Sunday, March 22, 2020

SER 01 OF X SERIALS (Infectious Diseases) : - Infectious Diseases and their impact on Civilisation

SOURCE:
https://medium.com/@adrian.esterman/infectious-diseases-and-their-impact-on-civilisation-4eb8ac72cc5b



INDEX
SER 12  (D)  OF X SERIALS (Infectious Diseases) VIRUS WAR

SER 12  (C)  OF X SERIALS (Infectious Diseases) VIRUS WAR


 SER 12  (B)  OF X SERIALS (Infectious Diseases)  VIRUS WAR
https://bcvasundhra.blogspot.com/2020/04/ser-12-b-of-x-serials-infectious.html
SER 12  (A)  OF X SERIALS (Infectious Diseases)  VIRUS WAR
https://bcvasundhra.blogspot.com/2020/04/ser-12-of-x-serials-infectious-diseases_16.html

  11  OF   X SERIALS (Infectious Diseases)

SER 09  OF   X SERIALS (Infectious Diseases)
https://bcvasundhra.blogspot.com/2020/04/save-lives-ready-shovels.html

SER 08   OF   X SERIALS (Infectious Diseases)
https://bcvasundhra.blogspot.com/2020/04/the-impossible-ethics-of-pandemic-triage.html

SER 07   OF   X SERIALS (Infectious Diseases)
https://bcvasundhra.blogspot.com/2020/04/how-it-will-end.html
 SER 06 ( B )   OF   X SERIALS (Infectious Diseases)

 SER 06 (A )   OF   X SERIALS (Infectious Diseases)
https://bcvasundhra.blogspot.com/2020/03/2020-coronavirus-pandemic-in-india.html
SER 05   OF   X SERIALS (Infectious Diseases)
HTTPS://BCVASUNDHRA.BLOGSPOT.COM/2020/03/SOURCE-HTTPSWWW.HTML

SER 04 / (C)   OF   X SERIALS (Infectious Diseases)
https://bcvasundhra.blogspot.com/2020/03/ser-04-c-of-x-serials-infectious_27.html

 SER 04 / (B)   OF   X SERIALS (Infectious Diseases)
https://bcvasundhra.blogspot.com/2020/03/2019-2020-cornavirus-pandemic_26.html

 SER 04 / (A)   OF   X SERIALS (Infectious Diseases)
https://bcvasundhra.blogspot.com/2020/03/2019-2020-cornavirus-pandemic.html

 SER 03 OF   X SERIALS (Infectious Diseases)
https://bcvasundhra.blogspot.com/2020/03/novel-coronavirus-covid-19.html

 SER 02 OF   X SERIALS (Infectious Diseases)
https://bcvasundhra.blogspot.com/2020/03/history-in-crisis-lessons-for-covid-19.html

 SER 01 OF   X SERIALS (Infectious Diseases)
https://bcvasundhra.blogspot.com/2020/03/infectious-diseases-infectious-diseases.html
 

How pandemics spread

            [   https://www.youtube.com/watch?v=UG8YbNbdaco  ]











My response to the current pandemic  COVID-19  is isolation (working from home), listening to my favourite classical music (Shostakovitch second piano concerto — Andante), drinking good wine (McLaren Vale shiraz), and writing these stories!                      

              -  Prof. Adrian Esterman

        Infectious Diseases and their impact

                          on Civilisation

                                    BY          

                 Prof. Adrian Esterman








In the beginning

Some 2.2 million years ago, the first human species, Homo habilis (or Handy Man) inhabited parts of sub-Saharan Africa. Very little is known of his life or mental capabilities. However the ability to walk upright gave him better use of his hands, and the ability to use simple stone tools. Homo habilis was a scavenger rather than a hunter, likely eating roots and dead animals.




