History of Medicine Test II

Dysentery; Typhoid

Dysentery = caused by amoebas, one of which is Entamoeba histolytica, and bores into the intestinal wall and it hard to get rid of; people can also be asymptomatic carriers; can hemorrhage into blood vessels and causes "swellings"; can also perforate intestinal wall (sepsis) lots of diarrhea and dehydration; common issue in Jamestown with fecal-oral transfer especially in the first two summers Typhoid = caused by bacteria salmonella typhi and dehydrates and can lead to long-term anemia and intestinal perforation, high fever, ; can be spread by asymptomatic carriers (Typhoid Mary) (fecal-oral transfer and spread in Jamestown via infected water supplies)

New World Food Insecurity; Medieval ideas about food; food in Jamestown and Plymouth; Edward Maria Wingfield

Food insecurity in the New World was real, but beliefs about it made it worse; on the macro level hunger is a problem but sources say they have food - why?; Medieval established agriculture was pretty good and it is harder in the New World than they expected (climate is harder, had to build farms on completely uncultivated land, starting with animal husbandry is also difficult, hunting is hazardous w/ threat of Native Americans and animals aren't familiar, fishing nets with catch/tear/tangle); people are suspicious of/ slow to adopt native foods, negative opinion of corn (harmful/ not nourishing/bread is harder/it would make them more savage or give them a melancholic temperment); they did learn how to incorporate/grow it but it took a while, also didn't like the hunting-gathering mix (said it was "savage trash" and disorderly), really dependent on European shipments (so LOTS of starvation fluctuation throughout the year) People in Medieval England thought in hierarchy (society is ordered by God) and food should reinforce this (the upper-class gets the most/best choice/variety, more meat/best fruit and veg) and this is visible even within families at banquets, with the lord providing for all his house; this worked as long as there was enough to go around; Jamestown = everyone eating from the same supply and saying there is no hierarchical distinction is essentially anarchy; food is scarce so the ruling council can continue food stratification (people will die) BUT food all-alike has a fear of chaos; Wingfield's idea about the Common Kettle but also his hypocrisy Plymouth = also have food trouble (long/cold winters and native food suspicion) BUT they adapt faster (incorporate native foods, pursue the Common Kettle); the colony wasn't about money but wanted to be a more "godly society" (care for everyone); the Common Kettle was followed for the first few years but later they decided that people would do better if everyone could have their own plots (wouldn't hold back their society and they could take advantage of everyone's skill versus everyone having to work in ag) Edward Maria Wingfield: a younger noble son (couldn't inherit the estate) who invests in the Virginia Company and is elected president of the ruling council BUT by September he is on trial/kicked out of the colony because he refused to share his chickens/beer with the OTHER MEMBERS of the council (NOT the general public); Wingfield said many should share equally and wouldn't allow the ruling council to take more BUT he didn't apply this rule to himself; other leaders were mad he treated them like commoners (Wingfield tried to put himself above everyone else); eating Indian food would equate them to natives/animals (food hierarchy ideas)

Smallpox Handout: early modern history and changes; what happened after 1721 innoculation controversy; changes in support/eventual acceptance

By 1600s frequency and mortality of smallpox epidemics were increasing = Bills of Mortality show smallpox rates overtaking plague rates, replaced famine as the most severe limit on population growth, by 1700s its responsible for 8-20% of all deaths, in places like London (where it was endemic) up to 75% of the population had it at some point in life; variola major could have increased around this time (evidence for this mutation on Lithuanian skeletal remains); huge econ impact (like yellow fever only worse because it wasn't confined geographically or would die out in the winter) Remained controversial and not widely accepted despite Boylston demonstrating that it was less deadly than "natural" smallpox; Religious objections (innoculation would avoid divine justice and discussion was over the fate of both the body AND the soul); mortality was low but not the lowest, it was costly and a lot of time investment (needed a "preparation" period, poor cannot afford to benefit from innoculation), seemed reasonable only in a crisis moment but otherwise seen as an unnecessary risk Enlightenment thinking changed (God gave people minds to exert control over the world) (innoculation also comes from God); Robert Sutton increasing the fortunes of innoculation (did small incisions and dabbled it with smallpox matter than large open cuts or small scratches and got the pus in its early week when it was thin and watery, so lower innoculation mortality), innoculation "houses" in a business model format (large-scale approach rather than simply doing it in homes), more innoculators and competition made it affordable, began to be seen as a group benefit (British army innoculations, slave trade innoculations, mass innoculations to prevent the economic costs of an epidemic); innoculation remained unpopular in America and was generally banned or avoided outside of the mid-Atlantic region

