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The History of Medicine

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Title: The History of Medicine Author: gsarka Last modified by: Srinivas Created Date: 8/7/2007 4:26:43 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: The History of Medicine


1
The History of Medicine
  • By George Sarka MD,MPH,FACP,FACR
  • DrPH Candidate in Public Health at UCLA
  • Assistant Clinical Professor in Medicine at UCLA
  • Governor-Elect of the ACP Southern CA, Region 2
  • President of the LA Neurological Society
  • President of LA County Medical Association-Distric
    t 1
  • Staff Neurologist at SMMC
  • Staff Rheumatologist at CSMC
  • Staff Physician at the Klotz SHC at CSUN
  • Medical Historian and Medical Lecturer
  • Diplomate in Internal Medicine, Rheumatology,
  • Neurology, Headache Medicine, Sports Medicine,
    Geriatrics and Emergency Medicine

2
Objectives for the Lecture
  • At the end of this lecture, the physician should
    be able to do the following
  • 1. Discuss the evolution and significant events
    in the history of medicine.
  • 2. Discuss the significant individuals
    responsible for the advances in medicine.
  • 3. Discuss how this subject is germane to medical
    issues today.

3
Drug Company Affiliation
  • None

4
William Osler said of Medicine and Art
  • Medicine is a science of uncertainty and an art
    of probability. SirWilliam Osler

5
In the Beginning
  • In September 1940, four teenagers around the
    northern slopes of Frances Pyrenees mountains
    stumbled upon one of the most famous and
    astounding repositories of Paleolithic art in the
    world the cave of Lascaux

6
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7
Cave of Lascaux
  • Hundreds of paintings and etchings of red cows,
    yellow horses, bulls and black stags fan out
    across the caves walls and ceilings in a literal
    stampede.
  • It is the worlds oldest example of medicine in
    art, dating back 15,000 years.

8
Cave of Lascaux
  • The lone human figure among all the animals is
    the man with a head of a bird, who appears to be
    in some kind of trance during a confrontation
    with a bull. Beside him is a staff.
  • It is widely believed that the human figure is
    some sort of shaman.
  • Shaman were in charge of the knowledge of health,
    and of life death.

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11
Trepanning
  • Primitive man believed that head pain was the
    work of evil spirits who invaded the body of
    unfortunate individuals.
  • If headache was caused by the invasion of evil
    spirits, then letting the spirits out of the
    skull should bring relief.
  • Thus was born the surgical procedure known as
    trepanning which dates back ten thousand years or
    more.
  • Such procedures were found in the South Pacific,
    Europe, North America and South America.

12
Themes in Medicine
  • Superstition, Evil Spirits, Humours
  • Blind Loyalty and Downright Stupidity
  • The Emergence of Iconoclasts
  • Ingenuity
  • Common Sense
  • Serendipity
  • Kindling Phenomenon
  • The Art and Science of Medicine
  • Hard Work and Dedication
  • Techology
  • Imagination

13
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14
Imhotep- the One Who Walked in Peace
  • Vizier of a Pharaoh, lived about 2900 BC
  • He is credited with many accomplishments in many
    fields and one of his activities seems to have
    been that of a successful physician.
  • He is one of the first medical men whose name is
    on record and rose from the role of medical hero
    to become God of Medicine.
  • He began using simple surgery instead of just
    magic.

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16
Sir William Osler tells us that Imhotep was the
  • "..first figure of a physician to stand out
    clearly from the mists of antiquity." Imhotep
    diagnosed and treated over 200 diseases, 15
    diseases of the abdomen, 11 of the bladder, 10 of
    the rectum, 29 of the eyes, and 18 of the skin,
    hair, nails and tongue. Imhotep treated
    tuberculosis, gallstones, appendicitis, gout and
    arthritis. He also performed surgery and
    practiced some dentistry. Imhotep extracted
    medicine from plants. He also knew the position
    and function of the vital organs and circulation
    of the blood system. The Encyclopedia Britannica
    says, "The evidence afforded by Egyptian and
    Greek texts support the view that Imhotep's
    reputation was very respected in early times. His
    prestige increased with the lapse of centuries
    and his temples in Greek times were the centers
    of medical teachings." 

17
The Healing Art and Disease
  • Physicians based their healing art upon the
    belief that evil spirits, hateful demons, and
    vengeful gods struck people with diseases.
  • Invisible arrows shot by the Greek god Apollo
    caused pain.
  • One treatment for disease was for the victim to
    travel to one of the many pagan temples in
    Greece.

