ANTH-2560-D01 (Unit 2 Study Notes) Part 1

Name the two reasons why the disease caused by bacteria, viruses, protozoa, and hemiliths, are important in medieval anthropology ?

(1) the etiology, ie the cause of these disorders understood well biomedically. (2) Diseases responsible for many deaths worldwide with a major impact on human populations in the past.

When was plague causation identified?

- 1800s, when microorganisms were discovered.

The number of cases of plague worldwide from 1981 to 1995 totalled?

- 21,087 with 1,932 deaths occurring

Describe HIV/AIDS on the microbial level:

- AIDS stands for Acquired Immune Deficiency Syndrome and it is caused by the Human Immunodeficiency Virus (HIV). - Individuals can carry the virus and not develop AIDS for a long period of time. - HIV is a retrovirus meaning it is an RNA virus with a reversal aspect; it has an enzyme called reverse transcriptase so that the message is transferred back to DNA, which is then incorporated into the chromosomes of the infected cell. - Retroviruses have a great capacity for mutation. - HIV mutates quickly inside every infected person so that the dominant strain of the virus changes during the course of infection. - HIV is transmitted through bodily fluids exchanged between individuals during sexual intercourse. The virus can also be transmitted through blood and blood products, and perinatal transmission can occur through fluid exchange at birth. - The virus induces immunosuppression in individuals so they are much more susceptible to other infections: pneumonia, skin problems, gastrointestinal ailments and tuberculosis.

It is a genetic condition caused by a mutation in DNA:

- All individuals have at least two alleles that code for different traits. - An allele is an alternate form of a gene. Some alleles are dominant and some are recessive. - Sickle-cell anemia is a recessive disorder. - A recessive allele can be masked by a dominant one. When they occur together the recessive will not be expressed.

Describe Anita's case and treatment with the community for HIV/Aids

- Anita was a Haitian woman who contracted the disease through her lover Vincent. - Anita nursed Vincent and then years later she became ill. - Her father and godmother took her in and nursed her, wanting to keep her with family rather than have her treated in the clinic. - Her quality of life was most important so she remained with her family until she died. - All Anita wanted was a radio to listen to the news and a lambs wool blanket. She received what she wanted. - Her treatment reflects core cultural values in Haiti. - Her family did not blame her --> no stigmatisation. - There was more of a sociocentric orientation; her place was with her family and community. - There was little reliance on biomedicine and technology and it was important that she die a decent death.

Describe the Nutritional concept in disease ecology. List all examples

- Dietary deficiency that leads to malnutrition is a major cause of disease. - exs.) marasmus, a deficiency of calories and protein; - kwashiorkor, a lack of protein; - - vitamin deficiencies such as beriberi (lack of thiamine); pellagra (lack of niacin), scurvy (lack of vitamin C); rickets (lack of vitamin D); and keratomalacia (lack of vitamin A).

Define environmental in disease ecology

- Disease can also be caused by substances in the environment. - includes toxic chemicals, plastics, asbestos, electrical hazards, work-related agents in mining, and agriculture, to name a few.

Describe climate change in regards to plague

- Generally, warm climatic conditions existed throughout the tenth to twelfth centuries. Therefore, more food was produced that led to trade and urbanization. By the thirteenth century, however, climate began to change; it became colder and wetter (Little Ice Age) and this affected agriculture. It lowered yields

Describe the causes of infectious diseases

- Humans act as hosts for a variety of microrganisms often referred to as parasites. - Disease occurs when the interaction between the host and the infectious agent (the host-parasite relationship) is no longer symbiotic. - Many parasites have an interrelationship with their host that is symbiotic = they do not cause disease. - It is in the interests of the parasite to reproduce and not kill its host.

How was plague discovered?

- In 1894 two doctors (Alexander Yersin and Shiba Kitasato) working on plague in Hong Kong found a bacillus known as Yersinia pestis. - Two years later, Simond of France established the link between the rat and human (the rat flea, Xenopsylla cheopsis).

Name the occurrence of population increases?

- In A.D. 950 there were approximately 25 million. By A.D. 1250 there were between 75 and 80 million. - The population increase was due to agricultural and technological innovations that led to a food surplus: new crops; new planting techniques; horses used instead of oxen; new sources of power, windmills and watermills.

Describe social change in the plague world:

- In the twelfth century conditions started to change in terms of social structure: peasants had to pay rent to the landowners in food and labour. Changed to money as food surpluses increased and food was sold to townspeople. - The rural peasantry obtained their partial freedom by paying their lords cash and by expanding land by draining marshes and clearing forests = A market economy. - More wealth meant that people left the rural areas and congregated in towns. There was more specialization and this led to a new class of merchants whose assets were not land but other commodities based on cash transactions.

Name an alternative example of a stigmatized disease in past history

- Leprosy, for example, was thought to be a punishment for sin and it was associated with sexual misconduct. - Lepers were also considered to be heretics and were feared, shunned, regarded with suspicion and denied treatment (Moore, 1990; Watts, 1997).

History of malaria?

- Malaria used to be endemic in the United States and was thought to have been introduced into the U.S. in the 16th and 17th centuries by European colonists and African slaves. - It peaked in 1875 and it is estimated that 600,000 cases occurred prior to 1914. - Malaria was eradicated in the 1940s and 1950s using DDT and measures such as moving from rural to urban areas, drainage of swampland, improved housing, and availability of quinine for treatment. - Cases that have occurred in the U.S. and Canada since then are due to travellers returning from infected areas, blood transfusions from individuals with the parasite, and infected mosquitoes hitchhiking on aircraft.

