Asleep: The Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries Read Online Free PDF Page A
Author: Molly Caldwell Crosby
There it began, slowly, to collect dust for the next eighty years.
E pidemiologv literally means “the study of what is upon the people,” and in particular, it implies investigating an outbreak of disease. The complex study includes a cross section of several factors that may or may not seem related to disease, like environment, genetics, food and water sources, seasons, contact with animals and insects, or even the way people bury their dead. It requires a mind that can collect minute details and data, while also being able to see the larger patterns they create. An epidemiologist is interested in not only the behavior of a disease, but also the behavior of its victims. Above all else, what will set a talented medical investigator apart from others is the ability to challenge deeply entrenched theories and see the things others have missed. Often, people are blinded by their established beliefs; so much so that they become oblivious to the obvious.
Hippocrates is usually considered the first epidemiologist. He made the connection between illness and human behavior, finding a kinship between the diversity of life and the diversity of illness. An epidemic, he observed, is just the opposite: “When a large number of people all catch the same disease at the same time, the cause must be ascribed to something common to all. . . . ”
Notable examples of epidemiology include John Snow’s mapping of the cholera outbreaks in London around a contaminated water source; Robert Koch’s demonstration that a germ was causing diseases like cholera; Walter Reed’s work with typhoid in the army camps and his demonstration that mosquitoes spread yellow fever; Sara Josephine Baker tracking the case of Typhoid Mary; and Constantin von Economo’s discovery of sleeping sickness.
Identifying the pathogen or its spread is not what led these epidemiologists to triumph—it was their ability to understand the disease’s relationship to a place and its people, because epidemiology’s long shadow inevitably falls on public health. After all, the work of an epidemiologist often has the greatest impact on cities and communities, and the people in those neighborhoods will live or die by the epidemiologist’s success or failure. A true medical investigator has to understand both the organism beneath the microscope and the larger organisms that make up a population. And so the story of an epidemic disease is really just the breakdown of organisms: those that cause the disease, those that suffer the disease, and those that adapt to it.
I n 1919, in New York City, a large number of people all caught the same disease at the same time. The medical investigators did not know the common cause, and they could not see the microorganism beneath the microscope. But they witnessed firsthand, in frightening numbers, those suffering the disease.
The epidemiologists began looking at the larger organisms in the equation: the victims. They looked for connections among people, in neighborhoods, in what they ate or drank, in how they lived, in their behavior. They examined the relationship between the disease and its victims and the kinship between those victims and the place in which they lived.
If an organism is truly a living system that grows and changes in order to maintain a stable whole, there was one more large, complex organism in the story of this epidemic. It was the city of New York itself.
CASE HISTORY TWO
New York City, 1918
NAME: Ruth
PHYSICIAN: Dr. Frederick Tilney
CHAPTER 4
New York City
N ew York grew faster than any of the world’s largest cities—cities that had centuries and all of history to build their empire. It would grow from a sliver of island where ship masts towered over squat buildings to one with a mountain range of skyscrapers. The science of life and the science of a city are not very different, and a city must adapt in order to survive. New York City did more than just survive; it thrived. The city
E pidemiologv literally means “the study of what is upon the people,” and in particular, it implies investigating an outbreak of disease. The complex study includes a cross section of several factors that may or may not seem related to disease, like environment, genetics, food and water sources, seasons, contact with animals and insects, or even the way people bury their dead. It requires a mind that can collect minute details and data, while also being able to see the larger patterns they create. An epidemiologist is interested in not only the behavior of a disease, but also the behavior of its victims. Above all else, what will set a talented medical investigator apart from others is the ability to challenge deeply entrenched theories and see the things others have missed. Often, people are blinded by their established beliefs; so much so that they become oblivious to the obvious.
Hippocrates is usually considered the first epidemiologist. He made the connection between illness and human behavior, finding a kinship between the diversity of life and the diversity of illness. An epidemic, he observed, is just the opposite: “When a large number of people all catch the same disease at the same time, the cause must be ascribed to something common to all. . . . ”
Notable examples of epidemiology include John Snow’s mapping of the cholera outbreaks in London around a contaminated water source; Robert Koch’s demonstration that a germ was causing diseases like cholera; Walter Reed’s work with typhoid in the army camps and his demonstration that mosquitoes spread yellow fever; Sara Josephine Baker tracking the case of Typhoid Mary; and Constantin von Economo’s discovery of sleeping sickness.
Identifying the pathogen or its spread is not what led these epidemiologists to triumph—it was their ability to understand the disease’s relationship to a place and its people, because epidemiology’s long shadow inevitably falls on public health. After all, the work of an epidemiologist often has the greatest impact on cities and communities, and the people in those neighborhoods will live or die by the epidemiologist’s success or failure. A true medical investigator has to understand both the organism beneath the microscope and the larger organisms that make up a population. And so the story of an epidemic disease is really just the breakdown of organisms: those that cause the disease, those that suffer the disease, and those that adapt to it.
I n 1919, in New York City, a large number of people all caught the same disease at the same time. The medical investigators did not know the common cause, and they could not see the microorganism beneath the microscope. But they witnessed firsthand, in frightening numbers, those suffering the disease.
The epidemiologists began looking at the larger organisms in the equation: the victims. They looked for connections among people, in neighborhoods, in what they ate or drank, in how they lived, in their behavior. They examined the relationship between the disease and its victims and the kinship between those victims and the place in which they lived.
If an organism is truly a living system that grows and changes in order to maintain a stable whole, there was one more large, complex organism in the story of this epidemic. It was the city of New York itself.
CASE HISTORY TWO
New York City, 1918
NAME: Ruth
PHYSICIAN: Dr. Frederick Tilney
CHAPTER 4
New York City
N ew York grew faster than any of the world’s largest cities—cities that had centuries and all of history to build their empire. It would grow from a sliver of island where ship masts towered over squat buildings to one with a mountain range of skyscrapers. The science of life and the science of a city are not very different, and a city must adapt in order to survive. New York City did more than just survive; it thrived. The city
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