医学史简论（9)
A Brief History of Medicine
浙江大学医学院 余 海
Yuhai@zju.edu.cn
The History of Therapeutics


The ups and down of blood-letting
therapy
The origin and development of surgery
The ups and down of bloodletting

The therapy of Bloodletting
(phlebotomy) began before
Hippocrates time

The theological basis of
bloodletting is Four Humors
Theory, it was said to
cure inflammation, infection
strokes, manic psychosis and
more
Ancient Greek painting in a vase, showing
a physician (iatros) bleeding a patient
The ups and down of bloodletting

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
1540-1745
Blood letting was widely
applied in the Middle Ages
The barber-surgeons
undertook the procedure
The ups and down of bloodletting

Apart from phlebotomy，
skin scratch, cupping
and leeches were also
used.“Leech”became the nick
name for a doctor .
放血术的兴盛和衰落

In 18th century
medical text
books described
the detailed of
bloodletting
including the
indications,
location, the
methods and
tools used
The ups and down of bloodletting

The tragedy of Washington： December 13, 1799 George
Washington got acute epiglottitis, the remedy his doctors
gave was mixture of honey, vinegar and butter for gargle
and bloodletting; within 24 hours total 82 ounces blood
(2500ml)was drained and he died 2 days later
George Washington
1731-1799
The ups and down of bloodletting


1840, French physician Pierre Louis
conducted a clinical trial proving that
bloodletting was useless or harmful for
treatment of pneumonia
Bloodletting, the therapy used for over
2000 year was abandoned except for
some rare conditions like
hemochromatosis, polycythemia vera
and porphyria cutanea tarda.
Pierre Louis
The History of Surgery
trephination 颅骨环钻
术
The History of Surgery
The early surgerytrephination
(7000-3000B.C. Neolithic period)
for both medical reasons
(epileptic seizures, migraines and
mental disorders and mystical practices
by letting evil spirits escape
Trephination
•Trepanation is surgery in which a hole
is drilled into the human skull to
treat epidural and subdural hematomas
•400 BC Hippocrates treated head injuries
with
Trephination
•1st century
Celsus
and Galen
performing
trephination
1497 Trephination
18th Century French trephination
Modern Neurosurgery: Remove Brain Hematoma
The early
surgery was
developed
from the
treatment of
battle wounds:
suturing
lacerations,
amputating
insalvageable
limbs, set
bone and
draining and
cauterizing
Roman surgeon
open wounds
Iliad
Odessey
Hippocratic
Corpus
described
many
methods for
treatment of
bone
fractures
(crookback)
According to History of Three
Kingdoms (184-280) Hua Tuo
invented the general
anesthesia with Mafeisan
which render a person
unconscious and allow him to
perform surgical procedures
145-208
Surgery in ancient India
In Susrutha Samhita, he describes in exquisite
detail the examination, diagnosis, treatment,
and prognosis of numerous ailments, as well
as procedures on performing various forms
of plastic surgery,
Sushruta 600 BC
(妙闻）
Indian Rhinoplasty
“nacta” –the nose cut off
as a punishment
Carpue’s Rhinoplasty
1814
Italian Gasparo Tagliacozzi
（1546－1599）
外科学的产生和发展
Since the Pope Innocence Ⅲ banned
surgery，there had been a career
Barber-surgeon who performed the
surgical procedures.1735, The Royal
College of Surgeon was established and
the surgeon became an independent
career and should have a formal training
was required the status
of surgeon gradually
became equal to physicians
Early Surgical Treatment

Surgical treatment used be a
cruel and painful experience- no
anesthesia, no antisepsis, with
boiled oil and burned iron to stop
bleeding
cauters
cauterization
初期的外科治疗

截肢 amputation
Early surgery-amputation

乳腺切除术 Mastectomy
Johnnes Scultetus the Elder:
Armetarium Chirurgicum (1744)
Wilhelm Hildanus 1560－1634
Break
Three Breakthroughs in Modern Surgery
Pain, infection, bleeding were the three major
problems to prevent surgery from progressing
into modern science. The development of
modern surgery has been benefited from
three inventions:
 Anesthesia 麻醉术
 antisepsis and disinfection防腐消毒术
 transfusion输血术
Invention of anesthesia