Describe HIV/AIDS in terms of cultural ecology

- Much of the exposure to HIV is through sexual contact - in the early 1980s in homosexual men in the United States. - High-risk groups targeted in the United States include homosexuals (although heterosexuals are also at risk), intravenous drug users, and haemophiliacs. Also at risk are sexual contacts of the above groups, both male and female and children of infected individuals. - In Africa, the spread of HIV is different and is primarily heterosexual rather than homosexual. The risk group most targeted is female sex workers or prostitutes. - They critique the idea that sex workers are the major problem and propose that research should emphasize three areas: 1) deconstructing high risk groups; 2) analyzing the dynamics of sexual decision making and sexual networking; and 3) assessing interventions, specifically condom promotion.

The diet of people in medieval times was not good at the best of times: describe their diet

- On very special days they would supplement their diet with herring, venison, pork, and poultry. - There was heavy reliance on cereals, and people, for the most part, ate gruel three times a day with little meat and few vegetables. - The unfavourable weather conditions led to situations of chronic malnutrition.

What did the medical profession do for plague?

- Physicians might suggest rest, change of diet, or bloodletting, but they did not have much to combat plague or any infectious disease. Most of their advice was preventative - Physicians regarded plague as fever and thought the plague was passed due to corruption of air. This was referred to as miasma contagion ("miasma" means infectious or noxious vapour).

What was the impact of climate change in the plague world?

- Planting became more intensive as crop yields lowered - Pastures were planted leading to reduction of livestock = eliminated an important source of protein and fertilizer - Peasants turned to the cultivation of wheat exclusively due to its higher yields - This move lessened the diversity of crops. - cycle of poverty began and living standards dropped. Starvation occurred if crops failed.

What was the impact of social change in the plague world?

- Population growth was outstripping food production. People became poorer and poorer. The peasantry were stressed and they had more work and less food. - In the late thirteenth century, there were a series of famines due to bad weather and crop failures. People began to starve and added to this was a series of diseases adding to greater mortality, typhoid fever, dysentery, and diphtheria. - Population numbers dropped, but after each famine as conditions improved, population increased again.

Features of untreated bubonic plague

- Rapid diagnoses and treatment with antimicrobial therapy (antibiotics) are essential in preventing deaths. Recently however, a multidrug resistant strain of Y. pestis was found in a patient in Madagascar. It is not known at this time how widespread this resistance is.

Define schistosomiasis:

- Schistosomiasis (information from Brown, Inhorn, and Smith, 1996 and von Lichtenberg, 1997) is an infection caused by a helminth or worm found in tropical areas of Africa, Asia, and South America.

Indicate some reservoirs of infection:

- Sex workers have been identified as reservoirs of HIV infection, and condoms have been provided to protect male clients.

what areas are most effected by malaria?

- The areas most affected are Africa (90% of the P. falciparum deaths occur on this continent), Central and South America, southeast Asia, and the Middle East.

In many areas of the developing world, rats live in close contact with humans in slum areas, with lack of proper sewage disposal. Provide an example?

- The black rat, for example, is an excellent climber and it can easily escape by moving over high electrical wires in urban areas.

Describe basis of the medical system in medieval times in relation to health

- The body was like the natural world, hence the association with air, water, fire, and earth. If a person was in good health, this meant the humors were in equilibrium. If not, this meant the humors were out of balance and the goal of the physician was to restore balance.

Name the different types of host for plague:

- The flea (primary carrier or host). Those carrying the bacilli turn to humans only when rodents are not available. - The rat is the (secondary host) (although other barnyard animals can also be carriers, except for the horse). - Humans are the tertiary host. When plague becomes epizootic in rodents (epidemic in humans); meaning it infects in large numbers that it kills its host, fleas will seek a new host. - "humans are victims of changes in insect and rodent ecology" (Gottfried, 1983, 7).

List some general biological adaptations to disease (malaria):

- The human immune system is a biological adaptation. This system has changed over the course of human evolution; - as the human system changes the disease organisms also adapt and change = example of mutual adaptation. Therefore, acute, lethal infectious diseases are less well-adapted to humans than are chronic infections.

Symptoms of malaria?

- The periodic release of cells from the disrupted blood cells causes symptoms like chills and fever. - Anemia, headaches, nausea, vomiting, low back pain, anorexia and fatigue are also symptoms of malaria. - An attack begins with a chill and shivers and severe sweating (called the cold, hot, and wet phases) which can be accompanied by severe convulsions. This occurs in cycles that may last 12 hours and occur every other day, lasting from two to six weeks. - In severe cases, cerebral malaria leads to unconsciousness and death. Capillaries in the brain become obstructed by parasitized red blood cells. Children are particularly susceptible to this form of malaria.

Define hierarchical class system:

- There were three main divisions: clergy, military elite, and the peasants, mostly rural who worked the land as serfs for the aristocracy. The peasants paid rent for lands in produce, and they had other obligations in terms of labour; this was called the manorial system or feudal system.

