As we all know that Theodar Bilharz ,a German Physician, was the first who recovered Schistosoma haematobium flukes from a Egyptian peasant in Cairo (Kasr El
Aini) in 1851 and named the fluke as Distoma haematobium. Cobbold in 1859 tried
to create a new genus Bilharzia to honor
its discoverer but three months earlier Weinland (1858) had named it
Schistosoma (cleaved body) hence the parasite became S.haematobium.It is not only S.haematobium but two
other schistosomes i.e. S.mansoni and S.japonicum that were incriminated of
causing disease in human beings; while S.haematobium is responsible for bladder
disease and haematuria , the two later flukes affect digestive system of its
host leading to diarrhea ,dysentery , pot belly
The important question , I wish to
raise here is whether Theodar Bilharz incriminated bladder disease in the boy due
to Schistosoma or he merely described the fluke as his predecessors were doing
for other parasites ? In other words , when exactly we incriminated these parasites
for causing disease in man ? Answer of this question is important as this will
help in deciding when in reality we started believing germ theory of the
disease .
If we look back to the history of
medicine this was Luis Pasteur which established germ theory of the disease (puerperal
fever, pyogenic vibrio) by different experiments in 1880 though persons started
suspecting germ/worms responsible for the disease but only in nineteenth or
eighteenth century . Pasteur’s discovery was supported by the German
scientist Kock who prescribed certain postulates
for deciding a pathogen responsible for particular disease .
As regards to
animal parasites regarding them as pathogens, this was French doctor Alphanso Laveran who is
credited to discover a protozoan in 1880 which he named Laveran bodies (blood form of Plasmodium)
responsible for malaria disease. Our
present knowledge suggests this was only in eighteenth century when man started
suspecting germs responsible for disease and it will be erroneous to link
diseases with germs by persons of tenth
century or so and certainly wrong to
link it with persons living before Christ era or in our Vedic era .
Thus , it is interesting to imagine what may be the position of the
society in that period ; let us imagine what was the situation when three
important civilizations were emerging or might be at their peak – one was in Egypt, other in China and third
was in India or Bharat –this might be about 3000 to 5000 years back . At that time ,
there appears three important diseases that were affecting our large part of human civilization – these were small pox,
malaria and schistosomiasis. However, we must also remember that human living, social behavior, population per km of geography, animal contacts
were quite different in those days from present days . Similarly, the pathogens might be
different in dealing host parasite relationship ; all these factors , as we
know, influence the disease.
Small pox and malaria are the two
diseases which were pandemic in nature ,affecting human beings from all
continents. Though etiology of these two diseases could be confirmed much
later, yet persons started dealing these two diseases in their own way.
If we go back in prehistoric era, the
diseases were considered curse of the God ,witchcraft or influence of demons,
adverse astral influence or will of Gods – this is also reflected by general
saying in India for small pox “devi nikli hai “As per an estimate, small pox
appeared around 10,000 BC and obviously it was considered a great curse of God
for sins of man ; the cure of the diseases were in the hands of “Priests” which
were treating them with some rituals and magical substances. Later , they
started incorporating plants ,animal parts ( some civilizations are still using
wild animal parts for treating specific ailments) and minerals more often as
rituals and magical substances.
We should not forget that in Vedic
era, learning was restricted in India to
elite group and it was not wide spread as of present day. Mostly this was
either Brahmin or Cchatriya who were privileged group to assess literature. Notwithstanding
these facts, it became a common knowledge ,as early as 430 BC, that survivors
of small pox were protected from further exposures. With passage of time and long before 18th century man
was practicing “inoculation” method in India, Africa and China to protect himself from small pox ; in
‘inoculation’ method fresh matter from ripe pustule of smallpox
sufferer was transferred to a susceptible
man using a lancet (this was merely by scratching skin ). This inoculation method came to Europe in the
beginning of eighteenth century with the
arrival of travelers from Istanbul and termed as Variolation as in Europe,
smallpox was called “Variola” -derived from latin word “Varius” meaning stained
or varus means mark on skin . Jenner modified the method in 1796 by using cow
pox fluid to protect man against small pox- that is a well known history .
