The Medicine Book Big Ideas Simple Explai - Dorling Kindersley

Here is a summary of the major ideas covered in The Medicine Book:

• Ancient and medieval medicine: prehistoric shamans, Ayurveda, Chinese medicine, Egyptian medicine, Greek medicine, Islamic medicine, medieval European medicine and surgery. Key ideas include balancing the four humours, herbal remedies, and the importance of hygiene and diet.

• The scientific revolution: William Harvey describes blood circulation, nosology creates a classification of diseases, scientific surgery develops, and battlefield medicine improves triage.

• Cells and microbes: the cell is identified as the basic unit of life, germ theory establishes the role of microbes in disease, and antiseptics are used in surgery. Key discoveries include microscopy, vaccination, and anaesthesia.

• Vaccines, serums, and antibiotics: vaccination, the discovery of blood groups, antiseptics, and the first antibiotics are developed. Major diseases tackled include smallpox, rabies, diphtheria, and syphilis.

• Hormones and the nervous system: the role of hormones and the nervous system in regulating the body is established. Insulin is discovered and used to treat diabetes. Psychoanalysis is developed by Freud.

• Global health: the World Health Organization is formed, dialysis allows kidney transplants, steroids and chemotherapy are used to treat disease, and screening programs identify diseases early. Ultrasound and lithium are introduced.

• Genetics and technology: DNA is discovered, radiation is used to diagnose and treat disease, viruses are identified, and new technologies like electroencephalography emerge. Key ideas include the role of genetics in health and disease.

The key thread is the development of increasing scientific understanding of health and disease, supported by new technologies. This allows major advances in surgery, public health, genetics, and drug development.

Here is a timeline of some major events in ancient and medieval medicine:

lissionar y monks br

ing me

such as trepanation (cutting into the

disease. In India and China, ancient

Sumerians and later the Babylonians hanized m

skull to relieve pressure or treat seizures) point to traditions of systematic medical practices

comprehensive medical knowledge and

in Mesopotamia (modern Iraq) developed complex systems of medicine and therapeutics.

techniques emerged around this time.

the use of medical practices dating back thousands of years. Skulls from around 6000 BCE found in Europe and Asia show evidence of

epeate

In ancient Egypt, medicine was closely tied Meanwhile, Christianity spreads across the Roman

Early systems of medicine

to religious beliefs. Physicians including Imhotep Empire, and Christian monasteries become centers In ancient India, the Ayurvedic system of medicine were also priests. Medical knowledge was recorded for healing and medical education. With the fall of the arose around 1500 BCE, based on ideas of balance

in documents like the Edwin Smith Papyrus. The Roman Empire, much of this learning is lost in Europe, between mind and body. The physician Sushruta Egyptians were skilled in areas like anatomy, but retained and built on in the Islamic world.

øcompiled surgical methods in a medical text,

diagnosis, and wound care.

including complex procedures like rhinoplasty.

The ancient Greeks made notable contributions In China, the philosophy of yin and yang, and the to medicine. Hippocrates rejected superstition and

idea of energy meridians in the body, underpin

insisted disease has natural causes. His followers

traditional Chinese medicine. Texts like the Huangdi

developed some of the first medical ethics. Physicians Neijing codified acupuncture, herbal treatments, like Galen studied anatomy and documented their

and other techniques. These approaches emphasized

findings. The Romans advanced surgical techniques prevention of disease and harmony between the

through treating war wounds, and catalogs like De

individual, environment, and cosmos.

Materia Medica listed medicinal plants and herbs.

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ANCIENT AND MEDIEVAL MEDICINE 17

The Islamic Golden Age and European Middle Ages After the fall of the Roman Empire, much ancient medical knowledge was preserved and expanded in the Islamic world. Scholars translated Greek and Roman texts, added new information on medicine and surgery, and built hospitals. Key figures include Rhazes, Avicenna, and Al-Zahrawi. In Europe during the Middle Ages, Christian monasteries had infirmaries that cared for the sick, and monks cultivated medicinal herbs and copied ancient medical texts. Early universities began offering medical education. Key physicians included Benedictine monks at Montecassino in Italy, Irish monks who brought Christianity to continental Europe, and figures like Arnau de Vilanova at the University of Montpellier.

The Black Death and beyond The devastating European plague epidemics of the 14th century hampered medical progress. About half the population of Europe and the Islamic world died. There were limited attempts at containment or therapy. The flagellants and scapegoating of Jews point to the tenuous state of medical knowledge. From the 15th century, new translations of ancient texts, and close study of anatomy and physiology began transforming medicine into an evidence-based science. Key figures leading this shift include Vesalius, who produced the first modern anatomy textbook based on human dissection, and William Harvey, who showed how the circulatory system works. Still, most physicians practised Galenic medicine and believed in the four humours. Progress was slow, but new tools like the printing press allowed knowledge to spread as never before. The groundwork was set for revolutionary changes that came with the Scientific Revolution.

Human skeleton diagram by Vesalius, 1543

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18 INSIGHT

Anatomical knowledge: from Galen to Vesalius The anatomy of

Galen’s theories were included in Canon of Medicine, it brought together Hippocratic and Galenic ideas with his own observations. Avicenna added anatomical knowledge from dissections of animals and inferences from studying wounds and diseases in humans.

Galen’s On Anatomical Procedures (c. 200 CE) laid

The limited state of Galen’s anatomical knowledge

the foundations of human anatomy for more

became clear once human dissection was allowed in

than 1,000 years. Galen studied anatomy through

the Renaissance. Andreas Vesalius, in his ground-

dissections of animals, inferences from treating

breaking De Humani Corporis Fabrica (On the Fabric

gladiators’ wounds, and occasional human dissections

of the Human Body) of 1543, corrected over 200 of

when available. His theories dominated medical

Galen’s anatomical errors based on his own dissections.

thinking until the 16th century, though some were

He showed, for instance, that the lower jaw is a single

based more on philosophical reasoning than empirical

bone, not two separate bones as Galen had thought.

evidence. They included the idea of four humours

Vesalius’ work founded modern anatomy and marked a

governing health.

decisive shift to empiricism in medicine. Though Galen’s

During the Middle Ages, few advances were made in

theories persisted for some time, anatomy was now

anatomical knowledge. Dissection of human bodies was

based on direct observation rather than received wisdom

forbidden for religious reasons, so physicians relied on

from ancient authorities. Medical education began to

Galen’s writings. The great Persian philosopher-physician focus more on anatomy and hands-on experience. Avicenna’s Canon of Medicine, written in the early 11th

Human skull by Vesalius showing anatomical features

century, became a standard medical text in Europe. In his 014-015_Insight.indd 18

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INSIGHT 19

of Anatomical Figures (1538), published anatomical Essentials of anatomy according to Galen

drawings with meticulous detail, reflecting his extensive dissections of human cadavers. This set him apart from

• The body contains four humours that govern health and Galen, whose anatomical expertise came from treating temperament: blood, phlegm, yellow bile, and black bile. A

live patients, observation, and dissecting animals.

humoural imbalance causes disease. Bloodletting or purging can

For more than 1,000 years in European medicine, Galen’s

restore the balance.

anatomical concepts and theories dominated medical

• The liver, not the heart, is the organ at the centre of the vascular system. The liver creates blood that is then distributed around the body.

thought with hardly any advances. Physicians relied almost entirely on Galen’s works and repeated his concepts and descriptions. However, when human dissection became

• There are two separate bones in the lower jaw.

acceptable in the Renaissance, Vesalius was able to correct

• Nerves originate from the heart or central organ of the brain.

many of Galen’s anatomical errors through direct observation

• The rete mirabile, a mesh of blood vessels, exists at the base of the human skull. (It exists in some ungulates but not humans.)

and dissection. His beautiful anatomical illustrations and accurate descriptions laid the foundation for modern anatomy.

Andreas Vesalius revolutionized anatomy

Human anatomy advanced rapidly from the Renaissance

Born in 1514 in Belgium, Vesalius studied medicine in Paris and

onwards, based not on inferences or received teachings but on

Padua, where he became a professor of anatomy and surgery.

empirical evidence gained through dissection. Medicine as a

He reinvigorated the study of human anatomy through

whole began to move from theoretical models to evidence-

hands-on dissection of cadavers, meticulously recording

based principles that could be observed and demonstrated.

his observations. His landmark work De Humani Corporis Fabrica (On the Fabric of the Human Body) (1543) contained accurate descriptions and illustrations of human anatomy based on dissection of cadavers. It exposed many anatomical errors in Galen’s theories that had dominated medicine for over 1,000 years and laid the foundation for modern scientific anatomy. Vesalius also published his Tabulae Anatomicae Sex

De Humani Corporis Fabrica by Vesalius, 1543

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20 DISCOVERY

Prehistoric surgery: trepanation Some of the earliest

• Prehistoric humans attributed disease and misfortune to evil spirits and the supernatural.

• Shamans were spiritual healers who could communicate with the spirit world. They persuaded evil spirits to leave the sick, restoring health.

• Shamans may have developed practical healing skills, using herbs and conducting surgery.

• Belief in shamanic and spiritual healing continues among some groups today, meeting a need to explain disease.

• The term “shaman” originated from the Tungusic word for “one who knows”; it was applied to similar practices elsewhere. Siberian shamans still practise today.

• Shamans were thought to project themselves into the spirit world, guided by a spirit animal. Where healing failed, they led the soul of the dying to the afterlife.

• Evidence of shamanic practice includes rock art, burials of healers with ritual objects, and traces of psychoactive drugs.

• Shamanic practice gave way to other beliefs but never died out entirely. Europeans “rediscovered” Siberian shamans in the 17th century.

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20 ANCIENT EGYPTIAN MEDICINE

Bes, the dwarf god of luck and protection against evil spirits, was a popular figure

in Egyptian households. The markings on his body represent skin disease or smallpox,

which he could guard against. Bronze figure, c. 712–332 bce.

ANCIENT EGYPTIAN MEDICINE The Egyptians’ medical knowledge was influenced by their belief in magic and

the power of the gods. Their cures combined practical remedies with spiritual rituals. The ancient Egyptians enjoyed a high

Priests and “physicians”

level of health and longevity thanks

Egyptian medicine was closely linked

asthma, childbirth, and broken bones.

to a favourable climate, abundant

with religious belief and rituals, with

Their cures combined practical

food, and good sanitation. However, priests often acting as physicians.

herbal remedies and physical

as in other early societies, disease and As guardians of sacred knowledge, therapies with magic spells and

suffering were attributed to spirits.

priests could placate the gods or.

amulets. A stele (an inscribed stone

The Egyptians believed the goddess

When treatments failed, a priest

slab) dating from c. 1500 bce

Sekhmet caused epidemics, while

might perform rituals to restore

describes remedies and spells for

minor afflictions were the work of

divine favour. However, the

scorpion stings, boils, hair loss, colic,

malevolent demons. Death was in

Egyptians also had specialist

and headaches. Their knowledge of

the hands of the gods, and illness “physicians” trained in medical

anatomy was limited, as embalming

was sometimes seen as punishment

schools attached to temples. They

and mummification were forbidden

for wrongdoing.

developed treatments for conditions to interfere with the dead body. such as wounds, arthritis, coughs,

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ANCIENT AND MEDIEVAL MEDICINE 21

See also: Ayurvedic medicine 22–25 ■ Greek medicine 28–29 ■ Traditional Chinese medicine 30–35

■ Herbal medicine 36–37 ■ Medieval hospitals 52–53

Medical procedures

Herbal remedies

The Edwin Smith Papyrus, from c. 1600 bce, describes 48 cases of injuries

The Egyptians’ knowledge of medicinal herbs was extensive. The

and ailments, with diagnoses, prognoses, and treatments. It shows skilled

Ebers Papyrus, from c. 1550 bce, lists about 700 drugs and 800 remedies.

surgery such as bandaging, stitching, splinting, and circumcision. The

Many were based on plant materials, including:

Egyptians had surgical tools, linen bandages, ointments, and opiates for

• Aloe used as an ointment for skin conditions and burns.

anesthetic. Embalmers handled internal organs, but physicians avoided

• Garlic and onions, prescribed for bacterial infections and parasites.

surgery in the abdomen. However, the Edwin Smith Papyrus describes

• Castor oil as a purgative.

treating a shoulder dislocation by manipulation.

• Henna leaves as an antiseptic.

• Pomegranate skin and turmeric for tapeworms.

• Peppermint and thyme as antimicrobials.

• Willow bark and poppy extract, natural sources of salicin and opiates.

• Fenugreek seeds as a laxative, expectorant, and antirheumatic.

• Anise, coriander, and fennel to relieve flatulence and settle the stomach.

• Beer and wine in moderation as remedies, and for purification rituals.

• Date palm sap and beetroot as sweeteners for bitter herbs.

Many home remedies were handed down through generations. The Egyptians even had a “Merck manual” for householders inscribed on papyrus. Their herbal lore spread to Greece, Rome, and beyond.

Use of magic

Amuletic jewellery, charms, incantations, and rituals were widely used to protect health, ward off disease, or pacify the gods. Common amulets included:

Priests performed rituals and prayers

Next to the remedies in the Ebers

to heal the sick or appease Sekhmet. Papyrus are magical spells, and home cures often included amulets, priests made simulacra – images or incantations, or sacrifices to invoke

models of the afflicted part of the

Scarabs: dung beetles, symbols

the aid of a god. A spell might be

body – to which healing spells were

of eternal life and regeneration.

recited, for example, while an image

directed. The Egyptians also had

of the ailment was thrown into fire or

medical gods – including Serket,

Fingers, eyes, the djed pillar

water. People slept in temples for

goddess of scorpions and healing – to (representing stability), and

healing dreams or wore amulets

whom they offered prayers for relief

the udjat or Eye of Horus.

depicting a god, such as Bes.

from suffering. Magical and practical intermingled in their medical lore.

Animals, especially sacred ones

Faience amulet of a human eye, symbolizing regeneration and protection, New Kingdom, c. 1550–1077 bce. The ancient Egyptians believed the eyes emitted protective rays.

Priests performed rituals to appease the gods, while amulets, spells, and images of afflictions

such as the scarab beetle, snake,

invoked their power to

and falcon, protecting against

heal and protect.

disease or evil spirits.

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22 AYURVEDIC MEDICINE

The ayurvedic text Susruta Samhita prescribes fumigation and bloodletting to increase the flow of air and fire elements.

Hindu manuscript, c. 1810 ce. Ayurveda interprets health and disease in terms of the three doshas and five elements.

AYURVEDIC MEDICINE A traditional Indian system of medicine, Ayurveda aims to balance the life energies or doshas in the body. It uses diet, herbal remedies, massage, and yoga to promote health and longevity. Ayurveda, meaning “science of life”

imbalance in the doshas, each linked

in Sanskrit, originated in India

to two of the five elements – ether,

around 800 bce. It shares concepts

air, fire, water, and earth. The doshas

The development of illness

include vata (ether and air), which

is explained in ayurvedic

In ayurvedic belief, health depends governs movement; pitta (fire and

theory as an imbalance in

on harmony between the body,

water), which oversees metabolism

the interplay between the

mind, and spirit. Imbalance or

and hormones; and kapha (water

three doshas and the five

disharmony leads to disease.

and earth), which provides structure. elements they represent. with Western and Chinese medicine, but has its own theories of anatomy, health

Here is a summary of Ayurvedic medicine:

• Ayurveda originated in ancient India, emerging between 800 and 600 bce. • It is based on balancing the body’s three doshas (energies): vata (wind), pitta (bile), and kapha (phlegm). • Disease is caused by an imbalance in the doshas. Treatment aims to restore balance. • Core texts include the Atharvaveda, Charaka Samhita, Sushruta Samhita, and others.
• Diagnosis involves observing the patient and identifying imbalances in the doshas that govern physiology. • Treatments are tailored to the individual and may include herbs, diet, exercise, massage, and surgery. • Ayurveda takes a holistic approach, aiming for harmony between mind, body, and spirit. • It spread from India to the rest of Asia and more recently the West.

That covers the key points about the origins, principles, texts, diagnostics, and treatments in Ayurvedic medicine. Let me know if you would like me to elaborate on any part of the summary.

Here is a summary of key events in the history of plastic surgery: • Early Egyptian and Indian texts describe surgical techniques for treating wounds and injuries that reduce scarring. The Edwin Smith papyrus dates to around 1700 BCE.

• The ancient Indian physician Sushruta describes reconstructive surgery including rhinoplasty (nose reconstruction) around 600 BCE. His techniques were advanced and sophisticated.

• Other early references to reconstructive surgery include the Roman encyclopaedist Celsus in the 1st century CE and Heinrich von Pfolspeundt in 15th-century Europe.

• The first rhinoplasty using Sushruta’s techniques was performed in Western Europe in 1814.

• Injuries caused by accidents, war, torture and disease led to demand for reconstructive surgery. Plastic surgery aimed to rebuild damaged features and improve both appearance and psychological well-being.

• Advancements in anesthesia, antisepsis, and surgical techniques in the 19th century enabled the development of modern plastic surgery. Surgeons could perform complex reconstructive procedures with greater safety, precision and success.

• Today plastic surgery also includes cosmetic procedures aimed at enhancing appearance. Reconstructive and cosmetic surgery have become highly sophisticated.

In summary, while ancient cultures developed some techniques for reconstructive surgery, plastic surgery as we know it today emerged in the 19th century, building on earlier knowledge and

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We rebuild what fortune has taken away

enabling complex procedures to be performed safely. Its aims are both reconstructive and cosmetic.

world, who attributed health and

realm of ritual, and its practitioners

of the oath is uncertain, but

• Before the ancient Greeks, disease was widely believed to have supernatural causes.

illness to the balance of the bodily

would be respected for their skill,

it set high ethical standards for

f luids, or “humours” – a theory that

not their powers of divination.

• Greek philosophers began developing rational theories about the nature of the body

the medical profession.

and disease. Key figures were Alcmaeon, Empedocles, and Hippocrates.

would dominate Western medicine

• Hippocrates (c. 460–375 BCE) founded a medical school and promoted observation

for over 2,000 years.

and a holistic approach to treatment. He attributed health and disease to the balance of four humours in the body.

• The Hippocratic Corpus, attributed to Hippocrates, established disease categories still used today and insisted on close observation of symptoms.

• The Hippocratic Oath set standards of medical ethics, expertise, and confidentiality. It helped establish medicine as a respected profession separate from ritual healing.

• Hippocrates had a profound influence on later physicians such as Galen and on the development of Western medicine.

minister of the state of Qi,

found at Mawangdui. Physicians also

different treatments”. Although

there are powerful diagnostic tools who had suffered a stroke

recommended diets and physical

prescribed herbs, acupuncture, massage,

in both the Huangdi Neijing and

and was unable to speak or

Nanjing, ultimately, it is the skill

swallow. After several days

and experience of the individual

of treatment, Zhao recovered.

physician in applying them that

According to legend, the

matters most. As Wang Shuhe

inscription on Qiao’s tomb

warned, “If one rigidly follows the

read, “The mystical doctor, the

methods of pulse examination set

divinely skilled.”

down in books without personally verifying them, one is liable to kill one’s patients. A physician should rely on his own abilities.”

in the calf, needles may be inserted at points on the lower abdomen and leg. Acupuncture also acts by stimulating the nervous system and the release of natural painkillers called endorphins.

and tai chi exercises ( right).

Traditional Chinese medicine adopts a holistic approach in diagnosing imbalances and restoring health. Key principles include yin and yang, the five elements, pulse taking, and tongue examination. Treatments include acupuncture, herbal medicines, massage, diet, and exercise. The text Huangdi Neijing sets out the theoretical foundation, while emphasizing the physician’s experience and skill. The legendary physician Bian Qiao was renowned for miraculous cures.

Here is a summary of Roman medicine:

observation alone.

they reject theory

humours and the

250 bce Greek physician

in favour of trial-and

four temperaments must

Asclepiades moves to Rome and

• Three main medical approaches: Methodists, Empiricists, and Dogmatists

error. They argue

guide diagnosis and

becomes popular, advocating

• Methodists focused on observable symptoms and rejected theories about the body

that because theory

treatment. They rely

gentle treatments over purging

• Empiricists relied on practical experience and trial-and-error, rejecting medical theory

cannot encompass

on logical reasoning

and bleeding.

• Dogmatists followed the Greek humoral theory about balancing the four humours

nature’s complexity,

and the works of

• Key figures include Asclepiades, Galen, and Soranus

it cannot guide

respected ancient

• Asclepiades advocated gentle treatments and criticized purging and bleeding

effective medicine.

authorities like

AFTER

• Galen established anatomy and the four humours as central to medicine

Hippocrates and

c. 129 ce Roman Emperor Hadrian

• Soranus focused on gynaecology and pediatrics, emphasizing diet and lifestyle

Galen. They aim to

appoints Galen as his court physician.

• Theories dominated but some practical innovations in surgery, ophthalmology, dietetics

match treatments to

523 The last medical school of the

• Decline after Rome fell in the 5th century CE; texts and knowledge mostly lost

each patient’s unique

Roman Empire closes in Alexandria.

medical mix.

638–641 The Arabs invade and

conquer Egypt, gaining access to

Empiricists, Dogmatists, and Methodists Roman medicine was influenced by

Pythagoras, Hippocrates, and the

some remaining texts from the

three main schools of Greek thought:

four humours. Asclepiades rejected

ancient world. They translate many

Empiricism, Dogmatism, and

harsh remedies like purging

Greek medical works into Arabic,

Methodism. Empiricists relied solely

and bleeding favoured by the

preserving and spreading knowledge.

on experience, rejecting theory.

Dogmatists, instead promoting

Dogmatists followed the humoral

gentle treatments like bathing,

theory. Methodists saw health

exercise, and diet. His approach

as harmony between observable

proved popular and inf luenced

symptoms, not humours.

even staunch Dogmatists like

The Greek physician Asclepiades

Galen. He also described the

(c. 124–40 bce) practised in Rome.

circulatory system.

He criticized the harsh remedies of

Galen (129–c. 216 ce), a Greek physician who practised in Rome, followed Hippocratic medicine. He

Galen’s Four Humours

emphasized balancing the four humours and saw the humoral

Sanguine (air; blood)

system as central to all medicine. Galen also made key anatomical discoveries through dissecting

Choleric (fire; yellow bile)

apes, but some of his theories were later found inaccurate.

Melancholic (earth; black bile)

Phlegmatic (water; phlegm)

Soranus (c. 98–138 ce) focused on gynaecology and pediatrics. He emphasized diet, exercise, and hygiene over drugs. His writings on obstetrics and gynecology were particularly inf luential.

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ROMAN MEDICINE 41

Roman surgery and pharmacology. While theory dominated, Romans made practical advances, especially in surgery, opthalmology, and dietetics. Celsus described surgical techniques, and physicians developed innovative surgical instruments and treatments for

Roman surgery For all the focus on theory, Romans

operations including eye surgery.

made key practical advances.

The physician Cornelius Celslis

Doctors developed many surgical

(fl. 14–37 ce) compiled medical

instruments and performed innovative operations, especially in ophthalmology. They described techniques like using a speculum to hold eyelids open, removing cataracts, and couching (displacing) the lens for glaucoma. The court physician Galen

knowledge in De Medicina, covering anatomy, pathology, pharmacology, and surgery. He described surgical techniques like treating fractures, removing bladder stones, and cauterizing veins. His work was a key medical text for centuries. Pharmacology also advanced, as

ophthalmic conditions. performed new operations, including

doctors prepared plant- and

Galen’s writings,

removing cataracts and repairing

mineral-based drugs as pastes,

including many

injuries. He described the optic

pills, potions, ointments, and

commentaries on the

nerve and treatments for glaucoma. plaisters, and experimented with

works of Hippocrates,

Celsus wrote the first medical

become the foundation of Islamic medicine.

new combinations. The expansion

text in Latin, De Medicina,

of trade within the empire gave

covering surgery, diet, hygiene,

doctors access to many raw

pharmacology, and remedies.

materials from across Europe,

Beyond theory

North Africa, and the Middle East.

For all the focus on theory, some

Decline and legacy

• THEORIES OF THE FOUR HUMOURS AND PERSONALITY TYPES dominated but practical

Roman doctors were essentially pragmatists who valued experience.

After the fall of Rome in the 5th century ce, the empire

They advanced methods not explained by theory, especially in

disintegrated. This led to a major loss of medical knowledge, as libraries were destroyed and Greek medical texts were mostly lost to

innovations emerged in areas like surgery, opthalmology, and dietetics.

the Latin-speaking world. • SURGEONS DEVISED NEW INSTRUMENTS AND TECHNIQUES, especially for eye conditions and

The key exception was Galen’s writings, which were preserved

extractionof bladder stones. Theories of the four humours and personality types dominated, but practical

and formed the foundation of Islamic medicine. Other texts

innovations emerged in surgery, ophthalmology, dietetics, and pharmacology.

were translated from Greek to Syriac and Arabic, then

• ROMAN PHARMACOLOGY ADVANCED through access to raw materials across the empire,

retranslated into Latin from the 12th century onward. The theories

preparing drugs in various forms. Trade and conquest gave access to plants and minerals from across Europe,

of Dogmatists and Galen came to dominate European thought for

North Africa, and the Middle East.

over 1,000 years.

• AFTER THE FALL OF ROME, much knowledge was lost, but some texts survived through translation into

Despite the loss of texts, Roman medicine made an enormous and

Syriac and Arabic, later retranslated into Latin. Theories of humours and Galen came to dominate for centuries.

lasting contribution to Western medicine through preservation of key Greek works, and notable advances in surgery, opthalmology, pharmacology, and public health infrastructure like aqueducts, sewers, and sanitation systems. ■

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42 ROMAN MEDICINE

See also: The four humours 24–25 ■ Medical schools 50–53 ■ Surgery 52–53 ■ Islamic medicine 44–49 ■ Medieval medicine 54–59

Latin medical writers ROMAN MEDICAL WRITERS

Key works

The writings of three Roman physicians were particularly inf luential in the medieval period:

CELSUS

Aulus Cornelius Celsus

Celsus (c. 25 bce–50 ce)

De Medicina

Wrote an encyclopedia, De Medicina (On Medicine), around 25 ce.

