Today's Stories from our Past
A podcast about Australian family stories and social history. Everyone has a story that we want to tell.
To contact us, email us at:
todaysstories101@gmail.com
or search for "Today's Stories from our Past" on Facebook or YouTube.
Today's Stories from our Past
E17 - Diseases of the 19th Century - Part A
Deadly epidemics swept through 19th-century cities with terrifying regularity, leaving medical practitioners like Drs. Watts and Mayo powerless against invisible killers they couldn't understand.
What made these diseases so devastating, and how did we finally conquer them? Our medical expert takes us through the horrifying reality of cholera – nicknamed "the blue death" for the distinctive colour it turned victims' skin. The disease could kill within hours as patients lost up to 20 litres of fluid daily. During London's 1854 Soho outbreak, over 600 people died in a small neighbourhood within days.
The prevailing "miasma" theory blamed disease on foul air, until pioneering physician Dr John Snow meticulously mapped cholera cases around a contaminated water pump. His groundbreaking work effectively birthed modern epidemiology, proving disease spread through water rather than air – though the actual cholera bacterium wouldn't be discovered until decades later by Robert Koch.
We also explore the devastating impact of smallpox, which killed 30% of those infected and left survivors permanently scarred. The disease proved particularly catastrophic when introduced to populations with no previous exposure – like Australia's First Nations peoples, who suffered up to 70% mortality after the 1789 Sydney outbreak. The controversial origins of this epidemic raise difficult questions about early colonial history.
The podcast reveals fascinating stories behind smallpox vaccination – how Chinese and Islamic practitioners performed early forms of inoculation centuries before Edward Jenner, and how the famous "milkmaid story" about Jenner's discovery was actually fabricated by his biographer. Even more surprising, we discover that vaccine hesitancy isn't new – cartoons from 1802 show the same concerns we see in modern debates.
Join us for this eye-opening journey through medical history that shows how far we've come in disease understanding and treatment, while highlighting the crucial public health measures – like clean water systems – that save countless lives today. Next episode, we'll examine specific diseases encountered during Dr Mayo's 1836 voyage to Australia.
Contact us at todaysstories101@gmail.com.
On 31st August 1854, after several other outbreaks elsewhere in London, there was a major outbreak of cholera in Soho Over the next three days. 127 people on or near Broad Street died During the next week. Three quarters of the residents fled the area. By 10th September more than 500 people had died and the mortality rate was 12.8 per 1,000 inhabitants in some localities. By the end of the outbreak over 600 people had died.
Speaker 2:G'day I'm Peter and g'day I'm Peter and g'day I'm Greg. Welcome to Today's Stories from Our Past, a podcast about a history of Australia from about 1800 onwards. The story is told through the experiences of those who lived it. So in previous episodes we've talked about two doctors. In episode 10, we told the story of Dr Thomas Watts, who strived to improve the skills and the standing of the profession in England in the early 1800s. Another doctor who we discussed is Dr George Mayo. Dr Mayo did part of his training under Dr Watts and went on to be the ship's surgeon on two voyages to South Australia. During those voyages Mayo had a lot to contend with. Many children died on the second voyage in particular. After arriving on the second voyage, dr Mayo decided to stay in South Australia. He went on to have a long professional career there.
Speaker 3:Yeah, it was a period of change and challenges for the medical profession. They had to deal with many diseases that are not common to now and many diseases with names that we wouldn't even recognise today.
Speaker 2:Agreed. There's a lot in those episodes that we don't understand, so we've called in the good doctor to give us some expert advice. The good doctor is a practicing physician who, for professional reasons, will remain anonymous. However, I can assure you he's more than competent. So welcome Doc.
Speaker 4:Hi, thanks for having me.
Speaker 2:Now, in previous episodes we've encountered many diseases that Drs Watts and Mayo were required to treat. Obviously, a lot has changed in the past 150 to 200 years since they practised their profession in the 19th century. I thought we might tackle each disease they encountered one at a time, but roughly in the same way, depending on the circumstances.
Speaker 4:Sounds good. How do you want to do this?
