揭穿李连达的谎言和谬论

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揭穿李连达的谎言和谬论:  鱼腥草注射液能和氯霉素相提并论吗
关于揭穿李连达的谎言和谬论:鱼腥草注射液能和氯霉素相提并论吗?的原因,关于揭穿李连达的谎言和谬论:鱼腥草注射液能和氯霉素相提并论吗?的相关知识。     “西学中”的中西医结合可以休矣。    2006年,张功耀和方舟子等人对中医的讨伐引起了全国人民的震惊和反思。这期间,处境最尴尬的几个人中,有两个是赫赫有名的“西学中”的中西医结合鼓吹者,陈可冀和李连达。他们的尴尬来自几个方面:1。从阵营上看,他们两人已经被现代医学界抛弃了,他们是现代医学界的叛徒。2。从“成就”上看,他们对中国人民犯下了不可原谅的大错:即从1971年到1976年四人帮时代发明了冠心2号方(由丹参,川芎,红花,赤芍,降香组成)。1976年极其草率地将本方制成中药静脉注射剂。从此开创了中国中药静脉注射的先河。请大家特别注意,中药注射剂是人类历史上空前绝后的荒唐。事实是,和国际现代医学的标准治疗方法比,所有的中药静脉注射剂都是无效药或劣药,缺乏临床应用之前的认真的科学研究。而李连达之流却在中国随意扩大适应症,害死,致残了很多中国人。3。从中西医结合的队伍上看,像陈可冀和李连达这样“西学中”,“卖(西)医求荣”的人越来越少。后继无人。4。从风向上看,有个中医先声明了,中药静脉注射剂与中医无关,是西医自己编出来的不该发生的故事。5。从个人品德上看,陈可冀自2006年10月以后就不再发表言论了,"今后我会为年轻人铺路"。因为他知道很快就要轮到批判“西学中”的中西医结合了, 他这个中国中西医结合学会会长样样错误都脱不了干系,特别是中药注射剂。    陈可冀在2006年9月14日发表了《事关人命,要把好中药注射剂的关》的文章。读了让人很感动,说明陈可冀仍然是有科学家良知和勇气的人。文中说到:“我国现在已列入国家标准的中药注射剂有109种,其中属于复方中药注射制剂的约有50种,这些中药注射剂其所含原料药通常有3~7种,甚至可多达12种。由于不少处方的不甚合理,成分过于繁杂,稳定而可控的质量标准很难确定,严重影响了疗效和安全性。现有的中药注射剂研发标准规定,其注射剂所含有效物质不低于总固体的70%(静脉内使用的不低于80%)即可达到审批标准;这与国际上(包括我国)生物制剂的注射剂要求有效纯度必须达98%,且另有2%非有效成分或杂质也须弄明白是何成分相比,其标准显然相去甚远。直接将中药原料药经比较简单的工艺提取分离制成的中药注射剂,静脉注入或滴注入人体静脉血管内,显然存在一定或相当大的风险,可以说为世界各国所未曾见。”    有良知的中国人早就等着看“西学中”的中西医结合的笑话。精明的人都远离它。今天,在广州会议上还敢上来叫阵的就剩下这位李连达院士。很明显,这位中国中西医结合学会基础委员会副主任实在是被逼得没有退路了,因为在过去的30多年他领头做了“国家水平”的三件事。今天这三件事都没有办法向全中国人民交代:    1。在30年之间,编造出残害中国人民的109种中药(静脉)注射剂。    2。“首次建立我国中药药效学评价标准及技术规范,得到学术界公认及官方认可,并在全国推广应用。建立一些新的动物模型和试验方法,成为全国应用的标准方法,使中药研究与新药审评走上标准化、规范化及现代化新的发展阶段。”(附录1)    今天中国要和国际医学接轨了,才发现李连达花国家的钱建立起来的中药药效学评价标准及技术规范全都是“土匪语言”,国际根本不认可。全世界没有一个国家认为中药是“药”。不承认中药是“药”的原因是李连达建的那套标准比现代医药学的“药”的标准落后了十万八千里。李连达用纳税人的钱演了一场“八路军骗共产党”的把戏。    3.扩大中药适应症,研制成功70种新中药的事都与李连达有关。他的“科学研究”带动了中国巨大的商业利益和冲动。今天已经不是李连达这个“火车头”在拉动中药生产的商业利益这些“车厢”,而是这些“车厢”用自己的动力在推动李连达这个“火车头”往前跑。李连达现在正在品尝自己30年来编造出的“中药科学成果”的种种谎言的苦果,十分被动。谁都知道中医中药这些烂事,关上国门是真理,打开国门是谎言。    李连达,无论你用什么样的语言为自己和中医辩解,都无法掩盖今天全体中国人民必须面对的一个残酷的现实:为什么全世界所有的其他的人种都说它是草,只有中国人这个人种说它是药?我想了很长时间,才想通了。原来,中国人这个人种是一种把“别人的”草当自己的药的次等人种。中医就是活跃在这个次等人种中专门“以劝人吃草为己任”的一群愚教徒。正如很多人说的那样,只有到了中医药退出中国医疗舞台后,中国人这个人种才有可能“升等”。    最近,李连达不得不公开给中医和自己打气,他的话全是谎话和谬论。由于他的话集中地反映了中医和“西学中”对自己的问题到了2007年5月的最新综合性思考,所以,我正在连续写几篇文章对李连达的全部谎话和谬论逐一驳斥。现在发表的是第一篇。    题目:鱼腥草注射液能和氯霉素相提并论吗?    网文摘录:及此前鱼腥草注射液出现不良反应导致我国109种中药注射液处境艰难时,李连达表示,“西药的不良反应远远高于中药,美国上个世纪50年代氯霉素造成1000多人死亡,上个世纪60年代反应停造成1万多名婴儿畸形等等,西药有更多的不良反应但是从来没有人说要取消西药,盲目地说取消中药是不科学的。但是,鱼腥草注射液事件也要引起我们的重视,不能等死人了才重视,这样不仅会妨碍中药的发展同时也违背了职业道德。”    网文摘录:相比西药,中药安全,但不是无毒。李连达举例说,美国在上世纪50年代,氯霉素造成1000多人死亡,60年代,反应停造成1万多婴儿畸形,80年代,氟卡尼、恩卡尼,造成数万人死亡。而鱼腥草注射剂,2006年1—6月,用药者1.4亿人次,死亡者20人,发生率700万分之一。但这一事件却造成109种中药处境艰难。    王澄的批判:    说到氯霉素chloramphenicol就必须先讲班疹伤寒(epidemic louse-borne typhus)和肠伤寒(typhoid fever)。(附录2-5)引起班疹伤寒病的是立克次体,它是虱子身上的一种寄生物。体虱是人类班疹伤寒病的传播物。Charles Nicolle (1866–1936) 首次用实验的方法发现了体虱传播伤寒病的事实,因此而获得了1928年的诺贝尔奖。 肠伤寒的病原菌是沙门氏菌属的肠伤寒杆菌。    公元前430年,古希腊的雅典发生了一次大瘟疫 (Plague of Athens), 以后公元前429年和427-426年,又发生过两次大瘟疫。今天的医学家们认为那很可能就是班疹伤寒。    1489年,西班牙在Moorish Granada的战争中,3千个士兵死于和敌军作战,而1万7千个士兵死于班疹伤寒病。有医学文献记载的班疹伤寒蹂躏欧洲达400年之久,人人谈虎色变。在那几个世纪里,从西班牙独立战争到拿破仑兵败俄国,每一场战争中,班疹伤寒都大大削弱了军队的战斗力。    1577年英国牛津爆发流行性班疹伤寒,造成300人死亡。1557年到1559年,短短的三年时间,班疹伤寒病杀死了10%的英格兰人。英国Newgate Gaol监狱的犯人患了班疹伤寒,他们去法庭应审时把班疹伤寒从法庭传播到伦敦市内。 除了市民死亡外,还死了一位伦敦市市长。1759年当时的英国专家估计每年有四分之一的监狱犯人死于班疹伤寒。    1812年,拿破仑的军队从莫斯科撤退的时候,死于班疹伤寒的法国士兵比被俄国人打死的还多。拿破仑从厄尔巴岛逃出(复辟)后,他招募的军队一半也死于班疹伤寒。    1816年到1819年,从爱尔兰爆发的班疹伤寒流行到英格兰。以后1846年到1849年饥荒年间又爆发了两次,死了很多农民。    第一次世界大战中,班疹伤寒害死了300万俄国人,以及更多的波兰人和罗马尼亚人。那时在西部前线设立了士兵灭虱站,而班疹伤寒肆虐东部前线,仅仅在塞尔维亚就死了150万士兵。在那个时代,病人中容易死的都是班疹伤寒病人。    1941年,班疹伤寒在德国军队中爆发。班疹伤寒也害死了纳粹集中营的很多犯人。俄国的布尔什维克革命战争胜利后,红军和白军的内战过程中,班疹伤寒害死了3百万人。    由于它的历史“功绩”,有人建议班疹伤寒可用作细菌武器的范例。    斑疹伤寒常常发生在军队,囚犯,难民,流浪者和穷人。而肠伤寒却没有“阶级性”。1861年前后,英格兰每年有5万人患肠伤寒。Albert王子和 Consort王子都死于肠伤寒。    最初对肠伤寒的临床治疗是放血,催吐和导泻。而导泻常造成肠出血和肠穿孔。1912年以前的治疗只能是对病人体能的保护,卧床休息,加强护理,发烧时用冷水降温等。