醫(yī)學(xué)史簡論ABriefHistoryofMedicine課件

1、Why should we learn history The longer you look back, the further you can look forward -Winston Churchill 1944 以史為鏡，可以知興替 -唐太宗 Taking history as a mirror, one can draw lessons from raises and falls of powers - Li Shimin（First Emperor of Tang Dynasty)Why should we learn history What is History of Med

2、icine什么是醫(yī)學(xué)史 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. What is History of Medicine什么About the courseElective：32 teaching hours，2 credit pointsSche

3、dule： Lectures + discussion History of human diseases 6h Origin and history of medicine 18h Student presentation & discussion 6hTest：Essay writingAbout the courseElective：32 teReference BooksRoy Porter ：The Cambridge History of Medicine Cambridge University Press 1996，2006 revisedKenneth F. Kiple: T

4、he Cambridge World History of Human Disease The Press Syndicate of the University of Cambridge 2003Arturo Castiglioni：A History of Medicine (English translation), New York, J.Aronson 1975 11th EditionsFrederick Cartwright & Michael Biddiss: Disease & History Sutton Publishing 2000Internet /hmd, www.

5、historylearningsite.co.uk, /wiki/History_of_medicineReference BooksRoy Porter ：TheTime ScheduleTime ScheduleTime Schedule (cont.)Time Schedule (cont.)History of Human DiseaseHistory of Human DiseaseHuman Evolution智人 直立人能人南方古猿humanlike primates Australopithecine (hominid genus Australopithecus )Human

6、 Evolution智人 直立人能人南方古猿huHuman EvolutionSince the first man emerges on the Earth，the man and its disease have been bonded inseparably.Human Evolution人類疾病史 History of Human Diseases The history of mankind is the history of its diseases Folke Henschen Since the first man emerges on the Earth， mankind a

7、nd its disease have been bonded inseparably.人類疾病史 History of Human DiseasWhat 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 What is dis

8、ease疾病 Disease (disSmallpox 天花 天花病毒 poxviridae othopoxvirus Infectious disease caused by virus: Papule-vesicle-pustule-scar (pockmark)Smallpox 天花 Retinoblastoma視網(wǎng)膜母細胞瘤Inherited disease caused by Rb（13q14)gene deletion （two alleles） 9RetinoblastomaInherited diseasHistory of human disease studies:The

9、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

10、 society and human being itselfHistory of human disease studiPrehistorical Diseases Homo erectus“Turkana boy” of Kenya1.65 M yrs3.4 M yrsOsteosarcomaHomo habilis“Lucy” ofEthiopiaYaws, Treponema pallidumPrehistorical Diseases 1.65Prehistorical DiseasesRelated to gathering and hunting (hunter-gatherer

11、s):malnutritionparasitosisinjuryPrehistorical DiseasesRelated 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 Dise

12、ase in agricultural societ65 504635 2642 人畜共患病 ZoonosisOf the 1415 pathogens known to affect humans, 61% are zoonotic65 504635 2642 人畜共患病 ZoonosisPaleopathology Ancient Egypt Mummy PyramidPaleopathology Ancient EgypPaleopathologyPharaoh Ramses V died in1157 B.C from smallpox A louse found in a mummy

13、 of 3000 B.CPaleopathologyPharaoh Ramses V 血吸蟲病 Schistosomiasis Schistosoma heamatobium in Africa，Mideast S. Japonicum in China，Phillipines S.mansoni in Africa，Latin America 血吸蟲病 Schistosomiasis醫(yī)學(xué)史簡論ABriefHistoryofMedicine課件古病理學(xué) PaleopathologyExamining mummywith CT scanner Calcification in bladder c

14、aused by schistosomiasis古病理學(xué) PaleopathologyExamining mPaleopathologySchistosoma 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.Paleopathol

15、ogySchistosoma eggs PaleopathologySchistosoma 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. PaleopathologySchistCongestion of populatio

16、n, war and travelling result in outbreak and epidemics of infectious diseases CrusadesSilk roadMid age ParisCongestion of population, war Black death (plague) in 14th century Outbreak of plague epidemic in Europe 1346-1353（黑死病, black death）, more than 25 million people died and the population of Eur

17、ope reduced by one thirdCaffa Black death (plague) in 流感暴發(fā) 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 Wo

