**7. Neonatal tetanus<sup>10</sup>**

The best known health problem of these islanders was neonatal tetanus, causing the desperately distressing and tragic death of up-to two thirds of the babies born on St Kilda for at least a hundred and fifty years, between 1750 and 1900.

A visit to the island for three weeks was made by Martin Martin MD in 1695. He was an astute observer of all facets of life, yet noted:

'*They are not infested with several diseases which are so predominant in the other parts of the world*'.

The first mention of *trismus nascentium* or *tetanus neonatorum* was made by the Rev. Kenneth Macaulay, minister of Ardnamurchan, after a visit to the island of St Kilda in 1758, 61 years after Martin's visit. His 278 page book contains less than one page, quoted in full below, about these tragic neonatal deaths for which he had no explanation.

'*The St Kilda infants are peculiarly subject to an extraordinary kind of sickness; on the fourth, fifth or sixth night after their birth, many of them give up suckling; on the seventh day their gums are so clenched together that it is impossible to get anything down their throats; soon after this symptom appears, they are seized with convulsive fits, and after struggling against excessive torments, till their little strength is exhausted die generally on the eighth day. I have seen two of them expire after such agonies. It is surprising that Martin, who was himself bred to physic, and a person of unbounded curiosity, should have passed over in silence a circumstance so very striking, supposing that this very uncommon distemper had got any footing on Hirta in his time.*'

It seems highly improbable that Martin could have overlooked this classical description of neonatal tetanus. Possibly some important sterile technique was not passed on from one village midwife to her successor early in the 18th century, unfortunately the delivery methods were never documented or observed by a doctor or indeed any other male. Handover remains an imperfect process in current medical circles. The deaths continued and were documented by Dr John Morgan MA, MB, MRCP, on his visit to St Kilda in 1860 from the parochial Island Register kept by the resident missionary, the Rev. Neil Mackenzie.

The major source of food was the gannet and fulmar, caught on the cliffs and consumed either as eggs or as young birds, both fresh and cured. Boiling was the usual method of

Fishing was important, but at times was impossible due to the unpredictable weather and heavy seas. Much of the St Kildans' food produce, including most of their agricultural crops, was paid as rent and taken to Harris or consumed by visitors, leaving a nutritionally limited

Studies of Ascorbic acid supplements have shown some benefit in the treatment of respiratory infections, particularly in patients with more severe illness and pre-existing low vitamin C levels. Tetanus was another serious problem on St Kilda, and vitamin C deficiency may have contributed to the high death rate. A study has shown that the addition of 1,000 mg ascorbic acid to the standard therapy of anti-tetanus serum, sedatives and

The island population suffered from many diseases caused by micro-organisms including

The best known health problem of these islanders was neonatal tetanus, causing the desperately distressing and tragic death of up-to two thirds of the babies born on St Kilda

A visit to the island for three weeks was made by Martin Martin MD in 1695. He was an

'*They are not infested with several diseases which are so predominant in the other parts of the world*'. The first mention of *trismus nascentium* or *tetanus neonatorum* was made by the Rev. Kenneth Macaulay, minister of Ardnamurchan, after a visit to the island of St Kilda in 1758, 61 years after Martin's visit. His 278 page book contains less than one page, quoted in full below,

'*The St Kilda infants are peculiarly subject to an extraordinary kind of sickness; on the fourth, fifth or sixth night after their birth, many of them give up suckling; on the seventh day their gums are so clenched together that it is impossible to get anything down their throats; soon after this symptom appears, they are seized with convulsive fits, and after struggling against excessive torments, till their little strength is exhausted die generally on the eighth day. I have seen two of them expire after such agonies. It is surprising that Martin, who was himself bred to physic, and a person of unbounded curiosity, should have passed over in silence a circumstance so very striking, supposing that this very* 

