Looking at pandemics: From Black Death to swine flu

Abstract

200 British Journal of School Nursing April 2011 Vol 6 No 4 This paper will look at some of the history’s most destructive epidemics and pandemics that have occurred, including the Black Death in the 14th century, smallpox, cholera, typhoid and the influenza outbreak of 1918. Throughout history, magic, religion and science have ‘fought for supremacy’ over the explanations of the causes of disease (Ayliffe and English, 2003). Although direct observation of the patterns of infection occurrence eventually led to an understanding of the spread of disease, this took a long time. From the 1st century AD, infections such as cholera, the plague and chlamydia were thought to be spread through ‘miasma’ or bad air. It was believed that the air was filled with particles from decomposing matter (miasmata), which caused poisonous vapours to infect people. This was not an unreasonable supposition given that stagnant or contaminated possibly to different countries or continents. Infection has been a major cause of morbidity and mortality throughout man’s history. Along with genetics, environment, lifestyle choices and biology, it forms one of the five main causes of illness and death. Diseases spread by infection are transmitted through orifices in the human body, such as cuts in the skin, the mouth or respiratory tract, and through sexual activity. They are carried through the human body in the blood, saliva or in semen. The development of microscopes (in the 17th century) helped the development of germ theory. These discoveries enabled scientists to look closely at the microbes responsible for disease. Bacteria and viruses have the capability, as with other organisms, to mutate and adapt to their environment, as Darwin suggested in his theory of evolution (Darwin, 1859). We see this today with the occurrence of new strains of infections such as Methicillin-resistant Staphylococcus aureus (MRSA) (Ayliffe and English, 2003). Bacteria have been found in ancient Antarctic sedimentary rocks and ice (Magna, 2009). They are believed to have been among the first living things on earth, meaning that they have survived the course of the last three and a half billion years. Their ability to cause epidemics depends upon the virulence of the pathogen, the size of the host group, the immune response and the ability to find a victim (Magna, 2009). This ability to find a host was helped by changing social and economic developments. The domestication of animals provided opportunities for infections to cross species, and the development of increasingly larger social groups allowed them to be easily and quickly transmitted between human hosts. In addition to this, as cities grew, there were unclean living conditions with no human waste disposal, no safe drinking water and overcrowding; all contributing to the spread of disease. Poverty was also a major factor in increasing death rates; water has a foul smell and provides a perfect medium for microorganisms to grow: water borne infections, such as diarrhoea, dysentery, cholera and typhoid have been responsible for many epidemics over history. The explanation of bad air causing infections led to better sanitation and hygiene, which, despite being based on misguided assumptions, was positive for public health. Florence Nightingale subscribed to the miasma theory and, during the Crimean War, helped the introduction of cleaner hospitals and better conditions for recovering soldiers. Although this did not stop the spread of disease completely, it did reduce their transmission. In her Notes on Nursing, Nightingale refers to fresh air and describes an unventilated room: