HISTORY OF MEDICINE PART II

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HISTORY OF MEDICINE PART - II
Dr. Cristian Cardenas-Lailhacar
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Probably the most important contribution that was
made to medical progress by Islamic medicine was
the work of alchemists. They discovered many
chemicals which later were used as cures for
disease.
There is also a theory there was a lot of climate
change during the early Middle Ages, such as we
are beginning to see now, something else which
would have hindered medical progress (???)
The Renaissance The Renaissance was a re-birth
of Greek and Roman ideas. This included
architecture, art and even medicine. This was
very important because people began to think
about medicine again, instead of just following
the old ideas. Renaissance art helped medicine.
It is far more realistic than the art in the
middle ages and this influenced medicine in two
ways. Firstly, doctors such as Vesalius could
employ artists to draw realistic diagrams in
their medical books to spread the ideas. Perhaps
more importantly, however, for artists to draw
realistically they really needed to know about
what the human body was like inside so they
pushed for more dissections - something which
would obviously also help doctors.
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Andreas Vesalius Officially the world's first
modern anatomist, Andreas Vesalius was born in
Brussels in 1514 and studied medicine in Paris
and Italy. He was an early Renaissance doctor and
one of the first doctors to openly criticize
Galen. He corrected many of the mistakes that
Galen had made on human anatomy, saying that he
could now rectify Galen's errors because Galen
had been formed to rely on dissecting apes while
he could dissect humans. Leonardo da Vinci (1452
- 1519) was unofficially the world's first
anatomist, but his anatomy was used for
expression in art work rather than science.

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William Harvey William Harvey was born in 1578
in Kent and studied medicine in Cambridge
(Gonville and Caius College) and Padua. He, like
Vesalius, criticized Galen's idea, this time on
the phy - siology of the human body. Harvey's
greatest discovery was on the circulation of the
blood. The Greek doctors had believed that blood
was created by the heart, then carried by veins
to the limbs where it was used up. Harvey
disagreed - he likened the heart to the water
pump (a new invention at the time) and said that
the heart pumped the blood around the body. He
carried out many experiments and eventually
proved the idea when he realized that the amount
of blood leaving the heart every second was far
too high to have been produced by the body.
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Ambroise Pare Pare was born in France in 1510. A
war surgeon for the French Army, and one of the
first to improve surgery. One day, when he was
treating wounds (using the normal method of
pouring burning oil into them) he ran out of
oil. Desperate to help the injured soldiers, he
improvised with his own mixture of egg yolks, oil
of roses and turpentine. When he came back later
he found that the men who had been treated with
the boiling oil were feverous while the ones he
had treated with his own mixture were better.
This made him decide always to use this new
mixture when curing war wounds. In this
example, both chance and war played a role in the
discovery. It was lucky that Pare ran out of the
oil and even more lucky that his improvised
ingredients were ones that worked. If there had
not been a war, Pare would not have had so many
wounds to deal with and so might well not have
run out of the oil.
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After this discovery Pare realized that what he
had been taught was not always the best way of
treating wound, so he began to try other ideas of
his own. He noticed how painful men found the
cauterising (holding a red-hot iron against). of
open wounds so he tried a new method of tying
ligatures. Unfortunately, although this was a
good idea, the ligatures were often dirty and
introduced infection into the wound. This method
was only to become useful once anti-septics had
been discovered
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Government Intervention in Public Health 1750
1900 The 18th Century was the time of the
Industrial Revolution in Britain, which was
followed by similar revolutions in many countries
across the developed world. The Industrial
Revolution led to a sudden large number of people
moving to the cities to be near the work in new
factories. People were forced to live in tiny
back-to-back slum housing, squashed together with
other families. There was a large amount of
pollution in the cities and public health became
worse. Edwin Chadwick was a British civil
servant in the 1830s. He produced a report on
the Sanitary Conditions of the Labouring
Population. The report recommended a number of
measures to improve public health among the
working classes and led to the introduction of
laws to improve public health such as the Factory
Act, improvements in water supplies, compulsory
vaccinations and laws about child Labor. This was
the first time since the Roman times that the
government was truly becoming involved again.
However, many people resented this, preferring
to be ill than to be forced to be clean.
