Asiatic cholera is an epidemic disease which became pandemic in the 19^th century, attacking nearly every major country in the world. The disease is caused by Coma bacillus – Vibrio cholerae – discovered in 1883 by Dr. Robert Koch (1843-1910), and its toxins. The bacilli are ingested with contaminated water or food. The cholera epidemics had devastating effects among the population, when mortality averaged almost half of its incidence.

When cholera first reached Europe in 1830, scientists had already developed the basic principles of germ theory. Sightings through the microscope of “animalcules” enabled Anthony van Leeuwenhock (1632-1723) in 1676 to assert that “their seeds entered the body from without”. This concept of contagion-miasma maintained that the disease was communicated directly from person to person or indirectly by objects to material carrying the disease-bearing agent. Practical measures followed: severe quarantine policies, isolation of the sick, fumigation of goods, and banning of crowds and religious processions.

The notion of success of homeopathic treatment of cholera in the world’s pandemic[1] became part of all books on homeopathy. The results of treatment by homeopaths in the years 1830-1832 of cholera victims are presented today as the proof of effectiveness of homeopathy in present day conditions[2].

Hahnemann published four articles on cholera from June to October 1831. He was seventy-six years old at that time. The articles were:

1.      Cure of Cholera.

2.      Letter about the Cure of Cholera.

3.      Surest Cure and Eradication of Asiatic cholera.

4.      Appeal to Thinking Philanthropists Respecting the Mode of Propagation

Of Asiatic cholera.

Hahnemann was in tune with the thinking of his times by attributing cholera to infection. He also supported the contagion-miasma theory, the direct transfer of infection by contact of person to person. [3]

The anti-contagionists however ascribed epidemics to atmospheric factors, diet, miasma generated by decaying matter, and other environmental causes. They also objected to quarantines as causing more social harm than medical good. One of the anti-contagionists was Dr.Christoph W. Hufeland (1762-1836), a contemporary of Hahnemann. In 1831 Hahnemann vigorously attacked Hufeland for preferring the atmospheric and telluric theory. In the end the anti-contagionists were closer to the truth after excluding the irrational and planetary influences. The environmental causes pointed to the right direction in solving the problem of cholera.

Professor Max von Pettenkofer (1818-1901) claimed that cholera required certain conditions of the terrain for the epidemic to break out. His theory was that both cholera affected and healthy people transport the infection further; the infective material goes into the soil, particularly the water, and then acquires the necessary virulence, becoming the cause of epidemics.

There were other doctors in the first half of the 19^th century, who suspected the public water supply of being the source of cholera. Dr.John Snow compared cholera incidence in 1854 between customers of two London water supply companies who drew water different sources. He was able to establish a direct connection between five hundred fatal cholera cases and the pump which supplied their water. The Broad Street pump was the source of a particularly virulent cholera outbreak. Snow’s publication became an epidemiological classic. [4]

Hahnemann supported the contagion-miasma theory, the direct transfer of infection by contact of person to person. In his publication “Appeal to Thinking Philanthropists Respecting the Mode of Propagation of Asiatic Cholera” he had this to say on doctors who doubted the miasma theory: “They mostly remain uninfected and cheerful, although they were occupied individually every day with dying cholera patients. They even tasted the matter they ejected and the blood let from the veins and probably gone as far as to lie in bed alongside them, etc. This foolhardy, disgusting procedure they allege to be the experimentum crucis, that is to say, an incontrovertible proof of the non-contagious nature of cholera, that is not propagated by contagion but is present in the atmosphere and for this reason attacks individuals in widely distant places – fearfully pernicious and totally false assertion.” [5]

Perhaps from his own observation of cholera patients, from the letters of his followers and from contemporary literature, Hahnemann gave this description of the disease: “When the cholera first appears, it usually comes on in the commencement of the first stage with tonic spasmodic character. The strength of the patient suddenly sinks, he cannot stand upright, his expression is altered, his eyes sunk in, the face bluish and icy cold, as also the hands, with coldness of the rest of the body; hopeless discouragement and anxiety, with dread of suffocation, is visible in the looks; half stupefied and insensible, he moans or cries in a hollow, hoarse tone of voice, without making any distinct complaints, except when asked; burning in the stomach and gullet, and cramp pains in the calves; on touching the precordial region he cries out; he has no thirst, no sickness, no vomiting  or purging.” [6]

