Why Was Dissection A Major Advance In Healthcare?

Why Was Dissection A Major Advance In Healthcare

What did ancient people think was the cause of disease and illness? Supernatural spirits and demons. List (4) things Hippocrates stressed to help the body heal itself: (1) good diet (2) fresh air (3) cleanliness (4) exercise In the Dark Ages, what was the main method used to treat illness and disease? Prayer, and divine intervention. List at least (4) diseases that shortened the life span of individuals in the Middle Ages: (1) bubonic plague (2) diphtheria (3) smallpox (4) typhoid Why was dissection a major advance in health care during the Renaissance? It allowed a better understanding of anatomy and physiology. What was the significance of the invention of the microscope in 1666? It allowed physicians to see organisms that are too small to be seen by the human eye. What did apothecaries use to make many of the medications in the 17th century? Many of the medications were made from plants and herbs similar to those used in ancient times. Why was the invention of the stethoscope in 1819 important? It made physicians able to listen to the various sounds made by the heart and lungs. Identify (4) women who made who made important contributions to the advance of health care in the 19th century. Why were their contributions important? (1) Elizabeth Blackwell – first female physician in the U.S. (2) Florence Nightingale – founder of modern nursing. (3) Dorothea Dix – superintendent of the Female Nurses of the Army. (4) Clara Barton – founded the American Red Cross Why was the discovery of DNA in 1953 so important? It began the search for gene therapy to cure inherited diseases. Think of future health care. What major advancements would you like to see in the 21st century? Why? Cures for AIDS, cancer, and heart diseases; our technology is still developing, we could save many lives. Founded the American Red Cross in 1881. Used acupuncture to relieve pain and congestion. Artist who used dissection to draw the human body. Emphasis was placed on saving the soul and study of medicine was prohibited. Earliest people known to maintain accurate health records. Created the first mercury thermometer. Discovered penicillin in 1928. Described the circulation of blood to and from the heart. Developed a vaccine for smallpox in 1796. Developed the culture plate method to identify pathogens. Began using disinfectants and antiseptics during surgery. Established the patterns of heredity. Founder of modern nursing. Began pasteurizing milk to kill bacteria. An Arab physician who began the use of animal gut for suture material. Discovered X-rays in 1895. Began public health and sanitation systems. Developed the polio vaccine in 1952.

What did witch doctors do to help with illness during primitive times?

In the Primitive Times, how did the tribal witch doctors treat illness and what did they use as medicine? The tribal witch doctors treated illness with ceremonies to drive out evil spirits, and herbs and plants where used as medicine.

What things Hippocrates stressed to help the body heal itself?

Hippocrates stressed the importance of fresh air, a good diet and plenty of exercise.

What did ancient people think was the cause of disease and illnesses?

Cause of the Plague and Strategies for Prevention – The cause of the plague was not known, but there were many theories. The most popular explanation was that it was caused by ” miasmas,” invisible vapors that emanated from swamps or cesspools and floated around in the air, where they could be inhaled.

Others thought it was spread by person to person contact, or perhaps by too much sun exposure, or by intentional poisoning. The miasma theory was the most popular, however. One of the popes kept large fires burning at both ends of the room he worked in order to counteract the miasmas. The illustration on the left shows a “plague doctor,” who is covered from head to toe, including a hood, a mask, gloves, and a beak-like sack on his nose.

The covering on the nose contained aromatic herbs, which were believed to neutralize miasmas. There were also crude medicines that were concocted to prevent or cure the bubonic plague; one of them was known as theriac, Of course, smoke and aromatic herbs and theriac were ineffective, because the plague was primarily spread by flea bites (although sometimes victims developed a plague pneumonia that caused them to cough up a bloody, plague-filled aerosol that could be transmitted to others by inhalation; this was the ‘pneumonic’ form of the plague). While most believed that plague was caused by miasmas, the primary mode of transmission was actually via flea bites, and, in a sense, the real causes were increased population density and failure to dispose of garbage. Accumulations of garbage attracted rats and enabled the rat population to explode.

Rats had harbored fleas and Yersinia pestis for many years without major difficulty, and plague epidemics in humans didn’t occur until human behaviors created environments that brought people into proximity with rats, fleas, and Yersina pestis, These were the real causes of the plague epidemics. At first glance one might blame the lack of understanding about transmission and the ineffective preventive measures on the primitive level of scientific understanding.

However, the inability to identify the cause and the inability to identify effective control measures was not due to a lack of sophisticated technology. Instead, it was primarily due to the fact that humans had not yet developed a structured way to think about the determinants of disease.

There were certainly theories of how the plague spread and these led to preventive strategies, but none of the theories or preventive strategies or treatments were ever tested by collecting observations in groups of people.
The idea of studying groups of people to test associations between “risk factors” and disease outcomes had not yet evolved.

Key Concepts The lack of a systematic way of testing possible associations between exposures and outcomes (“risk factors” and disease) was the major factor that prevented advances in understanding the causes of disease and the development of effective strategies to prevent or treat disease.

What are four diseases that shorten the lifespan of individuals in the Middle Ages?

Besides battle wounds, what illnesses were common in the Middle Ages? Did people in the Middle Ages have the same diseases that we have today? By examining skeletons, archaeologists can tell how old the person was when they died, and sometimes what they died of as well.

It seems that only one out of every ten adults lived to be as old as fifty.
Many babies, children and teenagers died.
Common diseases were dysentery, malaria, diphtheria, flu, typhoid, smallpox and leprosy.
Most of these are now rare in Britain, but some diseases, like cancer and heart disease, are more common in modern times than they were in the Middle Ages.

There were regular waves of ‘pestilence’ or plague throughout the Middle Ages, but in 1348/9 an illness came to Britain that killed more people, even the young, strong and healthy, than ever before. It came into Europe from the East, carried by the fleas that lived on black rats. Burying the dead Whole villages were wiped out by the disease, or the surviving inhabitants fled. In many villages there was no one left to till the fields, and famine soon followed, killing or driving out those who were left. You can still see the sites of some of these deserted villages today. The deserted village of Cottam in Yorkshire No one knew what caused the disease, and Medieval medicine was powerless against it. People felt hopeless and afraid. They thought the Black Death epidemic was a sign that God was angry with them. : Besides battle wounds, what illnesses were common in the Middle Ages?

What was the main method to treat illness in the Dark Ages?

Medicine in Ancient Times Caduceus is the symbol of physician (doctor) or medicine Ancient Egyptians (3000 -300 BC) believed that the gods would heal disease, priests were trained as physicians who believed that the body was a system of channels (air, blood, tears, urine) that could be healed by leeches and blood letting.

doctor separate from religious leader
observation of patient
record observations
natural cause of disease rather than supernatural

Prior to Hippocrates health care was done by a witch doctor, evil spirits as the cause, life span was 20 years.
Aristotle (384 – 324 BC) was known as the father of anatomy, he began dissecting animals for study and believed that diet and hygiene were factors preventing disease.
Ancient Egyptians (3000 -300 BC) believed that the gods would heal disease, priests were trained as physicians who believed that the body was a system of channels (air, blood, tears, urine) that could be healed by leeches and blood letting.

Ancient Romans (753 BC – 410 AD) were the first to organize health care by providing treatment to soldiers. They had a system of public health and sanitation (aqueducts/sewers), and drained wetlands to reduce the spread of malaria. Life expectancy was 35 years.

In the Dark Ages (400 – 800 AD) science and medicine was prohibited. Treatment of illness was prayer and divine intervention. Herbal remedies were provided by monks. Life expectancy was 20 to 30 years. The Middle Ages (500 – 1500 AD) major diseases were smallpox, diphtheria, tuberculosis, typhoid, malaria and the bubonic plague (killed 3/4 of population in Europe and Asia.