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John Snow Cholera One of the killer diseases
of the 19th Century was cholera. There were major
epidemics throughout the century, but nobody knew
how to stop it, until Dr. John Snow proved the
link between cholera and water supplies. John
Snow was a London doctor. He researched an
outbreak of cholera in the Broad Street area of
London, and produced a map showing where people
lived who had caught cholera. He noticed that the
only people who caught the disease were people
who had drunk water from one pump. Snow had
information that suggested that cholera was
caused by drinking water from this source, but he
had not proved it. He removed the handle of the
pump so that people had to go to another pump for
their water. Nobody else died. Snow had proved
that infected water caused cholera, so now people
could stop the spread of cholera by identifying
the infected water source, but this was not all
he had also developed the epidemiological
approach to disease (he did research, statistics,
graphs, maps etc. to look for a pattern).
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Edward Jenner Vaccination Jenner a country
doctor in Britain. He discovered and introduced
the first vaccines (against smallpox) at the end
of the 18th Century. Jenner noticed that
milkmaids who caught cowpox, never caught the
deadly disease of smallpox. This led him to
wonder if cowpox prevented the development of
smallpox in some way. After conducting
experiments, he concluded that this must be the
case and introduced a new vaccine which involved
infecting patients with cowpox. This was followed
by the discovery of other vaccines by doctors who
followed Jenner's example. Smallpox had been a
deadly and extremely unpleasant disease. (If you
survived you would be scarred for life by the
disease.) It might have been expected that
everybody would want to try the vaccine which
might protect them from the disease. This was not
the case and Jenner met a lot of opposition.
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Jenner was a country doctor and most people in
the 19th Century people felt that country people
were not clever. This meant that people thought
that the vaccine might not work. The vaccine
involved catching a disease which was usually
present in cows. A lot of people were scared of
this since it would be unnatural and might affect
them in a strange way. (People opposed to the
vaccine put up posters of people turning into
cows as an example of the sorts of things that
Jenner's vaccine might do.) Finally, Jenner's
vaccine was new, and many people were scared of
the consequences of trying new things. Not an
un-familiar behavior.
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Louis Pasteur The Germ Theory During the 18th
and 19th Centuries, people began to understand
that germs caused disease. Until Pasteur, people
had believed that germs occurred spon- taneously
in places where there was disease. Pasteur proved
that it was, in fact the other way round
germs caused disease. Pasteur was working for a
brewery trying to find a way of preventing the
alcohol going bad. He knew the germs found in
alcohol were alive and that he could kill them by
heating the alcohol to a high temperature. He
also guessed that germs caused the alcohol to go
bad. Pasteur set-up an experiment to prove this.
He took two glass bottles containing alcohol and
heated them to kill the germs. He then heated the
spout of one and bent it to make a kink. Then he
left the bottles. When he came back he saw that
the alcohol had gone bad in the bottle without
the kink and that this contained germs. When he
looked at the bottle with the kink, he saw that
the alcohol was the same as when he had left it.
Further examination showed that there were germs
stuck in the kink in the spout.
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Pasteur's experiment had proved that the way to
prevent disease was to prevent germs getting in.
Finally, he knew the cause of disease. Pasteur's
theory was important, but it was not yet related
to medicine. Robert Koch Was the doctor who
related Pasteur's germ theory to human illness.
Koch was born in Prussia in 1843. He first became
a surgeon in the Franco-Prussian war, then a
country doctor. As a doctor, he made a study of
anthrax (affecting animals and humans) and
managed to prove that anthrax was caused by a
germ. Following this, Koch searched for the
germs which caused more diseases (made easier by
his discovery of staining germs with dyes so that
they could be seen more easily), and tracked
down many, perhaps the most significant of all
being the germ which causes tuberculosis. Koch
was recognized for his work with many honours
including the Nobel Prize for Medicine.
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The Royal College of Surgeons In the 18th
Century the reputation of surgeons rose. Until
1745, the surgeons had belonged to the Royal
College of Barbers and Surgeons, and as such had
not been considered proper members of the medical
profession, but in 1745 century surgeons broke
away from this college as they found themselves
earning more and more respect. One of the
reasons for this was education. Before, surgeons
had mainly been the uneducated members of society
but during the 18th Century they often attended
the growing numbers of anatomy schools. This
gained them a better reputation and more
recognition so that in 1800 The Royal College of
Surgeons in England was established. This college
proved to the world that surgeons and their work
was important in medicine, making it more likely
that surgeons would be educated people who would
be able to think of ways to improve surgery.
