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Nigel Paneth
Triumphs Of Epidemiology
Identification of water as a major reservoir and vehicle of communicable diseases such as cholera and typhoid fever (1849 - 1856) Identification of arthropod vectors for many diseases - malaria, yellow fever, sleeping sickness, typhus (1895-1909) Identification of the asymptomatic carrier as an important vector in typhoid, diptheria, polio (1893-1905)
Vehicle
Reservoir
Sorting out the MODES OF COMMUNICATION of disease, many of which involve vehicles, vectors and reservoirs, is the province of epidemiologists. Only work in the field can uncover the way in which an agent links to a host in the real world outside of the laboratory.
VEHICLE An inanimate object which serves to communicate disease. For example, a glass of water containing microbes, or a dirty rag, etc. VECTOR A live organism that serves to communicate disease. For example, mosquitoes and other arthropods. RESERVOIR A location that serves as a continuing source of disease for example, a water tower (common in legionella infections), the soil for tetanus, etc.
Snow discovered the waterborne route as a major mode of communication of disease, which turned out to apply not only to cholera, but also to typhoid fever and other infections.
In disease prevention, knowing the mode of communication is generally more important than identifying the specific agent. (Consider AIDS and SARS for example). Other routes of transmission were discovered after Snows work, especially arthropod vectors discovered between 1878 1911.
That period (1878 1911) can be viewed as the time of the GREAT VECTOR REVOLUTION. Occurring slightly later than the GREAT BACTERIAL REVOLUTION, it extended the findings of bacteriologists and provided information essential to disease control.
(two other modes of transmission were widely recognized by the 19th century sexual and airborne)
MODES OF TRANSMISSION 1. DIRECT CONTACT 1848 Semmelweis discovered that puerperal sepsis is transmitted manually from the autopsy room to the delivery room by doctors.
Diphtheria
Typhoid
1905
Meningococcus
1905
Polio
Wickman
1892 - Smith and Kilbourne (US) discovered that Texas Cattle Fever is transmitted perinatally by ticks (They also identified the causative babesia organism).
1895 Bruce (UK) discovered that African trypanosomias or sleeping sickness is transmitted by the bite of the Tse-tse fly.
1911 - Typhus
Charles Nicolle demonstrated that typhus is transmitted by lice. (Rickettsia were discovered by Ricketts at about the same time).
1st European epidemic in 1831-2. John Snow, as young apprentice physician, sees cholera cases in Yorkshire.
London and New York hit hard in 1848/9 and 1853/4 (more than 10,000 deaths in each city in each epidemic). Golden Square epidemic of 1854 leaves 500 dead within a 250 yard radius of a single water pump. Official Board of Health investigation denies waterborne transmission, attributes London epidemic to miasmas arising from the Thames.
#5. 1881-1896 BUT OTHERS HAVENT Though Koch had identified vibrio comma in 1883, Hamburg, under influence of Von Pettenkoffer, who did not believe in direct waterborne transmission, experiences 10,000 cholera deaths in 1893, from a clearly waterborne source.