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