Barbers performed surgery, amputations and blood letting. Regulation and licensing began to be introduced for male physicians, though most caregivers were religious orders. Life expectancy was 20 to 35 years. The Renaissance (1300 – 1600 AD), also known as the Age of Enlightenment, saw the advancement of scientific method, invention of the microscope, study of human anatomy, publishing of medical texts (invention of the printing press).

Why is witch doctor important?

A primary function of the witch doctor is to discover the worker of evil magic and denounce him as an enemy of the community. The witch doctor also controls the weather and often assumes the role of ‘rainmaker,’ on whom the welfare of the community depends.

How did Hippocrates improve the practice of medicine?

The Hippocrates Evidence-Based Knowledge – Another great contribution of Hippocrates to medicine is the professional ethics and standards that are respected and observed even today ( 28 ). According to Miles, Hippocratic medicine is founded on the available evidence based knowledge, as Hippocratic physicians were required to give complete and detailed medical histories, and this reminds us of the current research protocol in existence today ( 31 ).

Specifically, in their diagnoses of syndromes or diseases, Greek physicians were instructed to note the geographical location, climate, age, gender, habits and diet. Also rational mood swings, sleep duration, dreams, appetite, thirst, nausea, location and severity of pain, chills, coughing, sneezing, belching, flatulence, convulsions, nosebleeds, even menstrual changes were recorded.

The physical examination required great attention to be given to fever, respiration, paralysis and color of the limbs, pain on palpation, stool, urine, sputum and vomit. The overall assessment of these recordings interpreted the final diagnosis and determined the type of treatment of the disease.

Moreover, Schiefsky mentions that the key area of Hippocratic medicine was the precision or the details of prognosis and the reliability of prognostic signs ( 32 ).
According to a recent Greek review, the Hippocratic physician had to examine a patient, observe symptoms carefully, make a diagnosis and then treat the patient ( 33 ).

Therefore, Hippocrates established the basics of clinical medicine as it is practiced today. He introduced numerous medical terms universally used by physicians, including symptom, diagnosis, therapy, trauma and sepsis. In addition, he described a great number of diseases without superstition.

Their names are still used in modern medicine, for instance diabetes, gastritis, enteritis, arthritis, cancer, eclampsia, coma, paralysis, mania, panic, hysteria, epilepsy and many others.
Accordingly, Hippocrates greatly contributed to modern medicine by declaring that medicine should depend on detailed observation, reason and experience in order to establish diagnosis, prognosis and treatment.

Obviously, after Hippocrates there was no longer a mixture of superstition, magic, religious views and empirical treatments examined by priest-physicians, and medicine became a real science through accumulating experience ( 34 ).

Which is the fastest healing body part?

Closed up – Small wounds made in arm skin (top row) took more than six days to heal, but wounds in the mouth (bottom row) closed quickly with no scar. A probe marked in millimeters (black and white bar) shows how big the wounds are. Blue stitches indicate where the wound was made. Why Was Dissection A Major Advance In Healthcare R. Iglesias-Bartolome et al/Science Translational Medicine 2018 Knowing how the mouth performs its speed healing may eventually lead to therapies that fix skin sores without forming scars. Because the regulators are involved in many biological processes, including guiding an organism’s development, scientists need to discover which of these processes is important for wound healing, says Luis Garza, a skin researcher and dermatologist at Johns Hopkins School of Medicine.

The study may provide some clues.
Researchers made small wounds in both the mouths and the inner upper arms of 30 volunteers.
The mouth wounds healed about three times as fast as the wounds made in the arm skin — on average at a rate of about 0.3 millimeters a day in the mouth compared with less than 0.1 millimeter a day on the arm.

Reducing amounts of PITX1 and SOX2 in mouth keratinocytes grown in lab dishes altered the activity of genes involved cell movement. Boosting SOX2 levels in the skin of mice shortened healing time — from about nine days to about three.

Is the body designed to heal itself?

Abstract – The human body has tremendous self-healing capacity and regeneration after injuries and pathogen invasions. These factors are particularly important in older adults which take longer to heal and recover physically. In addition to clinical investigations, perspectives from both experts in the field and the living experiences of the general public could play significant roles to enhance the body’s healing mechanisms in older adults.

A semi-structured interview was conducted which included 15 participants (9 experts and 6 older adults aged 65 years and older).
Content analysis with an inductive approach was employed about participants’ experiences and perspectives.
All participants in this study revealed that self-healing mechanisms can be enhanced through physiological, psychological, and socio-environmental factors.

When more of these factors can be integrated into a recovery management plan, it can hasten self-healing in older adults. Social capability has a profound impact on an individual’s mental health while oral health and hygiene significantly affect the nutritional intake status.

What is the oldest disease known to mankind?

The Next Pandemic – Tuberculosis: The Oldest Disease of Mankind Rising One More Time Amer Saleem and Mohammed Azher Overview Of History Mycobacterium tuberculosis was first isolated on 24 th March 1882 by a German Physician Robert Koch, who received a Nobel Prize for this discovery in 1905 1,

Tuberculosis is one of the oldest diseases in the history of mankind with evidence of tubercular decay found in some Egyptian mummies from 3000-2400 BC 2, The study of tuberculosis was also known as phthisiatry from phthisis, the Greek term for tuberculosis. Hippocrates identified phthisis as the most widespread disease of the time which involved the coughing up of blood, fever and was almost always fatal 3,

Avicenna first identified that pulmonary TB was an infectious disease and developed the method of quarantine in order to limit the spread of disease 4 & 5, The disease was given the name of tuberculosis in 1839 by JL Schonlein 6, Burden Of Disease Tuberculosis (TB) is an infectious disease caused by various strains of mycobacteria; of which the commonest cause is Mycobacterium tuberculosis 7,

The disease can affect any part of human body but commonly attacks the lungs.
One third of the world’s current population has been infected by Mycobacterium tuberculosis and new infections occur at a rate of 1 per second 8,
About 5-10% of these infections leads to active disease which, if left untreated, kills about 50% of its victims.

TB affects approximately 8 million people worldwide and about 2 million people die of this disease annually. In the 19 th century pandemic tuberculosis killed about 1/4 th of the adult population of Europe 9, Nevertheless, these figures may be only the tip of the iceberg.

Tuberculosis is again on the rise and main cause for the resurgence of TB is immunodeficiency as a result of HIV co-infection or, less commonly, immunosuppressive treatment such as chemotherapy or corticosteroids.
Introduction To Mycobacteria Mycobacteria are aerobic and non-motile bacteria (with the exception of Mycobacterium marinum which is motile within macrophages) which are characteristically alcohol-acid fast 10,

They are present in the environment widely in water and various food sources. They are usually considered to be Gram-positive bacteria, but they do not generally retain the crystal violet stain and are thus called Gram-positive acid-fast bacteria. These acid-fast bacilli (AFB) are straight or slightly curved rods 0.2-0.6 mm wide and 1-10 mm long.

