The History of Medicine
An Introduction
Dr H K Lord
A Tour Through Time
From Ancient Civilisation to
The Enlightenment.
Beginnings
Ancient civilisations:
Mesopotamia
2000 - 3000 BC
Ancient Egypt, India, China
2000 BC
Crete and Mycenae
1000 -2000 BC
Ancient Hebrew medicine
1000 – 2000 BC
all had medical philosophies, usually based on religion.
Greek Mythology – 900 BC
Closely bound to religion of gods
Dionysius god of fertility
Athena god of the eyes
Hera protector of women in childbirth
Aesculapius god of healing. Son of Apollo, brought up by a centaur who
taught him all the healing crafts. So skillful as an adult he brought a dead
man back to life. Zeus feared the underworld would be depopulated and so
struck him dead with a thunderbolt. Went to the heavens as a deity and
worshipped with healing temples for centuries after.
Daughters Panacea and Hygea (healers in own right)
Health was a gift, disease a punishment.
Aesculapius
Aesculapius
Snake: its ability to shed its skin
was seen as symbol of rebirth and
healing, and its poison of death.
Ancient Greece 600 BC
Pre-Hippocratic Philosophers
Beginnings of rational, secular thought in relation to medicine.
Thales of Miletus 640 – 546 BC first true scientist / philosopher
of the Greeks. Did not use religious or supernatural means to
explain natural phenomena. Believed basic element of plants and
animals, and hence life, to be water.
Known as the Father of Science.
He wrote nothing down that survives – know of him from the
writings of others and passed down teachings.
Major influence on contemporaries and followers.
Ancient Greece 600 BC
Others of his time included Pythagoras and
Empedocles
Doctrine of four basic elements, as fabric of all things:
water, air, fire and earth.
These had corresponding qualities: wet, dry, hot and
cold.
Affected medical theory for thousands of years ( later
projected in to 4 humours)
Hippocrates 500 BC
On this background of rationale thought, Hippocrates on
the island of Cos developed his “Corpus Hippocratum.”
Probably a collection of works by a number of writers.
Illness no longer a punishment from the gods, but caused by
natural forces, requiring human effort to resolve and avoid.
However if man’s illness was impossible to cure or alleviate,
the patient was still abandoned both by physicians and
neighbours.
Stoics even advocated suicide in this instance.
Hippocrates 500 BC
4 balanced number in Pythagoran philosophy : 2 pairs of
opposites
4 elements (earth, fire, water, air)
4 qualities (wet, dry, hot, cold)
4 seasons
4 bodily fluids – blood, phlegm, black bile and yellow bile
If 4 humours in balance = health
If 4 humours imbalanced = disease
Hippocrates 500 BC
Emphasised clinical examination
Holistic approach – exercise, moderation of diet and
mental well being.
Wrote on anatomy, including the pericardium, the
ventricles and heart valves. However thought air
travelled with blood in the arteries and the difference
between veins and arteries not appreciated.
Wrote on making a diagnosis, surgery, therapies,
prognosis and obs and gynae.
Hippocrates 500 BC
Used instruments to examine patients – probes and
speculums to Ex orifices
Discussed ethics and how a doctor should behave and
present themselves.
“ a physician must have a worthy appearance; he
should look healthy and be well nourished… for most
people are of the opinion that those physicians who are
not tidy in their own persons can not look after others
well.”
Hippocratic Oath
Confidentiality
“ what I may see or hear in the course of the
treatment…..which on no account must spread abroad,
I will keep to myself, holding such things shameful to
be spoken about”
Pledges against harm to the patient, deadly drugs,
abortion and sexual relations with patients.
As such the basis of modern medical ethics.
Plato
Plato was a contemporary of Hippocrates (427 – 347 BC)
Student of Socrates and teacher of Aristotle
Interested in the soul and matter, and made logical but
distant speculations on medicine. Did not dissect and some
of his inaccurate beliefs became staunchly supported.
Supported in the 3rd C BC by the Dogmatists. Classified
disease by humours and used extreme purging and bleeding
as therapy, and treated fevers with dehydration regimes.
Perpetuated into the Middle Ages and failed to capitalise on
Hippocrates’ objectivity.
“The School of Athens” Rafael
1510
Aristotle 384- 322 BC
Pupil of Plato
Profound influence writing on logic, metaphysics, politics,
zoology and poetry amongst others.
Supported by Ptolemy, a general of Alexander the Great,
who set up a library in Alexandria. Its aim was to collect the
entire sum of human knowledge.
Studied embryology, described differences between veins
and arteries, described the aorta ( which he named) and the
course of the ureter.
Founder of comparative anatomy
Roman Medicine 150 BC –
200 AD
Greek Medicine reached a peak in Alexandria and
began to infiltrate Rome, which gradually became the
main political power.