Speaker 2:I'd suggest for each disease, you could Firstly give us a description of the symptoms and progression of the disease. Also give us the name or names given to that disease in the past. There are a few names that we've come across that we don't recognise, and I know that many people who are looking into their family trees read death certificates and can't understand the manner of death. Next, how is the disease transmitted, and was that known in the 19th century? Following that, would it be possible to give a definitive diagnosis for the disease at the time? Then, how did they treat the diseases at the time, if at all, although this might be difficult? What was the infection rate and mortality rate in the past?
Speaker 2:I know this is probably difficult because until the 20th century, accurate statistics were probably not kept Then for survivors of each disease, were there any long-term issues or complications, assuming that between now and then the disease has been brought under control or is easily treated? How was this achieved and by whom? And finally, what's the status of the disease in Australia today and why Does that sound like a reasonable approach?
Speaker 4:Sounds good. Which disease would you like to discuss first?
Speaker 3:Well, let's start with cholera. There were widespread cholera outbreaks in England in the 1830s, which is when doctors Mayo and Watts were practising. So what are the symptoms of cholera? I've been looking at some old illustrations from the time and many of the cholera patients have a blue tinge to their face. Now, what's that all?
Speaker 4:about Well. The primary symptoms of cholera profuse diarrhoea and vomiting of clear fluid. The symptoms usually start suddenly between half a day to five days after ingestion of the bacteria. The diarrhoea is frequently described as rice water in nature and might have a fishy odour. Other symptoms include extreme lethargy, erratic heartbeat, sunken eyes being dry, shrivelled skin with a characteristic blue tinge. So cholera has been nicknamed the blue death because a person's skin may turn bluish grey from extreme loss of fluid. An untreated person with cholera may produce 10 to 20 litres of diarrhoea a day, and the disease can be fatal within hours if not treated. Gosh.
Speaker 3:What was known about the disease at the time.
Speaker 4:The term cholera appears several times in ancient Greek writings and for more than 2,000 years it was used for just about any ill-defined, sporadic gastrointestinal disease. When the first pandemic of cholera in Europe started in 1817, it was known to have originated in Asia. As the superficial resemblance of its symptoms to those of the previous cholera were similar, it led to being given the name cholera. Some thought that cholera from Asia was an entirely new disease, while others believed that the old cholera had newly become an epidemic. This confusion of ideas on the nature and epidemiology of cholera lasted for many years, especially after 1830, when the disease began to spread widely in Europe.
Speaker 3:So what was the means of transmission known at the time?
Speaker 4:Because European doctors were not familiar with the symptoms and prognosis of cholera, they had no idea how it had spread. We need some context here. During the Industrial Revolution, great Britain became transforming from a rural country into an urban nation. By the 1800s London was the largest city in the world as a result of the social changes brought about by industrialisation, such as mass migration from the countryside to towns. But London was a city overwhelmed by the waste products of its overgrowing population, the majority of whom lived in the squalor of overcrowded slums. Human waste piled up in courtyard and overflowed from basement cesspits into the gutters and waterways.
Speaker 4:The combination of scary symptoms and fear of the unknown seized the public's imagination and cholera was characterised as a foreign epidemic which was invading from the nation. Thus it became commonly known as Asiatic cholera. In 1842 publication the Sanitary Conditions of the Labouring Population, chadwick used quantitative methods to show that there was a direct link between poor living conditions, disease and life expectancy. This investigation inspired the Public Health Act of 1848 and the establishment of the Central Board of Health, of which Chadwick was the first director.
Speaker 3:So wouldn't the Central Board of Health try to find its cause?
Speaker 4:Yeah, they certainly did. The Board of Health tried to find the cause of cholera and was criticised for not being able to do so.
Speaker 3:So wouldn't those filthy urban conditions have given the Board a clue as to the cause?
Speaker 4:Well, yes and no. The problem was the old theory that prevailed at the time. It was called miasma, or simply the night air. The miasma theory held that diseases such as cholera, chlamydia, the black death, were caused by miasma, which was a noxious form of bad air also known as night air. The theory held that epidemics were caused by miasma emanating from rotten organic matter. Miasma caused various illnesses. It was considered to be a poisonous vapour or mist filled with particles from decomposed matter. My asthma and thus diseases were the product of environmental factors such as contaminated water, foul air and poor hygienic conditions. Such infection was not passed between individuals, but would affect individuals within a neighbourhood due to the presence of the vapours there. It was identifiable by its foul smell.
Speaker 3:Well, it sounds like rubbish today, but I guess old dogmas can persist. So how did they overcome this dogma?
