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SO TODAY WE'RE HONORED TO HAVE
OUR SPEAKER DR. PHIL EPIGENETIC
A. MACKOWIAK, HE IS THE FELLOW
AND SULLIVAN HISTORY OF MEDICINE
AND SCHOLAR OF RESIDENCE AT THE
UNIVERSITY OF MARYLAND SCHOOL OF
MEDICINE.
HE IS ALSO A FORMER SENIOR
LECTURER IN THE DEPARTMENT OF
HISTORY AT THE UNIVERSITY OF
MARYLAND COLLEGE PARK.
DR. MACKOWIERK AK RECEIVED HIS
BACHELORS AT THE UNIVERSITY OF
PENNSYLVANIA AND EARNED HIS M.
D. AT THE UNIVERSITY OF MARYLAND
AND COMPLOATED MASTERS IN
BUSINESS ADMINISTRATION AT JOHNS
HOPKINS UNIVERSITY.
SHORTLY AFTER HE BEGAN HIS
CAREER IN ACADEMIC MEDICINE AS
AN EPIDEMIC INTELIENCE OFFICER
FOR THE CENTER FOR DISEASE
CONTROL IN THE EARLY 1970S.
IN 1975, HE YOINEDLET FACULTY OF
THE UNIVERSITY OF TEXAS
SOUTHWESTERN MEDICAL SCHOOL IN
DALLAS WHERE HE BECAME A
PROFESSOR OF MEDICINE BEFORE
JOINING THE FACULTY OF THE
UNIVERSITY OF MARYLAND SCHOOL OF
MEDICINE IN 1988.
THROUGHOUT HIS CAREER,
DR. MACKOWIAK HAS BEEN
RECOGNIZED FOR HIWORK AS A
TEACHER AND MENTOR.
TWELVE TIMES SINCE 1993, THE
GRADUATING CLASS OF THE
UNIVERSITY OF MARYLAND SCHOOL OF
MEDICINE HAS SLEBTED HIM AS A
FACULTY MARSHAL, 4 TIMES AS THE
MACE BEARER.
IN 1992, THE GRADUATING CLASS
HONORED HIM FURTHER BY INDUCKING
HIM INTO THE ALPHA OMEGA ALPHA
HONORS SOCIETY HE RECEIVED THE
DEPARTMENT OF MEDICINE'S HOUSE
STAFF TEACHING AWARD IN 1993,
STUDENT FACULTY AWARD IN 94 AND
98, AND THE AMERICAN COLLEGE OF
PHYSICIANS MARYLAND CHAPTERS
THEODORE E. WOODWARD AWARD FOR
TEACHING EXCELLENCE IN 2009.
IN 2007 HE WAS THE FACULTY
MEMBER CHOSEN TO ADDRESS THE
GRADUATING CLASS AT THE MEDICAL
SCHOOL'S BICENTENNIAL
CELEBRATION AND IN 2010, THE
MARYLAND CHAPTER OF THE ACP
HONORED HIM BY NAMING ITS ANNUAL
STUDENT AWARD, THE PHILLIP A.
MACKOWIAK AWARD.
FOR OVER 2 DECADES THE DOCTOR
HAS HOSTED AN BRAGZALLYALLY
ACCLAIMED SERIES OF HISTORICALLY
PATHOLOGICAL CLINICAL
CONFERENCES IN BALTIMORE.
THESE HAVE GIVEN RISE TO SCORES
OF PEER REVIEW ARTICLES AS WELL
AS A BOOK TITLED POSTMORTEM
SOLVING HISTORY'S GREATEST
MEDICAL MYSTERIES.
THESE WORKS EARNED DR. MACKOWIAK
EARNED HIM THE 2010 NICHOLAS E.
DAVIES MEMORIAL SCHOLAR ARK WARD
FOR SCHOLARLY ACTIVITIES IN THE
HUMANITIES AND HISTORY OF
MEDICINE AND HAVE ESTABLISHED
HIM AS 1 OF TODAY'S FOREMOST
MEDICAL HISTORIANS.
IN 2013 OXFORD UNIVERSITY PRESS
PUBLISHED A SEQUEL TO POSTMORTEM
TITLED: DIAGNOSING GIANTS,
SOLVING THE MEDICAL MYSTERIES OF
13 PATIENT WHO IS CHANGED THE
WORLD.
HIS LATEST BOOK, PATIENTS AS
ART, 40,000 YEARS OF MEDICAL
HISTORY IN DRAWINGS, PAINTINGS
AND SCULPTURES WAS PUBLISH
INDEED 2018 BY THE UNIVERSITY
PRESS.
THE DOCTOR HAS PUBLISHED OVER
150 PEER REVIEWED ARTICLES,
EDITORIALS AND BOOK CHAPTERS ON
A VARIETY OF MEDICAL TOPICS AND
PERHAPS BEST KNOWN IN THE
MEDICAL COMMUNITY FOR HIS WORK
ON THE DIAGNOSIS PROGNOSIS AND
TREATMENT OF FEVER.
HIS BOOK, FEVER, BASIC
MECHANISMS AND MANAGEMENT NOW IN
ITS SECOND EDITION, IS THE FIRST
COMPREHENSIVE MONOGRAPH ON THE
SUBJECT SINCE 1 WAS PUBLISHED BY
WANDERLECHEART ATTACK T IN 1998.
SO PLEASE JOIN ME IN WELCOMING
FOR HIS TALK PERICLES AND THE
PLAGUE OF ATHENS.
>> THANK YOU CHRIS, THANK YOU
FOR THE INVITATION AND THANK YOU
FOR THAT KIND INTRODUCTION WHICH
I WROTE MYSELF.
SO IT IS A GREAT HONOR TO BE
HERE.
LET ME SEE IF I CAN FIGURE OUT
HOW TO WORK THIS SO DISCLOSURE
WISE, I SAY I HAVE HERE NO
FINANCIAL RELATIONSHIPS TO
DISCLOSE.
WELL, IN FACT, I'M GOING TO TELL
YOU IN JUST A MINUTE THAT I DO
HAVE A DISCLOSURE TO MAKE, AND
THAT IS I SHAMELESSLY PROMOTE
THOSE HISTORY OF MEDICINE BOOKS
THAT CHRIS MENTIONED.
SHAMELESSLY, BUT I'M NOT ASHAMED
OF DOING IT BECAUSE I'VE BECOME
RICH DUE TO THOSE BOOKS.
AS A MATTER OF FACT, THE
ROYALTIES HAVE COME IN SO
REGULARLY, THAT I COULD TAKE
DR. KO AND DR. MONFORD WHO IS
BACK HERE WITH US, OUT TO LUNCH
1 DAY IF 2 OF US PAID OUR OWN
WAY.
SO LEARNING OBJECTIVES: I WILL
BE DISCUSSING A NUMBER OF THINGS
THAT HAVE RELEVANCE TODAY IN
THIS TIME OF MULTIPLE PANDEMICS
EMPLOY I WILL BE KISS CUSSING
PERICLES, AND HIS RELATIONSHIP
TO THE GOLDEN AGE OF GREECE.
I'LL BE DISCUSSING THE WAR, I
WILL DISCUSS THE EEIVETS OF THE
PANDEMIC THAT RAGED IN ATHENS
DURING THE WAR AND THE LIKELY
CAUSES OF THE DISORDERS.
