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Part 1 ina 2-part series. ‘Three distinct periods inthe history of medicine are associated with three different places and therefore different methods of determining diagnosis: From the middle ages to the 18th century, bedside medicine was prevalent; then between 1794 and 1848 camme hospital medicine; and from that time forward, laboratory medicine has served as medicine's lodestar. The laboratory's contribution to modern medicine has only recently been recognized by historians 23s something more than the addition of another resource to medica science and is now being appreciated asthe seat of medicine, where clinicians account for what they observe in thei patients ‘The first medical diagnoses made by humans were based on what ancient physicians could observe with their eyes and ‘ears, which sometimes also included the examination of human specimens. The ancient Greeks attributed all disease to disorders of bos fluids called humors, and during the late medieval period, doctors routinely performed uroscopy, Later, the mieroscope revealed not only the celular structure of human tissue, but also the organisms that cause disease. More sophisticated diagnostic tools and techniques-such as the thermometer for measuring temperature and the stethoscope for measuring heart rate-were notin widespread use until the end of the 19th century. The clinical laboratory would not become a standard fixture of medicine until the beginning ofthe 20th century. Ths 2-part article reviews the history and development of diagnostic methads from ancient to modem times as wel as the evolution of the clinical laboratory from the late sth century to the present. Ancient diagnostic methods In ancient Egypt and Mesopotamia, the earliest physicians made diagnoses and recommended treatments based primarily on observation of clinical symptoms. Palpation and auscultation were also used. Physicians were able to (describe dysfunctions ofthe digestive tract, heart and circulation, the liver and spleen, and menstrual disturbances; Unfortunately, this empiric medicine was reserved for royalty and the wealthy. ther les-than-scentific methods of diagnosis used in trating the middle and lower classes included divination through ritual sacrifice to predict the outcome of iless. Usualy @ sheep would be killed before the statue of a god, Is liver was ‘examined for malformations or pecullarities; the shape of the lobes and the orientation of the common duet were then sed to predict the fate ofthe patient. "Ancient physicians also began the practice of examining patient specimens. The oldest known test on body fluids was done on urine in ancient times (before 400 2¢). Urine was poured on the ground and observed to see whether it attracted insects. Hit did, patients were diagnased with bos, “The ancient Greeks also saw the value in examining body fluids to predict disease. At around 300 BC, Hippocrates promoted the use ofthe mind and senses as diagnostic tools, a principle that played a large part in his reputation as the "Father of Medicine.” The central Hippocratic doctrine of hurmoral pathology attributed all disease to disorders of fluids of the body. To obtain a clear picture of disease, Hippocrates advocated a diagnostic protocol that included tasting the patient's urine, listening tothe lungs, and observing skin color and other outward appearances. Beyond that, the physician was to “understand the patient as an individual." Hippocrates related the appearance of bubbles on the surface of urine specimens to kidney disease and chronic liness. He also related certain urine sediments and blood and pusin urine to disease. The frst description of hematuria, or the presence of blood in urine, by Rufus of Ephesus Surfaced at around AD 50 and was attributed tothe failure of kidneys to function properly in fiering the blood.Later (c.AD 180), Galen (AD 131-201), who is recognized as the founder of experimental physiology, created a system of pathology that combined Hippocrates hurnoral theories withthe Pythagorean theory, which held thatthe four elements {earth a, fre, and water), corresponded to various combinations ofthe physiologic qualities of dry, cold, hot, and oot, These combinations of physiologic characteristics corresponded roughly to the four humors of the human body: rot s moist blood; hot + dry = yellow bile; cold + molst= phlegm; and cold + dry = black bile. Galen was known for PRptaiing everything in ight of his theory and for having an explanation for everything. He also described dlabetes as cdiamhes of urine’ ond noted the normal relationship between fluid intake and urine volume, His unwavering belief in his own infallibilty appealed to complacency and reverence for authority. That dogmatism essentially brought innouation and discovery in European medicine toa standstill for nearly 14 centuries, Anything relating to anatomy, phystology, and disease was simply referred back to Galen as the final authority fam whom there could be no appeal Middle Ages nmedieval Europe, early