Category Archives: mortality

An Anniversary year for Natural Disasters: 1815, 1665, and 1315

There are major natural disasters every year. In the last year alone we have had the major earthquake in Nepal just in the last couple days and a historic epidemic of Ebola. It’s too soon to tell how these latest disasters will seen by history and effect historical interpretations. This year there are three natural disaster anniversaries that stand out from the rest not just due to their mortality but also because of their impact on how we interpret the past.

Tambora, 1815

Mount Tambora Volcano, Sumbawa Island, Indonesia
Mount Tambora Volcano, NASA image (public domain)
Just a few weeks ago there was a minor splash in the news to mark the 200th anniversary of the eruption of Tambora on April 5, 1815. The photo to the right is the caldera of Tambora taken from space. As tragic as the thousands of deaths directly related to the eruption are, 1815 is best known as the ‘year without a summer’, a volcanic winter. It is impossible to know how many deaths resulted from crop failures and unseasonable weather. As the most recent volcanic winter, 1815 is an important because we have the most reliable scientific data, economic data, and descriptions of the effects on health and culture from people in all walks of life all over the globe. I don’t know as much about Tambora and its after effects as I would like, so I’m planning on reading The Year Without a Summer by historian William Klingman and meteorologist Nicholas Klingman (2013). If I like it, maybe you will hear more about it later this year.


Great Plague of London, 1665

This year is also the 350th anniversary of the Great London Plague that was followed closely by the Great London fire. Despite its reputation, the great plague of London was not the last major plague of Europe by a long shot.

17th century London
17th century London

The 1665 plague of London claimed up to 100,000 lives, about as many as died in the Marseille plague of 1720-3. Fifty years later, a similar size plague struck Moscow under Empress Catherine the Great. Yet, the London Plague is the one that gets the most attention.

A great deal of the notoriety of the Great Plague of London comes from the amount and quality of resources available in English.  Daniel Dafoe immortalized the plague in his novel, Journal of a Plague Year written in 1722. A savvy author, Dafoe timed it to take advantage of plague fears in southern Europe, concurrent with the plague in Marseille. It is testament to the Dafoe’s skill as a writer than his novel is often taken as historical evidence. I think I’ll mark the anniversary by reading Defoe’s classic.

The London plague has also been magnified by it linkage with the great fire of London in 1666. The relationship between the fire and the plague has been controversial. It has been sometimes assumed that the fire ended the plague, but the plague was winding down before the fire began. However, it is likely that the fire removed the environment that had supported the plague preventing its return; over 80% of the citizens of London were left homeless. Restoration of the capital city after the great fire also immortalized 1665-6 in the history of London.


Great European Famine, 1315

A less combustible but perhaps equally deadly anniversary this year is that of the Great Famine of 1315 that effected most of continental Europe. Seven hundred years ago the famine began and, while its hard to estimate famine mortality over three to seven years, perhaps up to 15% of Northern Europeans died. It began with soaking and then flooding rains that destroyed winter crops for two years with yields of wheat and rye in England and Wales 60% below normal in 1316, and again in 1321 with similar drops in yield. Also beginning in 1315 the great bovine pestilence, possibly rinderpest,  begins in Central Europe and spread across the continent: France and Germany, the Low Countries,  Denmark and England by 1319. In just one year, England and Wales lost approximately 62% of all bovines (Slavin 2012). The loss of dairy and beef was compounded by the fact that oxen provided the vast majority of traction and fertilizer. With similar losses across Europe, it took nearly 25 years to return cattle numbers to the pre-epizootic levels.

There was no respite for the 14th century. The childhood survivors of the famine and food shortage were the adults who were cut down by the Black Death in the 1340s. What effect malnutrition had on their developing immune system is a line of inquiry being explored by anthropologists Sharon DeWitte and historian Philip Slavin (2013). Let us not forget, it still got worse, between the crop failures and panzootic of 1315 and the Black Death in 1346 , the Hundred Years’ War begins in 1337.

References

Devaux, C. A. (2013). Small Oversights That Led to the Great Plague of Marseille (1720-1723) Lessons From the Past. Infection, Genetics and Evolution, 14(C), 169–185. doi:10.1016/j.meegid.2012.11.016 (for comparisons to other epidemics)

Slavin, P. (2010). The Crisis of the Fourteenth Century Reassessed: Between Ecology and Institutions — Evidence from England (1310-1350). EHA Paper, 1–14.

Slavin, P. (2012). The Great Bovine Pestilence and its economic and environmental consequences in England and Wales, 1318–501. The Economic History Review, 1–28.

Dewitte, S., & Slavin, P. (2013). Between Famine and Death: England on the Eve of the Black Death—Evidence from Paleoepidemiology and Manorial Accounts. Journal of Interdisciplinary History, 1–25.

