Early Concepts of Disease

 Hunter-Gatherers
 Ten thousand years ago
humans were hunter-
gatherers
 They had a short lifespan
Mythology, Superstition, and Religion
 Primitive peoples believed in natural
spirits
 Examples:
 in the Philippines
 In India: Hinduism
 in ancient Greece: Pandora’s Box
 The Agricultural Revolution
 an agricultural model ensured a
more secure supply of food and
enabled the population to
expand
 Problems:
 Domesticated animals = also
carried diseases that could be
transmitted to humans
 rely heavily on one or two
crops = so their diets were
often lacking in protein,
minerals, and vitamins
 Problems during Agricultural Revolution
 People began living in larger
groups and staying in the same
place
 Faster transmission of diseases
 Garbage and waste
accumulated

 The picture above shows a

woman emptying her bedpan
into the street
The Hippocratic Corpus
Period of Epidemics
 The Bubonic Plague
(1347-1700s)
 caused by the bacterium
Yersinia pestis
 bacteria live in the
intestines of fleas
 transmitted to rats by flea
bites
 The rats, therefore, serve as
a natural reservoir for the
disease, and fleas are the
vectors.
 Black Death

 Two kinds of plagues:

Bubonic (from
infected fleas) – Kills
more than half of its
victims within a
week.
Pneumonic – spread
by coughs and spit of
the infected. Victims
died within 24 hrs.
Plague
 Theorieson the cause
of Plague:
 spread by person-to-
person contact
 by too much sun
exposure
 intentional poisoning
 The most popular
explanation though
was that it was caused
by "miasmas"
Quarantine and Isolation
 Datedback in the 4th century
 Quarantine comes from the Italian word
quarantena = meaning a 40 day period
 Used to combat plague
 Still Useful now, used to combat SARS

 Isolation
– isolation refers to the separation of
a person who has the disease
Ideas About Health

Girolamo Fracastoro (1546)  Italian physician, poet, astronomer,

and geologist
 he proposed the germ theory of
disease more than 300 years before
its formal articulation by Louis
Pasteur and Robert Koch.
 In 1546, Fracastoro outlined his
concept of epidemic diseases in "De
contagione et contagiosis morbis"
 each disease was caused by a
different type of rapidly multiplying
'seed' and that these could be
transmitted by direct contact,
through the air, or on contaminated
clothing and linens.
 John Graunt - The Bills of Mortality
(1662)
 Beginning around the year 1592
the parish clerks in London
began recording deaths (called
The Bills of Mortality).
 In 1662, John Graunt, a founding
member of the Royal Society of
London, summarized this data in
a publication entitled "Natural
and Political Observations
Mentioned in a Following Index,
and Made Upon the Bills of
Mortality."
Anton van Leeuwenhouk (1670s)

 Anton van Leeuwenhoek

from Holland was "the
father of microscopy.
 In 1674, by using his
inventions, he was the
first person to see
bacteria, yeast, protozoa,
sperm cells, and red
blood cells.
 John Pringle and "Jail Fever" (1740s)
 Scottish physician general to the
British forces during the War of the
Austrian Succession (1740–48)
 In London he became physician to
the Duke of Cumberland and to King
George III
 Pringle published "Observations on
the Diseases of the Army" in 1752
 He wrote at length on the importance
of hygiene to prevent typhus or "jail
fever," which was a common malady
among soldiers and prisoners in jails.
 Pringle also coined the term
'influenza'.
 James Lind and Scurvy (1754)
 Scurvy is due to a deficiency in
vitamin C that results in weak
connective tissue and abnormally
fragile capillaries that rupture
easily, causing bleeding, anemia,
edema, jaundice, heart failure, and
death
 James Lind, a Scottish naval
surgeon, suspected that citrus
fruits could prevent scurvy
 In 1754, Lind conducted what
may be the world's first controlled
clinical trial on 12 sailors with
scurvy.
 Francois Broussais & Pierre Louis (1832)

