MEDICINE – EPIDEMIOLOGY – CHOLERA / BRAZIL – PORTUGAL / FINE BINDINGS / RIO DE JANEIRO IMPRINT:
Emigdio Manoel da VICTORIO DA COSTA (1779 – 1848), Author. / Adolpho Manoel VICTORIO DA COSTA (1808 – 1878), Editor.
Apontamentos sobre a cholera-morbus epidemica na sua invasão em Portugal / Escriptos pelo fallecido Dr. Emigdio Manoel da Victorio da Costa / Antigo lente de medicina da Universidade de Coimbra / Coordenados por seu filho o Dr. Adolpho Manoel Victorio da Costa / Director do Collegio Victorio, Ex-Director e Benemerito do Gabinete Portuguez de Leitura, Socio Honorario do de Pernambuco, da Sociedade Portugueza de Beneficencia, e Antigo Examinador de Sciencias Propedeuticas da Escola de Medicina do Rio de Janeiro, Etc. Com um Proemio em que se trata Amplamente o Genero Desta Palavra.
Rio de Janeiro: Typ. commercial de Soares e C., 1855.
Cholera is a highly contagious gastrointestinal disease, incubated in pools of warm, contaminated water and spread by human contact. It has its origins in India’s Ganges Delta, where it has been a recurrent epidemic since ancient times. Traditionally, the disease’s spread had been limited to the Indian Subcontinent. However, in 1817, Cholera began to spread to various parts the world, carried by merchants and sailors, leading to a series of pandemics.
The First Cholera Pandemic (1817-24) severely affected many parts of Asia and Africa, while the Second Cholera Pandemic (1827-35), shocked the Western World, plaguing Europe and North America, killing hundreds of thousands.
The disease struck Portugal in 1833, after it was carried to Porto by the Liberal fleet during the ongoing Portuguese Civil War of 1828-34. The country, especially its northern regions, was hit hard, as over period of 16 months 40,000 perished.
The Third Cholera Pandemic (1839-56) raged throughout Europe, North Africa, and the Americas, but for the longest time did not affect Brazil. Many Brazilians naively believed that their country was naturally protected, reasoning that the disease had trouble crossing the Atlantic and bearing the intense heat of the Equator. These assumptions were dead wrong.
Brazil was poorly prepared for the arrival of cholera on its shores. While the country had two medical schools, at Rio de Janeiro and Bahia, and while some Brazilian students were educated in Europe, it had a severe shortage of doctors. Moreover, many Brazilian physicians were slow to learn of new medical discoveries abroad and often acted upon dated or incorrect assumptions.
Belém, in the Amazon, was the first city in Brazil to be significantly affected by cholera, after a ship of infected people arrived at its harbour, from Portugal, on May 15, 1855. This sparked the first of many debates between the ‘contagionists’, who believed that cholera was transferred human-to-human, while the ‘anti-contagionists’ believed that the disease was caused by environmental factors (ex. poor hygiene, climate, etc.) and could not be transferred only by human contact. Critically, many people who had no real idea of the nature of the disease followed the anti-contagionist line, as the prospect of quarantine ‘lockdowns’ threatened to ruin the economy and their livelihoods. Thus, key decisions were made on economic as opposed to scientific grounds.
The ‘anti-contagionists’ won the debate in Belém, so allowing cholera spread rapidly across the city and surrounding area. From Belém, the scourge raged southwards, ravaging Bahia, and Rio de Janeiro.
In the end, it is estimated that around 200,000 Brazilians died of cholera in 1855-6 (out of a total national population of around 8 million), making it, in the words of the eminent Brazilian historian José Pereira Rego, the “blackest page in the medical history of Brazil” (at least until the Covid-19 Pandemic of 2020-22, which killed around 700,000 Brazilians).
The Present Work in Focus
During the cholera outbreak in Brazil of 1855-6, physicians in Brazil went to great efforts to obtain European literature on the disease, especially works written by doctors who treated patients firsthand, and preferably with what appeared to be at least some success. Portugal was a prime source for these studies, not only due to its close ties to Brazil, but also because Portuguese physicians had particularly extensive experience with the disease.
Emigdio Manoel da Victorio da Costa (1769 – 1848), was Portuguese physician who was on the forefront of battling the 1833-4 cholera epidemic in Portugal. He obtained a medical degree from the prestigious University of Coimbra, located in his hometown. While he was destined for a bright academic career at the university, in 1803, he abruptly left Coimbra after an argument with the academic administration. He then settled in the nearby town of Soare.
Thirty years later, when the Coimbra region was devastated by the cholera scourge, Emigdio Manoel was still the town doctor, whereupon personally tended to hundreds of patients in the vicinity. During the outbreak, he wrote a treatise on cholera and carefully recorded his sessions with patients, however, he always kept these documents to himself. Upon his death, he left instructions to his children to publish whatever of his papers were “useful to humanity”, and to burn the rest.
Emigdio’s son, Adolfo Manuel Victorio da Costa (1808 – 1878), was given his father’s papers from the cholera epidemic, which he resolved to publish (someday). Adolfo had studied philosophy at the University of Coimbra, but on the eve of receiving his doctorate, in 1834, he was forced to flee Portugal, due to his ardent support of the losing side in the Portuguese Civil War. He went to Paris, where he gained his medical degree, before moving to Rio de Janeiro, where he opened a lucrative private practice and, in 1840, founded the Colégio Victorio medical school.
