Category Archives: disease

Small pox and the American Revolution

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With the USA’s 250th birthday coming up, there has been several books about the American Revolution.for example: The American Revolution: An Intimate History, by Geoffrey Ward and Ken Burns and a new Burns’ documentary. I was particularly interested in the section on smallpox.

Like Covid-19, smallpox was a viral disease and greatly feared.The initial symptoms were similar to the flu, Covid-19 and many other viral diseases: fever, muscle pain, fatigue and headache. Before the distinctive rash erupted, small reddish spots appeared on mucous membranes of the mouth, tongue, and throat. 

The characteristic skin rash form within two days after the reddish spots on the mucous membranes. The rash was formed of pustules with a dot (that became filled with fluid) in the center. These spots scabbed over and then the scabs fell off, usually resulting in scarring. In Murder On Principle, Constable Rouge suffers a case of smallpox and becomes terribly scarred.

The origin of smallpox is unknown although the theory says the virus developed in certain African rodents 60,000 or so years ago. The earliest evidence of human illness dates to the third century BCE with Egyptian mummies It is a lethal disease with a fatality rate for the ordinary kind of about 30 percent. Higher among babies. The Malignant and Hemorrhagic forms are over ninety percent fatal. Occurring in outbreaks, it killed hundreds of thousands, including at least six monarchs in Europe. In the twentieth century it is estimated to have killed 300 million alone. As recently as 1967, 15 million cases occurred worldwide.

During our Revolution, General Washington realized that a. smallpox epidemic would kill many of his troops. Accordingly, he had his soldiers vaccinated against the disease. They used a live virus so the risk of contracting smallpox was a possibility although usually the disease was less severe and less fatal.

In 1796, Edward Jenner discovered that milkmaids who had contracted cowpox, a much less serious disease, did not come down with smallpox. He began a trial and proved that inoculation with cowpox prevented smallpox. The cowpox was safer than the live virus..

Later, the vaccine was made of the killed virus. In Great Britain, Russia, the United States vaccination was practiced. However. My father contracted small pox as a toddler and lived to tell the tale. When he volunteered for the Army during WWII, they tried to vaccinate him but of course it never took because he was already immune.

A concerted global effort a to eradicate smallpox succeeded with the last naturally occurring case in 1977. (The last death was in 1978. A researcher contracted the disease from a research sample.) WHO officially certified the eradication of smallpox in 1980.

Slavery and the Will Rees Mysteries

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When I first began writing the Will Rees mysteries, I made a conscious decision to avoid jumping into that messy part of our history. Not because I didn’t think it was important, I did, but I didn’t think I was ready to navigate this serious subject. I allude to it in several books. In Death of a Dyer, for example, I mention the two people stolen from the village street by slave takers. This becomes important later.

Many books later, I wanted to set a mystery in the Great Dismal Swamp. Even now, although much smaller than it was 300 years ago, is still a pretty hostile environment. I’ve posted before about that previously. Anyway, fugitives from neighboring plantations, the escapees were called Maroons, set up small communities in the swamp. Tobias, the man stolen in Death of a Dyer, escapes and asks Rees to help recover his wife, now living in the swamp. Rees and Lydia travel to Virginia to do that and, of course, run smack into a murder.

Death in the Great Dismal forced me to confront slavery head on with characters who were so desperate for freedom they fled to the dangerous and forbidding swamp.

I continue the story in Murder on Principle. In the previous book, Rees and Lydia have rescued a couple of the enslaved people.

In Murder on Principle, the owner comes looking for them, bringing a grudge and smallpox that sweeps through the village. When he is found murdered, suspicion falls on the people Rees has brought north. I posed several ethical questions. One, if the slave owner intended to recover the people he thought of as his property, would they be guilty of murdering him or was it self-defense? How far does loyalty and friendship go in a case of murder? Are Tobias and Ruth justified in their anger at Rees for suspecting them? And finally, should Rees turn the murderer over to the constable or, considering the circumstances, let him go free? And what about the escaped slave who has lived in the north for years and is suddenly confronted with the prospect of recapture?

