Major Diseases that Changed Population - Essay Example

Several infectious diseases showed an emergence in Victorian times in Great Britain. The Victorian era was characterised by vast numbers of people moving to cities to find work in factories and this lead to immense overcrowding. There was a widespread deterioration in living conditions and historical accounts have made several references to the filthiness and overcrowding which was London during this time. The infectious diseases that appeared during this time had the effect of increasing mortality rates greatly and changing the dynamics of population structure. Life expectancy decreased substantially in this period, in some areas by much as 25 years. Some of the major diseases that changed population dynamics greatly were cholera, smallpox, tuberculosis amongst others. The government of Great Britain struggled to contain these diseases and it was only with better living conditions, increased sanitation, reduced virulence of the disease and vaccinations that finally reduced mortality rates. In modern day infectious diseases, many of the same concepts are applicable in their control and better understanding of these has led to a continuously increasing life expectancy since Victorian times. Cholera was one infectious disease that increased mortality greatly. Cholera epidemics affected Great Britain, primarily London, between 1831 and 1866 (Halliday, 2001). While it was not known at the time, cholera is a water-borne disease that is caused by drinking water contaminated with choleric excreta. The bacterium is temperature dependent and multiplies rapidly in high temperatures (Cholera in England, 1893). However, in the Victorian era, the `miasmatic` theory was formulated to explain incidence of cholera. This theory assumed it was air, not water, which acted as a vector of transmission (Halliday, 2001). This assumption was unsurprising given that air pollution was major problem in London at the time. In fact, during the summer of 1858, the river Thames, filled with sewage, was referred to “Great Stink”by the Times. It was an anaesthetist, John Snow, who offered up an alternate explanation to the miasmatic theory. Snow observed that there was a high mortality amongst the users of a contaminated water pump during the cholera epidemic and persuaded the parish to remove it. This reduced mortality rates in the area greatly (Halliday, 2001). Furthermore, he observed that people getting their drinking water from a part of the Thames that was not polluted, showed much lower mortality rates. Unfortunately Snow’s ideas were not accepted until after his death but the construction of a new sewage system in Great Britain was commissioned as a result of his work (Halliday, 2001) and this was essentially what ended the cholera epidemic. There was such a persistence of infectious disease in Victorian times that isolation hospitals were built. These were present to protect the wider population from the disease and also to attempt to rid the infected people of the disease (Mooney). Most people who were admitted to these hospitals were suffering from smallpox, scarlet fever or diphtheria (Mooney).To date, smallpox is considered one of the most deadly diseases to afflict humans. It is also the only disease that has been eradicated using vaccination (The College of Physicians of Philadelphia, 2010). An epidemic of smallpox in Great Britain in the 18th century killed over 36000 people in London just two decades. In London, 1 out of every 10 deaths was attributed to smallpox and amongst children under 5, this number increased drastically to 9 in 10 (History of Smallpox). Even between epidemics, there were always underlying cases to be seen (History of Smallpox).The year 1870 marked the beginning of the largest smallpox epidemic in Queen Victoria`s time. The method of transmission of smallpox was under debate for a long time and it was W.H. Power, a government medical inspector, who suggested that smallpox was contracted through aerial transmission (Mortimer, 2008). This presented the issue that isolation hospitals were useless in combating the disease and would instead be a centre-point for infection. In fact, this was demonstrated by Power as he showed that an increase in distance from these hospitals led to less chance of infection (Mortimer, 2008). There was seen to be no difference in infection rates between the rich and the poor which also pointed to the fact that smallpox was indeed transmitted aerially (Razzel and Spence, 2005). In 1796, in the midst of an epidemic in London, Edward Jenner discovered that inoculation with the pus from a cowpox sore would lead to protection against smallpox in a process referred to as variolation (History of Smallpox; The College of Physicians of Philadelphia, 2010). Variolation was initially practised until vaccinations were developed (History of Smallpox). Following publication of Jenner`s work and acceptance of his ideas, mass vaccination took place in Great Britain. This led to the number of people being infected dropping to very low levels at the start of the 19th century. When epidemics did occur, they were not as destructive as before (History of Smallpox). The popularity vaccination waned when the occurrence of smallpox went down but was revived when large epidemics occurred in later years (History of Smallpox). At that time, it was not known that being vaccinated once did not give protection for life and re-vaccination was necessary (Mercer, 1986). Re-vaccination was first introduced in the British army in 1858 and the general population much later (History of Smallpox). The main reason for people not getting re-vaccinated was that vaccination was a complicated procedure at that time as arm to arm inoculation was required. In addition, efforts by the government to make vaccination compulsory for all people led to violent anti-vaccination movements which believed that compulsory vaccination went against a person`s civil rights. However, with improvements in vaccine production and increasing knowledge of the virus, and also with the widespread effort to isolate cases of smallpox (Mortimer, 2008) smallpox was finally eradicated from Great Britain in 1934 (History of Smallpox). Another infectious disease that was a sequel to smallpox was tuberculosis. Any disease that was contracted right after smallpox might have contributed to a person`s death and tuberculosis is recognised as being the cause for up to 20% of deaths in Great Britain. Tuberculosis, like smallpox, is transmitted through the inhalation of infected droplets. (Mercer, 1986). Tuberculosis infections are now treatable using one or more antibiotics that