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医学史简论 A Brief History of Medicine 余 海 Yu Hai [email protected] Why should we learn history The longer you look back, the further you can look forward --Winston Churchill 1944 以史为镜,可以知兴替 -唐太宗 Taking history as a mirror, one can draw lessons from raises and falls of powers - Li Shimin(First Emperor of Tang Dynasty) What is History of Medicine 什么是医学史 History of Medicine is an interdisciplinary study leading toward an understanding of the origination and development of medicine and influencing factors; and its impact on society and human being. About the course Elective:32 teaching hours,2 credit points Schedule: Lectures + discussion History of human diseases 6h Origin and history of medicine 18h Student presentation & discussion 6h Test:Essay writing Reference Books Roy Porter :The Cambridge History of Medicine Cambridge University Press 1996,2006 revised Kenneth F. Kiple: The Cambridge World History of Human Disease The Press Syndicate of the University of Cambridge 2003 Arturo Castiglioni:A History of Medicine (English translation), New York, J.Aronson 1975 11th Editions Frederick Cartwright & Michael Biddiss: Disease & History Sutton Publishing 2000 Internet www.nlm.nih.gov/hmd, www.historylearningsite.co.uk, en.wikipedia.org/wiki/History_of_medicine Time Schedule Week Date Time Contents 2 Mar 11 Mon pm Introduction, History of Disease (1) 2 Mar 15 Fri am History of Human Disease (2) 3 Mar 18 Mon pm Origin of Medicine 3 Mar22 Fri am Medicine in early civilization 4 Mar25 Mon pm Medicine in ancient Greek, Rome 4 Mar 29 Fri am Student presentation (1) 5 Apr1 Mon pm Student presentation (2) 5 Apr 7 Sun am Development of modern medicine(1) 6 Apr 8 Mon pm Development of modern medicine(2) 6 Apr 12 Fri am History of infectious diseases (1) 7 Apr 15 Mon pm History of infectious diseases (2) Notes Changed from Apr5 Fri for Qingming Festival Time Schedule (cont.) Week Date Time Contents 7 Mar 23 Fri am Development of diagnostic techniques 8 Mar 26 Mon pm Development of therapeutic Techniques Notes History of Human Disease 智人 直立人 能人 南方古猿 humanlike primates Australopithecine (hominid genus Australopithecus ) Human Evolution Human Evolution Since the first man emerges on the Earth,the man and its disease have been bonded inseparably. 人类疾病史 History of Human Diseases The history of mankind is the history of its diseases – Folke Henschen Since the first man emerges on the Earth, mankind and its disease have been bonded inseparably. What is disease 疾病 Disease (dis-ease) an impairment of the normal state of an organism that interrupts or modifies its vital functions. To cure sometimes, to relieve often, to comfort always -Edward Livingston Trudeau Smallpox 天花 天花病毒 poxviridae othopoxvirus Infectious disease caused by virus: Papule-vesicle-pustule-scar (pockmark) Retinoblastoma 视网膜母细胞瘤 Inherited disease caused by Rb(13q14)gene deletion (two alleles) History of human disease studies: The natural history of disease (emerge, develop, outbreak, attenuate, eliminate) and the intervention of human activities The geographical and historical distribution of human diseases The impact of human society on the development of disease, and in turns the impact of disease on the development of human society and human being itself Prehistorical Diseases Homo habilis “Lucy” of Ethiopia 3.4 M yrs Homo erectus “Turkana boy” of Kenya 1.65 M yrs Yaws, Treponema pallidum Osteosarcoma Prehistorical Diseases Related to gathering and hunting (hunter-gatherers): malnutrition parasitosis injury Disease in agricultural society Zoonosis (disease transmitted from animals to humans or from humans to nonhuman animals) Epidemic of infectious disease Digestive air Insects Domestication of animals Settle down and domestication of animals 人畜共患病 Zoonosis 42 50 65 26 35 46 Of the 1415 pathogens known to affect humans, 61% are zoonotic Paleopathology Ancient Egypt Mummy Pyramid Paleopathology Pharaoh Ramses V died in 1157 B.C from smallpox A louse found in a mummy of 3000 B.C 血吸虫病 Schistosomiasis Schistosoma heamatobium in Africa,Mideast S. Japonicum in China,Phillipines S.mansoni in Africa,Latin America 古病理学 Examining mummy with CT scanner Calcification in bladder caused by schistosomiasis Paleopathology Paleopathology Schistosoma eggs discovered in a body of preserved ancient lady’s body (in Changsha Mawangdui of Hunan Province, 165 BC) Autopsy also discovered coronary heart disease, biliary stones and eggs of other intestinal parasites. Paleopathology Schistosoma eggs were also found in another wellpreserved body (167 BC) in Jiangling of Hubei . He also suffered from cholecystitis, cholelithiasis, pleuritis, and eggs of whipworm, tape worm, and Clonorchis sinensis etc. Congestion of population, war and travelling result in outbreak and epidemics of infectious diseases Crusades Mid age Paris Silk road Black death (plague) in 14th century Outbreak of plague epidemic in Europe 1346-1353(黑死病, black death), more than 25 million people died and the population of Europe reduced by one third Caffa 流感暴发 The outbreak of influenza in 1918 Starting from Camp