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CONTENTS
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Jacket Design Development Manager Sophia MTT
Jacket Editor Claire Gell
Pre-production Producer Nadine King
Producer Mandy Inness
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Publishing Director Jonathan Metcalf
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22 Secrets of Mummies
DK DELHI
Senior Editors Dharini Ganesh, Bharti Bedi, Anita Kakar 24 Medicine in Ancient
Senior Art Editor Mahua Sharma
Mesopotamia
Project Art Editor Shreya Anand
26 Early Chinese
Editors Arpita Dasgupta, Priyaneet Singh
Art Editor Anjali Sachar
ANCIENT WISDOM Medicine
Senior Editorial Manager Rohan Sinha
Managing Art Editors Sudakshina Basu, Anjana Nair
TO 700 28 Acupuncture
Jacket Designer Suhita Dharamjit
12 Timeline 30 Ayurveda
Managing Jackets Editor Saloni Singh
Picture Researcher Aditya Katyal
14 Healers and Herbalists 32 Medicine in Ancient
Manager Picture Research Taiyaba Khatoon Greece
DTP Designers Vijay Kandwal, Pawan Kumar 16 Early Surgery
Senior DTP Designers Harish Aggarwal, Sachin Singh 34 The Four Humors
Pre-production Manager Balwant Singh 18 Shamanism
Production Manager Pankaj Sharma 36 Hippocrates
20 Medicine in
First American Edition, 2016 Ancient Egypt 38 Medicine in Ancient Rome
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DISTILLING SPIRITS TREATING BATTLEFIELD CASUALTIES
RENAISSANCE
and Medicine
98 Scurvy 114 The First
72 The Anatomy Revolution
700 –1800
Stethoscope
100 Smallpox: The
76 Barber-surgeons Red Plague 116 Diagnostic
46 Timeline Instruments
78 Ambroise Paré 102 The First Vaccination
48 The Golden Age of Islamic 118 Resurrection Men
Medicine 80 Repair and Reconstruction 104 Phrenology
120 Miasma Theory
52 Ibn Sina’s The Canon 82 Discovering the Circulation 106 The Modern
of Medicine Hospital 122 Cholera
84 The Circulation
54 The First School of Medicine Revolution 108 Homeopathy 124 John Snow
126 Epidemiology and 150 Cell Theory 174 The Struggle Against Malaria 188 Minimally Invasive Surgery
Public Health
152 Pathology and 176 Transfusion Breakthrough 190 Diabetes and Insulin
128 Anaesthetics Medical Autopsy
192 War and Medicine
130 Early Anaesthetics 154 The First Antiseptics
194 Battlefield Medicine in
132 Dentistry 156 Tuberculosis World War II
134 Pregnancy and 158 Vaccines Come 196 Influenza and the
Childbirth of Age Pandemic
SPECIALIZATION
the Brain Penicillin
138 Childbed Fever
162 Mental Illness 200 Antibiotics in Action
140 Women in 1900 –1960
Medicine 164 Horror of the Asylum 202 The Evolution of Syringes
180 Timeline
142 Nursing 166 Viruses and How 204 Women’s Health
they Work 182 Sigmund Freud
144 Medical Publishing 206 Heart Disease
168 Fighting Rabies 184 The Development
146 Microbiology and of the ECG 208 Allergies and
Germ Theory 170 The Discovery of Aspirin Antihistamines
186 A Cure for
148 Louis Pasteur 172 X-rays Syphilis 210 Polio: A Global Battle
238 Artificial Body Parts 262 End-of-Life Care 282 The Cardiovascular System
9
ANCIENT
WISDOM
TO 700
ANCIENT WISDOM
TO 700
PREHISTORY 3000 BCE 1500 BCE
49,000 YEARS AGO 7,000 YEARS AGO 1500 BCE 500 BCE
Neanderthals possibly A man undergoes a The first reference to The concept of the four
use medicinal herbs, as deliberate and successful diabetes appears in an humors, central to many
evidenced by fossilized arm amputation at Egyptian papyrus. medical systems for the
Neanderthal teeth. what is now Buthiers- next two millennia,
Boulancourt, France. begins to take shape in
ancient Greece.
10,000 YEARS AGO 3000 BCE Stele of Hammurabi 1050 BCE 500 BCE
Traditions of shamanism Egyptian mummies surviving The landmark Early versions of Susruta
emerge on several from this time show broken Mesopotamian Sakikku Samhita, an Ayurvedic
continents. bones, signs of tuberculosis, diagnostic handbook is compilation, appear
and other health problems. completed by physician in India.
Esagil-kin-Apli of Borsippa.
2200 BCE
Per-Ankh, or Houses
of Life, are built in
ancient Egypt as places
for creation and preservation Lord Dhanvantri,
of knowledge. God of Ayurveda
1755 BCE
The Code of
Hammurabi,
2700 BCE ruler of Babylon,
The tomb of one includes several
of the earliest pronouncements on
known female medical care, such
physicians, ancient as physicians are
Egypt’s Merit-Ptah, is responsible for the
inscribed “Chief success and failure of
Physician.” their actions.
Mongolian shaman’s
decorated drum
1550 BCE
The Ebers
2650–2600 BCE papyrus
7,000 YEARS AGO In ancient Egypt, Imhotep mentions
Teeth of live patients are becomes the leading medical use of
drilled, perhaps for abscess priest-physician and is willow bark,
pain relief, in Mehrgarh, soon elevated to from which
Pakistan. godly status. aspirin is derived.
12
TO 700
Instincts for survival run deep. Our close cousins, chimpanzees and Egypt, China, and India developed their own medical systems, which
gorillas, respond to illness by self-medicating with herbs and clays. Early were mostly entwined with gods, devils, and the spirit world. Around
humans probably did the same. As civilizations evolved, individuals 2,500 years ago, ancient Greece and then Rome evolved their own
began to specialize in areas such as trade, warfare, and healing—and styles of medicine, which focused more on the human body. However,
so medicine was born. The great ancient cultures of Mesopotamia, progress stalled in the 5th century during Europe’s “Dark Ages.”
500 541
In Central America, The Justinian Plague
Mayan medical ah’men (probably bubonic plague)
use hallucinogenic plant kills more than one-third
extracts to divine disease of the population in
causes and treatments. Europe and West Asia.
Marble bust
of Hippocrates
Zhang
Zhongjing
169 CE
Claudius Galen returns
to Rome and begins his 700
prolific writing phase; Chinese scholars come to
his works will dominate Nalanda, India, to study
European medicine for Ayurveda and other
1,500 years. traditional medicine.
13
ANCIENT WISDOM TO 700
E
l Sidrón, an archaeological ◁ White Lady
site in northwestern Spain, The “White Lady” cave painting in Brandenberg
has yielded hundreds of Mountain, Namibia, is probably more than 2,000
fossilized bones and teeth from our years old. Originally believed to depict a female, it
closest cousins—the now-extinct may show the ritual dance of an African shaman
Neanderthals (Homo neanderthalensis). or medicine man, with white minerals on his limbs.
Microfossils of plants including ◁ Therapeutic herb
yarrow (Achillea millefolium) and For centuries yarrow has been
chamomile (Anthemis arvensis) have plants were chewed for medicinal a mainstay of herbal medicine
been found in these Neanderthals’ effects. For example, orchid bulbs across the Northern Hemisphere.
dental plaque—the hardened layer were chewed for digestive problems Its astringent qualities stem bleeding,
of debris on teeth. These herbs lack and willow bark—the natural source giving it local names such as woundwort
nutritional value and have a bitter, of aspirin (see pp.170–71)—was and staunch-nose (for nosebleeds).
unpleasant taste. However, they are chewed to ease fever and pain.
much used in traditional medicine. More than 7,000 years ago patients’
Yarrow is a tonic and an astringent, teeth were drilled, perhaps to relieve that they had a special role in their
and chamomile is a relaxant and has abscess pain, while bow-operated community as healers or therapists.
anti-inflammatory properties. The drills were used to bore holes in These healing roles are still seen
fossilized teeth date to 49,000 years the skull, a procedure known as today in native cultures across
ago and are possibly the earliest reset by smearing clay onto injured trepanning (see pp.16–17). the Americas, Africa, Asia, and
evidence for the use of medications. limbs; the clay then dried to form a Australasia. Spiritual, supernatural,
Each year, new evidence is being supportive cast. Herb poultices were Early healers and religious beliefs are all involved
discovered, showing that prehistoric secured onto wounds with animal- Prehistoric cave paintings and rock in their approach to illness and, as
medicine was more advanced than hide bandages. Plant saps soothed art of individuals wearing particular evil spirits and malicious demons
once thought. Broken bones were burns while other constituents of clothing and adornments suggest are often blamed for ill health,
treatments include offerings, spells,
sacrifices, and exorcism, along with
AUSTRIAN MUMMY c.33,000 bce
practical measures such as ointments
ÖTZI THE ICEMAN made from herbs, minerals, and
animal bones and blood.
A 5,300-year-old, naturally preserved, kit. Among his possessions were lumps revealed that he had painful bone and An individual who conjures up
mummified, frozen male found in of birch bracket fungus (Piptoporus joint conditions. Intriguingly, there are supernatural powers and mediates
the Ötztal Alps, Europe, in 1991 and betuinus), which has laxative as well more than 50 skin tattoos on these with the spirit world is known as a
named Ötzi, gives many clues about as antibiotic properties. A detailed painful areas. The tattoos, which shaman, medicine man or woman,
health and healing in prehistoric times. medical examination indicated the correspond to known soothsayer, or healer. He or she
Ötzi was 45 years old when he died, presence of whipworm parasite eggs in acupuncture points, conducts ceremonies with chants,
and was found with a knife, ax, bow, his large intestine. were probably meant clapping, dancing, drumming,
arrows, bark containers, and what may X-rays and scans as symbolic “therapy”
have been a simple prehistoric medical of his skeleton for pain relief.
25 PERCENT of modern
medicines that are
made from plants were first
used traditionally.
14
HEALERS AND HERBALISTS
Early Surgery
The first uses of surgery are unknown, but Stone Age
scrapers and blades were certainly sharp enough
to slice through flesh, and were perhaps used to
remove growths. The earliest clear evidence of
invasive surgery is trepanning—chipping or
boring through the skull bones to the brain.
T
repanning, or trephining, ▷ Multiple openings
involved making openings in Dated to around 4,000 years
the braincase, usually on the ago, this multiple-trepanned
forehead or the top of the head. skull was unearthed at Jericho
It may have been performed by (in modern-day Israel).
early peoples for religious, ritual, The neat, circular holes of
or therapeutic purposes. In one different sizes indicate that
large-scale survey of Neolithic several drills were used.
skeletons—some dating back more
than 7,000 years—about one in
10 skulls featured full openings Bone growth
or signs of attempts to make them. suggests healing
In these earliest examples, the
holes had jagged, untidy edges
from cutting with stone blades and records of surgeon Hua Tuo
scrapers, or perhaps chisel-shaped show how he proposed
implements hit with a hammer- to cure the headaches
stone. Hole shapes provide evidence of teenage emperor
that teeth from big cats and other Shao by “opening
predators were also used. In some the skull”; the offer
cases, a circle of bone was chipped was declined.
away and the freed part lifted out, There is evidence that
perhaps to be kept as a memento. by the 17th century,
trepanning was being
A global phenomenon carried out on almost
Many surgeons in ancient Egypt, every continent,
Greece, Rome, West Asia, and China including in remote
were familiar with trepanning locations such as the
and wrote treatises on the subject. Pacific islands of Polynesia
Evidence of its practice in Kashmir, and Melanesia. It was
India, was found in a 4,000-year- practiced widely in the
old skull with multiple trepanned pre-Columbian Americas, from
holes. In China, the 2,000-year-old Alaska to the southern tip of
South America. The Incas used a
ceremonial copper or flint knife,
known as a tumi, to make four
straight incisions in a hash (#)
shape to free a square of bone.
The Aztecs preferred a blade of
the glassy rock obsidian.
16
E A R LY S U R G E R Y
52
The number of
times French
surgeon Jean-
Jacques Bouestard
trepanned one patient over a
period of two months in the
mid-18th century.
17
1 TIBETAN TOOTH
NECKLACE
2 AFRICAN 3 CONGOLESE
HEALER’S HEALING DOLL
NECKLACE
Shamanism Heads of
“spirits
of affliction”
The tradition of the shaman, who reaches into the unseen realm
of spirits and souls to help and heal, is known in almost every
part of the world (see pp.14–15). Shamans use a variety of objects,
such as amulets and masks, to engage and direct their powers.
1 Tibetan tooth necklace Comprising many small shamans wore a mask with a broken nose,
teeth, this necklace is said to protect against evil spirits. representing legendary healer Hado’ih.
2 African healer’s necklace The charms on this 10 Native American fan Plains Indians
necklace include teeth, shells, claws, seeds, and a bird skull. regarded the eagle as the most sacred bird.
3 Congolese healing doll A Nte’va figurine made of Its healing powers could be transferred by
wood, nuts, leather, bone, and cloth, this doll is used cooling the patient with a fan made of the
to ward off illness. 4 Inuit séance carving This carving bird’s feathers. 11 Tibetan headdress The
depicts a shaman in a trance, with two fantasy helpers at fiery skull on top of the headdress was said to
hand. 5 Tanzanian divining bowl Items such as stones, frighten away evil. 12 Malaysian shaman
bones, and teeth were swirled in the bowl. The positions jacket This garment is made of pangolin skin.
where they stopped were thought to reveal the answer to Products derived from this scaly anteater are
a particular question. 6 Tibetan rhino horn repository much used in traditional medicine. 13 Native
Despite being proven false, legends about the medicinal American soul-catcher Amulets such as
properties of rhino horns persist. 7 Zambian divining these were believed to retrieve an ill person’s
bones A shaman would throw these carved, fish-shaped wandering soul. 14 Mongolian decorated
bones onto a mat or into a bowl and interpret their drum This was used to create insistent rhythms to summon
arrangement. 8 Sri Lankan exorcism mask This mask gods and spirits. 15 Tlingit oystercatcher rattle Tlingit
of fearsome deity Maha Kola was used to scare demons shamans from coastal northwest North America carved
from the body. 9 Native American mask Iroquois their rattles to resemble birds, in this case an oystercatcher. 8 SRI LANKAN EXORCISM MASK
18
SHAMANISM
9 NATIVE
AMERICAN MASK
Eagle wing
feathers
Real
human
hair
10 NATIVE
AMERICAN FAN
11 TIBETAN
HEADDRESS
Scaly skin
of pangolin
14 MONGOLIAN
DECORATED DRUM
15 TLINGIT
OYSTERCATCHER Soft leather
RATTLE
covers the
striking edge
ANCIENT WISDOM TO 700
T
he foremost figure in Egyptian be worshipped, and in ancient ▷ Mummy pathology
medicine was Imhotep. Leader Greece he became associated with Studies of mummies show
of a powerful cult of priest- Asclepios, the Greek god of healing that the average age of
physicians, he was active around (see pp.32–33). death in ancient Egypt
2630 bce, during the early period was 40. Major causes
of what is known as the Old Channels of the body included infectious
Kingdom. Imhotep’s origins are Influenced by Imhotep, other and parasitic diseases,
obscure, but he was probably an Egyptian priest-physicians worked bacterial infections,
ordinary citizen rather than of toward developing theories of and atherosclerosis
leading to heart failure.
royal descent. However, his fame disease. They drew comparisons
grew so rapidly that even during with the irrigation waterways dug
his lifetime he came to be regarded between the Nile and crop fields, Medical papyri The papyri are generally named
as a god, believed to be the son of and conceived a system of up to Much knowledge of ancient after the person who procured,
Sekhmet (goddess of healing) and 46 channels in the body, mostly Egyptian medicine comes from financed, or translated them, or
Ptah (creator of the universe). emanating from the heart. They preserved papyrus documents. the place where they were stored.
As a result of Imhotep’s rapid had only a vague knowledge of The most important of these None can be ascribed to a particular
deification, it is difficult to anatomy and may have are the Kahun papyrus—the physician, and many appear to
tell whether records of his viewed the arteries, veins, earliest (c.1800 bce), also known be rewrites or updates of earlier
life and achievements and intestines—and, as the gynecological papyrus—and versions. The longest of them is
are factual or mythical. possibly, tendons and the Edwin Smith, Ebers, Hearst, the Ebers papyrus (c.1550 bce),
He may have been nerves—as channels of Erman, London, Brugsch, and which lists hundreds of magical
a practicing healer, the body. They believed Chester Beatty papyri. chants and spells against bad
dispensing herbs and that “flow” through the
potions to patients, but it channels was important
is more likely that he was
in charge of a team of
for good health, and that
the body’s channels could
“ Bandage him with alum
physicians and took credit
for their successes. His
become blocked by evil
spirits, which would cause
and treat him afterward
other roles included
chancellor to the
sickness. Their remedy was
to unblock these conduits [with] honey every day
until he gets well.”
pharaoh, pyramid by using various purges,
architect, and high laxatives, and emetics,
priest to the sun god and offering prayers and
Ra. Even as Egypt’s gifts to relevant gods to TREATMENT FOR A DISLOCATED RIB, FROM THE EDWIN
civilization faded remove the root cause. SMITH PAPYRUS, c.1600 BCE
some 2,300 years The Channel Theory
ago, Imhotep was an important
continued to turning point
in medicine.
▷ Edwin Smith
Although it had
papyrus
▷ Lion-headed
a metaphysical
The world’s oldest
goddess basis, it was among surviving surgical
Sekhmet (“powerful the first attempts text, the Edwin Smith
one”) was the ancient to link illness with papyrus was written in
Egyptian goddess of the body’s processes, Egyptian hieratic script
medicine and healing. and it resulted in around the 17th century
Also the warrior goddess the development bce. It is likely that the
and a solar deity, she was of treatments that material was adapted
usually depicted with the focused on the body from a series of earlier
head of a lioness and a rather than simply documents going back
sun disk and cobra crown. pacifying the spirits. more than 4,000 years.
20
MEDICINE IN ANCIENT EGYPT
spirits, as well as mineral and trauma, bone-setting, and minor and treatment involved offerings and procedures that involved cutting
herbal remedies. It describes a surgery, which suggests that it chants. Unusually for its time, the open the body were unheard of,
range of ailments too, including may have been used by physicians Edwin Smith papyrus focuses on except after death for purposes
parasitic diseases, bowel disease, tending to soldiers wounded in practical advice not magic. of mummification (see pp.22–23).
ulcers, urinary difficulties, female battle. Although examining a One exception was trepanning
disorders, skin rashes, and eye patient to make a diagnosis is an Surgical procedures (drilling or scraping a hole in
and ear problems. essential part of medical practice Evidence suggests that surgical the skull), which was probably
today, this method was new in operations in ancient Egypt were performed to treat cranial trauma,
A more methodical approach ancient Egypt. More often, bad performed on the outside of the migraine, epilepsy, and mental
Dating back to around 1600 bce, spirits were blamed for the ailment, body only, and that truly invasive disorders, and to expel evil spirits.
the Edwin Smith papyrus is much
more systematic and explanatory—
closer in approach to a modern
medical text. It covers a total of
48 typical “case histories.” The
cases generally start at the head
and work down the body, and
each progresses in a logical
manner, with a title and notes on
examination, diagnosis, prognosis
(prediction), and treatment.
“[The heart]
speaks at the tips
of the vessels in
all body parts.”
“ON THE HEART AND VESSELS,” FROM THE EBERS
PAPYRUS, 1550 bce
21
ANCIENT WISDOM to 700
Secrets of Mummies
The study of Egyptian mummies today uses some of the
most modern technology, such as medical imaging, when
examining one of the most ancient methods of body
preservation. Scans reveal details of health issues that
afflicted even the most powerful people in ancient Egypt,
from broken bones to gut worms and kidney tuberculosis.
“ Absence of malignancies in
mummies… indicates cancer-
causing factors are limited
to… modern industrialization.”
PROFESSOR MICHAEL ZIMMERMAN, MANCHESTER UNIVERSITY, 2012
22
ANCIENT WISDOM TO 700
Medicine in Ancient
Mesopotamia
Although healing practices in ancient Mesopotamia (roughly centered on modern-day Iraq)
involved the use of magic, incantations, and divination, physicians had an extensive
knowledge of diagnosis, a wide repertoire of drug treatments, and carried out basic
surgery. They were also bound by a well-established, formal code of conduct.
T
he first medical texts from The Mesopotamians believed that made incantations to purify the △ Symbol of Gula
Mesopotamia survive in diseases were caused by a particular patient; the barû, or diviner, who The goddess Gula, or “the lady of health,” was
the form of clay tablets that god or demon, so a person with made predictions about the course the most important of the gods who had an
date back to c.2400 BCE. These venereal disease, for example, might of the illness, mainly through influence on medical affairs. Her symbol was
give recipes for medicines, but be referred to as struck by “the hand heptoscopy (reading the livers of the dog, and canine figurines have been found
the diseases for which these were of Lilith,” a female demon. The sheep); and the asû, or physician, at her cult temples in several Mesopotamian
intended as treatments are unclear. primary job of a doctor was to chase who made more conventional cities such as Isin, Nippur, Umma, and Babylon.
A much larger selection of diagnostic out the disease-causing demon diagnoses and prescribed remedies.
tablets from the library of the from the patient; the treatment
Assyrian King Ashurbanipal—who of the symptoms was considered a Medical preparations Doctors in Mesopotamia could
ruled in the mid-7th century BCE— secondary task. There were three Mesopotamian physicians used also perform surgery; a set of
gives a clearer impression of types of doctor: the masmassû, or around 250 medicinal plants, 120 bronze needles meant for cataract
Mesopotamian medical practice. exorcist, who conducted rituals and minerals, and about 200 other operations dating from around
substances. Some of the ingredients, 2000 BCE has been found, and
such as mandragora, henbane, an account survives of a surgeon
linseed, myrrh, and belladonna, cutting open the chest of a patient
were used by later physicians, while to drain pus from the lungs.
other more exotic ones, such as
10
crushed gecko and raven’s blood, SHEKELS The fee paid to
soon fell out of use. Remedies were a doctor in Babylonia for
prescribed for specific diseases: for performing successful surgery (with
instance, fish oil and an extract of a scalpel) on an upper class patient—
cedar were thought to treat epilepsy. equivalent to more than a year’s
Doctors were skilled in the pay for the average tradesman.
treatment of wounds, applying
bandaged poultices of sesame Knowledge of anatomy, however,
oil or honey and alcohol to was limited, since human dissections
prevent infection. They had a were not carried out in the region.
wide knowledge of the external
symptoms of diseases, and were Strict laws
able to give accurate descriptions The medical profession was strictly
of afflictions, such as epilepsy regulated by law, and the Law Code
and tuberculosis. They were also of Hammurabi, dating from around
aware that some diseases spread 1750 BCE, contains several clauses
by contagion, and they practiced relating to doctors. They were paid
a form of quarantine to prevent a set fee: for example, a doctor
the spread of fevers. was paid five shekels of silver for
mending a broken bone (although
this was reduced to three shekels if
◁ Stele of Hammurabi the patient was a commoner, and
Hammurabi, the ruler of Babylon in the 18th only two if the patient was a slave).
century BCE,is seen here receiving his law code Meanwhile, penalties for medical
from the sun god Shamash. The text contains more malpractice were severe: if a doctor
than 280 clauses, of which about a dozen deal caused a patient’s death, the doctor’s
with the regulation of the medical profession. hand would be cut off.
M E D I C I N E I N A N C I E N T M E S O P O TA M I A
▽ Nineveh tablet
This clay tablet from the library of Ashurbanipal at the
Assyrian capital of Nineveh contains diagnostic texts, the
symptoms of disease and their progress—and omens
the physician might note on his way to treat the patient.
Wedge shaped
cuneiform script
25
ANCIENT WISDOM TO 700
FIRE
Early Chinese
Medicine
WOOD EARTH
T
he Huangdi Neijing, an ▽ Qigong massage the universe. Yin is described as △ Yin-yang and the five phases
ancient Chinese medical text, One of the oldest and most adaptable dark, watery, cool, passive, and According to traditional Chinese medicine,
takes the format of question therapeutics, Qigong focuses feminine, while yang is bright, dry, well-being incorporates the concepts of
and answer discussions between on relaxation, meditation, hot, active, and masculine—and yin-yang, zang-fu, and the five elements, or
the semi-mythical Yellow Emperor, body postures, measured each cannot exist without the other. “phases.” The latter term reflects the belief
Huang-di, and his advisors. Huang- movements, and Zang-fu is a system of assigning that these entities are not fixed but rather, like
di asks a question, which in turn deep breathing body parts as either yin or yang. energy states, undergo continuous change.
is answered by his ministers, techniques. The lungs, heart, liver, spleen,
and through this process they and kidneys are zang organs
cover an encyclopedic range of (and are assigned as yin); the Surgery is not prominent in the
contemporary Chinese medical stomach, intestines, gallbladder, history of Chinese medicine, and
knowledge and practice. The work and urinary bladder are fu one of the few surgeons to gain
describes key traditional Chinese organs (and assigned as yang). fame was Hua Tuo, in the late
concepts such as yin-yang, zang-fu, Another concept is the five Eastern Han Dynasty (25–220 CE),
the five phases, and the flow of phases of energy, wu-xing: who also carried out acupuncture
qi or “life energy” along channels earth, water, fire, wood, and (see pp.28–29) and other forms
known as meridians (see pp.28–29). metal. The Huangdi Neijing of healing. He is reputed to have
It includes diagnostic procedures records: “The five elemental invented an anesthetic, known
such as feeling the pulse, observing energies… encompass all the as mafeisan, probably based on a
the tongue, and examining human myriad phenomena of nature. mixture of wine, cannabis, opium,
excrement, as well as a range of It is a pattern that applies equally and several relatively toxic herbs,
treatments, including herbal and The concept of yin-yang has to humans.” The five phases theory which he used for open surgery,
mineral concoctions, massage, permeated Chinese philosophy, also incorporates the cycles in which especially on the bowels.
special diets, bathing, meditation, culture, and medicine for millennia. the five elements interrelate: sheng Later, in about the 6th century,
and forms of physical exercise It represents the inherent duality— (generating); ke (controlling); cheng Sun Simiao compiled extensive texts
and ritualized movements. opposite yet complementary—in (overactive); and wu (contradictory). listing thousands of remedies. He
It is believed that yin-yang, zang-fu, also practiced alchemy, and placed
the phases (elements), and cycles great emphasis on gynecology,
C H I N E S E P H YS I C I A N ( C.1 5 0 – 2 1 9 CE)
interact to affect the flow of qi pediatrics, and medical ethics. In
ZHANG ZHONGJING (energy). An imbalance of the qi Qianjin Yaofang (Prescriptions Worth
results in disease; treatments aim a Thousand Gold) he emphasized the
A leading physician of ancient to restore harmony and balance. significance of a careful approach,
China’s Han Dynasty, Zhang impeccable morality, and dignified
Zhongjing is thought to have lived Influential physicians attitude in a physician. His doctrine
in Changsha, Hunan Province. One of the best known early spread throughout China, and can
He advocated a healthy diet and Chinese physicians was Zhang be seen as the Chinese equivalent of
exercise, close examination of the Zhongjing (see panel, left). the Hippocratic oath (see pp.36–37).
patient, treatment appropriate to
the symptoms, one medication at a
26
Rebalancing qi
This 10th-century Song Dynasty painting shows a doctor
burning moxa (a powder made from the herb mugwort)
on a patient’s skin (a process known as moxibustion) to
stimulate the acupuncture points and meridian channels,
in order to rebalance the body’s flow of qi (energy).
ANCIENT WISDOM to 700
Acupuncture
Also known as needling, acupuncture is a traditional
Chinese medical technique that has been used for
perhaps four millennia. Along with moxibustion
(see pp.26–27)—burning an herb called mugwort on
the skin—it is one of the earliest known therapeutic
systems with a logical theoretical basis.
◁ Acupuncture points
This reproduction from an illustrated version of Huangdi
NeiJing from 1000 CE shows the body’s meridians and
acupuncture points. The illustrated version itself derived
from China’s first great medical manual, of the same
name, dating back 2,100 years.
29
ANCIENT WISDOM TO 700
Ayurveda
A traditional system for health, well-being, healing, and medicine, Ayurveda (meaning “life knowledge”)
has been prevalent in India and southern Asia for more than 2,000 years. It originated around the same
time that the famed physician Hippocrates was developing the practice of medicine in ancient Greece.
T
wo major works form the basis centuries, masking their original means a compendium, collection, Three further works contribute
of Ayurveda—the Susruta content. The Susruta Samhita is or compilation. The Susruta Samhita to the main body of Ayurvedic
Samhita and the Charaka named after the celebrated Indian contains information about shalya knowledge: the Ashtanga Hridayam,
Samhita. However, both these physician Susruta, who probably chikitsa, or Ayurvedic surgery, the Ashtanga Sangraha, and the
ancient texts have been edited, lived in Varanasi, India, in the 6th including a wide range of complex Bower Manuscript. The Ashtanga
reworked, and altered over the century bce. The word samhita techniques for procedures such Hridayam and the Ashtanga
as tooth extraction, Sangraha date from around the
cyst drainage, cataract 5th century ce and were written
removal, repairing by the Indian physician and healer
hernias, setting broken Vagbhata. The Ashtanga Hridayam
bones, and cauterizing has eight sections, including
hemorrhoids. It describes chapters on general surgery,
more than a thousand internal medicine, gynecology,
conditions and hundreds pediatrics, mental and spiritual
of herbal remedies. problems, and sexual medicine.
The second work, the The Bower Manuscript (named
Charaka Samhita, is around after British officer Hamilton
43
2,300 years old and is
attributed to Charaka, OF THE 1,323
who may have been a VERSES in the
physician at an emperor’s Bower Manuscript
court. As with Susruta, deal with the origin
the historical details of and medical uses of garlic,
Charaka’s life are unclear. demonstrating its importance
The Charaka Samhita has in Ayurvedic medicine.
more than 110 chapters
divided into eight sections, Bower who acquired it in 1890)
and is written in verse dates from about the same time
to aid memorization. as the Ashtanga Hridayam and the
Like the teachings of Ashtanga Sangraha. It contains a
Hippocrates (see pp.36– group of wide-ranging medical
37), the treatise instructs texts, with content adapted and
physicians on how to updated from the earlier Susruta
examine a patient and Samhita and Charaka Samhita, along
make a diagnosis, and also with herbal recipes.
recommends treatments.
Most of the remedies Elements of Ayurveda
emphasize lifestyle, While various forms of Ayurveda
hygiene, exercise, and have developed over the centuries
diet, as well as herbal and in different regions, most systems
mineral-based medicines. are based on the concept of five
elements. These elements are jala or
ap (water), tejas or agni (fire), privthi
◁ Human body chakras or bhumi (earth), pavana or vayu
The seven chakras are spinning (air), and akasha (ether or space)—
centers of energy—part of the similar to the concept of the four
etheric realm—aligned along the elements and four humors
middle of the body. If they whirl developed in early European
out of balance, they can upset medicine (see pp.34–35). In each
other body systems, such as the person the proportion of these
doshas, and lead to illness. elements varies over time and
30
AY U R V E D A
2,000
balanced. Imbalance herbs and which includes the
brings unease and mineral-based brain and nerves),
sickness, often remedies are noted in the fat (medas), and
related to the Charaka Samhita. reproductive organs
dominant dosha. For (shukra). For
example, excessive vata can trigger example, the mamsa vaha srotas
indigestion, flatulence, and cramps. transport nutrients and waste
If kapha is dominant, it may result for the mamsa (muscle) dhatu.
in problems linked to mucus and Another Ayurvedic concept is
phlegm, such as lung ailments, that of agni, or “digestive fire.” This
coughing, and breathing difficulties. refers to the body’s metabolism
31
ANCIENT WISDOM TO 700
E
arly Greek medicine was and medicine was Asclepios, and physician who was deified and
influenced by and drew temples dedicated to him were worshipped as the Egyptian god
upon much from the ancient called asclepeions. Here, the sick of medicine.
Egyptians (see pp.20–21) and their offered prayers and gifts to him.
belief in the world of spirits and His sign was the Rod of Asclepios— Shift from mythology
the supernatural. Diseases were a staff with a snake coiled around As Greek medicine developed,
regarded as punishments it—and this is still symbolic of its emphasis changed. Gradually,
or even “gifts” from the gods, medicine and the healing arts disease was seen more as a
perhaps angered by sins and today. Although the origins of natural phenomenon or product
misdemeanors. Cures involved this sign are unclear, some of the earthly body, rather
priests, prayers, offerings, and historians trace the rod, serpent, than a visitation from the gods,
rituals to rid demons and lift and Asclepios himself back to and symptoms, diagnosis, and
curses. The Greek god of healing Imhotep of Egypt, an architect and treatment focused on the human,
32
MEDICINE IN ANCIENT GREECE
40–50
Empedocles YEARS The brain, heart, and criticism of some classical Greek Unusually for the time, relaxed regulations in
formulated the average lifespan blood vessels. medical theories, including the city allowed them to dissect human corpses.
notion of the four of humans in ancient Greece. Like Herophilus, humorism, and the rational, This led to the production of some of the
classical roots or he believed the observational, evidence-based earliest, realistic anatomical descriptions.
elements: air, fire, water, and heart was not the center of
earth. These were incorporated thoughts, feelings, and emotions,
into Greek medicine as the four but was a kind of pump with
humors—blood, yellow bile, black flaps, which could act as valves.
bile, and phlegm (see pp.34–35). Erasistratus suggested that air
It was suggested by Greek thinkers entered the body through the
that an imbalance in the humors lungs, and went to the heart where
caused illness. The concept of it was transformed and distributed
humorism was developed through as a mysterious “animal spirit,” or
the Classical Greek era (480–323 “pneuma,” by the arteries. Veins
bce) and was mentioned in the carried blood, from the heart to
Hippocratic Corpus—a body of the various organs. These early
knowledge and written works ideas on circulation were later
33
ANCIENT WISDOM TO 700
IR
A
BLOOD
With its origins in ancient Greece, the concept of humorism is based on the balance
W
O
ET
H
SPRING
of four humors (body fluids) in the human body—blood, yellow bile, black bile, and ILD H OO
D
CH
W
phlegm. This leading medical system thrived in Europe for more than two millennia
CREPITUDE
AT
MA
SUMMER
WINTER
E
YELLOW
R
NHOOD
PHLEGM
before it began to lose prominence in the 18th century. FI
RE
BILE
DE
OLD AGE
T
AUTUMN
he theory of four humors In the writings of Hippocrates hot–cold and wet–dry, and four
LD
D
RY
CO
BLACK
with wide-reaching effects on (see pp.36–37) and his followers, major organs that were each linked BILE
the body and temperament the four stages of life were to a humor.
H
was considered to be a well- linked to the seasons, and four According to Galen, ideal
RT
EA
rounded, wide-ranging, and highly temperaments, or personality types, temperament and health were
integrated approach that offered the result of a balance of all four
△ The quartets
24
insights into well-being and OUNCES (0.7 liters) of blood humors. This equilibrium was
sickness. The concept fitted was let over four days when different for each individual, which This diagram shows the link between
harmoniously with other Charles II of England fell ill in 1685. is why people varied in their levels bodily humors and other quartet systems.
foursomes in Greek scientific He died shortly after. of health, fitness, personality, and For example, blood is associated with heat
philosophy, such as the four susceptibility to ailments. and wetness, spring, and childhood.
elements (air, fire, earth, and emerge from the humors. In
water); the four attributes of Roman times, Roman physician Personality and health
matter (hot, cold, moist, and dry); Claudius Galen (see pp.40–41) The humor of blood was characterized by chills, shivering,
and the four seasons (spring, formalized the system and added associated with the heart, and coughs, and sneezes, which served
summer, fall, and winter). two further variables, namely an excess produced the sanguine to expel phlegm, mucus, and pus.
temperament—social, optimistic, Imbalances could also affect
energetic, and easy- temperament: too much blood
going. Blood was also humor could lead to abandoning
linked with air, heat/ tasks, being forgetful and late, while
wetness, and the spring an excess of yellow bile might cause
season. Yellow bile over-assertiveness, disorganization,
was connected to the and depression. Surplus black
liver, and those with bile could bring on worry,
a choleric personality anxiety, and withdrawal. Signs of
were deemed to be excessive phlegm might be laziness,
strong-willed, decisive, carelessness, and fear of change.
independent, and quick- The causes of humoral imbalance
tempered. Yellow bile were numerous and ranged
was grouped with fire, from stale vapor in the air and
heat/dryness, and the contaminated food and water, to
summer season. Black offending the spirits, or a surfeit
bile was allied to the of emotions such as jealousy.
spleen, an excess
producing melancholic
tendencies—quiet,
private, cautious, and
logical individuals. The
humor was related to
the earth, dryness/cold,
and fall. Phlegm was
associated with the brain:
the phlegmatic person was
calm, accepting, and slow to anger.
Phlegm was grouped with water, △ Cupping vessel
cold/wetness, and winter. Dating back to 79 CE, this vessel from
△ Public blood-letting When one humor became too Pompeii, Italy, was used to restore humoral
An illustrated version of Al Maqamat, by Arab poet strong, it was the likely cause balance. The air inside was heated,and the
and scholar Ibn Ali al-Hariri, depicts a crowd watching of sickness. For example, an cup placed on the skin to produce a vacuum
the blood-letting of a patient in 13th-century Iraq. excess of phlegm caused illness to draw yellow bile to the surface.
34
THE FOUR HUMORS
▷ Four temperaments
This 1760s reproduction of the Guild Book of
the Barber Surgeons of York, a 15th-century
manuscript, shows the four temperaments—
melancholic, sanguine, phlegmatic, and choleric
—with clothes, facial expressions, and postures
that contribute to the depiction of each one.
35
ANCIENT WISDOM TO 700
Hippocrates
“Sickness is not sent by
the gods… find the cause,
we can find the cure.”
HIPPOCRATES, GREEK PHYSICIAN
O
ne of the greatest names himself. The Hippocratic Corpus,
in the history of healing, a collection of around 60 works,
Hippocrates elevated some of which are ascribed to
medicine into a respected Hippocrates, marks Greek medicine
profession with a scientific basis. as separate and distinctive from
He took Greek medicine and Egyptian (see pp.20–21) and
rid it of its supernatural Mesopotamian (see pp.24–25)
elements, insisting medicine.
on observation However, there is
and accurate no certainty that
recording of all the writings
case histories. By attributed to
comparing these Hippocrates
histories, he made were actually
the first systematic authored by him.
differentiation of
diseases. He also Code of ethics
set standards for Although medical
doctors that are schools were
still admired and flourishing in
respected today. Sicily, southern
Hippocrates was Italy (see pp.54–
born on the island 55), and at Cyrene
of Cos in Greece in North Africa,
in around 460 BCE. △ The Hippocratic Oath the school at Cos
His father was A professional code of conduct, the that Hippocrates
a doctor and Hippocratic Oath is usually taken by all founded became
Hippocrates doctors and requires them to abide by the most famous,
learned medicine ethical principles. Seen here is a medieval and he came to
from him. He is Greek copy of the oath. be regarded as its
known to have greatest teacher.
traveled widely, possibly going as When entering this esteemed
far as Libya and Egypt, but very school, incoming students had to
little is known about the man take an oath, now known as the
Hippocratic Oath, in front of their
elders and peers. The oath, with its
◁ Modernizing medicine code of ethics, set a high standard
This marble bust of Hippocrates celebrates him of expertise and etiquette, and
as the father of modern medicine. He turned established medicine as a profession
away from divine notions of disease and healing that ordinary people could trust.
and used observations of the patient as the It separated doctors from other
basis of medical knowledge. “healers” and defined their practice.
H I P P O C R AT E S
surgeon and was interested in the ■ 430–427 bce Helps fight the plague in
study of orthopedics. Some of the Athens for three years. Recommends
principles found in the Hippocratic lighting fires to dry the atmosphere and
Treatises On Fractures and On Joints boiling water before consumption.
are still considered relevant today. ■ 431–404 bce Helps cure the injured in
the Peloponnesian War. He excels at
Ahead of time surgery, including that of the skull,
Hippocrates believed that the and also at setting fractures and
body contained four basic humors mending dislocations.
(fluids)—black bile, phlegm, yellow
bile, and blood (see pp.34–35).
This system offered a rationale
for understanding the human
condition and for explaining illness.
He believed that moods and
disease result from an imbalance
in the humors. He was probably
the first physician to believe that
diseases are natural occurrences
and are not caused by supernatural
forces or gods.
Hippocrates placed great emphasis
on strengthening and building up
the body’s inherent resistance to AN 11TH-CENTURY EDITION OF HIPPOCRATIC
disease. He prescribed diet, TREATISES ON FRACTURES AND ON JOINTS
gymnastics, exercise, massage,
hydrotherapy, and swimming in ■ 420–370 bce Around 60 books including
the sea. He also developed an textbooks, lectures, and essays, are
understanding of the importance written during this period, and later
The oath included a promise to medicine, as shown in the Corpus, of hygiene and cleanliness, as collated in the Library of Alexandria.
protect confidentiality, and not to stressed three things: close well as that of rest and quiet. Written by Hippocrates and other
“poison” patients. Hippocrates observation of symptoms, being When Hippocrates died, he was authors, they are united in their focus
insisted that doctors be of “good open to ideas, and a willingness to held in such high regard that it on Hippocratic medicine. Hippocrates
appearance” and well fed because explain the causes of disease. The was believed that honey made from also writes Hippocratic Treatises On
patients could not trust a physician Corpus is full of case studies, which the bees living on his gravestone Fractures and On Joints during this
who did not look capable of taking provide descriptions, for example of had special healing properties. time. Hippocrates promotes the concept
care of himself. According to the tuberculosis, mumps, and malaria. Hippocrates put the doctor fully of four humors and believes that an
imbalance in the humors causes disease.
oath, the doctor must be calm and In it Hippocrates defined different at the service of the patient, and
serene, honest, and understanding. categories of illness, such as his ground-breaking work has ■ 400 bce Sets up a school of medicine in
A Hippocratic doctor visited his epidemic, endemic, chronic, and been a constant and enduring Cos, Greece. In time he instructs his own
patient before noon, and enquired acute—terms that have survived source of inspiration for doctors sons, Thessalus and Draco, in the practice
about what sort of night the to this day. He was also a talented through the ages. of medicine. His medical school produces
many prominent scholars and pupils who
patient had experienced, before
add their experience and writings to the
performing a thorough examination
“I will use my power to help the
works of Hippocrates.
of the body, and looking at the
sweat and urine of the sufferer. ■ 370 bce Dies in Larissa, Greece, at the
37
ANCIENT WISDOM TO 700
T
he civilization of ancient
Rome rose to power around
1,500 years ago. The city
gradually grew in influence to rule
Italy and beyond, first as a republic
and then as an empire, until its
collapse in 410 CE. Roman writings,
art, statues, surgical instruments,
medicine jars, false teeth, and a
host of other objects survive that
provide a detailed picture of health,
sickness, and healing in the
“Eternal City” and the vast lands
under its control.
The Romans were among the first
to introduce public health measures,
such as clean drinking water and
organized sanitation, in their
towns and cities. They also began
spreading awareness about the
5
MILLION The number of
people in the Roman
Empire who died in
165–85 CE in the Antonine
Plague (probably smallpox).
Divine intervention
Roman philosophy and medical
theories incorporated the belief
that the gods wished sickness upon
those who lapsed in their worship
or morality. However, such divine
◁ Mythical medicine
A hero of Roman and Greek mythology, Aeneas is
treated by Lapyx, the god of healing. Romans had
many medicine-related gods who required prayers
and offerings before physicians could effect a cure.
38
MEDICINE IN ANCIENT ROME
PEDANIUS DIOSCORIDES
CE
39
ANCIENT WISDOM TO 700
Galen
“The best physician is
also a philosopher.”
CLAUDIUS GALEN, TITLE OF A TREATISE, ALSO QUOTED IN PERI CHREIAS MORION,
DE USU PARTIUM (ON THE USEFULNESS OF THE PARTS OF THE BODY), 165–175 CE
A
physician who was elevated father dreamed that Asclepios—the
to godlike status, Claudius Greek god of healing—asked his
Galen was the foremost son to take up medicine. After his
medical authority of the Roman father’s death, the 19-year-old
Empire. Building on the work of Galen moved to Smyrna (modern-
Hippocrates (see pp.36–37) and day Izmir, Turkey), where he was
other Greek physicians, he wrote instructed by the physician Pelops
a large number of works—more and the philosopher Albinus. He
than 400 volumes, containing then moved on to Corinth, Greece,
over 8 million words. His ideas and finally to Alexandria, Egypt,
and teachings on human where he acquired knowledge
anatomy, as well as the causes from the great library. The young
and symptoms of diseases, and Galen was interested in the
their treatments, became, in effect, medicine of Hippocrates and the
the laws of medicine for more than philosophy of Plato, and later
1,300 years. Much is known about analyzed their works in On the
Galen’s talents because he was a Doctrines of Hippocrates and Plato.
great self-publicist and regularly
promoted his own work. Illustrious career
Brought up in Pergamon (now In about 157 CE Galen returned
Bergama, Turkey), in a wealthy to Pergamon, Turkey, and took
family and well educated, Galen up his first medical post as a
was destined for a career in law physician-surgeon to the gladiators
or in the government, until his there, making notes on the
variability of wounds sustained
by them in the gladiatorial games.
◁ Prolific medical writer With his success at Pergamon,
More than half of Galen’s written works which saw death rates fall
were destroyed in a fire in 191 CE at dramatically, his reputation
Rome’s Temple of Peace. Yet, the and fame began to spread. The
number of surviving volumes of ambitious Galen then moved
his work still exceed those to Rome in 162 CE. Here, he
by almost any other was able to impress the Roman
medical author. establishment with his medical
abilities, speed of learning, and
confidence. After treating the
philosopher Eudemus in Rome,
Galen was introduced to the
government official Flavius
Boethus, who encouraged him
to begin to write and to give public
lectures and demonstrations.
However, he soon fell out with
GALEN
colleagues, whom he claimed and dissected an array of animals, of his medicine, he acknowledged TIMELINE
envied him, and decided to adopt including Barbary apes (a type of the achievements of Hippocrates.
■ c.129 Born into a wealthy family in
a low profile. He eventually Macaque monkey). His discoveries His extensive tracts on such
Pergamon—in modern-day Bergama,
returned to Pergamon. were numerous and accurate, and themes included On the Black
Turkey—a major center of the region
Galen went back to Rome in included finding the true identity Bile and On the Elements according
and Roman Empire.
169 CE after being summoned by and extent of many muscles and to Hippocrates.
Emperor Marcus Aurelius, and tendons, and he demonstrated the Galen’s writing style was diffuse, ■ 148 Galen’s father—Aelius Nicon—dies,
here began the most fruitful phase kidney’s role in making urine by leaving Galen financially well-off, and
wordy, rambling, and contained
able to travel around Europe and North
of his professional life. He began to clipping the ureter of live animals subjective comment. His medicine,
Africa to study medicine.
write prolifically and continued and showing that it filled with too, was interwoven with his very
to lecture and philosophize, urine. However, Galen’s supreme idiosyncratic beliefs. Over the ■ 157 Returns to Pergamon and takes
while also attending to a series confidence meant that he often centuries, while his philosophy up a post as physician to the gladiators
of five emperors as their personal there, successfully treating their injuries
and wounds. As the gladiatorial death
physician, even accompanying
them on their travels.
“In order to diagnose, one toll reduces,
his reputation
spreads to
Discoveries and contributions
Galen’s primary interest lay in must observe and reason.” Rome and
reaches the
anatomy, which he believed was MOTTO OF CLAUDIUS GALEN senior medical
the basis of all medicine, although fraternity
he was constrained by laws that who suggest
forbade the deliberate opening took educated guesses, or clues was discarded or superseded, Galen’s that he
of the human body. Nevertheless, derived from animals, as facts. medical teachings—complete with moves there.
building on his experience with For example, his study of the brain guesses and misconceptions— ■ c.162 Moves
gladiators, he experimented on and the functions of its parts led to became, to many, undeniable. to Rome as a
his assertion that the pineal gland It was not until the 16th century physician, but
helped support blood vessels, that challenges by Andreas Vesalius makes several
▽ Treating a gladiator a belief that continued to be (see pp.72–75), William Harvey enemies due
accepted through the Renaissance. (see pp.82–83), and others began A 1561 EDITION OF
This artwork from the 19th-century book, to his attitude GALEN’S WORK PRINTED
Vies des Savants Illustres, shows Galen treating Galen also developed the Greek to dismantle the Galenic tenets of toward other IN BASEL, SWITZERLAND
a gladiator in Pergamon. As a physician, he idea of humors, or body fluids, medicine, but even in the 1800s physicians and
studied human internal anatomy and regarded into an extensive fourfold scheme some Western medical doctors still their theories. He leaves the city
the physical body as a “vessel for the soul.” (see p.34–35). In this, as in much referred to his works. occasionally, and returns to Pergamon
for a time.
■ c.166 The Antonine Plague (probably
smallpox or measles) sweeps across
Europe. Galen writes extensively about
the effects and possible treatments for
this plague. A similar epidemic appears
in 198 CE.
■ 169 Recalled to Rome by Emperor
Marcus Aurelius to become his personal
physician, which he does until Aurelius
dies in 180 CE.
■ 170 Becomes physician to Emperor
Aurelius’ son and heir Commodus
until his death in 192 CE.
■ 191 A large number of his writings
are destroyed in a fire at the Temple
of Peace in Rome. Galen is devastated
by the loss of his works.
■ 193 Becomes physician to the new
Emperor Septimius Severus. Although
Galen starts fading from the spotlight,
his writings continue to be widely
circulated and remain immensely popular.
■ c.216 Dies in Rome, although some
authorities say Pergamon or Sicily and
put this date earlier, at around 200 CE.
41
ANCIENT WISDOM TO 700
Blade with a
central groove
Dilation blades
Leaf-
shaped 6 OBSTETRIC DILATOR
blade
5 MALE
1 SCALPEL 2 SCALPEL 3 SURGICAL KNIFE 4 SPATHA CATHETER
Roman Surgical
Tools
Roman surgeons performed a range of operations, including eye,
nose, and ear surgery, extraction of gallstones, and removal of tonsils.
Ancient surgical instruments have been found across the Roman Empire.
1 Scalpel The tool was used for surgical procedures, fractured skull. 9 Surgical forceps The sliding ring
such as mastectomy and hernia repair. 2 Scalpel The on this device fixed the tweezer jaws in place. 10 Ear
blade shape of this tool offered great flexibility, with uses specillum The small scooped end was used to remove
ranging from severing the umbilical cord to removing nasal hard wax from the ears. 11 Vaginal speculum This
polyps. 3 Surgical knife This general tool was used trivalve dilator was used for gynecological examinations
during surgery for making incisions and cutting through as well as the repair of uterine abscesses. 12 Osteotome
bone. 4 Spatha Also called a spathomele, the sharp- This was used to cut away at bone or remove hard
pointed tip of this tool was used for mixing drugs, and the membranes. 13 Thigh tourniquet This was used to stop
spatula-like end for applying pastes. 5 Male catheter bleeding during surgery or to stop the spread of venom. Screw mechanism
This tube made from bronze was used to extract urine 14 Shears Surgeons used these to cut through tissue, opens end blades wider
by inserting it into the urethra. 6 Obstetric dilator or to remove growths such as warts. 15 Hook The
Used as a vaginal speculum, this tool enabled internal sharp end of this hook could be used for holding open
gynecological examinations. 7 Bone lever This was incisions. 16 Clyster Large clysters were used to inject
an instrument for chiseling bones or moving them out medicines into the vagina or rectum. 17 Tile cautery
of the way while fixing fractures. 8 Bone forceps These A heated cautery was applied to a wound or blood
were used to remove fragments of bones, especially in a vessel to stop bleeding and prevent infection.
42
ROMAN SURGICAL TOOLS
Gripping blade
8 BONE
7 BONE LEVER FORCEPS
Slding ring
9 SURGICAL FORCEPS
10 EAR SPECILLUM
Screw-operating device
11 VAGINAL SPECULUM
Trivalve dilator
12 OSTEOTOME
Bronze blade
13 THIGH TOURNIQUET
17 TILE CAUTERY
43
REVIVAL AND
RENAISSANCE
700 –1800
1363
Guy de Chauliac completes
Chirurgia Magna (Great
Surgery), which will be a
standard anatomical, medical,
and surgical work in Europe
855 for three centuries.
Zan Yin completes Jingxiao
Chanbao (Tested Prescriptions
in Obstetrics), the first
Chinese text dedicated to
gynecology and obstetrics.
46
700–1800
From about the 8th century, the expanding Islamic world became the Renaissance in arts, sciences, and medicine, which began in the
focus of progress in arts, architecture, sciences, and medicine. Al-Razi, 13th century. Pivotal developments included the anatomy of Vesalius,
Ibn Sina, and other great physicians of this “Golden Age” expanded Harvey’s description of circulation, the assimilation of the microscope
and developed ancient knowledge, established hospitals, and returned into medicine, the founding of new-style medical schools and
Hippocratic humanity to medical care. Europe underwent its own professional organizations, and Jenner’s pioneering work in vaccination.
1600 1700
1628 1665 1676 1701 1790
William Harvey publishes Robert Hooke publishes Thomas Sydenham In Europe Giacomo Pylarini Samuel Hahnemann
De Motu Cordis (On the Micrographia, a pioneering publishes Observationes describes and practises begins to devise
Motion of the Heart and work in microscopy Medicae (Observations of variolation, a form of therapies based on
Blood)—a short report but and one of the first Medicine), an extremely smallpox vaccination “like cures like,”
monumentally significant due science bestsellers. influential text in Europe carried out in Asia. which becomes
to its description of how the for the next two centuries. known as
circulatory system works. homeopathy.
1723
Pierre Fauchard establishes
modern dental practices
with Le Chirurgien Dentiste
(The Surgeon Dentist).
1747
James Lind discovers
how to prevent scurvy by
carrying out one of the first
organized clinical trials.
1748
Jacques Daviel pioneers a
new technique to remove
cataracts, greatly advancing
their treatment.
1774 1793
Prussian blue is one of Jean-Baptiste Pussin and his
the first stains (dyes) to wife Marguerite, along with
color microscopic samples, Philippe Pinel, begin
advancing the area improvements in the care and
of histology. treatment of the mentally ill.
1661 1785
Marcello Malpighi, founder William Withering reports
of microanatomy, observes on his investigations into
capillaries—the “missing digitalis, the active
link” between arteries substance in foxgloves
and veins. used to treat dropsy.
47
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48
THE GOLDEN AGE OF ISLAMIC MEDICINE
T
he year 476 CE—when the last tolerance. Part of an integrated attitudes led to much progress, not
emperor, Romulus Augustulus, approach to learning that viewed only in the skills of physicians,
was deposed—is regarded mathematics, astrology, literature, but also in the provision and
as the end of the Western Roman philosophy, alchemy, and the organization of medical care.
Empire. After the collapse, Europe sciences as part of a unified truth, Pioneering hospitals and medical
entered an era of social upheaval the field of medicine in particular schools funded by charitable
and disorder referred to as the saw unprecedented innovation. individuals and wealthy rulers
“Dark Ages,” during which little were established from the 9th
progress was made in the arts A duty of care century onward in Baghdad and
and sciences, including medicine. Islamic teachings emphasize duties other cities. Open to all, they had
In contrast, from around the of care, both for the individual as organized wards, inpatient and △ Medicinal substance
8th century the Muslim lands of regards aspects of self-care such as outpatient services, dedicated Highly skilled Islamic pharmacists prepared
the Middle East and western Asia diet, exercise, hygiene, and mental nursing care, and in many cases a wide range of medicines using herbs
experienced an Islamic “Golden and emotional matters, and care offered outreach services for and other substances, such as naturally
Age.” Spreading out from Baghdad for others who are sick and needy. rural areas. Most significantly, occurring crystals and minerals. Sal ammoniac
(then capital of the Abbasid Medical treatment should be made they also provided hubs for crystals, seen here on the black stone, were
caliphate, now the capital of Iraq), available to all, and research into medical training and research. also used in alchemy.
academic and intellectual pursuits the prevention, treatment, and cure A comprehensive system of
flourished in an atmosphere of of illness should be sought. These medical education was established,
with physicians undertaking Born around 865 CE in the city of
ARAB SCHOLAR AND PHYSICIAN (1213–88)
basic scientific learning in subjects Rey (now Tehran, Iran), al-Razi
such as anatomy, physiology, became chief physician in hospitals
IBN AL-NAFIS and alchemy, followed by clinical in Rey and Baghdad. He wrote
training at hospitals that included more than 50 major texts and
A Muslim medical scholar and instruction in conducting physical hundreds of minor commentaries
polymath, Ibn al-Nafis attended examinations, taking patient notes, that combined the principles and
the medical school at Nuri Hospital, and administering treatments. practices he had found in ancient
Damascus (in modern-day Syria), medical works with his own
before moving to Cairo in Egypt. Building on the past clinical observations. His two most
A prolific writer, he produced The basis for these new advances famous encyclopedic texts, Kitab
numerous texts on general medicine, in medical education and practice al-Mansouri fi al-Tibb (The Book
ophthalmology, and surgery, as well was knowledge drawn from the on Medicine Dedicated to al-Mansur)
as on the interaction of medicine ancient world. Muslim physicians and Kitab al-Hawi fi al-Tibb (The
with law, religion, and philosophy. avidly translated, studied, and Comprehensive Book on Medicine),
However, al-Nafis may have invited assimilated works from the were used for centuries after his
controversy when he dissected scholars of the past—especially death in 925 CE, in western Asia
corpses to study anatomy—a the texts of Greek physician and, in Latin translation, in Europe.
practice that was then forbidden. Hippocrates (see pp.36–37) and Al-Razi’s writings emphasized
He came close to working out the Roman physician Galen (see the importance of the relationship
body’s circulatory system when pp.40–41), as well as traditional between doctor and patient. He
he described, for the first time, Chinese and Indian sources revived the Hippocratic approach
the movement of blood around the (see pp.26–27 and pp.30–31). that regarded all patients as being
pulmonary circuit, from the right side One of the greatest scholars equal and worthy of attention, and
of the heart through the lungs to the to play a part in this process that charged physicians to do
heart’s left side (see pp.82–83). of synthesis was the physician patients no harm through
al-Razi (also known as Rhazes). medical treatment. He also
49
emphasized
the importance
of patient interviews in
diagnosis, the need to amend
treatments based on past
experience, and the value of
clinical observation in medicine in
lieu of dogmatism and habit. These
observations allowed al-Razi to
advance theories on the nature
of diseases and the importance of
preventive medicine—the need to
investigate the causes of ailments, △ Tools of the trade
not just provide cures—and the Traditional knowledge of chemists, alchemists,
benefits of good diet and hygiene. and apothecaries provided Arabic physicians with
Recording the symptoms of the skills needed to make medicines. This bronze
smallpox (see pp.100–01) and mortar, from the 16th –18th centuries, would have
measles, for example, led held ingredients that were ground using a pestle.
him to propose the theory
that blood froths like
a fermenting drink
with vapors that seep
through the skin and
create blisters and sores. ▽ Fighting smallpox
This illustration is from a 17th-century Turkish
Age of discoveries edition of Ibn Sina’s Canon of Medicine. The
The advances in medical painting shows a man suffering from smallpox
knowledge gained waiting for treatment while the apothecary
through meticulous weighs the ingredients for his
record-keeping and medicine on a balance.
THE GOLDEN AGE OF ISLAMIC MEDICINE
(also known as Albucasis), born ancient Greece and Rome. From the 12th century, ROUTE OF
PARIS
in 936 CE, became renowned their writings were used in Latin translation in the SPREAD OF
MEDICAL
for their excellence in specific new medical schools in Italy, Spain, and France. KNOWLEDGE
PADUA
areas of medicine. Often referred BOLOGNA
MONTPELLIER
to as “the father of surgery,”
ROME
al-Zahrawi pioneered new this period, but in the early 13th SALERNO CONSTANTINOPLE
procedures and provided the first century the Andalucian botanist CORDOBA
illustrations of more than 200 Ibn al-Baytar produced a ground-
ATHENS
surgical instruments in his seminal breaking encyclopedia that was to BAGHDAD
Ibn al-Nafis (see panel, p.49) to Book of Foods and Simple Remedies)
demonstrate an understanding of alphabetically listed hundreds of
the body’s circulatory system. herbal medicines and remedies—
The introduction of new drugs and many of which were Ibn al- Age—for both contemporaries and was translated into a number of
methods of testing, along with the Baytar’s discoveries. later physicians—is characterized languages, including Latin and
development of processes such by the work of philosopher and Chinese, and became the standard
as dissolving and distillation, Medical canon physician Ibn Sina (later known medical textbook for physicians
also fuelled advances in The significance in the West as Avicenna). Born in for the next few centuries.
pharmacology. Many of this explosion in 980 CE near the historic city of Ibn Sina’s influential writings
prominent physicians also medical practice, Bukhara (a major center of Islamic promoted the development of a
translated ancient works research, theory, culture, now in Uzbekistan), Ibn comprehensive medical system
and wrote their own texts and writing during Sina began studying medicine as a in which observation, methodical
on medicinal plants during the Islamic Golden teenager, and by the age of 18 was experimentation, and deduction
employed as a physician by the were used to underpin medical
Samanid court. This provided him practice. He found methods for
with access to the royal library, filled testing the efficacy of drugs,
with ancient texts that fueled his established the importance of
learning and later writing. environmental factors (such as
Ibn Sina wrote on a wide range clean air and water) on health,
of topics, including mathematics, and identified the contagious
logic, astronomy, psychology, and nature of infectious diseases.
geology, but is best known for his These principles, and the great
240 surviving works on philosophy advances in medical science made
and medicine. Of these, the most during this dynamic period, began
important were Kitab al-Shifa to filter westward from the middle
(The Book of Healing) and Al-Qanun of the 12th century. Primarily
fi al-Tibb (The Canon of Medicine), translated into Latin, the texts of
published in about 1025. Collating Islamic physicians were copied (later
knowledge from Greek and Roman printed), disseminated, and studied
sources, Ayurvedic, Persian, and throughout Europe, eventually
Arabic works, and his own patient aiding the flowering of medicine in
interviews and observations, The the West during the Renaissance
Canon of Medicine (see pp.52–53) of the 15th century.
51
REVIVAL AND RENAISSANCE 700 –1800
One of the most famous Arabic writers of medicine, Ibn Sina, later
called Avicenna, was born in Persia in 980 CE. A precocious child,
he could recite the entire Qur’an by the age of 10. He studied
medicine at 16 and began to practice it at 18. He led a full life
characterized by hard work, and alleged drinking and promiscuity.
Ibn Sina’s Canon—a massive book containing a million words
across five volumes—is a collection of all that was known at
the time about medicine and surgery, including the doctrines
of Hippocrates (see pp.36–37), Galen (see pp.40–41), and the
Greek philosopher Aristotle. The first volume dealt with the
origins of health and sickness and aspects of the body’s
anatomy and function. The second volume listed information
on more than 700 drugs and medicines. The third volume
covered the diagnosis and treatment of diseases specific
to certain parts of the body, while the fourth focused on
conditions that affect the whole body. The final volume
discussed the preparation of medicinal remedies. The Canon
was translated into Latin in the 1100s and consequently came
to dominate approaches to medicine in the medieval period.
“ Therefore in medicine we
ought to know the causes
of sickness and health.”
IBN SINA, ON MEDICINE, c.1020
52
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0
A
ccording to ancient Egyptian ▷ The School of Salerno
scripts, medical schools By the early 900s the Salerno medical school
were established by around had become famous throughout Europe.
2200 BCE—when the first reference In 1099 Duke Robert II of Normandy visited
to Per-Ankh, or “Houses of Life,” the school to seek treatment.
as places for the creation and
preservation of written knowledge
appears. Senior physicians taught the Houses of Life, but they took
students and worked with scribes medical learning to a new level
to record information and produce based firmly on the principles of
copies of books on health practice. science rather than religion or
Although some Egyptian medicine superstition. This science-based
had its roots in logic and evidence, approach reached a new height of
much of the thinking was based on sophistication hundreds of years
religion and magic. Students from later with the opening of the
Greece and the Arab world studied ground-breaking Scuola Medica
in Egypt’s medical schools, then Salernitana, the first modern
returned home to integrate this medical school, in Salerno, Italy.
knowledge with local practices. Founded on the site of a former
monastery dispensary, the institute
Laying the foundation was unrivaled for four centuries
Both the Greeks and Arabs built in terms of both the scope of its
on the existing foundations of teaching and in the production
physician training established at of medical textbooks, including
translations of several important
Arab works. The school’s library
was renowned, and its shelves
were stacked with rare medical
texts supplied by the Benedictine
Abbey at nearby Monte Cassino,
one of the great medieval centres
of learning in Europe. The
collection at the Salerno library
represented the world’s most
extensive compilation of medical
science knowledge. It included
Latin translations of books by
◁ Matthaeus Platearius
Written in around 1470, by Salerno school
physician Matthaeus Platearius, De Simplici
Medicina (The Book of Simple Medicine)
described 270 drugs in detail.
