Cholera 1854: update

British Homoeopathic Journal April 1994, Vol. 83, pp. 117-121

Cholera 1854: update BERNARD LEARY, MRCGP, FFHOM Abstract In October 1987 a paper was published in this journal 1 attempting to assess the claims made by the British Homeeopathic Society concerning the efficacy of the treatment of cholera at Golden Square during the 1854 epidemic. Details of the treatment were not available at that time and had to be deduced. This paper fills in those details. The view expressed then that homoeopathy played a major part in bringing about substantially better results than the allopaths is reinforced. For background information the reader is referred to the original paper. KEY WORDS: Cholera; Hom~eopathy; Diarrhoea; Hydration.

Introduction

The medical profession were uncertain of the symptomatology for one thing. In August 1854 the Editor of the B M J was bemoaning the fact that few doctors ever defined what they meant by cholera. 2 In 1853 Mac Loughlin, a Board of Health Inspector, published a pamphlet to try and convince the medical establishment that cholera had a first stage of premonitory diarrhoea and collapse. Nearly 25 years after the first epidemic the Board of Health stated in its report of 1853: It is admitted that diarrhoea generally precedes cholera and that diarrhoea should never be neglected for a single hour in a time of epidemic cholera. If it be established that latter disease is invariably or almost invariably preceded by a well defined stage of illness which is amenable to medical treatment it will at once allay alarm and be a most important addition to the resources of medical science. The disease originated in India, approaching Europe via Russia, Poland and the Eastern Central European countries. Hahnemann was in correspondence with his supporters in these countries. He believed in the miasm idea but was also a contagionist, believing cholera to be spread mainly through carriage by doctors and nurses. According to him the miasm consisted of minute invisible living creatures. Perhaps the only even slightly humorous element in all his numerous writings is his description of the doctor hiding

The treatment of cholera in the nineteenth century and in particular the epidemic in London in 1854 has been held up by homeeopaths for the past century and a half as startling evidence of the efficacy of the system. Today, the statement that we hold a similar belief does not necessarily mean that the particular episode provides any real evidence. This paper looks at the available facts. Although there was a condition known as British cholera or cholerine in this country, which was summer diarrhoea, true Asiatic cholera was unknown in Europe until 1817 and did not reach the United Kingdom until 1830. In fact cholera was not the scourge that people feared. Influenza, for example, killed far more. But at a time when the plague had disappeared and smallpox seemed to be coming under control, here was a new killer to replace them. The British population knew it was coming as it spread across Europe and no form of quarantine seemed to control its spread. There were reports of people collapsing and dying within hours. People were frightened and doctors did not seem to be able to help. Based on a paper presented to the 15th Congress of the British Society for the History of Medicine, Newcastle, September 1993. 117

118 at the door and only slowly, over days, approaching the patient and thus acquiring immunity by repeated increasing exposure) From his correspondence he was able to build up a picture of the disease and to describe its stages. In the first, that of premonitory diarrhoea, he saw the need to provide a generally available medicine to stop the disease and prevent its progress to collapse and death. He suggested Camphor, a readily available medicine. This was to be given every few minutes by mouth, by rectum and rubbed into the skin. He ran into criticism from both his followers and his opponents for the frequency of dosage he suggested, which seemed to go against his Law of the Similimum but he gave this explanation: Camphor is so peculiar a drug that one might easily be tempted to regard it as an exception from all the rest; for though it makes a mighty impression on the human body, this is only superficial, and is at the same time so transitory as we see it in no other case; so that in homoeopathic use the dose must be repeated almost immediately, if the treatment should have any lasting effect. 4

Results of hom~eopathic treatment During the epidemics of 1830/32 and 1848/9 various hommopathic doctors claimed results far superior to those of their allopathic colleagues. For example: DrBakody practised in Raab, Hungary. Cholera broke out in July 1831. He suffered two attacks of the disease himself but recovered with homeeopathic treatment. In all he cared for 228 cases, with 8 deaths. Wilhelm Fleishmann practised in Vienna. In 1836 he treated 732 cases of whom 488 recovered. This was a 33% mortality compared with an allopathic rate of 70%. Compared with other hommopaths this was not a good result and it has been suggested that it was due to his inexperience. However, it was good enough to cause the Austrian ban on homceopathy to be lifted. lseman von Korsakoff was not a doctor but was probably the earliest Russian convert to hom0eopathy. He is best known for his devotion to high potencies. During the epidemics of 1830 and 1847 he was nominated as district inspector of hospitals. In his notes it is reported that a Dr Goldberg at the Catherine Hospital treated 1274 cases with only a 6% mortality. Dr Mabit was Professor of Pathology at Bor-

