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Leeches for sale: The economy of bloodletting in France, 1827-1836

N8000057-Leech_use,_historical_artwork-SPLI found this great post on drug shortages that appeared in BMJ today.  Among all of the other great gems in it, was this incredibly interesting article on the creation of a mechanical bloodletting device. Jean-Baptiste Sarlandière, a French anatomist and inventor, created the “mechanical leech”, a device intended to extract a controlled amount of blood from the body. Sarlandiere intended the device to replace leeches, which were subject to increasing demand, were becoming expensive, were difficult to cultivate, and were subject to shortages in the Netherlands, who was a large producer of leeches at the time.

A paper was written on the device back in 2009, and within there is a dataset of leech imports and exports to France, which includes data on the monetary value of leeches and public consumption. Of course, I couldn’t resist pulling this data out and doing something with it (despite having better things to do.)

Here is the data, pulled from yet another paper (Alexandre E Baudrimont, Adolphe J Blanqui, et al.Dictionnaire de l’industrie manufacturie`re, commerciale et agricole, Paris, J-B Baillière, 1833–1841, pp. 25–30.):

Year Number of leeches imported Value in Francs National consumption Exports Import export ratio Value per leech
1827 33653694 1009611 33456744 196950 170.87 0.03
1828 26981900 809457 26689100 292800 92.15 0.03
1829 44573754 1337212 44069848 503906 88.46 0.03
1830 35485000 1064550 34745848 739250 48 0.03
1831 36487975 1094639 35245875 1242100 29.38 0.03
1832 57487000 1724610 55591700 1895300 30.33 0.03
1833 41654300 1249629 40785650 868650 47.95 0.03
1834 21885965 656579 21006865 879100 24.90 0.03
1835 22560440 676813 21323910 1236530 18.24 0.03
1836 19736800 592104 18721555 1015245 19.44 0.03

Leeches

Of course, I am fascinated with this. The number of leeches exported from France rose during this period as did the market price of each leech. Though the entire industry would eventually collapse because other medical advances of the nineteenth century would supercede it, it is clear that increased demand and expense led to innovation to create devices to replace it. I don’t know whether the “mechanical leech” led to the development of other medical devices, but would like to think that even batshit ideas like how swamp worms draw out blood to cure any and all medical conditions would lead to the creation of methods which do improve health.

Kenya 2017 Election Violence: Some Data Analysis

I’m getting used to the new version of ArcGIS (which is a vast improvement!) and gave it a test run on some data from the ACLED (Armed Conflict Location & Event Data Project) database, specifically on this years round of violence surrounding the Kenyan election. ACLED keeps real time data on violence and conflict around the globe, the latest entry in 2017 is Nov 24, just five days ago.

KenyaViolence2017

The first election occurred on August 8th, 2017. The opposition contested the results of the election, claiming problems in vote tallying by the IEBC, resulting in a nullification by the Supreme Court. A new election was called and was to be conducted within 60 days of the nullification. Raila Odinga, the opposition leader, claimed that the election again would not be fair, dropped out of the race and called for a national boycott. The election went ahead as place on October 26, 2017 and Uhuru Kenyatta was declared the winner.

NairobiViolence

 

 

There was violence at every stage of the process, both by rioters in support of the opposition and by the police and military who were known to fire live rounds into groups of demonstrators. Opposition supporters were known to set fire to Kikuyu businesses. Local Kikuyu gangs were reported to be going house to house rooting out people from tribal groups from the West and beating them in the street. Tribal groups in rural areas were reported to be fighting amongst one another. The police response has been heavy handed and disproportionate leading to a national crisis.

As of now, though not nearly as violent as the post election violence of 2007-08, the violence has not yet abated.

In the database, there were 420 events logged, including rioting, protests and violence against civilians by the state, police and local tribal militias. There are 306 recorded fatalities in the data base, but this number should be approached with some caution. There were likely more. The database is compiled from newspaper reports, which don’t count fatalities and don’t cover all events.
ViolentTSI made two maps (above), one for Nairobi, and the other for Kenya. They include all non Al-Shabaab events (a Somali Islamist group the Kenya Defense Force has been fighting for several years.) I also included a time series of both events and fatalities.

Some excerpts from the notes:

“Police raided houses of civilians in Kisumu, beating civilians and injuring dozens. Live bullets were used on some civilians, including a 14 year old boy. Of the 29 people injured, 26 had suffered gun shots.”

“One man was found dead in a sugar cane plantation one day after ethnic tensions between the Luo and Kalenjin communities got into an ethnic clash. The body had been hacked with a panga.”

“Rioters started throwing stones at the police in the morning, protesting against the elections to be held the next day. The police responded with teargas and water canons. The rioters were mostly from the Luo ethnic group and they took the opportunity to loot several stores, attack residents and to burn a store owned by an ethnic Kikuyu. One woman was raped.” *This was in Kawangware, not far from my apartment. I was eating at a local bbq place when this happened. 

