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The puzzle of the blue death

This report can look at the history of cholera and the similarities between the first outbreaks and today, and can also look at why there are still cholera outbreaks today. Other topics viewed include how climate change can make a difference and the actual implications are of experiencing so much more traffic of individuals coming and going by flights now.

The Blue Death, also called Cholera, is a contagious bacterial intestinal contamination which is caused by drinking polluted water. The bacterium which causes this is named vibrio cholerae and affects the tiny intestine with symptoms of severe diarrhoea, vomiting and dehydration. Most affected are small kids and older people, with most circumstances resulting in loss of life because of the amount of body normal water lost. Up until a hundred years ago, cholera was a public health issue in Europe but with better sanitation and treatments of drinking water, the disease has virtually been eradicated in developed countries. Cholera pandemics have usually happened in expanding countries where there is poor sanitation and water treatment; however there were outbreaks in European countries and the united states, the most recent one being in Haiti.

Image of vibrio cholerae bacterium

Let's have a brief look at the history of cholera. John Snow (1813-1856) was a English doctor and surgeon-apothecary and is known as one the founders of epidemiology for his research into finding the way to obtain the cholera outbreak in the 19th century. . Scientists in those days had recognized the humoral model of disease and later the miasma model as the cause for outbreaks of cholera. However, John Snow had different thoughts and began his own research to find what he thought caused the cholera. It had been through his research that he was able to determine the reason, and he used models to help him in his conclusions. Models are analogies that help clarify hypotheses - proposed explanations of associations between causes and results, and play an essential and significant role in testing hypotheses. They allow scientists to investigate their findings and often in a variety of different ways. As well as putting practise into action, it allows scientists to observe their hypotheses at the job. However, using creature models will not accurately relate to humans but nonetheless gives an perception into the particular expected results may be. Only after effectively testing on pets would scientists then look for individual volunteers, which is because of ethics. In this instance, Snow's use of pet animal models led him to question studies that he had learned about harmful gas and as such gave way to a fresh hypothesis.

The humoral model of disease proposed that cholera was triggered by an imbalance in one of more of the following fluids; bloodstream, phlegm and dark-colored and yellow bile. These four were termed the 'humors' and treatment was applied by the physicians own interpretation of the humoral imbalance so was very varied. Often purgatives and emetics were prescribed to balance the machine. Some treatments even included the use of leeches to reduce the bad blood in the torso. However, researchers later developed the miasma style of disease which proposed that cholera was an epidemic disease which could be the cause of exposure to some sort of toxic gas or miasma and the medical orthodoxy in those days assumed that the harmful gas was a result of the fermentation of organic and natural materials such as real human waste. This resulted in early on promoters of general population health concentrating on the removal of cesspools and hemorrhoids of composting faeces, with the main aim being to build a network of sewer pipes that could carry waste material in to the River Thames.

After the first cholera outbreak in 1831, John Snow went on to do further medical studies and then practised surgery in a clinic in London. Anaesthesia was not used in surgery at that time and Snow got find out about it being used and actually got to see main demonstrations of it working. This resulted in Snow recognising that there was a lack of control over the complete medication dosage of anaesthesia required so he began to experiment and develop devices that could accurately measure precise doses, eventually making gauges and masks as well as utilizing a variety of dog models to check on. It had been a result of this experimentation that led him to question the miasma model of disease for the reason for cholera, as what he had learned about poisonous gas didn't seem regular with epidemics.

Snow's research on anaesthesia was experimental, unlike his focus on cholera, so firstly the essential skills of experimenting were necessary in conjunction with deep curiosity to learn just how things work and how they have got certain results on certain things, quite simply; careful, systematic observations. A clinical track record would be highly advantageous and you need to be prepared to acknowledge the fact that things might not turn out properly. For planning effective tests to test dosage measurements a scientist had to have the required equipment or improvise if possible, and be able to do this with some degree of correctness and also have the ability to record the results in an accurate way so that they could easily be interpreted. The capability to record results in a variety of various ways, like graphs, graphs and furniture, was also essential. The scientist needed an over-all knowledge and curiosity about what they wished to experiment and everything results had to be carefully and meticulously registered so a great deal of tolerance was also required. Planning contrasting observations could also be a good way to test hypotheses as well as using different kinds of models to record the consequences and properties of certain drugs. The use of models would also be beneficial in monitoring appropriate delivery systems for anaesthesia.

Therefore, experiments are believed strong testing of hypotheses because they ultimately test them and can either support them or produce choice ones. Sometimes several tests could be conducted and this could exclude a number of of the hypotheses. They also allow results to be analysed and conclusions to be reached and often researchers could form some kind of theory predicated on the results of any experiment which can then be placed into research papers to be mentioned thus publicising the results of experiments. It really is imperative that test results are noted accurately. An important fact to keep in mind is that experiments only support hypotheses; they can't ever establish it right or incorrect. A control experiment would be create so that any change could be monitored which control would be neutral.

