Today's Stories from our Past
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Today's Stories from our Past
E18 - Diseases of the 19th Century - Part B
The deadly journey to Australia wasn't just about surviving treacherous seas—it was about escaping invisible killers that stalked passengers in the cramped confines of sailing ships. Dr. George Mayo's diary from his second voyage records the heartbreaking reality: "Friday March 15th, aged two years three months, dead."
We're joined by a medical expert who unpacks the devastating diseases that claimed so many lives on these early voyages. Measles, often mistakenly considered benign today, killed millions annually before vaccination, with mortality rates reaching alarming heights in young children. The characteristic fever, rash, and respiratory symptoms proved fatal for many youngsters trapped in the close quarters of migrant ships.
Our discussion clarifies the crucial difference between measles and German measles (rubella)—the latter being particularly catastrophic for pregnant women. We learn about Australian ophthalmologist Norman Gregg's groundbreaking 1941 discovery linking rubella in pregnancy to congenital defects, a finding that would eventually save countless unborn children.
The conversation turns to whooping cough, aptly named the "100-day cough" for its persistent, violent spasms that could fracture ribs or cause bleeding in the eyes. Without modern antibiotics, this bacterial infection was especially lethal for infants. We also explore "the itch" (scabies), a non-fatal but miserable skin condition that spread rapidly in shipboard environments and was treated with remedies as dangerous as mercury compounds.
This episode provides remarkable perspective on our medical progress. Diseases that once decimated populations on voyages to Australia have been largely conquered through vaccination campaigns and antibiotics, though they remain threats when preventive measures falter. The suffering of early migrants reminds us how fortunate we are to live in an age where these once-inevitable killers can be prevented with a simple injection.
Ready to learn more about the medical challenges faced by Australia's early settlers? Subscribe now and join us next episode as we continue our exploration of 19th-century diseases.
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Friday March 15th, aged two years three months, dead. The child was put overboard this evening, tuesday, march 26th. Thomas Anderson, aged two years four months, measles.
Speaker 2:Peter Orme, aged eight months dead measles, mary Uphill, aged one year one month. I'm Peter.
Speaker 3:And g'day, I'm Greg.
Speaker 2: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 the previous episode we've talked about two of the major killer diseases of the 19th century cholera and smallpox. Over the centuries, these diseases killed tens of millions of people. Cholera was brought under control through the supply of germ-free drinking water and separate sewage removal systems. Smallpox was eliminated through a worldwide vaccination campaign.
Speaker 3:So what will we talk about in this episode?
Speaker 2:We've previously discussed Dr George Mayo. Dr Mayo did two voices to South Australia. During those voyages Mayo had a lot to contend with. Many children died on the second voyage in particular.
Speaker 3:Yeah, we started with this episode with some extracts from Dr Mayo's diary and, to quote George, it was a pretty good go for him.
Speaker 2:Yeah, and I've seen the medical equipment used by another doctor on a voyage to South Australia at about the same time. It's Dr Everett's kit that he had on the Afrikaan in 1836. We discussed that voyage in episode 5. His medical equipment is really just a collection of probing and cutting tools and very little medicine. In episode 12, about Dr Mayo's second voyage to Australia, there are a lot of diseases there that we don't understand, so we've called on the good doctor again to give us some expert advice. The good doctor is a practising physician who, for professional reasons, will remain anonymous. However, I can assure you he's more than confident. So welcome, doc. Hi, thanks for having me Now. In the previous episode we discussed cholera and smallpox, two dreadful diseases of the 19th century. In this episode we'll chat about the diseases that confronted Dr Mayo on his second voyage to South Australia. As per the previous episode, I thought we might tackle each disease as he encountered, one at a time, but roughly in the same manner as the previous episode, depending on the circumstances.
Speaker 4:Sounds good. What disease should we start with?
Speaker 2:I'd suggest that we start with measles. What disease?
Speaker 3:should we start with? I'd suggest that we start with measles. Ok, let's move on to the diseases that Dr Mayo had to contend with on his voyage to South Australia. The first entry that he makes about his medical duties on board the Asia is Friday, march 15th, ellis Male Sickened with measles.