Ebola’s Chain of Infection

Chain of Infection A chain of infection is a method for organizing the basic information needed to respond to an epidemic.  I’ve gathered the best information I’ve been able to find. As the current epidemic is analyzed, there is no doubt some of the recommendations and basic knowledge will change.

The Ebola Virus (EBOV)

img8The Ebola virus is a Filovirus, an enveloped RNA virus containing only eight genes. Three of the five ebola virus species are highly pathogenic to humans: Zaire ebolavirus (Case fatality rate (CFR) 70-90%), Sudan ebolavirus (CFR ~50%) and Bundibugyo ebolavirus (CFR 25%). The 2014 epidemic is caused by the  Zaire ebolavirus.

Ebola attaches to the host cell via glycoproteins that trigger absorption of the virus. Once inside the cell it uncoats and begins replicating the eight negative sense RNA genes (seven structural genes and one non-structural gene). It initially targets immune cells that respond to the site of infection; monocytes/macrophages carry it to lymph nodes and then the liver and spleen. It then spreads throughout the body producing a cytotoxic effect in all infected cells. Death occurs an average of 6-16 days after the onset of symptoms from multi-organ failure and hypotensive shock.

Symptoms present 2-21 days after infection and the patient is contagious from the onset of symptoms.  Symptoms include a fever, fatigue, headache, nausea and vomiting, abdominal pain, diarrhea, coughing, focal hemorrhaging of the skin and mucus membranes, skin rashes and disseminated intravascular coagulation (DIC). In the 2014 epidemic, abnormal bleeding has only occurred in 18% of cases and late in the disease process.

The Reservoir

Fruit bats in Africa are believed to be the primary reservoir. Transmission between bats and other animals is poorly understood.

ebola_ecology_800px

Portal of Exit

Ebola leaves its reservoir by contact with body fluids of an infected animal, often by bushmeat hunters. The spill-over is usually very small with the vast majority of human cases being caused by human to human transmission.

Transmission 

Transmission between humans occurs by contact of skin or mucus membranes with the body fluids of an infected person. Viral particles are found in all body fluids: blood, tears, saliva, sputum, breast milk,  diarrhea, vomit, urine, sweat and oil glands of the skin, and semen. Ebola can be found in semen three months after recovery from an infection but transmission by this route is poorly understood. Viral particles are found in other body fluids for 15 days or less after the onset of symptoms. It lasts the longest in convalescent semen and breast milk. All fluids from dead bodies are highly infectious.

All materials touched by the infected person, body fluids, medical waste, and used PPE must be discarded and destroyed as infectious medical waste. Non-disposable items like rubber boots, furniture, and building structures must be professionally decontaminated.

Ebola virus is a Biosafety Level 4 pathogen and a category A bioterrorism agent along with other viral hemorrhagic fevers.

Portal of Entry

Ebola enters the human body through breaks in the skin, including micro-abrasions and splashes on mucus membranes. Personal protective equipment (PPE) includes full body coverage including hood, mask or face shield, a tight fitting respirator, boots or shoe coverings, and double gloving. A buddy system should be used for dressing and disrobing. Removing PPE is a point of frequent contamination and should be done with help from another robed person.

Vulnerable populations

The most vulnerable populations for ebola are defined by their occupation. Care givers in medical facilities are at the highest risk because the viral titers reach the highest levels in fatal cases shortly before death. Mortuary and burial workers are also at high risk. The infectiousness of the bodies means that the usual burial practices can not be done in any setting or country. Home caregivers and decontamination workers would also be at a higher risk.

Information is lacking on survival vulnerabilities such as age, gender, pregnancy, or pre-existing conditions. More information on these aspects should be available in the post-epidemic analysis of the current epidemic.

 

References and further reading:

Martines, R. B., Ng, D. L., Greer, P. W., Rollin, P. E., & Zaki, S. R. (2014). Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg Viruses. The Journal of Pathology, n/a–n/a. doi:10.1002/path.4456 [in press]

Chowell, G., & Nishiura, H. (2014). Transmission dynamics and control of Ebola virus disease (EVD): a review. BMC Medicine, 12(1), 196. doi:10.1186/s12916-014-0196-0

Toner, E., Adalja, A., & Inglesby, T. (2014). A Primer on Ebola for Clinicians. Disaster Medicine and Public Health Preparedness, 1–5. doi:10.1017/dmp.2014.115

Bausch, D. G., Towner, J. S., Dowell, S. F., Kaducu, F., Lukwiya, M., Sanchez, A., et al. (2007). Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites. Journal of Infectious Diseases, 196(s2), S142–S147. doi:10.1086/520545

CDC: Ebola Virus Disease portal

Setting Affairs in Order During the Plague, Newcastle-Upon-Tyne 1636

9780300174472-1Keith Wrightson, Ralph Tailor’s Summer: A Scrivener, his City, and the Plague. New Haven and London: Yale University Press, 2011.