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Improvements in Surgery The 18th and 19th
Centuries saw most of the problems in surgery
solved, so that operations could finally be
undergone with a reasonably high chance of
survival. Pare had already solved the problem of
bleeding, and in the 18th Century, doctors
learned how to make surgery painless. James
Simpson invented the first anesthetics to
solve the problem of pain during surgery. Before
this alcohol had been the only pain relief so
many patients had died of the shock of the pain
rather than the actual operation. Chloroform was
probably the most widely used and was
administered by holding a rag soaked in it over
the mouth of the patient. As with most medical
progress, chloroform met opposition. First was
the fact that it was difficult to give the
correct dose and there were some tragic cases
where overdoses were given so that the patient
never woke up. The other reason was religions.
Some people believed that pain was sent by God
and that it was irreligious to stop that pain.
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Queen Victoria, the Queen of England challenged
that attitude when she requested chloroform
during the birth of her eighth son, Leopold.
Since members of the Church of England believed
that the Queen represented God, its members began
to believe that God must be happy with the use of
chloroform. Joseph Lister (1827 1912)
Anti-septics helped the next major step in
surgery when he invented the use of carbolic acid
(phenol) as an anti-septic to kill germs in
operations. He got the idea of using this because
carbolic acid was used in sewage works for
killing germs The carbolic acid was sprayed
everywhere, however, many surgeons were opposed
because it was very unpleasant and made their
hands crack. Jokes were made about Mr Lister's
microbes and a lot of surgeons did not take
Lister's advice. Surgeons that did follow
Lister's advice often did not follow his methods
carefully enough and so did not have such a high
success rate. However, this was a major step
forwards since it meant that the problem of
infection had finally been solved.
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20th Century Blood Transfusion Until the 20th
Century blood loss in operations was a problem
because they were usually unsuccessful and very
hard to perform, since blood could not be stored
so on-the-spot donors had to be found. In 1901
blood groups were discovered. Until then people
were given blood transfusions from people of any
group and even animals! No wonder they were
rarely successful. There was still no known way
to store blood, however blood transfusions could
be performed successfully with on-the-spot
donors. The next discovery was thanks to World
War I. During the war, large quantities of blood
were needed for transfusion so doctors were under
pressure to find a way of storing blood. Finally,
somebody had the idea of separating the plasma
from the rest of the blood so that blood could be
stored effectively and given to patients who
needed it after operations.
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Alexander Fleming
Penicillin - Anti-biotics
In 1928, Alexander Fleming discovered that
penicillium mould could fight bacteria when some
landed on a petri-dish in his laboratory. World
War 2 was imminent, and the British government
realised that antibiotics would be needed. They
funded a team of scientists to extract the
penicillin to a useable form and paid for a
factory so that it could be mass produced.
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National Health Services During the early 20th
Century, Health Insurance and Services were
introduced in many countries. This was the idea
that workers paid a very small fraction of their
wages to the government and in return they would
be given free medical treatment when they were
ill. This was a huge step forwards at the time,
but there were still problems since neither women
nor children could become part of the scheme.
During WWII, the UK government introduced a
temporary health scheme to deal with the problem
that all normal civilians were being wounded by
falling bombs and that they needed a healthy
nation t win the war. In the UK At the end of
the war a Labour government was voted into power.
They set up the British National Health Service
to which everybody contributed in their taxes and
from which everybody could get free treatment.
Around the same time, other countries followed
the same idea. The NHS is still essentially the
same principle as it was when it was first set
up. However, major changes have been made, due to
the increased cost to the government and limits
on the funds that the government have put in. For
example, once prescriptions were free for
everybody, whereas now most people have to pay.
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Recent Developments Recently medicine has been
developing rapidly in all areas due to
improvements in communication and teamwork
between people all over the world. Surgery
keyhole surgery is being developed Chemists
are always searching for new drugs. This is
helped by the exploration of areas such as
rainforests where natural chemicals (eg. from
plants) can be found and used as drugs. Mapping
of the Human Genome which could open up new ways
of screening for diseases and creating donor
organs etc. Conclusion the factors which
influence medical progress and regression are
still the same as they have always been
religion, war, individuals, team work, government
intervention and, perhaps most importantly,
chance.