1 HISTORY OF MEDICINE PART - II Dr. Cristian Cardenas-Lailhacar 2 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. 3 Andreas Vesalius Officially the worlds 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 Galens errors because Galen had been formed to rely on dissecting apes while he could dissect humans. Leonardo da Vinci (1452 - 1519) was unofficially the worlds first anatomist but his anatomy was used for expression in art work rather than science.
4 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 Galens idea this time on the phy - siology of the human body. Harveys 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. 5 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. 6 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 7 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. 8 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). 9 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 Jenners 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. 10 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 Jenners vaccine might do.) Finally Jenners vaccine was new and many people were scared of the consequences of trying new things. Not an un-familiar behavior. 11 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. 12 Pasteurs experiment had proved that the way to prevent disease was to prevent germs getting in. Finally he knew the cause of disease. Pasteurs theory was important but it was not yet related to medicine. Robert Koch Was the doctor who related Pasteurs 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. 13 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. 14 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. 15 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 Listers microbes and a lot of surgeons did not take Listers advice. Surgeons that did follow Listers 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. 16 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. 17 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. 18 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. 19 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.
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