Diseases of Modern Life Flashcards

Question

Journal of Chronic Diseases launched

Answer 1

in Cold War context, shift away from social factors to clinical parameters Heart disease and cancer were increasingly associated with affluence, public health interventions were aimed at educating people individually to reduce their personal risks of developing health problems later in life

Answer 2

urvey commissioned by the Ministry of Health in 1954 focused on the provision of services, finding that the majority of chronic sick beds were in former municipal and Poor Law hospitals much of the accommodation was unsuitable, in damp buildings with narrow staircases and without lifts, with insufficient bathrooms and dayrooms, and poor heating and lighting. All was still distinctly reminiscent of the workhouse. As in America, patients in these institutions were increasingly medicalized However, in Britain this led to the development of geriatrics as a specialty

Answer 3

we find ourselves in the fifth phase of an epidemiologic transition: the ‘age of obesity and inactivity’

Answer 4

Omran's article suggesting epidemiologic transitions has contributed to the misguided notion that chronic disease has only become a problem in the twentieth century In order to arrive at a more nuanced picture of such continuities and change, we need more histories that contrast and challenge the statistics-driven master narrative behind the theory of epidemiologic transition

Answer 5

chronic illness in the early twenty-first century is still linked to individual biographies and constitutions, and blamed on behaviours associated with civilization

Answer 6

Using historical medical files of soldiers who served in the Boer War and in the First and Second World Wars, we have attempted to test the hypothesis that the symptom clustering associated with PTSD existed before psychiatrists recognised it as a formal disorder Testing in partic, incidence of flashbacks - largely limited to PTSD as diagnostic tool 1856 cases were included (Table 1), drawn from seven conflicts and representing ten diagnoses Previous historical investigations have relied on single case studies to make the point that PTSD is a timeless disorder However, such studies lack a denominator and are instead based on an active search through historical literature for descriptions that resemble modern formulations of PTSD, while presumably discarding presentations that appear different.

Answer 7

symptoms of PTSD, including flashbacks, can be identified in the accounts of veterans of the American Civil War

Answer 8

‘this relatively common human problem has been known for many hundreds of years, although under different names’

Answer 9

PTSD is a culture-derived diagnosis and can only have existed in the late 20th century

Answer 10

showed that the heart alone (and not the head or the abdominal organs) was associated with emotional distress In the Hebrew Bible too, he found that the heart was interpreted as the seat of the emotions, will and intellect significantly different somatic vocabulary from that of today and the one reflected by PTSD.

Answer 11

- flashbacks - 'Re-experiencing of the trauma'. Recurrent recollections, dreams, feeling as if trauma reocurring. 1987, DSM-III-R included 'flashback' as synonym for some aspects of these experiences

Answer 12

- intrusive symptoms (such as nightmares, flashbacks and persistent memories) (1987, DSM-III-R included 'flashback' as synonym for some aspects of these experiences) - avoidance symptoms (such as emotional numbing, withdrawal from the world and avoidance of reminders) - symptoms of overarousal (such as insomnia and irritability)

Answer 13

Analysis of the 1856 cases revealed that flashbacks, symptoms of intrusion and avoidance, were virtually non-existent before the First World War and were still rare during the Second World War Although not a common phenomenon today, their incidence is significantly higher than in previous conflicts Somatic symptoms appear much more often in presentations of post-trauma illness from the 19th and early 20th centuries - somatic descriptions = poss explanation for rarity of flashbacks WW1 and 2 Shellshock, for example, was often depicted by contemporaries in terms of contractures, tics, movement disorders and paresis psychopathology of trauma is not static and that culture has an impact on the expression of distressing memories PTSD is one more phase in the continually evolving picture of human reaction to adversity

Answer 14

- Shorter - nature of medically unexplained syndromes has itself changed, with a shift from apparently neurological symptoms such as paralyses, tremors and fits to more ill-defined and subjective symptoms such as fatigue, pain and depression - Blank - direct association between the flashback and films/ rise of cinema - Yet films were an integral part of popular culture during the First and Second World Wars, when flashbacks appear to have been much rarer than today. Involuntary visual images may be tied more closely to the mass production of affordable television sets in the 1950s and 1960s and the subsequent introduction of video recorders. supported by the intrusive nature of the flashback. People make a conscious choice to go to the cinema. television in the home can be a source of sudden and disturbing imagery in a familiar and apparently safe situation.

Answer 15

Over recent years there has been a steady and important change in the public’s perception of the relation between aspects of modern life and health. Now, at the beginning of the 21st century, people’s suspicion of modernity has increased to such an extent that it has undermined their view of their own health, increased their worries about environmental causes of poor health, and fostered a migration to complementary medicine

Answer 16

This anxiety is reflected in the pattern of presentations of psychosomatic illness: the number of illnesses attributed to environmental factors—for example, sick building syndrome, multiple chemical sensitivity, total allergy syndrome, and 20th century disease—has increased Bc ppl feel more vulnerable, normal everyday symptoms such as headache and fatigue are now more easily interpreted as signs of disease or ill health.

Answer 17

increase in the public’s fascination with personal health and medicine, as evidenced by the burgeoning of gyms and fitness programmes, and the widespread adoption of a “healthy lifestyle. The media’s increased coverage of health topics, in stories on the dangers lurking in ordinary activities such as air travel and vaccination, has raised worries about routine health care Well publicised crises, most obviously bovine spongiform encephalopathy and foot and mouth disease, have severely dented confidence focus of the media on risks with a novelty value fosters the belief that they are far more common than they actually are the internet - new and unsubstantiated health worries can be instantly transmitted to an internet audience eagerly seeking information on health or to special interest networks, such as illness support groups. A recent US study of hospital outpatients found that 25% of the patients had used the web for medical information in the past year med scares transmitted on web + via email - antiperspirants causing breast cancer result of this deluge of information on the supposedly pervasive risks to personal health is that people now feel much more vulnerable.

Answer 18

increase in the public’s fascination with personal health and medicine, as evidenced by the burgeoning of gyms and fitness programmes, and the widespread adoption of a “healthy lifestyle. The media’s increased coverage of health topics, in stories on the dangers lurking in ordinary activities such as air travel and vaccination, has raised worries about routine health care Well publicised crises, most obviously bovine spongiform encephalopathy and foot and mouth disease, have severely dented confidence focus of the media on risks with a novelty value fosters the belief that they are far more common than they actually are the internet - new and unsubstantiated health worries can be instantly transmitted to an internet audience eagerly seeking information on health or to special interest networks, such as illness support groups. A recent US study of hospital outpatients found that 25% of the patients had used the web for medical information in the past year med scares transmitted on web + via email - antiperspirants causing breast cancer result of this deluge of information on the supposedly pervasive risks to personal health is that people now feel much more vulnerable.

Answer 19

The rapid introduction of new technologies has been accompanied by important adverse effects in the way people make sense of illness and present with health complaints.

Answer 20

Diagnostic and Statistical Manual | of the American Psychiatric Association (PTSD 1st included in DSM III)

Answer 21

called into question cross-cultural export of PTSD counselling programmes to non-Western communities who have suffered wartime violence

Answer 22

McFarlane suggests that the decline of interest in psychoanalysis as an explanatory model has decreased the emphasis on unconscious conflicts in the causation of psychiatric disorders, which in turn has lead to an increasing focus upon life events, and in particular, traumatic life events, as causative factors.

