Amboceptor

Microbiological, virological, bacteriological, immunological, medical, epidemiological, historical, anecdotal

Tag: Australia

Taiwau Bozu: The bald geisha plague of 1901

The strange disease which has produced so much hilarity came, it is said, from Formosa; and a person may conclude that he has been attacked by it when he gets up in the morning and finds a hitherto hairy poll as bare as a billiard ball. No other symptoms make their appearance. It is bad enough for the Japanese gentlemen, but the ladies are quite terrified at the prospect of losing those coiled masses of glistening, jet-black hair which are often veritable works of art.hairless-japan

In this light-hearted style, English-language newspapers noted of an “epidemic of baldness” which afflicted the rapidly-modernizing nation of Japan in 1900 and 1901. The Sydney Daily Telegraph‘s unnamed Tokyo correspondent, writing in March 1901, goes on to rhapsodize about the “long raven locks”, the “shiny coils and bride-cake intricacies”, which rested on the heads of “singing girls of the well-known type of Rudyard Kipling’s ‘O-Toyo, ebon-haired, rosy-cheeked, and made throughout of delicate porcelain’,” before revealing that “in at least three or four cases” prominent Japanese ladies have had their heads rendered egg-like and their status in society thereby ruined.

The article gives the impression that a lot more men than women have been afflicted, but “[t]he strong point of a Japanese [man] does not by any means lie in his hair, which generally sticks up on his head as bristly and as stiff as the hairs on a blacking brush.” Thus our sympathy should be directed at the “singing girls” or “dancing girls” who so prize their raven tresses. And the Japanese, led by their one famous bacteriologist (probably Shibasaburo Kitasato, though Hideyo Noguchi would soon achieve similar fame) can surely deal with this problem.

The study of medicine is pursued with great ardor and success in Japan, which claims the honour of having produced at least one bacteriologist of international fame; and it is not surprising, therefore, that the doctors are studying the new disease with the liveliest interest. It should be no difficult matter to get hold of the pestilent little microbe that is the cause of all the trouble.

* * *

The mysterious plague apparently originated on the island of Formosa (now called Taiwan), which was under Japanese military occupation, following the island’s relinquishment by China under the Treaty of Shimonoseki. Formosa was a poor place at the time, compared to Japan, and a plausible source for a tropical disease.

Also in 1901, the London Spectator gave a more clinical report of the outbreak, courtesy of Berlin correspondent Louis Elkind, probably summarizing German press reports. Evidently “there was an epidemic of baldness at Chiba last year, and there has been an even more serious one quite recently at Osaka, the same province where, as it will be remembered, an extensive epidemic of plague … prevailed in the last months of 1899 and at the very beginning of 1900.”

The effects of the disease exhibit several interesting peculiarities. The bald patches are irregularly spread over the head, but the first large one generally appears on the crown and extends down the back of the head instead of forwards towards the forehead; thus it may be that the back of the head is quite bald and the front covered with hair — the opposite of the course of baldness as we know it in Europe. Then, also, men’s beards are ravaged in a peculiar manner. The left cheek, say, may be completely bereft of hair while the rest of the beard is as usual, as also is the moustache, which, fortunately, is but slightly affected by the disease.

* * *

Elkind’s report sounds more plausible than the Sydney correspondent’s chatter about ladies “shedding their ebony tresses — and shedding at the same time tears large as eggs”.

Utamaro (1753-1806), Kami-yui (Hairdressing)

Utamaro (1753-1806), Kami-yui (Hairdressing)

But did this really happen?

No, according to Dr. Stuart Eldridge, friend of Ulysses Grant and longtime contributor of short dispatches from Japan to the ASPH journal Public Health Reports. Eldridge’s obituary suggests an interesting career, including at age 28 being part of “the scientific mission to Japan under General Horace Capron,” and staying in Japan until his death 30 years later.

After updating Public Health Reports on Japan’s plague outbreak of 1899-1900, Eldridge sent in two brief reports about the bald geisha plague (Report #1, Report #2). Here’s the first.

eldridge-japan-1

No source is cited, but Eldridge thinks the disease is spread quickly, is spread by barbers, originated in Osaka (though the Spectator claims it was in Chiba first), and there is evidence for all these assertions though we don’t know yet whether the baldness is permanent.

However… one week later, Eldridge has consulted with the leader of Japan’s bacteriological efforts, and now doubts that the outbreak ever happened.

