Main image to the article – a pencil drawing of potion to protect against Typhus Fever: Source: Roscommon & Leitrim Gazette – Saturday 29 June 1822

DON’T COUNT

Your

CHILDREN

Until

They’ve had

The

P O X!

A GRAPHIC HISTORY EXPLORING GENERATIONAL IMMUNITY

IRELAND & BEYOND

by

M.B. O’Hare

 

NATURAL IMMUNITY SERIES:

Contact DiG-Press via email for more information: mailto:diggingupthefuture@gmail.com

© M. B. O’ Hare. 2018.

May be used for educational purposes without written permission but with a citation and copyright notice linked to this source.

NATURAL IMMUNITY TEN PART SERIES

Introduction:

Can We Now Count Our Children?
 Part One:
How was the War on Bugs Won?
Part Two:
Whatever happened the Bubonic Plague and what has Chickenpox got to
do with it
Part Three:
The Many ‘Typhoid Marys’
Part Four:
Typhus: Filling in the Gaps
Part Five:
Cholera: The Disease that Inspired Bram Stoker to Write Dracula?
Part Six:
Scarlet Fever Returns: but it is a lot less deadly
 Part Seven:
Don’t Count Your Children Before They Get The Pox
Part Eight:
Would we survive Smallpox if it escaped from a Lab today?
Conclusion:
From the Plague to the Pox
————————————————————————-

Part Four: Typhus: Filling in the Gaps

Typhus’ Rise to Prominence

 

Typhus deaths Ireland

Fig. 1: Chart of the annual number of deaths in Ireland officially recorded from Typhus Fever since records began for this disease. Note the large spike at the beginning.  Source: Chart 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 death toll from Typhus may have been significantly greater prior to 1864 in Ireland. This is indicated by the rather large spike at the beginning of the graph above (Fig. 1). This spike accounts for some 2000 officially recorded deaths from Typhus and may just be the tip of the iceberg, or, in other words, the very tame tail-end of a much more devastating disease of the decades preceding it.

For instance, as Peterson has suggested  –

“…Mortality is incredibly high under epidemic conditions, nearing 100%…” (2018, 156) [1].

– and now we can perhaps begin to make a stab at the real impact of Typhus preceding 1864 by applying the estimates given in the following for what seems to be Ireland’s first major encounter with epidemic Typhus going back to 1816.

THE HISTORICAL IMPACT OF EPIDEMIC TYPHUS

Typhus had been recognized in Ireland as early as 1652, but it was not until 1816 that a major epidemic of the disease produced 700,000 cases out of a population of 6,000,000. Three more major epidemics thereafter, in 1821 and 1836, accompanied harvest failures.
Conlon, J. M., (2007, 13)
[2]

In an attempt to fill in the historical gaps, we can extrapolate the proposed fatality rate from Typhus (see Peterson, 2018, 156) and apply it to the figure of well over half a million cases estimated for the initial devastation of the 1816 Irish epidemic. Now, in the context of a total population of about six million, this means that Typhus may have been much more deadly than previously recognised. Almost one person out of every six of the entire population of six million had seemingly been infected and most of them probably didn’t survive. This begins to echo the scale of deadly impact within a naive population that is unfamiliar with a particular pathogen as discussed previously.

However, as also discussed thus far, in the case of any previously unexposed population, as devastating as a population’s initial encounter with an unfamiliar pathogen, it also appears to be the case that these same populations rapidly adapt to even the most deadly of pathogens and within a few short generations, become effectively resistant, and ultimately immune – via general background exposure (rebalance has been achieved perhaps?). ( See, previous discussion here).

Typhus, it seems, is no different as we are encouraged to see that when we look at the official data of recorded deaths annually in Ireland from this once mighty pathogen, we can clearly see that the annual number of deaths dropped dramatically from around 2000 deaths to an average of 500 deaths annually after the large spike of 1864, followed by a little rise again and then its fatality within the population as a whole becomes significantly less throughout the rest of the 19th Century. Finally, deaths from Typhus becomes a rarity by the first quarter of the 20th Century, never to be heard of again in this country (Fig. 1).