However most Roman physicians were slaves, or freed
men, usually of Greek, Egyptian or Jewish origin.
Improved water supply and sanitation led to health
benefits.
However the main, gigantic, influence from Roman
times was Galen
Galen 129-200 AD
Greek physician, born to wealth and education.
Became most influential writer on medical subjects of
all time.
Travelled widely developing knowledge and skill,
becoming the physician to Marcus Aurelius.
Believed the purpose of everything was pre-determined,
occasionally distorting the evidence before his own
eyes.
Galen
Used humoural theory. Took it further, to describe 4
personalities:
Sanguine
Phlegmatic
Choleric
Melancholic
In the Middle Ages Galen’s pronouncements were
swallowed wholesale, both right and wrong, and this led to
centuries of thought based on the humours.
Galen
Experimentalist and wrote extensively.
Showed that veins were connected to the heart
That nerves came from the spinal cord
Described recurrent laryngeal nerve
Described bones and their muscle attachments
Showed that arteries contained blood, not air.
Galen
Understood uncertainties and fears of sick
Continued the practice of purging and blood letting
but in moderate degrees. Followed Hippocratic
traditions of helping nature by gentle methods such as
diet, rest and exercise.
Developed pharmaceuticals, combining herbs and
agents into a vast variety of combinations.
His writings became virtually unchallenged for the next
1500 years.
Middle Ages 400 – 1500 AD
The Fall of Rome to the Goths in 476 beginning of
Middle Ages
Fall of Constantinople to the Turks in 1453 end of
Middle Ages
For 1000 years Western man failed to develop the
teachings of Hippocrates and Galen, and accepted
everything on faith. No longer felt capable of learning
from own observations.
Galen’s texts remained unchallenged
The extraction of the stone of
madness
Bosch 1475 Madrid
Middle Ages 400- 1500 AD
Middle Ages were unsettled times –certainty welcomed
Galen’s authoritative, confident approach gladly
received, providing constancy and reassurance.
Teleological reasoning ( all having a purpose ) fitted
well with Christian faith.
Early commentators enshrined his name and he
became known as the fountainhead of all medical
knowledge.
The Black Death
Bruegel 1347 Madrid
Middle Ages
Exact reason why rational thought abandoned is complex –
Black death, plague, feudal society.
Barbarian invasions – dissolution of Western Empire
Rise of Christianity
Development of monasteries and belief in miracles
Power of Saints, Martyrs and Virgin Mary
Growing belief in superstition and magic
Elsewhere however…..
Islamic Medicine 700 – 1100
AD
Baghdad became a centre of Islam and intellectual
thought.
Greek texts translated to Arabic.
Developed pharmacy with methods of extracting and
preparing medicines. Reflected in Arabic roots of many
chemical words: alkali, alcohol, elixir, syrup.
During a period of great unrest in the West, compiled
and preserved Hippocratic traditions and contributed
new knowledge.
Islamic Medicine 700 – 1100
AD
Understood communicable nature of TB
Developed efficient hospitals, far superior to basic
prototypes made by Christians.
The best known in Baghdad, Cairo and Damascus.
Renaissance 1450 -1600
Rebirth – return to cultural priorities of Ancient Greece and
Rome.
Western Europe looked again at the original writings, art
and architecture of these eras.
At same time, printing invented allowing dissemination of
information.
Trade and local industry led to wealth and creation of
money economy.
Sea routes to India and Americas discovered – opening
world to exploration and exploitation.
The Ambassadors
Holbein 1533
Renaissance 1450 - 1600
Open minded observation of natural phenomena as
Hippocrates had favoured, and Galenism and
scholasticism were discredited.
Italian Universities developed – Padua.
Amongst most important new physicians Theophrastus
Bombastus von Hohenheim, who was as bombastic as
his name suggests.
Otherwise know as Paracelsus
Paracelsus 1493- 1524
Educated in Italy as all good physicians were at this time.
Interested in alchemy, astrology and occult as well as
medicine.
Wandering spirit, challenging authority wherever he went,
criticising their blind acceptance of classics.
Taught not in Latin but in vernacular.
Angered those in authority and attracted the young in equal
quantity.
Paracelsus 1493- 1524
To him diseases were caused by influences of the stars
and planets
So whilst challenging much that was wrong, and in so
doing bringing about a confidence to question, his
own philosophy of thought was still off beat.
Renaissance Surgery
Ambroise Pare 1517- 1590 revolutionised surgery. Working
in French battlefields, he came to fame, having trained only
as a barber and wound dresser.
For gunshot wounds, traditionally held view was “those not
curable by iron are curable by fire.” Pare tried application of
clean water rather than boiling oil, and found his soldiers
less feverish and with less pain.
Used ligatures to control haemorrhage rather than
cauterising irons. Became master surgeon to Henri II despite
limited education – no Italian university for him.
