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História, Ciências, Saúde-Manguinhos

versión impresa ISSN 0104-5970versión On-line ISSN 1678-4758

Hist. cienc. saude-Manguinhos v.14 n.2 Rio de Janeiro abr./jun. 2007

http://dx.doi.org/10.1590/S0104-59702007000200002 

ANALYSIS

 

Cholera epidemics in Córdoba as seen through the press. The supply of preventive and curative products during the 1867-68 epidemic

 

 

Adrián CarbonettiI; María Laura RodríguezII

IResearch Director, Professor Escuela de Historia de la Facultad de Filosofía y Humanidades y del Centro de Estudios Avanzados de la U.N.C., CONICET Researcher Rómulo Carbia 2771 Bº Poeta Lugones Córdoba Argentina acarbonetti@cea.unc.edu.ar
IIBachelor in History PhD Student in Political Sciences Centro de Estudios Avanzados de la U.N.C. Becaria CONICET. Lisandro de la Torre 1832 Depto. 7, San Vicente Córdoba Argentina

 

 


ABSTRACT

Throughout human history, disease has always represented a moment of crisis for individuals and societies. When death brought by disease hangs heavy over societies, they are led to develop strategies to prevent and cure it. Epidemics, especially cholera epidemics, have had a strong impact on Argentine society and especially on Córdoba residents, because the first cholera outbreak was demographically and socially highly devastating. In this article we analyze the supply of products advertised in the press (the only media available at the time) during the first epidemic, which broke out in 1867-8. Our hypothesis is that the products available, which we believe were consumed by some groups in society, led to a sumptuary trade that was not common among the population when there were no epidemics. At times of epidemics, these products were directed towards more affluent groups. We also believe that the supply of such products changed as their trade increased.

Keywords: epidemic; cholera; Córdoba; advertising; press.


 

 

The consumption of crotoxin in the 1990s and of rice weevil in the 21st century were prescribed to cure cancer; the Pueyo and Friedman vaccines, and the treatments 'Azuero' and 'Zequeira' were used against tuberculosis; and camphor pills were taken to prevent from poliomyelitis. At all times and when faced with pain and death, societies look for and use drugs to cure or prevent disease, with or without approval by the medical profession. Often and particularly during epidemic outbreaks, countless kinds of practices have emerged to prevent a future that seemed inevitable. In this article we report on our studies about some of these practices.

Diseases and health have been important concerns for societies, mainly the infectious-contagious diseases that caused high mortalities when they became epidemics (Mc Neill, 1984). These diseases first emerged as people moved to cities and the contamination chain increased (McKeown, 1990). Smallpox, measles, the flu, typhoid fever, and yellow fever were the most common diseases, followed by the bubonic plague, which devastated the European continent in the 14th century. The plague was cause and consequence of dearth, and social and economic crises (Ruggiero, Tenenti, 1970). Cholera became a pandemic in the early 19th century and spread worldwide until the late 20th century.

The incidence of diseases among populations, the economic consequences of disruptions in market relations, the desertification of rural and urban areas, and the impact of changes on society led governments to create health programs to avoid or control such diseases in the late Middle Ages and early modern times, when incipient capitalist relations started to develop (Nadal, 1992; Cipolla, 1993).

Even though governments started to prevent and control epidemic outbreaks, social reactions remained similar to those during the Middle Ages: the richest fled the affected areas and processions pacified God's anger, because epidemics were considered a divine punishment and therefore the consumption of products, for reasons that were never explained, would protect people from the disease. These social reactions are found throughout the history of epidemic outbreaks well into the 20th century.

The social practices can be divided into two categories. One has a social goal and aims to save entire populations, and the other aimed at saving individuals who either engaged in preventive or curative practices or were their receivers. To the first category belong the processions, and to the second, the flight and consumption of ´preventive´ or ´curative´ products. In this study we emphasize individual practices and particularly the supply of certain products by physicians, general stores, and drugstores to prevent the horrible cholera from contaminating those who took the medicines. This is a case study of cholera in the city of Córdoba (1867-1868).

We hypothesized that products offered to and taken by individuals belonging to specific social categories developed a sumptuary business to which the population usually had no access during epidemics and which was oriented for the richer social categories. As such, we can see that the higher income social sectors could choose from several of the most efficient strategies to avoid suffering and death, whereas the lower income sectors could not.

