医学史简论 a brief history of medicine

A Brief History of Medicine Yu Hai [email protected]

Why should we learn history The longer you look back, the further you can look forward --Winston Churchill 1944

- Taking history as a mirror, one can draw lessons from raises and falls of powers - Li ShiminFirst Emperor of Tang Dynasty)

What is History of Medicine

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 courseElective32 teaching hours2 credit pointsSchedule Lectures + discussion History of human diseases 6h Origin and history of medicine 18h Student presentation & discussion 6hTestEssay writing

Reference BooksRoy Porter The Cambridge History of Medicine Cambridge University Press 19962006 revisedKenneth F. Kiple: The Cambridge World History of Human Disease The Press Syndicate of the University of Cambridge 2003Arturo CastiglioniA History of Medicine (English translation), New York, J.Aronson 1975 11th EditionsFrederick Cartwright & Michael Biddiss: Disease & History Sutton Publishing 2000Internet www.nlm.nih.gov/hmd, www.historylearningsite.co.uk, en.wikipedia.org/wiki/History_of_medicine

Time Schedule

WeekDateTimeContentsNotes2Mar 11 MonpmIntroduction, History of Disease (1)2Mar 15 FriamHistory of Human Disease (2)3Mar 18 MonpmOrigin of Medicine3Mar22 FriamMedicine in early civilization4Mar25 MonpmMedicine in ancient Greek, Rome4Mar 29 FriamStudent presentation (1)5Apr1 MonpmStudent presentation (2)5Apr 7 SunamDevelopment of modern medicine(1)Changed from Apr5 Fri for Qingming Festival 6Apr 8 MonpmDevelopment of modern medicine(2)6Apr 12 FriamHistory of infectious diseases (1)7Apr 15 MonpmHistory of infectious diseases (2)

Time Schedule (cont.)

WeekDateTimeContentsNotes7Mar 23 FriamDevelopment of diagnostic techniques

8Mar 26 MonpmDevelopment of therapeutic Techniques

History of Human Disease

Human Evolution humanlike primates Australopithecine (hominid genus Australopithecus )

Human EvolutionSince the first man emerges on the Earththe man and its disease have been bonded inseparably.

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 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 poxviridae othopoxvirus Infectious disease caused by virus: Papule-vesicle-pustule-scar (pockmark)

RetinoblastomaInherited disease caused by Rb13q14)gene deletion two alleles

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History of human disease studies:The natural history of disease (emerge, develop, outbreak, attenuate, eliminate) and the intervention of human activitiesThe geographical and historical distribution of human diseasesThe 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 erectusTurkana boy of Kenya1.65 M yrs3.4 M yrsOsteosarcomaHomo habilisLucy ofEthiopia

Yaws, Treponema pallidum

Prehistorical DiseasesRelated to gathering and hunting (hunter-gatherers):malnutritionparasitosisinjury

Disease in agricultural societyZoonosis (disease transmitted from animalstohumansor from humans to non-human animals)Epidemic of infectious disease Digestive air InsectsDomestication of animalsSettle down and domestication of animals

65 504635 2642 ZoonosisOf the 1415 pathogens known to affect humans, 61% are zoonotic

Paleopathology Ancient Egypt Mummy Pyramid

PaleopathologyPharaoh Ramses V died in1157 B.C from smallpox A louse found in a mummy of 3000 B.C

Schistosomiasis Schistosoma heamatobium in AfricaMideast S. Japonicum in ChinaPhillipines S.mansoni in AfricaLatin America

PaleopathologyExamining mummywith CT scanner

Calcification in bladder caused by schistosomiasis

PaleopathologySchistosoma eggs discovered in a body of preserved ancient ladys 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 well-preserved 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

CrusadesSilk roadMid age Paris

Black death (plague) in 14th century Outbreak of plague epidemic in Europe 1346-1353, black death, more than 25 million people died and the population of Europe reduced by one thirdCaffa

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)Epidemics outbreak of infectious diseasePandemicsEpidemic spreading across a large region

Disease in modern society Environmental changes Demographic changes

Life style changes

Disease profile of modern society Medical technologyPolitical, economic, cultural and technical development in society Epidemilogicaltransition

Influencing factors to modern diseasesDemographicdegeneration disease, chronic non-communicable diseasesEcological and environmentalpollution and occupational diseasesDietary and life stylesmoking, obesity, accident Stress and social pressuredepression and suicideProgress of medical technology: iatrogenic disease, brain death, vegetative state

Life Expectancy at Birth

Human by EraAverage Life expectancy at Birth (y)Upper Paleolithic33Neolithic20Bronze Age 18Classical Greece20-30Classical Rome20-30Pre-Columbian North America25-35Medieval Islamic Caliphate35+Medieval Britain20-30Early 20th Century30-40Current World Average(2008)66.7Japan 80.07China (2010)74.83 Zhejiang 77.29 Hangzhou 80.67(M78.63, F82.82

Ageing of populationChina: Life expectancyNational 71.44 (2000) Zhejiang 77.29 2010Hangzhou 80.26 (2010M77.98, F82.76)

Ageing of population World Life ExpectancyUS Life Expectancy1990-2050Life expectancyis the expected (in the statistical sense) number of years of life remaining at a given age.

