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Choleranomalies: The Unhistory of Medicine as Exemplified by Cholera

1972; Johns Hopkins University Press; Volume: 15; Issue: 3 Linguagem: Inglês

10.1353/pbm.1972.0044

1529-8795

Norman Howard-Jones,

History of Medicine Studies

CHOLERANOMALIES: THE UNHISTORY OF MEDICINE AS EXEMPLIFIED BY CHOLERA NORMAN HOWARD-IONES* Copying from one book, it has been said, is plagiarism, while copying from two books is research. Unfortunately, much of medical history is copied from two books that have in turn each been copied from two other books. This binary fission in reverse could, if continued long enough, ultimately involve quite a large library, were it not that different authors usually copy from the same books, thus serving to perpetuate and consolidate earlier errors while at the same time effecting an economy of effort. It is perhaps of some topical interest to analyze what medical historians, both popular and serious, have had to say about the circumstances in which the etiology of cholera, a disease that has been much in the news of late, was elucidated. Robert Koch has been universally hailed as the discoverer of the cholera vibrio, but a study of the publications from 1854 to 1880 of the Florentine physician Filippo Pacini (1812-1883) leaves no reasonable doubt that he anticipated Koch by thirty years. In 1854 he described the miriadi di vibrioni found in the small intestine, named the organism vibrio cholera (using this uninflected form of the specific epithet), and incriminated it as the causal agent of cholera. In later publications he used other designations for the same organism, but never ceased to maintain that it was the primary cause of the disease, although he did not, as Koch was to do later, isolate the organism in pure culture. I should have considered it audacious for one without the least pretension to a special knowledge of microbiology to have asserted Pacini's priority over Koch were it not that I dis- * Visiting scientist, National Library of Medicine, National Institutes of Health, Public Health Service, Department of Health, Education, and Welfare, Bethesda, Maryland 20014. 422 I Norman Howard-Jones · Choleranomalies covered belatedly, and quite accidentally, that a real authority on the subject had successfully argued Pacini's case a few years ago. In 1964, Dr. Rudolph Hugh, writing from the George Washington University , addressed to the Judicial Commission of the International Committee on Bacteriological Nomenclature a "Request for an Opinion" [1] in which he maintained that Pacini "was the first to use the generic name Vibrio with a validly published and legitimate specific epithet cholerae1 for the bacterium which is recognized as the causal agent of Asiatic cholera." Hugh's detailed, learned, and admirably concise case for Pacini was approved by a majority of the Judicial Commission that almost reached unanimity, and it ruled [2] in its Opinion 31 that "Vibrio cholerae Pacini 1854 is conserved as the name of the type species of the bacterial genus Vibrio Pacini 1854." Thus was Pacini's discovery given international acclaim by his peers eighty-two years after his death. Whether this will ever be recognized by the profane who write medical history is a matter for some doubt. But this is not Pacini's only claim to recognition in regard to the elucidation of the cholera process. He also developed a highly refined explanation of its dynamics, which he quantified in the form of algebraic equations expressing the disequilibrium between the rate of loss of fluid and the rate of reabsorption from the intestine. This mathematical treatment of the phenomena of the disease so impressed William Farr, who had visited Pacini in Florence in 1867, that he gave a very extensive and detailed account of it in a supplement to the twenty-ninth annual report of the registrar-general of England [3]. Such recognition was not accorded to Pacini by his Florentine colleagues for, as he himself recounts [4], someone in Florence dubbed his thoughtful—and correct—explanation of the physiopathological process in cholera, "in jest, but very justly," the hydraulic doctrine. Nor did Farr's tribute make any impact in England or elsewhere, although Pacini expressed himself as having been "most amply compensated" by it. The neglect of the importance of Pacini's contributions to the understanding of cholera is perhaps one of the more recondite points in the history of this disease, and for comic relief it is interesting to turn to what a...