Jan 3, 2013

Medicine – during 1st to 16th Centuries

By the beginning of the Christian era, the Romans had created a widespread empire that included lands from Gaul (France) through Greece and as far east as Syria. But the center of their empire, Rome, was crowded, dirty, and the frequent victim of epidemics of smallpox, bubonic plague, and other diseases. The Romans adopted important public health measures, building aqueducts to bring fresh water into the city and sewers to carry away wastes. Public baths were established to encourage personal hygiene and special buildings were set aside for care of the sick. War injuries advanced surgery: Roman surgeons could surgically reduce limb fractures, tie ligatures around blood vessels, and cauterize wounds to stop bleeding.

The most influential physician of ancient Rome was a Greek, Galen of Pergamum (ca. 129-ca. 216). He used pulse readings in diagnosing problems, showed that different parts of the spinal cord control different muscles, and demonstrated that arteries contain blood, not air as had been believed. But his misconceptions were many. For instance, he stated that pores connect the two sides of the heart and the liver is the main organ of the blood system. In his 300 known writings on physiology, anatomy, disease, and drugs, over half of which have survived, Galen brought together his ideas and those of predecessors and contemporaries. For more than 10400 years, these writings were considered infallible and were the basis of medical education in Europe.

Following the collapse of the Roman Empire in the fifth century, medical knowledge withered in Europe. Religious teachings about the causes of disease-and about other knowledge-were paramount; questioning these teachings risked charges of heresy and blasphemy. Dissections of human corpses were forbidden and experimental investigations suppressed. The great pestilences of the period were considered the will of God. Infirmaries were founded, but they were crowded, unsanitary places where care consisted of little more than kindness to the dying.

First scientific paper on infectious diseases
Meanwhile, Arab physicians preserved, adopted, and expanded on the rational ideas of the ancient Greeks and Romans. Persian scholar ar-Razi (Rhazes: ca. 860-ca. 925) was the first to write a scientific paper on infectious diseases and the first to describe smallpox; he used opium as an anesthetic, plaster of Paris for casts, and animal guts for sutures. His multivolume al-Hawi (Comprehensive Book) included all the medical knowledge of the time, including work handed down from earlier times.

The opening of hospitals
Beginning in the late eighth century, hospitals providing both medical care and medical apprenticeships were opened in major cities in the Empire. Another vast encyclopedia of medical information, the Qanum (Canon of Medicine) was written by another Persian polymath, Ibn Sina (Avicenna, 980-1037), who recognized that tuberculosis is a contagious disease and that some diseases are spread through water or soil. In the Islamic empire, medicinal plants were avidly collected; the number of drugs used to treat illness increased greatly and pharmacy became a separate vocation.

The Renaissance
In the 12 th century, the first medical school in Europe was established in Salerno, Italy, and was so influential that the Holy Roman Emperor Frederick II decreed that anyone who wanted to practice medicine had to be approved by the masters of Salerno. A revival of learning took place in Europe beginning in the early 13th century. Classical medical texts as well as works by Razi, Ibn Sina, and other Islamic scholars were translated from Arabic or Greek into Latin, and physicians such as Taddeo Alderotti (1223-95) urged their colleagues to read these texts. Major centers for the study of medicine opened in Paris and Montpellier in France and Bologna in Italy.

By the end of the 1400'S the Renaissance was well under way. The invention of printing in Europe led to books on surgery and medicinal plants. Experimentation became more common, as did dissection of human corpses. Seafaring explorations also influenced medical history for instance, a monk who accompanied Christopher Columbus described for Europeans how Native Americans smoked tobacco for medicinal purposes; sailors introduced smallpox to the Americas and brought syphilis into Europe.

In the 16th century, as religious prohibitions against human dissection were lifted, the modern study of anatomy began, allowing scientists to distinguish between abnormal and normal anatomical features. Andreas Vesalius (1514-64), a Belgian physician, dissected human and animal cadavers, demonstrating that Galen's descriptions of human anatomy were based on the dissection of animals whose structure differs markedly from that of humans. In 1543 Vesalius published De Humani corporis fabrica ("On the Structure of the Human Body"), the first work to accurately illustrate human anatomy.

Gabriele Falloppio (1523-62), a student of Vesalius, described the tubes between the ovary and the uterus, now called Fallopian tubes, as well as previously unknown structures in the skull and inner ear. Bartolomeo Eustachio (1513-74) described tooth structure at different ages and the tube that connects the middle ear to the back of the nasal cavity, today known as the Eustachian tube. Hieronymus Fabricius (ca. 1533-1619) helped found embryology. He compared the anatomy of embryos of dogs, cats, horses, and humans, and was the first to describe the placenta. He also provided detailed descriptions of the semilunar valves in blood veins. This led to the discovery of blood circulation by his student William Harvey (1578-1657). Harvey's Anatomical Study on the Movement of the Heart and Blood in Animals, published in1628, accurately explained that the heart pumps blood into arteries, the arteries carry the blood throughout the body, and the veins return the blood to the heart.

This new understanding of human anatomy allowed surgery to emerge as a separate discipline. Previously surgery was performed by barber-surgeons, and was considered a less dignified occupation than medicine. This perspective was changed by Ambroise Pare (1510-90) the leading surgeon in the 16th century, who served four kings and earned the reputation as the "father of modern surgery." Using the experience he gained on the battlefield, Pare pioneered the use of ligatures and dressings to stop bleeding instead of the painful practice of cautery. Pare is credited with originating the use of prostheses- artificial replacements for a missing part of the body-and popularized the use of the truss for treating hernias, which were previously often "cured" by castration. (Adapted from New York Times ‘Guide to Essential Knowledge')