30 July 2006
Table of Contents
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5.4. HISTORY ........................................................................................................... 22
5.5. DEFORMITY IN THE “BOXING BOYS” .................................................................... 22
5.6. GENES AND ARCHEOLOGY - A DIFFERENT KIND OF HISTORY ............................... 22
5.7. PRACTITIONERS OF MEDICINE (2100 B.C.E.) ...................................................... 23
6. ARTS AND DISEASE ............................................................................................ 23
6.1. DANTE AND MELANCHOLY (1265 –1321) ............................................................ 23
6.2. I GOT RHYTHM: GEORGE GERSHWIN AND BIRTH CONTROL IN THE 1930S ............. 23
6.3. PEARL BUCK AND PKU (1921 – 1960)............................................................... 24
6.4. VINCENT VAN GOGH (1853-1890) ..................................................................... 24
6.5. ROBERT LOUIS STEVENSON (1850 –1894) - HEREDITARY HEMORRHAGIC
TELANGIECTASIA ............................................................................................... 24
6.6. SLEEP APNEA - LEWIS CARROLL AND WILLIAM SHAKESPEARE .............................. 25
7. BASIC SCIENCE ................................................................................................... 25
7.1. GOLGI AND NEUROPSYCHIATRY (19TH CENTURY) ................................................. 25
7.2. ROBERT HOOKE (1635 – 1703) ......................................................................... 25
7.3. ANTON VAN LEEUWENHOEK (1632-1723) ........................................................... 26
8. CARDIOLOGY ....................................................................................................... 26
8.1. DIURETIC PROPERTIES OF MERCURY (19TH CENTURY) ......................................... 26
8.2. TETRALOGY OF FALLOT (1673) .......................................................................... 26
8.3. WILLIAM HARVEY (1578 – 1657) - CARDIAC OUTPUT AND THE HOUR GLASS ........ 27
8.4. WILLIAM SENHOUSE KIRKES (1822-1864) - PATHOGENESIS OF HYPERTENSION .... 27
8.5. RUDOLPH MATAS (1860-1957)– VASCULAR SURGEON ........................................ 28
8.6. WOLDEMAR MOBITZ (1924) - 2ND DEGREE ATRIOVENTRICULAR BLOCK ................. 28
8.7. JEAN-BAPTISTE DE SENAC (1693-1770) – ARTERIAL PULSE ................................ 28
8.8. WILLIAM WITHERING AND THE DISCOVERY OF DIGITALIS (1775)............................ 29
9. DENTISTRY........................................................................................................... 29
9.1. ETRUSCAN DENTISTRY (700 B.C.E.) .................................................................. 29
9.2. JAW FRACTURES (1863).................................................................................... 30
9.3. NECROTIZING ULCERATIVE STOMATITIS (NOMA) (16TH – 17TH CENTURIES) ............ 30
9.4. ORAL DISEASE (25,000 YEARS AGO) .................................................................. 30
9.5. PERIODONTAL DISEASE ..................................................................................... 31
9.5.1. Bartolomeo Eustachio (1520-1574) ......................................................... 31
9.5.2. History...................................................................................................... 31
9.6. TOOTH CARE (5000 B.C.E. – 1000 C.E.) .......................................................... 31
9.7. TOOTHWORM .................................................................................................... 32
10. DERMATOLOGY................................................................................................ 32
10.1. JOSEPH PLENCK (1735-1807)........................................................................ 32
11. DISCOVERIES ................................................................................................... 32
11.1. THE FIRST ISOLATED ANTIBIOTIC..................................................................... 32
11.2. ASPIRIN (ANCIENT ASSYRIA TO 1892) ............................................................. 33
11.3. CELSIUS THERMOMETER SCALE (1742)........................................................... 33
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11.4. CHEMISTRY AND MEDICINE (19TH CENTURY) .................................................... 34
11.5. CYTOPATHOLOGY (20TH CENTURY).................................................................. 34
11.6. DEBRIDEMENT (18TH CENTURY TO PRESENT) ................................................... 34
11.7. FEVER (17TH AND 18TH CENTURIES) .............................................................. 35
11.8. HANDWASHING AS PREVENTATIVE MEDICINE (19TH CENTURY) .......................... 35
11.9. OPIOIDS ........................................................................................................ 36
11.9.1. History of Opium .................................................................................. 36
11.9.2. Heroin and Other Opium Alkaloids (1898)............................................ 36
11.10. LIPIDS (1824)................................................................................................ 37
11.11. NITROGLYCERIN AND NITRIC OXIDE (19TH CENTURY) ........................................ 37
11.12. PENICILLIN (1928) ......................................................................................... 37
11.13. SHOE FITTING FLUOROSCOPE (1920 –1950)................................................... 38
11.14. X-RAYS (1895) ............................................................................................. 38
12. DISEASES.......................................................................................................... 38
12.1. DIABETES (1674)........................................................................................... 38
12.2. DWARFISM ANCIENT EGYPT (5TH DYNASTY) ..................................................... 39
12.3. CHILDBIRTH AND ANESTHESIA - PAIN OR TOIL (1846) ....................................... 39
12.4. CANCER (ANCIENT EGYPT TO PRESENT) ......................................................... 39
12.5. CUSHING'S DISEASE (1912) ........................................................................... 40
12.6. DEAFNESS, ASYLUMS AND EDUCATION (19TH CENTURY) ................................... 40
12.7. DUCHENNE MUSCULAR DYSTROPHY (1806 - 1875) ......................................... 40
12.8. DISEASES OF THE EAR (324-1453 C.E.) ......................................................... 40
12.9. ECLAMPSIA (ANCIENT GREECE TO PRESENT)................................................... 41
12.10. GLANDULAR THERAPY (19TH CENTURY) ........................................................... 41
12.11. HEART .......................................................................................................... 41
12.11.1. History .................................................................................................. 42
12.11.2. Heart Disease (20th Century)................................................................ 42
12.12. JAUNDICE (NEONATAL) (1785 – PRESENT)...................................................... 42
12.13. MACULAR EDEMA (1856 – 1950) ................................................................... 43
12.14. MALARIA ....................................................................................................... 43
12.14.1. Malaria (1880) ...................................................................................... 43
12.14.2. Dr. John Cropper - Malaria Researcher in Palestine ............................ 44
12.15. MYASTHENIA GRAVIS (1892) .......................................................................... 44
12.16. PELLAGRA ..................................................................................................... 45
12.16.1. Reports in the US (1700’s - 1902) ........................................................ 45
12.16.2. Civil War – 20th Century ....................................................................... 45
12.16.3. Pellagra (1914- 1926)........................................................................... 45
12.17. PROTEUS SYNDROME: ELEPHANT MAN DIAGNOSED (1884) .............................. 46
12.18. PULSE (300 C.E.) ......................................................................................... 46
12.19. SCURVY (14TH – 20TH CENTURY) ..................................................................... 46
12.19.1. Background .......................................................................................... 46
12.19.2. Scurvy - William Stark (1741-1770)...................................................... 47
12.20. SEPSIS (C.E. 129-1973) ............................................................................... 47
12.21. SITOPHOBIA (FOOD REFUSAL) AND ANOREXIA NERVOSA IN VICTORIAN ASYLUMS
(19TH CENTURY) ............................................................................................ 47
12.22. VERTIGO AND EPILEPSY (ANCIENT TIMES TO PRESENT) .................................... 48
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12.23. ULCERS (16TH CENTURY TO 1885) .................................................................. 48
13. DISEASES OF LEADERS .................................................................................. 48
13.1. WAS LOUIS XIV INFECTED WITH PARASITES? .................................................. 48
13.2. HEMOPHILIA AND QUEEN VICTORIA OF ENGLAND (1837-1901).......................... 49
13.3. WHAT DID GEORGE WASHINGTON DIE FROM?................................................. 49
13.4. KING GEORGE III AND ACUTE INTERMITTENT PORPHYRIA (1739 – 1820).......... 49
13.5. FRANKLIN D. ROOSEVELT (1882 – 1945)........................................................ 50
14. ENDOCRINOLOGY............................................................................................ 50
14.1. BACKGROUND (19TH AND 20TH CENTURIES) ...................................................... 50
14.2. CASTRATI (16TH CENTURY – 1924) ................................................................. 50
14.3. DIABETES MELLITUS (1ST CENTURY C.E.) ........................................................ 51
14.4. SURGERY (PREHISTORIC TIMES TO PRESENT).................................................. 51
15. GENERAL MEDICINE........................................................................................ 52
15.1. DR. PHILIP BARROUGH (1587) - FIRST BOOK ON MEDICINE IN ENGLISH ............. 52
15.2. WILLIAM BEAUMONT AND EARLY STUDIES OF GASTRIC SECRETION ................... 52
15.3. ANTONIO BENIVIENI (1443-1502)- TRAILBLAZER PATHOLOGIST........................ 52
15.4. HENRY INGERSOLL BOWDITCH (1808-1892) AND OLIVER WENDELL HOLMES
(1809-1894)................................................................................................. 53
15.5. FREDERICK CHOPIN (1810 – 1849) – DID HE HAVE CYSTIC FIBROSIS? ............ 53
15.6. ABRAHAM LINCOLN AND MEDICAL MALPRACTICE (1858) ................................... 53
15.7. JOSEPH LISTER (1827 – 1912) ...................................................................... 54
15.7.1. Report 1 ............................................................................................... 54
15.7.2. Report 2 ............................................................................................... 54
15.8. NOSTRADAMUS - DOCTOR AND PROPHET (1503 - 1566) .................................. 54
15.9. JAMES PARKINSON - CHILD ADVOCATE (1755-1824) ....................................... 55
15.10. LOUIS PASTEUR (1822-1895) ........................................................................ 55
15.10.1. Pasteur and Koch on American Medicine ............................................ 55
15.10.2. Work..................................................................................................... 55
15.11. WILLIAM PROUT - PHYSIOLOGICAL CHEMIST (1785 - 1850) .............................. 56
15.12. VESALIUS (1514 - 1564)................................................................................ 56
16. GENERAL TOPICS ............................................................................................ 56
16.1. AMPUTATION (NEOLITHIC TIMES - 1810).......................................................... 56
16.2. ANATOMY (980 – 1288)................................................................................. 57
16.3. ARROW WOUNDS AND THE DEVELOPMENT OF SURGERY ................................... 57
16.4. CHOREA ST. VITII (658-739) .......................................................................... 58
16.5. DOCTORING AS A PROFESSION ....................................................................... 58
16.5.1. Ancient Rome 1.................................................................................... 58
16.5.2. Ancient Rome 2.................................................................................... 58
16.6. EPHEMERA (15TH –16TH CENTURIES ................................................................ 59
16.7. EPIDEMIOLOGY (1830) ................................................................................... 59
16.8. ETHICS ......................................................................................................... 59
16.9. GERMANS, CELTS AND OTHERS ...................................................................... 60
16.10. HOSPITALS (820 C.E. TO 1311) ..................................................................... 60
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16.11. IMAGING (1890-1950).................................................................................... 61
16.12. INSANITY PLEA (1857) ................................................................................... 61
16.13. MEDICAL EDUCATION (19TH CENTURY) ............................................................ 61
16.14. MEDICAL THOUGHT (19TH CENTURY TO PRESENT)............................................ 62
16.15. MIDWIFERY (200 C.E.) .................................................................................. 62
16.16. NURSING STANDARDS (19TH CENTURY) ........................................................... 63
16.17. SOBRIETY AND ALCOHOL CONSUMPTION (1736 – 1871) .................................. 63
17. GYNECOLOGY .................................................................................................. 63
17.1. JAMES MARION SIMS, FATHER OF GYNECOLOGY.............................................. 63
18. INFECTIOUS DISEASES ................................................................................... 64
18.1. ANTHRAX ...................................................................................................... 64
18.1.1. Haitian Epidemic (1770) ....................................................................... 64
18.1.2. History (Antiquity to 2002) .................................................................... 64
18.2. BLACK PLAGUE .............................................................................................. 64
18.2.1. General Background (541 – 1970) ....................................................... 64
18.2.2. The Black (Bubonic) Plague of 542 ...................................................... 65
18.2.3. Bubonic Plague (1348)......................................................................... 65
18.2.4. The Great Plague 1665 ........................................................................ 66
18.2.5. China (1330s)....................................................................................... 66
18.3. CHAGAS DISEASE .......................................................................................... 66
18.3.1. Chagas Disease ................................................................................... 67
18.3.2. Chagas Disease in Mummies 9,000 Years Ago ................................... 67
18.3.3. Chagas Heart Disease ......................................................................... 67
18.4. CHOLERA ...................................................................................................... 68
18.4.1. Cholera and the Public Health (1854) .................................................. 68
18.4.2. Epidemic (1854) ................................................................................... 68
