TB…it’s back in the UK…

Royal Sea Bathing Victoria Ward…but did it ever go away?

World TB Day on 24 March commemorates the discovery of the causative agent of tuberculosis by Robert Koch in 1882. It aims to raise global public awareness of TB.

So…is this quote from a Victorian source or Modern Source?

‘Homelessness is a risk factor for TB, but it is also a risk factor for failure to treat and cure TB leading to an increase in suffering and expense, reduced accessibility to services, and a higher risk of community transmission’.

Sadly a modern source. In 2014:

  • There were 6,520 TB cases
  • 39% of cases were in London
  • 72% of cases were among non-UK born people
  • 10% of people with TB had at least one social risk factor for TB (a history of alcohol or drug misuse, homelessness or imprisonment)
  • 30% of people with pulmonary TB waited over four months from onset of symptoms to beginning treatment

Tuberculosis or Consumption as was known was a major disease throughout Victoria’s reign, killing one in four of its sufferers. London had the highest rate of TB admissions (15.3 per 100,000 population), with North Yorkshire and the Humber having the lowest (1.5 per 100,000 population). Among TB’s most famous victims were Emily Brontë, who succumbed to the bacterial infection in 1848, and Florence Nightingale in 1910.

I find it rather shocking that cuts in public finance are taking us back to the awful days of those awful diseases.


The White Plague

The White Plague, consumption or as it is more commonly known nowadays Tuberculosis was one of the biggest killers in the Victorian Era, actually probably one of the biggest killers of all time.

Estimated global tuberculosis deaths total 1 billion in the last two centuries.

“The filthy and miserable appearance of this part of London can hardly be imagined by those (and there are many such) who have not witnessed it. Wretched houses with broken windows patched with rags and paper: every room let out to a different family, and in many instances to two or even three — fruit and ‘sweet-stuff’ manufacturers in the cellars, barbers and red-herring vendors in the front parlours, cobblers in the back; a bird-fancier in the first floor, three families on the second, starvation in the attics, Irishmen in the passage, a ‘musician’ in the front kitchen, and a charwoman and five hungry children in the back one — filth everywhere — a gutter before the houses and a drain behind — clothes drying and slops emptying, from the windows; girls of fourteen or fifteen, with matted hair, walking about barefoot, and in white great-coats, almost their only covering; boys of all ages, in coats of all sizes and no coats at all; men and women, in every variety of scanty and dirty apparel, lounging, scolding, drinking, smoking, squabbling, fighting, and swearing.” Sketches by Boz (1836)

And dickens had far more to say about the poor and the conditions that caused this most dreadful or diseases. It wasn’t until 1865 that some understanding of how it spread strated to take root. Jean-Antoine Villemin, a military doctor showed that the disease could be passed from humans to cattle, and from cattle to rabbits. Current medical thinking held that each case of consumption spontaneously arose in those poor unfortunates who predisposed to it. It was shown that it was spread by micro organisms and this was demonstrated by Robert Koch conclusively that a bacterial infection caused TB.

If you caught it the chances of you surviving was not good, in fact only a 2 in 10 chance of surviving the disease and there were no cures.

Having no real cures people became desperate, one thing always leads to another and an outbreak of tuberculosis more thank likely caused the popularity in Laudanum as a cure all (it did relive the pain).

Tuberculosis (TB) is a potentially fatal contagious disease that can affect almost any part of the body but is mainly an infection of the lungs. It is caused by a bacterial micro organism, the tubercle bacillus or Mycobacterium tuberculosis. Although TB can be treated, cured, and can be prevented if persons at risk take certain drugs, scientists have never come close to wiping it out. Few diseases have caused so much distressing illness for centuries and claimed so many lives. medical-dictionary.thefreedictionary.com

Stranger still there was a short period of time in the Victorian Era when the tuberculosis look, that of a peaky pale completion with frequent bouts fainting) was quite the fashion, I suppose not unlike the recent ‘Heroin Chic’. Stranger still some Victorian women went to great lengths to emulate the look, some going as far to take arsenic to pale the skin which of course was a great way of poisoning yourself!

The worry thing is that according to a National Health Service agency the White Plague is staging a comeback in London, where some neighbourhoods suffer infection rates found in African countries in which the disease is endemic. The number of cases surged 50 percent in the 10 years to 2009.

“You wouldn’t expect to see that, TB is one of the biggest public health problems we have.” Brian McCloskey, the Health Protection Agency’s.

Apparently although not proven the diseases has taken root in recent immigrants, addicts, homeless, the poor and destitute.

Makes you wonder whether we have actually learned anything in the last 150 years.

Cholera in London or the prevention of…

Disease is rife in one place or another and mid-19th century Soho, the district of London was no different.