British Homeeopathic Journal

deaux and wrote extensively about cholera. In 1832 he treated 31 cases with 6 deaths (of whom 2 were moribund when first seen). If these were ignored the mortality would be 12%. Rocco Rubbini was an Italian living in Naples. During the epidemics of 1854, 1855 and 1865 he used Camphor and claimed to cure all of the 448 patients treated. 15 were described as being in an algid condition. Of those treated by others in the same way only 2 out of a total of 225 died. 5 In Barbados in 1854 homoeopaths claimed death rates a third of the allopathic results. 6

The Golden Square Hospital The first homoeopathic hospital to open in L o n d o n was the one in Golden Square, Soho, in October 1849, by which time that year's cholera epidemic was over. But in the 1854 epidemic the Governors decided to discharge all the ordinary cases and to devote the hospital entirely to cholera. This area of Soho was where the worst of the 1854 epidemic took place. Dr John Epps, a hommopath unconnected with the hospital, described the area in his diary as 'where the cholera was so fatal'] Patients were taken either to the Homeeopathic or to the Middlesex Hospital where Florence Nightingale was nursing. Dr John Snow, later to be famous as the anaesthetist who administered chloroform to Queen Victoria, recognized that the c o m m o n factor among many cases of cholera occurring in Soho was that they shared the same water supply. This was a pump over a well in Broad Street. Dr Snow induced the Parish Council to remove the handle from the pump. A dramatic reduction in mortality followed. The Board of Health issued instructions for the reporting of cases prior to the epidemic. To the surprise of the British Hommopathic Society, the homoeopathic results were totally omitted when the Board published its report in 1855. Having friends in high places they were able to get a parliamentary question put down by Lord Robert Grosvenor, demanding an explanation. As a consequence all the relevant information was laid on the table of the House, including the resolution of the Treatment Committee of the Medical Council of the Board: That by introducing the returns of hom0eopathic practitioners, they would not only compromise the value and utility of their average of cure, as deduced from the operation of known remedies,

119

Volume 83, Number 2, April 1994

[ ] MiddlesexHospital(%) 80

D HomoeopathicHospital(%)

70 60 50 40 30 20

10 0 ~

r.~

r~

Hue]

FIGURE1. Deaths at two London Hospitalsin 1854. but they would give an unjustifiabIe sanction to the empirical practice alike opposed to the maintenance of truth and to the progress of science)On the basis of this resolution the homceopathic returns were omitted. Discussion

L o r d G r o s v e n o r ' s question concerned 61 cases admitted to the hospital as cholera and 331 cases of simple and choleraic diarrhoea. The odd thing is that e v e r y b o d y seems to have mistaken the numbers. The hospital committee, in writing to Sir Benjamin Hall of the B o a r d of Health, the Minutes of the British H o m e o p a t h i c Society, L o r d R o b e r t Grosvenor, and every b o o k that has since referred to the m a t t e r talks of 61 cases. T h e r e is a TABLE 1.

Mortality in Wamngton 13

Aged, neglected or too late Obstinately refused medicine Treated with opium and stimulants Treated with Morrison' pill Treated by blood letting Treated by blood letting and salines Treated by salines alone Total