As mentioned before, it was Snow's experiments with anaesthesiology and dealing with gases that led him to discover that the patterns of cholera outbreaks were inconsistent with the patterns that would be expected from poising by toxic gas, and because he couldn't induce cholera in animal models, he realised he'd have to try a different strategy. He also found the symptoms of cholera to be inconsistent with symptoms that would be shown if subjected to dangerous gas. Cholera was categorised as the 'blue death' as it would cause a person's skin to turn blue scheduled to respiratory failing resulting in loss of life and is caused by the bacterium vibro cholerae, triggering severe diarrhoea and dehydration with death occurring anticipated to such a extreme lack of body fluid. It is mainly sent through contaminated drinking water, but may also be disperse through food such as fish and shellfish from contaminated drinking water, and produces contaminants which cause the symptoms.

John Snow assumed that cholera was brought on by either eating or having something that was contaminated because the gastrointestinal symptoms seemed to be more steady with this rather than dangerous gas poisoning. He tried to persuade his fellow scientists that cholera was transmitted through contaminated normal water but his ideas weren't accepted as of this early date because of the fact that scientists rarely acknowledge things. Each of them got different explanations and designed their own tests and accumulated data and didn't wish to know that their theory could be flawed or there could be another explanation. Because of the fact that there was lack of research to aid Snow's ideas, these were dismissed and generally overlooked as people accepted the miasma style of disease as the cause of cholera.

Symptoms of cholera

Cholera outbreaks are more consistent with contaminants of drinking water than air because of the fact that in 1854 London there was no running water in homes so people got to employ a communal drinking water pump that offered particular neighbourhoods. This intended everyone was posting the same drinking water source. John Snow experienced mapped locations of the pumps where cholera outbreaks happened and collected proof that everyone who acquired sick all required drinking water from the same pump. It was his opinion that cholera was multiply by contaminated drinking water and therefore was restricted to a specific area, whereas if it were due to polluted air, then there would be more widespread cases in London at the time and the outbreak could have propagate quicker. Also, none of them of the doctor's treating patients experienced contracted cholera themselves so this suggests that it might not need been air contaminants. However, the miasma model persisted because medical theory at that time believed the condition was cause by contaminated air, usually produced from decaying organic subject. This meant that people were more concerned about atmosphere pollution rather than water, and the fact that there was little evidence to aid Snow's theories at that time. The general medical opinion was that because mid-air can be corrupted by perspiration, dirt and grime and faeces, the squalid living conditions were blamed for cholera outbreaks. Because of this, John Snow realised that he'd have to discover a different way to test his hypothesis.

While Snow did not have a record in epidemiology, his previous research on anaesthesia helped him design a fresh model for the cause of cholera because he already had connection with using experimental techniques. His method of the research on cholera was similar to the research he does on anaesthesia, and started out with clinical observations, accompanied by creating a hypothesis which in turn led to a theory being created. His observations were not only based on his experiences in dealing with patients of the firs cholera outbreak, but also on the experience of others plus considerable study of medical literature available at the time. He realised that there is no possible way to do an experimental test of his hypothesis so he previously to consider different ways to do these tests. So he did extensive research of all available files and attempted to find some sort of structure. He also pointed out that there is severe lack of personal hygiene and overcrowding at that time which he associated with cholera and concluded that it was propagate by contaminated normal water.

After Snow posted a research newspaper in 1849 regarding cholera, it was recommended by the journalist that an test should be conducted of people living side by side with similar life-style but only the drinking water source should be mixed. This might provide critical data as it would basically be testing Snow's hypothesis about cholera being sent through contaminated drinking water. If one part was given drinking water from a contaminated source and the other aspect given sterile, boiled drinking water, then the final result would cause only one side exhibiting cholera symptoms. It could show that cholera was propagate by drinking contaminated water.

Between 1860 and 1865, Louis Pasteur (1822-1895) proposed the germ theory of disease which proven that a lot of infectious diseases were brought on by micro-organisms. He worked with French wine growers and contributed to the fermentation process to build up pasteurisation, which really is a method that killed germs. Originally he do his research with wines and beers, and confirmed that bacterias were accountable for beer and wine going sour, later on applying the same theory to milk. He found that parasites could be removed by boiling a water and then letting it cool down, and this is known as pasteurisation. It was this breakthrough that backed Snow's hypothesis about cholera being sent through contaminated drinking water.

This resulted in Snow questioning general population health and performed more research into the theme, doing door to door interviews of individuals afflicted by cholera and interviewing doctors that experienced cured cholera patients. Working alongside Snow was William Farr (1807-1883), who was keeping files of births and deaths on London plus they were looking for a few sort of structure. Snow started looking at the geographic circulation of cholera outbreaks set alongside the sources of drinking water available and mapped where in fact the cholera deaths happened. He was wanting to verify the source of the as it could help him trace where the outbreak may be stemming from. Snow found that by assessing a neighbourhood by their source of water provider would give him a better idea of where the contamination may be and he could basically use it as an experiment using one part as a control and then documenting the results. If he looked at two neighbourhoods with their own normal water source then it would be more difficult to pinpoint where in fact the contamination could be since there have been two separate resources, whereas with just the one neighbourhood, it might be easier to see and track record the results. The variables that were included in a informal web for cholera are living conditions, public health, water resources and illness at that time. Snow found his conclusions about cholera to be inferences based on his observations whereas the medical journal reviewer considered these to be conjectures. An inference is a final result drawn from background knowledge and facts, whereas a conjecture is based on speculation which has not been turned out.

