History of Medicine Final Exam

How did agriculture and the proximity to animals foster the development of human diseases?

They would shelter in the same house

What are some examples of diseases that have passed from animals to humans?

Messel’s, rinderpest, cattle plague

What is a zoonosis/zoonotic disease?

A disease that can pass from animals to humans

What disease is likely the greatest killer in human history

Smallpox

Smallpox is related to similar diseases found in which animals?

Camels and gerbils

In what geographic locations did smallpox possibly first emerge?

Mesopotamia, Africa or South Asia

What was the Plague of Antoninus?

Roman soldiers brought back smallpox from what we call the middle east

Who was Ge Hong?

He wrote about smallpox – prescriptions that he was writing about people that had smallpox

How did smallpox affect the Aztecs?

It allowed Cortez to conquer the Aztecs – smallpox killed 40% of their population in Tenochtitlan

Who was Shitala?

Smallpox goddess – a deity that visited earth and was rejected by humans so when she went back to her divine abode, she punished the humans by sending smallpox to them

Who does smallpox affect?

The entire world (Native American got hit hard)

What are the symptoms of smallpox?

Pus filled blisters all over (nose and ear canal) and if they merge into one mega blister that’s bad – there is no relief

Describe the progression of smallpox

Turn into hard, dry blisters – destroy oil canals & headache, fever, chills, muscle aches, and convulsions

What are some of the long term effects of smallpox?

Scar, blind, and kill (death can occur few days to a week after initial signs of blisters)

How is smallpox transmitted?

• First week passed through water droplets (sneeze, cough)

• Can live in fallen off scabs – or on the skin of people with smallpox (fomites: contagious for months)

Minor smallpox

2% fatality, common in Europe until 1600

Major smallpox

25-50% fatality, common in Europe after 1650

Why did so many Europeans powder their faces in the 18^th century?

To cover up smallpox scars

What was smallpox inoculation/variolation?

Introducing smallpox material from a suffer into a healthy individual (they would introduce pus under skin or eat/inhale the scabs)

Who was Lady Wortley Montagu and what did she do?

A natural beauty until she got smallpox (she survived)

What did Lady Wortley Montagu do?

Inoculated her whole family, prisoners, and orphans to prove that it worked - Introducing inoculation in England British Isles

Why was inoculation/variolation potentially dangerous?

It was active disease going in people, so you had a high chance of contracting the disease

Who was Edward Jenner?

Apprentice to a surgeon/apothecary and helped make the smallpox vaccine

Who was John Hunter?

Scottish anatomist and one of the most important surgeons in history

Who was Benjamin Jesty?

Farmer in Dorset that inoculated his wife and son with cowpox

Who was Sarah Nelms?  Who was James Phipps?

She had cowpox and put the pus into him (an 8-year-old boy) 

How did the Royal Society treat Jenner’s paper?  What did Jenner do in response to this?

They rejected it but he never gave up and continued to research and push his findings

Where did the word vaccination come from?

• Vacca – cow

• Vaccinia – cowpox

How was Jenner honored?

He received prizes from parliament

How did Jenner’s love of birds later plague him?

People ridiculed him for his findings of the cuckoos pushing out other eggs and chicks out of the nest even though later it was proven correct

How did smallpox shape the American West?

Killed 300 million and there was a lot of money spent to get rid of the disease

How and when was smallpox eradicated?

Government spent a lot of money and since there is no animal reservoir they were able to vaccinate enough people to get rid of it - 1980

What does the cholera bacterium look like?

Peanut with a tail

How many does it take for a person to get sick? 

Ingest 1-100 million to get sick

How many can be in a clear glass of water?

200 million for water to get cloudy

How does cholera cause the human body to spread it?

Rapidly reproduces in the lining of the small intestine – Reverses what your small intestine does (takes liquid you ingest and absorb majority and leave some so your waste has something to push it, so cholera has you expel 20 litters of water) – each mL contains 200 million choleras

How does cholera affect the body?

Strikes suddenly - completely empties the bowels, intense abdominal cramping, extreme thirst, complexion to pale blue, heart beats rapidly but can’t get through ultra thick blood and causes organs to stop working, body passes parts of intestinal lining – deaths come within a few hours after rice water stools

Who was Dr. Thomas Latta? 

First person to try and cure cholera with shots

What was Dr. Thomas Latta technique?

Intravenous injections with saline

When was the first cholera pandemic?

500 B.C.

How many cholera pandemics have there been?

7

In the early 1800s what did physicians and spiritual leaders say caused cholera?

Bad behavior, need a balance – no excessive behavior because that would weaken the body, victim blaming, bad smells 

How did industrialization and urbanization lend credence to the miasma theory?

people were packed in together in cities, human waste in the streets, butchers let blood flow in streets, factories were polluting air and water → this all led to bad smells in the air

When was the second cholera pandemic?

1827

Where did it start and what direction did it take across Europe?

Ganges river and went west

How did the response to cholera differ if the person favored miasma or contagion? Why did the business community not like quarantine?

Miasma supporters focused on cleaning the environment, while contagion supporters pushed for quarantines and isolation. Businesses disliked quarantine because it interfered with trade, shut down ports and commerce, and caused major economic losses

What European country got cholera for the first time in the second pandemic?  Who was William Sproat?

