Thehistory of medicine is both a study of medicine throughout history as well as a multidisciplinary field of study that seeks to explore and understand medical practices, both past and present, throughout human societies.[1]
The history of medicine is the study and documentation of the evolution of medical treatments, practices, and knowledge over time. Medical historians often draw from otherhumanities fields of study including economics,health sciences, sociology, andpolitics to better understand the institutions, practices, people, professions, and social systems that have shaped medicine. When a period which predates or lacks written sources regarding medicine, information is instead drawn fromarchaeological sources.[1][2] This field tracks the evolution of human societies' approach to health, illness, and injury ranging from prehistory to the modern day, the events that shape these approaches, and their impact on populations.
Early medical traditions includethose of Babylon,Egypt,China andIndia. Invention of the microscope was a consequence of improved understanding, during the Renaissance. Prior to the 19th century,humorism (also known as humoralism) was thought to explain the cause of disease but it was gradually replaced by thegerm theory of disease, leading to effective treatments and even cures for many infectious diseases. Military doctors advanced the methods of trauma treatment and surgery.Public health measures were developed especially in the 19th century as the rapid growth of cities required systematic sanitary measures. Advanced research centers opened in the early 20th century, often connected with majorhospitals. The mid-20th century was characterized by new biological treatments, such asantibiotics. These advancements, along with developments inchemistry,genetics, andradiography led tomodern medicine. Medicine was heavily professionalized in the 20th century, and new careers opened to women asnurses (from the 1870s) and as physicians (especially after 1970).
Prehistoric medicine is a field of study focused on understanding the use ofmedicinal plants, healing practices, illnesses, and wellness of humans before written records existed.[4] Although styled prehistoric "medicine", prehistoric healthcare practices were vastly different from what we understand medicine to be in the present era and more accurately refers to studies and exploration of early healing practices.
This period extends across the first use of stone tools byearly humansc. 3.3 million years ago[5] to the beginning ofwriting systems and subsequentrecorded historyc. 5000 years ago.
As human populations were once scattered across the world, forming isolated communities and cultures that sporadically interacted, a range ofarchaeological periods have been developed to account for the differing contexts of technology, sociocultural developments, and uptake of writing systems throughout early human societies.[6][7] Prehistoric medicine is then highly contextual to the location and people in question,[8] creating an ununiform period of study to reflect various degrees of societal development.
Without written records, insights into prehistoric medicine comes indirectly from interpreting evidence left behind by prehistoric humans. One branch of this includes thearchaeology of medicine; a discipline that uses a range of archaeological techniques from observing illness in human remains, plant fossils, to excavations to uncover medical practices.[3][9] There is evidence of healing practices withinNeanderthals[10] and other early human species. Prehistoric evidence of human engagement with medicine include the discovery ofpsychoactive plant sources such aspsilocybin mushrooms inc. 6000BCESahara[11] to primitive dental care inc. 11,900BCE (13,000BP) Riparo Fredian[12] (present-day Italy)[13] andc. 7000BCEMehrgarh (present-dayPakistan).[14][15]
Anthropology is another academic branch that contributes to understanding prehistoric medicine in uncovering the sociocultural relationships, meaning, and interpretation of prehistoric evidence.[16] The overlap of medicine as both a root to healing the body as well as the spiritual throughout prehistoric periods highlights the multiple purposes that healing practices and plants could potentially have.[17][18][19] Fromproto-religions to developed spiritual systems, relationships of humans andsupernatural entities, from Gods toshamans, have played an interwoven part in prehistoric medicine.[20][21]
A significant example of sophisticated prehistoric self-medication is the case ofÖtzi the Iceman (c. 3230 BC). According to archaeologistPatrick Hunt, Ötzi carried a deliberate "prehistoric medical kit" to treat his numerous documented ailments. This kit includedPiptoporus betulinus (birch polypore fungus), which Hunt suggests was used as both a vermifuge for intestinal parasites and an antibiotic for his Lyme disease; poppy seeds as an analgesic; sloe berries to treat vertigo and eczema associated withLyme disease; andsphagnum moss as an antiseptic wound dressing.[22]
Ancient history covers time betweenc. 3000BCE toc. 500CE, starting from evidenced development of writing systems to the end of the classical era and beginning of thepost-classical period. Sociocultural and technological developments could differ locally from settlement to settlement as well as globally from one society to the next.[23]
Ancient medicine covers a similar period of time and presented a range of similar healing theories from across the world connectingnature, religion, and humans within ideas of circulating fluids and energy.[24] Although prominent scholars and texts detailed well-defined medical insights, their real-world applications were marred by knowledge destruction and loss,[25] poor communication, localized reinterpretations, and subsequent inconsistent applications.[26]
TheMesopotamian region, covering much of present-dayIraq,Kuwait,Syria,Iran, andTurkey, was dominated by a series of civilisations includingSumer, the earliest known civilisation in theFertile Crescent region,[27][28] alongside theAkkadians (includingAssyrians andBabylonians). Overlapping ideas of what we now understand as medicine, science, magic, and religion characterised early Mesopotamian healing practices as a hybridnaturalistic andsupernaturalbelief system.[29][30][31]
TheSumerians developed one of the earliest known writing systems in the3rd millennium BCE, and created numerouscuneiform clay tablets regarding their civilisation. These included detailed accounts ofdrug prescriptions and operations, as well as exorcisms. These were administered and carried out by highly defined professionals includingbârû (seers),âs[h]ipu (exorcists), andasû (physician-priests).[32] An example of an early, prescription-like medication appeared inSumerian during theThird Dynasty of Ur (c. 2112 BCE –c. 2004BCE).[33]
Following the conquest of theSumerian civilisation by theAkkadian Empire and the empire's eventual collapse from a number of social and environmental factors,[34] theBabylonian civilisation began to dominate the region. Examples ofBabylonian Medicine include the extensive Babylonian medical text, theDiagnostic Handbook, written by theummânū, or chief scholar,Esagil-kin-apli ofBorsippa,[35]: 99 [36] in the middle of the 11th centuryBCE during the reign of the Babylonian kingAdad-apla-iddina (1069–1046 BCE).[37]
This medical treatise devoted great attention to the practice ofdiagnosis,prognosis, physical examination, and remedies. The text contains a list ofmedical symptoms and often detailedempirical observations along with logical rules used in combining observed symptoms on the body of a patient with their diagnosis and prognosis.[35]: 97–98 Here, clearly developed rationales were developed to understand the causes of disease and injury, supported by theories, agreed upon at the time, of elements we might now understand as natural causes, supernaturalmagic and religious explanations.[36]
Most known and recovered artefacts from the ancientMesopotamian civilisations centre on theneo-Assyrian (c. 900 – 600BCE) andneo-Babylonian (c. 600 – 500BCE) periods, as the last empires ruled by native Mesopotamian rulers.[38] These discoveries include a huge array of medical clay tablets from this period, although damage to the clay documents creates large gaps in our understanding of medical practices.[39]
Throughout the civilisations of Mesopotamia there are a wide range of medical innovations, including evidenced practices ofprophylaxis, measures to prevent the spread of disease,[29] accounts of stroke,[40] and an awareness of mental illnesses.[41]
Ancient Egypt, a civilisation spanning the valley of theriver Nile (throughout parts of present-dayEgypt,Sudan, andSouth Sudan), existed from itsunification inc. 3150BCE to its collapse viaPersian conquest in 525BCE[42] and ultimate downfall from theconquest of Alexander the Great in 332BCE.
Ancient Egyptians developed a complex, experimental, and communicative medical tradition that has been uncovered through surviving documents, most made ofpapyrus, such as theKahun Gynaecological Papyrus, theEdwin Smith Papyrus, theEbers Papyrus, theLondon Medical Papyrus, to theGreek Magical Papyri.[43]
Herodotus described theEgyptians as "the healthiest of all men, next to the Libyans",[44] because of thedry climate and the notablepublic health system that they possessed. According to him, "the practice of medicine is so specialized among them that each physician is a healer of one disease and no more." Although Egyptian medicine, to a considerable extent, dealt with the supernatural,[45] it eventually developed a practical use in the fields of anatomy, public health, and clinical diagnostics.
Medical information in theEdwin Smith Papyrus may date to a time as early as 3000 BCE.[46]Imhotep in the3rd dynasty is sometimes credited with being the founder of ancient Egyptian medicine and with being the original author of theEdwin Smith Papyrus, detailing cures, ailments andanatomical observations. This papyrus is regarded as a copy of several earlier works and was written c. 1600 BCE. It is an ancienttextbook on surgery almost completely devoid ofmagical thinking and describes in exquisite detail theexamination,diagnosis,treatment, andprognosis of numerous ailments.[47]
TheKahun Gynaecological Papyrus[48] treats women's complaints, including problems withconception. Thirty-four cases detailing diagnosis and[49] treatment survive, although some of them are mere fragments.[50] Dating to 1800 BCE, it is the oldest surviving medical text of any kind.
Medical institutions, referred to as Houses of Life, are known to have been established in ancient Egypt as early as 2200 BCE.[51]
TheEbers Papyrus is the oldest written text mentioningenemas. Manymedications were administered by enemas and one of the many types of medical specialists was an Iri, the Shepherd of the Anus.[52]
The earliest known physician is also credited toancient Egypt:Hesy-Ra, "Chief of Dentists and Physicians" for KingDjoser in the 27th century BCE.[53] Also, the earliest known woman physician,Peseshet, practiced inAncient Egypt at the time of the4th dynasty. Her title was "Lady Overseer of the Lady Physicians."[54]
Medical and healing practices in early Chinese dynasties were heavily shaped by the practice oftraditional Chinese medicine (TCM).[55] Starting around theZhou dynasty, parts of this system were being developed and are demonstrated in early writings on herbs inClassic of Changes (Yi Jing) andClassic of Poetry (Shi Jing).[56][57]
China also developed a large body of traditional medicine. Much of the philosophy oftraditional Chinese medicine derived from empirical observations of disease and illness byTaoist physicians and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales. These causative principles, whether material, essential, or mystical, correlate as the expression of the natural order of theuniverse.