In 1854, there is another cholera outbreak close to the Broad Neighborhood pump. Snow thought that the outbreak was triggered there by having less proper sanitation and the overall squalor of living conditions. His hypothesis was that polluted water from local cesspools was somehow leaking into the drinking water supply, leading to this outbreak of cholera. He had to do some non-experimental assessments so resorted to going door to door asking specific questions and striving to recognize a routine again. He took his conclusions to the Parish Panel and offered his findings, asking them to eliminate the cope with on the Comprehensive Street pump. This is regarded with scepticism at first but the deal with was removed and finally the number of cholera cases decreased.

Cholera outbreaks in Broad Streets, London 1854

Snow centered on households that were damaged by the cholera outbreak and conducted his interviews in those neighbourhoods to assemble his data. However, a minister of St Wayne Cathedral, Reverend Henry Whitehead, who was simply sceptical of Snow's explanations, began performing his own interviews but he centered on households which were not influenced by cholera and found that households using the pump at Large Streets were nine times much more likely to long term contract cholera than those who didn't use it. In this way, he increased on Snow's test of his hypothesis and actually identified where the first incident of cholera began - it was an infant living just a few ft from the pump that got perished from diarrhoea a few days prior to the outbreak. The two ended up working jointly, eventually asking the Plank of Public Health to dig up the area throughout the pump to try and identify the cause. When the region have been excavated, they discovered that water had been seeping from a cesspool under the building where in fact the infant had died and this was seeping into the water source at the pump. After making further inquiries, they discovered that the infant's mother had actually washed the soiled diapers of the sick child in the basement of her building and then dumped the water into the cesspool near to the pump. The main difference between relationship and causation is the fact that correlation describes the relationship between a couple of things or parameters whereas causation is causing something to happen. In cases like this, Snow and Whitehead looked at the correlation facet of why there were still cholera outbreaks. Following the excavation of the region round the pump revealed the contaminated water of cesspools leaking into the normal water resource and after a drought the next summer, Participants of Parliament voted to get started on a project that would improve the sewer system and move the sewer pipes further downstream of the Thames to be able to avoid further outbreaks of cholera.

After the construction of new sewer systems in Britain, there were no further outbreaks however, many have still took place mostly in expanding countries round the world, including the outbreak in Peru in 1991, which brought on a lot of deaths. The most recent outbreak has been around Haiti.

The main difference between general population health in the 19th century and today is that there surely is much more understanding now and things have been greatly better, especially with the technology of this closet and the sewer systems being advanced. However, as stated, there has been a recent cholera outbreak in Haiti, that was confirmed on Oct 21st 2010. That is thought to have been caused by breaches in water resource, sanitation and cleanliness infrastructure employed by large groups of men and women causing exposure to contaminated normal water or food and in order for it to occur to begin with, it's thought that it needed to be present among the populace but how this could happen is still unknown.

Climate change could play a major part in the spread of cholera, as the bacterias can lie dormant for long periods of time, and due to global warming and growing water temperature the bacterias is given the opportunity to come active and begin multiplying. In extreme temperature conditions, the bacterium would increase quickly in stagnant pools of normal water and in extreme wet conditions the bacterium can spread by overflowing rivers. Also, pets in this inflatable water can end up eating the bacterium and these pets are then eaten by humans, leading to the pass on of cholera.

These days, travel has become far more commonplace which greatly escalates the likelihood of cholera spreading in one country to some other, especially overseas. To battle this, understanding has been elevated about these concerns if travelling to another country, the general advice is to boil any water before drinking to make certain that any harmful bacteria are wiped out, thus reducing the probability of becoming unwell or contracting something. However, this is not guaranteed to avoid the pass on of cholera as the bacterium can lay dormant and could basically maintain most creatures in the sea that are used as delicacies, especially those that are eaten uncooked.

In conclusion, due to the improved public health and sanitation in developed countries, cholera is no more a challenge. However, it is still problems in growing countries, where the public health and living conditions are not as good as the developed countries and there seems to be a general insufficient education when it comes to personal health and cleanliness. The outbreaks of cholera generally tend to be centered around areas that have no running water and also have to chare a communal water source. This greatly escalates the risk of the bacterium growing.

One can only hope that with continued commitment and education, understanding can be lifted with regards to sanitation and public health, but unfortunately the conditions in some countries lead to outbreaks, normally there isn't enough money for proper sewer systems or education for people. Crowded living conditions coupled with natural disasters also boost the risk of cholera outbreaks. To sum everything up, hopefully 1 day cholera will be destroyed, but as it stands just now, this is something that will likely keep occurring because of the fact that some countries are better off than others. After all, everyone prays for the day where disease and death won't be the primary issue of day to day life.

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