History of Medicine

History of Medicine

اسلاید 1: www.tabaye.ir

اسلاید 2: 医学史简论 A Brief History of Medicine余 海 Yu Hai yuhai@zju.edu.cn

اسلاید 3: www.tabaye.ir

اسلاید 4: Why should we learn history The longer you look back, the farther you can look forward --Winston Churchill 1944 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 - Li Shimin（First Emperor of Tang Dynasty)

اسلاید 5: What is History of Medicine 什么是医学史 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.

اسلاید 6: About the courseElective：32 teaching hours，2 credit pointsSchedule： Lectures + discussion History of human diseases 4h Origin and history of medicine 22h Student presentation & discussion 6hTest：Essay writing

اسلاید 7: Time Schedule

اسلاید 8: Time Schedule (cont.)

اسلاید 9: Reference 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 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

اسلاید 10: Information for Slides down-loadVisit website: http://m-learning.zju.edu.cn“浙江大学医学院 数字化学习平台” （Digital Learning Platform)课程总览 (Course List) P4：History of Medicine“进入课程网站”(Enter Course Website)Lecture SlidesIf any problems contact Mr Ye Zhiguo, softlab@zju.edu.cn, Tel. 88206726

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اسلاید 15: History of Human Disease

اسلاید 16: Human Evolution智人 直立人能人南方古猿humanlike primates Australopithecine (hominid genus Australopithecus )

اسلاید 17: Human EvolutionSince the first man emerges on the Earth，the man and its disease have been bonded inseparably.

اسلاید 18: 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， mankind and its disease have been bonded inseparably.

اسلاید 19: 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

اسلاید 20: Smallpox 天花 天花病毒 poxviridae othopoxvirus Infectious disease caused by virus: Viremia + skin lesions Papule-vesicle-pustule-scar (pockmark)

اسلاید 21: Retinoblastoma视网膜母细胞瘤Inherited disease caused by Rb（13q14)gene deletion （two alleles） 9

اسلاید 22: 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

اسلاید 23: Prehistorical Diseases Homo erectus“Turkana boy” of Kenya1.65 M yrs3.4 M yrsOsteosarcomaHomo habilis“Lucy” ofEthiopiaYaws, Treponema pallidum

اسلاید 24: Prehistorical DiseasesRelated to gathering and hunting (hunter-gatherers):malnutritionparasitosisinjury

اسلاید 25: Disease in agricultural societyZoonosis (disease transmitted from animals to humans or from humans to animals)Epidemic of infectious disease Digestive air InsectsDomestication of animalsSettle down and domestication of animals

اسلاید 26: 65 504635 2642 人畜共患病 ZoonosisOf the 1415 pathogens known to affect humans, 61% are zoonoticPoultry

اسلاید 27: Paleopathology Ancient Egypt Mummy Pyramid

اسلاید 28: PaleopathologyPharaoh Ramses V died in1157 B.C from smallpox A louse found in a mummy of 3000 B.C

اسلاید 29: 血吸虫病 Schistosomiasis Schistosoma heamatobium in Africa，Mideast S. Japonicum in China，Phillipines S.mansoni in Africa，Latin America

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اسلاید 31: 古病理学 PaleopathologyExamining mummywith CT scanner Calcification in bladder caused by schistosomiasis

اسلاید 32: PaleopathologySchistosoma eggs discovered in a body of preserved ancient lady’s body (in Changsha Mawangdui of Hunan Province, 165 BC)Autopsy also discovered coronary heart disease, biliary stones and eggs of other intestinal parasites.

اسلاید 33: 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.

اسلاید 34: Congestion of population, war and travelling result in outbreak and epidemics of infectious diseases CrusadesSilk roadMid age Paris

اسلاید 35: Outbreak of plague epidemic in Europe 1346-1353（黑死病, black death）, more than 25 million people died and the population of Europe reduced by one thirdCaffa Black death (plague) in 14th century

اسلاید 36: 流感暴发 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)

اسلاید 37: Modern 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 spreading across a large region

اسلاید 38: Disease 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 technical development in society Epidemilogicaltransition

اسلاید 39: 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 medical technology: iatrogenic disease, brain death, vegetative state

اسلاید 40: Life Expectancy at Birth

اسلاید 41: Ageing of populationChina: Life expectancyNational 74.83 (2010) Zhejiang 77.29 （2010）Hangzhou 80.67 (2012，M78.63, F82.82)

اسلاید 42: 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.