It is a general belief that the
inoculation method was evolved in India and as they were exchanging with Arabs for
trading different goods, the inoculation method was known to the Arabs from
where it passed to the Europe. There are many questions which remain to be investigated
like :
1.
Who
developed this inoculation method in India and when ? Whether it was an
institution like Takshila or Nalanda or some Gurukul or some one else ?
2.
Two
languages , Pali and Sanskrit were common in BC era and where we are getting
any reference pertaining to inoculation method ?
3.
What
was the primitive form of this method . Whether it was accidental , by coming
in contact with sufferer and realizing protection or intentionally developed
the method
4.
Whether
some copper or iron material was used for scratching the skin or it was
plane wood that was used for scratching ?
5.
It
is more likely that at the start the method might be compounded with some
religious rituals . If so, when these were cast off. Whether the persons
considered developing vesicles from within the body or some external source was
thought ever ?
6.
How
the method spread to general Indian population.
7.
How
the method got popularity in the traders ?
Just like small pox, the ancient persons discovered treatment of Malaria in the form of Cinchona bark much earlier than discovery of its etiological agent.
However, the case of schistosomiasis is much more interesting than these two diseases.No doubt, schistosomiasis is an important disease of human civilization and might be causing havoc in ancient population (as finding of schistosome eggs in Egyptian and Chinese mummies indicate ) but the prime question is whether they were knowing about this infection ; if so , when ? and by what name ? Since the name schistosomiasis or bilharziasis came in existence only in ninteenth century
By the present accounts , we may assume that schistosomiasis was influencing two
important civilizations- one was flourishing in Egypt, other ,in China.
Though S.indicum group of schistosomes was existing in the third important
civilization i.e. India there are no
records showing it affected human beings (Indians do not have custom of preserving dead bodies ) .
This S.indicum group of schistosomes
is quite different from the other two groups. Perhaps , two differences are
prominent. The first is that all the schistosomes of S.indicum group develop in
fresh water snails (Indoplanorbis exustus, Lymnaea luteola and Lymnaea
auricularia ) which are inhabiting water ponds, tanks but not in rivers . While,as common with ancient civilizations, Indian civilization developed around Indus river and later near river Ganga- both these rivers are devoid of snail hosts of the schistosomes. The
other difference is that all these blood flukes produce less number of eggs which are
directly related to the damages to the host. Moreover, the social behavior of the Indians also kept them apart from endemic environs.
In contrast, the other two
schistosomes require snail hosts which are developing in important rivers of
these two civilizations.
S.haematobium is developing in
Bulinus snail species which in habitats primarily the ‘Nile river” ; the whole
Egyptian civilization has developed in the Nile river valley and it was the
annual floods of the river which enriched their soil and helped in agriculture
cultivation. Obviously, the persons who are coming
more in contact with the river were more prone to the infection. We can
categorize the Egyptian population in two categories –one was the
Pharos or Royal family and other were peasants. The peasants were exposing
themselves more frequently with river water hence snails and cercariae ;
therefore, we may assume schistosomiasis might be more common in the peasants.
However, Pharos were also not completely protected to the infection as there were certain rituals where the members of
the Royal family have to take bath in Nile river. There is the history of child death in these royal families and it will be a matter of investigation how much schistosomiasis was responsible for complicating the cases or children death in Egypt. Another support that these Pharos were suffering from schistosomiasis has come by
observing calcified fluke eggs in the mummies of the twentieth dynasty.
Chinese civilization was also
struggling with another schistosome parasite –Schistosoma japonicum whose amphibian snails (Oncomelania ) were
inhabiting Yellow river which played a great role in China civilization. The
disease was existing in ancient times has revealed by finding calcified eggs in Chinese mummies .
Though both these civilizations might
be confronting with schistosomiasis, the symptoms might be quite different at
these two places. S.haematobium is attacking urinary system hence the main
symptoms would be haematuria, pain in urination. Whereas Chinese people might
be complaining diarrhea, dysentery , pot belly, as cites.
