Infectious Diseases: Then and Now

PublicHealthNurseRedCrossWWIWarPosterI started this blog as the whole world was beginning to take seriously the COVID-19 Pandemic. In short order we’ve seen the World Health Organization declare it a pandemic and in the U.S. we’ve seen a major upswing in positive cases, a demand for more testing of suspected cases, self-quarantine recommendations and requirements, and the closing of multiple businesses where people congregate in large numbers. And worst of all, way too many deaths, some of which could have been avoided. Many learned the term “social distancing” and there was an frantic run on toilet paper (no pun intended!). A little perspective on some past communicable and infectious diseases and how our ancestors handled them might be in order. Just remember, if your ancestors had not survived smallpox, yellow fever and the 1918 Pandemic, there would be a good chance you wouldn’t be here. Panicking isn’t a necessary, or even useful, response to an infectious disease. Calm, thoughtful, rational preparedness and a willingness to settle into a new normal and learn to be grateful for what you have goes a long way.

Today, we have many advantages that our ancestors did not have in dealing with and preventing infection from a contagious disease. It was just a bit over 200 years ago that George Washington was bled repeatedly when he developed pneumonia after riding his property in cold and damp conditions. Bleeding with leaches was thought to balance the humors but generally just debilitated the patient. And it was just a little under 100 years ago that penicillin was discovered but it wasn’t used for treating infections until 1942. It was during the founding of our nation that people began to do vaccinations with live smallpox from an infected person, which was dangerous and could result in infection and death. The mosquito as the carrier for Yellow Fever wasn’t discovered until 1900. The cause of cholera wasn’t widely known until 1884 and the bacteria that causes tuberculosis was identified in 1882 but we did not begin to get it under control until the mid-20th century. And in our region of the world, malaria was not brought under control until the 1940s. During the Great War, also known as WWI, a worldwide pandemic occurred caused by a similar virus to what is causing COVID-19. Worldwide there were an estimated 500 million infected and 50-100 million who died. We should have learned something from that pandemic, and some in public health did, but we were still caught flatfooted and slow at the beginning of this pandemic.

Using the “Chronicling America” website and searching in The Pensacola Journal holdings I found quite a number of advertisements for cure-all medicines in 1905. The claims covered the gamut. For just one remedy, cures could be obtained for dandruff, piles, malaria and pneumonia. It was not until 1906 when the Pure Food and Drug Act was passed and manufacturers of food and patent medicines had to be able to prove their claims. Amazing how quickly some of these products disappeared! By 1905, we knew there were bacteria and viruses but had few effective ways to combat an infection other than quarantine, and in some cases didn’t really understand the interplay between an infectious disease and poor health or a debilitated constitution. Still don’t in some cases.

I did find an interesting article in The Pensacola Journal on page 8 of the 1 April 1905 edition in which the newspaper suggested that candidates for public office let people know where they stood on public works programs that would improve public health. In reality, it was not so much the development of antibiotics that improved overall health in the early part of the 20th century, it was the widespread implementation of public health measures that decreased exposures to human waste and contagions. Cleaning up drinking water and improving sanitation (sewage systems in cities and towns) made significant progress towards a healthier population long before we had antibiotics. The article in the newspaper made the case for the expenditures making good sense because a healthier population meant a more economically productive population.

It was also in 1905 when New Orleans had an outbreak of yellow fever that caused great concern in Pensacola. In the 26 July 1905 paper on the front page the headline “No Change in the Fever Situation” in The Pensacola Journal provided two articles on the yellow fever outbreak, one indicating that Joseph Y. Porter, then Florida State Health Officer and head of the Marine Hospital Service, would be in Pensacola to “get in touch with what is transpiring in New Orleans, relative to yellow fever, and to become acquainted with the work that is being done by the city authorities in cleaning up the city”. Dr. W. E. Anderson, the State Board of Health representative to Pensacola, also received additional instructions expanding the quarantine from just the Italian Quarter of New Orleans to the entire city. All classes of goods had been refused by the Louisville and Nashville out of New Orleans and that would remain the case until the quarantine was lifted. He was authorized to employ any necessary help that he might need at Flomaton, AL to enforce the strict quarantine. Fruit was to be fumigated before being allowed to enter the city. The second article indicated that the cases in New Orleans were remaining stable and it was believed that confinement of the fever was improving.

