Prof /Nawal S.

Banafa

*Natural history of disease(dynamic of disease.

*The Iceberg Phenomena in Human Diseases
 Natural History of Disease
Refers to the course or progression of a
disease takes, if it is left on its own , without
any intervention (preventive ,promotive ,
curative { medical or surgical nature}).

Stages Natural history of the disease :

1-Stage of pre-pathogenesis (pre disease)

2-Stage of pathogenesis:
HOW IT PROGRESSES?
Stages Natural history of the disease :
1-Stage of pre-pathogenesis (pre disease)
(susceptibility) = well:
The disease has NOT developed (man is not yet involved)
but man is very much exposed to risk factors which increase
the likelihood that the disease will develop.
2-Stage of pathogenesis:
It starts with entry of the agent in the human host and the
start of pathologic changes: (two sub stages):

a) Pre-symptomatic stage (latent disease ):

No signs or symptoms (incubation period)
It is the interval between the entry of disease cause into the body and
beginning of first non-specific symptoms and signs of disease
There are no manifestations of disease during this stage
Length of incubation period depends on:
1-The rate of proliferation of the causative agent,
2-Host defense mechanisms,
3-Previous sensitization of the host body by exposure to
disease agent,
4-Dosage of infectious agent.
b) Clinical disease stage (symptomatic disease):
Arising first non-specific symptoms and signs of disease
(prodromal stage )

There are specific symptoms and signs of specific disease (specific

manifestation of disease )
 Outcome (end results) of the disease process:

 Recovery (cure).
 Chronicity.
 Disability ((any limitations of person's activities
-mental or physical- as a result of acute or
chronic condition).
 Death.
The Iceberg Phenomena in Human Diseases

the magnitude of disease that is apparent

clinically is a small fraction of the entire load;
the major part of the load is not clinically
apparent (lies below the clinical horizon) and
hence lies hidden in the community.
This is in the same way that the part of an
iceberg which lies above the surface of water
is actually a very small part of the total
iceberg which lies submerged beneath the
water surface.
Component of the iceberg:
*Floating part ( what the physician sees)

*submerged portion (in apparent, pre-

symptomatic ,un-diagnosis ,carrier )

*the water line (between apparent and in

apparent )