Twisting of the guts

Know anyone who has died of headmoldshot recently? Or maybe they succumbed to imposthume? We live in a golden era of medical treatment: many once-fatal scourges are no more, thanks to better hygiene, improved diets, the development of vaccines and that 20th century miracle - antibiotics.

In 1962 Britain had a smallpox outbreak, which started in Wales and spread to other parts of the UK. The source was a man called Shuka Mia, who arrived in Cardiff by train from Birmingham; the day before he had arrived in Britain from Pakistan, where a smallpox epidemic had already killed hundreds. As epidemics go, the 1962 outbreak in Britain wasn’t bad – 25 people contracted the disease and six died. Hundreds of thousands of people were vaccinated, including me.

I remember visiting our local GP, an avuncular Irishman called Paddy Heydon, to get my vaccination. His ruddy face smiled as stood me on a chair and scratched my left upper arm, leaving a centimetre-long vivid green mark. I was protected against smallpox. Paddy was reputed to like the bottle, but he was a good doctor. I once had a wart growing right on the edge of my left eyelid. Today, no doubt, that would require numerous interventions and take an age to eradicate. Paddy simply took a pair of scissors and before I knew it had snipped the wart off. It never returned.

Paddy simply took a pair of scissors and before I knew it had snipped the wart off

The 1962 smallpox scare was no over-reaction. The mortality rate for smallpox was about 30% and those who survived were often left blind or severely pockmarked. In the early 1950s, more than a century after vaccination became possible, there were still 50 million cases of smallpox around the world. Introduced to Mexico in the 16th century by Spanish invaders, it wiped out the Aztecs and Incas, then did the same to North American Indians and later the Australian aborigines. In its most virulent form, hemorrhagic smallpox, the patient bleeds to death before developing pustules. Smallpox killed Queen Mary II of England, Emperor Joseph I of Austria, King Luis I of Spain, Tsar Peter II of Russia, Queen Ulrika Elenora of Sweden, and King Louis XV of France. Smallpox was globally eradicated by 1980 – which just goes to show that international cooperation can work if the threat is serious enough.

A random dip into the 18th century archives of deaths in London shows that ‘Small Pox’ was a major killer – but not the biggest cause of death. From London’s ‘Bills of Mortality’, which started in the early 16th century as a device to monitor incidences of bubonic plague, one can gauge the development of disease in Britain’s capital city. The 1665 bubonic plague killed about 25% of London’s population.

During December 1752-December 1753 ‘Small Pox’ did away with 774 Londoners out of a total of 19,276. The biggest killer by far was something called ‘Convulsion’, which presumably was an epileptic seizure of some kind; that year ‘Convulsion’ killed 5,977 people in London. ‘Consumption’ (tuberculosis) was the cause of death of a further 3,915, while ‘Fever, Malignant Fever, Scarlet Fever, Spotted Fever, and Purples’ accounted for 2,292. If you had the ‘Purples’ you had purple blotches all over the body, caused by the breaking down of small blood vessels. The underlying cause of death from ‘Purples’ would be something else. Death from old age brought down 1,466 Londoners, while ‘Dropsy’ – an excessive accumulation of water – did for 794. A further 570 were ‘Abortive and Stillborn’ but a staggering 961 deaths are simply put down to ‘Teeth’. ‘Jaundice’ killed 90 and ‘Inflammation’ another 64. ‘Asthma and Tissick’ – tissick being another way of describing TB – polished off 305, while ‘Measles’ did away with 253. ‘French pox’ (syphilis) did for 55.

‘Headmoldshot, Horseshoehead, and Water in the Head’ accounted for 64. In ‘Headmoldshot’ referred to a condition seen in newborns, when the cranial bones were so compressed by delivery that they overlapped one and fused together, usually causing fatal brain pressure. Today we call the condition craniosynostosis and it’s easily treatable. ‘Horseshoehead’ was the opposite of ‘Headmoldshot’ – the sutures of the skull are too far apart. ‘Water in the Head’ today is known as hydrocephalus.

