SCHISTOSOMIASIS ,SMALL POX AND MALARIA IN ANCIENT TIMES

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 18^th 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 7^th 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 7^th 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 ?