Copyright © Hans Högman 2021-09-10
Health Care and Diseases
in the Past (2)
Diseases of the Past - Sweden
Swedish names of diseases in earlier times often
ended with "sot" or "röta". For example, rödsot,
bleksot, rötfeber and lungröta. However, the
different diseases ending in ”-sot” or "-röta" were
not necessarily the same type of disease. "Sot" in
this context can be translated to "sickness".
Below is an account of the major diseases that have
struck Sweden over the centuries.
The plague or the Black Death is the disease that
people have feared most. From the mid-14th to the
early 18th century, the plague killed more people
than all the wars in world history put together. The
most famous epidemic was the Black Death (Swe:
Digerdöden) in the 14th century, when 25% of
Europe's population, about 25 million people, died.
In Sweden, it is estimated that the Black Death
claimed 200,000 lives. Sweden's population at the
time was just over 500,000.
Black Death came to Europe from Crimea in the
Black Sea. Via an Italian ship, which had been in
Crimea, the infection was brought to the city of
Messina in Sicily in autumn 1347. Then, the disease
migrated northwards and in spring 1348, Florence
was hit. In the same year, the plague spread across
most of Europe, with Paris, for example, being hit
The plague arrived in Scandinavia in 1349 on a
Hanseatic League ship, which drifted ashore at
Bergen, Norway. Over the next 6 months, Norway
lost about 30% of its population. The following year,
1350, Sweden was hit just as hard.
The plague was called the Digerdöden in Sweden
meaning the Great Death.
The plague affected all social classes, but the poor
were the worst affected. Poor hygiene, cramped,
dirty housing, lack of food, etc. were major causes.
Children were the worst affected. The contagious
agent was transmitted from person to person, e.g.
during a conversation or a visit to an infected
person. The infection could even be spread by
touching objects belonging to a plague-stricken
The infectious agent is found in rats and is
transmitted to humans by fleas. The incubation
period is 3-7 days, and the disease begins with high
fever, chills and headache. A local wound infection
first develops at the site of a flea bite, after which
the infectious agent spreads and causes a swelling
of the lymph nodes (abscess);
Those affected developed large abscesses under
their arms, on their neck and groin, high fever,
difficulty breathing, coughing up blood and foul
breath. Depending on how the sick were affected,
the plague was called bubonic plague, blood plague or
pneumonic plague. Those with bubonic plague had
about a 50% chance of survival, while the mortality
rate for the other types of plague was almost 100%.
Villages and areas could completely lay waste.
In Sicily, quarantine regulations were introduced in
1465 for incoming ships suspected of carrying the
disease. The word quarantine comes from the Italian
word quaranta, meaning forty. The ships suspected
of being infected had to anchor well outside the port
and stay there for 40 days, waiting to see whether or
not the plague would break out among the crew. For
those traveling by land, special letters were issued
guaranteeing that they came from a plague-free
area. With these letters in hand, the traveler could
pass through the city gates (passer par la porte in
French). From this word we get passeport, i.e.
The bacterium that causes the plague, Yersinia pestis,
was discovered in 1894. This bacterium is spread by
the black rat, Rattus rattus. Actually, it is the
bacterium's host, the plague flea (Xenopsylla cheopis),
which is spread by the black rat.
The plague also affected Sweden in the 15th and
16th centuries and the first half of the 17th century.
In the 16th century alone, Sweden was hit by dozens
of epidemics. Around 1640, regulations were
introduced in Stockholm, the capital of Sweden, that
plague stricken had to report it in good time so that
they could be taken to a special plague house. Failure
to do so resulted in punishment and banishment
from the city.
The last major epidemic ravaged the years 1710-
1713, starting in Stockholm in the autumn of 1710
and spreading throughout the country. In
Stockholm, an estimated 22,000 people died, almost
a third of the city's population. This was the biggest
disaster ever to hit the city. At its worst in October
1710, 1,600 people died in a single week.