18
The Healing Art and Disease
  • The sick person made a sacrifice and then spent
    the night in the temple. As he slept, he was
    supposed to dream away the sickness.

19
The Two Great Names in the History of Greek
Medicine
  • Hippocrates-dominated the beginning of a period
    of remarkable scientific creativity, which lasted
    more than 700 years
  • Galennear the end of the period, both furthered
    scientific knowledge and crystallized it in an
    amazing volume of written works. His influence
    lasted for 1500 years/45 generations.

20
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21
Hippocrates(460B.C.-377B.C.
  • Hippocrates is know as the Father of Medicine.
    He is considered one of the greatest physicians
    the world has ever known.
  • He was the first to attempt to separate the
    practice of medicine from religion and
    superstition.
  • Hippocrates developed his pledge of proper
    conduct for doctors. I will use treatment to
    help the sick according to my ability and
    judgment, but never with the view to injury and
    wrong doingInto whatsoever houses I enter, I
    will enter to help the sick.

22
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23
On Airs, Waters, and Places around 400B.C.
  • Hippocrates penned a tract called On Airs,
    Waters, and Places.
  • This was the earliest reference to epidemiologic
    thinking.
  • He emphasized familiarity not only with the
    patients symptoms, but also with the season of
    the year and the patients living conditions,
    diet fluid intake, and exercise habits

24
On Airs, Waters and Places
  • For if one knows all these things well, or at
    least the greater part of them, he cannot miss
    knowing, when he comes into a strange city,
    either the diseases peculiar to the place, or the
    particular nature of common diseases, so that he
    will not be in doubt as to the treatment of the
    diseases, or commit mistakes, as is likely to be
    the case provided one had not previously
    considered these matters. And in particular, as
    the season and the year advances, he can tell
    what epidemic diseases will attack the city,
    either in summer or in winter, and what each
    individual will be in danger of experiencing from
    the change of regimen.

25
Hippocrates Refusing Gift from Alexander by
Anne-Louis Girodet(1816)
26
The Hippocratic Oath
  • Hippocrates also made changes in how physicians
    looked upon their profession.
  • During his time, a doctor was sometimes bribed to
    see that a patient died, or asked to prepare
    poison to kill an enemy. If a ruler wanted to rid
    himself of a rival, he could hire a court
    physician who would see that the rival became
    sick and died.
  • Hippocrates taught against such improper conduct.
    He told his students to treat everyone the same.
  • Sometimes give your services for nothingfor
    where there is love of man, there is also love of
    medicine.

27
The Hippocratic Oath
  • A statement describing proper conduct.
  • It was a pledge and is a guideline for honorable
    standards of action.
  • I will use treatment to help the sick according
    to my ability and judgment, but never with the
    view to knjury and wrong doingInto whatsoever
    houses I enter, I will enter to help the sick.

28
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29
Allegories of the Healing Arts
  • An allegory, or a pictorial symbol, serves to
    formulate into some tangible aspect an idea or
    point of view that may exist vaguely in the minds
    of many.
  • The allegories of the Healing Artsvisual images
    around which are centered the faith and hope of
    mankind.

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32
Head of Asklepios(Greek Coin, II Century B.C.)
  • The earliest icon of medical significance
  • Head of Asklepios was pictured on a silver
    drachma, a Greek coin minted on the island of Cos
  • He was the son of Apollo
  • The centers of his cult were temples where the
    sick went, similar to our modern day sanatoriums,
    with emphasis on diet, massage, baths and the
    like.

33
Head of Asklepios(Greek Coin, II Century B.C.)
  • The god was supposed to reveal to the patient in
    a dream the cure for his/her disease.
  • The serpent, symbolic of regenerative power, was
    sacred to Asklepios and to Apollo.
  • The emblem, in the form of a rod with a coiled
    serpent, is still used to represent the art of
    medicine

34
Note the Hippocratic Oath
  • I swear by Apollo the physician and Asklepios
    and his daughters, Hygeia and Panacea, and all
    the Gods and Goddesses
  • Hippocrates was also born on the Island of Cos

35
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36
Galen Described Wounds as Windows to the Body
  • Galen, the great 2nd century physician and
    anatomist, spent his early medical career as a
    surgeon to the gladiators.
  • He employed as many as 20 scribes to write down
    all that he said in the work.
  • He dissected countless animals in his prolific
    medical research.
  • Galen also studied philosophy and wrote that a
    motive of profit was incompatible with a serious
    devotion to medicine, stating that doctors must
    learn to despise money.
  • He was a proponent of the miasma theory of
    infection, which essentially blamed infection on
    clouds of poisonous gases.

