Category Archives: Caribbean

Famine and Epidemic Anthrax, Saint-Domingue (Haiti), 1770

Map of Haiti, (Source: Wikipedia Commons, 2008 CIA World Factbook)

Earthquakes have brought devastation on the Port-au-Prince region many times in the last 300 years. The 1770 earthquake was stronger and relatively as destructive as the 2010 quake (Ker, 2010). It also was centered near Port-au-Prince and to the west of the city.   Ship captain accounts of the earthquake in the Boston Evening-Post from 9 July 1770 make it clear that the quake destroyed the buildings throughout the southern peninsula causing landslides, a tsunami and liquefaction of the valley where Port-au-Prince stands. A 100 family village called Croit De Bouquets was reported to have sunk and disappeared. Despite the destruction Spanish trade restrictions barring the importation of meat or fish remained in place. Famine followed throughout the western part of the island.

To compound the disaster, an epizootic broke out among their cattle. Here we have a rare description of what followed from Michel-Placide Justin, written about 1825:

“… The unfortunate slaves in the north of Saint-Domingue therefore experienced the most frightful famine. The dependencies of Fort Dauphin, that of Gros-Morne, [and] of Jean Rabel, were devastated. Codfish being entirely unavailable, the Spaniards whose hattes [… ‘cattle ranch’] or pastures were being thinned out daily by a terrible epizootic [“épizootie”], sought to salt or smoke all their ill or dead animals; and they [then] brought them into French establishments. These meats, known as tassau in the colonies, which the Negroes avoided eating when they could get [uncontaminated] salted beef or codfish, spread to the slaves the communicable agent [“germe“] of the disease with which they [the meats] were infected [“infectées’]. A type of epidemic disease [“peste“] , called anthrax [“charbon“], spread throughout all the neighboring dwellings of the Spanairds or the routes they frequently used, and in those where the Negroes had bought this tassau. Within six weeks, more than 15,000 white and black colonists perished of this terrible disease, and its ravages did not stop until the government, the magistrates, and the inhabitants themselves had all joined their efforts to repel the scourge introduced into the colony by Spanish greed.

But the numerous and rapid deaths caused by the disease were not all: at least 15,000 Negroes perished of hunger, and the escape of slaves increased in the northern dependency, causing serious fear for security of the colony…” (Morens, 2002:1160).

The mortality counts here may not be very accurate (Morens, 2002). There are no known records or more contemporary accounts for comparison. Perhaps the most important point is that Justin estimated that as many people died from the epidemic as the famine. Both are credited with killing 15,000. I have not been able to find a good mortality estimate for the earthquake itself either.

Its not uncommon for famine to follow natural disaster. The loss of buildings destroys food stores and flooding destroys crops in the field. In this case we have colonial powers taking advantage of the situation by continuing to enforce trade regulations despite the famine. We have to remember that the colonial powers were not shy about using biological warfare to their advantage, so taking advantage of a natural disaster would have seemed strategic. Justin’s account specifically says that people didn’t want to eat the contaminated meat, but it was all that was available to them. It is a good reminder that in times of famine people will eat food that they know will make them sick.

The relationship between famine and infectious disease is a topic I hope to explore in more detail here at Contagions in time. There is a direct relationship between the two; malnutrition severely weakens the immune system making people more vulnerable to contracting and dying of infectious disease.

Cutaneous anthrax (Source: Wikipedia commons/CDC)

The identity of the disease called charbon here is not as clear as the translation implies. Anthrax is a disease that has been compared to coal from ancient times; the term anthrax derives from the Greek word for charcoal. As you can see from the image to the left, cutaneous anthrax produces an ulcer with a  charcoal black center. The cutaneous lesions are really the only visible characteristic of anthrax. The problem comes in, as Morens (2002: 1181) notes, that charbon “was sometimes applied nonspecifically to other human diseases producing skin lesions, including not only dark or violaceous lesions of any sort but also plague and smallpox”.

The best clue we have is that the contagion came to humans from a cattle epizootic by ingestion. The Spanish, presumably in the eastern half of the island, were taking advantage of the situation by harvesting beef from dead and diseased animals. Morens notes that salted or smoked meat is usually ate without further cooking.