Theories on the Origins of Syphillis notes

Columbian Theory: Syphillis originated in the New World and did not reach the Old World until explorers (like Columbus) brought it back; would account for the European Epidemic in the 1500s (which closely resembled syphillis?) because it would've been a new disease brought back with explorers; evidence = European sources perceived it as a new disease (no name for it, assigned it a name with foreign origin), Native Americans were familiar with it/had a name for it/suggested remedies to Europeans BUT these are based on oral traditions/hard to date it and it would be shocking if only a handful of explorers managed to spread it all over Europe, abundant skeletal evidence of treponemal disease in the New World (dated reliably before European contact) Pre-Columbian Theory: Syphillis has been present in the Old World since Biblical times (but doesn't argue that it was absent from the New World/makes no claim about the New World); accounts for the European Epidemic in 1500s by saying it was already present but may have been labeled incorrectly as leprosy and not recognized as a separate disease, and several events could've brought it to light in the late 1400s/1500s = closing of leper houses (if people with syphillis incorrectly were put into leprosariums then they now mingled with the population and spread an unprecedented number of cases), expulsion of Jews and Muslims from Spain (new immigration and spread of cases), new medical knowledge and the printing press (knowledge now realized they were two separate diseases and there may not have been an actual epidemic but an increased printing of knowledge about it that made it appear as if it were an epidemic); evidence = medieval definitions of "leprosy" (sexually transmitted and causing genital warts) may have actually described syphilis, mercury cures (which don't affect leprosy but do have some impact on syphilis) but mercury was common among other cures and any documentary evidence could be leprosy or anything else, little skeletal evidence that doesn't come from the later Middle Ages and its dating is questionable at that, leper hospital burials often show true leprosy/not syphilitic damage Unitarian Theory: Syphilis is one of 4 diseases in genus Treponema and depending on the climate and human habits, different treponemal infections had become established in many places, including the Old World, before the time of Columbus; accounts for 1500s European Epidemic b/c treponemal disease as a veneral form was an adaptation after sanitary advancement made it difficult for it to be transferred via casual contact (the timing is a coincidence); evidence = no evidence for the major sanitation shift in the 1500s (if anything, it got worse), similar weaknesses in documentary evidence with Pre-Columbian Theory, skeletal evidence is most significant in the New World but other parts of the world have possible cases pre-dating European exploration Issues with evidence: New World disproportionate representation in the number of graves excavated, often skeletal remains are very minimal/partial at best (interpretation is still not 100 percent); still a contentious debate and right now, Unitarian theory seems to have the best support in terms of physical/skeletal evidence but its not assumed correct.

Boston smallpox innoculation controversy 1721: William Douglass (1681-1752) and Edmund Massey (1690-1765)

William Douglass has an MD and is the "most qualified" but is arrogant/blamed other inexperienced physicians for smallpox deaths; says ministers are overstepping (they have no expertise and they are abusing their church power), just because medical theories are published doesn't mean they are good/credible, says innoculation puts the whole town at risk, Boylston is too rash/not enough information is known/needs more qualified experimentation; racist judgement of Onesimus (he is a liar/not credible/will tell Mather just what he wants to hear); Mather is being taken more seriously than him and took matters into his own hands; in the end Douglass changes his mind (not during the 1721 epidemic) but he still hates Mather (he's jealous he didn't come up with it first) Edmund Massey is a reverend who focuses on the Book of Job/Satan inflicting Job with boils as a way to test his faithfulness to God and Massey connects this to smallpox; God sends diseases to mankind for a trial of faith (testing like Job) and as a punishment for sins (repent and God is doing this to you); God uses disease to warn others of the dangers of sin and he is the only one sending disease - as it is a part of God's plan (oddly reassuring?); men cannot lawfully do anything and everything they want (they are going against God's law), innoculation won't save someone from God's plan, stay faithful during your trial and God will bless you to survive