اسلاید 43: Ageing of populationLeading causes of death in US: comparison of 1990 and 1997

اسلاید 44: Injury (9.1%)non-communicable disease (59.0%)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

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اسلاید 46: Causes of death in different WHO regions: 2000AfricaMid-EastEuroSE-AsiaW-PacAmerica255075%Communicable, malnutrition, perinatalNon-communicableInjury资料来源: 2001年世界卫生报告

اسلاید 47: 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)

اسلاید 48: The greenhouse effectGreenhouse gases:CO2 carbon dioxideCH4 methaneO3 ozoneN2O nitrous oxideH2OIncoming wavelength absorption < 0.3μmOutgoing wavelength absorption > 0.7 – 30 μ m

اسلاید 49: Ecological damage－Global warming 生态破坏-全球变暖 Energy Consumption CO2 Emission Greenhouse effectGlobal WarmingEcological DamageDisease EpidemicsVector-borne infections Weather = Current state of the atmosphereClimate = average weather conditions* > 10 years

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اسلاید 51: Impact of climate changes on health 40 year trend in dengue and temperature, Singapore

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اسلاید 53: Ecological damage-ozonosphere hole Ozonosphere absorb ultraviolet lights <300nm 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

اسلاید 54: Environmental Pollution – Minamata Disease（水俣病）Minamata （水俣）located in Kumamoto （熊本）Prefecture used be a beautiful fishing village

اسلاید 55: Environmental Pollution Minamata Disease (Mercury poisoning)Chisso （智索）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 （舞蹈病）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.

اسلاید 56: Environmental Pollution –Minamata DiseasePlankton-shellfishes-small fishes- big fishes-human cerebrum cerebella

اسلاید 57: Environmental Pollution –Minamata Disease

اسلاید 58: Life style related disease－smoking 吸烟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,

اسلاید 59: Life style related disease－smokingEvery 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

اسلاید 60: Life style related disease－smoking

اسلاید 61: Smoking-related diseases

اسلاید 62: Life style related disease obesity and metabolic syndromeCauses: Inheritance dietary habit reduced physical activity

اسلاید 63: Life style related disease obesity and metabolic syndromeBody mass index BMI＝Kg/M2WHO 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

اسلاید 64: Obesity Trends* Among U.S. Adults BRFSS, 1985(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%

اسلاید 65: Obesity Trends* Among U.S. Adults BRFSS, 1986(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%

اسلاید 66: Obesity Trends* Among U.S. Adults BRFSS, 1987(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%

اسلاید 67: Obesity Trends* Among U.S. Adults BRFSS, 1988(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%

اسلاید 68: Obesity Trends* Among U.S. Adults BRFSS, 1989(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%

اسلاید 69: Obesity Trends* Among U.S. Adults BRFSS, 1990(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14%

اسلاید 70: Obesity Trends* Among U.S. Adults BRFSS, 1991(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%

اسلاید 71: Obesity Trends* Among U.S. Adults BRFSS, 1992(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%

اسلاید 72: Obesity Trends* Among U.S. Adults BRFSS, 1993(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%

اسلاید 73: Obesity Trends* Among U.S. Adults BRFSS, 1994(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%

اسلاید 74: Obesity Trends* Among U.S. Adults BRFSS, 1995(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%

اسلاید 75: Obesity Trends* Among U.S. Adults BRFSS, 1996(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%

اسلاید 76: Obesity Trends* Among U.S. Adults BRFSS, 1997(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% ≥20%

اسلاید 77: Obesity Trends* Among U.S. Adults BRFSS, 1998(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% ≥20%

اسلاید 78: Obesity Trends* Among U.S. Adults BRFSS, 1999(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% ≥20%

اسلاید 79: Obesity Trends* Among U.S. Adults BRFSS, 2000(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% ≥20%

اسلاید 80: Obesity Trends* Among U.S. Adults BRFSS, 2001(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

اسلاید 81: (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)Obesity Trends* Among U.S. Adults BRFSS, 2002No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

اسلاید 82: Obesity Trends* Among U.S. Adults BRFSS, 2003(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

اسلاید 83: Obesity Trends* Among U.S. Adults BRFSS, 2004(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

اسلاید 84: Obesity Trends* Among U.S. Adults BRFSS, 2005(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

اسلاید 85: Obesity Trends* Among U.S. Adults BRFSS, 2006(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

اسلاید 86: Obesity Trends* Among U.S. Adults BRFSS, 2007(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

