Much More Than You'll Ever Need To Know About The History Of Medicine

by Cristina Pelayo

[STITCHES 77:34, 35 1998. © 1998 Stitches Publishing Company]

Introduction

"We Have Conquered Pain!" exclaimed the London headlines on Dec. 21, 1846. Scottish surgeon Robert Liston had successfully amputated a man's leg while an assistant dispensed ether from a sponge-filled inhaler. It was the first European operation under anaesthesia, and the momentous breakthrough was immortalized by an excited artist, showing Liston removing the wrong leg.

Fortunately, the mistake was the artist's. But the tortuous path to medical achievement hasn't always been as fortuitous. At one time, castration was thought to be the cure for male hernias, and the proper procedure for a tonsillectomy was to "disengage it all round by the finger and pull it out."

Nevertheless, throughout history, the quest to conquer disease has produced intrepid individuals who, through endless trial and error, managed to achieve wonders for medical science.

The physician is one of civilization's oldest pioneers. As far back as 2700 B.C., Egyptians were performing surgery and had an extensive knowledge of herbs that enabled them to develop forms of anaesthetics and antibiotics. Their elaborate embalming procedures prove that these ancient people recognized the importance of the body's vital organs, such as the heart, intestines and stomach, which they carefully preserved in canopic jars within the burial chamber to ensure the deceased's well-being in the afterlife. Useless parts, like the brain, were thrown away.

Despite many advanced techniques used to treat disease in ancient times, no one could explain the real source of maladies, so people assumed disease was inflicted by the gods to punish some unforgivable oversight. It was a convenient explanation for the unexplained, and ancient civilizations created a proliferation of deities, among the most colourful of which were the petty and spiteful gods of Olympus.

The well-known medical symbol of a serpent-entwined staff belonged to Asclepius, the god of healing. According to legend, Asclepius was so good at his art that the population of Hades began dwindling rapidly, much to the annoyance of the god of the underworld. He complained to Zeus, who took care of matters by zapping Asclepius with one of his mighty thunderbolts.

In spite of his explosive end, Asclepius' art lived on and evolved through the persistence of inquisitive minds.

One of these great thinkers was Hippocrates, a kindly Greek recognized by many as a bust with curly beard, his brow furrowed in contemplation of humanity's ailments. Hippocrates pioneered clinical medicine -- the practical application of intelligent observation -- and practised around 400 B.C. what we now call holistic medicine.

Hippocrates firmly believed that the healing art was a gift that should never be abused, and he embodied his precepts in an oath to Apollo the physician, Asclepius, Hygeia, Panacea and all the gods and goddesses. Notwithstanding centuries of change and humanity's elastic morals, this ancient code of ethics survived the test of time and served to guide future medical practitioners.

First-century Rome produced another great thinker. The Greek physician Claudius Galen was one of the first to observe that arteries contained blood, not air, and (from attending numerous sacrifices) that the heart still beat after being cut from its body.

Galen's medical opinions were widely respected and his writings on medicine became the standard in medical textbooks up to the Renaissance. He observed, among other things, that we have two jawbones and seven breastbones, and that men and women don't have the same number of ribs.

Back To Square One

When Rome fell in the fifth century A.D., the carefully accumulated knowledge of ancient healing was all but forgotten. The invading barbarians were ruled by superstition, and there's no accounting for their peculiar approaches to medicine.

The remedy for ague was to swallow a spider wrapped in a raisin, relief for a toothache was to eat a mouse, and a popular cure-all was to rub the boiled-down fat of a newly deceased felon on troubled areas.

Although most classical writings on medicine in Europe were lost or destroyed at this time, the Jewish and Moorish inhabitants of southern Spain retained the ancient knowledge and continued to study and translate Greek manuscripts. Since most Jewish physicians knew Arabic and Greek, they were considered superior doctors, highly paid and therefore resented.

Just as civilization appeared to be recapturing the lost arts, religion interfered once again. Zeus had been replaced by the Church, which disliked doctors for much the same reason as the Olympian deities. As far as the Church was concerned, the cause of disease was obviously Sin, and the prescribed treatment was prayer, fasting, repentance and perhaps a generous donation.

When the plague killed off a third of Europe's population in the l4th century, there was no accounting for how everyone had sinned so greatly, not to mention simultaneously. So the Jews were blamed for poisoning the wells, although the argument was somewhat weakened by the fact that Jews also succumbed to the pestilence.

The search for an antidote to the plague produced some curious medical treatments:

• Setting a toad over a plague boil.
• Keeping spiders in the house so their webs would absorb noxious miasmas.
• Bathing in goat urine.
• Standing by a latrine and inhaling the stench.