1896年,把用热杀死的肠伤寒病原微生物注射入皮下作为免疫方法。1914年到1918年的战争中,给士兵注射疫苗预防肠伤寒获得了成功。发明了DDT杀虱子后,班疹伤寒在军队里的传播就被有效地阻止了。    1947年以前,全世界班疹伤寒病人和肠伤寒病人的死亡率在10%到40% 之间。    1947年,氯霉素被第一次实验性地用于玻利维亚和马来西亚的斑疹伤寒的治疗并取得成功。1948年,Woodward等首次报告用氯霉素治疗肠伤寒,这个药把肠伤寒病人的发烧期从35天减少到3.5天。肠伤寒的死亡率大大降低。人类终于到了能够治愈斑疹伤寒和肠伤寒的一天。在氯霉素出现以前,人类对这两个病几乎是束手无策。    氯霉素Chloromycetin 最初从霉菌中提取, 很快就人工合成了 chloramphenicol。 合成的氯霉素和霉菌中提取的效果完全一样。    从1948年到今天,氯霉素治疗班疹伤寒和肠伤寒近60年了,至今它还是主要药物之一。特别是在不发达国家使用得更广泛,因为它很便宜。今天的美国内科书上的具体建议是:治斑疹伤寒可用四环素或者用氯霉素。Treatment consists of either tetracycline (25 mg/kg/d in four divided doses) or chloramphenicol (50-100 mg/kg/d in four divided doses) for 4-10 days. 治肠伤寒用Ampicillin, 氯霉素, 或者 trimethoprim-sulfamethoxazole。    和其它抗生素相比,氯霉素的毒付作用较大。最严重的可致死性的毒付作用是骨髓抑制造成全部血球减少pancytopenia,最后有可能形成再生障碍性贫血aplastic anemia. 还可以造成白血病。 1993年的美国药理书称,氯霉素造成再生障碍性贫血的发生率是3万分之1。但是这种再生障碍性贫血的死亡率很高。所以,尽管氯霉素对很多革兰氏阴性细菌,厌氧菌和立克次体有治疗作用,氯霉素都不宜作为第一线药。只有当其它抗生素因为细菌抗药而治疗无效的时候,才考虑使用氯霉素。氯霉素目前主要是用在严重感染病人。包括斑疹伤寒,肠伤寒,脑膜炎,布氏杆菌病等。氯霉素也可用于滴耳和滴眼药。(附录6)    Today, the use of chloramphenicol is limited in developed countries, where more expensive but safer drugs are available. In developing countries, however, it is still widely used because it is so inexpensive to produce. It is used mainly to treat typhus, typhoid fever, meningitis, and brucellosis, but it can also be used for other infections. You may have used it yourself-in ear drops or eye drops.    下面是人类抗生素使用的历史摘要。在和病原微生物的斗争过程中,直到了抗生素出现的年代,人类才开始有能力战胜了一个又一个病原微生物导致的疾病。1936年合成磺胺,1940年开始使用青霉素,1944年用链霉素,1947年发现氯霉素,1948年四环素。以后直到1960年才使用头孢菌素。由于氯霉素是人类历史上被发现的第一个广谱抗生素。所以在50年代的大量使用是可想而知的。    History of Antimicrobial Therapy (Summary):    Early 20th century PAUL EHRLICH pioneers "chemotherapy"    1929 ALEXANDER FLEMING demonstrates inhibition of bacterial growth with penicillin moulds    Early 1930s GERHARD DOMAGK discovers "prontosil" a prodrug to sulfanilamide    1936 Sulfanilamide, the first synthetic sulfonamide in human medicine    1940 First therapeutic use of "penicillin" by FLOREY    1944 Streptomycin    1947 Chloramphenicol, the first broad-spectrum antibiotic    1948 Chlortetracycline    1960 Cephalosporines    1962 GEORGE Y. LESHER discovers nalidixic acid during chloroquine synthesis    1970s New 4-quinolones (pipemidic acid, oxolinic acid, cinoxacin)    1980 Norfloxacin, the first fluoroquinolone    1980 Enrofloxacin synthesized by GROHE and PETERSON    现在说说鱼腥草注射液。鱼腥草注射液有什么用啊?周超凡说:“鱼腥草注射液48种化学成分中,主要是甲基正壬酮,而究竟哪种成分对哪种细菌有抗菌消炎作用却不清楚。”    很清楚,氯霉素曾经是拯救人类生命出苦海的举世无双的大英雄,治疗斑疹伤寒和肠伤寒用了近60年了还在用;而鱼腥草注射液是毫无治病作用的骗钱害命的小混混。两者之间能作比较吗?世界上所有的人包括中国人都承认氯霉素是药。可是国际上有谁承认鱼腥草注射液是药?鱼腥草注射液是不是药连李连达都不知道,却要拿来和氯霉素这个有确切治疗针对性的药比较副作用。这就是李连达这个中华人民共和国中医卫生院院士的水平。 对医学常识如此缺乏,着急的时候竟然胡言乱语。现在李连达还认为氯霉素有这样大的毒付作用都不撤下来,所以鱼腥草注射液也不该撤下来?    李连达说,2006年1-6月,用鱼腥草注射剂的人达到1.4亿人次。我请李连达转过身来,面向全中国人民,大声回答我下面的问题:在短短6个月期间,中国能有1.4亿人(次)同时都得了同一个病而且必须要用同一个药物(鱼腥草注射剂)来治疗吗?有这种可能吗?你到底是个医生,还是个野药贩子?往深里说,李连达后半生所获得的荣誉,地位和奖励,是因为他的中药研究的结果让中国人的疾病得到了比以前更好更有效的治疗了吗?显然不是。他获得的这些荣誉是因为他的研究结果让中医卖出去了更多的“有李连达盖过手印的科学根据”的假药劣药。    我的一个病人从中国回到美国,她告诉我她在中国生了一次小病,去医院看了病。我就赶紧问,在中国看病贵不贵?她说看病倒不贵,只有几十块钱。但是那个中国医生很不好,一直劝她打一针中药注射剂。这个中药注射剂很贵,要300多块钱。她非常生气的是,她看出医生是在违心地做这种事,要她打中药注射剂完全不是为了她的健康,而是为了医院多赚钱。    鱼腥草注射液还有一个错是“注射液”的错。它违背了医疗原则。药物凡是能经过鼻口喷入,皮肤透入就不要口服,能口服就不要肌肉注射,能肌肉注射就不要静脉注射。比如,美国已经全面停止了抢救垂危病人时的直接心脏药物注射法,因为它不比静脉注射更有效。李连达等有什么理由让鱼腥草一下子跳过胃肠道的屏障,随着血液循环去发挥“速效作用”?    平心而论,李连达是我们的医学前辈,40多年来认认真真地搞中药研究,本应当是中国医生和医学研究人员的楷模。问题发生在荒唐的70年代,陈可冀和李连达发明了毫无科学根据的冠心2号中药静脉注射剂。这件事撒了谎,以后发现是假的也撤下不来了。(涉及到政治方面的原因我就不说了。)他们必须要用第二个谎去遮盖第一个谎。再用后面的谎去遮盖前面的谎。就这样,中药注射剂的错越搞越大。当科学研究人员急于求成的错误插上昏庸政治的翅膀变成愚民社会的商品生产的误导之后,这个巨大的生产力就刹不住车了。中药注射剂这件事,是人类近代史上中华民族的污点之一。(中华民族不止这一个污点。)    原本可以从以下几个方面原谅李连达1970年代的错误:1。当年年幼无知。2。科学素养差。3。与国际隔绝,闭门造车。4。四人帮极左思潮干扰科学研究。但是,直到2007年,李连达与国际间大量交往之后,仍然坚持中药注射剂的使用,不认错。