Wednesday, 14 June 2017

The story of leprosy: from 2000 BCE to now

Throughout human history, very few diseases have carried the levels of stigma and shame that leprosy brings upon it’s sufferers. One of the oldest known illnesses, Mycobacterium leprae is thought to have been with mankind in one form or another for well over four millennia and traveled along the migration routes through East Africa and the Near East.
Leprosy takes its name from the Latin word  lepra, meaning “scaly”, as the predominant symptom of infection are raised skin lesions. However in modern medical circles it is more commonly referred to as Hansen’s disease, after G. H. Armauer Hansen, the Norwegian physician who identified Mycobacterium leprae as the causative agent.

Girls in the Philippines identified as having leprosy. Image: National Museum of Health and Medicine
Contrary to popular belief, leprosy does not cause body parts to fall off. Infection with M. leprae instead leads to severe nerve damage in the skin, limbs and eyes. This can leave suffers vulnerable to secondary infection if they do not receive adequate medical attention, and gangrene may then set in.
Neither is leprosy particularly infectious. In fact, 95% of the world’s population has a natural immunity to M leprae (although they may still be able to carry it). Even then, it takes prolonged exposure to a sufferer for infection to pass. The idea that just brushing past a leper would make you somehow “unclean” is yet another myth.
In 2009, a mummified skeleton from circa 2000 BCE was found in northwest India. DNA analysis of the remains found evidence of  M. leprae infection within the skeleton, the oldest yet known case of leprosy. An Egyptian Papyrus document written around 1550 BCE makes mention of a disease that may be leprosy and Hippocrates discusses the infection in his writings in 460 BCE. In China, the Feng zhen shi manuscriptwritten about 250 BCE discusses a condition that leads to destruction of the nasal septum as well as anaesthesia, which is also very likely leprosy.
The Bible makes multiple reference to “tzaraath”, a disfiguring disease which most translations render as leprosy, DNA found on in a tomb in the Old City of Jerusalem, dated 1-50 AD confirmed the presence of the disease in the area at the time. In Ancient Rome both Pliny the Elder and Aulus Cornelius Celsus wrote about the presence of lepers in and around Rome and the Near East.
Historical accounts of leprosy can be hard to identify as some may mistake psoriasis, vitiligo or other skin conditions for leprosy. The descriptions of highly infection skin conditions are more likely fungal infections than leprosy, and, after 1492 when Columbus returned from the new world after exchanging small pox for syphilis, that gets added to the mix too.
In many writings from the mid-16th century onwards, descriptions of “leprosy” begin to more resemble congenital or tertiary stage syphilis – patients with collapsed noses and rotting ears, loss of skin on the palms of the hands and feet, deafness and loss of teeth. This may also explain the sudden increase in numbers of “leprosy” suffers seen in the 16th century.
Leprosy has long been associated with a curse, or believed to be a punishment from God for sins committed in this life or a previous one. This link has been made throughout many cultures and continents. Because of this, suffers throughout history were often denied treatment and care. Instead they were sunned by society and quarantined in purpose-built asylums or leper colonies.
Unlike many infectious diseases, leprosy does not have a long history of ridiculous cures and treatment. This is probably because of the association it has had with being unclean or cursed in some way. Doctors or priests would refuse to treat the afflicted as they would not want to be associated with the illness. There was also the general thought that you have “brought the disease upon yourself” in some way.
The Ancient Egyptians, writing circa 1550 CBE recommend bathing in blood to alleviate the symptoms of leprosy and it seems that this was the go-to treatment across Europe, the Middle East and into China for millennia. There is some variation in the source of the blood that is recommended, from child to dog to lamb, and whether or not it should be also used as a beverage, but the theme remains.
Pliney the Elder makes mention of snakes blood, but also mentions that he doesn’t think it will help. However Philippe Gaucher, a 19th century French doctor stepped it up to applying cobra venom to the skin lesions, and as late as 1913 a Dr Boinet tried increasing doses of bee stings (up to 4000, apparently) to no avail. Bare in mind, the bacteria causing the infection had been identified in 1873.
As of 2016, worldwide, two to three million people were estimated to be permanently disabled because of Hansen’s disease. Although the disease is now entirely treatable with multidrug antibiotic therapy, the stigma that is associated with leprosy infection still prevents some sufferers from seeking or receiving treatment.
The disease is traditionally associated with poverty and sadly that link still remains. The necessary multidrug treatment is comparatively expensive, however Novartis, the company that produces it, offers it for free.  Several leprosy charities exist, with the goal to treat those infected. Some also offer reconstructive surgery and artificial limbs, which can help sufferers reintegrate into society.