Speaker 4:Well, in the 1848-49 there was a second outbreak of cholera, and this was followed by a further outbreak in 1853 to 1854. Towards the end of the second outbreak, john Snow, a London-based physician, published a paper called On the Mode of Communication of Cholera, in which he proposed that cholera was not transmitted by bad air but was a waterborne infection. However, little attention was paid to his paper.
Speaker 3:Yeah, but it seems like Snow was on the right track there.
Speaker 4:Yeah, he was. It took the work of Dr John Snow to shed light on the source of the disease. On the 31st of August 1854, after several other outbreaks elsewhere in London, there was a major outbreak of cholera in Soho Over the next three days. 127 people on or near Broad Street died During the next week. Three quarters of the residents fled the area. By 10 September more than 500 people had died and the mortality rate was 12.8 per 1,000 inhabitants in some localities. By the end of the outbreak over 600 people had died. See, that sounds dreadful.
Speaker 4:Snow's hypothesis was that germ contaminated water was the cause, rather than miasma. By talking to local residents, snow identified the outbreak source as the public water pump on Broad Street at the intersection with Cambridge Street. Although Snow's chemical and microscopic examination of a sample of the water from the pump did not conclusively prove it dangerous, the patterns of illness and death amongst residents in Soho persuaded the authorities to disable the pump by removing its handle. Subsequently, snow produced a map showing the location of infected residents. He mapped the individual water pumps and generated cells representing all the points on his map that were closest to each pump. The section of Snow's map represented areas in the city where the closest available source of water was the Broad Street pump, and this had the highest incidence of cholera.
Speaker 4:But there was one significant anomaly None of the workers in the nearby Broad Street Brewery contracted cholera, as they were given a daily allowance of beer. They did not consume the water from the nearby well. During the brewing process, the unfermented beer is boiled so that the hops can be added. This step killed the cholera bacteria in the water that they used to brew, with making it safe to drink. Boiled so that the hops can be added, this step killed the cholera bacteria in the water that they used to brew, with making it safe to drink.
Speaker 3:So Snow conducted the World Source Epidemiological Study.
Speaker 4:Yeah. Snow later used a dot map to illustrate how cases of cholera occurred around this pump. His efforts to connect the incidence of cholera with geographic sources was based on what is now known as the Voronoi diagram. He mapped the individual water pumps and generated cells representing all the points on his map that were closest to each pump. The section of Snow's map representing areas in the city where the closest available source of water was the Broad Street pump had the highest incidence of cholera.
Speaker 4:Snow also performed a statistical comparison between the Southwark and Vauxhall Waterworks Company and a waterworks at Seething Wells that was further up river and hence had cleaner water. He showed that houses supplied by the former had a cholera mortality 14 times higher than those supplied by the later Germ. Theory was not yet established. Times higher than those supplied by the later Germ. Theory was not yet established. So Snow did not understand the mechanism by which disease was transmitted, but the evidence led him to believe that it was not miasma. Based on the pattern of illness amongst residents, he hypothesised that cholera was spread by some agent in the contaminated water.
Speaker 4:Okay so was there any treatment for cholera at that time? The treatment of cholera was evolving significantly since its first arrival in Europe. Early treatments included bloodletting. This practice, believed to relieve the heart and lungs, was a standard treatment in the 1830s, despite its total ineffectiveness. Though early attempts at intravenous fluid therapy had been made during the 1832 cholera outbreak in Britain, they were not widely adopted. Cholera outbreak in Britain they were not widely adopted. William Stevens and William O'Shaughnessy proposed oral rehydration that is, drinking a lot of clean water, but it lacked sufficient scientific evidence and didn't gain traction. Castor oil, brandy, opium, bismuth, salicylate and chloroform were all used, but these had limited benefits.
Speaker 3:Well, those treatments certainly weren't a cure. It seems obvious to a modern observer that some germ caused cholera. When was this discovered?
