Maria B. O'Hare's Blog

THE DECLINE OF SOME OF THE DEADLIEST PLAGUES KNOWN TO HUMANKIND…

Scarlet Fever Returns: but it is a lot less deadly

We don’t know much about Scarlet Fever from the earlier era (pre-1800s), but we do, however, understand that it was fairly widespread and existed in some form as it relates to another fairly similar disease – Diphtheria, as documented in the excerpt below taken from Charles Creighton’s 1894 history of epidemics.

A History of Epidemics in Britain

CHAPTER VII.
SCARLATINA AND DIPHTHERIA.
Scarlatina and diphtheria have to be taken together in a historical work for the reason that certain important epidemics of the 18th century, both in Britain and in the American colonies, which were indeed the first of the kind in modern English experience, cannot now be placed definitely under the one head or the other, nor divided between the two.
Creighton, C.  (1894, 678)
[1]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm#Page_693

Creighton also documents regular and widespread outbreaks of throat infections that often led to fatalities throughout Ireland, Britain and in parts of the U.S. over the course of the 18th Century (the 1700s) that were akin to what we would call Scarlet Fever. However, it wasn’t really until the 19th Century (the 1800s) that we begin to see specific epidemics erupt around the same time within Ireland, Scotland, England and Wales that Scarlet Fever becomes understood as a more distinct disease as indicated in the excerpt that follows.

A History of Epidemics in Britain

Vol. II.
SCARLATINA
… The general prevalence of malignant scarlet fever in the first years of the 19th century is farther shown by the accounts from Ireland, which were recalled by Graves in a clinical lecture of the session 1834-35, during the prevalence of a scarlet fever as malignant as that of thirty years before…
“In the year 1801,” he says, “in the months of September, October, November and December, scarlet fever committed great ravages in Dublin, and continued its destructive progress during the spring of 1802. It ceased in summer, but returned at intervals during the years 1803-4, when the disease changed its character; and although scarlatina epidemics recurred very frequently during the next twenty-seven years, yet it was always in the simple or mild form, so that I have known an instance where not a single death occurred among eighty boys attacked in a public institution.
The epidemic of 1801-2-3-4, on the contrary, was extremely fatal, sometimes terminating in death (as appears by the notes of Dr Percival kindly communicated to me) so early as the second day. It thinned many families in the middle and upper classes of society, and even left not a few parents childless. Its characters seem to have answered to the definition of the scarlatina maligna of authors.”
The long immunity from malignant scarlatina which Graves asserts for Ireland after 1804, is made probable also for England and Scotland after 1805…
It is not until 1831 that we begin to hear much of malignant scarlatina again. But it is clear that scarlet fever was common enough all through that interval, probably in its milder form. It was now the usual epidemic trouble of schools.
Creighton, C.  (1894, 722-3)
[2]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm#Page_693

Supporting this observation of Scarlet Fever taking a turn for the worse to become a much more lethal contagion of pandemic proportions throughout many of our developing nations, and bearing in mind that we also had to contend with other fairly consistently deadly contagions of the era such as, Measles, Diphtheria and Whooping Cough (Pertussis) alongside Scarlet Fever, as indicated below,  Scarlet Fever became so deadly that it began to supersede all of these  other contagions. Scarlet fever–past and present

AETIOLOGY 
In the early nineteenth century, the clinical presentation of the disease appears to have changed for the worse. Lethal epidemics were seen in Tours, France, in 1824; in Dublin, Ireland, in 1831; and in Augusta, Georgia, during 1832-33. Similarly, in Great Britain, the fatality rate from scarlet fever increased from between 1 and 2 % to more than 15% in 1834. From 1840 until 1883, scarlet fever became one of the most common infectious childhood disease to cause death in most of the major metropolitan centers of Europe and the United States, with case fatality rates that reached or exceeded 30% in some areas–eclipsing even measles, diphtheria, and pertussis.
Smith, T.C.(2011)
[3]
http://aetiologyblog.com/2011/07/06/scarlet-fever-in-hong-kong/

 In other words, you can imagine how parents felt as they not only were losing their children to all the other highly lethal contagions of childhood, but now they had to contend with the lesser of these killers rising to prominence as an even greater plague of destruction in the form of a particularly virulent increase of Scarlet Fever.

Scarlet Fever knew no social boundaries. When Scarlatina came to visit, it didn’t matter how poor or well off you were, she could still knock on your family’s door. For instance, as highlighted earlier in Creighton’s (1884) [4] discussion of the devastation of Scarlet Fever in Ireland of the beginning of the 1800s, he highlights the fact that even some of the more affluent families had been thinned by its impact. And indeed, the devastation often included some of our best-known figures of historical renown as highlighted in the following excerpt:

Scarlet fever–past and present 
AETIOLOGY

Children were always the worst affected, and proved to be highly susceptible. Charles Darwin lost two children to scarlet fever in the 1850s. Scarlet fever is also believed to have caused the 19-month old Helen Keller to lose her hearing and sight. John Rockefeller lost a two-year old grandson to scarlet fever, which is why Rockefeller University remains one of the world’s leading biomedical research centers in the world today.

Smith, T,C, (2011)
[5]
http://aetiologyblog.com/2011/07/06/scarlet-fever-in-hong-kong/

Scarlet Fever was so common and dreaded in childhood that it worked its way into children’s literature such as Little Women and  ‘Velveteen Rabbit’. Below is a short excerpt from the latter.

SYNOPSIS
The Velveteen Rabbit, or How Toys Become Real tells the story of a stuffed rabbit made of velveteen…
And then, one day, the Boy was ill.
His face grew very flushed, and he talked in his sleep, and his little body was so hot that it burned the Rabbit when he held him close.  Strange people came and went in the nursery, and a light burned all night and through it all the little Velveteen Rabbit lay there, hidden from sight under the bedclothes, and he never stirred, for he was afraid that if they found him some one might take him away, and he knew that the Boy needed him…
Presently the fever turned, and the Boy got better.  He was able to sit up in bed and look at picture books, while the little Rabbit cuddled close at his side.  And one day, they let him get up and dress
The Boy was going to the seaside tomorrow.  Everything was arranged, and now it only remained to carry out the doctor’s orders.  They talked about it all, while the little Rabbit lay under the bedclothes, with just his head peeping out, and listened.  The room was to be disinfected, and all the books and toys that the Boy had played with in bed must be burnt.
“Hurrah!” thought the little Rabbit.  “Tomorrow we shall go to the seaside!”
…Just then Nana caught sight of him.
“How about this old Bunny?” she asked.
“That?” said the doctor.  “Why, it’s a mass of scarlet fever germs!– Burn it at once.  

Williams, M., (1922, 33-36)

[6]

https://archive.org/stream/thevelveteenrabb11757gut/11757.txt

Thankfully, the boy (and seemingly the rabbit) survive the ordeal with Scarlet Fever – thus, leaving the reader with some hope that the disease could be gotten over without any bad effects. And most certainly, they needed hope, as you might imagine, at the coal face so to speak, there was a great deal of pessimism as we felt wholly helpless and unable to prevent this slaughter of innocence. Below are some quotes from the period which reveal this bewilderment and hope that our medical advances will hold the key to such senseless destruction of life sometime in the not too distant future.

Chapter 5
The Historiography of Social Medical Improvement
… the situation in February 1885 remained bleak:

The prevention of scarlet fever is as yet an unsolved problem. I trust such men as Pasteur and Koch will turn their attention to it; my only hopes of a satisfactory answer lie in that direction…

Davies was not alone in his pessimism…:

Yet, as knowledge and administrative resources now stand, official powers of preventing this murderous disease are, practically speaking, insignificant; and such general advice as may be given for individual preventive purposes has so little likelihood of being applied except in select cases, that, as regards the main mass of sufferers, it may seem almost insincere and derisory…

Bristol Historical Resource (2000)
[7]
http://humanities.uwe.ac.uk/bhr/Main/abstract_health/Health_5.htm

Creighton draws our attention to the remarkable pattern of  this disease as it rose from being so meek to such lethal virulent proportions for a number of decades from the mid-19th Century, and he also describes how it began to return to its milder form by the 1880s within England and Wales, but bear in mind that Ireland, Scotland and many other regions follow this pattern of peaks and troughs for the same period.

A History of Epidemics in Britain

Vol. II

The enormous number of deaths from scarlatina during some thirty or forty years in the middle of the 19th century will appear in the history as one of the most remarkable things in our epidemiology. There can be no reasonable doubt that this scarlatinal period was preceded by a whole generation with moderate or small mortality from that disease, just as it is now being followed by annual death-rates which are less than a half, perhaps not more than a third, of the average during forty years before 1880.

Creighton, C.  (1894, 72)
[8]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm#Page_693

As tabulated by Creighton (1894), although Scarlet Fever’s reign of terror is shown to continue ebbing, the statistics also demonstrate that Measles, and to some extent, Diphtheria, began to pick up the reins where Scarlet Fever left off up to the time of Creighton’s review published in the last decade of the 19th Century. This pattern is illustrated in the following graph for the era under discussion (Figure 1).

[image error]

Fig. 1 Graph generated using tabulations for individual annual death statistics in England and Wales from 1837 to 1880 compiled by Creighton, C. (1894) A History of Epidemics in Britain, Volume II, From the Extinction of Plague to the Present Time, p. 722-3, Cambridge University Press, Cambridge.https://www.gutenberg.org/files/43671/43671-h/43671-h.htm#Page_693

As we move into the 20th Century, we discover something that the earlier statisticians could not have foreseen. Scarlet Fever ceases to be a major threat to children and becomes a relatively benign disease of childhood.

[image error]

Fig. 2: Chart of the annual individual number of deaths in Ireland from Scarlet Fever since records began going beyond the period when deaths from this disease were no longer registered. Source: Chart generated using this tumultuous statistics reports since records began – “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of: An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link. © Copyright dig-press.com

Scarlet fever–past and present 
AETIOLOGY

Historical data suggest at least three epidemiologic phases for scarlet fever. In the first, which appears to have begun in ancient times and lasted until the late eighteenth century, scarlet fever was either endemic (always present at a low level) or occurred in relatively benign outbreaks separated by long intervals.

In the second phase (~1825-1885), scarlet fever suddenly began to recur in cyclic and often highly fatal urban epidemics. In the third phase (~1885 to the present), scarlet fever began to manifest as a milder disease in developed countries, with fatalities becoming quite rare by the middle of the 20th century.

In both England and the United States, mortality from scarlet fever decreased beginning in the mid-1880s. By the middle of the twentieth century, the mortality rate from scarlet fever again fell to around 1%.

Smith, T,C, (2011)
[9]
http://aetiologyblog.com/2011/07/06/scarlet-fever-in-hong-kong/

A drop to c. 1 per cent by the middle of the 20th Century in the death rate from Scarlet Fever is fairly spectacular.

The pattern seen in the above graph for deaths from Scarlet Fever in Ireland (Fig. 2) corresponds very closely with the historical documentation for the same timeframe as those charted for England and Wales and elsewhere.  Moreover, the fact that Scarlet Fever cases (infections) were very prevalent at the time when deaths from the disease was very rare in our more modern era (the 1950s and 60s) is clearly illustrated by the steep decline in deaths from Scarlet Fever and correspondingly high incidence of cases of the disease recorded from official statistics in England and Wales for infants and children even up to the 1940s (given in Figure 14) in: ‘A Century of Changes in the Mortality and Incidence of the Principal Infections of Childhood’ (Gale, A.H, Medical Officer, Ministry of Education, 1945) http://adc.bmj.com/content/archdischild/20/101/2.full.pdf [10].

Bearing in mind the fact that Scarlet Fever childhood outbreaks (epidemics) in our more modern era did not produce corresponding mortality and morbidity, it is not until we review the death statistics over the course of the earlier part of the 20th Century throughout our developed nations that we really grasp just how dramatic the decline in deaths from Scarlet Fever throughout this timeframe truly was.

For instance, this is clearly seen within graphs presented in Figure 4.15: Scarlet Fever from the turn of the 20th Century until modern times, with the overwhelming majority (over 99 per cent) decline in deaths occurring in the period 1901-45 (See ‘Atlas of Epidemic Britain: A Twentieth Century Picture’  Smallman-Raynor, M., and Cliff, A (2012) [11] https://books.google.ca/books?id=iMnN4fZrj70C&pg=PA48#v=onepage&q&f=false

This dramatic decline of Scarlet Fever as a major killer – also within England and Wales – is clearly seen in the graphs generated in Thomas McKeown’s research as illustrated in ‘The Role of Medicine’ (1979) http://peaceworkspartners.org/vault/Oxford/DPHPC/Health and Development Course/Int Dev Readings HT10/1a. Main Theories/McKeown The Role of Medicine 1979.pdf  [12].

This near-simultaneous decline in deaths from Scarlet Fever (but not its cases of infection) is also illustrated by the graphs generated for the United States for a similar timeframe here: Figure 1: Deaths per 100,000 from Rheumatic Fever and Scarlet Fever …Link https://www.econ.ucla.edu/costa/figureschicago.pdf ‘Health at Older Ages: The Causes and Consequences of Declining Disability among the Elderly’ (Costa,  D.L., 2009) [13]. 

Also see the graphs  ‘Mortality in the United States 1900 – 1950’ (Gordon, T., 1968, figure. 3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2024011/ [14], and ‘Vital Statistics Rates in the United States, 1940 -1960’, (Grove, R.D. and Hetzel, A., 1968) https://www.cdc.gov/nchs/data/vsus/vsrates1940_60.pdf [15] for very similar patterns of decline in deaths from Scarlet Fever and essentially the same endpoint for this disease ceasing to be a major killer – again, within the United States.

