The pamphlet by John Hancock is quite remarkable. He managed to get every single thing wrong. He was a passionate anti-contagionist, proving his points by inserting exclamation marks instead of arguments. He wrote his pamphlet before cholera actually arrived in England, on the basis of his 22 years experience in the tropics. He even suggested that nitrous oxide might be a cure for or even prevent not only cholera, but for other pestilential diseases, and also be a remedy for asphyxia from suffocation or drowning. Bear in mind that this was 1931, 13 years before Horace Wells had his tooth pulled under the influence of nitrous oxide. Hancock had to add a note in press about the cholera that arrived in Sunderland in November that year, brought by a sailor from Hamburg. Other people, he said, thought this proved cholera was contagious, but he personally blamed miasmas brought by the wind crossing in a direct line from the Baltic Sea. I do not know if it was the same Hancock who introduced anti-cholera galoshes the following year. If it was then maybe he had been converted to contagionism after all.

I could only find James Kennedy’s History of the contagious cholera, 3rd ed. in the Wellcome Foundation library in London, though the full text of the 2nd edition, published earlier the same year, available online and this describes in detail the spread of cholera within the country. Kennedy thought cholera could occur in any climate, but that it was contagious only to those who are predisposed to get it, i.e. he was a contingent contagionist. The 3rd edition has an extra section dealing with treatment Kennedy felt bloodletting was the mainstay, but he reported that two German physicians working in St Petersburg had given a salt solution, two tbsp of common salt in 6 oz of hot water, with further smaller doses, to 30 patients all of who had recovered. As they had bled the patients before giving the saline Kennedy felt that the bleeding might well have been the treatment that had succeeded. He also commented on a report by Dr Steevens in the Lancet about the successful treatment of 226 men with cholera at Coldbath Fields Prison. Dr Steevens had used a mixture of ½ drachm of carbonate of soda, 1 scruple of muriate of soda, 7 grains of chlorate of potash in a tumbler of water. There had only been 26 deaths. Kennedy was also unconvinced by this report and said that saline draughts could never be more than a humble accessory to other forms of treatment. Clearly though we have here two examples of 1830' s Dioralite. He also discusses the use of intravenous saline. With it Dr Latta of Leith turned a moribund woman into a jocular one within an hour, but sadly she died later. Lawrie, see above, tried it on six patients in Glasgow but had no success. In Edinburgh they used a solution of 120 grains of common salt, 40 grains of carbonate of soda, in 5 lbs and water heated to 110/115°F. They gave up to 40 lbs of this solution in two days and noted that ‘rigor was apt to follow’. In all cases there was an immediate improvement but then ‘reaction fever’ leading to death would follow. Other forms of treatment at this time included emetics, blistering, rubbing with hot towels, opium, calomel, purgatives, brandy, stimulants and even fluid restriction. 

After the great epidemics in India cholera became endemic there it began to spread outward. When it invaded Eastern Europe in 1830, France sent four commissions to observe the disease in Poland and Russia, two of them sponsored by the Academies of Sciences and of Medicine. In June 1831 cholera was added to the list of importable diseases, but in July L’Académie de Médicine in its Rapport sur le cholera morbus provisionally declared the disease not essentially contagious, but able to become so, and advised the government to take both sanitary and hygienic measures. When the epidemic arrived in 1832 it was catastrophic; in Paris alone 18,000 died. Medical remedies proved as futile as quarantines. Worse, the calamity signaled the breakdown of public order in France. 

       Edmund Parkes studied medicine at University College London, qualifying, bemedalled, in 1841. The following year he joined the army as a lowly Assistant Surgeon with the 84th (York and Lancaster) Regiment and was posted with them first to Madras and later to Moulmein, Burma. While there he experienced the 1842 and 1843 epidemics of cholera and dysentery where he had seen no evidence of contagion from person to person, but insisted ‘I by no means wish to generalise this observation and to conclude that the poison of cholera is never reproduced in the human body’. His researches provided material for publications, which appeared after his return to England and his resignation from the army. He believed that the cholera poison entered the bloodstream first, the alimentary canal secondarily, if at all. He thought cholera was caused by a specific morbid agent or virus that was presumably one of the more subtle gases undetectable by the chemical means then available. He argued that the blood was affected in cholera, secondarily to related changes that occurred in the hearts and lungs, but that it was a fibrin in the blood rather than the fluid and salt content that was altered. He also mentioned in passing that intravenous saline injections had been tried by some Indian practitioners with notable lack of success. In 1855 he went to the Crimea to take charge of a prefabricated hospital designed by Brunel. It was this year that he was dismissive of John Snow's theory of the faecal-oral transmission of cholera, though he did admit that it was difficult to explain away the Hampstead widow and her niece. In 1860 he became the Professor of Military Hygiene. 

