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人类与传染病的斗争 (2)(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

Antonie van Leeuwenhoek 1632-1723

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

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

Discovery of Viruses

tulips breaking virus

1619 (a morbid beauty)

tobacco mosaic virus

Discovery of Viruses 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.

Ивановсқий

(1864-1920),

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 “soluble living germ” as first the idea of the virus. Martinus Beijernick

(1851-1931)

Dimensions of viruses

about 20 nm to about 250nm in diameter

… just for comparisonLeukocyte

10 µm

… just for comparisonLeukocyte Bacillus subtitlis

1 m

10 µm

… just for comparison Leukocyte Bacillus subtitlis Herpesvirus

1 m

10 µm

Discovery of Viruses

1898 German scientist Loeffler and Frosch discovered Foot-and-mouth disease virus

1911, Rous discovered Rous sarcoma virus

1915-1917, Twort and d’Herelle discovered bacteriophage

TMV （ Tobacco mosaic virus)

phage

TYMV (Tomato yellow mosaic virus)

Shapes of Viruses

Spherical

Rod-shaped

Brick-shaped

Tadpole-shaped

Bullet-shaped

Filament

Bacteriophage

1

2

3

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

Rabies virus 545

Negri body

Rabies vaccine was first used on 9-year old Joseph Meister, on July 6, 1885

Invention of vaccines

Diphtheria antitoxinAt 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 co-worker 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

Franklin Roosevelt

himself was a victim of polio, launched the March of Dimes to raise the National fund for polio prevention in 1938

Jonas Salk invented live polio vaccine in 1954

Albert Sabin invented oral live-attenuated vaccine (pills)

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

Chemotherapy for Syphilis

Treponema pallidum

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

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


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


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)


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


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


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 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

婴幼儿死亡率平均期望寿命


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医学史简论 （ 8 ） a brief history of medicine

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医学史简论（ 8 ） a brief history of medicine