In Murder, Sweet Murder, I send the family to Boston. Lydia’s father has been accused of murder. Lydia, who has been estranged from her father for years, is reluctant to go and we soon learn why. He is a slave trader – despite the fact that Boston was the center of the Abolition movement.

Even though I do not address the issue of slavery in The Long Shadow of Murder directly, I feature the ripple effect of some of the actions taken during Murder on Principle. It is not just war that leaves people with PTSD but previous decisions and consequences from those decisions.

Ancient medicine

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We know the Ancient Greeks had medicine. Examples of the diseases that afflict us now, such as cancer and TB, and diseases we have managed to conquer such as smallpox, are found in their writings.

What do we know of medicine in Bronze Age Crete? Not very much. We know they used herbal remedies. An examination of Egyptian dynasties contemporary with Crete suggest other possible medical treatments. Papyri and scenes inscribed on walls depict medical instruments. The purpose of some of them, however, are still a mystery. Instruments from later dynasties have been found as well.

Papyri, and clay tablets from Mesopotamia, show that a huge feature in medicine was divine intervention. Prayer and animal sacrifice, which we know were also employed in Bronze Age Crete, were important features. Amulets, to keep demons and bad outcomes at bay, were commonly used. Astral medicine, i.e. using the stars to predict the best time for the best outcomes, was also very important. The zodiacal calendar was used to predict the most propitious times for medical treatments.

I want to add that seers were used to predict the best times for all important activities. The flights of birds was one method. The sacrifice of a sheep and the reading of the organs was another.

Our current medical system certainly has flaws. I am very glad, though, that a surgery appointment does not depend on how a flock of birds fly through the sky!

Diseases

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I am fascinated by the diseases that have stalked humans since they began walking on two legs and have blogged about some of these pathogens. TB: scarring on the fossilized bones of ancient bovines, diabetes: described in Egyptian and Greek writings, polio: pictured on ancient Egyptian stele. My point is that many of these diseases have been with us for a long time until better sanitation and vaccines pushed them back.

Cancer, a disease that seems to be a scourge during modern times, and a disease that still resists easy treatment, has probably also been with us for millennia. Well, many cancers probably escaped detection since they were inside the body and not visible unless an autopsy was performed. (The history of autopsies is a whole other fascinating topic since they have been permitted, or not, depending on the culture.) Breast cancer is the exception since it is visible. Evidence of breast cancer dates back 4200 years to ancient Egypt. Remains from that period display classic symptoms of the disease. For thousands of years, there was no treatment but cauterization and/or mastectomy. If the discovery of the remains is any indication, these treatments were not successful ones.

What about the so-called lifestyle diseases? Type II diabetes is one and, I suspect, present even in ancient times. Present perhaps, but not prevalent, as most people struggled to find enough to eat.

We know that apoplexy was present, and probably high blood pressure. But what about cholesterol? Although mitigated by exercise, it is not a cure. The effects of cholesterol is a fairly recent discovery.

Why do so many people now seem to develop these ‘lifestyle’ diseases? We all live longer. In Rees’s time, the average life span was in the forties. (This is skewed by maternal deaths during childbirth.) There were always people who lived longer, to the sixties and seventies. And sometimes much longer. The risk factors for developing choldesterol, hypertension, heart disease and so on increase with age.

With increased lifespans comes increased risk for disease. It doesn’t seem quite fair, does it?

Black Death

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Probably one of the most famous pandemics is the Bubonic Plague or the Black Death. I was most familiar with the plague that swept Europe in the 1340s (primarily from The Doomsday Book by Connie Willis. One of my favorites and one I reread almost once a year.)

But recent scholarship has discovered Yersina Pestis in Bronze Age Samples. This is a very old disease. The oldest human sample is 5000 years old but it is now estimated that the organism is probably 7000 years old. Wow. It is thought that the disease originated in Northern Eurasia but one of the Bronze Age samples is from England so the disease was already traveling.

But most of the graves found so far are individuals, not mass graves. What happened?

Well, the theory put forth in BBC History, Vol 23, is that the spread of the disease coincided with the rise of the Mongol empire in the thirteenth century. As they spread out, reaching even Italy, they carried some of their own provisions with them. Guess what loves grain? Rodents.

It has been known for some time that rodents and fleas were the disease’s vectors.

