History of medicine part 2.pdf

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 2 Medicine in the 18th + 19th centuries Medicine in the 20th century Medicine in the 21st century Takeaway: Challenges today A Timeline in dates Medicine in the 18th century During the Age of Enlightenment, the 18th century, science was held in high esteem. ★ Doctors still did not know what caused diseases. Some continued to believe in the four humors (although this theory declined during the 18th century). Other doctors thought diseases were caused by ‘miasmas’ (odorless gases in the air). ★ The health field was also crowded with self-trained barber-surgeons, apothecaries, midwives, drug peddlers, and charlatans. ★ Among the many diseases that had been afflicting humanity, smallpox was the major cause of death. Around 1706 the British lady Mary Montague had her son variolated after she witnessed the practice in the Ottoman empire, where it produced a mild form of the disease, securing immunity but at a risk. ★ Across Europe medical schools relied primarily on lectures and readings. The final year student would have limited clinical experience by trailing the professor through the wards, dissections were rarely done because of legal restrictions on cadavers. ★ Despite the decline of superstition, there were still many quacks in the 18th century. ★ In 1792 a Frenchman named Dominique-Jean Larrey created an ambulance service for wounded men. Medicine in the 18th century ★ Edward Anthony Jenner (1749) an English doctor, was the pioneer of vaccinations. He created the smallpox vaccine. ★ Jenner noticed that milkmaids tended to be immune to smallpox. He wondered whether the pus in the cowpox blisters protected them from smallpox. Cowpox is similar to smallpox but milder. ★ In 1796, Jenner inserted pus taken from a cowpox pustule into the arm of James Phipps, an 8-year old boy. When he noticed Phipps immune to smallpox, “vaccination” against smallpox with cowpox was then proven. Jenner’s successful experiments were published in 1798. Jenner coined the term “vaccine” from vacca, which in Latin means “cow.”  MEDICINE IN THE 19TH CENTURY In the early 19th century many scientists believed some living things spontaneously grew from non-living matter and that diseases, particularly major killer diseases, arose in the first instance from a weakness or imbalance in the internal state and quality of the afflicted individual. During the 19th-century medicine made rapid progress. Among the more powerful new techniques were anaesthesia, and the development of both antiseptic and aseptic operating rooms. The decline however in many of the most lethal diseases was due more to improvements in public health and nutrition than to advances in medicine. Medicine was revolutionized in the 19th century and beyond by advances in chemistry, laboratory techniques, and equipment. Old ideas of infectious disease epidemiology were gradually replaced by advances in bacteriology and virology. In 1816 a man named Rene Laennec invented the stethoscope, pioneered its use in the diagnosis of chest infections, diagnose bronchitis, tuberculosis and pneumonia 19th century medicine ★ During the 19th century, there were several outbreaks of cholera in Britain. At the 1854 epidemic, John Snow (1813-1858) showed that cholera was transmitted by contaminated water, giving rise to the Germ theory of disease. ★ In the 1840s, an austrian Dr. -Semmelweis- observed that the incidence of puerperal fever (bedside) in new mothers’ fell considerably if health workers disinfected their hands during delivery. Death rates fell significantly. At that time most people still believed that infections were caused by foul odors called miasmas. ★ Pasteur proved that the fermentation of wine and the souring of milk are caused by living microorganisms with a series of experiments in 1857.  19th century medicine ★ His research supported the germ theory of disease, Pasteur is credited for establishing the science of bacteriology. ★ Once doctors knew what caused disease they made rapid headway in finding cures or prevention. ★ Pasteur suggested heating drinks killed off disease-causing bacteria. He also invented a way of sterilizing liquids by heating them (called pasteurization). ★ His research led to his discovery of how to make vaccines by attenuating, or weakening the microbe involved. He developed the earliest vaccines against fowl cholera, anthrax, and rabies.  