MEDICINE

A. Primitive Medicine 1. Early human beings recognized two

categories of diseases: those attributed to the influence of evil demons or
spirits, and those involving physical disability. Magic played a major part
in the treatment, but so were cleaning and treating wounds by burning,
poultices, and stitching; resetting and splinting dislocations and fractures;
purges, diuretics, laxatives, emetics, and enemas. The use of plant
extracts as medical treatments was especially important.
2. As humans formed distinct cultures, the two trends in primitive
medicine became more institutionalized. Sorcerers and priests took up the
magico-religious approach. The empirico-rational trend, based on
experience and observation and lacking in mystical features, was
practiced at first by priests but was taken up increasingly by nonreligious
physicians. Modern medicine arose primarily from the empirico-rational
trend, as the human body and its functions became better known and as
science led medical practice away from superstition and the spiritual
realm.

B. Ancient Medical Practice 1. In ancient Egypt, by the 3rd

Dynasty, the physician emerged as an early form of scientist. The
Egyptians practiced embalming but their anatomical knowledge remained
at a low level, and they attempted only minor surgical procedures. In
Assyria and Babylonia, the liver was considered the seat of the soul and
was studied to determine the intentions of the gods. Hebrew medicine
was influenced by the Old Testament and emphasized hygienic
regulations, midwifery, feminine hygiene, separation of the sick, and
disinfection of materials capable of harboring and transmitting germs.
Ancient Hindu medicine became quite sophisticated, especially in the
field of operative surgery. Ancient Chinese medicine utilized acupuncture
and a wide array of drugs, including opium.
2. By the 500s BC, Greek medicine had become thoroughly
nonreligious, stressing clinical observation. Greek physicians based their
doctrine on experience gained by trial and error. The Greeks eventually
identified the brain as the physiological seat of the senses. Greece was the
home of Hippocrates, the father of Western medicine, and Aristotle, the
founder of comparative anatomy.
3. Greek medicine influenced conquering Rome. Galen, a Greek,
was the most important physician of the Roman period and influenced
medicine well into the Middle Ages. The Romans made important
contributions in the fields of public health and hygiene with their
organization of street sanitation, water supply, and public hospitals.

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 C. Medicine in the Middle Ages Medical practice reverted to magic
during much of the Middle Ages. Only a few Greek physicians
maintained classical learning. The Arabs, who conquered much of the
world in the 7th century AD, learned and revived Greek medicine and
became the keepers of the tradition through the Middle Ages. In Europe,
medicine became the realm of religious orders such as the Benedictines
and was practiced in monasteries, although sometimes shunned in favor
of prayer. Eventually, nonreligious medicine became acceptable and
began to be taught at universities. The ideas taught there differed little
from the ancient Greek teachings taken from Arab manuscripts. Early
medical scientists such as the English philosopher Roger Bacon made
valuable contributions based on experiment and careful observation but
did not sway the established traditions.

D. Renaissance Medicine No abrupt change in medical thought

occurred in the Renaissance, but criticism directed against Galen and the
Arabists increased, and the doctrines of Hippocrates were revived.
Leonardo da Vinci and others of his time made major advances in
anatomy, the practice of chemotherapy was founded, and important
insights were gained into the nature of contagious diseases.

E. The Dawn of Modern Medicine In the 17th century, the English

physician and anatomist William Harvey demonstrated the method of
blood circulation, and a new medical epoch began. Detailed studies of the
organs, diseases, and processes such as physiology and respiration
quickly followed, conducted by eminent physicians and scientists.
Medical debates focused on minute features of the body, how to treat
particular diseases, and the nature of life itself, whether physical or
chemical. Vitalists believed that the soul is the vital principle, but
mechanists saw the body as a machine and life as a mechanical process.
Important advances were made in the 18th century: the Italian naturalist
and biologist Lazzaro Spallanzani refuted the doctrine of spontaneous
generation; the Swedish botanist and taxonomist Carolus Linnaeus
devised the modern binomial system of biological nomenclature; and the
British physician Edward Jenner discovered the principle of vaccination
as a preventive measure against smallpox and established the science of
immunization.

F. 19th-Century Medicine 1. In the 19th century great advances

occurred in the diagnosis and treatment of disease and in surgical
methods. European researchers established the sciences of embryology
and histology and the central concept of the cell as the seat of disease.
The British scientist Charles Darwin advanced his theory of evolution.

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The Austrian biologist Gregor Johann Mendel laid out the basis of
classical genetics. Studies of fermentation by the French chemist and
microbiologist Louis Pasteur revived interest in the contagion theory of
disease. Pasteur and the German physician and bacteriologist Robert
Koch founded the field of bacteriology, considered the greatest single
advance in the history of medicine; many bacterial diseases became
preventable or controllable.
2. Bacteriology allowed important discoveries, including the role
of white blood cells in destroying microbes, the way in which bacteria are
carried, and the necessity of sterilization to prevent wound infection.
Other advances during this time took place in physiology (including
understanding of various glands and the nervous system), organic
chemistry and metabolism, optics and ophthalmology, and psychology.
The X-ray was discovered by the German physicist Wilhelm Conrad
Roentgen; the French physicists Pierre and Marie Curie discovered
radium. American physicians developed the field of gynecology and
identified mosquitoes as carriers of yellow fever.