The foundational text of Chinese medicine is theHuangdi Neijing, (orYellow Emperor's Inner Canon), written 5th century to 3rd century BCE.[58] Near the end of the 2nd century CE, during the Han dynasty,Zhang Zhongjing, wrote aTreatise on Cold Damage, which contains the earliest known reference to theNeijing Suwen. TheJin dynasty practitioner and advocate ofacupuncture andmoxibustion,Huangfu Mi (215–282), also quotes theYellow Emperor in hisJiayi jing, c. 265. During theTang dynasty, theSuwen was expanded and revised and is now the best extant representation of the foundational roots of traditional Chinese medicine.Traditional Chinese medicine that is based on the use of herbal medicine, acupuncture, massage and other forms of therapy has been practiced in China for thousands of years.
Critics say that TCM theory and practice have no basis inmodern science, and TCM practitioners do not agree on what diagnosis and treatments should be used for any given person.[59] A 2007 editorial in the journalNature wrote that TCM "remains poorly researched and supported, and most of its treatments have no logicalmechanism of action."[60] It also described TCM as "fraught withpseudoscience".[60] A review of the literature in 2008 found that scientists are "still unable to find a shred of evidence" according to standards ofscience-based medicine for traditional Chinese concepts such asqi, meridians, and acupuncture points,[61] and that the traditional principles of acupuncture are deeply flawed.[62] There are concerns over a number of potentially toxic plants, animal parts, and mineral Chinese compounds,[63] as well as the facilitation of disease. Trafficked and farm-raised animals used in TCM are a source of several fatalzoonotic diseases.[64] There are additional concerns over the illegal trade and transport of endangered species including rhinoceroses and tigers, and the welfare of specially farmed animals, including bears.[65]
TheAtharvaveda, a sacred text ofHinduism dating from the middleVedic age (c. 1200–900 BCE),[66] is one of the first Indian texts dealing with medicine. It is a text filled with magical charms, spells, and incantations used for various purposes, such as protection against demons, rekindling love, ensuring childbirth, and achieving success in battle, trade, and even gambling. It also includes numerous charms aimed at curing diseases and several remedies from medicinal herbs, overall making it a key source of medical knowledge during theVedic period. The use of herbs to treat ailments would later form a large part ofAyurveda.[5]
Ayurveda, meaning the "complete knowledge for long life" is another medical system of India. Its two most famous texts (samhitas) belong to the schools ofCharaka andSushruta. The Samhitas represent later revised versions (recensions) of their original works. The earliest foundations of Ayurveda were built on a synthesis of traditional herbal practices together with a massive addition of theoretical conceptualizations, newnosologies and new therapies dating from about 600 BCE onwards, and coming out of the communities of thinkers which included theBuddha and others.[67][68]
According to the compendium ofCharaka, theCharakasamhitā, health and disease are not predetermined and life may be prolonged by human effort. The compendium ofSushruta, theSushruta Samhita, defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Sushruta Samhita is notable for describing procedures on forms of surgery, includingrhinoplasty, the repair of torn ear lobes, perineallithotomy, cataract surgery, and other excisions and surgical procedures. Susruta also described more than 125 surgical instruments in detail. Sushruta had a penchant for scientific classification: his medical treatise consists of 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to aging and mental illness.
The Ayurvedic classics mention eight branches of medicine: kāyācikitsā (internal medicine), śalyacikitsā (surgery includinganatomy), śālākyacikitsā (eye, ear, nose, and throat diseases), kaumārabhṛtya (pediatrics withobstetrics andgynaecology), bhūtavidyā (spirit and psychiatric medicine), agada tantra (toxicology with treatments of stings and bites), rasāyana (science of rejuvenation), and vājīkaraṇa (aphrodisiac and fertility). Apart from learning these, the student of Āyurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines:distillation, operative skills, cooking, horticulture,metallurgy, sugar manufacture,pharmacy, analysis and separation of minerals, compounding of metals, and preparation ofalkalis. The teaching of various subjects was done during the instruction of relevant clinical subjects. For example, the teaching of anatomy was a part of the teaching of surgery, embryology was a part of training in pediatrics and obstetrics, and the knowledge of physiology and pathology was interwoven in the teaching of all the clinical disciplines.[clarification needed]
Even today Ayurvedic treatment is practiced, but it is consideredpseudoscientific, some ayurvedic medicines have been found to contain toxic substances.[69][70] Both the lack of scientific soundness in the theoretical foundations of ayurveda and the quality of research have been criticized.[69][71][72][73]
Thetheory of humors was derived from ancient medical works, dominated Western medicine until the 19th century, and is credited to Greek philosopher and surgeonGalen of Pergamon (129 –c. 216 CE).[74] In Greek medicine, there are thought to be four humors, or bodily fluids that are linked to illness: blood, phlegm, yellow bile, and black bile.[75] Early scientists believed that food is digested into blood, muscle, and bones, while the humors that were not blood were then formed by indigestible materials that are left over. An excess or shortage of any one of the four humors is theorized to cause an imbalance that results in sickness; the aforementioned statement was hypothesized by sources beforeHippocrates.[75] Hippocrates (c. 400 BCE) deduced that the four seasons of the year and four ages of man that affect the body in relation to the humors.[74] The four ages of man are childhood, youth, prime age, and old age.[75] Black bile is associated with autumn, phlegm with winter, blood with spring, and yellow bile with summer.[76]
InDe temperamentis, Galen linked what he called temperaments, or personality characteristics, to a person's natural mixture of humors. He also said that the best place to check the balance of temperaments was in the palm of the hand. A person that is considered to be phlegmatic is said to be an introvert, even-tempered, calm, and peaceful.[75] This person would have an excess of phlegm, which is described as a viscous substance or mucous.[77] Similarly, a melancholic temperament related to being moody, anxious, depressed, introverted, and pessimistic.[75] A melancholic temperament is caused by an excess of black bile, which is sedimentary and dark in colour.[77] Being extroverted, talkative, easygoing, carefree, and sociable coincides with a sanguine temperament, which is linked to too much blood.[75] Finally, a choleric temperament is related to too much yellow bile, which is actually red in colour and has the texture of foam; it is associated with being aggressive, excitable, impulsive, and also extroverted.
There are numerous ways to treat a disproportion of the humors. For example, if someone was suspected to have too much blood, then the physician would perform bloodletting as a treatment. Likewise, if a person believed to have too much phlegm should feel better after expectorating, and someone with too much yellow bile would purge.[77] Another factor to be considered in the balance of humors is the quality of air where one resides, such as the climate and elevation. Also, the standard of food and drink, balance of sleeping and waking, exercise and rest, retention and evacuation are important. Moods such as anger, sadness, joy, and love can affect the balance. During that time, the importance of balance was demonstrated by the fact that women lose blood monthly during menstruation, and have a lesser occurrence of gout, arthritis, and epilepsy than men do.[77] Galen also hypothesized that there are three faculties. The natural faculty affects growth and reproduction and is produced in the liver. Animal or vital faculty controls respiration and emotion, coming from the heart. In the brain, the psychic faculty commands the senses and thoughts.[77] The structure of bodily functions is related to the humors as well. Greek physicians understood that food was cooked in the stomach; this is where the nutrients are extracted. The best, most potent and pure nutrients from food are reserved for blood, which is produced in the liver and carried through veins to organs. Blood enhanced with pneuma, which means wind or breath, is carried by the arteries.[75] The path that blood take is as follows: venous blood passes through the vena cava and is moved into the right ventricle of the heart; then, the pulmonary artery takes it to the lungs.[77] Later, the pulmonary vein then mixes air from the lungs with blood to form arterial blood, which has different observable characteristics.[75] After leaving the liver, half of the yellow bile that is produced travels to the blood, while the other half travels to the gallbladder. Similarly, half of the black bile produced gets mixed in with blood, and the other half is used by the spleen.[77]
Around 800 BCEHomer in theIliad gives descriptions of wound treatment by the two sons ofAsklepios, the admirable physiciansPodaleirius andMachaon and one acting doctor,Patroclus. Because Machaon is wounded and Podaleirius is in combatEurypylus asks Patroclus to "cut out the arrow-head, and wash the dark blood from my thigh with warm water, and sprinkle soothing herbs with power to heal on my wound".[78] Asklepios, likeImhotep, came to be associated as a god of healing over time.
Temples dedicated to the healer-godAsclepius, known asAsclepieia (Ancient Greek:Ἀσκληπιεῖα, sing.Ἀσκληπιεῖον,Asclepieion), functioned as centers of medical advice, prognosis, and healing.[79] At these shrines, patients would enter a dream-like state of induced sleep known asenkoimesis (ἐγκοίμησις) not unlike anesthesia, in which they either received guidance from the deityin a dream or were cured by surgery.[80] Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing.[79] In the Asclepeion ofEpidaurus, three large marble boards dated to 350 BCE preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium.[80]Alcmaeon of Croton wrote on medicine between 500 and 450 BCE. He argued that channels linked the sensory organs to the brain, and it is possible that he discovered one type of channel, the optic nerves, by dissection.[81]
Hippocrates ofKos (c. 460 – c. 370 BCE), considered the "father of modern medicine."[82] TheHippocratic Corpus is a collection of around seventy early medical works from ancient Greece strongly associated with Hippocrates and his students. Most famously, the Hippocratics invented theHippocratic Oath for physicians. Contemporary physicians swear an oath of office which includes aspects found in early editions of the Hippocratic Oath.