37
Galen(Galenos) meaning calm or serene The
Infallible Master
  • The profession of medicine gained a wealth of
    facts and ideas from Galen.
  • He gave to the world a synthesis of medical
    thought and knowledge solid enough to last nearly
    1500 years.
  • His mind was quick and well organized.
  • He was well informed on many subjects.
  • In the earlier period of his life, he continually
    insisted on experiments and on demonstrable
    proofs.
  • But the open-minded young Galen later became one
    of the great dogmatists of all times. The
    magnitude of his dogmatism was increased by his
    followers and commentators.

38
Galen
  • Galen believed that disease resulted from an
    imbalance of the vital fluids, or humors, of the
    body. This idea was developed by Hippocrates, and
    consolidated by Galen.
  • The body has in itself blood, phlegm, yellow
    bile, and black bileWe enjoy the most perfect
    health when these elements are in the right
    proportion.
  • The medicine and pathology Galen practiced, and
    about which he wrote, were based mainly on
    speculative Hippocratic theories of the 4 humors,
    on critical days, and on fallacious theories
    regarding pulse and urine.

39
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40
The Four Humours
  • Developed out of the humoral theory of
    Empedocles(500 to 430B.C.), the Scilian
    philosopher.
  • Developed by Hippocrates and consolidated by
    Galen.
  • From the 4 elements earth, air, fire and water
    derived the idea of the 4 humours(or fluids) of
    black bile, yellow bile, blood and phlegm with
    their associated meancholic, choleric, sanguine
    and phlegmatic temperments.
  • It was believed that the balance of these humours
    in the body determined physical states of health.

41
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42
Galen
  • Galen made the first attempts to master anatomy.
    He studied the anatomy of animals and applied it
    to humans.
  • Medical schools used Galens books as textbooks
    for more than a thousand years. He became the
    undisputed authority. NO ONE DARED TO EVER DIFFER
    WITH HIM!
  • From physicians to emperors as well as commoners
    in the Roman Empire, Galen was considered a
    shrewd observer who gained much experience
    through experimentation.

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44
The Picture
  • Galen, whose teachings were accepted as dogma by
    medical men for 1500 years, is pictured in a 2nd
    century Roman home applying cupping, a form of
    treatment that he advocated.
  • Galen was a pillar of medicine and the last
    important pillar in the millennium of Greek
    domination of the medical world.

45
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46
St. Cosmas and St. Damian
  • Traditionally acclaimed the patron saints of the
    physician and apothecary
  • These 2 brothers were Syrian Christians who were
    reputed to have effected many miraculous cures
    before their matyrdom in the reign of Emperor
    Diocletian(A.D.303)
  • Seen frequently in paintings, miniatures, or
    prints

47
Rome Falls in 476A.D.
  • The Dark Ages of Medicine begin.

48
Medicine in the Dark Ages (roughly 500-1050 AD)
  • Massive decline in the number, and quality, of
    medical writings available.
  • 2 important features stand out during this
    decline
  • A) Preeminence of do-it-yourself handbooks,
    primarily of dietetic medicine.
  • B) The ecclesiastical takeover of medical
    learning and learning in general. For few could
    read outside the ecclesiastical community.

49
Medicine in the Dark Ages (roughly 500-1050 AD)
  • The relatively learned medicine was supplemented
    by the healing offered at shrines and by holy
    men.
  • Tales abound of miraculous cures via shrines and
    icons.
  • Some saints were almost specialists

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52
Some Saints as Medical Specialists
  • St. Dymphna was favored for mental diseases
  • St. Roch for plague
  • St. Hubert for rabies sufferers
  • St. Blaise for throat complaints

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54
The Kings/Queens Evil
  • Medieval people seemed to have suffered much from
    TB but most probably had the glandular form
    scrofula.
  • In England and France, it was believed that
    royalty had the power to cure the affliction by
    touching the sufferers, and from the 12th to the
    18th century, the kings/queens touch was
    regularly used against this condition.

55
The Kings/Queens Evil
  • Remember after the Reformation, the Church of
    England rejected all forms of recourse to Saints,
    relics, holy water, and so on, which the Roman
    Catholic Church had recommended.
  • This practice involved the ruling monarch curing
    victims of scrofula and similar ailments.

56
The Kings/Queens Evil
  • The king touched the victim and often also a gold
    coin  - usually an Angel, showing the Archangel
    Michael killing the dragon -  that was then worn
    around the victim's neck, and the person promptly
    recovered.