G. 20th-Century Medicine 1. The most important medical finding

of the 20th century was the discovery, by the American biologist James
Dewey Watson and the English biochemist Francis Harry Compton
Crick, of the structure of the genetic material, deoxyribonucleic acid, or
DNA. By 1970 the first gene had been synthesized; by the mid-1980s
genetic techniques were being used medically, and genetic engineering
was producing large quantities of pure human substances such as
hormones and interferon. Surgery advanced with the development of
operating microscopes and other techniques that allow delicate
procedures such as reattachment of severed limbs. Medical milestones
were reached with the successful transplantation of organs and the
development of the artificial heart and kidney. Plastic replacements for
joints relieved some patients from crippling arthritis, and lasers were
developed for medical use, especially in eye surgery.
2. Many infectious diseases have been conquered in the 20th
century by improved sanitation, antibiotics, and vaccines. Especially
important were the developments of the sulfonamide antibiotics and
penicillin, which immediately saved many lives in World War II (1939-
1945). Streptomycin, another drug, was used to defeat tuberculosis.
Vaccines are widely used against viral diseases, including poliomyelitis,
diphtheria, tetanus, yellow fever, measles, mumps, rubella (German
measles), hepatitis B, influenza, herpes simplex, and chicken pox.
Vaccine production was aided by new techniques such as tissue culture
production and genetic engineering. In the latter part of the 20th century
many microorganisms became resistant to antibiotics, and new diseases

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emerged, such as Legionnaires' disease and acquired immune deficiency
syndrome (AIDS).
3. In the 20th century the brain was carefully explored. Using
chemical dyes and sophisticated imaging devices, scientists discovered
the specific parts of the brain that control hearing, speech, and movement
of the limbs; they showed that the right and left halves of the brain were
functionally different. The discovery of the chemical/electrical method of
nerve impulse transmission was an important finding, as were the
complex way in which the brain regulates body function by hormones
and the complex connection between emotions and biochemistry.
Treatments became available for neurological diseases such as epilepsy
and Parkinson's disease.
4. Scientific insight into the workings of the immune system and
the structure of antibody molecules has allowed better treatment of
immune disorders, even temporary disabling of the immune system to
prevent rejection of transplanted organs. One form of antibody molecule
proved to be associated with allergy, now viewed as an immune system
disorder. The typing of blood by immune specificity has made transfusion
safe and widely applicable.
5. In recent years, new and better methods of seeing inside the
human body have revolutionized medical diagnosis. The computerized
axial tomography (CAT) scanner is a computer-assisted X-ray device.
Nuclear magnetic resonance imaging (MRI) employs radio waves to
identify molecular structure. Ultrasound produces images from sound
waves, and positron emission tomography (PET) scans the body with
antimatter.
Functional magnetic resonance imaging (FMRI) is a procedure that
uses MRI technology to measure and map brain activity by detecting
changes in the brain’s blood flow and oxygenation.
6. The treatment of mental disorders first became scientific and
successful in the 20th century. The Austrian physician and neurologist
Sigmund Freud pioneered the methods of psychoanalysis. Treatment of
psychosis by lobotomy and electroconvulsive therapy began in the 1930s,
although these are now seldom used. Drug therapy for mental illness
became possible in the 1950s. The first drugs widely used to treat
schizophrenia, the phenothiazines, have since been joined by lithium for
manic depressive disease and tricyclic antidepressants for depression.
Despite these successes, physicians now realize that some patients are not
helped by drugs, and that supportive psychological therapy must be
provided as well.
7. Heart disease, the number one killer in Western countries, has
declined dramatically because of recent medical advances such as cardiac
catheterization, angiography, nerve-blocking drugs, heart valve

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replacement, arterial bypass surgery, and heart transplants. Increased
awareness of the risks of smoking, stress, obesity, high blood pressure,
and elevated blood cholesterol have also helped reduce heart disease.
Cancer has become more prevalent in the 20th century. Research has
linked some cancers with exposure to certain chemicals; smoking is
known to cause lung cancer and other cancers. Surgery and radiation
were primary means of treatment until the 1960s, when drug therapy also
became effective against cancer.
8. The discovery of vitamins and their importance to the body
produced important advances in nutritional medicine. An example is the
discovery of vitamin B12 and its use to treat pernicious anemia.
Similarly, improved understanding of the hormones led to better control
of conditions such as hypothyroidism or cretinism, treated with thyroid
extract, diabetes mellitus, treated with insulin, and various reproductive
disorders, treated with synthetic testosterone and estrogen.
9. Advances have been made in birth control with the improvement
of intrauterine devices and the development of oral contraceptives.
Solutions to some fertility problems have been provided by in vitro
fertilization (“test-tube” babies) and transplantation of fertilized ova from
one womb to another. Diagnosis of some birth defects can now be made
through amniocentesis.
10. Complex medical ethics problems have gained increasing
attention, especially the question of abortion and the decision whether to
remove life support systems from terminally ill patients. Medical
treatments became increasingly expensive in the 20th century, and many
people came to distrust the orthodox medical establishment. This
situation led in the United States to the consumer medical movement, in
which people attempted to take control of their own health, largely
through preventive medical practices, and to understand more about
normal and diseased bodily function. Outgrowths of the movement
included many popular medical reference books and development of the
field of holistic medicine, which promotes good nutrition, physical
exercise, and “self-regulation” techniques, such as biofeedback and
relaxation.