a brief history of medicine 医学史简论 （ 7 ） a brief history of medicine...
TRANSCRIPT
送瘟神送瘟神 Send away the Good of Send away the Good of
PlaguePlague
人类与传染病的斗争人类与传染病的斗争 Battles to Infectious
Diseases
History of Infectious Diseases
Infection 感染 the invasion of the body by any of
various infectious agents – including bacteria, viruses, fungi, protozoan and worms， and the reaction of the body to them or their toxins.
Definitions Infectious disease 感染病 (cause)
The disease caused by infection and/or capable being communicable by infection
Communicable disease 传染病 (transmission)
The disease capable of being transmitted from one person to another or from animals (intermediate host) to human.
Epidemic disease 流行病 (incidence) The occurrence of cases of disease in excess of what is usually expected for
a given period of time. (epidemic hysteria)
Endemic disease 地方病 (location) The disease that is constantly present in people living in a particular
location (endemic thyroid disease-goiter)
Human and Infectious Diseases
Epidemics 流行 Sudden outbreak of diseases in excess of
what is expected
Pandemics （全球）大流行 Sudden geographically widespread
outbreak of diseases
History of Infectious Disease
Prehistoric period ： Infectious disease rare Agriculture society ： Increased transmission Urban civilization ： Congestion of urban inhabitation, war
and travelling result to outbreak of infectious diseases
Routes of transmission
Three factors of transmission of infectious disease•Source of infection (Typhoid Mary)
•Susceptible population
•Transmission routes
Direct touch
Indirecttouch
Droplet spittle Indirect
utensils
Air-borne
insect
Speed of sneeze: 170km/h 47.2m/s
Victories over infectious diseases
Smallpox plague Influenza Diphtheria Measles Tetanus poliomyelitis schistosomiasis
天花 smallpox
天花病毒 poxviridae
othopoxvirus
pockmarked face， from maculopapular rash to raised fluid-filled blisters to pustules
天花 smallpox Egyptian Pharaoh Ramses V died
from smallpox in1157 B.C Frequent outbreak in the history 300 million people died from
smallpox in 20th century (100 million died from wars)
Ramses V 1157 BC
Victims of Smallpox
Louis XV 1777 Elizabeth I 1533-1603
Joseph I d1711 顺治 1638-1661 Marry II 1662-1694
天花 smallpox
Lady Montagu
Chinese invented inoculation of human smallpox (variolation) in 10th century, widely used in 14-16 century
Lady Montagu brought back from Turkey to Europe in 1721
variolationBlow the scab of smallpox skin lesion
天花 smallpox Inspired by the fact that
dairymaids infected with cowpox were immune to small-pox, Edward Jenner invented cowpox vaccine against human smallpox.
Edward Jenner
1749-1823
variolation vaccination (vaccinia vacca-cow)
天花 smallpox Jenner deliberately infected
James Phipps, an eight year old boy, with cowpox in May 14, 1796. He then exposed Phipps to smallpox–which Phipps failed to contract. After repeating the experiment on other children, including his own son, Jenner concluded that vaccination provided immunity to smallpox without the risks of variolation. Jenner’s findings were published in 1798.
天花 smallpox in 1840 Vaccination
Acts were passed, the British government banned variolation and provided vaccination, free of charge.
In 1805 vaccination was introduced to China via Portugal merchants in Macao
天花 smallpox 1840 British vaccination Acts 1940 Smallpox was eradicated in Europe and North America 1960 Last Chinese case occurred in a Yunnan-Burma border village 1967 WHO launched smallpox eradication movement
（ At that time 30 million
patients,2million death every
year ） 30 countries
1700 medical doctors
200,000 health worker
Mobilized in the movement
天花 smallpox
Last natural infected Somalia patient cured in Oct 26 1977
A fatal incidence occurred in Birmingham University in August 1978 a woman lab photographer Janet Parker became the last victim of smallpox, Prof Henry Bedson committed suicide.