The inhabitants of the Kalaupapa leper colony in 1905. Image: Wikipedia
There are many leper colonies left in the world, over 800 in India alone and in Europe, one leper colony still remains. Tichileşti is in Romania and had 19 inhabitants in 2011. Although the people living there have been given the necessary treatment most are now very elderly and feel they are unable to leave.
Approximately 150 people are diagnosed with leprosy each year in the U.S.A, although due to the long dormancy period of the bacteria (from two years to over a decade) it is hard to identify where they contracted the initial  infection. There have been two cases reported in the last three years in the UK, both in men who recently moved from the Indian subcontinent.
M. leprae has a natural reservoir in armadillo populations and in red squirrels, although there have been no known cases of animal to human transmission from squirrels, there is some evidence that it may be possible to catch leprosy from an armadillo. If you were both unlucky enough to be genetically vulnerable to M. leprae and had prolonged exposure to said infected armadillo.
Cases of Hansen’s disease worldwide have dropped rapidly over the last 30 years, from 5.2 million in 1985 to about 210,000 a year now. In 2000 the WHO declared it was no longer a public health problem. Both the WHO and Novartis believe that, through new screening techniques that especially target at-risk children, by 2020 child suffers will no longer develop deformities. There is the potential to fully wipe out leprosy, as we did with smallpox, early detection of infection being key.

Published Nouse 13/06/2017

Monday, 22 May 2017

A brief history of the hangover

For the last 12, 000 years (at least) humans have been purposefully mixing fermented grain drinks, possibly even before the development of bread as a dietary staple. Almost every settled community across the globe has developed a form of alcohol and ceremonies based around the drinking of it. And ever since mankind discovered the wonders of fermented plant matter, humanity has also suffered the indignity of the hangover.
Egyptian hieroglyphics depict the pouring out of beer. Credit: WikiCommons

The term hangover only came to commonly apply to the aftereffects of a night of drinking around the turn of the 20th century. Before then, phrases such as the “morning fog” or “blue-devils” were used colloquially, and the phrase “bottle-ache” appears in several doctors’ notes from the mid-1800s.

In the UK, it was calculated that alcohol and the resulting days lost to hangovers accounted for almost £2.55 billion in lost wages. In Finland, over 1 million workdays are thought to be lost a year to hangovers, which is impressive considering the population is only 5 million.

One of the oldest and most persistent cures for a hangover has been to have another drink. The phrase “hair of the dog that bit you” comes from a Middle Ages remedy for a rabid dog bite, in which the patient drinks a concoction of honey, wine and the hair of the suspect canine. Not unexpectedly, this is an ineffective rabies treatment. However many will swear by it as a hangover remedy.
Dionysus, Greek god of wine, beer and inebriation. Credit: WikiCommons

In Ancient Egypt, the goddess of beer was known as Nephthys. She would answer drunken revellers’ prayers with the gift of vomiting, apparently allowing them to be hangover-free the next day. The Greeks had several gods of inebriation, from the most famous Dionysus and his son Comus, to the more beer and grain-specific such a Sabazios and Demeter. Drinking vessels can be found etched with prayers to Dionysus asking for the drinker to be blessed with a hangover-free morning after.
Pliney the Elder took some time to advise his fellow Romans on what to do after a night of overindulgence. His go-to cure was raw owls eggs, though he also recommends a nice fried canary with salt and pepper to taste. However he advises that drinkers are better to line their stomachs with a solid meal of roasted sheep’s intestine before a night on the town.
Sticking with the avian theme, ancient Assyrians would mix ground swallows’ beaks and myrrh whilst in Mesopotamia a mixture of myrrh, liquorice, cardamom, beans, oil and of course, wine was recommended to help shake off a particularly bad morning after. In Mongolia, pickled sheep’s’ eyes where the go-to restorative.

