Medicine’s Evolution: Healing through the ages
A Journey into the History of Medical Breakthroughs!
Discover the captivating story of medicine, an integral part of human existence that has shaped our lives in profound ways. From ancient healing practices steeped in mysticism to groundbreaking scientific discoveries, the history of medicine is a compelling journey that spans the ages. (One of the reasons this article took time in publishing).
In this comprehensive article, we embark on a chronological exploration, delving into the origins and milestones of medicine from its earliest beginnings to the cutting-edge advancements of today.
Do not worry, I have made conscious efforts to keep the article free from jargon and medicine lingo (there are too many!).
Medicine in Caves
In prehistory — the period before the writing systems were developed, a very primitive form of medicine existed. The common practices and methods used in brief were:
Herbal treatments: Living close to nature, through trial-and-error (and by accidents), different plants and their parts were identified for treating simple wounds and for getting relief from constipation.
Use of earth and clays: Eating and applying mud, chalk, and various other soils for potentially providing nutrition, and healing wounds was common in those times. This could be said as the first form of medicine.
Trepanation: The oldest surgical procedure known. The process involved drilling a hole into the skull (ouch!) to treat epilepsy, head wound, mental disorders, headache, or releasing pressure from the blood buildup after a head injury.
Dentistry: Archaeologists have found drilled and filled tooth dating back to 13000 years ago where the tooth was filled with a mix of bitumen, hair, and plant fiber. Evidence of drilled-and-filled teeth has been found in several places in the world.
You can see from the above that the willingness to solve illness through a variety of means was there in humans right from the start. No matter, surgeries, like Trepanation had a survival rate of less than 40% but gradual incremental improvements and learning, are what humans are known for.
Medicine in the Bronze & Iron Ages
Moving from the previous stone age, we see a lot of fresh developments in the field of medicine during the Bronze and Iron Ages.
The Oldest Books & The First Doctors
The oldest books in medical science history provide a diverse and valuable glimpse into the development of medicine.
Egypt
The Kahun Gynaecological Papyrus treats women’s complaints, including problems with conception. Dating to 1800 BC, it is the oldest surviving medical text of any kind while Edwin Smith Papyrus from 1600 BCE offers rational surgical approaches for treating 48 different types of injuries. It is the oldest written text mentioning enemas.
Another Egyptian text Ebers Papyrus from 1550 BCE, blends magical formulas with scientific knowledge, covering various medical topics. It recognized the heart as the center of blood supply, provided treatment for asthma, tumors, and abscesses, and also had chapters on contraception, diagnosis of pregnancy, dentistry, and bone-setting.
The world’s earliest known physician Hesy-Ra, also called as the Chief of Dentists and Physicians comes from Egypt. Not only this, the world’s earliest known women physician also Peseshet, also practiced in Ancient Egypt with the title of Lady Overseer of the Lady Physicians.
Babylon
The Diagnostic Handbook Sakikkū, from 1050 BCE, presents 300 case studies in a scientific symptoms-diagnosis-prognosis format with around 3000 symptoms logically arranged. The book was written by Esagil-kin-apli, the Chief scholar of the Babylonian king of his time.
India
The Sushruta Samhita composed by Sushruta in 600 BCE, details surgical procedures like cataract surgery and rhinoplasty — a form of plastic surgery on the nose. Sushruta is often considered one of the founders of surgery. It was one of the first texts to describe the use of anesthesia and antiseptics, kidney stone extractions, sutures, and the extraction of foreign objects.
Ancient poster by Shushruta, given in Sushruta Samhita showing surgical instruments, in which most of them still continue to exist today.
The Charak Samhita composed by Charaka in 100 BCE was a compilation of Ayurvedic treatments and provided the foundation of Ayurvedic medicine. These two texts along with Bhela-samhita served as the foundation of Indian Ayurveda.
China
The Huangdi Neijing, an ancient Chinese medical text from around 200 BCE, is a foundational source for ancient Chinese medicine. It introduced acupuncture techniques and influenced medical practices for over two thousand years.
Together, these ancient texts showcase the evolution of medical knowledge, from Babylon to Egypt, India, and China, leaving a lasting impact on the field of medicine.
