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Published by Oxford University Press on behalf of the International Epidemiological Association
ß The Author 2013; all rights reserved.
International Journal of Epidemiology 2013;42:58–61
doi:10.1093/ije/dys242
Commentary: John Lea’s Cholera with
Reference to Geological Theory, April 1850
Brian Altonen
Department of Community Health, Portland State University, NY, USA
*Corresponding author. E-mail: [email protected]
Accepted
18 December 2012
In 1850, John Lea (1782–1862) published his Cholera,
with Reference to the Geological Theory1 in Cincinnati,
Ohio. Unlike other interpretations of cholera produced
around this time, John Lea’s interpretation focused on
rocks and soil instead of animalcules, fungi or poisons. Lea relied upon a 50-year-old theory stating calcareous rocks were the cause for diseases due to their
alkalinity. It was Lea’s experiences with the 1830 epidemic in Tennessee that led him to develop this
theory when a severe Asiatic cholera epidemic struck
his town, preceded and followed by its milder form
cholera morbus. Earlier versions of this geological
theory were posed for such diseases as ‘black-vomit’
in 18002,3 (for which an opposite relationship was
developed), yellow fever between 1800 and 18404
and cholera after the first pandemic.5
John Lea’s ability to differentiate Asiatic cholera from
cholera morbus was not overly successful, for he was
COMMENTARY: JOHN LEA’S CHOLERA
not a physician. He was a notary public with a wife and
several children.6 He moved to Cincinnati, Ohio,
around 1840,7 and during his spare time was a gardener and horticulturalist8 who kept a weather journal9–12 and applied meteorological skills to improving
the products of his garden and fruit-bearing trees. It
was the observations Lea made about local topography
and water behaviour that brought him to his conclusions about the geological theory. When we read his
pamphlet we can tell Lea’s conclusions were very subjective and speculative. For example, he blamed the
cases suffered by newly arrived immigrants on their
inability to adapt to the new climate. For Bostonians
and New Yorkers, he blamed it on the ‘sub-acid’ or
alkaline oranges found in their diet which served as
an ‘exciting cause’, turning cholera morbus into its
more malignant form. Reading the world news, he
blamed the epidemics in Egypt on the low rainfall
which forced citizens to rely upon cholera-ridden Nile
River water. For those residing next to the Little Miami
River in Ohio, the highly alkaline calcium-rich fossil
beds were to blame.
To prevent ‘the virus of cholera’, Lea noted accurately the role water quality plays in disease prevention. He favoured the capture of rainwater with
barrels and cisterns, a very common practice locally.
But he also noted the value of ‘river water’ supplied
by iron pipes and steam power to town and city settings, ‘soft water’ provided to some towns by aqueducts and mineral-free water flowing through
sandstone and alluvial river beds. He also noted that
certain diets made you healthier, drinking tea prevented Asiatic cholera like it did in China, and
when rainwater wasn’t accessible, wine, spirits and
beer were healthy substitutes.13 Throughout all of
these discussions, geology was used to explain why
cholera occurred and how it could be prevented,
claiming ‘arenaceous’ or sandy soil and alluvium
were the safest soils to reside on.
In April 1850, Lea’s pamphlet was published just a
few weeks before the annual meeting of the American
Medical Association [AMA] in Cincinnati.14 During
this meeting, the Committee for Practical Medicine
and Epidemics displayed a map depicting the first
cases of cholera in the Philadelphia area (Figure 1).
Their map contrasted with that of Lea, and provided
no reasons for the disease whereas Lea’s map clearly
depicted cases and deaths in relation to houses and
the type of water that was used.
In August and September of 1850, portions of Lea’s
work were reprinted in the Eclectic Medical Journal15,16
produced by an alternative medical profession popular
to the region.17 This was months before the public
would hear about the AMA’s accomplishments and
coverage of this disease published in it Transactions.11
Lea’s article again appeared in February 1851 in the
Western Lancet.18 Two months later, Dr Theodore Bell
published an article summarizing the success of doctors with this epidemic.19 At the end of his article he
59
Figure 1 Philadelphia, 1849, 27 Asiatic Cholera Cases.
Source: Trans Am M Ass, Phila. 1850; 3, Fold-out map insert,
p. 124
referred to Lea as a member of ‘the Wernerian or
aqueous school’, a personal comment comparing
him to a late 18th-century geologist, hydrologist and
speculative miner.20 A few months later, news of
William Farr’s work on the elevation theory for cholera was published, with most of his findings contradicting Lea’s claims.21,22 As the credibility of Lea’s
work rapidly diminished, Cincinnatian physician
Thomas Carroll composed a summary of the local epidemic for the Western Lancet in 1854, in which he
stated only the following about Lea’s geological
theory: ‘[n]either sandy deserts nor mountain heights
could stop its progress’.23
In 1855, John Snow’s second edition of On the Mode
of Communication of Cholera was published.24 In this
book, Snow stated the following about Lea’s theory:
Mr John Lea, of Cincinnati, has advanced what he
calls a geological theory of cholera. He supposed
that the cholera-poison, which he believes to exist
in the air about the sick, requires the existence of
calcareous or magnesium salts in the drinking
water to give it effect. This view is not consistent
with what we know of cholera, but there are certain circumstances related by Mr Lea which deserve attention . . . The connection which Mr Lea
has observed between cholera and the water is
highly interesting, although it probably admits of
a very different explanation from the one he has
given.
The accomplishments of John Snow and William
Farr ultimately led to the popularization of the ‘zymotic theory’ for diseases like cholera during the late
1850s. This philosophy was embraced by nearly all
physicians during the decades to come.25–28 In 1884,
the vibrio identified by Filippo Pacini (1812–83)29 was
ultimately proven to be the cause for Asiatic cholera
60
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
by Robert Koch (1843–1910).30,31 Four years later, the
relationship between the vibrio and alkalinity was
documented by Japanese microbiologist Kitasato
Shibasaburō32 but by then Lea’s Geological Theory was
long forgotten. To date, Vibrio cholerae is the only
known human pathogen that can thrive in an environment with a pH above 8.0,33–35 demonstrating the
value of Lea’s discovery. In recent years, the changing
relationships between microorganisms and our environment make the study of the geology of disease an
important spatial global health care issue.36–40
13
14
15
16
17
18
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