AND THE LATERAL WILL BE
THEORETICAL SO THAT IN THE Q&A,
IF THOSE ARE WHO HAVE OTHER
IDEAS, I WILL CERTAINLY BE EAGER
TO HEAR THEM.
SO THIS IS 1 OF THE BOOKS THAT I
SHAMELESSLY PROMOTE, THAT'S
THE--I SHOW THIS 1 BECAUSE 1 OF
THE CHAPTERS IN THIS PARTICULAR
BOOK IS DEVOTED TO PERICLES AND
THE PLAGUE OF ATHENS AND THAT IS
WHAT I WILL SUMMARIZE TODAY
EMPLOY SO THE GOLDEN AGE OF
ATHENS, WHAT WAS IT?
IT WAS AN AMAZING INTELLECTUAL
TIME IN THE FIFTH CENTURY BCE.
IT WAS THE TIME IN WHEN ESA
CLEESE, ARIPH IDESE WROTE THEIR
ORIGINAL WORK, IT WAS A TIME
WITH HERODITISES, AND THEY WROTE
THE HISTORIES THAT BECAME THE
FOUNDATION FOR THE CURRENT
SCIENCE OF HISTORY.
IT WAS A TIME IN WHICH HIPIECE
OF CONTENTRITYS HYPICROTESE AND
HIS DISCIPLES CREATED THE
PHILOSOPHY THAT BECAME THE
FOUNDATION OF MODERN MEDICINE.
DEMOCRACY AS WE KNOW IT TODAY
FIRST FLOURISHED IN GREECE AT
THAT TIME.
AND IT WAS A TIME WHEN THIS
STRUCTURE HERE, THE P A RTHENON
FIRST TOOK PLACE OF THE
BUILDING.
THE GOLDEN AGE OF ATHENS OR
GREECE IS ALSO REFERRED TO AS
THE AGE OF PERICLES, IMAGE OF
WHICH IS SHOWN HERE.
IT'S REFERRED TO AS THE AGE OF
PERICLES BECAUSE HE WAS THE 1 TO
PRESIDED OVER THAT AGE AS
STRATEGOS, THE TOP GENERAL AND
POLITICIAN OF THAT ERA.
HE WAS THE 1 WHO GATHERED AND
NURTURED THE ILLUMINATI, WHO
WERE THE GOLDEN AGE OF GREECE.
HE WAS RESPONSIBLE FOR
INAUGURATING CONSTRUCTION OF THE
ACROPOLIS, AND IN PARTICULAR THE
P A RTENON.
HOWEVER, HE WAS ALSO THE 1 WHO
PRECIPITATED THE WAR WITH
SPARTA, AND SPARTA AND THE
PENELOPENES ISLANDS WHICH WAS
OCCUPIED BY SPARTA.
THIS PARTICULAR WAR, THE
PENELOPENNIAN WAR SWEPT AWAY
PERICLES GOALEN AGE IN LESS THAN
50 YEARS.
AMAZING HISTORICAL TRAGEDY.
SO, PERICLES WAS MANY THINGS AND
I MENTIONED SOME OF THEM.
ONE FOR WHICH HE IS NOTED IS HIS
ORA TORACLE ABILITIES.
HE IS WIDELY CONSIDERED 1 OF THE
GREATEST ORATORS OF ALL TIMES.
THIS IS WHAT HE SAID OVER THE
GRAVES OF ATHEENIANS THAT WERE
KILLED IN THE FIRST YEAR OF THE
WAR.
HE SAID I WOULD HAVE YOU DAY BY
DAY FIX YOUR EYES UPON THE
GREATNESS OF ATHENS UNTIL YOU
BECOME FILLED WITH THE LOVE OF
HER AND WHEN YOU ARE IMPRESSED
BY THE SPECTACLE OF HER GLORY
REFLECT THAT THIS EMPIRE AS BEEN
ACQUIRED BY MEN WHO KNEW THEIR
DUTY AND HAD THE COURAGE TO DO
IT WHO IN THE HOUR OF CONFLICT
HAD THE FEAR OF DISHONOR ALWAYS
PRESENT TO THEM AND WHO IF EVER
THEY FAILED IN AN BRISE WOULD
NOT ALLOW THEIR VIRTUES TO BE
LOST TO THEIR COUNTRY.
BUT FREELY GAVE THEIR LIVES TO
HER AS THE FAIREST OFFERING THEY
COULD PRESENT AT HER FEAST.
FOR THE LOVE OF HONOR ALONE, IS
EVER YOUNG AND NOT RICHES AS
SOME SAY BUT HONOR IS THE
DELIGHT OF MEN WHEN THEY ARE OLD
AND USELESS.
PERICLES.
THE ORATOR.
SO PERICLES AS I SAID
PRECIPITATED THE PELEPNISAIAN
WAR, AND ALSO THE STRATEGY FOR
THE WAR.
AFTER THE BALTIMORE NUMBER OF
MARATHON WHICH THE GREEKS WON,
THE GREEK CITY-STATES GOT
TOGETHER AND DEVELOPED A COMMON
DEFENSE FUND TO WHICH THEY ALL
ADDED THEIR FUNDS.
PERICLES CO-OPTED THAT FUND PER
LOINED THE MONIES WHICH HE USED
FOR A NUMBER OF THINGS, 1 IT WAS
BIG IN CONSTRUCTION OF THE P A
RTHENON, AND UPGRADE THE NAVY
AND THE NAVY RULED THE AEGEAN AT
THIS TIME.
AND WHEN SPARTA COULD NO
LOPPINGER TOLERATE BEING A
SUBJECT OF ABNORMAL ABNORMAL -O
RAFFLE JACKPOT EDUCATIONAL THE
AREA AROUND ATHENS.
SO PERICLES SORT OF DEPICTED IN
THIS DIAGRAM, STRATEGY, WAS TO
HUDDLE WITH HIS POPULATION
BEHIND THE WALLS OF ATHENS WHICH
SURROUNDED ATHENS ITSELF AND
WERE CONNECTED BY WHAT WAS KNOWN
AS A LONG WALL TO THEIR PORT OF
PYRCERTAINLY--CERTAINLY AUS, HIS
STRATEGY WAS TO STAY THERE,
HUDDLED UP WHILE THE SPARTANS
DESECRATED THE LAND OUTSIDE AND
WAS ABLE TO SUPPLY THE NEEDS OF
HIS POPULATION WITH HIS NAVY
WHICH RULED THE AGEAN SEA.
AND THIS WORKED FOR A WHILE BUT
ULTIMATELY ATHENS AS YOU WILL
SEE COLLAPSED.
SO--SORRY--SO THAT WAS THE
PELEPENESI,A N WAR, IT WAS THE
MOST VICIOUS AND COSTLY WAR OF
GREEK AGAINST GREEK EVER.
IT RAGED FROM 431-40 FOWF BCE
AND AS I IBDICATED WAS A RESULT
OF ATHEENIAN HUBEROUS AS
ORCHESTRATED BY PERICLES.
A DEVASTATING SEVERE AND
MYSTERIOUS PLAGUE ATTACKED
ATHENS ALMOST IMMEDIATELY AFTER
THE BEGENERATEDDING OF THE WAR
IN THE SUMMER OF 431 BCE.
