1. 医学史简论（7） A Brief History of Medicine
浙江大学医学院 余 海

2. Send away the Good of Plague-Battles to Infectious Diseases
送瘟神-
人类与传染病的斗争
Send away the Good of Plague-Battles to Infectious Diseases

3. History of Infectious Diseases
Infection 感染
the invasion of the body by any of various infectious agents – including bacteria, viruses, fungi, protozoan and worms，and the reaction of the body to them or their toxins.

4. Definitions Infectious disease 感染病 (cause)
The disease caused by infection and/or capable being communicable by infection
Communicable （contangious）disease 传染病 (transmission)
The disease capable of being transmitted from one person to another or from animals (intermediate host) to human.
Epidemic disease 流行病 (incidence)
The occurrence of cases of disease in excess of what is usually expected for a given period of time. (epidemic hysteria)
Endemic disease 地方病 (location)
The disease that is constantly present in people living in a particular location (endemic thyroid disease-goiter)

5. Human and Infectious Diseases
Epidemics 流行
Sudden outbreak of diseases in excess of what is expected
Pandemics （全球）大流行
Sudden geographically widespread outbreak of diseases

6. History of Infectious Disease
Prehistoric period：Infectious disease rare
Agriculture society：Increased transmission
Urban civilization： Congestion of urban inhabitation, war and travelling result to outbreak of infectious diseases

7. Routes of transmission
Three factors of transmission of infectious disease
Source of infection (Typhoid Mary, 52/7)
Susceptible population
Transmission routes
Direct touch
Droplet spittle
Air-borne
Indirectutensils
insect
Indirect
touch
Routes of transmission
Speed of sneeze: 170km/h 47.2m/s

8. Victories over infectious diseases
Smallpox
plague
Influenza
Diphtheria
Measles
Tetanus
poliomyelitis
schistosomiasis

9. 天花 smallpox 天花病毒 poxviridae othopoxvirus
pockmarked face，from maculopapular rash to raised fluid-filled blisters to pustules

10. 天花 smallpox Egyptian Pharaoh Ramses V died from smallpox in1157 B.C
Frequent outbreak in the history
300 million people died from smallpox in 20th century (100 million died from wars)
Ramses V 1157 BC

11. Victims of Smallpox Joseph I d1711 顺治 1638-1661 Marry II 1662-1694
Louis XV Elizabeth I
Joseph I d 顺治 Marry II

12. 天花 smallpox Lady Montagu variolation
Chinese invented inoculation of human smallpox (variolation) in 10th century, widely used in century
Lady Montagu brought back from Turkey to Europe in 1721
Lady Montagu
variolation
Blow the scab of smallpox skin lesion

13. 天花 smallpox
Inspired by the fact that dairymaids infected with cowpox were immune to small-pox, Edward Jenner invented cowpox vaccine against human smallpox.
Edward Jenner
variolation vaccination (vaccinia vacca-cow)

14. 天花 smallpox
Jenner deliberately infected James Phipps, an eight year old boy, with cowpox in May 14, He then exposed Phipps to smallpox–which Phipps failed to contract. After repeating the experiment on other children, including his own son, Jenner concluded that vaccination provided immunity to smallpox without the risks of variolation. Jenner’s findings were published in 1798.

16. 天花 smallpox
in 1840 Vaccination Acts were passed, the British government banned variolation and provided vaccination, free of charge.
In 1805 vaccination was introduced to China via Portugal merchants in Macao

17. 天花 smallpox 1840 British vaccination Acts
1940 Smallpox was eradicated in Europe and North America
1960 Last Chinese case occurred in a Yunnan-Burma border village
1967 WHO launched smallpox eradication movement
（At that time 30 million
patients,2million death every
year）
30 countries
1700 medical doctors
200,000 health worker
Mobilized in the movement

18. 天花 smallpox Last natural infected Somalia patient cured in Oct 26 1977
A fatal incidence occurred in Birmingham University in August 1978 a woman lab photographer Janet Parker became the last victim of smallpox, Prof Henry Bedson committed suicide.
May 8, 1980 WHO announced:
Global eradication of smallpox
Ali Maali

19. 天花 smallpox Reasons for possible eradication of smallpox
There are no other virus reservoirs but man
Only acute infection exists, the outcome of disease: die or life-long immunity
Virus is highly immunogenic, so vaccine has been most effective