 

Cholera characteristics

Throughout the world economic formation epidemics as well as endemic and contagious diseases, particularly the former continued to cause countless death among Europeans from the 15th century on, and also among American populations. The reason was that these diseases were closely related to the living conditions of populations, to economic cycles and wars (Nadal, 1992). In spite of the important advancements in medicine and public health during the 18th and 19th centuries, the standard of living of proletarians, who fostered the industrial revolution particularly in England, caused the development of infectious-contagious diseases and led to more deaths due to tuberculosis, gastroenteritis, yellow fever, and cholera.

The study of cholera should be approached from the context described above. The spread of the disease from India to the world is related to the development of capitalism during colonial expansion. It was not by chance that the disease spread in a frightening way exactly during the 19th century and that, as Mc. Neill said (1984, p.20), "the old and well-established cholera diffusion system in Indian territory was imbricated with the new market system and military actions pushed by the British. The result was that cholera crossed its original boundaries and flourished in new and unknown territories that completely lacked resistance and reaction to the disease". At the same time, the material living conditions created by the market system, with sanitarian problems among large sectors of the population, scarce medical care, and very inefficient sanitarian policies to control a sanitarian crisis, also allowed for the spread of cholera to most of the European countries and latter to American countries.1

Argentina was site for three cholera epidemics during the second half of the 19th century: in 1867, 1868, and 1871. The 1886-1887 and the 1894 epidemics certainly brought something new to society from the perspective of its impact on population dynamics within some regions, and the development of a feeling of powerlessness in the medical science and the State. This situation brought terror to the powerless societies, who sought all kinds of practices, and led to policies oriented to avoid new outbreaks of the disease.

Cholera incidence was different in each epidemic outbreak in Argentinean cities. During the 1867-68 Córdoba epidemics, most of the 2.371 people buried died from cholera, or approximately 8% of the city population. In Rosario, 1.256 people died in 1886-87, or approximately 2.5% of the population (Pietro, 1996, p.61). In Tucumán the 1886-87 epidemics caused 1.887 deaths, or 4.7% of the total population.

The incipient field of the history of health and diseases in Argentina has not emphasized studies on the development of cholera epidemics in the country.2 Studies have analyzed problems related to the role of the State, the relationship between environment and disease, social reactions to epidemics, and actions taken for their control. However, these studies have not approached the means, products and practices used by people to avoid epidemics, be it from a social or individual perspective.

We depart from Jean Charles Sournia´s concept of disease, where a disease can not exist on its own, as an abstract concept to which human beings give names. This concept depends on the level of development in medical knowledge and is a result of the society in which the medical science is inserted: "physicians … take part in their ideas, beliefs, resistance to change, and their knowledge models on the organization of the world and of life mechanisms" (Sournia, 1997, p.360)

When the first cholera epidemic broke out in Argentine, the main paradigms determining medical practice were miasma theory and contagion theory. According to the former, diseases develop because miasmas (nauseating smells) carry particles into the human body and cause diseases. For contagion theory, a disease is produced as consequence of the contact between healthy and unhealthy individuals (Carbonetti, 2003). These theories, whose explanations were often closer to witchcraft than to scientific medicine, determined the social practices to prevent diseases.

In 1867, cholera had spread to the cities of Buenos Aires, Rosario, Corrientes and Entre Rios and infected Army troops in the Argentinean Northeast during the Paraguayan War; in a few months it reached Córdoba province. Although cholera had already spread to other provinces, Córdoba people and government had taken precautions to avoid it. In spite of all preventive actions (a quarantine observation facility was installed in Río Segundo), cholera entered Córdoba province in December 1867. On the 6th, a few cases were reported in the villages of Villa Nueva and Villa María, and on the 16th the disease had spread to the city of Córdoba (Penna, 1897).

