Before I delve into malaria, cholera and smallpox, let me tell you the news about The Solitary Sparrow, my historical fiction novel. My agent is submitting the book to publishers! Hopefully one of them will pick it up for publication. So keep your fingers crossed. Meanwhile I’ve been forging ahead on the sequel, A Pelican in the Wilderness -- 60,000 words so far. (As a reminder, in both novels the main character is named Meg.)
In the last few weeks I’ve been thinking about diseases which have become scarce in the 21st century in the Western world. While doing research I came across a description of tetanus in a 14th century medical manuscript written by John of Arderne. He was educated at the University of Montpellier in France where Meg lives and practices. Writing in Middle English, Arderne describes the case of a gardener who accidentally buried a gardening hook into the fleshy area near his thumb: “. . . and by the morne the pacient was so taken with the crampe in the chekes [cheeks] and in the arme that he myght resseyve no mete in-to his mowth ne neyther opene the mowyth (lockjaw) and . . . in the xx (20th) day he dyde".
So I wondered, what if Meg—who wants to be a physician and is a little bit cocky about her skills—had a patient who was injured in a similar manner and who died an agonizing death despite every medication and every promise she made that he would recover? I'll give you a hint: she learns a good lesson in humility. Ironically, just as I finished writing the chapter I heard about a child in Oregon who was hospitalized with tetanus and who almost died. It was Oregon’s first tetanus case in over 30 years, according to a news report by CBS Portland affiliate KOIN. I was absolutely gobsmacked. Tetanus in this century? A kid?
The U.S. Centers for Disease Control and Prevention (CDC), reported that the boy, age 6, cut himself on the forehead while playing on a farm. His family stitched up the wound themselves. Six days later, he began clenching his jaw, arching his neck and back, and had uncontrollable muscle spasms. When the boy arrived at the emergency department, his muscle spasms were so severe he couldn’t talk, and was struggling to breathe. He asked for water but couldn’t open his mouth. His fever spiked to almost 105 degrees (40.5 Celsius). Forty-four days after he was hospitalized, the boy was able to sip clear liquids. After a month in the hospital and another month at home, the boy recovered. The boy had never received the childhood vaccinations for tetanus nor any other vaccinations. He received an emergency dose of the tetanus vaccine in the hospital, but his parents refused the booster and all other vaccinations after he recovered, according to KOIN and CBS.
The CDC recommends a five-dose series of tetanus shots for children between the ages of 2 months and 6 years and a booster shot every 10 years for adults. Widespread immunization for tetanus began in the U.S. in the 1940s. Since then, deaths from tetanus in the U.S. have dropped 99 percent.
Tetanus is a disease caused by the bacteria C. tetani, which is found in bacterial spores in the environment. Within three to 21 days after infection, toxin from the bacteria causes ceaseless muscle contractions throughout the body. Muscles in the jaw stiffen and the mouth clamps shut, hence the common name lockjaw. Face muscles pull the mouth into an unnerving teeth-baring grin, reflecting a more ancient name—The Grinning Death. Eventually respiratory muscles spasm and breathing is obstructed, causing death.
One of the most ghastly effects of tetanus is opisthotonus, an agonizing posture that occurs when stronger muscles cause the body to arch backwards and lock, with arms flexed and fists clenched. Sometimes the contractions of the back are so strong the spine is broken. The 19th century surgeon and artist Sir Charles Bell captured the agony of a soldier caught in the gruesome spasms of tetanus in 1808. I’ve included the painting at the bottom of this post, but be forewarned—it’s pretty grisly.
Tetanus is the reason that I ALWAYS made sure I was up to date on my tetanus booster shot before doing archaeology at Hungate in York, UK. Thoughts of bacteria made me a little squirrelly when I was digging in a 1000 year old cesspit.
So, back to the question at the top of my post: malaria, cholera, or smallpox?
As the Goddess of my story, I have deemed it necessary to hit the town of Montpellier with a scourge. While I want to smite the city because I think it will be fun to write, I have a more serious reason. Along the same lines as the tetanus chapter, I hope readers will understand and appreciate the world we live in today – the world after antibiotics and vaccines—and make a connection with the book’s characters who aren’t so lucky.
After days of research, I decided the scourge would be malaria and wrote the chapter accordingly. But now, I just don’t know . . . I don’t mean to be flippant, but I’m worried that modern readers will think malaria is too mild. A trip down the rabbit holes of the internet will prove that the disease is still extremely serious. Even so, I’ve been casting about for another possibility.
Perhaps I can smite the unsuspecting townsfolk with cholera. The disease has been around for centuries, according to the World Health Organization (WHO), although the worst pandemics occurred in the 19th century. Severe symptoms of cholera include serious diarrhea, vomiting, and leg cramps. Today, cholera is treated through fluid replacement and antibiotics. Cholera vaccines are available, although they only offer about 65% immunity, according to WHO.
Well, okay then. As the Goddess of my story, I declare a cholera epidemic. No, wait, I wrote about similar symptoms occurring at a monastery in an earlier chapter. I don’t want to repeat that. It was gross enough to write it once.
So, what about smallpox? All those horrible pox marks, and scabs and scars? Certainly a possibility. Actually, I shouldn’t joke; smallpox is not very funny.
Smallpox is caused by the variola virus. No one knows where or when smallpox first developed, but according to the CDC, it was a devastating disease that followed trade routes and the Crusades. It killed 3 out of every 10 victims. Those who survived were usually left with severe scars. A famous smallpox victim was Queen Elizabeth I who was struck by the disease in 1562. She developed a violent fever and it was feared she would die but she recovered and was not too badly scarred. Her friend Lady Mary Sidney did not fare as well. After nursing the queen, Lady Sidney herself caught smallpox and was horribly disfigured.* Her husband’s description of her is pretty brutal: ". . . I left her a full fair lady, in mine eye at least the fairest; and when I returned I found her as foul a lady as the smallpox could make her.” **
After a smallpox vaccine was developed fewer cases occurred worldwide. Routine smallpox vaccination among the American public stopped in 1972 after the disease was eradicated in the United States, according to the CDC. And on May 8, 1980, the 33rd World Health Assembly officially declared the world free of this disease. Eradication of smallpox is considered the biggest achievement in international public health.
So, smallpox seems to be a good contender. Meg herself hasn’t had smallpox. Her mentor Rebekah the Jewess had smallpox as a child. Has Gerard, Meg’s love interest, had it? Hmmm. I see possibilities here.
Well, if not smallpox, why not the Godfather of all diseases, you might ask? What about Plague? Well, Bubonic Plague is not a contender because the chapter I'm working on is set in 1326. Plague struck from 1348-1349. Besides, I’ve saved Plague until the end of the book. A fitting climax I think, with a tinge of apocalyptic doom.
So which will it be? Malaria, cholera, or smallpox? This weekend I’ll be mulling it over.
I will also be thinking constantly of a little boy in Oregon who suffered needlessly and who is incredibly lucky to be alive.
In the next post, I’ll talk about research and rabbit holes.
Have a good weekend, ya’ll. If you‘re a reader, thank you. If you are a writer, sit your derriere in the chair. Until next time . . .
* The Tudor Society, https://www.tudorsociety.com/10-october-1562-elizabeth-i-catches-smallpox/
** A Memoir of Sir Philip Sidney, by Henry Richard Fox Bourne, 1862.