Medical Chatter: Homeopathy and Cholera 1853-1855 Part II

The following are short précis excerpts taken from some articles published about the cholera epidemic at the time.

Association Medical Journal 18.11.1853 The Investigation of Cholera

 We have a poor understanding of cholera and no information has been collected and collated. ‘If the same kind of searching investigation had been pursued in tracing cholera from one individual to another, as if employed by the detective police officers in tracing criminals…’ A ‘clearer light’ may be shone, such that we will no longer be at the mercy of ‘every ingenious theorist’.

 The Lancet 8.10.1853 The Cholera in Newcastle

 1760 cases reported with mortality in excess of 2000.

Problems:

1. Deficient sewerage and drainage and supply of water.
2. Unpaved areas with liquid refuse and saturated subsoil.
3. Overcrowding and intolerable conditions which should be demolished, but the Corporation of Newcastle earns £2000 pa from these slums. The Poor Law Officers have not successfully persuaded the Council to effect repairs. Recent population increases have exhausted the water supply, despite efforts to address this as local industry took precedence of supply, resulting in the local population being forced to pay to use the polluted waters of the river.
4. The local doctors have been superceded by the Board of Health who does little to remedy the situation, are strangers to the area, who answer to local industry only.

Recommended allopathic treatment for cholera involves purging with calomel (mercury) in ‘large doses’. For the collapse stage, give emetic of sulphate of zinc and ipecacuana, and then repeat calomel – repeat this process every 10, 20 or 30 minutes.

Feed with beef tea (per mouth or per rectum) and allay thirst with ice and cold water. Then give rhubarb and sulphate of potash in peppermint water, or a castor oil draught. Then administer liquid ammonium acetate or some carbonated soda and tartaric acid effervescence. Opium can be added in small doses to the calomel, and leeches, chalk and brandy can be used as required. For infants, use calomel on the tongue and beef tea injections as often as necessary.

Letters printed after this article contain the following suggestions from allopaths:

1. Try soda sesquicarb and laudanum together, and possibly combine capsicum tincture with infusion of cascarilla.
2. To prevent homeopaths visiting Newcastle to inspect the disease, treatments and conditions because they are ‘spies’.
3. To give rough cider and refuse all other foods except biscuits and toast.
4. To use chloroform, or, as cholera is ‘caused by fungus in the air’, sulphate of soda may be helpful.
5. To give croton oil on loaf sugar, while applying hot bricks and bags of sand to the feet.
6. To give nitromuriatic acid diluted in water, or sulphuric acid diluted in water to induce vomiting.
7. As cholera is absent from areas where cider and hard ale is drunk, give cooked apples.

The British Medical Journal 1853; 1045 Improper Treatment of Cholera by an agent of Cotton the Herbalist

 George Burt (?-?), binge alcoholic, seen after a two week binge, complaining of diarrhoea, who received powders and a mixture from John Stephens (?-?), agent of Cotton and Herbalist, over two days, but died. The attending orthodox surgeon Alexander M Champneys (?-?), refused to accept a death certificate from John Stephens, rather he opened the body and sent the stomach to the London Hospital who discovered cayenne, ginger, lobelia, and deduced the stomach irritation was as a result of the herbal mixture.

The Coroner reported that John Stephens had been sent on two previous occasions to the Central Criminal Court on charges of manslaughter, but had been acquitted by the judge. The Coroner passed his verdict that George Burt died of natural causes which may have been accelerated by ‘improper medicine’. The attending surgeon Alexander M Champneys had recorded cholera on the death certificate.

 The Lancet 5.11.1853 The Cholera in the Metropolitan Hospitals

 The hospitals report very few deaths at this time. The best defence is to repair the atrocious conditions of the poor slums, and to enforce the Board of Health inspectors to force the slum landlords to clear out the conditions that make them rich!