54
THE FIRST SCHOOL OF MEDICINE
▷ Anatomy lesson
A woodcut from 1493 shows the practical
anatomy instruction that was common
at the medical school in Salerno. Initially only
animals were dissected but human dissection
was introduced at the school in 1250.
55
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Medieval Medicine
In the early medieval period in Europe (the 5th to the 10th century), progress in medicine
and science virtually ground to a halt. By the 12th century, however, the translation of
ancient medical texts and circulation of new ideas were promoting greater knowledge.
W
hen the Western Roman practice, and information about
BENEDICTINE ABBESS (1098–1179)
Empire finally dissolved herbal medicines. However, the
around 476 CE, the orderly new structure of Europe meant HILDEGARD OF BINGEN
regime of hygiene, literacy, medical that there was little transfer of
practice, and systematic agriculture information and limited means Hildegard of Bingen claimed to have
also faded. Western Europe of preserving existing medical had religious visions from a young
fragmented into small fiefdoms as knowledge other than in religious age and her parents offered her
Germanic tribes such as the Goths, centers. Monasteries were one of to the Benedictine monastery at
Vikings, Saxons, and Huns swept the few places that did promote Disibodenberg, Germany, where she
across the continent, replacing the learning and book production— eventually became abbess. Hildegard
safeguarding a legacy of knowledge is renowned for her prolific writing
1–2 PER YEAR The number until interest in medicine revived and her diverse talents. During her
of dissections that in the mid- to late medieval period. lifetime and beyond, she earned a
took place at medieval Indeed, the one unifying element reputation as a mystic and prophet, a
medical academies. in Europe was the Catholic Church, scientist, music composer, and writer,
which had become dominant in writing two monumental works on
cohesive administration of Rome the power vacuum left after the natural medicine and cures for illness.
with independent regions that fall of the Roman Empire.
were organized according to the
feudal system. Medical practices The rule of religion for sin, and urged sick people to pray Meeting medical needs
during this time were based largely Ideas and practices relating to to the saints for help. Surviving childhood—and for
on religious beliefs, folk tradition, medicine—such as how the human However, some devout Christians, women, surviving childbirth—
and superstition. The progressive body, sickness, and treatment were in particular the Benedictines, presented major medical challenges
thinking of the Greek and Roman perceived—came to be dictated by considered it a Christian duty to throughout the medieval period.
scholars, and the great Arabic the Church. Autopsy and dissection care for and treat the sick on a more Conception and childbirth were
texts on medicine and science, were banned, making it difficult to practical level. The use of natural considered a priority as populations
seemed all but forgotten. advance medical knowledge and medications and dwindled due to
542
Under the Roman Empire, Europe understanding. The Church viewed treatments The year when the disease, but access
had benefited from an influx of spiritual intercession and prayer as (particularly first hospital in to maternal care was
Greek doctors, the Roman Army the primary cure for disease, which herbs) was France was constructed. limited and variable.
30
medical corps, good hygiene was thought to be a punishment sanctioned on The number of hospitals Aristocratic women
the basis that in Florence, Italy, at the were generally
they had been end of the 14th century. attended by a
provided by physician familiar
God to assist man, and so were with the Greek and Roman texts
spiritual in origin. Herbs were on childbirth, but most of their
grown by monks and nuns to make knowledge was theoretical rather
remedies for their own use, and to than based on practical experience
treat sick members of the wider of women’s medicine. Other
community. Historical documents women managed childbirth
stored in monastic libraries also with the help of a local
◁ Sacred reliquary provided monks with a degree of midwife, who probably
Reliquaries, such as this one medical information and guidance
from 13th-century France, on the use of natural remedies.
housed relics that were A number of hospitals across ▷ Giving birth
thought to be the bones Europe were founded by religious The Cantigas de Santa Maria (Canticles of Holy
or remains of saints. orders in the medieval era, but Mary) is a collection of illustrated poems set to
Christians believed that most functioned like hospices or music, written in Spain during the 13th century.
by touching a relic they almshouses, providing general One poem describes a Jewish women in labor
would be protected medical care, housing, and spiritual who prays to the Virgin Mary, then gives birth
from sickness. guidance for those in need. to a healthy baby, and converts to Christianity.
56
57
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0
medieval period. Born in the that chestnuts are high in folates, The four humors
German Rhineland-Palatinate which are essential for brain and Like other medical writers and
at the end of the 11th century, nervous system development. To practitioners of the time, Hildegard
Hildegard became one of the most aid the heart, Hildegard advocated believed in the four humors
important authorities of the 12th a tonic of parsley and honey-wine; (see pp.34–35), a theory promoted
century on the subject of medieval parsley—rich in folic acid and by Hippocrates in ancient Greece.
pharmacology, and the beneficial essential oils—is today championed The four humors were identified
properties of plants. as a heart-healthy herb. as blood, yellow bile, black bile,
Living in a monastery, Hildegard
had access to early translations of
medical treatises from antiquity,
(see pp.32–33 and pp.38–39) and
also benefited from a boom in
translations of Islamic medical
texts (see pp.48–51) during the
12th century, as interest in the
subject grew. She began to
write her own books on the
subject of sickness and
treatment, all carefully set
within a framework that
placed God firmly at the
top, as the divine creator
△ Leper with bell of the natural world.
Early medieval physicians diagnosed leprosy as Some of Hildegard’s publications
an excess of “black bile,” and prescribed regular became essential reading for
blood-letting as well as a drink containing gold, medieval physicians and pharmacists.
which was thought to be purifying. They wrongly Her Causae et Curae (Causes and
believed that leprosy was easily spread, and forced Cures), for example, was a massive
lepers to ring a bell as a warning not to approach. work comprising almost 300
chapters on the causes of human
diseases and their treatment.
learned her skills through Perhaps even more impressive was
an apprenticeship, but had the accompanying nine-volume
little or no scientific training (see Physica, which detailed remedies
pp.140–41). This traditional type that could be made from plant and
of medicine animal extracts.
was often the
main recourse 300 The number of plants Both works took
with medicinal a well-organized,
for ordinary properties listed in the 12th encyclopedic
people without century manuscripts of approach that
access to Hildegard of Bingen. made them very
a physician. user-friendly.
Focusing on herbal remedies, Central to Hildegard’s view was
potions were typically dispensed by the use of herbs and botanical
women, who had learned from tonics as both preventive measures
older generations how to make folk and cures for specific conditions—
remedies. Alternatively, a patient many still valued in modern
could visit an apothecary, who medicine for their pharmaceutical
would concoct a tonic or remedy properties. To promote brain and
from herbs, spices, and wine. nervous system function, for
example, she recommended
Acquiring knowledge chestnut; today, nutritionists know
One author who could claim some
authority on the subject of both
women’s health and plant-based ▷ Leeches
medicine was Hildegard of Bingen Following principles first written down in ancient
(see panel, p.56). Hildegard Greece, physicians in the medieval period would
represents the reawakening of place leeches on a patient’s skin to draw out
interest in medical knowledge, and blood that was supposedly bad. In modern
the increase in its dissemination, medicine, leeches are sometimes used during
that began in the mid- to late reconstructive surgery to drain congested blood.
58
M E D I E VA L M E D I C I N E
and phlegm, and were thought who believed that the monthly Blood-letting perform the procedure instead.
to directly affect the health of the discharge of blood was essential Reducing excess humors was one In 1163, however, a church edict
body and emotions. All conditions to keep the humors in balance. of the main medical procedures in forbade the clergy from carrying
were considered to stem from Following this line of thought, medieval times—through blood- out blood-letting, and barbers spotted
either an excess or a lack of one they believed that post-menopausal letting, intestinal purging, and this opportunity to expand their
of the humors. Menstruation, for women were in great danger, since induced vomiting. Blood-letting businesses. Barbers began to function
example, was of great interest to they were no longer able to get rid was the most severe of these as medical practitioners—offering
medieval scholars and physicians, of “excess” blood. treatments and blood-letting
1140
was prescribed The year when King treatments, tooth
for many types of Roger II of Sicily extractions, lancing
illness, including forbade anyone from practicing of boils, and even
smallpox, medicine without a licence— amputation, as well
epilepsy, and the first regulation of its kind. as the usual haircuts
gout. Two main and shaves. Barber-
methods of blood-letting were surgeons (see pp.76–77) not only
used: leeching and the cutting of worked from their shops—
veins. Leeching (the milder of the identifiable from the blood-soaked
two options) involved placing live towels drying outside—but also
leeches on the skin and leaving them traveled around the countryside
to suck the patient’s blood. The performing surgical procedures, and
alternative was to open a vein with setting up temporary operating
a lancet or pointed wooden stick, rooms on battlefields. Anesthetics
and let the blood flow into a basin. were used, made from herbs or
If a doctor was not available to carry alcohol, but some of these were so
out blood-letting, monks and priests potent that they could kill the patient
were authorized to step in and before the operation had even begun.
▷ Apothecary’s jar
Apothecaries functioned in the same way
as modern-day pharmacies, dispensing
remedies based on herbs, spices, and wine,
stored in porcelain jars like this one.
59
REVIVAL AND RENAISSANCE 700 –1800
Anatomy Restored
The origins of the modern study of anatomy are usually
dated from Flemish anatomist Andreas Vesalius’ 1543 text
De Humani Corporis Fabrica (On the Fabric of the Human
Body) (see pp.72–75). However, Vesalius and his colleagues
owed much to the early anatomists who had developed
their knowledge at the medical schools of Europe.
◁ Anatomy class
This scene from an illustrated version of Guy de Chauliac’s
Chirurgia Magna shows the physician-surgeon identifying parts
of the body while referring to a book. Assistants (center) carry
out the actual dissection as students crowd in to observe.
61
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0
Apothecary Store
The profession of apothecary—the formulator and dispenser of drugs to
the sick—dates back to at least 2500 BCE. Skilled medics in their own right,
apothecaries prepared medical remedies with the herbs stored in their shops.
1 Pot marigold Also called calendula, the flower is used to coughs. 10 Pill silverer This pill silverer from the UK dates to
treat wounds and swelling, and as an infusion to calm fevers. c.1860. It was a device used to coat pills in silver, or sometimes
2 Vervain This plant was used to treat jaundice and gout, and gold; the pills dropped inside, and the apparatus rotated to
to stimulate lactation in new mothers. 3 St. John’s wort A form the coating. 11 Galangal A type of ginger, galangal is
strong anti-inflammatory, this plant is useful as a wound balm used as a remedy for colic, flatulence, and respiratory problems.
and to treat back pain. 4 China rose A tropical plant, China 12 Garlic Used as an antiseptic and against parasitic stomach
rose helps treat arterial and menstrual disorders. 5 Saffron infestations, garlic was also employed as a remedy for leprosy
Ground into a paste, this spice can be used as a sedative or a and smallpox. 13 Ginger This root is helpful in alleviating
diaphoretic—to induce sweating. 6 Cloves These dried nausea, vomiting, and indigestion. 14 Wild celery Commonly
flower buds were once, and are sometimes still, used as an employed as a diuretic (to promote urine production) it is also
anesthetic and antiseptic in dentistry. 7 Hops The flowers of used to treat rheumatism and arthritis. 15 Fresh mint Used to
the hop plant were used as a sedative, useful for insomnia, ease indigestion, colic, and flatulence, this is either chopped on
anxiety, and stomach pain. 8 Pestle and mortar These were food or used as an infusion. 16 Rosemary Said to improve
1 POT used to grind pharmaceutical ingredients into powders. This memory and banish bad dreams, this herb is also used to calm
MARIGOLD ivory example dates to 1500–1700. 9 Opium This container headaches. 17 Aloe vera leaves Taken internally, these cure
held Thebaic opium, a reference to its place of origin in the constipation. When applied to the skin they soothe rashes and
ancient Egyptian city of Thebes. In small quantities, opium itches. 18 Apothecary jar Jars such as this Italian one from
worked as a calmative, sedative, and an expectorant to treat the 1500s were used to store drugs in apothecaries’ shops.
Leafless
spike
5 SAFFRON 6 CLOVES
7 HOPS
4 CHINA ROSE
Pale lilac
flower
62
APOTHECARY STORE
11 GALANGAL
Tuberous root
grows below
the ground
12 GARLIC
15 FRESH
MINT
13 GINGER
14 WILD CELERY
16 ROSEMARY
17 ALOE VERA
LEAVES
18 APOTHECARY JAR
63
REVIVAL AND RENAISSANCE 700 –1800
Alchemy
A peculiar mix of science and magic, alchemy had various
lofty aims that ranged from changing ordinary metals
into gold to curing all illnesses. Dating back 4,000 years
in Asia and Africa, alchemy enjoyed a golden age in
Europe from the 12th to the 18th centuries.
The ancient civilizations of Egypt, India, and China all had long
traditions of alchemy. The aims of early alchemists varied, but the
underlying thread was always change or transmutation for the
sake of improvement—physically, to alter a common substance
into a precious one; spiritually, to bring light to darkness;
medically, to give good health to the sick; or preferably all three.
There was a tendency toward esotericism among alchemists—
restricting knowledge to a few privileged practitioners who could
thereby mystify ordinary people. Yet alchemists also helped
develop many real-world skills, such as extracting ingredients
from plants, animals, and rocks; mixing, boiling, condensing, and
purifying elements; and other procedures still practiced today.
Alchemy flourished during the “Golden Age” of Islamic medicine
(see pp.48–51) and then journeyed west. Englishman Robert of
Chester’s 1144 translation of Persian polymath Jabir ibn Hayyan’s
(also known as Geber) Kitab al-Kimya (The Book of Composition of
Alchemy) encouraged alchemical practices across Europe. Among
the alchemists’ medical aspirations were to find a universal
panacea to cure all ills and an elixir of youth. Swiss physician
Paracelsus was a celebrated practitioner, whose free spirit, lengthy
wanderings, contradictory statements, and yet practical talents,
embodied the alchemic tradition. However, by the 1700s, faced
with the rigorous application of the scientific method and the
young subject of chemistry, alchemy faded into an occult pursuit.
“ An alchymist is either a
physician or a soap boiler.”
CORNELIUS AGRIPPA, GERMAN POLYMATH, FROM THE VANITY OF THE
ARTS AND SCIENCES, 1530
65
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E
urope had experienced Recurring ravages The Black Death’s vector, or common name, the bubonic plague.
terrible plague epidemics The “Great Pestilence”—as spreading agent, was infected Black blotches then appeared on
before. The Great Plague contemporaries called the Black fleas harbored by the black rat the skin, and death soon followed.
of Athens, described by Greek Death—seems to have begun in (Rattus rattus), which thrived in the The Black Death caused panic
historian Thucydides in 430 BCE, Central Asia in the 1330s, before unsanitary conditions prevalent in throughout Europe. There was
and the Plague of Justinian, which reaching Crimea in 1347, from medieval cities, where rubbish and no cure. Ineffective treatments
devastated the Byzantine Empire where it rapidly spread westward human waste were omnipresent, (see pp.68–69) included avoiding
in 542 CE, both resulted in large- along maritime trade routes. Venice and animals lived in the houses. foods that were hard to digest, and
scale mortality, and may have and other Italian towns were struck The first symptoms of the disease purifying the air with attar (essential
been caused by the same organism that fall, and by the summer of were swellings in the lymph nodes
responsible for the Black Death; 1348 France, Spain, Portugal, and of the groin, armpits, or neck,
however, these earlier outbreaks England had been infected, with known as buboes –
of plague affected a much smaller Germany and Scandinavia falling giving the Black
geographical area. victim the following year. Death its other
TRABZON
VALENCIA CONSTANTINOPLE
SEVILLE MESSINA
oil) of roses, cinnamon, and cloves MOSUL
(one theory maintained that the
BAGHDAD
plague was spread by “miasmas” ALEXANDRIA
23
of the plague were devastating. While the Black Death can no
Amid the terror of the first DAYS The average longer decimate populations
epidemic, thousands of Jews were time from first unchecked, it has not been entirely
slaughtered in Germany because introduction of eradicated. In 1910 researchers
they were blamed for poisoning plague contagion realized that wild rodents, such
wells and thereby causing the among rats in a human as marmots (in Central
plague. As the population in community until first person Asia) and prairie
Europe declined, laborers became dies from the disease. dogs (in North
scarce and land became vacant, America), act as
allowing peasants to demand higher Finding a cure reservoirs of the
wages. Despite attempts to control In 1894 the plague-causing bacillus disease, and human
wage levels, they rose inexorably, was discovered by Japanese contact with these
particularly in England. bacteriologist Shibasaburo Kitasato
Periodic epidemics of plague and French bacteriologist Alexandre
became a feature of European life Yersin; it was eventually named ▷ Plague doctor
for more than three centuries. Yersinia pestis. Although early In order to avoid becoming
England experienced its final attempts to produce a vaccine infected, physicians called on
outbreak in London in 1665, when against the plague failed, the rat to treat plague victims wore
68,000 people died, and Marseilles, flea was identified as the vector in elaborate costumes, including
France, became the last European 1898, leading to successful efforts masks with birdlike beaks, to reduce
city to suffer, in 1720, when an to curb the spread of the disease exposure to the “miasmas” believed to
infected ship carried the bubonic by controlling the rat population. be the cause of the disease.
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I
n medieval times, the term epidemics evoked a variety of ▷ Spreading fragrance
“plague” was used to refer to responses, not the least of which This spherical, eight-sectioned
any epidemic. These plagues was fear and panic. pomander was used to
were often what we now know carry flowers, herbs,
to be diseases such as malaria, Prayer or flight and spices such as
typhoid, cholera, measles, syphilis, With no idea of what caused such nutmeg and musk that
and smallpox. The Black Death diseases or how they spread, some were thought to cleanse
(see pp.66–67), however, was the people simply fled them. However, the air and ward
worst of all plagues, unprecedented in the Islamic faith fleeing was not off infection by
in its virulence and destruction an option: plague was viewed as an the plague.
of human life. These devastating act of God, so had to be endured.
Preventing Plagues
Plagues were nothing new, but the arrival of the Black Death in the 14th century was one of
the most devastating pandemics in human history. Medicine was powerless to treat it, but
over time, organized responses were developed to prevent the spread of such diseases.
GUY DE CHAULIAC
brother… fathers and mothers refused
to see and tend their children.” Born in Auvergne, France, Guy
de Chauliac (see p.72) was a
GIOVANNI BOCCACCIO, ITALIAN WRITER, ON THE PLAGUE AS IT RAVAGED FLORENCE, 1348 physician and surgeon who studied
at the oldest university in Europe,
the University of Bologna. In 1342 he
“miasmas” (see pp.120–21), which The first permanent plague hospital was appointed by Pope Clement VI as
could be removed by lighting fires. (lazaretto) was opened by the his private physician. He attended the
People also began carrying sweet- Republic of Venice in 1423 on the pontiff during the Black Death that
smelling pomanders in an effort small island of Santa Maria di came to France in 1348. A third of
to cleanse the infected air. Nazareth, away from the heart of the cardinals at Avignon died, but
In some places, the authorities the city. This concept spread to Clement survived. Chauliac was
reacted by isolating the sick. The other parts of Europe as a way of also infected, but lived to record
cities of Venice and Milan refused containing the sick. Public officials the experience and, unlike many
entry to anyone suspected of being also used disinfection procedures, physicians, he stayed and cared
infectious. In 1348 ships arriving such as fumigation and the burning for the victims. In 1363 he wrote
in Venice from infected ports were of infected clothing and bedding. about it in graphic detail in his book
required to sit at anchor for 40 days The nature of the contagion itself Chirurgia Magna (Great Surgery),
before landing. The name for this was not yet understood, but these which became the most influential
practice—quarantine—was derived measures suggested a belief that surgical text for more than 200 years.
from the Italian words quaranta the disease was spread by people,
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Alchemy, Chemistry,
and Medicine
For centuries, people investigated the properties of substances, how to purify them,
and how they reacted when mixed. This field of science eventually became chemistry,
but its mystical forerunner, alchemy (see pp.64–65), had a much greater influence on
European medicine from the 12th to 18th centuries.
T
he ancient Greeks began ◁ Understanding the world
to offer explanations about In Utriusque Cosmi Historia (History of the
the structure of physical Two Worlds), published in 1617, physician
substances, or matter, as early as Robert Flood illustrated his ideas on how the
380 bce. The Greek philosopher world worked, divided into physical, celestial,
Democritus believed that all and spiritual dimensions.
matter was made up of invisible
components called atoms that
could not be broken down any explain the composition of, and
further. Around the same time, changing states of, matter. Among
the Indian philosopher Kanada its primary aims were finding a
came up with a similar proposal. way to convert common materials
However, neither of these theories into gold and silver and creating an
were based on physical evidence. elixir for everlasting life. However,
A major step forward came in the the secretive and often intentionally
8th century, when Persian polymath baffling work of many alchemists,
Jabir ibn Hayyan examined the classification system of physical who jealously guarded their
properties of materials using very chemistry. Hayyan’s texts describe materials and methods, eventually
basic laboratory equipment and processes familiar in chemical and led to skepticism from the general
processes such as crystallization drug research laboratories today. public and the wealthy patrons
and distillation. Through his Hayyan produced hundreds of who funded their work.
work, Hayyan developed an early concoctions which, as a physician,
chemical classification of matter: he was able to test on patients, Alchemical contribution
spirits, which vaporized when but he was not systematic about Nevertheless, medieval alchemists
heated; metals, including iron and recording and analyzing his results. did make useful contributions to
lead; and nonmalleable substances More popular at the time was the field of medicine. One of the
such as stone, which could be alchemy—a mix of mystical, most influential was the 16th-
powdered. His breakdown is philosophical, religious, and century Swiss physician Philippus △ Distilling spirits
remarkably close to the modern pseudoscientific approaches to Aureolus Theophrastus Bombastus An engraving by Mannerist artist Jan van
von Hohenheim, also known as der Straet shows distilling equipment from
Paracelsus. Although he adhered the late 1500s and early 1600s. Medical
to some of the spiritual dimensions alchemists used distillation to purify minerals
of alchemy, as well as various folk and herbal extracts for use as drugs.
beliefs, Paracelsus also introduced
many useful elements of chemistry
◁ At work to medical practice. He advocated wrote: “Many have said of
Physician Philippus that doctors should study nature alchemy, that it is for the making
Aureolus Theophrastus and conduct experiments to of gold and silver. For me such is
Bombastus von Hohenheim understand the body’s workings. not the aim, but to consider only
called himself Paracelsus He believed that metals were key what virtue and power may lie in
after the ancient Roman elements, and he connected certain medicines.” One of his beliefs—that
writer Celsus, who minerals to particular illnesses. For which makes a man ill can also
wrote the important example, he found that goiter was cure him—is the premise on which
early medical book De caused by the presence of certain most modern vaccines are based.
Medicina (On Medicine). minerals in drinking water. He Gradually, during the course of the
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A L C H E M Y, C H E M I S T R Y, A N D M E D I C I N E
IN PRACTICE
EXTRACTING PHOSPHORUS
16th and 17th centuries, alchemy’s mysticism, and attempted to progress in a scientific way. The
focus became less supernatural and identify the materials of the popularity of alchemy began
more rational, and alchemists were universe, picturing God as an to wane in the later part of the
seen less as sorcerers and more as alchemist in a laboratory. 17th century. In his textbook The
serious practitioners. Inspired by Sceptical Cymist (1661), Anglo-Irish
the ideas of Paracelsus, English Switch to chemistry chemist Robert Boyle proposed that
physician Robert Flood wrote and The individual approaches of scientific investigation was the key
illustrated Utriusque Cosmi Historia the alchemists, and the persisting to understanding chemistry. By
(History of the Two Worlds) (1617), spiritual and mystical dimensions, the 18th century, chemistry had
which mixed medicine with meant that alchemy could not become a fully fledged science.
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A
s the power of Rome faded introduced. Medicine is built on the as threats, Galen’s works gained establishment, who not only
in Europe during the 4th twin foundations of anatomy and godlike status and were accepted refused to understand what they
and 5th centuries, the arts physiology—the structure and the without question. saw with their own eyes, but
and sciences declined, along with workings of the human body. Beginning around the 13th–14th even refused to look. Vesalius had
many other intellectual pursuits However, the study of anatomy century, the European Renaissance studied medicine in Paris but he
(although progress continued in almost disappeared, and surgeons, gave fresh impetus and a new had to leave when his homeland,
the Islamic world; see pp.48–51). physicians, and others relied on questioning approach to art, now part of Belgium, was caught
Medicine relied on the great works the teachings of Claudius Galen architecture, and literature, up in a war between the Holy
of ancient Greece and Rome, (see pp.40–41). At a time when allowing room for innovation and Roman Empire and France (see
although these gradually came to new attitudes and the quest for invention. However, medicine, p.75). In 1536 he made his way
be distorted as new findings were fresh knowledge were regarded and science in general, lagged back to Belgium via the University
behind. Although some advances of Leuven (Louvain), before
were made by practitioners such moving on to Venice and then to
as the Italian physician Mondino Padua in northeast Italy, where
de Luzzi and French physician he studied for his doctorate in
and surgeon Guy de Chauliac, the medicine (Padua had an exceptional
influence of Galen, Hippocrates, reputation as a seat of learning).
and other ancient physicians On qualification as a physician in
was so great that most medical 1537, Vesalius was immediately
authorities saw no need to follow appointed professor of surgery and
the new Renaissance trends, and anatomy at the age of just 22 years.
any challenges to the accepted Vesalius soon began to show his
traditions were suppressed. independent attitude, adopting a
hands-on approach rather than
The breakthrough following the established method.
In 1543 Flemish physician and He focused on the demonstration
anatomist Andreas Vesalius of anatomy by dissection, believing
produced De Humani Corporis it was fundamental to medical
Fabrica Libri Septum. It is now knowledge and surgical practice.
considered to be the first major Following the example of his
anatomical work of the modern mentor in Paris, Jacques Dubois
era, yet at the time it was ridiculed (also known as Jacobus Sylvius),
by some members of the medical he opened up bodies himself
during anatomy lessons. He and
his students peered inside and
◁ Leonardo’s anatomy of the shoulder they studied what they saw.
Vesalius was inspired by the works of artist Vesalius illustrated the actual
and scientist Leonardo da Vinci, who had anatomy in front of them, using
also produced anatomical illustrations. his own skills and the guidance he
Both were interested in the way form obtained from his artist colleagues.
(shape) reflected function in the body. This observational, empirical
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T H E A N AT O M Y R E V O L U T I O N
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74
T H E A N AT O M Y R E V O L U T I O N
75
REVIVAL AND RENAISSANCE 700 –1800
Barber-surgeons
The 11th and 12th centuries saw the birth of a new
profession in Europe—that of barber-surgeons. Less
well bred and educated than doctors, barbers—with
their haircutting and shaving tools of sharp blades and
potions, as well as their knowledge of skin and blood—
were well equipped to take on medical challenges.
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Ambroise Paré
“I dressed him, and God
healed him.”
AMBROISE PARÉ’S MOTTO
F
rench barber-surgeon Ambroise medicine and surgery. He decided
Paré started a quiet revolution to observe carefully, use his own
in surgery in the mid-1500s. judgment, try new ideas, and assess
The changes he brought about the results. This experimental
were the result of his harrowing approach went against the blind
battlefield experience, which led acceptance of age-old methods
him to question many established used by most physicians and
surgical practices. surgeons at the time.
A key moment for Paré came in
1537, when he was serving as an Humble beginnings
army surgeon during the Siege of Born into a working-class family
Turin. Paré ran out of the boiling in France, Paré was apprenticed to
oil concoction used at the time to his elder brother, a barber-surgeon
cauterize (sear and seal) wounds (see pp.76–77) in Paris, when he
involving gunpowder, a process was a teenager. At the age of 22,
that allegedly “detoxified” the body Paré was accepted as an apprentice
of poisons believed to be carried by barber-surgeon at the Hôtel-Dieu
gunpowder and projectiles. In need in Paris, which was linked to
of an immediate alternative, the forward-looking Faculty of
Paré recalled an ancient Medicine at the Paris University.
treatment. He mixed a potion Unlike in other such institutions,
of egg yolks, rose oil, and the apprentices here attended
turpentine and applied it lectures, and received extensive
to the soldiers’ wounds. The training in medical theory, diagnosis,
next day, Paré saw that the and complex surgical procedures.
injuries were beginning to They often worked alongside the
heal. Moreover, the horrific highly qualified surgeons and
pain caused by the boiling oil physicians, rather than as assistants.
treatment had been avoided. The Hôtel-Dieu also introduced
In light of this experience, examinations and qualifications,
Paré resolved to change giving barber-surgeons professional
his attitude toward recognition for the first time.
Paré progressed well toward
his exams, but when his funds
ran low he joined the army as
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T
he reasons for malformations It has been used since ancient
and deformities of the face times in India, Greece, and
and body have changed Rome, along with prostheses
through time. In past centuries (see pp.236–37). One
leading causes were infectious of the first mentions of
diseases such as smallpox and reconstruction appears
leprosy, as well as growths and in the Indian text
tumors, gangrene, skin ulcers, Susruta Samhita (see
and radical surgery. Other causes pp.30–31), which
include wounds and trauma, dates back more
accidental burns, and amputations than 2,500 years.
by machinery. Congenital Conspicuous in this,
problems (present at birth), and other works too,
such as a cleft lip and palate, may is the nose, partly
occur due to inherited or genetic because in ancient India,
defects or malformation in the nose amputation was a
developing fetus. common punishment for
crimes such as adultery.
Ancient origins Susruta Samhita describes
Reconstructive surgery aims to the transplantation of
repair, rebuild, and restore the patches of skin and even
shape and function of a body part. whole noses from one
individual to another. The
ancient Egyptian Smith
papyrus (see pp.20–21),
dating back to about the
same time, also mentions
nose repair. Around 2,000
years ago, Roman writer
Aulus Celsus included
techniques for the
reconstruction of noses and
other parts in De Medicina
(On Medicine).
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R E PA I R A N D R E C O N S T R U C T I O N
1
on the forehead was reduced and MILLION The number of
camouflaged by stretching the skin rhinoplasty procedures Surgery of Mutilation by Grafting). The term plastic surgery, involving
and suturing (stitching) the edges, conducted in the US every year. This pioneering account helped reconstructive surgery for medical
4
and by wearing a turban or THOUSAND The number establish and advance several as well as cosmetic or esthetic
of rhinoplasty procedures kinds of reconstructive surgery, reasons, was introduced into
conducted in the UK every year. including the Italian method medicine in 1818. It was used in
of rhinoplasty based on using German surgeon Karl Ferdinand
cut off and developed his ideas into skin from the arm, which Branca von Gräfe’s report Rhinoplastik,
a marvelous art.” Facia reported had developed. which dealt with the procedure of
that Antonio Branca used skin Tagliacozzi reasoned that the nose reconstruction and improved
and flesh from the arm rather than option of reconstructive surgery upon older techniques. The report
the cheek or forehead, binding the involves weighing the benefits, came 90 years before the invention
patient’s arm up against the head ranging from the undoubtedly of synthetic, moldable plastics, and
for 15–20 days before severing the medical to solely cosmetic, against the term “plastic” was used to
pedicle. These techniques were potential disadvantages such as imply “being shaped or molded.”
refined by Prussian army surgeon discomfort, pain, infection, and
Heinrich von Pfolsprundt, who perhaps failure of the procedure.
wrote about the procedure in Buch For example, rhinoplasty has
der Bündth Ertznei (Book of Directions several advantages. It conceals the
for Bandaging) in 1460. deep nasal cavity visible when the
In 1597 Italian surgeon Gaspare nose is missing, which could be of
Tagliacozzi published De Curtorum great psychological benefit to the
Chirurgia per Insitionem (On the patient. It also helps keep the
mucous membranes lining the
cavity moist and free from
◁ The Italian method irritation, directs airflow in the
During the 15th and 16th centuries, a correct way, and restores more △ Prosthetic noses
series of Italian surgeons developed normal speech quality and tone. Disfigured noses were sometimes covered with
a method of using skin from the arm In addition, the nose provides prosthetics. Of the examples above, the nose on
for rhinoplasty. The arm had to be held support for eyeglasses, which were the left is made of ivory and that on the right of
in place firmly and tightly for weeks, rapidly becoming popular during plated metal. They were usually attached by pastes
otherwise the skin would easily detach. Tagliacozzi’s time. made from natural ingredients, such as plant sap.
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E
arly notions of the heart, how blood mixed with qi, or life Claudius Galen (see pp.40–41) heart, where it mixed with air
blood, and vessels were often energy, and spread around the body. showed that arteries contain bright from the lungs. Galen believed
metaphysical or fantastical. In In ancient Greece, Hippocrates red blood under high pressure, that blood emitted from the liver
ancient China, the Huangdi Neijing (see pp.36–37) believed that the while the veins through the veins
62,000
(Yellow Emperor’s Classic of Internal arteries carried air from the lungs contain dark MILES had a lowly form
Medicine, see pp.26–27) described and that the heart, thought to blood under low The total length of “natural spirit.”
have three chambers, was the pressure. He of the network of blood vessels In the heart,
seat of intelligence, vitality, and hypothesized a in the human body. blood seeped
▽ The dissection of Thomas Parr warmth. Another Greek physician, system in which through tiny
William Harvey carried out many dissections, Erasistratus, believed that the heart digested food went to the liver, pores in the wall, or septum,
including the bodies of his father and sister. Here produced a “life vapor,” or pneuma, where it was made into new blood, from the right to left side, and so
his subject is Thomas Parr, an Englishman who and blood ebbed to and fro in the which was then sent via the veins into the arteries. Here it became
was said to have lived to the age of 152 years. veins. In ancient Rome, physician to various body parts, including the charged with a higher form, or
D I S C O V E R I N G T H E C I R C U L AT I O N
83
REVIVAL AND RENAISSANCE 700 –1800
The Circulation
Revolution
William Harvey’s classic work De Motu Cordis (1628) was
badly printed and relatively short at 72 pages. However,
it contained a well-rounded explanation of the circulatory
system that revolutionized physiology and medical theory.
◁ Ligature sequence
This illustration from De Motu Cordis shows the valves that prevent
the reverse flow of blood in veins. A ligature, or tight band, around the
upper arm compresses superficial veins, where blood collects, unable
to flow toward the heart. Massaging blood toward the hand has no
effect due to the one-way valves, which appear as small lumps.
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Cataract Surgery
The world’s leading cause of poor vision and blindness is the misting, or clouding, of the
eye’s lens, known as cataract. While simple treatments began more than 2,000 years ago,
major advances made since 1967 now enable sight to be restored to millions each year.
T
he chief factor in cataract ◁ Anatomy of the eye and the cornea) to remove any
formation is advancing This semi-anatomical illustration is from the
fragments and fill the space in the
years. Other possible 13th-century Treatise on the Eye by Arabic capsule. With this development,
factors are tobacco smoking and physician al-Mutadibid. At that time, treatments
incisions in the cornea shrank to a
prolonged exposure to strong for eye conditions varying from bruising tofew millimeters. Cataract removal
sunlight. As a cataract forms, infection were in regular use. was transformed from a significant
the clear, flexible lens of the operation to a routine, one-visit
eye—through which light passes procedure that spread worldwide.
after the pupil (hole) and before suture the incision, so patients Kelman’s technique left the rear
the retina—gradually develops were immobilized for days while of the lens capsule in place, which
misty or opaque patches. healing. Topical anesthetics— facilitated the next development, a
Eventually in a “ripe” cataract applied to the surface of a body synthetic lens to make vision clearer.
the lens becomes toughened, stiff, part to numb it—were developed This intraocular lens (IOL) was
and milky, and blocks all vision. in the late developed in the
Early removal
1800s, and
these, along with 32MILLION PER YEAR The World
Health Organization’s (WHO)
1950s by British
ophthalmologist
global target of number of cataract Harold Ridley,
Cataracts were mentioned smaller, finer
millennia ago, in works such as sutures, allowed surgeries to be achieved by 2020. and after many
the Indian Susruta Samhita (see physicians. While the benefit was surgeons to trials IOLs
pp.30–31). In ancient Rome, that the lens could not slip back experiment with smaller corneal became routine from the 1970s.
Greek philosopher Celsus’s across the pupil, the risk of incisions at different sites. An IOL is often inserted into the eye
De Medicina described an already it breaking remained and the right after cataract removal. The
well-established cataract treatment technique was not widely adopted. Advances in surgery lens is shaped for the individual
called couching. In this procedure, In Paris in 1748, French eye doctor In 1967 US ophthalmologist patient’s optical prescription.
a sharp-pointed, but not slender, Jacques Daviel pioneered a new Charles Kelman devised the Newer, flexible materials allow
needle was pushed through the technique. He cut a C-shaped slit phacoemulsification, or “lens lenses to be folded or rolled so they
eye’s surface, its cornea, and the in the cornea; inserted a narrow jellification,” technique of cataract can be implanted through a small
pupil until it met the toughened spatula to hold the cornea away removal. This method uses incision, then opened out. Advanced
lens, which was then manipulated from the lens; freed the lens from ultrasound vibrations to emulsify surgery may use accommodative
downward within the eye. This its surrounding capsule with a the lens, which is then sucked out IOLs, which the inner eye muscles
allowed light to pass to the retina needle; and manipulated the spatula using a hollow needle. At the same can move and alter to focus both
again, although the loss of a so that pressure around the lens time fluid is washed through the far and near, thereby minimizing
focusing lens meant some blurring. caused it to pop out of the capsule, anterior chamber (between the iris the need for reading glasses.
An alternative to needle-couching and through the incision. Leaving
was to strike the eye with a blunt the lens capsule in the eye
instrument, so that the tiny meant less risk of fragments
ligaments holding the lens in place making their way to the
ruptured and the lens slid away of interior. Daviel’s method
its own accord. However with both was painful and there
these procedures an “unripe” were no stitches
cataract could rupture and spill lens small enough to
fragments into the eyeball’s jellylike
interior, risking inflammation,
pain, and further visual problems. ▷ Surgical detail
Couching remained the chief One of the earliest works with
cataract treatment for centuries. pictorial details of cataract
Progress of a sort occurred in the excision was Complete Human
10th century with the use of a Anatomy Treatise Including Surgical
wider, hollow needle to suck out the Treatments by French physician
whole lens, as described by al-Razi Jean-Baptiste Bourgery, completed in
(see pp.48–51) and other Islamic 1850. This edition dates from 1866.
86
Medieval cataract operation
In 1583 German barber-surgeon Georg Bartisch
published the illustrated text Ophthalmodouleia Das
ist Augendienst (In the Service of the Eyes). It described
cataract operations, correcting squints, and the removal
of growths and foreign bodies.
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0
Exchanging Epidemics
with the New World
When Europeans first came to the Americas in the late 15th century, they
triggered one of the greatest series of epidemics in world history. Without
natural immunity or appropriate medical care, tens of millions of native
Americans succumbed to infectious diseases brought by the newcomers.
T
he arrival of Europeans in fever, yellow fever, pertussis, resistance to their offspring; those △ Cinchona bag
the Americas is usually dated and malaria (see pp.174–75). with little resistence do not. The Used to treat a variety of maladies, cinchona
to explorer Christopher The main reason for the huge Europeans had lived with most of bark was collected in serons, or rawhide bags,
Columbus’s voyage there in 1492. death toll was that the native these diseases for millennia and such as this Peruvian example from the 1770s.
At this time, the population of the people had no immunity against had inherited resistance to the The bark could be chewed in its natural state
New World was estimated to be infections. During this time, they or dried, powdered, and added to drinks.
40–60 million. However, within a
century, the number had declined 5–8 MILLION had also developed preventative
measures, medical care, and
by as much as nine-tenths in some The estimated number of Aztecs treatments—none of which were Syphilis arrived in Europe around
areas, partly due to warfare, but who died of European diseases available to the native Americans. 1495. In the following decades, the
chiefly as the result of huge waves around 1519–20. infection had an estimated death
of infectious diseases inadvertently Two-way exchange rate of more than 75 percent.
brought by the Europeans. the new diseases. Through The Europeans also carried several This rate reduced noticeably within
These imported diseases included generations of evolution, the diseases back home from the a century as the population built
diphtheria, measles, bubonic human body’s immune system Americas. These included syphilis up immunity aided by several
plague (see pp.66–67), smallpox has adapted to combat infectious (see pp.186–87); pinta and bejel— factors. One of these was that
(see pp.100–01), cholera (see organisms in its environment. skin infections linked to syphilis; Europeans had lived closely with
pp.122–23), influenza (see pp.196– People with some degree of natural and Chagas disease (American domestic animals for thousands of
97), typhus, chickenpox, scarlet immunity survive and pass on their trypanosomiasis). years, and had accumulated some
immunity to their diseases—many
◁ Decimated empire related to human illnesses such as
5
This illustration from the
Florentine Codex shows CENTURIES The time it took
Aztecs dying of smallpox, for Central and South
which was allegedly America to recover their
introduced by one African population numbers
slave in the Spanish army. after the deaths that occurred
Almost half of the Aztec following the arrival of the
population succumbed first Europeans.
to the disease, including
their ruler Cuitláhuac.
smallpox and cowpox (see pp.100–
01). In contrast, native Americans
tended to follow a hunter-gatherer
lifestyle, and kept less domestic
stock. Also, Europeans lived in
towns and cities that were densely
populated, and tended to travel
extensively for warfare, trade, and
other reasons. Native populations
in the Americas were less dense
and more scattered, and individuals
traveled less widely and frequently.
So Europeans had a long history of
their bodies being challenged by a
variety of harmful microbes, which
88
EXCHANGING EPIDEMICS WITH THE NEW WORLD
helped build their immunity. the Columbian Exchange, which such as fever, diarrhea, aches, △ Sharing medicine
Therefore, when new diseases also involved an interchange of muscle spasms, and fatigue. In the Peruvian people offer bark from the cinchona
spread from the Americas, domesticated and wild animals 1620s Jesuit priests in the area tree to Europeans suffering from malaria.
resistance to them in Europe’s and plants, and human cultures, discovered that it was especially The Europeans learned much from the native
general population developed customs, and technologies. useful against malaria. In 1630 Americans about plant treatments, including
relatively rapidly—in contrast to One of the most significant a cinchona bark preparation arrowroot, yerba mate, and tobacco—initially
the situation in the Americas. exchanges of plants was that of the produced a malaria cure for Ana regarded as a cure-all for many illnesses.
bark of the cinchona tree, native to de Osorio, the Countess of Chincon
Miracle cure the Andes in South America. Local and wife of the Spanish Viceroy in
The exchange of infectious people, such as the Quechua of Lima, Peru. This encouraged the malaria and many other diseases.
organisms between Europe and present day Peru and Bolivia, knew widespread collection and export In 1820 the bark’s active ingredient
the Americas was part of a larger that ground preparations of the of the bark to Europe, where it was extracted by French chemist
trans-Atlantic phenomenon called bark were effective against ailments was heralded as a miracle cure for Pierre-Joseph Pelletier and his
colleagues, allowing the drug to be
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Thomas Sydenham
“ You must go to the bedside.
It is there alone that you
can learn disease.”
THOMAS SYDENHAM, ADDRESSING A YOUNG PHYSICIAN
O
ne of the most respected Plague (see pp.66–67), which
names in the history of swept through London in 1665–66.
British medicine, Thomas This work led to his first book
Sydenham is credited with Methodus curandi febres (The Method
describing and defining specific of Curing Fevers) in 1666, which was
diseases, as well as bringing doctors expanded into Observationes Medicae
out of the laboratories and into the (Observations of Medicine) in 1676,
sick room. His enduring influence a standard medical textbook for
led him to be called the “English over two centuries. His treatise on
Hippocrates” after his death. gout—a condition he suffered from
Sydenham did not devote himself himself—was published in 1683,
to medical practice until middle and is regarded as his masterpiece.
age. He had served under Oliver
Cromwell as a Puritan in the English Diagnosis and drugs
Civil War, and only began to practice A follower of Hippocrates (see
medicine in about 1656, in London. pp.36–37), Sydenham shared
Here, he made a thorough study of his belief in the healing
epidemics, inspired by the Great powers of nature, and kept
90
THOMAS SYDENHAM
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Early Microscopists
Some technological advances, such as X-rays (see pp.172–73), were quickly assimilated
into medical practice. The microscope on the other hand, invented in the 1590s, only
began to be used for medical research half a century after its invention (see pp.96–97).
S
imple magnifiers using a ◁ Janssen’s microscope
single glass convex lens— Made around 1876, this is a replica of
bulging in the middle—were a very early Janssen microscope from
in use in ancient Rome some 2,000 the 1590s. It has three tubular sections,
years ago. Lens-making improved which slide in and out to focus, and two lenses.
from the 13th century when the Maximum magnification was about 10 times.
use of eyeglasses began to
spread, and magnifiers
known as “flea glasses” curiosities with this time as the “microscopium”;
that could provide little scientific use. the English term “microscope”
magnifications of 10 They suffered from blurring came into use in the 1650s. In
to 15 times were also and chromatic aberration—a 1644 Italian astronomer Giovanni
invented. In the 1590s the problem where light waves of Hodierna reported that he had
compound microscope, using different lengths come into focus at used a telescope modified as a
two or more convex lenses, was different places to produce colored microscope to count 30,000 “little
invented. Some historians credit fringes—and their magnification squares” on a fly’s eye. In 1655
the invention of the microscope was limited to 15 to 20 times. Peter Borel, physician to King
to the Dutch lens-makers, father- Louis XIV of France, wrote De Vero
and-son duo Hans and Zacharias Early microscopic studies Telescopii Inventore (The True Inventor
Janssen. Others believe the Dutch One of the first publications to use of the Telescope). The telescope was
inventor and eyeglass-maker Hans microscopic studies was the 1625 now being improved at a much
Lippershey made the first Anatomy of the Bee, as Revealed by the faster rate and at the end of his
microscope. Italian polymath Microscope, by Italian scientist and text Borel included microscope
Galileo Galilei worked on writer Francesco Stelluti. He information and observations,
improving microscope lenses achieved clear magnifications of saying: “A microscope, whether
in the early 17th century, but around five to seven times. The it be a flea glass or a fly glass,
early microscopes were mainly device was known in Italy during whereby a flea is enlarged to the
size of a camel, and a fly to the size
DUTCH SCIENTIST (1632–1723)
of an elephant, is made out of two
glasses enclosed in a small tube:
ANTONI VAN LEEUWENHOEK the glass nearest the eye is convex
and made out of a small segment of
Originally a textile merchant, a spherule, whose diameter should
Antoni van Leeuwenhoek became be two inches: the other glass is
interested in microscopy while plane [has one flat side].”
trying to improve magnifier lenses
for inspecting cloth threads. He Pioneering microscopists
used an unusual single-lens Two people who helped the
design, through which he achieved microscope gain greater fame, and
magnifications of more than 250 encouraged its use in medicine,
times. As a merchant Leeuwenhoek were British polymath Robert
understood the need for trade Hooke and Dutch polymath Antoni
secrets and kept his methods to
himself—his unique lens-making
procedures were not rediscovered ▷ Campani’s microscope
until the 1950s. With almost 200 Dated 1686, this is the first illustration of
scientific articles published by the a microscope in medical use—to examine a
Royal Society by the time of his patient’s leg. The device (enlarged on the left),
death, Leeuwenhoek can be seen made by Italian inventor Giuseppe Campani, had
as the first expert microbiologist. a screw thread for focusing. Light concentrated
from a candle was used to illuminate the area.
92
E A R LY M I C R O S C O P I S T S
Planar mirror to
illuminate specimen
Lamp-oil
reservoir
Drawer to store
specimen and
instruments
Focusing
screw
Objective
lens
Stage for
holding
specimen
Device with
Illuminating polarizing
mirror prisms
Eyepiece
4 CULPEPER
MICROSCOPE
(C.1740)
5 SIMPLE MICROSCOPE
Brass stage
Screw to move
specimen up
or down
6 LEEUWENHOEK’S
MICROSCOPE (C.1674)
94
EVOLUTION OF MICROSCOPES
The first microscopes were simple devices with two lenses fixed together in a
tube. The magnified images they produced revealed a new world for scientists
to explore in minute detail. As the quality of lenses improved, so did the images.
Optical lens on top of
conical part of tube Bull’s eye lens
1 Small compound microscope This early voyage aboard the Beagle. 6 Leeuwenhoek’s focuses light
from source
microscope comprises two lenses. As a result, the image microscope Dutch scientist Antonie van Leeuwenhoek onto specimen
is twice magnified. 2 Hooke’s microscope This built this simple microscope, using a biconvex lens.
replica of British scientist Robert Hooke’s compound 7 Polarizing microscope Designed by British
microscope uses a water-filled glass container to focus geologist Allen Dick, this device uses polarized
light from a lamp onto the specimen being observed. light—with light waves undulating in a single plane.
3 Lyonnet’s microscope Dutch naturalist Pierre 8 Cary-Gould microscope This Gould-type
Lyonnet designed this simple microscope with a lens compound microscope by manufacturer Cary, London,
mounted on top of a series of ball-and-socket joints consists of three lenses. 9 Binocular microscope
attached to a small dissecting table. 4 Culpeper A complex microscope, this device has a built-in
microscope Built by British instrument-maker Edward illumination system and its twin eyepieces reduce strain
Culpeper, this compound microscope had an inflexible, on the eyes when used for longer periods. 10 Electron
upright style. 5 Simple microscope This simple microscope This microscope uses an electron beam
aquatic microscope is very similar to the one used by rather than light to form an image, and allows for
British naturalist Charles Darwin on his exploratory increased magnification and improved resolution.
High voltage
Electron gun
9 BINOCULAR 10 ELECTRON
Revolving
MICROSCOPE MICROSCOPE
nosepiece
holding
objective
lenses
Fine focusing
T
he invention of the light produced the irritation and pain of ▷ Seeing neurons
microscope in the 1590s conjunctivitis, and that removing The long, thin fibres of
uncovered a new world them solved the problem. nerve cells, or neurons,
of tiny objects and living things. Marcello Malpighi (see panel, are visualized here using
By the late 17th century, several below) was a principal pioneer a Golgi stain, containing
researchers were investigating the in microanatomy and medicine, silver compounds.
previously unknown and unseen and studied a huge variety of plant, Golgi discovered this
world of human tissues and animal, and human tissues. In staining technique in
cells, and the harmful microbes, about 1661 he identified tiny 1873 and called it the
“black reaction”.
or pathogens, that cause disease. channels or vessels in frog lungs
that had minute bodies moving
Microanatomy through them. This was one of the
In 1653 Peter Borel (see pp.92–93), first descriptions of capillaries—the also to stain or inject them with of the first automatic cutting
physician to the French King Louis “missing link” between arteries and substances so they could be better machines—the microtome.
XIV, provided one of the first veins in the circulatory system, as seen under the microscope. This device was improved in
accounts of the microscope for described by William Harvey (see the late 18th century, by Scottish
medical use. He described how tiny pp.84–85) in 1628. Malpighi also Beginnings of histology instrument-maker Alexander
ingrowing eyelashes, which could devised new methods to illuminate In the late 17th century, Malpighi Cumming, and then significantly
only be seen using a microscope, tiny specimens more brightly, and laid the foundations for histology, advanced by Swiss anatomist
a new branch of science. Derived Wilhelm His in the 1860s.
from the Greek word histos— A second area of progress for
I TA L I A N B I O L O G I S T A N D P H Y S I C I A N ( 1 6 2 8 – 1 6 9 4 )
meaning web or tissue—histology histology was in the treatment and
MARCELLO MALPIGHI is the study of tissues, which are a preservation of tissue samples with
collection of similar cells, such as chemicals. This made them firm,
Born near Bologna in Italy, to the Pope in Rome. He died muscle, bone, nerve, or cartilage. and therefore, easier to slice. In the
Malpighi received his there, probably of a stroke, French anatomist Marie-François 19th century this procedure was
doctoral degree in in 1694. His name is Bichat further developed the improved when the use of salts and
philosophy and medicine commemorated in many understanding of living tissues acids was replaced by the use of
from the University of areas of biology and in the 1790s. paraffin wax to penetrate and
Bologna in 1653. human microanatomy, The quality of microscopes support the sample during sectioning.
Alhough he showed from Malpighian tubules improved with time, and so did In the 1890s formalin came into
some interest in in the excretory system of the techniques used for examining fashion as a preservative-fixative—
teaching, by 1660 he had insects, to the Malpighian specimens. One method was to use a compound that hardened fresh
become a doctor and layer of the skin’s epidermis, a very thin slice, or section, of tissues, helping retain the minute
researcher in microanatomy, and Malpighian corpuscles— tissue. At first, sections were cut details of the cells. Another
and studied different kinds of clumps of white blood cells by hand using a razor blade; but in advance in histology was the
plants and animals at his estate near that are found in the spleen. 1770 George Adams invented one development of stains, or dyes, to
Bologna. He accepted professorships
at the universities of Pisa and
Messina, in 1656 and 1662,
respectively. However, his discoveries
“ Observation by means of the
challenged the approaches and
beliefs current at the time, provoking
microscope will reveal
controversy and making him
unpopular among his colleagues. more wonderful things
than those viewed in regard
In 1668 Malpighi became a
member of Britain’s Royal Society,
which reported much of his work.
Toward the end of his life in 1691,
Malpighi was appointed physician
CAPILLARIES IN
THE LUNGS DRAWN
BY MALPIGHI
to mere structure.”
MARCELLO MALPIGHI, ON THE DISCOVERY OF CAPILLARIES, DE PULMONIBUS, 1661
96
T H E F I R S T M I C R O A N AT O M I S T S
color certain structures and cells blue, while eosin stains Johannes Müller in 1838. During △ Artist at work
substances to be viewed under the the cytoplasm or “jelly” pink. the 19th century, microanatomy, In addition to being a histologist, Cajal was
microscope. One of the first stains, Hundreds of stains have since been histology, and histopathology were also a talented artist. He produced hundreds
introduced in 1774, was Prussian invented for specialist applications. responsible for many momentous of illustrations mapping the nervous system,
blue. A version devised in the medical advances, including germ which are still used as teaching aids today.
1860s to show up iron-containing Advances in histology theory (see pp.146–47), identifying
substances, such as hemoglobin, Histology is partnered with infectious microbes, vaccine
was known as Perls’ blue stain after histopathology in the study of development, and unraveling the
German pathologist Max Perls. abnormal tissues and how they microstructure of body systems, Golgi from Italy, and Santiago
The H&E (hematoxylin and eosin) lead to diseases. The first work to especially the brain (see pp.160– Ramón y Cajal from Spain. Golgi
stain, first described in 1876 by describe histopathology and its 61) and nerves. developed a stain to show the
chemist A. Wissowzky, is still the techniques was On the Nature and In 1906 the Nobel Prize in details of nerve cells, while Cajal
most popular stain used today. Structural Characteristics of Cancer by Physiology or Medicine was jointly described the organization of these
Hematoxylin colors the nuclei in German physiologist and scientist awarded to two histologists—Camillo cells in the brain.
97
REVIVAL AND RENAISSANCE 700 –1800
Scurvy
For more than 400 years, scurvy was the bane of sailors.
A breakthrough in understanding the disease came in
1747 when Scottish physician James Lind proposed that
scurvy was caused by vitamin C deficiency.
▷ Scurvy
This page from the journal of British naval surgeon Henry Walsh
Mahon from his time aboard HM Convict Ship Barrossa (1842)
shows the effects of scurvy. Here, he describes typical symptoms
that develop on a patient’s leg, including lesions; open, festering
wounds; dark patches; and bleeding.
98
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Smallpox:
The Red Plague
Of all human diseases, smallpox has perhaps the most
claims to fame—or rather, infamy. It has featured in all
of recorded history, killed billions, and inflicted lasting
suffering on billions more. It was the first infection to
be immunized against, as well as the first—and currently
only—major global disease to have been eradicated.
S
mallpox was caused by were left with disfiguring scars,
several forms of the Variola physical disabilities that sometimes
virus. In typical cases it included blindness, and mental
attacked small blood vessels in anguish since they were shunned
the skin, mouth, and throat, by or even cast out of society.
causing fluid-filled blisters. The Smallpox and its virus were part
most virulent forms killed an of a group of diseases that included
estimated one-third of victims. cowpox, horsepox, camelpox, and
However, during monkeypox. The
1
sudden, fast- The number of deaths term “pox” refers
spreading caused per second by to skin eruptions
epidemics the smallpox in the 19th century. or sacs that leave
death toll could be pitted pockmarks,
as high as 80 percent. and it has been applied to a wide
Smallpox spread through the range of diseases from acne to
inhalation of airborne droplets syphilis. The name “small pockes”
from an infected person’s mouth, was introduced in England in the
nose, and airways. It also spread late 15th century to distinguish
by direct contact with bodily the viral disease from syphilis,
fluids or shared objects such as which was then called the “great
clothing. Survivors of the disease pockes.” Smallpox was also
◁ Poxified mummies
Several Egyptian mummies have pitted, pockmarked skin
indicating smallpox infection. One of the victims was
Pharaoh Ramesses II (shown here), who died around
1213 BCE aged 90 years. His mummy was discovered in
1898 and has facial skin lesions. The remains of Ramesses V,
who died in about 1145 BCE, show similar evidence.
100
SMALLPOX: THE RED PLAGUE
101
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0
I
mmunization is the process of Early variolation for its acceptance in Britain. By Several others had investigated this
making the body resistant to an It was widely known in ancient 1721 with smallpox again on the link, such as the English physician
infectious disease by working times that the body develops rise, Lady Montagu persuaded John Fewster, who wrote a paper
with the body’s natural defenses. natural resistance to diseases. the royal doctor Hans Sloane to “Cow Pox and Its Ability to Prevent
Natural immunity starts to develop The earliest attempts to induce try variolation. Informal tests on Smallpox” in 1765, but it was largely
when infecting microbes invade immunity artificially may date prisoners were successful and ignored. In 1774 Benjamin Jesty, a
the body and the immune system back more than variolation gained farmer, reportedly used a darning
fights them by releasing antibodies. 2,000 years in India, popularity, having needle to introduce cowpox sore pus
After infection, the immune system
“remembers” those microbes and if
but the idea of
immunization rose
249 People given
variolation in been accepted by
1721 by physician Zabdiel members of royalty.
into his family, but he was mocked
when his wife became very ill.
it encounters them again it quickly to prominence in Boylston in Boston—the Variolation became
produces antibodies to prevent China in the first US inoculations. more common
the body from attack. Vaccination medieval period, throughout the
induces immunity artificially by when individuals were inoculated 18th century, but it continued to
imitating an infection, but without with the smallpox virus (see be unpredictable, with occasional
causing illness. An essential part of pp.100–01). Procedures involved serious cases and even deaths.
modern medicine, vaccines have taking blister fluids, pus, or scabs Another disadvantage was that
been developed against many from a person infected with a mild variolation necessitated the isolation
dangerous infectious diseases. case of smallpox and giving them to of the recipient for two weeks.
an uninfected person. This was done
by rubbing them into cuts in the Jenner’s breakthrough
skin or blowing ground scabs up the Edward Jenner was a successful
nose. While there was a slight risk country physician-surgeon in
of developing severe smallpox, this Berkeley, southwest England, as
method had a much greater chance well as a talented naturalist. He had
of offering protection, reducing undergone variolation in his youth,
mortality rates caused by smallpox which had made him ill for a time.
102
T H E F I R S T V A C C I N AT I O N
103
REVIVAL AND RENAISSANCE 700 –1800
Phrenology
The practice of phrenology—ascertaining a person’s
character, morality, and intellect by feeling and measuring
the contours of the head—is regarded as outdated and
unscientific today. Yet this field enjoyed considerable
success in the first half of the 19th century, chiefly in
Britain, Ireland, parts of mainland Europe, and the US.
▷ Head cases
This collection of around 60 model heads was sculpted by
Swiss-born, England-based wax modeler and phrenologist
William Bally to explain the principles of phrenology. Sets of
plaster casts such as these were sold as teaching aids and
displayed at Britain’s Great Exhibition in 1851.
104
Islamic hospitals
An Arab doctor carries out an inspection of a
ward in a hospital in Córdoba, Spain, which
was under Muslim rule until 1236. Islamic
hospitals practised advanced techniques,
including the use of willow as an antiseptic.
A
lthough the Roman most frequently cared for lepers, The Dissolution of the Monasteries of religiously run institutions.
army had established or, from the 14th century onward, under Henry VIII, between 1536 In Vienna, the Allgemeines
valetudinarian, or hospitals, for plague victims, those suffering and 1540, led to the closure of Krankenhaus (general hospital)
for wounded or sick soldiers (see from other infectious diseases, and hundreds of former monastic was remodeled by Emperor
pp.38–39), there is no evidence the mentally ill. hospitals in England. Only a few Joseph II in 1784, and included six
of specialized buildings to provide More formal hospitals did exist were refounded, so by 1700, medical and four surgical wards.
medical care for civilians before the in the Islamic world (see pp.48–51), London, a city of 500,000 people,
4th century CE, when charitable the oldest having originated in had only two substantial medical New hospitals
Christian donors began founding Baghdad around 805. Medical hospitals—St. Bartholomew’s and As London’s population grew
establishments to tend to the training was undertaken in some St. Thomas’s. Elsewhere in Europe and became more prosperous,
impoverished sick. Hospitals in of them, but they cared mainly the situation was slightly better there was increased pressure for
medieval times were commonly for the poor rather than the because the Reformation had not better medical coverage. Helped
associated with monasteries, and general populace. led to the wholesale closure by donations from rich merchants,
106
T H E M O D E R N H O S P I TA L
900
Royal Hospital for Diseases of College London established its own three months at the institute in
the Chest (1814). In the US the hospital dedicated to instructing 1851 before practicing what she PERCENT
earliest specialized hospital was medical students. had learned in field hospitals for The increase
in the
number
▷ Clarence ambulance of outpatients attended to
Adapted four-wheeled Clarence carriages, at St. Thomas’ Hospital, London,
drawn by two horses, were used as between 1800 and 1890.
ambulances in Scotland until the early
20th century. The first Scottish nursing school in Britain. From
ambulances were a pair of 1860 Nightingale’s institute
sedan chairs, purchased provided trained nurses to the
for the Edinburgh new English hospitals.
Royal Infirmary. As the medical services offered
by hospitals increased, there was
a danger that poor patients would
be squeezed out. Hospitals started
Carriage was harnessed charging patients a small fee, and
to horses middle-class patients began to
pay more for access to private
rooms. To counter this trend, new
Canvas stretched
across poles to carry “dispensaries” appeared, which
weight of patient provided medical care to the poor
for free. These institutions, such
as the New York Dispensary
(1790), the Public Dispensary
of Edinburgh (1776), and the
Finsbury Dispensary (1780),
were the true descendants of
their medieval forerunners.
107
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0
Homeopathy
A healing system developed in Germany in the 19th century,
homeopathy is based on the principle that “like cures like” or
the “law of similars.” It is one of several therapies that takes a
different approach from that of conventional Western medicine.
T
he basis of homeopathy—that ▷ Homeopathic medicine chest
a substance that causes certain This early 19th-century medicine chest contains
symptoms in a healthy body 69 small glass vials and six large bottles.
can, in lesser quantities, be used Professional homeopaths prepared and
to treat an illness with the same prescribed dozens of remedies, and dispensed
symptoms—was first recognized in them according to various lists and guides
ancient Greece and later developed compiled by Hahnemann and his followers.
by the Romans. In the 4th century
bce, the Greek physician Hippocrates
was making homeopathic remedies, were poisonous in quantity could
and homeopathic medicine was be beneficial in smaller doses. Von
described by Greek-born Roman Storck reported on experiments
apothecary Dioscorides in his De using some of the most feared
Materia Medica (see pp.38–39). herbs, such as hemlock.