were discovered in the 1940s (Nardell, 2008) but in Victorian times, as this was not known, it was the symptoms that were treated rather than the disease itself. At the end of the 19th century, the mortality rates due to tuberculosis fell and this has been attributed to changes in food hygiene and milk sterilization in forms of the disease that were non-respiratory. There was a disparity between the sexes in the fall in mortality due to tuberculosis and it has been suggested there was less of a decrease in males mainly due to working conditions and tobacco consumption (Mercer, 1986) A few other notable infectious diseases in Great Britain included scarlet fever, diphtheria, measles and whooping cough. These primarily affected children and lowered the life expectancy greatly (Hardy,1992). The decline in prevalence of these diseases seemed to show much variation. None showed a decline before 1870, though a reason for this is unknown (Hardy,1992). Measles and whooping cough were affected by the density in populations. Overcrowding only started to be eased out in Great Britain just before the twentieth century. However, the mortality rates due to whopping cough had slowly started to go down prior to this suggesting that the increasing quality in nutritional standards also played a part. On the other hand, the mortality rates of scarlet fever and diphtheria were influenced by the virulence of the dominant strain of the disease. There was a decline in virulence of scarlet fever from the 1870s and in diphtheria from the 1890s and hence a decreasing mortality rate (Hardy, 1992). An intensive look at the mortality rates in England and Wales revealed that five diseases or disease groups were almost entirely responsible for the drop in mortality between the years 1851-60 and 1891-1900. These disease groups were tuberculosis which accounted for a 47.2 per cent drop; typhus, enteric fever and simple continued fever, a 22.9 per cent drop; scarlet fever, a 20.3 per cent drop; diarrhoea, dysentery and cholera, a 8.9 per cent drop and smallpox, a 6.1 per cent drop (McKeown and Record,1962). After considering examples of some of the main infectious diseases that plagued Great Britain in the Victorian era, there appear to be some common reasons as to why there was a reduced mortality which over time led to an increased life expectancy. The reasons in order of importance were firstly, an improved standard of living. Of this, the main factor was improved nutrition which contributed to a reduction in the level of tuberculosis and typhus. Secondly, better sanitation conditions (mainly contributed towards a decline in cholera and typhus, typhoid). Lastly, a reduced virulence in several diseases brought down mortality rates, the main one being scarlet fever (McKeown and Record, 1962). Over the years, the infectious diseases are prevalent in Great Britain and elsewhere have been dynamic. Some of the diseases previously discussed in this paper do continue to make sporadic comebacks but new ones have emerged as well such as HIV, influenza, hepatitis (WHO, 2010). When epidemics do occur, such as the H1N1 and SARS pandemics recently, it appears that people and the governments of countries are much better equipped to deal with these outbreaks. The World Health Organisation (WHO) works to prepare guidelines for prevention and treatment of these infectious diseases (WHO, 2010) based on past experience and the production of medications that effectively combat disease. A system known as Global Alert and Response (GAR) has been developed and ensures that there is a co-ordinated response internationally to deal with infectious diseases (WHO,2010). To summarise, Great Britain in the Victorian era was known for its overcrowded cities, severe pollution and inadequate diet consumed by its people. These reasons led to several infectious diseases plaguing the country. The emergence of these diseases was characterised by high mortality rates which in turn led to a reduced life expectancy. Some of the main diseases included cholera, small pox and tuberculosis. It took a number of years to learn how to contain and control these epidemics. Successful control was possible after figuring out the method of transmission in cases like cholera or the development of a vaccine in cases like small pox. Overall, it was, greatly improved living conditions, improved sanitation and reducing virulence in several diseases were main factors in the successful control of these diseases. This led to a decreased mortality and over the years with living conditions improving, the life expectancy has continued to rise. Since the Victorian era, life expectancy has continued to increase and this is consistent with the increasing quality of life enjoyed by most people. There are now bodies to monitor and take action towards any infectious diseases that may occur and any episodes in recent history have not been as severe as in Victorian times. The methods of control, however, generally follow similar principles. References Halliday, S. 2001. Death and miasma in Victorian London: an obstinate belief. British Medical Journal. 323. Pp.1469–71. Hardy, A. 1992 Rickets and the Rest: Child-care, Diet and the Infectious Childrens Diseases, 1850-1914. The Society far the Social History of Medicine Pp 389-412. McKeown, T. and Record, R.G. 1962. Reasons for the Decline of Mortality in England and Wales during the Nineteenth Century. Population studies. 16(2). pp 94-122. Mercer,A.J. 1986. Relative Trends in Mortality from Related Respiratory and Airborne Infectious Diseases. Population Studies. 40(1). Pp 129-145. Mooney. G. Infection and Citizenship: (Not) Visiting Isolation Hospitals in Mid-Victorian Britain. Pp 147-173. Mortimer,P.P.2008. Ridding London of smallpox: the aerial transmission debate and the evolution of a precautionary approach. Epidemiology of Infectious Diseases. 136. pp 1297–1305. Nardell, E.A. 2008. (Online). Tuberculosis. The Merck Manuals. (Updated October 2008). Available at http://merckmanuals.com/home/sec17/ch193/ch193a.html. (Accessed 19 November 2010). Razzel, P and Spence, C. 2005.Social capital and the history of mortality in Britain. International Journal of Epidemiology . 34. Pp 477–492. The College of Physicians of Philadelphia. 2010. (Online). The History of Vaccines. Available at http://www.historyofvaccines.org/content/articles/history-smallpox). (Accessed 18 November 2010). The History of Smallpox and its Spread around the World (online). Chapter 5. Pp 209-244. whqlibdoc.who.int/smallpox/9241561106_chp5.pdf WHO. 2010 (Online). Global Alert and Response(GAR). Available at .http://www.who.int/csr/en/. (Accessed 20 November 2010). Read More