Diseases old and new

This issue of Wellcome News looks at two diseases of contrasting provenance. Severe acute respiratory syndrome (SARS) is, in all probability, less than a year old (see the Nature as bioterrorist) article). Tuberculosis, by contrast, is at least several thousand years old, and was certainly known to people at the time of the pharaohs.

By a remarkable combined effort by scientists and doctors around the globe, it looks as if SARS may have been contained before it has had a chance to secure a toehold in human populations. No such luck with TB: estimates vary, but TB is thought to be the world's most common infectious single-celled organism, causing up to three millions deaths a year and with perhaps one in three of the world's population infected with the TB bacterium, Mycobacterium tuberculosis. M. tuberculosis is a devilishly difficult organism to deal with - hard to kill, and tricky even to detect.

The SARS outbreak is a salutary reminder of the scale and breadth of response needed to tackle a new threat to health. Epidemiology and molecular biology have been applied to understand where the virus came from and how it has spread. Many researchers are applying themselves to the development of diagnostics, drugs and vaccines. Like so much of modern life, health has become globalized - infectious agents recognize national boundaries even less than big business.

It was not always thus. For most of human history, medicine was a very local affair. How people went about staying healthy and treating illness, even how they viewed disease, varied considerably across cultures. Only in the past 150 years or so has Western medicine assumed its dominant status - such that it has been essentially Western paradigms that have driven the response to the SARS virus.

Henry Wellcome, founder of the Wellcome Trust, was fascinated by humankind's constant struggle for survival, the means adopted through different ages and by different cultures to preserve health. He wanted to understand and explain, and only by looking back, he maintained, could we make sense of the present and anticipate the future. To this end, he collected voraciously, with a vision of creating a vast 'Museum of Man'. Sadly, he never lived to see his vision realized - and in all probability it never could have been. To commemorate the 150th anniversary of his birth, 700 or so objects have been reassembled at the 'Medicine Man' exhibition at the British Museum.

Wellcome's approach may seem dated, but in many ways his views have considerable contemporary relevance. His collections strikingly illustrate how the medical has always been intimately immersed in a social and cultural milieu. Perhaps SARS is evidence of the growing hegemony of Western medicine, but when it comes to dealing with diseases that have become established, sensitivity to local beliefs, customs and perceptions is likely to remain an important aspect of their control. 'Medicine Man' is a timely reminder that the social roots of medicine can be very deep indeed.

The Editor

IMAGE CREDITS
All images, unless otherwise stated below, are from the Wellcome Trust's Medical Photographic Library. Historical images are from material held in the Wellcome Library for the History and Understanding of Medicine. Material can be viewed at the Wellcome Library or copies obtained through the Medical Photographic Library.

NEWS SECTION

•Funding review
Image: Front of the Wellcome Building at 183 Euston Road.

•Medicine Man exhibition
Image: One of the many exhibits at the Medicine Man in the British Museum.

•Malaria trial
Image: Mosquitoes transmit the spread of falciparum malaria, which kills over a million people each year.

ANALYSIS SECTION

•The new Medicine Man
Front image: Dr Mark Walport.
Back image: Front of the Wellcome Building at 183 Euston Road.

•Why fish?
Front image: Zebrafish.
Back image: Growth of nerve fibres in an early zebrafish embryo. S Wilson/MPL.

•Friends again
Front image: Dr Paul Barlow, guardian of a nuclear magnetic resonance (NMR) machine at Edinburgh.

•A life's work
Front image: Henry Wellcome.
Back image: One of the many exhibits at the Medicine Man in the British Museum.

•On the record
Front image: Professor Harold Garnett Callan, geneticist.

RESEARCH DIRECTIONS SECTION

•Nature as bioterrorist
Front image: Professor Stuart Siddell, University of Bristol.
Back image: SARS virus particles showing the distinctive crown or 'corona' of envelope proteins. Hazel Appleton, HPA

•TB or not TB?
Front image: Dr Ajit Lalvani examining ELISPOT results.
Back image: Results from the ELISPOT technique; each spot is the 'footprint' of an individual IFN-gamma-producing T cell.

•Supplementary evidence
Front image: Professor Lucilla Poston.
Back image: Many babies in intensive care are delivered early because of pre-eclampsia.

POLYPTYCH SECTION

•Fruity peccadilloes
Images: Male flies have a prominent structure in their abdomen, the muscle of Lawrence, which develops if the neuron (green) that innervates it expresses the male form of Fru. In females, there is no signal from the neuron and thinner muscle fibres develop.

•Gut reaction
Image: Professor Jenny Ames

•Rewriting history
Front image: John Waller, author and researcher.
Back image: Louis Pasteur.

•Cold cure
Image: Cold shower: a patient endures hydropathy in a lithograph by C Jacque from 1843.

•'Treat Yourself': the exhibition
Image: Exhibition publicity.

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Editorial
Editor: Ian Jones

Editorial Staff: Kathryn Merritt and Lucy Moore

Writers: Penny Bailey, Dr Shaun Griffin, Deirdre Janson-Smith, Dr Giles Newton

Online Editor: Paul Tam

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