 

 

“Police forces attacked supporters of the opposition that went to the Lucky Summer neighbourhood to check on a ritual of beheading of a sheep that was taking place (suspectedly by the Mungiki sect). The police shot at the civilians. The police confirmed that it shot a man and that the group performing the ritual had sought protection.”

“As a revenge to the previous event, the Kikuyu joined forces and attacked the Luo. The ethnic tensions and violence led to one severely injured person. Residents claims three were killed and dozens, including three school children, were injured.”

The issue of borders…

I was just reading this column in a special section of the NYT from Maano Ramutsindela, geographer from the University of Cape Town.

The partitioning of Africa by European empires has had devastating social, economic, political and psychological impacts, and millions of lives have been lost in post-independence Africa defending colonial borders. We are overdue for an African renaissance, completing the decolonization – which remains unfinished business until boundaries are changed.

His piece is mostly about the issue of parks, but the following came to mind.

1. Perhaps the author does not realize that millions of European lives have also been lost over the issue of borders. Historically, countries in Europe also haven’t fully represented linguistic groups (what is a language anyway?).

2. While from afar it may seem self evident to create states based on language, I’m wondering how that plays out in a country like Kenya, where there are more than 40 languages spoken and where, since often ethnic groups represent occupational groups, linguistic regions overlap. The distinctions between languages and cultures are often artificial anyway. Though the Maasai and the Samburu speak mutually intelligible languages and share almost identical cultural practices, they are bitter enemies and have been at war with one another for centuries.

3. Perhaps we might hope that African states worry more about how to keep themselves together and how to mend their internal divisions, rather than arbitrarily create more. It’s bad enough that the Kenyan government is weak and unresponsive to the needs of its citizenry, but the local governments haven’t shown themselves to be much more effective.

4. Perhaps, instead of dividing Africa even further, we might hope that African states learn to trade amongst one another. One of the main impediments to development is that fact that most African countries don’t trade with one another. There is no domestic trade economy. Could one imagine a world where European countries like Switzerland and Germany only traded with China and not each other? Cause that’s what’s happening in Africa.

5. Worse yet, it assumes that there is such a thing as a “natural” political unit. There is no such thing. All countries are artificially and have been created through mostly undemocratic means.

Worrying about colonial borders is a low hanging side show. While the colonial borders certainly impacted the ways in which modern Africa formed, in the end focusing on the issue is a convenient way of not having to dig more deeply into the complexity of present day facts. Present day Kenya is not a basket case simply because of misplaced borders. I think we should give Kenyans much more credit. These narratives often do to little to take African countries themselves to task for their own failings.

A sick mother will make a sick baby who becomes a sick adult

As much as we’d like to believe it, babies aren’t a blank slate. Babies not only bear the social and economic legacies of the families which produce the, but also the scars of a lifetime of immunological insults.

This week, a paper, “Does in utero Exposure to Illness Matter? The 1918 Influenza Epidemic in Taiwan as a Natural Experiment,” appeared in the journal of the National Bureau of Economic Research which tracks the long term effects of the 1918-1920 worldwide influenza pandemic.

Turns out that babies which were born to mothers in that period were, on average, shorter than people born in other years, had more developmental problems, and, possibly, suffered from long term problems of chronic disease.

This paper tests whether in utero conditions affect long-run developmental outcomes using the 1918 influenza pandemic in Taiwan as a natural experiment. Combining several historical and current datasets, we find that cohorts in utero during the pandemic are shorter as children/adolescents and less educated compared to other birth cohorts. We also find that they are more likely to have serious health problems including kidney disease, circulatory and respiratory problems, and diabetes in old age. Despite possible positive selection on health outcomes due to high infant mortality rates during this period (18 percent), our paper finds a strong negative impact of in utero exposure to influenza.

It’s interesting to me, in that it’s a study of health on one of Japan’s former colonies, but also because Taiwan’s indicators in 1918 were atrocious. More than a fifth of babies didn’t live to see their fifth birthday, deaths in childbirth were common and life was short. In other words, it’s a lot like a lot of African contexts today.

The long term outcomes of common developing world diseases have mostly been ignored. There is every reason to believe that one of the reasons African countries suffer economically is that people’s developmental trajectory is set before even exiting the womb. SO we’re fighting against not only a bleak economic past, but also against a constant legacy of infectious insults.

And to moms in the developed world…. get your flu shots.

Did pathogens influence the course of human development?

Roman toilets

Roman toilets

I would say “it depends.” I was just reading an interesting article on the “pathogen stress theory” of the development of human societies, most often attributed to Randy Thornhill, an evolutionary biologist at the University of New Mexico.

According to the “pathogen stress theory of values,” the evolutionary case that Thornhill and his colleagues have put forward, our behavioral immune systems—our group responses to local disease threats—play a decisive role in shaping our various political systems, religions, and shared moral views.

If they are right, Thornhill and his colleagues may be on their way to unlocking some of the most stubborn mysteries of human behavior. Their theory may help explain why authoritarian governments tend to persist in certain latitudes while democracies rise in others; why some cultures are xenophobic and others are relatively open to strangers; why certain peoples value equality and individuality while others prize hierarchical structures and strict adherence to tradition. What’s more, their work may offer a clear insight into how societies change.

