Great Breakthroughs in Medicine: The Discoveries that Changed the Health of the World

By Robert Snedden

Throughout history, medical science has been at the helm of human development, from Neanderthals stitching their wounds with bone needles to modern organ transplantation.

Robert Snedden explores this fascinating subject, marking not a straightforward trajectory from primitive guesswork to sophisticated science but rather a winding narrative of twists and turns. Discover how 7th century Buddhist monks used vaccination techniques 1300 years before their accepted discovery, or how traces of antibiotics were detected in Roman skeletons.

Other topics include:
• Hippocrates and the four humors
• Public health and sanitation
• Progress made into the science of mental health
• Medical genetics, including DNA, blood types and genetic engineering

Full of useful timelines, fact boxes and eye-catching images, this full-color hardback provides an engaging introduction to this far-reaching subject. It presents some of the pioneers of medical discovery, including household names such as Leonardo di Vinci and Edward Jenner as well as lesser known figures such as Benjamin Jetsey and William Harvey. Discover the astounding breakthroughs of medical history which changed the world.

• Language: English
• Publisher: Arcturus Publishing
• Release date: Jun 1, 2020
• ISBN: 9781839405266

Book preview

The rise of the rational

TIMELINE OF RATIONAL MEDICINE

Throughout human history we’ve hoped to escape the pain and discomfort of disease and injury. When we feel unwell two questions follow hard on each other’s heels. Why am I ill? And what can I do to make things better? The history of medicine is all about looking for the breakthroughs that will provide answers to these questions.

MEDICINE AND MAGIC

We have little in the way of direct evidence of the lifestyles of our early ancestors. What scant evidence there is comes from the study of remains such as bones and teeth found at ancient burial sites. Increasingly sophisticated techniques such as electron microscopy and DNA analysis have opened a few windows. For example, analysis of Neanderthal bones suggests that most of the protein in their diet came from large animals, while studies of their teeth reveal that they also ate a variety of plants.

One theory on the disappearance of the Neanderthals speculates that they fell victim to diseases they had never encountered before, carried into Europe by modern humans arriving from Africa. However, gene studies of common disease-causing organisms, along with DNA analysis of Neanderthal and early human remains, suggests that certain diseases were associated with both hominid species.

Most diseases affect the soft tissues of the body, which leave little trace, but examination of bones and teeth can give some insights into health and disease. Researchers can identify injuries such as fractures and dislocations and see evidence of joint disease, for example.

We can only speculate as to the beliefs and practices of prehistoric people when it came to dealing with their sick and injured companions. It is certainly obvious that they had some skills in healing and medicine, much of it doubtless arrived at by trial and error. Just from simple observation, people would have had some awareness of how the body worked and come up with ways of helping the healing process. Evidence has been found of broken limbs reset and healed and of wounds stitched with bone needles.

For early humans, hunting for food was a dangerous pursuit and the risk of injury was a constant threat.

Magic and religion may have played a large part in the early human approach to medicine taken. Little consideration was given to the lifestyle choices or family history of the unfortunate sufferer! Serious illness or misfortune was the inevitable outcome of causing offence to a god or could be blamed on the spells of an ill-disposed sorcerer: a state of affairs that could only be reversed by following the appropriate rituals.

Examination of early human remains reveals information on their illnesses and injuries.

Magic and belief provided answers to things that could not otherwise be understood. It is entirely possible that the gestures and chanting of the local shaman, or a heartfelt appeal to a higher power, really would make the patient feel better. Almost certainly these rituals were carried out with sincerity and true belief in their efficacy. The placebo effect, in which a treatment that has no actual physical effect on the body nevertheless produces positive results, is a recognized component of modern medicine.

One course of treatment thankfully not much used today involved making a hole in the sufferer’s skull. There is evidence from unearthed remains dating back to 10,000BC that humans have been boring holes into other people’s heads since Neolithic times at least. One technique appears to have involved scraping away a deep groove in the skull using a sharp implement. When it was deep enough a disc of bone could be removed from the skull. It is speculated that the patient would then wear this disc like an amulet to protect from further misfortune.

