By Shannon Selin
Given the rudimentary nature of medical care in the early 19th century, Napoleon is probably right when he complains to Dr. Formento in Napoleon in America that “you kill more men than you save.” Disease was thought to be caused by imbalances within the body. There was little understanding of how infections began and spread, or of the importance of hygiene. Treatments included bloodletting and mercury. Many people died young, and some causes of death were unusual.
Causes of death in American cities in 1820
In 1820, there were a total of 9,617 deaths reported in New York, Philadelphia, Baltimore and Boston. (1) These were the four largest cities in the United States, with a combined population of 293,544. (2) Approximately half of those who died (4,762) were under 20 years old. Of these, fully half (2,436) were children under the age of one.
The largest single causes of death were:
Consumption (tuberculosis) – 1,619 deaths (17%)
Stillbirth – 561 (6%)
Cholera – 480 (5%)
Dysentery – 439 (5%)
Typhus fever – 368 (4%).
The remaining deaths were ascribed to a great variety of causes, hinting at rather discretionary methods of investigation and categorization: e.g., affection of the stomach & head (2 deaths), indigestion (1 death), hydrophobia (1 death), hysteria (1 death). Forty-six deaths were pinned on “teething.” Ninety-seven were simply classified as “sudden.” The 106 deaths attributed to “unknown” causes presumably had less inventive reporters. What really stands out, though, are the 16 deaths blamed on “drinking cold water.”
How drinking cold water could kill you
Dr. Benjamin Rush was the first to write about the phenomenon of people in Philadelphia “being diseased by drinking cold water.”
This mortality falls chiefly upon the labouring part of the community, who seek to allay their thirst by drinking water from the pumps in the streets, and who are too impatient, or too ignorant, to use the necessary precautions for preventing its morbid or deadly effects upon them. These accidents seldom happen except when the mercury rises above 85° in Fahrenheit’s thermometer.
Three circumstances generally concur to produce disease or death from drinking cold water. 1. The patient is extremely warm. 2. The water is extremely cold. And 3. A large quantity of it is suddenly taken into the body. The danger from drinking the cold water is always in proportion to the degrees of combination which occur in the three circumstances that have been mentioned. The following symptoms generally follow….
In a few minutes after the patient has swallowed the water, he is affected by a dimness of sight; he staggers in attempting to walk, and, unless supported, falls to the ground; he breathes with difficulty; a rattling is heard in his throat; his nostrils and cheeks expand and contract in every act of respiration; his face appears suffused with blood, and of a livid colour; his extremities become cold, and his pulse imperceptible; and unless relief be speedily obtained, the disease terminates in death, in four or five minutes. …
More frequently, patients are seized with acute spasms in the breast and stomach. These spasms are so painful as to produce syncope, and even asphyxia. They are sometimes of the tonic, but more frequently of the clonic kind. In the intervals of the spasms, the patient appears to be perfectly well. The intervals between each spasm become longer or shorter, according as the disease tends to life or death.
It may not be improper to take notice that punch, beer and even toddy, when drunken under the same circumstances as cold water, have all been known to produce the same morbid and fatal effects. (3)
Rush’s “one certain remedy” for the disease was liquid laudanum (tincture of opium). He also advised taking the following precautions before drinking a large quantity of cold liquid when one was overheated.
1. Grasp the vessel out of which you are about to drink for a minute or longer, with both your hands. This will abstract a portion of heat from the body, and impart it at the same time to the cold liquor, provided the vessel be made of metal, glass, or earth….
2. If you are not furnished with a cup, and are obliged to drink by bringing your mouth in contact with the stream which issues from a pump, or a spring, always wash your hands and face, previously to your drinking, with a little of the cold water. By receiving the shock of the water first upon those parts of the body, a portion of its heat is conveyed away, and the vital parts are thereby defended from the action of the cold.
By the use of these preventives, inculcated by advertisements pasted upon pumps by the Humane Society, death from drinking cold water has become a rare occurrence for many years past in Philadelphia. (4)
Dr. R. Tolifree later expanded Rush’s prescription.
