Louis Sambon and the Clash of Pellagra Etiologies in Italy and the United States, 1905-14

This article explores the extent to which the bacterial concept of disease acted as an obstacle to the understanding of deficiency diseases, by focusing on explorations into the cause of pellagra in the early twentieth century. In 1900, pellagra had been epidemic in Italy for 150 years and was soon to become so in the United States, yet the responses of medical investigators differed substantially. To account for these, the article reconstructs the sharply contrasting reactions to a provocative theory proposed by Louis Sambon. Applying a tropical diseases approach to pellagra, Sambon argued that pellagra had nothing at all to do with maize consumption, as the Italians had long thought, but was caused by the bite of a parasite-carrying insect. Italian pellagrologists, involved in a dogmatic quest for a toxin in maize, and with pellagra rates there on the decline, marginalized the Sambon hypothesis. By contrast, in the United States, with pellagra on the rise, the dominant infectious paradigm put Sambon center stage, his proposed etiology shaping the earliest American investigations. When the deficiency disease concept gained currency in 1913, the relatively closed world of Italian pellagrology was wrong-footed, while the more open-ended U.S. community was better able to follow up the new lead. The article discusses what these shifts and the resulting controversies reveal about the medical contexts. The actor-centered approach, with reaction to Sambon's intervention as a kind of test-case, is the key to understanding these controversies and why they mattered.

The Fielding H. Garrison Lecture: "Break-Bone" Fever in Philadelphia, 1780: Reflections on the History of Disease

In the Autumn of 1780 an epidemic hit the city of Philadelphia. The symptoms of the disease resembled those of present day dengue fever, and subsequent observers argued that the disease was in fact dengue. But was it? The question forces us to confront the challenges of retrospective epidemiology and how we examine the history of a disease. This paper examines the 1780 epidemic from two perspectives. First, it looks at evidence that the disease was dengue and examines what this tells us about the epidemic and the conditions that caused it. Second, it looks at the disease from the perspective of Dr. Benjamin Rush, who treated hundreds of patients during the epidemic. In other words, it examines the disease through the lens of eighteenth century medical ideas. The paper concludes that each approach is valuable and reveals different aspects of the relationship between society and disease.

From West End to Eastside: The Vancouver HIV/AIDS Epidemic, 1983-2013

Traditional histories of AIDS have used a few major American urban centres as proxies for the North American epidemic more broadly and have tended to frame the epidemic as a quintessentially gay and American experience. A careful examination of how the epidemic unfolded in Vancouver, British Columbia, however, reveals considerable differences, including the relative absence of local gay activist traditions prior to HIV/AIDS and the relative prominence of interventions such as Insite, North America's first sanctioned needle exchange program and safe injection site. An investigation of such differences emphasizes the local character of the epidemic and adds a Canadian perspective to the existing AIDS historiography.

[A battle won: the elimination of poliomyelitis in Cuba]

Poliomyelitis was introduced in Cuba in the late nineteenth century by American residents in Isla de Pinos. The first epidemics occurred in 1906 and 1909 and increased in intensity between 1930 and 1958. The scope of the paper is to reconstruct the history of the disease and its epidemics in Cuba prior to 1961, the first National Polio Vaccination Campaign (1962) and its results, as well as analyze the ongoing annual vaccination campaigns through to certified elimination of the disease (1994). The logical historical method was used and archival documents and statistics from the Ministry of Health on morbidity and mortality through 2000 were reviewed. Gross morbidity and mortality rates were calculated and interviews with key figures were conducted.

A forgotten epidemic that changed medicine: measles in the US Army, 1917-18

A US army-wide measles outbreak in 1917-18 resulted in more than 95,000 cases and more than 3000 deaths. An outbreak investigation implicated measles and streptococcal co-infections in most deaths, and also characterised a parallel epidemic of primary streptococcal pneumonia in soldiers without measles. For the first time, the natural history and pathogenesis of these diseases was able to be well characterised by a broad-interdisciplinary research effort with hundreds of military and civilian physicians and scientists representing disciplines such as internal medicine, pathology, microbiology, radiology, surgery, preventive medicine, and rehabilitation medicine. A clear conceptualisation of bronchopneumonia resulting from viral-bacterial interactions between pathogens was developed, and prevention and treatment approaches were developed and optimised in real time. These approaches were used in the 1918 influenza pandemic, which began as the measles epidemic waned. The outbreak findings remain relevant to the understanding and medical management of severe pneumonia.

