History of medicine-concise notes for PG students

History of medicine – concise notes for PG students

CONTENTS

SL NO	TOPIC	PAGE NUMB
1.	Introduction	3
2	Prehistoric medicine	5
3	Indian medicine	6
4	Chinese medicine	14
5	Egyptian medicine	19
6	Mesopotamian period medicine	27
7	Greek medicine	30
8	Alexandrian medicine	37
9	Romen medicine	38
10	Medivial period medicine	44
11	Renaissance period medicine	46
12	17th century medicine	56
13	18th century medicine	63
14	Modern medicine	72
15	NOTES

1.HISTORY OF MEDICINE – INTRODUCTION

PREHISTORIC MEDICINEINDIAN MEDICINECHINESE MEDICINEEGYPTIAN MEDICINEMESAPOTOMIAN MEDICINEGREEK MEDICINEALEXANDRIAN MEDICINE ROMAN MEDICINEMIDDLE AGESRENAISSANCE PERIOD18^TH CENTURY MEDICINEMODERN MEDICE

TIMELINE :

PREHISTORIC————BC 8000-5000

INDIAN MEDICINE——BC 5000

CHINESE MEDICINE —-BC 3500-500

EGYPTIAN MEDICINE—BC 3300-1000

MESAPOTOMIAN ——–BC 3000

GREEK MEDICINE———BC 500-100

ALEXANDRIAN MEDICINE—BC 300

ROMAN MEDICINE———–BC 300-200

MIDDLE AGES——————-AD 500-1500

RENAISSANCE PERIOD———AD 1300-1500

18^TH CENTURY MEDICINE——AD 1700-1800

MODERN MEDICINE ————1800—–+++

CLASSIFICATION :

ANCIENT SYSTEMS

1-EGYPTIAN

2-MESAPOTOMIAN

3-CHINESE

4-INDIAN

-AYURVEDA

-UNANI

-SIDDHA

MIDDLE AGES

1-BYSANTINE PERIOD

2-ARABIAN MEDICINE

RENAISSANCE PERIOD

1-AWKENING PERIOD

-includes beginning of renaissance movements

-new scientific sprit developed

-got influenced by medical knowledge from other parts of world.

2-PERIOD OF CONSOLIDATION

-is also called early modern period

– Period between renaissance and 18^th century

-experimentation, observation became the basis of science

-medical and scientific knowledge consolidated

MODERN MEDICINE

1-20^TH CENTURY MEDICINE

2-21^ST CENTURY MEDICINE

2.PRE HISTORIC MEDICINE (8000-5000 BC) :

• -it is old as Paleolithic dwellers
• -can be trace d back to 10000 years
• -had very less medical knowledge
• -was based on god, evil spirits, stars and planet-combination of superstition, religion, magic, witchcraft
• -called SUPERNATURAL THEORY of diseases
• -prayers, offerings, rituals, witch craft were done as part of treatments
• -but they had some knowledge of herbs e.g.-violet as cough medicine
• -believed cast of hair, nails, excretions would warn off the evil spirits. So they took care to burry such tings
• -TREPHENING-was primitive form of surgery, making hole on skull for epilepsy, infantile convulsions, and headache.

3.INDIAN MEDICINE 

• -India is world’s most ancient civilization
• -this civilization had enriched every art and science known to man
• -6^th BC itself Indians had described ligaments, sutures, lymphatics , nerve plexus, fascia, adipose, vascular tissue ,synovial membranes
• -described many more muscles than any modern anatomists
• -described digestive functions, gastric juices, chyme to chyleblood absorption
• -according to GRANT DUFF a British historian most of the modern advances were already developed in India centuries ago.

A.AYURVEDA :

• -Ayurveda –word means wisdom of living or knowledge for long life
• -aysh=life or life principle and Veda=knowledge, the science of life 
• –RIG VEDA and ATHARVA VEDA (BC 5000)- had mentioned about valuable medical information
• —ATHARMA VEDA described 2 systems
• 1-charms and magico –religious medicine
• 2-drugs on empirical basis
• -it is believed to be divine, the knowledge passed from god BRHAMAASHWINS INDRABHARADWAJA
• –DHANVANTHARI is considered as the god of Ayurveda
• -First human exponent of Ayurveda bharadwaja who believed to be learnt directly from indra
• -Ayurveda was first described in textbook form by AGNIVESA-in his book AGNIVESH TANTRA 
• -This book was revived by charaka and became known as CHARAKA SAMHITHA-
• –it is the most massive and most important compilation of Ayurveda
• -Another early text was SUSRUTHA SAMHITHA   by susrutha –around 1000 BC
• -It is the first compendia on Ayurveda medicine and surgery
• -susrutha was believed to be primary pupil of dhanvanthari
• -susrutha is called FATHER OF SURGERY
• -ophthalmology and obstetrics are described in susrutha samhitha
• -charaka samhitha and susrutha samhitha were the text books used in NALANDA and THAKSHASILA
• -followed HOLISTIC APPROACH 
• -school of physicians followed ATHREYA SAMPRADAYA and school of surgeons followed DHANVANTHARI SAMPRADAYA
• -Ayurveda used thousands of diagnostic terms and many surgical instruments,

THERAPEUTIC APPROACHES :

1-VIPAREETHA CHIKITSA

• -antagonize the disease and counter act etiological factors and symptoms (antipathy)

2 VIPAREETHA KARI CHIKITSA 

• -treating by medicines exerts similar effects (similia)

8 branches of Ayurveda are called ASHTANGAS :

• 1-internal medicine –KAYACHIKITSA
• 2-pediatrics –KOUMARABHRUTYA TANTRA
• 3-psychiatry psychology-BHUTA VIDYA
• 4-ears, eyes, nose, throat –SHALAKYA TANTRA
• 5-surgery-SHALYA TANTRA
• 6-Toxicology-AGATHA TANTRA
• 7-rejuvenation –RASAYANA TANTRA
• 8-fertility therapy –VAJIKARANA TANTRA

SAPTA DHATUS :

• -dhatu=that which forms the body or tissues
• -seven tissue types according to  Ayurveda are
• -RASA, RAKTHA, MAAMSA, MEDAS, ASTHI, MAJJA, and SUKLA
• -Central concept is –diseases are due to imbalance in DOSHAS—VATA, PITTA, KAPHA
• -body is made of five elements called PANCHABHUTAS-EARTH, AIR, WATER, FIRE, and VACCUM
• –VATA-is dynamic or kinetic principle -movements -–represented by AIR
• -PITTA is thermal or explosive force-transformations SUN
• -KAPHA-is cohesive force, electromagnetic and gravitational force

TYPE OF TREATMENTS :

1-SHAMANA (palliation)

• -means alleviation of symptoms
• -Internal medicines are given to suppress DOSHAS

2-SHODHANA (purification) 

• -means elimination of basic cause of disease
• -5 types of shodhanas are there called PANCHAKARMA 
• -They are VAMANA, VIRECHANA, NASYA, VASTI, and RAKTHA MOKSHANA
• -external treatments are given
• -there are 2 preparative steps for shodhana called POORVA KARMA
• 1-SNEHANA
• 2-SWEDANA
• -very effective in neurological, musculoskeletal, respiratory, metabolic and degenerative disorders

3-PATHYA VYAVASTHA 

• -Contain indications and contra indications in diet, activity, habits and emotional status

4-NIDAN PARIVARJAN 

• -complete avoidance of disease causing environment and factors (maintaining cause)

5-SATVAVAJAYA

• -idea of control of mental disturbances
• -restraining mind from desires
• -improve memory, concentration etc.

6-RASAYANA 

• -Promotion o health and vitality.

KEY FIGURES AND CONTRIBUTIONS :

1-CHARAKA 

• -wrote charaka samhitha
• -said it is more important to prevent occurrence of disease than to seek a cure
• -First physician to present concepts of digestion, metabolism and immunity
• -described doshas
• -Was aware of germs but didn’t give much importance to it –holistic approach
• -fundamentals of GENETICS 
• -studied anatomy very deeply said 360 bones are there in our body including teeth
• -wrongly believed heart had one cavity but said heart is connected to other parts by 13 channels

2-SUSRUTHA 

• -was a surgeon lived near Ganges
• -wrote susrutha samhitha
• -called FATHER OF SURGERY
• -Advocated practices of surgery on watermelons, clay pots –like modern practices of surgical workshops
• -Called FATHER OF PLASTIC SURGERY and FATHER OF COSMETIC SURGERY –did rhinoplasy

B.UNANI :

• -Based on GREEK philosophy
• -word unan in Arabic = land Greece
• -treatment by concept of balancing body humors

PRINCIPLES :

• –Body is made of 4 elements –earth, water, air, fire (Indian and Chinese-5 elements +vacuum)
• -3 parts of body are
• 1-SOLID PART (organs)
• 2-LIQUID PART (humors)
• 3-GASEOUS PART (pneuma)
• -4 TEMPEREMENTS are COLD, HOT, WET, And DRY
• -Mixed temperaments also exists COLD-DRY, WET-HOT etc
• -Phlegm-is cold and wet
• -Blood-is hot and wet
• -Yellow bile- is hot and dry
• -black bile is cold and dry
• -believes in promotion of health, prevention of disease and cure

• -Six essentials maintains life called ASBABE SITTA ZAROORYA are
• 1-atmospheric air
• 2-sreinks and food
• 3-sleep and wakefulness
• 4-excretion and retention
• 5-physical activity and rest
• 6-mental activity and rest

• –diagnosis was mainly based on pulse (NABZ)
• -Gave importance to physical examination of stool and urine

TYPES OF TREATMENT :

1-ILAJBIL TADBEER (regional therapy)

• -include exercise, massage, bath etc.

