While outbreaks of bubonic plague and their dreadful death tolls might have been consigned to history and efforts to eradicate coronavirus continue apace, other diseases such as cholera, dysentery, typhoid, smallpox, measles and influenza, were once responsible for extraordinary devastation here in Brittany.
In the 18th and 19th centuries, increases in population density, transport infrastructure and mercantile links were all key factors in giving diseases spread by cross-infection between humans the ability to spread far more widely than those seen in previous centuries.
The first of several deadly outbreaks of cholera that ravaged Brittany in the 19th century was part of a worldwide pandemic that was believed to have started in India in 1826. The seemingly relentless march of this disease westwards saw the French government impose border controls in August 1831 to stop infected people from entering the country. However, the disease reached Paris in March 1832 and the speed which the disease overtook its victims, some dying within a matter of hours, caused widespread panic; some people believed that government agents were deliberately poisoning the drinking fountains.
It seems that the disease first manifested itself in Brittany in May 1832, carried by a master mariner from Toulon who disembarked at Nantes before falling ill near the city of Vannes. Victims of cholera can start to display symptoms between one to five days after infection, so, it is impossible to know how many fellow travellers this diseased sailor infected on his two day journey to the south coast town of Quimper. Suffering from severe vomiting and diarrhoea, the patient was taken openly through the busy streets from his lodgings to the town’s hospice where he died. He was buried the next day and a little of his blood was diluted in water and given to birds to drink to see if they were affected by it. While the birds showed no negative reactions to this bloody concoction, two members of the nursing staff were already displaying symptoms; the first of more than 200 cholera fatalities in Quimper that summer.
Cholera is essentially a bacterial disease that causes an infection of the small intestine which swiftly leads to fairly brutal diarrhoea (sometimes as much as 10-20 litres or 3-5 gallons per day) and vomiting, resulting in severe dehydration and low blood pressure in the victims. Such acute dehydration shrivels the skin, sinks the eyes and usually turns the skin a shade of blue; the disease is therefore sometimes known as the Blue Death.
The disease is spread mostly by water and food that has been contaminated with human faeces containing the bacteria. At the time, people were at a loss to understand the disease as one side of a street could be hit, while the other was spared and it would be another twenty three years before the English doctor, John Snow, identified waterborne microbes as the culprit (it seems that he did know something after all!).
Some contemporary doctors believed cholera to be a contagion, others thought it was due to a miasma; one doctor in Quimper even advised the town in the grip of the epidemic that the disease was not contagious. While the medical establishment strived to understand the disease, two main but contradictory treatments were espoused; one held that cholera overstimulated the body and prescribed cold drinks, blood-letting and opium-laced enemas; the other advocated hot drinks, hot baths infused with vinegar and camphorated alcohol to stimulate the system. Amidst this confusion, charlatans profited by selling miraculous but bogus remedies to the desperate people with little enough to spare.
Unlike childhood diseases, such as measles or influenza, which were mainly only fatal to the elderly, cholera killed as many healthy young adults as any other age group; it is estimated that over 100,000 people died of cholera in France in 1832-34 – a shocking mortality rate of between 25 to 50 per cent – and well over 5000 in Brittany alone. In many towns it was noted that there were often more female than male fatalities, for example, in Morlaix, women represented 65 per cent of cholera deaths. This is likely a reflection of the fact that it was women who traditionally collected the family’s water from the communal fountain; a prospective source of contagion.
Poor hygienic conditions, lack of adequate sanitation, untended rubbish heaps and poorly sited wells were, in the opinion of many visitors, common features of most Breton cities at the time; all factors which contribute significantly to the spread of cholera. All diseases spread by cross-infection between people gain increasing powers of spread with increasing population density and thus cause the highest mortality rates in urban centres compared to the countryside.