Unlicenced practitioners

- These individuals did the work of physicians, although their services were much cheaper. In this group there were many women practitioners, and since they were barred from medical training, this was the only way for them to practice their skills; midwifery was one of these skills.

treatments for malaria?

- Treatment includes quinine, chloroquine, and a number of other antimalarials.

Describe Robert's case and treatment with the community for HIV/Aids

- being treated in a teaching hospital in Boston. - battling all the problems that come with AIDS - when in Boston his condition worsened he was taken to the emergency ward of the hospital. - He wanted to go back to Chicago and did not want further treatment; physicians treating him had other ideas. - He was kept in hospital, diagnostic studies were done, and just before he died, physicians used a feeding tube, an endoscope, and conducted a CT scan of his neck. - All he wanted was to be kept clean. His treatment reflects core cultural values in the United States. - reliance & love of technology and the tendency of biomedicine to use all sorts of technology and interventions to deal with disease. - The patient was isolated; reflects the stigmatization of individuals with AIDS in the United States. - Robert died a lonely death as he was subjected to a number of interventions to try to solve his problems. - The patient refusal of interventions was not part of hospital treatment.

After 1905, the spread of plague was largely halted by?

- controlling rats in seaports, and by isolation of ships in port. It was, however, imported into San Francisco in 1899; there were outbreaks in this city for two years. What is most troubling is that by 1908 plague was epizootic in ground squirrels, leading to enhanced spread to other wild rodent populations. It is now entrenched in the western U.S., particularly in the Southwest. In this area, the plague bacilli is carried by prairie dogs and rock squirrels.

Describe how the environment plays a role in the significance of the interaction between malaria and sickle-cell anemia

- cultural change affecting the environment.. - The sickle-cell allele is found in high frequencies in areas where malaria is endemic (Africa). - thought to be connected to a change in cultural practice (subsistence strategy) among inhabitants in these areas approximately 2,000 years ago (Turnbaugh et al., 2002). - Humans turned to agriculture from a foraging strategy. - As humans expanded their agricultural territories, they changed their environment. - Mosquitoes are not a big threat in areas that are heavily wooded and that have fast-flowing water - as the subsistence strategy changed, large areas were cleared and water collected into stagnant pools. - Humans and mosquitoes came into contact more frequently and humans had to exist in a malarial environment.

Does disease always occur ? What is the determinant for disease?

- disease is a possible result not everyone gets sick. Social environment is the key factor.

Describe schistomiasis, in terms of cultural ecology:

- emphasize human behaviour as being the most important element in schistosomiasis transmission. - occurs due to water use (water used in laundering and children playing in water) and agricultural practices. It occurs due to a lack of proper sanitation. It also occurs among Muslims due to the practice of ritual ablution (wudu).

In regards to plague world describe the average sizes of towns, villages and large centres, and indicate their locations *

- many small towns ~1,000 people, located far apart on rivers and by the sea. conditions in the towns were cramped and there was poor sanitation and the towns and villages were isolated. - villages ~200 people - few large centres, ; Paris, for example, had about 50,000 inhabitants.

List some examples of rodent species that carry plague

- marmots in Asia; prairie dogs and ground squirrels in North America; and mice and gerbils in Africa.

Assessing interventions in regards to HIV includes:

- may be impossible for sex workers to insist on condom use. if their clients object, they will not be paid and this profession is an economic necessity for many women. - use of condoms may go against cultural values; for example, fertility, particularly in social networks outside of the sex trade - other reasons given for not using condoms. In Rwanda, for example, it is important in terms of self-conceptualization to relate to others in certain ways. One way is the sharing of bodily fluids; this is considered good for health.

Define surgeons

- medical practitioners did not have the status of physicians - university trained in anatomy. - much of their knowledge was based on the dissection of pigs. - Surgeons performed all the operations.

The Y. pestis bacilli is enzootic; meaning?

- persists in particular animal populations as sylvatic plague (wild rodent plague). - provides a reservoir in which the disease can survive for long periods of time. - Reservoirs explain the cyclical nature of plague.

Important historical features of Plague

- plague is still with us, although less threatening due to antibiotic treatment yet different animal species are reservoirs of the plague bacillus. - a major disease worldwide since A.D. 542 - first plague epidemic, referred to as the Justinian plague, began in Egypt and lasted until A.D. 767. - second epidemic began in China and moved through India and the Middle East to enter Europe in Sicily in 1347 - From 1347 to 1351 it is estimated that plague killed 25 -50% of the population (close to 24 million people). - The third pandemic (pandemic means occurring in the population world wide) arose in southern China in 1894, spread to Hong Kong and then around the world by steamship. It is estimated that plague killed 12 million people during this pandemic

The analysis of the cultural context of HIV in sub-Saharan Africa needs to be combined with?

- political, historical, and economic factors.

Describe Gottfried's notes on French Village on Givry ?

- population of 1200-1500 people. - In the preplague period 1338-1348 an average of 30 people per year died. During the plague in one area in a 14-week period, 615 deaths occurred. 50% of the population died. - In Paris it is estimated that one third of the population of that city died; in Normandy, between 40-50%; in London 35-40%; in Greenland scattered outposts were wiped right out; and in Italy, in 1630, 30% of the population of Venice was destroyed. - Human settlement patterns were less important to the spread of plague than might be thought. It ravaged the countryside and it ravaged the cities. Density of population was only important when it involved pneumonic plague spread by human-to-human transmission.