Rapid growing: Mycobacteria that forms colonies clearly visible to naked eye within 7 days on sub-cultures
Slowly growing: Mycobacteria that do not form colonies clearly visible to naked eye within 7 days on sub-culture

On the basis of pigmentation mycobacteria are divided into 3 groups:

Photochromogens (Group I): Produce non-pigmented colonies in dark and pigmented colonies when exposed to light and re-incubation e.g., M. kansasii, M. marinum etc
Scotochromogens (Group II): Produce deep yellow to orange colonies when grown in the presence of either light or darkness e.g., M. scrofulaceum, M. xenopi etc
Non-chromogens (Group III & IV): Non-pigmented in light and dark or only a pale yellow, buff or tan pigment that does not intensify after exposure to light e.g., M. tuberculosis, M. avium-intra-cellulare, M. ulcerans etc

For Clinical Purposes mycobacteria are divided into 3 main classes:

Mycobacterium tuberculosis complex: These are the mycobacteria which can cause TB and include M. tuberculosis, M. bovis, M. pinnipedii, M. africanum, M. microti and M. canetti.
Mycobacterium leprae causes leprosy, also known as Hansen’s disease.
Non-tuberculous mycobacteria (NTM) or environmental mycobacteria, atypical mycobacteria and mycobacteria other than tuberculosis (MOTT). These include all other mycobacteria which can cause pulmonary disease resembling tuberculosis, lymphadenitis, skin disease or disseminated disease. These include: Mycobacterium avium complex, Mycobacterium abscessus, Mycobacterium fortuitum and M. Kansasii which can cause both tuberculosis and leprosy in mammals.

Spread Of Tuberculosis Today we know that TB is an airborne and highly infectious disease. A person becomes infected when he or she inhales Mycobacterium tuberculosis suspended in air as micro-droplets. Patients suffering from pulmonary TB who have detectable Mycobacterium tuberculosis in their sputum are known as smear positive cases of pulmonary TB. The bacterial load in sputum can be as high as 10,000,000 bacilli/mL. When such smear positive patients of pulmonary TB cough, sneeze or expectorate they produce micro-droplets of phlegm containing Mycobacterium tuberculosis (MTB). The size of these micro-droplets varies from 0.5 to 5mm in diameter. These micro-droplets can remain suspended in air up to 8 hours or even more (depending upon droplet size and environmental conditions including air flow). A single sneeze can produce up to 40,000 of these droplets 11, MTB cannot invade the mucous membranes of the respiratory tree and must reach the alveoli where it replicates. The size of the MTB-containing micro-droplet must be <1mm to be carried to the end of the bronchial tree otherwise it will be deposited on the walls of bronchial tree and cleared away by mucociliary action. Current knowledge asserts that even less than 10 bacteria may cause pulmonary infection 12 & 13, A sputum smear positive patient of TB, if left untreated, can cause infection in 10-15 new people each year. Definition of TB contacts: People exposed to someone with infectious TB, generally including family members, roommates or housemates, close friends, coworkers, classmates, and others. They are a high priority group for latent-TB infection (LTBI) treatment as they are at high risk of being infected with TB. Definition of close TB contacts: A person who had prolonged, frequent, or intense contact (i.e. >8 hours/day) with a person with sputum positive TB while he or she was infectious. They are more likely to become infected with TB than the contacts those who see the patient less often. Pathogenesis Once in the distal end of bronchial tree, MTB is engulfed by a macrophage in order to start replication within this host cell. Depending upon genetic factors, these macrophages can provide a variable environment for the replication of MTB. If this primary infection starts with a single mycobacteria and the initial host response is incapable of halting this process, within weeks or months there will be millions of tubercle bacilli within the body. MTB spreads in sequence from this primary site to the hilar-mediastinal lymph node initially. When seen on the X-ray, this primary focus of pulmonary infection is called a Gohn focus. It is generally located in the upper lobe or the apical segment of the lower lobe 7, The Gohn focus plus enlarged hilar-mediastinal node is called a Gohn complex. Tubercle bacilli enter the thoracic duct from the hilar-mediastinal lymph nodes, then by passing via the subclavian vein and right atrium, gain access to pulmonary and systemic circulation. As a result MTB can access, and subsequently infect, any organ of the body. Immunocompetent hosts can normally generate an effective immune response within 3-8 weeks, which tackles the primary Gohn focus and can cause involution of the lesions throughout the body. This immune response is a delayed type hypersensitivity reaction to the cell wall protein of bacilli and this is also responsible for positive tuberculin skin test, which appears 4-12 weeks after infection. The primary immune response is not however sufficient to sterilize the tissues and MTB can remain dormant in these foci. Latent foci may persist in the lungs or other organs of the body and are capable of producing disease reactivation which may be pulmonary or extra-pulmonary. In some cases where the initial host response is not capable of causing involution of the primary disease (such as infancy or an immunocompromised state) the infection proliferates and spreads, causing so-called “progressive primary disease”. Mycobacterium bovis is a mycobacterium that causes tuberculosis in cattle but which can also infect humans. It can be transmitted from cattle to human by ingestion of infected milk and very rarely by inhalation of animal aerosol micro-droplets and by eating infected raw meat. The process of pasteurisation kills M. bovis and other bacteria in milk, meaning that infections in human are rare 14, When To Suspect Tuberculosis Primary Tuberculosis: Tuberculosis caused by infection with tubercle bacilli and characterized by the formation of a primary complex in the lungs consisting of a small peripheral pulmonary focus and hilar or para-tracheal lymph node involvement; it may cavitate and heal with scarring or progress. It is mainly seen in children but 10% cases of adults suffering from pulmonary TB have primary infection. Reactivation Tuberculosis: Also known as chronic TB, post-primary disease, recrudescent TB, endogenous reinfection, and adult type progressive TB. It represents 90% of adult cases (in a non-HIV population), and is due to reactivation of dormant AFBs which are seeded at the time of the primary infection. The apical and posterior segments of the upper lobe and superior segment of the lower lobe of the lung are frequently involved. Clinical Features: Symptoms and signs vary greatly as do radiological signs. A literature review showed that common signs and symptoms seen in TB infection were 15, 16, 17, 18 :

Cough, which can be either productive or non-productive; it is often initially a dry cough which can later become productive.
Fever which seen in usually 70% of cases; generally it is low grade but could be as high as 390C, lasting for 14 to 21 days and in 98% cases is resolved completely by 10 weeks.
Night sweats which is usually seen in 50% of cases
Weight loss
Pleural effusion: 50% of the patients with pleuritic chest pain had pleural effusion
Chest pain: mainly pleuritic with some patients describing retrosternal and inter-scapular dull pain occasionally worsened by swallowing. This pain is believed to be due to enlarged bronchial/ mediastinal lymph nodes
Dyspnoea can be present in 33% of cases
Haemoptysis can be seen in 25%of cases
Fatigue
Arthralgia
Pharyngitis

Common radiological findings were as follows:

Hilar lymphadenopathy: can be seen as early as 1 week after the skin conversion and in almost all of cases within 2 months. It can be associated with right middle lobe collapse
Pleural effusion: typically within the first 3-4 months but can be seen as late as one year
Pulmonary infiltrates mainly in the upper zones and peri-hilar areas

How To Investigate 19
HIV testing should be done in all patients presenting with clinical features of tuberculosis
Active Pulmonary TB

CXR: Perform an X-ray chest PA view. If the appearance is suggestive of active tuberculosis perform further investigations
Sputum smear & culture for AFB: send at least 3 sputums for AFB smear and culture including at least one early morning sample. This ideally should be before starting treatment or within 7 days of starting treatment.
If clinical features and CXR are suggestive of active TB, do not wait for culture and sensitivity results, start the patient on the 4 drug initial treatment. This can be modified according to culture results later on.

Active Non-Respiratory TB A tissue sample should be taken from the suspected non-respiratory site and sent for histological analysis, AFB smear and culture analysis. Common examples of non-respiratory tuberculosis are tuberculous lymphadenopathy, tuberculous meningitis and disseminated tuberculosis.

Physicians should think about CNS tuberculosis such as TB meningitis if a patient with risk factors (i.e., immigrants from endemic areas, positive history of close contact etc) presents with signs and symptoms such as headache, low grade fever, photophobia and/ or focal neurological signs. Lumbar puncture (LP) after a CT brain to rule out any contra-indication for LP may yield the diagnosis in these scenarios.

