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MEDICINE

THE DEFINITI V E ILLUSTR ATED HISTORY


MEDICINE
THE DEFINITI V E ILLUSTR ATED HISTORY

STE VE PARKER
CONSULTANT
Steve Parker

CONTRIBUTORS
Alexandra Black, Philip Parker, Sally Regan, Marcus Weeks

DK LONDON
Senior Editor Kathryn Hennessy
Senior Art Editor Helen Spencer
Editors Alexandra Beeden, Polly Boyd, Anna Cheifetz,
Jemima Dunne, Georgina Palffy, Esther Ripley
US Editor Jill Hamilton TREATING A GLADIATOR
Managing Editor Gareth Jones
Senior Managing Art Editor Lee Griffiths

CONTENTS
Senior Jacket Designer Mark Cavanagh
Jacket Design Development Manager Sophia MTT
Jacket Editor Claire Gell
Pre-production Producer Nadine King
Producer Mandy Inness
Associate Publishing Director Liz Wheeler
Publishing Director Jonathan Metcalf
Art Director Karen Self
22 Secrets of Mummies
DK DELHI
Senior Editors Dharini Ganesh, Bharti Bedi, Anita Kakar 24 Medicine in Ancient
Senior Art Editor Mahua Sharma
Mesopotamia
Project Art Editor Shreya Anand
26 Early Chinese
Editors Arpita Dasgupta, Priyaneet Singh
Art Editor Anjali Sachar
ANCIENT WISDOM Medicine
Senior Editorial Manager Rohan Sinha
Managing Art Editors Sudakshina Basu, Anjana Nair
TO 700 28 Acupuncture
Jacket Designer Suhita Dharamjit
12 Timeline 30 Ayurveda
Managing Jackets Editor Saloni Singh
Picture Researcher Aditya Katyal
14 Healers and Herbalists 32 Medicine in Ancient
Manager Picture Research Taiyaba Khatoon Greece
DTP Designers Vijay Kandwal, Pawan Kumar 16 Early Surgery
Senior DTP Designers Harish Aggarwal, Sachin Singh 34 The Four Humors
Pre-production Manager Balwant Singh 18 Shamanism
Production Manager Pankaj Sharma 36 Hippocrates
20 Medicine in
First American Edition, 2016 Ancient Egypt 38 Medicine in Ancient Rome
Published in the United States by DK Publishing
345 Hudson Street, New York, New York 10014

Copyright © 2016 Dorling Kindersley Limited ANCIENT EGYPTIAN SURGICAL INSTRUMENTS


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ISBN: 978-1-4654-5341-9

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A WORLD OF IDEAS:
SEE ALL THERE IS TO KNOW

www.dk.com
DISTILLING SPIRITS TREATING BATTLEFIELD CASUALTIES

40 Galen 56 Medieval Medicine 86 Cataract Surgery

42 Roman Surgical Tools 60 Anatomy Restored 88 Exchanging Epidemics


with the New World
62 Apothecary Store
90 Thomas Sydenham
64 Alchemy

66 The Black Death


92 Early Microscopists
SCIENCE TAKES
68 Preventing Plagues
94 Evolution of
Microscopes CHARGE 1800 –1900
REVIVAL AND 70 Alchemy, Chemistry, 96 The First Microanatomists 112 Timeline

RENAISSANCE
and Medicine
98 Scurvy 114 The First
72 The Anatomy Revolution
700 –1800
Stethoscope
100 Smallpox: The
76 Barber-surgeons Red Plague 116 Diagnostic
46 Timeline Instruments
78 Ambroise Paré 102 The First Vaccination
48 The Golden Age of Islamic 118 Resurrection Men
Medicine 80 Repair and Reconstruction 104 Phrenology
120 Miasma Theory
52 Ibn Sina’s The Canon 82 Discovering the Circulation 106 The Modern
of Medicine Hospital 122 Cholera
84 The Circulation
54 The First School of Medicine Revolution 108 Homeopathy 124 John Snow

THE MEDICAL SCHOOL AT SALERNO INOCULATING A PATIENT


JOSEPH LISTER’S CARBOLIC SPRAY PILL PRODUCTION

126 Epidemiology and 150 Cell Theory 174 The Struggle Against Malaria 188 Minimally Invasive Surgery
Public Health
152 Pathology and 176 Transfusion Breakthrough 190 Diabetes and Insulin
128 Anaesthetics Medical Autopsy
192 War and Medicine
130 Early Anaesthetics 154 The First Antiseptics
194 Battlefield Medicine in
132 Dentistry 156 Tuberculosis World War II

134 Pregnancy and 158 Vaccines Come 196 Influenza and the
Childbirth of Age Pandemic

136 Midwives 160 Mysteries of ERA OF 198 The Discovery of

SPECIALIZATION
the Brain Penicillin
138 Childbed Fever
162 Mental Illness 200 Antibiotics in Action
140 Women in 1900 –1960
Medicine 164 Horror of the Asylum 202 The Evolution of Syringes
180 Timeline
142 Nursing 166 Viruses and How 204 Women’s Health
they Work 182 Sigmund Freud
144 Medical Publishing 206 Heart Disease
168 Fighting Rabies 184 The Development
146 Microbiology and of the ECG 208 Allergies and
Germ Theory 170 The Discovery of Aspirin Antihistamines
186 A Cure for
148 Louis Pasteur 172 X-rays Syphilis 210 Polio: A Global Battle

GUESTS IN A TRANCE AT MESMER BANQUET FIRST AID AFTER GAS ATTACK


EARLY ECG RADIOTHERAPY FOR A BRAIN TUMOUR

212 The Structure of DNA 228 Cancers 254 Robotic Surgery


REFERENCE
214 Inhalers and Nebulizers 232 Advanced Imaging 256 Emergency Medicine
274 Body Systems
216 Scanning Machines 234 The First Heart 258 Antibiotic Resistance 276 The Skeletal System
Transplant and Superbugs
218 The Pharmaceutical 278 The Muscular System
Industry 236 Implants and 260 Alzheimer’s Disease
Prostheses and Dementias 280 The Nervous System

238 Artificial Body Parts 262 End-of-Life Care 282 The Cardiovascular System

240 In Vitro Fertilization 264 Nanomedicine 284 The Respiratory System


286 The Endocrine System
242 HIV and AIDS 266 Global Medical
Bodies 288 The Digestive System
244 New Discoveries for
PROMISES OLD AND Old Diseases 268 Ebola Virus 290 The Immune System

NEW 1960 – PRESENT


Disease
246 Genetic Revolution 292 The Urogenital System
270 Stem Cell
222 Timeline 248 Genetic Testing Therapy 296 Sensory Organs
300 Who’s Who
224 The Contraceptive 250 Mental Health and
Pill Talking Therapies 305 Glossary
226 Margaret Sanger 252 Robots and Telemedicine 312 Index and Acknowledgments

NANOBOTS DNA SEQUENCING


Introduction
One of the greatest figures in the history of medicine,
Hippocrates of ancient Greece, believed that “A wise man
should consider health as the greatest human blessing…
To physicians: Cure sometimes, treat often, comfort always…
And make a habit of two things: Help; or at least, do no
harm.” While these words are more than 2,300 years old, their
sentiments still ring true today. Good health is a most precious
commodity and in the modern world medicine has achieved
towering status. Many nations spend more than one-tenth
of their entire wealth on prevention and treatment of illness
and allied health services.
The origins of medicine are hazy, but it is known that all
great ancient civilizations had specialists in healing arts, as
each region around the world developed knowledge and
learning in the area. Varied traditions arose, some effective,
but many bound up with spells and curses, spirits, demons, and
other supernatural entities. Progress toward modern medicine
quickened from about the 16th century, especially in Europe.
Here, the Renaissance led to the rise of organized observation,
recording, experimentation, analysis, and a rational, evidence-
based approach, and medicine evolved from art to science.
The past two centuries have seen momentous advances—
vaccination; antiseptics; anesthetics; the discovery of germs
and the antibiotics to fight them; improved diet, hygiene, and
sanitation; numerous uses for radiation; body imaging;
transplants and implants; and progress against cancers.
The average patient’s experience has changed immeasurably
since ancient times. But there are still abundant inequalities
around the world and challenges to meet, such as malaria,
HIV/AIDS, and other epidemic infections; chronic diseases of the
respiratory and circulatory systems; and the provision of clean
water, adequate nutrition, and comprehensive vaccination for
all. The 21st century also sees major new treatments emerging,
such as therapies exploiting genes and stem cells, and the
prospect of tailor-made “personalized medicine.”
All of these topics and more are covered in the following
chapters. The history of medicine is a vast subject, but this book
throws a spotlight onto what has been, the giant strides that
medicine has achieved, and how the balance between health
and illness looks set to improve for future generations.

◁ Always something new


The arrival of HIV/AIDS during the 1980s was a stark warning that
new diseases will continue to emerge. Here, copious HIV (human
immunodeficiency virus) particles (small bright spots) infect human
white blood cells, quashing their immune defensive abilities.

9
ANCIENT
WISDOM
TO 700

Arkesilaos weighing silphion


ANCIENT WISDOM

ANCIENT WISDOM
TO 700
PREHISTORY 3000 BCE 1500 BCE
49,000 YEARS AGO 7,000 YEARS AGO 1500 BCE 500 BCE
Neanderthals possibly A man undergoes a The first reference to The concept of the four
use medicinal herbs, as deliberate and successful diabetes appears in an humors, central to many
evidenced by fossilized arm amputation at Egyptian papyrus. medical systems for the
Neanderthal teeth. what is now Buthiers- next two millennia,
Boulancourt, France. begins to take shape in
ancient Greece.

20,000 YEARS AGO 5,300 YEARS AGO


Holes are drilled into In the European Alps, Ötzi
skulls—a procedure called the Iceman suffers gut
trepanning—to treat parasites, and painful bone
medical conditions. and joint conditions.
1400 BCE
The Mesopotamian Gula Cupping vessel to
Hymn includes: “I am a treat humoral imbalance
physician, I can heal; I carry
around all healing herbs,
I drive away disease; I give
cures to mankind.”

10,000 YEARS AGO 3000 BCE Stele of Hammurabi 1050 BCE 500 BCE
Traditions of shamanism Egyptian mummies surviving The landmark Early versions of Susruta
emerge on several from this time show broken Mesopotamian Sakikku Samhita, an Ayurvedic
continents. bones, signs of tuberculosis, diagnostic handbook is compilation, appear
and other health problems. completed by physician in India.
Esagil-kin-Apli of Borsippa.
2200 BCE
Per-Ankh, or Houses
of Life, are built in
ancient Egypt as places
for creation and preservation Lord Dhanvantri,
of knowledge. God of Ayurveda

1755 BCE
The Code of
Hammurabi,
2700 BCE ruler of Babylon,
The tomb of one includes several
of the earliest pronouncements on
known female medical care, such
physicians, ancient as physicians are
Egypt’s Merit-Ptah, is responsible for the
inscribed “Chief success and failure of
Physician.” their actions.

Mongolian shaman’s
decorated drum

1550 BCE
The Ebers
2650–2600 BCE papyrus
7,000 YEARS AGO In ancient Egypt, Imhotep mentions
Teeth of live patients are becomes the leading medical use of
drilled, perhaps for abscess priest-physician and is willow bark,
pain relief, in Mehrgarh, soon elevated to from which
Pakistan. godly status. aspirin is derived.

12
TO 700

Instincts for survival run deep. Our close cousins, chimpanzees and Egypt, China, and India developed their own medical systems, which
gorillas, respond to illness by self-medicating with herbs and clays. Early were mostly entwined with gods, devils, and the spirit world. Around
humans probably did the same. As civilizations evolved, individuals 2,500 years ago, ancient Greece and then Rome evolved their own
began to specialize in areas such as trade, warfare, and healing—and styles of medicine, which focused more on the human body. However,
so medicine was born. The great ancient cultures of Mesopotamia, progress stalled in the 5th century during Europe’s “Dark Ages.”

450 BCE 50 CE 400 CE


60 CE 200 400 530
In ancient Rome, Pedanius Hua Tuo pioneers anesthesia Translation of ayurvedic Sergius of Reshaina
Dioscorides produces De in China during a complex works into Chinese begins. translates around 30 works
Materia Medica (On Medical surgery with a cannabis- of Galen into Syriac; they
Matters), a treatment based concoction termed will go on to be further
370 BCE compendium; innumerable mafeisan. translated into Arabic
Hippocrates dies, subsequent versions become from the 8th century.
leaving many known as Materia Medicas.
followers to expand
and update his
German version of
teachings as the De Materia Medica
Hippocratic Corpus.

500 541
In Central America, The Justinian Plague
Mayan medical ah’men (probably bubonic plague)
use hallucinogenic plant kills more than one-third
extracts to divine disease of the population in
causes and treatments. Europe and West Asia.

Marble bust
of Hippocrates

130 CE 200 651


Soranus of Ephesus writes Zhang Zhongjing The Hôtel-Dieu Hospital
Gynaecology, one of the practices is founded in Paris, France;
first thorough texts in Changsha. it is Europe’s, possibly the
focusing on medicine world’s, oldest hospital still
260 BCE for women. active on its original site.
In Alexandria, Herophilous
and Erasistratus establish
440 BCE anatomy and physiology,
Hippocrates undergoes partly by the practice of
training at the local asklepieion androtomy (dissecting live
(healing temple). and dead human beings).

400 BCE 100 BCE 680


Huangdi Neijing (Yellow Chinese texts describe in Paul of Aegina produces
Emperor’s Classic of Internal detail acupuncture points the huge Medical
Medicine), an early classic text, and treatments. Compendium in Seven
establishes the framework for Books summarizing
traditional Chinese medicine. Western medical
Illustration of acupuncture 165 CE knowledge; it remains
points in the head a classic for a
The Antonine Plague
(possibly smallpox) millennium.
devastates populations
in Europe, West Asia,
and North Africa.

Zhang
Zhongjing

169 CE
Claudius Galen returns
to Rome and begins his 700
prolific writing phase; Chinese scholars come to
his works will dominate Nalanda, India, to study
European medicine for Ayurveda and other
1,500 years. traditional medicine.

13
ANCIENT WISDOM TO 700

Healers and Herbalists


Preserved evidence in fossilized Neanderthal teeth shows that the history of
medicine may stretch back almost 50,000 years, while modern anthropology reveals
that many cultures weave ideas about health into their belief systems—believing
in an invisible world of benign spirits, feared demons, lost souls, magic, and sorcery.

E
l Sidrón, an archaeological ◁ White Lady
site in northwestern Spain, The “White Lady” cave painting in Brandenberg
has yielded hundreds of Mountain, Namibia, is probably more than 2,000
fossilized bones and teeth from our years old. Originally believed to depict a female, it
closest cousins—the now-extinct may show the ritual dance of an African shaman
Neanderthals (Homo neanderthalensis). or medicine man, with white minerals on his limbs.
Microfossils of plants including ◁ Therapeutic herb
yarrow (Achillea millefolium) and For centuries yarrow has been
chamomile (Anthemis arvensis) have plants were chewed for medicinal a mainstay of herbal medicine
been found in these Neanderthals’ effects. For example, orchid bulbs across the Northern Hemisphere.
dental plaque—the hardened layer were chewed for digestive problems Its astringent qualities stem bleeding,
of debris on teeth. These herbs lack and willow bark—the natural source giving it local names such as woundwort
nutritional value and have a bitter, of aspirin (see pp.170–71)—was and staunch-nose (for nosebleeds).
unpleasant taste. However, they are chewed to ease fever and pain.
much used in traditional medicine. More than 7,000 years ago patients’
Yarrow is a tonic and an astringent, teeth were drilled, perhaps to relieve that they had a special role in their
and chamomile is a relaxant and has abscess pain, while bow-operated community as healers or therapists.
anti-inflammatory properties. The drills were used to bore holes in These healing roles are still seen
fossilized teeth date to 49,000 years the skull, a procedure known as today in native cultures across
ago and are possibly the earliest reset by smearing clay onto injured trepanning (see pp.16–17). the Americas, Africa, Asia, and
evidence for the use of medications. limbs; the clay then dried to form a Australasia. Spiritual, supernatural,
Each year, new evidence is being supportive cast. Herb poultices were Early healers and religious beliefs are all involved
discovered, showing that prehistoric secured onto wounds with animal- Prehistoric cave paintings and rock in their approach to illness and, as
medicine was more advanced than hide bandages. Plant saps soothed art of individuals wearing particular evil spirits and malicious demons
once thought. Broken bones were burns while other constituents of clothing and adornments suggest are often blamed for ill health,
treatments include offerings, spells,
sacrifices, and exorcism, along with
AUSTRIAN MUMMY c.33,000 bce
practical measures such as ointments
ÖTZI THE ICEMAN made from herbs, minerals, and
animal bones and blood.
A 5,300-year-old, naturally preserved, kit. Among his possessions were lumps revealed that he had painful bone and An individual who conjures up
mummified, frozen male found in of birch bracket fungus (Piptoporus joint conditions. Intriguingly, there are supernatural powers and mediates
the Ötztal Alps, Europe, in 1991 and betuinus), which has laxative as well more than 50 skin tattoos on these with the spirit world is known as a
named Ötzi, gives many clues about as antibiotic properties. A detailed painful areas. The tattoos, which shaman, medicine man or woman,
health and healing in prehistoric times. medical examination indicated the correspond to known soothsayer, or healer. He or she
Ötzi was 45 years old when he died, presence of whipworm parasite eggs in acupuncture points, conducts ceremonies with chants,
and was found with a knife, ax, bow, his large intestine. were probably meant clapping, dancing, drumming,
arrows, bark containers, and what may X-rays and scans as symbolic “therapy”
have been a simple prehistoric medical of his skeleton for pain relief.
25 PERCENT of modern
medicines that are
made from plants were first
used traditionally.

burning aromatic plants, and taking


potions to attain a trancelike state
in order to communicate with the
spirits. Modern analysis shows some
of the herbs used in these rituals
MUMMIFIED BODY OF ÖTZI THE ICEMAN contain psychoactive, mind-altering,
or hallucinogenic chemicals.