Funston, Kansas USA in spring of 1918 then spread worldwide, during 1918-1919 1 billion people (world population 1.7 b) infected and 25-40 million died, much more than killed in the 1st World War, incorrectly called “Spanish flu” (Triple Alliance, Triple Entente) Modern society : globalization leads to the speed of virus transmission spread as quick as that of the modern transportation (SARS 2003, N1H1 Flu 2009) •流行 Epidemics outbreak of infectious disease •大流行 Pandemics Epidemic spreading across a large region Disease in modern society 现代社会疾病 Demographic changes Political, economic, cultural and technical development in society Environmental changes Life style changes Medical technology Epidemilogical transition Disease profile of modern society Influencing factors to modern diseases Demographic:degeneration disease, chronic noncommunicable diseases Ecological and environmental:pollution and occupational diseases Dietary and life style:smoking, obesity, accident Stress and social pressure:depression and suicide Progress of medical technology: iatrogenic disease, brain death, vegetative state Life Expectancy at Birth Human by Era Average Life expectancy at Birth (y) Upper Paleolithic 33 Neolithic 20 Bronze Age 18 Classical Greece 20-30 Classical Rome 20-30 Pre-Columbian North America 25-35 Medieval Islamic Caliphate 35+ Medieval Britain 20-30 Early 20th Century 30-40 Current World Average(2008) 66.7 Japan 80.07 China (2010) 74.83, Zhejiang 77.29, Hangzhou 80.67(M78.63, F82.82) Ageing of population China: Life expectancy National 71.44 (2000) Zhejiang 77.29 (2010) Hangzhou 80.26 (2010,M77.98, F82.76) 社会老龄化的影响 Ageing of population World Life Expectancy US Life Expectancy 1990-2050 Life expectancy is the expected (in the statistical sense) number of years of life remaining at a given age. Ageing of population Leading causes of death in US: comparison of 1990 and 1997 World causes of death in 2000 Total death: 55,694,000 noncommunicable disease (59.0%) Communicable diseases, Malnutrition (31.9%) Injury (9.1%) 资料来源: 2001年世界卫生报告 Causes of death in different WHO regions: 2000 % Non-communicable 75 Injury 50 Communicable, malnutrition, perinatal 25 Africa Mid-East SE-Asia W-Pac America Euro 资料来源: 2001年世界卫生报告 Deaths, by broad group, 2000 World China 77.8% 58.9% Noncommunicable conditions (7 million) Noncommunicable conditions (33 million) 32.1% Communicable diseases (18 million) 11.1% 8.9% Injuries (5 million) 11.1% Communicable diseases (1 million) Injuries (1 million) Ecological damage-Global warming 生态破坏-全球变暖 Energy Consumption CO2 Emission Global Warming Greenhouse effect Ecological Damage Disease Epidemics Vector-borne infections Weather = Current state of the atmosphere Climate = average weather conditions* > 10 years The greenhouse effect Greenhouse gases: CO2 carbon dioxide CH4 methane O3 ozone N2O nitrous oxide H2O Incoming wavelength absorption < 0.3um Outgoing wavelength absorption > 0.7 – 30 um Impact of climate changes on health 40 year trend in dengue and temperature, Singapore Ecological damage-ozonosphere hole Ozonosphere absorb ultraviolet lights <300nm from solar radiation protecting living organisms in the earth from UV damage. Chlorofluorocarbons (CFCc) widely used for refrigerants and spray cause depletion of the atmospheric ozone layer by releasing free radical . Over exposure to UV may cause skin cancer, cataract,etc. Antarctic ozone hole Environmental Pollution – Minamata Disease(水俣病) Minamata (水俣) located in Kumamoto (熊本) Prefecture used be a beautiful fishing village Environmental Pollution Minamata Disease (Mercury poisoning) •Chisso (智索)Chemical Factory built in1925 used to produce fertilizer,started to manufacture choroethylene in 1949. Large amount mercury-containing catalyzer (methyl mercury) in waste water drained into the bay. •1956 cat chorea (舞蹈病)occurred in Minamata Bay area (“suicide cat”). Afterwards human patients presented the same symptoms: ataxia, numbness in the hands and feet, general muscle weakness, narrowing of the field of vision and damage to hearing and speech. In extreme cases, insanity, paralysis, coma and death follow within weeks of the onset of symptoms. •Total 2955 suffered the disease and 1784 died. Environmental Pollution –Minamata Disease Plankton-shellfishes-small fishes- big fishes-human cerebrum cerebella Environmental Pollution –Minamata Disease Life style related disease-smoking 吸烟 Columbus discovered the new continent and brought back the tobacco in 1492.For 500 year smoking has became the largest single risk factor threatening the health of population, particularly since the invent of cigarette in1881, Life style related disease-smoking Every year 3.5 million people die from smoking related disease in the world, the figure will reach to 10 million by 2030,if no effective actions are taken, the economy loses will be $200 billion , half in the low income countries. In China, 350m smokers, 1m died from smoking-related diseases Life style related disease-smoking Smoking-related diseases Life style related disease obesity and metabolic syndrome Causes: Inheritance dietary habit reduced physical activity Life