Epidemics: medicine against evolution
Bacteria, viruses and fungi that trigger diseases are inseparable from biological evolution. It lacks any rating as to whether something is cruel or does it good. Pathogens continue to haunt wild animals without being able to protect themselves: for example, every second wolf pup dies in the first year of life - especially from parasites inside the body. In humans, epidemics claimed more lives than all wars combined. However, they often spread during the wars when the infrastructure collapsed, people were weakened, suffered from hunger and the body's defenses could no longer work.
With technology against dying
“Many of the germs that infest Homo sapiens existed before his ancestors entered the world stage. Today we know that bacteria, parasites and viruses on the one hand and hosts on the other hand have developed side by side over time. This common evolution must have included most of the germs known to us. Typhoid, plague or cholera did not first arise with humans (…) ”(Jacques Ruffié and Jean-Charles Sournia).
People developed culture and technology - and so we were able to work step by step from natural selection. With fire, house building and clothing, we were able to artificially create a climate that suited us.
Medicine is one of the most important and first achievements of culture. No matter how wrong and irrational many healing methods of old societies seem to us, it was always a matter of finding remedies for the diseases that got us there.
At the same time, civilization had a price, and it was very high. When the communities of early humans grew beyond a certain size, they could no longer feed themselves as hunters and gatherers. Only agriculture and animal husbandry made it possible to provide more and more people with food.
A paradise for pandemics
Agriculture and animal husbandry were at the same time the prerequisite for the establishment of cities in which a large number of people lived together in a dense space. But this promoted epidemics, i.e. infections that infect a large number of people in the shortest possible time and spread from person to person.
The masses of people in a confined space built piles of rubbish in the immediate vicinity, and there were also stores full of grain. Both attracted animals that transmitted harmful bacteria to humans, especially the rats. But livestock also caused diseases that hunters and gatherers had had little contact with.
In addition, pathogens were able to multiply ideally in the people crowded together. Nomadic groups are far less exposed to epidemics. A lethal virus or bacterium in a clan of a few dozen hunters initially kills this group; the other groups of hunters are spared.
For example, plague bacteria have existed in the steppes of Central Asia for millennia, but the migrant shepherds in Mongolia and Kazakhstan never suffered the apocalyptic extinction of their peoples through the plague like people in Europe in the late Middle Ages.
The plague burned itself into the consciousness of Europe as the epitome of the end of the world and it claimed the greatest number of fatalities. But much more common were parasites and harmful microbes in the digestive tract, viruses and bacteria that our ancestors drank with the water, ate with bread or carried them into the grave with a "harmless" insect bite.
Today we know of such epidemics as cholera, typhoid or typhus, but even in modern times doctors could hardly distinguish the diseases from one another, and they often occurred together.
Before the nineteenth century, medical professionals only vaguely classified infections associated with nausea and vomiting, bloody diarrhea, incontinence, rapid weight loss and a greatly increased body temperature as "fever", "pestilence" or "discharge".
Viruses and bacteria were unknown as pathogens until the 19th century. Even in the Middle Ages, physicians recognized a connection between hygiene and epidemics, but firstly, this approach did not prevail, and secondly, there was a lack of technical possibilities and the will to change the situation.
It was getting worse: in cities like Edinburgh, the wealthy citizens lived in the upper municipal works, and the poor on the ground floor because the garbage on the streets literally stank to the sky. Stepping stones made it possible to move forward in the city without stepping into excrement like rotting food.
The “sewerage” was often the river on which the city lay, and organic waste, including viruses and bacteria, could spread further downstream. The poor and farmers lived with the farm animals in a confined space, and this livestock, without effective veterinary care, was what veterinarians call the "parasite mother ship".
Fleas, lice, mites and other pests, perfect carriers for infections, were so ubiquitous that the nobles hung out extra "flea furs" in the hope that the blood drinkers would control them.
Plague and cholera - a deadly choice
Cholera comes from the Greek word for bile and means “bile diarrhea”. It is a bacterial infection caused by Vibrio cholerae. It mainly affects the small intestine. The bacteria are usually transmitted via polluted water and contaminated food.
The infection leads to extreme diarrhea and severe vomiting, bluish spots form on the body and those affected lose a lot of weight very quickly. The loss of fluid is enormous, so that the body dries out very quickly. This goes hand in hand with a dangerous loss of electrolyte: the distribution of the water is organized by osmotically active substances, and these are mainly electrolytes.