Anyway,  everyone it seems began to sigh a great breath of relief as they were now counting more of their children with increasing confidence, from having had Scarlet Fever. But, it just so happened that Scarlet Fever returned and it would seem that we had forgotten just how tame this pathogen had become and we simply equated the return of the disease in our modern world with a return to the type of fatalities of the 19th and earlier 20th Century. It was a global comeback out of seemingly nowhere, and its impact left everyone scratching their heads.

THE ONCE-DEADLY SCARLET FEVER IS MAKING A WEIRD COMEBACK AROUND THE WORLD

What is happening!

After decades of decline, scarlet fever is once again on the rise in the UK and other places around the world, and doctors are scrambling to figure out why.

Beginning in 2014, the infection started to steadily rise, and in 2016, over 19,000 cases from 620 outbreaks were reported, mostly in schools and nurseries. This represents a seven-fold increase since 2011.

Starr, M., (2017)
[16]
https://www.irishtimes.com/life-and-style/health-family/scarlet-fever-is-back-in-the-21st-century-1.3291330

You can begin to imagine the fear as we began to realise that this was the very same disease and symptoms of Scarlet Fever of old. Would our children start dying from the disease in their thousands as emblazoned in our imaginations of the tragic stories of the dark days of the Victorian era?

 Scarlet fever: the disease in the UK
The Pharmaceutical Journal

…it may not sound terrible based on those symptoms, but it was responsible for 36,000 registered deaths in the first decade of the 20th century in England and Wales, and was a leading cause of child mortality.

There’s no vaccine for scarlet fever. Once contracted, it’s treated quite easily with a course of antibiotics, which – at least partially – contributed to the disease’s decline in developed countries after about 1945.

Marshall, S.  (2006)
https://www.pharmaceutical-journal.com/opinion/comment/scarlet-fever-the-disease-in-the-uk/10001690.fullarticle
[17]

This was a true pandemic as it almost went worldwide. It was horrifying for the poor parents of infants and children who got the disease as they had remembered stories of the massive death toll of the dreaded strawberry tongue.

Scarlet Fever, a Disease of Yore, Is Making a Comeback
The reason for the sudden surge remains a mystery,
Scientific America

Scarlet fever, a disease that struck fear into the heart of parents when cases surged in the days of yore, appears to be making an unexpected and puzzling comeback in parts of the world. England and Wales have seen a substantial rise in scarlet fever cases starting in 2014.

The number of cases tripled from 2013 and continued to increase in 2015 and 2016, with England and Wales last year recording the highest number of cases there in a half-century, British scientists reported Monday in the journal Lancet Infectious Diseases.

Similar and in some cases even larger surges of scarlet fever have been reported in recent years in South Korea, Vietnam, China, and Hong Kong. Hong Kong, which saw a tenfold rise in cases, continues to report increased annual counts five years after the resurgence was first noticed.

The reason for the sudden and surprising increase is a mystery. And the authors of a commentary that accompanied the article urge other countries to be on the lookout for similar spikes in cases.

Branswell, H. (2017)
[18]
https://www.scientificamerican.com/article/scarlet-fever-a-disease-of-yore-is-making-a-comeback/

However, the pandemic continued to sweep throughout our now developed nations, and its impact was nowhere near as devastating as we were beginning to anticipate. Different causes for the mildness of the modern pandemic were considered as seen in the following.

 Scarlet fever: the disease in the UK
The Pharmaceutical Journal

…The most obvious reason for a resurgence in a bacterial infection would be a new strain of the disease that spreads more easily and is possibly antibiotic-resistant – but molecular genetic testing has ruled this out.

Instead, tests showed a range of already established strains of the bacteria, leaving researchers still looking for a possible cause.

Meanwhile, the 2016 statistics put incidence at 33.2 cases per 100,000 people, with 1 in 40 cases being admitted to hospital (although around half of those get discharged the same day).

Marshall, S. (2006)
https://www.pharmaceutical-journal.com/opinion/comment/scarlet-fever-the-disease-in-the-uk/10001690.fullarticle
[19]

This posed the obvious question: if it was not the Scarlet Fever strain of old – the pathogen that killed so many – then,  what on earth was going on? The fact that it was essentially the same disease and amazingly, no deaths and rather brief and typically uneventful hospital visits, left them even more puzzled than before as indicated in the following excerpt:

Scarlet Fever, a Disease of Yore, Is Making a Comeback
The reason for the sudden surge remains a mystery,
Scientific America

“The strains didn’t give us the answer. We were really pinning our hopes on those, because that’s the most obvious answer,” she noted. “We’re left thinking what on earth it could be. We don’t have an answer at the moment.” Even though scarlet fever does not have to be reported to the CDC, Lamagni said a surge in the United States would be hard to miss. “If they were seeing what we’re seeing, they would know about it. It is unusual,” she said.

Branswell, H. (2017)
[20]
https://www.scientificamerican.com/article/scarlet-fever-a-disease-of-yore-is-making-a-comeback/

We now know that the pathogen didn’t change genetically – it’s still the same pathogen that killed thousands annually back in the day. And perhaps the answer to this quandary regarding Scarlet Fever’s return in our fully modern era points to another cause. It looks very likely that our immune systems have become highly educated regarding this particular pathogen. Our genes didn’t change to accommodate, it as it would take too long to make such a genetic change as discussed earlier – perhaps then, our fairly rapid adaptation is more indicative of an epigenetic phenomenon – leaving a long-term impression upon our existing genes that can be transmitted across generations.

Could it be that like the great plagues (Typhus, Typhoid, Dysentery and Cholera) discussed previously, that it was our familiarity and resistance to the pathogen that had changed over many generations and this memory was imprinted in our ancestor’s epigenome? This would provide us with very longterm resilience to the pathogen and it would be perfectly natural if the disease returned in our modern era, that it would behave in the way that it did – giving us all a much-needed booster, lest our immune systems forgot. See it as a type of fire drill and a way of keeping our systems up to date. After all, as the excerpt below indicates:

Scarlet fever: the disease in the UK
The Pharmaceutical Journal

Figures suggest that up to 40 per cent of the population are asymptomatic carriers, with low infectivity and little risk of developing complications.

Marshall, S. (2006)
https://www.pharmaceutical-journal.com/opinion/comment/scarlet-fever-the-disease-in-the-uk/10001690.fullarticle
[21]

With that number of asymptomatic carries (or silent carriers of Scarlatina), it seems that it is always circulating away in the background – but simply not generally expressing itself to any great degree.

It would appear that we just became more resilient to its attacks via exposure over the generations akin to what would seem to be the case with all the other – once more deadly contagions discussed thus far. Fortunately, with all the generations of exposure prior to this pandemic event, we were ready for Scarlatina’s return, even if we didn’t know it at the time. With no vaccine at hand, everyone assumed that deaths and horrors of the Victorian era would descend upon our children.

I suppose nobody knew to look back at the death statistics and watch in real-time, as, across all our developing nations, even by the mid-1940s,  this disease was already becoming a relatively benign and natural rite of passage in childhood and do also bear in mind that Measles went the same way shortly after.

Next Episode: Part Seven: (Don’t Count Your Children ’til they’ve had the POX) Killer Plagues of Our Modern Era – Plummet from Natural Causes..?
References to Part Six
[1]  Creighton, C. (1894) A History of Epidemics in Britain, Volume II, From the Extinction of Plague to the Present Time, Vol. II, p. 678, Cambridge University Press, Cambridge.https://www.gutenberg.org/files/43671/43671-h/43671-h.htm#Page_693
[2]  Creighton, C. (1894) A History of Epidemics in Britain, Volume II, From the Extinction of Plague to the Present Time, Vol. II, p. 722-3, Cambridge University Press, Cambridge.https://www.gutenberg.org/files/43671/43671-h/43671-h.htm#Page_693
[3] Smith, T.C. (2011) Scarlet fever–past and present, Aetiology Blog (July 6yh 2011) [Available online at aetiologyblog.com] http://aetiologyblog.com/2011/07/06/scarlet-fever-in-hong-kong/
[4] Creighton, C. (1894) A History of Epidemics in Britain, Volume II, From the Extinction of Plague to the Present Time, Vol II. Cambridge University Press, Cambridge.https://www.gutenberg.org/files/43671/43671-h/43671-h.htm#Page_693
[5] Smith, T.C. (2011) Scarlet fever–past and present, Aetiology Blog (July 6yh 2011) [Available online at aetiologyblog.com] http://aetiologyblog.com/2011/07/06/scarlet-fever-in-hong-kong/
[6] Williams, M., (1922) Velveteen Rabbit or How Toys Become Real, Doubleday & Company , Inc., New York. [Available on Project Gutenberg] https://archive.org/stream/thevelveteenrabb11757gut/11757.txt
[7] Bristol Historical Resource (2000) Chapter 5: The Historiography of Social Medical Improvement, in, (eds) ByIan Archer, Spencer Jordan, Keith Ramsey, Peter Wardley and Matthew Woollard [Available online website BHR] http://humanities.uwe.ac.uk/bhr/Main/abstract_health/Health_5.htm
[8] Creighton, C. (1894) A History of Epidemics in Britain, Volume II, From the Extinction of Plague to the Present Time, Vol. II, p. 72, Cambridge University Press, Cambridge.https://www.gutenberg.org/files/43671/43671-h/43671-h.htm#Page_693
[9] Smith, T.C. (2011) Scarlet fever–past and present, Aetiology Blog (July 6yh 2011) [Available online at aetiologyblog.com] http://aetiologyblog.com/2011/07/06/scarlet-fever-in-hong-kong/
[10] Gale, A. H. (1945). A Century of Changes in the Mortality and Incidence of the Principal Infections of Childhood. Archives of Disease in Childhood, Vol. 20, [101], pp. 2–21. http://adc.bmj.com/content/archdischild/20/101/2.full.pdf
[11] Smallman-Raynor, M, and Cliff, A (2012), Atlas of Epidemic Britain: A Twentieth Century Picture, Oxford University Press, Oxford. p.50, figure 4:18 (Measles); p. 52, figure 4:24 (Whooping Cough); p.49, figure 4:15 (Scarlet Fever). https://books.google.ie/books
[12] Mc Keown, T (1979) The Role of Medicine: Dream, Mirage, or Nemesis? Basil Blackwell, Oxford [Available online as PDF] http://peaceworkspartners.org/vault/Oxford/DPHPC/Health and Development Course/Int Dev Readings HT10/1a. Main Theories/McKeown The Role of Medicine 1979.pdf
[13] Costa, D. L., (2009) Health at Older Ages: The Causes and Consequences of Declining Disability among the Elderly in, (eds.,) David M. Cutler and David A. Wise, Selection from a published volume from the National Bureau of Economic Research, University of Chicago Press [Available online at the National Bureau of Economic Research NBER] http://www.nber.org/chapters/c11109.pdf
[14] Gordon, T. (1953) Mortality in the United States, 1900-1950. Public Health Reports, Vol. 68 [4], pp. 441–444. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2024011/
[15] Grove, R.D., and Hezel, A.M (1968) Vital Statistics Rates in the United States, 1940 – 1960, Department of Health, Education and Welfare Public Health Service, National Center for Health Statistics. [Available online cdc.gov] https://www.cdc.gov/nchs/data/vsus/vsrates
[16] Starr, M., (2017) The Once-Deadly Scarlet Fever is making a Weird Comeback around the World – What is happening! Irish Times, (November 29th 2017) https://www.irishtimes.com/life-and-style/health-family/scarlet-fever-is-back-in-the-21st-century-1.3291330
[17] Marshall, S., (2006) Scarlet fever: the disease in the UK, The Pharmaceutical Journal (July Issue 2006). https://www.pharmaceutical-journal.com/opinion/comment/scarlet-fever-the-disease-in-the-uk/10001690.fullarticle
[18] Branswell, H., (2017) Scarlet Fever, a Disease of Yore, Is Making a Comeback – The reason for the sudden surge remains a mystery, Scientific America (November 28th 2017). https://www.scientificamerican.com/article/scarlet-fever-a-disease-of-yore-is-making-a-comeback/
[19] Marshall, S., (2006) Scarlet fever: the disease in the UK, The Pharmaceutical Journal (July Issue 2006). https://www.pharmaceutical-journal.com/opinion/comment/scarlet-fever-the-disease-in-the-uk/10001690.fullarticle
[20] Branswell, H., (2017) Scarlet Fever, a Disease of Yore, Is Making a Comeback – The reason for the sudden surge remains a mystery, Scientific America (November 28th 2017). https://www.scientificamerican.com/article/scarlet-fever-a-disease-of-yore-is-making-a-comeback/
[21]  Marshall, S., (2006) Scarlet fever: the disease in the UK, The Pharmaceutical Journal (July Issue 2006). https://www.pharmaceutical-journal.com/opinion/comment/scarlet-fever-the-disease-in-the-uk/10001690.fullartic

 

The Lancaster County Cholera Epidemic of 1854 …
Cholera, which was endemic to India, escaped the subcontinent in 1817, striking Moscow in September 1830. It then spread westward across Europe, reaching England in 1831 and North America in 1832. The pandemic would return to Europe and America in 1849, 1854, and 1866, each time filling the population with terror and revulsion; the mystery surrounding the cause of the disease only exacerbated the situation. Its effects were both rapid and devastating, and death was agonizing to those who succumbed to the disease…
Osborne, J.D., (2009)
[1]
http://www.edwardhandmedicalheritage.org/cholera.html
Link

A disease that becomes pandemic (impacts nations world-wide often with deadly impact) is obviously one that can be passed from person to person. And Ireland, on the edge of Europe, was certainly not immune to Cholera’s devastation as highlighted in the following excerpt:

Why does cholera have such a reputation?
Cholera was once one of the biggest killers in Irish society. The 1832 epidemic killed 30,000 people… Folk memories of the cartloads of bodies during the 1832 epidemic helped inspire Bram Stoker to write the novel ‘Dracula’.
MedMedia Group (2018)
[2]
http://www.irishhealth.com/article.html?con=246
Link