Once again, we seem to be looking at a natural rise and fall pattern of deaths from a previously much more deadly contagion. This is well supported by the historical accounts of the disease as you will see throughout the discussion that follows. But first, we will explore some other proposals, that are commonly offered as explanations for such devastating epidemic outbreaks and their ultimate resolution.

One suggestion is given above (see Conlon, 2007, 13),  in terms of the disease coming in most fiercely on the back of harvest failures. This would seem a reasonable suggestion, however, when we drill down to the details, it doesn’t quite stand up to scrutiny as history has shown as argued by Dirks 1993, and Carmichael 1983:

“It should be pointed out that recent research has questioned the widely held assumption that malnutrition inevitably leads to increased susceptibility to infection.” (in Mokyr, J., and Ó Gráda, C., 2002, 21). [3].

This insight is further reiterated by other researchers who have concluded something similar regarding this widely held assumption, and also support the general proposal presented here in pointing out that the pattern of disease can best be explained from a biological perspective:

Famine, Mortality, and Epidemic Disease in the Process of Modernization

Chambers carried his case to the point of questioning the medical concept that under-nutrition and malnutrition interfere with the ability to resist infectious contagion, acknowledging, however, that nutritional deficiencies will exacerbate endemic illnesses …
Since European famines were not invariably followed by serious epidemics, it is possible that plague and similar crises of public health were essentially biological in origin and not directly related to problems of subsistence.
Thus Fernand Braudel has stated that “every disease has its own autonomous life, independent of the endless correlations” historians suggest, and that correlations with economic crises are “at most only minor accidents in a history linked with other factors”…
Post, J.D., (1975, 14)
[4]
https://www.jstor.org/stable/2594505?seq=1#page_scan_tab_contents

As highlighted above, seemingly outbreaks of any of the major contagious diseases within such widely disparate regions, do not necessarily correlate with famine, crop failures or malnutrition in general when viewed together and within the broader context of the impact and spread of the disease itself.

For instance, famines or crop failures are noted a number of times as occurring within Ireland at around the same time as various epidemic eruptions, including such diseases as Typhus (See Creighton, 1894) [5]. However, as highlighted above, this may not actually be causal to either its rise or its demise, but merely a coincidental historical observation.

For instance, the United States did not have any particular crop failures when it experienced its first major Typhus outbreak of the 1830s, around the same time as Ireland was experiencing its own Typhus epidemic, nor did many parts of Europe that experienced near-simultaneous Typhus outbreaks have corresponding widespread crop shortages.

Now, take, for example, London (see excerpt below), where it also seems that although a major Typhus epidemic was underway at around this time as the Irish epidemic of the 1830s,  crop failure is not the main factor in its eruption or spread?

Health and Hygiene in the Nineteenth Century

In the 1830s the “new fever,” typhus, was isolated. During its worst outbreak, in 1837-38, most of the deaths from fever in London were attributed to typhus, and new cases averaged about sixteen thousand in England in each of the next four years.
Douglas, L., (Victorian Web, 11th Oct., 2002)
[6]
http://www.victorianweb.org/science/health/health10.html

Another example that famine wasn’t a major factor in, or direct cause of, the rise of Typhus is highlighted in the following in relation to Scotland, which experienced the same type of epidemic Typhus of the same general period and experienced fairly large death tolls as Ireland; yet, as the excerpt points out:

A History of Epidemics in Britain, Volume II

“The increase of fever in Glasgow,” says Cowan, “during the seven years prior to 1837, had taken place, not in years of famine or distress, but during a period of unexampled prosperity, when every individual able and willing to work was secure of steady and remunerating employment.
Creighton, C., (1894, 191)
[7]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm

The evidence presented above lends good support to the idea that Typus was what we would call pandemic, i.e., it hit a great many nations, on different continents of the world, at about the same time, with a similar virulence. Thus, a localised crop failure in one region cannot possibly explain the similar eruptions in other nations not suffering a similar plight.

