Outline Middle ages – in Europe Renaissance – in Europe Modern medicine.

History of Medicine

Part 4

Prof. Mamoun KremliAlMaarefa College

Outline Middle ages – in Europe

Renaissance – in Europe

Modern medicine

Time-line 1543 C.E.

The first scientific textbook on human anatomy is published by Andreas Vesalius, physician and professor of medicine at the University of Padua in Italy. Vesalius based his work on dissection of human cadavers.

1628 C.E. William Harvey shows (for the first time) that the heart

pumps blood through the arteries to all parts of the body, and that blood returns to the heart through the veins.

1600s C.E. Antony Leeuwenhoek uses a microscope and discovers

red blood cells, bacteria, and protozoa

Time-line 1796 C.E.

The smallpox vaccine is developed by Edward Jenner, initiating the science of immunology.

1800s C.E. Florence Nightingale, through her work during the

Crimean War, establishes the foundation of modern nursing.

Circa 1840 C.E. Americans Crawford Long and William Morton

independently discover that ether gas can be used as a general anesthetic, allowing doctors to perform operations never possible before.

Time-line 1865 C.E.

Joseph Lister introduces antiseptic methods to surgery during a time when close to half of all surgical patients die of postoperative infection.

1898 C.E. Pierre and Marie Curie discover radium, which

becomes a powerful weapon against cancer.

1928 C.E. Sir Alexander Fleming discovers the germ-

killing power of a mold called penicillium, later isolated as penicillin, the first antibiotic.

Time-line 1950s C.E.

Jonas Salk develops the first successful polio vaccine.

1954 C.E. American surgeons transplant a kidney, the

first successful organ transplant.

1970s C.E. The World Health Organization announces

worldwide eradication of smallpox

Middle Ages (AD 800–1400)

Disease - Leprosy, Syphilis, Plague, Typhus

Privation – Pillaging, looting and sacking followed by

famine, starvation and disease leading to repeated mortality crises of 1/3rd of population

Bubonic Plague killed 75% of the population in Europe and Asia

Response - Quarantine introduced in Venice in 1403

Middle Ages (AD 800–1400)

Influence of Arabic medicine, translations and new books

Some studied abroad (scholarships) in Andalusia

There was renewed interest in medical practices of the Greek and Romans

Colleges opened

Middle Ages (AD 800–1400)

Medical Care: Self-help

- prayer, pilgrimage, charms, herbs, magic stones, holy water

Local noblemen knowledge of disease/therapy obtained by

formal education Professional healers

physician-clerics who had studied abroad Barber-surgeons

Middle Ages (AD 800–1400)

Arab physicians used chemistry to advance pharmacology

Arabs begin requiring physicians to pass examinations and obtain licenses

Renaissance (AD 1350–1650)

Dissection of the body led to an increased understanding of anatomy and physiology

Invention of the printing press allowed medical knowledge to be shared.

First anatomy book by Andreas Vesalius, was published

Renaissance (AD 1350–1650)

Healers: Quacks and Mountebanks Apothecaries Surgeons Physicians

Renaissance (AD 1350–1650)

Quacks and Mountebanks Set up in town for a few days

hen moved on Cheap remedies available to

the masses Popular with the people Attempts by corporations of

physicians and surgeons to prohibit them failed

Magistrates were aware of their popularity

Renaissance (AD 1350–1650)

Apothecaries Evolved from grocers and spicers

to supply physicians' needs to compound prescriptions

Physicians were prevented, by their code, from dispensing medications

Apothecaries were prevented from charging for giving advice although many patients sought their opinion

Became rich as a result of physicians' bizarre prescribing practices

Renaissance (AD 1350-1650)

Surgeons Decree of Pope Innocent III in

1163 discouraged monks from performing surgery

Barbers took over surgical work of monks

Familiarity with use and care of sharp, rustprone instruments

Incorporated with surgeons as a craft

Skills acquired by apprenticeship

Renaissance (AD 1350–1650)

Surgeons Wound healing Setting of fractures Amputations, embalming, removal of teeth,

treatment of skin disease, and blood letting Training by apprenticeship Converted to college/university degree in

1800's

Renaissance (AD 1350–1650)

Physicians Most prestigious of healers Distinguished by education

abroad and large fees Because of expense of

training, came from rich families

Large towns with reasonable number of rich potential patients

Management deliberately elaborate, including complicated mostly useless prescriptions

16th, 17th, and 18th Centuries

Invention of the microscope in 1666 allowed doctors to see disease-causing organisms

Apothecaries led to development of pharmacies

17th Century Circulation 1628: Harvey

Advances in physiology

The microscope 1676 (Antonie van Leeuwenhoek)

