Essay: The advancement of medicine

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The start of medicine is hazy, cave drawings and other historical artifacts show ancient civilizations having a wise elder which people consulted for medical advice. There were various traditions, some effective but mainly most were based around spells curses spirits demons and other supernatural creatures. Around the 11th century the Islamic world had made a significant contribution to the betterment of medicine, Europe adding to that in the 16 century. In Europe the renaissance led to the rise of organized observation recording experimentation analysis and evidence based research. More recently over the last 2 centuries we have seen more momentous advances such as the germ theory, antibiotics, vaccinations, improved diet and hygiene and more importantly scientific backed evidence for remedies and causes of disease. Never has been going to a doctor and seeking medical advice been so trusted and normal. People are not only healthier and living longer, but they’re aware of the reasons for this. Medical advancements have led to the advancement of human life and to this I dedicate my EPQ to those people who’ve improved our lives and the tremendous innovations that have saved more lives than those of any era since the dawn of medicine.

Humans and diseases:

In the beginning of time as humans colonized the globe they were colonized by pathogens themselves. Through research these could’ve been anything from fleas, ticks, helminths and arthropods, to other microorganisms such as bacteria and parasites1. Bacteria and parasites especially proved lethal due to the fact they had very fast reproduction rates. They produced severe illnesses in their hosts which almost always lead to death due to people being uneducated and unaware. Those who did survive were few and were of course very special as they were able to pass on their immunity. As you can see at the start the only medicine people had was their own immune system. If you had the gene to survive you survived, otherwise you perished with the rest. These microscopic enemies have become our main threat to existence as we have to co exist with them.

Although The advancement of human life brought agriculture which on the positive side brought a prevention to the threat of starvation it also gave us with a variety of fresh and dangerous infectious diseases. Pathogens which were once exclusive to animals now had new targets in humans. Animal diseases leapt through the species gap and turned into human ones (). This is why now humans share a plethora of diseases with a variety of other species.

Tuberculosis, smallpox and other small viruses were introduced to the human pathogen pool by cattle. Influenza came from pigs and ducks while the common cold and rhinoviruses came from horses and donkeys. Measles jumped from dogs to humans. Worms caused other problems too. The parasitic worm ‘ascaris’ took residence in humans and brought about diarrhoea and malnutrition. Others were responsible for tropical elephantiasis and river blindness. The agricultural environment didn’t help. People weren’t aware how clean they had to be and the faecally polluted water that people drank gave out disease such as polio, cholera, typhoid, hepatitis, whooping cough and diphtheria. Add to that agriculture led to people relying on starchy food low in nutrients which led them to be stunted which in turn made them more prone to diseases like marasmus, kwashiorkor, scurvy and other deficiency diseases.

Many centuries later trade, war and conquest came about and so did new diseases. As people came from one place to another they brought with them pathogens of new diseases. The epidemic in the Caribbean of swine influenza, measles, typhus and smallpox came from ships of the traveller Christopher Columbus and his crew and his animals. The locals had no immunity to the new diseases and so thousands died. In return the crew took back home with them new viruses and diseases such as syphilis. The slave trade also brought new diseases into Europe. The slaves brought along with them illnesses such as malaria and yellow fever. The worldwide epidemic of cholera in nineteenth century is another prime example. Started from Asia mainly through India, it moved to Europe and Africa fast even reaching as far as Russia. It killed millions of people to the extent that family stayed far away from each other. It is a very painful disease making the victim have extreme acute nausea and excessive vomiting and diarrhoea. Nearer to the last stage the victim will have extreme cramps and his stool will turn into a grey liquid with pieces of his gut. As awful as this sounds the ‘Spanish flu’ overtakes cholera as the worst worldwide epidemic killing over 60 million people in just under 2 years.

Only recently have people started to not fear disease, or in fact they fear many much less, people know they have a chance of surviving. In the past more than half the babies wouldn’t be born, those who were born a minority would pass infancy due to their weak immune systems, many mothers would die due to childbirth and the life expectancy was low as 30 years old in some places. Next we will look in more detail at the many diseases, how they were found and how people fought them in the past.