Homo erectus

Some 200,000 years later, Homo erectus evolved from Homo habilis. Homo erectus had a brain 50% larger than Homo habilis, in fact approaching that of modern man. Homo Erectus used sophisticated stone tools such as stone axes, could speak, and was almost certainly a carnivorous hunter.
Importantly, Homo erectus knew how to make fires. This meant that he could eat cooked rather than raw meat, reducing the incidence of disease. The cooked food was also softer, making it easier for the young and old to eat. Finally, the ability to make fires allowed him to migrate from the warm climate of Africa to the cooler climate of Europe.



Homo sapien



Homo sapiens, the first of our own species, emerged some 350,000 years ago. Theirs was a harsh life, suffering from crippling deformities, racked with arthritis, and lamed by injuries. Life was dangerous and life span was short. They were nomadic hunters, living in familial groups of 40–50 people.
Homo sapiens were susceptible to soil-borne diseases such as anaerobic bacteria, and they would have acquired anthrax and rabies from predators like wolves. They would have become infected with tape worm through eating raw animal flesh, while game would have transmitted relapsing fever, brucellosis and haemorrhagic fevers.
However, their nomadic existence and small group size would have protected them from many of the infectious diseases, and prevented the whole species being wiped out.

From hunters to farmers







At the end of the last Ice-Age, some 2.6 million years ago, population pressure and game depletion led to the domestication of animals and plants. As a result, hunters and gatherers became shepherds and farmers.
This meant that due to close contact with domestic animals, pathogens, until then exclusive to animals, were able to cross over to man. Cattle gave them tuberculosis and viral poxes, horses brought rhinoviruses, dogs gave them measles, and water polluted with animal faeces spread polio and typhoid fever.

Unfortunately, permanent settlement afforded golden opportunities for insects, vermin and parasites, whilst food stored in granaries became infested with insects, bacteria, fungoid toxins and rodent excrement.
However, none of these was severe enough to pose a major threat to mankind, that is until man developed civilisation!


Civilisation





The first civilisation, the Sumarian was established around 3500 BC. Ancient Egypt followed 400 years later. The Greek civilisation was established in 1100BC, and Ancient Rome was a comparative newcomer, established in 753BC.
Unfortunately, the establishment of towns and cities led to overcrowded and unsanitary conditions, a recipe for future disaster.

The plague of Justinian


From 98 to 180 AD the Roman Empire was relatively stable, but in the next century it crumbled. There were civil wars between 180 and 285 AD. The Persians raided from the East and in Europe the barbarians broke through the frontiers.

Constantine the Great was born in AD 285. He was the first emperor to legalise Christianity. With constant attacks by barbarians from the North and West, Constantine came to the conclusion that Rome was no longer a suitable capital for defending the empire. Apart from major rivers of the Rhine and Danube, it had no natural protective barriers — and even the rivers were useless during the Winter when they froze over allowing the barbarian hordes to attack.


He therefore moved his capital from Rome to the ancient city of Byzantine, renaming it Constantinople, and effectively splitting the Roman Empire into two halves, an Eastern and Western empire.
The Eastern Empire grew steadily, adopting the Greek language and culture. They kept the Barbarians at bay by clever use of bribes, inter-marrying and maintaining a large army.
The Byzantine Emperor Justinian reigned from AD 527 to 565. Justinian’s first years as emperor were full of action. Pagans were barred from the civil service, baptised Christians who lapsed into paganism were put to death, as were any persons caught making secret sacrifice to the gods.
Justinian had a dream of re-uniting the Holy Roman Empire. He defeated the Vandals in North Africa and the Ostrogoths in Italy, but only at the cost of long and bloody wars.






