Five Health Challenges that Were Deadly Before Antibiotics

Nola Palestrant, Tamalpais High School

    In 1928, Sir Alexander Fleming accidentally discovered humanity’s first antibiotic, Penicillin, which would come to revolutionize medicine. Antibiotics are a type of medicine that fight infections caused by bacteria. Bacteria are prokaryotes - single-celled organisms that lack a nucleus or other membrane-bound organelles. They were the first life forms to appear on earth, and have been interacting with humans since the dawn of our existence. Bacteria infect us in a variety of ways, including by penetrating our skin, riding in airborne particles that we inhale, residing in the food we eat, and transmitting through contact with vectors. Once inside our bodies, they rapidly reproduce, invading our cells to survive and grow, and sometimes releasing toxins. Though not all bacteria are harmful, those that are can infect almost every part of our bodies. Antibiotics function by killing bacteria outright or disabling their growth. Before the invention and widespread use of antibiotics, many infections were fatal, especially in vulnerable population groups. We can now cure most of them easily and are even able to prevent certain bacteria from causing harm through the use of vaccines. Antibiotics have been instrumental in allowing us to live longer and healthier lives. Here are some medical problems that were deadly in a pre-antibiotic era, but are now largely treatable with the use of antibiotics. 

1. Strep Throat

    Strep throat, also known as streptococcal pharyngitis, is an infection caused by the bacteria Group A Streptococcus (GAS). Strep throat is transmitted through air and saliva, and includes symptoms of a sore throat, fever, and swollen lymph nodes. There are more than three million cases of strep throat in the U.S. each year.

    With modern antibiotics, the duration of strep throat is around 7-10 days, and the majority of people experience no complications. The lack of complications is primarily a result of antibiotics. However, without treatments, the situation can be dire.

    Many unwanted medical conditions can result from untreated strep throat. Rheumatic fever can result from untreated strep throat, causing inflammation of the brain, heart, joints, and skin. Rheumatic fever has largely disappeared from industrialized countries due to the use of GAS-inhibiting antibiotics. Without additional medical care, it can lead to rheumatic heart disease (damaged heart valves). Strep throat can also lead to kidney disease, called post-streptococcal glomerulonephritis. 

    Without antibiotics, GAS can spread from the throat to other parts of the body, including the sinuses and ears. Ear infections can cause children’s eardrums to burst, and the bacteria can pass into the brain, leading to meningitis. Thankfully, many children who develop ear infections today won’t see serious repercussions, as antibiotics inhibit bacteria before they can cause irrevocable harm.

    Antibiotics, including Penicillin, have been instrumental in minimizing the consequences of strep throat. Today, cases of Group A Streptococcus infections in the U.S. are only severe in 12,000 people, and fatal in 1,300.

Group A Streptococcus (GAS), the bacteria that typically causes strep throat

2. Tuberculosis

    Tuberculosis (TB) is an infection caused by the bacteria Mycobacterium tuberculosis. It severely affects the lungs and is transmitted through airborne droplets. A TB infection goes through many stages, though Active TB doesn’t typically occur until months or even years after exposure and initial illness. 

    At present, there are fewer than 200,000 cases of TB per year in the U.S.; but between 1600 and 1800, TB was responsible for a quarter of all deaths in Europe. If left untreated, two-thirds of those who contract TB in its various forms will die.

    Miliary Tuberculosis is caused when M. tuberculosis enters the bloodstream and spreads throughout the body. It’s so named because of millet-like spots found on organs.

    Tuberculous meningitis occurs when bacteria infect the membranes of the brain and spinal cord to cause inflammation. These layers are necessary for protection, and so infection can be life-threatening. With modern medicine, only 15-30% of patients with TB meningitis will die, while 20% will experience lasting effects such as brain damage, epilepsy, paralysis, and hearing loss.

    Bone and joint tuberculosis impacts the spine, long bones, and joints, and typically isn’t diagnosed until TB is in its late stages. Bone and joint TB can lead to paralysis, neurological complications, limb shortening, and bone deformities. 

    Other problems arising from tuberculosis include: urogenital tuberculosis; pleural and pericardial effusions, where fluid builds up between tissues in the lungs and heart; and abdominal TB, which can incite problems with intestinal and reproductive organs.