Dealing with AIDS as suffering:

- provide insight into issues that individuals with AIDS cope with every day; - suffering is increased due to such things as treatment, discrimination, irrational fear by people in general, being treated as if they are socially dead, and the many inequities that occur between people with AIDS in terms of drug treatments.

A combination of what strategies/techniques gradually decrease plague, leading to be last seen in 1714 in Italy?

- quarantine and land-based controls

What do we mean by the term "psychogenic" in disease ecology?

- referred to as psychosomatic, the physical manifestation of psychological distress (somatization is another term that is used). - Ex.) voodoo death - a complex issue and appears to involve physiological reactions to stress.

Define evolution

- refers to biological or cultural change that occurs in relation to a specific environment.

Define latrogenic

- refers to problems created by inappropriate medical interventions and the illnesses caused by medications taken for specific complaints.

There was more violence and cruelty, which was?

- scapegoating; People needed a group to blame for the plague and one of the things the flagellants preached was anti-Semitism - persecution of the Jews began. They were virtually exterminated in some areas and sometimes this is referred to as a holocaust

Other infectious diseases that are important to study are?

- schistosomiasis and HIV/AIDS.

Name some examples where schistosomiasis have occurred:

- schistosomiasis increased 51% in three years in Egypt due to the development of the Aswan Dam-Lake Nasser development project; - in Ethiopia, schistosomiasis rates increased dramatically following the creation of large irrigation projects.

Describe the impact of malaria, in general

- second only to tuberculosis as a killer infection. - 300-500 million people worldwide have contracted malaria in 102 countries and approximately one million people die from it (WHO, 2002).

Country rats in an infected burrow tended to die off in

- six to ten years.

Nam another trend in the United States for plague

Another trend in the United States is plague carried by cats. Cats hunt wild rodents and in turn can be infected and can pass this on to human hosts. If animals develop respiratory plague, their close contact with humans can infect them, through cat to person transmission, not only flea bites. Also, tree squirrels have been found to carry the bacilli.

As humans encroach into areas where rodent populations carry plague, there will be more risk to humans.

In an outbreak of plague in India in 1994, the Indian gerbil was identified as the likely reservoir of plague in that region (Campbell and Hughes, 1995). This rodent is commonly found in arid grassland, or open plain environments and on the borders of cultivated areas. Irrigation schemes have been responsible for irrigating these arid grasslands and villages are built close to the fields. The burrows of the gerbil were found in dikes between the fields and in the villages themselves.

Another type of appeasement involved controlling the poor because plague was thought to flourish among the poor.

The urban poor "were a sickly looking people full to overflowing with the coarsest and filthiest humors" (Watts, 1997, 14). The poor were targeted in Italy with both fear and charity. People wanted to help the poor by giving them money (government aid), but there was more to it. They feared them as well, as plague was also thought to be a natural phenomenon caused by poor sanitation, dirt, garbage, and overcrowding, all things that were associated with the poor.

Define Apothecaries

They were similar to pharmacists, but they also prescribed drugs as they were trained as herbalists.

Define population stability

This was due to growth of government and military power.

The development of the sex trade in many areas was instigated by?

colonialism, and large urban centres with predominantly male populations were created as colonial powers attempted to extract resources (mining towns, for example).

The basis of the medical system in medieval times was ?

the theory of humors that originated in Greek medicine in the work of Hippocrates. There were thought to be four humors in the body: blood, phlegm, yellow bile, and black bile. These were associated with different organs, qualities, and aspects of nature. listed Humors: Organ, Qualities, & natural world: Blood: heart, hot and moist, air. Phlegm: brain, cold & moist, water yellow bile: liver, hot and dry, fire black bile: spleen, cold and dry, earth.

Indicate the advice physicians give:

• Prayer, due to the idea that plague was thought to be a punishment for sin. • Flight, from low areas with stagnant water to higher elevations. If one could not flee, they were advised to stay indoors, cover windows and stay cool. • Pleasant smells were important as they drove away noxious fumes. • Herbs and spices were recommended: myrrh, saffron, and pepper along with vegetables, garlic, and onions. • Food was to be eaten in moderation. • Purgation of body with laxatives, diuretics, and bleeding.

Describe the living conditions of the peasantry

- lived in small circular huts made of poles, sticks, and clay with low thatched roofs. - dwellings lacked windows and chimneys (except a small hole in roof), and livestock were often brought into the dwellings at night. - These dwellings provided a good environment for rodents that would inhabit the dark corners of the structures. - There were stories of rats falling from the thatch into the soup and rats chewing on infants while they slept. This type of setting was the perfect environment for plague to spread from rats to humans.

HIV/AIDS has been used to confer blame on its sufferers, how?

- When the disease was first identified in the early 1980s homosexual men were targeted and many believed that the illness was the result of immoral behaviour = their own fault. - idea that the disease was going to take over, that it was unstoppable, and this fear of the unknown led to the stigmatization of individuals who were different or marginal. - For example, some members of fundamentalist religious groups believe that HIV/AIDS is a punishment from God for immoral behaviour.

Anthropological studies demonstrated that more should be done about the spread of HIV than targeting sex workers?

- Wider social networks must be identified and the nature of sexual networking must be understood.

Disease ecology provides:

- a broad perspective -social and cultural factors effect the way disease is expressed

Define malaria How is it spread? Versions ?

