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Anesthetics in the Treatment of Cholera*
Dr. Eugene H. Conner, [Reprinted from Bulletin of the History of Medicine, Vol. XL, No. 1, January-February, 1966.] *Presented at the Thirty-eighth annual meeting of the American Association for the History of Medicine, Philadelphia, Pennsylvania, April 30, 1965. Descriptions of a sporadic disease characterized by diarrhea, vomiting, suppression of urine, severe cramps in the legs and arms, and loss of voice have been found in the writings of ancient medical authors since the time of Hippocraties.1 This sporadic disease is possibly the same as the disorder which became a devastating, world-wide epidemic by the second quarter of the 19th century. It was known as the Asiatic cholera, cholera morbus, cholera asphyxia, or simply cholera.
Cholera became epidemic in India in 1817. As a result of the far-reaching commercial and military operations of Europeans, it soon spread throughout Asia and the Near East. By 1831, the disease had reached England and, by the following year, the North American continent.
Medical science in this second quarter of the 19th century had reached the degree of sophistication that the contagiousness of certain diseases, such as the exanthemata, was recognized and its mechanism of spread by direct contact was fairly well understood. The contagious character of other diseases which were not spread by obvious direct contact with an affected individual, however, was not elucidated until mid-century.
Since the contagiousness of cholera was not recognized, direct therapeutic approach to the control of the disease was not possible, and a variety of treatments was tried. The method of treatment to be considered here, the use of anesthetic agents (nitrous oxide, diethyl ether, and chloroform), may seem ridiculous in light of our present knowledge, but in the 1830’s such was not the case.
In this era, medical thought was still greatly influenced by that of the 18th century. Classification of medical disease had been much in vogue and complicated classifications had been devised, such as that of Francois Boissier de Sauvages {1706-1767], who had categorized some 2,400 “species” of disease.2 William Cullen [1712-1790]3 and others continued to contribute to the complexities of nosologic systems. If for no other reason than its apparent simplicity, the Brunonian system proposed in 1780 by John Brown [1735-1788] was embraced by many practitioners. It is in this Brunonian system that we find the basis for the use of anesthetics in the treatment of cholera, although most probably neither the agents nor the disease was actually known to John Brown.
The Brunonian concept was quite simple: “The indication for the cure of sthenic diathesis is to diminish, that for the cure of the asthenic diathesis is to encrease the excitement, and to continue to encrease it . . . .”4
No patient could be better characterized as manifesting an asthenic diathesis or showing “depression of vital spirits” than the victim in the third stage of cholera or the stage of collapse. The patient was dehydrated to such an extent that his skin was wrinkled and discolored with scattered areas of lividity; his lips and nailbeds were cyanosed, his pulse was barely, if at all, palpable, and he was too weak even to cry out. This appearance of the victim of cholera was so frequent that the term cholera asphyxia came to be applied to the disease.
The application of Brunonian concepts to the treatment of such a patient clearly demanded the use of a drug which would stimulate the “vital spirits” and counteract this apparent state of asphyxia, and the bulk of knowledge available in 1830 indicated that nitrous oxide would be ideal for this purpose.
Nitrous oxide was thought to be not respirable by its discoverer, Joseph Priestly [1733-1804],5 and by the Dutch chemists who experimented briefly with the gas in 1792 and 1793.6,7 The observation that N2O was respirable was made by Humphry Davy [1778-1829] and published in 1799.8,9 The concept that nitrous oxide would be a useful therapeutic stimulant is based largely on the work of Humphry Davy.
During the year 1798-99, Davy carried out the first systematic studies on nitrous oxide at Thomas Beddoes’ Pneumatic Institute in Bristol. These careful studies were published in monograph form in 180010 and later widely quoted and reported. When he carried out this work, Davy was only 21 years old but showed remarkable scientific acumen and a rather thorough knowledge of current literature in science and medicine. Davy was not a medical man, but his physician-employer, Thomas Beddoes, M.D. [1760-1808], was an enthusiastic supporter of Brunonian concepts and exerted a strong influence on Davy’s thinking. 1Report of the Royal Academy of Medicine, to the Minister of the Interior, Upon the Cholera-Morbus. Published by order of the French Government. Trans. By John W. Sterling, M.D. New York: S. Wood & Son, 1832, pp. 5-10. 2Francois Boissier de Sauvages: Nosologia methodica sistens morborum classes, genera et species juxta Sydenhami mentem et botanicorum ordinem. Amstelodami: fratr. de Tournes, 1768. 3William Cullen: Synopsis nosologiae methodicae. Edinburgh, 1769. |