还为影响了109种中药注射剂的买卖鸣不平。还拿氯霉素举例乱说话。像李连达这种人如果在西方国家早都进监狱了,不是因为他的研究而获罪,而是因为他有权力参与批准了中药注射剂的临床使用,从而造成了极其严重的后果。可他还在中国获奖当院士。李连达的这种案例是中国所有有良知的人心里最痛恨的,中国社会黑白颠倒。在国家民族主义的淫威下,中国人的人命算个狗屁。下面的话不是李连达一伙人说的吗:“关于中药注射剂中20%成分不清问题,由于中药成份的复杂,不可能等全部问题都解决了再进行开发。”(王澄注:“开发”就是卖钱的意思。)    中华民族从古到今就是一个不讲人道主义的民族。 比如,中国的史学家们为了表达他们对能够建立丰功伟业的古代帝王的由衷的景仰,为了附和“本阶级”对劳动人民的聪慧,勤劳,勇敢的认同,以及今人为了给权贵献上阿谀,大家已经把中文里的好听的词都用尽了,曾经到过“海水当墨,树林当笔”的程度。可就是有一个词中国人怎么也说不出口,这个词就是“人道主义”。人道主义不属于中华民族。在中国近代史中,有一个伟人,他怕“人道主义”不听他的话,就把“人道主义”前面加了一个限定词:“革命的”。就像用一条铁链拴住了一条狗。果然,在这个伟人的后半生的革命实践中,他穷尽其极地蹂躏了“人道主义”的普世原则和内涵。对于这一点,邓朴方最有体会。所以邓朴方说:“中国需要人道主义。”因为中国从来就没有过人道主义。    我一想到从古到今中国人做的那些迫害自己同类同胞的极不人道的事,就不由地想起商纣王的炮烙,商鞅被车裂(五马分尸),吕后制造的人彘(猪),司马迁受宫刑,五代的凌迟(千刀万剐),江姐被钉竹签子,四人帮切断张志新的喉管。回头再看看李连达的中西医结合把“煮草水”注入10多亿中国人身体30多年来所造成的死和残的严重后果,难看这不是在那个不人道的中华文化传统上的一脉相承吗?只不过前者是被缚,后者是被骗;前者是受刑,后者是 “治疗”。    改革开放以后又怎么样?2006年1月到6月短短6个月的时间,全国人口的十分之一(1.4亿)接受了鱼腥草注射。可是现代医学居然完全看不出这1.4亿人中任何一个人有需要用这个“药”的指征。    “死人不要紧    只要主义真,    死了中国人,    还有中国人。“    (完)    P.S.    敬请大家留意我的下一篇文章,题目是:《揭穿李连达的谎言和谬论:二。中医药海外热,热在哪里?》李连达有任何评论和批评可发到我们《医学评论》网(www.yxpl.net)的信箱,yxplnet@hotmail.com 我们会立刻原文登出来。    鸣谢:感谢司履生,祖述宪两位老师帮我审查文中的医学内容。    附录介绍:    附录1:李连达简介(中文全文)    附录2:什么是班疹伤寒?(英文全文)    附录3:肠伤寒的历史(英文全文)    附录4:斑疹伤寒(英文全文)    附录5:斑疹伤寒(英文全文)    附录6:抗生素的历史(英文全文)    附录1:李连达简介    李连达 (1934.7.24 -) 中药药理学专家。出生于辽宁省沈阳市。1956年毕业于北京医科大学,曾任中国中医研究院西苑医院基础室主任、研究员,中国中西医结合学会基础委员会副主任。现任中国中医研究院西苑医院研究员及中国中医研究院首席研究员。    一、首次建立我国中药药效学评价标准及技术规范,得到学术界公认及官方认可,并在全国推广应用。建立一些新的动物模型和试验方法,成为全国应用的标准方法,使中药研究与新药审评走上标准化、规范化及现代化新的发展阶段。为推动中药药理学的学科发展及中医药研究的科技进步,做出了积极的贡献。    二、揭示“血瘀证”科学内涵,阐明“活血化瘀”治疗的基本规律与作用机理。提高疗效、扩大适应症,自主或合作研制了冠心Ⅱ号等70种新药(其中活血化瘀新药30种),为继承发扬中医药学、推动中西医结合及中医药现代化起到带头作用,在国内外掀起活血化瘀研究的新高潮,促进了中医事业的发展。已获得国家科技进步奖一等奖。    三、首创“中药与自体骨髓干细胞经心导管移植治疗冠心病”新疗法,解决了供体困难、排异反应、开胸手术风险、费用昂贵及伦理道德等难题。方法简便、安全有效、易于推广,为冠心病治疗开拓了新领域,为干细胞移植建立了新途径、新方法。已获得中华医药学会科学技术一等奖。    四十七年来坚持不懈的努力,献身于中医药事业,在继承的基础上,不断发展、勇于创新,在中医理论、中药研究、新药研制及推动学科发展等方面做出了应有的贡献。    2003年当选为中国工程院院士。    附录2: 什么是班疹伤寒?    Epidemic Typhus    The word "typhus" comes from the Greek word for "cloudy" or "misty," referring to the lethargic state of mind that occurs in typhus victims. Epidemic, or louse-borne, typhus, is also known as historic typhus, European typhus, jail, war, camp, or ship fever.    Epidemic typhus is caused by Rickettsia prowazekii, a small gram-negative obligately intracellular bacterium. The disease starts with an abrupt onset of symptoms following a one to two week incubation period. Clinical manifestations of typhus include intense headache, chills, fever, and myalgia. A characteristic rash develops on the fourth to seventh day of disease. It first appears on the upper trunk and then becomes generalized, involving the whole body except the face, palms, and soles. As the disease progresses, particularly in untreated patients, significant alterations of mental status, from stupor to coma, are observed. In patients with severe disease, hypotension and renal failure are common. Epidemic typhus is a life-threatening illness even for young, previously healthy persons. Fatal outcomes are observed in up to 40 percent of untreated cases.    Transmission and Epidemiology. Epidemic typhus is a disease of humans. The human body louse Pediculus humanus corporis is responsible for transmission of the agent from human to human. Charles Nicolle (1866–1936) first experimentally established this fact, and he received the Nobel Prize in 1928 for his contributions. Lice acquire rickettsiae while feeding on people infected with R. prowazckii. A person infested with infected lice acquires the bacteria when the lice or the rickettsiae present in the louse feces are rubbed into bite wounds or other skin abrasions. Epidemic typhus commonly occurs in cold climates where people live in overcrowded unsanitary conditions with few opportunities to change their clothes or bathe. Such conditions often occur during war and natural disasters, which typically facilitate louse infestation. The history of typhus is, in fact, largely the history of men in battle. The disease has been credited with deciding the outcome of more battles than any general's best-laid strategy. Epidemic typhus is currently prevalent in mountainous regions of Africa, South America, and Asia.    