History of medicine
From The Art and Popular Culture Encyclopedia
This article deals with medicine as practiced by trained professionals from ancient times to the present. The ancient Egyptians had a system of medicine that was very advanced for its time and influenced later medical traditions. The Egyptians and Babylonians both introduced the concepts of diagnosis, prognosis, and medical examination. The Greeks went even further, and advanced as well medical ethics. The Hippocratic Oath, still taken by doctors today, was written in Greece in the 5th century BCE. In the medieval era, surgical practices inherited from the ancient masters were improved and then systematized in Rogerius's The Practice of Surgery. Universities began systematic training of physicians around the years 1220 in Italy. During the Renaissance, understanding of anatomy improved, and the microscope was invented. The germ theory of disease in the 19th century led to cures for many infectious diseases. Military doctors advanced the methods of trauma treatment and surgery. Public health measures were developed especially in the 19th century as the rapid growth of cities required systematic sanitary measures. Advanced research centers opened in the early 20th century, often connected with major hospitals. The mid-20th century was characterized by new biological treatments, such as antibiotics. These advancements, along with developments in chemistry, genetics, and lab technology (such as the x-ray) led to modern medicine. Medicine was heavily professionalized in the 20th century, and new careers opened to women as nurses (from the 1870s) and as physicians (especially after 1970). The 21st century is characterized by very advanced research involving numerous fields of science.
All human societies have medical beliefs that provide explanations for birth, death, and disease. Throughout history, illness has been attributed to witchcraft, demons, adverse astral influence, or the will of the gods. These ideas still retain some power, with faith healing and shrines still used in some places, although the rise of scientific medicine over the past millennium has altered or replaced many of the old beliefs.
Medicine was revolutionized in the 19th century and beyond by advances in chemistry and laboratory techniques and equipment, old ideas of infectious disease epidemiology were replaced with bacteriology and virology. Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating the scientific field microbiology.
Ignaz Semmelweis (1818–1865) in 1847 dramatically reduced the death rate of new mothers from child bed fever by the simple expedient of requiring physicians to clean their hands before attending to women in childbirth. His discovery pre-dated the germ theory of disease. However, his discoveries were not appreciated by his contemporaries and came into general use only with discoveries of British surgeon Joseph Lister, who in 1865 proved the principles of antisepsis in the treatment of wounds; However, medical conservatism on new breakthroughs in pre-existing science prevented them from being generally well received during the 19th century.
After Charles Darwin's 1859 publication of The Origin of Species, Gregor Mendel (1822–1884) published in 1865 his books on pea plants, which would be later known as Mendel's laws. Re-discovered at the turn of the 20th century, they would form the basis of classical genetics. The 1953 discovery of the structure of DNA by Watson and Crick would open the door to molecular biology and modern genetics. During the late 19th century and the first part of the 20th century, several physicians, such as Nobel prize winner Alexis Carrel, supported eugenics, a theory first formulated in 1865 by Francis Galton. Eugenics was discredited as a science after the Nazis' experiments in World War II became known; however, compulsory sterilization programs continued to be used in modern countries (including the US, Sweden and Peru) until much later.
Semmelweis's work was supported by the discoveries made by Louis Pasteur. Linking microorganisms with disease, Pasteur brought about a revolution in medicine. He also invented with Claude Bernard (1813–1878) the process of pasteurization still in use today. His experiments confirmed the germ theory. Claude Bernard aimed at establishing scientific method in medicine; he published An Introduction to the Study of Experimental Medicine in 1865. Beside this, Pasteur, along with Robert Koch (who was awarded the Nobel Prize in 1905), founded bacteriology. Koch was also famous for the discovery of the tubercle bacillus (1882) and the cholera bacillus (1883) and for his development of Koch's postulates.
The participation of women in medical care (beyond serving as midwives, sitters and cleaning women) was brought about by Florence Nightingale. Nightingale showed a previously male dominated profession the elemental role of nursing in order to lessen the aggravation of patient mortality which resulted from lack of hygiene and nutrition. Nightingale set up the St Thomas hospital, post-Crimea, in 1852. Elizabeth Blackwell (1821–1910) became the first woman to formally study, and subsequently practice, medicine in the United States.
It was in this era that actual cures were developed for certain endemic infectious diseases. However the decline in many of the most lethal diseases was more due to improvements in public health and nutrition than to medicine. 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.
The Great War spurred the usage of Roentgen's X-ray, and the electrocardiograph, for the monitoring of internal bodily functions. This was followed in the inter-war period by the development of the first anti-bacterial agents such as the sulpha antibiotics. The Second World War saw the introduction of widespread and effective antimicrobial therapy with the development and mass production of penicillin antibiotics, made possible by the pressures of the war and the collaboration of British scientists with the American pharmaceutical industry.
Lunatic asylums began to appear in the Industrial Era. Emil Kraepelin (1856–1926) introduced new medical categories of mental illness, which eventually came into psychiatric usage despite their basis in behavior rather than pathology or etiology. In the 1920s surrealist opposition to psychiatry was expressed in a number of surrealist publications. In the 1930s several controversial medical practices were introduced including inducing seizures (by electroshock, insulin or other drugs) or cutting parts of the brain apart (leucotomy or lobotomy). Both came into widespread use by psychiatry, but there were grave concerns and much opposition on grounds of basic morality, harmful effects, or misuse. In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. There was also increasing opposition to the use of psychiatric hospitals, and attempts to move people back into the community on a collaborative user-led group approach ("therapeutic communities") not controlled by psychiatry. Campaigns against masturbation were done in the Victorian era and elsewhere. Lobotomy was used until the 1970s to treat schizophrenia. This was denounced by the anti-psychiatric movement in the 1960s and later.
The 20th century witnessed a shift from a master-apprentice paradigm of teaching of clinical medicine to a more "democratic" system of medical schools. With the advent of the evidence-based medicine and great advances of information technology the process of change is likely to evolve further, with greater development of international projects such as the Human genome project.