Medical Malaria information: Three "actors", types, symptoms and recovery

Actors: microorganism Plasmodium (either Malariae, Vivax, or Falciparum), the Anopheles Mosquito ("prophetless"/"useless", transmission vector), and humans (also a transmittion vector); all are necessary (parasite life cycle is split between the two vectors) to have malaria Malariae and Vivax are both milder (5% mortality) BUT do undermine health and make it hard to survive other diseases (so, lots of indirect deaths); Vivax is the most widespread form in America and people who have these forms tend to have relapses; Falciparum = 20% mortality (more deadly, attacks more red blood cells and these become "sticky"/can clot), tended to stay in the middle/deep South and concentrated in swampy areas (mosquitoes LOVE standing water); there are LOTS of different types of Anopheles mosquitoes that can transmit this (30-40 species) and are adapted to a variety of environments near water; can live up to 4 months but stop biting/die in winter and can vary in a geographic range Mosquito bites you and puts parasite in, parasites go to your liver for awhile to incubate (10-14 days but can be longer), then most will move into the bloodstream (BUT some will stay in the liver); these feed on RBCs and multiply inside them, cell apoptosis, continue to swim in your bloodstream; you get symptoms when they are in your bloodstream so you feel your body's immune response = malaise, prostration/fatigue, fever/chills (ague), maybe nausea, aches (not a lot of distinctive symptoms when malaria starts) for about 24 hours (fever paroxysm = so intense its like a seizure); THEN you feel better (but that's just because the parasite is in your RBCs and multiplying); so there is a cyclical fever with different patterns based on the type of malaria: vivax and falciparum = TERTIAN (every 3rd day), malariae = QUARTAN (every 4th day) More serious damage = kidney/liver issues, pneumonia, "cerebral" malaria; immune system is gradually learning how to deal with it, the spleen helps (filters out old and defective RBCs and debris and may enlarge over time/ called an "ague cake"); relapses occurs from those parasites that stay in the liver and the mosquitoes get it from them/the cycle starts again; the body can learn to adapt to being slightly infected/has a low level of parasite BUT it doesn't make you feel sick (HOLOENDIMICITY); the main people who get sick in these situations are pregnant women and children but holoendimicity doesn't happen in America because of the climate (winter always kills it out) and any "immunity" is strain-specific

Yellow Fever Handout notes; mosquito type and confined environment; course and symptoms

3 actors = virus that causes the disease, human (gets the disease), mosquito (that transmits it); mosquitoes = Aedes and Haemagogus genuses but primary mosquito that transmits it among humans is the Aedes aegypti (well-adapted to urban environments and small water supplies are all it needs/rain barrels/ditches/gutters/limits yellow fever to urban areas rather than the many types of Anopheles mosquitoes that spread malaria); mosquito dies in cold weather/lifespan is only 1-2 months so it disappears in cold weather and it always had to be imported from tropical regions back into America; struck seaports/river cities first and the mosquitoes short flight range meant it stayed in urban areas; most frequent in late summer/early autumn 3-6 days of incubation; 3 stages with initial infection (generic symptoms/fever/aches/prostration/malaise) for 2-3 days (some may not have known they were sick/asymptomatic), remission (reduced fever and symptoms and for some this is it, followed by recovery and may not have known they had yellow fever because it wasn't more sever), intoxication (about 15% of patients after a day of remission; impaired liver function/dying liver cells resulting in jaundice and hemorrhaging/leaking blood/black vomit, kidney failure, delirium; about 50% die after 7-10 days if they enter the toxic stage); immunity

Estimations on the New-World Pre-Contact Population

Early evidence used to estimate pre-Contact American populations is difficult = scattered/fragmentary/uneven and difficult to note out populations that may have had overlapping counts (thus making it hard to compare), SIGNIFICANT outside influence/motivation beyond just "counting" (clergy winning favors by saying they had a large number of conversions, military wanting to make themselves seem more powerful by defeating larger numbers, natives avoiding being counted), numbers weren't necessarily "precise" Efforts to estimate pre-Contact population began in 20th C but did not yet comprehend significant role that disease played in depopulation and had to deal with all the issues of documentary sources; early estimates were 1-2 million in North America and 8-9 million for the Americas as a whole; mid-20th C began to revise estimates upwards and considered that documentary evidence could involve undercounting rather than overcounting and attempted to supplement with archaeological data (number of burials/village size/trade patterns); mid-20th C estimates are 3-5 million in N. America and 30-50 million for New World as a whole; more recent estimates have added in statistical modeling with this and believed disease decimated indigenous populations even BEFORE European contact; these estimates are about 18 million for N. America and up to 113 million for New World as a whole (but these are criticized for ignoring evidence that contradicts it/generalizing between populations/not accounting for errors from compounded statistical manipulations)

Epidemic v. Endemic Disease notes; which diseases reflect which patterns;

Epidemic = definite beginning and end and begins with a disease entering a population containing a large number of susceptible individuals; rapid spread and many simultaneous cases and stops when it "runs out" of victims; those who survive are immune and can't spread it to others - not every susceptible person will get it, but enough will get it to act as "firebreaks" that protect others (HIGH HERD IMMUNITY); disappears until the number of non-immune individuals rises again and it is re-introduced again from the outside; pandemic = an epidemic that spreads across multiple countries or continents; epidemic pattern is most common when = surviving the disease gives permanent immunity (the number of victims "runs out") and there is no other reservoir where the disease can persist (insects/animals/human carriers/etc.) Endemic = no definite beginning/end and seems to be always or frequently present (no need for outside re-introduction); spreads slowly or sporadically with a small number of simultaneous cases (not enough to be an epidemic, but enough to where it doesn't disappear completely); endemic pattern is most common when = survival confers only short-term immunity, variant strains of the disease exist and short-term immunity doesn't cross strains, reservoirs exist where the disease can persist even if there are no active cases Some are always epidemic (bubonic plague with the absence of modern public health control) or always endemic (common cold), and some can exhibit both patterns depending on = climate (yellow fever endemic in the tropics because mosquitoes that transmit it are year-round, but in early America winter would kill it and it would need outside re-introduction and result in an epidemic), population size (smallpox in London was essentially endemic and was largely seen as a childhood disease or a disease that outsiders got but in New England was always epidemic because the population was so small/come back every time new immigrants came/birth rates replenished the population of susceptible people), population mobility (isolated areas are more likely to exhibit epidemic patterns b/c of little outside immigration/contact and areas with frequent outside contact were more likely to exhibit endemic disease patterns)

Europeans and the Fear of Hot Climates; adaptations to hot climates

Europeans expected similar climates in North America but had a fear of hot climates; when they did have health issues, Europeans attributed it to the hot climates; Europeans believed bodies were adapted to the climates you were born/grew up in and moving to a new place would require a different balance of humors (and would be a health risk); bludie flux/dysentery as the body attempting to correct itself; "seasoning" = period of trial by fire for the first few years in a new climate (period of humoral adjustment); also believed climate could change your character (volatile/riotous/tempers like the Spanish Main issue is that they didn't know the different between maritime climates (over the ocean, cool summers/mild winters/mild variation) and continental climates (hot summers/colder winters/big margins and extremes); earliest attempts at settlement are too north and cold, Carribean is too hot/tons of disease; people generally promoted the South as an "in-between" Blood vessels will dilate more/sweat more easily, metabolism slows, plasma volume increases; colonists noted they had "thinner blood" and recommended arrival in the autumn (when it wasn't as boiling hot), wearing less and thinner clothing (cotton/linen use), building houses with better ventilation, separate summer kitchens

Health Problems in Jamestown

Europeans were shocked at the extreme climates of North America, rivers fluctuated with seasonal water changes and increased the chance for waterborne illnesses; first two summers in Jamestown are hard = dysentery, salt intoxication, and "burning fevers" caused by famine, typhoid (bacterial and gets into the bowels and bloodstream), salt-poisoning (most are in summer when the water levels decrease and the oligohaline/point of brackish water moves upward and there is more stagnantion), hystolitica disease (parasite in the bowel walls and hemorrhages into the blood vessels), "swellings" from dysentery and all these diseases could reoccur 1609 "Starving Time" with a 44% mortality rate (but this is still less than when the colony was first established); movement to other ares (less population congregation) helped this as well as changes in diet (more beer/wine instead of river water, oysters and clams in spring when water is less contaminated/stagnant); John Smith = figured out the idea of moving outside of just one populous city, Thomas Dale = Jamestown governor who pushed diet and population changes to reduce mortality Jamestown rivers are both for drinking and close to where they dump their waste (they continued to drink from it because of the general idea that moving water was "pure"); the colonists believed it all came from starvation but other records show that there should have been enough to go around (contradiction here) (proof that there were other factors impacting mortality like water quality); evidence of cannibalism (cut marks on human bones), environmental issues (historic drought levels); spring = more water movement/snow melt while summer = slower movement/lower water levels/ brackish level moves closer inland Entamoeba hystolitica = one of the amoebas that causes dysentery; bores into the intestinal wall and is hard to get rid of; some people are asymptomatic carriers; typhoid can also be asymptomatic and people can be carriers even after they are better; people didn't always know they were sick (fecal-oral transfer); dehydrates, long-term anemia, can perforate the intestinal wall (sepsis)