If we compare symptoms of
schistosomiasis with the former two infections, the symptoms were non-specific
in schistosomiasis. Another important
fact is that the main symptoms i.e. haematuria, diarrhea ,dysentery ,pot belly
etc are developing in man after about one month of coming in contact with the
cercariae. Therefore, it appears impossible to co-relate any schistosomiasis
symptoms of man with earlier contact with
river water. Moreover, the symptoms might be intermittent including fever hence
persons may not be sure of suffering from any disease.
This was not the case either with
small pox or malaria. Small pox caused the symptoms and lesions only once in
whole life and they were persistent either with cure of the disease or fatality
of the case. Malaria also had intermittent fever which continued for a long
time.
These facts suggest that our ancient
persons might have not paid any attention on schistosomiasis as they might have
failed to co-relate symptoms with any such disease. As such they were not aware about schistosomiasis at that time.
However, there is some literature which suggests that our ancient people in 400BCE or in 7th century were aware about schistosomiasis (though might be with some other name). To support my statement what I found is narrated below when I searched google to know schistosomiasis in ancient time :
1.Schistosomiasis in ancient time China
: This write up informs “ Ancient Chinese writings described schistosomiasis in
400 BCE a “water poison attacking man… like a poisonous insect but invisible “.
2. In 7th century it was
noted “ there is a water poison disease in streams contracted easily in spring
and autumn …. In water, there are minute invisible sand lice that penetrate
human skin when a man is bathing in streams….rash appears at the beginning in
the size of millet and is pricking upon touch… onset with chill ,headache and
orbit pain (Mao and Shao 1982 Schistosomiasis control in the Peoples republic
of China . American journal of tropical medicine and hygiene 31 : 92-96)
3. An article by Berry Caban CS 2007
Return of the God of plague; schistosomiasis in China. Journal of Tropical
Public Health 6 : 45-53 (schistosomiasis research group , University of
Cambridge) mentions “Symptoms of the
disease recognized for a long time " ( they do not mention the time when Chinese
started recognizing them) Subsequently
it is mentioned “schistosome eggs recovered from both Chinese and Egyptian
mummies in 1910 by Sir Armand Ruffer who found calcified eggs
in the kidney of two mummies of the twentieth dynasty “.
There is the need to verify whether
these statements in the articles have been made without searching the old
literature or are the results of deep investigation. These statements are made in twentieth century looking to our present
knowledge on schistosomiasis and tilting the facts with our imagination what
might be happening in ancient times. Otherwise, the statements raise many
interesting questions to be solved. This is because as per these papers man
became aware about ‘water poison’ or ‘
invisible poisonous insect’ inflicting body damage to humans as early as 400
BCE or in 7th century. This statement requires authenticated proof
when any civilization realized “ there are minute invisible sand lice that
penetrate human skin when a man is bathing in streams…and causes rashes ....”
For reaching to a correct conclusion,
it is essential to assess the original old manuscript of the two civilizations ; these manuscripts may be in different language and require an
expert interpretation. There are chances of seeing only a few manuscripts while
others might have destroyed . However, if we find the proof of above facts ,
then there is the need to revise the history of medicine where we are taught that
the ancient period i.e. 400 BCE has considered ailments as curse of the God.
This will also mean that germ theory of
disease might have evolved much earlier then what we are considering .
I will welcome opinion of others under comments of this blog and same will be published so that a holistic view may be developed on the topic.
--------------------------------------------------------------------------------------------------------------------------Even after lapse of 9 months of posting above information, i could not receive any comment or information that may enrich our knowledge on the subject. However, on 5th Feb 2016, our daily news paper "Dainik Bhaskar" published an article on page 8 providing past history of vaccination.
A French Scientist "Hanery Merry Huson" in his book "Discnair thes Sciences Medicals' ? (the article is in Hindi hence may be mistake in writing correctly name of source) has referred Ayurved book "Shakteya Grantham" where crest or scab of small pox affected person is taken, grinded in powder form and used like vaccine.
Perhaps Budha monks transmitted this knowledge to China in tenth century. References are available showing between 14th to 17th century this scab powder was used to protect persons from small pox but by inhalation method through nose.
Obviously, there is no authentic information as i have mentioned in my post. And if vaccine or crest powder was used as inhalation , it opens further queries- why this rout was used ? Whether this was also the rout used in India or some other way was employed ? The whole subject is still open for discussion ?
