Download 医学史简论 （8） A Brief History of Medicine

医学史简论 （8）
A Brief History of Medicine
浙江大学医学院 余 海
Zhejiang University School of Medicine
人类与传染病的斗争(2)
Battles to Infectious
Diseases(2)
Infectious disease in Chinese Medicine



病：disease, illness, more individually
疾病预防：Disease prevention
疫：Epidemic, communicable disease, more
population based (瘟疫 plague)



防疫：Epidemic prevention
免疫：Immunity, Vaccination
疫苗：Vaccine
How did we win the battles

Identify the pathogens - Germ Theory

Effective therapy – Vaccine and Antibiotics

Prevention and control - Public Health System
Establishment of Germ Theory


De Contagione et Contagiosis Morbis (On
infection and infectious diseases,1546)
He proposed that epidemic diseases are
caused by transferable tiny particles or
"spores" that could transmit infection by
direct or indirect contact or even without
contact over long distances.
Girolamo Fracastoro
1478-1553
Establishment of Germ Theory
A Dutch cloth merchant used new method
for grinding and polishing tiny lenses of
great curvature which gave magnifications
up to 270 diameters
First to see and describe bacteria as
animalcules，
Leeuwenhoek
became the
pioneer of
microbiology
Antonie van Leeuwenhoek
1632-1723
Establishment of Germ Theory




Created germ theory of disease,
(germ theory vs miasma theory
and spontaneous generation)
Created the first vaccine for
rabies
Invented Pasteurizaion
Is regarded as one of the three
main founders of microbiology,
together with Ferdinand
Cohn and Robert Koch.
巴斯德 1822-1895
Louis Pasteur
Germ Theory vs Spontaneous Generation Theory
"Do not put forward anything that you cannot prove by experimentation"
swan-neck flask experiment
Establishment of Germ Theory
Heinrich Hermann Robert Koch
(1843-1910）
 German physician
 Isolating Bacillus anthracis (1877),
the Tuberculosis bacillus (1882)
and the Vibrio cholera (1883)
 Development of Koch’s postulates
 He was awarded the Nobel Prize
in Physiology or Medicine for his
tuberculosis findings in 1905.
Pure culture of
bacteria
Koch’s postulates
Koch’s postulates
Koch’s postulates
Discovery of Viruses
tobacco mosaic virus
tulips breaking virus
1619 (a morbid beauty)
Discovery of Viruses

Ивановсқий
(1864-1920),
The very first virus discovered is credited
to the St. Petersburg Academy of Science
on the 12th February 1892 by Dmitri
Iwanowsky a Russian botanist. While
studying mosiac tobacco disease, he
found that the agent causing the disease
was small enough for pass though
ceramic filter that are small enough to
trap all bacteria. This is generally
accepted as the beginning of Virology.
Discovery of Viruses

1898, Dutch scientist
Martinus Beijernick
confirmed Iwanowski's
results on tobacco mosaic
virus.

He developed with the
term "contagium vivum
fluidum" which means
Martinus Beijernick
(1851-1931)
“soluble living germ” as
first the idea of the virus.
Dimensions of viruses
about 20 nm to about 250nm in diameter
… just for comparison
Leukocyte
10 µm
… just for comparison
Leukocyte
Bacillus subtitlis
1 m
10 µm
… just for comparison
Leukocyte
Bacillus subtitlis
1 m
10 µm
Herpesvirus
Discovery of Viruses
TYMV (Tomato
yellow mosaic virus)



1898 German scientist
Loeffler and Frosch
discovered Foot-and-mouth
disease virus
TMV
（Tobacco
mosaic virus)
1911, Rous discovered Rous
sarcoma virus
1915-1917, Twort and
d’Herelle discovered
bacteriophage
phage
Shapes of Viruses
Spherical
Rod-shaped
Brick-shaped
Tadpole-shaped
Bullet-shaped
Filament
Bacteriophage
1
3
2
4
Bacteriophage
(Replication
of DNA virus ）
Influenza Virus
（Replication of RNA virus ）
HIV
（Replication of retrovirus)
Invention of Vaccine
In the 10th Century Chinese
invented variolation (blow the
scab of smallpox skin lesion)
In 1796 English doctor Edward
Jenner invented cowpox vaccine
against human smallpox
Invention of vaccines
Chicken cholera bacteria
placed
1880,Pasteur first invented
chicken cholera live
attenuated vaccine
Development of vaccines
1881, Pasteur
developed anthrax
vaccines, which were
based on live-attenuated
cultures of Bacillus
anthracis and effectively
protected livestock from
the disease
anthrax
Live-attenuated anthrax vaccine
Invention of rabies vaccine
Negri body
Rabies virus
545
Rabies vaccine was first used on 9-year
old Joseph Meister, on July 6, 1885
Invention of vaccines
Diphtheria antitoxin
At that time in Germany alone 50,000 children
died from diphtheria every year.
1891 Von Behring cured first case of diphtheria
with antitoxin, thousands of life have been saved
since he developed
serum therapy
Diphtheria toxin
and antitoxin
Diphtheria antitoxin
•Roux and Yersini
discovered diphtheria
toxin which is responsible
for the symptoms of the
disease
•Von Behring and his coworker Kitasato
discovered the diphtheria
antitoxin which lay
foundation of serum
therapy
北里柴三郎
Kitasato Shibasaburo
1852-1931
Emil Adolf von Behring
1854－1917
Tetanus antitoxin