30,000 deaths in a single Cholera outbreak of the 1830s pandemic in Ireland (the first and seemingly, the worst), although not as major in terms of the death toll estimated for the initial impact of Typhus in the early days (which could have been well over half a million in a population of only 6 million), is still a massive impact to a community of several million at this time. Take, for example, just one well-documented experience within a single county in the whole country of Ireland, as outlined in the following:

The Sligo epidemic that stoked Bram’s interest in all things
Stoker’s mother, Catherine Thornley, came from Sligo town, and witnessed at first hand the devastating cholera epidemic that swept the county in 1832. Bram — or Abraham, as he was christened — would avidly listen to Catherine’s sobering accounts of what she had witnessed in Sligo before he was born…
And Stoker experts believe Catherine’s vivid descriptions of the suffering she had seen stayed with young Stoker and helped fuel his macabre novel later on in life…
It’s not known how it started but the first signs of the disease were noted shortly after a heavy thunderstorm. A market was being held that day and thanks to the large concentration of people in a comparatively contained space, it struck with a brutal swiftness.
A farmer was infected as he mounted his horse on one side of the town and was dead by the time he reached the other. Another man who attended the funeral of an employee in the morning became ill during the burial and was dead by evening. One family saw six of its members die in the course of a single night. The death rate was so rampant that carpenters ran out of wood for making simple coffins and the dead had to be wrapped in pitched sheets and rolled into mass graves.
Local legend has it that some people were buried alive, so great was the haste to dispose of the corpses. The scenes at night around Sligo only served to heighten the sense of dread in the town. Tar barrels were lit in the streets in a misguided attempt to purify the air…
Doctors valiantly attempted to stem the outbreak, and had to contend with widespread ignorance about the disease. There was also suspicion that the medics themselves may have brought the disease upon the town — they had conducted tests on the water to see if the epidemic had started there, and word spread that the water had been tampered with. Even when five of the doctors contracted cholera and died, the allegations continued.
Some 15,000 people were forced to flee the county and it is thought more than 1,500 people died from the epidemic. The events of 1832 would scar Sligo for generations, and the suffering of those who survived would be exacerbated by the Great Potato Famine, which struck just 13 years later.
John Meagher, J., (Independent, Apr., 22nd 2012)
[3]
https://www.independent.ie/entertainment/books/the-sligo-epidemic-that-stoked-brams-interest-in-all-things-26845703.html

The most revealing part of this narrative is perhaps the swiftness of the spread of Cholera – seemingly person to person – with no particular trigger such as the locals all drinking contaminated water (note that Cholera is supposed to be a waterborne disease). We have other historical documentation to support this very point as seen in the excerpt below. It relates to a later pandemic of 1854 as Cholera broke out in a small pocket of Columbia, U.S.

The Lancaster County Cholera Epidemic of 1854 and the Challenge to the Miasma Theory of Disease
September 6, 1854, when two German immigrants, sick with cholera, were left at the railroad terminus in Columbia while their party continued west. The men died the next day. Four Columbians who had tried to aid them came down with cholera and died shortly thereafter…
By September 9, cholera had spread to almost every section of the town, and 30 people had died, many of whom had visited the stricken immigrants. Physicians had no doubt that the disease that they were witnessing was cholera. The virulence of the epidemic that struck Columbia caused Jackson to observe that two-thirds of the victims died within five hours of showing symptoms of the disease…
Although only 127 victims died in Columbia—out of a population of five thousand—Dr. Wilson Jewell of the College of Physicians of Philadelphia and president of the Philadelphia Board of Health estimated that if a similar outbreak had occurred in Philadelphia, it would have killed 75 people an hour.
Osborne, J.D., (2009)
[4]
http://www.edwardhandmedicalheritage.org/cholera.html
Link

This third recorded Cholera pandemic of 1854 strongly suggests that no amount of cleaning up sewers could have stopped the disease in its tracks, at least not at a national and transnational level once it had found a means of jumping from person to person, as also implied by the title of article excerpt above. And supporting this concept, as noted at the beginning – the very nature of pandemics goes against the idea that Cholera was spread due to the level of hygiene within any of our far-flung and emerging nations.

 In other words,  although this goes against our commonly and firmly held belief that Cholera and other old diseases like it, came to prominence and ultimately declined due to our level of cleanliness, does not appear to fit the historical facts. A case in point is documented in the following:

No better example of this belief exists than in the now famous case of the Broad Street pump incident as outlined below:

John Snow and the Broad Street Pump: On the Trail of an Epidemic
The first cases of cholera in England were reported in 1831, about the time Dr. Snow was finishing up his medical studies at the age of eighteen…
Dr. Snow believed sewage dumped into the river or into cesspools near town wells could contaminate the water supply, leading to a rapid spread of disease.
In August of 1854 Soho, a suburb of London, was hit hard by a terrible outbreak of cholera. Dr. Snow himself lived near Soho, and immediately went to work to prove his theory that contaminated water was the cause of the outbreak.
“Within 250 yards of the spot where Cambridge Street joins Broad Street there were upwards of 500 fatal attacks of cholera in 10 days,”
…Officials contended there was no way sewage from town pipes leaked into the pump and Snow himself said he couldn’t figure out whether the sewage came from open sewers, drains underneath houses or businesses, public pipes or cesspools.
The mystery might never have been solved except that a minister, Reverend Henry Whitehead, took on the task of proving Snow wrong.
… Reverend Whitehead interviewed a woman, who lived at 40 Broad Street, whose child who had contracted cholera from some other source.  The child’s mother washed the baby’s diapers in water which she then dumped into a leaky cesspool just three feet from the Broad Street pump, touching off what Snow called “the most terrible outbreak of cholera which ever occurred in this kingdom.”
A year later a magazine called The Builder published Reverend Whitehead’s findings along with a challenge to Soho officials to close the cesspool and repair the sewers and drains because “in spite of the late numerous deaths, we have all the materials for a fresh epidemic.”  It took many years before public officials made those improvements.
Tuthill, K., (2003)
http://www.ph.ucla.edu/epi/snow/snowcricketarticle.html
[5]

Although the Broad Street outbreak may have greatly exacerbated the ongoing pandemic of 1854 at a local level within this tiny area of the London suburb, I think we can safely say that this episode cannot account for the pattern of deaths from Cholera – the same pandemic of 1854 – experienced simultaneously throughout our diverse nations.

Recalling that it took years for the contaminated sewer leak at Broad Street, London to be repaired, it is also worth noting that such hygiene measures and attempts to control the spread of Cholera were not always successful,  or, even necessarily viewed as a good thing as encapsulated in the excerpt from a letter to the ‘Times’ around the time of the 1854 pandemic.

Letter to the ‘TIMES’ 1854
‘ We prefer to take our chance with cholera than be bullied into health. There is nothing a man hates so much as being cleansed against his will or having his floor swept, his hall whitewashed, his dung heaps cleared away and his thatch forced to give way to slate. It is a fact that many people have died from a good washing.’
Child, J and Shuter, P. (1992, 101)
https://books.google.ie/books/about/Understanding_History.html?id=DsNKdbFrP7wC&redir_esc=y
[6]

Obviously, some people were willing to take their chances with the disease itself, which appears by all historical accounts to be becoming significantly less deadly as time went on – and certainly, from the time when Cholera first impacted our developing nations around the 1830s.

Perhaps that is why people were beginning to get a little irked by this zealous cleanliness as I am sure that many people on the ground knew quite well that the Cholera that had, not that long ago, swept across their homelands (certainly in living memory) was becoming relatively tame compared to the earlier days of the deadlier Cholera of plague-like proportions that swiftly spread devastatingly from person to person and the fact that people may have noticed that the limp corpses of entire families  being tossed unto cartloads of putrifying wretched bodies to be buried alive or dead amidst the tar filled sulphur piles, were not a common sight in the Cholera outbreaks of 1854.

An indication of this relative tameness of later Cholera pandemics, is already clear when we look to the preceding pandemic recorded a few years earlier dating to the late 1840s – generally known as Asiatic Cholera. What is interesting about this particular pandemic in the context of Ireland, is that it erupted on the heels of what is commonly referred to as the Great Hunger (or Irish Famine) of the 1840s.

One would think that this would have greatly increased the numbers dying from the disease, given our very poor nutritional status and overall dreadful living conditions, however,  as it turns out, seemingly, starvation, famines and overall impoverishment and squalid conditions do not appear to have played a major role in increasing the death toll as one might expect; although, it certainly didn’t help matters as indicated in the excerpt that follows:

History Ireland
Epidemic Diseases of the Great Famine
The arrival of Asiatic cholera as a pandemic in 1848-49 exacerbated the situation. This fearsome disease added to the physical and mental suffering of the beleaguered population and increased the overall mortality.
Greary, L., (1996)
[7]
https://www.historyireland.com/18th-19th-century-history/epidemic-diseases-of-the-great-famine/
Link

Instead, it actually looks like Cholera is losing its grip – even at the height of the Great Irish Famine of the mid-1840s, as indicated by the data recorded in the following excerpt based upon the national census over the course of the main famine years:

Famine Disease and Famine Mortality: Lessons from the Irish Experience, 1845-50
… the census reported a total of 1,376 cholera deaths in the years 1841-47 (plus a further 2,502 in 1848).
Mokyr, J., and Ó Gráda, C., (1999, 7)
[8]
https://pdfs.semanticscholar.org/498e/2d40caf5ebe67dfc422718a200112a488f79.pdf

Therefore, if we compare the Cholera pandemic of this Asian type of the late 1840s, with the first major and preceding Cholera pandemic of the early 1830s, we can clearly see that the estimated 30,000 deaths, in a single outbreak of Cholera in Ireland alone, compared to the incredibly reduced estimates – even with all its inaccuracies and difficulties – reported from the Irish census of a few thousand deaths from Cholera over the worst of the Famine years ever recorded in this small nation, we truly begin to see that starvation, poverty and dreadfully stressful conditions all round does not necessarily lead directly to increased mortality from Cholera circulating as part of a broader pandemic at the time.

Moreover, this significant taming of Cholera is clearly seen from statistics recording deaths from the final major pandemic of Cholera – which occurs simultaneously throughout our developing nations in 1866. This is the first Cholera pandemic captured by the official statistics of deaths from Ireland which began two years previously (Fig. 1). The death figures for the 1866 pandemic in Ireland shows a significant decline in the number of deaths for several decades when it re-erupts briefly for another decade – but is not as deadly, and is suddenly never heard of again (Fig. 1). 

[image error]

Fig. 1: Chart of the annual number of deaths in Ireland from Cholera since records for this disease began in Ireland. Source: Chart generated using annual statistics reports since records began – “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of: An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link. © Copyright dig-press.com

Once again, we may be looking at natural resistance to the disease over generations of exposure as indicated in a more modern assessment of the disease of Cholera as seen in the more recent excerpt given in the following.

Etiology and Epidemiology of Cholera
When cholera first appears in epidemic form in an unexposed population, it can affect all age groups. In contrast, in areas with high rates of endemic disease, most of the adult population have gained some degree of natural immunity because of illness or repeated asymptomatic infections.
CDC (1999, 39)
[9]
http://www.bvsde.paho.org/texcom/colera/etiology.pdf

In other words, Cholera, and such diseases that are typically viewed as hygiene preventable, appear to be marginally impacted by any of our regional hygienic responses and attempts at intervening in the natural circulation of this pathogen –  except perhaps at a local level.

The historical archives and the statistical data presented above indicate a very similar natural patterning over national boundaries for corresponding timeframes for the fate of Cholera. We see the near-simultaneous rise of Cholera to deadly prominence in pandemic proportions, rapidly spreading from person to person, but within a few short generations – the massive devastation  as epitomised by the macabre accounts of the initial pandemic of the 1830s, just as quickly lost its lethal grip on our fledgling nations to become a relatively benign disease once again.

Cholera, a waterborne pathogen still exists. It never went extinct, but instead, it seems that we have built up natural resistance and immunity to this pathogen via generational exposure and as such, this pattern is indicative of a natural biological interplay between the pathogen itself and us as its host.

This brings us to another interesting pattern as seen in the following section which lends further support for the ultimate demise of Cholera from its much deadlier impact in the earlier part of the 19th Century, which can be seen from the interplay between the pathogens themselves, attempting to compete with each other for us as their own particular host.

 

A Tale of Two Pathogens

[image error]

Fig. 2: Chart of the annual number of deaths in Ireland from Cholera and Dysentery since records for this disease began. Note the large spike at the beginning, (from when records for both these diseases first began). These diseases decline somewhat thereafter, only to erupt again during the 1880s (Dysentery first, and then Cholera takes prominence from 1900 for almost a decade),– but both diseases stop abruptly with the first decade of the 20th Century. Source: Chart generated using annual statistics reports since records began – “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link. © Copyright dig-press.com

Notice from Figure 2, that there is a dramatic drop in deaths from Cholera (Dark Grey) just after the 1866 pandemic (shortly after official records began to record deaths from this disease). Note that deaths from Dystentery (Light Grey) since official records began, fill the space where Cholera seems suppressed somewhat by the predominance of Dysentery for a number of decades.  Note also, the slight gap in the graph that shows very few deaths from either Cholera or Dysentery compared to their loftier heights before records began as significantly more deadly diseases. As it turns out, this void of pathogen destruction appears to be filled by deaths from Typhus  (see the previous discussion on this disease) (Fig, 2).

Taking a closer look at Dysentery, we can see from (Fig.  2) that the deaths registered from this disease stop abruptly in 1900. Like Cholera, and all the other diseases discussed thus far in the context of our now developed nations, the historical records clearly show that Dysentery had a much deadlier beginning within our developing nations of the past.

Now, if we inspect the fate of Cholera (Fig. 2), we can now perhaps see what stopped Dysentery in its tracks. But even so, Cholera’s final reign only lasts a further decade before it too suddenly became an awful lot less deadly (note that these figures do not go beyond 1910, as there were simply no deaths officially being recorded annually in the register).