Recovery from epidemic typhus results in nonsterile immunity, permitting the persistence of R. prowazekii between epidemics. Individuals who have been infected sometimes suffer a relapse in the form of Brill-Zinsser disease, which has the symptoms of classic typhus but is usually milder. In the United States, R. prowazekii is also transmitted by the Orchopeas howarolii fleas of flying squirrels. Persons exposed to infected fleas sporadically acquire an infection that is referred to as sylvatic typhus and is typically milder than classic epidemic typhus.    Diagnosis and Treatment. Diagnosis of epidemic typhus is based on detection of specific antibodies in patient sera. The use of clinical and epidemiological data is necessary to distinguish among classic typhus, Brill-Zinsser disease, and sylvatic typhus. Doxycycline is highly effective for treatment of typhus. Epidemic typhus also responds well to treatment with tetracycline or chloramphenicol antibiotics.    Prevention and Control. Insecticides are used to kill body lice, disinfect louse-infested clothing, and prevent the spread of epidemic typhus. Control requires significant efforts to maintain sanitary conditions and living standards, as well as health education. There is no commercial vaccine for preventing epidemic typhus. Several excellent vaccine candidates have been protective in animal models, however.    (SEE ALSO: Communicable Disease Control; Rickettsial Diseases; Vector-Borne Diseases)    Bibliography    Walker, D. H., ed. (1988). Biology of Rickettsial Diseases. Boca Raton, FL: CRC Press.    Walker, D. H.; Raoult, D.; Brouqui, P; and Marrie, T. (1998). "Rickettsial Diseases." In Harrison's Principles of Internal Medicine, 14th edition, eds. A. S. Fauci et al. New York: McGraw-Hill.    附录3: 肠伤寒的历史    HISTORY    The genus Salmonella was originally created by medical bacteriologists to include organisms that gave rise to a certain type of illness in man and animals and were related to one another antigenically. Later it became clear that salmonellae had many common biochemical characters.    Thomas Willis can be regarded as the pioneer in typhoid fever. Until his classic description in 1659 and its translation into English in 1684, little had been done to separate this disease from the many which it might mimic.    However, a disease very similar, was known long before this time. Hippocrates described a fever that probably was typhoid (Gay), and it is said that Antonius Musa, a Romanian physician, became famous by treating Emperor Augustus with cold baths when he fell ill with typhoid.    Willis, in his description, described the typically variable onset and the classical type of pyrexia with its step-ladder rise during the first week, its maintenance during the second and third weeks, and its fall by lysis rather than crisis which subsequent authors have merely confirmed and enlarged upon. He described the variable symptoms, signs, duration and severity of the disease, with relapses when apparently cured.    