Early nineteenth century treatments for cholera

Although I am well acquainted with early nineteenth century medicine in the United States, I am seldom able to stifle a shudder when I read about the various treatments typical of the period.  Such was my experience over the past few days when I was reading about the cholera pandemics of the mid nineteenth century.  I am particularly interested in the impact of cholera on the Erie County Poorhouse in Buffalo, New York, as the pandemic of 1849 will figure significantly into my third book of the Orphans and Inmates series.

When reading medical accounts of cholera from the mid nineteenth century it is important to remember that most of the advances we now take for granted, like the germ theory of disease, came much later in the century.  By the 1848-49 pandemic, cholera was widely thought not to be an infectious disease.  The logic being that those who treated the sick seldom became ill.  In support of this was the claim of a physician to have slept on the very cot of a man who had died of the disease just the night before.  “To these facts I may add another, namely, of a gentleman with the disease dying upon my own cot, and my having not only slept, on the following night, in the same room, but upon the cot and bedding as well…”  

There was a general belief that environmental miasma, or poisonous air resulting from poor sanitation and overcrowding was to blame (for cholera and many other infectious diseases).  Such atmospheric toxins acted to depress the nervous and vital energies of the body and, as a result, produce other symptoms of the disease (such as vomiting and diarrhea).   Although London physician Dr. John Snow suggested as early as 1849 that contaminated water was the cause of cholera, it would be years later, during the 1854 pandemic, that he obtained proof by linking afflicted individuals to a specific well in London.   

          

While treatments during the 1849 pandemic varied, most practitioners held that the best results were obtained if therapy began in the primary stage of the disease.   The intent was to relieve “nervous prostration and congestion”.  Treatment was aimed at freeing the body of whatever might be in excess.  Initially substances were given to encourage perspiration such as Dover’s powder (a substance made up mainly of ipecac and opium), calomel, camphor, and opium.  After several hours of sweating, a patient was given cathartics (purgatives) such as rhubarb, magnesia and castor oil. Emetics, substances used to induce vomiting, were also employed.  Some physicians thought that cholera was caused by the accumulation of acids or other substances in the blood.  “Congestion” of the blood could be relieved either by bloodletting, cupping (the process of applying cups to the skin to form suction in the attempt to bring blood or heat to the skin’s surface) or by injecting substances like saline into the veins.  The problem with treatment in the primary stage of the disease according to physicians was that few individuals acknowledged symptoms like lethargy and loss of appetite and seldom sought treatment until the more severe symptoms like vomiting and diarrhea, characteristic of the later stages, set in.  It was generally agreed that treatment in the later phases was futile and mortality was high. 

According to C.B. Coventry, MD, a professor at both The Medical Institution of Geneva College and the Medical Department of the University of Buffalo in 1849, cholera came back to the United States aboard the packet ship called New York.  The ship left France in November of 1848 with over 300 steerage passengers, mostly from Germany, bound for New York.  At the time there was no cholera reported in Paris, or Havre, where the ship departed.  However, on November 25th, a single passenger became ill with a “severe bowel complaint”.  The disease spread and when the ship arrived in New York those who had not died were transferred to a quarantine hospital.  Although there were other passengers on that ship, only the Germans were afflicted with the disease.  Ninety one people were stricken by cholera in New York City as of January 1, 1849.  Of those, 47 died.  The disease would make its way via the Erie Canal to Buffalo, where over 900 people would lose their lives.  

Sadly, there are no surviving inmate records or hospital records from the Erie County Poorhouse for this period.  It is my hope that some mention of how the 1849 cholera epidemic in Buffalo impacted the poorhouse will be mentioned in the Keeper's Report, contained within the Erie County Board of Supervisors Report.  A trip to the Buffalo History Museum's research library is on the books for the upcoming weekend.  Wish me luck!!