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Chapter 8

9 HLTa01 Cholera [chapter 8] textbook notes.docx

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University of Toronto Scarborough
Health Studies
Caroline Barakat

Chapter 8- King Cholera Max von Pettenkofer  Father of public health, German chemical society  Took his own life, why?  Failed theory of the cause of cholera, “insightful’ theory for causation of cholera cholera morbus, “cholera of death” his theory postulated that there was a factor in the air called X but X couldn’t cause the disease itself so a factor called Y was required, which was found in the soil and united with Y it gave rise to “z”; a miasma stating that this caused malaria Miasmatists  Fellow travelers of Pettenkofer  Believed that the disease arises from “bad vapors” and NOT contagious agents[animalcules/microbes  Their beliefs about disease held sway until 1990; microbe that caused cholera was identified Cholera swept across Russia into Munich, Pettenkofer’s hometown  Epidemics started in the slums, poor suffered most but even killed those with money  It was believed to travel in the air, breathed in by all Physicians such as Pettenkofer thought its causes were filth, laziness, neglected hygiene, he was certain it was due to unhealthy environment  He said solution to this disease wasn’t cure but prevention  Munich; pub. Water was so filthy that poor drank it and died from diarrhea and fever  His theory was that stinking miasmas rose from low lying marshes and polluted streams to cause disease  Devoted all energy to improving quality of drinking water  He was convinced that Cleaning water, good food and fresh air would restore health, with this approach became the fist scientific hygienist  Cholera broke out in 1854, pettenkofer sought to identify the environmental factors  Made a map of where victims lived and died and incidence of disease, reasoning at the end that it must be the soil  Clean air went into damp soil where it activated a chemical reaction that resulted in a poisonous vapor and people who lived near came down w/cholera John Snow: Physician to queen victoria discussed the outbreak of 1854 in London’s soho community and made a map of the affected  In effect carried out an epidemiological study  His conclusion contrary to pettenkofer, he took sample of water from broad street pump, and found “white flocculent particles”  Convinced these were cause f cholera Louis Pasteur: French chemist demonstrated fermentation [beer/wine] and required a living microbe that wine soured because of the action of certain bacteria Pettenkofer; determined to his miasma theory, mounted vigorous public heath campaign and tried to bring the bean water to Munich 1882; Robert Koch, fellow German  Previously identified microbe that causes consumption, tubercle bacillus,  Studied in india where cholera occurred but didn’t match pettenkofer’s idea  Koch was dispatched to Cairo to isolate the microbe, used his microscope to see the bacteria in feces of patients and 10 corpse of people who died from it  Named it “vibrio” due to vibrating wiggles Pettenkofer then asked Koch to send him a culture prepared from a patent that had died fro the disease, put flask of bacteria to lips and drank it in fro of audience -He didn’t become ill but failed to mention that he had diarrhea ad he suffered from cholera few years earlier Perhaps the reason he didn’t die was his partial immunity by previous exposure too the disease But this demonstration was not enough to refute the “germ theory” [diseases are caused by tiny creatures microbes that invade the body The germ theory announced by Pasteur in 1862 was supported by many years of evidence of other disease causing microbes on stained in painstaking fashion butt Pasteur and his associates Koch and Hansen; leprosy [1873], anthrax, typhoid fever, bacterial pneumonia, tuberculosis [1882], diphtheria and cholera [1884] Sad story of pettenkofer shows that how scientist even good ones are unable to shake themselves free of old theories because they are blinded by their concept of nature, a model they create in their own mind A Look Back  Ancient times, outbreaks of disease were considered to be caused by divine intervention and a punishmentlater believe that there were vapors or plague miasmas that caused disease Italy, bubonic plague, physicians costumes robes, with paste of wax which would block miasmas or bad vapors, plague doctors wore goggled masks with sweet smell which would ward off spirits One of the consequences of miasmatists thinking was that disease was avoided if one shunned the sick and if the dead were disposed off, with minimum contact, like burning Microbial agents of disease couldn’t be identified by sense 1500, Italian girolamo fracastoro wrote about contagion, stating seeds or germs of disease were the cause, his theory was neglected for 3 centuries Where did these germs come from? Up until 1850s the theory of spontaneous generation was popular; life arising from the lifeless Francesco redi, classic test; it was necessary for flies to land on meat and deposit their eggs and they gave rise to maggots [fly larvae] Spallanzani; concluded that microbes must arise from other microbes But in 1862, Louis Pasteur the French chemist-microbiologist bashed the generation theory with experiment  He said not only do microbes cause disease in animals but are involved in decay and fermentation  Experiment proved that a vital force didn’t exist and that microbes come from other microbes  German Robert Koch and colleagues were able to identify the microbial agents responsible for numerous diseases  Also unambiguously designed the causative agent for microbial induced disease called Koch’s pustules  These microbe hunters established the firm foundation of the germ theory of disease The contagionists [Pasteur and Koch] believed that diseases were spread from person to person by an infectious agent the miasmatists [pettenkofer] believed that disease caused by “bad vapors” Until 1900s the view of disease causation espoused by the miasmatists [theory of spontaneous in guise] was the prevailing one The disease Cholera  Historian McNeil describes cholera: speed with which cholera killed was alarming, you could never feel safe from sudden death and symptoms were horrible included radical dehydration; victim shrank into thin form, few hours ruptured capillaries discolored skin, turning blue which was called the blue stage of cholera  Its effect was to make mortality visible, bodily decay  Cholera was disease that causes severe diarrhea, rice water stools, vomiting, convulsions, muscle cramps but little abdominal, diarrhea results from loss of water and electrolytes, leading to shock if untreated  Origin of word cholera, Greek word meaning, “gutter of roof, possible Hebrew. Arabic words “choleh rah”= bad illness  Cholera is a water or food borne disease that doesn’t manifest itself until germ enter the human digestive tract  Ancient times recorded in china, Europe, Asia  But presence in India was documented  In Greece by 400 bc  Hippocrates: vomited, purges and couldn’t be stopped of person, eyes were dark hollow, cold  History of cholera described in pandemics from 1816 to 1923  19 century epidemic of cholera  We are currently in the pandemic that began in 1961 in Celebes, spread in Asia and middle east, and reached Africa, after absence of 100 years cholera appeared in amerces  Affected: south Americans, Rwanda refugees [Hutus escaping Tutsi rebels], southern Africa  Prior to first pandemic, cholera was associated with Hindu pilgrims to Ganges river where the disease was endemic and remains till present  Next pandemic [1829-1851] emerged from either end
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