. He noted that the expectations of him since the Oscar nomination have not changed the way he approaches film-making, stating "I try, every film I do, to be as good as I can and that's all I can do."


title: Clive Owen

text: After "Closer", he appeared in "Derailed" alongside Jennifer Aniston, the comic book thriller "Sin City" as the noir antihero Dwight McCarthy and as a mysterious bank robber in "Inside Man". Despite public denials, Owen had been rumoured to be a possible successor to Pierce Brosnan in the role of James Bond. A public opinion poll in the United Kingdom in October 2005 by SkyNews found that he was the public's number one choice to star in the next instalment of the series. In that same month, however, it was announced that fellow British actor Daniel Craig would become the next James Bond. In an interview in the September 2007 issue of "Details", he claimed that he was not offered or approached concerning the role.


title: Clive Owen

text: In 2006, Owen spoofed the Bond connection by making an appearance in the remake of "The Pink Panther" in which he plays a character named "Nigel Boswell, Agent 006" (when he introduces himself to Inspector Clouseau, he quips that Owen's character is "one short of the big time").


title: Clive Owen

text: In 2006, Owen starred in "Children of Men". The film was nominated for various awards, including an Academy Award for Best Adapted Screenplay; Owen worked on the screenplay, although he was uncredited. The next year he starred alongside Paul Giamatti in the film "Shoot 'Em Up" and appeared as Sir Walter Raleigh opposite Cate Blanchett's Elizabeth I of England in the film "". He appeared in the Christmas special of the Ricky Gervais and Stephen Merchant show "Extras".


title: Clive Owen

text: Owen starred in "The International" (2009), a film which he described as a "paranoid political thriller". He played the lead in "The Boys Are Back", an Australian adaptation of the book "The Boys Are Back in Town" by Simon Carr.


title: Clive Owen

text: In June 2010 it was announced that Owen and Nicole Kidman would star in an HBO film about Ernest Hemingway and his relationship with Martha Gellhorn entitled "Hemingway & Gellhorn". James Gandolfini served as executive producer to the film, written by Barbara Turner and Jerry Stahl. The film was directed by Philip Kaufman and released in 2012. Owen played the lead in "Shadow Dancer", a joint UK/Ireland production about a young mother who is involved with Irish republicanism. It co-starred Andrea Riseborough, Gillian Anderson, and Aidan Gillen, and was directed by James Marsh. In April 2010, he was cast as the lead in Juan Carlos Fresnadillo's horror-thriller "Intruders".


title: Clive Owen

text: Owen starred in the film "Blood Ties", directed by Guillaume Canet, alongside French actress Marion Cotillard. It was released in June 2013 at the 2013 Cannes Film Festival. In 2015, Owen made his Broadway debut in a revival of Harold Pinter's "Old Times" at the American Airlines Theatre. He was selected to be on the jury for the main competition section of the 2016 Berlin Film Festival.


title: Clive Owen

text: In October 2017, Owen returned to Broadway as Rene Gallimard in a revival of David Henry Hwang's "M. Butterfly" at the Cort Theatre in New York City.


title: Clive Owen

text: In 2019, Owen played the role of the defrocked Reverend T. Lawrence Shannon in the West End theatre production of Tennessee Williams' "The Night of the Iguana" at the Noël Coward Theatre. Also in 2019, he played Dovidl Rapaport in "The Song of Names." He is playing Bill Clinton in the miniseries "Impeachment: American Crime Story".


title: Clive Owen

text: Owen met his wife, Sarah-Jane Fenton, in 1988, when they were both taking part in a production of Shakespeare's "Romeo and Juliet " at the Young Vic Theatre in London. They began dating shortly after and married in March 1995. The couple have two daughters together.


title: Clive Owen

text: Owen became patron of the Electric Palace Cinema in Harwich, Essex, and launched an appeal for funds to repair deteriorating elements of the historic building.


title: Clive Owen

text: Owen has received multiple nominations for his work in both film and television. He has one Academy Award nomination for Best Supporting Actor for his role as Larry in "Closer" (2004), three Golden Globe Award nominations, winning one in 2005 for Best Supporting Actor in a Motion Picture for his role in "Closer"; his other two nominations are for his roles in television including made-for-television film "Hemingway & Gellhorn" (2012) for Best Lead Actor in a Miniseries or Motion Picture Made for Television, and drama series "The Knick" (2014) for Best Lead Actor in a Television Series – Drama, one Primetime Emmy Award for Outstanding Lead Actor in a Limited Series or Movie nomination for his performance in "Hemingway & Gellhorn" (2012), and two Screen Actors Guild Award nominations – winning one in 2002 for Outstanding Performance by an Ensemble in a Motion Picture for his performance in "Gosford Park" (2002).


title: Betty Ford

text: Elizabeth Anne Ford (; formerly Warren; April 8, 1918 – July 8, 2011) was the first lady of the United States from 1974 to 1977, as the wife of President Gerald Ford. As first lady, she was active in social policy and set a precedent as a politically active presidential spouse. Ford also served as the second lady of the United States from 1973 to 1974 when her husband was vice president.


title: Betty Ford

text: Throughout her husband's term in office, she maintained high approval ratings and was considered to be an influential first lady. Ford was noted for raising breast cancer awareness following her 1974 mastectomy. In addition, she was a passionate supporter of the Equal Rights Amendment (ERA). As a supporter of abortion rights and a leader in the women's rights movement, she gained fame as one of the most candid first ladies in history, commenting on the hot-button issues of the time, such as feminism, equal pay, the Equal Rights Amendment, sex, drugs, abortion, and gun control. Surveys of historians conducted by the Siena College Research Institute have shown that historians regard Ford to be among the best and most courageous American first ladies.