Relationship between Distinct African Cholera Epidemics Revealed via MLVA Haplotyping of 337 Vibrio cholerae Isolates

Background

Since cholera appeared in Africa during the 1970s, cases have been reported on the continent every year. In Sub-Saharan Africa, cholera outbreaks primarily cluster at certain hotspots including the African Great Lakes Region and West Africa.

Methodology/Principal Findings

In this study, we applied MLVA (Multi-Locus Variable Number Tandem Repeat Analysis) typing of 337 Vibrio cholerae isolates from recent cholera epidemics in the Democratic Republic of the Congo (DRC), Zambia, Guinea and Togo. We aimed to assess the relationship between outbreaks. Applying this method, we identified 89 unique MLVA haplotypes across our isolate collection. MLVA typing revealed the short-term divergence and microevolution of these Vibrio cholerae populations to provide insight into the dynamics of cholera outbreaks in each country. Our analyses also revealed strong geographical clustering. Isolates from the African Great Lakes Region (DRC and Zambia) formed a closely related group, while West African isolates (Togo and Guinea) constituted a separate cluster. At a country-level scale our analyses revealed several distinct MLVA groups, most notably DRC 2011/2012, DRC 2009, Zambia 2012 and Guinea 2012. We also found that certain MLVA types collected in the DRC persisted in the country for several years, occasionally giving rise to expansive epidemics. Finally, we found that the six environmental isolates in our panel were unrelated to the epidemic isolates.

Conclusions/Significance

To effectively combat the disease, it is critical to understand the mechanisms of cholera emergence and diffusion in a region-specific manner. Overall, these findings demonstrate the relationship between distinct epidemics in West Africa and the African Great Lakes Region. This study also highlights the importance of monitoring and analyzing Vibrio cholerae isolates.

Cholera is caused by the toxigenic bacterium Vibrio cholerae. Since cholera was imported into the West African country of Guinea in 1970, cases have been reported on the continent every year. In Sub-Saharan Africa, cholera occurs in a heterogeneous manner; outbreaks primarily cluster at certain hotspots including the African Great Lakes Region and West Africa. To gain further insight into the mechanisms by which cholera outbreaks emerge and diffuse, we performed genetic analyses of 337 Vibrio cholera isolates from the Democratic Republic of the Congo (DRC), Zambia, Guinea and Togo. Isolates from both patients and environmental samples were examined. Our findings demonstrate the relationship between distinct epidemics in West Africa and the African Great Lakes Region. For example, certain strains in the DRC have circulated in the region over a period of several years, occasionally giving rise to expansive epidemics. We also found that the six environmental isolates in our panel were unrelated to the epidemic isolates. Such insight into the country- and region-specific dynamics of the disease is critical to implement optimized public health strategies to control and prevent cholera epidemics. This study also highlights the importance of analyzing Vibrio cholerae isolates to complement epidemiological studies.

[Epidemics on the sea: migrants journeys in the nineteenth century]

In the nineteenth century travelling by ship became faster due to the introduction of the steam engine. Population growth, economic crises and food shortages forced millions of Italians to consider migration towards the Americas as a real opportunity. Travel conditions on ships and steamers were particularly difficult. People were crammed into dormitories where ventilation was poor, food was insufficient, hygiene was appalling and promiscuity was rife. Under such conditions, epidemics of cholera, typhus and measles were all too likely to develop, but mycobacterium tuberculosis also proliferated. The health authorities attempted to block the spread of epidemics by means of either health licenses - papers certifying good health of the crew and passengers, which had to be exhibited on arrival - or quarantine, involving the ship and all its contents, if infectious diseases were detected or suspicious deaths occurred during the ship's voyage. In this article the particularly unfortunate stories of Italian immigrants, who boarded ships and steamers, are reported. In the second half of the nineteenth century, but also in the first decades of the twentieth, millions of Italians whose aim was to reach the Americas paid a very high price. Italy did not provide acceptable living conditions for millions of farmers and town-dwellers, and migration in search of work was in many cases the only solution. Although many during their sea voyages became ill or died of starvation or infectious diseases, migration, supported by hope, continued.