Before invention of
anesthesia the most
commonly used analgesic
agents were: marijuana,
opium, stramonium,
belladonna, alcohol or
hypnogenesis.
The effects were rather
poor, which cumber the
number of elective surgical
procedures
Invention of anesthesia
1772, British chemist Joseph Priesley
seprated nitrous oxide (N2O), because
it can relax diaphragm muscle and
make people laughing so called
laughing gas
1800,Humphry Davy found
the analgesic effect of nitrous
oxide
Invention of anesthesia
Due to the
euphoric
effects of
inhaling it, a
property that
has led to its
recreational
use as an
inhalant drug
As dancing
outreach (ecstasy)
today
Invention of anesthesia

March 30,1842 a country doctor Crawford
Long（1815－1878）successfully remove a
neck tumor with ether anesthesia for a
child, but the results not published

His Alma Mater Johns Hopkins University
recognized him as the first one using ether
as anesthetic agent

National Doctor’s Day – March 30 in USA
(since 1993)
Invention of anesthesia



December1844 a American
dentist Horace Wells(1815-1848)
successfully extracted his own
cheek teeth with inhaled N2O
But he failed in demonstration
in Harvard Medical School
Hospital February 1844
1864, American Association of
Dentists gave the credit of
invention of anesthesia to him.
Invention of anesthesia


October 16,1846, Wells’ assistant
William Morton (1819-1868)
during a public demonstration in
MGH let a patient to inhale ether,
and the famous surgeon Warren
dissected a mandible tumor from
the unconscious patient.
Morton was recognized the
inventor of surgical anesthesia
The first
operation
under
anesthesia by
Dr Morton
1846.10.16
麻醉术的发明
Obstetrician James Simpson（18111870)applied Chloroform instead ether as
anesthetic agent，the Queen Victoria
inhaled chloroform during the child birth.
Invention of anesthesia
“Inventor and Revealer of Inhalation
Anesthesia: Before Whom, in All Time,
Surgery was Agony; By Whom, Pain in
Surgery was Averted and Annulled;
Since Whom, Science has Control of
Pain.“ (to William Morton）
 Who was the first one to use
anesthesia has always been a big
debate
 1868, in Boston a monument was
erected to commemorate the first
operation under anesthesia in 1846, in
which engraved:
“To Ether or Either”

Invention of Surgical Antisepsis

Semmelweis a Hungarian
obstetrician investigated the
cause of high incidence of
puerperal fever （childbed
fever） in Vienna General
Hospital and advocated
hand wash with chloride of
lime solution leading to the
maternal death rate
dropping from 18% to 1%.
Ignac Semmelweis
1818-1865
Invention of Surgical Antisepsis


Semmelweis was attacked by his
conserved colleagues and
incurred persecution.
Ironically he died at 47 in an
asylum from septicemia, but was
honored as the “savior of
mothers” after his death
IQ Vs EQ
Your character is your destiny
Invention of Surgical Antisepsis

In middle of 19th century the sepsis
caused by operation was most popular
with a mortality rate of 50%

Inspired by Pasteur’s discovery Joseph
Lister created using carbolic acid in
surgical antisepsis，with this method he
saved a 11-year boy’s life who suffered a
open complicated fracture in 1865

The fetal rate for amputation，before
antisepsis invention：16/35(45.7%)，
after 6/40(15.0%)
Joseph Lister
1827-1912
外科防腐消毒法

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Lister’s antisepsis method was ignored
in Britain and US
1870, German adapted his method in
Prussian-French war and saved many
soldiers’ life.
1877, Lister took the position of
Department Head of Surgery in King’s
College，and made his name in
surgical circle and his surgical
antisepsis was popularized

1895－1900 Lister was appointed as
the Chairman of British Royal Society.
Your character is your destiny
Progress of Surgical Techniques

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1877 German doctor von Bergmann sterilized the surgical
instrument and dressing with high-temperature vapor
1885 German surgeon Neuber: surgical gown
1889 American surgeon Halsted: rubber gloves，Austrian
surgeon Mikulicz-Radecki: surgical mask
1890,Halsted proposed the basic principles of surgery，
laid the foundation of modern surgery
surgery 1870s (Dr Gross) surgery 1889 (Dr Billroth)
Operating theater in early 20th century
Surgery 1902
Modern operating theater
Invention of Blood transfusion



Blood loss is a threat for
patient’s life, to control
blood loss: cauterization,
ligature, and blood replace
1665, British physician
Richard Lower first tried
transfuse blood from sheep
to a psychiatric patient
Transfusion was soon
banned because of death
caused by transfusing animal
blood
Invention of Blood transfusion