Diet in the New World and Humoral Theory

Look at diet through humoral theory; race was more fluid (Native Americans were descendants from Noah BUT poor climate and nutrition made them the way that they were when Europeans saw them); European foods would thus protect the European balance of humors; Columbus's crew became ill after arriving to Hispanola and asked for European foods to "protect" them (lamb/chicken/turkey/wheat/wine) and to keep them healthy and looking European; Europeans were afraid of New World foods on paper BUT in reality relied heavily on them for sustenance; still attempted to cultivate European foods (describing the New World as a "savage" and "wild" climate but also acting like they found Eden/said they were getting 100:1 ratios but a lot of this was exaggerated); also tried to push European foods on Natives (contradiction with the idea that Natives were "so different they couldn't digest it")/attempts to Europeanize them and plant European crops to moderate the climate' Catholic sacrament contradiction on switching from wheat bread to maize bread; food is one singular but unique facet in the tools of colonization (especially in its contradictions)

Yellow Fever lightning talks: ideas about treatment, the nature of NOLA Yellow Fever hospitals, economic impact of Yellow Fever

Lots of treatment variety = "purging" the body with natural home remedies (vomiting/pooping/sweating), tonics, snake oils; people who had general nursing tended to do better than radical treatments from doctors; tried to separate the sick from the healthy but all the sick were close together ("contagious" issue); rich/wealthy would flee, family members would stay together (records of soldiers who would kicked out of the army and return to be nursed by their families, a woman breastfeeding her child while her husband died) Hospitals were used to help "treat" but they aren't necessarily better situations to be in; were separated by gender, barely enough room for nurses to walk through, the number of patients was overwhelming, many died because physicians would forget basic needs like food and water; burial boxes, naked corpses, unmarked graves, people in hospitals were poor/it was too late for them to recover and it was essentially a place to die Business hours and employees are limited, ports are closed/shipments delayed during quarantines, physical labor is overwhelmed, NOLA requests aid, insurance premiums go up, the "piano business" of coffins, ice and prescriptions are increasing (combat the fever/heat), newspaper business is impacted (reports are trying to downplay it to avoid a mass exodus)

Other Malaria info: origin, historic evidence, post-1800s info

Malaria is OLD and all forms originated in Africa; by the Roman Empire, there is evidence of it that far, vivax malaria already in costal England, falciparum spreads with the slave trade; African sickle-cell adaptation from dealing with it for so many centuries but this results in health being used to justify slavery Ebbs and flows in America but doesn't stay where it is cold (spreads after the Civil War to the north, but it always exists in the South); figured out mosquito transmission at the end of the 1800s but southern tolerance persists (people just deal with it - similar to how we have apathy to allergies now), poverty/many can't afford protection and malaria continues into the 1930s/gets worse during the Depression; DDT development during WW2 helps and malaria is gone from the US by the 1950s; over 200 million cases still globally and most common in Africa

Malaria in the Southern colonies

Malaria wasn't prevalent before European contact - brought vivax and falciparum w/ African slaves; deep South was the perfect environment for this, and the African tolerance of malaria reinforced racial stereotypes of them being naturally suited to ag slave work; use of false advertising to build the South Carolina colony (claimed mild summers and winters) (but initially it was pretty healthy...until Europeans brought disease); climate is hot and humid w/ 7-8 months of potential incubation, marshlands and rice fields in the low country mean lots of water, low mortality and high morbidity (LOTS are infected); mosquitoes can also travel up to a mile!! Adaptations: didn't realize mosquitoes spread it but did connect malaria to heat/summer/standing freshwater; wealthy would go inland or to the coast (summering in the "piney woods"/upcountry), others would use mosquito nets (but just because they were seen as a general pest); huge increase of malaria in 1760 and lots of fear about it, so around this time people move/vacation more in cities (cities, though not seen as healthy, were seen as less dangerous than "rural fevers"); increased survival rate from 15% to 51% for men living to 50. Eradication programs could be bad (death did mean there were less people dependent on cash crops), labor required fitness (could wipe out income for working laborers/more slave dependency/economic polarization); closer neighborhoods (spread more quickly), visitors bringing illnesses, families stepping in as caregivers; cultural differences arise on philosophy of life (gonna die young/ devil-may-care attitude), less southern intellectual activity, malaria seen as a "southern disease"/infected are seen as inferior; malaria became particularly a rural disease; yellow fever is one mosquito adapted to tiny water environs and only flies a few hundred yards/is thus an urban disease (costal and riverport city pandemics)

General Info about English immigrants/colonial American health; how to measure epidemic patterns; New England Colonies; Southern Colonies

