Brief History of Travel Travel Medicine Peter Felkai MD ...soshungary.hu/wp-content/uploads/2016/03/TMhistbriefEN.pdf · of Travel Medicine Peter Felkai MD.PhD. associate professor

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Brief History Brief History

of Travel of Travel

MedicineMedicinePeter Felkai MD.PhD.

associate professorhead of department

Internal Medicine FacultyTravel Medicine

Faculty Group

dr. Peter Felkai: Travel Medicine

Travel Travel

Medicine Medicine ––

what is that ?what is that ?

In 1988 a new medical discipline In 1988 a new medical discipline

has appearedhas appeared

As far as the men has left the cave, their travel has

accompanied different kind of external harmnesses

-The weather and hostile environment

-The enemy and the wild animals

-The diseases in the strange country

-Illnesses related to the travel

...And the Philistines fought, and Israel was smitten, and they fled every man

into his tent: and there was a very great slaughter; for there fell of Israel thirty

thousand footmen... And the ark of God was taken.... When the Philistines took

the ark of God, they brought it into the house of Dagon, and set it by Dagon.

...But the hand of the LORD was heavy upon them of Ashdod, and

he destroyed them, and smote them with emerods, even Ashdod and the coasts thereof...

And it was so, that, after they had carried it about, the hand of the LORD was against the city with a very great destruction: and he

smote the men of the city, both small and great, and they had emerods in their secret parts...

1Samuel 5,1 – 6,1

Main forms of traveling from stone Main forms of traveling from stone age till the medieval agesage till the medieval ages

Building Building –– up commercial up commercial roadsroads

Military actionsMilitary actions

PilgrimagesPilgrimages

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It was said that Julius Caesar suffered from sea-sickness.

That’s why he ordered a day rest for the Army and the

horses after crossing the English Channel.

Dr. Felkai Péter: Utazási orvostan

The „Big Headache Mountain „The „Big Headache Mountain „

Kilik Kilik -- pass, pass, 4,824 m.4,824 m. Afganishtan.Afganishtan.

The Chinese were the first to document the effects of The Chinese were the first to document the effects of altitude, in a classic text, the altitude, in a classic text, the Ch'ien Han Shu,Ch'ien Han Shu, that that

describes the route between China and what is probably describes the route between China and what is probably

Afghanistan around 37Afghanistan around 37--32 BC:32 BC:

‘‘From Pe Shan...From Pe Shan...Again on passing the Again on passing the Great Headache Mountain, the Little Great Headache Mountain, the Little

Headache Mountain, the Red Land and Headache Mountain, the Red Land and the Fever Slope, the men's bodies the Fever Slope, the men's bodies

become feverish, they lose colour and become feverish, they lose colour and are attacked with headache and are attacked with headache and

vomiting; the asses and the cattle all vomiting; the asses and the cattle all being in like condition.‘being in like condition.‘**

*Marc Aurel Stein: Innermost Asia, detailed report of exploratio*Marc Aurel Stein: Innermost Asia, detailed report of explorations in Central Asia ns in Central Asia

etc. 1928, Vol.1 , Chapt.8: The search for the ancient Chinese hetc. 1928, Vol.1 , Chapt.8: The search for the ancient Chinese high roadsigh roads

Kohat – pass (2,500 m.), the „Little Snowy Mountain”

in Pakistan

FaFa--hien and the two others, proceeding southwards, crossed the hien and the two others, proceeding southwards, crossed the

Little Snowy mountains. On them the snow lies accumulated Little Snowy mountains. On them the snow lies accumulated

both winter and summer. On the north (side) of the mountains, both winter and summer. On the north (side) of the mountains,

in the shade, they suddenly encountered a cold wind which made in the shade, they suddenly encountered a cold wind which made

them shiver and become unable to speak. Hwuythem shiver and become unable to speak. Hwuy--ying could not ying could not

go any farther. A go any farther. A white froth came from his mouthwhite froth came from his mouth, and he said , and he said

to Fato Fa--hien, “I cannot live any longer. Do you immediately go hien, “I cannot live any longer. Do you immediately go

away, that we do not all die here;” and with these words he diedaway, that we do not all die here;” and with these words he died. .

FaFa--hien stroked the corpse, and cried out piteously, “Our hien stroked the corpse, and cried out piteously, “Our

original plan has failed;original plan has failed;——it is fate. What can we do?” Heit is fate. What can we do?” He thenthen

againagain exerted himselfexerted himself, and, and they succeeded in crossing to the they succeeded in crossing to the

southsouth ofof the rangethe range, and, and arrived in the kingdomarrived in the kingdom ofof LoLo--e. e.

