In the writings of the Greek historian Thucydides, we find a description of a strange disease. In the 400s BC, medicine and sorcery were synonymous with a combination of witchcraft, folklore, and superstition. At that time, scientifically describing the symptoms was almost a landmark event. There was no manifestation of this strange disease. At first there was a fever but the surface temperature of the skin almost did not rise. As the internal temperature rose, it reached a point where the patient could not put the thread on the skin. Even if they sat in the water completely naked, their pain would not be relieved.
Also, many of those who came in contact with this contagious disease did not get relief. At first, the nose and mouth would swell, then there would be gradual bleeding from the surface of the skin. Foul-smelling perspiration from the body, severe bad breath. In worse cases the patient would vomit bile mixed with bile, and severe convulsions would appear in the body. Within days of the onset, the man died of excessive bleeding. There is no further mention of the disease described by Thucydides in the writings of other later historians. The disease seems to have spread in the air, so the cause of the disease is still unknown. The pathogen may have become extinct or mutations have lost the ability to spread the disease.
The Plague of Athens (described by Thucydides)
Such an incident is not one. From Legionnaires’ Disease to the medieval Black Death or the Spanish-flu of the last century, Ebola or the recent Corona. There have been repeated outbreaks of deadly diseases in our society in which the exact source of many diseases depends on the chance factor to diagnose or prevent. To reduce the monopoly of this chance factor, the lack of scientific analysis of the disease became apparent and it became necessary to characterize the disease individually – a new branch of science was born – in Hippocrates’ terminology, it was renamed epidemiology.
Hippocrates in 400 BC in his book on diagnosis (On Airs, Waters, and Places) he mentioned three possibilities – First look at any season of the year; which way is the sun at that time, what is the difference between day and night? Then you will notice the direction of the wind in that region, also look for the difference in temperature. Then you will see the character of the water, (it is important to know where the water flows), what kind of soil – clay, sand or silt – rain water or flood, etc. It is necessary to know all the information. It is natural for these words to seem common sense nowadays. But at that time any disease – from common fevers to epidemics- was considered a curse of the gods.
There Hippocrates made room for reason in the first alien panic. Many centuries have passed since then. Significant advances have been made in medicine, but the main focus of the study has been on curing personal ailments. There has been a lack of attention paid to the overall health of the larger population. The exceptions are a couple of illnesses that the public had at least some idea of, such as malaria outbreaks with bad air. This information would have been unknown to many had it not been for the first Pope Gregory the Great of Rome himself suffering from malaria! Nowadays, if there is any illness of celebrities, there is a lot of publicity in the media.
The second edition of John Grant’s book
John Grant testified to the basic research on the structure created by Hippocrates in his observational study. Published in 1662, based on church records “Natural and Political Observations Mentioned in a Following Index, and Made Upon the Bills of Mortality”. That’s where Grant writes – “Of the difference between the numbers of Males and Females. The next Observation is, That [sic] there be more Males than Females…There have been Buried from the year 1628, to the year 1662, exclusive, 209436 Males and but 190474 Females: but it will be objected, That [sic] in London it may be indeed so, though otherwise elsewhere; because London is the great Stage and Shop of business, wherein the Masculine Sex bears the greatest part. But we answer, that [sic] there have been also Christened within the same time 39783 Males and but 30866 Females and that the Country-Accounts are consonant enough to those of London upon this matter.”
Grant described in detail differences in birth and mortality by area, an annual census by region, seasonal differences, livelihood, and occupational mortality differences between men and women. Medical science is a little bit on the path of numbers beyond conjecture.
It would not be an exaggeration to say that today’s modern medical science and its accompanying epidemiology, Hippocrates, are a few steps ahead of Grant’s time, but the measure of progress, improvement, etc., is very relative. For example, radical mastectomy, performed by Dr. William Halstead, was once the only recognized treatment for breast cancer. As soon as cancer was detected, women were forced to surrender one of the experiences of their identity in the surgical table. Now it is unusual not to think it is barbaric. So as the field of research expands, old ideas will be discarded and new ideas will take its place – that is normal, and Medical science is not an exception. When it comes to cancer, the issue of smoking will also come up. The history of one of the most pioneering studies in modern medicine involving cancer and smoking.