Speaker 1:A pretty go for me so many children to have the disease.
Speaker 3:Throughout the voyage. Many children die of measles, so we need to cover it. My first question is about alternate names. As a child, I remember measles and German measles.
Speaker 4:Are they different diseases? Yes, absolutely. German measles is now known as rubella. We'll probably have to discuss that as a separate entity, okay?
Speaker 4:so there were different names for measles in the first half of the 19th century measles was called rubiola 10-day measles, red measles, and probably a lot of those measles were not even measles, they were probably other viruses. And doctors still even call lots of red rashes that are all over you morbilliform, which just means measles like. So we now test them and find out by swabs or blood testing. So in those days it would have been a guess of what that disease was.
Speaker 3:Okay okay, can you give us the description of the symptoms and progression of the disease?
Speaker 4:Well, measles is a very contagious viral illness that causes this apparently distinct rash, but it does change a bit with fever and cough. It's often mistakenly considered by the public as a fairly benign disease. After an incubation period of about two weeks, the disease begins with two to four days of an invasive phase with a progressive fever that can go as high as 40 degrees. That's pretty unusual. Most temperatures don't go past 39. The patient suffers general malaise and headaches. They often have severe rhinitis or runny nose, cough. They'll get red eyes or conjunctivitis, which is due to the virus virus. They have a thing called a Coplix spot, which is a red spot inside the mucosal membrane inside the mouth, which is almost diagnostic of measles.
Speaker 4:If you actually managed to see that in the early stages the disease can be associated by gastrointestinal symptoms like abdominal pain, vomiting, diarrhea, really. Then people will go on to meningeal syndrome, which can lead to by gastrointestinal symptoms like abdominal pain, vomiting, diarrhea Rarely then people will go on to meningeal syndrome, which can lead to convulsions and extreme headaches, real malaise and even being moribund. A maculopapular rash appears with no real itchiness, formed by large, irregular confluent plaques. The rash begins on the face, tends to spread and slowly covers the entire body over a three to four day period, usually eventually includes the palms, the hands and the soles of the feet. When the fever subsides, the rash starts to disappear. The patients are contagious for two to three days before the invasion phase and remain contagious for up to 10 days.
Speaker 3:Oh wow, was there a definite diagnosis for the disease, or was it confused with others?
Speaker 4:Like we just said before, like classic measles, pretty easy to diagnose, but there are lots of things that masquerade and are not exactly the same, so there's a bit of a differential diagnosis for us on a daily basis.
Speaker 3:Okay, so how would they have treated at the time?
Speaker 4:I don't know. I can only hypothesise that they would probably have put the person in the corner and treated them symptomatically. There would have been, and there really is still, nothing terribly active that we can do about getting rid of the illness.
Speaker 3:Okay, and what was the mortality rate for measles at that time?
Speaker 4:The mortality rates were far from negligible. There were numerous reports of measles epidemics in England, Scotland from the 17th century, including those in London in 1670 and 1674. Subsequently, the disease persisted in an endemic state in Britain and Europe into the 18th and 19th century. Mortality rates varied according to the age of patients, socioeconomic conditions and their general health. In Glasgow and Aberdeen in the early 20th century, careful studies revealed that the attack rate of measles amongst very young children was eight to ten times higher in families living in a one-room dwelling compared to those living in dwellings with four or more rooms. The highest mortality is found in children under three years of age, after which the percentage of death falls rapidly until the age of 15 and then is very low in adults. An English study published in 1914 by a statistician working for an insurance company reported an average mortality rate of 1 per cent based on results from 22 countries during the period of 1906 to 1910. However, there were large fluctuations in mortality between countries, For example, Chile 4.84 per cent, Hungary 4.43 per cent, Australia 0.24 per cent, Scotland 0.35 per cent, Spain 3.85 per cent, Italy and England and Wales 2.91 per cent and the USA 1.08 per cent.
