Introduction to Global Health

Anthropology 3283

Bacteriological Revolution

“Black death of the sea”

James Lind (1716 – 1794) and the origins of epidemiology

cholera epidemics

1817 epidemic in India – 25 million deaths

1829 epidemic in Moscow – 33,000 deaths

1831 epidemics in England – 130,000 deaths

1832 epidemics in Paris – 18,000 deaths (2 % of the population)

The Culture of Cholera Disease

“Dog’s Death,” “Blue Terror”

Carrion squads

Severe disability and scarring in survivors

Media reporting

“So many cholera victims were being buried inside churches and church yards already

full that infection was constantly breaking out.” Illustrated London News, 1849.

“A Court for King Cholera.” Punch Magazine, 1852.

Cholera and Fear

The threat of sudden devastation—your entire extended family wiped out

in a matter of days—was far more immediate than the terror threats of

today. At the height of a nineteenth-century cholera outbreak, a thousand

Londoners would often die of the disease in a matter of weeks—out of a

population that was a quarter the size of modern New York. Imagine the

terror and panic if a biological attack killed four thousand otherwise

healthy New Yorkers over a twenty-day period. Living amid cholera in 1854

was like living in a world where urban tragedies on that scale happened

week after week, year after year. A world where it was not at all out of the

ordinary for an entire family to die in the space of forty-eight hours,

children suffering alone in the arsenic-lit dark next to the corpses of their

parents.

- Steven Johnson, The Ghost Map

competing theories of disease

miasma

mal-aria

waterborne germ theory

William Farr

founding figure in medical

statistics

pioneering research on cholera in

1840s – 1850s London

initial focus on miasma

John Snow

You could be in the same room with a patient near

death and emerge unscathed. But, somehow, you

could avoid direct contact altogether with the

infected person and yet still be seized with the

cholera, simply because you lived in the same

neighborhood. Snow grasped that solving the

mystery of cholera would lie in reconciling these two

seemingly contradictory facts.

- Steven Johnson, The Ghost Map

A Natural Laboratory

“People of both sexes, of every age and occupation, and of every rank

and station were divided into two groups without their choice, and, in

most cases, without their knowledge.”

- John Snow

Company Houses Deaths Mortality Rate (per

1,000 population)

Southwark 40,046 1,263 32

Lambeth 26,107 98 3.8

Rest of London 256,423 1,422 5.6

William Budd (1811 – 1880)

landmark studies of cholera and typhoid in 1850s and 1860s

“Contagion multiplies at certain sites within the sick host, is eliminated and transported by definite routes, and can be destroyed or interrupted in its passage to other susceptible hosts.”

Max von Pettenkofer (1818 – 1901)Robert Koch (1843 – 1910)

fermentation and rotting known for millennia

‘spontaneous generation’

Louis Pasteur (1822 – 1885)

globules v. vibrios in wine & beer

pasteurization

microbiology

How wide and useful to pursue is the field of these

studies which bear such a close relationship to the various

illnesses of animals and plants, and which certainly provide a

first step along the desirable path of serious research into

putrid and contagious diseases.

- Pasteur, 1862

Joseph Lister (1827 – 1912)

hospitalism

“Decomposition in the injured part might be avoided by applying as a dressing some material capable of destroying the life of the floating particles.”

bacteriological revolution

1880 Typhoid, leprosy, malaria

1882 Tuberculosis (Koch)

1883 Cholera (Koch), strep

1884 Diphtheria, tetanus

1886 Pneumonia

1894 Plague, botulism

1898 Dysentery

Koch’s Postulates

• microorganisms are found in abundance in diseased organisms

• they can be isolated from the organism, grown in a pure culture, and

reintroduced into healthy organisms to induce sickness

• disease-causing microorganisms are sometimes also found in

abundance in asymptomatic individuals

cholera vibrio wager

October 7, 1892

“Even if I be mistaken, and this

experiment that I am making

imperils my life, I shall look

death quietly in the face, for

what I am doing is no frivolous

or cowardly act of suicide, but

I shall die in the service of

science as a soldier perishes on

the field of honor.”

The tragic irony of cholera is that the disease has a

shockingly sensible and low-tech cure: water.

- Steven Johnson, The Ghost Map

germ theory of disease

shift away from abstract focus on places and populations – new focus on

vectors & at-risk groups

importance of statistics and scientific research

structural violence, social medicine, & neo-miasma theory