18、rld War, incorrectly called “Spanish flu”(Triple Alliance, Triple Entente) 流感暴發(fā) TModern society : globalization leads to the speed of virus transmission spread as quick as that of the modern transportation (SARS 2003, N1H1 Flu 2009)流行Epidemics outbreak of infectious disease大流行PandemicsEpidemic sprea

19、ding across a large regionModern society : globalizationDisease in modern society 現(xiàn)代社會疾病 Environmental changes Demographic changes Life style changesDisease profile of modern society Medical technologyPolitical, economic, cultural and technical development in society EpidemilogicaltransitionDisease

20、in modern society 現(xiàn)代社Influencing factors to modern diseasesDemographic：degeneration disease, chronic non-communicable diseasesEcological and environmental：pollution and occupational diseasesDietary and life style：smoking, obesity, accident Stress and social pressure：depression and suicideProgress of

21、 medical technology: iatrogenic disease, brain death, vegetative stateInfluencing factors to modern Life Expectancy at BirthLife Expectancy at BirthAgeing of populationChina: Life expectancyNational 71.44 (2000) Zhejiang 77.29 （2010）Hangzhou 80.26 (2010，M77.98, F82.76)Ageing of populationChina: Li社會

22、老齡化的影響 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.社會老齡化的影響 Ageing of populatiAgeing of populationLeading causes of death in US: comparison of 1990 and 1997Ageing of po

23、pulationLeading caInjury (9.1%)non-communicable disease (59.0%)World causes of death in 2000Communicable diseases, Malnutrition (31.9%)Total death: 55,694,000資料來源: 2001年世界衛(wèi)生報告Injury (9.1%)non-communicable 醫(yī)學(xué)史簡論ABriefHistoryofMedicine課件Causes of death in different WHO regions: 2000AfricaMid-EastEuroS

24、E-AsiaW-PacAmerica255075%Communicable, malnutrition, perinatalNon-communicableInjury資料來源: 2001年世界衛(wèi)生報告Causes of death in different WDeaths, by broad group, 2000World ChinaNoncommunicableconditions (33 million)Noncommunicableconditions (7 million)Injuries (1 million)Injuries (5 million)Communicable di

25、seases(1 million)Communicable diseases(18 million)Deaths, by broad group, 2000Ecological damageGlobal warming生態(tài)破壞-全球變暖Energy Consumption CO2 Emission Greenhouse effectGlobal WarmingEcological DamageDisease EpidemicsVector-borne infections Weather = Current state of the atmosphereClimate = average we

26、ather conditions* 10 yearsEcological damageGlobal warmiThe greenhouse effectGreenhouse gases:CO2 carbon dioxideCH4 methaneO3 ozoneN2O nitrous oxideH2OIncoming wavelength absorption 0.7 30 umThe greenhouse effectGreenhous醫(yī)學(xué)史簡論ABriefHistoryofMedicine課件Impact of climate changes on health40 year trend i

27、n dengue and temperature, SingaporeImpact of climate changes on hEcological damage-ozonosphere hole Ozonosphere absorb ultraviolet lights 40Life style related diseaseobeObesity Trends* Among U.S. AdultsBRFSS, 1985(*BMI 30, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14%Obesity Trends* Among

28、 U.S. AduObesity 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. AduObesity 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. AduObesity Tre

29、nds* Among U.S. AdultsBRFSS, 1988(*BMI 30, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14%Obesity Trends* Among U.S. AduObesity 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. AduObesity Trends* Among U.S. Adul

30、tsBRFSS, 1990(*BMI 30, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14%Obesity Trends* Among U.S. AduObesity Trends* Among U.S. AdultsBRFSS, 1991(*BMI 30, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14% 15%19% Obesity Trends* Among U.S. AduObesity Trends* Among U.S. AdultsBRFSS, 199

31、2(*BMI 30, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14% 15%19% Obesity Trends* Among U.S. AduObesity 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. AduObesity Trends* Among U.S. AdultsBRFSS, 1994(*B

32、MI 30, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14% 15%19% Obesity Trends* Among U.S. AduObesity 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. AduObesity Trends* Among U.S. AdultsBRFSS, 1996(*BMI 3