2-ILAJBIL GHIZA (dieto- therapy)

3-ILAJBIL DAVA (pharmaco therapy)

• -treatment by drugs opposite to temperament-ILAJBIL ZID 
• -by drugs similar to the temperament-ILAJBIL MISL

• -Muslim physicians were called HAKIMS 
• -drugs were mainly herbs + some animal and mineral drugs
• -used single crude and compound drugs
• -GREEK, ARABIC, SPANISH AND INDIAN SYSTEMS had contributed a lot UNANI SYSTEM
  • it gained popularity because of efficacy and non toxicity of drugs
• –HAKIM AJMAL KHAN was a famous Indian unani medic who established Ayurveda and unani college in Delhi
• -he was the first person who introduced RESRPINE for hypertension to the world

C.SIDDHA :

• -was an ancient system in India
• –SIDDHARS were saintly figures mastered in yoga –this system was developed by siddha’s –
• -Practiced in Tamil speaking parts of India –literatures were in Tamil
• -this system is also called AGASTHYAR SYSTEM in name of saint Agasthya
• -this system was developed within Dravidian culture
• -is mainly therapeutic in nature
• -it is believed that medical knowledge came from LORD SHIVAPARVATHINANDIAGASTHYASIDDHARS

D.BASIC CONCEPTS :

• –iatrochemistry was followed like Ayurveda
• -believed human body was replica of universe so are the foods and drugs
• -believed body is made of 5 elements like in Ayurveda
• -deals with the concept of salvation or moksha by medicines, yoga and meditations

E.MATERIA MEDICA :

• -had rich medicinal knowledge
• -There are 25 varieties of UPPU –water soluble-alkalis and salts
• –64 mineral drugs-water insoluble-sublimating substances-in which 32 is natural and next 32 is artificial
  • 7 drug-water insoluble –emit vapors on heating
• -compounds of sulphur and mercury have great importance in siddha
• -used metals alloys as medicines
• -were aware of processes like sublimation, calcinations, distillation, fusion, conjunction, combination, congelation, cibation, fermentation, exaltation etc.
• -aware if Cupellation of gold and silver
• -followed polypharmacy
• -effective in skin problems like psoriasis, STD, UTI, liver and GIT diseases etc
• -used individualization for prescription

4.CHINESE MEDICINE 

• believed in god animated nature and universal animism
• -medical treatments were in hands of priests
• -during CHOU dynasty priests and doctors were separated
  • During yin dynasty (BC206-220) and han dynasty –medicines were recorded
• –HUA-TO performed first treatment in history using anesthetics
• -during tan dynasty all medical knowledge were collected
• -believed universe was spontaneously created by TAO made up of 2 souls YIN and YANG
  • YIN is feminine and YANG is masculine power of body
• -medical concepts were based on religion
• -3 religions dominant in china were –TAOISM by lao-zu, BUDDHISM-by Gautama Buddha and CONFUCIANISM- by Confucius
• -TAOISM laid close association between medicine and sex
• -persons with mystical powers were called ‘WU’
• -Oldest writing is HUANGDI NEIJING (yellow emperors inner classic)-contain dialogs between emperor HUANGDI and physicians especially SHENNONG
• -diagnostics, pathology, acupuncture etc. developed
• -believed prostrate problems are caused by dampness and treated accordingly
• -thought migraine is liver and blood disorder
• -human dissections had been conducted
• -anatomy and physiology were based on THEORY OF COSMOLOGY not observations
• -it was the first culture adopted hygiene as a prevention method for disease
• -obstetrics was in hands of midwives
• -medical education only for emperor and his court

PHYSIOLOGY OF CHINESE MEDICINE :

divide into external and internal

External -contain 12 meridian channels-attacked by wind, cold, damp dust, heat etc.

Internal

• -Contain 12 organs –formed from 5 elements
• -5- Element theory uses the scientific fact of rotation of earth on its own axis

• -they were 8 fundamental patterns of defining diseases
• -they were INTERIOR, EXTERIOR, HEAT OR COLD, EXCESS, DEFICIENCY, YIN and YANG
• -Form of energy was called “QI”
• -Whole universe is made of QI
• –INTERIOR and EXTERIOR – location of disease
• –INTERIOR-chronic disease
• –EXTERIOR-acute disease
• –COLD means deficient YANG and excess YIN-weakness
• –HEAT-excess YANG and deficient YIN-hyperactivity
• -herbs were used extensively in small fractions
• -divided herbs into 5 flavors with different use
• -BITTER HERBS –
  • remove heat from body,
  • cure cough
• -treat constipation
• -good for heart
• -SWEET
  • Spleen disorders,
• -pain reduction
• -restore harmony
• -PUNGENT–
• -Aids circulation
• -lung diseases
• -mild complaints
• SOUR 
• -Aid liver
• -diarrhea
• -prevent pus
• -SALT
• -Aid constipation
• -thyroid, abdominal, and kidney diseases

DIAGNOSIS: 

-Based on pulse-first exponent was CHIAO who wrote an authoritative book on it

-Tongue diagnosis –certain areas of tongue represented different organs

ACUPUNCTURE :

• -This was a common form of treatment in China
• -flu and chronic pains were treated successfully
• -it is based on idea that externally there are many points which has influence on inner boy—acupuncture points
• -inner and outer body is connected by 12 channels
• -formed by 6 yin and 6 yang channels
• -3 yin and 3 yang channel is present in one arm and leg
• -pressure of needles used in acupuncture was not painful

Other characteristics of Chinese system

• -intensity of symptom was used to divide disease into excess or deficient
• -wheezing indicated dampness
• -foul order indicated excess
• -less odor indicated deficiency
• Seasonal weather, geographical location, environment and personal factors like age, sex, temperament, and customs were considered
• -believed summer humidity cause dampness and cause diseases

MOXIBUSTION 

• -method of burning mug wort, small herbs to facilitate healing
• -believed this would stimulate flow of QI
• -2 methods of moxibustion were there-direct and indirect
• -used for cold and stagnant condition 

 QI GONG and TAI-CHI

Were breathing and spiritual exercises

KEY FIGURES :

1-BIAN QUE

-was an excellent diagnostician, acupuncture therapist

2-TSAN-KUNG (CANG GONG)

-famous for record keeping

-developed concept of prognosis

-described cancer, UTI, aneurisms, renal diseases etc.

3-CHANG-CHUNG-CHING 

-known as HIPPOCRATES OF CHINA or THE SAGE OF MEDICINE

-studied pregnancy, gynecology

4-HUA-TO

-First famous Chinese surgeon

-practiced Qi-gong and acupuncture

-HUA is a brand name in acupuncture needles

  5.EGYPTIAN MEDICINE  (3300-1000 BC )

• From the period of 3300 BC until the Persian invasion of 525 BC.
• Common procedure for healing was amulet or magical spell.
• Surgeons were known as PRIESTS OF SEKHMET.
• Destructive and powerful lion headed goddess of war SEKHMET –considered to be supreme deity of healing.
• Medical papyri- contain egyptian knowledge of medicine,anatomy and physiology.

HISTORICAL  SOURCES :

1.THE EDWIN SMITH PAPYRUS:

Most important documents pertaining to medicine in the ancient nile valley.-Deal with the ailments in the order of the bodily parts from head to foot.Discussion of each case in the order of

1.Title

2.Examination

3.Diagnosis

4.Treatment

5.Glosses (dictionary )

2.THE EBERS PAPYRUS  Most lengthy papyri.

Contain medical text books

1. Recitals before medical treatment,to increase the virtue of the remedy.
2. Internal medical diseases.Diseases of the eye.
3. Diseases of the skin(with an appendix of sundries)
4. Diseases of extremities
5. Diseases of women and matters concerning housekeeping.
6. Information of an anaomic,physiologic, and pathologic nature and explanation of words.
7. Surgical diseases

3.KAHUN  GYNECOLOGICAL PAPYRUS:

• The text was published in facsimile.
• Hieroglyphic transcription.
• Translation in to English by GRIFFITH in 1898.
• The gynecological text divided in to 34 paragraph.
• First seventeen have common format.Second section begin from third page and contain 8 paragraph.

Paragraph 19- recognition of who will give

Birth.

Paragraph 20-Fumigation procedure.

Paragraph 20-22-contraception.

4.MATERIAL PRESCRIBED FOR CONTRACEPTION:

       Crocodile dung.

45 ml of honey.

Sour milk.

• Third section-testing for pregnancy.
• Fourth and final section –contain two Paragraph.

First paragraph- toothaches during pregnancy.

Second paragraph-fistula b/t bladder and vagina with incontinence of urine.

