History of Medicine Notes

Ancient Egypt

Cause of Illness:

  • Illness occurred because a god/goddess was not pleased or because of the action of Seth.
  • Egyptians suffered from water and food contamination, parasitic infections, epidemics of smallpox, plague, TB, eye disorders...

Treatment:

  • Healers did not study anatomy despite the practice of embalming.
  • The internal vessels were considered a canal system of sorts and the intestine collected contents of all the canals. When illness occurred – most therapies focused on the intestines – enemas, purging of contents, etc.
  • Physicians were priests and were the first to maintain accurate health records. They classified the symptoms as the disease itself. Healers utilized a huge assortment of medicines but did not use surgery commonly.

Ancient China

Treatment:

  • Focused on prevention of disease: Huang Ti, father of Chinese Medicine quotes, “the superior physician helps before the early budding of disease.”
  • Dissection was forbidden, so knowledge of the body was obtained by reasoning, assumptions and observation. Physiological function was controlled by humor, emotion. Each emotion had its seat in a particular organ.
  • Diagnosis was done by questioning, feeling pulse and sometimes touching body.
  • Patient was examined as a whole person – as a reflection of his surroundings.
  • The pulse was most important diagnostic tool – patient lay in bed and extend arm through bed curtains for diagnosis.
  • It was considered bad form for a man to physically touch a woman, so special figurines were used to indicate where discomfort was felt.
  • It was necessary to cure the spirit, nourish the whole body, andgive medication in herbal form. Acupuncture and moxibustion were common practice (burning of mugwort onto skin). The goal was to put patient back on the right path, the tao. A doctor had to determine the cause of disharmony in the body and act accordingly
  • Notable: start of pharmacology… amazing supply of herbal remedies. Ephedra from the horsetail; ephedrine derived from it in modern times. Ginseng, used for delaying old age, restoring sexual powers, improve diabetes, stabilizing blood pressure. Seaweed, containing iodine, used to treat enlargement of thyroid. Willow plant, containing salicylic acid, for pain relief.
  • Search for medical reason for illness began.

Ancient Greeks: Time Period 1200-200 BC

  • The gods could cause disease. Many turned to the healing cult of Asclepios for treatment by the “god-priests”.
  • Health was achieved by maintaining balance in all things. Life’s illnesses were understood through philosophy rather than experimentation.
  • They developed the idea of four basic elements being the components of all substances: water, earth, fire, and air. Each had a specific quality: moist, dry, hot, cold and that pairs of opposites were to be kept in balance to achieve harmony and health. Similarly, all body fluids were composed of varying proportions of blood, phlegm, yellow bile and black bile.

Cause of Illness:

  • When the humors in balance, the body was healthy; when in excess or deficiency, there was illness. Greeks believed illness resulted from natural causes rather than just supernatural causes.

Treatments:

  • Initially – the soldiers cared for each other during battles.
  • With the rise of education, the physician would use external and internal medications, bound wounds, corrected fractures, bled and induced purging or vomiting to remove excess humors. Healthy diet, rest and exercise were prescribed. Surgery was performed, cauterizing was used.

Romans: Time Period 753 BC-410 AD

  • Romans emphasized agriculture, so there was a varied food supply.
  • The hopelessly ill and deformed were not cared for, nor were unwanted babies.
  • Hospitals established for soldiers, not common folk.

Cause of Illness:

  • Imbalance of the four humors.
  • Rational reason for illness.

Treatment:

  • Consisted of bleeding, prescribing of medicinal plants intended to balance the humors, purging, and enemas. Diet, rest and exercise prescribed.
  • Surgery performed by Galen, the most influential physician of this time period. Dissection of animals utilized to gain understanding of body function. His ideas were followed for many centuries.

Medieval Medicine: Time Period 400-1400 AD

  • After fall of Rome and resulting invasions by barbarians, study of medicine prohibited.
  • No understanding of hygiene, public sanitation, or prevention of disease.
  • Christianity rose and spread across Europe.

Cause of Illness:

  • Sin’s punishment or divine disfavor.
  • Man had lost the confidence in ability to learn and question.
  • There was an increased emphasis on faith and belief in the supernatural – loss of reason and logic.
  • No understanding of how the body worked – especially during Dark Ages.
  • Dealt with massive pandemic of the plague killing 75% of population of Europe and Asia, which resulted in great fear and superstition.

Treatment

  • Some treatment available in monasteries, but mostly the ill died at home. Some herbal remedies used. No medical study. Divine intervention and miracles were sought.
  • In the Middle Ages, a renewed interest in medical practice of Greek/Romans awakened: i.e. Galen’s concepts of the four humors.

Renaissance: Time Period 1350-1650 AD, 14th – 16th century

Health:

  • There was not a formal medical training program.
  • Individuals who helped wounded soldiers often became very knowledgeable through practice... not necessarily study.

