The Truth About Vaccines & Other Drugs in Africa

There seems to be a perception in the Western world that African children are dying due to lack of vaccines, but is that actually true? Not exactly.

In many cases, the relentless push for vaccines (usually by outside interests) as a magic fix for disease, has come at the expense of other interventions.

According to UNICEF statistics, Rwanda has 95% – 98% vaccination coverage for diptheria-tetanus-pertussis…yet 37% of children are stunted due to malnutrition. Only 62% have access to proper sanitation [1]

Botswana has 95% children vaccinated with three doses of diptheria-tetanus-pertussis vaccine…but just over half receive Vitamin A supplementation (lauded in the early 1990’s as THE most effective health intervention of all), and only 20% of infants are exclusively breastfed [2].

Malawi is ranked 9th poorest country in the world, with more than half its people living below the poverty line, 9.6 million Malawians (more than half the population) don’t have access to a decent toilet, 5.6 million people (1 in 3) don’t have access to clean water, and 42% of children are stunted [3], yet more than 80% of children are up-to-date with vaccinations…[4].

The Malawi vaccination schedule now includes vaccines for measles, polio, cervical cancer, rotavirus, pneumococcal disease, diphtheria, tetanus, pertussis, hepatitis B, Haemophilus Influenza type B (Hib) [5].

According to UNICEF, almost 90 percent of child deaths from diarrhoeal diseases are directly linked to contaminated water, lack of sanitation, or inadequate hygiene [6], but money that may have been spent on sanitation and procurement of clean water, is spent on rotavirus vaccines instead.

Also, recall that the diptheria-tetanus-pertussis vaccine used in poor African countries is likely the old whole-cell thimerosal-containing vaccine, due to being cheaper than the new acellular vaccine [7].

African countries are increasingly rolling out HPV vaccination campaigns for school-girls. While it’s true that the majority of cervical cancer cases are in developing countries, one can’t help but wonder if HPV vaccination is a wise use of resources, given the more pressing needs in many sub-saharan countries.

In 2011, Merck donated 2 million doses of Gardasil vaccine to Rwanda, and 95% of the nation’s 11-year-old girls were vaccinated. The freebies ran out after three years, at which time Merck offered the vaccine to the Rwandan government at ‘discount prices’. Such donations can have the effect of locking governments into programmes which they later have to fund themselves, at the expense of more pressing issues, and may be more about ‘priming the market’, than charity on the part of the drug company [8-9].

Between 2013 – 2016, 26, 766 young girls in Malawi were given quadrivalent HPV vaccination as part of a pilot project, supported by GAVI – and 2051 girls who participated were under the age of 9 [10].

Vaccination coverage in Tanzania in 2014 for school and out of school girls was estimated at 93 per cent and 92.6 per cent, respectively. The chief Health Minister boasted that, despite “heartbreaking stories of the ill effects of vaccines” online, Tanzania had not even registered one single adverse reaction from the vaccine [11]. Is there an incentive for African governments – hopeful of foreign investment from pharmaceutical companies to downplay risks and reactions, in order to keep up the flow of income?

In December 2012, 500 children in Chad received a new experimental meningitis vaccine, and 38 children were later hospitalized, with 7 of the children flown to Tunisia for specialized treatment. The Chadian government declared their “state of health is not worrying”, but other sources in Chad claimed the children were paralysed [12-13].

In 2008, the Center for Research on Multinational Corporations reported (among others) the case of clinical trials in Uganda between 1997 – 2003, where thousands of women suffered adverse reactions to the drug Nevirapine, and some died – and all of it went unreported, while testing continued [14].  

Supplemental Immunization Activities

In addition to routine childhood vaccines, WHO and other agencies also conduct ‘supplemental immunization activities’, which are mass vaccination campaigns that aim to administer extra doses of vaccines. According to the WHO, there have been “thousands of these supplementary vaccination campaigns” with oral polio vaccine since the 1980’s, with children vaccinated regardless of prior vaccine history. The extra doses were not recorded on the child’s health cards [15].

Extra doses of measles vaccines are also given. A quick look at the Measles and Rubella Initiative Calendar for 2019 shows they plan on supplementally vaccinating more than 100 million people in sub-Saharan Africa this year – in addition to routine vaccinations [16].

