Fear always brings out the best in people...

In 1900, San Francisco’s Chinatown was quarantined with barbed wire fences when a Chinese laborer was suspected to have died of Bubonic plague.

While the cause of death was still undetermined, a cordon was placed around Chinatown, and no Chinese American was allowed to leave the area bounded by California, Kearny, Broadway, and Stockton streets. This restricted the freedom of movement of people, some of whom were American citizens. It caused them many hardships, for they had difficulty in obtaining goods and services from people outside Chinatown. There was a shortage of food, and prices increased sharply. Chinese American businessmen faced a loss of income, and workers a loss of wages. After three and a half months, it was found that there were no cases of bubonic plague within Chinatown. This lengthy quarantine of Chinatown was motivated more by racist images of Chinese as carriers of disease than by actual evidence of the presence of bubonic plague. 

Still, at least they didn't accidentally  burn the area to the ground.

Bubonic Plague video classics

It's now traditional to open the Bubonic Plague week with these two Bubonic Plague video classics.

The always popular John Stewart and and an interesting depiction of medieval flagellants in a German rock video.

The Daily Show
Get More: Daily Show Full Episodes,Political Humor & Satire Blog,The Daily Show on Facebook

Sample midterm

I uploaded a sample midterm. It's also available via the links to the right.

Send in the cats

I was idly wondering whether any other disease outbreaks had been solved by airlifting cats when I came across this strangely parallel story from Borneo - at catdrop.com of course.

The story is that in 1959 DDT was being sprayed to reduce malaria in Borneo. This caused the death of cats in some areas where DDT was sprayed indoors. This then led to local outbreaks of bubonic plague. A “cat drop” occurred to replenish the local cat population and solve the bubonic plague problem by having them kill the booming rat population.

The website examines the truth behind this tale and digs up an actual Operations Record Book from the Royal Air Force which did indeed carry out at least one cat drop in a remote region. In this case twenty cats were dropped in special baskets. The record book notes that a reply was received saying “all cats safe and much appreciated.”

Actually if you look at the log book it says something much better:

That question mark is intriguing. Is there a chance that the locals were mystified as to why the RAF had just dropped a load of cats on them?

The Illustrious Dead

If you'd like to read more about how Typhus fever destroyed Napoleon's ambition then there's a recent book that makes the case - Stephan Talty's 'The illustrious dead':

When Napoleon invaded Russia in 1812, typhus ravaged his army, killing hundreds of thousands and ensuring his defeat, according to this breathless combination of military and medical history. After summarizing the havoc this disease wreaked on earlier armies and sketching Napoleon's career, the book describes his invasion of Russia with more than 600,000 men. Almost immediately typhus struck. Infected lice excrete the microbe in their feces, and victims acquire the disease by scratching the itchy bite. Talty describes the effects in graphic detail: severe headache, high fever, delirium, generalized pain and a spotty rash. Death may take weeks, and fatalities approached 100% among NapoleonÖs increasingly debilitated, filthy, half-starved soldiers. Talty makes a good case that it was typhus, not General Winter, that crushed Napoleon. Readers should look elsewhere for authoritative histories of NapoleonÖs wars and of infectious diseases, but Talty delivers a breezy, popular account of a gruesome campaign, emphasizing the equally gruesome epidemic that accompanied it.  (Publisher's Weekly review).

I haven't read this one but I think I'll add it to my reading list.

for something a little more immediately accessible you can read Insects,disease, and military history: the Napoleonic campaigns and historical perception. The version online is adapted from a paper of the same name in the American Entomologist. (1995)  41:147-160.

CLD or PLDS

That is, Chronic Lyme Disease or Post Lyme Disease Syndrome?



That's just the trailer, you can watch the longer reports here:
Part I 
Part II

The reports are quite sympathetic to sufferers who are clearly suffering from something but it isn't any clearer whether they are suffering from an undetectable Lyme infection, an immune response to an old infection or something else.

Don't click off the video at the end. Big 'Ol Fish comes on. It's awesome.

Tick removal

Many people seem to have heard of one or other supposed foolproof way to remove ticks. None of them seem to work very well though, or be any better than simply pulling the tick out. At least not according to 'Evaluation of five popular methods for tick removal' by Glen Needham from the Acarology laboratory at Ohio State.

It is recommended that the tick be grasped as close to the skin as possible with curved forceps; if these are not available, use tweezers or protected fingers. Pull straight up with steady even pressure. If cement or mouthparts remain, then extract if that is practical. Disinfect bite site before and after tick removal.

Commercial tools that function in this manner may make the task slightly easier.

Here's a video guide to removing ticks from the University of Rhode Island's TickEncounter Resource Center.

Bacterial conjugation

Bacteria having some conjugal fun. Any questions?