FaFa TsienTsien:: DeahDeah ofof HwuyHwuy--king in theking in the „„little Snowylittle Snowy mountain” XIV.mountain” XIV. chapterchapter

The shivering, coldness, dyspnoe and finally the „white foam from the mouth” is an exact

description of the acute mountain sickness and its consequence, the high altitude pulmonary

oedema in Fa- Tsien book ( „Fa Tsien Record of His Travel”).

Forms of traveling in the Forms of traveling in the medieval ages till the medieval ages till the

industrial revolution yearsindustrial revolution years

Discoveries, colonisationDiscoveries, colonisation

Pleasure, leisure tripPleasure, leisure trip

BathingBathing

In the middle ages the great plaque pandemy In the middle ages the great plaque pandemy

killed the onekilled the one--third of inhabitants of Europethird of inhabitants of Europe


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The Venetian council ordered the arriving ships for waiting outside the lagunas for 40 days - quaranta giorni . The island of Lazzaretto Vecchio was the decided place for that, where the old plaque-hospital and the cloister was found.

dr. Felkai Péter: Az utazási orvostan rövid története

2. A karanténok története



Peter Felkai: History of Travel Medicine

„ April 14th.

I am so sea-sick, that I cannot

write another line; except, to

say--God Almighty bless you,

my dearest beloved Emma!

prays, ever,

your faithful

NELSON & BRONTE.*”


*Letter XLI. April 14th. The Letters of Lord Nelson to Lady Hamilton, Vol II. With A

Supplement Of Interesting Letters By Distinguished Characters, 1814, Smithfield

Edward Jenner (1749 –

1823) English surgeon,

the discoverer of the

vaccination and methods

In 1797, Jenner informally submitted to the Royal Society a brief paper describing his experiment, along with an account of the traditional folk wisdom of cowpox's preventative powers. It was returned to him with the hint that if he valued the scientific reputation he had established, he should not argue for his idea on the basis of one experiment.


In December, 1931 Mr.

Churchill paid a visit in

New York. Due to the

English „tradition” he took

off the taxi cab on the

LEFT side. He listened

only to the right , and a

taxi cab, was coming from

left, hit him.

He suffered head-injury,

and multiple rib-fracture

moreover – as a

complication - he got a

pleuritis, eitherDr. Felkai Péter: Utazási orvostan

Churchill returns to England. He is heavily smoking his cigar, Churchill returns to England. He is heavily smoking his cigar,

contrary to his pleuritiscontrary to his pleuritisDr. Felkai Péter: Utazási orvostan

The modern forms of The modern forms of traveling 1.traveling 1.

Mass Mass –– tourism, tourism, tourist industrytourist industry

Business tourismBusiness tourism

Expatriots, guest Expatriots, guest ––workersworkers

Refugees, migrantsRefugees, migrants

Visiting friend and Visiting friend and relatives (VFR)relatives (VFR)

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The modern forms of traveling 2.The modern forms of traveling 2.

Humanitarian aid Humanitarian aid and missionsand missions

Adventure travel, Adventure travel, recreational recreational sportssports

The recent form of travelling 3.The recent form of travelling 3.

Trafficking, international prostitutionTrafficking, international prostitutionDr. Felkai Péter: Utazási orvostan

1492 Kolombusz crossed the Ocean 10 weeks

1838 Sirius, the first steam-engined ship sailed to

America 18 days

1920 Lindbergh flew over the Ocean 33 hours 30 minutes

1946 Super Constellation, the first scheduled

transatlantic flight 12 hours

1958 Comet, the first jet-engined commercial

airplane - flight 7 hours

1969 Concorde supersonic commercial 3 hours 32 min.dr. Peter Felkai: Travel Medicine

The The ttravel ravel -- iindustrial ndustrial rrevolution had a evolution had a

profound effect on profound effect on travel medicine travel medicine in in

Europe, Europe, and subsequently spread and subsequently spread

throughout eventually the worldthroughout eventually the world..


1990: RUNWAY MALARIA

1996: AIDS

2001: SARS

2003: AVIAN FLU

2009: SWINE FLU

2010: H1N1

2015: Ebola virus

In our ages new, travelIn our ages new, travel--related illnesses related illnesses

have appeared, which weren’t known have appeared, which weren’t known

before:before:

• jet – lag

• „economy class syndrome” ( DVT)

• high altitude sickness

• AIDS, SARS

• air- and space sickness

• „mal de ski”

• Traveler’s psychosis

• traveler’s diarrhoea


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The lowThe low--cost airlines and „last cost airlines and „last

minute” offers appeared. These minute” offers appeared. These

made the travel accesible even for made the travel accesible even for

the less wealthy people.the less wealthy people.Dr. Felkai Péter: Utazási orvostan


