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Chapter 2

Chapter 2

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Ann Herring

Chapter 2 – The Conquest of Infectious Disease - 1970’s people thought infectious diseases were a thing of the past, 1990’s completely changed, thought of as risks affecting ‘our’ futures Epidemiological Transitions - Omran (1971) theory of epidemiological transitions in early 1970 - 3 stages of epidemiological transition 1. First transition occurred after hunter-gatherer to agriculture transition o 10,000 yrs ago o Age of pestilence and famine  Mortality high and fluctuating  Average life expectancy 20-40yrs o Some people argue there were transitions within this transition  Ie. Classical time  Eurasian civilization had contact with different infections  Ie. Europeans colonized new world, given indigenous people old world diseases (ie. Measles and small pox) 2. Next epidemiological transition in Western Europe th th o 18 -19 centuries o During public health measures and improved nutrition o Epidemics of infectious diseases declined in frequency and magnitude  Average lif expectancy 30-55 3. By 1970’s most western countries were beginning of slow rise in human-made diseases caused by radiation, injury, accidents, occupational hazards, carcinogens o Morality rates declining among younger people  Life expectancy over 70 yrs o Developing countries high morality continued into 20 centuries  Transition was independent of socioeconomic level of country  Initiated by medical progress, organized health care, disease control programs (usually internationally assisted and financed) o 1970’s critical factor in population growth fertility rather than morality of in factious diseases The Age of Pestilence and Famine - Before shift to agriculture still suffered from epidemics (usually infectious, widespread but limited spatially and temporally) or sporadic episodes of infectious diseases (few instances now and then) o Exposed to zoonotic infections, healthy and well-balanced diet strengthened ability to counter them o Low group size, “crowd diseases” couldn’t be supported  ie. Measles o Not much trade allowed for introduction of new infections, no vector diseases from things like rats - Switch lead to smaller-bodied, less well-nourished, more disease-prone people, vulnerable to harvest failure 1 o Settlement living, increased animal proximity and their pathogens, feces, vermin o Endemic diseases (tuberculosis, leprosy, smallpox, measles, etc.) were possible if large enough population to support it  Population density reached 100 time hunter-gatherers o Trade would spread things - Roman period  rural and urban migration across Europe o Contract new diseases o Polio, leprosy, tuberculosis o bed bugs, lice, worms, black rats widespread in roman towns - fall of roman empire 210AD, clearance of lands  became marshy and wet, increased malaria o trade developed o densely packed buildings, filthy, poor contaminated living environments  cermin (lice and fly infestations), polluted water supplied - 664 in England occurrence of ‘plague’ lasted 50 yrs - Medieval Europe o Food production rose, population grew o 14 century, famine exacerbated the black death 1938-90  Killed half population in many European countries o Crowded houses, close to animals  zoonotic infections  tuberculosis and brucellosis o Drinking water contaminated, sewerage was dumped into streets o Most people only had one piece of clothing  ticks, fleas, lice o Poor hygiene = higher resistance - 1485-1551 epidemic ‘sweating sickness’ o Europe o Typhus, influenza, malaria, meningitis o Particularly affected upper class o Hemorrhagic fever dependent on tick vector (possible deer hunting, consumption of infected meat0 - 1493-1530 o Syphilis epidemic through Europe o Followed by Columbus new nation discovery (said to be from that) o With exception of TB (evidence showing it was before pre-Columbian America), natives had no resistance to old world crowd disease o Around time of new world chicken pox, measles, mumps, smallpox affecting th thtive populations - 16 /17 century Europe epidemic of typhus fever, typhoid fever and smallpox o Smallpox wasn’t lethal in Britain before 1630, after plague in 1665 new strain of smallpox evolved and introduced th o Smallpox peaked in early industrial revthution (18 century)  Responsible for 8-20% of 18 century deaths - Variolation: the inoculation into the skin of healthy people of material from pustules of those suffering with smallpox to induce immunity 2 o Reported in china and india in 10 century, Egypt 13 century th - Lady mary wortley-montagu introduced variolation to Britain from turkey in 1721 o Practice widespread o Use to be 1/6 for small pox = death, now 1/50 risk - 1765 refinements made this 1/500 - Edward jenner o English country doctor o Milkmaids did not contract smallpox, protected by similar disease of cattle, cowpox (came into contact while milking) o Experimented with cowpox pustules