title: Betty Ford

text: Following her White House years, she continued to lobby for the ERA and remained active in the feminist movement. Soon after leaving office, she raised awareness of addiction when she sought help for and publicly disclosed her long-running struggle with alcoholism and substance abuse. After recovering, she founded and served as the first chair of the board of directors of the Betty Ford Center for substance abuse and addiction. Ford also became involved in causes related to HIV/AIDS. For years after leaving the White House, Ford continued to enjoy great influence and popularity, continuing to rank in the top-ten of Gallup's annual most admired woman poll every year through 1991.


title: Betty Ford

text: Ford was awarded the Presidential Medal of Freedom by George H. W. Bush in 1991. She was also awarded the Congressional Gold Medal as a co-recipient with President Ford in 1998.


title: Betty Ford

text: Ford was born Elizabeth Anne Bloomer in 1918 in Chicago, Illinois, the third child and only daughter of Hortense (née Neahr; 1884 – 1948) and William Stephenson Bloomer Sr. (1874 – 1934), who was a traveling salesman for Royal Rubber Co. She was called Betty as a child.


title: Betty Ford

text: Hortense and William married on November 9, 1904, in Chicago. Betty's two older brothers were Robert (d. 1971) and William Jr. After the family lived briefly in Denver, Colorado, she grew up in Grand Rapids, Michigan, where she graduated from Central High School.


title: Betty Ford

text: In 1926, when she was eight years old, her mother, who valued social graces, enrolled her in the Calla Travis Dance Studio in Grand Rapids, where Ford was taught ballet, tap dancing, and modern movement. Dance developed into a passion for her, and she decided she wanted to seek a career in it. At the age of 14, she began modeling clothes and teaching children popular dances, such as the foxtrot, waltz, and big apple, to earn money in the wake of the Great Depression. She worked with children with disabilities at the Mary Free Bed Home for Crippled Children. She studied dance at the Calla Travis Dance Studio, graduating in 1935. While she was still in high school, she started her own dance school, instructing both youth and adults.


title: Betty Ford

text: Growing up, she was subject to teasing about her surname, with other kids in school calling her "Betty Pants" (a play on "bloomers" being a name for a type of lower-body garment). Bloomer disliked the surname.


title: Betty Ford

text: When Ford herself began the process of recovering from her own alcoholism, she disclosed to the public that both her father and her brother Bob had suffered from alcoholism as well.


title: Betty Ford

text: When Bloomer was 16, her father died of carbon monoxide poisoning in the family's garage while working under their car, despite the garage doors being open. He died the day before his 60th birthday. It was never confirmed whether his death had been accidental or a suicide. With her father's passing, her family lost its primary breadwinner, and her mother began working as a real estate agent to support the family. Her mother's actions in the wake of her father's passing are said to have been formative for her views in support of equal pay and gender equality.


title: Betty Ford

text: In 1936, after graduating from high school, Bloomer proposed continuing her study of dance in New York City, but her mother refused on account of the relatively recent loss of her husband. She instead attended the Bennington School of Dance in Bennington, Vermont, for two summers, where she studied under director Martha Hill with choreographers Martha Graham and Hanya Holm. After being accepted by Graham as a student in 1940, Bloomer moved to New York to live in Manhattan's Chelsea neighborhood; she worked as a fashion model for the John Robert Powers firm in order to finance her dance studies. She joined Graham's auxiliary troupe and eventually performed with the company at Carnegie Hall in New York City.


title: Betty Ford

text: Bloomer's mother was opposed to her pursuing a career in dance and insisted that she return home, and, as a compromise, they agreed that Bloomer would return home for six months and, if she still wanted to return to New York City at the end of that time, her mother would not protest further. Bloomer became immersed in her life in Grand Rapids and did not return to New York. Her mother remarried, to family friend and neighbor Arthur Meigs Godwin, and Bloomer lived with them. She got a job as assistant to the fashion coordinator for Herpolsheimer's, a local department store. She also organized her own dance group and taught dance at various sites in Grand Rapids, including the Calla Travis Dance Studio. She further taught ballroom dancing lessons for children with visual impairment and hearing loss and gave weekly dance lessons to African American children.


title: Betty Ford

text: In 1942, Elizabeth Bloomer married William G. Warren, whom she had known since she was 12. At the time they married, Warren worked for his own father in insurance sales. Shortly after they married, he began to sell insurance for another company. He later worked for the Continental Can Company, and after that for the Widdicomb Furniture Company. The couple moved frequently because of his work. At one point, they lived in Toledo, Ohio, where Elizabeth was employed at the department store Lasalle & Koch as a demonstrator, a job that entailed being a model and saleswoman. She worked a production line for a frozen food company in Fulton, New York. When they returned to Grand Rapids, she worked again at Herpolsheimer's, this time as the fashion coordinator. She had, three years into the marriage, concluded that their relationship was a failure. She desired to have a family with children and was unhappy with the frequent moves between cities she had experienced in her marriage. Warren was an alcoholic and diabetic, and was in poor health. Shortly after she decided to file for divorce, Warren fell into a coma. She paused her divorce, and supported him, living at Warren's family's home for the next two years as his health recovered. During these two years, she lived upstairs while he was nursed downstairs She worked jobs in order to support both herself and Warren. This experience has been credited with further cementing Ford's understanding of gender-based income inequalities between individuals doing the same work. After he recovered, they were divorced on September 22, 1947.