Slaughterhouses still reside in domestic areas, and hovels are still knee deep in effluvia. Many charitable hospitals have not been called upon to admit cholera patients, the north London hospitals have few cases. Guy’s received the greatest number, being south of the river, but St. Thomas’ have received only 2 cases.

It is not yet possible to determine the successful treatments, though cleanliness, warmth and clean air on the wards have obvious benefits. In the 1849 epidemic, cholera cases were not admitted to the hospitals, so no deaths were recorded.

Today, we record deaths in hospital because they have been admitted, and cases of contagion have been noted, though the Lancet says ‘they are not contagious’ even though these cases seem to prove such theories. Mortality amongst those patients admitted appears to be 50%.

 The Lancet 1854; 2:108 Announcement of the End of the Board of Health

 Set up in the Act of 31.8.1848, the Board of Health has been ‘pronounced unworthy of future confidence’ in the House of Commons.

 The Lancet 23.9.1854

 Benjamin Hall (1802-1867), a British politician, member of the British Privy Counsel 1708, president of the British Board of Health (1854-1858) and first commissioner of works under Gordon 4th Earl of Aberdeen, has issued printed forms for the concise registration of cases of cholera to all doctors – to be returned by 15.11.1854.

Aims:

1. To correct the ‘ignorance of the pathology of the disease’.
2. To ascertain the correct treatments.

‘The medical profession has, at this moment, to stem a perfect torrent of nostrums; some of the offspring of the silliest charlatanry and self sufficiency; some of value attested not by reason, not by experience that will bear sifting, but upon oath or affirmation; some that have the testimony of careful and competent observers to recommend them; these last are few’.

One of the most recent ‘little puffs of mystification’ is the castor oil hypothesis of Orthodox Physician George Johnson (?-?), Assistant Physician at Kings College Hospital 1840.

 The Lancet 28.4.1855 Statistical Results of the Treatment of Cholera and Diarrhoea

 A list of treatments used and the failures of those treatments is listed. (table not reproduced here as is it unintelligible, for example, salines and chalk (deaths 13.6% and 8% – failure rate 12.6%; calomel and opium (deaths 6.9% – failure rate 7.1%); etc).

However, The Lancet concludes that the statistics were rushed and not undertaken until the peak of the epidemic, the returns were poorly thought out, and the medical profession should have been more prepared to co-operate.

Of the % deaths recorded:                                     death rate

3. Alteratives (calomel, opium, salines) 48.5% (80% in collapse cases)
4. Astingents (sulphuric acid, logwood, catechu etc) 50% (78.9% in collapse cases)
5. Stimulants (ammonia, brandy, camphor, chloroform, creosote, capsicum etc) 79% (76.2% in collapse cases)
6. Eliminants (emetics and olive oil) 80.9% (77.6% in collapse cases)

War, Cholera, and the Ministry of Health. An appeal to Sir Benjamin Hall and the Wilkinson 1855 British People, outlines a paper by Doctor Homeopath James John Garth Wilkinson (1819-1899), who outlines the homeopathic treatment of cholera at this time. 30 drops of saturated spirit of camphor in half a tumbler of water to be taken every 5 minutes to half an hour, depending on the severity of the symptoms.

Abstain from food and rest. If the diarrhoea increases, take 20 drops of veratrum in half a tumbler of water, and 20 drops of arsenicum in half a tumbler of water, alternating every half hour. Add to this 20 grains of cuprum 3x if cramps and convulsions occur, to be taken when the pains are greatest. If the patient still worsens, then give carbo veg 3x tincture, or in extremis stramonium tincture 3x.

 The Lancet 1855; 1: 345-348 Report on the Results of the Different Methods of Treatment pursued in Epidemic Cholera

 The Board of Health reported 2749 cases (1104 in hospital and 1645 in the community). The mortality rate is reported as follows; alteratives (20.3%), astringents (36.2%), stimulants (54%), eliminants (71.7%).