Speaker 4:Heinrich Hermann Robert Koch was a German physician and microbiologist who was the discoverer of the specific causative agents of deadly infectious diseases, including tuberculosis, cholera and anthrax. He is regarded as one of the main founders of modern bacteriology. It's a long story, but in August 1883, the German government sent a medical team led by Koch to Alexandria, egypt, to investigate a cholera epidemic there. Koch eventually discovered the bacterium then known scientifically as Bacillus comma. Koch hypothesised that some sort of poison was used by the bacterium to cause the disease. In 1959, indian scientist Sambu Nath D discovered this poison, the cholerotoxin. Modern treatments didn't really start until the 1950s with oral rehydration therapy. Successful treatments based on careful intake and output balance studies were implemented. This became the cornerstone of the treatment in the 1960s, utilising a solution of sugar, salt and water to replace the lost fluids and electrolytes. For severely dehydrated patients, intravenous fluids are used to restore the hydration and electrolytes.
Speaker 3:Yeah, but isn't that just treating the disease? What about the prevention?
Speaker 4:Yes, major scientific breakthroughs, including the first cholera vaccine and the identification of Vibrio cholera, were subsequently made, but the real prevention was due to civil engineers, not doctors. London and other large cities undertook programs to reticulate clean, germ-free water through the cities and then to reticulate wastewaters away from the cities, namely the introduction of pipe sewerage systems. So today cholera rarely occurs in modern western cities, but persists in poor areas where drinking water supplies and sewerage mix.
Speaker 3:Do you know what the mortality rate is for untreated?
Speaker 4:cholera. Severe cholera without treatment kills about half of affected individuals. During the 19th century, four outbreaks of cholera between 1832 and 1866 ravaged London communities and led to the deaths of tens of thousands of people. However, treatment is straightforward rehydration and, if provided rapidly and appropriately, the case fatality rate should remain well below 1%. Researchers estimate there are still 1.3 to 4 million cases and 21,000 to 140,000 deaths from cholera worldwide every year.
Speaker 3:Wow, and for the survivors? Are there any long-term complications?
Speaker 4:Prompt treatment usually leads to full recovery without any long-term complications.
Speaker 3:Okay, so let's move forward to today in Australia. Does the disease occur here today and what preventative measures are taken?
Speaker 4:Cholera is rare in Australia about two to six cases annually in Australia and they're usually in individuals who contract the illness abroad. While the cholera bacteria, vibrio cholera, has been found in some rivers in northern Australia and Queensland, human cases are extremely uncommon.
Speaker 2:Now let's talk about one of the big killer diseases at the time smallpox. Can you give us a description of the symptoms and progression of that disease?
Speaker 4:Firstly, I should say that smallpox was one of the most virulent and deadly diseases to have afflicted humanity. Throughout its long history, it's infected hundreds of millions of people. Tens of millions of people have died. Those who have survived are often badly scarred, blinded or both.
Speaker 4:The initial symptoms of the disease include fever, frequently surpassing 38.3 or the old 101 Fahrenheit, and vomiting. There were generalised symptoms such as weariness, physical aches, intense headaches and general malays. This was followed by the formation of ulcers in the mouth and a skin rash. This was followed by the formation of ulcers in the mouth and a skin rash. A rash initially showed flat red spots or macules on the face, hands and forearms. Within a few days, the macules developed into raised bumps or papules, and then fluid filled vesicles or blisters and finally pus filled pustules. Rash spread to the trunk, chest and back then to the legs and arms, usually at the same rate and stage across the body.
Speaker 4:Lesions were often in the same stage of development at any given time. Lesions appeared evenly dispersed and developed through phases. Concurrently, each lesion featured a distinct core depression or umber location. The bumps then scabbed over and fell off, leaving scars. There were two forms of smallpox. Variola major was the severe and most common form, with a more extensive rash and high fever, and variola minor, which was a less common presentation, causing less severe disease, typically discrete smallpox, with historical death rate of less than 1%. Smallpox was highly contagious but generally spread more slowly and less widely than some other viral diseases, perhaps because transmission required close contact and occurred after the onset of the rash. The overall rate of the infection was also affected by the short duration of the infectious stage.
Speaker 2:So were there different names for smallpox in the 19th century.
Speaker 4:Other historical names for the disease include just the pox speckled monster red plague.
Speaker 2:So was there a definitive diagnosis for the disease? I mean, could it be confused with others, such as chicken pox or monkey pox or cow pox?