Symptoms of cholera were divided into three stages. The first stage came usually without warning. The patient who had been in good health developed sudden effortless and continuous diarhoea. The stool gradually assumed the appearance of rice-water. Profuse vomiting followed. The second stage was called the cold or choleric stage and could have overlapped the first stage. The description was essentially that of a state of collapse resulting from the tremendous loss of fluid and electrolytes. The pulse became rapid and almost imperceptible; the skin cold, pale and hollow, the tongue dry and little urine was passed. The voice turned husky, patients were restless and complained of severe thirst and cramps. Death often occurred at this stage. The third – febrile – stage developed if the patient survived. In milder cases the pulse became stronger and slower, the colour improved and the skin warmed up. In the most severe cases there was no improvement but a rapid deterioration ending in death, mostly caused by uremia.

Doctors admitted that the numerous and often contradictory methods of treatment employed indicated lack of true understanding of the cause of cholera. Treatment usually followed traditional lines. In the first stage the diarrhea was treated with Opium 1½ grains [1 grain = 0.0621 gram], twice in 24 hours. Calomel was added if the bowels continued to be purged, but no emetics were administered for vomiting. ‘Cautious’ bleeding should have relieved headaches and muscle cramps.

In the second stage it was felt necessary to control secretions by giving Calomel every half hour. Most doctors stressed total abstinence from all liquids, allowing only half a teaspoonful of water to help down the Calomel. Coldness was relieved with mustard cataplasms to the stomach and limbs whilst occasional mustard emetic ‘comforted’ the patient. Some doctors ordered Ammonium carbonate 5 grains and the same quantity of Magnesium carbonate half-hourly. Galvanism was tried without success, as were rectal injections of 4 to 6 oz of turpentine. If patient survived into the third stage, the milder cases only required a few leeches or a blister. Moderate cases had small amounts of blood removed by venesection from the arm.

The seriously ill were kept warm with mustard plasters, heated sandbags or bricks, warm baths if not too ill to be moved. Brandy, aromatic tinctures and camphor were administered, as well as more purgatives to clear out poisons; calomel to restore secretion. Some doctors considered it cruel to ignore the patient’s intensive craving for fluids and allowed the patients small quantities of lemonade, tartaric acid in water, or ginger milk and sugar. 

Different treatment tried in York in 1832 [7] included cold water treatment recommended by Dr. Shute from Gloucester, but after two patients died this was discontinued. Saline treatment method published by Dr. Stevents in a paper of the Royal College of Physicians was also unsuccessful. Other doctors tried the suggestion of Dr. Lawrie from Glasgow who was giving to patients with cholera injections of Laudanum and small quantities of whisky. Fatal results followed injections of bullock’s blood and of human serum. More interesting is the reference by Dr. Needham of Goodramgate of the use of intravenous saline injections. The solution consisted of two drams [drachms] of Muriate of soda and two scruples of Carbonate of soda in sixty ounces of water at a temperature of 108-110 degree of Fahrenheit, and was injected by means of a Read’s common syringe. This was based on the method adopted by Dr. Latta of Leith who recommended rapid replacement of lost body fluids. In York of the thirty cases treated in this manner only four recovered.