Speaker 4:In countries where measles was endemic. Epidemic outbreaks occurred every three to five years following the population renewal. Subsequently, much higher rates have been reported, reaching up to 10 per cent, particularly in the Pacific Islands and Africa. In the 1960s, very high mortality rates of up to 10 per cent had been reported, for example in Nigeria by the British paediatrician David Morley. Measles mortality began to decline in industrialized countries during the first half of the 20th century following the economic development, improved living conditions, hygiene, nutritional status and medical care, especially antibiotics to treat bacterial pneumonia, that came as a secondary consequence of the viral infection with measles. In 1963, before the introduction of the vaccine, the number of measles cases was estimated to be 30 million people per year, resulting in 2 million deaths each year worldwide.
Speaker 3:Wow, that's a lot, and for those who survived, were there any permanent issues or complications? A measles?
Speaker 4:sort of has three or four relatively common consequences. So people would have the rash as we talked about, which would disappear. Lots of people got middle ear infections which were due to the actual virus, measles, but also secondary bacterial infections. And middle ear infections can lead to all sorts of consequences. People get mastoiditis, they can get abscesses, cerebral abscess, encephalitis. There's also the.
Speaker 4:The virus itself would cause pneumonias and then there would be secondary bacterial infections from pneumonias. So those people might be left with permanent scarring and subsequent shortness of breath as they progress through life. And there's a couple of really unusual complications where, as we mentioned earlier, people get meningitis or encephalitis. Some of those people would die but a lot of those would be left with epilepsy or permanent brain damage. And there's one really unusual complication called subacute sclerosing pan encephalitis, which is a bit of a mouthful. We just call it sspe because it's easier to say. But those people are left with slow rhythmic changes in their electrical activity in their brain and are left with involuntary movements and seizure activity and usually some sort of intellectual impairment. So there were some really big long-term consequences from this infection.
Speaker 3:Yeah, I never realised it could be such a serious thing At that time. Were the means of transmission of the disease known or suspected?
Speaker 4:I don't know, but I presume that they had some basic understanding. They knew that measles must have been contagious and possibly they understood that it was transmitted by aerosols or through direct contact.
Speaker 3:And who? Where and when was the treatment for measles developed?
Speaker 4:There still is no active treatment for measles because it's a viral infection. We don't have an antiviral targeted at measles, but we certainly have very effective vaccinations and we have good quality control for secondary infections that come as a result of that. Most developed countries now have health organisations which advocate for vaccination but also allow us as doctors to know when there are outbreaks and how to quarantine and how to care for the people that may have complications and secondary infections. So, especially in Australia, we're very blessed to be notified of any impending outbreaks of measles.
Speaker 3:Okay, and moving to Australia today, I know we have measles outbreaks and we have these alerts that are triggered by overseas arrivals, but does a disease actually exist in Australia today and what preventive measures are taken?
Speaker 4:Well, we certainly see. The majority of new cases seem to come in from overseas, where people are not vaccinated, but with increasing numbers breaking out in the community, we're starting to see that that can be linked to reduction in vaccination rates amongst people that live in Australia. When there is an outbreak, we, as we said, like the health departments, let us know and we can try to quarantine if there's an outbreak, for instance in a family, a home or a school, so we can keep those people out of the community. There is a thing that we call herd immunity, so if the vast majority of people are protected by previous exposure or vaccination, then they have an inbuilt immunity and the more people that are immune, the less likely that that disease will spread. If there is someone that's not immune, okay that's very interesting.
Speaker 3:Okay, you said earlier that measles and German measles, which is now called rubella, are different diseases, so let's talk about it. Can you describe the symptoms, et cetera, of rubella?
Speaker 4:Well, rubella is another contagious viral infection, best known for its distinctive red rash. It's also called German measles or three-day measles. This infection may be mild no symptoms at all in some people, but it's a catastrophic illness if it's contracted during pregnancy. For the unborn baby. It's a teratogenic infection. That means it causes deformities in the child.
Speaker 3:And when was there a definite diagnosis of this disease as distinct from the ordinary measles, do they look similar?