Sodium determines the amount of extracellular fluid and the blood volume. This electrolyte system breaks down due to the loss of fluid. Then the infection becomes life-threatening because the circulation breaks down.
A cholera treatment means a permanent administration of mineral water to compensate for the loss of fluid. If left untreated, the disease leads to death in 20% to 70% of all cases.
From the swamps of South Asia
Cholera asiatica has probably been rampant in India for many centuries, but the epidemics have remained confined to individual regions. The disease was well known to Arab and European seafarers. For travelers to India from Great Britain, it was considered a "tropical fever", that is, a typical disease of hot exotic countries.
However, that changed when she first reached the Sunda Islands from Kolkata, then Indochina and finally China and Sri Lanka, the Mascarene Islands and finally Iran in the west.
Even a millennia-old medicine at a once high level did not save the people between Tabriz and Shiraz: in Persia, the epidemic struck like a weapon of mass destruction. Countless people died and the infrastructure collapsed to such an extent that the Russian Tsar's army took over much of the country unhindered. But this rapid invasion was literally contaminated: tens of thousands of the victorious Russian soldiers now died themselves from the intestinal infection.
As a pandemic that spanned several continents, it plagued large parts of Asia, the Middle East, East Africa, then Russia and Europe from 1817-1824. In 1830 she raged in Moscow, and with that she found a bridge from the vast expanse of Eurasia to the heart of the old continent.
In Europe there were rarely functioning sewage pipes and toilets. The rural people kept their cattle in the house, and the manure and feces from cattle and pigs polluted the groundwater, which also served as drinking water. The cholera bacteria found perfect conditions and were able to get into the intestines of Europeans unhindered.
In the Austro-Hungarian Empire, 250,000 died. The administrative pyramid, which was occupied by a German-speaking elite, collapsed, and historians are debating whether cholera is the Monarchy.
The horror migrated from Moscow to Warsaw, in 1831 the epidemic exploded in Berlin, then in Hamburg, embarked in England, raged in Calais and Arras in 1832 and in March of the same year the first 3 cases occurred in Paris.
Mockery and scapegoats
The French scientists Ruffié and Sournia meticulously worked through this first cholera epidemic in Paris and recognized many reactions that are typical of epidemics: Ignorance when the mass extinction still affected Eastern Europe, the search for scapegoats, as the number of deaths in the air shot, an "epidemic" of miracle healers who sold "alternative medicine" when "conventional medicine" was helpless against the disease - ultimately the establishment of more modern medical care when it was too late.
Although doctors warned early and asked for more beds to be set up in the hospitals, they were not heard. Since Napoleon, Parisians have been citizens of the world's capital, and they have seen “their city” as the center of modernity and civilization. Some even made fun of it when the first cholera cases appeared in France and considered the reports from the medical academy to be scaremongering.
Ruffié and Sournia say: "Certainly, cholera may claim its victims in Poland or in Russia, in these ultimately" uncivilized "distant countries, and perhaps even in England, but not in France." Even as Marshal Lobau's cook the cholera died, it only made fun of the fact that he would have poisoned himself with his bad food. Even when the hospitals in Paris had patients with identical symptoms every day, the press denied that it was cholera.
Bourgeois Paris fell for its own myth of civilization and cleanliness. The reality was anything but “clean”: the drinking water came from the Seine, which was overflowing with waste and from wells that were also polluted. The French professors write: “Debris contaminated the Bièvre, which had turned into a huge sewer. The disease continued to flow through the gutters of the streets. ”
Reality could not be suppressed as more and more people died. Soon 56 departments were affected. After April 2, 1832, there were around a hundred deaths every day; on April 14, the authorities counted thirteen thousand sick and seven thousand dead; at the end of April, twelve thousand eight hundred died.
Fear replaced ignorance and the helplessness of the authorities. Ruffié and Sournia explain: "(...) only a century ago, in that nineteenth century, scenes take place that seemed to have sprung straight from the dark Middle Ages: impotent authorities tried to play down the danger and gave completely absurd hygiene recommendations such as" healthy lifestyle ”without excessive food consumption or moderation with stimulating drinks. As in the case of the plague storms at the time of the Renaissance, provisional hospitals were set up in the most populous parts of Paris. ”As in plague times, many dignitaries left the city.
Carnival of horror
In the carnival processions, some tried to cope with their fear by ridiculing cholera: disguised as sick, with the typical bluish spots on their skin, they walked through the streets.
