Continuing on from A Lousy Life: 18thC Living Conditions, Part 3

Malaria

A debilitating, and often fatal disease spread by the Anopheles mosquito. Its symptoms include: fever, headache, chills, muscle pains and diarrhoea, whilst its complications can be as varied as anaemia, permanent brain damage, jaundice, shock, pulmonary oedema, hypoglycaemia, kidney failure and damage to the spleen. It was particularly prevalent in the marshy areas in Britain and France as the following contemporary accounts will make clear. The first is from Defoe’s “Tour through the whole island of Great Britain”, although it is, in all probability, a story that has been exaggerated over time, it gives a good idea of the conditions that the marsh people had to put up with.

That all along this Country it is very frequent to meet with Men that have had from 5 or 6, to 10 or 12 Wives; and I was informed, that in the Marshes, over-against Canvey Island, was a Farmer, who was then living with the 25^th; and that his Son, who was but 35 Years old, had already had about 14. […] The Reason, as a merry Fellow told me, who said he had had about a Dozen, was this, That they being bred in the Marshes themselves, and seasoned to the Place, did pretty well; but that they generally chose to leave their own Lasses to their Neighbours out of the Marshes, and went into the Uplands for a Wife: That when they took the young Women out of the wholesome fresh Air, they were clear and healthy; but when they came into the Marshes amongst the Fogs and Damps, they presently changed Complexion, got an Ague or two, and seldom held it above half a Year, or a Year at most: And then said he, we go to the Uplands again, and fetch another. […]

The same traveller’s tale was told not only in Essex, but also in Sussex and other marshy areas of England.

A similar situation existed in France as can be seen in the following tables compiled by Jean-Baptiste Moheau, one of the pioneers of demography.

In his work “Recherches et Considérations sur la population de la France 1778”, he compared numerous communities throughout France and entered information about the occupations and life expectancy of a particular place in a tabular format. In these tables he has compared the life expectancy of mountainous regions with that of marshy areas, and we can see that there is a considerable difference not only between the two, but within the regions themselves. In Grand Bois on the west coast, for example, life expectancy was 40 years and 8 months, whilst the inhabitants of Seillons, a poor hamlet situated in a rocky area with stagnant water in the nearby plains had a very poor survival rate with a life expectancy of only 16 years 5 months. However, the life expectancy of people born in La Napoule, a marshy area, was only 8 years. Moheau concluded that mountainous areas were more salubrious than those with a marshy outlook but he was unable to offer an explanation. Areas of swamp, salt marshes and stagnant water are the preferred breeding grounds of mosquitos, and as such would have been the ideal habitat for Anopheles. It would seem reasonable to assume that the reason for the unhealthiness of the marshy areas both in Britain and Europe was due to malaria transmitted by the Anopheles mosquito. Whether the high mortality rate was due to malaria itself, or to one of the complications that can arise from the disease we shall probably never know.

Measles

Measles is an acute, highly infectious disease, caused by a virus of the paramyxovirus family, and is one of the leading causes of death among young children. About 85% of those people exposed to the virus will become, infected and approximately 95% of those infected will develop the disease. It has a relatively high case-fatality rate, which in some African countries varies between 7.1% in small households to 12.8% in households of 8 or more members, and 15.6% for children under 1 year old, especially in populations with high levels of malnutrition, a rate which I suggest could easily have obtained in Europe during the 18^thcentury.

Most measles-related deaths are caused by complications associated with the disease which usually occurs in winter and spring. It starts with a high fever, often greater than 40°C, followed by a cough, runny nose, red eyes, and after three to five days by a flat red rash, and photophobia. Small white spots may develop inside the mouth during the first stages of the disease (Koplik’s spots). Complications are more common in children under the age of 5, or adults over the age of 30. The most serious include blindness, encephalitis, severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by other diseases.

Pneumonia

Pneumonia is an inflammation affecting the alveoli of either one or both lungs. It is usually caused by viruses, bacteria, fungi, or rarely parasites and is a frequent complication of influenza. The symptoms include shaking chills, frequent coughing, pain in the chest and a very high temperature which may reach 40.55°C. (105°F.) It was often fatal before the advent of antibiotics. In the early 20^th century, the fatality rate was between 30% and 40%, and even now, the WHO say that worldwide, it accounts for 16% of all deaths of children under 5 years old, killing over 920,000 children in 2015. As pneumonia had such a high death rate before the advent of antibiotics, it would be reasonable to think that the rate of mortality during the 18^th century was even higher.