19th century medicine ★ The era of mass vaccination programs initiated in the mid-19th. ★ In these years, another fundamental step of medical advances came in the field of anesthetics. ★ In 1846 William Morton in Boston carried out a tooth extraction and the patient felt no pain thanks to ether anesthesia. Surgery was revolutionized: intravenous anesthetics were introduced in 1874, and 10 years later cocaine was used as local anesthetic. Surgery was greatly improved by the discovery of Anesthetics, using chloroform for operations in 1847. ★ In 1865 Joseph Lister, a British surgeon and a pioneer of antiseptic surgery, successfully used phenol — then known as carbolic acid — to clean wounds and sterilize surgical instruments, resulting in a reduction in postoperative infections. In germany, surgeon’s hands and clothes were sterilized in the operation and surgical instruments were sterilized with superheated steam. Rubber gloves were first used in surgery in 1890. Anesthetics and antiseptics made surgery much safer. ★ In 1851 Herman von Helmholtz invented the ophthalmoscope. In 1853 two men, Alexander Wood and Charles Pravaz invented hypodermic needles. Then in 1866 Clifford Allbut invented the clinical thermometer. In 1895 x-rays were discovered by Wilhelm Roentgen. The same year aspirin was also invented.  19th century medicine ★ In 1882 Robert Koch (1843) was the first who isolated the germ that causes tuberculosis and he isolated the germ that causes cholera in humans. Koch is renowned as the founder of microbiology. ★ He received Nobel Prize in Physiology or Medicine for his work on tuberculosis. ★ The germ that causes typhoid was isolated in 1880. The germ that causes diphtheria was discovered in 1882. In 1884 the germs that cause tetanus and pneumonia were both discovered. Immunization against diphtheria was invented in 1890. A vaccine for typhoid was invented in 1896. ★ Pasteur introduced his third vaccine—rabies vaccine— in 1885 the first vaccine for humans since Jenner's for smallpox. Donations poured from across the globe to fund funding the Pasteur Institute, the world’s first biomedical institute.  MEDICINE IN THE 20TH CENTURY ★ Medicine made huge advances in the 20th century. ★ 1901: Landsteiner, an Austrian biologist and physician, identified the different blood types and classified them into blood groups. The Rhesus blood group system was found in 1937. ★ 1906: Frederick Hopkins, an English biochemist, discovered vitamins and suggested that vitamin deficiencies were the cause of scurvy and rickets. ★ 1921: Canadian American medical scientists discovered insulin. ★ The first non-direct blood transfusion was made in 1914. The EEG machine was first used in 1929. ★ 1923–1927: Scientists discovered and used the first vaccines for diphtheria, pertussis (whooping cough), tuberculosis (TB) and tetanus.  20th century medicine Traditional open surgery was partially replaced by minimally invasive surgery. Many new drugs were developed. In 1910 a drug used to treat syphilis was discovered. In 1928: Sir Alexander Fleming, a Scottish biologist and pharmacologist, discovered penicillin, which came from the mold Penicillium notatum. This discovery changed the course of history, saving millions of lives. In 1946: American pharmacologists discovered the first effective cancer chemotherapy drug, nitrogen mustard. They noticed that soldiers had abnormally low levels of white blood cells after exposure to nitrogen mustard. The World Health Organization was founded in 1948 as a United Nations agency to improve global health. In most of the world, life expectancy has improved since then.  20th century medicine ★ The first kidney transplant was performed in 1950. From the 1950s the invention of the heart-lung machine allowed the development of open-heart surgery and for new surgery procedures to be tried out. ★ Several new vaccines have been developed in the years after WWII, against infections such as measles, mumps, several strains of influenza and human papilloma virus. ★ 1952: Jonas Salk, an American medical researcher and virologist, invented the first polio vaccine. He was called a “miracle worker,” because polio had become a serious public health problem in the world after World War II. A vaccine for measles was discovered in 1963. ★ 1960: A group of Americans developed cardiopulmonary resuscitation (CPR). They tested it successfully on a dog first, and the technique saved a child’s life shortly afterward. ★ Meanwhile, surgery made great advances. The first implantable pacemaker in 1958. The first heart transplant was performed in 1967 by Christiaan Barnard. The first artificial heart was installed in 1982. The first heart and lung transplant was performed in 1987.  20th century medicine Treatment for infertility also improved in the late 20th century. The first test-tube baby was born in 1978. In the late 20th century medicine continued to develop rapidly. In 1980 the World Health Organisation announced that smallpox had been eradicated. In the 1980s the age of video laparoscopy allowed minimally invasive surgeries advances to grow in 1981 a terrible new disease called AIDS was isolated. Meanwhile in 1975 Computerized Axial Scanning or CAT was introduced. In 1983 Magnetic Resonance Imaging or MRI was introduced. Gene therapy was introduced in 1990. As infectious diseases became less lethal, Among the most widespread causes of death, heart disease became the first. The most common causes of death in developed countries were now tumors and cardiovascular diseases. MEDICINE IN THE 21ST CENTURY Marshall and R. Warren, Nobel Prize