Disease and Plagues

Disease and plagues have rocked world history, causing untold damage and claiming countless lives. Although still prevalent in the world today, modern advances in medicine and detection have made life a lot easier for those living today. However, before the intervention of current medicinal practices, disease and plagues wiped out populations, mutated and disfigured victims and spread epidemically. Efforts to quell the outbreaks included confined seclusion, laws passed on harbouring travellers or vagrants, and even those uninfected fleeing the area in panic! Unfortunately, it was usually only the wealthy who could afford to flee, leaving behind the poor to remain with the infected victims.

The Second Pandemic of the Plague culminated in the highest level of deaths worldwide from the 14th century to the 19th century – approximately 25% of the world’s population perished at the hands of the killer disease. In the UK, the first cases were noted in England but quickly spread throughout the country. Scotland called it “the foul death of England” and believed it to be God’s wrath upon them. With up to a third of the English population dead or dying, Scotland made a daring move to attack whilst defences were at an unprecedented low in the 13th century. Upon defeat, the remaining Scotsmen swiftly fled home with a few unwanted visitors in tow. The disease went on to decimate the Scots population at the end of the 1340’s. Known as Bubonic Plague, the Great Plague and, simply, the Plague, this infection initially caused lumps or tumours in the groin, neck or armpits of various ranging sizes. Symptoms progressed, with lumps spreading, becoming larger and displaying livid and/or black spotting (hence the over-arching name “Black Death”). Within days of infections, sufferers would run high fevers, vomiting and passing blood, before finally dying an agonising death. The infected usually died within 2 to 7 days of initial infection, causing huge problems for towns and cities with no available space to dispose of the infected corpses. Bubonic plague is a disease that is carried by fleas living on rodents, such as rats. As sailors moved from port to port, taking many uninvited rodent guests with them, the risk of disease increased. Unwittingly, these rats would then leave the ship at various ports around the world, infecting other rodents by passing on disease-ridden fleas.

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In 1585, plague appeared in Edinburgh, apparently brought there by a woman who had been visiting Perth. As it spread, special orders were quickly issued for the sanitisation of Edinburgh, including the removal of the coining-house to Dundee. Soon after this, the plague hit Dundee. Victims of the plague in Dundee were buried in the Roodyards burial ground in, often covered in lime salt to try and keep the disease from escaping the bodies. In times such as these, hygiene was not thought of in the way it is today. Everything was dirty, from the people, to their houses and the streets beyond. Sanitisation was not something of a priority, which did not help in curbing disease as it swept through the country. Royal orders on the matter included ceasing trading with any affected towns, cities or villages, very tight quarantine controls at ports, animals removed from the public area altogether, limitations on public houses and also a ban on gatherings of people. Any house known to have infected living in it or having died in it were prohibited from having furniture removed, for fear of spreading the disease further, and shops were restricted in the type of products they could sell. “Unwholesome” meats and perishables were banned from sale, which caused problems for those who were so poor they relied on these cheap (and often stale) food products to feed themselves and their families.

If that wasn’t bad enough, worse still was pneumonic plague, spread by the initial bubonic infection which attacked the lungs and was spread to other people through coughing and sneezing. Coughing, fever, headache, chest pain and blood in the mucus or saliva were the main symptoms of pneumonic plague. Septicaemic plague occurred when the bacteria entered the blood. In these cases, there was little hope of survival. Treatments and prevention at the time did not help. Sometimes, patients were bled with leeches. People thought impure air caused the disease and could be cleansed by smoke and heat. Children were encouraged to smoke to ward off bad air. Sniffing a sponge soaked in vinegar was also an option.

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As we mentioned before, cleanliness was not a high priority and sanitation improvements were not implemented until the mid-1800’s. As with any densely populated city or town, Dundee was a dirty, smelly and overcrowded place to live. Diseases such as cholera were rife due to the high volume of animal and human excrement, rubbish and discarded animal carcasses. Outdoor toilets were shared by dozens, if not hundreds of people who were crammed into tenement blocks, and conditions were far from sanitary. Drinking water and bathing water were contaminated with faeces and crawling with bacteria, but, with no other means of obtaining water, many were forced to drink and bathe from infected pools. . It was not a common practice to boil water in the 19th century, nor was bathing popular. Dirty water and unclean bodies were major factors in the spread of diseases such as cholera and typhoid. Milk and other dairy products were a common breeding ground for scarlet fever and diphtheria. Dairies and shopkeepers diluted milk with (infected) water to yield greater profits. Beer was even adulterated with narcotic substances such as strychnine to counter the effect of over dilution with water of the original.