18.5. DISEASE TRANSMISSION ................................................................................. 68
18.5.1. From Europe to the Americas (16th Century)........................................ 68
18.6. ENGLISH SWEATING DISEASE (1485 – 1551) .................................................. 69
18.7. FLU .............................................................................................................. 69
18.7.1. Spanish Flu of 1918 ............................................................................. 69
18.7.2. The 1918-19 Influenza Pandemic in Nigeria ........................................ 70
18.7.3. Influenza Pandemic - 1918................................................................... 70
18.8. FOURTH DISEASE (17TH CENTURY TO PRESENT) .............................................. 71
18.9. HEAD LICE IN THE MIDDLE AGES ..................................................................... 71
18.10. HEMORRHAGIC FEVER (1545 – 1576) ............................................................ 71
18.11. LEPROSY ...................................................................................................... 72
18.11.1. Leprosy in South America (19th Century) ............................................. 72
18.11.2. Leprosy in NY (2004) ........................................................................... 72
18.12. MEDIEVAL HOUSEHOLD PEST CONTROL .......................................................... 72
18.13. SCARLET FEVER EPIDEMICS (1848 –1900) ..................................................... 73
18.14. LYME DISEASE AND ERYTHEMA MIGRANS (1909 TO PRESENT).......................... 73
18.15. TICK-BORNE DISEASES (1889 TO PRESENT) ................................................... 73
18.16. TUBERCULOSIS .............................................................................................. 74
18.16.1. Gold Therapy For Tuberculosis (1920)................................................. 74
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18.16.2. History .................................................................................................. 74
18.17. TREATMENT .................................................................................................. 74
18.18. TYPHO-MALARIA DEBUNKED (19TH CENTURY) .................................................. 75
18.19. YELLOW FEVER AND POLITICS (1821 -1823 .................................................... 75
19. MESOPOTAMIA................................................................................................. 75
19.1. DENTAL DISEASE IN ANCIENT MESOPOTAMIA (2000 B.C.E.)............................. 75
19.2. HEBREW MEDICINE ........................................................................................ 76
20. MIDDLE AGES ................................................................................................... 76
20.1. DARK MIDDLE AGES (400-800 C.E.) .............................................................. 76
20.2. HIGH MIDDLE AGES (1200-1400) ................................................................... 77
20.3. PADUA: THE RENAISSANCE OF HUMAN ANATOMY AND MEDICINE ....................... 77
20.4. THE LATE MIDDLE AGES AND RENAISSANCE (1400-) ....................................... 77
20.5. MEDIEVAL MANUSCRIPTS (11TH TO 15TH CENTURIES) ........................................ 78
20.6. MEDIEVAL SPAIN (10TH AND 13TH CENTURIES)................................................ 78
21. MIDDLE-EASTERN MEDICINE ......................................................................... 78
21.1. SEREFEDDIN SABUNCUOGLU - TURKISH SURGEON (15TH CENTURY) .................. 79
22. NEPHROLOGY .................................................................................................. 79
22.1. HISTORY OF KIDNEY DISEASE (1ST CENTURY C.E.)........................................... 79
22.2. RICHARD BRIGHT (1789-1858)....................................................................... 79
22.3. HOMER SMITH FATHER OF NEPHROLOGY (1895 - 1962) .................................. 80
22.4. EMERICH ULLMANN - KIDNEY TRANSPLANTATION (1861-1937) ......................... 80
23. NEUROLOGY..................................................................................................... 80
23.1. BABINSKI ....................................................................................................... 80
23.1.1. Background .......................................................................................... 80
23.1.2. 100 Year Anniversary (1896-1996) ...................................................... 81
23.2. BRAIN SURGERY (LATE STONE AGE) ............................................................... 81
23.3. CAROTID ARTERY COMPRESSION (18TH CENTURY) ........................................... 82
23.4. EPILEPSY ...................................................................................................... 82
23.4.1. Electrical Theory (1873) ....................................................................... 82
23.4.2. Herodotus and Epilepsy ....................................................................... 82
23.4.3. Byzantine Emperor Michael IV (11th Century) ...................................... 83
23.4.4. Joan of Arc and Epilepsy...................................................................... 83
23.5. HEAD INJURY (1830)...................................................................................... 83
23.6. THE KNEE JERK (1875).................................................................................. 84
23.7. NERVE TRANSMISSION (1822) ........................................................................ 84
23.8. NEURONE DOCTRINE (1866) .......................................................................... 84
23.9. SEIZURE TREATMENTS (18TH CENTURY) .......................................................... 85
23.10. LLUIS BARRAQUER-ROVIRALTA (1907) ............................................................ 85
23.11. JEAN-BAPTISTE BOUILLAUD (1825) ................................................................. 86
23.12. DR. JULES COTARD (1840-1889) ................................................................... 86
23.13. SAMUEL COLLINS - COMPARATIVE NEUROLOGY (1618-1710) ........................... 86
23.14. HARVEY CUSHING - PEDIATRIC NEUROSURGEON (1869 - 1939) ....................... 87
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23.15. FREUD AND TOURETTE'S SYNDROME (1890 – 1911)........................................ 87
23.16. SIR VICTOR HORSLEY (1857 – 1916) - A PIONEER IN NEUROSURGERY ............ 88
23.17. WILLIAM WILLIAMS KEEN –NEUROSURGEON (1837-1932) ................................ 88
23.18. WILDER PENFIELD - SENSORY MAP................................................................. 88
23.19. ROBERT REMAK (1815-1865) – EMBRYOLOGIST/NEUROLOGIST ....................... 89
23.20. CHARLES SCOTT SHERRINGTON (1857-1952) - THE SYNAPSE ......................... 89
23.21. ROBERT BENTLEY TODD - FATHER OF EPILEPSY (1809-1860).......................... 90
23.22. THOMAS WILLIS (1621-1675) - FOUNDER OF MODERN CLINICAL NEUROSCIENCE
91
24. ONCOLOGY....................................................................................................... 91
24.1. EARLY REPORT OF CANCER IN A CHILD (1564-1617) ....................................... 91
24.2. ROSWELL PARK, M.D. (1852-1914) ............................................................... 91
25. ORTHOPEDICS ................................................................................................. 91
25.1. OSTEOGENESIS IMPERFECTA (1844-1849)...................................................... 92
26. PATHOLOGY ..................................................................................................... 92
26.1. FORENSIC ENTOMOLOGY (13TH CENTURY TO PRESENT).................................... 92
26.2. "JAKE WALK" - A TOXICOLOGICAL TRAGEDY (1930)......................................... 93
26.3. LEAD EXPOSURE (ANCIENT TO MODERN TIMES ................................................ 93
26.4. LEAD POISONING KILLED THE CREW OF THE FRANKLIN EXPEDITION? (1845)...... 93
26.5. VEGETABLE POISONS AND DEATH (1812) ........................................................ 94
26.6. TOBACCO’S HARMFUL EFFECTS IN HISTORY (10444 - 1600S) .......................... 94
26.7. RUDOLF VIRCHOW (821 – 1902) .................................................................... 95
26.8. RUSSIAN MEDICINE (18TH CENTURY) ............................................................... 95
27. PSYCHIATRY..................................................................................................... 95
27.1. AMNESIA (1892) ............................................................................................ 95
27.2. BIPOLAR DISORDERS (100 C.E.) .................................................................... 96
27.3. MENTAL ILLNESS (19TH CENTURY)................................................................... 96
27.4. RORSCHACH TEST (1884-1922)..................................................................... 96
27.5. SCHIZOPHRENIA (1911) ................................................................................. 97
28. SURGERY.......................................................................................................... 97
28.1. BRAIN SURGERY (7,000 B.C.E. – 900 C.E._.................................................. 97
28.2. CATARACT SURGERY (5TH CENTURY B.C.E.)................................................... 97
28.3. LAPAROSCOPIC SURGERY (1901 TO PRESENT)................................................ 98
29. VACCINES ......................................................................................................... 99
29.1. FIRST GLOBAL VACCINATION OCCURRED IN 1803 ............................................ 99
29.2. EMIL VON BEHRING – (1854-1917) – DIPTHERIA AND TETANUS ........................ 99
29.3. SMALL POX ................................................................................................... 99
29.3.1. Canadian Experience (1798 – 1962).................................................... 99
29.3.2. Vaccination in 1830's - Maybe We Should Take Note........................ 100
29.3.3. Vaccination - How Long Does It Last? ............................................... 100
30. WARS............................................................................................................... 100
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30.1. ILIAD (8TH CENTURY B.C.E.) ......................................................................... 100
30.1.1. Battlefield Exacerbated Dysentery ..................................................... 100
30.1.2. Wound Management .......................................................................... 101
30.2. US CIVIL WAR............................................................................................. 101
30.2.1. Lack of Medical Care - Major Cause of Death.................................... 101
30.2.2. The Hospital Ship (1862).................................................................... 102
31. WOMEN IN MEDICINE .................................................................................... 102
31.1. AGNODICE – A WOMEN DOCTOR IN ANCIENT GREECE.................................... 102
31.2. CLARA BARTON - FLORENCE NIGHTINGALE (1823-1912)................................ 102
31.3. MARY ANN BICKERDYKE - WOMAN HEALER IN THE CIVIL WAR (1817-1901) .... 103
31.4. DORCAS HAGER PADGET - MEDICAL ILLUSTRATOR (1906-1973) .................... 103
31.5. DOROTHY REED - HODGKIN'S DISEASE (1902) .............................................. 103
31.6. MARY GRANT SEACOLE - JAMAICAN MEDICINE WOMAN (19TH CENTURY) ......... 104
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1. ALTERNATIVE MEDICINE
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reduced longevity and poor sexual appetite/low virility. Chocolate paste was also a
medium used to administer drugs and to counter the taste of bitter pharmacological
additives. In addition to cacao beans, preparations of cacao bark, oil (cacao butter),
leaves and flowers have been used to treat burns, bowel dysfunction, cuts and skin
irritations.
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ulcers, sore throats, insomnia, abdominal pain, bronchitis, blood cleanser, herpes,
abscesses, food poisoning, treatment of cancer, and for the support the adrenal
glands during stress. Licorice is the most heavily used herb in China and is the
number one herbal "drug" in the world.
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gums, purify and perfume the breath and beautify and preserve the teeth from youth
to old age." Early dental researchers found that this remedy contained harsh
ingredients (such as acid, sharp abrasives and astringents) which could destroy
tooth substance. Mrs. Winslow's Soothing Syrup, an extremely popular dental
nostrum, was intended to quiet a fretful child during the teething process. However,
it contained generous levels of alcohol and morphine sulfate which could cause
coma, addiction or death. These two products were eventually removed from the
market in the 1930s.
2. ANCIENT EGYPT
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Egyptian physician normally spent years of arduous training at temple schools in the
arts of interrogation, inspection, and palpation (examining the body by touch).
Prescriptions contained some drugs that have continued in use through the
centuries. Favorite laxatives were figs, dates, and castor oil. Tannic acid, derived
principally from the acacia nut, was valued in the treatment of burns. According to
reports of the Greek historian Herodotus, the ancient Egyptians recognized dentistry
as an important surgical specialty.
2.6. Tuberculosis
Sir Marc Armand Ruffer, Professor of Bacteriology at Cairo Medical School in the
early 1900's, reported the presence of tuberculosis (Pott's disease) of the spine in
Nesparehan, a priest of Amun of the 21st Dynasty. The spine shows the typical
features of Pott's disease with collapse of thoracic vertebra, producing the angular
kyphosis (hump-back). A well known complication of Pott's disease is the
tuberculous suppuration moving downward under the psoas major muscle, towards
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the right iliac fossa, forming a very large psoas abscess. Ruffer's report has
remained the best authenticated case of spinal tuberculosis from ancient Egypt. All
known possible cases, ranging from the Predynastic to 21st Dynasty are
predynastic specimens collected at Naqada by Petrie and Quibell in 1895, as well
as nine Nubian Specimens from the Royal College of Surgeons of England. There is
very little doubt that tuberculosis was the cause of pathology in most, but not all,
cases. In some cases, it was not possible to exclude compression fractures,
osteomyelitis, or bone cysts as causes of death.
3. ANCIENT GREECE
3.1. Medicine
Ancient medicine integrated three components: experience (empirical observation),
religion/magic and speculations of natural philosophers. In contrast, Greek medicine
began to investigate the true causes of health and diseases, thus laying foundations
for diagnosis, prognosis and treatment. Hippocrates made a synthesis of existing
philosophical opinions from the point of view of a physician. His 58 writings were
preserved in the collection "Corpus Hippocraticum". The most relevant writing in it,
"Peri fyseos anthropu" (On the nature of man), is ascribed to Hippocrates' son-in-
law Polybos who developed the ancient humoral-pathological theory. In explaining
the human organism and its processes, Polybos integrated ancient teachings on
four basic humors (humoral theory), elements and qualities with observations of
manifestations of health and disease. Normal condition (health) was defined as
balance between the body fluids (eukrasia) and external environment. If this balance
was disturbed, the result was dyskrasia, i.e. disease studied by pathology.
According to Hippocrates, disease causes could be understood only through
empirical study, and that while man has the power to overcome disease, the right
diet is necessary to keep harmony in body fluids of an organism. The role of a
physician was just to support the nature. "Prognosis", another writing included in
"Corpus Hippocraticum", reflected Hippocrates' understanding of prognosis as a
necessary development of diagnosis based on past knowledge (anamnesis) and
present observation.