 Francois Broussais was a

prominent Parisian physician
and a strong proponent of
bloodletting with leeches.
 Pierre Louis was a
contemporary of Broussais's
who believed in using
numerical methods to
evaluate treatment. Louis
studied bloodletting and
found it ineffective, but many
dismissed his conclusions.
The Industrial Revolution
The Enlightenment (1700-1850)
 The
Enlightenment was a period that saw an
embrace of:
 Democracy
 citizenship
 Reason
 rationality
 social value of intelligence (the value of information
gathering)
 These ideas provided important foundations for
public health
Utilitarianism
 In the early 1800s, Jeremy Bentham and his disciples
(the theoretical radicals) developed the philosophy of
utilitarianism
 provided a theoretic structure for health policy and
wider social policies
 Example:
 One theme was that reducing mortality and improving health
had an economic value to society
 Another was the notion that one could measure 'evil' by the
degree of misery that was created (or relieved) by a particular
action
 
Ignaz Semmelweis (1840s)
 Ignaz Semmelweis was a
Hungarian physician
 Postpartum sepsis
(puerperal fever) was a
common occurrence at the
time and was almost
invariably fatal
 He required all birth
attendants to wash their
hands in chlorinated lime
water before attending to a
birth.
 “Father of Handwashing”
 Oliver Wendell Holmes (1840s)
 American physician,
professor, lecturer, and
respected literary author
(he wrote The Autocrat of
the Breakfast-Table in
1858)
 In 1843, he presented a
paper entitled "The
Contagiousness Of
Puerperal Fever" at the
Boston Society for
Medical Improvement
 John Snow - The Father of Epidemiology

 In the 1800s, there were

large epidemics of cholera
in Europe and America that
killed thousands of people
 The prevailing opinion of
the time was that cholera
was spread either by
miasmas or by person-to-
person contact
 He believed that perhaps it
was transmitted by water or
food consumption
 In retrospect, Snow made several important
contributions to the development of epidemiologic
thinking:
 He proposed a new hypothesis for how cholera was
transmitted.
 He tested this hypothesis systematically by making
comparisons between groups of people.
 He provided evidence for an association between
drinking water from the Broad Street well and
contracting cholera.
 He argued for an intervention which prevented
additional cases (removal of the pump handle).
The Sanitary Idea (1850-1875)
 In many respects, public health as we think of it today
(i.e., as a function of good government) took shape in
London and Paris in the wake of the devastating health
consequences of the Industrial Revolution
 The development of public health as a discipline had
many contributing factors:
 First was the importance of the monarchy and the power of the
state.
 Secondly was the emergence of the Enlightenment in the 18th
century
 A third factor was the recognition that poor health was a burden
that fell disproportionately on the poor.
William Farr
 John Graunt’s study the
importance of "numbering the
people" led to
 The establishment of the General
Registrar's Office in 1837 to
record births, deaths, and
marriages in England and Wales
 Dr. William Farr (right), who had
trained at the Royal Academy of
Medicine in Paris, was appointed
Chief Statistician
 Office established the
importance of surveillance with
respect to health.
Louis-René Villermé
 a physician in Paris
 had noticed that mortality rates varied widely among
the districts of Paris
 he used tax rates as an indicator of wealth
 Villermé found a striking correlation with mortality
rates
Edwin Chadwick
 In 1842, published a report entitled "The Report into the
Sanitary Conditions of the Labouring Population of Great
Britain“
 This advanced his idea that life expectancy was much lower
in towns than in the countryside.
 These social, economic, political, and philosophical
developments all contributed to the emerging idea that the
public's health was a legitimate interest of government.
 Chadwick was instrumental in creating a central public
health administration that paved the way for drainage,
sewers, garbage disposal, regulation of housing, and
regulations regarding nuisances and offensive trades.
Louis Pasteur (late 1800)
 French biologist and chemist
 “germ theory”
 In 1853 Pasteur began studying fermentation in wine and
beer and rapidly concluded that microorganisms were
responsible.
 He also discovered that microbes in milk could be killed
by heating to about 130 degrees Fahrenheit, a process
which is now known as 'pasteurization‘
 He discovered that some microorganisms require oxygen
(aerobic organisms), while others reproduce in the
absence of oxygen (anaerobic).
 Pasteur pioneered the idea of artificially generating
weakened microorganisms as vaccines.
History of Public Health in the U.S.