Renaissance Illness
Commonest illness now were no longer leprosy, plague or
cholera, but syphilis and gonorrhea.
Sailors and soldiers, exploring and conquering the world
brought back and spread venereal disease.
Small pox, measles and typhus also common.
Institutions for the lunatic and the poor increased, as those
displaced by urbanisation of society.
Witch hunting - aportioning blame on “heretic” Protestants
in Southern Europe, and on “papists” in Protestant North.
Renaissance Art
Study of human anatomy, botany, zoology, engineering
became closely allied to Art.
The anti-experimentalist approach of Middle Ages was
replaced by dynamic versatility – a natural world to be
explored and recorded.
The high authority of religion and indeed God
questioned. Observed data were not to prove the
validity of an assumed truth, but to develop principles
of thought. Empiricism.
Art and Medicine
Human dissection came
back into favour having long
been frowned upon and
forbidden for religious
reasons
Leonardo da Vinci 1452 1519 - made illustrations of
skeletal, muscular, venous
and nervous systems,
accurately depicted position
of foetus in utero and had
unrivalled artistic ability.
Leonardo da Vinci
1452 -1519
Vesalius 1514-1564
Trained in Paris and Padua.
Transformed anatomy and scientific teaching.
Wrote his opus magnum “ De humani corporis fabrica”
aged 28.
Related text to illustrations and used these to demonstrate
what written words struggled to convey. Relationship of
structures considered and structures seen as systems rather
than isolated organs.
With printing such texts could be widely distributed.
1600s Age of Science
A mathematical and mechanistic emphasis to thought.
Rather not why, but how, things happened.
Rene Descartes (1596 – 1650) and Francis Bacon ( 1561 –
1626) both saw objects as machines ruled by mechanistic
principles. Saw humankind as progressing and accumulating
benefits of scientific endeavour. Science was a way of gaining
power over nature.
Ancients saw life as cyclical, with rises and falls of
civilsation. Or that life was in decline from a Golden Age.
Inevitability.
1600s - Chemistry
Theory that disease was a distinct entity, living parasitically
in the body, as opposed to a derangement of humours
normally within the body.
Fever was not putrefaction of humours but reaction to
invading agents
New discoveries in chemistry led to concept of bodily acids /
alkalis
Support for concept of atoms making up matter
Boyle devised air pump and demonstrated necessity of air
for life.
Microscope…..
Developed by Leeuwenhoek, a linen merchant in Delft.
Visualised speramtozoa, allowing theories of embryo
formation to flourish.
A whole wealth of scientific discovery, dissemination of
knowledge and experimentation.
One of the greatest discoveries of this century was the
circulation of the blood.
William Harvey 1578 - 1657
Educated at Cambridge and
Padua.
Using experiments with
animals and dissection of
humans, he showed that
blood flowed in one
direction, that the heart was
a pump working with a
relatively fixed quantity of
blood, which circulated
around the body, returning
to the pump, to be pushed
around, again and again.
A confirmation of
mechanical science.
The Eighteenth Century –
The Enlightenment
Whilst many scientific
advances were made during
the 17th century, physicians
during the 18th century
struggled to apply all this
new knowledge to medicine
Patients still purged and bled
The humours still held
dominance for most
practitioners.
The
th
18
Century - advances
William and John Hunter founded first school of
anatomy on London.
Developed surgery and obstetrics and taught many
distinguished physicians.
Royal College of Surgeons chartered.
The
th
18
C
Discovery of vaccination by Edward Jenner, using fluid
from sores on cattle, to prevent smallpox.
James Lind (1716-1794) insisted on lemon juice to keep
away scurvy for sailors.
So the beginnings of the Industrial revolution were in
full progress in Britain, with scientific thought on the
ascendancy and Edinburgh a centre for learning and
excellence. A market economy was taking shape.
The Future
The 1700s passed with the spirit of experimentation.
1800s and 1900s were the centuries of therapeutic advance.
1800s saw Colonialism in Africa and Asia, and growing
confidence within Europe.
By 1800s, Science truly took over from philosophy.
Medicine advanced to the present day….at prolific
pace…..but that is another story.
So, In Conclusion
Medicine has always existed
Initially closely bound to gods and superstitions
The Greek philosophers wrote some of the earliest and best
records of concepts of medicine, some of which remain
today.
The Middle Ages were a stagnant period of accepting faith
and limited progress.
The Renaissance was a re-birth and re-assessment of Greek
and Roman ideas.
In Conclusion
This led on to an explosion of scientific thought and
discovery in the 17th century.
Further, but less bold, advances in the Enlightenment
era, when British society was becoming industrialised
and urbanised.
The 19th and 20th Centuries …. I leave for you to
discover…….in the context of what we have learnt
today.
Thank you for your attention.
Hannah Lord