Most people coming to America from 1600-1700 are English; England was moderately healthy with lots of regional variation (south of England is healthier, w/ more econ development/more predictable climate/better soil; cities generally tend to be unhealthier, coastal/lower elevations are less healthy b/c of vivax malaria being ongoing); often more prosperous people had higher tendencies to emigrate to America (its a mix, but not all are poor refugees fleeing); Epidemic patterns = frequently and deadly flare ups BUT not widespread (for diseases you can get only once), frequent and widespread but moderately deadly (for diseases where you don't achieve immunity); its rare for all three factors to converge NE Colonies: short growing season but long winters (keep disease away - less insects and people stay inside); low pop density/little urban growth (but, you also don't build up tons of immunity), nutrition is fine (can survive short growing season and have more land to farm); most families are not really in it for just money (they came for religion) so not a lot of inequality; population expands on its own (survival and reproduction, but people still don't build outside immunity); epidemic pattern = deadly and widespread BUT not frequent Southern Colonies: long growing seasons but waterborne/insect borne pathogens survive a LOT longer; low population density (less direct contagion but most problems still spread via water/insects), good nutrition (no major famines); perpetual malaria and yellow fever; people go here for money/significant income inequality (indentured servants/slaves) that is maintained via disease (the poor cannot afford rest/care); initially high morality but newcomers arrive/African slave ships bring falciparum (more deadly version of malaria); epidemics = frequent, deadly, AND widespread and people are aware of how dangerous it is

Yellow Fever lightning talks: reporting on symptoms, monthly changes, average number of deaths

Onset symptoms are initially confused with other diseases or just things associated with working = fever, muscle-aches followed by more severe phase (black vomit**, jaundice, lots of firsthand imagery of these visceral conditions); many wouldn't realize they were sick for the first few days or could not afford to rest (esp. poor) , and after 6-8 hours of severe symptoms people would usually die; severe phase is the "toxic phase" and the term comes from the discoloration of the skin ("yellowed" complexion from jaundice, and advertisements existed for snake oils to try and cure this) Began in NOLA in May/June with a peak in August; July 8 is earliest newspaper reports, August reports are daily about the widespread "frightful fever" with unprecedented mortality, Aug. 18 says 1000 died in the last week of July alone; quarantine expectations, burning bodies, NOLA requests relief money; Sept. death rates start to decline, spreads up the Mississippi Delta but it isn't as severe; Daily death rates and weekly death rates are calculated and publicly available, but there is wide disparity depending on the source; 1302 deaths for week of July 20th, 500-ish for week of July 28th, daily rates of 150-200 in August; total mortality for the 14 weeks before August 26th is 6170 (average of about 400/weekly and 150/daily)

Yellow Fever Handout notes: other names for yellow fever; place and time of yellow fever outbreaks

Other names = Barbados distemper (one of the places it spread to America from), vomito negro (named after characteristic black vomit), bleeding fever (named for hemorrhaging in severe cases), bilious fever (named for yellow bile/traditional humor), Saffron scourge (saffron is yellow), Yellow jack (yellow quarantine flag), Yellow fever (modern name appeared in 1750 and gradually replaced others) Originated in Africa and both the Aedes aegypti mosquito and yellow fever had to be imported to the New World before epidemics could occur; Carribean and Spanish America were the first New-World sites of yellow fever, epidemics in 1640 with establishment of sugar plantations; Northern US epidemics in late 1600s in northern seaports following establishment of sugar refineries and shifted south in 1830s (unsure why); Southern US hits peak in 1800s/1830s in NOLA/Savannah/Charleston and between 1841-1861 there was at least one epidemic each year in a southern city (infrequent during Civil War, probably related to the Union blockade)

Yellow Fever lightning talks: preconceptions and ideas about susceptibility, ideas about yellow fever origins and how it spreads

Preconceptions: warm and costal areas are where it happens, newcomers are vulnerable (sailors/poor/laborers who cannot rest), poor who couldn't afford treatments; they are surprised that it impacts rich and poor alike; politics impacted how they considered susceptibility (abolitionist papers discuss poor blacks, pro-slavery papers say slaves don't get it/should be laborers because of this natural barrier); acclimation to an environment was a preconceived barometer of health but in practice, this doesn't apply to the yellow fever Both foreign and domestic origin ideas = a crew from Rio, reports of West Indies crew fatalities, the cargo ship Adelaide from Rio, Veracruz, caused by internal imbalance from adjusting/acclimating to the climate, weather and climate influence (brought on by the rainy season) and it lessens with cold weather, issue of public sanitation (overcrowding, poor drains/standing water, poor ventilation); most agree on weather impact but it has to include more - comes from ports and spreads with poor urban conditions with ideal weather Believed that urban filth and clutter spread it, could have "infectious influence" (if you're already susceptible) but didn't see it as contagious; spread from north and south ports and "met" in the city center in NOLA, lower class suffered the most, people would falsely report being sick twice

Smallpox handout: deliberate spread and "smallpox blankets"; vaccination; end of smallpox?