Why people would carry out this painful procedure is uncertain. Was it to remove fragments from a fractured skull? Or was it an attempt to free the patient of the demons and evil spirits that were causing their illness? Whatever the reason, people actually survived this hair-raising procedure as skulls have been found that show evidence of healing around the opening.

EARLY CIVILIZATIONS

The change from a wandering nomadic existence to a settled farming life that came with the advent of agriculture brought advantages, but it brought many problems too. Large groups of people and animals gathered together in the same place, provided more opportunities for the spread of disease.

You can’t have an epidemic without a settled population. First, there has to be a big enough group of people for the disease to spread through, and secondly there has to be movement of people from one place to another, carrying the disease with them. Traders and conquerors spread disease and epidemics between communities and from one civilization to another.

With the transition to settled societies and the rise of the first civilizations we gain more knowledge of the standard of medical care on offer. The earliest written records of procedures come from ancient Mesopotamia. The laws of Hammurabi, set out in Babylonian texts from over 3,700 years ago, describe the surgeon’s responsibilities and rewards. Only wounds, fractures and abscesses were treated surgically and the penalty for causing a patient’s death could be the loss of a hand. A Sumerian clay tablet dating to around 2150BC details the use of beer for washing wounds and the application of poultices made from wine dregs and lizard dung.

The discovery in an Assyrian pharmacy of a detailed list of 230 treatments using plant, animal and mineral ingredients indicates a well-established medical tradition and knowledge that most likely had its roots deep in prehistoric times; in many ways this reaches forward into the folk and herbal remedies still used by many today. Just how effective any of these treatments might be is anyone’s guess. The Greek historian Herodotus, writing c.450BC noted the Babylonian habit of leaving the sick out in the street so that any casual passer-by might offer an opinion as to the best way of curing them.

Ancient tablets record the laws of Hammurabi governing the responsibilities of surgeons in ancient Babylon.

Egyptian medicine prescribed the use of ingredients not likely to be found in today’s pharmacies, such as hippopotamus fat and fried mice. The body was believed to be controlled by a system of vessels carrying the bodily fluids, such as blood and tears. Like the vital irrigation canals that watered the country, these vessels had to be kept clean and clear. Egyptian surgeons treated wounds and fractures and performed operations such as removing cysts and lancing boils. Their surgical equipment included the expected battery of scalpels, knives, forceps and probes, but also featured amulets to combat evil spirits. Knowledge of both incantation and embrocation were part of the Egyptian surgeon’s skill set.

Some of the tools used by Egyptian surgeons would be familiar to modern day doctors.

THE MEDICAL PHILOSOPHERS OF GREECE

In common with other civilizations, the people of ancient Greece saw health and illness as being in the hands of the gods. Many of their ideas about ill health and remedies were adopted from their neighbours in Egypt and Mesopotamia. Hundreds of temples called Asclepions were established for the worship of Asclepius, god of medicine and son of Apollo (see page 22–3).

Where the Greeks began to differ from other civilizations was in their developing interest in the natural world and their search for pragmatic explanations as to how it worked. The great mathematician Pythagoras, who lived around the 6th century BC, was one of the first Greek thinkers to take an interest in medical matters. He suggested that all things could be divided into pairs or opposites – good health depended on balancing pairs, such as moist and dry.

Empedocles (c.490–c.430BC) believed everything in the universe, including living organisms, was made of four elements – fire, water, earth and air. He also believed all matter, whether alive or not, was conscious. His four-element theory proved to be remarkably long-lived and to have a bearing on the developing history of medicine for a surprisingly long time.

The earliest known Greek medical schools were established in the 5th century BC at Knidos (now in Turkey) and on the island of Kos. The physicians of Kos were known for studying medicine generally, while their counterparts at Knidos were specialists. The doctors of Knidos recognized 12 different diseases of the bladder for instance. The differing approaches of the two schools simply reflected local tradition and neither was hostile to the other’s methods.

Euphoric oracles

The Greeks believed that the god Apollo could heal the sick or bring disease as a punishment. The words of the god would be conveyed by an oracle at the Temple of Delphi, which was said to be the centre of the world. The oracle, who was always a woman, would enter a chamber and inhale vapours emanating from a fissure in the earth, which made her fall into a trance-like state. Sometimes the oracle would become delirious and die. Scientists who investigated the site in 2001 have suggested that groundwaters beneath the chamber carried chemicals such as ethylene, which can produce a state of euphoria when inhaled, but which can also be fatal in higher doses.

