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A Brief History of Medicine

Fleming Laboratory at St Mary's Hospital, third floor, corner window

 

No doubt human kind has tried to alleviate its suffering throughout history, but the earliest medical systems and writings seem to originate in Asia around 2000BC. The earliest medical texts dating to this time are The Yellow Emperor's Inner Canon of Medicine, the Divine Husbandman's Materia Medica, the Canon of Problems, and the Treatise of Cold Damage Disorders. The first two of these works were scriptural in status, considered as the wisdom and teachings of legendary sages. These texts could not be challenged, since they were the word of gods. The second two were fundamental, but nevertheless still regarded as human knowledge which in exceptional circumstances could be queried. Nowadays we look at such attitudes to medicine with suspicion, but in China change did not, and to some extent still does not, have the value it does in the West. Stability of the state was linked to stability of the body. Medical systems were based on invisible energy channels, and such things can never be seen, tested or verified. For this reason, apart from any benefits it might involve, Asian medicine has had great durability through history. There was simply nothing physical to challenge or disprove. In many ways Asian medicine remains now as it was in 2000BC. As a massage therapist, some of the techniques I've used constitute a kind of living ancient history.

 

It was in ancient Greece that medicine was placed on a more recognisably modern footing, when Hippocrates (460 - 377BC) rejected a supernatural basis for healing and disease. When the Roman Empire collapsed around 300AD, this developing scientific world view was lost for around a thousand years to a fundamentalist Christian outlook. It wasn't until the fifteenth century that the writings and approach to knowledge of the ancient world began to be rediscovered. Ironically, it was at this point that the writings of Greek doctors such as Hippocrates were venerated in their turn, so that Greek medicine came to be regarded with the same unquestioning reverence as ancient supernatural Chinese texts. Once again some awkward person had to come along to start questioning what had long been thought to be true. That awkward person was the anatomist Vesalius ( 1514 - 1564) who realised that some of the things which Greek doctor Galen had said about the heart were incorrect. Vesalius realised that Galen was wrong about the pattern of blood flow through the heart. Unlike invisible energy flows of Chinese medicine, blood flow was something physical. There was something to see, to challenge, and that's what Vesalius had the courage to do. By 1527 the even more awkward town physician at Basle, Philippus Aureolus Bombastus von Hohenheim, known to history as Paracelcus, burned Avicenna's Canon, the most revered text of learned medicine, and a number of books by Galen. The early 1600s saw the English physician William Harvey developing an understanding of circulation, showing that circulation depended on the heart, rather than on arteries pumping blood. He had travelled to Padua and obeyed pleas of the Paduan anatomists to see for oneself. Harvey's work represented a crucial change in looking at medicine in terms of measurable quantities rather than undefined qualities. In the crucial eighth chapter of his book De Motu Cordis et Sanguinis in Animalibus (On the Motion of the Heart and Blood in Animals) Harvey discussed the "amount and source" of blood crossing from veins to arteries. This is a quantative question. Medieval medicine had seen the human body in terms of different kinds of state, states of wet and dry, heat and cold. A high temperature was a different humour to a normal temperature. After Harvey people began to see, for example, a high temperature as a variation of a single measurable sign. Harvey published his work on blood circulation in 1628. The first recorded use of the word "thermometer" in English dates to only a few years later, 1633 (see The Discoverers by Daniel Boorstin P370). Harvey's stress on observation was then enhanced by the increasingly widespread use of microscopes. The microscope had been invented by Dutch spectacle makers around 1600, and this device, combined with a new willingness to look, meant that Western medicine began to develop a more scientific approach. Harvey had correctly traced the circulation of blood through the heart and lungs, but had lacked a microscope to see tiny capillaries where deoxygenated blood picks up oxygen in the lungs, to continue its circuit around the body. Harvey just had to have faith that the link was there. In 1661 Marcello Malpighi of Bologna saw lung capillaries using a microscope, and the missing link in Harvey's theory of blood circulation was filled.

