History Of Medicine

Galen

(129 CE - 200 C.E.) Served as physician to Roman emperors Presented his writing as the perfection of hippocratic tradition Placed Hippocratic humoral theory in large physiological framework Three Spirits: Vital (heart), natural (liver), Animal (brain) "The Best Constitution of our bodies" - Healthy state is when 4 humors are in proportion Prolific writer, ultimate authority on anatomy for many many years Combined it with Plato's ideas about a division of the soul (Reason, spirit and appetite) Even in the 16th century Galen would prove to be influential as Vesalius proved him wrong, but many others would express their confidence in Galen. Bloodletting. Galen looked in the wounds of gladiators, dissected animals, and bodies washed upon shore

Renaissance

1400-1600 when Europe experienced an intellectual awakening Renewed interested for the texts of Greece and Rome - Florence. Return to the texts and ideals of the classical world (Ancient Greece and Rome) and the languages of these places. The rise of the university previously drew attention to the ancient texts. Also became centers for the learning and disseminating of knowledge. The printing press was invented and was more widely used by 1460. By not relying on scribes, a new print culture began in which books were far more widely available. Students were able to interact with texts more directly because they were printing in languages that were still spoken (French, English, German, Italian, etc...) instead of Latin or Greek, the knowledge and the readings became far more accessible. Books accessible to much larger audience Causes of Renaissance: The Black Death Religious skepticism might have pushed people to more secular explanation Death is very close, and it affected everyone (dissection) - Printing Press - Rise of universities Renaissance Humanism - arts, poetry, history - Advocated for perfecting humanity through education - didn't want to translate; return to original languages Renaissance Art Not medicine that stimulated interest in Anatomy during renaissance, but the art world "Anatomical knowledge gave the artist an understanding of proportions so that art could reflect the harmonies of nature"

Renaissance time period

15th to 17th century

Scientific Revolution time period

16th to 18th century

Transfusion

17th century Because of the obvious medical concerns with loss of blood, it seemed likely that replenishing blood will aid in health. Originally, direct transfusion was used from animal to animal, or animal to human. However, indirect transfusion using an intermediate storage source in between the time of blood donation and transfusion, was determined to be easier. Occasionally eating blood was thought to help heal the patient. Jean Baptiste Denis - 1667 Blood transfusion used 15oz of lamb's blood transfused into a sick patient. During the Franco-Prussian War the soldiers used direct blood transfusion on the battlefield. Dangers included blood incompatibility, blood storage, and infection. Transfusions were conducted with women who lost a lot of blood during childbirth No understanding of compatibility of blood types

Discordes

40-90 C.E. Greek doctor While traveled in Army as military surgeon, studied exotic plant species Published pharmaceutical guide which listed 500 herbs, roots, minerals, animal derivatives that were used in pharmaceutical remedies Provided practical information on how to harvest and store substances, and how to use them. His guide was so successful that it lasted 1500 years

Middle Ages / Medieval Europe time period

500-1500 CE

Islamic Golden Age

8th to 13th century

Nosology

A means of determining groups of illnesses by the symptoms observed. Germ theory: Define bubonic plague as microorganisms as the cause of disease nosology: the pustules.

Barber-Surgeons

Barber-surgeons were not trained as formal physicians were. They were trained in an apprenticeship system and were taught by practical means rather than the elite university education of the doctors. The disparity between them is clear in the term barber-surgeons. Because of incredible pain and the amount of infections, surgery was often the last resort of the ill. not granted respect of a physician in France at the time Paris Medical Faculty did not appreciate him writing a med ical manual (like Jacoba) Doctors sought to distinguish themselves from the manual labor of surgeons (intellectual work of brain) of doctor and (illiterate manual work of hands

Scientific Revolution

Between the late Renaissance and the Early Modern Period (1540's-18th century) There was a belief that it was time to move on from the ancient texts and beliefs by relying on observations and mathematical works. Scholars during the scientific revolution emphasized observation and mathematical deduction as a means to understand the natural world (building on Vesalius) Copernicus and Galileo disregarded and disproved several ancient theories about astronomy, although both faced persecution from the church. Bacon and Descartes created the Scientific Method as we know it now. Isaac Newton published a book that proved many natural laws that demonstrated the truths of heliocentrism. Religious opposition was fierce. Galileo was persecuted while advocates of Copernicus were.

