A Brief History Of Medicine Part 4 Renaissance to early 1900’s

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

The Renaissance

Time Period 1300 AD to 1600 AD “Re-birth” of knowledge

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".

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.

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.

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.

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.

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

Microscope Used for Science Antonie van Leeuwenhoek , 1670’s Dutch scientist Improved microscope* with smaller, superior lenses *Actually “invented” in 1590 by Zacharius Jannssen.

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

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

Treatment Changed Little Despite changes in knowledge, the major treatments were still Bleed Blister Purge Avoid sickness

Who’s 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

Beginnings of Modern Medicine

Time Period 1700’s to 1900’s

Hospitals in the 1700’s & 1800’s Hospitals were often unsanitary People were mixed in large rooms regardless of their disease They were a “last resort” when all else failed.

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 !!

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 Guy’s Hospital had three sets of blood types on them - dried and stained into the wooden handles of the instruments.

William Morton, 1846 American Dentist Used ether as an anesthetic to put the patient to sleep before surgery

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.

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

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

Smallpox Known since 10,000 BC Smallpox affected all levels of society. In the 1700’s 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

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

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 (1689–1762).

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

Edward Jenner’s 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 Jenner’s Original Report

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.

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

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.

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.

Snow’s 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

Louis Pasteur & Germ Theory French chemist & professor 1822-1895 Started studying fermentation in beer and wine Discovered that microorganisms were causing wine to spoil

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.

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

Science of Immunology Begins Showed that certain diseases could be prevented by vaccination Rabies Chicken cholera Anthrax Silkworm disease

Pasteur’s 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

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.

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.

Antiseptics British surgeon Joseph Lister in 1865 proved the principles of antisepsis in the treatment of wounds. Lister’s death rate dropped to 15% Few doctors followed this advice until a less annoying system was invented. Spray contraption

Robert Koch German scientist 1843-1910 Development of Koch's postulates to prove which germ caused which disease. http://www.abpischools.org.uk/res/coResourceImport/resources04/history/index-2.cfm

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

Koch’s 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

Koch’s 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

Major Accomplishments It was in the late 1800’s 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.

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

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.

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

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.