Answer 23

there has always been a tendency to push traumatic events, not only out of individual consciousness, but out of social consciousness as well. discourse on trauma has emerged because of a number of political developments, most importantly the rise of the women’s movement in Europe and North America The advent of feminism, she suggests, by allowing a recognition and understanding of the effects of rape and other forms of sexual violence, has made it possible for psychiatrists to examine the effects of trauma and to take the victims’ accounts of their suffering seriously. large-scale social movements which opposed the war in Vietnam allowed for a critical examination of the effects of wartime experiences PTSD has always existed but has remained almost invisible to psychiatry until recent polit developments

Answer 24

origins late 19th century when the notion of the ‘traumatic memory’ became popular in medicine recent discourse on trauma has inherited this concept but has also been substantially shaped by a number of theoretical developments in American psychiatry the concept of PTSD has been constructed over time; it has a history PTSD has come to be constructed on account of changes in psychiatry itself - t is part of an effort to secure a scientific basis for psychiatric classification

Answer 25

concern with psychological trauma is not simply a clinical issue, it would appear that it is also a cultural event A number of clinicians and researchers have argued that the characteristic intrusive and avoidance symptoms of PTSD can be best understood as evidence of the victim’s search for a new sense of meaning and order in the world in the wake of the traumatic experience. Cognitive theories have become dominant in this area and most researchers assume that trauma produces its effects by undermining the unconscious models or ‘schemata’ which serve to structure an individual’s reaiity

Answer 26

‘information processing’ model of trauma A traumatic event presents information which conflicts with pre-existing schemas. There is thus an incongruity which gives rise to distress. This provokes a ‘stress response’ which involves reappraisal of the event and revision of the schemas. If the event is highly traumatic this process is prolonged. However, until such time as the process is complete, the event remains stored in ‘active memory’: Because the representation of the traumatic event is stored in active memory it is replayed over and over again, each time causing distress for the individual To prevent emotional exhaustion, inhibition and facilitation processes become involved. If there is a failure of inhibition, intrusive symptoms such as nightmares and flashbacks occur.

Answer 27

cognitivists - psychology and culture are separate realms. While culture may help shape an individual’s understanding of the world, there are universal psychological processes which make such understanding possible in the first place. It is these that are damaged by trauma Anthropologists - Kleinman - very basic aspects of our reality are culturally constructed. Culture shapes emotions

Answer 28

need to look at ‘collective trauma’: Because traumatic experience can also be conceptualised collectively, person-centred accounts alone are insufficient to an understanding of traumatic reactions

Answer 29

the individualistic concept of PTSD cannot grasp the cultural dimension of suffering in times of war, particularly in non-Western settings

Answer 30

while rejecting Descartes’ ontological dualism, cognitivism continues to endorse his epistemological separation of inner mind from outside world

Answer 31

contradictions of post-modern society are simply exaggerated tensions which have always existed within modernity. One of the key features of modernity which makes it different to what Giddens refers to as ‘traditional society’, is its extreme dynamism. In most Western societies there has been a move away from religious and other belief systems which offered individuals stable pathways through life, and meaningful frameworks with which to encounter suffering and death. During the same period the individual self, although more important than ever before, has been undermined by the very forces which assert this importance For in the post-modern condition the self becomes the source of the meaning of the world while at the same time it becomes disconnected from that world. Within the cultural horizon of late or postmodernity individuals live their lives without recourse to firm foundations. While this offers unprecedented freedom for individuals to define their own identities, their relationships and their beliefs about the world, it also brings with it a burden of what Giddens calls ‘ontological insecurity’.

Answer 32

If attempts to reestablish a sense of coherence and order are what lie behind the intrusive and avoidance phenomena codified in the syndrome of PTSD, and these efforts are, to some extent at least, driven by the structures of the surrounding culture, then, we would expect that in cultures which cannot be characterised as modern or post-modern there might well be very different reactions to terrible events PTSD thus the product not of trauma in itself but of trauma and culture acting together PTSD is the product of a particular cultural situation. It is a disorder of our times

Answer 33

- separation of time and space - social and cultural institutions become separate from local contexts and stripped of specific local orientations - reflexivity

Answer 34

- Born in 1866 as exclusively somatic disease - 1880s - confusing psychical ailment - 1890s - a state of somatic-psychic flux - Early death in 1st decade of 20th C - Contribd to fundamental restructuring of the somatic paradigm and re-legit of psychogenic notions of causality Name of the condition - railway spine - was indicative of late 19th C med's materialistic orientation

Answer 35

Railroad accident, then cases of full or partial paralysis, headaches and various aches and pains oft emerged at later date wide variety of symptoms: ``` eg. defective memory ill temper hot head perverted taste and smell sexual impotence ``` cld only be diagnosed from patient's symptoms

Answer 36

1st to describe group of symptoms, mainly nervous, that frequently occurred after a concussion of the spine Argued by way of analogy and according to clinical observation Similarity w Beard - sought to apply single label to wide variety of symptoms

Answer 37

men more likely to be victims since most likely to travel by rail Presence of apparently hysterical symptoms in men convinced Erichsen that symptoms elicited by railway accidents and other traumas must be indicative of some serious organic disturbance - Inconceivable that man cld display hysterical symptoms w/o serious organic disturbance

Answer 38

hysterics typically denied the sympathy granted to sufferers from unquestionably organic ailments

Answer 39

Symptoms emerging at later date cld only be explained by psychical factors Fright itself = capable of eliciting neuromimetic symptoms by way of some willful hypnotic state Disappearance of symptoms following financial settlements Patient shld be freed from hurtful sympathy of friends This = one of the first exclusively psychological explanations for both cause and cure of functional ailments

Answer 40

Prior to publication of E's lectures, accident victim who failed to display clearly discernible anatomical or physiological symptoms not likely to fare well in a court of law E's book forever altered this situation Plaintiff - used Erichsen - organic - injury to spine Defence - Page - simulation Role played by juries was source of special irritation to railway surgeons and the corporations they repd - tendency to sympathise w plaintiff At trial, plaintiffs likely to win almost 70% of cases against railroads, and such findings rarely overturned on appeal

Answer 41

In 1st decade following publication of his book, English railway companies paid more than $11 million in damages Similar figures cited for the US Hundreds came from those seeking compensation for spinal concussion, or what an eminent physician soon termed 'Erichsen's Disease.'

Answer 42

Railway spine = merely a symptom of the present 'epidemic of madness and insane furor against the railroads and othe rcorporate enterprises.'

Answer 43

formation of several regional assocs of railway surgeons First such local assoc was estabd Jan 1882 Over course of the decade more than 50 additional local organizations established 28 June 1888 more than two hundred mems - representing several of these organizations - met in Chicago and founded the National Assoc of Railway Surgeons Later that yr, the assoc issued the first volume of the Natioanl Assoc of Railway Surgeons Journal Denied reality of spinal concussion

Answer 44

sympathetic attention of friends and loved ones aggravates patient's condition by fixing his mind on his ailments and suffering Physicians' role in creating this condition - when crashes in cities more railway spine cases bc more physicians to say so - 20x more accidents (neurologists partic to blame)

Answer 45

Traumatic neuroses, while legit med ailments, were typically the afflictions of the hereditarily tainted and morally suspect Borrowing from Charcot Claims railway accidents merely triggered preexisting tendencies. Their oft dismal plight bore little or no relationship to train wreck - like dry powder in search of a match Where free of vices, Bernheim's psychical doctrines more enticing - used to shift blame from accident to attending physician and sympathetic friends, loved ones, lawyers Punton - failure of enforcement of isolation to be sufficient ground to excuse any railroad company from further responsibility of any claims American railway surgeons thus unwittingly became first American med specialty to achieve consensus regarding therapeutic value of what wld soon be known as psychotherapy

