History Of Medicine And Pandemics PDF Fall 2022

HISTORY OF MEDICINE AND PANDEMICS Dima Karam Fall 2022 These lectures offer insights into medicine’s past, ask what has shaped contemporary medicine, highlighting the evolution in medical theory, understandings of how the body works, how disease occurs and advances in treatment. The course will al...

HISTORY OF MEDICINE AND PANDEMICS Dima Karam Fall 2022 These lectures offer insights into medicine’s past, ask what has shaped contemporary medicine, highlighting the evolution in medical theory, understandings of how the body works, how disease occurs and advances in treatment. The course will also address essential medical breakthroughs so that you have a firm general grasp of major advances in the history of medicine. We will follow a chronological order to cover the following periods: Session 1: ★ classical antiquity ★ arab and medieval medicine Session 2: ★ early modern ★ 20th and 21st century medicine Session 3: History of the most marking pandemics Learning outcomes On successfully completing the lectures you will be able to: 1. Understand and demonstrate the broad sweep of medicine’s development throughout history, and possess the skills needed to understand evaluate, contextualise and communicate effectively your knowledge of medical history. 2. Demonstrate knowledge in essential medical breakthroughs throughout history 3. Engage with the underlying issues associated with the evolution of how disease and health were understood throughout history, to gain an ability to evaluate and interpret these changes within their specific historical context 4. Be able to contextualise medical advances within the state of science at a particular period to be able to project what future developments may bring to the practice and project a physician’s role in that context History of medicine Part 1 Ancient medicine Arab and Islamic medicine Medieval medicine (5th - 14th/15th) Renaissance medicine (15th-16th)  Antiquity - Ancient medicine ★ 3000 BC: Imhotep: first figure of a physician to rise from antiquity. He was Egypt’s chief physician to the pharaoh, wrote a surgical treatise on the treatment of wounds and other injuries. Thought to have diagnosed and treated over 200 diseases in his lifetime ★ Greek god Asclepius of healing and medicinal arts, his rod is the predominant symbol for medicine and health care. Worshipped in temples around Greece. From about 300 BCE onwards, his cult grew very popular and pilgrims flocked to his healing temples (Asclepieia) to be cured of their ills. a particular type of non-venomous snake was often used in healing rituals, crawled around freely on the floor in dormitories where the sick and injured slept. ★ Unto Hippocrates (BC 460-370): Regarded as the father of Western medicine. He laid the foundation for a rational approach to medicine. When sickness was attributed to superstition and the wrath of the gods, Hippocrates taught that all forms of illness had a natural cause. ★ The Hippocratic oath, an ethical code or ideal, an appeal for just conduct has guided the practice of medicine throughout the world for more than 2,000 years. Hippocrates ★ In the oath, the physician pledges to prescribe only beneficial treatments, according to his abilities and judgment; to refrain from causing harm and to live an exemplary professional life. The oath also called for free tuition for students of medicine, ★ He established the first intellectual school devoted to teaching the practice of medicine. For this, he is widely known as the "father of medicine." ★ He and his school followed a holistic concept, combining scientific thought with drug therapy, diet schedules, physical and mental exercise. Hippocrates ★ 1st Western physician to view the body as a whole and to try to define a unifying system of medicine. ★ Central to Hippocrates’ views was that human beings consisted of a soul and a body. He developed the theory of the four humors, or fluids. The humors were yellow bile, black bile, blood and phlegm. Interactions of the humors explained differences due to age, gender, emotions and disposition. ★ Humors originated in different organs. Yellow bile was related to being choleric and to childhood, black bile to melancholia and old age, blood was connected to being eager and adolescence, Phlegm to being unemotional and maturity. ★ The key to good health was to keep the humors in balance; an excess or deficiency in one or more of the humors was associated with disease. Food was one of the most important ways to help balance these humors. One of Hippocrates' most famous quotes was in fact "Let food be thy medicine and medicine be thy food." ★ These ideas represented the first step away from the predominantly supernatural view of sickness and a step toward a new idea that