When, in 541, Justinian returned to his capital from his unsuccessful war in Persia, he found to his horror that his subjects were dying at the rate of up to 10,000 per day. Bubonic plague had struck. Because even mass graves could not be dug fast enough, Justinian ordered that the roofs be removed from the towers of the city walls to provide places to efficiently stack the corpses; soldiers then poured lye onto these tall piles of bodies to hasten their decomposition.
Over a period of six years the plague epidemic caused utter devastation throughout Italy, Spain, France, the Rhine valley, Britain, and Denmark. All over Europe, the dead littered the streets, and the living prayed for their lives.
By the time the plague epidemic ended, the population of the world was devastated with up to 100 million people dead.
This was the first of the three great plague pandemics. It was called the Plague of Justinian. It ended Justinian’s dreams of restoring the Roman Empire. The weakened Roman and Persian armies were unable to stop the onslaught of the Moslems who captured Syria, Egypt, Mesopotamia, Palestine and Cyprus, spelling the end of the Roman Empire.

The Middle-ages


We now move forward several hundred years to the 14th century. Medicine was well advanced. Doctors could amputate and cauterise limbs, and could treat headache, stomach ache, and menstrual cramps with herbs. Non-herbal treatments were mainly enemas, or bloodletting.
In Europe in the early 1300’s, the climate began to deteriorate. Wet summers, diseases among domestic animals and soil exhaustion caused many problems, and there was widespread famine





However, famine was only a minor problem that Century compared to a much greater disaster that hit the world      — the “Black Death” — the second of the three great pandemics of bubonic plague that occurred between 1348–1349.
The term “Black Death” is a comparatively recent invention. In those days it was known as “The Great Dying” or “The Great Mortality”.
It is estimated that 75 million people died as a results of the pandemic, and it was hundreds of years before the population of Europe recovered to its 14th Century levels.
There were many different ways that people dealt with the plague. Some formed small communities, living entirely separate from everybody else. They shut themselves up in houses where there were no sick, eating the finest food and drinking the best wine, avoiding all excess but rather passing the time in music and other cultural pleasures.
Others thought the sure cure for the plague was to indulge themselves, satisfying every appetite they could. They spent day and night going from tavern to tavern, drinking and debauching.




Flagellant Movement

One of the more interesting and bizarre episodes of the Black Death was the Flagellant Movement. In 1348, processions of men walking two by two passed through Austria, Hungary, Germany, Bohemia, the Low Countries and Picardy, summoning the townspeople to the marketplace.
The marchers, once they had arrived, would strip to the waist and form a large circle. Each brother carried a heavy leather thong, tipped with metal studs. With this they began to beat themselves and others. Three Brothers acted as cheerleaders while the Master prayed for God’s mercy on all sinners.
The leaders of the Flagellants, were also preachers spreading a particularly virulent form of Jew-hatred.
It was said that the Jews seemed curiously exempt from the plague, fewer of them died, and they poisoned wells.
In 1348, Jews were burnt in a number of Southern German cities. At Speyer the bodies were piled in great wine-casks and sent floating down the Rhine.
In February 1349, two thousand Jews were burned alive Strasbourg. As the ashes cooled at the place of execution, the good people of Strasbourg are said to have pawed through the charred remains hoping to find jewellery that might have survived the fire.
These persecutions lead to the mass exodus of Jews from Germany to the safer havens of Poland and Russia.




Plague doctor



Physicians lost their credibility as quickly as they lost their patients. The only effective prescription that an honest doctor could offer was fugo cito, vade long, rede tarde, which means flee quickly, go far, and come back slowly!
Fearing infection, doctors donned outrageous clothes with beaked masks. The best minds in medicine thought disease was spread by miasma, a noxious form of bad air. To defend against miasma, the long beak was packed with sweet smelling dried flowers, herbs and spices.
The infected poor were incarcerated in pest-houses. Physicians strenuously avoided going into these buildings and shouted up their cures from the pavement outside. The treatments were then applied by resident surgeons — a lower and expendable class of doctor!





