Excerpts from Wikipedia.org

Black Death

The Black Death, or the Black Plague, was one of the deadliest pandemics in human history, widely thought to have been caused by a bacterium named Yersinia pestis (Bubonic plague), but recently sometimes attributed to other diseases.

It most likely began in Central Asia and spread to Europe during the 1340s. It may have reduced the world's population from an estimated 450 million to between 350 and 375 million in 1400.

The scenario that would place the first outbreak in central Asia agrees with the first reports of outbreaks in China in the early 1330s. The plague struck the Chinese province of Hubei in 1334. On the heels of the European epidemic, more widespread disaster occurred in China during 1353–1354. Chinese accounts of this wave of the disease record a spread to eight distinct areas: Hubei, Jiangxi, Shanxi, Hunan, Guangdong, Guangxi, Henan and Suiyuan, throughout the Mongol and Chinese empires.

It is probable that the Mongols and merchant caravans inadvertently brought the plague from central Asia to the Middle East and Europe. The plague was reported in the trading cities of Constantinople and Trebizond in 1347. In that same year, the Genoese possession of Caffa, a great trade emporium on the Crimean peninsula, came under siege by an army of Mongol warriors under the command of Janibeg, backed by Venetian forces. After a protracted siege during which the Mongol army was reportedly withering from the disease, they might have decided to use the infected corpses as a biological weapon. The corpses were catapulted over the city walls, infecting the inhabitants. The Genoese traders fled, bringing the plague by ship into Sicily and the south of Europe, whence it spread.

The initial outbreak of plague in the Chinese province of Hubei in 1334 claimed up to ninety percent of the population, an estimated five million people. During 1353–54, outbreaks in eight distinct areas throughout the Mongol/Chinese empires may have possibly caused the death of two-thirds of China's population, often yielding an estimate of twenty-five million deaths. Japan and Korea had no outbreak of plague. It is estimated that between one-quarter and one-third of the European population (35 million people) died from the outbreak between 1348 and 1350.

Recent scientific and historical investigations have led some researchers to doubt the long-held belief that the Black Death was an epidemic of bubonic plague. For example, in 2000, Gunnar Karlsson pointed out that the Black Death killed between half and two-thirds of the population of Iceland, although there were no rats in Iceland at this time.

In addition, it was previously argued that tooth pulp tissue from a fourteenth-century plague cemetery in Montpellier tested positive for molecules associated with Y. pestis. Similar findings were reported in a 2007 study, but other studies have yielded negative results. In September 2003, a team of researchers from Oxford University tested 121 teeth from sixty-six skeletons found in fourteenth-century mass graves. The remains showed no genetic trace of Y. pestis, and the researchers suspect that the Montpellier study was flaw.

Leprosy

Leprosy, or Hansen's disease, is a chronic infectious disease caused by the bacterium Mycobacterium leprae. Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions are the primary external symptom. Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs, and eyes. Contrary to popular conception, leprosy does not cause body parts to simply fall off, and it differs from tzaraath, the malady described in the Hebrew scriptures and previously translated into English as leprosy.

In particular, tinea capitis (fungal scalp infection) and related infections on other body parts caused by the dermatophyte fungus Trichophyton violaceum are abundant throughout the Middle East and North Africa today and might also have been common in biblical times. Similarly, the related agent of the disfiguring skin disease favus, Trichophyton schoenleinii, appears to have been common throughout Eurasia and Africa before the advent of modern medicine. Persons with severe favus and similar fungal diseases (and potentially also with severe psoriasis and other diseases not caused by microorganisms) tended to be classed as having leprosy as late as the 17th century in Europe.

The word "leprosy" derives from the ancient Greek words lepros, a scale, and lepein, to peel.

Contrary to popular belief, Hansen's bacillus does not cause rotting of the flesh; rather, a long investigation by Paul Brand yielded that insensitivity in the limbs extremities was the reason why unfelt wounds or lesions, however minute, lead to undetected deterioration of the tissues, the lack of pain not triggering an immediate response as in a fully functioning body. Recently, leprosy has also emerged as a problem in HIV patients on antiretroviral drugs.

