HIST 123 Quiz 3 Flashcards

Question

What is/was Cholera?

Answer 1

- Vibrio cholera (bacteria) ingested through contaminated water or seafood, propelled into host’s intestinal lining. - Secrete a toxin that ruptures the bonds between cells - Cells empty salts and water into the gut - Heavy vomiting and watery diarrhea - Unless fluids and salts are replenished → death from dehydration - Effective way of spreading bacteria to others → if these secretions get into water that other’s consume → easy spread - Can see it pop up during war → harder to get clean water for treatment Live on their own or in association with plankton - Flourish in estuaries → where salt and fresh water mix - once good conditions arise → flourishing of this bacteria → likely to spread to humans

Answer 2

- Vibrio cholera (bacteria) ingested through contaminated water or seafood, propelled into host’s intestinal lining.

Answer 3

- Vibrio cholera (bacteria) ingested through contaminated water or seafood, propelled into host’s intestinal lining. - Secrete a toxin that ruptures the bonds between cells - Cells empty salts and water into the gut - Heavy vomiting and watery diarrhea - Unless fluids and salts are replenished → death from dehydration - Effective way of spreading bacteria to others → if these secretions get into water that other’s consume → easy spread - Can see it pop up during war → harder to get clean water for treatment

Answer 4

1. 1817-24: Began near Kolkata, spread through much of Asia including China and Japan 2. 1829-37: Spread from India to Asia, Europe and the Americas 3. 1846-60: Spread globally, most deadly pandemic - Worst outbreak in London’s history (over 14,000 deaths) 4. 1863-75: Spread to Europe, Africa, North America. - Indian Muslim pilgrims visiting Mecca spread it to the Middle East (30,000 of 90,000 pilgrims died) 5. 1881-96: Spread through Asia, Africa, South America and parts of France and Germany. Kept out of Britain and US. 6. 1899-1923: Killed more than 800,000 in Indian before moving into the Middle East, northern Africa, Russia and parts of Europe.

Answer 5

1846-60: Spread globally, most deadly pandemic - Worst outbreak in London’s history (over 14,000 deaths)

Answer 6

- During pandemics would impose quarantines and enforce isolation - Obstruct bodies, wash ans fumigate - But not necessarily that effective because the pathogen travelled by water. - SEE IMAGES - Quarantines at this time required ppl be washed regularly and their clothings and belongings be fumigated → not super helpful → ppl can be infected with cholera before they started showing signs

Answer 7

- Medieval European cities with > 100,000 people - Paris, Venice, Naples, Genoa, Milan - Between 1500-1700 add to these five: - Antwerp, Amsterdam, Rome, Palermo, Seville, Lisbon, Madrid, Messina, Marseilles, Vienna, London - Number of smaller cities also multiplied - Urban densities - London 1799 denser than Manhattan 1990 - London’s population in 1840 ~2 million - Led to development of slums: - live in muck and filth - No priviz → places where you dispose of filth → lack of management of human waste - Sewers before 19th c were about controlling surface waters - 19th night soil men who took the filth from the pits and took it out of the city - Cesspools → liquid waste - 1820 → volume of liquid waste started to increase → sometimes cesspools would overflow → starts to omit odours - If you have more people producing waste, need more water for people to eat → more wells dug → proximity of wells to cesspools → source of contamination - More of a problem if it was liquid wast ethan solid waste - >more opportunity for contamination - Between 1815-1830 condition of Thames deteriorated rapidly → putting waste into the Thames

Answer 8

- 1870s → came up with a way to test water for sewage - Tested wells - ones that people liked the taste best were most contaminated - Before 1840s water companies rarely filtered water before distribution → even systems at this point were not great - Water was polluted in the early 19th c. - Can see why cholera could them appear in these explosive epidemics in the 19th c.

Answer 9

- published report on cholera in 1848-1849 - Used statistics from British cities - Believed that cholera was spread through miasmas → poisonous air that hovered over cities - Believed airs at sea level were more dangerous than those at higher elevations → strongly believed elevation was a big factor → lower areas is usually where more poverty/people lived in poverty - Contagion-contingent theory - Well-received at the time → offered coherent understanding

Answer 10

surgeon, - apothecary, physician (1813-1858) - Didn’t buy into Farr’s theory - Known for contributions to science of anaesthesia - Cholorform to Queen Victoria during birth as anesthetic - Interested in cholera because to him, clearly not a gas - argued it was the bad water quality → - One of the earliest modern epidemiologists - used mortality reports that the city was producing, and gathered info from the companies that were supplying the city with water in different neighbourhoods, asked ppl sick with cholera where they were getting their water from - 1850s second cholera pandemic in Soho where he lived → went from place to place still doing his research - determined the source of cholera was a pump on Broad street were people took their water from - cases concentrated around this particular pump - 1855 published his work with the map and showed the connections between high cholera mortality and different water suppliers in the city of London → one company had 8x the rates of cholera than those getting their water form other companies → connection between water and cholera - More ppl believed Farr’s contingent-contagion than the water theory/epidemiological theory

Answer 11

- Snow’s findings emphasizing the role of contaminated water during 1854 epidemic were not universally accepted - Some argued outbreak already on the wane when pump handle removed - Snow died in 1858, before bacteria identified and the accuracy of his insights proven. - Retroactively seen as correct.

Answer 12

- Phthisis/tuberculosis is way higher than others - It is consistently high - Tuberculosis was the major 19th c. killer - Was not an epidemic → just like a wall of disease - Tuberculosis is an ancient disease - Hypocrates → “consumption” → but consumption meant a wasting disease, so cases of cancer were also causes of consumption as well → but cancer was relatively uncommon and tuberculosis was quite common so can most the time write them as tuberculosis

Answer 13

- Phthisis = pulmonary TB - Can infect any organs - (glands - scrofula/king’s evil; blood - miliary TB; bones, brain, etc.) - Mycobacterium tuberculosis - Mycobacterium bovis - introduced in the Americas → spread from cattle to bison - majority of cases of human cases are caused by mycobacterium TB - if humans get mycobacterium bovis → usually from contaminated milk or meat of a contaminated animal → Both cause TB disease in humans. → And related to Mycobacterium leprae which causes leprosy. → similiarity to cancer in that it is not an organ-specific disease

Answer 14

- M. tuberculosis (myobacterium TB) responsible for 98% of pulmonary TB cases and 70% of non-pulmonary TB - 3 routes of transmission - Infection usually airborne. - Dust, spit, droplets in the air - Crowded conditions and poor ventilation are key to spread of TB - Understood as a disease of poverty, in part due to crowded, poorly ventilated conditions.

