Louis Pasteur (1822 - 1895)

Louis Pasteur was the scientist who made the link between germs and disease, and then continued his work by making vaccines for diseases like chicken cholera. This post explores Pasteur's journey to his discovery, and how other scientists followed on from it.
History - Medicine through time - Fighting infectious disease


Science at that time: science was propelled forward  by advances that came before and with the industrial revolution. These include the invention of the thermometer (by Fahrenheit in 1709 and Celsius in 1742) and the invention of the microscope as early as 1683 (by van Leeuwenhoek). Microbes were known of at this point, but they were not believed to be the cause of disese, only the result of it. This theory is called spontaneous generation. This theory was only applied to microscopic organisms by this time because of the experiments of Francesco Redi in 1668, who showed that maggots did not spontaneously generate but came from eggs laid by flies. Pasteur was to disprove the theory of microscopic spontaneous generation.

Pasteur was an industrial scientist, not a doctor or pathologist (someone who investigates the cause and effect of disease). This meant that he dealt with the sientific problems facing big businesses. He made his discovery while investigating the reason why sugar beet mysteriously went sour during fermentation in 1857.

He believed that microbes were growing in the sugar beet and causing it to go sour. He proved this with the famous swan-necked flask experiment. In a swan necked flask, microbes cannot get in because they have to travel against gravity to go up the swan neck. Using this knowledge, he set his experiment as follows:

He took two sets of swan necked flasks and filled them with broth, which microbes love to feed on. He then strongly heated the broth in all of the flasks so that no germs would start inside the flasks. Since they couldn't enter through the swan neck, they would have to spontaneously generate to get in. He broke the swan necks of half of the flasks, which would allow microbes to float in on dust particles. After a while, all of the flasks with broken necks had lots of bacterial growth, but those with te swan necks had none. Since no microbes started in any of the flasks, this proved that microbes didn't spontaneously generate. He confirmed his idea in 1865-7 when studying a silkworm disease called pébrine.

Pasteur's ideas were followed up by other scientists such as Robert Koch, who started using this information to single out which microbes cause which diseases and then make a vaccine against that microbe. Pasteur followed this trend that resulted from his own idea by investigating the diseases anthrax, tuberculosis, cholera and others. This is explored in another post.

Important note: Jenner created the first vaccine against smallpox, so it would be unfair to claim that Pasteur and Koch began the trend entirely. However, Jenner created his vaccine without knowledge of why it worked, and so Pasteur's discovery is important because it represents the knowledge behind why vaccines work.

In summary, Pasteur was an industrial scientist who did not discover microbes, but proved that they did not spontaneously generate and also that they caused disease. He began and continued a trend of identifying microbes for the diseases they caused and creating vaccines for them.





Further reading:
http://bcs.whfreeman.com/thelifewire/content/chp03/0302003.html

Jenner and the Smallpox vaccine

The discovery of a vaccine to guard against smallpox was the first major step in counteracting infectious disease. This post explores the events preceeding the vaccine, the discovery of the vaccine and the public's reaction to it.
History - Medicine through time - 18th/19th Centuries


Vaccination is often confused with inoculation, as they are similar. Before the introduction of vaccines, inoculation was the best way of developing immunity to smallpox. Inoculation involves deliberately infecting someone with the pus from a person who only had a mild form of the disease, and hoping that the body would be able to fight it. By surviving the disease, the person could become immune to future.

The problem with inoculation was that it was very dangerous. People risked contracting a fatal form of the disease. It was introduced to Britain in 1718 by Lady Mary Wortley Montagu, and by the time Edward Jenner (1749-1823) began experimenting with his theories in 1796 many people had become rich by setting up inoculation houses and charging for the service. These people didn't want to lose their business to the new practice of vaccination that was introduced by Jenner, which is one of the reasons he received so much resistance when he introduced it.

How Jenner discovered his vaccine
Jenner was the student of John Hunter, 'the father of modern surgery', who taught him the importance of scientific observation. Jenner lived in the countryside and investigated the rumour that milkmaids, who were exposed to the non-fatal disease cowpox, didn't get smallpox.


