Great Epidemics Research Articles

Introduction: Ethical Responsibilities Regarding Drugs, Patents, and Health

HIV/AIDS threatens international health on a scale never before seen in human history. Previous plagues and great epidemics, devastating though they were to imperial China, urbanizing Europe, and the colonizing Americas (McNeill 1998), were regionally contained. More than forty million people worldwide are HIV-positive: about half of them live in sub-Saharan Africa, where it apparently originated and where whole tribes and, indeed, most of the adult population of Botswana may very well die of the disease. (Joint UN/WHO 2004). India has another five million people who are HIV-positive, the largest number outside Africa. AIDS is spreading rapidly in China and devastating Thailand, a regional center for prostitution that spreads it further throughout the Asia-Pacific region. No part of the world is spared. The economic, social, and political impacts of this pandemic have only begun to be felt and to be considered.Modern technological and organizational capacities—jet aircraft and globetrotting business and tourist travelers—turned what would have been, in previous eras, an African regional problem into an international crisis and made AIDS exceedingly difficult to contain. Yet, the human technological and organizational capacity to confront the AIDS pandemic also makes this health crisis different from epidemics in earlier times. Medical science applied by pharmacological research has created drug therapies that can control the disease, that can not only stave off death but make productive life possible for many years. The challenge of AIDS could be met, many in the health community say, if it were not that the life-sustaining drugs are owned by private enterprises (Oxfam 2002). The doctors at Médicins Sans Frontières contend, “Patents are not god-given rights. They are tools invented to benefit society as a whole, not to line the pockets of a handful of multinational pharmaceutical companies” (MSF 2003: 2). “[T]he patent monopoly means that a higher price than necessary has to be paid for patented inventions. This is acceptable if this higher price is merely an inconvenience…. However, if the patented invention is essential (say, if it could prevent your untimely death from disease), then the price is more of a dilemma” (MSF 2003: 5). These and other critics declare that drug makers put profits ahead of people and accuse the governments that grant them patent-intellectual property rights, especially the U.S. government, of contributing to this moral bankruptcy.

Epidemiological characteristics of salmoneilosis in Vojvodina

Salmonella infections are the most common food-born diseases transmitted from animals to humans. Epidemics of salmonellosis occur after eating improperly cooked contaminated foods. A descriptive epidemiological method was used to analyse epidemiological characteristics of salmonellosis in Vojvodina in the period 1978-2003. During this period there were 26,851 cases of salmonellosis (mean annual incidence of 51.1/100,000 and mean annual mortality of 0.9/100,000). Mean annual case fatality ratio during this period was 0.1%. The specific incidence was highest in 12-24 month-old children (251/100,000), and lowest in the oldest age group (13.9/100,000). Lethality was highest in children younger than 1 year, and persons older than 50 years (84%). The number of cases registered in food-born epidemics makes 41.7% of all registered cases. A mayority of 772 registered epidemics were small epidemics among families, relatives and friends. The great epidemics with large number of infected persons were due to an industrial bakery with 1713 ill persons and a public restaurant with 311 ill persons during the 80's. An epidemic was due to sandwiches from an industrial bakery distributed through the whole territory of Vojvodina with the highest incidence of salmonellosis in 1987 (137.7/100,000). The most common serotype was S. Enteritidis (69.7%), but 68 more serotypes were isolated. The most common cause of epidemics were eggs and egg products (76.2%). Salmonella spp. was isolated from food in small number of epidemics (less than 20%), because epidemics were discovered usually 2 or 3 days after their beginning.

HIV-1: a look back from 20 years.