From a medicinal standpoint, eggs are a good source of the amino acid cystine which is key in the liver’s metabolism of alcohol by products. Meanwhile myrrh does appear to have some analgesic effects, at least on toothaches although the effects internally are somewhat less clear. There is, as yet, no medical opinion on pickled sheep’s eyes.

In Medieval England, normally the source of some of the worst medical advice on record, raw eel and boiled cabbage were the breakfast of choice after a night on the tiles. A spot of sushi and some veg doesn’t sound so bad.

By the end of the 17th century, branding begins to come into medicine. One of the more famous cure-alls on the market at the time was Goddard’s Drops. Developed by the physician Jonathan Goddard, they contained, among other things, ammonia, the crushed skull of a hanged man, dried viper and ivory. Goddard claimed his drops could cure everything from a hangover to bladder stones.

The trope of “throw a bucket of cold water over the sufferer” seems to appear in the early 1800s, along with drinking a glass of warm water and soot. A Victorian suggestion of rubbing vinegar on the temples seems particularly ineffective. Meanwhile out in the Wild West the cowboys developed something called “jackrabbit tea” made from rabbit droppings.
Hall’s Coca Wine: The Elixir of Life. Credit: WikiCommons

At the turn of the 20th century cocaine was in, and no good hangover cure was complete without it. A popular British drink called Hall’s Coca Wine combined both the hair of the dog with a hefty dose of coca leaves to make a “great restorative”. Also introduced in 1905, was a seasickness treatment called Mer-Syren, sold as a mystical herbal treatment from India,  but six years later the British Medical Association discovered it was nothing but powdered potatoes.

PG Wodehouse describes a drink made up of Worcestershire sauce, raw egg, tabasco and pepper, fed to a suffering Bertie Wooster by the manservant Jeeves in the his 1916 short story Jeeves Takes Charge. This is practically a Prairie Oyster (minus the vodka), a cocktail developed back in 1878 New York as a pick me up for those having a particularly rough morning.

Famous drinker Kingsley Amis published his book On Drink in 1972. In this he described the metaphysical (ie, nagging feelings of guilt and self-loathing) aspects of a hangover as much worse than the physical. He recommends getting your mental house in order to better sort out your physical self. For the body though he suggests trying beefpaste and vodka, or baking soda and vodka or tomato juice and vodka. You may be noticing a trend. He also suggests vigorous sex if you can find a willing partner.

During the Cold War, both the KGB and the CIA were rumoured to be developing pills that would allow their agents to drink without either getting drunk or suffering a hangover. Now several versions of these apparently anti-hangover pills, such as Chaser and Alcohol-X are on the market. They are based around the concept of activated charcoal, mostly using vegetable carbon to bind and filter “toxins”. None of these pills have been through any sort of thorough clinical trials, so whether or not they are effective is yet to be proven.

In 2009, a study by Newcastle University concluded that a full English breakfast is the best cure for a hangover. However the subjective nature of the beast means that it is hard to control from person to person and night to night what a hangover will become. Obviously the only way to avoid a hangover fully is not to drink. But if, for whatever reason, that seems unlikely, then staying hydrated, replacing electrolytes and getting lots of rest is the tried and tested option.

Publish Nouse Online 18/05/17

Saturday, 6 May 2017

The sad story of Typhoid Mary Mallon

In the summer of 1906, the Warren family were summering on Long Island when six out of the eleven people staying at the rented house came down with typhoid fever.  Charles Warren wanted to know who to blame for the outbreak in his family so hired an investigator named George Soper. Soper soon decided that the most likely culprit was the cook, Mary Mallon.
Typhoid fever is caused by the bacterium Salmonella Typhi, which is easily transmitted through contaminated food and poor public sanitation conditions. One of the first outbreaks of typhoid is thought to have occurred in 430 BC Athens, killing a third of the population and helping to end the Age of Pericles.
In 1838, English doctor William Budd realised contaminated water was the factor in the spread of infectious disease. However during the American Civil War more soldiers were still killed by typhoid than died in battle and by the mid to late nineteenth century, the annual typhoid death rate in Chicago was 174 per 100,000.
Once Karl Eberth had identified the bacteria behind typhoid fever, it only look 16 years to develop a vaccine. The initial version of the vaccine was first used by British soldiers during the Second Boer War, and then 10 million doses of a more developed version were given to troops during WWI.
But for Mary Mallon, being accused of having typhoid in 1906 New York was insulting and degrading. Typhoid was now thought of as the disease of the dirty, unwashed masses. Not something that clean, proper folks caught.

