The History of Medicine

An Introduction

Dr H K Lord

A Tour Through Time

From Ancient Civilisation to The Enlightenment.

Beginnings

Ancient civilisations:

Mesopotamia 2000 - 3000 BC

Ancient Egypt, India, China 2000 BC

Crete and Mycenae 1000 -2000 BC

Ancient Hebrew medicine 1000 – 2000 BC

all had medical philosophies, usually based on religion.

Greek Mythology – 900 BC

Closely bound to religion of godsDionysius god of fertility

Athena god of the eyes

Hera protector of women in childbirth

Aesculapius god of healing. Son of Apollo, brought up by a centaur who taught him all the healing crafts. So skillful as an adult he brought a dead man back to life. Zeus feared the underworld would be depopulated and so struck him dead with a thunderbolt. Went to the heavens as a deity and worshipped with healing temples for centuries after.

Daughters Panacea and Hygea (healers in own right)

Health was a gift, disease a punishment.

Aesculapius

Aesculapius

Snake: its ability to shed its skin was seen as symbol of rebirth and healing, and its poison of death.

Ancient Greece 600 BCPre-Hippocratic Philosophers

Beginnings of rational, secular thought in relation to medicine.

Thales of Miletus 640 – 546 BC first true scientist / philosopher of the Greeks. Did not use religious or supernatural means to explain natural phenomena. Believed basic element of plants and animals, and hence life, to be water.

Known as the Father of Science.

He wrote nothing down that survives – know of him from the writings of others and passed down teachings.

Major influence on contemporaries and followers.

Ancient Greece 600 BC

Others of his time included Pythagoras and Empedocles

Doctrine of four basic elements, as fabric of all things: water, air, fire and earth.

These had corresponding qualities: wet, dry, hot and cold.

Affected medical theory for thousands of years ( later projected in to 4 humours)

Hippocrates 500 BC

On this background of rationale thought, Hippocrates on the island of Cos developed his “Corpus Hippocratum.”

Probably a collection of works by a number of writers.

Illness no longer a punishment from the gods, but caused by natural forces, requiring human effort to resolve and avoid. However if man’s illness was impossible to cure or alleviate, the patient was still abandoned both by physicians and neighbours.

Stoics even advocated suicide in this instance.

Hippocrates 500 BC

4 balanced number in Pythagoran philosophy : 2 pairs of opposites

4 elements (earth, fire, water, air)

4 qualities (wet, dry, hot, cold)

4 seasons

4 bodily fluids – blood, phlegm, black bile and yellow bile

If 4 humours in balance = health

If 4 humours imbalanced = disease

Hippocrates 500 BC

Emphasised clinical examination

Holistic approach – exercise, moderation of diet and mental well being.

Wrote on anatomy, including the pericardium, the ventricles and heart valves. However thought air travelled with blood in the arteries and the difference between veins and arteries not appreciated.

Wrote on making a diagnosis, surgery, therapies, prognosis and obs and gynae.

Hippocrates 500 BC

Used instruments to examine patients – probes and speculums to Ex orifices

Discussed ethics and how a doctor should behave and present themselves.

“ a physician must have a worthy appearance; he should look healthy and be well nourished… for most people are of the opinion that those physicians who are not tidy in their own persons can not look after others well.”

Hippocratic Oath

Confidentiality

“ what I may see or hear in the course of the treatment…..which on no account must spread abroad, I will keep to myself, holding such things shameful to be spoken about”

Pledges against harm to the patient, deadly drugs, abortion and sexual relations with patients.

As such the basis of modern medical ethics.

PlatoPlato was a contemporary of Hippocrates (427 – 347 BC)

Student of Socrates and teacher of Aristotle

Interested in the soul and matter, and made logical but distant speculations on medicine. Did not dissect and some of his inaccurate beliefs became staunchly supported.

Supported in the 3rd C BC by the Dogmatists. Classified disease by humours and used extreme purging and bleeding as therapy, and treated fevers with dehydration regimes.

Perpetuated into the Middle Ages and failed to capitalise on Hippocrates’ objectivity.

“The School of Athens” Rafael 1510

Aristotle 384- 322 BC

Pupil of Plato

Profound influence writing on logic, metaphysics, politics, zoology and poetry amongst others.

Supported by Ptolemy, a general of Alexander the Great, who set up a library in Alexandria. Its aim was to collect the entire sum of human knowledge.

Studied embryology, described differences between veins and arteries, described the aorta ( which he named) and the course of the ureter.

Founder of comparative anatomy

Roman Medicine 150 BC – 200 AD

Greek Medicine reached a peak in Alexandria and began to infiltrate Rome, which gradually became the main political power.