IT FIRST ARRIVED IN PYREAUS.
THE PORT OF ATHENS AND ARRIVED
SO SUDDENLY AND FURIOUSLY THAT
THE ATHENNIANS IN THAT
PARTICULAR AREA THOUGHT THAT THE
SPARTANS HAD POISONED THE
CISTERNS BUT THEN IN SHORT ORDER
IT MOVED ALONG THE LONG WALL AND
INTO ATHENS PROPER AND RAGED
THERE FOR ANOTHER 3 OR 4 YEARS.
IT CONTINUES TO BE 1 OF THE MOST
MYSTERIOUS, 1 OF THE FIRST TRULY
WELL DESCRIBED PANDEMICS OF ALL
TIME.
MYSTERIOUS AND IS YET TO BE
DIAGNOSED, THE CAUSE OF WHICH IS
YET TO BE DIAGNOSED IN SPITE OF
OVER 2000 YEARS OF SPECULATION.
PERICLES DIED IN THE SECOND YEAR
OF THE WAR.
THE PRESUMPTION IS THAT HE DIED
OF THE PLAGUE, BUT WE DON'T KNOW
THAT FOR CERTAIN.
BUT WHAT WE DO KNOW FOR CERTAIN
WAS THAT UPON HIS DEATH AT AGE
65 HE WAS REPLACED BY LESSER MEN
AND THAT MAY HAVE CONTRIBUTED TO
ABNORMAL GLUCOSE TOLERANCEN'S
FAILURE TO STAND UP TO SPARTAN
DURING THE PENELOPIAN WAR.
SO MANY OF YOU PROBABLY KNOW
THIS QUOTE: ALWAYS SOMETHING
NEW FROM AFRICA BY PLAYING THE
ELDER.
SO THERE'S SOMETHING NEW IN THE
FIFTH CENTURY BCE ACCORDING TO
FUCIDES, WHO I WILL DISCUSS IN A
MINUTE WHO WAS THE PLAGUE THAT
DESCENDED UPON ATHENS.
IN PRESENT DAY WE HAVE AIDS TO
ADD TO THE LIST, EBOLA, ET
CETERA.
SO EX AFRICA S
EMPER ALIQUID NOVI.
SO FLUCIDES, IS LARGELY CREDITOR
OF BEING THE FESTER MODERN
HISTORIAN.
HE WROTE A HISTORY OF THE
PENELOPESIAN WAR, DURING EXILE
ELSEWHERE AND I'M NOT SURE WHERE
HE RESIDED BUT HE WROTE A
HISTORY OF IT WHICH HE COMPLETED
SOME 20 QUEERS AFTER HE HAD BEEN
EXILED.
HE WAS ECILED BECAUSE HE WAS A
GENERAL WHO HAD FAILED TO
PROTECT 1 OF THE ATHENNIAN
ENCLAVES IN THIPILIS AND THE
GREEKS WERE EXPECTING THEIR
GENERALS TO WIN THEIR ENGAGE AMS
SO HE WAS EXILED.
COMPREHEND HE WAS NOT A
PHYSICIAN WHICH IS IMPORTANT,
ALTHOUGH HE WAS A VICTIM OF THE
PLAGUE.
HE DEVELOPED THE SIGNS AND
SYMPTOMS OF THE DISORDER WHICH
MAY HAVE GIVEN HIM SPECIAL
INSIGHT INTO THAT DISORDER.
IT'S ALSO BEEN SUSPECTED THAT IT
MAY HAVE PREJUDICED HIM TO THINK
THAT HIS SYMPTOMS WEREN'T
NECESSARILY TYPICAL OF THE
SYMPTOMS OF THE PEOPLE IN
GENERAL WHO WERE AFFECTED BY THE
PLAGUE.
LET MAY READ FOR YOU A
DESCRIPTION WHICH YOU SEE
SUMMARIZED HERE, THE CLINICAL
CHARACTERISTICS OF THIS EPIDEMIC
WHICH FLUCIDESE DESCRIBED.
SO ACCORDING TO HIM, THE ILLNESS
BEGAN WITH INTENSE HEAT IN THE
HEAD, MORE LIKELY WE'RE TALKING
ABOUT HEADACHE BUT WE DON'T KNOW
FOR SURE AND INFLM EGG OF THE
EYES AND THROAT.
SO KEEP THESE THINGS IN MIND AS
I GO THROUGH POSSIBLE CAUSES OF
THIS DISORDER.
THESE WERE FOLLOWED BY SNEEZING
AND HORSENESS AND THEN VIOLENT
COUGHING, VOMITING AND WRETCHING
WERE NEXT AND FINALLY A
GENERALIZED RASH, THE PREICIZE
NATURE OF WHICH AS I WILL
DISCUSS FURTHER IS UNCERTAIN.
BUT I HAVE DEFINITE THOUGHTS
ABOUT IT THAT WERE GIVEN TO ME
BY AN EXPERT IN THIS AREA.
THERE WAS FEVER, RESTLESSNESS,
SLEEPLESSNESS AND EXTREME
THIRST.
THERE WAS ALSO AN AVERSION TO
CLOTHING AND DESIRE TO SUBMERGE
1'S SELF-IN WATER.
DAVID DECKER URAK WHO DISCUSSED
THIS CASE FOR US DURING 1 OF THE
HISTORICAL CPCs, DURAK WAS
HEAD OF INFECTIOUS DISEASES AT
DUKE FOR A WHILE, THOUGHT THAT
MAYBE THAT WAS EVIDENCE IN
SUPPORT OF MEASLES AS I RECALL
BECAUSE THERE WAS AN OUTBREAK OF
MEASLES IN WHICH PATIENTS WERE
JUMPING INTO CISTERNS TO COOL
OFF.
PHYSICAL WASTING WAS NOT
MENTIONED NOR WAS ALTERED
MENTALMENTATION AT LEAST NOT
UNTIL THE FINAL STAGE OF THE
DISORDER.
THOSE WHO DIED DID SO ON THE
SEVENTH OR NINTH DAYS, THESE ARE
TARTING TO THE TYPICAL DAYS
ACCORDING TO THE TRADITION.
WHY 7 AND 9, I DON'T KNOW.
THE AVERAGE DURATION OF ILLNESS
IN NONFATAL CASES WAS NOT
DESCRIBED.
IN FATAL CASES DIARRHEA WAS A
PROMINENT TERMINAL COMPLAINT.
AND AT LEAST SOME CASES IT WAS
LOSS OF DIGITS OR GENITALIA, IN
SOME OF THOSE RECOVERED THERE
WAS PROFOUND AMNESIA.
SO KEEP THOSE CHARACTERISTICS IN
MIND.
SO HERE THE EPIDEMIOLOGICAL
CHARACTERISTICS WHICH WOULD HAVE
TO BE EXPLAINED IDEALLY IN
COMING UP WITH THE DIAGNOSIS, SO
JUST JUST AN EPIDIBLGIC IN AGHT
ENS BUT ACCORDING TO FLUCIDESE,
THE PAN DEMAT LEAST TO THE
EXTENT AS DESCRIBED AS HAVING
ASHINGED THE ENTIRE EASTERN
MEDITERRANEAN, WHAT WAS THEN THE
MAJOR PART OF THE KNOWN WORLD.
