Cholera

A few months ago I attended a talk on Kipling and Cholera by the Warwick academic Pablo Mukherjee.  My curiosity in medical history (never, admittedly, miles from the surface) being piqued, I typed ‘cholera’ into our catalogue search.  Among other sources I was greeted by eight Fellows – all elected in the 19^th Century.  Sir David Barry (1780-1836) and Sir William Russell (1773-1839) were both given titles as a result of their work during the cholera epidemic of 1832; and indicative of their work and that of their contemporaries on the disease, David Douglas Cunningham (1843-1914) and Edward Emmanuel Klein (1844-1925) were studying cholera in India in the second half of the century.  What of the other four then?  Unfortunately, they had been dispatched by cholera in the same period – a time when cholera was rife and epidemics across the world were rampant, the death toll somewhere in the millions.   

Cholera was, and still is, by all accounts, a thoroughly unpleasant way to expire, as Irwin W. Sherman recounts in Twelve Diseases That Changed Our World (2007):

“At first, the symptoms produce no more than a surprised look as the bowels empty without any warning.  Then surprise changes to agony as severe cramping pains begin.  Copious quantities of liquid, resembling rice water, pour through the anus.  As the pain intensifies, the only small relief is to draw oneself into a ball, chin held against the knees; the breath whistles softly between the teeth.  When death occurs at this stage, the body cannot be unrolled and the victim has to be buried in the fetal position.  Those who do not die from this first attack suffer a slow and painful decline.  The cheeks become hollow, the body liquids surge more slowly but still remain beyond control, and the watery stools contain fragments of the intestinal lining.  As the hours pass, the skin darkens, the eyes stare vacantly [...] and then life ends.”

In England, the key figures in combating the spread of cholera were John Snow (1813-1858), a physician who charted the spread of the disease and linked it to the contamination of drinking water; and Edwin Chadwick (1800-1890), who pioneered sanitary reforms for the improvement of public health.   The item that caught my eye, however, was by Nikolai Ivanovich Pirogoff (1810-1881), entitled Anatomie Pathologique du Cholera-Morbus.  Pirogoff (also spelt Pirogov) was an eminent Russian surgeon, member of the Russian Academy of Sciences and winner of their Demidov Prize on three separate occasions.  He is known for his influence on field surgery, having served as a military surgeon, for progressing the use of plaster casting in the treatment of fractures and for compiling the four-volume Topographical Anatomy of the Human Body (1851-1854).

Pirogoff’s Anatomie Pathologique du Cholera-Morbus, however, was a work made possible by the cholera epidemic that swept through Russia in the first half of the Nineteenth Century.  Pirogoff’s research was the result of more than 500 autopsies performed on cholera victims, examining the pathological effect of cholera on the cells and the organs of the sufferers.  Through this, he was able to ascertain two different types of cholera, simple cholera and compound cholera, and the symptoms each entailed.  This work focuses on the visual changes in cells and organs caused by the progression of cholera in the system, exploring how it attacks and following the different processes and changes. 

The images in the book are vividly coloured lithographs based on drawings by C. A. Meyer showing the effect of different types of cholera on cells, organs and membranes in the body.  Many are certainly not for the squeamish!  They do, however, provide a fascinating insight into the sheer amount of detail that went into the work undertaken by artists working in collaboration with scientists and doctors, particularly during this time, work that was made extremely difficult by the presumed lack of physiological knowledge on the part of the artist. 

The image presented here is a plate taken from the stomach of a patient who died in the ‘cold’ stage of cholera.  What is interesting here is the cultural as well as the medical implications, indicated by the presence of mushrooms in the stomach.  As Pirogoff notes, the patient died during the Russian Great Lent at which time dried mushrooms formed a large part of the diet and despite the vomiting that occurred in this case, there were still some to be found in the stomach – though this was not altogether unknown.  Pirogoff goes on the describe the condition of the stomach, noting that the mushrooms appeared to be almost attached to the mucus membrane of the stomach, which was itself highly swollen and dotted with suffusions of blood.

Pirogoff’s work provides an engaging insight into the changes the body underwent during the various forms of cholera.  The sheer number of autopsies he and his colleagues performed enabled him to identify the varieties of cholera and the ways in which they affected the human body to better enable medical professionals to understand the disease.  The artwork in the Anatomie Pathologique du Cholera-Morbusmay not exactly be beautiful; but the level of work put in by the artist into the striking images is certainly on a par with the effort undertaken by Pirogoff in his research.