One of the goods Italy was importing was grain.

COVID traveled via airplanes. The Black Plague traveled by ship as goods and people went from country to country. It returned in waves and one estimate posits that half the population in Europe died. Certainly entire villages were wiped out.

The disease is still around and still lethal without treatment.

Plagues

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After experiencing Covid this past week, I have a new interest in the plagues that have occurred throughout human history.

Some, like smallpox, have been eradicated in the wild. The last case occurred in 1978 when a lab worker was infected and died.

Smallpox has been around for over 3000 years; the exact beginnings are not known. It was widely feared, and with good reason.The ordinary type of smallpox was extremely lethal with death rates ranging between 30 and over 60 percent. Almost as feared was the scarring left in those who survived. The malignant form is even more lethal, causing death in almost 100 % of the time. Smallpox epidemics swept through the population in regular waves. George Washington was so nervous about the effect on the Continental troops that he insisted everyone be variegated (inoculated with matter from a pustule. Death could still occur but was less likely.)

Another greatly feared plague was the Bubonic, the so-called Black Death. It also swept over Europe in waves and is still the most lethal pandemic recorded, killing between 75 and 200 million people. Estimates of death rates in Europe range between 45 and 60%. The Hemmoraghic form had a mortality rate of between 90 to 95%. Entire villages were wiped out. The loss of so much population created tremendous economic and social upheaval and, arguably, contributed to the rise of the middle class.

The Black Death is so-called because it causes the flesh to die and turn black. Because the Bubonic Plague (called that because of the swellings, or buboes) is bacterial, it is treated with antibiotics and is now curable.

Influenza. There have been six pandemics in the last 140 years, with the 1918 pandemic being the worst. Millions died and millions more were sickened. Like COVID, it is a respiratory disease. Severe cases still cause death. Because it is viral, antibiotics do not work. A new vaccine shot must be taken every year as the virus mutates quickly.

And then we come to COVID. Vaccinated and boosted, my case was not terrible. I felt awful the first day but then the illness moderated to nothing worse than a bad cold.

Epidemics – Smallpox

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In almost every Will Rees mystery, I include at least one profession and one illness. In Simply Dead, for example, I studied hoop making (for barrels) and lumbering. One of the characters is severely ill with diabetes.

In A Circle of Dead Girls, tuberculosis was the disease of choice. Because the story is set against the early days of the circus, I included details about wagons and early magic tricks.

In Will Rees Number 10, A Murder of Principle, I am including smallpox. Like Covid-19, smallpox was a viral disease and greatly feared.

The initial symptoms were similar to the flu, Covid-19 and many other viral diseases: fever, muscle pain, fatigue and headache. Before the distinctive rash erupted, small reddish spots appeared on mucous membranes of the mouth, tongue, and throat. 

The characteristic skin rash form within two days after the reddish spots on the mucous membranes. The rash was formed of pustules with a dot (that became filled with fluid) in the center. These spots scabbed over and then the scabs fell off, usually resulting in scarring.

The origin of smallpox is unknown although the theory says the virus developed in certain African rodents 60,000 or so years ago. The earliest evidence of human illness dates to the third century BCE with Egyptian mummies It is a lethal disease with a fatality rate for the ordinary kind of about 30 percent. Higher among babies. The Malignant and Hemorrhagic forms are over ninety percent fatal. Occurring in outbreaks, it killed hundreds of thousands, including at least six monarchs in Europe. In the twentieth century it is estimated to have killed 300 million alone. As recently as 1967, 15 million cases occurred worldwide.

In 1796, Edward Jenner discovered that milkmaids who had contracted cowpox, a much less serious disease, did not come down with smallpox. He began a trial and proved that inoculation with cowpox prevented smallpox. Inoculation with the live virus had already begun but, although the disease tended to be less severe and less fatal, some people still died. The cowpox was safer.

Later, the vaccine was made of the killed virus. In Great Britain, Russia, the United States vaccination was practiced. However. My father contracted small pox as a toddler and lived to tell the tale. I am old enough to remember my smallpox vaccination and still bear the scar on my upper arm.