There were further major outbreaks of cholera in France in 1848-50 and again in 1853-54; two epidemics that resulted in some 300,000 deaths across the country. In the latter epidemic, eastern Brittany was particularly badly affected early although it seems that the disease ravaged the region on two fronts; from the east and also from the northern port of Morlaix where it spread to other coastal cities.
The epidemic reached the major Atlantic port of Brest towards the end of 1854 and many people claimed to have seen the source of the disease, ‘the Red Woman’, sowing the plague in the surrounding valleys; harking back to the superstitions of previous centuries regarding the semeurs de peste (plague sowers) who spread the contagion by witchcraft. At the time, knowledge of the nature of epidemic diseases was scant and most Bretons considered the plague and diseases such as cholera as divine punishment for their sins; and responded with prayer, coupled with either penitential acts to redeem God’s favour or with stoic fatalism to accept God’s will.
The region was again badly hit during an epidemic in 1865, which saw over 2,500 deaths, and only marginally less so by the epidemics of 1873, 1885-86 and 1893. In the fifty years covering these cholera epidemics, progresses in public health and hygiene programmes, improvements to urban planning and sanitation, coupled with advances in medical understanding and technology, greatly increased our ability to organise efficient countermeasures against epidemics.
However, tackling the human cost of such diseases was more problematical, as noted in 1866 by Jean-Baptiste Fonssagrives, Professor at the School of Naval Medicine in Brest: “Among all the chronic diseases that eat away at the social body, misery is certainly one of the most hideous, the most inveterate, perhaps even the least curable”.
At the beginning of the 19th century smallpox was a major global endemic disease, responsible for the deaths of between 50,000 to 80,000 people in France each year. During 1773–74, Brittany experienced a particularly deadly smallpox epidemic which helped to highlight the importance of inoculation; then a relatively novel practice and pursued with some vigour in Brittany by an Englishman, Simeon Worlock, who had been summoned from Nantes to work in Brest after the death of 600 children in that port.
It is therefore not surprising that France was one of the first nations to fully exploit Jenner’s pioneering work on vaccination; teams of doctors spent decades crossing the country inoculating those willing to receive the vaccine, often struggling against public trepidation and downright hostility. The vaccination programme quickly succeeded in reducing cases of smallpox across France but this highly infectious disease was particularly virulent in Brittany again in 1871, resulting in about 20,000 deaths. The last outbreak in Brittany was centred on the cities of Brest and Vannes in 1955 and involved almost a hundred cases, of whom 20 patients died.
It is difficult to neatly define dysentery epidemics as the disease is of great antiquity and was an ever present feature of daily life for our ancestors. The disease is usually the result of a bacterial infection which works its way through the bloodstream to the gut, manifesting itself in abdominal pain, sickness and bloody diarrhoea (up to over one litre or a quart of fluid per hour), leading to extreme dehydration, anaemia and often the poisoning of vital organs by bacterial toxins. Like cholera, the bacteria that causes dysentery is commonly spread by dirty water or foodstuffs having been contaminated with human waste; it is contagious and can be rapidly transmitted from person to person.
The spread of dysentery was facilitated by the rather basic living conditions of the Breton countryside; people and animals typically shared overcrowded dwellings, folks shared boxed beds while the farmyard was rich in dung-heaps and cess pits. In the towns and cities, the health situation was no better; open sewers, streets cluttered with rubbish and foodstuffs’ markets held on busy public roads. All these elements played a part in the rapid transmission of the contagion especially amongst bodies that were generally undernourished. Although, at the time, it was believed that the disease, like so many others, was caused by lethal miasmas and the main medical treatments, for those that could afford them, were purges, emetics and blood-letting. Those that could not afford the medical professionals trusted to the recuperative power of a few bunches of elderberry.