After this time, plague epidemics became rare in
Europe. One of the reasons for this was that the
spread of the brown rat displaced the black rat.
Another dreaded disease was dysentery (Swe:
dysenteri). An old Swedish name for dysentery was
“rödsot”. Dysentery is the inseparable companion of
poor hygiene. Violent epidemics of dysentery raged
in Sweden in the second half of the 18th century.
Between 1773 and 1784, about 15,000 people died
of dysentery each year. Another major epidemic
raged in the years 1808 - 1813 with 50,000 deaths
and in the ten-year period 1851 - 1860, 26,000 died.
Only in 1898 was the
The image to the right shows
a hospital ward at the end of
the 19th century. Photo Hans
Dysentery is an intestinal inflammation that causes
bleeding in the intestine. Dysentery can be caused
by bacteria belonging to the genus Shigella
(shigellosis) or by a single-celled parasite, Entamoeba
histolytica (amoebic dysentery). The organisms are
spread through food or water contaminated by
Infection with shigella bacteria attacks the intestinal
wall and is characterized by fever, severe abdominal
stabbing pain, and often bloody or mucous stools.
In most cases of field disease (camp fever) that
struck soldiers, it was dysentery that was the real
The 18th century was the century of smallpox (Swe:
smittkoppor) in Sweden. Between 1749 and 1800,
270,000 people died from the disease. Smallpox was
an infectious disease caused by the Variola virus.
Children were the main victims.
In Europe, it is estimated that around 60 million
people died of smallpox during the 18th century.
Smallpox was an extremely contagious disease. In
terms of contagiousness, it was only equaled by
measles, with which it was often mistaken for well
into the 18th century.
Because smallpox was so contagious, the virus
literally swirled around the sick person, it was
enough to be in the same room as the sick person to
become infected, though not necessarily sick. The
incubation period is 10 - 14 days and then begins
with flu-like symptoms such as headache, fever,
backache, vomiting and diarrhea. On the second day
after infection, patients developed redness of the
skin and on the third day a rash. These rashes
developed into fluid-filled blisters, later filled with
pus. If the patient survived the first two weeks, he
usually survived, though often blind, deaf or bald
and for the rest of his life tormented by the
prominent scaring of the skin. If black pox (internal
bleeding) developed, virtually all patients died.
The virus was quite environmentally sensitive, which
made it very difficult to stop.
Authorities and politicians saw smallpox as the great
threat to prosperity and searched desperately for a
cure. The first step was to combat the disease by
inoculation or variolation.
Variolation was an early method of inducing
immunological protection against smallpox. This was
done by introducing smallpox pus through the skin
or nasal mucosa of a healthy person, seeking to
induce a mild form of the disease. Variolation
originated in oriental folk medicine and became
known and partly accepted in Europe in the early
18th century by the Englishwoman Lady Montagu.
Smallpox inoculation was introduced in Sweden in
1756 and inoculation against smallpox began in
1769, and on a larger scale from 1799. Smallpox
inoculation was a risky craft requiring great skill and
extreme caution. The first inoculation was carried
out in England.
The English "doctor" Edward Jenner produced a
smallpox vaccine that could be used as a
preventive treatment (though it is unclear how he
got his medical title).
Milkmaids infected by cowpox escaped becoming ill
with smallpox. From the lymph of a cowpox-infected
milkmaid, he made a liquid that he called vaccine
(from the Latin vacca = cow). Jenner made the first
vaccination on 14 May 1796. As vaccination was
much less risky than smallpox inoculation, it quickly
The first smallpox vaccination in Sweden was
carried out on 23 October 1801. The Swedish
authorities were early to take advantage of Jenner's
discovery. In 1816, Sweden became the first country
in the world to legislate that all children under the
age of two should be vaccinated against smallpox.
Vaccinations were initially carried out by priests and
parish clerks (klockare), but later by special
vaccinators. The parish ministers were also obliged
to record who in the congregation had been
vaccinated and who had not. This was done in a
separate column in the household examination roll.