It seems highly improbable that Martin could have overlooked this classical description of neonatal tetanus. Possibly some important sterile technique was not passed on from one village midwife to her successor early in the 18th century, unfortunately the delivery methods were never documented or observed by a doctor or indeed any other male. Handover remains an imperfect process in current medical circles. The deaths continued and were documented by Dr John Morgan MA, MB, MRCP, on his visit to St Kilda in 1860 from the parochial Island Register kept by the resident missionary, the Rev. Neil Mackenzie.

cooking all meals, which would have further reduced the vitamin C content.

diet of seabirds, eggs, fish and the less nutritious vegetables for the islanders.

antibiotics reduced the mortality in children aged one to 12 years. 9

leprosy and tuberculosis, the more common conditions are discussed.

for at least a hundred and fifty years, between 1750 and 1900.

about these tragic neonatal deaths for which he had no explanation.

*uncommon distemper had got any footing on Hirta in his time.*'

**6. Infectious diseases on St Kilda** 

astute observer of all facets of life, yet noted:

**7. Neonatal tetanus<sup>10</sup>**

He noted thirty-three of the recorded 64 island deaths between July 1830 and September 1840 were attributed to the 'eight-day sickness'. Morgan spoke to the midwife, Betty Scott, who had herself lost 12 out of 14 of her own children to this condition about the clinical features. Scott excluded any obvious congenital problem stating:-

*'At the time of birth, there was no appreciable physical inferiority on the part of those infants who were so prematurely and suddenly selected as a prey. They were all proper bairns, and so continued till about the fifth or sixth day. The mother's eye might then not infrequently observe on the part of her child a strange indisposition to take the breast.'* 


Table 1. Figures from the Island and District Registers (incomplete 1840–56)

Graph 1. day of death

Limited Bio-Diversity and Other Defects of

outside.

cause.

Fig. 13. Fulmar gull

**8. The Smallpox epidemic in St Kilda<sup>7</sup>**

the Immune System in the Inhabitants of the Islands of St Kilda, Scotland 233

The solution was finally discovered in 1890 by the Rev. Angus Fiddes, a Free Church clergyman and scientist, who lived and worked on St Kilda. He visited the leading obstetricians in Glasgow, identified the problem as neonatal tetanus, and learned the latest delivery techniques, which when correctly applied prevented any further deaths, though some of the island women were initially opposed to new ideas and to a new midwife from

The precipitating cause remained unknown, and for some 80 years, the unsubstantiated view of Dr George Gibson FRCPEdin, that anointing the umbilical cord with oil from the fulmar gull caused the infection, held sway. Clearly some unhygienic midwifery practice was the cause, and recent bacteriological studies revealing the gull oil to be sterile, yet the soil, inside and outside the house and storage cleits, to be heavily infected with tetanus, suggests cutting the umbilical cord with an unsterilized blade, such as the dirty rusting lancet still used on St Kilda for bloodletting in the early 20th century, a much more probable

Biodiversity appears to play no part in the neonatal tetanus tragedy; however St Kildans

Smallpox outbreaks were common on the Scottish Islands in the eighteenth and nineteenth centuries. All the islands had a similar hostile climate, and varying degrees of isolation and malnutrition. Ten outbreaks occurred on the Shetland Islands between 1700 and 1830. The 1740 diary of Thomas Gifford of Busta, from Greig's *Annals of a Shetland parish*,7 recorded that two of his daughters became unwell and bed-bound, developed a rash five days later and died a further eight and nine days respectively after that. Some of Gifford's 11 other children developed a rash but all survived, thus illustrating the typical features of smallpox:

were also susceptible to common viral contagious diseases which had severe effects.