Hippocrates and his followers were first to describe many diseases and medical conditions. Thoughhumorism (humoralism) as a medical system predates 5th-century Greek medicine, Hippocrates and his students systematized the thinking that illness can be explained by an imbalance of blood, phlegm, black bile, and yellow bile.[83] Hippocrates is given credit for the first description ofclubbing of the fingers, an important diagnostic sign in chronic suppurative lung disease, lung cancer andcyanotic heart disease. For this reason, clubbed fingers are sometimes referred to as "Hippocratic fingers".[84] Hippocrates was also the first physician to describe theHippocratic face inPrognosis.Shakespeare famously alludes to this description when writing ofFalstaff's death in Act II, Scene iii. ofHenry V.[85] Hippocrates began to categorize illnesses asacute,chronic,endemic and epidemic, and use terms such as, "exacerbation,relapse, resolution, crisis,paroxysm, peak, andconvalescence."[86][87]
The GreekGalen (c. 129–216 CE) was one of the greatest physicians of the ancient world, as his theories dominated all medical studies for nearly 1500 years.[88] His theories and experimentation laid the foundation for modern medicine surrounding the heart and blood. Galen's influence and innovations in medicine can be attributed to the experiments he conducted, which were unlike any other medical experiments of his time. Galen strongly believed that medical dissection was one of the essential procedures in truly understanding medicine. He began to dissect different animals that were anatomically similar to humans, which allowed him to learn more about the internal organs and extrapolate the surgical studies to the human body.[88] In addition, he performed many audacious operations—including brain and eye surgeries—that were not tried again for almost two millennia. Through the dissections and surgical procedures, Galen concluded that blood is able to circulate throughout the human body, and the heart is most similar to the human soul.[88][89] InArs medica ("Arts of Medicine"), he further explains the mental properties in terms of specific mixtures of the bodily organs.[90][91] While much of his work surrounded the physical anatomy, he also worked heavily in humoral physiology.
Galen's medical work was regarded as authoritative until well into the Middle Ages. He left a physiological model of the human body that became the mainstay of the medieval physician's university anatomy curriculum. Although he attempted to extrapolate the animal dissections towards the model of the human body, some of Galen's theories were incorrect. This caused his model to suffer greatly from stasis and intellectual stagnation.[92] Greek and Roman taboos caused dissection of the human body to usually be banned in ancient times, but in the Middle Ages it changed.[93][94]
In 1523 Galen'sOn the Natural Faculties was published in London. In the 1530s Belgian anatomist and physicianAndreas Vesalius launched a project to translate many of Galen's Greek texts into Latin. Vesalius's most famous work,De humani corporis fabrica was greatly influenced by Galenic writing and form.
Two greatAlexandrians laid the foundations for the scientific study of anatomy and physiology,Herophilus of Chalcedon andErasistratus of Ceos.[96] Other Alexandrian surgeons gave us ligature (hemostasis),lithotomy,hernia operations,ophthalmic surgery,plastic surgery, methods of reduction of dislocations and fractures,tracheotomy, andmandrake as ananaesthetic. Some of what we know of them comes fromCelsus andGalen of Pergamum.[97]
Herophilus of Chalcedon, the renowned Alexandrian physician, was one of the pioneers of human anatomy. Though his knowledge of the anatomical structure of the human body was vast, he specialized in the aspects of neural anatomy.[98] Thus, his experimentation was centered around the anatomical composition of the blood-vascular system and the pulsations that can be analyzed from the system.[98] Furthermore, the surgical experimentation he administered caused him to become very prominent throughout the field of medicine, as he was one of the first physicians to initiate the exploration and dissection of the human body.[99]
The banned practice of human dissection was lifted during his time within the scholastic community. This brief moment in the history of Greek medicine allowed him to further study the brain, which he believed was the core of the nervous system.[99] He also distinguished betweenveins andarteries, noting that the latterpulse and the former do not. Thus, while working at the medical school ofAlexandria, Herophilus placed intelligence in the brain based on his surgical exploration of the body, and he connected the nervous system to motion and sensation. In addition, he and his contemporary,Erasistratus of Chios, continued to research the role of veins andnerves. After conducting extensive research, the two Alexandrians mapped out the course of the veins and nerves across the human body. Erasistratus connected the increased complexity of the surface of the human brain compared to other animals to its superiorintelligence. He sometimes employed experiments to further his research, at one time repeatedly weighing a caged bird, and noting its weight loss between feeding times.[100] InErasistratus' physiology, air enters the body, is then drawn by the lungs into the heart, where it is transformed into vital spirit, and is then pumped by the arteries throughout the body. Some of this vital spirit reaches the brain, where it is transformed into animal spirit, which is then distributed by the nerves.[100]
TheRomans invented numeroussurgical instruments, including the first instruments unique to women,[101] as well as the surgical uses offorceps,scalpels,cautery,cross-bladed scissors, thesurgical needle, thesound, andspeculas.[102][103] Romans also performedcataract surgery.[104]
The Roman army physicianDioscorides (c. 40–90 CE), was a Greek botanist and pharmacologist. He wrote the encyclopediaDe materia medica describing over 600 herbal cures, forming an influential pharmacopoeia which was used extensively for the following 1,500 years.[105]
Early Christians in the Roman Empire incorporated medicine into their theology, ritual practices, and metaphors.[106]
Byzantine medicine encompasses the common medical practices of theByzantine Empire from about 400 CE to 1453 CE. Byzantine medicine was notable for building upon the knowledge base developed by its Greco-Roman predecessors. In preserving medical practices from antiquity, Byzantine medicine influencedIslamic medicine as well as fostering the Western rebirth of medicine during the Renaissance.
Byzantine physicians often compiled and standardized medical knowledge into textbooks. Their records tended to include both diagnostic explanations and technical drawings. TheMedical Compendium in Seven Books, written by the leading physicianPaul of Aegina, survived as a particularly thorough source of medical knowledge. This compendium, written in the late seventh century, remained in use as a standard textbook for the following 800 years.
Late antiquity ushered in a revolution in medical science, and historical records often mention civilian hospitals (although battlefield medicine and wartimetriage were recorded well before Imperial Rome).Constantinople stood out as a center of medicine during the Middle Ages, which was aided by its crossroads location, wealth, and accumulated knowledge.
The first ever known example of separatingconjoined twins occurred in the Byzantine Empire in the 10th century. The next example of separating conjoined twins would be recorded many centuries later in Germany in 1689.[107][108]
TheByzantine Empire's neighbors, the PersianSassanid Empire, also made their noteworthy contributions mainly with the establishment of theAcademy of Gondeshapur, which was "the most important medical center of the ancient world during the 6th and 7th centuries."[109] In addition,Cyril Elgood, British physician and a historian of medicine in Persia, commented that thanks to medical centers like the Academy of Gondeshapur, "to a very large extent, the credit for the whole hospital system must be given to Persia."[110]
TheMuslim world rose to primacy in medical science as its physicians contributed significantly to the field of medicine, includinganatomy,ophthalmology,pharmacology,pharmacy,physiology, and surgery. Islamic civilization's contribution was a process that took hundreds of years. During theUmayyad Caliphate (661–750 CE), these fields were in their very early stages of development, and little progress was made.[111] One reason for limited advancement in medicine was the Caliphate's focus on expansion after the death ofMuhammad (632 CE).[112] The focus on expansionism redirected resources from other fields, such as medicine.[112]
Islamic medicine grew significantly when theAbbasid Caliphate (750–1258 CE) overthrew the Umayyad Caliphate in 750 CE.[113] This change in dynasty served as a turning point towards scientific and medical developments. A large contributor to this was that, under Abbasid rule, much of the Greek legacy was transmitted into Arabic which by then, was the main language of Islamic peoples.[112] Many Islamic physicians were heavily influenced by the works of Greek scholars of Alexandria and Egypt and were able to expand on those texts to produce new medical knowledge.[114] This period of time is known as theIslamic Golden Age where there was development and flourishment of technology, commerce and sciences, including medicine. The creation of the first Islamic Hospital in 805 CE by the Abbasid caliphHarun al-Rashid in Baghdad was a significant development.[111] This hospital provided educational opportunities for Islamic physicians.
Muslims were influenced by ancient Indian, Persian, Greek, Roman and Byzantine medical practices, and helped them to develop it further.[115]Galen &Hippocrates were pre-eminent authorities. The translation of 129 of Galen's works into Arabic by the Nestorian ChristianHunayn ibn Ishaq and his assistants, and in particular Galen's insistence on a rational systematic approach to medicine, set the template forIslamic medicine, which spread throughout theArab Empire.[116] Its most famous physicians included the Persian polymathsAbu Bakr al-Razi andAvicenna, who wrote more than 40 works on health, medicine, and well-being. Taking leads from Greece and Rome, Islamic scholars kept medicine moving forward.[117] Persian polymath Avicenna has been called the "father of medicine"[118] and wroteThe Canon of Medicine which became a standard medical text in medieval European universities,[119] considered one of the most famous books in the history of medicine.[120]The Canon of Medicine presents an overview ofmedicine in the medieval Islamic world, which had been influenced by earlier traditions includingGreco-Roman medicine,[121] Al-Rāzi[122] was one of the first to question the Greek theory ofhumorism, which nevertheless remained influential in medieval Western and Islamic medicine.[123] Some volumes of al-Rāzi's workAl-Mansuri, namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities.[124] He has been described as a doctor's doctor,[125] the father ofpediatrics,[126][127] and a pioneer ofophthalmology.