Humorism and Greek Medicine
The theory of humors dominated Western medicine till the 19th century. The theory proposed that the human body was governed by four bodily fluids or humors: blood, phlegm, yellow bile, and black bile. These humors were believed to determine a person’s physical and mental health.
According to the humoral theory, good health was achieved when the four humors were in balance, whereas an imbalance or excess of any humor led to illness.
The four humors as depicted in an 18th-century woodcut: phlegmatic, choleric, sanguine and melancholic
Treating an imbalance of the humors was approached through various methods, namely:
Bloodletting — intentionally removing an amount of blood from the body, Expectorating — removing mucus from lungs/throat and purging — emptying the stomach through induced vomiting.
For obvious reasons, all of these methods have become obsolete and fallen out in favor of modern science.
Hippocrates
Hippocrates, known as the “Father of Modern Medicine”, established a medical school at Cos (a Greek Island) and is the most important figure in ancient Greek medicine. He led to the formulation of the humoral theory and is also credited with greatly advancing the systematic study of clinical medicine, summing up the medical knowledge of previous schools, and prescribing practices for physicians to be followed under various circumstances.
Illustration of the story of Hippocrates refusing the presents of the Achaemenid Emperor Artaxerxes, who was asking for his services. Painted by Girodet, 1792.
Miasma Theory
Another theory advocated by Hippocrates was that diseases were caused by noxious and foul-smelling vapors, or miasmas, that originated from decaying organic matter, sewage, or other environmental sources. These miasmas were believed to contaminate the air and, when inhaled, would result in illness and epidemics. Miasma theory attributed the spread of diseases like cholera, malaria, and the bubonic plague to the presence of these harmful vapors.
The Hippocratic Oath
A seminal document on the ethics of medical practice is attributed to Hippocrates. It is the earliest expression of medical ethics establishing several principles of medical ethics which remain of paramount significance today. These include the principles of medical confidentiality and non-maleficence. While the Oath is rarely used in its original form today, it serves as a foundation for other, similar oaths and laws that define good medical practice and morals.
Galen
Galen was a renowned Greek physician who made significant contributions to the fields of anatomy, physiology, and pharmacology in 200 CE. Galen’s work focused on reconciling the teachings of Hippocrates with his own observations and experiments. He also emphasized the importance of humoral theory and was one of the first physicians to give importance to direct observation, dissection, and vivisection.
He performed many audacious operations — including brain and eye surgeries — that were not tried again for almost two thousand years. His theories dominated all medical studies for nearly 1500 years and had a profound impact on the development of medicine.
Medical Schools and Hospitals
From 400 CE onwards, the Eastern Roman Empire (aka Byzantine Empire) played the important role of preserving the previous works of Greeks and others. Paulus Aegineta, a Greek Physician published the Medical Compendium in Seven Books, in the 7th century which remained in use as a standard textbook for the following 800 years. For his works, he is often considered the “Father of Early Medical Writing”.
In the 10th century CE, the first known attempt to separate conjoined twins was performed. When one of the twins died skilled doctors separated them cleverly at the line of connection with the hope of saving the surviving one but after living three days he died also.
The fact that the second person survived for even a few days showed that it was at least partly successful. There would not be another case of conjoined twins being separated until the year 1689 (by Johannes Fatio).
Islamic Golden Age & The First Hospitals
During the early medieval period, around the 8th to 9th centuries, Islamic civilization played a crucial role in the development of hospitals as we know them today. A big contributor to this was the transmission of Greek knowledge in the Arabic language. Many Islamic physicians were heavily influenced by the works of Greek scholars of Alexandria and Egypt and were able to further expand on those texts to produce new medical pieces of knowledge.
Persian physician al-Rāzi was one of the first to question the Greek theory of humorism. He has been often regarded as the doctor’s doctor, the father of pediatrics, and a pioneer of ophthalmology. Some volumes of his works Al-Mansuri, namely “On Surgery” and “A General Book on Therapy”, became part of the medical curriculum in European universities.
The Islamic hospitals in those times were called “Bimaristan”. Al-Wahid Bimarstan, the first Islamic hospital, was built in the 8th century in Damascus.
Many of the features that are still used in hospitals, such as an emphasis on hygiene, a staff fully dedicated to the care of patients and separation of individual patients from each other, specialized wards for different medical conditions, systematic record-keeping, and educational programs for medical students were developed in Islamicate hospitals long before they came into practice in Europe (where hospitals were still the places of religion rather than institutions of science.)