May 8, 1980 WHO announced:
Global eradication of smallpox Ali Maali
天花 smallpox
Reasons for possible eradication of smallpox
There are no other virus reservoirs but man Only acute infection exists, the outcome of
disease: die or life-long immunity Virus is highly immunogenic, so vaccine
has been most effective
鼠疫 Plague
bacterium Yersinia pestis
Prairie dog Flea Rat
Bubonic and Pneumonic Plague
伍连德和鼠疫 Chinese Plague Fighter Wu Lien-teh
Born in Penang, Malaya in a Chinsese family
Studied Medicine in England 1907 Vice-Director of the Imperial Army
medical College in Tientsin In the winter 1910 a endemics of plague
outbroke in Manchuria which claimed 60,000 victims, the endemic was controlled under his leadership.
chaired the International Plague Conference in Mukden (Shenyang) in April 1911
He was the first president of the China Medical Association (1916–1920) and directed the National Quarantine Service
1937 he moved back to Ipoh as a GPWu Lien-Teh 1879-1960
伍连德和鼠疫 Chinese Plague Fighter Wu Lien-teh
1935 he was nominated as the candidate of Nobel Prize of Physiology or Medicine for work on pneumonic plaque and especially the discovery of the role played by the Tarbagan in its transmission.
(Folke Henschen)
梁启超：“科学输入垂五十年，国中能以学者资格与世界相见者，伍星联（即伍连德）博士一人而已！”
Black death in 14th century1346-1353 plague outbreak in Europe（ black death 黑死病） ,claimed 2.5million, 1/3 of European population ( Threw bodies into city using trebuchet to spread plague-first biological warfare
by Tartar cavalrymen)
CaffaCrimea
Learn from plaque： contagion gown
Beak fill of spices
Quarantenaria （ 40 天）Quarantine （检疫）
Learn from plague: quarantine
Bacteriological weapon
During the Sino-Japanese War , plague was used as a bacteriological weapon by the Imperial Japanese Army. These weapons were provided by Shiro Ishii’ Units ( 石井 , 731 部队） and used in experiments on humans before being used on the field.
Vivisection One of the survivorsBacterial bomb
血吸虫病 SchistosomiasisSchistosoma heamatobium (Bilharzia) Africa, Middle East
S. Japonicum China, Phillipines
S.mansoni Africa, Latin America
Paleopathology FindingsSchistosoma eggs discovered in a
well-preserved ancient lady’s body (in Changsha Mawangdui of Hunan Province, 165 BC) , and also found in another well-preserved man’s body (167 BC) in Jiangling of Hubei Province
血吸虫病 SchistosomiasisUsed be prevalent in 12 provinces, 400 counties, threatened 100 million people and 1 million domestic animals (buffalo)
Mass Movement of Schistosomiasis Prevention ( 血防 Xuefang)in 1950s
Treatment of patients and animals－ eradication of the sources
Clearance of snails-intermediate host
Water and feces control-cut the transmission routes
七律二首 送瘟神Send away the God of Plague 1958.07.01
绿水青山枉自多，华佗无奈小虫何！千村薜荔人遗矢，万户萧疏鬼唱歌。坐地日行八万里，巡天遥看一千河。牛郎欲问瘟神事，一样悲欢逐逝波。
春风杨柳万千条，六亿神州尽舜尧。红雨随心翻作浪，青山着意化为桥。天连五岭银锄落，地动三河铁臂摇。借问瘟君欲何往，纸船明烛照天烧。
The God of Plague (Shistosomiasis) is back
Infection disease control-Long way to go传染病控制 - 任重而道远
Eradicated: smallpox
Vaccine preventable: measles, poliomyelitis, diphtheria,
whooping cough, tetanus
Uncontrolled ： plague, cholera, tuberculosis, viral hepatitis
Re-emerging ： sex-transmitted disease, Dengue fever,
schistosomiasis
Newly emerging ： Legionnaires’ disease, Ebola fever, SARS,
bird flu, AIDS, Chikungunya Disease
流感 Influenza1918 flu pandemic (Spanish flu) spreading to nearly every part of the
world.
Caused by Influenza virus strain subtype H1N1.
