The theme for these past few months has been cultural medicine and medical geography.

The history of the Russian impact on medical geography, in particular zoonotic and combined zoonotic-anthroponotic diseases is a topic that really doesn’t get much attention from contemporary animal epidemiologists.  I believe I reached a good stopping point for this topic for a while.

A very unique historical medical geography topic that came to my attention was an epidemic that took place on Nantucket Island in 1763.  For more than two centuries the cause for this epidemic has returned to the journals.  In a recent write up on this piece of New England medical history it was speculated that this disease could be fungal in origin, a proposal that fit in very well with the sequent occupancy way of modeling past diseases. But most people felt it was yellow fever, which due to the times of the year it happened I suspected had to be wrong, so I had to apply my predictive, or in this case retrospective modeling technique to this disease.

About the same time, another epidemic erupted in the James River area in Virginia.  It was of a skin disease known as ringworm and had infected people residing considerably inland along the river.  I first came upon mention of this disease in 1982 after purchasing a copy of Benjamin Smith Barton’s 1798 to 1804 treatise of the first herbal medicines documented in United States history.  A single line in passing mentioned the possible use of Eupatorium perfoliatum, commonly known as ague weed or boneset to treat the James River Ringworm epidemic.  

The one thing peculiar about this epidemic was where it took place and the fact that it was so isolated from much of the rest of the country, which is how it earned its name.  That geographic feature of this disease is what made me decide to explore its history in detail to determine exactly what its cause could be and why it took place in such a remote place.

After a fairly thorough review of the populations of this part of the country and in particular of African and African-American (including Caribbean and Sudanese) slave culture,  I found ample amounts of medical geography evidence, in particular that of my sequent occupancy method of reviewing diseases, indicating it was a primarily a case of tinea cruris (today we term this ‘jock itch’), which apparently was very severe back then.  The following are some of the details of this discovery, which is covered and illustrated in more detail in the African and Caribbean Slaves section of my historical public health studies posted at this site.

 
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In medical history, James River is best known for its famous epidemic that struck the settlers when they ran out of food supplies.  Desperate for nutrition sources, many of the settlers ate a local plant, Datura stramonium, which made them very ill and gave a number of them hallucinations. For some it even resulted in death.  

From this point on, this plant had a common name–Jamestown Weed–a name later modified or adulterated into its common name Jimsonweed.

James River however has another important historical tale that to date doesn’t appear in too many books or historical writings about Virginia’s history.  Around 1766, there was this disease that ran rampant through certain parts of the state, in particular in communities situated well upstream along James River, quite a distance from most of civilization.  The lands located in mid-western Virginia, just east of the mountain ranges, were considered primary growing fields for the most important crop at this time–tobacco.  This disease had a very unique spatial distribution for the time and so was given the name “James River Ring Worm”, most likely by Thomas Jefferson [page link].

The majority of people residing in this part of the colony were local residents engaged in the traditional American pioneer lifestyle, some were merchants and farmers, and still others farmers with a large goal in mind, developing your own plantation.  But to run a farm like it was some sort of factory we need the right sorts of help, and that is where the history of slavery comes into this piece of Virginia’s history.  By the 1760s, several fairly large plantations were established, with some families owning large amounts of crop land on which to grown their tobacco.  The Jeffersons was one such family engaged in such an enterprise, with Peter Jefferson, the father of the famous president-to-be Thomas Jefferson, in possession of a large amount of this perfect tobacco growing country.  He died in 1764 leaving his plantations to Thomas, by which time the Jeffersons were legal owners of one of the largest number of slaves in this state.

Remember, this is a story of slaves, health and disease, not one about the many other stories that have surfaced about the Jeffersonian part of slavery history we often hear about, such as the fact that Thomas fathered a child with one of these slaves or that a number of slave families have now linked themselves to this famous piece of American history.  According to a story told by Thomas, probably to Philadelphia botanist Benjamin Smith Barton (but also likely to have been shared with the French writer and explorer of the United States, Louis Valentin), there were a number people living in the backwoods part of Virginia suffering from an unusual skin disease as early as 1766.

