Human history and disease history have always been with each other. Human evolution and social development are actually also a history of constant struggle against various diseases. In the thousands of years after the official birth of human civilization history, the various infectious diseases experienced by world-renowned cultural circles and major ethnic groups have had a huge impact on the local ethnic groups. This impact is disastrous, and some affect the direction and trend of regional development history and even world history. For example, the Black Death in the Middle Ages Europe and several major epidemics in my country's feudal history: the Black Death took away one-third of Europe's population and died of more than 25 million; while the colonial conquest of European powers often relied on hot weapons such as guns, but on plague bacteria such as smallpox and measles . The authoritative expert Diamond (Jared) Diamond pointed out in his famous "Guns, Germs and Steel" that it was infectious diseases rather than force that conquered the Americas. The Indians in the Americas were successively infected by smallpox (1518-1526), measles (1530-1531), typhoid fever (1546), and flu (1558-1559). More than 95% of the Indians died from these plagues. To some extent, it was the plague brought by Europeans that destroyed the Indian civilization in the American region. Smallpox, which has existed on Earth for more than 3,000 years, was once the biggest infectious virus that scared all mankind, and hundreds of millions of people died.
"Guns, Germs and Steel"
Various infectious diseases that cause great harm to humans have erupted many times in history. From the ancient Greek period of Europeans to the present, more than a dozen major influenza epidemics have occurred in world history. Even in recent decades, there have been several times, which have brought great impact on countries around the world, as well as on my country's economic development and people's lives.
Since the 20th century, there have been several major epidemics around the world, four of which were determined by WHO , during which hundreds of millions of people were infected and tens of millions of people died.
Let's first review history:
First of all, the outbreak of World War I in the last century caused about tens of millions of deaths. However, the "Spanish flu" that broke out in 1918 (not from the country, but because of the infection of about 8 million people in the country) eventually brought more deaths. Tens of millions of people worldwide died in vain. This influenza was first born in the barracks in the United States at the beginning of that year. It caused about 1 billion people worldwide (at that time, the total population of the world was about 1.7 billion), and the death toll was between 25 million and 40 million. This plague, which caused a mortality rate of 2.5% to 5%, is the second fatal infectious disease in human history. To a certain extent, this epidemic directly led to the early end of World War I, and in fact, there were almost no military sources among the countries participating in the war. In addition, there is the "Russian Influenza" in November 1977. This influenza outbreak in the Far East of the former Soviet Union spread to four continents except Africa. However, this "age-differentiated" epidemic mainly infected teenagers, and its incidence rate is not too high, and it cannot even be called a "pandemic". However, it is very intense in my country, especially in the Northeast. The monitoring report of the National Influenza Center shows that the intensity of influenza activity in my country that year was second only to 1968, but higher than other years. In 2018 and 2019, the Ebola virus outbreak in the Congo (Kinland) in Africa caused at least 2,200 people to die in this country by the end of 2018, and it also had a linkage effect on all parts of the world and has not been completely eliminated. In fact, this virus is the second outbreak after the Ebola epidemic in West Africa in 2014. Unexpectedly, before the harm of this virus ended, a new plague broke out in Wuhan, my country.
is followed by several infectious diseases that have occurred in my country. In 1957, the "Asian flu" (H2N2 subtype) occurred after the founding of New China. In February of that year, influenza appeared in Guizhou Province, which quickly spread to the mainland and to Hong Kong. In a short period of time, more than 250,000 people were infected, and then spread to Southeast Asia, Japan and other countries, eventually causing millions of deaths (between 1 million and 4 million).The "Hong Kong Influenza" that caused roughly a considerable population death occurred in July 1968. It was rapidly spreading in Southeast Asian countries, Japan, India, Australia and North America, and most parts of my country's mainland were affected. From the end of 2002 to 2003, 17 years ago, an outbreak of atypical pneumonia epidemic in China was reported in mainland my country. A total of 5,327 clinically diagnosed cases were reported, and 4,959 were eventually cured and discharged from hospital, and 349 deaths were 349. The scene at that time was still vivid in my mind. Of course, what we remember is the "2009 H1N1 Influenza A" 10 years ago. On April 25 of that year, the World Health Organization announced an outbreak of H1N1 influenza A ( Influenza A ) in Mexico and the United States. This influenza A caused hundreds of thousands of deaths worldwide, and there were more than 30,000 deaths in my country.