191 IN ONE SENSE, if AIDS had to come, the timing of the epidemic was fortuitous. Only a few years earlier (mid-1970s) the prevailing views in the scientific community were that viruses played no role in human cancer, that retroviruses did not infect humans (some even argued that it was not possible!), and that serious epidemics were no longer a problem for “us.” Additionally, some of the critical technology was not available. However, by 1981, when AIDS was first recognized, viruses were linked to over 20% of all human cancers, retroviruses of humans were discovered, and one, HTVL-1, was demonstrated to be a cause of an unusual leukemia as well as a fatal neurological disease. HIV/AIDS quickly became one of the greatest epidemics in medical history. Thus, the overconfidence and biases of the 1970s were destroyed. Additionally, techniques to grow primary human blood cells in liquid suspension culture were developed by the late 1970s, especially T-cells mediated by the discovery of what was first called T-cell mitogenic factor (1976), then T-cell growth factor, and finally interleukin-2 (IL-2). Also essential were the development of rapid, sensitive, and specific assays for reverse transcriptase developed during the 1970s. Thus, the discovery of HIV did not come “out of the blue.” Essential technological and conceptual advances preceded it. Work with HTLV-1 and HTLV-2 contributed to the HIV discovery by stimulation of the idea of a retrovirus cause and by providing experience working with immortalized CD4 T-cell lines. However, it was a double-edged sword in that it held me about 6 months too long to the view that the retrovirus of AIDS would be in the HTLV family. The lessons of the above history are clear enough, and include the need for recognition that microbes, including viruses, are here to stay, that we cannot predict sudden emergence of new epidemics, that no class of virus can be precluded as a candidate human pathogen, and that (for the HTLV link) one should not get overly specific in predicting nature’s behavior. For me, there is still another lesson, and that is the need for multiple Centers of Excellence in Virology (CEV), which in total, would include sophistication in every class of virus. I draw this conclusion because except the CDC, no one or group was responsible for solving the AIDS epidemic, and the CDC can not have adequate depth for each virus type except in their capacity for monitoring new epidemics. I know it was simply chance interest that we first became involved, and it was at a time when few virologists had experience in T-cell culturing, and many institutions had forbidden receipt of any specimens from AIDS patients. Some things addressing this problem have been done. NIAID has formed Centers studying candidate microbes of biological warfare, and have included new emerging infections in this program. However, I do not believe this completely answers the need; first, because the major function of these centers is in preparation against those microbes most likely used for terroristic acts, and most of these are bacterial; and second, these centers are regional, and hence, with political overtones; third, it is unlikely that they will foster sufficient breadth or depth in virology or that they will be able to bring in a sufficient number of “new faces.” Finding HIV was one thing, and demonstrating it to be the causative agent was quite another. HIV and AIDS, of course, were uniquely problematic compared to other viral diseases of the past or the recent SARS outbreak in two fundamental ways. First, signs of AIDS are only manifest years after infection. This had immensely complicated the epidemiology until a test was developed. Second, when AIDS did manifest itself the patient was riddled with numerous other infections. Picking out and showing the role of the correct agent was a challenge. A key breakthrough was continuous cell line production of the virus achieved with six different isolates by early 1984. This led directly to the blood test, which almost immediately gave us three major advances: (1) it made the blood supply safe again; (2) it allowed us to follow the epidemic for the first time; (3) it provided clear linkage of HIV to AIDS as its causative agent. Although numerous (48) isolates were reported by our group by early 1984, and one earlier by L. Montagnier and co-workers, this was difficult for most investigators to reproduce because of the inexperience in T-cell culture, and because of the institutional restrictions on AIDS specimens. However, the blood test was rapid, inexpensive, simple, safe, and could be quickly made available all over the world.

The history of the plague and the research on the causative agent Yersinia pestis

The plague is an infectious bacterial disease having a high fatality rate without treatment. It has occurred in three huge pandemics since the 6th century with millions of deaths and numerous smaller epidemics and sporadic cases. Referring to specific clinical symptoms of pulmonary plague the disease became known as the Black Death. This pandemic probably originated in central Asia and began spreading westward along major trade routes. Upon the arrival in the eastern Mediterranean the disease quickly spread especially by sea traffic to Italy, Greece and France and later throughout Europe by land. Until the 18th century many European cities were frequently affected by other great plague epidemics. The worldwide spread of the third pandemic began when the plague reached Hong Kong and Canton in the year 1894. The gram-negative coccobacillus now designated as Yersinia pestis has been discovered as the causative agent of plague in this Hong Kong outbreak. In the following years the role of rats and fleas and their detailed role in the transmission of plague has been discovered and experimentally verified. Today the plague is still endemic in many countries of the world.

Infectious diseases in cinema: virus hunters and killer microbes.

The world of infectious diseases has been rarely presented in the cinema with accuracy. Apart from random biographies of scientists and retellings of stories about great epidemics from the past, most films focus on the dangers presented by outbreaks of unknown agents that originate from acts of bioterrorism, from laboratory accidents, or even from space. We review these films and underline the possible effect that they have on the public's perception of infection--a perception that, when misguided, could prove to be problematic in times of epidemics.

