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University of Toronto Scarborough

ANTC68 WINTER 2013 Lecture # 2 - Epidemiology HISTORY OF EPIDEMIOLOGY  Hippocrates (460-377 BCE) o Book: ON AIRS, WATERS, AND PLACES o Seasonality and its impact on health o FATHER OF MEDICINE – A Greek Physician o Believed in HUMORAL Theory o Adhered to the principles of OBSERVATION in medicine o Diseases come from an IMBALANCE in nature; HOLISTIC o Thought that LOCATION impt. To determining disease outcomes o Recognized SEASONALITY of epidemics and treatments o Believed in MIASMA (Bad Air) as a cause of disease o Medical doctors still take the Hippocratic Oath  Anton van Leeuwenhoek (1632 – 1723) o FATHER OF MICROBIOLOGY o Visualized bacteria under the lens of a basic microscope o Important precursor to the GERM THEORY  John Graunt (1620-1674) o BILLS OF MORTALITY o Recognized SEASONALITY of epidemics o The Bills of Mortality began late 1500’s after the plague, important source of demographic info via searchers  Edward Jenner (1749-1823) o FATHER OF IMMUNOLOGY o 1796: Inoculated boy with milkmaid’s cowpox blister’s pus  injected boy with pus from active smallpox patient  boy lived o Vaccination eventually led to the eradication of smallpox  John Snow (1813-1858) o FATHER OF EPIDEMIOLOGY and Anesthesiology o August 1854 – London was experiencing yet another cholera epidemic o Didn’t believe in miasma theory, thought cholera was spread by drinking water contaminated by fecal waste o Broad Street Pump – realized it was the source and so he removed the handle but cholera deaths were already declining so no one believed him because MIASMA and no disease agent seemed more convincing o Shoe Leather Epidemiology: Door to Door to Ask Questions  William Farr (1807-1883) o FATHER OF EPIDEMIOLOGY o Registrar General of London o Bills of Mortality o Life Table – form of EVENT HISTORY ANALYSIS  Provides life expectancy at birth/number of years remaining  A way to see how mortality changes with age ANTC68 WINTER 2013 o Precursor to International Classification of Disease (ICD)  Ignac Semmelweiss (1818-1865) o FATHER OF EPIDEMIOLOGY o Hungarian Doctor o 1846: Maternal Death due to physicians not washing hands and transmitting PUERPERAL FEVER to women in labour by physicians who came directly from autopsies o Told them to wash hands with lime which decreased mortality rates but didn’t make him too popular o 1865: committed to an asylum for the mentally insane where he died  Louis Pasteur (1822-1895) o FATHER OF MICROBIOLOGY o Fermentation caused by microorganizatims, created PASUTERIZATION o Experiments supported GERM THEORY  Robert Koch (1843-1910) o FATHER OF MICROBIOLOGY o Identified Bacterium for tuberculosis and cholera o Death to Miasma theory o KOCH’S POSTULATES  Organism MUST be present in EVERY case of the disease but not in healthy individuals  Organism must be capable of being isolated from the sufferer and grown in pure culture  Specific disease must be reproduced when a pure culture of the organism is inoculated into a healthy, susceptible host  The organisms must be recoverable from the experimentally infected host o Problems with Koch’s Postulates  Asymptomatic disease carriers  New way to discriminate  Individual rights now secondary to the good of the community  Some organisms difficult to grow in culture  Humans no longer linked to their environment as with miasma theory  Single microorganism can produce multiple diseases  Penicillin and Medical Reductionism o Penicillin discovered by Alexander Fleming o As early as 1928, he recognized that something had contained
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