Lecture No.

Etiology of Disease

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 Aetiology of Disease

Supernatural Natural
Sin Genes
Witches/Wizards Environment
Evil eye Genes + Environment
Magic (ECOGENETICS)

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Historical relationship between the hypothetical causes of diseases and the
dependence on techniques for their elucidation

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 Etiology of Diseases
In early 18th century Europe, excess was the
foundation of disease
Drunkenness Intemperance
Gluttony Luxury
Indulgence Debauchery
Dissipation Vicious habits
Solitary vice Excessive venereal indulgence
Lustful excesses Indolence
Sloth Envy
Jealousy Anger
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200 years ago Medicine was a blend of
Myth, Superstition, Art and Science

Today, it is overwhelmingly a scientific

extension of 20th century technology

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 Etiology of Diseases - scientific
• Natural
- depend on forces of nature not
transgression of moral / social norms
• Universal
- same cause is common to every
instance of the disease

• Necessary
- disease does not occur in the absence
of its cause

- Koch’s postulates, 1901 6

Disease result from:
• Genetic make-up
• Environment
• Genetics & Environment
(Ecogenetics)

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 Nature and Nurture

Genes author, environment edits

Genes propose, environment disposes.

- Toby

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 Causes of Cell Injury
• Genetic Derangement
• Environmental agents
- Physical agents
- Chemical agents and drugs
- Infectious agents
- Nutritional Inbalances
- Ischemia/Hypoxia
- Immunological reactions
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- Inflammatory responses
Idiopathic
- unknown
- cryptogenic
Examples: Sarcoidosis
Crohn’s disease

Number diminishing with increasing insight into

disease causation through molecular genetics.
e.g. Dilated cardiomyopathy results from selective
loss of dystrophin from cardiac muscle 10
• Genetic derangement
 Genes direct protein production
 Protein molecules control
i. cell function
ii. cell structure
Diseases result from:
i. alteration of cell structure
ii. disturbance of cell function
Genetic mutation  altered protein  abnormal
function  DISEASE
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e.g HbS, haemochromatosis
 Causes of Cell Injury
Environmental Agents
Physical Agents
- Abrasions, lacerations
- High velocity injuries, bullets, road
traffic accidents
- High altitude injuries, oedema,
mountain sickness
- Extremes of temperature, burns,
sunstroke, frost-bite
- Outdoor exposure
- Radiation exposure, skin cancers
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Chemical Agents and Drugs:
- Acid burns and strictures
- Alcohol related diseases
- Drugs e.g. diuretics
- biochemical abnormalities – glucose, lipids
- rarely pancreatitis
- Environmental toxins
- pesticides, herbicides, fertilizers
- cyanide, CO
- heavy metals, Pb, arsenic, Cd
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BMJ 2006; 332:1294 (3 June)
News extra

More than 100,000 Europeans die

prematurely each year from
drinking, report warns

Alcohol is responsible for the premature

deaths of 115,000 Europeans every year - - -
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Infectious Agents:
- Prion disease
- Viruses e.g. HIV & AIDS, Polio
- Rickettsiae e.g epidemic typhus (louse borne)
- Bacteria e.g. boils, TB
- Fungi e.g. candidiasis
- Protozoa e.g. malaria, toxoplasmosis
- Parasites e.g. schistosomiasis, filariasis

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Nutritional Imbalances:
- Obesity
- Starvation
- Protein-calorie Imbalance
- Kwashiorkor
- Vitamin deficiencies

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Ischaemia / Hypoxia
- Atherosclerosis
CVS
- Hypertension

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Immunological reactions:
- Immuno-deficiencies
- Allergy and other hypersensitivity reactions,
asthma, penicillin, eczema
- Hashimoto’s disease
- Transplant rejections

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The man allergic to money

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Inflammatory responses:
- The enemy within
- Inseparable from immunological reactions
- Basis of ‘rheumatic’ diseases

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Age and Disease prevalence 21
Ecogenetics  Genetics + Environment

Epidemics - selective injury / death

e.g Plasmodium vivx malaria and Duffy
antigen
HIV
Malignant mesothelioma

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Examples of iatrogenic diseases

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Life style in the Computer Age:
- Watching TV
- Over-nutrition, fast foods
- Inactivity
- Recreational drugs
- Air-conditioning

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