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????? A Brief History of Medicine

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Title: ????? A Brief History of Medicine


1
?????A Brief History of Medicine
  • ? ? Yu Hai
  • yuhai_at_zju.edu.cn

2
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 Shimin(First
    Emperor of Tang Dynasty)

3
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.

4
About the course
  • Elective32 teaching hours,2 credit points
  • Schedule Lectures discussion
  • History of human diseases 6h
  • Origin and history of medicine 18h
  • Student presentation discussion 6h
  • TestEssay writing

5
Reference Books
  • Roy Porter The Cambridge History of Medicine
     Cambridge University Press 1996,2006 revised
  • Kenneth F. Kiple The Cambridge World History of
    Human Disease The Press Syndicate of the
    University of Cambridge 2003
  • Arturo CastiglioniA History of Medicine (English
    translation), New York, J.Aronson 1975 11th
    Editions
  • Frederick Cartwright Michael Biddiss Disease
    History Sutton Publishing 2000
  • Internet www.nlm.nih.gov/hmd, www.historylearnings
    ite.co.uk, en.wikipedia.org/wiki/History_of_m
    edicine

6
Time Schedule
Week Date Time Contents Notes
2 Mar 11 Mon pm Introduction, History of Disease (1)
2 Mar 15 Fri am History of Human Disease (2)
3 Mar 18 Mon pm Origin of Medicine
3 Mar22 Fri am Medicine in early civilization
4 Mar25 Mon pm Medicine in ancient Greek, Rome
4 Mar 29 Fri am Student presentation (1)
5 Apr1 Mon pm Student presentation (2)
5 Apr 7 Sun am Development of modern medicine(1) Changed from Apr5 Fri for Qingming Festival
6 Apr 8 Mon pm Development of modern medicine(2)
6 Apr 12 Fri am History of infectious diseases (1)
7 Apr 15 Mon pm History of infectious diseases (2)
7
Time Schedule (cont.)
Week Date Time Contents Notes
7 Mar 23 Fri am Development of diagnostic techniques
8 Mar 26 Mon pm Development of therapeutic Techniques
8
History of Human Disease
9
??
Human Evolution
???
??
????
humanlike primates Australopithecine (hominid
genus Australopithecus )
10
  • Human Evolution
  • Since the first man emerges on the Earth,the man
    and its disease have been bonded
  • inseparably.

11
????? 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.

12
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

13
Smallpox ??
  • ????

  • poxviridae
  • othopoxvirus

Infectious disease caused by virus
Papule-vesicle-pustule-scar (pockmark)
14
Retinoblastoma ???????
Inherited disease caused by Rb(13q14)gene
deletion (two alleles) 9
15
History of human disease studies
  • The natural history of disease (emerge, develop,
    outbreak, attenuate, eliminate) and the
    intervention of human activities
  • The geographical and historical distribution of
    human diseases
  • The 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

16
Prehistorical Diseases
Homo habilis Lucy of Ethiopia
Osteosarcoma
3.4 M yrs
Homo erectus Turkana boy of Kenya
1.65 M yrs
Yaws, Treponema pallidum
17
Prehistorical Diseases
  • Related to gathering and hunting
    (hunter-gatherers)
  • malnutrition
  • parasitosis
  • injury

18
Disease in agricultural society
  • Zoonosis (disease transmitted from
    animals to humans or from humans to non-human
    animals)
  • Epidemic of infectious disease
  • Digestive
  • air
  • Insects
  • Domestication of animals

Settle down and domestication of animals
19
????? Zoonosis
42
50
65
26
35
46
Of the 1415 pathogens known to affect humans, 61
are zoonotic
20
Paleopathology
  • Ancient Egypt
  • Mummy
  • Pyramid

21
Paleopathology
  • Pharaoh Ramses V died in
  • 1157 B.C from smallpox

A louse found in a mummy of 3000 B.C
22
???? Schistosomiasis
Schistosoma heamatobium in Africa,Mideast
S. Japonicum in China,Phillipines S.mansoni in
Africa,Latin America
23
(No Transcript)
24
???? Paleopathology
  • Examining mummy
  • with CT scanner

Calcification in bladder caused by schistosomiasis
25
Paleopathology
  • Schistosoma 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.

26
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.