This interplay between the rise and fall of these two diseases is supported by the historical reference from the closing decade of the 19th Century as seen in the excerpt below. Note, however, that when this observation was written, little did the author know that even Cholera would also, like its older country cousin, be a thing of past just over a decade later.

A History of Epidemics in Britain, Volume II
Dysentery, the old ” country disease,” has steadily declined to about a hundred deaths in the year, while the considerable mortality from diarrhoea, nearly two thousand deaths in a year, is nearly all from the cholera infantum or summer diarrhoea of children in the large towns.
Creighton, C., (1894, 296)
[10]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]

As investigated in the previous sections on Typhus and Typhoid, a similar interplay of the rise and fall seen in the graphs as the predominance of one disease over the other presumably reflects their attempts to opportunistically colonise us as their hosts.  This pattern strongly suggests a biological cause – more to do with the vying for dominance between the pathogens themselves – than any hygiene measures that our particular developing nations may have (or not) implemented at any given time, within any particular region to try and prevent these pathogen’s bid for dominance.

Irrespective of this interesting interplay of pathogens fighting amongst themselves for top dog position, it seems that our own mighty immune systems won the day and managed to bring them all under control in the end. 

References to Part Five
[1] Osborne, J.D., (2009) The Lancaster County Cholera Epidemic of 1854 and the Challenge to the Miasma Theory of Disease, Edward Hand Medical Heritage Foundation [Available online at edwardhandmedicalheritage.org http://www.edwardhandmedicalheritage.org/cholera.html]
[2] MedMedia Group (2018) Why does cholera have such a reputation? Irish Health, [Available Online http://www.irishhealth.com/article.html?con=246 ]
[3] Meagher, J., (2012) The Sligo epidemic that stoked Bram’s interest in all things, Independent, (Apr., 22nd 2012) [Available online independent.ie https://www.independent.ie/entertainment/books/the-sligo-epidemic-that-stoked-brams-interest-in-all-things-26845703.html
[4] Osborne, J.D., (2009) The Lancaster County Cholera Epidemic of 1854 and the Challenge to the Miasma Theory of Disease, Edward Hand Medical Heritage Foundation [Available online at edwardhandmedicalheritage.org http://www.edwardhandmedicalheritage.org/cholera.html]
[5] Tuthill, K., (2003) John Snow and the Broad Street Pump: On the Trail of an Epidemic, Cricket Magazine, Cricket Vol, 31, [3], pp. 23-31, (Nov. 2003); Carus Publishing Company. [Available online republished with permission in full online: http://www.ph.ucla.edu/epi/snow/snowcricketarticle.html ]
[6] Child, J and Shuter, P. (1992, 101), Letter to the ‘TIMES’ 1854, Understanding History, Vol. 2, Heinemann [Available Online on Google Books https://books.google.ie/books/about/Understanding_History.html?id=DsNKdbFrP7wC&redir_esc=y ]
[7] Geary L., (1996) 18th – 19th Century History/Epidemic Diseases of the Great Famine.., History Ireland Magazine, Vol. 4. [1] (Spring 1996) [Available online historyireland.com https://www.historyireland.com/18th-19th-century-history/epidemic-diseases-of-the-great-famine/ ]
[8] Mokyr, J., and Ó Gráda, C., (1999) Famine Disease and Famine Mortality: Lessons from the Irish Experience, 1845-50. PDF, p. 7. [Available Online as PDF at semanticscholar.org ] https://pdfs.semanticscholar.org/498e/2d40caf5ebe67dfc422718a200112a488f79.pdf]
[9] CDC (1999) Etiology and Epidemiology of Cholera, in, Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera, Centers for Disease Control and Prevention, Atlanta, Georgia, Chapt., 5, p. 39. [Available online as PDF http://www.bvsde.paho.org/texcom/colera/etiology.pdf ]
[10] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 296, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]

 

Next Episode: Part Six: Scarlet Fever Returns, but it is a lot less deadly.

For updates on this series make contact on Facebook at Natural Immunity Community below or fill out the contact form if you haven’t signed up for the series already.

[image error]

[contact-form]


Advertisements

Main image to the article – a pencil drawing of potion to protect against Typhus Fever: Source: Roscommon & Leitrim Gazette – Saturday 29 June 1822
DON’T COUNT
Your
CHILDREN
Until
They’ve had
The
P O X!

A GRAPHIC HISTORY EXPLORING GENERATIONAL IMMUNITY

IRELAND & BEYOND

by

M.B. O’Hare

 

NATURAL IMMUNITY SERIES:

Contact DiG-Press via email for more information: mailto:diggingupthefuture@gmail.com

© M. B. O’ Hare. 2018.

May be used for educational purposes without written permission but with a citation and copyright notice linked to this source.

NATURAL IMMUNITY TEN PART SERIES
Introduction:
Can We Now Count Our Children?
 Part One:
How was the War on Bugs Won?
Part Two:
Whatever happened the Bubonic Plague and what has Chickenpox got to
do with it
Part Three:
The Many ‘Typhoid Marys’
Part Four:
Typhus: Filling in the Gaps
Part Five:
Cholera: The Disease that Inspired Bram Stoker to Write Dracula?
Part Six:
Scarlet Fever Returns: but it is a lot less deadly
 Part Seven:
Don’t Count Your Children Before They Get The Pox
Part Eight:
Would we survive Smallpox if it escaped from a Lab today?
Conclusion:
From the Plague to the Pox

————————————————————————-

Part Four: Typhus: Filling in the Gaps

Typhus’ Rise to Prominence

 

[image error]

Fig. 1: Chart of the annual number of deaths in Ireland officially recorded from Typhus Fever since records began for this disease. Note the large spike at the beginning.  Source: Chart generated using annual statistics reports since records began – “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link. © Copyright dig-press.com

The death toll from Typhus may have been significantly greater prior to 1864 in Ireland. This is indicated by the rather large spike at the beginning of the graph above (Fig. 1). This spike accounts for some 2000 officially recorded deaths from Typhus and may just be the tip of the iceberg, or, in other words, the very tame tail-end of a much more devastating disease of the decades preceding it.

For instance, as Peterson has suggested  –

“…Mortality is incredibly high under epidemic conditions, nearing 100%…” (2018, 156) [1].

– and now we can perhaps begin to make a stab at the real impact of Typhus preceding 1864 by applying the estimates given in the following for what seems to be Ireland’s first major encounter with epidemic Typhus going back to 1816.

THE HISTORICAL IMPACT OF EPIDEMIC TYPHUS

Typhus had been recognized in Ireland as early as 1652, but it was not until 1816 that a major epidemic of the disease produced 700,000 cases out of a population of 6,000,000. Three more major epidemics thereafter, in 1821 and 1836, accompanied harvest failures.
Conlon, J. M., (2007, 13)
[2]

In an attempt to fill in the historical gaps, we can extrapolate the proposed fatality rate from Typhus (see Peterson, 2018, 156) and apply it to the figure of well over half a million cases estimated for the initial devastation of the 1816 Irish epidemic. Now, in the context of a total population of about six million, this means that Typhus may have been much more deadly than previously recognised. Almost one person out of every six of the entire population of six million had seemingly been infected and most of them probably didn’t survive. This begins to echo the scale of deadly impact within a naive population that is unfamiliar with a particular pathogen as discussed previously.

However, as also discussed thus far, in the case of any previously unexposed population, as devastating as a population’s initial encounter with an unfamiliar pathogen, it also appears to be the case that these same populations rapidly adapt to even the most deadly of pathogens and within a few short generations, become effectively resistant, and ultimately immune – via general background exposure (rebalance has been achieved perhaps?). ( See, previous discussion here).

Typhus, it seems, is no different as we are encouraged to see that when we look at the official data of recorded deaths annually in Ireland from this once mighty pathogen, we can clearly see that the annual number of deaths dropped dramatically from around 2000 deaths to an average of 500 deaths annually after the large spike of 1864, followed by a little rise again and then its fatality within the population as a whole becomes significantly less throughout the rest of the 19th Century. Finally, deaths from Typhus becomes a rarity by the first quarter of the 20th Century, never to be heard of again in this country (Fig. 1).

Once again, we seem to be looking at a natural rise and fall pattern of deaths from a previously much more deadly contagion. This is well supported by the historical accounts of the disease as you will see throughout the discussion that follows. But first, we will explore some other proposals, that are commonly offered as explanations for such devastating epidemic outbreaks and their ultimate resolution.

One suggestion is given above (see Conlon, 2007, 13),  in terms of the disease coming in most fiercely on the back of harvest failures. This would seem a reasonable suggestion, however, when we drill down to the details, it doesn’t quite stand up to scrutiny as history has shown as argued by Dirks 1993, and Carmichael 1983:

“It should be pointed out that recent research has questioned the widely held assumption that malnutrition inevitably leads to increased susceptibility to infection.” (in Mokyr, J., and Ó Gráda, C., 2002, 21). [3].

This insight is further reiterated by other researchers who have concluded something similar regarding this widely held assumption, and also support the general proposal presented here in pointing out that the pattern of disease can best be explained from a biological perspective:

Famine, Mortality, and Epidemic Disease in the Process of Modernization
Chambers carried his case to the point of questioning the medical concept that under-nutrition and malnutrition interfere with the ability to resist infectious contagion, acknowledging, however, that nutritional deficiencies will exacerbate endemic illnesses …
Since European famines were not invariably followed by serious epidemics, it is possible that plague and similar crises of public health were essentially biological in origin and not directly related to problems of subsistence.
Thus Fernand Braudel has stated that “every disease has its own autonomous life, independent of the endless correlations” historians suggest, and that correlations with economic crises are “at most only minor accidents in a history linked with other factors”…
Post, J.D., (1975, 14)
[4]
https://www.jstor.org/stable/2594505?seq=1#page_scan_tab_contents

As highlighted above, seemingly outbreaks of any of the major contagious diseases within such widely disparate regions, do not necessarily correlate with famine, crop failures or malnutrition in general when viewed together and within the broader context of the impact and spread of the disease itself.

For instance, famines or crop failures are noted a number of times as occurring within Ireland at around the same time as various epidemic eruptions, including such diseases as Typhus (See Creighton, 1894) [5]. However, as highlighted above, this may not actually be causal to either its rise or its demise, but merely a coincidental historical observation.

For instance, the United States did not have any particular crop failures when it experienced its first major Typhus outbreak of the 1830s, around the same time as Ireland was experiencing its own Typhus epidemic, nor did many parts of Europe that experienced near-simultaneous Typhus outbreaks have corresponding widespread crop shortages.

Now, take, for example, London (see excerpt below), where it also seems that although a major Typhus epidemic was underway at around this time as the Irish epidemic of the 1830s,  crop failure is not the main factor in its eruption or spread?

Health and Hygiene in the Nineteenth Century
In the 1830s the “new fever,” typhus, was isolated. During its worst outbreak, in 1837-38, most of the deaths from fever in London were attributed to typhus, and new cases averaged about sixteen thousand in England in each of the next four years.
Douglas, L., (Victorian Web, 11th Oct., 2002)
[6]
http://www.victorianweb.org/science/health/health10.html

Another example that famine wasn’t a major factor in, or direct cause of, the rise of Typhus is highlighted in the following in relation to Scotland, which experienced the same type of epidemic Typhus of the same general period and experienced fairly large death tolls as Ireland; yet, as the excerpt points out:

A History of Epidemics in Britain, Volume II
“The increase of fever in Glasgow,” says Cowan, “during the seven years prior to 1837, had taken place, not in years of famine or distress, but during a period of unexampled prosperity, when every individual able and willing to work was secure of steady and remunerating employment.
Creighton, C., (1894, 191)
[7]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm

The evidence presented above lends good support to the idea that Typus was what we would call pandemic, i.e., it hit a great many nations, on different continents of the world, at about the same time, with a similar virulence. Thus, a localised crop failure in one region cannot possibly explain the similar eruptions in other nations not suffering a similar plight.

Therefore, as resultant malnutrition are not necessarily linked directly to massively increased deaths from highly infectious diseases such as Typhus, instead – perhaps indirectly, the common body louse has been implicated in the disease – and by association – its spread as indicated below:

Epidemic Diseases of the Great Famine
It is now known that the vector of fever was not famine, nor social distress… but pediculus humanus, the human body louse.
Geary L., (Spring 1996, History Ireland Magazine)
[8]
https://www.historyireland.com/18th-19th-century-history/epidemic-diseases-of-the-great-famine/

Does that mean that crowded conditions and lice infections were the cause? Perhaps not entirely either, as another historical reference suggests.

A History of Epidemics in Britain, Volume II
The lesson of the history is unmistakable: with all the inducements to typhus from neglect of sanitation in the midst of rapidly increasing numbers, there was surprisingly little of the disease…
Creighton, C., (1894, 167)
[9]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm

It is therefore fairly unlikely that this pattern of disease within populations can be directly caused by any of the main factors that we would normally attribute to such spread and high mortality from such contagions.

The idea that neither famine, starvation, nor necessarily overcrowding and generally lousy conditions can fully explain the initial devastation of Typhus in its plague-like devastation is further supported by the evidence emerging from historical accounts of what is often referred to as the Great Irish Famine of the mid-1840s. (it was much more socially and politically complex than simply crop failure, but that is another story).

For instance, the estimates of deaths from Typhus at this time from the so-called famine relief workhouses (that kept fairly comprehensive records for the main famine years) are rather low relative to the high mortality from all the other famine-related causes of death – particularly, considering that the workhouses would have been hotbeds for body lice makes the following figures even more surprising.

