Did any of you see Four Corners on ABC last week about the rise of drug resistant diseases, in particular tuberculosis?

One of the doctors speculated that we could be facing a return to pre-antibiotic health, facing old world diseases that have grown strong and immune to us.

This is a little worrying, because diseases love cities, and some of the big ones have enjoyed Sydney in the past.

The first to make its presence felt was likely smallpox (or maybe a virulent form of chickenpox) that swept through the Aboriginal community around Sydney in 1789 but left the Europeans largely unscathed.  Whatever the disease, it appears to have struck a non-immune population with its full force and in the space of a few months, between March and May 1789, reportedly killed up to 50% of the Sydney Aboriginal population.

While Europeans escaped this first round, later epidemics got them too: tuberculosis, measles, smallpox, scarlet fever, plague and the flu.

The nineteenth century was a time when people lived with the knowledge that disease could take them at any moment.  There were no really effective remedies and even something as small as a bad tooth and a cold could lead to the grave.

Tuberculosis is a respiratory disease, spread through contact; hence it is quite happy in confined, overcrowded neighbourhoods with poor sanitation.  Sydney’s inner city areas in the mid and late nineteenth century were ideal.  Although never appearing as an epidemic as such, tuberculosis was a constant threat to health.

Health Week in Sydney 1952. TB was still a threat.

Early cases in Sydney were reported from the beginning of the 1800s, but from the 1850s until the early 1900s it consolidated its position as the biggest killer in Sydney.  While only accounting for 5.5% of all deaths in 1858, by 1882 it was the cause of 10% of all recorded deaths in Sydney.  For the 20-39 age group, tuberculosis was responsible for 32% of recorded deaths.

In 1867 Sydney was rocked by a measles outbreak that lasted from February to June.   Confined largely to the City of Sydney area, with outbreaks in some inner suburbs, Woollahra and Randwick, over 13,000 children contracted the disease.  While healthy children of Sydney’s middle and upper classes mostly recovered, children from poor and working class families, often undernourished and ill fell victim in large numbers.  In the five months the epidemic raged it killed 748 people, mostly children under 4, with 500 dying in the City area alone. At its peak in March, 60 children died every week.

But the big killers were flu.

In 1890-91 Sydney got a taste of what was to come when the Asiatic flu appeared.  The disease came out of Asiatic Russia, Siberia and the like, spreading through Russia and into Europe in 1889.  Between 1889 and 1891 in England it killed about 16,000 people.  It reached Sydney in late September 1891.  Onset was fast and fever would last 3-5 days.  For older suffers it often ended in pneumonia and bronchitis, while young children would suffer from vomiting and diarrhoea.

Estimates of people in Sydney who got the flu are around 100,000 in the months October to December, or around 26% of the population.  Of these 234 died, which doesn’t look much in comparison but does represent about on average 30 per week.

Today that would be panic stations.

But this was nothing on the Spanish flu of 1919.  Likely reaching Australia on the ships bringing back the Anzacs from World War I, the Spanish flu (although it likely started in the USA) is one of the biggest epidemic killers in human history.  Some claim it killed between 50 and 80 million in twelve months around the world.  World War I resulted in 37 million deaths.  In Sydney it infected 36% of the population and resulted in the deaths of over 5000 Sydneysiders including 800 health workers in a period of about 6 months.

Worryingly it attacked younger people, having the highest mortality rate in those between 20 and 50.  Recent research suggests the reason for this was due to it causing the immune system to go into overdrive.  Sadly those with strong immune systems were then attacked more rigorously by their own defences.

Spanish flu SOS response team at Riley St depot 1919.

The flu caused a major case of panic.  Masks were worn to stop its spread, schools, theatres and even Sydney Uni were shut for a time.  And then it stopped.

Eventually the study of the transmission of the disease and breakthroughs with drugs and treatments led to a rapid downturn in the mortality rate of these killers.  But as the return of TB demonstrates, maybe they never truly were beaten and are waiting patiently for another go.  Bird flu, swine flu….