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Bacteriological Revolution

Introduction to Global Health


Anthropology 3283

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


Dogs 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 devastationyour entire extended family wiped out
in a matter of dayswas 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 weeksout 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

Kochs 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