History Of Medical Science
Why History Matters
 Constant Change for 150+ Years
• Limited Development of Societal Consensus
• Always Ahead (or Behind) The Law
 Classic Divisions Still Prevail
• Shamanism
• Greco-Roman Rationalism
 The Best and Worst of Times
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Shamanism
 Oldest Medicine
 Primitive Tribes
 Alternative Medicine
 Integrates Religion And Medicine
 Persists Even Today In So Called Modern
Cultures
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Explicitly Ministers To The
Psyche And The Body
 Driven By Myths
 Trial And Error And Careful Observation
 Often Sophisticated Rituals And Herbals
 Some Cure, Most Do Not
 Leviticus
• Public Health Code
• Rules Reduce Food Poisoning
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Useful Pharmacopeia
 Ethnobotany
• Study Of Plants Used By Ritual Healer
• Many Drugs Have Been Discovered This Way
• Witches Used Foxglove - Digitalis
 Medicinal Chemists
• Refine And Modify Botanicals
 Conflicts Over Ownership of Indigenous
Remedies
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Greco-Roman Rationalism
 Galen And Successors
 Driven By Rational Theories
 Religion Is Left To Priests
 Observations Forced To Fit Into The Theory
• Plato Was Terrible About This
• Mistakes Are Not Corrected
 Predominant Until 16th Century
 Still Lurks in Clinical Decisionmaking
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Modern Medicine/Scientific
Medicine
 Not The Philosopher's Scientific Method
 The Imperative To Disprove Theories
 The Full Disclosure Of Information
 Science Is Constantly Questioning And
Rethinking
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Systematic Observation is the
Key
 Diseases Have Variable Courses
 Patient's Have Variable Conditions
 Serious Participant-Observer Problem
 Controlled Studies Are Key
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Problems With Controlled
Studies
 CCU
• Cannot Control Variables Well
• Many Things Do Not Work
• Rating The Severity Of The Patient's Condition
 Treatment Of Controls
• Someone Gets The Old/No Treatment
• Cannot Use Drugs Until Trials Are Over
 AIDS Example
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Science Versus Scientists
 Scientists Are Just People
• Probably More Honest Than Most
• Some Are Corrupt
• Some Are Naïve
 Science Is Process, Not People
• Weeds out the Bad Stuff
• Can Take Time
 Lawyers Seek Out The Worst
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A Brief Chronology of Medicine
Paracelsus
 Philippus Aureolus Theophrastus
Bombastus Von Hohenheim
 Early 16th Century
 Transition From Alchemy
 Experiments And Systematic Observations
 Antimony
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Anatomy And Function
 Andreas Vesalius
• Mid 16th Century
• Accurate Anatomy
 William Harvey
• Early 17th Century
• Flow Of The Blood And Operation Of The Heart
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Edward Jenner
 Smallpox
 Major Killer
 Wiped Out The Indigenous Peoples
 1798 – Published His Book On Cowpox
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John Snow
 Cholera In London
 Broad Street Pump
 Proved Cholera Is Waterborne
 1854
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Ignaz Philipp Semmelweis
 Childbed Fever
 Fellow Medical Student Died
 Controlled Studies
 1849
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Louis Pasteur
 Scientific Method
 Germ Theory
 Vaccination For Rabies
 Pasteurization
 1860s-1880s
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Foundation of Modern Surgery
 William Morton
• Anesthesia
• 1846
 Joseph Lister
• Antisepsis
• 1867-1880s
 Surgery Became Big Business
 Drove Development of Hospitals
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Infectious Diseases
 Koch’s Postulates - 1880s
• Agent Must Be Present In Every Case;
• Agent Must Be Isolated From The Host And
Grown In Vitro [In A Lab Dish];
• Agent Must Cause Disease When Inoculated
Into A Healthy Susceptible Host; And
• Agent Must Be Recovered Again From The
Experimentally Infected Host.
 Limitations
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Tuberculosis Control - 1900
 The Major Killer
 Koch And Pasteur
 Sanatoria
 Pasteurization Of Milk
 Disease Control Of Dairy Herds
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Drug Chemistry – 1880s
 German/Swiss Dye Industry
 Bayer
 Hoffman La Roche
 Ciba
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Antibiotics
 Sulfa Drugs In The 1930s
 Penicillin
• Alexander Flemming – 1928
• Purified By Chain And Florey In 1939
• World War II - Coconut Grove Fire (1942)
 Streptomycin – 1944
• First Antituberculosis Drug
• Selman Abraham Waksman – 1944
• (Coined The Term Antibiotic
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Post World War II
 Conquering Microbial Diseases
• Vaccines
• Antibiotics
 Chronic Diseases
• Better Drugs
• Better Studies
• Leukemia
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Technology
 Microelectronics
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Monitors
Pacemakers
Ventilators
Heart-Lung Machines
 Dialysis
 Most Depend On Drugs
• Infections
• Rejections
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New Challenges
 Aging Population
 Failure of Public Health
 Antimicrobial Resistance
 Justice Issues
• How To Pay For Health Care
• How To Deliver Health Care
 Should Health Care be a Right?
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