AND ACCORDING TO WAS THOUGHT TO
HAVE ORIGINATED IN AFRICA,
SUB-SAHARAN AFRICA AND WORKED
ITS WAY DOWN INTO THE ETHIOPIA
DOWN IN THE BASINS.
BASED ON WHAT FLUCIDES, ABOUT
THE DEATH RATE, THEY THOUGHT
THERE WAS A FATALITY RATE OF
ABOUT 25%.
A QUARTER OF THE POPULATION OF
ATHENS WHICH WAS HUDDLED
TOGETHER IN HORRIBLE
CONCENTRATION CAMPS, EXCUSE ME,
LIKE SOME CONCENTRATION CAMP HAD
A 25% MORTALITY RATE.
SOCIAL ACTIVITIES BECAME TOTALLY
DISRUPTED ENEMY FORCES ACCORDING
TO FLUCIDESE WERE NOT AFGHTED.
NOW THAT SEEMS HARD TO BELIEVE
BASED ON THE FACT THAT THE
ENTIRE EASTERN MEDITERRANEAN
SEEMS TO BE AFFECTED.
SOME SUSPECT THAT FLUCIDESE MADE
THIS CONTENTION AS A MEANS OF
JUSTIFYING ATHENS DEFEAT DURING
THE PENELOPESIAN WAR.
SURVIVORS WERE IMMUNE FROM
ATTACKS, IF NEVER CAME DOWN WITH
THE DISEASE OR IF THEY DID, IT
WAS NOT AS SEVERE AS THE FIRST
TIME SUGGESTING THIS WAS AN
INFECTION THAT IMMUNITY
DEVELOPED OR THE PERSON WAS
KILLED.
WHETHER OR NOT ANIMALS WERE
AFFECTED
AFLUCIDCERTAINLY--CERTAINLY SE
SUGGESTS IS A QUESTIONABLE
BECAUSE THIS WAS A TROAP THAT
WAS COMMONLY USED IN ANCIENT
DEKRIPGZS OF EPIDEMICS IN
GENERAL AND THERE WAS NO
SEASONAL SEASONAL AND THIS ORDER
RAGED DURING THE SUMMER OF 431
B. C. DURING THE HEAT OF THAT
SUMMER AND THIS IS IMPORTANT
BECAUSE HANS ZINETWORK SER
SUGJEFFS THAT IF THAT WAS TRUE,
THE NECROSIS WAS DIGITS AND
EXTREMITIES WAS UNLIKELY TO BE
CAUSED BY EPIDEMIC TYPHUS IN
WHICH THAT HAPPENS ALMOST DURING
WINTER ATTACKS.
IT WAS JUST 1 OF ANCIENT
EPIDEMICS SEEN HERE MUCH THE
PLAGUE OF SYRACUSE, THE KARGTA
GENERATEDDIAN SIEGE OF SYRACUSE
AND THE ROMAN PLAGUE HAD
CHARACTERISTICS ALMOST IDENTICAL
TO THE PLAGUE OF ATHENS BUT
THESE CAME LATER.
SO WHY AFTER ALL THIS TIME AND
THERE'S BEEN INTENSE SPECULATION
HOWEVER WHAT THE PLAGUE WAS
ATHENS WAS MANY THINGS HAVE BEEN
THE FATHER OF THE EISPROGRAM THE
AT CTHIS, C, WAS CAUSED BY
INFLUENZA COMPLICATED BY TOXIC
SHOCK SYNDROME.
I HOPE I GO THROUGH
POSSIBILITIES YOU WILL REALIZE
THAT THIS IS JUST IS NOT LIKELY
ALTHOUGH IT WAS PUBLISHED IN THE
NEW ENGLAND JOURNAL OF MEDICINE.
WE HAVE TO GIVE THEM CREDIT FOR
THAT.
I THINK HE HAD CONTEXT THERE
THOUGH.
CERTAINLY THIS IS AN INFECTIOUS
DEC GIVEN THE FACT THAT NO 1
SEEMED TO COME DOWN WITH IT MORE
THAN ONCE.
BUT IT WAS LIKE NO OTHER SEEN
BEFORE OR AFTERWARDS.
WHAT ARE THE POSSIBILITIES IN
WELL 1 POSSIBILITY IT WAS A
UNIQUE DISORDER THAT OCCURRED
ONCE DURING THE HISTORICAL
RECORD NEVER TO REAPPEAR.
IS THERE ANOTHER EXAMPLE OR
OTHER EXAMPLES OF SUCH,
POSSIBLY.
[INDISCERNIBLE] ENCEPHALITIS
WHICH WAS AN UNUSUAL FORM OF
ENCEPHALITIS THAT'S FOLLOWED THE
SPANISH FLU OF 1918, 1919,
KILLED A MILLION PEOPLE WORLD
WIDE.
AS FAR AS I KNOW THERE'S NEVER
BEEN AN OUTBREAK LIKE THAT
AGAIN.
NOR BEFORE.
COULD HAVE BEEN A DISORDER THAT
CHANGED OR MODIFIED OVER TIME TO
CHANGE TO SUCH AN EXTENT THAT
CURRENT VARIETIES OF THE
DISORDER ARE JUST UNRECOGNIZABLE
WHEN COMPARED TO THE ORIGINAL.
IS THERE AN EXAMPLE OF THIS?
WELL I THINK CIVILIS IS AN
EXAMPLE BECAUSE YOU WILL RECALL
WHEN COLUMBUS' CREW GRIEWSED
SYPHILIS INTO THE OLD WORLD IN
THE 1494 IT WAS A HIGHLY
AGGRESSIVE ACUTE DISORDER, VERY
DIFFERENT FROM WHAT WE SEE
TODAY.
IT COULD ALSO HAVE BEEN MULTIPLE
DISORDERS, IMPOSSIBLE TO TEASE
APART AT A DISTANCE AND TIME OF
OVER 2 MILLENNIA.
HERE'S WHAT HANS ZINSER, HE IS 1
OF THE GREATEST MICROBIOLOGIST
OF ALL TIME AND THE MOST
PROMINENT EXPERT ON EPIDEMIC
TYPHUS OF ALL TIME.
HE SAID: IT IS IMPORTANT TO
REMEMBER THAT IN ANY GREAT
OUTBREAK WHILE THE LARGE
MAJORITY MAY REPRESENT A SINGLE
TYPE OF INFECTION, THERE IS
USUALLY A CO INSURE MARKET DENT
INCREASE IN OTHER FORMS OF
CONTAGIOUS DISEASES, FOR
CIRCUMSTANCES THAT SPREAD
INFECTIOUS TO 1 AGENT OFTEN
CREATE OPPORTUNITIES TO THE
TRANSFORMATION OF OTHERS.
CERTAINLY MAKES SENSE.
SO PERHAPS WE WERE DEALING WITH
THAT, AND THEN FINALLY, IT'S
POSSIBLE, MAYBE EVEN LIKELY THAT
FLUCIDESE, WHO WAS A
NONPHYSICIAN AND MAY HAVE BEEN
PREJUDICE BY THE FACT THAT HE
HAD THE DISORDER WAS UNEQUAL TO
THE TASK OF GIVING A
COMPREHENSIVE ACCURATE DEKRIPGZ
OF THE DISORDER WHICH COULD
BE--LEND THE DIAGNOSIS TO LATER
INVESTIGATORS.