 

Some of the products used to prevent cholera

The spread of the disease on the Argentinean sea coast and within the area where Paraguayan War was taking place, in addition to outbreaks in Brazil and Uruguay in 1867 developed fear among the town population. The disease was not well-know, was different, and led to terrible manifestations before death; besides, physicians could not agree upon its origin, contamination mechanisms or lethality.3

As a consequence of fear, the only Córdoba newspaper began to publish recipes and articles dealing with prevention of the disease. Several of the products, most of which apozems, were related to notions concerning disease transmission mechanisms according to popular culture. As an example we have the homemade medicine published by Eco de Córdoba on April 6th. The note was about a homemade recipe to cure "intestinal occlusion, cholerine etc":

If a person feels dizzy, has weak legs, or has indigestion symptoms or any other sickness, this patient must be taken to bed, stay indoors and drink chamomile tea often and as fresh as possible. If it is only a stomach or abdomen problem, it is enough to drink strong tea or an infusion made from the real Irish moss. (Eco..., April 6 1867)

At the end of the article, the medicine above was considered successful against cholera in Montevideo, Rosario and San Nicolas. These potions were common during the pre-microbial phase, because the belief was that all diseases had the same origin and therefore medicines should be similar for all kinds of diseases.

A few days later, on April 16 1867, the newspaper Eco de Córdoba published a new recipe to control cholera; this time, the formula also contained some chemical compounds as follows:

The medicine should be combined with ice compresses and cold water. The news emphasized its utilization by French physicians, with "great results". Chemistry, one of the disciplines with significant development in Western countries after the 18th century, had an important role in pharmacopoeia, particularly medical pharmacopoeia and to a lesser extent in popular medicine. Nevertheless, the measuring of dosages was difficult to understand and apozem usage directions were not very precise. It is not known whether this kind of medicine was massively used for cholera cure or prevention or not; however, somehow new products were available during epidemics, which would seldom be used otherwise.

A different advertising, this time for cholera prevention, was published in the newspaper Eco de Córdoba on April 18 1867: cigarettes for adult and young males, perhaps the only ones socially allowed smoking cigarettes.

The ad "Cigarettes against cholera" was oriented towards a young audience and had a jocose language:

"No young guy nowadays refrains from using cigarettes as Raspaill does against cholera. It is known that Mr. Mayuard has become a celebrity for preparing cigarettes and has an enormous number of orders. Therefore young and beautiful men, if you don't have an antidote, get it" (Eco..., April 18 1867).

Although the publicity did not explain how cigarettes would prevent against cholera, such attribute was implicit. For a long time, people believed that diseases would spread by miasmas, the small particles coming from unhealthy environments and entering the human body and developing the disease. The cigarette, therefore, could prevent the action of unhealthy particles. The smell produced by cigarettes supposedly avoided the disease-producing smells. In a similar way, camphor and bleach were used to clean patients´ excrements.

On April 30 a new publicity was on Eco de Córdoba, now by Casa de Carlos Barrevier located downtown, where several products for cholera prevention were sold. This time, products were more sophisticated and contained primarily alcohol probably due to the belief that cholera, as other diseases were a consequence of the cooling of the body (Carbonetti, 2003, p.151).

Cholera prevention products
True White Cognac (exclusive products)
United Growers Cognac
Bordeaux Wine demijohn
½ bottle fine wine
½ bottle Cherry
Havanan Cigarettes
Fine rosé Champagne
Chocolate Vanilla
(Eco..., April 23 1867)

The sale of such products was often contrary to the advice given by the local physician on food to prevent people from acquiring cholera, as publicized by the municipality in the newspaper mentioned earlier. In this publication, people were advised to eat "sparely, preferably fresh meat, soft-poached eggs, bread, broth, coffee and wine". This diet was said to enhance digestion and therefore avoid cholera, a digestive system disease related to food digestion. Therefore, among the forbidden products one would find all the "alcoholic liquors and all the food that requires long digestion" (Eco..., April 14 1867). The previously mentioned recommendations were related to excesses of all kinds (drinks, food and sex), another belief at that time that any excess would lead to disease; this was often held true by local physicians: "The alcoholic, the gastronome and the libertine have always been preferred by these diseases" (Eco..., April 14 1867).

Even though cholera did not reach the city of Córdoba during the months of May, June or July, the mentioned publicity of potions and strategies to prevent cholera continued to be published in the newspaper.

