The Importance of Having a Brain: Tales from the History of Medicine
This book describes her journey "as a patient through a doctor's eyes", and is therefore invaluable to any health professional, particularly medical students and young doctors. This book helped me to appreciate just how important the little things are — sitting down at the same level as a patient, holding someone's hand and introducing yourself. Muddy Bhatt, a medical student specialising in neurology at University College London, said that reading this particular book inspired him to apply to medical school: The Checklist looks at how medical professionals deal with the increasing complexity of their responsibilities, and examines human failure.
Comparing the practice of medicine with aviation mechanics and construction of skyscrapers, this book made me think about failure in a completely different way — even in a complex situation, the reasons for failure can be extraordinarily simple. Optimism is essential for us to survive and thrive, but there is a dark side to the optimism bias: This book helped me to better understand why people may not easily heed health advice something we'll be giving out a lot as doctors.
This Venetian medical mystery tells the fascinating story of the discovery of prions, infectious misfolded proteins that affect the brain. It also delves into the nature of sleep, following a family with an inherited form of fatal insomnia. Jing Ouyang, a medical student at Imperial College London, counts this book as one of his favourites.
It also shows the wider reach of disease in terms of academics and politics. Some students may still wish to pre-learn textbook facts, but these books will give you a deeper understanding of the patient's perspective. If we can carry this throughout our career, I think it will help to make us better doctors who can connect with patients and see them as more than just their disease. Share your suggestions in the comments section below. The Other Side by Kate Granger Granger is a doctor specialising in geriatric medicine, but she is also a terminally ill cancer patient.
In the Spanish Empire , the viceregal capital of Mexico City was a site of medical training for physicians and the creation of hospitals. Aztec emperor Cuitlahuac died of smallpox. Medical education instituted at the Royal and Pontifical University of Mexico chiefly served the needs of urban elites.
Male and female curanderos or lay practitioners, attended to the ills of the popular classes. The Spanish crown began regulating the medical profession just a few years after the conquest, setting up the Royal Tribunal of the Protomedicato, a board for licensing medical personnel in Licensing became more systematic after with physicians, druggists, surgeons, and bleeders requiring a license before they could publicly practice. Elites and the popular classes alike called on divine intervention in personal and society-wide health crises, such as the epidemic of The intervention of the Virgin of Guadalupe was depicted in a scene of dead and dying Indians, with elites on their knees praying for her aid.
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In the late eighteenth century, the crown began implementing secularizing policies on the Iberian peninsula and its overseas empire to control disease more systematically and scientifically. The practice of medicine changed in the face of rapid advances in science, as well as new approaches by physicians. Hospital doctors began much more systematic analysis of patients' symptoms in diagnosis. However the decline in many of the most lethal diseases was due more to improvements in public health and nutrition than to advances in medicine.
Medicine was revolutionized in the 19th century and beyond by advances in chemistry, laboratory techniques, and equipment. Old ideas of infectious disease epidemiology were gradually replaced by advances in bacteriology and virology. In the s in Italy, Agostino Bassi traced the silkworm disease muscardine to microorganisms. Meanwhile, in Germany, Theodor Schwann led research on alcoholic fermentation by yeast , proposing that living microorganisms were responsible. Leading chemists, such as Justus von Liebig , seeking solely physicochemical explanations, derided this claim and alleged that Schwann was regressing to vitalism.
In in Vienna, Ignaz Semmelweis — , dramatically reduced the death rate of new mothers due to childbed fever by requiring physicians to clean their hands before attending childbirth , yet his principles were marginalized and attacked by professional peers. Eminent French scientist Louis Pasteur confirmed Schwann 's fermentation experiments in and afterwards supported the hypothesis that yeast were microorganisms. Moreover, he suggested that such a process might also explain contagious disease. In , Pasteur's report on bacterial fermentation of butyric acid motivated fellow Frenchman Casimir Davaine to identify a similar species which he called bacteridia as the pathogen of the deadly disease anthrax.
Others dismissed "bacteridia" as a mere byproduct of the disease. British surgeon Joseph Lister , however, took these findings seriously and subsequently introduced antisepsis to wound treatment in German physician Robert Koch , noting fellow German Ferdinand Cohn 's report of a spore stage of a certain bacterial species, traced the life cycle of Davaine 's bacteridia , identified spores, inoculated laboratory animals with them, and reproduced anthrax—a breakthrough for experimental pathology and germ theory of disease.