Answer 15

- Acute or latent - Periods of remission - Causative germ lodges in the body - Bodies immune system begins to react - A tubercule gets walled off → immune system causes it to be enclosed - Immune response - Walled off “tubercule” contains the bacillus and prevents further spread - Person will test positive for tuberculin test (developed in 1908) - didn’t necessarily have active tuberculosis → weren’t necessary actively sick with the disease at that time - the disease might never become active in their body → may stay latent → still healthy - In some ppl, disease would become active - Factors that affected this depended on person’s immune system and genetic factors - Often find active cases clustered in families - Would also see ppl who have weakened immune systems developing active TB disease (impoverished ppl) - But no clinical symptoms of disease.

Answer 16

- In England, epidemic waves of TB began in the 16th c. and peaked around 1780 - At the time estimated 20% of all deaths due to ‘consumption’. - Declined in late 19th century, but even after 1900, remained a leading cause of death in Western Europe. - 1944-45: development of effective antibiotics. - so could be treated by antibiotics bc it was a bacteria. - Persists into the modern world - Actually huge as a cause of mortality globally - Concentrate in subservent Africa → due to HIV and synergistic effects with TB → weakens immune system → susceptible to TB - Some forms of TB have developed antibiotic resistance

Answer 17

- Shortness of breath, phlegm and spit with blood in it, ppl would become very pale - Was a belief at the time that TB was hereditary → but was really that vulnerability has a genetic pattern to it - Growing understanding that there might be contagion involved.

Answer 18

- Benjamin Marten in 1772 proposed “an animalcule or their seed” transmitted by the “Breath [a consumptive] emits from his Lungs that may be caught by a sound Person.” - Others saw lesions as a form of irritation, caused by improper food or ingested matter, or muscular or nervous exhaustion. - Dissections showed lesions on the lungs - Hereditary, contagion, irritation of tissue.

Answer 19

- TB tie to culture - started to associate it with upper society even tho the vast majority of victims of TB were poor (later acknowledge in 19th and 20th c.) - Whitening powders replaced rouge - Emaciated look fashionable for men - Thin, pale women in pre-Raphaelite art - Consumptions and love connected in poetry and literature - John Keats → contributed to fashionable imagery of TB - Aesthetic value: pale skin, red cheeks → from TB infection - TB became connected to ppl’s character - Idea that it was sth about the person’s personality that was contributing to the progression of their sickness as well -> bc it has not expressed itself, passion moves inward, striking and blighting the deepest cellular recesses (Susan Sontag)

Answer 20

- In many part of the world including places that had urbanized and industrialized relatively early (eg. Western Europe). TB disease on decline in late 19th c. - Shift away from previous romanticization - Rise of new treatments, eg. sanatoria - Mountain destinations around hot spring s→ clean air, health benefits - Elsewhere, TB disease on the rise particularly among poorer populations and Indigenous populations in the Americas - Extirpation of the bison - Undermined the food security and health of indigenous plains populations - Indigenous ppl pushed on to reserves - Western agricultural settlement and treats - Cows and plows settlements → gov’t agreed to give Indigenous ppls supports to transition to agriculture but didn;t actually give them support - late recgonition that the gov’t owes them - Confined to reserves - Small, often poor land for agriculture - Not given supports to shift to agriculture

Answer 21

- Arrived in fur trade from both east and western Canada - Dominant Mycobacterium tb lineage in west shared with French Canadians - Also widespread among Russian fur traders in Alaska - Reports of consumption and scrofula - Became much more widespread and serious in 20th c. why? - Residential schools - Peter H. Bryce - Gov’t health officer responsible for western Indigenous peoples health - Advocated for government intervention in residential schools where TB was widespread - Indicated FIle Hills colony residential school → 60% of alumni had died from TB due to poor conditions and lack of sanitation in the schools → gov’t was directly responsible for such conditions - Gov’t ignored the recommendations - Published the story of a National Crime when he retired - Gov’t didn't want to spend the many and get the resources to make the schools healthy places - Disproportionate amount of deaths from Indigenous kids in residential schools -> - TB rampant in residential schools - >aggravated by malnutrition and milk from cows that have bovine TB - Indigenous ppl thought to be more prone to TB and that their schools were healthier than their homes

Answer 22

Government health officer responsible for Western Indigenous peoples - Advocated for government intervention in residential schools where TB was widespread.

Answer 23

- Graves found at residential schools and significance of disease as a cause of death. - Schools reproduced the worst of urban environments - Combined with failures of care and inadequate medical assistance: - Racist ideas about Indigenous health. - Costs of proper health care, adequate diets, and refusal to pay. → Ages 0-9 and 10-20 mostly died → family might lose all their children to this disease.

Answer 24

- Shift in attention to improving sanitation in the 19th c. - Cities better constructed in 14th c than wooden construction in 19th century - and in 14th c. better water supply - New problems in 19th c of deterioration

Answer 25

Problem of Overpopulation - Dramatic growth of population in cities during 19th c. - Eg. NY exploded in terms of population - Due to accelerated industrialization - Dramatic population growth → overcrowding - building buildings quickly → bad quality - Cows, horses, chickens also part of the urban environment in early industrialization of cities - Horses important for mechanical power and work - Horses produced a lot of waste - Left pounds of manure on the street everyday - Disgusting streets had effect on public health - Other kinds of waste also accumulated in cities - Piles of waste in the road - overflowing garbages - End of 19th c. → end of street manure → flushing waste into cesspools - Cesspools were not well-designed: often leaked into surrounding soil, even when they were cleaned there could be leakage - some cleaned only once a year - Sewers at the time were really large tunnels designed to be really large in part for maintenance. - Designed originally to pull water out of the city - Only once waste started getting flushed into the sewers, that it became their purpose. - Sewers became places for the city to flush their waste - 19th c human waste and waste from slaughterhouses flushed into rivers\

Answer 26

- Rene Villerme (1782-1863) - France, le parti d’hygiene - used outbreak of cholera in Paris to show statistical relations to cholera, mortality and poverty → poor living conditions contributing to disease - Lemuel Shattuck (1793-1859) - USA (Boston), 1841 publication of vital statisics of Boston - showed connections between declining health and deteriorating urban environment - but also moral connection → decline in living conditions leading to decline in moral value - public health and sanitary reform to control human behaviour - Edwin Chadwick (1800-1890) - English social reform - he wondered if it might not be cheaper in the long run to improve ppl’s health through sanitation instead of just trying to deal with epidemic disasters as they came (preventitive measures) - Followed philosopher Jermey Bentham - said disease was due to bad air

Answer 27

- Disease due to bad air with harmful particles in it - If places smell bad and the air is poor, these are places that have poor health - Health of rural areas compared to sickness of cities - Obsessed with how to solve the problem of filth and bad ventilation → thought it greater than the loss of death from wounds - Born in a farmhouse where washed all over everyday - A key to a clean society was wash everyday and provision of integrated water system for towns - Prevention of disease becomes a sort of technological problem and technological solution to social problems - Engineers in part responsible for disease prevention