Pigs on pills

Agricultural use of antibiotics for growth promotion is back in the news this week because of a paper published in PNAS this week: In-feed antibiotic effects on the swine intestinal microbiome
This comes hot on the heels of the failure of the FDA to take a harder line against big business on the topic. In fact the Atlantic has an article on this subject today: The Rise of Antibiotic Resistance: Consequences of FDA's Inaction
By allowing big food to self-regulate when it comes to using antibiotics as a growth promoter in animals, the FDA is setting us up for disaster.

New antibiotics

There's an article in The Daily Telegraph, a British Newspaper, tomorrow about the lack of new antibiotics: The battle to discover new antibiotics.


Most of our antibiotics, and practically all of the different classes of antibiotics (ie the different families with different modes of action) were discovered over a period of three decades from the early 1940's to the late 1960's. No new classes of antibiotics were discovered for over thirty years and only two new classes have been discovered since 1968 - the Oxazolidinones in the late 1990's (although one of them was used against Tuberculosis since 1956) and the Lipopeptides approved in 2003.

The figure to the left is from a similar article in the New York Times in 2010 and shows the steep decline in the number of antibiotics approved for sale over the last three decades. This is the absolute number of antibiotics, not different classes, most of these antibiotics are variations on existing themes.

Interestingly both these articles make the same point that it is not necessarily the science that is lacking but the financial incentive:

While the notion of directly subsidizing drug companies may be politically unpopular in many quarters, proponents say it is necessary to bridge the gap between the high value that new antibiotics have for society and the low returns they provide to drug companies.

New TB aconym

On Monday we will discuss MDR-TB (multi-drug resistant TB) and XDR-TB (extensively drug resistant TB). Although a completely resistant strain was identified in Italy in 2007 it wasn't until reports from India this week that the name TDR-TB (totally drug resistant TB) seems to have become general.

The Indian Government is disputing whether the strain is totally or merely extensively drug resistant but in either case it is not good news for India which sees about 2 million new cases of Tuberculosis each year.

Favorite episodes

We don't get repeats on TV anymore we just get favorite episodes and marathon weekends. In the same spirit here are some favorite and dearly beloved blog postings from the past that you may enjoy at this point in the course.

• Minié balls and infection before penicillin
• The smart of the knife... 
• Saving not just lives...
• Meet the Penicilliums
• Waverly Hills Sanatorium  
• TB Blues 
• Medicinal pneumothorax  and Just a flesh wound

Sneezing correctly

During the recent swine flu pandemic there were a number of public health awareness measures aimed at getting people to sneeze a little more carefully. Many of these were provoked by a New Zealand study that showed that as few as 5% of people sneeze 'correctly' (ie cover both mouth and nose whether with their hand, a tissue or their sleeve). The vampire cough became a popular meme.

This is only the latest in a long running series of campaigns to prevent people spreading germs. Until recently the concern was not for just colds and flu but also for the far more dangerous Tuberculosis. During the second world war these campaigns were intensive due to the importance of maintaining production and reducing absenteeism due to sickness. Although the posters have been around for years and have been reproduced in many books the old public service films are also now increasingly available online and are BRILLIANT.

Remember this was an era before television so most of the audience would watch these films at the cinema which would have had a huge attendance.

There's so much to like about this film. I love how the 'prankster' who kicks a guy headfirst into a river is considered 'pretty harmless'.

Photographs Highlight Drug-Resistant Tuberculosis

Photographer James Nachtwey has been covering war and human rights stories for 30 years, traveling from Northern Ireland to Iraq, from the orphanages of Romania to the deadly killing grounds of the Sudan. He knows the power of news photographs to raise awareness and make real change. In 2007, he was awarded the TED Prize, which comes with $100,000 and one wish to change the world.  You can also watch his TED Talk online or visit XDRTB.org.

 What caught my attention in this article was the publish date of the article because we will be learning about this in class tomorrow. And this certain type of tuberculosis does not yet have a cure which is exhilarating because we do not know what this disease can do to our bodies. Like how this can affect our world that we live in, and if vaccines can be made in time...most likely not. However, researchers say, "this bacterium can leave you on antibiotics for approx. 9 months"...which is crazy because I can't even handle being on antibiotics for a week!

      Here is the start of the article which came out yesterday, Jan. 16:

Experts have long feared the eventual arrival of a completely drug-resistant TB (tuberculosis) - a hospital in India has reported the nation's first cases of a type of tuberculosis for which there are no effective drugs, making the TB virtually untreatable. Other untreatable TBs have emerged over the last nine years; there have been reported cases in Iran and Italy. Most likely, there are many more cases that have never been documented, experts believe.

The link: http://www.medicalnewstoday.com/articles/240357.php

Love in the Time of Cholera

If you've never read it, or you've only seen the movie, I strongly recommend Gabriel García Márquez's novel Love in the Time of Cholera. Despite it's main theme, that lovesickness is literally an illness, a disease comparable to cholera, it is a beautifully written book that has a lot to say about love in its myriad forms.