An abridged version of Scot’s 1924 report was published in 1831 and then again in 1849. In his introductory remarks in 1849 he says that the mortality from cholera continued to be as great, opinions even more unsettled, rules of practice as undefined, men's minds as much adrift as ever. He thought dysfunction of the ganglionic system of nerves formed the primary seat of the disease. He recognized that bodies of men travelling through the country could catch the disease while passing through affected areas and then carry cholera along with them. He discussed the role of the rivers, which were generally thought to have a great influence on the prevalence and intensity of cholera. However he says Dr Lorimer reports that out of 121 outbreaks only 37 occurred on the banks of rivers and he comments that cities are built on rivers, which are the lowest, and often most squalid, parts of any city. In the UK cholera clearly is an imported disease. He discusses treatment by opium, calomel, bloodletting and stimulants. Bloodletting might be all right on general principles early in the disease, but in the collapsed patient it was often deleterious.

Dr. John Parkin is something of an enigma. In 1832 he had suggested using a charcoal as a water filter, because he thought the cholera poison, having been generated in the earth, found its way into various springs and then into the stomach. Later he became a fanatical opponent of the water-borne theory and ridiculed the suggestion that cholera was caused by a living organism. In his 1846 paper he claimed to have a specific remedy, namely carbonic acid gas, to prevent collapse in cholera patients. He mixed 30 gr sesquicarbonate of soda or potash, 20 gr citric or tartaric acid, 1½ wine glasses of water and 1 dessertspoonful of syrup. This was given every 15 minutes for the first hour; less often thereafter. Fluids were allowed as the patient wished. Sesquicarbonate is a naturally occurring mixture of carbonate and bicarbonate. So what Parkin was actually doing was giving alkali therapy with fluids and plenty of sodium or potassium, a 1840s dioralite. In a collapsed apnoeic patient sodium bicarbonate therapy can be very harmful because carbon dioxide can diffuse readily into the cells and add to the acidosis. Here however the patient is getting rid of carbon dioxide by burping and he is also able to breathe it out. I guess this treatment is not as bizarre as it first sounded. The syrup was added to stop the carbon dioxide gas bubbling away before the patient had swallowed the medicine, because Parkin thought this was the active agent. 

Before I tell you about the last pamphlet bought by the Society I need to refer to three papers that it did not purchase. In September 1849 John Snow published his pamphlet On the mode of communication of cholera and this was followed 29 days later by William Budd’s Malignant Cholera: Its Mode of Propagation and Prevention. The two men agreed that cholera was a disease of the gut, that other features were from dehydration and that water contaminated with cholera evacuations was a major source of spread. They disagreed in that Budd thought transmission by inhalation was feasible and that the causative agent was a fungus, one that had been identified by Joseph Swayne and his colleague Dr Frederick Brittan, who later became a member of the Reading Society. Budd was always meticulous in giving priority to Snow.

In 1954 John Snow had the opportunity of further studies on cholera, especially those where he related deaths from cholera to houses with piped water supplies from different water companies, or alternatively houses who got their water from different pumps, especially during the epidemic in the neighbourhood of Golden Square. Beside those who questioned whether Snow’s theory was true were those who said it wasn't original. Snow however had approached the matter in a scientific manner and had produced substantial statistical evidence to support his theory.

The last paper on cholera the Society bought was by John Simon, the first Medical Officer of Health in London, reporting to the General Board of Health in 1856. However he did not acknowledge Snow's work, of which his own was corroboration and an extension. At a meeting of the British Medical Association in Manchester later in the year Budd strongly supported a motion of regret at this omission, once again giving Snow the priority.

Finally I strongly recommend to you the recent biography of William Budd by Michael Dunnill, who was a medical student in Bristol in the 40s and who feels William Budd's worth has been inadequately recognized. Bruce Perry in his list of the ten most important doctors in Bristol fails to mention Budd. It will only cost you £12.99, and is a fascinating read. The biography of John Snow, see below, is also a splendid and scholarly book.