Answer 46

little Prior to first decade of 20thC, nervous disorders, regardless of perceived etiology and pathology, were treated in virtually identical manners

Answer 47

Practically all humans live in social groups All diseases at least trivially = diseases of civilization Infections e.g. measles need pools of susceptibles to provide continuous chains of hosts in space and time Fact of history at least until recent times that disease incidence runs in direct ratio to settlement density

Answer 48

17th C rise of 'new diseases' - e.g. rickets, assoc by contemps w deleterious facets of urban life TB widely ident as essentially an urban diseases, esp tragic bc cuts off young in prime Rural enclaves oft escaped epidemics 19th-C, correlation between disease and the city appeared most inescapable 1852 'Great Stink' from Thames forced adjournment of Parliament Spread of big city life apparently making pops more vulnerable to new modes of ailment midwived by modernity e.g. hysteria, hypochondria 20th C, great killer infections that had so long decimated urban communities were in rapid retreat Affluent city came to be recognized as site of the most effective h-c delivery system It is the First World - urbanized, industrialized, civilized, that enjoys longevity and salubrity at close of 20th-C

Answer 49

Link between societies and sickness made explicit in Early modern med Charting, containing and curbing town-specific diseases exercised med administrators of early modern Europe Public-hlth experts in Renaissance Italy promoted and perfected quarantine protocols

Answer 50

renewed methods made during Enlightenment to document disease and plot patterns of incidence against natural and social-environmental factors such as climate, waste disposal etc

Answer 51

'Contagionists' - indiscriminate bodily contacts towns created 'Miasmatists' - e.g. Chadwick, argued the new 'shock towns' produced highest concentrations of garbage, rotting refuse, decaying animal, faeces etc, all of which emitted gaseous effluvia, which were disease in own right or at least its bearers Others emphd moral links - idleness, indigence, ignorance amongst w-c's bred lifestyles which bred disease. Greeat pop of such arguments on both sides of Atlantic during cholera pandemics 1830s and 1840s

Answer 52

Concept of 'diseases of civ', superimposing medical and moral, 1st activated 18th C - serving as secularized revamping of Christian legend of the Fall, wherein Original Sin and expulsion from Paradise had inaugurated the regime of hard labour, disease, suffering and death in the temporal world Rousseau - 'primitivist' - and popularizing physicians e.g. Scot George Cheyne - argued what might be termed 'noble savages' and their sturdy hunter-gatherer and peasant descendants, of necessity pursued hlthy life-styles Devel of town life led to deleterious habits e.g. (590) over-eating, hard drinking Artificial demands of smart, high-pressure high society and enlightened living amongst literati and glitterati were seen as creating new world of diseases

Answer 53

Cheyne, Tissot and followers - discarding conventional theories of humoral balance, they emphd that key to hlth and happiness lay in correct nervous tone Excessive consumption of fine foods and alcohol, and lack of exercise, combined to obstruct the nervous fibres Notion of diseases of civilization went hand-in-hand w increased explanatory import of the central nervous system 1670s, Thomas Sydenham guessed that about 1/3 of all disorders in Br were 'nervous' By 1800, Trotter was suggesting their incidence had doubled 'nervousness' cld be taken as symptom of success no less than sickness Applied to nations as well as individs

Answer 54

19th-c that notion of 'diseases of civ' attained greatest credibility and max scare-power Shift - instead of diseases of civilization and signifying superiority, idea's dark side became dominant Partly bc certain disorders that fell under epithet's umbrella grew more deadly, above all TB, which climaxed around mid-19th C, accounting for up to 1/4 of all urban deaths in north-western Europe and eastern US seaboard, esp those of young adults Leading TB docs e.g. Beddoes explicitly blamed the menacing curse of the disease upon the effete and aetiolated hot-house life-styles cultivated by the beau monde

Answer 55

- Growing stress on role of heredity in spreading sickness down generations - Social Darwinist view that nations and races locked in struggle for survival that would penalize weakness - W rise of class tensions and social strains in age of industrialization, widespread feeling the social body itself was sick - fears grew that soc itself being crippled by growing burden of delinquent and maladapted - parasites of the ghetto and its subcultures - degenerationism

Answer 56

- Originally assoc w Morel - Socio-cultural traits of modernity were morbidly self-destructive - US nerve-doc George Beard, career strains in the business rat-race devitalized high-flyers - Cerebral circuits suffered overload - Widely assumed that the degenerate would breed disproportionately

Answer 57

anthropometry and psychiatric criminology which employed cranial measurement and photography to identify the diseased sectors of civilization, w view to isolating, treating or even sterilizing criminal and prostitute types, atavists and immoralists

Answer 58

- direct response to perceived rise of degenerate underclasses - Immigration restrictions - Aliens Act 1905 - US - several state legislatures promoted programmes of castration and sterilization - Nazi programme of race hygiene

Answer 59

- complaints commonly presented by patients e.g. depression cld be attribd to psycho-pathology of everyday life in modern, urban, affluent civilization - Bourgeois respectability and prudishness and delayed marriage took heavy psychological toll - 'repression model' presumed that biologically healthy drives e.g. libido were necessarily suppressed to meet demands of social order - Resulted in pschological and psychosomatic disorders

Answer 60

- 1930s and 40s - championed in partic by Winternitz at Yale and Ryle at Oxford - devel of sci med under bacteriology was counterproductively narrow -Epidemiology had to move beyond the pathology laboratory and into society as a whole - Sickness trends = functions of social variables such as class, income, status, occupation ---> what was psycho-socially triggered could not adequately be treated by pharmaceutical or surgical interventions alone. - Bc of their research and publicity efforts, became common wisdom that certain sorts of disorders consequential upon deleterious life-styles and environments

Answer 61

e.g. caused by more precise diagnostic techniques more intense screening

Answer 62

- Black Report and other British surveys: heart attacks pre-eminently afflict not social groups one and two but four and five - the poor, deprived, under-educated - Much in heart disease that has been assoc w category of 'civilization' may be attributable specifically to nicotine - W spread of hlth ed, enlightened eating habits, seems likely that today's so-called diseases of civilization are not in any straightforward sense the products of affluence, but rather diseases disproportionately afflicting the least privileged mems of advanced socs - cancers, heart conditions, respiratory diseases etc are rapidly worsening amongst the masses of the Third World, evidently spread by industrial toxins, dietary dislocation, cigarette smotking - AIDS - for many moralists, the quintessential disease of modern life-styles - has mainly devastated Third World

Answer 63

- Suggested such diseases as cancers have defied sci research and resisted cure precisely bc methods of sci (fixated upon reductionistic, materialist approach to the body, and expectation of specific remedies, a 'pill for every ill') are inappropriate for handling systemic and constitutional disorders, from MS to ME, whose aetiology may include an irreducible psycho-somatic component and be personality linked - Illich: modern med = one of the prime diseases of civilization, not only spreading iatrogenic disorders, but orchestrating a disabling 'expropriation of health'.

