John B. Osborne

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John B. Osborne | The Lancaster County Cholera Epidemic of 1854 and the Challenge to the Miasma Theory of Disease | The Pennsylvania Magazine of History and Biography, 133.1 | The History Cooperative

The Lancaster County Cholera Epidemic of 1854 and the Challenge to the Miasma Theory of Disease

Early on the morning of Sunday, September 10, 1854, the fellows of the College of Physicians of Philadelphia received an urgent appeal for medical aid from the hastily assembled Sanitary Committee of Columbia, Pennsylvania, seventy-five miles to the west, on the eastern bank of the Susquehanna River. Cholera had broken out in the town, and by Saturday, September 9, it had killed thirty people, including one of the town's six physicians. The desperate townspeople turned naturally to the College of Physicians. Founded in 1777 by a group of prominent medical men in Philadelphia to advance the medical profession and to promote public health, the college had become the most prestigious medical society in the country. Henry Hartshorne, MD, a fellow of the college and noted Quaker humanitarian, responded immediately, leaving for Columbia that day. T. Heber Jackson, MD, of Philadelphia, arrived the same day. The next day, Monday, September 11, the college held a special meeting and resolved that a delegation of five fellows be sent to Columbia, including the eminent physicians Wilson Jewell and Rene La Roche. They arrived in Columbia on September 12, joining other volunteer physicians in aiding the sick and instituting measures intended to curb the further spread of the disease.¹ Believing they knew the etiology of cholera, they came to Columbia to discover its source, not its cause.	1
The committee that went to Columbia was made up of outspoken advocates of the miasma theory and were convinced that cholera was spread by foul air emanating from filth. The committee's observations in Columbia confirmed their beliefs, and the fellows focused their efforts on finding the source of filth they believed to be responsible for the miasma. When they discovered rotting carcasses of animals in the river, they deduced that these were the sources of the corruption responsible for the epidemic. Having prescribed sanitary measures for the city, the majority of the fellows returned to Philadelphia the next day convinced that "the prevailing affection presented no peculiar features."²	2
Dr. Jackson remained in Columbia gathering data on the disease, and he reassessed the validity of the miasma theory subscribed to by the fellows. Little is known about T. Heber Jackson. His name does not appear on the rolls of the College of Physicians of Philadelphia or in either contemporary or modern medical biographical dictionaries. Like Jackson, John Atlee, a physician and associate fellow of the College of Physicians, found that his observations of a less severe cholera outbreak in nearby Lancaster could not be explained by the conventional miasma theory. The professional debate that ensued between Jackson and Atlee and the leadership of the College of Physicians can be pieced together from articles in medical journals, essays, and the records of the meetings of the College of Physicians. Their efforts were part of a larger challenge to then current medical orthodoxy and helped to pave the way for the rejection of the miasma theory of disease and the acceptance of the germ theory in America.	3
Cholera, which was endemic to India, escaped the subcontinent in 1817, striking Moscow in September 1830. It then spread westward across Europe, reaching England in 1831 and North America in 1832. The pandemic would return to Europe and America in 1849, 1854, and 1866, each time filling the population with terror and revulsion; the mystery surrounding the cause of the disease only exacerbated the situation. Its effects were both rapid and devastating, and death was agonizing to those who succumbed to the disease. The victims were attacked by diarrhea and vomiting, followed by intense thirst, cramps in the trunk and legs, shortness of breath, and a radical shrinking of the flesh as the body became dehydrated. The afflicted person's bodily fluids were excreted as "rice water." He or she collapsed and turned blue, with death following quickly for the more fortunate ones. As many as 50 percent of those who contracted cholera died.	. . .

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