Public opinion of “Typhoid Mary” was swayed by pamphlet campaigns. IMage: Flickr
From her childhood in poverty in County Tyrone, Ireland, Mary had immigrated to the United States alone at just 15. Her career as a cook for various wealthy New York families was impressive and well paid. By her mid-thirties she had built herself a small reputation around Manhattan for her fine peach ice-cream.
As Soper went through her employment records, he found that she had worked for seven families since 1900. In those households, 22 people had become sick with typhoid and one had died. Soon he had tracked her to her new workplace and the investigator confronted the cook.
Mallon was unimpressed by the strange man in her kitchen accusing her of infecting her employers, and chased him out with a meat fork. Soper then brought the New York Health Department and police officers to Mallon’s house.
Confused, and scared, Mallon ran and then put up a fight. Eventually she was taken into custody and placed in a quarantine ward on North Brother Island. There was no long term plan for Mary, she was kept in virtual isolation and treated poorly by staff and other patients.
Over 163 samples of various bodily fluids were taken from Mary, mostly against her will, and 120 tested positive for typhoid. Doctors did not understand at the time how she was able to shed the bacteria and yet show no symptoms of the disease.
Soon public opinion was moving into Mary’s favour. By 1910 was perceived as unfair that a woman that did no willful wrong could be held against her will. After three years in quarantine she was eventually allowed to leave the hospital on the understanding that she would no longer work as a cook.
Authorities eventually lost track of Mary, but in 1915 a typhoid outbreak at a maternity hospital lead to 25 sick and, sadly, two deaths. A woman named Mary Brown was working in the kitchens, and it didn’t take long for her to be recognised as Mary Mallon.
Once again, Mary was hunted down and arrested. It seems that she truly didn’t understand that she was capable of infecting people with this disease as she had never had typhoid symptoms herself.
None of the doctors had ever taken the time to explain to her how the bacteria could lie dormant, they had just demanded that she give up the only line of work she had ever known. However the public had no sympathy for Mary now and she spent the remaining 23 years of her life in quarantine.

Mary Mallon was kept in quarantine for over 23 years. Image: WikiCommons
By the time Mary Mallon died, 400 other asymptomatic typhoid carriers like her had been identified in the USA. None of the other carriers were quarantined like Mary, not even Alphonse Cotils who worked as a baker or Tony Labella who is thought to have caused over 100 cases of typhoid fever and at least five deaths.
Why Mary alone was forced to spend her life in isolation is unknown. It’s possible she completely refused to comply with demands to change her profession, that the trust was broken after the incident at the maternity hospital, or that doctors thought she was incapable of understanding her situation.
Mary died of pneumonia after suffering a stroke in the Riverside Hospital in 1938. Samples taken during her autopsy found evidence of typhoid still in her system. Mary was cremated and her name became synonymous with anyone who, knowingly or not, spreads sickness and disease.

Tuesday, 25 April 2017

World Penguin Day: Overfishing and climate change impacts penguin populations

World Penguin Day is celebrated on the 25th April every year. This coincides roughly with the start of the annual northward migration of the five Antarctic species of penguins.