To some onlookers this disease probably reminded them of the common disease associated with people around the world–ringworm–an important disease to understand when you are a slave buyer.  But this ringworm was peculiar because it aggregated about the waist and stomach area on down to the thighs.  It was a fairly consistent reddish color, as if a dye were applied to the surface of the skin, and most importantly, it affected mostly males.

The philosophy for the time was that disease could be due to miasm wandering about in the air, some form of infectious material that once it entered the body began to create havoc with our physiology and make way for other problems to develop such as fevers, asthma, rheumatism, dropsy, or consumption (tuberculosis).  Also according to the philosophy for the time, since different regions had different climates, weather patterns, topography, etc., these different regions also manifested diseases in different ways.  Such was the philosophy for those who believed in medical geography during this time and is how and why James River Ringworm earned its name.

A possible migration route  trichophyton rubrum or mentagrophytes into the United States as the cause for tinea cruris or James River Ringworm.  A hierarchical diffusion route is presented on this map (non-hierarchical is more likely the case and is illustrated on the main page for this topic).  Yellow lines are borders of population density regions, grey lines with arrows represent the diffusion-migration route to the continent’s interior.  Red polygons define clusters regions for the various plantations. The numbers represent the case clusters identified, the method for which is also detailed on the main page for this disease. (#1 is Thomas Jefferson’s estate, Monticello.).

Unfortunately, Thomas Jefferson never provides us with the exact details as to where this epidemic existed or even whether or not it infected only or mostly his slaves.  What we do know is that he is apparently the first one to ever document this epidemic and its unique location(s), suggesting that more than likely its existence and his knowledge about its presence had much to do with the family’s plantations.  With this in mind, I developed a way to analyze and map this disease using a series of spatial epidemiological techniques I have been applying to other diseases of the past.  I first utilized this method to show how Asiatic cholera that struck the Great Plains along the Oregon trail was different from the western cholera or dysentery that struck the western half of this route in Oregon in 1852.  I have since used it to review other diseases of the past, adding another step to each of these analyses engaged in over the past two years.

Figure from my Thesis (Cholera on the Oregon Trail)  

With this analyses, I was able to conclude that the ringworm infection that impacted more than likely the slaves was tinea cruris.  This tinea was much worse back then due to the period it had to develop and the lack of any effective way of treating or knowledge of how to prevent it during the late 18th century.  In addition, this tinea in a modern sense has potentially four fungal causes capable of infecting humans in this fashion, two of which I removed from the list for geographic reasons.  This leaves us to only consider two potential causes for the James River Ringworm epidemic of 1766 to approximately 1806–the first is the most common form of fungus responsible for this disease Trichophyton rubrum, the second a species linked mostly to domestic animals like dogs, cats and horses, Trichophyton mentagrophytes.

My personal bet is on the former, although Jefferson like most others from this time did favor horseback riding, and due to their value, may have had horses present on each and every one of his plantations.

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Left:  Tinea imbricata, common to Africa, perhaps not common or persistent in North America if brought in by slaves.  Center and Right:  The most common bacterium responsible for tinea cruris, Trichophyton rubrum is growing in the petri dish to the right. (By the way, doesn’t the ringworm mark resemble someone like a young George Washington or John Singleton Copley?)

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The mapping of this disease is what enabled me to determine where it most likely took place amongst Jefferson’s and Jefferson’s friends’ plantations throughout middle Virginia, along the James River and its southern Fork.

James River Ringworm is one very basic example of the African Slavery history and how it relates to public health history during the late 1700s and early 1800s.   Other cultural medical geography topics I have started to add pages on pertain to African/African-American demographic medical and disease history, foreign born disease pattens and their behaviors in this country, the classic field of study for historical epidemiologists–Native American medical history, and travel and migration related disease patterns such as the flow of disease along the Pacific Rim routes.

Felkin’s map of Pandemic Isoclines (the lines) and wind patterns over the United States

The following historically important disease maps have been posted.

Both Aitken’s and Felkin’s work have another page providing additional information about their personal histories and/or books.  Charles Denison’s work is historically important to American medical history.  He was the first physician to develop an entire medical facility devoted mostly to tuberculosis treatment based upon the documented impacts of the high elevation,  mountain air environment setting upon the cause for this disease, which at the time was yet to be discovered.  (Denison has a second set of maps on the healthiness of the mountain environment for treating phthisis (tuberculosis), to be reviewed next time around.)

