HISTORY OF MEDICINE (5TH Year)

20-10-2010
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1905, Karl suddhof : 1 insitut in Leipzig

Aug,1920 1st Congress of history of medicine (History of art and healing) in Anvier, Belgium
Sep, 1929 Romanian socaity of history of medicine prof.Gomoiu
Sep, 1932, 9th Congress of international society occurred in Buchurest
Sep, 1970, 22nd Congress of international society occurred in Buchurest and Constanta

Prehistoric Medicine
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The most important characteristic was that medicine was connected with religion. The priests would act as
both religious and medical counsel.
Divination invoke God to heal a patient.
Evidence of medical instruments, properly healed fractures, medical plants e.g. opium, coca leaves
(cocaine) etc. Most of them have an anesthetic effect and an effect of euphoria.
The evidence shows that people had some type of medical knowledge.
Important to remember the examples of the plants used and the healers.

Sumerian and Babylonian Civilization

- 1st civilization in history when talking about medical professionals pure doctors, not priests as doctors.
- 1st private practice, 1st time regarding payments and punishments (malpractice). Was in 2000 B.C.
- E.g. Cuneiform writing reveals 1st medical prescription in Nineveh 700B.C.
- Most important legal evidence Code of Laws of Hammurabi 40 laws carved in stone. Now can be
seen in the Louvre.
- 1 of the laws concerns the medical profession. It regards payments, rewards and punishment.
Indian Medicine
- Written evidence.
- Oldest, most important is a book Ayurveda. Was translated to today in different forms.
- Humeral theory in Ayurveda 3 humors of the body breath, bile, cough (phlegm). In Greek
civilizations it is divided into 4: black bile, yellow bile, breath, and cough.
- Theory states that health means when the 3 humors are in equilibrium.
- Medical procedure yoga 1st described in Ayurveda.
- Massage medical procedure invented in India.
- Instruments evidence of medical and surgical.
- So called experts in rhinoplasty.
- Able to make a connection between the plague and rats, as well as a connection between malaria and
mosquitoes.
- In anatomy described many muscles, tendons, bones and even cranial nerves. They made the connection
between the nerves and their functions.
Medicine in Ancient Jews
- Most of the information derived from the bible.
- Completely subordinated to religion.
- 1st to forbid pork said to have known about the diseases associated with pork. It is just a theory.
- Believed that the internal organs also had psychic functions.

Chinese Medicine
- Root of traditional Chinese medicine.
- Ancient Chinese medicine not very developed because they did not accept medicine as a science.
- The paradox is that some emperors practiced medicine.
- Dissection was forbidden anatomical information was scarce.
- Invented cosmogonical theory took knowledge of universe and put in the human body.
- They said that the heart has 7 chambers because bursa major contains 7 stars.
- Yin and Yang in balance.
- A lot of plants and remedies.
- Ginseng is still used today for the same purposes as in ancient Chinese medicine.
- Invented sphygmology science of the pulse. Developed it extremely practically.
- Invented acupuncture 3000B.C. accepted as a science today.

Egyptian Medicine
- Was subordinated to religion.
- Priests acting as doctors, temples acting as hospitals.
- 1st time in history God of healing Imhotep. (Not the God of Medicine).
- Imhotep really existed a scientist, politician and doctor.
- After his death, he was declared as the God of healing temples were dedicated to him and the priests
were priests of Imhotep.
- 1st medical library in history Library of the temple of Imhotep.
- This library was believed to be in Memphis, there was also an important medical school in ancient Egypt
Herodot (Greek) studied there.
- It is believed that the library still exists.
- Representatives of Egyptian medicine Herophilus 1st anatomical structure described by him venous
sinus crossing in the skull and also the roof of the 4th ventricle named it calamus scriptorius, considered
it the location of the human soul. It shows that he must have done some dissections.
- Also evidence that there was vivisection in ancient Egypt, on slaves and prisoners of war.
- Documents stating that he had dissected over 600 bodies dead and alive.

27-10-2010

Medicine in Ancient Greece and Rome

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It has 2 levels of evolution:

1 Pre-Hippocratic Age
2 Hippocratic Era.
Apollo protector of medicine.
Asclepius God of Medicine. (Imhotep God of healing.)
Asclepius was a famous doctor, after his death was considered the God of Medicine.
Homer Odyssey and The Iliad written by him.
Clancula clavicle.
Astragalus Talus (posterior of the tarsal bone).
Peritoneus peritoneum, umbilicus, intestine, urinary bladder.
Most famous Achilles tendon structure of the triceps muscle.
Wound classification.

