Coughs and Sneezes Spread Diseases

In our last post we talked about the tragic story of the sisters who died of whooping cough just one day apart. Today in blog 4 of our Little Lives series, paleopathologist Dr. Annie Snoddy talks about the diseases that used to make childhood so dangerous for our colonists.

Infants and children are the “canary in the coal mine” for community health. They are the first to experience the physical effects of hardship because of their immature immune systems and rapid growth. Infants and children are particularly vulnerable to many infectious diseases (although this doesn’t appear to be the case with the COVID-19 pandemic we’re currently experiencing). Often, the number of tiny graves in a cemetery will tell us of an outbreak which affected the wider community. Today I will talk a little bit about some of the infectious diseases that we know sadly took the lives of some of the children of 19th century Milton. Thankfully many of these diseases are preventable today with vaccination and good hygiene!

As Hallie mentioned, most infections do not leave evidence in bones which means usually we can’t tell exactly what someone suffered from when they died. However, we are fortunate to have historical records associated with St. John’s Burial Ground, Milton that give us the cause of death of many of the children who were buried there and this gives us an idea of some of the illnesses that sadly cut their lives short.

Pertussis (“Whooping Cough”)

Whooping cough, so called because of its characteristic sound, is an acute bacterial respiratory infection caused by Bordetella pertussis. Prior to the creation of a vaccine in 1914, this was a leading cause of childhood mortality and a very common childhood illness. It is still a significant public health threat in developing countries with the WHO estimating 195,000 deaths due to this disease in 2008 alone.

The infection begins like a common cold with a runny nose, low fever, and mild cough. However, after about a week the disease course can become quite serious. This is because the bacteria work to paralyze the cells in the lungs that help to clear out mucous and debris. This means that no matter how hard a person coughs they are not able to clear out their lungs which can lead to acute respiratory distress and death.

Yesterday Hallie introduced the story of the two sisters in the St. John’s burial ground who died of whooping cough, sadly succumbing to it on the same day. Some treatments would have been available in Victorian New Zealand but most of these contained respiratory depressants such as morphine and would have caused more harm than good! Today we have a jab for whooping cough and although it is not 100% effective it does mean that many cases are prevented and those that are not are less serious than they would be otherwise.

https://iiif.wellcomecollection.org/image/L0041350.jpg/full/full/0/default.jpg
Ayers Cherry Pectoral contained a hefty dose of morphine, making it less than ideal for the treatment of whooping cough. (Wellcome Images, CC BY 4.0).

“Croup” and Pneumonia

Croup is a viral inflammation of the upper airway that causes narrowing of the trachea or “windpipe”, leading to a characteristic barking cough. It is most common in infants and very young children. It can be caused by several viruses but parainfluenza type-I (HPIV-1) is the primary cause of childhood croup. The disease onset can be very, very sudden and can cause serious respiratory distress if the windpipe is very inflamed. Although there is currently no vaccination for viral croup, we do have supportive treatments such as oxygen therapy in hospital which means that today even serious cases are unlikely to result in death. Sadly, there was little that the settlers of Milton could do to support children in severe respiratory distress which may be why this is listed as the cause of death for a 15 month old boy at St. Johns Burial Ground.

Far from containing “no evil drug” as this advertisement claims – remedies like German Syrup also contained hefty doses of morphine to ‘treat’ croup (Clutha Leader, 30th Dec 1892, accessed via Papers Past)

Pneumonia is a catch-all term for infection of the lungs and can be caused by many types of viruses and bacteria. Children are particularly susceptible to respiratory diseases because they have relatively untrained or “naïve” immune systems and don’t necessarily have the best hygiene practices. We can’t know for what was responsible for pneumonia at Milton but we do know that secondary bacterial infection following viral illness is the one of the most common causes of it today. In these cases, bacteria that normally would not cause illness settle in lung tissue that has already been damaged by a viral infection such as influenza. Pneumonia is listed as the cause of death for two children at St. John’s Burial Ground, a one-year-old boy and a seven-month-old boy. As with whooping cough, those suffering from pneumonia at Milton in the 19th century may have been treated with a morphine-containing syrup which paradoxically would make it more difficult to breathe.

Tuberculosis

 We’ve talked about tuberculosis (TB) at Milton previously, particularly the case of an adult man (Burial 21). This community appears to have had an unusually high prevalence of TB! Children were not spared which is actually somewhat unusual. Although TB infection often occurs in childhood it usually remains in a dormant (latent) state until later in life. However, if a child’s immune system is very stressed by other infections or malnutrition it may become active sooner. When active TB occurs in children it’s often missed because the symptoms, such as recurring fever and non-productive cough, are very non-specific and may be caused by other diseases. What is so unusual about the death certificates at St. John’s Milton is that several children appear to have died with quite specific forms of tuberculosis. For example, an 8-month old boy is recorded as having died of “tubercular meningitis” which is a very serious infection of TB in the tissue that overlies the brain. Likewise, a two-year-old girl is listed as having died of a “psoas abscess” which is caused by tuberculosis invading one of the muscles of the hip. The fact that several children here were suffering from forms of TB identifiable to 19th century doctors is intriguing and might indicate that the larger population experienced very stressful lives which resulted in depressed immunity.

Other causes of death

We’ve discussed before the problems with interpreting Victorian “causes of death” – 19th century doctors, particularly those working in colonial New Zealand, did not have access to the diagnostic techniques we have today! Many illnesses have similar symptoms and sometimes the listed cause of death may be incorrect or simply something non-specific like: “natural weakness”. We do know that children in 19th century New Zealand we vulnerable to other illnesses like measles and rubella. Thankfully we have vaccinations for these diseases today but in the past they could lead to death, particularly in children who were already weak from hunger or other infections. Even in modern times, measles can be very serious with the WHO reporting nearly 150,000 deaths globally in 2012. It’s possible that these diseases are responsible for some of the “unknown” or non-specific causes of death listed in the burial records of Milton.

Victorian childhood was not easy and the children of colonial Otago were especially vulnerable to many diseases we rarely give a thought to today. Looking at the children of the past shows us how fortunate we are now, to have good pre- and post-natal care, clean hospitals, vaccinations and knowledge of how diseases work.

Annie Snoddy, 30th April 2020

Join us tomorrow where we move on from looking at diseases and medicines, to looking at childhood food…

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