14
HEALERS AND HERBALISTS

The practice of Shamanism (see


pp.18–19) is seen especially in “We return thanks to all herbs, Historically, the Aztec peoples also
had a vast herbal medicine chest

which furnish medicines to


Africa and the Americas. Native and they too believed that ill
American tribal groups all have health was handed down from
distinct beliefs and medical practices, gods and spirits. One of their most
but they also have much in common,
believing health is a balance among
cure our diseases.” important medicines was pulque or
octli, an alcoholic drink fermented
mind, body, and spirit. Healing TRADITIONAL IROQUOIS NATIVE AMERICAN OFFERING from maguey, a succulent plant.
involves restoring the balance In South America, meanwhile, the
in these three areas with the herb ipecacuanha was used as an
shaman’s mediation, for example Healers of the Maya civilization, shrub iboga is used as both a emetic, and the leaves of the coca
by reconsidering personal thoughts in pre-Columbian Central America, stimulant in low doses and as a plant were chewed as a stimulant—
and emotions, receiving herbal were known as ah’men. They spent hallucinogen in larger quantities. the source of cocaine, a drug that
remedies, and praying and making much time discussing their patients’ The South African herb buchu is is globally much misused today.
offerings to the spirits. Shamans are personal life, habits, and worries—a valued for its essential oils and as a
often apprenticed to a senior practice that might today be termed traditional remedy for a number of
mentor, who imparts ritual practices psychotherapy or counseling. digestive and urinary problems. In ▽ Earliest herbal medicine
using amulets, tokens, and charms. North America, smoking tobacco in Research has shown that the Neanderthals in
In divination, natural objects such Medicinal herbs a medicine pipe is a central part of El Sidrón had a gene that enabled them to taste
as bones, feathers, and crystals are Herbs are still used in many cultures prayer and healing ceremonies, and bitter substances. This suggests that plants such
scattered to reveal a disease’s cause for medicinal purposes. In West and the shaman could choose from many as yarrow and chamomile were selected for
and treatment. Central Africa, the root bark of the other traditional herbal remedies. reasons other than taste, such as medication.
ANCIENT WISDOM TO 700

Early Surgery
The first uses of surgery are unknown, but Stone Age
scrapers and blades were certainly sharp enough
to slice through flesh, and were perhaps used to
remove growths. The earliest clear evidence of
invasive surgery is trepanning—chipping or
boring through the skull bones to the brain.

T
repanning, or trephining, ▷ Multiple openings
involved making openings in Dated to around 4,000 years
the braincase, usually on the ago, this multiple-trepanned
forehead or the top of the head. skull was unearthed at Jericho
It may have been performed by (in modern-day Israel).
early peoples for religious, ritual, The neat, circular holes of
or therapeutic purposes. In one different sizes indicate that
large-scale survey of Neolithic several drills were used.
skeletons—some dating back more
than 7,000 years—about one in
10 skulls featured full openings Bone growth
or signs of attempts to make them. suggests healing
In these earliest examples, the
holes had jagged, untidy edges
from cutting with stone blades and records of surgeon Hua Tuo
scrapers, or perhaps chisel-shaped show how he proposed
implements hit with a hammer- to cure the headaches
stone. Hole shapes provide evidence of teenage emperor
that teeth from big cats and other Shao by “opening
predators were also used. In some the skull”; the offer
cases, a circle of bone was chipped was declined.
away and the freed part lifted out, There is evidence that
perhaps to be kept as a memento. by the 17th century,
trepanning was being
A global phenomenon carried out on almost
Many surgeons in ancient Egypt, every continent,
Greece, Rome, West Asia, and China including in remote
were familiar with trepanning locations such as the
and wrote treatises on the subject. Pacific islands of Polynesia
Evidence of its practice in Kashmir, and Melanesia. It was
India, was found in a 4,000-year- practiced widely in the
old skull with multiple trepanned pre-Columbian Americas, from
holes. In China, the 2,000-year-old Alaska to the southern tip of
South America. The Incas used a
ceremonial copper or flint knife,
known as a tumi, to make four
straight incisions in a hash (#)
shape to free a square of bone.
The Aztecs preferred a blade of
the glassy rock obsidian.

△ Stone Age trepanning drills Accessing the brain


While the bottom two of these replica Neolithic Trepanning usually began with
drills are tipped with flint, the top example cutting, loosening, and folding back
features a shark’s tooth. The shafts were the skin and underlying tissue to
probably spun between the palms. reveal the skull; the skin and tissues

16
E A R LY S U R G E R Y

could be put back in place


afterward. An opening was then
made in the skull to reveal the
brain’s membranes, and in some
cases the cortex, or gray surface
layer of the brain. Some accounts
describe patients being heavily
intoxicated with alcohol, or given

52
The number of
times French
surgeon Jean-
Jacques Bouestard
trepanned one patient over a
period of two months in the
mid-18th century.

herbal or fungal sedatives and


natural analgesics during surgery,
but many were unanesthetized.
Despite the high risk of infection,
signs of bone healing after the
operation indicate that many
patients survived the procedure.

Tools of the trade


Mechanical trepans with drill-type
rotation were being used in Europe
by the medieval period. The string “When an indentation by a △ Painful procedure
In the 17th-century painting A Surgical
of a bow was wrapped several times
around a metal- or stone-pointed
weapon takes place in a bone… Operation on a Man’s Head, Flemish artist David
Teniers the Younger depicts a barber-surgeon,
stick, allowing the stick to be spun to
and fro by the bow’s sawing motion.
attended with fracture and with female assistant, performing trepanning
with a slim knife.
In the late 1570s metal-geared contusion… it requires trepanning.”
woodworking drills were adapted to
HIPPOCRATES, FROM ON THE INJURIES OF THE HEAD, 4TH CENTURY BCE
turn a variety of hard bits and burrs who had died—perhaps a powerful
to give a round, neat-edged hole. chief—by allowing a new, reviving
However, this involved holding a saw-edged hole-cutter that freed a had no apparent external cause, life force to enter the head.
the trepan in one hand and turning well-trimmed disk of bone. Another such as severe headaches and Trepanning was also used in
it with the other—and it was hard method involved boring a circle of migraines, epileptic seizures, medieval European cultures as a
to keep it steady. To stabilize the small, closely spaced holes, then encephalitis (inflammation of the cure for mental conditions, such as
spinning mechanism, special frames chiseling away the bone between brain tissue), and brain tumors paranoia, depression, and bipolar
that could be attached to the head them to free the middle section. and hemorrhage. Trepanning disorder—believed to be caused
were devised. The 1600s saw more was also performed to treat deep by demonic possession. A hole in
developments, such as hand-cranked A radical solution wounds, and to heal skull bones the skull was thought to provide a
or clockwork-spring adaptations, This painful and risky procedure fractured, depressed, or splintered much-needed exit for the demon
small circular saws that could be may have been performed to in accidents or on the battlefield. during exorcism. The removed
turned around a central axle, and address medical conditions that The 16th-century French wartime bone fragment could then act as
barber-surgeon Ambroise Paré an amulet or charm, worn by its
(see pp.78–79) described several owner to keep the demon at bay.
trepanning techniques, and Trepanning began to fade from
designed his own equipment. Western medicine in the 18th
In early South American cultures, century. The growth of specialized
trepanning may have been used in treatments for conditions such as
an attempt to revitalize someone epilepsy and migraine, especially
the development of new medicinal
drugs, led to its decline as a surgical
◁ Trepanning instruments treatment. However, the procedure
Three different types of trepanning instruments has its equivalent in modern surgery,
are being used in this 17th-century illustration, where precision instruments and
including a spinning mechanism stabilized on power drills are used to access brain
the patient’s head by a frame with four legs. tissue for a variety of conditions.

17
1 TIBETAN TOOTH
NECKLACE

2 AFRICAN 3 CONGOLESE
HEALER’S HEALING DOLL
NECKLACE

Teeth set in metal

4 INUIT SÉANCE CARVING 5 TANZANIAN DIVINING BOWL 6 TIBETAN RHINO 7 ZAMBIAN


HORN REPOSITORY DIVINING BONES

Shamanism Heads of
“spirits
of affliction”

The tradition of the shaman, who reaches into the unseen realm
of spirits and souls to help and heal, is known in almost every
part of the world (see pp.14–15). Shamans use a variety of objects,
such as amulets and masks, to engage and direct their powers.

1 Tibetan tooth necklace Comprising many small shamans wore a mask with a broken nose,
teeth, this necklace is said to protect against evil spirits. representing legendary healer Hado’ih.
2 African healer’s necklace The charms on this 10 Native American fan Plains Indians
necklace include teeth, shells, claws, seeds, and a bird skull. regarded the eagle as the most sacred bird.
3 Congolese healing doll A Nte’va figurine made of Its healing powers could be transferred by
wood, nuts, leather, bone, and cloth, this doll is used cooling the patient with a fan made of the
to ward off illness. 4 Inuit séance carving This carving bird’s feathers. 11 Tibetan headdress The
depicts a shaman in a trance, with two fantasy helpers at fiery skull on top of the headdress was said to
hand. 5 Tanzanian divining bowl Items such as stones, frighten away evil. 12 Malaysian shaman
bones, and teeth were swirled in the bowl. The positions jacket This garment is made of pangolin skin.
where they stopped were thought to reveal the answer to Products derived from this scaly anteater are
a particular question. 6 Tibetan rhino horn repository much used in traditional medicine. 13 Native
Despite being proven false, legends about the medicinal American soul-catcher Amulets such as
properties of rhino horns persist. 7 Zambian divining these were believed to retrieve an ill person’s
bones A shaman would throw these carved, fish-shaped wandering soul. 14 Mongolian decorated
bones onto a mat or into a bowl and interpret their drum This was used to create insistent rhythms to summon
arrangement. 8 Sri Lankan exorcism mask This mask gods and spirits. 15 Tlingit oystercatcher rattle Tlingit
of fearsome deity Maha Kola was used to scare demons shamans from coastal northwest North America carved
from the body. 9 Native American mask Iroquois their rattles to resemble birds, in this case an oystercatcher. 8 SRI LANKAN EXORCISM MASK

18
SHAMANISM

9 NATIVE
AMERICAN MASK
Eagle wing
feathers

Real
human
hair

10 NATIVE
AMERICAN FAN

11 TIBETAN
HEADDRESS

Scaly skin
of pangolin

12 MALAYSIAN SHAMAN JACKET

Tube made of ivory

13 NATIVE AMERICAN SOUL-CATCHER

14 MONGOLIAN
DECORATED DRUM
15 TLINGIT
OYSTERCATCHER Soft leather
RATTLE
covers the
striking edge
ANCIENT WISDOM TO 700

Medicine in Ancient Egypt


For the ancient Egyptians, medicine and healing were inseparable from religious worship.
Their physicians wrote manuals on human ailments and shared some surgical knowledge,
but their treatments often revolved around magic, spells, and prayers to the gods.

T
he foremost figure in Egyptian be worshipped, and in ancient ▷ Mummy pathology
medicine was Imhotep. Leader Greece he became associated with Studies of mummies show
of a powerful cult of priest- Asclepios, the Greek god of healing that the average age of
physicians, he was active around (see pp.32–33). death in ancient Egypt
2630 bce, during the early period was 40. Major causes
of what is known as the Old Channels of the body included infectious
Kingdom. Imhotep’s origins are Influenced by Imhotep, other and parasitic diseases,
obscure, but he was probably an Egyptian priest-physicians worked bacterial infections,
ordinary citizen rather than of toward developing theories of and atherosclerosis
leading to heart failure.
royal descent. However, his fame disease. They drew comparisons
grew so rapidly that even during with the irrigation waterways dug
his lifetime he came to be regarded between the Nile and crop fields, Medical papyri The papyri are generally named
as a god, believed to be the son of and conceived a system of up to Much knowledge of ancient after the person who procured,
Sekhmet (goddess of healing) and 46 channels in the body, mostly Egyptian medicine comes from financed, or translated them, or
Ptah (creator of the universe). emanating from the heart. They preserved papyrus documents. the place where they were stored.
As a result of Imhotep’s rapid had only a vague knowledge of The most important of these None can be ascribed to a particular
deification, it is difficult to anatomy and may have are the Kahun papyrus—the physician, and many appear to
tell whether records of his viewed the arteries, veins, earliest (c.1800 bce), also known be rewrites or updates of earlier
life and achievements and intestines—and, as the gynecological papyrus—and versions. The longest of them is
are factual or mythical. possibly, tendons and the Edwin Smith, Ebers, Hearst, the Ebers papyrus (c.1550 bce),
He may have been nerves—as channels of Erman, London, Brugsch, and which lists hundreds of magical
a practicing healer, the body. They believed Chester Beatty papyri. chants and spells against bad
dispensing herbs and that “flow” through the
potions to patients, but it channels was important
is more likely that he was
in charge of a team of
for good health, and that
the body’s channels could
“ Bandage him with alum
physicians and took credit
for their successes. His
become blocked by evil
spirits, which would cause
and treat him afterward
other roles included
chancellor to the
sickness. Their remedy was
to unblock these conduits [with] honey every day
until he gets well.”
pharaoh, pyramid by using various purges,
architect, and high laxatives, and emetics,
priest to the sun god and offering prayers and
Ra. Even as Egypt’s gifts to relevant gods to TREATMENT FOR A DISLOCATED RIB, FROM THE EDWIN
civilization faded remove the root cause. SMITH PAPYRUS, c.1600 BCE
some 2,300 years The Channel Theory
ago, Imhotep was an important
continued to turning point
in medicine.
▷ Edwin Smith
Although it had
papyrus
▷ Lion-headed
a metaphysical
The world’s oldest
goddess basis, it was among surviving surgical
Sekhmet (“powerful the first attempts text, the Edwin Smith
one”) was the ancient to link illness with papyrus was written in
Egyptian goddess of the body’s processes, Egyptian hieratic script
medicine and healing. and it resulted in around the 17th century
Also the warrior goddess the development bce. It is likely that the
and a solar deity, she was of treatments that material was adapted
usually depicted with the focused on the body from a series of earlier
head of a lioness and a rather than simply documents going back
sun disk and cobra crown. pacifying the spirits. more than 4,000 years.

20
MEDICINE IN ANCIENT EGYPT

spirits, as well as mineral and trauma, bone-setting, and minor and treatment involved offerings and procedures that involved cutting
herbal remedies. It describes a surgery, which suggests that it chants. Unusually for its time, the open the body were unheard of,
range of ailments too, including may have been used by physicians Edwin Smith papyrus focuses on except after death for purposes
parasitic diseases, bowel disease, tending to soldiers wounded in practical advice not magic. of mummification (see pp.22–23).
ulcers, urinary difficulties, female battle. Although examining a One exception was trepanning
disorders, skin rashes, and eye patient to make a diagnosis is an Surgical procedures (drilling or scraping a hole in
and ear problems. essential part of medical practice Evidence suggests that surgical the skull), which was probably
today, this method was new in operations in ancient Egypt were performed to treat cranial trauma,
A more methodical approach ancient Egypt. More often, bad performed on the outside of the migraine, epilepsy, and mental
Dating back to around 1600 bce, spirits were blamed for the ailment, body only, and that truly invasive disorders, and to expel evil spirits.
the Edwin Smith papyrus is much
more systematic and explanatory—
closer in approach to a modern
medical text. It covers a total of
48 typical “case histories.” The
cases generally start at the head
and work down the body, and
each progresses in a logical
manner, with a title and notes on
examination, diagnosis, prognosis
(prediction), and treatment.

“[The heart]
speaks at the tips
of the vessels in
all body parts.”
“ON THE HEART AND VESSELS,” FROM THE EBERS
PAPYRUS, 1550 bce

For example: “Instructions for a


split in his cheek. If you examine
a man having a split cheek and
you find that there is a swelling,
raised and red, on the outside of
his split. You shall say concerning
him: One having a split in his
cheek. An ailment which I will
treat. You should bandage it with
fresh meat on the first day. His
treatment is sitting until his
swelling is reduced. Afterward
you should treat it (with) grease,
honey, and a pad every day
until he is well.” Raw meat was
believed to stop bleeding, and
honey to counter infection.
The Edwin Smith papyrus was
probably a teaching document.
It covers mainly wounds, general

▷ Ancient surgical instruments


Dating back to c.100 bce, this relief from a
temple in Kom Ombo, Egypt, shows a range
of medical and surgical instruments including
forceps, scalpels, and saws. The temple was
used as a sanitorium in ancient times.