Cholera is a bacterial infection caused by drinking water contaminated with the bacteria, or by the consumption of food that has been in contact with the tainted water. Sickness and diarrhoea were the main contributing factors to death from cholera, as, more often than not, sanitary rehydration and salt replacement were not options. As the victim’s blood pressure plummeted, they would succumb to shock and died thereafter. A significant number of graves in the Howff house victims of the cholera epidemic. Thankfully, due to significant improvements in sanitation and proper water hygiene, cholera has been eradicated in most of the world. The rapid growth in Scotland’s urban population in the 19th century brought with it unprecedented social problems, of which ill-health was one. However, although ill-health was recognised as a major social problem, our knowledge of death rates and the causes of death in the first half of the 19th century is patchy. It was not until 1855 that the civil registration of births and deaths was introduced. Even after this date many deaths went uncertified, or the causes were wrongly entered on the death certificate. Still-born babies went unregistered and had no burial ceremony. In places with few doctors the cause of death was badly recorded. The diseases causing the most deaths were cholera, tuberculosis, typhus, whooping cough, measles and smallpox.

With more than two million people killed by tuberculosis (TB) every year, and perhaps a third of the world’s population infected, the World Health Organisation has declared the epidemic of the disease a global emergency. Tuberculosis is a bacterial infection of the lungs and sometimes other parts of the body, and is spread by droplets in the coughs or sneezes of a person with the disease. Tuberculosis was known as ‘consumption’ in the 19th century and was a major cause of death in Scotland at that time. The disease is still common where there is overcrowding, malnourishment and poor health care. It was during the 19th century that tuberculosis was dubbed “The White Plague”. It was seen as a ‘romantic disease’. Suffering from tuberculosis was thought to bestow upon the sufferer heightened sensitivity. The slow progress of the disease allowed for a “good death” as sufferers could arrange their affairs. The disease began to represent spiritual purity and temporal wealth, leading many young, upper-class women to purposefully pale their skin to achieve the consumptive appearance. British poet Lord Byron wrote, “I should like to die from consumption,” helping to popularize the disease as the disease of artists.

The Antonine Plague, also known as the Plague of Galen, was probably smallpox or measles. The disease killed as many as one-third of the population in some areas, and decimated the Roman army. Measles is an endemic disease, meaning it has been continually present in a community, and many people develop resistance. In populations not exposed to measles, exposure to the new disease can be devastating. In roughly the last 150 years, measles has been estimated to have killed about 200 million people worldwide. Measles also claimed a lot of young lives, the evidence of which is still present within the Howff. The graves of many mark the final resting place of children who succumbed to the infant-killing disease. In addition to children with an unfavourable nutritional status, young children living in large families are also much more prone to being infected with measles than are children living in families with one or two siblings. Nowadays, when the total population of most western European countries is rapidly shrinking due to the limitation of family size, and at a time when most European and European-American parents have their children immunized against all common infectious diseases, measles has become rare in the West. Thankfully, when measles do make an appearance in our lives, it’s usually no more than a minor setback, quickly and easily eradicated. As with everything, there are always exceptions to the rule, and still, to this day, many people in underdeveloped countries die from this disease.

 

The history of smallpox holds a unique place in medicine. One of the deadliest diseases known to humans, it is also the only disease to have been eradicated by vaccination. Symptoms of a typical smallpox infection began with a fever and lethargy about two weeks after exposure to the Variola Major virus. Headache, sore throat, and vomiting were common as well. In a few days, a raised rash appeared on the face and body, and sores formed inside the mouth, throat, and nose. Fluid-filled pustules would develop and expand, in some cases joining together and covering large areas of skin. In about the third week of illness, scabs formed and separated from the skin. About 30% of cases ended in death, typically in the second week of infection. Most survivors had some degree of permanent scarring, which could be extensive. Other deformities could result, such as loss of lip, nose, and ear tissue. Blindness could occur as a result of corneal scarring. Survivors of smallpox outbreaks were protected from subsequent infection by a process called variolation. This involved inhalation of the dried crusts from smallpox lesions or inoculation of the pus from a lesion into a scratch on the skin. These were potentially hazardous procedures, yet deemed acceptable at the time as smallpox caused such severe mortality and morbidity. The practise was introduced by Edward Jenner in 1798 upon noting that a person who had previously caught cowpox did not later catch smallpox. Vaccination still occurs today, where necessary, but is not used en-masse due to it’s known adverse effects and the risk of death.

