Epidemic Diseases of the 19th Century

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Epidemic Diseases of the 19th Century
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The Demographic Context

• 19th century experienced explosion of endemic
  epidemic diseases
• Related to
• Industrialization
• Urbanization
• Trade activities
• Military activities

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• Factors were similar to the Middle Ages
• Scale of these changes exponentially greater
• Britain first country to experience
  industrialization
• Associated with
• Significant population growth
• Significant migration to urban centres

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• Explosive growth of cities outstripped their
  infrastructures
• Water supply
• Sewage
• Housing
• Manchester is an example

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• Northern industrial cities such as Manchester
  Liverpool grew faster than London
• Result was horrific living conditions for the
  working class
• Subject of many studies
• Chadwick Report on the Sanitary Conditions . .
  .(1842)
• Engles Condition of the Working Class . .
  .(1844)
• Mearns Bitter Cry of Outcast London . . .(1883)

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• Emergence of statistics helped Britons see the
  impact of urbanization
• William Farr
• Prominent epidemiologist
• 2nd Registrar General of the Central Board of
  Health
• Instituted systematic collection of vital
  statistics
• Developed many statistical methods still in use
  today

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• Farrs 1843 Report concluded that urban life
  expectancy was lower than rural life expectancy
• Average national life expectancy 41 years
• Rural Surrey 46 years
• London 36.7 years
• Liverpool 25.7 years
• Highest mortality in children under age 5
• ½ of all children in Liverpool dead by 5th
  birthday
• In Surrey, ½ dead by age 50

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• Several diseases emerged as significant threats
  to health during this time
• Cholera
• TB
• Typhoid Fever

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The Medical Context

• Most physicians influential lay people believed
  that epidemic diseases were caused by miasma
• Literally pollution
• By 19th century, understood as poisonous air
  filled with particles from decomposed matter
• Night air was considered worse

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• Idea originated in Hippocratic times
• By 19th century, a few diseases recognized as
  contagious
• Smallpox
• Most were not

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• Miasma theory supported by many prominent 19th
  century health reformers
• William Farr
• Florence Nightingale
• Made more sense given the knowledge of the time
• Under girded the sanitary emphasis of the 1st era
  of the public health movement

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• Miasma theory also supported by business
  community politicians
• Would make quarantine unnecessary
• This kept international trade military activity
  going

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Cholera

• An important example of a disease that
  successfully moved out of its original geographic
  location
• concentrated peoples minds (Porter)
• Cause bacteria Vibrio cholerae
• Severe diarrheal disease spread through
  contaminated water

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• Death can occur within hours
• Victims were frightening to behold
• Complete loss of control of bodily functions
• Shock, circulatory collapse
• Bodies almost black
• Disease is endemic to India
• Often spread by religious pilgrimages

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• Always burned out
• In 19th century, the difference was presence of
  Europeans in India
• Spread to Europe, Asia Africa along trade
  military routes

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• 1st pandemic (1816-18)
• overland to Nepal, Afghan
• by sea to Asia, Africa
• 2nd pandemic (1826-1832)
• to Russia 1831
• Europe, winter of 1831-32
• Canada, New York, 1832
• Pacific coast, 1834

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• Panic in Europes major cities
• No one knew what caused it
• Churches viewed it as a moral issue
• Others believed it was miasma
• Physicians emphasized protection of individual
  constitutions

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• 3rd pandemic (1852-60)
• Worst impact in Russia
• 4th pandemic (1863-75)
• Mostly Europe Africa

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• During 3rd pandemic, debate between advocates of
  miasma contagion crystallized
• Major figure of this era was John Snow (1813-58)

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• Snow spent many years thinking about cholera
  prior to 1854
• In 1831, as a medical student, cared for coal
  miners sick with cholera near Newcastle
• Later speculated that it was spread by invisible
  entities on their hands
• Living in London by 1848 when cholera struck again

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• Investigated origins of this outbreak
• Again proposed contagion as reason for spread
• Speculated that contaminated food or water might
  spread the disease
• Published these ideas in 1849
• Provided evidence to support them

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• Snows hypothesis not well received
• Always alternative, more plausible explanations
• 1854 cholera outbreak in London
• Snow suspected spread was due to contaminated
  water
• Perfect natural experiment existed in the
  district where he was working

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• 2 different water companies supplied water to the
  district
• One drew water from contaminated section of the
  Thames River (Southwark Vauxhall Co.)
• One drew water from above the sewage outlets
  (Lambeth Co.)
• Snow traced local victims determined who had
  consumed water from which source

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• Statistical analysis indicated 715 ratio of
  deaths from Southwark Vauxhall as opposed to
  Lambeth
• Results still not accepted
• Alternative theories proposed by supporters of
  miasma

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• In late August, cholera broke out in Soho
• Water companies supplying water had a clean
  source
• Snow speculated that a pump on Broad St. might be
  contaminated
• Initial investigation of pump proved negative

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• Snow mapped all cholera victims
• Used this evidence to persuade removal of the
  handle of the Broad St. pump
• Epidemic stopped
• Subsequently, source of contamination found

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• Several points must be made about Snows
  contributions to germ theory
• He was often unwilling to go head to head with
  colleagues who supported miasma
• He beat William Budd by 10 days in publishing his
  theory of the spread of cholera
• Cholera bacillus was seen under a microscope in
  1854 by Fillipo Pacini, whose findings were not
  translated into English

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• William Farr proposed an equally plausible theory
  (for the times) as to why cholera deaths were
  concentrated near the Thames River
• Some historians argue that Farr contributed far
  more to epidemiology than did Snow
• Snow just happened to be correct

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• By 1860s, germ theory accepted
• V. cholerae rediscovered by Koch in 1884