21
ANCIENT WISDOM to 700

Secrets of Mummies
The study of Egyptian mummies today uses some of the
most modern technology, such as medical imaging, when
examining one of the most ancient methods of body
preservation. Scans reveal details of health issues that
afflicted even the most powerful people in ancient Egypt,
from broken bones to gut worms and kidney tuberculosis.

The oldest Egyptian mummies date back about 5,000 years.


They were preserved using a mix of sodium salts, substances
containing elements such as arsenic and mercury—to
dehydrate the body and prevent decay—and aromatic oils
and resin. They were then wrapped in linen strips. These
mummified remains preserve anatomical details in both their
hard and soft tissues.
Current technologies such as X-rays and CT scans offer a
way of studying some of the medical problems that afflicted the
ancient Egyptians without disturbing their remains. Parasites
such as tapeworms, roundworms, and the worms that cause
elephantiasis—a disease that involves extreme enlargement of
the legs or scrotum—have been detected in mummies. Dental
decay, sinus infections, malaria, and tuberculosis also appear to
have been prevalent. Dozens of mummies show atherosclerosis—
the narrowing and hardening of the arteries due to the buildup
of fatty deposits. Dispelling the idea that this is a modern disease
resulting from a rich diet, in ancient Egypt it may have been
caused by inherited factors in noble families, accompanied by
long-term infection and parasites.

“ Absence of malignancies in
mummies… indicates cancer-
causing factors are limited
to… modern industrialization.”
PROFESSOR MICHAEL ZIMMERMAN, MANCHESTER UNIVERSITY, 2012

▷ CT scan of an Egyptian mummy


The 2,800-year-old coffin and mummified body of Egyptian
priest Nesperennub were scanned at University College Hospital,
London, in 2007. The 1,500 scans of the mummy reveal details
of his age, lifestyle, and health, and how he was mummified.

22
ANCIENT WISDOM TO 700

Medicine in Ancient
Mesopotamia
Although healing practices in ancient Mesopotamia (roughly centered on modern-day Iraq)
involved the use of magic, incantations, and divination, physicians had an extensive
knowledge of diagnosis, a wide repertoire of drug treatments, and carried out basic
surgery. They were also bound by a well-established, formal code of conduct.

T
he first medical texts from The Mesopotamians believed that made incantations to purify the △ Symbol of Gula
Mesopotamia survive in diseases were caused by a particular patient; the barû, or diviner, who The goddess Gula, or “the lady of health,” was
the form of clay tablets that god or demon, so a person with made predictions about the course the most important of the gods who had an
date back to c.2400 BCE. These venereal disease, for example, might of the illness, mainly through influence on medical affairs. Her symbol was
give recipes for medicines, but be referred to as struck by “the hand heptoscopy (reading the livers of the dog, and canine figurines have been found
the diseases for which these were of Lilith,” a female demon. The sheep); and the asû, or physician, at her cult temples in several Mesopotamian
intended as treatments are unclear. primary job of a doctor was to chase who made more conventional cities such as Isin, Nippur, Umma, and Babylon.
A much larger selection of diagnostic out the disease-causing demon diagnoses and prescribed remedies.
tablets from the library of the from the patient; the treatment
Assyrian King Ashurbanipal—who of the symptoms was considered a Medical preparations Doctors in Mesopotamia could
ruled in the mid-7th century BCE— secondary task. There were three Mesopotamian physicians used also perform surgery; a set of
gives a clearer impression of types of doctor: the masmassû, or around 250 medicinal plants, 120 bronze needles meant for cataract
Mesopotamian medical practice. exorcist, who conducted rituals and minerals, and about 200 other operations dating from around
substances. Some of the ingredients, 2000 BCE has been found, and
such as mandragora, henbane, an account survives of a surgeon
linseed, myrrh, and belladonna, cutting open the chest of a patient
were used by later physicians, while to drain pus from the lungs.
other more exotic ones, such as

10
crushed gecko and raven’s blood, SHEKELS The fee paid to
soon fell out of use. Remedies were a doctor in Babylonia for
prescribed for specific diseases: for performing successful surgery (with
instance, fish oil and an extract of a scalpel) on an upper class patient—
cedar were thought to treat epilepsy. equivalent to more than a year’s
Doctors were skilled in the pay for the average tradesman.
treatment of wounds, applying
bandaged poultices of sesame Knowledge of anatomy, however,
oil or honey and alcohol to was limited, since human dissections
prevent infection. They had a were not carried out in the region.
wide knowledge of the external
symptoms of diseases, and were Strict laws
able to give accurate descriptions The medical profession was strictly
of afflictions, such as epilepsy regulated by law, and the Law Code
and tuberculosis. They were also of Hammurabi, dating from around
aware that some diseases spread 1750 BCE, contains several clauses
by contagion, and they practiced relating to doctors. They were paid
a form of quarantine to prevent a set fee: for example, a doctor
the spread of fevers. was paid five shekels of silver for
mending a broken bone (although
this was reduced to three shekels if
◁ Stele of Hammurabi the patient was a commoner, and
Hammurabi, the ruler of Babylon in the 18th only two if the patient was a slave).
century BCE,is seen here receiving his law code Meanwhile, penalties for medical
from the sun god Shamash. The text contains more malpractice were severe: if a doctor
than 280 clauses, of which about a dozen deal caused a patient’s death, the doctor’s
with the regulation of the medical profession. hand would be cut off.
M E D I C I N E I N A N C I E N T M E S O P O TA M I A

▽ Nineveh tablet
This clay tablet from the library of Ashurbanipal at the
Assyrian capital of Nineveh contains diagnostic texts, the
symptoms of disease and their progress—and omens
the physician might note on his way to treat the patient.

Rules divide off


sections of text

Wedge shaped
cuneiform script

Text reads from


left to right,
and from top
to bottom

25
ANCIENT WISDOM TO 700

FIRE

Early Chinese
Medicine
WOOD EARTH

The prime source of knowledge about early Chinese medicine is the


2,000-year-old Huangdi Neijing (Yellow Emperor’s Classic of Internal Medicine).
Although it has been revised through the ages, it still remains central to WATER METAL
traditional procedures and practices today.

T
he Huangdi Neijing, an ▽ Qigong massage the universe. Yin is described as △ Yin-yang and the five phases
ancient Chinese medical text, One of the oldest and most adaptable dark, watery, cool, passive, and According to traditional Chinese medicine,
takes the format of question therapeutics, Qigong focuses feminine, while yang is bright, dry, well-being incorporates the concepts of
and answer discussions between on relaxation, meditation, hot, active, and masculine—and yin-yang, zang-fu, and the five elements, or
the semi-mythical Yellow Emperor, body postures, measured each cannot exist without the other. “phases.” The latter term reflects the belief
Huang-di, and his advisors. Huang- movements, and Zang-fu is a system of assigning that these entities are not fixed but rather, like
di asks a question, which in turn deep breathing body parts as either yin or yang. energy states, undergo continuous change.
is answered by his ministers, techniques. The lungs, heart, liver, spleen,
and through this process they and kidneys are zang organs
cover an encyclopedic range of (and are assigned as yin); the Surgery is not prominent in the
contemporary Chinese medical stomach, intestines, gallbladder, history of Chinese medicine, and
knowledge and practice. The work and urinary bladder are fu one of the few surgeons to gain
describes key traditional Chinese organs (and assigned as yang). fame was Hua Tuo, in the late
concepts such as yin-yang, zang-fu, Another concept is the five Eastern Han Dynasty (25–220 CE),
the five phases, and the flow of phases of energy, wu-xing: who also carried out acupuncture
qi or “life energy” along channels earth, water, fire, wood, and (see pp.28–29) and other forms
known as meridians (see pp.28–29). metal. The Huangdi Neijing of healing. He is reputed to have
It includes diagnostic procedures records: “The five elemental invented an anesthetic, known
such as feeling the pulse, observing energies… encompass all the as mafeisan, probably based on a
the tongue, and examining human myriad phenomena of nature. mixture of wine, cannabis, opium,
excrement, as well as a range of It is a pattern that applies equally and several relatively toxic herbs,
treatments, including herbal and The concept of yin-yang has to humans.” The five phases theory which he used for open surgery,
mineral concoctions, massage, permeated Chinese philosophy, also incorporates the cycles in which especially on the bowels.
special diets, bathing, meditation, culture, and medicine for millennia. the five elements interrelate: sheng Later, in about the 6th century,
and forms of physical exercise It represents the inherent duality— (generating); ke (controlling); cheng Sun Simiao compiled extensive texts
and ritualized movements. opposite yet complementary—in (overactive); and wu (contradictory). listing thousands of remedies. He
It is believed that yin-yang, zang-fu, also practiced alchemy, and placed
the phases (elements), and cycles great emphasis on gynecology,
C H I N E S E P H YS I C I A N ( C.1 5 0 – 2 1 9 CE)
interact to affect the flow of qi pediatrics, and medical ethics. In
ZHANG ZHONGJING (energy). An imbalance of the qi Qianjin Yaofang (Prescriptions Worth
results in disease; treatments aim a Thousand Gold) he emphasized the
A leading physician of ancient to restore harmony and balance. significance of a careful approach,
China’s Han Dynasty, Zhang impeccable morality, and dignified
Zhongjing is thought to have lived Influential physicians attitude in a physician. His doctrine
in Changsha, Hunan Province. One of the best known early spread throughout China, and can
He advocated a healthy diet and Chinese physicians was Zhang be seen as the Chinese equivalent of
exercise, close examination of the Zhongjing (see panel, left). the Hippocratic oath (see pp.36–37).
patient, treatment appropriate to
the symptoms, one medication at a

“ If the authentic qi flows


time, and recording the results—all
unusual for the time. His major work
was Shanghan Han Za Bing Lun
(Treatise on Febrile, Cold, and
Miscellaneous Diseases).
easily… How could illness arise?”
FROM SUWEN, THE FIRST PART OF THE HUANGDI NEIJING, 2ND–1ST CENTURY BCE

26
Rebalancing qi
This 10th-century Song Dynasty painting shows a doctor
burning moxa (a powder made from the herb mugwort)
on a patient’s skin (a process known as moxibustion) to
stimulate the acupuncture points and meridian channels,
in order to rebalance the body’s flow of qi (energy).
ANCIENT WISDOM to 700

Acupuncture
Also known as needling, acupuncture is a traditional
Chinese medical technique that has been used for
perhaps four millennia. Along with moxibustion
(see pp.26–27)—burning an herb called mugwort on
the skin—it is one of the earliest known therapeutic
systems with a logical theoretical basis.

As a method of alleviating pain, easing suffering, healing, and


even curing a range of illnesses, acupuncture’s origins may
go back 4,000 years. The Huangdi Neijing (Yellow Emperor’s
Classic of Internal Medicine), a 2,100-year-old Chinese medical
compendium, describes the techniques and uses of acupuncture
in its second book, the Ling Shu (Divine Pivot). Widely used
across East Asia in various forms, acupuncture has been found
by modern Western studies to be effective in relieving certain
forms of pain and discomfort.
According to traditional Chinese beliefs, health relies on a
vital force, energy stream, or life flow moving through the body.
Known as qi, this force flows along routes or channels called
meridians. Problems such as pain and illness arise when
someone’s qi is disturbed. Acupuncture aims to correct the flow
and restore the qi balance by inserting very thin needles into the
skin and underlying tissues at specific sites called acupuncture
points. These points may be located in parts remote from the
problem area; for instance, some points for lower back pain can
be found on the hand. Great skill and experience are needed
when diagnosing and discerning relevant points, and when using
the needles. The acupuncture points may also be stimulated by
pressing (acupressure), or by using heat or strong light.

“ Needling and moxa…


cure the corpse that is numb.”
BIAN QUE, CHINESE PHYSICIAN, PROBABLY REFERRING TO A PERSON
UNCONSCIOUS AFTER SEIZURE, 310 BCE

◁ Acupuncture points
This reproduction from an illustrated version of Huangdi
NeiJing from 1000 CE shows the body’s meridians and
acupuncture points. The illustrated version itself derived
from China’s first great medical manual, of the same
name, dating back 2,100 years.

29
ANCIENT WISDOM TO 700

Ayurveda
A traditional system for health, well-being, healing, and medicine, Ayurveda (meaning “life knowledge”)
has been prevalent in India and southern Asia for more than 2,000 years. It originated around the same
time that the famed physician Hippocrates was developing the practice of medicine in ancient Greece.

T
wo major works form the basis centuries, masking their original means a compendium, collection, Three further works contribute
of Ayurveda—the Susruta content. The Susruta Samhita is or compilation. The Susruta Samhita to the main body of Ayurvedic
Samhita and the Charaka named after the celebrated Indian contains information about shalya knowledge: the Ashtanga Hridayam,
Samhita. However, both these physician Susruta, who probably chikitsa, or Ayurvedic surgery, the Ashtanga Sangraha, and the
ancient texts have been edited, lived in Varanasi, India, in the 6th including a wide range of complex Bower Manuscript. The Ashtanga
reworked, and altered over the century bce. The word samhita techniques for procedures such Hridayam and the Ashtanga
as tooth extraction, Sangraha date from around the
cyst drainage, cataract 5th century ce and were written
removal, repairing by the Indian physician and healer
hernias, setting broken Vagbhata. The Ashtanga Hridayam
bones, and cauterizing has eight sections, including
hemorrhoids. It describes chapters on general surgery,
more than a thousand internal medicine, gynecology,
conditions and hundreds pediatrics, mental and spiritual
of herbal remedies. problems, and sexual medicine.
The second work, the The Bower Manuscript (named
Charaka Samhita, is around after British officer Hamilton

43
2,300 years old and is
attributed to Charaka, OF THE 1,323
who may have been a VERSES in the
physician at an emperor’s Bower Manuscript
court. As with Susruta, deal with the origin
the historical details of and medical uses of garlic,
Charaka’s life are unclear. demonstrating its importance
The Charaka Samhita has in Ayurvedic medicine.
more than 110 chapters
divided into eight sections, Bower who acquired it in 1890)
and is written in verse dates from about the same time
to aid memorization. as the Ashtanga Hridayam and the
Like the teachings of Ashtanga Sangraha. It contains a
Hippocrates (see pp.36– group of wide-ranging medical
37), the treatise instructs texts, with content adapted and
physicians on how to updated from the earlier Susruta
examine a patient and Samhita and Charaka Samhita, along
make a diagnosis, and also with herbal recipes.
recommends treatments.
Most of the remedies Elements of Ayurveda
emphasize lifestyle, While various forms of Ayurveda
hygiene, exercise, and have developed over the centuries
diet, as well as herbal and in different regions, most systems
mineral-based medicines. are based on the concept of five
elements. These elements are jala or
ap (water), tejas or agni (fire), privthi
◁ Human body chakras or bhumi (earth), pavana or vayu
The seven chakras are spinning (air), and akasha (ether or space)—
centers of energy—part of the similar to the concept of the four
etheric realm—aligned along the elements and four humors
middle of the body. If they whirl developed in early European
out of balance, they can upset medicine (see pp.34–35). In each
other body systems, such as the person the proportion of these
doshas, and lead to illness. elements varies over time and

30
AY U R V E D A

IN PRACTICE ▷ Administering medication


The ears are a traditional pathway or route
HERBAL HEALING into the body for Ayurvedic medications,
which are administered as vapors, waxes,
Ayurvedic medicine stresses the oils, and massage.
importance of preventing illness
through good hygiene, exercise,
and healthy diet, and of healing The doshas flow through the body
with natural herbal and mineral along pathways and through pores
remedies. One of the main herbs known as srotas, rather like the
used is lahsun or lasuna—garlic meridian energy channels of
(Allium sativum)—which is viewed acupuncture (see pp.28–29).
as a general stimulant. Different Most Ayurvedic texts state that
parts of the plant can be utilized there are 16 srotas, which carry
for a range of ailments, including energy, nutrients, and waste, as
colds and coughs, digestive upsets, well as learning and wisdom.
and skin problems such as sores, Of these srotas, three are connected
spots, bites, and stings. Tulsi or to the outside world: the prana
thulasi—holy basil (Ocimum vaha, which carries the prana
sanctum)—is valued for its (breath); anna vaha, which
warming effect and transports solid and liquid or ability to digest food efficiently, the three doshas and other influences,
soothes conditions foods; and udaka vaha, which to process and assimilate learning, such as the seven chakras, or “energy
caused by an excess carries water. Another three life experiences, and memories, centers.” These chakras are likened
of the kapha (phlegm) srotas monitor and control the and ability to prepare and burn to spinning vortexes and are not
dosha, such as elimination of metabolic waste off waste products for removal part of the physical body but of the
colds, coughs, products: the purisha vaha for through the skin’s pores, and from etheric, psychic, or “subtle” realm.
and flu, as well solid waste; mutra vaha for the mind. Agni can be affected by While various forms of Ayurveda
as relieving urine; and sveda vaha for are common in the Indian
bloating and perspiration. The srota mano subcontinent, Ayurvedic
indigestion. vaha is associated with the mind ▷ God of Ayurveda practice has also spread
and carries thoughts, ideas, Lord Dhanvantari is the god of Ayurvedic worldwide, especially
feelings, and emotions. medicine, and physician to many other among people interested
Two more srotas deal with gods. It is believed that prayers and in alternative and
menstruation (artava vaha), and offerings to him help maintain health complementary
contributes to the three doshas lactation (stanya vaha). Seven srotas and ensure successful treatment. therapies.
(approximately corresponding are linked to the Ayurvedic notion
to the European humors). The three of dhatus—the seven tissues that
doshas are vata (wind), pitta (bile), make up the body. These dhatus
and kapha (phlegm). Good health are the blood (rakta), lymph (rasa),
and well-being occur when muscles (mamsa), bones (asthi),
the doshas are well bone marrow (majja,