The Disordered Body: Epidemic Disease and Cultural Transformation (review)

Readers should turn to the last chapter of this book first. From that chapter, "Corporeal Catastrophe: Bodies 'Crash' and Disappear," the millenarian framing that Suzanne E. Hatty and James Hatty have elected for their review of leprosy, plague, and syphilis in medieval and early modern Europe unfolds. Publishing just before the year 2000, Hatty and Hatty heard loudest the voices of those concerned with imminent doom. They heard both religious apocalyptical fears and secular worries of emergent infectious diseases, of the demise of national populations from HIV/AIDS, of the ethically problematic translation of human bodies by and into machines, and even of the disappearance of other animal species on the planet foreshadowing our own undoing. Without that chapter in [End Page 125] mind, many historians of medicine may look for argument and historical analysis based on the promises of the first chapter, "Imaging the Body." Hatty and Hatty boldly assert there that "disordered" bodies were the dominant feature of great epidemics, and that the historical sequence and the pathological characteristics of three very different human epidemic diseases during the period from the seventh to the seventeenth centuries led Western thinking about "the body" to a great ideological watershed, the Cartesian separation of mind and body. The central problem with this interesting book is its failure to attend to the diachronic "how" that such an assertion demands. The central flaw of the volume--once we forgive an understandable attempt to reach a very broad general audience with juicy examples from cultural studies--is the authors' tendency to substitute assertions and illustrative quotations for the tougher work of proof and analysis.

Las dudas de la corona: La política de repartimientos para la minería de Potosí (1680–1732)

Potosí’s mita continues to intrigue students of colonial Andean history. Peter Bakewell, Jeffrey Cole, and Enrique Tandeter analyzed how the system of forced labor affected the mining economy of Upper Peru. Other scholars, especially the late Thierry Saignes, examined the mita’s impact on indigenous society in the home provinces. Ignacio González Casasnovas now provides an insightful study, based on his doctoral dissertation, of the conditions at Potosí and in the mita provinces that led to the late-seventeenth-century attempts to reform the labor system.Not particularly original but useful nonetheless, the first third of the book summarizes the secondary literature about how the mita by the late 1600s affected life in the Andean villages subject to Potosí. Drawing on works by Saignes, Luis Miguel Glave, Carlos Sempat Assadourian, and others, González Casasnovas presents an excellent synthesis of the structural problems that undermined the provinces’ ability to fill their mita quotas. The mita uprooted and dislocated the indigenous population at the same time powerful interest groups, such as kurakas, provincial governors, village priests, and Spanish agriculturalists, competed with the Potosí silver producers to control labor. Provincial interests complained that the mita killed and maimed workers, that survivors failed to return home, and that Indians fled to avoid conscription for Potosí. The silver refiners accused provincial elites of greedily hiding Indians from the mita and criticized the government for failing to produce promised contingents of workers. Meanwhile, rather than waiting passively to be exploited, many Andeans sought conditions that offered more security and opportunity, even if to do so required migration.By the 1680s complaints from Potosí and the decline in revenues from Potosí’s silver mines prompted a major attempt to revive the mita, the subject of the middle third of González Casasnovas’s book. The duke of the Palata (viceroy 1681–89) ordered a census of the viceroyalty and with the resulting information tried to satisfy the silver refiners’ demands. Palata subjected forasteros (previously exempt Indians who had abandoned their ancestral communities) to the mita. He also extended the mita into new provinces. A victory for the silver refiners and, Palata hoped, the royal treasury, Palata’s policy harmed interest groups in the provinces. Kurakas refused to serve, the new mita provinces resisted sending workers to Potosí, and provincial Spanish elites protested vehemently. Palata had tried to revive the sixteenth-century model for the Peruvian economy, which privileged Potosí when its ores were rich, the indigenous population comparatively larger, and competition for labor less intense.The final third and most original part of the book traces the attempt to develop a new paradigm for dealing with Potosí. This phase began with the arrival in 1689 of Palata’s successor, the count of Monclova, to govern Peru. González Casasnovas considers Palata’s policies misguided, but sees Monclova as honest, enlightened, and astute. As viceroy of Mexico, Monclova had seen colonial mines prosper without forced labor. He rescinded Palata’s initiatives and formed a commission to analyze the Potosí question. For González Casasnovas, the commission’s work constituted “one of the most transcendent episodes of American history during the colonial period” (pp. 259–60). Following the lead of a judge from the Lima high court, Matías Lagúnez, the commission concluded that with Potosí’s exhausted ores, refiners only garnered a profit by paying below-subsistence wages to the mitayos. Most silver registered in the Potosí treasury came from mines in the surrounding provinces that enjoyed no mita subsidy. The mita abused the Indians and degraded the provinces, while Potosí’s mines contributed less and less to the economy. The commission decided that Potosí’s Rich Hill no longer deserved its privileged position and that the mita was both immoral and a waste of labor. With careful analysis, a determined Lagúnez advocated the mita’s abolition. The viceroy and crown instead reduced its size commensurate with the number of tributaries in the old provinces; freed the new provinces from the mita; and removed mitayos from marginal and inactive silver refining mills. Spurred by Lagúnez’s arguments, pressure to end the mita continued. In 1718 the Council of the Indies decided to abolish it. The great Andean epidemics of 1719–20 caused labor shortages, and the Council’s rivalry with the new secretary of the navy and the Indies hindered its implementation. The debate ended in 1732 when the crown permitted the mita’s survival.Broadly researched in archival and secondary materials, the book will reward readers interested in colonial labor systems, mining, indigenous policy, and the early Bourbon reforms. The first, synthetic section is long but profitable. González Casasnovas provides more detail than Cole about the Palata-Monclova period. His analysis of the early Bourbon period shows that the historiographical gap between the studies of Cole and Tandeter had hidden a real possibility, but tragically missed opportunity, of eliminating the mita.

