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
- 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
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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
-
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.
-
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.
-
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.
-
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:
-
Finding drugs like azathioprine and cyclosporine to suppress the immune system and reduce organ rejection
-
Matching donors and recipients by HLA testing to increase compatibility
-
Performing the first successful kidney transplant between twins in 1954
-
Attempting the first liver and heart transplants in 1963, though initial survival was poor
-
The first long-term survivor of a heart transplant in 1967, living for 18 days
-
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
- 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
- Consistency: The association is consistent when it appears in different studies,
and 70s. However, global
by different researchers, in different populations.
cigarette consumption
- 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
- 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
- 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
- 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.
- 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,
- 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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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
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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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09/10/20 6:24 PM
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
9/10/20 6:25 PM
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
-
Al-Zahrawi, Islamic scholar, 49, 52, 170, 171, 193, 262, 263
-
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).
328-335_Index_Quote_attributions.indd 332
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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.
deathS per dayRed colour showsdays in which(tl). AlamyStock Photo: Mandman (bl, 102 Art Collection 3 / Alamy(br). Stock Photo (bc). 103Alamy Science
(Science Pictures (br). 205 AIM Group (rt). 206 Alamy Stock tr Stock
Varatharaj for picture research assistance.
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DK would also like to thank the following
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individuals and organizations for their kind
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permission to reproduce their photographs:
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Rapho via Getty Images (X-ray). 5 Chalky Tim /
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mummy). 21 Art Collection 3 / Alamy Stock Photo: Mandman (bl). 22 Z. Radovan / Science Photo Library / Getty Images (‘Anatomy of the veins’ woodcut). 23 Art
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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.
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About Matheus Puppe