Moving Forward with Engineers & Scientists
During the early modern period (15th to 18th centuries), several key inventions and discoveries significantly shaped the development of medicine and healthcare. Let’s discuss the important ones.
Printing Press — invented in 1450, this is often considered one of the most significant inventions of mankind, and its inventor Johannes Gutenberg is described as the “man of the millennium”. His design directly impacted the mass spread of books across Europe, causing an information revolution. For the field of medicine, this meant more translations and prints of medical texts and treatises allowing for wider sharing of medical information and fostering the spread of new ideas.
Microscope — Antonie van Leeuwenhoek designs a single-lens microscope in 1676 and achieves up to 300 times magnification. In 1677 he identifies “animalcules”, which we now know as microorganisms. He becomes the first to document microscopic observations of muscle fibers, bacteria, spermatozoa, and red blood cells, and among the first to see blood flow in capillaries. Being the first person to directly observe microorganisms, he is often referred as the father of microbiology.
A replica of a microscope by Van Leeuwenhoek. Credit: Jeroen Rouwkema
Blood Circulation — William Harvey, an English physician, makes a groundbreaking discovery in 1628 demonstrating the circulation of blood in the human body in his publication “De Motu Cordis”. This discovery lays the foundation for modern physiology and understanding of the cardiovascular system.
Thermometer — Galileo Galilei invents the first thermoscope, a device without scales to detect changes in temperature without providing a numerical reading.
In 1612, Santorio Santorio (yes twice) improves upon Galileo’s work by adding a graduated scale, allowing for more precise and quantitative measurements of temperature. Santorio invents several medical devices and goes on to be regarded as the father of modern quantitative experimentation in medicine.
Study of Metabolism — Over the course of thirty years, Santorio (yes, again!), meticulously uses a chair device to weigh not only himself but also everything he eats and drinks, along with his urine and feces. Comparing the weight of his intake to that of his waste products, he finds that the latter is significantly smaller, as he has excreted only 3 pounds of waste for every eight pounds of food consumed.
His experiments and study lead to the origin of weight measurement in medicine and also earns him the tag of the father of experimental physiology.
Vaccination — In 1796, an English doctor named Edward Jenner decides to investigate a widespread belief that if someone had caught cowpox, they would be protected from the more dangerous smallpox disease.
To test this idea, he takes some cowpox vesicles from a milkmaid named Sarah Nelmes and uses them to infect an eight-year-old boy named James Phipps. Two months later, Jenner exposes the boy to smallpox, but surprisingly, the boy does not develop the illness.
Jenner is often called “the father of immunology”, and his work is said to have saved “more lives than any other man”.
Homeopathy
In the late 18th century, Samuel Hahnemann, a German physician while translating a medical treatise into German came across a theory that the bark of cinchona tree cured malaria because it was bitter. Hahnemann ingested some bark specifically to investigate what would happen. He experienced fever, shivering, and joint pain: symptoms similar to those of malaria itself.
From this, Hahnemann came to believe that all effective drugs produce symptoms in healthy individuals similar to those of the diseases that they treat. This “like cures like” was the founding principle of this branch of alternative medicine — homeopathy.
Hahnemann developed the process of “potentization,” involving dilution and succussion, to enhance a substance’s healing properties while minimizing toxicity. In 1810, he published his influential work “Organon of Medicine,” outlining the fundamental principles of homeopathy. The practice gained popularity in Europe during the 19th century and spread to various parts of the world.
Despite its widespread use and dedicated followers, homeopathy faces criticism from conventional medicine due to its departure from scientific understanding and lack of proven efficacy.
Later works by other scientists showed that that the bark of cinchona tree cures malaria because it contains quinine, which kills the parasite that causes the disease.
Modern Times: Evidence-based medicine (1800s to now)
Germ Theory
Till the 19th century, the humor theory from the times of Hippocrates and Galen was in prominence. The invention of the microscope, and subsequent observations of microorganisms lead to the start of a new era.
