Transcript 医学史简论 A Brief History of Medicine

医学史简论(2)
A Brief History of Medicine
Yu Hai
Zhejiang University School of Medicine
[email protected]
疾病改变历史，疾病改变人类
The history of mankind is the history of its
diseases
– Folke Henschen (1881-1977)
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Disease changes the human civilization and
human history
Disease changes human itself genetically
疾病对人类社会的影响
Impact of disease on the human society
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Fear, anxiety and panic results in social instability
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Population dramatically decreased, including the
elite groups of society
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Political turmoil, economic recession and social
development stagnated or went down
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Impact on the outcome of wars
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Enhance the development of public health and
medical sciences
The impact on population of disease
疾病对人类社会的影响
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From Zhou and Qin (1046-256 BC) to Ming and Qing
Dynasty (1368-1644) the Chinese population
fluctuated from 10 to 60 million, it did not reach 100
million till Qianlong Reign (1735-1795)of Qing
Dynasty
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Apart from war and famine the most influential factors
for population is the disease epidemics
2011.10. 31
7 billion
Trends of World Population
疾病 对文明进程的影响
Impact of disease on progress of civilization
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The golden ages of Greece
ended by plaques
in 430 BC Spartans （斯巴达人）
ravaged the surrounding
countryside of Athens, an epidemic
（smallpox？）struck the crowded
urban populace , killed thousands,
including General Pericles (伯里克
利 429 BC). Ended the Greek
golden age (338 BC Philip II of
Macedonia, 146 BC fell in Roman)
Pericles (495?-429) BC
疾病 对文明进程的影响
Impact of disease on progress of civilization
The decline and fall of Rome
Empire – impact of plagues
瘟疫导致罗马帝国的衰落
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166-180 AD “Plaque of Galen” (smallpox?)
two Roman emperors — Lucius Verus
(169BC) and Marcus Aurelius (180BC)
died from the epidemic, total death toll
reached to 4-5 million
211-266 AD second epidemics contributed
to final fall of Roman Empire in 476 AD
Marcus Aurelius 121-180
(Falciparum malaria)
Meditation
疾病 对文明进程的影响
Impact of disease on progress of civilization
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Since 16 century western
colonists started entering
the Africa, but the fatal
infectious disease stopped
them (white people’s tomb”)
The discovery of quinine let
Europeans managed to
colonize Africa
“Tropical disease”
Voyage of Columbus
Since 1492 Columbus discovered the
new continent, European colonists
brought disasters to native Americans
Columbus voyage 1492
疾病 对文明进程的影响-美洲文明
Ancient American civilization
Three civilizations
Maya （2500BC-8th century）
Aztec
Inca
Impact of Disease on civilization
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Spanish General Cortes
conquered Aztec in 15191521 (300+ smallpox vs 15
million）, The capital
Tenochtitlan fell, population of
Aztec dropped to 1million
Spanish conquest Pizarro
colonized Inca in 1553
resulting dramatically reduced
Incan population (200 vs 50,000)
Impact of Disease on Human Civilization
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1518 slave trade started，brought
infectious diseases previously not
existing in America (malaria, yellow fever)
and insects, resulting further decrease of
native population
Impact of Disease on Human Civilization
16th century
epidemics in America
1518-1529 smallpox
1530-1531 measles
1546 typhus
1558-1559 influenza
By the end of 16th century
the number of native
Americans reduced by
90-95%
Disease changed human itself－Evolution of
immune system
先天性免疫
Innate Immunity
Toll样受体
Toll-like Receptor, TLR
获得性免疫
Adaptive Immunity
树突状细胞
Dendritic Cell, DC
Disease changed human itself － Impact
on human genes
A
T
Gl
Val
Change of configuration
HbAHbA
HbAHbS
HbSHbS
 A A
 AS
SS
镰状红细胞贫血
Sickle cell anemia
Homozygote Heterozygote
Disease changed human itself －
Impact on human genes
Distribution of
Falciparum malaria
Distribution of sickle
cell gene carrier
Disease changed human itself －
Impact on human genes
In sub-Saharan Africa the
incidence of sickle cell anamia
as high as 1/400,
Heterozygote--carriers of a
single sickle cell allele are 810%
The sickle cells have protection
from malaria (plasmodium can
not parasite), it may be the
results of evolution (mutant
events back to 70-150,000
years ago)
AIDS virus
And
CD4 T-cells
Two receptors are
necessary for HIV to
enter the CD4 T cell ：
CD4 and CCR5
CCR5 and HIV infection
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In 2008, German doctors
reported that an HIVinfected leukemia patient had
received a bone marrow
transplant from a donor who
is homozygous for the CCR5Δ32 trait. After 600 days, the
patient was healthy and had
undetectable levels of HIV in
the blood and in examined
brain and rectal tissues
疾病改变人类－CCR5Δ32
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T-cell membrane receptor
CCR5 variant CCR5-Δ32 was
found in people with natural
immune to HIV
Frequency of CCR5-Δ32 varies:
Not in African or Asian origin
North European 14%
Mediterraneans 2%
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Average 10% Europeans with
one allele, 1% with two alleles
Origin of CCR5 mutation?