Experimental Vaccines

In addition to routine vaccinations and supplementary vaccination, poor African countries are increasingly used to test experimental vaccines because it’s quicker and cheaper and less stringent regulations than western countries “Development cycles can be reduced thanks to the faster recruitment of subjects from a larger pool of patients. The costs of recruiting patients and paying investigators are lower too” [17]

This poses some real ethical problems. I have never been to Africa but I have lived in a developing country, and witnessed first-hand the reverence given to those who are in positions of power, or overseas-trained. People are too embarrassed or intimidated to ask questions of their doctor or report side-effects, as it would seem disrespectful and ‘out of line’ with the societal and cultural hierarchy.

Other developing regions face similar issues. M. Nabeel Ghayur, a pharmacologist who worked in drug development in Pakistan says: “People actually have blind trust in their doctor in South Asia. They have no idea what drug development is, they have no idea what clinical trials are.

He said there was little red tape in those countries, and that people would rarely ask about drug side effects and legal issues” [18].

Starting next month (March, 2019), 750,000 babies in Kenya, Ghana and Malawi will be given a new experimental malaria vaccine. The vaccine Mosquirix will be given to children in four doses- at six, seven, nine and 24 months through an injection on the upper arm [19].

 The Star newspaper in Kenya reported: “Mosquirix, also called RTS,S, was first conceived in the 1980s and has undergone all clinical trials, returning less than optimal results.

The vaccine – made by GSK – is only effective in 30 to 50 per cent of patients, says the WHO.

Its effectiveness diminishes over time and it disappears fastest in children who are most exposed to malarial mosquito bites. However, because no defence against malaria is perfect, the vaccine is being considered in addition to the existing defences” [20].

GlaxoSmithKline and its backers, including Bill and Melinda Gates Foundation, had already spent $565 million on developing the drug, which brought back disappointing results in early testing, and did not meet the expected criteria for a malaria vaccine set out by a WHO-led consortium”, which requires a “protective efficacy of more than 50% against severe disease and death, and last longer than one year.” [21]

In 2017, the Global Task Force on Cholera Control launched a very ambitious set of goals, including 90% reduction in cholera deaths by 2030. Naturally, vaccines feature prominently, namely the oral cholera vaccine. A year later, the ‘largest vaccination drive in history’ took place, with over 2 million people vaccinated for cholera in Zambia, Uganda, Malawi, South Sudan and Nigeria [22].  

As of January 2019, more than 66,000 people in the Democratic Republic of Congo have been vaccinated with Merck’s V920, an experimental Ebola vaccine [23].

A Chinese-made genetically-engineered Ebola vaccine was given to 500 adults in Sierra Leone in 2015, as part of a Phase II trial. The Chinese FDA then approved the vaccine, without any Phase III trials [24].

In 2018, some 20,000 Malawian children were enrolled to receive an experimental typhoid conjugate vaccine [25].

Supplemental Drugs

In addition to routine vaccines, supplemental vaccines and experimental vaccines…many African children (and pregnant women) are also given supplemental drugs – malaria (sulfa) drugs, three times during the first year of life (starting from 10 weeks old), or several times per year during childhood – even if they have no infection [26]. During pregnancy, mothers are given the drugs at least three times during the 2nd and 3rd trimesters – again, even if they have no infection [27].

This is called “intermittent preventive therapy”, and it was promoted aggressively by the Bill and Melinda Gates Foundation, to the tune of at least $28 million dollars, with the establishment of the ‘IPTi Consortium’ [28].

in 2008, a technical advisory group at the World Health Organization (who coincidentally has received more than $2.4 billion in donations from the Bill and Melinda Gates Foundation, since 2000 [29], including a $1.2 million grant in 2006, with the express purpose of ensuring “that the IPTi consortium outcomes are collated, assessed by international experts, and result in a WHO policy recommendation” [30])  failed to recommend the program, due to concerns over safety and efficacy.

The protests from the Gates Foundation and their scientists were so loud and insistent, it prompted WHO malaria chief to write a memorandum (which was later leaked to newspapers) to WHO director, Margaret Chan, saying: “although it was less and less straightforward that the health agency should recommend IPTi, the agency’s objections were met with intense and aggressive opposition from Gates-backed scientists and the foundation…” [31]

Not to be deterred, the Gates Foundation then donated funds to have the Institute of Medicine conduct another review, chaired by a doctor whose work has received at least $50 million in funding from the Gates Foundation [32].

