Presentation on theme: "The History of Medicine"— Presentation transcript:
1The History of Medicine An IntroductionDr H K Lord
2From Ancient Civilisation to The Enlightenment. A Tour Through TimeFrom Ancient Civilisation to The Enlightenment.
3Beginnings Ancient civilisations: Mesopotamia 2000 - 3000 BC Ancient Egypt, India, China BCCrete and Mycenae BCAncient Hebrew medicine – 2000 BCall had medical philosophies, usually based on religion.
4Greek Mythology – 900 BC Closely bound to religion of gods Dionysius god of fertilityAthena god of the eyesHera protector of women in childbirthAesculapius 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.
6Aesculapius Snake: its ability to shed its skin was seen as symbol of rebirth andhealing, and its poison of death.
7Ancient Greece 600 BC Pre-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.
8Ancient Greece 600 BCOthers of his time included Pythagoras and EmpedoclesDoctrine 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)
9Hippocrates 500 BCOn 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.
11Hippocrates 500 BC4 balanced number in Pythagoran philosophy : 2 pairs of opposites4 elements (earth, fire, water, air)4 qualities (wet, dry, hot, cold)4 seasons4 bodily fluids – blood, phlegm, black bile and yellow bileIf 4 humours in balance = healthIf 4 humours imbalanced = disease
12Hippocrates 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.
13Hippocrates 500 BCUsed instruments to examine patients – probes and speculums to Ex orificesDiscussed 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.”
14Hippocratic 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.
15Plato Plato was a contemporary of Hippocrates (427 – 347 BC) Student of Socrates and teacher of AristotleInterested 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.
17Aristotle 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
18Roman Medicine 150 BC – 200 ADGreek 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
19Galen 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.
20GalenUsed humoural theory. Took it further, to describe 4 personalities:SanguinePhlegmaticCholericMelancholicIn the Middle Ages Galen’s pronouncements were swallowed wholesale, both right and wrong, and this led to centuries of thought based on the humours.
21Galen Experimentalist and wrote extensively. Showed that veins were connected to the heartThat nerves came from the spinal cordDescribed recurrent laryngeal nerveDescribed bones and their muscle attachmentsShowed that arteries contained blood, not air.
22Galen 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 years.
23Middle Ages 400 – 1500 ADThe Fall of Rome to the Goths in 476 beginning of Middle AgesFall of Constantinople to the Turks in 1453 end of Middle AgesFor 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
24The extraction of the stone of madness Bosch 1475 Madrid
25Middle Ages ADMiddle Ages were unsettled times –certainty welcomedGalen’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.
27Middle AgesExact reason why rational thought abandoned is complex – Black death, plague, feudal society.Barbarian invasions – dissolution of Western EmpireRise of ChristianityDevelopment of monasteries and belief in miraclesPower of Saints, Martyrs and Virgin MaryGrowing belief in superstition and magicElsewhere however…..
28Islamic Medicine 700 – 1100 ADBaghdad 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.
29Islamic 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.
30RenaissanceRebirth – 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.
32RenaissanceOpen 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
33ParacelsusEducated 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.
34ParacelsusTo him diseases were caused by influences of the stars and planetsSo 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.
35Renaissance SurgeryAmbroise Pare 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.
36Renaissance IllnessCommonest 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.
37Renaissance ArtStudy 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.
38Art and MedicineHuman dissection came back into favour having long been frowned upon and forbidden for religious reasonsLeonardo da Vinci made illustrations of skeletal, muscular, venous and nervous systems, accurately depicted position of foetus in utero and had unrivalled artistic ability.
40Vesalius 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.
411600s Age of ScienceA 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.
421600s - ChemistryTheory 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 agentsNew discoveries in chemistry led to concept of bodily acids / alkalisSupport for concept of atoms making up matterBoyle devised air pump and demonstrated necessity of air for life.
43Microscope….. 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.
44William 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.
45The 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 medicinePatients still purged and bledThe humours still held dominance for most practitioners.
46The 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.
47The 18th CDiscovery of vaccination by Edward Jenner, using fluid from sores on cattle, to prevent smallpox.James Lind ( ) 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.
48The Future The 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.
49So, In Conclusion Medicine has always existed Initially closely bound to gods and superstitionsThe 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.
50In ConclusionThis 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.