Answer 64

lies in its ability to link philosophies of sickness to a wider disaffection w, and critique of, industrial soc, nostalgically evoking myths of golden ages of hlth and seeking a return to Nature

Answer 65

still exercises a powerful Romantic hold, largely over those who are the greatest beneficiaries of the civilizing process itself

Answer 66

the origins of 'ME' lie not in 1955 or 1934, but in the last century, and in the condition known as neurasthenia

Answer 67

profound physical and mental fatigue, especially after physical or mental exercise, together with a variety of other symptoms especially neuromuscular, cardiovascular and gastrointestinal

Answer 68

Myalgic encephalomyelitis

Answer 69

condition results from a virus, and was first recognized at the Royal Free Hospital in 1955

Answer 70

- American neurologist - published his essay introducing neurasthenia in 1869 - definitive clinical text published 1880

Answer 71

- profound fatigability of body and mind were the principal symptoms - organic disease - common in educated and professional classes - resulted largely from environmental factors - treatment was rest

Answer 72

- assumed that ME is an organic disorder of the peripheral or central nervous system. 'purely organically and virologically based' (Smith, 1989) (shift from early emph on neurological features to emph on absence of abnormal neurological signs) - emph on muscle fatigability and mental fatigability - similar list of over 70 symptoms including alterations in temperature regulation and difficulties in accommodation - refusal to acknowl existence - Beard's accusation of docs' refusal; principal theme of most ME self-help lit = absence of recognition accorded to patients - disorder of mood / depression - patients' mistrust of psychiatrists - belief (also widespread among docs) that psychiatric diagnosis implies denial of reality of distress and illness - restricted to developed nations - infectious origin (w neurasthenia, this followed revolution in bacteriology 1870-1900) - rest vs activity debate

Answer 73

impossibility of measuring objectively a personal experience such as fatigue

Answer 74

on one hand, vague sense of being under the weather - reported by most ppl most of the time Other hand - profound disabling fatigue state is there clear cut-off between the two extremes? Using data from the 1987 US General Social Survey it has been shown (Wesseley & Thomas, 1989): Some degree of fatigue is found in nearly all the population, but only a very small minority report severe fatigue The number of fatigue symptoms endorsed is more important than any single item, supporting the concept of fatigue as a dimensional rather than a categorical variable.

Answer 75

alleged aetiology George Savage (1875) - fatigue was commonest in professions requiring an unflagging devotion to work, or a high degree of emotional stress (he listed architects, surveyors, policeman, artists, etc)

Answer 76

one of the products of civilisation, confined largely to the professional and clerical callings, and to women of the middle classes

Answer 77

Physicians then (and now) displayed sympathy towards their patients based on their perceptions of whether the illness was acquired through praiseworthy or contemptible means. Neurasthenia, the disease of overwork, came into the former category

Answer 78

With the decline in neurasthenia, and its partial replacement by the concept of neurosis, patients were treated less sympathetically by the non-psychiatrist. By World War I both neurasthenia and hysteria were held in low medical esteem (Stone, 1985), although this was tempered by the fact that neurasthenia was the disease of officers Perhaps the term neurosis (or any psychiatric label) was interpreted by the unsophisticated doctor as implying that the patient was responsible for their disease, and thus less liable to sympathy

Answer 79

great harm resulted from patients meeting in sanatoriums and 'spreading the mental infection by constant conversation and comparison of their complaints

Answer 80

Ideas concerning organic versus functional lie at the heart of the both neurasthenia and ME. Beard's neurasthenia began as a physical disease, which may have accounted for its success.

Answer 81

The prime cause of modern nervousness is modern civilisation - environmental causes: newspapers, steam, science and wireless telegraphy = principal offenders - pace of modern life neurasthenia resulted from 'overload'

Answer 82

less the result of overwork, but more of the work-ethic itself, the drive to succeed. He shows that fatigue was seen in professions demanding an 'unflagging devotion to the task or a high degree of emotional pressure

Answer 83

'disease of the twentieth century'

Answer 84

'an overload disease unique to this century'

Answer 85

Obviously some modern causes were unknown to Beard, for example 'agent orange' (Hall & MacPhee, 1985) or pesticides (Dawes & Downing, 1989), but the idea of illness created by an external' toxin' was entirely familiar. Even current theories implicating the immune system are consistent with Beard's views, since the alleged dysfunction is blamed on the excesses of modern living and the 'deteriorating quality of the world we live in' (Dawes & Downing, 1989), via notions of overstressing of the immune system ME blamed on: - widespread use of antibiotics - altered environmental factors such as pollution with tobacco, petrol or other allergens making victims more susceptible - excessive exercise

Answer 86

rather than identifying a major health problem, neurasthenia was the problem 'it is neurasthenia which breeds the almost universal anxiety about health which is one of the signs of the times. This leads to a corresponding prevalence of quackery of every kind'

Answer 87

nature of the principal alleged aetiological agent Viruses are among the commonest explanations given for nonspecific transient illnesses that abound in the community The agent is external, and is beyond the subject's control no guilt or self-blame External attributions of illness to entirely organic causes distinguish ME patients from matched psychiatric controls

Answer 88

- neurasthenia was shifting from being the concern of neurology to psychiatry. This change was of critical importance, since once neurasthenia was viewed as psychiatric, a principal social function was lost. - increasing sophistication of psychiatric nosology rendered the diagnosis untenable. In the USA Dana (1904) began the protest against the broad definitions and lack of precision - change in social demography. From disease of upper classes to lower classes. Savill, first to study neurasthenia in a 'Poor Law Infirmary', stated that the illness was actually more common in that setting: neurasthenia was now 'a disease of clerks'

Answer 89

The neurasthenic model, valuable because it gave credence to non-verifiable symptoms and to emotional distress that was not outright insanity, was dismantled when it proved too large and cumbersome to be subdivided into more specific categories

Answer 90

the label of neurasthenia is often in order to evade a duty - the duty imposed on us to declare a correct diagnosis

Answer 91

England - did not fare well Clark, Lancet, 1886 - 'vicious, inaccurate and therapeutically misleading'. It was a 'an assemblage of incoherent indications of disorder borrowed more or less freely from inchoate forms of insanity, and from almost every disease of the nervous system

Answer 92

neither neurasthenia nor ME fits into a simple medical model failures of a medical model are not corrected by studies that ascribe psychiatric diagnoses to many (but not all) of patients with ME syndromes both neurasthenia and ME can only be understood within their social context.

Answer 93

Physicians wrote occasional papers on 'Chronic nervous exhaustion' (Macy & Allen, 1934) or neurocirculatory asthenia (Wheeler et al. 1950), but more often patients were simply described by their symptoms, such as ' exhaustion' (Dowden & Johnson, 1929), 'tired, weak and toxic' (Alvarez, 1935) or simply 'weak and fatigued' (Allan, 1944)

Answer 94

one may argue that they represent culturally sanctioned expressions of distress, in effect culture bound syndromes difficult to ignore the parallels between attitudes to work and material success between the late Victorian age and now, the periods of neurasthenia and ME, and not to suggest that the intervening years were characterized by different attitudes to both work and the expression of emotional distress

Answer 95

psychiatric illness remains as stigmatizing as ever dislike and distrust shown by patients and doctors towards psychiatry. This may be direct, but is more often indirect, indicated by the many statements affirming the 'genuine' or 'real' nature of ME

Answer 96

Based upon the analysis of mortality, life expectancy, and survival data for the United States from the turn of the century to 1980, and projections to the year 2020, the United States appears to have recently entered a fourth stage in the epidemiologic transition - characterized distinctly by rapid mortality declines in advanced ages that are caused by a postponement of the ages at which degenerative diseases tend to kill. "The Age of Delayed Degenerative Diseases" This stage will propel life expectancy into and perhaps beyond eight decades

Answer 97

govt gave them as economic supplement to old age pensions

Answer 98

free to those in | deprived areas as a remedy for inequality.