3.2. Remedies
A large number of remedies, known as "pharmaca" in Greek, which are currently
used in medical practice have been traced back to the Hellenic period.
Archeological data, as well as literary and scientific texts, suggest that the ancient
Greek physicians knew how to use many remedies from herbs, plants, metals and
minerals, and animals. These remedies were given orally in liquid form (katapotia in
Greek), in poultice form, or in the form of ointments and eye-drops (collyria). The
main problem of ancient pharmacology was that chemistry had not yet become a
science so that it was difficult to distinguish the individual effects of each of the
substances. However, especially during the classical period (6th-4th century B.C.E.)
and from the end of the Hellenic period and thereafter, remedies were presented
clearly and in detail in prescriptions, giving medicine a more scientific profile of their
workings.
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3.3. Aristotle (384 - 322 B.C.E.)
Aristotle was born in 384 B.C.E. He was the son of a physician at Stageira in
Macedonia, and was one of the most noted philosophers and scientists of the
ancient world. Once a student of Plato at his Academy in Athens, Aristotle adopted
his own methods of inquiry different from that of his teacher. Unlike Plato, Aristotle
felt that one could, and in fact must, trust one's senses in the investigation of
knowledge and reality. Aristotle's writings cover a wide variety of subjects, from
human and animal anatomy, to metaphysics, statesmanship, and poetry. His
treatises on human anatomy are lost, but his many works on animals advocate
direct observation and anatomical comparisons between species through dissection.
He wrote extensively on the soul, classifying the souls of different forms of life and
inanimate objects, including the earth and the heavens. Aristotle wrote extensively
on animal life and reproduction, making him in many ways the founder of Western
natural philosophy. Aristotle died in 322 B.C.E.
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3.6. Dioscorides of Anazarbus- Father of Pharmacology (40-90 C.E.)
Dioscorides of Anazarbus was a Greek physician born in southeast Asia Minor in
the Roman Empire in the first few decades of Common Era (CUE.). During his
lifetime, Dioscorides traveled extensively seeking medicinal substances from all
over the Roman and Greek world. He benefited greatly from the ease of travel
across wide stretches of territory under the control of the Roman Empire at the
height of its growth. Between about 50-70 C.E., he wrote his fundamental work,
known in Latin as De materia medica. This five book study focused upon "the
preparation, properties, and testing of drugs" and became the most central
pharmacological work in Europe and the Middle East for the next sixteen centuries.
As was the case with many Greek medical texts, De materia medica was treated as
dogma for many years. By the mid-16th century, however, his message that
investigation and experimentation were crucial to pharmacology began to emerge
and modern research into medicines began.
3.8.1. Report 1
Galen was a Greek physician who was born in Pergamum in Asia Minor. Galen
began to study medicine at the age of 16, and at 20 went to Alexandria. He became
a surgeon to the gladiators at Pergamum at the age of 30, and after four years he
went to Rome in 162 as the physician to the court of the Emperor Marcus Aurelius.
After returning to Pergamum for three years, he went back to Rome in 169 C.E. and
stayed there for the last 30 years of his life. Besides dealing with clinical problems
and treatment, Galen studied anatomy, physiology, and pharmacology. He is
especially known for his anatomical studies and his scientific methods. He studied
the work of Erasistratus (c. 290 B.C.E.) and Herophilus (300 B.C.E.), and dissected
both the Barbary ape and pigs. Galen established that the arteries contain blood
and not air, as had been taught by Aristotle. He did not, however, understand the
circulation of the blood, but thought that it flowed to and fro like the tides, with the
arterial surges being quite separate from those in the veins. His teaching was
accepted as authoritative by the Church. He did not recognize the healing force
which Hippocrates (c. 410 B.C.E.) had attributed to nature. However, he insisted
that the varying symptoms of diseases should be studied and individually treated,
with the treatment depending upon the organs affected by the disease. Galen wrote
17
more than 400 books, of which about 100 are now known. His work remained
virtually unchallenged until the more critical Renascence period.
3.8.2. Report 2
Galen was born in Pergamos in Asia Minor in the year 131 C.E. (common era). After
receiving medical training in Smyrna and Alexandria, he gained fame as a surgeon
to the gladiators of Pergamos. He was eventually summoned to Rome to be the
physician of the Emperor Marcus Aurelius. Galen spent the rest of his life at the
Court writing an enormous corpus of medical works until his death in 201 C.E.
Taking Hippocrates notions of the humors and pathology, Galen incorporated the
anatomical knowledge of noted Alexandrians such as Herophilus of Chalcedon
(335-280 B.C.E.). A supporter of observation and reasoning, he was one of the first
experimental physiologists, researching the function of the kidneys and the spinal
cord in controlled experiments. Galens works in many ways came to symbolize
Greek medicine to the medical scholars of Europe and the Middle East for the next
fifteen centuries. While his message of observation and experimentation were
largely lost, his theories became dogma throughout the West. In the mid-16th
century, his message that observation and investigation were required, allowed for
modern methods of research to finally come into place.
3.8.3. Report 3
Galen hailed from Pergamon, an ancient Roman center of civilization which
contained a library second in importance only to Alexandria. Galen's training was
eclectic and although his chief work was in biology and medicine, he was also
known as a philosopher and philologist. Training in philosophy was, in Galen's view,
not merely a pleasant addition to, but an essential part of the training of a doctor.
His treatise entitled "That the Best Doctor is also a Philosopher" provides a rather
surprising ethical reason for a doctor to study philosophy. The profit motive, says
Galen, is incompatible with a serious devotion to the art. Galen felt that a doctor
must learn to despise money and he often accused his colleagues of avarice.
Galen's first professional appointment was as surgeon to the gladiators in
Pergamon. In his tenure as surgeon, he gained much experience and practical
knowledge in anatomy from the combat wounds he was compelled to treat. After
four years he immigrated to Rome where he attained a brilliant reputation as a
practitioner and a public demonstrator of anatomy. Among his patients were the
emperors Marcus Aurelius, Lucius Verus, Commodus and Septimius Severus.
3.9.1. Topic 1
Hippocrates of Cos was a Greek physician who lived around the 5th and 4th
centuries B.C. Although he believed that "humors" and "foul vapors" caused
disease, many of his teachings are consistent with modern medicine. Hippocrates
believed that nature healed all wounds and the physician was a modifier of that
natural healing. He taught that medications could produce a countereffect to the
symptoms of a disease, "opposite through opposite". Although public opinion during
18
his time condemned dissections of the human body, Hippocrates did perform them
to a limited extent. He also emphasized the observation of external signs and
symptoms in establishing diagnoses. In addition, Hippocrates dealt well with
fractures and was a master in the use of splints. He even treated fractures of the
skull with trepanning (removing a circular area of bone) and urged his students to be
careful not to mistake suture lines for fractures. Most of all, Hippocrates was a good
observer. This can best be demonstrated by his "Aphorisms" or his advice to
physicians.
3.9.2. Topic 2
It was in the 5th century B.C.E. that Hippocrates name and image began to emerge
as a leader in medical research and thought. Hippocrates is generally credited with
turning away from divine notions of medicine and using observation of the body as a
basis for medical knowledge. Prayers and sacrifices to the gods did not hold a
central place in his theories, but changes in diet, beneficial drugs, and keeping the
body "in balance" were the key. Central to his physiology and ideas on illness was
the humoral theory of health, whereby the four bodily fluids, or humors, of blood,
phlegm, yellow bile, and black bile needed to be kept in balance. Illness was caused
when these fluids became out of balance, sometimes requiring the reduction in the
body of a humor through bloodletting or purging. The Hippocratic Corpus, or the
collected writings attributed to Hippocrates, contains about sixty works on a variety
of medical topics, including diagnosis, epidemics, obstetrics, pediatrics, nutrition,
and surgery.
4. ANCIENT ROME
19
could not be buried until the child had been removed. The law also stipulated that a
Caesarean section could not be performed on a living pregnant woman until the
tenth month of gestation. Ancient physicians were unable to save the life of the
mother in such cases, thus the procedure was rarely performed. We know from
ancient sources that Julius Caesar could not have been born by Caesarean section,
because his mother, Aurelia, lived to be an adviser to her grown son.
20
practice, even into modern times. Spontaneous recovery of some forms of epilepsy
may be responsible for the illusion of therapeutic effectiveness and for the
confirming statements by physicians who have commented on this cure.
5. ANCIENT WORLD
5.2. Diseases
The unique conditions of preservation of the Copper age mummy found in the Val
Senales glacier (Italy) has allowed the analysis of the general state of health of a
man of the late European prehistory. Investigations conducted within the
organizational framework of an International Research Project revealed the
presence of a series of alterations, that, in a broad sense, can be considered of
paleopathological interest. These can be classified as: 1) post mortem lesions such
as scalp erosions, alopecias (balding), soft tissue loss in the right gluteal region,
joint dislocations; 2) lesions that occurred during life such tattooings, dental wear,
trichorrexis nodosa (bamboo hair), nail hypoplasia, moderate osteoarthritis of the
lumbar vertebral column and of the hip joints, and ankle osteosclerosis. The
palaeopathological analysis of this unique mummy has shed vivid light on the
mutual interactions between disease, environment, and culture, that shaped human
life in a distant past.
5.3. Gases
Ancient historical references consistently describe an intoxicating gas, produced by
a cavern in the ground, as the source of the power at the oracle of Delphi. These
ancient writings are supported by a series of associated geological findings.
Chemical analysis of the spring waters and travertine deposits at Delphi show the
presence of methane, ethane, and ethylene. The effects of inhaling ethylene, a
major anesthetic gas in the mid-20th century, are similar to those described in the
ancient writings. It is believed that the probable cause of the trancelike state of the
21
Priestess (the Pythia) at the oracle of Delphi, during her mantic sessions, was a
result of inhaling ethylene gas or a mixture of ethylene and ethane from a naturally
occurring geological vent.
5.4. History
In ancient Egypt by the 3rd Dynasty, the physician emerged as an early form of
scientist. The Egyptians practiced embalming but their anatomical knowledge
remained at a low level and they attempted only minor surgical procedures. In
Assyria and Babylonia, the liver was considered the seat of the soul and was
studied to determine the intentions of the gods. Hebrew medicine was influenced by
the Old Testament and emphasized hygienic regulations, midwifery, feminine
hygiene, separation of the sick, and disinfection of materials capable of harboring
and transmitting germs. Ancient Hindu medicine became quite sophisticated,
especially in the field of operative surgery. Ancient Chinese medicine utilized
acupuncture and a wide array of drugs, including opium.
22
observed in any contemporary Europeans, raising the possibility of a lack of
continuity between the mesolithic and present-day European gene pools.
6.2. I Got Rhythm: George Gershwin and Birth Control in the 1930s
Gershwin's song 'I Got Rhythm' serves as a backdrop representing the social
context of the inter-war years. On center stage is a particular aspect of the history of
birth control - the application of a new theory of ovulation to contraception. Starting
in 1928, a series of experiments revealed a biochemical rhythm in the female
23
reproductive cycle, which contradicted the widespread idea that ovulation and
pregnancy could occur at any time. This discovery was applied to a new
contraceptive method, the rhythm method, which enjoyed significant popularity
during the 1930s, especially among Catholics. For a short period, women could join
Ethel Merman in the refrain 'I got rhythm, I got my man, who could ask for anything
more.' Unfortunately, the rhythm method has not lived up to its promise.
24
6.6. Sleep Apnea - Lewis Carroll and William Shakespeare
Both Lewis Carroll and William Shakespeare appear to have made clinical
observations of sleep apnea syndromes. Long before these syndromes were
discovered by medical science, these great authors seem to have understood
something about their physiological mechanisms. The somnolent dormouse in Alice
in Wonderland indicates that his problem is one of sleep and breathing and would
be subject to modern treatment for obstructive apnea. Shakespeare, in Henry IV,
presents a case of obstructive apnea along with a case of Cheyne-Stokes breathing
and uses the plot of these history plays to explain by analogy the theoretical basis
for periodic breathing.
7. BASIC SCIENCE
25
7.3. Anton van Leeuwenhoek (1632-1723)
Anton van Leeuwenhoek (1632-1723) was an unlikely scientist. A tradesman of
Delft, Holland, he came from a family of tradesmen, had no fortune, received no
higher education or university degrees, and knew no languages other than his
native Dutch. This would have been enough to exclude him from the scientific
community of his time completely. Yet with skill, diligence, endless curiosity, and an
open mind free of the scientific dogma of his day, Leeuwenhoek succeeded in
making some of the most important discoveries in the history of biology. It was he
who discovered bacteria, free-living and parasitic microscopic protists, sperm cells,
blood cells, microscopic nematodes and rotifers, and much more. His researches,
which were widely circulated, opened up an entire world of microscopic life to the
awareness of scientists. At some time before 1668, Anton van Leeuwenhoek
learned to grind lenses, made simple microscopes, and began observing with them.