illness is related to the environment and what is going on inside the body. Hippocrates ★ Hippocrates noted the effect of food, of occupation, and especially of climate in causing disease, he studied the entire patient in his environment. ★ Dissection was taboo for Greeks, Hippocrates focused on general diagnosis and prognosis, seeking to allow his patients to rest, be well-nourished and clean, so that their bodies could have the greatest chance of healing themselves. ★ He first categorized illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence." ★ Hippocrates’ treatises explained how to set fractures and treat wounds, feed and comfort patients, and take care of the body to avoid illness. A treaty called Diseases deals with serious illnesses, proceeding from the head to the feet, giving symptoms, prognoses, and treatments.  Galen ★ Galen (Greek physician, AD 129 – 216) : Galen regarded anatomy as the foundation of medical knowledge. He founded experimental physiology, One of his most important demonstrations was that the arteries carry blood, not was was thought for centuries, as air. Why is he important? Achievement in cardiovascular physiology was the concept of unidirectional flow of blood and air through the lungs, which was accepted until the 17th c. He was the first to identify the physiological difference between veins and arteries. ★ showed how the heart sets the blood in motion in an ebb and flow fashion. He showed that Pneuma (breath) inspired air was drawn into the heart and carried throughout the body by the arteries. He based this knowledge on the examination of animals, generalized these findings to the human body. He studied how urine flowed from kidney to bladder. ★ Galen is regarded as one of the greatest surgeons of the ancient world, performed many audacious operations, including brain and eye surgeries. ★ Both Hippocrates and him attached clinical importance to observation and prognosis. ★ Galen’s vivisection experiments, set a base to understand physiology: such as tying off nerves to show that the brain controls the voice, performing a series of transections of the spinal cord to establish the functions of the spinal nerves, and tying off the ureters to demonstrate kidney and bladder functions. Galen ★ The body for Galen consisted of three connected systems: the brain and nerves, responsible for sensation and thought; the heart and arteries, for life-giving energy; and the liver and veins, for nutrition and growth. ★ Unlike Hippocrates, Galen argued that humoral imbalances can be located in specific organs and in the body as a whole. His writings formed the basis of medical education in the new medieval universities. ★ His systemization of medicine was accepted by authorities through the Middle Ages. His works profoundly affected the practice of medicine in the West for a long period, despite their faults. It was only with Vesalius in 16th c. that new advances began to be added to medical science in the West. showed that Galen’s anatomy was more animal than human in some of its aspects. Only then did it become clear that Galen and his medieval followers had made many errors. ★ But Galen’s notions of physiology, lasted for a further century (1400 years), until the English physician William Harvey correctly explained the circulation of the blood. The renewal and then the overthrow of the Galenic tradition in the Renaissance had been an important element in the rise of modern medicine. Arab & Islamic medicine During the early Middle Ages medicine passed into the hands of the Christian church and Arab scholars. Rhazes (Abu Bakr al-Razi) a Persian (AD 800) wrote a voluminous treatise on medicine, (A Treatise on Smallpox and Measles). It was the 1st to distinguish between these two diseases and give a clear description of both. A pioneer of ophthalmology: the first to recognize the reaction of the eye's pupil to light. Some his works, namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. His book on childcare deals with various illnesses in newborns, infants and children: covering topics like skin diseases, eye and ear diseases, and gastrointestinal symptoms like vomiting, abdominal distention, diarrhea and constipation. He devoted chapters to paralysis, epilepsy and enlargement of the head (hydrocephalus). He developed instruments used in apothecaries (pharmacies) like mortars and pestles, flasks, spatulas, beakers and glass vessels. Arab & Islamic medicine Al Razi has important contributions to neurology: stating that nerves had motor or sensory functions, described and numbered cranial nerves and classified spinal cord nerves Avicenna (AD 980-1037) wrote The Canon of Medicine, a standard medical text till the 17th c. in many European universities, + considered one of the most famous books in the history of medicine. In it he describes cataract surgery, the use of forceps during difficult infant deliveries. It also includes an approach to scientifically testing drugs for efficacy and dosage, in effect creating the framework for clinical trials. He gave the first correct explanation of pulsation: He was the pioneer of the modern approach of examining the pulse using the wrist which is still practiced in the current time.  