In addition to contributions to understanding human anatomy, Islamic physicians played a role in the development of the modern hospital system.[128] During the Safavid Empire (16th–18th centuries) in Iran and the Mughal Empire (16th–19th centuries) in India, Muslim scholars transformed the institution of the hospital, creating an environment in which developing medical knowledge could be passed among students and teachers from a range of cultures.[129] There were two main schools of thought with patient care. These included humoral physiology from the Persians and Ayurvedic practice. After these theories were translated from Sanskrit to Persian and vice-versa, hospitals could have a mix of culture and techniques. Hospitals became increasingly common as wealthy patrons commonly founded them. Many features still in use today, such as emphasis on hygiene, a staff dedicated to the care of patients, and separation of individual patients were developed in Islamic hospitals before they came into practice in Europe.[130] The patient care aspect of hospitals in Europe had then not taken effect. European hospitals were places of religion rather than science. As was the case with much of the scientific work done by Islamic scholars, many of these novel developments in medical practice were transmitted to European cultures, after they had long been used throughout the Islamic world. Although Islamic scientists were responsible for discovering much of the knowledge that allows the hospital system to function safely today, European scholars who built on this work still receive the majority of the credit.[128]
Before the development of scientific medical practices in the Islamic empires, medical care was mainly performed by religious figures such as priests.[128] Without an understanding of how infectious diseases worked and why sickness spread from person to person, these early attempts at caring for the ill and injured often did harm. With the development of new and safer practices by scholars and physicians in hospitals of the Islamic world, ideas vital for the effective care of patients were developed, learned, and transmitted. Hospitals developed concepts and structures, still used today: separate wards for male and female patients, pharmacies, medical record-keeping, and personal and institutional sanitation and hygiene.[128] Much of this knowledge was recorded and passed on through Islamic medical texts, many of which were carried to Europe and translated for the use of European medical workers. The Tasrif, written by surgeon Abu Al-Qasim Al-Zahrawi, was translated into Latin; it became one of the most important medical texts in European universities during the Middle Ages and contained useful information on surgical techniques and spread of bacterial infection.[128]
The hospital was a typical institution included in most Muslim cities, and although they were often physically attached to religious institutions, they were not themselves places of religious practice.[129] Islamic hospitals, along with observatories used for astronomical science, were some of the most important points of exchange for the spread of scientific knowledge.
After 400 CE, the study and practice of medicine in the Western Roman Empire went into deep decline. Medical services were provided, especially for the poor, in the thousands of monastic hospitals that sprang up across Europe, but the care was rudimentary and mainly palliative.[131] Most of the writings of Galen and Hippocrates were lost to the West, with the summaries and compendia ofSt. Isidore of Seville being the primary channel for transmitting Greek medical ideas.[132] TheCarolingian Renaissance brought increased contact with Byzantium and a greater awareness of ancient medicine,[133] but only with theRenaissance of the 12th century and the new translations coming from Muslim and Jewish sources in Spain, and the fifteenth-century flood of resources after the fall of Constantinople did the West fully recover its acquaintance with classical antiquity.
The Carolingian Renaissance served as a starting point for incorporating ancient medicine into the early Middle Ages. One work which stands out in the historical timeline is theLorscher Arzneibuch, a product of the scriptorium at the Lorsch monastery, copied between 784 through the early 9th century.[134] To bolster confidence in medicine, the author of this apologetic work reasoned that medicines were created from earth materials, and that some of these materials, such as balm, were mentioned in Scripture. This example of borrowing late antique texts was part of how the Carolingian Empire reasoned through ancient knowledge and applied this knowledge to its Christian empire.[135]
In late Antiquity, using medical knowledge from the ancient world was part of a collective shift of intellectual, socio-cultural and religious awareness; however, the use of ancient recipes was impacted by a lack of available ingredients. There is a dearth of evidence regarding recipes and practical therapy in the Carolingian era.[136] In the Carolingian Renaissance, melding ancient ways with the early Middle Ages did present challenges of interpretation and practicality. Additionally, as the Carolingian Renaissance was part of the construction of the Holy Roman Empire, it was paramount that medicine continued to blend with Christianity. Appropriating classical or late antique/early Medieval medical knowledge gained traction within this era when it was emphasized that healing came from God.[137]
Greek and Roman taboos had meant that dissection was usually banned in ancient times, but in the Middle Ages it changed: medical teachers and students at Bologna began to open human bodies, andMondino de Luzzi (c. 1275–1326) produced the first known anatomy textbook based on human dissection.[93][94]
Wallis identifies a prestige hierarchy with university educated physicians on top, followed by learned surgeons; craft-trained surgeons; barber surgeons; itinerant specialists such as dentist and oculists; empirics; and midwives.[138]
The first medical schools were opened in the 9th century, most notably theSchola Medica Salernitana at Salerno in southern Italy. The cosmopolitan influences from Greek, Latin, Arabic, and Hebrew sources gave it an international reputation as the Hippocratic City. Students from wealthy families came for three years of preliminary studies and five of medical studies. The medicine, following the laws of Federico II, that he founded in 1224 the university and improved the Schola Salernitana, in the period between 1200 and 1400, it had in Sicily (so-called Sicilian Middle Ages) a particular development so much to create a true school of Jewish medicine.[139]
As a result of which, after a legal examination, was conferred to a Jewish Sicilian woman,Virdimura, wife of another physician Pasquale of Catania, the historical record of before woman officially trained to exercise of the medical profession.[140]
At theUniversity of Bologna the training of physicians began in 1219. The Italian city attracted students from across Europe. Taddeo Alderotti built a tradition of medical education that established the characteristic features of Italian learned medicine and was copied by medical schools elsewhere.Turisanus (d. 1320) was his student.[141]
TheUniversity of Padua was founded about 1220 by walkouts from theUniversity of Bologna, and began teaching medicine in 1222. It played a leading role in the identification and treatment of diseases and ailments, specializing in autopsies and the inner workings of the body.[142] Starting in 1595, Padua's famous anatomical theatre drew artists and scientists studying the human body during public dissections. The intensive study of Galen led to critiques of Galen modeled on his own writing, as in the first book of Vesalius'sDe humani corporis fabrica.Andreas Vesalius held the chair of Surgery and Anatomy (explicator chirurgiae) and in 1543 published his anatomical discoveries inDe Humani Corporis Fabrica. He portrayed the human body as an interdependent system of organ groupings. The book triggered great public interest in dissections and caused many other European cities to establish anatomical theatres.[143]
By the thirteenth century, the medical school at Montpellier began to eclipse the Salernitan school. In the 12th century, universities were founded in Italy, France, and England, which soon developed schools of medicine. TheUniversity of Montpellier in France and Italy'sUniversity of Padua andUniversity of Bologna were leading schools. Nearly all the learning was from lectures and readings in Hippocrates, Galen, Avicenna, and Aristotle. In later centuries, the importance of universities founded in the late Middle Ages gradually increased, e.g.Charles University in Prague (established in 1348),Jagiellonian University inKraków (1364),University of Vienna (1365),Heidelberg University (1386) andUniversity of Greifswald (1456).
In England, there were but three small hospitals after 1550. Pelling and Webster estimate that in London in the 1580 to 1600 period, out of a population of nearly 200,000 people, there were about 500 medical practitioners. Nurses and midwives are not included. There were about 50 physicians, 100 licensed surgeons, 100 apothecaries, and 250 additional unlicensed practitioners. In the last category about 25% were women.[144] All across England—and indeed all of the world—the vast majority of the people in city, town or countryside depended for medical care on local amateurs with no professional training but with a reputation as wise healers who could diagnose problems and advise sick people what to do—and perhaps set broken bones, pull a tooth, give some traditional herbs or brews or perform a little magic to cure what ailed them.
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The Renaissance brought an intense focus on scholarship to Christian Europe. A major effort to translate the Arabic and Greek scientific works into Latin emerged. Europeans gradually became experts not only in the ancient writings of the Romans and Greeks, but in the contemporary writings of Islamic scientists. During the later centuries of the Renaissance came an increase in experimental investigation, particularly in the field of dissection and body examination, thus advancing our knowledge of human anatomy.[145]
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At theUniversity of Bologna the curriculum was revised and strengthened in 1560–1590.[148] The representative professor wasJulius Caesar Aranzi (Arantius) (1530–1589). He became Professor of Anatomy and Surgery at the University of Bologna in 1556, where he established anatomy as a major branch of medicine for the first time. Aranzi combined anatomy with a description of pathological processes, based largely on his own research, Galen, and the work of his contemporary Italians. Aranzi discovered the 'Nodules of Aranzio' in the semilunar valves of the heart and wrote the first description of the superior levator palpebral and the coracobrachialis muscles. His books (in Latin) covered surgical techniques for many conditions, includinghydrocephalus,nasal polyp,goitre andtumours tophimosis,ascites,haemorrhoids,anal abscess andfistulae.[149]
Catholic women played large roles in health and healing in medieval and early modern Europe.[150] A life as a nun was a prestigious role; wealthy families provided dowries for their daughters, and these funded the convents, while the nuns provided free nursing care for the poor.[151]
The Catholic elites provided hospital services because of their theology of salvation that good works were the route to heaven. The Protestant reformers rejected the notion that rich men could gain God's grace through good works—and thereby escape purgatory—by providing cash endowments to charitable institutions. They also rejected the Catholic idea that the poor patients earned grace and salvation through their suffering.[152] Protestants generally closed all the convents[153] and most of the hospitals, sending women home to become housewives, often against their will.[154] On the other hand, local officials recognized the public value of hospitals, and some were continued in Protestant lands, but without monks or nuns and in the control of local governments.[155]
In London, the crown allowed two hospitals to continue their charitable work, under nonreligious control of city officials.[156] The convents were all shut down but Harkness finds that women—some of them former nuns—were part of a new system that delivered essential medical services to people outside their family. They were employed by parishes and hospitals, as well as by private families, and provided nursing care as well as some medical, pharmaceutical, and surgical services.[157]
Meanwhile, in Catholic lands such as France, rich families continued to fund convents and monasteries, and enrolled their daughters as nuns who provided free health services to the poor. Nursing was a religious role for the nurse, and there was little call for science.[158]
In the 18th century, during the Qing dynasty, there was a proliferation of popular books as well as more advanced encyclopedias on traditional medicine. Jesuit missionaries introduced Western science and medicine to the royal court, although the Chinese physicians ignored them.[159]
Unani medicine, based onAvicenna'sCanon of Medicine (ca. 1025), was developed in India throughout the medieval and Early Modern periods. Its use continued, especially in Muslim communities, during the Indian Sultanate andMughal periods. Unani medicine is in some respects close to Ayurveda and to Early Modern European medicine. All share a theory of the presence of the elements (in Unani, as in Europe, they are considered to be fire, water, earth, and air) and humors in the human body. According to Unani physicians, these elements are present in different humoral fluids and their balance leads to health and their imbalance leads to illness.[160]
Sanskrit medical literature of the Early Modern period included innovative works such as theCompendium of Śārṅgadhara (Skt.Śārṅgadharasaṃhitā, ca. 1350) and especiallyThe Illumination of Bhāva (Bhāvaprakāśa, byBhāvamiśra, ca. 1550). The latter work also contained an extensive dictionary of materia medica, and became a standard textbook used widely by ayurvedic practitioners in north India up to the present day (2024). Medical innovations of this period included pulse diagnosis, urine diagnosis, the use of mercury andchina root to treat syphilis, and the increasing use of metallic ingredients in drugs.[161]
By the 18th century CE, Ayurvedic medical therapy was still widely used among most of the population. Muslim rulers built large hospitals in 1595 inHyderabad, and inDelhi in 1719, and numerous commentaries on ancient texts were written.[162]
During theAge of Enlightenment, the 18th century, science was held in high esteem and physicians upgraded their social status by becoming more scientific. The health field was crowded with self-trained barber-surgeons, apothecaries, midwives, drug peddlers, and charlatans.