Furthermore, this was also noted in the moving
However, it turned out that vaccination, unlike
inoculation, did not provide lifelong immunity. In
1839, the Swedish National Board of Health and
Welfare issued regulations on periodic vaccinations.
Today, smallpox is considered an eradicated disease.
Cholera (Swe: kolera) was the "plague" of the 19th
century. Cholera is a stomach disease with diarrhea
and vomiting, caused by a small bent bacterium,
Vibrio cholerae. It is spread by water and food.
During the period 1834-1873, Sweden was hit by
nine epidemics. In the largest of these, in 1834, more
than 25,000 people fell ill, of which more than half
The symptoms of cholera are very frequent bowel
movements with diarrhea but no or low-grade fever
and usually no vomiting. The diarrhea is caused by a
toxin secreted by the bacteria, which affects the cells
of the intestine, increasing the flow of fluid into the
intestine. If left untreated, the dehydration of the
body that results from diarrhea can lead to death. As
a result of the severe dehydration, the sick person
could shrink into a distorted picture of himself.
People were affected virtually without warning. After
a few hours, they could be dead. The normal
incubation period is 2 - 3 days, but sometimes only a
few hours. It is highly contagious but is sensitive to
dehydration and hardly spreads at all through the
The first time Sweden was hit by a cholera epidemic
was in 1834. That year, 3,500 people died of cholera
in Stockholm. In the 1860s, cholera also ravaged
Norrland (northern half of Sweden). In the 1850s,
cholera was rampant. Before 1817, it was completely
unknown on our continent.
When cholera came to Sweden in 1834, it was in
Gothenburg that it first arrived. The first case
involved a 52-year-old sailor, Anders Rydberg, and
occurred on 30 July. Then cholera spread
northwards. One of the Swedish cities worst affected
was Jönköping. One in three of the city's 3,300
inhabitants fell ill and one in six died. As usual, it was
the poorest and most run-down parts of the city that
were worst affected, in Jönköping it was
On 19 August 1834, Stockholm was hit by cholera.
On that day, Emanuel Malmberg, a customs officer,
fell ill with cholera. In Stockholm, it was the poor
Katarina parish in the South district (Södermalm)
that was particularly hard hit.
Special cholera cemeteries were set up to take care
of all those who died of cholera.
No one knew how the disease spread. The cholera
bacillus was not discovered until 1884 by Robert
Koch. If the bacillus gets into a water source, cholera
can spread explosively.
Special cholera hospitals were opened in major
cities. However, there was great distrust of the
hospitals, and people preferred to stay at home and
wait for death rather than be admitted to a hospital.
This mistrust was well justified as the doctors
themselves did not know what the disease was
caused by or how to cure it. Many people guessed
that cholera was related to poor hygiene, but it was
thought that bad air was the culprit rather than
The last major outbreak was in 1873, but then only
Skåne in the South of
Sweden was affected.
The image to the right
shows the interior of a
pharmacy at the
beginning of the 20th
century in Linköping.
Photo Hans Högman,
Tuberculosis or TB (Swe: tuberkulos, TBC) was
another troublesome disease. It affected the
respiratory tract. TB is an infectious disease and is
caused by mycobacteria. It was discovered in 1882 by
Robert Koch and can be transmitted from cattle to
humans, including through contaminated milk. In
Swedish, the disease was also called lungsot, tvinsot
eller vita pesten. In English, it is also known as the
great white plague and consumption. In the mid-19th
century, 4 million people a year in Europe died of
tuberculosis. Tuberculosis is the most deadly disease
in history, including the plague.
The infection is usually spread by coughing and
mainly affects elderly people and people with poor
nutritional status. The infection mainly affects the
lungs and pleural sack. It can spread through the
blood to other organs, which can become covered
with small infectious lesions, a life-threatening
condition known as miliary tuberculosis. As the initial
symptoms are mild, the sick person can spread the
infection without being aware of it.