In the 1790s German physician However the technology to
Samuel Hahnemann began to extract active ingredients in
develop a set of therapies based on their pure form was not
this theory, which became known available at the time, so
as homeopathy. Prior to this, von Storck’s results were
Greek-Swiss physician Paracelsus inconclusive. Hahnemann
(p.70) and Austrian physician began to investigate these
Anton von Storck, among others, claims, often using himself
had suggested that materials that as an experimental subject.
He tested plant materials
such as cinchona bark—
later found to be a source
of the antimalarial
compound quinine
(see pp.174–75)—
and the leaves and
berries of belladonna
(known as deadly
nightshade).
Diluted remedies
Hahnemann suspected
that if smaller doses of
a substance could treat a
symptom, even smaller
ones would have a greater
effect while reducing any
unwanted side effects. He
developed the technique of diluting
his extracts in water or alcohol
many times shaking the container
△ The cinchona bark experiment at each stage of dilution (known as
Hahnemann consumed an extract of the cinchona “succussion”). He also devised the
plant—traditionally used as a cure for malaria— centesimal scale, or “C-scale,” in
to show that in a healthy person it led to order to measure the potency of the
symptoms similar to malaria. solution. A 1C dilution consisted of
108
H O M E O P AT H Y
SAMUEL HAHNEMANN
can produce… Born in Meissen, near Dresden,
one part remedy in 99 parts Institute of Homeopathy in 1844. and 1970s, alongside other aspects he or she considers to be helpful,
water, 2C referred to a 1C This popularity was probably led of counterculture or “alternative” not knowing that it is a placebo
solution diluted in another by the fact that homeopathy was lifestyles, literature, and music. (ineffective preparation). Even if
hundred-parts liquid, and so gentler than some of the other there is no discernible improvement
on. This process of dilution is brutal treatments of the day. The placebo effect in objective terms, the patient may
called “potentization” because, Another advantage was that Despite millions vouching for the perceive one. Modern medicine is
paradoxically, the more dilute patients could be treated at home effectiveness of homeopathy, many still investigating the mechanism
the remedy is, the higher the rather than in a hospital, where studies claim it is in fact the “placebo of the placebo effect, which is
potency; some remedies are they sometimes caught additional effect” at work—that is, if someone often observed but is difficult to
so dilute they no longer infections or faced conventional believes that they will get better, explain. Some studies tie it to active
contain any molecules of treatments that often did more they have an increased chance of substances found naturally in the
the original substance. harm than good. Another wave improvement. This is especially true brain, such as endorphins, which
of popularity came in the 1960s if a patient takes a substance that cause an improvement in health.
Growing popularity
Hahnemann set forth his
findings in The Organon of the
Healing Art (1810). He proposed
that diseases were caused by
underlying weaknesses (“miasms”)
and that homeopathy could gently
coax these out of the body. His
publications were circulated widely
and homeopathic practitioners,
journals, and organizations began
to emerge in Europe and North
America. The German Central
Association of Homeopathic
Doctors was founded in 1829,
and many other similar groups
followed, such as the American
109
SCIENCE TAKES
CHARGE
1800 –1900
112
1800–1900
Some of medicine’s greatest achievements came during the responsible for mass killers such as cholera, tuberculosis, and
19th century, including anesthesia, antiseptic procedures, and rapid tetanus. Microscopes also encouraged great progress in histology
advances in vaccination. Louis Pasteur and Robert Koch led the way and pathology. Women began to qualify as doctors, and nursing
in replacing age-old ideas of spontaneous generation and miasma became a recognized profession. In the last decade, X-rays opened
with germ theory, while microscopic studies revealed the bacteria up a new world of noninvasive medical imaging.
1880 1895
1881 1882 1890 1897
The first professional Robert Koch identifies Giovanni Grassi and Chemists at Bayer in
midwives organization, the cause of tuberculosis: Raimondo Filetti discover Germany, including Felix
Matrons’ Aid Society, is Mycobacterium tuberculosis. there are several kinds of Hoffman and Heinrich
founded in Britain, and malarial parasites; Ronald Dreser, produce a
soon changes its name to Ross demonstrates that synthetically modified
the Midwives 1884 mosquitoes transfer these version of salicylic acid
Institute. Robert Koch isolates parasites between humans. that is better tolerated
the causative germ for by the body; it is
cholera and describes how named Aspirin.
it is spread, and prevention
and control measures.
1893 1899
William Einthoven introduces Aspirin goes on sale
Sphygmomanometer the term “electrocardiogram” worldwide and
and publishes New Methods becomes one of the
for Clinical Investigation most successful and
concerning the heart’s adaptable medical
electrical activity and drugs of all time.
its relevance to disease
and diagnosis.
1895 1896
In Vienna, Karl Landsteiner The sphygmomanometer
begins his studies of is improved by Scipione
immunity, antibodies, and Riva-Rocci, who adds a 1899
blood, especially how cuff around the arm to Sigmund Freud publishes
and why it clots. apply even pressure The Interpretation of
to the limb. Dreams setting out various
1895 psychological theories,
Sigmund Freud and Josef including a model of mental
Breuer coauthor Studies on structure based on the
Hysteria, the first main work unconscious, preconscious,
in psychoanalysis. and conscious.
113
SCIENCE TAKES CHARGE 1800 –1900
The First
Stethoscope
The invention of the stethoscope in 1816 gave doctors
a new way to listen to sounds inside the body. One of the
most important—and simplest—diagnostic innovations in
all of medicine, it soon became a vital piece of equipment
for physicians and an enduring symbol of their profession.
◁ Early stethoscope
This sketch shows a stethoscope being used by Surgeon Captain
Whiston in a field hospital in Sudan, 1867, as Anglo-Egyptian
forces fought to retake the country. The monaural—held to one
ear—stethoscope resembles a small telescope.
115
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
1 PART OF LAËNNEC’S
Plate shaped
STETHOSCOPE (EARLY 4 CYLINDRICAL like an ear
19TH CENTURY) STETHOSCOPE (1830S)
Large ear
plate
Hollow
tube
Ivory
earpieces Small ear plate
for children
Narrow
metallic
cylinder
Plate fit
snugly
over ear
Diagnostic Instruments
Over thousands of years, advances and breakthroughs in understanding
the human body, as well as innovations in technology, have improved
the way diseases are diagnosed and treated.
1 Laënnec’s stethoscope Invented by French physician Hoffmann, this was used to look inside a patient’s ears.
René Laënnec, this stethoscope was essentially a wooden 10 Sphygmomanometer This device was used
tube. The first model had three detachable parts. to measure blood pressure. 11 Laryngoscope Spanish
2 Wooden stethoscope This device was monoaural— vocal specialist Manuel Garcia used this device to view the
its user could only listen with one ear. 3 Early binaural glottis and larynx for the first time. 12 Ophthalmoscope
stethoscope The binaural stethoscope enabled physicians This model had a mirror that reflected light into the eye
to listen in with both ears. 4 Cylindrical stethoscope and a peep hole in the center to look inside the eye.
This device had a disk-shaped sound collector at one end 13 Ophthalmoscope Some ophthalmoscopes, such 9 OTOSCOPE
that could help pick up high-pitched sounds. 5 Hughes’ as this one, came with a variety of lenses. 14 Brass (1841)
stethoscope Another monoaural, this stethoscope usually endoscope This was used for examining the bladder
had a wooden earplate. 6 Hare’s stethoscope This and urinary tract. 15 Percussor This device was designed
stethoscope is made of wood but later versions were made to detect abnormalities in the chest. 16 Glass clinical
of ivory. 7 Celluloid stethoscope Celluloid replaced thermometer British physician Thomas Allbutt
Rubber bulb
ivory in this model’s ear plate, which also had a metal body. invented this compact clinical thermometer.
8 Tuning fork This was used to detect hearing disorders. 17 Albumenometer This tested the amount of the
9 Otoscope Invented by German medical officer Friedrich protein albumen in urine to detect kidney problems.
116
DIAGNOSTIC INSTRUMENTS
11 LARYNGOSCOPE
(1854)
Mirror
12 OPHTHALMOSCOPE
Pressure
gauge
Funnel concentrating
Rubber Candle light
tubing
15 PERCUSSOR
(1860)
14 BRASS
ENDOSCOPE (1853)
Viewing lens
16 GLASS CLINICAL
THERMOMETER
(18TH CENTURY) 17 ALBUMENOMETER
117
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
Resurrection Men
In the 18th and 19th centuries the insufficient supply of corpses to medical schools in Britain
for the purpose of dissection gave rise to the “resurrection men.” Often operating in gangs,
resurrectionists disinterred fresh corpses and supplied them to anatomists. Outrage at such
activity led to a change in the law so that medical schools could acquire cadavers legally.
A
dvances in anatomical countries took a more pragmatic for dissections. Even after the This sinister but highly lucrative
science since the medieval approach, allowing the unclaimed Murder Act 1752 decreed that practice became so widespread
period had come about as corpses of the poor to be supplied criminals could be dissected by that the Edinburgh College of
a result of the dissection of human to anatomical schools. The detail anatomists after execution, the Surgeons introduced a clause in
corpses. Although Pope Benedict and accuracy of Flemish physician supply was wholly inadequate to their contracts in 1721 forbidding
VIII had forbidden the practice in Vesalius’s (see pp.72–75) drawings meet the needs of medical schools. trainees from dealing with the
1300 on pain of excommunication, of many anatomical features in For this reason, surgeons turned resurrectionists. However, the
the authorities in most European his 1543 work De Humani Corporis to the service of resurrection men, restriction was largely ignored,
Fabrica (On the Fabric of the Human who would disinter freshly buried since anyone with aspirations to
Body) was only made possible corpses and sell them for dissection be a surgeon needed to witness
▽ The Burke and Hare murders through human dissections. for a fee ranging from 2 to 20
Burke and Hare’s first corpse was a pensioner, In Britain, the law was much guineas (the latter being
who died of natural causes at their lodgings. stricter. In 1540 Henry VIII gave well over 20 times
After that they lured potential victims—mainly the Company of Barber Surgeons the average weekly
vulnerable women—with the promise of alcohol, the right to take four corpses of wage of a surgeon
then got them drunk and smothered them. executed felons each year to use at the time).
RESURRECTION MEN
349
and dissection, but it faced initial
The number opposition from those who were
of corpses against a relaxation of the law.
supplied by Finally, in 1832 an Anatomy Act
resurrection was passed that allowed licensed
men in 1809–10, from evidence anatomy lecturers to use unclaimed
given to the House of Commons dead bodies from workhouses,
Select Committee in 1828. hospitals, and prisons. As medical
schools no longer needed illegally
picks lurking in the shadows were thousand people. However, as Burke and William Hare sold 16 acquired corpses, demand dropped
not in fact gravediggers, but “body long as the authorities turned a corpses to the Edinburgh-based and the price that the resurrection
snatchers.” In desperation, some blind eye, little was done about physician Robert Knox. It turned men could charge for their services
local communities funded graveyard them. In England, the removal of out, after the body of a dead plummeted; within a few years,
patrols, and wealthy families paid a corpse was not officially an offense woman was found under a bed at they had disappeared entirely.
for security measures, such as the until 1788, when courts ruled that their address, that they had never
mortsafes (iron cages) or the “Patent “common decency” required the dug up any corpses. Instead, they
Coffin,” invented in 1818, with practice to stop; even then, there had murdered their victims and
its metal-sprung catches that were was no specific statute against it. sold the fresh corpses to Dr. Knox.
designed to thwart tools used by After a notorious trial, Burke was
the resurrectionists to open coffins. Motive for murder hanged on January 28, 1829, and
The resurrectionists were never Such was the demand for corpses, his body was publicly dissected
popular—a riot in Greenwich in some resurrectionists took things the following day. Hare escaped
1832 against the activities of the even further. Between 1827 and by giving evidence against his
West Kent gang involved several 1828 Irish immigrants William former partner.
119
SCIENCE TAKES CHARGE 1800 –1900
Miasma Theory
Bad smells, which are associated with rot and decay,
have long been linked with illness. The miasma theory,
believed since ancient times, held that diseases were
caused and spread by a mix of foul-smelling vapors,
gases, and possibly tiny particles present within them.
The notion that poisonous air was the cause of illness grew from
observations that disease was more common in crowded areas
and in places where unsanitary conditions such as rot, mold, dirty
water, excrement, and putrid odors abounded. In the medieval
period, as towns and cities grew, outbreaks of diseases such as
plague, tuberculosis, cholera, and malaria (from the Italian for
bad air, “mala aria”) increased with them.
By the 18th century, with the discovery of many previously
unseen microscopic menaces, the miasma theory was redefined.
It was believed that poisonous vapors and tiny particles from
decomposing matter, too small for microscopes but identified by
their offensive smell, were released into the air, and made their
way into the body and caused disease. Although the work of
John Snow during the London cholera outbreaks (see pp.122–23)
pointed to contaminated water as the disease’s source, rather
than bad air, his findings were dismissed at the time as the ideas
of the miasma theory prevailed. It was not until the 1870s and
the work of Robert Koch and others, that miasma theory was
finally replaced with the germ theory of disease (see pp.146–47).
Yet, despite their inaccurate basis, anti-miasma public health
measures, such as clean drinking water and sanitation, had been
beneficial as they had helped not only remove the smells but also
the germ-causing microbes.
◁ Poisonous air
This mid-19th century cartoon by British illustrator Robert
Seymour, titled Cholera Tramples the Victor and the Vanquished
Both, shows a ghostlike figure spreading cholera across
the battlefield.
121
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
Cholera
One of the most virulent diseases ever known, cholera has killed millions of
people and had a huge social impact around the world. The study of microbiology
during the 19th century contributed to the understanding and control of this
disease but, without safe water available to all, outbreaks continue to occur.
122
CHOLERA
Developing treatment
The recurring epidemics of the
19th century made the need for
effective treatment increasingly
pressing. In the 1830s physicians
began to realize that dehydration
was the real cause of death in
cholera patients. This led to
new experiments with fluid
replacement therapies, involving
intravenous injections of water
and salt. Improvements in the
salt concentrations, the amount
of fluid given, and the rate of
delivery gradually reduced
fatalities, but it took until the
mid-20th century for major
advances to be made.
In 1958 US Navy medical
researcher Raymond Watten
invented a cot with a hole in the
middle, allowing for an accurate
measurement of excrement, so
that rehydration fluids could be
given in the right amount, and of
the same chemical composition as
was being lost. The “Watten cot”
3–5 recordedNumber
MILLION of
cholera cases
every year, killing more than
100,000, according to the World
Health Organization (WHO).
123
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
John Snow
the bottle helps
ether to vaporize
A
quiet, modest, hard-working In 1836 he moved to London, ▷ Ether inhaler
English physician, John where he acquired membership of This device was invented by Snow in 1847, just
Snow brought about vast prestigious medical colleges, became one year after the first demonstrations of ether
Mouthpiece
changes in our understanding of president of the Westminster in the US. The temperature of the water bath,
how infectious diseases spread, Medical Society, and in 1849 top right, could be altered to adjust the dose.
the need for public health and became a founder member of the
sanitation, and the significance of Epidemiological Society of London,
epidemiology (see pp.126–27) as which aimed to examine the origin, surgery. Snow read avidly on the in Killingworth colliery in northern
a specialist area of study. However, propagation, mitigation, and subject of anesthetics and began England. In 1849 he witnessed more
Snow’s reasoning, which ultimately prevention of epidemic diseases. to devise his own equipment. He cases and began to investigate the
led to these advances, was rejected tested new gases—especially cause and spread of the disease.
at the time and he did not live to see Ether and anesthetics chloroform—on animals and, to Since its major early symptoms
his work accepted, dying at the early During the 1840s Snow developed his detriment, himself (modern- were vomiting and diarrhea, he
age of 45 years old. an interest in anesthesia (see day scientists speculate that his suspected that it was a digestive
After an education in which pp.128–31). The medical use self-experimentation may have problem and probably transmitted
he showed an aptitude for of chemicals to dull sensation exacerbated preexisting health by eating or drinking contaminated
mathematics and statistics, and pain and to induce problems and led to his early death). matter. However, the miasma theory
Snow gained early unconsciousness was a He wrote articles on the subject (see pp.120–21) was also prevalent
medical experience in popular area of research and also created the profession of at the time, and many experts
Newcastle upon Tyne. at the time. In 1846 there “specialist anesthetist.” The Royal regarded cholera as a blood-based
was news from Boston, Medical and Chirurgical Society (a sickness. In the first edition of
Massachusetts, that ether forerunner of the Royal Society of his pamphlet, On the Mode of
could be safely used Medicine) described him as “more Communication of Cholera (1849),
as an anesthetic in extensively conversant with its Snow wrote: “It is quite true that
dentistry and general operation, and more successful in a great deal of argument has been
administering it, than any living employed on the opposite side, and
person.” Snow gained much that many eminent men hold an
◁ Death’s recognition and was instrumental opposite opinion.”
dispensary in making anesthetics safer, more In 1854 Snow applied an
A cartoon from 1866 effective, and more widely accepted. epidemiological approach when he
shows how Snow’s studied a cholera epidemic centered
deductions about the Studying cholera on Broad Street in Soho, London. He
spread of cholera by Snow’s first encounter with the visited houses, interviewed residents,
water were accepted bacterial infection of cholera and delved into plans of the area’s
a decade later. (see pp.122–23) was in 1831–32 water supplies and sewage disposal.
124
JOHN SNOW
125
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
Epidemiology and
Public Health
Until the 19th century, little progress was made in containing epidemics in the
rapidly growing cities. However, the breakthrough came when medical scientists
began to discover the causative agents of diseases, leading to effective control
and prevention strategies and considerable advancements in public health.
I
n the 4th century BCE, Greek faster than the means of preventing The cholera epidemic that struck △ “Typhoid Mary”
physician Hippocrates tried to the diseases it scrutinized. In 1662 London in 1831–32 led to calls In the early 20th century, it became clear that
explain diseases in terms of British statistician John Graunt for reform. In 1842 British lawyer people without symptoms could still carry the
external and environmental factors analyzed mortality records in Edwin Chadwick compiled a report typhoid pathogen and transmit the disease.
rather than divine displeasure, as England, differentiating deaths on sanitary conditions in cities. Mary Mallon, a cook, infected more than 50
had always been the case. However, by the age and sex of the deceased, This prompted the establishment of people in several households where she worked.
doctors were unable to understand, the time of year, and the location. a Royal Commission on the Health
let alone control, the spread of Similar studies by Louis Villermé in of Towns and also local boards of
infectious diseases. Nonetheless, France in 1826 concluded that the health, which were responsible for efforts turned to the use of vaccines
during the Black poor had higher enforcing sanitary and hygiene (or in some cases drug treatments)
30.6
Death in Italy in the PER THOUSAND The rates of mortality regulations in their districts. Public for fatal diseases. Britain began the
14th century, death rate in Paris’s than their middle- Health Acts gave these bodies first mass vaccination program—for
the introduction poorest districts in 1826. and upper-class greater powers, starting in 1848, smallpox (see pp.100–01)—in
19.1
of quarantine and PER THOUSAND The counterparts. The when they were given a remit to 1853, which extended worldwide
isolation hospitals death rate in Paris’s “miasma theory” inspect lodging houses and provide over following decades, eventually
(see pp.68–69) richest districts the same year. (see pp.120–21), sewers. Clean water had become leading to the disease’s global
showed an which was popular a concern after British physician eradication in 1977. Other similar
awareness that reducing contact in the 19th century, maintained John Snow’s discovery of the programs for polio, typhoid,
with infected persons was the most that bad vapors in the air caused by waterborne nature of cholera mumps, and measles gradually led
obvious way to contain the disease. filth were the primary agents of (see p.122). In 1858 the British to these once-common, often fatal,
disease, and efforts were made to parliament gave £3 million to the infections becoming rarities.
Supporting sanitation clean up cities that were growing Metropolitan Board of Works to
The science of epidemiology—the uncontrollably as a result of the build new sewers for London; when Noncommunicable diseases
study of disease patterns, causes, Industrial Revolution, which drew completed in 1870, these finally As epidemics of infectious diseases
and epidemics—at first progressed workers from rural to urban areas. put an end to the cholera epidemics became rarer in industrialized
of the previous four decades. countries after World War II, global
BRITISH PHYSICIAN 1877–1967
public health efforts turned to
Mass vaccination programs noncommunicable diseases—for
JANET LANE-CLAYPON The discovery that diseases were example, cancer and diabetes—and
transmitted by bacteria and viruses to those, like malaria, whose main
The first woman to receive a research (see pp.166–67) meant that, in the impact was felt by poorer countries.
scholarship from the British Medical late 19th century, public health Studies in the early 1950s linked
Council, physician Janet Lane-Claypon
pioneered two research methods that
are key to the field of epidemiology.
She used cohort studies to compare
“ The primary and most important
weight gain between one group of
children who were breast-fed and
measures… are drainage, the removal
another group who were bottle-fed of all refuse from habitations, streets
milk. In 1923 she used a case-control
study to conclude that women who and roads, and the improvement of
married earlier, had more children,
and breast-fed them were less likely the supplies of water.”
to develop breast cancer. EDWIN CHADWICK, BRITISH LAWYER, FROM THE SANITARY CONDITION OF THE LABOURING
POPULATION OF GREAT BRITAIN, 1850
126
E P I D E M I O L O G Y A N D P U B L I C H E A LT H
127
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
Anesthetics
Since antiquity surgeons have looked for ways to dull the pain experienced by their patients
during an operation. In 1846 American dentist William Morton finally came up with an effective
solution by using gas to anesthetize a patient, and the era of modern pain-free surgery began.
I
n ancient times surgery was not Nitrous oxide ▷ Mandrake
only dangerous but also very A more promising avenue for pain The root of the mandrake
painful, although surgeons tried relief during surgery proved to be plant contains hallucinogenic
many methods of pain relief. Hemp the inhalation of gases and vapours. and narcotic compounds and
was used as an anesthetic in China In 1799 British chemist Humphry was used in the medieval
in the 2nd century CE, while in the Davy observed the intoxicating period as an anesthetic,
medieval period Arab doctors soaked effect of nitrous oxide and suggested sometimes mixed with
“sleep sponges” in aromatics and that “it may be used with advantage opium. In too large a dose,
soporifics, such as mandragora during surgical operations”. He did it could cause delirium
and even death.
and opium. Extreme not pursue this idea,
80
compression of the PER CENT The however, and nitrous
nerves near the part approximate rate oxide, often called
of the body being of death after operations “laughing gas”, was was pain free.
operated on using before the 19th century. for decades taken However, in 1845
screw-clamps was mainly at parties. a demonstration
tried in the 18th century, but this The real advances came from by Wells in Boston
often caused the patient as much dentists in the US. In the 1840s failed, since the
pain as the operation itself. More dentist Horace Wells experimented patient experienced
effectively, in the 1770s German with administering nitrous oxide pain. This operation
physician Anton Mesmer pioneered through a wooden tube attached was performed on
mesmerism (see p.160)—a form to an animal bladder. He even had William Morton—a
of hypnosis that could induce a one of his own teeth extracted former dental partner
trance in patients and reduce their under the influence of nitrous of Wells—and Morton
sensitivity to pain. oxide to prove that the procedure resolved to try a
different approach.
128
ANESTHETICS
molar—was carried out, and the By January 1847 anesthesia gas—chloroform—was pioneered easing pain during childbirth after
second—an amputation—was reached France, and six months by obstetrician James Young pioneer anesthetist John Snow
performed just two days later. The later an operation was carried out Simpson, Professor of Midwifery gave Queen Victoria chloroform
amputation was so successful in Australia. However, ether fell in Edinburgh, Scotland, who first for her last two births (pp.124–25).
that the patient asked when the out of fashion because it was slow used it in 1847. It was faster-acting
operation was going to begin, after to take effect and often induced and gentler than ether, and in the The road ahead
his leg had been sawn off. vomiting in the patient. A new 1850s became a popular method of Within a year of Morton’s first
effective anesthetic operation,
surgery had been revolutionized.
Operations could be longer, and
Hanaoka Seishu surgeons could work more slowly
Japanese physician Hanaoka Seishu and carefully without fear of their
devised an anesthetic drink made from patients dying from shock. Through
a variety of herbs, including angelica. In the second half of the 19th century
1804 he used it as a general anesthetic anesthesia continued to undergo
during a mastectomy operation.
many refinements. As the gases
improved, better masks and pumps
were devised to administer them
more effectively. Local anesthetics
appeared in 1884—the first one to
be used was cocaine, used as eye
drops in optical surgery. Intravenous
anesthetics, which acted far more
swiftly than those administered
through inhalation, were first used
in 1874, and spinal anesthesia was
introduced in the 1890s.
The remarkable developments
that had occurred in anesthesia
in the 19th century transformed
surgery, and they paved the way
for more complex operations in
the 20th and 21st centuries, most
notably those on internal organs.
△ Chloroform apparatus
In 1862 English doctor Joseph Thomas
Clover devised an apparatus, shown here,
to deliver chloroform in accurate and measured
doses, overcoming the earlier problem of
patients dying from an overdose.
129
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
4 19TH-CENTURY
REPLICA OF MORTON
ETHER INHALER
Seed capsule
2 CHLOROFORM INHALER (1848) 3 HEWITT DROP BOTTLE (1886) 5 MINNITT GAS-AIR ANALGESIA APPARATUS (1950)
6 ANESTHETIC
Early Anesthetics
FACE MASK (19TH
CENTURY)
Gauze
mask
cover
The administration of anesthesia (see pp.128–29) at first required
complex apparatus to create, mix, store, and deliver the gas. Over
time instruments became more compact and manageable.
7 COMBINED-GAS
APPARATUS
1 Poppy seed capsule The seeds of the opium poppy over a wire frame, with a sponge soaked in ether that
have a sedative effect and were used in ancient times to sat over the patient’s nose and mouth. 7 Combined-
provide pain relief. 2 Chloroform inhaler Invented by gas apparatus This had a large cylinder from which
John Snow, this inhaler had two tubes. Chloroform was chloroform or ether was passed to the smaller portable Cylinder
pumped in through one tube and breathed out of the brass cylinder. A tube connected the smaller cylinder to with
chloroform
other. 3 Hewitt drop bottle This bottle was used to the patient’s face mask. 8 Hypodermic syringe This
administer drops of chloroform or ether at a controlled allowed the easy intravenous injection of drugs. 9 Boyle’s
rate. 4 Morton ether inhaler This inhaler was first used apparatus The Boyle bottle allowed anesthetists to control
by William Morton in 1846. Ether was passed through the the vaporization of gas from a liquid to create a safe
tap, soaked by the sponge, and released through a rubber mixture of gases. 10 Clayfield’s mercurial holder This
tube and mask. 5 Minnitt gas-air analgesia device measured the amount of nitrous oxide inhaled by
apparatus This gas-air machine was designed to produce a patient. 11 Basket Boyle anesthesia machine This
a mixture of nitrous oxide and air to provide pain relief machine allowed a continuous flow of anesthetic gases.
for women in labor. 6 Anesthetic face mask This 12 Nitrous oxide cylinders These were commonly used
Cylinder
19th-century face mask consists of a gauze cloth stretched in dentistry from the 1850s. with ether
130
E A R LY A N E S T H E T I C S
Ether
vaporizer
8 HYPODERMIC SYRINGE (20TH CENTURY)
Patient circuit
9 BOYLE’S through
APPARATUS (1930) which gas is
administered
Gas
tubing
10 CLAYFIELD’S
MERCURIAL
HOLDER
(20TH-CENTURY
REPLICA)
Movement
of weights
indicate
level of gas
remaining
in the jar
above the
mercury
12 NITROUS OXIDE
Connector
CYLINDERS (20TH CENTURY) for mask
131
SCIENCE TAKES CHARGE 1800 –1900
Dentistry
Advances in dental technology have dramatically
improved oral health. Where once complete extraction
was the only solution for widespread tooth decay, now
dental patients are far more likely to retain most, if not
all, of their own teeth.
▷ Elecro-anesthesia
From the 1840s electricity was tried as a dental anesthetic, especially
in France, as shown in this 1870s dental school in Paris. Results were
disappointing and injectable anesthesia eventually took over.
132
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
M
odern medical specialties One of the first texts on women’s physician and
relating to women’s health and childbirth was Gynaikeia apothecary
health, childbirth, and (Gynecology), written by the Eucharius
children include gynecology, for 1st-century CE Greek physician Rösslin helped
dealing with female reproductive Soranus of Ephesus. The first disseminate
health; midwifery, for health care major Chinese work on obstetrics medical
during uncomplicated pregnancy and gynaecology was Jing Xiao knowledge
and birth; obstetrics, for more Chan Bao (Treasured Knowledge of with his 1513
medically involved pregnancy and Obstetrics) published c.850 by the publication
birth; and pediatrics, for infants Chinese physician Zan Yin. It Der Schwangeren
and children through to puberty. covers treatments from traditional Frauen und Hebammen Rosengarten △ Cesarean operation in Uganda
However, such specialties have Chinese medicine (see pp.26–27), (The Rose Garden for Pregnant The original purpose of a cesarean section was
not always been in existence. and herbal remedies for pregnancy- Women and Midwives). to save a baby when the mother would probably
related conditions from morning In 1609 the practical and die. However, medical advances in the 19th
Ancient wisdom sickness to miscarriage. progressive midwife to French century, such as anesthesia and antiseptics,
For millennia, pregnancy and birth Cesarean section—the delivery royalty, Louyse Bourgeois, became improved the mothers’ chances of survival too.
were private matters involving of a baby through an incision—is the first woman to write a medical
female family members and close one of the oldest known surgical treatise on obstetrics, Observations
friends, who were usually non- procedures, with descriptions of diverses sur la stérilité, perte de fruits,
Japanese
medical. In ancient Mesopotamia this surgery dating back 3,000 fécondité, accouchements et maladies ivory doll
and Egypt, female birth attendants years in China and 2,200 years des femmes et enfants nouveaux-nés
helped the mother give birth, and in India. The term is said to be (Various Observations on the Sterility,
specialists—the midwives of their derived from the name of Roman Fruit loss, Fertility, Childbirth and
day—were described in the Ebers emperor Julius Caesar, allegedly Diseases of Women and Newborn
papyrus (see pp.20–21). born by this method in 100 BCE, Infants). But the male takeover
but the more likely origin is of the traditionally female
caedare, Latin for “to cut.” practice of midwifery
In 1598 French royal surgeon continued, giving rise to
Jacques Guillemeau introduced the often derogatory term
the term “section” rather accoucheur, or man-midwife.
than operation in his book on
midwifery. German gynecologist Japanese
Ferdinand Kehrer is credited with ivory doll
successfully performing the first
modern cesarean section in
Meckesheim village, Germany,
in 1881. This involved making an
incision across the lower part of
the mother’s uterus to deliver the
baby, while minimizing blood loss.
134
PREGNANCY AND CHILDBIRTH
In the first half of the 1700s was acknowledged and formalized AMERICAN MIDWIFE AND AUTHOR (1940– )
obstetric forceps were introduced the world over. In 1861 the
by Scottish obstetrician William Professional Midwifery Education INA MAY GASKIN
Smellie, who also published Foundation was set up in the
A Treatise on the Theory and Practice of Netherlands. In Britain, meanwhile, Born in Iowa, Gaskin published
Midwifery in the 1750s. The vaginal women’s rights campaigner Louisa Spiritual Midwifery in 1977. In this
speculum, known since Roman Hubbard founded what became the book, she explained pregnancy,
times (see pp.42–43), also came into Midwives’ Institute in 1881. In 1902 delivery, and infant feeding from a
wider use. By this time, more births the Midwives Act in England and natural viewpoint, emphasizing the
were happening in hospitals than Wales established midwifery as a mental, intellectual, emotional, and
homes, reinforcing the power of specialized profession with training traditional aspects of childbirth, as
obstetricians over midwives. This and certification. The UK Midwives’ well as the medically mediated
trend had its own problems, such Institute became the Royal College physical processes. She supported
as childbed fever (see pp.138–39)— of Midwives in 1947, the French the natural childbirth movement,
caused by lack of hygiene, leading College of Midwives was set up in advocating minimal intervention,
to infections on the wards—and the 1949, and the American College of active roles for family and friends,
new male “experts” often lacked the Nurse-Midwifery in 1955. By the and home births as the norm. Her
empathy, experience, and traditional mid-20th century many other Guide to Childbirth (2003) has
knowledge of female midwives. nations had established similar become a bestseller.
recognitions and qualifications.
Midwives recognized
Following the work of Florence
Nightingale and other pioneers “ Our bodies must work pretty well, or there
in nursing (see pp.142–43),
midwives, too, began receiving wouldn’t be so many humans on the planet.”
recognition. Gradually, midwifery INA MAY GASKIN, AMERICAN MIDWIFE AND WRITER, INA MAY’S GUIDE TO CHILDBIRTH, 2003
▽ Diagnostic dolls
Cultural taboos, or perhaps
simple modesty, often prevented
male physicians from examining
a woman’s genital area, so
the female patient would explain
her predicament using a diagnostic
doll. These examples of such dolls
are from China and Japan in the
18th and 19th centuries.
Shoes worn to
meet demands
of traditional
modesty, which
insisted that Ivory
women’s feet Chinese doll
be covered at with feet
all times covered
135
SCIENCE TAKES CHARGE 1800 –1900
Midwives
Sculptures and papyri from ancient Egypt record specially
trained women attending mothers during pregnancy and
birth, and in Islamic medicine the midwife was a highly
regarded specialist. However, this status did not last, and
not until the 19th century did female midwives regain
their standing within the medical community.
136
△ Handwashing in maternity wards
Childbed Fever
In 1847 Ignaz Semmelweis noted that after he
advocated regular handwashing, death rates at
the First Clinic in the Vienna General Hospital
fell from 12–13 percent to 1–2 percent.
In the 1840s simple observations and actions by Ignaz Semmelweis dramatically reduced
occurrences of childbed (or puerperal) fever. However, his work was initially ridiculed and
its importance was only recognized years later, once the germ theory was widely accepted.
C
hildbed fever has long been epidemic proportions—but only The only significant difference that and that the course of his infection
a dreaded infection for in one of its two maternity clinics. he discovered was the visiting staff: was very similar to that of childbed
new mothers and infants, Semmelweis was puzzled by the the First Clinic was a training center fever. From this, Semmelweis
but the first major reduction in difference in infection and death for apprentice physicians, while the inferred that Kolletschka had died
the death rate did not come until rates between the First and Second Second Clinic was for the teaching from the same disease and it was
Ignaz Semmelweis implemented Clinic: it was well known that of student midwives only. likely that the wound made by the
changes on a maternity ward in there were many more maternal contaminated knife had caused his
Vienna, Austria. fatalities in the First Clinic, but Deadly particles colleague’s death.
After completing his medical no one knew why. Methodically, In March 1847 Semmelweis was While there seemed to be a link,
training in Vienna, Semmelweis Semmelweis eliminated possible saddened by the untimely death of the nature of the contamination
was appointed assistant to the factors, such as food and drink, a colleague and professor of forensic remained a mystery, because the
professor at the maternity unit temperature, humidity, and other medicine, Jakob Kolletschka. The existence of germs was not yet
in the Vienna General Hospital. environmental conditions; he postmortem showed that he had proven. Semmelweis suggested that
At the time, new mothers were noted the age of patients, their suffered an accidental knife wound some kind of infective matter, which
dying from childbed fever in backgrounds, and even religion. during an autopsy demonstration, he named “cadaverous particles,”
138
CHILDBED FEVER
IGNAZ SEMMELWEIS
Born in Budapest, Hungary, he introduced the same hand-
Semmelweis received his washing routine that he had
doctoral degree in medicine introduced in Vienna. In
from the University of 1855 he was appointed
Vienna, Austria, in 1844. professor at the University
He was then appointed of Pest, Hungary, and he
to the Vienna General published his principal work
Hospital’s obstetrics clinic, on childbed fever in 1861
where he became involved but generally it was not well
with the problem of childbed received. Semmelweis’s behaviour
fever. After being passed over for became increasingly erratic after he
promotion, in 1850 he returned to developed a kind of dementia, and
Budapest and joined the Szent Rokus he died only two weeks after being
Hospital as Head of Obstetrics, where admitted to an asylum in Vienna.
was to blame for both Kolletschka’s (calcium hypochlorite) for all his that the “cadaverous particles” Childbed Fever), but his work was
death and childbed fever. He argued staff. The results were sudden and existed and his theory did not fit in generally rejected. Semmelweis
that surgeons and medical students very startling. Death rates from with long-established beliefs, such died in obscurity in Vienna in 1865.
often came from autopsies and childbed fever fell drastically in the as the concept of the four humors The same year, pioneering British
corpse dissections directly to the First Clinic to about the same level (see pp.34–35) or the miasma surgeon Joseph Lister began using
maternity clinics (in the case of as those in the Second Clinic, and theory (see pp.120–21). Also, the phenol antiseptics (see pp.154–55)
Vienna, the First Clinic), and that they continued to fall through the surgeons he accused of carrying the after reading Louis Pasteur’s
they carried the particles on their following year. contamination were important men theory—partly derived from an
hands and equipment, which then Semmelweis regarded his views as who refused to accept that they interest in childbed fever—that
infected the mothers. proven and vitally important. Yet he were to blame. In addition, political unseen germs cause disease
was met with enormous criticism and religious factors came into play, (see pp.146–47). It was only
Handwashing routine and inaction by the medical given that Semmelweis was a after this advance that the work
Semmelweis was convinced that establishment who, Jewish Hungarian living in Austria. of Semmelweis came to be fully
the solution to the problem of typically, were In 1861 Semmelweis published a appreciated. Today, he is praised for
cross-contamination was thorough sceptical of book about his findings titled Die his great work on childbed fever and
handwashing. Believing that soap the new and Ätiologie, der Begriff und die improving hygiene in hospitals, as
was not sufficently powerful, he untested ideas. Prophylaxis des Kindbettfiebers well as his research into antiseptics,
introduced a routine of regular Semmelweis (The Etiology, Concept, how contagious diseases spread, and
handwashing using chlorina liquida could not prove and Prophylaxis of how microbial germs cause disease.
139
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
Women in
Medicine
Over the millennia and around the world, the medical
profession has often reflected wider society. As a result,
medical practitioners, especially at senior levels, have been
overwhelmingly male. A degree of equality has only been
achieved during the past century, but not yet in all nations.
W
omen have always played 2,300 years ago, however nothing
important roles as more is known of her life. Another
caregivers, nurses (see ancient Greek woman, Agnodice,
pp.142–43), and midwives (see is said to have practiced medicine
pp.136–37), but until the 19th while disguised as a man.
century, only a few rose to higher
ranks in the medical profession. Early influencers
One of the earliest known female There are records of female healers
physicians was ancient Egypt’s in the medieval Islamic world
Merit-Ptah, around 4,700 years from the 8th century, although, in
ago. Not much is known about her, common with many other cultures
except her tomb inscription, which through history, they only treated
reads “chief physician.” At Heliopolis other women. Female surgeons are
in Egypt, female students attended depicted in the illustrated manual
medical school around 3,500 years Cerrahiyyetu’l-Haniyye (Imperial
ago, but little detail is known. Surgery) by male Turkish surgeon
Women’s involvement in medicine Sabuncuoglu Serefeddin. Christian
in ancient Greece was also limited. Europe was far less enlightened and
Greek physician Metrodora is only a few female physicians are and physician. Her works from △ Interview panel
recognized as the first female writer known from the period. Hildegard the 1150s include Liber Simplicis Despite gaining a medical license in England,
on medicine. She wrote On the of Bingen (see pp.56–59) was a Medicinae (Book of Simple Medicine), Elizabeth Garrett Anderson was forbidden from
Diseases and Cures of Women around prominent abbess, poet, musician, later called Physica, which describes working in hospitals. She traveled to Paris to
hundreds of treatments made gain a French medical degree and worked there.
from minerals, herbs, and animal This illustration shows her being interviewed by
parts. Trotula de Ruggiero, a more the Faculty of Medicine of the Sorbonne, Paris.
shadowy personality who, if real,
lived during the latter half of the
11th century, is associated with subjects such as feminine hygiene,
several medical publications. fertility, conception, pregnancy,
“The Trotula” became the collective and childbirth.
name for several works, including
Diseases of Women, Treatments for Female medical pioneers
Women, and Women’s Cosmetics. The The acceptance of women into the
writings were refreshingly practical, medical profession began to happen
and covered a wide range of in the 18th century. In 1732 Italian
Laura Bassi was named professor
of anatomy at the University of
◁ Hildegard of Bingen Bologna, before continuing her
This altarpiece depicts the arrival of Hildegard career in physics. In Prussia,
with her family at the Benedictine Abbey of Dorothea Erxleben, with special
Disibodenberg, in about 1112. Hildegard wrote permission from King Frederick the
a number of scientific and medical works, and Great, graduated in medicine from
founded several monasteries. In 2012 she was the University of Halle in 1754.
named “Doctor of the Church” by the Pope. But these were still isolated cases.
140
WOMEN IN MEDICINE
BRITISH–AMERICAN
PHYSICIAN (1821–1910)
ELIZABETH BLACKWELL
49
Medicine for although an
ELIZABETH BLACKWELL, BRITISH–AMERICAN PHYSICIAN Women in 1886. PERCENT of all underlying
In 1859 Garrett general practitioners prejudice still
In 1849 Elizabeth Blackwell became Anderson had in the UK in 2015 remained for
the first American medical graduate, met and been were women. many decades.
and went on to have a long and inspired by Women were
distinguished career, pioneering Blackwell. She became also gaining access to the medical
women’s roles in medicine (see a nurse at London’s Middlesex profession in other nations, especially
panel, right). In England, she Hospital, and in 1862 joined the in Europe. Madeleine Brès was the
helped establish the London Society of Apothecaries to gain a first Frenchwoman to receive a
School of Medicine for Women license for medical practice—a first medical license in 1875. The trend
in 1874 with British physicians for a British woman. She opened spread and, in Japan, physician’s
Sophia Jex-Blake and a private practice, then St. and women’s rights campaigner
Mary’s Dispensary for Women Yoshioka Yayoi founded the Tokyo
and Children, and in 1872 the Women’s Medical University in
▷ Agnodice New Hospital for Women 1900. By this time the women’s
Around the 4th century BCE, in ancient (later renamed the Elizabeth rights and suffragette movements
Greece, Agnodice disguised herself Garrett Anderson Hospital). were also gaining momentum,
as a man to help women during Continuing her pioneering and from about 1914 feminist
pregnancy and childbirth. At this time, work, she became the first campaigner Margaret Sanger (see
women were banned from working female member of the British pp.226–27) also fought for women
as doctors and could be executed. Medical Association, and carried as patients and health services users.
141
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
Nursing
Although nursing is one of the oldest medical occupations, it has not always had a good reputation.
It took the influence of one extraordinary woman—Florence Nightingale—to transform nurses from
uneducated “ward maids” to the academically qualified, skilled professionals that we know today.
I
n Europe during the medieval gained a reputation for Nursing was on the
period hospitals were usually ignorance, drunkenness, threshold of reform.
attached to religious institutions, and promiscuity. In 1860 Nightingale
such as monasteries and convents, The push for nursing realized her dream of
with patients nursed by monks and reform in Europe began establishing a training
nuns. However, in the 16th century in the 19th century, school for nurses at
many hospitals were shut down as largely instigated by the St. Thomas’ Hospital
a result of Protestant reformations. Christian community. in London; it became
With the growth of industrialization Many visitors to Germany a blueprint that was
in the 18th century, new secular were impressed by the copied throughout
hospitals were founded. During this work of pastor Theodor the British Empire
period, sometimes termed the Fliedner, who opened a and the US. Nursing
“Dark Ages of nursing,” the quality hospital on the Rhine in associations were
of care was frequently dire—nurses 1836 (see pp.106–07). established across the
tended to be recovering patients, or Nurses were given simple world, which brought
hired men and women who could clinical instruction and in standardization
not read or write and often drawn studied pharmacy—the of training and finally recognized
from the poorhouses. Nurses practice of preparing and △ Wartime nursing recruitment poster nursing as a profession. In 1863
dispensing drugs. The nursing Thousands of nurses flocked to the Western the International Red Cross (see
course was quite advanced for its Front in the early months of World War I as a pp.266–67) was set up to offer
BRITISH NURSE (1820–1910)
time, and Fliedner’s most famous result of recruitment posters such as this. The neutrality and protection to those
FLORENCE NIGHTINGALE student—Florence Nightingale— first trained nurses reached France just eight wounded in armed conflict, and it
spent three months at his hospital days after the war on the Western Front began. endorsed the training of nursing.
Born into a wealthy English family, in 1851. By the mid-19th century,
Florence Nightingale reformed the the concept of women being trained A modern profession
profession of nursing. A woman to nurse was well established. English General Hospitals in Until World War I the Nightingale
of very strong will, her tireless Turkey”—a powerful position that legacy prevailed. Nurses were seen
work caring for soldiers during the Nurses go to war gathered huge attention. as the guardians of hygiene, the
Crimean War established her as The advent of the Crimean War Nightingale enforced a strict code dispensers of compassion, and the
“The Lady with the Lamp.” Her (1853–56) transformed nursing. of discipline, discouraging nurses center of calm amid the chaos of
reforms led to a dramatic reduction Cholera spread rapidly in the from fraternizing with the patients the hospital. However, the nurses’
in deaths. She founded a training British army camp, and surgeons and doctors, as well as promoting actual duties were rather vaguely
school for nurses at St. Thomas’ had to perform major operations hygiene, sobriety at all times, and described. During World War I the
Hospital, London, in 1860, and and amputations without light, good manners. Nightingale and her
90,000
helped promote nursing as a anesthetics, or even bandages. small band of nurses were a great The number of
respectable career for women. When the British press reported inspiration to women, showing volunteers with
that the wounded and the sick that war was no longer a male the Red Cross’s Voluntary Aid
were not being properly cared for, preserve. When the American Civil Detachments during World War I.
the government responded by War broke out in 1861, the Sanitary
sending female nurses abroad to Commission—a forerunner to the boundaries between medicine and
tend to the casualties. Florence Red Cross—was founded. Armed nursing broke down. As doctors
Nightingale was appointed as the with the knowledge of good hygiene struggled to cope with emergency
“Superintendent of the Female practices from the Crimean War, it surgery, trained nursing staff took
Nursing Establishment of the recruited a large number of nurses. on duties that would not normally
142
NURSING
fall to them, including triage (see of new wartime technology—for ▷ Modern nurses
p.256), the administration of saline example, learning how to use The role of nurses has
drips and intravenous injections, oxygen cylinders for soldiers with developed to occupy
and the dispensing of narcotic lungs filled with mustard gas, and an ever-wider range
drugs. The nursing staff were also applying sodium bicarbonate to of healthcare duties.
responsible for implementing many their blinded eyes. Modern nurses are not
of the new developments aimed at World Wars I and II emphasized merely caregivers—
combating infection and passing the growing need for fully trained, they have to display a
on their knowledge to volunteers well-educated nurses, and today high level of technical
competence and may
from the Red Cross’s Voluntary Aid many countries demand that nurses
also act as clinicians,
Detachments (VADs), which were have a university degree. From an
diagnosing illness and
set up to provide supplementary occupation of the poor and illiterate,
making decisions about
first aid and nursing to the medical nursing has evolved to become one
suitable treatments.
service in wartime. In addition, of the most important professions
nurses had to cope with the effects within the healthcare industry.
143
SCIENCE TAKES CHARGE 1800 –1900
Medical Publishing
In 1858 English anatomist Henry Gray wrote Anatomy:
Descriptive and Surgical, illustrated by his colleague
Henry Vandyke Carter. Gray died just three years later,
at the age of 34 years, but his name lives on in the best-
known educational and reference work in all of medicine.
145
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
Microbiology and
Germ Theory
Less than 200 years ago, the existence of the germs that are now known to cause
infections was unsuspected. The gradual discovery of these harmful microbes and
methods to combat them were among the greatest advances in all of medicine.
N
ature can generate life almost scientists and physicians began to Henle proposed: “The material
anywhere, minute plants infer that these could be responsible of contagions is not only an
sprouting and infinitesimal for the transmission of diseases. organic but a living one.” In 1847
animals appearing as if out of In 1668 Italian naturalist-physician Hungarian obstetrician Ignaz
the air. With no evidence to the Francesco Redi began investigating Semmelweis reasoned that △ The cause of anthrax
contrary, people assumed that living the supposedly spontaneous “cadaverous particles” caused Koch cultured and tested 20 generations of the
things could arise from nonliving appearance of maggots on dead childbed fever (see pp.138–39). rod-shaped anthrax bacterium (Bacillus anthracis)
matter—a concept known as meat. He carried out experiments In 1854 British physician John to prove that it caused the disease. He also noted
spontaneous generation. Another with old meat in jars—some open Snow suspected contagion during that the bacteria could survive tough environments
popular notion was miasma theory to the air, some covered with cloth, a cholera outbreak (see pp.122–23). by transforming into dormant spores, which would
(see pp.120–21), which stated and some stoppered. Redi noted The contagion, or germ, theory reactivate when conditions improved.
that noxious vapors and gases that maggots would develop only of disease—according to which
somehow penetrated the body if flies could land on the meat. transmissible living particles are
to produce diseases. After the A century later, Italian priest responsible for human diseases— Initially a colleague of Pasteur
invention of the microscope (see Lazzaro Spallanzani boiled meat was gaining ground, although but later a bitter rival, German
pp.92–93) in around 1600, these broth and sealed some samples miasma theory still prevailed. physician Robert Koch qualified
perceptions gradually began to in glass vessels while leaving with distinction in medicine at
change. This novel instrument others open. The sealed samples Isolating harmful microbes Göttingen University in 1866 and
showed for the very first time stayed uncontaminated, but the In 1862 French biologist Louis was inspired by his professor Jakob
that there were minute animals, others soon began to deteriorate. Pasteur (see pp.148–49) performed Henle to pursue microbiology.
or “animalcules,” everywhere, and The 19th century saw a steady pivotal experiments with boiled He set up a home laboratory in
stream of discoveries. In 1835, meat broth and glass “swan-neck” Wollstein (now Wolsztyn, Poland),
while studying a silkworm disease, flasks. He concluded that some where he began a series of studies
▽ Refuting spontaneous generation Italian entomologist Agostino kind of contagion led to the with far-reaching effects. Koch’s
Francesco Redi’s 1668 work Experiments on Bassi deduced that the condition development of molds in broths first subject was anthrax—a highly
the Generation of Insects showed that maggots occurred due to some kind of open to the air, but not in those infectious disease of herbivores.
hatched in old meat not through spontaneous “contagion” or “transmissible broths that were protected from He inoculated some mice with
generation but from eggs laid by visiting flies. particle” spread by contact or contamination. Despite protests samples from healthy, and some
However, the theory of spontaneous generation close proximity. In 1840 German from supporters of spontaneous with samples from diseased, farm
persisted for another two centuries. anatomist and histologist Jakob generation, Pasteur’s evidence animals. The former did not
boosted the notion of germ develop the disease, but the latter
theory—and that transmissible did. He then set about purifying
living particles might cause anthrax bacteria, growing them
human diseases. in a laboratory culture medium,
146
MICROBIOLOGY AND GERM THEORY
Louis Pasteur
“In the field of observation,
chance favors only
the prepared minds.”
LOUIS PASTEUR, ON APPOINTMENT AS DEAN OF SCIENCE FACULTY, LILLE UNIVERSITY, 1845
O
◁ Founder of microbiology ne of France’s greatest
Along with Robert Koch—at first his colleague scientists, Louis Pasteur made
but then great rival—Pasteur placed the study significant contributions to
of microbial life onto a scientific footing and almost every field he ventured into.
moved it into mainstream medical research. He developed the process of killing
germs using heat, now called
pasteurization; helped replace the
theory of spontaneous generation
with germ theory (see pp.146–47);
and aided the silk industry by
identifying a disease of silkworm
caterpillars. From the 1870s he
developed vaccinations for chicken
cholera, forms of animal anthrax,
and rabies in animals and humans
(see pp.168–69).
Breakthrough research
Pasteur’s first major contribution
to life sciences was to investigate
why alcoholic drinks sometimes
“spoil”(go bad or sour)—a costly
problem for the French beer and
wine industries. After exhaustive
microscopic studies he drew two
conclusions. First, fermentation
was not a simple chemical change,
as believed, but a living process
carried out by yeast microbes.
Second, souring was caused by
contamination with bacterial
microbes. The remedy he devised
in 1864 was to heat the drinks
briefly to 122–140°F (50–60°C),
to kill off disease-causing bacteria
without altering the beverage’s
aging process, taste, or appearance.
In the 1880s the process became
known as pasteurization—in his
honor. Medically it helped save
many lives, for example preventing
diseases such as tuberculosis, which
L O U I S PA S T E U R
149
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
Cell Theory
Before the 19th century no one had a clear notion of the basic building blocks of life. The
use of microscopes (see pp.92–93) allowed the development of cell theory—that living
organisms are composed of cells—which had enormous effects in many fields of medicine.
T
he invention of the the term “cell” because the angular skeletal rod (notochord) of existing ones—a process
microscope in the 1590s structures reminded him of the primitive fish. Schwann took he had observed in algae.
made it possible for the first cells, or living quarters, of monks. Schleiden’s theory a step further, As early as 1842 Swiss
time to observe animal and plant In 1682 Dutch polymath Antoni applying it to animals as well as botanist Karl von Nägeli had
matter at a level that had van Leeuwenhoek observed the plants, and defining the three identified small structures in the
previously been invisible to the nucleus of a cell in the red blood structural parts of a cell—the nucleus, which came to be called
naked eye. Plant cells were first corpuscles (RBCs) of a salmon. wall, nucleus, and cellulose, or chromosomes, and which contain
described by British polymath Some hundred years later, in 1800, fluid content. In 1839 Schwann the cell’s genetic material. By the
Robert Hooke in 1665. He coined French anatomist and physiologist published the paper Microscopic 1850s microscopes had become
Marie-François Investigations on powerful enough to allow scientists
G E R M A N B O TA N I S T
(1804–1881)
Bichat took
advantage of 37
TRILLION A 2013 estimate
of the number of cells in
the human body.
the Accordance in
the Structure and
to see cell division taking place,
and in 1879 German military
improvements in Growth of Animals physician Walther Flemming
MATTHIAS SCHLEIDEN the magnification and Plants, in observed chromosomes separating
levels of microscopes to catalog which he famously observed that, as the cell divided, in a process he
Educated in law at Heidelberg the structure of human skin, which “all living things are composed of named “mitosis.” Other components
University in Germany, Schleiden he compared to a woven fabric. cells and cell products.” of cells were also identified. These
found legal practice distasteful and However, it was not yet understood However, how cells are created included, in 1890, mitochondria—
became a botanist instead. He had that all life forms are composed and how growth occurs were not the cell’s “powerhouses,” which
already rejected the contemporary of these small structures, or that yet understood. Schleiden believed, play a role in processing sugars
botanical preoccupation with all cells are derived from other and Schwann accepted, that new and oxygen to produce energy,
classification—which he mockingly cells by cell division or cell-based cells were crystallized from the decribed by German pathologist
described as recognizing plants reproduction. Indeed, in the early fluid that lay between previously Richard Altmann.
“with the least possible bother”— 19th century it was thought that existing cells. This focus on the
in favor of examining samples with cells could spontaneously generate material outside the cell held back A basis for new advances
the microscope. His observations from nonorganic matter, or from cell biology for some years. The development of cell theory
led him to conclude that all plants decomposing living material. Finally in 1851 German botanist gave scientists a firm basis for
are composed of cells, which Hugo von Mohl proposed that new the understanding of heredity.
formed the basis of cell theory. Recognizing building blocks cells are formed by the division of In 1869 Swiss biochemist Friedrich
After a brief stint as a lecturer in In 1838 Matthias Schleiden,
Russian-ruled Dorpat (in Estonia), professor of botany at the University
he returned to Germany, where he of Jena, Germany, wrote the
was a private teacher. article “Contributions to Plant
Phytogenesis,” in which he used
previous scientific observations and
his own observations through a
microscope to deduce that all parts
of plants are composed of cells. He
explained his theory to his friend
German physiologist Theodor
Schwann, who had seen similar
cell-like structures in the internal
▷ Schwann’s drawings
Schwann’s 1839 publication included drawings
of different types of animal cells. Although they
varied widely in form, the presence in all of them
of a nucleus and an enclosing membrane, or cell
wall, convinced him that they were all versions
of the same basic cellular building block.
150
CELL THEORY
Centrosome,
containing Chromosomes
microtubules have replicated
and begin to
condense
Cell nucleus,
INTERPHASE
containing replicating
chromosomes Microtubules
move into a
spindle
formation
Original cell ▷ Cell division
forms two
separate cells
Cell mitosis is the process by which a cell EARLY PROPHASE
divides to create two identical daughter cells.
In this process the membrane of the nucleus
dissolves, the replicated chromosomes split Chromotids (newly copied
Nuclear chromosomes that are
membrane has into two sets and these are pulled to opposite
still joined in pairs)
formed around ends of the cell when the nuclear membranes
each set of re-form. Finally the cell itself splits to form
chromosomes Spindles
two new cells.
CYTOKINESIS
METAPHASE
TELOPHASE ANAPHASE
151
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
T
he period from the late 1700s including Italian anatomist Marco
to the early 1800s proved Aurelio and the Dutch surgeon
to be a watershed for the Nicolaes Tulp. Some physicians
science of pathology—the branch even published “autopsy reports,”
of medicine that focuses on the the most important of which was
examination of organs, tissues, and Italian anatomist Giovanni Batista
bodily fluids in order to diagnose Morgagni’s De Sedibus et Causis
disease. This emerging field thrived Morborum per Anatomen Indagatis
on autopsies (postmortems).
152
P AT H O L O G Y A N D M E D I C A L A U T O P S Y
▷ Postmortem instruments
A more rigorous scientific approach
to postmortems in the 19th century
required dedicated instruments.
This box includes a head clamp, bone
saw, chisels, scissors, and a mallet.
153
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
T
he fact that pus forms in to combat the problem: in the ▷ Sterilizing instruments
wounds when they become 4th century BCE, Hippocrates (see The autoclave, a closed pressure chamber for
infected and fester was well pp.36–37) recommended the use the sterilization of surgical instruments using
known to physicians. This “sepsis,” of wine and vinegar in wound high-pressure steam was invented by French
or putrefaction of flesh, was so dressings, as both are mild antiseptics microbiologist Charles Chamberland in 1879. It
difficult to treat that many doctors that he thought should prevent represented a major advance in aseptic surgery.
even came to regard it as a natural sepsis. Although it was successful
part of the healing process, in spite in some instances, it never worked
of the fact that so many of their with compound fractures. These Vienna, ordered a regime
patients died. Attempts were made injuries are especially susceptible of rigorous hand-washing
to infection since many shattered in chlorinated water and the
bone fragments are exposed to air, cleansing of surgical instruments
BRITISH SURGEON
(1827–1912) allowing germs access to the body. and dressings (see pp.138–39),
Progress did come in 1812 when which reduced infection rates.
JOSEPH LISTER French chemist Bernard Courtois However, the real cause of such
discovered iodine—a more potent infections was not fully understood Carlisle, UK, and asked for samples
antiseptic agent—while searching until the 1850s when Louis Pasteur of the acid. In August 1865 he
for a substitute for the saltpeter (see pp.148–49) showed that the applied it to the wound of an
used in making gunpowder. It was culprits were microorganisms 11-year-old boy with a compound
not widely adopted at the time as entering wounds, not just bad fracture of the leg during surgery.
its use was not backed by research. vapors. Joseph Lister, a young Although the acid caused mild
Edinburgh doctor, hypothesized flesh burns, the boy’s leg did not
Banishing filth that finding a way of preventing become infected. Over the next
The belief that “miasmas” (bad the microorganisms from entering year he used the acid on nine
vapors in the air, see pp.120–21) a wound might solve the problem. patients, seven of whom came
caused infections was common He experimented with a variety of through surgery without infection.
in the 19th century, and led to substances, including zinc chloride,
an emphasis on cleanliness, which but nothing seemed to work with Spraying clean
did yield results. For example, in compound fractures. He then So effective was Lister’s
1847 Hungarian physician Ignaz heard about the use of carbolic “antiseptic” acid that its use soon
Semmelweiz, who worked in acid in the treatment of sewage in became routine at his Glasgow
46
Lister inherited his scientific PERCENT The proportion
curiosity from his wine-merchant
father, an amateur physicist with “It occurred to me that of amputation patients
at Glasgow Royal Infirmary who
154
THE FIRST ANTISEPTICS
155
SCIENCE TAKES CHARGE 1800 –1900
Tuberculosis
Also known as TB, phthisis, consumption, and white
plague, tuberculosis is one of the world’s longest-known,
most widespread, and deadliest diseases. Even today,
it affects 8–10 million people every year.
“… the overcrowded
dwellings of the poor…
[are] the real breeding places
of consumption.”
ROBERT KOCH, GERMAN PHYSICIAN, FROM THE ADDRESS
TO THE BRITISH CONGRESS ON TUBERCULOSIS, 1901
▷ Fading away
During the 18th to early 20th centuries, tuberculosis was
“romanticized” by writers, poets, playwrights, and artists as a
disease of the able, intelligent, and creative. This serene scene
is part of a five-image montage of a young, dying woman that
was composed by English photographer Henry Peach Robinson.
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esearch by French neglected to do so. A month later, New vaccines are discovered
microbiologist Louis Pasteur the chickens were injected with By the late 1880s researchers had
(see pp.148–49) on the “old” batch, still sitting on the realized that toxins in blood serum,
microorganisms and the germ shelf. The birds, while showing released by certain bacteria such
theory (see pp.146–47) gave hope mild signs of the disease, survived. as diphtheria and tetanus, were
that agents might be developed Pasteur then injected them with responsible for the diseases’
to combat a range of diseases, fresh bacteria and they did not symptoms. German physiologist
and that more vaccines might be become ill. He had discovered the Emil von Behring discovered that
created in addition to the one principle of attenuation, by which by injecting nonlethal doses of
Edward Jenner had devised a weakened form of a disease- diphtheria into guinea pigs, and
against smallpox (see pp.102–03). bearing organism bestows immunity later horses, he was able to extract
A major breakthrough came in to the full form of the disease if a serum from the test subjects that
1879, when Pasteur produced the administered to a patient. In 1882 then conferred immunity on other
first laboratory-developed vaccine. Pasteur extended the principle to animals that were injected with it.
He was researching chicken cholera anthrax and, in 1885, to rabies. The discovery of the tetanus toxin
by injecting birds with live in 1889 enabled von Behring and
bacteria and then his colleague Shibasaburo Kitasato
observing the to develop an antitoxin against △ Vaccine ampoules
◁ Symptoms
progression the disease the following year. The ampoules shown here, from 1915, contain
of diphtheria
of the fatal A diphtheria vaccination became serums that were used to vaccinate against
This disease is characterized
disease. One commercially available in 1892, typhoid and paratyphoid. These vaccines were
by a fever, severe cough,
day, he asked and the death rate declined especially important in wartime, as more soldiers
and a gray coating over the
his assistant to dramatically. In 1921 there were tended to die from typhoid than battle injuries.
infected areas, particularly
inject the birds the throat and tonsils. If left 206,000 cases of diphtheria in the
with a fresh untreated, diphtheria is fatal US; now, there are less than five
bacterial culture, in young children in about cases annually. Noguchi found that he could grow
but the assistant 20 percent of cases. the Vaccinia virus (related to the
Working on viruses Variola virus that caused smallpox)
Most of the early advances in inside the testes of live rabbits.