The RAMC at Belsen 1945: typhus revisited

OBJECTIVE

The Royal Army Medical Corps (RAMC) has justly regarded its relief of the appalling conditions found in the liberated Nazi concentration camp at Bergen-Belsen in April 1945 as one of its more glorious achievements. This view has, in the last decade, come under attack from historians who have, inter alia, criticised the nature and speed of the medical measures employed by the British. This has focused particularly on the management of the typhus epidemic, erroneously claimed to be the major disease killer of the survivors, and which was the catalyst for the premature German surrender of the camp to the approaching Allies about 3 weeks before the end of the war. This review examines the veracity of this statement and the nature of the evidence on which it was based.

METHODS

Review of all the relevant extant primary source written evidence both published and archived in major collections in London, Washington and Belsen, in addition to the relevant subsequent secondary evidence.

RESULTS

Disprove the ill-considered and scientifically flawed attempts to discredit the RAMC and demonstrate that the RAMC can be shown to have made the correct prioritising decisions in relieving starvation as well as in implementing the appropriate public health anti-typhus measures and to have acquitted itself honourably.

DISCUSSION

Underlines the pitfalls of basing sweeping conclusions on an imperfectly understood inadequate selection of the available evidence.

Hypothesis: dynamics of classical malaria epidemics show Plasmodium falciparum's survival strategy

Areas of marginal transmission can generate enormous lethal falciparum malaria epidemics when factors favoring the parasite shift only slightly. Although usually described in terms of vectorial capacity, medical scientists working in India in the early 20th century came to the conclusion that "an epidemic of relapses" was the key triggering event of malaria epidemics. This explanation has been largely discarded, because the biology of Plasmodium falciparum recrudescence has since been differentiated from P. vivax relapse. Using data from the Punjab in 1908 and Ceylon in 1934-1935, the genesis of malaria epidemics has been re-examined to inform current control efforts. The epidemics were focused geographically depending on recent rainfall or drought. Epidemics arose very suddenly and simultaneously in several places. Malaria spleen surveys indicated very little recent malaria transmission, and blood smears showed very few gametocytes just before the epidemic. Population stress as indicated by high grain prices because of a poor harvest caused by drought the previous year was a risk factor for malaria epidemics. Although increased female Anopheline survival because of increased humidity played an important part in the magnification of the epidemic, it does not explain its genesis. Human population stress triggering a shift toward gametocytogenesis is hypothesized as the key initiation factor for malaria epidemics. Its evolutionary significance may be that it allows the parasite to match the tropical agricultural cycle.

Samuel Holden Parsons Lee (1772-1863): American physician, entrepreneur and selfless fighter of the 1798 Yellow Fever epidemic of New London, Connecticut

Samuel Holden Parsons Lee practised medicine at a time when the germ theory of disease had not yet been proposed and antibiotics remained undiscovered. In 1798 he served selflessly as the only physician in town who was willing to battle the Yellow Fever outbreak of New London, Connecticut. Because he practised at the dawn of the age of patent medicine, unfortunately his name also came to be associated with medical quackery. We argue that his contributions have been grossly underestimated. He compounded and vended medications - including bilious pills and bitters - that were gold standards of the day. Moreover, one preparation for treatment of kidney stones led to his sub-specialization in this field and was met with such success that its sale continued for nearly 100 years after his death. While a talented medical man, Lee also had a knack for business, finding success in trading, whaling and real estate.

[Hippocrates. Aphorisms and Epidemics III. Two clinical texts]

The two Hippocratic texts, Aphorisms and Epidemics III, have not been translated into Danish previously. The Aphorisms are 412 short, pithy statements, mostly on the prognosis in relation to certain symptoms in the course of the diseases, very often febrile. The Aphorisms begin with the famous words: "Life is short, the Art long, opportunity fleeting, experiment treacherous, judgment difficult." (Transl. W H S Jones [22]). Epidemics III consists of 28 case histories, again mostly of febrile patients, but also of observations on the connection of the seasons with general morbidity and mortality. The author describes an epidemic, which in some respects resembles Thucydides' report on the plague in Athens in 430 BC. It is suggested, that observations as have been recorded in the seven Hippocratic texts on epidemic diseases are the material on which prognostic statements as those collected in the Aphorisms are founded.