Pulmonary tuberculosis peaked as a cause of death in
Sweden around 1875 and was then, as long before,
most prevalent in the provinces around Lake
Mälaren. Tuberculosis was then, with more than one
in ten deaths, still the most common cause of death
in Sweden, second only to the diseases of old age.
As late as the 1930s, nearly 10,000 people died each
year from pulmonary tuberculosis.
Early treatment methods include the Italian Carlo
Forlanini's pneumothorax treatment ("gas treatment",
"collapsed lung"), which he proposed as early as
1882 and which was applied well into the future as a
method to speed up healing.
At the end of the 19th century, the first TB
sanatorium in Sweden was built, in 1896 in Mörsil,
Jämtland province. Subsequently, a large number of
sanatoriums were established, including Österåsen,
north of Sollefteå (Y). The sanatoriums were always
located in a beautiful natural environment with a
healthy climate, preferably in mountainous areas
near forests and lakes. Finally, in the 1920s, a
vaccine against the tuberculosis bacterium, the BCG
vaccine, was developed. Live but weakened bacteria,
BCG (Bacille Calmette-Guérin), are injected. It was also
called the Calmette vaccine.
Vaccination provides some protection, but not
completely. In Sweden, all newborn babies were
vaccinated from the 1940s to 1975. Many people will
remember the annual tuberculin test at school. The
pupil received a shot in the arm, which was then
expected to produce a blush as a sign that the pupil
had adequate protection against TB. If the result was
negative, vaccination, Calmette vaccine, was given.
Spanish flu (Swe: Spanska sjukan) is the name given
to the severe influenza epidemic that swept the
world in 1918-1919 and is estimated to have caused
the deaths of around 20 million people. The cause
was a variant of influenza virus type A. The epidemic
got its name from the fact that it was first reported
in Spain. That was at the end of May 1918.
At the end of World War I, this severe influenza
epidemic spread throughout the world. In less than
12 months, more people died from Spanish flu than
had died on the battlefields of World War I.
Symptoms were high fever, cough, pain in the eyes,
ears, and lower back, soreness of the head and
throat, coating of the tongue, nausea, and a weak
and irregular pulse.
It arrived in Sweden at the turn of June and July
1918. The first cases occurred in Hyllinge parish
outside the city of Helsingborg in Skåne province.
In Sweden, about 35,000 people died during the
actual epidemic of 1918-1919 and another 3,000 in
1920. Here, as in the rest of the world, mortality was
highest among people aged between 20 and 40. The
new influenza variant often led to pneumonia with a
violent and dangerous course.
In the second half of 1918 alone, 516,013 cases were
reported in Sweden. The number of deaths among
these was 27,379. The population of Sweden at this
time was 5,700,000. In 1919, 200,000 people fell ill,
but the death rate dropped to 9,000.
In the United States, an estimated 500,000 people
have died from the Spanish flu.
In Sweden's northernmost sparsely populated areas,
Spanish flu hit particularly hard. In Arjeplog, nearly
3% of the parish's inhabitants died in a few weeks in
February and March 1920.
Health Care in the past
Swedish names of diseases in earlier times
History of the Swedish Hospitals
"Svenska sjukdomsnamn i gångna tider" av
Gunnar Lagerkrantz, tredje upplagan 1988,
utgiven av Sveriges släktforskarförbund.
"Vår Svenska Historia" av Alf Åberg, fjärde
upplagan, 1978 (sid 319-321).
"Hembygdsforska! steg för steg" av Per
Clemensson och Per Andersson, 1990, (sid 123).
"Allt var inte bättre förr .....", Om hälsovård och
sjukvård i Medelpad efter 1700 av Gösta
Skriften "Sundsvallsbygden" nr 15, årgång
14/97, artikel "Historiska fakta och berättad
familjehistoria i Sundsvallsområdet" sid 21 av
Skräckens tid, farsoternas historia av Berndt
Tallerud, Prisma 1999.
Gamla tiders sjukdomsnamn, Olof Cronberg,
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