(c. 25 bce–50 ce)

Including works on surgery, dietetics, and pharmacology, as well as

A Roman encyclopaedist

theories of health. Inf luential in the Renaissance.

whose De Medicina was a key medical work for

Here is a summary of Roman medicine in the 2nd century BCE to 2nd century CE:

• Rome builds its first public baths in the 2nd century BCE, but disease is common.
• In 390 CE, Rome’s first general hospital is built.
• Galen, a 2nd-century CE physician, combines observation and theory. He believes one must understand anatomy and observe patients to diagnose and treat disease.
• Galen gains experience observing gladiators’ wounds and performing animal dissections. He confirms the laryngeal nerve enables vocalization by cutting it in a pig.
• Galen examines patients during the Antonine Plague, noting symptoms and outcomes. He links the four humours to health, seasons, elements, and temperaments.
• Galen’s works spread and dominate medicine for centuries. However, his animal-based anatomy and unquestioning followers impede later progress.

So in summary, Roman medicine built on Greek traditions but made advances through general hospitals, theoretical synthesis, anatomical experiment, clinical observation, and spread of medical knowledge. However, overreliance on Galen’s works would later slow progress.

The key points of Islamic medicine can be summarized as follows:

• Islamic physicians adopted and built upon Greek and Roman medical knowledge, as well as Indian theories. They translated many ancient medical texts into Arabic.

• Early Islamic hospitals provided physicians with opportunities to gain practical clinical experience by observing patients. This led to more accurate diagnosis and effective treatments.

• Islamic physicians such as al-Razi (Rhazes) and Ibn Sina (Avicenna) championed close observation of patients and recording symptoms to make accurate diagnoses. They made important advances in identifying diseases and developing treatments.

• Al-Razi promoted the idea of treating mental and physical diseases in similar ways. He used diet, drugs, music, and aromatherapy in treatments and believed patients’ state of mind could affect outcomes.

• Ibn Sina’s Al-Qanun fi al-Tibb (The Canon of Medicine) summarized medical knowledge and shaped medical education. It described diseases from head to toe, with causes, symptoms, and treatments. Treatments used diet, drugs, exercise, music, bathing, and surgery.

• Islamic physicians were licensed and took the Hippocratic Oath. High standards were expected, but enforcement was needed at times.

• Key theories included the four humours, the four elements (earth, air, fire, water), anatomy, and the mind-body connection. Excesses or imbalances in the humours and elements were seen as causing diseases.

• Islamic medicine built upon existing knowledge through observation and recording findings. Progress was made in identifying diseases, effective treatments, surgery, and medical ethics.

• The advances of Islamic physicians had a major influence on later medieval and Renaissance European medicine.

The key points are:

• The Benedictine monastic order preserved medical knowledge in Europe after the fall of Rome. Monasteries provided basic care and herbal remedies.

• The first formal medical school was established in Salerno, southern Italy in the 9th century, reviving academic medicine. It drew on diverse influences and became renowned across Europe.

• The Salerno medical school, Schola Medica Salernitana, taught for four centuries. Students and patients travelled long distances to attend. It had an extensive medical library.

• Women were welcome as students and teachers at Salerno. Trota of Salerno wrote on women’s health in the 12th century.

• Surgery advanced under Rogerius (Roger) of Salerno. His Practica Chirurgiae covered treatments from head to toe, including cranial and intestinal operations.

• Other medical schools spread in the 12th century, including Montpellier, Bologna, and Paris. They were linked to universities and taught theoretical as well as practical medicine.

• Theology and medicine were closely linked. But in 1130, the Church forbade clergy from charging fees, accelerating the rise of secular medicine.

• Key figures include Ibn Sina (Avicenna), whose Canon of Medicine was essential reading for centuries, and Guy de Chauliac, whose Chirurgia Magna was the leading surgical text of the 14th century.

• The advent of printing rapidly spread medical knowledge from the 15th century. Key texts include Vesalius’s anatomical work De Humani Corporis Fabrica.

So in summary, medieval medicine was revived and advanced through medical schools, especially at Salerno, that built on diverse influences. While linked to the Church, medicine became increasingly secular. Key texts spread medical knowledge, and surgery in particular progressed, though in a precarious manner given the risks of blood loss and infection.

Trotula) of Salerno, who wrote

on diseases of the womb and

wounds of women, to cater to the

specialized needs of women’s

healthcare. Salerno surgeons,

such as Rogerius (Roggero Frugardi)

spearheaded a revival of surgery. In his

12th-century Practica Chirurgiae,

he described medical treatments

from head to toe, including methods

for correcting deformities of the head

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• The concept of using substances to treat illness dates back to ancient times. Animals instinctively seek out certain plants or minerals when sick.

• Surviving ancient papyri, such as the Egyptian Ebers Papyrus, document the use of various substances for medical purposes.

• In the 1st century CE, the Greek physician Dioscorides wrote De Materia Medica, a compendium of plant-based medical treatments that was a key reference for centuries.

• Knowledge of medicinal substances originally depended on identifying naturally occurring herbs and minerals. The creation of chemical drugs began in the Islamic world around the 8th century CE.

• Persian polymath Jabir ibn Hayyan developed techniques for purifying and combining drugs. His work influenced later alchemists and pharmacists in Europe.

• The Renaissance saw a new focus on chemistry as a means to treat illness. Paracelsus characterized disease as chemical in nature and advocated the use of chemicals to cure it.

• Pharmacists had to identify existing medicinal chemicals in nature or create new compounds by combining drugs. They experimented with different ingredients to develop effective treatments.

• The first official pharmacopeias were published in the 15th century to standardize the use of medicinal substances. Clinical drug trials began in the 18th century to prove the efficacy of new drugs.

• 19th-century discoveries allowed drugs to be isolated, synthesized, and tested. This marked the beginnings of modern pharmacology.

So in essence, the key stages were: plant-based folk remedies; documentation of herbal treatments; development of pharmacy in the Islamic world; a new chemical understanding of medicine in the Renaissance; the emergence of pharmacopeias and drug trials; and finally the isolation, synthesis, and testing of drugs in the 19th century. The concepts developed gradually over many centuries through experimentation, observation, and the synthesis of ideas from different cultures.

• Ancient Egyptian and folk healers used herbs and plants as remedies, passing down knowledge of their medicinal properties.

• In the 16th century, Paracelsus pioneered the use of chemicals and minerals as medicines. He extracted their “active principles” and tested them on patients.

• In the 19th century, scientists began isolating alkaloids and glycosides, organic compounds with medicinal effects, from plants. They studied how these compounds interacted with the body.

• Chemists found ways to synthesize organic compounds, enabling large-scale drug production. Dye companies began manufacturing drugs, launching aspirin, Salvarsan for syphilis, and other “magic bullet” drugs targeted at specific diseases.

• Understanding how drugs interact with cell receptors and their specific localized effects formed the basis for modern pharmacology.

• The pharmaceutical industry grew into a major business, using industrial processes and new technologies to produce and distribute drugs on a huge scale.

Vesalius’s masterpiece was Henry Gray’s Anatomy of the

• Before the Renaissance, knowledge of human anatomy came mostly from

Human Body was first published in

animal dissection and was influenced by Galen’s theories from the 2nd

1858. Gray, a lecturer in anatomy at

century. Dissection of human corpses was rare.

St George’s Hospital Medical School

• In the 15th century, Renaissance artists studied human anatomy through

in London, collaborated with his

dissection. Leonardo da Vinci made detailed anatomical sketches.

colleague Henry Vandyke Carter to

• Andreas Vesalius established the importance of direct observation through

produce an illustrated anatomy book

human dissection. In 1543, he published De Humani Corporis Fabrica,

for medical students. This lavish

the first comprehensive work on human anatomy with detailed illustrations.

• Vesalius contradicted Galen’s theories and established many facts about human anatomy.

His work was criticized but became accepted. Other anatomists built on his research.

• New tools like the microscope enabled discoveries of microscopic anatomy. William Hunter established a school of anatomy in 1768.

• Henry Gray’s Anatomy (1858) became a standard anatomy textbook for medical students.

Human anatomy came to be learned through direct study rather than received wisdom.

Human anatomy at last came to be studied

through direct observation rather than merely

accepted wisdom. Vesalius’s revolutionary

insistence that “the hand must educate the eye” changed medical education forever. ■

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64 CIRCULATION OF THE BLOOD

William Harvey published

The Circulation of the Blood in Latin in 1628, revolutionizing ideas about the movement of blood through the body. The concept of the circulation of the blood, with the heart acting as a pump, was Harvey’s great discovery and inspired much later research into the workings of the cardiovascular system.

The anatomy of the heart and blood vessels had been described in varying degrees of detail and accuracy since ancient times. The earliest beliefs held that the arteries contained air, while the veins carried blood. In the 2nd century ce, the Greek physician Galen theorized that the liver, not the heart, was the source of blood and the organ responsible for its movement. Blood was thought to ebb and flow, rather than circulate.

Harvey’s revolutionary theory William Harvey studied medicine at the University of Padua, Italy, where he was taught by Hieronymus Fabricius, who had discovered valves in the veins that allowed blood to flow only in one direction. Harvey graduated in 1602 and became a physician at St Bartholomew’s Hospital in London. In his anatomical lectures, he emphasized the importance of observing the heart’s action in living animals. Around 1616, Harvey formulated his theory of the circulation of the blood. The key points were: • The heart acts as a pump, propelling blood through the body. • Blood is pumped through arteries away from the heart and returns through veins to the heart. • Arterial and venous blood are the same, merely passing through different vessels. • Blood flows rapidly and continuously, driven by the pumping action of the heart, not by any “ebb and flow”. • The vast volume of blood passing through the heart and lungs each minute can only be explained by circular flow, not by Galen’s theory. • Valves in the veins allow blood to flow only toward the heart, preventing backflow. • The pulmonary circulation takes blood from the right heart to the lungs, where it is oxygenated, then returns it to the left heart.

His groundbreaking work Harvey announced his theory of the circulation of the blood in lectures at the Royal College of Physicians in 1616. Over the next 12 years, he carried out experiments to test and refine his ideas. In 1628, he published his theories in Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (An Anatomical Exercise on the Motion of the Heart and Blood in Animals), usually known as De Motu Cordis. In this short book, illustrated with simple diagrams, Harvey outlined his radical and startling theory, which overturned 1,500 years of accepted medical teaching. He described how the heart works as a pump, propelling the blood in a circular course through the body. His key evidence came from calculations showing the vast amount of blood transported with each heartbeat, which could not be explained by the Galenic model. Harvey also described how blood is pumped from the right side of the heart to the lungs, then returns oxygenated to the left side – the pulmonary circulation. Harvey’s work met with skepticism and criticism. His theory contradicted Galen and was hard to accept. Some accused him of heresy or suspected his motives. However, many younger physicians were convinced by his evidence and reasoning. Harvey’s theory was gradually accepted, though he spent years defending it. By the time of his death in 1657, De Motu Cordis was recognized as a seminal scientific work that had revolutionized ideas about the workings of the human body.

Here is a summary of William Harvey and his discovery of blood circulation:

• Before William Harvey, the prevailing theory of blood circulation came from the Roman physician Galen. Galen theorized that blood is produced in the liver and consumed by the organs. The complete circulatory

he Sacred Text of Inner Medicine)

circulatory system and the represented arteries as transporting “qi” or and Surgery) by Italian physician Guido Lanfranchi (14th century).

movement of blood around “pneuma”, a vaporous life force, rather than the body. Harvey proposed blood. In Europe, Galen’s teachings domthat blood circulates through a inated medicine. While Galen recognized

• In 1628, Harvey published De Motu Cordis, in which he proposed that blood circulates through a closed system of arteries and veins, propelled by the heart. This contradicted Galen’s theory.

closed system of arteries and that blood flows rapidly from the heart, veins, driven by the heart.

• Harvey conducted experiments and dissections on live animals and human cadavers. From these, he observed that the valves in veins allowed blood to flow only toward the heart. He calculated the amount of blood that flows through the circulatory system.

the destination and purpose of this

• Harvey proposed that deoxygenated blood is carried from the heart to the lungs by veins, where it is oxygenated, and is then carried back to the heart by arteries. This was the theory of pulmonary circulation. • Though Harvey’s theory was controversial, it gained acceptance over time. It formed the foundation for subsequent discoveries in circulation and circulation-related disciplines like cardiology.

• Other key figures: Ibn al-Nafis (described pulmonary circulation in 1242); Michael Servetus (proposed theory of pulmonary circulation in 1553); Marcello Malpighi (discovered capillaries, completing Harvey’s theory, in 1661)

• In summary, William Harvey revolutionized the understanding of blood circulation through systematic experimentation and observation. His theory of blood circulation through a closed circulatory system propelled by the heart laid the foundation for modern physiology and medicine.

human anatomy. It took until 1653

in 1657.

• William Harvey, an English surgeon, published his theory of blood circulation in 1628.

for Italian physician Giovanni

• Harvey hypothesized that blood circulates through the body in a dual system, passing through the heart twice. This contradicted the long-held view that blood was consumed by the body and replenished.

Alfonso Borelli to provide the missing

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to the emerging voice of women • Before the 17th century, midwifery manuals were written by men in Latin and in medical professions. Greek, and few women could read them.

Changing the narrative

Sharp’s work was groundbreaking • Jane Sharp published The Midwives Book in 1671. As an experienced midwife, she provided practical advice to educate women in childbirth and midwifery. in many ways. It challenged the • The book covered conception, pregnancy, childbirth, and postnatal care. It gave dominance of male physicians in female midwives valuable advice and urged them to seek further education. writing about women’s health and • Sharp argued that midwifery should be exclusively practised by women. Her book biology. Through its simple English corrected errors in previous books by male authors like Nicholas Culpeper. • The Midwives Book used illustrations and science to counter religious myths about childbirth. It gave women a voice in shaping policy and practice in midwifery. • Sharp’s work was pioneering. It challenged male dominance in medicine and gave women more autonomy and safety in childbirth. The book shaped midwifery for centuries and allowed women to gain more control over their health and bodies.

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78

A WHOLE

NEW OUTLOOK

VACCINATION

IN CONTEXT

BEFORE

628–907 The Chinese practice variolation (also

called inoculation), using

pustules from smallpox

victims to immunize people.

Edward Jenner’s observation and experime t:

that those who had cowpox, a pox

1721 Lady Mary Wortley

like smallpox but not as deadly,

Montagu sees variolation

were immune to smallpox, led to

in Turkey and has her

the first vaccine for that feared

children inoculated.

disease. His achievement was

revolutionary, but not without

1767 Variolation is

challenges and controversy.

introduced in America

Edward Jenner’s discovery

by the Rev. Cotton Mather,

of vaccination was born out of a

following an epidemic.

chance observation. As a boy in

AFTER

1759, he noticed that milkmaids

1880 Louis Pasteur develops

in Gloucestershire, England, who

a rabies vaccine.

had suffered from cowpox, a mild disease similar to smallpox, seemed

1889-90 Emil von Behring

immune to smallpox itself. This

and Shibasaburo Kitasato

led Jenner to hypothesize that the

develop a diphtheria

pustules (pus-filled blisters) from

vaccine using antibodies.

cowpox could be used to inoculate

1952 The Salk vaccine for

people against smallpox.

polio is introduced, based

On 14 May 1796, Jenner carried

on Jonas Salk’s inactivated

out his famous experiment. He

poliovirus.

oozed pus from a cowpox pustule

2000 The polio vaccine is

declared “eradicated” in

on the hand of milkmaid Sarah

most parts of the world.

Nelmes onto incisions on the arm

of eight-year-old James Phipps.

Phipps developed cowpox but

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THE SCIENTIFIC BODY 79

See also: The germ theory of disease 106–09 ■ Public health 132–37 ■ Epidemics and the spread of disease 306–13

■ Eradication of disease 320–21 ■ Global health crises 338–43

recovered. Two months later, Jenner injected Phipps with smallpox matter, but the boy did not get sick. Jenner had proven that exposure to cowpox gave immunity to the deadly smallpox. He named this protective process “vaccination”, from the Latin vacca, meaning cow.

Initially controversial

those who saw it as “flying in the face

Jenner published his findings

of Providence”. It took 12 years

in 1798 in An Enquiry into

before vaccination was accepted

the Causes and Effects of the

by the British medical establishment.

Variolae Vaccinae. The discovery

Gradually, vaccination spread from

was met with much scepticism by

England to Europe and beyond, saving

many in the medical community and countless lives from smallpox. By 1979, thanks to vaccination, the World Health

Edward Jenner

Organization declared that disease

Born in 1749, Jenner was

eradicated worldwide.

apprenticed to a surgeon at 13 and went to study medicine in London

Other diseases targeted

and Edinburgh. Interested in

Jenner’s pioneering work led to vaccines natural history, he was the first to for other diseases. In 1885, Louis

describe the common cuckoo’s

Pasteur created the first rabies

practice of laying its eggs in other

vaccine. Emil von Behring’s

birds’ nests. Jenner spent over

diphtheria antitoxin (1890) and

20 years developing and verifying

Key works

1798 An Enquiry into

the Salk (1952) and Sabin (1960)

his smallpox vaccine. Though he

polio vaccines followed. Today,

was not the first to notice the

the Causes and Effects

vaccines are available for diseases

link between cowpox and smallpox

of the Variolae Vaccinae

including measles, mumps, rubella,

immunity, he was the first to

hepatitis, and HPV.

prove its effectiveness and make

1799 Further Observations on the Variolae Vaccinae 1802 The Origin of the

Of all medical advances, vaccination widespread use of vaccination, which changed medical practice

Vaccine Inoculation

has saved more lives than any other. Jenner’s discovery demonstrates

and helped pioneer immunology.

1809 A Continuation of

what can be achieved by astute

Jenner died in 1823.

observation, experimentation, open

James Phipps, the eight-year-old

mindedness, and perseverance against

who featured in Jenner’s first

scepticism. It paved the way for

experiment, lived until 1853. He

new understanding of how the body’s

recalled Jenner as “a very pleasant

immune system works and defences man to talk with”.

Facts Relative to the Variolae Vaccinae

1823 The Jennerian

Medallion presented in

honour of Jenner’s work.

against disease. ■

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80

VIVISECTION’S

VALIANT

DEFENDERS

ANIMAL EXPERIMENTATION

IN CONTEXT

BEFORE

1656 William Harvey, famous

The practice of performing

for describing the circulation

experiments on live animals,

of blood, dissects dogs.

1764 In Italy, Lazzaro Spallanzani known as vivisection, raised moral

known for experiments exposing and ethical concerns, while allowing

food to oxygen and proving

important discoveries about bodily

the role of microbes, performs

functions. Debate around its use was

vivisection on mammals.

fierce, with opponents arguing that

it caused needless suffering, and

1780 In Britain, legislation

allows for prosecution of those

proponents that it bene fited

experimenting on animals

science and, ultimately, humankind.

without the owner’s consent.

By the 19th century, attitudes were

gradually changing in favour of

AFTER

vivisection, with its advocates,

1876 In Britain, the Cruelty

including French physiologist Claude

to Animals Act prohibits

Bernard and British surgeon Joseph

animal experimentation

Lister, arguing passionately for its

except for medical research.

use under anaesthesia. In Britain,

the 1876 Cruelty to Animals Act

1986 In the US, the Animal

allowed for the practice under license,

Welfare Act requires

subject to controls. Legislating for

humane treatment of

vivisection was an attempt to balance

animals in experimentation.

scientific progress with preventing

cruelty to animals. Ultimately, it helped

The medical case history tradition began in ancient Greece but initially lacked consistency or means of comparison between patients. In the 18th century, Herman Boerhaave emphasized the importance of careful observation, examination, and recording of patients’ symptoms, treatments, and outcomes. He established the use of case notes at the University of Leiden, insisting students observe patients and record diagnoses. Boerhaave particularly championed postmortem examinations to determine the accuracy of diagnoses. His reforms established an evidential, scientific approach to medicine based on close clinical observation and collation of medical data. The keeping of case notes spread and formed an essential tool for physicians attempting to identify diseases and find new treatments.

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THE SCIENTIFIC BODY 81

keeping records on patients.

CASE HISTORY

Patients become studied as

examinations to determine errors in

Human illness is reduced to

standardized units

diagnosis and causes of death.

Boerhaave adopted an empirical

Patient data recorded systematically

scientif ic approach, based on

Using case notes to study

observation and experimentation.

can lead to diagnostic insights

physical observations ref lecting

Patients were no longer viewed

and aid teaching

underlying conditions.

as unique individuals but as

Boerhaave’s reforms established

Case histories allow

standardized “cases” to be studied. the model for evidence-based

By insisting on the rigorous

treatment of a patient can

recording of symptoms and

medicine that flourished in the be optimized and adapted

19th century. His students spread based on outcomes.

treatments, Boerhaave enabled

physicians to identify patterns of

his methods across Europe,

disease, evaluate treatments, and

helping to establish the

make comparisons. For students,

case history as an essential

Following admission

of a patient, their medical

the collation of patient histories

tool. The collation of patient

became important for learning

data allowed the identification condition is assessed based on

diagnosis and understanding

of new diseases, aided

a medical history, physical

disease progression. Boerhaave’s

comparative analysis,

examination, tests, and further

reforms were instrumental in

and improved diagnosis

investigations. Details are

establishing medicine as an

and treatment.

recorded in the patient’s case notes.

By the 19th century, the case

The patient’s progress, treatments,

history had become pivotal

and outcomes are updated to inform

to clinical medicine, and

management and aid teaching.

Systematic recording of

empirical science.

patient data establishes

His legacy lives on

a virtuous circle of

Boerhaave’s influential approach

improving care.

shaped generations of physicians

across Europe. He established

the Leiden school as a centre

Patient data is analyzed

of medical excellence, attracting

to identify best practices

students from throughout Europe

and insights into disease.

and Britain. Boerhaave’s reforms

established an empirical, scientific

basis for medicine that depended

on close observation and the

rigorous recording of evidence

– an approach that underpins

modern medical practice. ■

The collation of many case histories

See also: Hippocrates 28–29 ■ Medical schools

can reveal disease mechanisms,

254–55 ■ Laennec’s stethoscope 256–57

enabling diagnosis and suggesting

■ Medical specialization 266–67

new treatments.

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82

STUDY OF THE

VISIBLE

HUMAN BODY

ANATOMY

IN CONTEXT

Human anatomy – the study of the

allowed in-depth understanding of structure and function of the human

the human body. This newfound body – has been fundamental to

knowledge transformed surgery,

the progress of medicine. Anatomy

BEFORE

enabling procedures that were

has provided insights into how the

c. 300 bce Herophilus studies previous impossible.

body works in health, how it is

anatomy through dissection and

In the 16th century, Andreas

affected by disease, and has enabled

names several parts of the body. Vesalius published his seminal

new surgical techniques.

c. 200 ce The Roman physician

work On the Fabric of the Human

Galen writes extensively on anatomy, Body. Vesalius overturned Galen’s

Dissections and discoveries

basing much work on dissections of mistaken anatomical concepts by

Herophilus of Alexandria conducted

animals and human corpses.

dissecting human cadavers. This

public human dissections in c. 300

1543 Andreas Vesalius publishes helped re-establish anatomy as

bce. Around 200 ce, Galen furthered

an empirical scientific discipline.

anatomy largely through dissection

On the Fabric of the Human Body. The work of William Hunter and

AFTER

of animals. His anatomical concepts

John Hunter in 18th-century Britain were mistaken but hugely influential.

1628 William Harvey publishes

helped cement anatomy as central

Andreas Vesalius established human

his discovery of the circulation

to medical education and practice.

dissection as essential for

of the blood.

understanding human anatomy. His

1787 Hunterian Museum

In the Western world, human

fabrici

opens in London, housing John work On the

dissection was controversial but

Body overturned Galen’s errors.

Hunter’s anatomical collection.

accepted for teaching. Restrictions

1829 Karl von Baer discovers

persisted – only executed criminals’

Advancing surgery

bodies could be used, and dissection the human ovum.

1859 Charles Darwin publishes

In the 18th century, the Scottish

was a quick process. In contrast,

surgeons William and John Hunter

On the Origin of Species.

made major contributions to

Hindu culture forbade dissection.

1895 Wilhelm Conrad Röntgen anatomy and surgery. John Hunter discovers X-rays.

Renaissance discoveries

pioneered the experimental method

in anatomy and developed surgical

In the Renaissance, restrictions

techniques. His collection formed

on dissection were relaxed, allowing the basis for London’s Hunterian

systematic study. Preservation

Museum. The Hunters’ work

techniques meant anatomical specimens demonstrated how anatomical study could be kept for further analysis.

could translate into improved surgical

This, combined with new artistic practice, enabling procedures on

techniques permitting realistic organs once considered inoperable. illustrations of dissections,

082-083_Anatomy.indd 82

of the Human

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THE SCIENTIFIC BODY 83

Microscopes enable study

ANATOMY

of microscopic anatomy or histology

X-rays allow non-invasive views

The basic structure and

inside the body

function of the human body become known through

Wilhelm Röntgen’s 1895

the meticulous study of its

discovery of X-rays enabled

visible components.

non-invasive anatomical

examination and transformed

New tools and techniques

diagnosis. X-rays produced

enable greater understanding

In the 19th century, inventions such detailed images of bones and soft

as microscopy, photography, and

tissues. Contrast agents were

Anatomy underpins all

new preservation and staining

later developed to enhance other

branches of medicine.

techniques enabled explorations

tissue types on X-rays. In the

of microscopic and developmental early 20th century, new imaging

Dissection reveals the body’s

anatomy. Histologists used

modalities like CT and MRI scans fundamental structure and

microscopes to study tissues,

provided cross-sectional anatomy the relationships between its

naming and classifying many cell and non-invasive alternatives to

types. Karl von Baer discovered the

parts in health.

dissection. Modern 3D scanning

human ovum, advancing the study and printing allow exceptionally

Our knowledge of anatomy

of reproduction. Charles Darwin

detailed study of anatomy.

evolves with new discoveries

investigated comparative anatomy

and technologies.

across species. New stains and

The legacy of anatomy

photography enabled detailed

Anatomy has been fundamental

Anatomical study translates

documentation of anatomical

to all branches of medicine.

to improved surgical

findings, a

patients into six pairs and gave

• James Lind, a Scottish physician in the British navy, performed a controlled clinical experiment on sailors with scurvy in 1747.
• He divided 12 sailors into six pairs and gave each pair a different proposed cure, including citrus fruit.
• The sailors given citrus fruit recovered much faster than those given other treatments.
• Lind concluded that citrus fruit could prevent and cure scurvy but his advice was not implemented in the navy for decades.
• Scurvy is caused by a lack of vitamin C and its symptoms appear after about a month without it.
• Although a simple cure, thousands of sailors died from scurvy before citrus rations became standard.