There was a growing problem with filth due to the large influx of people and a lack of proper sanitary services. There was no sewer system as it had yet to reach the Soho district.

Cellars and basements simply became cesspools of night soil, that is human excrement collected at night from buckets, and outhouses, sometimes used as manure.

The London government decided in it’s infinite wisdom to dump it into the River Thames, thus the water was contaminated that lead, not surprisingly to the cholera outbreak!

Here is a translation of the above poster:

1. We would urge the necessity, in all cases of Cholera, of an instant recourse to medical aid, also under every form and variety of indisposition; for, during the prevalence of this epidemic all disorders are found to merge in the dominant disease.
2. Let immediate relief be sought under disorder of the bowels especially, however slight. The invasion of Cholera may thus be readily and at once prevented.
3. Let every impurity, animal and vegetable, be quickly removed to a distance from the habitations; such as slaughterhouses, pig-sties, cesspools, necessaries, and other domestic nuisances.
4. Let all uncovered drains be carefully and frequently cleansed.
5. Let the grounds in and around the habitations be drained, so as effectually to carry off moisture of every kind.
6. Let all partitions be removed from within and without habitations, which unnecessarily impede ventilation.
7. Let every room be daily thrown open for the admission of fresh air, and this should be done about noon, when the atmosphere is most likely to be dry.
8. Let dry scrubbing be used in domestic cleansing, in place of water.
9. Let excessive fatigue and exposure to damp and cold, especially during the night, be avoided.
10. Let the use of cold drinks, and acid liquors, especially under fatigue, be avoided or when the body is heated.
11. Let the use of cold acid fruits and vegetables be avoided.
12. Let excess in the use of ardent and fermented liquors and tobacco be avoided.
13. Let a poor diet, and the use of impure water in cooking, or for drink, be avoided.
14. Let the wearing of wet and insufficient clothing be avoided.
15. Let a flannel or woollen belt be worn around the belly. This has been found serviceable in checking the tendency to bowel complaint so common during the prevalence of Cholera. The disease has, in this country, been always found to commence with looseness in the bowels, and in this stage is very tractable. It should, however, be noticed that the looseness is frequently unattended by pain or uneasiness, and fatal delay has often occurred from the notion that cholera must be attended with cramps. In the earlier stage here referred to, there is often no griping or cramp, and it is at this period that the disease can be most easily arrested. In all such cases let from twenty to forty drops of Dr. J Lenacs Cholera Tincture be administered in half a glass of brandy, and the symptoms will abate immediately.
16. Let personal cleanliness be carefully observed.
17. Let every cause tending to depress the moral and physical energies be carefully avoided.
18. Let crowding of persons within houses and apartments be avoided.
19. Let sleeping in low damp rooms be avoided.
20. Let fires be kept up during the night in sleeping or adjoining apartments, the night being the period of most danger from attack, especially under exposure to cold or damp.
21. Let all bedding and clothing be daily exposed during winter and spring to the fire, and in summer to the heat of the sun.
22. Let the dead be buried in places remote from the habitation of the living.
Every one should provide themselves with the Asiatic Cholera Tincture, as the most ready and effectual Remedy in Cholera, Diarrhoea, Flatulency, Cholic, and Bowel Complaints.
In bottles at 2s.9d, 4s 6d, 11s, and 21s. Duty included.
The Anti-Cholera Fumigators, for purifying Air of Dwellings, and destroying the Contagious influence of CHOLERA, TYPHUS FEVER, and other INFECTIOUS DISEASES
They are particularly recommended for the Sick Chambers, Hospitals, Churches, Chapels, Literary Institutions, Theatres, Assembly Rooms, Counting Houses, Taverns, the Cabins and Holds of Vessels, &c.
In Boxes, at 6d.-1s and 2s.6d each, or Carriage free, at 1s,-1s.6d. and 3s.
Packages for Extensive Buildings, at 10s.-20s.-40s. and £5.
44, Coleman Street, City, London.
N.B. Money Orders must be made payable to Dr.Jaques Lenac.


Miasma, Suffering and Death in Victorian London

This was a huge idea among the medical profession in the early to mid Victorian era. The Miasma, basically this belief held that people could with most diseases which was caused by inhaling air that was infected through exposure to corrupting matter.

So that would include rotting vegetation, the exhalations of other people already infected, sewage and of course the rotting corpse.

Edwin Chadwick’s Report on the Sanitary Condition of the Labouring Population of Great Britain was published in 1842 it argued for:

‘the improvement of house drainage to remove noxious smells from dwellings’. 

And he was not the only one. Sir Francis Head a former colonial governor who had agreed with his report in the rather influential the Quarterly Review. Chadwick’s criticism of poor drainage and ventilation was applauded by Head and the miasmatic theory of disease propagation was starting to take hold.