Answer 28

- Prevention of disease as the responsibility of engineers - Fresh supply of piped water to every house - Use hydraulic force to push wastes and sewage along - smaller pipes too → so it didn’t just sit in pools - Needed government intervention - Property rights - Overlapping authorities - Chadwick recommended single local authority under central government expert guidelines - 1848 Public Health Act and Central Board of Health - compelled ppl to service their sewers and cesspools - raise taxes to pay for this - Emphasis in sewer systems reflected concept of miasmatic diseases - Emphasized era more than water but with snows work, there was an integration that polluted air was part of this too

Answer 29

- John Simon (1816-1904) - Surgeon and pathologist - Medical Officer of Health for London - Florence Nightingale (1820-1910) - Famous for reorganizing military nursing services during the Crimean War (1854-56) - Sanitary reform in British army and in India - Advocate for sanitary reform - But opposed to Germ Theory → thought dirt was causing disease - New emphasis on new practices, new sanitation - Sanitary transformation of urban environments (water-and-sewer construction) - Not just engineering / technical achievement - Cultural shift - New personal habits and behaviour - Hand washing - Preparation of foods - in a cleanly fashion - Pasteurization of milk - Spitting prohibited - “Cleanliness is next to Godliness”

Answer 30

- Caused by bacilli *Salmonella typhi* - Not to be confused with typhus caused by Rickettsia organisms - Name came from similarity to typhus “resembling typhus” but identified as distinct in the late 1820s. - Clincal characteristics laid out by William jenner, physician to the London Fever Hospital in 1849 - Sometimes called “the filth disease” - connecting to idea of miasmas - by 1870s → typhoid as an interic fever (relating to intestines) - Sustained fever, stomach pain, diarrhea or constipation, loss of appetite, lethargy, can develop a rash - Death (if untreated, up to 30% of infections; coudl be treated tho bc of antibiotics and it was casued by bacteria) - Sustained fever — lead to cerebral complications - Pneumonia - Intestinal bleeding or perforation — lead to death.

Answer 31

- 3 chief means of transmission of the bacteria responsible: - Water (wells), food, or human carrier - image of typhoid fever bacteria - human carriers were healthy carriers in particular - Different incubation periods - Water, 18 days up to 3 weeks (before sb gets sick) - Food-borne, up to 9 days; as little as 34 hours - contaminated salads, canned goods, milk.

Answer 32

- Most serious form and attracted the most attention - Ensuring clean water supplies in the late 19th c. → started to see effective dealing in typhoid → decreased death rate of typhoid in American cities - Deaths peaked in 1870 in Toronto - Improved water filtration had substantial health effect - Water filtration systems were recognized as chief achievements of modernity and progress - also made them elaborate buildings themselves → represent positives of modern urban industrial society and having conquered sanitation

Answer 33

(people weren’t calling it that at the time) - 1860s - idea that cholera was caused by a ‘germ’ - But could a tiny organism cause something as awful as cholera? - Ideas about contagion were very old - recognized as somewhat different from germs - And even ideas about germs had been around for a while - Many sanitationists opposed germ theory which they thought was too simplistic - little bigs spreading disease → seen as too simplistic - Won over many converts between 1870-1885 - EVIDENCE OF MICROORGANISMS as causing disease started being gathered in 1830s - Eg. microorganism that causes trichinosis → roundworm - Eg. in 1835, Richard Owen and James Paget, while conducting an autopsy, observed a mass of worms lining the diaphragm of a cadaver. Led to the identification of Trichinella spiralis, the roundworm that causes trichinosis. - 1870s → microorganism in animals that causes anthrax found

Answer 34

- 19th century - Born in France - Studied crystallography at university in Paris - 1854 turned attention to fermentation (in beer and wine) - Interested in practical problems - Pasteurization (heating) to kill microogrganisms and prevent spoliage. - If you heated things (milk or other products) to the correct point to kill off unwanted microorganisms - where pastuerization came from - showed that part of what was causing problems for wine and beer makers were these microorganisms in what they were making Pasteur - Interested in vaccine development as well as identifying the causes of disease - Using these diseases to innoculate animals with anthrax or rabies to protect ppl in animal husbandry.

Answer 35

- British surgeon Joseph Lister (1827-1912) - Eg. he helped develop listerine to kill bacteria - Germs as responsible for sepsis - Infections that follow wounds and surgical openings - Beginning in 1864 experimented through trial and error with different techniques of “antisepsis” in surgery - American Civil War (1861-65) - 620,000 people did in the conflict - Many who survived lost limbs.

Answer 36

- Published in 6 volumes between 1870 and 1888 (after American civil war) - Dealing with hospital gangrene and erysipelas - Photographs that showed wounded pictures of survivors after the war with the limbs they lost and detailed description of patient’s history and how they tried to deal with it -> Each photograph was accompanied by a case history detailing where the patient was wounded, the course of treatment, result of the case and the doctor's name. - If you got gangrene or erysipelas → mortality rate of (45.6%) and 41%, respectively. - Hospital gangrene (caused by variety of bacteria, most commonly Clostridium perfringens or streptococcal bacteria) was prevalent in most 19th c. hospitals - Moved quickly among patients because they did not understand importance of antiseptic techniques and sterilization. - Destroyed tissues, blood clots would form → further bacterial infection → putrefication - Eg. similar weather and less gangrene → first instance, patients crowded together (more gangrene); second instance, patients isolated - Was probably not weather as critical factor but the factor of patients being isolated or in a clinical ward with others. - Soldiers were typically willing to participate in these experiments bc they wanted better survival and to survive their injuries.

Answer 37

- Practitioners like Lister and US army surgeons - Experimental and empirical understandings of contagion - Robert Koch (1843-1910) - Medical degree, University of Gottingen - Practiced medicine, 1876 publication on anthrax - moved quickly from anthrax to looking at other diseases > looked for other animal disease: chicken cholera, rabies - Focused on animal disease bc need to isolate an organism, grow it in a culture, inject it in another organism to find it again - Need a healthy organism to inject it into → couldn’t do this to humans → but could do this to pigs and horses.

Answer 38

- Mycobacterium leprae - Gerhard Hansen (1868) - Neisseria gonorrhoeae - Alberta Neissner (1879) - Bacteria that causes typhoid - Carl Eberth (1880) - Eberthella typhi - Salmonella enterica subspeices enterica serovar Typhimurium - Mycobacteriumm tuberculosis - Koch (1882) - Yersinia pestis - Yersin and Kitasato (1894)

Answer 39

- How to confirm whether a particular microogranism is the microorganism responsible for the disease 1. The microorganism or other pathogen must be present in all cases of the disease. 2. The pathogen can be isolated from the diseased host and grown in pure culture. 3. The pathogen from the pure culture must cause the disease when inoculated into a healthy, susceptible laboratory animal. 4. The pathogen must be re-isolated from the new host and shown to be the same as the originally inoculated pathogen.