1) Pre-Hippocratic era
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Clinical examination inspection, percussion, palpation, auscultation.

1st stamp of a doctor.
Medical school in Kos (where Hippocrates was born).
Alkmaion student of Pythagoras, like dissecting animals. He discovered the auditory tube and the optic
nerve.
Empedocles developed the humeral theory, proposed the 4th humor. This theory from the Greek
Romans rest of Europe and accepted by the church.

2) Hippocrates medicine
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Was born in 460, died in 375B.C. Father was a doctor.

1st to say that disease has nothing to do with Gods punishment.
Founder of the Rational Theory in medicine.
Father of clinical experiments considers the human body as an engine which needs food and water.
Invented prophylaxis Prevention is better than cure.
Described the meninges, blood vessels, heart valves, diseases like tetanus, chronic alcoholism, and
psychiatric diseases.
Contribution to philosophy First, do no harm, Nature is the best doctor.

Aristotle Father of compared anatomy (comparisons between human and animals).

Wrote a book History of Animal describes differences between animal and human anatomy.
Also the father of embryology. Was a professor to Alexander the Great.

Roman Medicine
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Roman Empire interest in medicine was low. The slaves practiced medicine and became somewhat
famous, with houses etc. but still remained slaves.
2 major contributions Public health fresh water supply, sewage systems, Roman public bath called
teime.
Military medicine developed by law 1st by Julius Caesar doctors have to be on the battlefield.
Hospitals were invented by the Romans.
Roman representative Claudius Galenus. 129-201, born in Pergam, Turkey. Father was a Roman
senator. Philosophy in Smirna, Turkey. Then studied medicine in Alexandria.
Human dissection was not done, only on animals. At 28 becomes a doctor in a gladiator school and he
gains access to other knowledge. Becomes famous and gets called by emperor Marcus Aurealis to become
his personal doctor.
Contributions: described 7 pairs of cranial nerves, spinal nerves, heart chambers, muscles of the head and
neck, internal organs and description of the uterus- called it the matrix and said that in the matrix the seed
of the male and female are mixing. Also described the portal system and the mesentery.
Physiological contribution: support of the humeral theory, major contribution in surgery, paralyses by
cutting the spinal cords and in dogs cut the laryngeal nerve and caused aphonia.
Pharmacology: prescription, Galenica (no drugs like today). Famous drug Teriac common medication,
mixture invented by Galenus with opium.
Levels of evolution of disease, stages, 4 signs of acute local inflammation (Celsius sign).

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Middle Age Medicine

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Was called the Dark Ages because there was a lack of knowledge. And also because of the civilization
at that time. Was approximately 5-15th century.
Dominated by the power of the church in Europe, overpowered even the kings and royal families.
Only the monks were allowed to practice a very primitive form of medicine. Subordinated medicine to
religion.
E.g. St Bernard was responsible for any lung pathologies.
Medical schools were included in the monasteries.
Medical treatments were mostly prayers.
Church forbid medical research destroyed books of medical knowledge. Only Galenus was accepted by
the church.
*The Royal Touch method of treatment the king/queen would touch the patient royalty was
considered as a branch of God on Earth. This even existed in 15th century England.

1 Medical schools
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Medical school of Salerno (Italy) close to Naples. One of the 1st schools that was under public authority
not the church also very close to Monte Casino. This is important because students had access to the
library in Monte Casino (monastery).
1st time in medical history that we have the medical diploma 1140. It was accepted all over Europe.
Also accepted women 1st school in history. One of the most famous graduates was Trota 1095 she
wrote the 1st medical book regarding female diseases.
Medical school of Montpelier 1st medical faculty 1220 under the citys authority but founded by the
church the 1st dean was a cardinal. Still exists today.
Medical school of Paris.
Medical school of Bologna.
Medical school of Padova (1228) 1st anatomical amphitheatre, 1st public dissections 13 and 14th
century approved as entertainment by the church.
University of Prague 1348.