But, Ruffié and Sournia write, whole carts full of “pierrots and colombines” came to the hospitals “that had contracted the disease in the middle of the celebration, so that they were brought straight to the hospital without having the time to change at home. Some of them were buried directly in their costumes, as we know from Heinrich Heine's descriptions. ”
As the number of deaths increased, there were problems burying them. The authorities confiscated cabins, horse buses, cargo carts, and all sorts of other companions, and even used army vehicles because the hearses were insufficient. It wasn't long before the dead were even brought to the cemeteries on wheelbarrows. The corpses dammed up in front of the cemeteries. The authorities had mass graves created in which the dead were separated from one another only by lime.
The poor died. In the quarters of the rich middle class, life went on as before. As in Edgar Allan Poe's "Mask of Red Death", the wealthy celebrated or met in the theater, but in the miserable settlements of the workers with their appalling hygienic conditions, people passed away - by the thousands.
Quack and lynching
Social unrest mixed with conspiracy fantasies. In 1830, the Republicans had called for a democratic society in the July Revolution. Now more and more of them saw cholera as poisoning by the rulers to punish the people. There was a bloody uprising against the king and his government.
But the poison fantasy also flourished in general. As in the not very distant past of witch hunts, anyone suspected of carrying or doing something “unusual” was suspected. The prefect Casimir-Périer himself spread this fable and had posters put up, which called on the population to be vigilant. As in the days of the Jewish pogroms, the mob now murdered innocent people.
The conspiracy fantasies focused on the doctors. Those who heal can kill, and medical doctors have always been suspected of poisoning or hexing people. The quacks that stood on every street corner and denounced the “failure” of academic medicine were rather harmless, in order to sell their desperate hocus-pocus to the desperate.
The mob was more dangerous. He threatened doctors, got together in front of ambulances, looted pharmacies - then he committed the first murder: "Anger citizens" stabbed a student who helped in a rescue center.
Even the sub-prefect took part in the search for scapegoats and seriously asked whether a young doctor might not have been sent by the government to spread poison. In addition, more and more doctors and nurses themselves died of the plague.
The doctors were helpless because they did not know the cause of the cholera - now they were also in mortal danger because the people were looking for an outlet for fear, anger and hatred. The mob had previously ransacked hospitals and killed medical personnel in Poland and Russia.
The Parisian doctors quarreled when discussing the causes of the disease, especially the question of whether it was contagious, which caused fruitless controversy. Many doctors adhered to the tradition and trusted bloodletting.
Although it is not always as harmful as it is often portrayed today, it can relax a blood congestion and allow infected blood to flow away, but it was fatal for cholera: additional blood loss in those suffering from extreme lack of body water accelerated their way from the world of the living.
As if the debates in the medical academies had not been senseless enough, the Catholic Church also interfered. Some enlightened doctors demanded that the bodies be cremated to prevent possible infection, which is a matter of course for an unknown cause. Catholic fundamentalists are now creating a new conspiracy fantasy and rushing against the medical profession as a "Freemason".
The epidemic peak reached its peak in April 1832, after which the death rate fell. It didn't stay with the poor. Nobles and businessmen died, as did Prime Minister Casimir-Périer and General Maximilien Lamarque.
The funeral of this staunch Republican escalated in a popular uprising: thousands of artisans and workers fought a battle with 25,000 soldiers in Saint-Antoine. In the end, 200 people were killed.
Meanwhile, the number of cholera victims decreased day by day and the authorities closed the emergency hospitals. That was a mistake: the number of deaths peaked again in July. On July 18, 225 people died in a single day. Soldiers in barracks and prisoners in prisons were the most affected.
Cholera claimed significantly more deaths in the metropolises, and proportionally, than in the villages. The French scientists write: "The contagion density was directly related to the social environment, wages and the hygienic conditions in the apartments."
On the one hand, people lived close to each other in the cities, so that the bacteria could jump directly from person to person. On the other hand, however, the water quality in the countryside was generally better than in the rampant metropolises such as Paris or London - in particular much healthier than in the quarters of the urban workers.
Back to the hatchery
The Parisian bourgeoisie turned its nose up at the peasants, who lived with their cattle wall to wall and were generally considered dirty. But in the more sparsely populated regions of the country, the rivers were cleaner, the groundwater was less dirty, and the cholera bacteria were less likely to get into the human body.
Only a year after the outbreak of the epidemic, in April 1833, there were no more dead. The cholera was gone for the time being. It raged for four more years in rural France. In 1849 the infectious disease broke out again in Paris and found 20,000 victims, and then again in 1853, 1865, 1873 and one last time in 1884.