Therefore, eliminative treatments are not recommended, alterative treatments are the best, especially in collapse cases (mortality 59.2%). The mortality in hospital is greatest as they are almost always severe cases who have been transported.

The lowest mortality is seen in private practice in affluent patients. However, The Lancet notes confusion and lack of accuracy across the returns, and the profusion of different methods used, also the many different presentations of the disease, the inaccuracy of recording events, such that details of early treatment stages are often absent, and so many anomalies and inaccurate detail in collection and recording was discovered in the returns, such that conclusions are dubious and difficult to reach.

 The Lancet 1855; 1: 412 The Results of Different Methods of Treating Cholera

 2749 cases analysed:

1. Those from the Metropolitan Hospitals (1104)
2. Those from the Metropolitan District not in hospital (1645)
3. Those from provincial districts.

The treatments fall into 4 classes:

1. Alteratives (calomel, salines)
2. Astringents (sulphuric acid, chalk, opium, iron, alum, acetate of lead, cinchona/quinine)
3. Stimulants (ammonia, brandy, ether, camphor, chloroform, cajeput)
4. Eliminants (castor oil, ipecac, tartarised antimony)

Conclusion: The eliminative method is condemned altogether. The alterative method is confirmed, especially when combined with opium (but only in severe cases in large doses.

Results:

1. Alteratives (36.2% mortality)
2. Astringents (20.3% mortality)
3. Stimulants (54% mortality)
4. Eliminants (71.7% mortality

The mortality rates in hospitals are greater than in private practice, thus ‘gives the final blow’ to the homeopathic idea of administering agents similar to the disease (eliminants), so the Lancet denounces the castor oil treatment.

 The Lancet 1855; 1:519-520

 The Lancet reports that Homeopaths were upset as the Board of Health did not record their cholera returns. Robert Grosvenor 1st Baron Ebury (1801-1893)[1], a British politician, founder of The British Homeopathic Association BHA (1847-1849) and President of the Board of Health, also supported the staff of the Hahnemann Hospital at 39 Bloomsbury Square (1847-1853), and complained to the Board of Health. Benjamin Hall defended the exclusion of the Homeopathic report, and reports that the Medical Council was tasked to analyse the various methods of therapeutic treatment of cholera, ad what has Homeopathy to do with therapeutics?

The Lancet ridiculed the ‘third dilution of the billionth of a grain’ (despite the 1x, 2x, 3x and mother tinctures in common Homeopathic use at this time), and The Lancet refutes the claim that medical doctors who convert to Homeopathy are capable of diagnosing cholera. The Lancet bristles under the epithet ‘allopath’ and accused Robert Grosvenor of ‘falling short of his duty to the country’.

 The Lancet 1855; 2: 202-203 The Board of Health and the Cholera Epidemic

 The Lancet lauds the ‘great pains’ taken to audit the comprehensive report, though it also notes that no complete number of those afflicted exists as there is no State Register of the Causes of Sickness. This report includes the returns of over 300 medical doctors, and furnishes data of 3188 cases in England (46% mortality), and the returns of the Poor Law Board of Scotland, who record 14,430 (47.5% mortality), so the Lancet infers that overall 25,000 cases of cholera occurred in England over the course of this epidemic.

The Board of Health estimates some hundreds of thousands of cases in total. 5271 cases of diarrhoea were recorded (87 fatal), overall total 17,351 (1.6% mortality), though it must be considered that a multitude of cases of diarrhoea never came to medical attention at all.

Overall, this report gives an’ inadequate conception’ of the epidemic. The Lancet discusses the different presentations of the disease, the effects of locality, air, water, atmosphere and the similarity of the 1849 and 1854 epidemics, the 1854 epidemic being judged less severe.

 The Lancet 1855; 2:346-348 Report of the Committee for Scientific Inquiries in Relation to the Cholera Epidemic of 1854

 This report examines 4271 cases of cholera (3188 in the Metropolitan District (46% mortality), and 20,301 cases of diarrhoea (17.460 in the Metropolitan District), collated from the returns submitted to the Board of Health by orthodox medical practitioners.