2,000
balanced. Imbalance herbs and which includes the
brings unease and mineral-based brain and nerves),
sickness, often remedies are noted in the fat (medas), and
related to the Charaka Samhita. reproductive organs
dominant dosha. For (shukra). For
example, excessive vata can trigger example, the mamsa vaha srotas
indigestion, flatulence, and cramps. transport nutrients and waste
If kapha is dominant, it may result for the mamsa (muscle) dhatu.
in problems linked to mucus and Another Ayurvedic concept is
phlegm, such as lung ailments, that of agni, or “digestive fire.” This
coughing, and breathing difficulties. refers to the body’s metabolism

“ It is more important to prevent


the occurrence of disease than
to seek a cure.”
CHARAKA, INDIAN SCHOLAR, FROM CHARAKA SAMHITA, 1ST CENTURY ce

31
ANCIENT WISDOM TO 700

E
arly Greek medicine was and medicine was Asclepios, and physician who was deified and
influenced by and drew temples dedicated to him were worshipped as the Egyptian god
upon much from the ancient called asclepeions. Here, the sick of medicine.
Egyptians (see pp.20–21) and their offered prayers and gifts to him.
belief in the world of spirits and His sign was the Rod of Asclepios— Shift from mythology
the supernatural. Diseases were a staff with a snake coiled around As Greek medicine developed,
regarded as punishments it—and this is still symbolic of its emphasis changed. Gradually,
or even “gifts” from the gods, medicine and the healing arts disease was seen more as a
perhaps angered by sins and today. Although the origins of natural phenomenon or product
misdemeanors. Cures involved this sign are unclear, some of the earthly body, rather
priests, prayers, offerings, and historians trace the rod, serpent, than a visitation from the gods,
rituals to rid demons and lift and Asclepios himself back to and symptoms, diagnosis, and
curses. The Greek god of healing Imhotep of Egypt, an architect and treatment focused on the human,

Medicine in Ancient Greece


The most significant figure in ancient Greek medicine, and perhaps in all of medical history, ▽ God of medicine
In this stone-carved scene Asclepios treats
is Hippocrates (see pp.36–37). However, many other physicians and healers helped to a female patient. Women of a higher status
establish the Greek medical approach, procedures, and ethics that are still familiar today. had relatively good access to medicine.

32
MEDICINE IN ANCIENT GREECE

sometimes attributed to ◁ Common treatment


Hippocrates, but which was Greek physicians popularized blood-letting,
more likely compiled and built or bleeding, as a treatment for many ailments.
upon by his followers. This was based on the concept that imbalance
in the four humors caused illness. If the
Developing theories blood humor became too plentiful and
A century after dominating, it had to be removed.
Hippocrates, Greek
physician Herophilus
of Chalcedon worked approach of Hippocrates.
in Alexandria, Egypt. Asclepiades conceived a
He is often regarded as new theory of disease
the first true anatomist according to which
because he dissected and tiny atoms, or corpuscles,
△ Sanctuary of Asclepios studied human bodies. His moved around the body
Temples devoted to the Greek god of medicine writings were later taken through minute holes or
were places of refuge, rest, prayer, and healing. up in Rome by the physician pores. Disturbances in the
Asclepios was said to be born at Epidaurus, where Claudius Galen (see flow—caused, he thought, by
his most famous temple—now a UNESCO World pp.40–41) and others. pores too small, or atoms too
Heritage Site—was built in the 4th century BCE. Herophilus made the first numerous—led to ill health. His
accurate descriptions of the brain, mainstays of treatment were
nerves, eye, arteries and veins, and exercise, massage, bathing, and
rather than on the supernatural digestive organs. His suggestion diet, with few herbal potions.
and spiritual. This began a more that conscious rational thought extended by Galen and persisted Despite his confidence, the
scientific approach by which and intellect were based in the until William Harvey accurately theories of Asclepiades made little
the physician made observations brain, not in the heart, were described circulation in 1628 impact, and Roman physicians
of the patient, recorded evidence, controversial at the time. (see pp.82–83). built on the mainstream aspects
and assessed results. Herophilus worked with Greek As the Greek civilization faded of Greek medicine (see pp.38–39).
Philosophers and thinkers such physician Erasistratus of Ceos. and the Roman Empire expanded,
as Socrates, Plato, and Aristotle Erasistratus is often seen as the many Greek physicians moved
greatly contributed to the evolution first physiologist—he studied how to the new regime. One of the ▽ Herophilus and Erasistratus
of Greek medicine. Even before the body works, or functions, and best known was Asclepiades of These two eminent physicians were colleagues
Socrates, researched the Bithyni, in part because of his at Alexandria, Egypt, in the 3rd century BCE.

40–50
Empedocles YEARS The brain, heart, and criticism of some classical Greek Unusually for the time, relaxed regulations in
formulated the average lifespan blood vessels. medical theories, including the city allowed them to dissect human corpses.
notion of the four of humans in ancient Greece. Like Herophilus, humorism, and the rational, This led to the production of some of the
classical roots or he believed the observational, evidence-based earliest, realistic anatomical descriptions.
elements: air, fire, water, and heart was not the center of
earth. These were incorporated thoughts, feelings, and emotions,
into Greek medicine as the four but was a kind of pump with
humors—blood, yellow bile, black flaps, which could act as valves.
bile, and phlegm (see pp.34–35). Erasistratus suggested that air
It was suggested by Greek thinkers entered the body through the
that an imbalance in the humors lungs, and went to the heart where
caused illness. The concept of it was transformed and distributed
humorism was developed through as a mysterious “animal spirit,” or
the Classical Greek era (480–323 “pneuma,” by the arteries. Veins
bce) and was mentioned in the carried blood, from the heart to
Hippocratic Corpus—a body of the various organs. These early
knowledge and written works ideas on circulation were later

“ When health is absent,


wisdom cannot reveal itself,
wealth is useless, and
reason is powerless.”
HEROPHILUS, GREEK PHYSICIAN, 3RD CENTURY BCE

33
ANCIENT WISDOM TO 700

The Four Humors

IR
A
BLOOD
With its origins in ancient Greece, the concept of humorism is based on the balance

W
O

ET
H
SPRING
of four humors (body fluids) in the human body—blood, yellow bile, black bile, and ILD H OO
D
CH

W
phlegm. This leading medical system thrived in Europe for more than two millennia

CREPITUDE

AT
MA
SUMMER

WINTER

E
YELLOW

R
NHOOD
PHLEGM
before it began to lose prominence in the 18th century. FI
RE
BILE

DE
OLD AGE

T
AUTUMN
he theory of four humors In the writings of Hippocrates hot–cold and wet–dry, and four

LD
D
RY

CO
BLACK
with wide-reaching effects on (see pp.36–37) and his followers, major organs that were each linked BILE
the body and temperament the four stages of life were to a humor.

H
was considered to be a well- linked to the seasons, and four According to Galen, ideal

RT
EA
rounded, wide-ranging, and highly temperaments, or personality types, temperament and health were
integrated approach that offered the result of a balance of all four
△ The quartets
24
insights into well-being and OUNCES (0.7 liters) of blood humors. This equilibrium was
sickness. The concept fitted was let over four days when different for each individual, which This diagram shows the link between
harmoniously with other Charles II of England fell ill in 1685. is why people varied in their levels bodily humors and other quartet systems.
foursomes in Greek scientific He died shortly after. of health, fitness, personality, and For example, blood is associated with heat
philosophy, such as the four susceptibility to ailments. and wetness, spring, and childhood.
elements (air, fire, earth, and emerge from the humors. In
water); the four attributes of Roman times, Roman physician Personality and health
matter (hot, cold, moist, and dry); Claudius Galen (see pp.40–41) The humor of blood was characterized by chills, shivering,
and the four seasons (spring, formalized the system and added associated with the heart, and coughs, and sneezes, which served
summer, fall, and winter). two further variables, namely an excess produced the sanguine to expel phlegm, mucus, and pus.
temperament—social, optimistic, Imbalances could also affect
energetic, and easy- temperament: too much blood
going. Blood was also humor could lead to abandoning
linked with air, heat/ tasks, being forgetful and late, while
wetness, and the spring an excess of yellow bile might cause
season. Yellow bile over-assertiveness, disorganization,
was connected to the and depression. Surplus black
liver, and those with bile could bring on worry,
a choleric personality anxiety, and withdrawal. Signs of
were deemed to be excessive phlegm might be laziness,
strong-willed, decisive, carelessness, and fear of change.
independent, and quick- The causes of humoral imbalance
tempered. Yellow bile were numerous and ranged
was grouped with fire, from stale vapor in the air and
heat/dryness, and the contaminated food and water, to
summer season. Black offending the spirits, or a surfeit
bile was allied to the of emotions such as jealousy.
spleen, an excess
producing melancholic
tendencies—quiet,
private, cautious, and
logical individuals. The
humor was related to
the earth, dryness/cold,
and fall. Phlegm was
associated with the brain:
the phlegmatic person was
calm, accepting, and slow to anger.
Phlegm was grouped with water, △ Cupping vessel
cold/wetness, and winter. Dating back to 79 CE, this vessel from
△ Public blood-letting When one humor became too Pompeii, Italy, was used to restore humoral
An illustrated version of Al Maqamat, by Arab poet strong, it was the likely cause balance. The air inside was heated,and the
and scholar Ibn Ali al-Hariri, depicts a crowd watching of sickness. For example, an cup placed on the skin to produce a vacuum
the blood-letting of a patient in 13th-century Iraq. excess of phlegm caused illness to draw yellow bile to the surface.

34
THE FOUR HUMORS

Spread and decline


The principles of humorism,
developed in Greece and Rome,
made their way into Islamic
medicine (see pp.48–51), were
adopted by medieval practitioners,
and also featured in Ayurvedic
medicine in India (see pp.30–31).
Renaissance physicians in Europe
were drawn to Galen’s teachings
on humorism through new
translations of his Greek texts.
Extensive tracts were written
about the correct treatments to
administer when the equilibrium

“[Humors] are the


things that make
up the body’s
constitution
and cause its
pains and health.”
ATTRIBUTED TO POLYBUS, A FOLLOWER
OF HIPPOCRATES, FROM THE NATURE
OF MAN, 400 BCE

was disturbed. For example,


the practice of blood-letting was
thought to relieve an excess of
the blood, a factor in many diseases.
Cupping was believed to withdraw
yellow bile, while emetics or
purging potions removed yellow
or black bile. Eccentric diets and
herbs were often prescribed to
damp down or restore the balance
of a particular humor.
Throughout the 17th century,
humorism was still practised
widely in Europe; blood-letting,
in particular, often had extreme
consequences. From the late
18th century, it was swept away
in a wave of methodical scientific
research and a new understanding
of human physiology that
undermined its basic tenets.

▷ Four temperaments
This 1760s reproduction of the Guild Book of
the Barber Surgeons of York, a 15th-century
manuscript, shows the four temperaments—
melancholic, sanguine, phlegmatic, and choleric
—with clothes, facial expressions, and postures
that contribute to the depiction of each one.

35
ANCIENT WISDOM TO 700

GREEK PHYSICIAN Born 460 BCE Died 370 bce

Hippocrates
“Sickness is not sent by
the gods… find the cause,
we can find the cure.”
HIPPOCRATES, GREEK PHYSICIAN

O
ne of the greatest names himself. The Hippocratic Corpus,
in the history of healing, a collection of around 60 works,
Hippocrates elevated some of which are ascribed to
medicine into a respected Hippocrates, marks Greek medicine
profession with a scientific basis. as separate and distinctive from
He took Greek medicine and Egyptian (see pp.20–21) and
rid it of its supernatural Mesopotamian (see pp.24–25)
elements, insisting medicine.
on observation However, there is
and accurate no certainty that
recording of all the writings
case histories. By attributed to
comparing these Hippocrates
histories, he made were actually
the first systematic authored by him.
differentiation of
diseases. He also Code of ethics
set standards for Although medical
doctors that are schools were
still admired and flourishing in
respected today. Sicily, southern
Hippocrates was Italy (see pp.54–
born on the island 55), and at Cyrene
of Cos in Greece in North Africa,
in around 460 BCE. △ The Hippocratic Oath the school at Cos
His father was A professional code of conduct, the that Hippocrates
a doctor and Hippocratic Oath is usually taken by all founded became
Hippocrates doctors and requires them to abide by the most famous,
learned medicine ethical principles. Seen here is a medieval and he came to
from him. He is Greek copy of the oath. be regarded as its
known to have greatest teacher.
traveled widely, possibly going as When entering this esteemed
far as Libya and Egypt, but very school, incoming students had to
little is known about the man take an oath, now known as the
Hippocratic Oath, in front of their
elders and peers. The oath, with its
◁ Modernizing medicine code of ethics, set a high standard
This marble bust of Hippocrates celebrates him of expertise and etiquette, and
as the father of modern medicine. He turned established medicine as a profession
away from divine notions of disease and healing that ordinary people could trust.
and used observations of the patient as the It separated doctors from other
basis of medical knowledge. “healers” and defined their practice.
H I P P O C R AT E S

◁ Ancient scene on marble


TIMELINE
This scene from the 4th or 5th century bce
shows a Greek physician attending to ■ 460 bce Born on the Greek island of
a patient. The doctor places great emphasis Cos into a wealthy family. Hippocrates’
on the patient, using his hands to discern schooling includes nine years of primary
breathing and lung function. and two years of secondary education,
during which he studies reading, writing,
poetry, and music.

surgeon and was interested in the ■ 430–427 bce Helps fight the plague in
study of orthopedics. Some of the Athens for three years. Recommends
principles found in the Hippocratic lighting fires to dry the atmosphere and
Treatises On Fractures and On Joints boiling water before consumption.
are still considered relevant today. ■ 431–404 bce Helps cure the injured in
the Peloponnesian War. He excels at
Ahead of time surgery, including that of the skull,
Hippocrates believed that the and also at setting fractures and
body contained four basic humors mending dislocations.
(fluids)—black bile, phlegm, yellow
bile, and blood (see pp.34–35).
This system offered a rationale
for understanding the human
condition and for explaining illness.
He believed that moods and
disease result from an imbalance
in the humors. He was probably
the first physician to believe that
diseases are natural occurrences
and are not caused by supernatural
forces or gods.
Hippocrates placed great emphasis
on strengthening and building up
the body’s inherent resistance to AN 11TH-CENTURY EDITION OF HIPPOCRATIC
disease. He prescribed diet, TREATISES ON FRACTURES AND ON JOINTS
gymnastics, exercise, massage,
hydrotherapy, and swimming in ■ 420–370 bce Around 60 books including
the sea. He also developed an textbooks, lectures, and essays, are
understanding of the importance written during this period, and later
The oath included a promise to medicine, as shown in the Corpus, of hygiene and cleanliness, as collated in the Library of Alexandria.
protect confidentiality, and not to stressed three things: close well as that of rest and quiet. Written by Hippocrates and other
“poison” patients. Hippocrates observation of symptoms, being When Hippocrates died, he was authors, they are united in their focus
insisted that doctors be of “good open to ideas, and a willingness to held in such high regard that it on Hippocratic medicine. Hippocrates
appearance” and well fed because explain the causes of disease. The was believed that honey made from also writes Hippocratic Treatises On
patients could not trust a physician Corpus is full of case studies, which the bees living on his gravestone Fractures and On Joints during this
who did not look capable of taking provide descriptions, for example of had special healing properties. time. Hippocrates promotes the concept
care of himself. According to the tuberculosis, mumps, and malaria. Hippocrates put the doctor fully of four humors and believes that an
imbalance in the humors causes disease.
oath, the doctor must be calm and In it Hippocrates defined different at the service of the patient, and
serene, honest, and understanding. categories of illness, such as his ground-breaking work has ■ 400 bce Sets up a school of medicine in
A Hippocratic doctor visited his epidemic, endemic, chronic, and been a constant and enduring Cos, Greece. In time he instructs his own
patient before noon, and enquired acute—terms that have survived source of inspiration for doctors sons, Thessalus and Draco, in the practice
about what sort of night the to this day. He was also a talented through the ages. of medicine. His medical school produces
many prominent scholars and pupils who
patient had experienced, before
add their experience and writings to the
performing a thorough examination
“I will use my power to help the
works of Hippocrates.
of the body, and looking at the
sweat and urine of the sufferer. ■ 370 bce Dies in Larissa, Greece, at the

sick to the best of my ability… I


age of about 90.
Father of modern medicine ■ 2nd century ce Greek physician Soranus
of Ephesus writes the first biography of
will abstain from harming
Knowledge of anatomy and
physiology was limited in Hippocrates. It becomes the main source
Hippocrates’ time because the for information about Hippocrates’
Greek respect for the dead meant
that dissection was not allowed.
or wronging any man by it.” personal life.