Predictably enough, the IOM review concluded that “an intervention with results of this magnitude is worthy of further investment as part of a public health strategy to decrease morbidity from malaria infections in infants“, although they noted that “time and resources did not allow independent audits of trial conduct, data management, or analysis” [33].

The WHO malaria chief who protested the excessive influence of the Gates Foundation, was later replaced…by a member of the Gates-founded IPTi Consortium (and now Vice-President of Johnson & Johnson pharmaceutical company [34]) and WHO then proceeded to recommend these sulphonamide drugs to infants ( given at the same time as routine vaccines for diptheria-tetanus-pertussis and measles), children and pregnant mothers, despite evidence of increasing drug-resistance in sub-Saharan Africa…

Prior to the IPTp and IPTi programs, pregnant women in malaria-endemic areas of Africa were given weekly doses of chloroquine, until drug resistance and compliance issues made it unfeasible to continue [35].

Other chemical exposures

The use of DDT to control mosquitos in malaria-endemic areas was endorsed by the World Health Organization in 2006, and its use has been increasing ever since. The chemical is sprayed inside homes and buildings – according to a report by the United Nations Environment Program, at least 3952 tonnes of DDT were sprayed in Africa and Asia in 2007 [36].

Agricultural spraying of DDT is common in Africa, especially in West Africa, where mosquitos have developed resistance to it [37].

The vast wealth of precious metals and natural resources in Africa have been both a blessing and curse to its people. Gold and other mining in Africa have produced countless mountains of toxic wastes that pollute the air, soil and water, most notably with uranium, arsenic and lead [38].

Another form of pollution experienced in poorer parts of the world, such as sub-Saharan Africa, is indoor air pollution from cooking over open fires, using wood, charcoal, kerosene or animal dung. The World Health Organization estimates that as many as 3.8 million people die prematurely every year, due to health conditions caused by indoor air pollution, the majority due to pneumonia [39].


[1] UNICEF, Statistics: Rwanda Accessed February, 2019

[2] UNICEF Statistics: Botswana, Accessed February, 2019.

[3] WaterAid, Facts and Statistics: Malawi, Accessed February, 2019.

[4] WHO, WHO and UNICEF Estimates of Vaccine Coverage, 2017 Revision,, Accessed February, 2019.

[5] GAVI The Vaccine Alliance, Iceland pledges US $1 Million to Immunise Children in Malawi,, Accessed February, 2019.

[6] UNICEF, Press Release, Children Dying Daily Because of Unsafe Water Supplies and Poor Sanitation and Hygiene, New York: UNICEF, 2013.

[7] WHO, Biologicals: Pertussis, Accessed February, 2019.

[8] The Guardian, Drug donations are great, but should Big pharma be setting the agenda? Accessed September, 2017.

[9] Editorial, Financing HPV vaccination in developing countries, The Lancet, 2011, 377(9777):1544.

[10] Msyamboza KP, et al, Implementation of a human papillomavirus vaccination demonstration project in Malawi: successes and challenges, BMC Public Health series, 2017, 17:599.

[11] AllAfrica, Tanzania: Cancer Vaccination Program Registers Success,, Accessed February, 2019.

[12] MedicalExpress, 38 children hospitalised after meningitis shot in Chad, Accessed February, 2019][

[13] England C, Minimum of 40 children paralyzed after new meningitis vaccine, VacTruth, Accessed February 2019

[14] Kelly S, Testing drugs on the developing world, The Atlantic, 27th February 2013, Accessed February, 2019.]

[15] Helleringer S et al, Supplementary polio immunization activities and prior use of routine immunization services in non-polio-endemic sub-Saharan Africa, Bulletin of the World Health Organization, 2012, Accessed February, 2019.

[16] Measles and Rubella Initiative, SIA Schedule, Accessed February, 2019.

[17] Edwards M, R & D in Emerging Markets: A new approach for a new era, McKinsey & Company, 2010, Accessed February, 2019.

[18] Joelving F Many drugs for US kids tested in poor countries, Reuters, 23rd August 2010, Accessed February, 2019.

[19] Kulkani P, Malaria Vaccine trials in Africa: Dark saga of outsourced clinical trials continues, Newsclick, March 2018,, Accessed February 2019.

[20] Muchangi J, Kenyan children to get first malaria vaccine in the world next month, The Star,14th February, 2019, Accessed February, 2019.

[21] Kulkani P, Malaria vaccine trials in Africa: Dark saga of outsourced clinical trials continues, Newsclick, 17th March 2018, Accessed February, 2019.