Epidemic disease and regulation of migration in Canada

Beginning with the French Revolution and the Napoleonic Wars, the Parliament of Lower Canada adopted a rational and scientific mechanism for regulating migratory movements within its territory. Other than internal imperatives pertaining to security, this mechanism revolved around a prophylactic control of these movements of population. With the great migrations of 1830-1834 and 1847, the politicians of Lower Canada and the United Canada subsequently needed to revisit their regulatory mechanism in order to render it more efficient. In truth, new arrivals were frequently the spreaders of infectious diseases. Yet more importantly, the great epidemics, such as that of cholera in 1832, or of typhus in 1847, were not merely physically lethal, but were potentially disastrous to the social order. How then to resolve the potential pathological threats to the physical body with those to the political body? The political powers of the day adopted an entire method of thinking and a vocabulary which was more scientific, replete with medical references. Adopted under the seal of an emergency, these new measures of state control of prophylaxis were greatly inspired by those medical theories concerning infection and contagion which were prevalent prior to the arrival of the Pasteurian model of medicine. Those in power then used this new framework to analyze the question as a rational political problem. In the end, they would establish a tighter mechanism of state-controlled prophylaxis through the law, through regulations, and through devices for surveillance and control such as quarantine. The guarantor of social discipline through the erosion of individual freedom, this mechanism of state-run prophylaxis of migratory movements would, from that point forward, be justified by the health demands of the Cité organique, of the public health.

In the Shadow of Polio: A Personal and Social History

Polio Katherine Black has produced a dramatic account of the poliomyelitis epidemics and their social impact. In the Shadow of Polio is skillfully written and has an abundance of references (262 notes plus a bibliography). The author has portrayed the medical and social dilemmas that patients, families, physicians, and society faced in this often fatal or crippling disease. The social and psychological impact of polio during the great epidemics is identified, and the need to recognize these factors in the proper care of patients in contemporary epidemics and with postpolio syndrome is pointed out. The book should be of interest to all physicians, as it provides essential insights for those who care for such patients. A daughter's search for her mother is the major theme. When the author was 4 years old her mother developed paralytic poliomyelitis during one of the great epidemics of the first part of this cen

Les insectes ne connaissent pas nos frontières

One of the major consequences of the joined action of demographic pressure and evolution of human activities lies in enormous increase of transportation, both in frequence and speed; taking advantage of these facilities, some arthropods could increase their geographical distribution and create new health threats. Several demonstrative examples are exposed in order to illustrate this anthropic dissemination of the vectors : the introduction of Anopheles gambiae s.l. in Mauritius Island between 1850 and 1865, in north-east of Brazil in 1930, and in the Nile valley in 1942, these three phenomena being followed by great malaria epidemics; the arrival and dissemination in Africa of chigoe (Tunga penetrans) and, more recently, of the human flea (Pulex irritans); the propagation, in the west Indies, of the african cattle tick Amblyomma variegatum; finally, the expansion of two mosquito species, Aedes aegypti and Ae. albopictus, with real or potential consequences in the field of yellow fever and dengue transmission. These facts, among many others, attest of the constant evolution of epidemiological situations, and of the necessity of a permanent entomological surveillance in order to be able to take adequate measures in time.

