Transcript 医学史简论 A Brief History of Medicine

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