Medicine: Disease: 1. Disease

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1. Disease

This article is meant to give some pointers to authors. It is not intended to be comprehensive, and it simplifies many complicated issues.
If you find something inaccurate, please email me. If you have questions that are not addressed, I'd be glad to add information to address them.
Warning! This article is somewhat graphic in a clinical way. Not for the very squeamish.


There isn't a lot of information on disease in Middle-earth. We know elves don't get sick, and that men and hobbits do. I am unsure about dwarves, but I would assume that they do. Orcs are a tossup. If they take after the elves they were originally perverted from, they might not. However, looking at their teeth, one could certainly argue that they do get diseases.

Plague
The Great Plague occurred in 1636 and affected Gondor, Rhovanion, and Eriador, including the Shire. Since another name given was the Dark Plague, could it have been similar to the Western Europe's Black Plague? If one equates the two, it is bubonic plague, caused by Yersinia Pestis. The discussion below all pertains to bubonic plague.
Plague is spread 3 ways: by fleas from infected rodents, direct contact with infected tissues or fluids from handling sick or dead animals or people, airborne droplets from cats (yup, that's what the scientific sites say) and people with pneumonic plague.

Plague causes very painful, usually swollen, and often hot-to-the touch lymph nodes, called buboes, and is accompanied by fever and extreme exhaustion.
Onset of bubonic plague is usually 2 to 6 days after a person is exposed. Initially the patient will have fever, headache, and general weakness, then the development of painful, swollen lymph nodes. The disease progresses rapidly and the bacteria can invade the bloodstream, producing severe illness, called plague septicemia. Without antibiotic treatment, bubonic plague is about 50% fatal.

Onset of pneumonic plague is usually 1 to 3 days after a person is exposed. The character will have overwhelming pneumonia with high fever, cough, bloody sputum, and chills. Without antibiotic treatment, it is nearly 100% fatal.

Septicemic plague occurs when the bacteria gets into the bloodstream, and the patient will have fever, chills, extreme weakness, abdominal pain, shock and bleeding into skin and other organs. It is also nearly 100% fatal.

Treatment in Middle-earth
As soon as a healer suspects plague, the patient should be isolated. Anyone closely associated with the patient, particularly in cases with pneumonia, should be examined for evidence of disease. Contacts of pneumonic plague patients should be placed under observation, as this is much more easily spread person to person.

The prevention measures available in Middle-earth are similar to public health measures today. Isolate known, or even suspected cases. General infection control techniques are extremely important: good handwashing, disposal of contaminated clothes and dressings, and sterilization of instruments by boiling. Control rats by eliminating food and shelter for them, by making buildings as rat-proof as possible, and by removing brush, rock piles, junk, and food sources.

Herbs that are reported (nonmedical literature) to deter fleas:
Sachets of cedar, rosemary and pennyroyal. Dried branches and leaves of lavender, savory, wormwood, rue and pennyroyal.
Plant rows of insect repelling herbs in a plant border. Use plants such as rosemary, rue and pennyroyal inter-planted.

Note that there are quiet periods, during which few people get plague, and these periods may last for years. Plague is not considered to be something that can be completely eliminated. It can always reappear. Poor sanitation, overcrowding, and high numbers of rats are conditions that make transmission of the disease more likely.


Sanitation:
This is extremely important in preventing disease. It is not something most authors include, but there are situations to use it. One fantasy that does it well is Elizabeth Moon's "The Deed of Paksenarrion," published several years ago.

If you have nine people wandering in little traveled areas, it may not make much difference. If you have an army of several thousands, good sanitation practices are crucial to keep your soldiers from getting sick. (Nuzgul for someone: An army of orcs, who can't be expected to have good sanitation, gets so sick of dysentery that the good guys never even have to fight.) This is especially important for prolonged sieges or camps. In the American Civil War, two soldiers died of disease (dysentery, diarrhea, typhoid, and malaria) for every one killed in battle. It was even worse in earlier wars, as by the Civil War sanitary practices were known.

An interesting speculation on one BB's "Geek thread" had to do with hobbit longevity, and noted that hobbits like to bathe, a good infection control practice. The same thread noted that the chamberpots seen under the beds in Bree also indicated good sanitation practices, but having chamberpots isn't enough. It's what you do with the contents that really counts.

From a US Army field sanitation manual:
A latrine can be no closer than 100 ft (30.5 meters) to a water source.
A latrine should be at least 100 meters (328 ft or 109 yards) downhill or downstream in relation to the mess hall.
Garbage pits should be located at least 90 ft or 30 yards (27.5 meters) from the mess hall, and no closer than 100 ft (30.5 meters) from any water sources.

A straddle trench should measure 1 ft (.3 meters) wide, 4 ft (1.2 meters) long and 2 1/2 ft (.8 meters) deep.
Enough straddle trenches should be dug to accommodate 8 % of the unit at one time.

This information can be found here Field Sanitation Manual


If you want to make your healer believable, have them wash their hands whenever possible. Note that book Aragorn is always having someone heat water. Unfortunately he is usually only descibed as using it to steep athelas, but also occasionally to bathe wounds.
Personal peeve: Don't have your characters wash wounds, poisons, or infected body parts in a stream. Take water from the stream to the contaminated body part. Unless of course the only people downstream are orcs, and no one else could possibly be affected by the contaminated stream you have just created.

This is a work of fan fiction, written because the author has an abiding love for the works of J R R Tolkien. The characters, settings, places, and languages used in this work are the property of the Tolkien Estate, Tolkien Enterprises, and possibly New Line Cinema, except for certain original characters who belong to the author of the said work. The author will not receive any money or other remuneration for presenting the work on this archive site. The work is the intellectual property of the author, is available solely for the enjoyment of Henneth Annûn Story Archive readers, and may not be copied or redistributed by any means without the explicit written consent of the author.

Story Information

Author: Lyllyn

Status: General

Completion: Complete

Era: Other

Genre: Research Article

Rating: General

Last Updated: 12/17/02

Original Post: 10/31/02

Go to Medicine: Disease overview

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