The epidemics finally led to the implementation of health concepts that enlighteners had already designed in the 18th century. France created several public health authorities, the forerunners of today's health departments. The hospitals were equipped with more beds for crisis situations. And a broad public accepted that diseases are contagious - a fact that was still highly controversial in the decades after bacteria were discovered under the microscope. Their opponents developed strange theories like homeopathy, a pseudoscience that still has many followers today.
In 1855, the plague struck London, and here the doctor Dr. John Snow a revolutionary discovery. He demonstrated that the cholera epidemic in the Soho district of London was caused by contaminated drinking water. Previously, the doctors had assumed that the plague was caused by miasms, i.e. airborne vapors.
Filippo Pacini had discovered the pathogen a year earlier and described it as a comma-shaped bacterium. In 1884, Robert Koch ultimately cultivated the pathogen from the intestines of deceased patients.
In 1898, cholera had initially ended its extermination campaign through Asia, Africa and Europe and remained where it started - in the Indus Delta. The wave of epidemics since the early 19th century had cost 30 to 40 million lives, almost as much as World War II.
She was not defeated: in 1923 she broke out in the Balkans after Muslims brought her from her pilgrimage to Mecca. In 1939 the horror returned to Iran, in 1947 her death was in Egypt, and in the 1970s people all over Africa died.
Cholera is no longer a threat in western industrialized countries. The hospitals have enough beds, the pathogen is known and can be controlled, the supply of clean drinking water is largely guaranteed, the waste water is treated and disposed of. The main routes through which the disease spreads are blocked.
Prophylactic vaccinations are just as natural in Europe as rehydration and antibiotics, so that even the outbreak of the disease hardly leads to death.
In poor countries in Asia and Africa, however, cholera remains a deadly threat. In India, Tanzania or Cambodia, drinking water and sewage systems are rarely separated from one another, the hygienic conditions in the slums are similar to those in Parisian workers' quarters in the 19th century, and drinking water is often contaminated by cholera pathogens, which are caused by faeces in river, sea and and groundwater. The pathogens also carry fish that the locals catch from waters contaminated with faeces.
When the disease breaks out, Third World countries also lack adequate replacement of water, sugar and salts, usually intravenously, to protect the inflamed stomach and intestines. This simple help, supported by antibiotics, lowers the death rate from 60% to less than 1%.
Filtered water is the number one precaution in the countries still affected today. Even simple filters made of fabric reduce the infection rate by half, researchers in Bangladesh found.
Typhoid fever was a recurrent agony for Europeans well into the 19th century. It is an infection with Salmonella, which mainly shows as severe diarrhea, but also attacks the skin and internal organs and is associated with a high fever. Typhoid is not such a mass killer as cholera in the 19th century, the epidemics remain local, go away and many sufferers survive the fever.
Most people got infected with drinking water and food, the pathogens mostly stayed in the feces like urine of the infected. As with cholera, the breeding ground for typhus was and still is poor hygiene, especially not separate drinking and waste water, dirty public toilets and contaminated food. Today, these conditions are still present in large parts of Asia, Africa and South America and the disease is spreading.
In 1880, Karl Joseph Ebert recognized the pathogen, and medicine could use it to develop antidotes. You can be effectively vaccinated against typhoid. Vaccination works for at least one year.
The disease was known, but it was rampant among soldiers of all parties in the two world wars. Where the soldiers were vaccinated and the accommodations were clean, there was little or no infection.
However, it is impossible to find out which infections exactly killed the soldiers and civilians who were ill at the time, because other diarrheal diseases such as typhus fever also claimed their victims.
Spotted fever begins with chills, rising fever, limb and headaches, and occasional loss of consciousness. This is followed by a blue and red-stained rash that gave the disease its name.
Ruffié and Sournia write: “Not all epidemics wreak havoc like cholera. Nevertheless, they too must be mentioned, if only to remember the millions of deaths they claimed and to remember the scientists who killed the epidemics. ”
The stain fever already spread in ancient times. Already in the Peloponnesian War, symptoms were described in soldiers who indicated the plague, and clearly the troops of Lautrec in the 16th century and many decades later, the people in today's Germany suffered in the Thirty Years' War.
The infection became best known in Napoleon's army when it withdrew from Russia. Ruffié and Sournia: "When they retired from Moscow, the Grande Armée left more doomed typhus patients in the military hospitals than dead on the battlefields and in the pack ice of the Beresina."