Arab & Islamic medicine His description of cardiac diseases was the first time such an explanation was presented perhaps in the history of medicine. He explained the symptoms, effects, and treatment of palpitation in detail, described atherosclerosis and pericardial disease. Others also like difficulty in breathing, palpitation, and syncope. He also described the effects of some psychological states like depression, stress, and anxiety on cardiovascular function. Avicenna was the first person to diagnose “love sickness”. When he was treating a very ill patient, he noticed changes in patient's pulse when mentioning a link with the beloved. Avicenna described in detail the subject of health preservation promoting disease prevention. One of the most important factors for him to attain this goal was “Exercise”. According to him, if exercise was used correctly, intermediately and in an appropriate time, it can prevent physical illnesses as well as diseases. He made a treatise on cardiac drugs. discussed the action of available drugs on the heart in detail and mentioned their indications and contraindications. One of the drugs mentioned in this book is ‘zarnab’, a herbal medicine. He wrote that it sets the heart at ease. Recently demonstrated that this drug possessed calcium channel blocking activity.  Arab & Islamic medicine Avicenna was the first person to realise that diseases such as measles could be transferred from one person to another. To prevent this, he suggested quarantining of sick people so the disease wouldnt spread. He used antiseptics to prevent and cure infections. He was the first to describe the antiseptic properties of alcohol, which is still now a very common used antiseptic. He focused on the necessity of prevention of infection and inflammation before and after surgery by keeping clean and promoting healing with a suitable diet. Avicenna also wrote on handling and preventing depression based on natural remedies and changes to lifestyle, introduced roughly 30 medicinal herbs for the treatment and management of depression. He created a system of medicine that we would call today “holistic” and in which physical and psychological factors, drugs, and diet were combined in treating patients.  Arab & Islamic medicine Ibn al-Nafis, AD 1200 Physician born in Damascus, first described the pulmonary circulation of the blood. Also the first recorded discoverer of how the blood circulates from heart to lungs and back again, exchanging waste carbon dioxide for life-giving oxygen. In finding that the wall between the right and left ventricles of the heart is solid and without pores, he disputed that the belief that blood passes directly from the right to the left side of the heart. Blood then must pass by way of the lungs. The significance of his statement remained unheeded, and, in fact, was probably unknown by physicians in western countries. His achievement was brought to light in the 20th c. Al Hazen (AD 965): id known for his book on optics. Described in detail the various parts of the eye and introduced the idea that objects are seen by rays of light emanating from the objects and not the eyes. Regarded as “the father of optics.” Al Zahrawi (AD 936): He is considered the father of operative surgery. With drawings of more than 200 tools, with detailed descriptions of numerous surgical procedures. His work stood for nearly 500 years as the leading textbook on surgery in Europe. He also devised and invented surgical scissors, grasping forceps and obstetrical forceps. By inventing a new instrument, an early form of the lithotrite (to crush bladder stones), he was able to crush the stone inside the bladder without the need for a surgical incision. He is credited with performance of the first thyroidectomy. His book features the earliest known description of hemophilia. His use of catgut (natural fiber substance capable of dissolving and is acceptable by the body.) for internal stitching is still practised in modern surgery.  