winners in 2005, discovered how Helicobacter pylori cause 80% of all gastric ulcers. In 2000, Scientists completed the draft of the Human Genome Project (HGP). Involving collaborators from around the world, it aimed to determine the sequence of chemical base pairs that make up DNA + To identify and map all 20,000–30,000 or so genes of the human genome. The project may lead to the development of new medications and treatments to prevent or cure genetically-based diseases. Genomics advancements have furthered cancer research and treatment with the creation of more targeted drugs. In the early 21st century new types of transplants were performed. In 2005 the first face transplant took place. Then in 2011, the first leg transplant. In 2012, the first womb transplant, in 2021 the first trachea transplant. Among the syndromes which are not yet curable, degenerative mental disorders became more worryingly common across the whole of the population. Alzheimer's disease has affected more than 35 million people so far and it is expected to double by 2030.  21st century medicine 2020: Advances In Genetic Engineering: The most well-known process for accomplishing this is CRISPR, targeting editing a living organism’s genes. This gene “scissor” tool “snips out” pieces of DNA to restore them to their normal function,” Correcting congenital defects and mutations that cause disease. The 2020 Nobel Prize in Chemistry was awarded to Jennifer Doudna and Emmanuelle Charpentier for developing the technique. Charpentier and Doudna showed that these genetic tools could be controlled to cut any kind of DNA molecule at a designated location. It can also be used to create agricultural products, genetically modified organisms, and control pests and pathogens. In 2020, CRISPR was used effectively to treat glioblastoma and metastatic ovarian cancer. This technology will make it possible in the future to prevent genetic and inherited conditions, such as heart disease, leukemia, cystic fibrosis, and hemophilia. Targeted Cancer Therapies: Doctors are starting to use a new class of drug called biologics to treat cancer and other diseases. Unlike conventional chemotherapy, which can destroy fast-growing healthy cells, these drugs target specific proteins on cancer cells and cause less damage to the whole body.  21st century medicine Robotics: Robotics and remote-controlled tools can already help surgeons carry out certain types of procedures by controlling the movements of a surgical robot while looking at a monitor. This enables greater precision, less side effects and removes some of the risks of human error. Advances in nanomedicine for drug delivery: nanomedicine uses tiny designed nanoparticles made to target specific cells taking medicine directly to the affected cells. Nanomedicine avoids healthy cells and limits side effects, improving drug effectiveness and survival rates. Nanotechnology-based drugs are already on the market for cancer and transplants. Next generation of mRNA vaccinology: the COVID-19 pandemic showed that the world needed the rapid development of a vaccine that was easily deployable around the globe. Because of previous research that had laid the groundwork for this technology, an effective COVID-19 vaccine was developed, produced, approved and deployed in less than a year. This landscape-changing technology offers the potential to quickly eliminate some of healthcare’s most challenging diseases. Takeaway: Challenges today ★ While modern medicine continues to make headway, some significant challenges remain. ★ One is the growing risk of antibiotic resistance, partly in response to the overuse of antibiotics and also because pathogens, or germs, are adapting to resist them. ★ Another is the increase in pollution, environmental hazards and global warming. Another to consider is intrusion of human activity on the wild/natural world, urban areas expanding and wild hunting. This last cause stands behind the development of covid-19. ★ And the last most recent one is the rise of zoonoses (disease transmitted from animals to humans) epidemics, like covid-19. Further readings: o Medical milestones: Key advances since 1840: https://www.bmj.com/content/suppl/2007/01/18/334.suppl_1.DC2/milestones.p df o Medicine in the 20th century: https://www.britannica.com/science/history-of-medicine/Medicine-in-the-20th-ce ntury o What is modern medicine? https://www.medicalnewstoday.com/articles/323538#medical-milestones-19th-ce ntury o Weird and Wonderful Medicine in 17th and 18th Century England: https://www.historic-uk.com/HistoryUK/HistoryofEngland/Weird-Wonderful-17th- 18th-Century-Medicine/ o A History of medicine https://localhistories.org/a-history-of-medicine/ o A brief history of Western medicine: https://www.sciencedirect.com/science/article/pii/S2095754820300545 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: Nobel prize for CRISPR a gene editing tool technology 2020 covid-19 vaccine Source:http://www.datesandevents.org/events-timelines/10-history-of-medicine-timeline.htm