The age-old social stigma associated with the advanced form of leprosy lingers in many areas, and remains a major obstacle to self-reporting and early treatment. Effective treatment for leprosy appeared in the late 1930s with the introduction of dapsone and its derivatives. However, leprosy bacilli resistant to dapsone gradually evolved and became widespread, and it was not until the introduction of multidrug therapy (MDT) in the early 1980s that the disease could be diagnosed and treated successfully within the community

Syphilis

Syphilis is a curable sexually transmitted disease caused by the Treponema pallidum spirochete. The route of transmission of syphilis is almost always by sexual contact, although there are examples of congenital syphilis via transmission from mother to child in utero. The signs and symptoms of syphilis are numerous; before the advent of serological testing, precise diagnosis was very difficult. In fact, the disease was dubbed the "Great Imitator" because it was often confused with other diseases, particularly in its tertiary stage. Syphilis (unless antibiotic-resistant) can be easily treated with antibiotics including penicillin. The oldest and still most effective method is an intramuscular injection of benzathine penicillin. If not treated, syphilis can cause serious effects such as damage to the heart, aorta, brain, eyes, and bones. In some cases these effects can be fatal. In 1998, the complete genetic sequence of T. pallidum was published which may aid understanding of the pathogenesis of syphilis.

There were originally no effective treatments for syphilis. The Spanish priest Francisco Delicado wrote El modo de adoperare el legno de India (Rome, 1525) about the use of Guaiacum in the treatment of syphilis. He himself suffered from syphilis. Another common remedy was mercury: the use of which gave rise to the saying "A night in the arms of Venus leads to a lifetime on Mercury".

The first well-recorded European outbreak of what is now known as syphilis occurred in 1494 when it broke out among French troops besieging Naples. The French may have caught it via Spanish mercenaries serving King Charles of France in that siege. From this centre, the disease swept across Europe.

There have been three theories on the origin of syphilis which formed an ongoing debate in anthropological and historical fields.

The pre-Columbian theory holds that syphilis symptoms are described by Hippocrates in Classical Greece in its venereal/tertiary form. There are other suspected syphilis findings for pre-contact Europe, including at a 13–14th century Augustinian friary in the northeastern English port of Kingston upon Hull. This city's maritime history is thought to have been a key factor in the transmission of syphilis. Carbon dated skeletons of monks who lived in the friary showed bone lesions typical of venereal syphilis. Skeletons in pre-Columbus Pompeii and Metaponto in Italy demonstrating signs of congenital syphilis have also been found, although the interpretation of the evidence has been disputed.

The Columbian Exchange theory holds that syphilis was a New World disease brought back by Columbus and Martin Alonzo Pinzon. Supporters of the Columbian theory find syphilis lesions on pre-contact Native Americans and cite documentary evidence linking crewmen of Columbus's voyages to the Naples outbreak of 1494. A recent study of the genes of venereal syphilis and related bacteria has supported this theory, by locating an intermediate disease between yaws and syphilis in Guyana, South America

Tuberculosis

Tuberculosis (abbreviated as TB for tubercle bacillus) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. Tuberculosis most commonly attacks the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin.

One-third of the world's current population has been infected by TB, and new infections occur at a rate of one per second.

In the past, tuberculosis was called consumption, because it seemed to consume people from within, with a bloody cough, fever, pallor, and long relentless wasting.

Tuberculosis has been present in humans since antiquity. Skeletal remains show prehistoric humans (4000 BC) had TB, and tubercular decay has been found in the spines of mummies from 3000-2400 BC. Phthisis is a Greek term for tuberculosis; around 460 BC, Hippocrates identified phthisis as the most widespread disease of the times involving coughing up blood and fever, which was almost always fatal. Genetic studies suggest that TB was present in South America for about 2,000 years. In South America, the earliest evidence of tuberculosis is associated with the Paracas-Caverna culture (circa 750 BC to circa 100 AD).

* Tuberculosis Treatment

Typhoid Fever

Typhoid fever, also known as enteric fever, bilious fever or Yellow Jack, is an illness caused by the bacterium Salmonella enterica serovar Typhi. Common worldwide, it is transmitted by the ingestion of food or water contaminated with faeces from an infected person. The bacteria then multiply in the blood stream of the infected person and are absorbed into the digestive tract and eliminated with the waste. The organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella. The bacteria grows best at 37°C (human body temperature).

Around 430–426 B.C., a devastating plague, which some believe to have been typhoid fever, killed one third of the population of Athens, including their leader Pericles. The balance of power shifted from Athens to Sparta, ending the Golden Age of Pericles that had marked Athenian dominance in the ancient world. Ancient historian Thucydides also contracted the disease, but he survived to write about the plague. His writings are the primary source on this outbreak. The cause of the plague has long been disputed, with modern academics and medical scientists considering epidemic typhus the most likely cause. However, a 2006 study detected DNA sequences similar to those of the bacterium responsible for typhoid fever. Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study. The disease is most commonly transmitted through poor hygiene habits and public sanitation conditions; during the period in question, the whole population of Attica was besieged within the Long Walls and lived in tents.

