TUBERCULOSIS (Captain of Men of Death)
◦ 9 million people annually 1person/second.
◦ 2.5 million people died every year, or 1 person/15 seconds
1. Women as primary caregivcrs.
2. Women spending time at home with the sick.
1. The onset (stressor) of childbearing/giving birth.
2. Symptoms of cough and sputum expectoration is less common in
3. Women delayed the seeking of treatment.
Bovine (M. Bovis)
◦ Possible that TB is a mutant bovine form.
◦ Domestication of cattle (Neolithic 6000-7000BC, Old World) – TB was
1. Non-motile (incapable of motion), rod-shaped.
2. Covered in 'waxy sheath'.
3. Does not produce any significant toxin.
4. Multiplies slowly (6-12 hours).
5. Can survive outiside human host.
6. Can survive dessication (it doesn't dry up).
7. 4000-gene sequence or genome of the TB bacillus.
8. 24hr: An infected host can expel 2-4 bacilli.
9. Immune system response – only a fraction of those infected will
develop active disease.
◦ Influence on genetics.
Transmission optimal conditions:
◦ Poor public/personal hygiene.
Resistance Diseases Decline in deaths due to respiratory tuberculosis (1830-1860)
Identified in 1880 (Robert Koch).
Chemo and vaccines in 1950s.
Frost & Grigg: A theoritical plot of TB morbidity and mortality.
Morbidity is sickness, mortality is deaths.
Mortality or death rate=total number of deaths/population at risk. Expressed as a
proportion or rate.
Crisis Mortality as an Agent of Change
The sudden and dramatic increase in the death arising from a common,
unusual casual factor operation for a limited period.
Triggered by famine, flood, drought, war, epidemic, smog.
In most western industrialized countries, there has been a progressive
decline in the death rate.
The improvement in health varies in every population.
◦ Uniqueness of the mortality experience.
Decline occurred before modern medical biomedicine.
◦ Better living quality/hygiene.
◦ Selection/immunity takes place.
Epidemiological transition (Omran): Population goes to stages and phases.
A sudden increase in an infectious disease frequency above typical
background or prevailing death rates for a given population.
Pandemic: A special case of an epidemic which is spread over a vast
geographic area. Massive Disease Outbreak
Trying out new medicine.
1818: Flu crisis
Creating a catastrophe.
Gibraltar Case Graph
Logit: p/1-p, where p is a proportion.
3 distinct time: Periods of marked change.
The lines of best fit.
The shaded area: Error there is inherent in the estimation of the mortality
Harvesting Effect or short-term mortality displacement
Occurs when there is a heightened, temporary, mortality rate in those with