REFERENCESLast JM: Public Health and Human Ecology, 2nd Edition.
Stamford, CT: Appleton & Lange, 1998; pp 8-9.Thucydides: The
Peloponnesian War. Translated by Rex Warner. Harmondsworth: Penguin
Classics, 1954; Book 2, Chapter 5, pp 123-129For a good
introduction, see for example McNeill W: Plagues and Peoples. New
York: Doubleday, 1976 Zinsser H, in Rats, Lice and History (Boston:
Little, Brown & Co, 1935) gave a sparkling account of the
influence of typhus on the outcome of wars. Diamond J, in Guns,
Germs and Steel (New York: Norton, 1997) strains credibility with a
grand theory based on flimsy factual foundations Semmelweiss IP:
Die Aetiologie, der Begriff und die Prophylaxis des
Kindbettfiebers. Pest, Wien und Leipzig: CA Hartleben, 1861
*WE THINK WE KNOW EVERY THING ABOUT DISEASE DYNAMICSBUT STILL
THERE ARE GAPS.ARE THEY GAPS IN OUR UNDERSTANDING OR IN
REALITY?THIS ACTUALLY PROMPTED ME EXPRESS MY DOUBTS AND TO DEVELOP
THIS LECTURESECONDLY, I WISH TO GIVE A GROSS PICTURE ABOUT THE
DISEASE TO THE STUDENT DISCUSSING THE PRESENT REALITIES.
**
CONTEXTS TO UTILIZE SIX HONEST SERVINGMEN WHILE PREPARING LESSON
PLAN ON ANY TOPIC
WHAT =DEFINITIONWHY= PUBLIC HEALTH
SIGNIFICANCE(MAGNITUDE)HOW=PROCESSWHEN= TIME TRENDSWHERE= PLACE
DISTRIBUIONWHOM=PERSONS USUALLY AFFECTED
*IS IT AN AFTER-EFFECT OF A GERMS EFFORT TO MAINTAIN ITS OWN
RACE BY MULTIPLYING AND SURVIVING AS A PARASITE IN MAN? IS IT A
DISTURBED MANS INTERNAL AND EXTERNAL ENVIRONMENT DUE NEGATIVE LIFE
STYLES? IS IT THE DESTINED EFFECT ACQUIRED FROM THE FOREFATHERS? IS
IT A GENE AND ENVIRONMENTAL INTERACTION?
ALL ARE TRUE TO SOME EXTENT BUT NONE IS THE COMPLETE ANSWER.
THIS SHOWS THAT DISEASE HAS GOT AS MANY FACES AS GOD AND VERY
DIFFICULT TO DEFINE.
*IT IS ALSO DESCRIBED AS OPPOSITE OF HEALTH WHEREIN SOME PART OR
ORGAN OF THE HUMAN BEING IS DISTURBED OR AFFECTED AT SOME LEVEL,
FROM CELLULAR TO ORGAN OR FUNCTIONAL LEVEL.
SOME THINK LIBERALLY THAT SICKNESS, IMPAIRMENT, DISABILITY AND
HANDICAP ARE SYNONYMOUS WITH THE DISEASE.
USUALLY IMPAIRMENT IS CONSIDERED AS LOSS OF ANATOMICAL PART OF
THE BODY, DISABILITY AS FUNCTIONAL LOSS, HANDICAP AS A SOCIAL LOSS
AND SICKNESS AS A SOCIAL ROLE PLAYED DUE TO ILLNESS. ALL THESE ARE
THE CONSEQUENCES OR EFFECTS OF A DISEASE. **VERY FEW PEOPLE KNOW
AND ACCEPT THAT IT IS DUE TO THEIR OWN NEGATIVE LIFE STYLES
(FAULTS)
SCIENTIFIC PEOPLE BELIEVE IN ALL , INCLUDING SUPERNATURAL ORIGIN
AS THEY CANNOT EXCLUDE IT AS A CAUSE OF THE DISEASE.
ARE THE CONCEPTS OF ORIGIN OF THE DISEASE REALLY CHANGING OR
MIXING ?
*BOTH THESE BELIEFS ARE PERPETUATED BY IGNORANCE, ILLITERACY AND
POVERTY PREVALENT NOT ONLY IN THOSE TIMES BUT ALSO IN THE PRESENT
DAYS
.THIS SUPERNATURAL ORIGIN OF THE DISEASE TOOK SUCH A STRONG
ROOTS IN THE PEOPLES MINDS MAKING THE CONTROL AND ERADICATION OF
ANY DISEASE DIFFICULT EVEN TODAY AS IT IS POTENTIALLY INFLUENCED BY
THE INDIVIDUAL S PERSONAL BELIEFS AND ATTITUDE.
