医学史简论ABriefHistoryofMedicine课件.ppt

1、Why should we -Winston Churchill 1944 -Li Shimin（First Emperor of Tang Dynasty)ook back,the further you can look forward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 History of Medicine is an interdisciplinary study leading toward an understanding of t

2、he origination and development of medicine and influencing factors;and its impact on society and human being.About the courseElective：32 teaching hours，2 credit pointsSchedule：Lectures+discussion History of human diseases 6h Origin and history of medicine 18h Student presentation&discussion 6hTest：E

3、ssay writingReference BooksRoy Porter：The Cambridge History of Medicine Cambridge University Press 1996，2006 revisedKenneth F.Kiple:The Cambridge World History of Human Disease The Press Syndicate of the University of Cambridge 2003Arturo Castiglioni：A History of Medicine(English translation),New Yo

4、rk,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_medicineTime ScheduleTime Schedule(cont.)Human Evolution智人智人 直立人直立人能人能人南方古猿南方古猿humanlike primates Aust

5、ralopithecine(hominid genus Australopithecus)Human EvolutionSince 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，mank

6、ind 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 othopoxviru

7、s 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）9History of human disease studies:The natural history of disease(emerge,develop,outbreak,attenuate,eliminate)and the intervention of human act

8、ivitiesThe 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 itselfPrehistorical Diseases Homo erectus“Turkana boy”of Kenya1.65 M yrs3.4 M yrsOsteo

9、sarcomaHomo habilis“Lucy”ofEthiopiaYaws,Treponema pallidumPrehistorical DiseasesRelated to gathering and hunting(hunter-gatherers):malnutritionparasitosisinjuryDisease in agricultural societyZoonosis(disease transmitted from animals to humans or from humans to non-human animals)Epidemic of infectiou

10、s disease Digestive air InsectsDomestication of animalsSettle down and domestication of animals 65 504635 2642 人畜共患病 ZoonosisOf the 1415 pathogens known to affect humans,61%are zoonoticPaleopathology Ancient Egypt Mummy PyramidPaleopathologyPharaoh Ramses V died in1157 B.C from smallpox A louse foun

11、d 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 PaleopathologyExamining mummywith CT scanner Calcification in bladder caused by schistosomiasisPaleopathologySchistosoma eggs discovered in a

12、 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.PaleopathologySchistosoma eggs were also found in another well-preserved body(167 BC)in Jiangling of Hubei.He also

13、 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 ep

14、idemic in Europe 1346-1353（黑死病,black death）,more than 25 million people died and the population of Europe reduced by one thirdCaffa 流感暴发 The outbreak of influenza in 1918The outbreak of influenza in 1918 Starting from Camp Funston,Kansas USA in spring of 1918 then spread worldwide,during 1918-1919 1

15、 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

16、(SARS 2003,N1H1 Flu 2009)流行流行Epidemics outbreak of infectious disease大流行大流行PandemicsEpidemic spreading across a large regionDisease in modern society 现代社会疾病 Environmental changes Demographic changes Life style changesDisease profile of modern society Medical technologyPolitical,economic,cultural and

17、 technical development in society EpidemilogicaltransitionInfluencing factors to modern diseasesDemographicDemographic：degeneration disease,chronic non-communicable diseasesEcological and environmentalEcological and environmental：pollution and occupational diseasesDietary and life styleDietary and l

18、ife style：smoking,obesity,accident Stress and social pressureStress and social pressure：depression and suicideProgress of medical technology:Progress of medical technology:iatrogenic disease,brain death,vegetative stateLife Expectancy at BirthAgeing of populationChina:Life expectancyNational 71.44(2

19、000)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 ExpectancyUS Life Expectancy1990-2050Life expectancy is the expected(in the statistical sense)number of years of life remaining at a given age.Ageing of populationLeading causes of death in US:comparis

20、on of 1990 and 1997Injury(9.1%)non-communicable disease(59.(59.0 0%)%)World causes of death in 2000Communicable diseases,Malnutrition(31.9%)Total death:55,694,000资料来源:2001年世界卫生报告Causes of death in different WHO regions:2000AfricaMid-EastEuroSE-Asia W-Pac America255075%Communicable,malnutrition,perin

21、atalNon-communicableInjury资料来源:2001年世界卫生报告Deaths,by broad group,2000World ChinaNoncommunicableconditions(33 million)Noncommunicableconditions(7 million)Injuries(1 million)Injuries(5 million)Communicable diseases(1 million)Communicable diseases(18 million)Ecological damageGlobal warming生态破坏-全球变暖Energ

22、y Consumption CO2 Emission Greenhouse effectGlobal WarmingEcological DamageDisease EpidemicsVector-borne infections Weather=Current state of the atmosphereClimate =average weather conditions*10 yearsThe greenhouse effectGreenhouse gases:CO2 carbon dioxideCH4 methaneO3 ozoneN2O nitrous oxideH2OIncomi

23、ng wavelength absorption 0.7 30 umImpact of climate changes on health40 year trend in dengue and temperature,SingaporeEcological damage-ozonosphere hole Ozonosphere absorb ultraviolet lights 40Obesity Trends*Among U.S.AdultsBRFSS,1985(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%Obes