 

Cholera and its publicity

The disease was important not only to increase the supply and demand of often luxury products that were not in high demand during non-epidemic times, but also to attract readers´ attention to the newspaper. On April 30 1867, for example, the ad "El cholera en Córdoba" was about the loss of a topaz jewel in town by a lady who was asking to have it returned to her house (Eco..., April 30 1867).

The same strategy to call readers attention was used by means of other article headings, such as the one on July 5 1867: "Cholera has arrived", about a house for sale in the city of Córdoba (Eco..., July 5 1867).

When the cholera epidemic was under control in Rosario, it was no longer a threat for the Córdoba population and therefore, no longer a reason for holding readers´ attention or for reading of articles that would avoid the disease spread. As a consequence, no advertisements were published in the newspaper we analyzed.

 

Epidemic outbreak and the increase in product sales and purchases

By mid-December 1867, cholera threatened the city of Córdoba again, according to Eco de Córdoba. In Villa Nueva, a village located 150 kilometres from the city, three cases were reported. On the 12th of the month, the municipality agreed upon some sanitarian policies based mainly on the supply of a mixture of lime and water to fumigate all households and latrines.

On the 12th stagecoaches and carriages coming from Villa Nueva were not allowed to go on:

"Stop work in canyons and tanneries, prohibit sales of non-ripe fruit, cover all coffins with lime and fumigate the mail" (Eco..., December 12 1867).

On the 13th the "preventive actions" were published once again. Among them were: get up 30 minutes before sunrise, walk outside, ventilate households and beds, fumigate households with an incense of "rosemary, lavender and Benjamin", eat with moderation, drink preferably alcoholic wine during meals with moderation, nothing sour, avoid crowds, keep a calm mood, work out, be not frightened, and do not drink mate (infusion made of Yerba mate or Ilex paraguariensis). Priests should forbid mourning and corporal punishment (Eco..., December 13 1867).

As seen above, several of the advices fostered by the newspaper were the same as the social and medical views held at the time. The fear of miasmas can be assessed by advices to fumigate and ventilate the household, and to avoid crowds and prevent contagion; there was also the perception that individual psychological conditions would facilitate the development of the disease.

According to the local physician, the pharmacopoeia's scaffolding} in situations when the disease developed was the following:

"As soon as you feel the symptoms of the disease take camomile tea with sugar and 13 to 20 drops of the anti-cholera concentrated spirits, and rub your whole body."

This was all that the city physician recommended for controlling cholera.

On December 14, Agaita drugstore advertised in the Eco de Córdoba that they sold anti-cholera liquor, and Águila drugstore that they had the anti-cholera friction products, as well as lime chloride and Labarraque.

On December 16, the first cholera patients were reported in town (Penna, 1897, p.160) and on the 19th a potion called "anti-cholera spirit" was first advertised. The product was prepared at Ancla Dorada drugstore. According to the ad, the liquor had been used in Europe and Buenos Aires and was recommended by a Paris medical journal and the Buenos Aires sanitarian council, being also approved by the city physician (Eco..., December 19 1867). Except for the information provided in the ad, no official consent by the city physician for sale and consumption of the product was found. The ad ended saying that the product would be free for the poor.

These were times of rapid increase in numbers of cholera patients and of ads marketing products that emphasized efficiency in saving those with the disease. Simultaneously to publicity referred in the previous paragraph, Eco de Córdoba advertised a new product. As before, it was about liquor:

"Gin, the true medicine for all diseases and mainly for cholera and yellow fever. Produced only by Juan Peters in Hamburg."

The flask containing the liquor sold as Virgen del Carmen was sold for 12 reales at Senestrary Brothers) and at the Buenos Aires Confectionary, across from the main building.

Cholera led not only to a large number of products for prevention and cure of the disease but also to competition among businesses that offered differently priced products to prevent it. This was the case of an advertising on December 21 1867, "Prevention against cholera", recommending purchase and consumption of "tasty cigarettes at a very fair price". Gustavo Follín (Eco..., December 21 1867) prescribed tobacco to evade cholera, but his business probably was not well known because the ad oriented people to go "across the home of Mr. Rudesindo Ibazeta" for purchase.

Mortality increased due to cholera, and on December 24 (see Figure1) the drugstore Águila Dorada gave away sulphur for fumigation, at anytime during the day and until 9 pm, probably as a marketing strategy.