title: Betty Ford

text: In August 1947, she was introduced by mutual friends to Gerald Ford, a lawyer and World War II veteran who had just resumed his legal practice after returning from Navy service, and was planning to run for the United States House of Representatives. They married on October 15, 1948, at Grace Episcopal Church in Grand Rapids. Gerald Ford was in the middle of his campaign for the U.S. House of Representatives. In the first of adjustments for politics, he had asked her to delay the wedding until shortly before the primary election because, as "The New York Times" reported, "Jerry was running for Congress and wasn't sure how voters might feel about his marrying a divorced ex-dancer." For their honeymoon, the two briefly traveled to Ann Arbor, Michigan, where they attended a college football game between the Michigan Wolverines and the Northwestern Wildcats, before driving to Owosso, Michigan, to attend a campaign rally for Republican presidential nominee Thomas Dewey. The Fords would ultimately be married for the next 58 years, until Gerald Ford's death. An anecdote that was later reported was that, when Gerald Ford left Grand Rapids for Washington, D.C., Betty Ford's new sister-in-law Janet Ford remarked to her, "with Jerry, you'll never have to worry about other women. Your cross will be his work."


title: Betty Ford

text: Betty and Gerald Ford had four children together: Michael Gerald Ford (born 1950), John Gardner Ford (nicknamed Jack; born 1952), Steven Meigs Ford (born 1956), and Susan Elizabeth Ford (born 1957).


title: Betty Ford

text: The Fords lived in Washington, D.C. after his election, until the spring of 1955, when the Fords moved into a house they constructed in the D.C. suburb of Alexandria, Virginia. Gerald Ford had ambitions to rise to the rank of speaker of the house, and therefore maintained a busy travel schedule, regularly crisscrossing the United States to fundraise and campaign on behalf of other Republicans in hopes that they would, in turn, provide him with the support he'd eventually need to become speaker. This meant that Gerald Ford was away from home for roughly half the year, placing a great burden on Ford to raise their children. As a mother, Ford never spanked or hit her children, believing that there were better, more constructive ways to deal with discipline and punishment.


title: Betty Ford

text: Ford served as a parent-teacher association member, Sunday school teacher at Immanuel Church-on-the-Hill, and a Cub Scout "den mother". She regularly drove her children around to their activities, such as her sons' Little League Baseball games and her daughter's dance classes. She was also involved in her husband's political career by fulfilling the commitments expected of congressional spouses to help elevate her husband's regard among his House colleagues. She accompanied her husband to congressional and White House events, as well as on some trips abroad, and made herself available to newspaper and magazine articles. Ford also posed for newspaper publicity photographs and was a clothing model for charity fashion shows, after a Republican had urged her to do so since they felt that Democratic Party spouses had far outnumbered Republican spouses in such publicity-generating activity. Ford also volunteered for local charitable organizations, including serving as the program director of the Alexandria Cancer Fund Drive. Ford also held active membership in groups such as the 81st Congress Club and National Federation of Republican Women.


title: Betty Ford

text: Ford's busy life took a toll. In 1964, a pinched nerve on the left side of Ford's neck sent her to the hospital for two weeks. After her pinched nerve, she began suffering several effects, including muscle spasms, periphrasic neuropathy, numbing the left side of her neck, and arthritis on her shoulder and arm. She would be given prescription medication, including Valium. Ford would ultimately develop an addiction to prescription medication (and would ultimately confront and recover from this addiction in 1978). Ford's health problems and the stress of her husband's career (which saw him frequently away from their household) compounded, particularly after her husband's career became even more demanding after he became House minority leader in January 1965. In 1965, Ford suffered a significant nervous breakdown, erupting in severe crying that had appeared inexplicable to others. This led her to seek psychiatric assistance. Ford had weekly meetings with a psychiatrist approximately between August 1965 and April 1967. Ford received support from her family and managed to resume a busy lifestyle. However, notably, Ford had not managed to address her increasing prescription pain medication dependency, which sometimes saw her taking as many as twenty pills in a single day. Nor did she address her relationship with alcohol, which she, at the time, believed was typical consumption.


title: Betty Ford

text: Ford accompanied her husband on a trip to mainland China in 1972. That same year, her husband brought up the possibility that he might retire from congress in 1977, which would make the 1974 United States House of Representatives election the last he would run in. This prospect elated Ford. Such talk was due to Gerald Ford, following the Republican Party's failure to win a majority in the 1972 United States House of Representatives elections, seeing it as unlikely that he would ever fulfill his ambition of becoming speaker of the House.


title: Betty Ford

text: Spiro Agnew resigned as vice president on October 10, 1973. Two days later, on October 12, 1973, President Richard Nixon nominated Gerald Ford to serve as vice president. Ford felt an obligation to attend her husband's testimony at his confirmation hearings. During his testimony, Gerald Ford was questioned about attending psychiatric care. After this, Betty Ford was transparent with the news media that she had received psychiatric care. She explained that, while her husband had attended two sessions with a psychiatric doctor, those sessions were for her care, and not care of his own. Gerald Ford was confirmed as vice president by the United States Congress on December 6, 1973, and Gerald Ford took the oath of office before a joint session of the United States Congress, placing his hand upon a bible which Betty Ford held. With her husband assuming the office of vice president, Ford became the second lady of the United States.