57
The Emergence of Medicine from the Dark Ages
  • Occurred around 1050 in the region of Salerno,
    southern Italy where this thriving medical
    community was in touch with the Greek and Arab
    worlds as well as the wealthiest and
    intellectually most advanced abbey of Europe,
    Monte Cassino.
  • In 1080, the Salernitan masters reintroduced
    theoretical speculation into medical teaching.

58
The Emergence of Medicine from the Dark Ages
  • From 1200, Latin translations of some Arabic
    texts by Constantine the African, re-established
    Galenic academic learning, combining commentary
    on a few set texts with philosophical discussion
    of wider issues.
  • By 1250, practical demonstrations of animal
    anatomy was introduced.

59
The Three Consequences of Translation Movement
  • 1.The amount of learned medical material suddenly
    burgeoned beyond all recognition
  • 2.The language of medicine was heavily arabized
    and its therapeutics depended heavily on Arabic
    sources, especially in pharmacology/surgery.
  • 3.Now, there was a heavy philosophical component,
    based on Aristotle (natural philosophy) in the
    new medicine.

60
The Arab Influence
  • Arab medicine, so-called because of the language
    in which it was written down, greatly influenced
    the medical thinking of the West from the 12th to
    15th centuries.
  • The Arabs played an import part in teaching the
    art of prescribing and surgery.
  • Avicenna(980-1037 A.D.), the prince of
    physicians, is noted for his Canon of Medicine.

61
Avicenna(980-1037 A.D.) and the Canon of Medicine
62
The Development of University Medicine
  • First occurred in northern Italy, in the wealthy
    towns of Bologna and Padua, then in France (Paris
    and Montpellier), and in England (Oxford).
  • Germany lagged behind, but by 1400 many areas of
    Western Europe had their own institutions of
    higher learning.

63
The Development of University Medicine
  • Medicine came late into the universities.
  • Professional associations of medical teachers, as
    at Salerno, joined universities only when they
    saw the advantages of the new institutions
    ability to secure their own rights and privileges
    in law and theology, and many universities,
    especially in France, never had a medical faculty.

64
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65
Hotel Dieu, 1500 by Triptych
  • Triptych showing the Hôtel Dieu in Paris, about
    ad 1500. The comparatively well patients (on the
    right) were separated from the very ill (on the
    left). Note there were always two patients to a
    bed.

66
The Father of Modern Toxicology
  • Phillipus Aureolus Theophrastus Bombastus von
    Hohenheim
  • All substances are poisons there is none which
    is not a poison. The right dose differentiates a
    poison and a remedy.

67
Paracelsus(1493-1541) and Chemical Remedies
  • One of the most famous questioners of medical
    authority.
  • Paracelsus was an enigmatic character,
    flamboyant, quarrelsome and reforming. His
    somewhat eccentric behavior prevented his
    settling down in any one place and gave his life
    a vagabond flavour.
  • Not content with refuting the authority of Galen
    and Avicenna, he publicly burned their books.
  • He is credited with enlisting the help of
    chemicals in therapeutics and vigorously opposing
    polypharmacy, or the prescription of multiple
    ingredients in a single medicine.

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69
Andreas Versalius(1514-1564)
  • Was the first master of human anatomy.
  • His careful studies provided doctors with the
    accurate information that they need to save
    lives.
  • Versalius did not accept the teachings of Galen
    without experimenting on his own.
  • Versalius kept a copy of Galens books on hand
    and made changes in them. He found over 200
    mistakes in the ancient booksmistakes that were
    still being taught by doctors of his day!

70
Andreas Versalius(1514-1564)
  • Versalius learned human anatomy by looking at
    humans not just animals.
  • He made detailed drawings of his findings so
    others could also learn.

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72
The Fabric of the Human Body
  • Varesalius was just 28 when he published the
    above.
  • It was published in 1543, contained 663 pages and
    300 beautiful illustrations.
  • Versalius spent his personal fortune and all his
    enthusiasm on it.
  • The publication of Fabric marked a turning point
    in the history of medicine.

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76
The Father of Modern Surgery
  • Professors in medical schools seldom performed
    surgery.
  • They did not think that it was proper for a
    professional man to do such work.
  • Surgeon is from a French word meaning one who
    works with his hands.
  • In the Europe of the 1500s, barbers, not doctors,
    performed minor operations, pulled teeth, and
    treated cuts.
  • Barbers who gained skill in closing wounds were
    called barber-surgeons.