Across Europe medical schools relied primarily on lectures and readings. The final year student would have limited clinical experience by trailing the professor through the wards. Laboratory work was uncommon, and dissections were rarely done because of legal restrictions on cadavers. Most schools were small, and onlyEdinburgh Medical School, Scotland, with 11,000 alumni, produced large numbers of graduates.[163][164]
In theSpanish Empire, the viceregal capital of Mexico City was a site of medical training for physicians and the creation of hospitals. Epidemic disease had decimated indigenous populations starting with the early sixteenth-centurySpanish conquest of the Aztec Empire, when a black auxiliary in the armed forces of conquerorHernán Cortés, with an active case ofsmallpox, set off a virgin land epidemic among indigenous peoples, Spanish allies and enemies alike. Aztec emperorCuitlahuac died of smallpox.[165][166] Disease was a significant factor in the Spanish conquest elsewhere as well.[167]
Medical education instituted at theRoyal and Pontifical University of Mexico chiefly served the needs of urban elites. Male and femalecuranderos or lay practitioners, attended to the ills of the popular classes. The Spanish crown began regulating the medical profession just a few years after the conquest, setting up the Royal Tribunal of the Protomedicata, a board for licensing medical personnel in 1527. Licensing became more systematic after 1646 with physicians, druggists, surgeons, and bleeders requiring a license before they could publicly practice.[168] Crown regulation of medical practice became more general in the Spanish empire.[169]
Elites and the popular classes alike called on divine intervention in personal and society-wide health crises, such as the epidemic of 1737. The intervention of theVirgin of Guadalupe was depicted in a scene of dead and dying Indians, with elites on their knees praying for her aid. In the late eighteenth century, the crown began implementing secularizing policies on the Iberian peninsula and its overseas empire to control disease more systematically and scientifically.[170][171][172]
Botanical medicines also became popular during the 16th, 17th, and 18th Centuries. Spanish pharmaceutical books during this time contain medicinal recipes consisting of spices, herbs, and other botanical products. For example, nutmeg oil was documented for curing stomach ailments and cardamom oil was believed to relieve intestinal ailments.[173] During the rise of the global trade market, spices and herbs, along with many other goods, that were indigenous to different territories began to appear in different locations across the globe. Herbs and spices were especially popular for their utility in cooking and medicines. As a result of this popularity and increased demand for spices, some areas in Asia, like China and Indonesia, became hubs for spice cultivation and trade.[174] The Spanish Empire also wanted to benefit from the international spice trade, so they looked towards their American colonies.
The Spanish American colonies became an area where the Spanish searched to discover new spices and indigenous American medicinal recipes. TheFlorentine Codex, a 16th-century ethnographic research study in Mesoamerica by the SpanishFranciscan friarBernardino de Sahagún, is a major contribution to the history ofNahua medicine.[175] The Spanish did discover many spices and herbs new to them, some of which were reportedly similar to Asian spices. A Spanish physician by the name ofNicolás Monardes studied many of the American spices coming into Spain. He documented many of the new American spices and their medicinal properties in his surveyHistoria medicinal de las cosas que se traen de nuestras Indias Occidentales. For example, Monardes describes the "Long Pepper" (Pimienta luenga), found along the coasts of the countries that are now known Panama and Colombia, as a pepper that was more flavorful, healthy, and spicy in comparison to the Eastern black pepper.[173] The Spanish interest in American spices can first be seen in the commissioning of theLibellus de Medicinalibus Indorum Herbis, which was a Spanish-American codex describing indigenous American spices and herbs and describing the ways that these were used in natural Aztec medicines. The codex was commissioned in the year 1552 by Francisco de Mendoza, the son ofAntonio de Mendoza, who was the first Viceroy of New Spain.[173] Francisco de Mendoza was interested in studying the properties of these herbs and spices, so that he would be able to profit from the trade of these herbs and the medicines that could be produced by them.
Francisco de Mendoza recruited the help of Monardez in studying the traditional medicines of the indigenous people living in what was then the Spanish colonies. Monardez researched these medicines and performed experiments to discover the possibilities of spice cultivation and medicine creation in the Spanish colonies. The Spanish transplanted some herbs from Asia, but only a few foreign crops were successfully grown in the Spanish Colonies. One notable crop brought from Asia and successfully grown in the Spanish colonies was ginger, as it was considered Hispaniola's number 1 crop at the end of the 16th Century.[173] The Spanish Empire did profit from cultivating herbs and spices, but they also introduced pre-Columbian American medicinal knowledge to Europe. Other Europeans were inspired by the actions of Spain and decided to try to establish a botanical transplant system in colonies that they controlled, however, these subsequent attempts were not successful.[174]
The London Dispensary opened in 1696, the first clinic in the British Empire to dispense medicines to poor sick people. The innovation was slow to catch on, but new dispensaries were open in the 1770s. In the colonies, small hospitals opened in Philadelphia in 1752, New York in 1771, and Boston (Massachusetts General Hospital) in 1811.[176]
Guy's Hospital, the first great British hospital with a modern foundation, opened in 1721 in London, with funding from businessmanThomas Guy. It had been preceded bySt Bartholomew's Hospital andSt Thomas's Hospital, both medieval foundations. In 1821 a bequest of £200,000 by William Hunt in 1829 funded expansion for an additional hundred beds at Guy's.Samuel Sharp (1709–78), a surgeon at Guy's Hospital from 1733 to 1757, was internationally famous; hisA Treatise on the Operations of Surgery (1st ed., 1739), was the first British study focused exclusively on operative technique.[177]
English physicianThomas Percival (1740–1804) wrote a comprehensive system of medical conduct,Medical Ethics; or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons (1803) that set the standard for many textbooks.[178]
In the 1830s in Italy,Agostino Bassi traced the silkworm diseasemuscardine to microorganisms. Meanwhile, in Germany,Theodor Schwann led research onalcoholicfermentation byyeast, proposing that living microorganisms were responsible.Leading chemists, such asJustus von Liebig, seeking solelyphysicochemical explanations, derided this claim and alleged that Schwann was regressing tovitalism.
In 1847 in Vienna,Ignaz Semmelweis (1818–1865), dramatically reduced the death rate of new mothers (due tochildbed fever) by requiring physicians toclean their hands before attending childbirth, yet his principles were marginalized and attacked by professional peers.[179] At that time most people still believed that infections were caused by foul odors calledmiasmas.
French scientistLouis Pasteur confirmedSchwann's fermentation experiments in 1857 and afterwards supported the hypothesis that yeast were microorganisms. Moreover, he suggested that such a process might also explain contagious disease. In 1860, Pasteur's report on bacterial fermentation ofbutyric acid motivated fellow FrenchmanCasimir Davaine to identify a similar species (which he calledbacteridia) as the pathogen of the deadly diseaseanthrax. Others dismissed "bacteridia" as a mere byproduct of the disease. British surgeonJoseph Lister, however, took these findings seriously and subsequently introducedantisepsis to wound treatment in 1865.
German physicianRobert Koch, noting fellow GermanFerdinand Cohn's report of a spore stage of a certain bacterial species, traced the life cycle ofDavaine'sbacteridia, identified spores, inoculated laboratory animals with them, and reproduced anthrax—a breakthrough forexperimental pathology andgerm theory of disease. Pasteur's group added ecological investigations confirming spores' role in the natural setting, while Koch published a landmark treatise in 1878 on the bacterial pathology of wounds. In 1881, Koch reported discovery of the "tubercle bacillus", cementing germ theory and Koch's acclaim.
