Author | Li Yun
Viruses and humans go hand in hand, and diseases accompany cities.
What major plague events have mankind experienced to this day? How far is the end of the Great Plague related to climate change? What are the successful experiences of TCM in the prevention and treatment of plague? What epidemic prevention and control in history will provide lessons for this epidemic?
The 12 questions you are concerned about in the history of human plague, Gao Xi, professor of the Department of History of Fudan University and executive director of the Chinese Society for the History of Science and Technology, replied:
1. Q: What are the major plague events in human history? What is the most lethal? What lasts the longest?
▲ Answer:
It is generally believed that the ten major plague events in history are:
HIV/AIDS recognized in 1976
Hong Kong Flu 1968
Asian Flu 1956
Flu Pandemic of 1918, also known as Spanish Flu
Sixth Cholera Pandemic of 1910-1911
Russian Flu of 1889-1890
Third Cholera Pandemic of 1852-1860
The Black Death of 1346-1353
Plague of Justinian 541-542
Antonine Plague of 165
In addition, some people believe that the global outbreak of typhus in 1945 is also a major epidemic.
The most lethal plague of the moment was the Black Death, which lasted for a long time and broke out, resulting in the largest number of fatal layers of smallpox.
The longest-lasting is AIDS.
2. Q: What outbreaks have changed the course of history?
Historians believe that the plague of Antony had a major impact on the political culture of the Roman Empire around the 2nd century AD, the Black Death in the 14th century influenced the rise of "humanism" in the Renaissance, and some Chinese historians believe that Cao Cao was defeated at the Battle of Chibi because of the outbreak of plague and the battle with Wu and Liu.
But what will change the course of human history can never be a plague, but must involve many other factors, such as politics, economy, culture, religious beliefs, and so on.
3. Q: What are the major epidemic events in China's history? Which is the most serious?
According to the "Chronology of Epidemics in Ancient China" compiled by Zhang Zhibin, there have been "great epidemics" in almost every year of Chinese history, either due to natural disasters (floods, droughts and earthquakes), or due to man-made disasters (war and hunger).
Because of the lack of ancient historical records, statistical analysis from the available data can confirm that the epidemic disease in the Ming and Qing dynasties was the most serious, with four peaks in 1580-1589, 1639-1648, 1813-1822, and 1857-1866.
Three of the outbreaks (1579-1588, 1610-1611, 1633-1644) were known as the great plagues of the late Ming Dynasty and were related to the demise of the Ming Dynasty. In 1756, there was a great epidemic in the south of the Qianlong River, and "the dead were not counted".
In 1817, cholera was introduced to China by sea, moved north from Wenzhou and Ningbo, and finally to the southwest region of Tibet, about this plague is more studied by historians, the space of the epidemic is distributed in Fujian, Jiangnan, the lower reaches of the Yellow River and the Yunnan-Guizhou region, the time is not short, extended to 1824, can be considered as the most widespread in modern times, the greatest impact, the research results are also quite a lot of epidemic, the number of deaths of the epidemic, serious areas reached 10%, causing a great impact on people's psychology, once appeared "watermelon eaters are dead" Social panic incidents.
It has seriously affected the socio-economic development, resulting in market depression and economic stagnation.
4. Q: How did the big pandemic end? Is climate change the most important factor?
There are many factors that have ended the pandemic, and climate change is just one of them.
Judging from the results, the death or termination of transmission of some germs is related to climate change or seasonal changes, and the end of the epidemic that is easy to cause people is climate-related.
In fact, in addition to biological and bacteriological factors, the impact of medical rescue, social response mechanism (isolation, lockdown), folk charity relief, and the awakening of people's self-prevention awareness are also affected by the trend of the plague, which are brought together and ended after a period of regulation (biological and social).
5. Q: Is the heavy casualty of the epidemic in history related to the medical conditions at that time?
It has an important relationship with medical conditions. Bacteriological theory was only applied to the clinic in the late 19th century and early 20th century, before the Western medical community generally attributed the outbreak of infectious diseases to "miasma", believing that the filthy air, foul-smelling mud and unclean environment caused diseases, because they did not understand the invisible bacteria in the air, and it was impossible to find a "magic bullet" to deal with the disease, so they would suffer heavy casualties.
However, medical conditions are not the decisive factor for causing major losses, in China, although there are countless outbreaks of "major epidemics" or records of so-called "disease years", because Chinese medicine has always had methods and measures to deal with diseases, and has complete medical theory support, so historically, China's major diseases are often related to natural disasters, and even hunger, rather than caused by diseases.
These are not problems that can be solved by medical conditions, but require the intervention of state forces and charitable organizations, and the public health concepts and preventive medical measures established in the late 19th century and the early 20th century are the guarantees for reducing the risk of epidemics.
