4.1 FAMOUS DISEASES IN HISTORY

I. SYPHILIS

This is an infectious disease that occurs only in humans. It is usually transmitted from one human being to another by direct contact, usually by sexual intercourse. The causative organism is a spirochete. The organism was isolated in 1905. There is no vaccine for syphilis.

Left untreated, syphilis becomes a systemic disease involving any part of the body. Of interest to anthropology is skeletal evidence of the disease. Long term syphilis leaves characteristic skeletal defects on top of the cranium, which helps in tracing the history of the disease.

Did it arise in the New World? This is the subject of considerable debate. Paleopathological (skeletal) evidence of the disease only appears after contact. Also, syphilis wiped out American Indians with the same ferocity as it did in Asia, North Africa, and Europe. Had it been endemic in the New World, American Indians would probably have had at least a partial immunity to it. The origin of syphilis is an ongoing debate.

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Many people are unaware of a child skin disease called yaws. It is caused by the same spirochete microorganism that causes syphilis. Evidence for yaws reaches into antiquity, with possible references to it in the Old Testament.

Yaws spreads between children by skin-to-skin contact. The spirochete could effectively exploit the ecology of early urban life by taking advantage of the frequent cuts and sores on the legs of children, coupled with the close leg-to-leg contact of young children who slept together crowded into village hovels and huts. When the spirochete established itself under the skin, it produced a localized infection that often healed.

(My note: In academic circles, the theory that syphilis came from the New World is called the Columbian theory. A competing theory that syphilis is a systemic version of the more localized skin diseases known as yaws, bejel, and pinta is called the Unitarian theory.)

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The spirochete could only emerge as a sexually transmitted disease in a densely urban setting. The double standard of chastity in the home and promiscuous (or deviant) behavior in the anonymity of the city dates back to the very beginnings of city life. Chance infection of the genital area could easily spread when many persons of the population frequently had sexual intercourse with a variety of partners. While yaws was a 'disease of the unsophisticated', syphilis arose as a disease of advanced urbanization. It is very much a 'crowd' disease.

Later in this course we have a unit on the Black Death--plague. Again consider: following the Black Death of the fourteenth century, most of Europe sank into disarray and lawlessness. Crime soared and promiscuity escalated.

Syphilis reached epidemic proportions in 1495 amongst French soldiers waging war in Naples. Within two years the disease was known the world over. The disease struck humankind as something completely new, and incredibly devastating.

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When left untreated, the disease produces destructive tumor-like masses called gummas. These occur in the skin, nervous system, and bones. The latter lesions are studied by the paleoanthropologist. Syphilis crosses the placental barrier in pregnant women producing a variety of congenital defects.

Before antibiotics, syphilis was treated with mercury, bismuth, and arsenic compounds. Penicillin was the first definitive treatment, and is still the drug of choice. Antibiotic resistance is an increasing problem for the treatment of this disease.

..... CJ '99

Resources

Berkow, R. ed. Merck Manual, 16th ed. Rahway: Merck & Co., 1992.

Garrett, L. The Coming Plague. New York: Farrar, Straus & Giroux, 1994.

Kipple, K. ed. Plague, Pox, & Pestilence. New York: Barnes & Noble Books, 1997.

Smith, D. Zinsser Microbiology. New York: Appleton Century Crofts, 1960.

Wills, C. Yellow Fever Black Goddess Reading: Heliz Books Addison-Wesley, 1996.

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II. HERPES VIRUS

This virus belongs to a group of viruses that produce chronic infections in humans. Often these diseases live in various parts of the body, not producing symptoms until there is a breakdown of the normal immune response.

Herpes is an infection in humans that affects mucous membranes or skin surfaces. It is caused by two closely related viruses: HSV-1 and HSV-2. Anyone who has 'cold sores' can tell you the characteristic sequence of events: they begin with a 'tingling' sensation. Within hours, small terse vesicles appear. In a day or two, a crust forms. The site of infection generally corresponds to the location of the body where the virus entered. This is true for lesions on the lips, genitals, anus, and occasionally elsewhere on the body.

Herpetic whitlow is a herpes infection in the fingers which occurred in dental personnel before he era of mandatory glove use. Like herpetic lesions elsewhere on the body, the herpes outbreaks are often painful and at times disabling. There is no herpes vaccine.

The origin of herpes in human history is unknown. HSV-1 has probably been around as long as anyone could diagnose the distinctive fever blisters. Studies of the elderly in Europe and the United States have shown that 90% have been exposed to the virus. (My note: the implication is that the older you are, the more likely is exposure to the virus.) Contagion of HSV-1 has declined with the understanding that the herpetic sores shed the virus and that these can be spread with just a kiss.

HSV-2 is primarily passed sexually between humans. When there are active lesions, the chance of passage to a sexual partner without protection.

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With infection of the lip, the virus takes up residence in a nerve cluster called the trigeminal ganglion. After the surface lesion has healed, the virus remains dormant in the nerve cell bodies. In times of stress, the virus travels down the sensory nerves to reappear in the skin or mucous membranes enervated by those nerves. As a rule, the recurrent attacks are not as severe as the original infection. Some fortunate persons have no recurrence.

Acyclovir © preparations help to suppress recurrent eruptions of the disease. This is a transmission-by-contact disease. When lesions are active, the virus can easily be spread to others. Self infection to the eye is also a hazard. If you suffer from fever blisters, take this as a warning. Avoid inoculating another part of your body, especially the eye.

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Herpes virus is related to viruses that cause chicken pox, shingles, infectious mononucleosis, and Epstein-Barr. The virus has been around a long time. The ancient Greeks knew about it. The name herpes comes from the Greek, meaning 'to creep'. It was their way of observing sores that seemed to creep over the surface of the skin.