However, for the living Hippocratic FROM THE HIPPOCRATIC OATH

37
ANCIENT WISDOM TO 700

Medicine in Ancient Rome


The civilization of ancient Rome is famed for its contributions to medicine. Founded
largely on Hippocratic and Greek traditions, Roman physicians, surgeons, and pharmacists
made many advances, and extensively recorded their medical theories and practices.

T
he civilization of ancient
Rome rose to power around
1,500 years ago. The city
gradually grew in influence to rule
Italy and beyond, first as a republic
and then as an empire, until its
collapse in 410 CE. Roman writings,
art, statues, surgical instruments,
medicine jars, false teeth, and a
host of other objects survive that
provide a detailed picture of health,
sickness, and healing in the
“Eternal City” and the vast lands
under its control.
The Romans were among the first
to introduce public health measures,
such as clean drinking water and
organized sanitation, in their
towns and cities. They also began
spreading awareness about the

5
MILLION The number of
people in the Roman
Empire who died in
165–85 CE in the Antonine
Plague (probably smallpox).

importance of general hygiene,


including bathing. Exercise and diet,
too, were a significant part of their
lives. Often, at the first sign of
illness, a physician would advise a
change of foods and eating habits;
for example, cutting down on rich
meats and exotic spices in favor
of more wholesome local bread
and fruit.

Divine intervention
Roman philosophy and medical
theories incorporated the belief
that the gods wished sickness upon
those who lapsed in their worship
or morality. However, such divine

◁ Mythical medicine
A hero of Roman and Greek mythology, Aeneas is
treated by Lapyx, the god of healing. Romans had
many medicine-related gods who required prayers
and offerings before physicians could effect a cure.

38
MEDICINE IN ANCIENT ROME

“ People can live without G R E E K B O TA N I S T A N D P H A R M A C O L O G I S T 4 0 – 9 0

PEDANIUS DIOSCORIDES
CE

doctors, though not, of A Greek-born Roman physician,

course, without medicine.” herbalist, and apothecary, Pedanius


Dioscorides is best known for his
PLINY, NATURAL HISTORY, C.10 CE five-volume compendium, De Materia
Medica (On Medical Matters), see
left. Dioscorides was attached to
◁ Medicinal plants the Roman army, and traveled as a
This German version of Dioscorides’ De Materia surgeon with the armies of Emperor
Medica, published in 1543—almost 1,500 years Nero. His travels provided him with
after it was written—illustrates healing herbs an opportunity to study the medicinal
such as yarrow, foxglove, and primrose, along properties of a large number of herbs
with notes on their preparation and application. and minerals.
De Materia Medica is a five-volume
work that details the features and
abortion. His other works included uses of more than 600 substances,
On Acute and Chronic Diseases, On including plants, animals, oils, supplemented and revised. Its title,
Signs of Fractures, and On Bandages. wines, and minerals. In the work, like the term pharmacopoeia, has
The Empiric School held that Dioscorides aimed to cover “the since passed into general medical
experience was the key factor and preparation, properties, and testing terminology to mean a database
that remedies should be familiar, of medicines.” of collected information about a
tried, and tested. The Dogmatic A landmark work of ancient particular substance, whether
School highlighted the traditions Rome, De Materia Medica gained a time-honored natural herb
of Hippocrates and concepts such a great reputation over the following or the latest computer-designed
as the humors (see pp.34–35), centuries and was regularly chemotherapeutic compound.
which were to be followed as
closely as possible. This school
of thought was developed by the could treat many kinds of injuries and patients received alcohol,
intervention was seen as less foremost physician of ancient caused on the battlefield and opium, and herbs for pain relief,
significant than in ancient Egypt or Rome, Claudius Galen (see pp.40– in everyday life, and they had and wound dressings of hot oils,
Greece. Chief among the medical 41), who believed that illnesses extensive sets of equipment that herbal poultices, and vinegar.
deities was the adopted Greek god were caused by an imbalance in included numerous knives;
of healing, Asclepios. The Romans bodily fluids. Rebalancing the scalpels of various sizes and shapes; Early hospitals
added others, including Vejovis, humors to restore health included amputation saws with a range Late in the Empire’s history, its
god of healing; Febris, goddess changes in diet and exercise as well of tooth designs; rotary drills for organization spread to the medical
protecting against malaria and as a wide array of herbal, mineral, procedures such as trepanning and system and the first dedicated
other fevers; Endovelicus for public and other treatments. Bleeding, tumor excision; hooks to extract hospitals were set up. These were
health; Carna, for the heart and cupping, and cauterization were foreign bodies such as embedded largely reserved for eminent citizens
inner organs; and Bona Dea, common for many minor ailments. weapons; retractors to access inner like government officials and
goddess of women and fertility. For a civilization founded on parts; catheter tubes to insert into merchants, soldiers of high and
Offerings and prayers to them were military prowess, surgery became the urethra and bladder to remove medium rank, and sometimes,
a routine part of many treatments. a leading medical discipline—both stones and blockages; and various favored slaves. Medical units with
on the battlefield and during throat and vaginal speculums. There physicians and caregiver slaves
Schools of thought gladiatorial displays. Surgeons were many prostheses for the eyes,
In ancient Rome, there were
various approaches to medicine,
nose, teeth, arms, hands, legs,
and feet, made of materials such 3 MILLION Number of soldiers
in Emperor Augustus’ army.
known as schools. The Methodic
School emphasized identification
as wood, iron, silver, and gold.
Surgery was swift but careful 2 THOUSAND Number of physicians
to tend to the emperor’s army.
of the disease first, followed by
treatment—it paid less attention were attached to the army. They
Gold tooth holder
to the individual patient. One of ◁ Roman dentistry set up mobile hospitals and medical
the most eminent followers Although dentistry rooms in forts. In the provinces a
of the Methodic School was had not emerged as physician’s role (apart from those
Soranus of Ephesus (c.98– a profession at the who attended important people)
140 CE), who moved from time, some Roman was of relatively low status.
Greece to settle in Rome. He surgeons specialized in treatments for the Although some formal training and
authored a number of books, mouth and teeth. A copy of a Roman original, licensing was introduced, there
including Gynaecology, which these bridges were fitted over existing teeth to were still no official qualifications
covered midwifery, baby care, and hold additional ones (real or ivory). and almost anyone could practice.

39
ANCIENT WISDOM TO 700

ROMAN PHYSICIAN Born c.129 CE Died c.216 CE

Galen
“The best physician is
also a philosopher.”
CLAUDIUS GALEN, TITLE OF A TREATISE, ALSO QUOTED IN PERI CHREIAS MORION,
DE USU PARTIUM (ON THE USEFULNESS OF THE PARTS OF THE BODY), 165–175 CE

A
physician who was elevated father dreamed that Asclepios—the
to godlike status, Claudius Greek god of healing—asked his
Galen was the foremost son to take up medicine. After his
medical authority of the Roman father’s death, the 19-year-old
Empire. Building on the work of Galen moved to Smyrna (modern-
Hippocrates (see pp.36–37) and day Izmir, Turkey), where he was
other Greek physicians, he wrote instructed by the physician Pelops
a large number of works—more and the philosopher Albinus. He
than 400 volumes, containing then moved on to Corinth, Greece,
over 8 million words. His ideas and finally to Alexandria, Egypt,
and teachings on human where he acquired knowledge
anatomy, as well as the causes from the great library. The young
and symptoms of diseases, and Galen was interested in the
their treatments, became, in effect, medicine of Hippocrates and the
the laws of medicine for more than philosophy of Plato, and later
1,300 years. Much is known about analyzed their works in On the
Galen’s talents because he was a Doctrines of Hippocrates and Plato.
great self-publicist and regularly
promoted his own work. Illustrious career
Brought up in Pergamon (now In about 157 CE Galen returned
Bergama, Turkey), in a wealthy to Pergamon, Turkey, and took
family and well educated, Galen up his first medical post as a
was destined for a career in law physician-surgeon to the gladiators
or in the government, until his there, making notes on the
variability of wounds sustained
by them in the gladiatorial games.
◁ Prolific medical writer With his success at Pergamon,
More than half of Galen’s written works which saw death rates fall
were destroyed in a fire in 191 CE at dramatically, his reputation
Rome’s Temple of Peace. Yet, the and fame began to spread. The
number of surviving volumes of ambitious Galen then moved
his work still exceed those to Rome in 162 CE. Here, he
by almost any other was able to impress the Roman
medical author. establishment with his medical
abilities, speed of learning, and
confidence. After treating the
philosopher Eudemus in Rome,
Galen was introduced to the
government official Flavius
Boethus, who encouraged him
to begin to write and to give public
lectures and demonstrations.
However, he soon fell out with
GALEN

colleagues, whom he claimed and dissected an array of animals, of his medicine, he acknowledged TIMELINE
envied him, and decided to adopt including Barbary apes (a type of the achievements of Hippocrates.
■ c.129 Born into a wealthy family in
a low profile. He eventually Macaque monkey). His discoveries His extensive tracts on such
Pergamon—in modern-day Bergama,
returned to Pergamon. were numerous and accurate, and themes included On the Black
Turkey—a major center of the region
Galen went back to Rome in included finding the true identity Bile and On the Elements according
and Roman Empire.
169 CE after being summoned by and extent of many muscles and to Hippocrates.
Emperor Marcus Aurelius, and tendons, and he demonstrated the Galen’s writing style was diffuse, ■ 148 Galen’s father—Aelius Nicon—dies,
here began the most fruitful phase kidney’s role in making urine by leaving Galen financially well-off, and
wordy, rambling, and contained
able to travel around Europe and North
of his professional life. He began to clipping the ureter of live animals subjective comment. His medicine,
Africa to study medicine.
write prolifically and continued and showing that it filled with too, was interwoven with his very
to lecture and philosophize, urine. However, Galen’s supreme idiosyncratic beliefs. Over the ■ 157 Returns to Pergamon and takes
while also attending to a series confidence meant that he often centuries, while his philosophy up a post as physician to the gladiators
of five emperors as their personal there, successfully treating their injuries
and wounds. As the gladiatorial death
physician, even accompanying
them on their travels.
“In order to diagnose, one toll reduces,
his reputation
spreads to
Discoveries and contributions
Galen’s primary interest lay in must observe and reason.” Rome and
reaches the
anatomy, which he believed was MOTTO OF CLAUDIUS GALEN senior medical
the basis of all medicine, although fraternity
he was constrained by laws that who suggest
forbade the deliberate opening took educated guesses, or clues was discarded or superseded, Galen’s that he
of the human body. Nevertheless, derived from animals, as facts. medical teachings—complete with moves there.
building on his experience with For example, his study of the brain guesses and misconceptions— ■ c.162 Moves
gladiators, he experimented on and the functions of its parts led to became, to many, undeniable. to Rome as a
his assertion that the pineal gland It was not until the 16th century physician, but
helped support blood vessels, that challenges by Andreas Vesalius makes several
▽ Treating a gladiator a belief that continued to be (see pp.72–75), William Harvey enemies due
accepted through the Renaissance. (see pp.82–83), and others began A 1561 EDITION OF
This artwork from the 19th-century book, to his attitude GALEN’S WORK PRINTED
Vies des Savants Illustres, shows Galen treating Galen also developed the Greek to dismantle the Galenic tenets of toward other IN BASEL, SWITZERLAND

a gladiator in Pergamon. As a physician, he idea of humors, or body fluids, medicine, but even in the 1800s physicians and
studied human internal anatomy and regarded into an extensive fourfold scheme some Western medical doctors still their theories. He leaves the city
the physical body as a “vessel for the soul.” (see p.34–35). In this, as in much referred to his works. occasionally, and returns to Pergamon
for a time.
■ c.166 The Antonine Plague (probably
smallpox or measles) sweeps across
Europe. Galen writes extensively about
the effects and possible treatments for
this plague. A similar epidemic appears
in 198 CE.
■ 169 Recalled to Rome by Emperor
Marcus Aurelius to become his personal
physician, which he does until Aurelius
dies in 180 CE.
■ 170 Becomes physician to Emperor
Aurelius’ son and heir Commodus
until his death in 192 CE.
■ 191 A large number of his writings
are destroyed in a fire at the Temple
of Peace in Rome. Galen is devastated
by the loss of his works.
■ 193 Becomes physician to the new
Emperor Septimius Severus. Although
Galen starts fading from the spotlight,
his writings continue to be widely
circulated and remain immensely popular.
■ c.216 Dies in Rome, although some
authorities say Pergamon or Sicily and
put this date earlier, at around 200 CE.

41
ANCIENT WISDOM TO 700

Blade with a
central groove
Dilation blades
Leaf-
shaped 6 OBSTETRIC DILATOR
blade

5 MALE
1 SCALPEL 2 SCALPEL 3 SURGICAL KNIFE 4 SPATHA CATHETER

Roman Surgical
Tools
Roman surgeons performed a range of operations, including eye,
nose, and ear surgery, extraction of gallstones, and removal of tonsils.
Ancient surgical instruments have been found across the Roman Empire.

1 Scalpel The tool was used for surgical procedures, fractured skull. 9 Surgical forceps The sliding ring
such as mastectomy and hernia repair. 2 Scalpel The on this device fixed the tweezer jaws in place. 10 Ear
blade shape of this tool offered great flexibility, with uses specillum The small scooped end was used to remove
ranging from severing the umbilical cord to removing nasal hard wax from the ears. 11 Vaginal speculum This
polyps. 3 Surgical knife This general tool was used trivalve dilator was used for gynecological examinations
during surgery for making incisions and cutting through as well as the repair of uterine abscesses. 12 Osteotome
bone. 4 Spatha Also called a spathomele, the sharp- This was used to cut away at bone or remove hard
pointed tip of this tool was used for mixing drugs, and the membranes. 13 Thigh tourniquet This was used to stop
spatula-like end for applying pastes. 5 Male catheter bleeding during surgery or to stop the spread of venom. Screw mechanism
This tube made from bronze was used to extract urine 14 Shears Surgeons used these to cut through tissue, opens end blades wider
by inserting it into the urethra. 6 Obstetric dilator or to remove growths such as warts. 15 Hook The
Used as a vaginal speculum, this tool enabled internal sharp end of this hook could be used for holding open
gynecological examinations. 7 Bone lever This was incisions. 16 Clyster Large clysters were used to inject
an instrument for chiseling bones or moving them out medicines into the vagina or rectum. 17 Tile cautery
of the way while fixing fractures. 8 Bone forceps These A heated cautery was applied to a wound or blood
were used to remove fragments of bones, especially in a vessel to stop bleeding and prevent infection.

42
ROMAN SURGICAL TOOLS

Gripping blade

8 BONE
7 BONE LEVER FORCEPS

Slding ring

9 SURGICAL FORCEPS

10 EAR SPECILLUM
Screw-operating device

11 VAGINAL SPECULUM

Trivalve dilator

12 OSTEOTOME

Bronze blade

13 THIGH TOURNIQUET

14 SHEARS 15 HOOK 16 CLYSTER

17 TILE CAUTERY

43
REVIVAL AND
RENAISSANCE
700 –1800

Phrenology snuff box


R E V I VA L A N D R E N A I S S A N C E

REVIVAL AND RENAISSANCE


700 –1800
700 1100 1400
750 1000 1123 1242 1494–95 1537
Madhav Acharya compiles Al-Zahrawi produces the St. Bartholomew’s Ibn al-Nafis describes the First reports of syphilis During the Siege of Turin,
the 79-chapter Rug immense surgical and becomes Britain’s first pulmonary circulation appear in Europe, the Ambroise Paré tries an old
Vinischaya, also known medical classic Kitab al-Tasrif truly medical hospital. from the heart’s right side disease probably having recipe for a wound-healing
as Madhav Nidana. (The Method of Medicine). through the lungs to been brought from balm, and begins a new era
1144 the left side. the Americas. in battlefield medicine.
Robert of Chester’s De
Compositione Alchemiae 1247
800 (The Book of the Song Ci produces Xiyuanlu,
Varied works of Composition of Alchemy) a collected record of medical
Galen are translated is one of Europe’s first jurisprudence, an early classic
into Arabic. alchemical treatises. of forensic medicine.

1025 1150S 1316 1518 1543


Ibn Sina (Avicenna) Hildegard of Bingen produces Mondino de Luzzi writes In Britain, the College Andreas Vesalius revolutionizes
completes Al-Qanun Liber Simplicis Medicinae Anathomia Corporis Humani of Physicians receives anatomy with De Humani
fi al-Tibb (The Canon (Book of Simple Medicine, (Anatomy of the Human Body). its royal charter. Corporis Fabrica (On the Fabric
of Medicine). later called Physica). of the Human Body).

Altarpiece 1520S 1546


depicting arrival Smallpox, brought Girolamo Fracastoro suggests
of Hildegard at from Europe, begins to that epidemic diseases, such as
the Benedictine
Abbey take a toll on people in rabies, spread due to some kind
the Americas. of communicable “spores.”

1077 1529 1563


Constantine the Philippus Aureolus Garcia de Orta writes
African teaches Theophrastus Colóquios dos simples
at Salerno medical Bombastus von e drogas da India
school, the first Hohenheim, who (Conversations on the
such teaching achieved both fame Simples, Drugs and Materia
institution in and infamy in Medica of India), an early
Europe. various sciences work in the field of
and the occult, tropical medicine.
including alchemy,
adopts the name
“Paracelsus.”