- a disease caused by protozoa of the genus Plasmodium. There are four species of malaria: P. falciparum. - spread through the female Anopheles mosquito to humans. In the mosquito the protozoa multiplies (takes 8-13 days to mature in this host) and when the mosquito feeds on humans transfers the parasite. In humans, the parasite feeds on the liver and red blood cells and multiplies. It parasitizes the RBCs and takes 10-14 days to produce male and female gametes that can then be transferred to mosquitoes when humans are bitten. The mosquito is the vector and humans are the intermediate host and reservoir of the parasite. - both mild and severe cases.

The notion that God must be appeased led to the development of cults. The most prominent of these was the flagellants, describe them

- a group who travelled from place to place atoning for the sins of the world. They did this by beating themselves on the back with leather braids (knotted leather with small iron spikes imbedded at the end). The basic idea was that God sends plague to punish sin; baptism in water is not enough for salvation so baptism in blood is necessary. Bands of flagellants moved in long processions of 50-300. They claimed to be able to ward off plague and the devil. When they reached a town, they gathered in the square around the church and formed a circle. They proceeded to scourge themselves or were scourged by others with leather whips; they performed this twice a day. During each performance they would fall down and lay on the ground sobbing and weeping, a portrayal of symbolic death. Then they would move on. Unfortunately many were sick and as they moved they spread plague.People welcomed the flagellants and gathered around these bands and collected blood and nail clippings. Since no one knew the cause of plague the ritual service of the flagellants was as good a remedy as any, especially if the plague was considered as a pestilence from God. By 1350 the movement had been eradicated as the cults were dominated by elements out to swindle and take what advantage they could get. However, as late as 1570 clerics were still advocating penitential processions.

Brown, Inhorn, and smith (1996, 187); defined disease in the disease ecology approach as ?

- a method associated to a process where host and environment insult interact; often a pathogen organism or worm

HIV/AIDS is considered to be?

- a pandemic, a global epidemic. Currently it is estimated that 40 million people are infected with the virus (UNAIDS 2001)

define disease ecology

- an approach that looks at the interactions between humans , infectious agents and the environment - useful for assessing the cause and spread of infectious disease.

what are the symptoms fo sickle cell anemia, as well as treatments ?

- anemia, fatigue, and heart problems. The crescent cells clog blood vessels and capillaries reducing oxygen transport. - brings on a sickling crisis with severe pain. Lack of blood supply to affected areas causes ulcers and sores. - Blockage of vessels in the brain can cause stroke and paralysis. - can be lethal although improvements in medical treatments prolong life. - Treatment is primarily with antibiotics early in life to combat infection.

What are the causes of infectious diseases ?

- are caused by a variety of microbes and macrobes including bacteria, viruses, protozoa, helminths and prions (abnormal proteins).

Define genetic in gene ecology

- are heritable diseases resulting from mutations. Ex.) sickle-cell anemia - The interaction between sickle-cell anemia and malaria (a disease caused by a protozoa) provides an example of the way in which biology and culture interact. a random mutation that resulted in sickle-cell anemia - due to human adaptation to the environment - Movement of people with this mutation into a mosquito infested and malarial environment led to resistance to malaria. - Individuals who carry one copy of the mutated allele are not susceptible to malaria

Infectious diseases are caused by a variety of microbes and macrobes: Name them

- bacteria - viruses - protozoa, - helminths - prions

Plague was thought to be ?

- be a punishment for sin; Plague was an unmistakable sign of the wrath of God. It was a pestilence sent from God so it was important to appease God and try to curb the sins of the populace such as gambling and loose living.

Characteristics of plague:

- lives in the digestive tract of fleas, particularly rat fleas (Xenopsylla cheopsis and Cortophylus fasciatus) - can also live in the human flea, Pulex irritans. - Periodically, Y. pestis bacilli multiply in the flea's stomach and cause a blockage. The flea will starve unless it regurgitates large numbers of the bacilli when it is feeding.

Describe schistomiasis, in terms of political ecology:

- emphasize that water contact patterns must be analyzed in terms of the macrosociological or larger political and economic issues that contribute to unsafe water supplies. - has increased in frequency due to the building of dams and irrigation projects, in other words, development projects that have been instigated to improve economic conditions in many areas. - Economic disparity is also a factor contributing to the spread of schistosomiasis.people are constantly moving from one area to another to make a living, and the helminth is carried by workers migrating to different areas. - Political ecology deals with the political-economic determinants of disease. The development projects instigated by world aid organizations are intended to provide more and better economic prospects for people in developing countries; - these projects change the environment and provide a good habitat for snails with the creation of relatively slow-moving water. The intent may be admirable in these projects, but there may be more costs than benefits to individuals living in these areas. - Another factor is the availability of safe water: one would think that a basic human right is the right to safe water, but in many areas of the world water supplies are unsafe

In terms of social responses of immediate consequences are:

- everyday activity such as ploughing, shopkeeping, and religious service - stopped. - A state of anarchy occurred: there was more stealing and murder and looting. - Daily life was suspended. The plague inverted the normal world. But the social structure remained intact for the short term, as people were busy trying to survive

In Europe, the black rat (Rattus rattus) was a common carrier. Describe the black rat species

- fairly sedentary species and it lived close to humans (lived in thatched roofs and in corners of dwellings in the time period - preferred to establish burrows near grain reserves) so it was very dangerous to humans. - Often bakers and millers were the first victims of plague. These rats boarded ships and settled down in the luggage of travellers. - Once on land, the black rats came into contact with several varieties of field or country rats and transferred the fleas to these rats. - burrows of black rats died in an even shorter period.

the individual who is heterozygous (carries two different alleles) will have?