An MRI brain is also very sensitive for picking up tuberculomas in such cases. Latent TB Offer Mantoux testing to the household contacts and close contacts of the person with active TB (aged 5 and older). If the Mantoux is positive or if results are unreliable, as can be the case with BCG-vaccinated persons consider interferon gamma testing (T-spot TB Test).

If Mantoux is inconclusive, the patient should be referred to a TB specialist.
A similar approach should be used for new entrant TB screening.
QuantiFERON-TB Gold (QFT-G) Test & QuantiFERON-TB Gold in Tube (QFT-GIT) Test Both of these tests have replaced the QuantiFERON-TB (QFT) Test.
It is an interferon gamma release assay (IGRA) and measures a component of cell-mediated immune reactivity to mycobacterium tuberculosis.

In QFT-G test a blood sample is mixed with antigens (2 Mycobacterium TB protein) and a control. Mixtures are incubated for 16 to 24 hours and then the amount of interferon gamma is measured. If the patient is infected with mycobacterium TB, white blood cells will release interferon gamma when they come in contact with TB antigens.

This test requires a single patient visit to draw a sample
Results are available within 24 hours
Results are not dependent on reader
It is not affected by prior BCG vaccination

Its limitations/ disadvantages include:

The blood sample must be processed within 12 hours of collection (while white cells are still viable)
There is limited data for use of QFT-G in immune-compromised patients, children under 17 years of age and persons recently exposed to MTB
False positive results may occur with Mycobacterium szulgai, kansasii and marinum infection

QFT-GIT is a modification of QFT-G test. It consists of 3 blood collection tubes containing: 1) no antigen, 2) TB antigen, 3) mitogen. These tubes must be transferred to an incubator within 16 hours of blood collection. Interferon gamma detection is then carried out via ELISA.

Its specificity varies from 96-99% and sensitivity is as high as 92% in individuals with active disease. T-Spot TB Test It is a type of ELISPOT assay, developed by the researchers at the University of Oxford in England. It counts the number of effector T-cells in the blood that produce gamma interferon so gives an overall measurement of antigen load on immune system.

As it does not depend upon production of antibody or recoverable pathogen, it can be used to detect latent TB and it is much faster. In one study it was found that its sensitivity is 97.2% 20, Treatment Of Tuberculosis (Caused By Mycobacterium Tuberculosis) Active TB will kill 2 of every 3 people affected, if left untreated.

Disseminated TB is 100% fatal if untreated.
For the treatment of TB, drugs are used in combination and never singly.
Patients require regular supervision of their therapy during treatment to monitor compliance and side effects of medications.
Treatment of atypical mycobacterial infections should be under the care of specialized units as this needs special care and drug regimens are complicated.

Drugs for treatment of TB are divided into 3 categories: 1 st Line Drugs: 1 st line anti-TB drugs are very effective against TB. There are 5 first line drugs. All have 3 letter and 1 letter standard abbreviations.

Rifampicin is RMP or R
Isoniazid is INH or H
Ethambutol is EMB or E
Pyrazinamide is PZA or Z
Streptomycin is STM or S

Using a single drug usually results in treatment failure and drug resistant strains 21, The frequency of Mycobacterium tuberculosis developing spontaneous mutations conferring resistance to an individual drug is well known: 1 in 10 7 for EMB, 1 in 10 8 for STM & INH, 1 in 10 10 for RMP 22,

A patient with extensive pulmonary TB usually has 10 12 bacteria in his body and hence will have about 10 5 EMB-resistant bacteria, 10 4 STM-resistant bacteria, 10 4 INH resistant bacteria and 10 2 RMP resistant bacteria. Drug-resistant tuberculosis occurs when drug-resistant bacilli outgrow drug-susceptible bacilli.

Mutations can produce bacilli resistant to any of the anti-tuberculosis drugs, although they occur more frequently for some drugs than others. The average mutation rate in M. tuberculosis for resistance to isoniazid is 2.56 x 10 -8 mutations per bacterium per generation; for rifampicin, 2.25 x 10 -10 ; for ethambutol, 1.0 x 10 -7 ; and for streptomycin, 2.95 x 10 -8,

The mutation rate for resistance to more than one drug is calculated by multiplying the rates for the individual drugs. For example, the mutation rate for resistance to both isoniazid and rifampicin is approximately 2.56 x 10 -8 times 2.25 x 10 -10, or 5.76 x 10 -18, The expected ratio of resistant bacilli to susceptible bacilli in an unselected population of M.

tuberculosis is about 1:10 6 each for isoniazid and streptomycin and 1:10 8 for rifampicin. Mutants resistant to both isoniazid and rifampicin should occur less than once in a population of 10 14 bacilli. Pulmonary cavities contain about 10 7 to 10 9 bacilli; thus, they are likely to contain a small number of bacilli resistant to each of the anti-tuberculosis drugs but unlikely to contain bacilli resistant to two drugs simultaneously 23,

There are different regimens available for the treatment of TB.
The initial 2 months of treatment (usually rifampicin based) is called Initial Phase or Intensive Phase Treatment which later leads to Continuation Phase Treatment.
Initial intensive phase treatment is designed to kill actively growing bacteria.

Drugs are listed using their single letter abbreviation and a prefix denotes the number of months a treatment has to be given and a subscript denotes intermittent dosage. For example; 2RHEZ/4RH 3 = 2 months of initial phase treatment with Rifampicin, Isoniazid, Ethambutol, Pyrazinamide and 4 months continuation phase treatment with Rifampicin and Isoniazid given 3 times per week.

2RHEZ/4RH3 (in less endemic areas)
2RHEZ/4RH (mostly practised, especially in non-endemic areas including UK); standard recommended regimen 24
2RHEZ/7RH (in most endemic areas)
2RHEZ/10RHE (in cases of disseminated, bone and CNS tuberculosis)

2 nd Line Drugs 25 & 26: These are less effective than 1st line drugs, have more toxic side effects and are usually not available in most of the developing countries of the world. There are 6 classes of 2ndline anti-TB drugs:

Aminoglycosides: e.g., Amikacin (AMK) & Kanamycin (KM)
Polypeptides: e.g., Capreomycin, Viomycin
Fluoroquinolones: e.g., Ofloxacin, Ciprofloxacin (CIP), Levofloxacin, Moxifloxacin (MXF)
Thioamides: e.g., Ethionamide, Prothionamide
Cycloserine:
p-Aminosalicylic acid: (PAS or P)

3 rd Line Drugs : These are drugs which may be useful, but are not on the WHO list of second line drugs. These are not as effective.3 rd line drugs include:

Rifabutin (this is an effective drug but is very expensive for developing countries, so it not included in WHO list). Occasionally this can be used for patients who are intolerant to or have bacterial resistance to Rifampicin.
Macrolides: Clarithromycin (CLR), Azithromycin
Linezolid: (LZD) not of proven efficacy
Thioacetazone (T)
Thioridazine
Arginine
Vitamin D
R207910: efficacy not proven

Indications of Steroids in the treatment of TB Steroids should be used along with anti-TB drugs in following situations:

CNS TB (proven benefit)
TB pericarditis (proven benefit)
TB involving eye (definitely beneficial)
TB pleuritis (beneficial – 20-40mg tapered over 4-8 weeks)
Extremely advanced TB (beneficial)
TB in children (may be beneficial)
Miliary TB (beneficial)
Genitourinary TB (beneficial)
Laryngeal TB (may be beneficial – scanty evidence)
TB peritonitis (may be beneficial – scanty evidence)

Important Definitions / Terms 25, 27, 28, 29
New Case: A patient diagnosed as having TB who has never had anti-TB treatment before or had taken anti-TB treatment for less than 4 weeks.
Sputum Smear Positive Case of Pulmonary TB: A patient who has 2 out of 3 consecutive sputum samples positive for AFB.
Sputum Smear Negative Case of Pulmonary TB: A patient clinically and radiologically suspected to have pulmonary TB but with 3 consecutive sputum samples which are negative for AFB and is also culture negative for AFB.
Culture Positive Case of Pulmonary TB: A patient with 3 consecutive sputum smear samples which are negative for AFB but with at least 1 specimen positive for AFB in culture.