Pathologic anatomy (1682 – 1771)

Air was vital to life (1685)

Andreas Vesalius

Prior to Vesalius learning anatomy consisted of reading the texts of ancient Greek physicians

First to use hands on dissections to teach about anatomy

Instead of digging up bodies in the dark he started to be allowed to do dissections on executed criminals

Produced fantastic diagrams based on human experimentation (Galen’s drawings were from apes)

De Humani Corporis Fabrica

(On the fabric of the human body)

De Humani Corporis Fabrica

(On the fabric of the human body)

De Humani Corporis Fabrica

(On the fabric of the human body)

Ambroise Pare Pioneered many surgical

treatments and specialized in the treatment of wounds

Used a mixture including turpentine to heal wounds (cleaned the wound)

Used ligatures of arteries to reduce blood flow and slow bleeding

Ambroise Pare Used cauterization

techniques prior to amputation

Hypothesized that phantom pain after amputation arose in the brain

Revived the practice of podalic versiori to deliver babies not coming out safely

Bezoar Stone Experiment

The Bezoar stone was reputed to be able to cure the effects of any poison

Pare’s cook was caught steeling silverware

The cook agreed to be poisoned to determine if the stone in fact worked

The cook died days later proving that the Bezoar stone had no miraculous healing properties

William Harvey Described the process of blood

being pumped around the body by the heart

Discovered how valves in the veins work

Postulated that the circulatory system was closed and that the heart re-circulated throughout the body

Clashed with Galen’s concept that blood was created in the liver and that there were two types of blood

William Harvey Theorized that there are two separate

loops of the circulatory system, one to the lungs and the other to the rest of the body

Carried out dissections showing that embryos do not possess characteristics of adults

16th, 17th, and 18th Centuries

Edward Jenner developed the first vaccination to prevent the spread of smallpox in 1796

Surgery Louis XIV: Fistula Separated from barbers 1745

Child birth: male obstetricians

Industrial revolution Urbanization: overcrowding Industrial hygiene and disease of workers

18th Century

(19th Century)Modern Medicine

1840: first clear statement of living agents of disease

1842-46: Ether as an anesthetic agent

1844: nitrous oxide: pain control

1847: Chloroform anesthetic

(19th Century)Modern Medicine

1868: Thermometry

Hypodermic syringe

1886: The ampoule

With all these advances, medical

services were not available to the average individual

19th Century Formal training for nurses

led by Florence Nightingale began

Infection control methods were developed once microorganisms were associated with disease

(19th Century)Medical Education

1871 Harvard

Raised entrance requirements

Lengthened to 3 years

Better facilities for lab and clinical instruction

(19th Century)Medical Education

1893 John Hopkins

Required Bachelor's Degree

Student serve as clerks

Graduates spent several years as interns and residents

Research become dominating feature in all department

(19th Century)Medical Education

1909 – 1911 Flexner: report

Closed many schools

Raised standards

Revised curricula

Only the elite

(19th Century)

Medical ResearchOutstanding scientist in 19th Century

Liebig at Giessen 1824

Virchow in berlin 1856

Pasteur in Paris 1888

Koch in Berlin 1905

(19th Century)

Medical Research Huge sums to foster research

Quest of new knowledge

1850 US $ 74 Million

1955 US $ 261 Million

1974 US $ 4 Billion

(19th Century)

Medical Research Scientific Journals 1800 100 1900 10 000 2000 1000 000

20th Century Gained an increased knowledge

about the role of blood in the body:

ABO blood groups discovered

Determined how white blood cells protect against disease

20th Century New medicines were

developed: Insulin to treat diabetes Antibiotics to fight

infections caused by bacteria

Vaccines to prevent people from getting diseases caused by viruses

20th Century New machines were developed:

Kidney dialysis machine Heart lung machine Computerized axial tomography (CAT) scan

20th Century Surgical and diagnostic techniques

were developed to cure once fatal conditions:

Organ transplants

Limbs reattached

Test tube babies

Amniocentesis

Implanted first artificial heart

20th Century Ultrasound

CT scan

Bone scan

MRI

Operative navigation systems

3-D printing

20th Century Health care plans developed to help

pay the cost of health care

Medicare and Medicaid marked the entry of the federal government into the health care arena

HMO’s provided an alternative to private insurance

Hospice was organized

History of medicine - highlights

Plague pandemic started in 1332 in India, spread through China and Russia to Constantinople and Italy