Here's the start of Thomas Pynchon's review of the book for the New York Times:

Love, as Mickey and Sylvia, in their 1956 hit single, remind us, love is strange. As we grow older it gets stranger, until at some point mortality has come well within the frame of our attention, and there we are, suddenly caught between terminal dates while still talking a game of eternity. It's about then that we may begin to regard love songs, romance novels, soap operas and any live teen-age pronouncements at all on the subject of love with an increasingly impatient, not to mention intolerant, ear.

At the same time, where would any of us be without all that romantic infrastructure, without, in fact, just that degree of adolescent, premortal hope? Pretty far out on life's limb, at least. Suppose, then, it were possible, not only to swear love "forever," but actually to follow through on it -- to live a long, full and authentic life based on such a vow, to put one's alloted stake of precious time where one's heart is? This is the extraordinary premise of Gabriel García Márquez's new novel Love in the Time of Cholera, one on which he delivers, and triumphantly.

Max Joseph von Pettenkofer

I love the Internet. Not just for its vast array of information but for the fact it provides me with this information in the comfort of my own home at any hour of the day.

I has been meaning to look up some more information on Max Joseph von Pettenkofer - that most famous of cholera drinkers. In particular I was curious if any of his students had died from their cholera drinking activities. It took only a few clicks to find this biographical sketch of von Pettenkofer published in the Journal of Nutrition in 1977.

In 1892, when almost 74 years of age, Pettenkofer performed on himself what he called his experimentum cruets. He swallowed 1cc of a cholera culture prepared from the "rice-water" stools of a dying man. No symptoms resulted except a "light diarrhea with an enormous proliferation of the bacilli in the stools".

Pettenkofer's students repeated the experiment on themselves. In two cases, the reaction was severe, but no one died. Pettenkofer considered the results a vindication of his views, but most epidemiologists were not swayed by these results.

So none of the students died but I was amazed to discover that Pettenkofer had carried out this experiment at the age of 74. I need to change the picture I use of him.

Miasma - not to be confused with miasm

The long discredited idea of the miasma lives on in homeopathic medicine as the 'Miasm' which, according to homeopaths, is the underlying cause of many diseases which is described as "a peculiar morbid derangement of the vital force".


And if you enjoyed that Mitchell and Webb sketch you should check out this one from a later series that nicely illustrates the uptight nature of the Victorians. Unless you are easily offended (like the Victorians). In  which case you shouldn't.

Miasma and mass graves

I mentioned in class that the fear of disease spreading from unburied corpses is largely unfounded and probably dates back to our fear of miasma. The worst miasma was that created from decaying corpses.

I wanted to chase up a citation for this since this comment was something I originally came upon in a historical paper on miasma. I found this press release, Mass burials do more harm than good, from UCLA Center for Public Health and Disasters that not only substantiates this comment but raises several points I hadn't considered about why the very hasty burial of bodies, in mass graves following large natural disasters for example, may be problematic.

(H)ealth workers said it was a myth that dead bodies constituted an acute health risk after earthquakes.
"As far as public health professionals have been able to determine, this concern has never been substantiated," Steven Rottman, director of the UCLA Center for Public Health and Disasters, told AlertNet.
Rottman said no scientific evidence existed that bodies of disaster victims increased the risk of epidemics, adding that cadavers in fact posed less risk of contagion than living people. 

Indiscriminate burial demoralises the survivors and can lead them to be deprived of transferable pension benefits through failure to provide death certificates for pension holders.
In some countries it is difficult for survivors -- especially women -- to prove their ownership of inherited property without proper documentation.
Alexander pointed out that spraying was a waste of disinfectant and manpower. 

The World Health Organisation has long challenged the often-cited need to conduct quick mass burials after earthquakes to prevent the spread of disease.
"The most pressing issue is preserving the identity of those who have lost their lives," its U.S. arm, the Pan American Health Organisation, said in a report in October. "Under no circumstances are burials in common graves or cremations justified or warranted."

The Sewer King

I haven't watched it yet but I just discovered that Episode 4 of a BBC series entitled Seven Wonders of the Industrial Age is all about Joseph Bazalgette and the construction of London's sewer system.

Set in London during the 1850s, this episode focusses on the construction of the London sewerage system, built to replace the antiquated medieval system that was overworked and inadequate for the needs of the-then largest metropolis in the world, causing epidemics of disease and a permanent foul stench to fill the air. The episode follows the efforts and work of Joseph Bazalgette, the brilliant engineer who designed the influential and modern sewer system that would purify the city, transform the streets above and would result in the end of the epidemics of cholera and typhoid that had ravaged the population - although, ironically not for the reasons that he initially thought.