Die Cholera in Medizin und Pharmazie: Im Zeitalter des Hygienikers Max von Pettenkofer (review)

Reviewed by: Die Cholera in Medizin und Pharmazie: Im Zeitalter des Hygienikers Max von Pettenkofer K. Codell Carter Ellen Jahn. Die Cholera in Medizin und Pharmazie: Im Zeitalter des Hygienikers Max von Pettenkofer. Boethius, no. 33. Stuttgart: Franz Steiner, 1994. 222 pp. Ill. DM 74.00; öS 577.00; Sw. Fr. 74.00. Jahn’s book is a collection of diverse materials concerning nineteenth-century cholera epidemics in Germany and the work of Max von Pettenkofer (1818–1901). The themes are related in that Pettenkofer, a hygienist and biochemist, resisted Robert Koch’s bacterial account of cholera and advocated a particular miasmatic concept of the disease. In the first quarter of the book, Jahn reviews the secondary literature, early-nineteenth-century beliefs about cholera, and Pettenkofer’s own opinions about the disease. The second quarter contains previously unpublished scientific correspondence between Pettenkofer and various contemporaries (including three letters from Koch to Pettenkofer). In the third quarter, Jahn lists and discusses several nineteenth-century therapeutic and prophylactic measures against cholera. The last portion of the book contains two hitherto-unpublished accounts by a Hamburg clinical physician of events during the 1831 cholera epidemic, select bibliographies of essays on cholera from the medical literature of 1831 and of the late nineteenth and early twentieth centuries, and lists of European libraries that currently possess Pettenkofer’s correspondence. The book also includes a bibliography, an index, and numerous illustrations. Jahn’s goal is to make available new materials to enhance our understanding of the nineteenth-century response to cholera, and to revive interest in Pettenkofer’s work. Her view is that Pettenkofer’s commitment to public and private hygiene and his criticisms of pure bacteriology were partially vindicated when, in 1893/94, bacteriologists found cholera bacteria in the Hamburg public water supply, thereby confirming the significance of public hygienic measures. No doubt Pettenkofer deserves more attention than he has yet received, and, of course, the publication of new primary materials is always welcome. However, a problem with this book is the diversity of its contents. Most of the materials will be of use only to persons with specialized interests, and it is difficult to imagine that any such person will be interested in more than a few of the amazingly diverse items here included. On the other hand, Jahn does an excellent job of presenting and explaining her new materials, and her explanations provide coherence to the overall effort. For those interested in the great cholera epidemics of the nineteenth century, Jahn’s book is definitely worth examining. K. Codell Carter Brigham Young University Copyright © 1996 The Johns Hopkins University Press

The EI Niño Southern Oscillation and the historic malaria epidemics on the Indian subcontinent and Sri Lanka: an early warning system for future epidemics?

The recurrent great malaria epidemics which occurred in the Punjab province of former British India and Ceylon before the introduction of residual insecticides have been related to excessive and failing monsoon rains respectively. In the arid Punjab, rainfall facilitated breeding and increased the lifespan of the mosquito vector and, in the wet part of Ceylon, failing monsoon rains caused rivers to pool, creating more favourable breeding conditions. The periodic fluctuations in monsoon rainfall and epidemic malaria are here explained in relation to the El Niño Southern Oscillation. In the Punjab, epidemic malaria between 1868 and 1943 correlates significantly (r = 0.34, P < 0.005) with the sea surface temperature anomalies in the Eastern Equatorial Pacific, a parameter of the oscillation, and epidemics were significantly more prevalent in a year with a wet monsoon following a dry El Niño year than in other years. In Ceylon, epidemics were significantly more prevalent during El Niño years, when the same south-west monsoon tends to fail. With the reduced reliance on residual insecticides and the recurrence of epidemic malaria on the Indian subcontinent, advances made in predicting El Niño events may be used to forecast high and low risk years for future malaria epidemics.

