The History of Western Medicine
In most early civilizations medicine was closely linked to religion, and diseases were either believed to be caused by gods, who might also affect cures, or regarded as being the work of a malevolent, supernatural force. Treatment for simple medical problems was based on the use of herbs and magic or incantations, while seriously ill and debilitated people were often killed to ease the burden of caring for them.
Such was not the case with the ancient Greeks, whose scientific rigour and rationalism is said to have made them the true founders of Western medicine. The Greek physician Hippocrates, who believed that moderation in all things is the key to good health and who emphasized careful diagnosis in all cases of illness, is regarded as the 'father of modern medicine'. Born around 460 BC on the island of Cos, he is honoured for his establishment of medical ethics through his legacy of some 70 books called the Hippocratic Corpus, upon which the modern Hippocratic Oath, taken by doctors, is based.
Elements and humours explained
The Greek theory of the elements and the humours was based on the belief that everything is formed of combinations of four elements - air, water, earth and fire - which correspond to four qualities - cold, wet, dry and hot. The ancient Greeks thought that the qualities blended to form four humours in the body: blood (hot and wet), yellow bile (hot and dry), black bile (cold and dry), and phlegm (cold and wet). Good physical and mental health was supposed to depend on the correct balance of the humours.
The Greek theory of the elements and the humours - which originated with the philosophers Empedocles (c. 490-430 BC) and Aristotle (384-322 BC) - influenced the direction of medicine for many centuries, and produced the growth of most of the larger medical specializations. Aristotle is regarded as the founder of anatomy and embryology, Erasistratus (304-250 BC) pioneered physiology, and Plato (c. 428-348 BC) was the first to coin the term 'anaesthesia' and to investigate psychosomatic cures.
Greek medicine was so powerful, all-encompassing and successful that the Romans made few advances. For most of the duration of the Roman Empire, Greek physicians were employed. They enjoyed the status of free citizens and one of their number, Galen (Latin name Claudius Galenus, c. AD 130-201), combined the theory of the humours with his own studies in anatomy and physiology to produce a comprehensive medical encyclopedia, which remained a standard reference for more than 1000 years despite the fact that his anatomical descriptions, which were based on dissections he had carried out on animals, were riddled with errors. Rome's only contribution to the history of medicine was its development of an elaborate public health system, entailing garbage and sewage disposal, public baths, and a good fresh water supply.
There was no encouragement of scientific research by either Church or State after the fall of the Roman Empire and, as with most things during the Dark Ages, medicine went into decline in Western countries. Progress during this period tended to be in Arabian countries where Greek learning was preserved and greatly advanced, and where the first hospitals were built.
Ancient knowledge began to return to the West from about AD 1000 via the development of monastic medicine and centers such as the medical school at Salerno. Later, medicine was taught at new universities established in Cambridge, Oxford, Bologna, Montpellier and Paris - where, in the 14th century, anatomy lessons often included the public dissection of human corpses but the teaching of surgery was prohibited by the Church. Students wishing to be trained in this field had to be tutored by a practising surgeon.
In general, medieval medicine was a mixture of ancient physiology, empirical knowledge of the effects of some drugs, medical superstition and the charlatanism of apothecaries.
The 16th century
By the 16th century, the Royal College of Physicians in London had been established but it was not an easy time in the history of medicine as the forces of conservatism fought a rearguard action against the inevitability of change. Michael Servetus, the discoverer of the pulmonary circulation was burned at the stake in 1533 for daring to question the efficacy of apothecaries' potions.
Although individual doctors had frequently doubted Galen's authority on specific points, it was the Flemish anatomist Andreas Vesalius (1514-64) who showed the inadequacies and inaccuracies of Galen in his book De Humani Corporis Fabrica ('On the Fabric of the Human Body'). It was the first accurate book of human anatomy, based on the dissection of human corpses, and laid the foundations of modern anatomy.
Surgery was advanced at the same time by the Frenchman Ambroise Paré (1510-90), who opposed the use of cauterization (the application of red-hot irons or boiling oil) to treat wounds.
The Italian Girolamo Fracastoro (Latin name Fracastorius, c. 1484-1553) discovered the 'French' or 'love' disease of syphilis. The idea that specific diseases required specific treatments was pioneered by the Swiss physician and alchemist, Philippus Aureolus Paracelsus (real name Theophrastus Bombastus von Hohenheim, 1493-1541), who also introduced the use of chemicals into medicine, pioneering the use of mercury and laudanum.
The 17th and 18th centuries
Substantial advances were made in anatomy during the 17th century but all were overshadowed by the English physician William Harvey (1578-1677) who, in 1616, articulated the true nature of the heartbeat and the principle of blood circulation. His book De Motu Cordis ('On the Movement of the Heart') established the basis of all modern physiology.
A further aid to the study of physiology - and to medical science in general - was provided by the invention of microscopes. The Dutchman Anton van Leeuwenhoek (1632-1723) demonstrated the value of these fundamental research tools by using them to investigate blood cells, spermatozoa and microbes.
During the 18th century a number of medical schools, including those at Vienna and Edinburgh, were founded. Significant advances occurred in surgery, and the science of neurology was pioneered by the Swiss physiologist Albrecht von Haller (1708-77).