However most Roman physicians were slaves, or freed men, usually of Greek, Egyptian or Jewish origin.

Improved water supply and sanitation led to health benefits.

However the main, gigantic, influence from Roman times was Galen

Galen 129-200 AD

Greek physician, born to wealth and education.

Became most influential writer on medical subjects of all time.

Travelled widely developing knowledge and skill, becoming the physician to Marcus Aurelius.

Believed the purpose of everything was pre-determined, occasionally distorting the evidence before his own eyes.

Galen

Used humoural theory. Took it further, to describe 4 personalities:

Sanguine

Phlegmatic

Choleric

Melancholic

In the Middle Ages Galen’s pronouncements were swallowed wholesale, both right and wrong, and this led to centuries of thought based on the humours.

Galen

Experimentalist and wrote extensively.

Showed that veins were connected to the heart

That nerves came from the spinal cord

Described recurrent laryngeal nerve

Described bones and their muscle attachments

Showed that arteries contained blood, not air.

Galen

Understood uncertainties and fears of sick

Continued the practice of purging and blood letting but in moderate degrees. Followed Hippocratic traditions of helping nature by gentle methods such as diet, rest and exercise.

Developed pharmaceuticals, combining herbs and agents into a vast variety of combinations.

His writings became virtually unchallenged for the next 1500 years.

Middle Ages 400 – 1500 AD

The Fall of Rome to the Goths in 476 beginning of Middle Ages

Fall of Constantinople to the Turks in 1453 end of Middle Ages

For 1000 years Western man failed to develop the teachings of Hippocrates and Galen, and accepted everything on faith. No longer felt capable of learning from own observations.

Galen’s texts remained unchallenged

The extraction of the stone of madness

Bosch 1475 Madrid

Middle Ages 400- 1500 AD

Middle Ages were unsettled times –certainty welcomed

Galen’s authoritative, confident approach gladly received, providing constancy and reassurance.

Teleological reasoning ( all having a purpose ) fitted well with Christian faith.

Early commentators enshrined his name and he became known as the fountainhead of all medical knowledge.

The Black DeathBruegel 1347 Madrid

Middle Ages

Exact reason why rational thought abandoned is complex – Black death, plague, feudal society.

Barbarian invasions – dissolution of Western Empire

Rise of Christianity

Development of monasteries and belief in miracles

Power of Saints, Martyrs and Virgin Mary

Growing belief in superstition and magic

Elsewhere however…..

Islamic Medicine 700 – 1100 AD

Baghdad became a centre of Islam and intellectual thought.

Greek texts translated to Arabic.

Developed pharmacy with methods of extracting and preparing medicines. Reflected in Arabic roots of many chemical words: alkali, alcohol, elixir, syrup.

During a period of great unrest in the West, compiled and preserved Hippocratic traditions and contributed new knowledge.

Islamic Medicine 700 – 1100 AD

Understood communicable nature of TB

Developed efficient hospitals, far superior to basic prototypes made by Christians.

The best known in Baghdad, Cairo and Damascus.

Renaissance 1450 -1600

Rebirth – return to cultural priorities of Ancient Greece and Rome.

Western Europe looked again at the original writings, art and architecture of these eras.

At same time, printing invented allowing dissemination of information.

Trade and local industry led to wealth and creation of money economy.

Sea routes to India and Americas discovered – opening world to exploration and exploitation.

The Ambassadors Holbein 1533

Renaissance 1450 - 1600

Open minded observation of natural phenomena as Hippocrates had favoured, and Galenism and scholasticism were discredited.

Italian Universities developed – Padua.

Amongst most important new physicians Theophrastus Bombastus von Hohenheim, who was as bombastic as his name suggests.

Otherwise know as Paracelsus

Paracelsus 1493- 1524

Educated in Italy as all good physicians were at this time.

Interested in alchemy, astrology and occult as well as medicine.

Wandering spirit, challenging authority wherever he went, criticising their blind acceptance of classics.

Taught not in Latin but in vernacular.

Angered those in authority and attracted the young in equal quantity.

Paracelsus 1493- 1524

To him diseases were caused by influences of the stars and planets

So whilst challenging much that was wrong, and in so doing bringing about a confidence to question, his own philosophy of thought was still off beat.

Renaissance Surgery

Ambroise Pare 1517- 1590 revolutionised surgery. Working in French battlefields, he came to fame, having trained only as a barber and wound dresser.

For gunshot wounds, traditionally held view was “those not curable by iron are curable by fire.” Pare tried application of clean water rather than boiling oil, and found his soldiers less feverish and with less pain.