GERMAN PHYSIOLOGIST (1854–1917)
the development of vaccinations By the 1930s viruses were being
EMIL VON BEHRING involved diseases transmitted by cultured inside chicken eggs,
158
△ Plague inoculation against measles and mumps were
CONCEPT
The 1906 outbreak of plague in Burma (now
developed, in 1963 and 1968
Myanmar) led to a widespread program of respectively, and soon became part HOW VACCINES WORK
inoculation using a vaccine devised in 1897.
of a regular schedule of childhood
Unfortunately, this vaccine was limited in its
vaccinations in most countries. Vaccination involves introducing a The antibodies bind themselves to
effectiveness and 6,000 people still died.The public health benefits of weakened form of a bacterium or virus modified cells, which persist in the
vaccination are incalculable in into a living host. The disease-causing host’s bloodstream as “memory cells.”
terms of lives saved and medical agent carries antigens—substances The next time the host encounters the
Promoting vaccination resources that do not have to be that provoke the host’s immune system disease, its body already has antibodies
As vaccines became more widely expended on sufferers of infectious into producing special proteins, called to fight it, and so will either suffer a
available, many nations introduced diseases. Research scientists antibodies, to fight the infection. very mild form of it or not suffer at all.
public health programs to promote continue to develop vaccines for
Antigen Disease-causing pathogen
their take-up or even to make serious diseases that are difficult binds to memory cells
them compulsory. One of the to treat, especially viral infections Weakened pathogen produced from vaccination
earliest such programs such as HIV/AIDS (see pp.242–43)
was established and Ebola (see
27,000The number Memory cell
in the UK, where pp.268–69). Other Destroyed
of people who Antibody pathogen
the Vaccination targets include
contracted polio during the
Act was passed diseases where White
1916 outbreak in the US. blood cell
in 1853 ordering the method of
the mandatory
vaccination of all
73
The number of polio
cases worldwide in 2015.
transmission
is hard to control,
Antigen Antibodies are
released to kill
infants against smallpox (see for instance, malaria (see pp.174– infection
pp.100–03) within four months of 75) or the Zika virus disease, which RESPONSE TO VACCINE RESPONSE TO INFECTION AFTER VACCINATION
birth. In the 20th century, vaccines are both spread by mosquitoes.
159
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he brain’s uniform structure, With the revival of anatomy as During the 18th century there △ Brain cell of a fish
few obvious demarcations, a science in the 14th century, the were major advances in the Advances in microscopy enabled scientists such
and lack of moving parts give gross structure of the brain—the understanding of the brain, but as Santiago Ramón y Cajal (see p.97) to study
little clue to the magnitude of its parts visible with the unaided also fashions concerning mind and nerve cells. This fish brain cell has been colored
functions. Access is difficult since eye—became clearer. In 1543 behavior with little scientific basis. with Boveri stain (silver nitrate).
the brain is heavily protected by Flemish physician Andreas Vesalius Phrenology (see pp.104–05),
the skull. Nevertheless, physicians (see pp.72–75) depicted the brain’s the reading of skull contours,
throughout history have tried coverings, or meninges, its outer was popular in the early 1800s. methods of staining or coloring.
to treat its physical disorders surface, inner chambers, nerves, Another since discredited theory, These advances enabled 19th-
by methods as and blood vessels. that of “animal magnetism,” was century clinicians such as French
drastic as boring
holes in the skull 3,000 The number
of neurological
The chambers or
“cells” were
developed by German physician
Franz Anton Mesmer. He believed
professor Jean-Martin Charcot
to establish neurology as a major
(see pp.16–17). patients under Charcot’s care allocated functions: that an unseen force or energy, branch of medicine.
The nerves, too, at the Salpêtrière Hospital, imagination to subject to the laws of magnetism, Charcot was a talented clinician,
look like pale France, in the 1860s–70s. the anterior; flows through all living things. interviewing and examining
strings with no reason to the Those who were able to manipulate patients, diagnosing diseases, and
clear indication as to how they middle; and memory to the this force could use it for healing. At prescribing treatment. Over a
work. Neurological conditions such posterior chamber. These cerebral Mesmer’s gatherings or “banquets” career of more than 40 years, he
as epilepsy and migraines were ventricles, as they have since patients were placed in a trancelike recorded patterns of symptoms
often attributed to evil spirits or been named, actually contain state. “Mesmerism” is now thought in patients and linked his clinical
to divine punishment. cerebrospinal fluid, which has to have had close links to hypnosis. findings to postmortem findings
In the 4th century BCE, Aristotle no part in mental processes. using tools of anatomy, pathology,
claimed that the heart was the In 1664 English physician The birth of neurology and microscopy. He defined
center of emotion and intelligence, Thomas Willis published Cerebri The development of anatomy numerous neurological conditions:
while Roman physician Galen Anatome (Anatomy of the Brain), and pathology through the 18th as many as 20 still bear his name.
(see pp.40–41) associated the brain which offered a detailed anatomy century was aided by microscopy Charcot was influential in
with “animal spirits” or “psychic of the brain and nerves, and (pp.92–93) and histology—the distinguishing between neurology
faculties,” such as reason, thought, introduced the term “neurology” study of the microscopic anatomy and psychiatry. While neurology
perception, and memory. for the study of nerves. of tissues and cells, often using concerns mainly the physical brain,
and how problems of anatomy and
physiology cause conditions such
as stroke and multiple sclerosis,
psychiatry developed to focus on
mental health, and disorders of
mood, emotions, and thoughts
such as anxiety, depression, and
schizophrenia that have few or
no physical signs.
Charcot considered French
physician Guillaume-Benjamin-
Amand Duchenne, who was
the first to describe and devise
treatment for several nervous
◁ A Mesmer banquet
Mesmer held healing “banquets,” at which
wealthy patients held metal rods immersed
in a tub of “magnetic water” and entered
a trancelike state. They believed this would
remedy the “imbalance” within and cure them.
160
MYSTERIES OF THE BRAIN
161
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Mental Illness
The idea that the mentally ill should be separated from society and treated in asylums
may have seemed like progress in the 18th and 19th centuries, but the reality of their
confinement and treatment continues to haunt the history of medicine.
T
wo hundred years ago (hence the word “lunatic”) or seen those not sheltered by their family △ Fool’s tower
there was still very little as communications or prophesies risked appalling abuse unless they The Narrenturm, or Fool’s Tower, at the Vienna
understanding of the causes from the gods. A supposed link were taken in by convents, General Hospital, Austria, was the first specially
of mental illness. In early times between mental problems and the monasteries, or workhouses. built mental asylum. It was constructed in 1784
episodes of madness had been balance of the four humors (see with 139 cells to house inmates.
linked to the phases of the moon pp.34–35) was first made in ancient First asylums
Greece and remained popular into Models for the safekeeping of
medieval times and beyond. the mentally ill had existed for approach to asylums in Europe
▽ Advocating humane treatment In communities with a deep hundreds of years, since the first from the early 15th century
French physician Philippe Pinel was one of the sense of ancestral pride and honor, facilities were provided in 8th- onward was based on brutality
first to insist on “moral” treatment for patients madness was a stain on the family, century Baghdad, based on the and incarceration: “treatment”
suffering from mental illness. In this painting he and sufferers were concealed from Qur’an’s principle of humane included whipping, stripping,
is shown releasing inmates from their chains at public life or even abandoned. treatment for those “weak of and restraining with chains.
the Bicêtre Hospital asylum in Paris in 1793. In Europe in the medieval period, understanding.” However, the Early establishments included
162
M E N TA L I L L N E S S
the notorious Maison de Charenton with minimal coercion. This ◁ Electroconvulsive therapy
in Paris in the 1640s and the emphasis on “moral treatment” The Ectonustim 3 machine transmitted a current
Narrenturm in Vienna in 1784. traveled from Europe to the US. through the brain by means of electrodes
In the 19th century the drive for After visiting humane Quaker attached to the scalp of the anesthetized
the mentally ill to be placed in establishments in England in her patient. The current induced convulsions in the
madhouses, or asylums, gathered campaign for reform, American hope of alleviating mental disorders
momentum. In Britain the Lunacy teacher Dorothea Dix visited such as severe depression.
Act and County Asylum Act 1845 public and private mental facilities
insisted that local authorities take in the US, and documented
responsibility for the “mad.” Asylums appalling conditions.
multiplied throughout Europe and Yet old habits prevailed. As
North America in this period too. asylums became overcrowded,
practices such as the use of
Moral treatment straightjackets and seclusion
Although harsh treatment made a comeback. Patients became
prevailed, there had been pockets institutionalized, and asylums
of resistance since the late 18th remained a testing ground for
century when, in Paris, Philippe unscientific theories. One popular
Pinel and Jean-Baptiste Pussin treatment saw patients swung on
stated that the mentally ill were a harness to “calm the nerves.” as a treatment for mental problems environment in which physicians
patients and not criminals (see that lay buried deep within the could practice novel treatments.
pp.164–65). In England, Quaker New approaches unconscious mind of the patient. Lobotomy, in which surgery was
philanthropist William Tuke From the 1890s Austrian physician Freud believed that mental illness, used to sever physical connections
advocated that patients be housed Sigmund Freud developed and in particular hysteria, stemmed between the prefrontal, frontal,
in pleasant settings and treated psychoanalysis (see pp.182–83) from repressed emotions and and other parts of the brain, had
memories, which could be unlocked unpredictable and sometimes
through therapy. In Freud’s “talking disastrous results.
cure,” patients were encouraged to The first of what became known
talk freely about their urges, desires, as convulsive therapies was
and dreams, initiated in 1934
250,000
which were The number in Budapest,
analyzed by of inmates Hungary, when
the therapist. in asylums in the US in 1900. psychiatrist
World War I In 1880 the figure was 40,000. Ladislas von
(1914–18) saw a Meduna began
new approach to treating mental a regime of drug-induced seizures
illness, when many thousands to treat schizophrenia. This was
of soldiers who were traumatized replaced by electroconvulsive
by war were taken to specialized treatment (ECT), initiated in 1938,
hospitals. Shell shock became which involved passing an electric
recognized as a mental disorder current through the brain to trigger
affecting all ranks and classes, a seizure. By the 1960s ECT was
although numerous shell-shocked used to treat a variety of conditions,
soldiers were charged with desertion. notably severe depression. It
After World War I there was a remains in limited use, but it has
renewed enthusiasm for “physical been largely replaced by new drug
therapies” to cure mental illness. therapies developed in the second
Again, asylums were the perfect half of the 20th century.
163
SCIENCE TAKES CHARGE 1800 –1900
◁ Frightful fate
“The Madhouse” is an 1835 engraving by Swiss draftsman Heinrich
Merz, after a drawing by German painter Wilhelm von Kaulbach.
The varied facial expressions of mentally ill patients convey their
emotional states amid crowded, bleak conditions typical of the time.
165
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A
t the close of the 19th infected plant, filtering the liquid that the contagion was not able
century, the first vaccines through paper to remove bacteria, to grow on its own—it needed a
were being administered and then rubbing the liquid onto living host in order to replicate.
and began to be incorporated an uninfected plant. Mayer had Beijerinck’s work established
into public health programs, laid the foundations for the without doubt that a new type of
thanks to the pioneering efforts discovery of the first known virus. infectious agent existed—a virus,
of English physician Edward A few years later, in 1892, Dmitry from a Latin word meaning
Jenner (see pp.102–03) and French Ivanovsky repeated the principle of “poison” or “slimy liquid.”
chemist and microbiologist Louis Mayer’s experiments by applying
Pasteur (see pp.148–49). Jenner the technique of filtration to The virus particle
had developed the world’s first tobacco plants with mosaic disease. Whereas Beijerinck had asserted
vaccine for smallpox, using the Unlike Mayer, however, Ivanovsky that a virus was a liquid, a study
cowpox virus, in the 1790s. used a more stringent method of of livestock by German scientists
Pasteur, who was born the year filtration—the Chamberland filter, Friedrich Loeffler and Paul Frosch,
before Jenner’s death, devised a porcelain tube that uses water the same year, found evidence that
vaccines for rabies and anthrax to separate any trace of bacterial it was actually a particle. They had
in the 1880s. However, the nature toxin from a sample. Invented discovered the world’s second
of the diseases targeted by these by French microbiologist Charles known virus—foot and mouth
vaccines was not fully understood. Chamberland in 1884, and used by disease. By the 1920s more than
Genetic material—DNA
(deoxyribonucleic acid)
Viral infections wreaked havoc on the populations of three or RNA (ribonucleic acid)
continents in the 18th century, fueling efforts to deliver Capsid, or
the world’s first vaccines. Yet it took a further century shell, made
of protein Virus shell binds to
the cell membrane
to identify and understand the nature of the viruses of host cell
responsible for these diseases, and how they spread.
1 ATTACHMENT
Scientists did not comprehend the Louis Pasteur in his development
mechanics of viral activity until of vaccines, the filter allowed
Russian microbiologist Dmitry Ivanovsky to remove all bacteria
Ivanovsky described the first known from the liquid concentrate that
virus in 1892, almost a hundred had been taken from a diseased
years after the development of the tobacco plant. The filtered sample
first vaccine. was still infectious, proving that
the disease was not transmitted 2 PENETRATION
Virology begins by bacteria.
The history of virology, the study Building on
of viruses, began with a sick Ivanovsky’s findings,
tobacco plant in the laboratory Dutch microbiologist Virus shell disintegrates to
release its genetic material
of Adolf Mayer in 1879. Mayer, Martinus Beijerinck
a German agricultural chemist, went one step further
was studying mosaic disease, which in 1898, concluding
contaminated tobacco plants and that not only was
destroyed entire tobacco crops. mosaic disease
Over the following 10 years, he still infectious 3 REPLICATION
demonstrated that the disease after being
could be artificially spread to other filtered for
plants by taking sap from an bacteria, but Nucleus of host cell
166
VIRUSES AND HOW THEY WORK
DMITRY IVANOVSKY
a filterable virus… a virus In 1887 Dmitry Ivanovsky, a
New virus
Cytoplasm
of host cell
New virus is
released from ▽ Virus mechanism
dying cell A bacteriophage virus acts like a parasite,
injecting its genetic material into the cell of
a host bacteria, which is typically found in
soil, seawater, or in the stomach of an animal.
Once the virus’s DNA or RNA has penetrated
the cell, it begins to replicate, destroying or
taking over the machinery of the cell.
Virus instructs
production of new
viral genetic material
4 SYNTHESIS
167
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Fighting Rabies
Dreaded since antiquity, rabies—which spreads through the nervous system to the
brain—causes terrible suffering, aggressive behavior, paralysis, and eventual death.
Louis Pasteur’s development of a vaccine was therefore a very welcome breakthrough.
I
n the late 19th century the microscopes, which use focused Building immunity △ Rabies vaccine warning sign
dreaded “mad dog” disease (as light and a lens to enlarge small To create a vaccine, Pasteur first This German sign warns that vaccine-containing
rabies was known) continued to samples, did not provide sufficient needed to weaken the virus enough pellets have been left out for foxes, to make
confound physicians, who struggled magnification to see the rabies that it would provide immunity them immune so they would not spread rabies,
to treat those who were affected. A virus—a type of rhabdovirus from rabies without causing the so dogs must be kept away.
breakthrough came in 1880, when called Lyssavirus—which is less disease. Working with Roux and
French microbiologist Louis Pasteur than 0.0002mm long. Also, since others, Pasteur tried the idea of
(see pp.148–49) became interested viruses multiply in living cells, dissecting the spinal cords of whose disease was too advanced
in the disease. At the time France Pasteur and his collaborator, Émile infected, freshly dead rabbits, then to be treated. But on July 6, 1885,
was increasingly Roux, had to placing them in open flasks that a distraught mother brought her
troubled by carry out tests contained potassium hydroxide, nine-year-old son Joseph Meister,
packs of feral
dogs, some of
60 HOURS The time after being
bitten, when French boy
Joseph Meister had the first of 13
on live animals
—including
which acted as a drying and who had been repeatedly bitten
168
FIGHTING RABIES
Pasteur repeated the procedure on A vaccine for the future returned home healthy. More rabies centers in the US, Brazil, Europe,
a shepherd, who had been attacked That December, four boys who patients flocked to France to be India, and China. Today the rabies
and severely bitten by a rabid dog, had been bitten by a dog thought treated—largely the result of the US vaccine, which has been improved,
then gradually others followed. to be rabid arrived from New Jersey. campaign. In March 1886 Pasteur is on the essential medicines list
Later that year Pasteur officially A national campaign had been announced that he had treated 350 of the World Health Organization
reported the results from the Paris launched to fund their travel to patients with only one loss, and by (WHO) and is thought to save up
trials, and news spread worldwide. Pasteur for treatment, and they 1890 there were rabies vaccination to 300,000 lives annually.
▽ Treating rabies
As news of Pasteur’s vaccine spread, lines
formed to see him. Some wanted treatment
for bites, others sought immunity in case of
a future bite, which was the aim of
Pasteur’s initial research.
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
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he quest to find an effective In the 19th century science began meadowsweet flower, but it was △ Willow bark
remedy for pain is as old as to be seen as a true profession not until 1853 that French chemist In 1763 it was discovered that willow bark
human civilization. Perhaps rather than natural philosophy, Charles Frédéric Gerhardt made dramatically reduced ague, a fever with
remarkably, the people of the and it flourished, partly spurred the breakthrough that opened the symptoms similar to malaria. It was later found
ancient world found solutions to on by growth in industry and way for potential mass production that the active ingredient in willow bark is
pain relief containing the same key commercial activity. The goal of the medication. salicylic acid, which forms the basis of aspirin.
ingredient as modern-day aspirin. of many researchers was to find Salicin, as it is found in willow
Ancient Egyptians used willow tree useful medicines, and efforts and meadowsweet, is relatively
extract to ease aches and pains, to pinpoint exactly how willow low strength, with a mild effect of patients with rheumatism had
while Greek physician Hippocrates worked gained momentum. on pain. Gerhardt extracted a more experienced reduced fever and
recommended willow-leaf tea potent derivative of salicin, called joint inflammation after taking the
to women to relieve the pain of Experiments with salicin salicylic acid, and worked out the chemical compound. Maclagan had
childbirth. Almost two thousand In 1828 Joseph Buchner, professor molecular formula, which enabled chosen to use salicin rather than
years later, in the 1750s, the of pharmacy at Munich University, him to produce it in a laboratory, at the stronger salicylic acid because
English clergyman Edward Stone extracted a small quantity of a much higher concentrations than it was gentler on the stomach,
conducted a five-year experiment compound from willow bark and it was found in plants. However, making it more suitable for the
that demonstrated that dried, named it salicin. The following year, although salicylic acid provides subjects of his trial.
powdered willow bark helped French chemist Henri Le Roux effective pain relief, it is hard on
to cure fever. The Royal Society refined the process further to the stomach and can cause nausea, Final steps
published his results in 1763. extract salicin in crystal form. bleeding, and diarrhoea, so it needs The chemist who finally succeeded
Interest grew among scientists Around the same time Swiss to be “buffered” or neutralized in in creating a powerful pain
and medical practitioners in the pharmacist Johann Pagenstecher order to avoid these effects. In medication without severe side
potential of willow for pain relief. also found salicin in the the course of his effects was Felix
40,000
work on acid TONS The Hoffmann, an
FRENCH CHEMIST (1816–1856)
anhydrides, quantity of aspirin employee of dye
Gerhardt took consumed globally each year. manufacturer
CHARLES FRÉDÉRIC GERHARDT the first step in Friedrich Bayer
addressing the side effects when he & Co. in Germany. Hoffmann’s
Born in Strasbourg, France, Charles mixed acetyl chloride with salicylic father suffered from rheumatism
Gerhardt learned about chemistry acid, which created a rudimentary and urged his son to develop a
from a young age. His father form of acetylsalicylic acid for pain remedy that was less irritating
owned a lead production plant but the first time. Although Gerhardt on the stomach than existing
had little scientific understanding showed little interest in pursuing medicines based on salicylic acid.
of the processes in his factory, so his discovery further, other Hoffmann and his colleagues at
young Gerhardt was sent to study scientists did. Bayer successfully developed an
chemistry at Karlsruhe Polytechnic in Two decades later, in 1876, the easily synthesized, effective form
Germany. In later years, Gerhardt medical journal The Lancet published of acetylsalicylic acid, which caused
also attended the University the results of the first clinical trial less upset to the stomach than
of Giessen, Germany, and the of salicin. Scottish doctor Thomas salicylic acid. They produced the
University of Paris, France, where Maclagan concluded that a group first sample of pure acetylsalicylic
he benefitted from the best
chemistry teaching available in
both countries. He devoted his
research career to simplifying the “ Aspirin is a drug that has been used
classification and formulas used
in chemistry, but his greatest
for many years—it is effective,
achievement was the synthesis of
acid anhydrides, which ultimately
inexpensive, and widely available.”
led to the discovery of aspirin. JEFFREY BERGER, AMERICAN DOCTOR, FROM JOURNAL OF THE
AMERICAN MEDICAL ASSOCIATION, 2006
170
THE DISCOVERY OF ASPIRIN
acid in 1897. Friedrich Bayer & Co. prevent stroke, peptic ulcers, and ◁ Aspirin crystals
patented the invention and began certain types of cancer. Hoffmann Aspirin is a white, crystalline, weakly acidic
distributing the medication under could scarcely have imagined that substance. This color-enhanced scanning
the trademark “Aspirin” in 1899. more than a century after his electron microscope image shows a closeup
discovery, aspirin would become view of the analgesic.
The “wonder” drug a multipurpose wonder drug
In its first 50 years, aspirin capable of saving lives.
dominated the market as the
world’s most frequently sold
painkiller, but by the 1970s
researchers had discovered a
radical new application for aspirin.
Controlled trials indicated that
aspirin thins the blood and helps
prevent blood clots from forming.
More recent research has also
confirmed that taking low doses of
aspirin as a preventative measure
can reduce the chance of having
a heart attack. It can also help to
△ Aspirin carton
Aspirin—with a capital “A”—
remains a registered trademark
of Bayer in Germany, but
“aspirin” has become a generic
word used worldwide.
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X-rays
The chance discovery of X-rays by a German physicist at the end of the 19th century
sparked a new age of medical imaging. Medical diagnosis was revolutionized—for
the first time, physicians could look inside the body without the need for surgery.
G
erman physicist Wilhelm materials, including wood, copper, X-rays were soon being used △ Barium X-ray imaging
Röntgen conducted an and aluminum, but the rays to diagnose a wide range of The insoluble salt barium sulfate shows up on
experiment on cathode rays penetrated all of them. conditions. Within a year, the X-rays in the same manner as metal or bone. It
in his laboratory on November 8, world’s first radiology department can be administered orally into the gastrointestinal
1895. He removed all air from a Looking inside the body was set up at a hospital in Glasgow, tract, which is not visible on standard X-rays, so
glass tube, filled it with a special However, when he held a lead disk Scotland, and produced the first that its lining, size, and shape can be examined.
gas, and passed a high-voltage in front of the tube he was amazed X-rays of a kidney stone and a
current through it. As he did this, to see the bones of his own hand coin stuck in a child’s throat.
the tube emitted a fluorescent glowing on the screen—it was the The first machines were basic and However, in 1904 American
glow. Next, Röntgen darkened the first ever radiographic image. He emitted weak radiation, so patients inventor Thomas Edison’s assistant,
room and shielded his tube in a then placed his had to remain Clarence Dally, who worked
casing of thick black cardboard to wife’s hand in still for more extensively with X-rays, died of
exclude all light. To his surprise, he the path of the “ I did not think, than 30 minutes cancer. His death caused scientists
noted that even though his tube
was completely encased a nearby
rays over a
photographic I investigated.” for images to be
captured. It also
to begin to take the risks of X-ray
radiation more seriously.
screen that was coated with a plate, capturing became apparent
WILHELM RÖNTGEN, IN AN INTERVIEW
fluorescent chemical glowed. the world’s first
FOR MCCLURE’S MAGAZINE, 1896
that X-rays Further developments
Röntgen studied this for several X-ray image. caused burns More work was needed to fully
weeks and concluded that the glow The bones were and hair loss. comprehend the nature of X-rays.
must result from an undiscovered clearly visible, while the soft tissue But by the early 1900s scientists In 1912 German physicist Max
kind of ray—a type of radiation was barely noticeable. Six weeks had also discovered that controlled von Laue decided to transmit
that differed from visible light. later, Röntgen published a paper doses of X-ray radiation could be X-rays through crystals, and in
He named it “X-ray”—“x” being titled Über eine Neue Art von Strahlen used positively to fight cancers and the process demonstrated that
the mathematical term for an (On a New Kind of Rays). skin diseases. X-rays proved useful X-rays, like light, were subject to
unknown quantity. Röntgen’s discovery caused a in wartime—during World War I diffraction (interaction after being
Röntgen subsequently tried to public sensation. The implications military doctors used X-ray machines split). The diffraction pattern
block the path of the X-rays to his of being able to look inside the to locate bullets and shell fragments showed how a crystal’s atoms were
screen with a selection of denser human body were immense, and in soldiers’ bodies. arranged—a technique crucial to
the analysis of molecular structure.
GERMAN PHYSICIST (1845–1923)
X-ray crystallographic techniques
were later used to study the
WILHELM CONRAD RÖNTGEN structure of proteins and were
employed by researchers worldwide.
Born into a family of cloth merchants This work has lead to incalculable
in Lennep, Prussia (now Germany), advances in chemistry and
Wilhelm Röntgen spent part of his molecular biology.
childhood in the Netherlands. Far Although X-rays continue to be
from being a brilliant pupil, he was used for medical diagnosis, they
expelled from school, and found are employed in a wide range of
his vocation only after he was taken other fields, from biotechnology,
under the wing of an inspiring tutor. genetics, and astronomy, to
Although he is best known for his scanning luggage for security.
discovery of X-rays, Röntgen studied Röntgen was a modest man who
several areas of physics, including loathed all the attention that was
gases, heat transfer, and light. He died heaped on him after his discovery.
of intestinal cancer (not thought to be In 1901 he was awarded the first
related to his work with X-radiation). Nobel Prize for physics, but he
bequeathed the prize money to
X-RAY IMAGE OF RÖNTGEN’S WIFE’S LEFT HAND,
scientific research and deliberately
WITH HER WEDDING RING VISIBLE never patented the X-ray, ensuring
that the public could benefit.
172
Early X-ray examination
Wilhelm Röntgen is shown preparing a young patient
for a chest X-ray in this woodcut from 1900. Shortly
after they were discovered, X-rays became a critical
diagnostic tool for physicians, permitting them to see
inside a patient’s body without intrusive methods.
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
The Struggle
against Malaria
One of the deadliest diseases, malaria has shaped much of world history. It has dictated
patterns of migration and settlement, decided wars, and shattered peace. The ongoing
search for a malaria vaccine is one of the most intensive in medicine.
M
alaria is caused by several Herbal treatments for the disease ▷ Malaria parasite
kinds of single-celled are mentioned in two texts dating The red blobs seen here are egg clusters of the
parasites belonging to the back more than 2,000 years: malaria parasite in the mosquito gut. Each cluster
Plasmodium genus. It is transmitted the Chinese Huangdi Neijing produces thousands of infectious, actively moving
when a female Anopheles mosquito, (Yellow Emperor’s Classic of Internal parasites, which travel to the mosquito’s salivary
having fed on the blood of an Medicine) and the Indian Susruta glands and are injected into people when it bites.
infected human, bites a healthy Samhita. The latter asserted that
individual. The main symptoms of the illness was associated with
malaria are flulike and include a 21). In the medieval period, this
high temperature (fever), shaking,
chills, headaches, muscle aches, 220 MILLION The estimated
number of cases of
malaria each year.
notion remained popular and the
name “malaria” came into use,
and fatigue. Vomiting, nausea, and from the Italian for “bad air.”
diarrhea may also occur. In severe
cases, malaria may lead to kidney insect bites. The ancient Greek Treatments and causes
failure, confusion, seizures, coma, physician Hippocrates noted the One of the first effective malarial
and sometimes death. Symptoms effects of malaria, and the ancient treatments was cinchona bark
usually start 7 to 30 days after Romans called it “swamp fever” (see pp.88–89), brought back from
infection, although they can take because they believed that the South America to Europe in the
up to one year to develop. In some disease was caused by the noxious 1630s. The bark’s active ingredient
forms, the illness recurs for many fumes of foul-smelling, swampy was identified as quinine—still a
years, because the parasite can areas—an idea that became known mainstay of malaria medication.
remain dormant in the liver cells. as the miasma theory (see pp.120– However, the cause of the infection
was not known until a series of
◁ Malaria vector
The mosquito shown here is the South
American malaria vector mosquito (Anopheles
albimanus). Although there are approximately
430 Anopheles species, only 30 to 40 of these
transmit malaria. Anopheles mosquitoes are
found throughout the world, except Antarctica.
174
THE STRUGGLE AGAINST MALARIA
◁ Antimalarial spray
This device was used to
Wooden
spray the insecticide powder
bellows
Paris Green—a poisonous
mix of copper and arsenic.
The insecticide was common
in the 1940s, until it was
discovered to be fairly toxic
to plants and damaging to
human health.
Tin-plate nozzle
RONALD ROSS
Born in India, Ronald Ross studied
medicine at St. Bartholomew’s
Hospital, London, UK. He joined
the Indian Medical Service in 1881
and became interested in malaria in
1892. In 1899 Ross returned to the
UK to teach at the Liverpool School
of Tropical Medicine and worked
as a medical troubleshooter for the
government during World War I.
He was also the first director of the
Ross Institute for Tropical Diseases,
London, founded in recognition
of his work in 1926.
175
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0
Transfusion Breakthrough
Today, blood transfusions are everyday procedures, responsible for saving millions of lives.
However, it took many failed attempts and false starts—and an important discovery at the
turn of the 20th century—before blood tranfusions became a practical reality.
A
fter British physician William transfer blood directly between two same year, Lower and his colleague AUSTRIAN-BORN PHYSICIAN
Harvey’s account of blood’s patients, using slim tubes inserted Edmund King transfused blood (1868–1943)
continual circulation (see into the donor’s and the recipient’s from a lamb into an ailing patient;
pp.84–85) was published in 1628, vessels. However, he did not record the man survived and said his KARL LANDSTEINER
medical minds began to consider his results. condition was much improved.
the possibility of transferring blood Further experiments followed,
between living beings—both from Early developments mainly in France, Italy, and
animals to humans and between In 1665 British physician Richard England, but the results were so
humans. However, a major problem Lower showed how blood could be unpredictable that governments
observed in the early experiments transferred between two dogs by and religious authorities banned
was that blood tends to clot the joining their blood vessels. In 1667 the practice.
moment it is exposed to air. In French physician Jean-Baptiste In 1828 London-based obstetrician
1654 Italian physician Francesco Denys described using lamb’s blood James Blundell revived the idea,
Folli wrote that he had managed to to treat a feverish patient. The to treat new mothers who suffered
▷ Animal–human
blood transfusion
“A single pint can save
The apparent similarity between
the blood of humans and other
three lives… create a
mammals led to experimental
transfusions in the 17th century. million smiles.” Born in Baden bei Wien near
Lamb’s blood was often used, with Vienna, Austria, Landsteiner
AMERICAN POSTER TO RAISE AWARENESS
the additional aim of qualified in medicine at Vienna
FOR WORLD BLOOD DONOR DAY, 2012
conferring youth University in 1891. Five years later,
and vitality to
he joined the Vienna Hygiene
the human
from excessive bleeding after Institute, where he carried out
recipient.
childbirth. The donor was often a much of his research into blood.
close family member, and the blood After World War I, he moved
flowed directly between donor and to the Rockefeller Institute for
recipient. Others developed the Medical Research, New York.
procedure by using apparatus He received the Nobel Prize in
such as funnels, syringes, and Physiology or Medicine in 1930
valves. Again, the results were for his “discovery of human blood
inconsistent. Attempts to delay groups.” Landsteiner died of heart
clotting using chemicals, in order failure in New York City in 1943.
to do away with the necessity of
having a donor next to the patient
at the time of transfusion, were In 1895 Karl Landsteiner became
also unsuccessful. interested in immunity and how
the body defends itself using
The A-B-C-O of blood antibodies to “fight” alien matter
In 1875 German physiologist such as invading germs. He focused
Leonard Landois described the his studies on blood serum—that
process of mixing blood plasma— is, blood plasma from which cells
the liquid without cells—from and clotting substances have been
one animal with the red cells removed. In 1900 Landsteiner
from another. He observed that this began a long and complex series of
often caused the red cells to clump experiments to see if agglutination
together (a mechanism known as took place every time human blood
agglutination) and even burst. samples were mixed, and noticed
TRANSFUSION BREAKTHROUGH
◁ Blundell’s apparatus
James Blundell began transfusions for mothers
who bled profusely after giving birth. Blood
was drawn from a vein in a donor’s arm
and then injected directly into an artery in the
recipient’s arm before it could clot.
▷ Human serum
The two World Wars
prompted much
research into
that it did not occur in all cases. cells. So mixing group A blood from and as a result blood from people blood storage and
In 1901 he described his findings one person with A from another in this group can be given to any transfusion. This
and stated that every individual did not result in agglutination and recipient. In 1902 a fourth group bottle of human
has blood from one of three likewise for B and B. Also, he called AB was identified. serum was prepared
different groups, which he called found that group C red cells did from blood donated
A, B, and C. Landsteiner observed not clump when added to either Rhesus factor to the Canadian
that agglutination occurs when A or B serum as they have no Landsteiner moved to New York Red Cross Society
antibodies in blood serum react antigens. Group C blood, now and began a collaboration with in 1944 as part
with the substances called antigens know as O, has both anti-A and Russian-born blood specialist Philip of the wider
on the surface of the red blood anti-B antibodies in the plasma Levine and in 1927 they identified war effort.
177
ERA OF SPECIALIZATION
1900 –1960
ERA OF SPECIALIZATION
1900 –1960
1900 1910 1920
1901 1905 1910 1916 1921 1924
Alois Alzheimer Fritz Schaudinn and Erich Hans Christian Jacobaeus Progress in anticlotting Bacillus Calmette–Guérin Hans Berger records
writes the first Hoffmann identify the carries out early laparoscopic and storing blood allows (BCG) vaccine, developed the first human
account of a form causative bacterium (minimally invasive or front-line transfusions for over many years by Albert electroencephalogram,
of dementia that of syphilis, Treponema “keyhole”) surgery on a soldiers in World War I. Calmette and Camille EEG, showing the
will come to be pallidum. human patient. Guérin, comes into use electrical activity
known as against tuberculosis. of the brain.
Alzheimer’s Treponema
disease. pallidum
1921 1926
Margaret Sanger and her Alexander Glenny greatly
colleagues found the increases the efficacy of
American Birth Control diphtheria toxoid vaccine,
League, in the campaign to although problems remain.
put women in charge of
contraceptive use.
1901
Karl Landsteiner announces 1905 1921
that blood exists in Eduard Zirm carries Edward Mellanby shows
different forms, or groups, out the first successful that lack of newly discovered
initially termed A, B, and C. cornea transplant. vitamin D causes rickets.
1923 1927
George N. Papanicolaou Karl Landsteiner and
devises the Pap test, Philip Levine identify
or Pap smear, for the M, N, and P
cervical screening. blood groups.
1924 1928
An effective toxoid Lax laboratory
vaccine is introduced practices allow
for tetanus. Alexander Fleming
to discover the
antibiotic penicillin.
180
1900–1960
Progress in the field of medicine continued in the 20th century with antibiotics. The roles of hormones in health and illness became clearer
more new vaccines; better, implantable prosthetics; and rapid with the introduction of insulin-containing pancreatic extracts to
advances in blood transfusions and other aspects of emergency control diabetes in 1922. The lengthening list of medical specialities
medicine spurred on by two world wars. World War II also stimulated included geriatrics, primary care, and oncology, with developments
mass production of penicillin, and further research yielded more in cancer screening, chemotherapy, and radiotherapy.
1952
Charles Hufnagel implants
the first mechanical heart
valve—a ball-in-cage device
that he designed himself.
181
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
Sigmund Freud
“ Dreams are the royal road
to the unconscious.”
SIGMUND FREUD, THE INTERPRETATION OF DREAMS, 1900
F
ew medical specialities owe ▷ Father of psychoanalysis
as much to one person as Freud founded psychoanalysis, a new approach
psychoanalysis does to Sigmund to mind and behavior that greatly affected
Freud. From a form of treatment Freud Western civilization. He is regarded as one of
first used to treat a young woman the most influential, and controversial, figures
in the 1880s, psychoanalysis has of the 20th century.
become a philosophy and a theory of
psychotherapy; and it has had a lasting
influence on 20th-century thinking.
It has spread throughout Western
culture into literature, cinema, and
theater, and has transformed
notions of identity, memory,
childhood, and sexuality.
Early years
Freud was born in Pribor (now in
the Czech Republic) and his family
moved to Vienna when he was 3
years old. He studied at the University
▽ Mind map
Freud suggested that the human psyche is similar
to an iceberg, with the id (the primitive drives) hidden
in the unconscious. The ego, which deals with conscious
thoughts, regulates both the id and the superego (the
critical and judging voice).
CONSCIOUS
EGO PRECONSCIOUS
SU
PER
EG
O
ID UNCONSCIOUS
182
SIGMUND FREUD
TIMELINE
■ 1885–86 Trains under Jean-Martin
Charcot at the Salpêtrière Hospital in
Paris, France, where he studies hysteria
and the use of hypnosis.
■ 1887–1902 Returns to Vienna, Austria.
Corresponds with German physician
Wilhelm Fliess in Berlin. These letters,
published posthumously, reveal his views
as he was developing his theories.
■ 1888 Drops the use of hypnosis for treating
hysteria and turns to free association.
■ 1895 Publishes Studies on Hysteria, with
his friend Josef Breuer, introducing the
concept that symptoms of hysteria were
symbolic representations of traumatic
memories, possibly of a sexual nature.
183
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
A
round 1786 Italian scientist- stimulated muscle contraction. sensitivity meant that in 1827 In the mid-19th century, the
physician Luigi Galvani These findings encouraged further Italian physicist Leopoldo Nobili, true nature of electricity and
noticed that a dead frog’s leg research into the presence and effect from Florence, managed to detect its relationship with magnetism
would twitch when pieces of metal of electricity in all manner of living tiny electrical currents, again in was still a mystery. In spite of this,
were applied to it. He believed that things, from worms to humans. dissected frogs. In 1838 one of all manner of electrical batteries,
this phenomenon was intrinsic to Nobili’s students, Carlo Matteucci, generators, and other machines
life, and called it “animal electricity.” Early apparatus a physics professor in Pisa, Italy, were being invented, and some of
A few years later, Galvani’s rival Galvani’s name lives on as the connected a frog’s heart to its leg these were marketed as electrical
Alessandro Volta showed that an galvanometer (a device to measure muscle and noticed that it twitched or electromagnetic treatments
electric current was made by the electric current developed in 1820) with each heartbeat, indicating that for therapeutic use on patients.
combination of various metals is named after him. Improvements the heart itself actually gave out These devices sent small amounts
with the leg, and it was this that in the galvanometer’s design and some kind of electrical activity. of “tingling” electrical current or
▽ Commercial success
Einthoven’s string galvanometer,
which responded to the heart’s
electric currents, was quickly taken
up by manufacturers for commercial
profit. This machine was built by the
Cambridge Instrument Company, UK.
THE DEVELOPMENT OF THE ECG
WILLIAM EINTHOVEN
true value... from the work Born in Java in the Dutch East Indies
0.25
and diseased hearts. knowledge was obtained without The invention of increasingly
MV The invasive procedures, it allowed for small transistor electronics led
voltage of Putting ECGs to use much better treatment, and even to desktop versions by the 1960s
a P wave From about 1910 heart specialists prevention, of existing disorders. and, more recently, compact
of an began using ECGs to diagnose heart The drawback was that the early electronic systems and microchips
ECG—equivalent to 1/400 conditions such as atrial fibrillation machines were cumbersome and have allowed for the development
of an electrical volt. (fast, erratic “trembling” of the required a dedicated room. The of ECG recorders that can easily
upper chambers), angina (disorder first portable ECG machines, fit in the hand.
applied to their chests. In 1887 at
St Mary’s Medical School, London,
British physiologist Augustus
Waller published an article titled A
Demonstration on Man of Electromotive
Changes Accompanying the Heart’s
Beat, which described what is
regarded as the first human ECG.
▷ Modern ECG
It used leads connected to sensors
Sensors can be attached to
on a patient’s hands and feet,
patients to give an instant
rather than directly to an exposed reading or a person can be fitted
heart. However, the procedure with an ambulatory device—an
was complex and not suited ECG machine small enough to
to practical use. wear. The “portable” device can
In 1890 British physician George store recordings of the heart for
J Burch, based in Oxford, published up to two weeks as the wearer
several articles showing how goes about their normal daily
variations in electricity too rapid activities. The readings are then
to be recorded by a galvanometer downloaded to a computer for
could be worked out using analysis—as shown here.
185
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
A
n extremely virulent the French invasion of Naples, expel the toxins of the disease
disease, syphilis claimed Italy. In France it was called the from the body. Unfortunately
the lives of thousands. “Italian disease,” and in Italy, it was the severe side effects of mercury,
Victims of the disease suffered thought to be of French origin—no such as mouth ulceration, tooth
disfiguring and painful pus-filled nation wished to be known as its loss, and bone deterioration were
sores and skin ulcers, and in birthplace. Another popular theory often confused with the original
extreme cases soft tumors that maintains that syphilis was brought symptoms of syphilis. So, many △ Treponema pallidum
ate into the flesh and bones. Many back to Europe by sailors returning patients suffered from needless Syphilis is caused by a thin, spiral-shaped
died of the disease, and those who from Columbus’s first voyage to additional pain as a result. organism that spreads through sexual contact.
did not were left with scars and the Americas in 1493. This is The name “pallidum” comes from the very pale
were often disfigured. Sufferers supported by the widespread Identifying syphilis colour of this bacillus. Its paleness made it very
were stigmatized, doubly so when evidence that shows the presence Attempts to identify the cause of difficult to observe and hence to discover.
it became apparent that the disease of diseases of the treponemal the disease were hampered by its
was sexually transmitted. family—which includes syphilis— early confusion with leprosy, which
in ancient American skeletons. causes similar disfiguration. From can be affected, causing blindness
Questionable origin By 1502 syphilis had spread the 16th to the 19th centuries, and insanity. Ricard also observed
A number of theories exist to Central and Northern Europe. syphilis was also confused with that the third stage of syphilis
regarding the origin of syphilis. At However, by this time it had gonorrhea, another sexually may even occur after years of
first it was believed to have come apparently mutated into a slightly transmitted disease. It was not until remission.By 1876 doctors had
via mercenaries who had fought in milder form. It was common in 1837 that French also identified
40
European life, affecting about venereologist PER 100,000 Syphilis cardiovascular
10 percent of the adult population Philippe Ricard deaths in France syphilis, which
▽ Pleasure and pain at any one time. Physicians confirmed that before use of penicillin. spreads through
This 17th-century engraving is a wry comment
on the sexual nature of contracting syphilis. It
devised many treatments but none
was reliable. Of all the available
syphilis and
gonorrhea were two 5 PER 100,000 Syphilis
deaths in France after
the blood, but
they were still no
points out the contrast between the “one remedies, mercury was the distinct infections. use of penicillin. nearer to finding
pleasure” the victim may have, with the preferred drug. It was believed Ricard also the microorganism
“thousand pains” that will follow. that the sweating it induced would identified three stages of syphilis: responsible for the disease, let alone
the primary stage, in which canker a cure for it. In the absence of a
sores (small, painless, nodular cure, a public health approach was
growths or ulcers) appear at the adopted to try to control the spread
site of contact; the secondary of syphilis. In 1864 the Contagious
stage in which a more general Diseases Act was passed in Britain
inflammation, flulike symptoms, calling for the regular examination
and a rash occur; and a tertiary of prostitutes, and their necessary
stage, in which soft tumors may detention and treatment if they
appear, and the nervous system were found to be infected.
“ A disease so cruel, so
distressing… nothing more
terrible or disgusting, has ever
been known on this earth.”
JOSEPH GRÜNPECK, FROM THE PUSTULAR EPIDEMIC “SCORRE,”
OR THE FRENCH SICKNESS, 1496
186
The search for the cure reached a low point in the 1950s. ◁ The Salvarsan kit
In 1905 German zoologist Fritz Since then, the number of syphilis Laboratory tests found the drug
Schaudinn finally identified the cases around the world has Salvarsan to be so effective
microorganism that caused syphilis fluctuated, with a general increase against the syphilis bacteria, and
(Treponema pallidum), and the race during the 2000s. The disease there was such a high demand
to find a cure began. remains a serious public health for the medicine, that Paul
The decisive step toward a problem, with more than 110,000 Ehrlich was forced to make it
cure was made by German deaths worldwide in 2010, while commercially available before
immunologist Paul Ehrlich. He patients with tertiary syphilis any further tests. This Salvarsan
kit is from the year 1910.
began looking at different variants continue to suffer debilitating
of arsenic, seeking what he called long-term damage.
a “magic bullet”—a term he coined
to describe a drug that would
target a disease without affecting
any other parts of the body. In
doing this he was initiating the
concept of chemical therapies,
now known as chemotherapy.
In May 1909 Sahachiro Hata, a
Japanese researcher working in
Ehrlich’s laboratory, was testing
the 606th arsenical compound
and found that it worked on
Treponema pallidum. Human
testing of the drug—named
Salvarsan—rapidly followed,
and within a year, it was publicly
available. This was the first drug
to target a particular pathogen.
Salvarsan, and its variant
Neosalvarsan—introduced
a few years later—remained
the principal anti-syphilitic drugs
for two decades, until 1943,
when it was found that the new
antibiotic, penicillin (see pp.198–
99), was even more effective.
The invention of the Wasserman
test in 1906, named after its
inventor, German bacteriologist
August Paul von Wassermann,
also aided treatment. It tested
blood to see if the syphilis
bacterium antibody was
present, and with this test it
was possible to identify victims
of the disease even if there
were no symptoms.
▷ Encouraging treatment
The drug Salvarsan had a number of toxic
side effects and patients had to continue
treatment for two years. Only around
25 percent of patients actually completed
the course, which greatly reduced
its effectiveness.
187
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
Minimally Invasive
Surgery
Surgeons in ancient times had no alternative but to make large openings
in the body to access the operating area. Improvements in equipment and
techniques gradually reduced the size of these cuts. In the 20th century
new technology enabled surgery through tiny “keyhole” incisions.
B
odies from the Neolithic centuries, most notably in the invasive surgery (MIS)—first
period show clear evidence areas of antisepsis and pain relief, became a reality in the 20th
of a form of surgery known the premise remained the same— century. Unlike traditional open
as trepanning (see pp.16–17), cutting the body open to perform surgery, which requires at least one △ The “Lichtleiter” (light conductor)
which involved cutting a small surgery, then stitching it up again. large cut to access the operation The first endoscope with internal illumination
hole in the skull. The ancient site, minimally invasive surgery was invented by German surgeon Philipp
Greeks and Romans are known A surgical revolution involves making a small incision Bozzini in 1806. It consisted of an aluminum
to have practiced basic surgical Carrying out surgery without just large enough to insert a tube containing a candle and a mirror, which
procedures too. Although advances significantly cutting up the body— miniature light source and imaging reflected light from the candle into the body,
were made over the ensuing a procedure known as minimally device (usually fiberoptic), as well as helping physicians see the organs better.
Arthroscopy
The surgeon can examine damaged joints by
inserting an arthroscope (a type of endoscope)
into a small incision in the joint. The arthroscope
often has a channel so the surgeon can insert
tiny tools to collect tissue or provide treatment.
188
M I N I M A L LY I N V A S I V E S U R G E R Y
189
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
Diabetes
and Insulin
A disease of the endocrine glands in the pancreas,
diabetes was known to physicians for thousands of
years. However, it was not until the discovery of the
hormone insulin in 1921 that it was possible to treat
people with this condition.
T
he first reference to diabetes “honey.” However, it was not
appears in an Egyptian until 1776, when Liverpool-based
papyrus dating back to British physician Matthew Dobson
c.1500 BCE, where it is described discovered that the evaporated
as a disease of “too great emptying urine of a diabetic left a sugarlike
of the urine.” The condition of residue, that physicians began to
excessive urination, or polyuria, understand that the condition was
was also observed by ancient Greek associated with an excess of blood
physician Aretaeus of Cappadocia, sugar. This residue was confirmed
who noted the excessive thirst that to be glucose in 1815.
the disease caused. In the 6th
century Indian physician Susruta Link with pancreas
identified the characteristic sweet The cause of diabetes, however,
or honey taste of diabetic urine. remained unknown. In 1673 Swiss
However, the awareness of these scholar Johann Brunner found
symptoms was not accompanied by that a dog suffered from polyuria
any remedy, and diabetics usually after removal of its spleen and its
died young. pancreas—an organ in the upper
The sweetness of diabetic urine left abdomen that helps digestion
was rediscovered in the 17th by secreting enzymes that assist
century by British physician in the breakdown of nutrients in
Thomas Willis—who gave the food. The procedure was repeated
disease the name diabetes mellitus in 1889 by German physiologist
after the Latin word mel meaning Joseph von Mering and Lithuanian
pathologist Oskar Minkowski, who
found that removal of the pancreas
led to diabetes in dogs. However,
they also found that when a portion
of the organ was replaced, the
disease subsided.
In 1884 Friedrich von Frerichs,
a German biochemist, found that
one-fifth of diabetic patients had
lesions or other damage in the
pancreas, again identifying it as
◁ Canine insulin
American-born scientist Charles Best (left) and
Canadian physician Frederick Banting removed
the pancreas from dogs, making them diabetic;
injecting the dogs with insulin allowed them to
survive. In 1923 only Banting received a Nobel
prize for this work.
190
DIABETES AND INSULIN
CONCEPT
191
ERA OF SPECIALIZATION 1900 –1960
▷ Gas attack
The use of poison gases during World War I posed a health threat
to soldiers and civilians alike, prompting research into respiratory
medicine and the treatment of chemical burns. Here German
nurses treat victims of an allied gas attack at the Western Front.
192
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
Battlefield Medicine
in World War II
Medical innovation raced ahead during World War II. Progress was made in the fields of
infection prevention, drug therapy, treatment for medical shock, rapid trauma surgery,
and the speedy transportation of casualties by employing a highly organized system.
I
t is often said that wartime sees Typhus, which is spread by lice, ◁ Popular painkiller
more deaths from disease than was another infection risk, mainly Processed from the poppy
from military action. During in Europe and North Africa. The plant, morphine was widely
World War II (1939–45), millions US Typhus Commission was used as an analgesic during
lost their lives to infections such formed in 1942 to research the World War II. To prevent
as malaria (see pp.174–75). Supply prevention and treatment of the accidental overdose or
shortages and enemy blockades disease. The commission supplied addiction, a syrette—a small
hampered the availability of three million doses of the vaccine, tube with a measured dose
the antimalarial drug quinine, used insecticides such as DDT that could be injected at
the battlefront—was used
increasing the spread of the (dichlorodiphenyltrichloroethane)
to administer the drug. It was
infection among Allied troops to treat military personnel, their
then attached to the casualty’s
(the US, UK, France, and others). kits, and camps, and circulated
collar to show the dose taken.
A synthetic version had been information about conditions that
invented in Germany in the encouraged typhus such as poor
1930s, so those tablets were made sanitation and decaying refuse.
available to the troops instead. The Penicillin was successfully being for treating open wounds and a reconstituted with distilled water.
tablets had a very bitter taste, and used as an antibiotic toward the bandage for protection. Frontline As the war progressed, US
occasionally caused headaches end of the war (see pp.198–99). first aiders and combat medics researcher Edwin Cohn devised a
and vomiting; however, An earlier generation of antibiotics carried both tablets and the powder. process to purify serum albumin—
they were also called sulfonamides (see the main protein in blood, and
effective and Allied pp.200–01) was also used. Life-saving blood one that is essential for healthy
soldiers had Many soldiers were given a Rapid advances were made in blood volume, blood pressure,
orders to take first-aid pouch containing stored-blood transfusion (see and tissue supply. Transfusions
their doses. antibacterial sulfa powder pp.176–77), which had first of these blood products (known
been used during World War I. as fractions) saved thousands
Techniques were developed that from medical shock due to severe
◁ Vital jobs meant blood could be separated blood loss, which if left untreated
After returning home, many disabled war into its constituents, such as the was fatal.
veterans continued to support the war effort, liquid portion, or plasma, and red New blood donation and transport
for example, by producing artificial limbs cells. The plasma lasted longer in routines were also huge life-savers.
that they themselves tested and storage, was easier to transport, The 1940 “Blood for Britain”
improved. War stimulated huge and for many purposes was as campaign encouraged civilians to
improvements in reconstructive effective as whole blood. The donate blood, and the American
and plastic surgery next major development was Red Cross collected blood from
(see pp.238–39). dried plasma, which could be donors in New York City to export
its plasma to the UK. The US Blood pain relief and blood transfusions,
Donor Service and the American and other emergency care. The use
Red Cross Blood Bank were of triage assessment (see pp.256–57)
established in 1941. ensured that those needing further
attention were moved on to mobile
Battlefield care systems field hospitals.
By the end of the war, the Allies In August 1945 the US established
had established a massive military their Mobile Army Surgical Hospital
machine for medical care, which (MASH) units. These played major ▷ MASH in Korea
extended all the way from the roles in the Korean War (1950–53) A sergeant selects blood
battlefield to hospitals back home. and Vietnam War (1955–75), when for transfusion to a
Combat medics provided first aid helicopter air ambulances (see patient at a MASH unit
just behind the front line. Mobile pp.256–57) revolutionized casualty during the Korean War.
aid stations, located further into transport. MASH-type units were A seriously wounded
Allied territory, received casualties used by many other nations and soldier had a 97 percent
on stretchers. At the clearing led to the Combat Support chance of survival at
stations‚ still further back—staff Hospitals (CSH) that are still such hospitals during
checked field dressings, provided in use today. the conflict.
▽ On the battlefield
Front-line blood, plasma, and serum albumin
transfusions helped stabilize casualties for
transport to proper facilities. Here, a wounded
soldier is shown receiving a transfusion before
being evacuated to a hospital ship during the
Allies’ Normandy landing in 1944.
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
P
rivate Albert Gitchell reported bleeding from mucus membranes, done soon enough. People were The Spanish flu pandemic of 1918
to military medics at the US especially the nose, ears, stomach, urged to avoid gathering in large was over by 1919, vanishing as
Army base at Fort Riley, and intestines. The disease also crowds, but this proved difficult to quickly as it had arrived. A virus
Kansas, feeling unwell on March made its victims vulnerable to enforce. On September 28, 1918, that usually makes people ill for a
11, 1918. He said he had a bad bacterial infections and many 2,000,000 people gathered in few days had claimed an estimated
cold, was achy and feverish, with of them died of pneumonia. Philadelphia, Pennsylvania, for 50 million lives. More people had
a burning throat and bad cough. the fourth Liberty Loan Drive—a
He was quarantined in a tent for From epidemic to pandemic parade to raise money for the war
soldiers suffering from infectious As soldiers made their way to the effort. The city lost more than
diseases. However, by lunchtime, battlefields of France during World 12,000 people to Spanish flu in
107 soldiers were unwell, all War I, and then back home, the the month that followed. In Britain
complaining of the same virus traveled swiftly to all corners thousands gathered at Trafalgar
symptoms. The disease spread of the globe. It became a pandemic, Square in London to celebrate
rapidly—by the end of the week an infectious disease that spreads the Armistice announcement
522 men were affected. Far from over a wide geographical area. It on November 11, 1918, causing
being a common cold, these men later became known as “Spanish many more flu-related casualties.
were suffering from a virus called flu” because the Spanish press was
influenza, or “flu.” the first to report it widely.
Influenza was not a new Doctors tried all known methods ▷ Makeshift hospital
phenomenon, but this strain of of treatment to deal with the This US school gymnasium was converted into
the virus—H1N1—was particularly virus, but there was no cure. Total a hospital during the Spanish flu pandemic
virulent and lethal. It caused an isolation—which involved cutting of 1918. Wearing gauze masks was mandatory.
array of violent symptoms rarely the infected people off from the Drapes and sheets can be seen here separating
seen with the disease, such as outside world—was successful if patient beds.
CONCEPT
196
I N F L U E N Z A A N D T H E PA N D E M I C
influenza so expertly as he did.” virus strain that caused the 1918 Spanish flu
pandemic. Scientists hope to identify the traits
SIR FRANK MACFARLANE BURNET, AUSTRALIAN PHYSICIAN, ON HAVING MET A YOUNG JONAS SALK, 1943 that made it so lethal and develop new vaccines.
died in one year than perished in tissue from 1918 preserved by US first vaccine against flu. This was
a century of the bubonic plague army doctors. They concluded that used to protect US military forces
in the medieval period. the virus passed from birds to pigs, from the disease in World War II.
then jumped another species barrier While flu vaccines have become
Searching for a cure to humans. They also believed increasingly effective, it is not
Through the 1920s and 1930s that the strain of flu was so lethal possible to create a lifelong
researchers looked for the origin because it rapidly filled victims’ immunization because flu viruses
of the pandemic, without success. lungs with fluid, so they drowned. mutate constantly (see panel,
Then in 1997 US scientists obtained In 1938 US physicians Jonas Salk opposite). Scientists predict that
the virus’s genetic material in lung and Thomas Francis developed the another flu pandemic is inevitable.
197
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
M
old—in the form of bread bacillus. French bacteriologist described his belief that
gone bad—had traditionally Jean Paul Vuillemin named the Penicillium could impede
been used to treat infected phenomenon “antibiosis” in 1889. bacterial growth. But
wounds. British apothecary John Scientists began to make attempts this early research was
Parkington had recommended to exploit this property for its taken no further, and the
its use as far back as 1640, yet therapeutic purposes. active chemical agent
physicians did not know how British surgeon Joseph Lister responsible for antibiosis
mold worked, could not control had tried a crude form of antibiotic remained unidentified.
its operation, and had no way of using mold to treat surgical
making it effective against infections. infections in the 1870s. In 1895 Turning point
It was only after work on germ Italian researcher Vicenzio Tiberio The breakthrough came in 1928
theory (see pp.146–47) in the at St. Mary’s Hospital, London, UK, △ Alexander Fleming’s culture plate
10
mid-1800s by French microbiologist The number of people who where pharmacologist Alexander The upper half of Fleming’s original culture
Louis Pasteur (see pp.148–49) could be treated with the Fleming was studying the effect of plate from 1928 is covered with Staphyloccus
that scientists discovered the penicillin available in 1942. lysozymes—enzymes that attack bacteria. The growth of the Penicillium mold
has retarded the development of bacteria toward
600
mechanisms by which bacteria BILLION The number of bacterial cell walls—and needed to
spread diseases, and began to penicillin doses produced culture Staphylococcus bacteria for the bottom, and few bacterial colonies exist there.
devise ways to counter them. In by US drug companies in 1945. his research. He went away for a
1871 British physiologist John month’s vacation and found on his
Sanderson observed that spores of injected Penicillium extract into return that his culture dishes had professor of biochemistry at London’s
the microscopic fungus Penicillium typhoid-infected mice and found been stacked in a sink. While most School of Hygiene and Tropical
seemed to inhibit the growth it had some effect in inhibiting the of the petri dishes were covered Medicine, made progress toward
of bacteria. In 1877 Pasteur and disease. In 1897 French researcher with Staphylococcus, on one there extracting penicillin, but it was
German microbiologist Robert Ernest Duchesne published a paper was a moldlike substance that chemically unstable and the process
Koch observed that airborne spores entitled On the Antagonism between seemed to inhibit the growth of extraction destroyed much of it.
impeded the growth of the anthrax Mold Fungi and Bacteria in which he of bacteria around it. Intrigued, In the late 1930s a team at Oxford
Fleming cultured this mold in University, led by Australian-born
SCOTTISH PHARMACOLOGIST (1881–1955)
a broth and found that he could pathologist Howard Florey and his
replicate its antibacterial property. German-born colleague Ernest
ALEXANDER FLEMING Chain, overcame the problem by
Extracting the drug freeze-drying the broth, which kept
The son of a Scottish farmer, Fleming published his findings the it stable for long enough to extract
Alexander Fleming studied medicine following year. The mold was the penicillin. In 1940 Chain and
in London, UK, under British identified as Penicillium notatum, Florey improved the process by
bacteriologist Almroth Wright, a and the substance secreted by it was using a carbon-based solvent to
pioneer of vaccine therapy. After named penicillin. Efforts to isolate extract and purify penicillin. By
serving in World War I, he returned penicillin proved frustrating. From doing this, they were able to
to medical research, producing 1930 to 1932 Harold Raistrick, manufacture enough of the
important work on lysozymes—
enzymes for which little therapeutic
use could be found at the time. He
became professor of bacteriology
“ [The discovery of] penicillin
at London University in 1928.
Fleming’s accidental discovery of the started as a chance observation.
My only merit is that I did not
antibacterial properties of penicillin
led to him being awarded the 1945
Nobel Prize in Physiology or Medicine,
alongside researchers Howard Florey
and Ernest Chain, who developed it.
neglect the observation.”
ALEXANDER FLEMING, IN HIS NOBEL PRIZE LECTURE, 1945
198
THE DISCOVERY OF PENICILLIN
Penicillin’s source
The penicillin-making mold that Fleming identified was
a variety of fungus known as Penicillium notatum (now
called Penicillium chrysogenum). It is common in humid
environments in temperate and subtropical regions,
and its spores travel easily through air.
substance to test it on a human—a funds for the research, but drug ▷ Penicillin in use
policeman who was suffering from companies in the US developed it during World War II
blood-poisoning. At first, the results and were soon able to manufacture Penicillin injections were
were startling and the infection penicillin in large quantities. It was first given to wounded
began to disappear. However, the trialed on war wounded in North soldiers in May 1943. By
effect of the penicillin was short Africa in 1943 and by the time of June 1945 the US was
lived and it had to be reinjected the Normandy landings in 1944 it producing enough of the
every three hours and when the was being used routinely on battle antibiotic to treat over
supplies ran out, the patient died. casualties. After the war, it was 250,000 battle casualties.
The death rate of soldiers
employed on a massive scale and
with chest wounds fell by
Interest from drug companies saved thousands of lives. Doctors,
around two-thirds after
Nonetheless, the results were who had previously had few
the drug was introduced.
promising enough to raise interest options to fight bacterial disease
in the pharmaceutical industry. and infections, now had a powerful
War-ravaged UK lacked the new weapon.
199
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
B
efore penicillin’s widespread after it was observed that synthetic under the name Prontosil, this was as well as for discovering new
use in the 1940s, antibiotics dyes from distilled coal tars may the first commercially available types. Penicillin belongs to a class
were available in the form of have antibacterial effects. In 1932 general antibiotic. For his work, of antibiotics known as beta-
the sulfonamides, or sulfa drugs. German pathologist Gerhard Domagk received the Nobel Prize lactams. These antibiotics have
These work by disrupting bacterial Domagk discovered that one in Physiology or Medicine in 1939. a beta-lactam ring (a square
production of folic acid, which chemical, sulfanilamide, countered molecular structure that has one
affects bacteria’s ability to make bacterial infection in mice. He tested Ways of attack nitrogen atom and three carbon
genetic material so they cannot the chemical on humans, including The detail of how atoms are atoms, one of which is attached
grow and breed. Sulfonamides were his daughter when she fell ill with arranged in different drugs is vital to an oxygen atom). They work
developed in the 1930s in Germany, an infection. Marketed in 1935 for understanding how they work, by interfering with the way a
▷ Lines of attack
Antibiotics combat bacteria in various ways. They
may damage the protective cell wall, stop the
parts called ribosomes from making essential
proteins, or prevent the genetic material from
being copied so the bacterium cannot multiply.