The trade routes such as the Silk Road in Asia and the pilgrimage routes to Jerusalem or Mecca also spread the disease.
Confused with typhoid
In the past, spot fever and typhoid were often confused. The symptoms are similar, but the pathogen is different. William Jenner recognized in London in 1847 that it was a separate disease. Before that, spotted fever also fell under “typhoid”. Today, spotted fever is still called “typhus” in English, but the German “typhoid” in Great Britain is called “typhoid fever”. The biologist Henrique da Rochalima discovered the pathogen in 1916 and described it for the first time.
The louse jumps from war to war
With the wars, the fever spread internationally. This is how French soldiers in America infected the rebels there, and when they returned home, they brought the plague with them to Brittany, where it was firmly established.
Spotted fever continued to accompany the war in the 20th century. It had been known since 1909 that a clothing louse transmitted the pathogen, which was of little use under the conditions of the world wars: on the contrary, the constant change of positions and the poor hygiene in the camps offered the clothing lice what zoo directors call animal welfare .
The pathogen Rickettsia prowazek infected the Russian soldiers from 1914 to 1917 as well as the German-Austrian. In Russia, the fever also attacked the civilian population, and the great death continued after the war. A study by the League of Nations estimated the number of typhus infections to be twenty-five million between 1917 and 1921 - three million people died.
Lenin described the louse as an enemy of communism, because in the civil war after the October Revolution between 1918 and 1922, the fever in Russia killed 2.5 million people.
Human experiments in the concentration camp
Spotted fever also spread during the Second World War. But it was not an unknown plague against which nothing could be done, but the cause was the contempt for human beings of the Nazis.
They locked up forced laborers, prisoners of war, political opponents, citizens of Eastern Europe, Jewish people like Sinti and Roma in concentration camps. The hygienic conditions were barbaric. Delousing measures against the typhus pathogen were known, but the Nazi personnel carried them out completely inadequately.
All hairy parts of the body were shaved and "privileged" prisoners showered, but the weaknesses caused by hunger, other illnesses, and destructive work made infections easy. Thousands of concentration camp inmates died of spot fever.
The horror took on an even more drastic form: in human trials, criminal Nazi doctors injected their victims with typhus to "research" the plague and try treatments. Several hundred people died from the artificially induced infection.
But the soldiers on the front also got infected on the clothes louse. There were also various other wounds and diseases. Thus wrote the Austrian Johann Wagner, who excavated mass graves in a death squad: “An appendicitis was advancing, before the first attack of malaria, the plug-in shot in a night attack
left lower leg, an upper arm bullet when captured, in the Ruhr prison camps, Whale fever, typhus, typhus, paratyphus and then in 1945 a very severe pneumonia. So I doubted whether I would survive that. "
The pathogen Rickettsia prowazekii can only live in the human body. The lice do not transmit it among themselves. The germ stays in the body for a long time. Anyone who has contracted a fever, or who has become infected without showing any symptoms, still has the pathogen in the body. A louse can become infected from this person at any time and spread the disease again.
Relatives of the pathogen do not live in humans, but in animals - this is how Rickettsia mooseri attacks rats and triggers murine fever.
In Africa, Rickettsia prowazekii also colonizes pets, and instead of clothing lice, the pathogen is then transmitted by ticks, which bite the animals first and then humans. Related fever diseases are the American "Rocky Mountains Fever", the African "button fever" and the "Japanese river fever". The “Q fever” in Australia, the USA and Africa triggers Rickettsia burnettii.
There has been a vaccine against R. prowazekii since World War II, but the main way to avoid typhus fever is to protect it from the wearer, i.e. from lice, ticks and other ectoparasites. Infections with this pathogen are extremely rare in Germany today.
This epidemic typhus has recently occurred among German citizens only among humanitarian workers. Fever was relapsed in people who contracted it in World War II. (Dr. Utz Anhalt)
Professional supervision: Barbara Schindewolf-Lensch (doctor)
Jacques Ruffié; Jean-Charles Sournia: The Plague in Human History. Munich 1992
Thomas Werther: Fleckfieberforschung in the German Reich 1914-1945. Dissertation. Wiesbaden 2004.
Gerhard Dobler, Roman Wölfel: Spotted fever and other ricketsiosis: Old and emerging infections in Germany. In: Deutsches Ärzteblatt Int. No. 106 (20), 2009, pp. 348-354 (article).
Information material from the University of Erlangen on typhus tests in the Buchenwald concentration camp