Disease management: 以感染性疾病為例子 20Carriers.JPG For lecture only, BC Yang Nightmare and consolation Note: 疾病是否獨立於文化之外？

Disease management: 以感染性疾病為例子

http://vaso.webzdarma.cz/gallery/D/Disease%20Carriers.JPG

For lecture only , BC Yang

Nightmare and consolation

Note: 疾病是否獨立於文化之外？

• There are at least twelve gods or goddessess for healing alone; health personified is named Hygeia, pronounced Hi-je'-a. It is derived from the root word hugies or hygies , meaning healthy, which is also the root word for hygiene. The traditional male-dominated medical profession prefers to use the god of Medicine, Asclepius, (or the Roman name Aesculapius) which is much harder to spell and pronounce, and rarely associated with women.

Klimt, GustavHygeia (1907)

http://www.hygeia.com/goddess.htmlhttp://www.homepages.indiana.edu/020201/text/asclepion.htmlhttp://www.artchive.com/artchive/K/klimt/klimt_hygeia.jpg.html


http://www.artchive.com/artchive/K/klimt.html

http://www.artchive.com/artchive/K/klimt.html

The name Ophiuchus is derived from the Greek word for “serpent handler.” There is no healer or god with the name Ophiuchus, but he has always been asso

ciated with Asclepius. (Apollo 的兒子 , Chiron 教以醫理 )

Asclepius 有起死回生的本領 , 有一次 , 克里特島皇 Minos 之幼子 Glaucus 溺斃於一瓶蜜糖中 ,Asclepius 在救他時 , 一條蛇剛巧經過 ,Asclepius 立時以杖殺蛇 , 此時另一條蛇叼著草藥救死去的蛇 ,Asclepius 攫去那些草藥救活 Glaucis, 因此星圖中 Asclepius 手持蛇 , 蛇因每年蛻皮而成為復活的象徵 , 亦有說 Asclepius 曾受Medusa 身體右面的復活血( 身體左面的是毒血 ), 所以以蛇為醫學象徵 , 而雙蛇杖的醫學標記一直沿用至今 . Just for fun!

星座與神話 :http://hometown.aol.com/lklstars2/cons.htm http://www.bud.org.tw/chen/chen0408.htm


• Aesculapius worked in Thessalay (near Macedonia) in the 5th century BC. He is reported to have treated patients with relaxation, diet, hydrotherapy, herbs, massage, advice and tender loving care. Serpents were used at this stage as tools in curing patients; and it is the staff of Aesculapius, with a serpent knotted around it, that has become the symbol of medicine.

http://www.wischik.com/lu/massage/ljwhistory.html


www.eastemple.org.tw/ common/about7.aspx

藥王，梵名 Bhaisajya-raja ，音譯鞞逝捨羅惹。藥王菩薩求法火煉身，為施與良藥，救治眾生身、心兩種病苦之菩薩。據觀藥王藥上二菩薩經載，過去無量無邊阿僧祇劫，有佛號琉璃光照如來，其國名懸勝幡。有日藏比丘，聰明多智，為大眾廣說大乘如來之無上清淨平等大慧。時眾中有星宿光長者，聞說大乘平等大慧，心生歡喜，以雪山之良藥，供養日藏比丘及眾僧，並發願以此功德回向無上菩提，若有眾生聞己名者，願其得滅除三種病苦。其時，大眾讚嘆星宿光長者為藥王。菩薩久修梵行，諸願已滿，藥王菩薩於未來世成佛，號淨眼如來（梵 Vimal-netra ）。藥上菩薩於未來世成佛，號淨藏如來（梵 Vimala-garbha ）。

藥王菩薩藥上菩薩


Sir Luke Fildes's popular masterpiece, The Doctor was commissioned by Henry Tate in 1887. Fildes eldest son, Phillip died Christmas morning, 1877. He was attended by Dr. Murray, who impressed Fildes greatly with his care and attention to his dying child. The painting has a happier ending than real life did, as the child has survived through the night and dawn is breaking.