The Rx sign used today on pharmaceutical prescriptions was originally an astrological sign for the planet Jupiter. Mediaeval doctors believed the planets influenced health, and Jupiter was thought to be extremely effective in curing disease. But for the most part, bleeding, purging, puking and perspiring were the standard medical treatments.

Doctors didn't have a clue as to what caused illness, but whatever it was, it seemed sensible to get rid of it. The Roman physician Celsus, like his successor Galen, advocated bleeding. Since both had an enormous influence on medical science for centuries, the two of them must have wiped out a good deal of the European population.

Leeches were widely used as bleeding agents from about 900 A.D. Monasteries and abbeys appointed certain monks "leeches" to care for the sick, and the term "leech" became synonymous with "doctor."

By the end of the 19th century, just about every household kept a leech jar by the bedside table, and Venetian bleeding-glasses became treasured heirlooms. The use of leeches lasted until 1953 when they were applied to Stalin, who died soon thereafter.

Holy Smoke

The Middle Ages weren't as backward as we suppose. There's evidence of women licensed to practise medicine, and quite a few freethinkers speculated that knowledge of human anatomy might aid in the healing process. But since the Church held the human corpse sacred, autopsies were out of the question.

That didn't stop a 16th-century medical student with a fixation for dissection. With his seven-volume work De Humani Corporis Fabrica, Andreas Vesalius was one of the first to debunk the unquestioned dogma of Galen, after discovering first-hand that many of Galen's theories were a bit off.

The Church naturally frowned on Vesalius' hobby, and when he dissected the "cadaver" of a nobleman who alarmingly stirred under the knife, the Inquisition sentenced him to an expiating pilgrimage to Jerusalem on which he was shipwrecked and starved to death on a remote island.

Despite religion's control over science, the Church produced a Pope who took an interest in medicine. Pope John XXI was actually a physician, and his zeal to unlock the secrets of medical science was so great that he virtually abandoned his papal duties and built a separate room to conduct scientific experiments. Unfortunately, he died when the ceiling fell on him.

He was, of course, an exception. In the grand scheme of things, the Church regarded scientific advancement with a jaundiced eye. The year 1553 saw Michael Servetus burned alive by Calvin for discovering pulmonary circulation. Talk about a disincentive to do research!

Science and religion have been at each other's throats for centuries. In the 1800s, Dr. Oliver Wendell Holmes, Sr., arrived at a patient's house one day to find a priest departing.

"Your patient is very ill," said the priest. "He's going to die."

"Yes," Dr. Holmes nodded, "and he's going to Hell."

The priest was horrified. "You mustn't say such things! I've just given him extreme unction!"

Holmes shrugged. "Well, since you expressed a medical opinion, I had just as much right to a theological one."

Troubleshooting

A curious collection of surgical oversights reported to a London physicians' insurance agency over a period of 18 years listed a total of 482 swabs and 946 miscellaneous instruments (including a large forceps) left inside patients after surgery. Despite such incidents, and the threat of malpractice claims hanging over them, physicians today enjoy a certain amount of prestige.

Strangely enough, they didn't enjoy the same prestige in the days before insurance and medical-malpractice lawsuits. In ancient China, doctors were paid only if their patients were kept well, and often had to pay patients who fell ill. For every life lost, a special lantern was hung outside the physician's home -- an early, lethal version of the Nielsen ratings.

The European doctor's prestige likewise teetered on the edge. The 18th-century physician Thomas Dimsdale successfully inoculated Catharine the Great and her son the Grand Duke Paul against smallpox, for which he was given a generous pension and a Russian barony. However, had things gone awry, the fatalities wouldn't have ended with the inoculees, and Dimsdale had prudently laid out an escape route for just that eventuality.

For centuries, doctors have faced numerous obstacles, not the least of which were difficult patients. In the 1860s, Napoleon III refused to allow his physicians to remove an enormous bladder stone, claiming it was rheumatism that caused him to walk bow-legged. Apparently more terrified of doctors than of battle, the emperor commanded his army in the Franco-Prussian War of 1870 wearing a makeshift diaper of towels stuffed down his breeches.

Surgery À La Mode

Surgery goes back a long way and curiously shares a common past with hairstyling. In ancient Egypt, dentistry was performed by hairdressers, and mediaeval barbers often doubled as surgeons, probably because they already had the necessary tools and were used to the sight of blood.

In 1503, the University of Paris Medical Faculty upped the standing of barbers to surgeons, and in England barbers scaled the social ladder when Henry VIII declared them surgeons. Barber/surgeons lasted well into the l9th century. The red and white colours on barber's poles originally symbolized bleeding and bandaging. (Blue was probably added later to denote the colour one turned on receiving the bill.)