This led him to believe that getting cowpox and defeating it somehow gave a person resistance to smallpox as well. He decided to investigate by infecting someone with cowpox, and then testing them with smallpox. He chose a young boy, James Phipps, and tried the experiment. he found that catching and defeating cowpox did indeed give immunity to smallpox. Jenner wrote about his discovery in 1798.


Because cowpox was non-fatal, this was an excellent way to safely give any healthy person immunity to smallpox. He had discovered the vaccine.

Reactions to the vaccine
As prevously said, Jenner's vaccination method would put many people out of business. They attacked his techniques and spread rumours of strange and horrible side effects that could result from Jenner's discovery. The picture in this post shows the fears that some people had about the vaccine's 'side effects'.


However, the vaccine was so effective that the resistance was crushed. Members of the Royal Family were vaccinated, he was given £30,000 by the government (1802-6) and Emperor Napoleon even released a prisoner at Jenner's request!

Vaccines are used to this day since they became compulsory for all children in 1853. They have had an effect of great magnitude on modern preventative medicine.


Further reading:
http://www.jennermuseum.com/edwardjenner.html
http://en.wikipedia.org/wiki/Edward_Jenner
http://www.historylearningsite.co.uk/edward_jenner.htm

William Harvey

Born: 1578

University of Padua: 1598 – 1602
History - Medicine through time - 16th/17th Century


Harvey studied at Padua and then left to work in London as a doctor and then as a lecturer in anatomy at the Royal College of surgeons. From 1618 he was physician to James I and then Charles I. He was taught anatomy be Geronimo Fabricius who identified the valves in the veins and wrote about them in De Venarum Ostiolis (1603). He also designed the new anatomy theatre at Padua.

Before Harvey’s discoveries there were others that are important when discussing Harvey. In the 1543 edition of medicorum Pautinae profefforis, de humani corporis fabrica Libri feptum by Andreas Vesalius, Galen’s theory that heart passed through small holes in the Septum was accepted, however in the 1555 edition he went one step further and denied this. Vesalius’ successor at Padua, Realdo Colombo, showed that blood passed from one side of the body to the other via the lungs and wrote about it in De re Anatomica in 1559.

Harvey discovered that Galen’s theory that blood was recreated instant by instant and was not used again was wrong. He discovered this by looking at the hearts of cold blooded animals, and seeing that the blood as circulating far too quickly for it to be remade. He said that blood flowed out in the arteries and back in the veins, which explained his teacher’s findings of the valves. He wrote down his findings in ‘On the Motion of the Heart’ (1628) after first announcing them in public in 1616.

Harvey was helped by technology of his time. Galen was not around in a time where there were pumps such as the ones used to put out fires, whereas Harvey was. This would have meant that the idea of a pump in any situation would be more open to Harvey’s mind in any situation than Galen’s.

Ambroise Paré (1510-1590)

History - Medicine through time - 16th Century
Paré was the the most famous surgeon of his time, having served four successive French kings. He developed and pioneered many new ways to treat war wounds, for example his new treatment of gunshot wounds. His combined works were published in 1575.

Paré was born to a barber-surgeon in 1510, in a small French village. He wanted to be a barber-surgeon too, even though this was considered to be quite a lowly profession.

He went to Paris to train in 1533 and became surgeon to the Hotel-Dieu in 1534, which was the only public hospital in Paris. He didn’t have enough money to take the tests to become a barber-surgeon so he joined the military. France was engaged in much civil and international war, which was advantageous for his practice. He developed a new way of treating gunshot wounds which was much kinder to the victim.

He published his Method of treating wounds in 1545 in French, because he couldn’t speak Latin. In ’52 he was appointed surgeon to Henri II of France and the first edition of his collected works was published in 1575. He was attacked by the Faculty of Physicians but had the king’s support so could go on publishing books. He published The Apology and Treatise of Ambroise Paré in 1585, which criticized those who had done so to him, saying that they hadn’t had any actual experience but merely read books and ‘chatter[ed] in a chair’.

He was the leader of one of the most important developments of the 16^th Century, which was the proper way to test a theory, which he did to eliminate the myth of the bezoar stone in 1575. He wanted the free flow of ideas and made all of his ideas public.

What a legend.