 

 

A different drugstore, Avenida, advertised the sale of chloride of lime and explained its potential utilizations as follows: "used for fumigation of rooms and yards, useful and often used for air purification similarly to Zeits water, cinnamon extract, mint extract, pepperine" (Eco..., December 25 1867).

Throughout the epidemic, the Eco de Córdoba often repeated the previously mentioned advertisements. However, the ads were not only about the supply of anti-cholera products for the population, but also the supply and demand of homes in the outskirts of Córdoba; the rent there was probably very expensive considering that only the richest could afford leaving town. As such, other sectors also found their economic niches brought by cholera, such as shelters against the disease. Also in this case, publicity was related to cholera prevention:

"To those who need rooms in the countryside or the mountains, you should go to the Don Marcos Arredondo farm in Santiago; please contact the owner if interested" (Eco..., December 19 1867).

Even though cholera created the supply of certain products, it was again used also to call readers´ attention. Ad headings emphasized cholera epidemics whereas article contents had different meanings. One of the most important examples was the December 18 ad, at a time when the epidemic had already spread. The heading was:

"Cholera!!!!! Attention!" with a completely different content: "You'll find great hot bread at Don José de Igarsabal Bakery from 8:30 pm. You'll also find the best American cookies ever" (Eco..., December 18 1867).

On December 24, a new ad used cholera for other purposes. This time the heading was "The cholera medicine". Nevertheless, the ad tried to convince the person who "found a wallet" to return it; the way to do so was: "and the person who turns it in this office will be free from cholera and will be rewarded" (Eco..., December 24 1867). No question the ad was intelligent; on the one hand, it called readers´ attention and on the other, it used horror and fear of the disease to pass on the idea of prevention by returning the lost object.

From December 25 to January 17, when the highest mortality due to the disease was reported (Figure 1), no information could be obtained from newspapers. In fact, it is impossible to know whether information were published and then lost or never printed. However, advertisements of the same kind as reported above were found in newspapers dated January 5.

On January 17 1868, when the epidemic was almost under control, the Eco de Córdoba brought ads of new products, such as the one by Botica Del Águila. The heading was: "Guaranteed effective drug against cholera developed by Dr. Rubine de Naples". Four drops of saturated tincture of camphor every five minutes were prescribed; under severe situations, dosage should be increased to 15 and up to 20 drops (Eco..., January 17 1868). The interesting aspect of the product was its marketing strategy:

This medicine has been prepared after considerable improvements on the prescriptions made by Dr. Rubine and by considering London news containing a list by this doctor, which was signed by Naples governor and highest officials ... This list confirmed that all 592 patients with Asian cholera, several of whom in extreme conditions, were saved. (Eco... January 17 1868)

The medicine was sold at Botica Del Águila. The same drugstore also advertised Dr. Alber´s method, which consisted of drops of an unknown potion also used to cure the disease. In this case, camomile tea and bottles with hot water were used to stop disease symptoms (Eco..., January 19 1868).

Another article published in Eco de Córdoba on January 19 and sponsored by the Senestrarian house was about a sanitarian and anti-cholera liquor. In this case, marketing was oriented to the potentially wide use of the product and emphasized "the fastest and most efficient curative agent against cholera". If taken at the early stage of the disease, the drug was said to "reduce disease to a temporary discomfort", thus freeing the patient from treatment (Eco..., January 20 1868).

With the development of the disease, the supply of products changed due to a publicity oriented towards cure with products endorsed by physicians, including those never heard of in Córdoba but 'successful' elsewhere, where the epidemic had spread and the medicines were mainly supplied by local drugstores. The supply of such products did not invalidate the previous ones, but the new publicity tended to emphasize cure rather than prevention of the disease.

The medicines taken by higher income families can be identified from a letter sent by C.R. Lozano to his brother on January 13 1868 from Río Ceballos, where he fled with his family4:

"Drugs are available. Mint essence, tincture of (sic). Some more ether would be easily sold. Anti-cholera liquor, anti-cholera tincture. Anti-cholera drops by Dr. Frances, instruction by Wever. There is enough for cataplasms, as we ordered a sample."