[22] UNICEF, Global Task Force on Cholera Control marks a year of progress toward ending cholera worldwide, Accessed February, 2019.

[23] Ward Hackett D, Ebola vaccinations expanding in Central Africa, Accessed February, 2019.

[24] Liu A, China approves domestic Ebola vaccine developed from recent outbreak, FiercePharma, Accessed February, 2019.

[25] Gordon M, Trial kicks off in Malawi: First child vaccinated with typhoid conjugated vaccine in Africa, Accessed February, 2019.

[26] WHO, Intermittent Preventive Treatment in Infants, Accessed February, 2019.

[27] WHO, Intermittent Preventive Treatment during Pregnancy, Accessed February, 2019.

[28] Bill and Melinda Gates Foundation, New grants to accelerate malaria research and development, Accessed February 2019.

[29] Huet N & Paun C, Meet the world’s most powerful doctor: Bill Gates, Politico, 4th May 2017, Accessed February, 2019.

[30] Bill and Melinda Gates Foundation, How We Work: Grant, WHO, Accessed February, 2019.

[31] McNeil DG, Gates Foundation’s Influence Criticized, New York Times, 16th February 2008, Accessed February 2019.

[32] VCU School of Medicine, Myron Levin M’67: A pioneer of the modern discipline of vaccinology, Accessed February, 2019.

[33] [IOM, Committee on the Perspectives on the Role of Intermittent Preventive Treatment for Malaria in Infants, 2008, available at: Accessed February 2019.

[34] UW Dept of Global Health, Robert Newman, Accessed February 2019.

[35] Heymann DL, Antenatal chloroquine chemoprophylaxis in Malawi: chloroquine resistance, compliance, protective efficacy and cost, Trans R Soc Trop Med Hyg,.1990;84(4):496-8.] [Kayentao K et al, Comparison of Intermittent Preventive Treatment with Chemoprophylaxis for the Prevention of Malaria during Pregnancy in Mali, The Journal of Infectious Diseases, 2005, 191(1):109–116.

 [36] Cone M, Should DDT be used to combat malaria? Scientific American, 4th May 2009, Accessed February 2019.

[37] WorldWatch, Malaria, Mosquitos and DDT, Accessed February. 2019.

[38] AlJazeera, Toxic City: The cost of gold-mining in South Africa, Accessed February 2019.

[39] WHO, Household air pollution and health, Accessed February, 2019.

15 Reasons Why Millions of People Once Died From ‘Infectious’ Disease


During the 19th century, the population of London swelled by more than six-fold, from 1 million to more than 6 million inhabitants, to become the largest city in the world [1].

All across the western world, as the Industrial Revolution took hold, vast numbers of rural folk moved into towns and cities. For example, in 1750, only 15% of the population lived in towns, but by 1880, a massive 80% of the population were urban dwellers [2]. The Industrial revolution, and city living, promised a better life but, for many, it became an unimaginable nightmare.

With housing in short supply, unscrupulous landlords turned buildings into tenements, and leased every spare inch to desperate families – dingy damp cellars, fire-trap attics and under-stair storage rooms, many without any ventilation or light. Just imagine the damp, mouldy air that these people were constantly breathing – it’s hardly a wonder that tuberculosis and pneumonia were the biggest killers, accounting for one-fifth of all deaths [3].

Disease and death were distressingly close in these crowded quarters: “…the report of a health officer for Darlington in the 1850’s found six children, aged between 2 and 17, suffering from smallpox in a one-roomed dwelling shared with their parents, and elder brother and an uncle. They all slept together on rags on the floor, with no bed. Millions of similar cases could be cited, with conditions getting even worse as disease victims died and their corpses remained rotting among families in single-roomed accommodations for days, as the family scraped together pennies to bury them” [5].


Entire streets had to share one outdoor toilet, which was usually in foul condition – cleaning supplies were expensive, and flies hung around in droves (and then made their way through open windows to nearby kitchens etc), and of course, diarrhoea was ever-present!

Sewerage drained into waterways via open channels in the streets and lanes, or simply lay stagnant in stinking cesspools of filth.

Henry Mayhew was an investigative journalist who, in 1849, described a London street with a ditch running down it, that contained the only drinking water available to residents. He said it was ‘the colour of strong green tea’, and ‘more like watery mud than muddy water’.

