The term epidemic is used to indicate an unusual prevalence of a disease. The disease which most harried early navigators, occurring in epidemic form on long voyages, was scurvy. It was known that the condition was caused by absence of fresh food in the sailor’s diet. Only in the present century, however, was it discovered that the factor absent from such stored or preserved foods was a vitamin. Vitamin C, the anti-scorbutic factor, is the most vulnerable of all the vitamins, readily destroyed by heating, drying and other methods of food preservation. Thus the precise reason why Jan van Riebeeck (appropriately a physician) was instructed to start a settlement at the Cape was the poor keeping quality of vitamin C. The vegetables and fruit he raised on the banks of the stream flowing into Table Bay effectively dealt with the epidemics of scurvy on the ships which called there.
Smallpox
Other epidemics soon, however, began to afflict the early settlers as well as the indigenous people. Smallpox, introduced from the Orient, first made its appearance in 1713. Many Europeans died and whole tribes of Hottentots were wiped out. The epidemic of 1755 caused the death of nearly a thousand Whites and more than a thousand non-Whites. Further smallpox epidemics occurred at the Cape in 1767, 1807, 1812, 1839, 1858 and 1881. That of 1881 was the most virulent. By that time Jennerian (calf lymph) vaccination was already recognised as a most effective prophylactic measure, but had not been adopted to any extent in South Africa. The Malay population at the Cape, who on religious grounds had consistently refused vaccination, suffered particularly severely. But in other races, largely also unvaccinated, there was also heavy mortality, and the disease spread far inland. The lesson was learned, and the first compulsory vaccination law was enacted by the Cape Parliament. Vaccination continues to be resisted by certain sections (and sects) of the population, with the result that not since 1881 has the country been entirely free of the infection..’ Read more
Bubonic Plague
Bubonic plague was introduced into South Africa during the Second Anglo-Boer War in rat-infested fodder imported by the British military authorities from ports in South America and India where the plague was raging at the time. It is a disease primarily of rodents; South African harbours at the beginning of the century teemed with domestic rats. As the rats died, their fleas left their cold bodies for humans, who developed first the bubonic and later the more fatal pneumonic form of the disease. Bubonic plague can be caused only by the bite of a flea carrying the infection from a rodent; the pneumonic form spreads directly from man to man by droplets from the mouth or nose. The largest outbreaks of plague occurred in Cape Town, Port Elizabeth, Durban, East London and Johannesburg. A total of 1,694 cases was reported, with 947 deaths. With the wiping out by plague of the domestic rodent population of the towns, and the isolation, particularly of the pneumonic cases, the epidemic came to an end. Unfortunately, as transpired later, the infection had spread to a veld rodent, the gerbil, and persists among gerbils to this day, accounting for the occasional human case. During recent years only two cases have been notified, both Bantu, in 1968.
On 7 February 1901 bubonic plague broke out in the District 6. Policemen, armed with revolvers, and had to clear out the tenants from the infected area, and gangs of White and non-White workers moved in on condemned properties which they levelled to the ground. Hundreds of men, women and children were moved out, and the evacuees were housed in an emergency camp on the Cape Flats, where Pinelands now stands. After the menace was over, ferry-builders started building new houses during 1902 and 1903, most of them unfit to live in. On the ruins of the old District Six a new one arose, as bad as, if not worse than, its forerunner. By 1964 the area had become hopelessly overcrowded (113 people to an acre), to an extent quite untenable in terms of the Public Health Act and the Slums Act. Organised gangs became a serious menace and liquor-running, dagga-smuggling and other evils were rife.
Thanks to the determined action of the police, crime gradually lessened. Dangerous gangs were stamped out, shebeens and dagga-smuggling brought under control, hooliganism curbed, and knifing and murders checked. Yet District Six remained one of Cape Town’s worst slum areas.
Typhus
Frequent epidemics of typhus used to occur in Bantu areas, such as the Transkei and Ciskei, until the introduction of DDT. This potent, long-acting (residual) insecticide deals effectively with the louse, the only intermediary in the spread of the infection from man to man. Small outbreaks continue to occur in poverty-stricken districts; they are dealt with expeditiously by the authorities as soon as cases are notified. In the three-year period to the end of 1969 a total of 385 cases were notified: 2 Whites and 383 Bantu.
Typhoid however is a disease of insanitation, spread by contaminated human excrement. The only serious epidemic of this disease occurred in South Africa at the beginning of the century as a result of the disorganisation brought about by the Second Anglo-Boer War. The mortality among civilians and military personnel was severe. Fairly high incidence continues in primitive, un-sanitated communities.
Malaria
Until the advent of the residual insecticide DDT, malaria was responsible for frequent epidemics during the late summer in the subtropical regions of Zululand and the Northern Transvaal. These not infrequently involved thousands of cases, particularly among the Bantu of those areas. So high did the mortality rise that many settlements had to be abandoned and received frightening names, such as `White man’s grave’. Since the Second World War the incidence has been reduced to what would previously have been considered negligible proportions. During the whole of 1969 the notifications of malaria were: Whites 53 ; Coloureds and Asiatics 3 ; Bantu 161.
Polio
Poliomyelitis epidemics occur periodically in South Africa. The public tends to be gravely frightened of this disease because of the pitiful crippling of children that so often results. The total number of cases occurring has, however, been relatively small compared with the other diseases that occur in epidemic form. There were epidemics in 1918, 1948 and (the worst one) the summer of 1956-57. `Epidemics’ of some hundreds of cases occurred in 1960 and 1966. In epidemic years vast numbers of children became infected without showing any sign of the disease. Such children are naturally immunised, but this is a very risky method of acquiring immunity, as the paralytic form may so easily be triggered off; e.g. by violent exercise or trauma of any kind. Subsequent crops of babies will not acquire such immunity and will provide material for the next epidemic unless submitted to vaccination.
Influenza
Although not listed by the legislature as a notifiable infectious disease, has been responsible for at least one major epidemic in South Africa, in 1918 – 1919. This virus disease occurs in world-wide epidemics or pandemics which usually spread to South Africa. That of 1918-19 caused the death of some twenty million people throughout the world -approx. 150,000 in South Africa. The influenza virus has been isolated and protective vaccines prepared. Owing to the continual evolutionary change taking place in the virus, vaccines to be at all effective must be locally prepared from recently isolated strains. The pandemic of 1957 also reached South Africa, but caused only minor disease with low mortality. Between 1918 and 1957 and subsequent to the latter date numerous small epidemics occurred in South Africa, but seldom caused serious illness.
