Lecture 2

HISTORY 135F

Infectious and Epidemic Disease in History

Department of History
University of California, Irvine
Instructor: Dr. Barbara J. Becker

Lecture 2. Epidemic Disease before 1300 CE.

Development of Human/microbe Symbiosis

Years, BP	Human and microbe proximity	Estimated world population
12,000	small, but permanent settlements most human disease due to environmental factors	1 million (~San Jose, 2010)
10,000	domestication of plants and animals contact with herd animals introduces new crowd diseases	5 million (~Singapore, 2010)
6,000	large cities population density sustains communicable diseases	7 million (~Hong Kong, 2010)
2,000	extended trade routes contact with outsiders sustains epidemic diseases	170 million (~Pakistan, 2010)
1,000	Crusades and colonization contact with previously isolated peoples introduces pandemics	300 million (~US, 2010)
100	industrialization, rapid transit, and global warfare antibiotics and antisepsis modernization disrupts natural evolution of microbe/human symbiosis	1700 million (~China +US, 2010)
today	what now?	6878 million (2010)

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As long as a microbe can infect more than one new host, disease will spread even if original host dies:

having an adequate number of initial hosts is important
having others readily available to infect is essential

Methods of microbe transmission:

Passive--

microbe is ingested
microbe is inspired
microbe enters body through break in skin, insect bite...
microbe is passed from pregnant host to fetus

Active--

microbe alters host's anatomy

generates sores, mucus ....
causes bleeding, drooling ....

death of host opens opportunities for other agents to spread microbes

On the fertile Euphrates....

...a short sneeze from Babylon!

LOOKING FOR A NEW HOME?

King Nammu invites YOU to
come live in Ur

--Lotsa People in
Close Quarters--

   Luxurious
         Microbial
                   Paradise !!

increase your social contacts

enjoy healthful and productive proximity to plentiful human and animal waste

new farming techniques (manure; night soil; irrigation) guarantee unlimited employment opportunities for enterprising parasites and microbes

unlimited access to pests gives every microbe a

CHANCE TO THRIVE!!

Over time, natural selection has favored the following physiological responses to disease:

fever
increased production of white blood cells
antibodies
genetic resistance

sickle cell anemia (malaria)
Tay-Sachs (tuberculosis)
Cystic fibrosis (bacterial diarrheas)

co-existence

How have humans responded socially, emotionally, intellectually to disease?

Disease viewed as consequence of supernatural intervention in human affairs

Job
attributed to Moses (ca. 1450 BCE)

Chapter 1 The Lord said to Satan, Have you noticed my servant Job? There is none like him in the world -- he is a perfect and an upright man, one that fears God and shuns evil.

Satan replied, Do you think Job fears you for nothing? Haven't you protected him and his household, and blessed his work so that he has prospered? Take all this away from him and he will curse you to your face!

The Lord said, Very well, then, everything he has is in your hands. Do what mischief you will, only spare his life....

And Satan smote Job with sore boils from the sole of his foot to the top his head....

[Job's] wife said to him, "Are you still holding on to your integrity? Curse God and die! (Benedic deo, et morere.)"

________________

The Iliad
attributed to Homer (ca. 550 BCE)

Book I

... And which of the gods was it that set [Achilles and Agamemnon] on to quarrel? It was [Apollo]; for he was angry with the king and sent a pestilence upon the host to plague the people, because [Agamemnon] had dishonored Chryses his priest....

________________

	Greek vase ca. 470 BCE Physician prepares to "bleed" his patient
5th c. BCE Aesclepius, son of Apollo, practices the art of healing and teaches his disciples the cures established by his father.

Disease viewed as product of natural forces

The Ionians

Ionia, 5th and 4th c. BCE

First Principles of Ionian Explanation

To account for		which the Greeks called...
stability in the world...	find what is fundamental, constant and unchanging...	arché
diversity in the world...	find what is different, what changes, and how it changes; this will reveal the rules or agencies that control the change process...	physis
pattern in the world...	use these rules to organize the fundamentals into a "neat array"...	cosmos
________________
Empedocles (490-430 BCE)
Agents of love and strife (attraction and repulsion) act on 4 elements (earth, air, fire, water) to produce diversity observed in the world. We can know about the world because we are made of these elements. Tension and balance generated by opposing qualities (wet vs. dry; cold vs. warm) is behind all change observed in terrestrial world.

