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.

[Effects of the periodical spread of rinderpest on famine, epidemic, and tiger disasters in the late 17th Century]

This study clarifies the causes of the repetitive occurrences of such phenomena as rinderpest, epidemic, famine, and tiger disasters recorded in the Joseon Dynasty Chronicle and the Seungjeongwon Journals in the period of great catastrophe, the late 17th century in which the great Gyeongsin famine (1670~1671) and the great Eulbyeong famine (1695~1696) occurred, from the perspective that they were biological exchanges caused by the new arrival of rinderpest in the early 17th century. It is an objection to the achievements by existing studies which suggest that the great catastrophes occurring in the late 17th century are evidence of phenomena in a little ice age. First of all, rinderpest has had influence on East Asia as it had been spread from certain areas in Machuria in May 1636 through Joseon, where it raged throughout the nation, and then to the west part of Japan. The new arrival of rinderpest was indigenized in Joseon, where it was localized and spread periodically while it was adjusted to changes in the population of cattle with immunity in accordance with their life spans and reproduction rates. As the new rinderpest, which showed high pathogenicity in the early 17th century, was indigenized with its high mortality and continued until the late 17th century, it broke out periodically in general. Contrastively, epidemics like smallpox and measles that were indigenized as routine ones had occurred constantly from far past times. As a result, the rinderpest, which tried a new indigenization, and the human epidemics, which had been already indigenized long ago, were unexpectedly overlapped in their breakout, and hence great changes were noticed in the aspects of the human casualty due to epidemics. The outbreak of rinderpest resulted in famine due to lack of farming cattle, and the famine caused epidemics among people. The casualty of the human population due to the epidemics in turn led to negligence of farming cattle, which constituted factors that triggered rage and epidemics of rinderpest. The more the number of sources of infection and hosts with low immunity increased, the more lost human resources and farming cattle were lost, which led to a great famine. The periodic outbreak of the rinderpester along with the routine prevalence of various epidemics in the 17thcentury also had influenced on domestic and wild animals. Due to these phenomenon, full-fledged famines occurred that were incomparable with earlier ones. The number of domestic animals that were neglected by people who, faced with famines, were not able to take care of them was increased, and this might have brought about the rage of epidemics like rinderpest in domestic animals like cattle. The great Gyeongsin and Eulbyeong famines due to reoccurrence of the rinderpest in the late 17th century linked rinderpester, epidemics and great famines so that they interacted with each other. Furthermore, the recurring cycle of epidemics-famines-rinderpest-great famines constituted a great cycle with synergy, which resulted in eco-economic-historical great catastrophes accompanied by large scale casualties. Therefore, the Gyeongsin and Eulbyeong famines occurring in the late 17th century can be treated as events caused by the repetition of various periodic disastrous factors generated in 1670~1671 and in 1695~1696 respectively, and particularly as phenomena caused by biological exchanges based on rinderpester., rather than as little ice age phenomena due to relatively long term temperature lowering.

[Epidemics in the news in Portugal: cholera, plague, typhus, influenza and smallpox, 1854-1918]

In severe health crisis like those of 1854-1856, 1899 and 1918, especially in Porto, where cholera morbus, the bubonic plague, typhus fever, pneumonic influenza and smallpox killed high percentages of the population, the images of the epidemics in the press enable us to identify the scientific knowledge in a country considered peripheral, but which had studies and personnel specialized at the most advanced levels for the time. A database of 6,700 news items and announcements reveals the medical and pharmaceutical knowledge of the second half of the nineteenth and early twentieth centuries, the way it was transmitted and disclosed to the public and the solutions offered by the health authorities. Hygiene was consistently highlighted in the news and announcements.

Analysis of the causes of spawning of large-scale, severe malarial epidemics and their rapid total extinction in western Provence, historically a highly endemic region of France (1745-1850)

BACKGROUND

The two main puzzles of this study are the onset and then sudden stopping of severe epidemics in western Provence (a highly malaria-endemic region of Mediterranean France) without any deliberate counter-measures and in the absence of significant population flux.

METHODS

Malaria epidemics during the period from 1745 to 1850 were analysed against temperature and rainfall records and several other potentially relevant factors.