THE HISTORICAL IMPACT OF EPIDEMIC TYPHUS
Approximately 190,000 Irish citizens died from typhus contracted in the louse-infested workhouses they were forced to inhabit….
Conlon, J. M., (2007, 13)
[10]
http://www.montana.edu/historybug/documents/TYPHUS-Conlon.pdf

No other circumstances should have been more conducive to encouraging the ravages of Typhus and other widely infectious diseases than this. But, as suggested in the figures given above (almost 200,000 deaths from Typhus over the course of the few years of the Great Famine which, broadly speaking would average out to less than 50, 000 deaths from Typhus over each of the famine years), is still significantly lower than the estimated death toll for the initial epidemic of 1816 (perhaps as much as half a million in a single outbreak) when living conditions were significantly better than during the Famine years of the mid 1840s onwards.

In other words, it looks like the later outbreaks of Typhus – (post-early 1800s), the widespread Typhus pandemics of the 1830s, and onwards until the Great Irish Famine era (even at the height of great famine,  pestilence and recorded louse infestations) and certainly after this point, Typhus, as a harbinger of near-certain death in the early days to an estimated one in every six of the entire population of relatively healthy and hardy people, had become increasingly tame over the decades that followed; even during the nation’s most dreadful famine years of the mid to late-1840s.

Indeed, there are historical accounts that support the taming of this once more deadly disease of Typhus, as supported in the following:

A History of Epidemics in Britain, Volume II
It was from 1830 to 1834 that a change in the reigning type of fever began to be remarked in London, Dublin, Edinburgh and Glasgow, the new type becoming more and more evident as fevers became more prevalent in the ‘ thirties ‘ and ‘forties.’
Relapsing Fever the common type in 1847, …
Mayo and Galway, and in Gweedore, Donegal, not more than one in a hundred cases of relapsing fever proved fatal. In Limerick the mortality was ” very small.” In many places it is given at three in the hundred cases, in some places as high as six in the hundred. When deaths occurred, they were often sudden and unexpected…
Creighton, C., (1894, 189)
[11]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm

Relapsing Fever as it turns out is actually the less lethal form of Typhus and it is notable that this phenomenon is near-simultaneous – from the 1830s onwards – throughout many regions, including  Ireland. The fatalities indicated in the excerpt above for those that got the relapsing form of the fever are significantly less (one or as many as six per hundred of cases of the disease and the cases themselves do not seem to be that many) than those estimated for the initial 1816 epidemic.

Interestingly, although communities were finally starting to sigh a breath of relief as Typhus (relapsing fever) was seemingly becoming less deadly, after the mid 19th Century, people on the ground – so to speak, were beginning to feel its replacement in the form of another contagion: namely, Enteric Fever, which is another name for Typhoid Fever (see previous article here) as referenced below:

A History of Epidemics in Britain, Volume II
The cases of enteric fever increased decidedly after 1865… ….The disappearance, during the last twenty years, of typhus and relapsing fevers from the observation of all but a few medical practitioners in England, Scotland and Ireland, is one of the most certain and most striking facts in our epidemiology.
…Still more recently, the relative proportions of typhus and enteric fever have been reversed, so that there have been years with little or no typhus but with a good deal of enteric fever… Typhus declined, and typhoid rose…
Creighton, C., (1894, 202)
[12]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm

[image error]                              

Fig. 2: Chart of the annual number of deaths in Ireland from Typhus Fever (black) compared to the annual number of deaths officially recorded from Typhoid Fever (light grey and translucent) in Ireland since records for these diseases began. Source: Chart generated using annual statistics reports since records began – “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link. © Copyright dig-press.com.

Figure. 2 above, clearly shows this rise in deaths of Enteric Fever (Typhoid) as deaths from Typhus decline. Now we know why the deaths from Typhoid Fever were only recorded from 1881 onwards, as Typhoid hadn’t much hope of getting in while Typhus was wrecking havoc. It also puts the comparatively small number of deaths from Typhoid annually in Ireland into some sharp relief when we begin to calculate the estimated mass devastation that Typhus seems to have caused at its height – prior to when official records began. The graph above (Fig. 2) also clearly illustrates the dramatic and ultimate decline in deaths from both diseases in the end.

This historical investigation into the fate of Typhus revealed that this once mighty disease soon lost its grip throughout much of the 19th Century in Ireland and elsewhere and this is strongly indicated by the historical estimates as well as the documented observations of a  shift from the more deadly form of Typhus to what came to be known as relapsing fever (the less deadly form). This evidence is indicative of natural resistance to the pathogen due to exposure over generations, even in the greatest years of hunger and destitution, which finds further support in the excerpts that follow.

A History of Epidemics in Britain, Volume II
… The best illustrations of the greater severity and fatality of typhus among the well to do come from Ireland, in times of famine…
But it may be said here, so that this point in the natural history of typhus fever may not be suspected of exaggeration, that the enormously greater fatality of typhus (of course, in a smaller number of cases) among the richer classes in the Irish famines, who had exposed themselves in the work of administration, of justice, or of charity, rests upon the unimpeachable authority of such men as Graves, and upon the concurrent evidence of many…
Creighton, C., (1894, 189)
[13]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm

This historical excerpt begins to explain the possible reason why the death toll was not much more massive during the Irish Famine of the 1840s, as it seems that most of the Irish who were impacted the greatest by malnutrition and just about everything else that could be thrown at them, were for the most part, essentially resilient to Typhus’ worst effects  (and those that did survive had to face the onslaught of  an unfamiliar pathogen that was implicated in Typhoid).

On the other hand, as reiterated below, those who were the least exposed to such conditions – the most hygienic, best-fed and generally healthiest individuals – the professionals and philanthropists trying to care for the destitute Irish, were the most vulnerable to Typhus’ worst effects.

Epidemic Diseases of the Great Famine
“During the Great Famine, relapsing fever was the prevalent disease among the general population, while the higher social classes tended to contract the more deadly typhus fever, especially those who were most exposed to infection, notably clergymen, doctors, members of relief committees and those connected with the administration of the poor law. The mortality rate from typhus was also more pronounced among the middle and upper classes than it was among the poor, who may have developed some immunity through long-term exposure”.
Geary L., (Spring 1996, History Ireland Magazine)
[14]
https://www.historyireland.com/18th-19th-century-history/epidemic-diseases-of-the-great-famine/

 

It seems that it is the less well-washed and most exposed to body lice populations that were able to build up the most formidable resistance to the disease, whilst, unfortunately, it was the people who had the least resistance that ended up with the poorest immunity, those with the greatest intentions, that ended up more frequently with the decidedly deadlier form of Typhus than those they were trying to help.

The key point from this historical investigation is that it is obviously quite important to be exposed to such pathogens in the first place in order to build up familiarity and utlimate immunity, particularly as our ancestors have seemingly already taken the hit for us. Thus, by not being too squeaky clean and allowing a little clean dirt into our lives, we are actually building up robust resistance to all sorts of pathogens – whether we know it or not.

Remember, just like the pathogen that appears to trigger Typhoid or, the pathogen implicated in the Plague, these microbes never actually went anywhere – they still exist all around us today and can, very occasionally, find a little chink in our armour. And particularly under extreme conditions that can and have sometimes erupted in later history into sporadic epidemics – but nowhere ever on the scale of previous times. Nor, has the common body louse and its own particular parasite that is supposed to be the main cause of  Typhus gone extinct  – it still exists today.  

So, obviously, it helps not to invite the return of such critters to test just how robust our ancestral immunity may actually be, but, as we generally do not – thankfully – hear much about Typhus in our own developing nations these days, perhaps we are more generationally resistant to it than we realise. At this stage, after two major world wars and the amount of travelling that we have done over the past few generations, I would say that our immune systems are all pretty much now familiar with the Typhus pathogen. The fact that we do not often hear about the disease, is probably due to our immune systems doing such a good job all these years. Long may it continue. And presumably, the less developed nations currently having their own battle with such pathogens, as we once did not that many generations ago, will soon follow suit in terms of their own more robust immunity.

Hopefully, this has filled in some of the gaps in our knowledge regarding Typhus.

 

References for Part Four
[1] Peterson, K.D., (2018) Typhus, Entomology Group Insects, Disease, and History, Montana State University, p.156. [Available online]
[2] Conlon, J. M., (2007) The Historical Impact of Epidemic Typhus, Entomology. Montana Education, History of the Bug, p. 13. [Available Online Google].
[3] Mokyr, J., and Ó Gráda, C., (2002) Famine Disease and Famine Mortality: Lessons from the Irish Experience, 1845-50. in: eds., Tim Dyson & Cormac Ó Gráda. Famine Demography: Perspectives from the Past and Present, Oxford University Press, p. 21. [Available Online]
[4] Post, J.D., (1976) Famine, Mortality, and Epidemic Disease in the Process of Modernization, The Economic History Review. Vol. 29, [1], pp. 14-37 [Available online at JSTOR.ORG https://www.jstor.org/stable/2594505?seq=1#page_scan_tab_contents ]
[5] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[6] Douglas, L., (2001) Health and Hygiene in the Nineteenth Century, The Victorian Web (11th Oct., 2002), http://www.victorianweb.org/science/health/health10.html
[7] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 191, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[8] Conlon, J. M., (2007) The Historical Impact of Epidemic Typhus, Montana Education, History of Bugs. p. 13 [Available online as PDF from http://www.montana.edu/historybug/documents/TYPHUS-Conlon.pdf ]
[9] Geary L., (1996) 18th – 19th Century History/Epidemic Diseases of the Great Famine.., History Ireland Magazine, Vol. 4. [1] (Spring 1996) [Available online historyireland.com https://www.historyireland.com/18th-19th-century-history/epidemic-diseases-of-the-great-famine/ ]
[10] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 167, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[11] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 167, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[12] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 189, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[13] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 202, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[14] Geary L., (1996) 18th – 19th Century History/Epidemic Diseases of the Great Famine.., History Ireland Magazine, Vol. 4. [1] (Spring 1996) [Available online historyireland.com https://www.historyireland.com/18th-19th-century-history/epidemic-diseases-of-the-great-famine/ ]

 

Next Week’s Episode: Part Five: Cholera: The Disease that Inspired Bram Stoker to Write Dracula? (note the name change from Typhus to Typhoid.)

Fill in the contact form below – if you haven’t already – this lets me know that if you want weekly updates as each episode becomes available of the series: ‘Don’t Count Your Children Until They’ve Had the POX!’

[contact-form]

 

 

 

 

Darwin vs, D’Arcy, Evolution by non-Darwinian Means … Beta Preview Available to view here

Click book cover for preview:

[image error]

Or click HERE: Beta reading preview Darwin vs D Arcy evolution by non Darwinian means

I need to limit the Beta Readers – so as to make the most of the feedback. So if you are really keen – please let me know ASAP by filling in the contact form below and tell me a little bit about why you have an interest in this topic and any background in sciences that you might have. And/Or share with someone you think might be a particularly suitable Beta Reader for this book.

Cheers

Look forward to hearing from you.

Mariabrigit
[contact-form]

BOOK NOW AT BETA READING STAGE: Full title: Darwin vs, D’Arcy, Evolution by non-Darwinian Means by M. B. O’Hare (PhD – but not in Evolution).

I will have several clear categories for Beta Readers to focus on (Readability, Lay person’s scientific understanding, Flow, Logic, Bumps on the Road, Style, Level of Interest, i.e., Nod Factor – nodding off to sleep in parts etc…) and to grade 1 to 5 (five being the most and one being the least). Each category will have a very short comment section and overview summary at the end to highlight main issues and solutions.

[image error]

I have included most of part one HERE: Beta reading preview Darwin vs D Arcy evolution by non Darwinian means to give you an idea of what is in the rest of the book.

The book will be about 180 pages (including a significant bibliography and original infographics) when fully formatted. After feedback – the book should be published by mid-Autumn (Fall) 2018. In return, for anyone who has participated as a Beta Reader for this book, you will be sent the Finished product in Kindle or any other e-reader compatible format that you would prefer which can be shared.

I need to limit the Beta Readers – so as to make the most of the feedback. So if you are really keen – please let me know ASAP by filling in the contact form below and tell me a little bit about why you have an interest in this topic and any background in sciences that you might have. And/Or share with someone you think might be a particularly suitable Beta Reader for this book.

If you are interested in becoming a reviewer of this book (preferably on Amazon if you have an account/Goodreads etc or any of your main reading platforms) when it is published or submit here directly to be associated with the book  – I will send you a direct e-book/kindle version – there is no commitment regarding these reviews, all I ask is that they are genuine constructively critical and relevant.  (A paperback version will go to the first 3 reviewers who have also been a Beta Reader for the same book). Again fill in the contact form below and state your interest: BETA READER, POTENTIAL REVIEWER, BETA READER AND POTENTIAL REVIEWER.

Cheers

Look forward to hearing from you.

Mariabrigit
[contact-form]

via Part Three (of ‘Don’t Count Your Children Until They’ve Had The POX!’) The Many ‘Typhoid Marys…’

Click Here for last week’s article: Part Two ‘Whatever Happened to the Bubonic Plague and what has Chickenpox got to do with it?
Part Three of Weekly Series:
DON’T COUNT
Your
CHILDREN
Until
They’ve had
The
P O X!

A GRAPHIC HISTORY EXPLORING GENERATIONAL IMMUNITY

IRELAND & BEYOND

by

M.B. O’Hare

 

NATURAL IMMUNITY SERIES:

Contact DiG-Press via email for more information: mailto:diggingupthefuture@gmail.com

© M. B. O’ Hare. 2018.

May be used for educational purposes without written permission but with a citation and copyright notice linked to this source.