‘As we gazed in horror at it, we saw drains and sewers emptying their filthy contents into it; we saw a whole tier of doorless privies (toilets) in the open road, common to men and women built over it; we heard bucket after bucket of filth splash into it’ [6].


With no environmental laws in place, raw sewage poured into drinking water supplies, as did run-off and toxic waste from factories and animal slaughterhouses.

 “The spill-off from the slaughter-houses and the glue factories, the chemicals of the commercial manufacturers, and all of Chicago’s raw sewage had begun to contaminate the drinking water” [7].

In London, the River Thames, which was the source of drinking water for many Londoners, became a stinking flow of excrement and filth, as human, animal and industrial waste was dumped into it. “In the heatwave of 1858, the stagnating open sewer outside Westminster’s windows fermented and boiled under the scorching sun” [8].

During a cholera epidemic in London, in 1854, Dr John Snow realized that the only people who seemed to be completely unaffected were the workers at a local brewery – they were drinking beer instead of water [9]! The discovery that disease could be spread via water was revolutionary, and paved the way for massive sanitary reforms


With slow, unreliable transport, and no refrigeration, food was often past its use-by date. Diseased and rotting meat was made into sausages and ham. ‘Pigs are largely fed upon diseased meat which is too far gone, even for the sausage maker, and this is saying a great deal; and as a universal rule, diseased pigs are pickled and cured for ham, bacon etc’ [10].

Milking cows were often fed on ‘whisky slops’ and other rotting, cheap food, and therefore became diseased. ‘New York’s milk supply was also largely a by-product of the local distilleries, and the milk dealers were charged with the serious offense of murdering annually eight thousand children’ [11].

Before pasteurization, milk was treated with formaldehyde to prevent souring [12].

‘Fresh’ produce, when it was available, was not so fresh after all – often slimy, putrid and unfit for human consumption [13].


During the 19th century, countless mothers died during, or soon after, childbirth.

There were a number of reasons for this:

a) Rickets, and malnutrition in general, was rife,

b) Doctors, who had impinged into the female-only world of childbirth, took offense at the idea they had dirty hands, and refused to wash them [14],

c) chloroform and forceps were used unnecessarily, even in uncomplicated labours [15]

If the baby survived past infancy, they could generally look forward to a life of malnutrition, hard labor and improper care, often performed by older siblings.

During the Industrial Revolution, many mothers worked long hours in factories, leaving their young children in the care of hired ‘nurse-girls’, who were little more than children themselves, between 8-12yrs of age [16].

Many children ended up living on the streets, driven to stealing and pilfering in order to survive. ‘In 1848 Lord Ashley referred to more than thirty thousand ‘naked, filthy, roaming lawless and deserted children, in and around the metropolis‘ [17].


With the Industrial Revolution in full swing, and labour in short supply, children as young as three and four years old were put to work in sweatshops and factories. Many of the jobs involved long hours, working in dangerous conditions, such as around heavy machinery or working near furnaces [18].

Children were forced to do back-breaking work in the most appalling conditions: ‘Children began their life in the coal-mines at five, six or seven years of age. Girls and women worked like boys; they were less than half-clothed, and worked alongside men who were stark naked. There were from twelve to fourteen working hours in the twenty-four, and these were often at night…A common form of labour consisted of drawing on hands and knees over the inequalities of a passageway not more than two feet, or twenty-eight inches high a car or tub filled with three or four hundred weight of coal, attached by a chain, and hooked to a leather band around the waist’ [19].

Children were sometimes crushed or ground to death, or had limbs severed, in some of the more dangerous industries, such as underground mining [20]

Basically, millions of children had no childhood, but a monotonous, depressing existence.

‘Children had not a moment free, save to snatch a hasty meal, or sleep as best they could. From earliest youth they worked to a point of extreme exhaustion, without open air exercise, or any enjoyment whatever, but grew up, if they survived at all, weak, bloodless, miserable, and in many cases deformed cripples, and victims of almost every disease’ [18].

And to make matters worse, many children were constantly exposed to poisons, such as arsenic, lead and mercury, which were being widely used in industries, such as silk and cotton spinning [21].

Adulthood didn’t bring much change – hard labour, often for 12-16 hours per day. The terrible conditions and over-work, along with poor diet, aged people quickly: “…from the 1830’s photographs show working people looking old by their thirties and forties, as poor nutrition, illness, bad living conditions and gross overwork took their toll’ [22].