In 1897, Almroth Edward Wright developed an effective vaccine.

Most developed countries saw declining rates of typhoid fever throughout first half of 20th century due to vaccinations and advances in public sanitation and hygiene. Antibiotics were introduced in clinical practice in 1942, greatly reducing mortality. At the present time, incidence of typhoid fever in developed countries is around 5 cases per 1,000,000 people per year.

Cholera

Cholera is an infectious gastroenteritis caused by the bacterium Vibrio cholerae.Transmission to humans occurs through the process of ingesting contaminated water or food. The major reservoir for cholera was long assumed to be humans themselves, but considerable evidence exists that aquatic environments can serve as reservoirs of the bacteria.

Vibrio cholerae is a Gram-negative bacterium that produces cholera toxin, an enterotoxin, whose action on the mucosal epithelium lining of the small intestine is responsible for the characteristic massive diarrhea of the disease. In its most severe forms, cholera is one of the most rapidly fatal illnesses known, and a healthy person may become hypotensive within an hour of the onset of symptoms; infected patients may die within three hours if treatment is not provided. In a common scenario, the disease progresses from the first liquid stool to shock in 4 to 12 hours, with death following in 18 hours to several days without oral rehydration therapy.

Recent epidemiologic research suggests that an individual's susceptibility to cholera (and other diarrheal infections) is affected by their blood type: Those with type O blood are the most susceptible, while those with type AB are the most resistant. Between these two extremes are the A and B blood types, with type A being more resistant than type B.

It has also been hypothesized that the cystic fibrosis genetic mutation has been maintained in humans due to a selective advantage: heterozygous carriers of the mutation (who are thus not affected by cystic fibrosis) are more resistant to V. cholerae infections. In this model, the genetic deficiency in the cystic fibrosis transmembrane conductance regulator channel proteins interferes with bacteria binding to the gastrointestinal epithelium, thus reducing the effects of an infection.

Anthrax

Anthrax is an acute disease in humans and animals caused by the bacterium Bacillus anthracis which is highly lethal in some forms. There are effective vaccines against anthrax, and some forms of the disease respond well to antibiotic treatment.

The anthrax bacillum is one of only a few that can form long-lived spores: in a hostile environment, caused perhaps by the death of an infected host or extremes of temperature, the bacteria become inactive dormant spores which can remain viable for many decades and perhaps centuries. Spores are found on all continents except Antarctica. When spores are inhaled, ingested, or come into contact with a skin lesion on a host they reactivate and multiply very rapidly.

Anthrax most commonly infects wild and domesticated grass-eating mammals (ruminants) which ingest or inhale the spores while eating grass. Anthrax can also infect humans when they are exposed to dead infected pigs, eat tissue from infected animals, or are exposed to a high density of anthrax spores from an animal's fur, hide, or wool.

Anthrax spores can be grown in vitro and used as a biological weapon. Anthrax does not spread directly from one infected animal or person to another, but spores can be transported by clothing, shoes etc.; and the body of a mammal that died of anthrax can be a very dangerous source of anthrax spores.

The name anthrax comes from anthrakitis, the Greek word for anthracite (coal), in reference to the black skin lesions victims develop in a cutaneous skin infection.

Anthrax is one of the oldest recorded diseases of grazing animals such as sheep and cattle and is believed to be the Sixth Plague mentioned in the Book of Exodus in the Bible. Anthrax is also mentioned by Greek and Roman authors such as Homer (in The Iliad), Virgil (Georgics), and Hippocrates. Anthrax ("siberian ulcer") is now fairly rare (5 confirmed fatalities in 2006) in humans although it still occasionally occurs in ruminants, such as cattle, sheep, goats, camels, wild buffalo, and antelopes.

Flesh-Eating Bacteria

Necrotizing fasciitis or fasciitis necroticans, commonly known as “flesh-eating bacteria" is a rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue. Many types of bacteria can cause necrotizing fasciitis (eg. Group A streptococcus, Vibrio vulnificus, Clostridium perfringens, Bacteroides fragilis), of which Group A streptococcus (also known as Streptococcus pyogenes) is the most common cause.