Salerno medical school 1530 1590


The first text The compound microscope
devoted to is invented, revealing a
dentistry, Little whole new world of tiny
Medicinal Book life forms that will
for Diseases and impact hugely on
Infirmities of the medicine, but
820 Teeth, is published not for
A Benedictine hospital is 1200S 1347 in Germany. several
established in Salerno; Treatments for eye conditions, The Black Death reaches decades.
the medical school will Illustration from the such as bruising and infections, Europe, in one of the Early compound
develop from it. 13th-century Treatise on the Eye are regularly used. greatest of all pandemics. microscope

1363
Guy de Chauliac completes
Chirurgia Magna (Great
Surgery), which will be a
standard anatomical, medical,
and surgical work in Europe
855 for three centuries.
Zan Yin completes Jingxiao
Chanbao (Tested Prescriptions
in Obstetrics), the first
Chinese text dedicated to
gynecology and obstetrics.

46
700–1800

From about the 8th century, the expanding Islamic world became the Renaissance in arts, sciences, and medicine, which began in the
focus of progress in arts, architecture, sciences, and medicine. Al-Razi, 13th century. Pivotal developments included the anatomy of Vesalius,
Ibn Sina, and other great physicians of this “Golden Age” expanded Harvey’s description of circulation, the assimilation of the microscope
and developed ancient knowledge, established hospitals, and returned into medicine, the founding of new-style medical schools and
Hippocratic humanity to medical care. Europe underwent its own professional organizations, and Jenner’s pioneering work in vaccination.

1600 1700
1628 1665 1676 1701 1790
William Harvey publishes Robert Hooke publishes Thomas Sydenham In Europe Giacomo Pylarini Samuel Hahnemann
De Motu Cordis (On the Micrographia, a pioneering publishes Observationes describes and practises begins to devise
Motion of the Heart and work in microscopy Medicae (Observations of variolation, a form of therapies based on
Blood)—a short report but and one of the first Medicine), an extremely smallpox vaccination “like cures like,”
monumentally significant due science bestsellers. influential text in Europe carried out in Asia. which becomes
to its description of how the for the next two centuries. known as
circulatory system works. homeopathy.

Harvey carrying out Homeopathic


a postmortem medicine chest

1723
Pierre Fauchard establishes
modern dental practices
with Le Chirurgien Dentiste
(The Surgeon Dentist).

1747
James Lind discovers
how to prevent scurvy by
carrying out one of the first
organized clinical trials.

1748
Jacques Daviel pioneers a
new technique to remove
cataracts, greatly advancing
their treatment.

1774 1793
Prussian blue is one of Jean-Baptiste Pussin and his
the first stains (dyes) to wife Marguerite, along with
color microscopic samples, Philippe Pinel, begin
advancing the area improvements in the care and
of histology. treatment of the mentally ill.

1630S 1673 1694 1775 1796 1799


Cincona bark (the source of The Royal Society of Britain Zhang Lu’s Zhangshi Yitong Percivall Potts describes Edward Jenner inoculates Humphry Davy discovers
quinine) is brought from the begins its publication of reports (Chang’s General Medicine), how scrotal cancer is an 8-year-old boy against that nitrous oxide acts as
New World to Europe to by innovative microscopist a vast medical collection, much more common smallpox using cowpox an anesthetic and wonders
treat and prevent malaria. Antoni van Leeuwenhoek. describes inoculation in chimney sweeps—one material, establishing the if it might alleviate pain
against smallpox. of the first accounts principle of vaccination. during surgery.
Antoni van Leeuwenhoek implicating a carcinogen,
and a landmark for 1796
occupational medicine. Franz Joseph Gall writes his
first main text on phrenology.
It will flourish for a few Collection of model heads to
decades, then disappear. explain principles of phrenology

1661 1785
Marcello Malpighi, founder William Withering reports
of microanatomy, observes on his investigations into
capillaries—the “missing digitalis, the active
link” between arteries substance in foxgloves
and veins. used to treat dropsy.

47
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0

Medical practice in action


Dated to around 1260, this “Europeanized” illustration of
al-Razi treating a patient is from the Recueil Des Traités
de Médecine (Collection of Medical Treatises), which was
based on a Latin translation of his work by Gerardus
Cremonensis, a noted translator of Arabic medical texts.

48
THE GOLDEN AGE OF ISLAMIC MEDICINE

The Golden Age of


Islamic Medicine
As Europe entered the “Dark Ages,” the Middle East and western Asia saw a blossoming
of culture and science, especially in the field of medicine. Building on knowledge from the
ancient world, these advances eventually flowed back to Europe during the Renaissance.

T
he year 476 CE—when the last tolerance. Part of an integrated attitudes led to much progress, not
emperor, Romulus Augustulus, approach to learning that viewed only in the skills of physicians,
was deposed—is regarded mathematics, astrology, literature, but also in the provision and
as the end of the Western Roman philosophy, alchemy, and the organization of medical care.
Empire. After the collapse, Europe sciences as part of a unified truth, Pioneering hospitals and medical
entered an era of social upheaval the field of medicine in particular schools funded by charitable
and disorder referred to as the saw unprecedented innovation. individuals and wealthy rulers
“Dark Ages,” during which little were established from the 9th
progress was made in the arts A duty of care century onward in Baghdad and
and sciences, including medicine. Islamic teachings emphasize duties other cities. Open to all, they had
In contrast, from around the of care, both for the individual as organized wards, inpatient and △ Medicinal substance
8th century the Muslim lands of regards aspects of self-care such as outpatient services, dedicated Highly skilled Islamic pharmacists prepared
the Middle East and western Asia diet, exercise, hygiene, and mental nursing care, and in many cases a wide range of medicines using herbs
experienced an Islamic “Golden and emotional matters, and care offered outreach services for and other substances, such as naturally
Age.” Spreading out from Baghdad for others who are sick and needy. rural areas. Most significantly, occurring crystals and minerals. Sal ammoniac
(then capital of the Abbasid Medical treatment should be made they also provided hubs for crystals, seen here on the black stone, were
caliphate, now the capital of Iraq), available to all, and research into medical training and research. also used in alchemy.
academic and intellectual pursuits the prevention, treatment, and cure A comprehensive system of
flourished in an atmosphere of of illness should be sought. These medical education was established,
with physicians undertaking Born around 865 CE in the city of
ARAB SCHOLAR AND PHYSICIAN (1213–88)
basic scientific learning in subjects Rey (now Tehran, Iran), al-Razi
such as anatomy, physiology, became chief physician in hospitals
IBN AL-NAFIS and alchemy, followed by clinical in Rey and Baghdad. He wrote
training at hospitals that included more than 50 major texts and
A Muslim medical scholar and instruction in conducting physical hundreds of minor commentaries
polymath, Ibn al-Nafis attended examinations, taking patient notes, that combined the principles and
the medical school at Nuri Hospital, and administering treatments. practices he had found in ancient
Damascus (in modern-day Syria), medical works with his own
before moving to Cairo in Egypt. Building on the past clinical observations. His two most
A prolific writer, he produced The basis for these new advances famous encyclopedic texts, Kitab
numerous texts on general medicine, in medical education and practice al-Mansouri fi al-Tibb (The Book
ophthalmology, and surgery, as well was knowledge drawn from the on Medicine Dedicated to al-Mansur)
as on the interaction of medicine ancient world. Muslim physicians and Kitab al-Hawi fi al-Tibb (The
with law, religion, and philosophy. avidly translated, studied, and Comprehensive Book on Medicine),
However, al-Nafis may have invited assimilated works from the were used for centuries after his
controversy when he dissected scholars of the past—especially death in 925 CE, in western Asia
corpses to study anatomy—a the texts of Greek physician and, in Latin translation, in Europe.
practice that was then forbidden. Hippocrates (see pp.36–37) and Al-Razi’s writings emphasized
He came close to working out the Roman physician Galen (see the importance of the relationship
body’s circulatory system when pp.40–41), as well as traditional between doctor and patient. He
he described, for the first time, Chinese and Indian sources revived the Hippocratic approach
the movement of blood around the (see pp.26–27 and pp.30–31). that regarded all patients as being
pulmonary circuit, from the right side One of the greatest scholars equal and worthy of attention, and
of the heart through the lungs to the to play a part in this process that charged physicians to do
heart’s left side (see pp.82–83). of synthesis was the physician patients no harm through
al-Razi (also known as Rhazes). medical treatment. He also

49
emphasized
the importance
of patient interviews in
diagnosis, the need to amend
treatments based on past
experience, and the value of
clinical observation in medicine in
lieu of dogmatism and habit. These
observations allowed al-Razi to
advance theories on the nature
of diseases and the importance of
preventive medicine—the need to
investigate the causes of ailments, △ Tools of the trade
not just provide cures—and the Traditional knowledge of chemists, alchemists,
benefits of good diet and hygiene. and apothecaries provided Arabic physicians with
Recording the symptoms of the skills needed to make medicines. This bronze
smallpox (see pp.100–01) and mortar, from the 16th –18th centuries, would have
measles, for example, led held ingredients that were ground using a pestle.
him to propose the theory
that blood froths like
a fermenting drink
with vapors that seep
through the skin and
create blisters and sores. ▽ Fighting smallpox
This illustration is from a 17th-century Turkish
Age of discoveries edition of Ibn Sina’s Canon of Medicine. The
The advances in medical painting shows a man suffering from smallpox
knowledge gained waiting for treatment while the apothecary
through meticulous weighs the ingredients for his
record-keeping and medicine on a balance.
THE GOLDEN AGE OF ISLAMIC MEDICINE

an emphasis on clinical observation ▷ Return of medical knowledge KEY


led to progress in all medical fields During the Golden Age of Islamic medicine, GREATEST
EXTENT OF
as well as greater specialization. physicians from the Middle East and western Asia ISLAMIC
Physicians such as al-Zahrawi continued to expand upon the medical wisdom of CONQUESTS

(also known as Albucasis), born ancient Greece and Rome. From the 12th century, ROUTE OF
PARIS
in 936 CE, became renowned their writings were used in Latin translation in the SPREAD OF
MEDICAL
for their excellence in specific new medical schools in Italy, Spain, and France. KNOWLEDGE
PADUA
areas of medicine. Often referred BOLOGNA
MONTPELLIER
to as “the father of surgery,”
ROME
al-Zahrawi pioneered new this period, but in the early 13th SALERNO CONSTANTINOPLE

procedures and provided the first century the Andalucian botanist CORDOBA
illustrations of more than 200 Ibn al-Baytar produced a ground-
ATHENS
surgical instruments in his seminal breaking encyclopedia that was to BAGHDAD

encyclopedic work, Kitab at-Tasrif become the authoritative text on


(The Method of Medicine). By the herbalism for centuries. Al-Kitab
13th century progress in the study ‘l-jami’ fi ‘l-aghdiya wa-’l-adwiyah ALEXANDRIA

of anatomy allowed the physician al-mufradah (The Comprehensive CAIRO

Ibn al-Nafis (see panel, p.49) to Book of Foods and Simple Remedies)
demonstrate an understanding of alphabetically listed hundreds of
the body’s circulatory system. herbal medicines and remedies—
The introduction of new drugs and many of which were Ibn al- Age—for both contemporaries and was translated into a number of
methods of testing, along with the Baytar’s discoveries. later physicians—is characterized languages, including Latin and
development of processes such by the work of philosopher and Chinese, and became the standard
as dissolving and distillation, Medical canon physician Ibn Sina (later known medical textbook for physicians
also fuelled advances in The significance in the West as Avicenna). Born in for the next few centuries.
pharmacology. Many of this explosion in 980 CE near the historic city of Ibn Sina’s influential writings
prominent physicians also medical practice, Bukhara (a major center of Islamic promoted the development of a
translated ancient works research, theory, culture, now in Uzbekistan), Ibn comprehensive medical system
and wrote their own texts and writing during Sina began studying medicine as a in which observation, methodical
on medicinal plants during the Islamic Golden teenager, and by the age of 18 was experimentation, and deduction
employed as a physician by the were used to underpin medical
Samanid court. This provided him practice. He found methods for
with access to the royal library, filled testing the efficacy of drugs,
with ancient texts that fueled his established the importance of
learning and later writing. environmental factors (such as
Ibn Sina wrote on a wide range clean air and water) on health,
of topics, including mathematics, and identified the contagious
logic, astronomy, psychology, and nature of infectious diseases.
geology, but is best known for his These principles, and the great
240 surviving works on philosophy advances in medical science made
and medicine. Of these, the most during this dynamic period, began
important were Kitab al-Shifa to filter westward from the middle
(The Book of Healing) and Al-Qanun of the 12th century. Primarily
fi al-Tibb (The Canon of Medicine), translated into Latin, the texts of
published in about 1025. Collating Islamic physicians were copied (later
knowledge from Greek and Roman printed), disseminated, and studied
sources, Ayurvedic, Persian, and throughout Europe, eventually
Arabic works, and his own patient aiding the flowering of medicine in
interviews and observations, The the West during the Renaissance
Canon of Medicine (see pp.52–53) of the 15th century.

“ Restlessness, nausea, and


anxiety occur… with measles
… pain in the back is more
apparent with smallpox.”
AL-RAZI, IN AL-JUDARI WAL HASABAH (CONCERNING SMALLPOX AND MEASLES)

51
REVIVAL AND RENAISSANCE 700 –1800

Ibn Sina’s The Canon


of Medicine
Ibn Sina’s masterpiece, Al-Qanun fi al-Tibb (The Canon
of Medicine) had a vast influence on medical teaching
in the West as well as in the Arab world. A definitive
encyclopedia, it remained a standard medical textbook in
Europe for 500 years—from the 12th to the 17th century—
earning Ibn Sina the title of Prince of Physicians.

One of the most famous Arabic writers of medicine, Ibn Sina, later
called Avicenna, was born in Persia in 980 CE. A precocious child,
he could recite the entire Qur’an by the age of 10. He studied
medicine at 16 and began to practice it at 18. He led a full life
characterized by hard work, and alleged drinking and promiscuity.
Ibn Sina’s Canon—a massive book containing a million words
across five volumes—is a collection of all that was known at
the time about medicine and surgery, including the doctrines
of Hippocrates (see pp.36–37), Galen (see pp.40–41), and the
Greek philosopher Aristotle. The first volume dealt with the
origins of health and sickness and aspects of the body’s
anatomy and function. The second volume listed information
on more than 700 drugs and medicines. The third volume
covered the diagnosis and treatment of diseases specific
to certain parts of the body, while the fourth focused on
conditions that affect the whole body. The final volume
discussed the preparation of medicinal remedies. The Canon
was translated into Latin in the 1100s and consequently came
to dominate approaches to medicine in the medieval period.

“ Therefore in medicine we
ought to know the causes
of sickness and health.”
IBN SINA, ON MEDICINE, c.1020

▷ The Canon of Medicine


Anatomical drawings of the heart, ear, brain, and other body parts
from a 14th-century edition of the Canon are shown here. Human
dissection was rare at this time, and Ibn Sina probably gained his
anatomical knowledge from Galen and other ancient physicians.

52
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0

The First School


of Medicine
Although different approaches to medical training
emerged around the world as early as the 23rd century BCE,
the first formal facility for teaching medicine was the
Scuola Medica Salernitana, in the southern Italian city
of Salerno, which was founded in the 9th century.

A
ccording to ancient Egyptian ▷ The School of Salerno
scripts, medical schools By the early 900s the Salerno medical school
were established by around had become famous throughout Europe.
2200 BCE—when the first reference In 1099 Duke Robert II of Normandy visited
to Per-Ankh, or “Houses of Life,” the school to seek treatment.
as places for the creation and
preservation of written knowledge
appears. Senior physicians taught the Houses of Life, but they took
students and worked with scribes medical learning to a new level
to record information and produce based firmly on the principles of
copies of books on health practice. science rather than religion or
Although some Egyptian medicine superstition. This science-based
had its roots in logic and evidence, approach reached a new height of
much of the thinking was based on sophistication hundreds of years
religion and magic. Students from later with the opening of the
Greece and the Arab world studied ground-breaking Scuola Medica
in Egypt’s medical schools, then Salernitana, the first modern
returned home to integrate this medical school, in Salerno, Italy.
knowledge with local practices. Founded on the site of a former
monastery dispensary, the institute
Laying the foundation was unrivaled for four centuries
Both the Greeks and Arabs built in terms of both the scope of its
on the existing foundations of teaching and in the production
physician training established at of medical textbooks, including
translations of several important
Arab works. The school’s library
was renowned, and its shelves
were stacked with rare medical
texts supplied by the Benedictine
Abbey at nearby Monte Cassino,
one of the great medieval centres
of learning in Europe. The
collection at the Salerno library
represented the world’s most
extensive compilation of medical
science knowledge. It included
Latin translations of books by

◁ Matthaeus Platearius
Written in around 1470, by Salerno school
physician Matthaeus Platearius, De Simplici
Medicina (The Book of Simple Medicine)
described 270 drugs in detail.