Answer 40

- Sociologist of science - argued laboratory science had to be translated (in part through experimental performance) into public knowledge. - Was a process of new knowledge coming out of the lab and then translation into public knowledge as well

Answer 41

- Mutually reinforcing - part of what is in the water and in the air, is this bacteria. - Germ theory: reinforces idea of disease as external, independent of humans - (Going back to Thomas Sydenham’s ideas of disease as having natural histories) - Still some hold outs: eg. Florence Nightingale - Disease is an adjective (the diseased body) not a noun (the disease) - did not believe disease as things that are out there

Answer 42

definition — the branch of medicine which deals with the incidence, distribution, and possible control of disease and other factors relating to health. - Established as a separate branch of medical science by end of 19th c. - Collection of data about individual health and assertion of control over individual bodies - Privacy and autonomy: case of Typhoid Mary

Answer 43

- Food borne, incubation period can be up to 9 days; as little as 24 hours. - Contaminated shellfish, salads, canned goods, milk. - Related to (but not the same as) the bacteria that causes salmonella food poisoning - Health or chronic carriers: ~2% of victims of acute typhoid become chronic carriers. - Can carry it but not become sick with it

Answer 44

- Born Mary Mallon in Ireland, 1869. - Emigrated to US in 1884, found work as a domestic servant - Summer 1906, typhoid outbreak in the household where she was employed (6 family members fell sick with it) - Family hired George Soper to trace the source of the outbreak - George A. Soper (1870-1948) sanitary engineer - He went through her work history → she went in to 8 families, cooked → left before they showed symptoms and went to a different household → then the families would fall sick - got physicians and police to bring in Mary for testing → stool tested positive for typhoid - She was taken to a ward → confined for 2 years → continually spread it to others - She eventually got out → promised she wouldn’t touch food → didn’t get paid as well in laundry → went back to cooking in a maternity hospital (also changed her name) → people started falling ill again. - She was re-arrested, confined in a cottage where she would live out the rest of her life. (23 years) - Not everyone supported her being quarantined → personal freedom issue - And she didn’t understand how she could spread disease to people when she was healthy.

Answer 45

- Those who recovered from illness, but continued to carry typhoid bacteria and were infectious. - Up to 2% of those infected with typhoid in this period became chronic carriers. - By 1938, New York City had registered hundreds of chronic carriers - Mary Mallon was the only one quarantined for life - also may be due to her low status as an Irish immigrant → Problem now is increasing antibiotic resistance to typhoid

Answer 46

- Third plague began in Yunnan region in China (multiple outbreaks since 1772) and really turned to a plague pandemic in 1894/95 - 2 reservoirs: - 2 creatures in which plague was endemic - The red-backed vole and - yellow breasted rat - Vector - flea - exenopsylla cheopsis - Contact between a hunter or trapped could lead to infection (not in urban areas) - Someone infected with plague, wouldn’t necessarily start a pandemic → might just die and that was that. - Danger to humans was never really far away.

Answer 47

- As the name suggests, ongoing history of plague. - New bacteriological understanding applied to this pandemic - Illuminates some of scientific competition at the time. - Important example of intersection between history of disease and western imperialism. - Important moment in the history of understanding of plague

Answer 48

- 2 reservoirs: - 2 creatures in which plague was endemic - The red-backed vole and - yellow breasted rat - Vector - flea - exenopsylla cheopsis - Contact between a hunter or trapped could lead to infection (not in urban areas) - Someone infected with plague, wouldn’t necessarily start a pandemic → might just die and that was that. - Danger to humans was never really far away.

Answer 49

- Bubonic plague existed in Yunan in 16th-17th c. - they distinguish between yi (epidemic) in major epidemic (da yi) but do not distinguish what these epidemics were - Carol Benedict argued that most of these epidemics were most likely plague, bc these were areas where you had endemic reservoirs of these diseases - Mining activity, rat population growth → lead to epidemic → rise and fall of mining activity accordingly with increased rat population - As more and more traders passed through Yunnan, more people came into contact with plague-infested fleas → take disease back to a city or town - Rise of opium trade (mid 18th-19th c) lead to further spread of disease in the world - Opium produced in Yunnan → transported by river and land to Guangzhou → centre for trade - Spread outward, as well as into the region - eg. cholera from India into China - but plague spread outward - Beginning 1894 → spread of plague from Yunnan to Guangzhou and from there, spread globally. - Rise of fast moving steamships also a factor - By 1880s, have steamships replaced junks (vessels that moved goods along the Chinese coast)

Answer 50

- Hong Kong and Guangzhou - 1894 - Guangzhou: 40,000 people died of plague in 4 months (equivalent to 2.5% of population) - Hong Kong: 12,000 deaths (equivalent to 9.6% of population) - India - 1896-1908 - 6 million deaths (equivalent to 3.33% of population) - New Plague Reservoirs - Seeded in Madagascar and the US - (southern African reservoirs most likely date from 2nd plague pandemic) - Now: almost every other year in Madagascar, there is death from plague - due to suboptimal healthcare system - need to get treated right away by antibiotics or else it will cause enough damage that even if you get treated, you’ll die. - By 1899 plague had spread out of China to Honolulu, Glasgow, San Francisco - Plague linked to race → Chinatown in San Francisco → barbed wire to keep people from getting out and in - Chinese ppl as more susceptible to disease - But really, steamship routes played a huge role → carrying the disease everywhere and quickly - Plague reached Japan in 1899 - Japan had not been previously affected by plague

Answer 51

- When the plague bacteria, Yersinia pestis, was identified - Alexandre Yersin and Shibasaburo Kitasato - Kitasato had spent time in Koch’s labs in Berlin and had discovered the bacteria causing tentnus ?? in 17th c. - Both sent to Hong Kong to do research on 3rd plague pandemic - Both had portable lab supplies - Kitasato got there a few days before Yersin and got complete access to bodies of plague victims to work on it - Both men found bacteria that they designated the cause of disease - Yersin’s research more accurate → used buboes - Kitasato used blood - Yersin names the bacteria Pasteurella pestis (named by Yersin in honour of Louis Pasteur and the Pasteur Institute) - Yersina pestis (renamed in 1944 in recognition of A. yersin)

Answer 52

- 3rd plague pandemic (late 19th c.) - Role of Western imperialism in shaping pandemics - Sanitation and Vaccination - Interventionist state medicine - British Crown ruled in India (1858-1947) - From 1870s established sanitation departments - And separate vaccination department - Plague arrived in Mumbai (Bombay) in Aug/Sept 1896. - Killed an estimated 180,000 people in Bombay before 1914 and acorss sub-continent more than 10 million by 1921 - International conference pushed for quarantine - Aggressive response from colonial authorities - First Englishman to get the plague, was a plague photographer himself - Segregation camps → plague victims sent - If plague was seen to be in a household, people might have their possessions burned - Flushing Engine cleansed Infected Houses - used formeldyhyde, sulphur-based cleaning agents to clean the houses as well → good permanently damaged by these processes as well (chemical burns) - Hospitals in context of epidemics → places of coercion and control of plague victims and Indian ppl