Oracle of Delphi.

At the time the medical schools were set up there was a movement towards trying to identify material, rather than supernatural, causes for illnesses and their treatment. Greek physicians began to take a greater interest in the body itself and to explore the relationships between the symptoms of an illness and the way it could be treated. While Knidian medicine focused attention on the disease rather than on the patient, the physicians of Kos took the opposite view, emphasizing the patient rather than the disease. This was particularly the case under the influence of Hippocrates.

One feature that began to distinguish Greek medicine from what had gone before was the idea that the patient could do something to improve their condition beyond simply awaiting the whim of the gods. A change in diet, for example, might have a positive effect on an illness. It was also recognized that a person who was generally healthier, through exercise and a good diet, was less likely to fall prey to illness.

THE FATHER OF MEDICINE

Widely regarded as ‘the father of medicine’, Hippocrates (c.460–c.370BC) was a teacher and physician, practising on Kos, the island of his birth, and elsewhere, including Athens. Little is known about his life and some have suggested that he may not even have been a real person or that there may have been more than one Hippocrates with several men sharing the same name. Whatever the truth of the matter, the collection of writings gathered together under the name of Hippocrates became the foundation of Western medicine.

The Greeks theorized that everything was comprised of four elements – air, earth, fire and water.

Hippocrates and his followers rejected superstition and magic as explanations for health and disease, looking instead to nature and reason for their answers. Central to Hippocratic thinking was the belief that the patient’s symptoms should be closely scrutinized and treatment based on the physical causes of the illness. Hippocratic medicine also proposed the existence of natural healing forces that the physician should work in harmony with. The body essentially fought off disease by, as it were, ramping up its normal functions. Hippocrates rejected the notion that the causes and treatment of a disease could be found in magic and the supernatural. We can thank Hippocrates and his teachings that our present-day doctors diagnose and treat diseases according to the symptoms they see.

Hippocrates and his followers brought a new approach to medicine that still influences doctors today.

Ars longa, vita brevis…

The practice of medicine taught by Hippocrates and his followers was based on logic, observation and a cautious scepticism, an outlook that was summarized in the first lines of Hippocrates’ Aphorisimi:

Life is short,

and art long,

opportunity fleeting,

experiment perilous,

and judgement difficult.

Ars longa, vita brevis, the familiar Latin translation, reverses the first two lines of the original quote. Hippocrates was saying that acquiring skills is a lengthy process and a lifetime may be inadequate for the purpose. He goes on to say, ‘The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals co-operate.’

An illustration from a medieval copy of Hippocrates’ Aphorismi.

FOUR HUMOURS

In the treatise On the Nature of Man, Hippocrates discussed the theory of humours, an idea that was to become a pillar of medical thinking for many centuries to come. It was based on a system of fluids in the body, the balance of which affected the health of the individual. According to the treatise, the human body ‘…contains blood, phlegm, yellow bile and black bile. These are the things that make up its constitution and cause its pains and health.’ Hippocrates drew analogies between the four humours of the human body and the four elements of Empedocles.

According to Greek medicine, the healthy body was believed to have an excess of heat and moisture. The most important of the body’s organs were the heart, the brain and the liver. These organs were respectively dry and hot, moist and cold, and hot and moist. Each person had his or her particular temperament according to the make-up of their bodily humours. We still use these personality types today: ‘sanguine’ – cheerful and optimistic; ‘phlegmatic’ – calm and perhaps a little sluggish; ‘bilious’ – ill-tempered; and ‘melancholic’ – sad or depressed.

Hippocrates’ medical theories were based on his belief in the four humours.

An excess of one or other of the humours resulted in diseases with characteristic symptoms. As a consequence of this belief the treatment for disease was all about restoring balance. The physician determined which of the humours was out of kilter and then set about correcting it. Methods for doing so ranged from taking more exercise and changing one’s diet, to more unpleasant interventions such as purging with emetics and laxatives, bloodletting and blistering.

In the century following Hippocrates, the work of Aristotle came to have a great influence over the development of medicine. Aristotle was a student of Plato and his interests encompassed the entire