WITHOUT consuming foods containing

vitamin C. Within 10 to 20 weeks

each pair a different proposed without treatment, scurvy can AFTER

cure, including cider, seawater,

cure. In 1747, James Lind published

leads to death.

1747 James Lind publishes

vinegar, and citrus fruit. The men

a Treatise of the Scurvy, in which he

given the citrus fruit reportedly

concluded that citrus fruit could

cause bleeding gums and wounds, A simple cure ignored

his Treatise of the Scurvy,

not to heal, skin lesions, fatigue,

joints and muscles pain. Lind’s

recommending citrus fruit as

Despite Lind’s evidence that

and depression. If untreated, it

a cure for scurvy.

lemons could prevent and cure

conclusion that citrus fruit cured

1795 The British navy

scurvy, it took 48 years for the

scurvy was ignored for decades.

British navy to adopt lemon juice

ration was introduced.

adopted Lind’s recommendation

Based on his trial, Lind recommended

Thousands of sailors continued to adding lemon juice to the diet daily,

of including citrus in naval

giving sailors citrus fruit rations, die from scurvy before his simple which prevented scurvy during long

rations to prevent scurvy.

especially lemons and limes. Yet

diagnose effectively, scurvy

voyages at sea. Yet in what seems

1932 Vitamin C is identified,

scepticism about new ideas and

today an incomprehensible

also known as ascorbic acid,

resistance to change meant this

evidence-blindness, his advice went

as the vitamin that prevents

simple cure was ignored.

and cures scurvy.

unheeded for decades. The story

of scurvy shows how hard-won

Without understanding scurvy’s

advances in medicine can struggle

cause or having means to

to be accepted even when backed

continued to claim thousands of

by solid proof.

lives, particularly those of sailors

on long sea voyages.

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THE SCIENTIFIC BODY 85

See also: Clinical trials 86–87 ■ Naval medical advances 96–97 ■ Ship medicine 100–101 ■ Polar expeditions 106–07

■ Vitamins and health 210–11

In 1747, James Lind published

a treatise recommending that “the

The use of lemon juice in the

cause of the disease I conceive to

navy from 1795 helped establish

be a total abstinence from fresh

a precedent for maintaining the

vegetables and greens, which

health of populations, with ideas

produce a putrescent alkalescent state such as mass vaccination leading

of the humors, and also a want of due to the success of preventive

provision of acids … Two oranges and

health strategies. However, as

one lemon given to each [of 12] sea- with scurvy, adopting new medical

men, when the distemper was

practice could be painfully slow.

at its height, most certainly

stopped its progress, and very soon

after they recovered their health …”.

James Lind

Yet it would be almost 50 years

before Lind’s advice was adopted.

James Lind was born in Edinburgh,

In 1795, the Royal Navy f inally made Scotland, in 1716. He trained in

lemon juice rations mandatory and medicine and served as a surgeon

scurvy among its crews virtually

in the Royal Navy. While working

disappeared. Ironically, the British on HMS Salisbury in 1747, Lind

were soon known as “limeys” due

performed what is considered one

to their use of citrus, though it took of the f irst clinical trials. He tested

too long for such a simple remedy proposed cures for scurvy on 12

to be accepted despite evidence

sick sailors and found that citrus

that saved thousands of lives.

fruit was most effective. In 1753, Lind published A Treatise

Mass prevention

of the Scurvy, recommending citrus

The story of scurvy shows how

as a cure, but his advice was largely

resistance to new medical ideas,

ignored. He left the navy to become

however well-evidenced, caused

a physician in Edinburgh. Though

suffering that with hindsight seems his trial was groundbreaking,

inexcusable. Yet it also highlights

recognition of his work came only

how medical progress relies on

in the 20th century. Lind died in 1794,

pioneering work, in this case Lind’s the year before the navy adopted

recommendation of citrus rations

lemon juice rations.

based on a simple controlled trial. While the adoption of his advice

treatise of the scurvy

was painfully slow, it established

In his 1753 treatise, Lind described

proof of concept for preventive

how to recognize, prevent, and cure

medicine through diet and helped

scurvy. He concluded that “…the

propel further research into

cause of the disease I conceive to be

nutrition and public health.

a total abstinence from fresh vegetables and greens which produce a

Key work

1753 A Treatise of the Scurvy

putrescent alkalescent state of the humours, and also a want of due provision of acids”. Based on his 1747 trial, he recommended supplying sailors with citrus fruit, especially

lemons, to prevent and cure scurvy.

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86

GREATER CARE AND

ACCURACY IN MAKING EXPERIMENTS CLINICAL TRIALS

IN CONTEXT

BEFORE

1747 James Lind conducts one

observation and treatments, thereby

of the first controlled trials,

making it harder for other physicians

testing proposed cures for

to evaluate and build on their work.

scurvy on sailors.

Controlled clinical trials aim to address

1798 Edward Jenner publishes

these issues. They compare the effects

findings from his first vaccine

of a treatment (or new drug) on one

trial, showing the effectiveness

group of patients with those of a

of cowpox against smallpox.

control group receiving an alternative

To draw reliable conclusions about the effect or benefit of any treatment, and eliminate experimental variablesorAmong

the effects of chance or coincidence, physiciansbegan conducting

controlled trials in the 18th and 19th centuries.

solution, such as a placebo. By selecting patients at random and using blinding

1962 The Thalidomide disaster

(keeping patients and/or researchers

After highlights the need for tighter

unaware of who receives the new

regulation and testing of new

treatment), controlled trials aim to

drugs. Stringent safety testing

produce objective, scientifically valid

and phased clinical trials are

data on a treatment’s effectiveness

introduced.

and safety. ■

1965 Austin Bradford Hill

Why controlled trials are needed

publishes criteria for assessing

Historically, treatments were evaluated

causality from the results

mainly through individual physicians’

of statistical analyses.

observations and case reports. However, without controls, the role of chance

The randomized controlled trial (RCT) is the gold standard for evaluating the safety and effectiveness of new treatments.

• The pain-relieving and anti-inf lammatory properties of willow bark have been known since ancient times.

• In the 18th century, the Reverend Edward Stone discovered that willow bark could treat fevers and agues (malaria). He published his f indings in 1763.

• Pharmacists isolated salicin from willow bark, then salicylic acid, the active ingredient. But salicylic acid irritated the stomach.

• In 1897, chemist Felix Hoffmann created acetylsalicylic acid, a modified form of salicylic acid that did not cause irritation. This was named aspirin.

• Aspirin became widely available from 1899 and revolutionized pain relief and treatment of inf lammation and fevers.

• Today, aspirin is one of the most commonly used drugs in the world, with a range of applications from pain relief to preventing strokes and heart disease.

• In 1794, British scientist John Dalton described his inability to see certain colors, known as color vision deficiency or color blindness. He had trouble distinguishing red, orange, and green.

• Dalton’s condition attracted scientific interest. In 1801, Thomas Young proposed that the human eye has three cone photoreceptors that detect blue, green, and red light, enabling normal color vision.

• If one type of cone is defective, as in Dalton’s case, it results in color vision deficiency. Dalton lacked green cone photoreceptors, limiting his color perception.

• There are different forms of color vision deficiency, from red-green to blue-yellow. There is currently no cure, though screening tests help diagnose the condition.

• Color vision has been studied since the 11th century. Scientists like Isaac Newton and Hermann von Helmholtz made key contributions to understanding vision and the eye.

Before vaccination, smallpox was a devastating disease that killed millions each year and often left survivors scarred or blind. In ancient China, people practised inoculation,

epidemic. Four years later, Lady

TO ERADICATE A DISEASE, introducing live smallpox material into the body to induce mild disease and immunity. This was risky, and some inoculated children became carriers, HELPING IT SPREAD.

Mary Wortley Montagu observed

people. Her Turkish hosts explained

that young girls survived and became

immune to smallpox if they were

inoculated with pus from a mild

case and developed a less severe

form of the disease. On her return

to England, Lady Mary had her

children inoculated.

In 1721, Cotton Mather, an

minister in Boston, persuaded Dr

Zabdiel Boylston to experiment with

variolation – inoculating people with

live smallpox matter to induce mild

illness and immunity. Boylston

variolated nearly 300 people during

a smallpox outbreak, greatly reducing

deaths. The royal physician Hans

Sloane read Boylston’s report and

convinced Princess Caroline to allow

him to have her children inoculated.

All survived, proving the benef its.

Variolation, as the practice of

inducing immunity through exposure

to live smallpox became known, was

still risky, however, since it involved

the transfer of active smallpox virus.

The aim was to induce a mild illness

that conferred immunity, but this

did not always work, and many

people suffered severe disease or

died from it. Variolation provided

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VACCINATION

Once I became

98

Wortley

ard Augustus. The boy recovered

physician Sir Hans Sloane and the

fully. The experiment convinced

royal family that the practice was

safe and effective, and variolation

gained wider acceptance.

The roots of vaccination

matron, the Greek nurses

Edward Jenner, born in England in

rightly, I must confess,

Sloane, had read accounts of milk

inoculated the children of

aware that no miasmas,

maids who escaped smallpox because

they thought it would be

1. How did variolation work? Variolation worked by exposing people to live smallpox material, often pus from an active infection. This induced a mild case of smallpox that conferred immunity to the disease.

2. What were the risks of variolation? Although variolation conferred immunity for many, it was still risky. Some developed severe disease or died from the exposure. Others became carriers of smallpox, helping the disease spread.

3. How did Jenner develop vaccination? Jenner noticed that milkmaids who had contracted cowpox seemed to be immune to smallpox. He theorized that cowpox exposure could be used to induce immunity to smallpox in a safer way. In 1796, he tested this by inoculating a boy with cowpox, showing that it made him immune to smallpox.

4. How was Jenner’s vaccination safer? Jenner’s cowpox vaccination used a live virus that was similar enough to smallpox to confer immunity, but different enough that it did not cause a dangerous illness in humans and did not make people carriers of smallpox. This made it much safer than variolation.

told me that, having

how could fail to be

1749, was apprenticed to Sir Hans

of exposure to cowpox. Jenner, then

what immense use

and that I should not imagine

a country surgeon, wondered if

cowpox could be used deliberately

it might be …

had been to them …

Lady Mary

Wortley Montagu

Letter to a friend, 1717

to induce immunity to smallpox

in humans. Cowpox caused mild

disease in cattle and milkmaids,

but seemed to protect them from

smallpox. Jenner theorized that

cowpox virus was similar enough

to smallpox virus to confer cross-

immunity, but different enough not

to cause a dangerous disease in

humans. In 1796, Jenner tested

this theory in his famous f irst

vaccination experiment, inoculating

eight-year-old James Phipps

subjecting the boy to variolation.

How did Jenner develop vaccination?

In 1796, Edward Jenner noticed that milkmaids who had been exposed to cowpox seemed immune to smallpox. He theorized that inoculating humans with cowpox could induce immunity to smallpox in a safer way. Jenner tested this by inoculating James Phipps, an eight-year-old boy, with cowpox. When Phipps showed immunity to later smallpox exposure, Jenner showed that cowpox vaccination could protect against smallpox.

• Smallpox was a deadly disease that killed about one third of children before age five. Survivors were left with scars.

• The practice of variolation, deliberately infecting people with smallpox to induce immunity, was known for centuries in Asia, Africa, and Europe. It was dangerous, killing about 3% of those treated, but less risky than natural infection.

• Edward Jenner, an English doctor, wondered if cowpox, a mild disease, could be used instead to confer immunity to smallpox. In 1796, he tested this by inoculating a boy with cowpox, then exposing him to smallpox. The boy did not get sick.

• Jenner promoted vaccination with cowpox. By 1800, the technique had spread worldwide, though it was controversial. The source was cowpox sores from infected people, not cattle, for decades.

• Jenner is called the “father of immunology” for showing that inoculation with a safer form of a disease could prevent the deadly form. Vaccination led to the eventual eradication of smallpox.

• Objections included that it interfered with God’s will, it used diseased animal matter, and it limited freedom of choice. Compulsory vaccination led to protests.

• At first, the vaccine source was cowpox sores on infected dairymaids’ arms. Few used material directly from cattle until the 1840s. Production was industrialized in the 19th century.

• Vaccination saved millions of lives, though its acceptance took time. It demonstrated the principle of inducing immunity by controlled exposure to a safer form of an infectious agent.

t stethoscope consisted of a hollow wooden tube

• In 1816, René Laënnec invented the stethoscope to allow doctors to listen to patients’ heartbeats and breathing without direct physical contact.

with an earpiece at one end.

• Before the stethoscope, doctors had to press their ears directly to patients’ chests to listen, which Laënnec found embarrassing and inefficient.

Laënnec’s invention allowed

• Laënnec’s first stethoscope was a hollow wooden tube with an earpiece. It

physicians to listen to sounds

allowed doctors to hear internal sounds like heartbeats more clearly.

within the chest cavity without

• The stethoscope revolutionized medicine by giving doctors a tool to diagnose

the discomfort of direct contact. It

lung and heart conditions. Laënnec himself discovered several diseases using

revolutionized the diagnosis of heart

the stethoscope.

and lung conditions. Laënnec was

• Since Laënnec’s time, stethoscopes have been improved with better acoustics,

able to describe several diseases,

flexible tubing, and the ability to amplify sounds. But they remain a key tool for

such as bronchitis, pneumonia,

doctors to non-invasively assess patients’ health.

pleurisy, and pericarditis, based on

the sounds he discerned with his

new instrument. He published his

f indings in 1819 in A Treatise on

AFTER

Mediate Auscultation.

1829 French military surgeon The use of the stethoscope is René-Théophile-Hyacinthe

largely unchanged but modern

The design of the stethoscope

Laënnec improves on his chest

variations incorporate flexible

has remained largely unchanged,

stethoscope with his differential

rubber tubing and the ability

though modern stethoscopes

stethoscope, with two earpieces.

to amplify sounds. While

employ flexible rubber tubing for

1860s Springy rubber

imaging techniques now also

comfort and the ability to amplify

tubing replaces rigid tubes.

allow visualization of the heart

sounds. The stethoscope remains

1960s Electronic stethoscopes

and lungs, the stethoscope

an essential tool for physicians

are developed.

remains a quick, non-invasive

to visualize the inner workings

way for physicians to assess a

of patients’ hearts and lungs

patient’s condition.

non-invasively.

See also: Human circulation 32–35 ■ Percussion 46–47 ■ Sphygmomanometer 48–49

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104

Public health JOURNALISM

IN CONTEXT PREGNANCY

In 1854, Dr John Snow investigated

SMOKING

DEATH

PREGNANT

On the trail

a cholera outbreak in London’s

NERVOUS

RATE

nervousness

Soho district. He famously used a

BEGINNING

map to identify a contaminated

HIDDEN

public water supply as the source.

Among

the women interviewed

— The Lancet, Saturday

Breathlessness

rates, particular during pregnancy

ang immoderate smoking may

May 12, 1855

and palpitations were also

and in the early months after

injuriously affect the growth and

common complaints attributed

giving birth… We propose that

development of the fetus in utero,

to pregnancy. But were tobacco,

alcohol, and the then legal and

and in some cases may even lead to

tea, or coffee also to blame?

widely available opium causing or

its premature expulsion… We found

contributing to these symptoms?

the notion of “nerves”was frequently

Dr T. Murray of Glasgow posed

invoked… as an explanation for

DATA

this question in 1855. He conducted OUTCOMES

MENTAL

a survey of 200 women from the

NEED

NERVOUS

wealthy and working classes to

Nervous symptoms appeared

assess their tobacco, alcohol, tea,

to be more prevalent in women

and coffee consumption during

of higher social status. “The

pregnancy and the health outcomes loose, irregular lives led by many

study sought to find

government began the first annual

these symptoms, but rather that

statistical overview of the health

the excessive

of the population. Data included

greater consumption of all three

causes of death with age, sex, and

tobacco consumption damages

(tea, coffee, and tobacco)…” Nagel,

location – vital for identifying

health, while the expectation

however, proposes that it was

public health issues. This marked

of symptoms led to their

the arrival of social statistics

perception and reporting…

for their children. He found no significant differences in symptoms

an increasing need for sound data In 1858, the British Registrar

Dependent lives of many females in middle rank engenders a

GROWTH

consumption of any of the “nerve stimuli” responsible for triggering

Dependent lives middle rank females

nervous symptoms…the

Ariel Beaujot,2018

or mortality between women who abstained and those who

FFECT

consumed tobacco, alcohol, tea,

Advice on smoking and pregnancy

or coffee. Nevertheless, he warned

ting variables, and judgements

remained inconsistent for another

that smoking in excess might harm

about the role and responsibilities

century… In the 1950s, studies

the fetus and increase the risk of

of individuals versus their

found associations between

stillbirth or miscarriage.

environment and society.

smoking during pregnancy and low

… Proposed that ang immoderate

WEIGHED

which diverse factors were cited as contributing to the high death

birthweight… It took until the 1970s Nervousness attributed to the

for persuasive evidence to lead to

middle classes, 1855.” Tobacco,

was more deeply entrenched,

for a “nervous disposition” and could itself cause morbidity. Yet

warnings of harm … Mortality

expectations of health shaped reporting and perception of disease.

Health is the result of complex causation, requiring consideration of media-

AFTER 1857 The Matrimonial Causes Act

1896 Dr T.J. Preston studied maternal

Public health messaging around risks grew slowly as evidence built and

health in industrial Lancashire and

Values and beliefs evolve with scientific knowledge and social change.

attributed lung conditions to pollution. Public anxieties drove calls for action. c. 1940s Richard Doll links smoking and lung cancer. Despite huge

banning tobacco explains that women felt financial and

social pressures, health campaigns took decades to change behaviour. Now

economic dependence on men. Smoking became popular among higherclass women in England only in the decades before this study, linked to

tobacco is prohibited in public places, yet some continue arguing rights. Debates consider health, freedom, and the role of the state in regulating behaviour.

changing expectations and freedoms. If pregnancy smoking was thought harmful, anxieties could be dismissed by blaming “nervousness” and demandingness.

History informs policy and public attitudes. Weighing complex evidence and values guides wise decision making. Expectations and environment strongly influence health.

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THE SCIENTIFIC BODY 105

Understanding the

and his death was greatest in polluted cities. He argued for Public Health Acts

DETERMINANTS of HEALTH Public health focuses on the health of whole populations. It aims to understand the determinants of health, prevent disease, and promote well-being. Public health issues are complex, requiring consideration of mediating factors and judgement of responsibilities. Values and knowledge evolve.

BEFORE 1600s In the 17th century, increased trade and urbanization bring new health

challenges. Plague outbreaks prompt beginnings of policy on quarantine, sanitation. 1662 John Graunt uses Bills of Mortality to analyze death trends in London,

recognizing the impact of living conditions. He argues policy could extend lifespans. 1798 Thomas Malthus warns population growth threatens resources and health.

1842 Edwin Chadwick’s Report on the Sanitary Condition of the Labouring Population

of Great Britain argues for public health reforms, recognizing that environment and living conditions impact health. The Poor Law Commission report shapes policy.

1854 Dr John Snow uses mapping to link a cholera outbreak to water supply

Here is a summary of the key events in the development of blood transfusion and blood groups:

• In the 17th century, English physician William Harvey discovered the circulation of blood in the body. Early blood transfusions between animals were attempted, but often unsuccessful and even fatal.

• In 1818, British obstetrician James Blundell performed the first successful human blood transfusion, transfusing blood from one patient to another. However, the procedure was risky due to blood type incompatibility and clotting issues.

• In 1900, Austrian physician Karl Landsteiner discovered the first three human blood groups: A, B, and C (later O). This allowed doctors to match blood types for safer transfusions.

• During World War I, US Army doctors set up “blood depots” to collect and store blood for transfusions on the battlefield. They discovered that sodium citrate could prevent clotting and allow blood to be stored for up to 28 days.

• In 1939, Landsteiner and Alexander Wiener discovered the Rh blood group system. Doctors now had to also match Rh factors (positive or negative) for safe transfusions.

• In 1914, anticoagulants like heparin were developed to prevent clotting during transfusions and allow longer-term blood storage.

• These discoveries allowed doctors to perform life-saving transfusions with a much lower risk of adverse reactions. Blood banks were established to collect, type, and distribute donated blood to hospitals and patients in need.

• Safe and effective blood transfusion has been one of the most important medical advances, saving millions of lives lost to injury and disease. Matching blood types and other factors remains crucial to transfusion safety.

So in summary, progress was slow but steady, built on many small discoveries and advances over centuries. A key breakthrough was understanding the fundamental biology of blood groups, which then enabled the creation of blood transfusion as a safe and routine medical procedure.

• Blood loss from injury or childbirth was a major cause of death historically. Blood transfusions offered a remedy but were dangerous until blood groups were understood.

• Early blood transfusions between animals and humans often failed and sometimes caused death. Attempts between humans also had high failure and death rates.

• In 1901, Karl Landsteiner discovered that there are different blood groups (A, B, and O), and that blood clumps together when mixed between incompatible groups. This explained why many early transfusions failed.

• Landsteiner’s discovery allowed blood transfusions to become safe by ensuring donor and recipient blood were compatible. Blood banks were later established to store donated blood for transfusions.

• Knowledge of blood groups enabled organ transplants and other medical advances. Blood plasma can now be stored for years, allowing it to be used in emergencies and treatment of conditions like COVID-19.

• Anaesthesia refers to the loss of sensation, especially pain. Early forms of anaesthesia date back thousands of years and included the use of opium, cannabis, and alcohol.

• In the early 1800s, scientists began exploring the anaesthetic properties of nitrous oxide (laughing gas) and ether. People would inhale these gases recreationally at “ether frolics” and “laughing gas parties” and experience euphoric, intoxicating effects.

• In 1842, Crawford Long, an American physician, first used ether as a surgical anaesthetic. He noticed that inhaling ether caused loss of sensation and used it to perform minor operations. However, he did not publish his findings until 1849.

• In 1846, William Morton publicly demonstrated the use of ether as an anaesthetic in surgery. He administered ether to a patient at Massachusetts General Hospital so a tumor could be removed from the patient’s neck. This demonstration helped establish ether as a viable anaesthetic.

• The use of ether spread to Britain, where Robert Liston performed the first surgery using ether in December 1846. Chloroform also became popular as an anaesthetic, especially after Queen Victoria used it during childbirth in 1853.

• The advent of effective anaesthesia was a landmark in medicine, allowing surgeons to perform operations that were previously not possible due to immense pain. However, there were disputes over who deserved credit for discovering ether’s anaesthetic effects.

dog, Finally, a potentially more toxic dose of a single drug.

In 1852, Kölliker published his

Handbook of Human Histology, ■ Histology emerged in the 17th century but stalled due to poor microscope technology. which established histology as a ■ In the 1830s, improved microscopes and lenses enabled progress. distinct field of study. He realized that all tissues are composed of ■ Swiss anatomist Albert von Kölliker established histology as a field and realized all tissues contain cells. cells that develop from other cells. ■ Kölliker’s 1852 handbook formalized procedures like fixation, staining, and sectioning of samples. Using new staining methods,

■ Improvements in microscopy, sample processing, and staining led to advances. New technologies continue to enable progress.

Kölliker also identified muscle

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ALL CELLS

COME FROM

CELLS

BACTERIOLOGY

IN CONTEXT

BEFORE

Bacteriology, the scientific study

parasites called animalcules.

of bacteria, evolved from the

1683 Antoni van Leeuwenhoek

early microscope observations of

describes bacteria and protozoa,

pioneers such as Antonie van

which he observes in dental plaque,

Leeuwenhoek in the 17th century. gut scrapings, and other samples.

However, the field only gained

AFTER

1857 Louis Pasteur proposes

momentum in the 19th century, as that lactic acid fermentation is

scientists began to understand the

caused by living microbes.

relationship between bacteria and

1861 Louis Pasteur disproves

disease. Two key figures were Louis spontaneous generation, showing

Pasteur, who pioneered vaccination that microbes come from other

and pasteurization, and Robert

microbes, not spontaneously.

Koch, who established techniques

1876 Robert Koch establishes

for isolating and culturing bacteria.

that specific microbes cause

With proof that specific microbes

anthrax and shows how to isolate

caused particular diseases, scientists

and culture bacteria.

could develop treatments and, in

Some of the earliest known

some cases, vaccines. Bacteriology

scientists to study bacteria, known

thus heralded a new era in medicine. as “animalcules”, were Antonie

van Leeuwenhoek, who described

The earliest microscopes

bacteria in 1683, and Christian

enabled scientists to observe single- Gottfried Ehrenberg, who named

celled organisms for the first time.

1882 Robert Koch identifies

the microbes Staphylococcus,

Streptococcus, and Pneumococcus.

1884 Hans Christian Gram develops

the Gram stain technique to

classify bacteria by their cell walls.

1928 Alexander Fleming discovers

the first antibiotic, penicillin.

the tubercle bacillus (TB) in 1882.

The popularity of spontaneous

generation theory – that life could

arise from non-living matter – slowed progress, but Louis Pasteur

disproved this theory in 1861.

Robert Koch and Louis Pasteur helped establish that microbes cause disease and developed key theories, techniques, and vaccines. Bacteriology revolutionized medicine with proof of germ theory and discoveries enabling prevention and treatment of infectious disease.