CONCEPT OF MEDICINE:

• The ancient Egyptians considered cosmos hold universe together. Sum total of all universal force was the GOD,THE SUPREME.
• Human races owes to the concept of the LAW OF ANALOGY – “that which is above is like unto that which is below,and that which is below is like unto that which is above.”
• The ancient Egyptian  taught that human body was the MICROCOSM or  LITTLE COSMOS, made in the form of MACROCOSM or the GREAT COSMOS.
• Ancient Egyptian medicine known by Egyptian as  NECESSARY ART has two main aspects – medical and magical.The MAGICAL aspects deal with disease or illness caused by divine acts of gods.The MEDICAL aspects deals with anatomy and surgery which involves the preservation of the dead.
• Magic and religion were the part of everyday life in Egypt. God and demons were responsible for many ailment.so treatment involve  supernatural elements.
• AMULETS were known for their magical purposes.Health related amulets are classifieds in to

1. HOMEOPOETIC AMULETS:An animal or part of an animal from which wearer hopes to assimilate positive attributes.
2. PHYLACTIC AMULETS:Protective , warding off harmful gods and demons.FAMOUS EYE OF HORUS was used on phylactic amulets
3. THEOPHORIC AMULETS:Represents Egyptian gods.

CAUSES OF DISEASE: They believed in SEKMET, the war goddess –causes illness.THOTH gave doctors the ability to cure. Believed in evil spirit.Believed that the channel of thebody (veins) could become blocked causing illness.

CURE OF DISEASE:

• All measures of treatment were directed towards the removal of cause.
• SEKMET could be pleased by religious rituals .The god BES –frighten away evil spirit.
• Body channel could be cleared by laxatives.
• Herbal cures.Eg:honey for the disease of eye.
• OPIUM used to drive away evil spirit.
• People wore amulets and  charms to avoid and cure illness.

ORIGIN OF MEDICAL KNOWLEDGE:

Strong belief in life after death.They were pre occupied with dead body and the notion that it must remain intact and have a proper burial.

Earliest form of surgery – THE ART OF EMBALMING.Benefits of art of embalming are:

1.preserve dead body.

2.to be familiar with the appearance,nature, and mutual positioning of internal organs.

3.first opportunity for the observation of human anatomy.

During the process of embalming,internal organs were removed except the heart,which was thought to be necessary for the after life.this made them aware of

• Brain was the seat of the body control
• Heart as the source of blood vessels.
• Physiology  of circulation
• Importance of pulse – speech of heart.
• Disease like osteoarthritis.

MEDICAL PRACTICE:

• Ancient Egyptian word for doctor is SWNW.The earliest recorded physician in the world is also credited to ancient Egypt.
• HESYRE – CHIEF OF DENTIST AND PHYSICIANS for the king Djoser in the 27 th century.
• The lady   PRESESHET (2400 BC) ,mother of Akhethotep known as IMY-R- SWNWT.translated as LADY OVERSEER OF THE LADY PHYSICIANS. SWNWT is the feminine of swnw.first recorded female doctor. Many ranks and specializations in the swnw.
• Ancient Egyptian term for proctologist,neruphuyt translated as shepherd of the anus.
• Medical institutions have been established in ancient Egypt as early as 1 st dynasty.By the time of 19 th  dynasty  their employees enjoyed benefits as medical insurance,pension,sick leave.

DISEASES OF CHILDREN AND WOMEN:

• Fertility was diagnosed by placing garlic in the vagina for one night.If the next day the women can taste or smell it in her mouth.this is based upon the connection between genital tract and interior of the body.such connection could be losed in obstructed fallopian tubes.
• Diagnosis of pregnancy and sex determination of child based on the fact that pregnant urine germinate cereals  more  rapid than non pregnant. If the child is male,urine would germinate wheat.if a female it would germinate barley.
• Delivery was performed in the squatting position,with women supporting her arms on knees and sitting on two bricks.some wall painting shows the evidence of caesarean section.
• Difficult labors were aided by burning resin or massaging the abdomen by saffron powder and beer.
• Abortions were done by introduction of warm oil and fat in the vagina.contraception performed by insertion of crocodile oil,gum acacia,honey consperge,natron in to the vagina.
• Gum acacia when dissolved produces lactic acid –a very effective known spermicidal.

SURGERY:

• The Edwin smith papyrus shows the suturing of non infected wounds with needle and thread.Raw meat was applied on first day,subsequently replaced by dressing of astringent herbs,honey and butter or bread. Raw meat prevent bleeding.Honey – hygroscopic and stimulate secretion of WBC.
• Piles and rectal prolapse treated  by medication, suppositories, laxatives and enema.
• For burns – a mixture of milk of a women who has  a new born male child,gum,rams hair.
• Urethral stricture dilated using reeds.
• Antiseptics used are frankincense,date wine,turpentine,acacia gum.
• Hot fire drill used in cauterization.
• Patients were sedated by opiates.local anesthesia was also known.water mixed with vinegar,Memphite stone resulting in formation of carbon dioxide – know for its analgesic effect.

PUBLIC HEALTH:

• They were farming community.clean people used to bath.shave their head,and had toilet, but had to be emptied manually ,probably by slaves.
• They developed mosquito nets which would offer some protection against malaria.

CHARACTERISTICS OF EGYPTIAN MEDICINE:

1. Knowledge about anatomy of human body even though they never dissected the body.Eg: they know how to get brain out of the body via the nose by a long hook.
2. Set simple breaks and remove boils and tumours from the surface.
3. Heart pumps blood through the body and could tell the exact position of heart from persons heart beats.
4. Different emperors of countries write to Egyptian pharaoh to sent them their best surgeon for operation.
5. Advice to stay health is to wash and shave the body,including under the arms
6. Public health and hygiene were regulated by law.cities were well planned with public baths and underground drains.
7. Organotherapy was practiced.
8. Alternative treatments like herbal ,physiotherapy,heliotherapy,hydrotherapy were practiced.
9. Medical institutes were known as PERI-ANKH – HOUSES OF LIFE.
10. 10.Medical services were granted to everybody.

KEY FIGURE:

1.IMHOTEP:

Founder of third dynasty in 13 th century.known as GOD OF MEDICINE  and  PRINCE OF PEACE.

He was learned man astronomer ,physician, architect.He was the builder of the first pyramid,the step pyramid of Saqqara.

CONTRIBUTIONS:

1.Diagnosed and treated 200 disease-15 disease of abdomen,11 of bladder,10 of rectum,29 of eyes etc.

2.treated tuberculosis,gall stones, appendicitis, gout.

3.performed surgery and practiced some dentistry.

4.extracted medicine from plants.

5.knew the position and function of the vital organs and circulation of the blood system.

6.MESOPOTAMIAN ( 3000 – 668 )

• The origins of civilization can be traced to a group of people living in southern Mesopotamia called the Sumerians. By 3500 BC, the Sumerians had developed many of the features that characterized subsequent civilizations. True civilization is said to have begun around 3100 BC with the development of cuneiform writing.
• Cuneiform was a system of writing established by the Sumerians which required the use of a stylus in order to make wedge-shaped marks on wet clay tablets, once the tablets were dry they could by stored, transported, etc. Many of the tablets that do mention medical practices have survived from the library of Asshurbanipal, the last great king of Assyria (668 BC)
• Mesopotamian diseases are often blamed on pre-existing spirits: gods, ghosts, etc.
• Each spirit was held responsible for disease in specific  part of the body.
• It can also be shown that the plants used in treatment were generally used to treat the symptoms of the disease.
• Specific offerings were made to a particular god or ghost when it was considered to be a causative factor.
• There were two distinct types of professional medical practitioners in ancient Mesopotamia:

1) Ashipu

2) Asu

• The wealthiest patients probably sought medical attention from both an Ashipu and an Asu in order to cure an illness.
• Ashipu and the Asu often worked in cooperation with each other in order to treat certain ailments.

Law Code of Hammurabi :

• It was not a code of law in the modern sense, but probably a collection of legal decisions made by Hammurabi (1700 BC) in the course of his activities as a judge and published to advertise his justice.
• Several similar collections are known from other areas and periods, and Hammurabi’s cannot be taken as representative of all Mesopotamian justice — in fact, it is outstanding for its application of the principle of an eye for an eye and a tooth for a tooth, while other “codes” allow monetary penalties.
• If a surgeon operated and saved the life of a person of high status, the patient was to pay ten shekels of silver.
• If the surgeon saved the life of a slave, he only received two shekels.
• However, if a person of high status died as a result of surgery, the surgeon risked having his hand cut off. While if a slave died from receiving surgical treatment, the surgeon only had to pay to replace the slave.

Temple of Gula :

• Temple Gula was one of the alternative method for procuring health in Mesopotamia.
• Patients were not  housed at the temple while they were treated.
• These temples may have been sites for the diagnosis of illness
• These temples were also libraries that held many useful medical texts.

7.GREEK MEDICINE :

• -leader of Greek system was AECULAPIUS (BC 1200)
• -His daughter HYGEA was worshipped as GODDES OF HEALTH

HIPPOCRATIC PERIOD :

• -Period 460-136 BC
• -Hippocrates born in 460 BC in cos island close to Asia Minor
• -he is called father of med
• -he learnt med from
• -Father, grand father
• -Democritus  and gorgias –
• -Herodicus
• -Traveled a lot to Thessaly, Thrace, sea of marmara , taught and practiced med–
• -probably died at age of 83-90
• –introduced
• -Systematic study of clinical medicine.
• -collected med knowledge from previous schools and physicians
  • During this period medicine became a profession
• -was an intellectual school revolutioned ancient Greek med
• -Mentioned diseases are not only PATHOS-suffering but also PONOS –reactions to recover-Hippocrates advised doctors
• -do right things at right time in which patient, attendant and external circumstances must cooperate
• -focus on the attention on patient
• -common contraceptive used by Greeks was SYLPHIUM
• -word HYSTERIA was derived from Greek meaning womb
• -word surgery was derived from Latin word chirurgia which is formed from Greek cheiros=hands ,ergon=work

ANCESTORS OF GREEK MEDICINES AND THEORIES :

-theories were based on 4 elements.