From March 1918 to June 1920, estimated 20 to 100 million people were killed (mortality rate 2.5-5%)
The extreme virulence may be associated with overreaction of immune system-cytokine storm
Mittelmachte (Central Power 同盟国 )Entente Power ( 协约国）
Avian Influenza (Bird Flu) Bird flu is influenza caused by viruses adapted to birds,
which belong to Influenza virus A
Influenza virus with the diameter of 80 ～ 120nm
Hemagglutinin,H: H1～ H15,Neuraminidase, N: N1～ N9 ,Theoretically there could be 135 subtypes,
Treatment: Tamiflu (Oseltamivir phosphate) A neuraminidase inhibitor
Avian Influenza Virus
Ecology of Avian Influenza Virus
Bird migration
Viet N
am
Cambodia
Thailand
Indonesia
Felines (tiger, leopard) can be infected with bird flue (60 tigers and 1 leopard in Thai zoo died from bird flue in 2003)
Country
2003-2009 2010 2011 2012 2013 2014 Total
case death case death case death case death case death case death case death
Azerbaijan 8 5 0 0 0 0 0 0 0 0 0 0 8 5Bangladesh 1 0 0 0 2 0 3 0 1 1 7 1Cambodia 9 7 1 1 8 8 3 3 26 14 9 4 56 37Canada 0 0 0 0 0 0 0 0 1 1 0 0 1 1
China 38 25 2 1 1 1 2 1 2 2 2 0 47 30
Djibouti 1 0 0 0 0 0 0 0 0 0 0 0 1 0
Egypt 90 27 29 13 39 15 11 5 4 3 3 0 176 63
Indonesia 162 134 9 7 12 10 9 9 3 3 2 2 197 165
Iraq 3 2 0 0 0 0 0 0 0 0 0 0 3 2
Laos 2 2 0 0 0 0 0 0 0 0 0 0 2 2
Myanmar 1 0 0 0 0 0 0 0 0 0 0 0 1 0
Nigeria 1 1 0 0 0 0 0 0 0 0 0 0 1 1
Pakistan 3 1 0 0 0 0 0 0 0 0 0 0 3 1
Thailand 25 17 0 0 0 0 0 0 0 0 0 0 25 17
Turkey 12 4 0 0 0 0 0 0 0 0 0 0 12 4
Viet Nam 112 57 7 2 0 0 4 2 2 1 2 2 127 64
Total 468 282 48 24 62 34 32 20 39 25 18 8 667 393
Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO 2003-2012
The overall case fatality rate 393/667=59.0%
禽流感和“猪流感”发病对比Comparison of bird flu with “swine flu”
Cytokine storm “细胞因子风暴”
死亡率 ～ 60% vs ～ 1%
Antigenic drift抗原漂移
Antigenic shift抗原转移
Potential risk 潜在危险 The mutation of virus may
cause the outbreak of pandemics of avian influenza (gene shift or draft, leading to transmitted from human to human)
Nature estimated： That may cause one third of world population infected , 30 million may need hospitalized, one quarter
of which would die.
AIDS- 世纪之疫
AIDSAIDS-the plague for the century-the plague for the century
Plague in 21th century-AIDS•1981 in US 5 cases reported and named as Acquired Immunodeficiency Syndrome (AIDS)
•1983 and 1984 Montagnier of Pasteur Institute and Gallo of NIH isolated the virus (lymphadenopathy-associated virus, LAV; human T-lymphotropic virus type III, HTLV-III)
•1986 naming as “Human Immunodeficiency Virus HIV”
•1987 President Mitterrand of France and President Reagan of the USA met that the major issues were ironed out.
Epidemiologic Notes and ReportsPneumocystis Pneumonia --- Los AngelesIn the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.Patient 1: A previously healthy 33-year-old man developed P. carinii pneumonia and oral mucosal candidiasis in March 1981 after a 2-month history of fever associated with elevated liver enzymes……
June 5, 1981 / 30(21);1-3
The Nobel Prize in Physiology or Medicine 2008
Harald zur Hausen Francoise Barre-Sinoussi Luc Montagnier
Germany Cancer Research Center , Heidelberg, b 1936
Regulation Retroviral Infections Unit, Virology Department, Institut Pasteur, b 1947
World Foundation for AIDS Research and Prevention, b 1932
"for his discovery of human papilloma viruses causing cervical cancer"
"for their discovery of human immunodeficiency virus"
AIDS virus
retrovirus
CCR 5
Replication of HIV
Clinical manifestation- cachexia
Clinical manifestation-Kaposi’s sarcoma
Pneumocystis carnii pneumonia ）
Clinical manifestation- Pneumocystis carnii pneumonia
Estimate Range
People living with HIV/AIDS in 2007 33.0 million 30.3-36.1 million
Adults living with HIV/AIDS in 2007 30.8 million 28.2-34.0 million
Women living with HIV/AIDS in 2007 15.5 million 14.2-16.9 million
Children living with HIV/AIDS in 2007 2.0 million 1.9-2.3 million
People newly infected with HIV in 2007 2.7 million 2.2-3.2 million
Children newly infected with HIV in 2007 0.37 million 0.33-0.41 million
AIDS deaths in 2007 2.0 million 1.8-2.3 million
Child AIDS deaths in 2007 0.27 million 0.25-0.29 million
More than 25 million people have died of AIDS since 1981.Africa has 11.6 million AIDS orphans.In developing and transitional countries, 9.7 million people are in immediate need of life-saving AIDS drugs; of these, only 2.99 million (31%) are receiving the drugs.
