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In this video I'm going to talk about two diseases, leprosy and tuberculosis,

that are important to understand when you think about control measures and

legal procedures that occur with infectious diseases.

Starting with tuberculosis.

Tuberculosis used to be the number one infectious disease killer in the world.

It's now been out paced by HIV, but

it still infects one third of the world's population.

It used to go by the name consumption because it actually consumed people.

People became very, very skinny,

they had a lot of weight loss, and other symptoms would be fever, coughing,

coughing of blood, night sweats and like I said, weight loss.

And sometimes they would have real cavities in their lungs

that would erode into a blood vessel, and

people would, would cough up copious amounts of blood and die that way.

It was a, it's a progressive chronic disease.

People get infected unknowingly, and for 90% of the people,

they never have any problems with this.

They may have, you may have had a skin test for, for

tuberculosis that may be positive, and 90% of those people with positive TB exposure

don't actually develop symptoms of the disease.

However, 10% do, and it's those people that we're talking about.

Disease ha, this disease has a very storied history.

A lot of famous people died of tuberculosis or had tuberculosis,

and actually was considered to be kind of cool to have tuberculosis in earlier eras.

So people like Doc Holliday,

the famous gunslinger in the wild west, he was a dentist who also had tuberculosis.

The poet, John Keats.

Think about the, the operas, La Boheme, La Traviata.

They both focus of tuberculosis.

So this was a disease that really made its mark on human history.

There was no real treatment for it.

People did a lot of things, bloodletting, and all of the stuff that we talked

about earlier, but what people started to think might work was sanatoriums,

getting fresh mountain air.

There's a famous book called The Magic Mountain,

about a sanatorium in, in Europe, where people went to heal from tuberculosis.

But that really didn't do anything either, but

it did create a big culture sanatoriums.

There's a very famous one in the United States called Saranac Lake.

What really changed tuberculosis was improvements in hygiene, sanitation and

nutrition, along with the discovery of antibiotics that could cure it, and

that happened in the 1940s or so, and we really have seen a massive tapering off of

tuberculosis cases in the developed world because of that.

However, those gains are threatened because of the fact that there is

multi-drug resistant and extensively drug resistant tuberculosis, and

the HIV epidemic, which makes people much more likely to develop active tuberculosis

than if they don't have HIV.

In the United States,

we're pretty much at our lowest level right now of tuberculosis.

We have less than 10,000 cases, and

65% of those cases are in people that were born in foreign countries.

So this isn't something that is on everybody's doorstep, but

it is something that we have to think about.

The other thing is, tuberculosis is spread through the airborne route, so

when people are diagnosed with active tuberculosis and refuse to take treatment,

or are contagious, they may be subject to quarantine orders.

There often are quarantine orders issued for tuberculosis patients.

In 2000, in the, in the 2000s, there was a, a famous case

of a man named Andrew Speaker who flew on an airplane with possible multi-drug

resistant tuberculosis in which the president had to sign a quarantine order.

So tuberculous really forms a basis for

a lot of our public health protective legal actions.

The next disease I'm going to talk about, and

it's related to tuberculous because it's in the same bacterial family, is leprosy.

We don't usually use the leprosy any more because of the stigma associated with it.

It's called Hanson's disease now.

This, this thing really was outrageous when you think of it in modern terms.

Le, leprosy has a history that dates all the way back to the Bible,

where you see references to leprosy there.

It's something that's been with the human race for a very long, very long time, and

what it is, is a progressive infection of the nerves in your skin.

People will have areas of their body where they can't feel anything, and eventually,

sometimes people can have limbs that are affected, where things amputate and

come off, and that's kind of the, the most gruesome features of, of leprosy,

is that some people do have parts of their body fall off.

You know, people were so scared of lepers that they used to have them wear

bells around their necks so that people could tell that they were coming.

But what we really found out is leprosy is not that contagious of a disease.

It is spread through respir, contact with people's respiratory secretions in close

contact, but it's really not everybody that can get, get leprosy,

only about 95% of the human population is actually susceptible to leprosy.

Another interesting fact about leprosy is that its natural host is an arma,

is armadillos.

So people who have armadillos as pets may have a risk of getting leprosy.

But in terms of the stigmatization, it really went to extremes.

So for example, in the state of Hawaii, or before it was a state, it was a kingdom.

They had a special island there called Molokai,

which was a leaper colony where people were exiled there for life for

a disease that really wasn't that contagious to others.

Some people weren't even actually diagnosed leprosy, and

people were left there to die.

But actually, eventually a thriving colony appeared there, and

lots of books have been read, written about it.

There's been a movie about it, a very famous saint called Father Damien was

canonized after working on, on that island.

Jack London went there and wrote stories.

So it became kind of a folklore, this this island.

The United on the continental United States, we had a, a,

a place called Carville in Louisiana, which was also a sanitarium

where a lot of research in leprosy still goes on in Louisiana now, but these,

these sanatoriums, these pest houses, where they are putting people with leprosy

really was the result of laws that allowed the government to do that for people.

And I think this is an important point, is that you have to make sure that your

remedy actually fits the contagiousness of the disease.

Is the risk of this disease spreading justify putting people on an island?

And the answer for leprosy was no.

And I think you have to a,

ask that question with any disease when you have a control measure in place.

Leprosy isn't gone from the United States, we still have about 200 cases per year,

and they're easily treatable with antibiotics, and

nobody needs to be quarantined or isolated, but

it is a disease that really made it's mark in, in public health law.

Thank you.

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Week 2 Video 6: Leprosy and Tuberculosis

流行病及其爆发

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