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医学史简论 ( 8 ) A Brief History of Medicine
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医学史简论 ( 8 ) A Brief History of Medicine
浙江大学医学院 余 海Zhejiang University School of Medicine
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人类与传染病的斗争人类与传染病的斗争 (2)(2) Battles to Infectious
Diseases(2)
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Infectious disease in Chinese Medicine
病:disease, illness, more individually 疾病预防: Disease prevention 疫:Epidemic, communicable disease, more
population-based ( 瘟疫 plague) 防疫: Epidemic prevention 免疫: Immunity, 免疫学: Immunology 疫苗: Vaccine 预防接种 Vaccination ( Inoculation )
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How did we win the battles
Identify the pathogens - Germ Theory 病原理论 Effective therapy – Vaccine and Antibiotics 疫苗和抗菌素
Prevention and control - Public Health System 公共卫生
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Establishment of Germ Theory De Contagione et Contagiosis Morbis (On
infection and infectious diseases,1546) He proposed that epidemic diseases are
caused by transferable tiny particles or
"spores" that could transmit infection by
direct or indirect contact or even without
contact over long distances.
Girolamo Fracastoro
1478-1553
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Establishment of Germ Theory
Antonie van Leeuwenhoek 1632-1723
A Dutch cloth merchant used new method for grinding and polishing tiny lenses of great curvature which gave magnifications up to 270 diameters
First to see and describe bacteria as animalcules 小动物,
Leeuwenhoek
became the
pioneer of
microbiology
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Establishment of Germ Theory Created germ theory of disease,
(germ theory vs miasma theory and spontaneous generation)
Created the first vaccine for rabies
Invented Pasteurizaion Is regarded as one of the three
main founders of microbiology, together with Ferdinand Cohn and Robert Koch.
巴斯德 1822-1895
Louis Pasteur
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Germ Theory vs Spontaneous Generation Theory"Do not put forward anything that you cannot prove by experimentation"
swan-neck flask experiment
broth
broth
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Establishment of Germ Theory
Heinrich Hermann Robert Koch (1843-1910 )
German physician Isolating Bacillus anthracis (1877),
the Tuberculosis bacillus (1882) and the Vibrio cholera (1883)
Development of Koch’s postulates He was awarded the Nobel Prize
in Physiology or Medicine for his tuberculosis findings in 1905.
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Pure culture of bacteria
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Koch’s postulates
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Koch’s postulates
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Koch’s postulates
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Discovery of Viruses病毒的发现
tulips breaking virus
1619 (a morbid beauty)
tobacco mosaic virus
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Discovery of Viruses The very first virus discovered is credited
to the St. Petersburg Academy of Science on the 12th February 1892 by Dmitri Iwanowsky a Russian botanist. While studying mosiac tobacco disease, he found that the agent causing the disease was small enough for pass though ceramic filter that are small enough to trap all bacteria. This is generally accepted as the beginning of Virology.
Ивановсқий
(1864-1920),
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Discovery of Viruses 1898, Dutch scientist
Martinus Beijernick confirmed Iwanowski's results on tobacco mosaic virus.
He developed with the term "contagium vivum fluidum" which means “soluble living germ” as first the idea of the virus. Martinus Beijernick
(1851-1931)
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Dimensions of viruses
about 20 nm to about 250nm in diameter
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… just for comparisonLeukocyte
10 µm
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… just for comparisonLeukocyte Bacillus subtitlis
1 m
10 µm
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… just for comparison Leukocyte Bacillus subtitlis Herpesvirus
1 m
10 µm
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Discovery of Viruses
1898 German scientist Loeffler and Frosch discovered Foot-and-mouth disease virus
1911, Rous discovered Rous sarcoma virus
1915-1917, Twort and d’Herelle discovered bacteriophage
TMV ( Tobacco mosaic virus)
phage
TYMV (Tomato yellow mosaic virus)
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Shapes of Viruses
Spherical
Rod-shaped
Brick-shaped
Tadpole-shaped
Bullet-shaped
Filament
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Bacteriophage
1
2
3
4
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Bacteriophage(Replication
of DNA virus )
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Influenza Virus( Replication of RNA virus
)
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HIV( Replication of
retrovirus)
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Invention of Vaccine
In the 10th Century Chinese invented variolation (blow the scab of smallpox skin lesion)
In 1796 English doctor Edward Jenner invented cowpox vaccine against human smallpox
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Invention of vaccines Chicken cholera bacteria 鸡霍乱
placed
1880,Pasteur first invented chicken cholera live attenuated vaccine
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Development of vaccines
1881, Pasteur
developed anthrax 炭疽vaccines, which were
based on live-attenuated
cultures of Bacillus
anthracis and effectively
protected livestock from
the disease
anthrax Live-attenuated anthrax vaccine
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Invention of rabies vaccine 狂犬病
Rabies virus 545
Negri body
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Rabies vaccine was first used on 9-year old Joseph Meister, on July 6, 1885
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Invention of vaccines
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Diphtheria antitoxin 白喉抗毒素At that time in Germany alone 50,000 children
died from diphtheria every year.