Pasteur's group added ecological investigations confirming spores' role in the natural setting, while Koch published a landmark treatise in on the bacterial pathology of wounds. In , Koch reported discovery of the " tubercle bacillus ", cementing germ theory and Koch's acclaim. Upon the outbreak of a cholera epidemic in Alexandria, Egypt , two medical missions went to investigate and attend the sick, one was sent out by Pasteur and the other led by Koch.
On losing the rivalry in Alexandria, Pasteur switched research direction, and introduced his third vaccine— rabies vaccine —the first vaccine for humans since Jenner 's for smallpox.
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Although his proposed tuberculosis treatment, tuberculin , seemingly failed, it soon was used to test for infection with the involved species. In , Koch was awarded the Nobel Prize in Physiology or Medicine , and remains renowned as the founder of medical microbiology. Women had always served in ancillary roles, and as midwives and healers. The professionalization of medicine forced them increasingly to the sidelines. As hospitals multiplied they relied in Europe on orders of Roman Catholic nun-nurses, and German Protestant and Anglican deaconesses in the early 19th century.
They were trained in traditional methods of physical care that involved little knowledge of medicine. The breakthrough to professionalization based on knowledge of advanced medicine was led by Florence Nightingale in England. She resolved to provide more advanced training than she saw on the Continent.
At Kaiserswerth, where the first German nursing schools were founded in by Theodor Fliedner , she said, "The nursing was nil and the hygiene horrible. The Nightingale solution depended on the patronage of upper class women, and they proved eager to serve. In the wife of the British king took control of the nursing unit of the British army, became its president, and renamed it after herself as the Queen Alexandra's Royal Army Nursing Corps ; when she died the next queen became president.
In the United States, upper middle class women who already supported hospitals promoted nursing. The new profession proved highly attractive to women of all backgrounds, and schools of nursing opened in the late 19th century. They soon a function of large hospitals, where they provided a steady stream of low-paid idealistic workers.
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The International Red Cross began operations in numerous countries in the late 19th century, promoting nursing as an ideal profession for middle class women. The Nightingale model was widely copied. Linda Richards — studied in London and became the first professionally trained American nurse. She established nursing training programs in the United States and Japan, and created the first system for keeping individual medical records for hospitalized patients.
They ran hospitals, clinics, almshouses, pharmacies, and shelters as well as training schools for nurses. In the Soviet era — , with the aristocratic sponsors gone, nursing became a low-prestige occupation based in poorly maintained hospitals. It was very difficult for women to become doctors in any field before the s.
Elizabeth Blackwell — became the first woman to formally study and practice medicine in the United States. She was a leader in women's medical education. While Blackwell viewed medicine as a means for social and moral reform, her student Mary Putnam Jacobi — focused on curing disease. At a deeper level of disagreement, Blackwell felt that women would succeed in medicine because of their humane female values, but Jacobi believed that women should participate as the equals of men in all medical specialties using identical methods, values and insights.
Paris France and Vienna were the two leading medical centers on the Continent in the era — In the s—s Paris became a world center of medical research and teaching. The "Paris School" emphasized that teaching and research should be based in large hospitals and promoted the professionalization of the medical profession and the emphasis on sanitation and public health. He created the Paris Hospital, health councils, and other bodies. Louis Pasteur — was one of the most important founders of medical microbiology. He is remembered for his remarkable breakthroughs in the causes and preventions of diseases.
His discoveries reduced mortality from puerperal fever , and he created the first vaccines for rabies and anthrax. His experiments supported the germ theory of disease. He was best known to the general public for inventing a method to treat milk and wine in order to prevent it from causing sickness, a process that came to be called pasteurization.
He is regarded as one of the three main founders of microbiology , together with Ferdinand Cohn and Robert Koch. He worked chiefly in Paris and in founded the Pasteur Institute there to perpetuate his commitment to basic research and its practical applications. As soon as his institute was created, Pasteur brought together scientists with various specialties.