There is a letter by Dr. Stule from Berlin addressed to Hahnemann from the 31^st August, 1831, in which he writes: “According to reports, in a Polish locality, 250 patients were treated by rubbing them with a mixture of Camphor, mustard, pepper, spirits of wine and vinegar and the results were so good, that only two, who would not submit to this treatment, died.” [8]

Amongst documents and memorabilia [9] deposited in the year 1831 in a church spire in the town of Ostrava [Czech Republic] and inspected for the first time in 1966, was a description of a successful treatment of cholera. It is a piece of paper written in German and dated 30^th June 1831. The first paragraph describes a remedy used in treatment of cholera. The remedy consisted of ½ quarter [of a liter] of brandy (Aquavit); ¼ quarter of strong vinegar; two lots [= 29.8 gram] of Camphor; two lots of pepper; two lots of mustard, and two heads of garlic. All had to be mixed well together and placed into a glass container which already had in it brandy and vinegar. The container was to be left standing for twelve hours exposed to strong sunshine or on a hot stove.

The second paragraph describes how to use this concoction. As soon as the first symptoms of cholera appeared, the patient had to go to bed. Immediately after, the sick person should have been wrapped repeatedly in flannel towels soaked in the above described mixture. This procedure was to be continued as long as the patient showed signs of life and as long as strong perspiration persisted. To help to maintain the perspiration (‘zur befoerderung und erhaltung des schweisses’) an application of hot sand, ashes or wheat wrapped in a towel, placed on the whole abdomen and the region of the heart and stomach, was advised. Furthermore it was necessary to rub the legs from ankles upwards and also the soles of the feet with towels soaked in hot vinegar. During the process of rubbing, the patient was made to drink very hot tea prepared from Folia Melissae Officinalis, and from Folia Menthae Piperitae. The patient had to stay covered with an eiderdown for at least 24 hours. As nourishment a pure barley pudding was served. Also advisable was to rub around the umbilicus Oleum Menthae Crispae, and to apply warmth around the body for at least 48 hours.

Five persons simultaneously were required for rubbing the five parts of the patient’s body, the limbs and the trunk with coarse towels or brushes, rubbing in brandy or spirits on the whole body, applying hot bricks to the soles of the feet and between the legs. At the same time the patient was covered with corn porridge and made to drink a large amount of tea from Folia Menthae Piperitae. A patient on whom these procedures were started immediately was saved when headaches ceased and cooling of the limbs occurred. In such case the infection did not even provoke the vomiting. Each person during the process of rubbing was to drink a bottle of brandy, smoke tobacco and on finishing the job, wash the hands and face with warm vinegar or with a solution of slaked lime.

From what has been said it becomes clear that doctors faced with an unknown disease in 1831 were inclined to treat it the traditional way, with blood-letting, purgatives, and restriction of fluid intake. Lay people, on the other hand, as the example from Ostrava shows, were prepared to do more and to use different methods.

Almost all the remedies used during the cholera epidemic contained Camphor. Dr. Gross wrote in a letter to Hahnemann, dated October 1831: “The allopaths… use Camphor everywhere!” [10]  Indeed Camphor seems to have been included in most medicines at that time. And Camphor was what Hahnemann recommended as the only protective and curative specific agent against cholera.

Camphor is a ketone obtained from the volatile oil of Cinamonum Camphora, a tree indigenous to Eastern Asia. [11] It would appear that Hahnemann had chosen Camphor on the basis that it was included in almost all the contemporary medication to combat cholera in 1831. There is a chapter in Hahnemann’s Materia Medica Pura, which appeared first in 1811, where he says: “I do not look upon the list of symptoms which are known of Camphor, as complete; I consider it merely a beginning of such a list, which may be completed hereafter … This medicine has always been given at random in large doses, so that its true action could never be known …The action of this substance on the healthy body is extremely problematic and difficult to define …”. [12]

However Hahnemann considered Camphor as a remedy specific for Asiatic cholera in the first, or cold, stage. The list of other indications of Camphor Hahnemann gives is long and various. Compilation of provings by different authors makes the indication of it even more bewildering.