20. 鼠疫 Plague
bacterium 
Yersinia pestis
Prairie dog
Flea Rat

21. Bubonic and Pneumonic Plague

22. 伍连德和鼠疫 Chinese Plague Fighter Wu Lien-teh
Born in Penang, Malaya in a Chinsese family
Studied Medicine in England
1907 Vice-Director of the Imperial Army medical College in Tientsin
In the winter 1910 a endemics of plague outbroke in Manchuria which claimed 60,000 victims, the endemic was controlled under his leadership.
chaired the International Plague Conference in Mukden (Shenyang) in April 1911
He was the first president of the China Medical Association (1916–1920) and directed the National Quarantine Service
1937 he moved back to Ipoh as a GP
Wu Lien-Teh

23. 伍连德和鼠疫 Chinese Plague Fighter Wu Lien-teh
1935 he was nominated as the candidate of Nobel Prize of Physiology or Medicine for work on pneumonic plaque and especially the discovery of the role played by the Tarbagan in its transmission.
(Folke Henschen)
梁启超：“科学输入垂五十年，国中能以学者资格与世界相见者，伍星联（即伍连德）博士一人而已！”

24. Black death in 14th century
plague outbreak in Europe（black death 黑死病）,claimed 2.5million, 1/3 of European population ( Threw bodies into city using trebuchet to spread plague-first biological warfare
by Tartar cavalrymen)
Caffa
Crimea

25. Learn from plaque：contagion gown
Beak fill of spices

26. Quarantenaria （40天） Quarantine （检疫）
Learn from plague: quarantine
Quarantenaria （40天） Quarantine （检疫）

27. Bacteriological weapon
During the Sino-Japanese War , plague was used as a bacteriological weapon by the Imperial Japanese Army. These weapons were provided by Shiro Ishii’ Units (石井, 731 部队） and used in experiments on humans before being used on the field.
Vivisection
One of
the survivors
Bacterial bomb

28. 血吸虫病 Schistosomiasis
Schistosoma heamatobium (Bilharzia) Africa, Middle East
S. Japonicum China, Phillipines
S.mansoni Africa, Latin America

29. Paleopathology Findings
Schistosoma eggs discovered in a well-preserved ancient lady’s body (in Changsha Mawangdui of Hunan Province, 165 BC) , and also found in another well-preserved man’s body (167 BC) in Jiangling of Hubei Province

31. 血吸虫病
Schistosomiasis
Used be prevalent in 12 provinces, 400 counties, threatened 100 million people and 1 million domestic animals (buffalo)
Mass Movement of Schistosomiasis Prevention (血防Xuefang)in 1950s
Treatment of patients and animals－eradication of the sources
Clearance of snails-intermediate host
Water and feces control-cut the transmission routes

33. The God of Plague (Shistosomiasis) is back

34. Infection disease control-Long way to go传染病控制 - 任重而道远
Eradicated: smallpox
Vaccine preventable: measles, poliomyelitis, diphtheria, whooping cough, tetanus
Uncontrolled：plague, cholera, tuberculosis, viral hepatitis
Re-emerging：sex-transmitted disease, Dengue fever, schistosomiasis
Newly emerging：Legionnaires’ disease, Ebola fever, SARS, bird flu, AIDS, Chikungunya Disease

35. 流感 Influenza 1918 flu pandemic (Spanish flu)
spreading to nearly every part of the world.
Caused by Influenza virus strain subtype H1N1.
From March 1918 to June 1920, estimated 20 to 100 million people were killed (mortality rate 2.5-5%)
The extreme virulence may be associated with overreaction of immune system-cytokine storm
Mittelmachte (Central Power 同盟国)
Entente Power (协约国）

36. Avian Influenza (Bird Flu)
Bird flu is influenza caused by viruses adapted to birds, which belong to Influenza virus A
Influenza virus with the diameter of 80～120nm

37. Avian Influenza Virus Hemagglutinin,H: H1～H15,
Neuraminidase, N: N1～N9 ,
Theoretically there could be 135 subtypes,
Treatment: Tamiflu (Oseltamivir phosphate)
A neuraminidase inhibitor
Avian Influenza Virus

38. Ecology of Avian Influenza Virus

39. Bird migration

40. Viet Nam
Cambodia

41. Thailand

42. Indonesia

43. Felines (tiger, leopard) can be infected with bird flue (60 tigers and 1 leopard in Thai zoo died from bird flue in 2003)

44. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO 2003-2012
Country
2010
2011
2012
2013
2014
Total
case
death
Azerbaijan 8 5
Bangladesh 1 2 3 7
Cambodia 9 26 14 4 56 37
Canada
China 38 25 47 30
Djibouti
Egypt 90 27 29 13 39 15 11
176 63
Indonesia 
162
134 12 10
197
165
Iraq
Laos
Myanmar
Nigeria
Pakistan
Thailand 17
Turkey
Viet Nam
112 57
127 64
468
282 48 24 62 34 32 20 18
667
393
The overall case fatality rate 393/667=59.0%

45. Comparison of bird flu with “swine flu”
禽流感和“猪流感”发病对比
Comparison of bird flu with “swine flu”
Cytokine storm “细胞因子风暴”
死亡率 ～60% vs ～1%

46. Antigenic drift
抗原漂移
Antigenic shift
抗原转移

47. Potential risk 潜在危险
The mutation of virus may cause the outbreak of pandemics of avian influenza (gene shift or draft, leading to transmitted from human to human)
Nature estimated：That may cause one third of world population infected , 30 million may need hospitalized, one quarter of which would die.