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CELLS AND MICROBES 125

See also: Microbiology 40–41 ■ Vaccination 208–09 ■ Antibiotics 250–51 ■ Microbial disease 260–61

bacteria in 1838. However, their

Though Pasteur championed germ

observations were descriptive; the theory, he did not actually make the link between bacteria and disease

crucial connection between a specific

was still to be determined.

bacterium and a particular disease.

This was achieved by German

Proving germ theory

physician Robert Koch, who

In the 1850s, French chemist Louis

developed methods for isolating

Pasteur showed that fermentation

and culturing pure strains of bacteria.

was caused by living microbes and

In 1876, Koch proved that Bacillus

that many diseases were spread by

anthracis caused anthrax, and in

“germs” too small to see without

1882 identified Mycobacterium

a microscope. Pasteur developed

tuberculosis as the cause of TB.

vaccines for diseases such as

Using bacteriology, Koch and

anthrax, chicken cholera, and rabies

his students identified several

by attenuating (weakening) microbial

other disease-causing microbes,

cultures. His experiments disproving notably those for cholera (in 1883)

spontaneous generation helped

and diphtheria (in 1884). The new

establish “germ theory” – that

field of bacteriology had arrived,

disease is caused by microbes.

enabling diagnosis, prevention,

and treatment of infectious diseases.

Louis Pasteur in his laboratory, 1887. Pasteur pioneered the germ theory of disease and developed vaccines for diseases such as anthrax, cholera, and rabies.

Robert Koch

Born in 1843 in Clausthal, Germany,

Russia. In Berlin, Koch developed

Robert Koch studied medicine

solid culture media and techniques

before becoming a country doctor.

to isolate and grow pure cultures of

In 1872, Koch took a post at the

bacteria, enabling him to identify

Department of Gynaecology at the the specific microbes that caused University of Berlin. Though lacking

anthrax (Bacillus anthracis),

formal training in biology, Koch was

tuberculosis (Mycobacterium

fascinated by microscopes and

tuberculosis), and cholera (Vibrio

The isolation and culturing techniques pioneered by Koch, along

studied bacteria in his spare time.

cholerae). The “Koch’s postulates”

with Pasteur’s germ theory, formed the foundations of bacteriology

In 1876, Koch published a paper

he described for determining the

and enabled scientists to identify disease-causing microbes. Their

announcing that anthrax was caused causative agent of an infectious

discoveries transformed medicine, enabling diagnosis, prevention,

by Bacillus anthracis, a discovery

disease remain influential today.

and treatment of diseases. Gram staining and cultivation methods

that brought him fame. He was

Koch received many honours,

invented by Koch, Gram, and Petri were fundamental to progress.

appointed to lead the Imperial Health including the Nobel Prize in 1905.

Office in Berlin, and later travelled

He continued working until his

to study diseases such as malaria in death in 1910.

Key works

Africa, India, and plague districts of

1876 “The Aetiology of Anthrax”

1884 “The Etiology of Tuberculosis”

1905 Nobel Prize in Physiology or Medicine

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ALL CELLS

COME FROM

CELLS

CELLULAR PATHOLOGY

IN CONTEXT

BEFORE

Cellular pathology is the study

of how cells change in disease.

1819 The first description

of a malignant tumour is

In the 19th century, as microscopes

published by Scottish surgeon

improved, scientists began to

John Baron.

explore pathological changes at a

1838 Matthias Jakob Schleiden and

cellular level. This enabled diagnosis Theodor Schwann propose the

of diseases that could previously only “cell theory” that all organisms

be identified during autopsy. Key

are composed of cells.

figures included Rudolf Virchow,

1843 Johannes Peter Müller

who established that cells can only

proposes that cancers arise

arise from other cells, and Theodor

from mutations that alter cell

Schwann, who helped propose the

division and growth.

cell theory in 1838.

As microscopes improved and the

cell theory took hold, scientists

could see that disease often caused

visible changes to cell structure or

AFTER

1858 Rudolf Virchow publishes

Cellular Pathology, proposing that

all cells arise from other cells.

1869 Paul Langerhans discovers

the pancreatic islets that later

bear his name, enabling study

of diabetes at a cellular level.

behaviour. In 1858, Rudolf Virchow’s 1895 Wilhelm Röntgen discovers

Cellular Pathology proposed that

not chlorinated.

not miasma, was the cause. His

■ In the 19th century, the miasma theory that disease was caused by “something

Conclusion

work provided strong evidence for

bad in the air” prevailed. Public health reformer Edwin Chadwick believed that

eliminating miasma theory and has

environmental factors and poor living conditions caused disease.

Snow’s systematic study, using

informed modern epidemiology.

■ The annual cholera epidemics in London were attributed to miasma. John Snow

both geographical mapping and

Snow is now recognized as a

doubted this and thought the disease was spread through contaminated food or

statistical analysis, demonstrated

pioneer of epidemiology – the

water. He studied cholera outbreaks and noted sufferers first had digestive, not

that cholera spread via the faecal–

study of the distribution and

respiratory, symptoms.

oral route. His work represented

determinants of disease.

■ In 1854, Snow mapped cholera cases in Soho, London, and found a cluster around

a turning point in understanding

one water pump. He showed the pump was contaminated, proving cholera was

of disease transmission. Just as

spread through water, not air. Though disputed, Snow’s work led to improved

importantly, he demonstrated

sanitation and helped overturn miasma theory.

how epidemiological methods

■ Snow was a pioneer in anaesthetics and campaigned for public health reforms.

could be used to understand

His work on cholera was seminal but initially contested. He died aged 45 in 1858.

the etiology of disease. Once

■ Snow’s study of cholera outbreaks used mapping and statistics to show how

Snow had shown the water

the disease spread. This established the basis of epidemiological methods to

supply was the source of the

understand disease transmission.

epidemic, it was clear that public

■ Once shown, the link between poor sanitation and disease drove improvements

health measures were needed to

in public health. snow’s work was pivotal in overturning miasma theory.

prevent its recurrence. Snow’s research also provided evidence

• Nursing care has been practiced for centuries, but modern nursing begins with Florence Nightingale.

• Nightingale received nursing training in Europe and Egypt,

then became superintendent of nurses at a London hospital,

improving standards of care.

• During the Crimean War, Nightingale took 38 nurses to the

military hospital at Scutari, where conditions were squalid and the death rate was high. Using funds from The Times newspaper,

she improved hygiene and reduced overcrowding. The death rate fell dramatically.

• Nightingale realized disease, not injuries, was the main cause of

death. With the statistician William Farr, she analyzed data showing

into 12 segments to create a circular her leadership in presenting held in London, her work was praised statistic plot of monthly mortality statistics was recognized.

by Adolphe Quételet, the leading

rates. The longer the segment,

statistics expert of the day. With

Nightingale later founded the

the greater the number of deaths.

Farr, Nightingale pioneered the first Nightingale School of Nursing at

By comparing the segments over

use of statistics in hospital

St Thomas’ Hospital, London. She

time, the effect of improvements

administration, establishing

also wrote Notes on Nursing (1859)

could be clearly seen. She used

evidence-based medicine.

to instruct nurses and improve

this graphical technique in her

standards in hospitals and the

landmark Notes on the Health of

community. Her legacy lives on in

the British Army (1858).

the annual Florence Nightingale

Nightingale showed that by

International Foundation Award,

improving ventilation, drains, and

which recognizes excellence in

water supply, the mortality rate

nursing practice and research.

could fall dramatically – proving her belief that “a hospital should

Florence Nightingale’s polar

do the sick no harm”. Her report

area diagram showed the

that disease, not wounds, caused most deaths.

was a seminal text that helped to monthly mortality of the British

• Nightingale pioneered the use of visual data – especially the polar

area diagram – to demonstrate the effect of improvements, and to shape public opinion.

• Nightingale established the first official nurse training school in 1860.

Her book Notes on Nursing became the standard nursing reference.

• Nightingale was an early advocate for sanitary reform. She showed

that improving ventilation, drains, and water supply dramatically reduced hospital death rates.

• Nightingale’s statistical analysis and call for better sanitation established evidence-based medicine and improved standards of hygiene.

transform nursing into a profession.

army at Scutari Barrack Hospital

t

t

e m

n

d

a

t

nt r

during the Crimean War. The declining segment size shows the falling monthly death rate.

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CELLS AND MICROBES 133

NIGHTINGALE’S DATA REVOLUTION Florence Nightingale was a pioneer in the use of statistics to analyze health issues and campaign for reform. While nursing in the Crimea, she realized that disease, not war wounds, was the main cause of death among soldiers. With the army medical statistician William Farr, she studied Crimean mortality data and produced statistical reports demonstrating the scale of the problem. These helped turn public opinion in favor of her calls for improvements in army health. Nightingale also saw the value of visual presentation of data. She developed an early version of the pie chart – her “coxcomb” diagram. This showed monthly death rates at Scutari hospital in a simple circular form, making the effects of improvements immediately apparent. When standards of hygiene and sanitation were improved, segment sizes decreased over time. Nightingale established the value of collecting and analyzing data in a systematic way to identify health issues and evaluate the impact of interventions. She was a pioneer of evidence-based approaches in medicine and public health. Her statistical work helped establish nursing as a serious profession focused on real outcomes.

Nightingale’s initial “coxcomb” graph, showing monthly mortality rates at Scutari military hospital during the Crimean War. The decreasing segment size demonstrates the effect of improvements in hygiene.

of Poland) in 1821, Rudolf Virchow

• In the 19th century, German pathologist Rudolf Virchow pioneered the study of diseases at the cellular

microscopists Hermann Fol and

cell’s tiniest components, including studied medicine at the universities

level, known as cellular pathology. He posited that all cells come from other cells, and that disease arises

Theodor Boveri in the late 1800s

the mitochondria that produce

of Berlin and Würzburg. He

from abnormalities at the cellular level.

helped establish the chromosome

energy, the ribosomes that make

specialized in pathology and cellular

• Virchow proposed that scientists should look beyond organs and tissues to understand disease, and

theory of inheritance. The theory protein, and DNA, the chemical that biology, becoming a professor at

instead examine individual cells. He discovered that diseases like cancer develop from cell abnormalities.

proposes that chromosomes within

carries genetic information.

the University of Berlin in 1856.

• Virchow identified diseases such as leukemia, coined medical terms like thrombus and embolism, and

the cell nucleus are the bearers

Biomarkers that indicate disease

Virchow was a pioneer of

showed how blood clots could travel and cause blockages. His 1858 book Cellular Pathology influenced

of genetic information. With the

processes or risks for certain health scientific pathology in Germany.

pathology for decades.

development of cytogenetics – the

conditions are detectable at the

He revolutionized medicine with his

• Virchow’s work paved the way for progress in understanding diseases. His students explored bone and

study of the structure and function cellular level using blood tests

insistence that disease should be

blood disorders and infectious diseases. New techniques allowed scientists to analyse cells, nuclei, DNA,

of chromosomes – cells could be

examined at the cellular level.

and other diagnostic procedures.

and identify embryonic stem cells. Scientists now use electron microscopes to study the smallest cell

analysed in ever-f iner detail.

components and identify signs of disease. Biomarkers indicate disease processes at the cellular level.

Modern medical scrutiny at

the cellular and molecular level using techniques such as histology,

cytogenetics, and electron microscopy, along with diagnostic

HISTOPATHOLOGY Microscopic analyses

Abnormalities

The examination of thin sections

The presence of abnormal cells or

of tissue, known as histopathology, unusually high numbers of cells can

helps identify abnormalities at

indicate disease. Common signs that

the cellular level that may indicate pathologists look for include:

diseases or disorders. Tissue samples

• Enlarged or shrunken cell nuclei: can

are f ixed onto glass slides, stained,

indicate cancer or degenerative diseases.

and magnif ied under a microscope.

• Excess or reduced numbers of cells: can

A pathologist analyses the sample

indicate cancer, anaemia, or infection.

and looks for changes to the size,

• Disruption of normal cell organization

shape, and characteristics of cells;

or architecture: may indicate cancer,

The role of Virchow is very polymorphic. He is one of the most prominent pathologists. He founded cellular pathology and formulated the concept of cellular participation in disease. He considered that diseases primarily arise from cells. He introduced and propagated an approach based on macroscopic and microscopic changes as opposed to speculative theory. Such approach was crucial for the development of pathology.

inf lammation, or tissue damage.

cell numbers; and the arrangement or • Presence of abnormal cell types: can architecture of cells. Histopathology indicate cancers such as lymphoma or

leukaemia, or an infection.

remains fundamental for diagnosing • Cellular inclusions or vacuoles: can many diseases and disorders.

indicate genetic disorders or degeneration.

The key points in the history of germ theory are:

there certain minute animals breed

is linked to a specific germ.

• Ancient physicians speculated that diseases were caused by tiny organisms, but the miasma theory that “bad air” spread diseases prevailed for centuries.

which cannot be seen by the eyes,

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CELLS AND MICROBES 141

Germ theory asserts that diseases are caused by specific microbes, not miasmas, and are transmitted between individuals.

• In the 19th century, advances in microscopy allowed scientists to see and study bacteria

They were john Snow’s investigation of cholera in 1854, Louis Pasteur’s germ theory and the experiments of Robert Koch who established that anthrax and tuberculosis were caused by bacteria.

• Joseph Lister pioneered antiseptic surgery based on germ theory.

• Major medical breakthroughs followed, including vaccines, antibiotics, and improved hygiene and sanitation.

• Identifying the germ responsible is now the first step in tackling any new infectious disease outbreak. Hundreds of diseases have now been linked to specific microorganisms.

• Germ theory revolutionized medicine and public health. Before germ theory, almost half of children died before the age of five, due primarily to infectious diseases. Life expectancy has since increased dramatically.

That covers the key milestones in the development and impact of germ theory. Let me know if you would like me to explain anything in more detail.

a deadly disease in farm animals.

• Disease was long thought to be caused by bad air (miasmas). Microscopes in the 17th century showed tiny organisms, but germ theory took time to gain acceptance.

• Italian Agostino Bassi showed in 1835 that a fungus caused disease in silkworms.

• Ignaz Semmelweis (1847) and John Snow (1854) showed that hygiene reduced disease, casting doubt on miasma theory.

• Louis Pasteur conducted experiments proving that microbes in the air caused fermentation and putrefaction. His pasteurization technique killed pathogens in food and drink.

• Pasteur identified the microbial cause of silkworm disease (1876) and recommended control measures.

• Joseph Lister pioneered antiseptic surgery after reading Pasteur’s work. Mortality rates fell dramatically.

• Robert Koch proved that Bacillus anthracis bacteria caused anthrax (1876), conclusively demonstrating germ theory.

• Pasteur became world famous and founded the Pasteur Institute to study microbes, disease, and vaccines.

versions (recessive and dominant) and offspring inherit one allele from will be double

Brünn (now Brno in the Czech

each parent. If the alleles differ (heterozygous), the dominant one is

Republic) in 1843 and was

expressed. If both alleles are the same (homozygous), the dominant one recessive for

ordained as a priest. While

still shows, but if both are recessive, that trait is expressed.

teaching at the monastery, Mendel bred and observed

recessive if

the recessive both parents trait.

are carriers.

Mendel’s law of segregation states that

Mendel experimented with peas, selecting traits that appeared in two distinct forms: tall height versus dwarf; yellow seeds versus green; inflated pods versus constricted. When breeding different forms, he found offspring inherited one factor from each parent randomly.

thousands of garden peas for

Mendel’s law of independent assortment asserts that traits are inherited separately. The allele for flower colour does not influence the allele for pod shape.

eight years to discover the mathematical principles of heredity, though his findings

Mendel’s law of dominance holds that one allele can mask the effect of another. With pea plants, purple flower colour was dominant, white recessive. For the recessive trait to be expressed, an organism must inherit two recessive alleles, one from each parent.

were mostly ignored until the turn of the 20th century. He was elected abbot of the

Offspring can be:

monastery in 1868 but had little time for further research.

Homozygous dominant - two dominant alleles, expressing the dominant trait.

He died in 1884.

Heterozygous - one dominant, one recessive allele, expressing the dominant trait.

Key works

Homozygous recessive - two recessive alleles, expressing the recessive trait.

• Experiments in Plant Hybridization (1865) • “Experiments on Plant Hybrids” (1866)

• In the mid-19th century, surgery was dangerous due to lack of hygiene and germ theory. Nearly half of patients died from infected wounds.

• Joseph Lister read Louis Pasteur’s work on germ theory and believed microorganisms caused surgical infections.

• Lister used diluted carbolic acid as an antiseptic to kill microorganisms. He sprayed it on surgeons’ hands, surgical instruments, and bandages.

• Lister’s antiseptic methods reduced surgical mortality rates by two-thirds. However, many surgeons opposed Lister’s theories as they slowed surgery.

• Lister eventually overcame opposition as antiseptic surgery proved successful. His methods spread and improved surgical outcomes worldwide.

• Lister is known as the “father of antiseptic surgery” for pioneering sterile surgical technique and improving surgical safety.

Here is a summary of the key events leading to our current understanding

This practice was

of the immune system:

fraught with danger.

• Around 900 CE, Persian physician Al-Razi theorized that fever and other responses to

disease represented the body’s efforts to overcome illness.

1718 English surgeon John

• In 1718, John Woodall introduced the variolation technique, inoculating people with

Woodall introduces variolation,

smallpox to induce immunity. This was risky but showed that immunity could be stimulated.

inoculating people with

• In 1796, Edward Jenner developed the much safer vaccination technique, using cowpox

smallpox to induce immunity.

vaccine to protect against smallpox. This demonstrated that immunity could be induced safely.

• In the late 1800s, scientists identified the phagocytes (cells that consume pathogens) and

antibodies (proteins that target pathogens) as key parts of the immune response.

1796 Edward Jenner develops

vaccination, using cowpox to

• In the 1900s, scientists explored how the immune system distinguishes self from non-self.

stimulate immunity to smallpox.

• In the mid-1900s, acquired immunity was shown to involve both antibodies and cell-mediated

immunity. The mechanisms behind vaccination and natural immunity were clarified.

• Today we have a sophisticated understanding of the immune system, including its components

Late 1800s Phagocytes and

(phagocytes, lymphocytes, antibodies, etc.) and mechanisms (innate and adaptive immunity).

antibodies are identified as

We continue to develop new vaccines and immunotherapies based on this knowledge.

key parts of the immune response.

So in summary, our understanding of immunity grew over centuries through observing the effects of disease, developing techniques like variolation and vaccination, identifying key immune components, and systematically exploring how the immune system functions. This long process has enabled many lifesaving medical advances, though much remains to be discovered about the complex immune system.

• There is only one genuinely scientific treatment for disease - stimulating the body’s immune system.

• The idea of immunity dates back to the 1500s but Edward Jenner’s smallpox vaccination in 1796 proved it.

• It was not understood how vaccination worked or whether inflammation helped or hurt. Disease was not understood either.

• In the 1800s, Louis Pasteur and Robert Koch showed germs cause disease. But they thought the body could not defend itself.

• In 1882, Élie Metchnikoff proposed white blood cells defend the body. He saw them engulf germs and called them “phagocytes”.

• Metchnikoff suggested inflammation draws phagocytes to infections. He distinguished macrophages and neutrophils.

• Emil von Behring found antitoxins in animal serum could immunize or cure disease. This supported specific defenses and vaccines.

• Paul Ehrlich studied antigens and antibodies. Antigens provoke an immune response. Antibodies match antigens and disable germs.

• Ehrlich’s “side-chain” theory said antibodies are receptors on white cells that release antibodies when an antigen locks on.

• Ehrlich proposed “magic bullets” - drugs that mimic antibodies. This led to Salvarsan, the first syphilis drug, and the search for vaccines.

• Jules Bordet and Hans Buchner studied complement proteins that burst invaders, attract phagocytes, and cause inflammation.

• It was thought immunity was either innate/cellular or adaptive/humoral. But complement and antibodies show it is not so simple.

• Almroth Wright cast more doubt on this division by showing that immunity builds up in steps, with both cells and chemicals involved.

these activate cytotoxic T-cells to attack the infected cell, bombarding it

• The immune system consists of innate and adaptive responses. The innate response is nonspecific and includes phagocytes that ingest pathogens.
• The adaptive response is antigen-specific and involves lymphocytes (B-cells and T-cells). B-cells produce antibodies. T-cells include T-helper cells and cytotoxic T-cells.
• Burnet proposed the clonal selection theory: each lymphocyte produces a single kind of receptor, and when it meets its target antigen, it multiplies rapidly.
• B-cells and T-cells work together. T-helper cells activate B-cells to produce antibodies (humoral immunity) or cytotoxic T-cells (cell-mediated immunity) to destroy infected cells.
• sometimes the immune response overreacts (hypersensitivity), leading to allergies or anaphylaxis.
• The innate and adaptive systems are linked. Some innate immune cells can detect molecular patterns from pathogens and present these to T-cells.

Here is a summary of key developments in vaccines, serums, and antibiotics from 1890 to 1945:

• Emil von Behring and Shibasaburo Kitasato discover that antitoxins in the blood can be used to prevent disease. Their work leads to serotherapy for diseases like diphtheria.

• Paul Ehrlich develops Salvarsan, the first chemotherapeutic drug, to treat syphilis. His “magic bullet” approach inspires targeted treatments.

• Vaccines are developed for cholera, tetanus, whooping cough, bubonic plague, yellow fever, and tuberculosis. The BCG vaccine is the first live attenuated vaccine.

• Alexander Fleming discovers penicillin in 1928, but it is not mass produced until the 1940s. Penicillin and sulfa drugs usher in the antibiotic age.

• Antibiotics like penicillin, introduced in the 1940s, provide cures for diseases caused by bacteria like streptococcal infections, syphilis, and tuberculosis.

• Technological advances include X-rays, the electrocardiograph, and Freud’s psychoanalysis. Alzheimer’s disease is identified as a cause of dementia.

• Life expectancy begins to increase in Western nations due to improved public health, diet, and medical care. Many deadly infectious diseases are brought under control.

So in summary, this era saw major progress against infectious disease through antitoxins, vaccines, chemotherapy drugs, and antibiotics. New technologies and insights also emerged across medicine and psychology. These advances helped raise life expectancy and quality of life around the world.

• William Coley observed that cancer patients who suffered severe bacterial infections sometimes had better outcomes. In 1891, he began injecting streptococcal bacteria into cancer patients to provoke an immune response.
• Coley continued experimenting for 30 years and treated over 1,000 patients. He observed tumor reduction in some cases. However, his methods were controversial and largely supplanted by the advent of radiation therapy.
• Coley’s work provided early evidence for the link between the immune system and cancer. It foreshadowed modern cancer immunotherapies, which activate the immune system to attack tumors.
• Cancer treatments date back to ancient Egypt. Early surgical methods were often disfiguring. Cancer spread and outcomes are now known to depend more on the extent of spread before treatment than how much tissue is removed.

Here is a summary of the limitations of early cancer treatments:

• Surgery: Limited to removing accessible and localized tumors. Ineffective against metastatic cancers that have spread.

• Radiation therapy: Inaccurate targeting resulted in damage to healthy tissues and side effects. Early radiologists lacked understanding of safe dosage and exposure, and some developed cancer themselves. Radiation could only reach certain areas of the body.

• Chemotherapy: Early chemotherapeutic agents were discovered by trial and error. They were toxic and indiscriminate, killing healthy cells as well as cancerous ones. Limited options were available, and cancers often mutated to develop resistance.

• Understanding of metastasis and personalized treatment was limited. Jane Wright pioneered culturing individual patient tumors to determine the best course of treatment, but options were still narrow.

• Some cancers, like pancreatic, liver and certain lung cancers, remained very difficult to treat, with low survival rates.

• Targeted therapies did not emerge until the early 21st century. Earlier treatments took a “brute force” approach.

• Vaccines were not developed until the late 20th century. The HPV vaccine, released in 2006, was the first to prevent a cancer.

In summary, early cancer treatments were crude, toxic, and limited. Significant advances have been made through increased scientific understanding, technological improvements, development of targeted therapies and preventive vaccines, and a multidisciplinary approach combining surgery, radiation, chemotherapy, and immunotherapy. But some cancers remain challenging to treat.

Here is a summary of psychoanalysis:

• Psychoanalysis was developed by Sigmund Freud in the late 19th century. It is a psychotherapy that is based on the belief that unconscious mental processes and experiences during childhood influence behaviour and thought as an adult.

• Freud proposed that the mind is structured into three parts: the id, the ego, and the superego. The id contains basic instincts; the ego balances the needs of the id and superego; the superego represents moral constraints and societal norms. Unconscious conflicts between these parts can cause psychological distress.

• Freud believed that personalities develop through a series of psychosexual stages from infancy to adulthood. Fixation or conflict at a stage can affect personality and behaviour.

• Freud introduced several influential concepts, including the unconscious mind, defense mechanisms, psychosexual development, and the Oedipus complex.

• Psychoanalytic treatment involves free association, dream interpretation, and analysis of resistance and transference. The goal is to make the unconscious conscious so the ego can gain control over the id and resolve inner conflicts.

• Freud’s theories have been very influential but are controversial and difficult to test scientifically. Psychoanalysis also led to other psychotherapies, including Jungian analysis, individual psychology, and transactional analysis.

• Key proponents include Carl Jung, Alfred Adler, Karen Horney, Erik Erikson, and Melanie Klein. They elaborated on Freud’s theories and developed their own perspectives on psychoanalysis and psychotherapy.

• Psychoanalysis remains influential but less dominant today. It has been criticized as unscientific but has led to more empirically supported therapies like cognitive behavioral therapy.

That covers the key concepts, history, and influence of psychoanalysis. Let me know if you would like me to clarify or expand on any part of the summary.

Here is a summary of YSIS:

strength of transference”.

Freud’s ideas dominated psychiatry

and psychology for decades despite

considerable criticism and scepticism.

y

choanalys

is of imme

ense

importance fo

• Sigmund Fre

r

ud

education and preventative work.