Earlier healers and herbalists:

Preserved evidence in fossilized Neanderthal (our closest cousins who are now extinct) teeth shows that the history of medicine may stretch back more than 50,000 years ago, while modern anthropology reveals that many cultures weave ideas about health into their belief systems- believing in an invisible world of benign spirits, feared demons, lost souls, magic and discovery just like past tribes (). Every year there are new discoveries which show that historic medicine could’ve been more advanced than first thought. For example, evidence shows that clay was smeared onto a broken limb till it dried in order for it to act as a supporting cast. Other examples include plants such as Orchid Ulbs being eat to solve digestive problems or willow bark- natural source of aspirin- was chewed for pain relief.

Otzi the iceman was a 5,300-year-old male found in Europe, 1991. He gave us many clues on how healing was at his time. With hi he had some tools like an axe and sword and what was thought to be a simple first aid kit. He was also found to have bracket fungus which is known for its laxative and antibiotic features (find source online).

Early healers were any individual who has supernatural powers and communicate with the spirit world. They were commonly known as shaman or healer in the community. The person would do some sort of ceremony with singing, dancing, fire and potions so they could contact the spirits for them to gain insight why the person is sick and what needs to be done.
Modern analysis shows some of these potions contained herbs which had mind-altering or hallucinogenic chemicals (). Shamans were often found in Africa and the Americas.

Early surgery:

Trepanning was a common practice in ancient Egypt, Greece, Rome, India and China. There’s evidence of its origins in Kashmir, India from a 4,000-year-old skull with holes from trepanning. The procedure involves making holes normally at the top of ones’ head to access the brain. Patients weren’t usually anaesthetised although some were heavily intoxicated by alcohol. The procedure started by cutting and folding back the skin to reveal the skull, then drilling into the skull to reveal the interior. This way let the doctors able to put the skin back together afterwards. Though one would expect that the patient would die from the pain many survived and there were often signs of healing. Trepanning was commonly used after a person had received a head injury due to battle. In medieval Europe it was used to treat mental illnesses which were linked to evil demons. The holes were there to let out the demon. The practice faded away around the 18th century as specialised treatment came about.

Medicine in ancient Egypt:

Healing in ancient Egypt was part of their religion. Their doctor’s treatments were usually focused on spells, magic and praying to their gods. Their idea of health was due to ‘channels’ in the body which had to be unrestricted as not to block the ‘flow’ of health. They had limited knowledge of anatomy as usually their surgical procedures were often on the outside only and rarely did they ever open up the body except after death for mummification. Much knowledge of ancient Egypt is based on papyri which is thousands of years old and very limited hence we don’t have that much reliable information.

Medicine in early china:

Most people don’t realise that William Harvey wasn’t even the first European to introduce the idea of blood circulation. In actual fact the Chinese had discovered the concept two thousand years prior to his published discovery in 1628. Before Harvey European physicians such as Realdo Colombo and Giordano Bruno had introduced the idea to Europe after reading the works of an Arab physician Al-Nafis. However, in china there is detailed evidence to prove that the concept had originated from there.in early china the Chinese had accepted the idea that the body had a ‘biology clock’, a concept which a doctor in the 1960’s would be risking his career for. They had come to this conclusion after concluding experiments in which they removed blood vessels from corpses and measuring the total distance travelled by the blood. From this they were able to calculate a partially inaccurate value of how often the blood circulated. This led them to observing different kinds of patients at different times of the day and seeing the deviation of their symptoms. Now due to extensive research scientists have found their concept of the body having a ‘biology clock’ being true and that for different disease the severity of their symptoms changes according to the time of the day. For example, towards the evening fevers and body temperatures increase. The Chinese had even founded the science of endocrinology. Endocrinology is The branch of physiology and medicine concerned with endocrine glands and hormones (https://en.oxforddictionaries.com/definition/endocrinology). During the 2nd century they were separating hormones from human urine to obtain the crystals and to use them for medical purposes. S. ascheim and B. zondek in 1927 published their findings that pregnant women’s urine was populated with steroid sex hormones. And now the fertility drugs given to woman so their body can make more eggs are produced by extracting urine from special nuns in Italy. Extracting sex hormones out of urine is a very common practice today and is extremely beneficial and crucial to many treatments. Due to hindsight we can see that the crystals the Chinese got were nit as pure as they should’ve been, they were still full of the needed hormones and would’ve worked fine, providing the biological effects needed. Another impressive discovery made by the Chinese was how they used to use soap to precipitate the hormones out of solution. Only in 1909 did Adolf Windaus realise that natural soaps could be used to precipitate.