Whooping Cough was (and still is) known as “The Kink” in Scotland.  Known medically as ‘pertussis’, it is a bacterial illness caused by the Bordetella Pertussis. It can be a severe illness resulting in prolonged coughing spells that can last for many weeks but rarely causes death. It can affect anyone, but is most dangerous in children under the age of 12 months because they are not able to cough away the phlegm that threatens to choke them.  Such extreme coughing spells can make it difficult for a person to eat, drink, and breathe – people may lose weight and become dehydrated. In infants, it can cause pneumonia and in rare and severe cases, lead to brain damage, seizures and mental retardation.  From the 17th century and up to the early 19th century, pertussis was considered a killer disease, especially within infancy.  A physician was often helpless and ignorant in dealing with children because, unlike adults, they could not contribute to his diagnosis by articulate complaints.”    Before the Bordetella Pertussis vaccine became available, the illness was a leading cause of death in infants, and nearly all children developed whooping cough. The vaccine itself cannot solely be credited with the decline in pertussis deaths, however, as this was also when public sanitation systems were implemented, clean drinking water became available, better distribution of fresh fruits and vegetables and also the focus on personal hygiene was stressed.  During the 1970’s, amid claims that the vaccine was not safe, there was a decline in the number of people willing to have their children immunised.  As a result, this led to two further epidemics. Each epidemic affected an estimated 400,000 children. Immunisation rates then went up again and most children are now immunised. Whooping cough is now uncommon in UK children but remains a major cause of illness in children in countries with poor rates of immunisation.

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Typhus is a series of acute infectious diseases that appear with a sudden onset of headache, chills, fever, and general pains, proceed on the third to fifth day with a rash and toxemia (toxic substances in the blood), and terminate after two to three weeks. Typhus (actually not one illness but a group of closely related diseases) is caused by different species of rickettsia bacteria that are transmitted to humans by lice, fleas, mites, or ticks. The insects are carried person to person or are brought to people by rodents, cattle, and other animals. The most important form of typhus has been epidemic typhus (borne by lice).   The lice will initially feed on an infected human, drinking in the infectious blood before jumping to another host body.  The disease is transmitted to an uninfected human who scratches the louse bite (which itches) and inadvertently rubs infected faeces into the wound left by the blood-sucking joyrider.  Rats carry the disease, and the disease is also found in the faeces of cats, skunks and raccoons.  Whilst prompt antibiotic treatment will cure nearly all patients, left untreated, the mortality rate is as high as 60%.  Effective use of pesticides and the destruction or de-sanitisation of clothing and personal items such as bedding and towels is essential.

Polio, or poliomyelitis, is a highly contagious viral infection that can lead to paralysis, breathing problems, or even death.  The virus usually enters the environment in the faeces of someone who is infected. In areas with poor sanitation, the virus easily spreads through the faecal-oral route, via contaminated water or food. In addition, direct contact with a person infected with the virus can cause polio.   Polio, in its most debilitating forms, displays symptoms such as paralysis and death. However, most people with polio don’t actually display any symptoms or become noticeably sick. When symptoms do appear, there are differences depending on the type of polio.  Non-paralytic polio leads to flu-like symptoms that last for a few days or weeks, such as fever, sore throat, headache, vomiting, fatigue, back and neck pain, arm and leg stiffness, muscle tenderness, muscle spasms, and meningitis.  Paralytic polio will often begin with symptoms similar to non-paralytic polio, but will progress to more serious symptoms such as a loss of muscle reflexes, severe muscle pain and spasms, and loose or floppy limbs that is often worse on one side of the body.  “Poliomyelitis struck Dundee in 1947 with 43 cases and 4 deaths – this outbreak received considerable press coverage, although curiously less notice was taken of an outbreak of infantile gastroenteritis which killed 42 of 160 babies admitted to hospital. Polio struck again in 1950 with 157 cases and 9 deaths. Salk’s vaccine appeared in 1955, although an early faulty batch which caused 260 cases of polio and 10 deaths led to a degree of public apprehension as can be seen from newspaper reports of the time.  A further outbreak of polio occurred in Dundee in 1962, mainly in the Fintry area, with 40 cases and one death. However, a mass vaccination campaign in the city with 118,000 doses of the new Sabin oral vaccine brought the outbreak to an abrupt end.” (www.dundee.ac.uk).

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