I found it on YouTube but only with subtitles I'm afraid. Looks good if you like your history reenacted.

First case of Cholera in Haiti

Man collecting water in Port-au-Prince, Haiti.

Earlier this week a Boston aid group reported that it had tracked down the first person to be infected by Cholera in Haiti's epidemic. Cholera had been eliminated from Haiti for many decades prior to the recent earthquake

A mentally ill man who bathed in and drank from a contaminated river most likely was the first person to be infected in the Caribbean country's deadly cholera outbreak. Althoug the man's family had access to clean drinking water he bathed in and drank frequently from a river into which the Meye River fed. The Meye has been identified as the likely source of the epidemic. Studies suggest the cholera was likely brought to Haiti by a United Nations peacekeeping battalion from Nepal, where the disease is endemic.

"It's a striking example of how mental health, infectious disease and community health affects overall well-being." Dr David Waltern, a co-author of the study.

Given the conditions in Haiti it is perhaps inevitable that cholera might break out but this interaction with mental health is especially interesting, and tragic.

Great stink

In the sweltering summer of 1858 the stink of sewage from the polluted Thames was so offensive that it drove Members of Parliament from the chamber of the House of Commons. Sewage generated by a population of over two million Londoners was pouring into the river and was being carried to and fro by the tides. The Times called the crisis "The Great Stink". Parliament had to act - drastic measures were required to clean the Thames and to improve London's primitive system of sanitation.

I was going to post a link to some more information about the book I mentioned, The Great Stink of London, in case anyone was curious about this, the smelliest period in history, when I discovered that someone has written a novel about it with a very similar title set in the same era.

It takes a world of confidence to name your debut novel The Great Stink, and to set it in a sewer. Not even a modern sewer--charmless though that may be--but the crumbling, cholera-laden, rat-infested, fungus-rich sewers of London in the mid-Victorian period, from which pockets of deadly gas frequently burbled to the surface. Clare Clark's unsavory but completely absorbing first novel is a Dantean tour of this reeking underworld and its denizens: both the scavengers--human and animal--and the reformers, who brave the tunnels in the service of public hygiene and social progress after the 1858 Act of Parliament that called for the rebuilding of the sewer system. The Great Stink juxtaposes two darknesses, both embodied in the filthy tunnels: the lawless desperation of the very poor, and the despair of madness.

#cholera

Thanks to Julio for the tip on this article today in Nature reporting on a study that showed social media data, including Twitter posts, accurately tracked Haiti's cholera outbreak and provided this data up to two weeks before official reports.

Such data could allow health workers to "gain early insight into an evolving epidemic" — and help plan a response sooner.

Just an appendix...

Cholera cases by region. The size of a region shows the proportion of all cholera cases found in that region

We barely had time to get started with Cholera today but there was an interesting article on the Scientific American blog last week about how the appendix may not be as useless as we previously thought.

The essence of the argument is that in the presence of serious diarrheal diseases like Cholera the appendix forms a refuge for beneficial gut bacteria that are being purged from your intestines (hopefully along with the Cholera bacteria).

(T)he appendix serves as a nature reserve for beneficial bacteria in our guts. When we get a severe gut infection such as cholera (which happened often during much of our history and happens often in many regions even today), the beneficial bacteria in our gut are depleted. The appendix allows them to be restored.  In essence, Parker sees the appendix as a sanctuary for our tiny mutualist friends, a place where there is always room at the inn. If he is right, the appendix nurtures beneficial bacteria even as our conscious brains and cultures tell us to kill, kill, kill them with wipes and pills.

Welcome

Welcome to the blog for EEMB40 - the Ecology of Disease - for Winter 2012. It will also serve as a class website and you will find links to lectures etc. in a box at the top right imaginatively called 'links'. Lecture slides will be available shortly after each lecture. They are put there for your convenience (you don't need to scribble down details of a graph because you know it will be available later) but please note that they are not designed to be lecture notes. In fact in most cases my slides would make very poor notes. In order to help you take notes I have made a glossary for the class - also linked on the right. All the terminology you will be required to know is listed in the glossary.

You are all welcome, and encouraged to post here. To do that all you need to do is to send me an e-mail saying just that. I will then add your address and Google will send you an invitation to be an author. Just follow the simple instructions and away you go.

Postings to the blog should be relevant to the class but the blog is specifically designed to be a place where you don't need to worry about how relevant your post is. (I give you 'Basket full of puppies' as an example). I will be posting lots of things that I read in the news or that I take out of lecture (for time purposes) but that some of you may find interesting. By putting it here you can look at it at your leisure and you know it won't be on the exam.

I try to post every day when the class is running and, where possible, the postings are relevant to the current topics we are covering in class. You can access older postings (there are nearly 800 of them from the previous times I have taught this class) by using the 'Labels' (scroll down and they'll be on the right hand side) to pull up posts on particular topics.