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A section of Denison’s map

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A section of William Aitken’s map

Since African/African-American health is the focus for many of the projects I engaged in during recent months, I am putting together my history of medicine resources pertaining to slavery and health, including coverage on culturally-bound syndromes [part1, part2], culturally-linked diseases and syndromes, and culturally-related disease states and medical conditions [link to the main African Diseases page].  Examples of culturally-bound syndromes include Clay Pica (see Malacia Africanorum page below) and certain psychological syndrome related to the practice of voodoo (to be referred to as “Opi” or “Opa” here, its 18th century name).  Culturally-linked African diseases include such conditions as African Cardiomyopathy and Sickle Cell.  Culturally-related but not culturally-caused medical conditions include the more basic problems we often hear about, such as the late diagnosis of breast cancer in older African women or the impact of diabetes on the African elder’s quality of life, and a number of microorganism related diseases such as yaws, bejel, nomi, and kuru.

There are a number of controversial topics I have reviewed so far regarding African culture (West African, Sudan-African, and Caribbean by the way), but none not as controversial as those related to slavery.  The following African-, Carribean- and African-American related health or medical practices or conditions are detailed in my section on this subject, and represent some of the first articles ever published by United States medical journals on these topics (more to come):

The most controversial of the above articles is on infibulation. a Sudanese-African (and typically Muslim-Middle East) tradition indicative of slave in-migration from places other than the Gold Coast of the African continent (for more, see http://www.accmuk.com or http://www.quora.com/What-is-infibulation).  This is possibly the first medical journal article published in the U.S. on this topic.  The article on Malacia Africanorum (‘calm of Africans’) is documentation of clay pica, a behavior still documented in contemporary medical journals and practiced a lot in the Caribbean.  The review of Jestis Weed is an example of that old controversy in ethnobotany and plant medicines–who owns the rights or claims to the rights involving the intellectual property attached to cultural medicines? the one who practices it, or the one to first publish this method of treatment? The owner of the slave who gave his “master” this knowledge no doubt favored the former, but of course fell victim to the latter.  The last article is an example of a unique occupational disease related to African and African-American “servants” living in the New York-New England region, manumission or not.

I have also started posting the theories of different doctors about the first disease to be mapped repeatedly in U.S. medical history–yellow fever.  These are usually kept close to each other on this blog.  For examples see:

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Sequent Occupancy in Nantucket, ca. 1600 – 1850

Aside from topics related to African medical history, there was one malingering epidemic I had to work through these past several months involving a Native American group residing just south of Massachusetts on Nantucket Island.  In 1763, there was an unusual epidemic that took place in this setting which many have considered to be yellow fever.  For the most part this is right.  But there was that malingering problem with the late November re-eruption of this disease that gave it its name “Extraordinary Disease” by its reporter Reverend Thomas Oliver.  Mosquitoes are required for yellow fever and the likelihood of a mosquito still thriving at that latitude in mid to late November, in high enough quantities to cause so many deaths, is, for lack of a better word, extraordinary.  My hypothesis is that these deaths had to be due to something that was a fever epidemic, but not yellow fever, but one more likely to happen in late fall and early winter.   For this reason, I again applied my various spatio-temporal modeling techniques to this disease and determined the November and December cases were probably due to typhus, a result expected by epidemiologists trained in historical epidemiology mapping and research and familiar with this period in medical history.

The points here are several.  First, the ability to map and analyze a disease in order to explain or predict its behaviors is an important GIS skill.  Second, these diseases and the education we get by reviewing this past is always helpful to the field of epidemiology as a whole. This way of interpreting diseases is very applicable to work in other aspects of this field such as homeland security, bioterrorism, livestock epidemiology, and those concerned about epidemic disease resurgence patterns brought on by population growth, antibiotic resistance, changes in land use patterns, and global warming.

Two of Alfred Haviland’s several maps on Cancer and Geology/Soil Chemistry, 1875 – to be covered next time around