Le double décomposé. Rencontres des vivants et des morts à la fin du Moyen Age

En 1538, les frères Gaspar et Melchior Trechsel publièrent à LyonLes simulachres &amp; historiées faces de la mort, avtant élégamment pourtraictes, que artificiellement imaginées: un nouveau type de danse macabre, rapidement fameux grâce aux gravures sur bois dessinées plus d'une décennie avant par Hans Holbein le Jeune et gravées par Hans Lützelburger. L'édition, qui donnait de fortes impulsions à la figuration et la méditation de la mort des siècles suivants, est précédée par une épître dédicatoire, due à l'écrivain lyonnais Jean de Vauzelles (« dun vray Zèle » ; 1495-avant 1559) qui s'occupa beaucoup d'oeuvres charitables.

Clinical observations on acute poliomyelitis.

During the years of the polio epidemics, most patients with the poliovirus had little or no paralysis. In those with paralytic polio, the extent of involvement of the anterior horn cells was often underestimated. Thus, patients with post-polio syndrome now often report that a limb was uninvolved; however, the original record will show clear evidence of initial paralysis that improved so that the patient no longer recognized the weakness. The epidemics were associated with great anxiety involving the patients, their families and all of society. Treatment was for the most part ineffective and was sometimes confused or inappropriate. Patients developed coping techniques that have been singularly useful and effective. These coping techniques often include strategies that require maximal athletic development of little-used muscles. The coping techniques developed by post-polio patients would be of great benefit to patients with other forms of disability. Review of the medical histories, biographies, and autobiographies of patients who had severe disability because of poliomyelitis reveals that they adopted firm convictions about their disease and their recovery. We must be aware of these convictions if we are to treat their later disabilities. These convictions include the belief that their condition can only improve, that their improvement is related primarily to the willingness of the patient to engage in exercise, and that improvement is more a thing of the spirit than of medication. Associated with this conviction is denial--often concurred with by the family--of the extent of the disability. Furthermore, the confusion of physicians that patients witnessed during the great epidemics suggests to patients that physicians can be of little help to them now. Convictions that were invaluable to patients who were young and vigorous become a liability when aging and progressive weakness supervene. Patients who had adapted to muscle weakness through great physical and emotional effort are unable to continue functions they had regained. However, such patients cannot accept that they do not continue to improve. Some become depressed, but this is unusual.

Pediatrics

As late as the 1980s, serious invasive diseases caused by<i>Haemophilus influenzae</i>type b (Hib), chiefly meningitis and epiglottitis, were important causes of morbidity and mortality in children, especially in infants younger than 15 months. The mortality associated with Hib meningitis was 3% to 6%, and permanent neurological sequelae occurred in 20% to 30% of survivors. This degree of morbidity and mortality was comparable to that observed during the last great epidemics of paralytic poliomyelitis during the 1950s. The first vaccines active against Hib disease were prepared from the Hib capsular polysaccharide polyribosylribitol phosphate (PRP) and introduced in the 1980s. These Hib PRP vaccines were immunogenic and clinically effective in children older than 18 months. However, they elicited little antibody response in infants aged 3 to 17 months, and two thirds of serious invasive Hib disease occurs in infants younger than 18 months. Despite this, in 1985 PRP vaccine administration

The Great White Plague and other epidemics: Lessons from early

Visiting nurses today are challenged by communicable diseases such as tuberculosis and AIDS. These challenges are similar to those that confronted the first visiting nurses in this country who cared for persons with communicable diseases around the turn of this century. They fought tuber culosis, influenza, and infantile paralysis (polio) while struggling with limitations posed by social, medical, and environmental constraints. Remarkably dedicated and innovative, their efforts formed the basis for home care today, and many of their ideas are still relevant.

Arthropod-Borne and Rodent-Borne Viral Diseases

This book constitutes the written report of a WHO Scientific Group that met in early 1983 to discuss arthropod- and rodent-borne viral diseases. The book contains sections on virus classification, global and regional public health problems, epidemiological concepts, and diseases and their management, methods for detecting these infections, pathogenesis, associated biohazards, surveillance, prevention and control, preparedness for emergencies caused by these viruses, and excellent recommendations by the Scientific Group. The book was not intended to replace textbook chapters but to update the 1967 WHO Technical Report on arboviruses and human disease. From 1966 to 1983, the recognized number of arthropod- and rodent-borne viruses increased from 200 to 460, of which 97 were known human pathogens. By 1985, these have increased to 504, of which 118 are known human pathogens. Since the 1966 report, great epidemics and significant outbreaks of arboviral and rodent-borne viral diseases have occurred.