1818, British
obstetrician
Blundell first
transfused blood
to a postpartum
bleeding woman
from her husband
Afterwards he
tried 10 times and
5 was successful
Invention of Blood transfusion



1875,Landois found the
cause of transfusion
reaction- agglutination of red
cells
1900, Austrian scientist
Landsteiner discovered
agglutination was caused by
immune reaction，and
proposed the ABO blood
types
1939－41 Rh type was found
（Rhesus monkey ）
Karl Landsteiner
1868-1943
.
ABO blood type system
Rh Blood Type
Rh-Caucasian15%，Chinese 0.3%
Therapy for newborn jaundice：
intrauterine transfusion
Blood replacement
Phototherapy
Invention of Blood transfusion


Discovery of blood type and the establishment of
blood match laid the foundation of blood transfusion
and promoted the development of surgery.
Landsteiner obtained the
Nobel Prize in 1930
Advances in Modern Surgery
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Organ
transplantation
Minimal
invasion surgery
Robot surgeon
Telesurgery
器官移植 Organ Transplantation

Main obstacles for organ
transplantation:
Blood vessel anastomosis
Organ preservation
Graft rejection


More than 1 million people
received organ
transplantation worldwide
Renal transplant is most
common (500,000 cases) next
is heart and liver.
"Limb Transplantation Miracle by
Saints Cosmos and Damian,"
from around 1500.
Milstones of Organ Transplantation



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1931, Felatove performed first cornea transplant
1954, Joseph Murry successfully conducted first kidney
transplantation between two identical twines
1963, Starzl: first liver transplant，Hardy: first lung transplant
1967, South African surgeon Barnard performed first heart
transplantation
1974, Thomas：first bone marrow transplantation (graftversus-host disease)
1980s Clinical application of Cyclosporin as immunosuppressor drug
Liver transplantation
Kidney transplantation
活供体肝脏移植
live donor liver transplantation
面部移植 Face Transplantation
The first face transplantation was
performed on November 27,
2005 in Amiens Hospital of
France
First Chinese patient received face
transplantation in April 14 2006 in
Xijing Hospital,Xi’an
Before
After
李国兴于2007年12月出院回家，不幸于
2008年6月底去世死亡原因不详，去世前
三星期接受西京医院郭树忠医师的检查

A French patient Pascal Coler
suffered from Von
Recklinghausen’s disease
（multiple neurofibroma），face
transplantation was performed
March 2008
Connie Culp shot by her ex-husband on face in
2004，received face transplant in Crifland
Hospital Dec 10 2008, the operation lasted for
22 hours Photo taken before and after surgery
(March 5 2009)
The First Full Face transplant


BOSTON 3/21/2011 — A Texas
construction worker horribly disfigured
in a power line accident in 2008 has
undergone the nation's first full face
transplant in hopes of smiling again
and feeling kisses from his 3-year-old
daughter.
Dallas Wiens, 25, received a new
nose, lips, skin, muscle and nerves
from an unidentified dead person in
Brigham and Women‘s Hospital.
Laparoscopic Surgery
腹腔镜
Laparoscopy
(application of Artificial pneumoperitoneum)
Laparoscopic Surgery
腹腔镜胆囊摘除术
cholecystectomy
Laparoscopic Surgery
腹腔镜手术-食道切除术
Laparoscopic esophatectomy
Transgastric
cholecystectomy
Transgastric
appendectomy
Transvaginal
nephrectomy
经自然腔道内镜手术
Natural orifice
transluminal
endoscopic surgery
(NOTES)
Surgical
scar
convention
al surgery
Surgical
scar
minimallyinvasive
surgery
手术机器人
Robot Surgeon
2000,da Vinci robot surgeon
system developed in US
远程手术


Telesurgery
First telesurgery was in September
between New York and Paris for
cholecystectomy
First Chinese telesurgery in September
10, 2003 between Beijing and Shenyang
for a intracranial hematoma removal
纳
米
机
器
人
nanorobots
Through the battle through defeat
Moving yet and never stopping
Pioneers! o Pioneers!
- Walt Whitman (1819-1892)
屡战屡败，屡败屡战
勇往直前，永不止步
先驱者，啊， 可敬的先驱者！
Andrew Balfour (1873-1931) the first
Director of London School of
Hygiene and Tropical Medicine (1923）
The End