Before antibiotics, was every infection fatal ?
July 1, 2013 9:00 AM   Subscribe

A hundred years ago, if you had an infection that we would today treat with antibiotics, what was the typical prognosis ? Death ?

Is there a general extrapolation on what happened to people when they came down with something we'd treat today with antibiotics ? Is it that some infections you may recover from, some will kill you, or most all will kill you, etc ?

Cuts/scrapes happen all the time. Sometimes the cut gets infected (bursitis, cellulitis, etc). What happened in the past with such an infection ? Amputation ?

Staph and strep infections seem to be common as well.

Kids seem to get get ear infections regularly. I assume no one died from them, but maybe went deaf ?

(I'm not asking about virus and things you can get vaccinated against, and can probably skip the plague, as that's well documented.)
posted by k5.user to Health & Fitness (20 answers total) 13 users marked this as a favorite
See this wiki.

I should add, your body does a pretty deceent job fighting infection. It's when they go systematic that it gets bad. Primitive medicine wasn't all that remote from what's going on now. They drained swelling and used poltices and pain killers until they beat them or they beat you.
posted by The 10th Regiment of Foot at 9:12 AM on July 1, 2013 [3 favorites]

Best answer: This NY Times article is pertinent to your interest: It says the death rate for untreated skin infections was about 11%.

Of course outcome without treatment varies depending on the type of infection. Strep might cause scarlet fever, which might result in heart failure. The effects of syphilis are well-documented. Some infections will resolve on their own -- fever and redness are signs of your body's attempt to kill off the bacteria, after all. (And actually some pediatricians are now encouraging parents to wait before using antibiotics for an ear infection to give them time to resolve without treatment.)
posted by Andrhia at 9:13 AM on July 1, 2013 [2 favorites]

Cuts/scrapes happen all the time. Sometimes the cut gets infected (bursitis, cellulitis, etc). What happened in the past with such an infection ? Amputation ?

You have an immune system, it's quite good at fighting off infection. You get an infected cut, your body fights off the infection, and while the healing process may be long and sucky, you have an 90% chance of healing without antibiotics.

See: New York Times.
posted by DarlingBri at 9:14 AM on July 1, 2013 [1 favorite]

Best answer: Infant mortality was severe, and life expectancy has increased, but some findings from the 1970s suggest that antibiotic and chemotherapeutic drugs have not had the dramatic effect of the mortality of infectious diseases popularly attributed to them. It should also be noted that the improvement of infant and young child survival can be attributed to broader list of medical improvements than just antibiotics.

When not fatal, infection caused serious illness. For instance, ear infections sometimes spread from the ear to the brain, causing severe problems.
posted by filthy light thief at 9:14 AM on July 1, 2013 [1 favorite]

The human body has the capacity to fight infection, but the system can be overwhelmed - which is where antibiotics come into play.
posted by she's not there at 9:14 AM on July 1, 2013

Prior to antibiotics, people who sought the services of medical doctors (for anything, including childbirth), did in fact have a very high mortality rate from infection. However, midwife delivery, country healers, and folk cures were actually quite successful. Poultices infused with various plants and herbs (e.g. cloves) and fresh honey, all of which are demonstrated to have antiseptic properties, were commonly applied to cuts of varying severity. Also, midwives traditionally practiced frequent handwashing, which amazingly, doctors did not.

I'm actually not certain that ear infections were all that common in children prior to modern times. There were various teas, mixed with honey, that were traditionally given to people with sore throats. Perhaps these helped prevent bacteria from entering the ear via the eustachian tubes.
posted by RRgal at 9:22 AM on July 1, 2013 [1 favorite]

A brief overview: Streptococcus pyogenes caused half of all post-birth deaths and was a major cause of death from burns. Staphylococcus aureus was fatal in 80 percent of infected wounds and the tuberculosis and pneumonia bacteria were famous killers.

Also, syphilis was widespread; by the early 20th century, treatment had started to move from mercury (which didn't work) to Salvarsan, which was basically arsenic chemotherapy. Salvarsan was effective but still a pretty awful treatment regimen, so antibiotics were an amazing leap forward on that front as well.
posted by scody at 9:22 AM on July 1, 2013 [3 favorites]

I am dealing with cellulitis (staph infection) right now. If left untreated, the staph could get into the blood stream and cause death (so I understand).
posted by michellenoel at 9:32 AM on July 1, 2013

Keep in mind, too, that even before germ theory was really understood, people did still have access to medicine and medical treatment. Some of this was total quackery, but some of it was stuff that people had correctly observed would keep you from dying--the use of plants with antibiotic properties, maggot therapy, etc.
posted by kagredon at 9:39 AM on July 1, 2013

My father-in-law had scarlet fever as a kid (before antibiotics). It damaged his heart and at the time his family was told he wouldn't live to adulthood. He did have to have a valve replacement in his 70s but lived to be 89.
posted by leslies at 9:42 AM on July 1, 2013

In more recent history they used sulfa drugs.
posted by The 10th Regiment of Foot at 9:50 AM on July 1, 2013

Best answer: Here are a few thought experiments:

By the age of 25, how many times will most people have contracted some sort of infection that is treated with antibiotics? At least a couple of times, probably? And that's with a greatly reduced likelihood of contracting the major vaccinatible diseases such as whooping cough, greatly reduced likelihood of contracting all manner of other infections caused by contaminated food and water thanks to improved sanitation. I think it is safe to say, actually, that in the pre-modern world people contracted infections even more often than they do today.

If all of these infections had an extremely high likelihood of fatality (or amputation or some other horrific outcome), hardly anyone would survive to reproductive age.