اسلاید 87: Obesity Trends* Among U.S. Adults BRFSS, 2008(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

اسلاید 88: Obesity Trends* Among U.S. Adults BRFSS, 2009(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

اسلاید 89: Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

اسلاید 90: 2010 State Obesity Rates2010 State Obesity Rates2010 State Obesity Rates2010 State Obesity Rates2010 State Obesity Rates2010 State Obesity Rates2010 State Obesity Rates2010 State Obesity RatesState%State%State%State%Alabama32.2Illinois28.2Montana23.0Rhode Island25.5Alaska24.5Indiana29.6Nebraska26.9South Carolina31.5Arizona24.3Iowa28.4Nevada22.4South Dakota27.3Arkansas30.1Kansas29.4New Hampshire25.0Tennessee30.8California24.0Kentucky31.3New Jersey23.8Texas31.0Colorado21.0Louisiana31.0New Mexico25.1Utah22.5Connecticut22.5Maine26.8New York23.9Vermont23.2Delaware28.0Maryland27.1North Carolina27.8Virginia26.0District of Columbia22.2Massachusetts23.0North Dakota27.2Washington25.5Florida26.6Michigan30.9Ohio29.2West Virginia32.5Georgia29.6Minnesota24.8Oklahoma30.4Wisconsin26.3Hawaii22.7Mississippi34.0Oregon26.8Wyoming25.1Idaho26.5Missouri30.5Pennsylvania28.6  

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اسلاید 92: Obesity- Heavy burden for the society

اسلاید 93: Obesity: risk factor for various disorders

اسلاید 94: 肥胖与代谢综合症

اسلاید 95: Surgical treatment of obesity

اسلاید 96: Life style related disease－accident25million 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

اسلاید 97: Life style related disease－accidentAccident 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

اسلاید 98: Stress from modern society - depression 现代社会的压力－抑郁症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 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 one’s life time

اسلاید 99: 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.

اسلاید 100: Stress from modern society - depression Suicide rate in severe depression reaches 15％, writers or poets are a high-risk population for suiciceErnest Hemingway l899～1961Kawabata Yasunari Gu ChengSanmaoIris ChangXu ChiMikhail Sholokhov) Fajeyev

اسلاید 101: Stress from modern society - depression High risk population-entertainment circle陈百强 李恩珠 倪敏然陈宝莲 张国荣

اسلاید 102: Development of medical technology iatrogenic disease 医源性疾病 Tetracycline teeth (enamel) Deaf induced by toxicity of aminoglycoside antibiotic (streptomicine, neomycine Kanamycine, gentamycine, Kasugamyxine) account for 50% of acquired deaf and dumb 聋哑Dance “Thousand-hand Goddess of Mercy

اسلاید 103: Development of medical technology iatrogenic disease 医源性疾病Thalisomide, a sedative produced by ChemieGruenenthal, Germany in 1957 for sick of pregnant women.Up to 1959 more than 1m took the drug, 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(海豹肢 Seal’s limb)

اسلاید 104: Descriptive studyCountrySold Thalidomide(kg)Cases of Phocomelia Austria2078Belgium25826UK5769349Holland14025Norway6011Portugal372Switzerland1136Germany300995000

اسلاید 105: Eco-epidemiological studyNumber of phocomelia casesDrug sold

اسلاید 106: Case-control studyHistory of drug useMother of birth defect childControlTotalYes34(68.0%)2(2.2%)36No1688104Total5090140χ2=69.40, P<0.001, OR=93.5

اسلاید 107: Cohort studyHistoryNumber with deformed infantNumber without deformed infantsTotalIncidence rate(%)Use at 8-10 week pregnancy10142442Not use at early pregnancy5121,43421,4850.24RR=175, AR=41.76%

اسلاید 108: Animal experiments and interventionThalidomide induced limb defects in Rhesus monkeyThalidomide was banned in market in1961.Limb defect have become rare again since 1962

اسلاید 109: 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

اسلاید 110: 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), Kaposi’s sarcoma (HIV infection)Further researched revealed: the effect of thalidomide is associated with inhibition of TNF-α and anti -angiogenesisNo weal without woe.  (Luck and Misfortune comes in turn.) 福兮祸所伏 , 祸兮福所倚integrinthalidomideDNA intercalation

اسلاید 111: Chinese 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 without 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 follow (thee).

اسلاید 112: 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

اسلاید 113: ThanksTHANK YOU FOR YOUR ATTENTION