An Italian anatomist, Giovanni Battista Morgagni (1682-1771), established modern pathology with his argument that disease is localized in parts of the body rather than spread throughout, while the invention of the stethoscope by the French physician René Théophile Hyacinthe Laennec (1781-1826) was to prove a major aid in the diagnosis of disease.
One of the first significant steps in disease prevention was the introduction of vaccination by the English physician Edward Jenner (1749-1823), when he discovered in 1796 that inoculation with the cowpox virus gives immunity to smallpox. Immunization against various other diseases was to be introduced over the next two centuries.
The 19th century
By the beginning of the 19th century, which was the century of progress in Western medicine, the human body was well understood. One of the century's most important discoveries was the demonstration by the Frenchman Louis Pasteur (1822-95) and the German Robert Koch (1843-1910) that diseases such as tuberculosis, rabies and cholera are caused by micro-organisms called bacteria. They showed precisely which bacteria cause which disease, and between 1875 and 1906 over 20 fatal diseases were made preventable through immunization.
Although by the 19th century many kinds of surgical operation had been successfully carried out, large numbers of patients died from infections entering their bodies through wounds or during operations or childbirth. They also had to endure the agony of being fully conscious during operations. Pain control by anaesthesia was pioneered by the Americans Horace Wells (1815-48), using nitrous oxide, and William Thomas Green Morton (1819-68), using ether. In Britain, general anaesthesia - rendering the patient totally unconscious - by means of chloroform was introduced by the Scottish surgeon Sir James Young Simpson (1811-70). In the 1840s, the Hungarian Ignaz P. Semmelweiss (1818-65) showed the crucial importance of asepsis (a germ-free environment) in childbirth wards, and in 1865 the Scottish surgeon Joseph Lister (1827-1912) introduced antisepsis (the destruction of bacteria), by spraying the area being operated on with carbolic acid.
The century also saw many measures introduced to improve public health. Chief among these were improved sewage and sanitary conditions, and such preventative measures improved the life expectancies of millions.
Finally, the century saw the emergence of modern nursing, largely due to Englishwoman Florence Nightingale (1820-1910), who showed that good nursing had a dramatic effect on reducing death rates in hospitals.
The 20th century
The 20th century was an era of technological innovation in medicine, particularly in diagnosis. In 1895 the German physicist Wilhelm Konrad Röntgen (1845-1923) discovered X-rays, the medical applications of which had been realized by the turn of the century. Other inventions of the early part of the century included the electrocardiograph (for measuring heart activity) and the electroencephalograph (for measuring brain activity). The introduction of ultrasound scanning in the 1970s allowed even more accurate pictures than X-rays.
Work on the chemistry of nutrition by the German Emil Fischer (1852-1919) gave rise to biochemistry (the study of the chemistry of living organisms), and the chemical study of disease is now a basic medical approach. Subsequently, British biochemist Sir Frederich Gowland Hopkins (1861-1947) discovered that certain substances - later called vitamins - are essential to the diet in minute amounts, and that disease occurs if they are absent.
Chemotherapy, treatment by chemicals that attack disease agents with minimum harm to the body, was pioneered by the German scientist Paul Ehrlich (1854-1915), who discovered that synthetic dyestuffs could kill bacteria. The sulphonamides, derived from dyestuffs and introduced in 1932, greatly reduced the number of post-operative infections. Ehrlich also initiated the study of the body's immune system. A large number of bacterial infections - many of which were previously fatal - were rendered curable by a new range of drugs, the antibiotics. These drugs were developed from the accidental discovery by the British microbiologist Sir Alexander Fleming (1881-1955) that a growth of penicillin mold had destroyed a bacterial culture he was working on.
Modern medicine, with its open-heart surgery, antibiotics and organ transplants is something Western man has taken for granted. Too often we fail to appreciate the histories behind the splint on a broken finger or the antibiotic that wards off pneumonia or tonsillitis. There is little doubt that medicine is one of man's most miraculous achievements.
Most people know of the Hippocratic Oath but few people actually know what it says. The following is a translation of the original oath:
'I swear by Apollo the healer, invoking all the gods and goddesses to be my witnesses, that I will fulfil this oath and this written covenant to the best of my ability and judgment.
I will look upon him who shall have taught me this Art even as one of my parents. I will share my substance with him, and will supply his necessities, if he be in need. I will regard his offspring even as my own brethren, and I will teach them this Art, if they would learn it, without fee or covenant. I will impart this Art by precept, be lecture and by every mode of teaching, not only to my own sons but to the sons of him who has taught me, and to disciples bound by covenant and oath, according to the Law of Medicine.
The regimen I adopt shall be for the benefit of my patients according to my ability and judgment, and not for their hurt or for any wrong. I will give no deadly drug to any, though it be asked of me, nor will I counsel such, and especially I will not aid a woman to procure abortion. Whatsoever house I enter, there will I go for the benefit of the sick, refraining from all wrongdoing or corruption, and especially from any act of seduction, of male or female, or bond or free. Whatsoever things I see or hear concerning the life of men, in my attendance on the sick or even apart therefrom, which ought not to be noised abroad, I will keep silence thereon, counting such things to be as sacred secrets. Pure and holy will I keep my life and my art.'
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