The Doctor exhibited 1891


人有什麼機會突破單純的盼望？

三種處理傳染 / 感染性疾病的方式：

公共衛生免疫學抗生素還有更好的辦法嗎 ?


A fact

For lecture only For lecture only , BC Yang

175.9 Malignant neoplasms:

56.7 Heart diseases

56.2 Cerebrovascular diseases

44.6 Diabetes mellitus

31.1 Accidents

25.7 Pneumonia

22.5 Chronic liver disease and cirrhosis

22.2 Nephritis, nephrotic syndrome, and nephrosis

17.2 Suicide

8.6 Hypertensive disease

Gastritis, enteritis, and colitis 135

Pneumonia 134.5

Tuberculosis, all forms 91.6

Heart disease 49.0

Vascular lesions affecting central nervous system 48.8

Cause of perinatal mortality 44.1

Nephritis and nephrosis 36.3

Malignant neoplams 30.7

Bronchitis 28.1

Malaria 27.5

Death per 100,000, 1952 versus 2007 (WHO 2008)

Some facts


近代醫學處理疾病的三種思考進路：免疫學、公共衛生及抗生素。


金納 (1798)

斯諾 (1849)

巴斯德 (1859)

李斯特 (1866)

柯霍 (1876)

弗萊明 (1929)

沙賓 (1957)/ 沙克 (1953)

( 民國八十四年 Louis Psateur 逝世百年 )

The earliest reports of dehydrating diarrhea were recorded in Sanskrit, predating Christ.

Hippocrates reported the symptoms of cholera. The epidemic cholera was originally largely isolated to India, and outb

reaks occurred after pilgrimages to the Ganges River, in regular cyclic fashion.

The first modern reporting of epidemic cholera was from Garcia del Huerto, a Portuguese physician working in Gao, India. Yet, no primary source of V. cholerae has been determined that time.

http://info.bio.cmu.edu/Courses/03441/TermPapers/99TermPapers/ChoTox/history.htmlFor lecture only , BC Yang

http://65.107.211.206/health/health10.htmlhttp://www.victorianweb.org/science/health/health10.html


The first outbreak of Asiatic cholera in Britain was at Sunderland on the Durham coast during the Autumn of 1831. From there the disease made its way northward into Scotland and southward toward London. Before it had run its course it claimed 52,000 lives.

在馬雅各的病人中，當時所說的 ”腸塌” 疾病，可能是普通的腸胃炎外，或者是當時台灣常見的赤痢，甚至是霍亂。在 1864-1866 年倫敦發生霍亂時，可能是因為與英國通商、通航而帶來了病源，台灣打狗地區在 1865 年 9 月也緊跟者霍亂流行『註三十』。雖然已無當時的病歷資料和正式的治療紀錄可查，對於那些早期台灣常見的感染性疾病，馬雅各的醫療知識應該並不管用。當年在倫敦發生霍亂時，馬雅各的祖國 ( 英國 ) 的醫師們面對疾病的流行時說：「霍亂是外邦的、不可知而且詭異的，它造成無與倫比的傷亡，引人驚懼，卻大多無法解釋 ....」『註三十一』。

• 註三十：『新樓情、舊相簿』， p18 。 1865 年 9 月旗後地區發生霍亂。

• 註三十一： http://65.107.211.206/health/health10.html 。 A doctor recalled “cholera was something outlandish, unknown, monstrous; its tremendous ravages, so long foreseen and feared, so little to be explained,.....” 。

1865 年 6-7 月 : 東方和西方醫學在台灣的交會楊倍昌國立成功大學微生物及免疫學研究所


• In 1849 Snow proposed that the "Cholera Poison" reproduced in the human body and was spread through the contamination of food or water. Although he was awarded for this work, without the technology and knowledge that we have today, Snow had no way to prove his theory.