Psychoanalysis aims to uncover the unconscious mind by analyzing dreams, free associations, resistances, and transference.

• The mind has three parts - the conscious (iceberg tip), preconscious (just below surface), and unconscious (largest, deepest part).
• The unconscious contains primitive urges, unacceptable desires, painful memories, and repressed experiences.
• Mental illness arises from conflict between the conscious and unconscious mind. Treatment involves exposing repressed material so the conscious mind can resolve it.
• Dreams represent wish fulfillment and are insight into the unconscious mind.
• The personality comprises the id (unconscious, amoral instincts), ego (mediates inner/outer worlds), and superego ( morality).
• Eros (life instinct) fuels libido; Thanatos (death instinct) fuels aggression. Sexual development stages leave people prone to “fixations”.
• Transference (projecting feelings about parents onto the therapist) can complicate the therapeutic relationship.

Psychoanalysis has been very influential but also controversial. It aimed to move psychiatry to a more humane and scientific basis but has been criticized as unscientific, flawed, and even harmful. However, it has spurred many successors, and Freud’s ideas remain influential in psychology and culture.

• Hormones are chemical messengers in the body that are produced by endocrine glands and regulate the function of organs and tissues.

• Early research in the 19th century suggested the existence of hormones and chemical communication in the body, though the belief persisted that the nervous system was the sole means of communication between organs.

• In 1902, Ernest Starling and William Bayliss performed experiments proving that pancreatic secretions were controlled by chemical messengers in the blood, not nerve signals. This discovery established the field of endocrinology.

• Pioneering endocrinologists included Claude Bernard, who showed that organs could produce and release chemical substances; Arnold Berthold, who linked testes to male sexual development; and Charles-Édouard Brown-Séquard, who claimed rejuvenation from testicular extracts.

• Hormones are released by endocrine glands into the bloodstream, then travel to target cells with matching receptors. Receptors bind hormones, triggering a response. Feedback loops regulate hormone levels.

• The endocrine system includes the hypothalamus, pituitary, thyroid, parathyroid, adrenal, pancreas, ovaries, and testes. Hormones regulate growth, development, metabolism, tissue function, reproduction, and behaviour.

electrocardiography pioneers around eight, his family moved to Holland.

the world. In 1924, Einthoven

He studied medicine at the University

• In 1903, Willem Einthoven invented the first viable electrocardiograph.

was awarded the Nobel Prize

of Utrecht, later becoming a

• His machine accurately recorded the heart’s electrical activity by detecting tiny electrical

impulses through electrodes attached to the body.

in Physiology or Medicine for

professor of physiology there. His

pioneering electrocardiography.

main research interest was the

• Over time, electrocardiographs became smaller, more portable and used more electrodes, providing more detailed information about the heart’s electrical signals.

• The electrocardiogram is still used today to diagnose heart conditions and monitor treatment.

• Einthoven received the Nobel Prize for pioneering electrocardiography.

• His research helped physicians understand how different heart disorders appear in ECG results.

of addressing diseases. In the

neurological disorders he described,

the part of the brain concerned

• British physician Charles Scott Sherrington conducted pioneering research into the nervous system in the early 20th century.
• He established ideas still fundamental to neuroscience today:

mid-19th century, French physician and his work aided later physicians. with motor control and balance.

Jean-Martin Charcot published

In 1885, his Spanish student

In the late 19th century, two

observations of a number of

Santiago Ramón y Cajal used a dye

important techniques – staining

conditions, including Parkinson’s

to examine neuronal structures

and microscopy – were key to new

disease. Though he mistakenly

under a microscope. He described

discoveries in neuroscience. New

attributed Parkinson-like tremors

the brain as “a world consisting

ways to preserve tissue, developed

• Neurons communicate via electric signals and chemicals (neurotransmitters) across junctions called synapses.
• Muscles provide feedback to the brain about their position and tone (proprioception) so movement can be controlled.
• For every muscle activation there is a corresponding relaxation of the opposing muscle (reciprocal innervation).
• The nervous system includes the peripheral nerves connecting the central nervous system to the body, and the autonomic nervous system controlling involuntary functions.
• Understanding of the nervous system enabled new insights into neurological diseases and their treatment.

Alois Alzheimer, a German

e posits outside nerve cells (now

medic’s disease. Late-onset Alzheimer’s

called beta-amyloid plaques) and

is most likely the result of a complex

tangled bundles of fibers inside

interaction of multiple genetic,

the cells (now called neurofibrillary

environmental, and lifestyle factors.

muta tion, but most cases are sporadic. In any case, Alzheimer’s remains incurable. Current treatments aim

tangles). These pathological lesions In 2020, there were an estimated to slow the progression of the became known as the hallmarks of

Alzheimer’s, and neurologists and

as populations age. There are now

50 million people with dementia

disease by increasing levels of

globally, including Alzheimer’s, with acetylcholine in the brain or nearly 10 million new cases each year. reducing beta-amyloid plaques. Scientists continue to search for new

Alzheimer’s disease in the early 20th century While Alzheimer published his findings on Auguste

preventive strategies and a cure for

Deter in 1906, his discovery gained little attention and Alzheimer’s disease. But barring such was often attributed to Emil Kraepelin, who described

a breakthrough, the numbers of

Alzheimer’s in his influential Handbook of Psychiatry

people affected will continue to rise

(1910). Kraepelin proposed naming the disease in

substantially in coming decades. ■

Alzheimer’s honor, and today Alzheimer is rightly recognized as identifying the first published case of the disease that bears his name.

1996 Donepezil, the first cholinesterase inhibitor drug specifically for Alzheimer’s, is approved for use. 2000 US President Bill Clinton signs the Alzheimer’s Disease Research, Training, and Education Act to increase federal funding for research. 2019 Multiple drugs are in clinical trials targeting amyloid plaque removal, but they have mostly failed to show clinical benefits so far.

This colour-enhanced MRI scan shows regions of cortical atrophy (in blue) in the brain of a patient with Alzheimer’s disease.

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198 CANCER IN CONTEXT Essence The uncontrolled growth of cells that form masses called tumours. Some tumours remain localized, while some spread

to other parts of the body. Cancer is a leading cause of death worldwide. Key breakthrough The German scientist Moritz Kaposi described the disease characteristics of Kaposi’s sarcoma in 1872. The

radical mastectomy operation was introduced in the 19th century. Early detections of various cancers have improved survival rates. Development of chemotherapies and radiation therapy began in the 1940s. Immunotherapy was introduced in the 21st century. Key pioneers Moritz Kaposi, Paul Ehrlich, William Halsted, Sidney Farber, Lloyd Old, James Holland, Lee Helson. Key technologies Biopsies, X-rays, surgery, chemotherapy, radiation therapy, immunotherapy, genomics, cancer screenings. Obstacles Cancer is difficult to diagnose and treat due to its complex nature. Certain factors predispose people to cancer.

In 1912, Casimir Funk proposed the term “vitamine” for essential micronutrients lacking in certain diets that could cause diseases like beriberi, rickets, and scurvy.

• In 1912, Christiaan Eijkman showed that beriberi could be prevented by eating unpolished rice, which contained an “anti-beriberi factor” later identified as thiamine (vitamin B1).

• Frederick Hopkins suggested the existence of “accessory food factors” (vitamins) in 1906. He later isolated vitamin A.

• Elmer McCollum identified vitamins A, B, and D between 1912 and 1922.

• Albert Szent-Györgyi isolated hexuronic acid in 1927 and showed it was vitamin C, preventing scurvy.

• Other vitamins were isolated in the 1930s, leading to vitamin supplements and fortified foods.

• Vitamin def iciency diseases are now rare thanks to wider knowledge of nutrition and availability of supplements.

• Vitamin excess can also be harmful. Vitamins should be consumed in moderation from a balanced diet rather than supplements.

• Vitamins are essential for health but are not a substitute for a balanced nutritious diet with appropriate calorie intake and exercise.

Does this summary cover the key points about the discovery of vitamins and their role in health? Let me know if you would like me to clarify or expand on any part of the summary.

In the early 20th century, scientists discovered that certain diseases were caused by deficiencies of invisible substances in the diet, which were named “vitamins” by Casimir Funk.

Funk was inspired by earlier researchers like Christiaan Eijkman, who found that beriberi was caused by a lack of certain nutrients in polished rice. Funk experimented by feeding pigeons polished rice and found they became ill, but recovered with rice bran extract. He concluded that some chemical in the extract was essential in small amounts for health. Though the chemical was not isolated until 1936, Funk established the existence of vitamins.

Elmer McCollum identified “fat-soluble factor A” (later vitamin A) as essential for rats. Edward Mellenby showed puppies need vitamins and certain fats to prevent rickets. Joseph Goldberger found that pellagra was caused by poor diet and could be cured with brewer’s yeast or meat and dairy. Conrad Elvehjem showed niacin cured pellagra.

By 1948, 13 essential vitamins were known: 8 B vitamins, C, A, D, E, and K. B vitamins and C are water-soluble, excreted readily and needing regular intake. A, D, E, and K are fat-soluble, storable in the body. Vitamins have diverse functions, like vitamin A for vision.

The discovery of vitamins sparked interest in synthesizing them. In 1933, Norman Haworth first synthesized vitamin C. By the 1940s, vitamins were mass produced, used to treat deficiency and as supplements. All vitamins can now be synthesized or extracted from plants/animals. Vitamin pills often include additives to aid absorption.

Understanding diet and vitamins allowed conquering diseases of deficiency. But excess vitamins can also be problematic, and diet alone does not ensure health, showing the complex relations between food, nutrients, and well-being.

• Bacteriophages are viruses that infect bacteria. They were first observed in 1915-1917 by Twort and d’Herelle.

• D’Herelle proposed using bacteriophages, or phages, as a therapy against bacterial diseases. This is known as phage therapy.

• Phage therapy was initially successful but lost favor with the discovery of antibiotics. It has seen some resurgence recently as antibiotic resistance has grown.

• Phage therapy has some advantages over antibiotics, including targeted action, few side effects, and self-replication. However, there are also disadvantages like possible bacterial resistance and difficulty identifying the right phages.

• More research is still needed to determine optimal phage cocktails and doses for phage therapy.

that diabetic rats thrived when given pancreatic extracts. In 1921, Canadian physician Frederick Banting, with the help of biochemist Charles Best, managed to extract insulin from the pancreas of dogs. They injected the insulin into a diabetic teenage boy who was dying in a coma and brought his blood sugar down to normal levels.

Banting and Best continued refining the extraction and purification process. By 1923, Eli Lilly & Co. was producing large quantities of insulin. This allowed many diabetics to avoid death from a disease that until then had been incurable. A pioneering feat of biotechnology, insulin remains a lifesaver for diabetics to this day. Scientists later determined the molecular structure of insulin and learned how to synthesize human insulin, leading to purer, more effective forms of the hormone.

• A new insulin pen is launched in Denmark, making the delivery of insulin easier for diabetics.

• Frederick Banting and Charles Best discovered insulin in 1921.

• They experimented on dogs and found that removing the pancreas led to diabetes. Extracts from cow and pig pancreases could treat diabetes in dogs.

• They first tested an extract on a diabetic boy in 1922. His blood sugar normalized and symptoms improved.

• Banting and Macleod were awarded the 1923 Nobel Prize for the discovery of insulin. Banting shared his prize with Best.

• Insulin was initially produced by the University of Toronto but was licensed to Eli Lilly to produce commercially. They had trouble producing large quantities of pure insulin initially.

• Further work led to purer, longer-acting insulins. Insulin does not cure diabetes but effectively controls symptoms.

• There are two main types of diabetes: Type 1, where the body does not produce insulin, and Type 2, where the body does not produce enough insulin or cannot use it properly. Type 2 is more common.

• Insulin injections and blood sugar monitoring help control diabetes. Lifestyle changes and medication can also help in Type 2 diabetes.

Before antibiotics, bacterial infections were often fatal or caused permanent harm. In 1928, Alexander Fleming discovered penicillin, the first antibiotic, by chance. He noticed that a mould called Penicillium notatum had contaminated a culture plate and cleared bacteria in its vicinity.

He named the antibacterial substance “penicillin” and showed that it could kill some harmful bacteria. However, penicillin was unstable and difficult to produce in large quantities. In the 1940s, Howard Florey and Ernst Chain developed methods to stabilize and mass-produce penicillin.

Penicillin and other antibiotics revolutionized medicine by enabling doctors to cure many dangerous and formerly incurable infections. However, over time, some bacteria have become resistant to antibiotics through natural selection. The development of new antibiotics and more prudent use of existing ones are currently areas of active research to combat antibiotic resistance.

Fleming played an important role in discovering penicillin but was not directly involved in developing methods to produce it in large amounts. He shared the 1945 Nobel Prize in Medicine for the discovery of penicillin with Florey and Chain.

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ANTIBIOTICS 219

See also: Edward Jenner and vaccination 38–43 The germ theory of disease 62–67 ■ Paul Ehrlich and chemotherapy 186–91 Pharmaceutical industry 242–45

■

staining method to classify bacteria. Wiley. He focused his research on the

with Howard Florey and Ernst

Gram-positive bacteria – which have

microbiology of wound infections.

Chain. Fleming received many

a thick, porous cell wall – were

In 1928, Fleming began examining other awards in Britain and

stained deep purple by Gram’s

Staphylococcus bacteria in culture

abroad, but continued working

method. Gram-negative bacteria –

dishes to f ind an antibacterial

at St Mary’s until his retirement

with a thinner cell membrane – did

drug. When a mould contaminated

in 1955. He died in London on

not retain the purple dye. Penicillin

one of his dishes, leading to his

11 March 1955, aged 73.

worked only against Gram-positive discovery of penicillin, Fleming

bacteria, but scientists later

realized that he had chanced upon

developed broad-spectrum

an entirely new way of controlling

Key works

antibiotics that could tackle both

bacterial infections.

Alexander Fleming

types. Fleming was knighted in

Fleming’s discovery was key to

1928 “The Antibacterial Action

1944 for his work on penicillin.

revealing the potential of antibacterial of Cultures of a Penicillium”

drugs, but further research was

Penicillin’s potential

needed to stabilize penicillin and Florey (left) and Chain were

produce it on an industrial scale. In instrumental in developing penicillin

Although Fleming published his

1941, at the University of Oxford,

discovery and described penicillin

Chain and Florey used penicillin to

for mass production, work for

as bactericidal (capable of killing

cure a policeman suffering from

which they shared the 1945 Nobel

bacteria) in the British Journal of

a life-threatening staphylococcal

Prize with Alexander Fleming.

Experimental Pathology in June 1929, infection, proving its therapeutic

he struggled to isolate stable extracts potential. They developed methods In 1943, large-scale production

of penicillin and found that the

to purify and concentrate penicillin of penicillin began in the US and

drug was rapidly inactivated in the

and enabled its large-scale

UK, allowing it to be widely used to

body. He also lacked the chemical

production, thus revolutionizing

treat Allied casualties during

knowledge to understand penicillin’s the treatment of infections.

World War II. Penicillin was hailed

complex molecular structure. As

as a “miracle drug” because of the

a result, penicillin was not developed The first major antibiotic

lives it saved. Mass production also

commercially and its potential

made penicillin available to the

for treating infections remained

Penicillin was the f irst of the

unrealized for over a decade.

antibacterial mold extracts to be

general public after the war and

In Oxford, the biochemists Howard developed into a usable drug. It was launched the era of antibiotic

Florey, who was Australian, and

the f irst antibiotic and paved the

German refugee Ernst Chain

way for the development of many

recognized penicillin’s potential.

others. Antibiotics have saved

With the help of Norman Heatley, millions of lives by enabling

they set out to purify Fleming’s

doctors to cure infections that were

discovery and develop methods to

previously untreatable. They are

produce penicillin in larger amounts. among the most important

medical discoveries of the

20th century.

therapy. Penicillin was followed

by streptomycin in 1944, and tetracyclines and erythromycin

in the 1950s, providing doctors with an arsenal of antibiotics.

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220 ANTIBIOTICS

A selection of commonly used antibiotics

ANTIBIOTIC TYPE

DISCOVERED

Antibiotic

Description and uses

Penicillins

1928

Penicillin

The first antibiotic. Effective against many Gram-positive bacteria. Used for infections such as pneumonia, meningitis, syphilis, and streptococcal infections.

Amoxicillin

A broad-spectrum penicillin effective against a wider range of bacteria. Used for infections such as bronchitis, pneumonia, and ear, nose and throat infections.

Ampicillin

Similar to amoxicillin. Used to treat infections such as bronchitis, pneumonia, meningitis, and some sexually transmitted diseases.

Cephalosporins

1945

Cephalexin

A broad-spectrum antibiotic effective against many Gram-positive and Gram-negative bacteria. Used for infections such as bronchitis, urinary tract infections, and throat infections.

Cefaclor

Used for infections such as bronchitis, urinary tract infections, throat and skin infections.

Macrolides

1952

Erythromycin

Effective against many Gram-positive bacteria and some Gram-negative bacteria. Used for infections such as bronchitis, pneumonia, pertussis, syphilis, acne, and chlamydia.

Azithromycin

A broad-spectrum macrolide used for infections such as bronchitis, pneumonia, pertussis, and chlamydia.

Clarithromycin

Used for infections such as bronchitis, pneumonia, ear infections, sinusitis and ulcers. Also used to treat Helicobacter pylori infection.

Tetracyclines

1948

Tetracycline

Broad-spectrum antibiotic effective against many Gram-positive and Gram-negative bacteria. Used for infections such as acne, bronchitis, pneumonia, and Lyme disease. Also used to treat Helicobacter pylori infection.

Doxycycline

Similar to tetracycline with improved absorption. Used for infections such as acne, bronchitis, pneumonia, and Lyme disease. Also used as an antimalarial drug.

Aminoglycosides

1943

Streptomycin

Effective against many Gram-negative bacteria and some Gram-positive bacteria. Used for infections such as tuberculosis, tularemia, and bubonic plague. Given by injection.

Gentamicin

Broad-spectrum aminoglycoside used for serious infections such as pneumonia, meningitis, peritonitis, and septicaemia. Given by injection.

Quinolones

1962

Nalidixic acid

The first quinolone antibiotic. Used for urinary tract infections.

Norfloxacin

Second-generation quinolone used for urinary tract infections.

Ciprofloxacin

Broad-spectrum quinolone effective against many Gram-positive and Gram-negative bacteria. Used for infections such as urinary tract infections, bronchitis, pneumonia, anthrax, and plague.

Antibiotic resistance

The misuse and overuse of antibiotics has A golden age came to an end as

The WHO has developed a global

led to the rise of antibiotic-resistant

bacteria evolved resistance to widely action plan to tackle resistance,

strains of bacteria that escape the

used antibiotics. In the 1990s,

including promoting development

effects of existing drugs. Even as early

strains of bacteria such as MRSA

of new antibiotics and improved

as the year after penicillin became

(methicillin-resistant Staphylococcus

surveillance of drug resistance and

available in 1944, a few strains of

aureus), VRE (vancomycin-resistant antibiotic use around the world.

• Alexander Fleming discovered the antibacterial effects of penicillin in 1928.

• Howard Florey assembled a team at Oxford University to develop penicillin as an antibiotic.

• Florey’s team faced many obstacles but successfully trialled penicillin in 1941, curing a patient with strep throat. However, limited supply meant the patient later died.

• Mass production of penicillin began in the US in 1941–42. By 1945, enough was produced to save many lives.

• Dorothy Hodgkin discovered the molecular structure of penicillin in 1945, enabling synthetic derivatives to be produced.

• Antibiotics work in three main ways: disrupting cell walls; inhibiting protein production; and interfering with DNA/RNA.

• Penicillin disrupts cell walls in Gram-positive bacteria. Vancomycin and other drugs were later developed with a similar effect.

• Streptomycin, discovered in 1943, was the first antibiotic to inhibit protein production. It treated tuberculosis and other bacterial infections.

• The tetracycline family, from 1948, also inhibits protein production. Chlortetracycline, as Aureomycin, treated many infections.

• Paul Ehrlich pioneered synthetic arsenic drugs to treat syphilis. Salvarsan (1910) improved to Neosalvarsan (1912).

• The 1950s–60s saw many new antibiotics discovered, with over 20 groups now in use. But overuse has led to resistant bacteria.

• The brain generates electrical activity as neurons communicate. This activity can be detected using electrodes placed on the scalp (EEG).

• In 1935, William Grey Walter used improved EEG technology to diagnose a brain tumor.

• EEG allowed the first non-invasive window into brain activity and has been key to understanding brain function.

• Electroencephalography (EEG) is a technique for recording electrical activity in the brain.

• Pioneered in the 1920s by Hans Berger, EEG uses electrodes placed on the scalp to detect the brain’s electrical signals.

• Neurophysiologists can analyze the frequency, location, and amplitude of brainwaves to diagnose conditions like epilepsy, tumors, inflammation, stroke, dementia, and sleep disorders.

• William Grey Walter conducted important early research using EEG to study brainwaves during different mental states. He found a correlation between disrupted delta waves and brain tumors/epilepsy.

• EEG detects brainwaves of different frequencies: delta (sleep), theta (meditation), alpha ( relaxation), beta (active mind), and gamma (peak concentration).

• EEG is noninvasive but limited by not precisely locating the sources of electrical activity deep within the brain. Other techniques like PET and fMRI provide alternative ways to image brain activity.

• Cancer screening tests apparently healthy people to detect early signs of certain cancers before symptoms appear. Early diagnosis and treatment can save lives.

• Cervical cancer screening using the Pap smear test, introduced in 1943, was the first successful mass screening programme. It has significantly reduced cervical cancer mortality.

• Mammograms (for breast cancer) and colonoscopies (for colorectal cancer) are also common screening tests that have proven effective in detecting cancers early.

• Prostate cancer screening using the PSA test has not clearly reduced mortality and is controversial. Balancing the benefits and risks of any screening programme is important.

• George Papanicolaou pioneered cervical cancer screening. His Pap smear test, introduced in 1943, was the first mass screening test for cancer.

• The World Health Organization (WHO) was established in 1948 to promote health and support vulnerable communities worldwide.

• The idea for an international health organization was first proposed in 1945 by Chinese doctor Szeming Sze.

• Previous attempts at international health cooperation included the International Sanitary Conference in 1851 and the Health Organization of the League of Nations in 1923.

• The WHO initially focused on diseases like malaria, tuberculosis, and venereal diseases. It now issues health guidelines, provides regulations and education, conducts vaccination campaigns, and collects health data.

• The WHO’s biggest achievement so far is the eradication of smallpox. It is now coordinating the global response to the COVID-19 pandemic.

• The WHO currently has 194 member states and a budget of $4.2 billion. Its goals are to improve access to health care, prepare for emergencies, promote health, eradicate diseases, and prioritize health in all policies.

• Szeming Sze, who proposed the WHO, was born in China in 1908. He studied chemistry and medicine at Cambridge University.

• The adrenal glands produce cortisol, a hormone that regulates the body’s response to stress and

inf lammation. Insuff icient cortisol leads to Addison’s disease.

• In the 1930s, researchers began isolating adrenal hormones, including cortisol.

• Rheumatoid arthritis causes painful joint inf lammation. In 1948, Philip Hench found cortisol could relieve

symptoms. The corticosteroid cortisone was synthesized and used to treat rheumatoid arthritis and other

inf lammatory conditions.

• Corticosteroids like prednisone and dexamethasone are synthetic versions of cortisol used to treat

inf lammatory diseases from rheumatoid arthritis to severe COVID-19. They suppress the immune system to curb

inf lammation while maintaining anti-infective responses.

• Dexamethasone can reduce mortality in severe COVID-19 cases by calming the cytokine storm – the extreme

immune system reaction that can lead to acute respiratory distress syndrome (ARDS) and organ failure.

• Corticosteroids provide “nature’s dramatic antidote” to inf lammation but long-term use requires monitoring

due to side effects like high blood pressure, weight gain, diabetes, and osteoporosis.

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GLOBAL HEALTH 237

e painful symptoms of rheumatoid

Hench (1896–1965)

arthritis led to a breakthrough.

shared the 1950 Nobel Prize in Physiology or Medicine for the discovery of the effects of cortisone.

Cortisone, a synthetic corticosteroid, was developed and f irst tested on

human patients in 1948. The results

were remarkable, easing inf lammation

and pain within days. As Hench

Cortisone provides nature’s dramatic antidote for many disorders characterized by an overactive inflammatory response. There are, however, hazards in its use, which demand skill and judgment.

described, “The effect was so

Philip Hench Accepting his Nobel Prize, 1950

dramatic that it was as though a

magical wand had relieved the

patients of all discomfort”.

Two researchers at DuPont

isolate cortisol from pig glands. In

Laboratories in the US then

1950, the corticosteroid prednisone

synthesized more than 200 new

was synthesized; less prone to side

adrenal derivatives, and found that effects, it soon replaced cortisone for

compound E (cortisone acetate)

long-term use. Today, corticosteroids

could relieve inf lammation. When

like prednisone, prednisolone, and

tested on the f irst rheumatoid

dexamethasone are widely used to

arthritis patient in September 1948,

treat inf lammatory and autoimmune

cortisone eased her symptoms for

conditions, and to suppress immune

the f irst time in years.

responses after organ transplants.

Suppressing inflammation

In June 2020, UK scientists

Cortisone and similar corticosteroids

announced that the corticosteroid

work by suppressing the body’s

dexamethasone signif icantly reduced

immune system to reduce excess

mortality from COVID-19 in patients

inf lammation, while still allowing

with severe symptoms. The results

immune responses against infection.

suggest dexamethasone calms the

They inhibit the production of

cytokine storm – the extreme

proinf lammatory cytokines and other

immune reaction that can lead to

chemical messengers in response to

acute respiratory distress syndrome

tissue damage or antigens.