Probably happened often but few definitive cases exist; Fort Pitt 1763 = Amherst and Bouquet discuss idea of giving smallpox to Indians via blankets and traders at the fort had already done this; Portsmouth and Yorktown 1780 = theories that Brits used enslaved people to spread it but its unlikely; Brit advantage during Revolution because of their immunity or inoculation against smallpox, Washington's inoculation orders were ignored or delayed in 1777 Edward Jenner 1790s with cowpox used to grant smallpox immunity (named vaccination b/c of Latin word for cow); produced a single pustule where it was injected and that was it, and those who were vaccinated didn't have smallpox and couldn't spread it; though it was better it wasn't immediately more accepted than inoculation - cowpox was uncommon and needed a fresh case/would have to transport material, people thought introducing something from animals was dangerous, didn't see need for it without a crisis and may remained unvaccinated Last US case in 1949 and was disappearing from developed countries, massive vaccine campaigns in the 1960s w/ goal of complete eradication, eradication in 1977 in Somalia; vaccines were stopped in 1980 as a result and now are only given in special circumstances; still no cure beyond supportive care and US/Russia continue to work with the virus (biological terrorism?)

Boston smallpox innoculation controversy 1721: general smallpox info; ideas and fears about smallpox in 1721

Smallpox = variola virus ("spotty"/"pimply") and spreads via direct contact like the flu and measles (no insects/vectors/water spread/long-term human carriers); incubation period is about 12 days; early symptoms = flu-like/fever/body aches/malaise/prostration/some nausea for 2-3 days, then the characteristic rash starts; starts in mucous membranes and spreads to the face/torso/limbs, spots rise/look blistery then become pustules (thick/rubbery/filled with pus); smallpox is a retronym (used ot be called "the pox" but became smallpox after syphillis was termed the "Great Pox"; pustules last for about a week/become very painful/death is likely to happen during this time, then after 8-9 days the rash will subside/pustules become scabs for a few weeks and then you have scars; scabs can also spread smallpox ("smallpox blankets") by 1721: smallpox is the worst disease that people know of (the plague is moving off) and people are afraid ESPECIALLY in Boston; Smallpox is endemic in London so most people get it as children or if they are outsiders so most cases are sporadic. Boston isn't big enough for it to be endemic so smallpox occurs in waves of pandemics every 10-20 years; people cannot get away from it when it occurs (poor in the city), everyone believed it was contagious and knew you were immune if you survived; recognized minor and mild forms and major/severe forms - but BOTH give you immunity; innoculation = actually giving someone a real case (not like the "dead" viruses in modern immunizations)

Boston smallpox innoculation controversy 1721: Cotton Mather (1662-1727); Zabdiel Boylston (1680-1766)

Smallpox picks up in 1721 and people seek less conventional methods of treatment; Mather hears his slave Onesimus discuss African innoculation practices and Mather hears about cases in Turkey/Asia that involve collecting pus in a warm glass/putting it into open cuts/leaving it covered for a few hours; says very few died this way and could "prove" their immunity; Jacobus Pylarinus (a Greek operatrix observing a folk practice of innoculation) used similar methods but used more cuts/said winter was the best time to do this; Mather argued that natural smallpox was riskier via aerozolization into the respiratory system rather than localized direct infection which could be "controlled"; would also be able to choose the variola minor pus or pus from the previously innoculated; Mather was a clergyman who brought up the idea but Boylston was the one who actually did the innoculations; Mather was PROMINENT in Bostonian society (strong Puritan bloodlines and a Puritan "divine" = respected and accomplished scholar/theologian and seen as very knowledgable and wrote over 400 books) and would often borrow books from Douglass (he was an intellectual and expected people to listen to him) Mather gets the Turkish testimony and hears about it from Onesimus and April 1721 an outbreak appears/Mather publishes his ideas and Boylston is the doctor who reads it; Boylston had confluent pox/variola major and was scared for his children's health; the initial subjects included one of his sons and his slave; Boylston performed over 246 innoculations and tended to do more in the summer (that's when most happen/samples will denature after awhile); need a distinct case of variola minor, lance the boil/take the pus, cut the upper arm/inside of leg for placement (easy access and dressing), add a small amount and seal it with plant plasters/heated diacolons, keep patient in their homes/wait it out/use antimonials (emetics)/blood-letting/clean plasters and hot poultices; Boylston says natural mortality is 1/6 and with innoculation it is 1/46; diluted in pus and uses the selection of mild cases, more severe deformities are less common as a result; innoculation was difficult due to extreme opposition, summoned by authorities; issues with Dr. Douglass (wouldn't read the documents/ was pompous and arrogant and Boylston says he lied and misprepresented his practice); invited other doctors to see that it worked but they didn't come, news also reports that innoculation would bring back the plague; Boylston had no MD but was still very respected (no US med schools at the time so actually having an MD is more uncommon than the other way around), had the biggest Boston apothecary and was an early surgeon willing to take risks; purposefully exposed himself to smallpox because he knew he would have to in order to be a doctor