77
The Striped Barber Pole
  • The barber pole is a symbol of the profession and
    is a legacy of bloodletting.
  • After the operation, the bandages would be hung
    on the staff and sometimes placed outside as
    advertisement.
  • Twirled by wind, they would form a red white
    spiral pattern that was later adopted for painted
    poles.
  • The earliest poles were surmounted by a leech
    basin, which in time was transformed into a ball.
  • The stripes of a barber pole still show the red
    for blood and the white for bandages. Sometimes
    there were poles with blue representing the
    veins.

78
Ambroise Pare(1510-1590)
  • Pare used ointments and silk thread to repair
    injuries in place of burning oil and hot pokers.
  • Pare discovered new techniques that made surgery
    practical.
  • He published his book in French with useful
    information that all doctors could use.
  • Pare did not have a formal education. He never
    earned a medical degree. Yet he became Frances
    most skilled surgeon. In 1562, he was given the
    dignified title, First Surgeon of the King.
  • I treated him. God healed him.

79
Medicine Prior to the 17th Century
  • The old-style physician had almost no diagnostic
    technology nor did he conduct a full, hands-on
    physical exam. Rather, he worked on the basis of
    his senses sight, touch (of the wrist for the
    pulse), hearing, smell and taste (sampling urine
    for the sweetness symptomatic for DM.

80
Uroscopy
  • Elaborate diagnostic charts exist, correlating
    these indications with various maladies.
  • Even in the written literature of William
    Shakespeare does the above exist Sirrah, you
    giant, what says the doctor to my water?...He
    said, sir, the water itself was a good healthy
    water but for the party that owned it he might
    have more diseases than he knew for. from Henry
    IV. Uroscopy

81
The Village Doctor by David Teniers the
Younger(17th Century)
82
Uroscopy Wheel
  • This is taken from The Fasciculus Medicinae by
    Johannes De Kethan, 1491.
  • This was a collection of medical treatises
    dealing with medicine and surgery dating back to
    the 13th century and included the first modern
    anatomic illustration.

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84
Galens View of Blood Circulation-Based on False
Ideas
  • Galen said that blood in the veins always carried
    blood away from the heart.
  • The flow was slow and irregular. Blood ebbed and
    flowed like tides.
  • Galen taught that the liver manufactured new
    blood to replace the old.
  • Blood surging through the heart caused it to
    beat. He had no ideas that the heart itself
    pumped blood.

85
The Age of Enlightment
86
Medicine in the 17th Century
  • The greatest physiological advance of the 17th
    century was the discovery of the circulation of
    blood.
  • Credit goes to the Englishman William
    Harvey(1578-1657).
  • In 1628, Harveys De Motu Cordis which concerned
    with the mechanical process of circulation.

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89
The Four Humors and William Harvey
  • The "humors" theory of the body was centered on
    "vital spirits" moving from the heart they
    regulated the balance of the four humors and
    could be disturbed by the spiritual intervention
    of the devil. Once Harveys notion that the heart
    was just a muscular pump moving blood around the
    body became prevalent, explanations in terms of
    demonic spirits no longer convinced.

90
William Harvey by Robert Hannah, 1848
  • Harvey is famous for his discovery that blood
    circulates around the human body.
  • He proved that blood circulates through the body
    in one direction.

91
Antoni van Leeuwenhoek (1632-1723)
  • Developed the most powerful microscopes of his
    day.
  • He discovered one-celled protozoans and bacteria.
  • His work eventually led to the discovery of the
    causes of diseases, such as the Black Death.

92
The Art of Medicine Becomes Scientific
  • Although this movement was launched in the 17th
    century during the Age of Enlightment, it was not
    until the 19th century that the true age of
    science was born.

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96
Edward Jenner(1749-1823)
  • Jenner was ridiculed and resented by his fellow
    doctors.
  • This cartoon makes fun of Jenners inoculations.
    In a crowded room, Jenner prepares to vaccinate a
    young woman sitting in a chair. The scene about
    them is mayhem as several former patients
    demonstrate the effects of the vaccine with cows
    sprouting from various parts of their bodies.

97
Edward Jenner(1749-1823)
  • Jenner discovered that having cowpox protected a
    person against smallpox.
  • Jenners cowpox serum saved many lives, and
    almost eliminated the disease of smallpox.
  • His discovery of vaccination is considered one of
    the most important discoveries in medicine.
  • Jenner nor any other doctor knew the cause of
    infectious diseases or why vaccination worked.