Short Course Therapy for TB: The short course therapy for treatment of TB includes 2RHEZ/4RH and also known as standard regimen. If PZA is not included in the regimen for treating TB, the course should be extended from 6 months to 9 months. If rifampicin is not included in treatment regimen then the length of course should be 18 months in total.

Treatment Failure: A TB patient is said to have treatment failure if they remain smear or culture positive while on treatment at the 5 th month or if they were initially smear positive, became negative but then reverted to positive at the end of 5months of treatment. Another scenario is that of a patient who was initially smear negative but then becomes smear positive after 2 months of treatment.

Important things to note are:

Never add a single drug to a failing anti-TB regimen
Most cases are due to non-compliance
There is a high chance of Mycobacterium developing resistance to anti-TB drugs

Relapse of TB: A patient is said to have a relapse of TB if they were treated and declared cured but is again smear or culture positive; with the same organism. If the patient gets an infection with a new MTB then they are deemed to be a new case. Because genetic analysis of the infecting MTB is required to determine if re-infection is with the same organism or a new one, it is difficult to accurately diagnose TB relapse.

TB Default Case: A TB patient who completed 1 month of anti-TB treatment, stopped the treatment, and then returns for TB treatment over 2 months after treatment was first initiated.
If the patient returns within 2 months of initial treatment, then his/ her initial regimen should be continued.
Re-treatment Regimen: A patient should be a given re-treatment regimen when they relapse or are a TB default case.

In highly endemic areas for TB, most authorities prefer an initial intensive phase with 5 drugs for 3 months (2 months RHEZS and 1 month RHEZ). Chronic Case of TB: A patient is said to be a chronic case of TB, who remains sputum smear positive after 1 re-treatment course.

Such patients invariably have drug resistant TB. Extra-pulmonary TB: TB involving organs other than lungs is called extra-pulmonary TB. For the purpose of treatment and understanding, TB of the central nervous system is excluded from this classification. Pulmonary TB: Tuberculosis involving lungs is called pulmonary TB.

Respiratory TB: TB involving lungs, pleural cavity, mediastinal lymph nodes or larynx. CNS Tuberculosis: TB can involve the meninges, brain & spinal cord. It is called TB-meningitis, cerebritis & myelitis respectively. Standard treatment is for 12 months and steroids are mandatory.

INH & PZA have 100% penetration into CSF. Miliary Tuberculosis: This a complication of 1–3% of all TB cases. Tuberculosis involving 2 or more organs/ systems of the body is called disseminated TB or miliary TB. It is also called tuberculosis cutis acuta generalisata and tuberculosis cutis disseminate. It is a form of tuberculosis that is characterized by the wide dissemination and by the tiny size of the TB lesions (1–5 mm).

Its name comes from a distinctive pattern seen on a chest X-ray of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term “miliary” tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen.

XDR-TB: Extensively-drug Resistant TB (XDR-TB) is defined as TB caused by mycobacterium tuberculosis resistant to isoniazid, rifampicin, quinolones and any 1 of 3 injectables: kanamycin, capreomycin or amikacin.
Treatment Categories of TB Patients:
There are four treatment categories of TB patients for details see table 1.
Table 1

Treatment Category	Type of TB Patient
Category I	New sputum smear +ve or Smear –ve pulmonary TB cases with extensive parenchymal involvement New severe extra-pulmonary TB cases
Category II	TB relapse casesTB treatment failure cases
Category III	Non-severe sputum smear –ve pulmonary TBNon-severe extra-pulmonary TB
Category IV	Chronic TB case

Directly Observed Treatment Short-course (DOTS): In this programme a trained person observes the patient swallowing tablets for preferably the whole course of treatment or at least the initial 2 months of treatment. Daily or thrice weekly dosages are recommended but twice weekly dosages are not recommended because of the risk of omitting (by mistake or by chance) one dose.

Government commitment to control TB
Diagnosis based on sputum smear microscopy tests done on patients who actively report TB symptoms
Direct observation short course chemotherapy treatment
Definite supply of drugs
Standardized reporting and recording of cases and treatment outcomes

DOTS-Plus: WHO extended the DOTS programme in 1998 to include treatment of MDR-TB and this is called DOTS-Plus. It requires the capacity for drug susceptibility testing and provision of 2 nd line anti-TB drugs with facilities for identification and drug sensitivities.

Latent TB Infection (LTBI): A patient is said to have LTBI when he is infected with MTB but does not have any symptoms and signs suggestive of active TB and has a normal chest X-ray.
Such patients are non-infectious but 10% of these persons go on to develop active TB in their life at a later stage.
They have positive tuberculin skin test and positive Interferon Gamma Release Assay (IGRA) tests (e.g.

T-SPOT.TB test, QuantiFERON-TB Gold &QuantiFERON-TB Gold-in tube tests). There are different regimens for treatment of LTBI, commonly used are the following:

9H; 9 months INH (gold standard – only practised in USA)
6H; 6 months INH
3RH; 3 months INH + RMP (recommended in UK)

Common Causes Of Rising Burden Of Tuberculosis

The following are a few causes of rising burden of TB globally:
Non-compliance with medication
Presence of drug resistant strains of mycobacteria
Faulty regimens
Un-diagnosed cases
Under-diagnosed cases
Lack of newer, more effective anti TB medication.

Role Of Pcr In The Diagnosis Of Tuberculosis There have been a number of studies regarding the role of PCR in the diagnosis of TB. They show that it has a high sensitivity and specificity but gold standard is still tissue smear and culture for AFB. In certain scenarios PCR of different tissue samples (pulmonary or extra-pulmonary) urine, CSF, sputum and blood can be useful and can also tell us about mycobacterial rifampicin resistance.

Inform all patients with infectious TB that they must not travel by air on a flight exceeding 8 hours until they have completed at least 2 weeks of adequate therapy.
Inform all patients with MDR-TB and XDR-TB that they must not travel by air until they are culture-negative.
Advise patients with TB who undertake unavoidable air travel of less than 8 hours’ duration to wear a surgical mask or to otherwise keep the nose and mouth covered when speaking or coughing during the flight. This recommendation should be applied on a case-by-case basis and only with the agreement of the airline(s) involved and the public health authorities at departure and arrival.
Inform relevant health authorities of the intention of a patient with infectious TB to travel against medical advice.
Inform relevant health authorities when a patient with infectious TB has a recent history of air travel (travel within 3 months).

Side Effects Of Medications Used For Treatment Of Tuberculosis 31, 32, 33, 34 Patients who are on treatment for TB should be monitored regularly for any signs of medication toxicity. This may include blood tests in addition to clinical examination. Common side effects of the routinely used 4 anti-TB medications (INH, rifampicin, Ethambutol & PZA) are as follows: Hepatotoxicity: INH, PZA and rifampicin are known to cause liver toxicity.

Ethambutol is a safer medication in patients with known liver problems. INH is contraindicated in patients with active hepatitis and end stage liver diseases.20% patients can have an asymptomatic rise in AST concentration in the first 3 months of therapy. Symptoms of liver toxicity include anorexia, nausea, vomiting, dark urine, jaundice, fever, persistent fatigue, abdominal pain especially in the right upper quadrant.