- greater reproductive success as the individual has immunity to malaria. This is an example of balancing selection that favours heterozygotes.

What does illness mean as a metaphor?

- illness as metaphor refers to the social transformation of disease and illness.

Define Barber-surgeons

- individuals did not have formal training. - They apprenticed and did the less complex surgery. - They were barbers on the side in order to supplement their incomes, and their fees were lower than surgeons.

Due to political inequities between countries in the world, treatments for HIV/AIDS that are available in wealthier countries are not provided for who? Also, indicate why.

- individuals within Africa. These drug treatments are costly and many countries cannot afford to purchase and fund drug programs. Consequently, many people are denied treatment in all parts of Africa.

what about women who were not sex workers? Many women who were partners of labourers returning home were at risk yet were not targeted for?

- information on condom use

Define sickle cell anemia

- is a hemoglobin disorder caused by a mutation that produces an abnormal type of protein found in the red blood cells (RBCs). - protein functions to transport oxygen from the lungs to the body tissues. The abnormal hemoglobin causes the RBCs to become crescent or sickle-shaped and the oxygen carrying capacity of the blood of reduced.

How did people respond to plague ?

- isolated themselves from the dead; others turned to excess in eating and drinking (the Epicurean response). Others went about their business carrying flowers and herbs which they thought would combat the pestilence. - Flight was often an immediate consequence, more so among the wealthy. - Bubonic plague was no respecter of persons. High status people in the wrong place at the wrong time were as likely to be struck dead as were half-starved vagrants or peasants." - There was some wisdom to fleeing cities. - In extremely crowded areas, mortality was high and in the less populated countryside. - Many who fled the cities were already sick with pneumonic plague and they helped to spread it through the countryside. In many cases all three strains of plague were present so mortality was higher in some locations than others, and flight did not help when pneumonic plague was the mode of transmission. Often the city became a zone of isolation and scarcity of goods became a problem; no produce could enter the city so starvation often occurred among some inhabitants.

The Y. pestis bacilli can survive after the secondary hosts (rats) have died; How can they live on?

- it can live in the burrows and if new rodent populations replace the dead ones, this population can become infected

What is bubonic plague?

- known as the Black Death, is usually associated with enormous death rates in medieval Europe. It was one of the worst infectious diseases in human history

List the different views of viruses:

- life forms composed of DNA or RNA - not living organisms; structures composed of a protein coat surrounding nucleic acid molecules, either DNA or RNA, capable of replication only within living cells - the ultimate predators and harbingers of disease - many ways to define viruses: "If viruses were human, they would appear to have multiple personalities" (Ryan, 1997, 51).

What are the dynamics of sexual decision-making and sexual networking?

- limiting HIV has focused on limiting sexual partners or the avoidance of promiscuity. - People in Sub-Sahara Africa may have more than one sexual partner, but they do not consider themselves to be promiscuous. - More than one partner may be the norm in many areas and may exist for economic reasons. Such as: - may be an economic necessity to have relationships with more than one man in order to support children. - sex workers have lives away from the sex trade. Most have long-term partners. - Sex workers may insist on condom use at work - may not be used at home due to risk. In fact, the woman may acquire HIV from her long-term partner.

What are some examples of infectious diseases:

- malaria - HIV - plague - tuberculosis - emerging infectious diseases.

Where has plague spread? what were the main causes? Indicate 2 examples what are the additional causes?

- spreading in Eurasia; it is thought to have spread from Mongolia, into China, into India, and then into the Mediterranean. - The spread was primarily due to two factors: trade and change in climate in Eurasia. An epizootic of plague erupted in 1320 in the Gobi Desert. Due to trade and expansion by the Mongol Empire, Mongolian horsemen and their supply trains carried plague to many areas. It was a matter of time before other trade caravans would bring it to Europe: this occurred by land and by sea. Climatic change was also occurring in Asia. Rodent populations spread eastward and westward in search of food as it was becoming hotter and drier in Asia. Sylvatic rodent populations also infected local rodent populations at the same time. - by displaced rodents infecting local populations, and by trading vessels bringing infected rodents. A type of plague was transmitted by the merchants themselves, pneumonic plague. "In the summer of 1347 rats and fleas infected with bubonic plague boarded Genoese merchant ships at Caffa on the Black Sea (Watts, 1997, 1)." Later on they travelled to Italy.

Natural selection is one of the prime forces affecting biological change. what is the advantage for those who pose it ? What does natural selection involve?

- tend to survive and produce offspring who will inherit the trait that confers the advantage. - involves differential fertility and mortality. If individuals possess an unfavourable trait (i.e., disease), then fertility and mortality is lowered and this trait will not be passed on or selected. Usually, diseases arising from a mutated allele will be rare in the population.

Rat/human transmission of this disease was not recognized for centuries. According to Watts (1997) in 1347 the prevailing wisdom was?