He seems to have been inspired to take up microscopy by having seen a copy of
Robert Hooke's (1635-1703) illustrated book Micrographia, which depicted Hooke's
own observations with the microscope and was very popular. Leeuwenhoek is
known to have made over 500 "microscopes," of which fewer than ten have survived
to the present day.
8. CARDIOLOGY
26
The third part of Tetralogy of Fallot involves the aorta being positioned over the
ventricular septal defect instead of in the left ventricle. Finally, the right ventricle in
infants born with Tetralogy of Fallot is more muscular than normal. The chronicle of
tetralogy of Fallot is part of a dramatic evolution in cardiology, cardiac surgery, and
understanding of the developing heart. Many new tools and concepts have evolved
since Steno of Denmark first described the defect in 1673, and since Fallot of
Marseilles coined the term tetralogy in 1888. Four major eras of progress can be
recognized. The 1st, the era of pathologic anatomy, culminated in the publication of
Maude Abbott's Atlas of Congenital Cardiac Disease in 1936. The next, the era of
clinicophysiology and surgery, was highlighted by the 1st Blalock-Taussig
anastomosis in 1944, by open-heart surgery 10 years later, and by a new team
approach to cardiology. The 3rd, or infant era, began in the mid 1970s with
successful intracardiac repair in infants, the rise of echocardiography, and the
introduction of prostaglandin therapy. The current era of cardiac development
(beginning in the 1990s) gives hope for early understanding of the molecular basis
of tetralogy. Tribute is due to the surgical and medical pioneers, and to the pioneer
patients and their families, for revolutionary changes in diagnosis and treatment.
The challenge of the next 100 years lies in increased understanding of the
molecular biology of the defect and in preserving the blend of humanism,
scholarship, and skill that have graced the advances of the past 3 centuries.
8.3. William Harvey (1578 – 1657) - Cardiac Output and the Hour Glass
In 1636, the Rostock (Germany) professor of medicine and the art of poetry, Peter
Lauremberg (1585-1639), was one of the earliest to cite the concept of blood
circulation, which had been discovered by William Harvey. In 1628 William Harvey
proved the existence of blood circulation by calculating the "cardiac output in a half
an hour (semihora)". The answer to the question why Harvey chose half an hour as
the time range can be found in the way of measuring time at that period. The
sandglasses were turned half-hourly in maritime navigation and the wheel-clocks on
shore had only the hour-hand. Improved chronometry was one of the prerequisites
for measuring cardiac output. The minute-hand became usual after 1700 and the
second-hand shortly thereafter. Taking into consideration the alterations of cardiac
output, being able to measure seconds was one of the most important discoveries
for cardiac diagnosis, prognosis and therapeutics.
27
renal disease, and the neglect of his contribution probably resulted from his early
death.
28
atrium consequent on distension or reflux of blood irritating the atrial wall. De Senac
also commented on disconcerted action and rippling of the ventricular wall before
final cessation of movement in a dying heart (ventricular fibrillation). De Senac's
ideas were a century and a half ahead of his time.
9. DENTISTRY
29
have been fastened together (juncti) with gold" could be so buried. It was illegal in
all other cases to bury gold with a corpse.
30
9.5. Periodontal Disease
9.5.2. History
Periodontal (gum) diseases are considered as old as the history of mankind.
Magical, religious and herbal treatments were demonstrated in almost all early
writings. However, methodical, carefully reasoned therapeutic approaches did not
exist until the middle-ages, and modern treatment with a scientific base and
sophisticated instrumentation did not develop until the 18th century. Prior to the
1950s, periodontal diseases were mostly treated by root debridement and the
extraction of the affected teeth. Until the 1970s, it was primarily the symptoms of
periodontal diseases that were treated. The goal was radical elimination of the
periodontal pocket (resective therapy). The means were gingivectomy, flap
procedures and osseous surgery. The disadvantages were the massive sacrifice of
periodontal tissues, lack of regeneration and clinically elongated teeth. These
disadvantages, along with the realization of the importance of causative agents,
raised questions about the necessity of total pocket elimination, and the control of
subgingival infection by a thorough scaling and root planing (nonsurgical therapy).
Scaling and root planing, with and without antibiotics, became the most commonly
used treatment during the 1980s. Comparative longitudinal studies, surgical versus
nonsurgical, demonstrated that both surgical and nonsurgical therapy result in
limited regeneration and healing with a long junctional epithelium.
31
gold wire. With the fall of the Roman Empire, the evolution and development of
toothpaste became less clear and little is known of any changes until 1000 C.E.
During these times, evidence shows the Persians further developed toothpaste.
According to writings, advice was given on the dangers of using hard toothpowders
and recommendations were made to make toothpowder from burnt hartshorn, the
burnt shells of snails and oysters and burned gypsum. Other Persian recipes
included dried animal parts, herbs, honey and minerals. One formula for
strengthening teeth included green lead, verdigris, incense, honey and powdered
flintstone.
9.7. Toothworm
The concept of a toothworm, which according to popular belief, caused caries and
periodontitis, has existed in diverse cultures and across the ages. During the
Enlightenment, however, the theory of the toothworm was assigned by medical
doctors almost exclusively to superstition. Even so, the idea that toothache was
caused by gnawing worms held on even into this century. There were many different
ideas with regard to the appearance of toothworms. In England, for instance, it was
thought that the toothworm looked like an eel. In Northern Germany, people
supposed the toothworm to be red, blue, and gray and in many cases the worm was
compared to a maggot. The gnawing worm was held responsible for many evils and,
in particular, was blamed for toothache provoked by caries. In popular medicine,
numerous therapies were applied in order to eradicate the toothworm. In addition to
the fumigations with henbane seeds, which allowed the toothworm to develop in the
form of burst seeds, there were also magical formulas and oaths.
10. DERMATOLOGY
11. DISCOVERIES
32
bacteria. In 1887, Rudolf Emmerich showed that the intestinal infection cholera was
prevented in animals that had been previously infected with the streptococcus
bacterium and then injected with the cholera bacillus. While these experiments
showed that bacteria could treat disease, it was not until a year later, in 1888, that
the German scientist E. de Freudenreich isolated an actual product from a
bacterium that had antibacterial properties. Freudenreich found that the blue
pigment released in culture by the bacterium Bacillus pyocyaneus arrested the
growth of other bacteria in the cell culture. Experimental results showed that
pyocyanase, the product isolated from B. pyocyaneus, could kill a multitude of
disease-causing bacteria. While pyocyanase while the first antibiotc discovered, it
unfortunately proved toxic and unstable, and could not be developed into an
effective drug.
33
11.4. Chemistry and Medicine (19th Century)
Chemical research by certain physicians in Britain in the early 19th century occurred
in the context of medical traditions founded on vitalism, distillation analysis, and
limited chemical knowledge. Urine chemistry figured prominently in this period
together with the analysis of kidney and bladder stones. Richard Bright's team
studying albuminuria was the first clinical research school in Britain. William Prout's
survey of physiological chemistry, based on meticulous attention to analysis, was
the best summary of human metabolism before Justus Liebig's Animal Chemistry.
Liebig's ideas influenced all physicians who were interested in chemistry. Henry
Bence Jones based his medical practice on Liebig's theories. His research relating
urinary phosphates to diet and exercise revealed the so-called Bence Jones
proteins and investigated the distribution and persistence of drugs in the body.
J.L.W. Thudichum used analytical skills learned from Liebig in his brain chemistry
work. George Owen Rees investigated the composition of urine and the relationship
between urine and blood, using Liebig's practical methods. These and similar
studies showed that chemistry could improve clinical medicine, and that chemistry
could also reveal the onset of disease even before clinical symptoms developed,
thus offering valuable support to preventive medicine. Interestingly, so many
physicians resisted the introduction of chemistry that progress toward the
establishment of clinical chemistry in nineteenth-century Britain was slow.
34
modern controversy about the management of gunshot wounds. The "tug of war"
between excision and incision, dramatic as it sounds, is not based on the clinical
reality. These are two different procedures with two different indications. The
orthodox doctrine, inherited from military surgeons, consists of aggressive tissue
excision around the bullet track. This radical policy is being challenged by advocates
of a more conservative approach. Minimal tissue excision is sufficient and safe in
many cases, provided careful monitoring of the wound is instituted. Wound incision
alone to relieve tension and allow drainage is possible in certain cases. Surgical
debridement may be very extensive such as in fasciatus, or moderate such as in
burns or minimal such as abrasion and open fractures.
35
year he was ridiculed and criticized in scientific journals, and by leading
obstetricians in Europe. In 1861, Semmelweis published his principal work, The
Cause, Concept and Prophylaxis of Childbed Fever, in which he carefully explained
how handwashing by doctors would save thousands of lives every year. After years
of attempting to persuade other physicians to follow his ideas Semmelweis was
admitted to a mental hospital in Vienna in August of 1865, after suffering a mental
breakdown, and died shortly thereafter. Today, Semmelweis is hailed as a hero, the
"Savior of mothers". But we must never forget how long and hard he had to fight for
his ideas, because they were not part of the "accepted" science of his day.
11.9. Opioids
36
codeine. Ethylmorphine was the first semi-synthetic morphine derivative to be
introduced into the clinic and probably influenced the subsequent decision of F
Bayer & Co to introduce heroin for similar clinical purposes.
37
development of penicillin represent one of the most important developments in the
annals of medical history.
12. DISEASES
38
directed by Giovanni Bizio, one of the first chemists who graduated at Padua
University. By 1863, chemical analyses were commonly carried out in Venice as in
the other parts of Habsburg empire.
39
possible by using magnetic resonance cholangiopancreatography and cytological
diagnosis of the pancreatic juice.
40
poultices, or by using special instruments and apparatus. Among the documented
diseases were otitis, rupture of the eardrum, hemorrhage from the ears, deficiency
of hearing and deafness, vertigo, tinnitus, and earwax. Furthermore, based on early
Byzantine texts, surgical techniques are described for cases of atresia of the
external auditory canal, for defects in or lack of the pinna, and for removal of foreign
bodies and fleshy tumors. Some of the earliest hearing aids were also identified.
Based on original works of Byzantine writers, it is evident that numerous treatments
and surgical techniques relating to otology were practiced. These were derived not
only from compilation of knowledge obtained from the ancient Greek medical
sources, a considerable part of which are now lost, but also enriched by Byzantine
physicians' personal experience. This knowledge influenced medieval European
medicine and, through it, that of the rest of the world.
12.11. Heart
41
12.11.1. History
In human historical thought, the heart was not always considered part of the blood
circulating system. It was only included as a suction pump when Harvey argued that
the heart is actually a compression pump, the central organ of the circulation, and
the only organ responsible for the motion of blood. While the heart was considered
initially as an autonomous pump, it gradually became viewed as subservient to the
needs of the peripheral organs it perfused. Constant properties assigned to the
heart had to be replaced, one after another, by adjustable parameters. Even the
adequacy of the heart as the sole pump has been doubted, an issue that is still
present today.
42
ventricle, the hippocampus, and the central parts of the cerebellum. While the
contribution of Orth was limited to this single case report, in 1903 Christian Schmorl
presented the results of his autopsies of 120 jaundiced infants to the German
Society for Pathology. All of these infants' brains were jaundiced, but only 6 cases
demonstrated a staining phenomenon similar to that previously described by Orth.
Schmorl coined the term kernicterus (jaundice of the basal ganglia) for this staining
pattern.
12.14. Malaria
43
parasites was also formulated independently in 1898 by W. G. MacCallum working
in the United States on Halteridium, a hematozoan infecting crows.
44
12.16. Pellagra
45
reported to be a member of the B-group of vitamins. In October 1937, a researcher
at the University of Wisconsin identified nicotinic acid (niacin) as the curative factor
for pellagra. See: Goldberger, Joseph and G.A. Wheeler. The Experimental
Production of Pellagra in Human Subjects by Means of Diet. Washington:
Government Printing Office, 1920. (Hygienic Laboratory Bulletin)
12.19.1. Background
Scurvy, a disease of dietary deficiency of vitamin C, is uncommon today. However,
among diseases, scurvy has a rich history and an ancient past. The Renaissance
period (14th to 16th centuries) witnessed several epidemics of scurvy among sea
voyagers. In 1747, James Lind, a British Naval surgeon, performed a carefully
designed clinical trial and concluded that oranges, lemons and limes had the most
antiscorbutic effect. Eventually, with the provision of lemon juice and lime juice to
the sea voyagers, scurvy became rare at sea. Infantile scurvy appeared almost as a
new disease toward the end of the 19th century and has been attributed to the
usage of heated milk and proprietary foods. Thomas Barlow described the classic
clinical and pathologic features of infantile scurvy in 1883. Between 1907 and 1912,
Holst and Frolich induced and cured scurvy in guinea pigs by dietary modification. In
1914, Alfred Hess established that pasteurization reduced the antiscorbutic value of
milk and recommended supplementation of fresh fruit and vegetable juices to
46
prevent scurvy. Such pioneering efforts led to the eradication of infantile scurvy in
the United States.