Eyam- the Plague village in England
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September 1665 Black death
outbreak in the village, the
villagers decided self-isolated
from others
260 out of 350 villagers dies in 1
year
From death records since 1630,
the descendants of survivors
were traced, 14% of them carry
the gene mutation ofCCR5-Δ32
Origin of CCR5 mutation?
Which disease facilitated the natural selection?
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Plague?
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Smallpox?
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Scott and Duncan: mathematical modeling study
reveals the CCR5-Δ32 may appear 2500-3000 ago
It may be related to a feverish viral disease
similar to Ebola hemorrhagic fever
Disease and the outcome of war
(For want of a nail – rhyme)
For want of a nail the shoe was lost.
For want of a shoe the horse was lost.
For want of a horse the rider was lost.
For want of a rider the battle was lost.
For want of a battle the kingdom was lost.
And all for the want of a horseshoe nail.
-Benjamin Franklin （1706-1790）
因缺少一颗钉子而损失一匹战马
Napoleon’s hemorrhoids and defeat at Waterloo
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Napoleon Bonaparte (1769-1821)，
was finally defeated by Duke of
Wellington at Waterloo on June 18
1815, because painful thrombosis
hemorrhoids prevented him
personally
surveying
the battle
fields on the
horse back.
（anecdotage)
Exiled to Saint Helena
1812 Napoleon’s Invasion of Russia
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June 1812 Napoleon
mobilized 500,000
French and allied
troopers to invade
Russia, retreated on
December with less
than 10,000 men
remained. Who
defeated Napoleon?
Marshall Kutuzov?
Cold winter in Moscow?
Who defeated Napoleon? Endemic Typhus
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Fatal epidemics of typhus
outbroke among French
soldiers, resulting severe
depletion of troopers, when
Napoleon entered Moscow
only 90,000 men left.
斑疹伤寒 Typhus (Trench
Fever or Jail Fever)
Caused by Rickettsia
transmitted by louse or flea.
Rickettsia Prowazekii
Russian Revolution and Fall of Romanov Reign
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February 1917 Revolution (Julian
calendar March in the Gregorian calendar)
the Tzar Nicola II was deposed and
replaced with the Provisional
government
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October Revolution (November 7) the
Provisional Government was
removed and replaced with a
Bolshevik (Communist) government,
finally let to the establishment of
Soviet Union
Fate of Romanovs
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The Romanov family under
house arrested in the
Yekaterinburg were
executed by Bolsheviks
without any trial at early
morning of April 17,1918
July 17, 1998 the remains of
Royal family were reburied
in a state ceremony
Who overthrew the Romanov Regime?
Vladimir Lenin
1870-1924
Queen Victoria
1817-1901
血友病 Hemophilia
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Hemophilia is a rare, inherited
bleeding disorder in which the
blood doesn’t clot normally
Type A: 80-85%, deficiency of
clotting factor VIII
Type B: 15-20%, deficiency of
clotting factor IX
Sex chromosome-linked inheritance
(recessive allele)
A pedigree European Royal Family
Victoria and Royal Family
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Tsar Nicholas II married Alexandra，gave birth of Alexis，the misfortune of
Romanovs started: Tsar and Tsarina were preoccupied with the health of their
son, the affairs of state deteriorated, culminating in the Russian revolution.
But Alexis did not die from hemophilia, at the
age of fourteen he was executed with the rest
of the family.
Starets Rasputin - the last straw
The End