*These human ecological concepts, i.e. the study of human
relationship with environment made the later thinkers search the
cause in environment. His advice in his treatise on Airs, Waters
and Places elucidates vividly the role of environmental influences
upon and relationships with human being in causing the disease.
HE RIGHTLY ADVISED TO SEARCH AIR, WATER AND PLACES FOR THE CAUSE
OF A DISEASE.
It is the first scientific approach or reasoning regarding
disease causation. He loaded the gun of scientific thinking about
disease causation while Pasteur, Henle, Koch and Pettenkoffer
pulled the trigger.
**SELF ELIMINATION OF THE DISEASE
BEING WELL-FED, BETTER HOUSED, WELL-INFORMED, AND SEPARATED FROM
OTHERS BY ENOUGH SPACE TO REDUCE THE PROBABILITY OF
PERSON-TO-PERSON TRANSMISSION OF INFECTION, ALL HELPED TO REDUCE
THE BURDEN OF PREMATURE DEATH.
BEING WELL-FED, BETTER HOUSED, WELL-INFORMED, AND SEPARATED FROM
OTHERS BY ENOUGH SPACE TO REDUCE THE PROBABILITY OF
PERSON-TO-PERSON TRANSMISSION OF INFECTION, ALL HELPED TO REDUCE
THE BURDEN OF PREMATURE DEATH.
*
*These postulates are rigid and strongly confirm one-one theory,
i.e. unifactorial causation of the disease. Though these are true
to some extent for infectious diseases, they cannot explain the
etiology of all diseases, particularly non-infectious diseases.
Moreover it was found that a single cause can cause several
diseases and several causes can cause a single disease refuting 1-1
relationship even with infectious diseases. . Germ cannot be found
in certain diseases, particularly, non-communicable diseases
further contradicting the postulates. Sometimes, disease is found
even in the absence of a germ and vice versa e.g. sputum negative
tuberculosis
*PETTENKOFFER TOOK A RIDE ON THE UNIFACTORIAL THEORY STATING
THAT KOCHS POSTULATES CANNOT EXPLAIN THE NON COMMUNICABLE DISEASE
CAUSATION WHERE ONE CANNOT FIND A GERM. HE GAVE GENERALIZED
EXPLANATION APPLICABLE TO ALL DISEASES, INFECTIOUS AND
NON-INFECTIOUS AS WELL THAT DISEASE IS MULTIFACTORIAL.
PETTENKOFFER CONTRADICTED THE UNIFACTORIAL THEORY OF DISEASE
CAUSATION AND EMPHASIZED THAT DISEASE IS MULTIFACTORIAL IN
CAUSATION. SEVERAL CAUSES OR FACTORS ACTING JOINTLY, CUMULATIVELY,
BY COMPLEMENTING OR IN AN UNEXPLAINED MANNER WILL LEAD TO THE
DISEASE.
THIS THEORY OF WEB OF CAUSATION EXPLAINS BOTH THE INFECTIOUS AND
NON-INFECTIOUS DISEASES. THESE MULTIPLE CAUSES WORK THROUGH
DIFFERENT GROUPS OR CONSTELLATIONS.
* FOR A PLANT TO GROW, SEED MUST BE PLANTED IN A FERTILE SOIL
AND SHOULD BE NOURISHED WITH WATER. SIMILARLY, THE DISEASE OCCURS
ONLY WHEN THE AGENT (SEED) FINDS A SUSCEPTIBLE HOST (FERTILE SOIL)
AND FAVORABLE ENVIRONMENT (SHOWER) FOR INTERACTION. *Actually,
several causes form into groups or constellations to cause the
disease. A necessary or principal cause will be helped and
complemented by other causes (predisposing, enabling,
precipitating, reinforcing causes) making it sufficient to initiate
the disease. Unless a necessary cause has enough support by other
causes by means of their complementing and synergistic action, that
cause can never become sufficient enough for disease initiation.
These causal partners will not loose their identity and
individuality while complementing necessary cause but just help the
necessary cause. While doing so, these causal partners form a web
of cumulative and synergistic action with the necessary cause to
initiate the disease. That means when a necessary cause is fully
complemented with its causal partners, it becomes sufficient enough
to cause the disease. Presence of a sufficient cause means that
disease is initiated. This explanation is true serves for both the
infectious and non-infectious disease.
