医学史简论 A Brief History of Medicine

1. 医学史简论A Brief History of Medicine 余 海 YuHai yuhai@zju.edu.cn

2. Why should we learn history The longer you look back, the further 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)

3. Whatis 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.

4. About the course • Elective：32 teaching hours，2 credit points • Schedule： Lectures + discussion History of human diseases 6h Origin and history of medicine 18h Studentpresentation & discussion 6h • Test：Essay writing

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

6. Time Schedule

7. Time Schedule (cont.)

8. History of Human Disease

9. 智人 Human Evolution 直立人 能人 南方古猿 humanlike primates Australopithecine (hominid genus Australopithecus )

10. Human Evolution Since the first man emerges on the Earth，theman and its disease have been bonded inseparably.

11. 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.

12. 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 -EdwardLivingstonTrudeau

13. Smallpox天花 天花病毒 poxviridae othopoxvirus Infectious disease caused by virus: Papule-vesicle-pustule-scar (pockmark)

14. Retinoblastoma 视网膜母细胞瘤 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) • Epidemicof infectious disease Digestive air Insects Domestication of animals Settle down and domestication of animals

19. 人畜共患病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. 血吸虫病 Schistosomiasis Schistosoma heamatobium in Africa，Mideast S. Japonicum in China，Phillipines S.mansoniin Africa，Latin America

24. 古病理学 Paleopathology Examining mummy with CT scanner Calcification in bladder caused by schistosomiasis

25. Paleopathology Schistosoma 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 stonesand 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. Congestionof 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（黑死病,black death）, more than 25 million people died and the population of Europe reduced by one third Caffa

29. 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)

30. Modern society : globalization leads to the speed of virus transmission spread as quick as that of the modern transportation (SARS2003,N1H1Flu2009) • 流行 • Epidemics outbreak of infectious disease • 大流行Pandemics • Epidemic spreading across a large region

31. Disease in modern society 现代社会疾病 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 • Demographic：degeneration disease, chronic non-communicable diseases • Ecological and environmental：pollution and occupational diseases • Dietary and life style：smoking, obesity, accident • Stress and social pressure：depression and suicide • Progress of medical technology: iatrogenic disease, brain death, vegetative state

33. Life Expectancy at Birth

34. Ageing of population China: Life expectancy National71.44 (2000) Zhejiang77.29 （2010）Hangzhou 80.26(2010，M77.98,F82.76)

35. 社会老龄化的影响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%) 资料来源: 2001年世界卫生报告

39. Causes of death in different WHO regions: 2000 % Non-communicable 75 Injury 50 Communicable, malnutrition, perinatal 25 SE-Asia Euro Africa Mid-East W-Pac America 资料来源: 2001年世界卫生报告

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生态破坏-全球变暖 Energy Consumption CO2 Emission Greenhouse effect Global Warming Ecological Damage Disease Epidemics Vector-borneinfections Weather = Current state of the atmosphere Climate = average weather conditions* > 10 years

42. The greenhouse effect Greenhouse gases: CO2 carbon dioxide CH4 methane O3 ozone N2O nitrous oxide H2O Incoming wavelength absorption < 0.3um Outgoing wavelength absorption > 0.7 – 30 um

44. Impact of climate changes on health40 year trend in dengue and temperature, Singapore

45. Ecological damage-ozonosphere hole • Ozonosphere absorb ultraviolet lights <300nm from solar radiation protecting living organisms in the earth from UVdamage. • Chlorofluorocarbons (CFCc）widely used for refrigerants and spray cause depletion of the atmospheric ozone layerby releasing free radical .  • Over exposure to UV may cause skin cancer, cataract，etc. Antarctic ozone hole

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

48. Environmental Pollution Minamata Disease(Mercury poisoning) • Chisso （智索）Chemical Factory built in1925used to produce fertilizer，started to manufacture choroethylene in 1949. Large amount mercury-containing catalyzer （methyl mercury) in waste water drained into the bay. • 1956cat 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 1784died.

49. Environmental Pollution –Minamata Disease Plankton-shellfishes-small fishes- big fishes-human cerebrum cerebella

50. Environmental Pollution –Minamata Disease