The first five departments were directed by Emile Duclaux general microbiology research and Charles Chamberland microbe research applied to hygiene , as well as a biologist, Ilya Ilyich Mechnikov morphological microbe research and two physicians , Jacques-Joseph Grancher rabies and Emile Roux technical microbe research. One year after the inauguration of the Institut Pasteur, Roux set up the first course of microbiology ever taught in the world, then entitled Cours de Microbie Technique Course of microbe research techniques.
It became the model for numerous research centers around the world named "Pasteur Institutes. The First Viennese School of Medicine, —, was led by the Dutchman Gerard van Swieten — , who aimed to put medicine on new scientific foundations—promoting unprejudiced clinical observation, botanical and chemical research, and introducing simple but powerful remedies. When the Vienna General Hospital opened in , it at once became the world's largest hospital and physicians acquired a facility that gradually developed into the most important research centre.
Vienna was the capital of a diverse empire and attracted not just Germans but Czechs, Hungarians, Jews, Poles and others to its world-class medical facilities. Basic medical science expanded and specialization advanced. Furthermore, the first dermatology , eye, as well as ear, nose, and throat clinics in the world were founded in Vienna. The textbook of ophthalmologist Georg Joseph Beer — Lehre von den Augenkrankheiten combined practical research and philosophical speculations, and became the standard reference work for decades.
After Berlin, the capital of the new German Empire, became a leading center for medical research. Robert Koch — was a representative leader. He became famous for isolating Bacillus anthracis , the Tuberculosis bacillus and Vibrio cholerae and for his development of Koch's postulates. He was awarded the Nobel Prize in Physiology or Medicine in for his tuberculosis findings.
Koch is one of the founders of microbiology , inspiring such major figures as Paul Ehrlich and Gerhard Domagk. In the American Civil War —65 , as was typical of the 19th century, more soldiers died of disease than in battle, and even larger numbers were temporarily incapacitated by wounds, disease and accidents. Weapon development -particularly the appearance of Springfield Model , mass-produced and much more accurate than muskets led to generals underestimating the risks of long range rifle fire; risks exemplified in the death of John Sedgwick and the disastrous Pickett's Charge.
The rifles could shatter bone forcing amputation and longer ranges meant casualties were sometimes not quickly found. Evacuation of the wounded from Second Battle of Bull Run took a week. The hygiene of the training and field camps was poor, especially at the beginning of the war when men who had seldom been far from home were brought together for training with thousands of strangers.
First came epidemics of the childhood diseases of chicken pox, mumps, whooping cough, and, especially, measles. Operations in the South meant a dangerous and new disease environment, bringing diarrhea, dysentery, typhoid fever, and malaria. There were no antibiotics, so the surgeons prescribed coffee, whiskey, and quinine. Harsh weather, bad water, inadequate shelter in winter quarters, poor policing of camps, and dirty camp hospitals took their toll. This was a common scenario in wars from time immemorial, and conditions faced by the Confederate army were even worse.
The Union responded by building army hospitals in every state. What was different in the Union was the emergence of skilled, well-funded medical organizers who took proactive action, especially in the much enlarged United States Army Medical Department, [] and the United States Sanitary Commission , a new private agency. A major breakthrough in epidemiology came with the introduction of statistical maps and graphs. They allowed careful analysis of seasonality issues in disease incidents, and the maps allowed public health officials to identify critical loci for the dissemination of disease.
John Snow in London developed the methods. In , he observed that the symptoms of cholera, which had already claimed around lives within a month, were vomiting and diarrhoea. He concluded that the source of contamination must be through ingestion, rather than inhalation as was previously thought. It was this insight that resulted in the removal of The Pump On Broad Street, after which deaths from cholera plummeted afterwards.
English nurse Florence Nightingale pioneered analysis of large amounts of statistical data, using graphs and tables, regarding the condition of thousands of patients in the Crimean War to evaluate the efficacy of hospital services. Her methods proved convincing and led to reforms in military and civilian hospitals, usually with the full support of the government. By the late 19th and early 20th century English statisticians led by Francis Galton , Karl Pearson and Ronald Fisher developed the mathematical tools such as correlations and hypothesis tests that made possible much more sophisticated analysis of statistical data.
Civil War the Sanitary Commission collected enormous amounts of statistical data, and opened up the problems of storing information for fast access and mechanically searching for data patterns. The pioneer was John Shaw Billings — A senior surgeon in the war, Billings built the Library of the Surgeon General's Office now the National Library of Medicine , the centerpiece of modern medical information systems.