98
The Birth of Anesthesia
A nineteenth-century physician administering
chloroform prior to surgery. Ether was one of the
earliest anesthetics to be used but it was
difficult to administer as it usually made the
patient choke.
99
Sir Humphry Davy (1778-1829)
  • Humphry Davy discovered laughing gas(nitrous
    oxide) which has made dentistry much less painful.

100
Sir James Young Simpson (1811-1870)
  • James Young Simpson discovered chloroform could
    be used as an anesthetic.
  • Simpson fought to make anesthesia an established
    part of surgery.

101
William Thomas Green Morton(1819-1868)
  • Invented a special glass inhaler and added
    perfume to ether.
  • Successfully used either to pull a tooth and to
    then perform painless surgery.
  • His tutor Dr. Charles Jackson gave Morton some
    advise on using ether and then later claimed it
    was all his idea.

102
The Recognition of Nutrition and Disease
103
James Lind(1716-1794)
  • In James Linds experiment, those that ate citrus
    fruit stayed healthier.
  • Captain Cook took Linds advice and his crew
    stayed health for a four-year journey.
  • The British Navy finally ordered sailors to drink
    lime juice.
  • Lind had found the cure for scurvyvitamin C.

104
Christian Eijkman(1858-1930)
  • Found that bacteria did not cause beriberi.
  • He found that brown rice was a cure for beriberi
    because of a vitamin (now know to be thiamine) in
    the husks.

105
Jean Boussingault (1802-1887)
  • Jean Boussingault found that a mineral called
    iodine could cure a goiter of the thyroid gland.

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108
Rene-Theophile-Hyacinthe Laennec and the
stethoscope
  • In 1816 I was consulted by a young woman
    presenting general symptoms of disease of the
    heart. Owing to her stoutness little information
    could be gathered by application of the hand and
    percussionI recalled a well-known acoutic
    phenomenonnamely, if you place your ear against
    one end of a wooden beam the scratch of a pin at
    the other extremity is distinctly audible. It
    occurred to me that this physical property might
    serve a useful

109
Rene-Theophile-Hyacinthe Laennec and the
stethoscope
  • This physical property might serve a useful
    purpose in the case with which I was then
    dealing. Taking a sheet of paper I rolled it into
    a very tight roll, one end of which I place on
    the precordial region, whilst I put my ear to the
    other. I was both surprised and gratified at
    being able to hear the beating of the heart with
    much greater clearness and distinctness that I
    hever before by direct application of my ear.

110
The Stethoscope
  • Rene Laennec, who invented the first stethoscope,
    commented that "no patient report could suffice
    to characterize disease, and that for a certain
    diagnosis, mediate auscultation is required."

111
Miasmata
  • Originated from Galen
  • Poisons in the atmosphere emanating from cesspits
    and rotting material caused illness.
  • In 1840, the German pathologist Jakob
    Henle(1809-1885) published his essay On
    miasmata and contaia, in which he tried to show
    that tiny living creatures in the human body
    caused infectious diseases.
  • The idea of germs began to challenge the
    prevailing theory were caused by miasmata.
  • The above was supported by the work of Frechman
    Louis Pasteur and the British surgeon Joseph
    Lister.

112
Public Health
  • The concept had it origins in Biblical rules on
    health and hygiene as well as in great
    architectural works such as the building of the
    aqueducts to supply fresh water to Rome and the
    removal of waste by means of the great drain, the
    cloaca maxima.
  • Principles regarding safe diets and person
    hygiene were taught by the great religions. These
    were reinforced by later miasmatic notions. Evil
    smells do indicate poor sanitation and their
    removal reduces sources of infection.

113
John Snow(1813-1858), the Father of Public Health
  • Effectively brought an end to the 1854 epidemic
    in Soho, London by demonstrating only those who
    drank from the infected Broad Street pump
    contracted the disease.

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Ignaz Phillipp Semmelweiss
  • 1. Childbed fever was taking thousands of lives
    of young mothers
  • 2. More women were dying under the care of
    doctors than midwives.
  • 3. Some doctors were more interested in their
    reputations than in saving lives.

116
Ignaz Phillipp Semmelweiss
  • 1. Discovered that the doctors were spreading
    childbed fever.
  • 2. He proved that doctors were carrying the
    disease from corpses to their patients.
  • 3. He proved that cleanliness could prevent
    childbed fever.

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Problem in Surgery
  • Infection was a major problem during surgery.
  • People often died after surgery from the
    infection alone.
  • Compound bone fractures almost always ended in
    death because of infections.