Global HIV/AIDS estimates, end of 2007UNAIDS 2008 Report of the global AIDS epidemic
Adult HIV Prevalence
Region
Adults & children
living with HIV/AIDS
Adults & children
newly infected
Adult prevalenc
e*
Deaths of adults & children
Sub-Saharan Africa
22.0 million
1.9 million 5.0% 1.5 million
North Africa & Middle East
380,000 40,000 0.3% 27,000
Asia 5 million 380,000 0.3% 380,000
Oceania 74,000 13,000 0.4% 1,000
Latin America
1.7 million 140,000 0.5% 63,000
Caribbean 230,000 20,000 1.1% 14,000
Eastern Europe & Central Asia
1.5 million 110,000 0.8% 58,000
North America, Western & Central Europe
2.0 million 81,000 0.4% 31,000
Global Total
33.0 million
2.7 million 0.8% 2.0 million
Regional statistics for HIV & AIDS, end of 2007* Proportion of adults aged 15-49 who were living with HIV/AIDS
Region
Adults & children
living with HIV/AIDS
Adults & children
newly infected
Adult prevalenc
e*
Deaths of adults & children
Sub-Saharan Africa
22.0 million
1.9 million 5.0% 1.5 million
North Africa & Middle East
380,000 40,000 0.3% 27,000
Asia 5 million 380,000 0.3% 380,000
Oceania 74,000 13,000 0.4% 1,000
Latin America
1.7 million 140,000 0.5% 63,000
Caribbean 230,000 20,000 1.1% 14,000
Eastern Europe & Central Asia
1.5 million 110,000 0.8% 58,000
North America, Western & Central Europe
2.0 million 81,000 0.4% 31,000
Global Total
33.0 million
2.7 million 0.8% 2.0 million
RegionAdults & children
living with HIV/AIDSAdults & children
newly infectedAdult prevalence*
Deaths of adults & children
Sub-Saharan Africa 22.0 million 1.9 million 5.0% 1.5 million
North Africa & Middle East
380,000 40,000 0.3% 27,000
Asia 5 million 380,000 0.3% 380,000
Oceania 74,000 13,000 0.4% 1,000
Latin America 1.7 million 140,000 0.5% 63,000
Caribbean 230,000 20,000 1.1% 14,000
Eastern Europe & Central Asia
1.5 million 110,000 0.8% 58,000
North America, Western & Central Europe
2.0 million 81,000 0.4% 31,000
Global Total 33.0 million 2.7 million 0.8% 2.0 million
Reported:
HIV infection 492,191
（ surviving 383,285 ） （Dec, 2012 ）
Estimated ：
HIV infection 780,000,
AIDS patients 154,000
AIDS death 160,000
中国爱滋病形势 AIDS in China
Ice burgerIce burger
IDUsbl ood trsexual l ybl ood prMTCTothers
61.6%
18.7%
9.4%
8.4%1.6%
0.3% 18.7%
AIDS transmission:China
Mode of Transmission ：Between US and China
11.6%Sexually transmitted (1985-2005) 75.2% (2011) half of which via MSM
爱滋病的来源？
Origin of Aids?
The origin of HIV HIV virus not detected in any blood samples before
1959 It may transformed from simian immunodeficiency
virus (SIV) of African primates (African Green Monkey, Chimpanzee)
发达国家艾滋病死亡率下降 （美国）
艾滋病传布途径 AIDS transmission
control transmission
控制性传播 控制输受血传播 控制医源性传播 控制吸毒传播 控制母婴传播
Prevention from iv drug use
Drug control
Detoxification
Provision of sterilized syringes
两害相较取其轻To choose the lesser of two evils
Prevention of sexual transmission
Abstinence
Be faithful
Condom
两害相较取其轻
To choose the lesser of two evils
No condomNo condom
No sexNo sex
World Aids Day: 1 December (since 1988）
World AIDS Day, 1 December 2013
“GETTING TO ZERO.“ 行动起来，向零艾滋迈进 全民参与，全力投入，全面预防 ZERO New HIV infections. ZERO Discrimination and ZERO AIDS-related deaths.
Essay writing
Medicine: its past, present and future You may choose any topics as long as follow the theme of
“history of medicine” Should be ORIGINAL Using your own words, not “copy” and
“paste” or “control-v””control-c” No less than 2000 words, including title, abstract, full text,
references, with your name and student number Word format, student number as file name Electronic version only Send to: [email protected], before April 20, 2014
谢谢谢谢