[Dr. Józsa Dániel (1795-1849)--Daniel Józsa, MD (1795-1849)]

The present study summarizes the most important events of life and professional career of Daniel Józsa born 220 years ago. Józsa, the Medical Chief of former Crasna county was born in Uzon of Székely region on 1, October, 1795. From the age of 10 he studied at the Bethlen College in Nagyenyed. In 1822 he attended the University of Medical Sciences in Vienna, where he got his doctor's degree in 1828. He wrote his dissertation on the diseases of the female breast. In the same year he settled with his first wife in Szilágysomlyó, Crasna county, where he was appointed Medical Chief of the county by the Transylvanian Governor. He gained great medical reputation being a lively, correct and energetic man with rational medical principles ahead of his time. He took part and held a presentation at the general meeting of the Hungarian physicians and nature researchers in Kolozsvár in 1844. As a result, he was elected associate member by both the Royal Hungarian Natural Science Society and the Royal Medical Association of Budapest. While he successfully fought against the spread of cholera during the epidemics of 1831, 1836 and 1848-49, he regularly took part in the public life of the county. From his first wife he had 6 children, from his second wife he had one child. He died in the village Bályok in Bihar county on 10, April, 1849. His tomb has been saved for future generations by the generosity of the local Reformed Church and of some doctors from Bályok.

Demystifying the epidemic among Achaeans during the Trojan War

Although some modern scholars believe that Homer had at least a basic medical education, given that a plethora of medical terms may be found in his poems, in the case of the pestilence that killed the Achaeans (one of the Hellenic peoples believed to have inhabited the Peloponnese) at Troy, his reference was simply informative. No symptoms were mentioned and the only thing known was that mules and dogs were the first to die. While Delphic Apollo was usually on the side of Peloponnesians, during the Trojan War Apollo Smintheus (the Mouse God) sided with the Trojans. Apollo was invoked as Smintheus by his priest Chryses two times and on both occasions a pestilence ensued. In our paper we try to clarify whether this pestilence, as we believe, was caused by a member of the Alphavirus genus, which can inflict a serious epidemic both on human and animal species, especially in equines.

1831: the map that launched the idea of global health

Today we take for granted the idea of global health, of disease as an international event. Increasingly, we assume as well that the international spread of disease can be traced to human travel patterns as well as to recurring environmental conditions. Perversely, the idea of ‘global health’ and its inverse, global disease, owes little to the three-dimensional imaging of the planet and almost everything to the two-dimensional plane of the map. Here the idea of global disease is traced from its beginnings in the 18th century to its 19th-century introduction in maps of the first cholera pandemic. This global perspective, and the responsibilities it promoted among civil officials, can be seen in modern studies of cancer, influenza and other conditions with both environmental foundations and international presence.

[Nurses in the face of the Great War's epidemics]

In 1914, nurses were still considered as volunteers. By 1918, given more efficient training, they had acquired legitimacy among the French public. Their skills and their professionalism were appreciated and recognised, notably thanks to the crucial role they played in the fight against the tuberculosis and Spanish flu epidemics.

Mortality risk and survival in the aftermath of the medieval Black Death

The medieval Black Death (c. 1347-1351) was one of the most devastating epidemics in human history. It killed tens of millions of Europeans, and recent analyses have shown that the disease targeted elderly adults and individuals who had been previously exposed to physiological stressors. Following the epidemic, there were improvements in standards of living, particularly in dietary quality for all socioeconomic strata. This study investigates whether the combination of the selective mortality of the Black Death and post-epidemic improvements in standards of living had detectable effects on survival and mortality in London. Samples are drawn from several pre- and post-Black Death London cemeteries. The pre-Black Death sample comes from the Guildhall Yard (n = 75) and St. Nicholas Shambles (n = 246) cemeteries, which date to the 11th-12th centuries, and from two phases within the St. Mary Spital cemetery, which date to between 1120-1300 (n = 143). The St. Mary Graces cemetery (n = 133) was in use from 1350-1538 and thus represents post-epidemic demographic conditions. By applying Kaplan-Meier analysis and the Gompertz hazard model to transition analysis age estimates, and controlling for changes in birth rates, this study examines differences in survivorship and mortality risk between the pre- and post-Black Death populations of London. The results indicate that there are significant differences in survival and mortality risk, but not birth rates, between the two time periods, which suggest improvements in health following the Black Death, despite repeated outbreaks of plague in the centuries after the Black Death.