Speaker 4:Smallpox, chicken pox, monkey pox, cow pox all were distinct viral illnesses, though they can all cause a rash. Smallpox, caused by the variola virus, was a devastating illness throughout history, resulting in large epidemics and significant mortality rates. The development of the smallpox vaccine and global immunisation efforts resulted in the disease's eradication in the 1980s. Chickenpox, caused by the varicella zoster virus, is a frequent paediatric infection with a characteristic rash and minor systemic symptoms. Monkeypox is a rare disease with symptoms that are similar but milder than the symptoms of smallpox. However, monkeypox can cause death. Monkeypox is an emerging infection in Africa, and outbreaks of imported cases of monkeypox sometimes happen in other countries, including the United States. Cowpox is a zoonotic disease caused by the cowpox virus, primarily affecting cattle, but it can also infect humans and other animals like cats. Zoonotic means to be able to be spread from animals to humans. It's known for causing skin lesions and, in rare cases, systemic symptoms. Hence, dairy workers can get this mild disease.
Speaker 2:So how was smallpox treated at the time?
Speaker 4:There was no specific therapy for smallpox. Once symptoms occurred, treatment was generally focused on supportive care to control symptoms and prevent complications. Individuals infected with the virus were quarantined to prevent it from spreading any further. Medications to alleviate temperature and pain were used. Adequate hydration intake was important. Vaccinations soon after exposure within three to four days, could prevent or reduce the severity of the sickness.
Speaker 2:So do you know what the mortality rate was for smallpox?
Speaker 4:The mortality rate from variola minor was approximately one percent, whilst the mortality rate from variola minor was approximately 1%, whilst the mortality rate from variola major was approximately 30%. In fatal cases of ordinary smallpox, death usually occurred between days 10 to 16 of the illness. The cause of death from smallpox was not clear, but the infection was now known to involve multiple organs but the infection was now known to involve multiple organs.
Speaker 2:Okay, For those 70% who survived. Were there any permanent issues or complications?
Speaker 4:Many smallpox survivors had permanent scars over large areas of their body, especially their faces.
Speaker 2:Yes, they're horrible-looking scars. Do you know if smallpox, well well, and any other diseases for that matter were more infectious and deadly for communities that had never been exposed to the disease, compared to communities such as Europe, where the disease had existed for centuries?
Speaker 4:Europeans infected with such diseases typically carried them in a dormant state, were actively infected but asymptomatic, or had only minor symptoms. Because Europe had been subject for centuries to a selective process by these diseases, explorers and colonists in Australia and North America often unknowingly passed the diseases to First Nations peoples. Smallpox was a significant disease in Australia's history, particularly in the Sydney area in 1789. It devastated First Nations populations who had no pre-existing immunity. In April 1789, 15 months after the First Fleet arrived to establish a penal colony in New South Wales, a major smallpox epidemic broke out. The outbreak did not affect the British colonists, most of whom had been exposed to the disease during their infancy. As a result, smallpox was not detected until members of the First Nations communities living between Sydney Cove and the Heads were found, according to Newton Fowle, lying dead on the beaches and in the caverns of rocks. They were generally found where there remains a small fire on each side of them and some water left within their reach. Without previous exposure to the smallpox virus, first Nations people had no resistance and up to 70% were killed by the disease. The question of how smallpox appeared among the local First Nations groups was settled to the satisfaction of the early settlers by blaming the French. La Perouse had anchored his ships in Botany Bay for six weeks after the British first arrived. At least one of the crew died during this period and was buried on the shore of the bay. Had the French infected the local population, the outbreak would have started in the early months of 1788, not more than a year later.
Speaker 4:Subsequent commentators have suggested that unsuspecting Makassar fishermen brought smallpox to Australia's north, after which it travelled down well-established trade routes. However, given the relatively high population densities required for the disease to spread and the fact that those infected quickly became incapable of walking, any such outbreak is unlikely to have spread across the desert trade routes. A more likely source for the disease was the variolus matter. Surgeon John White brought with him on the First Fleet. Variolus matter is pus taken from a recovering smallpox sufferer and sealed in a glass bottle to isolate and preserve it. White intended to use it to variolate any children born in the settlement. Research in the 1970s has shown that smallpox virus withstands a wide range of temperatures and humidity and remains viable over many years. How this material could have infected the local tribes is unknown. The appalling devastation it wrought probably silenced anyone in the colony who might have known.
Speaker 2:So could the disease be transmitted using blankets that infected people had been sleeping in?
