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January 2009 Meeting Report

The Fen Plagues – by Dr Tim Wreghitt OBE

It was a pleasure to welcome Tim to the first Society meeting of 2009. He had co–presented a talk on the history of the Sawston and Selsingen Twinning Association back in the days we met at the Orchard House Community Room.

He started by giving a brief description of the Fens, which was the largest swampland in England with an area of approximately 2,500 square miles. It was formed by the silting up of a large bay in the North Sea at the end of the Ice Age some 10, 000 years ago.

The major plague to hit the Fens was, of course, the Black Death in 1348-9. This started in East Asia and spread inexorably westward. It was at its height in 1349 in England killing around 30% of the population, but sometimes more in a particular town or village. A documented Fen victim was John of Wisbech, who decorated Ely Cathedral Lady Chapel. As a result of the mortality much of the Fenland was abandoned. Indeed, the population of many towns and villages did not recover for several hundreds of years. This also lead to the decline of Spinney Abbey near Wicken, which was absorbed into the priory of Ely in 1449. Worldwide it is believed there were 75 million deaths - truly a pandemic.

One of the other major recorded Fen plagues was the cholera outbreak to hit Ely in 1831. In a population of 5,000 at that time there were 148 recorded cases with 59 deaths, a 40% mortality rate, although this is probably an underestimate as not all cases were properly recorded. The symptoms were diarrhoea, apoplexy, nausea and “imperfect” vomiting (which begs the question, what on earth is perfect vomiting?). From first getting the symptoms many of the sufferers were dead within one day. Local Health Boards were set up to separate the sick from the healthy and to provide ‘proper houses’. Suspected cases had to be reported immediately. A somewhat macabre consequence was the incidence of body snatching, presumably to supply the Cambridge Medical School with corpses, so it was necessary to employ cemetery night-watchmen. It was also noted that there was no help from the Central Government, although this being 1832 with outbreaks of civil unrest cropping up all over the place, perhaps not too surprising.

The most significant ‘Fenny’ disease was ‘the Ague’, which is an older name for malaria, also known as ‘Marsh Fever’. This had been endemic in the Fens for centuries, with numerous recorded outbreaks from around 1500, with a 7% mortality rate. The epidemics were associated with warm weather. It was widely noted that ‘the Ague’ occurred especially near low marshy districts, but the cause remained unknown until the 20th century. It was thought that the Fen fogs might be the cause hence ‘Marsh Miasma’. As these outbreaks resulted in the richer people migrating away from the Fens only the poor remained, often living in extreme poverty as recorded by Wentworth–Day of a local family, the Badcocks living in Burwell Fen, who thought nothing of having “a mess o’ water rats for supper”.

During an outbreak in 1661 Pepys noted, “The heat lasted on unbroken into the winter … hath been very sickly”, and the historian Sydenham wrote of ”intermittent fevers doing harmful mischief”.

An unexpected social consequence (but it would seem, not just social) was the bride-hunting of Fen men to neighbouring counties, such as Nottingham to seek new brides to replace the ones who had succumbed to the Ague. In the Fens Malaria had died out by 1900 as a result of the Fen drainage, which removed most of the marshes and improved housing. So presumably then the pretty Nottinghamshire lasses didn’t need to be locked up at night!

It is now known that ‘the Ague’, Italian ‘bad air’ or malaria, as it is now called, is caused by a parasite that infects the red blood cells and is transmitted to people by the female mosquito. The mozzy undergoes a complex transformation throughout the 4 stages of the life cycle from egg- larva- pupa- adult. The female adult then lays her infected eggs after her bloody meal on the reluctant human host.

There were remedies to alleviate the ague symptoms, such as opium from white poppies which led to an opium trade based in the Fen towns of Ely and Wisbech. Sometimes local pubs sold opium laced beer. White opium poppies were grown in many local cottage gardens.

The only real treatment for malaria was with quinine based drugs. Quinine occurs naturally in the bark of the chinchona tree, indigenous to the eastern Amazon region. It derived its name from the Countess of Chinchon, the wife of a Peruvian envoy and who was cured of malaria with an extract from the chinchona bark in 1638. Now synthetic quinine, as quinine sulphate is widely used. Could this be the origin of tonic water, traditionally drunk in the tropics with a drop (or two) of gin, as this contains a generous amount of quinine sulphate?

In the UK, there are about 2,000 cases of malaria per year with an approx 1% mortality rate. However world-wide there are 500 million cases, with, assuming a similar mortality rate as in the UK, 5 million deaths. The symptoms of malaria occur only about 10-15 days after infection and are fever, shivering, headaches, nausea, vomiting, and perhaps death. The diagnosis is difficult because the symptoms can be quite varied and the travel history is vital. Somewhat alarmingly, with the onset of global warming there is increasing evidence that the mosquito bearing parasite is migrating further northwards. There have already been reported outbreaks in Italy. It is assumed however, that the availability of modern healthcare and medicines will severely limit the spread of this unpleasant disease.

Another disease historically associated with the fens is rheumatoid arthritis, which was a severe problem with manual labourers working in damp atmospheric conditions. Tim also mentioned the somewhat unpleasant disease, syphilis, as an unusual outbreak was recorded in early 2000 in Cambridgeshire. This only involved middle aged heterosexual people. This requires prompt diagnosis and treatment but at least no longer, for men, entailing the use of mercury being injected very uncomfortably into certain parts of the male anatomy.

Tim ended his fascinating talk by telling us about his very successful involvement in the 2008 Chelsea Flower with the Royal College of Pathologists (of which Tim is now Vice–President). The theme of his stand, which won a gold medal, was “Malaria and Global Warming”. On display were a variety of plants to help prevent malaria by repelling mosquitoes. These included Artemisia arbrotanum, Ocimum americanum and Cymbopogon citratus or lemon grass. For alleviating the symptons there were: Dichroa febrifuga; Aristolochia elegans,;Cosmos suphureus and Musa paradisiacal. Apart from quinine the other main plant with anti malarial properties is Artemisia annua or Chinese wormwood. The anti-malarial properties of this were first discovered by the Chinese in 340BC and it is now produced in a semi-synthetic version, artemether, as Riamet, in tablet form. Surprisingly Musa paradisiacal, or bananas, also have anti malarial properties.

While at the Chelsea show, Tim met several celebs including Princess Anne, Chris Tarrant, and Alan Titchmarsh - the latter was very apologetic that some of his fans had rampaged over much of the planted area of the RCPath stand. No doubt, had these been youngsters wearing hoods it would have been headline news!!

Tim very kindly donated to the Society some samples of quinine bark, a well as a copy of That Alarming Malady, by Reg Holmes, which describes the Ely cholera outbreak. Another useful source of information for this very thoroughly researched talk was Fenland Ague in the 19th century by Alice Nichols taken from Medical History, 2000, 44,515-530.

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