Therefore, as resultant malnutrition are not necessarily linked directly to massively increased deaths from highly infectious diseases such as Typhus, instead – perhaps indirectly, the common body louse has been implicated in the disease – and by association – its spread as indicated below:

Epidemic Diseases of the Great Famine

It is now known that the vector of fever was not famine, nor social distress… but pediculus humanus, the human body louse.
Geary L., (Spring 1996, History Ireland Magazine)
[8]
https://www.historyireland.com/18th-19th-century-history/epidemic-diseases-of-the-great-famine/

Does that mean that crowded conditions and lice infections were the cause? Perhaps not entirely either, as another historical reference suggests.

A History of Epidemics in Britain, Volume II

The lesson of the history is unmistakable: with all the inducements to typhus from neglect of sanitation in the midst of rapidly increasing numbers, there was surprisingly little of the disease…
Creighton, C., (1894, 167)
[9]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm

It is therefore fairly unlikely that this pattern of disease within populations can be directly caused by any of the main factors that we would normally attribute to such spread and high mortality from such contagions.

The idea that neither famine, starvation, nor necessarily overcrowding and generally lousy conditions can fully explain the initial devastation of Typhus in its plague-like devastation is further supported by the evidence emerging from historical accounts of what is often referred to as the Great Irish Famine of the mid-1840s. (it was much more socially and politically complex than simply crop failure, but that is another story).

For instance, the estimates of deaths from Typhus at this time from the so-called famine relief workhouses (that kept fairly comprehensive records for the main famine years) are rather low relative to the high mortality from all the other famine-related causes of death – particularly, considering that the workhouses would have been hotbeds for body lice makes the following figures even more surprising.

THE HISTORICAL IMPACT OF EPIDEMIC TYPHUS

Approximately 190,000 Irish citizens died from typhus contracted in the louse-infested workhouses they were forced to inhabit….
Conlon, J. M., (2007, 13)
[10]
http://www.montana.edu/historybug/documents/TYPHUS-Conlon.pdf

No other circumstances should have been more conducive to encouraging the ravages of Typhus and other widely infectious diseases than this. But, as suggested in the figures given above (almost 200,000 deaths from Typhus over the course of the few years of the Great Famine which, broadly speaking would average out to less than 50, 000 deaths from Typhus over each of the famine years), is still significantly lower than the estimated death toll for the initial epidemic of 1816 (perhaps as much as half a million in a single outbreak) when living conditions were significantly better than during the Famine years of the mid 1840s onwards.

In other words, it looks like the later outbreaks of Typhus – (post-early 1800s), the widespread Typhus pandemics of the 1830s, and onwards until the Great Irish Famine era (even at the height of great famine,  pestilence and recorded louse infestations) and certainly after this point, Typhus, as a harbinger of near-certain death in the early days to an estimated one in every six of the entire population of relatively healthy and hardy people, had become increasingly tame over the decades that followed; even during the nation’s most dreadful famine years of the mid to late-1840s.

Indeed, there are historical accounts that support the taming of this once more deadly disease of Typhus, as supported in the following:

A History of Epidemics in Britain, Volume II

It was from 1830 to 1834 that a change in the reigning type of fever began to be remarked in London, Dublin, Edinburgh and Glasgow, the new type becoming more and more evident as fevers became more prevalent in the ‘ thirties ‘ and ‘forties.’
Relapsing Fever the common type in 1847, …
Mayo and Galway, and in Gweedore, Donegal, not more than one in a hundred cases of relapsing fever proved fatal. In Limerick the mortality was ” very small.” In many places it is given at three in the hundred cases, in some places as high as six in the hundred. When deaths occurred, they were often sudden and unexpected…
Creighton, C., (1894, 189)
[11]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm

Relapsing Fever as it turns out is actually the less lethal form of Typhus and it is notable that this phenomenon is near-simultaneous – from the 1830s onwards – throughout many regions, including  Ireland. The fatalities indicated in the excerpt above for those that got the relapsing form of the fever are significantly less (one or as many as six per hundred of cases of the disease and the cases themselves do not seem to be that many) than those estimated for the initial 1816 epidemic.