NATURAL IMMUNITY SERIES
Introduction:
Can We Now Count Our Children?
 Part One:
How was the War on Bugs Won?
Part Two:
Whatever happened the Bubonic Plague and what has Chickenpox got to
do with it
Part Three:
The Many ‘Typhoid Marys’
Part Four:
Typhus: Filling in the Gaps
Part Five:
Cholera: The Disease that Inspired Bram Stoker to Write Dracula?
Part Six:
Scarlet Fever Returns: but it is a lot less deadly
 Part Seven:
Don’t Count Your Children Before They Get The Pox
Part Eight:
Would we survive Smallpox if it escaped from a Lab today?
Conclusion:
From the Plague to the Pox

 

Part Three
The Many ‘Typhoid Marys’

Typhoid fever facts, information, pictures | Encyclopedia.com articles about typhoid fever
Typhoid fever is passed from person to person through poor hygiene, such as incomplete or no hand washing after using the toilet. Persons who are carriers of the disease and who handle food can be the source of epidemic spread of typhoid. One such individual gave her name to the expression “Typhoid Mary,” a name given to someone whom others avoid.
[1]
 Gale, T. (2006)
Typhoid Fever, Gale Encyclopedia of Medicine, 3rd ed.

But, as it turns out, Mary Mallon, the silent carrier of Typhoid Fever, was not actually as deadly as her infamy would lead us to believe. It is simply that her case was the most publicised at the time.

1938 – DEATH OF MARY MALLON (BORN IN COOKSTOWN, COUNTY TYRONE), ALSO KNOWN AS TYPHOID MARY…

“Mary Mallon was born in 1869 in Cookstown, Co Tyrone. She emigrated from Ireland to the United States in 1884.

Mallon became the focus of one of the best-known episodes in the history of communicable disease when U.S. health officials identified her as a healthy carrier of the organism causing typhoid fever. Mallon, who refused to acknowledge her role in spreading the disease as a cook, is known to have infected at least 53 people, resulting in three deaths. Unable to stop her from cooking for others, New York City authorities confined her for 26 years…”
Stair na hÉireann/History of Ireland (2014)
[2]

I am sure if we could explain to Mary back then (but no one knew at that time), that she simply could not feed anyone uncooked food – no matter how delicious her recipe for frozen peaches was, and still would have been able to maintain herself through work and not spend more than a quarter of her life in captivity with threats of removing her gallbladder.

Mary mostly cooked for wealthy families, some of which she inadvertently infected, and as you will see below, she also infected other well-scrubbed and well-fed individuals such as, doctors, nurses and medical staff at a maternity hospital. Essentially, people who would have had the least exposure from their environment of such a pathogen.

Refusing Quarantine: Why Typhoid Mary Did It
Health officials lost track of her for a few years, but found her again in the midst of another typhoid outbreak, this time at a Manhattan maternity hospital where 25 people, mostly doctors and nurses, were infected. Mary had been cooking there under a fake name, but fled before health officials could catch her. They traced her to a house in Queens, where they had to sneak in through a second-story window, using a ladder, to apprehend her, according to the Times report on the event.
[3]
Latson, J (2014) , Time Magazine (Nov., 11th 2014)

In some ways, as tragic as the few deaths were that Mary inadvertently caused, look how many people she infected (particularly the most hygienic health professionals as they probably had managed to avoid such an unhygienic infection up to this point in their lives), and did survive to tell the tale, thus leaving them with immunity from the disease for life. Moreover, her spate of silently spreading the disease to previously unexposed individuals should be viewed in the context of the bigger picture of the devastation the disease itself had caused amongst populations both within Ireland, her homeland, and across the Atlantic.

[image error]

Fig. 1: Chart of the annual number of deaths in Ireland from Typhoid Fever since records for this disease began. Note the dramatic decline throughout the late 19th Century through to the mid 20th Century. Source: Chart generated using annual statistics reports since records began – “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link. © Copyright dig-press.com

When the rate of annual deaths from Typhoid Fever are compared between the U.S. and Ireland we find a near identical decline for a similar timeframe where the main difference is simply a matter of scale. I.e., the U.S. population being much greater than that of a tiny country like Ireland, the proportions of deaths per population from Typhoid would have been similar, but of course the  actual total numbers of deaths per year in the U.S would have been in the tens of thousands.

For instance, a graph [4], Figure 16, p. 82, Vital Statistics Rates, Death rates for Typhoid Fever: Death –registration States, 1900-32, and United States, 1933-60, based upon rates per 100,000 population show that at its height,  there were 32 deaths per 100,000 per year starting at 1900 (in a population of a couple of hundred million, that’s a lot of deaths) and declining to less than 20 deaths per 100,000 dramatically dropping from 1910 onwards and from the 1920s, this downward trend continues until deaths from Typhoid Fever becomes very rare by the 1960s.

In Ireland, (See Fig. 1), the deaths per year from Typhoid Fever had become almost a rarity by the 1920s and 30s, with a slight peak in the 1940s and then practically unheard of after this period. The Irish had seemingly won their battle against the disease, as did Americans. In other words, in the scheme of things, Typhoid Mary was a drop in the Atlantic Ocean when it comes to being responsible for the spread of Typhoid Fever in the States.

By the time Mary Mallon had landed as an Irish immigrant on the U.S. shores, deaths from Typhoid Fever were already on the brink of free-fall, suggesting that the vast majority of people were well on their way to becoming immune to the disease already. Almost everyone had most likely already been exposed to the Typhoid, whether they knew it or not, and had become immune for life. This is reflected in the statistical data, indicating that generations had already become resilient and hardened to the disease, making it increasingly more difficult for the pathogen to gain a foothold in these populations as a whole. Was Mary alone in not remembering that she had the disease, or perhaps she was correct when she said she never had any symptoms at all.

As it turns out, she was not the only ‘Typhoid Mary’ type – apparently there were many others just like her, but of course, they weren’t all called Mary. Although her case is certainly the most famous, being a silent, or latent carrier of Typhoid was not actually that uncommon.

Typhoid and Paratyphoid Fever
About 1 in 300 people infected with typhoid fever may have a low-grade infection.
They may not develop any significant symptoms, and then become carriers of the disease’.
Tidy, C. (2018)
[5]

That’s not taking into account the ones that were infected but didn’t know it for some time after as symptoms develop late in this disease as also indicated in the rest of the article excerpted above. So you can perhaps begin to imagine how much of the population in both Ireland and the United States had already had exposure to the disease and built up community immunity from having survived it.

This begins to make sense of the steep decline in deaths in both nations over a similar course of time, and how the pathogen was dramatically losing its grip on the population as a whole – it was running out of options to colonise new hosts – fresh victims now only remained in small pockets of previously unexposed individuals. But what if we imaged for a moment that Mary was put on a boat and set out to sea, maybe to keep her company they gathered up all the known silent carriers. ‘Typhoid Mary’ and her merry band of exiles, although, not as lethally infectious in the scheme of things back home, due to so many having already built up resistance, if they happened upon a previously naive native population who had absolutely no immune resistance or experience to these foreign pathogens, their arrival would be devastating, at least initially.

The vessel carrying the bunch of ‘Typhoid Mary’ types, would not be that different from what has been all too commonly documented historically, particularly when explorers and colonisers of the so-called New Worlds of the Americas and Southern Latitudes arrived as silent carriers showing no signs of diseases or particular ill-health themselves, yet little did anyone know until the previously uninfected Indigenous Peoples begin dying in great numbers that what had happened began to sink in – old pathogens within previously exposed and now resilient populations had found new virgin territory to colonise.

Charles Darwin – the great evolutionist, directly quotes and comments on such incidences in relation to his own experience whilst on his adventures to the South seas in the Beagle.

CHAPTER XIX Australia in 1836:
The Rev. J. Williams, in his interesting work, … says, that the first intercourse between natives and Europeans, “is invariably attended with the introduction of fever, dysentery, or some other disease, which carries off numbers of the people.” Again he affirms, “It is certainly a fact, which cannot be controverted, that most of the diseases which have raged in the islands during my residence there, have been introduced by ships; … and what renders this fact remarkable is, that there might be no appearance of disease among the crew of the ship which conveyed this destructive importation.”
This statement is not quite so extraordinary as it at first appears; for several cases are on record of the most malignant fevers having broken out, although the parties themselves, who were the cause, were not affected.
Darwin, C (1839)
[6]
In :Alice Bergfeld – Rolf Bergmann – Peter v. Sengbusch BOTANY Online – The Internet Hypertextbook 2004.

Historically, this was an all too common phenomenon, but thankfully, it would seem that most of the world has had experience with many of these much deadlier infectious contagions and they are now incredibly rare, at least in our more developed nations. Interestingly, there is an indication from the literature in general that these same diseases are becoming rarer in less developed nations too. It looks like Nature is on the case and as you will see below, there is strong evidence to suggest they too will soon be looking back at their mortality statistics and seeing a similar pattern of plummeting deaths as we have thankfully experienced now in the developed world.

For example, the article excerpt below describes the historical devastation from Europeans – who were like Typhoid Mary and her band of silent carriers of plague-like proportions as given in accounts from when these new settlers and adventures began to colonise the Americas from the 16th Century onwards. However, it also offers hope, as it describes the natural resilience that can come about from having exposure to such pathogens circulating in general.

Rationalizing epidemics: meanings and uses of American Indian mortality since 1600
Europeans encountered new populations, in Hispaniola and Mexico in the 1500s, in New England and Quebec in the 1600s, and even in Alaska and the Amazon in the 1900s, they witnessed terrible mortality. Epidemics of smallpox, measles, and influenza took the highest toll. These diseases, endemic in Europe, had not been present in the Americas before European arrival. Europeans, exposed as children, developed immunity that protected them as adults. American Indians, without this immunity from prior exposure, and stressed by the chaos of European colonization, were dangerously vulnerable. They died in great numbers…
 Jones, D.S. (2004)
Rationalizing Epidemics: Meanings and Uses of American Indian Mortality since 1600. Cambridge: Harvard University Press, p. 26
[7]

The above excerpt reveals that seemingly, the Europeans themselves, due to exposure as children had become rather resilient to such previously devastating plagues, to the point where they all became ‘Typhoid Mary’ types, and although it was initially devastating to the previously unexposed natives, there is actually a possitive side to this story as that surely, if the Eurpeans had become immune generations before, then so could the natives themselves. The Europeans would have once been in the same boat generations before. The article excerpt below lends some support to this idea:

Immune Aspects of First Contact Epidemics
Isolated island populations were clearly subject to disastrous outcomes when new infectious diseases were first introduced, but this often did not extend to subsequent epidemics by the same pathogen…
Mathematic models make it clear that whatever the reason the extreme mortality rapidly decreased after the first-contact epidemics on Pacific islands, it was not due to Darwinian selection of disease-resistance genes. The time interval of only 2–3 generations is simply too short to involve such putative disease-resistance genes.
Shanks, G.D. (2016)
Am J Trop Med Hyg. 2016 Aug 3; 95(2): 273–277. doi: 10.4269/ajtmh.16-0169
Lethality of First Contact Dysentery Epidemics on Pacific Islands
[8]

We have only in more recent times began to gain more insight into just how adaptable and responsive the immune system actually is. Seemingly, just about every living thing can rapidly respond and defend itself from danger and threats, particularly disease, without having to wait around for millions of years in hope that we might end up with the lucky genes that will save us in the end. In other words, as indicated in the excerpt above, adaptation and resistance to disease can be handed down through generations and goes directly againt our current dogma of genetically-driven adaptation as the following excerpt title highlights:

Your Immune System Is Made, Not Born
New research dispels the belief that the strength of the body’s defense system is genetically programmed
…genes themselves need instructions for what to do … Those instructions are found not in the letters of the DNA itself but on it, in an array of chemical markers and switches, known collectively as the epigenome, that lie along the length of the double helix. These epigenetic switches and markers in turn help switch on or off the expression of particular genes. Think of the epigenome as a complex software code, capable of inducing the DNA hardware to manufacture an impressive variety of proteins, cell types, and individuals.
Landhuis, E. (2015)
[9]

You see, Nature may not be in the business of only allowing the fittest to survive, but ensuring that we all survive via a very different flexible non-genetic epi-genetic code  and one of the ways this is done in via our mothers.

Immune Priming: Mothering Males Modulate Immunity
Non-genetic transfer of immunity from mother to offspring is a well-recognized phenomenon known as transgenerational immune priming. Mammals, for instance, exchange immunological information on abundance and composition of pathogens to offspring via the placenta and antibody-rich mother’s milk…
The paradigm is that offspring who are destined to be raised in a similar disease environment to their mothers will benefit from a maternal enhancement of offspring immunity that reflects the current environmental challenges.
Keightley M.C., Wong B.B.M, and G J. Lieschke (2013)
[10]

It also now looks like we can inherit this hard-fought-for immunity, not just from our mother’s directly, but from their mother’s and perhaps generations of mothers before them as suggested by the following study – at least in pigeons.

Grandmothers can pass immunity to their grandchildren, at least in pigeons
At the moment of birth, a newborn leaves behind its safe protective environment and enters a world teeming with bacteria, parasites, viruses, and infectious agents of all sorts. However, the babies do have one trump card: antibodies and immune compounds passed across the placenta from their mothers. These short-lived molecules can dip into mom’s immunological experience to protect the newborn until the immune system gets up to speed. Now, a new study in pigeons suggests that some baby birds owe their early immunity not just their mothers, but to their grandmothers as well.
…previous research has suggested that these early maternal immune compounds may have “educational effects” on the newborn’s developing immune profile—that they may somehow be priming the system to be on the lookout for common local diseases or parasites…
Shultz. D (2015)
[11]

In other words, it is now looking quite likely that our immune systems can memorise past battles with pathogens – epigenetic imprinting which is generational – i.e. these adaptations can be inherited along with your genes and we can pass those experiences and expertise gleaned from the battles to our offspring.

You see, your immune system, as we are coming to appreciate in more recent times, as we gain more insights into tiny biochemical and molecular world beyond the relatively fixed and unchanging genes, is just as clever and flexible as the pathogens themselves.  Most of us have heard of antibiotic resistant strains of bacteria and how bugs can become superbugs due to their rapid adapation to our efforts to eradicate them? Well, our immune systems also adapt rapidly to pathogens, it is just that we are more complex and bigger than bacteria, so it might take us a few generations for the whole community to become robustly immune as suggested by the mathematically model study highlighted earlier.