Bacterial DNA
Plasmid ring
Cell wall
Tail-like filament
that helps
bacterium move
200
ANTIBIOTICS IN ACTION
bacterium makes its outer coat— different versions were launched, ▷ Antibiotics
the cell wall. Pencillin targets but finally came into medical use and viruses
conditions such as blood poisoning, in the 1960s. There are now five Most antibiotics
and local wound and skin or more successive generations have little or no effect
infections. Ampicillin became of cephalosporins with dozens of on viral diseases. A
available for general use in 1961, individual kinds. virus has no cellular
widening the use of beta-lactams to machinery and
target new kinds of bacteria, such as Further classes processes of its own.
those causing pneumonia and The aminoglycosides are another It uses those of its host
cell, which antibiotics
bacterial meningitis. One of the class of antibiotics that work by
do not disrupt.
most common beta-lactams is interrupting the action of
amoxicillin, developed in England ribosomes—the molecular
in the 1960s, then released into “factories” in bacteria that make
the market in the1970s. the proteins used for cell structures
A subgroup of cell-wall disrupting and the enzymes that control cell
beta-lactams is the cephalosporins. reactions. Streptomycin, the first
They were to be discovered
extracted from
a fungus—
Cephalosporium
150 The number of
different antibiotics
that have come onto the
(and still widely
used), was made
by another
acremonium market since Prontosil in 1935. bacterium,
(now known as Streptomyces
Acremonium)—growing in sea griseus. Streptomycin was found in
water near a sewage outlet on soil samples in 1943 by US student
the Mediterranean island of and microbiologist Albert Schatz,
Sardinia. Italian Giuseppe Brotzu who was searching for an antibiotic
discovered the fungus in 1945 while that could combat tuberculosis.
researching why there were fewer Schatz was working with eminent
cases of typhoid fever in the city US-based scientist Selman
than elsewhere. He noticed that the Waksman, who had coined the
fungus worked against Salmonella term “antibiotic” the previous
typhi, the bacteria that caused year, and whose team identified
typhoid. The cephalosporins had several other antibiotics. In 1952 another type of bacterium, chloramphenicol, found in
long, complicated trials and many Waksman was awarded the Nobel Streptomyces aureofaciens. It was 1947; macrolides, an example
Prize in Physiology or Medicine. identified in 1948 by 76-year-old being erythromycin from 1949;
Other aminoglycosides include US plant biologist Benjamin glycopeptides such as vancomycin,
▽ Testing antibiotics neomycin, discovered in 1949, and Duggar, who had already made isolated from a soil sample from
A specific bacterium is grown on a gel, and disks gentamicin, found in 1963. many prominent contributions to Borneo in 1952; rifampicin,
of antibiotics are added. The antibiotics on the Protein manufacture by ribosomes botany and plant physiology. isolated in 1957; quinolones;
left plate have killed the bacteria around the disk, is affected by the tetracyclines, the During its testing phase, the drug streptogramins; nitroimidazoles;
leaving clear areas—zones of inhibition. The first of which was also discovered is credited with saving the life of lipopeptides, discovered in 1987,
antibiotics on the right plate were not effective. in a soil sample, and is made by a five-year-old boy, Tobey Hockett, and oxazolidinones, in use since
who had a ruptured and infected 2000. Each member of each
appendix. Known as tetracycline class of antibiotics has its own
for its four-ring structure, it was special uses and side effects. The
later called chlortetracycline to many kinds of antibiotics are
distinguish it from the many other neccessary because bacteria can
antibiotics that followed. develop resistance to existing
There are numerous other classes drugs. Patterns of treatment are
of antibiotics that attack different constantly changing to stay ahead
kinds of bacteria in various ways, of the development of antibiotic-
including amphenicols, such as resistant bacteria (see pp.258–59).
201
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
The Evolution
of Syringes
A syringe is a tube with a plunger, which lets liquid enter when it is pulled up or
leave when pushed down. The invention of the hypodermic syringe in 1855 added a
needle, which allowed medicine to be injected subcutaneously (beneath the skin).
1 Silver tube with plunger Arab physician al-Zahrawi administration, auto-injectors or “EpiPens” come with
used this type of device to extract bladder stones. 2 Pewter single-use dosages. They are particularly useful for allergy
syringe and nozzle Syringes such as this one were used sufferers experiencing anaphylactic shock. 8 Insulin pen
to deliver enemas to patients. 3 Mechanical syringe and cartridge These pens allow diabetics to carry insulin
Mechanically operated syringes such as this could be used conveniently and to measure doses accurately. 9 Packet
to extract fluids from patients. 4 Disposable syringe of hypodermic needles Made in Germany, these needles
Invented by New Zealand pharmacist Colin Murdoch, this were probably used by the German army during World War I.
syringe overcame the problems of cross-infection caused 10 Butterfly cannula This device allows a precision grip
by reuse. 5 Tuberculin syringe This syringe, with its close to the needle, making intravenous injection and blood
multiple-puncture “Sterneedle gun”design, was used to test collection easier. 11 Coated needles in tin box Used by
for tuberculosis. 6 Glass syringe in case The invention of British doctors during World War II, these handy tins
these sterilizable, precision-made glass syringe bodies in the contained needles that were coated in paraffin wax to keep
1940s allowed contents to be seen and the plunger to be them in good condition. 12 Trocar Used to drain fluid-filled
fitted accurately. 7 Auto-injector Designed for self- swellings, trocars consist of a puncturing device inside a tube.
Barrel held
Pewter detachable
plunger barrel six-point
needle block
Needle case
3 MECHANICAL
SYRINGE (17TH–
18TH CENTURIES)
Trocar was inserted into
4 DISPOSABLE
the skin after an incision
was made with a lancet SYRINGE (1956) 5 TUBERCULIN SYRINGE (1960)
202
THE EVOLUTION OF SYRINGES
Dose
calibration
window
Metal and
glass
plunger
Disposable
insulin
cartridge
Metal barrel to
attach needle
to plunger
7 AUTO- 8 INSULIN
INJECTOR PEN AND
(LATE 20TH CARTRIDGE
CENTURY) (1985)
9 PACKET OF
HYPODERMIC
NEEDLES
(C.1914–18)
10 BUTTERFLY CANNULA
(LATE 20TH CENTURY)
Holding the wings
helps place the
needle in the
patient precisely Silver cannula
Ivory casing
12 TROCAR (1860S)
203
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
Women’s Health
The 20th century saw great progress in the field of women’s health. The discovery of
estrogen and progesterone, and the means to detect cervical cancer—previously a
common killer—dramatically improved women’s quality of life and life expectancy.
A
t the beginning of the 20th G R E E K – A M E R I C A N PAT H O L O G I S T ( 1 8 8 3 – 1 9 6 2 )
century women were still a
mystery to the largely male- GEORGE PAPANICOLAOU
dominated medical profession. Even
Sigmund Freud (see pp.182–83), A Greek-born American physician,
founder of psychoanalysis, admitted Papanicolaou worked at the Cornell
that he found women difficult to University Medical College, New York,
understand. Female hysteria, which from 1913 to 1962. It was during an
had been a notion since ancient examination of vaginal smears of
times, gained ground as a medical guinea pigs to study their sex cycle
diagnosis in the 19th and early 20th that he found cancer cells originating
centuries. At a time when female in the cervix. In 1943 he published
nervous disorders were perceived Diagnosis of Uterine Cancer by the
as directly connected to a woman’s Vaginal Smear. His method later came
reproductive organs, operations to be known as the Pap test. His work
such as ovariotomies (removal of led to the acceptance of cytology as a
the ovaries) and hysterectomies basis for diagnosing cervical cancer.
(removal of the uterus) began to
be carried out as extreme cures.
rates. To treat the disease, he Papanicolaou, who developed it. In
Early examinations advocated a radical hysterectomy 1925 Papanicolaou began a joint
The speculum has been used in followed by radiation therapy. study with the Woman’s Hospital
gynecological inspections since Despite Schiller’s milestone in of the City of New York and
Roman times, although it was cervical cancer treatment, cure Cornell University Medical College’s
modified in the 19th century to rates were only about 30 percent, Department of Anatomy. Looking
resemble the instrument still used and his screening technique using at changes in various tissues during
today. At the time, the use of the iodine was discovered to be too the reproductive (menstrual) cycle
device set off a vigorous debate in nonspecific. At around the same he was able to detect cancerous cells.
the medical community. Doctors time, a more effective screening
thought that such an intrusive technique was developed in the
procedure was indecent and might form of a test based on examination ▷ Cells in normal cervical smears
corrupt women. Yet the speculum of cervical smears (samples taken The Pap test has saved the lives of millions
enabled doctors to examine the from the cervix): exfoliative cytology. of women. As hospitals began using the test,
cervix and perform cervical biopsies. training on how to recognize certain cells
In the 1930s gynecological Birth of the Pap test and changes became imperative for accurate
pathologist Walter Schiller carried Exfoliative cytology at the opening diagnosis. These drawings by George
out studies on cervical cancer of the cervix became known as the Papanicolau depict different types of normal
at the University of Vienna. He Pap test, or Pap smear, after George cervical cells.
followed the development of
lesions of the cervix (the opening
of the womb), which he believed
indicated the presence of cancerous
“The first observation of
cells. Schiller concluded that
cervical cancer usually develops cancer cells in the … cervix:
one of the greatest thrills …
slowly, and if identified early it
can be treated before spreading
to other tissues. Schiller devised a
simple screening test that involved
painting the cervix with diluted
[of] my scientific career.”
iodine, and promoted the idea of GEORGE PAPANICOLAOU, ON EXAMINATION OF
routine testing to reduce mortality A SMEAR OF THE UTERINE CERVIX
204
W O M E N ’ S H E A LT H
60
PERCENT Decline
in the incidence
of cervical cancer
in the US from the
introduction of the Pap test
into everyday clinical practice,
in the 1940s, to 1992.
Discovery of hormones
The discovery and isolation of
the female sex hormones estrogen △ Screening for breast cancer
and progesterone revolutionized This colored mammogram of a woman’s breast
women’s health too. In 1905 shows a cancerous tumor, highlighted in blue.
British physiologist Ernest Starling Regular self-examination and screening through
referred to certain glandular mammography can help ensure the early
secretions as “hormones,” and detection of breast cancer, allowing for effective
shortly after this endocrinology— treatment before metastasis occurs.
the study of hormones—advanced
rapidly. American scientists Edgar
Allen and Edward Doisy first in 1934 led to its use to prevent
isolated estrogen in 1929. By miscarriage and treat infertility,
the mid-1930s pharmaceutical and the idea of hormonal
companies were manufacturing contraception became a reality
estrogen products to help with (see pp.224–25). Hormone
symptoms of menopause. The replacement therapy (HRT)
discovery of progesterone first became available in 1942,
with the drug Premarin, as the
IN PRACTICE
replacement of lost estrogen, or
both estrogen and progesterone,
PROGESTERONE by HRT had been found to
bring relief from symptoms of
The female sex hormone menopause such as hot flashes.
progesterone did not become
viable as a therapeutic agent Further developments
until almost two decades after In the 20th century scientific
it was first discovered. Isolated advances in women’s health
by American anatomy professor expanded rapidly. Developments
George Corner, American included the early detection of
gynecologist Willard Allan, breast cancer through mammograms
and German biochemist Adolf (introduced in the 1960s), improved
Butenandt in 1934, it was family planning, in vitro fertilization
extremely difficult, and expensive, (IVF, see pp.240–41), safer delivery
to extract from natural sources. of babies, and better methods of
Its synthetic forms were developed pain relief in labor and childbirth.
by Bulgarian-American chemist Partly due to greater understanding
Carl Djerassi for Syntex in 1951, of women’s health, female life
and American chemist Frank expectancy in, for example, the US,
Colton for Searle in 1952. increased from 48 years in 1900 to
78 years in 1980.
205
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
Heart Disease
The most common cause of death worldwide, heart disease includes a range of malfunctions
and degenerations of the valves and muscles of the heart. Modern understanding of the
heart’s mechanisms has enabled limited treatment of heart disease, but is yet to reveal a cure.
A
ncient physicians recognized ▷ Unblocking
the heart as a critical organ arteries
for well-being—Greek Coronary angioplasties
philosopher Aristotle even regarded are carried out to widen
it as more important than the brain. blocked arteries and
However, it was not until English allow greater blood flow.
physician William Harvey (see pp. The procedure involves
84–85) discovered the circulation of placing a stent, or tube
blood in 1628 that physicians began (seen here in blue), in an
obstructed artery. The
to understand how modifications
method was first used in
in that circulation, caused by
1977, but balloons were
damage to the heart, might be
employed at that time
fatal to a patient.
instead of stents.
Advances in knowledge
Early understanding of heart disease
was gained through anatomical some patients might be the cause on the Diseases of the Heart and Great
dissections, such as those carried of disease and death. This would Vessels. However, doctors could do
out by Italian physician Giovanni be confirmed nearly two centuries little to treat the disease.
Mara Lancisi. His 1707 work later, in 1912, by American Advances were made in detecting
De Subitaneis Mortibus (On Sudden cardiologist James B Herrick. the signs of heart disease, such
Death) examined the effects of Late 18th-century cardiology as the invention of the stethoscope
cardiac dilatation—the enlarging focused on the nature and cause by French physician René Laënnec
of the heart cavity and stretching of of angina pectoralis—severe chest in 1816 (see pp.114–15). In 1855
the heart muscle—on the heart’s pains caused by the blocking of German physician Karl Vierordt
valves. In the 1720s German the arteries—which was first devised the sphygmograph, which
professor of physiology Friedrich identified as a disease by English allowed a graph of pulse activity to
Hoffmann theorized that the physician William Heberden in be traced. Others gradually refined
narrowing of arteries observed in 1768. When Scottish surgeon the device until, in 1890, Scottish
John Hunter was dissected in cardiologist James Mackenzie
1793 following his death after a invented a means to distinguish
severe angina attack, his coronaries between the pulse in the veins
were found to be ossified (or and in the arteries. This permitted
hardened)—further confirming more sophisticated monitoring of
suspicions of the disease’s cause. heart irregularities.
Physicians produced increasingly
detailed accounts of the state of Lifestyle causes
hearts suffering from coronary After Herrick’s 1912 discovery,
artery disease—caused by doctors understood the role of
atherosclerosis, or blocking of the atherosclerosis in causing heart
arteries—such as English physician disease. However, it was only
James Hope’s 1831 work A Treatise gradually that the role of patients’
lifestyles became apparent. In
1948 the United States Heart
◁ Restarting the heart Institute began the Framingham
A heart that has stopped or become irregular Heart Study, intended to identify
during a cardiac arrest can be revived with a behaviours that made heart
defibrillator—a device that delivers electric disease more likely. Smoking,
impulses to restart heart contractions. It was high alcohol intake, lack of
invented by American electrical engineer William exercise, obesity, and diabetes
Kouwenhoven in 1930. emerged as high risk factors.
206
HEART DISEASE
IN PRACTICE
207
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
Allergies and
Antihistamines
Greater understanding of allergies in the 20th century led physicians to
explore their prevention, treatments, and cures. However, the fast-rising
prevalence of asthma (see pp.214–15) and other allergic conditions
means they have become a “21st-century epidemic.”
A
llergies are nothing new: (such as hay fever—the world’s occurs within minutes of allergen △ Bovet’s breakthrough
records of allergic reactions most widespread allergy) to the exposure, causing swelling (of, for For his ground-breaking work in developing
date back thousands of severe or life-threatening (such as example, the eyes, throat, or hands), the first antihistamine, Daniel Bovet received the
years. Chinese Emperor Shennong reactions to medications, wasp or difficulty breathing or swallowing, a Nobel Prize in Physiology or Medicine. In 1947
(c.2700 BCE) was the first to treat bee stings, or foods such as peanuts, sudden drop in blood pressure, and he set up the Therapeutic Chemist Laboratory at
respiratory distress, now known shellfish, and dairy products). even a loss of consciousness. the Superior Institute of Health, Rome, where he
as allergic asthma, with ephedra, Research progressed further in worked with his wife, the scientist Filomena Nitti.
a shrub related to pines and firs. Allergies and anaphylaxis 1906 when Viennese pediatrician
However, little was understood As vaccines against some of the Clemens von Pirquet noted that
about allergies until the early world’s most virulent diseases exposure of the body to a particular
1800s, when English physician were developed, it was noted that substance resulted in the production
John Bostock described hay fever some caused inexplicable reactions. of antibodies. He called this response
or seasonal allergic rhinitis as a Unharmed by the initial injection, “allergy,” from the Greek allos
disease that affected the upper some patients would react violently (“other”), and ergia (“capacity to
respiratory tract. It is now known to the second. In 1902 French react”). The symptoms were caused ▷ Skin-
that allergic reactions arise as physiologist-physicians Paul Portier by the body’s attempts to fight off testing kit
a result of unwanted immune and Charles Richet coined the term a disease agent. Applying this idea, This early 20th-
responses to harmless substances “anaphylaxis” on discovering this hay fever can be explained as fluid century skin-testing
called allergens, and can range life-threatening response to certain production to protect the nasal kit contains a variety
from the seasonal and common medications. Anaphylactic shock passages against attack by an of potential allergens. The
“invader”—actually harmless pollen. substances responsible
CONCEPT
Histamine was first recognized and for allergies in some people are
suggested as the cause of allergic put onto or injected into the skin,
HOW ANTIHISTAMINES WORK reactions by British physiologist to see if they cause a reaction, typically
Henry Dale and British virologist redness or inflammation.
An allergic reaction occurs when or watery eyes. There are four types Patrick Playfair Laidlaw in 1910.
the body assumes that something of histamine receptors, H1–H4. It is Histamine is released from cells
harmless, such as pollen or dog hair, mainly through the H1 receptors that when the body is irritated by outside relieve the symptoms of allergies.
is a dangerous invader. On detecting histamines cause the symptoms of hay substances. The body then tries to In 1937 Bovet discovered the first
an allergen, the inflammatory fever. Antihistamines block histamines, expel the perceived invader, causing antihistamine substance, which, in
response in tissues involves mast cells and prevent them from binding to the symptoms typical of an allergic countering the effect of histamine,
releasing histamines. These bind to histamine receptors. This prevents reaction (see panel, left). By 1932 became effective in treating allergic
histamine receptors, causing reactions receptor activation and the events histamines were confirmed as reactions. This discovery led
such as localized swelling, itchiness, leading to an allergic reaction. causative agents in allergic response. to the development of the first
antihistamine drugs in 1942.
H1 receptor H Discovery of antihistamines Further milestones were reached
Histamines H
H
A H In the 1930s Swiss-born Italian with the detection of allergens
H
H H A A pharmacologist Daniel Bovet began such as pollen, dust mites, peanuts,
H H H
ALLERGENS – H H H a search for compounds that would and latex. In 1967 Japanese
H H
SUCH AS PARTICLES H
H H H H
FROM ANIMALS H H
H H H H A CELL A H
OR PLANTS
LUCRETIUS, ROMAN PHILOSOPHER, IN DE RERUM NATURA (ON THE NATURE OF THINGS), 56 BCE
208
A L L E R G I E S A N D A N T I H I S TA M I N E S
immunologists Kimishige
and Teruko Ishizaka discovered
the role of IgE (immunoglobulin E)
class antibodies in allergic reactions.
In response to repeated exposure to widely used to determine certain
an allergen, the allergic individual food, insect venom, and drug
produces IgE antibodies, which allergies. A drop of liquid allergen is 10 years, and the incidence of
cause mast cells (a type of white placed on the skin, then a pinprick peanut allergy alone tripled between
blood cell) to release chemicals, is made through the drop; an itchy, 1997 and 2008. The rise in eczema
such as histamines, into the red bump then appears within and asthma has gone hand-in-hand
bloodstream. Drugs that interact 15 minutes if the patient has an with this increase, and it appears
with this process can offer effective allergy to that substance. Home- that Western, developed countries
allergy treatments. testing kits are also available, but have higher incidences than
△ Mast cell The cause of some allergic reactions some question their accuracy. developing countries. Research
Mast cells contain histamine, an important can be difficult to diagnose. Allergy The number of people suffering continues into the causes of the
substance for fighting infection. When an testing kits were first developed with allergies has increased in increase, although it has been linked
allergic reaction occurs, the mast cells release in 1894 with the “functional skin recent years. The rate of those with to urbanization, environmental
a high quantity of histamine into the body. test.” Skin-prick testing is now food allergies doubles roughly every factors, air pollutants, and diet.
209
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
T
he polio strains of Enterovirus, paralysis, especially of the lower and even death. In 1916 the US living conditions improved, people’s
a group of viruses that affect limbs. Polio can also affect the recorded almost 28,000 cases and natural immunity decreased.
the digestive tract, spread muscles of the throat and chest, more than 6,000 deaths. While the The US led the way in polio
from person to person making swallowing and reasons for this sudden upsurge research. In 1935 two early
through mucus and breathing difficult. in the disease remain unclear, the vaccines underwent extensive
other nose and mouth hygiene hypothesis suggests that as trials—one at New York University
secretions, and via History of polio
contaminated water While the history of
and food. Up to 98 polio may be traced
percent of cases have back to antiquity, the
either no symptoms, disease was not much
or mild ones, such as written about until the
fever, vomiting, and 19th century—perhaps
diarrhea. However, because its vague and
depending on the often mild symptoms
virus strain, and were difficult to
the age and health identify. It was first
of the sufferer described as a distinct
(children tend to be △ Victims from the past disease in 1840 by
more affected by the Perhaps the earliest image of German physician
disease than adults), polio is an ancient Egyptian Jakob Heine, and
in 1–2 percent of scene, the “polio stele,” from in 1874 it was given
cases polio proved about 1,400 years ago. It shows its current name
more serious. The a man, probably a priest, with a by another leading
virus can move from deformed leg and foot. German physician,
the digestive system Adolph Kussmaul.
into the nerves, especially the By the early 1900s outbreaks
spinal cord, which can lead to of polio began to occur in Europe
deformity, wasting of muscle, and and North America. The epidemics
became increasingly serious and
widespread. Severe cases resulted
in permanent paralysis, major
breathing problems—treated by
placing the patient in a metal
chamber called an “iron lung” that
pulled air in and out of the lung—
▷ Rehabilitation
In 1927 US President Franklin D. Roosevelt set
up the Georgia Warm Springs Foundation (now
Roosevelt Warm Springs) for the treatment and
rehabilitation of polio patients. Here patients
in the 1950s read their mail from home.
210
P O L I O : A G L O B A L B AT T L E
Could you patent the sun?” well-being, this mascot’s first assignment was
to increase awareness regarding Sabin’s oral
JONAS SALK, AMERICAN PHYSICIAN AND MEDICAL RESEARCHER, 1955 polio vaccine in Atlanta and across the US.
and the other at Temple University, contracted polio in 1921, became discovered the polio virus in the
Philadelphia. Both of the trials used the focus of the major fundraising digestive tract, suggesting that it
attenuated (weakened) viruses and “March of Dimes” campaign, when entered the body via the mouth.
failed badly, with many volunteers people were asked to donate 10 In 1949 new and less expensive
becoming very ill, and some died. cents each to help fight the disease. methods of growing the virus
Three years later US President In 1941 the US-based researcher for vaccine development were
Franklin D. Roosevelt, who had Albert Sabin and his colleagues discovered, and by 1950 further
trials resulted in some success.
Polio vaccine
In 1952 the US suffered its worst
ever polio epidemic—there were Further improvements to polio
more than 57,600 recorded cases, vaccines, and global campaigns to
21,000 of which involved paralysis. administer them, made outbreaks
American virus expert Jonas Salk’s of polio rare by the 1990s. However,
team began new polio vaccine trials it lingered on in some regions, such
by administering the killed virus, as India (which was finally declared
which gave immunity but was not polio-free in 2011), Afghanistan,
long-lasting. In 1954 large-scale Pakistan, and Syria. The World
trials began. More than one million Health Organization (WHO), in
children were injected with the Salk conjunction with governments
vaccine. It proved up to 90 percent worldwide, launched the Global
effective against paralytic polio. Polio Eradication Initiative in 1988.
At the same time, Albert Sabin Renewed in 2013, with injectable
was developing an oral vaccine vaccines, the initiative aims to
against polio using live, attenuated banish the infection by 2018.
viruses. After another major trial,
this vaccine was deemed successful
too. Easier to administer than the ▽ Vaccine being administered
Salk vaccine, and mimicking the Vast numbers of volunteer health workers have
natural virus’s entry into the body, been involved in the polio eradication campaign.
mass vaccination began around the Here infants in Ghazni, Afghanistan, receive the
world from the early 1960s. vaccine in droplet form.
211
ERA OF SPECIALIZATION 1900 –1960
213
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
Inhalers and
Nebulizers
Asthma and other respiratory conditions have been treated for thousands
of years by inhaling medicine into the lungs. By the end of the 18th century,
specific inhalation devices were invented, which have now evolved into
sophisticated inhalers that can deliver precise doses of medication.
T
he benefits of breathing
in the smoke of certain
herbs, or the vapor from
an infusion of them, were
discovered at least 4,000 years
ago. At first this was simply
a matter of breathing in the
fumes of a fire or steam from a
cooking vessel, but more specific
inhalation therapies evolved in
many ancient civilizations.
In Egypt, for example, herbs
were put onto hot stones, and
the resultant vapor was inhaled,
while Indian ayurvedic medicine
recommended smoking pipes that
contained an herbal preparation
of the roots of datura plants,
which are now known to act
as bronchodilators that open
up constricted airways. Similar
medicinal pipes were also used
in Central and South America to
smoke a number of different herbs.
Early inhalers
The first specific inhalation device
was possibly designed in ancient
Greece, and has been attributed
to the physician Hippocrates
(see pp.36–37). This inhaler
was simply a cooking pot, with
a hole in its lid through which a
straw could be inserted. The pot
would be filled with an infusion
of herbs, spices, or other
214
INHALERS AND NEBULIZERS
BRONCHIAL ASTHMA
solution to a mist so fine The characteristic difficulty in The immediate effects can be
it actually floats in air.” breathing experienced during
an asthma attack is due to the
alleviated by the inhalation of drugs
to dilate the airways. The causes of
FROM INSTRUCTIONS FOR ASTHMANEFRIN HAND-BULB NEBULIZER, 1940 constriction and obstruction of the asthma are complex, including genetic
airways caused by inflammation. and environmental factors. Attacks
As well as swelling of the bronchi, can be triggered by pollution, pollen,
medicines and heated, and the of opium for his device, broncho- muscles around the airways contract, animal hair (see pp.208–09), or changes
vapor that arose would be dilating datura plants began to be and excess mucus is produced, in air temperature. Exercise, stress, or
inhaled through the straw. imported from India in the early restricting breathing still further. anxiety can also bring on an attack.
Despite its simplicity, this Greek 1800s, and by the middle of the
invention became the model for century, this became the standard
the first modern inhalers, which drug for inhalation therapy.
appeared in the late 18th century. However, many users of these
At that time, the Industrial ceramic inhalers simply breathed in
Revolution was well under way the steam from plain warm water.
in England, and innovations of
all kinds were in the air—as was a Invention of atomizers
great deal of atmospheric pollution A breakthrough in the development
from burning coal by industry. So it of inhalers was made in the
is perhaps not surprising that it was middle of the 19th century, with
an English physician, John Mudge, the invention of the atomizer by
who, in 1778, revived the idea of French doctor Auphon Euget-Les
334
an inhalation Bain. As much
vessel, modifying MILLION a product of the
a pewter beer The number French perfume
tankard along of people industry as
the same lines in the world an advance
as the Greek suffering from asthma, in medical
device. Holes according to the 2012 Global technology, this
in the handle of Burden of Diseases study. device used air operated by a hand pump, while electric compressor that could be
the tankard pressure to form a steam-powered inhaler was regulated more easily.
allowed air to be drawn through a mist of droplets from a liquid, developed by German doctor
the liquid in the tankard and which could then be inhaled. This Emil Siegle. These atomizers were Further developments
inhaled through a mouthpiece technology was used to develop originally designed to deliver a Ensuring an accurate dosage
fitted to the lid. Mudge’s invention nebulizers—machines that mist of mineral waters from spas, of medication was still difficult,
soon caught on, and in the 19th “atomize” liquid medicine into a and later included medicinal however. In 1948 researchers
century ceramic versions of this mist or spray to be inhaled via ingredients. However, at the turn at Riker Laboratories in the
inhaler became common. While nose, mouth, or both. Jean Sales- of the 20th century the discovery US developed the Aerohaler,
Mudge had advocated an infusion Giron’s portable inhaler was that adrenal extract worked as a which gave a measured dose of
bronchodilator prompted the use isoprenaline or isoetharine powder
of epinephrine in aerosols to treat when air was inhaled through
asthma. The success of the drug it. The turning point came in
led to widespread use of nebulizers, the 1950s with the development
which became more portable and of the pressurized metered-dose
convenient to use with compressed inhaler (pMDI), which used a
air produced by squeezing a bulb. valve on a pressurized container
Another important innovation that delivered a single measured
of the 1930s was the use of an dose of atomized liquid.
Unfortunately, the pMDI devices
relied on chlorofluorocarbon (CFC)
propellants in the pressurized
▷ Hand-bulb nebulizer cartridge, which were banned
This inhaler, made in England in 1987 in an effort to protect the
in the 1940s, was operated by ozone layer. CFCs have been
squeezing the rubber bulb. This superseded by hydrofluoralkenes
forced liquid medicine through (HFAs). Also available are dry
an atomizer, sending a fine mist powder inhalers (DPIs), which
into the plastic face mask. were first developed in the 1970s.
215
Early MRI machine
One of the pioneers of MRI, Dr. Raymond
Damadian (standing) demonstrates his body
scanning machine, which used a “super
magnet” to detect cancerous cells. The first
MRI body scan in 1977 was of the thorax of
his colleague Laurence Minkoff (seated), and
took nearly five hours.
SCANNING MACHINES
Scanning Machines
The discovery of X-rays in 1895 made it possible to see inside the body without surgery. Further
advances in medical imaging came in the second half of the 20th century, with the development
of various methods of scanning that provide more detailed, three-dimensional images.
A
ttempts in the early 20th data is then processed digitally ▷ CT scan of
century to improve the level to produce a three-dimensional healthy lungs
of information provided by (3D) image. The three-dimensional
X-ray images (see pp.172–73) led to CT scanning became a mainstay capabilities of CT
the invention of the first scanning of medical imaging soon after it scanning are especially
technology—tomography, from was introduced. The principle of useful in examining the
the Greek tomos, meaning a slice tomography, however, was not internal structure of lungs,
or section. Initially, tomography restricted to X-ray imaging. At which cannot be as
involved moving an X-ray source the time the first CT scanners clearly seen using simple
radiography.
and detector simultaneously over appeared, research was already
a patient, which created a single, underway into an alternative to
blurred image with one plane in X-rays—using radio waves and
focus. By the mid-20th century, magnetic fields.
several X-ray images of a “slice”
of an object or body from various Magnetic resonance imaging
angles could be assembled to create When a body is subjected to a very
a composite image. strong magnetic field, particles Other imaging techniques A new generation of imaging
known as protons are forced into Developed in the 1950s, ultrasound machines is now being developed,
Computerized tomography alignment. When they return to scanning transmits high-frequency based on discoveries in nuclear
The first computerized tomography their original positions, the protons sound waves into the body and medicine. Molecular imaging
(CT) or computerized axial emit detectable radio signals. The detects their echoes, using the techniques such as SPECT (single-
tomography (CAT) scanning protons of different tissues send same principle as the sonar used by photon emission computed
machines appeared in the early out different signals, enabling the submariners. Ultrasound machines tomography) and PET (positron
1970s, and were slow and clear imaging of bones and soft can now produce real-time moving emission tomography) use gamma
cumbersome. Today, however, tissues, including tumors. images, and have the advantage rays, and are sometimes used in
modern CT scanners can take Magnetic resonance imaging (MRI, of being more mobile than other a hybrid machine along with CT
thousands of X-ray readings in see pp.232–33) was pioneered in scanning technologies, with or MRI scanning to take highly
seconds, and interpret them to the 1970s, and is now widespread. hand-held devices available. detailed images of the body.
create a consolidated computer Unlike X-rays and CT scanning, MRI
image almost immediately. As does not involve exposing the patient BRITISH ELECTRICAL ENGINEER (1919–2004)
the patient passes through the to radiation. However, the patient
hoop-shaped machine, the must remain still during an MRI scan, SIR GODFREY HOUNSFIELD
scanner rotates around the frame, lying on a table that passes through
sending and detecting beams of the machine, which is effectively a Godfrey Hounsfield was a pioneer in
X-rays through the body. The hollow cylindrical magnet. the field of computerized tomography
in the 1960s and 1970s. Fascinated by
electronics from childhood, Hounsfield
worked on electronics and radar with
◁ Pulsed doppler
the Royal Air Force during World
Modern ultrasound
War II before studying electrical
scanners can assess
engineering at Faraday House in
the blood flow in
veins and arteries by London. In 1949 he joined Electrical
sending and receiving and Musical Industries (EMI), where
pulses of high- he developed the idea of building
frequency sound a cross-sectional image of an object
waves, and taking into from X-ray readings taken from
account the Doppler various angles. He was a joint
effect—changes in winner with physicist Allan McLeod
wave frequency that Cormack of the 1979 Nobel Prize
occur with direction for Physiology or Medicine.
of movement.
217
E R A O F S P E C I A L I Z AT I O N 1 9 0 0 – 1 9 6 0
T
he last 200 years have seen used in the textile industry. These bacteria. Demand for the drug The thalidomide scandal
enormous growth in the include Bayer in Germany, and was so high that Ehrlich made it However, not all new drugs were
development of medicines. Pfizer in the US. Bayer’s first move available commercially with no entirely beneficial. There was little
Advances in the field of chemistry into manufacturing medicine came further tests (see pp.186–87). rigorous testing, and the toxicity
during the 19th century led to the with the development of aspirin The Germans and the Swiss of some drugs was discovered too
isolation of active ingredients, such (see pp.170–71)—one of the most became the dominant forces in the late. One example of this came
as morphine extracted from opium, successful pharmaceutical products expanding pharmaceutical industry with the use of thalidomide in the
and quinine from the bark of the ever—which it began distributing prior to World War I. However, in 1950s and 1960s. Developed by
cinchona tree. In the 19th century, in 1899. 1917, the aspirin trademark and its West German company Chemi
small firms such as Merck in The end of the 19th century also US assets were seized from German Grünenthal, thalidomide was
Germany, Hoffmann-La Roche in saw the development of vaccines, company Bayer introduced as
Switzerland, Burroughs Wellcome
in England, and Smith Kline in
such as those for diphtheria and
tetanus (see pp.158–59), which
and the US
subsidiary of 1 TRILLION US DOLLARS The a sleeping pill,
total level of pharmaceutical and later given
the US started making and selling created further business for Merck was split revenue worldwide in 2014. to pregnant
these drugs wholesale. Other fledgling pharmaceutical firms. off from its mothers to ease
firms that are now well-known In 1909 German scientist Paul German parent company. morning sickness. After a short
pharmaceutical companies began Ehrlich and his assistant Sahachiro Germany’s position as leader time on the market in Europe,
as makers of organic chemicals, Hato found that the compound of the pharmaceutical industry obstetricians observed that babies
producing dyes and other substances Salvarsan was deadly to syphilis was compromised and other were being born with deformities
companies, particularly in the to their limbs. Research rapidly
US, took advantage of this. The identified thalidomide as the
pharmaceutical industry was about culprit and it was withdrawn in
to experience phenomenal global 1961. Thalidomide led to a public
growth, boosted by breakthroughs outcry over the insufficient testing
such as the isolation of insulin to of drugs, and as a result major
treat diabetes (see pp.190–91) and regulatory reforms were enforced.
the discovery of penicillin in 1928
(see pp.198–99). Blockbuster drugs
A number of world-changing
drugs were developed in the
post-war era. The contraceptive
◁ Thalidomide victim pill, introduced in 1960 (see
A victim of thalidomide leaves court in a pp.224–25), transformed society
wheelchair, while a protester stands with and the lives of women. Valium
a banner reading “Thalidomide, Justice!” (diazepam)—used mainly to treat
during the trial of the drug’s manufacturer anxiety disorders, seizures, and
in Madrid, Spain. This was one of a spate alcohol withdrawal symptoms—
of cases against the makers, Grünenthal. was brought to the market by
218
Pill production
After World War II, drugs were being mass produced and
manufacturers began compromising on quality and safety.
This technician did not observe hygiene measures, such
as gloves and a mask, when working with these pill-
coating machines, each with a capacity of 400,000 tablets.
219
PROMISES
OLD AND NEW
1960 – PRESENT
1977 1979
Experts agree that Michael Bishop and Harold
the term “Alzheimer’s Varmus discover the first
disease” can be used oncogene (cancer-linked
for presenile and senile gene), c-Src.
dementias; the condition
is no longer seen as 1989
being linked to age. 1983 The first telemedicine
Harald zur Hausen and system for remote
coworkers identify diagnosis and treatment
human papillomaviruses is launched, specializing
(HPVs) in cervical cancer. in cardiac defibrillation.
222
1960–PRESENT
The late 20th century raised great hopes that the new gene and stem Other fields race ahead, including preventive medicine, vaccination,
cell therapies would revolutionize many forms of treatment, but the and the battle against cancers. Technology also brings great progress,
early 21st century moderated that optimism—while some techniques for example, noninvasive imaging and “bionic” implants. Advances in
achieved success, others showed slow, patchy progress. Smallpox was medicine have helped raise global life expectancy from 31 years in
eradicated but other infections continue to be stubbornly resistant. 1900 to 70-plus today, with more of those years in good health.
223
PROMISES OLD AND NEW 1960–PRESENT
H
istorically, women had used a century the most common form in rabbits. They began tests using Rican test subjects had experienced
variety of methods to prevent of contraceptive was the pessary, Djerassi’s synthetic progesterone nausea and dizziness; subsequently
conception. Some, such a hollow rubber hemisphere and a similar compound developed oral contraceptive use was linked
as the pessaries used by ancient covering the outer cervix to prevent by Frank Colton at the Searle to thrombosis (blood clots) and
Egyptian women made of cotton sperm entry; later designs included pharmaceutical company. coronary embolisms (heart vessel
soaked in date juice, honey, and the diaphragm and cervical cap. All blockages). A US Senate hearing in
acacia, may have these methods, Consequences of contraception
17.1
been effective. The percentage of however, were In 1956 full-scale human trials of
More dubious American women cumbersome, an oral combined (progesterone-
methods included aged 15–44 using the pill as a costly, or simply estrogen) contraceptive began in
the medieval contraceptive method in 2010. did not work well. Puerto Rico, involving more than
advice of wearing 200 women. The trials had a 100
outlandish wreaths of herbs, Developing the pill percent success rate in preventing
desiccated cat’s livers, or weasel In the 1920s, research on hormones pregnancy. In 1960 the Food and
testicles to prevent pregnancy. active in the female reproductive Drug Administration (FDA)—the
Condoms were first mentioned by cycle (see p.205) offered hope that US drugs regulator—approved the
Italian physicist Gabriele Fallopio in a chemical means of impeding pill for contraceptive use, and by
a 1564 work on syphilis as a means pregnancy could be found. In 1921 1961 the UK and Germany had
of preventing the disease and were Austrian physiologist Ludwig followed suit. By 1965 6.5 million
in common use as contraceptives by Haberlandt transplanted the ovary American women were using the
the 17th century. By the late 19th of a pregnant rat into one that was pill. Women could now control the
not pregnant, and the second rat timing of their pregnancies and
CONCEPT
stopped ovulating. This led to the avoid the risky, and often illegal,
discovery of progesterone, one of process of abortion. This led to a
HOW THE PILL WORKS the main hormones involved in rise in female participation in the
pregnancy, in 1934. labor force, which in the US rose
The contraceptive pill contains the In 1942 American chemist Russell from 26.2 million in 1965 to 73
female hormones estrogen and Marker found a way to extract million by 2014. Some, though,
progesterone. Estrogen prevents progesterone from Mexican yams, were uneasy that the “sexual
the pituitary gland from secreting
another hormone which normally
triggers ovulation. The progesterone
thins the lining of the womb as well,
“ … reproductive health includes
which makes it difficult for an egg contraception and family
to implant there, and it thickens the
mucus around the cervix, making planning and access to legal,
it harder for sperm to pass through.
safe abortion.”
HILLARY CLINTON, US SECRETARY OF STATE, AT THE G8 FOREIGN MINISTERS’ MEETING, 2010
224
THE CONTRACEPTIVE PILL
Margaret Sanger
“ No woman can call herself free
until she can choose whether
she will or will not be a mother.”
MARGARET SANGER, FROM WOMAN AND THE NEW RACE, 1922
L
iberal thinker Margaret Sanger ▷ Activist on trial
is credited with having given This picture of Sanger was taken at the time of
women the right to choose her 1916 trial, after she opened the first US birth
and use modern methods of “birth control center in New York City. Although she
control”—a term she invented. was found guilty and the clinic closed, her
A tireless activist, health worker, campaign gained huge momentum.
and campaigner, she argued against
the Comstock Laws—US legislation
that limited access to contraceptives of 23 years. Her mother’s early
and information regarding them. death at the age of 49 set Sanger
on a course toward the nursing
Early years profession. She interrupted her
Sanger was greatly affected by her training to marry, have three
upbringing as one of 11 offspring children of her own, and share
surviving from her mother’s her developing radical views
18 pregnancies over a period about society and politics with
her husband William Sanger.
After moving to New York City,
she began to join left-wing
groups, attend socialist rallies,
and also nurse in the city’s
poorer areas. Here she
encountered women from
working families who
had no knowledge or means
to obtain contraception and
who had suffered at the hands
of “backstreet,” or illegal,
abortionists, often with
serious, long-term harm.
Sanger felt that women should
be in charge of their bodies,
their health, and their ability
to enjoy sex without it leading to
motherhood. But, in the early
1900s, the Comstock laws—anti-
△ Radical women’s journal obscenity legislation originally
Margaret Sanger published the first issue of passed in 1873—bracketed
The Woman Rebel in March 1914. The journal contraception with indecency
embraced the view that every woman should and prostitution. It was therefore
be the “absolute mistress of her own body.” a federal offense to disseminate
226
MARGARET SANGER
▷ Birth control
TIMELINE
in court
Crowds gather outside ■ 1879 Born Margaret Louise Higgins
a courtroom in New York in Corning, New York, into an Irish-
City in 1929 to attend American family.
hearings regarding a ■ 1899 Her mother dies of a tuberculosis-
raid on a birth control related condition, and leaves an
clinic. Clinics that enormous impression on her.
dispensed contraceptive
■ 1900 Attends White Plains Hospital
information faced
as a probationer nurse.
constant harassment
under the Comstock ■ 1902 Marries architect-decorator
legislation. William Sanger. They have three
children but later separate.
■ 1911 Moves with her family to
New York City and begins work
in the poor East Side area.
■ 1914 Coins the term “birth control.”
She spends time in England to avoid
being summoned for trial.
■ 1916 After several warnings from the
authorities, Sanger is arrested for opening
birth control information or items
through the mail or across state “Contraceptives can put the first US birth control center. Her
pamphlets “What Every Mother
227
PROMISES OLD AND NEW 1960–PRESENT
K
nown since antiquity, process called metastasis. Some describes growths on the skin, in Theories of cause
different cancers affect varied cancers do not form physical the rectum, and in urinary passages. Ancient Greeks attributed the
parts of the body, have diverse tumors but cells still multiply Ancient Greek physician causes of cancers to imbalance in
causes, and some tend to affect out of control, as in certain Hippocrates (see pp.36–37) noted the body’s four humors (see
people of a certain age, gender, or leukemias that affect the blood. that formations of new blood vessels pp.34–35). In the 17th century
occupation. This is probably why in and around a tumor resembled some form of contagion was
they were not grouped as a single Cancer through the limbs of a favored; later cancers were thought
disease until the 18th century.
Despite their diversity, all cancers
the ages
Evidence of 8.5MILLION Estimated number crab, or karkinos
of cancer deaths in the
world every year. Cancers are the
in Greek. Galen
to have a parasitic origin. In 1761 a
more scientific basis for cancers was
have the same underlying basis: cancerous (see pp.40–41) established when Italian anatomist
second biggest killers in the US,
out-of-control cells. Instead of growths dates and are responsible for two in five used onkos Giovanni Morgagni began linking
following the usual path of growing, back more than deaths in the UK. to refer to a features of his patients’ illnesses
doing their job, and dying as part 3,000 years to nonspreading to abnormal findings in autopsies
of the body’s natural cell turnover, ancient Egypt. Abnormal bone swelling, mass or tumor; oncology, after their deaths.
mutant cells fail to perform normally, shapes in excavated mummies are the branch of medicine dedicated to In 1838 German physiologist
multiply too fast, accumulate into suggestive of tumors, and the cancer, is derived from this term. and microscopist Johannes Müller
a tumor or growth, and may also Edwin Smith and George Ebers Great Islamic physicians (see proposed the blastema theory:
spread to where they should not papyri (see pp.20–21) describe pp.48–51) such as al-Razi and Ibn according to this, cancers arose
be. Self-contained benign tumors probable cancers, especially of the Sina described various growths of from budding elements (blastema)
are noncancerous. In malignant (or breast. Even older accounts from the eye, nose, tongue, stomach, liver, sprinkled between normal tissues.
cancerous) tumors, cells detach and the Sumerian civilization report kidney, bladder, testes, and breast. His student, German pathologist
disperse to other parts of the body, “ulcers that spread,” while in India, Rudolph Virchow (see pp.152–53)
forming secondary tumors, in a the Susruta Samhita (see pp.30–31) proposed some form of tissue
Cancers
One of the five major causes of death worldwide, cancer has always been regarded as
a mystery, and its causes the subject of many theories. However, in the last half-century
there has been huge progress in the understanding and treatment of cancers.
CONCEPT
Fewer repaired
proto-oncogenes
228
CANCERS
◁ Cancer cell
Lung cancers may begin as a single cell
as seen here. They multiply fast and
after 25–30 doublings, a solid tumor
contains about a billion cells and is
10–15 mm in size. Once a cancer can
stimulate blood vessel growth to
nourish itself, a process called
angiogenesis, it may develop even
more rapidly.
229
PROMISES OLD AND NEW 1960–PRESENT
230
CANCERS
Advances in radiotherapy
A patient about to undergo radiotherapy for
a brain tumor lies under a linear accelerator.
Radiation beams are delivered with
accuracies of less than a millimeter.
Real-time imaging keeps track of movements
such as breathing and adjusts the strength
and direction of the beams accordingly.
231
PROMISES OLD AND NEW 1960 – Present
Advanced Imaging
In 1895 the use of X-rays (see pp.172–73) provided the
first noninvasive internal views of the human body.
The following century saw much progress in imaging
technologies, and the foremost of these was magnetic
resonance imaging (MRI), introduced in 1980.
▷ Brain scan
This MRI scan of a 35-year-old patient’s head reveals fine details,
including nerve fibers, blood vessels, connective tissue, and the
fluid-filled cavity under the wrinkled cortex. The face and neck
bones have been imaged by computerized tomography (CT).
232
PROMISES OLD AND NEW 1960–PRESENT
T
he first slow steps toward with healthy donated ones, was the and Richard Lower at Stanford, functions for several hours while
successful transplantation ability to perform vascular suturing, California, in 1959. They used a surgery is carried out. In 1954
began in the 1890s, when that is, sew back torn or severed technique of topical hypothermia, the science of transplantation
skin grafts using the patient’s own blood vessels. This procedure was in which the donor heart is frozen took a major step forward with
tissue were successfully carried out; established by French surgeon outside the body, preserving its the first successful human kidney
but those using donor skin, for Alexis Carrel from 1901 to 1910. transplant—between identical
example from corpses, had little twins. Rejection—when the
success. An attempt to transplant a First transplants recipient’s immune system attacks a
donor pancreas in 1894 also failed. The first transplantation attempts donor organ because it recognizes it
Doctors did not as yet understand were carried out on dogs, starting as foreign tissue—was a danger, but
the role of the immune system in with their kidneys. The earliest in this case it was low as donor and
accepting donor organs. successful canine heart transplant recipient were genetically identical,
Another prerequisite for the was carried out by Norman Lumway and the kidney recipient lived for
complex surgery needed to remove nine years. In general the survival
diseased organs and replace them rate was much lower because
▷ Pioneering surgery
Christiaan Barnard (left) with Michael
DeBakey (centre) and Adrian Kantrowitz.
Kantrowitz performed the first paediatric
heart surgery, on a 2-day-old baby, just
three days after Barnard’s first operation,
while DeBakey developed an early form
of artificial heart.
THE FIRST HEART TRANSPLANT
33
ways, and can also take into procedure—is then sutured
YEARS Longest period account the condition of the old into place.
survived by a heart and donor heart. In 2006 “beating heart”
transplant patient— In heterotopic transplantation, surgery was introduced,
John McCafferty, the patient’s old heart is left in place, where the donor heart is
who died on February 9, 2016. giving it a chance to recover or take not cooled but connected
over if the new heart fails. On the to a machine that allows
body’s immune system—were other hand, in orthotopic heart it to pump blood,
developed by British surgeon Roy surgery, the patient’s chest is opened increasing the amount of
Calne, and survival rates soon up and the blood vessels (such as time it can be kept viable.
improved. These drugs, as well as the aorta and pulmonary artery) are Donor Old
refinements to the heart-lung dissected before the old heart is HETEROTOPIC HEART TRANSPLANT heart heart
machines that could take over the
function of those organs during
surgery, made heart transplants five hours: the surgeons first conducting heart transplants and of transplant operations rapidly
feasible. However, ethical concerns removed Washkansky’s diseased by 1971, 180 operations had been increased, reaching around 3,500
delayed surgeons from performing heart, and then carefully sutured performed. However, survival rates per year by the early 21st century.
the operation for several years. the blood vessels in his chest to the remained disappointing. There was Some heart transplant patients
donor organ. The new heart failed a high rate of rejection and the have now lived for over 30 years
The big leap to beat at first, but it was shocked immunosuppressant drugs had and the 10-year survival rate
On December 3, 1967, Christiaan into life with a defibrillator. The severe side effects. In 1976 Belgian has reached 65 to 70 percent.
Barnard, a South African surgeon operation had worked, but 19 days immunologist J. F. Borel discovered A continuing problem is transplant
at Groote Schuur Hospital in Cape later Washkansky succumbed to the immunosuppressant qualities coronary artery disease—the
Town, successfully transplanted a pneumonia, aggravated by an of cyclosporine. It had far fewer excessive narrowing of arteries
heart from a donor—a 24-year-old immune system that had been toxic side effects than previous where blood vessels are sewn back
woman who had died in a traffic suppressed to stop organ rejection. antirejection drugs and was together during surgery. Resolving
accident—into the body of 54-year- In January 1968 Barnard operated licensed for use in transplant this, the most common cause of
old Louis Washkansky, who was on his second patient, Philip surgery in 1983. When tried in death after heart transplantation,
suffering from a terminal heart Blaiberg, who lived for 594 days. heart surgery, survival rates for is one of the most serious challenges
disease. The operation took nearly Surgeons in other countries began patients improved and the number faced by heart surgeons today.
transplant a heart
than to bury it to be
devoured by worms.”
CHRISTIAAN BARNARD, SOUTH AFRICAN SURGEON,
Left outflow
TO TIME MAGAZINE, 1969
▷ Artificial heart
The first artificial heart—designed
to keep a patient alive while
waiting for a donor heart—was
implanted in 1982. This AbioCor
artificial heart, first implanted in
2001, has an internal battery that lasts
4 hours, and has a lifespan of 18 months.
235
PROMISES OLD AND NEW 1960–PRESENT
Retinal implant
One form of retinal implant uses an external digital
camera and a processor, which transmits signals into
the eye, to the latticelike implant. This emits pulses of
electricity directly to retinal cells, to stimulate the optic
nerve and create a simulation of vision.
A
rtificial limbs were among ▷ Early eyeball
the first prostheses to be Dating to 4,800 years ago, this artificial
fitted, mainly to replace legs eyeball found in Iran is the oldest known eye
or arms amputated after war prosthesis. Made of tar and animal fat, it has
injuries or accidents. Protheses gold wire inserted in it to give a realistic
are mentioned in the Rig Veda, impression of the natural capillaries of the eye.
a Hindu religious text from the
2nd millennium bce. The oldest below the knee. A projecting In 1575 Ambroise Paré (see leather harnesses and knee-locking
surviving artificial leg, made of pole was strapped to the stump, pp.78–79) produced Les Oeuvres, mechanisms. Over the years
bronze and iron with a wooden which, although ungainly, allowed the first work on limb prosthetics. incremental improvements were
core, was found in Capua in Italy the wearer some mobility. It Based on his career as a French made in comfort and functionality,
and dates from 300 BCE. Early remained the most common military surgeon, Paré described but the problem of being unable
artificial legs were “peg-legs” leg prosthesis throughout the more sophisticated artificial legs to flex the leg persisted in those
used to replace limbs amputated medieval period. that incorporated adjustable who had undergone below-knee
236
IMPLANTS AND PROSTHESES
237
PROMISES OLD AND NEW 1960–PRESENT
1 HIP JOINT
PROSTHESIS
(1960S)
5 PLASTIC DENTURES
(20TH CENTURY)
Polyethylene
femoral end
4 CARDIAC VALVES 6 PROSTHETIC
(1978–79) HAND (2014)
2 RUSSIAN PACEMAKER (2015)
3 JARVIK-7
ARTIFICIAL
HEART (1982)
Openings connect to
major arteries and veins
Aluminium
One of the oldest known prostheses—an ancient Egyptian wood-and-leather toe— casing
dates back to c.1000 BCE. Today’s bionic body parts have advanced composites and
powered joints that respond to signals from muscles or even direct from the brain.
1 Hip joint prosthesis This low-friction model used amputees; it allowed no real use of the hand for
polyethylene ends to reduce wear, an improvement on manipulation. 8 Prosthetic eye During World War II,
the first hip replacements, which used prostheses made artificial eyes made of acrylic were substituted for those
of glass and metal. 2 Russian pacemaker This model made of glass. 9 Bionic arm This powered arm
is “three-chambered,” with an extra lead to harmonize the was made using 3-D printing, which may soon allow
beating of the right and left ventricles; electric pacemakers mass-production of such prostheses at a fraction of the
to regulate the heartbeat were first implanted in 1958. previous cost. 10 Modern artificial leg Made of light
3 Jarvik-7 artificial heart The first artificial heart to be material, this leg includes customized joints to spread
implanted in a human, this device required a 397-lb weight and microprocessor controls that allow gait to
(180-kg) power unit to function. Modern models have be adapted to walking speed. 11 Prosthetic leg This leg
portable external batteries. 4 Cardiac valves These Starr- has lockable knee and ankle joints, and a perforated
Edwards valves were used for mitral valve replacements, leather corset that helps the wearer stay cool. 12 Prosthetic
a procedure developed in 1960. 5 Plastic dentures In arm Made of aluminum, this arm has more flexible joints
the 20th century plastic dentures replaced those made of than its wooden predecessors. 13 Knee arthroplasty
ivory, porcelain, or sometimes the teeth of dead soldiers. replacement prosthesis The plastic total condylar knee—
6 Prosthetic hand The medical applications of 3-D with single tibial unit and a central stem—invented in the
printing, as used here, are increasing, especially in the area 1970s closely mimicked the action of a natural knee joint.
of reconstructive surgery. 7 Artificial arm This iron hand 14 Electric prosthetic foot This was the first artifical foot
Attachment
included a forearm and was designed for below-the-elbow that was powered using the patient’s nerve impulses. strap
238
8 PROSTHETIC EYE
(20TH CENTURY)
Socket, which
forms the
connection
with the
residual limb
9 BIONIC ARM
(2015)
Modular
shank
Independently pylon
operable fingers
10 MODERN
ARTIFICIAL LEG
(21ST CENTURY)
11 PROSTHETIC
LEG (1861–1920)
Fully
flexible
thumb
Tibial unit
Canvas-coated hand
Elbow joint 12 PROSTHETIC ARM to resemble glove
(EARLY 20TH CENTURY)
14 ELECTRIC
13 KNEE ARTHROPLASTY PROSTHETIC
REPLACEMENT PROSTHESIS (2006) FOOT (1987)
239
PROMISES OLD AND NEW 1960 – Present
In Vitro Fertilization
The world’s first baby created in vitro (by fertilizing a
mother’s egg outside the body), Louise Brown was born in
Oldham, north England, in 1978. A ground-breaking and
controversial event, it divided communities, as well as
religious and political leaders. Since then, more than 3
million in vitro fertilization (IVF) babies have been born.
▷ Infertility
Intracytoplasmic sperm injection (ICSI), like all forms of IVF,
involves the fertilization of the egg by the sperm outside the body.
However, rather than the egg being placed in a dish with lots of
sperm, in ICSI, the egg is directly injected with a single sperm.
240
PROMISES OLD AND NEW 1960–PRESENT
I
n the late 1970s physicians In 1983–84 two research teams
in California noted an increasing identified a viral agent believed
occurrence of Kaposi’s sarcoma, to be responsible. The French
a rare type of cancer, and of team, led by Luc Montagnier,
Pneumoncystis carinii, a form of named it lymphadenopathy-
pneumonia previously seen only in associated virus (LAV); Robert
patients whose immune system had Gallo’s US team called it human
been compromised (for example T-lymphotropic virus III (HTLV-III).
by chemotherapy). By 1981 the US It was realized that these were
Centers for Disease Control and the same microorganism,
Prevention (CDC) diagnosed these which, in 1986, was named
patients with a new disease, which human immunodeficiency
came to be called Acquired Immune virus (HIV).
Deficiency Syndrome, or AIDS. The search for a cure
became urgent as, from the
Pattern of transmission first isolated cases, AIDS turned
Initially, clusters of victims into an epidemic. By 1989
were identified among the there were 100,000
male homosexual community, AIDS cases in the US
intravenous drug users, and and a further 142,000
users of blood products such worldwide, rising to
as hemophiliacs or patients 30 million by 1993.
undergoing transfusions. This The early cases were
seemed to indicate a cause predominantly in the
associated with the transfer of homosexual community, but
blood or other human body fluids. the balance tipped as rates
among intravenous drug
users in the US and Europe
▽ Tip of the iceberg rose. Millions of cases were
Public health campaigns used television also reported in sub-Saharan
advertisements such as this one from 1987 to Africa, where the disease
emphasize the severity of AIDS, which had claimed appeared to be spreading
many lives and would continue to do so if ignored. primarily as a result of
Protein matrix
242
HIV AND AIDS
ANTIRETROVIRAL DRUGS
danger we have faced for Treatment using antiretrovirals acts
243
PROMISES OLD AND NEW 1960–PRESENT
S
cientists had long been associated with an excess of acid, findings in 1982, but the medical △ HeLa cells for research
puzzled by a range of diseases and patients were commonly community was slow to accept These cells are a part of a line of cells that were
that were characterized advised to consume a bland diet them, and the treatment of ulcers first extracted in 1950 from the tumor of a
by inflammation or cancerous and reduce stress in their lives. with antibiotics was not approved woman with cervical cancer. The cell line was
tumors. Although the progression An alternative link was found in until 1996. It is now known later found to be infected with HPV-18 and
of these diseases was understood, 1979, when Australian pathologist that Helicobacter pylori causes 80 played a key role in the identification of
the causes remained unclear. Robin Warren found the curved percent of all gastric ulcers, and a vaccine against HPV.
Factors such as pollution, lifestyle, bacteria Helicobacter pylori in the has a role in the development
heredity, and aging were blamed stomach of a patient suffering of stomach cancer too.
for conditions such as stomach from dyspepsia (indigestion), Chlamydia pneumoniae, identified
ulcers and several forms of cancer. a milder condition of the upper Viruses and vaccinations in 1986 as a cause of respiratory
gut. Warren conducted further Cervical cancer is the fourth diseases, has been shown in
Linking bacteria and cancer investigations with his colleague most common cancer among laboratory tests conducted with
Ulcers and abrasions in the lining Barry Marshall and found a women, causing more than animals to play a role in athero-
of the stomach or duodenum (the correlation between the presence 250,000 deaths worldwide each sclerosis (hardening of the arteries).
first section of the small intestine) of Helicobacter and duodenal year. In developing countries, Recent studies have also
had long been understood to be ulcers. The pair announced their where screening programs suggested that Parkinson’s disease—
are unaffordable, it is the most a progressive condition affecting
A U S T R A L I A N PAT H O L O G I S T S
common form of cancer among the nervous system—may be
women. In 1974 German virologist linked to inflammation of the
BARRY MARSHALL (1951–) AND ROBIN WARREN (1937–) Harald zur Hausen first suggested brain caused by infections such as
a possible link between cervical influenza or Japanese encephalitis.
Marshall (left) and Warren (right) a case of acute gastritis (a mild cancer and Human Papilloma Further research is likely to add to
conducted biopsies on 100 patients inflammation of the gut) as a result. Virus (HPV), which is part of the number of diseases understood
as part of their research to discover The Australian scientists suffered a family of viruses that cause to be caused by infectious agents.
the bacterial causation of stomach almost a decade of scorn from infections including genital warts.
and duodenal ulcers. In 1984, as gastroenterologists before their In 1986 zur Hausen identified two
part of their study, Marshall even theory was accepted. They were subtypes, HPV-16 and HPV-18, as
drank a culture of Helicobacter awarded the 2005 Nobel Prize the agents that cause most cervical
bacteria to infect himself, contracting in Physiology or Medicine. cancers. This discovery led to the
development of a vaccine for
the condition, potentially saving
thousands of lives.
Inflammatory diseases
Recent research has indicated that
a range of other inflammatory
diseases and cancers may be linked
to infectious agents. For example,
the small flatworm that causes △ Protection against HPV
schistosomiasis—a waterborne First approved in 2006, the HPV vaccine is
disease endemic in parts of the part of routine vaccination programs for young
Middle East and East Africa that girls in nearly 60 countries today. However,
affects the bladder, kidney, and as HPV takes many years to cause cervical
liver—has been linked to bladder cancer, the efficacy of the vaccine is yet to be
cancer since the 1970s. Meanwhile fully established.
244
NEW DISCOVERIES FOR OLD DISEASES
Ulcer-causing bacteria
Helicobacter pylori is harbored by half the world’s
population, but most people never have associated
gastric problems. The bacteria (shown here as dark specks
in the central area) enter the stomach lining to avoid acidic
conditions, and in susceptible individuals the bacteria in
the lining may set up inflammation and ulceration.
245
PROMISES OLD AND NEW 1960 – Present
Genetic Revolution
The Human Genome Project began in 1990 with the aim
of mapping and understanding all the genes found in
humans (collectively known as the genome). In 2003
the project announced that it had identified all 3 billion
bases, or “code letters,” of human DNA (see pp.212–13).
The same year the ENCODE (Encyclopedia of DNA
Elements) project began, setting out to determine
what all the genes and DNA instructions do.
▷ DNA sequencing
Computers visualize DNA sequences in terms of their
color-coded bases or “letters”— A, T, G, and C. Tiny variations
among the 3.2 billion base pairs, differing on an average by
0.1 percent between individuals, are compared to find the
genetic basis of health and disease.
246
PROMISES OLD AND NEW 1960–PRESENT
Genetic Testing
Research into the molecular structure of DNA (deoxyribonucleic acid) during the 1980s led to
a greater understanding of genetic disorders. Consequently, a new field of medical genetics
has emerged that offers the possibilities of predictive and personalized medicine.
O
ne of the key discoveries revolutionized many different Techniques of analysis ◁ Biochemical
that made the new field of areas of medicine. In particular, The procedure for obtaining analysis
genetic medicine possible it has enabled the detection of a sample of a patient’s DNA Samples containing a
was that each of us has a unique mutant or damaged genes and the is simple and painless. Genetic person’s DNA are pipetted
DNA “fingerprint,” recognizable by specific genes associated with many testing can be performed on into a multiwell plate prior
differences in the arrangement of genetic diseases. Research, especially almost any body tissue, such to analysis. Chemical analysis
genes on the chromosome. Genetic that conducted by the international as blood, skin, or hair, but can identify individual genes.
profiling has proved invaluable Human Genome Project from 1990 the usual method is to take This makes it possible to detect
in forensic investigations and to 2003, led to the development of cells from the inside of the genetic disorders, which may
indicate a risk of genetic disease.
for the purpose of establishing a a range of techniques to identify patient’s mouth using a
child’s parentage, but perhaps most the approximately 20,000 protein- swab or a mouthwash
importantly genetic testing has making genes found in human DNA. of saline solution.
Genetic tests can be carried out
on unborn children by taking a
“ Gene therapy is ethical because it can sample of the amniotic fluid around
the fetus. Sample cells are then
3.2
medicines. Today BILLION The approximate risk of a genetic
there are several number of base pairs in disorder, such as
genetic disorders. As more people inherited from one or both parents. thousand specific the human genome. sickle-cell anemia
become aware of genetic disorders, However, other diseases—such genetic tests that among people of
the demand for genetic screening as cancers—occur when genes are used in many different ways. African-American descent. The
has grown. Today many companies mutate and become damaged. For example, genetic testing can exciting, specialized field of
offer home testing kits to collect Every time DNA is copied, there be used as a diagnostic tool, when pharmacogenetic testing has also
samples of DNA to send off for is a chance that an error can be a patient displays symptoms that emerged, which involves studying
genetic analysis. made, which leads to mutations. may relate to a genetic disorder. genes to determine the effects of a
Damage to DNA is more likely to By checking for the presence of patient’s genetic make-up on the
Diseases and disorders occur with age, and it can also be specific mutations or damage at efficacy of different drugs. Results can
Many diseases—including cystic triggered by environmental factors, the gene level, genetic tests can be used to tailor a patient’s treatment
fibrosis, sickle-cell anemia, and such as radiation, sunlight, and confirm or rule out the diagnosis of to the optimum dose of the safest,
hemophilia—are present at birth tobacco smoke, as well as diet, a particular genetic condition. This most effective medication—so-called
and are caused by a defective gene alcohol, and possibly stress. form of testing is especially useful “personalized meds.”