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Joseph Lister(1827-1912) and Infection
  • Discovered that carbolic acid prevented infection
    on compound infections.
  • By insisting that everything be kept clean and
    disinfected, he lowered the death rate in his
    surgeries.
  • He discovered it was not the presence of acid bit
  • the absence of germs that mattered in surgery.

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The Search for the Etiology of Disease
  • Robert Koch discovered that anthrax was caused by
    bacteria.
  • He discovered how to grow bacteria in cultures
    for study, and how to add stain in order to see
    them.
  • Robert Koch proved that most diseases are caused
    by a particular bacteria.
  • Microbiologist, Robert Koch discovered the
    tubercle bacillus in 1882 where one in seven
    deaths in Europe was due to TB.

123
Kochs Postulates to Advance the Germ Theory
  • The causative agent must be present in every case
    of the disease and must not be present in healthy
    animals.
  • The pathogen must be isolated from the diseased
    host animal and must be grown in pure culture.
  • The same disease must be produced when microbes
    from the pure culture are inoculated into
    healthy, susceptible animals.
  • The same pathogen must be recoverable once again
    from this artificially infected animal and must
    be able to be grown in pure culture.

124
Louis Pasteur(1822-1895)
  • Louis Pasteur dismissed t he miasmatic theory
    of disease. He argued that diseases were caused
    by germs and so effectively established
    bacteriology as a science.

125
Louis Pasteur Returns to the Scene
  • Louis Pasteur discovered that chickens could
    survive cholera when given a weakened form of the
    disease.
  • He found that an anthrax vaccine could be made by
    heating the bacteria.
  • He discovered rabies was caused by a virus
    instead of bacteria and then developed a vaccine
    for humans.

126
Medical Schools in the United States
  • High-quality medical schools and clinical
    investigations developed more slowly.
  • In its laissez-faire, business-dominated
    atmosphere, many schools were blatantly
    commercial, inadequately staffed and offering
    cut-price degrees.

127
What Was It Like to be a Medical Student 140
years ago?
  • No one worried about admissions, for entrance
    requirements were lower than they are for a good
    high school student.
  • Instruction was superficial and brief.
  • The terms lasted only 16 weeks, and after the
    second term the M.D. was automatically given,
    regardless of a students academic performance

128
What Was It Like to be a Medical Student 140
years ago?
  • Teaching was by lecture alone.
  • Thus, students were spared the onerous chores of
    attending labs, clinics and hospital wards.
  • It was not uncommon for students to graduate
    without ever having touched a patient.

129
Medical Schools in the 1860s and 1870s
  • Many were privately owned, operated for profit
    and without university affiliation.
  • Physicians often had little to offer their
    patients other than sympathy and tender care for
    ailments they lacked the means to cure.
  • The medical profession was held in low regard by
    the general public.

130
The Birth of Johns Hopkins University and Medical
School
  • At Hopkins, a new era of American medicine was
    born, with rigorous admission requirements and a
    quality of training that set new standards in the
    United States and compared favorably with the
    venerable European institutions.

131
At Johns Hopkins University and Medical School
  • Candidates for admission to Hopkins were required
    to have a four-year college degree, including
    two years of premedical training in biology,
    chemistry and physics, and a reading knowledge of
    French and German.

132
The Four Doctors by John Singer Sargent(1905)
133
The Big Four of Hopkins
  • William H. Welch in pathology and the future Dean
  • Osler in medicine
  • William S. Halsted in surgery
  • Howard A Kelly in gynecology
  • All younger than 40 years old, organized the
    hospital departments.

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Evolution of Disease
  • In the 19th century, diarrheal diseases were the
    biggest killer of children, and tuberculosis was
    the leading cause of adult mortality.
  • In the 20th and 21st centuries, chronic diseases
    are now the leading cause of disease and death in
    adults.

137
Technology Reigns Supreme
  • William Crookes invented the Crookes tube which
    developed into TVs and monitors.
  • Wilhelm Roentgen invented the x-ray machine by
    using the Crookes tube.
  • Because of its ability to see inside the body,
    x-ray photography is one of the most important
    medical discoveries.

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The Use of Radiation
  • Henri Becquerel proved that radiation from
    uranium is like x-rays but more powerful and is
    credited in discovering radioactivity in 1896.
  • Pierre and Marie Curie discovered radium and
    other radioactive elements.
  • When controlled, these radioactive elements can
    be used to enhance x-rays and fight cancer.