In fact Chadwick felt so strongly he address a parlimetary committee in 1846 stating that:

“All smell is, if it be intense, immediate acute disease; and eventually we may say that, by depressing the system and rendering it susceptible to the action of other causes, all smell is disease.”

Chadwick actually put forward that it was more important to remove smells from dwellings than to purify drinking water! But alas he was not the only fan of the miasmatic theory, in 1844 the Dr Neil Arnott told the Royal Commission for Enquiring into the State of Large Towns and Populous Districts that:

“The immediate and chief cause of many of the diseases which impair the bodily and mental health of the people, and bring a considerable proportion prematurely to the grave is the poison of atmospheric impurity arising from the accumulation in and around their dwellings of the decomposing remnants of the substances used for food and from the impurities given out from their own bodies.”

Florence Nightingale added to it claiming that people could get:

‘scarlet fever, measles, and smallpox to the practice of building houses with drains beneath them from which odours could escape and infect the inhabitants’

Mind you it is worth recalling that the Great Stink of 1858 and even before that various outbreaks of Cholera.

Sur, -May we beg and beeseech your protection your proteckshion and power. We are Sur, as it may be, livin in a Wilderniss, so far as the rest of London knows anything of us, or as the rich and great people care about. We live in muck and filthe. We aint got no privies, no dust bins, no drains, no water splies, and no drain or suer in the hole place. The Suer Company in Greek Street, Soho Square, all great rich and powerful men, take no notice watsotnedever of our complaints. The Stenche of a Gully-hole is disgustin. We all of us suffur, and numbers are ill, and if the Colera comes Lord help us… A Letter to The Times 1849

More from the times:

“The intense heat had driven our legislators from those portions of their buildings which overlook the river. A few members, bent upon investigating the matter to its very depth, ventured into the library but they were instantaneously driven to retreat, each man with a handkerchief to his nose.” The Times June 1859

The Great Stink or mass murderer as the pungent odor was deemed has at last

prompted parliament to put into practice Joseph Bazalgette’s plans for a comprehensive sewerage system especially since Parliament was right next to the river and a surgeon pronounced:

“it would be dangerous to the lives of the jurymen, counsel and witnesses to remain. It would produce malaria and perhaps typhus fever.”

But it was in the shape of Willam Farr, whose study of the Whitechapel cholera epidemic of 1866 finally persuaded him that water, not air, was the cause but the miasma theory still held water for many into the early part of the twentieth century.

The Pox

Sloughing lip following smallpox 1846?

Smallpox was an horrendous disease but was a frequent visitor and killer in the Victorian Era.

There are two forms of smallpox, Variola major is the most serious. The illness can be life threatening in people who have not been vaccinated, and Variola minor which is a milder infection that rarely causes death. Horrific scarring can be the result if you manage to survive it.

The symptoms may include: Backache, Delirium, Diarrhea, Excessive bleeding, Fatigue, High fever, Malaise, Raised pink rash — turns into sores that become crusty on day 8 or 9, Severe headache and Vomiting. These will manifest themselves within two weeks of the initial infection.

Now if you manage to overcome all of these there is a chance of complications: Arthritis and bone infections, Brain swelling (encephalitis), Eye infections, Pneumonia, Scarring, Severe bleeding, Skin infections (from the sores) and of course the ultimate complication death!

All in all it best avoided i’d say! If we look at Dickens great novel Bleak House we see Esther Summerson, our heroine of the story contract small pox (although the disease is not named).

It all begins when John Jarndyce and Esther discover that Jo, the young crossing sweeper, is ill and insist on taking him back to the house to care for him. He mysteriously goes missing overnight and by morning, Esther has contracted smallpox.

She nearly dies and is left with horrendous scarring which scares away her unwanted suitor Mr Guppy…probably a bonus in this case.

In 1853 laws were put ion the statute books making the vaccination of children compulsory but oddly this aroused considerable opposition and the poor quite simply ignored it.

Some fifty years later opposition was still bring expressed:

Compulsory medicine… is opposed to the ancient constitution of England, and is, therefore, a gross infraction of the liberty of the Citizen and of parental rights. The work of our Congress is to assist in restoring the birthright of our citizens, to give back to parents their highest duty and privilege—the sacred right to protect and defend their offspring from evil , and to liberate the oppressed of many nations from an ignorant, unjust, and indefensible tyranny. Anti-vaccinationist campaigner Dr Walter Hadwen 25 January 1896:

The global eradication of smallpox was certified, based on intense verification activities in countries, by a commission of eminent scientists on 9 December 1979 and subsequently endorsed by the World Health Assembly on 8 May 1980.WHO Factsheet. Retrieved 2007-09-22

So it took nearly 140 years to eradicate smallpox from the world after the initial mandatory vaccinations of our Victorian forebears.