Medieval medicine ★ The practice of medicine in the Middle Ages was rooted in the Greek Hippocratic tradition. The body as made up of four humors—yellow bile, phlegm, black bile, and blood—and controlled by the four elements—fire, water, earth, and air. The body could be purged of excess by bleeding, cupping, and leeching—medical practices that continued throughout the Middle Ages. ★ Across Europe, the quality of medical practitioners was poor, and people rarely saw a doctor, although they might have visited a local wise woman, or witch, who would provide herbs or incantations. ★ Methods of diagnosis did not improve much from as the Middle Ages turned into the early Renaissance. ★ The Church was an important institution, Religious faith was a potent medicine for the sick in the Middle Ages. People started to mix or replace their spells and incantations with prayers and requests to saints, together with herbal remedies.  Medieval medicine Hospitals during the Middle Ages were more like the hospices of today, or homes for the aged and needy. In time, public health needs, such as wars and the plagues of the 14th century, led to more hospitals. By the twelfth century, there were medical schools throughout Europe. The most famous was the school of Salerno in southern Italy. It permitted women to study there. Another imp one: The medical school at Montpellier traces its roots back to the tenth century. By mid 14th, the university at Montpellier included a school of anatomy. In the late Middle Ages, apothecary shops opened in important towns. Physicians were trained in the art of diagnosis—often shown in manuscripts holding a urine flask up for inspection. Observation, palpation, feeling the pulse, and urine examination would be the tools of the Dr. throughout the Middle Ages. Medieval medicine ★ Surgery such as amputations, cauterization, removal of cataracts, dental extractions, and even trepanning (perforating the skull to relieve pressure on the brain) were practiced. Surgeons would rely on opiates for anesthesia and doused wounds with wine as a form of antiseptic. People used wine as an antiseptic for washing out wounds and preventing further infection. ★ Physicians still did not know how to cure infectious diseases. When faced with the plague or syphilis, they often turned to superstitious rites and magic. Explorers discovered quinine in the New World and used it to treat malaria. ★ Many people would have sought out the local healer for care, or might have gone to the barber to be bled or even leeched. Midwives took care of childbirth (21.168) and childhood ailments. Many large monasteries did have hospitals attached to them. Medieval medicine ★ Some of the most notorious illnesses of the Middle Ages were the plague (the Black Death), smallpox, typhoid and leprosy (less infectious). From 1346, the plague ravaged Europe, and rich and poor alike succumbed with terrifying speed. The only hope for those who escaped the dread disease was prayer or pilgrimage. ★ Many people died of much less dramatic diseases. Women often died in childbirth or succumbed to postpartum infections. Children frequently did not live into adulthood. ★ Barber-surgeons carried out surgery. Their skill was important on the battlefield, where they also learnt skills in tending to wounded soldiers. Tasks included removing arrowheads and setting bones. ★ In the Islamic World then (AD 900), Avicenna having written “The Canon of Medicine” it became an essential reading throughout Western Europe for several centuries. Renaissance medicine The Renaissance From the 1450s onwards, the Middle Ages gave way to the Renaissance, the Age of Discovery. This brought new challenges and solutions. Girolamo Fracastoro (1478), an Italian doctor, suggested that epidemics may come from pathogens outside the body. He proposed that these might pass from human-to-human by direct or indirect contact. He introduced the term “fomites,” for items, such as clothing, that could harbor pathogens from which another person could catch them. Andreas Vesalius (1514), a Flemish physician, wrote one of the most influential books on human anatomy “On the Structure of the Human Body”. He enjoyed remarkable fame already during his lifetime. His anatomical work was accompanied by 400 illustrations He dissected a corpse, examined it, and detailed the structure of the human body, demonstrating anatomy by dissection. His empirical approach was unconventional and it brought him to contradict Galen and other authorities (undisputed for 1100 year). Renaissance medicine Leonardo Da Vinci (1452), from Italy, was skilled in different fields. He became an expert in anatomy and made studies of tendons, muscles, bones, and other features of the body. He created over 200 pages of illustrations with notes about anatomy. Da Vinci also studied the mechanical functions of bones and how the muscles made them move. He was one of the first researchers of biomechanics. Ambroise Paré (1510), from France, helped lay the foundations for modern forensic pathology and surgery. He was an expert in battlefield medicine, particularly wound treatment and surgery. Paré treated a group of wounded patients in two ways: cauterization and Paré revived the Greek method of ligature strings of vessels and of the arteries to stop blood loss during amputation, instead of cauterization, significantly improving survival rates. This was an important breakthrough in surgical practice, despite the risk of infection. Paré also believed that phantom pains, sometimes experienced by amputees, were related to the brain, and not something mysterious within the amputated limb.  