Andreas Vesalius (1514 - 1564)

History - Medicine through time - 16th Century
Vesalius made important discoveries in anatomy and respectfully corrected the mistakes of the famous Roman anatomist Galen. He also established the important link between science and illustration in his book Tabulae Sex and, more famously, the 1543 edition of the Fabric of the Human Body (Humani Corporis Fabrica). 

Vesalius was born into a medical family and grew up around medical books. The fact that the medical profession ran in his family meant that he was more likely to get a job in medicine, and the fact that his family were well educated meant that he was more likely to get a place in a university (which he did, Louvain 1528-1533 and then he moved to Padua, Paris).

Vesalius was a fan of Galen’s ideas and made many ameliorations to his theories without openly challenging him. An example of this would be that in the Tabulae Sex (1538), he showed the human liver to have five lobes (as Galen wrote) instead of two, even though he knew that it had two because he had performed the dissection himself (he also made a drawing of a two lobed liver in a different view). He strongly believed in illustrations to help readers understand exactly which part of the body he was talking about and how exactly it was made up. As such, he personally invigilated every single carving of his illustrations. In 1543 he left Padua to spend months with the printer in Basel. This was while he was planning his book ‘The Fabric of the Human Body’ which was published in 1543. He also wrote a summary of his book, called the Epitome.

He dedicated the Fabric to the Holy Roman Emperor Charles V, and was given a job at Charles’ court. From here he published another edition of the Fabric with more changes on Galen’s theories but he went on as a doctor, not an anatomist.

In the Fabric, he suggested public dissections and led the way with a new way of publishing books by using illustrations. He was helped by the introduction of the printing press by John Gutenberg in 1454 which allowed his diagrams to be accurately reproduced in copies of his books.

In his Letter on Venesection, he argued in favour of the classical doctors, saying that more blood should be taken and that it should be taken from the same side of the body as the illness.

The First Anaestetics

History - Medicine through time - 18th/19th Century
In the 18th Century, surgery was very dangerous and often lethal. Patients very often died of trauma and pain or blood loss during the operation, or of infection shortly afterwards. Blood transfusions usually failed because it was not known that there were blood groups to be matched. There were no anaesthetics except for alcohol and  opium, and operations were carried out in unhygienic conditions. Many doctors in ordinary clothes would gather around an operating table while surgeons performed the operation with unclean instruments and no gloves or face-masks. Surgery in the Middle ages was grim indeed.

The discovery of Anaesthetics - a timeline

1. The first anaesthetic was the result of progress in the field of chemistry when chemist Humphrey David discovered pain could be relieved by inhaling nitrous oxide. He suggested this would be useful in the field of surgery but was ignored by the medical profession.
2. During the 1840s there were several attempts to find an effective anaesthetic and an American doctor, Crawford Long, found out ether was a useful anaesthetic. He did not announce this.
3. In 1845 an American dentist, Horace Wells, made the same connection between nitrous oxide and anaesthesia as Humphrey David. When he tried to demonstrate this he failed as he did not realise nitrous oxide did not have the same affect on everybody, including his volunteer. 
4. In 1846 William Thomas Green Morton convinced the head of surgeon of the Boston Hospital to carry out an operation using ether as an anaesthetic. The patient had a tumor removed from his neck painlessly. News of this spread quickly and use of ether as an anaesthetist soon became common and widely accepted.
5. In 1847, James Young Simpson, a professor of Midwifery at Edinburgh University, wanted to find something to relieve pain during childbirth. He found ether had a pungent smell and irritated the lungs. He discovered the effects of chloroform, which he found was easier to administer than ether. Within a month of his discovery he had used it 50 times with a 100% success rate.

Opposition to anaesthetics

Most people agreed with the use of anaesthetics, however there were certain groups who did oppose it. Some thought that the surgeons could not be trusted to give the correct dose or control the side effects, or that they didn't want to leave themselves unconscious and in the surgeon's power. Lots of Christians thought that women should have to bear pain during childbirth because it is written in the Bible, and the army considered it to be 'soft'.

There were problems that followed the use of anaesthetics which will be covered in another post. An example would be the extra confidence that painless operations gave to surgeons, which led them to delve far too deeply into the human body and expose their patients to disease and infection. As well as the problem of infection, blood loss had also yet to be conquered.