A concerted global effort a to eradicate smallpox succeeded with the last naturally occurring case in 1977. (The last death was in 1978. A researcher contracted the disease from a research sample.) WHO officially certified the eradication of smallpox in 1980.

Epidemics – measles

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I felt I had to include measles as one of the epidemics that use to ravage human populations. In fact, the measles had a significant outbreak in the United States just last year, in 2019.

Now commonly thought of as a childhood disease, measles is highly contagious. Nine out of ten people who are exposed will contract the disease. It is airborne and is spread by infected droplets from coughs or sneezes. Although not as lethal as smallpox (the subject of my next post), it can cause death and/or blindness.

Contracting the disease usually confers lifelong immunity.

The most obvious symptom is a red rash that begins on the abdomen. It is flat red spot that I can tell you from personal experience itches like crazy. Now there is an effective vaccine to prevent the illness.

Like many of the diseases that afflict humans (including Ebola and the coronaviruses), measles mutated from rinderpest and jumped to humans. Unlike TB or smallpox, which both have a long human history, measles is fairly recent. One source lists the first recorded mention of measles as 500 AD.

Next up: smallpox.

Epidemics – Tuberculosis

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In my Will Rees mysteries, he meets people who are ill with tuberculosis several times. The frequency of deaths from this disease in my fiction in not an accident. It was a pandemic that still has not been eradicated. In 2017, there were more than 10 million cases of active TB which resulted in 1.6 million deaths; it is therefore the number one cause of death from an infectious disease. Most of these deaths, and most of the new infections, occur in the developing world.

I was mostly familiar with TB as ‘consumption’, a disease that afflicted Victorian poets. Although TB was common in both the poets, the upper classes and the slum-dwellers, it was not a new disease during Victorian times. It has been around for millennia. Bison remains from 17,000 years ago display the effects of the disease.  (No one is sure if TB jumped to humans from the bovine like smallpox or whether it developed independently.) TB scars have been found on Neolithic skeletons and on the spines of Egyptian mummies.

So, it has been around a very long time. Despite that, it was not identified as a single disease until 1820 and the bacillus that caused it was not discovered until 1882 (by Robert Koch. He received the Nobel prize but failed to recognize that one of the transmissions of TB was via infected milk.)

Before the advent of antibiotics, and even with the best care in the sanatoriums set up for this purpose, 50% of the patients died within five years. In 1815, one in four died of the illness in England.

Antibiotics beat back the disease, but new drug resistant strains raise the possibility of a new epidemic. Even now, in modern times, about one quarter of the world’s population is infected with TB.

Epidemics – Yellow Fever

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ellow fever

Yellow fever is a viral disease spread by an infected female mosquito. It began in Africa and was transported to the New World via the slave trade. Because it was so prevalent in Africa, many Africans had some immunity to it. But so many white men died in what is now Nigeria, it was called ‘white man’s grave.’

In most cases, symptoms include the usual: fever, chills, loss of appetite, muscle pains particularly in the back, and headaches, exactly like other diseases such as the flu. Symptoms typically improve within five days. In about 15% of people, within a day of improving the fever comes back, abdominal pain occurs, and liverdamage causes jaundice. Because of this, yellow fever has been nicknamed Yellow Jack and Bronze John. Death occurs in up to half of those who get severe disease. A vaccine exists for yellow fever and some countries require it before travel.

 Although yellow fever is most prevalent in tropical-like climates, major epidemics have occurred in Africa, Europe and the Americas.  New York City had an outbreak in 1668 and other cities such as Philadelphia and Baltimore had outbreaks in 1669. All three saw other occurrences in the 18th and 19th centuries. In 1793, Philadelphia, which was then the capital of the country saw an epidemic. Several thousand people died. (The government at that time fled the city.)  Dr. Benjamin Rush gained fame during this disaster. A great book to read about this episode in Laurie Halse Anderson’s Fever 1793.

Since the disease traveled along steamboat routes, New Orleans suffered many major epidemics during the 19th centuries, causing 100,000 – 150,000 deaths in total. It was greatly feared and the wealthy abandoned the city to summer homes to escape the disease. The more things change, the more they remain the same. Barbara Hambly’s Benjamin January series refers to Yellow fever throughout.