The History of the Cholera in Exeter in 1832. By Thomas
Shapter, M. D., Physician to the Devon and Exeter Hospital,
&c. 8vo. pp. 297. London, 1849.
This account of the first epidemic of cholera in Exeter includes
many details, which, although of historical interest to the people
of that city, do not require special notice here. Notwithstand-
ing the disease had given timely warning of its approach,
and a panic fear of it existed throughout the community, there
were but few effectual measures of precaution adopted, before it
actually arrived. Thus, the multiplicity of nuisances, the want of
underground drainage, the insufficient supply of water, the want
of hospitals for the sick and suitable places of interment for the
dead, were discovered too late to be remedied, with any prospect of
arresting the progress of the disease. The natural position of
Exeter is particularly salubrious. It is situated upon the side
of a wedge-shaped hill, with a broad river flowing at its
foot, and enjoys a mild and genial climate; but at the same
time it is a very old city, closely and irregularly built, with
narrow streets and projecting upper stories. Nuisances of the
most offensive kind, we are told by Dr. Shapter, had been allowed
to accumulate for years, and even with the daily expectation of
the approach of the cholera, many of the inhabitants objected
strongly to the removal of such of them as were a source of profit.
The disease prevailed most extensively in the older part of the
city; that portion, which, from the lowness of its situation,
the closeness and filth of its streets and houses, and the misery of
its inhabitants, was most likely to favor its spread. The great
prevalence of the disease in those quarters bordering upon the
river, and the comparative immunity enjoyed by the higher and
more open modern town and suburbs, are admirably shown by a
map, accompanying Dr. Shapter’s book, in which the spots visited
by the cholera are marked by red lines ; these form uninterrupted
rows in the lower and thickly populated portion of the city, but
are few and scattered, along the wider and more airy streets. It
appears that some hope had been entertained by the authorities of
Exeter, that the disease might be excluded by a strict enforce-
ment of quarantine regulations; but while its entrance into the port
was thus hindered, it introduced itself into the city by other
unguarded avenues. The first cases occurred in persons who had
arrived respectively from London and Plymouth, in both of which
places the cholera was prevailing. One had been suffering for
some days from the premonitory diarrhoea, the other had nursed a
patient who had died of the cholera. During the first week, after
the occurrence of these cases, it did not diffuse itself to any great
extent, a few cases only occurring daily ; “ but from this time to
the commencement of the next fortnight, it rose rapidly and con-
tinuously to its height, then gradually subsided, and in about a
month afterwards, had, as a prevailing epidemic, passed away.”
The population of Exeter was at this time about 28,000. The
total number of cases from the 19th of July to the 27th of Octo-
ber, was 1,135, and the deaths during that period, 345.	“ The
whole of the deaths,” Dr. Shapter says, “ were not returned, as
will subsequently be shown, and the daily numerical returns record
many deaths, not previously reported as cases,” but we cannot
find any correction afterwards of these errors. Every one is
aware of the sources of error in cholera statistics, and although
when these are collected from different and numerous sources, it
may be assumed, that the errors in one report neutralize those in
another, yet taken singly, they offer a very fallacious basis for
induction, and particularly as to the rate of mortality. But a full
consideration of this important subject would lead us into too
large a digression, we therefore return to the general results
deduced by Dr. Shapter from his statistics. The general impres-
sion, that, as the disease numerically declined, its malignancy or
fatality diminished in like proportion, is not confirmed by his
observation. He finds that the rate of mortality, through the
whole course of the epidemic, was constantly about 35 per cent.
Nor is it true, according to these results, that other diseases sub-
sided as the cholera advanced. Excluding the few deaths, which
occurred after the 19th of September, the deaths from cholera were
336, those from other causes 90, or 45 per month, the average
mortality in other years being about 50 monthly, so that the deaths
from cholera seem merely to have been superadded to the ordinary
mortality. We are not informed, how many of these other cases
were due to bowel diseases. The influence of age, appears from a
carefully constructed table, to be, that “ during infancy, the mor-
tality is rather above that which takes place between the ages of
10 and 35, when the deaths are by no means numerous, and that,
after the age of 35, there is a constant increase in the relative
amount of mortality, but, that its greatest proportionate amount
takes place after 55 years of age.” Hence the mortality is the
greatest at the two extremes of life. With regard to the mode of
propagation of epidemic cholera, Dr. Shapter states, that after a
full consideration of the controversy, he has “ arrived at the con-
clusion, that the Asiatic cholera is essentially an epidemic, origi-
nating in and chiefly due to aerial influences, but capable, under
peculiar and rare conditions, of being transmitted from man to
man.” We feel inclined to pass by speculations upon the origin
and nature of cholera, of which we have had lately a sufficient
quantity, but Dr. Shapter alludes here to one fact which is
of particular importance in a practical point of view, viz:
that the collapse is not due to the loss of fluid by the intestinal
canal, for in some instances, and those indeed usually the most
rapid and fatal, there was no diarrhoea of consequence. This
fact is not satisfactorily explained, by alleging that the
liquid effusion is, in these instanced, retained in the bowels, as
this is never so abundant as to account for the collapse. We
venture to assert, that in many cases of watery diarrhoea there is
more liquid poured out from the bowels than in many of the
most malignant cholera. Dr. Shapter, indeed, goes so far, as to
advance, that the choleraic discharges maybe beneficial by an elimi-
nation of the “ materies morbi,” a supposition, which might now
be very consistently maintained by the. believers in the “ cholera
fungi.” The nervous system, or that particular portion of it termed
the sympathetic system, is considered by our author, to be the
portion of the economy which receives the first impression of
the epidemic influence. All the prominent phenomena of the
disease can be beautifully explained by this theory, and there may
be very good reason to believe, from what we know of the functions
of the sympathetic system, that it is implicated seriously in the
attack ; but, however ingenious the supposition, it is a mere diver-
sion of the mind, having no practical bearing. For whether it
be the nerves or the blood-vessels, or the blood itself, or the bowels,
which are first “ disordered,” we need not stop to inquire; the sick
man calls for aid, and happy is he who can resolutely say, this
medicine has cured another, it may save you ! Certainly, if there
is any disease, before which the impotence of theories, as thera-
peutical indications, is demonstrated, that disease is the Asiatic
cholera. It will not be necessary for us to extract Dr. Shapter’s
account of the general treatment pursued in Exeter ; it is what
is called a rational one, because it holds fast to the results of the
“ juvantia et loedentia” in other morbid states, which offer a
greater or less similitude to the cholera.
We will therefore close this brief and imperfect notice of a work,
which is evidently the result of a great deal of laborious persever-
ance, by recommending its perusal to all those who are desirous of
collecting historical facts, in reference to a subject of so much
interest as that of epidemic cholera ; since it contains, besides the
points which we have noticed, much that is deserving of atten-
tion even from the unprofessional reader.	M. S.