Routine base line LFTs are recommended prior to starting treatment. After that they should be repeated at least once a month and more frequently in those who are at risk of developing hepatotoxicity. Patients at increased risk of hepatotoxicity include:

HIV positive
Pregnant or post-partum (3 months after delivery)
History of or at risk of chronic liver disease (daily use of alcohol, IV drug users, hepatitis, liver cirrhosis)
Patients taking any other medication which have potential hepatotoxic side effects
The risk of hepatotoxicity increases with age (> 35 years old)

Suspect drug induced liver injury if there is AST/ ALT rise > 3 times base line with symptoms or > 5 times in the absence of symptoms, or disproportionate rise in ALP and total bilirubin. In such a situation:

Stop hepatotoxic anti-TB medications (INH, rifampicin and PZA) immediately
Admit the patient to hospital
Carry out serological tests for Hepatitis A, B, and C (particularly in those who are at risk for hepatitis)
Look for other causes (hepatotoxic medications, high alcohol consumption)
In acutely ill smear or culture positive patients start liver friendly medications i.e. Ethambutol Quinolones, and Streptomycin, until the cause for hepatotoxicity is identified.
Re-challenge: Once LFTs are normal (or < two times the upper normal limit) start with Ethambutol and add INH 1 st, If LFTs do not rise after 1 week add Rifampicin. Next add PZA if there is no rise in LFTs after 1 week of adding Rifampicin. If at any point LFTs increase or symptoms recur, stop the last added drug – as this is the culprit drug.

Gastro-intestinal (GI) upset: GI upset is quiet common with anti-TB medications and usually occur in the first few weeks of therapy. Symptoms usually are nausea, vomiting, anorexia, abdominal pain. In such a case recommend good hydration, change the timing of medication (advise to take with a light snack and at bed time) and also check LFTs for possible hepatitis.

Mild rash or itching: administer anti-histamines 30 minutes prior to anti-TB medications and continue with the therapy. If no improvement, add prednisolone 40mg/day and gradually taper down when the rash clears.
Petechial rash: Red pinpoint sized dots under the skin due to leakage from capillaries – suspect rifampicin hypersensitivity. Monitor LFTs and full blood count. If platelet count is below normal (base line), stop rifampicin and do not restart it.
Erythematous rash with fever: and/ or mucous membrane involvement; stop all anti-TB medications immediately and hospitalize the patient. Rule out anaphylaxis (angio-oedema, swollen tongue, throat, stridor, wheezing, flushed face, hypotension) and Stevens-Johnson Syndrome (systemic shedding of mucous membranes and fever). If situation does not permit to stop TB medication then try 3 new drugs i.e. aminoglycoside and 2 oral agents from second line. Once the rash has settled, can re-introduce first line TB medications one by one every 2-3 days, 1 st rifampicin, then INH, then PZA and then Ethambutol. While re-introduction, monitor the signs and symptoms of rash, if rash recurs at any point remove the last agent added.

Peripheral neuropathy: signs and symptoms include numbness and tingling in feet and hands, increased sensitivity to touch and stabbing pain. INH can cause peripheral neuropathy. It is more common in malnourished people, diabetes, HIV, renal failure, alcoholism, pregnancy and in breast feeding women. Prevention is the key; prophylaxis is with Pyridoxine (vitamin B6) 10mg/ 100mg INH (normally 25 – 50mg) per week is used in high risk patients. Optic neuritis: the main agent responsible for this is Ethambutol. It is dose related and gets more intense if treatment is continued. Signs and symptoms are difficulty in reading road signs, decreased red-green colour discrimination, blurring or vision, and colour blindness. These can be unilateral or bilateral. Ethambutol is not recommended in children <5 years of age as visual changes are difficult to monitor. Visual acuity and colour blindness tests are recommended at baseline and also on a monthly basis. Fluctuations of 1 or 2 lines on the Snellen chart is considerable and Ethambutol must be stopped. More than 10% visual loss is considered significant. Fatigue: INH can cause fatigue and in such situations patients should take the medication at bedtime. If it continues, check LFTs to look for hepatotoxicity. Flu-like symptoms/joint aches and pains: These are usually seen with Rifampicin and treatment is symptomatic. Drug-induced lupus: It is seen with INH and blood tests should be done to differentiate it from SLE. It can be managed with steroids while the patient is taking INH.

Competing Interests None Declared Author Details AMER SALEEM, BSc, MBBS, MCPS, FCPS, Specialist Registrar Chest Medicine, Bedford Hospital NHS Trust, Bedford, UK. MOHAMMED AZHER, MBBS, FRCP, Consultant in Chest Medicine, Bedford Hospital NHS Trust, Bedford, UK. CORRESPONDENCE: DR MOHAMMED AZHER,Consultant in Chest Medicine, Bedford Hospital NHS Trust, Bedford, UK. Email: [email protected]

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The above article is licensed under a, : The Next Pandemic – Tuberculosis: The Oldest Disease of Mankind Rising One More Time

What is the oldest known illness?

Oldest infectious disease of humans September 25, 2013 10:40 pm | Updated November 16, 2021 09:51 pm IST Mycobacterium tuberculosis (MTB) may well be the oldest pathogen to haveinfected humankind. Modern humans (or homo sapiens) emerged out of the “hominid” group almost two million years ago, and began wandering out of Africa about 70,000 years ago to populate the world.

How healthy were these people? What kind of illnesses affected them? Do we carry these afflictions to this date? Questions such as these form the main research themes for a group of scientists who call themselves paleopathologists — paleo for ancient and pathology to define and describe the kind of illness.

One such paleopathologist, Dr. Charlotte Roberts of Durham University, U.K. has written the book “The Archaeology of Disease”, where she argues that analysis of the DNA found in ancient human samples would help in understanding the origin and history of diseases that have affected us since antiquity.

Dr. Garth Sundem writes in his lucid essay ” ” that in such studies, one should distinguish between diseases caused by external agencies (addiction, poisoning, infection) and age-dependent bodily dysfunctions (arthritis, epilepsy and such “conditions”) which are innate natural process of systemic malfunctions.

The clue to zone in on the most ancient infection comes from both a study of bone abnormalities (seen in excavated bodies and mummies) and from analysis of all the DNA present in them. He points out that, contrary to the oft-quoted statement, dead men do tell tales.

Such a double analysis, plus information contained in ancient texts from across the world suggest the presence of ten diseases to be among the oldest to affect mankind. These are: tuberculosis (or TB), leprosy, cholera, smallpox, rabies, malaria, pneumonia, trachoma (chronic infection of the eyelid), influenza, measles and the black plaque.

This list has been compiled by analysing information available from ancient texts and books such as the Vedas, the Bible, Greek history, oriental texts and oral history. The Rigveda (about 1500 BC) refers to TB and leprosy, the Egyptian “Ebers papyrus” (about 1500 BC) mentions leprosy, Thucydides of Greece (430 BC) mentions the plague, the Bible (Leviticcus 13.2) talks about leprosy and the Romans describe malaria.

Aboriginal skeletons (800 BC) have shown skull lesions around the eyes, later suggested by circumstantial evidence as due to trachoma.
Sundem also refers to the analysis in Israel of the fossilized bones of a mother and child (estimated to be about 9000 years old) revealing the infection as due to TB, and also to a Turkish sample even older (50,000 years old!) again with the suggestion of TB affliction.

It would thus seem that mycobacterium tuberculosis (MTB) may well be the oldest pathogen to have infected humankind. MTB comes not as single strain but there are as many as 259 varieties that we know of today. Yet, DNA analysis of these strains has revealed not a great deal of diversity or heterogeneity, but very few mutations and nearly identical DNA sequences.