27
Congestion of population, war and travelling
result in outbreak and epidemics of infectious
diseases
Crusades
Mid age Paris
Silk road
28
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 third
Caffa
29
???? 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)

30
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 disease
  • ???Pandemics
  • Epidemic spreading across a large region

31
Disease in modern society ??????
Demographic changes
Environmental changes
Epidemilogical transition
Political, economic, cultural and technical
development in society

Disease profile of modern society
Life style changes
Medical technology
32
Influencing factors to modern diseases
  • Demographicdegeneration disease, chronic
    non-communicable diseases
  • Ecological and environmentalpollution and
    occupational diseases
  • Dietary and life stylesmoking, obesity, accident
  • Stress and social pressuredepression and suicide
  • Progress of medical technology iatrogenic
    disease, brain death, vegetative state

33
Life Expectancy at Birth
Human by Era Average Life expectancy at Birth (y)
Upper Paleolithic 33
Neolithic 20
Bronze Age 18
Classical Greece 20-30
Classical Rome 20-30
Pre-Columbian North America 25-35
Medieval Islamic Caliphate 35
Medieval Britain 20-30
Early 20th Century 30-40
Current World Average(2008) 66.7
Japan 80.07
China (2010) 74.83, Zhejiang 77.29, Hangzhou 80.67(M78.63, F82.82)
34
Ageing of population
China Life expectancy
National 71.44 (2000) Zhejiang 77.29
(2010)Hangzhou 80.26 (2010,M77.98, F82.76)
35
???????? Ageing of population
World Life Expectancy
US Life Expectancy 1990-2050
Life expectancy is the expected (in the
statistical sense) number of years of life
remaining at a given age.
36
Ageing of population
Leading causes of death in US comparison of 1990
and 1997
37
World causes of death in 2000
Total death 55,694,000
non-communicable disease (59.0)
Communicable diseases, Malnutrition (31.9)
Injury (9.1)
???? 2001???????
38
(No Transcript)
39
Causes of death in different WHO regions 2000

Non-communicable
75
Injury
50
Communicable, malnutrition, perinatal
25
Africa
Mid-East
Euro
SE-Asia
W-Pac
America
???? 2001???????
40
Deaths, by broad group, 2000World
China
Noncommunicable conditions (7 million)
Noncommunicable conditions (33 million)
Injuries (1 million)
Injuries (5 million)
Communicable diseases (18 million)
Communicable diseases (1 million)
41
Ecological damage-Global warming????-????
Energy Consumption
CO2 Emission
Greenhouse effect
Global Warming
Ecological Damage
Disease Epidemics
Vector-borne infections
Weather Current state of the atmosphere Climate
average weather conditions gt 10 years
42
The greenhouse effect
Greenhouse gases CO2 carbon dioxide CH4
methane O3 ozone N2O nitrous oxide H2O
Incoming wavelength absorption lt 0.3um Outgoing
wavelength absorption gt 0.7 30 um
43
(No Transcript)
44
Impact of climate changes on health40 year
trend in dengue and temperature, Singapore
45
Ecological damage-ozonosphere hole
  • Ozonosphere absorb ultraviolet lights lt300nm from
    solar radiation protecting living organisms in
    the earth from UV damage.
  • Chlorofluorocarbons (CFCc)widely used for
    refrigerants and spray cause depletion of the
    atmospheric ozone layer by releasing free radical
  • Over exposure to UV may cause skin cancer,
    cataract,etc.

Antarctic ozone hole
46
(No Transcript)
47
Environmental Pollution Minamata Disease(???)
Minamata (??)located in Kumamoto (??)Prefecture
used be a beautiful fishing village
48
Environmental Pollution Minamata Disease
(Mercury poisoning)
  • Chisso (??)Chemical Factory built in1925 used to
    produce fertilizer,started 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, numbness in
    the hands and feet, general muscle weakness,
    narrowing of the field of vision and damage
    to hearing and speech. In extreme
    cases, insanity, paralysis, coma and death 
  • follow within weeks of the onset of symptoms.
  • Total 2955 suffered the disease and 1784 died.

49
Environmental Pollution Minamata Disease
Plankton-shellfishes-small fishes- big
fishes-human cerebrum cerebella
50
Environmental Pollution Minamata Disease
51
Life style related disease-smoking ??
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,
52
Life style related disease-smoking
  • Every year 3.5 million people die from smoking
    related disease in the world, the figure will
    reach to 10 million by 2030,if no effective
    actions are taken,the economy loses will be 200
    billion , half in the low income countries.
  • In China, 350m smokers, 1m died from
    smoking-related diseases

53
Life style related disease-smoking
54
Smoking-related diseases
55
Life style related diseaseobesity and metabolic
syndrome
Causes Inheritance dietary habit
reduced physical activity
56
Life style related diseaseobesity and metabolic
syndrome
  • Body mass index
  • BMIKg/M2