The Chinese were also aware of deficiency diseases such as scurvy, beriberi and rickets centuries before the west. This goes back to the Chinese view of balance in life and so balance in diet. A very prominent author on the matter, Hu Ssu-Hui, had wrote a book called ‘The principles of correct diet’ (1330). In his book he says to take “half a pound of small beans, two-tenths of an ounce of ch’eng fruit skin and the same amount for small dried peppers and dried grass seed” as a remedy for beriberi, a deficiency disease due to lack of vitamin B. all of the the items n his remedy are now known to have a good supply of vitamin B, meaning he knew what he was giving to his patients.

Before 643 AD the Chinese were aware of how to use the thyroid hormone. The expertly figured out that they could use the hormone to treat goiter – swelling of the neck due to the thyroid gland becoming bigger. The first account of this is in a Chinese physicians book, Chen Chu’uan’s ‘Old and new tried and tested prescriptions’. In it he had given 3 different uses of the hormone taken from the thyroid glands of a ram. One of these prescriptions he instructs the physician to treat the patient by removing a thyroid gland from a sheep and taking the fat off it thereafter giving the gland raw to the patient to put it into his/her mouth for it to be sucked of its juices completely then to finish by eating the remains. Only in 1860 hundreds of years later did the scientist Murray and his colleagues prove that giving thyroid extracts to patients helped them get better.

Medicine in ancient Greece:

Just like in ancient Egypt a lot of medicine in ancient Greece was based around religion, their belief in the world of spirits and the supernatural. People thought disease was either punishment from god or as a test sent to them to improve their piety. Cures involved prayers, offerings and rituals. The Greek god of medicine Asclepius had special temples made for him called asclepeions where people came to their rituals etc. physicians and philosophers like Plato, Socrates and Aristotle had a major impact on the advancement of Greek medicine in their separate lives. Another important figure was Herophilus of Chalcedon who worked in Egypt. Their he studied the human body through dissection and is regarded by many as the first true anatomist. This comes from the fact his drawings of the eyes, nerves, veins, arteries, brain and digestive organs are thought to be the first accurate ones. He is also believed to be the first person who came up with the idea that intellect and thoughts didn’t come from the heart and actually came from the brain, a concept very controversial for his time.

A medical system which thrived till the 18th century was the concept of humorism. This originally came from Greece. It was based around four humours or body fluids of the human body. They were blood, yellow bile, black bile and phlegm. The concept was that if a person was ill then it was due to unbalance of one or more of the four humours. The concept also aligned perfectly with the four elements of the earth – air, fire, earth and water and the four seasons meaning that the humours being unbalanced could be linked to the seasons or an unbalance of one of the elements. Herbs or diets which were eccentric were used as remedies to restore the balance of the humours. Other methods include cupping or drinking potions to let out extra yellow or black bile and blood letting to get rid of extra unhealthy blood. During the 18th century with all the scientific research and the new understanding of the body the concept was quickly put to bed.

Hippocrates:

Considered by the majority as the godfather of modern medicine. The Hippocratic oath written by him is still used to this day. The oath set by him turned medicine into a profession respected by people. The doctors taking this oath and trained by him were respected worldwide and he quickly became the greatest teacher of his time. He took Greek medicine to the next level. He got rid of the supernatural concept people had focusing on providing evidence for the causes o disease and why their remedies worked. He was known for telling his students “sickness is not sent by the gods, find the cause and you will find the cure”. He made sure to put the doctor at serve the patient and not the opposite. He changed the course of medicine for the rest of time.