Folk Medicine

Common sense remedies based off of prior observations were often a basis for the tradition of folk medicine. Medicinal plants and herbs combined in more simple remedies and some religious associations all contributed to folk medicine. Charms and amulets containing herbs or certain patterns of words (such as prayers or verses) were often distributed to patients who did not understand them but trusted the healers. The requirements for the participation of the patients was quite high, often to prevent the blame being assigned to the healer in the event that the remedy was ineffectual. Black witches; evil, spreading evil forces and thoughts Persecuted in 16th and 17th century witch craze White witches: healers; just amulets and religious resources (citing Lord's prayer) Authority (guild)

Pulmonary Circulation

Difficult to give credit to one person for it's discovery; collective discovery Ib al-nafis -- 13th century, no pores William Harvey 16th century - Blood is recycled not continuously created used mathematical calculations to determine this Royal College: Authority of Medical knowledge Harvey: Peer review; by of scholars looking at and interrogating work Opposite of Galen, who was very arrogant and always assumed he was right Did not just express his own ideas but illustrated how if logic and reason was applied to previous ideas, it could be witnessed that they were incorrect. Explains why Galen was incorrect Wanted Approval of the President of the Royal college and his colleagues. Demonstrated in front of them so that his conclusions could be confirmed. All we know is still infinitely less than all that still remains unknown" Galen's inaccurate belief: The pulse has the same function as respiration Function of heart is to pump blood

Anesthesia

First ether and then chloroform were used. This increased the safety of the procedures so that the reputation of the surgeons also benefitted. Patients rapidly came to expect pain-relief as a right as a patient, rather than accepting the pain. However, some surgeons maintained that pain was effective means of determining if the surgery was too close to important organs. Prior to the 1840's surgeons might get patients, drunk hit them in the head before performing surgery. Humphrey Davey "Laughing gas' lots of self-experiementation 19th century was Anestehtic Revolution surgeons could spend more time, more exercise

Four Humors

Founded by Hippocrates. Disease does not exist outside the body of the patient. Not what the patient has, but who the patient is. Galen expanded on this idea and placed Hippocratic humoral theory in large physiological framework and introduced the three vital spirits. Both Hippocrates and Galen believed a humoral balance was necessary to to be healthy. Three Spirits: Vital, natural, animal Bloodletting

Black Death

Historians are fairly confident that the Y. pestis bacterium caused this plague and was carried by fleas, not the rats that carried them. It was a devastating plague, the most in the middle age. Conservative views of the effect estimate between 1/3, and ½ of the European population was killed in this plague. It is possible that this disease was a major cause of the Renaissance. Scapegoat religious differences to explain devastation (blame Muslims, then Jews etc...) The plague as a divine punishment and blaming religious minorities as a result Looking to religion as an explanation Flagellants (threatened with ex-communication)

Ibn Sina (Avicenna)

Islamic Golden Age He worked in philosophy as well as medicine. In order to ease the lives of students, who learned by rote memorization, he wrote the practical medical guide: The Canon of Medicine, and shortened it into the "Poem of Medicine." Easy to memorize and understand. The Canon is a key factor in the modern Western understanding of Galenic medicine, and contained information on humors, symptoms, diseases, recipes for medicines, and the instructions for the medical practices of examining the human pulse and urine.

Al-Razi

Islamic Golden age (8th-9th century) Believed in reason above all else, and was unafraid to challenge both ancient and contemporary medical professionals. He used clinical trials and his observations on specific patients and diseases to better understand the human body. Also used his own body. Noted specific details of each case/patient to draw up conclusions, which were often contradicting conclusions of earlier doctors He differentiated between small-pox and the measles. Rectified holes in Galen's writings. Attributed disease outbreaks to the special characteristics of a particular place. (He wanted to maintain the independence of medicine as secular field) Pointed out that very little about sickness or curing was mentioned in the Qur'an

Antisepsis

Joseph Lister 19th century Antisepsis: Kill germs in a wound using germicides Initially believed germs were air-borne. Chlorine and water solution to wash hands

Bedlam

London Began as charitable institution in 13th century 18th century — infamous as horrifying institution of incarceration Restraining methods Goal not to cure, but to confine

Religious Healing

Medieval Christianity placed an emphasis on the soul rather than the body which in some ways slowed the progress of the medical field. The judgment of the soul was a key focus of the church and therefore the view was often held that the illness was a punishment from God, Rather than a natural phenomenon. In some ways this seemed to say that the doctor was going against the will of God. Suffering was also viewed as a trial rather than a pain to alleviate. Some saints were also considered to have healing powers (these replaced the healing gods of other religions). Relics were also used to heal, as were healing shrines. People went on pilgrimages. Education and medicine became matters for the church community Monasteries became centers of medical knowledge Theologians figured out how to justify medicine

Royal College of Physicians

Medieval Europe Created by Henry VIII in 1518, it had the power to examine, license, and police doctors in London, but had no power outside of London. Women initially allowed to practice medicine, but then restricted Royal College: Authority of Medical knowledge - Harvey wanted approval of the president of the Royal College Masculine Domain

"Official" Medicine

Medieval ages As medicine began to become more organized, the rise of the university enabled a more educated group of doctors. In order to differentiate themselves from the folk healers, quacks, doctors began to form several governing bodies called medieval guilds. - Maintain standards of the craft - Police the boundaries of the craft - Gave physicians a sense of collective identity Allows doctors to establish medical authority

Jacoba Felicie

Middle Ages Accused of practicing without a license, however was not considered to be incompetent, and therefore said that she should not be prosecuted. Her witnesses attempted to share that she was the only practitioner that could help them and that was one of the main issues that the medical organizations had with her. However, she was threatened with excommunication if she continued to practice. Her trial indicated that formal education was not necessary for competence, and in fact her competence and similarity to the official physicians may have been the main reason that she was viewed as such a threat. Paris Medical Faculty

Hildegard von Bingen

Middle Ages/Medieval Europe Talented and influential composer. She was a founder of two monasteries, She was the only woman of her time who's opinions on religious matters were considered authoritative by the church. Encouraged by the pope. Some of her writings included the topics of female bodies and explanations for sexuality. Received visions from God, which aided her influence in the world and in the church. "Causes and Cures" People subject to illness because of the fall of Man (Adam and Eve) Sexual difference (how much they need/want a men, child bearing) -humor Reproductive process - semen and love Causes and treatments of illness, and also theories on the creation of the universe

Blood

One of the four main humors that must be in balance so that the body maintains its health. Often considered to be a source an marker of vitality. Everyone has seen their own blood so they all know something of it. The religious belief of transubstantiation, and a religious rule regarding eating of blood both show that religion is tied to the understanding of blood. Bloodletting Greek medicine: restore humoral balance also in Islamic World and with the Romans Scientific Revolution Harvey questioned how blood moved throughout the body Ibn al-nafis discovered pulmonary circulation in the 13th century but Harvey more credited with it. Heart does not connately produce new blood but rather circulates or "recycles" it !!

Royal Touch

People believed that the touch of kings had a healing power, specifically over the illness: scrofula. Originally, the royal touch was only the laying on of hands, however eventually grew to include charms and coins given to the ill. Originated around 11 century with touch, later ceremonial elements were added. This tradition continued into the 17th and 18th century. Some believed that the King could heal this either because of a bodily power or because of the King's prayers, or a combination of the two. Some physicians denied its efficacy, however popular belief was in the touch. Reasons why they believed King had this power: Source of healing power was the actual body of the King; something inherent in his body that made his touch magical. Inherently because of holy body. Source of power was the king asking God to intervene on the patient's behalf

Andreas Vesalius

Renaissance (16th century) Italy Created book which included "six anatomical pictures" to be used for medical instruction, designed for students Some inaccuracies however perhaps because wasn't ready to challenge Galen's authority right away Wanted to challenge Galen's authority: Conflict between the authority of the text and the authority of the body. Don't just read ancients and theorize relationship between bodily organs. Actual observation of the body in that context. Dissecting human bodies was becoming more accepted and authorities began placing the corpses of executed criminals at the disposal of universities Vesalius did not like this division of labor so he took the scalpel into his own hands Result: Proved many of Galen's observations to be false Discrepancies were attributed to the "fact" that the human body had changed over time Vesalius: Galen did not dissect on human bodies, but animals Published results in "On the Fabric of the Human Body"

Natural Philosophy

Same set of physical laws govern the universe but also the individual body Philosophy and medical ideas were closely interconnected The human body contains the universe The body as a microcosm of the universe The theory that the universe and the human body are governed by the same rules and forces. Therefore, the system of balance that is required by the universe must be seen in the body. This also ties into the concept that the humors are affected by the seasons.

Hippocratic Corpus

Series of 50-70 texts attributed to Hippocrates, (known as the "Father of Modern Medicine"); Compiled in 250 B.C.E, but other texts added later on Likely many different authors. Texts are not consistent. and present contradictory ideas. Some read like case notes and describe patients, others develop theories for diseases etc... What unifies the texts is that they emphasized reason and place it above supernatural forces. It was independent from the intervention of gods and supernatural forces. Science and religion co-existed in Greece at the time but these documents contrasted to the idea that the Gods would heal you and instead focused on natural forces as the healers of disease and Hippocrates believed that the primary way to achieve this was through diet/regiment, drug therapy, and surgery (as a last resort). Hippocrates was one of the first Physicians known who considered medicine to be a science, and to be separate from religion which was portrayed through the Hippocratic corpus. He pretty much laid the foundation for medicine as a science. The Hippocratic corpus also included the Hippocratic Oath which introduced patient confidentiality, a practice which is still used today.

Asclepius

Son of Apollo and God of medicine. Had two daughters, Hygieia, goddess of health and hygiene and Panacea; goddess of remedies. Often depicted with staff with 2 snakes. By 200 B.C.E every town in Greece had a temple to Asclepius. Individuals who wanted to be cured would visit the temple and spend time in temple to receive vision in dream Gods could cure patients directly or send dream that can be interpreted/deciphered by priest Significance: Contrasts with views of disease and illness later on in history; at this point if someone was sick it could be blamed on the God's since they would exercise their wrath on humans; however this also mean they had the power to heal. Nowadays if you are paralyzed you might go to a hospital to get treatment; in Ancient Greece, you would go to a temple and be cured by God. Asclepius not only had an influence in the Greek world but also in the Roman world. Although Rome initially resisted the influx of Greek medicine, In 293 BCE after Roman gods were unable to stop a disease, Romans contacts the temple of Asclepius. One year later a cult to Asclepius was established in Rome.

Salerno Medical School

Southern Italy (c.1100) (Middle ages) Revival of academic medicine in medieval Europe One of the first universities in medieval Europe, founded in 1063, in 1200, universities began to spring up much more rapidly. Rise if Universities ! The medical training was heavily text based, using canonical texts such as the Articella (Medical Caompedium which empahszied Galen), Canon of Medicine although the learning would be based off of one manuscript that was read to the students in a lecture style. Highly theoretical and speculative They had oral examinations that were very academic and highly text based. Some schools did require some "apprenticeship" style learning for the degree, but not for the examinations. Huge projects of translation

Bayt al-Hikma (House of Wisdom)

The "House of Wisdom" was a library in Baghdad, founded in the 9th century. Islamic Golden Age. It was a place of translation, learning, and new writings and functioned as a center of intellectual work and incredible translation progress. Hundreds of Greek texts were translated into Arabic, and new terms were created to match Greek meanings It was government funded and the emphasis on gaining knowledge in the Islamic tradition promoted incredible works. The discovery of paper enabled a more durable, long lasting, and easy to store, option for translations (books). Translators would translate works but also add their own commentary, expanding the knowledge

Pathology

The study of disease / suffering FIRST, pathology is used to explain suffering. Illness demands a 'logical' explanation, rooted either in the cultural and spiritual ideas of sin and blame or in the more material and 'scientific' ideas of structure, function, heredity, contagion, and risk. SECONDLY, pathology is used to identify or define the ailment from which a person suffers; the process of diagnosis THIRDLY, pathology is used to predict outcomes. In some cultures, accurate prognosis was at least as important as an ability to cure. FOURTH, pathology is used to justify treatments. Most treatments were discovered through observation rather than reasoning (empirically) FINALLY, pathology has been used to prove the reasonableness of an explanation, a diagnosis, or a course of action. Pathology has changed with time; to explain suffering Ancient Greeks might blame the gods or humoral theory whereas nowadays germ theory might be used to logically explain illness.

Anatomy

The study of the structure of the human body. Under Roman law dissection was prohibited (angered Galen) Greek world banned dissection Between the death of Alexander the Great and the endpoint of the Greek world and the beginning of the roman empire, Alexandria Egypt became a cultural center and dissection was allowed Beginning in 1442, the University at Bologna was provided with two corpses each year. However, most dissections were performed in order to prove Galen and the Ancients and not to discover discrepancies or new knowledge. Dissections were to confirm authority of the ancients (prove Galen) Galen was ultimate authority for anatomy for many years

Moral Treatment

The treatment of patients using a method that pertains directly to the individual patient rather than the base treatment of all patients. Treatment of moral illnesses should be designed to act upon the mind. Rather than using physical means of altering the patient's mental condition, using mental means; talking, emotionally shocking them (manipulative, but for the patient's benefit) Using fear of violence rather than violence. Focus on the mind: intellect and emotions Socialization Philippe Pinel

Physiology

Working to identity and classify the processes of life (digestive system works, how respiration works) Applied to anatomy to understand how different body parts and organs interact with each other Harvey during the scientific revolution explained physiology in terms of physical forces (heart as a pump)