1-water as primary substance-THALES of MELITUS 

2-Earth as primary substance –PHREKIDES

3-air as primary substance-ANAXOGORUS 

4-fire as primary substance –HERACLITUS 

THEORY OF 4 SUBSTANCES  – by EMPEDOCLES 

-said not 5 but 4 elements : water, earth, fire, air.

THEORY OF ATOM – by DEMOCRITUS 

• -He rejected all other theories
• -said everything is composed of atoms which is always in motion

THEORY OF INNUMERABLE SUBSTANCES – by ANAXOGORUS

• –said primary substances are innumerable
• -First Greek medic proposed the importance of mind

Hippocratic corpus or (corpus Hippocraticum –Latin) :

• -is a collection of around 70 ancient Greek medical works
• -written in ionic Greek
• -Not written by one person-
• -followed the principles of Hippocrates so it is called corpus Hippocraticum
• -contain text books,lectures,research,notes and philosophical essays
• -No particular order of arrangement-
  • Very important of those works are :
    • -the Hippocratic Oath
    • -the book of prognostics
    • -on regimen in acute disease
    • -aphorisms
    • -on airs, waters, places
    • -instruments of reduction
    • -On the sacred diseases

Hippocratic theory :

• -First physician rejected supernatural or divine causes if disease
• -was against mystical disease concepts
• -separated discipline of med and religion
• -argued diseases are due to change in environmental factors, diet and life habits
• -only hypothetical concept of Hippocrates-humeral theory
• -Greek customs were against human body dissections
• -so Greek school didn’t know anything about anatomy
• -ancient Greek school was split into 2 knidian school and koan school.
• Knidian school :
  • focused on diagnosis.
  • Couldn’t analyze symptoms to conclusion-because of lack of anatomical knowledge.
• Koan school:

• focused on prognosis and patient care .
• was more successful .
• applied general diagnosis and given passive treatments .
• clinical practices got great development

Humorism or humoral theory :

• -Humeral theory states- diseases are due to dyscrasia (bad mixtures) or   imbalance   in humors
• -humors are fluids which were naturally equal in proportion (pepsis)
• -4 humors –blood, black bile, yellow bile, phlegm
• -e.g.-used citrus for phlegm excess
• -anger was believed to be due to excess of yellow bile in blood
• -this theory had been connected to astrology

Crisis :

• -is a concept in Hippocratic medicine
• -crisis is a point in progression of disease at which patient could either go to death or recovery
• -after a crisis a relapses might occur which cause another crisis
• -crisis usually occurs on critical days
• -Critical days – are fixed time after contraction of disease
• -if crisis occurred far from critical day relapses might be expected

Basis of Hippocratic medicine :

• -Based on vis medicatrics nature (Latin)-healing power of nature
• -Says body contains power to heal itself to re balance humors –power is called physis
• -given capital importance to rest and immobilization in treatments

Strengths of Treatment in this period 

• -was simple, and passive
• -passive approach was very successful in simple ailments
• E.g. –broken bones –traction used
• -Hippocratic bench was used for such treatments
• -emphasized on prognosis
• -strict professionalism, discipline and rigorous practice
• -Hippocratic work ‘on physician’ recommends physicians should be well kempt, honest, calm, understanding and serious
• -he followed detailed specifications in ancient operating room for …
• -lighting
• -personnel
• -instruments
• -positioning of patient
• -bandaging and splinting
• -gave importance to clinical observation and documentation.
• -Hippocrates made regular notes for complexion, pulse, fever, pains, movement                                                                             and excretions
• -he extended clinical observation into family history and environment
• -he is more properly called father of clinical medicine

Direct contribution to medicine :

1-clubbing-first described by Hippocrates—so called Hippocratic fingers

2-hippocratic face – used in prognosis

3-first categorized illness as acute, chronic, endemic, epidemic

4-first used terms like-exacerbation, relapse, resolution, crisis, paroxysm, peak, convalescence

5-first described symptomatology, physical findings, surgical treatment, and prognosis of thoracic empyema

6-he was the first documented chest surgeon

7-description of rectal ailments and treatment effectively- described in corpus

-Hemorrhoids -cautery, excision ligation, hot iron drying, application of salves

-Used rectal speculum -constitutes fundamental concept of proctoscopy ,and earliest reference of endoscopy

Hippocratic face :

Nose sharp, eyes hollow, temples shrunken, ears cold with lobes turn outward. Skin of face parched and tenses the color yellow and very dusky

Drawbacks of Hippocratic School :

• general diagnosis and therapy only used
• -Hippocrates were reluctant to use specific therapy –might be wrongly chosen and end in more danger
• -potent drugs used in certain occasions only

Hippocratic Oath :

• Document on ethics
• -most famous of corpus hippocraticums

Aphorisms of Hippocrates :

• -His first aphorism-life is short art is long
• Some importance ones—-
• 6^th-for extreme disease extreme strictness of treatment is efficacious
• 2^nd-when sleep puts an end to delirium it is a good sign
• 19^th-all diseases occur at all seasons but some diseases are more apt to occur and to be aggravated at certain seasons

• -Next to Hippocrates –Galen 129-200 BC retained and perpetuated Hippocratic medicine
  • Middle ages -Arabs adopted Hippocratic medicine
• -After European renaissance –this school was further expanded by sydenham, Herberden, Charcot and Osler

ANOTHER KEY FIGURE OF THIS ERA

1.ARISTOTLE 

• -known as MASTER OF THEM THAT KNOW 
• -was a disciple of PLATO 
• -his work on logic was known as ORGANON 
• -wrote about memory, dreams, soul, and prophesying
• -believed only in scientifically explainable things
• -his method was both inductive and deductive
• -described embryological developments
• -described genera and species 
• -wrote thesis on meteorology, hydrologic cycle
• -he used the term analytics for logic
• -the logic was introduced by Xenocrates

Concepts of Greek medicine was inherited to whole world .

Especially to Alexandrian system and Roman system .

8.ALEXANDRIAN MEDICINE :

• after death of Aristotle his pupil alexander the great started a great medical school at Alexandria, Egypt
• -Human body dissection was a regular practice –which enriched anatomical knowledge
• -2 most influential persons were HEROHILUS and ERASISTRATUS 

HEROPHILUS

• –  is known as   FIRST ANATOMIST IN HISTORY
• -He could differentiate nerves from blood vessels motor and sensory nerves
• -dissected eye and descried retina
• -coined the term retina, duodenum
  • Most important contribution was – theory of diagnostic value of pulse

ERASISTRATUS 

• -founded a school of anatomy at Alexandria
• -distinguished cerebrum from cerebellum
• -distinguished pulmonary and systemic circulation
• –rejected pneuma theory and said nerves are not hollow
• -Gave importance to diet, massage, bath etc.

 9.ROMAN MEDICINE 

• -limited scientific knowledge and deep religious and mythological believes are the base of roman system
• -early roman medicine was agriculture based
• -used home remedies
• -head of the family was the dispenser of medicines
• -clinical observation and record keeping had been followed
• -prayers, offerings, sacrificing to gods were parts of treatments
• -many of the roman gods were believed to be with healing powers
• –GOD OF HEALING –AESCLAPIOUS 
• -GOD OF HEALTH-SALUS with symbolic snake entwined staff (used even today in medical field s an emblem)
• -believed diseases were due to disfavor of gods
• -magical treatments were common
• -used natural products as medicines (Herbology)
• -used primitive forms of witchcraft
• -adopted Greek system and teachings of Hippocrates
• -expanded Hippocratic works by adding religious believes

Important names in roman medicine :

1-ARETAEUS CAPADOCIA

• -was a Greek physician of 1^st century
• -wrote treaties on DISEASE, CAUSE, SYMPTOMS, AND CURES which is still extant
• -divided disease into acute and chronic
• -was able to distinguish cerebral and spinal paralysis

2-GALEN (AD 130-200)