This is a reasonable view, and something I’ve long observed from working on infectious diseases in developing countries. The developmental trajectory of a country is influenced by the deliberate avoidance of illness. An example can be seen in the locations of African cities. Many African administrative capitals are located on isolated, cool hilltops, far away from rivers and lakes. Colonialists would intentionally set up shop in areas where they were unlikely to encounter malaria.

Developmentally, this has had major implications for trade within Africa. European cities are often placed along water ways amenable to domestic European trade. The lack of trade between African countries is one of the reasons the continent has developed so poorly. This is the direct result of not only colonial priorities of resource extraction to Europe, but also the unfortunate placement of economic centers in response to malaria.

Certainly, the nature of cities themselves have much to do with the control of infectious diseases. Public works often involve the management of sewage waste and the delivery of clean water. Thornhill might suggest that the development of democracy, citizen involvement and taxation to pay for urban improvements are in direct response to enteric diseases.

However, while it is interesting to try to apply this view, it can be taken to the extreme:

Fincher (a graduate student of Thornhill) suspected that many behaviors in collectivist cultures might be masks for behavioral immune responses. To take one key example, collectivist cultures tend to be both more xenophobic and more ethnocentric than individualist cultures. Keeping strangers away might be a valuable defense against foreign pathogens, Fincher thought. And a strong preference for in-group mating might help maintain a community’s hereditary immunities to local disease strains. To test his hypothesis, Fincher set out to see whether places with heavier disease loads also tended toward these sorts of collectivist values.

I’m not sure it’s that easy to boil down political differences between Asia and Europe to a need to manage infectious disease. Certainly, Sweden is more collectivist than England, but I wouldn’t say that their infectious disease profiles are all that different.

Worse yet, if taken to the extreme, this “hunt for significance” will provide one with evidence to support any crazy theory at all. Pathogens exist wherever humans do. Moreover, we risk attributing the contribution of pathogens to human development based on current conditions, assuming that the present is deterministically preordained centuries ago. Until very recently, nearly the entire world was at risk for malaria, but despite this, various societies have embarked on different social and political trajectories.

The biggest problem I have with the theory is in its basic in rational theory. It assumes that humans are making rational choices based on pathogen threats, when we know, and particularly those of us who work in the tropics, that humans often have poor conceptions of disease transmission and causes of illness. At times, despite very obvious threate, humans will act in manners which exacerbate that threat. The history of enteric disease is filled with tales of ignorance and folly.

If we are going to subscribe to a rational model of political and social development which includes pathogens, then we have to also address first, the ability of pathogens to hijack human behavior to create new opportunities for replication and survival and second, that social changes can exacerbate the worst effects of infection. For the first point, I would look to the development of international trade systems which allow pathogens such as influenza to move around the world quickly, increasing opportunities for mutation to avoid immune responses. For the second I would point to polio, a disease which becomes a problem on after the introduction of water sanitation practices.

Thornhill’s ideas are interesting, and certainly provide good material for the popular press and BBQ conversation, but they require that the reader suspend too much consideration of the details of the complex history of human social and political development. Taken with restraint, as in the example of the locations of African cities, they can provide interesting insights into how current conditions are impacted by past pathogenic threats.

I like to think that we are doing better now…..

Every once in a while, you run across something that just gives you the chills.

“A report presented to the World Health Organization (WHO) in 1948 states: “It is not enough to quote that about 3,000,000 deaths are caused yearly by malaria in the world, or that every year about 300,000,000 cases of malaria occur …… that malaria is prevalent in tropical and subtropical areas where food production and agricultural resources are potentially very high, and that, by affecting the mass of rural workers, it decreases their vitality and reduces their working capacity and thus hampers the exploitation of the natural resources of the country. At a time when the world is poor, it seems that control of malaria should be the first aim to achieve in order to increase agricultural output” (WHO, 1948).

Snow RW, Amratia P, Kabaria CW, Noor AM, Marsh K: The changing limits and incidence of malaria in Africa: 1939-2009. Adv Parasitol 2012, 78:169-262.

I really don’t want the US to go back to 19th century monetary policy

But Ron Paul did.

I’m checking out the graphic below, and, first, wondering why anyone ever thought that gold was the only investment to make given it’s bubblish nature, and second, wondering what it must have been like to have investments in the 19th century. Granted, most people didn’t, and some people were even the targets of investment themselves. The wide volatility in the inflation rate must have driven people nuts.

If you owed money, one year, you’d make out like gangbusters, watching inflation obliterate your debt obligations, the next year, you’d watch your world crumble as the currency became worthless. If people owed you money, you’d be in the opposite pinch. Either way, you were screwed and had little ability to plan for the future. By the time you rode out the constant rough spots, though, you’d end up with the same amount of money you started with decades earlier. I’ll take steady inflation and reasonable economic certainty over crazyland, but Ron Paul might be into it, I guess.

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