6. Q: Are there any methods and ideas for fighting diseases in TCM theory?
According to the existing historical data, the epidemic in ancient China was at the end of the Eastern Han Dynasty and the Ming and Qing dynasties, and these two periods were the two stages of innovation of the theoretical system of Chinese medicine:
1. At the end of the Eastern Han Dynasty, Zhang Zhongjing wrote "On Typhoid Fever and Miscellaneous Diseases": "The Yu clan is multi-faceted, and xiang Yu is two hundred." Since the Jian'an Dynasty, there have been no more than ten people, and its deaths have been two out of three, and typhoid fever has been seven out of ten. Feeling the loss of the past, the helplessness of the wounded, but diligently seeking the ancient teachings, absorbing the wisdom of the masses, writing and using the "Su Qing", "Nine Volumes", "Eighty-One Difficulties", "The Great Theory of Yin and Yang", "Record of fetal medicine", and "Dialectics of the Plain Pulse", for the "Treatise on Typhoid Fever and Miscellaneous Diseases" in sixteen volumes, although it has not been able to cure all diseases, Shu can see the source of the disease, if you can find the rest of the collection, think about half of it", although it can not be called a monograph to deal with the epidemic, but has a basic understanding of the epidemic.
Modern scholars have pointed out six ways of contamination summarized by the ancients: (1) direct contact with patients; (2) long-term or close contact with patients; (3) participation in specific activities in specific locations; (4) abnormal climate and environmental changes; (5) diet; and (6) being attacked by ghosts.
All in all, for the cause of the epidemic, the ancients believed that it was mainly the contagion between people and the work of ghosts and gods.
It should be emphasized that the role of "qi" can be found in the complicated expositions of the ancients, whether it is a metaphysical explanation of the cause of illness or an explanation of the disease caused by ghosts and gods, there is a main line to connect it - qi.
2. At the end of the Ming Dynasty, Wu Yousheng, a native of Wu County, Jiangsu Province, created the theory of Wen Disease, and wrote "On Wen Disease", in which he distinguished infectious diseases from "typhoid fever", "The disease of wen epidemic is not wind, not cold, not summer, not wet, but there is a different feeling between heaven and earth." ”
At the same time, Ye Tianshi also wrote "On Warm Heat", and Xue Shengbai and Wu Jutong wrote "Debate on Warm Heat", focusing on "damp heat" and "temperature disease".
It is generally believed that by the early Qing Dynasty, the medical community gradually formed a more systematic understanding of the causes of epidemic diseases, and doctors understood and explored the relationship between epidemic gas and "poison".
In the late Qianlong period, the medical records would associate the epidemic gas with the poisonous gas, believing that the poisonous gas and the plague were the end of the end.
However, in general, there is no breakthrough in the cognition of epidemic gas infection, thinking that the infection of the plague is transmitted through 'gas', but there are also some intuitive or vague understandings of the transmission methods such as contact transmission, food transmission, water transmission, and insect vector transmission.
Since modern times, a typical example of the clinical use of traditional Chinese medicine to deal with infectious diseases is the special study on the epidemic of Japanese encephalitis in the 1950s.
1954-1955 Shijiazhuang Japanese encephalitis epidemic, the local use of traditional Chinese medicine to treat Japanese encephalitis to obtain significant results, but this method used in Beijing, the effect is not good, the old Chinese medicine dialectical found that the epidemic situation in the two places is the same, but the climate is different, so the effect of the formula is not obvious, after the improvement of the old Chinese medicine in Beijing, the effect is particularly remarkable.
7. Q: Epidemics are not just problems that medicine can solve, what forces are needed to intervene?
When scientists and medical scientists realized that medical means alone could not fundamentally solve the problem of disease transmission, public health and preventive medicine came into being. The concept of preventive medicine was born out of the pandemic.
My understanding is that prevention is divided into 3 levels:
1. The State shall establish a public health prevention mechanism and establish health regulations, so that when an epidemic occurs, it can respond effectively and assume the responsibility of protecting the health of the whole society and the population;
2. In addition to undertaking the exploration of scientific research, it is necessary for scientists and public health scientists to popularize preventive medicine knowledge and public health knowledge;
3. Personal awareness of prevention, in addition to maintaining personal health and hygiene, it is more important to assume social responsibility and comply with the provisions of the Health Law.
8. Q: What experience has humans accumulated in the face of the plague and what effective measures have been formed?
After the outbreak of the Black Death in Europe in the 14th century, two important measures have been in use to this day and can effectively control it.
1. In 1383, the French Marseille officially established a seaport quarantine station to quarantine goods and foreigners.
For example, in 1377, the Republic of Ragusa on the eastern shore of the Adriatic Sea first stipulated that all suspected plague infected persons must stay in designated places considerable distance from cities and seaports, and stay in a fresh and sunny environment for 30 days before entering the country, which was later extended to 40 days, called Quarantenaria.
2. The Government shall establish a committee to supervise and guide the collection of corpses, funerals, the vigilance of foreign vessels, isolation, and the reporting of illness.
