History of Disease

1
History of Disease

• Hughes Evans, MD, PhD

2
Dr. Evans Top Ten
3
(No Transcript)
4
(No Transcript)
5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
Changing health in America

• Life expectancy
• Infant Mortality
• Leading causes of death
• Death rates for specific diseases

13
Life expectancy by sex, 1800-1980

• Average American lives more than 2x as long as
  colonial counterpart
• Colonial era average life expectancy was 30y and
  1/2 children died before age 10
• Why the improvement?
• Why do women live longer?

14
Life Expectancy and Race

• What accounts for differences between white and
  nonwhite?

15
Causes of Infant MortalityNYC, 1898-1950
16
Infant Mortality, 1854-1974

• Deaths in the first year
• as high as 200/1,000 in urban areas
• causes of death
• causes of IM decline
• less diarrheal disease
• improved water
• improved nutrition
• better living conditions

17
Leading causes of death, 1900
1992

• flu/pneumonia
• TB
• gastritis
• heart disease
• stroke
• chronic infections
• accidents
• cancer
• diseases of infancy
• diphtheria

• heart disease
• cancer
• stroke
• pulmonary disease
• accidents
• flu/pneumonia
• diabetes
• HIV
• suicide
• homicide

18
Tuberculosis
19
Tuberculosis and hygiene
20
(No Transcript)
21
(No Transcript)
22
Diphtheria death rate, 1860-1960
23
Small Pox death rate, 1860-1960
24
Decline of infectious diseases

• Cleaning physical environment
• improved living conditions
• decreased crowding
• improved diet
• fewer vitamin deficiencies
• impact on infectious diseases
• regulating water sources and sewerage
• less dysentery, cholera, infantile diarrhea

25
Did medical advances lead to the decline of
infectious diseases?

• Small pox vaccination
• variolation available in 1721, not mandatory
• Streptomycin introduced in 1947 for TB
• TB declining before adequate medical therapy
• Quinine for malaria used since colonial era
• malaria decline reflected changing environmental
  conditions, draining of swamps
• use of insecticides and screens

26
Social Construction of Disease

• Disease is a socially or culturally defined
  notion. Society defines nl vs abnl.
• Examples??
• Numbers like hypertension, cholesterol
• Qualities like appearance, goiters, height
• Genetic make-up like cystic fibrosis
• Can vary over time, culture

27
History and social constructionDemedicalization

• Masturbation
• from disease/sin to bad habit to normative
• Homosexuality
• dropped from psychiatric nosology in 1973
• Drapedomania
• slaves running away
• Neurasthenia, chlorosis

28
History and social construction Medicalization

• Drug addiction
• 1962 Supreme Court declared it a disease
• Obesity
• losing its moral blame
• Alcoholism
• bad habit or disease?
• Pregnancy

29
Anorexia Nervosa

• London 1888
• Characterized by
• Mostly young females
• Food refusal
• Compulsive acts
• Binging/purging

30
Anorexia Nervosa

• present in medieval times
• named and described in 1870s
• rare for a century
• incidence began to rise after WWII
• incidence accelerated over last 30-40 years
• affects 1 million young women in USA
• the characteristic psychopathology of
  middle-class adolescent women

31
Features of Anorexia Nervosa

• Shift from psychiatric to communicable disease
• metaphorical epidemic
• imitative acts
• associated social psychology
• heightened cultural pressure to be thin

32
Anorexia Nervosa over time

• Food Refusal
• Victorian slimness had spiritual and social
  meaning associated somatic complaints
• Today preoccupation with weight and dread of
  fatness
• Ann Beckers work in Fiji

33
(No Transcript)
34
Anorexia Nervosa over time

• Compulsive Acts and Activity
• Victorian compulsive good acts
• Today compulsive exercise
• Both are culturally sanctioned
• Binging and Purging (Bulemia)
• Victorian time alone not available, lack of
  toilets, meals highly visible and social
• Today access to large amounts of food, easy to
  eat alone, easy to hide purged food