Unfortunately, there are casualties, particularly when a pathogen that our immune systems are not familiar with gains a foothold, as illustrated by the large number of deaths from Typhoid Fever in the earlier days since records began as seen in the Irish chart and discussed for the U.S. Our immune systems are built to adapt to and withstand all sorts of pathogens as illustrated so clearly, not just in the mortality charts for Typhoid, but for all the other highly infectious disease that were once significantly more deadly as the record clearly shows.

Therefore, it seems that the more the immune system is exposed to the pathogen, directly, or indirecly as it silently circulates in the natural background (bear in mind that the Typhoid causing pathogen never went extinct, it is still with us today), the more adept our immune system becomes at defending us. In effect, each exposure – even if we are not sometimes aware of the pathogen circulating, trains and educates our immune systems to deal with just about everything in the end.  And now, it looks like this immunity is not just for life if you survive the ordeal, or even have to experience the disease  directly to gain general resistance,  but that immunity may be inherited as well.

And just one more point on this long-term, non-genetic generational immunity. This means that there is hope for us even today, if for some reason one of these much deadlier contagions did erupt out into our modern-day world (perhaps via an intentional bioweapon), we may not have to fall about dying to build up community immunity all over again. This is supported in the following excerpt, which suggests that the disease doesn’t even need to be circulating in an obvious way for us to still build up and retain resistance to it. In other words, we may have now forgotten those diseases, but our immune systems have not.

Rethinking the Origin of Chronic Diseases
Some modern-day diseases reflect the capacity of organisms to “memorize” responses to external signals and transmit them across generations; …
 the original causative agent may not be extant today, but “memory” of the infection has persisted.
 
Shoja, M.M  et al, (2012)
BioScience, Volume 62, Issue 5, 1st May 2012,
[12]

So perhaps now you might see Mary Mallon’s story with a slightly different lens when we realise that being exposed to pathogens, in the broader scheme of things, although tragic for the few that lost their lives, there is actually a positive aspect underlying this means of infection via a healthy silent carrier of the disease.

It seems that we have our ancestors to thank for taking the greatest hit for us. Recall that each person who Mary infected (remember most survived), not only gained life-long immunity, but they gained something of even greater value – generationally immunity that they could then pass on to their own offspring for the future. We are that future.

——————————————————————————————————————————————————-
Next week: Part Four: From Typhus to Typhoid.
Fill in the contact form below for updates on the Ten Part weekly series: Don’t Count your Children Before they’ve had the Pox.

 

[contact-form]

 

References to Part Three

[1]  Gale, T. (2006) Typhoid fever facts, information, pictures, Gale Encyclopedia of Medicine, 3rd ed. [Available online Encyclopedia.com]
[2]  Stair na hÉireann/History of Ireland (2014)  1938 – Death of Mary Mallon (Born in Cookstown, County Tyrone), Also known as Typhoid Mary [Available online]
[3] Latson, J (2014) Refusing Quarantine: Why Typhoid Mary Did It, Time Magazine (Nov., 11th 2014) [Available online]
[4], Grove, R.D. and Hetzel, A.M.  (1968) Vital Statistic Rates in the United States, 1940-1960, U.S. Department of Health Education, and Welfare Public Health Service, Washington D.C. National Centre for Health Statistics (Figure 16, p. 82 Vital Statistics Rates, Death rates for Typhoid Fever: Death –registration States, 1900-32, and United States, 1933-60), [Available Online].
[5] Tidy, C. (2018), Typhoid and Paratyphoid Fever [Available online]
[6] Bergfeld, A, Bergmann R. and Sengbusch, P.V. (2004), Charles Darwin (1839), CHAPTER XIX :Australia in 1836,  BOTANY Online – The Internet Hypertextbook 2004.[Available online]
[7] Jones, D.S. (2004)  Rationalizing Epidemics: Meanings and Uses of American Indian Mortality since 1600. Cambridge: Harvard University Press, p. 26
[8] Shanks, G.D. (2016) Immune Aspects of First Contact Epidemics, Lethality of First Contact Dysentery Epidemics on Pacific Islands, Am J Trop Med Hyg. Vol. 95 [2], pp. 273–277. doi: 10.4269/ajtmh.16-0169 [Available Online]
[9] Landhuis, E. (2015), Your Immune System Is Made, Not Born, Discovery Magazine (Jan., 29th 2015)  [Available online]
[10] Keightley M.C., Wong B.B.M, and G J. Lieschke (2013) Immune Priming: Mothering Males Modulate Immunity, Current Biology, Vol. 23, [2] pp. 76-78 [Available online] doi:org/10.1016/j.cub.2012.11.050
[11] Shultz. D (2015) Grandmothers can pass immunity to their grandchildren, at least in pigeons, Sciencemag.com (Nov. 10th 2015), [Available Online]
[12]Shoja, M.M  et al, (2012), Rethinking the Origin of Chronic Diseases, BioScience, Vol, 62, [5], [Available online]

[image error]

GOT A STORY ?

Have you, or a loved one, had a personal experience with one of those once much more deadly infectious diseases and survived to tell the tale? Diseases such as Measles, TB, or Scarlet Fever.

It is amazing how many stories I have heard recently about Scarlet Fever – I thought that disease had disappeared – we never had a vaccine for it and when it did return, it didn’t start killing children in their thousands as it once did. Mind you there was a near miss with one family friend who nearly lost his daughter.

My story is of TB and the much less potentially deadly disease of Mumps (getting it from my son who was fully vaccinated) and I can tell you, it’s a whole lot worse getting it when older and the irony is that I didn’t get it as a child (but I got just about everything else going from Measles to Chickenpox) because my Mother – as it turned out – had protected me from it when my older sisters had it. I only found out when I had the Mumps and stood with my mouth agape, Saying to my apologetic Mother:

‘ YOU DID WHAT…?’

I’d love to include these stories in a full article on natural immunity (anonymously) –

SO PLEASE GET IN TOUCH IF YOU HAVE A NATURAL IMMUNITY STORY that fits into the theme of: ‘BEEN THERE, DONE THAT AND IMMUNE ALREADY BECAUSE OF IT.’

USE THE CONTACT FORM BELOW OR VISIT FACEBOOK  PAGE ‘NATURAL IMMUNITY COMMUNITY’ HERE

or

message directly on facebook below:

[image error]

[contact-form]

 

DON’T COUNT
Your
CHILDREN
Until
They’ve had
The
P O X!

A GRAPHIC HISTORY EXPLORING GENERATIONAL IMMUNITY

IRELAND & BEYOND

by

M.B. O’Hare

 

NATURAL IMMUNITY SERIES:

Contact DiG-Press via email for more information: mailto:diggingupthefuture@gmail.com

© M. B. O’ Hare. 2018.

May be used for educational purposes without written permission but with a citation and copyright notice linked to this source.

NATURAL IMMUNITY SERIES
Introduction:
Can We Now Count Our Children?
 Part One:
How was the War on Bugs Won?
Part Two:
Whatever happened the Bubonic Plague and what has Chickenpox got to
do with it
Part Three:
The Many ‘Typhoid Marys’
Part Four:
Typhus: Filling in the Gaps
Part Five:
Cholera: The Disease that Inspired Bram Stoker to Write Dracula?
Part Six:
Scarlet Fever Returns: but it is a lot less deadly
 Part Seven:
Don’t Count Your Children Before They Get The Pox
Part Eight:
Would we survive Smallpox if it escaped from a Lab today?
Conclusion:
From the Plague to the Pox

————————————————————————-
INTRODUCTION
 Can We Now Count Our Children?

Whatever happened to the Great Plague of the middle ages; a disease we never had any medical interventions for? Although, back in the day, protection was adopted by visiting doctors who attended the sick – the mask with the beak of a bird was filled with various herb potions and if the afflicted didn’t die from the plague, surely they would have died of fright at the sight of such a vision on one’s sick bed.

[image error]

Fig. 1: Physician attire for protection from the Black Death by Paul Fürst; Source: (CC-BY), commons.wikimedia. Vaccine added by author.

Now imagine what would happen if the old Plague in its true original colours (the same genes as the original Plague) returned to our modern communities today? Would we begin to die in our millions, or a third of Ireland’s population and the same proportion in Europe be wiped out as before? And bear in mind that as it turns out,  black rats and their fleas may be innocent after all! Therefore, no amount of avoiding them, or cleaning up rat-infested cesspits, would limit the spread of the Plague to-day.

[image error]

Fig. 2: Rats may be innocent after all! Designed by the author.

As it happens, we don’t need to panic as the actual same Plague that once killed millions has already escaped out into the public at large on a number of occasions not that long ago. And in one unusually fatal case, it not only killed a pet (it is usually cats that get it – but it is still very rare indeed), but it also killed its owner – who unwittingly spread it to the broader community including unsuspecting infants in a day-care centre where she worked and they didn’t even show as much as a sniffle.

Interestingly, as the Plague itself hasn’t changed over the past half a millennia or so, we now find that having something like Chickenpox or Cold sores may actually have a lot to do with why we aren’t currently dying in our millions in more modern times.

Similarly, we could ask: What if Smallpox returned in its old colours? We don’t even have a vaccine any more to protect us! You may remember hearing of the threat of bioterrorist attacks being imminent in the early 2000s, and efforts were made to produce safe and effective vaccines, with rather mixed results on both counts? Again,  as it turns out – there may not be a need for panic as some of the most virulent strains have already escaped – quite by accident – into the public arena. These all originated from several labs and again, the impact was surprisingly minor.

All in all, it looks like we may have become generationally and naturally, immune to these once significantly more deadly pathogens – the Plague and Smallpox. Now we don’t have detailed and accurate mortality data  for the former disease due to it being so old, but we do have such data for the latter disease from London and this is compared to Ireland where official records only began in 1864 – the year after compulsory vaccination was introduced here and elsewhere as seen below:

[image error]

Fig. 3: Reproduced from Fig. 5.4. Deaths from smallpox per 1000 deaths from all causes in London, from 1629 to 1900. (Data from Guy (1882) and the Registrar General’s Statistical Review of England and Wales.) in F. Fenner, D. A. Henderson, I. Arita, Z. Jezek, I. D. Ladnyi (1988) – Smallpox and its Eradication. World Health Organization (WHO) 1988. Online here at the WHO website with Irish original data superimposed.   F. Fenner, D. A. Henderson, I. Arita, Z. Jezek, I. D. Ladnyi (1988) – Smallpox and its Eradication. World Health Organization (WHO) 1988. Online here at the WHO website. Irish graph superimposed number of annual deaths since records began in 1864, one year after compulsory vaccination – significantly scaled down to make a comparison with London data. Data derived from “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link.

As you can see from the above graphs, and indeed, clearly illustrated repeatedly throughout this study using graphs and historical sources, when we combine this with our more recent insights into natural generational immunity, we begin to understand how Nature works in much more sophisticated and mysteriously molecular ways than we have hitherto appreciated.

For instance, our history books describe in terrifying detail what can happen when an isolated indigenous community was initially devastated when they had first encountered some foreign and unfamiliar pathogens. Interestingly, these isolated populations were some of the healthiest and fittest individuals and naturally pristine natives.

However, this phenomenon has been studied in more recent times and we can now see that the relatively rapid recovery – over a few generations from such an event – cannot be explained via our current genetic inheritance evolutionary model as this kind of rapid adaptation simply could not have occurred by Darwinian means. Instead, it seems that these communities recovered and became ancestrally resistant to these same pathogens and our more recent molecular insights help explain just how this highly adaptive, rapid robust resilience works.

In summary, Nature appears to have an incredibly long-term memory for such pathogen/host battles of the past – leaving us with something of immense value to pass on silently to our children. Therefore,  even if we had all but forgotten these devastations – thankfully, our immune cells haven’t.

The history of successive onslaughts throughout the generations of some of the deadliest contagions known to humankind is inscribed in the charts presented throughout this study which mainly focuses on Ireland, with comparative data from several other nations, thus, these charts and graphs illustrate, in real time, our shared ancestral battle with the bugs. The overarching picture is that the identified pattern is of a near-simultaneous rise and dramatic decline in death rates from the same contagions for broadly the same timeframe –  is that it is an almost universal phenomenon and follows the natural principle of, what goes up, must also come down.

Thankfully, as this study aims to demonstrate, it would appear that we can now count our children because our ancestors have had the Plague, the Pox and just about everything else that has ever circulated in the past.  Now, isn’t that a relief?

Read on to explore natural immunity within its historical context and the newly emerging molecular science behind it...
————————————————————
PART ONE:
How was the War on Bugs Won?
[image error]Fig. 4: Comparative scaled charts for all annual number of deaths recorded for all the major epidemic diseases in Ireland since first officially recorded. Charts generated using annual statistics reports since records began – “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link. © Copyright dig-press.com

It is difficult to grasp just how many deaths occurred in Ireland from infectious disease over the course of time. As you can see from the above charts in Figure 4 (showing the relative scale of mortality), some diseases were significantly deadlier than others. Compare, for instance, the annual death toll at its peak from TB to Smallpox which is discussed in greater detail in their relevant topics within this series. Figure 5 shows a range of once that these, irrespective of whether they are viral or bacterial become significantly less deadly, particularly by the mid-20th Century.

Note that some diseases such as Tetanus, Chickenpox, Mumps and Rubella are not illustrated above, as their impact on populations was so minuscule.

[image error]
Fig. 5: Comparative charts showing the annual number of deaths recorded for many major epidemic diseases – bacterial and viral in Ireland since first officially recorded. Note the significant decline post mid-20th Century. Charts generated using annual statistics reports since records began – “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link. © Copyright dig-press.com

The essential pattern from the above charts is that all infectious diseases became significantly less deadly over time – to the point where they no longer register on the graphs above. This dramatic decline in deaths is not of course peculiar to Ireland, as irrespective of which disease we are talking about, or in which region we are viewing in the developing world for a similar timeframe, this great mountain of historical devastation dramatically declined – essentially, as discussed here, this is without our intervention.