Many people contributed directly or indirectly. In 1847 in Vienna, Ignaz Semmelweis dramatically reduced the death rate of new mothers (due to childbed fever) by requiring physicians to clean their hands before attending childbirth. Then Louis Pasteur’s experiments around the same time established the link between microorganisms and fermentation, while Robert Koch’s work in the late 19th century identified specific germs causing diseases.
Koch’s postulates solidified the germ theory, demonstrating the direct connection between germs (microorganisms) and illnesses. Acceptance of the germ theory brought significant advancements, such as pasteurization, improved hygiene, and the development of antibiotics and vaccines.
Anesthesia
Throughout recorded history, humans have tried several things for the purpose of general anesthesia (a method of medically inducing loss of consciousness that renders a patient unarousable even with painful stimuli). Alcohol and herbs were common in the past, although partially effective.
Local anesthetics were used in Inca civilization where shamans (religious practitioners) chewed coca leaves and performed operations on the skull while spitting into the wounds they had inflicted to anesthetize.
In the late 18th century, the discovery of nitrous oxide (laughing gas) by Sir Humphry Davy laid the groundwork for modern anesthesia. On 14 November 1804, Hanaoka Seishū, a Japanese doctor, became the first person to successfully perform surgery using general anesthesia which was based on a herbal formula that he named tsūsensan.
The next breakthrough came in the mid-19th century when William T.G. Morton demonstrated successful ether anesthesia, followed by James Young Simpson’s introduction of chloroform.
You can appreciate the importance of these developments by understanding that in past many patients chose “certain death” rather than undergo surgery, largely because of the associated pain.
X-ray
Wilhelm Conrad Roentgen, a German physicist, accidentally discovered X-rays in 1895 while experimenting with cathode ray tubes. He observed that these mysterious rays could penetrate materials and create shadow images on photographic plates, leading to the birth of X-ray technology.
He named them “X-rays” with “X” signifying the unknown nature of the radiation. Very soon X-rays found medical applications for non-invasive imaging of internal structures in the human body.
Stethoscope
This common and easily recognizable instrument was invented in France in 1816 by René Laennec. The invention story is a good example of how a simple necessity led to an important invention.
Laennec, while examining a young female patient with symptoms of heart disease, felt comfortable and awkward placing his ear directly onto a woman’s chest in order to listen to her heart. To overcome this challenge, he rolled up a piece of paper and placed one end on the patient’s chest and the other end near his ear.
This improvised device allowed him to hear the sounds more clearly, as the paper acted as an amplifier. Amazed by the sound clarity, he refined the design by using a wooden cylinder, creating the first version of the stethoscope in 1819.
The word “stethoscope” originates from two Greek words, “stethos” (chest) and “skopein” (to look into or examine).
ECG (Electrocardiogram)
In 1872, British physiologist Augustus Waller was among the first to demonstrate that the electrical activity of the heart could be measured by attaching electrodes to the skin. He created the first ECG machine with surface electrodes. (The electrical activity is basically due to the flow of charged ions across cell membranes).
In 1887, the Dutch physiologist Willem Einthoven developed the first practical ECG machine. This instrument allowed for a more precise recording of the electrical signals produced by the heart, providing detailed graphical representations of the heart’s electrical activity. Einthoven’s work laid the foundation for modern ECG and earned him the Nobel Prize in Medicine in 1924.
Initially, Waller did not think electrocardiograms would be useful in hospitals. Many other physiologists convinced him otherwise and Waller went on to publish a study of over 2000 traces of heart conditions.
Blood groups and transfusion
In 1901, Karl Landsteiner, an Austrian immunologist, made the groundbreaking discovery that some people’s blood clumped together with other blood, whilst some did not. He identified three blood groups ABC, which would later be renamed ABO. The less common AB group was discovered a year later by Alfred Von Decastello and Adriano Sturli.
Later, Landsteiner and his colleagues also discovered the Rh factor (Rhesus factor) in 1940, further categorizing blood into Rh-positive or Rh-negative. The term Rh factor comes from Rhesus monkeys from which this particular protein was identified.
Till the late 19th century, blood transfusions were risky and many resulted in the death of the patient due to incompatibility and coagulation of the blood. Due to the high risk, it was often considered the last resort even by trained doctors. Only after the discovery of blood groups and understanding of blood compatibility, the field saw a great improvement and success in the blood transfusion process.
First Antibiotics
An antibiotic is a type of antimicrobial substance active against bacteria.
