Category Archives: history of medicine

CFP: Medieval Landscapes of Disease

Call for Papers
Medieval Landscapes of Disease
International Congress of Medieval Studies
Kalamazoo, MI  May 12-15, 2016

Following on a successful session last year, I’m offering another session on Medieval Landscapes of Disease this year at Kalamazoo.

In recognition that diseases are manifestations of their environment, this session seeks papers that place medieval diseases within their environmental context. Just as a seed must be placed in good soil to grow, infectious disease requires a permissive environment to develop into an epidemic (or epizootic) and an ideal environment to bloom into a pandemic or panzootic.  I am open to all manner of studies and disciplines that address these issues.

Examples of acceptable topics:
  • Historic impacts of  epidemics and/or epizootics
  • Endemic disease in medieval environments
  • Environmental causes of disease such as malnutrition or industrial pollution related disease
  • Health effects of human-animal interactions
  • Applications of the One Health Approach to medieval disease
  • Archaeological assessments of human health and disease
  • Landscape alterations intended to improve human or animal health
  • Ecology of the built environment

Abstracts of no more than 300 words and the Participant Information Form should be sent to Michelle Ziegler at ZieglerM@slu.edu by September 15. Pre-submission queries are welcome.

The Participant Information Form and additional information be found at  http://www.wmich.edu/medieval/congress/submissions/index.html .

Spring Reading

spring1
It has been a busy spring. I haven’t had a chance to blog as much as I would have liked to, but I have done quite a bit of reading. Some of my reading has been on the complex world of the first plague pandemic. To say that it was transformative would be an understatement.  One of the social questions for the first plague pandemic is how does plague and other natural disasters effect a population that is the midst of conversion?  When the Black Death came it encountered a fully Christian and Muslim world, but not so during the first pandemic. Most of Europe was not yet Christian in 541. There were some Jews, Christians of several varieties, Roman pagans, Germanic pagans, Celtic pagans, Zoroastrians, North African and Middle Eastern pagans, etc. Yet at the end of the pandemic period, Islam is born (and fast growing) and Christianity is dominant in Europe (and united by Rome). The plague began in a polytheistic world and ended in a monotheistic one. What role did the plague play, if any? Yet to be determined. This really isn’t a peripheral issue. Every writer of the first pandemic was involved in this transformation (winners and losers) in some way and it effected how they wrote about the plague and other calamities. So I have a lot of reading to do; below is a start and a few other things that caught my attention.

Books:

Marilyn Dunn. (2010) The Christianization of the Anglo-Saxons, c. 497- c.700: Discourses of Life, Death and Afterlife.

Marilyn Dunn (2013) Belief and Religion in Barbarian Europe, c. 350-700. Bloomsbury.

Peter Brown (2015) The Ransom of the Soul: Afterlife and Wealth in Early Christianity. Harvard University Press.

Peter Heather (2013) The Restoration of Rome: Barbarian Popes and Imperial Pretenders. Oxford University Press.

Articles:

Balbir Singh and Cyrus Saneshvar (2013) Human Infections and Detection of Plasmodium knowlesi. Clinical Microbiology Reviews. 26 (2): 165-184.

Runfola, J. K., House, J., Miller, L., Coltron, L., Hite, D., Hawley, A., et al. (2015). Outbreak of Human Pneumonic Plague with Dog-to-Human and Possible Human-to-Human Transmission — Colorado, June–July 2014. MMWR. Morbidity and Mortality Weekly Report, 64(16), 429–434.

Smith-Guzmán, N. E. (2015). Cribra orbitalia in the ancient Nile Valley and its connection to malaria. International Journal of Paleopathology, 10, 1–12. doi:10.1016/j.ijpp.2015.03.001

Benovitz, N. (2014). The Justinianic plague: evidence from the dated Greek epitaphs of Byzantine Palestine and Arabia. Journal of Roman Archaeology. doi:10.1016/S1473-3099(13)70323-2)

Bernard Bachrach, (2007) Plague, Population, and Economy in Merovingian Gaul. Journal of the Australian Early Medieval Association. 3: 29-57.

