Lecture 1B part 1

Question 1

In ancient times, what was thought to cause dz?

Answer 1

Supernatural dz causation
Divine retribution
Demonology/evil spirits

Question 2

What was the predominant theory of dz causation by the 600s BCE?

Answer 2

Environmental theory

Question 3

Describe the components of environmental theory of dz causation.

Answer 3

Dz caused naturally by environmental factors
Correlations between geographical and meteorological conditions and health
Miasmas- poisonous vapors

Question 4

How did Hippocrates contribute to dz causation theory in the 400s BCE?

Answer 4

Categorized illnesses and described sx
Dz caused by imbalance among vital humors (yellow bile, black bile, phlegm, blood)

Question 5

What was the dz theory of 1500s CE?

Answer 5

Early germ theory
Chemical substances transmitted by air, direct contact, fomites

Question 6

What is the theory associated with sanitary stats in the late 18th and early 19th centuries?

Answer 6

Miasma theory: poisoning by foul emanations from soil, air, and water

Question 7

Which scientists are associated with sanitary stats?

Answer 7

John Graunt (1600s)
James Lind (1700s)
William Farr (1800s)

Question 8

What theory is associated with the infectious dz era of the late 19th and early 20th centuries?

Answer 8

Germ theory: single microscopic agents related to specific dzs

Question 9

Which scientists and trials are associated with the infectious dz era?

Answer 9

John Snow (1800s)
Streptomycin TB Trials (1940s)

Question 10

What theory is associated with the chronic dz era of the mid to late 20th century?

Answer 10

Black box: exposures related to health outcomes without knowing mechanisms involved

Question 11

What scientists and trials are associated with the chronic dz era?

Answer 11

Framingham Heart Study (1940s)
Doll and Bradford Hill (1950s)
Kenneth Rothman (1970s)

Question 12

What did John Graunt do?

Answer 12

Analysis of mortality data in 1662 (Bills of Mortality)
The first person known to quantify patterns of birth, death, and dz in a large pop

Question 13

What were the Bills of Mortality?

Answer 13

A weekly count of ppl who died, conducted by parish clerks of London since 1592 to track the plague

Question 14

What did James Lind do?

Answer 14

Conducted one of the earliest experimental medical studies
1747 controlled trial of sailors showed that oranges and lemons could cure/prevent scurvy
New way of thinking about how to compare txs
“Treatise of the Scurvy” published in 1753
Navy adopted compulsory lemon juice rations on ships in 1795

Question 15

What did William Farr do?

Answer 15

He was the British Compiler of Statistical Abstracts for General Registry Office
Combined registry data (births, marriages, deaths) with census data on pop size (i.e., numerator and denominator)

Question 16

What were some of Farr’s methodological contributions?

Answer 16

Attempt to ensure collected data were accurate and complete (data quality)
Devised categorization system for the causes of death (International Classification of Dzs)
Invented the “standardized mortality rate” adjustment for making comparisons btwn grps with different age structures
Used data to draw inferences about the English pop and form hypotheses about the causes and preventions of dz

Question 17

Describe John Snow’s role in the 1st cholera epidemic

Answer 17

Epidemic #1: 1831
-Medical apprentice

Question 18

Describe John Snow’s role in the 2nd large cholera epidemic

Answer 18

Epidemic #2: 1848
-Investigated cholera victims to track progress of dz and determine how it spread
-Developed a theory that cholera was spread through contaminated water (1849 pamphlet)

Question 19

Describe John Snow’s role in the 3rd large cholera epidemic

Answer 19

Epidemic #3: 1854
-Broad St OB investigation and water company analysis (1855 pamphlet)

Question 20

How did John Snow track the cholera epidemics?

Answer 20

He went and physically mapped cases through surveys, figuring out who died in each HH and what their water source was.
Snow superimposed his maps showing death locations with maps of public water supplies and was able to find an area where the deaths clustered near a water pump on the city’s Broad St.

Question 21

John Snow’s research eventually became part of what field?

Answer 21

Disease diffusion mapping

Question 22

What is dz diffusion mapping?

Answer 22

An area of study that claims that a dz starts from a central source and spreads according to the patterns and conditions of the environment

Question 23

John Snow’s experiment during the 1854 epidemic was one of the first uses of _______.

Answer 23

analytic epidemiology

Question 24

What type of study method did John Snow use?

Answer 24

Observational study

Question 25

In the 20th century, what caused dramatic decreases in deaths d/t infectious dz?

Answer 25

Combination of sanitary stats and germ theory
This was even before we had txs for the dzs