In 1928, Scottish bacteriologist Alexander Fleming accidentally discovered penicillin. While studying bacteria, he noticed that a mold called Penicillium notatum had contaminated one of his Petri dishes, and the bacteria around the mold seemed to be killed. He identified this mold as a potent antibacterial agent and named it penicillin.
However, the extraction of penicillin from the mold and using it as a medicine took another 10 years. Australian pharmacologist Howard Florey and his team are credited for developing penicillin into a usable form. They successfully treated the first human patient with penicillin in 1941.
Medicines
While many medicines have interesting origin stories, it won’t be possible to discuss all of them. It is worthwhile to consider the three popular ones.
Aspirin — Aspirin’s history dates back to ancient times when willow bark was used to relieve pain and inflammation. However, the active ingredient, salicylic acid, was not isolated until the late 19th century. In the 1890s, chemists Felix Hoffmann and Arthur Eichengrün at the German company Bayer successfully synthesized a stable and purified form of acetylsalicylic acid, creating the modern aspirin we know today.
You can appreciate the work done in ancient times, by realising that many of the current allopathic medicines have origin in plants and herbs. Quinine (cinchona tree), Lovastatin (red yeast rice), Morphine (opium poppy), Taxol (Pacific yew tree) are some examples.
Paracetamol — This common medicine was synthesized in 1877, but it took more than 70 years for the usefulness of this medicine to be correctly realized. First, it was tested on humans 10 years after its synthesis in 1887 by Joseph von Mering. Surprisingly von Mering wrote a paper reporting on the clinical results of paracetamol with phenacetin and claimed that paracetamol produced a slightly harmful condition in the blood.
Paracetamol was then quickly discarded in favor of phenacetin. Von Mering’s claims remained essentially unchallenged for half a century until 1949 when another paper was published highlighting that phenacetin also produced the same condition in the blood which altogether was happening for completely different reasons!
This led to the re-birth of the medicine and it was remarketed in the United States in 1950 under the name Triagesic, a combination of paracetamol, aspirin, and caffeine.
Insulin — The discovery of insulin is attributed to Frederick Banting, a Canadian medical scientist, who was investigating the role of the pancreas in diabetes. In 1921, Banting and his colleague Charles Best successfully isolated insulin from the pancreas of dogs and used it to treat diabetic dogs, demonstrating its ability to reduce high blood sugar levels.
In 1922, the first human clinical trial was conducted on a 14-year-old boy with severe diabetes, and the results were remarkable, leading to the widespread use of insulin to manage diabetes effectively.
Before insulin was made available for medical use, being diagnosed with Type 1 diabetes was a death sentence. Death happened quite quickly, usually within months, and sometimes within weeks or days.
Exploring Medical Controversies
Dr. William Beaumont and his patient, Alexis St. Martin
In 1822, Alexis St. Martin, a young French-Canadian, suffered a severe gunshot wound to his stomach, leaving him with a fistula, an abnormal connection between the outside skin and the inner stomach lining.
Dr. William Beaumont, an American army surgeon attended to Martin’s injury. To everyone’s surprise, the wound did not heal completely, creating an open hole in his stomach that allowed direct observation and access to the digestive processes within.
Intrigued by this rare opportunity, Dr. Beaumont saw an opportunity for groundbreaking medical research. Over several years, he meticulously conducted a series of experiments and observations on St. Martin’s stomach, introducing various foods and liquids through the fistula and analyzing their effects on digestion. These studies provided significant insights into the human digestive system, including the stomach’s acid secretion and its role in breaking down food.
The knowledge gained from the experiments with Alexis St. Martin contributed to advancements in medical understanding and laid the foundation for modern gastroenterology. Dr. Beaumont published his findings in 1833 in a book titled “Experiments and Observations on the Gastric Juice and the Physiology of Digestion.”
Sulfanilamide Elixir Incident
In 1937, a pharmaceutical company named S.E. Massengill Company produced a new medication called Sulfanilamide elixir, intended to treat bacterial infections. However, instead of using a safe solvent to dissolve the drug, the company used diethylene glycol, a poisonous substance commonly used in antifreeze. This decision was made without any prior safety testing or consideration of the potential risks.