Sarris, P. (2002). The Justinianic plague: origins and effects. Continuity and Change, 17(02), 169–182. doi:10.1017/S0268416002004137

Newfield, T. P. (2015). Human–Bovine Plagues in the Early Middle Ages. Journal of Interdisciplinary History, 46(1), 1–38. doi:10.1179/146141010X12640787648612

Inskip, S. A., Taylor, G. M., Zakrzewski, S. R., Mays, S. A., Pike, A. W. G., Llewellyn, G., et al. (2015). Osteological, Biomolecular and Geochemical Examination of an Early Anglo-Saxon Case of Lepromatous Leprosy. PLoS ONE, 10(5), e0124282. doi:10.1371/journal.pone.0124282.s001

Shanks, G. D., & White, N. J. (2013). The activation of vivax malaria hypnozoites by infectious diseases. The Lancet Infectious Diseases, 13(10), 900–906. doi:10.1016/S1473-3099(13)70095-1

Dick, H. C., Pringle, J. K., Sloane, B., Carver, J., Haffenden, A., Stephen Porter, H. A., et al. (2015). Detection and characterisation of Black Death burials by multi-proxy geophysical methods. Journal of Archaeological Science, 1–50. doi:10.1016/j.jas.2015.04.010

Lowell, J. L., Antolin, M. F., Andersen, G. L., Hu, P., Stokowski, R. P., & Gage, K. L. (2015). Single-Nucleotide Polymorphisms Reveal Spatial Diversity Among Clones of Yersinia pestis During Plague Outbreaks in Colorado and the Western United States. Vector Borne and Zoonotic Diseases (Larchmont, N.Y.), 15(5), 291–302. doi:10.1089/vbz.2014.1714

Neil, B. (2013). The Papacy in the Age of Gregory the Great. A Companion to Gregory the Great, 3–28.

Brogiolo, G. P. (2015). Flooding in Northern Italy during the Early Middle Ages: resilience and adaption. Post-Classical Archaeologies, 5, 47–68.

Kostick, C., & Ludlow, F. (2015). The dating of volcanic events and their impact upon European society, 400-800 CE. Post-Classical Archaeologies.  5, 7–30.

Riehm, J. M., Projahn, M., Vogler, A. J., Rajerison, M., Andersen, G., Hall, C. M., et al. (2015). Diverse Genotypes of Yersinia pestis Caused Plague in Madagascar in 2007. PLoS Neglected Tropical Diseases, 9(6), e0003844. doi:10.1371/journal.pntd.0003844.s002

Makundi, R. H., Massawe, A. W., Borremans, B., Laudisoit, A., & Katakweba, A. (2015). We are connected: flea–host association networks in the plague outbreak focus in the Rift Valley, northern Tanzania. Wildlife Research, 42(2), 196. doi:10.1071/WR14254

Syndemics and Historic Diseases

I’ve been looking for a model or framework to bring together interdisciplinary evidence on diseases of the past. There are a variety of disciplinary approaches but few that can readily incorporate very different types of evidence well.

Apart from past discussions of discrete co-morbidities, the most common framework for understanding historic disease ecology has been pathocoenosis or ‘disease pools’ originated by M. D. Grmek in 1969 and popularized as ‘disease pools’ through McNeill’s Plagues and Peoples (1976). While this concept has proven popular among historians of medicine in high level overviews of human history, the concept begins to break down when practically applied to specific problems, as outlined by Robert Sallares (2004). It is hard enough to identify all of disease-causing microbes in a modern environment, much less a historic environment or population. It is often the minor or chronic disease-causing agents that make the most difference during a co-infection; malaria being a prime contender for the most important.  Pathocoenosis doesn’t adequately take into account the dynamic complexity of microbes in any population (however defined) and the idea that epidemics are disruptions in the equilibrium of pathogens in the population caused by new entrants to the population often doesn’t hold up.

Syndemics is a related concept emerging among biologists and medical anthropologists as a way to understand the diverse complex outcomes of diseases in populations. Syndemic comes from the terms synergistic and epidemic; it is a synergistic epidemic. A synergism exists when two conditions together produce a much greater effect than either individually added together ( ex. 1 +1 = 5 not 2).

A syndemic, in short, involves a set of enmeshed and mutually enhancing health problems that, working together in a context of deleterious social and physical conditions that increase vulnerability, significantly affect the overall disease status of a population (Singer, 2014).

The theory of syndemics is still evolving. The CDC’s definition refers specifically to two epidemics in the same population that produce a synergistic adverse outcome in human health. Consequently biology and medicine focus primarily on coinfections with an occasional look at nutrition. So far they are beginning to find some fascinating insights into how the immune system copes with two or more disease-causing microbes at once. We have to really take in that we are all coinfected all of the time. It comes down to if there is a significant interaction between multiple microbial species and the immune system. (It should be also said that coinfection can occasionally be protective as well.) Not surprisingly medical anthropologists insist on there always being a social component like malnutrition causing events, human behaviors like drug abuse and sexual practices,  or social disorder and inequality. So far from what I’ve read, these different focuses are complementing each other pretty well.