When cholera struck Brazil in 1855, Adolfo was motivated to quickly edit and publish his father’s writings on the disease, to serve as an aid to doctors in both Brazil and Portugal in combatting the scourge. The work was duly published in Rio de Janeiro. It consisted of a preface by Adolfo, followed by his father’s treatise on the history, nature, symptoms, and treatments for cholera, and concluded with Emigdio’s numerous case studies of patients, based upon his own practice.
In his ‘Proemio’ (preface), Adolfo writes that “…the notes on cholera-morbus asiatica… must be useful to Portugal… the doctor who undertakes to read the detailed history of this epidemic in its invasion of Portugal, will find there, true documents about the invasion, progress and termination of the disease; the practical doctor will have more to consult on a series of cases… and the legislator will be able to draw from there rules to preserve the people from major epidemics, as much as possible… We also think that these notes should be useful to Brazil; the Brazilian doctor can take advantage of reading this advice, giving due consideration to the climate, the body’s conditions and the thousands of causes that influence illnesses, their course and treatment (p. viii).
There then follows Emigdio’s remarkably astute (for the time) treatise on the disease, ‘A Cholera-Morbus Asiatica’ (pp. 1-22), which is noted as having been written in Saure, on November 30, 1833. The discourse includes a short history of cholera, and then reveals that Emigdio was a committed ‘contagionist’, who believed that the vector of transmission went “person to person” via a poisonous “miasma”, from either the air, vessels of the skin, or “material excreted in digestive tracts” (the latter of which was correct). He observed that, in the Coimbra region, the disease was transmitted from town to town only when an infected person travelled that way.
Emigdio goes on to opine that cholera is a disease of “the nervous system and vascular blood”, before describing its horrific and varied symptoms in considerable detail.
As for treatments, Emigdio shows an awareness of the common contemporary ‘remedies’, that involved enemas, potions and bloodletting (usually totally ineffective, and often dangerous). He notes his own courses of treatment which involved the varied use of opium, nutmeg, and laudanum and, rarely, quinine sulfate. These medicines may have marginally helped some patients but were far from being cures.
The final, and largest and most valuable section of the work consist of Emigdio’s case studies (pp. 23-127), drawn from his patient notes, taken in the field, during the cholera pandemic. Here his records an amazing 462 cases, which are classified as ranging from ‘Caso Leve’ (light cases) to ‘Caso Gravissimo’ (grave cases). Each case notes the patient’s name, age, symptoms, treatment (if administered) and outcomes. Anecdotally, Emigdio noticed that children were less affected by cholera, while the poor, and people with substance abuse issues were especially vulnerable to negative outcomes.
The book was well-received on both sides of the Atlantic, with a contemporary Portuguese reviewer of the book praising its qualities and practical utility as guide for physicians, writing that the work is “greater in merit than its size”, before going on to say that it records “…a memory about this disease, progress, ways of invasion and means of remedying them; The small book we are dealing with presents a large number of cases, which constitute a statistical archive, rich in therapeutic and clinical data, and of great advantage to the surgeon… who has to deal with such a serious illness; because it provides, in a quick glance, a large number of observations, interesting in themselves, and recommendable, as they are authored by the recognized probity of the faculty. Furthermore, the work “…is recommended in all respects, and as such we advise it to experts. In addition to presenting new ideas about the scourge, in addition to correctly and clearly drawing all the features and phases of the epidemic, to covering in a short space how much you need to know about the common clinical subject, making for this reason an excellent vade-mecum” [Dr. Emigdio Manoel da Victorio da Costa]” (A. Paganino, ‘Bibliographia – Apontamentos sobre a cholera-morbus…’, A Illustração luso-brazileira. Jornal universal, vol. 1 (Lisbon, 1856), p. 154).
A Note on Rarity
The present work is very rare. We can locate only 5 institutional examples, held by the Biblioteca Nacional de Portugal (2 examples); University of California-Los Angeles; Ohio State University Library; and the Cleveland State University Library. The only sales record we can trace for another example is for one offered at a Brazilian auction in 2015.
Importantly, the present example may be unique, owing to its sumptuous velvet binding and fine detailing.
References: Biblioteca Nacional de Portugal (2 examples): S.A. 33315 V. and S.A. 4306 V.; University of California, Los Angeles: WC 264 C837a 1855; Ohio State University Libraries: RC133.P8 C6 1855; Cleveland State University Library: RC133.P8 C6.; OCLC: 3332570; INOCÊNCIO, Diccionario Bibliographico Portuguez, vol. 2, p. 233 and vol. 9, p. 172; Rodrigues de GUSMÃO, Memorias biographicas dos medicos t cirurgiões portugezes, que, no presente seculo, se teem feito conhecidos por seus escriptos (Lisbon, 1858), p. 25; O Instituto: Jornal scientifico e litterario, vol. 11 (Coimbra, 1863), p. 261; A. PAGANINO, ‘Bibliographia – Apontamentos sobre a cholera-morbus…’, A Illustração luso-brazileira. Jornal universal, vol. 1 (Lisbon, 1856), p. 154; Revista do Instituto Histórico e Geográfico do Brasil, 3.a serie, supplemento ao tomo XVIII (1855), p. 88.