24、ity Trends*Among U.S.AdultsBRFSS,1986(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%Obesity Trends*Among U.S.AdultsBRFSS,1987(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%Obesity Trends*Among U.S.AdultsBRFSS,1988(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%1

25、0%14%Obesity Trends*Among U.S.AdultsBRFSS,1989(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%Obesity Trends*Among U.S.AdultsBRFSS,1990(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%Obesity Trends*Among U.S.AdultsBRFSS,1991(*BMI 30,or 30 lbs.overweight for 5 4”person)No

26、Data 10%10%14%15%19%Obesity Trends*Among U.S.AdultsBRFSS,1992(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%Obesity Trends*Among U.S.AdultsBRFSS,1993(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%Obesity Trends*Among U.S.AdultsBRFSS,1994(*BMI 30,or 30 lbs.ov

27、erweight for 5 4”person)No Data 10%10%14%15%19%Obesity Trends*Among U.S.AdultsBRFSS,1995(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%Obesity Trends*Among U.S.AdultsBRFSS,1996(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%Obesity Trends*Among U.S.AdultsBRFS

28、S,1997(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%20%Obesity Trends*Among U.S.AdultsBRFSS,1998(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%20%Obesity Trends*Among U.S.AdultsBRFSS,1999(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%20

29、%Obesity Trends*Among U.S.AdultsBRFSS,2000(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%20%Obesity Trends*Among U.S.AdultsBRFSS,2001(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%20%24%25%(*BMI 30,or 30 lbs.overweight for 5 4”person)Obesity Trends*Among U.S

30、.AdultsBRFSS,2002No Data 10%10%14%15%19%20%24%25%Obesity Trends*Among U.S.AdultsBRFSS,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.AdultsBRFSS,2004(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%20%24%25%Obesity Trends*

31、Among U.S.AdultsBRFSS,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.AdultsBRFSS,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.AdultsBRFSS,2007(*BMI 30,or 30 lbs.overwei

32、ght for 5 4”person)No Data 10%10%14%15%19%20%24%25%29%30%Obesity Trends*Among U.S.AdultsBRFSS,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.AdultsBRFSS,2009(*BMI 30,or 30 lbs.overweight for 5 4”person)No Data 10%10%14%15%19%20%24%25%2

33、9%30%Obesity Trends*Among U.S.AdultsBRFSS,2010(*BMI 30,or 30 lbs.overweight for 5 4”person)Obesity-Heavy burden for the societyObesity:risk factor for various disorders肥胖与代谢综合症Surgical treatment of obesityLife style related diseaseaccident25million people died from traffic accidents since Karl Benz

34、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 2030Life style related diseaseaccidentAccident is the number one cause of death for children under 14 in China acco

35、unting for 26.1%of all death.It is estimated 40million children suffer from accident and 3.35 m hospitalized 0.4m disabledvFive leading causes:drowning,traffic accident,poisoning,falling and suffocationStress from modern society-depression现代社会的压力抑郁症WHO estimates:there are 120-200m people suffer from

36、 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 time，about 13%20%has one or more depressive episodes or experiences in ones life timeStress from modern society-depressionDepression is a mental disor

37、der characterized by a pervasive low mood,low self-esteem,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-depressionSuicide ra

38、te in severe depression reaches 15,writers or poets are a high-risk population for suiciceErnest Hemingway l8991961Kawabata Yasunari Gu ChengSanmaoIris ChangXu ChiMikhail Sholokhov)FajeyevStress from modern society-depressionHigh risk population-entertainment circle陈百强 李恩珠 倪敏然陈宝莲 张国荣Development of m

39、edical technology iatrogenic disease 医源性疾病 Tetracycline teeth(enamel)Deaf by toxicated by aminoglycoside antibiotic(streptomicine,neomycine Kanamycine,gentamycine,Kasugamyxine)account for 50%of acquired deaf 聋Dance“Thousand-hand Goddess of MercyDevelopment of medical technology iatrogenic disease 医源

40、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 motherThe drug was banned in Nov 1961 but already 10000-120

41、00 malformed infants born,4000 died before 1y.phocomelia(海豹肢 Seals limb)Descriptive studyEco-epidemiological studyNumber of phocomelia casesDrug soldCase-control study2=69.40,P0.001,OR=93.5 Cohort studyRR=175,AR=41.76%Animal experiments and interventionThalidomide induced limb defects in Rhesus monk

42、eyThalidomide was banned in market in1961.Limb defect have become rare again since 1962Lessons 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

43、management strengthenedThalidomide:a tragicomedyIt 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

44、 is associated with inhibition of TNF-and anti-angiogenesisNo weal without woe.(Luck and Misfortune comes in turn.)福兮祸所伏,祸兮福所倚integrinthalidomideDNA intercalationChinese Aphorism福兮祸所伏,祸兮福所倚 -老子 Lao TseMisfortune,that is where happiness depends;happiness,that is where misfortune underlies.No weal wit

45、hout 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 foll

46、ow(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 thank you for your attention