Pandemics

Welcome back!

After a bit of an interlude, the blog is back, ready to delve into the murky and fascinating world of epidemics, told through the words of poets and writers. Just when you think that the world of microbes has caused enough destruction to leave little to the imagination, here comes a particularly dark little story of a fictional disease, as told by the master of horror, Edgar Allan Poe…

Edgar_Allan_Poe_portrait_B

Oscar Halling’s portrait of Edgar Allan Poe, late 1860s. Image in public domain at Wikimedia Commons [link]

‘The Masque of the Red Death’ narrates the grisly events that occur during the fictional reign of Prince Prospero. The story plunges us straight into a vivid description of the Red Death, a longstanding epidemic with high fatality rates and a gruesome effect on its victims, causing profuse bleeding, pain, seizures – and a mercifully rapid death.

“Blood was its Avatar and its seal”. The death toll is staggering: half the population have already succumbed by the beginning of Poe’s story.

Prince Prospero, who appears indifferent to the plight of his subjects, decides to “bid defiance to the contagion”, and with ample provisions, shuts himself and a thousand friends away in one of his sumptuous abbeys, to dance and merry-make in security from the Red Death. This seclusion continues successfully for the next six months, whilst those without fare poorly.

The Masquerade

A motley collection of masked guests, as illustrated by Arthur Rackham in “Poe’s Tales of Mystery and Imagination (1935). Image in public domain at Wikimedia Commons [link]

A masquerade! Prince Prospero certainly knows how to entertain, and throws an extravagant masked ball for his guests. The rooms are decorated vividly, as we enter a realm of metaphors. With some bizarre interior design, Prospero makes his tapestries and Gothic windows colour-coordinate; six rooms in blue, purple, green, orange, white and violet; a seventh of deep scarlet windows and black velvet walls, illuminated with fire. Ominous and wild, the revellers shy away from entering this last room: but each hour, stand transfixed in horror by the disconcerting toll of a pendulum clock from deep within the seventh chamber.

At the twelfth hour, as the clock chimes heavily and the waltzing falters, a masked figure fades into notice; a masked figure of unparalleled distaste, costumed as the Red Death itself. Tall, gaunt, corpse-like, phantasmagorical, daubed with blood, “besprinkled with the scarlet horror”: a vision of nightmare indeed!

The Red Death

“The dagger dropped gleaming upon the sable carpet” by Harry Clarke (1919). Image in public domain at Wikimedia Commons [link]

The encounter, suffice to say, with all its foreboding, ends badly, and rapidly, for Prince Prospero and his courtiers, who believed themselves safe against the Red Death. “One by one dropped the revellers in the blood-bedewed halls of their revel, and died each in the despairing posture of his fall… And Darkness and Decay and the Red Death held illimitable dominion over all.”

Well! Edgar Allen Poe isn’t renowned for his happy endings, so this gruesome end is probably to be expected. Just as well this is only a fictional disease….or is it?

In the wake of the recent devastating Ebola pandemics of Sierra Leone, Liberia and Guinea-Bissau, the parallels of the Red Death with one of the known haemorrhagic fevers can’t help but spring to mind. These haemorrhagic fevers include Ebola and Marburg fever, and have similar symptoms of fever, muscle pain, headache, nausea, then diarrhoea, vomiting and in some cases significant bleeding (WHO 2014).

As I suspected, I’m not the first to notice this: in fact, a published article in the journal ‘Emerging Infectious Diseases’ by Vora & Ramanan in 2002 explored this very question! The article is well worth a read and is available here. The authors postulate the mode of transmission of the Red Death (person-to-person, and possible aerosol inhalation) and the potential for either a very long incubation period for the Red Death microbe, or a new exposure to the abbey by an unspecified route.

So could Poe have modelled the Red Death after a known disease, or did he imagine up all of the gruesome features of the whole epidemic? Well, Poe probably have reasonable knowledge of yellow fever, a different type of haemorrhagic fever, – but one which causes liver failure and jaundice, neither of which are evident with the Red Death. Poe was also well aware of tuberculosis, which can manifest with coughing up blood from the lungs: both his mother and wife died of the disease. Since Ebola, Marbug virus and another counterpart, Crimean-Congo haemorrhagic virus, all emerged in the 1900s, after Poe’s death, the parallel with the Red Death must be purely coincidental.

Whatever Poe’s experience of contemporary diseases, however, his description of the Red Death is vivid, realistic, and perhaps a warning of how complacency and seclusion in the interests of self-preservation are no match for a virulent pestilence with no respect for social contexts and hierarchy! Perhaps then, we should interpret Poe’s tale as a graphic and timely warning – public health initiatives, take note!