Some of the well-recognized syndemics include:

  • malaria + malnutrition
  • influenza + bacterial pneumonia
  • HIV + TB
  • HIV + HCV
  • HIV + HCV + IV drug use
  • Lyme disease + other Tick Borne Diseases
  • malnutrition + war (social disruption) + infectious disease (mostly diarrhea)

HIV has had a critical role in recognizing syndemics. Not unexpectedly, HIV coinfection with multiple organisms causes recognized synergetically worse outcomes. In many parts of the world, liver disease is a leading cause of HIV+ patient deaths due to Hepatitis C (HCV). It has also highlighted social conditions and behaviors that increase risk and vulnerability. The massive size, duration and amount of research done on AIDS is what has really allowed syndemic theory to become established.

Syndemics is just beginning to look at zoonotic disease but the future is already promising. As has already been suggested by work on pathocoenosis, malaria is a leading candidate to understand the syndemics of zoonoses. Syndemic effects have been suggested for malaria plus malnutrition, HIV and influenza.  Patients with long-term and serious health outcomes from Lyme disease are often coinfected with other less common tick born infectious diseases that are often undiagnosed (Singer & Bulled, 2014).

From what I have read so far, syndemics appears to take the best parts of the pathocoenosis paradigm, while jettisoning the unsupportable, over-reaching baggage. As we can already see for HIV and malaria, the syndemics approach has the potential to build up a foundation to understand the multifaceted outcomes of disease causing agents in different environments and provide insights into how the human microbiome and immune system interact. While its not perfect and doesn’t incorporate all of the disciplines needed to understand historic disease, it may provide a basis to build upon.

References and further reading:

Sallares, R. (2005). Pathocoenoses ancient and modern. History and Philosophy of the Life Sciences, 27 (2): 201–220. [Malaria]

Singer, M. (2014). Pathogen-pathogen interaction.Virulence, 1(1), 10–18. doi:10.4161/viru.1.1.9933

Singer, M., & Clair, S. (2003). Syndemics and public health: reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 17(4), 423–441.

Rock, M., Buntain, B. J.,Hatfield, J. M., & HallgrImsson, B. (2009). Animal–human connections, “‘one health,’” and the syndemic approach to prevention. Social Science & Medicine (1982), 68(6), 991–995. doi:10.1016/j.socscimed.2008.12.047

Singer, M. C. (2009). Doorways in nature: Syndemics, zoonotics, and public health. A commentary on Rock, Buntain, Hatfield & Hallgrı ́msson. Social Science & Medicine (1982), 68(6), 996–999. doi:10.1016/j.socscimed.2008.12.041

Ostrach, B., & Singer, M. (2013). Syndemics of War: Malnutrition-Infectious Disease Interactions and the Unintended Health Consequences of International War Policies.  Annals of Anthropological Practice, 36(2), 257–273. doi:10.1111/napa.12003

Morano, J. P., Gibson, B. A., & Altice, F. L. (2013). The Burgeoning HIV/HCV Syndemic in the Urban Northeast: HCV, HIV, and HIV/HCV Coinfection in an Urban Setting. PLoS ONE, 8(5), e64321. doi:10.1371/journal.pone.0064321.t003

Kwan, C. K., & Ernst, J. D. (2011). HIV and Tuberculosis: a Deadly Human Syndemic. Clinical Microbiology Reviews, 24(2), 351–376. doi:10.1128/CMR.00042-10

Conant, K. L., Marinelli, A., & Kaleeba, J. A. R. (2013). Dangerous liaisons: molecular basis for a syndemic relationship between Kaposi’s sarcoma and P. falciparum malaria. Frontiers in Microbiology, 4(article 35), 1–14. doi:10.3389/fmicb.2013.00035/abstract

Faure, E. (2014). Malarial pathocoenosis: beneficial and deleterious interactions between malaria and other human diseases. Frontiers in Physiology, 5. doi:10.3389/fphys.2014.00441/abstract

Herring, D. Ann, & Sattenspiel, L. (2007). Social contexts, syndemics, and infectious disease in northern Aboriginal populations. American Journal of Human Biology, 19(2), 190–202. doi:10.1002/ajhb.20618   [1918 influenza]

Singer, M., & Bulled, N. (2014). Ectoparasitic Syndemics: Polymicrobial Tick-borne Disease Interactions in a Changing Anthropogenic Landscape.Medical Anthropology Quarterly, n/a–n/a. doi:10.1111/maq.12163