medicine, history

Medical and surgical instruments excavated from the house of the surgeon at Pompeii, Italy, in a late 19th-century illustration. These are some of the best-surviving examples of a surgeon's tools in the 1st century BC, and – since innovation in surgical tools was relatively slow after the classical period – are also typical of surgical practice for nearly a millennium. Indeed, some tools, such as the vaginal speculum (bottom centre), changed little until the 20th century. Other instruments seen here include a cupping vessel for blood-letting, forceps, surgical scissors, a male catheter, and scalpels. (Bibliothèque des Arts Décoratifs, Paris).

The medieval notion of anatomy, c.1508. The findings of the Ancient Greek physician Galen, whose studies were based on the dissection of animals, were the only source of anatomical knowledge until 1543. Andreas Vesalius then published his classic work De humani corporis fabrica which was based on his own observation of human corpses.

Medical science has developed by gradual steps from very early times. There is evidence of trepanning (cutting holes in the skull to relieve pressure) being practised in the prehistoric medicine of Stone Age peoples. In the earliest societies, medical practice was part of the duties of the priests; it relied more on the influence of the gods than on the value of the methods adopted. In ancient Greek medicine, even the priests of Asclepius, the god of healing, relied mainly on religious exercises to effect a cure. The main advances in medical practice came in the 1800s and 1900s, and today physicians and surgeons have a record of some success in treating and curing disease and injuries.

For a long time many people practised sympathetic medicine, in which plants were used to cure the organs they were thought to resemble. Others believed that herbs were under the influence of one or other of the planets. Great advances in medical practice came in the 1700s and 1800s, with a more scientific approach to the use of drugs. Surgery was difficult because of the lack of anaesthetics and the frequency with which wounds became septic and killed the patient. The advent of antiseptics, and of reliable anaesthetics, revolutionized surgery, and the development of the nursing profession improved patient care.

In the 1900s modern advances in drugs and surgical practices have revolutionized medicine, and as a result more people are able to enjoy good health and live longer. (See also doctors, history of, public health, and medicine: factors of development.)

Early medicine The earliest known physician was Imhotep, physician and architect to the Egyptian pharaoh Zoser in the 2980s BC (see ancient Egyptian medicine). He is the only physician to have been declared a god. The ancient Greeks knew of him, and regarded him as the same person as Aesculapius. The next historical milestone was probably in Babylon around 1900 BC, when a code of medical practice was recorded by the ruler Hammurabi.

A famous medical school was founded at Cnidos, a Greek city in southwest Asia Minor (modern Turkey), between 700 and 600 BC. It was mainly concerned with the description of signs and symptoms, not related to a patient. In this respect it differed from the school founded on the Greek island of Cos by the physician Hippocrates, who lived around 460 BC.

Hippocrates began the practice of purely rational curative methods. He was an outstanding member of a profession that was already flourishing in Greece. The main feature of his work was the recognition that disease has natural causes. He and his followers bequeathed to the medical world the principles of minute observation of signs and the consideration of these in relation to the patient and the environment, principles that form the basis of today's clinical medicine.

The theory of the Hippocratic school was that there were four humours in the human body: blood, phlegm, yellow bile, and black bile. If these were not in their proper proportions, they caused disease. Careful observation was necessary to diagnose the state of the body with regard to these elementary humours, and the available means of cure were then applied.

The Alexandrian school The conquests of Alexander the Great spread Greek knowledge throughout the known world, and a school of physicians sprang up in Alexandria, Egypt, which began what has been called the empirical school. Its followers observed effects instead of inquiring after causes, and built up a body of clinical experience that appears to have led to considerable practical success.

Roman medicine produced the school of ‘methodics’, which assigned all morbid conditions to excessive constriction or relaxation of the pores separating the atoms of the body. Treatment, therefore, involved increasing or decreasing the amount of constriction to the required extent by the use of drugs and dieting.

All the medical knowledge of the ancients was coordinated and the results recorded by the Greek physician Galen, who lived for most of his working life in Rome. He was the first person to try to investigate the function of the body, and he laid the foundations of experimental physiology. He also recognized the importance of anatomy. Galen was a voluminous writer and his works were copied and his precepts followed down to the Middle Ages. Where his facts were wrong his mistakes were perpetuated (see Islamic medicine and medieval medicine).

Renaissance medicine The revival of learning, later known as the Renaissance, helped to clear away some of the mass of superstition that had been superimposed on the work of Galen. The year 1543 marks an important point in Renaissance medicine and the development of modern medicine. In that year the Belgian anatomist Andreas Vesalius published his De Humani Corporis Fabrica/The Fabric of the Human Body. This revealed for the first time the real structure of the body. Vesalius prepared the way for independent observation in anatomy and medicine. He overthrew the Galenic tradition that had lasted for a thousand years, and ushered in the era of modern medicine.