References:

Vora, S.K. & Ramanan, S.V. (2002) Ebola-Poe: A Modern-Day Parallel of the Red Death? CDC Emerging Infectious Diseases 8(12):December 2002

World Health Organisation (2014) Ebola Virus Disease: background and summary. Published 3 April 2014, available at: http://www.who.int/csr/don/2014_04_ebola/en/

First official Infectious Reads blog post! I thought I’d start by introducing you to a beautifully constructed little novel by William Maxwell. ‘They Came Like Swallows‘, first published in the 1930s, has autobiographical undertones from Maxwell’s own childhood, growing up in the American Midwest at the close of the First World War in 1918.

The First World War has barely ended when a new trouble spreads innocuously into the lives of the Morison family. We experience the Spanish influenza pandemic through the eyes of eight-year old Bunny, described as angel-like, a delicate, bullied child; thirteen-year old Robert with his toy soldiers; and their seemingly stern father James, whose worlds revolve around the mother of the family, the newly pregnant Elizabeth. At first a distant threat, noted with polite interest, ‘flu cases start to break out closer and closer to home: Chicago, St Louis, then Bunny’s school. Suddenly, the Morisons are presented with the stark reality of how fragile they are, as they each catch the highly infectious disease, and face the unthinkable, that the Spanish influenza may tear their family unit apart forever.

IMG-20170618-WA0003[1]

A time of horrors, this subtly written book presents the personal sufferings of people gripped by one of the most lethal pandemics in history. Maxwell’s own first-hand experience of losing his mother to the pandemic is explored quietly with themes of love, loss and grief interwoven with historical context.

Without spoiling the events of this delicate story – I’ll leave you to discover it yourselves – it is fascinating to see how Maxwell describes the illness; its symptoms, spread and in particular the public health response to its spread. No 24 hour news channels, trending Facebook feeds, Twitter storms to warn the world of the arrival of the Spanish ‘Flu! No: James Morison reads out a newspaper public service announcement to the family over dinner.

“‘Spanish influenza’ resembles a very contagious kind of ‘cold’ accompanied by fever, pains in the head, eyes, back, or other parts of the body, and a feeling of severe sickness. The Morisons hear that most cases recover rapidly within 3-4 days, but that some develop ‘pneumonia, or inflammation of the ear, or meningitis, and many of these complicated cases die’.

Maxwell’s descriptions are on point, including the specific complications which caused such a high death toll from a usually nasty, but rarely so deadly, virus. So, too, do the descriptions of Bunny being “adrift utterly in his own sickness” with his “eyes glittering with fever” conjure up the image of a child in the grip of the ‘flu: I can picture him, shivering and wrapped up in blankets as his mother Elizabeth and aunt Irene try to comfort him.

Why so deadly? The Spanish influenza was caused by the influenza A virus, in fact by the same strain that caused the swine flu pandemic in 2009: H1N1. Sure, the ‘flu still causes a number of deaths each year, particularly in older, or health-compromised people. But why so much deadlier than our usual ‘flu season’? Well, the ‘flu virus changes over time, and each year different strains emerge as the dominant strains. This is the reason why ‘flu vaccines are given annually, to cover the most problematic strains of that particular year.

In 1918, before ‘flu vaccines, before antibiotics to cover bacterial complications of influenza infections, and at a time when the health systems of the world were weakened by the demands of war, the influenza strain that emerged was much deadlier than usual. In total, an estimated 20-40 million people died, MORE than during the War itself. Strangely, a lot more young people succumbed to this strain of ‘flu than usual – we’re talking teenagers, young adults to mid-thirties. It’s thought that the Spanish ‘Flu triggered the immune system in a way that made it over-react, with deadly consequences from the excess effects to those with stronger immune systems. Another high-risk group were pregnant women: even if the mother survived, there were high numbers of babies who succumbed in the womb.

Where did it come from? The virus strain probably originated from China, and spread along trade routes; although according to Bunny’s Uncle Wilfred, the Spanish ‘Flu was brought in on German submarines. Whilst it was not actually used as a bioweapon, the ships coming to and from Europe and the US undoubtedly contributed to the spread of the virus, in addition to the celebrating crowds around Armistice Day. A perfect virus breeding ground…

‘They Came Like Swallows’ is sadly an accurate representation of the scale of devastation caused by the Spanish ‘Flu pandemic, made more real in the knowledge that it probably reflects true aspects of Maxwell’s own childhood. As ‘Flu Season’ gets underway here in Australia – the time of year when infectious diseases cause coughs and sneezes – I will be thinking of Bunny and Robert, thankful of some of the defences we have against similar pandemics, and mindful of how vulnerable we still are to this little virus.

Got a comment or question? Have you read ‘They Came Like Swallows’? Get in touch here!

← Back

Infectious Reads

Microbes, medicine and manuscripts

The Microbe behind the Mask

Story of a Pandemic

Thank you for your response. ✨