style related disease obesity and metabolic syndrome Body mass index BMI=Kg/M2 WHO standard classification of obesity Normal BMI18.5-24.9 Overweight: 25.0-29.9 Obesity class I 30.0-34.9 Obesity class II 35.0-39.9 Obesity class III > 40 Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity- Heavy burden for the society Obesity: risk factor for various disorders 肥胖与代谢综合症 Surgical treatment of obesity Life style related disease-accident 25million people died from traffic accidents since Karl Benz invented the first car in 1885 About 500,000 people die from road accident every year in the world Death from road accident ranks 7 in China, 10 for the world, but it may become the 4th by 2030 Life style related disease-accident Five leading causes: drowning, traffic accident, poisoning, falling and suffocation Accident is the number one cause of death for children under 14 in China accounting for 26.1% of all death. It is estimated 40million children suffer from accident and 3.35 m hospitalized 0.4m disabled Stress from modern society - depression 现代社会的压力-抑郁症 WHO estimates: there are 120-200m people suffer from depression in the world, it would become the second leading cause of death or disability by 2020 The prevalence rate of depression is 6.1%~9.5% for life time,about 13%~20% has one or more depressive episodes or experiences in one’s life time Stress from modern society - depression Depression is a mental disorder characterized by a pervasive low mood, low selfesteem, and loss of interest or pleasure in normally enjoyable activities, sadness, unhappy thoughts, apathy, and dejection. Up to 60% of all people who commit suicide have depression or another mood disorder. Stress from modern society - depression Mikhail Sholokhov) Fajeyev Ernest Hemingway l899~1961 Gu Cheng Suicide rate in severe depression reaches 15%, writers or poets are a high-risk population for suicice Sanmao Kawabata Yasunari Iris Chang Xu Chi Stress from modern society - depression High risk populationentertainment circle 陈百强 李恩珠 倪敏然 陈宝莲 张国荣 Development of medical technology iatrogenic disease 医源性疾病 Deaf by toxicated by aminoglycoside antibiotic (streptomicine, neomycine Kanamycine, gentamycine, Kasugamyxine) account for 50% of acquired deaf 聋 Tetracycline teeth (enamel) Dance “Thousand-hand Goddess of Mercy Development of medical technology iatrogenic disease 医源性疾病 Thalisomide, a sedative produced by ChemieGruenenthal, Germany in 1957 for sick of pregnant women. Up to 1959 more than 1m took the drug, in 1960 phocomelia (birth defect) increased which was related to the drug use during the pregnancy of the mother The drug was banned in Nov 1961 but already 10000-12000 malformed infants born, 4000 died before 1y. phocomelia (海豹肢 Seal’s limb) Descriptive study Country Sold Thalidomide(kg) Cases of Phocomelia Austria 207 258 5769 140 60 8 26 349 25 11 37 113 30099 2 6 5000 Belgium UK Holland Norway Portugal Switzerland Germany Drug sold Eco-epidemiological study Number of phocomelia cases Case-control study History of drug use Mother of birth defect child Yes Control Total 34(68.0%) 2(2.2%) 36 No 16 88 104 Total 50 90 140 χ2=69.40, P<0.001, OR=93.5 Cohort study History Use at 8-10 week pregnancy Not use at early pregnancy Number with deformed infant Number without deformed infants 10 14 24 42 51 21,434 21,485 0.24 RR=175, AR=41.76% Total Incidence rate(%) Animal experiments and intervention Thalidomide induced limb defects in Rhesus monkey Thalidomide was banned in market in1961. Limb defect have become rare again since 1962 Lessons to be learnt After thalidomide events the congenital deformation monitoring system was established in many countries, and drug epidemiological studies, screening procedures the pharmaceutical manufacture and management strengthened Thalidomide: a tragicomedy integrin thalidomide DNA intercalation It was found in 1965 that thalidomide alleviated the skin symptom in leprous patients, and then found it was effective for tuberculosis, systemic lupus erythematosus (SLE), Kaposi’s sarcoma (HIV infection) Further researched revealed: the effect of thalidomide is associated with inhibition of TNF-α and anti angiogenesis No weal without woe. (Luck and Misfortune comes in turn.) 福兮祸所伏 , 祸兮福所倚 Chinese Aphorism 福兮祸所伏 , 祸兮福所 倚 -老子 Lao Tse Misfortune, that is where happiness depends ; happiness , that is where misfortune underlies. No weal without woe. Luck and misfortune comes in turn 有心栽花花不开,无心 插柳柳成荫 The flower that you spent time to care for does not grow, while the willow that you accidentally planted flourishes and gives shade. Watered flowers never bloom, but untended willows prosper. Follow love and it will flee; flee love and it will follow (thee). Summary • The origin of mankind and its disease came together • The development, spread and epidemic are the results of joint effects of natural environment and social environment, so there are unique disease profiles in certain historical era. • To study the history of disease may enhance our understanding on the natural law of disease development and is of value in heath policy making THANK YOU FOR YOUR ATTENTION Thanks