48. AIDS-the plague for the century

49. Plague in 21th century-AIDS
1981 in US 5 cases reported and named as Acquired Immunodeficiency Syndrome (AIDS)
1983 and Montagnier of Pasteur Institute and Gallo of NIH isolated the virus (lymphadenopathy-associated virus, LAV; human T-lymphotropic virus type III, HTLV-III)
1986 naming as “Human Immunodeficiency Virus HIV”
1987 President Mitterrand of France and President  Reagan of the USA met that the major issues were ironed out.

50. Epidemiologic Notes and Reports Pneumocystis Pneumonia --- Los Angeles
June 5, 1981 / 30(21);1-3
Epidemiologic Notes and Reports
Pneumocystis Pneumonia --- Los Angeles
In the period October 1980-May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. Two of the patients died. All 5 patients had laboratory-confirmed previous or current cytomegalovirus (CMV) infection and candidal mucosal infection. Case reports of these patients follow.
Patient 1: A previously healthy 33-year-old man developed P. carinii pneumonia and oral mucosal candidiasis in March 1981 after a 2-month history of fever associated with elevated liver enzymes……

51. The Nobel Prize in Physiology or Medicine 2008
"for his discovery of human papilloma viruses causing cervical cancer"
"for their discovery of human immunodeficiency virus"
Harald zur Hausen Francoise Barre-Sinoussi Luc Montagnier
Regulation Retroviral Infections Unit, Virology Department, Institut Pasteur, b 1947
World Foundation for AIDS Research and Prevention, b 1932
Germany Cancer Research Center , Heidelberg, b 1936

52. AIDS virus
retrovirus
CCR 5

53. Replication of HIV

55. Clinical manifestation- cachexia

56. Clinical manifestation-Kaposi’s sarcoma

57. Clinical manifestation- Pneumocystis carnii pneumonia

58. HIV/AIDS
HIV continues to be a major global public health issue, having claimed more than 34 million lives so far. In 2014, 1.2 (1.0–1.5)million people died from HIV-related causes globally.
There were approximately 36.9 (34.3–41.4) million people living with HIV at the end of 2014 with 2.0 (1.9–2.2) million people becoming newly infected with HIV in 2014 globally.
Sub-Saharan Africa is the most affected region, with 25.8 (24.0–28.7) million people living with HIV in Also sub-Saharan Africa accounts for almost 70% of the global total of new HIV infections.

59. Adult HIV Prevalence

61. 中国爱滋病形势 AIDS in China Ice burger Reported: HIV infection 492,191
（surviving 383,285）
（Dec, 2012）
Estimated ：
HIV infection 780,000,
AIDS patients 154,000
AIDS death 160,000
Ice burger

62. Mode of Transmission： 18.7% 18.7% 8.4% 61.6% 9.4% Between US and China
0.3%
1.6%
8.4%
61.6%
9.4%
AIDS transmission:China
11.6%Sexually transmitted ( ) 75.2% (2011) half of which via MSM

63. 爱滋病的来源？
Origin of Aids?

64. The origin of HIV
HIV virus not detected in any blood samples before 1959
It may transformed from simian immunodeficiency virus (SIV) of African primates (African Green Monkey, Chimpanzee)

65. 发达国家艾滋病死亡率下降 （美国）

66. 艾滋病传布途径 AIDS transmission

67. control transmission
控制性传播
控制输受血传播
控制医源性传播
控制吸毒传播
控制母婴传播

68. Provision of sterilized syringes
Prevention from iv drug use
Drug control
Detoxification
Provision of sterilized syringes
两害相较取其轻
To choose the lesser of two evils

69. To choose the lesser of two evils
Prevention of sexual transmission
Abstinence
Be faithful
Condom
两害相较取其轻
To choose the lesser of two evils

71. No condom
No sex

72. World Aids Day: 1 December (since 1988）

73. World AIDS Day, 1 December 2013
“GETTING TO ZERO.“
行动起来，向零艾滋迈进
全民参与，全力投入，全面预防
ZERO New HIV infections.
ZERO Discrimination and
ZERO AIDS-related deaths.

74. 谢谢