Waves of peasant deaths lead to acute labour shortages. Peasants demanded wages for cultivating land and landowners had Parliament pass laws banning payments. The peasants organised a revolt and won. Panicky landowners paid good wages, or broke up their estates to rent to peasants who became tenants or landowners themselves. Peasants became yeomen or free men, and the Feudal system was finished.
Eventually the acute labour shortage stimulated European involvement in the slave trade. Europe’s shrunken population and fragmented markets forced merchants to travel widely to sell and exchange their goods. Trade with America, Africa and Asia was in particular greatly enhanced.
The death of large numbers of clergy loosened Latin’s stranglehold on education and ended its reign as Europe’s universal language.
The plague also seriously undermined the Church’s authority. As each succeeding wave of plague rolled across Europe, it became plain to the faithful that God had run amok and his priestly servants were fleeing their parishes in search of ale and mistresses.
 Many of their replacements were neither trustworthy or holy. One English friar spent so much time robbing his parishioners that he was called “William the One-day Priest” before they hanged him.







The affluent built country homes and moved there at the first hint of the plague’s coming. Before returning, city houses were fumigated with sulphur. Then a poor serving woman was left inside the home for several weeks as an early warning system — a bit like a canary in a mine. If she died, the owners enjoyed a couple more pleasant months in the country.
The breaking up of the big estates held both by nobles and the church lead to the formation of new land laws, and made legal practitioners very wealthy!
On a brighter note, by 1200, Europeans had cut and ploughed their way across the continent with such thoroughness that they threatened to create a treeless desert. The plague gave Europe’s much abused forests a chance to recover.

The Great Plague of London of 1665








London had changed little in 300 years. Houses were still tightly packed together and conditions unsanitary — ideal conditions for the plague to spread, particularly during the hot summer of 1665.
When plague broke out in Holland in 1663, Charles II stopped trading with that country in an attempt to prevent plague infested rats arriving in London. However, despite these precautions, plague broke out in the capital in the Spring of 1665.
The Summer of 1665 was one of the hottest summers recorded and the numbers dying from plague rose rapidly. People began to panic and the rich fled the capital. By June it was necessary to have a certificate of health in order to travel or enter another town or city and forgers made a fortune issuing counterfeit certificates.
The temperature and the numbers of deaths continued to rise. The Lord Mayor of London, desperate to be seen to be doing something, heard rumours that it was the stray dogs and cats on the streets that were spreading the disease and ordered them to be destroyed. This action unwittingly caused the numbers of deaths to rise still further since there were no stray dogs and cats to kill the rats.
Those houses that contained plague victims were marked with a red cross. People only ventured into the streets when absolutely necessary preferring the ‘safety’ of their own homes. Carts were driven through the streets at night, the drivers calling out ‘bring out yer dead‘.
In 18 months, the Great Plague killed about 100,000 people — almost a quarter of London’s population.
The Spanish Flu





The First World War was different from prior military conflicts. It was a meeting of 20th century technology with 19th century mentality and tactics. This time, millions of soldiers fought on all sides and the casualties were enormous, mostly because of the more efficient weapons like machine guns. Much of the action took place in the trenches, where thousands died for each square meter of land.
In the autumn of 1918 the Great War was winding down and peace was on the horizon. The Americans had joined in the fight, bringing the Allies closer to victory against the Germans. Deep within the trenches these men lived through some of the most brutal conditions of life, which it seemed could not be any worse.
Then, in pockets across the globe, something erupted that seemed as benign as the common cold. The influenza of that season, however, was far more than a cold. In the two years that this outbreak ravaged the earth, a fifth of the world’s population was infected. The flu was most deadly for people ages 20 to 40. This pattern of morbidity is unusual for influenza which is usually a killer of the elderly and young children.
Spain was neutral in the Great War, and thus its press was uncensored. When the flu epidemic was announced in the Spanish newspapers, everyone thought that the outbreak had originated in Spain, and it was therefore called Spanish flu.
The Great War, with its mass movements of men in armies and aboard ships, probably aided in its rapid diffusion and attack. Many thought it was a result of the trench warfare, the use of mustard gases and the generated “smoke and fumes” of the war.
The flu that winter was beyond imagination as millions were infected and thousands died. Entire fleets were ill with the disease and men on the front were too sick to fight. The flu was devastating to both sides, killing more men than their own weapons could.
Of the U.S. soldiers who died in Europe, half of them fell to the influenza virus and not to the enemy. 1918 would go down as unforgettable year of suffering and death.