Image: Wikimedia Commons
The State Of Antarctic Penguins 2017 report, released today by non-profit organisation Oceanites, calculated the number of penguins in Antarctica at 12 million. The report uses satellite technology to help assess the bird numbers over huge areas and across seasons.
Adélie and chinstrap penguin numbers in Antarctica have declined rapidly over the last few years. As global warming has affected the ice caps where the birds live, they are particularly vulnerable.
Outside of the Antarctic, penguin populations are not faring that much better. Twelve out of the 18 penguin species in the world are facing population decline. According to the International Union for Conservation of Nature’s Red List, 10 of the 18 are either endangered or vulnerable.
In South Africa, penguin population has fallen by 70 per cent in the last twelve years. Penguins complete with commercial fisherman and as sardines and anchovies stocks are depleted they struggle to feed their young.
Overfishing, especially dragnet fishing to make fishmeal that goes on to feed farmed salmon, chickens and other livestock affects many marine species. The decline in penguin numbers is yet another side effect of the emptying of the oceans.
​Glynn Davies, WWF’s executive director of global programmes, said: “The decline of species is reaching a critical point and we cannot ignore the role of unsustainable livestock production.“If nature is to recover, we need to work together and encourage sustainable farming systems which will limit pollution, reduce habitat loss and restore species numbers.”
Penguins live across the Southern Hemisphere from the southern Australian coast to the Galapagos Islands and Peru. They occupy a huge variety of habitats from the extreme frozen wastelands of Subantarctic Islands to urbanised beaches in South Africa and forests in New Zealand. Penguins are one of the most popular species of birds, they have a friendly nature and a cuddly appearance. Zoos and popular culture have kept them in the forefront of the public’s imagination from Chilly Willy in the 1950s to Happy Feet.  
However the threat of environmental destruction, including oil spills and illegal egg harvesting threatens all species of penguins. With World Penguin Day 2017, WWF, Bird Life Europe and Compassion in World Farming hope to highlight the impact humans have on these birds and other marine species.

Published Nouse Online 25/04/2017

Warm winters drive the spread of Lyme disease

As climate change drives the spread of Lyme disease carrying ticks across new areas of the Northern Hemisphere, we still have no human vaccine against the infection. Neither is there a medical consensus about the existence of “chronic Lyme disease”, the symptom complex that some sufferers experience even after being treated for the initial infection.

Lyme disease, or Lyme borreliosis is a bacterial infection of Borrelia burgdorferi spread to humans by infected tick bites. The bite can leave a bulls-eye shaped rash and initial infection causes fever, headache and exhaustion. If left untreated, Lyme disease may develop over several weeks, months or years, leading to inflammatory arthritis, heart problems, issues of the nervous system and even meningitis.

Imagr: Flickr
Lyme borreliosis is the most common disease spread by ticks in North America and is estimated to affect at least 65,000 people a year in Europe alone. The autopsy of Ötizi the Iceman, a 5,300 year old mummy found in the Ötztal Alps between Austria and Italy discovered the DNA of Borrelia burgdorferi, making him the earliest known human to have suffered from Lyme disease,

Since 2001, cases of Lyme disease in the UK have increased ten-fold. In the US, the Centres for Disease Control has called the increased incidence of infection “a major US public health problem”. This seems to be linked to the warmer winters we have been experiencing over the last decade.

As global warming increases world average temperatures, Lyme disease is spreading outside of its usual territories. Whilst those who live in Lyme disease zones are aware of how to avoid contact with ticks, the spread of the insects to new areas means those less familiar with tick awareness will begin to encounter the disease.

When a tick initially bites, it is only the size of a poppy seed and some people do not display the typical “bulls-eye” rash that would otherwise signify infection with Lyme disease. Likewise, initial flu-like symptoms are easily misdiagnosed and because antibodies to Lyme disease can take weeks to develop, early tests may miss it.

The best approach to combat Lyme disease would be vaccination of those at risk, and in 1998 GSK released Lymerix, an FDA approved human vaccine against Borrelia burgdorferi. However, some recipients of this vaccine claimed it had caused them to suffer autoimmune arthritis, and lead by pressure from various anti-vax groups, Lymerix was withdrawn from the market.

The FDA has since confirmed there was no link between the Lyme vaccine and any autoimmune side effects, but the damage to the vaccines image was done and Lymerix was declared unmarketable by GSK. There are, however, various animal-approved vaccines for Lyme disease, so most farm animals and pets are protected.

The French biotech company Valneva is working on a new human Lyme vaccine that will improve on Lymerix by immunising recipients against all five strains of the disease, however it is still only in the early stages of human trails.

In the meantime, if you plan on hiking in a “high risk” area, such as the North York moors, read up on your anti-tick precautions. Lyme disease can be treated with a two or four week course of antibiotics, and if you suspect you have been bitten by a tick you should seek medical advice.