2 Middle Age Pandemics

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Plague (The Pest): - 1st major plague in 540 in Constantinople approximately 1000 deaths per day.
Biggest plague in 14th century in 1346 in Europe. 25 million deaths in 1 year (at that time was 1 in 4
people). Tends to appear at ports and harbor cities.
No one knew how it appeared, how to treat or cure, therefore a lot of mistakes were made.
As a benefit from the plague, we have quarantine. Happened in Ragusa 1st (close to Venice) ships had to
stay 30 days before it was accepted in the harbor. Then employed all over Europe became 40 days. It
was the only efficient method.
Last major plague 1720. Appeared in the south of France Marseille.
English Fever around the 15th century.
Fire of Saint Anton digestive problem caused by a fungus in flour.
Cholera
Leprosy today it is called Hansen bacillus. Patient was secluded dies in months or even years.
Created leper colonies to isolate them. Patients were forced to go there were not abandoned but declared
dead even had a death ceremony. Wife/husband was then allowed to divorce which was usually not
allowed according to the church.

3 Arab Medicine
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Arab empire expanded around the 5th century from around Iran to the Arab peninsula, North Africa, Spain
and Portugal.
Divided in the Eastern Empire Baghdad, Western empire Cordova (Spain).
Arabs translated all of Hippocrates books.
Extremely well developed medicine.
Invented the clinical hospital with students studying there.
Pharmacies in hospitals.
All examinations were free pay as much as you could afford.
Many schools, faculties, hospitals. E.g. Cordova had 1 million inhabitants and 70 public libraries and 17
universities.
Representatives of Arab medicine: Ipsina Latinized was Avichena 1 of 3 major names in the history
of medicine (Galenus, Hippocrates, and Avicenna).
Born in 980 in Buhara, Iran. Died in 1037.
Philosopher, astronomer, politician (up to vizier), poet.
Credited with approximately 150 books, 16 of them medical books.
Canon of medicine most important book of Avichena and also in Europe during the renaissance.
Contributions in pharmacy, anatomy and pathology.
1st time described diabetes (disease of sweet urine).
Described sciatica (disease of the great nerve on fire).
Describes anemias, treated them with bone marrow, to eat.
Canon of medicine in 5 volumes- 1 general medicine and anatomy, pharmacology, diseases specific to
organs, general pathology, pharmaceuticals (how to prepare the drugs).
Abul Kaziz born in Cordova.
Razes born in Baghdad and described variola and rugiola.
Arabs 1st to attempt vaccinations, tried to vaccinate using extracts from variola secretions.
Mymonede was a Jew, born in Cordova, left Spain (12th century Jews were forced to leave). Went to
Egypt and worked for Saladin. Author of the famous text Medical Prayer of Mymonede was used then
as we use the Hippocratic Oath.
Ibn Al Nafis born in Damascus, practiced in Cairo. In 1260 described the lesser circulation.

10-11-2010

Medicine of the Renaissance

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Rediscovery of the classics and rediscovery of the human body.

Development of the great national empires: English, Russian.
Development of the cities- open to trade, science, and scientific exchanges.
Discovery of modern day printing- books became cheaper, greater access to knowledge. Diminished
control of the church over knowledge.
Experimental medicine.
Rediscovery of the human body artists contributed greatly.
Leonardo De Vinci 1452-1519 credited with creation of anatomical posters, more than 700 posters but
only 220 survived.
Also considered to be the inventor of anatomical castes 1st caste was a mould of the cerebral ventricles.
Inventor of sectional anatomy, regional/topographical anatomy, artistic anatomy proportions and
surfaces.
Michelangelo statue of David considered being in perfect proportions.
Albrecht Durer painter Adam and Eve wrote a book about symmetry and proportion of the human
body.