title: Betty Ford

text: Before the end of December, Ford played a role in establishing the Republican Women's Federal Forum, partnering with Barbara Bush, whose husband George H. W. Bush was chairman of the Republican National Committee at the time. The organization sought to bring together political spouses and female government federal employees to discuss current party activates and ideas about legislation. Ford also, in a television interview with Barbara Walters, expressed her support for the United States Supreme Court's Roe v. Wade decision ruling abortion as constitutionally protected. Ford remarked, "I agree with the Supreme Court’s ruling. I think it’s time to bring abortion out of the backwoods and put it in the hospitals, where it belongs.” Disregarding criticism to her stance, Ford would remark, “Maybe I shouldn’t have said it, but I couldn’t lie. That’s the way I feel."


title: Betty Ford

text: The media "broke" the story that Ford had a previous marriage and had been divorced, initially reporting it as a secret revelation. However, Ford simply responded by giving the explanation that it was not something she had tried to hide, but, rather, something she had only not shared with the news media because none of them had broached the topic in their previous questions to her. This response proved effective in killing the speculation that she was covering-up her past, and earned her some admiration in the media. At one point, Ford disclosed to the public that her husband had previously promised her that he would retire from the House of Representatives in 1976 in order to return to private legal practice and dedicate more time to his family. Ford became overwhelmed by the media attention she received and became somewhat reclusive for a period early into her time as second lady. However, by the spring of 1974, Ford was seen as embracing her position as second lady, becoming less reclusive and more active. Ford would, ultimately, for most of the nine months she was second lady, be a high-profile public figure.


title: Betty Ford

text: As she became a more active second lady, Ford adopted an objective of promoting the arts. In April 1974, she made her first official solo trip as second lady when she spent two-days visiting the states of Georgia and Tennessee to help in publicizing the "ARTRAIN", which was a traveling exhibit of art, visual displays, and performance pieces housed in six railway cars, and which was to travel through small towns across the southern United States. Ford was the most prominent national supporter of the project. Her candor on this trip received a positive reception by the news media.. Among those she met on the two-day trip was Georgia Governor Jimmy Carter and his wife Rosalynn Carter. The Carters would, ultimately be the Fords’ successors as president and first lady after Carter defeated Ford in the 1976 United States presidential election. On May 31, 1973, Ford made her first major speech when she gave a commencement address to the graduates of the Westminster Choir College. This set a contrast with First Lady Pat Nixon, who routinely rejected invitations to give formal speeches. Ford was also observed as upgrading her wardrobe, adding designer clothing. In addition to the arts, Ford also gave focus to projects helping the disabled during her time as second lady.


title: Betty Ford

text: On March 12, 1974, the Fords hosted a state dinner for King Hussein of Jordan after president Nixon, with a week's notice, asked Vice President Ford to take over for him in hosting the already-scheduled state dinner. The dinner was held in the John Quincy Adam's Drawing Room, one of the Diplomatic Reception Rooms at the United States Department of State headquarters at the Harry S Truman Building.


title: Betty Ford

text: In June 1974, Ford represented the Nixon administration by attending the funeral of Alberta Williams King, the assassinated mother of the late civil rights leader Martin Luther King Jr. Other Nixon administration official figures did not attend, continuing with other obligations. Ford was the only individual in attendance at the funeral not directly ingrained in the civil rights movement, with the exception of Georgia Governor Jimmy Carter. Ford's attendance at the funeral was, in actuality, a break from the administration. Ford had believed it to be of great importance for the administration to show an expression of direct concern pertaining to the assassination, while Nixon's staff disagreed with her. Ford also broke from the administration in giving her support to federally-funded child daycare, which the Nixon administration opposed.


title: Betty Ford

text: Ford had an extremely busy schedule by July 1974. Magazines such as "Vogue" and "Ladies Home Journal" were planning to publish spreads on Ford in upcoming issues. With her husband, as vice president, tasked with heavily campaigning on behalf of his party for the 1974 midterm elections, Ford occasionally hit the campaign trail herself. Ford had declared that she would be accompanying her husband at campaign functions, "when he wants me to." The Fords had planned to make a diplomatic trip to European nations after the midterm elections.


title: Betty Ford

text: Both Betty and Gerald Ford refuse to comment on speculation that President Nixon might be forced out of office due to the Watergate scandal. Ford did indirectly indicate her willingness to step into the role of first lady by affirming that she would make any sacrifices required for her husband to carry out his constitutional obligations, but also opined that it would be traumatic if the nation had to endure a president being forced from office. Ford also publicly expressed admiration and friendship toward First Lady Pat Nixon.


title: Betty Ford

text: On August 9, 1974, after the resignation of Richard Nixon, Gerald Ford ascended to the position of president of the United States, and Betty Ford became the first lady of the United States. As was the case during Gerald Ford's vice presidential swearing-in, Betty Ford held the bible upon which he placed his hand while taking his oath of office. In his remarks at his inauguration, Gerald Ford remarked, "I am indebted to no man and only one woman, my dear wife, Betty, as I begin this very difficult job."