Answer 53

- Waldemar Haffkine developed plague vaccine, used after 1901 in Punjab - Rumours: - Poison prepared by government - made with flesh of pigs and cattle - Vaccinating 500,000 people, 19 died of tetanus - didn’t use effective sterile techniques → got tetanus from the jab, and died

Answer 54

- Other tool by colonial authorities was vector control and dealing with reservoirs - Examined rats (reservois) - Found that what was most effective was getting rats out of people’s houses

Answer 55

- Vaccination, public health vector and animal control inseparably intertwined with imperialism - Fuelled mistrust and opposition to measures that were not necessarily oppressive - British actions shaped by excessive coercion, failure to recognize cultural values, and racism

Answer 56

- Before 1894, Chinese government rarely imposed public health measures during epidemics - Chinese medicine did not consider plague contagious - Sino-Japanese War (1894-5) - Chinese reformed public health to include level of policing - Applied during pneumonic plague outbreak in Manchuria (1910-11) - Tarbagan, Siberian marmot host for pneumonic plague

Answer 57

Wu Lien-teh (1879-1960) - Led response to plague outbreak in Harbin - Got Russians outside of Manchuria to stop sending in trains to stop spread - He believed spread was through the breath → which was correct → encouraged people to wear masks - Pushed masking as an essential for stopping spread of plague - Mask-wearing as a sign of modernity

Answer 58

- New expertise: bacteriological revolution of late 19th century and rise of germ theory - New tools: sanitation, public health (fumigation (chemical control), masking) alongside older practices of quarantine and isolation. - New therapies: vaccines - Attention to power dynamics that overlapped with new medical interventions.

Answer 59

- *New expertise:* microbiologists, chemists, epidemiologists, engineers. medical entomologists - *New tools*: fumigation, disinfection, masking, new laws and powers alongside older practices of quarantine and isolation. - *New therapies*: vaccines, serums, antitoxins - actual plans of how to deal with pathogens and what they do to the body. - Attention to power dynamics that overlapped with new interventions.

Answer 60

- Symptoms: high fever, muscle pains, headache, nausea and dizziness. - Last 3-4 days, then disappear - If recur, followed by jaundice (”yellow fever”) and internal hemorrhage - Victims ooze blood through nose and ears, suffer delirium, and vomit up partly coagulated blood (”black vomit”) - Onset of symptoms to death ~2 weeks - Young healthy adults at prime risk because of immune reaction. - strong immune reaction to the virus caused death in young people - Populations who lived outside the yellow fever belt were most likely to fall ill because of no previous exposure; while those who lived in the Yellow Fever belt were better off. Eg. Spanish were able to take advantage of this to fight off British aggression.

Answer 61

- Sanitation and disease control not just about public health but also about imperial control. - Canals provided much shorter routes from place to place. - Eg. Suez canal from Mediterranian to Europe - eg. Panama canal shorter trade routes from South America to North America. - Originally, it was France that wanted to undertake the construction of the Panama Canal - Canals involved large scale digging → beset by some engineering challenges and by disease - Eg. Typhoid bc of poor sanitary conditions, Yellow Fever because many of the officials involved in directing the project and some of the workers were brought in from Europe → disproportionately got and died from Yellow Fever. - America took it over → the first mountain to overtake was that of Yellow Fever/Yellow Jack - American’s implemented a sanitary campaign in the panama canal zone - Medical entomology - The branch of science that deals with insects that cause disease or that serve as vectors of organisms that cause disease in humans. - Late 19th c. medical specialization - Focus in Panama on Aedes aegypti involved cooperation of sanitarians and entomology.

Answer 62

- (1851-1902) US Army physician - US bacteriologist and professor at Army Medical School - Spanish-American War investigation of typhoid fever - 1899 appointed head of Yellow Fever Commission in Cuba - 1900 confirmed that *Aedes aegypti* was vector for yellow fever. - Reed and other researchers who were working on this in Cuba and elsewhere were also the ones to establish the habits of aedes agypti - Once infected, Aedes aegypti needs to incubate the Yellow Fever virus for more than a week before it will infect someone new - Very fussy mosquito about habitat and feeding practices - Relatively easier to control a vector than the disease itself.

Answer 63

1. Report and quarantine active cases 2. Screens - on windows → so during quarantine a mosquito can’t travel between you and a healthy person 3. Limit breeding sites - find out where they’re breeding and get rid/control the larvae 4. Fumigation - Kill the adult mosquitoes

Answer 64

- Panama City and Christobal - Sanitarians worked with entomologists to better understand mosquito breeding habits, identify larvae, and then scoured urban areas to find them - US had sole authority in the Canal Zone but terminal cities - Colon and Panama - shared authority with Republic of Panama.

Answer 65

- The branch of science that deals with insects that cause disease or that serve as vectors of organisms that cause disease in humans. - Late 19th c. medical specialization - Focus in Panama on Aedes aegypti involved cooperation of sanitarians and entomology.

Answer 66

- Cleaning up trash (especially that that could hold liquid) - Americans didn’t want to build an entire water and sewer structure - Dealt mainly with the established patterns of water collection - Normally, there would be large barrels beside the house and rainwater would go through the gutters and directly into the barrels - People would use Tinajas or ceramic vessels to collect water from barrels or cisterns and then store in homes. - Ideal for Aedes aegypti (ideal texture) - These provided ideal breeding grounds for larvae and were a target for US sanitary reforms. - People would use a spoon to scoop water out, so there was always a little bit of water left in the barrels for mosquitoes. - Implemented practices: screens put on the top of the barrels so water could pour on but mosquitoes could not get in - and put a tap in the bottom - Told locals the Tinajas had to be regularly washed and rinsed → found resistance from locals who were already immune to Yellow Fever and who found it a waste of water - Sanitary inspectors would go to houses to see how locals used Tinajas and locals would refuse to cooperate and hide them. - Americans also started to build sewers. - Also implemented fumigation: using sulphur powders and pythrum to fumigate the houses infected - Sanitary measures went against efforts at water conservation - Fumigation damaged property and homes → so people would refuse to leave; and some would complain about damage after fumigation - These efforts were to protect the not local panamians and not the locals themselves - Americans recognized that effort was intended primarily to protect Americans and backed support from US

Answer 67

- Walter Reed Commission → Significant finding: Showed that the agent the causes Yellow Fever passed thorough bacteria-proof filters. - Took more time before identified (and persuaded others) about the role of a virus. - Until the 1930s, the way they confirmed whether a virus was presented was by preparing a serum that has an agent in it → then pass it through a filter that is to small to pass any bacteria through it → if it has passed through the filter and there is something in it that is causing a disease that is called a filter-virus/invisible virus - Couldn’t see it but knew there was something still causing illness. - Vector control is about prevention.