Social thought and social statistics in the early nineteenth century: the case of sanitary statistics in England.

The numerical determination of the relationship between the sanitary conditions in which people live, and the risks to health and life this may involve is a relatively new method of understanding infectious disease. It came to be known as “sanitary statistics” in the early nineteenth century, when this kind of investigation reached the climax of its social importance. But its roots go back to the late seventeenth century, when England was again visited by the plague, shattering a country that had hardly recovered from two decades of civil unrest. The two basic motives of sanitary statistics, which later made it so potent a reformist tool, were already present then in a first outline, namely the attempt to rationalize the frightful phenomenon of the epidemic and the conviction that its causes were somehow bound up with the social organization of urban life. As long as people had seen in the great epidemics God's punishing hand, the flagellants' reaction made sense. Man could only bow to Him; the arm of flesh might at most seek to avoid His punishment by punishing itself in advance. But when in 1854 the Presbytery of Edinburgh suggested to the Home Secretary, Lord Palmerston, to call for a national fast against cholera, they received the cold reply that “the weal or woe of mankind depends on the observance or neglect of those laws” which sanitary statistics had recently discovered. Divine reference was replaced by statistical reference, and the correlations thus revealed pointed to action by the “arm of flesh”.

Eradicating sources or removing results.

With few exceptions, the prevalence of disease has never been reduced by improved treatment. Success has followed identifying and eliminating, or reducing, causative factors. This has been true of infective disease in the West and of the great tropical epidemics. Yet vastly greater endeavour and expenditure are devoted to the treatment of non-infective diseases than to efforts to identify and tackle their causes. This in spite of the fact that they are increasingly recognized as characteristic of modern western culture.

150 Jahre pandemische Ausbreitung der asiatischen Cholera von 1831 bis 1981

The first occurrence of the Asiatic cholera in Europe in 1831 has been followed by a series of migrations of this disease always setting on from India and moving forward to many countries of other continents. These migrations keeping on for several years were called “pandemics” and have been counted since August Hirsch. He described 4 pandemics. Pollitzer is of the opinion that-after the end of the 6 th pandemic — since the disappearance of cholera from Russia in 1926 no further outbreak in Europe took place except a small epidemic occurrence in the Ukraine during World War II. He describes the world situation of cholera from 1927 to 1954 with the great epidemics in India during the thirties of this century causing several hundreds of thousands of fatal cases and spreading over the neighbouring countries in the fourties as well as to Egypt in 1947 and Syria in 1948. Pollitzer did not deduce from this phenomenon a new pandemic which was indeed described as the 7 th one first in the German medical journal “Die Medizinische Welt” in 1940, showing a map about the distribution of cholera to the west and east. During this pandemic the local outbreaks were very dangerous so that at first time mass campains with vaccinations against cholera were arranged in Afghanistan, Iran, Indochina, China and Manchuria. The first pandemics were spreading on land routes, later on also by sea, and at last in the 20 th century by air. It might be that during the 7th pandemic, cholera was imported by air from Pakistan to Egypt in 1947 on 22 September to El Korein. Since 1961, cholera once more started a new migration — the 8 th pandemic — coming from South East Asia and spreading by this time through the classical routes, westwards to the Black Sea, the Mediterranean countries, Africa, and even Europe. The new cholera migration since 1961 differs from the preceding ones in the way that the causative agent is of the biotope Cholera El Tor and not of the classical vibrio comma. During the 8 th pandemic we see in the map of cholera El Tor spread the importation via air from the Black Sea coast (Odessa, USSR) by Guinean students returning from USSR by air to have brought the germs out of an outbreak in USSR. Furthermore, importation by air took place from Africa to Europe, from Europe to Africa and to Australia. This fact is not surprising, because the biotype El Tor is more resistent to environmental factors and survives longer with virulence than the classical cholera vibrio. Mild cases and asymptomatic infections with biotype El Tor are more frequent than with the classical type. Therefore, these characteristics may play an important role in spreading epidemic cholera during the now 8 th pandemic in the world. This pandemic represents the third great cholera spread in our century and should, therefore, be considered as the 8 th pandemic in continuation of the counting since August Hirsch and Georg Sticker up to now.