描述性的流行病學

Dr Snow took a sample of water from the pump, and, on examining it under a microscope, found that it contained "white, flocculent particles." By 7 September (1849), he was convinced that these were the source of infection, and he took his findings to the Board of Guardians of St James's Parish, in whose parish the pump fell.

Though they were reluctant to believe him, they agreed to remove the pump handle as an experiment. When they did so, the spread of cholera dramatically stopped. [actually the outbreak had already lessened for several days]

http://www.ph.ucla.edu/epi/snow/broadstreetpump.htmlhttp://www.cvm.uiuc.edu/courses/VP350/cholera/cholera.html最完整的資料在 : http://www.ph.ucla.edu/epi/snow.html

Father of epidemiology: John Snow: 1813-1859


"Health by the Numbers"

In 1855 William Farr observed that users of Lambeth Water Company water, taken upstream of London, had 1/10 the death rate of users of other water suppliers, who drew their water from the polluted river downtown. Farr concluded that sewage-contaminated water caused cholera. Public health measures slowly followed, but not before cholera took the life of Louis Pasteur's infant daughter, Camille.

http://www.cvm.uiuc.edu/courses/VP350/cholera/cholera.html http://www.cvm.uiuc.edu/courses/vp350/vp350.html http://www.lshtm.ac.uk/library/archives/farr.html


Robert Koch made the actual discovery of the bacteria that causes cholera in 1876.

6 bacterial pathogens in wound infection in 1878.

Specifically in 1884, Koch isolated Vibrio cholera from the polluted Elbe River in Germany.


The missing piece of mystery; the last hit

Mitten in der Arbeit über die Tuberkulose wurde Koch mit der Führung einer Kommission beauftragt, die im Sommer 1883 in Ägypten ausgebrochenen Cholera untersuchen sollte. Koch und seinen Mitarbeitern gelang es, in Ägypten und später in Indien, den Choleraerreger nachzuweisen und zu beschreiben.

Im April 1885 wechselte Koch, nachdem er einen Ruf nach Leipzig abgejehnt hatte, vom Kaiserlichen Gesundheitsamt zur Berliner Universität über, wo er als Geheimer Medizinalrat und Ordentlicher Professor Direktor des Hygiene-Instituts wurde.

http://www.charite.de/history/de/


後藤新平 (1857-1929) 生於岩平縣的水澤市，旱年習醫二十歲執業，西元一八八二年任名古屋醫院和醫學院院長。中日甲午戰爭時在軍中主持傳染病防治工作表現優異，而為兒玉所賞識。 1898 年 2 月起擔任臺灣總督府民政長官長達八年之久， 1907 年轉任南滿鐵道株式會社社長，大正年問出任東京市長及日本都市研究會 ( 日本都市計畫協會之前身 )的首任會長 (1917─1928) 。他有一套政治生物學原則：「任何殖民制度都必須根據生物學原則。即以適者生存的條件才能贏得勝利」。在臺期問，後藤創辦「臨時臺灣舊慣調查會」，大舉進行調查工作、蒐集統治基礎資枓。這些資料後來成為統治臺灣的無形寶藏。

治台總督兒玉源太郎殖民期間 (1898-1906) ，採取懷柔與鎮壓政策，並籌劃使財務獨立自給自足。而對於反對殖民統治的武裝抗日又厲行殘殺。至明治三十五年 (1902)止，共殺害臺胞三萬二千人。

http://www.tcfsh.tc.edu.tw/contest/%A5x%A4%A4%A4%BD%B6%E9/C-4-3.htmhttp://members.shaw.ca/aifeichen/mainp6c.htm

治台名言：「台灣人貪生怕死、貪小便宜、愛面子 (大頭症 )」


後藤新平

兒玉源太郎

http://www.tcfsh.tc.edu.tw/contest/%A5x%A4%A4%A4%BD%B6%E9/C-4-3.htm


日人治台初期對台灣的印象 :

一年四季皆有傳染病流行 : 霍亂、瘧疾、赤痢、傷寒、腸炎、腳氣病、鼠疫。

台灣人衛生習慣差，台府 (台北 )街市房屋周圍或院內，流出污水，又到處滯留成沼，或人與犬豚雜居。雖有公共廁所之設備，又往往到處散放糞便 ................台南府地方，雜亂廢棄物自不傭論，卽糞尿亦到處散放堆積，道路兩旁之排水溝，污水積滯，惡臭充鼻 ......