RESULTS

Statistical analyses indicated that relatively high temperatures in early spring and in September/October, rainfall during the previous winter (principally December) and even from November to September and epidemics during the previous year could have played a decisive role in the emergence of these epidemics. Moreover, the epidemics were most likely not driven by other parameters (e.g., social, cultural, agricultural and geographical). Until 1776, very severe malarial epidemics affected large areas, whereas after this date, they were rarer and generally milder for local people and were due to canal digging activities. In the latter period, decreased rainfall in December, and more extreme and variable temperatures were observed. It is known that rainfall anomalies and temperature fluctuations may be detrimental to vector and parasite development.

CONCLUSION

This study showed the particular characteristics of malaria in historical Provence. Contrary to the situation in most other Mediterranean areas, Plasmodium falciparum was most likely not involved (during the years with epidemics, the mean temperature during the months of July and August, among other factors, did not play a role) and the population had no protective mutation. The main parasite species was Plasmodium vivax, which was responsible for very severe diseases, but contrary to in northern Europe, it is likely that transmission occurred only during the period where outdoor sporogony was possible, and P. vivax sporogony was always feasible, even during colder summers. Possible key elements in the understanding of the course of malaria epidemics include changes in the virulence of P. vivax strains, the refractoriness of anophelines and/or the degree or efficiency of acquired immunity. This study could open new lines of investigation into the comprehension of the conditions of disappearance/emergence of severe malaria epidemics in highly endemic areas.

Measles epidemics of variable lethality in the early 20th century

Until the mid-20th century, mortality rates were often very high during measles epidemics, particularly among previously isolated populations (e.g., islanders), refugees/internees who were forcibly crowded into camps, and military recruits. Searching for insights regarding measles mortality rates, we reviewed historical records of measles epidemics on the Polynesian island of Rotuma (in 1911), in Boer War concentration camps (in 1900-1902), and in US Army mobilization camps during the First World War (in 1917-1918). Records classified measles deaths by date and clinical causes; by demographic characteristics, family relationships (for Rotuma islanders and Boer camp internees), and prior residences; and by camp (for Boer internees and US Army recruits). During the Rotuman and Boer War epidemics, measles-related mortality rates were high (up to 40%); however, mortality rates differed more than 10-fold across camps/districts, even though conditions were similar. During measles epidemics, most deaths among camp internees/military recruits were due to secondary bacterial pneumonias; in contrast, most deaths among Rotuman islanders were due to gastrointestinal complications. The clinical expressions, courses, and outcomes of measles during first-contact epidemics differ from those during camp epidemics. The degree of isolation from respiratory pathogens other than measles may significantly determine measles-related mortality risk.

Arthur Conan Doyle (1859-1930): Physician during the typhoid epidemic in the Anglo-Boer War (1899-1902)

When the Anglo-Boer War broke out in October 1899, Arthur Conan Doyle, a retired ophthalmologist, was already famous as the creator of Sherlock Holmes. Motivated by patriotism and adventure, Doyle joined the medical staff of a private field hospital endowed by philanthropist John Langman (1846-1928). Langman Hospital opened in Bloemfontein, South Africa, at the height of that city's typhoid fever epidemic which raged from April to June 1900. There were nearly 5000 cases of typhoid and 1000 deaths but official statistics do not truly reflect the magnitude of the suffering. Doyle argued that the British Army had made a major mistake by not making antityphoid inoculation compulsory. Because of the new vaccine's side effects, 95% of the soldiers refused immunization. Despite his strong opinions, Doyle failed to press the issue of compulsory inoculation when he testified before two Royal Commissions investigating the medical and military management of the war in South Africa. One can only imagine how the army might have benefited from the new idea of prophylactic vaccination in preventive medicine if Doyle had not let these opportunities slip away. As a consequence, antityphoid inoculation was still voluntary when Great Britain entered World War I in August 1914.

[The contribution of T. Sydenham (1624-1689) to the formation of modern Western medicine (on the occasion of the 390th anniversary of his birth)]

The article is devoted to the contribution of the English physician T. Sydenham to the formation of modern Western medicine. Based on the analysis of his major works, the authors concluded that T. Sydenham's main merit was not the application of an empirical approach to studying human diseases, but the development of two theoretical concepts in the 1660s to 1680s, which introduced new ideas about the causes of diseases and epidemics. Recognition of T. Sydenham's ideas by the majority of the medical community led to a fundamental revision of the views on illnesses, to the emergence of qualitatively new approaches to the study, diagnosis, treatment and prevention of human diseases, by giving rise to a new subject of medical study, such as physical and social environmental factors in man along with his body in health and disease.