MOST OF THE SIGNS AND SYMPTOMS
THAT FLUCIDESE DESCRIBES ARE
NONSPECIFIC AND COULD BE SEEN IN
ALMOST ANY DISORDER YOU WANT TO
MENTION.
THE KEY TO DIAGNOSIS IS THE TERM
HE USED WAS LIKE THE BLISTERS
FOUND IN THE RASH PH YLKTAINAI,
IT WAS JUST BE BLED, BULLA,
ERUPTION, PUOF THULE, VESICLE,
PIMPLE OR WELK.
NOW ROBERT LITTMAN WHO DISCUSSED
THIS CASE, POINTED OUT THAT THE
TERM IS USED IN ANCIENT GREEK
LITERATURE TO DESCRIBE THE
BLISTERS FOUND ON A LOAF OF
BREAD OR ON THE HANDS OF ROWERS
SUGGESTING THAT MAYBE THERE WAS
AN ERUPTION, VESICLE ERUPTION,
PUSTULE, THAT HAD RUPTURED.
SO WITH ALL OF THESE THAT HAVE
BEEN MENTIONED, TOXIC SHOCK,
PLAGUE, ERGAATISM, THE 2 MOST
LIKELY ARE SHOWN IN THE NEXT 2
SLIDES.
THIS 1 YOU SEE HERE IS A PATIENT
THAT DR. THEO WOODWARD TOOK A
PHOTOGRAPH OF DURING THE SECOND
WORLD WAR AND IT IS RIP ROARING
EPIDEMIC TYPHUS.
THERE'S MANY FEATURES OF
EPIDEMIC FEATURES OF TYPHUS THAT
SAYS IT'S WORRY AS A CAUSE OF
THE PLAGUE OF ATHENS.
SO FOR THOSE WHO HAVEN'T SEEN A
CASE OF EPIDEMIC TYPHUS, ANYBODY
HERE SEEN A CASE.
SO CHARLES [INDISCERNIBLE] WHO
WAS A RICKETTESIA, TAUGHT ME
MICROBIOLOGY AND SPOKE TO US
ABOUT EPIDEMIC TYPHUS WHICH HE
HAD BEEN STUDYING AT THE TIME
BUT I HAD NEVER SEEN A CASE.
SO HERE'S WHAT HA BEEN WRITTEN
ABOUT IT, IT'S A DEVASTATING
INFECTION TODAY IN WHICH
PATHOGENIC BACTERIA, TALKING
ABOUT RICKETSIA, DAMAGED A WIDE
VARIETY OF CELLS THRUT THE BODY,
ESPECIALLY THOSE LINING THE RED
BLOOD VESSELS, THIS CAUSES
DIFFUSE VASCULAR DAMAGE
CHARACTERIZED FIRST BI
DELETATION OF CAPILLARIES AND
THEN THROMBOSIS OF PROGRESSIVELY
LARGER VESSELS.
RUPTURE OF VESSELS RESULS IN
LOCALIZED HEM RANKINGS.
IN TD SKIN THIS PROCESS FIRST
MANIFEST AS FLAT OR MACULAR OR
SLIGHTLY RAISED OR PACKULAR
LESIONS, LATER AN AS RASH, BLOOD
VEASESLES OF A WAY PRODUCES
EARLIEST AND MOST PROMINENT
SYMPTOMS, EXCRUCIATING HEADACHE.
IN SEVERE CASES INFLAMMATION OF
VESSELS CAN CAUSE STROKE AS WELL
AS ALTERED CONSCIOUSNESS AND
AMNESIA.
SOUND FAMILIAR IN IF VESSELS
SUPPLYING THE OPTIC NERVE,
BLINDNESS CAN ENSUE AND IN VASC
LIGHTIS IS CONCERNED, AND INN
VOLVES THE LARGER EXTREMITIES OF
THE IMENTALLIA THERE WILL BE A
NECROSIS OF FINGERS, TOES AND
GENITALIA.
SOMETHING TO THINK ABOUT.
SO IF IT'S NOT EPIDEPRIVATIONIC
TYPHUS, THE ONLY OTHER MAJOR
CONSIDERATION I WOULD BE
THINKING IS THE DISORDER THAT
THIS WOMAN SUFFERED AND DAYED
OF.
SHE WAS A VICTIM OF AN EPIDEMIC
OF SMALLPOX THAT TOOK PLACE IN
BOSTON AT THE TURN OF THE 20th
CENTURY AND YOU CAN SEE THE
PROGRESS OF THE DISORDER ISSUES
JUST A HORRIBLE, HORRIBLE
INFECTION.
I HAD AN OPPORTUNITY TO SEE 1 OF
THE FINAL CASES OF SMALLPOX WHEN
I WAS IN BANGLADESH BUT I HAD
ALREADY BEEN OUT IN THE FIELD
AND I WAS TIRED AND SICK AND
COULDN'T GET MYSELF TO GO OUT
ANDEE THIS CASE AND I'VE BEEN
KICKING MYSELF EVER SINCE, SO I
HAVE NO PARTICULAR INSIGHT, BUT
HERE'S WHAT'S BEEN WRITTEN ABOUT
SMALLPOX FOR THOSE WHO HAVEN'T
SEEN A CASE.
SMALLPOX HAS AN INCUBATION
PERIOD OF A WEEK TO 17 DAYS.
SO IF IT'S A WEEK TO 17 DAYS,
SMALL BOX, COULD HAVE POPPED UP
VERY QUICKLY IN PYREUA OF THE
FFORT DAY OF THE WAR.
THE ILLNESS BEGINS ABRUPTLY WITH
AN INITIAL PHASE OF 2-3 DAYS OF
SEVERE HEADACHE, REMEMBER THE
DESCRIPTION OF A HEAD PROBLEM IN
THE CASE THAT I WENT THROUGH
EARLIER, BACK ACHE AND FEVER.
AT FIRST THE FEVER WAS HIGH AND
THEN SUBSIDES OVER 2-3 DAYS.
NEXT THERE'S INFLAMMATION OF THE
TONGUE MOUTH AND THROAT AND
SHORTLY THEREAFTER, THE
APPEARANCE OF THE CHARACTERISTIC
RASH.
THE CARB OVER THE COURSE OF 1-2
DAYS BECOME RAISED WITH
DIAMETERS OF 2-3-MILLILITERS, IT
APPEARS FIRST ON THE FACE,
EXTREMITIES AND GRADUALLY
SPREADS TO COVER THE ENTIRE BODY
EMPLOY AS IT MATURES, THE RASH
TRANSFORMS INTO PUOF THULES WITH
DIAMETERS OF 4-6-MILLIMETERS.
THESE FIRST APPEAR 4-7 DAYS
AFTER THE RASH IS' ONSET 7 DAYS.
REMEMBER THAT'S A CRITICAL
PERIOD THAT THE GREEK'S
MENTIONED IN THEIR DESCRIPTION
EMPLOY A SECOND GRADE FEVER
SOMETIMES DEVELOPED 5-8 DAYS
AFTER THE APPEARANCE OF THE RASH
ANDENTIOUS SPECIALLY IN CASES
WITH SECONDARY BACTERIAL
ENFEKSS.
OF THE PATES WITH SEVERE
INFECTION WHO IS SURVIVE, 65-80%
ARE PERMANENTLY SCARED WITH
PIECE OF CONTENT MARKS PRIMARILY
ON THE FACE.