Interestingly, although communities were finally starting to sigh a breath of relief as Typhus (relapsing fever) was seemingly becoming less deadly, after the mid 19th Century, people on the ground – so to speak, were beginning to feel its replacement in the form of another contagion: namely, Enteric Fever, which is another name for Typhoid Fever (see previous article here) as referenced below:

A History of Epidemics in Britain, Volume II

The cases of enteric fever increased decidedly after 1865… ….The disappearance, during the last twenty years, of typhus and relapsing fevers from the observation of all but a few medical practitioners in England, Scotland and Ireland, is one of the most certain and most striking facts in our epidemiology.
…Still more recently, the relative proportions of typhus and enteric fever have been reversed, so that there have been years with little or no typhus but with a good deal of enteric fever… Typhus declined, and typhoid rose…
Creighton, C., (1894, 202)
[12]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm

Typhus and Typhoid deaths Ireland compared                              

Fig. 2: Chart of the annual number of deaths in Ireland from Typhus Fever (black) compared to the annual number of deaths officially recorded from Typhoid Fever (light grey and translucent) in Ireland since records for these diseases began. Source: Chart 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.

Figure. 2 above, clearly shows this rise in deaths of Enteric Fever (Typhoid) as deaths from Typhus decline. Now we know why the deaths from Typhoid Fever were only recorded from 1881 onwards, as Typhoid hadn’t much hope of getting in while Typhus was wrecking havoc. It also puts the comparatively small number of deaths from Typhoid annually in Ireland into some sharp relief when we begin to calculate the estimated mass devastation that Typhus seems to have caused at its height – prior to when official records began. The graph above (Fig. 2) also clearly illustrates the dramatic and ultimate decline in deaths from both diseases in the end.

This historical investigation into the fate of Typhus revealed that this once mighty disease soon lost its grip throughout much of the 19th Century in Ireland and elsewhere and this is strongly indicated by the historical estimates as well as the documented observations of a  shift from the more deadly form of Typhus to what came to be known as relapsing fever (the less deadly form). This evidence is indicative of natural resistance to the pathogen due to exposure over generations, even in the greatest years of hunger and destitution, which finds further support in the excerpts that follow.

A History of Epidemics in Britain, Volume II

… The best illustrations of the greater severity and fatality of typhus among the well to do come from Ireland, in times of famine…
But it may be said here, so that this point in the natural history of typhus fever may not be suspected of exaggeration, that the enormously greater fatality of typhus (of course, in a smaller number of cases) among the richer classes in the Irish famines, who had exposed themselves in the work of administration, of justice, or of charity, rests upon the unimpeachable authority of such men as Graves, and upon the concurrent evidence of many…
Creighton, C., (1894, 189)
[13]
https://www.gutenberg.org/files/43671/43671-h/43671-h.htm

This historical excerpt begins to explain the possible reason why the death toll was not much more massive during the Irish Famine of the 1840s, as it seems that most of the Irish who were impacted the greatest by malnutrition and just about everything else that could be thrown at them, were for the most part, essentially resilient to Typhus’ worst effects  (and those that did survive had to face the onslaught of  an unfamiliar pathogen that was implicated in Typhoid).

On the other hand, as reiterated below, those who were the least exposed to such conditions – the most hygienic, best-fed and generally healthiest individuals – the professionals and philanthropists trying to care for the destitute Irish, were the most vulnerable to Typhus’ worst effects.

Epidemic Diseases of the Great Famine

“During the Great Famine, relapsing fever was the prevalent disease among the general population, while the higher social classes tended to contract the more deadly typhus fever, especially those who were most exposed to infection, notably clergymen, doctors, members of relief committees and those connected with the administration of the poor law. The mortality rate from typhus was also more pronounced among the middle and upper classes than it was among the poor, who may have developed some immunity through long-term exposure”.

Geary L., (Spring 1996, History Ireland Magazine)
[14]
https://www.historyireland.com/18th-19th-century-history/epidemic-diseases-of-the-great-famine/

 

It seems that it is the less well-washed and most exposed to body lice populations that were able to build up the most formidable resistance to the disease, whilst, unfortunately, it was the people who had the least resistance that ended up with the poorest immunity, those with the greatest intentions, that ended up more frequently with the decidedly deadlier form of Typhus than those they were trying to help.