This is what Hahnemann had to say on Camphor ant its use in Cholera Asiatica in 1831: “In the first stage Camphor gives rapid relief, but the patient’s friends must themselves employ it, as this stage soon ends either in death or in the second stage, which is more difficult to be cured, and not with Camphor. In the first stage, accordingly, the patient must get as often as possible (at least every five minutes) a drop of Spirit of Camphor (made with one ounce of Camphor to twelve of Alcohol) on a lump of sugar or in a spoonful of water. Some Spirit of Camphor must be taken in the hollow of the hand and rubbed into the skin of the arms, legs, and chest of the patient; he may also get a clyster [enema] of half a pint of warm water, mingled with two full teaspoonfuls of Spirit of Camphor, and from time to time some Camphor may be allowed to evaporate on a hot iron, so that if the mouth be closed by trismus, and he can swallow nothing, he may draw in enough of Camphor vapour with his breath. … The quicker all this is done at the first onset of the first stage of the disease, the more rapidly and certainly will the patient recover; often in a couple of hours, warmth, strength, consciousness, rest, and sleep return and he is saved.” [13]

What is of interest in this context are homeopathic provings with Arsenic. Cholera symptoms are quite similar to those of acute Arsenic poisoning. Dr.Ackernecht, the famous historian of medicine, mentions that under the cover of cholera during the pandemics quite a few domestic murders may have been committed. [14]

Toxic effects of Arsenic appear suddenly within one hour of ingestion: watery or hemorrhagic diarrhea, vomiting, cold and clammy skin, and fall in body temperature, convulsions and coma. Death follows within fifteen hours from circulatory failure. It is almost an identical clinical picture as in Asiatic cholera victims.

From the homeopathic point of view Arsenic seems to be the right drug to use in Cholera Asiatica. Its picture on provings – and there is a long history of Arsenic use by professional poisoners – is similar to the symptoms of cholera. Hahnemann however had chosen Camphor.

Toxic effects of Camphor are nausea, vomiting, and abdominal colic. There is a prevalence of central nervous system signs: visual disturbances, dizziness, and epileptiform convulsions. Rigidity of the body, accelerated pulse, facial twitching, muscular spasm, body temperature is usually elevated. Delirium and death comes from respiratory failure.

The clinical picture of Camphor poisoning is therefore different, not even similar, to the clinical condition of Asiatic cholera victims. Camphor is basically a central nervous stimulant and has been used as such in the past. Even homeopathic literature itself lists Camphor for use as an analeptic in vasomotor collapse and heart and circulatory insufficiency. [15]

After many hundreds of years of use Camphor has been deleted from the US Pharmacopoeia. [16] The American Academy of Pediatrics described the toxicology of Camphor as follows: “…the first symptoms are nausea and vomiting, followed by headache, dizziness and delirium, than by tremors, convulsions and coma. Death occurs from respiratory failure or other central nervous system damage.”

Hahnemann must have than selected Camphor for treatment in Asiatic cholera not because of the Law of similarity, but on the basis of reports and wide use by others during the first Cholera epidemic.

The frequent claim by homeopaths of effectiveness of homeopathic method in treatment of Asiatic cholera deserves a comment. The statistics homeopaths presented in the 19^th century were certainly in their favour. However these results have not been achieved because of superiority of the homeopathic method. Homeopathic provings with Camphor, as described in Hahnemann’s Materia Medica Pura (first published in 1811), do not justify its use in cholera. For example the effect of Camphor on bowel movements – as given in the 1846 edition – is constipation, obstinate constipation! There is no way the Hahnemann’s description of Camphor provings would match or be similar to the clinical symptoms of Asiatic cholera.

Hahnemann’s recommendation of Camphor in Asiatic cholera epidemic in 1831 must have been based on different criteria than the Law of Similia Similibus Curentur. The choice Hahnemann made had to be done on the basis of good reports of Camphor used as a stimulant, and of its widespread use. From the homeopathic point of view Arsenic should be the first choice to use in Asiatic cholera according to the Law of similar.

Hahnemann and homeopaths have achieved better results than the orthodox medical practitioners only during the first epidemic of Asiatic cholera in 1830. However homeopathy did not do as well as the lay treatment. As the knowledge of Cholera Asiatica as a disease increased and the progress in medical sciences advanced, homeopathic treatment has not shown itself to be of any advantage in dealing with this problem. After the initial good results in handling cholera victims, the scales of history moved against homeopathy.