ALTHOUGH COUGH IS NOT USUALLY
PROMINENT, IN SEVERE CASES WITH
RESPIRATORY SYMPTOMS IN
PNEUMONIA MAY DEVELOP,
GASTROINTESTINAL COMPLAINTS SUCH
AS VOMITING AND DIARRHEA MAY BE
A TERMINAL COXEM RAW DATA AND
TERMINAL FATAL CASES.
SMALLPOX AS A CASE FATALITY RATE
OF 30%, THIS SEVERE CASE OF
SMALLPOX, AS OPPOSE TO DWIF%.
CALCULATED FOR THE PLAGUE OF
ATHENS.
SPREADS PRIMARILY BY RESPIRATORY
AEROSOL HOWEVER INFECTED BED OR
CLOTHING CAN SERVE AS A VEHICLE
FOR TRANSPORTATION.
IT'S LESS CONTAGIOUS THAN
MEASLES OR CHICKEN POX AND IS
SPREAD OFTEN BY CLOSE CONTACTS
SUCH AS FAMILY MEMBERS OR
HEALTHCARE WORKERS.
SO THIS COULD EXPLAIN POSSIBLY
WHY THE PANDEMIC WAS MORE SEVERE
AMONG THE ATHEENIANS WHO CROWDED
TOGETHER BEHIND THE WALLS THEN
AMONG THE SPARTANS.
PATIENTS WHO HAVE SEVERE
INFECTIONS, ESPECIALLY THOSE
WITH INROFULMENT OF ARE THES OF
THEIR RESPIRATORY SYSTEM ARE
HIGHLY CONTAGIOUS.
THERE IT IS.
OKAY.
SO LET'S DO THE PROS AND CONS.
TYPHUS, YOU SEE THE EVIDENCE FR
THE DIAGNOSE.
FEVER, RASH, MORTALITY RATE'S
OKAY, MORTALITY IN UNTREATED
TYPHUS IS AT LEAST 20% DURING
THE PREANTIBIOTIC AREA.
IT'S A ERA DISORDER BUT NOT A
PANDEMIC DISORDER BECAUSE OF THE
NEED FOR THE POPULATION TO BE
INFESTED WITH LICE, AND IT'S
HARD TO IMAGINE THAT THE ENTIRE
EASTERN MEDITERRANEAN WAS
INFECTED WITH LICE.
AND THE SEQUELA ARE CONSISTENT
WITH WHAT WAS DESCRIBED.
I'VE ALREADY MENTIONED ZENSER'S
VIEW THAT NECROSIS OF DIGITS AND
EXTREMITIES OCCURS PRIMARILY IN
WINTER MONTHS, WHEREAS FLUCIDESE
PLAGUE ATTACKED IN THE SUMMER.
THE RASH IS NOT RIGHT, TYPHUS
DOES NOT CAUSE A RASH.
YOU CAN SEE OTHER SYMPTOMS BUT
THAT THE UNXON.
NECROSIS, WINTER MONTHS AND THE
EPIDEMIOLOGY, IT CAUSES
LOCALIZED OUTBREAKS, NOT
PANDEMICS.
WHAT ABOUT SYPHILIS IN
SORRY--MAKE THAT SMALLPOX IF YOU
DON'T MIND.
I THINK THE EVIDENT ALTHOUGH NOT
PERFECT BY A LONG SHOT, IS MUCH
STRONGER FOR THIS DIAGNOSIS, SO
THE PRODROAM IS RIGHT, CASE
FATALITY IS RIGHT, THE
EPIDEMIOLOGY IS CORRECT, IF IT
IS BRUCEED FOR THE FIRST TIME TO
A TOTALLY NONIMMUNE POPULATION,
WHICH IS THOUGHT THAT HAVE BEEN
THE CASE IN THE FIFTH CENTURY
BCE WHEN THE INFECTION FOUND ITS
WAY OUT OF AFRICA AND INTO THE
MEDITERRANEAN BASIS.
ADDITIONAL NECROSIS IS NOT
SOMETHING YOU WOULD NECESSARILY
SEE UNLESS THEY WERE SECONDARY
BACTERIAL INFECTION.
THE MOST DAMNING EVIDENT AGAINST
THE DIAGNOSE IS THE ABSENCE OF
BACK ACHE WHICH IS EXTREMELY
COMMON DURING INITIAL PHASES OF
SMALLPOX AND FLUCIDESE FAILURE
TO DESCRIBE PIECE OF CONTENT
MARKS ON THE FACES WHICH HE
COULDN'T POSSIBLY HAVE MISSED OF
PATIENTS WHO HAD SURVIVE THE
PANDEMIC.
THERE ARE 2 POSSIBLE
EXPLANATIONS FOR THESE, FIRST OF
ALL HE MAY HAVE BEEN 1 OF THE
FEW PATIENTS WHO DID NOT HAVE
BACK ACHE AND HE DIDN'T THINK
BACK ACHE WAS A PROBLEM, NOR DID
HE DEVELOP PIECE --POKS BUT ALO
HIPPOCRATIC PHYSICIANS WERE MORE
INTERESTED IN PROGNOSIS THAN
OUTCOME OF INFECTIONS AND THE
POK MARKS IN THE AFTERMATH OF AN
ACUTE INFECTION HAVE NO
PROGNOSTIC SIGNIFICANCE.
SO I AM GOING TO FINISH UP NOW
WITH A CONCLUSION.
SO HERE'S WHAT I HAVE TO SAY.
THE PENELOPESIAN WAR RAGED ON
FOR 20 YEARS AFTER PERICLES
DEATH AND AFTER THE FLUCIDESE
PLAGUE.
IN VIEW OF THE EPIDEMICS
DEVELOPMENTAL
ENDOCRINOLOGYITATING EFFECT ON
THE ATHENNIAN MILITARY, IT IS
UNLIKELY THAT ATHENS COULD HAVE
DENIED THIS SPARTAN VICTORY FOR
SO LONG AFTER THE DEPRIVATION
DEMIC HAD DONE ITS WORST.
HAD THE PLAGUE ALSO MAYBE NOT
DECIMATED BUT ALSO ADVERSELY
ASHING THE SPARTAN WAR MACHINE.
SIMILARLY BAZ THE ATHENNIAN
DEFENDERS CONTINUED THEIR
STRUGGLE FOR 2 DECADES AFTER THE
EPIDEMIC AND AFTER THE DETH OF
PERICLES, NEITHER THROUGH
THUCYDIDES, OR PERICLES CAN
FULLY PLAIN THE SURRENDER TO
SPATTERRA IN 4040 BCE.
NOW AFTER MORE THAN 2000 YEARS
WE CONTINUE TO PONDER THE CAUSE
OF THE PLAGUE THAT TOOK PERICLES
AND SO MANY OTHERS DURING THE
FIRST FEW YEARS OF THE
PELEPENETWORK SIAN WAR.
IF SMALLPOX WAS THE CAUSE,
SKELETONS DATING TO 430 BCE
WHICH WERE UNCOVERED IN ATHENS
IN 1994, 1995, FOR EXCAVATIONS
FOR A SUBWAY TO SUPPORT THE
TWEBT 11 OLYMPICS, MAYBE THEY
WILL PROVIDE THE DIAGNOSIS AND
THEY HAD BEEN IN THE Q&A, I CAN
DISCUSS THOSE FINDINGS ABOUT YOU
THEY WERE INCONCLUSIVE.