Into the eighteenth century, pharmacology became hugely influential in medicine. Rather than a medicine of vague qualities and energy, pharmacy was a world of carefully controlled quantities of drugs, given in carefully managed programmes. Pharmacy more than anything else illustrates the change from the idea of indefinable qualities to the idea of measureable quantities in medicine. Plants had been used since ancient times to relieve symptoms, and the first botanic garden in Britain devoted solely to growing medicinal plants was the Oxford Botanic Garden, opened in 1633. The Chelsea Physic Garden followed soon after in 1673. Hall's Croft in Stratford, house of seventeenth century doctor John Hall, has a range of herbs that would have been used in his practice. Pharmacology came about when efforts were made to isolate substances in plants that were having a therapeutic effect. The beginnings of modern pharmacy can be traced to the work of Pierre-Joseph Pelletier, and Francois Magandie. Early in the nineteenth century these two French men began to isolate therapeutic substances from plants. As early as 1809 Magandie was getting close to isolating strychnine. By 1817 Pelletier was using mild solvents to isolate all kinds of plant substances. Perhaps the most important of these was quinine, which allowed treatment of malaria. The next step was to put these substances into a convenient form. Initially pills were produced in a pharmacy, with the pharmacist combining different powders using glucose syrup, cutting up the resulting mass, and then rolling the cut pieces in talc or, if their customers were rich, in silver or gold, to produce a finished pill. Mass production of sugar coated pills started in France. Then in 1866 R. Warner of Philadelphia refined the pill making process and began production of small pills. Gelatine capsules went into general use in 1875. Tablet compressing machines were introduced in England by William Brokeden in 1843, and in the USA by Jacob Denton in 1864. Henry Wellcome teamed up with Silas Burroughs, and they set themselves up in Holborn, and brought medicines to Britain in the form of mass produced tablets. A highpoint for pharmacology then came in 1928 when Alexander Fleming isolated penicillin from a mould growing in a petri dish in his laboratory at St Mary's Hospital, Paddington. By 1941 penicillin was allowing effective treatment of bacterial infection, which represented a massive step forward in medicine.

 

Edward Jenner's house in Berkeley, now the Jenner Museum

Alongside pharmaceutical development, techniques of vaccination were advancing, and once again this crucial technique resulted from close scientific observation. Edward Jenner (1749 - 1823), a doctor from Berkeley in Gloucestershire, was a practical man who had no time for the classical education which doctors commonly went through in the eighteenth century. He was more interested in studying the habits of birds and mice than reading Latin texts. As a young man he had known that university would not suit him. Instead Jenner became an apprentice in a surgical partnership at Chipping Sodbury. Rapidly making a name for himself as a sensible and observant doctor, he went to work in London's St George's Hospital in 1770, and was offered a place as a naturalist on Captain Cook's second voyage in 1771. Turning this offer down, Jenner returned to Berkeley, to work as a doctor and continue his wide ranging researches. Small pox was always an interest. Jenner had been given a dose of small pox as a boy, using the "mild" strains employed in those days to try and confer immunity without killing the patient. The suffering he then endured led to a lifelong obsession with the disease. 1796 saw the famous experiment based on folk wisdom that people who caught the mild disease cowpox were immune to deadly smallpox. In May 1796 Jenner took some material taken from the pock marked hand of one of his patients with cowpox, and rubbed it into a few scratches made in the arm of James Phipps. James was the eight year old son of Jenner's gardener. An attempt was then made to infect the boy with smallpox, using "mild" immunising strains. James proved immune to the virus. Many other experiments followed, the research published in 1798 as An Inquiry Into The Causes And Effects Of The Variolae Vaccine; A Disease Discovered In Some Of The Western Counties Of England, Particularly Gloucestershire, And Known As Cow Pox. With this paper the modern practice of immunisation began. Techniques were then refined by a long line of researchers. Notably in 1885 Louis Pasteur discovered how to use weakened bacteria to confer immunity without causing disease. Pasteur gave the first rabies vaccine in 1885 to a boy who had been bitten by a rabid dog. In 1905 Emil von Behring, and Shibasaburo Kitasato discovered that antibodies against diphtheria and tetanus toxins could be used as vaccines. On this basis immunisation became a powerful medical tool. In the eighteenth century 10% of all deaths, and 35% of child deaths were caused by smallpox. Even in the twentieth century, 300 million people were killed by smallpox, more than the death toll of all the twentieth century's wars combined. Using immunisation smallpox was completely eradicated by 1980 (figures from Edward Jenner Museum materials).

 

 

Former chapel at St Thomas's Hospital, now housing the Old Operating Theatre Museum

In tandem with advance in immunology and pharmacy, surgery was also making great strides. Back in the early nineteenth century when poet John Keats was training to be a surgeon at Guys Hospital, the only anaesthetic was alcohol. This meant surgery was confined to amputations, and to dealing with superficial complaints. There was an operation to remove bladder stones that took over an hour and involved entering the bladder from the back. It doesn't bear thinking about. Keats worked at Guys and St Thomas's between 1809 and 1816, and it was at about this time that anaesthetics were first developing. Humphrey Davy discovered nitrous oxide in 1799, and in 1805 Serturner isolated the active ingredient from opium derived from poppies, and named it morphine. It wasn't until the 1840s, however, that anaesthetics were used in surgery. William Thomas Morton performed the first surgery using nitrous oxide in Boston in October 1846. Local anaesthesia was first used by Doctor Carl Koller, in eye surgery in 1884.