In the 11 July 1914 Pensacola Journal page 1, we find a large headline indicating that a fourth case of bubonic plague had been reported out of New Orleans with three deaths. The outbreak had started on 27 June and this fourth case resulted in no burial permits being issued until an investigation was conducted on each cause of death. Also all passengers arriving in the canal zone from New Orleans would be quarantined for seven days.

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Influenza Ward, 1918

And now we come to the Influenza Pandemic of 1918-1919. On 5 January 1919, The Pensacola Journal carried an article indicating that the pandemic was costing the U.S. $1,000,000 daily. That would be about $15,000,000 in today’s dollars. They went on to break that down based on no more than 100,000 dying and no more than 2,000,000 sick in a four month period. Funerals – $1,000,000; Doctors – $16,000,000; Nurses – $16,000,000; Drugs – $8,000,000; Loss of workers – $24,000,000; Loss of business – $48,000,000. That totaled to $115,000,000 for a four month period or $28,000,000 a month (about $420,000,000 a month in today’s dollars). The article goes on to point out that quarantine measures were unpopular. Some Los Angeles churches refused to obey the city ordinance and some attempt to get people to wear a mask also proved unpopular. Stanford University has a good website covering the 1918 Pandemic and notes, “The effect of the influenza epidemic was so severe that the average life span in the U.S. was depressed by 10 years.” The first wave of influenza appeared in the early Spring of 1918 in Kansas and quickly thereafter in military camps across the country. No steps were taken in early 1918 because the war took precedence. But the flu came back in the fall and winter of 1918 and ravaged the entire world.

Children in Florida 1918

Florida children Ready for School During the 1918 Flu Epidemic

In the Fall, it’s first appearance was in Boston in September 1918. It spread rapidly, killing nearly 200,000 in October 1918. The war ended on 11 November 1918 and many communities celebrated with parades and parties (a bit like Mardi Gras and spring break today). Those communities that did not give in to the parties and parades fared better than those that did and data tells us they recovered economically faster after the outbreak. In the U.S., millions were infected and it killed thousands. To quote the Stanford website again,  “ (t)hose who were lucky enough to avoid infection had to deal with the public health ordinances to restrain the spread of the disease. The public health departments distributed gauze masks to be worn in public. Stores could not hold sales, funerals were limited to 15 minutes. Some towns required a signed certificate to enter and railroads would not accept passengers without them. Those who ignored the flu ordinances had to pay steep fines enforced by extra officers. Bodies piled up as the massive deaths of the epidemic ensued. Besides the lack of health care workers and medical supplies, there was a shortage of coffins, morticians and gravediggers.” An attached page with some interesting graphs from the time should be visited. They may look vaguely familiar to today’s graphs.

Our ancestors suffered through wars, depressions, economic downturns, loss of livelihoods, and disease and somehow each of us are here experiencing this one that our descendants will look back on and judge our responses and analyze what we did right and wrong. This isn’t going to be easy, it hasn’t been up until now and it won’t be going forward. As has been pointed out by some experts, we may see a falling off of cases in the summer and then a resurgence in the fall. We just don’t know, so getting use to a new normal might be the best medicine we can all take. Stop whining; stop hoarding; stop panicking; start a garden, whether in a pot or in the ground; stop and be grateful for what you have, individually, communally and nationally; and finally find peace in the quiet of the day; whether by prayer or meditation or a long walk or sitting and listening to the birds.

Our nation has come through a lot of difficult times – famine, the Revolutionary War, the Civil War, the Great Depression, multiple epidemics large and small, WWI and WWII. The economy has rebounded after each, as has our citizens. The economy won’t die but our fellow Americans might if we don’t listen and do the right thing. Put this in perspective and find your balance and the place where you can be thoughtful and careful with yourself and with others. Have a blessed month.

Until Next Time.

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