Willis's diagnosis was of necessity entirely on clinical grounds, and the fact that this was undoubtedly correct with few exceptions, is a gentle reminder that today, as 300 years ago, the diagnosis is essentially clinical and the laboratory, valuable as it is, must take second place to the senses. The pathologist and bacteriologist come into their own in the diagnosis of the atypical case and for differentiating certain similar diseases such as typhus, malaria, and the severe paratyphoids. They will always be essential in tracing the source of epidemics, and confirming a clinical diagnosis; but the present tendency to use the laboratory instead of one's clinical ability is to be deplored in typhoid more than in most diseases.    Willis's treatment of "let blood, vomit and purge", may leave much to be desired, but it is doubtful whether his mortality was very much higher than ours was before the first introduction of an effective antibiotic in this disease.    Another classical paper on certain aspects of typhoid was written by Trousseau in 1826 on the work of Pierre Bretonneau of Paris. He attempted to clarify the picture of typhoid mainly from the pathological angle, and to separate true typhoid from all the other gastro-intestinal infections, which he stated were often confused with it. He described the classical inflammation of the glands of Peyer and Briinner and gave a detailed description of post-mortem appearances. Even at this time the cause of typhoid was unknown, the bacteriologist unheard of, yet the diagnosis was seldom in doubt. Trousseau summarised the knowledge of typhoid in the early nineteenth century with the words: -    " This disease, just as common and no less murderous than smallpox, measles, and scarlet fever, that few people go to the end of their lives without having experienced its attacks, affects an individual only once during life, and is perhaps of a contagious nature."    The famous Pierre Louis in 1829 gave another classical picture of typhoid and described in detail post-mortem findings, especially the enlargement and ulceration of the Peyer's patches. He was also the first to use the word "Typhoid". He, however, did not clearly differentiate between typhoid and typhus, which were undoubtedly sometimes confused.    It remained for Gerhard in 1837 to he the first to differentiate clearly between the typhoid and typhus fevers. Again it was on the clinical picture alone that this was done. He described the more acute onset of typhus with typical rash. Even after Gerhard's paper in 1837 most medical critics were unconvinced that the typhoid and typhus fevers were of different aetiology.    Jenner in 1850, long before S. typhi was discovered, put the matter beyond all reasonable doubt in an admirable and detailed comparison of the two diseases, based on clinical and post-mortem appearances of 66 fatal cases. He showed how the general symptoms differed in the two diseases, that the rash was never identical and how the lesions of Peyer's patches and the mesenteric glands, so characteristic of typhoid, were never seen in typhus. With the publication of this paper the question was settled once and for all, Typhoid, also unlike typhus, is no respecter of classes, and both prince and common man are susceptible to its virulence. Prince Albert, the Prince Consort, died of it in 1861, and it has been calculated that about 50,000 cases a year occurred in England alone about this time.    William Budd of Devon, from 1856 to 1860, 20 years before the bacterial origin of infectious diseases had been discovered, stated that typhoid fever was not spread by stench, but was an alimentary disease in which the infective material in faeces contaminated water, milk, and the hands of those who attended the sick.    