- that all living things were linked in a Great Chain of Being. Humans were high up on this chain, close to God while other creatures inhabited rungs much lower and humans were separated by many links from lowly rats. This philosophy impeded recognition of the rat/human connection.

infectious diseases have not been conquered. One reason for our inability to defeat infectious disease is?

- that humans are intimately connected to microbes in an evolutionary and ecological sense. - As humans change and as the environment changes, we come into contact with both new and old pathogens that are trying to survive. - microbes are capable of genetic change and can mutate rapidly. This change allows them to circumvent our methods of treatment.

Name the control measures that were implemented for plague:

- the Ideology of Order which was created in Florence in the 1500s. - Italian plague control consisted of five elements: controlling movements of people and instituting quarantine, burial of victims in special pits and destroying their possessions, isolating people with plague, free medical aid and food to people placed in isolation, and aid to those who livelihoods had been affected. - Some of these measures; quarantine, isolation of plague victims, special burial and the destruction of victim's possessions were not accepted well by the populace because they disrupted prevailing norms and traditions. For example, people felt that the dead were not being treated appropriately and when victim's possessions were burned, this interrupted basic inheritance patterns.

Due to economic inequities in many areas of Sub-Saharan Africa, many women have no choice but to engage in?

- the sex trade. It becomes very difficult for those women to insist on condom use as this may directly affect their livelihood.

If the issue is not that condoms do not work as an intervention; then what is the issue ?

- the use of intervention strategies in one cultural setting transferred to another without thought of whether these strategies will be adopted due to the cultural beliefs and practices present in another setting.

People were traumatized. There was a moral crisis and people became disillusioned with the old values they had once held. Which resulted in a loss of?

- their faith (Christianity) as the church was powerless to fight plague. Quite often the clergy either fled or died.

many sex workers were not able to demand safe sex from clients, why?

- this was an economic survival strategy that depended on male cooperation.

Define physicians

- usually members of the clergy and were the elite of the medical system; - university trained. The title - "physician" was given to scholars who studied physics. - "Physics was the study of the natural world and was part of the larger discourse known as natural philosophy" (Watts, 1997, 12). Another term was used as well - empirics - to denote practitioners who learned informally from other empirics. They did not have the status of physicians

List all those "deconstructing risk groups":

-Risk groups that have been identified in Sub-Saharan Africa include truck drivers, long-distance traders, military personnel and prostitutes. Prostitutes constitute the most problematic designation because of the tendency to categorize sex workers as a homogenous group. - There are differences between sex workers depending on the locale they inhabit, whether in indigenous locations (African cities) or in colonially created urban centres. - in urban centres: large numbers of males were encouraged to settle in areas without many females. This led to an influx of sex workers, and both sex workers and labourers would return periodically to their families. Therefore, these wider social networks need to be examined more closely in terms of the spread of HIV. - Condom use was targeted toward prostitutes

Name & describe the three types of plague

1. Bubonic plague. The most common and least toxic of plague, although it kills 50-60% of its victims (without antibiotic treatment). Transmitted by the flea the incubation period is six days. Symptoms are blackish pustules at the point of the bite, followed by lymph node enlargement in the armpits, groin, or neck. These pustules are called buboes. Subcutaneous hemorrhaging occurs with purplish blotches appearing. 2. Pneumonic plague. More virulent it kills 95-100% of its victims. Transmission is person to person through infected sputum and pneumonic plague only develops when the temperature drops sharply. Pneumonic infection moves into the lungs. The incubation period is from two to three days. The major symptom is a severe cough and sputum (with bloody sputum discharge from lungs). The sputum contains Y. pestis bacilli. Rapid cyanosis occurs and the skin becomes bluish due to oxygen deficient blood. 3. Septicaemic plague. Always fatal, but very rare. Transmission is by the flea, although etiology is not completely known. Y. pestis bacilli enter the bloodstream in high numbers. Because it is present in the bloodstream, it can also be transmitted by the human flea and lice. Incubation period is hours. Symptoms: a rash forms and death occurs within a day.

Disease is important in evolutionary terms because it results in differential rates of mortality and fertility. There are three main mechanisms through which disease affects evolution:

1. large-scale mortality from epidemics: epidemics can kill many individuals and therefore can have enormous effects on gene pools. Also, diseases can be introduced into populations (either deliberately or accidentally) that have had no exposure to them. If there is no immunity, massive mortality can result (e.g., measles infection in some Amazonian tribes represents a dire threat). If the cause is unknown, many people will die before receiving any kind of treatment (the cause of plague in medieval Europe was unknown and consequently killed one quarter of the population). 2. excess mortality from endemic disease: this is particularly evident in infant and child mortality. Malaria, for example, will strike all age groups, but most mortality occurs in children. 3. parasitism: this is the relationship between hosts and parasites (mutual adaptation); however, the relationship can become dysfunctional if parasites change and an asymbiotic relationship develops. Parasitism affects populations by limiting energy; by producing disease symptoms; and by limiting population growth.

The disease ecology approach includes different levels of causation:

1. microbiological level: this level focuses on how pathogens affect humans biologically; this also takes into account the pathogen's adaptive strategy for survival. 2. microsociological or cultural ecological level: this refers to the sociocultural context of disease; human behaviour can place individuals at risk and can alter the environment (e.g., agricultural practices). Cultural practices can also minimize risk (e.g., settlement patterns and medical knowledge). 3. macrosociological or political ecological level: this refers to the political-economic determinants of disease and relates to differential power relationships between populations globally, historical features pertinent to their development and economic variables (e.g., differential access to medical treatment, impact of poverty, and overcrowding and migration).