SO IF THEY WERE SUBJECTED TO
PROPER MOLECULAR ANALYSIS MAYBE
THEY COULD PROVIDE AN ANSWER.
IF NOT HE WILL TAUNTED.
HE SAID NOW LET EVERY MAN,
PHYSICIAN OR OTHER CONCERNING
GROUND OF THIS SICKNESS, WHERE
IT SPRUNG, AND WHAT CAUSES HE
THINKS ABLE TO PRODUCE SO GREAT
AN ALTERATION, SPEAK ACCORDING
TO HIS OWN KNOWLEDGE.
FOR MY OWN PART, I WILL DELIVER
BUT THE MANNER OF IT AND LAY
OPEN ONLY SUCH THINGS AS 1 MAY
TAKE HIS MARK BY TO DISCOVER THE
SAME IF IT COMES AGAIN.
THANK YOU FOR YOUR ATTENTION.
[ APPLAUSE ]
>> THANK YOU FOR PRESENTING THIS
EXCELLENT CASE.
WHILE WE'RE WAITING FOR
QUESTIONS TO COME IN ONLINE, IF
THERE ARE ANY, ANYBODY WITH
QUESTIONS PLEASE FEEL FREE TO
COME UP TO THE MICROPHONES.
I CAN START WITH A QUESTION.
DO YOU HAVE ANY INFORMATION DID
IT TAIL OFF AS QUICKLY AS IT
CAME ON?
>> NO IT WAS MOST SEVERE DURING
THE FIRST YEAR OF THE PANDEMIC.
BUT THEN DID DISAPPEAR GRADUALLY
AS MYSTERIOUSLY AS IT ARRIVED,
CHRIS, AND THAT'S 1 OF THE MANY
MYSTERIES ASSOCIATED WITH THE
PANDEMIC.
>> THANK YOU VERY MUCH FOR YOUR
TALK.
IT WAS REALLY FASCINATING.
>> THANK YOU EMPLOY.
>> MY QUESTION ABOUT WHAT DO WE
KNOW ABOUT SPARTA'S MILITARY
STRATEGY IN TERMS OF HOW THEY
QUARTERED THEIR TROOPS, RIGHT IN
BECAUSE IF WE THINK ABOUT LATER
PANDEMICS HAVE SPREAD WHERE
TROOPS WERE CONCENTRATED IN
PLACES, RIGHT IN AND I KNOW
SPARTA WE HAVE LESS RECORDS
ABOUT SPARTA COMPARED TO ATHENS
BUT I WAS CURIOUS DO WE KNOW
KIND OF HOW SPARTA TROOPS WERE
QUARTERED IN.
>> IT SAID THAT SIEGES AND
PROBABLY NOW WERE POROUS AFFAIRS
AND SO THERE WAS A LOT OF
INTERCHANGE GOING ON OF FOODS
AND MATERIALS AND ARMOR SO THEY
MUST HAVE BEEN INTERACTING WITH
THE ATHEENIANS AND THE IDEA THAT
SOMEHOW EVEN SO, THEY WERE NOT
AFFECTED BY THE PLAGUE, JUST
DOESN'T SEEM REASONABLE, THEY
MUST HAVE ALSO HAD LESSER EXTENT
TO INFECTIONS AMONG THEIR OWN
FORCES BUT THEY WERE NOT NEARLY
AS CONCENTRATED IN TERMS OF
THEIR POPULATION AS THE
ATHENNIANS WERE HUDDLED BEHIND
THE WALLS.
>> THANK YOU.
NSO 1 OTHER QUESTION THAT CAME
IN ONLINE IS WHY NOT VARICEL LA?
>> I WAS RECENTLY WONDERING
ABOUT THAT MYSELF.
VARIC ELLA, HAS BEEN IN RECENT
TIMES AS BEEN IMMUNIZED IN EARLY
POPULATIONINGS SO ADULLS WERE
SUBSTANTIALLY LESS LIKELY TO
COME DOWN WITH VARICELLA, IT IS
A BLISTERING ERUPTION AND IT'S
CONCEIVABLE THAT IN A POPULATION
THAT HAS NO IMMUNITY WHATSOEVER,
IT COULD PRODUCE A DISORDER THAT
WAS SO DESTRUCTIVE THAT
THYUCIDES, WOULD ARE CONSIDER.
>> THANK YOU NTHANK YOU VERY
MUCH, ENJOYED THE PRESENTATION
EMPLOY MY QUESTION IS AFTER THIS
PANDEMIC, FROM HISTORICAL RECORD
OR GREEK LITERATURE, IS THERE
ANY RECORD OR OCCUPATION FOR HOW
MA MAY BE ATHENNIAN CULTURE
WOULD HAVE CHANGED, LOOKING AT
MORE RECENT HISTORY, THE SPANISH
FLU, IT SEEMED LIKE THAT WAS
SORT OF LIKE MASS AMNESIA,
EVERYONE FORGOT ABOUT IT.
I THINK WE'RE STILL WAITING TO
SEE, WHAT HAPPENED WITH COVID
AND HOW THAT'S CHANGING OUR
DAY-TO-DAY LIVES.
BUT I'M WONDERING WITHIN THAT
PARTICULAR PLAGUE, WAS THERE ANY
FUNDAMENTAL CHANGE.
>> THERE CERTAINLY WAS DURING
THE WAR AND DURING THE--IN
PARTICULAR DURING THE EARLY
PHASES WITH THE PLAGUE, SOCIAL
ORDER TOTALLY DISINTEGRATED,
THERE ARE AND WE SEE EVIDENCE OF
THIS IN SOME RECENT PLAGUES,
EBOLA FOR INSTANCE, THEY WERE
ACCORDING TO THYUCIDES, BODIES
LYING ALL OVER THE CITY.
PEOPLE HAD GIVEN UP ALL PRETENSE
OF PROPER DECORUM.
THEY RESEARCH WERE LIVING FOR
THE MOMENT WHEREAS FUNERAL
BURIALS WERE A FORMAL THING IN
ANCIENT GREASE, IT TOTALLY
DISINTEGRATED SO MEMBERS OF THE
POPULATION WHEN THEY LOST A
RELATIVE AND DIDN'T HAVE THE
WHERE WITH ALL TO DEAL WITH A
DEAD RELATIVE WOULD JUST SNEAK
UP AND DUMP THEM ON THE PYRE
THAT WAS ALREADY BURNING.
SO THERE WAS THAT AND THEN
LONG-TERM, WHAT I WOULD SAY IS,
THE GOLDEN AGE OF GREASE WITH
ALL THOSE WONDERFUL ILLUM NATTY
JUST DISAPPEARED AFTER THAT AND
IT'S SORT OF REMINISCENT OF
SPECULATION ABOUT MOZART.
WHAT COULD HAVE BEEN
ACCOMPLISHED IN TERMS OF HIS
AKIGZAL SYMPHONYS IF HE LIVED
LONGER WHAT ELSE COULD THE
GREEKS HAVE ACCOMPLISHED IF
THEIR GOLDEN AGE HADN'T
BASICALLY BEEN DESTROYED BY THE
WAR. YES, SIR?