Marston in 1863 added another important string to the diagnostic bow with a differentiation between Malta Fever or Brucellosis and Typhoid Fever. This he did on clinical and pathological grounds, thus showing that brucellosis, which was at that time called "Gastric Remittent Fever", was a completely different disease from typhoid.    In 1875 water supplies and sanitary conditions in England were improved by a Public Health Act. This more than halved the death rate in the next decade, and markedly diminished the incidence of typhoid fever. This was more than 20 years before prophylactic inoculation against typhoid had been thought of.    It was not until 1880 that the crucial advance in the diagnosis of typhoid occurred with Eberth's discovery of "B typhosus". All proof of typhoid up to that time was of necessity purely clinical, and although undoubtedly correct in the vast majority of cases, was open to the occasional error that only the laboratory could prevent. Eberth's discovery opened new fields, both in diagnosis and prophylaxis.    Gaffky in 1884 completed the diagnostic and prophylactic picture with the first successful culture of S. typhi and was one of the first (with Virehow) to stress that the infection was water borne, and not air borne.    Achard and Bensaude in 1896 were the first to isolate S. paratyphi B, and to use the term 'Paratyphoid Fever'. Subsequently S. paratyphi A and C were discovered together with the numerous other members of the salmonella group.    Widal in 1896, and Widal & Sicard in 1896 described the Widal reaction, and this test has proved of value in cases where positive cultures have been unobtainable.    Advances in treatment during this era, however, were far less spectacular, and consisted of improvements in general treatment. It was becoming realised that bed rest and good nursing were the first essentials, and that Willis's recommended 'purge', which was quite the fashion, was liable to precipitate haemorrhage and perforation. Apart from this, nothing could be done except to allow the disease to follow its natural course.    Osler in 1912 was still advocating cold baths every three hours for patients if their temperature rose above 102° C, and this appeared undoubtedly to reduce both mortality and toxaemia. Water was not restricted only to the 'outer man', and patients were treated by the 'washing out method'. These treatments, by present day standards might leave much to be desired, but their efficacy appeared undisputed at the beginning of this century.    The first prophylactic inoculation against typhoid was introduced by Pfeiffer & Kolle in 1896 and Wright in 1896, and Wright & Semple in 1897. It consisted of a suspension of typhoid bacteria killed by heat and injected subcutaneously. This vaccine was not used to an appreciable extent in the Boer War, in which, as in previous wars there was a very high incidence of enteric infections with a correspondingly high mortality. It was first used with success in India before the Great War (Harvey) and had a great measure of success during the 1914-18 War. In 1915 it was fortified with S. paratyphi A and B, and this vaccine, modified by preservation with phenol, was used almost exclusively in Europe until alcoholised vaccine was introduced by Felix in 1941.    In 1947 Marriott published his papers on salt and water depletion, and the greater appreciation of this important factor in disease has undoubtedly led to the saving of countless lives. This was especially true in the treatment of typhoid in the tropics where excessive sweating often accompanied by diarrhoea or vomiting, was enough to tip the fatal scales in a severely toxic patient. Even in 1947 there was no specific drug in the treatment of typhoid, and with, the best nursing and general treatment the mortality was often between 10 and 30 per cent, and sometimes higher, with a correspondingly high complication rate.    