Pure Anatomists
- Renaissance was the birth of modern anatomy.
- Andreas Vesarius published his 1st anatomy book called Fabrica in 7 volumes, printed in 1543. This
was the 1st printed anatomy that contradicted Galenus.
- Church had a violent reaction and declared him a heretic.
- Sacrum, azygous system of veins and lenses of the eye were described.
- Jacques Dubois Latin name Silvius professor of anatomy in Paris.
- Gabriele Fallopius disciple of Vesarius Fallopian tubes, fallopian aqueduct 1st to accurately describe
the external genital organs.
- Leonardo Botalo orifice of Botalo (inter-atrial communication foramen ovale).
- Constantina Variolio professor in Bologna, personal doctor of the Pope. Described the pons.
- Casperus Bauhinus ileocecal valve.
- Jan Riolan blood supply of the intestine, lived at the end of the 16th century never rejected Galenus.
- Francois Glison capsule of the liver
- Johan Viersun
- Thomas Vartan duct of the submandibular gland.
- Niels Stensen parotid duct
- Thomas Willis arterial circle of Willis 1664 book De Anatomie Cerebri 1st book of neuroanatomy.
- Marcello Marlpigi kidneys studied all parenchymous organs.
- William Harvey 1st published in 1628 complete anatomy of the cardiovascular system.
Renaissance physiology
- Physiology directly related to experimental medicine.
- Major belief iatromechanism connection between mechanics and medical profession said all things
can be described with mathematics invented formulas extreme point of view.
- Founder Rene Descartes of iatromechanism said humans were animal machines describes simple
reflexes, nerve impulses (called the animal spirits).

Pathology
- Most famous doctors of Renaissance Paracelsus (in Latin) named himself Over Celsus had a
problem with ancients (Romans and Greeks).
- Professionally the best, humanely the worst.
- Said that the dress of a doctor should be a comfortable one.
- 1st to teach students in their native language (used to be only in Greek and Latin).
- Contributions in practice rejects humeral theory for 1st time in history, promoted experimental medicine.
Surgery
- Was not accepted as a medical science.
- 2 categories: (1) General physicians who perform surgery. (2) Barbers supervised by physicians.
- Barber surgeons was a profession but was not taught in faculties. Performed bleeding maneuvers and
dentistry.
- Representative of surgery Ambraz Pare surgeon to 4 French kings.
- Was rejected from medical school in Paris because he did not know Latin.
- Became a surgeon of war, became famous. Inaugurated the department of surgery in the university 20
years later.
- Prosthetics for teeth and limbs 1st in history to make false teeth from porcelain.

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Modern Medicine
Development of medical specialties. End of the renaissance, beginning of the 18th century surgery (and
branches), internal medicine and branches, transfusions and radiology.
- In surgery, e.g. anesthesia general anesthesia 1842 1st anesthesia with ether for dental extraction Dr
Crawford Long.
- 1st local anesthesia 1884 Karl Koller with cocaine into the eye in conjunctival sac.
- Rachianesthesia spinal anesthesia 1899 August Karl Bier.
- Transfusion - 1901 Karl Lansteiner (Vienna) discovered blood groups and Rh factor. Nobel Prize in
1930 for this discovery.
- Asepsia and antisepsia.
- Louis Pasteur boiling instruments at 120C for 1 hour.
- Father of antisepsia Joseph Lister washing hands and instruments and phenol.
Famous surgeons: Francois Chopard amputations; William Hunter; Percival Pot; Jean Pean forceps
and 1st pylorectomy; James Pageant; Theodore Billroth; Alexis Carrel blood vessel surgery, Nobel Prize
for arterial and venous transplant in 1912; Christian Barnard 1st heart transplant in 1967; Paul Brocha
father of neurosurgery, 1st cerebral abscess.
Forensic Medicine (legal medicine):
Appears at the end of the 17th century.
Cezare Lombrozo psychiatrist.
Internal Medicine:
Percussion in 1761 Leopold Ausnbrugger.
Auscultation in 1816 Renee Laennec.
John Cheyenne and William Stokes Cheyn-Stokes breathing.
Thomas Addison suprarenal insufficiency 1855.
James Parkinson.
Thomas Hodgkins.
Pierre Poiton cardiologist invented the pipette.
Psychiatry:
End of the 18th century with a theory no corporal violence against mentally ill patients.
Radiology:
1895 William Conrad Rengen professor of physics accidentally discovered the X-ray. 1st x-ray
film was of his wifes right hand.
Genetics:
1902- William Bateson introduces the term gene.
1933 Nobel Prize Thomas Morgan.
1953 James Watson and Frank Crick propose the model of DNA.
1954 Model confirmed by Michael Williams. 1962- Nobel Prize to Watson, Crick and Williams.
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Bioethics
- Also called medical deontology code of rules in the medical profession.
- 2 types of euthanasia active and passive.
- Based on consent:
- Voluntary euthanasia patient has to be completely informed.
- Involuntary euthanasia patient was misinformed, rejects euthanasia.
- Non-voluntary euthanasia in patients who are unable to express their will e.g. patients in comas, small
children, new borns etc.