I have communicated with Professor Kitasato, thinking that, if it was of the importance and malignity ascribed to it by the newspapers and common fame, the institution under his charge would have already begun the investigation of the matter. Professor Kitasato informs me that so far he has been unable to obtain proper material for study, and that the cause of the malady has not been, as yet, ascertained. I am now somewhat inclined to believe that both the number affected and the severity of the disease have been greatly exaggerated, and that it may eventually prove that the ordinary cases of alopecia, always rather prevalent in Japan, and neither contagious nor particularly severe, have been magnified by newspaper sensationalism into something new and alarming.

At the same time Kitasato published an article in the newspaper Jiji Shinpo. Given his stature in Japanese medicine, I’m guessing this was a decisive blow against the local baldness hysteria. Kitasato’s thoughts were summarized by Albert Ashmead in American Medicine — after first giving a sample of that hysteria.

albert-ashmead-taiwau-bozu

“In some villages the hair of all the women in the place has fallen out. The people call the hair plague ‘Taiwau Bozu.’ The disease has robbed several dancing girls of their beauty. It is said to have been imported from Formosa, and the health authorities have gangs of men at work disinfecting the poor quarters of the towns. The hair plague seems to be spreading over a large area.”

Allow me to observe that Taiwau Bozu is not a new disease. The words mean Formosan Priest. All Buddhist priests in Japan have the head shaved, and thus one who is completely bald is said to look like a priest, in fact is called “priest.” … Dr. Kitasao says that “it is not the first time the disease has been epidemic in Japan. It does not come from Formosa, although the people think so. It is not very contagious. It is the same disease which occurs all over Europe, etc.” Inasmuch as the syphilis of Formosa is fiercer than the syphilis of Japan, and the syphilis of Europe is fiercer than that of Formosa, so Taiwau Bozu’s ravages differ in different countries.

… The disease is simply epidemic Tokuhatz-fizo (bald disease); Alopecia areata of specific origin (syphilitic), and it is contagious.

So according to the experts, we have a minor urban flare-up of secondary syphilis. (“The classic alopecia of secondary syphilis is patchy with a “moth-eaten appearance” and has been reported in up to 7% of patients.”) Possibly associated with the return of military forces from Taiwan (or Taiwau), as outbreaks of venereal disease sometimes are. Albert Ashmead’s interest in Japanese history lets him put the whole thing into perspective.

I add that in 1967, when the licensing of prostitution went into effect in Japan, the professions for women of “Geisha” dancing, tea-house and archery-gallery keeping, became crowded with prostitutes (more or less syphilitic) to evade the payment of the government tax. Then the hospitals of Tokio had to do with a great number of cases of syphilitic alopecia in no way different from the present outbreak

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Yeast vs. Typhoid: Requiem

In 1891, a flurry of medical interest followed the experiments of Auguste de Bavay, a 35-year-old Belgian chemist and yeast expert, who had moved to Melbourne, Australia in 1884 and quickly revolutionized the colony’s primitive brewing industry.

Dr. J. W. “Springy” Springthorpe was the Vice President of the British Medical Association, Victorian Branch (“Victorian” as in “Victoria, Australia”, thus this was basically the Melbourne Medical Association). To publicize a new use for his beloved Saccharomyces yeast, Monsieur de Bavay (he is universally referred to as “Monsieur de Bavay” in these articles) wrote a speech that was read by Dr. Springthorpe at the June 1891 meeting of the Victorian Branch.

In 1891 M. de Bavay was working for the Victoria Parade Brewery, makers of fine ales.

In 1891 M. de Bavay was working for the Victoria Parade Brewery, makers of fine ales.

Earlier, M. de Bavay had become aware of an interesting sample of fluid, consisting of chyle (fat-rich lymph from the lymphatics that drain the intestines) from someone with a chest injury.

Some time last year, Dr. Cox introduced Dr. O’Hara to me, and submitted for analysis a milky-looking fluid, which they believed to be possessed of antiseptic and deodorising properties, this fluid having escaped from the thoracic duct through an ulceration.