日本衛生隊實查紀錄 : 台灣醫療發展史 , 陳永興著 , 月旦出版社 , 1997; p:76 (實際文獻出處待查 )


台北市街景 (太平町通 )

台北太平町後面街道大平町 (今延平北路 1 、 2段 )

台南小西門

台灣老照片第壹輯二南堂人文相本系列圖庫作品http://www.bisouth.com.tw/a-4-1.html

Around 1880

Napoleon conquered much of Europe, reforming and rationalising as he went, creating a 'revolution from above'.

Lincoln Inns Fields , London around 1780

Tokyo, ca. 1880s. 1848 in Seneca Falls, New York,



1910: 防治瘧疾 (寒熱症 , 瘴氣病 ) 的策略

http://www.issp.sinica.edu.tw/hygiene/eng/bibliography/7th_m_01.htmlhttp://www.cdc.gov.tw/museum/gallery/3/page1-003.htm

日據時代（ 1895-1945 ），殖民政府曾經大規模抽血篩檢瘧原蟲，並且採 Robert Koch 法 (?) ，以奎寧全面投藥治療瘧疾 (帶原蟲者，強制服藥 ) ，自 1911 年起在台灣展開「防瘧計畫」。此外殖民政府也透過環境的改變，如都市計畫考慮採光，建築物設計考慮防蚊，填補窪穴排除沼澤，以及自檀香山引進專食孑孓的食幼蚊魚與大肚魚等，設法降低瘧蚊的繁衍與人蚊接觸。在第二次大戰前，台灣的瘧疾死亡率曾經大幅下降。

1897: 證實瘧疾由瘧蚊傳播 1901: 木下嘉七郎發表第一篇台灣有瘧蚊的報告 (?)

鄭成功時期 1661: 200,000

滿清時期 1811: 2,002,861 1895: 2,545,731

日本殖民時期 1896: 2,587,688 (含日本人 10,584) 1905: 3,123,302 1920: 3,655,308 1930: 4,594,061 1945: ~6,000,000

台灣人口統計

台灣醫療發展史 , 陳永興著 , 月旦出版社 , 1997; p:67



Jenner's Inquiry, first published in 1798, reported

how, over a period of years, he had noticed the im

munity provided by cow-pox, and how he decided

deliberately to introduce the disease into a patient

to see if the effect could be artificially produced. S

oon afterwards, he would again inoculate his patie

nts, this time with live smallpox virus ("variolatio

n"), to see if the cow-pox had worked. The "healt

hy boy" whom Jenner, on May 14 1796, first vacci

nated with virus from the dairymaid Sarah Nelme

s was James Phipps, who proved Jenner's point b

y surviving repeated unsuccessful attempts to infe

ct him with smallpox.

http://www.sc.edu/library/spcoll/nathist/jenner.html

"Vaccination," the word Jenner invented for his treatment (from the Latin vacca, a cow), was adopted by Pasteur for immunization against any disease.

Edward Jenner ， 1749-1823

John Hunter give a famous advice to E. Jenner:

Don’t think, try!