>> IT SAYS RECURRING DISEASE,
[INDISCERNIBLE] DISEASE, WHEREAS
WEEKS OR MONTHS AFTER YOU GET
WELL, YOU GET SICK AGAIN.
AND THERE'S NO MENTION OF THIS
IN THAT.
>> YES THAT'S EXACTLY RIGHT NSO
IS THAT AGAINST THE DIAGNOSIS OF
TYPHUS IN I DON'T KNOW HOW
COMMON [INDISCERNIBLE] DISEASE
MIGHT HAVE BEEN BACK THEN.
>> YOU WOULD CERTAINLY KNOW
BETTER THAN I AND I'M NOT GOING
TO TRY TO ADD ANY THOUGHTS YOU
MIGHT HAVE BUT OTHER THAN TO
SAY, IT IS SUBSTANDIALLY LESS
SEVERE.
BUT YOU'RE RIGHT THYUCIDES,
DOESN'T MENTION ANYTHING ALONG
THOSE LINES.
GOOD TO SEE YOU DR. BENNETT.
>> YOU HAD MENTIONED DURING YOUR
TALK THAT THEY RECENTLY DUG UP A
LOT OF ARTIFACTS AND YOU KNOW
WHILE PREPARING FOR THE
OLYMPICS, ANYTHING YOU WANT TO
SHARE WITH US THAT NEED
FINDINGS?
NYEAH, THIS WAS VERY
INTERESTING.
SO IN PREPARATION FOR THE 2011
OLYMPICS, THE GREEKS WERE
EXCAVATING OUTSIDE OF ATHENS TO
PRODUCE A NEW SUBWAY SYSTEM AND
THEY UNCOVERED A GROUP OF BODIES
THAT WERE BURIED IN A TOTALLY
DISORDERED FASHION AND THEY WERE
DATED BACK TO THE FIFTH CENTURY
BCE, AND SO THEY WERE PRETTY
SURE THAT THESE WERE BODIES THAT
FROM THE PLAGUE OF ATHENS, SO
SCIENTISTS FROM THE UNIVERSITY
OF ATHENS GOT AHOLD OF ACTUALLY
TEETH FROM THESE ABOUTS AND THEY
EXAMINED THEM FOR A NUMBER OF
THINGS 1 OF WHICH WAS THE
TYPHOID BACILLUS, I HAVE THEM
WRITTEN DOWN HERE SOMEWHERE, AND
SEVERAL OTHER THINGS AND THE
ONLY--THE ONLY POSITIVE RESULT
THEY OBTAINED USING MODERN
MOLECULAR TECHNIQUES WAS
EVIDENCE OF TYPHOID BACILLUS.
AND SO FIRST OF ALL UNLESS
TYPHOID WAS A TOTALLY DIFFERENT
DISORDER IN THE FIFTH CENTURY
BCE, IT JUST DOESN'T FIT WITH
THE CLINICAL DESCRIPTION.
THEY DID NOT CHECK FOR SMALLPOX,
THEY CHECKED FOR COW POX AND I
DON'T KNOW WHETHER THERE'S ANY
OVERLAP BETWEEN THE 2 BUT I
SUSPECT NOT AND THEN THERE WAS A
LETTER TO THE EDITOR AND A
SUBSEQUENT ISSUE FROM A GROUP AT
OXFORD AND IN COLLABORATION WITH
ANOTHER INVESTIGATOR FROM THE
[INDISCERNIBLE] INSTITUTE AND
THEY BASICALLY POO POO'D THEIR
TECHNOLOGY AND SAID, NO, THEY
DIDN'T SHOW ANYTHING.
SO I'M INCLINED BASED ON THE
FACT THAT THERE'S NO CLINICAL
EVIDENCE OF TYPHOID FEVER, AT
LEAST IF WE KNOW IT TODAY TO
SUPPORT THE DIAGNOSE TO THINK
THAT THEIR INVESTIGATION BOGUS
EMPLOY
>> THANK YOU SO MUCH.
I ENI DIDN'TED THE LECTURE, I
ALWAYS LEARN ABOUT MEDICAL
HISTORY.
>> SAME HERE.
>> IN LISTENING TO YOUR TALK, I
WAS WONDERING HOW IMPORTANT
MEDICAL HISTORY IS FOR ALL OF US
THAT IN THIS PROFESSION AND IN
TERMS OF JUST AN OPPORTUNITY TO
REFLECT ON LESSONS LEARNED AND
ALSO EVEN IMPORTANT THINGS LIKE
PHYSICAL DIAGNOSIS, AND JUST AN
APPRECIATION FOR HOW WE'VE COME
PERHAPS--
>> OR HOW FAR WE HAVEN'T COME.
>> --THAT'S RIGHT.
DO YOU HAPPEN TO KNOW IF THE
MEDICAL HISTORY IS BECOMING MORE
OF A FOCUS IN MEDICAL EDUCATION
AND IF NOT, GOOD WAYS IN WHICH
WE CAN INCORPORATE IT MORE SO
AND MAKE IT RELEVANT TO MOTERN
MEDICAL STUDENTS?
>> SADLY, EVERYTHING I KNOW
ABOUT THE TEACHING OF THE
HISTORY OF MEDICINE IS THAT IT
IS NOT A PROMINENT PART OF OUR
MEDICAL EDUCATIONAL SYSTEM.
THERE ARE ONLY A FEW HIGH
PROFILE UNIVERSITIES THAT HAVE
MEDICAL HISTORY PROGRAMS,
HOPKINS, YALE, UNIVERSITY OF
MARYLAND AND A FEW OTHERS AND IT
DOESN'T LOOK LIKE WE'RE MOVING
IN THE DIRECTION OF MORE
TEACHING OF MEDICAL HISTORY AND
I CAN UNDERSTAND THIS.
I MEAN THE VOLUME OF INFORMATION
THAT WE'RE TRYING TO GIVE TO OUR
TRAINEES IS JUST OVER WHELMING
TO SAY THE LEAST.
SO THERE ARE A NUMBER OF THINGS
THAT MEDICAL HISTORY CAN TEACH
US WHICH I THINK ARE CRITICALLY
IMPORTANT IN THE PROFESSION,
MOST IMPORTANT OF WHICH IS
HUMILITY.
BECAUSE IF YOU--IF YOU'RE
SERIOUS ABOUT DELVING INTO
MEDICAL HISTORY, IT CAN'T HELP
BUT OCCUR TO YOU THAT WHAT
YOU'RE DOING NOW WHICH JUST
SEEMS SO OBVIOUSLY RIGHT AND
PROPER IN ANOTHER GENERATION
WILL BE THOUGHT OF AS JUST
ABSOLUTE FOLLY BECAUSE IT
HAPPENS OVER AND OVER AGAIN.
AND I THINK THAT TYPE OF
HUMILITY IS WORTH SOMETHING.
THANK YOU FOR THOSE COMMENTS.
>> ALL RIGHT.
WELL, THANK YOU ALL VERY MUCH
FOR JOINING US AT THE
CONTEMPORARY CLINICAL GREAT
TEACHER GRAND ROUNDS.
THANK YOU DR. FOR YOUR WONDERFUL
TALK AND THIS CONCLUDES OUR
SESSION.
THANK YOU.
THANK YOU FOR COMING.