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- 我是Steffen Stenger
-My name is Steffen Stenger.

这堂课我将介绍结核病的历史
In this sequence, I will present the history of tuberculosis.

结核病是一种古老的疾病
Tuberculosis is an ancient disease

在2500多年前的秘鲁和古埃及木乃伊中
which was first detected more than 2500 years ago

就发现了该病毒
in Peruvian and Egyptian mummies.

在过去的几百年中
In the past hundreds of years,

和由鼠疫杆菌引起的黑死病相反的是
as opposed to the Black Death, the plague, caused by yersinia pestis,

结核病不是一种具有破坏性
which is a devastating,

侵略性的急性病
aggressive, acute disease,

而是一种慢性疾病
tuberculosis,

又被称作“白色瘟疫”
the White Plague, is a chronic disease.

人们咳嗽
People cough,

体重减轻
they lose weight,

感到疲劳和倦怠
they feel fatigue and tired.

但是
But after all,

它毕竟并不像黑死病那样糟糕
it does not seem as bad as the Black Death.

那时有些人
Some people, those days,

甚至谈到 善终
even spoke of the good death.

拥有现世的财富和精神上的纯洁
Spiritual purity, temporal wealth.

有些女性甚至使自己的皮肤变得苍白
Some women even paled their skin

看起来像是肺痨病人
to achieve consumptive appearance.

George Sand（乔治·桑）曾这样描述
George Sand said about

她年轻的男友 Chopin（肖邦）的咳嗽中
her much younger boyfriend "Chopin coughs

蕴含着无限的优雅”
with infinite grace."

终究
But after all,

Chopin（肖邦）死于结核病
he died of tuberculosis.

英国着名诗人Lord Byron（拜伦）甚至说过
Lord Byron, the famous British poet,

我愿死于肺痨
even stated "I should like to die from consumption."

在本慕课讨论的病人中
In this picture is reflected by one of the patients

一位病人的图片也反映了这一点
discussed during this MOOC.

Anton
Anton.

他看起来并不严重
He does not look seriously ill,

是吗
does he?

这个观念在19世纪的许多戏剧
This notion was also reflected in many plays

和歌剧中也有所体现
and operas during the 19th century.

比如Giuseppe Verdi（威尔第）
Think of "La Traviata",

基于Alexandre Dumas（小仲马）的小说
from Giuseppe Verdi, based on the novel by Alexandre Dumas,

创作的《茶花女》
where a prostitute, Violetta,

该剧的主题就是遭受结核病折磨的
suffers from tuberculosis,

妓女维奥莱塔
which is the main topic of the play.

越来越明显的是
It became increasingly clear

结核病曾与贫穷有关
that tuberculosis was poverty related.

像是Giacomo Puccini（普契尼）
"La Bohème",

创作的《波希米亚人》
from Giacomo Puccini,

故事发生在拥挤的巴黎
plays in the crowded Paris.

Mimi贫困且重病
And Mimi...very poor, very sick,

死于结核病
dies of tuberculosis,

Rodolfo因她的死亡而十分悲痛
and Rodolfo is extremely sad,

这是这部着名歌剧的主线
which is the central topic of this famous opera.

拥挤和贫困伴随着结核病
Crowdedness and poverty are associated with tuberculosis.

这在本次慕课中的另一位患者身上表现出来
This is reflected by another patient presented in this MOOC.

Leila有两个孩子
Leila has two children

他们可能患有结核病
who may or may not be affected

也可能没有结核病
by tuberculosis.

1882年
In 1882,

结核病的神秘面纱被揭开了
the whole mystic topic was over.

柏林的Robert Koch（罗伯特·科赫）
Robert Koch, in Berlin,

发现了结核分枝杆菌
discovered mycobacterium tuberculosis, a bacterium,

它是结核病的致病菌
as the definitive cause of tuberculosis.

现在我们找到了结核病的病因
Now that we found the reason, the cause of tuberculosis,

就可以先预防
it was possible to first prevent and then,

后治疗之
later, treat the disease.

在20世纪20年代
During the 1920s,

法国的两位研究人员Calmette（卡大夫）
two researchers, Calmette and Guerin, in France,

和Guerin（介大夫）用牛型结核杆菌的
vaccinated children with a live attenuated vaccine derived

减毒活疫苗给儿童接种
from mycobacterium bovis.

这在某种程度上是成功的
It was somehow successful,

但统计数据遭到了批评
but the statistics were criticised.

最重要的是
And most importantly,

发现了其中一个批次的疫苗被毒性细菌污染
it was found that one of the batches was contaminated with virulent bacteria.

这是结核病疫苗接种的一个严重缺陷
This was a severe drawback in attempts to vaccinate against tuberculosis.

又过了十多年
It took another more than ten years

联合国儿童基金会和世界卫生组织
until the vaccine was spread

建议广泛使用疫苗
and suggested by the UNICEF and the WHO.

除荷兰和美国之外
Most countries,

大多数国家都使用了卡介苗
except for the Netherlands and the US, implemented BCG.

它直到现在仍然是全世界使用最广泛的疫苗
It still is the most widely used vaccine worldwide.

有了疫苗
Next to vaccination,

又知道了病因
when you know the cause of the disease,

就可以开始合理的治疗
you can also start rational treatment.

在抗生素治疗前
The conventional treatment of tuberculosis

常规治疗结核病的方法是新鲜空气
before antibiotics was based on fresh air

高海拔和疗养院
and high altitude and on sanatorium.

直到1947年
It took until 1947,

第一个抗结核药物链霉素
when the first antituberculosis drug, streptomycin,

被引入治疗
was introduced into therapy.

接下来的20年中
During the following 20 years,

还开发了更多的药物
additional drugs were developed.

最主要的是异烟肼
Most importantly,

乙胺丁醇
INH,

和利福平
ethambutol and rifampicin.

40年来
For 40 years,

没有新的发现
nothing happened.

直到贝达喹啉
Until bedaquilin and delamanid were introduced

和德拉马尼
as novel agents

成为抗重症耐多药结核病的新药物
against severe multi-drug resistant tuberculosis.

这种疗法的问题在于这些药物
The problem with this therapy is that several of these drugs

必须联合使用至少六个月
have to be taken in combination for at least six months.

如果不这么做
And if you don't,

会出现严重的问题
you develop severe problems.

结核病会发展成具有复发性
You develop relapse disease,

和耐多药性的疾病
multi-drug-resistant disease,

这将会在本慕课的
and this will be exemplified by patient number C,

C号患者身上表现出来
which will be presented in this MOOC.

非常感谢您的关注
Thank you very much for your attention

希望您能喜欢本慕课的其他部分
and I hope you enjoy the rest of the MOOC.