When it comes to the Black Death, many people will think of the bird beak mask worn by doctors at that time
used "isolation" to resist the epidemic. This method of anti-epidemic has been used by humans for more than 3,000 years:
(1) It originated from the record of the 5th century BC: "father of medicine" in the West and the founder of the golden age of ancient Greek medicine - Hippocrates (460-370 BC), whose famous "Hippocratic Oath" was adopted by the World Medical Association in 1948 as the "Geneva Oath" that influenced later generations. As a sacred book of professional ethics, its normative effect far exceeds that of the medical community and has become a moral norm suitable for all human social organizations to suppress the evil of human nature. The "principle of non-harm, principle of patient interests and confidentiality" proposed by the "Hippocratic Oath" is also a pioneering principle, representing the value judgments and codes of conduct followed by later generations, and also providing methods and guidelines for "isolation and containment". In addition, his famous medical works record the history of human beings using isolation to curb the epidemic of infectious diseases 3,000 years ago.
Hippocrates
(2) The "quarantine hospital" of the Arabs in the 8th century AD: The prosperity of Arab culture is particularly reflected in the development of its medicine, the most famous of which is the hospital established in Damascus today in Syria . In 706 AD, more than 1,300 years ago, in order to curb the spread of patients with leprosy and other diseases, the imperial emperor Walid I (the sixth generation caliph of the Umayyad dynasty of the Arab Empire) established the first Islamic hospital in the capital Damascus. This "group isolation" system was also extremely advanced: at that time the hospital also set up special wards for patients with leprosy.
(3) Quarantine ("quarantine") originates from the Black Death: The word "quarantine" comes from the Italian in . It originally means to observe the sea for 30-40 days on ships and personnel on board as a strict measure to prevent and curb the spread of the Black Death. The "Black Death" in Europe ( plague , blackdead), which scared later generations of people, caused one-third of the population to die, but this disaster also gave birth to real isolation. The Black Death, which lasted for more than three centuries (14th-17th centuries), only reduced the population of Europe by one third in just two years from 1347-1349.
Crisis and crisis have also brought about efforts to solve problems. For example, in order to control their wanton spread, Dubrovnik, a famous port city in Croatia, established a famous quarantine system. This city was a busy port in 1377. At that time, it was under the jurisdiction of the Republic of Venice. It was an important trading port in the Adriatic Sea. It was then named " Ragusa " (Ragusa). It issued a ban on "Trentina" after the outbreak of the Black Death (the word is "30", which means: ships traveling around the sea for 30 days before entering the port, and those who are healthy can land after the waiting period ends). In addition, Ragusa also promulgated the quarantine law for the first time: the hospital is responsible for treating and reporting the condition under the supervision and guidance of a specially established committee.
The European Middle Ages were a period of so-called "ignorance", "darkness" and "backward", but they achieved great achievements in curbing the plague. This is of course the huge challenges and responses brought about by the Black Death epidemic. For example, the method of building leprosy hospitals was gradually becoming popular throughout Europe, and the effective "isolation" method was adopted by various places.In 1377, in order to prevent the rapid spread of the virus, the Republic of Venice required that all ships must stay in designated places that are quite far from cities and harbors, and are in an environment with fresh air and sunshine for 30 days before entering the country; in 1448, the Venetians extended the quarantine period to 40 days, but this process is called "Quaranta Giorni", because the number of days from infection to onset of the Black Death was about 30 days, and a 40-day quarantine could verify the diagnosis and blockade of suspected infected people. Since then, the Italian word "40" has derived "quarantine" and later "quarantine" in English. After a long historical period and modern scientific development, practice has proved that the above-mentioned "40-day quarantine period" is very effective in verifying and verifying the health status of travelers, because the period from infection to death at that time and later plague patients were generally within 40 days. Of course, the origin of the above-mentioned standard implementation is not in Venice , but in the Republic of Ragusa on the eastern coast of the Adriatic Sea.