The history of surgery, and of the herbal medicine that preceded pharmacology can be explored at the Old Operating Theatre and Herb Garret in Southwark London, housed in what was once the chapel of St Thomas's Hospital. (St Thomas's is also relevant to the history of nursing. More details can be found on our page dedicated to The Florence Nightingale Museum).

 

All these advances, then had to be combined with a change in attitude to public health. Preventing people getting sick in the first place was as important as treating them when they were sick. A survey in the 1840s found two thousand eight hundred and fifty people people living in ninety five decrepit houses in the St Giles area of London. These conditions bred disease, and between November and December 1847 half a million Londoners were infected with Typhus, out of a population of two and a half million. Cholera was also endemic due to poor sanitation. A breakthrough came in 1854 when John Snow worked out that cholera was a waterborne infection, and that all cases in Soho at that time related to the use of water from one pump. In 1855 Snow advocated massive improvements in drainage and sewerage systems. The summer of 1858 saw the "Great Stink" when summer heat combined with sewerage in the Thames caused an overpowering smell which focused the minds of MPs in the Houses of Parliament beside the fetid Thames. Work started on a sewerage system which was completed by 1875. Millions of lives were saved by this work, and the Crossness Pumping Station in west London is as relevant to the history of medicine as the Old Operating Theatre.

 

These developments coming together meant that medicine was much more powerful by the twentieth century. We should not, however, get too carried away with the supposed scientific basis of modern Western medicine. The first randomised trial of a medicine using human subjects did not take place until 1946, with the trial of streptomycin in the treatment of tuberculosis. Medicine remains a mysterious, and often irrational business. The colour of a drug, seemingly only used to ease visual identification, has a bearing on how effective it is perceived to be. People also continue to buy medicines which have no proven effect, and this is true of "mainstream" as well as complimentary medicine. I worked in pharmacies for many years and it always gave me pain that the British National Formulary, the Bible of pharmacy in Britain, dismissed many best selling over the counter medicines as having no effect at all. It seems people were wasting their money on sugary throat pastilles, antiseptic creams, and cough medicines. A display at the Royal Pharmaceutical Society Museum told me that in 2005 £96.7 million was spent on cough medicine, while the British National Formulary has the following to say about the ingredients in such medicines: "Expectorants are claimed to promote expulsion of bronchial secretions but there is no evidence that any drug can specifically facilitate expectoration. The assumption that sub-emetic doses of ammonium chloride, ipecacuanha and squill promote expectoration is a myth. However, a simple expectorant mixture may serve a useful placebo function and has the advantage of being inexpensive". As Henry James says in one of his novels, disease is a state "of suffering as opposed to doing. 'To do' - it hardly mattered what - would therefore be an escape" (Portrait of a Lady P414).

 

 

Oxford Botanic Garden

To some extent medicine remains the mysterious business it has always been. There is evidence that as medical techniques improve people actually start to feel worse about themselves. Although the first part of the twentieth century saw huge advances in medical care, a study quoted by Roy Porter found that between 1928 and 1931 self-reported illness increased by one and a half times (see The Greatest Benefit to Mankind P685). It is often assumed that stroke and heart disease are increasing, when in fact between 1971 and 1991 stroke deaths declined by 40% and coronary heart disease fatalities by 19%. When I was training as a massage therapist I was told that the increasing stress of modern life was leading to all kinds of new disease. When I suggested that life is actually less stressful than it used to be, and quoted a few studies on the decline in working hours, I was met with blank looks.

 

Although in most instances a decline in health is more perceived than real, it is a sad fact that the war on bacteria and viruses actually creates new strains to defeat our medicines. The Greeks, those clever people who first looked at medicine in a rational way, already seemed aware of the paradox of medicine. The word pharmakos, from which we derive our modern word pharmacy, denoted both medicine and poison, and the god Apollo was the god of physic, and also the sender of disease. Perhaps we should remember that life is contradictory at its base. Bodies are continually breaking themselves down and renewing themselves in an endless cycle of death and rebirth. Medicine cannot hope to stop this process and produce some kind of endless stability. We cannot put up an impenetrable wall between us and the rest of life. The borders between us and the microbial "enemies" we fight are not clear. Many of the constituent parts of our cells were probably derived from bacterial invasion in the distant past. As Lynn Marguilis writes in her book Microcosmos "Our own cells... most likely require former bacterial intruders to live and breathe" (P126). Indeed many of our modern diseases involve parts of our defense systems turning on our own bodies, and the uneasy alliance of ancient cells within us still carries old enmities. In the end medicine remains as mysterious as those invisible Chinese energy channels.

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