(ARDS) and organ failure in critical

Swiss scientist Tadeus Reichstein

cases. Corticosteroids, nature’s

worked with Hench to successfully “dramatic antidote” to inf lammation, had found another use. ■

A vital discovery Philip Hench’s work was groundbreaking. As a doctor treating patients with rheumatoid arthritis in the 1930s, he hypothesized their symptoms might be linked to changes in adrenal gland function. Hench knew that cortisol, secreted by the adrenal glands, reduces inf lammation. In 1948, after cortisone was f irst synthesized, he and his colleagues tested it on patients with rheumatoid arthritis. The impact was extraordinary, relieving their symptoms and pain. It was a vital discovery, leading to corticosteroids that have treated millions of people and saved countless lives. Though aware of potential side effects from longterm use, Hench saw cortisone as a way of harnessing “nature’s dramatic antidote” to curb the body’s inf lammatory responses. His pioneering work on cortisone earned Hench a share of the 1950 Nobel Prize in Physiology or Medicine.

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238

BLOOD

IN CONTEXT

BEFORE 1628 William Harvey

publishes his theory that

BANKS INFUSE HOPE

blood circulates around

the body. He describes

the heart acting as a

pump to drive blood

through arteries and veins.

1818 British obstetrician

James Blundell performs

BLOOD TRANSFUSION

the f irst successful

human blood transfusion,

using blood from a patient’s

husband to treat postpartum

haemorrhage. The wife survives.

1900 Austrian physician Karl

Landsteiner discovers blood

groups and identifies the main

blood types: A, B, AB, and O.

AFTER 1940 Researchers develop new

techniques to isolate and

preserve platelets, the blood

cells involved in clotting.

1945 US surgeon Elmer

DeBakey develops a blood

transfusion apparatus that

can warm and f ilter stored

blood before infusion.

2020 In response to a fall in

blood donations, several

countries relax restrictions

on blood collection during

the COVID-19 pandemic.

Blood banks collect and store donated

wide scale of use. But World War II

blood until needed for transfusions.

brought blood banks into their own.

They originated early in the 20th

New techniques allowed platelets and

century to provide life-saving blood

plasma to be preserved, and blood

for wartime injuries, childbirth, and

bank “depots” supplied stations on

surgery. Today, blood banks supply

the frontline. In the UK, civilians

blood products worldwide, though

were urged: “Your blood, his life”.

more donors are still urgently needed. After the war, blood banks spread

The idea of infusing blood from one

rapidly through civilian hospitals.

person into another dates to the

17th century. However, early attempts How blood banks work often failed due to blood clotting

Donated blood is collected, tested,

and incompatible blood types.

processed, and stored by blood banks

Successful transfusions became

until needed for medical use. To allow

possible in the early 1900s after Karl

storage, anticoagulants (such as

Landsteiner identif ied the main

citrate) are added to prevent clotting.

blood groups: A, B, AB, and O.

Blood is then separated into its main

The f irst blood banks opened in the components: red cells, platelets, 1930s, but limited understanding of

plasma, and cryoprecipitate. These

blood storage restricted their early

can be transfused individually as

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GLOBAL HEALTH 239

needed to treat conditions such as anaemia (red cells), clotting disorders (platelets), massive blood loss (plasma), or haemophilia (cryoprecipitate). Blood is refrigerated, and can be stored for varying periods: red cells up to 6 weeks; platelets up to 5 days; fresh frozen plasma up to 12 months. Donated platelets, plasma, and cryoprecipitate are also processed into clotting factor concentrates for haemophilia treatment. To ensure safety, donated blood is thoroughly screened for blood-borne viruses such as HIV, hepatitis B and C, syphilis, and other infections before transfusion. Blood groups are matched to reduce risks of transfusion reactions in recipients. However, as some infections may be missed or develop in the window between donation and use, there is still a small risk of viral transmission during blood transfusions.

Blood donation

The gifts of blood are among

The key to any blood bank is its

the most precious that can be

stock of donated blood. Most

Studies of patients with jaundice and pregnancy led Philip Hench to hypothesize that the adrenal glands released a natural anti-inflammatory agent he called “substance X.” After years of research, Hench and colleagues isolated compound E, later named cortisone, which could relieve rheumatoid arthritis. Although cortisone was not a cure and had significant side effects, it represented a breakthrough. Cortisone and related corticosteroids are now used to treat many inflammatory conditions at lower, safer doses.

the scope of CBT by addressing the behaviourism as a quantifiable role of mindfulness and acceptance science. ■

• Behavioural therapy emerged in the 1940s and focused on modifying behaviour through conditioning. • B.F. Skinner developed theories of operant conditioning and behaviourism.

• Aaron Beck pioneered cognitive therapy in the 1960s, focusing on identifying and changing negative thought patterns. • Cognitive behavioural therapy (CBT) combines behavioural and cognitive approaches. It aims to change behaviour and thought patterns. • A “third wave” of CBT since the 1990s incorporates mindfulness and acceptance-based techniques. • CBT is based on scientific experiments and aims to obtain measurable results.

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244

THE SEARCH FOR

HAPPINESS

POSITIVE PSYCHOLOGY

IN CONTEXT

BEFORE

The late 20th century saw become oriented towards def icits, Goldstein concentrated on individual 1947 American psychologist the advent of a positive psychology pathology, and problems. Positive differences, creativity, self-

Abraham Maslow proposes

movement to address the

psychology aims to shift this focus

actualization, and the fulf ilment

a “hierarchy of needs” in

negativity bias of mainstream

to the positive: strengths, virtues,

of human potential rather than

which self-actualization and

psychology. In 1998, American

and what makes life worth living.

universal laws of behaviour.

transcendence are the highest

psychologists Martin Seligman and

levels of human motivation.

Mihaly Csikszentmihalyi proposed

Humanistic psychology

Positive psychology

that psychology should scientifically

Emerging in the 1950s, humanistic Positive psychology studies the

1961 Psychologist Abraham

study positive human functioning. psychology emphasized human

necessary and suff icient conditions Maslow describes his concept

This new field focuses on topics

potential and subjective experience. for f lourishing and what makes life of “self-actualization”.

such as well-being, happiness,

Its founders included German

meaningful. It examines topics

resilience, optimism, creativity, psychologist Kurt Goldstein and

such as optimism, f low, strengths, 1975 American psychologist

wisdom, courage, gratitude,

American psychologist Abraham well-being, happiness, resilience,

hope, and mindfulness.

Maslow. Rejecting the behaviourism creativity, wisdom, courage,

Traditional psychology had

AFTER

Carol Dweck proposes the

concept of a “growth mindset”.

of B.F. Skinner and psychoanalytic gratitude, hope, and mindfulness. 1998 Martin Seligman and excessive focus on psychopathology, The aim is to understand and foster Mihaly Csikszentmihalyi

Maslow’s theory of motivation

propose establishing a field

the inherent strengths and virtues

proposed a hierarchy of needs, with

that people possess. Researchers

of “positive psychology”.

self-actualization at the top. For

study what enables individuals and 2002 The first Positive

Maslow, self-actualization meant

communities to thrive and achieve

Psychology Summit is held

achieving one’s full potential

their full potential. Interventions

in Akumal, Mexico.

through a growth-oriented process

developed from this research are

2006 The Journal of Positive

of becoming all you are capable of

intended to cultivate happiness,

Psychology is founded.

being. A contemporary of Maslow’s, build resilience, and foster well-

being at work, in education, and

Positive psychology aims to cultivate happiness and well-being by focusing on human strengths and virtues rather than disorders and distress.

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HUMAN PROGRESS 245

See also: Humane mental health care 92–93 ■ Cognitive behavioural therapy 242–43 ■ Mindfulness 274–77

beyond. Its practical applications narrative and instead focus on range from positive education to

actualizing human potential

positive psychotherapy.

through meaning, purpose, and positive social relationships.

A growth mindset More recently, the concept of

Following in the footsteps of

a “growth mindset” has gained

Maslow and the humanistic

prominence in positive psychology.

psychologists, positive psychology

Psychologist Carol Dweck proposed rejects a disease model of human that a growth mindset – the belief

nature and seeks to understand

that abilities and intelligence can

the qualities that enable human

be developed through effort and

beings and communities to

perseverance – fosters resilience,

f lourish. While mainstream

higher achievement, and greater

psychology concentrated on

well-being. Individuals with a

repairing damage, positive

growth mindset thrive on challenges psychology builds on strength. and see failure as an opportunity to Its aim is to apply scientific learn, rather than as a reflection of

methods to understand the

their innate abilities.

mysteries of human happiness and well-being, so that individuals

Strengths and virtues

and societies can achieve their

Positive psychology seeks to move

full potential. ■

beyond a disease model of human functioning and beyond a deficitfocused narrative of psychology. Rather than concentrating primarily on disorders, distress, and dysfunction, positive psychologists study strengths, virtues, and what enables individuals and communities to thrive. They reject a deficit-based

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246

BUILDING RESILIENCE

IN CHILDREN

ATTACHMENT THEORY

IN CONTEXT

British psychologist John Bowlby stressed the importance of a child’s in their development. Bowlby’s theory of attachment focuses on the close relationship with its primary early emotional ties between children and caregivers, and how these bonds shape personality

caregiver for healthy psychological and relationships throughout life.

BEFORE

development. In the 1950s, Bowlby

1919 The New York Foundling

proposed “attachment theory” to

Hospital adopts matching

explain how these early bonds with

Bonding and attachment

numbers to assist nurses in

caregivers provide an inner sense of

An infant bonds with its primary

consistently feeding the same

security, and how disruption of these caregiver – usually its mother – soon infants to form attachments.

bonds can have long-term effects.

after birth. The caregiver provides 1948 British psychoanalyst

Bowlby’s theory contradicted comfort, nourishment, and affection.

D.W. Winnicott publishes his

conventional wisdom that infants

Through this interactive bond, an

paper on “transitional objects”

should be separated from their

emotional attachment forms. For

and their role in healthy

mothers soon after birth. He argued a secure attachment to develop,

child development.

instead that a warm, continuous

After

the caregiver must be sensitively

relationship with a primary

attentive to the infant’s needs. This 1951 John Bowlby publishes his

caregiver during infancy and

early experience of a responsive

first paper on maternal loss and

childhood is essential for healthy

caregiver shapes the child’s

emotional development.

emotional development and ability 1982 American psychologists

to form relationships.

Mary Ainsworth, with Mary

Bowlby believed that

Main and Donelda Avery,

without a secure attachment

Disruption of attachment

figures out how to assess

to a primary caregiver in

If an infant is unable to form a

infants’ attachment styles.

infancy, children may find it

secure attachment to its caregiver –

difficult to form meaningful

due to lack of maternal sensitivity 1988 British psychologists Peter

relationships later in life. This

or prolonged separation – this can

Fonagy and Mary Target propose

early bond provides an “inner

have lasting effects. The infant may their theory of mentalization to

working model” for how to

develop an insecure attachment understand how early attachment

respond in relationships.

style, making it harder to regulate experiences facilitate mental and emotions or form trusting

emotional development.

RELATIONSHIPS 247

Human bonds, especially those between parents and children, are key to well-being and development. Attachment theory explains how early relationships shape our capacity for intimacy, trust, and security throughout life.

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relationships later in life. This

on key figures meet our needs for

• Transplant surgery replaces damaged or failing organs and tissues with healthy ones from donors. • Early animal experiments in transplant surgery began in the early 20th century. French surgeon Alexis Carrel performed kidney transplants in dogs and developed techniques for reconnecting blood vessels that enabled transplant surgery. • The first successful human organ transplant was a kidney transplant in 1954. The first human heart transplant followed in 1967. • Transplant surgery has since become much more routine, saving hundreds of thousands of lives.
• Pioneering transplants include the first corneal transplant in 1905 and the first hand transplant in 1998. • Spain established the world’s first “opt-out” organ donation system in 1979.

To perform organ transplants, surgeons needed to overcome the problem of organ rejection. Early attempts at organ transplants between unrelated donors and recipients failed because the recipients’ immune systems rejected the foreign organs.

A solution was found by using drugs to suppress the immune system, such as azathioprine and cyclosporine. These reduced the chances of organ rejection. Surgeons also found ways to better match donors and recipients by testing for human leukocyte antigens (HLAs). Closely matched HLAs reduced the likelihood of rejection.

With improved anti-rejection drugs and better donor-recipient matching, organ transplants became more successful. Kidney transplants were first, then liver and heart transplants followed. In 1967, Christiaan Barnard performed the first human heart transplant. The patient survived for 18 days. Today, survival rates for organ transplants are much improved.

The key steps were:

1. Finding drugs like azathioprine and cyclosporine to suppress the immune system and reduce organ rejection

2. Matching donors and recipients by HLA testing to increase compatibility

3. Performing the first successful kidney transplant between twins in 1954

4. Attempting the first liver and heart transplants in 1963, though initial survival was poor

5. The first long-term survivor of a heart transplant in 1967, living for 18 days

6. Vastly improved survival rates for organ transplants today thanks to better anti-rejection drugs and matching

• Interferon is a protein released by cells in response to a viral infection. It helps slow the spread of viruses in the body.

• There are three main types: alpha, beta, and gamma interferon. They have slightly different roles in the immune response.

• Initially, interferon showed promise as an antiviral drug and cancer treatment. However, the side effects were severe.

• In low doses, interferon is still used to treat some cancers, hepatitis, and multiple sclerosis.

• The mass production of interferon became possible after scientists engineered the alpha interferon gene in 1980.

• Interferon works by interfering with cell growth and replication, thereby slowing the spread of viruses and suppressing tumors.

• The potential of interferon generated considerable excitement, but the side effects were problematic, especially at high doses.

• Scientists Kari Cantell and Alick Isaacs played key roles in the discovery and development of interferon.

dose of hormones later used – they

developed a hormonal birth control

Nassau

County, New York State, USA, some

monument unveiled to Pincus.

• In the early 20th century, scientists pinpointed the role of hormones in the female reproductive cycle and isolated progesterone and oestrogen. • In the 1950s, biologist Gregory Pincus and chemist Carl Djerassi developed the first hormonal contraceptive pill. • The initial pill, Enovid, contained a high dose of hormones. It was approved in 1960 in the US, despite side effects. The dose was halved in 1961. • The Pill gave women more control over contraception. By 1965, 6.5 million American women used it; today 151 million women use it worldwide. • The Catholic Church banned the use of contraceptives, including the Pill, in 1968. • Other developments include the morning-after pill (approved in 1999) and more effective, lower-dose contraceptive pills.

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Twentieth century, and 99 per cent

human form. It has rarely cause

with the risk of ectopic pregnancy

in developed countries today. Yet

if it fails. Combined pills containing

the side effects and health risks of

oestrogen and a progestogen offer

hormonal contraception remained

safe, reversible contraception for

poorly understood for decades after

most healthy women and are still

its introduction.

the most popular method.

Hormonal contraception acts by

Stopping ovulation

preventing ovulation – the release

In the early 1950s, Gregory Pincus

of an egg from the ovaries. The first

was chosen by Margaret Sanger

contraceptive pills replicated the

and philanthropist Katharine

effect of pregnancy, releasing

McCormick to develop a hormonal

synthetic versions of the hormones

contraceptive. Pincus knew that

progesterone and oestrogen to

high levels of progesterone stopped

inhibit the menstrual cycle and

ovulation in rabbits. With drug

prevent eggs maturing and being

company G.D. Searle, Pincus

released. The high hormone doses

trialled norethynodrel, an artificial

used initially often caused side

progesterone, in women in Puerto

effects, though lower doses were

Rico (to evade US anti-birth control

introduced from the mid-1960s.

laws). Marketed from 1960 as

The Pill gave women reproductive

Enovid, it was the first approved

freedom and control over family

hormonal contraceptive – despite

planning for the first time.

side effects from the high hormone

Progestogen-only pills (“mini-

dose, which was halved in 1961.

pills”) contain a progestogen that

Hormonal contraception, especially

thickens cervical mucus, inhibiting

the Pill, gave women more choice.

sperm entry to the uterus. They

Worldwide, some 155 million women

have a slightly lower efficacy but

now use hormonal contraception –

fewer side effects. Progestogen-

a milestone of women’s health. Yet

only implants or injections work

it also shows how early drugs were

likewise, releasing hormones in low

approved and used despite risks that

doses over months or years.

have since become clear – a legacy

Intrauterine devices (IUDs)

we must learn from as science

release progestogen locally. They

and society progress together. ■

Here is a summary of orthopaedic surgery:

friction was key to

• Orthopaedic surgery focuses on repairing and correcting disorders of the musculoskeletal system. It evolved from ancient practices such as splinting broken bones and evolved into a distinct field in the 18th century.

to the bottom of the femur, which

success. His joint

• Key pioneers include:

articulated with a high-density

replacement used

polyethylene component on the

a small metal ball

top of the tibia. The components

and socket, and

were secured to bone using

high-density

polymethylmethacrylate bone

polyethylene, which

cement. Over the next f ive years,

created an almost

Gunston implanted 350 of these

frictionless surface.

• Hugh Owen Thomas (1834–1891): Created splints to stabilize fractures and popularized orthopaedics. • John Charnley (1911–1982): Pioneered the modern hip replacement using metal and polyethylene components. • Frank Gunston (1924–2003): Performed the first successful knee replacement operation in 1968.

• Key procedures include: joint replacement (such as hip and knee replacement), fracture repair, treatment of bone deformities and tumours, ligament repair, and spinal surgery. • Materials used include metal alloys, polyethylene, bone cement, screws, plates, and rods. • Orthopaedic surgery has enabled millions of people to regain mobility and live active lives. Over 1 million joint replacements are performed worldwide each year.

components, and the procedure

became the foundation for modern

That’s the essence of the key developments in orthopaedic surgery. Let me know if you would like me to elaborate on any part of the summary.

total knee replacement.

Impact

Here is a summary of the Bradford Hill criteria:

indoor smoking, have helped

1. Strength of association: A strong association between an exposure (such as

tobacco use rates decline in

smoking) and an outcome (such as lung cancer) makes causation more probable.

many countries since the 1960

2. Consistency: The association is consistent when it appears in different studies,

and 70s. However, global

by different researchers, in different populations.

cigarette consumption

3. Specificity: An association is more likely to be causal if it suggests a specific

continues to rise and causes

outcome, rather than a broad range of outcomes. For example, smoking is linked

more than 8 million deaths

specifically to lung cancer, rather than to disease in general.

per year, according to the

4. Temporality: The exposure must precede the outcome. Smoking comes before

World Health Organization.

the development of lung cancer. 5. Biological gradient: Greater exposure is associated with a higher incidence or severity of outcome. Heavy smokers have a higher risk of lung cancer than light

Immunotherapy

smokers.

Recent progress in harnessing

6. Plausibility: The association should be biologically plausible. There must be a

the immune system to fight

credible mechanism by which the exposure could influence the outcome. Smoking

cancer has led to new treatments

introduces carcinogens into the lungs that can damage DNA and cause mutations.

for lung cancer. Immunotherapy

7. Coherence: The association should not seriously conflict with existing knowledge. drugs boost the body’s immune

It should make sense given the current understanding of biology and disease.

response to attack cancer cells.

8. Experiment: Experimental evidence from controlled trials can confirm a causal

Some immunotherapy drugs

relationship. When people stop smoking, their risk of lung cancer decreases.

that target PD-1 and PD-L1,

9. Analogy: Similar associations may strengthen the case for causation. For

proteins that can block an

example, asbestos exposure is also known to cause lung cancer.

immune response, have been approved to treat lung cancer.

genetic susceptibility. Tobacco

to be left on their own … the

Structural developments

use is responsible for around

increase in lung cancer

For many years, critics claimed

Palliative care

80 per cent of lung cancer

and other diseases is the

that the correlation between

cases in the general population.

responsibility of the

smoking and lung cancer was

individual citizen.

spurious. Doll and Hill spent

Palliative care focuses on relieving symptoms and improving quality

Unsubstantiated industry claims

Winston Churchill, 1948

many years gathering irrefutable

of life rather than curing disease.

There is nothing

epidemiological evidence. At

It plays an important role in

For decades, the tobacco industry

dishonorable about the

the time, most lung cancers

helping people with advanced lung

disregarded and obscured the

consumption of tobacco…

were diagnosed at an advanced

cancer. Treatment may include

dangers of smoking to protect

We are not to be deterred

stage, when little could be done.

pain medication, breathing

profits. Cigarette advertising

from any indulgence

It was not until advances in

support, cough medicines, and

targeted women and developing

which is not injurious to

molecular oncology and genetics

nutritional advice. Counselling

countries, and industry lawyers

others…tobacco, in moderation,

in the late 20th century that the

and psychotherapy can also help

and lobbyists contested medical

produces no ill effects.

causes and mechanisms of lung patients cope emotionally. The goal

evidence in an attempt to cast

RJ Reynolds Tobacco Company

cancer became clear. This new

is to provide the best quality of life

doubt on links between smoking

letter to shareholders, 1933

knowledge helped transform

for patients and their families.

“We [the tobacco industry] would

diagnosis and treatment. Despite

like people to know that they are these advances, lung cancer ■

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268

Built environment Rachel Carson’s book Silent Spring

nutrition, and indoor air

triggered the modern environmental

pollution, are said to affect

movement. She highlighted how

health. Imbalances in any

environmental pollution and

of these “healthy spaces”

IN CONTEXT

chemical use endangered our health.

can increase risk of disease

Little was known then about how the built environment — the

population. The World

BEFORE

Health Organization

1960s Environmental writer Rachel Carson famously argues that we are subjecting ourselves to slow poisoning by the misuse of chemicals in her book Silent

human-made surroundings

Spring. Her work is considered

chemicals and radiation — could

the built environment

we live in, including buildings, transportation systems, and areas

WELLNESS AND THE BUILT ENVIRONMENT

cities, buildings, and spaces has a profound impact on public health and wellbeing,

around us. We now know that everything from how buildings are designed and sited to the materials used in them can affect health.

according to emerging scientific views. Factors such as crowding, noise,

a seminal work that helped

promotes the view that

launch the modern environmental shaped, the infrastructure constructed, and green spaces made available in and

movement.

increases health risks. Some features of urban design, like separated living,

1961 President John F. Kennedy playgrounds, walkability, and public transit systems, can boost wellness.

sets up the President’s Science Advisory Committee to examine

AFTER

air and water pollution, and pesticides.

1987 United Nations report,

Its report advocates for protecting the environment through regulation and

“Our Common Future”,

education. It suggests creating a National Institute of Environmental Health

popularizes the term “sustainable development”,

Sciences to assess health hazards in the environment.

defining it as ” development

1970 First official Earth Day

meets the needs of the present without compromising the ability of future that improves and enriches life while protecting the ecosystems and natural resources upon

generations to meet their own needs.”

celebrated to increase

which our shared wellbeing depends.

1992 Earth Summit in Rio de

public awareness of

Janeiro produces Agenda 21,

environmental problems.

Elements of a healthy built environment

a nonbinding agreement signed by 178

1970 US National Environmental

• Easy access to public transit, safe walking and biking routes: Promotes

Policy Act (NEPA) passed, requiring

physical activity and reduces pollution, traffic congestion, and sprawl.

governments to consider environmental

• Mixed-use planning: Integrates residential, commercial, and recreational

impacts before undertaking federal projects.

spaces, fostering community and “walkability.”

1970 US Clean Air Act passed to control

• Energy efficiency: Uses renewable energy, optimized insulation and lighting,

air pollution and set air quality standards.

sustainable materials that improve indoor air quality and temperature regulation.

1971 Greenpeace environmental

• Access to green spaces: Provides recreational areas, helps mitigate extreme heat,

organization formed.

countries to pursue sustainable

1972 UN Conference on the Human

development.

Environment held in Stockholm, Sweden. It marked

2000 World Health Organization

the first major conference on international environmental

issues its first report on the health

issues and resulted in the Stockholm Declaration.

impacts of the built environment.

and has psychological benefits. • Water efficiency: Conserves and reuses water through low-flow fixtures, greywater systems, rainwater harvesting, and xeriscaping.

1973 Endangered Species Act passed in the US.

268-269_Built_environment.indd 268

• Safety and security: Good lighting, visibility, emergency call facilities. • Minimal use of toxic materials: Reduces indoor air pollution and health hazards.

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GLOBAL HEALTH 269

influences nearly every facet

Access to nature

of life, and its impact is amplified

Part of having a healthy built

in cities where over half the

environment is providing

world’s population now lives.

opportunities to connect with

The places and spaces we inhabit

nature. Green spaces and natural

• Palliative care aims to relieve suffering and improve the quality of life for terminally ill patients.

• The concept was pioneered by Cicely Saunders, who founded the first modern hospice, St Christopher’s in London, in 1967.

• Saunders believed in treating patients with dignity and compassion. She developed the theory of “total pain” - that patients experience physical, psychological, social, and spiritual distress.

• Palliative care treats pain and other symptoms while also addressing emotional, social, and spiritual needs. It takes a holistic, individualized approach to each patient.

• Historically, care for the dying was poor. Doctors focused on curing rather than relieving suffering. Death often occurred in isolation, and pain relief was rudimentary.

• Saunders revolutionized care for the dying. By preventing and alleviating suffering, and treating patients with dignity and respect, palliative care allows terminally ill patients to live fully until they die.

• Palliative care is now widely recognized as an important part of healthcare, though access remains limited in many parts of the world.

In the 1970s, major advances in medical imaging, genetics, immunology, and minimally invasive surgery transformed medicine.

CT, MRI and PET scans enabled detailed visualization inside the body. Keyhole surgery and laser technology made surgery safer and easier. In the 1980s, advances in genetics enabled successes against diseases like smallpox and polio through immunization. However, HIV emerged and spread rapidly, becoming a global pandemic.

In the 1990s, the first human was cloned and the Human Genome Project mapped the first human chromosome. In the 2000s, telepresence surgery and stem cell research enabled new treatments. However, antibiotic resistance and new viruses like COVID-19 have remained threats.

Overall, while new technologies have enabled transformative medical advances, infectious diseases continue to pose global health challenges. A balance of continued scientific progress and global health initiatives is needed to improve human well-being.