Medicine in ancient Rome:

After the rise of the powerful roman empire many Greek physicians started practising medicine in Rome. You could say the roman medicine was based largely on Hippocratic and Greek traditions. One of their most important contributions is the fact they were used to recording their observations and preserving them. The romans were also one of the first to introduce clean drinking water and organized sanitations as measure of public health services in their villages and cities. They were keen on spreading awareness of a healthy lifestyle, diet and cleanliness. They also believed in religion and so thought that disease was a punishment from god, so prayers and offerings were part of treatment. On the other hand, they weren’t as far as the ancient Egyptians and Greeks in the sense that physician would ascribe treatments such as changing diet and lifestyle as well as the religious part. As an empire founded on battle, the romans would pay special attention to surgery. They had created special equipment for battle wounds. They made various catheter tubes to remove stones in the bladder which have been used to model present equipment. They crafted different kinds of prostheses for different body parts once again which have been used to model present day ones. One of their finest inventions include the purpose-built mobile hospitals which they used to move along with them to their battles. Something which was copied by the other armies at the time, something which is now a normal part of modern day armies.

Galen:

Another physician who was considered to be as vital to the field, Claudius Galen. A physician who wrote hundreds of books on the different subjects many of them who were used as manual for more than a thousand years after his death. His main success and interests lay in anatomy. He made many discoveries with the majority being accurate. He correctly identified the kidneys job in producing urine. He was able to identify many muscles and tendons. On top of that he was able to advance the concept of the four humours. His work was referred to all the way till the late eighteen hundred.

The golden age of Islamic medicine:

As the roman empire was broken down completely and entered its dark ages the Islamic world saw a massive rise in scientists and inventions. This was the Islamic regions ‘golden age’. Like the romans the Muslims believed that disease could’ve been a punishment or trial from god, however their treatments were based on prayers as well as treating the illness through diagnosis, prescriptions and surgery. The Muslims built their knowledge and progress from the work of the past, especially that of Hippocrates and Galen. A famous scholar Al-Razi whose writings and teachings were used for centuries after him revived the Hippocratic approach to medicine making sure that the doctor put the patients needs first and introducing the fact that no patient is more important than another whether rich, poor, black or white, morals which are prominent in modern medicine. He was also adamant to teach his students to investigate disease not to cure but to prevent, this being a new concept at the time. Another great of his time was Al-Zahrawi, the father of surgery. He had given the world the first illustrations of over 200 surgical instruments and instructions how to use them. Add to that he created new surgical techniques some of which are still used to this day. In the 13th century producing a ground-breaking encyclopaedia on herbalism which was to be used as the go to text for centuries later was the teacher Ibn Al-baytar. Inside he had hundreds of herb-based remedies many of which were his creations. Also in the 13th century Ibn Al-Nafis was the scholar who had come close to describe the circulatory system for the first time when he wrote about the bloods movement around the pulmonary circuit from the right side of the heart passing through the lungs and then to the hearts left hand side.

Known in the west as ‘Avicenna’ Ibn-Sina was the author of the world famous and surviving ‘Canon of medicine’. His book became the standard manual for medicine over the next few centuries and parts of it are still used to this day. His writings promoted the process of recording and preserving. His was able to find a way to test the efficacy of drugs, he made sure to educate people on the importance of environmental factors and hygiene on health. He had rightfully earned the title of ‘Prince of physicians’.

The first school of medicine:

From ancient Egyptian scripts and papyri, the Egyptians established medical schools called the house of life. However, they were of a place to study knowledge rather than just medicine. It is believed that the first formal medical school was in Italy. It was formed in the 9th century and called the ‘Scuola Medica Salernitana’. it was an unrivalled institute for many centuries due to its teachings, curriculum and availability of rare transcripts and books from around the world. The schools’ success came from the fact that students came from all over the world to attend and with them they brought their diverse knowledge. Passing levels were high and only the best survived. The school brought out well rounded and educated doctors and brought respect to the field. What really made the universities special however is that it was centuries ahead of its time in the sense that it accepted women as both employees and students. The schools’ values, morals and standards set the bar for the for any medical school of the future.