Smallpox Handout: smallpox and contagiousness; ancient and medieval history of smallpox

Transmits within 6ft after prolonged contact (so, less contagious than measles or influenza), 90% or more of those exposed will develop smallpox; not very contagious before the rash develops, highly infectious during the first week of the rash, virus can still spread via pustules/scabs (spots are a warning to STAY AWAY); was conceived as contagious in pre-modern times (could happen anywhere, in any climate, at any time, and could be traced from one case to another) Transferred from animals to humans (but no agreement on which animal) and then mutated to a version that only spreads between humans; needs a large population so it probably "jumped" after agriculture (sustainable large human populations and would've meant more connections with animals w/ domestication); Africa, India and China have all been proposed as the first places but no final answer yet; written descriptions between 2000-1000BC in India and the Middle East and China, possible smallpox lesions on mummies (but physical evidence is very rare), no evidence for Europe or New World origins Medieval: smallpox present in Europe but may not have been a serious health threat; Rhazes = 10th C Islamic physician who provided first clear evidence of smallpox, describing it as universal but mild; Abroise Pare = 16th C French surgeon and only devoted a few pages to smallpox (suggests it wasn't a big issue)

Yellow Fever Handout notes: is it contagious?; treatment;

YF is communicable through a mosquito vector but not directly contagious BUT that wasn't known until 1900/lots of debate beforehand; some thought it was directly contagious and spread w/ travel (advocated for quarantines ), more thought it was caused by miasmatic fumes from garbage/stagnant water and hot air (advocated for urban clean-up) (explained its correlation with heat and why people would get it without direct contact), other middle-ground theories too Treatment differed little from other diseases - focus on "cleansing" the body (emetics, purgatives, diaphoretics for vomiting/pooping/sweating, bloodletting), home is still where most care takes place (poor were viewed as suspicious and magnets for disease and would usually end up at hospitals but they are overwhelmed/lots of horror stories

Malaria Handout notes: when did we learn its cause; issues with diagnosing malaria in history

most people thought it was caused by bad air (look at the name) and focused on wet terrain/humid air more than mosquitoes; figured out mosquito vector at the end of the 1800s Malaria was so common in early America people saw it as a non-disease (like modern colds and allergies) and may have just been called a "fever"; the general symptoms could be a number of things (though IF a cyclical fever is mentioned, it is a better indicator); many different names (country fever, swamp fever, ague, remittent fever, Tertian fever/quartan fever, congestive fever); seen as a quintessential miasmatic disease (again, look even at the modern name); quinine is a specific remedy for it/bark of the cinchona tree brewed had quinine BUT they could've use that to try and treat other fevers

Malaria Handout notes: how it spreads; fever paroxysm; issue of immunity; factors encouraging and checking malaria spread in early America

spreads mostly via mosquitoes but can rarely spread congenitally and via blood transfusions; Plasmodium organism (p. vivax, p. malariae, p. falciparum) one of the most characteristic symptoms of malaria; intense attack of fever that climbs very high very quickly and lasts a few hours then breaks off completely and in between "attacks" the patient feels almost normal Malaria immunity is strain-specific and there are multiple strains within each species too; immunity is partial and temporary (holoendemic malaria can happen but people have to be in an environment where Anopheles mosquito is constant) Factors encouraging its spread = lots of movement and immigration, disrupting natural drainage with rough land clearing, creating ponds/mills for livestock, rice cultivation, canal travel, crude housing (mosquitoes can get in); factors limiting it = cold winters, less water-intensive crops, improved housing, urbanization