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The Birth of the EKG
  • Sir Thomas Lewis mastered the technology of the
    electrocardiogram in 1912.

145
Andrew W. Doc Fleischer
  • In 1921, the above developed the mercurial
    sphygmomanometer and spent his career refining
    medical instruments, including the modern
    stethoscope.

146
The Birth of Medical Organizations/Societies
  • ACP-1915Joining of the ACP and ASIM
  • AAN
  • AAFP
  • ACR
  • AGS
  • Etc.

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The Advent of Drugs
  • Dr. Gerhard Domagk(1895-1964) discovered sulfa
    drugs.
  • This drug became world famous when Dr. Perrin H.
    Long used sulfa drugs to treat Franklin Roosevelt
    Jr.
  • Sulfa was called a wonder drug because it
    killed bacteria but did not hurt the cells of
    human tissue.

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Mold Becomes A Medical Ally in the Battle Against
Bacteria
  • Alexander Fleming(1881-1955) discovered
    penicillin which killed staphylococcal bacteria.
  • Florey and Chain isolated the chemical and found
    that it could be mass-produced, making it more
    affordable.
  • Penicillin was stronger(bacteriocidal) that
    sulfa(bacteriostatic) and had fewer side effects.

151
Technology Transform the Medical Arena
  • Dr. Richard Drew(1904-1950) established the use
    of transfusion and blood banks.
  • Dr. Christian Barnard(1922-2001) performed the
    first heart transplant in 1967.
  • Dr. William Kolff developed an artificial kidney
    machine.
  • James Watson and Francis Crick discovered DNA.

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Technology and the 20th/21st Century(Medicines)
  • Antiseptics
  • Antibiotics
  • Antiepileptics
  • Antipsychotics
  • Chemotherapies
  • Myoclonal Antibodies
  • Vaccines
  • Biologic Agents
  • Continuing Story of Aspirin
  • Blood Transfusions and Blood Banks

156
Technology and the 20th/21st Century(Evaluative
Procedures)
  • Electron Microscope
  • CT Scans
  • MRI Scans
  • MRA Scans
  • Pet Scans
  • Functional MRI
  • The Human Genome
  • Genetic Testing
  • Genetic Enzyme Replacements Therapy

157
Technology and the 20th/21st Century(Surgeries)
  • Artificial Kidney MachineDialysisKidney
    Transplants
  • Coronary Artery Bypass
  • Angioplasty
  • Total Hip and Knee Replacements
  • Neurosurgery
  • Lasik Surgery
  • Organ TransplantsHeart, Kidney, Lung, Liver,
    Pancreas, etc.

158
The Transformation of Medical Education
  • Medical Schools and the Gender Gap
  • Medical Schools and Diversity
  • The Soaring Cost of a Medical Education
  • The Primary Care Physician v. the Specialist
  • Board Certification
  • The Integration of
  • Complimentary Alternative Medicine
  • The Introduction of the Medical Home--ACP

159
Transformation of Medical Care
  • The Advent of Chronic Disease as a Major Cause of
    Morbidity/Mortality
  • Home Care to the Office to Hospital Care
  • The Private Practictioner to the Medical
    University
  • The Advent of Medicare/Medicaid in the USA
  • Universal Coverage in Many Countries
  • Managed Care
  • HMOs, IPOs, PPOs, POS
  • Primary Care Physician v. the Subspecialist
  • The Advent of Medical Home Model(ACP)
  • Hospice Care
  • Accreditation, Quality Assurance, Board
    Certification
  • HIPPA
  • Medical Malpractice/Lawyers

160
Ethics and Medicine
  • Sexuality
  • Abortion
  • What is Death?
  • Growing Old
  • Euthanasia/Right to Life/Pro life
  • Quality of Life Issues
  • Limited Health Care Resources
  • Rationing of Health Care
  • The Uninsured, The Undocumented Worker
  • Universal Health Care
  • The Use of Physicians in State Executionsi.e.,Cal
    ifornia

161
Challenges for the Future
162
Challenges for the Future
  • Obesity/Diabetes Mellitus
  • Smoking
  • The Geriatric Population
  • Drugs/Medications
  • Alzheimers Disease
  • Depression
  • Medicare/Medicaid
  • Euthanasia
  • Etc.

163
The Future of Medicine
  • Balance between the art of medicine and the
    science/technology of medicine with imagination,
    ingenuity and a little luck.

164
The Giant(1923) by N. C. Wyeth
165
Question and Answer Period
166
The End
167
Thank You!
168
See You Next Year!
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