Earlier work on such low level genetic variation, studied in 2005 by Dr.
Veronique Vincent and colleagues at the Pasteur Institute, Paris, suggests that the present-day bacterium originated form a precursor or progenitor species — call it mycobacterium proto-tuberculosis, which could be as old as 3 million years.

And the question is — when did this divergence from the single ancestor progenitor occur, how closely related in their DNA these 250 strains are and how sensitive or resistant each set of these strains is towards anti-tubercular drugs that we have today.

It is here that the recent paper by an international group led by Dr. Sebastien Gagneux of the Swiss Tropical and Public Health Institute, published in the 1 September 2013 issue of Nature Genetics is of value. The group analysed the DNA sequences of 259 TB strains from around the world, and showed that genetic diversity arose in them roughly around 70,000 years ago, concurrent with the outward migration from Africa of anatomically modern humans.

When interviewed, Dr Gagneux pointed out that “the evolutionary path of humans and the TB bacteria show striking similarity. We see that diversity of MTB has increased markedly when human population expanded.” In other words, what was dormant and restricted largely to the Rift Valley of Africa, where our far remote ancestors lived, became active and diverse as they started living in communities and passed on infection from person to person.

What did people believe caused disease in medieval Europe?

IN THE TRADITION OF CLASSICAL ANTIQUITY – In the Middle Ages, the practice of medicine was still rooted in the Greek tradition. The body was made up of four humors: yellow bile, phlegm, black bile, and blood. These were controlled by the four elements: fire, water, earth, and air.

An imbalance of humors caused disease and the body could be purged of excess by bleeding, cupping, and leeching – medical practices that continued through the Middle Ages.
Many diseases were thought to be caused by an excess of blood in the body and bloodletting was seen as the obvious cure.
An important aspect in the treatment of ailments was diet.

The food choices we make can have an important impact on health. This was known since antiquity for Hippocrates is quoted as saying, “Let food be thy medicine and medicine be thy food.” The Greek concept of the four humors as revised by Galen was the basis of all diagnosis and treatment, but it had evolved into a theory of temperament, which accounted for psychological and social as well as physical characteristics.

An excess of blood, phlegm, yellow bile, or black bile made a person sanguine, phlegmatic, choleric, or melancholic.
Physicians were, however, trained in the art of diagnosis: observation, palpation, feeling the pulse, and urine examination were the tools of the doctor throughout the Middle Ages.
They were often shown in manuscripts holding a urine flask up for inspection or feeling the pulse.

On first visiting patients, doctors noted their appearance, listened to their stories, felt their pulses, and examined their urine. Urine inspection was the most common method of diagnosis and the urine flask became the symbol of the doctor. In our time of course, the stethoscope is the symbol of the doctor, but that too may change. Medieval doctors used the color of urine to diagnose an illness. Physician examining a urinal The belief in classical antiquity that the moon and planets played an important part in good health continued in the Middle Ages. They believed that the human body and the planets were made up of the same four elements (earth, fire, air, and water). For the body to operate well, all four elements had to be in harmony with no imbalances.

It was believed that the moon had the greatest influence on fluids on earth, and that it was the moon that had the ability to affect positively or negatively the four elements in the body.
Where the moon and planets were, a knowledge of this was considered important when making a diagnosis and deciding on a course of treatment.

Physicians needed to know when to treat a patient and when not to, and the position of the planets determined this. A so-called Zodiac Chart also determined when bloodletting should be done as it was believed by some that the moon and planets determined this as well.

How long were humans meant to live?

Extinct species – We found the lifespan of the bowhead whale, thought to be the world’s longest lived mammal, is 268 years. This estimate is 57 years higher than the oldest individual that has been found, so they may have a much longer lifespan than previously thought.

We also found the extinct woolly mammoth had a lifespan of 60 years, similar to the 65-year span of the modern-day African elephant. The extinct Pinta Island giant tortoise had a lifespan of 120 years by our estimate. The last member of this species, Lonesome George, died in 2012 at age 112. Interestingly, we found Neanderthals and Denisovans, which are extinct species closely related to modern humans, had a maximum lifespan of 37.8 years.

Based on DNA, we also estimated a “natural” lifespan modern humans of 38 years. This matches some anthropological estimates for early modern humans. However, humans today may be an exception to this study as advances in medicine and lifestyle have extended the average lifespan.

What old diseases are no longer around?

Disease	Burden of disease	Cause
Smallpox	Declared eradicated in 1980	Variola virus
Rinderpest	Declared eradicated in 2011	Rinderpest virus
Poliomielitis	116 cases in 2017	Poliovirus
Guinea worm disease	30 cases in 2017	Parasitic worm Dracunculus medinensis

What was the name of the disease that killed 60% of people in the Middle Ages?

Clinical Significance –

• The Black Death or bubonic plague killed more than 25 million people in fourteenth-century Europe. • Yersinia pestis (the plague bacteria) can be easily weaponized as a bioterrorism agent. • Early plague treatment is curative, but its symptomatology can be nonspecific. Modern outbreaks still regularly occur. The plague existed in the ancient world and has killed more than 200 million across centuries. • Familial Mediterranean fever carriers have plague immunity, which is an important evolutionary adaptation.

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What did medieval people think caused illness?

Although many Medieval doctors continued to believe in the theory of the four humours, they also said disease was caused by demons, sin, bad smells, astrology and the stars, stagnant water, the Jewish people etc.

How did medieval people try to prevent disease?

Purifying the air – The miasma theory indicated that unclean air could make people unwell. People tried to prevent disease and illness by cleaning the streets to make sure the air was clean. People would also try to prevent breathing in bad air by:

carrying posies – bunches of sweet-smelling herbs and flowers
lighting fires to drive away any bad air and sometimes burning herbs or substances to ‘clean’ the air
ringing bells or allowing birds to fly around the house to keep the air moving

Medieval towns, especially in late medieval England, worked hard to keep their streets clean. They did this by:

employing rakers to keep the streets clean
punishing people if they threw waste onto the streets – waste was not just everyday rubbish, as it could include human excrement as well
making butchers dispose of their waste outside the city walls
building public latrines

Who were the healers in the Dark Ages?

Women Healers of the Middle Ages: Selected Aspects of Their History Women Healers of the Middle Ages: Selected Aspects of Their History By William L. Minkowsli American Journal of Public Health, Vol.82, No.2 (1992) Introduction: She was known as the Angel of Alsace Street.

As a bonnefemme, she was wise in the ways of folk medicine, midwifery, and disposal of the dead. Responding to all who called on her for healing and comfort, she was cherished in her wretchedly poor English neighborhood. Her compensation was love, respect, and a paltry pittance for her unstinting labors.

She was the woman healer of the Middle Ages, the quintessential woman healer of every age. Healing has always been regarded as the natural responsibility of mothers and wives. With techniques learned from family and friends or from observation of other healers, women have always succored the whimpering, feverish child and mended the wounded worker-warriorhunter husband.

But because they were excluded from academic institutions, female healers of the Middle Ages had little opportunity to contribute to the science of medicine.
Rather, they served as herbalists, midwives, surgeons, barber-surgeons, nurses, and empirics, the traditional healers.
As women of lower or higher birth, as nuns in convents or members of secular orders, these healers were notable for their devotion to the sick under the most stressful circumstances.

Untutored in medicine, they used therapies based on botanicals, traditional home remedies, purges, bloodletting, and native intelligence. Their medications were compounded of plant materials, some superstition, and a dash of charlatanism. : Women Healers of the Middle Ages: Selected Aspects of Their History

What is a voodoo doctor?