Before Robert Liston performed his famous amputation using anaesthesia, he was known and respected as a surgical speed-whiz. Speed was an extremely sought-after skill in any surgeon of pre-anaesthesia days. Liston boasted a record of 2 1/2 minutes per amputation, but his enthusiasm to maintain that record sometimes caused disturbing side-effects.

In his most memorable case, Liston amputated a man's leg in less than two minutes, but in the process he also amputated the fingers of his assistant and slashed through the coattails of a spectator, who thought that the knife had pierced his vitals and dropped dead from fright. Apart from such incidents, Liston performed many successful amputations. Unfortunately, a substantial number of his patients died from post-operative infections or gangrene.

In those days, surgeons used the same worn-out gowns or aprons, stiff with blood and guck, from one operation to the next. The theory was the filthier the coat, the busier the practice. Thankfully, in 1865, a flash of genius inspired Joseph Lister to discover antiseptic surgery.

Lister attempted to destroy assorted germs, often administered to the patient through the surgeon's unsterilized knife, by using carbolic acid as a disinfectant. He devised a steam-driven spray operated by a cumbersome mechanism known as the donkey-engine, with which doctors had to perform operations obscured in a cloud of phenol.

Despite this drawback, Lister used the unwieldy donkey engine to operate on Queen Victoria when she suffered the indignity of an abscess in the royal armpit. Inevitably, the fogged-in surgical team accidentally sprayed the Queen in the face with the caustic compound.

We don't know how the royal wrath was manifested, but Lister obviously lived. He did away with the donkey engine in 1887, reverted to gauze infused with carbolic, and became Lord Lister, one of Britain's first medical peers.

Oops!

Most medical breakthroughs were quite accidental. Take the stethoscope. Since the time of Hippocrates, doctors had simply applied ear to chest in order to hear the sounds of heartbeat and lung. But in the l8th century, Dr. René Laënnec was unnerved by an unusually buxom patient and decided the traditional method was ineffective, inconvenient, indelicate and downright disgusting. The flustered physician resolved his dilemma by rolling up a quire of paper and listening from a respectable distance.

Anton van Leeuwenhoek invented the microscope when he accidentally got two lenses stuck in a tube. His stroke of luck enabled future pioneers like Louis Pasteur to discover the micro-organisms that caused unwanted fermentation.

Pasteurization was itself an accident, as Pasteur was more interested in salvaging the French wine industry than he was in milk. While probing into an epidemic of wine acidification, he forgot he'd left a bacterial specimen in his lab and went on holiday. A similar accident allowed Alexander Fleming to discover penicillin.

Edward Jenner discovered the smallpox vaccine in 1796 because he was intrigued by an old wives' tale that milkmaids who contracted cowpox were immune to smallpox. Jenner pondered the theory for about 20 years before he took action and implanted two light scratches of pus from a cowpox-infected milkmaid into the arm of young James Phipps.

Two months later, Jenner scratched James with human smallpox pus and found the child was immune to the disease. Despite an ongoing superstition that one might develop bovine characteristics from the vaccination, and the fact that Jenner had no more idea than the cow that smallpox was caused by a virus, the experiment worked and vaccination, from the Latin vacca, meaning cow, caught on.

Apart from isolated cases of serendipity, medical treatment was basically hit or miss. As late as the mid-1800s, cures for cholera included tobacco enemas, blood-letting, bathing in scalding water, and rubbing the skin with cayenne pepper. Thomas Spencer, a New York physician, suggested plugging the anus with sealing wax. It didn't work.

The Last Laugh

Perhaps it's inevitable that we come full circle, returning to Hippocrates and his realization that the human body is capable of healing itself. Today we even acknowledge the human psyche as one of medicine's most powerful tools, bringing us to one of the oldest and simplest elixirs -- laughter.

Studies have shown that laughter stimulates the cardiovascular system, improves arterial pressure and relaxes muscular tension. It's said that a bout of laughter twice a day can be as effective as 45 minutes of yoga. Cancer and AIDS patients have shown higher pain tolerance when they're animated, and many hospitals treat these patients with laugh therapy sessions. Seemingly insignificant, laughter is one of the most effective sources of well-being, readily available even when no other relief seems possible.

When the l9th-century British physician John Abernathy was consulted by a man complaining of melancholy, he conducted a thorough examination and diagnosed a simple lack of recreation.

"AIl you need is amusement," the good doctor pronounced. "Go and hear the comedian Grimaldi. He'll make you laugh, and that will be better for you than any drugs."

The patient sighed. "I am Grimaldi," he said.