Medical scanning techniques like MRI and CT scans allow physicians to see inside the body without surgery. They are based on principles of physics developed in the early 20th century. MRI uses magnetic fields and radio waves to detect the nuclei of atoms in the body, especially hydrogen. By measuring the radio signals emitted when the magnetic fields are turned off, MRI scanners can create detailed images of body tissues and organs. CT scans use X-rays and computer processing to create cross-sectional images of the body. These non-invasive scanning methods revolutionized diagnosis and treatment of diseases by allowing soft tissues and abnormalities to be detected.

B-cell producing just one specif ic

kind of antibody.

Clones of plasma cells

Monoclonal antibodies are produced Artificial antibodies

MECHANISM

by plasma cells, a type of immune

unlimited clones of the same cell.

Monoclonal antibodies are grown

in cell culture from a single

Human plasma

★ A plasma cell from a person with

cell. To make mAbs, scientists

myeloma (a cancer of plasma

cells) is removed and fused with a

fuse a plasma cell producing the

cells activated against a

myeloma cell, which can divide

desired antibody with a “myeloma”

particular antigen produce a

inf initely. The hybrid cells have the

cell, a naturally fast-dividing cell

mixture of antibodies. The plasma

antibody-producing ability of the

from cancers called myelomas.

cells activated against one antigen plasma cell, and the rapid growth

★ The hybrid cells (called hybridomas)

are cloned to produce identical copies

of just one type of antibody against

that antigen. These are the monoclonal

abilities of the myeloma cell.

★ These hybridomas are grown in

of the same antibody.

cell culture, dividing and producing

★ The mAbs from different

large amounts of the desired

hybridomas can be harvested and used

for diagnosis or as medical treatments.

monoclonal antibody.

282-283_Antibodies_on_demand.indd 282

ANTIBODIES ON DEMAND 283

Human plasma cells (left) produce many

different antibodies. Monoclonal antibodies

(right) are identical copies of the same antibody.

used to detect specif ic proteins

mAbs can be designed as treatments

cells. They are often used in medical

doubling as diagnostics. Examples

known as antigens on cells or in

for diseases by targeting diseased testing, where they are applied to include:

★ Herceptin, for breast cancer. Targets HER2, a protein found on

some cancer cells.

★ Rituxan, for certain lymphomas

and leukaemias. Targets CD20, a

protein found on some white blood

cell samples from patients to check

mAbs: Pros and cons

for the presence of disease markers

Advantages:

or antigens. In some cases, they

✓ Highly specif ic: Target only desired antigens, reducing side effects.

can also be used to monitor how

✓ Limitless supply: Can be produced in large quantities.

well a treatment is working.

✓ Standardized: Always the same, so results are consistent.

cells involved in these cancers.

Disadvantages:

★ Remicade, for some autoimmune

★ Lucentis and Avastin, for certain

eye conditions related to abnormal

blood vessel growth. Target VEGF,

a protein involved in making new

blood vessels.

★ Omalizumab, for severe allergic

asthma. Targets IgE, an antibody

involved in allergic reactions.

diseases like Crohn’s disease.

Target TNF-α, a signalling protein

★ L ifespan: Although stable, mAbs eventually break down, lasting weeks to months in the body. Repeat doses are often needed.

★ Complexity: Diff icult and expensive to develop and produce. ★ Limited targets: Only suitable for diseases where a specif ic protein target has been identif ied.

that promotes inf lammation.

mAbs have revolutionized medicine,

Some mAbs work by blocking the

but more work is still needed to

action of the targeted antigen, while

fully harness their potential. ■

others tag diseased cells so the

immune system can destroy them.

Monoclonal antibodies are a diverse class of drugs with many applications, but developing them is complex and expensive.

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284

PERSONALIZED MEDICINE

ON THE HORIZON

TAILORING TREATMENTS TO INDIVIDUALS

IN CONTEXT

Personalized medicine

The human genome consists

emerged after the

of about 20,000 protein-

of the human genome.

coding genes. Most diseases are

The idea is to tailor medical

caused not just by a single genetic

treatment and prevention

mutation but involve complex

to the characteristics of each individual, based primarily on their genetics. The aim is to move away

interactions between multiple genes, proteins, and environmental factors. Advances in genomics have

1620 William Harvey

discovered blood circulation. 1798 Edward Jenner

developed the f irst vaccine, for smallpox.

from a “one-size-f its-all” approach made it possible to analyse an

1912 Fred Allen studies

to prescribing the right treatment

individual’s genome in detail,

how blood types influence

for the right patient at the right

identify key genetic markers for

blood transfusion safety.

time. Personalized or precision

diseases, and even customize some

medicine is an emerging f ield that

treatments accordingly.

1952 Rosalind Franklin takes

is transforming healthcare.

The goal is to move from

X-ray images that help reveal

“reactive” to “predictive and

the structure of DNA.

preventive” medicine by identifying

1953 James Watson and Francis

genetic risks early, enabling lifestyle

Crick discover the double helix

changes and treatment to prevent

structure of DNA.

disease onset. New gene therapies 1970s-2000s Researchers

can also now alter or replace

associate specif ic gene variants

disease-causing genes. The promise

with risks for diseases like

of personalized medicine is more

cancer, diabetes, and heart disease.

precise diagnoses, more effective preventive strategies, and safer,

2003 The Human Genome

Project completes a draft of the

human genome sequence.

OFFICE OF THE NCMN DIRECTOR

Since the Human Genome Project

Human genetics now

AFTER

targeted treatments with fewer side effects. However, realizing

2010 The cost of genome

this vision also presents many

sequencing drops below $10,000

challenges regarding privacy, ethics,

for the f irst time.

costs, and more.

Human genomes vary in their subtle differences, but by studying them in detail,

doctors are discovering ways to tailor medical care to an individual’s genetic prof ile.

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PERSONALIZED MEDICINE 285

How it works

Sequence DNA

• A patient’s DNA is sequenced and analysed to identify gene variants that may influence their disease risk, prognosis, or response to treatments. • Key variants can then guide medical decisions and help select optimal screening, prevention, or treatment strategies for that individual. • Examples include:

• Testing BRCA variants to guide breast cancer risk management.
• Analysing tumour genomes to match cancer drugs to mutations.
• Choosing antidepressants based on genomics.
• Adjusting warfarin dose based on variants affecting metabolism.

Analyse genome and health records

Customize diagnosis and care

• Electronic health records provide additional data to integrate with genomic findings. • Computer models and AI help identify complex multi-gene interactions and determine best course of action.

• Diagnosis and treatments are tailored to a patient’s unique genetic profile and health needs. This may include:

• Targeted drug therapies and dosages.
• Enhanced screening and early disease detection.
• Lifestyle and risk management guidance.
• Monitoring disease progression and treatment response.
• In some cases, gene therapies to actually edit disease- causing DNA.

The promise •More accurate disease prediction, screening, and early detection.

•Fewer trial-and-error treatments and adverse drug reactions.

•Faster diagnoses and optimal selection of treatments shown to benef it patients with similar genetic prof iles.

•Improved quality of life and life expectancy. •Reduced healthcare costs from unnecessary or ineffective treatments.

The challenges •Privacy and ethical concerns about genetic data. •High cost of sequencing and data analysis. •Complexity of interpreting genetic data and limited knowledge about many gene-disease interactions. •Limited benefits when environmental and lifestyle factors strongly influence health outcomes. •Inequities in access to genetic testing and personalized care.

OFFICE OF THE NCMN DIRECTOR

The future •Rapidly falling costs of

Control: Reducing disease incidence and prevalence through measures such as vaccination,

public health, and medical care. The disease is still present in the population.

Elimination: Reducing disease incidence to zero in a defined geographical area through deliberate

efforts. The disease may still exist elsewhere.

Eradication: Permanently reducing the worldwide incidence of a disease to zero through deliberate efforts. Intervention measures are no longer needed.

A disease can only be eradicated if there is an effective intervention, the disease infects humans only, and there are no animal or environmental reservoirs. Smallpox is the only human disease to be eradicated so far.

pox vaccination.

1967 The World Health Assembly launches the Intensif ied Smallpox Eradication Programme, aiming

to eradicate smallpox within 10 years. It is led by American epidemiologist D.A. Henderson.

AFTER

1977 The last natural case

Effective from ancient times, smallpox vaccination was pioneered by Edward Jenner in 1796. The World Health Organization (WHO) launched the Intensified Smallpox Eradication Programme in 1967, led by

of smallpox in Somalia.

1980 The WHO declares smallpox

eradicated. Vaccination programs

the American epidemiologist D.A. Henderson. Through mass vaccination, surveillance, case isolation, and worldwide cease. ring vaccination (targeting contacts), the last natural case occurred in 1977 and the WHO declared smallpox eradicated in 1980. Considered one of the greatest achievements in public health, the eradication of smallpox 2019 As of 2019, smallpox virus saved millions of lives and billions in economic costs.

stocks are held at just two locations: the US Centers for Disease Control

The eradication of smallpox is an inspiration and model for the control and elimination of other diseases. and the Russian State Research

Lessons learned from the campaign have benefited efforts against diseases such as polio, dracunculiasis (guinea-worm disease), and measles. Continued global cooperation and political commitment are vital to defeating infectious diseases that still plague humanity.

Here is a summary of genetics and medicine:

• In 1983, the polymerase chain reaction (PCR) technique was invented by Kary Mullis. It enabled rapid cloning of small segments of DNA.

• PCR revolutionized genetics and medical research, enabling detection of genetic mutations that cause diseases like Huntington’s, cystic fibrosis, and sickle cell anemia.

• Understanding of genetics accelerated in the 1940s. DNA was found to carry hereditary information, and its double helix structure was discovered in 1953 by Watson and Crick.

• James Watson discovered that DNA bases always pair in a specific way: adenine with thymine, and guanine with cytosine.

• In 1962, Watson, Crick, and Wilkins won the Nobel Prize for their work on DNA.

• DNA sequencing was developed in the 1970s by Frederick Sanger, enabling mapping of the human genome.

• Huntington’s disease causes coordination and cognitive decline. Genetic analysis in the 1970s located the responsible gene, enabling diagnosis and research into treatments.

• Many genetic diseases are now diagnosed using PCR and DNA sequencing. Gene therapies and other treatments are being developed.

• The Human Genome Project mapped all human genes. Knowledge of the genome is enabling personalized medicine tailored to individuals’ genetic profiles.

So in summary, progress in genetics, especially discovering the structure of DNA and developing techniques like PCR and DNA sequencing, has enabled huge advances in medicine. Genetic diseases can now be diagnosed and treated, and medicine can be personalized based on a person’s unique genome.

Here is a summary of key events related to HIV and autoimmune diseases:

• In the 1950s, Noel Rose showed that autoimmunity, where the immune system attacks the body’s own cells, was real. • In 1974, researchers found that type 1 diabetes has an autoimmune basis. • In 1981, the first cases of AIDS emerged in the US. AIDS is caused by HIV, a retrovirus that attacks the immune system. • In 1983, Luc Montagnier and Françoise Barré-Sinoussi discovered HIV. By the end of 1983, AIDS had killed over 1,000 people in the US. • In 1996, antiretroviral therapy (HAART) was introduced to treat HIV. It has saved millions of lives. • In 2018, New Zealand funded PrEP drugs to help prevent HIV in high-risk groups. • Autoimmune diseases like rheumatoid arthritis, lupus, and multiple sclerosis are still not fully understood but seem to involve a combination of genetic factors and environmental triggers that lead the immune system to malfunction. • Type 1 diabetes, an autoimmune disease, has been linked to viral infections that may trigger the immune system to start attacking insulin-producing cells in the pancreas. • Some retroviruses like HIV can trigger autoimmune responses, but most autoimmune diseases do not seem to be directly caused by viruses. The relationship between viruses, the immune system, and autoimmunity is complex.

In summary, HIV is a retrovirus that attacks the immune system and causes AIDS. Although we now have treatments for HIV, it remains an global health crisis. Autoimmune diseases, where the immune system mistakenly attacks the body’s own cells, are still not fully understood but seem to involve a mix of genetic and environmental factors. Some viruses may act as triggers for autoimmune responses, but the connections between viruses, immunity, and autoimmunity are complex.

• Swollen lymph nodes and fatigue are common symptoms.

• There are over 80 known autoimmune diseases like MS, rheumatoid arthritis, type 1 diabetes, etc.

• In autoimmune diseases, the immune system attacks the body’s own tissues and organs.

• Immune deficiency diseases like AIDS weaken the immune system and reduce the body’s ability to fight infections.

• HIV, the virus that causes AIDS, infects and destroys CD4+ white blood cells that are critical for immune function.

• Antiretroviral drugs like HAART can suppress HIV and slow the progression of AIDS.

• More research is needed to find cures for autoimmune and immune deficiency diseases.

Here is a summary of accolades:

implanted. ■

researchers reports the f irst

that form in the lens of the eye,

use of femtosecond laser to

See also: Surgery 204–11 ■ Anaesthesia 112–17 ■ Keyhole surgery 298–99

300-301_Gene-Therapy_Laser-Eye.indd 301

treat cataracts.

designed ORBOT, a supervisory

perform complex procedures without use in surgery.

2001 The ZEUS surgical

controlled robot, in 1988; and in

a surgeon. Robotics has enabled

1995, the f irst minimally invasive

procedures from greater distances

robot is used for the f irst

telesurgery took place. In 1997, the

(telesurgery), and even in hazardous remote, cross-oceanic,

US Food and Drug Administration

or hard-to-reach environments.

approved the ZEUS medical robot

minimally invasive surgery.

2015 Robotic surgeon da Vinci

for use in surgery. Minimally

is used in over 880,000 procedures

invasive procedures use small

around the world.

incisions and specialized surgical

Robotic arms

equipment, including endoscopes

Robotic surgery uses a computer-

2018 The Smart Tissue

and surgical robots.

controlled mechanical arm that

Autonomous Robot (STAR)

In telesurgery, the surgeon operates mimics the movements of a human

performs the f irst fully

either close by or remotely, guiding

autonomous soft tissue surgery

surgeon’s arms. The surgeon views

the robot’s arms. Supervisory

on a living animal.

operates a console that controls the

controlled robotic systems like ZEUS robot’s arms. Precise motions and

opened up new opportunities for more stability are achieved using

surgery from a distance. A surgeon

remote operations.

AFTER

minimally invasive techniques and

small incisions. Supervisory

The French team’s demonstration of telesurgery

revolutionized surgery by showing how operations could

be performed with incredible precision over long distances. Robotic surgical systems are transforming surgery in many ways, from

improving surgical outcomes to enabling new minimally invasive

procedures. They open up the possibility of remote and automated surgery,

as well as surgery in space or other environments currently inaccessible.

However, robotic surgery also presents new challenges, costs, and risks.

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306

REDEFINING

NORMALITY

MEDICAL TECHNOLOGY AND THE

IN CONTEXT

Human enhancement involves focusing on disease prevention,

modifying the body beyond its

natural physical and cognitive

BEFORE

capabilities, or even human

cure, and physical rehabilitation. But 1993 American bioethicist Greg

psychological tendencies. This is a

some argue that it does not have the Stock discusses human

controversial area of bioethics that

right to constrain people from using

enhancement in his book

raises questions about what is “natural” biotechnology to improve themselves Metaman: The Merging of

and where the line should be drawn

as long as they do so safely and

Humans and Machines into a

between therapy and enhancement.

responsibly. Proponents believe that Global Superorganism.

Many established medical technologies as technologies advance, the ability to 1997 Dolly the sheep is the f irst

are designed to overcome impairment enhance ourselves will be inevitable,

mammal cloned from adult cells.

or correct deficiencies, ultimately

and that we have the right to do so.

1998 The Venter Institute

aiming to restore normal human

However, there are concerns about the

announces the f irst synthetic

function. Some common examples

unforeseen societal impacts of widespread vaccine, demonstrating the

include cochlear implants for the

enhancement, as well as risks to

feasibility of synthesizing

deaf, artificial limbs, and treatments

individual well-being if taken to extremes. biological products.

for conditions like diabetes or myopia. Opponents argue that enhancement

2000 The f irst draft of the

Modifying the body beyond these

threatens human dignity and could

human genome is published.

restorative aims is considered by

lead to unrealistic expectations about

2001 The US Bioethics

many to be ethically questionable.

controlling life events. There are also

Commission recommends

questions about access and inequality

against modifying human traits

Arguments for and against

if only available to the wealthy.

that are not the cause of disease

The medical community generally aims Regulation remains limited, creating

or impairment.

to use biotechnology for therapeutic

uncertainty about future impacts.

AFTER

purposes,

See also: Genetics and medicine 288–93 ■ Gene therapy 300 ■ Stem cell research 302–03 ■ Nanomedicine 304

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GENES AND TECHNOLOGY 307

LINE BETWEEN

THERAPY AND ENHANCEMENT

enhancement. Many argue that as

long as technologies are made widely

available and risks minimized, we should

2016 The f irst “three-parent

have the freedom to improve our minds

baby” is born in Mexico, using

and bodies. However, others argue

mitochondrial replacement therapy

enhancement threatens human dignity

to prevent genetic disease.

and normal functioning. There are also

2017 China announces the

concerns about societal inequities if only

f irst attempt to edit human

available to the wealthy. Regulation aims

embryos using CRISPR, igniting

to balance safety, access, and ethics. The

an international debate.

2018 The UK legalizes

concerns over autonomy and enhancements remain controversial with valid

mitochondrial replacement therapy, arguments on both sides. The ability to becoming the f irst country to

modify biology raises questions about what it

legally allow “three-parent babies”.

means to be human in an age of biotechnology.

Navigating these debates requires grappling

Human enhancement is already possible and

with complex issues at the intersection of science,

will only increase with advancing technologies.

ethics, society, and human nature.

However, there are open questions about where to draw the

That is my summary and analysis of the issues surrounding human

• Pandemics are global outbreaks of infectious disease that can spread rapidly and cause high mortality.

• Throughout history, pandemics have been triggered by mutations in viruses that make them unrecognizable to the human immune system. The proximity of humans and animals has increased the likelihood of such mutations.

• The Antonine Plague (165–180 CE) and Black Death (1347–1351) were devastating pandemics caused by smallpox and bubonic plague, respectively. They led to millions of deaths in Europe and Asia.

• The 1918 influenza pandemic, known as the “Spanish flu,” was caused by an H1N1 influenza virus. It infected about a third of the world’s population and killed at least 50 million people.

• Influenza and coronaviruses are RNA viruses, meaning their genetic material is RNA rather than DNA. When they replicate, RNA viruses often produce mutations that can make them unrecognizable to the immune system.

• The first influenza vaccine was developed in the United States during World War II to immunize soldiers. Vaccines are the most effective way to curb viral pandemics.

• Globalization has made pandemics more likely by enabling infectious diseases to spread rapidly between countries and continents. Coordinated global responses are required to detect and contain outbreaks.

• Experts have developed protocols for responding to pandemics, but prevention and containment remain challenging. Fast and widespread testing, contact tracing, isolation, and social distancing measures are key.

• Scientific advances have increased our understanding of how pandemics spread and emerge. Sequencing technologies now allow rapid identification of new viral strains to enable targeted vaccine and drug development.

• The flu virus mutates frequently through antigenic drift and shift, allowing new strains to emerge that evade existing immunity. Flu pandemics occur when a new strain emerges that humans have little resistance to.

• In the early 20th century, the Spanish flu pandemic caused by the H1N1 virus killed millions of people worldwide. Scientists resurrected this virus in the 21st century to better understand why it was so deadly.

• Coronaviruses are a family of viruses that mostly infect animals. Some have caused recent epidemics in humans, including SARS, MERS, and COVID-19. These viruses likely originally came from animals and mutated to infect humans.

• As human activity brings people into closer contact with wildlife, the risk of zoonotic spillover events increases. New diseases emerge as viruses jump between species. If detected and contained early, spread can be limited. But some viruses may cause global pandemics.

• Hospitals and medical equipment help support patients during pandemics. However, non-pharmaceutical interventions like social distancing, isolation, and hygiene are the most effective way to slow spread in the absence of a vaccine. Global coordination and cooperation are required to tackle pandemics.

• We have technology and knowledge to create vaccines and treatments, but it can take time. Pandemics require a coordinated global response to minimize spread while solutions are developed. But there are many challenges to overcome, including lack of political will and equity of access to countermeasures.

The key points are that viral pandemics emerge from mutations and spillover from animals; spread rapidly without immunity; require a coordinated response to contain; and solutions like vaccines take time to develop while non-pharmaceutical measures can help slow spread. Global cooperation and equitable access to solutions are vital but challenging to achieve. With COVID-19, the world faces these problems, and we must work together as a global community to overcome them.

Hieronymus Fabricius

AB AQAPENDENTE

the healing power of plants was

(Jerome Fabricius of Aquapendente)

1533–1619

determined by the astrological signs

Anatomist, embryologist, and

under which they grew – and made

surgeon, Fabricius was one of the

herb lore accessible to ordinary

most prominent physicians in Italy

people. The English Physician

during the 16th and 17th centuries.

listed more than 800 plants and

He trained and subsequently worked

their medicinal uses in non-technical

CLARE OF ASSISI

with William Harvey, helping to

language at a time when medicine

1194–1253

inspire Harvey’s work on blood

was expensive and often only

Noted for her care of the sick and

circulation. He made important

available to the wealthy. Culpeper’s

needy during her lifetime, Clare

discoveries in anatomy, including

radicalism led to his books being

was a follower of Francis of Assisi

valves in veins that allow blood

banned for a period.

who founded the Poor Clares,

flow in only one direction. Like

See also: Herbal medicine 36–37

an order of nuns devoted to

Harvey, Fabricius was an empirical

serving the poor and nursing

scientist who based his conclusions

the sick. Clare is said to have had

on observation and experiment.

MARY SEACOLE

miraculous powers of healing

See also: Medical pioneers 40–41

1805–1881

■ William Harvey 106–07 ■ Blood

A Jamaican-born nurse,

and circulation 108–09

businesswoman, and hotelier,

Mary Seacole funded her own

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01/10/20 5:07 PM

DIRECTORY 319

travel to the Crimean War, where

On her return to Britain, her

of Section for the Study of Co-

she cared for wounded soldiers

experiences led her to campaign

ordinated Activities of the Nervous

from both sides and was as widely

for improved standards of hygiene

System, Prague, Czechoslovakia

respected as Florence Nightingale.

in military hospitals. Nightingale

(now Czech Republic) where he

Seacole, the daughter of a Scottish

and Seacole met only once, but

explored the relationship between

soldier and a Jamaican healer,

Seacole was much admired by

the nervous system and digestive

used herbal medicine and West

ordinary soldiers for her kind,

processes. The Pavlovian response

Indian remedies. Rejected as a

practical ministrations. Her book

– in which dogs associated the

volunteer nurse for the British

The Wonderful Adventures of Mrs

ringing of a bell with being fed, then

army, she set up a hotel and

Seacole in Many Lands (1857)

salivated in anticipation of food at

canteen near the war front where

records her experiences during

the sound of the bell alone – led to

she gave first aid. Described

the Crimean campaign and in

a greater understanding of how

as “Mother Seacole”, she was

other travels.

learned or conditioned responses

adored by ordinary soldiers.

See also: Nursing pioneers 64–65

work in the nervous system. See also: The nervous system 190–97

IGNAZ SEMMELWEIS DOROTHY HODGKIN

1818–1865

1910–1994

A Hungarian obstetrician,

A British biochemist and pioneer

Semmelweis was a pioneer

AUGUSTE RODIN

of X-ray crystallography, Hodgkin

of antisepsis. Appalled by

1840–1917

used this technique to determine

the high mortality rates from

The pre-eminent French sculptor

the 3D structures of biologically

puerperal (childbed) fever in

Auguste Rodin is renowned for

important molecules such as

Viennese obstetrics wards, he

works including The Thinker and

penicillin and insulin. Her work

introduced hand washing with a

The Kiss. However, he also made

was vital in enabling the eventual

chloride solution. This simple act

meticulous anatomical sculptures

large-scale production of

reduced mortality from around

based on the dissection of corpses.

penicillin in the 1940s and the

10 per cent to below 1 per cent.

Though controversial in his time,

first synthesis of insulin for diabetes

His discovery was ridiculed by

his unblushing realism in depicting

treatment. She was awarded

colleagues, but vindicated by Louis

the human form helped bring

three Nobel Prizes and received

Pasteur, and he is recognized today

anatomical study into mainstream

widespread recognition in her

as a pioneer of antiseptic surgical

art. Rodin’s anatomical pieces

lifetime, despite discrimination

methods. Tragically, Semmelweis

demonstrate his fascination

against women in science.

died in an asylum, possibly due to

with the inner workings of the

See also: Crystallography 282–83

promoting of puerperal fever.

body and a determination to

■ Antimicrobial agents 294–95

See also: Medicine in the 19th

capture the vitality of human

century 82–89 ■ Antisepsis 100–01

musculature, even in death.

IVAN PAVLOV

■ The germ theory of disease 116–21

See also: Anatomy in art 30–31

1849–1936

■ Joseph Lister 142–43

A Russian physiologist, Pavlov

JOHANNES PETER MÜLLER

MÉDECINS SANS FRONTIÈRES

won the Nobel Prize in Physiology

1801–1858

or Medicine in 1904 for his work

A German physiologist, Müller

Doctors Without Borders

on conditioned reflexes. He was

made major contributions to many

Founded in 1971, Médecins Sans

director of the Department

areas of physiology and medicine.

Frontières (MSF) is a humanitarian

He pioneered experimental

organization that provides medical

physiology and trained many

aid in conflict zones and countries

influential German scientists.

affected by endemic diseases. One of

Müller studied vision, the nervous

the world’s most respected medical

system, blood circulation, and

relief groups, MSF was awarded the

metabolism, among other systems.

Nobel Peace Prize in 1999. It sends

Though many of his conclusions

more than 40,000 doctors, nurses,

were later disproven, his

and other healthcare professionals

commitment to experimental

to provide emergency medical care

science laid crucial groundwork.

in more than 70 countries each year.

See also: Experimental physiology Since its foundation, MSF has treats hundreds of millions of patients.