The ancient Romans knew about herpes. Two thousand years ago, Roman Emperor Tiberius attempted to curb an epidemic of herpes labialis by outlawing kissing during public ceremonies and rituals.

An obstetric risk is transmission to a child during birth when genital herpes lesions are active. The genital lesions are also a risk to birth attendants.

Is herpes a crowd disease? Certainly. When there are dense populations where individuals can have many interpersonal contacts, spread of the virus is inevitable. There is a more sinister aspect of this disease: it easily mutates to outwit Acyclovir©. Even before approval of the drug, scientists were warning of cross resistance. In the modern global village, spread of the resistant forms of herpes is easy and rapid.

..... CJ '99

Resource

Cartright, F. Disease and History. New York: Dorset Press, 1972.

Garrett, L. The Coming Plague. New York: Farrar, Straus and Giroux, 1994.

Hamilton, R. The Herpes Book. Los Angeles: J. P. Tarcher, Inc. 1980.

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III. TUBERCULOSIS: THE PEOPLE'S PLAGUE

The historic origin of tuberculosis in the human population is unknown. For some time it was assumed that human tuberculosis was derived from bovine tuberculosis in domestic cattle. It may be, however, a disease endemic in some animals rather that a 'crowd' disease sustained only in human hosts. It is now known that tuberculosis is maintained in a variety of wild animal reservoirs. These include buffalo and wild bird populations.

Robert Koch isolated the tubercle bacillus in 1882. The infection is usually airborne. Large numbers of people carry the bacillus. For most people, the infection is a silent, benign event. Read that sentence again. On average, infected people have only a 3 percent chance of developing active disease during their lives and a 1 percent of coming down with lethal disease. (My note: keep in mind that TB is an opportunistic disease that attacks the vulnerable with increased ferocity.) With the onset of the AIDS epidemic, the incidence of TB has increased alarmingly amongst persons infected with HIV.

In the 1990s, MDR (multiply drug resistant) TB outbreaks occurred first in Miami, San Juan Puerto Rico, New York City and elsewhere around the United States. In 1995 there was an outbreak in the Illinois Kane County jail spread by a poorly designed ventilation system. Outbreaks have been feared aboard airplanes with closed air circulation.

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Tuberculosis probably first appeared in the Iron Age. TB is reported to have appeared as isolated cases in Germany and Denmark during the Neolithic. It was not common in Britain until Roman times and became a significant disease burden only in the Middle Ages. How do we know this? TB leaves characteristic traces on the ribs and tends to destroy the bodies of lower (lumbar) vertebrae, producing a characteristic angle in the lower spine.

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Years ago, TB was one of the greatest killers of mankind. It has often been called 'the white plague.' In recent times, the TB epidemic really began in Europe about 400 years ago. The last large area to be reached by TB was New Guinea in the 1940s, ironically when effective chemotherapy was developed half way around the world--a triumph of biomedicine.

For a time, the disease was seen in a religious or moralistic manner. People so afflicted 'deserved it as punishment by the Lord.' It was even 'fashionable' amongst writers and the upper classes to have consumption (the term then used for TB). The sallow, thin appearance was even considered beautiful.

By the 1890s, TB had become the peoples' plague, a disease of the masses--lower class poor and immigrants crowded into cities. There was no cure. A variety of strange concoctions were pandered as 'cures'. Many contained opium. With Koch' discovery in 1882, TB now had a microbial basis--a stunning scientific achievement. Also, with a microbe as its cause, there was now something to fight.

Tuberculosis as a germ-caused disease led to the board of health boom across the United States. Public health became law enforcement. TB also raised civil rights issues and prejudice which would emerge again with the AIDS pandemic in the 1980s. Eastern European Jews were associated with tuberculosis and were targeted as a special threat much as Haitians were unjustly targeted as AIDS carriers almost two decades ago.

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Northern Europeans had some resistance to TB; however, it was utterly devastating to Native Americans. TB particularly devastated the Apache Indians when they were moved to Florida in the 1800s. American Indian children placed in the infamous Pennsylvania boarding school at Carlisle who became seriously ill with TB would be quietly removed before death to keep mortality statistics at that school in a more favorable perspective.

In America, a whole sanatorium industry appeared which emphasizing rest and fresh air. In the 1940s, chemotherapy developed first with streptomycin. Drug resistance appeared in months. Later streptomycin was combined with the drugs PAH and INH as accepted therapy. TB seemed defeated, public health measures were dismantled, and TB reemerged in the 1990s. As the decade closes, however, TB is again in decline.

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Thanks to chemotherapy and public health measures, TB declined in the late 1940s and 1950s. According to figures released by the CDC, TB increased from the mid 1980s until 1992. The number of new cases is again on the decline; the figures released in 1997 are the lowest since the CDC began record keeping in 1992. These figures are especially favorable when you consider that the population of the United States has nearly doubled since 1953.

Is there a vaccine? Yes and no. Robert Koch himself produced tuberculin which he claimed would cure TB. Sadly, he died in disgrace over its commercial use. Its use faded in the 1920s. Bacille Calmette-Guerin (BCG) is used as a vaccination in developing countries, but has achieved little acceptance here. Its effectiveness is in doubt.

..... CJ '99

Resource

Garrett, L. The Coming Plague. New York: Farrar, Straus and Giroux, 1994.

Kipple, K. Plague, Pox & Pestilence New York: Barnes & Noble Books, 1997.

"U.S. new TB cases fewest in 43 years" Chicago Tribune March 25th, 1997.