title: Betty Ford

text: At the time her husband assumed the presidency, reporters speculated on what kind of first lady Ford would be, as they thought her predecessor, Pat Nixon, as noted by one reporter, to be the "most disciplined, composed first lady in history." Ford ultimately became a popular and impactful first lady. In the opinion of "The New York Times" and several presidential historians, "Mrs. Ford's impact on American culture may be far wider and more lasting than that of her husband, who served a mere 896 days, much of it spent trying to restore the dignity of the office of the president." She was regarded to be the most politically outspoken first lady since Eleanor Roosevelt. Ford regarded Roosevelt a role model. Active in social policy, Ford broke new ground as a politically active presidential spouse.


title: Betty Ford

text: Repeatedly speaking out on women's issues, Ford was a leader in the changing status of women in American society. Ford surprised the media and the public by explicitly supporting a woman's right to an abortion, the Equal Rights Amendment (ERA), and grass roots activism. Ford took these stances despite recognizing that they created a political risk of conservative backlash against her husband. However, not everything Ford did as first lady broke tradition. Ford also enjoyed the traditional role as hostess of the White House and on a daily basis spent most of her energy on the family, health, and filling in for her husband on the hustings.


title: Betty Ford

text: Steinhauer of "The New York Times" described Ford as "a product and symbol of the cultural and political times—doing the Bump dance along the corridors of the White House, donning a mood ring, chatting on her CB radio with the handle First Mama—a housewife who argued passionately for equal rights for women, a mother of four who mused about drugs, abortion and premarital sex aloud and without regret." Ford was open about the benefits of psychiatric treatment, and spoke understandingly about marijuana use and premarital sex. The "New York News Service" wrote that Ford was, "constitutionally incapable of uttering 'no comment' or otherwise fudging an answer.". As first lady, remarking on her honest candor and the sometimes-controversial remarks it resulted in, Ford declared, "I am not very good at making up stories." In another instance, she commented, "it's just impossible for me to lie and look someone in the eyes and talk to them. This is my problem". While President Ford never attempted to silence his wife, some of his senior staff resented her independent candor.


title: Betty Ford

text: Ford filmed an interview with the television news program "60 Minutes" which was broadcast on August 10, 1975. The broadcast of the interview saw strong interest from the public. After the interview aired, a number of Ford's remarks in this interview on hot-button issues generated particularly immense media attention. Due to conservative backlash from Ford's comments on premarital sex, marijuana use, and abortion in a 1975 "60 Minutes" interview, President Ford initially quipped to her that her comments had lost him a large number of votes. However, polling would show that her comments were accepted by many Americans.


title: Betty Ford

text: In 1975, when "Time" named the "American women" as its "Person of the Year", the magazine profiled Ford as one of eleven women selected to represent "American women". That same year, "People" named Ford one of the three most intriguing people in America. In 1977, the World Almanac included Ford in its ranking of the 25 most-influential American women. In January 1976, Ford made a cameo appearance on the popular television program "The Mary Tyler Moore Show".


title: Betty Ford

text: The Fords were among the more openly affectionate first couples in United States history. Neither was shy about their mutual love and equal respect, and they were known to have a strong personal and political partnership. This open affection was evident from the beginning of Gerald Ford's presidency. Ford was observed audibly telling her husband "I love you" following a kiss they shared right after he was sworn in as president. Later that day, President Ford was caught momentarily patting Betty's buttocks before the press gathered outside of their Virginia residence. Weeks later, when the Fords moved from their Virginia residence into the White House their king size bed was photographed being moved into the White House, which prompted Betty to quip that they had been outed for breaking the tradition of first couples keeping separate bedrooms in the White House. Early into her time in the White House, during a televised tour of the White House she once again noted that she and her husband shared the same bed. In a 1975 interview with "McCall's", Ford remarked that she was asked just about everything, except for how often she and the president had sex. "And if they'd asked me that I would have told them," she said, adding that her response would be, "As often as possible."


title: Betty Ford

text: On January 19, 1977, her last full day as first lady, Betty Ford used her training as a Martha Graham dancer to jump up on the Cabinet Room table. White House photographer David Hume Kennerly took a photo of her on the table. Gerald Ford did not know about or see the photo until 1994. A Ford family friend said that he "about fell off his chair" when he saw the photo for the first time. The photo was subsequently published and is regarded as an "iconic" photograph of Ford's time as First Lady. Kennerly has touted the image as both capturing Ford's personality and being a symbolic image showing the feminist first lady posing in what had conventionally been a room occupied predominantly by white men.


title: Betty Ford

text: Ford was popular with the American public. Her overall approval rating was, at times, as high as 75%. Ford's popularity often was higher than her husband's. Ford said, during her husband's failed 1976 presidential campaign, "I would give my life to have Jerry have my poll numbers." This reflects a common trend of American first ladies often being more popular than the presidents to which they are married.


title: Betty Ford

text: Ford ranked as one of the top-10 most admired women in the results of Gallup's annual most admired man and woman poll every year from 1974 (the year her husband first became president) through 1991, with the exception of Gallup having failed to conduct such a poll in 1976 (the final full year of her husband's presidency). The poll gauges Americans' most admired men and women without providing respondents any pre-arranged list of names. In 1974, Ford placed second in the poll. She placed first in 1975. In 1977, the year her husband left office, she placed fourth. After her tenure as first lady ended, she would top the poll for a second time in 1978, the year she had established herself as an advocate for people with drug and alcohol dependence. Contrarily to her, while President Ford ranked in the top-10 positions of most admired men in multiple years, he never managed to top it.


title: Betty Ford

text: In "Good Housekeeping"'s annual readers' poll of most admired women, Ford placed second in 1974 and first in 1975. By late-1975, Harris found Ford to have established herself as one of America's most popular first ladies. In January 1976, the editors of the "New York News Service" wrote that Ford was, "one of the most charming and popular First Ladies ever to occupy the White House".