47
doctor's office, or in general hospitals. This pattern may be partly attributed to the
fact that both patients and doctors were focusing on symptoms of self-starvation like
emaciation, constipation, and amenorrhea, which were primarily interpreted as
referring to somatic diseases. Additionally, wealthy families probably preferred
private care in water-cure establishments, sanatoria, and rest homes to the
stigmatizing referral of their anorectic child to an asylum. Hence, the fact that late
19th-century institutionalized psychiatry was only incidentally confronted with
anorexia nervosa may explain its lack of interest in the emerging syndrome.
48
excavations revealed the site of several latrines. Examination of their sedimented
faecal remains showed that two nematode parasites--ascaris and trichinella--were
particularly widespread. Also found were many well preserved taenia eggs. In some
of the specimens, the characteristic hooks that allow these tapeworms to fix
themselves on the intestinal wall were still distinguishable. Taeniasis was doubtless
caused by the consumption of insufficiently grilled meat, favoured by the nobility.
Another parasite that infested the king's court was Fasciola hepatica, probably
present in watercress and dandelion. Records testify that watercress was
fashionable and was brought from Cailly, in Normandy, and from Orleans. To this
day, Fasciola hepatica parasitosis has not been eradicated in France.
13.4. King George III and Acute Intermittent Porphyria (1739 – 1820)
Porphyria is a group of different disorders caused by abnormalities in the chemical
steps leading to the production of heme. King George III, King of England during the
American revolution, was afflicted by acute intermittent porphyria, a hereditary
metabolic disorder. The symptoms of this rare hereditary disease include paralysis,
high blood pressure agonizing abdominal pain, manic overactivity, skin rash, red
urine, delirium and psychosis. King George’s porphyria also most likely exacerbated
his metabolic disorders, accentuating his hostilities towards the colonies. The king
played a part in the complex political maneuverings that resulted in the arrival of
William Pitt the Younger as prime minister in 1783. Political stability continued until
autumn 1788, when George III fell ill with acute intermittent porphyria. In 1810,
George suffered a final decline in his mental health and became blind and deaf. He
suffered from short-term memory loss as well as senile dementia. By 1817, George,
now very old and thin, could no longer walk. His only amusements were eating
cherry tarts and striking the keys of his harpsichord. He was often in tears and
sometimes laughed wildly. George had another violent outburst at Christmas 1819,
49
when he talked continually. Then he began to refuse food and grew weaker. He died
on 29 January 1820, at age 81
14. ENDOCRINOLOGY
50
responsible for the lowering of pitch of the male voice during puberty. From the late
16th century, castration was carried out in Italy to preserve the unbroken male voice
into adult life, but the high pitch was accompanied by fully grown resonating
chambers and a large thoracic capacity, giving rise to the unique voice of the
castrato. The initial stimulus for the production of castrati came from the Sistine
Chapel in Rome, to provide singers for the complex church music of the time. The
second reason was the coming of opera to Italy at the beginning of the 17th century.
Boys were castrated between the ages of 7 and 9 years, and underwent a long
period of voice training. A small number became international opera stars, of whom
the most famous was Farinelli, whose voice ranged over three octaves. By the end
of the 18th century, fashions in opera had changed so that the castrati declined
except in the Vatican, where the Sistine Chapel continued to employ castrati until
1903. The last of the castrati was Alessandro Moreschi, who died in 1924 and made
gramophone recordings that provide the only direct evidence of a castrato's singing
voice.
51
operations on the thyroid, parathyroids, and pituitary. Notable advances followed
adequate resection of thyroid tissue and the use of iodine and antithyroid drugs
before operation for toxic goiter. The use of cortisone rendered adrenalectomy safe
for the relief of cancer of the breast and prostate and of Cushing's syndrome. For
about 40 years, increasing numbers of surgeons have specialized in endocrine
surgery as a discipline within general surgery, and results of treatment have
improved greatly.
52
anatomy, carried out by dissection of the normal human body as part of medical
education. This revitalization is epitomized by the De Humani Corporis Fabrica,
(1543) of Andreas Vesalius, Professor of Anatomy and Surgery at Padua.
15.4. Henry Ingersoll Bowditch (1808-1892) and Oliver Wendell Holmes (1809-
1894)
Two Bostonians, Henry Ingersoll Bowditch (1808-1892) and Oliver Wendell Holmes
(1809-1894), went to Paris for advanced medical training. They came home ardent
disciples of Pierre Charles Alexandre Louis, leader of the French school that derived
its eminence from expert auscultation and careful correlation of bedside and
autopsy findings. Both Bowditch and Holmes became leaders in 19th-century
American medicine. Bowditch, a successful practitioner and prolific medical writer,
wrote the first important American text on physical examination and became
America's first specialist in pulmonary disease. He pioneered in the public health
movement, was a charter member and later president of the American Medical
Association, and was an abolitionist and an advocate for equal rights for women in
medicine. Holmes left practice to become a medical educator. As Dean of Harvard
Medical School, he tried unsuccessfully to admit white women and free black men to
the school. Although his greatest fame came as a man of letters, Holmes
considered himself first a physician and medical educator, and was justifiably proud
of his definitive study, "The Contagiousness of Puerperal Fever" (1843).
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15.7. Joseph Lister (1827 – 1912)
15.7.1. Report 1
Joseph Lister is one of the pioneers of Infection Control. Not only did he reduce the
incidence of wound infection (usually fatal pre-Lister) by the introduction of
antiseptic surgery using carbolic acid, but also he was the first to apply Pasteur's
principles to humans. He showed that urine could be kept sterile after boiling in
swan-necked flasks. He was the first person to isolate bacteria in pure culture
(Bacillus lactis) using liquid cultures containing either Pasteur's solution of turnip
infusion and a special syringe to dilute the inoculum. As a result, Lister can be
considered a co-founder of medical microbiology with Koch, who later isolated
bacteria on solid media. Lister also pioneered the use of catgut and rubber tubing
for wound drainage.
15.7.2. Report 2
Joseph Lister (1827-1912) did not discover a new drug but made the link between
lack of cleanliness in hospitals and deaths after operations. For this reason, he is
known as the “Father of Antiseptic Surgery”. As Professor of Surgery at Glasgow
University, he was very aware that many people survived the trauma of an operation
but died afterwards of what was known as “ward fever”. In 1865, after reading about
the work done by Louis Pasteur on how wine was soured, Lister hypothesized that
microbes carried in the air caused the diseases which spread in the wards. People
who had been operated on were especially vulnerable as their bodies were weak
and their skin had been cut open so that germs could get into the body with more
ease. Lister decided that the wound itself had to be thoroughly cleaned. To test his
hypothesis, Lister covered compound fracture wounds with a piece of lint covered in
carbolic acid. Death by gangrene was common after such an accident. His success
rate for survival was very high. Lister then developed his idea further by devising a
machine that pumped out a fine mist of carbolic acid into the air around an
operation. As a result, the number of patients operated on by Lister who died fell
dramatically.
54
their tongues at all times without swallowing them. He was reputed to have saved
thousands from plague in Narbonne, Carcassone, Toulouse and Bordeaux.
Gradually, he became famous for his healing powers and when he returned to
Montpellier to take his doctorate degree, a large crowd gathered to hear him defend
his unorthodox practices. He was awarded his degree and held a place on the
medical faculty for three years before moving on to practice in Toulouse and then in
Agen. Nostradamus died at the age of 66, probably of renal complications of gout.
15.10.2. Work
Throughout his career, the problems that attracted Louis Pasteur (1822-1895)
almost invariably involved considerations of specificity of structure and/or of action.
Thus, his work on asymmetric crystals showed that chemical form not only specifies
crystalline structure, but affects the affinity of ferments as well. In his studies of
diseases of silkworms, of beer, and of wine, he could microscopically distinguish the
specific agents of disease. From this emerged his concept of the specificity of
species which was in contrast to the nonspecificity of spontaneous generation. From
55
this came the germ theory of disease. It was in the new field of immunology,
however, where the manifestations of specificity were most clearly seen. Here,
Pasteur's vaccines worked because he chose the specific pathogen in order to
induce a specific immunity. He succeeded each time. But the two most prominent
Pastorian successors in immunology, Elie Metchnikoff and Jules Bordet, were not
equally successful. Although each contributed significantly to the birth of
immunology, each advanced a theory that neglected the principle of specificity.
Metchnikoff's phagocytic theory of immunity could not survive the demonstrable
specificity of humoral antibodies, while Bordet's physical adsorptive concept of the
antibody-cell interaction quickly fell to the demonstration by Paul Ehrlich of the
stereochemical determination of immunological specificity.
56
was completed in one cut (i.e., detachment of the skin, muscles, and bone at the
same level). This technique, known as "classic circular cut," was modified several
times. In order to reduce suture tension, Petit recommended that the skin be
transected first and the muscles and bone more proximally ("two-stage circular cut,"
1718); Bromfield suggested that the skin be cut first, the muscles more proximally
and the bone most proximal ("three-stage circular cut," 1773). Lowdham (1679),
Verduyn (1696), and Langenbeck (1810) changed the operative technique in that
they used a soft-tissue flap to cover the bone without tension ("flap amputation")
57
arrow wounds, favored rapid extraction and aggressive therapy, and he taught
recruits not to apply traction on the shaft. The principles established by Celsus,
Paulus, Pare, and Bill not only mark important landmarks in the evolution of surgery
but can also serve as the basis for modern treatment of arrow wounds, which still
occur, although on a small scale.
58
(Martial, Epigrams 1.47). Another example is again from Martial, Epigrams (8.74),
"You are now a gladiator, although until recently you were an ophthalmologist. You
did the same thing as a doctor that you do now as a gladiator." Medical training
consisted mostly of apprentice work. Men trained as doctors by following around
another doctor. For example: "I felt a little ill and called Dr. Symmachus. Well, you
came, Symmachus, but you brought 100 medical students with you. One hundred
ice cold hands poked and jabbed me. I didn't have a fever, Symmachus, when I
called you, but now I do." (Martial, Epigrams 5.9). Plutarch grumbled that
practitioners used all sorts of questionable methods to gain patients, ranging from
escorting the prospective patient home from bars to sharing dirty jokes with him.
16.8. Ethics
Ethics codes and guidelines date back to the origins of medicine in virtually all
civilizations. Developed by the medical practitioners of each era and culture, oaths,
prayers, and codes bounded new physicians to the profession through agreement
with the principles of conduct toward patients, colleagues, and society. Although
59
less famous than the Hippocratic oath, the medical fraternities of ancient India,
seventh-century China, and early Hebrew society each had medical oaths or codes
that medical apprentices swore to on professional initiation. The Hippocratic oath,
which graduating medical students swear to at more than 60% of US medical
schools, is perhaps the most enduring medical oath of Western civilization. Other
oaths commonly sworn to by new physicians include the Declaration of Geneva (a
secular, updated form of the Hippocratic oath formulated by the World Medical
Association, Ferney-Voltaire, France) and the Prayer of Moses Maimonides,
developed by the 18th-century Jewish physician Marcus Herz.
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16.11. Imaging (1890-1950)
Within weeks of Roentgen's announcement of his discovery of X-rays in January
1890, the news had been broadcast to the world via the telegraph and the popular
press. No internet in those days. Although many properties of X-rays were known by
the turn of the century, practical applications developed only gradually. Physicians
were eager to employ X-rays to capture the exact shape of bone fractures, the
location of foreign objects embedded in flesh and the study of growth abnormalities.
The difficulty of using fragile and balky X-ray equipment, however, hampered the
growth of medical radiology. Only when the Coolidge tube had replaced the
unreliable Crookes tube in 1913 and after nitro-cellulose based photographic film
supplanted glass-plate negatives around 1920 did radiology become attractive to
most physicians. Some applications of X-rays were more serious than others, and
ignorance of the dangers of excess radiation hampered the spread of the new
technology. Fluoroscopy, for example, which substituted a screen of light-emitting
crystals for the photographic plate and thus enabled viewers to seek skeletal
structures and organs in motion was a marvelous diagnostic and teaching device.
Yet beginning in the 1920s, floor-model fluoroscopes were installed in shoe stores
and induced a generation of customers to wriggle their toes and see the bones in
their feet. The serious radiation risk of fluoroscopy only became fully apparent in the
early 1950s.
61
of medical training in schools throughout the nation. Flexner argued strongly for
placement of medical education within the structure of American universities, away
from strict control of practitioners, and he emphasized the need to close
substandard schools. For Flexner, the desired ideal was truly academic training,
with clinical teaching in close geographical association with university science
departments.
62
soft, presumably so she would not cause discomfort to either mother or child.
Soranus reasoned that the best midwives should be literate so that they can be
knowledgeable about obstetrics and pediatric theory. Soranus also felt that the
midwife must be free from superstition "so as not to overlook salutary measures on
account of a dream or omen or some customary rite."
17. GYNECOLOGY
63
history. In 1845, Sims established the first woman's hospital in history in
Montgomery, Alabama. Later, in New York, he established the Woman's Hospital,
which became the forerunner and pattern for similar institutions around the world.