IN PRACTICE
GENE THERAPY
Advances in medical genetics have as damaged or mutant genes
enabled scientists not only to identify (genes in a specific position on the
the genes responsible for genetic chromosome) are replaced with
disorders but also to develop means healthy versions. Clinical trials of
of treating them. By introducing gene therapy have been conducted
nucleic acid polymers (large since 1990, leading to the approval
biomolecules) into a patient’s of a growing number of drugs for
cells, their DNA can be modified, clinical use in the 21st century.
Normal version of
gene is cut out Normal gene
is prepared
for insertion
Healthy chromosome
249
Melancholia
Domenico Fetti’s Melancholia (1622)
depicts depression, known as
melancholia prior to the 19th
century. It was believed to be caused
by an imbalance of the four humors,
specifically an excess of black bile. In
fact, the word melancholia is derived
from the Greek for “black bile.”
M E N TA L H E A LT H A N D TA L K I N G T H E R A P I E S
F
or much of history, mental and so would need a psychological disorder (OCD). Freud developed
disorders were considered to treatment. This shift in thinking the psychodynamic theory, in
be incurable. “Madness,” or was inspired by the work of several which he divided the mind into the
“mania,” was generally regarded neurologists in Europe, including “conscious” and the “unconscious,”
as a congenital abnormality, and Jean-Martin Charcot (see and believed that many mental
“melancholia” (depression) as a pp.160–61) from France, who disorders were caused by conflict
personality disorder caused by described the physical characteristics between the two areas. He thought
an imbalance of the humors (see of the human brain and studied the that hypnosis would help him
pp.34–35). Rather than being given effects of hypnosis. Charcot’s unlock the contents of the patient’s
treatment, the mentally ill were research then influenced Austrian unconscious mind to help resolve △ Scientific analysis
often simply isolated from society this conflict. Freud also developed Using modern imaging techniques, neuroscientists
1 in 4
(see pp.164–65). people worldwide will a method of psychoanalysis—a are now able to distinguish the differences in
suffer from mental or “talking therapy,” based on the patterns of neural activity in depressed (top)
A new outlook neurological disorders at some point Breuer’s successful treatment of and healthy (bottom) brains.
In the 19th century a more in their lives. his patient Anna O—which became
enlightened approach to mental the model for many types of
health arose as a result of a greater physician Josef Breuer and his psychotherapy in the 20th century. based on development of cognitive
understanding of the brain and its colleague, neurologist Sigmund Freud’s pioneering work attracted and behavioral psychology. Rather
functions. New branches of medicine Freud (see pp.182–83). Freud used many followers, including the Swiss than delving into the unconscious,
developed, including neurology, hypnosis on patients to treat them psychotherapist Carl Jung and the new therapies found more practical
which viewed mental disorders as for what are now termed affective Austrian doctor and psychologist ways of changing the behavior or
having physical or anatomical causes disorders—which include Alfred Adler. Different versions of thinking that affect the patient’s
that could be treated and cured. depression, bipolar disorder, and the “talking therapy” began to mental well-being, thereby helping
Toward the end of the century the mania—and a variety of anxiety emerge, incorporating ideas from them deal with their problems.
idea emerged that mental disorders disorders such as phobias, panic various branches of psychology, but Several cognitive and behavioral
might have a psychological cause, attacks, and obsessive–compulsive psychoanalysis remained the main therapies were developed toward
form of psychotherapy until after the second half of the 20th century,
SOCIAL WORKER (1859–1936)
World War II. all of which came together in the
cognitive-behavioral therapy
BERTHA PAPPENHEIM (ANNA O) Advancements in therapy (CBT) pioneered by the American
In the 1950s some psychologists psychoanalyst Aaron Beck. Under
Known by the pseudonym Anna O, questioned the validity of Freud’s the guidance of a therapist, patients
Bertha Pappenheim—a German psychodynamic theories and even learn to understand distressing
social worker—first experienced the very notion of psychoanalysis thought patterns, and find strategies
symptoms of hysteria, including as an effective therapy. Although to modify the way in which they
headaches and hallucinations, while the idea that psychological problems react. More recently there has
she was caring for her ailing father. should be treated by psychological been a movement of “positive
She was treated by Josef Breuer, means rather than drugs or surgery psychology,” placing an emphasis
who encouraged her to talk freely was well established, there were on mental health rather than
and express her thoughts and different approaches to treatment, mental disorder.
feelings. Pappenheim dubbed this
therapy a “talking cure.”
Her case study was later published “ The word ‘happiness…’ would lose its
in Studies on Hysteria that Breuer
wrote with Freud in 1895.
meaning if… not balanced by ‘sadness’.”
CARL JUNG, SWISS PSYCHOTHERAPIST
251
PROMISES OLD AND NEW 1960–PRESENT
C
omplex mechanical aids, and in 1992 the Robodoc was “keyhole,” surgery, for example
such as heart-lung bypass employed to mill out bone tissue Doctor interacts laparoscopy (see pp.188–89).
with patient
machines, have been used in in the femur in order to create Developed in the 20th century,
operations since the 1950s, but the a smooth surface for a hip these procedures usually involve
surgery itself was carried out by replacement. By 1999 robots had making a small incision and
humans. At the end of the 20th become advanced enough to assist Mobile robot inserting a miniature imager
century major changes began to in a heart bypass operation at monitors patient and light source so that the
take place with the development Ohio State University. surgeon can examine the area,
of sophisticated robots—electro- There are many advantages to ▷ InTouch robots as well as small surgical tools
mechanical machines that can be using robots to perform surgery. Telehealth increasingly such as biopsy forceps. The
uses robots for remote
programmed to carry out a wide They can be capable of greater introduction of computer
consultation. A screen,
variety of functions and are able precision, flexibility, and control technology in the mid-1980s
camera, speaker,
to manipulate objects. than a human; they make remote meant magnified images could
and microphone
Early robots were most suited to surgery possible, when the surgeon be shown on a monitor so the
allow for two-way
straightforward tasks that required is not physically present at the communication,
surgeon could see inside the body
precision, and the first robot used operation (see Lindbergh operation, and with the latest clearly and guide the tools to
in surgery was Arthrobot, during opposite); and they reduce physical machines devices the correct place.
a hip replacement procedure in stress on surgical staff, who can sit such as a digital In 2000 the da Vinci Surgical
Vancouver, Canada, in 1983. After down during lengthy operations. stethoscope or System was developed. With
this advances followed rapidly: in ultrasound machine this system, instead of surgeons
1985 a PUMA 560 robot was used to Minimally invasive surgery can be connected operating the tools manually,
insert a needle during a brain biopsy, One of the principal reasons for to the robot they direct the surgery from
in 1988 a robot carried out prostatic developing robots for surgery was for patient a computer console, which
surgery at Imperial College London, to assist in minimally invasive, or examination. then transmits instructions
to a robot that carries out
Robots and
the actions. Another way
of controlling robots is
telemanipulation—a process in
which the surgeon wears a glove
that transmits motion to the robot.
Telemedicine
Recent innovations have meant that
a surgeon can now program a
computer in advance to carry out
the entire procedure—a method
first employed in Italy in 2006.
Technological advances at the end of the 20th century allowed surgeons to use robots
for basic surgical procedures. Physicians also benefited from telemedicine, which involves 400,000 The number
of robotic
surgeries performed in the US
carrying out a range of consultative procedures using telephones, videoconferences, and in 2012.
the Internet without the need for the patient to be in the same room, or even country.
Robotic laparoscopic surgery
reduces the level of trauma for
patients because smaller incisions
are made, there is less blood loss,
and less risk of infection than
traditional open procedures, so
recovery time is quicker. As a result,
the scope of robotically assisted
operations has increased to include
bladder reconstructions (2007) and
kidney transplants (2009).
Telemedicine
Technological advances have also
made telemedicine possible—that
◁ Teleconsultation is, the remote diagnosis and
A telemedical consultation is carried out treatment of patients by means of
involving doctors from two different hospitals. telecommunications technology. An
The monitor transmits information directly to early pioneer of telemedicine was
the second doctor, giving access to additional the Australian Royal Flying Doctor
medical expertise. Service, set up in 1928 to provide
252
“ In my opinion, there is no way back
from robotic surgery.”
TRADITIONAL
BIOPSY
FORCEPS
PIER CRISTOFORO GIULIANOTTI, CHIEF OF MINIMALLY INVASIVE, GENERAL,
AND ROBOTIC SURGERY AT THE UNIVERSITY OF ILLINOIS, CHICAGO, 2013
remote consultation by radio to care. The use of telemedicine means that telemedicine
faraway communities. The practice permits the provision of care to can be adapted to new
spread as technology became patients in remote areas without fields, for example
increasingly sophisticated, starting the need for expensive medical telerehabilitation,
with the telephone, then video, and infrastructure, particularly in in which patients
now via the Internet. It has become developing countries where there can be monitored
possible for patients to consult with are few doctors or specialists. by physical therapists
doctors, and for diagnosis to be Remote surgery is another growing remotely. Meanwhile, MU-GRIPPER
made from a distant location. innovation in telemedicine. in robotics, the △ Biopsy tools
Teleradiology, which enables the development of nanobots Less than 0.04 in (1 mm) across, microgrippers
electronic exchange of images, Further developments (see pp.264–65)—tiny (µ- or “mu-”grippers)—a fraction of the size of
such as X-rays and scans, is a key Robotic surgery and telemedicine specialized robots less than a traditional biopsy tools—are released in clusters
example of the growing use of continue to make great strides as millimeter long—which can into a patient. Their star-shaped gripping arms
technology to share information and technology advances. The falling perform tasks such as clearing collect tiny tissue samples and they are retrieved
records for more efficient patient cost of electronic communications arteries, offer great potential. using a magnetic tool.
Lindbergh operation
In September 2011 the first transatlantic
operation (gallbladder removal) was
carried out by surgeons located in New
York using robots on a patient in France.
High-speed, cutting-edge communication
technology was used to prevent time lag.
PROMISES OLD AND NEW 1960 – Present
Robotic Surgery
Until the 1990s, robots were not considered adept
enough to match the skills of a surgeon. However,
advances in robotic technology since then have enabled
the invention of sophisticated surgical robots. Today,
robotically assisted surgery is performed regularly,
aiding rather than replacing human surgeons.
▷ Remote control
Sitting at a console, a surgeon performs minimally invasive
surgery using a remotely controlled surgical robot. Three
of the arms of the robot are equipped with surgical tools, which
the surgeon manipulates via the console, while the fourth holds
a camera to provide him with a 3-D image of the operation site.
254
PROMISES OLD AND NEW 1960–PRESENT
Emergency Medicine
Unexpected illness and injury occur in every lifetime. Emergency medicine has been in
use for millennia, progressing from desperate measures on the battlefield to high-tech
diagnosis and treatment in one of the newest areas of medical specialization.
L
ike so much else in the medical ▷ Pioneering service
sciences, emergency medicine This 1869 ambulance
has taken great strides forward operated out of Bellevue
in wartime (see pp.192–95). Urgent Hospital, New York City.
care for the sick and wounded, Bellevue was the second
such as tourniquets to stem blood US hospital to start an
loss, has been around since battles ambulance service in 1869.
in ancient Rome, East and South The Commercial Hospital,
Asia, and China. At the time of the Cincinnati, Ohio, set up the
first one in 1865.
First Crusade in the 11th century,
groups such as the Knights of the
Order of St. John of Jerusalem (the
Knights Hospitaller) specialized in
first aid for battle casualties as well
as for pilgrims.
Mobile medicine
During the Napoleonic wars of horse-drawn carriages, which he conflict, rather than waiting until
the late 18th and early 19th adapted from “flying artillery” fighting ceased, by which time
centuries, the French army chief that was trained to move quickly many would have died.
surgeon Dominique Jean Larrey around the battle area. His teams Larrey formalized the concept
brought many innovations to established mobile field hospitals of triage, the selection of patients
emergency medical care. He with medically trained staff, and based on the severity of their
is credited with introducing brought back wounded soldiers condition, which is still used today.
ambulances in the form of rapid from the battlefield during the When resources are stretched to
the limit, casualties are assigned
into three groups: those who will By the time of the American
FRENCH SURGEON (1766–1842)
probably recover without medical Civil War (1861–65), almost
DOMINIQUE JEAN LARREY care; those who will probably die all regiments had ambulances;
even with medical care; and those railroad trains and steamships
Starting as an apprentice surgeon in rapid surgery and his compassion. He who might be saved by medical were also used in emergencies.
Toulouse, France, Dominque Jean became Napoleon’s surgeon-in-chief care. The last group is given priority. In 1899 the first motorized
Larrey moved to the Hôtel-Dieu in in 1797, and traveled extensively from ambulances, powered with
Paris before beginning his long army Egypt to Russia with the army. He was Modern advances
career in 1792. France’s many military
campaigns needed talented surgeons,
taken prisoner at Waterloo, but was
later released. After Napoleon’s death,
Larrey also described the critical
choice between bringing limited 10 MINUTES Ambulance response
time in New York City, US.
180
and Larrey was noted for his skill at he again became chief army surgeon. emergency medical care to the CALLS HOURLY to the
patient or taking the patient to London Ambulance Service.
more highly equipped emergency
facilities. This choice remains at the electricity, were introduced in
heart of emergency care, although Chicago, Illinois. Gasoline-engined
recent advances in equipment and versions followed in 1905 and took
training have dramatically improved over from horse-drawn carriages,
outcomes for onsite treatment. especially during World War I.
256
In the early 1950s disasters such events shifted the role of the has stopped, are assessed regularly, △ Air ambulance crew
as the Richmond Hill rail crash in ambulance from a fast means and guidelines are updated by World War I saw the first casualty evacuations
New York City, three air crashes of transport to a mobile “mini- authorities such as the Red Cross, in specially equipped airplanes. Helicopters were
in Elizabeth, New Jersey, and the hospital,” equipped with compact the American Heart Association, used from World War II and many nations now
Harrow and Wealdstone rail crash ECG machines and heart monitors and the UK Resuscitation Council. have air ambulance services for the most rapid
in London left hundreds developed using newly invented In the 1950s US physicians Peter emergency response.
dead or injured. These transistors. Emergency medicine Safar and James Elam developed
was established in hospitals in the the protocol A-B-C for CPR: first
same decade. ensure Airway is open, then assist in the veins), and ischemic stroke
▷ Help on two wheels Portable cardiac defibrillators Breathing, then assist Circulation. (in which the blood supply to part
Cycle response units can to restart or normalize the In 2010 A-B-C was revised to of the brain is reduced or blocked).
reach incidents faster heartbeat were introduced C-A-B, to reflect the finding that In the 1950s R. Adams Cowley
than motorized in the 1960s; from the chest compressions offer the best introduced the idea of a “golden
ambulances in 1990s these have been chance of saving a life. hour,” to highlight that fact that
congested cities installed for use in public Ambulance services and hospital treatment in the first hour after
and large places such as emergency departments have also a medical emergency greatly
pedestrian spaces, shopping malls. benefitted from new medications improved chances of survival and
such as airports. Life-saving such as thrombolytic or “clot-buster” recovery. With the introduction of
procedures drugs that disperse thrombi (blood smartphones and the Internet in
such as cardio- clots) in the body. Most effective if the 1990s, along with a rise in the
pulmonary administered soon after the event, number of trained paramedics and
resuscitation they are used in medical emergencies first responders, the golden hour has
(CPR) for a such myocardial infarction (heart become the “platinum 10 minutes,”
person whose attack), deep-vein thrombosis (a reflecting today’s rapid assessment,
breathing or heart condition in which blood clots form treatment, and transportation.
257
PROMISES OLD AND NEW 1960–PRESENT
Antibiotic Resistance
and Superbugs
Within decades of the discovery of the miracle of antibiotics, some bacteria began to develop
immunity to the drugs. By the late 20th century the spread of “superbugs” with resistance to
multiple antibiotics threatened to return medicine to the days of untreatable infections.
When bacteria are exposed to an antibiotic, a very small easily passed to other hosts. Once a particular defense Superbugs
number may have mutated and acquired a defense against against antibiotics has been acquired, genes for it can The first “superbug” to be identified
it. This is more likely to occur where courses of drug also be passed on to totally different species of bacteria was Staphylococcus aureus, a bacterium
treatment are not completed. The surviving bacteria, which through horizontal gene transfer. associated with throat infections
are now drug-resistant, divide and transfer the resistant that is harbored by 30 percent
gene to their “offspring” in a process called vertical gene NORMAL BACTERIUM RESISTANT BACTERIUM of the population. The bacteria
transfer. In environments such as hospitals bacteria are DEAD BACTERIUM acquired immunity to penicillin
and then to methicillin, just three
years after the latter drug was
introduced in 1959. The resistant
strain MRSA (methicillin-resistant
Staphylococcus aureus) led, in 2005
alone, to 18,650 deaths in the US.
Further drug-resistant strains
followed. In 2011 an estimated half
BACTERIA INCLUDING ANTIBIOTIC KILLS MOST RESISTANT BACTERIA DRUG-RESISTANT
a million new cases of multi-drug-
A RESISTANT VARIETY NORMAL BACTERIA MULTIPLY STRAIN DEVELOPS resistant tuberculosis (MDR-TB)
were reported worldwide. VRE
258
A N T I B I O T I C R E S I S TA N C E A N D S U P E R B U G S
259
PROMISES OLD AND NEW 1960–PRESENT
Alzheimer’s Disease
and Dementias
The radical increase in life expectancy during the 20th century saw a corresponding rise
in diseases of old age, especially degenerative mental disorders. The most common of
these are dementias, in particular Alzheimer’s disease, which causes irreversible damage.
S
ince ancient times, medical century later. The number of elderly ▷ Diseased brain cells
practitioners have noted that patients rose accordingly and there In a patient with Alzheimer’s disease, the treelike
mental capacity seems to was a surge of interest in their structures formed by the brain’s nerve cells are
decline with increasing age. Greek medical care. obstructed by tangled clusters of proteins that
mathematician Pythagoras, writing In 1849 George Day, professor block the synapses and impede the passing of
in the 6th century BCE, of medicine at the University electrical impulses between the neurons.
defined “senium,” or old of St. Andrews, Scotland,
age, as the period from published A Practical
the age of 63 when Treatise on the Domestic Alois Alzheimer. In 1901 he
mental abilities Management and Most treated Auguste Deter, a female
regress to those Important Diseases patient at the Frankfurt Asylum
of an infant. In the of Advanced Life, who was suffering from severe
1st century BCE the which gave one of short-term memory loss. After
Roman physician the first full descriptions Deter died in 1906, Alzheimer
Celsus used the of the symptoms examined her brain and found an
term “dementia” to of dementia. abundance of abnormal structures.
describe a persistent The loss of memory Insoluble deposits of a protein
35
state of mental that characterized the
impairment. disease troubled MILLION The
However, until the physicians, who number of people
19th century, medical began to seek a who suffer from
scholars had no physical cause for Alzheimer’s disease
clear idea of the △ Brain with Alzheimer’s this mental decline. worldwide. This number is
causes of dementia, Comparing a cross-section of brain In 1894 Jean expected to double by the
which came to tissue from a healthy subject (top Noetzli, working in year 2030.
describe the above) with that of the brain of an Zurich, examined
syndrome of severe Alzheimer’s patient (below) highlights the post-mortems called beta-amyloid had formed
memory loss that the startling loss of tissue, as well as of 70 patients with plaques between neurons (nerve
affected many older lesions and scarring, in the latter. dementia and found cells), which inhibited the electrical
people. There was a degenerative changes and chemical signals between
tendency to accept it as a natural and weight loss caused by the them that coordinate thought
part of aging, rather than as a wasting away of the brain (atrophy) and memory (among numerous
disease with a clinical foundation. in almost all of them. Just under other processes). He also found
Over a period of 100 years the half had lesions in specific areas. buildups of twisted protein
industrialized world had seen a However, the key work in both threads called “neurofibrillary
marked increase in life expectancy: identifying the external signs of tangles” clustered around the
in Victorian England, for example, dementias and the internal changes neurons (see panel right).
it had risen from around 35 years occurring in the brain was carried Alzheimer’s precise description
for women in 1800 to 48 years a out by German neuropathologist of the physical and mental
symptoms of his patient’s syndrome
prompted his mentor, Emil
260
ALZHEIMER’S DISEASE AND DEMENTIAS
261
PROMISES OLD AND NEW 1960–PRESENT
End-of-Life Care
Palliative care is the act of looking after someone at the end of their life, in the
hospital or a hospice, or at home. This service, which traditionally combines spiritual
and physical care, has a venerable history that dates back to early medieval times.
F
or centuries people in Europe healing, where those traveling Europe to do the same. The Irish modern medical advances. The
died at home cared for by could seek shelter. The houses Sisters of Charity, which were hospice provided the patient with
friends and family. However, of rest also provided another founded in 1815, were especially drugs for pain management as well
as circumstances changed during important function—offering active, opening Harold’s Cross as emotional and spiritual support.
the medieval period it was not a place where the incurably ill Hospice in Dublin Saunders assembled
3,200
always possible for them to spend and injured who were unable in 1879 and The estimated highly skilled teams
the last months, or days, of their to get home could live out their St. Joseph’s Hospice number of that represented a
life at home. At the end of the last days. in South London in hospice programs in wide range of medical
11th century, Pope Urban II called 1902. Fifty years the US. disciplines, from
for Christians in Western Europe Early hospices later a young nurse consultants and
to travel to the Middle East and The early efforts of the Knights named Cicely Saunders began work researchers to pharmacologists and
take possession of the Holy Land. Hospitaller were revived in the 17th at St. Joseph’s as a full-time medical nurses. The hospice even had a
This prompted thousands to century, when French Roman officer—an experience that would post-mortem room, with the aim of
undertake the long journey and Catholic priest St. Vincent de Paul shape the future of end-of-life care. reaching a better understanding
fight to the death. In response to established the Sisters of Charity of the extent of each patient’s
this the Knights Hospitaller (a in Paris to care for the sick and Modern hospice movement symptoms and how to control
Roman Catholic military order) dying. His work inspired religious Saunders recognized that the care the pain associated with them.
established houses of rest and organizations in other parts of that was offered to the terminally Central to Saunders’ concept was
ill in hospitals was inadequate, so that the hospice should be designed
she initiated a new movement in with comfort as well as practicality
palliative care, with an emphasis in mind, so that patients could
on providing specific centers for maintain a sense of dignity and
patients with terminal illness. In individualism to the end. Rather
1967 she founded St. Christopher’s than replicating a typical hospital
Hospice in South London, where ward—usually a long, open space
the terminally ill could spend their lined with about 30 beds—Saunders’
last days in peace. Her main aim design for St. Christopher’s included
was to combine the humanitarian single rooms, offering greater patient
principles of love and devotion with privacy (and also helped reduce
infection). The designs included
large windows to allow natural
◁ Knights Hospitaller light to flood the interior, and clean
The history of palliative care can be traced back modernist lines to help staff work
to the Knights Hospitaller, founded in Jerusalem efficiently. Artificial lighting was
in the 11th century to provide care for sick and carefully considered too, with
dying pilgrims. Besides their charitable work, fluorescent and warmer, softer
the Knights were also a military organization lighting used in different areas.
dedicated to joining battle in the Crusades Above all, St. Christopher’s was
and defending Christian pilgrims. designed to create a welcoming
262
END-OF-LIFE CARE
space, which was neither hospital hospice environment. In 1969 she BRITISH NURSE, PHYSICIAN, AND WRITER (1918–2005)
nor home, but an entirely new type helped launch the first palliative
of facility that set the standard for home-care nursing program, CICELY SAUNDERS
palliative care in future decades. and took the care provided at
The design served as the prototype St. Christopher’s out into the The founder of St. Christopher’s
for many hospices that followed. community too. Hospice in London, Cicely Saunders
Saunders’ efforts in the area of is also considered the founder of the
Further developments palliative care had a major impact modern palliative care movement.
The next logical step for Saunders on professional medical care and After training as a nurse and medical
was to allow patients to die at home, the provision of services for the social worker, her life’s course was
should they choose to do so, with terminally ill, together with the changed by her deep friendship with
the same level of pain control and recognition that all aspects of patient a young Polish man, David Tasma,
support that was provided in the care need to be addressed, from who was dying of cancer, and the
day-to-day physical care and pain fact that she felt called by God to
relief to emotional sustenance. By devote the rest of her life to the care
▽ Palliative care nurses the late 1980s, palliative care was of the terminally ill. Saunders was
End-of-life care has improved immeasurably in recognized as a certified medical particularly focused on alleviating the
the past 50 years. Specialized nurses are trained speciality in the UK, and it had pain and suffering associated with
in pain and symptom management, and offer spread worldwide by the 1990s, terminal illnesses, especially cancer,
psychological and spiritual support. Some work although it was not officially and subsequently became involved in
in hospitals or hospices, while others are out in certified in the US and many researching pain-relieving drugs.
the community, visiting people in their homes. parts of Europe until the 2000s.
263
PROMISES OLD AND NEW 1960 – Present
Nanomedicine
The science of diagnostics, therapeutics, and surgery
conducted at a molecular scale—or nanomedicine—only
became practically possible in the 1990s, the decade that
saw the first use of targeted drug delivery mechanisms.
Now, tiny robot surgical units, less than a millimeter
long, are being tested, offering the potential of the
ultimate noninvasive surgery.
“ … it would be interesting in
surgery if you could swallow
the surgeon.”
RICHARD FEYNMAN, AMERICAN PHYSICIST, FROM THE LECTURE
“THERE’S PLENTY OF ROOM AT THE BOTTOM,” 1959
◁ Nanobots
The development of robots to conduct internal surgery on a tiny
scale first became possible around 2013. In the future they may
be able to repair DNA or map damaged vascular systems,
rendering X-rays redundant.
265
Red Cross to the rescue
On September 19, 1985, a major earthquake registering
8.1 on the Richter scale hit Mexico City, killing between
5,000 and 10,000 people. The Red Cross organized
humanitarian aid, rescuing bodies trapped in collapsed
buildings and providing medical assistance.
GLOBAL MEDICAL BODIES
I
nternational collaboration in confined by borders or by national
health care began in 1851, when policies. Prompted by a yellow
the first International Sanitary fever outbreak that spread from
Conference met in Paris to discuss Latin America to the US, the first
quarantine regulations in Europe. international health agency—the
No agreement was reached, but Pan-American Sanitary Bureau
at the 1892 conference a protocol (PASB)—was established in 1902.
concerning quarantining ships with Shortly afterward, in 1907, 23
cholera cases on board was signed. European countries founded the
International Office of Public
Global governmental agencies Hygiene, to prevent the spread of
By the start of the 20th century it yellow fever, cholera, and plague.
had become increasingly apparent When the League of Nations was
that infectious diseases could not be established in 1919, it formed a
Health Committee that encompassed
both the work of the PASB and that
FOUNDER OF THE RED CROSS
(1828–1910)
of the International Office of Public
Hygiene. However, its effectiveness
JEAN-HENRI DUNANT was limited due to lack of funding.
A major development in global △ Fighting Ebola NGO is Médecins Sans Frontières
Upon witnessing the bloody battle health care came when the World In 2013 a outbreak of Ebola virus disease (MSF), set up by a group of French
of Solferino in Italy in 1859, Swiss Health Organization (WHO) was began in West Africa (see pp.268–69). Efforts doctors in 1971 in response to
humanitarian and businessman founded in 1948. As the healthcare by dedicated health workers helped control the humanitarian disasters such as the
Dunant argued that volunteers arm of the United Nations, the WHO epidemic, but the WHO was criticized for Biafran War in Nigeria. With a
should be trained to help the held considerable political sway. It its delayed response. commitment to providing health
wounded on the battlefield—an expanded on existing work in care to all, MSF has projects in
idea that led to the foundation of monitoring communicable diseases some of the world’s most troubled
the International Committee of the and launched eradiction campaigns, soldiers (see panel, left), in 1929 countries, and works in areas—
Red Cross in 1863. In 1872 he its greatest successes to date being the Red Cross extended its support such as parts of Syria and Yemen—
lobbied for a court of arbitration to against smallpox (see pp.100–01) to prisoners of war and civilians where few international medical
settle international disputes, but the and polio (see pp.210–11). In recent in war zones, and lobbied for the bodies will send staff.
idea was premature. Bankrupt and years the WHO has strengthened its adoption of the Geneva Convention,
a recluse for the last 35 years of his role in coordinating a swift response which aims to protect people not
life, Dunant was awarded the first to disease outbreaks—for example taking part in armed conflict. ▽ Raising awareness
ever Nobel Peace Prize in 1901. Severe Acute Respiratory Syndrome Today, the ICRC (which includes From 2015 the Zika virus, carried by Aedes
(SARS) in 2003 and swine flu in the Red Crescent movement aegypti mosquitoes, began to spread rapidly
2009, both of which threatened established in Islamic countries) in Brazil and beyond. In early 2016 the WHO
to become worldwide pandemics. consists of 190 national societies declared this a “Public Health Emergency of
Increasingly, the WHO plays a around the world, and is a neutral, International Concern”
key role in health education and the independent presence in most and coordinated
sponsorship of health programs areas of armed conflict. multinational action.
throughout the developing world. Other such NGOs have been set
up to coordinate medical responses
Nongovernmental bodies to disasters or to manage national
In parallel with international approaches to longer-term health-
governmental agencies, several care challenges. These include the
nongovernmental organizations World Federation of Mental Health
(NGOs) have developed. The first (1948), the International Planned
was the International Committee Parenthood Federation (1952),
of the Red Cross (ICRC). Initially and the World Medical Association
set up in 1863 to care for wounded (1947). Typical of a newer breed of
PROMISES OLD AND NEW 1960 – Present
268
PROMISES OLD AND NEW 1960–PRESENT
W
hen a stem cell divides, Stem cell types a person’s life. They are present in △ Dolly, the cloned sheep
each new cell can either There are many different types of many mature organs and tissues, Born in 1996, Dolly was the first mammal copied,
remain a stem cell (to stem cells, but broadly speaking and are more specialized than or cloned, from a specialized adult stem cell—
maintain their numbers) or become they can be divided into two main embryonic stem cells. Typically, they in this case, a mammary gland cell. In 2013
one of more than 200 different types groups: embryonic and adult. produce specialized cells exclusively scientists produced human embryonic stem
of specialized cells. The cells multiply Embryonic stem cells exist only for the specific tissue or organ in cells (hESCs) using a similar cloning technique.
to replace those specialized cells that at the earliest stage of development which they live. For example,
die as part of the body’s natural cell and are pluripotent, which means blood-forming (hematopoietic) stem
turnover and tissue maintenance. they have the potential to become cells in the bone marrow can create who in 1962 had discovered that
For example, bone marrow stem almost any type of specialized cell. red or white cells or platelets, the specialization of mature cells is
cells produce more This makes them but cannot make liver or muscle reversible, received the Nobel Prize
300
than two million BILLION The estimated very valuable to cells. This ability to create multiple in Physiology or Medicine for their
new red and white number of new cells medical science, specialized cell types is referred to groundbreaking findings.
blood cells every that stem cells produce in the as they provide a as multipotent, but there are also
second, to replace body on a daily basis. renewable resource unipotent stem cells, which can Established therapies
a similar number for research and develop into only one type of cell. Bone marrow transplant, or
that reach the end of their normal therapies. These cells are obtained Adult stem cells can be difficult hematopoietic stem cell
lives. Different types of body tissue from human embryos, usually to find in the body and grow in transplantation (HSCT), is well
replace cells at different rates—for those that were fertilized in vitro laboratory culture less easily than established to treat various blood
instance, cells in the blood, skin, and (IVF) and are no longer needed. embryonic stem cells. However, disorders. First performed in 1956
digestive tract lining renew quickly, Adult (or somatic) stem cells they are still extremely useful for in New York, its subjects were
whereas nerve tissues are replaced appear during foetal development scientific research and therapies. identical twins, one of whom had
very slowly, if at all. and remain in the body throughout In 2006 there was a breakthrough leukemia. Since the subjects were
in stem cell research, when Shinya identical, the problem of rejection
CONCEPT
Yamanaka, a Japanese researcher, did not occur. Progress in
reprogrammed mature, specialized immunosuppression, to prevent
HOW STEM CELL THERAPY WORKS skin cells to become pluripotent; the immune system from rejecting
these new cells were termed cells, led to the first bone marrow
All cells in the body contain the full become a specialized cell—a process induced pluripotent stem cells transplant between nonidentical
set of human genes as their DNA known as “differentiation” in which (iPSCs). In 2012 Yamanaka and siblings in 1968, and between an
(deoxyribonucleic acid). However, the cell goes through various stages, British researcher John Gurdon, unrelated but tissue-matched
different types of cells have specific becoming more specialized at each
genes activated in them. For instance, step. These instructions are triggered
in skin cells some genes are activated by various means, including natural
while others remain inactive. Similarly, signaling substances such as growth
each stem cell has its own particular factors or cytokines. Stem cell research
set of genes activated. These instruct
it to multiply and either replicate
involves recreating these conditions
to manipulate the cells along various
“ Stem cell research is the
itself, producing copies that are
identical to the original cell, or to
pathways, for example, growing a
new tissue to replace a diseased one.
key to developing cures for
STEM CELL RENEWAL degenerative conditions
FULLY
DIFFERENTIATED,
like Parkinson’s and motor
SPECIALIZED CELL
neurone disease…”
STEM CELL CELL BEGINS DIFFERENTIATION STEPHEN HAWKING, BRITISH PHYSICIST AND COSMOLOGIST
(AND MND SUFFERER), IN A PRESS RELEASE, 2006
270
STEM CELL THERAPY
donor and recipient in 1973. Today rheumatoid arthritis, repair of ◁ Research and
HSCT patients can be given their spinal cord and other tissues, and development
own hematopoietic stem cells baldness. One of the primary aims Research into stem
that have been removed and of research is to develop the cell therapy is one
stored. They also have a course technology to take a few donated of the most exciting
of chemotherapy or radiotherapy cells and grow them into new developments in
to eradicate the diseased cells. In tissues or organs, such as a new medicine in recent
some cases, such as tissue matching heart, liver, or eye. Tissue or organ years. However, there
problems, umbilical cord blood is transplants using iPSCs should be is some controversy
surrounding the ethics
used as an alternative. safer than transplants from other
of research using
people; since the cells would be
human embryos.
Ongoing research taken from and put back into the
Stem cell therapy holds vast same individual, they are less likely
promise. Research involving iPSCs to provoke the patient’s immune
and adult stem cells is currently system into rejecting the new
being carried out to treat a range tissue or organ. Stem cell research
of conditions, including certain is still in its infancy, but it already
cancers, diabetes, retinal problems, represents a medical revolution.
271
6
REFERENCE
Body SKELETAL
This is the solid
MUSCULAR
Muscles work with the
Systems
movable framework skeleton, providing
that surrounds and pulling force
protects delicate for movement.
structures. Bones Involuntary muscles
act as levers and control internal
anchor plates for processes, such
The study of the human body has fascinated the muscles to as digestion and
physicians for ages. Galen’s writings were pull against, blood distribution.
seen as definitive for centuries until 1543, generating Nerves control
when Andreas Vesalius first published images movement. the muscles and
of dissected bodies. Once William Harvey had They make the circulatory
established the basic function of the heart blood cells system supplies
and release them oxygen.
and circulation, 19th-century scientists made
minerals for (See pp.278–79)
advances in cardiovascular medicine. Doctors
use elsewhere
and scientists continued to piece together
in the body.
how all the different systems work together—
(See pp.276–77)
for the most part, harmoniously. As a result,
specialties developed and medical treatments
advanced significantly. It helps to have an
understanding of the basics of each body Components Components
system, as well as to see how they are so Bones, cartilage, Skeletal muscle, tendons,
interdependent, to appreciate the enormity ligaments smooth muscle in organs,
of what has been achieved in the study of cardiac muscle
human biology and medicine, and what may
continue to develop in the future.
274
BODY SYSTEMS
275
BODY SYSTEMS
Radius
Pelvis
Carpals Cervical (neck)
(wrist bones) vertebrae
Sacrum
Metacarpals Shoulder
(hand bones) blade
Thoracic
Phalanges (chest)
(finger bones) vertebrae
Femur (thighbone)
is the longest and
strongest bone
in body Sacrum
Coccyx
Patella (tail bone)
(knee cap)
Fibula
(calf bone)
◁ Symmetrical structure
△ Imaging the body The skeleton is arranged
Fibula
Early anatomists had to dissect cadavers symmetrically on both sides of (calf bone)
to study human anatomy. Today, medical the body and has two main
Talus Tibia
practitioners have a number of ways to parts—the axial skeleton (skull,
(shin bone)
view bones, from X-rays and magnetic Tarsals (ankle bones) spine, ribs, and breastbone)
resonance images (MRIs) to colored Metatarsals (foot bones) and the appendicular skeleton
computer tomography (CT) scans. This (shoulder blade, pelvis, and Calcaneus
Phalanges (toe bones) (heel bone)
is a CT scan of a normal spine. bones of the arms and legs). REAR VIEW
276
T H E S K E L E TA L S Y S T E M
IN FOCUS
Bone shaft comprised
BLOOD FACTORY mostly of outer layer
of compact bone
filled with marrow
Red bone marrow contains
hemopoietic tissue, which produces
all three main types of blood cell Arteries supply nutrients
needed by the body—platelets, and oxygenated blood
red cells, and white cells. Red to bone tissue
marrow is present in all bones at
birth, but with age, marrow in △ Inside a bone
the long bones gradually becomes Bones are formed from a combination of spongy
yellow and its ability to make vital (cancellous) bone tissue surrounded by compact
blood cells is reduced. (cortical) bone; the ratio changes with age and
Ephyisis, the expanded
activity. Long bones such as this thighbone have head of bone, contains
a hard outer casing, then a central shaft, which mainly spongy bone tissue
MICROSCOPIC IMAGE OF RED BONE
MARROW WITH RED BLOOD CELLS contains red bone marrow, and a “head” of
spongy bone tissue at each end.
277
BODY SYSTEMS
278
THE MUSCULAR SYSTEM
Extensor digitorum
Transverse ligament muscle splits into
Tendon cross-braces Sharpey’s four tendons, one
sheath tendons Periosteum fiber Bone to each finger
Extensor retinaculum,
a band of ligament that
▷ Network of tendons overlies the tendons
in the right hand
The hands (and feet) have
long tendons that extend
from muscles as far back
as the elbows (and knees).
These tendons are enclosed
in self-lubricating sheaths
that prevent them from
rubbing against the bones.
279
BODY SYSTEMS
Deltoid nerve
Radial nerve
Spinal nerves
Spinal ganglion—
one of many
nodules in
The spinal cord ganglia chain
that send sensory
The brain and spinal cord both contain information
gray matter (neuron cell bodies and to brain
nonsheathed, or unmyelinated, nerve
Meninges
fibers) and white matter (myelinated
nerve fibers).
Femoral
Gluteal nerve
nerve
IN FOCUS
Pudenal Digital
WHAT IS A NERVE? nerve nerves
280
THE NERVOUS SYSTEM
Meninges—three
membranes (dura Cerebrum, Thalamus
mater, arachnoid divided into two Corpus callosum, a Cerebrospinal fluid, relays
layer, pia mater) that parts—the bundle of fibers that a clear fluid that signals to
surround the brain right and left connect the right and surrounds the brain cerebral
and spinal cord hemispheres left side of the brain and spinal cord cortex
Temporal lobe
plays a role in
memory and
sound recognition Cerebellum is
involved with skilled
movement, balance,
and posture Skull
△ External structures
The largest part of the brain is the cerebrum.
It has a heavily folded surface and is divided
into several areas, called lobes. The smaller
Hypothalamus has
cerebellum sits beneath it. many functions,
including controlling
the ANS
Motor cortex Somatosensory
controls coordinated cortex receives
muscle movement and analyzes
impulses from
touch receptors
Premotor cortex Sensory cortex
creates intention processes sensory
to move information
Visual cortex
integrates visual
data with memory
and other senses
Pituitary, or
Primary visual master, gland
cortex receives
Prefrontal nerve impulses
cortex is from eyes
involved in
determining Brain stem
thought and Wernicke’s area
regulates
personality is associated
heartbeat and Cerebellum
with language
breathing or “little
Broca’s area
controls speech and brain”
clear articulation Primary auditory Temporal cortex
of words cortex analyzes integrates auditory
nerve impulses data with memory Spinal cord
from the ears and other senses
281
BODY SYSTEMS
Coronary
Capillary Cell arteries supply
wall, nucleus Inferior Heart blood to heart
formed of vena cava muscle muscle Common Femoral vein
single layer iliac artery
of cells △ The heart
A cone- or pear-shaped organ with a
pointed end, the heart has an apex angled
CAPILLARY Venous network
Protective down and left. Seen above are the major Femoral artery of knee
outer layer Elastic and blood vessels that carry blood to and
connective
tissue fro between the heart and different Arterial network
Layer of
muscle parts of the body. of knee
and Inner
elastic lining Anterior tibial
fibers Anterior vein
tibial artery Posterior tibial
ARTERY
vein
Outer Thin layer
layer of muscle ▷ Blood vessels
The circulatory system has an intricate network Posterior
Inner of some 90,000 miles (150,000 km) of blood tibial artery
lining vessels. Like other body systems it is symmetrical,
Valve
prevents so for every artery there is a corresponding vein.
backflow Here, vessels carrying oxygenated blood (usually
VEIN
arteries) are shown in red and those carrying
deoxygenated blood (mostly veins) are blue.
282
T H E C A R D I O VA S C U L A R S Y S T E M
Platelet, a short-lived White blood cell, also known Red blood cell; these Wall of blood
cell fragment that as leucocyte, plays a vital role have a lifespan of vessel
helps in clotting in infection control around three months
283
BODY SYSTEMS
Nostril
Mouth
Epiglottis, flap of cartilage that opens and closes
to prevent food and liquid entering trachea
Larynx, or voicebox, the tube of cartilage
that plays a role in speech production, controlled △ Air sacs in the lungs
by the frontal llobe (p.281)
Each tiny tube (bronchiole)
Trachea, or windpipe, in the lungs ends in a group
the main airway to lungs of air sacs, or alveoli, where
the gas exchange between the
lungs and the circulatory
Right lung comprises system takes place.
55–60 percent of
total lung volume Bronchioles
Aorta
Primary bronchus
Superior lobe
Secondary bronchus
Intercostal muscles
Rib
Pulmonary
Middle lobe
artery
Pleural membrane,
two layers that Left lung, smaller
enclose each lung than right to make
way for heart
Inferior lobe
Heart
284
T H E R E S P I R AT O R Y S Y S T E M
Carbon dioxide
diffuses into
alveolus
△ Gas exchange in the lungs
When fresh, oxygen-rich air reaches the
alveoli, the oxygen must pass through Heart
several layers before it reaches the red Deoxygenated blood
that contains carbon
blood cells. At the same time carbon dioxide dioxide returns from
passes into the alveoli to be breathed out. body tissues
285
BODY SYSTEMS
△ Pancreas
The pancreas contains clusters of
cells—islets of Langerhans—that
Heart secretes
make the hormones insulin and
atriopeptin, which
reduces blood glucagon, which are vital in the
Kidney
volume and control of blood glucose levels.
regulates fluid
balance ◁ Ovary
The ovaries
manufacture the
Stomach makes female hormones
hormones that
aid digestion
estrogen, which
stimulates egg
ripening, and
progesterone, which
Intestines also thickens the uterine
make hormones wall with each
that aid digestion
menstrual cycle.
△ Testes
These organs make the male hormones ◁ Hormone production
(androgens), such as testosterone, that Hormones are released directly into the bloodstream
regulate male characteristics such as sperm by specific endocrine glands. The actual release
production, development of facial hair, and mechanism varies and many are under the control
the deepening of the voice at puberty. of other hormones produced by the pituitary gland.
286
THE ENDOCRINE SYSTEM
Neurosecretory
cells, nerve cells
that produce
antidiuretic
Blood vessels that carry hormone (ADH)
releasing-factor hormones and oxytocin,
from the hypothalamus which flow
to anterior pituitary through the cell
fibers to posterior
Modified nerve fibers carry pituitary gland
hormones made in the
hypothalamus to posterior
pituitary lobe for release
Pituitary stalk
Anterior lobe
contains cells IN FOCUS
that make about
Skin eight hormones HOW HORMONES WORK
Melanocyte-stimulating Artery
hormone (MSH) causes special Hormones work by altering the
cells in the skin (melanocytes) chemistry of their target cells. They
to make the pigment melanin. do not initiate a cell’s reactions—
instead, they adjust the rate at which
they occur. The stimuli that cause an
Kidney tubules endocrine gland to release more or
Adrenal gland These tubules less of its hormone vary. In some
Adrenocorticotrophic respond to cases, the hormone reacts to the
hormone (ACTH) stimulates antidiuretic level of a substance in the blood, in
adrenal glands to produce hormone (ADH), others, an intermediate mechanism,
steroid hormones that control which controls such as the hypothalamus–pituitary
stress and the body’s use of amount of water complex, triggers activity.
fats and carbohydrates. removed from
blood in kidneys, Hypothalamus receives
and constricts small information from cells tracking
Thyroid sex hormones; produces
arteries if blood gonadotropin releasing hormones
Thyrotropin-releasing hormone
pressure falls.
(TRH) released by hypothalamus
triggers thyroid stimulating
hormone (TSH), which in turn Posterior lobe
stimulates thyroid activity and Pituitary
affects the body’s releases
metabolic rate. gonadotropins,
including
luteinizing
hormone (LH)
Bone and growth Sex glands Uterine muscles and follicle-
LH and
Growth hormone (GH) Luteinizing hormone (LH) These react to oxytocin, FSH travel stimulating
promotes protein and follicle-stimulating which stimulates their in blood to hormone (FSH)
manufacture, bone hormone (FSH) trigger contractions during labor sex gland
Mammary (testis)
enlargement, and testes and ovaries to make glands
Testis stimulated
building new tissue. hormones and stimulate These produce to produce male
production of ripe eggs prolactin, a sex hormone,
in a woman’s ovary hormone that testosterone
and mature sperm in triggers release
a man's testes. of breastmilk. HYPOTHALMIC–
PITUITARY CONTROL
287
BODY SYSTEMS
Inner mucosa
Small intestine is has goblet
made up of three cells that
parts: duodenum, secrete mucus
jejunum, and ileum
Rectum Submucosa
layer contains
Layers of muscle lymph vessels
△ Stomach wall
The muscles of the stomach’s wall relax △ Inside the large intestine
and contract to mix food with gastric Also known as the colon, this muscular tube
juices and churn it to form semiliquid Anus has a smooth undulating inner wall that
chyme. This process lasts 2–5 hours. makes mucus to ease the passage of feces.
288
THE DIGESTIVE SYSTEM
◁ Gallbladder
This organ holds about 1.7 fl oz (50 ml) of bile.
It receives the bile via hepatic ducts from the
liver and feeds it directly into the duodenum
when needed.
Cystic
duct Hepatic vein Ligament that
drains blood from attaches to front of
liver into inferior abdominal wall
vena cava
Commom
bile duct
Stomach
Hepatic
artery delivers
oxygen-rich
Hepatic portal blood to liver
vein brings
nutrient-rich
blood to liver
from intestine
▽ Pancreas
Although only 6 in (15 cm) long,
each day the pancreas produces
Gallbladder
around 3 pints (1.5 liters) of
digestive juices containing
enzymes that break down lipids,
proteins, and carbohydrates.
▷ Liver
This organ is unusual because it
has two blood supplies: oxygen-
rich blood from the circulatory
system, and nutrient-rich but
oxygen-depleted blood from the
intestine. It has more than 250
functions, from making digestive
juices and storing and circulating
key vitamins and minerals to Head of
eliminating blood waste and Duodenum Pancreas Large intestine pancreas
recycling old red blood cells.
289
BODY SYSTEMS
Mucus lining of
genitourinary tract traps
foreign matter, and
harmless bacteria
restrict growth of
harmful organisms
Popliteal nodes
drain lymph from
Lymph capillaries collect knee and lower leg
interstitial fluid, which
becomes lymph and
drains into lymphatics Lymphatics contain
valves to ensure
▷ Auxiliary immune system one-way flow of lymph
Many organs play a key role in protecting Skin forms a mechanical
barrier against invading
against invading microbes, supplementing organisms ◁ Lymphatic system
the internal immune system (see right). This system is composed of a series of organs,
Tasks range from providing a physical nodes, and ducts that carry lymph. Lymph
barrier to producing mucus, which traps is not pumped along the ducts, but flows
microorganisms, and body chemicals, passively through the system with the
which help destroy them. contraction of the surrounding muscles.
290
THE IMMUNE SYSTEM
BASOPHIL
▷ Inside a lymph node
Lymph nodes vary in size and swell when fighting Vein for outgoing blood Granules
infection or illness. Protected by a fibrous outer B-shaped play key roles
capsule, they contain many channels, or sinuses, nucleus in allergic
where white blood cells ingest bacteria or Outgoing lymph vessel— reactions
EOSINOPHIL
each node has just one
foreign matter and debris.
IN FOCUS
Immune response
White blood cells respond to invasion by different microorganisms.
VIRUSES AND BACTERIA The system aims to create a condition of immunity in which the body is
protected or is resistant to future attacks by that type of microorganism.
The two main categories of obtain energy, process nutrients, and The immune response may involve attacks on specific toxins or bacteria
harmful microorganisms attacking reproduce, which also makes them reaction to any kind of damage, such as injury. Damaged tissue releases
the body are viruses and bacteria. vulnerable to chemical interference; a chemicals that attract white blood cells, the blood capillaries become
Viruses cannot exist independently feature exploited by the introduction more porous to allow white cells to the area and the “battle” proceeds.
and the body relies on the of antibiotics (see pp.200–01).
immune system’s response to
fight them. However, bacteria Skin wound Microbes White cells pass through capillary
have the cellular capacity to attempt to
invade White cells engulf microbes
291
BODY SYSTEMS
Bladder outlet
Renal artery
carries blood
to kidney
Prostate gland, part
of the reproductive
system involved with Renal
activating sperm vein returns
cleaned blood
Urethra to inferior
vena cava
Penis
Ureter
△ Male urethra
In the male, the urethra passes through
the prostate gland, at the base of the
bladder, then along the length of
the penis. The same vessel conveys
semen from the body.
Urethral
sphincter
▷ Urinary anatomy
The renal blood vessels carry
about 2.5 pints (1.2 liters) of Opening
blood per minute. The amount, of ureter
composition, and concentration
Bladder wall
of urine is controlled by hormones
released by the pituitary and Bladder
lining
adrenal glands. Urine is stored
in the bladder and when it is full,
stretch receptors signal impulses
that initiate a desire to urinate.
Urethra
In females (right) the urethra is
shorter than in males (above).
292
T H E U R O G E N I TA L S Y S T E M
Bladder
Vas deferens,
thick-walled
tube that carries
sperm to
ejaculatory duct
Corpus cavernosum,
one of a pair of
spongelike regions
within the penis; it
contains most of
the penis’s blood
during an erection
Urethra conveys
sperm from
testes, or urine
from bladder
Corpus spongiosum,
spongy erectile
tissue surrounding
urethra
Prepuce
(foreskin),
loosely
fitting skin
293
BODY SYSTEMS
Ovary secretes
follicle stimulating
hormone (FSH),
which causes it to
produce ripe egg,
and luteinizing
hormone (LH),
which causes it to
release the egg
Uterus is a
thick-walled
muscular organ
that protects a
baby during
pregnancy
Rectum
Cervix is the
“neck” of
the uterus
Symphysis pubis,
cartilaginous joint
where right and left
sides of pelvis meet
294
T H E U R O G E N I TA L S Y S T E M
Inheritance ◁ Sperm
The genitals include parts of the sexual or The 23 paternal chromosomes are
reproductive system. This produces egg and carried in the head of the sperm
Tail of sperm Middle
sperm cells that carry genetic information from propels it toward piece cell, or spermatozoon. The cap, or
parent to child—termed biological inheritance. the ovum acrosome, penetrates the outer
Every human cell normally has 23 pairs of membrane of the egg at fertilization.
▷ Ovum Nucleus
chromosomes (46 altogether), numbered 1
Each egg, or ovum, is a
to 23, approximately largest to smallest. The
giant cell that contains Follicle
fertilized egg has one of each pair from the Sex
the 23 maternal cells chromosome Y
mother and the other from the father. The chromosomes as well as
23rd pair is the dissimilar sex chromosomes, all of the energy sources
XX signifying female and XY male. Information, needed for the first cell
in the form of chemical codes, is carried by divisions that shape the
deoxyribonucleic acid (DNA) in the chromosomes. early embryo.
All chromosomes together carry an estimated
20,000 genes, forming the human genome. A Jellylike film
gene consists of sequences of DNA needed to
Corona cells on outer Sex
construct one particular protein (proteins are layer secrete chemicals chromosome X
the body’s main building blocks). Many body that aid egg development
features are governed by more than one gene, Chromosome
pair 22
termed polygenic inheritance. For example,
eye color involves at least 15 genes, most ▷ Human genome
on chromosome 15. This is the full complement of genetic instructions
carried by chromosomes. The complete set of human DNA
was first identified in 2003 by the Human Genome Project.
T G
G G C T
A A C
C C G
295
BODY SYSTEMS
Sensory Organs
The sense organs inform and help to protect the body. The tongue, and ears, respectively. Each of these structures
five main senses are sight, smell, touch, taste, and hearing. contains specialized nerve receptors that send information
The structures that provide them are the eyes, nose, skin, to the brain via sensory neurons.
Skin, hair, and nails Matrix Nail root Cuticle Nail bed ◁ Nail structure
The skin is the largest organ in the body and weighs about Composed of hard plates of keratin,
6–9 lb (3–4 kg). It is very complex and comprises two Nail nails grow continuously. The matrix
main layers—the outer epidermis and the underlying dermis. below the visible part of the nail
It contains many different cell types, some of which are capable adds keratinized cells to the root
of producing hair and nail tissue. It can repair itself if injured and and pushes the whole structure
every month the outer layer is completely replaced, shedding along the nail bed.
cells at a rate of around 30,000 a minute; likewise, body hair
and nails are also self-replacing. Fat
Bone
296
SENSORY ORGANS
Superior rectus
muscle moves eye to
look up and down
Cornea, domed
Fovea has dense window at front
concentration of eye, which
of cone cells bends light
as it enters
Optic nerve
contains more
than a million
nerve fibers
Eyelid
Retina, region
that contains rods
and cone cells
297
BODY SYSTEMS
IN FOCUS
HOW WE HEAR
Malleus Incus Stapes
Cochlear
nerve Auricular Inner ear
cartilage
Ear canal
Cochlea, the organ
Lining of canal of hearing
secretes wax to trap
unwanted debris
298
SENSORY ORGANS
Temporal lobe
Nerve fiber
Olfactory
receptor cell Olfactory bulb
sorts and
Cilia integrates nerve
signals and sends
Lining of them to brain
nasal passage
Airflow
Odor molecule Olfactory nerve
△ How we sense smell cells carry odor
signals from
Odors dissolve in the lining of the nasal surface of nasal
chamber and when they touch the cilia chamber to
(hairlike endings to the nerve receptors) olfactory bulb
a nerve impulse is generated and sent
along the olfactory nerve.
Roof of nasal chamber
is lined with cilia-
bearing receptor cells
Mandibular
branch of
facial nerve
Facial
Larger nerve
vallate
papillae
Nerve endings Trigeminal Medulla, structure
in tongue and facial that receives taste
nerves gather signals from the
information cranial nerves to be
from the front sent to thalamus
of the tongue
Small
papillae
▷ Nerve pathways in
nasal cavity and mouth
△ Taste structures of the tongue Smell and taste sensations pass Glossophayrngeal nerve
The tongue is covered in thousands of along cranial nerves (12 pairs of collects information from
taste buds that contain gustatory receptor nerves that arise directly from the the rear of tongue
cells. These are found on and between brain, not the spinal cord). Smell
the pimplelike protuberances (papillae) signals pass to a patch of the surface
on the tongue as well as in the roof of called the olfactory cortex, and taste
the mouth, throat, and epiglottis. sensations pass to the gustatory cortex.
WHO´S WHO
Who´s who
Alphanus I c.1015–1085 of underlying organs. He published his retained an active interest in heart surgery In 1902 Boveri and American geneticist
A notable physician and Latin poet, findings, but he was largely ignored until until 1983, when he had to retire because Walter Sutton both independently
Alphanus I was born in Salerno, Italy. René Laënnec adopted the technique with of rheumatoid arthritis. observed that chromosomes are the
He taught at the university there and his new invention—the stethoscope. carriers of genetic material, which became
entered the Benedictine monastery at Becquerel, Antoine Henri 1852–1908 known as the Boveri–Sutton chromosome
Monte Cassino. In 1058 he was appointed Babinski, Joseph 1857–1932 A French physicist who discovered theory. From his work on worms and sea
Archbishop of Salerno. Alphanus translated Son of a Polish military officer who radioactivity; the international system urchins Boveri went on to demonstrate
Greek medical texts into Latin and his most fled to France, Babinski was a clinical unit (SI) of radioactivity is named after that each chromosome regulates embryo
influential work, De quattuor humoribus neurologist who initially studied under Becquerel. He shared the Nobel Prize development in a different way so they
(On The Four Humors), became the Jean-Martin Charcot at the Salpêtrière in Physics with Marie Sklodowska Curie must all be present for it to take place. He
cornerstone of medical theory. Hospital in Paris, France. He was the and Pierre Curie in 1903. identified the centrosome, the specialized
first person to differentiate hysteria from cell structure that regulates cell cycles. He
al-Nafis, Ibn 1213–1288 organic diseases. He wrote more than Behring, Emil von 1854–1917
also hypothesized that cellular processes
See p.49 200 papers on nervous disorders and See p.158
cause cancer—that is, a tumor must
became professor of neurology at the begin with a single cell in which the
al-Hariri, Ibn Ali 1054–1122 Bernard, Claude 1813–1878
University of Paris. He described Babinski’s chromosomal information is scrambled.
A wealthy Arab poet and silk trader, A French physiologist, Bernard is
sign, a reflex of the big toe that indicates
al-Hariri is best known for writing often considered to be the “father of
a type of brain injury. Broca, Paul 1824–1880
Al Maqamat, a book consisting of 50 physiology.” He used rigorous experimental
Physician, surgeon, and anatomist, Broca
short stories, each with a particular moral; Banting, Frederick 1891–1941 work to make important discoveries about
was born in southwest France, the son
the book was once memorized by scholars. the functioning of the liver, pancreas,
In 1921 Canadian doctor Banting, together of a surgeon in Napoleon’s service. He is
The text of the book was based on the and the nervous system; and also
with Charles Best, discovered insulin—the best known for his discovery of the speech
Qur’an, well-known proverbs, and classical established the principle of biological
life-saving treatment for diabetes. In 1922 center in the frontal lobes of the brain—
poems. The book was later published in regulation. Bernard’s experiments on living
the duo injected insulin into a diabetic. named Broca’s area after him. Not only
English as The Assemblies of al-Hariri. animals were controversial but resulted in
Banting worked in the laboratories of was this the first anatomical proof of
several breakthroughs in medicine. He was
physiologist Professor John Macleod at localized brain function, but it also
al-Razi, Ibn 854–925 CE the first scientist to be awarded a public
the University of Toronto; Charles Best was revolutionized the understanding of
Also known by his latinized name Rhazes, funeral in France.
Banting’s research assistant. In 1923 only language processing.
al-Razi was born in Rayy, Mesopotamia
Macleod and Banting were awarded the
(now in Iran). He was a physician, Best, Charles Herbert 1899–1978
Nobel Prize in Physiology or Medicine, so Carpi, Jacopo Berengario da
philosopher, and alchemist who encouraged A Canadian medical scientist, Herbert 1460–1530
Banting shared his half of the award money helped discover insulin in 1921, after
experimentation. He headed one hospital The son of a barber-surgeon, Italian
with Best. Banting was appointed senior which it became a standard treatment
in Rayy, then two more in Baghdad. Among physician and anatomist Carpi studied
demonstrator in medicine at the University for diabetes. Best worked closely with
his many achievements was the first medicine at the University of Bologna in
of Toronto, Canada. He continued research Frederick Banting, but missed out on
recorded clinical trial, which he undertook Italy. Carpi wrote a number of treatises,
into silicosis, cancer, and the mechanism of winning the Nobel Prize in Physiology
on patients with meningitis. His Kitab but he is best known for Anatomia Carpi
drowning. His interest in aviation medicine or Medicine in 1923. He went on to
al-Mansouri fi al-Tibb (Book of Medicine (Carpi’s Anatomy)—the first anatomical
led him to work with the Royal Canadian develop heparin, recognizing that it
for Mansur), written in 903 CE for the text with illustrations—published in 1535.
Air Force on a number of projects. could be an important anticoagulant
Persian Prince Mansur, was highly influential All the illustrations were based on Carpi’s
in the Islamic world and the West—it was drug for preventing blood clotting. personal dissection experience and it was
Barnard, Christiaan 1922–2001
translated into Latin in the 12th century the first work since the time of Galen to
A South African cardiac surgeon, Barnard Blackwell, Elizabeth 1821–1910
by Italian scholar Gerard of Cremona. display original anatomical information
became the first person to perform a See p.141 based upon personal investigation and
Auenbrugger, Joseph Leopold human-to-human heart transplant in
observation; it undermined Galen’s theories.
1722–1809 December 1967. He studied medicine Boveri, Thomas 1862–1915
An Austrian physician, Auenbrugger at the University of Cape Town, then in German biologist Boveri, the second of Carter, Henry Vandyke
discovered the diagnostic value of the Minneapolis, Minnesota, under Walt four sons of a physician, studied at the 1831–1897
percussion technique, which involved Lillehei. Returning to South Africa, Barnard University of Munich. By 1892 he was A British anatomist, surgeon, and anatomical
putting his ear to a patient’s chest and introduced open-heart surgery at Cape professor of zoology and comparative artist, Carter drew the illustrations for
lightly tapping on it to assess the texture Town’s Groote Schuur Hospital. He anatomy at the University of Wurzburg. Anatomy: Descriptive and Surgical (later
300
WHO´S WHO
known as Gray’s Anatomy) from 1856 to Crick, Francis 1916–2004 Duchenne studied medicine in Paris Erasistratus c.304 BCE–c.250 BCE
1857. Born in Hull, England, he was the son A British biophysicist and neuroscientist, before returning to Boulogne, France. An ancient Greek anatomist, Erasistratus
of an artist. He studied in London, and was Crick determined the structure of He specialized in disorders of nerves was royal physician under Seleuceus I
a student of human and comparative deoxyribonucleic acid (DNA) in 1953, with and muscles, and experimented with Nicator of Syria. He founded the school of
anatomy at the Royal College of Surgeons. his colleague James Watson. Crick, Watson, the therapeutic qualities of electricity— anatomy in Alexandria, along with fellow
He was also a demonstrator of anatomy and Maurice Wilkins were jointly awarded showing how electrical stimulation of physician Herophilus. He is credited with
at St. George’s Hospital, London. In 1858 the 1962 Nobel Prize in Physiology or the brain could cause the facial muscles describing the valves of the heart, noting
he joined the Indian Medical Service in Medicine for this work. In England, Crick to contract. He also described the that the heart functioned as a pump, and
Bombay, India, only returning to the UK studied in London, and then Cambridge. genetic disorder known as Duchenne distinguishing between arteries and veins,
after his retirement in 1888. He later moved to the Salk Institute in muscular dystrophy. although he thought that arteries were
California, where he spent the remainder full of air. He also described the cerebrum
Charcot, Jean-Martin 1825–1893 of his career. Dunant, Jean Henri 1828–1910
and cerebellum in the brain, observed a
See p.161 See p.267
difference between motor and sensory
Davy, Humphry 1778–1829
Ehrlich, Paul 1854–1915 nerves, and linked them to the brain.