Describe schistomiasis on the microbial level:

• This disease is also known as bilharzia (urinary schistosomiasis) and it is a blood fluke infection (a large flatworm). Schistosomiasis is transmitted through water and affects over 200 million people in 74 countries. • Infected humans pass the eggs of the parasite into water. Once in fresh water, the eggs rupture and free-swimming larvae (miracidia) are released that seek out a snail host; the snail is the intermediate host. After a few weeks in the snail, infective larvae (cercariae) are released and they infect humans who wade through water or use it in daily activities. The life cycle of a schistosome alternates between sexual reproduction in blood vessels of humans and asexual multiplication in snails. • There are three species of schistosomes: Schistosoma haematobium (live in the bladder); Schistosoma mansoni and Schistosoma japonicum (live in the bowel). The worms, which are approximately 1-2 cm. long, mate and produce eggs that are passed in the urine and feces. • Sexually mature worms produce hundreds of thousands of eggs per day and can live between 5 to 10 years. Schistosomiasis is not fatal, but can cause many problems in the human host over time that can result in death. The eggs cause damage to the bladder and intestine, and one of the first signs of the disease is bloody urine; blockages of eggs not excreted build up in the bloodstream and can cause epilepsy if lodged in the brain and cirrhosis of the liver if lodged in the liver. • Control of schistosomiasis has focused on the killing of snails, providing proper sanitation, providing safe water supplies, and the use of chemotherapy.

Describe all the characteristics of Viruses.

• a microorganism smaller than a bacterium, billions of viruses could fit within a drop of water; • identified in 1933 • need a host to reproduce; • capacity for mutation so new strains can appear (e.g., influenza); • cause disease in all life forms people, chimpanzees, whales, and majority of viruses do not pose a threat to humans, some have the ability to species-hop and those tend to be lethal; and • fewer effective treatments for viruses other than vaccines not controlled by antibiotics so pose a global threat.

Describe all the characteristics helminths.

• also known as round worms or nematodes and flatworms, size varies from small to very large; • many develop in a vector organism, like snails and insects; • some injected into the body by a bite; others enter through the mouth and through the skin; • need high temperatures and high humidity so generally found in the tropics; • difficult to treat as treatments usually affect host; and • can be controlled by attacking the vector.

Reasons for its re-emergence of malaria include:

• failure of eradication programs. DDT was used in the past to destroy mosquitoes, but this program was discontinued due to the harmful environmental effects of DDT also, mosquitoes started to develop resistance to DDT; • antimalarial drug resistance, in particular resistance to the drug chloroquine; • social change: migration to urban areas by infected individuals; • more utilization of areas infested with mosquitoes; • civil wars have caused medical infrastructure to break down so there is less treatment; • increased international travel and tourism: more people are coming into contact with malaria; • climatic change: more rain in arid areas with higher temperature and humidity provide more breeding places for mosquitoes;

Possible allelic combinations and the relationship to malaria:

• homozygous dominant: an individual can carry two copies of the 'normal' allele (Hba) blood will be normal but they will be susceptible to malaria. • heterozygous: an individual can carry one 'normal' allele (Hba) and one sickling allele (Hbs) - they will be immune from malaria. • homozygous recessive: an individual can carry two sickling alleles (Hbs) they will have sickle-cell anemia.

Describe all the characteristics of Bacteria

• one-celled microorganisms, rod-shaped, round or spiral forms; • free-living life forms made up of DNA and RNA which reproduce very quickly; • mutations can occur frequently; • found in soil, air, water, and in any type of dead organic material and living organisms; • in humans, bacteria are found in the digestive tract, the linings of the mouth, nose and throat, on the skin, normally harmless, however, there are harmful strains that are responsible for diphtheria, scarlet fever, typhoid, tuberculosis and cholera, to name a few; • bacteria need food for growth and energy: it has been suggested that disease-producing bacteria have lost the ability to synthesize some essential components so they become parasitic in living human hosts (Ryan, 1997); and • bacteria can be controlled with antibiotics except for those that have become resistant to current antibiotics.

Describe all the characteristics protozoa:

• small, unicellular animals, larger than bacteria; • composed of a single cell with a well-developed nucleus, capable of movement and of feeding on smaller microorganisms; • found in water in tropical areas; • two types of protozoan diseases: 1) those transmitted from person-to-person such as amoebic dysentery; and 2) those in which the parasite is transferred by an insect, e.g., malaria (vector is the mosquito), and sleeping sickness (vector is the tsetse fly); • various interventions can prevent the spread of the protozoa; killing the vector and using drugs which damage the parasite without harming the host.

Describe all the characteristics prions.

• stands for proteinaceous infectious particles; • abnormal proteins found in mammalian brains; • does not contain genetic material so can not reproduce, but each abnormal protein can cause normal proteins to change - populate the brain through shape changing until host dies, damages the nervous system; • thought to be due to the amino acid molecules protein flipping and producing abnormal form that causes damage to brain tissue; and • cause disease called transmissible spongiform encephalopathies (TSEs): examples are Kuru, scrapie, bovine spongiform encephalopathy (mad cow disease), and Creutzfeld-Jacob disease (CJD) in humans.