Factories spewed soot and waste into the air, unchecked and unregulated. Cities were covered in a layer of grease and grime [23].

It’s no surprise that lung and chest complaints were rife. And then there was the ever-present stench of open sewage, rubbish, animal dung etc.

Refuse, including the rotting corpses of dogs and horses, littered city streets. In 1858, the stench from sewage and other rot was so putrid that the British House of Commons was forced to suspend its sessions’ [23].

That episode became known as ‘The Great Stink’, and in 1952, atmospheric conditions coupled with coal-fire burning, led to the event now known as ‘The Great Smog” – which killed thousands within the space of weeks [24].

Even today, an estimated 9000 people die prematurely each year in London alone, due to air pollution [25]. Yet the levels of pollution in Victorian times were up to 50x worse than they are today [26] – how many lives must have been cut short because of the foul air poisoning their lungs?


Infant formula was first patented and marketed in 1865, consisting of cow’s milk, wheat and malt flour, and potassium bicarbonate – and regarded as ‘perfect infant food’ [27].

Over the next 100 years, breastfeeding rates dropped to just 25% [28], as social attitudes disdained the practice as being only for the uneducated, and those who could not afford infant formula [29].

Not only did millions of babies miss out on the nurturing of their mother’s breast, but their formula was poor quality, and often made with contaminated water in unsterile bottles, and milk quickly spoiled during warm weather without refrigeration.

It’s hardly a wonder that so many babies succumbed to diarrheal infections, such as typhoid fever.


Without a proper disposal system in place, alleys, courtyards, and streets became littered with rubbish and waste – sometimes knee-high, which was not only offensive-smelling, but a great attraction for all kinds of scavengers – rats, pigs, dogs, cockroaches and swarms of flies [30].


Because horses and donkeys were used to transport goods, they also had to be housed in overcrowded cities, often in close quarters to humans, since space was at a premium. Rotting carcases were left to decompose where they lay.

By late 19th century, 300,000 horses were being used in London, creating 1000 tonnes of dung per day [31].

Pigs roamed freely in the streets, ferreting amongst the rubbish – some towns recorded more resident pigs than people.

Animal slaughterhouses were located amongst high-density tenement housing – animals were constantly slaughtered in full view of the surrounding residents, and the sounds and smell of death were constantly in the air [32].


Due to the burning of coal, and wood fires, cities were blanketed in a thick, black smog that covered everything in grime.

The murk was so dense that countless accidents occurred, including horses and carts running into shop-fronts, or over pedestrians, or into each other [33].

Vitamin D deficiency was widespread, and in the late 1800’s, studies concluded that up to 90% of children were suffering from rickets [34]. In young girls, this often led to deformed hips, and later on, problems in childbirth.


Millions of families subsisted on the cheapest food possible, and many lived on the brink of starvation. Malnutrition was rife, with so little fresh fruits and vegetables in the diet.

Scurvy (Vitamin C deficiency) claimed an estimated 10,000 men during the California Gold Rush in the mid-1800’s [35]. Even in those who did not have overt signs of scurvy, a state of mild deficiency must have been prevalent, leading to weakened immunity to disease and infection.


If you thought blood-letting and leeches were bad, how about an injection of arsenic – proudly brought to you by Merck and Co [36]? Or a gargle with mercury – where’s the harm [37]?

And if you have smallpox, we’ll dab your sores with corrosives [38].

Treatment for syphilis included mercury rubs, bismuth injections, and arsenic injections – some patients endured more than 100 such injections [36].

It’s highly possible that the medical ‘treatments’ killed more people than the diseases they were intended to treat.

Hospitals were known to be breeding-grounds of disease, and over-run by rats, that were so numerous and hungry, they ate patients [39].


With less than 2% of the urban population with running water to their homes [40], and soap/detergents viewed as luxuries, washing of hands, clothes, plates and utensils had to be done with dirty, contaminated water – or not at all.

Note that items such as nappies and sanitary ‘rags’ also had to be washed – no ‘disposables’ in those days!


We now know that stress and fear take a huge toll on the body, resulting in immune system malfunction [41]. Can you imagine the mental anguish of being surrounded by abject poverty, and seeing no way of escape for yourself or your children? Or the panic of watching everybody you love succumb to a dreaded disease, and not having the knowledge or means to protect yourself?

