Tuesday, 21 October 2014

Plus ça change: Infectious Diseases Past & Present

“It troubled me to pass by Coome farme where about twenty-one people have died of the plague, and three or four days since I saw a dead corps in a coffin lie in the Close unburied, and a watch is constantly kept there night and day to keep the people in, the plague making us cruel, as doggs, one to another.”[1]
                                                                                 - Samuel Pepys, Monday 4 September, 1665.
“My parents said, quite a few times, that they wish I died.  I’m not sure that wouldn’t have been a better thing.  I’d come crawling through the living room, when they had company, and the subject would change, as to why I wasn’t walking and what was wrong.  They didn’t want anybody to know about it.  It’s something that’s contagious, and nobody wanted to be around it, for fear of catching it.  They would put me in the closet when they had company.”[2]
                                                                - Rick Spalsbury contracted polio in 1945 at the age of 2.
“Racial tension has swept through a block of flats in a suburb favoured by upwardly mobile immigrants where one resident has gone down with the disease despite having no direct exposure to carriers. ‘Our parents and our teacher told us to keep away from Chinese,’ said Narges Aziz, a nine-year-old whose parents were born in Afghanistan. ‘It's scary.’ Narges and her brother Daoud both wore surgical masks and surgical gloves to avoid infection when opening the door to the flats in the suburb of Scarborough.”[3]
                          - Marcus Warren "Sars spreads racial tension as Toronto feels pariah status," 2003.
“Warranted or not, the Ebola scare has hit Howard Yocum Elementary School in Maple Shade, New Jersey. The school has been notifying parents that two students from an east African nation have enrolled. They were supposed to begin classes on Monday; however, after backlash from parents, those kids are now being kept out of school.  The children in question moved here from Rwanda, which is about 2600 miles away from the closest affected country in West Africa. That's about as close as Seattle, Washington is to Philadelphia. But for some parents it really doesn't matter. ‘Anybody from that area should just stay there until all this stuff is resolved. There's nobody affected here let's just keep it that way,” said parent John Povlow.’”[4]
                                                              - Chris O'Connell "Burlington Students Kept Home," 2014.
Infectious diseases breed fear.  That this fear is then compounded by ignorance and whispered rumours, media, and our own imaginations is simply a fact of life.  Recently these fears have been reflected, perhaps too well, in news articles prophesying new superbugs and the end of civilization.
Disease, however, is an inevitable part of life.  As Tony McMichael wrote in his Human Frontiers, Environments and Disease, “as the scale of social-demographic change and of human impact on the ecosphere escalates, so the probabilities of infectious diseases, both new and resurgent, increase.”[5]  

Indeed, only in the past 50 years we’ve identified the following diseases and/or their pathogens: ebola (1976), Lyme disease (1982) HIV (1988), Hepatitis C (1989), “Mad Cow” disease and H5N1 bird flu (1997).[6]  We face the re-emergence of diseases like plague (bubonic), tuberculosis, and polio.

It is no wonder that we see pictures of people wearing surgical masks and homemade hazmat suits, or that sales of hand sanitizer have increased significantly, and that there are companies preying on people’s desperation by selling unapproved remedies.  In response to everything from the Justinian plague, to the sweating sickness, to influenza, SARS, and now ebola, humans have reacted in both truly heroic and truly horrible and illogical ways. 

Fear, panic, and anger, it seems, are universal reactions to infectious disease that transcend time.  As public health services seek to confine disease, it’s up to the rest of us to act responsibly and compassionately. 
For the second half of this post, Dr. Heather Battles shares some of the similarities between the mid-20th century polio epidemic and the current crisis over ebola:

The fear and panic over Ebola today echoes similar reactions in previous epidemics in human history - including polio in Canada in the mid-20th century.
Globe and Mail, August 18 1937, pg. 4
In an incident reminiscent of recent stories of people donning plastic body suits and face masks at airports out of fear of Ebola, during the 1937 polio epidemic in Ontario a tourist reportedly arrived at Niagara Falls wearing a gas mask.[7]  During that same epidemic, a Letter to the Editor by someone who signed himself “Family-Man” called for American tourists to be subjected to a medical examination upon entering Canada.[8]

Along with such anecdotes about individuals, the news media often presented contradictory and confusing messages about polio (sound familiar?).[9]  A 1948 Maclean’s article entitled “Don’t Panic Over Polio” attempted to reassure worried parents that polio was really a fairly uncommon disease and that their children’s chances of contracting it and either dying or being crippled by it were relatively low.[10]  However, the same article describes polio as “among the most mysterious of mankind’s afflictions”[11] and “the most difficult human disease to diagnose”[12] with “no known drug or treatment that can ward off paralysis.”[13] 

A further example of contradictory messages from media and public health officials can be found in three articles from the Globe and Mail newspaper in August of 1937.  One article reported on August 7 that three new paralytic polio cases had arisen and that officials were warning parents that all children with flu-like symptoms, which could be the start of polio, should be examined by a doctor.[14]  Another article on August 11 advised that “no complaint should be overlooked.”[15] Then on August 18, the page four headline screamed “Unfounded Paralysis Fear Causes Near Panic: Parents’ Imagination Blamed for Influx of Tots to Hospital.”[16]  The article quotes health officials as blaming parents for panicking and acting hysterical when most cases turn out not to be polio.[17]  Clive Seale notes in his book Media and Health that it is common for newspapers to appeal to readers “not to panic” while their stories encourage just that.[18]

Plus ça change…

Let me/us know what you think here or on Twitter, I’m @medhistorian with @anthroetc

[1] Diary of Samuel Pepys, 4 September 1665.
[2] Julie Silver and Daniel Wilson, Polio Voices: An Oral History from the American Polio Epidemics and Worldwide Eradication Efforts, Greenwood Publishing Group (2007), 67-68.
 [5] Tony McMichael, Human Frontiers, Environments and Disease: Past Patterns, Uncertain Futures, Cambridge University Press (2001), 122.
[6] Ibid., 115-116.
[7] Leslie Scrivener, “The Plague of ’37: When Polio Hit Toronto Schools and 758 Lives Changed Forever,” Toronto Star, September 6 1987, D1.
[8] Globe and Mail, September 2 1937, 6.
[9] Kathryn Black, In the Shadow of Polio: A Personal and Social History (New York: Addison-Wesley, 1996), 46-47.
[10] Nevill, “Don’t Panic Over Polio,” 7.
[11] Nevill, “Don’t Panic Over Polio,” 7.
[12] Nevill, “Don’t Panic Over Polio,” 32.
[13] Nevill, “Don’t Panic Over Polio,” 33.
[14] Globe and Mail, August 7 1937, 4.
[15] Globe and Mail, August 11 1937, 6.
[16] Globe and Mail, August 18 1937, 4.
[17] Globe and Mail, August 18 1937, 4.
[18] Clive Seale, Media and Health (London: SAGE Publications, 2002), 81.