into health people to protect against small pox, then put smallpox into these people to see if cowpox provided immunity  Process = vaccination - 1798 smallpox at most destructive stage in Europe - Jenners discovery adopted throughout Europe and spread around the world o Decline in mortality in Europe largely due to this - 1840, british parliament passed an act that forbid practice of variolation - 1841, act enabled cowpox-type vaccine to be made available to those who cannot afford it - From beginning-18 the century  religious objections, not the will of god The Successes of Public Health Campaigns - 1800 leprosy andthlague disappeared from Europe, malaria and smallpox declining - Ague, later 17 century o Malaria like - Communicable diseases less severe and widespread in 18 then 17 th th o Influence and syphilis still common o Increase in childhood killers (scarlet fever, whooping cough (pertussis) masles, diphtheria) - Northern Europe fall in death rate end of 18 due to decrease in child deaths (over 1 yr) - Death rates under 1 depended on how often they were breast fed - Sweden, children over 1 (especially from poor families) more vulnerable (then breast- fed infants) to economic fluctuations, more likely to die in later years  poor harvest, lack of resistance due to malnutrition th - 18 century o Rural to urban migration continued o Mortality remained high, risk of famine o Death from infectious diseases  poor hygiene, contaminated drinking water, th inadequate sewage, rise in population, overcrowding in slums - 19 century o TB and cholera - TB associated with artistic people - Contagiousness established in 1882, before this people thought it was hereditary (only improved or cured by change in climate) - Thought affected those more sensitive or artistic 3 - Influences fashion  for pale women, high neckerchiefs to hide any swelling o Upper class though to be beautiful and artistic o Lower class, miserable and thightening - Industrialized countries in 19 century saw epidemics of intestinal diseases  cholera and typhoid - Cholera circulated india (unknown to Europe or amerce before 1800’s), British entered india - After east Indian company took control of bengel in 1757 cholera caused epidemic and spread o Killed less people then TB - 1830 spread to Russia, then Europe, then America - Produced “rice-water” diarrhea, usually died within a few days - Asiatic cholera directly responsible for public health movement in britian - “fever nests”: slums, these spread disease o Victorian slums  no ventilation, fresh water, sanitation, overcrowded - Chadwick’s report said they were responsible for generating disease - ‘sanitarians’ said that streets should be flushed out, sewerage systems introduced  success with this confirms their theory - John snow (1850’s) cholera was linked to contaminated water supplies - Use cholera viewed more religiously, associated with poor crowded neighborhoods, impurity and intemperance - British act of parliament (1853) smallpox vaccination before age 4, if parents refused they had to pay o Violent riots resulted - Antivaccine movement (1854) - 1867 act, non-vaccination of infants, imprisonment for 14 days o Argued law was being brought into disrepute, criminalizing - Anti-vaccination movement flourished all over o Ie. Stockholm - 1874 major epidemic, widespread vaccination to end further epidemics - 19 century smallpox vaccination fell into disuse in USA, reappeared in 1870’s - American demonstration by 100,000 people in Leicester, lead to new vaccination act (1885) o Clause that allowed right to refuse vaccination - Vaccination significant part of smallpox prevention policy in britian o Vaccination by itself did not give life long immunity - 1870-1872 britian had worse small pox epidemic of the century o 44, 500 death (8,000 london alone) o Lead to a stamping out policy, isolation in hospital - Outbreak in 1901, nearly eliminated within a year - Increased acceptance of government roth in public health in western countries - High population growth from 18 century on due to reduction in deaths from infectious diseases, not increased birth rates 4 - Decrease in these diseases due to medical knowledge, improvement in nutrition and environment - Intestinal issues reduced due to water purification and sewage disposal, improved food hygiene (especially with milk) The Golden Age of Medicine - Period between 1870’s-1970’s “the golden age of medicine” - Before 1870’s, discoveries by Pasteur and Koch the germ theory was not accepted o Most doctors though health was a harmony between individual, environment and forced working within the body o Thought one disease developed from another, not separate - 20 centuries many medical breakthroughs and successes with medicine and drug therapies for non-infective causes in anesthetics and surgery - Most significant breakthroughs were surrounding infectious diseases - 1877 Kock developed practical techniques of b
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