title: Betty Ford

text: During her time as first lady, Ford was an outspoken advocate of women's rights and was a prominent force in the Women's Movement of the 1970s. Her active political role prompted "Time" to call her the country's "Fighting First Lady" and was the reason they profiled her, among several others, to represent the "American Women" as the magazine's 1975 Person of the Year. On September 4, 1974, weeks after becoming first lady, Ford conducted press conference in the State Dining Room of the White House in which she remarked that she, "would like to be remembered in a very kind way; also as a constructive wife of a president."


title: Betty Ford

text: Ford avidly supported the proposed Equal Rights Amendment. In her September 4, 1974 press conference, Ford declared her support for it. Ford lobbied state legislatures to ratify the amendment, and took on opponents of the amendment. Ford utilized phone calls, letter-writing, and telegrams as means of lobbying in support of the ERA.


title: Betty Ford

text: Ford was also unapologetically pro-abortion rights. In a 1975 interview with the news program "60 Minutes", Ford called Roe v. Wade a "great, great decision". Ford's abortion position differed from the political platform of the Republican Party. For a long time, it was unclear whether Gerald Ford shared his wife's pro-abortion rights viewpoint. In December 1999, he told interviewer Larry King that he, too, was pro-abortion rights and had been criticized for that stance by conservative forces within the Republican Party.


title: Betty Ford

text: Ford successfully lobbied her husband to, in 1975, sign an executive order to establish the National Commission on the Observance of International Women's Year. Ford also, unsuccessfully, lobbied her husband to appoint the first woman to the Supreme Court of the United States or as a running mate in the 1976 election. Ford took personal credit for the appointment of Carla Anderson Hills as secretary of Housing and Urban Development.


title: Betty Ford

text: In May 1975, during a four-day trip, Ford met with former Prime Minister of the Republic of Vietnam Nguyễn Cao Kỳ to discuss Southeast Asia refugees. Afterwards, Ford stated she was impressed with the conduct of the refugees.


title: Betty Ford

text: Ford's involvement in political issues received some conservative criticism. Phyllis Schlafly accused Ford of acting improperly by intervening in state affairs. Some women protested Ford's lobbying for the ERA by carrying placards outside of the White House reading "Betty Ford, Get Off the Phone". On June 30, 1976, Ford attended the opening of "Remember the Ladies", a Revolutionary War-era women's exhibit. She drew boos from demonstrators against the Equal Rights Amendment in stating, "This exhibit about neglected Americans should give us strength and courage to seek equal rights for women today."


title: Betty Ford

text: Weeks after Ford became first lady, she underwent a mastectomy for breast cancer on September 28, 1974, after having been diagnosed with the disease. Ford decided to be open about her illness because "There had been so much cover-up during Watergate that we wanted to be sure there would be no cover-up in the Ford administration." Her openness about her cancer and treatment raised the visibility of a disease that Americans had previously been reluctant to talk about.


title: Betty Ford

text: "When other women have this same operation, it doesn't make any headlines," she told "Time". "But the fact that I was the wife of the President put it in headlines and brought before the public this particular experience I was going through. It made a lot of women realize that it could happen to them. I'm sure I've saved at least one person—maybe more."


title: Betty Ford

text: Adding to heightened public awareness of breast cancer were reports that several weeks after Ford's cancer surgery, Happy Rockefeller, the wife of Vice President Nelson Rockefeller, also had a mastectomy. The spike in women self-examining after Ford went public with the diagnosis led to an increase in reported cases of breast cancer, a phenomenon known as the "Betty Ford blip".


title: Betty Ford

text: According to Tasha N. Dubriwny, the massive media coverage of Ford's mastectomy was constrained by stereotypical gender roles, particularly the need for breast cancer patients to maintain their femininity. Betty Ford was portrayed as an ideal patient within a success narrative that presented the key sequences of her breast cancer diagnosis and treatment in a progressive, linear fashion that inspired optimism. Her coverage minimized the complexity of breast cancer as a disease and ignored the debates surrounding best treatment practices. It amounted to as aestheticization of breast cancer and her coverage became the major discursive model for looking at all breast cancer survivors.


title: Betty Ford

text: As First Lady, Ford was an advocate of the arts. She successfully lobbied her husband to award the Presidential Medal of Freedom to choreographer and dancer Martha Graham in 1976. She received an award from Parsons The New School for Design in recognition of her style.


title: Betty Ford

text: Despite the brevity of her husband's presidency (roughly two and a half years), he hosted 33 state dinners, the fifth most state dinners of any United States president. The first of these came only a week into Ford's presidency, hosting King Hussein of Jordan on August 16, 1974. Once she became first lady, it fell to Ford to arrange this already-scheduled dinner. She found out of this upcoming dinner and her responsibility for planning it through a phone call she received within 24-hours after her husband's swearing-in as president. As previously mentioned, the Fords had hosted a state dinner for King Hussein months earlier, during Gerald Ford's vice presidency, on March 12, 1974, after president Nixon asked then-Vice President Ford to take over for him in hosting a planned dinner for the King. At the first state dinner that she arranged as first lady, Ford revived dancing as an activity of White House state dinners. The Nixons had previously removed dancing from the state dinners during Nixon's presidency. At the state dinners of the Ford presidency, the president and first lady always led off the dancing, and dancing often lasted beyond midnight.