Twentieth Century Mortality Trends in England and Wales
“Infectious diseases have declined to low levels, with the epidemics of the early part of the century no longer occurring”.

Griffiths and Brock, (2003) Office for National Statistics [1]

For comparative graphs to those from Ireland, see Thomas McKeown’s publication for England and Wales: The Role of Medicine: Dream, Mirage, or Nemesis? (1979) [2].  Again, these same type diseases are seen to become significantly less deadly across the board in the U.S. as well as seen in the study, ‘Annual summary of vital statistics: trends in the health of Americans during the 20th century’.

Annual summary of vital statistics: trends in the health of Americans during the 20th century
the beginning of the 20th century, the leading causes of child mortality were infectious diseases, including diarrheal diseases, diphtheria, measles, pneumonia and influenza, scarlet fever, tuberculosis, typhoid and paratyphoid fevers, and whooping cough. Between 1900 and 1998, the percentage of child deaths attributable to infectious diseases declined from 61.6% to 2%.

Guyer et al. (2000)  Paediatrics [3]

For comparative graphs of the dramatic decline of deaths throughout the earlier part of the 20th Century in the U.S.  See: Trends in Infectious Disease Mortality in the United States During the 20th Century (1999) by Armstrong et al, for graphs [4]. Also graphs of the decline of infectious diseases, again relating to the U.S. Infectious Diseases and Human Population History, (1996) by  Dobson and Carper [5].

Certainly, judging by the above graphs and historical records in general, by the earlier part of the 20th Century, our developing nations were becoming significantly safer for infants in particular that they were some decades before. This and a very similar decline in highly infectious diseases for essentially the same diseases are also noted as far north as Iceland corresponding to a comparable timeframe.

The Development of Infant Mortality in Iceland, 1800–1920
The great epidemic infant and child killers of the nineteenth century, such as measles and whooping cough, had lost much of their virulence. Occasionally, they were even successfully coped with in individual places with quarantine measures. By 1920 Iceland had become relatively safe for infants and young children in comparison with the dreadful situation prevailing around the mid-nineteenth century.

Loftur Guttormsson and Ólöf Garðarsdóttir (2002) [6]

What is perhaps more remarkable, is the fact that this common pattern of deaths from once deadlier diseases behaved similarly within nations on the other side of the world such as Australia as indicated in the two excerpts that follow:

Death registration and mortality trends in Australia 1856–1906
The age-standardised rate of all-cause mortality peaked at around 2,000 per 100,000 population in 1860—a year of fearsome epidemics. An important turning point occurred in 1885, after which mortality declined steadily and with less annual variation. The death rate fell from 1,600 in 1885 to under 1,000 in 1906, a fall of one-third over two decades.

Michael Willem de Looper (2014), Abstract, p. iv [7]

Epidemiologic Transition in Australia: The last hundred years
Long-term changes in major causes of death Australia experienced substantial changes in cause-specific mortality over the period 1907 to 2012 … mortality from infectious diseases decreased substantially during the first half of the twentieth century: in 1907, infectious diseases accounted for 16 per cent of the total standardised mortality rate for males and 23 per cent for females, but by 1946 accounted for less than 6 per cent for both sexes, and decreased to insignificant levels by 1960.

Booth,  Tickle and  Zhao (2016) [8]

[image error]

Fig. 6: Dramatic decline in deaths from some of the greatest killer infectious diseases (mainly affecting children) in the pre-vaccine era.- Ireland (chart generated by A. Parent using annual statistics reports since records began – “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link. © Copyright dig-press.com Fig, 1a: U.S. comparable data. Source: Tavia Gordon, Public Health Reports, (1896-1970), Vol. 68, No. 4 (Apr. 1953), figure. 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2024011/  Link to PDF The charts above compare the actual deaths recorded officially for Ireland since records began with deaths per 100, 000 from the United States. Below are comparable charts relating to the same dramatic decline in these same diseases as recorded from England and Wales for infants and children.

Take for example Figure 6, comparing a few of such major diseases where deaths from these diseases declined throughout the 20th Century in as far-flung nations as Ireland and the U.S. Deaths from the Measles virus or the bacterial pathogens known as: Pertussis (whooping cough) and Scarlet Fever – the other great killers of the 19th and earlier 20th Century – particularly amongst children, similarly plummeted according to a near identical pattern irrespective of the diversity or geographical location of our developing nations.

When we compare the decline in deaths from Scarlet Fever, Whooping Cough (Pertussis) and Measles seen within the above charts from such diverse regions as Ireland and the U.S. with graphs generated from England and Wales, we find once again, a very similar pattern of decline as seen in Figure 7. The only real difference between them all is that of number or rate of deaths annually which of course scales according to population sizes between these respective regions. For instance, if we removed the number individual deaths (as all the Irish charts employ), or the rate of deaths (used by most other more populous nations – per 100,000 or sometimes per million if their population is very large), apart from scale, these graphs would be difficult to tell apart.

[image error]

Fig. 7: Adapted graphs based upon figures: 4.15 (Scarlet Fever), 4.24 (Whooping Cough/Pertussis) and 4.18 (Measles) showing rates of annual death rates per 100,000 of the population in England and Wales from 1901 – 2000. The shaded area represents post-WWII, after,Smallman-Raynor, M, Cliff, A (2012), Atlas of Epidemic Britain: A Twentieth Century Picture, Oxford University Press, Oxford. p.50, figure 4:18 (Measles); p. 52, figure 4:24 (Whooping Cough); p.49, figure 4:15 (Scarlet Fever). https://books.google.ie/books

Regarding the commentary about the above charts adapted for the purposes of this study (Fig. 7), the following statistics corresponds in percentage terms (not actual numbers of deaths as England and Wales would have a much larger overall population size compared to Ireland for the same period) very closely to what we observe in the Irish charts for the same diseases over the same timeframe.

Atlas of Epidemic Britain: A Twentieth Century Picture
A total of 67, 791 deaths from scarlet fever were recorded in England and Wales during the twentieth century, with the overwhelming majority (over 99 percent) occurring in the period 1901-45…
A total of 274,347 deaths from measles were recorded in England and Wales during the twentieth century, with over 98 percent occurring in the period 1901-45…
A total of 233,698 deaths from whooping cough were recorded in England and Wales during the twentieth century, with 97 percent occurring in the period 1901-45…

Smallman-Raynor, M, Cliff, A (2012), pp. 50, 52, 49, [9]

Causes of Death: A Study of a Century of Change in England & Wales
It is interesting that 3%, 2% and 4% of the reduction in mortality rate between 1901 and 1971 was due to whooping cough, measles and scarlet fever, respectively, but none of the decline in the mortality rate after this period. This is because by 1971 the mortality rate from these diseases already was extremely low.

Baillie et al.  (2012), p.6. [10]

This is just an example of the commonality of the decline in deaths over the same period and by similar percentages of certain diseases: Measles, Pertussis and Scarlet Fever across far-flung nations.

Not by our interventions?

In Thomas McKeown’s study dating to the late 1970s, The Role of Medicine: Dream, Mirage, or Nemesis? [11] he proposes, based upon the statistics of declining deaths within the context of our historical record of medical practice, that our medical intervention cannot, for the most part, be the direct cause of this decline – as these interventions came either too late or were not available at all to account for the almost universal decline in deaths from almost all of these once deadlier contagions of the past.

For instance, almost all of the previously more deadly diseases declined most significantly throughout the first half of the 20th Century, where there was a near 99 percent reduction in deaths in many regions as discussed above from the beginning of the 1900s if not earlier in some cases, to almost zero per by 1945 or the end of the Second World War (WWII), a time when antibiotics were only becoming more widely available which could begin combating the deadlier effects of many diseases and some antibiotics came later still depending upon specific infections.

Antibiotics are also only useful in fighting a disease that is bacterial and therefore, even taking into account their relatively late availability, cannot explain in any way for the decline in deaths from viral diseases that are discussed throughout this study. Nor can many of our vaccine or inoculation interventions be correlated directly with either the most significant decline in deaths, or the final demise of all the diseases discussed here as they either came too late – after the fact – or were not implemented at all.

This, of course, begs the question as to what is the cause of such an almost universal phenomenon in terms of the dramatic decline in deaths from some of the most deadly diseases? Scholars such as Thomas McKeown, suggest that other factors such as economics, improved living standards, better nutrition and a cleaner environments (the hygiene hypothesis as it is sometimes referred to) have commonly been offered as possible driving factors in the overall decline in infectious disease, as it now looks very like our medical interventions played a, perhaps surprisingly, small part in the historical and most major decline of deaths throughout the 20th Century – which is essentially the finding of this present study.

However, although this present study broadly supports McKeown’s conclusions regarding the fact that our medical interventions did not directly cause the decline in deaths from infectious diseases throughout the past few hundred years, the evidence that emerged from this present investigation does not support the alternative proposal offered by McKeown and others to account for the significant and often dramatic decline in deadly contagions throughout so many diverse nations for approximately the same timeframe. Their proposal simply doesn’t fit the data, or the historical record when we dig deeper into the context, rise and fall pattern over the course of time for each of the major diseases under discussion throughout this Natural Immunity Series.

This study will offer instead, a natural biological explanation as it relates to generational immunity over the course of time that can explain the almost universal pattern of decline in deaths from some of our most deadly contagions clearly evidenced throughout our nations as they developed into the modern era.

These more recent insights into the dynamic and sophisticated interplay between pathogens and us as their hosts are well supported by the historical record and matches the overall pattern of death statistics in general than either the medical intervention or the hygiene/population dynamics offered by others as an alternative. This present study revisited historical accounts of each of these plagues of humanity in the light of the findings produced from several lines of molecular investigations and found that this matched the data much better than other proposals offered thus far.

 

References for Intro & Part One
1. Griffiths C and Brock A (2003) Twentieth Century Mortality Trends in England and Wales. Health Statistics Quarterly, Issue 18, pp. 5–17. [Available online as PDF] https://www.ons.gov.uk/ons/rel/hsq/health-statistics-quarterly/no–18–summer-2003/twentieth-century-mortality-trends-in-england-and-wales.pdf
2 Mc Keown, T (1979) The Role of Medicine: Dream, Mirage, or Nemesis? Basil Blackwell, Oxford [Available online as PDF] http://peaceworkspartners.org/vault/Oxford/DPHPC/Health%20and%20Development%20Course/Int%20Dev%20Readings%20HT10/1a.%20Main%20Theories/McKeown%20The%20Role%20of%20Medicine%201979.pdf
3 Guyer B, Freedman MA, Strobino DM, Sondik EJ. (2000) Annual summary of vital statistics: trends in the health of Americans during the 20th century, Pediatrics. Vol. 106, [6]: pp. 1307-17. https://www.ncbi.nlm.nih.gov/pubmed/11099582
4. Gregory L. Armstrong, G.L, Conn L.A, Pinner, RW (1999) Trends in Infectious Disease Mortality in the United States During the 20th Century, JAMA. Vol. 281 [1]: pp.61-66. DOI: 10.1001/jama.281.1.61 https://jamanetwork.com/journals/jama/fullarticle/768249
5. Dobson, AP. and Carper, ER (1996) Infectious Diseases and Human Population History: Throughout history the establishment of disease has been a side effect of the growth of civilization, BioScience, 46, Issue [2,] pp. 115–126, DOI: 10.2307/1312814 [Available online as PDF] https://academic.oup.com/bioscience/article-abstract/46/2/115/252374
6 Guttormsson, L and Garðarsdóttir, Ó (2002) The Development of Infant Mortality in Iceland, 1800–1920, Hygiea Internationalis, An Interdisciplinary Journal for the History of Public Health, Vol. 3 [1] pp. 151 – 176, PDF · [Available online as PDF] DOI: 10.3384/hygiea.1403-8668.0231151 https://pdfs.semanticscholar.org/d338/90ffb7c01490bde7a729270285926ea3b17e.pdf
7 De Looper, MW (2014) Death registration and mortality trends in Australia 1856–1906, Abstract, p. iv. PhD Thesis: The Australian National University [Available online as PDF] https://openresearch-repository.anu.edu.au/…/De%20Looper%20Thesis%202015.pdf
8 Booth, H, Tickle, L, Zhao, J (2016) Epidemiologic Transition in Australia: The last hundred years, Canadian Studies in Population Vol. 43, [1–2]: pp. 23–47. https://journals.library.ualberta.ca/csp/index.php/csp/article/viewFile/25702/20363
9 Smallman-Raynor, M, Cliff, A (2012), Atlas of Epidemic Britain: A Twentieth Century Picture, Oxford University Press, Oxford. p.50, figure 4:18 (Measles); p. 52, figure 4:24 (Whooping Cough); p.49, figure 4:15 (Scarlet Fever). https://books.google.ie/books
10 Baillie, L. and Hawe, E. (2012) Causes of Death: A Study of a Century of Change in England & Wales, OHE (Office of Health & Economics) p.6. https://www.ohe.org/publications/causes-death-study-century-change-england-and-wales#
11 Mc Keown, T (1979) The Role of Medicine: Dream, Mirage, or Nemesis? Basil Blackwell, Oxford [Available online as PDF] http://peaceworkspartners.org/vault/Oxford/DPHPC/Health%20and%20Development%20Course/Int%20Dev%20Readings%20HT10/1a.%20Main%20Theories/McKeown%20The%20Role%20of%20Medicine%201979.pdf

 

Next weekly episode: Part Two:Whatever happened the Bubonic Plague and what has Chickenpox got to do with it?

Use the contact form below for updates of forthcoming series and book (Beta readers required – going to publication Autumn 2018…) or simply get in touch via diggingupthefuture@gmail.com

 

 

 

 

[contact-form]