Dr. Sims practiced for several years in Paris and London and accepted invitations to
perform his unique operations. Several European governments honored him with
their highest awards. New York claims Sims as its own by virtue of his work and
death there. South Carolina claims him by reason of his birth in Lancaster, S.C., but
Alabama was the scene of Sims' early work and his initial successes that were to
spring him into an honored spot in medical annals.
18.1. Anthrax
64
The first time Bubonic Plague affected Western Europe was in the early Middle
Ages. From 541 to 767 C.E. there were no fewer than 15 outbreaks in southern
Europe. Plague then disappeared from Europe for some seven centuries but came
back with a vengeance in 1347, this time by way of the Mediterranean. Plague
ravaged the entire continent for five years, resulting in a serious demographic
depression. From then on until 1722, Plague remained endemic to Europe,
periodically undermining its economy. These epidemics were major determinants of
medieval history, but their study has not been completed to this day. It was not until
the 1970s that archeo-zoologists finally discovered that the black rat had indeed
been present in Europe since Roman times. Further extensive research revealed
that the rat population had gradually grown from a fairly restricted one in the early
Middle Ages to a significant one in the 11th and 13th centuries. The rodents spread
along the major highways explaining the very different geographical impact of the
various Plague epidemics of the early and late medieval periods. However, the
mystery of the exact mechanisms by which plague spread has still not been entirely
elucidated, since the Asian rat flea, Xenopsylla cheopis, whose role as vector was
demonstrated by P. L. Simond, could not have survived in the temperate European
climate. Thus, the question of the European vector is still left hanging: was it a
human or a rat flea? Was the rat a propagator or simply an initiator?
65
of the major European cities succumbed to the plague in the first two years. In the
wake of the first infestations there were attacks on women lepers and Jews who
were thought either to have deliberately spread the plague or, because of their
innate dishonor, to have polluted society and brought on God's vengeance. The
recurrence of plague also affected the general understanding of public health.
Beginning in Italy in the 1350s there were new initiatives aimed at raising the level of
public sanitation and governmental regulation of public life. And, finally, by the
sixteenth century a debate over the causes of plague spread in the medical
community as old corruption theories inherited from Greece and Rome were
replaced by ideas of contagion.
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18.3.1. Chagas Disease
Human Chagas disease, transmitted by the reduviid bug, is perhaps a purely
accidental occurrence. As humans came into contact with the natural foci of
infection, primarily in Central and South America, they might have become infected
as a single addition to the already extensive host range of Trypanosoma cruzi that
included other primates. Thus began a process of adaptation and domiciliation to
human habitations through which the reduviid bugs had direct access to abundant
food as well as protection from climatic changes and predators. Studies have now
been performed using a specific polymerase chain reaction of T. cruzi DNA obtained
from mummified human tissues. Results have shown a positive diagnosis of Chagas
disease in a series of 4,000-year-old Pre-Hispanic human mummies from the
northern coast of Chile. The area has been inhabited at least for 7,000 years, first by
hunters, fishers and gatherers, and then gradually by more permanent settlements.
The studied specimens belonged to the Chinchorro culture, a people inhabiting the
area now occupied by the modern city of Arica. Members of the Chinchorro culture
were essentially fishers with a complex religious ideology. This accounts for the
preservation of their dead in the way of mummified bodies, with further
enhancement by the extremely dry conditions of the desert. Chinchorro mummies
are, perhaps, the oldest preserved bodies known to date.
67
description of a disease in a 9-month-old child depicted the existence of a new
human trypanosomiasis. Chagas named the trypanosome species after his
colleague and mentor Oswaldo Cruz. In subsequent papers, Chagas described the
morphology and evolutionary cycle of the trypanosome and the clinical features of
the disease, including involvement of the heart. Never before or since, has one
physician fully characterized a disease from its grass roots to the clinical forms more
or less all by himself.
18.4. Cholera
68
With the discovery of the New World, the Europeans who flocked to America
brought infectious diseases with them. During long sea voyages the agents of these
diseases increased their diffusion capacity in a suitable environment. Lack of
hygiene, chronic fatigue, food privation, a diet without vitamins and many persons
kept in confined spaces were the essential features of this environment. Sick
persons, whose health conditions worsened during the journey to the New World,
carried the germs of infectious diseases. The first disease to appear in the New
World was smallpox described in hospital records in 1518 in Hispaniola. From there
the disease moved rapidly to Mexico in 1520, exterminating most of the Aztecs. It
then moved into Guatemala and into the territories of Incas from 1525-26, killing
most of them, as well as their King. The second disease, influenza, appeared in La
Isabela, a few years later, causing a heavy epidemic between 1558 and 1559. Other
diseases followed such as yellow fever and malaria. So Europeans and these
invisible and mortal agents caused enormous destruction of American populations.
In fact historians have estimated that beginning in 1500, for only 50 years, the
population of Peru fell from 60 to 10 million; and in Mexico, in one century, the
populations fell from an initial 10 million to only 2 million.
18.7. Flu
69
appalling epidemic ever to sweep through the world since the 'Black Death' of the
1300s was still raging, the scientific community had to admit that influenza
originated not from a microbe, but from a virus.
70
18.8. Fourth Disease (17th Century to Present)
Measles and scarlet fever were differentiated from one another in the 17th century.
By 1881, Rubella was accepted as the third distinct pediatric exanthem (an eruptive
disease). Nil Filatow in 1885 and Clement Dukes in 1894 described two distinct
forms of rubella, and in 1900 Dukes proposed that one of these forms of rubella was
a separate entity which he called the fourth disease. For the past five decades,
fourth disease has been considered a non-entity, perhaps a mild form of scarlet
fever, but certainly not a distinct disease. In 1979 Keith Powell resurrected the idea
of the fourth disease and argued that it was caused by exotoxin-producing
Staphylococcus aureus.
71
18.11. Leprosy
72
seed does resemble a flea so much, that it is hard to discerne the one from the
other'; Willow herb (Primilaceae or Lysimachia sp.), 'it is reported that the fume or
smoke of the herbe burned doth drive away fleas and gnats and all manner of
venomous beasts'.
73
town of Strmec, Croatia. In humans, the vectors of most reported cases are ticks of
the genus Ixodes, which are among the most predominant ticks in Austria. Smith
and Kilbourne's work was the first demonstration that ticks transmit disease of any
kind. Furthermore, by proving that ticks carry Babesia microti--which causes
babesiosis in animals and humans, this is the first account of a zoonotic (animal to
human) disease and the foundation of all later work on the animal host and the
arthropod vector.
18.16. Tuberculosis
18.16.2. History
Tuberculosis (TB) since time immemorial has inflicted most miseries in mankind. In
ancient times TB was called by many names but the modern one comes from the
word 'tubercle'. TB, also known as Pott's disease, was widely prevalent among
Egyptians in 3700-1000 B.C.E.. Hippocrates (460-377 B.C.E.) recognized the
symptomatology of TB. The name tuberculosis was first used by Lanneac and Bayle
in early 19th century. Robert Koch in 1882 discovered the tuberculosis bacillus and
Calmette and Guerin laid the foundation BCG vaccination. In 1943, chemotherapy
for TB began with the advent of streptomycin followed by PAS in 1946 and then INH
in 1951.
18.17. Treatment
Tuberculosis (TB) is today a health priority in Asia, Africa, and South America and is
a re-emerging social disease in the Western World. While the pharmacological
therapy of TB is well established, preventive measures are still under-powered and
under-estimated. Current failures in the prevention of tuberculosis are even more
surprising considering that, already a century ago a comprehensive preventive of
defense against TB had been designed by clinicians and health care managers
such as Enrico Pieragnoli. Pieragnoli was an Italian physician who lived in Florence
between the 19th and 20th century, and who, after many years of accurate planning,
succeeded in 1906 in opening the first Italian TB preventive center. Pieragnoli
considered it his mission to fight against TB, a public enemy that was to be defeated
using the weapons of global prevention; Pieragnoli had crystal clear concepts of
74
prevention, of the predisposing factors to the disease, and of the need for
aggressive treatment. He established his preventive institute with two main aims:
the modification of the individual substratum in which the germs grew and the
removal of contagion. The prophylactic and diagnostic accuracy of his preventive
institute are shown in a number of clinical documents containing objective body
measurements (height, weight, thoracic circumference), quantitative clinical
comparisons (intra-and inter-subjects) and field epidemiology.
19. MESOPOTAMIA
75
B.C.), shows a genetically homogeneous, diseased, and short-lived population.
These ancient Mesopotamians suffered severe dental attrition (95%), periodontal
disease (42%), and caries (2%). Many oral congenital and neoplastic lesions were
noted. During this period, the "local dentists" knew only a few modern dental
techniques. Skeletal (dental) evidence indicates that the population suffered from
chronic malnutrition which was probably caused by famine. This is substantiated in
historic cuneiform and biblical writings, geologic strata samples, and analysis of
skeletal and forensic dental pathology. These people had modern dentition but
relatively poor dental health. The population's lack of malocclusions, caries, and
TMJ problems appear to be due to flat plane occlusion.
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20.2. High Middle Ages (1200-1400)
The 13th and 14th centuries were times of great growth and development in
medicine. Medical teaching had progressed to the point where university degrees
were required to practice medicine. In 1140, Roger, King of Sicily enforced a law
prohibiting anyone from the practice of medicine who had not graduated. Twelfth
and 13th century Europe gave birth to great universities. The two greatest
universities with medical schools were in Bologna and Montpellier. In Bologna, there
was a medical faculty as early as 1156. Early on, the school was mainly scholastic,
reading and repeating the works of the ancients, without any experimentation. There
were two physicians from the school at Bologna who made great contributions to
medicine. William of Saliceto (1210-1280) was instrumental in setting up a school of
surgery. He recommended the use of the knife instead of the cautery in surgery and
taught that pus in a wound was a bad thing. He sutured severed nerves back
together in surgery and tried to bring the disciplines of surgery and medicine closer
together. Theodoric, Bishop of Cervia advocated the use of wine to clean wounds
and suggested that the noxious compounds commonly used only impeded healing.
He also wrote of narcotics such as opium, mandragora, and others being soaked
into sponges and held over the patients' noses to induce a "deep sleep" during
surgery. Spectacles for the eyes were first documented by Bernard de Gordon at
the end of the 13th century.
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other to have the best hospitals. Plastic surgery was founded in the 16th century.
Ambroise Pare (1510-1590) was one of the great surgeons of the Renaissance. He
found that a mixture of eggs, oil of roses and turpentine allowed wounds to heal
better than scalding oil. His contemporaries discovered the tourniquet and found
that ligated arteries did better than cauterized ones.
78
21.1. Serefeddin Sabuncuoglu - Turkish Surgeon (15th Century)
Serefeddin Sabuncuoglu (1385-1468 C.E.) was a Turkish surgeon who lived in the
Ottoman Empire during the fifteenth century, a time of progressive expansion. When
in his eighties, he wrote Cerrahiyyetu'l-Haniyye, which means Imperial Surgery. His
book is the first example of an illustrated surgical textbook in the Turkish-Islamic
medical literature. The importance of his book rests upon the inclusion of color
miniatures of the surgical procedures, incisional techniques and instruments, all
drawn by Sabuncuoglu himself. Only three hand-written copies exist, two of which
were originally written by the author and are currently exhibited in Paris and
Istanbul. The book was rediscovered in 1936, but some parts of it are still suspected
to be missing. At present, the book consists of three chapters divided into 193
known sections. The sections deal with all fields of surgery including ophthalmology,
and cite relevant Greek, Arabic and Persian textbooks.
22. NEPHROLOGY
79
22.3. Homer Smith Father of Nephrology (1895 - 1962)
From the 1930s until his death in 1962, Homer Smith was considered one of the
leaders in the field of renal physiology. Smith played a major role in introducing and
popularizing renal clearance methods, such as non-invasive methods for the
measurement of glomerular filtration rate, renal blood flow and tubular transport
capacity. Dr. Smith also provided insights into the mechanisms of excretion of water
and electrolytes. Smith was also a superb writer of several inspiring textbooks of
renal physiology that exerted great and lasting influence on the development of
renal physiology. Smith's intellectual insights and ability for critical analysis of data
allowed him to create broad concepts that defined the functional properties of
glomeruli, tubules and the renal circulation. A distinguishing feature of Smith's
career was his close contact and collaboration, over many years, with several
clinicians of his alma mater, New York University. So great was Smiths influence
and preeminence, that Robert Pitts, in his tribute to Homer Smith in the Memoirs of
the National Academy of Science, stated that Smiths death brought an end to what
might be aptly called the Smithian Era of renal physiology.