Upon the outbreak of acholera epidemic inAlexandria, Egypt, two medical missions went to investigate and attend the sick, one was sent out by Pasteur and the other led by Koch.[181] Koch's group returned in 1883, having successfully discovered thecholera pathogen.[181] In Germany, however, Koch's bacteriologists had to vie againstMax von Pettenkofer, Germany's leading proponent ofmiasmatic theory.[182] Pettenkofer conceded bacteria's casual involvement, but maintained that other, environmental factors were required to turn it pathogenic, and opposed water treatment as a misdirected effort amid more important ways to improve public health.[182] The massive cholera epidemic inHamburg in 1892 devastated Pettenkoffer's position, and yielded Germanpublic health to "Koch's bacteriology".[182]
On losing the 1883 rivalry in Alexandria, Pasteur switched research direction, and introduced his third vaccine—rabies vaccine—the first vaccine for humans sinceJenner'sfor smallpox.[181] From across the globe, donations poured in, funding the founding ofPasteur Institute, the globe's firstbiomedical institute, which opened in 1888.[181] Along with Koch's bacteriologists, Pasteur's group—which preferred the termmicrobiology—led medicine into the new era of "scientific medicine" upon bacteriology and germ theory.[181] Accepted fromJakob Henle, Koch's steps to confirm a species' pathogenicity became famed as "Koch's postulates". Although his proposed tuberculosis treatment,tuberculin, seemingly failed, it soon was used to test for infection with theinvolved species. In 1905, Koch was awarded theNobel Prize in Physiology or Medicine, and remains renowned as the founder ofmedical microbiology.[183]
The breakthrough to professionalization based on knowledge of advanced medicine was led byFlorence Nightingale in England. She resolved to provide more advanced training than she saw on the Continent. At Kaiserswerth, where the first German nursing schools were founded in 1836 byTheodor Fliedner, she said, "The nursing was nil and the hygiene horrible."[184] Britain's male doctors preferred the old system, but Nightingale won out and her Nightingale Training School opened in 1860 and became a model. The Nightingale solution depended on the patronage of upper-class women, and they proved eager to serve. Royalty became involved. In 1902 the wife of the British king took control of the nursing unit of the British army, became its president, and renamed it after herself as theQueen Alexandra's Royal Army Nursing Corps; when she died the next queen became president. Today its Colonel in Chief isSophie, Countess of Wessex, the daughter-in-law ofQueen Elizabeth II. In the United States, upper-middle-class women who already supported hospitals promoted nursing. The new profession proved highly attractive to women of all backgrounds, and schools of nursing opened in the late 19th century. Nurses were soon a part of large hospitals, where they provided a steady stream of low-paid idealistic workers. The International Red Cross began operations in numerous countries in the late 19th century, promoting nursing as an ideal profession for middle-class women.[185]
A major breakthrough in epidemiology came with the introduction of statistical maps and graphs. They allowed careful analysis of seasonality issues in disease incidents, and the maps allowed public health officials to identify critical loci for the dissemination of disease.John Snow in London developed the methods. In 1849, he observed that the symptoms of cholera, which had already claimed around 500 lives within a month, were vomiting and diarrhoea. He concluded that the source of contamination must be through ingestion, rather than inhalation as was previously thought. It was this insight that resulted in the removal of The Pump On Broad Street, after which deaths from cholera plummeted. English nurseFlorence Nightingale pioneered analysis of large amounts of statistical data, using graphs and tables, regarding the condition of thousands of patients in the Crimean War to evaluate the efficacy of hospital services. Her methods proved convincing and led to reforms in military and civilian hospitals, usually with the full support of the government.[186][187][188]
By the late 19th and early 20th century English statisticians led byFrancis Galton,Karl Pearson andRonald Fisher developed the mathematical tools such as correlations and hypothesis tests that made possible much more sophisticated analysis of statistical data.[189]
During the U.S. Civil War the Sanitary Commission collected enormous amounts of statistical data, and opened up the problems of storing information for fast access and mechanically searching for data patterns. The pioneer wasJohn Shaw Billings (1838–1913). A senior surgeon in the war, Billings built theLibrary of the Surgeon General's Office (now theNational Library of Medicine), the centerpiece of modern medical information systems.[190] Billings figured out how to mechanically analyze medical and demographic data by turning facts into numbers and punching the numbers onto cardboard cards that could be sorted and counted by machine. The applications were developed by his assistantHerman Hollerith; Hollerith invented the punch card and counter-sorter system that dominated statistical data manipulation until the 1970s. Hollerith's company becameInternational Business Machines (IBM) in 1911.[191]
Until the nineteenth century, the care of theinsane was largely a communal and family responsibility rather than a medical one. The vast majority of thementally ill were treated in domestic contexts with only the most unmanageable or burdensome likely to be institutionally confined.[192] This situation was transformed radically from the late eighteenth century as, amid changing cultural conceptions of madness, a new-found optimism in the curability of insanity within the asylum setting emerged.[193] Increasingly, lunacy was perceived less as aphysiological condition than as a mental and moral one[194] to which the correct response was persuasion, aimed at inculcating internal restraint, rather than external coercion.[195] This new therapeutic sensibility, referred to asmoral treatment, was epitomised in French physicianPhilippe Pinel's quasi-mythological unchaining of the lunatics of theBicêtre Hospital in Paris[196] and realised in an institutional setting with the foundation in 1796 of the Quaker-run YorkRetreat in England.[49]
From the early nineteenth century, as lay-led lunacy reform movements gained influence,[197] ever more state governments in the West extended their authority and responsibility over the mentally ill.[198] Small-scale asylums, conceived as instruments to reshape both the mind and behaviour of the disturbed,[199] proliferated across these regions.[200] By the 1830s, moral treatment, together with the asylum itself, became increasingly medicalised[201] and asylum doctors began to establish a distinct medical identity with the establishment in the 1840s of associations for their members in France, Germany, the United Kingdom and America, together with the founding of medico-psychological journals.[49] Medical optimism in the capacity of the asylum to cure insanity soured by the close of the nineteenth century as the growth of the asylum population far outstripped that of the general population.[a][202] Processes of long-term institutional segregation, allowing for the psychiatric conceptualisation of thenatural course of mental illness, supported the perspective that the insane were a distinct population, subject to mental pathologies stemming from specific medical causes.[199] Asdegeneration theory grew in influence from the mid-nineteenth century,[203] heredity was seen as the central causal element in chronic mental illness,[204] and with national asylum systems overcrowded and insanity apparently undergoing an inexorable rise, the focus of psychiatric therapeutics shifted from a concern with treating the individual to maintaining the racial and biological health of national populations.[205]
Emil Kraepelin (1856–1926) introduced new medical categories ofmental illness, which eventually came intopsychiatric usage despite their basis in behavior rather thanpathology or underlying cause. Shell shock among frontline soldiers exposed to heavy artillery bombardment was first diagnosed by British Army doctors in 1915. By 1916, similar symptoms were also noted in soldiers not exposed to explosive shocks, leading to questions as to whether the disorder was physical or psychiatric.[207] In the 1920ssurrealist opposition to psychiatry was expressed in a number of surrealist publications. In the 1930s several controversial medical practices were introduced including inducing seizures (byelectroshock,insulin or other drugs) or cutting parts of the brain apart (leucotomy orlobotomy). Both came into widespread use by psychiatry, but there were grave concerns and much opposition on grounds of basic morality, harmful effects, or misuse.[208]
In the 1950s newpsychiatric drugs, notably the antipsychoticchlorpromazine, were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such astardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. There was also increasing opposition to the use of psychiatric hospitals, and attempts to move people back into the community on a collaborativeuser-led group approach ("therapeutic communities") not controlled by psychiatry. Campaigns againstmasturbation were done in theVictorian era and elsewhere.Lobotomy was used until the 1970s to treatschizophrenia. This was denounced by theanti-psychiatric movement in the 1960s and later.
It was very difficult for women to become doctors in any field before the 1970s.Elizabeth Blackwell became the first woman to formally study and practice medicine in the United States. She was a leader in women's medical education. While Blackwell viewed medicine as a means for social and moral reform, her studentMary Putnam Jacobi (1842–1906) focused on curing disease. At a deeper level of disagreement, Blackwell felt that women would succeed in medicine because of their humane female values, but Jacobi believed that women should participate as the equals of men in all medical specialties using identical methods, values and insights.[209] Although the majority of medical doctors in theSoviet Union were women, they were paid less than the male dominated factory workers.[210]
Finally in the 19th century, Western medicine was introduced at the local level by Christian medical missionaries from theLondon Missionary Society (Britain), theMethodist Church (Britain) and thePresbyterian Church (US).Benjamin Hobson (1816–1873) in 1839, set up a highly successful Wai Ai Clinic in Guangzhou, China.[211] TheHong Kong College of Medicine for Chinese was founded in 1887 by theLondon Missionary Society, with its first graduate (in 1892) beingSun Yat-sen, who later led the1911 Revolution. TheHong Kong College of Medicine for Chinese was the forerunner of the School of Medicine of theUniversity of Hong Kong, which started in 1911.[citation needed]
Because of the social custom that men and women should not be near to one another, the women of China were reluctant to be treated by male doctors. The missionaries sent women doctors such as Dr.Mary Hannah Fulton (1854–1927). Supported by the Foreign Missions Board of the Presbyterian Church (US) she in 1902 founded the first medical college for women in China, the Hackett Medical College for Women, in Guangzhou.[212]
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European ideas of modern medicine were spread widely through the world by medical missionaries, and the dissemination of textbooks. Japanese elites enthusiastically embraced Western medicine after theMeiji Restoration of the 1860s. However they had been prepared by their knowledge of the Dutch and German medicine, for they had some contact with Europe through the Dutch. Highly influential was the 1765 edition of Hendrik van Deventer's pioneer workNieuw Ligt ("A New Light") on Japanese obstetrics, especially on Katakura Kakuryo's publication in 1799 ofSanka Hatsumo ("Enlightenment of Obstetrics").[213][214] A cadre of Japanese physicians began to interact with Dutch doctors, who introduced smallpox vaccinations. By 1820 Japanese ranpô medical practitioners not only translated Dutch medical texts, they integrated their readings with clinical diagnoses. These men became leaders of the modernization of medicine in their country. They broke from Japanese traditions of closed medical fraternities and adopted the European approach of an open community of collaboration based on expertise in the latest scientific methods.[215]
Kitasato Shibasaburō (1853–1931) studied bacteriology in Germany underRobert Koch. In 1891 he founded the Institute of Infectious Diseases in Tokyo, which introduced the study of bacteriology to Japan. He and French researcherAlexandre Yersin went to Hong Kong in 1894, where; Kitasato confirmed Yersin's discovery that the bacteriumYersinia pestis is the agent of the plague. In 1897 he isolated and described the organism that caused dysentery. He became the first dean of medicine at Keio University, and the first president of the Japan Medical Association.[216][217]
Japanese physicians immediately recognized the values of X-Rays. They were able to purchase the equipment locally from the Shimadzu Company, which developed, manufactured, marketed, and distributed X-Ray machines after 1900.[218] Japan not only adopted German methods of public health in the home islands, but implemented them in its colonies, especially Korea and Taiwan, and after 1931 in Manchuria.[219] A heavy investment in sanitation resulted in a dramatic increase of life expectancy.[220]
The practice of medicine changed in the face of rapid advances in science, as well as new approaches by physicians. Hospital doctors began much more systematic analysis of patients' symptoms in diagnosis.[221] Among the more powerful new techniques were anaesthesia, and the development of both antiseptic and aseptic operating theatres.[222] Effective cures were developed for certain endemic infectious diseases. However, the decline in many of the most lethal diseases was due more to improvements in public health and nutrition than to advances in medicine.[citation needed]
Medicine was revolutionized in the 19th century and beyond by advances in chemistry, laboratory techniques, and equipment. Old ideas of infectious diseaseepidemiology were gradually replaced by advances inbacteriology andvirology.[147]
The Russian Orthodox Church sponsored seven orders of nursing sisters in the late 19th century. They ran hospitals, clinics, almshouses, pharmacies, and shelters as well as training schools for nurses. In the Soviet era (1917–1991), with the aristocratic sponsors gone, nursing became a low-prestige occupation based in poorly maintained hospitals.[223]
Paris (France) and Vienna were the two leading medical centers on the Continent in the era 1750–1914.