The infection begins locally, at a site of trauma, which may be severe (such as the result of surgery), minor, or even non-apparent. The affected skin is classically, at first, very painful without any grossly visible change. With progression of the disease, tissue becomes swollen, often within hours. Diarrhea and vomiting are common symptoms as well. Inflammation does not show signs right away if the bacteria is deep within the tissue. If it is not deep, signs of inflammation such as redness and swollen or hot skin show very quickly. Skin color may progress to violet and blisters may form, with subsequent necrosis (death) of the subcutaneous tissues. Patients with necrotizing fasciitis typically have a fever and appear very ill. Mortality rates have been noted as high as 73 percent. Without medical assistance, such as antibiotics, this doesn't take a long time to progress.

“Flesh-eating bacteria” is a misnomer, as the bacteria do not actually eat the tissue. They cause the destruction of skin and muscle by releasing toxins (virulence factors). These include streptococcal pyogenic exotoxins and other virulence factors. S. pyogenes produces an exotoxin known as a superantigen. This toxin is capable of activating T-cells non-specifically. This causes the over-production of cytokines.

The diagnosis is confirmed by either blood cultures or aspiration of pus from tissue, but early medical treatment is crucial and often presumptive; thus, antibiotics should be started as soon as this condition is suspected. Initial treatment often includes a combination of intravenous antibiotics including penicillin, vancomycin and clindamycin. If necrotizing fasciitis is suspected, surgical exploration is always necessary, often resulting in aggressive debridement (removal of infected tissue). As in other maladies characterized by massive wounds or tissue destruction, hyperbaric oxygen treatment can be a valuable adjunctive therapy, but is not widely available. Amputation of the affected organ(s) may be necessary. Repeat explorations usually need to be done to remove additional necrotic tissue. Typically, this leaves a large open wound which often requires skin grafting. The associated systemic inflammatory response is usually profound, and most patients will require monitoring in an intensive care unit.

Plague Doctor

A plague doctor's duties were often limited to visiting victims to verify whether they had been afflicted or not. Surviving records of contracts drawn up between cities and plague doctors often gave the plague doctor enormous latitude and heavy financial compensation, given the risk of death involved for the plague doctor himself. Most plague doctors were essentially volunteers, as qualified doctors had (usually) already fled, knowing they could do nothing for those affected.

Considered an early form of hazmat suit, a plague doctor's clothing consisted of: 1. A wide-brimmed black hat worn close to the head. At the time, a wide-brimmed black hat would have been identified a person as a doctor. 2. A primitive gas mask in the shape of a bird's beak. A common belief at the time was that the plague was spread by birds. 3. A long, black overcoat. The overcoat worn by the plague doctor was tucked in behind the beak mask at the neckline to minimize skin exposure. 4. A wooden cane. The cane was used to both direct family members to move the patient, other individuals nearby, and possibly to examine the patient with directly.

Renewed religious fervor and fanaticism bloomed in the wake of the Black Death. This spelled trouble for minority populations of all sorts, as some Christians targeted "various groups such as Jews, friars, foreigners, beggars, pilgrims", lepers and gypsies, thinking that they were to blame for the crisis. Lepers, and other individuals with skin diseases such as acne or psoriasis, were singled out and exterminated throughout Europe.

Leprosy

The Colony: The Harrowing True Story of the Exiles of Molokai
by John Tayman

Historically, leprosy has affected humanity since at least 600 BC, and was well-recognized in the civilizations of ancient China, Egypt and India. In 1995, the World Health Organization (WHO) estimated that between two and three million people were permanently disabled because of leprosy. Although the forced quarantine or segregation of patients is unnecessary—and can be considered unethical—a few leper colonies still remain around the world, in countries such as India, Japan, Egypt, and Vietnam.

Portrait of Gerard de Lairesse by Rembrandt van Rijn. De Lairesse, himself a painter and art theorist, suffered from congenital syphilis that severely deformed his face and eventually blinded him.

Some famous historical personages, including Franz Schubert, Charles VIII, Hernando Cortez of Spain, Adolf Hitler, Benito Mussolini, and Ivan the Terrible, have been alleged to have had syphilis. Guy de Maupassant and possibly Friedrich Nietzsche are thought to have been driven insane and ultimately killed by the disease. Al Capone contracted syphilis as a young man. By the time he was incarcerated at Alcatraz, it reached its third stage, neurosyphilis, leaving him confused and disoriented. Syphilis led to the death of artist Edouard Manet and artist Paul Gauguin is also said to have suffered from syphilis.