Cause of Illness

  • Still not understood. The humor system still the dominant explanation. Many people still dying from simple infections.
  • When Columbus’ sailors brought back with them syphilis and gonorrhea and it spread through the Spanish army, Italian scholars began to investigate the cause and treatment of these diseases and in 1546, Girolamo Fracastoro of Verona stated that the cause of the diseases were two different invisible germs. Knowledge was being sought.

Treatment

  • Slight improvement. Studying occurring by scientists and artists. The knowledge they gained did not shuffle down to the common man yet.

However:

  • Rebirth of interest in study of the body started in northern Italy.
  • Dissection of human body by both scientists and artists – Michelangelo, Da Vinci. More understanding of the body’s structure.
  • Vesalius published the first anatomy book.
  • The invention of the printing press allowed exact copies of books to be made and information spread across the world – rather than hand copied manuscripts
  • Advances: ligatures to stop bleeding arteries, cleaning of wounds rather than pouring boiling oil on them (Pare), identification of the tympanic membrane & Fallopian tube (Fallopius), Eustachian tube (Eustacho).

1600 – 1799 17th & 18th century - SCIENTIFIC REVOLUTION

  • Disease and infection still claimed many victims.
  • Health depended on the air quality, the amount and type of food, the amount of exercise, rest, sleep and alertness, the retention or evacuation of body fluids and the calmness or disturbances of the mind.
  • There was more of a concept of a cause of disease rather than a supernatural punishment. Children of the poor received no health care – so adults who survived childhood had been fortunate or had survived many infections.
  • Public health was deplorable – hygiene and water supplies were not much improved from medieval times.

Cause of Illness

  • Not known
  • There was an increased amount of focus on how disease occurred and the microscope allowed some study. But the advancements made in science were not sufficient to benefit common man.

Treatment

  • The many advances in science were not seen as useful to practical clinical medicine.
  • The ill or injured had few choices. Physicians were very rare as there were few medical schools and the education was dependent on ancient works with inadequate anatomy training. Often monks, women trained in use of herbs or surgeon-barbers would treat the sick. Surgeon-barbers would deal with wounds, broken bones and dental issues. Their training was variable and many were untrained quacks- causing more harm than good.
  • Apothecaries would prepare medications prescribed – or sometimes prescribed it themselves.

Advances: The era of the Scientific Revolution.

  • Scientists were trying to determine how a disease caused illness rather than why
  • Mathematically driven; the rise of chemistry was very influential.
  • The way of thinking was changing: logic, experimentation, generalizations from observed facts – becoming new mode of thinking.
  • Major advances: Description of the circulation of blood to and from the heart in a closed system (Harvey), the first vaccination for smallpox (Jenner), invention of the microscope (Leeuwenhoek), invention of the thermometer – several different men worked on it and it began to be used to monitor patients during this time – however it required 25 minutes to get an accurate temp!!

1800 – 1900: 19th century – Beginning of modern medicine

  • The beginning of the century resembled previous times, the advancements made mid- century changed medical practices dramatically.
  • Crucial discoveries: anesthesia and microorganisms as causes of disease.

Health:

  • Average life span 40-60 years
  • The overcrowding and slum conditions brought on by the Industrial Revolution were a catalyst for attention to public health. In the early part of century, much focus on supplying clean water and getting rid of garbage. Bad odors (miasma) still thought to be cause of disease.
  • The water closet allowed sewage to be removed from the wealthy homes – into cesspools that then contaminated water supplies. MANY epidemics worsened by crowded cities: cholera, malaria, yellow fever, typhoid. 1854 – 14,000 cases of cholera in London!

Treatment:

  • The Red Cross was founded to assist the wounded soldier during war.
  • The concept of sterilization DRAMATICALLY reduced infection in hospitals and combined with the understanding that microorganisms caused disease led to HUGE advancements in the handling and prevention of infections and infectious disease.

1900 – 2000: 20th century

Health:

  • Average life span was 60-70 years
  • Expected that a child would live to adulthood. Understanding of relationship of health to diet and exercise, use of vitamin supplements and active prevention of illness.
  • Doctors are respected as able professionals who utilized scientific knowledge to fight and prevent disease. Doctors could see inside the body with imaging technology and accurately diagnose disorders.
  • Immunizations were being developed to prevent infectious disease.
  • Cancer was being studied and ways to fight it were being developed.
  • The chances of survival GREATLY increased for the patient.

Cause of Illness:

  • Pathogens, risk factors from lifestyle, genetic mutations, carcinogens.

Treatment:

  • Medical care has greatly improved effectiveness. More accessible, yet health care costs and insurance issues have greatly affected availability for all. Survivability rates high; infant mortality rates low.

Advancements:

  • Imaging
  • Screening tests
  • Understanding of disease mechanisms
  • Human Genome Project allowing understanding of cancer causing, disease causing genes and hopefully therapy to prevent their expression.
  • New, more potent medications
  • Surgery with minimal invasion and amazing results.