Pulmonary Tuberculosis

Pulmonary tuberculosis is recognised as being a disease of squalor, poverty, overcrowding, lack of decent sanitation and bad working conditions. The disease has been known throughout human history, but it was only in the eighteenth and nineteenth centuries that it reached truly epidemic proportions in Britain and Europe, and it has been calculated that it killed one billion people throughout the world. Tuberculosis is most commonly an infection of the lungs caused by the bacterium, Mycobacterium tuberculosis. Infection is almost invariably either by inhalation or ingestion of the organism, and once established may spread locally by direct invasion or more widely by the blood stream or lymphatics. Infections can, however, develop in areas outside the lungs, for example, the bones and joints, lymph nodes in the neck, when it is called scrofula, and the digestive, reproductive, urinary and nervous systems.

Rickets

Rickets is a disease caused by a lack of Vitamin D, phosphorous or calcium which can lead to defective mineralization or calcification of bones before epiphyseal closure. It is a potentially devastating condition which can cause difficulties in walking, delayed growth, skeletal deformities such as bowed legs and thickened wrists and ankles, bone pain, osteomalacea, convulsions, tetany and hypotonia. It also increases the risk of pneumonia, and may be a cause of death if the infant is fed a Vitamin D deficient diet.

Vitamin D is synthesized by the skin on exposure to sunlight, and can be found in various foods such as oily fish and egg yolks. Living in conditions which had little sunlight, and/or a very smoky or foggy atmosphere, was bound to inhibit the formation of vitamin D, which is essential for the absorption of calcium.

Francis Place, referring in his autobiography to his childhood in the 1770s, remembered how:

“…the number of children who had ‘cheese cutters’, i.e. with the shin bone bowed out (with rickets) was formerly so great that if an estimate were made now (1824) it would not be believed.”

Scarlet fever or Scarlatina

Scarlet fever is caused by group A Streptococcus bacteria, the usual time of infection being from September to April. The disease is spread by aerosols caused by coughing and sneezing, direct contact with infected people or handling utensils and other objects which are contaminated with the bacteria. The symptoms are a red sore throat, swollen tonsils, high fever, followed by a red rash that looks like sunburn and feels like sandpaper, “strawberry” tongue, and nausea. It was once a very serious childhood disease, its complications may include, pneumonia, rheumatic fever, and kidney disease.

Scrofula or King’s Evil

Scrofula is a painless swelling of the lymph nodes of the neck, caused by the bacteria, Mycobacterium tuberculosis. In rare cases there may be a fever. At one time it was believed that it could be cured by a touch from Royalty. The practice began with King Edward the Confessor in England (1003/4-1066) and Philip I (1052-1108) in France, and continued up until the reign of Queen Anne in England (died 1714) and Charles X in France (abdicated 1830).

The following more bizarre cures have also been noted: the touch of a seventh son or blacksmith, or a toad‘s leg in a silk bag round one’s neck. Reginald Scot, writing in “The Discoverie of Witchcraft”, in 1584, said:

Remedies to cure the Kings or Queenes evill, is first to touch the place with the hand of one that died an untimelie death. Otherwise: Let a virgine fasting laie hir hand on the sore, and saie; Apollo denieth that the heate of the plague can increase,where a naked virgine quencheth it: and spet three times upon it.

The person who died an untimely death was often a hanged man.

Scurvy

This was a widespread disease during the 16^th to 18^th centuries caused by the lack of vitamin C. The symptoms include fatigue, malaise, pain in limbs, small blue spots under the skin, gum disease, loosening of teeth, poor wound healing, and emotional changes occur. If left untreated, the disease will ultimately lead to death due to hemopericardium or various kinds of haemorrhage. Normally thought of as a scourge of the European navies during this period, it may seem surprising that it could occur in all sectors of the population, especially when one considers that the majority of people lived either in, or within easy reach of, the countryside.

People, did, of course, eat fruit and vegetables from pleasure or necessity, but there is overwhelming evidence that when possible, or when they could afford to, many people ate almost exclusively meat, fish, game, pies and sweetmeats, to the exclusion of vegetables, from their diet. This is one reason why well-off people came down with scurvy.