Renaissance medicine William Harvey (1578), an English doctor revolutionized the idea of blood circulation. He showed that the heart’s beat produces a constant circulation of blood through the whole body. He explained how the heart pumps it around in a circular course through the body through a single system of arteries and veins. Galen’s theory of unidirectional blood circulation was then refuted (1400 yrs). With 2 circulations the first, pulmonary, from the heart via the lungs and back, the second, systemic, from the heart through the body and back. ★ Observing the heart beating in animals he concluded that the active phase of the heartbeat, when the muscles contract, is when the heart decreases its volume and that blood is expelled with considerable force from the heart. His observations of dissected hearts showed that the valves in the heart allowed blood to flow in only one direction. ★ He also established that the heart contracts at the same time as a pulse is felt Harvey was also the first to suggest that humans and other mammals reproduced via the fertilisation of an egg by sperm. Further readings: o The Oxford Handbook of the History of Medicine: https://books.google.com.lb/books?id=6KJ0y_oSaAsC&printsec=frontcover#v= onepage&q&f=false o Timeline of discovery: https://hms.harvard.edu/about-hms/history-hms/timeline-discovery o History of medicine : A very short introduction https://books.google.com.lb/books/about/The_History_of_Medicine_A_Very_ Short_Int.html?id=dsAiN7N3OeoC&redir_esc=y o History of Medicine: Louis Magner https://books.google.com.lb/books?id=qtUzscI9_VIC&printsec=frontcover#v=o nepage&q&f=false o This Doctor Upended Everything We Knew About the Human Heart: https://www.nationalgeographic.com/history/history-magazine/article/history- william-harvey-medicine-heart o Britannica history-of-medicine https://www.britannica.com/science/history-of-medicine  A Timeline in dates 3000 BC Description of diagnosis / treatment of 200 diseases by the Egyptian Imhotep 460 BC Birth of Hippocrates, the Greek father of medicine begins the scientific study of medicine and prescribes a form of aspirin 300 BC first known anatomy book: Diocles AD 130 Birth of Galen. Greek physician to gladiators and Roman emperors 910 Persian physician Rhazes identifies smallpox 1010 Avicenna writes The Book of Healing and The Canon of Medicine 1489 Leonardo da Vinci dissects corpses 1543 Vesalius: findings on human anatomy 1590 Invention of the microscope 1628 William Harvey: An Anatomical Study of the Motion of the Heart and of the Blood in Animals: basis for future research on blood vessels, arteries and the heart A Timeline in dates 1670 Discovery of blood cells 1701 Giacomo Pylarini gives the first smallpox inoculations 1763 First successful appendectomy 1796 Edward Jenner develops the process of vaccination for smallpox, the first vaccines for any disease 1800 Discovery of nitrous oxide as anesthetic 1816 Invention of the stethoscope 1818 First successful transfusion of human blood 1849 Elizabeth Blackwell is the first woman to gain a medical degree from Geneva Medical College in New York 1853 Development of the syringe 1857 Louis Pasteur identifies germs as cause of disease 1867 Joseph Lister: use of antiseptic surgical methods and publishes Antiseptic Principle of the Practice of Surgery 1870 Robert Koch and Louis Pasteur establish the germ theory of disease A Timeline in dates 1879 cholera vaccine 1890 Discovery of antitoxins and develops tetanus and diphtheria vaccines 1896 typhoid fever vaccine 1899 development of aspirin 1901 system to classify blood into A, B, AB, and O groups 1922 Insulin first used to treat diabetes 1927 tuberculosis vaccine Tetanus vaccine 1928 Sir Alexander Fleming discovers penicillin 1937 typhus vaccine 1938 influenza vaccine 1950 invention of the first cardiac pacemaker A Timeline in dates 1952 Jonas Salk develops the first polio vaccine 1953 work on the structure of the DNA molecule 1967 1st human heart transplant 1977 pneumonia vaccine 1978 Birth of 1st test-tube baby 1983 Identification of HIV, the virus that causes AIDS 1985 invention of the artificial kidney dialysis machine 1996 Dolly the sheep becomes the first clone 2006 First vaccine to target a cause of cancer 2020 covid-19 vaccine Source:http://www.datesandevents.org/events-timelines/10-history-of-medicine-timeline.htm