‘Cholera’: an early 19th century interpretation

In the last quarter of 1831 news of a fatal cholera outbreak in Sunderland, believed to have originated from a ship which had been allowed to dock without quarantine in the city’s port. It sent alarm bells ringing across the country.  The government issued emergency regulations for civic administrations to control the outbreak, but nevertheless it spread mercilessly across Britain, claiming at least 30,000 lives by the following summer. In 1831 there was still limited knowledge of how disease was spread or how best it should be treated. Below is a letter to the editor of Aris’s Birmingham Gazette, taken from the edition of November 21st, 1831 and presenting what appears an authoritative presentation of the causes by T. Langston Parker, a surgeon at the General Hospital.  The claims really reflect ideas of the time, that disease could be spread by touch or by ‘miasma’, by which was meant bad smells or atmosphere. Parker refers to it here as an ‘effluvia’. 

Cholera
To the Editor of Aris’s Gazette

Sir,
Allow me, through the medium of the Gazette, to offer some remarks upon the problematic nature of the Epidemic Cholera. It is evident that a specific virus or poison is the sole cause of all pestilential diseases, in which class the cholera of Asia holds a conspicuous rank. The origin of this virus is due in the first instance, without doubt, to a combination of atmospheric causes which we cannot appreciate, such as electricity, heat, moisture, sol-lunar influence, marsh-miasm or malaria. This appears incontrovertible, since we find cholera originating in those countries where pestilential diseases appear most frequent and fatal, and where, at the same time, such diseases are both epidemic and contagious. However this virus or poison may have originated, it is manifest, from the evidence of facts, that the same combination of causes which produced it are not necessary to its propagation. It may be propagated by contagion; an individual, or a number of individuals, having become diseased from exposure to the first combination of causes, throw off from the body a contagious virus which is capable of producing a disease of a similar character in a healthy individual. Admitting this as one mode of propagating diseases whose character is contagious we must not forget that a similar combination of atmospheric influences may produce the complaint without exposure to contagion; and here one fact may be established that in the present state of our knowledge admits of no dispute, viz.- that all contagious diseases may become epidemic, and that they are most commonly at the same time both epidemic and contagious. This theory of cholera is the only one that can explain and reconcile the conflicting and contradictory statements with which we are on all sides overwhelmed and perplexed. When any doubt exists as to the contagious nature of a pestilential disease, the profession and the public should always decide in favour of contagion, since “no harm can come of taking up the contagious theory”. When cholera is propagated by contagion, or from exposure to human effluvia, the contagious atmosphere is limited to a certain extent around the diseased person, the poisonous effluvia becoming innocuous as it is mingled with and diffused by atmospheric air. Mr. Hermann of Moscow found the air immediately surrounding persons suffering from cholera to contain a peculiar principle, similar to that separated by Moscati from infected air. This contagious effluvia may attach itself to certain articles of clothing or merchandize, of which silks, furs, and woollen goods are the best retainers. A neglect or ignorance of this fact appears to have added in a marked manner to the spread of the cholera at Moscow. All persons do not become diseased on exposure to the matter of contagion. An individual pre-disposition appears to be required, which renders the body susceptible of being diseased by contagion. Poverty and its attendant evils, nervous irritability, characterized by fear or anxiety, bowel complaints, cold, errors in diet, and in intemperance, form the chief causes which pre-dispose to cholera, whether epidemic or contagious. Three persons out of every hundred were the subject of pre-disposition in Moscow.
The atmospheric, or animal effluvia, or virus, producing cholera acts directly upon the nervous system; whether this system may be primarily affected, or whether it become so secondarily from change produced in the nature of the blood, is a point which at present is undetermined, and indeed it is of little consequence since the natural connexion of the nervous system and the blood is so intimate that one cannot possibly be affected without disease or disorder being produced in the other.
It is most probably that the primary impression of the person which produces cholera is made through the organs of respiration on the blood, and secondarily in the nervous system, the blood itself being unduly carbonized and unfitted for the natural stimulus required by the nervous and muscular organs. Hence the diminished irritability of the heart and arteries, the cramp and spasm of the muscular organs, the oppression about the chest, and the torpor of the brain and senses.
The discharges and alteration of the secretions of the bowels and stomach in cholera, are either secondary effects of this general nervous depression, or arise from the direct application of the contagious principle to the internal surface of these organs, most probably from the former. On the nature of disordered secretion, such as that noticed in cholera, I have a remark of some importance to offer, which probably in some measure both the preventative and curative remedies adopted with regard to this disease. The healthy secretions of the body present, on analysis in a state of health, a slight excess of acid or alkali – but under a depraved or disordered nervous influence, or from irritation, the nature of these secretions becomes changed, the acid being rendered alkali and the alkaline acid. It appears from the most minute chemical analysis that the fluids formed in the stomach and bowels are, in a state of health, sensibly alkaline, and that these secretions become acid when the nervous influence which presides over the secretions becomes deranged.  In cholera the fluids voided contain a great proportion  of acetic and butyric acid which was detected by the analysis of M. Hermann, of Moscow. The blood of cholera patients always contains more or less acetic acid in which, in a state of health, a solution of alkaline salts only can be found. These facts, which do not appear to be generally known, are of the greatest importance, both in the prophylactic and curative treatment of this alarming disease. The discovery of acetic acid in the blood of a person afflicted with cholera is due to Dr. Walker of St. Petersburgh.
Since there seems to be so great a disposition to the formation of acids in the fluids of the body in cholera, every kind of ailment should be avoided which tends in the production of acidity in the stomach and bowels. Such are vegetables, particularly green ones, fruits, malt liquors, above all, poor beer, bottled ale and porter. British or French wines with ardent or neat spirit. The acid which commonly assists in malt liquors should be neutralized previous to drinking by carbonate of soda. All indigestible substances which do not immediately form acid, should be carefully avoided, as the irritation which they cause in the stomach may produce a change in its secretions. Mild cholera having prevailed epidemically during the last three months, errors in regimen solely are not unlikely to change the mild into a malignant or fatal disease.
I remain, Mr. Editor,
Your most obedient servant,
T. Langston Parker
34, St. Paul’s Square,
Nov. 16, 1831

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