When people did eat vegetables or fruit, they weren’t, unfortunately, guaranteed an adequate supply of vitamin C throughout the year. Owing to the poor dental health of the population, vegetables, which were tougher than they are today, had to be boiled for long enough to soften them, thus destroying most of their inherent goodness. And it must not be forgotten that fresh fruit and vegetables were seasonal commodities, only being available during the spring and summer months. This meant that the only produce available were things that could keep reasonably well, such as onions and apples. Potatoes, although rich in Vitamin C and well known in Europe as animal food, did not gain acceptance for humans until well on into the century. We must also remember the vicissitudes of the weather and the problems caused by insect pests. These frequently produced crop failures and shortages of locally grown produce that could not easily be accommodated owing to the bad state of the roads and the slowness and high cost of transport from other regions or countries.

It is interesting to note that the second edition of “A New and Complete Dictionary of Arts and Sciences” published in 1764, has this to say about the causes of the disease, and recommends mineral waters, a milk diet or whey impregnated with, amongst other things, the juices of antiscorbutic herbs such as scurvy-grass and water-cress.

… the scurvy chiefly affects the inhabitants of cold northern countries, especially those who live in marshy, low, fat, and moist soils, near stagnating waters, whether fresh or salt. Those who live idle sedentary lives are most subject, chiefly in the winter-time, to the attacks of this distemper; as also those feeding upon salted and smoke-dried flesh or fish, sea-biscuit, stinking water, unfermented farinaceous vegetables, peas, beans, sharp, salt, old cheese; likewise, those who are subject to melancholic, maniacal hysteric or hypochondriacal disorders.

The English naval surgeon, William Clowes, writing in 1596, gave a graphic description of the disease:

Their gums were rotten even to the very roots of their teeth, and their cheeks hard and swollen, the teeth were very loose neere ready to fall out … their breath a filthy savour. Their legs were feeble and so weak, that they were not scarce able to carrie their bodies. Moreover they were full of aches and paines, with many blewish and reddish staines or spots, some broad and some small like flea-biting.

Smallpox

A highly infectious disease which was caused by one of two variants, Variola major and Variola minor, V. major being the most dangerous. It has been estimated that smallpox was killing as many as 400,000 people per year in Europe by the end of the 18^th century. Sadly, the majority of these deaths were children, as it was “chiefly a disease of infancy and early childhood”. However, even if some of the population survive the disease itself, they may well succumb to secondary infections such as bronchopneumonia and streptococcal septicaemia.

Syphilis and Gonorrhoea

It used to be thought that gonorrhoea which is caused by the bacterium, Neisseria gonorrhoeae and syphilis by the bacterium, Treponema pallidum, were manifestations of the same disease and it was not until 1838 that Philippe Ricord proved that they were separate diseases. Syphilis was known as the Great or French Pox, the morbus gallicus, in England, whilst the French called it the Neapolitan disease, the Spanish disease, and later grande or grosse verole. It first made its terrible appearance in Naples in 1493-94 during the war between Spain and France and by 1500 had spread throughout Europe like wildfire. The disease began with genital sores, progressed to a general rash, ulceration, and abscesses, eating into bones and destroying nose, lips and genitals, and often proved fatal.

Venereal diseases are seldom mentioned as a direct cause of death; for example, in the London Bills of Mortality, French Pox only accounted for 49 deaths out of a total of 19,024, i.e. 0.257% in 1783, and in 1784 only 32 deaths out of a total of 17,828, i.e. 0.179%, were recorded. However, unpleasant as they were, they must have been extremely familiar to many as can be seen from the large number of adverts appearing in the newspapers of the time. The following, of which this is a typical example, appeared in the “Chester Chronicle”, 1^st October 1790:

A MEDICINE

For the PREVENTION and infallible CURE of

ALL DEGREES of

VENEREAL INFECTION                                    

THE Abbe Blondel’s Grand Chymical Specific (a preparation founded on true medical principles) is now in the highest estimation throughout France, Spain, Portugal, Germany, Italy, and other parts of the continent of Europe For its peculiar efficacy in the PREVENTION of the VE- NEREAL DISEASE, and effectual CURE of it when caught; and what heightens its importance is, that it renders the com- mon mercurial preparations unnecessary; by the profuse admi- nistration of which (either through ignorance or unwarranta- ble quackery) a far greater number of patients have been de- stroyed than cured….

As the medical profession relied on cures of doubtful efficacy using mercuric compounds, one cannot wonder that the general public proved an easy prey for the vendors of such nostrums.

Next time: even more diseases.