WHO standard classification of obesity Normal
BMI18.5-24.9 Overweight  25.0-29.9 Obesity class
I 30.0-34.9 Obesity class II 35.0-39.9 Obesity
class III gt 40
57
Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
58
Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
59
Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
60
Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
61
Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
62
Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
63
Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
64
Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
65
Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
66
Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
67
Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
68
Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519
69
Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
70
Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
71
Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
72
Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
73
Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
74
Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
75
Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
76
Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
77
Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
78
Obesity Trends Among U.S. AdultsBRFSS, 2006
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
79
Obesity Trends Among U.S. AdultsBRFSS, 2007
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
80
Obesity Trends Among U.S. AdultsBRFSS, 2008
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
81
Obesity Trends Among U.S. AdultsBRFSS, 2009
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
82
Obesity Trends Among U.S. AdultsBRFSS,
2010(BMI 30, or 30 lbs. overweight for 5 4
person)
83
(No Transcript)
84
Obesity- Heavy burden for the society
85
Obesity risk factor for various disorders
86
????????
87
Surgical treatment of obesity
88
Life style related disease-accident
  • 25million people died from traffic accidents
    since Karl Benz invented the first car in 1885
  • About 500,000 people die from road accident every
    year in the world
  • Death from road accident ranks 7 in China, 10 for
    the world, but it may become the 4th by 2030

89
Life style related disease-accident
  • Accident 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 disabled
  • Five leading causes drowning, traffic accident,
    poisoning, falling and suffocation

90
Stress from modern society - depression???????-??
?
  • WHO estimates there are 120-200m people suffer
    from depression in the world, it would become the
    second leading cause of death or disability by
    2020
  • The prevalence rate of depression is 6.19.5
    for life time,about 1320 has one or more
    depressive episodes or experiences in ones life
    time

91
Stress from modern society - depression
  • Depression is a mental disorder 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.

92
Stress from modern society - depression
Mikhail Sholokhov)
Fajeyev
Ernest Hemingway l8991961
Kawabata Yasunari
Suicide rate in severe depression reaches 15,
writers or poets are a high-risk population for
suicice
Gu Cheng
Iris Chang
Sanmao
Xu Chi
93
Stress from modern society - depression
High risk population-entertainment circle
??? ???
???
??? ???
94
Development of medical technology iatrogenic
disease ?????
Deaf by toxicated by aminoglycoside antibiotic
(streptomicine, neomycine Kanamycine,
gentamycine, Kasugamyxine) account for 50 of
acquired deaf ?

Dance Thousand-hand Goddess of Mercy
Tetracycline teeth (enamel)
95
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 mother
  • The drug was banned in Nov 1961 but already
    10000-12000 malformed infants born, 4000 died
    before 1y.
  • phocomelia
  • (??? Seals limb)

96
Descriptive study
Country Sold Thalidomide(kg) Cases of Phocomelia
Austria 207 8
Belgium 258 26
UK 5769 349
Holland 140 25
Norway 60 11
Portugal 37 2
Switzerland 113 6
Germany 30099 5000
97
Eco-epidemiological study
Drug sold
Number of phocomelia cases
98
Case-control study
History of drug use Mother of birth defect child Control Total
Yes 34(68.0) 2(2.2) 36
No 16 88 104
Total 50 90 140
?269.40, Plt0.001, OR93.5
99
Cohort study
History Number with deformed infant Number without deformed infants Total Incidence rate()
Use at 8-10 week pregnancy 10 14 24 42
Not use at early pregnancy 51 21,434 21,485 0.24
RR175, AR41.76
100
Animal experiments and intervention
  • Thalidomide induced limb defects in Rhesus monkey
  • Thalidomide was banned in market in1961.
  • Limb defect have become rare again since 1962

101
  • Lessons to be learnt
  • After thalidomide events the congenital
    deformation monitoring system was established in
    many countries, and drug epidemiological studies,
    screening procedures the pharmaceutical
    manufacture and management strengthened

102
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-a and anti -angiogenesis
  • No weal without woe.  (Luck and Misfortune comes
    in turn.)????? , ?????

integrin
thalidomide
DNA intercalation
103
Chinese Aphorism
  • ???????,???????
  • 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).
  • ????? , ????? -?? Lao Tse
  • Misfortune, that is where happiness depends
    happiness , that is where misfortune underlies. 
  • No weal without woe. 
  • Luck and misfortune comes in turn

104
Summary
  • The 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

105
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