Medieval Medicine to 18th19th Century Views of Disease

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Medieval Medicineto 18th-19th Century Views of
Disease

• The Old
• Middle Ages Peter and Bartolomeo
• 18th Century Cullen and dropsy
• The New
• 19th Century Bright and dropsy
• Paris Medical School
• Richard Bright and Brights Disease
• Pneumonia in Philadelphia continuity and change

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• Peter the Venerable, abbot of Cluny
• b1092-1156
• Bartolomeo, physician of Salerno
• Winter 1150-51

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Peter the Venerables letter

• Postponed bloodletting ? catarrh
• Postponed it again
• After 4 months, 2 bloodlettings in 3 weeks, but
• Catarrh remains
• Voice is weak
• Chest is heavy
• Lots of phlegm

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Peter the Venerables letter

• Local physicians
• Bloodletting has ? loss of heat
• cold and sluggish phlegm is diffused throughout
  the veins and vital channels
• Rec heating and moistening foods/medications

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Peter the Venerables letter

• Peter objects
• Cold, moist disease ought to be treated with hot,
  dry remedies (galenic law of contraries)
• Also worried about omitting his regular
  bloodletting
• Local docs reply
• Throat and trachea should be soothed with moist
  things, not irritated with dry things

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Bartolomeos Letter

• Avoid bloodletting until catarrh better
• For headache cautery to the head
• Moist medicines might be potentially dry and
  therefore suitable for moist disease
• (In effect endorses opinion of local physicians
  w/out direct contradiction of Peter)

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Bartolomeos Letter

• Rec
• Hot baths, medicated steam
• Poultice for chest, gargles, lozenge, laxative

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Science/Medicine The West
in the West

• Dark Ages 500-1000 AD
• End of Roman empire 476
• Rome sacked by Alaric the Goth 410
• Literacy declining 600s
• Apogee of Islamic conquest 732
• Battle of Tours
• Middle Ages 1000-1450 AD
• 12th century renaissance

• Medicine (and other forms of learning) preserved
  by the church
• Secular medicine reappears in medieval
  universities

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Complexion

• Df the balance of hot, wet, cold and dry among
  the elements of the body
• From Galen who got it from Hippocratic writings
• Each individuals complexion is unique
• Varies by sex and age and climate
• Each organ has a complexional quality
• Well-balanced complexion is an achievement

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Humoralism
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Disease in the Middle Ages

• Peter has medical knowledge and argues with his
  doctors
• Disease complexion theory
• Galen
• Theory is applied flexibly by physicians

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William Cullen 1710-1790
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Nosology
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Disease in the 18th Century

• Classification based upon symptoms (not anatomy
  or pathology)
• Explanations focus upon the body as a whole
• Causes operate at basic levels that affect the
  entire organism

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Disease 18th Century vs Before

• No Galen, humors, complexion
• but
• Disease is systemic, a matter of balance, and
  therapeutics is directed at the bodily system as
  a whole

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Xavier Bichat 1771-1802
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Richard Bright 1789-1858
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Brights Disease

• Some or all of
• dropsy
• vomiting, headaches, pericarditis, seizures
• albumen in the urine
• morphological changes in the kidneys

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Humoralism Implications for Diagnosis and
Treatment

• Shared knowledge between physician and patient
• Holism

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Disease Pre-Paris
School to Afterwards

• Df
• imbalance of invading
  entity the
  organism ? path lesion
• Character
• systemic, holistic organ/tissue-
  specific
• Therapeutics
• aimed at the whole aimed at the
  lesion

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Ambulance Runs
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Pneumonia

• Df inflammation of the parenchyma of the lungs
• Presentation usually ushered in with a chill,
  often very decided, followed by febrile reaction,
  difficult breathing, cough and severe pain in the
  side or back part of the chest

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Pneumonia

• The disease is often very obscure
• many cases (run) their whole course quite
  unsuspected. Cough and pain in the chest are
  sometimes wanting and fever with headache and
  hurried respiration, which are common to this
  with numerous other diseases, are the only
  obervable phenomena.
• Even the symptom of viscid and rusty sputa
  often fails us

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Pneumonia

• Physical signs
• of the highest importance
• before the processes of percussion and
  auscultation, many cases ran their whole course
  unsuspected
• Percussion and auscultation
• Laennec preferred the stethoscope but his
  arguments in its favor have not been considered
  conclusive and immediate auscultation is now
  generally preferredThe ear is the most
  convenient instrument. It is always at hand,
  and, by the facility with which it can be
  applied, and the quickness with which it can pass
  from point to point, saves much time.

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Pneumonia
Recovery
(rare)
6 Days-2 Weeks
Course
1-4 Days
Variable
Gray Hepatization (pus)
Congestion
Hepatization (consolidation)
Pathology
sl diminution of healthy resonance
decided dullness or flatness
decided dullness or flatness
Percussion
No Sound or Bronchial Respiration
No Sound or Bronchial Respiration
Crepitant rale
Auscultation
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Pneumonia Treatment

• Bleeding No disease bears the loss of blood
  better than open, well-developed, pneumonia
• Diminish the labor of the lungs
• Relieve the inflammation

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Pneumonia Treatment

• As all the blood in the body must pass through
  the lungs after reaching the heart, before it can
  be again distributed, and as in pneumonia a
  considerable portion of the lungs performs the
  duty but imperfectly, a greater burden
  necessarily falls upon the remainder..

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• And thus, not only is the sound part of the lung
  unduly loaded with blood, but the movements of
  respiration must be accelerated in proportion.
  By diminishing the amount of blood, we relieve
  the lung of a portion of this duty

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Bleeding bowl
3 bladed lancet
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Pneumonia Treatment

• After 2 or 3 days, when the force of the
  circulation has been sufficiently subdued by the
  lancetmixture of
• Opium
• Ipecacuanha
• Calomel
• procures rest for the patient, obviates the
  injurious effect of cough,..lays the foundation
  for a mercurial impression.

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Pneumonia Treatment

• Should the disease prove obstinate (e.g. no
  improvement by 5th day)
• Continued opium/ipecac/calomel
• and
• Mercury
• It is important to push the mercurial plan until
  the gums become somewhat affected, when the
  symptoms will generally begin to improve.

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Pneumonia

• Blister
• At the same time that this plan is in operation,
  a blister may with great propriety be applied to
  the chest. (6x8 to 8x10)
• Before this period it would be improper as
  without unseating the inflammation, it might
  injuriously aggravate the fever.

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Pneumonia Treatment

• As improvement occurs
• Expectorant medicines
• Digitalis (if the pulse remains frequent)
• Advanced stages
• Should the strength fail in the advanced stages,
  it will often be found very useful to emply
  carbonate of ammonia
• Other stimulants wine-whey, oil of turpentine

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Pneumonia in 19th Century Philadelphia

• Specific pathology of the lung
• (vs. systemic excess of phlegm or blood)
• but
• Therapeutics is directed at balance
• Bloodletting and heavy metals to lower the
  system in early stages
• Stimulants/tonics to raise the system when its
  too low (late stages).

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