There wasn’t much doctors could do. In the course of the epidemic nearly every known therapy was tried — quinine tablets, bleeding, castor oil, digitalis, morphine, enemas, aspirin, tobacco, hot baths, cold baths, iron tonics, and expectorants of pine tar. Little was known about the virus, except that it was contagious.
After deaths from the disease began in earnest, many local governing bodies closed down theatres, churches, and other public gatherings. Ordinances made it illegal to spit, cough, or sneeze in public. When people went out they wore gauze masks over their nose and mouth, often soaked in camphor. One US town even made it illegal to shake hands!
In 1997 a team from the USA managed to recover some of the genetic material of the Spanish influenza virus from a female victim whose body was buried in permafrost in Alaska. Based on this sample, we now the genetic make up of the Spanish flu, and why it was so virulent, especially in young, fit people. It turns out that this particular strain of the flu caused the body to have a massive cascade of cytokines — small protein molecules produce by the immune system that either increase or decrease the amount of inflammation at the infection site. The cytokines badly damaged the lungs which were then attacked by bacteria, and it is this bacterial lung infection that caused the death rather than the flu itself. The stronger the body’s immune system, the greater the cytokine explosion — which is why the disease primarily killed fit, healthy men. Of course, these days we have antibiotics that can treat the bacterial infection, but unfortunately they were not discovered until 1928.





In 1919 the leaders of the Allies met at the Palace of Versailles to decide on the peace settlement after the Great War. Georges Clemenceau of France wanted Germany to pay for war damage, return Alsace-Lorraine, and hand over the Rhineland to France. David Lloyd George was more moderate. He wanted Germany to be able to recover, and did not want France to get the Rhineland. Vittorio Orlando of Italy wanted Italy to be given the Adriatic coast.
Most moderate of all was President Woodrow Wilson. He wanted a League of Nations to be set established to settle disputes between countries in the future, and did not want Italy to get the Adriatic Coast.
Unfortunately, during the last few days of the conference, President Woodrow Wilson himself came down with Spanish flu, and was bedridden. With the most moderate representative unable to attend the Conference, the French and Italians had their way, and Germany paid the price.
The German people were horrified when they discovered the terms of the Treaty. It is believed that these harsh measures against Germany were the root cause of World War II.

2020 and the current COVID-19 pandemic


















































My response to the current pandemi  COVID-19  is isolation (working from home), listening to my favourite classical music (Shostakovitch second piano concerto — Andante), drinking good wine (McLaren Vale shiraz), and writing these stories!
Reading the above, I hope you have seen many similarities with the current Covid-19 pandemic. We are lucky in that medicine has advanced hugely since 1918. We now have antibiotics and antiviral medicine. Vaccines are being tested and should be available by the end of the year. Isolation does work, and we now know how to slow the epidemic down relieving pressure on our health services. I am optimistic about the future.
I will leave you with this wonderful poem — I am not sure who penned it:
“A sickly season,” the merchant said,
“The town I left was filled with dead,
and everywhere these queer red flies
crawled upon the corpses’ eyes,
eating them away.”
“Fair make you sick,” the merchant said,
“They crawled upon the wine and bread.
Pale priests with oil and books,
bulging eyes and crazy looks,
dropping like the flies.”
“I had to laugh,” the merchant said,
“The doctors purged, and dosed, and bled;
And proved through solemn disputation
The cause lay in some constellation.
“Then they began to die.”
“First they sneezed,” the merchant said,
“And then they turned the brightest red,
Begged for water, then fell back.
With bulging eyes and face turned black,
they waited for the flies.”
“I came away,” the merchant said,
“You can’t do business with the dead.
So I’ve come here to ply my trade.
“You’ll find this to be a fine brocade…”
And then he sneezed.
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