It is no exaggeration to say that epidemic dysentery was one of the worst blights to affect Europe and the wider world throughout the 18th and 19th centuries. There were major outbreaks in Brittany in 1639, 1676 and 1719. The disease was widespread in Brittany between 1738 and 1740, the epidemic of the latter year was especially fatal amongst children but there was an even deadlier outbreak in 1741 which claimed well over 30,000 lives; in some Breton towns, the mortality rate was over 45 per cent. There were smaller outbreaks in 1749, 1765 and 1777 but in 1779 Brittany and other parts of western France were ravaged by an outbreak that took some 175,000 lives with over 50,000 dead in Brittany alone.
The disease continued to take its heavy toll throughout the 19th century, with the last notable outbreak recorded here in 1900. Scientists have identified more than 330 strains of the bacteria that cause dysentery but it is worth noting that 99 per cent of strains have now developed a resistance to antibiotics and while dysentery may sound to many of us a disease of the past, it remains a major killer in some parts of the world today.
Typhus and typhoid fevers were other diseases that ravished the Brittany of yesteryear. The former is a louse-borne disease that thrives on a host’s poor personal hygiene and can survive on its host for some time. A particularly pernicious outbreak of both diseases spread across Brittany in the years 1741-42 and caused an estimated 40,000 deaths; other major epidemics occurred in 1757 and 1779. In 1793-94 an epidemic of typhus in Nantes is estimated to have resulted in the death of 10,000 people.
Many have described typhoid fever as endemic in Brittany by the mid-19th century but focused improvements in public health and basic hygiene, particularly relating to the supply of clean, uncontaminated water and the evacuation of wastewater meant the death tolls from the epidemics of 1874 and 1892-93 were less severe than those seen in earlier years. The western part of Brittany was particularly badly affected due to the disease spreading on account of the fairly itinerant habits of agricultural labourers and mariners and the migrations of people from the countryside to the towns. As an example of how significant such urban movements were, between 1856 and 1911 the population of the arrondissement (administrative region) of Quimper swelled from almost 81,000 to over 204,000.
Outbreaks of influenza have always left heavy death tolls, particularly amongst the elderly and poorer sections of society but the virulent virus behind the influenza pandemic of 1918-20 caused the most severe pandemic in recent history. This contagious viral infection attacked the respiratory system and was inexplicably most deadly for young adults; it has been suggested that this might be because older people had built-up a degree of immunity as a result of the earlier flu pandemic of 1889-90. Pneumonia or other respiratory complications brought-on by influenza were often the main causes of death. Estimates vary as to the number of deaths caused by the disease but it is believed to have infected a third of the world’s population and killed at least 50 million people; over 240,000 in France alone.
Despite significant advances in medical treatment and care, influenza remains a significant public health issue today with annual seasonal outbreaks affecting between 2-8 million people in France every year, with influenza-related deaths estimated at 10,000 to 15,000 per year.
It is important to view the epidemics and pandemics noted above within the context of their time; these diseases took root and spread thanks to the circumstances then existing. Generally poor living conditions and hygiene; undernourished bodies less able to fight infection; low degrees of medical knowledge surrounding the nature of bacteria and the transmission of diseases – all conspired to make it an insurmountable task to moderate the impact of a virulent epidemic disease, despite the best efforts of the medical establishment of the time.
Improvements in living standards, town planning, public health, hygiene and sanitation, coupled with massive advances in medical knowledge and technology have helped to greatly reduce the worst ravages of epidemic mortality that were once an accepted part of our ancestors’ lives. Even as late as 1950, the majority of deaths in Europe were due to infectious diseases. Since then, life expectancy has soared and diseases such as polio, diphtheria, tuberculosis, tetanus, whooping cough, smallpox, measles, mumps and rubella have been virtually wiped out. Yet, despite the massive leaps in medicine, infectious diseases have been controlled rather than conquered; they remain a threat that can never be truly extinguished.
It is still too early to see where the current coronavirus disease pandemic will sit amongst the long history of pandemics; to date, over 160,000 people have died as a result of the disease in France alone and we are, unfortunately, in the midst of yet another rise in infection rates. The disease will eventually be brought under control but its social and economic legacy will likely be as profound as many of the other blights once endured by our ancestors.