    TB can be treated with antibiotics, though it is a strenuous process and can take years for the disease to be fully eliminated. Even with this drawback, TB is incredibly infectious and deadly without proper treatment. 

3. Bacterial Meningitis

    Bacterial Meningitis is a severe infection in the meninges - the three membranes that line the brain and the spinal cord. They protect the central nervous system, and in the case of meningitis, become inflamed. While meningitis can be caused by both viruses and bacteria, bacterial meningitis tends to be more harmful.

    The bacterium that typically cause bacterial meningitis is streptococcus pneumoniae, neisseria meningitis, listeria monocytogenes, and staphylococcus aureus. These bacteria don’t specifically attack your meninges. As they infect other parts of your body, they cause infections there, each with its own unique complications. They result in meningitis by chance, and when they do, these bacteria can have detrimental effects. 

    Meningitis is frequently accompanied by sepsis, a serious condition that results in multiorgan failure and shock. Sepsis is often fatal.

    Even when bacterial meningitis is not deadly, it can cause strokes and significant brain damage, leaving victims with issues such as memory problems, learning disabilities, seizures, movement disorders, and paralysis.

    Even with the assistance of antibiotics, 1 in 10 people who contract bacterial meningitis will die, and 1 in 5 will experience serious complications. However, in the pre-antibiotic era, the mortality rate for bacterial meningitis was nearly 100%. Medical advances have enabled us to treat and prevent such infections through vaccination and cleanliness. 

        4. Childbirth

    More than three million babies are born every year in the U.S., yet 1,000 mothers will die from childbirth. Five infants in every 1,000 births won’t survive. However, up until the 1930s, mothers and babies routinely perished in childbirth. 

    In the late 18th century, maternal death rates were estimated to be about 25 per 1,000 women. Because of the high total fertility rate (average number of children a woman bears), the likelihood of childbirth complications was significant. Sepsis, a condition where the body improperly responds to an infection, was the cause of half of these deaths. Accounting for another large portion of deaths were uterine infections that led to Puerperal fever.

    British doctor Irvine Loudon described puerperal fever; “A woman could be delivered on Monday, happy and well with her newborn baby on Tuesday, feverish and ill by Wednesday evening, delirious and in agony with peritonitis on Thursday, and dead on Friday or Saturday.” 

    In 1900, one in every six American infants died before their first birthday. Infections were a primary contributor to this number. Death rates for mothers and infants dropped when antibiotics were developed, able to combat the bacteria responsible for so many deaths. A decreased maternal and infant mortality rate played a large role in enabling a spike in population growth. Without the development of antibiotics to lower the fatalities associated with childbirth, bringing new life into the world would be very different.

5. General Infections

    Bacteria are everywhere, and people are always susceptible to infections by them. In a pre-antibiotic era, even the smallest infections were typically incurable.

    Minor surgical procedures often had very high infection risks. Because no other medicine existed, people were forced to clear those infections in ways that increased their susceptibility to additional infections, such as amputation or surgery. Those who contracted severe infections succumbed to them.

    Sexually transmitted infections (STIs) caused by bacteria were often deadly. Syphilis eventually leads to paralysis, blindness, heart disease, and death. It also caused many neurological problems. Gonorrhea and chlamydia had severe consequences as well.

    Staphylococcus aureus is a bacteria that causes a wide variety of infections and symptoms. In the time before antibiotics, 80% of staphylococcus aureus infections were fatal. The bacteria would cause abscesses, cellulitis (inflammation of connective tissue), and bloodstream infections. 

    Pneumonia was another prevalent bacterial disease that claimed many lives. It occurs when one or both of the lungs become infected, and the air sacs fill with fluid or pus. Up until the 1940s, medical books recommended harmful practices like bloodletting to cure pneumonia.

    E. coli infections were problematic in the pre-antibiotic era. E. coli bacteria are often found in the intestines, but can reside in a number of locations. They can cause urinary tract infections, intestinal infections, and diarrhea, and may lead to life-threatening cases of kidney failure and other serious issues.

    Antibiotics have played a critical role in reducing mortality from all of these infections, and they will continue to do so as medical science advances. Along with improvements in sanitation and illness prevention, we have managed to dramatically increase life spans, and can treat a multitude of infections that were deadly before the invention of antibiotics.

Staphylococcus aureus, the bacteria responsible for several infections

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Images:
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