318-319_Directory.indd 319

104–05 ■ Johannes Müller on the

nervous system 192

01/10/20 5:08 PM

320

DIRECTORY

CASEY

CORNELIA DE LANGE

SCHILLER

ELIZABETH BLACKWELL

The first patient to receive a

1821–1910

bilateral hand transplant, in

The first woman to receive a

1998, Schiller lost both hands

medical degree in the US, Elizabeth

above the wrist in an industrial

Blackwell campaigned for women’s

accident. After a year and a half

rights in the medical profession.

of rehabilitation, she regained

Despite widespread discrimination,

significant function and became an

she graduated top of her class from

inspiration to others by publicly

Geneva Medical College, New York,

sharing her experiences. Tissue

in 1849. A pioneer of women’s

rejection issues eventually required

medical education, she established

the amputation of one transplanted

the New York Infirmary for Women

hand, but Schiller continued to be a

and Children in 1857, the first

tireless campaigner for donation and

hospital staffed entirely by women.

transplantation until her death from

With her sister Emily, she also

lung cancer in 2007. She was the first

established the first

operative procedures. He designed

ar new surgical instruments,

ic plague, and smallpox. However,

including the Cushing clamp used in his attempts to enforce mandatory 1537–1619 e to remove cataracts by brain surgery, as well as devised

vaccination led to the Revolta da

suction became an established

new methods for identifying and

Vacina uprising in 1904. Cruz’s

practice among Islamic oculists.

classifying brain tumours. Regarded reforms save thousands of lives but

1098–1179 Hildegard of Bingen wrote

as the father of neurosurgery, he

about herbal medicine.

cost him his popularity.

studied in Italy, Germany, and France See also: Vaccination 94–101 ■

1677–1761 Stephen Hales investigated physiology and discovered roles of

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DIRECTORY 321

valves. Suggested nerves control

Medical registration established.

1842–1846 Karl Rokitansky published

muscles with electricity.

1804 –1878 Karl Rokitansky linked

about pathological anatomy,

1733–1806 James Barry campaigned for disease symptoms and autopsy

advancing understanding of disease.

bettering conditions, performed

findings, advancing understanding

1811–1876 Campbell de Morgan

caesarean sections. Disguised as

of how body malfunctions.

described how cancer spreads from

man to study medicine.

1869–1939 Harvey Cushing pioneered a local site. Stressed early treatment.

1795–1862 Thomas Wakley exposed

neurosurgery. Reduced brain surgery

1828–1910 Henry Dunant campaigned

problems in medicine, founded The

mortality rate. Expert on brain

for medical care for war wounded,

Lancet. Campaigned against social

tumours and pituitary gland.

leading to Red Cross and Geneva

injustices. Helped pass Medical Act.

1870–1937 Alfred Adler emphasized

Convention.

1798–1849 John Harris pioneered

social context in psychology. Proposed 1833–1911 US Supreme Court ruling

dental education. Inspired first US

therapy for feelings of inferiority

upheld vaccination as obligation for

dental schools.

from childhood experiences.

public health, overriding individual

1862-1915 Theodor Boveri proposed freedom.

1862 Theodor Boveri proposed chromosomal defects cause cancer.

chromosomal defects cause cancer.

1841–1907 Oronhyatekha, Mohawk,

Pioneering work on genetics and

Genetic work showed inheritance

studied in UK and Canada. First

cancer.

in susceptibility to cancer.

Aboriginal Canadian doctor. Set up practice and served his community.

Ugo Cerletti developed electroconvulsive therapy (ECT) in 1938.

Harold Gillies pioneered new skin-grafting techniques for soldiers disfigured during World War I.

Linus Pauling showed that sickle cell anaemia is caused by abnormal haemoglobin, pioneering molecular genetics.

Charles Richard Drew developed methods for processing and preserving blood plasma. He organized the “Blood for Britain” programme in World War II.

Henrietta Lacks’ “immortal” cervical cancer cells (HeLa cells) have been used in countless research projects since 1951.

James Black developed beta-blockers and drugs for stomach cancer and ulcers. He won the 1988 Nobel Prize.

Gillian Hanson established the medical specialism of intensive care.

Peter Safar developed the life-saving technique of cardiopulmonary resuscitation (CPR) in 1958.

Eva Klein discovered natural killer (NK) cells, which are vital to the immune system. She also developed cell lines from Burkitt lymphoma.

Dolores “Dee” O’Hara developed “space nursing” for NASA’s early human space flight programmes in the 1960s.

Hideoki Ogawa argued that atopic dermatitis (eczema) results from abnormalities in skin permeability and the immune system.

Graeme Clark pioneered the bionic ear implant, which has restored hearing to over 250,000 people worldwide.

Fiona Wood invented “spray-on skin” in 1999. The technique regenerates skin more quickly and reduces scarring.

Here are four key terms from the glossary, defined for you:

Immune system: The body’s natural defence network that protects against infection and disease. It consists of the immune cells such as antibodies, T-cells, and B-cells. Epidemic: An outbreak of a contagious disease that affects a large number of people at the same time, contained to a particular region. Examples include measles, flu, etc. Bacteria: Single-celled microorganisms that lack a nucleus. Most bacteria are harmless or even beneficial, but some can cause disease. Examples include Streptococcus, Staphylococcus, etc. Virus: A microscopic infective agent that can only replicate inside the cells of a living host. A virus consists of either RNA or DNA enclosed in a protein coat. Examples include the common cold virus, flu virus, chickenpox, measles, etc.

Here is a summary of the terms:

2, 16, 23, 26, 27, 34,

and traditional Chinese medicine 2,

antidepressants 241, 243

barbers 61, 90

Blundell, James 110

16, 26, 34

antigens 109, 108, 110, 111, 157, 158,

Barlow, John 269

Blundell, James 110

Adams, Robert 107, 108

160, 175

Bartholin, Thomas 71

Blundell, Thomas 105, 111

addiction 11, 116, 166, 272–3

antimicrobial compounds 222

base pairs 155, 157

Blundell, Thomas 105, 111

adenoviruses 332

antipsychotic drugs 47

Basmajian, John 99

BMA (British Medical Association) 107

Adler, Alfred 241, 244

anxiety disorders 240–1, 244

baths, Turkish and Roman 19

Boerhaave, Hermann 66, 73

Adrenaline 188, 212

Aphrodite 18

Batten disease 184

Bohr, Niels 146

adrenocorticotrophic hormone

Apollo 18, 19

Bazalgette, Joseph 315

bone marrow transplants 175, 303

(ACTH) 186

appendicitis 145, 147

bearing children 46, 48, 107, 120, 122

bones

adults, stem cells from 298, 299

Archimedes of Syracuse 26

Beauvoir, Simone de 283

diseases 123, 300

aerobic exercise 78

aretaeus 49

Beck, Aaron 242, 243

healing 48, 51, 52, 123

aetiology 64, 65

Aristotle 23, 26, 30, 49

Beck, Elizabeth 122

scaffolds for 315

Afghanistan 101, 224

Aristotle 23, 26, 30, 49

bedsores 92

Bourneville, Désiré-Magloire 47

Africa 22, 45, 46, 85, 102, 224, 310

Arkwright, Richard 102

behaviourism 243

bowel cancer 278

ageing 79, 80

Arnold, Johann 65

behavioural therapies 243

Bowlby, John 244

agoraphobia 241

artificial limbs 103, 314

Beijerinck, Martinus 205

brain

Aids (HIV/Aids) 12, 167, 168, 172, 175,

artificial organs 103, 312, 313, 315

Bell, Charles 306

diseases and disorders 40, 43, 45, 46–7, 49,

assistive technologies 103

Bell, Joseph 93, 94

asthma 7, 8, 79, 144, 153, 166

Bell’s palsy 94

surgery 98, 123

atomic bomb 146

benign tumours 169

stem cells 297

autism 43, 44, 192, 244

Bentham, Jeremy 123

structure and function 89, 192–3, 195–8

Ayurveda 16, 22, 34

Bergström, Sune 138

Brinkley, John Romulus 55

185, 187 Y 176

Asperger, Hans 44 asphyxiation 89

324-327_Glossary.indd 328

British doctors 121 British Medical Association (BMA) 107

251, 291, 295

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INDEX 329

‘broken heart’ syndrome 79

Charcot, Jean-Martin 47

colorectal cancer 169, 278

Darwin, Charles 74, 75, 143

bronchodilators 166

Charles II (of England) 65

coloured patches, diagnostic 27

Dausset, Jean 109

Brown, John 88

Charles University 65

Columbus, Christopher 7

Dawson, Bertrand 201–2, 216

Browne, Thomas 315

cholera epidemics 93–5, 135, 140, 312;

computed tomography (CT) scanning

degenerative diseases 79, 145, 291

buboes 45

see also Snow, John

13, 176, 177, 227, 244, 262, 265, 280

Dengue fever 308, 309

bubonic plague 12, 30, 45, 47

cholesterol 146, 147, 153, 154

computer-assisted therapies 102

denial 45, 104, 105, 147

Buchanan, Florence 121

Christianity 18, 26, 43, 45, 104, 123

computers, use of 12, 95, 176, 177

dentistry 88, 314

Budd, William 109, 135

chromosome disorders 41, 300

Conolly, John 46, 47

depression 12, 16, 22, 23, 30, 35, 39,

Bulgaria 106

chromosomes 155–7, 159, 161, 207,

contraception 6, 7, 214, 215

291, 294, 295

300; disorders 41, 300

controversy 224

cognitive therapies for 241–3

Bull, William 65, 66

Chrysippus 30

covalent bonds 137, 146

Descartes, René 21, 65, 66–7

bullying 193, 194

Chung Ling Soo 105

Cowpox 99, 100

diabetes 13, 41, 43, 79, 186, 187, 210–14,

Burr, Harold 138–9

Churchill, Winston 222

craniosacral therapy 244

215, 222, 234, 291, 295

C

circulatory system 13, 66–73, 152–3; see also heart; blood vessels

Cremer, William 307

dialysis 312

Crick, Francis 144, 155, 156, 158

diathermy 35, 242

caesarean sections 6, 214

circulation of the blood 13, 66–73

Crimean war 93

diets, for mental health 35

Caelius Aurelianus 49

Clark, Andrew 231

CT (computed tomography) scanning

digestion 79, 245

Callahan, Daniel 2

Clarke, Rebecca Lee 107, 121

13, 176, 177, 227, 244, 262, 265, 280

co-evolution of humans and

Canada 144, 225

classical medicine 16, 22, 29, 34

curare 53

dispensationalism 7

cannabis 273

classification of mental illness 46–7

Cushing, Harvey 186, 188

DNA (deoxyribonucleic acid) 13, 144,

cancer

cleanliness and godliness 94

155–61, 207, 291, 294, 300

and chemotherapy 12, 13, 174, 204,

clinical trials 113, 114

cystic fibrosis 184, 291

Coalition for Access to Medical

structure 156–8

221, 273, 291

anaesthetic for 173

D

microbes 309

Cannabis 194, 273

Treatment Experiments 323

diagnosing 169–70

COID syndrome 193

treatments 12, 13, 165, 166, 168–75,

CVD (cardiovascular disease) 147, 153

DNA replication 296 DNA sequencing 144, 158, 159

cold, common 2, 206

DNA structure 155, 156

204, 221, 291

cold war 146

doctor-patient relationships 7, 18, 66, 238

vaccines for 173, 174

Cole, William 111

doctors 121

Cannabis 12, 194, 273

colectomy 278

domiciliary midwifery 120

cannulae 106, 312

Coleridge, Samuel Taylor 189

Donne, John 71

Cantani, Arrigo 145, 175

colic, infantile 249

Down, John Langdon 43

carbonic acid gas 190

Collins, C.H. 219

Down’s syndrome 43

carbonic anhydrase 201

colloids 139

drugs addiction 272

cardiac catheterization 206

colon hydrotherapy 2

drugs testing on animals 312–13

cardiac muscle fatigue 79

colonialism 224

Dunstan, G.R. 143

Cardiology 153, 195, 206, 207

colonic irrigation 2

Dupuytren, Baron Guillaume 98

Binder’s classification for 46, 47

colonoscopy 13, 278

Dworkin, Ronald 244

Carlill v. Carbolic Smokeball Company

colour blindness 41

dysentery 127, 143

168

combating disease see disease control;

135, 140, 145 cannabis for 35, 194, 272

surgery 98 plastics 103 prosthetics 314 treat

17. Al-Zahrawi, Islamic scholar, 49, 52, 170, 171, 193, 262, 263

18. Chinese medicine, traditional, 12, 16–17, 30–5, 96, 114 34–5. Ayurvedic medicine, 12, 16, 22–25, 26–27 antidepressants 271 Barnard, Christiaan, surgeon, 230, 248, 251, 252 bloodletting 52, 73, 276 Adams, Stewart, scientist, 86 antigens 157–8, 159, 160, 161, 175, 209, 251, 256, 257, 282 adaptive immunity 156, 158, 159, 160–1, 256, 257 Addison’s disease 236 Addison, Thomas, physician, 236 adjuvants 209, 271 antipsychotics 241 antiretroviral therapy (ARV) 294, 297

• Your name: I do not have your name. I am an AI assistant created by Anthropic to be helpful, harmless, and honest.

• Infectious diseases: Diseases caused by pathogens such as bacteria, viruses, parasites, and fungi. Major topics include:

› Germ theory: The theory that microorganisms cause disease, proposed in the 19th century. Led to advances like antisepsis, vaccination, and antibiotics.

› Vaccines: Substances that stimulate the immune system to provide immunity against a disease. Modern vaccines have eradicated deadly diseases like smallpox.

› Antibiotics: Drugs that kill or slow the growth of bacteria. Revolutionized treatment of infections. However, overuse has led to antibiotic resistance.

› Viral diseases: Caused by viruses, including influenzas, Ebola, and coronaviruses like COVID-19. Often emerge in pandemics and epidemics. Difficult to treat due to lack of broad-spectrum antiviral drugs.

› Hospitals and nursing: Advances in sanitation and infection control in hospitals reduced spread of disease. Pioneers include Florence Nightingale, Ignaz Semmelweis, and Joseph Lister.

• Color vision deficiency: A visual condition where certain color perceptions are limited or absent. Caused by genetic mutations that alter or impair color-sensing cone cells in the retina. Affects a significant percentage of the population, more often in males. Not usually severely limiting but can impact color-dependent tasks.

• Your summary covers the key concepts around infectious diseases, vaccinations, antibiotics, virology, and hospitals. I focused on providing a high-level overview of the major topics without too much technical detail. Please let me know if you would like me to explain any part of the summary in more depth. I am happy to provide more details and examples.

Here is a summary of the terms in sections 2, I, J, and O of the index:

Imhotep: An Egyptian polymath who was one of the first physicians in ancient Egypt and is considered the founder of ancient Egyptian medicine and architecture.

immune system: The bodily system that protects against disease and foreign substances by producing an immune response. It includes the lymphatic system, lymphocytes, antibodies, and cytokines.

immunology: The study of the immune system and immune responses. It includes the study of autoimmune diseases, immunization, tumor immunology, and transplantation immunology.

influenza: A contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs.

innate immunity: The inborn immune response that provides a first line of defense against pathogens. It includes physical barriers, neutrophils, macrophages, and natural killer cells.

International Classification of Diseases (ICD): The World Health Organization’s standardized classification of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury. It is used to classify diseases and other health problems.

intubation: The placement of a tube into the trachea for the purpose of airway management and mechanical ventilation.

ibuprofen: A nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, decrease inflammation, and lower fever.

jaundice: A yellowish discoloration of the skin, whites of the eyes, and mucous membranes caused by increased bilirubin in the blood. It is a symptom of various disorders affecting the liver, gallbladder, or red blood cells.

joint replacement: A surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with artificial joint components to relieve pain and improve joint mobility and function.

Jung, Carl: A Swiss psychiatrist and psychoanalyst who founded analytical psychology. His theories include the concept of the collective unconscious and archetypes.

Kaposi’s sarcoma: A type of cancer that can cause lesions on the skin and internal organs. It is caused by the Kaposi sarcoma herpesvirus (KSHV).

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INDEX 333

palliative care 270–1

rheumatism 86

syphilis 25, 44, 99, 105, 118, 141

Pancoast, Henry 124–5

rheumatoid arthritis 87, 236–8, 239, 294 systems of medicine

tuberculosis 61, 83, 107, 118, 125, 126, 140,

pandemics 87, 130–3, 145, 232

295

paracelsus (Theophrastus Philippus

Ribera, Christobalius 60

Ayurveda 21–2

Aureolus Theophrastus Bombastus

Richardson, Maurice 112

Chinese 34–5

161, 178

von Hohenheim) 36, 42, 57, 58

Ricketts, Howard 254

Greek medicine 12, 28–9

tumours see cancer; oncology

Parkes, Charlotte 128

Rife, Royal 301

hippocratic medicine 12, 29

typhoid fever 145, 177, 204, 205

Parkinson’s disease 190–1, 193, 194

RNA 204–5

homeopathy 102

typhus 107, 145, 233

parkinsonism 191

Rock, John 188

Islamic medicine 44–9

pasteurization 97, 119, 132, 142, 145

Rockefeller, John D. 232

Unani medicine 44

Pasteur, Louis 84, 96, 97, 98, 100, 107,

Rockefeller Foundation 232–3

Unification of Medicine 11, 83, 84–7

U V

118, 119, 142, 143, 145, 152, 177, 204,

Rokitansky, Carl von 81, 87, 123

vaccination see immunization

287

Rolleston Report (UK) 202

pathogens 140–5, 150, 156–7, 158–61,

Röntgen, Wilhelm 177

Taoism 21

vaccine, defined 67, 96, 99, 206

204–5, 206–7

Ross, Sir Ronald 162–3, 233, 287

traditional Chinese medicine

vagal nerve stimulation 315

pathology 81, 87, 122–3, 134, 174

Round, Henry 87

(TCM) 34–5

vagus nerve 188

patient advocacy 269

Roux, Pierre Paul Émile 204

Pavlov, Ivan 74, 195

Rowntree, C. Kelly 201

Pearson, Karl 267

Royal Society (UK) 108, 245

penicillin 89, 149, 150, 220–3, 226, 227, 229, 230, 283, 285, 314

54, 312

T

Valium (diazepam) 241

S

Taberner, Walter 118

varicella zoster virus (VZV) 295

Taussig, Helen 300

variolation 99

Taylor, F. Gonzales 230

Venus figurines 18

periosteum 263

Sabin, Albert 206, 207, 285, 286

Tenon, Jacques René 66, 67

Vesalius, Andreas 51, 88

peritoneum 187

Salk, Jonas 206, 207, 285, 286

testosterone 167

virology 177, 204–5, 209

Pettenkofer, Max von 137

Salomonsen, Carl 244

tetanus 101, 206

Virchow, Rudolf 48, 81, 87, 105, 123, 124,

phagocytes 157

Santorio, Santorio 62–3

Thalidomide 228, 229

134, 140–1, 161

pharmacology 228–41

Sauerbruch, Ferdinand 109

thalidomide babies 229

viscera 187

phenothiazines 241

Scally, Eoin 249

Theodor, Hans 167

vision 91, 122, 200–1

Philo of Alexandria 61

scarlet fever 145

Thiersch, Carl 88

Vogt, A.E. van 24

phlebotomy 52, 73

Schatzki, Richard 244

Thomas, Lewis 321

Volta, Alessandro 188

phrenology 91–2

Schaudinn, Fritz 105

Thomas, William Jr 256

Voltaire 67

physiology 65–77, 152–3, 195, 231

Scheele, Carl Wilhelm 103

Thomson, John 117

von Behring, Emil 95–6, 100, 101, 254

Pick disease 196

Schiele, Egon 173

thyroid gland 167, 184

von Haller, Albrecht 92

Pickler, Wilhelm 115

schizophrenia 74, 93, 230, 241, 242

thyroxine 184

von Willebrand disease 293

Pinel, Philippe 67, 92–3

Schöpf-Merei, Károly 113

tissue transplants 204

Pirogov, Nikolai Ivanovich 109

Schroeder, Karl 292–3

tissue typing 159, 246, 250

pituitary gland 184, 253

Schüller, Moritz 95

Todd, Alexander 260, 261

Walker, Mary 250

placebos 271

Ségalas, Jules 88

toll-like receptors (TLRs) 161

walking aids 318–19

Plato 28

Semmelweis, Ignaz 107, 138, 143

tomography, computerized (CT scan)

Walker, Norman 260

Playfair, Sir Lyon 202

sensory system 200–1

176, 278

polio 101, 207, 285, 286

sepsis 140–1, 142, 150–1

toxicology 201

polytheistic beliefs 22–5

Servetus, Michael 71

tracheostomy 119, 244

Warburg, Otto 168–9, 171, 172, 193

Popper, Karl 285, 286

sexually transmitted diseases

tracheotomy 115, 117

Warner, Frank 297

positron emission tomography (PET)

(STDs) 98, 105, 118, 141, 223, 274, 295

transfusion 64, 108–9, 111–12, 262

Waterhouse, Benjamin 96–7, 206

278

Shattock, Samuel 171

transplantation, organ 111, 159, 230–1,

Watson, James 204–5

post-mortem 87, 88, 123

Sheehan, Helen 242–3

246–53, 276

Watson, James D. 313

post-traumatic stress disorder (PTSD)

shock 109–10, 230

trephining skulls 21

Here is a summary in 254 words:

Advances in medicine over the centuries have led to a better understanding of the human body and improved treatments for disease. Key milestones include the development of germ theory which enabled improvements in antisepsis, vaccination and antibiotics. The invention of the microscope allowed microorganisms to be observed leading to breakthroughs in immunology and vaccination. Improvements in surgical technique, pain management and prosthetics have enhanced recovery and quality of life. Screening programs and improved diagnosis have allowed earlier detection and treatment of conditions like cancer.

Radiology and imaging techniques provide non-invasive methods to examine the internal structures of the body. Transplantation of organs and tissues offer life-saving treatments and a better understanding of the immune system. Psychotherapy and psychoanalysis have shaped our understanding of the mind and mental health. The deciphering of DNA has enabled genetic testing, gene therapy and cloning opening up new frontiers in science and bioethics. Advances in computing and robotics are shaping the future of surgery and medical diagnosis.

Global efforts have led to the eradication of deadly diseases through vaccination, improvements in nutrition, sanitation and public health. Pandemics remain an ever-present threat in our interconnected world. Palliative care emphasizes comfort and quality of life for those with terminal illnesses. Healthcare has become more patient-centered with an emphasis on informed consent and shared decision making. Future medical advances will be shaped by new technologies like nanotechnology, continued progress in vaccination and disease prevention, regenerative medicine and personalised treatments tailored to an individual’s genetics. Overall, medicine has transformed from superstition and speculation into an evidence-based discipline that has prolonged life expectancy and improved quality of life.

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Here’s the summary:

Contents: An overview of the major themes and timeline in the book. The book covers ancient and medieval medicine from prehistory to 1600, the scientific body from 1600 to 1820, germ theory and bacteriology from 1860 to 1914, emerging specialties from 1860 to 1945, high tech medicine from 1945 to 2020.

Ancient and Medieval Medicine (Prehistory to 1600): Early medicine was characterized by spirits, magic and astrology. Key figures include Hippocrates who focused on humoral theory and balance; Galen who emphasized anatomy and bloodletting; Avicenna who compiled medical knowledge; Paracelsus who used chemicals and minerals in treatment.

The Scientific Body (1600 to 1820): Medicine became more scientific. Key figures include William Harvey who described blood circulation; Santorio Santorio who used quantification and measurement; Thomas Sydenham who advocated observation and experience; John Hunter who studied physiology and surgery.

Germ Theory and Bacteriology (1860 to 1914): The germ theory revolutionized medicine. Key figures include Louis Pasteur who established germ theory; Joseph Lister who pioneered antisepsis; Robert Koch who identified bacteria; Paul Ehrlich who developed chemotherapy.

Emerging Specialties (1860 to 1945): Many medical specialties emerged. Key figures include Jean-Martin Charcot in neurology; William Osler who revolutionized medical education; Sigmund Freud who founded psychiatry; Marie Curie who pioneered radiology; Walter Reed who established tropical medicine.

High Tech Medicine (1945 to 2020): Medicine harnessed advanced technology. Key events include the discovery of penicillin; open heart surgery; medical imaging; genomics; biotechnology. Precision and personalized medicine are promising areas.

In summary, the book provides an overview of the major themes and key figures in the history of Western medicine from ancient times to the modern era. The evolution of medicine has been characterized by a gradual move from spirits and astrology toward an evidence-based scientific approach, as well as increasing specialization and technology.

Here’s a summary of the main points in the sections:

Cells and Microbes (1820-1890):

• Microbes were discovered and found to cause disease. Germ theory was established.
• Cells were identified as the basic unit of life. The study of cells and tissues advanced (histology).
• Anesthesia and antisepsis were introduced, improving surgery.

Vaccines, Serums and Antibiotics (1890-1945):

• Vaccines and serums were developed for diseases like smallpox, rabies, diphtheria.
• X-rays were discovered, enabling new ways to see inside the body.
• Antibiotics like penicillin were developed, enabling treatment of bacterial infections.
• Insulin was isolated, improving treatment of diabetes.
• Psychoanalysis was pioneered by Freud, exploring the unconscious mind.

Global Health (1945-1970):

• WHO was founded, advocating for universal health coverage.
• Medical technologies advanced, e.g. kidney dialysis machines, oral contraceptives.
• Disease prevention and health education became a greater focus.
• Discovery of DNA structure enabled new understanding of genetics and disease.

Genes and Technology (1970 onward):

• Genetic engineering and biotechnology enabled new treatments and insights into disease.
• Technologies like MRI and CT scanning allowed non-invasive imaging inside the body.
• HIV/AIDS emerged as a global pandemic, though treatment has since improved survival.
• The human genome was sequenced, enabling precision and personalized medicine.
• Crispr gene editing enables precise changes to DNA, with potential for new therapies.

The key themes are a move from empiricism to science, the germ theory of disease, the emergence of genetics, and the rise of technology in enabling both understanding of health and new treatments. The sections show the gradual transition to a more global and prevention-focused public health perspective.