2. Health legislation, the establishment of isolation places and shelters, to isolate the epidemic situation and rescue patients.
3. National health mobilization and popularization of public health knowledge: health posters (now publicized on the Internet), prevention guidance manuals (handwashing, masks, chopsticks, disinfection, etc.).
Ancient societies dealt with segregation (eviction from villages or empty houses on the outskirts of towns), burning corpses; lifestyle changes, such as starting to bathe and wash their hands; modern societies inventing the use of chopsticks and wearing masks; and adjusting communication methods.
The rise of prevention and health statistics.
V. Traditional Chinese medicine targeted anti-epidemic formulas and modern targeted vaccines.
9. Q: What epidemic prevention and control in history will provide experience for this epidemic?
1. For example, the method of dealing with leprosy is isolation, in the early days it was to deport patients (townships), and in modern times it is to establish leprosy hospitals, where patients are concentrated in prescribed areas for recuperation, and contact with outsiders is prohibited.
2. When acute and large-scale infectious diseases suddenly occur, compulsory household closures or lockdowns are adopted to block the spread and spread of infectious diseases.
For example, in the 1911 plague incident in the northeast, Wu Liande took the initiative to cut off the train entering Shanhaiguan from the northeast and control the epidemic in the northeast region first to prevent the spread of the epidemic to Guannei; when the epidemic broke out in the british town in the Middle Ages, the residents of the town took the initiative to lock down the city and sacrifice themselves to interrupt the spread of the disease; there were also infected patients and families who closed themselves at home; or it was to establish a special epidemic hospital to receive infected patients, special treatment, and isolation from other patients in the hospital.
3. Establish a strict quarantine system, as mentioned earlier.
4. Get vaccinated.
The history of continuous outbreak of smallpox, resulting in the overall number of deaths far more than the plague, the mortality rate of up to 25%, since the Song Dynasty, Chinese society to take the human pox vaccination method to prevent smallpox, other Asian countries and Arab doctors will also be this method, around the 18th century human pox vaccination method spread to Europe, in 1796 the British pox vaccinator Jenner invented vaccinia vaccination, became an effective vaccine against smallpox harmless vaccine.
However, at that time, people did not fully realize the role and significance of this vaccine, and the British Parliament legislated to enforce vaccination.
Vaccination methods are effective in preventing the outbreak of many infectious diseases, similar to the 20th century before the harm to society and population of typhus, diphtheria and other infectious diseases have been controlled.
5. Each outbreak of the epidemic, accompanied by another hidden plague: the spread of rumors, rumors and superstitions, non-scientific so-called folk remedies, these social epidemics, the spread of faster, infecting people faster, their harm is not necessarily weaker than the biological epidemic, or even more than that, more likely to cause social panic; therefore, an important measure to prevent and control the epidemic is transparency of information, popularization of scientific knowledge and timely guidance on prevention and control methods.
10. Q: What lessons have not been learned?
Eating wild animals is a lesson in history that has never been learned. From ancient times to the present, many large-scale infectious diseases have been caused by animals and spread from animals to humans.
In 1988, hepatitis A occurred in Shanghai because Shanghai was accustomed to eating Qidong's hair cockles, resulting in the epidemic, and the number of infected people exceeded 300,000, which is undoubtedly a rare and exceptionally large public health event.
The SARS incident was also caused by the indiscriminate consumption of wild animals, and the Wuhan coronavirus is still for the same reason.
11. Q: What have the plague changed in human cognition?
Plagues enable human beings to gain knowledge of new diseases, invent new methods and new drugs to deal with diseases; change in the values of life, the establishment of new mechanisms for the state to defend life and maintain health, and teach human beings the principles of living with nature and animals.
Because epidemics go hand in hand with civilization.
It is worth mentioning that the SARS incident not only promoted the reform and improvement of China's public health prevention and response mechanism, but also pushed the research on the history of medicine, public health history and medical social history from a hidden research field to the forefront of academic research, becoming an obvious science, which has attracted more and more attention from historians, sociologists and anthropologists, and opened up new fields of historical research.
12. Q: In terms of measures and responses to the prevention and control of the epidemic, what progress has been made compared to SARS? What are the deficiencies?
When the SARS attack suddenly occurred 17 years ago, whether it was government agencies, public health scholars, or scientists, they lacked the measures and methods to deal with it.
The SARS incident, first, has promoted the country to make important progress in health prevention and control and disease prevention and control, and established a stress mechanism, and second, it has improved the public's vigilance and self-prevention awareness, which is a fundamental progress.
But precisely because we all believe that we have fully prepared and believe in the existing mechanisms, we have relaxed our vigilance at the first time, which means that the road to combating the epidemic is still a long way off, and the popularization of national public health awareness and the education of civil social responsibility still have a long way to go.
(China Science Daily reporter Li Yun interviewed and synthesized the "surging question" collation.) ）