In the middle of 14th c.- whole Asia, Europe and north Africa

…wasteland, extinct cities, corps lying around, with no one to bury them

History of medicine - highlights

“black death" most prominent in Dalmatia (Split, Zadar, Dubrovnik)

In Dubrovnik in 1377 – first quarantine in the world – 40 days of isolation and observation prior to unloading the cargo and people

Hadith shareef:

History of medicine - highlights

Girolamo Fracastoro – theory about invisible germs that spread and cause diseases

Through direct contact, via objects, ability to spread far from the source

Refutes Galen’s "miasm theory” (poisonous air and fumes)

Girolamo Fracastoro "De contagione et contagiosis

morbis“ in 1543 – claims that germs multiply, are poisonous, could be destroyed by fire

Recommends regular body hygene, clean environment, water and food sanitation, disinfection

History of medicine - highlights

Microscope discovery

Antony van Leeuwenhoek in 1670 Analyzed blood, saliva, bones, muscles,

human eye lens, ect. Achieved magnification up to 40-160 times,

later up to 270 times

History of medicine - highlights

In 18th c. doctor from Slovenia Marko Anton Plenčić supports the theory about small living creatures which cause communicable diseases

He hypothesized that different creature causes different, specific disease

History of medicine - highlights

At the end of 18th c. British doctor Edward Jenner noticed that women who milk cows often get cow pox (much more benign than smallpox) and never get smallpox, as a consequence

Edward Jenner After 20 years of observation –

experiment on 8yrs old boy James Phipps

Jenner took the pus from the hand of a women with cow pox and applied it to the boy – after 6 weeks the boy was exposed to smallpox – didn’t get smallpox

Published a book about vaccination in 1798 (vacca=cow)

History of medicine - highlights

Only in 19th century bacteria have been discovered

Pollender discovered one of the largest bacteria - anthrax in the blood of dead animals

History of medicine - highlights

Louis Pasteur – foundations for modern theory about causes of communicable diseases discovered yeasts introduced pasteurization for wine and milk Noticed how anthrax culture loses virulence –

when applied to healthy animal it didn’t cause the disease

Created vaccine to immnunize rams against anthrax

In 1881. discovered streptococcus and staphylococcus bacteria

Louis Pasteur In 1885 L. Pasteur introduced

vaccination agains rabies

Dried spinal cord from dogs died of rabies Pasteur applied for 9yrs old boy Joseph Meistera, who was bitten by a rabid dog – the boy was saved

Countless lives were saved all over the world

History of medicine - highlights

During 19th c. in England – great cholera epidemic

John Snow – a doctor perticulary interested in this epidemics in 1854 creates hypothesis that cholera was transmitted via water

History of medicine - highlights

1882 Robert Koch discovered M. tuberculosis

1890 discovered tuberculin, first considered cure, later became diagnostic tool

Tuberculosis was a pandemic at the end of 19th c. due to poor social and economic conditions

History of medicine - highlights

At the end of 19th c. Koch and Pasteur formed new discipline – Microbiology

History of medicine - highlights

Beginning of 20th c. – discovery of viruses

1908 - Karl Landsteiner - poliomyelitis virus

1912 - Wilhelm Grueter – herpes virus

History of medicine - highlights

In 1907 Paul Erlich introduced chemotherapy (chemicals that selectively destroy microorganisms, without causing damage to the host)

1923 – systematic prophylactic BCG vaccine

History of medicine - highlights

1928 Alexander Fleming accidental finding that the presence of molds blocked coccus culture growth

Penicillium notatum - penicillin

History of medicine - highlights

Only from 1940s penicillin was applied during WWII against coccus bacteria, C. diphtheriae, anthrax, tetanus

Over following years – discoveries of other antibiotics, most important was streptomycin (Selman A. Waksman – coined term antibiotic)

Top achievements in medicine?

http://science.discovery.com/convergence/100discoveries/big100/medicine.html

http://www.healthfiend.com/weeklytop/top-10-greatest-medical-discoveries-of-all-time/

Jon Queijo: Breakthrough!: How the 10 Greatest Discoveries in Medicine Saved Millions and

Changed Our View of the World

Chapter 1. The World’s First Physician: Hippocrates and the Discovery of Medicine

Chapter 2. How Cholera Saved Civilization: The Discovery of Sanitation

Chapter 3. Invisible Invaders: The Discovery of Germs and How They Cause Disease

Chapter 4. For the Relief of Unbearable Pain: The Discovery of Anesthesia

Chapter 5. I’m Looking Through You: The Discovery of X-Rays

Chapter 6. The Scratch that Saved a Million Lives: The Discovery of Vaccines

Chapter 7. From Ancient Molds to Modern Miracles: The Discovery of Antibiotics

Chapter 8. Breaking God’s Code: The Discovery of Heredity, Genetics, and DNA

Chapter 9. Medicines for the Mind: The Discovery of Drugs for Madness, Sadness, and Fear