1. The Patient’s Turn
The applications were developed by his assistant Herman Hollerith ; Hollerith invented the punch card and counter-sorter system that dominated statistical data manipulation until the s. Johns Hopkins Hospital , founded in , originated several modern medical practices, including residency and rounds. European ideas of modern medicine were spread widely through the world by medical missionaries, and the dissemination of textbooks. Japanese elites enthusiastically embraced Western medicine after the Meiji Restoration of the s.
However they had been prepared by their knowledge of the Dutch and German medicine, for they had some contact with Europe through the Dutch. These men became leaders of the modernization of medicine in their country. They broke from Japanese traditions of closed medical fraternities and adopted the European approach of an open community of collaboration based on expertise in the latest scientific methods. In he founded the Institute of Infectious Diseases in Tokyo, which introduced the study of bacteriology to Japan. He and French researcher Alexandre Yersin went to Hong Kong in , where; Kitasato confirmed Yersin's discovery that the bacterium Yersinia pestis is the agent of the plague.
In he isolates and described the organism that caused dysentery. He became the first dean of medicine at Keio University, and the first president of the Japan Medical Association. Japanese physicians immediately recognized the values of X-Rays. They were able to purchase the equipment locally from the Shimadzu Company, which developed, manufactured, marketed, and distributed X-Ray machines after Until the nineteenth century, the care of the insane was largely a communal and family responsibility rather than a medical one.
The vast majority of the mentally ill were treated in domestic contexts with only the most unmanageable or burdensome likely to be institutionally confined. From the early nineteenth century, as lay-led lunacy reform movements gained in influence, [] ever more state governments in the West extended their authority and responsibility over the mentally ill. Emil Kraepelin — introduced new medical categories of mental illness , which eventually came into psychiatric usage despite their basis in behavior rather than pathology or underlying cause. Shell shock among frontline soldiers exposed to heavy artillery bombardment was first diagnosed by British Army doctors in By , similar symptoms were also noted in soldiers not exposed to explosive shocks, leading to questions as to whether the disorder was physical or psychiatric.
In the s several controversial medical practices were introduced including inducing seizures by electroshock , insulin or other drugs or cutting parts of the brain apart leucotomy or lobotomy. Both came into widespread use by psychiatry, but there were grave concerns and much opposition on grounds of basic morality, harmful effects, or misuse.
In the s new psychiatric drugs , notably the antipsychotic chlorpromazine , were designed in laboratories and slowly came into preferred use.
Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. There was also increasing opposition to the use of psychiatric hospitals, and attempts to move people back into the community on a collaborative user-led group approach "therapeutic communities" not controlled by psychiatry. Campaigns against masturbation were done in the Victorian era and elsewhere.
Lobotomy was used until the s to treat schizophrenia. This was denounced by the anti-psychiatric movement in the s and later. The ABO blood group system was discovered in , and the Rhesus blood group system in , facilitating blood transfusion. During the 20th century, large-scale wars were attended with medics and mobile hospital units which developed advanced techniques for healing massive injuries and controlling infections rampant in battlefield conditions. During the Mexican Revolution — , General Pancho Villa organized hospital trains for wounded soldiers. Boxcars marked Servicio Sanitario "sanitary service" were re-purposed as surgical operating theaters and areas for recuperation, and staffed by up to 40 Mexican and U.
Severely wounded soldiers were shuttled back to base hospitals. Those practices were combined to broaden cosmetic surgery and other forms of elective surgery. During the First World War , Alexis Carrel and Henry Dakin developed the Carrel-Dakin method of treating wounds with an irrigation, Dakin's solution, a germicide which helped prevent gangrene. The Great War spurred the usage of Roentgen 's X-ray , and the electrocardiograph , for the monitoring of internal bodily functions. This was followed in the inter-war period by the development of the first anti-bacterial agents such as the sulpha antibiotics.
Public health measures became particular important during the flu pandemic , which killed at least 50 million people around the world. Male doctors were unable to cure the patients, and they felt like failures. Women nurses also saw their patients die, but they took pride in their success in fulfilling their professional role of caring for, ministering, comforting, and easing the last hours of their patients, and helping the families of the patients cope as well.