正確的解讀這句話 : Stop reading philosophical theories, back to Hippocratic methods; or as said by Claude Bernard: When entering a laboratory one should leave theories in the cloakroom.


http://sca.lib.liv.ac.uk/exhibitions/images/pox.gif

John Hunter (1728-1793): A great surgeon

John Hunter was born in 1728 on a Scottish farm on the outskirts of Glasgow; the youngest of 10 children. He received little in the way of a formal education and dropped out of school at the age of 13 years. Despite this background he was to become one of the of the most influential British surgeons of the 18th century. The lack of a university education failed to lessen his contributions to surgery, medicine and science. Many of these contributions were the result of clear and concise personal observations based on innumerable hours spent preparing anatomical dissections. His anatomical and surgical teaching was held in high regard and his famous pupils include Benjamin Bell, Astley Cooper, Everard Home and Edward Jenner.

http://www.surgical-tutor.org.uk/default-home.htm?surgeons/hunter.htm~right


Who is who

Claude Bernard (1813 - 1878):A great experimental physiologist

Claude's weakness in exams, and he failed to pass the exam that would get him a job teaching medicine. Working as a research assistant didn't provide much pay so he had to find another way of making a living. A friend suggested that he get married and so he did, to the daughter of a rich doctor. His wife provided the money to keep him but their marriage was stormy and unhappy.

In 1847 Claude became Magendie's deputy and began a series of experiments that lead to important discoveries. He showed that the pancreas, a small organ situated towards the back of the abdomen produces substances that break down molecules of fat. Claude realized that the body has control mechanisms producing hormones that maintain body temperature and the levels of nutrients and waste products. This was later called homeostasis.


Who is who (just for reference)


我國最早有關天花的記載，始于晉代葛洪 (283-363) 的《肘後備急方》，因為天花是在大約西元一世紀的戰爭中由俘虜帶來的，所以當時被稱作“虜瘡”。宋真宗 (968-1022) [北宋皇帝（ 997—1022 ）。名趙恒 , 原名趙德昌，

太宗第三子。 ] 年間，天花的流行比較嚴重，當時丞相王旦他擔心自己的小兒子感染天花，當聽說四川峨嵋山有一位道士有預防天花的仙方時，便派人把道士請回了府中。這位道士拿出一些藥沫，倒在一個小竹管裏，拿起小竹管將藥沫吹到小孩的鼻孔裏，並說種了這個以後，過十天大概會發燒，然後會出現一些紅色的皮疹，再過幾天，燒退疹消，小孩今後就不會再得天花了，後來果然如此。這種“仙方”其實用天花病人身上的幹痂研磨成的粉末。把這種含有天花病毒的粉末吹入小孩的鼻內，他就會染上輕度天花。我國古代把天花稱為“痘”，把道士的這種預防方法稱為“種痘”。古代醫學家的基本思想是以毒攻毒，也就是取已經得過天花的人的天花，它是帶有毒性的，人接觸了一定量的有毒物質後就獲得了對毒物的抵抗能力。

http://www.cctv.com/science/20030822/100328.shtml

值得參考的資料在 :科學人雜誌 : 2002 年 4 月號 http://www.sciam.com.tw/forum/forumshow.asp?FDocNo=41&CL=16


Louis Pasteur

1870, established the germ theory of disease

1881, developed an anthrax vaccine

1882, developed a rabies vaccine

Emil von Behring

1890, discovers antitoxins, develops tetanus and diptheria vaccines

Jonas Salk of the University of Pittsburgh developed a vaccine made from killed virus, and to vast national relief it was declared safe and effective in 1955. Five years later, Albert Sabin's more effective oral vaccine was introduced.

Louis Pasteur

Emil von Behring

Albert Sabin (1906-)Discovery of the Oral Polio Vaccine

Sabin looked for weak strains of polio virus, found three, and began to develop oral, "live" vaccine, administered at first on a lump of sugar or in a teaspoonful of syrup.

In 1957 the World Health Organization (WHO) decided Sabin's vaccine deserved world-wide testing. (Russia, Holland, Mexico, Chile, Sweden and Japan).