return of cases totalling 61, but in addition there are o t h e r returns for 1, 2 and 26 patients, making a grand total of 90, with 17 deaths, that is roughly 19 %. If only the 61 patients are considered the rate falls to 16.4%. Of these deaths one was a drunkard, one was in hospital with typhoid when the hospital changed over to cholera care. She was too ill to be m o v e d but recovered only to catch cholera during convalescence. O n e patient reached the hospital in the last stages of the disease, having b e e n given up by the allopathic parish doctor, one was found to be dead while being carried up the stairs to the hospital. O n e was in the last stages of phthisis and a habitual drunkard. 9 These are of interest but no d o u b t other hospitals had a similar story to tell. They can be contrasted with the results at other hospitals. B e t w e e n 23 July and 23 O c t o b e r 1854 St B a r t h o l o m e w ' s Hospital a d m i t t e d 322 cases of w h o m 105 died (32.6%). m A t the Middlesex there were 231 cases of which 123 died ( 5 3 . 2 5 % ) . 11 If these are e x a m i n e d in detail (Fig. 1) they can be c o m p a r e d with the h o m m o p a t h i c death rates. T h e figures were generally better at the H o m m o p a t h i c Hospital. T h e question is why. T h e r e are several possible reasons. First and most obvious ~s that homoeopaths desisted from using violent treatments. In contrast every patient a d m i t t e d to the Middlesex received a hot bath of 104~ followed by an emetic of mustard and salt r e p e a t e d once or m o r e often if the vomiting induced was slight. In addition hot fomentations and turpentine applications were applied and the whole chest and a b d o m e n was covered with a large synapism or m u s t a r d plaster. These were followed by calomel, cod liver oil or lead acetate. 12 It is obvious that not doing these debilitat-

Cases

Deaths

Recovery

n

n

%

30 4 23 3 13 7 23

30 4 23 3 13 0 2

0 0 0 0 0 100 92.3

103

75

27

120

British Homeeopathic Journal IIMiddle~x Ilospita111(%) [~ 15mmeop;llhic 15=spirals (%)

35 31) 25 211

15 10 5 0 --

rl

FIGURE 2. A d m i s s i o n s by w e e k e n d s , 1854. See Fig. 1.

ing things to patients would help the mortality rate. However, if this was the only factor explaining the difference in rates then the patients treated homceopathically have to be regarded as having no treatment at all. In a m o d e r n text book the death rate for untreated cholera is given as of the order of 50%, not u n d e r 20% as obtained at G o l d e n Square. In Warrington the few who persistently refused treatment had a 100% mortality (Table 2). So there must be other factors. Was the diagnosis correct? Or, at least, were the hom~eopaths dealing with the same condition as the allopaths? O n e thing the homceopaths had and the allopaths did not have was H a h n e m a n n ' s description of the disease which would be acceptable nowadays. But perhaps more important David MacLoughlin, the Board of Health Inspector who had insisted that cholera had a premonitory diarrhoea, wrote to the homceopathic hospital saying: That there may be no misapprehension about the TABLE

2.

cases I saw in your hospital, I will add that all I saw were true cases of cholera, in the various stages of the disease, and that I saw several cases which did well under your treatment which I have no hesitation in saying would have sunk under any other. 14 The third question was, were these cases of a different intensity than those treated by others. Was there some natural factor which would alter the figures? Certainly there was a rapid diminution in the n u m b e r of cases from Soho after the initial explosion. There were 500 deaths in 10 days after which the overall death rate halved. Although Snow's theory of a water-borne aetiology of cholera was correct, it is now thought probable that the dramatic fall in incidence and mortality after the removal of the Broad Street p u m p handle owed more to a natural reduction in the severity of the disease than to his actions. But it is difficult to see how the G o l d e n Square Hospital could have selected the patients more likely to live, although it is possible that most of their admissions took place outside the time of m a x i m u m pathogenicity. Fortunately these figures can also be compared (Fig. 2). Thus it can be seen that the admissions took place in roughly the same time span as those at the Middlesex. The last question is, did the homceopaths hydrate their patients, a measure which, of course, we now know to be essential. In fact the opposite seems to have been the case. The idea had been put forward by various people, including H e n r y Ancell, who reported one case which recovered. ~5Latta was practising in Leith 16 and D r Stevens, an opinionated advocate of the m a i n t e n a n c e of fluid levels had his

Treatment of cholera cases, Middlesex Hospital 1854.17 Male

Salines alone Calomel & saline Calomel Saline & cajuput oil Chloroform & camphor Castor oil H2SO4 Acetate of lead Hyposulphite of soda Quinine NOz Stimulants alone Totals