Now everyone from eight to eighty knows how harmful smoking is to health and many chain smokers has reduced smoking due to social constraints. But there was a time when smoking was synonymous with all contradictory entities like machoness, social progressivism, processional revolutionary consciousness, etc. Returning from the New World, Columbus presented tobacco leaves to Queen Isabella of Spain. Tobacco spread from Spain to all over Europe, with rising demand skyrocketing on the eve of the Industrial Revolution. The United States earned a lot of foreign currency by exporting Virginia tobacco to Europe.
A contemporary ad
Amid this universal acceptance of smoking, another picture was emerging in parallel research. Multiple types of research since the early 1940s have shown that smoking is linked to cancer – but no one dared to take the responsibility of breaking the news in general, lest they be alone! Scientists did not dare to break the elite image of cigarettes in the society of that time. Added to this is the powerful lobby of the tobacco industry who wants to suppress any such news.
Anyone who has seen the “Mad Men” series will know that the series is based on a fictional advertising agency on Madison Avenue in New York in the fifties and sixties, where the evolution of American consumerist civic culture is reliably portrayed on celluloid. There is an incident – the son of the owner of the cigarette company has come to renew the advertising contract with the company. Alone in the darkroom, the client tries to force himself close to the agency’s Art Illustrator. When the incident became known, the company layoff the correspondence artist in accordance with the client’s demand. The reason is simple – a quarter of the agency’s annual revenue comes from cigarette advertising, so management is forced to do what the client wants.
It was at this time that the Surgeon General’s report was published in 1964. The first official acknowledgment in this report is that there is a specific relationship between smoking and increased mortality. Nearly a decade-long study by two British researchers has profoundly influenced this report. Dr. Austin Bradford Hill and physician Ronald Dahl conducted multiple studies on British doctors in the forties and fifties. The main objective of the survey was to collect the health data of the newly formed doctors working in the National Health Service.
There was a question in the questionnaire – whether they smoke and how much they smoke (how many cigarettes do they smoke each day/week?). Initially, about fifty thousand doctors took part in it. Reviewing the results of the study, it was found that smokers were 12 times more likely to develop lung cancer than non-smokers. Some of the effects of the post-survey response on Hill’s psyche can be traced back to his speech at a commemorative meeting in 1965 at the Occupational Medicine of the Royal Society of Medicine in London.
Excerpt: Dr. Bradford Hill and his research paper (published in the British Medical Journal)
“I have no wish, nor the skill, to embark upon a philosophical discussion of the meaning of ‘causation’. The ‘cause’ of illness may be immediate and direct; it may be remote and indirect, underlying the observed association. But with the aims of occupational, and almost synonymously preventive, medicine in mind, the decisive question is whether the frequency of the undesirable event B will be influenced by a change in the environmental feature A.”
Now the question is the report of the US Surgeon General and how did Dr. Hill come to this conclusion?
To reach the main point, we have to resort to some philosophy. Several conditions must be met to be sure of the cause of an event. One of them is Specificity. Among many other possible causes, only the ubiquitous factor is more likely to have a direct link to the event outcome. In the case of different patients, if the same event occurs again and again within their own scope, then the applicability of the cause can be considered more crucial (Strength of Association). But correlation doesn’t always imply Causation.
What will happen then?
From this source, Hill made another observation – he proved that most patients have started smoking before and have been diagnosed with cancer. That is, the cause is present before the event (temporality – preeminence of causation). But critics aren’t entirely satisfied with that either – it may have caught on in the survey, but what’s the evidence that the same thing will happen in other cases? Therefore, multiple prospective and retrospective studies were conducted; the results of all the surveys are almost the same. That is Consistency upon repetition.
Bradford Hill’s dissertation is a milestone in modern epidemiology. Bradford Hill is a worthy successor to the genre of science that John Grant started based on numerology. The cornerstone of public health sciences these are based on a few principles. Whether it’s Pulse Polio or Small Pox, SARS to Ebola, or the most recent Zika virus or Corona, these are no less dangerous than the atomic bomb.
Every one of us could have been subdued inadvertently and has become, witnessing the history of the middle Ages. But the path that Hippocrates showed, the beginning of the branch of applied science in the hands of philosophy, the implementation of planned group resistance, is the cornerstone of our civilization. Many evolutionary changes have taken place in epidemiology in the last two thousand years. But its principles are still equally relevant and will remain so in the future. Because public health science is inextricably linked with our group existence.
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