A Brief History Of Medicine

1
A Brief History Of Medicine
Part 4 Renaissance to early 1900s
2
Throughout History

• People have had illness.
• People have tried to explain the cause of
  disease.
• Humans have sought cures for sicknesses.

3
The Renaissance
4
Time Period

• 1300 AD to 1600 AD
• Re-birth of knowledge

5
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".

6
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.

7
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.

8
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.

9
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.

10
William Harvey

• The Heart is a pump it does not make blood (as
  most doctors thought)
• Blood circulates around and through the body.

11
Microscope Used for Science

• Antonie van Leeuwenhoek , 1670s
• Dutch scientist
• Improved microscope with smaller, superior
  lenses
• Actually invented in 1590 by Zacharius
  Jannssen.

12
Leeuwenhoek

• Was actually studying various fabrics
• First to observe bacteria 1676
• Little beasties
• Also observed protists and muscle fibers
• Discovered blood cells

13
Marcello Malpighi

• Italian physician biologist
• Malpighi first to study blood with microscope in
  1690s
• Also studied skin, kidney liver tissues
• Revolutionized the study of biology

14
Treatment Changed Little

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

15
Whos 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

16
Beginnings of Modern Medicine
17
Time Period 1700s to 1900s
18
Hospitals in the 1700s 1800s

• Hospitals were often unsanitary
• People were mixed in large rooms regardless of
  their disease
• They were a last resort when all else failed.

19
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 !!

20
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 Guys Hospital had three
  sets of blood types on them - dried and stained
  into the wooden handles of the instruments.

21
William Morton, 1846

• American Dentist
• Used ether as an anesthetic to put the patient to
  sleep before surgery

22
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.

23
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
24
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
25
Smallpox

• Known since 10,000 BC
• Smallpox affected all levels of society.
• In the 1700s in Europe, 400,000 people died each
  year
• Up to 60 who got it died
• Smallpox killed thousands of Native Americans
  when the Europeans brought the infection to the
  New World

26
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

27
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 (16891762).
28
Edward Jenner

• English country doctor 1749-1823
• Noticed that people who had cowpox (mostly
  milkmaids) never got smallpox

29
Edward Jenners 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

Jenners Original Report
30
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.

31
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

32
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.
33
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.

34
Snows 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

35
Louis Pasteur Germ Theory

• French chemist professor 1822-1895
• Started studying fermentation in beer and wine
• Discovered that microorganisms were causing wine
  to spoil

36
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.

37
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

38
Science of Immunology Begins

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

39
Pasteurs 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

40
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.

41
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.

42
Antiseptics

• British surgeon Joseph Lister in 1865 proved the
  principles of antisepsis in the treatment of
  wounds.
• Listers death rate dropped to 15
• Few doctors followed this advice until a less
  annoying system was invented.

Spray contraption
43
Robert Koch

• German scientist 1843-1910
• Development of Koch's postulates to prove which
  germ caused which disease.

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44
Great Microbiologist

• First to isolate anthrax bacteria
• Discovered bacteria that causes tuberculosis
• Identified germ that causes cholera

45
Kochs 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

46
Kochs 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

47
Major Accomplishments

• It was in the late 1800s 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.

48
Major Accomplishments

• Invention of X-rays 1895
• Wilhelm Roentgen, German physicist
• Led to science of radiology

49
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.

50
Alexander Fleming

• Scottish doctor
• Discovered penicillin in 1928
• First antibiotic
• Won Nobel Prize in Medicine in 1944

51
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.