By George Sarka MD,MPH,FACP,FACR DrPH Candidate in Public Health at UCLA Assistant Clinical Professor in Medicine at UCLA Governor-Elect of the ACP Southern CA, Region 2 President of the LA Neurological Society President of LA County Medical Association-District 1 Staff Neurologist at SMMC Staff Rheumatologist at CSMC Staff Physician at the Klotz SHC at CSUN Medical Historian and Medical Lecturer Diplomate in Internal Medicine, Rheumatology, Neurology, Headache Medicine, Sports Medicine, Geriatrics and Emergency Medicine
In September 1940, four teenagers around the northern slopes of France’s Pyrenees mountains stumbled upon one of the most famous and astounding repositories of Paleolithic art in the world: the cave of Lascaux
Sir William Osler tells us that Imhotep was the:
"..first figure of a physician to stand out clearly from the mists of antiquity." Imhotep diagnosed and treated over 200 diseases, 15 diseases of the abdomen, 11 of the bladder, 10 of the rectum, 29 of the eyes, and 18 of the skin, hair, nails and tongue. Imhotep treated tuberculosis, gallstones, appendicitis, gout and arthritis. He also performed surgery and practiced some dentistry. Imhotep extracted medicine from plants. He also knew the position and function of the vital organs and circulation of the blood system. The Encyclopedia Britannica says, "The evidence afforded by Egyptian and Greek texts support the view that Imhotep's reputation was very respected in early times. His prestige increased with the lapse of centuries and his temples in Greek times were the centers of medical teachings."
Hippocrates is know as the “Father of Medicine.” He is considered one of the greatest physicians the world has ever known.
He was the first to attempt to separate the practice of medicine from religion and superstition.
Hippocrates developed his pledge of proper conduct for doctors. “I will use treatment to help the sick according to my ability and judgment, but never with the view to injury and wrong doing…Into whatsoever houses I enter, I will enter to help the sick.”
“ For if one knows all these things well, or at least the greater part of them, he cannot miss knowing, when he comes into a strange city, either the diseases peculiar to the place, or the particular nature of common diseases, so that he will not be in doubt as to the treatment of the diseases, or commit mistakes, as is likely to be the case provided one had not previously considered these matters. And in particular, as the season and the year advances, he can tell what epidemic diseases will attack the city, either in summer or in winter, and what each individual will be in danger of experiencing from the change of regimen.
Hippocrates also made changes in how physicians looked upon their profession.
During his time, a doctor was sometimes bribed to see that a patient died, or asked to prepare poison to kill an enemy. If a ruler wanted to rid himself of a rival, he could hire a court physician who would see that the rival became sick and died.
Hippocrates taught against such improper conduct. He told his students to treat everyone the same.
“ Sometimes give your services for nothing…for where there is love of man, there is also love of medicine.”
Galen believed that disease resulted from an imbalance of the vital fluids, or humors, of the body. This idea was developed by Hippocrates, and consolidated by Galen.
“ The body has in itself blood, phlegm, yellow bile, and black bile…We enjoy the most perfect health when these elements are in the right proportion.”
The medicine and pathology Galen practiced, and about which he wrote, were based mainly on speculative Hippocratic theories of the 4 humors, on critical days, and on fallacious theories regarding pulse and urine.
Developed out of the humoral theory of Empedocles(500 to 430B.C.), the Scilian philosopher.
Developed by Hippocrates and consolidated by Galen.
From the 4 elements: earth, air, fire and water derived the idea of the 4 humours(or fluids) of black bile, yellow bile, blood and phlegm with their associated meancholic, choleric, sanguine and phlegmatic temperments.
It was believed that the balance of these humours in the body determined physical states of health.
Medieval people seemed to have suffered much from TB but most probably had the glandular form scrofula.
In England and France, it was believed that royalty had the power to cure the affliction by touching the sufferers, and from the 12 th to the 18 th century, ‘the king’s/queen’s touch” was regularly used against this condition.
The king touched the victim and often also a gold coin - usually an Angel, showing the Archangel Michael killing the dragon - that was then worn around the victim's neck, and the person promptly recovered.
Occurred around 1050 in the region of Salerno, southern Italy where this thriving medical community was in touch with the Greek and Arab worlds as well as the wealthiest and intellectually most advanced abbey of Europe, Monte Cassino.
In 1080, the Salernitan masters reintroduced theoretical speculation into medical teaching.
From 1200, Latin translations of some Arabic texts by Constantine the African, re-established Galenic academic learning, combining commentary on a few set texts with philosophical discussion of wider issues.
By 1250, practical demonstrations of animal anatomy was introduced.
