Selective suppression by the medical establishment of unwelcome research findings: the cholera treatment evaluation by the General Board of Health, London 1854

Cholera haunted the 19th century. The origins of the painful and frightening new disease that could result in death within hours were unknown, and treatments were useless. History tells us that the bacterial cause was not understood until 1883, and the gold standard treatment of oral rehydration therapy was first used in 1960.1 Of the six 19th-century cholera pandemics, the third, in 1849–1860, resulted in the most fatalities. In Great Britain, there were 23,000 deaths, 10,000 in London alone. The government responded with an epidemiological survey and a comparative evaluation of rival treatments,2 the subject of this article. Under Sir Edwin Chadwick (1801–1890), the General Board of Health had been a non-governmental organisation. Chadwick’s crusade for administrative reform as the necessary springboard to bring about improved public health, allied with a zealous lack of tact, had been enormously unpopular with the laissez-faire elements in mid-19th-century British society and led to his removal in August 1854.3 The Board was reconstituted with greatly reduced powers as a government ministry on 12 August, on the lines of the Poor Law Board. In charge was Sir Benjamin Hall MP (1802–1867) – a bureaucrat of the class that had provoked Chadwick’s scorn and previously known mainly for his support of mild ecclesiastical reform. Incongruously given his background, Hall’s first act on 12 August was to initiate a coordinated scientific and medical response to the 1853–1854 cholera epidemic, then at its worst in London. By September, Hall had gone on to commission a major epidemiological survey of the epidemic. He was also anxious to know which treatments were most effective. His letter circulated at the beginning of September to all practitioners appearing in the Medical Register for 1854 states that he had established a Medical Council4 ‘representing all branches of the medical profession’ because of the great want that is now felt of some systematic record of cases of choleraic disease, their treatment, and results, with a view to determine, in so far as may be possible, the best mode of meeting this formidable epidemic. (p. 67) The Council consisted of 12 members nominated by Hall, the Royal Colleges and the Society of Apothecaries, under the chairmanship of John Ayrton Paris, President of the Royal College of Physicians. Three (sub)committees would facilitate the survey: Scientific Inquiries: to look into the nature, extent and probable causes of cholera; Treatment: to assess the relative advantages of rival methods; and Foreign Correspondence: to glean relevant information from scientists abroad.