Great Britain (UK) and he was the first person to get cholera there

Why did cholera not seem contagious?

You could be around people with cholera and not get sick and it seemed to only affect poor people

How did doctors treat cholera?

• Opiates – person would feel better, but it wouldn’t cure it

• Clean water (they thought bad water makes body weak)

Who were the night soil men, and why was it hard to get human waste out of London?

Cleaned human waste from homes and cesspits and it was hard to keep up with because London was so overpopulated

Where did a lot of human waste in London go?

Into cesspits or into the Thames river

Who was John Snow?

Doctor in London and published a pamphlet in 1849 that argued that Cholera is a poison found in human excretions that reproduced itself in the body

What did John Snow do?

Outbreak in 1854 and he investigated it and found that the area around the Broad Street Pump had the most cases/deaths. He also investigated two water sellers – one sold water from the upper Thames (before sewer dumped in) and one sold water from lower Tims (after sewer dumped in). He published these findings in 1855

Who was Edwin Chadwick?

Lawyer – last secretary to the grandfather of utilitarianism Jeremy Bentham (greatest good for the greatest number) – became ultimate utilitarians

What did Edwin Chadwick do (regarding the New Poor Law, Cholera, Nuisances, etc.)? 

• Didn’t like workhouses, so he made them awful (separated by genders, had uniforms, dehumanizing, based on belief that work is always available – did however lower money sent to the poor “New Poor Law”)

• National Board of Health (1848)

• Nuisances (feces) Removal and Contagious Disease Prevention act (1848) (cholera act) – nasty cesspit then it would get removed and constructed sewers in London

Why did Chadwick say, “All smell is disease”?

Is a miasmatic – testified to the parliament that all smell is immediate acute disease – thought that clean water would wash away miasma

What did Joseph Bazalgette do?

Designed the London’s 283-mile sewer system

Who was Florence Nightingale, and what did she do?

Head nurse of army hospital in Scutari and she cleaned up the kitchen to make sure soldiers got good meals and improved the hospital conditions (ventilating the rooms, people got clean water, cleaned up human wastes)

Who isolated the cholera bacterium during the fifth cholera pandemic?

Robert Koch

Robert Koch believed cholera came from where?

Dirty water

Max von Pettenkofer believed cholera came from where?

Bad smells

Describe the rivalry between Robert Koch and Max von Pettenkofer regarding cholera

Max drank a vial of water from the Thames and didn’t really get sick (only a bit of diarrhea) and it was only because he had had cholera before

How were Jews in NYC targeted during the fifth cholera pandemic?

Every Jewish home that had diarrhea was investigated and locked in. This was really because they didn’t want this group there

When did Europe stop seeing cholera?

1911

What is the El Tor strain, and during which cholera pandemic did it first appear?

New strain of cholera that started in 1961 to the present in the middle east and 90% of cases are in Africa today – this is the 7th cholera pandemic

What did Theobald Smith and Daniel Salmon do?  Did they get credit?

• First kill vaccine – heat killed cholera injected into pigeons

• No, Rue and Chamberlin got credit

What did Emil von Behring and Kitasato Shibasaburo contribute to vaccine development?

Antitoxin (antibody)

What did Paul Ehrlich add?

1 antibody to every 1 antigen (1:1 ratio)

Did researchers know that something like a virus existed before they could see it through a microscope?

No, they knew there was something that they couldn’t see so they thought a virus was a small bacteria

Who was Alexander Fleming and what did he do?

Scottish physician and microbiologist – discovered penicillin in 1928

Why might a person argue that Gosio or Duchesne made the penicillin discovery first?

These two knew about it and wrote about it in 1896 but no one really read what they wrote

What did Florey, Chain, and Heatley do?

They extracted penicillin (1 part per 200 million parts)

Who was Albert Alexander? 

A policeman who was chasing someone and fell and scratched his face on a rose bush and he became very sick and close to death but was treated with penicillin with five days, but they ran out of penicillin and he died because of it

Who was honored with a Nobel Prize in 1945 for the discovery of antibiotics, and who was left out?

Florey, Chain, and Fleming (Heatley was left out)

How was Heatley honored?

Oxford gave Heatley and honoree Doctor of Medicine in 1990

What did Jonas Salk and his team do, and why was it important?

Developed the first effective polio vaccine - it was mainly striking down children, thousands of kids would die or be paralyzed by polio

Why was polio an issue for the developed world?

It affects the developed or healthier worlds and not so much the underdeveloped or less healthy – it resides in untreated water or sewage

What statistic can you give to argue that childhood vaccines save lives?

Without vaccines childhood death would be about 20-50% of all children born

Who was Maurice Hilleman, and what did he do? 

Vaccine developer that uses his farming background to do it well

Describe the development of the mumps vaccine

Took a sample of the mumps from Jeryl Lynn’s throat and gave it to his kids, the kids at the asylum, and kids whose parents signed a vague wavier – this turned out to be a huge success

What is the Jeryl Lynn strain?

If you’ve received a mumps vaccine, then you’ve been exposed to Jeryl Lynns strain of the mumps