Speaker 4:Outwardly they probably look fairly similar, except the magnitude of the illness. So I think even the docs in the good old days would have noticed that there was a difference in the progression of the rash and how it started at the top and went down with measles. Whereas the rubella sort of comes out fairly evenly across the whole body, it's less florid. The people that are infected are less sick. The people with measles get this spot inside their mouth called the coplic spot, which we don't see with rubella. So there probably was a fairly good clinical diagnostic difference.
Speaker 3:Okay, so it seems that the disease itself was not so serious. But who, how and when was the issue of the effect on unborn babies found?
Speaker 4:So some medical history first. Rubella was first described in the mid-18th century. German physician and chemist Friedrich Hoffmann made the first clinical description of rubella in 1740, which was confirmed by de Bergen in 1752 and Orlo in 1758. In 1814, George de Martin first suggested that it be considered a disease distinct from both measles and scarlet fever. All these physicians were German and the disease was known as Rothung. Rothlich means red or pink in German. The fact that three Germans described it led to the common name German measles. Henry Veale, an English royal artillery surgeon, described an outbreak in India. He coined the name rubella from the Latin word meaning little red, in 1866. It was formally recognised as an individual entity in 1881. In 1914, Alfred Fabian Hess theorised that rubella was caused by a virus based on his work with monkeys. In 1938, Hero and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases.
Speaker 3:Okay, so rubella was a known disease for centuries. Presumably, women were giving birth to deformed babies, also for centuries, and no one knew why.
Speaker 4:Yes, that must have been happening. Now the discovery of the link between rubella and its teratogenic effect on unborn babies In 1940, there was widespread epidemic of rubella in Australia. Subsequently, ophthalmologist Norman Alistair Gregg found 78 cases of congenital cataracts in infants and 68 of them were born to mothers who caught rubella in early pregnancy. Greg published an account Congenital Cataract Following Germinal Measles in the Mother in 1941. He described a variety of problems now known as congenital rubella syndrome and noticed that the earlier the mother was infected, the worse the damage seemed to be. Since no vaccine was yet available, some popular magazines promoted the idea of German measles parties for infected children to spread the disease to other children, especially girls, to immunise them for life and protect them from later catching the disease whilst pregnant.
Speaker 3:Yeah, I do remember those parties because in the mid-70s my wife used to take our daughter to play group and if someone had one of those diseases people would make sure they all turned up so the kids could spread the infection. Does that still happen today?
Speaker 4:Hopefully, and probably not. Most of the people now are vaccinated and those diseases are not terribly common and certainly there is a great fear of spreading that. So getting together to try and catch it and get it over and done with seems to be a bit of an old-fashioned thought. Back to the real solution to the problem. The virus was isolated in tissue culture in 1962 by two separate groups. There was a pandemic of rubella between 1962 and 1965, starting in Europe and spreading to the United States. In the years 1964 to 1965, the United States had an estimated 12.5 million rubella cases. This led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these, 2,100 died as neonates, 12,000 were left deaf, 3,580 were blind and 1,800 were intellectually disabled. In New York alone the congenital rubella syndrome affected 1% of all births. So the link between rubella and affected 1% of all births. So the link between rubella and its teratogenic effect on unborn babies was clearly established and doctors have been aware of the issue and taking appropriate steps ever since.
Speaker 3:Okay and moving forward to today in Australia, does the disease occur here today and what other preventive measures are taken?
Speaker 4:These are very similar to the things we were talking about with measles. So rubella, or German measles, is a virus and we don't have a treatment for it per se. We do have an effective vaccination that we can use and that's heavily encouraged for pregnant ladies to have before they fall pregnant. We don't like to do the vaccine because it is a live viral vaccine, so we don't do it during pregnancy because theoretically it would have the same consequences as the person contracting rubella. So most ladies, when they are first diagnosed as pregnant, we do a blood test to see if they have immunity, either from previous exposure or vaccination. If they haven't, we try and sequester them away from public contact. We certainly from the point of view of the general populace. We have outbreaks from time to time and the health departments notify doctors that there are people in the community. If we know they're in a school or an environment, then we will contact any of the direct contacts of that individual person and try and keep them away. So they'll be quarantined.