Used ligatures to control haemorrhage rather than cauterising irons. Became master surgeon to Henri II despite limited education – no Italian university for him.

Renaissance Illness

Commonest illness now were no longer leprosy, plague or cholera, but syphilis and gonorrhea.

Sailors and soldiers, exploring and conquering the world brought back and spread venereal disease.

Small pox, measles and typhus also common.

Institutions for the lunatic and the poor increased, as those displaced by urbanisation of society.

Witch hunting - aportioning blame on “heretic” Protestants in Southern Europe, and on “papists” in Protestant North.

Renaissance Art

Study of human anatomy, botany, zoology, engineering became closely allied to Art.

The anti-experimentalist approach of Middle Ages was replaced by dynamic versatility – a natural world to be explored and recorded.

The high authority of religion and indeed God questioned. Observed data were not to prove the validity of an assumed truth, but to develop principles of thought. Empiricism.

Art and MedicineHuman dissection came back into favour having long been frowned upon and forbidden for religious reasons

Leonardo da Vinci 1452 - 1519 - made illustrations of skeletal, muscular, venous and nervous systems, accurately depicted position of foetus in utero and had unrivalled artistic ability.

Leonardo da Vinci1452 -1519

Vesalius 1514-1564

Trained in Paris and Padua.

Transformed anatomy and scientific teaching.

Wrote his opus magnum “ De humani corporis fabrica” aged 28.

Related text to illustrations and used these to demonstrate what written words struggled to convey. Relationship of structures considered and structures seen as systems rather than isolated organs.

With printing such texts could be widely distributed.

1600s Age of Science

A mathematical and mechanistic emphasis to thought.

Rather not why, but how, things happened.

Rene Descartes (1596 – 1650) and Francis Bacon ( 1561 – 1626) both saw objects as machines ruled by mechanistic principles. Saw humankind as progressing and accumulating benefits of scientific endeavour. Science was a way of gaining power over nature.

Ancients saw life as cyclical, with rises and falls of civilsation. Or that life was in decline from a Golden Age. Inevitability.

1600s - Chemistry

Theory that disease was a distinct entity, living parasitically in the body, as opposed to a derangement of humours normally within the body.

Fever was not putrefaction of humours but reaction to invading agents

New discoveries in chemistry led to concept of bodily acids / alkalis

Support for concept of atoms making up matter

Boyle devised air pump and demonstrated necessity of air for life.

Microscope…..

Developed by Leeuwenhoek, a linen merchant in Delft.

Visualised speramtozoa, allowing theories of embryo formation to flourish.

A whole wealth of scientific discovery, dissemination of knowledge and experimentation.

One of the greatest discoveries of this century was the circulation of the blood.

William Harvey 1578 - 1657

Educated at Cambridge and Padua.Using experiments with animals and dissection of humans, he showed that blood flowed in one direction, that the heart was a pump working with a relatively fixed quantity of blood, which circulated around the body, returning to the pump, to be pushed around, again and again.A confirmation of mechanical science.

The Eighteenth Century – The Enlightenment

Whilst many scientific advances were made during the 17th century, physicians during the 18th century struggled to apply all this new knowledge to medicine

Patients still purged and bled

The humours still held dominance for most practitioners.

The 18th Century - advances

William and John Hunter founded first school of anatomy on London.

Developed surgery and obstetrics and taught many distinguished physicians.

Royal College of Surgeons chartered.

The 18th C

Discovery of vaccination by Edward Jenner, using fluid from sores on cattle, to prevent smallpox.

James Lind (1716-1794) insisted on lemon juice to keep away scurvy for sailors.

So the beginnings of the Industrial revolution were in full progress in Britain, with scientific thought on the ascendancy and Edinburgh a centre for learning and excellence. A market economy was taking shape.

The FutureThe 1700s passed with the spirit of experimentation.

1800s and 1900s were the centuries of therapeutic advance.

1800s saw Colonialism in Africa and Asia, and growing confidence within Europe.

By 1800s, Science truly took over from philosophy.

Medicine advanced to the present day….at prolific pace…..but that is another story.

So, In Conclusion

Medicine has always existed

Initially closely bound to gods and superstitions

The Greek philosophers wrote some of the earliest and best records of concepts of medicine, some of which remain today.

The Middle Ages were a stagnant period of accepting faith and limited progress.

The Renaissance was a re-birth and re-assessment of Greek and Roman ideas.

In Conclusion

This led on to an explosion of scientific thought and discovery in the 17th century.

Further, but less bold, advances in the Enlightenment era, when British society was becoming industrialised and urbanised.

The 19th and 20th Centuries …. I leave for you to discover…….in the context of what we have learnt today.

Thank you for your attention.

Hannah Lord