It was, therefore, a very great advance when Woodward et al., in 1948 published the first report on the use of Chloromycetin in typhoid. This drug drastically cut the duration of pyrexia from about 35 days to an average of 3.5 days, with a corresponding diminution in toxaemia, morbidity, and mortality.    It was not long before Chloromycetin was synthesised under the name of chloramphenicol, and was found to have an identical therapeutic action to its biological cousin, which was extracted, from a mould.    Despite the dramatic effects of chloramphenicol, the perfect antibiotic was yet to be discovered. Relapses, complications and carriers still occurred, relapses even more frequently than previous to specific drug treatment. 3.5 days might be a great advance on 35 days, but it was still a period during which the disease might be, and occasionally was, fatal; especially as there was often an absolute lag period of 2 days in which there was no apparent effect at all of chloramphenicol.    Since 1948 drugs such as Aureomycin, Terramycin and Achromycin have been tried, both in the acute disease and the carrier state, with only limited success. In 1951 both Woodward et al. and Smadel et al. published reports of trials with cortisone, and cortisone plus chloramphenicol in typhoid. They found that chloramphenicol with cortisone had a much speedier action than chloramphenicol alone, but that complications and relapses still occurred, and there were dangers associated with this combined therapy.    Many other drugs had been tried recently, but nothing approached the efficacy of chloramphenicol.    The terminology introduced by White (1929) and modified by Kauffmann accorded specific rank to each antigenically distinguishable salmonella type, and the convention was established that each new type should be named after the place in which it was first isolated. The first published table contained some 20 serotypes; the current number is 2200.    附录4:斑疹伤寒    Typhus appears to be a relatively new disease with the first reliable description is from the Spanish siege of Moorish Granada in 1489. The disease gave rise to sores that could become gangrenous and the victims stank of rotting flesh and became delirious and stupefied. While the Spaniards lost 3,000 men to enemy action during the siege, they lost 17,000 to typhus. The disease ravaged Europe for four centuries and even artillery surrendered its crown as queen of the battlefield to typhus. More than any other disease, it may have served as a model for the use of biological weapons to harry an enemy in the field. It affected the course of every war from the liberation of Spain to Napoleon's failure in Russia. It even killed half of the army he raised after escaping from Elba. In World War I, it still ravaged the armies of the Eastern front.    Not only armies were affected. In London, typhus frequently broke out amongst the ill-kept prisoners of Newgate Gaol and went from there through the courts to the general population, killing at least one Lord Mayor of London. In the aftermath of World War I and during the civil war between the White (Royalist) and Red (Communist) armies that followed the Bolshevik Revolution, typhus killed three million in a devastated and anarchic Soviet Union. It came closer to toppling Lenin than the White Army ever did.    附录5:斑疹伤寒    Typhus in history    The first description of typhus was probably given in 1083 at a convent near Salerno, Italy.