The travel business The travel business

developed the olddeveloped the old--

age people and the age people and the

pensioners, as a pensioners, as a

potential buyers of potential buyers of

the prethe pre-- and post and post

tourist seasons’ tourist seasons’

offeroffer

Because of the multiplying of the number Because of the multiplying of the number

of travels, and the cheaper forms of of travels, and the cheaper forms of

traveling respectively, three new and high traveling respectively, three new and high

risk groups have appeared:risk groups have appeared:

• family travelers

• young travelers („backpackers”)

• old age travelers


The traditional trias of the primary (biomedicinal)

profilaxis,

- the vaccination

- the chemoprofilaxis

- and the infectiological-based travel advice

has already unabled to prevent the whole spectrum of

peri-travel illnesses, accidents, neither their

therapeutical procedures, too.

„More travel advice and fewer vaccination More travel advice and fewer vaccination

needed”*needed”**Hoveyda N, Behrens R.: More travel advice and fewer vaccinations

are needed. BMJ. 2002 Aug 3;325(7358):260-4.Dr. Felkai Péter: Utazási orvostan

That’s why the westernThat’s why the western-- European European

travel medicine’s priorities have travel medicine’s priorities have

changed. The idea of „travel health” was changed. The idea of „travel health” was

replaced by the „travel medicine”.replaced by the „travel medicine”.

Travel health = prevention

Travel medicine = prevention and therapy*

*Steffen R.,Dupont H.L.: Travel medicine 2010 in: Dupont-Steffen ed.: Textbook of Travel

Medicine and Health, sec.ed.2001, 534 p.Dr. Felkai Péter: Utazási orvostan

The fourThe four--leave clover theoryleave clover theory•Prevention. Vaccinations, chemoprophylaxis and giving information.

•Wilderness medicine. Preparing travelers for extreme sports and adventure travel, and providing advice regarding the safety of the sports (especially for winter sports and diving) and the safety aspects of the equipment involved.

•Travel insurance medicine: Advising travelers about travelers' insurance. Policies have changed from the simple travel insurance into the modern assistance based travel

insurance (BBP). Travelers are made aware of the risks of activities, the benefits and costs of available insurance, and how

to file for claims when necessary.

•Assistance medicine. This deals with organizing medical

providers abroad for Hungarian travelers, managing repatriation processes, and treating travelers when they return home sick or injured.

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The fourThe four--leaved clover theoryleaved clover theory

TRAVEL

MEDICINE

assistance medicine

wilderness

medicinebiomedicinal

prevention

travel insurance

medicine

Belgyógyászat

Infektológia

Népegészségtan

Traumatology

Sport medicine

Toxicology

Internal medicine

Infectology

Public health-care

Insurance

medicine

Forensic

medicine

Emergency medicine

Intensive therary

Internal medicine

TRAVEL MEDICINETRAVEL MEDICINEThe four- leave clover theory of the travel medicine

Challenge of Space Challenge of Space AgeAge

Dr. Felkai Péter: Utazásorvostan

The space research business ( NASA, The space research business ( NASA,

Russian Federal Space Agency) has Russian Federal Space Agency) has

offered space visit for the civilians since offered space visit for the civilians since

2001. The fare of an extraterrestrial ride 2001. The fare of an extraterrestrial ride

costs 25 million US$. The seats has costs 25 million US$. The seats has

already fully booked...already fully booked...


The experience of space tourism was exhilarating. The experience of space tourism was exhilarating.

You could gobble like a pig and weight nothing...You could gobble like a pig and weight nothing...Dr. Felkai Péter: Utazási orvostan

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Returning from the MoonReturning from the Moon-- the the

cosmonauts was quarantined cosmonauts was quarantined

because of the possible because of the possible

extraterrestrial exposures, 1969extraterrestrial exposures, 1969






Perhaps travel cannot prevent bigotry, Perhaps travel cannot prevent bigotry,

but by demonstrating that all peoples but by demonstrating that all peoples

cry, laugh, eat, worry, and die, it can cry, laugh, eat, worry, and die, it can

introduce the idea that if we try and introduce the idea that if we try and

understand each other, we may even understand each other, we may even

become friends.become friends.””

Maya Angelou,„Wouldn't Take Nothing

for My Journey Now”

The number of The number of

travelers will be the travelers will be the

triple of the present triple of the present

figure (1,6 billion figure (1,6 billion

people)! Therefore people)! Therefore

the travel medicine the travel medicine

doctors will be doctors will be

never unemployed!never unemployed!

Thank you for your attention !

Documents

Brief History of Travel Travel Medicine Peter Felkai MD ...soshungary.hu/wp-content/uploads/2016/03/TMhistbriefEN.pdf · of Travel Medicine Peter Felkai MD.PhD. associate professor