Speaker 4:In Europe. Some infections of laundry workers with smallpox after handling contaminated bedding suggested that smallpox could be spread through direct contact with contaminated objects or fomites, but this has been found to be a rarity in Europe.
Speaker 2:So who, how and when was the disease brought under control?
Speaker 4:In China, a technique called variolation or inoculation was developed around the 1500s, where people were deliberately infected by having dried smallpox scabs blown up their noses. Patients contracted a mild form of the disease with a mortality rate of only 1-2%. Those who survived were then immune, were then immune. In 1717, lady Mary Wortley Montagu learned a variolation from Islamic doctors in Constantinople, the capital of the Ottoman Empire. In 1721, the Princess of Wales supported Lady Montagu in urging that the procedure be tested in England. Prisoners and abandoned children had live smallpox virus in the form of pus inserted under their skin. They survived and several months later were exposed to the disease, which none of them contracted. Variolation was then used across Western Europe.
Speaker 4:No cure for smallpox was ever found, but in 1796, the English doctor Edward Jenner performed an experiment that would eventually lead to the eradication of smallpox. He inoculated a child with a material from a cowpox postule, just as he would have done from a smallpox postule. About six weeks later, he performed a conventional inoculation on the same child using smallpox material. When there was no reaction to the inoculum, jenner believed that he had demonstrated that the cowpox could produce immunity to smallpox just like the real smallpox virus. His experiment had worked by relying upon a similar but less virulent infection associated with an animal host, jenner's vaccine held a key advantage over the previous and dangerous, unpredictable practice of variolation, a technique which conferred immunity to the disease through inoculation with a mild strain of the smallpox virus. Jenner dignified cowpox in print with a name derived from the Latin term variola, smallpox and vacca cow. His tribute to the source of his discovery lives on in modern usage of the words vaccine and vaccination.
Speaker 2:Yes, I wonder what the ethics committees would think of some of those experiments in the past. But nevertheless, let's move forward to Australia today. Does the disease occur here? What preventative measures are taken? I mean, I know that I still have a small scar from when I was vaccinated against smallpox.
Speaker 4:Well, no, the disease has been completely eradicated worldwide due to the vaccination programs. But having gone through the history of the eradication of smallpox, there are a few observations to be made. Firstly, in my childhood I was always led to believe that the Englishman Edward Jenner came up with the concept of vaccination himself, which subsequently rid the world of the horrendous disease. We now know that the Chinese and Islamic doctors were doing vaccinations for centuries before Jenna appeared on the scene and that Lady Mary Wortley Montague and Charles Maidland had introduced inoculation to England 75 years earlier. In this context, inoculation and immunisation are essentially the same thing. Secondly, history texts and children's stories all focused on the role of milkmaids in guiding Jenner to cowpox. Sadly, the milkmaid story is a lie invented by John Barron, jenner's friend and first biographer. Jenner himself never claimed to have discovered the value of cowpox, nor did he ever say, despite a huge volume of correspondence, how he came across the idea. The myths of the milkmaids are just that myths To modern eyes.
Speaker 4:Jenner is revered for eradicating smallpox by using cowpox. In his lifetime, however, edward Jenner faced severe criticism from jealous competitors and from many ordinary doctors who did not trust his method because, unlike inoculation, it did not give permanent immunity to smallpox. John Barron invented the milkmaid story to counteract these criticisms. The third observation is that whilst researching old newspapers and books, at Jenner's time there was scepticism and fear about vaccination. Time there was scepticism and fear about vaccination. The 1802 cartoon by English cartoonist James Gilray from 1756 to 1815 is a striking reminder that the controversy surrounding vaccination is as old as the earliest days of the procedure itself. It seems there was nothing new under the sun. It is just as well that Jenna's vaccine was adopted widely and the curse of smallpox is now gone.
Speaker 3:Well, it seems that Drs Watts and Mayo were really behind the eight ball when it came to managing most of the diseases that broke out at that time. Yes, absolutely.
Speaker 2:Yes, now, in the next episode, we'll discuss the diseases that Dr George Mayo encountered on board the Asia in 1836 during his second voyage to Australia. Great Thanks for listening, so it's goodbye from me.
Speaker 3:And it's goodbye from me.
Speaker 4:And it's goodbye from me, thank you.