Firstly, diarrhoea and cholera must not be considered distinct diseases, but must be considered as the same process, especially when they prevail together epidemically.

If the 36 districts of London are arranged in order of their elevation above high water mark of the Thames, then the mortality is invariably in relation to it. Upon the highest terraces, the diarrhoea is as fatal as the cholera, and on the lowest ground, the cholera is 4 times as fatal as the diarrhoea.

It is noted that at the height of the epidemic, the atmospheric pressure had risen high above normal, the temperatures were above average, especially in September when the epidemic was at its height.

The air quality was very poor at the height of the epidemic and a drought ensured. These effects were most noticeable in alluvial districts, the chief seats of cholera in London, thus proving beyond doubt that the climate is London accelerated the epidemic.

The air in the hospitals during the epidemic was rife with organic matter, fungi and vibriones, which declined as the disease declined. These findings make frequent escapes to the purity of the country air vital for all classes.

Reports on the variability of water purity have previously been reported in the Lancet, some of our London water contains unacceptable amounts of raw sewage, easily seen under the microscope. However, the theory of contamination through ingestion of contaminated water in cholera is still in dispute.

The results of the efficacy of different treatments is reviewed, but The Lancet concludes that the study was based on too few cases to allow satisfactory conclusions to be made.

The British Journal of Homeopathy 1855; 13:62-78 Observations on the Cholera Epidemic by British orthodox physician who converted to Homeopathy John Anderson (1817-1875)[2]

This article is a report on 166 cases (4 deaths) treated by John Anderson, and he summarises the cases. The remedies used throughout (in 1x, 2x, 3x and mother tincture) were Camphor (often already taken by the patient before consultation), veratrum, ipecac, nux vomica, mercury corrosivus, arsenicum, china, secale, pulstalilla, digitalis, belladonna, cuprum, ignatia, carbo vegetalis, chamomilla. NB: camphorated chloroform was used in cases of pulmonary congestion. John Anderson illustrates two types of Cholera (fear and mental dread were noted in all cases):

1. Rumbling and griping in abdomen with diarrhoea and fever of 2-8 days duration.
2. Vomiting thin, grass green fluids after a meal or from an error of diet, with diarrhoea, fever, prostration, cramps, with marked raging thirst accompanying the severe cases, severe collapse (as if dead), with suppression of urine, and very severe cramps with severe contortion of the whole body just prior to death (4 cases).

Atypical presentations were noted. Not all symptoms were always present. Some cases were noted to exhibit exacerbations or amelioration of existing symptoms during the illness.

Some cases had absence of diarrhoea after an initial evacuation. In some cases, the fever led to delirium (which could be violent with screaming), asphyxia (one case – treated with camphorated chloroform). NB: eruptions and boils after homeopathic treatment proceeded cure in some cases.

Problems:

1. Malignant cholera was not always easy to determine.
2. It is as if a remedy for the collapse stage has not yet been identified.
3. A statistical comparison chart for successful homeopathic treatments would be of great value.

Interments of the House of Commons 14.5.1855

 Robert Grosvenor 1st Baron Ebury asks whether the Board of Health forms received from Homeopaths were refused on receipt. Benjamin Hall replied that forms were sent out to all doctors listed in the Medical Directory, Homeopath and orthodox, and those forms returned by Homeopaths had been systematically identified and excluded from the report.

 The Lancet 28.7.1855 The Resignation of Benjamin Hall as President of the Board of Health

 Benjamin Hall took over when confidence in the Board of Health was very low, and he carried the Metropolitan Local Government Bill and the Disease Prevention Act 1855 through the House of Commons. The Lancet bemoans his ‘removal from office’.

© Sue Young  2.10.09

[1] Sue Young Histories

[2] Sue Young Histories