Hygiene Among the Greeks

• Epidemics have shifted from being seen as divine punishments to manifestations of microscopic infectious agents.
• Hygiene, including personal, public, and hospital hygiene, has fluctuated in importance over the centuries along with the fight against infectious and epidemic diseases.

Antiquity: Hygiene Among the Greeks

• Hippocrates, born in 460 BC, believed disease stemmed from an imbalance in the body's four humors: blood, yellow bile, phlegm, and black bile.
• This imbalance could result from internal factors, dietary errors, or environmental causes like winds, seasons, and temperature.
• Disease has natural causes, not divine intervention; good hygiene helps to prevent illness and maintain health.
• Gymnasiums emerged in the 7th century BC as spaces for both intellectual and physical activities, including sports, diet, and hygiene.
• Public fountains were built, making water available for domestic use, and baths were gradually installed in gymnasiums.

Antiquity: Hygiene Among the Romans

• Romans greatly valued public hygiene, surpassing other ancient civilizations in this area.
• They emphasized thermalism, placing it at the center of their lifestyle.
• Roman bathhouses were inspired by Greek models but improved over time, serving as social hubs and places for well-being and personal care.
• These grand and refined establishments were frequented by all social classes and included cold baths (frigidarium), warm baths, and hot baths (caldarium), heated by hypocaust systems.

Antiquity: Epidemics

• Reliable sources on early epidemics are scarce, but they likely began in antiquity or even the Neolithic period with the rise of villages and higher population densities.
• The development of large empires and increased trade facilitated the spread of diseases beyond local areas.
• All severe epidemic illnesses were broadly categorized as "plague."
• The "Plague of Athens" began in Ethiopia and spread to the Mediterranean, killing 25% of Athens' population around 430 BC. Its precise nature is unknown, but it was likely typhus or smallpox.
• The "Antonine Plague" struck Rome in 166 AD and lasted until around 190 AD, likely originating in Mesopotamia and reducing the empire's population by 10-25%. Evidence suggests it was actually an epidemic of smallpox.

Middle Ages and Modern Era: Key Ideas in Medicine

• The Salernitan School of Medicine was founded in the 9th century at the crossroads of Mediterranean civilizations; it was the first European institution to offer structured medical education.
• Its reputation was based on the 12th-century book "The Salernitan Health Regime".
• The book advises to breathe pure air, adjust exercise and bathing, get 6-7 hours of sleep, practice daily careful hygiene (including dental care), eat two meals a day, and eliminate bodily waste through purges and bloodletting.

The Renaissance and Hygiene Practices

• Despite the common image, people in the Middle Ages were concerned about cleanliness and hygiene.
• Public hygiene was problematic, with poor sewage disposal, street filth, and rat infestations leading to unsanitary conditions and disease spread.
• The Renaissance saw a decline in personal hygiene, especially bathing, due to the association of public bathhouses with debauchery and fears of waterborne illnesses.
• Washing was reduced to wiping visible parts of the body, with a focus on clean clothing.

Responses to Epidemics

• Epidemics influenced medical thought, leading doctors to question the miasma theory, which attributed diseases to foul air from decaying organic matter.
• Girolamo Fracastoro proposed the idea of interpersonal contagion, proposing invisible particles ("seminaria") that could invade the body and transmit through direct contact, vectors, or air.

Public Health Measures

• Leaders gradually recognized the dangers facing populations, leading to public hygiene initiatives, like sanitation, better housing, and promotion of healthy habits.

More Epidimics: The Black Death

• Numerous epidemics ravaged Europe during this period, with the Black Death having the most significant impact.
• This bacterial infection, spread by rat fleas, was contagious through saliva and direct contact; originating in extreme East, it spread through trade routes.
• The disease reached Constantinople in 1347 and quickly spread to Mediterranean port cities before arriving in Paris in 1348.

Responses and Death Toll

• Due to the limited knowledge of the period, the virulence of the infection was alarming and caused significant numbers of deaths.
• Responses were varied, including incinerating bodies, isolating the sick, and quarantining ships; within 5 years, the Black death devastated over a quarter of Westerners and similar amounts in the East.
• Physicians wore long black robes, gloves, and a beaked mask filled with vinegar-soaked sponges.

Responses to Syphilis

• Syphilis spread in Europe, playing a role in understanding contagion; the disease spread rapidly through seuxal contact and stigmatized society.
• The origin of the disease has been debated, but some believe it was transported from America.
• Syphilis has been associated with feelings of guilt and shame, affecting all social classes.

Responses to Smallpox

• Smallpox also devastated the Americas, decimating native populations lacking immunity to the disease.

Contemporary Era: Major Advances:

• The 18th century saw adoption of "variolation", inspired by Chinese practices.
• The notion of variolation consisted of deliberately infecting people with smallpox pus.
• Edward Jenner noticed that cowpox seemed to protect humans from smallpox; he performed an experiment by injecting pus from a cowpox lesion into James Phipps.

Progress in Vaccination and Germ Theories

• Despite initial resistance, Jenner's vaccination method spread rapidly, and in 1980, smallpox was declared officially eradicated.
• Louis Pasteur discovered that weakened bacteria could still provide protection against diseases such as chicken cholera.
• Lister used phenol to clean wounds and surgical instruments, resulting in significant reduction in post op infections, marking the birth of antisepsis.

Contagion and Germ Theory

• Despite the advancements in microscopy, germ theory had yet to gain widespread approval, and the study of micro organisms was born.
• Louis Pasteur’s swan neck flask experiment proved microorganisms can only develop if introduced from outside and therefore disproving "spontaneous generation".
• Koch contributed to the foundation of microbiology by discussing the specific causal link between disease and a given microorganism.
• Pasteur and Koch identified numerous pathogenic organisms.

Cholera and Epidemiology

• Cholera is a waterborne disease caused by bacteria, causing dehydration and possibly death.
• John Snow found those affected lived near the Broad Street pump, the handle was removed and cases declined; this established water was responsible.
• John Snow also developed anasthesia with Choloroform.

AIDS

• In 1981, the Centers of Disease Control noted high demand for a drug used to treat immnocompromised patients.
• The first cases were patients within gay communities and research narrowed it down to the origin being the same disease affecting monkeys within Africa, being transmitted inadvertently to humans.
• The research team at the Pasteur Institute identified HIV.

Conclusions on Disease Control

• We understand the mechanism for prevention, sanitation, and asepsis, and largely treat them with antibiotics.
• Despite our knowledge, it overlooks the diversity and evolutionary capabilities of microbes.
• An epidemic is the result of a connection between a microbe, a population, and an environment.