The letter contains the main palliative actions to control cholera, which are similar to the drugs offered mainly by Córdoba drugstores. We must be aware that at that time the epidemic had spread and therefore, the pharmacopoeia was geared toward cure rather than prevention.

Following from the above, the writer of the letter asked his brother for instructions about what to do if the patient had stopped vomiting and diarrhoea:

"It so happens that once vomit, diarrhoea and cramps are gone, the patient develops fever. At this stage of the disease, we know absolutely nothing about what to do or what we must give patient. Find out about all this."5

Consumption of these products was, in this case, oriented toward cure rather than prevention. Drug administration prescriptions and drug prices remain unknown.

 

Final considerations

In general, we can separate two stages of product supply due to cholera development: the early 1867, and January and February 1868. At first, before the development of the disease and when it was only a threat, products - particularly the sumptuary ones - were oriented toward cholera prevention. In most cases they were scented liquors, chocolate and cigarettes, perceived as effective in preventing cholera by keeping away nauseating smells or by improving digestion. This kind of drug supply was found when cholera spread in Rosario during the first months of 1867 until the disease became a threat for the town in the late 1867, when the disease became a reality for the population. During this time, there were several products offered by all kinds of businesses such as general stores, candy shops, and drugstores among which there seemed to be some competition.

Early in 1868, when the epidemic incidence decreased, a new series of products came to the market. This time they were not for prevention but for treatment of the disease with methods endorsed by physicians. These physicians were probably unknown to the population and justified product use after the "success" obtained in other cholera locations and after the endorsement of their profession. In this case, drugstores offered products whereas general stores and candy stores maintained liquor and cigarette publicities.

However, cholera fostered not only the sale of this kind of products but also of ads offering homes for those wishing to flee from the city. It seems that in spite of the offers, people fled anyway and in several cases without any planning. In this aspect, the province proto-physician warned Córdoba neighbours about the early departure from the city and its consequences due to the sanitarian conditions that made them victims of the epidemics, as it happened occasionally (Eco..., December 29 1867).

Cholera was also used to bring to attention other issues such as publicity of products with no relationship to the development of the disease, as the sale of bread or property, or the return of lost jewels or wallets.

From what has been said so far, we believe that cholera not only led to action by the State and the medical profession but also to the development of several kinds of businesses that would control the epidemic, as was the case of several luxury items as well as of drugs made intentionally to treat the disease, and all led to market competition.

This is the first step to understand the development of consumption throughout the cholera epidemic, particularly at the time academic medicine had not yet reached the monopoly of attention in health. The different consumption patterns among social sectors and their most common practices, their similarities and differences remain to be studied.

 

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Received for publication in August 2006.
Approved for publication in October 2006.
English Translation: Marisa Corsânego

 

 

Collaborators:
Noelia Rimonda
Yamila Martina
History Students Escuela de Historia de la Facultad de Filosofía y Humanidades de la U.N.C.
* This article belongs to a more comprehensive study on the social impact of the cholera epidemic in the city of Córdoba, Argentina.
1 Several studies on cholera have been conducted in almost every European country, being of particular importance those by Bourdelais and Raulot (1987), and the study on Peurs et terreurs face a la contagion (Bardet et al., 1988). Several studies are on the Spanish epidemic in the 1990s: Betancor Gómez, Marset Campos, 1994; Fernández Sanz, 1991, and Gómez Días, 1993.
2 For the city of Rosario, see the study by Agustina Prieto, 1996; for the city of Córdoba, Arcondo, 1997. For the Tucumán case, see Goldman, 1990. For the Buenos Aires province, Tancredi and Tuis, 2001.
3 In Eco de Córdoba, March 29 1867, the note "Cholera in Rosario" was a private letter reporting on the existance of a disease whose symptoms were the same as cholera morbidus and upon which physicians could not agree; some say it is women´s cholerine and others say it is men´s cholerine. On April 3, the same newspaper published the article that originally appeared in Siglo, the daily Montevideo newspaper, where cholera transportation and contagium were denied.
4 We shall keep in mind that the strategy of fleeing from cities was undertaken only by the wealthy in society.
5 A.A.C, Instituto de Estudios Americanistas (08273 Rollo 26), Jan.13 1868.

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