In the 1770s–1850s Paris became a world center of medical research and teaching. The "Paris School" emphasized that teaching and research should be based in large hospitals and promoted the professionalization of the medical profession and the emphasis on sanitation and public health. A major reformer wasJean-Antoine Chaptal (1756–1832), a physician who was Minister of Internal Affairs. He created the Paris Hospital, health councils, and other bodies.[224]
Louis Pasteur (1822–1895) was one of the most important founders ofmedical microbiology. He is remembered for his remarkable breakthroughs in the causes and preventions of diseases. His discoveries reduced mortality frompuerperal fever, and he created the firstvaccines forrabies andanthrax. His experiments supported thegerm theory of disease. He was best known to the general public for inventing a method to treat milk and wine to prevent it from causing sickness, a process that came to be calledpasteurization. He is regarded as one of the three main founders ofmicrobiology, together withFerdinand Cohn andRobert Koch. He worked chiefly in Paris and in 1887 founded thePasteur Institute there to perpetuate his commitment to basic research and its practical applications. As soon as his institute was created, Pasteur brought together scientists with various specialties. The first five departments were directed byEmile Duclaux (generalmicrobiology research) andCharles Chamberland (microbe research applied tohygiene), as well as a biologist,Ilya Ilyich Mechnikov (morphological microbe research) and two physicians,Jacques-Joseph Grancher (rabies) andEmile Roux (technical microbe research). One year after the inauguration of the Institut Pasteur, Roux set up the first course of microbiology ever taught in the world, then entitledCours de Microbie Technique (Course of microbe research techniques). It became the model for numerous research centers around the world named "Pasteur Institutes."[225][226]
The First Viennese School of Medicine, 1750–1800, was led by the DutchmanGerard van Swieten (1700–1772), who aimed to put medicine on new scientific foundations—promoting unprejudiced clinical observation, botanical and chemical research, and introducing simple but powerful remedies. When theVienna General Hospital opened in 1784, it at once became the world's largest hospital and physicians acquired a facility that gradually developed into the most important research centre.[227] Progress ended with the Napoleonic wars and the government shutdown in 1819 of all liberal journals and schools; this caused a general return to traditionalism and eclecticism in medicine.[228]
Vienna was the capital of a diverse empire and attracted not just Germans but Czechs, Hungarians, Jews, Poles and others to its world-class medical facilities. After 1820 the Second Viennese School of Medicine emerged with the contributions of physicians such asCarl Freiherr von Rokitansky,Josef Škoda,Ferdinand Ritter von Hebra, andIgnaz Philipp Semmelweis. Basic medical science expanded and specialization advanced. Furthermore, the firstdermatology, eye, as well asear, nose, and throat clinics in the world were founded in Vienna. The textbookLehre von den Augenkrankheiten ofophthalmologistGeorg Joseph Beer (1763–1821) combined practical research and philosophical speculations, and became the standard reference work for decades.[229]
After 1871 Berlin, the capital of the new German Empire, became a leading center for medical research. TheCharité is tracing back its origins to the year 1710. More than half of all German Nobel Prize winners in Physiology or Medicine, includingEmil von Behring,Robert Koch andPaul Ehrlich, worked there. Koch, (1843–1910), was a representative leader. He became famous for isolatingBacillus anthracis (1877), theTuberculosis bacillus (1882) andVibrio cholerae (1883) and for his development ofKoch's postulates. He was awarded theNobel Prize in Physiology or Medicine in 1905 for his tuberculosis findings. Koch is one of the founders ofmicrobiology andmodern medicine. He inspired such major figures as Ehrlich, who discovered the firstantibiotic,arsphenamine andGerhard Domagk, who created the first commercially available antibiotic,Prontosil.[226]
In theAmerican Civil War (1861–65), as was typical of the 19th century, more soldiers died of disease than in battle, and even larger numbers were temporarily incapacitated by wounds, disease and accidents.[230][231] Conditions were poor in theConfederacy, where doctors and medical supplies were in short supply.[232] The war had a dramatic long-term impact on medicine in the U.S., from surgical technique to hospitals to nursing and to research facilities. Weapon development—particularly the appearance ofSpringfield Model 1861, mass-produced and much more accurate than muskets—led to generals underestimating the risks of long range rifle fire; risks exemplified in the death ofJohn Sedgwick and the disastrousPickett's Charge. The rifles could shatter bone forcing amputation and longer ranges meant casualties were sometimes not quickly found. Evacuation of the wounded fromSecond Battle of Bull Run took a week.[233] As in earlier wars, untreated casualties sometimes survived unexpectedly due to maggotsdebriding the wound—an observation which led to thesurgical use of maggots—still a useful method in the absence of effective antibiotics.
The hygiene of the training and field camps was poor, especially at the beginning of the war when men who had seldom been far from home were brought together for training with thousands of strangers. First came epidemics of the childhood diseases of chicken pox, mumps, whooping cough, and, especially, measles. Operations in the South meant a dangerous and new disease environment, bringing diarrhea, dysentery, typhoid fever, and malaria. There were no antibiotics, so the surgeons prescribed coffee, whiskey, and quinine. Harsh weather, bad water, inadequate shelter in winter quarters, poor policing of camps, and dirty camp hospitals took their toll.[234]
This was a common scenario in wars from time immemorial, and conditions faced by the Confederate army were even worse. The Union responded by building army hospitals in every state. What was different in the Union was the emergence of skilled, well-funded medical organizers who took proactive action, especially in the much enlarged United States Army Medical Department,[235] and theUnited States Sanitary Commission, a new private agency.[236] Numerous other new agencies also targeted the medical and morale needs of soldiers, including theUnited States Christian Commission as well as smaller private agencies.[237]
The U.S. Army learned many lessons and in August 1886, it established the Hospital Corps.
Johns Hopkins Hospital, founded in 1889, originated several modern medical practices, includingresidency androunds.
![Robert Koch, (1843–1910), known for his founding, with Pasteur, of modern bacteriology, and a father of modern medicine.[238][239] He provided proofs for the scientific basis of public health.[240]](/mt/?noimg=&dark=on&url=https%3a%2f%2fen.wikipedia.org%2fwiki%2fFile%3aRobertKoch_cropped.jpg)
TheABO blood group system was discovered in 1901 byKarl Landsteiner at theUniversity of Vienna.Landsteiner experimented on his staff, mixing their various blood components together, and found that some people's blood agglutinated (clumped together) with other blood, while some did not. This then lead him identifying three blood groups, ABC, which would later be renamed to ABO.[241] The less frequently found blood groupAB was discovered later in 1902 by Alfred Von Decastello and Adriano Sturli.[242] In 1937Landsteiner andAlexander S. Wiener further discovered the Rh factor (misnamed from early thinking that this blood group was similar to that found inrhesus monkeys) whose antigens further determine blood reaction between people.[242] This was demonstrated in a 1939 case study by Phillip Levine and Rufus Stetson where a mother who had recently given birth had reacted to their partner's blood, highlighting the Rh factor.[243]
Canadian physicianNorman Bethune, M.D. developed a mobileblood-transfusion service for frontline operations in theSpanish Civil War (1936–1939), but ironically, he himself died ofsepsis.[244]
In 1958,Arne Larsson in Sweden became the first patient to depend on anartificial cardiac pacemaker. He died in 2001 at age 86, having outlived its inventor, the surgeon, and 26 pacemakers.
Cancer treatment has been developed withradiotherapy,chemotherapy andsurgical oncology.
X-ray imaging was the first kind ofmedical imaging, and laterultrasonic imaging,CT scanning,MR scanning and other imaging methods became available.
Prosthetics have improved with lightweight materials as well asneural prosthetics emerging in the end of the 20th century.
Oral rehydration therapy has been extensively used since the 1970s to treatcholera and other diarrhea-inducing infections.
As infectious diseases have become less lethal, and the most commoncauses of death in developed countries are nowtumors andcardiovascular diseases, these conditions have received increased attention in medical research.
Starting in World War II,DDT was used as insecticide to combatinsect vectors carryingmalaria, which was endemic in most tropical regions of the world.[245][246][247] The first goal was to protect soldiers, but it was widely adopted as a public health device. In Liberia, for example, the United States had large military operations during the war and the U.S. Public Health Service began the use of DDT for indoor residual spraying (IRS) and as a larvicide, with the goal of controlling malaria in Monrovia, the Liberian capital. In the early 1950s, the project was expanded to nearby villages. In 1953, theWorld Health Organization (WHO) launched an antimalaria program in parts of Liberia as a pilot project to determine the feasibility of malaria eradication in tropical Africa. However these projects encountered a spate of difficulties that foreshadowed the general retreat from malaria eradication efforts across tropical Africa by the mid-1960s.[248]
The1918 influenza pandemic was a global pandemic in the early 20th century that occurred between 1918 and 1920. Sometimes known as Spanish Flu due to popular opinion at the time thinking the flu originated from Spain, this pandemic caused close to 50 million deaths around the world.[249] Spreading at the end ofWorld War I.[250]
Public health measures became particularly important during the1918 flu pandemic, which killed at least 50 million people around the world.[251] It became animportant case study in epidemiology.[252] Bristow shows there was a gendered response of health caregivers to the pandemic in the United States. Male doctors were unable to cure the patients, and they felt like failures. Women nurses also saw their patients die, but they took pride in their success in fulfilling their professional role of caring for, ministering, comforting, and easing the last hours of their patients, and helping the families of the patients cope as well.