Speaker 3:So someone like me who thought that German measles was a big problem because of the risks with pregnant women. We're slightly off the mark in that ordinary measles is the big worry for everybody really.
Speaker 4:Measles is a much more serious illness for people that contract it. The rubella is. The serious consequence is for the unborn child of the mother that might have contracted it.
Speaker 3:That's good. Thank you OK. The next disease that we need to discuss is whooping cough. So were there different names for whooping cough in the 19th century?
Speaker 4:Yeah, it was called pertussis or the 100-day cough.
Speaker 3:OK, and can you give us a description of the symptoms and the progression of the disease?
Speaker 4:Initial symptoms are usually similar to those of the common cold, with a runny nose, fever, mild cough, but they follow a couple of two to three months of severe coughing fits. Following a fit of coughing, a high-pitched hoop sound or gasp may occur as the person breathes in. The violent coughing may last for 10 weeks or more, hence the name, the 100-day cough. The cough may be so hard that it causes vomiting, fractures, ribs, causes fatigue, causes bleeds in your eye. Children less than a year old may have little or no cough instead of periods where they can't breathe. The incubation period is usually around the 7 to 10-day mark. The disease may occur in those who have been vaccinated, but symptoms are usually much milder. It's an airborne disease spread through droplets that land on bits of dust, particles that we call fromites and usually introduced by people's hands when they bite their nails or eat their lunch.
Speaker 3:Was there a definite diagnosis for this disease?
Speaker 4:One characteristic of a whooping cough, which has remained constant from at least the 18th century to the present day, is it of being a disorder that principally affects children. In 1674, thomas Willis described chin cough as assaulting chiefly children and infants, implying that adults could be affected and that in autumn it was want to be epidemical. His list of symptoms included the disease being taken with frequent and fierce coughs, fits of coughing wherein names the organs of breathing do not only labour in pain, but also being affected convulsively. They do variously suspend or interrupt their actions, inspiration and expiration being suppressed for a space. The vital breath can scarcely be drawn in, so much that coughing is being almost strangled by a hoop and, by reason of the blood stagnating, they contract a blackness in their countenance. Diagnosis Diagnosis is by collecting a sample from the back of the nose or throat. The sample can then be tested by either culture or by PCR polymerase chain reaction.
Speaker 3:How was the disease treated back in the 1830s?
Speaker 4:It would have been purely symptomatic treatment. So just supportive encouragement, maybe steam I think people used to use hot showers and inhalations, but it would have been fairly ineffectual.
Speaker 3:Doctor, can you tell me what was the mortality rate for whooping cough at that time?
Speaker 4:Currently, about 50% of infected children less than a year old require hospitalisation and nearly half of 1% so 1 in 200, die. Even at the end of the 18th century, the London death rate was around 400 per annum and accounted for more deaths than measles.
Speaker 3:Okay, and for those who did survive, were there any permanent issues or complications?
Speaker 4:Yeah, as we said before, some people would develop hernia. Some people would have eye hemorrhages. Infrequently people would actually have hemorrhages within their brain. Lung damage can be left with permanent scarring and some people have things like bronchiectasis, which is a dilatation of their airways. It comes from whooping cough and a mixed bacterial infection which will leave you with ongoing secretions and complicated airway disease for the rest of your life.
Speaker 3:So who, how and when was the means of transmission of the disease known and a treatment developed?
Speaker 4:The specific bacterium was discovered in 1906 by Jules Bourdais and Octave Gengale. It was subsequently named Bordetella pertussis in honour of Jules Bourdais. They were able to successfully culture Bordetella pertussis and went on to develop the first inactivated whole cell vaccine in 1912, followed by other researchers in 1913 and 1914. These early vaccines had limited effectiveness. In the 1920s, louis Sauer developed a vaccine for whooping cough at Evanston Hospital for whooping cough at Evanston Hospital. In 1925, danish physician Thorvald Madsen was the first to test a whole-cell vaccine on a wide scale. Madsen used the vaccine to control outbreaks in the Faroe Islands in the North Sea. However, two children died shortly after receiving the vaccine.