With the same principle Von
Behring and Kitasato developed
tetanus antitoxin
Von Behring won the first Nobel
Prize in Physiology or Medicine
in 1901 for developing
serum therapy against
diphtheria and tetanus
opisthotonus
角弓反张
dorsal， ventral
Poliomyelitis (infantile paralysis)
＆ Poliovirus
Poliomyelitis
18th Dynasty (1580-1350 BC)
Equinus clubfoot
Three American scientist
John Enders, Thomas
Weller and Frederick
Robbins discovered
method to culture polio
virus using non-nervous
tissue, they won Nobel
Prize in 1954
Jonas Salk
invented live polio
vaccine in 1954
Franklin Roosevelt
himself was a victim of
polio, launched the March
of Dimes to raise the
National fund for polio
prevention in 1938
Albert Sabin
invented oral liveattenuated
vaccine (pills)
Chemotherapy for Syphilis
Before chemotherapy
introduced, mercury used
be the only cure for
syphilis, but the harm of
mercury poisoning is more
serious than the disease
itself
A night in the arms of
Venus leads to a lifetime
on Mercury
风流一夜情 水银伴终生
Treponema pallidum
Chemotherapy for Syphilis

Paul Ehrich intended to find the magic bullet
against microorganism from chemical dyes

In 1909 he and his student Hata Sahachiro
(秦佐八郎） developed a arsenical
compounds Salvarsan (Arsphenamine ，606
）, which is effective against syphilis

Ehrlich received the Nobel Prize for
Medicine together with Mechnikov in 1908
Paul Ehrlich(1854－1915)
and Hata Sahachiro
Discovery of antibiotics and the therapeutic
revolution


Domagk found f red dye
Prontosil and its derivant
sulfonamide to be effective
against streptococcus, and
treated his own daughter
Alice with it, saving her the
amputation of an arm.
Prontosil became the first
commercially available
antibacterial agent
Gerhard Domagk
1895-1964
Discovery of antibiotics and the therapeutic
revolution


Afterward a series of
sulfonamides were synthesized
and sulfonamides became a
revolutionary weapon at the
time, but were later replaced by
penicillin
Domagk received the
1939 Nobel Prize in Physiology
or Medicine
Discovery of antibiotics and the therapeutic
revolution

Flaming discovered
the antibiotic
penicillin from the
fungus Penicillium
notatum in 1928, and
published in 1928
Alexander Flaming
1881-1955
staphylococci
Sir Alexander Fleming Twice Saved Churchill's Life
(A false story)
Discovery of antibiotics and the
therapeutic revolution




1939, biochemist Ernst Chain (1906-1979）and pathologist
Howard Florey (1898-1968） took up researching and mass
producing it with funds from the U.S and British governments.
They started mass production after the bombing of Pearl
Harbor. When D-day arrived they had made enough penicillin
to treat all the wounded allied forces.
Feb 12,1941, penicilline was first applied clinically
Penicillin was referred as one of three major invents during
the World War II (Atom bomb, Radar and Penicillin)
抗菌素的发现－治疗学的革命
Discovery of antibiotics and the
therapeutic revolution



Waksman performing research in soil bacteriology in Rutgers
University
Waksman and his team discovered
several antibiotics, including actinomycin
clavacin, streptomycin, neomycin and others.
Of these streptomycin was the first
antibiotic that could be used to cure
the disease tuberculosis
(1943)
Selman Waksman
1888-1973
Dispute about discovery

The details and credit for the discovery of its use as
the antibiotic streptomycin were strongly contested
by one of Waksman's graduate students, Albert
Schatz, and resulted in litigation. The litigation ended
with a substantial settlement for Schatz and the
official decision that Waksman and Schatz would be
considered co-discoverers of streptomycin. Schatz
made the discovery while working in Waksman's
basement lab, and using Waksman's equipment
Discovery of antibiotics and the
therapeutic revolution


After the discovery of penicillin and streptomycin,
more antibiotics were isolated from the soil,
upon 1960s more than 600 antibiotics were
available in practice
Thanks of discovery and application of antibiotics
severe bacterial infection has no longer a
incurable disease and the average life expectancy
increased by 10 year leading to the therapeutic
revolution.。
Public Health System





Early religions attempted to regulate behavior that
specifically related to health, from types of food eaten, to
regulating certain indulgent behaviors, such as
drinking alcohol or sexual relations.
Rome：water supply and sewage system, public bath and
public toilet
After plague outbreak in Middle Ages: clearance,
sanitation, removing bodies of the dead, burning parts of
the city and quarantine system
1848 passed British Public Health Act
1946 CDC was founded in US (Communicable Disease
Center-1980 Centers of Disease Control)
August 1854 cholera outbreak
in London Soho, 140,000
infected and 618 died. John
Snow surveyed the cause and
transmission of the disease
Public Health System



An English social reformer, noted for his
work to reform the Poor Laws and improve
sanitary conditions and public health
1842, Chadwick proposed 'Report into the
Sanitary Conditions of the Labouring
Population of Great Britain'
1848 British parliament passed the British
Public Health Act

People found him rude and dictatorial. Some
said that they would rather take their chance
with cholera than be told what to do by
Chadwick!
Sir Edwin Chadwick
1800-1890
Public Health System

Public health is “the science and art of preventing disease,
prolonging life and promoting health through the
organized efforts and informed choices of society,
organizations, public and private, communities and
individuals.” (1920, C. E.A. Winslow)

The goal of public health is to improve lives through the
prevention and treatment of disease. The WHO defines
health as "a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity."
Functions of Public Health






Prevention of infectious diseases and other diseases through primary,
secondary, tertiary prevention
Changing health behavior, improving diet and nutrition through health
education and health promotion
Improving environment including living environment and occupational
environment
Reproduction health
Epidemilogical survey, disease surveillance, statistics, research and
education
Changing the Leading Causes of Death
Leading causes of death in US: comparison of 1990
and 1997 1990年和1997年美国主要死因比较
Public Health System
婴幼儿死亡率
平均期望寿命
再
见 The End