Some maintain there is but one certain remedy, laudanum. This view is too contracted; for if laudanum be not at hand, we should give alcohol, essence of peppermint, &c. in doses much larger than usual. (5)
The drunkards’ disease?
Some people apparently took to using alcohol as a preventive measure, which “A. Physician” affiliated with the Temperance Union frowned upon.
I have observed, within a few days past, a number of deaths have been reported from ‘drinking cold water,’ accompanied in some of the newspapers by earnest cautions against drinking cold water when heated, as though this alone were the cause of death. These reports and cautions, there is reason to fear, have had a tendency to influence many to use ardent spirits in the water they drink in the present warm weather, more than one instance of which have fallen under my observation. And with the view of preventing such imprudence, it is fit that the facts of the case should be understood.
The instances of sudden death from drinking cold water almost universally occur among intemperate foreigners, or others who indulge habitually in the use of spirituous liquors. Such persons, after creating a thirst by the use of ardent spirits, which rum will not allay, go to a pump or spring of water and drink to satiate this morbid thirst, which is more owing to their intemperance than to labour and heat combined.
The effect of cold water, thus suddenly applied to the stomach, is supposed to be a paralysis, extending from that organ to the heart. That such examples of paralysis from drinking water, however cold, or however much the individual may be heated, ever did occur, except when the stomach had previously been impaired by intemperance or otherwise, remains to be proved. Hence such accidents proverbially occur among drunkards, to an extent which should serve as a warning to the intemperate and a salutary lesson to the sober.
Such persons, however, may avoid the mischief they dread in a much better way than by mixing aspiritous liquors with the water they drink. Let them wash the hands and face with cold water before drinking, or hold their mouths full a few moments before swallowing it, and they may then safely satiate their thirst, even with iced water, without harm. (6)
Perhaps one of the saddest cases of death from drinking cold water was this one, in 1834.
Very many deaths have happened from drinking cold water, but at New York, one of the sextons, becoming heated when digging a grave for a person that had so died, drank plentifully of cold water, and so died himself. (7)
So what was going on?
An article published in the American Journal of Forensic Medicine and Pathology in 1999 notes a case of sudden cardiac death in a 12-year-old boy after rapid ingestion of a frozen slurry drink. After observing that ingestion of cold liquids has been associated with syncope (fainting), the authors conclude that “ingestion of cold liquids should be considered a potential trigger for fatal cardiac arrhythmias in patients with underlying heart disease.” (8)
Maybe this was behind some of the deaths caused by drinking cold water in the 19th century.
1. Eclectic Repertory and Analytical Review, Medical and Philosophical, Vol. XI (Philadelphia, 1821), pp. 133-140.
2. “Population of the 61 Urban Places: 1820,” United States Census Bureau, http://www.census.gov/population/www/documentation/twps0027/tab05.txt, accessed October 14, 2016.
3. Benjamin Rush, Medical Inquiries and Observations, Vol. 1, Second Edition (Philadelphia, 1805), pp. 183-185.
4. Ibid., pp. 186-187.
5. R. Tolifree, “Observations on Death from Drinking Cold Water when the Body is Heated,” Baltimore Medical and Surgical Journal and Review, edited by E. Geddings, Vol. 1 (Baltimore, 1833), p. 295.
6. A. Physician, “Deaths from Cold Water,” Journal of the American Temperance Union, Vol. 2, No. 8 (Philadelphia, August 1838), p. 116.
7. Niles’ Weekly Register, Vol. 46 (Baltimore, August 2, 1834), p. 379.
8. P. Burke, M.N. Afzal, D.S. Barnett, R. Virmani, “Sudden death after a cold drink: case report,” American Journal of Forensic Medicine and Pathology, Vol. 20, No. 1 (March 1999), pp. 37-39.
Image: Death’s Dispensary, cartoon by George Pinwell in FUN Magazine, August 18, 1866