Answer 68

- Specific treatments: - Serums, antitoxins - Bacteriostatic agents including sulpha drugs - Antibiotics

Answer 69

- Bacteria produce a toxin → responsible for some or all of disease symptoms - Eg. Scarlet Fever, diphtheria - Antitoxins: antibodies that can neutralize the specific toxin that caused the disease. - Serum therapy: use blood products from animals to treat human disease.

Answer 70

- Caused by bacteria: Corynebacterium diphtheriae - Produces a toxin with pathological effects - Symptoms: weakness, sore throat, fever, swollen glands - Pseudomembrane → covers inside of nose, voicebox, throat, making it hard to swallow → the tissues - “Strangling Angel of Children” → choked/strangled children from the inside bc they had smaller throats, noses, etc. - Organ damage when enters blood stream. - 19th c: 5-10% case mortality - Could be as high as 20% in children under 5 and adults over 40 - Medical reports of deadly “strangulation” first apper in 17th c. - Airborne disease. - Late 1880s, identified the bacteria that caused diphtheria

Answer 71

- Kitasato and Emil Von Behring discovered that there is a toxin produced by the bacteria. - Injected the toxin into animals (guinea pigs) and realized they could evoke an immune response from the animal and use the blood product from the guinea pigs that could be used to fight the toxin in an animal that was a already sick. - Could use serum from an immunized animal to treat diphtheria - Kitasato treated a child on Christmas day with this method. Emil Von Behring (1854-1917) - Conducted successful experiment with antitoxin in 1891 - Needed precise qualification and standardization protocol - Developed by Paul Ehrlich - To concentrate antitoxins and see consistent success - Antitoxin manufactured using horses, including at the Connaught Laboratories’ “Farm” - because guinea pigs were not enough to produce these blood products - now start to see animals as being employed to study diseases and to manufacture therapies and vaccines. - Would inject the serum into people → would attack the toxin in your body and be cured. - Less concern than vaccines → bc vaccines were injecting people before they got sick; with antitoxins you inject it into a person who is already sick and might die, so less resistance. - With primates, you can get diseases mixed into medical products that are then injected to humans, but not from horses (bc they’re not primates)

Answer 72

- Conducted successful experiment with antitoxin in 1891 - Needed precise qualification and standardization protocol - Developed by Paul Ehrlich - To concentrate antitoxins and see consistent success - Antitoxin manufactured using horses, including at the Connaught Laboratories’ “Farm” - because guinea pigs were not enough to produce these blood products - now start to see animals as being employed to study diseases and to manufacture therapies and vaccines. - Would inject the serum into people → would attack the toxin in your body and be cured. - Less concern than vaccines → bc vaccines were injecting people before they got sick; with antitoxins you inject it into a person who is already sick and might die, so less resistance. - With primates, you can get diseases mixed into medical products that are then injected to humans, but not from horses (bc they’re not primates)

Answer 73

- Now that you have cures, you start to get stories about rescuing and curing people at distance. - Wide reach of bacteriological revolution - 1925 in Alaska → breakout in Nome - Antitoxin was in Anchorage and they had to get it from Anchorage to Nome - Got it as far as they could by rail and then sent it the rest of the way through dogsled in relay - Balto!! Slay!! → he was the musher dog for the last leg of the journey to Nome. - Wop May and Vic Horner agreed to take the antitoxin in an open cockpit to Vermillion and got it there in time and saved ppl’s lives. - When they returned to Edmonton, 10,000 people greeted them to celebrate theri success.

Answer 74

- Places that were at a distance from laboratories and sites of medical manufacturing / production did not fully benefit from new cures and therapies. - Need for “mercy flights” and dog relays used to show reach of new technologies, but also showed limitations of health care infrastructure.

Answer 75

- Diphtheria remained a serious disease and leading cause of death for children under 14 into the 1920s. - Preventative toxoid (vaccine that produced immunity to the toxin) developed in 1924 and released for use in Canada in 1926 - Rendered diphtheria obsolete in the 1920s. - Diphtheria-toxoid vaccine still part of combination vaccines recommended for infants. - No all serums were successful... -> Ampoule, of typhoid serum by Laboratorie de Serotherapie de l'Armee, French, 1915.

Answer 76

- Sulphonamides or Sulpha drugs - First produced by Gerhard Domagk in 1935 - From experimenters with chemical dyestuffs - lead to antibiotics - chemical dyestuffs most effective - “Prontosil red” - protected mice from streptococci. - Prontosil was the first commercial sulphonamide antibacterial, available from 1935 onwards. - Inhibited multiplication of parasitic microorganisms.

Answer 77

- Asthmas and silicosis suffered by miners, potters - Necrosis (”phossy jaw”) and match manufacturing - Bleach workers exposed to chlorine - Rubber workers exposed to naphtha - Widespread industrial use of poisonous lead and arsenic

Answer 78

- 1858 - 1906 - Reports of industrial workers suffering from jaw necrosis - Red inflammation in the jaw → the jaw would overtime get a worm-eaten appearance - sometimes like a punic stone with smaller holes - progresive deterioration - often required surgical intervention → had jaws surgically removed - many people who suffered from it committed suicide - but disease itself had 20% mortality rate - By 1900s it was clear it was linked to match factories - “Strike anywhere” matches - Used yellow phosphorous - Factory workers (mixers, dippers, boxers) exposed to heated fumes of the phosphorous was dependent on how much time they spent exposed to the fumes - Yellow phosphorous matches banned in Finland and Denmark (1872 and 1874) - James Barker, founder of Salvation Army, - Led activist campaign to improve working conditions for working poor - advocated for improved living and working conditions - focused specifically on dangers of match industry → took people to see people who suffered from phossy jaw → turn out the lights → the exposed bone in the jaw would glow from inhaling of the phosphorous fumes - 1906 Berne Convention banned strike-anywhere matches - 1903s use declined in USA

Answer 79

- comes from inhaling silica particles - Results from inhaling silica particles - Silicon most common element in the earth’s crust after oxygen - Industrial technologies greatly increased amounts of dust produced in mining - Inhaled by miners, etc. caused lung damage → degenerative lung disease - Overtime - if ppl had tuberculosis it made it worse, but hard to say which one it was - contributed to TB - ambiguous symptoms - Concern as public health issue in US peaked in 1930s.

Answer 80

An example of silicosis. - Used dry blasting techniques to blast a hole in the mountain without any protection - Of the 2,900 men that worked inside the tunnel, 764 died very soon after their work in the tunnel -> Of these men, silicosis claimed the lives of at least 764 workers. -> greatest death toll ever from silicosis in the US - Silicosis but was called tunnelitus - Predominantly African American workers who faced the health consequences - Was more immediate and direct so attracted more attention to silicosis - Resulted in increased protective measures - But there was a lot of resistance to these protections bc it costed money → but this incident made the need for protection much clearer.