54
THE FIRST SCHOOL OF MEDICINE

al-Razi and Ibn Sina, in medicine, the school


who were famous also taught philosophy,
Arab practitioners religion, and law. Ethics
of pharmacy and was another important
medicine (see subject, as was
pp.48–53). physician-patient
One of the school’s relations. According
early supporters was to one book, The
the Archbishop of Coming of a Physician
Salerno, Alfanus I, who to His Patient, “When
was a talented physician the doctor enters the
himself. Fluent in several dwelling of his patient,
languages, he translated he should… put the
a number of medical patient at his ease before
books and worked his examination
to raise funds for begins and the
the building of the pulse should be
△ Diagram of body
Salerno school. Also felt deliberately
showing muscles
instrumental in the and carefully.”
Treatise on the Human Body,
success of the school Unusually for the
published in England in 1292,
was Constantine the time, women were
illustrated numerous aspects of
African, a physician physiology as understood at the
welcomed as both
who arrived in time. It included diagrams of the students and staff.
Salerno from North arteries, bones, and muscles of The school’s most
Africa to study, but the body (shown here). famous female
ended up staying on faculty member
to teach. He shared his knowledge was Trotula de Ruggiero, who wrote
of Islamic medicine and translated several books on gynecology. Once
several key Arabic texts that would they had completed the relevant
become essential reading for training, women were granted
medical students in Europe. licenses for gynecology, obstetrics,
midwifery, pre- and post-natal care,
Well-rounded curriculum as well as for general practice. With
The Scuola Medica Salernitana was a its scope, its acceptance of women,
melting pot of different approaches and the volume of books generated
to medicine and attracted many there, the Scuola Medica Salernitana
international students. The training set the standard for the medical
methodology at the Salerno school colleges of the future.
fused Greek and Roman theory
and practice together with Arab
and Jewish traditions to create the
most comprehensive curriculum
available at the time. Courses were
well-organized, with high standards
and a strict policy of passing one
level with the required marks
before moving on to the next.
Typically, students would
undertake three years of study,
followed by four years of hands-on
medical training with physicians,
surgeons, medical herbalists,
and other specialists. As well as
preparing the students for careers

▷ Anatomy lesson
A woodcut from 1493 shows the practical
anatomy instruction that was common
at the medical school in Salerno. Initially only
animals were dissected but human dissection
was introduced at the school in 1250.

55
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0

Medieval Medicine
In the early medieval period in Europe (the 5th to the 10th century), progress in medicine
and science virtually ground to a halt. By the 12th century, however, the translation of
ancient medical texts and circulation of new ideas were promoting greater knowledge.

W
hen the Western Roman practice, and information about
BENEDICTINE ABBESS (1098–1179)
Empire finally dissolved herbal medicines. However, the
around 476 CE, the orderly new structure of Europe meant HILDEGARD OF BINGEN
regime of hygiene, literacy, medical that there was little transfer of
practice, and systematic agriculture information and limited means Hildegard of Bingen claimed to have
also faded. Western Europe of preserving existing medical had religious visions from a young
fragmented into small fiefdoms as knowledge other than in religious age and her parents offered her
Germanic tribes such as the Goths, centers. Monasteries were one of to the Benedictine monastery at
Vikings, Saxons, and Huns swept the few places that did promote Disibodenberg, Germany, where she
across the continent, replacing the learning and book production— eventually became abbess. Hildegard
safeguarding a legacy of knowledge is renowned for her prolific writing

1–2 PER YEAR The number until interest in medicine revived and her diverse talents. During her
of dissections that in the mid- to late medieval period. lifetime and beyond, she earned a
took place at medieval Indeed, the one unifying element reputation as a mystic and prophet, a
medical academies. in Europe was the Catholic Church, scientist, music composer, and writer,
which had become dominant in writing two monumental works on
cohesive administration of Rome the power vacuum left after the natural medicine and cures for illness.
with independent regions that fall of the Roman Empire.
were organized according to the
feudal system. Medical practices The rule of religion for sin, and urged sick people to pray Meeting medical needs
during this time were based largely Ideas and practices relating to to the saints for help. Surviving childhood—and for
on religious beliefs, folk tradition, medicine—such as how the human However, some devout Christians, women, surviving childbirth—
and superstition. The progressive body, sickness, and treatment were in particular the Benedictines, presented major medical challenges
thinking of the Greek and Roman perceived—came to be dictated by considered it a Christian duty to throughout the medieval period.
scholars, and the great Arabic the Church. Autopsy and dissection care for and treat the sick on a more Conception and childbirth were
texts on medicine and science, were banned, making it difficult to practical level. The use of natural considered a priority as populations
seemed all but forgotten. advance medical knowledge and medications and dwindled due to

542
Under the Roman Empire, Europe understanding. The Church viewed treatments The year when the disease, but access
had benefited from an influx of spiritual intercession and prayer as (particularly first hospital in to maternal care was
Greek doctors, the Roman Army the primary cure for disease, which herbs) was France was constructed. limited and variable.

30
medical corps, good hygiene was thought to be a punishment sanctioned on The number of hospitals Aristocratic women
the basis that in Florence, Italy, at the were generally
they had been end of the 14th century. attended by a
provided by physician familiar
God to assist man, and so were with the Greek and Roman texts
spiritual in origin. Herbs were on childbirth, but most of their
grown by monks and nuns to make knowledge was theoretical rather
remedies for their own use, and to than based on practical experience
treat sick members of the wider of women’s medicine. Other
community. Historical documents women managed childbirth
stored in monastic libraries also with the help of a local
◁ Sacred reliquary provided monks with a degree of midwife, who probably
Reliquaries, such as this one medical information and guidance
from 13th-century France, on the use of natural remedies.
housed relics that were A number of hospitals across ▷ Giving birth
thought to be the bones Europe were founded by religious The Cantigas de Santa Maria (Canticles of Holy
or remains of saints. orders in the medieval era, but Mary) is a collection of illustrated poems set to
Christians believed that most functioned like hospices or music, written in Spain during the 13th century.
by touching a relic they almshouses, providing general One poem describes a Jewish women in labor
would be protected medical care, housing, and spiritual who prays to the Virgin Mary, then gives birth
from sickness. guidance for those in need. to a healthy baby, and converts to Christianity.

56
57
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0

medieval period. Born in the that chestnuts are high in folates, The four humors
German Rhineland-Palatinate which are essential for brain and Like other medical writers and
at the end of the 11th century, nervous system development. To practitioners of the time, Hildegard
Hildegard became one of the most aid the heart, Hildegard advocated believed in the four humors
important authorities of the 12th a tonic of parsley and honey-wine; (see pp.34–35), a theory promoted
century on the subject of medieval parsley—rich in folic acid and by Hippocrates in ancient Greece.
pharmacology, and the beneficial essential oils—is today championed The four humors were identified
properties of plants. as a heart-healthy herb. as blood, yellow bile, black bile,
Living in a monastery, Hildegard
had access to early translations of
medical treatises from antiquity,
(see pp.32–33 and pp.38–39) and
also benefited from a boom in
translations of Islamic medical
texts (see pp.48–51) during the
12th century, as interest in the
subject grew. She began to
write her own books on the
subject of sickness and
treatment, all carefully set
within a framework that
placed God firmly at the
top, as the divine creator
△ Leper with bell of the natural world.
Early medieval physicians diagnosed leprosy as Some of Hildegard’s publications
an excess of “black bile,” and prescribed regular became essential reading for
blood-letting as well as a drink containing gold, medieval physicians and pharmacists.
which was thought to be purifying. They wrongly Her Causae et Curae (Causes and
believed that leprosy was easily spread, and forced Cures), for example, was a massive
lepers to ring a bell as a warning not to approach. work comprising almost 300
chapters on the causes of human
diseases and their treatment.
learned her skills through Perhaps even more impressive was
an apprenticeship, but had the accompanying nine-volume
little or no scientific training (see Physica, which detailed remedies
pp.140–41). This traditional type that could be made from plant and
of medicine animal extracts.
was often the
main recourse 300 The number of plants Both works took
with medicinal a well-organized,
for ordinary properties listed in the 12th encyclopedic
people without century manuscripts of approach that
access to Hildegard of Bingen. made them very
a physician. user-friendly.
Focusing on herbal remedies, Central to Hildegard’s view was
potions were typically dispensed by the use of herbs and botanical
women, who had learned from tonics as both preventive measures
older generations how to make folk and cures for specific conditions—
remedies. Alternatively, a patient many still valued in modern
could visit an apothecary, who medicine for their pharmaceutical
would concoct a tonic or remedy properties. To promote brain and
from herbs, spices, and wine. nervous system function, for
example, she recommended
Acquiring knowledge chestnut; today, nutritionists know
One author who could claim some
authority on the subject of both
women’s health and plant-based ▷ Leeches
medicine was Hildegard of Bingen Following principles first written down in ancient
(see panel, p.56). Hildegard Greece, physicians in the medieval period would
represents the reawakening of place leeches on a patient’s skin to draw out
interest in medical knowledge, and blood that was supposedly bad. In modern
the increase in its dissemination, medicine, leeches are sometimes used during
that began in the mid- to late reconstructive surgery to drain congested blood.

58
M E D I E VA L M E D I C I N E

and phlegm, and were thought who believed that the monthly Blood-letting perform the procedure instead.
to directly affect the health of the discharge of blood was essential Reducing excess humors was one In 1163, however, a church edict
body and emotions. All conditions to keep the humors in balance. of the main medical procedures in forbade the clergy from carrying
were considered to stem from Following this line of thought, medieval times—through blood- out blood-letting, and barbers spotted
either an excess or a lack of one they believed that post-menopausal letting, intestinal purging, and this opportunity to expand their
of the humors. Menstruation, for women were in great danger, since induced vomiting. Blood-letting businesses. Barbers began to function
example, was of great interest to they were no longer able to get rid was the most severe of these as medical practitioners—offering
medieval scholars and physicians, of “excess” blood. treatments and blood-letting

1140
was prescribed The year when King treatments, tooth
for many types of Roger II of Sicily extractions, lancing
illness, including forbade anyone from practicing of boils, and even
smallpox, medicine without a licence— amputation, as well
epilepsy, and the first regulation of its kind. as the usual haircuts
gout. Two main and shaves. Barber-
methods of blood-letting were surgeons (see pp.76–77) not only
used: leeching and the cutting of worked from their shops—
veins. Leeching (the milder of the identifiable from the blood-soaked
two options) involved placing live towels drying outside—but also
leeches on the skin and leaving them traveled around the countryside
to suck the patient’s blood. The performing surgical procedures, and
alternative was to open a vein with setting up temporary operating
a lancet or pointed wooden stick, rooms on battlefields. Anesthetics
and let the blood flow into a basin. were used, made from herbs or
If a doctor was not available to carry alcohol, but some of these were so
out blood-letting, monks and priests potent that they could kill the patient
were authorized to step in and before the operation had even begun.

▷ Apothecary’s jar
Apothecaries functioned in the same way
as modern-day pharmacies, dispensing
remedies based on herbs, spices, and wine,
stored in porcelain jars like this one.

“ Every day we see new


instruments and new
methods being invented by
clever and ingenious surgeons.”
THEODORIC OF LUCCA , SON OF HUGH OF LUCCA, MEDIEVAL SURGEON, 13TH CENTURY

59
REVIVAL AND RENAISSANCE 700 –1800

Anatomy Restored
The origins of the modern study of anatomy are usually
dated from Flemish anatomist Andreas Vesalius’ 1543 text
De Humani Corporis Fabrica (On the Fabric of the Human
Body) (see pp.72–75). However, Vesalius and his colleagues
owed much to the early anatomists who had developed
their knowledge at the medical schools of Europe.

Toward the end of the early medieval period, Europe witnessed


a revival in medical learning from ancient Greece and Rome.
Medical knowledge from the Islamic world also flowed west.
There was a renewed interest in anatomy, dissection, and
autopsy, partly facilitated by new laws that permitted the
dissection of human bodies for educational purposes. A
prominent practitioner, Italian physician Mondino de Luzzi
reintroduced public dissections for the benefit of students in
about 1315, and wrote Anathomia Corporis Humani (Anatomy
of the Human Body) in 1316. Mondino’s pupil Nicola Bertuccio
continued the practice and also produced works on how the
body is affected by diseases, diets, and poisons.
In turn, Bertuccio’s most famed student French physician Guy
de Chauliac (see p.69) wrote Chirurgia Magna (Great Surgery),
which went on to become a standard anatomical, medical, and
surgical text in Europe for three centuries. In it, Chauliac urged
all surgeons to study anatomy, and acknowledged the work of
the physicians who had helped advance the field before him,
including Hippocrates (see pp.36–37) and Galen (see pp.40–41),
and their Islamic colleagues al-Razi (see pp.50–51) and Ibn Sina
(see pp.52–53). It was almost two centuries later that Andreas
Vesalius (see p.75) took the study of anatomy to the next level.

“ A surgeon who does not


know his anatomy is like a
blind man carving a log.”
GUY DE CHAULIAC, FROM CHIRURGIA MAGNA (GREAT SURGERY), 1363

◁ Anatomy class
This scene from an illustrated version of Guy de Chauliac’s
Chirurgia Magna shows the physician-surgeon identifying parts
of the body while referring to a book. Assistants (center) carry
out the actual dissection as students crowd in to observe.

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Apothecary Store
The profession of apothecary—the formulator and dispenser of drugs to
the sick—dates back to at least 2500 BCE. Skilled medics in their own right,
apothecaries prepared medical remedies with the herbs stored in their shops.

1 Pot marigold Also called calendula, the flower is used to coughs. 10 Pill silverer This pill silverer from the UK dates to
treat wounds and swelling, and as an infusion to calm fevers. c.1860. It was a device used to coat pills in silver, or sometimes
2 Vervain This plant was used to treat jaundice and gout, and gold; the pills dropped inside, and the apparatus rotated to
to stimulate lactation in new mothers. 3 St. John’s wort A form the coating. 11 Galangal A type of ginger, galangal is
strong anti-inflammatory, this plant is useful as a wound balm used as a remedy for colic, flatulence, and respiratory problems.
and to treat back pain. 4 China rose A tropical plant, China 12 Garlic Used as an antiseptic and against parasitic stomach
rose helps treat arterial and menstrual disorders. 5 Saffron infestations, garlic was also employed as a remedy for leprosy
Ground into a paste, this spice can be used as a sedative or a and smallpox. 13 Ginger This root is helpful in alleviating
diaphoretic—to induce sweating. 6 Cloves These dried nausea, vomiting, and indigestion. 14 Wild celery Commonly
flower buds were once, and are sometimes still, used as an employed as a diuretic (to promote urine production) it is also
anesthetic and antiseptic in dentistry. 7 Hops The flowers of used to treat rheumatism and arthritis. 15 Fresh mint Used to
the hop plant were used as a sedative, useful for insomnia, ease indigestion, colic, and flatulence, this is either chopped on
anxiety, and stomach pain. 8 Pestle and mortar These were food or used as an infusion. 16 Rosemary Said to improve
1 POT used to grind pharmaceutical ingredients into powders. This memory and banish bad dreams, this herb is also used to calm
MARIGOLD ivory example dates to 1500–1700. 9 Opium This container headaches. 17 Aloe vera leaves Taken internally, these cure
held Thebaic opium, a reference to its place of origin in the constipation. When applied to the skin they soothe rashes and
ancient Egyptian city of Thebes. In small quantities, opium itches. 18 Apothecary jar Jars such as this Italian one from
worked as a calmative, sedative, and an expectorant to treat the 1500s were used to store drugs in apothecaries’ shops.
Leafless
spike

5 SAFFRON 6 CLOVES

7 HOPS

4 CHINA ROSE

2 VERVAIN 3 ST. JOHN’S WORT

Pale lilac
flower

8 PESTLE AND MORTAR 9 OPIUM 10 PILL SILVERER

62
APOTHECARY STORE

Long stem appears


above ground

11 GALANGAL
Tuberous root
grows below
the ground
12 GARLIC

15 FRESH
MINT

13 GINGER

14 WILD CELERY

16 ROSEMARY

17 ALOE VERA
LEAVES

18 APOTHECARY JAR

63
REVIVAL AND RENAISSANCE 700 –1800

Alchemy
A peculiar mix of science and magic, alchemy had various
lofty aims that ranged from changing ordinary metals
into gold to curing all illnesses. Dating back 4,000 years
in Asia and Africa, alchemy enjoyed a golden age in
Europe from the 12th to the 18th centuries.

The ancient civilizations of Egypt, India, and China all had long
traditions of alchemy. The aims of early alchemists varied, but the
underlying thread was always change or transmutation for the
sake of improvement—physically, to alter a common substance
into a precious one; spiritually, to bring light to darkness;
medically, to give good health to the sick; or preferably all three.
There was a tendency toward esotericism among alchemists—
restricting knowledge to a few privileged practitioners who could
thereby mystify ordinary people. Yet alchemists also helped
develop many real-world skills, such as extracting ingredients
from plants, animals, and rocks; mixing, boiling, condensing, and
purifying elements; and other procedures still practiced today.
Alchemy flourished during the “Golden Age” of Islamic medicine
(see pp.48–51) and then journeyed west. Englishman Robert of
Chester’s 1144 translation of Persian polymath Jabir ibn Hayyan’s
(also known as Geber) Kitab al-Kimya (The Book of Composition of
Alchemy) encouraged alchemical practices across Europe. Among
the alchemists’ medical aspirations were to find a universal
panacea to cure all ills and an elixir of youth. Swiss physician
Paracelsus was a celebrated practitioner, whose free spirit, lengthy
wanderings, contradictory statements, and yet practical talents,
embodied the alchemic tradition. However, by the 1700s, faced
with the rigorous application of the scientific method and the
young subject of chemistry, alchemy faded into an occult pursuit.