23. NEUROLOGY
23.1. Babinski
23.1.1. Background
In 1896 Joseph Francois Felix Babinski described for the first time the phenomenon
of the toes. In his first paper he simply described extension of all toes with noxious
stimulation of the sole of the foot. It was not until 1898 that he specifically described
the extension of the hallux with stimulation of the lateral border of the sole. Babinski
was probably not aware at the time that E. Remak, a German physician, had
previously described the sign. In his third paper of 1903 Babinski concluded that if
other authors had described the abnormal reflex before him, they found it
fortuitously and did not realize its semiologic value. Babinski probably discovered it
by a combination of chance, careful observation and intuition. He also had in mind
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practical applications of the sign particularly in the differential diagnosis with hysteria
and in medico-legal areas. Several of his observations and the physiopathological
mechanisms proposed by him are still valid today. He realized since 1896 that the
Babinski reflex was part of the flexor reflex synergy. He observed that several
patients during the first hours of an acute cerebral or spinal insult had absent
extensor reflexes. He realized that most patients with the abnormal reflex had
weakness of the toes and ankles. He found a lack of correlation between
hyperactive myotatic reflexes and the presence of an upgoing hallux. He discovered
that not all patients with hemiplegia or paraplegia had the sign. He thought
erroneously that some normal subjects could have an upgoing toe. His dream of a
practical application of the sign has been fully achieved. The motto of Babinski was
Observatio summa lex. Perhaps there is no better dictum in clinical neurology.
81
and the nobility. Surgical tools in South America were made of both bronze and
man-shaped obsidian (a hard, sharp-edged volcanic rock).
23.4. Epilepsy
82
Herodotus' account of the mad acts of the Persian king Cambyses II contains one of
the two extant pre-Hippocratic Greek references to epilepsy. This reference helps to
illuminate Greek thinking about epilepsy, and diseases in general, at the time
immediately preceding the publication of the Hippocratic treatise on epilepsy. In his
treatise entitled “On the Sacred Disease, Herodotus attributed Cambyses' erratic
behavior as ruler of Egypt to either the retribution of an aggrieved god or to the fact
that he had the sacred disease. Herodotus considered the possibility that the sacred
disease was a somatic illness, agreeing with later Hippocratic authors that epilepsy
has a natural rather than a divine cause. Archaeological evidence, however,
suggests that Herodotus slanders Cambyses, since there is no corroboration that
the Persian king had epilepsy or any other disease. However, the view of epilepsy
as a somatic disease and uncertainty about the cause of madness shows Herodotus
as a transitional figure between supernatural and naturalistic medical theories.
83
of forces within the brain. Gama thought that he could thus observe oscillatory and
vibratory movements of the wires representing the effects of concussion without
visible structural brain lesions. Although it was crudely constructed, entirely
subjective as to evaluation of results, and lacking the essential instrumentation that
only modern technology can provide, this hypothesis-driven pioneer experiment
should be regarded as the first to use the novel approach of physical modeling of
the brain. Even today, this approach has not been fully exploited.
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successively older specimens. For example, he contrasted the young embryo N,
whose nerves stopped only halfway with the distal part of the extremity completely
nerve-free, with the older embryo Zw, in which the nerves had already reached the
root of the fingers, but none were in the territory of the end phalanges. In the 1870s
and 1880s, using a discrete collection of 12 human embryos of consecutively older
ages, His observed the development of nerve fibers and, from this pattern of growth,
eventually suggested that nerve cells were individual units and that the transmission
of impulses was possible without direct continuity between neurons.
85
23.11. Jean-Baptiste Bouillaud (1825)
In 1825, Jean-Baptiste Bouillaud read a paper at the Royal Academy of Medicine in
Paris supporting Franz Gall's theory of a relation between speech and the frontal
lobes. Bouillaud argued that if the frontal lobes are crucial to speech, two conditions
must be satisfied: when the frontal lobes are affected, speech must also be affected;
conversely, when the frontal lobes are spared, speech is also spared. Following
these principles, he tested and argued in support of Gall's theory by analyzing the
data from two neuropathological casebooks (Lallemand, 1820-1823; Rostan, 1820
and 1823). It is now known that Bouillaud was wrong, since the crucial dichotomy is
between the left and right hemispheres and not between the anterior and posterior
areas. What is interesting is that the actual data refute Bouillaud's conclusion.
Bouillaud experiments were replicated recently by reanalyzing the 147 clinical cases
described by Lallemand. There were, of course, some cases with frontal lesions and
speech disorders; other cases, however, had speech disorders with lesions outside
the frontal lobes, and still others had frontal lesions without speech disorders.
Although Bouillaud did not notice it, as expected, almost all patients with speech
disorders had a left hemisphere lesion.
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science of comparative neurology with the largest collection of brain illustrations (as
well as of other organ systems) attempted in his era. Although lacking the
conceptual insight that might derive from a true "comparative" anatomy and an
understanding of the relations of different animals, the handsome engravings
exemplified the new direction of the 'enlightenment' of the scientific revolution and
are discussed in the context of relevant events of this period.
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23.16. Sir Victor Horsley (1857 – 1916) - A Pioneer in Neurosurgery
Immortalized in surgical history for the introduction of "antiseptic wax," Sir Victor
Horsley played a pivotal role in shaping the face of standard neurosurgical practice.
His contributions include the first laminectomy for spinal neoplasm, the first carotid
ligation for cerebral aneurysm, the curved skin flap, the transcranial approach to the
pituitary gland, intradural division of the trigeminal nerve root for trigeminal
neuralgia, and surface marking of the cerebral cortex. As a tireless scientist, Sir
Victor was a significant player in discovering the cure for myxedema, the eradication
of rabies from England, and the invention of the Horsley-Clarke stereotactic frame.
As a pathologist, Horsley performed research on bacteria and edema and founded
the Journal of Pathology. Horsley's kindness, humility, and generous spirit endeared
him to patients, colleagues, and students. Born to privilege, he was nonetheless
dedicated to improving the lot of the common man and directed his efforts toward
the suffrage of women, medical reform, and free health care for the working class.
Knighted in 1902 for his many contributions to medicine, Sir Victor met an untimely
death during World War I from heat stroke at the age of 59. An iconoclast of keen
intellect, unlimited energy, and consummate skill, his life and work justify his epitaph
as a "pioneer of neurological surgery."
88
epilepsy, Penfield stimulated different parts of their brains with electrodes to locate
the cells that set off their attacks. He could do this while the patients were awake,
since the brain does not feel what is happening to it. In this way, Penfield soon
learned exactly where each part of the body that was touched or moved was
represented in the brain. He then showed it in his famous "homunculus" cartoons of
the somatosensory and motor areas. The brain's map of the body extends along a
vertical strip of cerebral cortex near the center of the skull. The cortex-a large,
deeply wrinkled sheet of neurons, or nerve cells, on the surface of the brain's two
hemispheres-governs all our sensations, movements, and thoughts.
89
emphasized that mechanical explanations must be sought when determining the
function of a muscle. He argued, in his corpuscular theory, that fine particles derived
from the blood, which he called animal spirits, were conducted and transmitted
along nerves to the muscle. Later, Galvani (b.1737) showed that animal spirits were
not corpuscular but electrical. In the 19th century, Matteucci, du Bois-Reymond and
Helmholtz, took Galvani's discoveries and showed that nerves possess a potential
across their walls that could give rise to a propagating transient potential change
which was transmitted to muscles with a finite velocity. It was, however, not until the
early part of the 20th century that a conceptual scheme for the synapse involving
transmitters and receptors was developed.
90
23.22. Thomas Willis (1621-1675) - Founder of Modern Clinical
Neuroscience
Thomas Willis (1621-1675) is regarded as a founder of modern clinical
neuroscience. He conceived the word "neurology" and left a body of work that
defined mid-seventeenth-century medicine. Recent interpretations of Willis's work
have led to a growing appreciation of his significant contributions to pediatric
neurology, a specialty founded properly some three centuries after his death. Willis
fused astute history taking and clinical observation (sometimes supported by
subsequent post-mortem studies) into a structured medical intervention. Willis's
practice was state of the art, being based on acceptance of Harvey, a traditional
Galenic infrastructure, iatrochemistry and Gassendi's "psychology". Although Willis's
discoveries became a cornerstone of modern medical science, his medical practice
did not lead to any therapeutic advances. However, up to the mid-eighteenth
century his works were internationally accepted for their practical usefulness. The
corpus of material left by Willis affords a fascinating insight into the clinical rationale
of a seventeenth century physician in his management of pediatric cases.
24. ONCOLOGY
25. ORTHOPEDICS
91
25.1. Osteogenesis Imperfecta (1844-1849)
Osteogenesis imperfecta (OI) or Vrolik's syndrome is a heterogeneous group of
inherited conditions arising from a variety of biochemical and morphological collagen
defects. It was Willem Vrolik, Professor of Anatomy, Pathological Anatomy and
Zoology at the Athenaeum Illustre (University of Amsterdam), who described in his
Tabulae ad illustrandam embryogenes in hominis et mammalium, naturalem tam
abnormem (1844-1849), a newborn infant with numerous fractures and
hydrocephalus. In the Tabulae, Vrolik used in the heading of Plate 91 the term
Osteogenesis imperfecta (in Dutch: gebrekkige beenwording). Vrolik also mentioned
that the infant lived three days and that both the parents were suffering from lues
universalis at the time of birth. On examination, the whole skeleton appeared poorly
mineralized. The fairly large skull exhibited a broad and high forehead, large
fontanels, frontal and temporal bossing, shallow orbits, and a protruding occiput.
The calvaria consisted of many Wormian bones. The tubular bones, although of
normal length and only slightly curved, were very thin, as were the ribs. All the
skeletal structures showed one or more fractures and many fractures showed callus
formation. Willem Vrolik was one of the first to realize that many skeletal dysplasias
were not the result of a postnatal acquired disease, such as "rickets" or
"osteomalacia" as many of his contemporaries believed. He thought that it might be
due to insufficient intrinsic "generative energy." He substantiated this by stating that
in this specimen, a primary impairment of ossification is present and not a
secondary degeneration. The descriptions given by Willem Vrolik in some of the
specimens generated the term Osteogenesis imperfecta, and the eponym Vrolik's
syndrome, for this genetic disorder characterized by increased fragility.
26. PATHOLOGY
92
26.2. "Jake Walk" - A Toxicological Tragedy (1930)
In 1930, thousands of cases of muscle pain, weakness of upper and lower
extremities, and minimal sensory impairment occurred in the United States. The
illness was caused by the consumption of an adulterated Jamaica ginger extract
("Jake"). Jake was an illicit beverage then popularly used in the Southern and
Midwestern United States to circumvent prohibition statutes. An additive, tri-ortho-
cresyl phosphate, caused severe, and only partially reversible damage to the spinal
cord and peripheral nervous tissue. Victims with resultant gait impairment,
sometimes permanent, were said to have the "Jake Leg" or "Jake Walk." Twelve
commercial phonographic recordings made between 1928 and 1934 by southern
rural artists, white and black, refer to Jake or Jake-induced infirmity. These reveal
preepidemic cultural familiarity with Jake, and the later, postepidemic performances
reflect a whimsical, even cynical, cultural attitude that those with "Jake Leg" were
suffering the wages of sin and should not be regarded as objects of pity or
sympathy.
26.4. Lead Poisoning Killed the Crew of the Franklin Expedition? (1845)
In 1845, the Franklin expedition left London with 2 ships and 134 men on board in
an attempt to find the route through the Northwest Passage. The ships were built
with state-of-the-art technology for their day, but provisioned with supplies from the
lowest bidder. After taking on fresh provisions in the Whalefish Islands, off the coast
of Greenland, the entire crew was never heard from again. Graves found on remote
Beechey Island indicate that three able-bodied seamen died during the first winter.
A note written on a ship's log, later found in a cairn, indicate that the expedition's
leader, Sir John Franklin, died during the second winter entrapped on the ice, by
which time 24 men had also perished. The remaining crew failed in their attempt to
walk out of the Arctic by an overland route. In 1981 Owen Beattie, from the
93
University of Alberta, exhumed the remains of the sailors from the three graves on
Beechey Island. Elevated lead levels were found in all three sailors. While lead
poisoning has been a leading theory of the cause of the crew's deaths, blamed on
the crudely tinned provisions the ships carried with them from England, chronic lead
exposure may only have weakened the crew, not necessarily killed them. One of
three exhumed sailors also had in his intestine the spores of an unspecified
Clostridium species. The theory is that Botulism, type E, which is endemic in the
Arctic, may have been responsible for the deaths.
94
prohibited tobacco smoking for the members of the Sikh community. He said "Wine
is bad; Indian hemp (bhang) destroyth one generation; but tobacco destroyth all
generations'.
27. PSYCHIATRY
95
27.2. Bipolar Disorders (100 C.E.)
Perhaps the first person who described mania and melancholia as two different
phenomenological states of one and the same disease, was the Greek physician of
the 1st century C.E., Aretaeus of Cappadocia. Emil Kraepelin, however, in 1899,
unified all types of affective disorders in “manic-depressive insanity. In spite of some
opposition, Kraepelin's unitary concept was adopted worldwide. In the 1960s,
however, the rebirth of bipolar disorders took place through the publications of Jules
Angst, Carlo Perris, and George Winokur, who independently showed that there
exist clinical, familial and course characteristics validating the distinction between
unipolar and bipolar disorders. In addition, they verified several of the corresponding
opinions of the Wernicke-Kleist-Leonhard school. The concept of unipolar and
bipolar disorders has further advanced in the last three decades. Landmark
developments include the renaissance of Kraepelin's mixed states and of
Kahlbaum's and Hecker's cyclothymia and related affective temperaments, the
concept of soft bipolar spectrum (Akiskal), and the distinction of schizoaffective
disorders into unipolar and bipolar forms.