The key point from this historical investigation is that it is obviously quite important to be exposed to such pathogens in the first place in order to build up familiarity and utlimate immunity, particularly as our ancestors have seemingly already taken the hit for us. Thus, by not being too squeaky clean and allowing a little clean dirt into our lives, we are actually building up robust resistance to all sorts of pathogens – whether we know it or not.

Remember, just like the pathogen that appears to trigger Typhoid or, the pathogen implicated in the Plague, these microbes never actually went anywhere – they still exist all around us today and can, very occasionally, find a little chink in our armour. And particularly under extreme conditions that can and have sometimes erupted in later history into sporadic epidemics – but nowhere ever on the scale of previous times. Nor, has the common body louse and its own particular parasite that is supposed to be the main cause of  Typhus gone extinct  – it still exists today.  

So, obviously, it helps not to invite the return of such critters to test just how robust our ancestral immunity may actually be, but, as we generally do not – thankfully – hear much about Typhus in our own developing nations these days, perhaps we are more generationally resistant to it than we realise. At this stage, after two major world wars and the amount of travelling that we have done over the past few generations, I would say that our immune systems are all pretty much now familiar with the Typhus pathogen. The fact that we do not often hear about the disease, is probably due to our immune systems doing such a good job all these years. Long may it continue. And presumably, the less developed nations currently having their own battle with such pathogens, as we once did not that many generations ago, will soon follow suit in terms of their own more robust immunity.

Hopefully, this has filled in some of the gaps in our knowledge regarding Typhus.

 

References for Part Four

[1] Peterson, K.D., (2018) Typhus, Entomology Group Insects, Disease, and History, Montana State University, p.156. [Available online]
[2] Conlon, J. M., (2007) The Historical Impact of Epidemic Typhus, Entomology. Montana Education, History of the Bug, p. 13. [Available Online Google].
[3] Mokyr, J., and Ó Gráda, C., (2002) Famine Disease and Famine Mortality: Lessons from the Irish Experience, 1845-50. in: eds., Tim Dyson & Cormac Ó Gráda. Famine Demography: Perspectives from the Past and Present, Oxford University Press, p. 21. [Available Online]
[4] Post, J.D., (1976) Famine, Mortality, and Epidemic Disease in the Process of Modernization, The Economic History Review. Vol. 29, [1], pp. 14-37 [Available online at JSTOR.ORG https://www.jstor.org/stable/2594505?seq=1#page_scan_tab_contents ]
[5] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[6] Douglas, L., (2001) Health and Hygiene in the Nineteenth Century, The Victorian Web (11th Oct., 2002), http://www.victorianweb.org/science/health/health10.html
[7] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 191, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[8] Conlon, J. M., (2007) The Historical Impact of Epidemic Typhus, Montana Education, History of Bugs. p. 13 [Available online as PDF from http://www.montana.edu/historybug/documents/TYPHUS-Conlon.pdf ]
[9] Geary L., (1996) 18th – 19th Century History/Epidemic Diseases of the Great Famine.., History Ireland Magazine, Vol. 4. [1] (Spring 1996) [Available online historyireland.com https://www.historyireland.com/18th-19th-century-history/epidemic-diseases-of-the-great-famine/ ]
[10] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 167, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[11] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 167, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[12] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 189, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[13] Creighton, C., (1894) A History of Epidemics in Britain, Volume II, p. 202, Cambridge, University Press. [Available online at Gutenberg.org https://www.gutenberg.org/files/43671/43671-h/43671-h.htm ]
[14] Geary L., (1996) 18th – 19th Century History/Epidemic Diseases of the Great Famine.., History Ireland Magazine, Vol. 4. [1] (Spring 1996) [Available online historyireland.com https://www.historyireland.com/18th-19th-century-history/epidemic-diseases-of-the-great-famine/ ]

 

Next Week’s Episode: Part Five: Cholera: The Disease that Inspired Bram Stoker to Write Dracula? (note the name change from Typhus to Typhoid.)

Fill in the contact form below – if you haven’t already – this lets me know that if you want weekly updates as each episode becomes available of the series: ‘Don’t Count Your Children Until They’ve Had the POX!’


 

 

 

 

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