Answer 99

- 1950s, issue of smoking and lung cancer crystallized the post‐war change of emphasis from acute infectious to chronic disease and the beginnings of a new lifestyle‐oriented, activist, single-issue, public health - this came to fruition 1970s - 1980s, passive smoking symbolized the reincorporation of environmentalism within public health - 1990s, the ‘discovery of addiction’ for smoking also typified new developments in public health. These entwined prevention with treatment, and gave a greater role for pharmaceutical interventions and for genetics sigificant change in attitude of govts - took on the role, not without discussion, of advising on and regulating the individual health behaviour of the electorate.

Answer 100

the efforts of societies and individuals to prevent | disease, prolong life, and promote health

Answer 101

Nineteenth‐century public health paid little attention to smoking as a health hazard, and its health dangers were little discussed Its health benefits were more central and were recognized to include alleviation of stress the smoker might be weak willed but he was not diseased.

Answer 102

during the inter‐war years, statisticians like the American Raymond Pearl, working for the insurance industry, began to link smoking to reduced life expectancy and to cancer. In Britain in these interwar years, there was little connection between formal public health and opposition to smoking MoHs worked to contain infectious disease

Answer 103

located in the post‐war rise of chronic disease and the rise of risk factor epidemiology public health focus on these ‘diseases of affluence’ was what lay behind the reorientation of ideology Smoking and related lifestyle issues brought a new style of health activism into public health. Single‐issue organizations developed science‐based campaigns: the role of the mass media in public health initiatives became central, as a tool to be used, or as a mode to be attacked when used by others

Answer 104

1962 report on smoking produced by the Royal College of Physicians was the harbinger of a (16) new media‐based role for medicine Science, initially epidemiology, was central to the focus on lifestyle and risk. A population‐level style of argument nevertheless placed its emphasis on modifying the behaviour of individuals Health economics, psychology, and the social survey, outgrowths of social medicine, became the standard tools of this new public health.

Answer 105

Concern was roused by the gradual increase in the incidence of cancer ``` work carried out in the Statistical Research Unit at the London School of Hygiene and Tropical Medicine (LSHTM) by Professor Bradford Hill and Dr Richard Doll. The results, published in the British Medical Journal (BMJ) in 1950, concluded that there was a ‘real association’ between carcinoma of the lung and smoking and that smoking was a factor, and an important one, in the production of carcinoma of the lung. ``` Work by Wynder and (25) Graham in the United States, published just before, had come to similar conclusions. In the UK context, the work of Doll and Hill was the watershed. This was a case control study based on twenty London hospitals. The Parliamentary Secretary to the MH on 27 June 1957 expressed for the first time unambiguous support for the conclusions reached by Doll and Hill in 1950. --> MH circular encouraging local authorities to develop health education campaigns on smoking

Answer 106

smoking was the exemplar of what came to be the main style of postwar public health. Such a style emphasized the role of individual behaviour, legitimated through population‐based epidemiology, as the dominant focus. major change away from explanation in terms of social structure, economic inequality, occupation, or environment. Smoking and lung cancer epitomized this pending change and helped to accelerate it. The RCP report in 1962 was the catalyst for a new era in which the presentation of science to the public through the media with the authority of scientists and the medical profession became central. As consumerist trends in society consolidated, and medicine and public health both sought ‘modernization’, the old tradition of ‘giving the facts’ to citizens was transformed into warnings about health risk.

Answer 107

Between the 1840s and 1971, three‐quarters of the improvement in death rates had been due to the decline in infectious disease, with non-infectious conditions accounting for the remaining quarter. But this pattern changed after the Second World War. The old ‘public health’ diseases like TB or diphtheria were in decline. For TB effective chemotherapy, and mass radiography, virtually eliminated the need for treatment by the mid‐1950s As the population lived longer, so noninfectious causes of death such as heart disease, strokes, and cancer grew in importance.

Answer 108

Concept of social medicine remained vague. Although to Ryle it symbolized the combination of social conscience with clinical medicine, other leading proponents like Richard Titmuss and J. N. Morris attached importance to the involvement of social science, the use of epidemiology, and the study of health policy.

Answer 109

Legitimizing the smoking and lung cancer link was the first stage in the establishment of society focused on individual health and obsessing over the concept of risk Environmental concerns were changing to population ones and to the focus on risk. 1960s, research and the social survey began to outline a new view of ‘the public’ and to establish a relationship between medicine and the social sciences Governments assumed a new duty to advise and warn about health risk, to persuade their citizens rather than to assume that a sense of public duty inherent in the population would lead them to make up their own minds

Answer 110

the early twenty‐first century was in sharp contrast to the 1950s, with public attention focused on public space rather than (p.281) the private and family realm, the regulation of domestic space and the home being the traditional concern of public health Public health retained the emphasis on the role of the individual lifestyle, but increasingly this contained a strengthened criminal justice and punitive approach with a particular emphasis on the regulation of public behaviour by young people. By the end of the century, many of the public health tactics and concepts which were novel and unusual in the 1950s and 1960s were so commonplace as to be unremarkable. People expected doctors to give advice on lifestyle conditions and politicians to give advice on how the population should eat and drink. Government itself had become a public health activist. The reorientation of epidemiology post‐war to (p.282) concepts of risk in relation to chronic disease were part of everyday currency, although they had been novel and lacking in legitimacy in the 1950s

Answer 111

chronic disease - though a traditional med term - was primarily an American policy construct during the first half of the twentieth century

Answer 112

hundreds of books on chronic disease were published in the 18th and 19th centuries suggesting it was far more common than official mortality statistics or historians' focus on infectious diseases wld suggest chronic diseases were not a major category for public hlth

Answer 113

many of those who died of infectious disease already gravely ill Secondary terminal infections carry off many patients w incurable disease

Answer 114

difficulty of docs getting fams to talk about such matters implication of hereditary taint or wrongdoing

Answer 115

1. 12 per 1000 responders had an acute illness | 7. 9 per 1000 had a chronic illness

Answer 116

most famous 19th-C med work on the subject

Answer 117

term acquired new meaning as one of the most serious problems facing national hlthcare systems

Answer 118

Armstrong has assoc the spread of the notion of chronic disease w the rise of a new kind of med - 'surveillance med' - replacing the hosp med that predominated for nearly 2 centuries; this regime takes patients out of hosps and focuses on prevention of a growing num of conditions through ever-more pervasive and sophisticated forms of monitoring and screening however, surveillance and preventive med began w infectious diseases like TB and syphilis

Answer 119

- interwar campaign for physical examinations - New York City campaign to rationalise hosp and welfare institutions - National Heath Survey - established in the public consciousness that chronic disease was a major public hlth problem - estimated more than 1/6 American ppl have some chronic disease or impairment - 1940 American Hospital Association and American Public Welfare Assoc published statement about need to improve institutional care for the chronically ill - Commission on Chronic Illness 1949-55. final report transformed concern that had achieved significance during the 1930s as part of drive for national hlth insurance into an autonomous issue of substantial import for the hc, public hlth and social services professions

Answer 120

- Older population of Britain (few percentage points) - US preoccupation w chronic illness predicated on assumption it affected large nums of young or middle-aged men and women. Cure = national priority. Illnesses of older ppl appeared part of natural order - US wealthier and not burdened w having to pay for national hlth service/ insurance