96
scoring systems have been developed, resulting in improvements in standardization
and norms.
28. SURGERY
97
The earliest written reference to cataract surgery is found in Sanskrit manuscripts
dating from the 5th century B.C.E. It is believed that these writings were by the
Hindu surgeon Susruta who practiced a type of cataract surgery known as couching
or reclination. In couching, cataractous lens are displaced away from the pupil to lie
in the vitreous cavity in the back of the eye. This displacement of the lens enables
the patient to see better. However, vision is still blurred because of the unavailability
of corrective lenses. As recently as the middle of this century, couching was still
practiced in Egypt, India, and Tibet. In the Western world, recent excavations in
Babylonia (Iraq), Greece, and Egypt have uncovered bronze instruments that would
have been appropriate for cataract surgery. The first written description of the
cataract and its treatment in the West appears in 29 C.E. in De Medicinae, the work
of the Latin encyclopedist Celsus. In it, Celsus describes in this work the practice of
needling, or discission, of cataracts, a technique in which the cataract is broken up
into smaller particles, thereby facilitating their absorption. Interestingly, Hippocrates
does not refer to cataract surgery in his writings. Galen, the pivotal medical figure of
antiquity whose theories went unchallenged for more than 1,500 years, erroneously
believed that the lens rather than the retina was the seat of vision, and that its
removal would cause blindness. History also records the use of bloodletting,
antiphlogistics (agents to counteract inflammation and fever), and mercury to
prevent or dissolve cataracts, all of which were unsuccessful.
98
29. VACCINES
99
through most of the 19th century. Vaccination and quarantine eliminated endemic
smallpox throughout Canada by 1946. The last case, in Toronto in 1962, came from
Brazil.
30. WARS
100
Agamemnon's insulting the priest Chryses when he came to ransom his captured
daughter. According to Homer, at the onset of the plague, Apollo only shot his
arrows at mules and dogs in the camp and then later at the Greek soldiers
themselves (Iliad I.9ff). What Homer describes is a highly communicable disease
with acute fever, sudden in onset and rapidly fatal, such as easily might attack an
army. After the Greeks appeased Apollo with sacrifices and by the return of the girl,
they set about cleansing the camp by throwing "defilements" into the sea. This
suggests that part of the disease was a severe dysentery exacerbated by battlefield
conditions.
101
soldiers died from disease. The second major cause of death was battlefield
injuries, totaling around 200,000. The overwhelming number of wounded created
problems in removing them from the battlefield. As late as 1862 there was no
ambulance corps. Doctors in the field hospitals also had no notion of antiseptic
surgery, resulting in extremely high death rates from post-operative infections.
102
Thyself." The second factor was her experience of gender discrimination on her first
two jobs which strengthened her for living in a male dominated Victorian era. The
third factor was her psychohygienic therapy for her long term nervous condition
which changed her approach to mental illness. With this background, Barton went
on to gain world-wide acclaim. During the Civil War, she was revered as the
American Florence Nightingale, although she was not a nurse. At age 55, Barton
first embarked on the lengthy struggle to found the American Red Cross. She was
president of the Red Cross for 23 years and rendered aid and comfort at a host of
national and international calamities. On April 12, 1912, she died at age 90.
31.3. Mary Ann Bickerdyke - Woman Healer in the Civil War (1817-1901)
Mary Ann Bickerdyke, nurse, herbalist, and humanitarian, stood out as a singular
figure during the American Civil War and afterward. She advocated nutrition and
herbal medicines at a time when "heroic," if futile, treatments were often the rule.
Her compassion toward ill soldiers was legendary and provided her with the
nickname "Mother." Nevertheless, she did not hesitate to stand up to the
bureaucratic and occasionally incompetent physician administrators who opposed
her. Working in an arena typically off limits for women, she exceeded the bounds
proscribed for her gender during the 19th century as a naturopathic physician,
humanitarian, and social reformer.
103
infant mortality, an interest that lasted throughout her career. In 1937, her efforts
were rewarded when Madison, WI received recognition for having the lowest infant
mortality of any city in the United States. Reading Reed's paper on Hodgkin's
disease, it is clear that her observations go far beyond a description of a specific
cell. Her presentation of macroscopic and microscopic features is remarkable for the
distinction between "young" and "old" growths: Reed saw Hodgkin's disease as a
process, rather than the spreading of a cancer. She was the first to note that those
most commonly affected are boys or young adults, especially those whose general
health before the disease had been excellent. Reed was also the first to note anergy
(skin reaction) to tuberculin. Dorothy Reed defined Hodgkin's disease in relation to
tuberculosis, described its pathologic features, and offered comments on its
pathogenesis, epidemiology, and immunology that still deserve to be discussed.
104
INDEX
105
Digitalis, 30 Greece, 20, 43, 62, 70, 104, 108
Diodorus Siculus, 13 Gynecology, 67, 104
Dioscorides, 17 Handwashing, 37
DNA, 23, 71, 72 Hantavirus, 74
Dorcas Hager Padget, 109 Harrower, Henry R., 44
Dorothy Reed, 110 Harvard Medical School, 56
Duchenne Muscular Dystrophy, 42 Harvey, William, 28, 29
Dwarfism, 41 Head Lice, 75
Ear, 42 Healer, 24, 64, 107
Eclampsia, 43 Heart, 10, 17, 27, 28, 29, 30, 44, 45, 49, 53,
Edward Jenner, 105 61, 72, 87, 91, 95, 99, 100
Ehrlich, Paul, 59, 79 Heart Disease, 27, 30, 44, 45, 72
Emil von Behring, 105 Heliopolis, 13
Emmerich, Rudolf, 34 Hemophilia, 52
English Sweating Disease, 74 Hemorrhagic Fever, 76
Ephemera, 63 Herbs, 10, 16, 33, 43, 64, 82
Epilepsy, 10, 21, 25, 51, 87, 88, 89, 94, 96, Hering, Constantin, 39
103 Hermes, 21
Erasistratus, 17, 18 Hermione, 12
Ethics, 63 Herodotus, 13, 14, 88
Etruscan, 20, 21, 30 Herophilos, 49
Eye Disease, 20 Herophilus, 17, 18
Fat, 39, 44, 50, 91 Herz, Marcus, 64
Fever, 10, 11, 29, 37, 62, 63, 70, 73, 75, 78, Hippocrates, 15, 18, 19, 34, 41, 61, 79, 82,
80, 104, 107, 110 83, 84, 104
Fistula, 55 Hippocratic Oath, 63, 64
Fleas, 71, 77, 78 His, Wilhelm, 90
Fleming, Alexander, 39, 50 Hodgkin's Disease, 110
Flexner, Abraham, 65 Holmes, Oliver Wendell, 56
Florentine Codex, 10 Hooke, Robert, 26, 27
Florey, Howard Walter, 39, 50 Hospital, 31, 37, 40, 48, 50, 51, 64, 66, 67,
Fluoroscope, 40 73, 82, 83, 101, 102, 108
Fluoroscopy, 65 Hospital Ship, 108
Forensic Entomology, 98 Humors, 10
Fourth Disease, 75 Ibn-i Nafis, 60
Franklin, Ben, 66 Iliad, 61, 106, 107
Galen, 17, 18, 37, 50, 60, 61, 82, 84, 95, 104 Imhotep, 14
Gallaudet, Thomas Hopkins, 42 India, 12, 31, 33, 63, 100, 103
Gastric Juice, 55, 60 Influenza, 73, 74, 75
George III, 52 Jake Walk, 98
Germ Theory, 59 Jaundice, 45, 76
Gershwin, George, 24 Jefferson, Thomas, 66
Gladiator, 21 Jones, Henry Bence, 35
Glass Harmonica, 11 Kabbalah, 58
Golgi, Camillo, 26 Kedfinger, 64
Gout, 11, 58 Keen, William Williams, 94
106
Kidney Disease, 84 Newton, Isaac, 10, 35
Kidney Stones, 11 Nicholas II, 52
Koch, 57, 59, 68, 79, 107 Nightshade, 12
Laparoscopic Surgery, 104 Nitroglycerine, 39
Laxative, 14 Noma, 31
Lead, 98 Nostradamus, 58
Lead Poisoning, 99 Nurses, 64, 67, 105, 108
Leeches, 11 Odyssey, 107
Leprosy, 77, 81 Ophthalmology, 20
Licorice, 12 Opium, 21, 22, 38, 82
Lincoln, Abraham, 57, 65 Osteogenesis Imperfecta, 97
Lister, Joseph, 57 Padua, 41, 56, 60, 82
Louis XIV, 51 Padua University, 41
Lyme Disease, 78 Papanicolaou, 35
Macular Edema, 45, 46 Parkinson, James, 58
Magendie, Francois, 90 Parkinson's Disease, 58
Maimonides, Moses, 64 Pasteur, Louis, 34, 46, 50, 57, 58, 59, 68, 74,
Malaria, 46, 72, 73, 80, 107 107
Manuscripts, 83 Pathology, 14, 15, 18, 26, 47, 56, 58, 81, 91,
Mary Ann Bickerdyke, 109 100
Matas, Rudolph, 29 Paulus, 61
Maya, 10 Pellagra, 47, 48
Measles, 75 Penfield, Wilder, 94
Medical Dducation, 56 Penicillin, 31, 39, 50
Medical Education, 65, 66, 82 Pennyroyal, 21, 22
Medicinal Plants, 13 Per Ankh, 13
Meige, Henri, 62 Periodontal Disease, 32, 81
Memphis, 13 Pharmacology, 16, 17, 18, 39, 44
Mental Illness, 102 Pierre Janet, 101
Mercury, 27, 104 Pitt, William, 52
Mering, 38, 54 Plato, 16, 19, 20
Merman, Ethel, 24 Plenck, Joseph, 33
Merrick, Joseph, 48 Pliny, 13
Mesopotamia, 23, 81 Poison, 12, 30, 100
Metchnikoff, Elie, 46, 59 Polio, 14
Midwife, 66, 67, 81 Porphyria, 52
Minkowski, 54 Prout, William, 35, 59
Mobitz, Woldemar, 29 Psychosomatic, 12
Morphine, 13, 38 Puerperal Fever, 50
Movement Disorders, 62 Queen Victoria, 52
Mummy, 14, 15, 22 Rees, George Owen, 35
Myasthenia Gravis, 47 Remak, Robert, 95
Myrrh, 13, 21, 32 Robert Bentley Todd, 96
Nerve Transmission, 89 Roentgen, 40, 65
Neurofibromatosis, 48 Roman, 17, 18, 20, 21, 31, 33, 61, 62, 64,
Neurone Doctrine, 90 68, 69, 81
107
Rome, 18, 19, 20, 54, 62, 70, 81, 103 Stomatitis, 31
Roosevelt, Franklin D., 53 Strabo, 13
Rorschach Test, 102 Surgery, 19, 22, 28, 29, 32, 40, 41, 42, 50,
Roswell Park, 97 54, 55, 57, 61, 65, 82, 83, 84, 87, 92, 93,
Rudolf Virchow, 100 94, 97, 101, 103, 104, 108
Russian Medicine, 100 Synapse, 95, 96
Sabuncuoglu, Serefeddin, 84 Tetralogy of Fallot, 27
Saint Vitus' Dance, 62 Texas Fever, 78
Samuel Collins, 92 Thomas Willis, 96
Scarlet Fever, 78 Thoracotomy, 61
Schistosoma haematobium, 15 Thyroidectomy, 54, 55
Schistosomiasis, 15 Tobacco, 100
Schizophrenia, 92, 102, 103 Toothpaste, 32, 33
Scurvy, 49, 50 Toothworm, 32, 33
Seacole, Mary Grant, 110 Tourette's Syndrome, 93
Seizure Treatments, 90 Trichinella, 51
Semmelweis, 37, 50 Tuberculosis, 11, 15, 38, 40, 56, 59, 74, 79,
Semmelweis, Ignaz Philipp, 37 110
Seneb, 41 Typhoid Fever, 80
Senhouse Kirkes, William, 28 Ulcer, 51
Silphium, 21 Vaccines, 105
Sims, James Marion, 67, 68 van Gogh, Vincent, 25
Sitophobia, 50 van Leeuwenhoek, Anton, 26, 27
Sleep Apnea, 25 Vegetable Poisons, 99
Small Pox, 105 Vertigo, 43, 51
Smith, Homer, 85 Vesalius, Andreas, 56, 60
Snow, John, 73 Victor Horsley, 93
Soranus, 66 Waksman, Selman, 50
Sozodont Tooth Powder, 13 Wars, 106
Spain, 10, 80, 84, 91, 103, 105 Washington, George, 52
Spanish Flu, 74 Women in Medicine, 108
Starling, 53 Wound Management, 107
Stevenson, Robert Louis, 25 X-rays, 40, 65
Stokes, William, 27 Yellow Fever, 80
108