• -born in pergamos in asia minor
• -followed Hippocrates methods and rejected mythical approaches
  • followed DOCTRINE OF HUMOURS
• -described temperaments sanguine, phlegmatic, choleric and melancholic
• -recognized EXCITING CAUSES and PREDISPOSING CAUSES
• -dissected human body and explained anatomy and physiology
• -known as FIRST EXPERIMENTAL PHYSIOLOGIST
• -First physician to use pulse as indicator of diseases
  • divided diseases into 3 classes
  • Affecting similar parts or simple tissues e.g.; to muscles, nerves
  • Organic –affecting compound tissues
  • general-humoral dyscrasias
• -wrote books on anatomy, physiology, pulse, pathology, megatechne or therapeutics, temperaments, pharmacy etc
• -described many surgical instruments used by roman and Greek doctors
• -under Emperor Augustus he compiled medical texts and manuals
• -was the most well known roman medic
• -introduced THEORY OF PNEUMA
• According to this theory body systems are divided into 3
• These systems exist in the form of PNEUMA- an air like substance       essential for life
• 3 systems are
  • Brain and nerves – animal spirit-(PNEUMA PHYSICON)
  • Heart and arteries -vital spirit – (PNEUMA ZOTICON)
• -Liver and veins –natural spirit 
  • According to Galen vital principle was pneuma
  • by breathing pneuma enter lungsmixes with blood formed from liver right ventriclewhole body gets nutritionimpurities are exhaleda part of venous blood in heart reaches pores in inter-ventricular septummixes with blood from lungs by arterial vein (he called this pulmonary artery)charged with vital spirit.
  • said blood is formed in liver fro food stuff of chyle brought from intestine by portal vein
  • He recognized arteries, veins
• -recognized arteries contain blood
• -said heat set blood I motion
• -had no idea about blood circulation

3-DIOSCORIDES (PEDANIOS)-AD 65

-Wrote text on HERBAL MEDICINE –still used by alternative systems of medicine

4-SORANUS 

-Lived in Ephesus

-wrote book on OBSTETRICS AND GYANECOLOGY 

5-ONBASIUS (AD 325)

-Wrote an encyclopedia 

6-AULUS CORNELIUS CELSUS (AD 30)

• -Compiled medical corpus (de medicine)consist of 8 books one belong to surgery
• -That book on surgery was the first medical book printed –in 1478
• -Described cardinal signs inflammation –RUBOR, CALOR, DOLOR, TUMOR
• BARBARIC practices were there –used bleeding cups to take blood from various parts of body for cure

Public health : 

• maintained good public health
• -used aqueducts, fresh running water, toilets, sewer systems
• -prevented standing water based diseases
• –disposed wastes from populated areas
• -kept excellent hygiene and food supply
• –roman baths were integral part of the society
• -tried boiling medical tools as a cleansing method
• -was aware about harmful effects of common materials like asbestos and lead
• -but they were unaware of how to stop such harmful effects other than limiting exposure

ANCIENT ROMAN DOCTORS :

• Doctors had low social position unlike in Greece
• -profession was believed to be fit for slaves, freedman non Latin citizens especially Greeks
• -doctors were considered as cheaters, liars, quacks
• -some of them got reputation in society
• -many doctors were without proper knowledge
• -reputed doctors set up shops with office and staffs
• -others were like snake oil sales men selling products
• -cosmetics and beauty supplies were commonly purchased from such doctors
• -women performed important services as midwives as doctors were not expertized in this field
• -there was no licensing board
• -any one could call himself a doctor
• -medical training consisted mostly of apprentice work.

ROMAN SURGERY :

• Did surgeries for tumor, hernia etc
• -more extensive surgeries occurred under military care
• –TREPANATION– was the method of brain surgery for headaches to relieve pressure, using a drill—but patient had high survival rates
• –CATARACT –surgery using a thin needle-had a moderate success rates
• -cosmetic surgery was performed

CAESAREAN SECTION 

• According to caesarean law when a pregnant woman died, she could not be buried until child had been delivered—
• -they had fine knowledge about reproductive cycle—10 months
• -actually Caesar was not born by this method—his mother Aurelia lived for many years after his birth

ROMAN HOSPITALS

• Were limited to military camps
• -after establishment of Christianity hospitals were built
• -there were temples such as Aesulapium-sick persons spent there at night offering prayers
• -there were houses to care dying or infirmed patients
• -concept was not cure but care
• -wealthy estates possessed facility to isolate injured and diseased slaves

ROMAN DRUGS AND PHARMACEUTICALS :

• an army doctor DIOSCORIDES had written about 600 plants 100 drugs tested on patients
• -medicines were made from minerals, animal substances etc
• –cough and chest problems-treated with-special herbs mixed with wine
• –eye infection-lead, zinc and iron oilments
• –Snake bites and skin problems –sap from trees
  • used mercury as curative medicine
• -boiled medical tools for cleansing
  • used mortar and pestles –given drugs as pills
• -developed many antidotes to poisonings
• –acetum used as more effective antiseptic than carbolic acid (discovered by joseph Lister –in 1860 s)
• -used anesthetics
• -Used opium poppies– action was known to them-deadens nerve endings and limits movements
• –henbane seeds-scopolamine induces sleep
• –Mandrake-deadens pain, slows heart rate, also controls bleeding

ROMAN MEDICAL TOOLS :

• SCALPEL-made of bronze, iron, steel
• –MEDICAL SCISSORS 
• -HOOKS AND PROBES 
• -Blunt hooks –for dissection and raising blood vessels
• –Sharp hooks –hold and lift small pieces of tissues
• –BONE DRILLS – to remove growths and to make holes
• –METAL FORCERPS –to extract small pieces of tissues and bones
• –CATHETERS-urinary, nasal-used metal tubes
• –BONE SAW– for amputation to prevent gangrene
• –VAGINAL SPECULUM
• –BONE LEVERS –in fractures, or to remove teeth
• –RECTAL SPECULUM–

10.MEDIVIAL PERIOD ( MIDDLE PERIOD )

It is the period of thousand years between Greek, roman era and the period of renaissance

– It includes :BYSANTINE MEDICINE AND ARABIAN MEDICINE

BYSANTINE MEDICINE :

• -this period was during eastern empire BYSANTINE 
• -First BYSANTINE physician believed to be wasDIOSCORIDES
• -his famous work was COMPENDIUM OF ALLMATERIA MEDICA
• -He followed an earlier work by CRATEAUS  
• -Greatest compiler of medical knowledge in this era was ORIBASIUS 
• -important contribution was they built hospitals
• -Chief physician was called ARCHATROI
• -professional nurses were called HYPOURGOI
• -Staffs were called HYPERTOI
• -CHRISTIANITY became more popular –they built more churches and hospitals

PERIOD OF DEPRESSION IN EUROPE (500-1300 AD) :

• -hygiene, bathing and general health care lost during this period
• -starvation became a main issue then
• -believed epidemics were punishment of god
• -Biggest challenge of this period was plague (bubonic)–called BLACK DEATH 
• -religion played important role in this period
• -role of women was limited to midwives and nurses
• -FirstEuropeanmedieval institutions considered to be universities (first in Paris)

KEY FIGURES :

1-PETER ABERALD

• -was a French philosopher
• –YES OR NO, DIALECTICA were his important works
• -followed ideas of Aristotle

2-ALBERTUS MAGNUS

• -was a German philosopher
• -followed Aristotle’s teachings
• -was called Aristotle’s ape
• -Isolatedarsenic for first time –first element to be isolated
• -was interested in musical healings
• -was called THE GREAT or DOCTOR UNIVERSALIS

3-ROGER BACON

• -Was known as DOCTOR MIRABILIS
• -was a great philosopher

4-HUGH LUCCA

• -was a surgeon 
• -observed that wine was so effective in cleaning wounds and preventing infections (there was no idea about germs causing illness)

11.RENAISSANCE PERIOD 

• Renaissance started in Italy in 14^th, 15th, and 16^th centuries and expanded to whole Europe –Italian period is called beginning of modern epoch.
• -their thinking was influenced by Greek, roman cultures and also by humanism
• -humanism emphasizes the worth of individual
• -humanist believed improvement of society was possible by classical education-moral philosophy, disciplines, poetry, history etc.
• -Word renaissance means –rebirth
• -word renaissance was first used by VASARI in his book VITE
• -it represents the connection between classic and modern
• Period
• -influenced by Galen, Ptolemy (believed earth was center of universe), Dante etc.
• –ALCHEMY, ASTONOMY, GEOGRAPHY were related to medical science
• –PAUDAN school became most important center for education

SCIENCE IN RENAISSSANCE

• -humanism had an indirect influence
• -polish astronomer Copernicus -16^th century had a pivotal role
• -Plato contributed mathematical rather than descriptive approaches
• -Belgian physician André us vesalius  –did human body dissection and learnt anatomy deeply
• -curiosity and experimentation of scientists created great developments
• -navigation, astronomy, mathematics, medicine fields had tremendous developments
• -Before renaissance period medical practice was an art more than science-except Hippocrates and Galen
• -a new scientific spirit developed which strongly opposed all the mystical approaches
• -Scientific spirit- included
• 1-spirit of inquiry –unprejudiced inquiry -divided all knowledge till then to two :
  • • • results of generation experience-very valuable.
      • heirloom rubbish
• 2-demand of real connection between cause and effect 
• 3-the spirit which keep one close to fact 
• this period more aptly called age of reasons

MEDICINE IN RENAISSANCE :