Answer 121

- 1951, International Congress on Hospitals in Brussels - devoted to chronic and elderly patients - 1957, European Section of the WHO held symposium in Copenhagen on the Public Hlth Aspects of Chronic Disease

Answer 122

- national public system of British Poor Law - inadequate but divisions in Poor Law Commission 1905 - National insurance. Debate centred around plugging holes in this rather than specific issue of 'chronic disease' - statisticians generally skeptical about data showing dramatic rise in mortality from cancers and coronary diseases - unlike in US context, less reason to mobilise issue of chronic disease to create change bc change already underway

Answer 123

-series of regional reports based on survey of hosp accommodations carried out during the war by Nuffield Provincial Hosps' Trust and Min of Hlth, published 1945-6. Gave impression of inadequacy - chronic patients parked in inferior facilities of welfare authorities. Half all chronic patients in public assistance sector. Understaffed - seen as dumping ground for elderly and chronically ill. Increasing concern w elderly - 1949, BMA and other agencies reporting that general hosps refusing to admit many older patients - 1953, Ministry of Hlth, Boucher Comte to examine services to the chronically sick and elderly. 1957 report - hosps generally adequate. need for improved rehab services -Thomas McKeown - 1960s, had accepted 2 key ideas of US chronic disease movement - developed societies faced new set of illnesses that cld not be dealt w w trad means. One cld best prevent such diseases by modifying individ behaviours - 1963 talk at Royal Society of London, Morris (leading social med exponent), referring directly to larger category of chronic disease as scourge of new vulnerable group of middle-aged, emerging since WW1 Morris - ways of healthy living, needed to avoid dangers e.g. air pollution. Also obesity, smoking, stresses. It was thus poss to think beyond individ diseases to more general category, 'chronic illness' By mid-1960s such thought widespread

Answer 124

focus on modification of individual behaviour fit less comfortably into public hlth thinking in Britain than US - in former, longstanding public hlth tradition concerned w hlth inequalities based on social class

Answer 125

degeneration became inextricably bound up w German and French med discourses on neurasthenia from the 1890s onwards. British and Dutch med discourses, this seems to have been much less the case

Answer 126

somatic to psychic early 20th C illness of weakness to one of ove-excitement

Answer 127

Britain - only in wake of WW1 do we hear of shell-shocked soldiers being diagnosed as neurasthenic as means of getting social insurance - may assume that diagnosis of neurasthenia was not as widely extended to the British working-class as was the case in Germany

Answer 128

1660s - Thomas Willis - study of nervous system revealed hidden causes of diseases and symptoms 1730s - George Cheyne - 1/3 of all disorders = nervous

Answer 129

fashionable living = deleterious, w its late rising, later nights, artificial lighting and heating, sophisticated cuisines w dishes rich, salted, sauced, pickled, highly-seasoned, and liquors

Answer 130

mid-19th C - second law of thermodynamics posited that the quantum of energy avail in the Universe decreasing entropy theory incorp into med - Maudsley - energy of the human body = definite and not inexhaustible quantity

Answer 131

1st outlined 1869 anxiety, despair, insomnia, fatigue, migraine, palpitations.... etc disorder of modernity - US nervousness = 'distinguished malady', product of US civilisation insufficient nerve force = explanation for every neurasthenic symptom

Answer 132

mixed reception some approved - brought coherence others less willing to forego old diagnostic categories of spinal irritation of hysteria

Answer 133

when its claimed neurophysiological foundations were not validated - increasingly vulnerable to charge it was merely terminological fig-leaf to cloak ignorance in cases of what was essentially (merely) a psychological condition

Answer 134

English Malady = refinement of the old pathology of luxury American nervousness = disease of labour

Answer 135

emph moved from physiological to more specifically include cultural factors - steam power, press, telegraph, sciences and mental activity of women preferred cure = application of electric current to replenish the nerve force

Answer 136

treatment regimen of diet, rest, massage and electricity

Answer 137

- shift from body to mind - rise of idea of power of mental suggestion - decline of neurasthenia not as fast as sometimes thought - resistance to rise of psychology - in exasperation at persistence, one doc in 1930 complained about 'dumping ground of neurasthenia'. Late as the 1950s GPs still to be found utilising the unreliable and vague diagnosis - rise of interventionist state, National Insurance Act, rise of panel docs w sense of duty to reduce cost to state. Aftermath of national mobilisation of WW1 - mental hygienists claiming that conditions like neurasthenia were huge financial burden on the nation. - patients - not declining purely against what patients wanted, as Shorter claims. Some were accepting of psychological over somatic illness definitions - catered better to spirituality through discovery of the whole self. Also, forcing patients to acknowl psychological basis of conditions like neurasthenia cld be attractive and empowering

Answer 138

Los Angeles County General Hospital 1934 - outbreak of 'atypical poliomyelitis'

Answer 139

subset from the LAC outbreak suffered from prolonged and recurrent symptoms e.g. group of nurses 1950s LAC epidemic featured prominently in number of reviews. New syndrome defined - most commonly called benign myalgic encephalitis

Answer 140

its brief history spans less than a decade early 1980s - case series describing lingering viral-like illness, manifested as fatigue and other largely subjective symptoms, which appeared to be assoc w serological evd of recurrent or prolonged infection w the Epstein-Barr virus (EBV) Outbreak at Lake Tahoe April 1985, conference on chronic Epstein-Barr virus infection 1988, growth in skepticism in med literature. Call to rename, to CFS, as new consensus stressed minimal diagnostic utility of the EBV serological tests Conference participants proposed 'Chinese menu' approach to diagnosis - presence of symptoms meeting two major plus any eight of fourteen minor criteria series of studies cast doubt on somatic basis of the syndrome. Few demonstrated high rates of prevalence of psychiatric disease among ppl w CFS

Answer 141

CFS gained notice as a new disease only as result of attention given to the apparent correlation between abnormal EBV serologies and a vague viral-like illness

Answer 142

docs had only their clinical judgement to distinguish polio from other diseases. Public hlth officials, believing import of early diagnosis and fearing polio upsurge, launched campaign to raise public awareness about protean nature of the disease and need for early recognition. Patients thus more prone to detect symptoms and seek med attention clinicians likely to have lower threshold for suspecting polio

Answer 143

fact patients at LAC and Royal Free epidemics were themselves h-c professionals lent weight Mary Bigler, head of LAC contagion unit, took ill June 1934, and later co-authored one of the epidemiological review of the outbreak

Answer 144

probs major influence on lay and med interp of ubiquitous background complaints and self-limited illness as due to polio

Answer 145

ME wld not have captured attention on clinical grounds alone - needed polio as vehicle for recognition perception of CFS affected by the contemporary AIDS epidemic

Answer 146

e.g. early in the Los Angeles epidemic, public hlth authorities used the stark incidence figures to justify increased public hlth spending

Answer 147

diseases caused by virus or hysteria? both sides of the debate have acted as if the onus of responsibility falls much more severely on the patient whose disease does not have a specific somatic etiology Tension between critique of med authority and the desire for its acceptance of the patient's condition as a normal disease some arguing against the disease see it as potential undermining of med control (much more up to patient to 'define' the disease/ how they experience it) and potential source of abuse of the sick role overall faith of both sides in sci to eventually get things right, and high regard placed on attaining legitimacy of med professsion

Answer 148

journalistic accounts have used terms 'yuppie flu' and 'Hollywood blahs' for CFS, suggesting it may result from the stress of being an ambitious young professional - e.g. Cleveland Amory

