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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 compromising 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. The medical system was 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 healing and disease based on the supernatural. Ironically, however, the writings of Greek doctors such as Hippocrates were venerated in their turn, so that after the loss of the Greek and Roman civilisations, through the Dark Ages, Greek medicine was regarded ironically with the same unquestioning reverence as the 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 the Greek doctor Galen had said were incorrect. Vesalius realised that Galen was wrong about the pattern of blood flow through the heart. Unlike the invisible energy flows of Chinese medicine the flow of blood 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 Paracelsus, town physician at Basle, burned Avicenna's Canon, the most revered text of learned medicine, and a number of books by Galen. The early 1600s saw William Harvey developing an understanding of circulation, showing that circulation depended on the heart, rather than on arteries pumping the blood. He had travelled to Padua and obeyed the plea of the Paduan anatomists to see for oneself. In 1600 the microscope had been invented by Dutch spectacle makers, and this device, combined with a new willingness to look, meant that Western medicine began to develop a more scientific approach. In fact it was in the field of medicine that science, the use of direct observation in the gathering of knowledge truly began.

 

Crest of the Royal Pharmaceutical Society

Into the eighteenth century, pharmacology became hugely influential 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. Pharmacology came about when efforts were made to isolate the substance in the 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. In the early part of the 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 substances from plants. Perhaps the most important of these was quinine, which allowed the treatment of malaria. The next step was to put these substances into a convenient form. Initially pills were produced in the pharmacy, with the pharmacist combining different powers using glucose syrup, cutting up the resulting mass, and then rolling the cut pieces in talc or, if the customer was 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 process and began the 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 Silias Burroughs, and brought medicines to Britain in the form of mass produced tablets. Burroghs Wellcome and Co set up in Holborn and procured the British patent for the process.

 

 

 

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

It was around this time that surgery was also making great advances. Back at the beginning of the nineteenth century when the 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. 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 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 water bourne 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 the Thames became for all intents and purposes, an open sewer. Since Parliament sat right next to the Thames, minds were focused and 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 steptomycin 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 a chemist shop 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 a large 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 advance 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. (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 an aromatherapist 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 those old enmities. In the end medicine remains as mysterious as those invisible Chinese energy channels.