Medieval medicine:

The roman empire saw an outstanding system of health, organization and research. Under the empire Europeans benefited from scholars from all around the continent which was a major factor in enhancing the medical field. After the fall this system faded and Europe fragmented into smaller sections controlled by Vikings, Saxons and other tribes. The problem that came with the splitting was that each section only cared about itself and expanding its territory. Trade and peace wasn’t common between them, so knowledge was barely shared. Religion overtook science. The church ruled and made sure people focus on prayers as cure for disease. It banned dissections and autopsy. These factors were the main causes for the downfall of medicine during the medieval period. More importantly was the downfall of life expectancy. Surviving childhood was true struggle and for women it was childbirth.

An important figure in this hard time was surprisingly a woman, bearing in mind women were looked down upon in those times. She was known as Hildegard of Bingen. She is known for the revival of scientific medicine. Living in a monastery she had access to translations of medical texts from the Arabs and ones from the old empire. She gained success in her writings due to the fact she put god on top and made sure to instruct the patient to continue with their prayers as well as taking their medicine. She would often recommend herbs and tonics as cures, many of which are known today to have immense pharmaceutical properties.

In 1140 king roger ii of Sicily introduced a law that no body could practice medicine without a license. It was the first of its kind an was an important move in the history of medicine. It led to the introduction of barber surgeons. They offered their normal services of shaves and hair cuts but add to that was leeching, extractions and even amputations. It wasn’t as far as that some even were on the battlefield. They used anaesthetics of herbs and alcohol, however many patients died of the anaestetic before the operation even began due to their potency. They started to fade away after specialised doctors came about in the 17th century.

The black death:

During the 14th century the black death caused huge problems both socially and economically. Killing 60 percent of the continents population and lasting 5 years from 1347 till 1352 it was more lethal than the world wars. Europe had experienced epidemics before, but none compared to this one in the sense that the black plague affected a very large area. The others were only accountable for deaths in a much smaller area. It is believed to originate from the central parts of Asia. From there it spread to Crimea in 1347, spreading from here to the rest of the continent through trade routes. Italian towns were inflicted by autumn and by the summer of the next year places as far as Spain, France, Portugal and England had caught the disease. In 1949 the disease finally reached and infected the borders of Scandinavia through Germany. The spreading agent was the black rat. Scientific name being Rattus rattus. This type of rats enjoyed living in conditions medieval cities had to offer, so places where animals their waster and human waste was always present, dirty places. Starting symptoms were swellings in different parts of the body, also called buboes and this is where the black plague gets its other name, the bubonic plague. Afterwards black patches appeared over the victim’s body and death followed shortly after. Doctors of the time tried everything, different herbs, medicines, purifying the air with sweet scents, avoiding certain foods but nothing from all over the continent seemed to worked. During its first spell it killed around 50 million people before it died out. It then came back again in 1360 till 1363, 1370 and finally in 1400. This time around it weren’t as deadly as some people had acquired immunisations from the previous generation. Unfortunately, those times as well no cure was found. A cure was eventually found in 1894, but this is not part of our timeline. Unfortunately, though the disease hasn’t been eradicated, just as recently as 2015 there were cases of the disease. At the time as people couldn’t find a cure they reverted to prayer and actions to god such as whipping themselves in repentance for their sins. As the disease didn’t go away more people started to blame the devil and his agents especially Jews and witches. Authorities tried to prevent the disease or contain it by trying to purify the air or isolating the sick. Some people even tried to light fires and maintain them to get rid of the pathogen which they thought was present in the air. Many places with ports especially refused to let any outsiders enter. These preventive actions taken by the authorities came with many problems both socially and economically. Socially people weren’t interacting as they couldn’t and there was a separation between the infected and those who weren’t, rightly so. Economically trade decreased majorly as countries stopped people entering so imports were no longer a thing in many places, hence many businesses failed. On the other hand, this brought by a procedure still used to this day, which is that people entering a country had to undergo a medical examination before being allowed to enter.