1891 Von Behring cured first case of diphtheria with antitoxin, thousands of life have been saved since he developed
serum therapy
Diphtheria toxin
and antitoxin
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Diphtheria antitoxin
•Roux and Yersini discovered diphtheria toxin which is responsible for the symptoms of the disease
•Von Behring and his co-worker Kitasato discovered the diphtheria antitoxin which lay foundation of serum therapy
北里柴三郎 Kitasato Shibasaburo
1852-1931
Emil Adolf von Behring 1854 - 1917
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Tetanus antitoxin 破伤风
With the same principle Von Behring and Kitasato developed tetanus antitoxin
Von Behring won the first Nobel Prize in Physiology or Medicine in 1901 for developing
serum therapy against
diphtheria and tetanus
opisthotonus角弓反张
dorsal , ventral
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Poliomyelitis (infantile paralysis) & Poliovirus 脊髓灰质炎 (小儿麻痹症)
Poliomyelitis 18th Dynasty (1580-1350 BC)
Equinus clubfoot
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Franklin Roosevelt
himself was a victim of polio, launched the March of Dimes to raise the National fund for polio prevention in 1938
Jonas Salk invented live polio vaccine in 1954
Albert Sabin invented oral live-attenuated vaccine (pills)
Three American scientist John Enders, Thomas Weller and Frederick Robbins discovered method to culture polio virus using non-nervous tissue, they won Nobel Prize in 1954
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Chemotherapy for Syphilis 梅毒
Treponema pallidum
Before chemotherapy
introduced, mercury used
be the only cure for
syphilis, but the harm of
mercury poisoning is more
serious than the disease
itself
A night in the arms of
Venus leads to a lifetime
on Mercury
风流一夜情 水银伴终生
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Chemotherapy for Syphilis
Paul Ehrich intended to find the magic bullet
against microorganism from chemical dyes
In 1909 he and his student Hata Sahachiro (
秦佐八郎) developed a arsenical
compounds Salvarsan (Arsphenamine , 606
) , which is effective against syphilis
Ehrlich received the Nobel Prize for
Medicine together with Mechnikov in 1908 Paul Ehrlich(1854 -1915) and Hata Sahachiro
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Discovery of antibiotics and the therapeutic revolution
Domagk found f red dye Prontosil and its derivant sulfonamide to be effective against streptococcus, and treated his own daughter Alice with it, saving her the amputation of an arm.
Prontosil became the first commercially available antibacterial agent
Gerhard Domagk
1895-1964
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Discovery of antibiotics and the therapeutic revolution
Afterward a series of sulfonamides 磺胺 were synthesized and sulfonamides became a revolutionary weapon at the time, but were later replaced by penicillin
Domagk received the 1939 Nobel Prize in Physiology or Medicine
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Discovery of antibiotics and the therapeutic revolution
Flaming discovered the antibiotic penicillin 青霉素 from the fungus Penicillium notatum in 1928, and published in 1928
Alexander Flaming 1881-1955
staphylococci
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Sir Alexander Fleming Twice Saved Churchill's Life
(A false story)
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Discovery of antibiotics and the therapeutic revolution
1939, biochemist Ernst Chain (1906-1979 ) and pathologist Howard Florey (1898-1968 ) took up researching and mass producing it with funds from the U.S and British governments.
They started mass production after the bombing of Pearl Harbor. When D-day arrived they had made enough penicillin to treat all the wounded allied forces.
Feb 12,1941, penicilline was first applied clinically Penicillin was referred as one of three major invents during
the World War II (Atom bomb, Radar and Penicillin)
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抗菌素的发现-治疗学的革命
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Discovery of antibiotics and the therapeutic revolution
Waksman performing research in soil bacteriology in Rutgers University
Waksman and his team discovered several antibiotics, including actinomycin clavacin, streptomycin, neomycin and others. Of these streptomycin 链霉素 was the first antibiotic that could be used to cure the disease tuberculosis (1943)
Selman Waksman
1888-1973
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Dispute about discovery The details and credit for the discovery of its use as
the antibiotic streptomycin were strongly contested by one of Waksman's graduate students, Albert Schatz, and resulted in litigation. The litigation ended with a substantial settlement for Schatz and the official decision that Waksman and Schatz would be considered co-discoverers of streptomycin. Schatz made the discovery while working in Waksman's basement lab, and using Waksman's equipment
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Discovery of antibiotics and the therapeutic revolution
After the discovery of penicillin and streptomycin, more antibiotics were isolated from the soil, upon 1960s more than 600 antibiotics were available in practice
Thanks of discovery and application of antibiotics severe bacterial infection has no longer a incurable disease and the average life expectancy increased by 10 year leading to the therapeutic revolution. 。
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Public Health System 公共卫生系统 Early religions attempted to regulate behavior that specifically
related to health, from types of food eaten, to regulating certain indulgent behaviors, such as drinking alcohol or sexual relations.
Rome : water supply and sewage system, public bath and public toilet
After plague outbreak in Middle Ages: clearance, sanitation, removing bodies of the dead, burning parts of the city and quarantine system
1848 passed British Public Health Act 1946 CDC was founded in US (Communicable Disease Center-
1980 Centers of Disease Control)
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August 1854 cholera outbreak in London Soho, 140,000 infected and 618 died. John Snow surveyed the cause and transmission of the disease
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Public Health System
An English social reformer, noted for his work to reform the Poor Laws and improve sanitary conditions and public health
1842, Chadwick proposed 'Report into the Sanitary Conditions of the Labouring Population of Great Britain'
1848 British parliament passed the British Public Health Act
People found him rude and dictatorial. Some said that they would rather take their chance with cholera than be told what to do by Chadwick! Sir Edwin Chadwick
1800-1890
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Public Health System
Public health is “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.” (1920, C. E.A. Winslow)
The goal of public health is to improve lives through the prevention and treatment of disease. The WHO defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
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Functions of Public Health
Prevention of infectious diseases and other diseases through primary,
secondary, tertiary prevention
Changing health behavior, improving diet and nutrition through health
education and health promotion
Improving environment including living environment and occupational
environment
Reproduction health
Epidemilogical survey, disease surveillance, statistics, research and
education
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Changing the Leading Causes of Death
Leading causes of death in US: comparison of 1990 and 1997 1990 年和 1997 年美国主要死因比较
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婴幼儿死亡率 平均期望寿命
Public Health System
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The EndThe End再见