Ragusa implemented the first law to implement the quarantine law at that time. Ancient hospitals set up committees to supervise and guide treatment and report the condition. Therefore, after the outbreak of the "Black Death" in Europe in the 14th century, at least two important measures have been used to this day and can effectively control it. One is quarantine, the other is quarantine. In 1383, Marseille, France officially established a harbour quarantine station to quarantine goods and foreign personnel.
The heavy disaster brought by the Black Death is also a historical turning point. Among them, the landmark event was the establishment of urban isolation centers such as "Lazareto". The aforementioned Ragusa not only brought about an epoch-making isolation inspection system, but also established the first truly "isolated island isolation center" in history - Lazareto. The measures to establish this isolation center have been continued. They are another by-product of European powers brought to all parts of the world, especially the Americas. European civilization in the 19th century began to move towards and gradually conquered the world, and Europeans gradually established real urban isolation centers around the world. Of course, compared with the simple isolation and containment in history, the technical content of anti-epidemic isolation has made great progress since the 20th century, and it is now more effective.
(4) "She's the empty house" - China's "isolation and containment" 2000 years ago:
??First of all, it is the practice and behavioral record of isolating and curbing the spread. In the pre-Qin period, "Lüshi Chunqiu " has recorded the harm of infectious diseases; a famous "medical mystery" in the Spring and Autumn Period corresponds to the incident of "looking at the disease through the window" when Confucius visited his dear disciple Yan Hui: Although there is controversy about this, Zhu Xi and others in the Song Dynasty believed that Confucius was in isolation from his disciples because of concerns about infection. Of course, we can also think that it is more likely that his disciples are responsible for being isolated from Confucius and looking at him. This kind of self-isolation has been around for a long time in ancient my country. There are countless cases of isolation in Mr. Zhang Zhibin's "Chronology of the Epidemic of Ancient China": During the Five Dynasties and Ten Kingdoms, a plague occurred in Suizhou, Hubei and Dengzhou, Henan. After being severely infected, many people closed their doors tightly to avoid spreading to their relatives. They only opened a small hole in the window to pass on food and toilet buckets. When passing on, they were carried out with long bamboo poles. During the transmission period, they broke out with plague in Shandong under the rule of the Jin Dynasty in the Southern Song Dynasty, and eight out of ten died. Survivors "abandoned their houses" and had to throw their infected relatives at home and fled to other places themselves - this kind of "extreme practice is not just isolation, it is simply abandonment." As for the Ming and Qing dynasties, this self-isolation and top-down isolation system was more systematic and strict. In the early Qing Dynasty, smallpox was often rife in the capital, and it was afraid of it like a tiger. Both Emperors of Shunzhi and Emperor Kangxi were strict orders: "Anyone who has acne from the people should move it forty miles away to prevent infection." The patient was forcibly isolated 40 miles away from the capital. Before Shunzhi's death, flowers were popular in the capital. Shunzhi moved to the palace and asked eunuchs to deliver food and charcoal. During this period, they were worried that they were infected by eunuchs and palace maids. "There is a 50-meter-long resident of the Sihuan Office, and all people who live in the face (suspected patients), regardless of gender, are expelled."
??The second is the establishment of the isolation center. In ancient China, the conscious establishment of "isolation" protection from top to bottom was earlier than that of the West and other civilized areas.As early as 2,000 years ago in the Western Han Dynasty, there were clear records of isolation observation and treatment, which appeared in the "Book of Han: Emperor Ping Ji": "In the second year of Yuanshi, drought locusts and people who were sick and ill, they left empty houses to build medicine." This "left empty houses" can be said to be the earliest "isolation hospital" clearly recorded.
?? Again, the establishment of the quarantine system. During the Northern and Southern Dynasties, in order to curb the rapid spread of epidemics, isolation methods have become a system established by the central government. 1,500 years ago, the Northern Wei Imperial Medical Office "established a separate hall in the idle place, so that all those who were sick inside and outside the capital would be ordered to live." The "Six Illness Museum" is a specialized institution established for the purpose of isolation, containment and protection. It not only treats patients, but also effectively isolates patients from healthy people.
Author: Gao Fujin (Professor and doctoral supervisor of the School of Marxism, Shanghai Jiaotong University) Editor: Liu Liyuan Editor-in-chief: Yang Yiqi
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