Some critics have argued that the character of Edward Rochester's first wife, Bertha, in Charlotte Brontë's novel Jane Eyre, suffers from the advanced stages of syphilitic infection, general paresis of the insane, and point to corroborative evidence within the text to substantiate this view.

"The Vampire", by Edvard Munch.

Before the Industrial Revolution, tuberculosis may sometimes have been regarded as vampirism. When one member of a family died from it, the other members that were infected would lose their health slowly. People believed that this was caused by the original victim draining the life from the other family members. Furthermore, people who had TB exhibited symptoms similar to what people considered to be vampire traits. People with TB often have symptoms such as red, swollen eyes (which also creates a sensitivity to bright light), pale skin and coughing blood, suggesting the idea that the only way for the afflicted to replenish this loss of blood was by sucking blood.

Typhoid Mary

Mary Mallon also known as Typhoid Mary, was the first person in the United States to be identified as a healthy carrier of typhoid fever. Over the course of her career as a cook, she infected 47 people, three of whom died from the disease. Her fame is in part due to her vehement denial of her own role in causing the disease, together with her refusal to cease working as a cook. She was forcibly quarantined twice by public health authorities and died in quarantine. It was also possible that she was born with the disease, as her mother had typhoid fever during her pregnancy.

1892 Cholera outbreak in Hamburg, Germany, disinfection team

Cholera was originally endemic to the Indian subcontinent, with the Ganges River likely serving as a contamination reservoir. The disease spread by trade routes (land and sea) to Russia, then to Western Europe, and from Europe to North America. Cholera is now no longer considered a pressing health threat in Europe and North America due to filtering and chlorination of water supplies.

Cholera has been a laboratory for the study of evolution of virulence. The province of Bengal in British India was partitioned into West Bengal and East Pakistan in 1947. Prior to partition, both regions had cholera pathogens with similar characteristics. After 1947, India made more progress on public health than East Pakistan (now Bangladesh). As a consequence, the strains of the pathogen that succeeded in India had a greater incentive in the longevity of the host and are less virulent than the strains prevailing in Bangladesh, which uninhibitedly draw upon the resources of the host population, thus rapidly killing many victims.

2001 Anthrax Attacks

The 2001 anthrax attacks in the United States, also known as Amerithrax from its FBI case name, occurred over the course of several weeks beginning on September 18, 2001. Letters containing anthrax spores were mailed to several news media offices and two Democratic U.S. Senators, killing five people and infecting 17 others. The crime remains unsolved.

Anthrax spores can and have been used as a biological warfare weapon. There is a long history of practical bioweapons research in this area. For example, in 1942 British bioweapons trials severely contaminated Gruinard Island in Scotland with anthrax spores of the Vollum-14578 strain, making it lethally dangerous to all mammals including humans, until it was decontaminated by 1990. The Gruinard trials involved testing the effectiveness of a submunition of an "N-bomb"—a biological weapon. Additionally, five million "cattle cakes" impregnated with anthrax were prepared and stored at Porton Down in 'Operation Vegetarian'—an anti-livestock weapon intended for attacks on Germany by the Royal Air Force The infected cattle cakes were to be dropped on Germany in 1944. However neither the cakes nor the bomb were used; the cattle cakes were incinerated in late 1945.

Jan Peter Balkenende, Prime Minister of the Netherlands since 2002, was infected in 2004. He was in the hospital for several weeks, but recovered fully. Balkenende is sometimes referred to as "Harry Potter" by Dutch citizens because of his physical resemblance to the storybook character.

Other well-known victims:

* Lucien Bouchard, former premier of Québec, Canada, who became infected in 1994 while leader of the federal official opposition Bloc Québécois party. He lost a leg to the illness.

* Eric Allin Cornell, winner of the 2001 Nobel Prize in Physics, lost his left arm and shoulder to the disease in 2004.

* David Walton, a leading economist in the UK and a member of the Bank of England’s Monetary Policy Committee which is responsible for setting interest rates, died of the disease within 24 hours of diagnosis on June 21, 2006.

* Lana Coc-Kroft, a New Zealand television celebrity, was infected after she stepped on a coral reef in Fiji in 2005.

* Alexandru Marin, an experimental particle physicist, professor at MIT, Boston University and Harvard University died from the disease in 2005.

* Alan Coren, British writer and satirist, announced in his Christmas 2006 column for The Times that his long absence as a columnist had been due to contracting the disease while on holiday in France.