Fall of the Roman Empire and the Dark Ages

A short post on how the fall of the Roman Empire led to a decline in medicine/public health in Europe. 
History - Medicine through time - AD300-500

In AD359 the empire split into East and West (as any RTW player will know).  In AD410 the Goths invaded Italy and sacked Rome.  In AD476 a Germanic chieftain deposed the Roman Emperor.  The last Roman troops left Britain about AD410.

Britain was no longer controlled by the Pax Romana, so it began to fall apart. The Roman infrastructure (e.g. sewage systems and aqueducts) stopped working and some villages became Saxon settlements. Heating systems stopped working and bands of Saxon invaders attacked most towns.

Those with the knowledge of how to build aqueducts or how to treat illness died, and nobody was trained to replace them, therefore the knowledge was lost apart from a very small number of books which made their way into Arabic Libraries via the Nestorians.

For more information on the Nestorians and how knowledge was preserved after the sack of Rome read the 'Islamic Medicine' post.

Islamic Medicine

History - Medicine through time - 500BC-AD1000
For the first post, I've decided to talk about Islamic Medicine, in particular the century and a half after the collapse of the Roman Empire in 500BC. 


The Muslims lived largely by the guidance of Islam's holy books, mainly the Qur'an which was believed to be the words of Allah, and later the Hadith which contained the prophet Muhammad (Born AD570)'s interpretations of the Qur'an and his 'wise sayings'. By extension, they based much of their medicine on these sacred texts which proved to be beneficial to them.


Their religion encouraged them to embrace learning, which meant that they learned from the Nestorians who were Christians that fled persecution in the West. The Nestorians brought with them medical ideas that had originated in the West from writers such as Hippocrates and Galen. Hippocrates was the author of the idea of Clinical Observation, a medical practice that involved closely watching a patient's symptoms, the Hippocratic Oath that is taken in a modified form by doctors to this day, and many other ideas contained in his collection of books called the Hippocratic Corpus (although it is known that Hippocrates did not write all of the books himself). Galen made anatomical discoveries that were far past his age, and some of his works, such as On Anatomical Procedures were brought back into the West after being translated from Arabic and may not have been preserved had the Muslims not preserved them.

When Muhammad died in AD632, caliphs ruled the Islamic world and they spread their ideas, sometimes by force. They expanded the Muslim Empire and by AD1000 it stretched from Spain to the River Indus. The caliphs became rich and build beautiful cities like Cairo and Baghdad, and built schools and universities because education was important to the society. They also built mosques and public baths because the Qur’an said that hygiene was important. The success of the Muslims is important because they were the ones who had the knowledge of the Greeks and Romans, so they spread their ideas all over their empire.

Now, for some examples of the medicine that they actually used:

• They invented processes like distillation that allowed them to produce the drugs that they wanted. This technique was also carried over into the West by the Muslims.
• Superstitious beliefs were not encouraged because the Qur'an states that Allah did not create pain without a cure.
• The Qur'an insists on cleanliness, and so the authorities organised the construction of public baths and most people followed a regimen of cleanliness and good health.
•       The famous doctor Rhazes wrote over 200 medical books like On Smallpox and Measles and El Hawi which described many diseases and openly embraced Western medicinal ideas.
  ·         Another doctor, Avicenna, also wrote many medical books. His Canon of Medicine also included Greek ideas, and so when it was translated into Latin and brought back to the West it returned the Greek ideas there.
  ·         They invented a way to anaesthetise the patient.
  ·         They used surgery as a last resort because they knew how dangerous it could be. Abulcases wrote about good surgical procedures including preparing everything beforehand and knowing exactly what you are going to do before opening the body.
  ·         They brought their skills in external surgery to the Western world.
  
  
  They were hindered in ways, because:
  ·         Their religion did not allow dissection, and people who set up medical practices without a license from a hospital were not stopped
  
  
  In summary...
  Usually religion is considered a hindering factor in the development of medicine, however in this case the opposite was true. The Islamic empire did make many advances of its own, but was very important in taking in the ideas of the West after its collapse and spreading them throughout their empire, which allowed Western Medicine to advance.