Chauliac, Guy de c.1300–1368 Born in Penzance, southwest England,
Davy was a chemist and inventor. He was Born in Lower Silesia, now part of Poland,
See p.69 Fabricius, Hieronymus 1537–1619
apprenticed to a surgeon in Penzance, Ehrlich was the son of an innkeeper and
A pioneering Italian surgeon and
Colombo, Realdo c.1516–1559 then became a chemist in the apothecary’s distiller. He started his medical studies
anatomist, Fabricius was educated at
Born in Cremona, Italy, this anatomist and dispensary. In 1798 he became medical in Breslau and after obtaining his
the University of Padua, Italy, where he
surgeon was the son of an apothecary. superintendent of the Pneumatic Institution, doctorate he began working in
studied under Gabrielle Fallopio—and
Colombo studied philosophy in Milan, Bristol, which was established to investigate Berlin, Germany. During his career
in 1565 succeeded him as the professor
then pursued his father’s profession in hematology (study of blood), he
the medical powers of gases, including of anatomy. Fabricius’s pioneering work
before becoming apprenticed to the developed stains that made it possible
nitrous oxide (laughing gas). In 1801 Davy on veins had a great influence on his
Venetian surgeon Giovanni Antonio to distinguish between different cells—
joined the Royal Institution, first as lecturer, student William Harvey, who went on to
including bacteria. From this he pursued the
Lonigo. In 1538 he enrolled at the then professor of chemistry, and was later describe blood circulation. He identified
concept of the “magic bullet”—a drug that
University of Padua, Italy, to study elected a fellow. He discovered a number the larynx as a vocal organ, and elevated
could target specific infectious organisms
anatomy and medicine, where he became of elements including potassium (the first embryology to an independent science.
or cancerous mutations, now known as
close friends with Andreas Vesalius. In metal isolated by electrolysis), sodium, and In his Tabulae Pictae, published in 1600,
chemotherapy. He was awarded the
1544 he moved to the University of Pisa, calcium. He also invented the Davy gas he described the cerebral fissure that
1908 Nobel Prize in Physiology or
as the “master of anatomy and surgery.” safety lamp for miners. separates the frontal and temporal lobes
Medicine for his contributions to the
He then moved to Rome in 1548, where of the brain.
Democritus c.460–c.370 BCE science of immunology.
he taught anatomy until his death. His
An ancient Greek natural philosopher, Falloppio, Gabrielle 1523–1562
only treatise, De Re Anatomica (On Einthoven, William 1860–1927
Democritus was born in Abdera to a wealthy Born in Modena, Italy, Falloppio studied
Things Anatomical) was published See p.185
noble family. He is known for his ideas on
shortly after his death. medicine in Ferarra and went on to
the formulation of the atomic theory of the Empedocles c.490–c.430 BCE teach anatomy there and in Padua.
Constantine the African Universe, but much of his work is inspired A philosopher born in the ancient Greek He succeeded Realdo Colombo as
c. 1020–died before 1099 by that of his mentor and teacher— city of Agrigentum (Acragas), Sicily professor of anatomy and surgery at the
A widely traveled Muslim scholar from Leucippus, a 5th-century BCE Greek (now in Italy), Empedocles is best known University of Padua and is credited with
Tunisia whose translations of Arab texts philosopher. Known to Aristotle as well, for formulating the four elements, or many discoveries in the anatomy of
influenced European scholars, Constantine many consider Democritus to be the humors—earth, air, fire, and water—later the eyes, ears, and nose, as well as the
is thought to have studied medicine in father of modern science. formalized by Galen. He was a famous human reproduction system. He wrote
Africa and Baghdad, and had knowledge orator and had a reputation for his a number of treatises, but only one,
Dioscorides, Pedanius 40–90 CE
of Mesopotamian, Greek, and Indian knowledge of curing disease and averting Observationes Anatomincae
See p.39
medicine. He became a Christian and epidemics. Much of his work was written (Anatomical Observations), was
entered the Monte Cassino monastery at Duchenne, Guillaume Benjamin in verse and some fragments survive. published in his lifetime.
Salerno, where he remained translating Armand 1806–1875 According to Aristotle, Empedocles died
medical books from Arabic into Latin Also known as Duchenne du Boulogne, at the age of 60, although some suggest Fleming, Alexander 1861–1955
until his death. he descended from a family of fishermen. he lived to more than 100. See p.198
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Florey, Howard Walter tissue) and white matter (conducting tissue) Gray, Henry 1827–1861 Hippocrates, these included one for
1898–1968 in the brain. A British anatomist and surgeon, midwives, as well as treatises on the
An Australian pharmacologist and Gray is most famous for publishing the causes of sudden death and anatomy.
pathologist, Florey shared the 1945 Galvani, Luigi 1737–1798 book Anatomy: Descriptive and Surgical All of his writing was lost in the
Nobel Prize in Physiology or Medicine Born in Bologna, Italy, Galvani was the (later known as Gray’s Anatomy) which destruction of the great library at
with Ernst Boris Chain and Alexander son of a goldsmith. Philosopher, physician, has became a standard medical reference Alexandria in 272 CE.
Fleming for his role in the development biologist, and physicist, he is best known work and is still in print today. Gray was
of penicillin (while Fleming discovered for his theories on animal electricity and born in London, England, and studied at Hildegard of Bingen 1098–1179
penicillin, it was Florey who carried out in particular his accidental discovery that St. George’s Hospital. He was elected a See p.56
the first clinical trials). Born in Adelaide, electricity could make the muscles of Fellow of the Royal College of Surgeons
Australia, Florey studied medicine in his a dead animal twitch. He trained as a at the young age of 27. The first edition Hippocrates 460–370 BCE
home city, then moved to the University physician at the University of Bologna, of Gray’s book Anatomy was published See pp.36–37
of Oxford, England. After periods in the in 1858 and featured 350 illustrations by
was made public lecturer in anatomy in
US and at the University of Cambridge, Hopps, John Alexander
1762, and became its president in 1772. his friend and colleague Henry Vandyke
1919–1998
England, he was appointed professor Carter. A second edition followed in 1860.
of pathology at the University of Sheffield, A Canadian biomedical engineer, Hopps
Gaskin, Ina May 1940–
England, but returned to Oxford in Hahnemann, Samuel 1755–1843 was one of the pioneers of the heart
See p.135
1935, where he carried out his work See p.109 pacemaker. Born in Winnipeg, Hopps
on penicillin. Gerhardt, Charles Frédéric studied at the University of Manitoba
1816–1856 Harvey, William 1578–1657 and in 1942 joined the National Research
Franklin, Rosalind 1920–1958 See p.170 Born in England, Harvey studied at the Council of Canada. In 1949 he moved
A British chemist and crystallographer, University of Padua, Italy. He had a to Toronto to work at the university’s
Franklin produced the X-ray diffraction Golgi, Camillo 1843–1926 deep conviction in the importance of Banting Institute and, with Wilfred
image of deoxyribonucleic acid (DNA), the An Italian scientist, pathologist, and experimental science and a particular Bigelow and John Callaghan, designed
so-called “Photograph 51,” which revealed physician, Golgi spent much of his career interest in the circulation of blood. In and developed the first external heart
a cross pattern that suggested DNA was studying the central nervous system. In 1628 he published the results of 30 years' pacemaker—used to pace a dog’s heart
helical in shape. This was the key evidence 1873 he published On the Structure work in which he established that blood is in 1950. Hopps founded the Canadian
for James Watson and Francis Crick’s double of the Brain Gray Matter, in which he circulated around the body via the heart’s Medical and Biomedical Engineering
helix model. However, she did not share in described a revolutionary silver-nitrate, pumping mechanism. He was appointed Society and was its first president.
the Nobel Prize for this achievement tissue-staining technique initially named physician to Kings James I and Charles I of
because she died before it was awarded. the “black reaction”; Golgi staining England. He also tended to the victims Hounsfield, Godfrey 1919–2004,
or Golgi impregnation is still in use of the English Civil War (1642–1651). See p.217
Freud, Sigmund 1856–1939
today. Golgi established the Institute
See pp.182–83 Hayyan, Jabir ibn Ivanovsky, Dmitry 1864–1920
of General Pathology in 1881 and was c.721–815
jointly awarded the Nobel Prize in See p.167
Galen, Claudius c.129–c.216 CE An Islamic alchemist, astronomer,
See pp.40–41 Physiology or Medicine in 1906 with physicist, and natural philosopher, Hayyan Jenner, Edward 1749–1823
Santiago Ramón y Cajal. was also known as Jabir Geber or by A British scientist and medical practitioner,
Gall, Franz Joseph 1758–1826 the full name of Abu Musa Jabir ibn
Gräfe, Karle Ferdinand von Jenner demonstrated how inoculation
A German neuroanatomist and physiologist, Hayyan, and described as the father of
1787–1840 with the cowpox virus could safely provide
Gall was the first to ascribe various mental Arab chemistry. He turned alchemy into
A German surgeon who pioneered plastic immunity from the deadly viral disease of
functions to different parts of the brain. a science, invented many pieces of
and reconstructive surgery, especially smallpox—the world’s first vaccine. Born
Born in Baden, he studied first in Strasbourg, laboratory equipment, and identified
France, and then in Vienna, Austria. Through of the nose and eyelids. Gräfe studied in Gloucestershire, England, Jenner was
chemical substances such as hydrochloric
observations about skull sizes and facial in Halle and Leipzig, in Germany, and in the son of a vicar and the eighth of nine
acid and nitric acid.
features Gall developed the theory of 1811 was appointed professor of surgery children. At the age of 14 he was first
organology, which led to cranioscopy and director of the Ophthalmological Herophilus c.335–c.280 BCE apprenticed to a local surgeon, then
(later known as phrenology), a theory Institute in the University of Berlin. He A Greek physician who, along with in 1770 to one of London’s most
that asserts that the shape of a person’s developed his own techniques using Erasistratus, founded the school of distinguished surgeons, John Hunter,
skull reveals intellectual and emotional modifications of methods used by Italian anatomy in Alexandria, Egypt, Herophilus at St. George’s Hospital. In 1773 he
characteristics. His work was condemned surgeon Gasparo Tagliacozzzi as well described anatomical organs and returned to Gloucestershire to become a
by religious leaders in 1802 and three years as ancient Indian practices. He performed structures including the pancreas, liver, family doctor and surgeon, and remained
later he left Austria for France. He was the one of the first operations for the genitals, and eye. He wrote at least nine there until his death. He was elected
first person to identify gray matter (active treatment of cleft palate. books and, according to notes from Fellow of the Royal Society in 1788.
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Kanada, probably lived in uncle who worked on the faculty of became a full surgeon at the Glasgow Royal graduating. He did receive an honorary
2nd century BCE medicine in the University of Nantes, Infirmary in 1877, and was Regius Professor degree from Washington University of
A Hindu sage and philosopher, Kanada France. In 1799 he went to Paris to of Surgery at the university by 1892, a post Medicine in 1852.
founded the philosophical school of continue his medical studies under previously held by Lister.
Vaisheshika. His primary area of study several physicians including Jean-Nicolas Nightingale, Florence 1820–1910,
was Rasavadam—a type of alchemy. Corvisart-Desmarets, who reintroduced the Malpighi, Marcello See p.142
He believed that all living things were 1628–1694
use of sound as a diagnostic aid; at the
composed of five elements: water, fire, See p.96 Nobel, Alfred 1833–1896
time this meant placing an ear against
earth, air, and ether. A Swedish chemist, Nobel invented
the patient’s chest. Laënnec also Marshall, Barry 1951–
dynamite and its less sensitive form
developed an understanding of many See p.244
Kelling, Georg 1866–1945 nitroglycerine, and also founded the Nobel
other conditions, coined the term
See p.189 Prizes. He amassed a fortune and willed
melanoma, and studied tuberculosis, Meduna, Ladislas Joseph
the condition that eventually took his life. 1896–1964 most of it to the Nobel Prize annual awards
Kelman, Charles 1930–2004
Born in Budapest to a well-to-do Hungarian in physics, chemistry, economics, physiology
Born in New York, Kelman was an
Landsteiner, Karl 1868–1943 family, Meduna began his medical studies or medicine, literature, and peace.
ophthalmologist who pioneered new, safer
See p.176 in 1914, but did not complete them until
methods of cataract surgery as well as Papanicolaou, George N.
after World War I. He pursued a career in
repairing retinal detachments. He studied Lane-Claypon, Janet 1883–1962
neurology at the Hungarian Institute for
at Tufts University, Massachusetts, and 1877–1967 See p.204
Brain Research and began looking into the
then in Geneva, Switzerland. He later See p.126
structure of the pineal gland in the brain. He Pappenheim, Bertha (Anna O)
returned to the US—first to Brooklyn,
Larrey, Dominique-Jean moved to the Psychiatric Institute and began 1859–1936
then Philadelphia’s Wills Eye Hospital,
1766–1842 research into psychotic conditions such as See p.251
and finally back to New York. Kelman was
See p.256 schizophrenia. There he developed a method
also an accomplished saxophonist and Paracelsus 1493–1541
of treating psychotic patients with chemically
even performed at Carnegie Hall. Leeuwenhoek, Antoni van 1632–1723 Born in Switzerland as Philippus von
induced seizures. Meduna emigrated to
See p.92 Chicago, Illinois, in 1938 and remained there Hohenheim, Paracelsus’s adopted name
Koch, Robert 1843–1910
for the rest of his life. meant equal to or greater than Celsus—
A German physician, Koch is considered to Lister, Joseph 1827–1912
a Roman scholar of medicine. Paracelsus
be a founder of modern bacteriology. His See p.154 Mesmer, Franz Anton traveled widely in Europe, Africa, and the
discoveries facilitated the development 1734–1815
Middle East, and had many interests
of the first chemicals designed to attack Luzzi, Mondino de c.1270–1326 A German physician, Mesmer also had an
specific bacteria (Ehrlich’s “magic bullet”). An Italian physician, anatomist, and including alchemy, astrology, medicine,
interest in astronomy. He developed a theory
Building on Louis Pasteur’s germ theory, surgeon, Luzzi was born to a Florentine psychology, and toxicology. A prolific writer,
that there was a natural transfer of energy
Koch isolated the bacilli for anthrax (1877), family, but worked in Bologna; he is he established the use of chemistry in
between all animate and inanimate objects
tuberculosis (1882), and cholera (1883). sometimes known as Mundinus. Luzzi medicine, introducing laudanum, sulfur,
that he called animal magnetism—later
He also developed Koch’s postulates of famously reintroduced the practice lead, and mercury as medical remedies,
called mesmerism—a form of hypnosis
germ theory that sets out the criteria to of dissecting bodies for the study of and gave a clinical description of syphilis.
that could induce a trance. His idea had a
be met to establish whether specific bacteria anatomy. One of his most famous pupils Paracelsus was an outspoken opponent
substantial following, but never achieved
cause specific diseases. Koch received was Nicólò Bertuccio, who succeeded of the merely academic knowledge of
scientific recognition.
the 1905 Nobel Prize in Physiology him and in turn taught Guy de Chauliac. medicine that was acquired at universities.
or Medicine for his tuberculosis-related Morton, William Thomas Green
Macewen, William 1848–1924 1819–1868 Paré, Ambroise 1510–1590
discoveries. He was appointed professor
A Scottish surgeon, Macewen was not only Morton was the dentist who first publicly See pp.78–79
of hygiene at the University of Berlin in
1885, and was director of the Institute a pioneer of modern brain surgery and demonstrated the use of ether as a surgical
Pasteur, Louis 1822–1895
for Infectious Diseases, Berlin, from the development of bone grafts, but also anesthetic for a tooth extraction in 1846.
See pp.148–49
1891 to 1904. (influenced by the work of Joseph Lister) an Born in Massachusetts, Morton had various
innovator in the field of surgical practice— jobs before entering Baltimore Dental
Pott, Percivall 1714–1788
Laënnec, René 1781–1826 introducing antisepsis in operating College in 1840. However, he left two
See p.230
The inventor of the stethoscope, Laënnec rooms. He adopted the deep cleansing years later without completing his degree
was born in Brittany, France. The son of a and disinfection of arms and metal and went to work with another dentist, Ramón y Cajal, Santiago
lawyer, his mother died when he was 5 instruments, also sterilization with steam; Horace Wells. In 1844 Morton entered 1852–1934
years old and he was sent to live with a the use of surgical gowns; and the recently Harvard Medical School, where he was A Spanish pathologist, histologist,
great uncle who was a priest. At the age discovered anesthesia. Macewen studied introduced to the anesthetic properties and neuroscientist, Ramón y Cajal is
of 12, Laënnec went to study with an at the University of Glasgow, Scotland, of ether, but again he left without considered by many to be the founder
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of modern neuroscience. He was Sanger, Margaret 1879–1966 the outbreak of bubonic plague in Hong and legal ramifications of mesmerism. After
responsible for identifying the type of See pp.226–27 Kong and later described the organism a series of tragic events he developed mood
nerve cell that controls the slow waves that causes dysentery. swings and depression, and eventually died
of contractions that move food along Saunders, Cicely 1918–2005 in a mental hospital in Switzerland.
the intestine, and an expert in hypnotism, See p.263 Simpson, James Young
1811–1870 Tuo, Hua c.140–c.208
which he used to help his wife during
Schleiden, Matthias 1804–1881 A Scottish obstetrician, Simpson An ancient Chinese physician and
labor. Ramón y Cajal and Camillo
See p.150 discovered the anesthetic properties surgeon, born in Bozhou province, Tuo
Golgi were jointly awarded the Nobel
of the gas chloroform in 1847, which lived in the late Eastern Han Dynasty. He
Prize in Physiology or Medicine in Seishu, Hanaoka 1760–1835 became a popular method of pain relief is best known for the use of acupuncture
1906 in recognition of their work A Japanese surgeon, Seishu gained an in childbirth. Born in West Lothian, and a concoction made from wine and
on the nervous system. extensive knowledge of Chinese herbal Simpson completed his studies at the máfèisàn (a herbal formulation made
medicine and Western surgical techniques age of 18, but was not allowed a license to from hemp), as a general anesthetic.
Röntgen, Wilhelm Conrad
1845–1923 that he learned from the Dutch. Seishu practice medicine for another two He also pioneered hydrotherapy and
See p.172 studied medicine in Kyoto, but due to years. He designed the air tractor, an early did innovative work with physical therapy
the self-imposed isolation of Japan at the version of the ventouse (vacuum extraction, using a series of exercises known as
Ross, Ronald 1857–1932 time, there were few foreign medical texts and improved the design of forceps to this the frolics of the five animals.
See p.175 available. Seishu is noted for combining day known as Simpson’s forceps.
Dutch and Japanese surgery and bringing Vesalius, Andreas
Ruggiero, Trotula de modern techniques to Japan. Sina, Ibn 980–1037 1514–1564
c.1090–unknown See p.75
Also known by his latinized name Avicenna,
An Italian physician born to a wealthy Semmelweis, Ignaz Ibn Sina was born in Uzbekistan. A prolific
family, also known as Trotula de Salerno, 1818–1865 Virchow, Rudolf Karl Ludwig
scholar, he made important contributions 1821–1902
she is considered one of the first expert See p.139
to medicine as well as mathematics, See p.152
gynecologists. Trotula studied at the new
Servetus, Michael 1511–1553 chemistry, astronomy, psychology, and
medical school at Salerno—the first of the
geology. Ibn Sina claimed to have treated Warren, Robin 1937–
Western world—and went on to become Spanish theologian, physician, cartographer,
patients by the time he was 16. He is known See p.244
a professor. She is known for having and Renaissance humanist, Servetus is
also known as Miguel Servet. He wrote to have written 450 works, some of which
written two particularly important works, Watson, James Dewey 1928
several treatises on medicine and human have survived. His major work Al Qanun
the most famous of which is Passionibus An American molecular biologist,
anatomy and was the first European fi al-Tibb (The Canon of Medicine) (see
Mulerium Curandorum (The Diseases of geneticist, and zoologist, Watson
to describe the function of pulmonary pp.52–53) written when he was in the court
Women), sometimes called Trotula Major. discovered the double helix structure
(heart–lung) circulation correctly in of Shams al Dawla of Hamadan, became a
It is a 63-chapter compendium covering of deoxyribonucleic acid (DNA) in 1953
everything from anatomy and sex to his book Christianismi Restitituto standard text in European universities.
with Francis Crick, and shared the Nobel
menstruation, and it was written to (The Restoration of Christianity). However, Prize with both Crick and Maurice Wilkins
Snow, John 1813–1858
educate her male colleagues. The second his theological works were considered in 1962. Watson wrote many science text
See pp.124–25
work—Trotula minor—covered more heretical and he was burnt at the stake books and was widely honored for his
general information. for his views. Sydenham, Thomas work. Crick was also associated with
1624–1689 the US National Institutes of Health.
Salk, Jonas Edward Shibasaburo, Kitasato See pp.90–91 He played a leading role in establishing
1914–1995 1853–1931
the Human Genome Project and was
An American medical researcher, Salk A Japanese physician and bacteriologist, Tourette, Georges Gilles de la appointed head of the project from
discovered a vaccine for the debilitating, Shibasaburo was educated at Kumaoto 1857–1904
1990 to 1992.
and often fatal, disease polio. Benefiting Medical School and Tokyo Imperial A French physician, Tourette described
from the work of Harvard’s John Franklin University. He studied under Robert Koch a syndrome he called “maladie de tics” Zhongjing, Zhang 150–219 CE
Enders, who had developed a way to grow in Berlin, Germany, from 1885 to 1891, (illness of tics), which was later named See p.26
polio in test tubes, Salk began a human where he met and worked with Emil von Gilles de la Tourette’s illness in his honor
trial of the vaccine in 1955. When it was Behring. Shibasaburo was the first person by his mentor Jean-Martin Charcot. Born
made public, he became famous overnight to grow the tetanus bacillus, and together in southeastern France, he began his medical
and polio was virtually eradicated. In he and von Behring discovered that studies in Poitiers, then moved
1963 he founded the Salk Institute injecting dead or weakened disease- to Paris where he studied under influential
for Biological Studies and in 1977 was causing bacteria into an animal caused neurologist Charcot at the Salpêtrière
awarded the US Presidential Medal its blood to make antibodies. In 1894 Hospital. Tourette studied and lectured in
of Freedom. he identified the bacterium that caused psychotherapy, hysteria, and the medical
304
GLOSSARY
Glossary
A
Antagonist drug Blocks the action of under completely sterile conditions (that Outbreaks in Europe continued into
a natural substance in the body. are free of all living microorganisms). the 18th century.
Acute condition One that begins Anthrax A serious, potentially fatal, Atherosclerosis Disease of the arteries Blastocyst Hollow ball of cells that
abruptly and may last for a short time, bacterial infection that affects livestock characterized by deposits of fatty material is an early stage in the development
in contrast with a chronic condition. but can spread to humans through contact on the linings of artery walls. of an embryo.
with affected animals, or inhaling spores
Agonist drug Simulates a natural Atria The two chambers of the upper heart Blood circulation The continuous flow
from contaminated animal fibers.
substance and replicates its effects that receive blood from veins. of blood around the body via the heart
in the body. Antibiotic Drug that is used to kill and blood vessels.
Autoclave Steam-heated container used
or inhibit the growth of bacteria, usually
AIDS Abbreviation for acquired immune for sterilizing medical instruments at high Blood pressure The pushing force of
those causing infections.
deficiency syndrome, a deficiency of the temperature and pressure. blood as it is pumped around the body
immune system that can occur as a result Antibodies Proteins produced in the by the heart; it can be detected at
B
of infection with HIV. body by white blood cells to mark foreign points where arteries are close to
particles or antigens and stimulate the the skin’s surface.
Alchemy A medieval practice that tried, immune response.
among other things, to find a way to Bacteriophage Parasitic virus that infects Blood type/group Any of several
change common metals, such as Antigen A substance that stimulates bacteria; also called a phage. types—A, B, AB, or O—into which
the body to produce antibodies and an an individual’s blood can be classified
lead, into gold and create an elixir Bacterium (plural: bacteria) A single-
immune response. based on the antigens on the surface
for eternal life. celled microscopic organism that does not
Antimicrobial Substance capable of of red blood cells.
Allele Form or version of a gene, for have a membrane-enclosed nucleus or
killing microbes that cause infection or other organelles and is too small to see. Brain stem A stalk of nerve tissue that
example there are several versions of
stopping them from multiplying. forms the lowest part of the brain and
the genes for eye color. Base pairs Complementary pairs
Antiretroviral drugs Drugs used for links to the spinal column.
Alveolus (plural: alveoli) A tiny air of nucleotide bases that link the two
the treatment of retrovirus infections, sides of the double spiral, or helix, of a Bubonic plague Highly contagious
sac in the lungs.
principally HIV. DNA molecule. The order of base pairs disease that causes fever and painful
Amino acid A simple organic compound swelling of the lymph glands—
Antisepsis Prevention of infection by spells out the DNA code.
that contains one or more amino groups sometimes called buboes, hence its
inhibiting or arresting the growth and Bile Dark green/yellowish substance
and one or more carboxyl groups. name. Other symptoms include spots
multiplication of microbes. that aids the digestion of fats in the
Amino acids are the chemicals that on the skin, that turn black, so it was
make up proteins. Antiseptic An antimicrobial substance small intestine. Produced by the liver,
also known as the Black Death. Today,
applied to living tissue skin to reduce the it is stored and released by the
Anesthesia Medical inducement for the disease mainly affects rodents,
risk of infection, which works by killing gallbladder. Also the yellow and black
pain relief or complete loss of sensation. but can be transmitted from person
microbes that may be present. “bile” in humorism, a system of
May be in part of the body (local to person by fleas.
medicine that thrived in Europe from
anesthesia) or in all of the body Antitoxin An antibody that
around 500 bce to the 19th century.
C
(general anesthesia). counteracts a toxin, or poison.
Biopsy The taking of a tissue or fluid
Analgesia Form of pain relief. Apothecary A term used in medieval
sample for analysis.
times, to refer not only to the place Cancer A group of diseases characterized
Anatomist Person who studies the where remedies were dispensed, but Bipolar disorder A long-term mental
structure of living things. Human anatomy by the abnormal and unrestrained growth
also to the person who dispensed them. condition characterized by alternating
of cells in body organs or tissues.
is the study of the human body. periods of depression and elation;
Arteriole Smaller blood vessel that
previously called manic depression. Capillary Minute blood vessel with thin
Angina (or angina pectoris) Chest leads from the arteries and links to
walls through which nutrients and waste
pain that occurs when the blood supply the capillaries. Black Death An outbreak of the highly
products pass to and from body tissues.
to the muscles of the heart is restricted, contagious bubonic plague that began
Artery Blood vessel that carries blood
usually because the arteries supplying in Central Asia in the 1330s, arriving in Cardiac dilatation A condition in which
away from the heart.
the heart become hardened and Europe in 1347. After five years the the heart cavities become enlarged,
narrowed. Importantly the pain eases Aseptic technique The performance outbreak had killed approximately causing the outer muscular wall
with rest. of a medical or laboratory procedure 60 percent of Europe’s population. (myocardium) to become thinner.
305
GLOSSARY
Cardiology The study of the heart and Cholera An infection of the small intestine Crookes tube An experimental electrical Diagnosis Identification of an illness from
circulatory system; a cardiologist is a that causes severe watery diarrhea. It discharge tube with a partial vacuum its symptoms (what the person describes)
doctor who specializes in cardiology. results from ingesting water or food that invented by 19th-century British physicist and signs (what is observed).
contains the bacterium Vibrio cholera. William Crookes.
Cardiovascular system The system Diastole/diastolic The period when all
comprising heart, blood vessels—arteries, Chromatid One of two threadlike strands Crystal A solid whose constituent the chambers of the heart are relaxed
capillaries, and veins—and blood. into which a chromosome divides during atoms, ions, or molecules are arranged and the heart is filling with blood. Diastolic
cell division—each one contains a double- in a regularly repeating pattern. A crystal pressure is the second number of a
Cartilage Firm, flexible tissue found in
helix of DNA. lattice is the repeating pattern of atoms blood pressure reading, for example
various forms in the body, for example,
or ions that forms a crystal. 120/80 or 120 over 80.
in the larynx and respiratory tract, the Chromosome A structure made of
external ear, and on the articulating DNA and protein that is found in cells. Crystallogram The pattern formed on a Diffraction The phenomenon that occurs
surfaces of bones at joints. A chromosome contains the genetic photographic plate by passing X-ray beams when a light wave hits an object or passes
information (in the form of genes) through a crystal. through a gap and splits, or bends.
Cautery The practice of cauterization,
for an organism; humans have 23 pairs.
or burning, of part of a body to remove Crystallography The study of atomic Digestion The breaking down of food into
or close off the area, for example in an Chronic condition A persistent medical and molecular structure. simpler molecules that can be utilized by
attempt to stop bleeding or remove condition that usually lasts six months the body.
unwanted growth. or longer and may result in long-term CT scan/CAT scanning Computerized
Digestive system The digestive tract
change in the body. (axial) tomography is an imaging technique
Cell The smallest unit of an organism that (mouth, esophagus or gullet, stomach,
that uses weak X-rays to record thin 2-D
can exist on its own—the building blocks Cilium (plural: cilia) A tiny “hair” small and large intestines), plus associated
slicelike views through the body, then
of the body. Humans have more than 250 projecting from a cell, usually on the organs—liver, pancreas, and gallbladder.
combines them to make 3-D images.
different types of cells. surface of a tissue or small organism. Cilia
Diphtheria Highly infectious disease
line surfaces inside the body, for example Culture medium A nutritious substance,
Central nervous system The collection characterized by a fever, severe cough,
the respiratory tract. sometimes called a growth medium, to
of nerves in the brain and spinal cord that and a grey coating over the infected
support the growth of microorganisms,
acts to control the body. Congenital A physical abnormality or areas, particularly the throat and tonsils.
for example in a laboratory.
condition that is present from birth and
Centrosome An organelle near the Disinfect Make something clean and free
can be the result of environmental or Cystic fibrosis Hereditary disorder of
nucleus of an animal or plant cell that from infection, especially with the use of
genetic factors. the exocrine glands that causes excess
contains the centrioles from which the germ-killing chemicals.
mucus production, which leads to
spindle fibers develop in cell division. Congestive heart failure A condition in
clogging of the airways. Distillation A process by which
which the heart is not pumping effectively;
Cerebellum Area at the back of the a pure liquid is separated from
this can be the result of coronary artery Cytoplasm The liquid contents of a cell,
brain, below the cerebrum, whose a mixture of liquids.
disease or persistent high blood pressure. apart from organelles.
primary role is to control movement
DNA (Deoxyribonucleic acid)
and maintain balance. Conjunctiva The mucous membrane that
D
A long thin double-helix-shaped
covers the front of the eye and lines the
Cerebrum The largest part of the brain in molecule that makes up the chromosomes
inside of the eyelids.
humans, responsible for most conscious found in almost all cells. It contains
thought and activity. In humans it is Contagion A living thing, usually a Defibrillator A device for restoring the encoded genetic information of
divided into two cerebral hemispheres microbe, that can be passed between the rhythmic beating of the heart by the living organisms.
(left and right) and surrounds most of people to cause disease. administration of a controlled electric shock. Dosha In Ayurvedic medicine a dosha is an
the rest of the brain.
Contrast medium A substance through Dermis Inner layer of skin composed of energy believed to circulate round the body.
Chakra In Indian Ayurvedic medicine which X-rays cannot pass. connective tissue interspersed with hair There are three doshas—vata (wind), pitta
a chakra is a spinning center of energy follicles, sweat glands, sebaceous glands, (bile), and kapha (phlegm)—and good
Coronary artery disease A condition that
aligned along the middle of the body; blood and lymph vessels, and sensory health and well-being occur when all three
results when a waxy substance (plaque)
there are seven chakras altogether. receptors that detect pressure, temperature, doshas are well-balanced.
builds up inside the coronary arteries that
Chemotherapy Treatment that uses supply the heart muscle, causing them to and pain. Double helix A pair of parallel helices
drugs to target/kill cancer cells (also narrow and restrict blood flow. Diabetes A disease that results from lack that intertwine around a common axis, for
called cytotoxic drugs). of or insufficient insulin production by the example in the structure of a DNA molecule.
Cranial nerves Twelve pairs of nerves that
Chickenpox Also called varicella, this arise directly from the brain, not via the pancreas. Type 1 diabetes is caused by lack Dysentery An intestinal infection that
is a common infectious disease caused spinal cord, and pass through openings in of insulin; in Type 2 diabetes insulin is causes diarrhea and severe abdominal
by the varicella-zoster virus, and is the skull, for example, the optic nerves and produced, but the body is not able to pain. It results from infection by either
characterized by a rash and a fever. the auditory nerves. use it properly. Shigella bacteria (shigellosis)
306
GLOSSARY
or the parasite Entamoeba histolica Endorphins Protein molecules produced side. An electric current “excites” the gas, Germ A harmful microbe, such as a virus,
(amoebic dysentery). by the body that relieve pain by activating producing short-wave ultraviolet light that bacterium, fungal spore, or protist.
opiate receptors in the nervous system. causes the phosphor coating to glow.
Gland Specialized cells or groups
E
Electrocardiogram (ECG) A noninvasive
Endoscope A viewing instrument inserted
into the body though a natural orifice or
a surgical incision. Endoscopes may be
Fluorescent screen A glass screen, one
face of which is coated with a salt that
emits light under the action of X-rays, or
of cells that produce and secrete a
specific substance, such as a hormone
or digestive enzyme.
test that measures and records the flexible or rigid, and comprise a light cathode rays.
Glucagon Hormone that stimulates
electrical activity in the heart. source, and a series of lenses or a
Fungus Member of a group of unicellular, the liver to turn stored glycogen into
miniature camera. Surgical instruments multicellular, or syncytial spore-producing
Electroencephalogram (EEG) A glucose when blood sugar levels are
may be passed inside endoscopes to organisms that feed on organic matter.
noninvasive test that measures and records low; the opposite effect of insulin.
carry out operations or take samples. They include molds, yeasts, mushrooms,
the electrical activity of the brain. Glucose A simple sugar that is the main
Enlightenment A philosophical and toadstools.
Electron A subatomic particle with carbohydrate source of energy in most
movement of the 18th century
G
a negative electric charge. living cells.
characterized by belief in the human power
Electron microscope A microscope of reason and innovations in political, Glycogen A form of glucose stored in
that uses a beam of electrons to produce religious, and educational doctrine. animal cells, made mainly in the liver
Gallstones Lumps of solid matter
a magnified image of an object. In a and muscles.
Enzymes Substances secreted by organs composed mainly of cholesterol or
transmission electron microscope (TEM) Golgi staining A method of staining
in the body that speed up or slow down bile pigments that can form in the
electrons pass through a thin section
the rate of chemical changes, for example gallbladder or its ducts. nerve tissue with silver nitrate so that
of a specimen; with a scanning electron
when food is digested. it can be viewed under a microscope.
microscope (SEM) electrons bounce off Galvanometer Instrument for detecting
the surface to give a 3-D image. Epidemic An outbreak of a contagious the existence of small electrical currents Gynecology The branch of medicine
disease in which the incidence rate is much and determining their strength. that deals with the function and disease
Elephantiasis A disease that occurs
higher than expected, but it is confined to of the reproductive system of girls
in the tropics characterized by massive Gamete A sex cell—the sperm in males
a particular region. and women.
swelling and thickening of the legs, and the ovum in females.
Epidemiology The study of diseases,
H
arms, and scrotum, with thickening and Gastroenterology The study of the
darkening of the skin. It is mostly caused how common they are, their causes and
conditions that affect the digestive system;
by chronic lymphatic obstruction due to effects, and how they can be controlled.
a gastroenterologist is a doctor who
an infection by a parasitic roundworm. Epidermis The outer layer of skin made specializes in gastroenterology. Hematology The branch of medicine that
Embryo The first stage of development up of keratin and dead cells. As dead cells deals with the diagnosis and treatment of
Gene Basic unit of heredity in living things,
of newly conceived offspring. In human are worn away they are replaced by new disorders of blood; a hematologist is a
typically a segment of DNA or RNA that
beings, it covers the first eight weeks ones from the base of the epidermis. doctor who specializes in this area.
provides the coded instructions for a
of pregnancy. Epilepsy A tendency to have recurrent particular protein. Hemoglobin Protein in red blood cells
Endocrine system The glands and seizures. In many cases the cause is that combines with oxygen from the lungs
Gene map A plot of the sequence of
cells of this system make and control unclear—it may be genetic or the result so it can be carried around the body.
genes along a strand of DNA.
the production of the body’s chemical of injury, illness, or metabolic disorder.
Hemorrhage The escape of blood
General practitioner A primary care
messengers—hormones. The main Evaporation The process by which a from a blood vessel, usually after injury; a
physician, who treats patients’ minor
structures are: the hypothalamus, liquid, for example water, becomes a gas. hemotoma (bruise) is an accumulation
disorders and refers them to a specialist for
pituitary, thyroid, thymus, adrenal glands, of blood from a torn blood vessel that
Excretion The elimination of waste treatment of more serious conditions.
pancreas, ovaries (female) and testes remains within the tissues.
(male). The heart, stomach, and intestines by organisms.
Genetic code Sequence of nucleotide
also produce hormones. bases on DNA that codes for a Heart valves Structures within the heart
307
GLOSSARY
L M
Hepatologist A doctor specializing in (hip replacement), electronic (heart
conditions that affect the liver. pacemaker), or a combination of
all three.
Histology The study of the microscopic Laporascope A type of endoscope Magnetic resonance imaging (MRI)
structure of tissues and cells. In vitro fertilization (IVF) An artificial A form of computerized scanning that uses a
inserted directly into the abdomen
method of conception in which egg cells powerful magnetic field and radio pulses to
HIV Abbreviation for human through an incision.
are fertilized by sperm outside the womb, visualize 2-D slices through the body, then
immunodeficiency virus, a retrovirus that
in vitro (in glass). Larynx Structure in the neck at the top combines them to create a 3-D image.
is the cause of AIDS. HIV gains access to
of the trachea (windpipe) that contains
the body through blood contact, infected Infection A disease caused by invading Malaria A disease caused by the parasitic
needles, or sexual intercourse. the vocal cords.
microbes such as bacteria, viruses, protists, protozoa Plasmodia and spread by the bite
Hormone A substance (chemical or similar life forms. Laser surgery Surgery performed with of female Anopheles mosquitos. It causes
messenger) produced in an endocrine Inheritance The range of natural a laser beam, for example, reshaping flulike symptoms: a high temperature
gland that controls a specific biological characteristics and potential passed on the cornea to improve eyesight. (fever), shaking chills, headaches, muscle
process or activity in the body. by parents or ancestors to offspring. aches, and fatigue. Vomiting, nausea, and
Leeching The application of a living
diarrhea may also occur. In severe cases,
Human genome The complete set Inoculation In immunization, the leech to the skin in order to initiate blood
it causes kidney failure, confusion, seizures,
of genes for a human—there are introduction of disease-causing flow or deplete blood from a localized
comas, and sometimes death.
approximately 20,000 genes. organisms into the body in a mild or area of the body.
harmless form to stimulate the production Matter Anything that has mass and
Humors Body fluids or temperaments Lens The structure near the front of the
of antibodies that will provide future occupies space—it can be liquid,
(blood/sanguine, yellow bile/choleric, black eye that fine-focuses vision.
protection against the disease. solid, or gas.
bile/melancholic, and phlegm/phlegmatic).
Early physicians believed in the concept Lesion An abnormality, such as an Median A “line” down the middle of the
Insulin A hormone, produced by the
of the four humors, also known as ulcer, in body tissue or an organ. body, in the plane that divides the body
Islets of Langerhans in the pancreas,
humorism, which stated that well-being that regulates the use of glucose Leucocyte A general term for any into right and left halves.
depended on balancing these four body in the blood. Lack of it causes Type 1 white blood cell. Meiosis The type of cell division that
fluids, or humors. diabetes; the body’s inability to use it
Ligament A short, elastic band of fibers results in daughter cells that have half the
can result in Type 2 diabetes.
I
that connects two bones or cartilage number of chromosomes of the parent cell.
Intestine The longest part of the digestive Meiotic division results in the production of
at a joint.
tract—from the stomach to the anus. It egg and sperm cells.
Immune system The body’s natural consists of the small intestine (duodenum, Ligature A cordlike item used to tighten
Melanin A brown pigment found
defense network that protects against jejunum, and ileum) where most food is or constrict, for example a filament or
especially in the skin, hair, and eyes.
infection and other diseases. It includes broken down and absorbed, and the fine thread used to tie up a bleeding artery
the thymus gland, spleen, white blood shorter large intestine. during surgery. Meridian According to Chinese medicine,
cells, lymph ducts and vessels, and meridians are a network of pathways
Iris The colored part of the eye that Limbic system A collection of structures
lymph—the fluid that passes along them. through which life energy, or qi, flows.
surrounds and controls the size of the pupil. in the centre of the brain that play a
Immunity The ability of an organism, or vital role in the control of the automatic Metabolism The sum of the physical and
JK
the body, to resist or fight a particular (autonomic) body functions, emotions, chemical processes that takes place within
infection or toxin by the action of and sense of smell. the body, from digesting food to using
antibodies or white blood cells. energy for muscle action.
Joint An area of the body where bones Lymph The excess fluid that collects in
Immunization Rendering a person Metastasis The spread of cancerous cells
meet. They are normally held together the tissues as blood circulates through
resistant to attack from microbes, which from one part of the body to the other.
by bands of fiber called ligaments. the body; it contains mainly white
would otherwise cause infectious disease,
blood cells. Microbe Any living organism that is too
usually by inoculation. Keratin One of the main proteins in
small to be seen by the naked eye.
skin, hair, and nails. Lymphatic system An extensive network
Immunosuppressant Substance that
of tubes, small organs, and glands that Microscope An instrument that produces
reduces the workings of the immune Keyhole surgery Surgery performed
drains lymph from the body’s tissues into magnified images of very small objects.
system, for example to prevent rejection through a very small incision, using
of transplanted organs. special instruments and an endoscope. the bloodstream. Microscopy The process of examination
Lymphocytes White blood cells that by microscope—often to make a diagnosis.
Implant An item surgically inserted Kidney One of a pair of internal organs
into the body. It may be living (for that filter waste products and excess protect against infection, for example Mineral A naturally occurring and usually
example, bone marrow cells), mechanical water from the blood. by producing antibodies. inorganic solid.
308
GLOSSARY
Mitochondria Sausage-shaped Nephrology Study of conditions affecting Organelles Specialized membrane-bound 2. An elastic or rigid device that is
organelles, found in cells, that contain the kidneys; a nephrologist is a doctor who structures within a cell. inserted into the vagina to support
genetic material and make energy available specializes in this branch of medicine. the uterus.
Orthopedics The study of bones
for a cell to live and function.
Nephron One of the million or so and joints. Pharmacist A person who prepares and
Mitral valve The valve between the two minute purification and filtration units dispenses drugs; today, a pharmacist must
Ovary One of two structures, each at the
chambers of the left side of the heart. in the kidney. be professionally qualified.
end of a fallopian tube, that makes egg
Molecular structure Arrangement, type, Nerve A sheathed bundle of threadlike cells or ova. Pharmacology The study of drugs and
position, and direction of the bonds that projections, or fibers, of nerve cells how they act on the body.
Ovulation The release of an ovum or egg
link atoms within a molecule. (neurons) that carry electrical impulses
cell from the ovary about midway through Philosophy The study of the
between the brain, spinal cord, and
Molecule The smallest unit of an element a woman’s menstrual cycle. fundamental nature of knowledge,
body tissues.
or compound that contains at least two reality, and existence through
Ovum (plural: ova) The egg cell.
atoms bonded together; water (H2O), for Nervous system The body system made logical reasoning; early physicians
and scientists were referred to as
P
example, has three atoms: two hydrogen up of the brain, spinal cord, and nerves.
and one oxygen. natural philosophers.
Neurology The study of the nervous
Motor nerves Nerve fibers that carry system; a neurologist is a doctor who Photographic plate A flat sheet coated
impulses (electrical signals) to the specializes in this branch of medicine. Pandemic A very large-scale outbreak/ with a light-sensitive chemical.
muscles or glands. epidemic of a contagious disease
Nucleotides Chemical subunits or that affects the human population Phrenology An 18th-century practice
Mucous membrane Soft, pink, skinlike base of deoxyribonucleic acid (DNA) and in a huge geographical area, such in which detailed study was made of
layer that lines many cavities, tubes, and ribonucleic acid (RNA) that function as as a continent. the shape and size of a skull, which was
ducts in the body. The mucous membranes code letters for genetic information. thought to be an indication of a person’s
contain millions of goblet cells that secrete Pathogen A microbe that causes disease character and mental abilities.
Nucleus The part of a cell in which genetic or other harm.
a fluid called mucus.
information is stored. Physician A person who practices
Mucus Thick slimy fluid secreted by mucous Pathology The study of disease—its medicine—especially one who
Nutrients Substances in food that are causes, mechanism, and effects on the
membranes that moistens, lubricates, and specializes in diagnosis and medical
used by living organisms for growth, body. Pathologists conduct autopsies
protects cavities, tubes, and ducts in the body. treatment rather than surgery.
maintenance, and reproduction. to determine cause of death and
Musculoskeletal system The body’s Physiology The study of the normal
Nutrition The processes in which an ascertain the effects that a disease
bones, joints, and muscles form this system. function of living organisms and
organism takes in food and uses it for or treatment has had.
their parts.
Myelin A fatty material found especially growth and maintenance. Parasite An organism that lives in or
around nerve fibers. Pituitary gland Known as the master
on another living creature.
O
gland, the pituitary gland is the most
Myocardial infarction Often called a Pediatrician A doctor who specializes in important gland in the endocrine system.
heart attack, this is a condition that occurs the diagnosis and treatment of disorders It regulates and controls the activities
when one or more of the arteries that Obstetrics The branch of medicine affecting children. of most other endocrine glands and
supply blood to the heart muscle (coronary concerned with pregnancy and childbirth;
Penicillin An antibiotic, or group many body processes.
arteries) become blocked, so depriving the a doctor who specializes in this subject
area beyond the blockage of blood. of antibiotics, produced naturally by Placebo A chemically inert substance
is an obstetrician.
certain blue molds; they are now usually given instead of a drug. Many new drugs
Myocardium Special muscle type only Oncology The branch of medicine prepared synthetically. First discovered are tested against a placebo preparation.
found in the heart; its fibers form a concerned with cancers and similar in 1928, penicillin was one of the
network that contracts spontaneously. Plasma The liquid part of the blood.
diseases; an oncologist is a doctor first antibiotic agents and is still widely
Myofibril Stretchy threads found in who specializes in oncology. used today. Platelets Cells in the blood that are vital
muscle cells. to the blood-clotting process.
Ophthalmology The branch of medicine Pertussis Also known as whooping cough,
concerned with the study and treatment this is a highly contagious, potentially Pneumonia Inflammation of the air sacs
N
Natural philosophy Ancient term used
of disorders and diseases of the eye; a
doctor who specializes in this area is an
ophthalmologist.
fatal infectious disease that causes severe
bouts of coughing that often end with
a “whooping” sound, hence its name.
and smaller air passages in the lungs due
to infection or inhalation of irritants.
309
GLOSSARY
R
Polymath A person with expertise Rictus (of limbs) Severe “twisting” pain in used in the 19th century—it gave a
in many wide-ranging subjects. the limbs that can arise from scurvy, which is reading on a piece of paper. It has been
a disease resulting from lack of vitamin C. replaced by the sphygmomanometer cuff
Positron emission tomography Rabies An acute viral infection of
and meter used today.
(PET) A form of computerized scanning the nervous system, also known as RNA (Ribonucleic acid) In most
that uses rays given off by substances hydrophobia (fear of water), which organisms, a molecule that decodes Spinal cord A bundle of nerves
primarily affects animals, but can be DNA’s instructions to make proteins running from the brain down through
put into the body to identify very busy
passed to humans by a bite or lick and control this process. the spinal column.
(metabolically active) cells and tissues.
over a wound. Spinal nerves Thirty-one pairs of
S
Pox Skin eruptions or sacs that leave
Radiation Emission or transmission nerves that carry motor and sensory
pitted pockmarks on the skin; the term
of energy in the form of waves or signals between the spinal cord and
has been applied to a wide range of body tissues.
particles through space or through Scarlet fever A contagious disease
diseases—from acne to syphilis.
a material medium. caused by the streptococcal bacteria that Sterilization 1. The removal of life forms
Prosthesis An artificial item used as results in high fever, severe sore throat, from an object. 2. Medical procedure to
Radiotherapy The treatment of disease,
a substitute or replacement body part. vomiting, and a rash of tiny red spots. prevent reproduction.
especially cancer, using localized X-rays
Proteins Huge molecules made up of or similar forms of radiation. Schizophrenia Long-term mental Stethoscope An instrument used for
chains of amino acids—proteins are condition that causes a range of symptoms listening to body sounds, particularly
Red blood cells Biconcave, disk-shaped
the building blocks of the body. including hallucinations, delusions, from the heart, lungs, and digestion.
cells that contain hemoglobin. There are
muddled thoughts, and extreme
Protists Single-celled eukaryotic 4–5 million in 1 cubic mm (0.06 cubic in) Subcutaneous Situated or applied
behavior changes.
of blood. just under the skin.
microorganisms (the cell has a nucleus),
Sense organs The structures that
some of which are parasites and Renaissance Meaning “rebirth,” Sublimation Chemical process in which
provide the five main senses of sight, smell,
cause disease. this term describes the revival of arts, a solid turns into a gas without going
touch, taste, and hearing. They are the eyes,
literature, science, and learning in Europe through a liquid stage.
Psychology Scientific study of the nose, skin, tongue, and ears. They detect
from the 14th and15th centuries.
human mind and its functions, information from outside the body and Superficial veins Veins that run very
especially those affecting behavior Renal Relating to the kidneys. transmit it to the brain. close to the surface of the skin.
in a given context. Reproductive system The organs Sensory nerve Nerve that carries Syphilis A chronic bacterial infection
involved in reproduction. It is the part sensory information from the tissues that is contracted mainly through sexual
Psychotherapy The treatment of
of the body that most differs between toward the spinal cord and brain. intercourse, but can also be passed to a
mental disorders by psychological
males and females. developing fetus.
rather than medical means. SI (Système International) unit
Respiration 1. Bodily movements A unit in the international system Systole/systolic The phase when the
Pulse Rhythmic expansion and of measures based on the meter, heart muscle contracts to pump blood out
of breathing. 2. Gas exchange of
contraction of an artery as blood oxygen for carbon dioxide in the lungs. kilogram, second, ampere, kelvin, of its chambers to the lungs or the rest
is forced through it. 3. Similar gas exchange in the body candela, and mole. of the body; systolic pressure is the first
Pupil The opening in the iris that allows tissues. 4. Breakdown of molecules to number of a blood pressure reading, for
Skeleton The frame of bone and
release their energy for cellular action. example 120/80 or 120 over 80.
light into the eye; it opens (dilates) and cartilage that supports the body and
closes (contracts) under the control Retina Light-sensitive layer that lines protects its organs.
of the iris. the inner side of the back of the eye.
The retina converts optical images into
Smallpox A highly contagious viral
infection causing fever, red rash, blisters, T
Q
nerve signals that travel to the brain and bleeding in its severest form, hence its Talking cure A method of treating
via the optic nerve. name the “red plague.” Smallpox has now psychological disorders or emotional
Rhinoplasty Plastic or cosmetic surgery been eradicated following worldwide difficulties by talking to a therapist
qi In Chinese culture qi, or ch’i, “breath, vaccination programs. or counselor, either one-to-one or
performed on the nose.
air,” is an active or energy-based part of in groups.
Rickets A condition that arises from Sperm One of the male reproductive
a living thing. cells released in semen during ejaculation, Tendons Bands of fiber that attach
vitamin D deficiency and which affects
Quinine A bitter crystalline compound which must enter an ovum for fertilization muscles to bones.
bone development. Bones become
found in cinchona bark used as a tonic to take place.
soft and weak and if the condition is Tetanus A disease of the central nervous
and once prescribed as a treatment untreated it may lead to deformities Sphygmograph A mechanical device system marked by rigidity and spasm
for malaria. such as bowed legs. used to measure blood pressure commonly of the voluntary muscles. It is caused
310
GLOSSARY
by infection of a wound with spores water contaminated by the bacteria pustules taken from someone with a mild or digital image of the internal composition
of Clostridium tetani bacteria. Salmonella typhi. form of the disease. of something, especially a body part, taken
with X-rays.
Tissue Groups of similar cells Typhus Any of a group of illnesses caused Vector Organism that transmits disease.
that carry out the same function, by rickettsiae and spread by insects or
Y
Veins Blood vessels that carry blood
such as muscle tissue, which similar animals. Potentially fatal, symptoms
from all parts of the body back to
can contract. of typhus include headache, back and
the heart.
limb pain, followed by high fever, a rash, Yellow fever A serious viral disease
Tissue typing The identification of
and confusion. Ventricle A chamber or compartment,
antigens in the tissue of a donor and spread by mosquitoes that affects the liver
usually fluid-filled. For example, two
recipient before procedures such as and kidneys causing fever and jaundice.
U
of the large cavities of the heart
organ transplantation, in order to
Z
(cardiac ventricles) and four cerebral
minimize the possibility of rejection
ventricles in the brain.
caused by antigenic differences. Ultrasound Sound with a frequency
above that which the human ear Venule Smaller blood vessels that link the
Tourniquet A device used to prevent Zygote Cell produced when an ovum
can detect. capillaries to the veins to carry blood back
blood flowing through a vein or artery, is fertilized by a sperm.
to the heart.
typically by a tight bandage or cord. Ultrasound scan Diagnostic technique
in which high-frequency sounds are Vessel A duct or tube carrying blood
Toxicology The study of toxic or
passed into the body; reflected echoes or other fluid through the body.
harmful substances.
are analyzed by computer to build up Virus Smallest type of harmful microbe,
Toxin A harmful substance, especially one
an image of the organ or structure. consisting of genetic material wrapped in
produced by certain bacteria, and some
animals and plants. UNESCO Abbreviation for United Nations a protective coating; it can only multiply
Educational, Scientific, and Cultural by invading other living cells.
Trachea Air passage between the throat
Organization. Set up in 1945, UNESCO Vitamin Organic compound found in
(pharynx) and the lungs.
encourages international peace and respect foods that is essential for good health.
Transcription The copying of sequences for human rights and has its headquarters There are 13 vitamins: A, C, D, E, K,
of genes from DNA to RNA. in Paris, France. Its motto is “Building peace B12, and seven grouped under
Transfusion The transfer of blood in the minds of men and women.” vitamin B complex.
from a donor to a recipient. Urinary system The system comprising
W
Translocation Movement of a segment organs of the body that form and eliminate
of a chromosome from one location to urine from the body: kidneys, ureters,
another, either on the same chromosome bladder, and urethra.
Wavelength Distance between
or to another chromosome. Urine A yellowish waste fluid made in successive crests of a wave,
Transplant The taking and implanting the kidneys, stored in the bladder, and especially points in a sound
of tissue or organs from one part of discharged through the urethra. wave or electromagnetic wave.
the body to another, or from a donor
V
White blood cells Any of the colorless
to a recipient.
blood cells that play a part in the body’s
Tricuspid valve The valve between the defensive immune system.
two chambers of the right side of the heart. Vaccination Deliberate introduction of a
World Health Organization (WHO)
weakened disease-causing substance to
Tuberculosis (TB) An infectious Specialized agency within the United
provide immunity against the disease.
bacterial disease characterized by Nations concerned with public health
the growth of nodules (tubercles) in Vaccine A preparation of weakened around the world. The WHO was
the tissues, especially the lungs. or neutralized germs, or harmful products, established in 1948 and its headquarters
that makes the body become immune are in Geneva, Switzerland.
Tumor A growth or lump of abnormal
to the germs.
cells that may be malignant (cancerous)
and spread throughout the body or
benign (noncancerous) with no tendency
to spread.
Vacuum tube Sealed glass tube
containing virtually no gases, to allow freer
passage of electrons (electric current).