Christians believed that disease was either punishment for sin or the result of witchcraft or possession. Diagnosis was superfluous. The basic therapy was prayer, penitence, and invocation of saint. Lay rmecicine Posed agnosis on symptoms, examination, pulse, palpitation, percussion, and inspection of excreta and sometimes Semen. Diagnosis by “water costing” (uroscopy) was practiced, and the urine flask became the emblem of medieval sarzcine. By AD 200, Insaeludacus, 2 Jewish physician and philosopher, had devised guideline for the use of urine a5 2 agnostic ald; and under the Jerusalem Code of 1020, fllue to examine the urine exposed a physician to public bestings, Patient carried their urine to physicians in decorative flask cradled in wicker baskets, and because urine ould be shipped, diagnosis at long distance was common. The frst book detailing the color, density, quality, and sediment found in urine was written around this time, as well. By around AD 1300, uroscopy became so widespread that ‘twas at the point of near universality in European medicine. ‘Medieval medicine also included interpretation of dreams in its diagnostic repertoire, Repeated dreams af floods indicated "an excess of humors that required evacuation"; and dreams of fight signified “excessive evaporation of humors.” Seventeenth century ‘The medical advances ofthe 17th century consisted mostiy of descriptive works of bodily structure and function that Tald the groundwork for diagnostic and therapeutic discoveries that followed. The status of medicine was helped along by the introduction ofthe scientific soclety in Italy and by the advent of periodical iterature, Considered the most mamentous event in medical history since Galen's time, the discovery of the circulation of blood by Wiliam Harvey (1578-1657) marked the beginning ofa period of mechanical explanations foro variety af functions and processes including digestion, metabolism, respiration, and pregnancy. The English scientist proved through vivisection ligation, and perfusion thatthe heart acts as @ muscular pump propeling the blood throughout the body in 2 continuous eye, ‘The invention of the microscope opened the door to the invisible world just as Galileo's telescope had revealed a vast astronomy. The earliest microscopist was a Jesult priest, Anthanasius Kircher (1602-1680) of Fulda (Germany), who was probably the first to use the microscope to investigate the causes of disease. His experiments showed how maggots and bther living creatures developed in decaying matter. Kircher's writings included an observation that the blood of patients with the plague contained “worms"; hawever, what he thought to be organisms were probably pus cells and Fed blood corpuseles because he could not have observed Bacilus pests with a 32-power microscope. Robert Hooke (1635-1703) later used the microscope to document the existence of "ttle boxes’ or cells, in vegetables and inspired the Works of later histologsts; but one of the greatest contributions to medical science came from Italian microscopist, ‘Marcello Malpighi (1628-1654), Malpighi, wha is described as the founder of histology, served as physician to Pope Innocent Xil and was famous for his investigations of the embryology ofthe chick and the histology and physiology of the glands and viscera. His work in embryology describes the minutiae of the aortic arches, the head fold, the neural ‘groove, and the cerebral and optic vesicles.Ufoscopy was stillth widespread‘use andad' gained poputinty as a metioa'to aliagnose “thibrasis, “or ibve-stét your |women, and sometimes to test for chastity. Other methods of urinalysis had their roots in the Ith century as well. The ‘gravimetric analysis of urine was introduced by the Belgian mystic, Jean Baptiste van Helmont (1577-1644), Van Heimont ‘weighed a numher of 24- hour specimens, but was unable to draw any valuable conclusions from his measurements. It ‘wasn't until the late 17th centurywhen Frederik Dekkers of Leiden, Netherlands, observed in 1694 that urine that contained protein would form a precipitate when boiled with acetic acid that urinalysis became more scientific and ‘more valuable. The best qualitative analysis of urine atthe time was pioneered by Thomas Willis (1621-1675), an English physician and proponent of chemistry. He was the first to notice the characteristic sweet taste of diabetic urine, which established the principle fr the differential diagnosis of diabetes mellitus and diabetes insipidus. Experiments with blood transfusion were also getting underway with the help ofa physiologist in Cornwall, England, ‘named Richard Lower (1631-1681). Lower was the first to perform direct transfusion of blood from one animal to another. Other medical innovations of the time included the intravencus injection of drugs, transfusion of blood, and the first attempt to use pulse rate and temperature as inicators of heath status. Eighteenth century ‘The 48th century is regarded as the Golden Age of bath the successful practitioner as well as the successful quack. Use ‘of phenology (the study of the shape of the skull to predict mental faculties and character), magnets, and various powders and potions for treatment of iness were a few of the more popular scams. The advancement of medicine during ths time was more theoretical than practical. Internal medicine was improved by new textbooks that catalogued and described many new forms of disease, as well as by the introduction of new drugs, such as digitalis and opium. The state of hospitals in the I8th century, however, was alarming by today's standards, Recovery from surgical operations was rare because of septicemia, The concept of antisepsis had not yet been discovered, and hospitals were notorious for filth and disease well into the 18th century (ne notable event that Is 2 forerunner to the modern practice of laboratory measurement of prothrombin time, plasma thromboplastin time, and other coagulation tests, was the discovery of the cause of coagulation. An English physiologist, William Hewson (1739-1774) of Hexham, Northumberland, England, showed that when the coagulation of the blood is delayed, a coagulable plasma can be separated from the corpuscles and skimmed off the surface. Hewson found that plasma contains an insoluble substance that can be precipitated and removed from plasma ata temperature slighty higher than 50°C. Hewson deducted that coagulation was the formation in the plasma ofa substance he called "coagulable lymph," which is now knavin as flrinogen. later discovery that fibrinogen Is 2 plasma protein and that in coagulation its converted int fibrin, attests to the Importance of Hewson's work. ‘The clinical diagnostic methods of percussion, temperature, heart rate, and blood pressure measurements were further refined, and there were some remarkable attempts to employ precision instruments in diagnosis. Leopold Avenbrugger (1722-1803) was the first to use percussion of the chest In diagnosis in 1754 in Vienna. This ‘method involved striking the patient's chest while the patient holds his or her breath. Auenbrugger proposed that the chest of @ healthy person sounds lke a cloth-covered drum. A student of Auenbrugger's, Jean Nicolas Corvisart, a French physician at La Charte n Paris, pioneered the accurate diagnosis of heart and lung diseases using Auenbrugger's chest ‘humping technique. Corvisar's transition of Avenbrugger's treatise on percussion, "New Invention to Detect by Percussion Hidden Diseases in the Chest," popularized the practice of thumping on a patient's chest. The resulting sounds are different when the lungs contain lesions or fluids than in healthy people, This observation was validated by postmortem examination James Currie (1756-1805), a Scot, was the first to use cold baths in treatment of typhoid fever; and by monitoring the patient's temperature using a thermometer, he was able to adjust the temperature and frequency of the baths to treat individual patients t took another hundred years, however, before thermometry became a recognized feature In clinical diagnosis.11707, Sir John Floyer (1649-1734) of Staffordshire, England, introduced the concept af measuring pulse rate by timing pulse beat with 2 watch. He counted the beats per minute, and tabulated the results; but is work was ignored because of a healthy skepticism for an old Galenic doctrine of there being a special pulse for every disease. ‘The groundbreaking work for measuring blood pressure was done by Stephen Hale, (1677-1761), an English clergyman, By fastening along glass tube inside a horse's artery. Hales devised the frst manometer or tonometer, which he used to ‘make quantitative estimates ofthe blood pressure, the capacity of the heart, and the velocity of blood current. Hales’ Work was the precursor forthe development ofthe sphygmomanometer used today to measure arterial Blood pressure, Additional advances in urinalysis occurred with J.W. Tichy’s observations of sediment in the urine of febrile patients (1774); Matthew Dobson's proof that the sweetness ofthe urine and blood serum in diabetes is caused by sugar (1776); and the development ofthe yeast test for sugar in diabetic urine by Francis Home (1780) Introduction to medical technology chapter 1 Definition of Medical Technology Heinemann — the application of principles of natural, physical and biological sciences to the performance af laboratory procedures which aid in the dlagnosis and treatment of diseases. Fagelson ~ The branch of medicine concerned with the performance of laboratory determinations and analyses used in the diagnosis and treatment of disease and the maintenance of health. ‘Walters ~ the health profession concerned with performing laboratory analyses in view of obtaining information necessary in the diagnosis and treatment of disease as well asin the maintenance of good heath. RA'S527- | also known asthe Philippine Medical Technology Act of 1969. That was approved on June 21 1969. {An auxilary branch of laboratory medicine which deals with the examination of tissues, secretion and excretion ‘of the human body and body fluids by various