But in the US Sabin had a hard time convincing the Poliomyelitis Foundation and the U.S. Public Health Service his method was any better than Jonas Salk's "killed" vaccine method. The first US test was held on "Sabin Sunday," April 24, 1960.


http://www.cincinnatichildrens.org/about/history/sabin.htm

Jonas Salk (1914-1995)

Salk discovered an

inoculation against

poliomyelitis in 1953.

It is courage based on

confidence, not daring,

and it is confidence

based on experience (?).

http://www.wwnorton.com/college/history/ralph/resource/43salk.htm

http://www.lucidcafe.com/library/95oct/jesalk.html ( 很完整的資料收集 )


http://www.lucidcafe.com/library/95oct/jesalk.html

A brief history of antibiotics 1495, mercury to treat syphilis. 1630, quinine (chinchona tree) for malarial fever by South Americ

an Indians. 1889, Buillemin defined antibiosis. 1910, Paul Ehrlich developed arsenical compound (Salvarsan) for

syphilis, term: the chemical knife. 1929, Alexander Fleming found penicillin. 1935, Gerhard Domagk showed the value of sulfonamides. 1940, Ernst Chain and Howard Flory demonstrated the effect of p

enicillin. 1940-1970, then searching for new antibiotics ~ recent year: modifying old drugs, finding new discipline in antib

acterial combats Early time in war: thanks penicillin, we can go home now Now a day……….Oh eh?!


A tale by A. Fleming• He took a sample of the

mold from the contaminated plate. He found that it was from the penicillium family, later specified as Penicillium notatum. Fleming presented his findings in 1929, but they raised little interest. He published a report on penicillin and its potential uses in the British Journal of Experimental Pathology.


Thanks to work by Alexander Fleming (1881-1955), Howard Florey ( 1898-1968) and Ernst Chain (1906-1979), penicillin was first produced on a large scale for human use in 1943. At this time, the development of a pill that could reliably kill bacteria was a remarkable development and many lives were saved during World War II because this medication was available.

E. Chain H. FloreyA. Fleming


http://www.nature.com/nsu/021028/021028-2.html

Inspired by musicologists' use of fragmented scores to complete the unfinished works of great composers, a British researcher has pieced together Alexander Fleming's laboratory scribblings to recreate a paper that he says restores the reputation of the much-maligned discoverer of penicillin.


中藥中的抗生素• Antibiosis

• 草藥 , 砒霜 .............

• 怎麼只說免疫調節 ?


在中醫理論中，沒有抗生素這個概念；許多中藥，特別是成藥、成方藥，具有多重作用，儘管按照西藥方法研究有抗菌作用，不能因此以偏概全就把這種中成藥叫“抗生素”。如中藥黃連有清熱、祛火、解毒等功能，而黃連素對痢疾桿菌、肺炎雙球菌、金黃色葡萄球菌、鏈球菌、傷寒桿菌等有抑制作用，屬於抗生素，其成分是從黃連中提取的小檗堿，不過不能就把黃連就叫做抗生素。北京中醫醫院陳勇 ??

那一種方法比較有效 ?

http://www.160.cc/160/0003/0303/images/k03030307_4.jpg


柯南不見了 ?

Diagrammatic representation of the results of treatment related to specific chemotherapy

Patients with normal immunity and uncomplicated mild to moderate infections

Patients with serious life-threatening infections


Tetanus

Patient number in CanadaAfter antitoxin vaccine1941-1995

Tetanus toxin:


In Britain the decline of T.B. was continuous for over 100 years before the introduction of the vaccine. The Dept of Health has, surprisingly, decided that routine BCG vaccination will be phased out in the 1990s. As T.B. deaths are now around 400 per year, the Dept may have a problem with claiming that the climb down is due to eradication.

http://www.health.org.nz/tb.htmlFor lecture only , BC Yang

By Robert Kock

Vaccine for Diphtheria

toxin


Documents

Disease management: 以感染性疾病為例子 20Carriers.JPG For lecture only, BC Yang Nightmare and consolation Note: 疾病是否獨立於文化之外？