History of Medicine: Early Beginnings to the 19th Century

1. Lecture 15 : History Of Medicine(1)Overview EARLY BEGINNINGS ANCIENT GREECE THE ROMAN WORLD DARK AGES / MEDIEVAL PERIOD RENAISSANCE / ENLIGHTENMENT NINETEENTH CENTURY

2. Early Beginnings • Evidence suggests that Neanderthals practised a form of folk medicine. • Written records indicate medicine practiced in the early urban civilisations in 2nd or 3rd millennium BC.

3. Ancient Greece • Asclepius was Greek god of medicine. Temples were early health resorts. • Two daughters: Hygieia (health) and Panacea (cure all). • Hippocrates of Cos (460-370 BC) is regarded as father of scientific medicine. Believed diseases had natural rather than supernatural causes. • Hippocrates recognised the importance of geographical (i.e. social and environmental) factors. • Code of conduct forms the basis of that used today.

4. The Hippocratic Oath I swear by Apollo the physician, and Asclepius, and Health, and All-heal, and all the gods and goddesses . . . to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. . . . Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.

5. The Roman World • Greek medicine was promoted by the medical school in Alexandria. • Greeks physicians were prominent in Roman Empire. • Most influential was probably Galen of Pergamum (130-210) – generally regarded as the father of physiology. • Although wrong, Galen’s understanding of the human body prevailed for over 1,000 years.

6. Dark Ages / Medieval • Dark Ages were dominated by the Church. • Hospitalia established to provide shelter for pilgrims. evolved into places of refuge for the sick and dying. • Some evolved specialised functions e.g. Lazar houses. • Classical medical knowledge was preserved in the Moslem world. • The most significant figure was Abu Bakr Muhammad Ibn Zakariya Al-Razi(865-932) – or Rhazes in Latin. • Classical ideas were reintroduced into the west by medical school at Salerno.

7. Renaissance / Enlightenment • Renaissance saw a revival of interest in scientific enquiry. • William Harvey (1578-1657) published his views on the circulation of blood in 1628. Completely overturned Galen’s physiology. • Renes Descartes (1590-1650) put forward the idea that the body was a machine made up of parts (Cartesian view). • Hospitals and medical schools established in 18th century. • James Lind (1716-1794) identified a cure for scurvy (citrus fruit) using a controlled experiment in 1747.

8. Jenner’s Smallpox Vaccine • Smallpox inoculation introduced into Britain from Turkey by Lady Mary Wortley Montagu. • Quite widely used in rural areas from 1740s onwards. • Edward Jenner (1749-1823) noticed that milkmaids who caught coxpox rarely developed smallpox. • Innoculated a boy with cowpox in 1796. He then unsuccessfully attempted to infect him with smallpox. • Jenner’s vaccination was much safer than smallpox inoculation, became popular and did much to reduce smallpox mortality.

9. Jenner And The Royal Society • When Jenner submitted his findings to the Royal Society of London his paper was rejected with the following admonishment: ‘A Fellow of the Society should be cautious and ought not to risk his reputation by presenting to the learned body anything which appears so much at variance with established knowledge, and withal so incredible.’ (Ewald, 2002)

10. The 19th Century (1) • Girolamo Fracastoro (1478-1553) had suggested that diseases were caused by invisible ‘seminaria’ (i.e. germs). • The prevailing view in early 19th century was that diseases were caused by ‘miasmas’. • French investigation of yellow fever epidemic in Barcelonea in 1822 ‘proved’ contagion was not possible. • Mediterannean countries stuck with contagionist viewpoint, whilst more ‘advanced’ countries supported miasmatic theory. • We know now that germ theory is corrrect.

11. The 19th Century (2) • Ignaz Philipp Semmelwiss (1818-1865) reduced deaths from puerperal fever in Vienna and Budapest by insisting that anyone delivering a baby should wash in chlorinated lime. He was driven out of work and died in a madhouse. • Joseph Lister (1827-1912) reduced mortality from infections after surgery from 50% to 15% in 1861 using antiseptics. Met resistance before being accepted in 1880s. • Louis Pasteur (1822-1985) published his germ theory in 1861. Devised method for attenuating agents to use as vaccines. • Robert Koch (1843-1910) identified causal agents of tuberculosis (1882) and cholera (1883). • By 1900 miasmatic theory was totally discredited.