The Four Elements

In the human body, the four elements constitute the four fluids:

Fluid	Reservoir	Temperament
Blood	Heart	Sanguine (cheerful)
Phlegm	Brain	Phlegmatic (sluggish)
Yellow Bile	Gall-bladder	Choleric (irritable)
Black Bile	Spleen	Melancholic (sad)

Disease results when the fluids are out of balance.

To restore health, actions must be taken to the balance must also be restored--

sometimes Nature does this on its own;
sometimes human intervention is required to assist Nature in its task;
sometimes the imbalance is beyond restoration.

"Hippocrates"
(460-377 BCE??)

marked a transition from mythological conjecture to rational explanation

applied Ionian principles to medical practice

accounted for causes and symptoms in purely natural terms

treatises display an entirely rational outlook towards disease

Works attributed to Hippocrates:

Ancient Medicine
On Airs, Waters, and Places
The Book of Prognostics
On Regimen in Acute Diseases
Of the Epidemics
Of Injuries of the Head
On the Surgery
On Fractures
On the Articulations
Instruments of Reduction
Aphorisms
The Law
On Ulcers
On Fistulae
On Hemorrhoids
On the Sacred Disease

excerpt from
On Airs, Waters, and Places (c. 400 BCE) by Hippocrates

Whoever wishes to investigate medicine properly, should proceed thus--

First consider the seasons of the year, and the effects each of them produces; they are not at all alike, but one spring can differ as much from another as summer differs from autumn.

Then the winds -- both hot and cold; those common to all countries, as well as those peculiar to each locality.

Consider the qualities of the waters, for as they differ from one another in taste and weight, so also do they differ much in their qualities.

In the same manner, when one comes into a city to which he is a stranger, he ought to consider its situation, how [the city] lies as to the winds and the rising of the sun; for its influence is not the same whether it lies to the north or the south, to the rising or to the setting sun.

These things one ought to consider most attentively--

...the waters which the inhabitants use -- are they marshy and soft, or hard and running from elevated and rocky situations? are they saltish and unfit for cooking?

the ground -- is it bare and dry, or wooded and well-watered? does it lie in a hollow and is it hot, or is it elevated and cold? and

the mode in which the inhabitants live -- what are their pursuits? are they fond of drinking and eating to excess, and given to indolence? or are they fond of exercise and labor, and moderate in eating and drinking?

For if one knows all these things well, or at least the greater part of them, he cannot miss knowing, when he comes into a strange city, either the diseases peculiar to the place [endemic diseases], or the particular nature of common diseases, so that he will not be in doubt as to the treatment of the diseases, or make mistakes, as is likely to be the case provided one had not previously considered these matters.

And in particular, as the season and the year advances, he can tell what epidemic diseases [diseases that are not always present in the population] will attack the city, either in summer or in winter, and what each individual will be in danger of experiencing from the change in routine.

Two Early Recorded Epidemics

The Plague of Athens (430 BCE)

The Plague of Justinian (Constantinople, 542 CE)

How do these historic epidemics compare with those today?

How does the incidence of plague alter the social, political, economic, and moral fabric of affected communities? How do individuals cope with the added stress in their daily lives?

What happens to accepted systems of explanation and belief in the face of such challenges?

Who will write the tales of the plagues of our time? How might readers five hundred or a thousand years from now respond to them?

Go to:

History 135F Home Page

The History of the Peloponnesian War by Thucydides (460-400 BCE)

The Lives of the Noble Grecians and Romans by Plutarch (460-400 BCE)

On Airs, Waters, and Places by Hippocrates (460-377 BCE)

Of the Epidemics by Hippocrates

History of the Wars by Procopius (c. 500-560 CE)

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