Fear and hysteria ran high during disease outbreaks – during a cholera epidemic in the US in 1849 “thousands fled panic-stricken before the scourge…The streets were empty, except for the doctors rushing from victim to victim, and the coffin makers and undertakers following closely on their heels” [42].

Not to mention the stress of toiling for long hours in monotonous or dangerous work, with hardly a piece of dry bread to fill your hungry stomach?

Given the poor living conditions that millions suffered, it was hardly a wonder that average life expectancy was, tragically, just 15 or 16 years among the working class [43].


[1] GB Historical GIS / University of Portsmouth, London GovOf through time | Population Statistics | Total Population, A Vision of Britain through Time.

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[4] Chesney K. The Victorian Underworld, Penguin Books, 1972.

[5] Porter D, Health, Civilization and the State – A History of Public Health From Ancient to Modern Times, Routledge, Oxfordshire, England, 1999.

[6] Mayhew H. A Visit To The Cholera Districts of Bermondsey, The Morning Chronicle, 24th September, 1849.]

[7] Byrne J, My Chicago, Northwestern University Press, Evanston, Illinois, 1992.

[8] Mann E, Story of Cities #14: London’s Great Stink heralds a wonder of the modern world, The Guardian, 4th April, 2016, Accessed January, 2019.

[9] Radeska T, The 1854 cholera outbreak of Broad Street, Everyone got sick except those who drank beer instead of water, Vintage News, 26th September, 2016,, Accessed January, 2019.

[10] The British and Foreign Medico-Chirurgical Review, Quarterly Journal of Practical Medicine and Surgery, Volume XXXV, John Churchill and Sons, London, Jan-Apr 1865, pp 32-33.

[11] Cole AC, The Irrepressible Conflict 1850-1865: A History of American Life, Volume VII, Macmillan, New York, 1934, p 81.

[12] Formaldehyde and Milk, JAMA. 1900; XXXIV(23):1496.

[13] Report of the Council of Hygiene and Public Health of the Citizen’s Association of New York, 1865, p 59.

[14] Wertz RW, Wertz DC, Lying In: A History of Childbirth in America, Yale University Press, 1989, p 122.

[15] Loudon I, Maternal Mortality in the Past and its Relevance to Developing Countries Today, American Journal of Clinical Nutrition, 2000, 72:241S-246S.

[16] Newman G, Infant Mortality: A Continuing Social Problem, Methueun and Co, London, 1906, p 95.

[17] Horn P. The Victorian Town Child, New York University Press, 1997.

[18] Willoughby WF, de Graffenried C, Child Labor, American Economic Association, Guggenheimer, Weil and Co, Baltimore, 1890, p 16.

[19] Cheyney EP. An Introduction to the Industrial and Social History of England, Macmillan, New York, 1920, pp 243-244.

[20] Lovejoy OR, Child Labor in the Coal Mines, Child Labor – A Menace to Industry, Education and Good Citizenship, Academy of Political and Social Science, 1906, p 38.

[21] The American Journal of Nursing, 1903, 3(8):664.

[22] Mearns A, Preston WC. The Bitter Cry of Outcast London: An Inquiry Into the Condition of the Abject Poor, James Clarke and Co, London, 1883.

[23] Noble TFX, Straus B, Osheim DJ, Neuschel KB, Accampo AE, Roberts DD, Choen WB. Western Civikization: Beyond Boundaries, Volume II, 6th Edition, Wadsworth, Boston, Massachesetts.

[24] Carrington D, The truth about London’s air pollution, The Guardian, 5th February, 2016, Accessed January, 2019.

[25] Vaughan A, Nearly 9500 die every year in London because of air pollution, The Guardian, 15th July, 2015, Accessed January, 2019.

[26] UK Air, What are the main trends in particulate matter in the UK? Chapter 7,, Accessed January, 2019.

[27] Stevens EE, Patrick TE, Pickler R. A history of infant feeding. J Perinat Educ. 2009;18(2):32-9.

[28] Hirschman C, Butler M. Trends and differentials in breast feeding: an update, Demography, 1981, 18:39-54.

[29] Riordan J; Countryman BA. “Basics of breastfeeding. Part I: Infant feeding patterns past and present.”, JOGN Nurs 1980., 9 (4): 207–210.

[30] Oatman-Stanford H, A Filthy History: When New-Yorkers Lived Knee Deep in Trash, Collector’s Weekly, Accessed Januray, 2019.

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