Chapter 10. A Return to Tradition: The Rediscovery of Alternative Medicine

Landmark AdvancesYear Landmark Inventor

C. 1280 Spectacles ?

1540 Artificial limb Ambrose Pare

1714 Mercury Thermometer Gabriel Fahrenheit

17715 Bifocal lenses Benjamin Franklin

1792 Ambulance Jean Dominique Larrey

1796 Vaccination Edward Jenner

1816 Stethoscope Theophile Laennec

1817 Dental Plate Antony Plantson

Running Press Cyclopedia,

Landmark AdvancesYear Landmark Inventor

1827 Endoscope Pierre Segalas

1846 Anesthetics William Morton

1851 Ophthalmoscope Hermann von Helmholtz

1853 Hypodermic syringe Alexander Wood

1865 Antiseptic Joseph Lister

18815 Rabies Vaccination Louis Pasteur

1867 Contact lenses Adolf Fick

1895 X-ray Wilhelm Rontgen

Running Press Cyclopedia,

Landmark AdvancesYear Landmark Inventor

1903 Electrocardiography William Einthoven

1928 Antibiotics Alexander Fleming

1957 Pacemaker Clarence W Lillehie and Earl Bakken

1967 Heart transplant Christiaan Bernard

1973 CAT scan Godfrey Hounsfield and Allan Cormack

1979 Ultrasound scan Ian Donald

1982 Artificial Heart Robert Jarvik

Running Press Cyclopedia,

http://www.kaahe.org/health/ar/class/173-- - المسلمين- األطباء أعالمhtml.والعرب

http://www.nytimes.com/interactive/2012/10/05/health/digital-doctor.html?ref=thedigitaldoctor&_r=0#/#time15_375

http://en.wikipedia.org/wiki/Timeline_of_medicine_and_medical_technology Detailed timeline from 2600 BC to 2013 AC

http://www.historylearningsite.co.uk/history_of_medicine.htm

Look for Arabic / Muslim

Medicine

Chinese Medicine

Egyptian Medicine

Greek Medicine

Native American Medicine

Old Indian Medicine

Roman Medicine

Prehistoric Medicine

Medicine in the Middle Ages

Eastern Medicine

Nobel prize winners in Medicine

Look for History of herbalism

History of hospitals

History of medicine Canada, USA, UK, Europe,

History of nursing

History of pathology

History of pharmacy

History of surgery

History of Virology

History of Microbiology

History of Epidemiology

History of Nursing

History of Psychiatry (Medicine of the mind)

Thomas Clifford Allbutt History of medicine[134]

