Week 7 - History of Medicine PDF

The Rise of Scientific Medicine Mark Sholdice HS 2220 Medicine and major historical periods Age of the Enlightenment (c. 1700-1789) emphasis on use of reason and skepticism towards dogmas Age of Revolutions (1789-1848) political instability and warfare...

The Rise of Scientific Medicine Mark Sholdice HS 2220 Medicine and major historical periods Age of the Enlightenment (c. 1700-1789) emphasis on use of reason and skepticism towards dogmas Age of Revolutions (1789-1848) political instability and warfare across Europe and the New World rise of the modern nation-state (need for healthy citizens/soldiers) “First” Industrial Revolution (c. 1750-1850) associated with industrialization, urbanization, and new technologies health problems associated with industrial work, urban life, and poverty  th 18 -century Debates body as a mechanism Hobbes, Descartes: humans are machine-like vital force: body moved by a soul Georg Ernst Stahl (1659-1734): “animism” mechanism vs. vital force debate carries on throughout 1700s and into 1800s preformationists vs. epigenecists preformationists: sperm (or egg) contains a homunculus-sperm contains a human being that grows over time and only men contribute vital parts to the development from the sperm epigenecists: fetus develops over pregnancy Paris Medicine: Overview Paris became the home of clinical practice in the early 19th century vast public hospital system 20,000 beds hospitals as teaching centres up to 5,000 medical students characteristics: scientific observation, pathological anatomy, quantification "read little, see much, do much" Paris Medicine: Disease the idea of lesions anatomico-pathological- understanding of disease and study autopsy medicine of the gaze doctors begin to try to observe and measure disease, rather than just treat reported symptoms The Stethoscope René Théophile Hyacinthe Laennec (1781-1826) stethoscope created in 1816 – also symbolize the authority of a physician The way the stethoscope sounds can tell you something about the anatomy why is this revolutionary? before stethoscope: illness = patient’s subjective symptoms after stethoscope: illness = lesions detected by doctors Laennec's "Aha" Moment "In 1816 I was consulted by a young woman presenting general symptoms of disease of the heart. Owing to her stoutness little information could be gathered by application of the hand and percussion. The patient’s age and sex did not permit me to resort to [direct application of ear to chest]. I recalled a well-known acoustic phenomenon: namely, if you place your ear against one end of a wooden beam the scratch of a pin at the other extremity is distinctly audible. It occurred to me that this physical property might serve a useful purpose in the case with which I was then dealing. Taking a sheet of paper I rolled it into a very tight roll, one end of which I placed on the precordial region, whilst I put my ear to the other. I was both surprised and gratified at being able to hear the beating of the heart with much greater clearness and distinctness than I had ever before by direct application of my ear." Stethoscopic Practice first stethoscope described in Treatise of Medical Auscultation (1819) diagnostic impact stethoscope allowed doctor to bypass unreliable account of patient, rendering diagnosis more objective descriptive impact stethoscope allowed for anatomical technicalities Leannec’s triumph idea of pulmonary tuberculosis as a unified disease La Méthode Numérique in Paris, lots of patients = lots of disease = ability to quantify diseases Pierre Louis (1787-1872) created basis for clinical trials showed phlebotomy does not work “therapeutic nihilism”: evidence and experience showed that medicine rarely cures Blood letting does not help pneumonia Paris – Impact (I) medical students trained in Paris- a step to being an established doctor returned to home countries, bringing stethoscope and numerical method systematic and scientific medicine students drilled in diagnosis examples Thomas Hodgkin (1798-1866): brought French pathology to England Carl von Rokitansky (1804-78): made pathological anatomy compulsory in Viennese medical schools Paris – Impact (II) influence of French medicine in other places Robert Graves (1796—1853): brought stethoscope and modern clinical practice to Ireland Americans produced French- inspired research treatises on consumption, typhus, and typhoid but medical training at a low standard in the US The Laboratory began to replace the hospital as a site of discovery new scientific medicine: measurable, weighable, and testable methods in controlled environments no variables, as in a hospital microscopes became more important than stethoscopes histology: the study of the microscopic structure of tissue (term coined 1819) Microscopy – Pioneers by the mid-1800s, Germany became seat of microscopy, especially due to better equipment Jacob Henle (1809-85) described body from macro- and microscopic standpoints microscope an educational tool for students Albert von Kölliker (1817-1905) applied cell theory to descriptive embryology microscopical anatomy key to understanding organs and physiological systems Scientific Education in German States German universities: the best in Europe by mid 19th century prestige and industrial development = government investment in universities German became the language of scientific research and Germany became the centre of “high-tech” industries Zeiss Machine  Alexis St. Martin's Fistula not all advances made in the lab in 1822, William Beaumont (1785- 1853), US Army doctor in Michigan, treated French Canadian fur trader Alexis St. Martin (1802-1880) for gunshot wound to the chest St. Martin recovered, but with a fistula (hole) into his stomach Beaumont employed St. Martin as a servant and began experiments on the fistula helped to explain digestion process Beaumont wrote a book about the digestive process on how it works a chemical process Physiology and Medical Materialism need to quantify physiology (study of body’s functions) doctors increasingly rejected vitalism need for quantification = need for new measurement devices kymograph: invented 1846 by Carl Ludwig (1816-95) to measure blood pressure Materialist extremism Karl Vogt: "The brain secretes thought as the stomach secretes gastric juice, the liver bile, and the kidneys urine” Cell Theory cell theory made possible by microscopes English word cell coined by Robert Hooke in his 1665 book Micrographia began in botany and spreads into other areas (plant tissue easiest to observe) mid-19th-century German physicians and scientists formulated and applied cell theory to animals cells came to be seen as the basis unit of all living things but many unanswered questions: Are cells eternal or do they die? How are they created? Rudolf Virchow (1821 -1902) argued that cells always develop from pre-existing cells through cellular division; no spontaneous generation "There is no life but through direct succession“ / "Each cell from a cell” life is a hereditary succession of cells also a political reformer and founder of modern public health “Medicine is a social science, and politics is nothing else but medicine on a large scale.” Science and Practice attempts to apply methods of science to all of medicine new measurement devices and techniques: Carl Wunderlich's The Temperature in Diseases (1868) sphygmomanometer: easy-to-use blood pressure gauge invented 1896 spirometer developed over 1800s: measures volume of air breathed the “ward-laboratory” of the late 19th-century merger of hospital (valued in France) and laboratory (valued in Germany)