‘Headmoldshot, Horseshoehead, and Water in the Head’ accounted for 64

But there are plenty of puzzles in the ‘Bills of Mortality’ for 1752-53. Eleven people sucumbed to ‘Evil’ – what on earth was that? Probably scrofula, sometimes referred to as the ‘King’s Evil’ (as the touch of the monarch was superstitiously thought to be a cure), a disease involving swollen glands and probably a form of tuberculosis. Twelve died from ‘Imposthume’, which was a form of abscess. ‘Mortification’ did away with 201 and was probably a form of gangrene or necrosis. ‘Rising of the Lights’ – a blockage of the trachea or larynx – affected one person, probably a child, while ‘Frighted’ dealt with two and ‘Grief’ with seven. ‘St Anthony’s Fire’ (erysipelas), a feverish condition caused by bacterial infection and creating a intense deep red inflammation of the skin killed two people, as did ‘Livergrown’ (an enlarged liver) – perhaps related to the 15 people who died from ‘Excessive Drinking’ – and ‘Leprosy’. ‘Scald Head’ – which embraced any number of diseases causing head pustules and led to hair failling out – affected two people.

Perhaps surprisingly, given the draconian laws of the time, only 18 people were executed during that same 12 month period. And one oddity is that no deaths were recorded for cholera, a water-borne disease. This only became a real scourge in the 19th century, when the Thames was so polluted and pure drinking water became much more difficult for Londoners to come by. ‘Poisoned’, ‘Smothered’, ‘Stabbed’, and ‘Sciatica’ each accounted for just one person, while seven starved to death, three were murdered, 36 ‘Killed themselves’ and a further 86 drowned. Three were ‘Bit by mad Dogs’, 11 were infected by ‘Worms’ and 34 were just ‘Found Dead’. ‘Colick, Gripes, and the Twisting of the Guts’ did away with 128.

Three were ‘Bit by mad Dogs’, 11 were infected by ‘Worms’ and 34 were just ‘Found Dead’

If the ‘Bills of Mortality’ were merely a list of the wierd and wonderful diseases that have either disappeared, thanks to medical advances, or have become better known under other names, it would have limited interest. But appended to it is an ‘Essay in Political Arithmetic concerning the growth of the City of London’ by Sir William Petty, first composed in 1683, three years before his death. Petty, a friend of Samuel Pepys, served both Oliver Cromwell and Charles II and was personal secretary to Thomas Hobbes. Petty might be considered one of England’s first economists, but we shouldn’t necessarily hold that against him. His ideas were picked up by Adam Smith, Karl Marx and John Maynard Keynes.

In his essay, Petty tries to calculate the likely population growth for London and the world. He estimated that in 1683 there were 320 million people in the world and that the population doubled every 360 years. He wrote that that would mean “within the next 2,000 years” (i.e. by 3683) “one head for every two acres of land in the habitable part of the earth. And then, according to the prediction of the Scriptures, there must be wars and great slaughter, &c.”

One can smile at the ludicrousness of such a calculation – wars and great slaughter on a scale that Petty could not have imagined have already happened, after all. But his greatest blindness was the failure to contemplate how humanity became so good at first laying a golden egg, and then killing the goose that laid it. The 20th century created the biggest life-saver of all – antibiotics – and is now on the verge of destroying that miracle. Of the as much as 200,000 tonnes of antibiotics manufactured every year, the vast majority are consumed not by humans but animals, administered on industrial-scale farms. Almost without realising it we have prioritised fat healthy animals over plump rosy-cheeked children. It’s estimated that about 70% of all bacteria now have developed a resistance to known antibiotics. Between 1935 and 1968 14 different classes of antibiotic were created; no new classes have been developed since 1987. Now there is a desperate race to recover lost ground; it is touch and go. And Big Pharma is not really interested because there’s not enough money in antibiotics. Of course there will be – when it’s too late.

Sir Alexander Fleming, who shared the 1945 Nobel prize for medicine for his co-discovery of pencillin, sounded what he called “one note of warning” about overuse of penicillin and the growth of bacterial resistance. “The time may come when pencillin can be bought by anyone in the shops.” That time is here. Who knows – perhaps ‘Scald Head’, ‘Imposthume’ and ‘Mortification’ will reappear in the 21st century’s Bills of Mortality. Or something worse. Such as smallpox, which has started coming back in certain developing countries.

Paddy, now long in his grave, would be having nightmares.