Or think of the situation with wild animals--they are also getting infected with potentially fatal diseases, infected wounds, etc. etc. Some of them will die from these things, but most do not, thanks to the immune system.

Even a really ass-kicker of an infection such as bubonic plague will only kill about half the infected population. The point of bringing that into the discussion is that most of the common infections that beset people in the pre-antibiotic world had a much lower incidence of fatality, and the persons who were most susceptible were those with weaker immune systems, such as infants, the elderly, and people with compromised nutrition.

To sum up: lots of infections could kill you in the pre-antibiotics age, but the body can and did fight off most of them on its own.
posted by drlith at 10:44 AM on July 1, 2013 [2 favorites]

Best answer: This figure does not answer your question but is interesting; it shows that much of the reduction in mortality occured before the introduction of antibiotics, probably because of improved public health measures, such as the introduction of clean water. From the original article (Trends in Infectious Disease Mortality in the United States During the 20th Century):

"During the first 8 decades of the 20th century, the infectious disease mortality rate in the United States declined substantially, consistent with the concept of epidemiologic transition. Improvements in living conditions, sanitation, and medical care probably accounted for this trend. ...

A closer examination of the decline from 1900 to 1980 revealed that it was characterized by 3 distinct periods. During the first (1900 to 1937) and third (1953 to 1980) periods, infectious disease mortality fell by 2.3% to 2.8% per year. During the 15 years between these periods, the annual decline in the infectious disease mortality rate accelerated to 8.2%. The disease categories that contributed most to this decline were pneumonia and influenza, which fell sharply from 1938 to 1950 and subsequently leveled off for several years, and tuberculosis, which fell abruptly from 1945 to 1954 and continued to fall until the mid 1980s. These declines coincided with the first clinical use of sulfonamides (1935), antibiotics (penicillin in 1941 and streptomycin in 1943), and antimycobacterials (streptomycin, first used against tuberculosis in 1944, para-aminosalicylic acid in 1944, and isoniazid in 1952).17 However, the reasons for the steep decline from 1938 to 1952 are probably many and cannot be determined by examination of the mortality data alone."
posted by Mr.Know-it-some at 10:45 AM on July 1, 2013

When I was discussing options for a severely impacted wisdom tooth, I (rather morbidly) asked the oral surgeon if I could have died of it back in the 1800s. He said that if I never got the tooth pulled, then probably it wold have gone septic and killed me; if I survived the surgery, I had about a 50/50 chance of recovery but would have convalesced much longer without antibiotics. Dentists back then would have used salt water or alcohol as germ killers.
posted by Nibbly Fang at 11:51 AM on July 1, 2013

This topic has always amazed me since my Dad was born pre-antibiotic age, and was even allergic to Sulfa drugs and penicillin. He lived into his 90's. Even my Grandmother had, according to an x-ray later in life, scars on her lungs due to Tuberculosis that she didn't even know she had had, and she lived well into her 90's. I think some folk have more heavy duty immune systems than others. I also believe in home remedies; salt, vinegar, honey, cranberry juice, etc. to help heal before running to get an antibiotic.
posted by PJMoore at 12:49 PM on July 1, 2013

I don't mean to stir a hornet nest, but there are contemporary populations who survive without the benefits of antibiotics. You can see some of the more commons causes of death among Christian Scientists, for example. A quick look seems to indicate things diabetes and organ issues like bowel obstruction and appendicitis kill at a far greater rate than bacterial conditions. There are also very poor or displaced populations in 3rd world countries without access to medical care. People in these countries are distinct from their better-off neighbours in that they primarily die of infectious diseases, only some of which are treatable with antibiotics.

Historically, you may be interested in TB. It was rampant and killed anywhere from 10 - 50% of people who had it, but what made the largest difference in mortality rates was not antibiotics but public sanitation. Note that even at peak, a large percentage of people survived without antibiotic treatment.
posted by DarlingBri at 2:52 PM on July 1, 2013

Best answer: I would suggest that, like people who choose to not take vaccines, those who choose to not use antibiotics have a greater life expectancy now because the vast majority of people around them who do take vaccines and antibiotics. A healthier population on the whole is good for everyone.

And to nudge that hornet's nest a bit more, I consider improved public sanitation a form of antibiotics, in the basic form of killing bacteria. For example, this history of military medicine is a good overview of the common practices during World War I, before antibiotics.

If you're still looking for more, Pneumonia Before Antibiotics looks like an interesting and relevant book.
posted by filthy light thief at 8:22 PM on July 1, 2013 [1 favorite]

The immune system doesn't fight off syphilis when left to its own devices, either. In the absence of effective treatment, syphilis invariably means horrific misery in the short run and a long, lingering, painful death (often accompanied by severe mental illness) in the long run. (And don't forget it can be passed from pregnant women to infants; as a bonus, given the taboo around the infection, many women didn't even know they were infected.) With 10-15% of the U.S. population (by conservative estimates) infected by the turn of the twentieth century, it was an absolute public health disaster that was only curbed by antibiotics.
posted by scody at 10:08 PM on July 1, 2013 [1 favorite]

Two more issues: quality of life was different. If you had access to good nutrition and reasonable sanitation, you could generally hope to survive without much intervention. If you were malnourished and living in a crowded dirty area, your life expectancy and your health plummeted. Nowadays, even if you have serious health issues, antibiotics can still save your life.

Also, people had much bigger families. I really find it amazing what a demographic shift we've had from large families due to child mortality to the "norm" rapidly spreading worldwide of 1-2 children. Most kids that make it past the first year do okay. My preemie is alive in part due to antibiotics, and I know of two babies in Cambodia who died because they didn't get taken to a hospital for antibiotic treatment early enough.
posted by viggorlijah at 5:02 AM on July 2, 2013 [1 favorite]

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