P O X!
A GRAPHIC HISTORY EXPLORING GENERATIONAL IMMUNITY
IRELAND & BEYOND
NATURAL IMMUNITY SERIES:
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NATURAL IMMUNITY SERIES
Can We Now Count Our Children?
How was the War on Bugs Won?
Cholera: The Disease that Inspired Bram Stoker to Write Dracula?
Scarlet Fever Returns: but it is a lot less deadly
Don’t Count Your Children Before They Get The Pox
Would we survive Smallpox if it escaped from a Lab today?
From the Plague to the Pox
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.
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.
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:
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...
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.
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 
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) . 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 
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 . 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 .
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) 
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 
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) 
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.
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, 
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. 
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?  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, : 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 : 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  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?
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