title: Betty Ford

text: The Fords opted to have eclectic array of guests at their state dinners, including notable celebrities from the entertainment industry. The Fords' children often also attended the dinners they hosted.


title: Betty Ford

text: During their final year in the White House, the Fords hosted eleven state dinners. This large number of state dinners was, in part, due to great interest from foreign dignitaries in visiting the United States for a state dinner amid the United States bicentennial celebrations. Ford made the decision that year to erect a tent in the White House Rose Garden to host dinners outside. For state dinners held using this tent, the receptions, entertainment, and dancing portions of the evenings were still held inside of the White House.


title: Betty Ford

text: Among the most notable state dinners the Fords hosted was a July 7, 1976 state dinner honoring Queen Elizabeth II and Prince Philip, the Duke of Edinburgh. This dinner was part of the American bicentennial celebrations, and was held in tents on the South Lawn of the White House.


title: Betty Ford

text: Of the state dinners she planned, Ford said, "From the beginning, Jerry and I tried to make the White House a place where people could have fun and enjoy themselves. Most of all we wanted the state dinners to express the very best about America, particularly during the bicentennial year."


title: Betty Ford

text: Dishes that Ford particularly liked serving at state dinners included wild rice, Columbia River salmon, soufflé, and flambé. The state dinners that Ford planned as first lady made a deliberate effort to showcase American ingredients. By late 1974, Ford had shifted to exclusively serving wine that was American-cultivated at state dinners. The November 12, 1974 state dinner for Austrian Chancellor Bruno Kreisky saw the first instance in which a wine from the Fords' home state of Michigan was served at a White House state dinner, with wine from the Tabor Hill Winery being served. It was not until 2016 that a Michigan wine would again be served at a White House state dinner.


title: Betty Ford

text: Ford accompanied her husband abroad on several diplomatic trips. Among the nations that Ford accompanied her husband to were China, Poland, Romania, and Yugoslavia.


title: Betty Ford

text: Ford did not take any solo trips aboad as first lady. She is the most recent first lady not to have done so. Ford's failure to conduct a solo trip is not all that extraordinary, however. The first instance of a first lady conducting one had been Eleanor Roosevelt in 1942. Ford's recent predecessor Lady Bird Johnson was among other first ladies that did not conduct solo trips abroad.


title: Betty Ford

text: During the Fords' 1976 trip to mainland China, when being shown an exhibition by a Chinese arts college dance group, Ford decided to join the dancers. Photos of this moment were published widely in the American press, resulting in Betty Ford somewhat upstaging President Ford in the press.


title: Betty Ford

text: Ford supported numerous charities as first lady. Ford assisted in fundraising for the little-known Hospital for Sick Children in Washington, D.C., whose patients were predominantly African American. She also fundraised for No Greater Love, in appreciation of its work benefiting Children of Vietnam War MIA and POWs. She served as the honorary president of the National Lupus Foundation, regarding lupus as a disease which impacted women, yet received minimal public attention. Her philanthropic support additionally placed a specific focus on charities serving children with special needs.


title: Betty Ford

text: In November 1975, it was reported by the Associated Press that Ford's husband's advisors, who had previously worried her outspoken comments would hurt him in the 1976 presidential election, were now recognizing her popularity and desiring for her to have a greater role in the campaign. Ford ultimately played an important role in the 1976 election campaign. Ford made campaign appearances and delivered speeches across the United States.


title: Betty Ford

text: Ford was also used, both by Ford supporters and detractors, as a symbol of liberal Republicanism, with her politics contrasting with the Republican Party's conservative and moderate wings.


title: Betty Ford

text: During the campaign, many Ford supporters wore campaign buttons with phrases like "Betty's Husband for President in '76" and "Keep Betty in the White House". The use of Ford in such a manner to promote her husband's candidacy was not the work of the campaign itself, but rather, produced by supporters outside of the campaign organization. The campaigns of the previous three presidents that sought election to an additional term (Dwight D. Eisenhower, Lyndon B. Johnson, Richard Nixon) had needed to manufacture campaign publicity involving their first ladies (Mamie Eisenhower, Lady Bird Johnson, and Pat Nixon). In contrast, there was tremendous organic excitement for Betty Ford among supporters of the campaign.


title: Betty Ford

text: Ford campaigned actively both during primary elections and the general election. A contrast was publicly drawn between Ford and Nancy Reagan, the wife of Ford's primary election challenger Ronald Reagan. Reagan had contrasting views on issues such as drug experimentation by teenagers and the Equal Rights Amendment (which she opposed passing).


title: Betty Ford

text: During the primaries, Ford recorded radio advertisements on behalf of the campaign that were broadcast in New Hampshire. She also traveled to Iowa before its caucus, and delivered a speech on behalf of the president (who had been unable to make his planned appearance) in which she labeled herself as being his political partner. The campaign made a deliberate effort, ahead of the 1976 Republican National Convention, of sending Ford to liberal and moderate-leaning states and not more conservative states in the western and southern United States.


title: Betty Ford

text: Between Labor Day and election day, for the general election campaign, Ford conducted multi-stop speaking tours, during which she visited western states (including California, Colorado, Texas, and Utah) as well was northern midwest states including Illinois, Michigan, and Wisconsin.


title: Betty Ford

text: The heavy campaigning placed a strain on Ford's health. During the general election, her busy campaign activity saw the reigniting of her pinched nerve. However, even after this, Ford continued with her planned campaign schedule.