Speaker 4:In 1932, an outbreak of whooping cough hit Atlanta, georgia, prompting paediatrician Leila Denmark to begin her study of the disease Over the next six years. Her work was published in the Journal of the American Medical Association and, in partnership with Emory University and Eli Lilly and Company, she developed the first safe and effective pertussis vaccine. In 1942, american scientists Grace Eldering, loni Gordon and Pearl Kendrick combined the whole-cell pertussis vaccine with diphtheria and tetanus doxoids to generate the first DTP combination vaccine. To minimise the frequent side effects caused by the pertussis component, japanese scientist Yuji Sato developed an acellular vaccine consisting of purified hemagglutinins. This is the filamentous strep throat and leukocytosis promoting factor HA, or hemagglutinin which is secreted by border-tail pertussis. Sato's acellular pertussis vaccine was used in Japan starting in 1981. Later versions of the acellular vaccine in the countries consisted of additional defined components of border teller pertussis and were often part of the DTPA combination vaccine.
Speaker 3:Okay, a bit of international cooperation to tackle this problem. Is it still a big issue for us?
Speaker 4:We definitely see outbreaks of whooping cough, even in Australia. Prevention is mainly by vaccination with the pertussis vaccine Initially. Immunisation is recommended between six weeks of age, with four doses given in the first two years of life. The whooping cough vaccine has a bit of a story to it. It started off as a whole cell bacteria, so dead pertussis was given to the person and it was very effective. But as it created that immunity and there were lots of proteins in the dead bacteria, it created big reactions. So those people that were being vaccinated would often feel sick, they would have high temperatures and sometimes even have febrile convulsions and to that end a lot of people started to go.
Speaker 4:This is probably not as good as we thought it was and lots of people started to withhold vaccination from their children. The newer vaccine is a split very on, so it only gives you a piece and it's a bit like if I give you the task of remembering two different vehicles. You could learn the whole product information or you could just look at their headlights and tell us which one was which. This is like giving you the headlights so your body can recognise it. The vaccine is not quite as effective, so we have to do more doses and because it's not quite as effective. We do see breakouts of whooping cough in vaccinated people, but they're normally not nearly as severe.
Speaker 4:The other thing just to quickly say about the vaccination was it used to be done at eight weeks of age. Now we've found that it's safe to bring it back to six weeks of age. And we also have discovered that pregnant mums have antibodies that cross the placenta. So we give mums a vaccination booster during their pregnancy, towards the end of the second trimester, to boost their antibody levels. So it will cross placentally and cover the bump in the hopes that the baby has the protection for the first six weeks till we can do their vaccination. And the very last thing is we try to make sure that grandies and close relatives of the unborn baby get vaccinated before the baby's born so that anyone that will be in close contact for that first six weeks we will minimise the potential spread.
Speaker 3:That makes sense and is it a case that if you had whooping cough or vaccination as a child, that you're covered?
Speaker 4:forever? Really good question. Actually, not. The further you go into the future, the less cover you have. We consider 10 years as a good safety buffer. So for those people that are going to be around, babies that are young, we'd like them to be revaccinated if it's been 10 years since their previous vaccination.
Speaker 4:The other thing just to say about vaccines is this is very effective at reducing the infection. It doesn't stop it totally. As we alluded to before, we do see outbreaks of whooping cough now in older people and it doesn't follow the classic hoop that we expected with children. We just see a chronic cough it's still the 100-day cough and there are lots of people where they present to the doctors. They've been managed conservatively, they've been treated with antibiotics, and eventually someone tests and we discover that they've got whooping cough and the only effective treatment for whooping cough are appropriate antibiotics very early in the disease. Once it's been going for a few days, it's too late. So we find this, and often especially the older people that contract it just have to suffer it out because it's too late. So we find this and often, especially the older people that contract it just have to suffer it out because it's too late to give them a curtailing dose of antibiotics.