In 1628 the English physician William Harvey first described the circulation of the blood, but it was some time before the importance of this discovery was recognized. A German professor of anatomy, Johann Schonlein, heralded a new era by his discovery that a parasite was the cause of the fungal skin disease known as favus.

19th-century medicine Bacteriological research led, in the hands of the French chemist and bacteriologist Louis Pasteur and others, to the concepts of toxins produced in the blood by bacteria, and of the antitoxins that the body makes in self-defence. The modern treatment of infectious diseases is based on the work of Pasteur and the German bacteriologists Heinrich Koch and Edwin Klebs. Pasteur carried out pioneering work in the fields of vaccination and inoculation; Koch worked out the life-history of certain infective organisms, showing their relation to disease. Klebs discovered the bacteria causing typhoid fever and diphtheria, and showed that some bacteria could be removed from a medium by filtration. He thus began the work that led to the discovery of viruses. The results obtained by these three pioneers stimulated research on bacteriology and parasitology. As a result, most infectious diseases are now under control. Pasteur's results helped to direct the British surgeon Joseph Lister in his quest to prevent wound infections; surgery, general healing, and hospital sanitation were advanced by the introduction of antiseptics; see 19th-century medicine.

Tropical medicine Exploration and colonization led Europeans to work and live in tropical places, and to suffer from diseases that were new to them. This gave an impetus to the study of bacteriology and parasitology. The parasitologist Patrick Manson started a school of tropical medicine in Hong Kong in 1866. The London School of Tropical Medicine was founded in 1899, and soon became part of the University of London. Similar schools were opened in many busy ports, notably Amsterdam, Hamburg, Liverpool, and Marseille. Much has been done to prevent, alleviate, and cure diseases caused by bacteria and parasites in tropical countries.

During the 1800s considerable progress was made in public hygiene, particularly with water supplies, sanitation, and the improvement of conditions in factories. The introduction of salvarsan for the treatment of syphilis by the German haematologist Paul Ehrlich in 1911 paved the way for the introduction in the 1930s of the sulphonamide drug prontosil (now no longer used). It was followed by still more efficient bactericides.

Wartime developments Wars have usually stimulated advances in medicine. The Crimean War of 1853–56 led to a revolution in nursing, thanks to the efforts of Florence Nightingale. The Austro-Sardinian War of 1859 led Jean Dunant to found the Red Cross movement, which exists to relieve suffering and provide emergency aid.

20th-century medicine The advances of 20th-century medical technology were stimulated by two world wars, and saw progress in preventitive medicine, and the development of transplantation and genetics. World War I gave rise to research in most branches of medicine. New methods of surgery were necessitated by the large number of cases needing immediate attention, and quick methods of blood transfusion were introduced. Inoculation against influenza, cholera, typhoid and paratyphoid fevers, and other infectious and epidemic diseases was in general use in the army, and military hygiene was vastly improved. New antiseptics were introduced, and special investigations were made into diseases peculiar to warfare, such as trench fever and gas gangrene.

The term ‘shell-shock’ was coined to describe what is now recognized as battle fatigue, and the condition was often misdiagnosed as cowardice. Many soldiers were shot as cowards when they were in reality too ill to help themselves.

World War II led, among other improvements in medicine, to the large-scale production and use of the antibiotic penicillin, and stimulated research to discover other antibiotics. Streptomycin, chloramphenicol, and chlortetracycline were the first of many to be discovered or synthesized.

preventive medicine Other noteworthy advances during the 1900s included preventive measures to raise standards of health. Much was done in the developed countries to improve the health of children, and to reduce infant mortality. The mortality rate of mothers during childbirth was been reduced by improvements in obstetric practice. The discovery of the rhesus factor in the blood in 1940 enabled notable advances to be made in the treatment of haemolytic disease in the newborn.

Endocrinology has developed into a specialized branch of medicine, connected closely with biochemistry. Cortisone, both natural and synthetic, has been used in the treatment of rheumatoid arthritis and in restoring the electrolyte balance of the tissues in conditions of stress.

transplantation Considerable progress has been made in the transplantation of tissues and organs. While almost any tissue can be successfully grafted from one part to another of the same person, a transplant from one person to another provokes a hostile reaction and is rejected. A good deal of research has been undertaken into methods of suppressing this reaction. Successful transplants of the kidney, liver, heart, heart and lungs together, and other organs are now almost routine.

genetics In the last part of the 20th century great advances have been made in the study of genetics, which has enabled scientists to understand why some people are susceptible to certain diseases and others are not.