The problem persisted late in the 19th century, with frequent deaths, personal and family tragedies, and a failure to replenish the society with children who would ultimately sustain the workforce. George Murray, the island's schoolteacher, wrote in his diary on 12th December 1886:

*'Last night at 10.30, after six days' intense suffering, the child departed this life. Every one expressed great wonder how it lived so long after being seized with the illness, as they generally succumb at the end of a week after they are born. This one was 13 days except one and a half hours. It had a frequent cry since it was born; but the first signs of its being dangerously ill was at the end of a week, when it ceased to suck the breast, but still sucked the bottle. The following day, the jaws fell (thuit na gilan), when all hope of its recovery were given up. From that time until its death it occasionally took a little milk in a spoon or out of a bottle. The last two days a little wine in water was given once or twice. It often yawned and sometimes looked hard at you. It was pitiful to see the poor little things in the pangs of death. May God prepare us all for the same end.'* 

When the child was buried, Murray wrote, showing significant insight into the cause of neonatal tetanus in the last sentence:

*'In the grave which was opened, I saw the coffins of its two little brothers that died in the same way. The one coffin was quite whole, there being only about 16 months since it was interred. On looking through the churchyard, I felt sad at the sight of so many infant graves. One man, not yet 50 years old, I should say, pointed to the place to me where he buried nine children. He is left with four of a family. Another buried no less than a dozen infants and is left with two now grown up. Sad to think of the like. Bad treatment at birth must have been the cause of so many dying.'* 

Fig. 12. Graveyard

The solution was finally discovered in 1890 by the Rev. Angus Fiddes, a Free Church clergyman and scientist, who lived and worked on St Kilda. He visited the leading obstetricians in Glasgow, identified the problem as neonatal tetanus, and learned the latest delivery techniques, which when correctly applied prevented any further deaths, though some of the island women were initially opposed to new ideas and to a new midwife from outside.

The precipitating cause remained unknown, and for some 80 years, the unsubstantiated view of Dr George Gibson FRCPEdin, that anointing the umbilical cord with oil from the fulmar gull caused the infection, held sway. Clearly some unhygienic midwifery practice was the cause, and recent bacteriological studies revealing the gull oil to be sterile, yet the soil, inside and outside the house and storage cleits, to be heavily infected with tetanus, suggests cutting the umbilical cord with an unsterilized blade, such as the dirty rusting lancet still used on St Kilda for bloodletting in the early 20th century, a much more probable cause.

Biodiversity appears to play no part in the neonatal tetanus tragedy; however St Kildans were also susceptible to common viral contagious diseases which had severe effects.

Fig. 13. Fulmar gull

232 Biodiversity Loss in a Changing Planet

The problem persisted late in the 19th century, with frequent deaths, personal and family tragedies, and a failure to replenish the society with children who would ultimately sustain the workforce. George Murray, the island's schoolteacher, wrote in his diary on 12th

*'Last night at 10.30, after six days' intense suffering, the child departed this life. Every one expressed great wonder how it lived so long after being seized with the illness, as they generally succumb at the end of a week after they are born. This one was 13 days except one and a half hours. It had a frequent cry since it was born; but the first signs of its being dangerously ill was at the end of a week, when it ceased to suck the breast, but still sucked the bottle. The following day, the jaws fell (thuit na gilan), when all hope of its recovery were given up. From that time until its death it occasionally took a little milk in a spoon or out of a bottle. The last two days a little wine in water was given once or twice. It often yawned and sometimes looked hard at you. It was pitiful to see the poor little things in the pangs* 

When the child was buried, Murray wrote, showing significant insight into the cause of

*'In the grave which was opened, I saw the coffins of its two little brothers that died in the same way. The one coffin was quite whole, there being only about 16 months since it was interred. On looking through the churchyard, I felt sad at the sight of so many infant graves. One man, not yet 50 years old, I should say, pointed to the place to me where he buried nine children. He is left with four of a family. Another buried no less than a dozen infants and is left with two now grown up. Sad to think* 

*of the like. Bad treatment at birth must have been the cause of so many dying.'* 

December 1886:

Fig. 12. Graveyard

*of death. May God prepare us all for the same end.'* 

neonatal tetanus in the last sentence:
