A Brief History Of Medicine

Part 4

Renaissance to early 1900’s

People have had illness.People have tried to explain the cause of

disease.Humans have sought cures for

sicknesses.

Throughout History

The Renaissance

Time Period

1300 AD to 1600 AD “Re-birth” of

knowledge

Major Advancements

1543 Flemish Scholar Andreas Vesalius began to use human bodies for anatomy study

Wrote the first complete textbook on human anatomy: "De Humani Corporis Fabrica", meaning "On the Fabric of the Human Body".

Major Advancements

Girolamo Fracastoro 1546

Theory of contagion Said disease infection can

be caused by minute bodies (“germs”) capable of self-replication, transmitted from infector to infected.

Major Advancements

The French army doctor Ambroise Paré, born in 1510, revived the ancient Greek method of tying off blood vessels.

After amputation the common procedure was to cauterize the open end of the amputated appendage to stop the hemorrhaging. This was done by heating oil, water, or metal and touching it to the wound to seal off the blood vessels.

Major Advancements

Pare also believed in dressing wounds with clean bandages and ointments.

He was the first to design artificial hands and limbs for amputation patients. On one of the artificial hands, the two pairs of fingers could be moved for simple grabbing and releasing tasks and the hand look perfectly natural underneath a glove.

Major Advancements

1628, William Harvey explained the circulation of blood through the body in veins and arteries.

It was previously thought that blood was the product of food and was absorbed by muscle tissue.

William Harvey

The Heart is a pump – it does not make blood (as most doctors thought)

Blood circulates around and through the body.

Microscope Used for Science

Antonie van Leeuwenhoek , 1670’s

Dutch scientist Improved microscope*

with smaller, superior lenses

*Actually “invented” in 1590 by Zacharius Jannssen.

Leeuwenhoek

Was actually studying various fabrics

First to observe bacteria 1676

“Little beasties” Also observed protists

and muscle fibers Discovered blood cells

Marcello Malpighi

Italian physician & biologist

Malpighi first to study blood with microscope in 1690’s

Also studied skin, kidney & liver tissues

Revolutionized the study of biology

Treatment Changed Little

Despite changes in knowledge, the major treatments were still Bleed Blister Purge Avoid sickness

Who’s Who?

Physician – university trained doctor who could prescribe medicine & do surgery (most expensive!)

Apothecary – shopkeepers with a little training; skilled at mixing herbs

Surgeon – “bone cutter” who did amputations

Barber – minor surgery (like removing moles)

Midwife – women who assisted with childbirth

Beginnings of Modern Medicine

Time Period 1700’s to 1900’s

Hospitals in the 1700’s & 1800’s

Hospitals were often unsanitary

People were mixed in large rooms regardless of their disease

They were a “last resort” when all else failed.

Surgery Was Crude & Dangerous

Operations were still likely to lead to death as a result of infection - even if the patient had survived the operation.

Doctors wore dirty overcoats over their normal day coat in the operating theatre in anticipation of the blood and other fluids that might be spilt in quantity - they did not want to spoil their day-to-day clothes !!

Surgery Was Crude & Dangerous

Surgical instruments were not disinfected afterwards as they did not know about germs.

Operating tools would be used form one patient to another and not cleaned. One set of operating tools found at the old Guy’s Hospital had three sets of blood types on them - dried and stained into the wooden handles of the instruments.

William Morton, 1846

American Dentist Used ether as an

anesthetic to put the patient to sleep before surgery

Major Advancements - Nursing

The participation of women in medical care (beyond serving as midwives, sitters and cleaning women) was brought about by the likes of Florence Nightingale and Clara Barton.

These women showed a previously male dominated profession the importance of nursing in order to lessen the death rate which resulted from lack of hygiene and nutrition.

Major Advancements - Nursing

Florence Nightingale (1820-1910) was a nurse in London (rare for a woman from a wealthy family)

Nightingale took over the St Thomas hospital in 1852.

In 1854, the British army asked her to help during the Crimean War.

She revolutionized hospital care with cleanliness and organization

Set up school for nurses; soon all nurses were well-trained

Florence Nightingale

Nursing in America

Clara Barton (1821-1912) Coordinated medical supplies

for the Union Army in the Civil War

After the War, she coordinated the search from missing Union soldiers

Founded the American Red Cross in 1881

Clara Barton, Civil War nurse

Smallpox

Known since 10,000 BC Smallpox affected all levels of society. In the 1700’s in Europe, 400,000 people

died each yearUp to 60% who got it diedSmallpox killed thousands of Native

Americans when the Europeans brought the infection to the New World

Smallpox Symptoms

High fever, body-aches (like many viruses)

Pus-filled bumps covered the body, especially face, arms, and legs.

Bumps were hard and itchy then burst and spread the pus

1/3 of survivors went blind Most had disfiguring pock-marks Smallpox was highly contagious

and caused epidemics

Inoculation or Variolation

Lady Montague learned this process in Turkey

Introduced variolation to England in 1721

This process introduced a tiny amount of smallpox pus into a healthy person

Most people got a very mild case of smallpox and were then immune for life

Lady Mary Wortley Montague (1689–1762).

Edward Jenner

English country doctor 1749-1823

Noticed that people who had cowpox (mostly milkmaids) never got smallpox

Edward Jenner’s Experiment

Took pus from a cowpox blister

Injected it into a young boy several times

Then he injected smallpox into the boy

The boy got a mild illness & survived

Jenner’s Original Report

The End of Smallpox

At first people refused to believe such a result

It worked well and became well-accepted

Better vaccines were later developed

Smallpox was eradicated worldwide in 1979.

Cleanliness for Doctors

Ignaz Semmelweis -- 1847

Dramatically reduced the death rate of new mothers from childbed fever by simply requiring physicians to clean their hands before attending to women in childbirth

Ignaz Semmelweis

Other doctors refused to accept his theory

Most still believed in humours and miasmas as the cause of disease

20 years later, Pasteur confirmed his ideas

Streptococcus pyogenes (red-stained spheres) is responsible for most cases of severe puerperal fever.

John Snow

“Father of Epidemiology” 1849 – published theory

that cholera was spread by contaminated food or water

Solved 1854 cholera epidemic in London

Showed that bacteria came from contaminated water in the Broad Street pump.

Snow’s Scientific Method

Snow created detailed maps of London showing where cholera deaths were occurring

Showed greatest infection rate near Broad Street pump

Once the pump was closed, the epidemic ceased

Louis Pasteur & Germ Theory

French chemist & professor 1822-1895

Started studying fermentation in beer and wine

Discovered that microorganisms were causing wine to spoil

Pasteurization

"the germs of microscopic organisms abound in the surface of all objects, in the air and in water."

He determined that such micro-organisms could be killed by heating liquid to 55 degrees Celsius (about 130 degrees Fahrenheit) or higher for short periods of time.

This simple process is now known as pasteurization

Used today in milk and many other beverages.

Germ Theory

Pasteur then turned his attention to other aspects of microorganisms

Theorized that germs could cause disease

Most doctors thought germs were a result of disease

Science of Immunology Begins

Showed that certain diseases could be prevented by vaccination Rabies Chicken cholera Anthrax Silkworm disease

Pasteur’s Importance

Linking microorganisms with disease, Pasteur brought about a revolution in medicine.

His experiments confirmed the germ theory.

Founded the Pasteur Institute in Paris.Pioneering clinic for the study of infectious

diseases Still active today

Joseph Lister

Pasteur's work on the link between bacteria and disease came to the attention of the famous Edinburgh surgeon Lord Edward Lister.

He was concerned with the number of people who died after having operations in hospital – about 46% of all surgery patients.

Joseph Lister

Lister introduced disinfectant sprays during operations, these prevented bacteria from entering a wound.

Used a fine spray of carbolic acid in the operating room (annoying to doctors!)

He also introduced the use of dressings soaked in carbolic acid and strict hygiene rules to combat sepsis.

The sterile methods introduced by Lister, drastically reduced the number of hospital deaths.

Antiseptics

British surgeon Joseph Lister in 1865 proved the principles of antisepsis in the treatment of wounds.

Lister’s death rate dropped to 15%

Few doctors followed this advice until a less annoying system was invented.

Spray contraption

Robert Koch

German scientist 1843-1910

Development of Koch's postulates to prove which germ caused which disease.

http://www.abpischools.org.uk/res/coResourceImport/resources04/history/index-2.cfm

Great Microbiologist

First to isolate anthrax bacteria

Discovered bacteria that causes tuberculosis

Identified germ that causes cholera

Koch’s Postulates

1. The organism should always be found in sick animals and never in healthy ones;

2. It must be grown in pure culture; 3. The cultured organism must make a

healthy animal sick; 4. It must be re-isolated from the newly sick

animal and re-cultured and still be the same

Koch’s Importance

Put an end to miasma theory Created scientific process to identify disease-

causing organisms Founded bacteriology as a science Awarded the Nobel Prize for Medicine in 1905 The Robert Koch Award & Medal now honor

great achievements in microbiology

Major Accomplishments

It was in the late 1800’s that actual cures were developed for certain common infectious diseases.

The decine in many diseases was more due to improvements in public health and nutrition than to medicine.

Major Accomplishments

Invention of X-rays 1895

Wilhelm Roentgen, German physicist

Led to science of radiology

Other Advancements

1842 -- Crawford W. Long uses ether as a general anesthetic

1896 -- First vaccine developed for typhoid fever 1897 -- First vaccine developed for Bubonic plague 1899 – Felix Hoffman develops aspirin 1901 - Karl Landsteiner introduces the system to

classify blood into A, B, AB, and O groups 1923 -- First vaccine developed for diphtheria. 1926 -- First vaccine developed for whooping cough 1927 -- First vaccines developed for tuberculosis &

tetanus.

Alexander Fleming

Scottish doctor Discovered penicillin

in 1928 First antibiotic Won Nobel Prize in

Medicine in 1944

Major Advancements

It was not until the 20th century that the application of the scientific method to medical research began to produce multiple important developments in medicine, with great advances in pharmacology and surgery.