From to , the American Red Cross moved into Europe with a battery of long-term child health projects. It built and operated hospitals and clinics, and organized antituberculosis and antityphus campaigns. A high priority involved child health programs such as clinics, better baby shows, playgrounds, fresh air camps, and courses for women on infant hygiene.
The advances in medicine made a dramatic difference for Allied troops, while the Germans and especially the Japanese and Chinese suffered from a severe lack of newer medicines, techniques and facilities. Harrison finds that the chances of recovery for a badly wounded British infantryman were as much as 25 times better than in the First World War. The reason was that:. Unethical human subject research , and killing of patients with disabilities, peaked during the Nazi era, with Nazi human experimentation and Aktion T4 during the Holocaust as the most significant examples.
Many of the details of these and related events were the focus of the Doctors' Trial. Subsequently, principles of medical ethics , such as the Nuremberg Code , were introduced to prevent a recurrence of such atrocities. In Unit , Japanese doctors and research scientists conducted large numbers of vivisections and experiments on human beings, mostly Chinese victims.
Starting in World War II, DDT was used as insecticide to combat insect vectors carrying malaria , which was endemic in most tropical regions of the world. In Liberia, for example, the United States had large military operations during the war and the U. In the early s, the project was expanded to nearby villages. In , the World Health Organization WHO launched an antimalaria program in parts of Liberia as a pilot project to determine the feasibility of malaria eradication in tropical Africa.
However these projects encountered a spate of difficulties that foreshadowed the general retreat from malaria eradication efforts across tropical Africa by the mids. The World Health Organization was founded in as a United Nations agency to improve global health. In most of the world, life expectancy has improved since then, and was about 67 years as of [update] , and well above 80 years in some countries. Eradication of infectious diseases is an international effort, and several new vaccines have been developed during the post-war years, against infections such as measles , mumps , several strains of influenza and human papilloma virus.
The long-known vaccine against Smallpox finally eradicated the disease in the s, and Rinderpest was wiped out in Eradication of polio is underway. Tissue culture is important for development of vaccines. Though the early success of antiviral vaccines and antibacterial drugs, antiviral drugs were not introduced until the s. As infectious diseases have become less lethal, and the most common causes of death in developed countries are now tumors and cardiovascular diseases , these conditions have received increased attention in medical research.
Tobacco smoking as a cause of lung cancer was first researched in the s, but was not widely supported by publications until the s. Cancer treatment has been developed with radiotherapy , chemotherapy and surgical oncology. Oral rehydration therapy has been extensively used since the s to treat cholera and other diarrhea-inducing infections. The sexual revolution included taboo-breaking research in human sexuality such as the and Kinsey reports , invention of hormonal contraception , and the normalization of abortion and homosexuality in many countries.
Family planning has promoted a demographic transition in most of the world. With threatening sexually transmitted infections , not least HIV , use of barrier contraception has become imperative. The struggle against HIV has improved antiretroviral treatments. X-ray imaging was the first kind of medical imaging , and later ultrasonic imaging , CT scanning , MR scanning and other imaging methods became available.
Genetics have advanced with the discovery of the DNA molecule, genetic mapping and gene therapy. Stem cell research took off in the s decade , with stem cell therapy as a promising method. Evidence-based medicine is a modern concept, not introduced to literature until the s. In , Arne Larsson in Sweden became the first patient to depend on an artificial cardiac pacemaker.
He died in at age 86, having outlived its inventor, the surgeon, and 26 pacemakers. Lightweight materials as well as neural prosthetics emerged in the end of the 20th century. Cardiac surgery was revolutionized in as open-heart surgery was introduced for the first time since In Joseph Murray , J. Hartwell Harrison and others accomplished the first kidney transplantation.
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Transplantations of other organs, such as heart, liver and pancreas, were also introduced during the later 20th century. The first partial face transplant was performed in , and the first full one in By the end of the 20th century, microtechnology had been used to create tiny robotic devices to assist microsurgery using micro-video and fiber-optic cameras to view internal tissues during surgery with minimally invasive practices. Laparoscopic surgery was broadly introduced in the s. Natural orifice surgery has followed.
Remote surgery is another recent development, with the Lindbergh operation in as a groundbreaking example. From Wikipedia, the free encyclopedia. This article is about the history of human medicine. For veterinary medicine, see History of veterinary medicine.
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