Speaker 3:That's something very interesting, Thank you. The next disease that we need to discuss is the itch. And then Dr Mayo noted in his diary a boy, Catharine's son, has the itch.
Speaker 1:So what is the itch? And then Dr Mayo noted in his diary A boy, Catharine's son, has the itch. So what is the?
Speaker 4:itch. The itch is scabies. Scabies is also known sometimes as the seven-year itch. Ok, well, why seven years? Because it lasted a long time. It was hard to get rid of. It's a skin condition caused by tiny mites. It leads to intense itching and a pimple-like rash that can appear on different parts of the body. It's a contagious human skin infection by the tiny 0.2 to 0.45 of a millimeter mite, sarcopte scabii, the variety hominis. The word is from the latin scabia, which literally means to scratch. The most common symptoms are severe itchiness and a pimple-like rash.
Speaker 3:Okay, and can you give us a description of the symptoms and the progression of the scabies?
Speaker 4:Scabies is caused by infection with the female mite Sarcoptes scabii hominis, an ectoparasite. The mite burrows into the skin to live and deposit its eggs. The symptoms of scabies are due to an allergic reactionoparasite. The mite burrows into the skin to live and deposit its eggs. The symptoms of scabies are due to an allergic reaction to the mite. Often, only between 10 and 15 mites are involved in an infection.
Speaker 4:Scabies might often spread during a relatively long period of direct skin contact with an infected person, for example about 10 minutes, such as that would occur during sexual activity or living together. Spread of the disease may occur even if the person has not developed symptoms yet. Crowded living conditions, such as those found in childcare facilities, group homes, prisons, increase the risk of spread. Areas with a lack of access to water also have disease rates. The characteristic symptoms of scabies infection include intense itching and superficial burrows. Because the host develops these symptoms as a reaction to the mite's presence over time, typically a delay of four to six weeks occurs between the onset of infestation and the onset of itching. Similarly, symptoms often persist for one to several weeks after successfully eradicating the mites. As noted, those re-exposed to SCABI's often successful treatment may exhibit symptoms of the new infestation in a much shorter period, in as little as, say, one to four days.
Speaker 3:Was there a definite diagnosis for scabies?
Speaker 4:Dr. Symptoms of early scabies infestations mirror other skin diseases, including dermatitis, syphilis, erythema multiforme, various urticaria-related syndromes, allergic reactions, ringworm-related diseases and other ectoparasites such as lice and fleas. How was the disease treated at the time? In the 19th century, scabies were treated with vinegar compresses and baths and a mercury-coated girdle.
Speaker 3:Wow, mercury-coated. I assume that this condition is not fatal, it's definitely not fatal. Okay, and for those who survived, were there any permanent issues or complications?
Speaker 4:Probably the only thing that most people would have noticed would have been permanent scarring if they'd scratched, so what we call dermatitis artefacta, which is where the person has been scratching and left a permanent damage there.
Speaker 3:Okay, and at that time was the means of transmission of scabies known?
Speaker 4:Scabies is contagious and can be contracted through that prolonged physical contact with an infected person, so difficult to manage in the close confines of a ship, right so people associated close contact with the spreading of scabies.
Speaker 3:Okay, well, let's move forward to today. Does scabies occur here today, and what preventive measures are taken?
Speaker 4:Yeah, scabies is still fairly common. Like we said before, it's common amongst people that are in close confines, so aged care facilities, childcare centres, doctors and their patients. Because we have close contact, doctors and their patients because we have close contact, it's not highly contagious unless you have some period of contact from skin to skin, but it certainly does occur and it actually seems to prefer people with clean skin, which seems a little paradoxical.
Speaker 3:Oh, ok, well, thank you very much.
Speaker 2:So in our next episode we'll continue our discussion about diseases of the 19th century, including others that occurred on Dr Mayo's voyage that we haven't had time to address yet and some other diseases that will come up in future episodes. Great Thanks for listening. So it's goodbye from me and it's goodbye from me.
Speaker 4:And it's goodbye from me, thank you.