[6] In 1546, Girolamo Fracastoro, a Florentine physician, described typhus in his famous treatise on viruses and contagion, De Contagione et Contagiosis Morbis.[7] Before a vaccine was developed in World War II, typhus was a devastating disease for humans and has been responsible for a number of epidemics throughout history.[8] These epidemics tend to follow wars, famine, and other conditions that result in mass causalties.    During the second year of the Peloponnesian War (430 BC), the city-state of Athens in ancient Greece was hit by a devastating epidemic, known as the Plague of Athens, which killed, among others, Pericles and his two elder sons. The plague returned twice more, in 429 BC and in the winter of 427/6 BC. Epidemic typhus is one of the strongest candidates for the cause of this disease outbreak, supported by both medical and scholarly opinions.[9][10]    Typhus also arrived in Europe with soldiers who had been fighting on the isle of Cyprus. The first reliable description of the disease appears during the Spanish siege of Moorish Granada in 1489. These accounts include descriptions of fever and red spots over arms, back and chest, progressing to delirium, gangrenous sores, and the stink of rotting flesh. During the siege, the Spaniards lost 3,000 men to enemy action but an additional 17,000 died of typhus.    Typhus was also common in prisons (and in crowded conditions where lice spreads easily), where it was known as Gaol fever or Jail fever. Gaol fever often occurs when prisoners are frequently huddled together in dark, filthy rooms. Imprisonment until the next term of court was often equivalent to a death sentence. It was so infectious that prisoners brought before the court sometimes infected the court itself. Following the Assize held at Oxford in 1577, later deemed the Black Assize, over 300 died from Epidemic typhus, including Sir Robert Bell Lord Chief Baron of the Exchequer. The outbreak that followed, between 1557 to 1559, killed about 10% of the English population. During the Lent Assize Court held at Taunton (1730) typhus caused the death of the Lord Chief Baron, as well as the High Sheriff, the sergeant, and hundreds of others. During a time when there were 241 capital offenses--more prisoners died from 'gaol fever' than were put to death by all the public executioners in the realm. In 1759 an English authority estimated that each year a fourth of the prisoners had died from Gaol fever.[11] In London, typhus frequently broke out among the ill-kept prisoners of Newgate Gaol and then moved into the general city population.    A U.S. soldier is demonstrating DDT-hand spraying equipment. DDT was used to control the spread of typhus-carrying lice. Epidemics occurred throughout Europe from the 16th to the 19th centuries, and occurred during the English Civil War, the Thirty Years' War and the Napoleonic Wars. During Napoleon's retreat from Moscow in 1812, more French soldiers died of typhus than were killed by the Russians. A major epidemic occurred in Ireland between 1816-19, and soon spread to England. Another typhus epidemic occurred during and after Irish potato famine between 1846 and 1849, and killed a large number of peasants.    In America, a typhus epidemic killed the son of Franklin Pierce in Concord, New Hampshire in 1843 and struck in Philadelphia in 1837. Several epidemics occurred in Baltimore, Memphis and Washington DC between 1865 and 1873.    During World War I typhus caused three million deaths in Russia and more in Poland and Romania. De-lousing stations were established for troops on the Western front but the disease ravaged the armies of the Eastern front, with over 150,000 dyi