The Three Consequences of Translation Movement
1.The amount of learned medical material suddenly burgeoned beyond all recognition
2.The language of medicine was heavily arabized and its therapeutics depended heavily on Arabic sources, especially in pharmacology/surgery.
3.Now, there was a heavy philosophical component, based on Aristotle ( natural philosophy ) in the new medicine.
Professional associations of medical teachers, as at Salerno, joined universities only when they saw the advantages of the new institutions’ ability to secure their own rights and privileges in law and theology, and many universities, especially in France, never had a medical faculty.
The old-style physician had almost no diagnostic technology nor did he conduct a full, hands-on physical exam. Rather, he worked on the basis of his senses: sight, touch (of the wrist for the pulse), hearing, smell and taste (sampling urine for the sweetness symptomatic for DM.
Elaborate diagnostic charts exist, correlating these indications with various maladies.
Even in the written literature of William Shakespeare does the above exist: “ Sirrah, you giant, what says the doctor to my water?...He said, sir, the water itself was a good healthy water; but for the party that owned it he might have more diseases than he knew for.” from Henry IV. Uroscopy
The "humors" theory of the body was centered on "vital spirits" moving from the heart; they regulated the balance of the four humors and could be disturbed by the spiritual intervention of the devil. Once Harvey’s notion that the heart was just a muscular pump moving blood around the body became prevalent, explanations in terms of demonic spirits no longer convinced .
Jenner was ridiculed and resented by his fellow doctors.
This cartoon makes fun of Jenner’s inoculations. In a crowded room, Jenner prepares to vaccinate a young woman sitting in a chair. The scene about them is mayhem as several former patients demonstrate the effects of the vaccine with cows sprouting from various parts of their bodies.
Jenner discovered that having cowpox protected a person against smallpox.
Jenner’s cowpox serum saved many lives, and almost eliminated the disease of smallpox.
His discovery of vaccination is considered one of the most important discoveries in medicine.
Jenner nor any other doctor knew the cause of infectious diseases or why vaccination worked.
The Birth of Anesthesia A nineteenth-century physician administering chloroform prior to surgery. Ether was one of the earliest anesthetics to be used but it was difficult to administer as it usually made the patient choke.
Rene-Theophile-Hyacinthe Laennec and the stethoscope
“ In 1816 I was consulted by a young woman presenting general symptoms of disease of the heart. Owing to her stoutness little information could be gathered by application of the hand and percussion…I recalled a well-known acoutic phenomenon:namely, if you place your ear against one end of a wooden beam the scratch of a pin at the other extremity is distinctly audible. It occurred to me that this physical property might serve a useful…
Rene-Theophile-Hyacinthe Laennec and the stethoscope
This physical property might serve a useful purpose in the case with which I was then dealing. Taking a sheet of paper I rolled it into a very tight roll, one end of which I place on the precordial region, whilst I put my ear to the other. I was both surprised and gratified at being able to hear the beating of the heart with much greater clearness and distinctness that I hever before by direct application of my ear.”
Rene Laennec, who invented the first stethoscope, commented that "no patient report could suffice to characterize disease, and that for a certain diagnosis, mediate auscultation is required."
Poisons in the atmosphere emanating from cesspits and rotting material caused illness.
In 1840, the German pathologist Jakob Henle(1809-1885) published his essay: “On miasmata and contaia,” in which he tried to show that tiny living creatures in the human body caused infectious diseases.
The idea of “germs” began to challenge the prevailing theory were caused by “miasmata.”
The above was supported by the work of Frechman Louis Pasteur and the British surgeon Joseph Lister.
The concept had it origins in Biblical rules on health and hygiene as well as in great architectural works such as the building of the aqueducts to supply fresh water to Rome and the removal of waste by means of the great drain, the cloaca maxima .
Principles regarding safe diets and person hygiene were taught by the great religions. These were reinforced by later miasmatic notions. Evil smells do indicate poor sanitation and their removal reduces sources of infection.
John Snow(1813-1858), the Father of Public Health
Effectively brought an end to the 1854 epidemic in Soho, London by demonstrating only those who drank from the infected Broad Street pump contracted the disease.
Many were privately owned, operated for profit and without university affiliation.
Physicians often had little to offer their patients other than sympathy and tender care for ailments they lacked the means to cure.
The medical profession was held in low regard by the general public.
The Birth of Johns Hopkins University and Medical School
At Hopkins, a new era of American medicine was born, with rigorous admission requirements and a quality of training that set new standards in the United States and compared favorably with the venerable European institutions.
At Johns Hopkins University and Medical School
Candidates for admission to Hopkins were required to have a four-year college degree, including two years of premedical training in biology, chemistry and physics, and a reading knowledge of French and German.