As a result, when patients took the Sulfanilamide elixir, the diethylene glycol caused severe poisoning and led to a significant number of deaths. The victims suffered agonizing symptoms, including kidney failure, severe vomiting, and convulsions.
The incident quickly caught public attention, leading to widespread outrage and demands for better regulation and oversight of the pharmaceutical industry. In response to this, the U.S. Congress passed the Federal Food, Drug, and Cosmetic Act in 1938. This landmark legislation mandated that drug companies must conduct proper safety testing before releasing medications to the market, ensuring the safety of patients and preventing similar tragedies in the future.
War crimes and research
War crimes and medical research have been intertwined in some dark chapters of history, where unethical and inhumane experiments were conducted on prisoners and vulnerable populations during times of conflict.
One of the most notorious examples occurred during World War II when the Nazi regime under Adolf Hitler conducted horrific medical experiments on prisoners in concentration camps. These experiments were conducted without the subjects’ consent and often involved inflicting severe pain and suffering.
One infamous figure associated with these war crimes was Josef Mengele, known as the “Angel of Death.” He conducted cruel and deadly experiments on inmates, including twins and children, in an attempt to further the Nazi ideology of racial superiority. These experiments involved gruesome surgeries, infections, and other torturous procedures.
The Imperial Japanese Army was also responsible for heinous medical experiments during World War II, particularly during the Japanese occupation of China. Unit 731, a secretive military unit, conducted inhumane experiments on prisoners, such as vivisection, infecting individuals with diseases, and testing chemical and biological weapons.
These atrocities were exposed after the war, leading to the Nuremberg Trials and the establishment of the Nuremberg Code, which laid the foundation for modern medical ethics. The Nuremberg Code emphasizes the importance of informed consent and protecting human subjects from harm during medical research.
Thalidomide Tragedy
The Thalidomide tragedy was the “biggest man-made medical disaster ever,” that occurred in the late 1950s and early 1960s. Thalidomide, a drug developed by a German pharmaceutical company, was introduced as a sedative and anti-nausea medication for pregnant women. It was also prescribed to alleviate symptoms of morning sickness in expectant mothers.
However, unknown to medical professionals at the time, Thalidomide had severe teratogenic effects, meaning it could cause severe birth defects when taken during pregnancy. Many pregnant women who took the drug gave birth to children with limb deformities, particularly shortened or missing limbs.
The tragedy unfolded as more than 10,000 babies were born with these birth defects, leaving families and communities devastated. The extent of the damage was heartbreaking, and many of the affected children faced lifelong challenges due to their physical disabilities.
The Thalidomide disaster prompted a significant overhaul in drug regulation and testing practices worldwide. Governments and health authorities strengthened drug approval processes, implementing rigorous testing protocols to ensure the safety of medications, especially for pregnant women.
A Bright Future Lies Ahead
Medicine has achieved remarkable feats that once seemed beyond imagination.
Organ transplantation stands as a shining beacon of hope. Since the first successful kidney transplant in 1954, the field has expanded to include heart, liver, lung, and other organ transplants.
Plastic surgery has empowered patients by restoring physical appearance and boosting self-confidence. The Lindbergh operation that was carried out by a team of French surgeons located in New York on a patient in Strasbourg, France, in 2001 has shown the potential of remote surgery in bridging the geographical gaps.
Prosthetics have become sophisticated devices, offering amputees newfound mobility and independence. Medicine’s progress extends to animals as well. Veterinary medicine has made incredible strides, ensuring our furry friends lead healthier, happier lives.
The future of medicine holds exciting possibilities. Hibernation and anti-aging, once confined to science fiction, could revolutionize critical care. We still have an ongoing fight against cancer and AIDS, which when solved will save millions of people worldwide.
Reflecting on the past, we are reminded of human resilience. From ancient remedies to cutting-edge technologies, medicine has evolved, guided by the noble pursuit of healing. How the work from different fields intersects and crosses each other paths baffles me all the time. (Just imagine medicine without the invention of a “lens” that led to the microscope).
I hope you enjoyed this article on the history of medicine. When I had finalized this topic, I had no idea this would become the longest article of Human Work History, to date. And still, there were so many sub-topics that I had to skip.
Feel free to ask any questions or share your thoughts on this article or any feedback you have. This publication is made for you!
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