 1799 – Boston established the first board

of health and the first health department
in the United States.
 Paul Revere is named as the first health
officer.
 1800 – Dr. Benjamin Waterhouse
introduced the smallpox vaccination to
the US.
 1842- Lemuel Shattuck, a Massachusetts
legislator, established the first US system in the
US for recording births, deaths and marriages.
 Among Shattuck's many contributions were his
proposal for a standard nomenclature for disease;
establishment of a system for recording mortality
data by age, sex, occupation, socioeconomic
level, and location; the application of data to
programs in immunization, school health,
smoking, and alcohol abuse. .
 The Immigration Act of 1891 required that all
immigrants entering the US be given a health
examination by Public Health Service (PHS)
physicians.
 The law stipulated the exclusion of :
1. all idiots, insane persons, paupers or persons likely
to become public charges
2. persons suffering from a loathsome or dangerous
contagious disease
3. criminals
 The largest inspection center was on Ellis Island
in New York Harbor.
 1894 - The first epidemic of polio struck the United States.
 1900 - Some estimates indicate that HIV was transmitted
from monkeys to humans as early as 1884, but was either
unrecognized or failed to initiate human to human
transmission until later.
 1906 - Congress passed the Federal Meat Inspection Act
requiring the US Department of Agriculture (USDA) to
inspect meats entering interstate commerce. They also
passed the Food and Drug Act. The law forbade adulteration
and misbranding of foods, drinks, and drugs in interstate
commerce, but contained few specific requirements to
ensure compliance.
 1912 - The (PHMHS) Public Health and Marine Hospital
Services was renamed the United States Public Health
Service, and it was authorized to investigate human
diseases (such as TB, hookworm, malaria, and leprosy),
sanitation, water supplies and sewage disposal.
  1916 - Johns Hopkins University founded the first school
of public health in the United States with a grant of
$267,000 from the Rockefeller Foundation. And in1952 -
Polio cases surged in the US. Early testing of the vaccine
developed by Jonas Salk is encouraging. 1954 - A large-
scale clinical trial of the Salk polio vaccine began.
 1953 - Under President Eisenhower, Congress created the
Department of Health, Education, and Welfare (HEW).
 1970 - The Occupational Safety and Health Act was passed by
Congress, and the Occupational Safety and Health Administration
(OSHA) was founded in 1971.
  1970 - The Environmental Protection Agency (EPA) was established
to consolidate federal research, monitoring, standard-setting and
enforcement activities to ensure environmental protection.
 1979 - Smallpox was declared eradicated by the World Health
Organization (WHO). The eradication of smallpox, one of the
deadliest and most dreaded diseases, was the result of a massive
global effort utilizing case-finding and vaccination. The last known
case occurred in 1977 in Somalia.
 1981 - Dr. Michael Gottlieb and his associates report on
four previously healthy young men who had developed
Pneumocystis carinii pneumonia. They hypothesized that
this was a new syndrome of acquired immunodeficiency
caused by a sexually transmitted infectious agent.
 Some of the Major Achievements of Public Health In the
20th Century
 Vaccination to reduce  Decline in death rate from
epidemic diseases cardiovascular disease
 Eradication of  Improvements in maternal and
smallpox child health
 Improved motor  Family planning
vehicle safety
 Fluoridation of drinking water
 Safer workplaces  Reductions in the prevalence of
 Control of infectious tobacco use
diseases