Newcastle-upon-Tyne is one of those cities that is rarely the focus of a plague study – an industrial town whose prosperity and continued existence was based on its economic impact. Coal was king in seventeenth century England and Newcastle had an abundant local supply that not only supplied southern England but was exported throughout the North Sea. The port brought the plague to Newcastle possibly from the Netherlands in October 1635, at least six months before it arrived in London. Initially the plague was light but it was percolating through the rats of Newcastle, and a note in May 1636 marks the the realization that the plague was intensifying.  Still, the port never closed entirely throughout the epidemic. Cities in southern England were willing to risk the plague to keep the coal flowing. Rather than isolate the city and close it port, they opted to board up the infected, their families and caretakers in their homes and quarantine ships. Wrightson hypothesizes that this forced quarantine/isolation was responsible for the high mortality rate within families. Some ships were even willing to visit the port and wait out quarantine more than once during the plague to keep the coal flowing. 

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Railph Tailor Scr.

Wrightson was first drawn to Ralph Tailor by his fancy autograph. He explains that this nearly illegible signature was an anti-forgery device. Scriveners made their living writing documents in the proper style for a court or business contract. Ralph Tailor was a young scrivener still trying to get established when the plague arrived in Newcastle in 1636. With due diligence and some personal risk, Ralph Tailor established his footing in Newcastle by writing wills for the stricken sometimes through boarded up doors and windows, and later estate inventories for their probate.

Plague response in Newcastle depended upon a spontaneous community assistance to be workable. Keeping families boarded up in their homes for weeks requires external support primarily from friends and neighbors. Someone had to bring them food and be their contact with the outside world including summoning Ralph Tailor to write their wills and other documents. It says something about the straights of poor women that they were willing to take jobs as ‘keepers’ (nurses) who were shut up in houses with plague infected families for a small wage. Social safety nets as we know them today did not exist, but neighborly safety nets did. People wove their own safety nets through relationships with neighbors, fraternities and guilds, and kin. While craftsmen and service providers like scriveners were in competition, they also worked together for the good of their craft to support each other and their industries.

Very little narrative information survives of Ralph Tailor or his customers. Yet, a few bare records of deaths and marriages along with the wills and related documents provides a remarkable amount of information about their lives. By comparing witnesses, beneficiaries and debtors in wills the web of community connections can be partially reconstructed. It is possible in some cases to track the plague’s path through these networks as people refer to each other as beneficiaries or recently deceased so that not only was plague hitting some families much harder than others, it hit their support networks as well.  Wrightson was able to divide the city into parishes, very uneven in size and economic status, as another view at how these neighborhood networks were faring on a larger scale. This is the type of painstaking historical research that needs to be done to understand pre-modern plague epidemiology. Very few cities have adequate, perfectly preserved data for modern epidemiological analysis. It takes a skilled historical epidemiologist to make sense out of these incomplete records and to resurrect data from the scattered historical remains in archives.

Ralph Tailor did survive the plague and went on to be a man of means in Newcastle. Fourteen of the wills written by Ralph Tailor during the plague survive linking him personally with 92 people who served as witnesses, clients, co-appraisers of inventories, etc. He married during the plague and furnished his first home with items bought from estate sales of some of the plague victims. (Buyers and prices are recorded for estate sales because they are part of the probate record.) He later became a notary public and diversified his business interests in Newcastle. Writing documents for people must given him the opportunity to learn of good deals. When the hearth tax was taken in 1665, the notary public Ralph Tailor owned a six hearth home “in Corner Tower Ward, a relatively wealthy ward located below Allhallow’s church” in addition to other homes in the poorer wards that must have been rental property (p. 149). Only 6% of the homes in Newcastle that year had six or more hearths.   He managed to remain a prominent townsman and contracted civil servant without becoming personally entangled in the political and religious wars of the seventeenth century within Newcastle and beyond. Eventually twice married, he left no children and his heirs were relatives of his second wife when he died in 1669. He was buried under a now lost memorial stone in Allhallow’s church yard with his first wife.

Wrightson’s microhistory provides a vivid look into life in Newcastle during the plague of 1635-6. This book will be of interest for those interested in plague in 17th century England, especially among craftsmen and port workers. Noble, elites and clergy are rarely mentioned in this book. Through the works of Ralph Tailor we see that extra-ordinary year through the life and work of an ordinary man.