33、0, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14% 15%19% Obesity Trends* Among U.S. AduObesity Trends* Among U.S. AdultsBRFSS, 1997(*BMI 30, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14% 15%19% 20%Obesity Trends* Among U.S. AduObesity Trends* Among U.S. AdultsBRFSS, 1998(*BMI 30

34、, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14% 15%19% 20%Obesity Trends* Among U.S. AduObesity Trends* Among U.S. AdultsBRFSS, 1999(*BMI 30, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14% 15%19% 20%Obesity Trends* Among U.S. AduObesity Trends* Among U.S. AdultsBRFSS, 2000(*BMI

35、30, or 30 lbs. overweight for 5 4” person)No Data 10% 10%14% 15%19% 20%Obesity Trends* Among U.S. AduObesity 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%Obesity Trends* Among U.S. Adu(*BMI 30, or 30 lbs. overweight for 5 4”

36、person)Obesity Trends* Among U.S. AdultsBRFSS, 2002No Data 10% 10%14% 15%19% 20%24% 25%(*BMI 30, or 30 lbs. overweObesity 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. AduObesity Trends* Among U.S. A

37、dultsBRFSS, 2004(*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. AduObesity Trends* 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. AduObe

38、sity 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. AduObesity Trends* Among U.S. AdultsBRFSS, 2007(*BMI 30, or 30 lbs. overweight for 5 4” person) No Data 10% 10%14% 15%19% 20%24% 25%29% 30%

39、 Obesity Trends* Among U.S. AduObesity 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. AduObesity Trends* Among U.S. AdultsBRFSS, 2009(*BMI 30, or 30 lbs. overweight for 5 4” person) No Data 1

40、0% 10%14% 15%19% 20%24% 25%29% 30% Obesity Trends* Among U.S. AduObesity Trends* Among U.S. AdultsBRFSS, 2010(*BMI 30, or 30 lbs. overweight for 5 4” person)Obesity Trends* Among U.S. Adu醫(yī)學(xué)史簡論ABriefHistoryofMedicine課件 Obesity- Heavy burden for the society Obesity- Heavy burdenObesity: risk factor fo

41、r various disordersObesity: risk factor for vario肥胖與代謝綜合癥肥胖與代謝綜合癥Surgical treatment of obesitySurgical treatment of obesityLife 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 ye

42、ar in the worldDeath from road accident ranks 7 in China, 10 for the world, but it may become the 4th by 2030Life style related diseaseaccLife 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 40mil

43、lion children suffer from accident and 3.35 m hospitalized 0.4m disabledFive leading causes: drowning, traffic accident, poisoning, falling and suffocationLife style related diseaseaccStress from modern society - depression現(xiàn)代社會的壓力抑郁癥WHO estimates: there are 120-200m people suffer from depression in

44、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 - dStress from modern society - depressionDepressi

45、on 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. Stress from modern soci

46、ety - dStress from modern society - depressionSuicide rate 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 - dStress from modern socie

47、ty - depressionHigh risk population-entertainment circle陳百強 李恩珠 倪敏然陳寶蓮 張國榮Stress from modern society - dDevelopment of medical technology iatrogenic disease 醫(yī)源性疾病 Tetracycline teeth (enamel) Deaf by toxicated by aminoglycoside antibiotic (streptomicine, neomycine Kanamycine, gentamycine, Kasugamyxin

48、e) account for 50% of acquired deaf 聾Dance “Thousand-hand Goddess of MercyDevelopment of medical technolDevelopment of medical technology iatrogenic disease 醫(yī)源性疾病Thalisomide, a sedative produced by ChemieGruenenthal, Germany in 1957 for sick of pregnant women.Up to 1959 more than 1m took the drug, i

49、n 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(海豹肢 Seals limb)Development of medical technolDescriptive studyDescriptive stud

50、yEco-epidemiological studyNumber of phocomelia casesDrug soldEco-epidemiological studyNumbeCase-control study2=69.40, P0.001, OR=93.5Case-control study2=69.40, P Cohort studyRR=175, AR=41.76% Cohort studyRR=175, AR=41.Animal experiments and interventionThalidomide induced limb defects in Rhesus monkeyThalidomide was banned in market in1961.Limb defect have become rare again since 1962Animal experiments and interveLessons to be learntAft