electronic, chemical, microscopic and ather medical laboratory procedures or techniques either manual or automated which will aid the physician in the diagnosis study and treatment (of disease and in the promotion of health in general, Clinical laboratory itis focity that performs chemical and microscopic examinations of various body fluids like blood and tissues. Pathologist ‘The dicector ofa clinical laboratory s @ pathologist. A pathologists @ licensed physician with 2 specialty in Pathology as certified by the Philippine Board of Pathology. Pathology 's defined as the practice of medicine which contributes to diagnosis, prognosis, and treatment through knowledge gained by laboratory applications to biologic, chemical or physical sciences to man or material obtained from 2 areas of pathology ‘Anatomic Is the dlagnosis for surgical tissues Clinical ~ Specializes in chemical, microbiological and hematologic procedures,Medical Technologist a baccalaureate degree program from a college or university recognized by CHED, completed a specified clinical Internship ina training laboratory by the Bureau of health facilities and DOH Passed the licensure examination ‘administered by the Board of Medical Technology of the Professional Regulation Commission ‘work of a medical technologist + Medical detectives Identify microorganisms and analyze cells + Do blood tests Measure substance in blood and other fluids ‘Identify organisms causing infection and disease Operate complex apparatus, instrument and machines 1 Use standards and control to improve the celiility of laboratory results Work under pressure with speed and ‘accuracy and precision They adhere to high ethical standards of performance Medical Technician {An individual certified and registered with PRC to run various tests under the supervision ofa registered medical technologist or pathologist. May also log specimens in the laboratory and prepare samples for testing Employment opportunities for medical technologist ‘+ Medical technology generalist in a hospital government or private, clinical laboratories ‘Medical technology specialist (mierabiology, hematology, blood banking, clinical chemistry, etc) Clinical laboratory supervisors chief medical technologist and laboratory owners Sales and public relations representative, or educational representatives for a company or a part of the health program for the emplayees, Researchers (industrial or medical research) ‘+ Teachers or instructor in high school or in college handling chemistry, mathematics and especially biological sciences or medical sciences ‘+ Opportunities for employment abroad A stepping stone to a medical career To succeed in the medical technology profession a person needs ‘© Stamina ‘© Good eve sight © Anormal color vision © Manual dexterity ‘© Good intellect and an aptitude forthe biological sciences ‘+ Caring atitude Goad cammunication skls and ability to relate wellto fellow workers © Observant + Motivated * Able to perform precise manipulations and calculations Good organizational skills + Service oriented + Patience Honesty, accuracy and skils + Dedication + Emotional maturity # °X factor makes one likeable not only as a medical technologist but as a total person.MEDICAL TECHNOLOGY PRACTICE WAS INTRODUCED BY: ‘THE 26TH MEDICAL INFANTRY OF THE 6” US ARMY. First Clinical Laboratory inthe Philippines + QUIRICADA ST,, Sta. CRUZ, MANILA + (MANILA PUBLIC HEALTH) ‘The lab offered training pragrams to high school graduates as early as FEBRUARY, 1944, 1943, (THE US ARMY LEFT in JUNE + Endorsed it to the NATIONAL DEPARTMENT OF HEALTH «= The Department rendered the laboratory non-funcSonal for some time, R. PIO DERODA + ORGANIZED MANILA PUBLIC HEALTH LABORATORY from the remnants of the deserted laboratory. ‘OCTOBER 4, 1945 ‘+ With Dr. Matiane Ieasiano as hs assistant and who was then the MANILA CITY HEALTH OFFICER, 3947 += Training of high school graduates to work as medical technicians by Dr. Pio de Roda and Dr. Prudencia de Sta. Ana + No periad of training was set and no cetificates were given. 1954 ‘AG months laboratory training with certificate upon completion was given tothe trainees. “Dr Sta, Ana prepared the syllabus forthe training program. ‘Medical Technology Educaton in the Philippines + The Training program offered by Dr. Pio De Roda dd not last long. +The FIRST B'S, Degree course in Medical Technology was offered by the PHILIPPINE UNION COLLEGE and MANILA SANITARIUM. * After 2 years, PUC produced is first graduate, Dr esse Umall, now a successful O8-Gynecologist. 1957-1958 + Dr. Antonio Gabriel and Or, Gustavo Reyes ofthe FACULTY of Pharmacy, University of Sto. Tomas offered medical technology as an elective subject to 4 and 5* year BS. Pharmacy students. Rew, Lorenzo Rodriguez Decided to offer it as course because of the popularity of medical technology among pharmacy students JUNE 17, 1957 > Temporary permit was issued by the Dept. of Education, for first to third year students. University ofthe Philippines > Offers 3 similar course but the degree being conferred in 8.S. Public Health