Answer 149

convergence of interests - docs, helping them to explain encounters w patients in which disease cld not be diagnosed -patients - absolution from responsibility, relief from uncertainty, promise of therapy

Answer 150

obesity is the result of our hunter gatherer instinct to gorge on high calorie foods when they're presented to us But modern life has made it so readily available the instinct no longer serves the same purpose and now it's making us really fat

Answer 151

Health and Nutrition Examination Survey - increase of 40% between 1980 and 1990 currently more than 1/3 of the adult US population is obese described by WHO as 'escalating epidemic', 'one of the greatest public hlth problems of our time' also epidemic of child obesity - greater than 10% of 4-to-5-yr-old children currently obese

Answer 152

obesity is a chronic disease that is long-term or lifelong condition for most persons

Answer 153

e. g.: - coronary heart disease -type 2 diabetes more than 80% of individs w type 2 diabetes are obese - stroke - sleep apnea

Answer 154

- genetic factors (implausible argument for recent dramatic surge in prevalence) - lifestyle factors Surgeon General's report Physical Activity and Health - only 22% US adults regularly active at the 30 minutes per day lvl - environmental facotrs. Technology decreasing need for physical activity, plentiful and energy-dense food. US food industry - produces more than 3,700kcal food everyday for every man, woman and child and spends billions advertising - nutrition factors

Answer 155

hc community in general and physician community in partic has not been active enough in treatment of obesity as a chronic disease recent survey - fewer than 40% of the overweight and obese men received counseling concerning the adverse health consequences of their increased weight most current insurance plans do not reimburse for obesity-related therapies some stigma on part of physicians - seeing as self-inflicted importance of variety of therapeutic approaches - nutrition, excecise chronic disease treatment model shld be used for obesity

Answer 156

Three successive ages of mortality. - Stone age until eighteenth century: pestilence and famine. - Victorian age: pandemics (receding). - Twentieth century: degenerative and man-made conditions.

Answer 157

'chronic, incurable illness, leading to slow but apparently inevitable deaths, has a history that long precedes the twentieth century and has been blamed on civilisation by many past commentators'

Answer 158

- associated with cold and heavy drinking, caused fluid buildup - like consumption, diagnosis based on symptom manifestation, causes found in biography/lifestyle - Richard Bright (1789-1858)'s urine test meant patients could be diagnosed with 'Bright's Disease' with no symptoms - Triumph for pathological anatomy

Answer 159

J. Michael Gaziano, 'Fifth Phase of the Epidemiologic Transition: The Age of Obesity and Inactivity J. Olshansky and A. B. Ault, 'The Fourth Stage of the Epidemiologic Transition: The Age of Delayed Degenerative Diseases'

Answer 160

The manifestations of insanity had traditionally been understood to be either supernatural in origin (visitations of God or the Devil) or essentially organic, provoked by an excess of black bile (melancholy), or yellow bile (choler), or by some brain defect. Now a socio-pathological account achieved popularity. Madness was increasingly seen as in the mind, a disorder of the imagination or understanding. ``` It was, in other words, psychological, and the realm of the psyche was viewed as being significantly programmed by the ensemble of linguistic, literary, and intellectual signals in cultural circulation (for example Methodism, Romanticism) ```

Answer 161

- as the airborne and water-home infections classically associated with high-density living (typhoid, diphtheria, tuberculosis, etc.) have been vanquished, new classes of diseases have gained in prominence: ``` cardiovascular disorders, degenerative conditions of the nervous system, hypertension, diabetes mellitus, cirrhosis of the liver, the cancers, Alzheimer's disease, depression, chronic fatigue syndrome ``` How well did you k

Answer 162

atmospheric carcinogens, obesity, | cigarette smoking, addictions

Answer 163

Ivan Illich, argues that modem medicine is one of the prime diseases of civilization, not only spreading iatrogenic disorders, but orchestrating a disabling 'expropriation of health'. Illich has commended the health and disease cultures of simpler times and peoples.

Answer 164

'The key to the new post-war public health would be a revised epidemiology which dealt with chronic rather than infectious disease'

Answer 165

- The traditional focus on public health had been the outbreak of epidemic...but this pattern of disease and disease-related mortality began to change in the middle of the twentieth century. - As the population lived longer, so non-infectious causes of death such as heart disease, strokes and cancer grew in importance.

Answer 166

1840s-1971, 75% of mortality rate reduction due to decline of infectious disease

Answer 167

- George Beard, Boston Medical and Surgical Journal 1869 | - Van Deusen also used the term that year

Answer 168

French doctor: 'everything could be explained by neurasthenia: suicide, decadent art, dress and adultery'

Answer 169

- 'a disease of the nervous system...characterised by enfeeblement of the nervous force.' - 'nervous exhaustion, characterised by undue fatigue and muscular weakness' An exceptionally broad church: 1) male hysteria 2) chronic fatigue 3) depression 4) prototype and foundational for other diseases

Answer 170

- 'It was doubted if neurasthenia really was 'a disease of modern life (Schofield, 1908) - we had become more tender in our ills - Dubois, 1909

Answer 171

- we live longer, have less physically stressful occupations, and have easier access to food - a mental illness on the spectrum with anorexia nervosa - access to poor food - addiction - genetic: an 'ob-gene'

Answer 172

Jeffrey M. Friedman discovered the ob-gene, Working with a special strain of mice, he set out to identify the hormone that normal animals use to control their appetite - a molecule that was missing in the plump rodents. After eight years he found it The OB gene encodes leptin, a hormone that inhibits hunger

Answer 173

'One social product of the stigmatisation of the obese by the 1960s was the appearance of advocacy groups of overweight individuals who argued not only that their bodily status should not be stigmatised but also that they were happy and proud to be fat.' NAAFA (1969): to 'eliminate discrimination based on body size'. Later splintered into offshoot groups --> obesity 'a natural state or a disease process'?

Answer 174

- As of 2013, UK had the highest obesity level in Europe - 24.5% of uk obesity - By 2050, could be 50% SOURCE: NHS Live well - more commonly lower socioeconomic and socially disadvantaged groups

Answer 175

- claims his gluttony 'kills every year' - physicians encourage Cornaro to diet was certainly ill with many of the diseases attributed to obesity in the Galenic tradition: “I had pains in the stomach, frequent pains in the side, symptoms of gout, and, still worse, a low fever that was almost continuous; but I suffered especially from disorder of the stomach, and from an unquenchable thirst.”3 But he also lost his ability to reject temp- tation, having become addicted to eating and drinking.

Answer 176

-S. Sanctorius (1561-1636): weigh body to promote losing excess weight - 19th Century: Adolphe Quelet, ‘l’homme moyen’—average man—by the mean values of measured variables having a normal distribution! - Keys proposed in this 1972 article that the index devised by Quetelet, the ratio of weight over height squared, now be called the ‘body mass index’ (BMI)

Answer 177

He maintained that obesity was ‘ugly but does not itself cause CHD’,12 and was not necessarily dangerous for mortality risk in the average working man in the traditional populations we studied in mid century - Writing around 1949-1950, aware of potential for obesity epidemic in affluent societies

Answer 178

In his 1897 book, The Female Offender, author Cesare Lombroso “This greater weight among prostitutes is confirmed by the notorious fact of the obesity of those who grow old in their vile trade, and who gradually become positive monsters of adipose tissue.”

Answer 179

“Obesity always carries with it physical and often mental weakness…”

Answer 180

“Clearly, although the strength of these three reform movements and the personnel involved differed across issues, temporal periods, and locales, they were part of a larger Protestant-infused ‘clean living’ movement that ascribed moral value to self-restraint and self-regulation, and condemned ‘pathological’ excess.”