"Patient Zero": the absence of a patient's view of the early North American AIDS epidemic

This article contextualizes the production and reception of And the Band Played On, Randy Shilts's popular history of the initial recognition of the American AIDS epidemic. Published over twenty-five years ago, the book and its most notorious character, "Patient Zero," are in particular need of a critical historical treatment. The article presents a more balanced consideration-a "patient's view"-of Gaétan Dugas's experience of the early years of AIDS. I oppose the assertion that Dugas, the so-called Patient Zero, ignored incontrovertible information about the condition and was intent on spreading his infection. Instead I argue that scientific ideas in 1982 and 1983 about AIDS and the transmissibility of a causative agent were later portrayed to be more self-evident than they were at the time. The article also traces how Shilts's highly selective-and highly readable-characterization of Dugas rapidly became embedded in discussions about the need to criminalize the reckless transmission of HIV.

The influenza epidemic of 1889-90 in selected European cities--a picture based on the reports of two Poznań daily newspapers from the second half of the nineteenth century

The largest nineteenth-century epidemic of influenza, called 'the Russian epidemic,' arrived in Europe from the east in November and December of 1889. It was one of the first epidemics of influenza that occurred during the period of the rapid development of bacteriology. It was the first epidemic to be so widely commented on in the intensively developing daily press. Daily Polish newspapers published in Poznań, a Polish city that was then under Prussian rule, also had a share in providing information on the epidemic. Press reports not only referred to the local spread of the disease, but also discussed the situation in numerous, often distant, European cities, such as Paris, London, Vienna, and Berlin. Apart from data about where and when the illness occurred, the reports provided: descriptions of symptoms, treatment methods, data on morbidity and mortality, effect on individual people of high rank in the country, information on the activities of public authorities, and impact of the epidemic on daily life. The 1889-1890 influenza epidemic had 2 faces: the real one, discovered while being afflicted with the disease, and the media one, discovered through the information available in the press.

Snippets from the past: the evolution of Wade Hampton Frost's epidemiology as viewed from the American Journal of Hygiene/Epidemiology

Wade Hampton Frost, who was a Professor of Epidemiology at Johns Hopkins University from 1919 to 1938, spurred the development of epidemiologic methods. His 6 publications in the American Journal of Hygiene, which later became the American Journal of Epidemiology, comprise a 1928 Cutter lecture on a theory of epidemics, a survey-based study of tonsillectomy and immunity to Corynebacterium diphtheriae (1931), 2 papers from a longitudinal study of the incidence of minor respiratory diseases (1933 and 1935), an attack rate ratio analysis of the decline of diphtheria in Baltimore (1936), and a 1936 lecture on the age, time, and cohort analysis of tuberculosis mortality. These 6 American Journal of Hygiene /American Journal of Epidemiology papers attest that Frost's personal evolution mirrored that of the emerging "early" epidemiology: The scope of epidemiology extended beyond the study of epidemics of acute infectious diseases, and rigorous comparative study designs and their associated quantitative methods came to light.

History lessons

There was a time when epidemics were solely the province of infectious diseases. Indeed, most dictionary definitions of the term refer first to contagious diseases that spread rapidly among a given population.

[The contribution of I.I. Molleson in becoming and development of sanitary service in the Saratov guberniia]

The article presents in the historical perspective a brief biography data about I.I. Molleson. The main issues are covered concerning the development of sanitary service in the Saratov guberniya in the end of nineteenth century. The scientific and practical contribution of I.I. Molleson into becoming and development of sanitary business in Russia is demonstrated.

The Thasian epidemic of mumps during the 5th century BC

This article briefly reminds the readers of the huge importance of Hippocrates observation about the epidemic of mumps in Thasos during the fifth century BC. By putting great emphasis on the value of observation of the disease process, mainly from the practical point of view, the Corpus Hippocraticum gave us the first written detailed description of the disease.