It has been a while, Outlander friends! How are we all holding up? What have you been watching and reading? Any great recommendations? We’ve got some time to fill between now and September…
In the meantime, for those who haven’t seen the season 3 teaser (or just want to watch again!):
— Outlander (@Outlander_STARZ) April 17, 2017
A few months ago at a meet up with local Outlander fans, a lovely new friend commented that she’d read more than once of something called the morbid sore throat in the Outlander books and wondered what the heck it was. Strep throat? Abscess in the throat? Something else? With a name like morbid sore throat, it has got to be something pretty terrible!
References to the morbid sore throat are scattered throughout the Outlander books, including this excerpt from Dragonfly in Amber. Here, Claire learns the fate of the man against whom Jamie once dueled over his sweetheart Annalise de Marillac:
“A duel? With whom?” I asked, glancing around warily for any male attachments to the China doll who might feel inclined to follow up an old quarrel.
“Och, he isna here,” Jamie said, catching and correctly interpreting my glance. “He’s dead.”
“You killed him?” Agitated, I spoke rather louder than intended. As a few nearby heads turned curiously in our direction, Jamie took me by the elbow and steered me hastily toward the nearest French doors.
“Mind your voice, Sassenach,” he said, mildly enough. “No, I didna kill him. Wanted to,” he added ruefully, “but didn’t. He died two years ago, of the morbid sore throat. Jared told me.”
From Dragonfly in Amber by Diana Gabaldon, Chapter 11
In episode 202, this is changed to smallpox, which does tie in nicely with the smallpox epidemic at the docks in episode 201 and a later with Claire’s concoction to mimic the symptoms of smallpox in episode 206.
“The Scourge of Childhood”
The morbid sore throat, known now to us as diphtheria, was morbid indeed. Without modern treatment, half of those infected with diphtheria died, with the young and old particularly hit hard. Even now, with modern medicine, the fatality rate is 5-10%, but approaches 30% for those younger than 5 years or older than 40!
Much More than the Common Cold!
Transmitted through respiratory droplets from coughing or sneezing, or from touching a contaminated object, infection with diphtheria begins innocently enough. Initially, a person infected with diphtheria may experience symptoms of a typical cold – sore throat, fever, runny nose, body aches, cough, etc. However, within 2-3 days, it becomes clear this is no run of the mill cold. The diphtheria bacteria starts wreaking havoc by producing a toxin that acts by both suffocating and poisoning its victim.
The toxin begins to destroy the healthy tissues of the throat and upper respiratory tract. This dead tissue forms a thick grey substance called a pseudomembrane that adheres very tightly to the tissues and spreads over the lining of the nose, throat, tonsils, and even over the trachea, blocking the airway and suffocating the victim.
And as though that wasn’t enough, the toxin also spreads throughout the body causing damage in the heart and kidney as well as paralysis!
Prior to the era of antibiotics and vaccinations, diphtheria was one of the most dreaded of diseases, with frequent wide-spread outbreaks. Treatment options were few. Some attempts at intubation and tracheostomy were made to prevent suffocation from airway obstruction. No doubt many herbal and medicinal remedies were attempted, like this one from 18th Century New England. Devastating epidemics took countless lives, including as many as a third of all children under 10 in some New England towns from 1735-40. As recently as the 1920s, the US saw over 200,000 cases and over 15,000 deaths per year.
The start of widespread use of the vaccine in the 1940s led to a rapid drop in diphtheria cases. The CDC has had only 5 cases reported in the US in the past 10 years. However, it is still reported globally, with the WHO reporting 4,530 cases in 2015. Adults should receive the tetanus and diphtheria booster shot every ten years to remain protected!
Morbid sore throat is just one of many old wonderfully descriptive names for medical problems. Ague. Apoplexy. Dropsy. Quinsy. I’ve started a small glossary of them here and I’m sure there will be plenty more to add as we all read and re-read the big books!
Thank you to Gina for the question about the morbid sore throat! What archaic medical terms have you come across that you’d like to learn more about? Leave a comment here or find me on Twitter or Facebook if you have a suggestion for a post.
Stay strong, Outlander friends! September is coming!
Header image: STARZ