Answer 181

Obesity is not just a health risk but a disease. Estimates of the genetic contribution to weight gain in susceptible families range from 25—40% Obviously there is a major environmental effect but this genetic susceptibility alone removes this condition from a social stigma to the disease category Mortality rates affected, link with CHD Associated with 45 diseases inc. gout, several cancers, heart disease, t2 diabetes

Answer 182

- Many cannot easily return/shift to a healthy weight - For many the transition to being obese is very slow, over several years - Many go through cycles, returning to a healthy weight before relapsing into obesity again - Most effectively managed not just with intervention but with management: pharmaceutical, surgical, lifestyle changes

Answer 183

- Probably 30-40% hereditability - 'Clearly, genetic shifts represent an implausible argument for the recent dramatic surge in the prevelance of obesity. Lifestyle factors such as overconsumption of energy and decreases in physical activity offer more reasonable explanations.' - food intake, esp. high fat, does contribute - plentiful energy-dense food

Answer 184

It is concluded that most of the concepts which are the basis for research in obesity had their origin in the 19th century and often earlier.

Answer 185

Obesity has existed ever since civilisation has been recorded. - The Venus of Hohle Fels, a crude statuette of a naked obese woman, is estimated to be 35 000 years old in 500 bc, the ancient Indian surgeon Sushruta described “obesity, voracity, gloss of the body, increased soporific tendency and inclination for lounging in bed or on cushion” Avicenna, the great Persian physician, prescribed an appetite suppressant for his obese patients Hippocrates said, “Men who are constitutionally very fat are more likely to die quickly than those who are thin.” Galen of Pergamon, physician to several Roman Emperors, described the polysarkos phenotype, who “cannot walk without sweating, cannot reach when sitting at the table because of the mass of his stomach, cannot breathe easily, cannot give birth, cannot clean himself”

Answer 186

Jean Anthelme Brillat-Savarin (1755–1826), The Physiology of Taste or, Meditations on Transcendental Gastronomy (1825) “(Obesity) is not actually a disease, it is at least a most unpleasant state of ill health, and one into which we almost always fall because of our own fault.”

Answer 187

- Railway spine: paralysis, headaches, other ailments, following traumatic high-speed rail crash - First materialistic (spine) - Psychological (hysteria/neurasthenia) Erichsen (1866): 'concussion of the spine': must be organic disturbance, as 'couldn't fathom' that men could fall victim to hysteria, too. Jean-Martin Charcot and Herbert Page, insisted that some symptoms could be caused by hysteria (now known as conversion disorder).

Answer 188

assumed to across cultures and time by Diagnosis and Statistics Manual (DSM, US), WHO

Answer 189

While historically there is considerable evidence of physical and psychological reactions to terrifying events in the medical and non-medical literature, most of these reports point to symptom complexes which are not co-terminus with the defined symptoms of PTSD US Civil War: 'soldiers heart' (withdrawn) WW1: 'shell shock' (nerve damage, organic) --> the symptoms of these military syndromes were simply not the same as those of PTSD

Answer 190

- Tested cases of disordered action of the heart/shellshock/psychoneurosis from Boer to Persian Gulf - Had to accommodate for changing language (eg 'flashback' wasn't a word in WW2, so included 'visual hallucinations instead) --> - Although we did find cases from the First and Second World Wars which would meet today’s criteria for PTSD, their incidence was significantly lower than for the Gulf conflict. Previous historical investigations have relied on single case studies to make the point that PTSD is a timeless disorder. However, such studies lack a denominator and are instead based on an active search through historical literature for descriptions that resemble modern formulations of PTSD, while presumably discarding presentations that appear different. ------> Our findings imply that the psychopathology of trauma is not static and that culture has an impact on the expression of distressing memories. There is no single way for human beings to respond to the terrifying events of war, and the concept of a ‘universal trauma reaction’ appears flawed. We suggest that PTSD is one more phase in the continually evolving picture of human reaction to adversity (Young, 1995)

Answer 191

'Do you hold your breath when a man looks at you? 'You'll be in better shape all round if you lose a few pounds. And you'll feel better, too.' Is your body coming between you and the opposite sex?

Answer 192

George Cheyne, The English Malady (1733). Immoderate and luxurious modern lifestyle was bad for health. Advocate of vegetarianism. Diseases of Modern Life, B. W. Richardson, 1876 'Diseases from Worry and Mental Strain...Influence of the Passions...Impurity of Air' Discusses dangers of smoking for changes to the blood, but denies smoking causes cancer as 'Cancer was present for ages before tobacco was introduced as a luxury'

Answer 193

Smoking does not cause cancer: 'Cancer was present for ages before tobacco was introduced as a luxury' -- Disease is not 'modern', but new causes are modern: entertains the idea that cancer may 'excite, locally...the disease cancer?'

Answer 194

Systematic gradualism was a strategy particularly important in the 1950s and 1960s when smoking as an activity was deeply embedded in society, in cultural and social practices Coercive permissiveness, on the other hand, was the strategy which emerged in the 1960s and 1970s and grew in importance for public health both nationally and internationally as the cultural significance of smoking began to wane. It argued for individual self‐determination—but within a framework of behaviour increasingly defined by the state.

Answer 195

The main period of concern came in the early 1900s when a number of anti‐smoking organizations were founded to oppose smoking in children. British Lads Anti‐Smoking Union Work linking Smoking to Cancer in US/Germany BUT In Britain in these interwar years, there was little connection between formal public health and opposition to smoking...MoHs worked to contain infectious disease, ....Changing individual habits like smoking were not part of this mindset at all. Later banned advertising on TV in 1965 Public smoking ban in 2005

Answer 196

This grim conclusion may surprise you, but 18 studies reported during the past 16 years, covering 800,000 people overall, back it up. In 2010, for example, the journal Circulation published an investigation following 8,800 adults for seven years. Those who sat for more than four hours a day while watching television had a 46 percent increase in deaths from any cause when compared with people who sat in front of the tube for less than two hours. https://www.scientificamerican.com/article/killer-chairs-how-desk-jobs-ruin-your-health/

Answer 197

Smoking, it argued, was not a ‘disease’ in the way cancer, or indeed infectious disease was. It might lead to disease, but not for many years. The notion of long‐term ‘risk’, as we have seen, was not yet central to public health in the 1950s.

Answer 198

The obesity epidemic in the United Kingdom is out of control, and none of the measures being undertaken show signs of halting the problem, let alone reversing the trend. The United States is about 10 years ahead in terms of its obesity problem, and it has an epidemic of type 2 diabetes with obesity levels that are rocketing. Obesity is a global problem—levels are rising all over the world

Answer 199

global problem—levels are rising allvover the world. Moreover, certain ethnic groups seem to be more sensitive than others to the adverse metabolic effects of obesity. For example, high levels of diabetes and related diseases are found in South Asian and Arab populations

Answer 200

Every year obesity costs the UK economy £3.5bn (€5.1bn, $6.4bn), and results in 30 000 deaths;18 million days of work taken off for sickness each year Strategies for primary care that encourage primary prevention of chronic disease, including obesity management, would achieve considerable financial rewards

Answer 201

More than 250 years ago, Giovanni Battista Morgagni used surgical dissection to show visceral fat. He linked its presence to hypertension, hyperuricaemia, and atherosclerosis

Answer 202

the National Association to Advance Fat Acceptance (est 1969)