Timeline of nursing history

Timeline of medicine and medical technology

Milestones in history of medicine

Major developments in medicine

Men of MedicinePeriod Name Discovery –

Famous for

Hippocrates Father of Medicine

Galen

850- Rhazes الرازي

Ali Ben el-Abbas بن عليالعباس

Albucasis Zahrawi القاسم آبوالزهراوي

980-1037 Avicenna سينا ابن

Ibn Nafis النفيس ابن

AVENZOAR / Ibn-Zohr ابنزهر

Averroës (Ibn Rushd) ابنرشد

1188 – 1248

Ibn al-Baitar البيطار ابن

Men of MedicinePeriod Name Discovery – Famous

for

1493-1541

Parcelsus

1514-1564

Andreas Versalius

1510-1590

Ambroise Pare

1578-1657

William Harvey

1632-1723

Antoni van Leeuwenhoek

1716-1794 James Lind Scurvy cured by Vit C

1749-1823 Edwaed Jenner

1778-1829 Sir Humphry Davy Nitrous Oxide anesthesia

1811-1870 Sir James Young Simpson

Chloroform anesthesia

1819-1868 William Thomas Green Glass inhaler - Ether

1802-1887 JEAN boussingault Iodine cures goiter

Men of MedicinePeriod Name Discovery – Famous

for

1813-1858§

John Snow Father of public health

1858-1930

Christian Ejikman Beriberi cured by brown rice

1816 Rene - Theophile - Hyacinthe

The stethoscope

Ignaz Phillipp Semmelweiss

Childbed fever spread by doctors

1827-1912

Joseph Lister Aseptic surgery

Robert Koch Bacteria caused disease

1822-1895

Louis Pasteur Bacteriology / Vaccination / Pasteurization

1881-1955

Alexander Fleming Penicillin

1904-1950

Richard Drew Blood transfusion / banks

1922-2001

Christian Barnard First heart transplant 1967

Men of MedicinePeriod Name Discovery – Famous

for

James Watson / Francis Crick

Discovered DNA

William Kolf Artificial Kidney machine

Wilheim Rontgen X-ray in 1895

Techniques & Procedures

Abortion

Acupuncture

African traditional Medicine

Alchemy

Ambulance

Amniocentesis

Amputation

Amulets and talismans

Anesthesia

Angioplasty

Animal/human transplants

Antibiotics

Antidepressants

Antimalarial drugs

Artificial eye

Aspirin

Autopsy

Ayurveda

Techniques & Procedures

BCG vaccine

Biopsy

Blood Groups and transfusion

Blood pressure

Bloodletting

Bone setters

Breast implant

Breathalyzer

Burns – treatment skin graft

Cancer / anti-cancer

Chemotherapy

Chloroform

Clinical trials

Contact lens

Corneal transplant

Cortisone

CT / CAT scan

Cupping

Techniques & Procedures

Defibrillator

Diet

Dissection

DNA structure

ECG

EEG

Electroconvulsive Therapy

Electrotherapy

Electron microscopy

Endoscope

Genetic testing

Genes and human genome

Germs and germ theory

Gloves, gowns

Hearing aid

Heart-Lung Machine

HeLa Cells

Herbal medicine

Hippocratic medicine

Hippocratic oath

Homeopathy

Techniques & Procedures

Hormones

Hospitals

Hydrotherapy

Hygiene

Hygienic products

Hypodermic syringe

Incubators

Intravenous infusion

In-Vetro Fertilization (IVF)

Informed consent

Inhalers

inoculation

Insecticides

Insulin

Techniques & Procedures

Intrauterine device IUD

Iron lung (Respirators)

Kampo (Japanese medicine)

Kidney dialysis

Kidney transplant

Laser in medicine

Leech tharapy

Liver transplant

Lung transplantMagic bullets

Massage

Meat inspection

Mechanical ventilators

Medical education

Miasma theory

Techniques & Procedures

Microscope

Military hospitals

MRI

Neurosurgery

Nuremburg code and trials

Nursing

Ophthalmoscope

Oral contraceptive pill

Ophthalmoscope

Orthopedic surgery

Osteopathy

Pacemaker

Palpation

Patients' records

Techniques & Procedures

PCR

Percussion and palpation

Plaster of Paris

Penicillin

PET scan

Physiotherapy

Pregnancy tests

Pulse measurement

Randomized controlled trials

Radio-isotope scan

Renal Dialysis

Rhinoplasty

Robotic surgery

Sterilization

Techniques & Procedures

Speculum

Stem cells

Stethoscope

Surgical instruments

Surgery

Thermometer

Thermal ablation

Tissue culture

Traditional medicine

Trephination

Triage

Ultrasound

Scurvy

Syphilis

Techniques & Procedures

Vaccination

Vivisection

War surgery

Wet-nursing and milk banks

wheelchair

Wu Xing

X-rays

Yin and Yang

العربي التجبير

الشعبي الطب

History of Diseases Allergy

Alzheimer’s disease

Appendectomy

ARDS

Asthma

Bladder stone Beriberi

Botulism

Brain surgery

Carcinogens

Cholera

Cochlear implant

Cataract

Cholera

Diabetes

History of Diseases Diphtheria

DVT

Epilepsy

Food poisoning

Gallstones

Gangrene

Goiter

Gout

Hearing aid

Heart valve replacement

Heart failure

Heat stroke

Hepatitis

Hernia

History of Diseases Herpes

Hypertension

Internal fixation of fractures

Jaundice

Joint replacement

Kyphosis

Leprosy

Malaria

MERS (Corona)

Meningitis

MRSA

Open heart surgery

Plague

Pleurisy

History of Diseases Poliomyelitis

Puerperal fever

Rabies

Rickets

Surgery

Swine flue (H1N1)

Tetanus

Thyroid disease

Tonsillectomy

Trachoma

Tuberculosis

Thalidomide

Typhus

Urethral stones and strictures

http://thequeenstable.blogspot.com/

Medical Students 140 yrs ago

No one worried about admissions entrance requirements were lower than they

are for a good high school student

Instruction was superficial and brief

The terms lasted only 16 weeks, and after the second term the M.D. was automatically given, regardless of a student’s academic performance

Medical Milestones

MEDICAL MILESTONES | BMJ | jANUARY 2007 | volume334

Medical Milestones

MEDICAL MILESTONES | BMJ | jANUARY 2007 | volume334