title: Betty Ford

text: After Gerald Ford's defeat by Jimmy Carter in the 1976 presidential election she delivered her husband's concession speech because he had lost his voice while campaigning. The speech was delivered on the day after the election. This is the only time that a major United States presidential candidate's spouse has delivered their concession on their behalf.


title: Betty Ford

text: After her husband's narrow defeat, there was some anecdotal speculation that Ford may have both have helped to alienate conservative Republicans from voting for her husband and at the same time helped attract him support from liberal and moderate Republicans, Democrats, and independents.


title: Betty Ford

text: After leaving the White House in 1977, Ford continued to lead an active public life. In addition to founding the Betty Ford Center, she remained active in women's issues, taking on numerous speaking engagements and lending her name to charities for fundraising. Many of Ford's most significant contributions as an activist came following the Fords' departure from the White House.


title: Betty Ford

text: In March 1977, Ford signed with NBC News to appear in two news specials within the following two years along with contributing to "Today", and jointly signed with her husband to write their memoirs. In June 1977, Ford was a speaker at the Arthritis Association Convention. In September of that year, Ford traveled to Moscow for a television program taping and to serve as hostess for "The Nutcracker". In November 1977, Ford appeared at the opening session of the National Women's Conference in Houston, Texas.


title: Betty Ford

text: Ford had suffered from a dependency on prescription medication and from alcoholism prior even to her husband's presidency. Ford had, particularly, become addicted to prescription medication (opioid analgesics) that she had been originally prescribed in the early 1960s to treat a pinched nerve. Ford took doses of this medication in excess of her prescription. In her 1987 memoir she reflected on these addictions, writing, "I liked alcohol, it made me feel warm. And I loved pills. They took away my tension and my pain". The fact that Ford had, for years, been given tranquilizers to treat a pinched nerve in her neck, was public knowledge as far back as her time as second lady. During her time as first lady, there had even been some speculation about substance abuse by friends and members of the press who observed occasional slurred speech from Ford. After they left the White House, her addictions became more evident to her family and appeared life-threatening. On April 1, 1978, her family staged an intervention which forced her to acknowledge the negative impact that her addiction was having on her health and family relationships. She agreed, that day, to detox from her medicine. She also, ultimately agreed to attend rehab at the Naval Regional Medical Center in Long Beach, California. Ford succeeded in getting sober. Ford registered herself at the hospital on April 11, 1978.


title: Betty Ford

text: As she had previously been with her breast cancer diagnosis and treatment, Ford was transparent with the public about her addictions and admittance to rehab. Ford's transparency was praised by experts in drug abuse treatment, who predicted that it would make a major and positive impact. The week she entered rehab, Ford disclosed her addiction to prescription medication. Days later, Ford also disclosed to the public that she had come to realize that she was additionally an alcoholic. She disclosed her alcoholism through a statement that a family spokesman read on her behalf at a press conference (at which Ford was not herself present) held outside of the hospital. In this statement, Ford disclosed, "I have found I am not only addicted to the medication I have been taking for my arthritis but also to alcohol". In this statement, she also praised the reputation of the hospital's addiction treatment program, and declared her pleasure to have the opportunity to attend the treatment. The statement also declared, "I expect this treatment and fellowship to be a solution for my problems. I embrace it, not only for me, but all the many others who are here to participate." The "Washington Post" reported that Ford's disclosure of alcoholism came as a surprise to a number of Ford's close friends, who had regarded her as merely a social drinker and were oblivious to her drinking problem.


title: Betty Ford

text: Ford published her first memoir in 1978, "The Times of My Life", in which she discussed her battle with addiction.


title: Betty Ford

text: During a January 1984 address in Michigan to a crowd of individuals who were in the early stages of alcohol and drug dependency treatment, Ford declared that the six years since she began her treatment for alcohol and drug abuse, "have been the best years in my life from the standpoint of feeling healthier and feeling more comfortable with myself".


title: Betty Ford

text: In 1982, after recovering from her own addictions, Ford established the Betty Ford Center (initially called the Betty Ford Clinic) in Rancho Mirage, California, for the treatment of chemical dependency, including treating the children of alcoholics. She served as chair of the board of directors. She also co-authored with Chris Chase a book about her treatment, "" (1987). In 2003, Ford produced another book, "Healing and Hope: Six Women from the Betty Ford Center Share Their Powerful Journeys of Addiction and Recovery". In 2005, Ford relinquished her chair of the center's board of directors to her daughter Susan. She had held the top post at the center since its founding.


title: Betty Ford

text: Barbara Bush, a later first lady, opined that Ford, after discovering she was dependent on drugs, "transformed her pain into something great for the common good. Because she suffered, there will be more healing. Because of her grief, there will be more joy."


title: Betty Ford

text: Ford continued to be an active leader and activist of the feminist movement after the Ford administration. She continued to strongly advocate and lobby politicians and state legislatures for passage of the ERA. In 1977, President Jimmy Carter appointed Ford to the second National Commission on the Observance of International Women's Year (the first had been appointed by President Ford). That same year, she joined First Ladies Lady Bird Johnson and Rosalynn Carter to open and participate in the National Women's Conference in Houston, Texas, where she endorsed measures in the convention's National Plan of Action, a report sent to the state legislatures, the U.S. Congress, and the President on how to improve the status of American women. Ford continued to be an outspoken supporter of equal pay for women, breast cancer awareness, and the ERA throughout her life. She was an active member of the Junior League.