There’s no indication of why Drs. Cox and O’Hara believed this, but M. de Bavay found that they might have been right. The fluid contained no culturable organism, except for a Saccharomyces yeast that he assumed was a contamination from his brewery work. Which it probably was, so the original fluid is irrelevant for what follows. But then…

Some six months afterwards, however, I examined these flasks again. To my surprise, though in every instance I had sown considerable quantities of the chyle, no bacteria had made their appearance in either medium. … To further test the power of these saccharomyces to resist the growth of bacteria, I mixed some germs of putrefaction with them. The result was, that the saccharomyces developed very rapidly, whilst it was difficult to find traces of the germs of putrefaction. Some of these saccharomyces added to matter undergoing putrefaction, and very foul smelling, removed the offensive odour in a very short time.

* * *

There’s no need to go through all of M. de Bavay’s results, which are presented in the June 1891 issue of the Australian Medical Journal, pages 351-360 (available at Google Books here). A synopsis was syndicated in various other publications (e.g the Montreal Medical Journal (1890), pages 631-632). The main points are as follows (I don’t know how much of this is true):

  • Typhoid bacilli (what we now call Salmonella Typhi) produce more of their toxin under alkaline conditions. Toxicity was measured by taking bacterial cultures, heating them to kill the bacteria, and injecting them into guinea pigs.
  • Under these conditions, most of the toxin precipitates into a solid, instead of remaining dissolved.
  • Yeast produce acid as they grow.
  • Acid is good, because it makes the typhoid toxin stay soluble, thus poisoning the bacteria themselves. This is similar to the way yeast eventually produce so much alcohol that the yeast themselves get poisoned.
  • Also, typhoid toxin that stays in solution in the gut might have an additional benefit: activating the immune system to attack typhoid bacteria.
    “Pasteur, Roux, Chantemesse, Vidal, Martin, Hankin, Salomon, Charrin, Ruffer, and others, have proved that immunity can be given to animals by injecting the soluble products of the life of the microbe. This is precisely the effect I claim for yeast, when its acid renders soluble the poison of typhoid and allows of its absorption. Consequently, the yeast is not the direct cause of the cure, but the means of bringing about an automatic vaccination of the tissues with the produce of the growth of the typhoid bacilli.”
  • It’s perfectly safe to feed people large amounts of yeast, with regular food or by itself.
  • Adding sugar makes the yeast work better. Particularly maltose, as found in barley.
  • Dr. Matthew Barclay Thomson of the Alfred Hospital has “given a clinical trial to the cure thus recommended.” He’ll be presenting the results soon.

* * *

At the next month’s meeting, there was considerable discussion of this, followed by Dr. Barclay Thomson’s presentation of his clinical results, all taking up pages 402-407 of the July Australian Medical Journal (found in the same 1891 pdf file linked above). And here’s the electrifying conclusion:

barclay-thomson-yeast

Well, that sounds good!

And yet, I don’t see any further work on this would-be cure. It sounds vaguely plausible, particularly from the probiotic perspective, in a world without antibiotics. Dr. Barclay Thomson also says:

The striking difference between [the various drugs that have been used to attempt to destroy the germs] and the saccharomyces is the power the latter has of reproducing itself, in its passage through the intestines.

And another doctor points out in the discussion that during typhoid, evidence from the feces suggests that the normal bacteria have effectively been outcompeted and replaced by the typhoid bacteria. Maybe something else could outcompete typhoid! But it was not to be.

* * *

The Australian and New Zealand media certainly took note of these investigations. In fact, before his presentation to the medical society, M. de Bavay attracted attention from ordinary doctors and patients.

February 27, 1891: “A physician” interviewed for the Melbourne Argus expresses extreme distaste for the whole idea and suggests that the idea of yeast as an antibacterial agent was debunked 50 years ago.

March 18, 1891: The Argus reports the death of a patient being treated by Dr. Springthorpe with M. de Bavay’s fungal concoctions. However, this is not proof that the treatment is worthless.

July 4, 1891: A correspondent writes the Melbourne Age with evidence that yeast is useful for typhoid and other fevers. Apparently Edmund Cartwright, inventor of the power loom that so enraged the Luddites, had been a medical student. Cartwright wrote in his memoirs that when he was practicing in the benighted village of Brampton, Derbyshire, he gave yeast to a boy whose typhoid responded to no other treatment, and it worked great, especially for something that was affordable to the impoverished townsfolk of Brampton.

Of course, this would have been around 1775, so if it hadn’t spread into popular use over the ensuing century, it probably didn’t work. But it’s always good to give something a second try, when it can be improved by new scientific methods!

Most Nourishing

Disillusioned by his failure to cure typhoid, M. de Bavay left Victoria Parade and turned corporate, helping Foster’s accelerate mass production of its watery lager.