Evidence-based medicine is a modern concept, not introduced to literature until the 1990s.
Thesexual revolution included taboo-breaking research inhuman sexuality such as the 1948 and 1953Kinsey reports, invention ofhormonal contraception, and the normalization of abortion and homosexuality in many countries.Family planning has promoted ademographic transition in most of the world. With threateningsexually transmitted infections, not least HIV, use ofbarrier contraception has become imperative. The struggle against HIV has improvedantiretroviral treatments.
Tobacco smoking as a cause of lung cancer was first researched in the 1920s, but was not widely supported by publications until the 1950s.
Cardiac surgery was revolutionized in 1948 as open-heart surgery was introduced for the first time since 1925. In 1954Joseph Murray,J. Hartwell Harrison and others accomplished the firstkidney transplantation.Transplantations of other organs, such as heart, liver and pancreas, were also introduced during the later 20th century. The first partialface transplant was performed in 2005, and the first full one in 2010. By the end of the 20th century,microtechnology had been used to create tiny robotic devices to assistmicrosurgery using micro-video andfiber-optic cameras to view internal tissues during surgery with minimally invasive practices.[253]Laparoscopic surgery was broadly introduced in the 1990s. Natural orifice surgery has followed.
During the 19th century, large-scale wars were attended withmedics andmobile hospital units which developed advanced techniques for healing massive injuries and controlling infections rampant in battlefield conditions. During theMexican Revolution (1910–1920), GeneralPancho Villa organized hospital trains for wounded soldiers. Boxcars markedServicio Sanitario ("sanitary service") were re-purposed as surgical operating theaters and areas for recuperation, and staffed by up to 40 Mexican and U.S. physicians. Severely wounded soldiers were shuttled back to base hospitals.[254]
Thousands of scarred troops provided the need for improvedprosthetic limbs and expanded techniques in plastic surgery orreconstructive surgery. Those practices were combined to broadencosmetic surgery and other forms ofelective surgery.
From 1917 to 1932, theAmerican Red Cross moved into Europe with a battery of long-term child health projects. It built and operated hospitals and clinics, and organized antituberculosis and antityphus campaigns. A high priority involved child health programs such as clinics, better baby shows, playgrounds, fresh air camps, and courses for women on infant hygiene. Hundreds of U.S. doctors, nurses, and welfare professionals administered these programs, which aimed to reform the health of European youth and to reshape European public health and welfare along American lines.[255][256][257]
The advances in medicine made a dramatic difference for Allied troops, while the Germans and especially the Japanese and Chinese suffered from a severe lack of newer medicines, techniques and facilities. Harrison finds that the chances of recovery for a badly wounded British infantryman were as much as 25 times better than in the First World War. The reason was that:
During thesecond World War,Alexis Carrel andHenry Dakin developed theCarrel-Dakin method of treating wounds with an irrigation, Dakin's solution, agermicide which helped preventgangrene.[259]
The War spurred the usage ofRoentgen'sX-ray, and theelectrocardiograph, for themonitoring of internal bodily functions. This was followed in the inter-war period by the development of the first anti-bacterial agents such as thesulpha antibiotics.
Unethicalhuman subject research, and killing of patients with disabilities, peaked during the Nazi era, withNazi human experimentation andAktion T4 duringthe Holocaust as the most significant examples. Many of the details of these and related events were the focus of theDoctors' Trial. Subsequently, principles ofmedical ethics, such as theNuremberg Code, were introduced to prevent a recurrence of such atrocities.[260] After 1937, the Japanese Army established programs of biological warfare in China. InUnit 731, Japanese doctors and research scientists conducted large numbers of vivisections and experiments on human beings, mostly Chinese victims.[261]
TheWorld Health Organization was founded in 1948 as a United Nations agency to improveglobal health. In most of the world,life expectancy has improved since then, and was about 67 years as of 2010[update], and well above 80 years in some countries.Eradication of infectious diseases is an international effort, and several newvaccines have been developed during the post-war years, against infections such asmeasles,mumps, several strains ofinfluenza andhuman papilloma virus. The long-known vaccine againstSmallpox finally eradicated the disease in the 1970s, andRinderpest was wiped out in 2011.Eradication of polio is underway.Tissue culture is important for development of vaccines. Despite the early success of antiviral vaccines and antibacterial drugs,antiviral drugs were not introduced until the 1970s. Through the WHO, the international community has developed a response protocol against epidemics, displayed during theSARS epidemic in 2003, theInfluenza A virus subtype H5N1 from 2004, theEbola virus epidemic in West Africa and onwards.
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The discovery ofpenicillin in the 20th century byAlexander Fleming provided a vital line of defence against bacterical infections that, without them, often cause patients to suffer prelonged recovery periods and highly increased chances of death. Its discovery and application within medicine allowed previously impossible treatments to take place, includingcancer treatments,organ transplants, toopen heart surgery.[262] Throughout the 20th century, though, their overprescribed use to humans,[263] as well as to animals that need them due to the conditions ofintensive animal farming,[264] has led to the development ofantibiotic resistant bacteria.[262]
The early 21st century, facilitated by extensive global connections, international travel, and unprecedented human disruption of ecological systems,[265][266] has been defined by a number of noval as well as continuing globalpandemics from the 20th century.[267]
TheSARS 2002 to 2004outbreak affected a number of countries around the world and killed hundreds. This outbreak gave rise to a number of lessons learnt from viral infection control, including more effective isolation room protocols to better hand washing techniques for medical staff.[268] A mutated strain ofSARS would go on to develop intoCOVID-19, causing the future COVID-19 pandemic. A significantinfluenza strain,H1N1, caused a furtherpandemic between 2009 and 2010. Known as swine flu, due to its indirect source from pigs, it went on to infect over 700 million people.[269]
The continuingHIV pandemic, starting in 1981, has infected and led to the deaths of millions of people around the world.[270] Emerging and improvedpre-exposure prophylaxis (PrEP) andpost-exposure prophylaxis (PEP) treatments that aim to reduce the spread of the disease have proven effective in limiting the spread of HIV[271] alongside combined use ofsafe sex methods,sexual health education,needle exchange programmes, and sexual health screenings.[272] Efforts to find aHIV vaccine are ongoing whilehealth inequities have left certain population groups, liketrans women,[273] as well as resource limited regions, likesub-Saharan Africa, at greater risk of contracting HIV compared with, for example,developed countries.[274]
The outbreak ofCOVID-19, starting in 2019, and subsequent declaration of theCOVID-19 pandemic by theWHO[275] is a major pandemic event within the early 21st century. Causing global disruptions, millions of infections and deaths, the pandemic has caused suffering throughout communities. The pandemic has also seen some of the largest logistical organisations ofgoods, medical equipment, medical professionals, and military personnel sinceWorld War II that highlights its far-reaching impact.[276][277]
The rise ofpersonalised medicine in the 21st century has generated the possibility to develop diagnosis and treatments based on the individual characteristics of a person, rather than through generic practices that defined 20th century medicine. Areas likeDNA sequencing,genetic mapping,gene therapy, imaging protocols,proteomics,stem cell therapy, and wireless health monitoring devices[278] are all rising innovations that can help medical professionals fine tune treatment to the individual.[279][280]
Remote surgery is another recent development, with the transatlanticLindbergh operation in 2001 as a groundbreaking example.
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Racism has a long history in how medicine has evolved and established itself, both in terms of racism experience upon patients, professionals, and wider systematic violence within medical institutions and systems.[281][282] See:medical racism in the United States,race and health, andscientific racism.
Women have always served as healers and midwives since ancient times. However, the professionalization of medicine forced them increasingly to the sidelines. As hospitals multiplied they relied in Europe on orders of Roman Catholic nun-nurses, and German Protestant and Anglican deaconesses in the early 19th century. They were trained in traditional methods of physical care that involved little knowledge of medicine.
{{cite journal}}: CS1 maint: DOI inactive as of July 2025 (link)Constructive approaches to divining the potential usefulness of traditional therapies are to be welcomed. But it seems problematic to apply a brand new technique, largely untested in the clinic, to test the veracity of traditional Chinese medicine, when the field is so fraught with pseudoscience. In the meantime, claims made on behalf of an uncharted body of knowledge should be treated with the customary skepticism that is the bedrock of both science and medicine.
These pseudoscientific theories may ... confuse metaphysical with empirical claims (e.g. ... Ayurvedic medicine)(subscription required)
Ayurveda, a traditional Indian medicine, is the subject of more than a dozen, with some of these 'scholarly' journals devoted to Ayurveda alone ..., others to Ayurveda and some other pseudoscience. ... Most current Ayurveda research can be classified as 'tooth fairy science,' research that accepts as its premise something not scientifically known to exist. ... Ayurveda is a long-standing system of beliefs and traditions, but its claimed effects have not been scientifically proven. Most Ayurveda researchers might as well be studying the tooth fairy. The German publisher Wolters Kluwer bought the Indian open-access publisher Medknow in 2011....It acquired its entire fleet of journals, including those devoted to pseudoscience topics such asAn International Quarterly Journal of Research in Ayurveda.
{{cite book}}:ISBN / Date incompatibility (help)By writing a monograph on 'Diseases in Children' he may also be looked upon as the father of paediatrics.
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