The differential diagnosis has pretty much always been between anthrax and plague. Smallpox doesn’t cause epizootics, so it can be ruled out.  Individual large mammals, like camels, can be infected with plague but it doesn’t cause epizootics. Gastrointestinal plague is usually caused by eating raw meat, like raw camel liver (apparently a Middle Eastern tradition). How well Yersinia pestis would survive salting or smoking is unclear; it doesn’t produce endospores. On the other hand, the spores of anthrax can easily survive salting, smoking and even incomplete cooking. Anthrax spores can survive 140ºF and harsh chemicals (Morens, 2002). Anthrax was a fairly common disease of livestock in the colonial period (Morens, 2003).

Further support for the diagnosis of anthrax comes from 1775 reports that the same disease reoccurred in milder epizootics in Saint-Domingue yearly from 1772-1775 (Morens, 2002 & 2003). Each outbreak had the same epizootic and epidemic characteristics involving both cattle and humans. These Caribbean outbreaks contributed to the characterization of anthrax as a distinct disease by French scientists (Morens, 2003).  To this day, anthrax is considered to be hyperendemic in Haiti.

Morens DM (2002). Epidemic anthrax in the eighteenth century, the Americas. Emerging infectious diseases, 8 (10), 1160-2 PMID: 12396933

Morens DM (2003). Characterizing a “new” disease: epizootic and epidemic anthrax, 1769-1780. American journal of public health, 93 (6), 886-93 PMID: 12773345

Ker, Richard. (13 Jan 2010) Haiti Could Have Been Even Worse. ScienceNOW

Thomas Truxes, (Feb 1, 2010) Earthquake at Port-au-Prince, June 3, 1770. [Excerpt from the Boston Evening-Post, July 9, 1770]

See also: “1770 Port-au-Prince earthquake” (last modified 22 Feb 2011).

Clonal origins of Haiti’s Cholera epidemic

Haiti had been free of cholera for 50 years when the earthquake struck in January 2010. The destruction of Haiti’s infrastructure by the earthquake made it vulnerable to infectious disease outbreaks but it was hoped that cholera would pass it by. As we all know by now, this unfortunately has not been the case. Cholera has spread extensively throughout the country and it is feared that with the vast infrastructure damage, it will become entrenched in Haiti.

Finding the source of the epidemic has been politically sensitive locally and internationally. While locals may be quick to accuse outsiders of increasing their misery, determining the exact origin of the bacteria is necessary to understand the outbreak and determine long-term response. Spread of Vibrio cholerae from the South American outbreak that started in Peru in 1991 or the gulf shore of the United States has been ruled out. Several groups have produced results that point toward a south Asian origin but no one has been able to conclusively prove that it came from Nepalese peacekeepers who have shouldered most the blame to date.

A forthcoming report by Ali et al in the April issue of Emerging Infectious Disease confirms a recent clonal origin for specimens taken within the first three weeks of the epidemic. Of the specimens  taken from 19 diarrhea patients in St Mark’s hospital, Artibonite, 16 patients had the altered El Tor biotype of  Vibrio cholerae O1 Ogawa with the classical cholera B toxin gene. Genetic analysis was unable to pinpoint an origin location for this strain. The lack of VNTR diversity suggests a clonal expansion of a point-source outbreak along the Artibonite river. Ali et al do not believe that this strain could have come from a long-standing environmental reservoir in Haiti because of the lack of diversity and the relatively recent origin of the El Tor  biotype.

Ali, A., Chen,Y.,  Johnson, J.A,  Redden, E., Mayette, Y.,   Rashid, M.H.,  Stine, O.C., and Morris,  J.G. (2011). Recent Clonal Origin of Cholera in Haiti. Emerging Infectious Disease, 17 (4 — April) : 10.3201/eid1704.101973

Expedited release of this article can be found here (as of Feb 20, 2011).

Enserink M (2011). Epidemiology. Despite sensitivities, scientists seek to solve Haiti’s cholera riddle. Science (New York, N.Y.), 331 (6016), 388-9 PMID: 21273460