Female

Total

cases 34 48 3 1 3 10 10 0 3 9 0 0

died 16 24 2 1 0 7 7 0 3 8 0 0

cases 39 40 5 4 1 6 11 1 0 1 1 1

died 15 25 3 2 0 1 6 0 0 1 1 1

cases 73 88 8 5 4 16 21 1 3 10 1 1

died 31 49 5 3 0 8 13 0 3 9 1 1

% 45.2 55.7 62.5 60 0 50 61.9 0 3 9 1 1 1

121

68

110

55

231

123

53.24

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effect at the Middlesex (Table 2). Stevens gave a mixture of chlorate of potash, carbonate of soda, chloride of sodium per rectum. 17 A t the Middlesex this could be combined with calomel, or cajuput oil. O n e patient received an intravenous injection of a saline mixture. She improved dramatically, then collapsed again and died. The idea of repeating the injection does not seem to have occurred to anyone. As Howard Jones said, there were two problems. 18 O n e was that the concern was to restore the thickened blood to a normal consistency rather than to replace fluid and this was combined with humoral pathology which implied that the great loss of salts must m e a n that there was an excess in the body rather than a d i m i n u t i o n due to repeated evacuations. Secondly, n o b o d y realized the need for sterile solutions. In contrast the reaction of the homceopaths was as follows: We are disappointed at not finding more details of the effect of the saline treatment recommended by Dr Stevens. More fatal than 100% it could not be, although we may suspect that the enthusiasm of the veteran pathologist has misled his judgement and induced him to overcolour the success of this mode of treatmentJ9Apart from that the only other reference was by a Mr Scale who was a novice in homoeopathy and had not treated cholera homoeopathically. He should recommend white wine whey as a means of maintaining the strength of the patient as it was easily absorbed. He had tried the injection of serum into the veins but the patient was surrounded by Irish neighbours who made a rush at him as he was commencing operations and he was fain to escape as best he could. He thought a very important point in prophylaxis was the avoidance of long abstinence.2~

Conclusion While it is impossible to be certain of anything at this distance, the hom0eopathic results can not be explained as merely the result of avoiding toxic and debilitating treatments. If the hom0eopathy was ineffective then the death rate ought to have been much higher, as it is and was for untreated patients. There is evidence here that homoeopathy played a part in Address for correspondence Dr B. Leary Windycroft Brimington Chesterfield $43 lAX

121 the higher recovery figures. Controlled trials of hommopathy are being conducted on cholera cases in Peru and these may help our j u d g e m e n t of the episode. Meanwhile it has provided a fascinating insight into the prejudices, ignorance and desperation of the medical m e n of the period. Furthermore, and perhaps more significantly, the hom0eopathic doctors of the period are regarded by some m o d e r n followers of homoeopathy as being semi-geniuses. U n f o r t u n a t e l y it comes out that apart from this one thing they were no cleverer and just as ignorant as their allopathic contemporaries.

References 1 Leary B. Cholera and Hommopathy in the Nineteenth Century. Br Horn J 1987: 76: 190. 2 Editorial. BMJ 1854; 463. 3 Hahnemann S. Lesser Writings'. Tr. R. E. Dudgeon. R 759.New Delhi: Jain. 4 Boenninghausen CMF von. Lesser Writings. Bradford T.L. ed. P. 306. New Delhi: Jain 1979. 5 Black E Hommopathic treatment of Asiatic Cholera.

Br J Hom1843:1,1. 6 Chapman. Cholera in Barbados. Br J Hom 1855; 13, 51,1-24. 7 Epps E. Diary of the late Dr John Epps. London: Kent. Undated. 8 Return of an Address of the Honourable House of Commons dated 17 May 1855. Parliamentary Papers 1854-5; (255) 45, 189. 9 Ibid. 10 Minutes of the Governors of St Bartholomew's Hospital; 9 November 1854 p. 71 11 Sibley S.W. The Middlesex Hospital. Report on the Cholera Patients admitted into the Hospital during the year 1854. 12 Ibid. 13 From a Warrington Correspondent. Medical Gazette 1832, p. 731. 14 Return of an Address at the House of Commons. 15 Ancell C. Recovery of a Case of Cholera. BMJ 1854; 755. 16 Morris R.J. Cholera 1832 p. 176. London: Croom Helm 1976. 17 Howard-Jones N. Cholera Therapy in the Nineteenth Century. JHist Med 1972; 27:4 18 Ibid. 19 Minutes of the British Homoeopathic Society 1855. 20 Ibid.