• -medicine escaped from traditions and dogmas
• -books were translated from Arabic and learnt more about anatomy
• –vesalius and lenardo-davinci dissected human body and made first anatomical drawings 
• -church didn’t permit body dissection but scientists dissected criminals or sinners bodies
• -human body was believed as creation of god
• -humeral theory prevailed
• -blood letting and treatment by assisting nature were followed
• –WILLIAM HARVEY– discovered blood circulation
• -Modern concept of human body-which consist of specialized systems that work together, developed during this period
• -Knowledge on herbs advanced –taken from Arabic writings
• -renaissance pharmacists were called apothecaries
• -plants brought from different lands by explorers like Columbus were tested
• -Quinoa –QUININ was used for malaria
• -they had knowledge about the medicinal properties of tobacco
• -LAUNDANUM-an opium based pain killer was in use
• -Trades between different parts of world increased-so diseases started spreading globally –e.g. bubonic plague from china to Europe
• -hospitals in Europe started teaching medicine
• -Surgery advanced but instruments remained basic –local barbers performed surgery and tooth extraction
• -Tying wounds to stop bleeding –been to be used
• –12^th century –translated works of Avicenna and other Arabic medics
• –13^th century –anatomical knowledge increased
• -Hippocratic theories gradually got neglected
• -studied about side effects of drastic drugs
• –16^th century-PHILIPUS A THEOPHRASTUS BOMBASTUS VON HOHENHEIM-known as PARACELSUS rejected Hippocrates and developed new philosophy
• -Paracelsus –philosophy
• -was based on Christian dogma
  • neoplatonic philosophy
• -connection between micro and macrocosm
• -but Paracelsus gave unwanted importance to astrology and alchemy
• -according to him diseases were chemical in origin and could treat only chemically
• -he focused on theories of unseen chemical phenomena than observable signs and symptoms

IMPORTANT PERSONALITIES :

1-LEONARDO DA VINCI (1452-1592) 

• -Was a god gifted artist, painter
• -so he could contribute to medicine by drawing human anatomical drawings
• -was first to demonstrate ventricles of brain by wax injection-
• -First to depict fetus and its membrane within uterus
• -first to depict the double S shape of back bone
• -was the master of TOPOGRAPHIC ANATOMY
• -is called UNIVERSAL GENIUS
• -studied bones ,spine valves ,muscles-its origin insertions ,viscera,brain-cross section ,blood vessels
• -discovery of atrio-ventricular band in right heart 

2-HEIRONYMUS FRACARTORIUS GIROLAMO(1484-1553)

• -born in xero
• -was contemporary of Paracelsus
• -work on syphilis he called it as Gallic disease
• -considered as THE FOUNDER OF MODERN EPIDEMOLOGY
• -First to recognize typhus 
• -another work In 1546- DE CONTAGION –described 3 methods spread of inflammation direct contact, fomites and droplets (seminaria)
• -used mercury and guaco for treatments
• -believed seeds of diseases were chemicals

3-ANDREAS VESALIUS  (1514-1564)

• -He belonged to a medical family
• -he secretly collected skeleton of a criminal and studied
• -was a professor of surgery and anatomy
• -rejected many concepts of Galen
• -published anatomical drawings-called  TABULA ANATOMIACAE
• -Many figures represented body in action
• -First to discover –lower jaw contain single bone
• -First to describe sternum has 3 parts not seven
• -observed valves of veins
• -First to find each artery has a corresponding vein
• -First he admitted pores in interventricular septum but later rejected
• -described vestibule in temporal bone, ductus venosus
• -in anthropology filed-he used reflecting light and found Germans are round headed and Belgians are long headed

4-REALDUS COLUMBUS 

• -succeeded vesalius
• -described blood flow from right heart to lungs ,clitoris,lense of eyes etc
• -demonstrated pulmonary circulation
• -it was published in book DERE ANATOMICA

5-COITER OF GRINGEN 

-made complete picture of anatomy of human ear

6-GABRIEL FALLOPIUS 

-Discovered fallopian tubes

-described tympanum round and oval window

-pointed out connection between mastoid cells and middle ear

-First to use aural speculum

7-BARTOMELIUS EUSTACHIUS 

-First to illustrate thoracic duct, ciliary muscle, facial muscle, larynx and kidney

8-AMBROISE PARE

-contributed to surgery

-proclaimed knowledge from experience were not enough or surgeons

-said a remedy thoroughly tested is better than recently invented

-invented gun powder

-detailed fractures and dislocations

-invented artery forceps

-suggested syphilis has a course of aneurism

9-THOMAS VICARY (1505-1570)

-His book- TREASURE FOR ENGLISHMEN– contain anatomy

-was the first master of barber surgeons in England

-barber surgeons were called GILD or groups

10-PIERRY FRANCO (1505-70)

-First to perform SUPRA PUBIC LITHOTOMY

-Wrote an article on hernia-and described operation for strangulated hernia

-was successful in doing cararact surgery

11-GASPARE TAGLIACOZZI

-Was an Italian surgeon

-First to describe rhinoplasty 

12-WILLIAM CLOWES 

-Was an English surgeon

-a work on gun shot wounds

–a treatise on venereal diseases

13-JOHN WOODALL (1569-1643)

-Wrote a book-THE PATHWAYS TO SURGEONS CHEST –details necessary instruments and their use

14-PERTER LOWE 

-Wrote first English textbook on surgery

15-PARACELSUS (1490-1541)

• -Was the most disputed person of 16^th century, was considered as a charlatan, a drunken quack
• -in 19^th century scientists recognized his importance-called LUTHER OF MEDICINE (most original thinker of 16^th century
• -all his writings were published after his death
• -advocated chemical view of life
• -his main work was PARAMIRUM
• -Proposed every action of body depends on sulphur, mercury and salt-imbalance of these 3 chemicals causes diseases
• -sulphur burns, mercury becomes smoke and salt becomes ash
• -in brief 3 diseases and 3 medicines
• -Though theory is unscientific –he tried to simplify prescriptions
• -Said all medicine rest upon FOUR PILLARS OR COLUMNS –PHILOSOPHY, ASTROLOGY, ALCHEMY and VIRTUE
• -he gave more importance to astrology but didn’t believe stars control destiny of individuals
• -stated aim alchemist to separate food from poison
• -Opinioned poisons get deposited on teeth –called tartar
• -wanted physician must be god fearing
• -believed in DOCTRINE OF SIGNATURA
• Examples-
  • -Cyclamen –for ear disease-as leaf of plant resembles human ear
  • -lungs of fox used for lung diseases
  • -Yellow drugs –for jaundice
• -doctrine of signatura was revived by Rademacher and Hahnemann
• -believed in SIMILARS
• -introduced metals like iron antimony, minerals, salts, inorganic substances in therapeutics
• -believed body produces a natural balsam and heals the wounds
• -introduced doctrine of LATENT FORCES OF NATURE
• -was first to connect goiter with minerals and salt

16-RENE DESCARTES

-Was a French mathematician-invented analytical geometry, algebra

-called FATHER OF MODERN PHILOSOPHY

– He studied optics of vision, dynamics of mind etc.

-believed pineal gland was seat of intelligence

17- ROBERT HOOK

-was an English philosopher

-advocated medicinal use of Indian hemp

-his work is MICROGRAPHIA 

-Coined the term cell 

18-ANTONIE VAN LEEUWEHOEK (1632-1723)

-called FATHER OF MICROBIOLOGY

-distinguished kingdom Protista

-devised first simple microscope

-discovered bacteria, vacuole of call, spermatozoa, muscle fibers

-called microorganisms ANIMACULES

19-ROBERT BOYLE (1627-1691)

-Known as first modern chemist

-discovered chemical nature of blood

–Boyles law-pressure is inversely proportional to volume

-First to describe decompression sickness

20-FRANCIS BACON 

-proposed single, small-medium dose

-criticized search for imaginary cause of disease

-advised to be unprejudiced

–his first book was ADVANCEMENT IN LEARNING

–INSTAURATIO MAGNA, NOVUM ORGANUM, THE WORLD, etc. are his classic works

21-MARCELLO MALPIGHI (1628-1694)

–ITALIAN 

-known as FATHER OF MICROSCOPICAL ANATOMY and HISTOLOGY

-also known as FATHER OF EMBRYOLOGY

-explained excretory system-malpighian tubules

22-THOMAS WILLIS 

-English

-studied cerebral anatomy

23-THOMAS SYDENHAM

-called ENGLISH HIPPOCRATES or FATHER OF ENGLISH MEDICINE

-preferred simple remedy treatments

-gave importance to observation and following nature

-Work-OBERVATION OF MEDICINE

-Studied on epidemics—(genus epidemicus)

-Observed chorea in rheumatic fever –Sydenham’s chorea

24 JEROME CARDAN (1501-1576)

-Italian mathematician

-wrote book on algebra

-another work is DE SUBSTITUTA-household encyclopedia

12.SEVENTEENTH  CENTURY 

• Age of scientific revolution 
• 20^th century philosopher Alfred whitehead mentions the 1600’s as the “century of genius” as Galileo, Newton, Kepler, Descartes, Bacon, & Harvey graced the century by their presence.
• Renaissance certainly prepared the way for modern science.
• The 17^th cent made great advances that established the natural science by turning from speculations to experimentation.
• The 17^th cent was also an age of religion.. During this cent different schools like materialism, idealism & substantial’s continued to speculate & interpret their observations in their own methods. Advancement in physical science provided  materialism the upper hand.
• The two philosophers who profoundly influenced the seventeenth century and also had its effect on the medicine were F Bacon & Rene Descartes.

During the 17^th cent different schools  continued to speculate & interpret their own methods :

• Idealism: experience is ultimately based on mental activity.
• Materialism: holds that the only thing that exists is matter. That all things are composed of material and all phenomenon are the result of material interactions. So to many philosophers physical’s is synonymous with materialism. Advancement in physical science provided materialism an upper hand over the other schools
• Substantialism: matter does not disappear it only changes form..

