Dutch Settlers at Voorzorg in Suriname Decimated by 1845 Epidemic: A Multifaceted Approach to Unravel Mystery about Etiologic Microbial Agent

Abstract

Background. In 1845, an attempt at Dutch farmer colonization of the overseas colony of Suriname failed because within weeks of the arrival of 384 colonists, an outbreak occurred that killed half of them. The outbreak at plantation Voorzorg was identified as ‘gastric biliary fever’, which was later interpreted as typhoid fever. However, sparse data support this diagnosis. Herein, we took a multifaceted approach to characterize the outbreak and establish the likely microbiological cause. Methods. Archival research was combined with identification and excavation of a burial site, analysis of aDNA of skeletal remains as well as modelling of the outbreak on epidemiological findings. Results. A timeline of events constructed from archival records revealed that the 1845 febrile illness affected >95% of the 384 colonists, likely transmitted human-to-human and was characterized by fever, nausea, vomiting, in cases abundant often bloody diarrhea, and progressed into delirium and stupor (‘Typhus’). Within 1-2 weeks of symptom onset, half of the affected persons died (189 of 384) with overrepresentation from the young and elderly. A few postmortems had revealed multiple small, purulent colonic ulcerations. We discovered a burial ground and uncovered 17 skeletal remains presumed to be colonists. Subsequently, metagenomic testing did not reveal a pathogenic microorganism fitting the disease description, but typing mitochondrial DNA (possible in 15 of 17) showed that the skeletal remains sampled likely did not originate from Europe. Mathematical modelling of epidemic curves depicting cumulative mortality of those arriving by subsequent ships revealed that transmission characteristics of bacillary dysentery rather than typhoid fever fitted the epidemiological findings the best. Conclusion. A multifaceted approach revealed that the 1845 outbreak at Voorzorg among Dutch colonists was probably caused by bacillary dysentery and not typhoid fever. Likely, the high mortality was a consequence of dehydration that in tropical conditions particularly affected the young and elderly. This outbreak contributed to the failed colonization attempt.