The anatomy revolution:

During the period in Europe when the church ruled and dissections were illegal anatomy nearly disappeared. People used the centuries old works of Galen and Hippocrates. Their works were given god like status and no body would dare to question them. A Flemish man called Andreas Vesalius changed this in 1543. He was a successful professor who made sure to actually dissect the body himself and study it with his students instead of giving it a quick glance and quickly getting rid of the body as the process was illegal. From his research he found that what he saw didn’t always correlate with Galen’s teachings. He brought his findings to a local judge who became interested and provided him with permission to dissect the bodies of criminals. In 1543 after working with his artist colleagues of the university he produced the first major and modern piece of anatomical work, his book ‘De Humani Corporis Fabrica’. Even with all the opposition to his ways the book soon sold out. He corrected various old beliefs. For example, he said the liver has two holes instead of five or that the jaw is one bone and not two. Of course there was medicals who objected but they were a minority and sooner rather than later had to accept what was in front of them. Andreas Vesalius massively contributed to the field not only through his book but by inspiring other professionals to believe in what they saw rather in what they believe and on top of that he produced outstanding students who also significantly contributed to the field.

The discovery of circulation:

Some old myths of how the blood flowed was completely wrong while others such as that of the Chinese’s was close. The only problem they had was that the blood mixed with some sort of life energy which they called ‘qi’. This mixing was believed to be what carried the blood around. The first contesting of these concepts came thousands of years later when the Arabic Scholar Ibn Al-Nafis dissected a heart and saw it didn’t have tiny pores. Other scientists like Andreas Vesalius contributed to getting rid of the idea of the heart having pores. Andres Laguna proved that the heart had 2 ventricles rather than 3 in 1535. Furthermore, in 1540 Amato Lusitano discovered valves, debunking Galen’s concept of a two-way flow system inside the heart. William Harvey was the one to finish the puzzle when he introduced the idea pf pulmonary circulation and systematic circulation in his book ‘De Motu Cordis’ which was published in 1628. Due to not having a microscope he wasn’t able to identify capillaries, however they were later identified by an Italian scientist after the invention of microscopes.

Cure for malaria:

Expeditions to explore the new world in the 15th century brought back many diseases and epidemics. On the other hand, in the 17th century travellers brought back with them from south America bark of the cinchona tree. The locals believed it could cure fevers, diarrhoea and fatigue. It was given to the countess of Peru in 1630 after she fell ill with malaria. After she cured and with other accounts of the plant being the cure it was majorly exported to Europe. Not only did it cure malaria it was a cure for a variety of diseases. It was seen as a miracle drug.

Scurvy:

Scurvy had always been associated with sailors. It had been around for as long as sailors but didn’t become a major problem till the Europeans started exploring the new world. Scurvy is a deficiency disease. It happens to people who don’t have vitamin c in their diets. Crews especially were forced to eat salted food as it was cheap and lasted the long journeys. In the 18th century an English doctor James Lind carried out an investigation and his findings were that it was due to having a lack of nutrients in a persons’ diet and he recommended for sailors to eat more fruits. He published his results in 1753. Afterwards many ships took his advice and took lemons on board and they would come back scurvy free. Unfortunately, it took time for the navy to provide lemons to its crew as part of a standard daily meal.

Vaccinations:

The Chinese thousands of years ago had their own way of vaccinations, however although it worked sometimes it wasn’t controlled enough and so uncontrollable. Edward Jenner, an English doctor was the person accounted for bringing safe vaccinations to light. He vaccinated 23 patients against cow pox in 1798. All 23 of them survived after they were introduced to the disease. He was enlightened with his findings and published his results for the world. Due to him being careful, observing and scientific in his method, his results were accepted by most scientists and quickly vaccinations were improving and spreading around the world.

Conclusion:

In conclusion from research I have found out that it is evil to bestow praise to only a few people. Everyone I mentioned above had a major impact on the field. However, the truth is that the advancement of the field came through teamwork. No body single handled improved the field by themselves, or even a whole sector by themselves. They all relied on each others findings and results to improve the lives of billions. Not only that, there are many more e people that I don’t know about or I just weren’t able to fit in. We should be grateful that we weren’t born in a time were there is a massive chance for us to die before we are even able to reproduce and expand the world.

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