FRANCIS BACON (1561-1626) :

• He played a major role in the rise of modern medicine. He emphasized the observation of phenomena & the accumulation of data. He privileged the process of induction over deduction.
• Bacon taught men to take “reason” directly from the pages of nature. He emphasized that truth is the daughter of time, not of authority.
• Acc to Bacon man using his art could do nothing but bringing things near to one another & the rest is performed by nature. Thus art can give only certain powers  in a particular direction & medicine is the art by which such a particular direction is given to certain powers of nature to check diseases. All therapeutics are only giving certain powers of nature a particular direction.
• Bacon brought out the faults of Aristotelian system of syllogism (reasoning from general to particular i.e,deductive reasoning).
• He lead no new school of philosophy he simply revived the platonic method of reasoning in his book “NOVUM ORGANUM”
• His two important major writings are:
• Advancement of learning—1605 
• NovumOrganum— 1620

RENE DESCARTES(1596-1650)

• Father of modern philosophy
• Devoted his entire life to scholarship in the field of mathematics & philosophy.
• He invented analytical geometry.
• Acc to him all things in nature including animals  were machines composed of substances in motion, governed by mechanistic principles obeying mathematical laws. 
• He made a sharp distinction between the body & mind, stating them as radically different entities.
• He believed that intelligent soul was located in the pineal gland of the brain & that soul caused movement in the body by stirring up the brain thus generating animal spirits in the cerebral ventricles with the spread of these spirits to cause movement of blood.

WILLIAM HARVEY( 1578-1657)

• Born in folkestone , England.
• Description of little doors (the valves) by his teacher Fabricius was an important observation which Harvey latter used to support his circulation theory.
• Obtained his medical degree at the age of 24.

• While practising medicine he found out time to carry out investigations in anatomy & in physiology, dissecting more than a hundred different species of animals & humans.

• It was from these studies that his ideas emerged crystallizing his work “De MotuCordis et Sanquinis in Animabilus”(on the motion of the heart & blood in animals) published in 1628 which set out his revolutionary theory of the circulation of blood.

• Thomas Sydenham, MD : the father of clinical observation – 1624-1689

THOMAS SYDENHAM(1624-1689)

• He has been hailed as the “English Hippocrates”. He opposed iatro-physical and iatro-chemial view, instead suggested observation and recording of clinical phenomena.
• He preferred simple remedies.
• He advised specifics for diseases conditions & to observe and to follow nature. He went back to the Hippocratic method of recording the sick phenomenon . He put two alternative before medical profession
  • • To follow Hippocrates & imitate the methods of nature.
    • To attack maladies directly with specifics.

• • • His opinion was that the art of healing would attain full maturity only when specific medicines for all the prevalent diseases are discovered. He could not live up to his ideals due to the shortage of such specifics.

ATHANASIUS KIRCHER (1602 – 1680) :

• He published a work in 1646 which included a chapter on the wonderful structure of things in nature, investigated by the microscope.
• He published physico-medical scrutiny of contagious pestilence in 1658.
• His was certainly the first clear statement on the ‘germ theory’ of contagious diseases based upon microscopical view.

ROBERT HOOKE (1635 – 1702)

• Published ‘micrographia’ in 1665 and showed the histology of vegetable structures.
• He was apparently the first writer to employ the term cell.
• He was noted for his biological drawings

MARCELLO MALPIGHI(1628 –1694)

• He has been called the father of embryology.
• Malpighi’s ‘De formation pulli in ovo’ was published in 1666.
• His anatomical observations on the lungs in 1661showed that the lungs are made up of numerous air vesicles in which the bronchioles end, and that a capillary anastomosis exists between the small arteries and veins. 
• He also published on plant morphology.
• Marcello Malpighi (10 March 1628 – 29 November 1694)

ANTON VON LEEVONHOEK(1633 – 1723)

He has been described as the father of protozoology and bacteriology.

He described large number of bacteria and protozoa.

Anton van Leeuwenhoek
1632-1723

CHRISTOPHER WREN (1632 – 1723)

He experimented with infusions in 1656.He injected wine, opium, ale and other substances into dogs intravenously and led the way for blood transfusions

RICHARD LOWER(1631– 1691)

He successfully transfused the blood of one animal to another in 1665 and transfused a poor man with blood of a sheep without complication in 1667

He published his ‘Tractatus De corde’ in 1669.

It contains anatomy  and physiology of the heart and respiration and his method of transfusion.

JACOB BONTIUS (1592 – 1631)

• He produced the first authoritative work on tropical diseases and the first description of beriberi in the European literature.
• Renier de Graf
• Renier De Graaf
• He published treatise on pancreatic juice in 1664
• He described an illustrated method of collecting the juice through the cannula
• He obtained bile from the bile duct and saliva from the parotid gland by same method.
• He published a volume containing three treatises in 1668 on the anatomy of the male and organs of regeneration. The follicles of ovary were described & have been called graffian follicles.

THEOPHILEBONET (1620 –1689)

• He produced sixteen medical books.
• His first publication was the ‘sepulchretum’ in 1679.
• This ranks few medical books of importance and gave impetus to study of pathological anatomy.
• This was an encyclopaedia which contained a record of each recognizable disease from ancient times to that date.

ROBERT BOYLE (1627 – 1691) :

• He published his first book in 1660. this volume contained his law, “at a stated temperature a given mass varies inversely proportional to the pressure.”
• He studied respiration, combustion, the chemical nature of blood and urine, magnetism, electricity and almost every thing except astronomy.
• He was considerably influenced by Lord Bacon. He asked the physicians to dismiss prejudice and blind authority.
• He wanted the physicians to concentrate more on the “uncertainities’ of diseases than the ‘certainities” because he visualised diseases as phenomena and he believed that restoration of the sick and relief of sufferings depend on the uncertain aspects of diseases.
• He was against mixture prescription.
• He criticized the blind methods of Galen and also Hippocrates’ imitation of Nature, in their therapeutics.
• He asked the physicians to find out substances which exercise a directly curative power-a power of neutralising the causes of diseases, without producing any disturbing effects on the body.

13.EIGHTEENTH CENTURY

• industrialization caused crowding of peoples in towns and attacked with many diseases, cholera, TB, pneumonia, infections etc.
• -2 big medical advances-were VACCINATION (small pox) and X RAY
• -small pox was known as SPECKLED MONSTER
• -rejected theory of humors
• -Believed diseases were due to bad air –miasms 
• -doctors were better trained

1-CLINICAL MEDICINE DEVELOPMENTS 

• • Many simple diagnostic tools developed
• -Rene theophile lennec (1781-1826) wrote thesis ON MEDIATE AUSCULTATION –described chest pathologies
• -Laennec invented stethoscope-wooden tube
• -till that time chest examination of female patients were difficult because of social taboo
  • Rubber tube stethoscope invented in mid century
• -In 1852 American physician George .p.camman devised two- ear stethoscopes
• -Discovered thermometers-which was a foot long and difficult to use at bedside –GALILEO discovered first thermometer during this period
• –SPHYMOGRAPH-pulse recorder was discovered by KARL VEIRORDT
• –SPHYGMOMANOMETER was discovered by RIVA-ROCCI
• –HYPODERMIC SYRINGE was invented

2-BIOCHEMISTRY

• -18^th century MATHEW DOBSON developed test for diabetes
• –RICHARD BRIGHT described test kidney diseases-later called bight’s disease

3-ANATOMY

-human bodies for dissection were totally unavailable

-body of great English philosopher Jeremy Bentham in accordance with his direction was dissected

4-ANAESTHETICS

-Anesthetic quality of NO were discovered by English scientist sir HUMPHRY DAVI-1795 

– He tested various gases himself

5-RELIGION AND MEDICINE

-Religious oppositions were there against anesthesia

6-PUBLIC HEALTH

-outbreaks of many diseases occurred due to industrialization

–PERCIVALL POTT 1n 1775-found chimminey sweepers scrotal cancer

7-WAR AND EFFECT ON MEDICINE 

-many wars of Napoleon happened

–DOMINIC JEAN LARRY – introduced ambulance for transporting wounded soldiers

8-BLOOD TRANSFUSION

-First attempted by JAMES BLUNDELL

9-PREDOMIENT THEORIES 

–MIASM THEORY

-widely accepted

-disproved by johns snow following an epidemic

–THEORY OF SPONTANEOUS GENERATION-from non living matters

–GERM THEORY –by LOUIS PASTURE

-THEORY OF EVOLUTION- Darwin

-CELLULAR THEORY-RUDOLF VIRCHOW

KEY FIGURES IN THIS ERA :

1-JOHN PRINGLE

-established military hospitals

-word ANTISEPTIC used for first time

-a book on disease of the army

2-WILLIAM CULLEN 

-described importance of nervous system in health and disease

-First to assign chemistry in proper position

-wrote TREATIS ON MATERIA MEDICA

3-PERCIVALL POTT

-One of the founders of orthopedics

-found chimmeney sweepers cancer

-Got a fracture on his ankle –later such fractures were called pott’s fracture

-First described TB of spine-pott’s disease

4-JOHN HUNTER

-was a Scottish surgeon

-was an excellent anatomist

-studied on dentistry 

-studied in inflammation

-some works on venereal diseases

–an understanding of nature of digestion

5 JOSEPH BARTHEZ 

-French physician, physiologist, encyclopeadist

-introduced concept of vital principle

6-JOHN BROWN 

-A Scottish physician

-classified disease in to sthenic and asthenic

-Published ELEMENTA MEDICINE –called Brunonian system of medicine

-treated diseases as caused by defective and excessive excitation

7-EWARD JENNER (English)