Answer 81

FLINT MICHIGAN - Lead in pipes → when they changed the source of the water, the lead became more active/elevated lead in water - In kids, it is bad causes impaired intelligence (bc it severely damages the brain and central nervous system) - Acute exposure to lead: convulsions, coma, death - Lead accumulates over time in the body - Children can suffer developmental delays, damaged hearing, learning disabilities. - Lead used in many things → lead in paint resulted in these bright colours - Toys with lead paint a problem\ - Lead paint in houses a bigger problem - Lead was widely used in early 20th c. - Brightly coloured paint could be made up of up to 70% lead pigments. - Toxic effects of lead known from 19th century. - Highly competitive commercial markets - Commercial interests pushed back against the toxicity of lead → so took a long time for intervention

Answer 82

- Lead dealt with on a case-by-case basis. (individuals bore much of expense) - Governments would intervene if there was acute exposure - Lead exposure associated with children living in poverty - No effective state intervention before 1970s - Most residences painted prior to 1978 contain some lead-based paint. It was widely used on exterior woodwork, siding, and windows as well as interior finishes.

Answer 83

- Phossy jaw and silicosis as examples of occupational hazards - Lead saw wider but less acute consequences because adopted into consumer products - Posed both occupational health issues - As well as issues for consumers and wider public - What other examples can you think of? - Eg. Asbestos - Challenges is not having an immediate impact - hatters → mercury causes neurological effects → where you get “mad as a hatter” - Not as deadly as pathogens, many come from compounds of industrial production. - Many thinkers started thinking about the precautionary principle → just bc sth is new doesn’t mean we should put it into wide use, we should see how it holds up after a long time.

Answer 84

- Not as deadly as infectious pathogens. - Many came about in the context of new technologies and compounds applied to industrial production. - Novel chemicals, new uses of old substances, found their way into human bodies in many different ways: - Workplaces - Households - Wider environment

Answer 85

- When cells in a part of the body begin to grow out of control - Grow, divide, re-divide or do not die when they should. - Travel to other parts of the body (metastasis) where grow - Still named by original site - Causes are often obscure - Sometimes it develops aggressively and leads to a quick death, sometimes it is slow

Answer 86

- Surgery - Radiation therapy - Widely available after 1915 - x-ray and radium salts - filling tubes with radium salts and then applying them directly to the tumours - Chemotherapy - World War 2 testing of chemical weapons - mustard gas - Learned during testing that mustard gas could kill normal white blood cells and wondered if it could be applied to abnormal blood cells; - there are similarities of TB and cancer - both could attack almost any part of the body - could affect anyone - >young, adults, elderly - could be chronic or acute - overlaps in experience of disease → consumption could have been TB or cancer - culturally, TB and cancer - discourses of causes of TB similar to cancer - biologically very different: TB = bacterium bovis; cancer = cells with damaged DNA → most times from exposure to sth in the environment (carcinogens)

Answer 87

- there are similarities of TB and cancer - both could attack almost any part of the body - could affect anyone - >young, adults, elderly - could be chronic or acute - overlaps in experience of disease → consumption could have been TB or cancer - culturally, TB and cancer - discourses of causes of cancer similar to cancer - biologically very different: TB = bacterium bovis; cancer = cells with damaged DNA → most times from exposure to sth in the environment (carcinogens)

Answer 88

Cancer-causing substance? - Viruses and bacteria: -> Rous sarcoma virus -> Human papilloma virus (HPV), Hepatitis B -> Helicobacter pylori - Natural carcinogens -> Fungus: Aspergillus flavus (image on right): produce Aflatoxin. - Inorganic compounds -> Asbestos, cadmium, radon, benzene

Answer 89

- Men have a way higher rate of lung and bronchus cancer - For women there is a steady incline around 1965 for lung cancer - Prostate cancer a lot higher, until the end, than uterine cancer - Prostate is a good example of new screening techniques → in the 1990s was development of prostate specific antigen tests that could better detect them - Stomach cancer decline → Helicobacter pylori → spread through water → if you have better water filtration and treatment → less incidents of stomach cancer from this bacteria

Answer 90

- Annual per capita cigarette consumption - Rates of death grow steadily alongside cigarette consumption - Around 1990 the rates of consumption has fallen off before the rate of cancer has fallen off → speaks to the time delay of cancer → it doesn’t just stop developing - Also speaks to the fact that there are improved treatments that would have enabled people to survive

Answer 91

- Long history - Dates back to 17th c. - Slave people worked harvesting tobacco - What changes was the rise of cigarettes (which came about in 20th c.) - Previously there was pipe smoking and snuff → oral cancers but did not inhale the smoke - In early 20th c. they start to make cigarettes using machines - Put in a bunch of new additives that make it easier for the smoke to go into the lungs - Machine-made cigarettes used new strains of tobacco processed to produce milder smoke that could be inhaled into the lungs - Cigarettes distributed free to soldiers and many became addicted → calming qualities - New cultural view of cigarettes → was seen as a feminine thing and then they started to use marketing of soldiers smoking cigarettes to get people to buy them

Answer 92

- Strong prohibitions in Canada and the US - Women teachers could be fired if they smoked - First wave femininist pushed for fewer restrictions on women smoking - Cigarette companies played up theme of liberation and weight loss - History of marketing and advertising of ciagerette companies

Answer 93

- Risk of cigarettes known since 1950s but covered up - 4 converging lines of evidence: 1. Population studies - smokers more likely than non smokers to develop lung cancer 2. Animal testing - painted with tobacco or sth on mice → developed tumours 3. Cellular Pathology 4. Carcinogens in tobacco smoke - insiders knew cigarettes were dangerous but worked hard to conceal it - Worked actively against it - >used doctors to advertise for the health of cigarettes - Took campaigns in the West to bring about change in views and buying on cigarettes - but they are still popular around the world and have new products which are also popular

Answer 94

- Polio (polimyelitis) caused by a human enterovirus. - disease of the gut - Three serotypes (poliovirus 1,2, and 3) - Before the 19th c. polio thrived in dense human populations, most infections were asymptomatic. - ancient disease → Hieroglyphics from Egypt that have been interpreted as evidence of polio - initially young children were protected by maternal antiobodies - most children were infected with it, but most didn’t show it in the past → children would show some symptoms (fever, sore throat) - only in a small number of cases would it move into the central nervous system → causing permanent paralysis → destroy motor nervous cells → effect ability to breathe → death

Answer 95

- ~ 25% - mild poliovirus infections (but bc it was mild and symptoms non-specific, wasn’t identified) : 7-10 days incubation; fever, headache, sore threat - <1% - move into the central nervous system where it could cause permanent paralysis. - Polio was an endemic disease in human populations for centuries. - In 19th c. it moved from a hidden and universal disease to one that was less common and far more apparent - In Western Europe and North America where the sanitary transformation took place much more quickly