Published Nouse Online 21/04/2017

Tuesday, 18 April 2017

Marmite is good for the brain, York study suggests

Eating a spoonful of Marmite everyday could have a positive impact on your brain’s health, researchers at York have found.
A group from the University of York’s Department of Psychology have identified a potential link between Marmite and the increase of gamma-amino butyric acid (GABA) – a chemical messenger which is associated with healthy brain function.
Marmite contains a high concentration of vitamin B12 Image:Flickr
Dr Daniel Baker, Lecturer in the Department of Psychology and senior author of the paper, said: “The high concentration of Vitamin B12 in Marmite is likely to be the primary factor behind results showing a significant reduction in participants’ responsiveness to visual stimuli.”
The study looked at 28 healthy volunteers who were split into two groups; half ate a teaspoon of Marmite every day for a month whilst the control group where given peanut butter.
The participants’ responses to visual stimuli were measured and they recorded electrical activity in the brain using electroencephalography (EEG). Subjects that had been eating the “yeast extract product” saw a reduction of around 30% in the brain’s response to the visual stimuli.
GABA is an inhibitory neurotransmitter; it reduces the excitability of neurons in the brain, as a delicate balance of activity is needed for brain health. Abnormal levels of GABA are associated with epilepsy, autism and depression.
Anika Smith, PhD student in York’s Department of Psychology and first author of the study, said: “These results suggest that dietary choices can affect the cortical processes of excitation and inhibition – consistent with increased levels of GABA – that are vital in maintaining a healthy brain.
“As the effects of Marmite consumption took around eight weeks to wear off after participants stopped the study, this suggests that dietary changes could potentially have long-term effects on brain function.
“This is a really promising first example of how dietary interventions can alter cortical processes, and a great starting point for exploring whether a more refined version of this technique could have some medical or therapeutic applications in the future. Of course, further research is needed to confirm and investigate this, but the study is an excellent basis for this.”
Published Nouse Online 5/4/17

Thursday, 9 March 2017

New approaches to childhood obesity

METABOLIC SYNDROME, sometimes referred to as insulin resistance syndrome, is a term used for the group of various medical conditions including obesity, elevated blood pressure and high fasting blood glucose levels. It is associated with the risk of developing cardiovascular disease and type 2 diabetes. Approximately 25 per cent of the world’s adult population exhibit the cluster of risk factors that make up metabolic syndrome, and one of the highest risk factors leading to adult metabolic syndrome is childhood obesity.
Childhood obesity has reached epidemic levels in many developing countries as well as in most developed countries. In the UK, 28 per cent of children aged 2 to 15 are at least overweight and half of those are obese. Childhood obesity can have a serious impact on a child’s health, both physically and mentally. It may affect their social and emotional well-being, and obesity is associated with lower self-esteem and bullying, despite it becoming more common.

Image: Pexels
A recent report by the NHS has shown that many parents of overweight children wrongly thought their child was a healthy weight – 91 per cent of mothers of overweight children and 48 per cent of mothers of obese children. Factors that impact obesity, both in childhood and adulthood, are complex. They include environmental factors, socioeconomic status, lifestyle preferences, and the culture around you. The study looked at 60 000 children and their parents from all over the country, and tried to identify problems in tackling childhood obesity. Although the root causes of obesity can be hard to challenge, spotting the problem early is key in healthcare.
A 2007 report in the New England Journal of Medicine showed how obesity can spread through a social circle. Both adults and children are less likely to acknowledge their own weight gain if those around them are obese. There is also the key factor of denial: parents don’t want to accept that there may be a problem. Simply telling a child they are fat is not the solution, however, as this can lead to stress, comfort eating or ill-informed diet options. In fact, the children are likely to be aware that they are overweight, even when the parents fail to notice. A better approach is education. Lessons in cooking and nutrition are becoming more common in schools, along with better food labeling standards. A study from the University of Michigan last year taught children and teenagers about how fast food companies use advertising to manipulate your desires, and disguise their poor nutritional content.
It turns out that being informed about your choices leads to better decision making. The junk food market is manipulative and targets young children in its ad campaigns. Simply informing young people of the unfair practices of the food industry can lead them to making their own decisions in an almost social justice-oriented, rather than focussing efforts on diet or weight-loss. Healthy habits are important at a young age, and of course parents should lead by example. Early intervention to prevent childhood obesity can have a very positive impact on future health.
Published in Nouse 08/03/2017