Ageing of populationLeading causes of death in US: comparison of 1990 and 1997

Injury (9.1%)non-communicable disease (59.0%)World causes of death in 2000Communicable diseases, Malnutrition (31.9%)Total death: 55,694,000: 2001

Causes of death in different WHO regions: 2000AfricaMid-EastEuroSE-Asia

W-PacAmerica255075%Communicable, malnutrition, perinatalNon-communicableInjury: 2001

Deaths, by broad group, 2000

World ChinaNoncommunicableconditions (33 million)Noncommunicableconditions (7 million)Injuries (1 million)Injuries (5 million)Communicable diseases(1 million)Communicable diseases(18 million)

Ecological damageGlobal warming-

Energy Consumption CO2 Emission Greenhouse effectGlobal WarmingEcological DamageDisease EpidemicsVector-borne infections Weather = Current state of the atmosphereClimate = average weather conditions* > 10 years

The greenhouse effectGreenhouse gases:CO2 carbon dioxideCH4 methaneO3 ozoneN2O nitrous oxideH2OIncoming wavelength absorption < 0.3umOutgoing 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

Environmental Pollution Minamata DiseaseMinamata located in Kumamoto Prefecture used be a beautiful fishing village

Environmental Pollution Minamata Disease (Mercury poisoning)Chisso Chemical Factory built in1925 used to produce fertilizerstarted to manufacture choroethylene in 1949. Large amount mercury-containing catalyzer methyl mercury) in waste water drained into the bay.1956 cat chorea occurred in Minamata Bay area (suicide cat). Afterwards human patients presented the same symptoms: ataxia, numbnessin the hands and feet, generalmuscle weakness, narrowing of thefield of visionand damage tohearingandspeech. In extreme cases,insanity,paralysis,comaanddeathfollow within weeks of the onset of symptoms. Total 2955 suffered the disease and 1784 died.

Environmental Pollution Minamata DiseasePlankton-shellfishes-small fishes- big fishes-human cerebrum cerebella

Environmental Pollution Minamata Disease

Life style related diseasesmoking 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 diseasesmokingEvery year 3.5 million people die from smoking related disease in the world, the figure will reach to 10 million by 2030if no effective actions are takenthe 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 diseasesmoking

Smoking-related diseases

Life style related diseaseobesity and metabolic syndromeCauses: Inheritance dietary habit reduced physical activity

Life style related diseaseobesity and metabolic syndromeBody mass index BMIKg/M2

WHO standard classification of obesity Normal BMI18.5-24.9 Overweight:25.0-29.9Obesity class I 30.0-34.9Obesity class II 35.0-39.9 Obesity class III > 40

Obesity Trends* Among U.S. AdultsBRFSS, 1985(*BMI 30, or ~ 30 lbs. overweight for 5 4 person)No Data

(*BMI 30, or ~ 30 lbs. overweight for 5 4 person)Obesity Trends* Among U.S. Adults BRFSS, 2002No Data

Obesity Trends* Among U.S. AdultsBRFSS, 2005(*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data

Obesity Trends* Among U.S. AdultsBRFSS, 2010(*BMI 30, or ~ 30 lbs. overweight for 5 4 person)

Obesity- Heavy burden for the society

Obesity: risk factor for various disorders

Surgical treatment of obesity

Life style related diseaseaccident25million people died from traffic accidents since Karl Benz invented the first car in 1885About 500,000 people die from road accident every year in the worldDeath from road accident ranks 7 in China, 10 for the world, but it may become the 4th by 2030

Life style related diseaseaccidentAccident 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 disabledFive leading causes: drowning, traffic accident, poisoning, falling and suffocation

Stress from modern society - depressionWHO estimates: there are 120-200m people suffer from depression in the world, it would become the second leading cause of death or disability by 2020The prevalence rate of depression is 6.1%9.5% for life timeabout 13%20% has one or more depressive episodes or experiences in ones life time

Stress from modern society - depression

Depression is amental disordercharacterized by a pervasivelow mood, lowself-esteem, andloss 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.


Suicide rate in severe depression reaches 15, writers or poets are a high-risk population for suicice

Ernest Hemingway l8991961Kawabata Yasunari Gu ChengSanmaoIris ChangXu ChiMikhail Sholokhov) Fajeyev


High risk population-entertainment circle

Development of medical technology iatrogenic disease Tetracycline teeth (enamel) Deaf by toxicated by aminoglycoside antibiotic (streptomicine, neomycine Kanamycine, gentamycine, Kasugamyxine) account for 50% of acquired deaf Dance Thousand-hand Goddess of Mercy

Development of medical technology iatrogenic disease 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 motherThe drug was banned in Nov 1961 but already 10000-12000 malformed infants born, 4000 died before 1y.phocomelia( Seals limb)

Descriptive study

CountrySold Thalidomide(kg)Cases of Phocomelia Austria2078Belgium25826UK5769349Holland14025Norway6011Portugal372Switzerland1136Germany300995000

Eco-epidemiological studyNumber of phocomelia casesDrug sold

Case-control study2=69.40, P

Cohort studyRR=175, AR=41.76%

HistoryNumber with deformed infantNumber without deformed infantsTotalIncidence rate(%)Use at 8-10 week pregnancy10142442Not use at early pregnancy5121,43421,4850.24

Animal experiments and interventionThalidomide induced limb defects in Rhesus monkeyThalidomide was banned in market in1961.Limb defect have become rare again since 1962

Lessons to be learntAfter 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

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), Kaposis sarcoma (HIV infection)Further researched revealed: the effect of thalidomide is associated with inhibition of TNF- and anti -angiogenesisNo weal without woe. (Luck and Misfortune comes in turn.) , integrinthalidomideDNA intercalation

Chinese Aphorism , - Lao TseMisfortune, that is where happiness depends ; happiness , that is where misfortune underlies. No weal without woe. Luck and misfortune comes in turn

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).

SummaryThe 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

ThanksTHANK YOU FOR YOUR ATTENTION

********We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.

*We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.

*We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.

***

医学史简论 a brief history of medicine

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