Answer 96

Infantile Paralysis - 19th century polio - After 1860s, a poliovirus shifted from an endmeic disease to an epidemic disease in Western Europe and North America - First US polio epidemic in Vermont in 1894 - Deaths mostly in older children and adults

Answer 97

- Early 20th century - Linked to sanitary transformation in different ways - Sanitary transformation made it hard for cholera, etc to get people - Sanitary transformation made it so people dind’t get polio as infants, but if they got polio when they were older, they were more likely to face a serious response/severe outcome - Children, particularly those in more sanitary environments, were more likely to get a serious disease and suffer paralysis and even death. - but wasn’t this understanding at the time - Before, 1950s, 1916 was a major Europe for polio epidemic

Answer 98

- July through October - Nationwide (USA) - 27,000 cases, 6,000 deaths - New York City: - 8,900 cases, 2,400 deaths - 80% of cases, children under the age of 5 - Quarantined homes, closed public spaces, regulated travel of children. - Initial response was a sanitary response - Cleaning up → washing children, disposing of waste properly - Selective quarantine was enforced → signs indicating buildings where cases had been tied to would be closed. - Movement of children became regulated → children weren’t allowed to leave or enter NYC → had to get a travel certificate proving they were polio free - Quarantine and sanitation ineffective in controlling spread - Originated in poor neighbourhood, but rural and affluent neighbourhoods saw greater impactss - Eg. Staten Island: lowest population density and best sanitary conditions of NY’s five boroughs but where epidemic was most prevalent - wealthy ppl suggested wealthy neighbourhoods were being infected by carriers from slums

Answer 99

- Son of wealthy family - Ran as VP - Was vacationing in Bay of Fundy in 1921 at 38 years old when he fell ill with some kind of sickness → chills, exhausted - Started to develop infantile paralysis (polio)→ unable to stand or walk without support - Hid his disability - Barely seen with wheelchair in public - Exceptional bc he was adult - But as a wealthy white person it was not uncommon for him to get polio in his later years

Answer 100

- March of Dimes raised funds to support care of people affected by polio and research into its prevention and treatment - Financing was essential to development of polio vaccines after World War 2 - encouraged adults and kids to donate → everybody donate a dime → would support children who were disabled due to this disease - Important trend of 20th century → financing medical research through charity

Answer 101

- When children and adults survived polio, many were left with significant disabilities. - Required medical support, treatment, assistance for the rest of their lives. - Epidemic polio = increased number of survivors who lived with disabilities - Polio epidemics became widespread across industrialized world from mid-1920s to 1950s. - From 1940s, was pretty regular that there would be a peak in polio → children kept from pools, etc. - In the 30s and 40s the idea was to keep children who had polio immobilized → was the idea that would increase the recovery of someone from the initial paralysis.

Answer 102

- Nursing sister from Australia - Advocated for physiotherapy and orthopedic treatments instead to help polio survivors recover from their disease

Answer 103

The iron lungs. - developed in1928 - Prior to the Iron Lung, people would mostly pass away if they had problems swallowing - due to paralysis of the diaphragm from polio - Exerted a push and pull motion on the chest, activating the diaphragm, breathing for the person → if you could get people through the acute phrase, then they would have a chance of survival where they could breathe on their own again. - SEE account by MArshall Barr - Had to eat timed with the breathing of the machine - Couldn’t turn or move around - Port holes on the side to do physical therapy with - Mirrors on them so ppl could see sth of the world around them - Coughing difficult - If ppl didn’t recover from the acute phase, the iron lungs could be a lifelong experience - Eg. Fred Snite Jr. - Got married and had children from the iron lung → could get off the iron lung for a while/short period of time on a portable respirator - His family was very wealthy so they were able to support his medical care - The severity and essentiality of polio epidemic brought to light the cost of medical technologies and research - Eg. formed support of publicly provided medical insurance (access to medical insurance) - Canadian prime minister Paul Martin → increased funding for healthcare

Answer 104

- First challenge with polio is that it’s caused by a virus (Which we couldn’t see until the 1930s) - Could see the characteristic changes to lesions of the spinal chord → could diagnose from these lesions - Landsteiner and Poppr identified polio was caused by “invisible” virus - Took it from a boy and put it into a monkey → monkey died → had the sdame lesions on the spine as boy - Polio is a primate disease (humans and monkeys) - Keeping poliovirus alive in a laboratory setting required continuous intracerebral passage in monkeys - Injected virus into its brain - Kill the monkey - Used the virus from the brain and injected it into other monkeys to keep it alive - Bc it had paralytic effects, people thought it was a virus of the brain → slowed research down in some ways - Logistical issues of keeping alive and breeding monkeys to use for trials - 1 Spadina Crescent → in basement they had an area where they kept the monkeys - Had to take the monkeys with them when there was an epidemic - Made it difficult to study - Costs high, understanding what was happening was complicated - Studies on environmental factors (sugar in diets, seasonality) - Epidemiology very important to the study of polo because of challenges of laboratory research - Seasonality - Nutrition (candy and sweets) - Eg. book by Sandler → “Diet Prevents Polio” → wrong → now cited by antivaxers - Vectors - Thought flies were playing a role - Students in swimming pools sprayed with DDT in the late 1940s - awareness of spraying chemical was not broadly known

Answer 105

- Successful development of tissue cultures - Reproducing virus in tissue cultures - Tissue cultures → lab grown tissues that can be used for body research without needing a whole body - Medium #199 → what they fed the tissue cultures - Raise of tissue cultures changed the character of biomedical research and studying disease - Monkeys still were used → became the source (raw) material for tissue cultures - Used monkey kidneys to produce these tissue cultures - Exported so many into Europe from India that they imposed a monkey export embargo

Answer 106

- Using other pathogen-carrying animals for research can result in exposure to other pathogens - Herpes B - W.B Brebner → contracted unknown disease from a bite → died from it → was Herpes B - SV40: polyoma simian virus 40 → causes cancers in laboratory animals - Polio vaccines produced between 1955 and 1963 were contaminated with SV40 because of the use of monkey kidney cells infected with the virus in the manufacture of vaccines - Role in SV40 in human cancers remains to be proven. - Bc no one now will contaminate vaccines to see if this relationship is certain

Answer 107

- Jonas Salk - inactivated (killed) virus in vaccine in 1955 - Contained all 3 serotypes - Single vaccine would protect you - Virus itself was killed by formaldehyde then injected - Cutter incident 1955 - Cutter labs did not properly kill the virus → 7000 ppl actually were injected with polio virus → 200000 cases of polio, many cases of paralysis and death - fodder for antivaccination - Albert Sabin - weakened (attenuated) virus in oral vaccine ,1962 → live but so weak it won’t cause severe paralysis (historic evidence) - Serila passage in monkeys and tissue cultures - was an oral vaccine → could drink it → easier to disseminate - more accessible - Did not patent - more accessible - less expensive - Field trials in USSR - Between 1963 and 1999 Sabin live vaccine largely replaced Salk vaccine globally