-presented observation of migration of birds to royal society

-discovered vaccination successfully against small pox

8-SAMUEL HAHNEMANN 

-founder of homoeopathy

-called FATHER OF EXPERIMENTAL PHARMACOLOGY

-discovered primary and secondary action of medicines

9-GEORGE EARNEST STAHL 

-said soul and body are closely blended

-source of vital movements are soul or anima

10-HERMAN BOERHAVE

-institutions medicae

-aphorisms

-index plantarum

11-FREDERICH HOFFMANN 

-Opinioned universe is pervaded by a vital substance not exactly spirit soul or mind-which keeps body in equilibrium

12-JACOB HENLE

-Discovered kidney tubules ( Henles loop)

-called VASALIUS OF HISTOLOGY

-Supported Robert Koch –made henle-koch postulates for diagnosis

13-FLORENCE NIGHINGALE

-created first school for nursing in 1856

-wrote a book NOTES ON NURSING

14-HERNY DUNANT

-created international Red Cross

-After that -RED CRESENT- for Islamic countries was developed

15 CHARLES BELL

-Studied on neuro anatomy

-studied about facial nerve in detail

-Bell’s palsy- from his name

-Bell’s nerve-posterior thoracic nerve

-Bell’s spasm-involuntary twitching of facial muscles

-Bell-magendie law-states anterior spinal roots are motor and posterior, sensory

16-RENE LENNEC

-Studied on neuro -anatomy

-studied about facial nerve in detail

-bell’s palsy- from his name

-bell’s nerve-posterior thoracic nerve

-bell’s spasm-involuntary twitching of facial muscles

-bell-magendie law-states anterior spinal roots are motor and posterior, sensory

-invented stethoscope

-described bronchiectasis, melanoma, cirrhosis (Laennec’s cirrhosis)

17-MARSHAL HALL

-introduced theory of reflex arc

-First to show capillaries are intermediate channels between arteries and veins

-described methods of resuscitation

18-THOMAS ADDISON

-Did a lot of research in dermatology

-Found out pigmentation on skin-now called Addison’s disease-bronze skin

-Addison’s crisis-in Addison’s disease

-Addison’s-symptoms in Addison’s disease

-Addinsonian anemia-pernicious anemia

-Addison-schilder syndrome=Addison’s disease+ cerebral sclerosis

19-CLAUDE BERNAD 

-studied functions of pancreas, liver and about diabetes

-explained vasomotor nerves

-introduced idea of homoeostasis

20-CARL LUDWIG

-was a physiologist

-demonstrated existence of secretary nerves

-Advised KYMOGRAPH– to record blood pressure from blood vessels

-designed mercurial blood pump

21-LOUIS PASTEUR

-is called GREATEST BIOLOGIST OF ALL TIME

-introduced

–GERM THEORY

     -PASTEURIZATION

     -RABIES, DIPHTHERIA, ANTHRAX VACCINES 

-he opposed Darwinism

22-JOSEPH LISTER

-called FATHER OF ANTISEPTICS AND ASEPSIS

-invented sinus forceps, catgut ligature

-classified diseases into sthenic and asthenic types

-Listerine mouth washes were named after him

23-ROBERT KOCH

-Pasteur and Koch are called fathers of microbiology

-discovered tubercle bacillus, vibrio cholera,

-developed Koch postulates

SCIENTIFIC CONCEPTS OF 18^TH AND 19^TH CENTURY :

1-holistic idea changed to REDUCTIONIST CONCEPTULIZATION as organs, functions were discovered scientifically

2-SANITATION, HYEGINE, PREVENTIVE MEDICINES

3-SERUM THERAPY

4-BACTERIOLOGY

5-SPECEFIC CAUSES OF DISEASES

6-DENTISTRY

7-CELLULAR PATHOLOGY

8-AUTOPSY-by ANTONIO BENIEVEINI-FATHER OF PATHOLOGIC ANATOMY

9-MODERN PATHOLOGY- by XAVIER BICHAT –FATHER OF MODERN PATHOLOGY

10-EXPERIMENTAL PATHOLOGY-by JULIUS COHNEIM-FATHER OF EXPERIMENTAL PATHOLOGY

11-IMMUNOLOGY

12-INFLAMMATION

13-ANTIBODIES

14-ANAPHYLAXIS

15-CONTACT SENSITIVITY AND DELAYED HYPERSENSITIVITY

14.MODERN MEDICINE 

A.MEDICINE IN 20^TH CENTURY 

• -maximum discoveries and advancement occurred in 20^th century
• -germ theory was accepted
• -discovery of leucocytes led to immunology
• –vaccination and antisera developed markedly
• –eliminated many diseases which were prevalent and dangerous before
• –Filterable viruses were discovered-in 1980
• -identified viruses causing yellow fever, smallpox, typhus, measles, polio, rabies, and viral meningitis

MILESTONES 

1-ERADICATION OF SMALL POX

-Last case reported in Africa in1977

-in 1980 WHO declared end of small pox

-there are highly guarded stocks of virus in Russia and USA

2-INSULIN

-In 1921 by Frederick banting and Charles best –Canada

-Egyptian writings in BC 1500 described diabetes-as wasting disease with sweat smelling like urine

-1922-14 year old Leonard Thompson successfully treated with insulin

–1928-Oskar winter Steiner proved insulin was a protein

–1955-FREDERICH SANGER found amino acid sequence of human insulin

3-ANTI TUBERCULAR DRUG

–HOWARD FLOREY, EARNST CHAIN, SEMAN A WAKSMAN discovered streptomycin-first effective anti tubercular drug-they got Nobel Prize in 1952

-Florey and chain showed that penicillin could be used to save lives

4-RESISTANCE TO ANTIBIOTICS

-antibacterial, antifungal, ant parasitic and, antiviral drugs had to face resistance

5-BARBITURATES 

-for psychiatric complaints

– were introduced in 1903

-followed by phenobarbitone  in 1912, and evipan-barbiturate anesthetic in 1932

6-SYNTHETIC DRUGS 

-In 1910 EHRLICH and Dr.Harta (japan) discovered salvarsan –for syphilis

-Progesterone-used as OCP s

7-BIRTH CONTROL

-Term coined by MARGERATE SANGER in1914

-contraceptives were criminalized that time

-1921-foundation of American birth control league

-she along with GREGORY and MC CHIANG found first oral contraceptive in 1960(envoid)

8-VITAMINOLOGY

-Polish biochemist FUNK isolated first vitamin –riboflavin

-funk coined the term vitamin-vita=life. amine=a chemical term

-CECIL DRUMMONED prosed E to be dropped and coined vitamin

9-BLOOD GROUP SPECIFICATIONS 

-made transfusions convenient

10-AUTOTRANSPLANT 

-First successful auto transplant of kidney into neck of dog by FREDERICH ULLMANN in 1902

11-TISSUE GRAFTS

-First successful kidney graft between identical twins by JOSEPH-E-MURRAY in 1954

12-ORGAN TRANPLANTATION

– Heart transplantation by CHRISTIAN BARNAD In 1967

13-ONCOLOGY

-greatly advanced

-chemotherapy, radiation developed

14-MOLECULAR BIOLOGY

• -compositions of organs, tissues, cells, organelles, and membranes had been elicited in 1998
• -synthesis and metabolism of many compounds were discovered
• -immunology, virology, cellular biology, peptide research, structural biology had vast developments
• -chemical mediators and pharmacological modifiers were discovered
• -neuroscience, biophysics developed

• -this era can be grouped into 2 first pivotal event and second pivotal event

FIRST PIVOTAL EVENT

• -Discovery of ANTIBIOTICS-in 1935-45
• -First antibiotic drug –sulphonamide
• -Then penicillin became available –in 1940
• -First research on antibiotics –ALEXANDER FLEMMING-found penicillin-first antibiotic discovered

SECOND PIVOTAL EVENT 

• -Was revolution in GENETICS -double helical structure of DNA was discovered in 1953 by FRANCIS CRICK and JOHN .B.WATSON 
• -1980-developed genetic code reading technique, isolation of specific genes, and cloning
• -Human genome project -2003-using highly automated analytical technology
• -genetic disorders were listed

DNA SEQUENCING TECHNIQE

-exact structural alteration of gene is identified by this method

-loci of mutation are identified

GENE THERAPY 

-is the pharmacological modification of specific gene action

–RUDMAN in 1990 said aging is due to decreased secretion of GH

X-RAY 

–ROENTGEN received first Nobel Prize in physics-in 1901 for discovery of x ray

-X ray can be used in treatment of cancer

-low energy x ray is used in airports to check baggages

B.MEDICINE IN 21^{ST CENTURY} 

• NANOTECHNOLOGY is on progress
• -GENE THERAPY
• -STEM CELL TREATMENTS
• -ADVANCED DIAGNOSTICS

Source : Treasure – as received