From Wikipedia, the free encyclopedia Two Lassa witch doctors in Nigeria A witch doctor (also spelled witch-doctor ) was originally a type of healer who treated ailments believed to be caused by witchcraft, The term is now more commonly used to refer to healers, particularly in regions which use traditional healing rather than contemporary medicine,

What gender is the Witch Doctor?

Idea: Male and Female Variants of Most NPCs NPC names are re-rolled whenever they die and respawn, which implies it’s a different person every time, so I think it’d be interesting and add some variation to the game if that was expanded on by letting most of them be male or female.

The change would be mostly a sprite- and name-pool-swap, but NPC interactions would also change (eg. the Wizard would mistake the player for any NPCs of the same gender, or always recognize them if there are none in the world). Male and female versions of the same NPC would still be recognizable as that NPC, and would be called the same thing in all cases except the Party Girl/Guy.

The male version of the Nurse costume might have to be changed to look like whatever the male Nurse looked like. I leave it up to the developers to decide what they’d want to do about NPC-NPC romance, if anything. There are three special cases that need to be addressed:

NPCs you rescue : the Angler, Stylist, Goblin Tinkerer, Mechanic, Clothier, and Tax Collector. The fact that you need to rescue these guys before they move in (especially the Clothier, who is present on worldgen as the Old Man) implies that it’s one person each who keeps respawning instead of different people coming to fill the same role. This could be emphasized by having their name and gender fixed when they are rescued (or at worldgen/after defeating Skeletron for the Clothier), meaning that a female Mechanic named Marshanna will always be replaced by another female Mechanic named Marshanna, and so on. The fact that most of them will keep appearing until you rescue them would effectively allow the player to choose whether the corresponding NPC for that world is male or female by waiting for a male/female Sleeping Angler/Bound /Tortured Soul to spawn. NPCs with no apparent gender : the Skeleton Merchant, Witch Doctor (a male Lihzahrd, who knew), Truffle, and possibly the Cyborg. These would not have variations. NPCs based off of pre-existing characters : the Tavernkeep and Santa Claus. These two would stay as themselves, but, although she’s less iconic of the Christmas season, a Mrs. Claus could also be added if desired.

What do you guys think?

Does Witch Doctor use intelligence?

Intelligence – Intelligence is the core stat used by the Witch Doctor and Wizard classes. Intelligence is the core stat that provides a damage boost to these two classes. In addition, Intelligence provides all classes with a boost in Resistance to All Elements.

What was used as medicine during the primitive era?

The bark of the willow tree contains one of the oldest medicinal remedies in human history. In its modern form, we call it aspirin. More than 3,500 years ago, the ancient Sumerians and Egyptians used willow bark as a traditional medicine for pain relief.

How did doctors treat many illnesses during the Middle Ages?

An imbalance of humors caused disease and the body could be purged of excess by bleeding, cupping, and leeching – medical practices that continued through the Middle Ages. Many diseases were thought to be caused by an excess of blood in the body and bloodletting was seen as the obvious cure. An important aspect in the treatment of ailments was diet.

An excess of blood, phlegm, yellow bile, or black bile made a person sanguine, phlegmatic, choleric, or melancholic.
Physicians were, however, trained in the art of diagnosis: observation, palpation, feeling the pulse, and urine examination were the tools of the doctor throughout the Middle Ages.
They were often shown in manuscripts holding a urine flask up for inspection or feeling the pulse.

It was believed that the moon had the greatest influence on fluids on earth, and that it was the moon that had the ability to affect positively or negatively the four elements in the body. Where the moon and planets were, a knowledge of this was considered important when making a diagnosis and deciding on a course of treatment.

What did the Egyptian doctors use to treat illnesses?

2. Some basic concepts about traditional ancient Egyptian medicine – Ancient Egyptians did not have a clear dichotomy between both medicine and magic, they considered health and illness resulted from a person’s relationship with the universe including people, animals, good and bad spirits ( Zucconi, 2007 ).

The basic concept of health and disease according to the Ebers Papyrus is that the body has twenty-two mtw (vessels) which connect the body carrying various substances such as blood, air, semen, mucus, and tears. These mtw (vessels) are linked up at some junctures, controlled by the heart, and opened to the outside from several points like an anus.

Egyptian healers should determine the condition of mtw -vessels by examination of the patient’s pulse. The balance ( maat ) of this movement is vital for human health just like the balance of the Nile flooding and irrigating is vital for Egypt. If the mtw -vessels were blocked by foreign or noxious matters ( wekhedu ), the disease takes place.

These matters may enter the patient’s body through wounds or natural openings ( Veiga, 2009, Zucconi, 2007 ).
Medical practice was rigidly prescribed by the Hermetic Books of Thoth, and if a patient died as a result of a deviation from this strict line of treatment, it was regarded as a capital crime, if the patient didn’t improve after four days of treatment, physicians were allowed to modify the treatment ( Garrison, 1921 ).

There was a hierarchy of medical profession starting with the ‘swnw’ (ordinary doctor); ‘imyr swnw’ (overseer of doctors); ‘wr swnw’ (chief of doctors); ‘smsw swnw’ (eldest of doctors); and ‘shd swnw’ (inspector of doctors) ( Reeves, 1992, Sullivan, 1995 ), there is also evidence proved the existence of women physicians ( Willerson and Teaff, 1996a ).

Ancient Egyptians got a surprising knowledge about anatomy, a lot of diseases of the osseous, alimentary, respiratory, circulatory, genital, muscular, nervous, ocular, auditory, and olfactory systems were described in details, They identified the function of the heart, and its relation to the two types of blood vessels, in addition, cerebrospinal fluid was known to them too ( El-Assal, 1972 ).

They wrongly thought that the heart was the center for all body fluids including urine and tears ( Ja, 1962 ). The surgery in ancient Egyptian was so advanced, surgeons used various instruments similar to what we using today such as the scalpel, forceps, and scissors, splints were made of reeds tied together by strips of linen or pieces of wood padded with plant fibers ( Reeves, 1992, Saber, 2010 ).

They sutured wounds, stopped bleeding using cautery ( Reeves, 1992, Saber, 2010 ).
Boils, abscesses, and septic wounds were opened surgically and drained by pieces of linen, and poultices were used as well ( Sipos et al., 2004, Todd, 1921a ).
A dislocated shoulder was treated in a similar way to the Kocher method, also a dislocated mandible was reduced by the method used today ( Sullivan, 1996 ).

The plaster used for fractures consisted of linen soaked in a sticky material which hardened, They made circumcision a lot and there are some reports documented a surgical treatment of a hernia ( Ja, 1962, Saber, 2010 ). They knew psychology; Diodorus reported that it was written over the library of the Ramesseum ” Healing Place of the Soul “.

The patient suggested to write his troubles in a letter to dead relatives (catharsis), also there were some specialists in dream interpretation ( El-Assal, 1972 ). In most cases, doctors prescribe a remedy of different drugs, not a single drug. The routes of drug administration were basically five; oral, rectal, vaginal, topical, and fumigation.

Treatments were given in different forms like; pills, cakes, ointments, eye drops, gargles, suppositories, fumigations, and baths ( Bryan, 1930 ).

What was the way medieval practitioners tried to prevent illness and disease?

carrying posies – bunches of sweet-smelling herbs and flowers
lighting fires to drive away any bad air and sometimes burning herbs or substances to ‘clean’ the air
ringing bells or allowing birds to fly around the house to keep the air moving

Medieval towns, especially in late medieval England, worked hard to keep their streets clean. They did this by:

employing rakers to keep the streets clean
punishing people if they threw waste onto the streets – waste was not just everyday rubbish, as it could include human excrement as well
making butchers dispose of their waste outside the city walls
building public latrines