X
X-ray 1. A type of electromagnetic
Typhoid fever An infectious disease Variolation An early method of immunizing radiation with a wavelength shorter
contracted by ingesting food or patients by infecting them with smallpox than ultraviolet radiation. 2. A photographic
311
INDEX
Index
Page numbers in italics indicate a caption amulets 14, 18 ascorbic acid see vitamin C Berger, Jeffrey 170
to an illustration, and those in bold a anesthesia 124, 128–29, 130–31 Ashtanga Hridayam 30 Berlichingen, Goetz von 237
main entry. for cataract surgery 86 Ashtanga Sangraha 30 Bernard, Claude 300
Chinese 26 Ashurbanipal, King 24, 25 Bertuccio, Nicola 61
A
electric 132 aspirin 170–71, 218 Best, Charles Herbert 190, 191, 300
for trepanning 17 asthi 31 beta-amyloid 260, 261
anaphylaxis 208 asthma 115, 209, 214–15 beta-lactams 200
Anathomia Corporis Humani (Anatomy of the asû 24 Beydeman, Alexander 109
AbioCor 235
Human Body) 61 asylums 162–63, 164–65 bezoar stone 79
abortion 226
Anatomy 145 atherosclerosis 22, 244 bhumi 30
accoucher see man-midwife
anatomy 160, 72–75 atomizers 215 Bian Que 29
acetylsalicylic acid 170
from autopsy 152 atrial fibrillation 185 Bicêtre Hospital asylum 162
Acremonium 201
brain 160, 281 Auenbrugger, Joseph Leopold 300 Bichat, Marie-François 96, 150
acupressure 29
cardiovascular 282 Aurelio, Marco 152 bile
acupuncture 14, 28–29
digestive 288 Aurelius, Marcus, Emperor 41 black 33, 34, 58, 250
points on body 29
Galen’s ideas on 40–41, 160 auscultation 115 yellow 33, 34
Acute and Chronic Diseases, On 39
hands 145 Australian Royal Flying Doctor Service bionic arm 238
Adams, George 96
heart 282 252–53 bionic eyes 237
Adler, Alfred 251
medieval to Renaissance 55, 60–61 autoclave 154 biopsy 253
adrenal glands 286, 287
microanatomy 96, 160 auto-injector 202 bipolar disorder 251
adult stem cells 270
respiratory system 284–85 autopsy 61, 152–53 birch bracket fungus 14
Aedes aegypti 267
theater 73 Avicenna 50, 51, 52–53 birth 136
Aeneas 38
urinary 292 Ayurveda 30–31 birth control 226–27
Aerohaler 215 Bishop, J. Michael 229
Anatomy Lesson by Velpeau 119 azidothymidine (AZT) 243
AESOP 254 Anatomy of the Bee, as Revealed by the Black Death 66–67, 68
Ätiologie, der Begriff und die Prophylaxis des Aztecs
Microscope 92 dying from epidemics 88, 88 Black Bile, On the 41
Kindbettfiebers, Die (The Etiology, Concept, ancient history medicine 12 black reaction 96
and Prophylaxis of Childbed Fever) 139 herbal medicine 15
see also Chinese medicine; Egyptian trepanning 16 Blackwell, Elizabeth 141
agglutination 176–77 medicine; Greek medicine, ancient; bladder cancer 244
B
agni 30, 31 Islamic medicine; Roman medicine, Blaiburg, Philip 235
Agnodice 140, 141 ancient bleeding, herbs for 14
Agrippa, Cornelius 65 Anderson, William French 248 blood
ah’men 15 angina 185 agglutination 176–77
AIDS see HIV/AIDS angina pectoralis 206 Babinski, Joseph 300 cancers 152
air, foul-smelling 121 angiogenesis 229 Bacillus 122 capillaries 96
akasha 30 angiogenesis inhibition 231 B. anthracis 146 circulation 49, 82–83, 84–85, 283
al-Baytar, Ibn 51 angioplasty, coronary 206 back pain, acupuncture for 29 clotting 152, 170, 176
Albucasis see al-Zahrawi angiotensin converting enzyme (ACE) Bacon, Roger 65 donation 194
albumenometer 116 inhibitors 219 bacteriology 93, 153, 167, 200–201, 291 flow, assessment 217
alchemy 49, 64–65, 70–71 Anglesey leg 237 bacterial culture 147 glucose test 191
Alfanus I, Archibishop of Salerno 55 anna vaha 31 bacterial resistance 258 groups 176–77
al-Hariri, Ibn Ali 300 Anopheles mosquito 174–75 cancers linked to bacteria 244 as humor 33, 34
Al-Judari Wal Hasabah (Concerning A. albimanus 174 cholera 122 letting 33, 34, 35, 58, 59
Smallpox and Measles) 51 anthrax 146, 149, 158 bacteriophage 167, 291 making cells 277
Al-Kitab ‘l-jami’ fi ‘l-aghdiya wa-’l-adwiyah antibiotics 200–201 balance 298 plasma 194, 194–95
al-mufraddah (The Comprehensive Book resistance 258–59 Baliff, Peter 237 serum 176–77, 177
of Foods and Simple Remedies) 51 for TB 156 Balkan War, First 123 serum albumin 194
Allen, Edgar 205 antigens 176–77 Bally, William 104 transfusion 176–77, 194, 195
allergies to drugs 208–9 antihistamines 208–9 Bandages, On 39 vessels 282
Allgemeines Krankenhaus 106 antiretroviral drugs 243 Banting, Frederick 190, 191, 300 what is it? 283
Allium sativum see garlic antiseptics 139, 154–55 barber-surgeons 59, 76–77, 118 see also white blood cells
al-Nafis, Ibn 49, 51, 83 Antonine plague 38, 41 barium X-ray imaging 172 bloody flux 90
aloe vera 62 anxiety disorders 251 Barnard, Christiaan 234, 235, 300 Blundell, James 176, 177
Alphanus I 300 ap 30 Bartisch, Georg 87 Boccaccio, Giovanni 67, 69
Al-Qanum fi al-Tibb (The Canon of Medicine) apothecary 62–63 barû 24 body-snatchers 118–19
52–53 apothecary jar 59, 62 basil, holy 31 body systems 274–75
Al-Qanun fi al-Tibb (The Canon of Medicine) 51 Aretaeus of Cappadocia 190, 191 basket Boyle anesthesia machine 130 Boethus, Flavius 40–41
al-Razi, Ibn 48, 49–50, 55, 61, 86, 101, Aristotle 160 Bassi, Agostino 146 Bona Dea 39
228, 300 arms Bassi, Laura 140 bone forceps 42
Altmann, Richard 150 artificial 194, 237, 238 Bayer 218 bone growth 287
al-Zahrawi 51, 202 bionic 237, 238 Bayliss, William 185 bone lever 42
Alzheimer, Alois 260, 261 prosthetic 238 Beatson, Thomas 231 bone marrow
Alzheimer’s disease 260–61 arsenic 187 Beck, Aaron 251 cells 270, 271, 277
ambulances 256 artava vaha 31 Becquerel, Antoine Henri 300 transplant 270
American hospitals 107 artemisinin 175 behavioral therapy 251 bone structure 277
AMI see myocardial infarction, acute arterial narrowing 206, 206 Behring, Emil von 158 Borel, J. F. 235
aminoglycosides 201 Arthrobot 252 belladonna 108 Borel, Peter 92
amoxicillin 201 arthroplasty, knee 238 Bellevue Hospital, New York 256 Bostock, John 208
amphenicols 201 arthroscopy 188 Benedict VIII, Pope 118 Bouestard, Jacques 17
ampicillin 201 Asclepiades of Bithnyi 33 Benedictine Abbey, Monte Cassino 54 Bourgery, Jean-Baptiste 86
amputation 78, 78, 128, 154 Asclepios 32, 32, 29, 39, 40 Benedictines 56 Boveri, Thomas 300
312
INDEX
Boveri stain 160 Catholic Church role in medicine 56 Clement VI, Pope 69 Deaconess Institutions 107
Bovert, Daniel 208, 208 Causae et Curae (Causes and Cures) 58 clinical medicine 107 DeBakey, Michael 234
bowel cancer 230 Çavuşoǧlu, M. Cenk 189 Clinton, Hillary 224 defibrillator 185, 206, 257
Bower Manuscript 30 CD4-helper cells 243 cloning 270 deformities, repair 80–81
Boyle, Robert 71 celery, wild 62 Clostridium difficile 259 dehydration 123
Boyle’s apparatus 130 cells 93 clot busters 257 DEKA arm 237
Bozzini, Philipp 188, 189 cell theory 150–51 Clover, Thomas 129 dementias 260–61
Brahe, Tycho 80 cycle regulators 231 clyster 42 Democritus 70, 301
brain 160–61 HeLa 244 coca 15 demons 24
Alzheimer’s disease 260 turning cancerous 228, 229 cognitive therapy 251 dentistry 132–33
anatomy 75, 281 see also stem cell therapy Cohn, Edwin 194 ancient Roman 39
biopsy 252 Celsus, Aulus 80, 86, 260 Cohn, Ferdinand 93 instruments 132
depression and 251 Centers for Disease Control and Cohnheim, Julius 153 dentures 238
function 58 Prevention 127 Colombo, Readlo 83, 301 Denys, Jean-Baptiste 176
nervous system 280 centesimal scale 108–9 Colton, Frank 205, 224 deoxyribonucleic acid (DNA) see DNA
primitive 281 cephalosporins 201 Columbian Exchange 89 depression 163, 250, 251
scan 232 Cephalosporium acremonium 201 Columbus, Christopher 101 Desormeaux, Antoine 189
Branca, Gustavo 81 cerebral ventricles 160 Coming of a Physician to His Patient, The 55 Desoutter brothers 237
Brand, Henning 71 Cerebri Anatome (Anatomy of the Brain) 160 Commodus, Emperor 41 Deter, Auguste 260
breast cancer Cerrahiyyetu ‘l-Haniyye (Imperial Surgery) 140 Complete Human Anatomy Treatise including Dhanvantari, Lord 31
drugs for 230 cervical cancer 204, 230, 231, 244, 244 Surgical Treatments 86 dhatus 31
epidemiology 126 Cesalpino, Andrea 83 computerized tomography (CT) 217, 232 d’Herelle, Félix 167
genes 230 cesarean section 134, 134 Comstock Laws 226 diabetes 190–91
screening 205, 205 Chadwick, Edwin 126 condoms 224, 227 Diagnosis of Uterine Cancer by the Vaginal
breathing 285 Chain, Ernest 198 congenital disorders 80 Smear 204
Brès, Madeleine 141 chakras 30, 31 congenital heart abnormalities 207 diagnostic instruments 116–17, 135,
Breuer, Josef 183, 251 Chamberlain filter 166, 166 conjunctivitis 96 204
British hospitals 107 chamomile 14, 15 Constantine the African 55, 301 diagnostic procedures 90–91
Broca, Paul 300 chancres 186 consumption 156 early medicine 26
bronchial asthma 215 Channel Theory 20 contraception 226–27 genetic testing 249
bronchiole 284 Charaka 30 contraceptive pill 218, 224–25 Islamic medicine 50–51
Brotzu, Giuseppe 201 Charaka Samhita 30 convulsive therapies 163 see also imaging
Brown, Louise 240 Charcot, Jean-Martin 160–61, 183, 251 Cook, James 98 diaphragms 227
Brunner, Johann 190 charités 107 Cormack, Allan McLeod 217 diazepam (Valium) 218
buboes 66 Charles V, Emperor 75 Corner, George 205 Dickens, Charles 107
bubonic plague see Black Death Chauliac, Guy de 61, 61, 69, 72 coronary angioplasty 206 digestive problems 14
Buch der Bündth Ertznei (Book of Directions chemistry 70–71 coronary artery disease, transplant 235 digestive system 274, 288–89
for Bandaging) 81 see also alchemy Corvisart, Jean-Nicolas 207 dilator, obstetric 42
Buchner, Joseph 170 chemotherapy 187, 230, 230–31 couching 86 Dioscorides, Pedanius 39, 39, 108
buchu 15 chestnut 58 Courtois, Bernard 154 diphtheria 153, 158, 158
Budd, William 125 childbed fever 135, 138–39 Cowley, R Adams 256, 257 Diseases and Cures of Women, On the 140
Burch, George J. 185 childbirth 134–35 cowpox 102, 103, 103 Diseases of Women 140
Burke, William 118, 119 bleeding after 176, 177 CPR 257 dispensaries 107
burns 81 forceps 139 Crick, Francis 213, 301 dissection of corpses 33, 61, 61,
Butenandt, Adolf 205 Medieval times 56 Crimean War 127, 142 118–19
butterfly cannula 202 China Root Epistle 72, 75 Crocco, John 145 Dissertatio epistolaris (Dissertation on
bypass surgery 207 Chinese medicine crystallography 172 Letters) 91
C-scale 108–9
C
acupuncture 28–29 distillation 70–71
anesthesia 128 CT scans 22, 217 divining 18, 24
childbirth 134 Cuitláhuac 88 Dix, Dorothea 163
early medicine 26–27 Culpeper microscope 95 Dix Livres de la Chirurgie (Treatise on
C-A-B protocol 257 malaria 174 Cumming, Alexander 96 Surgery) 79
Calcar, Jan van 74 smallpox 101 cupping 34, 35 Djerassi, Carl 205, 224
Calne, Roy 235 trepanning 16 Curtorum Chirurgia per Insitionem, De (On the DNA 246–47
Campani, Giuseppe 92 Chirurgia Magna (Great Surgery) 61, 61, 69 Surgery of Mutilation by Grafting) 81 bacterial 200
Campani’s microscope 92 Chlamydia pneumoniae 244 cyclosporine 235 electrophoresis 249
cancers 228–31 chloramphenicol 201 cystoscope 189 HIV 243
bacteria and 244–45 chlorina liquida 139 cytology, exfoliative 204 sequencing 246, 295
D
cell theory 151 chlormethine 230 structure 212–13
drugs 219 chlorofluoroocarbon inhalers 215 testing 248–49
lung 229 chloroform 124, 128–29, 129, 130 Dobson, Matthew 190
cannula 202 Chloroform and Other Anesthetics, On 125 Doisy, Edward 205
Canon of Medicine 50 chlortetracycline 201 da Vinci, Leonardo 72, 83 dolls as diagnostic tools 135
Cantigas de Santa Maria (Canticles of Holy cholera 121, 122–23, 124–25, 126, 147, da Vinci Surgical System 252, 254 Dolly the sheep 270
Mary) 56 149, 158 Dale, Henry 208 Domagk, Gerhard 200
capillaries 96 cholera beds 122, 123 Dally, Clarence 172 Doppler, pulsed 217
carbolic acid 154, 155 Cholera Tramples the Victor and the Damadian, Raymond 216, 232 doshas 30, 31
carcinogens 228 Vanquished Both 121 Danchell, Frederick 122 Down syndrome 249
cardiac see heart Christianismi Restitutio (The Restoration of datura 214, 215 Downs, Fred 237
cardiovascular system 275, 282–83 Christianity) 83 Daunton, Martin 122 dreams 182–83
Carna 39 chromosomes 150, 295 Daviel, Jacques 86 Drexler, Eric 265
Carpi, Jacopo Berengario da 300 cimetidine 219 Davy, Humphry 128, 301 drills 14, 132
Carter, Henry Vandyke 145, 300–301 cinchona 89, 89, 108, 108, 174 Day, George 260 drugs see medicines and specific
Cary-Gould microscope 95 cinchona bag 88 DDT (dichlorodiphenyltrichloroethane) drugs, e.g. aspirin
cataract surgery 24, 86–87 Clarence carriages 107 175 du Bois-Reymond, Emil 185
catheter, male 42 Clayfield’s mercurial holder 130 de Osorio, Ana 89 Dubois, Jacques 72
313
INDEX
G
Duchenne, Guillaume- epilepsy 24 Guillemeau, Jacques 134
Benjamin-Armand 160–61, 301 trepanning for 17 Guinea Pig Club 81
Duchesne, Ernest 198 epinephrine 215 Gula 24
Duggar, Benjamin 201 Epipens 202 Gurdon, John 270
Dunant, Jean-Henri 267 galangal 62 Gynecology 39
Epistolae responsoriae (Letters and Replies) 91 Galen, Claudius 39, 40–41
duodenal ulcers 244 Epitome 75 Gynaikeia (Gynecology) 134
dyes 96–97 anatomy 72, 73, 160
H
Erasistratus 33, 82, 301 blood circulation 82
dysentery 90 Erxleben, Dorothea 140 cancers 228
E
erythromycin 201 humors 34
ether 124, 128–29, 130 Gall, Franz Joseph 104, 302
ethics: early medicine 55 gallbladder removal 253 H&E stain 97
Euget-Les-Bain, Auphon 215 Gallo, Robert 242 Haberlandt, Ludwig 224
ears 298 Exercitatio Anatomica de Motu Cordis et Galvani, Luigi 184, 302 Hahnemann, Samuel 108, 109
administration of medicine via 31 Sanguinis in Animalibus (An Anatomical galvanometer 184, 184, 185 hair 296
Ebers papyrus 20–21, 134, 228 Exercise on the Motion of the Heart and Garcia, Manueal 116 hallucinogenics 14
Ebola virus disease 159, 268–69 Blood in Animals) 83, 83, 85 garlic 30, 31, 62 Halstead, William 230
ECG see electrocaradiogram Exercitationes Duae Anatomicae de Circulatione Garrett Anderson, Elizabeth 140, 141 Hamman, Edouard 73
ECT 163, 163 Sanguinis 83 gas attack 192 Hammurabi 24, 24
eczema 209 exorcism 18, 24 gas exchange in lungs 285 Handbook of Psychiatry 260
education for medicine 49, 54–55, 107 Experiments on the Generation of Insects 146 gases, foul-smelling 121 hands
Edwards, Robert 240 Gaskin, Ina May 135 anatomy 145
extended-spectrum beta-lactamase
Edwin Smith papyrus 20, 21, 228 gastrointestinal imaging 172 artificial 78, 237, 238
resistant bacteria 259
ego 182 Geber 65 imaging 172
eyes 297
Ego and the Id, The 183 Geist, Emil 192 tendons 279
Egyptian medicine 20–21, 54 artificial 236, 237, 238 washing 138
gene therapy 249, 265, 270
cancers 228 retinal implant 236, 237 Hare, William 118, 119
genetics
childbirth 134 surgery 86–87 Hare’s stethoscope 116
cancerous cells 228
F
diabetes 190 coding 295 Harrington drill 132
inhalers 214 DNA sequencing 246–47 Hartwell, Leland 231
polio 210 DNA structure 213 Harvey, William 33, 41, 82–83, 84–85, 302
smallpox 101 horizontal gene transfer 258 Hasson, Harrith 189
willow use for pain relief 170 Facia, Bartolomeo 81 inheritance 295 Hausen, Harald zur 231, 244
women working in 140 Fallopio, Gabrielle 224, 301 smallpox 101 Hawking, Stephen 270
Ehrlich, Paul 187, 187, 218, 230, 301 Farmer, John 151 testing 245 hay fever 208
Einthoven, Wilhelm 184, 185 Febris 39 viruses 167 Hayyan, Jabir Ibn 302
Eisenhower, Dwight D. 194 Fehling, Hermann von 191 urogenital system 292–95 Hayyan, Jamir Ibn 65
Elam, James 257 feminism 225 genome project 246–47 healing power items 18
elbows: how they work 279 Fetti, Dominico 250 gentamicin 201 hearing 298
electricity and ECG 184 Gerardus Cremonensis 48 heart
Fewster, John 102
electric shocks 185 Gerhardt, Charles Frédéric 170 anatomy 75, 282, 283
Feynman, Richard 265
electro-anesthesia 132 germ theory 125, 146–47, 198 artificial 235, 238
Filetto, Raimondo 174
electrocardiogram (ECG) 184–85 Gill, William 119 attack 185
electroconvulsive therapy (ECT) first aid 195, 256 bypass surgery 207, 252
ginger 62
163, 163 fish, brain cell 160 cardiopulmonary resuscitation 257
gladiators 40–41, 41
electron microscope 95 Five Arabic Treatises on Alchemy 71 gloves for surgery 155 damage 207
electrophoresis of DNA 249 fixatives 96 glucose, excess 190 defibrillator 185, 206, 257
elements, five 30–31 flagellation against plague 69 glycopeptides 201 dilatation 206
Elements According to Hippocrates, fleas 66, 93 Goetz, Robert 207 disease 206–7
On the 41 Fleming, Alexander 198, 258 goiter 70 drugs 219
elephantiasis, in mummies 22 Flemming, Walther 150 Golgi, Camillo 97, 174, 302 electric currents 184, 185
elixir of youth 65 Fliedner, Theodore 107, 142 Golgi stain 96 enlarged 207
El-Sidrón 14, 15 Fliess, Wilhelm 183 gonorrhea 186 restarting 206
embryonic stem cells 270 Flood, Robert 70, 71 gout 90, 91 transplants 207, 234–35
emergency medicine 256–57 Florentine Codex 88 Gräfe, Karle Ferdinand von 81, 302 valve replacements 238
Empedocles 33, 301 Florey, Howard Walter 198, 302 Grassi, Giovanni 174–75 valves 85
Empiric School 39 flu see influenza Graunt, John 126 heart attacks, aspirin and 170
Encode 246 fluid replacement therapy 123 graves, caged 119 heart-lung machines 235
endocrine system 274, 286–87 Folli, Francesco 176 Gray, Henry 145, 302 Heine, Jakob 210
end-of-life care 262–63 Fool’s Tower 162 Gray’s Anatomy 145 HeLa cells 244
endoscopes 116, 188, 189 foot, electric prosthetic 238 Great Ormond Street hospital 107 Helicobacter pylori 244, 245
Endovelicus 39 foot and mouth disease 166 Great Pestilence see Black Death hematopoietic stem cell transplantation 270
Enovid 227 forceps 42, 139 Great Plague of Athens 66 hematoxylin and eosin 97
Enquiry into the Causes and Effects Great Plague of London 68, 69, 90 hemp 128
formalin 96
of Vaccinae, An 102 Great Plague of Marseilles 66 Henle, Jakob 146
Francis, Thomas 197
Enterovirus 210 Greek medicine, ancient 32–33, 56 Henry VIII 118
Franklin, Rosamund 213, 302
ephedra 208 alchemy 70 herbal medicine 62–3
Ephesus 134 free association 183 alchemy 70
cancers 228
Epidaurus 33 freezing cancers 230 childbirth 134 ancient 14, 15
epidemics 88–89 freezing tissue 153 diabetes 190 asthma 214
cholera 122–23, 126 Frerichs, Friedrich von 190 homeopathy 108 for Black Death 67
polio 210 Freud, Sigmund 161, 163, 182–83, 204, smallpox 101 Indian medicine 31
smallpox 100–101 251 women working in 140 Islamic 51
studying 90 frontotemporal dementia 261 Grünenthal, Chemi 218 Medieval 56, 58
yellow fever 69 Frosch, Paul 166 Grünpeck, Joseph 186 Mesopotamian 24
see also pandemics; plagues Functions of the Brain and of Each of Guide to Childbirth 135 rabies 168
epidemiology 124, 126–27 its Parts, On the 104 Guild Book of the Barber Surgeons of York 35 Thomas Sydenham 91
314
INDEX
L
Herberden, William 206 Hunter, John 206, 230 Islamic medicine 48–51
Herophilus 33, 33, 302 Hustin, Albert 177 alchemy 65, 70
Herrick, James B 206 hydrofluoroalkene inhalers 215 anesthesia 128
Hewitt drop bottle 130 hygiene 38 cancers 228
Hideyo Noguchi 158 hypnosis 128, 160, 251 laboratory instruments 149
cataract surgery 86 Laënnec, Mériadec 115
highly active antiviral therapy (HAART) hypodermic syringe 130 childbirth 136
243 hypophosphatemia 71 Laënnec, René 114–15, 206, 303
hospitals 106, 106 Laënnec’s pearls 115
Hildegard of Bingen 56, 58, 140, 140 hypothermia, topical 234 schools of medicine 55
Himsworth, Harold 191 hysteria 163, 183, 204 Laennec’s stethoscope 116
smallpox 101 Laguess, Gustave-Edouard 191
hip replacement surgery 252
I
women working in 140 Laguna, Andres 83
Hippocrates 36–37
islets of Langerhans 191 Laidlaw, Patrick Playfair 208
antiseptics 154
Ivanovsky, Dmitry 166, 167 Lancisi, Mara 206
blood circulation 82
Landois, Leonard 176
J
cancers 228 iboga 15
diseases 126 Landsteiner, Karl 176–77
ibuprofen 219 Lane-Claypon, Janet 126
early surgery 17 id 182
endoscopy 189 laparoscopy 189, 252
IgE 209 Lapyx 38
homeopathy 108 imaging 172–73, 216–17, 232–33 Jacobaeus, Hans Christian 189
humanity 164 jala 30 Larrey, Dominique-Jean 256
Imhotep 20, 32 laryngoscope 116
humors 34 immune response 291 Jamir ibn Hayyan 70
inhalers 214 lashun 31
immune system 102–3, 274, 290–91 Janssen, Hans and Zacharias 92
malaria 174 lasuna 31
antibodies 176 Jarvik-7 artificial heart 238
TB 156 laudanum 91, 91
against epidemics 88 Jefferson, Thomas 102 Laudanum sydenhamii 91
Hippocratic Corpus 33 against smallpox 101 Jenner, Edward 101, 102, 158, 166, 302
Hippocratic Oath 36 Laue, Max von 172
transplants and 234 Jesty, Benjamin 102
Hippocratic Treatises On fractures and On laughing gas 128
immunization see vaccination Jex-Blake, Sophia 141
Joints 37, 37 Laveran, Charles 174
immunoglobulin E (IgE) 209 Jing Xiao Chan Bao (Treasured Knowledge of
hip prostheses 238 laws regarding medicine 40–41
immunosuppressant drugs 235 Obstetrics) 134
His, Wilhelm 96 League of Nations 267
immunotherapy, anticancer 230 joints 277
histamines 208–9 leeches 58, 59
implants 236–37 Jung, Carl 183, 251
histology 96–97, 160 Leeuwenhoek, Antoni van 92, 93, 150
in vitro fertilization 240–41
Leeuwenhoek’s microscope 95
K
histopathology 97 Incas: trepanning 16
HIV/AIDS 9, 159, 242–43 legs, artificial 236–37, 238
incubators 136
Hockett, Tobey 201 leprosy 58
Indian medicine
Hodierna, Giovanni 92 leukemia 152
alchemy 70
Hoffman, Felix 170 Kahun papyrus 20 Levine, Philip 177
Ayurveda 30–31, 214
Hoffmann, Friedrich 116, 206 Kamen, Dean 237 Lewishohn, Richard 177
cancers 228
homeopathy 108–9 diabetes 190 Lewy body dementia 261
Kanada 70, 303
Homo neanderthalensis 14 inhalers 214 Liber Simplicis Medicine (Book of Simple
Kantrowitz, Adrian 234
homosexuals, HIV/AIDS and 242–43 malaria 174 Medicine) 140
kapha 31
hook 42 nose reconstruction 80, 81 Lichtleiter 188, 189
Kaposi’s sarcoma 242
Hooke, Robert 92–93, 93, 150 prostheses 236 lifestyle
karkinos 228 coronary disease and 206
Hooke’s microscope 95 smallpox 101 Kaulbach, Wilhelm von 165 Hippocrates and 37
Hope, James 206 trepanning 16 Kehrer, Ferdinand 134 ligatures 78
Hôpital de la Charité 107 infection 153 Kelling, Georg 189 light conductor 188, 189
Hopps, John Alexander 302 ancient Egyptian medicine 21
hops 62 Kelman, Charles 86, 303 limbs, artificial 236–37
childbed fever 138–39
hormonal therapy for cancer 231 keyhole surgery 188–89, 252 Lind, James 98–99
Mesopotamia medicine 24
hormone production 286, 287 kidney Lindbergh operation 253
penicillin against 198
hormone replacement therapy (HRT) 205 in wartime 192 anatomy 75 lipopeptides 201
Horsley, Victor 161 inflammatory diseases 14, 244, 245 role 41 Lippershey, Hans 92
hospices 262–63 influenza 192, 196–97 transplants 234 Lister, Joseph 139, 154, 198
hospitals 56, 106–7 Inhalation of the Vapour of Ether, On the 125 tubules 287 Liston, Robert 128
ancient Rome 39 inhalers 214–15 King, Edmund 176 liver: anatomy 75
for influenza 196 Injuries of the Head, On the 17 Kitab al-Hawi fi al-Tibb (The Comprehensive livestock feed with antibiotics 258, 259
Islamic 49 Institute of Tropical Diseases 175 Book on Medicine) 49 lobotomy 163
plague 69 instruments see dentistry: instruments; Kitab al-Jadari wa ‘l-Hasba (Treatise on Loeffler, Friedrich 166
Hôtel-Dieu 78 diagnostic instruments; laboratory Smallpox and Measles) 101 London hospitals 106–7
Hounsfield, Godfrey 217 instruments; surgery: instruments Kitab al-Kimya (Book of Composition of Long, Crawford 128
Houses of Life 54 insulin 190, 190–91 Alchemy) 65 Lower, Richard 176, 234
HPV 244, 244 insulin pen and cartridge 202 Kitab al-Mansouri fi al-Tibb (The Book on Lucretius 208
HRT 205 International Committee of the Red Lumway, Norman 234
Medicine Dedicated to al-Mansur) 49
Huang-di 26 Cross 267 lung disease
Kitab al-Shifa (The Book of Healing) 51
Huangdi Neijing (Yellow Emperor Classic of International Office of Public Hygiene cancer 229, 230
Kitab at-Tasrif (The Method of Medicine) 51
Internal Medicine) 26, 29, 82, 174 267 smoking and 127, 127
Klebs, Edwin 153
Hubbard, Louisa 135 International Red Cross 142 TB 156
knee, arthroplasty 238 lungs
Huggins, Charles 231 Interpretation of Dreams, The 183
Hughe’s stethoscope 116 Knights Hospitaller 262, 262 capillaries 96
InTouch robots 252
Human Genome Project 248 intracytoplasmic sperm injection (ICSI) knives, surgical 42 CT scans 217
human papilloma virus (HPV) 244, 244 240 Koch, Robert 121, 122, 146, 146–47, 156, in respiratory system 284–85
Humani Corporis, De (On the Fabric of the intraocular lens (IOL) 86 198, 303 Luzzi, Mondino de 72, 303
Human Body) 61, 72–73, 74, 74–75, 75, iodine 154, 155 Kolletschka, Jakob 138 lymphatic system 290
83, 118 iodoform 158 Korean War 195 lymph nodes 291
humors 30, 33, 34–35, 37, 39, 41, 58–59, ipecacuanha 15 Kouwenhoven, William 206 Lyonnet’s microscope 95
162 iron lung 210 Kraepelin, Emil 260 lysozymes 198
Hunt, Tim 231 Ishizaka, Kimishige and Teruko 209 Kussmaul, Adolph 210 Lyssavirus 168
315
INDEX
M O
mental illness 162–65, 250–51 Morton ether inhaler 130
Alzheimer’s disease and dementias mortsafes 119
260–61 mosaic disease 166
trepanning for 17 mosquito 174, 174
McCafferty, John 235 Merck 218 O, Anna 183
Motolinía, Toribio 89
Macewen, William 155, 161, 303 mercury to treat syphilis 186 O’Brien, ‘Irish Giant’ 119
MacFarlane, Frank 197 Motu Cordis, De 83, 83, 85 Observationes Medicae (Observations of
meridians 26, 29 mouth 298
McIndoe, Archie 81 Medicine) 90
Mering, Joseph von 190 moxibustion 27, 29
Mackenzie, James 206 Observations diverses sur la stérilité, perte de
Merit-Ptah 140 MRI 216, 217
Maclagan, Thomas 170 fruits, fécondité, accouchements et maladies
Merz, Heinrich 165 MRSA 258, 259, 259
macrolides 201 des femmes et enfants nouveaux-nés
Mesmer, Franz Anton 128, 160, 160, 303 Mudge, John 215
mad dog disease see rabies (Various Observations on the Sterility,
mesmerism 128, 160 Müller, Johannes 97, 228
madness see mental illness Fruit loss, Fertility, Childbirth and Diseases
Mesopotamia medicine 24–25, 134, 228
mafeisan 26 Müller, Paul 175 of Women and Newborn Infants) 134
metastasis 228
magnetic resonance imaging (MRI) 216, mummies 14, 20, 22–23, 207, 228 obstetric dilator 42
methicillin-resistant Staphylococcus aureus
217, 232–33 mumps 159 Ocimum sanctum see basil, holy
258, 259
Mahon, Henry Walsh 98 Murdoch, Colin 202 octli 15
Méthode Curative de Playes et Fractures de la
Maison de Charenton 163 muscular system 55, 75, 274, 278–79 Oedipus complex 183
Tête Humaine (Treatment Method for
majja 31 mustard gas 230 estrogen 205, 224
Wounds and Fractures of the Human
malaria 89, 121, 159, 174–75 mutra vaha 31 Oeuvres, Les 236
Head) 78
malformations, repair 80–81 Mycobacterium tuberculosis 147, 147, 156 ‘Omnis cellula e cellula’ 152
Méthode de Traiter les Playes Faites par les
Mallon, Mary 126 myocardial infarction, acute (AMI) 185 oncogenes 228, 229
Arquebuses et Autres Bastons à Feu, La
Malpighi, Marcello 83, 96, 96 oncology 228
N
(Method of Curing Wounds Caused by
Malpighian corpuscles 96 Ophthalmodouleia Das ist Augendienst (In the
Arquebus and Firearms) 79
Malpighian layer of skin 96 Service of the Eyes) 87
Methodic School 39
Malpighian tubules 96 ophthalmoscope 116
mammary glands 287 Methodus curandi febres (The Method of
Curing Fevers) 90 opium 62, 91, 128, 130
mammograms 205, 205 Nägeli, Karl von 150 Oporini, Joannis 74
mamsa 31 methotrexate 230 nails 296
Metrodora 140 oral contraceptive 227
Mandela, Nelson 243 nanobots 253, 265, 265 orchids 14
mandible: anatomy 75 miasma theory 67, 69, 120–21, 124, 126, nanomedicine 264–65
146, 154 Organon of Healing, The 109
mandragora 128 Narrentum 162 osteotome 42
mandrake 128 miasms 109
National Committee on Federal Legislation otoscope 116
mania 250, 251 microanatomy 96
for Birth Control 227 Ötzi the Iceman 14
man-midwife 134, 134, 136 microbiology 146–47
National Health Service 127 ovaries 286
Marker, Russell 224 Micrographia 93, 93
Nature and Structural Characteristics of Cancer, ovum 295
Marshall, Barry 244 microgrippers 253
microprocessor control 237 On the 97 oxazolidinones 201, 259
masks Nature of Man, The 35
P
anesthetic 130 microscopes 152–53
microscopy 92–93, 94–95, 94–95, 96–97, Neal, Robert 143
shamanism 18 Neanderthals 14, 15
masmassû 24 230
microtome 96 nebulizers 214–15
Massachusetts Eye and Ear
midwives 56–57, 134–35, 136–37 needles 202 pacemakers 238
Infirmary 107
Miescher, Friedrich 150–51 needling 28–29 Pacini, Filippo 122
massage, Qigong 26
migraine, trepanning for 17 Nelmes, Sarah 103 Padua 72
mast cell 209
Materia Medica, De 39, 39, 108 Milan, Duke of 69 neomycin 201 pediatric hospitals 107
material property investigation milk pasteurization 149 Neosalvarsan 187 Pagenstecher, Johann 170
70 mind map 182 nervous system 275, 280, 280–81 pain relief 170
Maternité de Paris 136 minerals and alchemy 70 brain 160–61 see also anesthesia
maternity hospitals 107 Minkoff, Laurence 216 function 58 Palese, Michael 254
Matteucci, Carlo 184 Minkowski, Oskar 190 nasal cavity and mouth 299 palliative care 262–63
Maudsley, Henry 165 Minnitt gas-air analgesia apparatus 130 Nesperennub 22–23 Pan-American Sanitary Bureau 267
Mayer, Adolf 166 mint 62 neurofibrillary tangles 260, 261 Pancoast, William 240
Mayo, Charles 132 mitochondria 150 neurology 160–61, 251 pancreas 286
meadowsweet 170 mitosis 150 neurosis 183 artificial 190–91
measles 50, 159 MNSs blood group system 177 neurosurgery 161 diabetes and 190–91
medas 31 Mobile Army Surgical Hospitals 195 New York Call 227 pandemics
Médecins Sans Frontiers 267 Mode of Communication of Cholera, On the Nicon, Aelius 40, 41 cholera 123
medical publishing 144–45 125 Nightingale, Florence 107, 121, 127, 142– flu 192, 196–97
Medicina, De 80, 86 modern medicine timeline 222–23 43 see also epidemics
medicine chest 108 Mohl, Hugo von 150 Pap test 204, 204–5, 230
Ninevah tablet 25
medicines molds used against infection 198 Papanicolaou, George N 204, 230
nitrogen, liquid 230
for cancer 230 monasteries 56 papilloma virus 231
nitroimidazoles 201
computer modeling 219 Mondino de Luzzi 61 Pappenheim, Bertha 251
nitrous oxide 128, 130
development 51, 218–19 monoclonal antibodies 230 Paracelsus 65, 70, 91, 108, 303
Montagnier, Luc 242 Nitze, Maximilian Carl-Friedrich 189 paralysis from polio 210
nanomedicine 265
Montagu, Lady Mary 102, 102 Nitze cystoscope 189 Paré, Ambroise 17, 76, 78–79, 134, 236
reactions to 208
Moore, John 151 Nobel, Alfred 303 Parkington, John 198
Medieval medicine 56–57
Meduna, Ladislas Joseph von Moorfields Hospital 107 Nobili, Leopoldo 184 Parkinson’s disease 244
163, 303 moral treatment 163 Noetzli, Jean 260 Parr, Thomas 82
meiosis 151 Morgagni, Giovanni Batista 152, 153, 228 nose 298 Pasteur, Louis 139, 146, 148–49, 154, 158,
Meister, Joseph 168 morning-after pill 225 reconstruction 80, 80–81 166, 168–69, 198
melancholia 250 morning sickness 218 Notes on Nursing 121 pasteurization 148–49
memory loss 260 morphine 194 Nurse, Paul 231 Patent Coffin 119
Menkin, Miriam 240 Morrison, James 132 nursing 142–43, 192 pathology 152–53
menopause 205 mortality records 126, 127 palliative care 263 Paul of Aegina 231
menstruation 59 Morton, William Thomas Green 128, 303 training 107 Paul VI, Pope 224
316
INDEX
pavana 30 prostate Rhazes see al-Razi, Ibn Schwangeren Frauen und Hebammen
Pavy, Frederick 191 cancer 231 rhesus factor 177 Rosengarten, Der (The Rose Garden for
peanut allergy 209 surgery 252 rhinitis, seasonal allergic 208 Pregnant Women and Midwives) 134
Pelletier, Pierre-Joseph 89 prostheses 236–37, 238–39 Rhinoplastik 81 Schwann, Theodor 150, 150
penicillin 187, 194, 198–99, 200, arms 194, 238 rhinoplasty see nose reconstruction screening for cancers 229–30
200–201, 258 foot 238 ribonucleic acid (RNA) 243 scrotal cancer 230
Penicillium 198 hands 78, 238 ribosomes 201 Scuola Medica Salernitana 54–55
Per-Ankh 54 hip 238 ribs: anatomy 75 scurvy 98–99
percussor 116 knee 238 Ricard, Philippe 186 Sedibus et Causes Morborum per Nantomen
Perls, Max 97 noses 81 Richet, Charles 208 Indagatis, De (On the Seats and Causes of
personality 182, 183 protooncogenes 228 Ridley, Harold 86 Diseases as Investigated by Anatomy) 152
pestle and mortar 50, 62 psychiatry 160 rifampicin 201 Seishu, Hanaoka 129, 304
PET 217 psychoanalysis 161, 163, 182–83 Rig Veda 236 Sekhmet 20
Pfolsprundt, Heinrich von 81 psychodynamic theory 251 Robert of Chester 65 Semmelweiss, Ignaz 138–39, 146, 154
phacoemulsification 86 psychosexual development 183 Robinson, Henry Peach 156 sensory system 275, 296–99
pharmaceutical industry 218–19 public health 38, 126–27 Robodoc 252 sepsis 154
pharmacology 51 publishing, medical 144–45 robots use in medicine 189, 252–53, Serefeddin, Sabuncuoglu 140
phenol 139 puerperal fever 138–39 254–55, 265 Sergius, Marcus 237
Philip II, King of Spain 75 pulque 15 Roche 219 serum albumin 194
Phipps, James 102 pulverisateur 214 Rock, John 224, 240 Servetus, Michael 83, 304
phlegm 33, 34 PUMA robot 252 Rod of Asclepius 32 Severe Acute Repiratory Syndrome
phrenology 104–5, 160 purisha vaha 31 Rokitansky, Karl 152 (SARS) 267
phthiasis 156 Pussin, Jean-Baptiste 163, 164–65 Roman medicine, ancient 38–39, 56 Severus, Septimus, Emperor 41
Physica 58 Pythagoras 260 hospitals 106 sex glands 287
Q
pill silverer 62 prostheses 237 Sexual Discrimnation Act 225
Pincus, Gregory 224, 240 surgical instruments 42–43 Seymour, Robert 121
pineal gland, role 41 Röntgen, Willhelm Conrad 172–73 shalya chikitsa 30
Pinel, Philippe 162, 163, 164–65 Roosevelt, Franklin D 210 shamanism 14, 14–15, 18–19
Pirodon, Louise-Eugene 119 qi 26, 27, 29, 82 rose, China 62 Shanghan Han Za Bing Lun (Treatise on Febrile,
Pirquet, Clemens von 208 Qianjun Yaofang (Prescriptions Worth a rosemary 62 Cold and Miscellaneous Diseases) 26
pituitary gland 287 Thousand Gold) 26 Ross, Ronald 174, 175 Shao, Emperor 16
placebo effect 109 Qigong massage 26 Rösslin, Eucharius 134 shears 42
Plague of Justinian 66 quarantine 69 Roux, Émile 168 shell shock 163
plagues quartet systems 34 Royal Hospital for Diseases of the Chest 107 Shennong, Emperor 208
Antonine 38, 41 quinine 89, 174, 194 Ruggiero, Trotula de 55, 140, 304 Shibasaburo, Kitasato 67, 158, 304
S
in Athens 37 quinolones 201 shukra 31
Black Death 66–67, 68 Qur’an 51 sickle cell anemia 249
Great Plague of Athens 66 Siegle, Emil 215
R
Great Plague of London 68, 69, 90 Signs of Fractures, On 39
Great Plague of Marseilles 66 Sabin, Albert 211 silkworm disease 149
Plague of Justinian 66 Sabolich, John 237 simian immunovirus 243
preventing 68–69 rabies 149, 158, 167, 168–69 Safar, Peter 257 Simplici Medicina (The Book of Simple
red 101 radiotherapy 230–31, 231 saffroclovesn 62 Medicine), De 54
vaccination against 159 Raistrick, Harold 198 Sahachiro Hato 187, 218 Simpson, James Young 129, 304
white 156 rakta 31 St. Anthony’s Fire 69 Sina, Ibn 50, 51, 55, 52–53, 228, 304
yellow fever 69, 69 Ramesses II, Pharaoh 100 St. Christopher’s Hospice 262–63 single-photon emission computed
see also epidemics; pandemics Ramesses V, Pharaoh 100 St, John’s wort 62 tomography (SPECT) 217
plasma 283 Ramón y Cajal, Santiago 97, 97, 303–4 St. Thomas’ Hospital 107, 142 Sisters of Charity 262
Plasmodium genus 174 rasa 31 St. Vincent de Paul 262 skeletal system 74, 274, 276–77
plastic surgery 81 rat, black 66 St. Vitus’ Dance 69 skin 287, 296
Platearius, Matthaeus 54 Re Anatomica, De (On Things Anatomical) 83 sal ammoniac 49 skin prick test 209
platelets 283 Recklinghausen, Friedrich von 153 Sales-Girons, Jean 214 skin testing kit 208
Pliny 39 reconstructive surgery see surgery, salicin 170 skull 74
Pneumocystis carinii 242 reconstructive salicylic acid 170 sleeping drugs 218
podalic version 78 Recueil Des Traités de Médecine (Collection of Salk, Jonas Edward 197, 210, 211, 304 sleeping sickness 151
polio 158, 167, 210–11 Medical Treatises) 48 Salmonella Typhi 201 ‘slim’ disease 243
Polybus 35 red blood cells 283 Salpêtrière Hospital 161, 165 Sloane, Hans 102
polyuria 190 Red Crescent 267 Salvarsan 187, 218 smallpox 50, 50, 88, 100–101, 102–3, 126
pomander 68 Red Cross 142, 266–67 Salvarsan kit 187 Smallpox Eradication Campaign 101
Portier, Paul 208 Redi, Francesco 146, 146 Sanderson, John 198 smear test 204
positron emission tomography (PET) 217 Reformation medicine: hospitals 106 Sanger, Margaret 141, 226–27 Smellie, William 135, 136
postmortem instruments 153 Regaud, Claudius 230 Sanitary Commission 142 Smith, Gayle 268
pot marigold 62 rehydration therapy 123 sanitation see public health Smith papyrus 80
Pott, Percivall 229, 230 religion, role in medicine 56 sanitoria 156 smoking and cancer 127, 127, 229
Pound, D J 143 reliquaries 56 SARS 267 Snow, John 121, 122, 124–25, 126, 146
pox 100 Renaissance medicine timeline 46–47 Saunders, Cicely 262–63 Soho 125
Pox, Great 186–87 repression 183 scalpel 42 somatic stem cells 270
Practical Treatise on the Domestic Management reproductive system 275 Sceptical Cymist, The 71 Soranus of Ephesus 39, 134
and Most Important Diseases of Advanced female 294–95 Schatz, Albert 201 Souttar, henry 207
Life 260 male 293 Schaudinn, Frtiz 187 Spallanzani, Lazzaro 146
prana vaha 31 respiratory diseases 244 Schiller, Walter 204 Spanish flu 196
pregnancy 134–35 respiratory system 275, 284–85 schistosomiasis 244 spatha 42
see also childbirth; contraceptive pill resurrection men 118–19 Schlieden, Matthias 150 SPECT 217
prehistory medicine 12 retina 297 schools of medicine see education for speculum 204
privthi 30 implant 236, 237 medicine vaginal 42, 135
progesterone 205, 224 Revival medicine timeline 46–47 Schopenhauer, Arthur 71 sperm 295
317
INDEX
T
sphygmomanometer 116 Tuke, William 163 vitamin C deficiency 98–99
spinal cord 280 Tulp, Nicolaes 152, 152 Volta, Alessandro 184
Spiritual Midwifery 135 tulsi 31 Voluntary Aid Detachments 143
spontaneous generation 146 tumi 16 Voyages Faits en Divers Lieux, Les (Journeys
Tabulae Anatomicae Sex (Six Anatomical tuning fork 116 in Diverse Places) 78
srota mano vaha 31
Plates) 74 Tuo, Hua 16, 26, 304 Vuillemin, Jean Paul 198
srotas 31
Tagamet 219 Turpin, Dick 119
W
staining techniques 96, 96–97, 160
Tagliacozzi, Gaspare 81 twentieth century medicine
stanya vaha 31
talking therapy 163, 183, 250–51
Staphylococcus 198, 198 timeline 112–13
tamoxifen 231
S. aureus 258, 259 Twort, Frederik 167
Tasma, David 263
Starling, Edward 185 typhoid 126, 201 Waksman, Selman 201
taste 299
Starling, Ernest 205 typhus 158, 194 Waller, Augustus 185
teeth, fossilized 14
UV
steam-cleaning 155 teixobactin 259 Warren, Robin 244
Stelluti, Francesco 92 tejas 30 wartime medicine 127, 142, 192–93,
stem cell therapy 270–71 teleconsultation 252 194–95, 199
stent surgery 206 telemanipulation 252 Washkansky, Louis 235
stentrode 237 telemedicine 252–53 Über eine Neue Art von Strahlen (On a New water contamination 125
Steptoe, Patrick 240 teleradiology 253 Kind of Rays) 172 water-testing kit 122
Sterneedle gun 202 telerehabilitation 253 ultrasound scans 217, 217 Watson, James Dewey 213, 304
stethoscopes 114–15, 116–17 telescopes 92–93 University College London 107 Watten, Raymond 123
Stevenson, Robert Louis 119 temperaments, four 35 Urban II, Pope 262 Watten cot 123
Stock, Harald 218 Temple of Peace, fire at 40, 41 urethra, male 292 Weigert, Carl 153
stomach disorders 219, 244, 245 tendons 279 urinary system 275, 292–93 Wells, Horace 128
Storck, Anton von 108 Teniers, David 76 uterine muscles 287 Westmacott, John 145
Straet, Jan van der 70 testes 286 Utriusque Cosmi Historia (History of the Two Whiston, Surgeon Captain 115
streptogramins 201 tetanus 158 Worlds) 70, 71 white blood cells 96, 283, 291
Streptomyces tetracycline 200, 201 vaccination 158–59, 166 “White Lady” painting 14
S. aureofaciens 201 thalidomide 218, 218 cervical cancer 244 white plague 156
S. griseus 201 Theodoric of Lucca 59 how vaccines work 159 Whole Works Of That Excellent Practical
streptomycin 67, 156, 201 Theriaca Andromachi 67 influenza 197 Physician Dr Thomas Sydenham, The 90
string galvanometer 184, 185 thermometer 116 mass 126 Wiener, Alexander 177
Studies on Hysteria 183, 251 thigh tourniquet 42 Pasteur and 148–49 Wilkins, Maurice 213
Subitaneis Mortibus (On Sudden Death), De 206 Three Essays on the Theory of Sexuality polio 210, 211 Willis, Thomas 160, 190
183 rabies 168–69 willow use for pain relief 14, 170, 170
succussion 108–9
thrombolytic drugs 257 smallpox 102–3, 126 Winston, Robert 240
sulfanilamide 200
thrombosis 153 Vaccination Act 159 Wissowzky, A 97
sulfonamides 194, 200
Thucydides 101 Vaccinia virus 158 Woman Rebel, The 226
Sun Simiao 26
thulasi 31 Vagbhata 30 women in medicine 140–41
superbugs 258–59
thyroid gland 286, 287 vaginal speculum 42, 135 ancient times 55
superego 182 Medieval times 56–57
surgery tile cautery 42 valetudinaria 106
TNM staging of cancer 229–30 Valium 218 midwifery 136–37
ancient Egyptian 21 nursing 142–43
ancient Roman 39 tobacco causing cancer 229, 230 vancomycin 201
tobacco mosaic virus 166 vancomycin-resistant enterococci (VRE) wartime 192
barber-surgeons 76–77, 78–79 Women’s Cosmetics 140
cardiac bypass 207 tomography 216 258–59
tongue 299 Vanity of the Arts and Sciences, The 65 women’s health 204–5
for cataract 86–87 see also childbirth and specific issues,
Tourette, George Gilles de la 161, 304 Variola virus 100, 101
dissection 33, 61, 61, 118–19 e.g. menstruation
tourniquet 42 variolation see vaccination
early 16–17 World Health Organization 127, 267
Tractatus de Padagra et Hydrope (The Treatise Varmus, Harold 229
Indian 30–31 World War I 192
on Gout and Dropsy 91 vascular dementia 261
Islamic medicine 51 World War II 194–95, 199
Traditional Birth Attendant 136 vascular suturing 234
minimally invasive 188–89, 252 Wright, Almroth 198
Traité de L’Auscultation Médiate (A Treatise on vayu 30
neurosurgery 161 wu-xing 26
the Diseases of the Chest 115 veins, blood letting 59
plastic 81
XYZ
transfusion 176–77 Vejovis 39
reconstructive 80–81 Velpeau, Alfred 119
transmission of disease see germ theory
robotic 254–55 veress, Janos 189
transplants, heart 207
sepsis and 154–55 Vero Telescopii Inventore, De (The
see also prostheses
stent 206 trastuzumab 230 True Inventor of the Telescope 92 X-rays 172–73, 216, 232
trepanning 14, 16–17, 21, 188 Travers, Frederick 139 vertebroplasty 189 for cancer 230
surgical instruments Treatise on the Diseases of the Heart and Great vervain 62, 168 of mummies 22
ancient Egyptian 21 Vessels 206 Vesalius, Andreas 41, 61, 72–75, in wartime 192
ancient Rome 39, 42–43 Treatise on the Human Body 55 83, 118, 160 Yamanaka, Shinya 270
childbirth 139 Treatise of Scurvy, A 98–99 Vibrio cholerae 122, 147 yarrow 14, 14, 15
instruments 176, 177, 265 Treatise on the Theory and Practice of Victoria, Queen 125 Yayoi, Yoshioka 141
Islamic 51 Midwifery, A 135 Vienna General Hospital 162 yellow fever 69, 69, 167
for keyhole surgery 188–89 Treatments for Women 140 Vierordt, Karl 206 Yersin, Alexandre 67
postmortem 153 trepanning 14, 16–17, 21, 188 Villermé, Louis 126 Yersinia pestis 67
sterilizing 154 trepans 17 Virchow, Rudolf Karl Ludwig 151, yin-yang 26, 26
Susruta 30, 190 Treponema pallidum 186, 187 152, 228–29 Yu Hoa Long 101
Susruta Samhita 30, 80, 86, 174, 228 triage 143, 195, 256 virology 166–67 Zan Yin 134
swan-neck experiment 149 trocar 202 viruses 166–67, 291 zang-fu 26
swine flu 267 Trypanosoma brucei 151 cancer and 244 ZEUS 254
Sydenham, Thomas 90–91 Tu Youyou 175 HIV 243 Zhongjing, Zhang 26
Sylvius, Jacobus 72 tuberculin 147 influenza 196, 196 Zika virus 159, 267
synovial joints 277 syringes 202 mutation 196 Zimmerman, Michael 22
syphilis 80–81, 88, 186–87, 218, 224 tuberculosis 147, 147, 148–49, 156–57 vs. bacteria 201 zinc chloride 154
syringes 202–3 resistant 258 vision 297 ZMapp 268
318
ACKNOWLEDGMENTS
Acknowledgments
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Luca Tettoni (cr). Dorling Kindersley: Cecil History. 48–109 Wellcome Images http:// Archives Charmet. 88 Wellcome Images
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licenses/by/4.0/: Wellcome Library, London (cla, cla/EAR SPECILLUM). Courtesy of creativecommons.org/licenses/by/4.0/: Photo Library: (c). Wellcome Images http://
(c, bc). 14 akg-images: Jürgen Sorges (ca). Historical Collections & Services, Claude Wellcome Library, London (cra, bc). 80 creativecommons.org/licenses/by/4.0/. 113
Bridgeman Images: South Tyrol Museum of Moore Health Sciences Library, University Wellcome Images http://creativecommons. akg-images: (cra). Dorling Kindersley:
Archaeology, Bolzano, Italy / Wolfgang Neeb of Virginia: (tl, tc, r, b, cl). Wellcome Images org/licenses/by/4.0/: Wellcome Library, Science Museum, London (cl). Getty Images:
(b). 14–45 Wellcome Images http:// http://creativecommons.org/licenses/ London (bl). 80–81 akg-images. 81 Getty Science & Society Picture Library (crb).
creativecommons.org/licenses/by/4.0/: by/4.0/: Wellcome Library, London (ca, clb); Images: Science & Society Picture Library (br). Wellcome Images http://creativecommons.
Wellcome Library, London (t/Tab). 15 Science Science Museum, London (cb). 44–45 Science Rex by Shutterstock: Paul Fievez / Associated org/licenses/by/4.0/: Wellcome Library,
Photo Library: Mauricio Anton. 16 Getty Photo Library. 46 Bridgeman Images: Newspapers (cr). 82 Wellcome Images http:// London (bl). 114–115 Wellcome Images
Images: Science & Society Picture Library (clb, Historisches Museum, Bingen, Germany / creativecommons.org/licenses/by/4.0/: http://creativecommons.org/licenses/
r). 17 Alamy Stock Photo: The Art Archive Bildarchiv Steffens (c). Dorling Kindersley: Wellcome Library, London. 83 Science Photo by/4.0/: Wellcome Library, London. 114–177
(t). Science Photo Library: NLM / Science The Science Museum, London (br). Getty Library: (tc). Wellcome Images http:// Dorling Kindersley: Army Medical Services
Source (bl). 18 Getty Images: Werner Forman Images: DEA / G. DAGLI ORTI (bc); DEA creativecommons.org/licenses/by/4.0/: Museum (t). 116 Science & Society Picture
/ Universal Images Group (cl); Science & PICTURE LIBRARY (cla). 47 Getty Images: Wellcome Library, London (br). 84–85 akg- Library: Science Museum (cr). SuperStock:
Society Picture Library (br). Glasgow City Science & Society Picture Library (br). images: Album / Oronoz. 86 Bridgeman Science and Society (crb). 117 Dorling
Council (Museums): (tc). SuperStock: TopFoto.co.uk: 2003 Charles Walker (bl). Images: Bibliotheque de la Faculte de Kindersley: (l); The Science Museum, London
Science and Society (cr). Wellcome Images: Wellcome Images http://creativecommons. Medecine, Paris, France / Archives Charmet (cb). Science Photo Library: (fbr). Science &
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ACKNOWLEDGMENTS
Society Picture Library: Science Museum Science (br). 152 Alamy Stock Photo: World Schollmeyer, CC BY-SA 3.0 DE Corbis: Bettmann. 235 Alamy Stock Photo:
(br). SuperStock: Science and Society (ca). History Archive (cra). Dreamstime.com: (creativecommons.org / licenses / by-sa Mediscan (tr). Getty Images: (br). 236 Kaveh
Wellcome Images http://creativecommons. Alila07 (bl). Science Photo Library: / 3.0 / de / deed.en) (t). 190 Corbis: (bl). Farrokh: www.kavehfarrokh.com (crb).
org/licenses/by/4.0/: Science Museum, Humanities And Social Sciences Library / New 190–191 Alamy Stock Photo: Phanie. 191 Science Photo Library: Philippe Psaila (t).
London (tc). 118 Wellcome Images http:// York Public Library (bc). 153 Science Photo Alamy Stock Photo: Eric Carr (tc). 192–193 237 Corbis: DAVID CROSLING / epa (bl).
creativecommons.org/licenses/by/4.0/: Library. 154 Alamy Stock Photo: age Alamy Stock Photo: akg-images. 194 Alamy DEKA: Reproduced with the permission
Wellcome Library, London. 119 Alamy Stock fotostock (tr). Wellcome Images http:// Stock Photo: War Archive (bl). 195 Getty of DEKA Research & Development Corp.:
Photo: Stephen Dorey (crb). Getty Images: creativecommons.org/licenses/by/4.0/: Images: Interim Archives (tr); Mondadori (cr). 238 Corbis: Timothy Fadek (cra/3D
Heritage Images / Hulton Archive (tc). 120–121 Wellcome Library, London (cl). 155 Corbis: (t). Portfolio (b). 196–197 Alamy Stock Photo: Printing); Donat Sorokin / ITAR-TASS Photo
Alamy Stock Photo: Everett Collection Inc. SuperStock: Buyenlarge (br). 156–157 Getty Everett Collection Inc (b). 197 Science Photo (tc). Science Photo Library: CCI Archives
122 Alamy Stock Photo: ZUMA Press, Inc. Images: George Eastman House. 158 Getty Library: AMI Images (tr). 198 Corbis: (bl). (cra); DANIEL SAMBRAUS (ftr); Hank Morgan
(br). Wellcome Images http:// Images: Science & Society Picture Library Science Photo Library: St Mary’s Hospital (ca). SuperStock: Science and Society (tr, cr).
creativecommons.org/licenses/by/4.0/: (cra). Wellcome Images http:// Medical School (tr). 199 Alamy Stock Photo: 239 Corbis: Ed Kashi / VII (br); Image Source
Science Museum, London (cl). 123 Alamy creativecommons.org/licenses/by/4.0/: Nature’s Geometry (t). Science Photo (tl); Inga Spence, I / Visuals Unlimited (bc).
Stock Photo: World History Archive. 124 Wellcome Library, London (cl, bc). 159 Library: Otis Historical Archives, National Dreamstime.com: Uatp1 (cr). The Johns
TopFoto.co.uk: The Granger Collection (bl). Wellcome Images http://creativecommons. Museum Of Health And Medicine (br). 201 Hopkins University Applied Physics
Wellcome Images http://creativecommons. org/licenses/by/4.0/: Wellcome Library, Alamy Stock Photo: World History Archive Laboratory: (c). Wellcome Images http://
org/licenses/by/4.0/: Science Museum, London (t). 160 Alamy Stock Photo: The Art (bl). HSE: KICK Advertising and Design (tr). creativecommons.org/licenses/by/4.0/:
London (tr). 125 Science Photo Library: Archive / Gianni Dagli Orti (bl). Wellcome 202 Alamy Stock Photo: World History Science Museum, London (bl, r). 240–241
National Library Of Medicine (c). Wellcome Images http://creativecommons.org/ Archive (c). Dorling Kindersley: Thackeray Alamy Stock Photo: Phanie. 242 The
Images http://creativecommons.org/ licenses/by/4.0/: Wellcome Library, London Medical Museum (cb, br); The Science Advertising Archives. 243 Alamy Stock
licenses/by/4.0/: Wellcome Library, London (tr). 161 Alamy Stock Photo: Photos 12 (t). Museum, London (bl). 203 Alamy Stock Photo: Irene Abdou (br). Science Photo
(crb). 126 Mary Evans Picture Library: (tr). Corbis: Hulton-Deutsch Collection (br). Photo: Dina2001RF (crb). Science Photo Library: Dr P. Marazzi (tr). 244 Courtesy
Science Photo Library: National Library Of 162 Alamy Stock Photo: Granger, NYC (tr). Library: (br). Wellcome Images http:// Barry Marshall and J. Robin Warren: (bl).
Medicine (bl). 127 Alamy Stock Photo: 162–163 Bridgeman Images: Academie de creativecommons.org/licenses/by/4.0/: Getty Images: Joe Raedle (crb). Science
Granger, NYC (clb). Science Photo Library: Medecine, Paris, France / Archives Charmet Science Museum, London (clb). 204 Corbis: Photo Library: Thomas Deerinck, NCMIR (tr).
British Library (r). 128 Alamy Stock Photo: (b). 163 Getty Images: Science & Society Bettmann (cra). 204–205 Wellcome Images 245 Alamy Stock Photo: Cultura Creative
North Wind Picture Archives (bl). Corbis: Picture Library (tc). 164–165 Wellcome http://creativecommons.org/licenses/ (RF). 246–247 Science Photo Library: James
Stapleton Collection (cra). 129 Science Photo Images http://creativecommons.org/ by/4.0/: Wellcome Library, London (c). 205 King-Holmes. 248–249 Science Photo
Library: National Library Of Medicine (l). licenses/by/4.0/: Wellcome Library, London. Science Photo Library: Zephyr (tr). 206 Library: Tek Image (b). 249 Science Photo
Wellcome Images http://creativecommons. 166 Wellcome Images http:// Alamy Stock Photo: Wavebreak Media ltd Library: Louise Murray (tl). 250 akg-images:
org/licenses/by/4.0/: Wellcome Library, creativecommons.org/licenses/by/4.0/: (bl). Science Photo Library: Sovereign / ISM Erich Lessing. 251 Getty Images: Imagno /
London (br). 130 Dorling Kindersley: Science Museum, London (tr). 167 Science (cra). 206–207 Science Photo Library: (c). Hulton Archive (bl). Science Photo Library:
Thackeray Medical Museum (cra). Science Photo Library: (tr). 168 akg-images: ullstein 207 Science Photo Library: John Bavosi (tr). Wellcome Dept. Of Cognitive Neurology (cra).
Photo Library: (tr, ca); CC Studio (clb). bild / ullstein - Archiv Gerstenberg (bl). 208 Getty Images: Mondadori Portfolio (tr). 252 Corbis: APHP-HEGP-VOISIN / PHANIE /
Wellcome Images http://creativecommons. Science Photo Library: Simon Fraser (tr). 169 209 Corbis: CNRI / Science Photo Library (clb). phanie / Phanie Sarl (bl, bc). Getty Images:
org/licenses/by/4.0/: Science Museum, Wellcome Images http://creativecommons. SuperStock: Science and Society. 210 Alamy Pool DEMANGE / MARCHI (tr). 253 Corbis:
London (br). 131 Dorling Kindersley: org/licenses/by/4.0/: Wellcome Library, Stock Photo: Prisma Archivo (cla). Corbis: Dung Vo Trung / Sygma (b). Johns Hopkins
Thackeray Medical Museum (r). Science London. 170 Bridgeman Images: Tallandier Bettmann (bl). 210–211 Getty Images: University: Evin Gultepe, Gracias Lab (tr).
Photo Library: (cla). Wellcome Images (bc). Science Photo Library: Geoff Kidd (tr). Margaret Bourke-White (b). 211 Corbis: CDC / 254–255 Science Photo Library: Peter
http://creativecommons.org/licenses/ 171 Getty Images: Science & Society Picture PHIL (tr); Rahmat / Xinhua Press (br). 212–213 Menzel. 256 Alamy Stock Photo: Pictorial
by/4.0/: Science Museum, London (tl, bl, br). Library (cl). Wellcome Images: Annie Science Photo Library: A. Barrington Brown, Press Ltd (cra). Getty Images: Science &
132–133 Alamy Stock Photo: Historical Cavanagh (r). 172 Alamy Stock Photo: Gonville And Caius College. 214 www. Society Picture Library (bl). 256–257 Alamy
image collection by Bildagentur-online. 134 Lebrecht Music and Arts Photo Library inhalatorium.com. 215 Corbis: Biodisc / Stock Photo: Tom Wood (t). 257 Alamy
Wellcome Images http://creativecommons. (bc). Science Photo Library: Biophoto Visuals Unlimited (cra). Science & Society Stock Photo: Jack Sullivan (bl). 259
org/licenses/by/4.0/: Wellcome Library, Associates (tr). Wellcome Images http:// Picture Library: Science Museum (b). 216 Dreamstime.com: Ahavelaar (tr). Science
London (clb, tr). 134–135 Wellcome Images creativecommons.org/licenses/by/4.0/: Corbis: Bettmann. 217 Getty Images: BSIP Photo Library: Dr Kari Lounatmaa (b). 260
http://creativecommons.org/licenses/ Wellcome Library, London (bl). 173 akg- (bl); Central Press / Stringer / Hulton Archive Getty Images: Maggie Steber (c). 260–261
by/4.0/: Wellcome Library, London (b). 135 images. 174 Alamy Stock Photo: Nigel (br). Science Photo Library: Zephyr (cra). Science Photo Library: Juan Gaertner (c).
Getty Images: United News / Popperfoto (tr). Cattlin (bl). 174–175 Wellcome Images: 218 Press Association Images: Andres 261 Corbis: Visuals Unlimited (br). Science
136–137 Bridgeman Images: Look and Learn Hilary Hurd. 175 Science & Society Picture Kudacki / AP. 219 Corbis: Centers for Disease Photo Library: Schomburg Center For
/ Illustrated Papers Collection. 138–139 Library: Science Museum (tc). Wellcome Control - digital version copyright Science Research In Black Culture / New York Public
Science Photo Library: Jean-Loup Charmet. Images http://creativecommons.org/ Faction / Science Faction (t). Science Photo Library (tr). 262 Science Photo Library: CCI
139 Alamy Stock Photo: Pictorial Press Ltd licenses/by/4.0/: Wellcome Library, London Library: Colin Cuthbert (br). 220–221 Corbis: Archives (bl). 263 123RF.com: Cathy Yeulet
(cra). Getty Images: Imagno (cr). Science & (br). 176 Getty Images: ullstein bild (cra). Mark Thiessen / National Geographic Creative. (b). Getty Images: United News / Popperfoto
Society Picture Library: Science Museum Wellcome Images http://creativecommons. 222 Alamy Stock Photo: Phanie (c). Corbis: (tr). 264–265 Science Photo Library: Spencer
(bc). 140 Bridgeman Images: Historisches org/licenses/by/4.0/: Wellcome Library, Bettmann (bl). Getty Images: Science & Sutton. 266 Getty Images: Roland Neveu.
Museum, Bingen, Germany / Bildarchiv London (bl). 177 Science & Society Picture Society Picture Library (cla). Science Photo 267 Alamy Stock Photo: Agencia Brasil (br).
Steffens (bl). 140–141 Corbis: Hulton-Deutsch Library: Science Museum (tl, br). 178–179 Library: Zephyr (ca). 223 Corbis: Timothy Getty Images: Pascal Guyot (cra). Wellcome
/ Hulton-Deutsch Collection (t). 141 Getty SuperStock: Science and Society. 180 Alamy Fadek (cr). Science Photo Library: National Images http://creativecommons.org/
Images: Time Life Pictures (cr). Wellcome Stock Photo: Everett Collection Inc (c); World Institutes Of Health (crb); Peter Menzel (ca); licenses/by/4.0/. 268–269 Science Photo
Images http://creativecommons.org/ History Archive (bl). Corbis: (cr). Science James King-Holmes (bl). 224 Getty Images: Library: National Institutes Of Health. 270
licenses/by/4.0/: Wellcome Library, London Photo Library: James Cavallini (cla). 181 Science & Society Picture Library (bl). 224–225 Corbis: Najlah Feanny / CORBIS SABA (tr).
(bc). 142 Corbis: (bl). Library of Congress, Getty Images: Margaret Bourke-White (cla). Corbis: Henry Diltz (b). 224–271 PunchStock: 271 Getty Images: Monty Rakusen (tr).
Washington, D.C.: LC-USZC4-7767 (ca). 143 Press Association Images: Andres Kudacki / Image Source (t/Tab). 225 Getty Images: Science Photo Library: Steve Gschmeissner
akg-images: (b). Alamy Stock Photo: OJO AP (cr). Science & Society Picture Library: David Fenton (tr). 226 Sophia Smith (b). 276 Science Photo Library: Zephyr (clb).
Images Ltd (tr). 144–145 Image courtesy of Science Museum (cra). SuperStock: Science Collection, Smith College: Published by 277 Science Photo Library: Prof. P. Motta /
Biodiversity Heritage Library. http://www. and Society (clb). 182–183 Corbis: adoc-photos Margaret Sanger (bl). TopFoto.co.uk: The Dept. Of Anatomy / University "La Sapienza,"
biodiversitylibrary.org: Taken from Anatomy, (r). 182–219 123RF.com: photka (t/Tab). 183 Granger Collection (r). 227 Alamy Stock Rome (cl). 278 Science Photo Library: (clb/
descriptive and surgical / by Henry Gray; the Alamy Stock Photo: Prisma Bildagentur AG Photo: Everett Collection Inc (cr). Getty Smooth Muscle); Alfred Pasieka (bl); M.I.
drawings by H.V.Carter; the dissections jointly (t); World History Archive (cr). 184 Alamy Images: New York Daily News Archive (t). Walker (clb/Skeletal Muscle). 289 Science
by the author and Dr. Carter. 146 Corbis: CDC Stock Photo: World History Archive. 185 Rex by Shutterstock: Everett Collection (bc). Photo Library: Professors P. Motta & F.
/ PHIL (tr). Science Photo Library: King’s Corbis: BURGER / phanie / Phanie Sarl (br). 228–229 Corbis: Electron Microscopy Unit, Carpino / Univer- Sity "La Sapienza," Rome
College London (bl). 147 Corbis: (b). Science TopFoto.co.uk: The Granger Collection (tr). Cancer / Visuals Unlimited (b). 229 Alamy (tc). 291 Science Photo Library: Eye Of
Photo Library: (tr). 148 Wellcome Images 186 Corbis: (bl). Science Photo Library: Stock Photo: Scott Camazine (tc). 230 Science (bl). 295 Corbis: Andrew Brookes (bl).
http://creativecommons.org/licenses/ James Cavallini (tr). 187 Alamy Stock Photo: Bridgeman Images: Private Collection / Science Photo Library: Philippe Plailly (br).
by/4.0/: Wellcome Library, London. 149 war posters (b). Dorling Kindersley: Archives Charmet (tr). Corbis: National Cancer 297 Science Photo Library: Eye Of Science (tr)
Science Photo Library: (tc). SuperStock: Thackeray Medical Museum (tc). 188 Getty Institute - digital version copyright Science
Science and Society (cr). 150 Wellcome Images: BSIP (b). International Nitze- Faction / Science Faction (tl). Science Photo
Images http://creativecommons.org/ Leiter Research Society for Endoscopy, Library: National Library Of Medicine (bc). All other images © Dorling Kindersley
licenses/by/4.0/: Wellcome Library, London Vienna: (tr). 189 Science Photo Library: 231 Science Photo Library: BSIP, RAGUET. For further information see:
(bl, br). 151 Science Photo Library: Eye Of James Cavallini (bl). Wikipedia: M. 232–233 Science Photo Library: Zephyr. 234 www.dkimages.com
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