* Putting on a switch, though appears to be apparent single
cause resulting in lighting, it is actually the result of a group
or constellation of causes, which includes wiring, electricity,
unspent bulb along with the switch.
*Cancer cervix is more seen in multiparous women and less seen
in nullipara. This may be due to chronic irritation due to sexual
life for longer duration in multipara. Cancer lip is more seen with
chronic smokers due to chronic irritation of the delicate lip
mucosa, leading to purposeless neoplastic growth Cancer stomach is
more seen with those people who insult their gastric mucosa with
offending agents like drugs, hot and spicy foods, alcohol
etc.Cancer larynx is frequently seen with singers and teachers. who
abuse their voices.Personal experience. My own maternal uncle, who
developed a habit of folding and twisting the skin on his Adam s
apple for 40 years developed epitheilioma of skin there and died.
Hence God given tissue should be respected because that greatest
engineer has included in each cell , all the necessary ingredients
of life.
*In India, sciences of astronomy and astrology are 5000 years
old. They describe the various affects of the planetary
relationships on the health of the people. Planetary movements
cause seasons of the year. They explain also the seasonal effects
on health of the people. If there is no truth in it how can they
survive for centuries? This origin of the disease , we have to
diligently search.***Natural history of the disease is that course,
the disease takes, if it is left on its own , without any
interference or intervention either of preventive, promotive ,
curative, medical or surgical nature.
A disease when it is left like that (very rare) either ends in
recovery or death. It follows usually this course as shown in the
slide*Disease transmission depends upon several factors of agent
(virulence, critical density, antigenicity) host (immiunity, age,
personal habits) environment (herd immunity, sanitation staus,
socio economic status, climate etc.)*PLACE
DISTRIBUTION:-INTERNATIONAL LEVELNATIONAL LEVELREGIONAL LEVELLOCAL
LEVEL
PERSON DISTRIBUTION OF THE DISEASE:- AGE WISE, SEX WISE,
ACCORDING TO OCCUPATION,LITERACY, IMMUNITY, RACE, ETHNICITY,
MARIIED LIFE, PERSONAL BEHAVIOUR*JOHN SNOW DETECTED CLUSTERING OF
CHOLERA CASES AT BROAD STREET IN LONDON AND THIS CLUSTERING
PROMPTED HIM NOT ONLY TO CONDUCT HIS EXPERIMENT BUT ALSO TO REMOVE
THE HAD OF THE STREET PUMP TO PREVENT EPIDEMIC.*JUST LIKE THE
LAYERS OF THE ONION, THE OLD DISEASES WANE AND GIVE PLACE TO
NEWONES.INFECTIOUS ONES WILL BE REPLACED BY NON INFECTIOUS ONES TO
BE REPLACED LATERBY PERSONAL AND BEHAVIORALPROBLEMS.
*AT EVERY LEVEL, PREVENTION CAN BE TRIED AND SHOULD BE
TRIED.EVEN BEFORE DEATH, SOME THING CAN BE TRIED TO MITIGATE THE
SUFFERING. PHILOSOPHY OF PREVENTION IS THE CORNERSTONE WHILE
DEALING WITH PATIENTS IN HOSPITAL SETTING OR IN POPULATION *KEEPING
TRACK OF TRENDS AND EVENTS OF THE DISEASE.METHODS:-LAYMAN
REPORTINGACTIVE SURVEILLANCEPASSIVE SURVEILLANCESENTINEL
SURVEILLANCESERO SURVEILLANCE
** SOURCE S/ RESERVOIRS WITH VIRULENT AGENT ARE IN
ABUNDANCETRANSMISSION IS HIGHPOPULATION WITH PLENTY OF
SUSCEPTIBILESMethods of control
:-NotificationIsolationQuarantineSurveillanceChemotherapyProphylaxis
* LESS NUMBER OF SOURCES AGENT IS STLL PRESENT BUT LESS
VIRULENTTRANSMISSION IS PRESENT BUT AT LOW EBBSUSCEPTIBLES STILL
PRESENT**AGENT PERISHED IN POPULATIONNO TRANSMISSION NO
SUSCEPTIBLES IN POPULATIONS . (IMMUNE POPULATIONS)HENCE NO
DISEASE*