“ An alchymist is either a
physician or a soap boiler.”
CORNELIUS AGRIPPA, GERMAN POLYMATH, FROM THE VANITY OF THE
ARTS AND SCIENCES, 1530

◁ Seeking the elixir of youth


In the 13th century, English friar, philosopher, and alchemist
Roger Bacon experimented with finding the elixir of youth. His
reputation grew during the following centuries and inspired
many others to turn to medicinal alchemy.

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The Black Death


In 1347 a devastating epidemic struck Europe. Over the next five years, the infection—
a plague characterized by black blotches across the victim’s skin—killed approximately
60 percent of the continent’s population, causing massive socioeconomic disruption.

E
urope had experienced Recurring ravages The Black Death’s vector, or common name, the bubonic plague.
terrible plague epidemics The “Great Pestilence”—as spreading agent, was infected Black blotches then appeared on
before. The Great Plague contemporaries called the Black fleas harbored by the black rat the skin, and death soon followed.
of Athens, described by Greek Death—seems to have begun in (Rattus rattus), which thrived in the The Black Death caused panic
historian Thucydides in 430 BCE, Central Asia in the 1330s, before unsanitary conditions prevalent in throughout Europe. There was
and the Plague of Justinian, which reaching Crimea in 1347, from medieval cities, where rubbish and no cure. Ineffective treatments
devastated the Byzantine Empire where it rapidly spread westward human waste were omnipresent, (see pp.68–69) included avoiding
in 542 CE, both resulted in large- along maritime trade routes. Venice and animals lived in the houses. foods that were hard to digest, and
scale mortality, and may have and other Italian towns were struck The first symptoms of the disease purifying the air with attar (essential
been caused by the same organism that fall, and by the summer of were swellings in the lymph nodes
responsible for the Black Death; 1348 France, Spain, Portugal, and of the groin, armpits, or neck,
however, these earlier outbreaks England had been infected, with known as buboes –
of plague affected a much smaller Germany and Scandinavia falling giving the Black
geographical area. victim the following year. Death its other

▽ The Great Plague of Marseilles


These victims of the 1720 Marseilles plague
show the swellings characteristic of the bubonic
plague. The outbreak killed almost 100,000
people in Marseilles and its hinterland, and
caused panic in other European countries,
which feared a recurrence of the Black Death.
T H E B L A C K D E AT H

▷ The spread of the plague


The Black Death is believed to have reached
Europe in 1347 through the port of Kaffa (today
Feodosiya) in the Crimea, from where it spread
LONDON
throughout the Mediterranean on ships. By 1351 EUROPE

it had reached northern Scandinavia and Russia. PARIS TANA SARAI


ASIA
Only a few regions, such as Poland, escaped. BORDEAUX GENOA VENICE KAFFA ASTRAKHAN

TRABZON
VALENCIA CONSTANTINOPLE
SEVILLE MESSINA
oil) of roses, cinnamon, and cloves MOSUL
(one theory maintained that the
BAGHDAD
plague was spread by “miasmas” ALEXANDRIA

or noxious vapors). Doctors tried


prescriptions of elixirs, such as AFRICA
Theriaca Andromachi—a concoction
of herbs with up to 70 ingredients.
KEY
Nothing worked, and only very
remote communities escaped the 1347 1350

epidemic. After it had killed around


1348 1351
50 million people, the first pestilence ROUTE OF
died out. It recurred in further 1349 PLAGUE SPREAD
waves, in 1360–63, 1374, and 1400,
as new generations who lacked the plague into its port. Elsewhere, the By 1896 Yersin had produced an species causes periodic outbreaks.
immunity acquired from a previous disease remained endemic and a antiserum that was successful In 2013 a boy died in Kyrgyzstan
infection fell victim. new wave of the plague began in in about half of the cases, and the after eating a plague-infected
1894 in Canton in China, spreading introduction of the antibiotic marmot, while in the US there
Socioeconomic repercussions the next year to India, where it streptomycin in the 1940s increased were 15 cases of plague infection,
The social and economic effects claimed over a million lives. the cure rate to about 95 percent. including four deaths, in 2015.

23
of the plague were devastating. While the Black Death can no
Amid the terror of the first DAYS The average longer decimate populations
epidemic, thousands of Jews were time from first unchecked, it has not been entirely
slaughtered in Germany because introduction of eradicated. In 1910 researchers
they were blamed for poisoning plague contagion realized that wild rodents, such
wells and thereby causing the among rats in a human as marmots (in Central
plague. As the population in community until first person Asia) and prairie
Europe declined, laborers became dies from the disease. dogs (in North
scarce and land became vacant, America), act as
allowing peasants to demand higher Finding a cure reservoirs of the
wages. Despite attempts to control In 1894 the plague-causing bacillus disease, and human
wage levels, they rose inexorably, was discovered by Japanese contact with these
particularly in England. bacteriologist Shibasaburo Kitasato
Periodic epidemics of plague and French bacteriologist Alexandre
became a feature of European life Yersin; it was eventually named ▷ Plague doctor
for more than three centuries. Yersinia pestis. Although early In order to avoid becoming
England experienced its final attempts to produce a vaccine infected, physicians called on
outbreak in London in 1665, when against the plague failed, the rat to treat plague victims wore
68,000 people died, and Marseilles, flea was identified as the vector in elaborate costumes, including
France, became the last European 1898, leading to successful efforts masks with birdlike beaks, to reduce
city to suffer, in 1720, when an to curb the spread of the disease exposure to the “miasmas” believed to
infected ship carried the bubonic by controlling the rat population. be the cause of the disease.

“ Its earliest symptom… was the appearance


of… swellings in the groin or the armpit, some
of which were egg-shaped, while others were
roughly the size of the common apple.”
GIOVANNI BOCCACCIO, ITALIAN WRITER, IN THE DECAMERON, 1350

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I
n medieval times, the term epidemics evoked a variety of ▷ Spreading fragrance
“plague” was used to refer to responses, not the least of which This spherical, eight-sectioned
any epidemic. These plagues was fear and panic. pomander was used to
were often what we now know carry flowers, herbs,
to be diseases such as malaria, Prayer or flight and spices such as
typhoid, cholera, measles, syphilis, With no idea of what caused such nutmeg and musk that
and smallpox. The Black Death diseases or how they spread, some were thought to cleanse
(see pp.66–67), however, was the people simply fled them. However, the air and ward
worst of all plagues, unprecedented in the Islamic faith fleeing was not off infection by
in its virulence and destruction an option: plague was viewed as an the plague.
of human life. These devastating act of God, so had to be endured.

Preventing Plagues
Plagues were nothing new, but the arrival of the Black Death in the 14th century was one of
the most devastating pandemics in human history. Medicine was powerless to treat it, but
over time, organized responses were developed to prevent the spread of such diseases.

Dealing with the disease


During the Great Plague of London
(1665–66), fires burned day and night to
purify the air. Bell-ringers chimed for people
to bring out their dead, and infected houses
were sealed and marked with a red cross.
PREVENTING PLAGUES

Many Christians believed that ◁ Yellow fever


God was punishing humanity In 1793 the yellow fever epidemic in Philadelphia,
for its sins, so only prayer and USA, claimed 5,000 lives out of a population of
penitence could end the plague. 45,000. The streets were deserted except for the
As a result, self-flagellation became carriages that stopped to pick up the dead and
increasingly popular, which led to dying from the street.
thousands of penitents traveling
through towns and countryside,
flogging themselves with a three- ethos had made its way as far as
tailed lash and praying that the America, where thousands of
Lord would take pity on their travelers to the New World were
suffering and end the plague. stopped at Boston Harbor to be
Over time, less responsibility was checked, or risk a hefty fine of
placed on God for inflicting such $100. By the time the Great Plague
punishment. Plagues such as the ravaged London in 1665–66, all
Black Death and mass outbreaks London-bound ships were made
of disorders such as St. Anthony’s to drop anchor at the mouth of the
Fire (a gangrenous condition caused Thames River for 40, sometimes 80,
by ergot fungus poisoning), and days. Sick Londoners were forced
St. Vitus’ Dance (which presented to stay in their homes, which were
as manic dancing), were thought to often boarded up. Those who could
be the work of the devil, using his afford to, fled to the countryside.
human agents—heretics, Jews, or In the 18th century, the arrival of
witches. In turning fear and anger another plague—yellow fever—in
outward, thousands of innocents giorni, meaning 40 days. Quarantine a theory contested by Muslims who the Mediterranean ports of France,
were scapegoated and massacred. gradually became an accepted believed that Allah directed such Spain, and Italy forced governments
measure for treating outbreaks of plagues. Failure to prevent the to introduce strict quarantine rules.
Attempts at prevention plague. In 1374 the Duke of Milan spread of the Black Death was only The first major American yellow
Public officials, state rulers, and drew up an edict insisting that all explained centuries later, when it fever epidemic hit Philadelphia in
individuals all took action to try to those suffering from plague should was discovered that fleas were July 1793, but politicians resisted
prevent the spread of disease. Some be taken outside the city walls to carriers of the plague (see p.67). quarantines because they were
thought that the air was filled with a field or forest, until they either In the following centuries, systems reluctant to limit trade. It was only
disease-causing noxious vapors or recovered or died. for isolating the sick were greatly the continued outbreaks of this
improved. In the early 1600s a law disease over the next few decades
was passed forbidding travelers that finally prompted US Congress
“Such terror was struck into the hearts from entering Paris without a
medical examination. By 1650 this
to pass federal quarantine
legislation in 1878.
of men and women by this calamity,
that brother abandoned FRENCH PHYSICIAN (1300–1368)

GUY DE CHAULIAC
brother… fathers and mothers refused
to see and tend their children.” Born in Auvergne, France, Guy
de Chauliac (see p.72) was a
GIOVANNI BOCCACCIO, ITALIAN WRITER, ON THE PLAGUE AS IT RAVAGED FLORENCE, 1348 physician and surgeon who studied
at the oldest university in Europe,
the University of Bologna. In 1342 he
“miasmas” (see pp.120–21), which The first permanent plague hospital was appointed by Pope Clement VI as
could be removed by lighting fires. (lazaretto) was opened by the his private physician. He attended the
People also began carrying sweet- Republic of Venice in 1423 on the pontiff during the Black Death that
smelling pomanders in an effort small island of Santa Maria di came to France in 1348. A third of
to cleanse the infected air. Nazareth, away from the heart of the cardinals at Avignon died, but
In some places, the authorities the city. This concept spread to Clement survived. Chauliac was
reacted by isolating the sick. The other parts of Europe as a way of also infected, but lived to record
cities of Venice and Milan refused containing the sick. Public officials the experience and, unlike many
entry to anyone suspected of being also used disinfection procedures, physicians, he stayed and cared
infectious. In 1348 ships arriving such as fumigation and the burning for the victims. In 1363 he wrote
in Venice from infected ports were of infected clothing and bedding. about it in graphic detail in his book
required to sit at anchor for 40 days The nature of the contagion itself Chirurgia Magna (Great Surgery),
before landing. The name for this was not yet understood, but these which became the most influential
practice—quarantine—was derived measures suggested a belief that surgical text for more than 200 years.
from the Italian words quaranta the disease was spread by people,

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Alchemy, Chemistry,
and Medicine
For centuries, people investigated the properties of substances, how to purify them,
and how they reacted when mixed. This field of science eventually became chemistry,
but its mystical forerunner, alchemy (see pp.64–65), had a much greater influence on
European medicine from the 12th to 18th centuries.

T
he ancient Greeks began ◁ Understanding the world
to offer explanations about In Utriusque Cosmi Historia (History of the
the structure of physical Two Worlds), published in 1617, physician
substances, or matter, as early as Robert Flood illustrated his ideas on how the
380 bce. The Greek philosopher world worked, divided into physical, celestial,
Democritus believed that all and spiritual dimensions.
matter was made up of invisible
components called atoms that
could not be broken down any explain the composition of, and
further. Around the same time, changing states of, matter. Among
the Indian philosopher Kanada its primary aims were finding a
came up with a similar proposal. way to convert common materials
However, neither of these theories into gold and silver and creating an
were based on physical evidence. elixir for everlasting life. However,
A major step forward came in the the secretive and often intentionally
8th century, when Persian polymath baffling work of many alchemists,
Jabir ibn Hayyan examined the classification system of physical who jealously guarded their
properties of materials using very chemistry. Hayyan’s texts describe materials and methods, eventually
basic laboratory equipment and processes familiar in chemical and led to skepticism from the general
processes such as crystallization drug research laboratories today. public and the wealthy patrons
and distillation. Through his Hayyan produced hundreds of who funded their work.
work, Hayyan developed an early concoctions which, as a physician,
chemical classification of matter: he was able to test on patients, Alchemical contribution
spirits, which vaporized when but he was not systematic about Nevertheless, medieval alchemists
heated; metals, including iron and recording and analyzing his results. did make useful contributions to
lead; and nonmalleable substances More popular at the time was the field of medicine. One of the
such as stone, which could be alchemy—a mix of mystical, most influential was the 16th-
powdered. His breakdown is philosophical, religious, and century Swiss physician Philippus △ Distilling spirits
remarkably close to the modern pseudoscientific approaches to Aureolus Theophrastus Bombastus An engraving by Mannerist artist Jan van
von Hohenheim, also known as der Straet shows distilling equipment from
Paracelsus. Although he adhered the late 1500s and early 1600s. Medical
to some of the spiritual dimensions alchemists used distillation to purify minerals
of alchemy, as well as various folk and herbal extracts for use as drugs.
beliefs, Paracelsus also introduced
many useful elements of chemistry
◁ At work to medical practice. He advocated wrote: “Many have said of
Physician Philippus that doctors should study nature alchemy, that it is for the making
Aureolus Theophrastus and conduct experiments to of gold and silver. For me such is
Bombastus von Hohenheim understand the body’s workings. not the aim, but to consider only
called himself Paracelsus He believed that metals were key what virtue and power may lie in
after the ancient Roman elements, and he connected certain medicines.” One of his beliefs—that
writer Celsus, who minerals to particular illnesses. For which makes a man ill can also
wrote the important example, he found that goiter was cure him—is the premise on which
early medical book De caused by the presence of certain most modern vaccines are based.
Medicina (On Medicine). minerals in drinking water. He Gradually, during the course of the

70
A L C H E M Y, C H E M I S T R Y, A N D M E D I C I N E

IN PRACTICE

EXTRACTING PHOSPHORUS

Hamburg-born alchemist Henning


Brand searched for the philosopher’s
stone. In the process he discovered
a new chemical element in 1669.
After reading a recipe claiming urine
could be turned to silver he heated
the residue from boiling down 60
buckets of urine, and isolated a
white, waxy, glow-in-the-dark
substance—called phosphorus after
the Greek for “light-bearing.” This
was a new material for alchemists
to exploit and some found that
its compounds helped patients
suffering from muscle weakness
and lack of energy—a condition
known as hypophosphatemia.

◁ Alchemy in the Middle East


This illustration from Five Arabic Treatises
“ The alchemists in their search for
on Alchemy shows the distillation process.
A large number of natural substances were
gold discovered many other things
discovered by Islamic alchemists using
equipment such as this.
of greater value.”
ARTHUR SCHOPENHAUER, GERMAN PHILOSOPHER, 1780–1860

16th and 17th centuries, alchemy’s mysticism, and attempted to progress in a scientific way. The
focus became less supernatural and identify the materials of the popularity of alchemy began
more rational, and alchemists were universe, picturing God as an to wane in the later part of the
seen less as sorcerers and more as alchemist in a laboratory. 17th century. In his textbook The
serious practitioners. Inspired by Sceptical Cymist (1661), Anglo-Irish
the ideas of Paracelsus, English Switch to chemistry chemist Robert Boyle proposed that
physician Robert Flood wrote and The individual approaches of scientific investigation was the key
illustrated Utriusque Cosmi Historia the alchemists, and the persisting to understanding chemistry. By
(History of the Two Worlds) (1617), spiritual and mystical dimensions, the 18th century, chemistry had
which mixed medicine with meant that alchemy could not become a fully fledged science.

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The Anatomy Revolution


One of the most important publications in medical history, Andreas Vesalius’s anatomical
masterwork De Humani Corporis Fabrica (On the Fabric of the Human Body), 1543, was
pivotal in jolting medicine out of the stagnation of the medieval period.

A
s the power of Rome faded introduced. Medicine is built on the as threats, Galen’s works gained establishment, who not only
in Europe during the 4th twin foundations of anatomy and godlike status and were accepted refused to understand what they
and 5th centuries, the arts physiology—the structure and the without question. saw with their own eyes, but
and sciences declined, along with workings of the human body. Beginning around the 13th–14th even refused to look. Vesalius had
many other intellectual pursuits However, the study of anatomy century, the European Renaissance studied medicine in Paris but he
(although progress continued in almost disappeared, and surgeons, gave fresh impetus and a new had to leave when his homeland,
the Islamic world; see pp.48–51). physicians, and others relied on questioning approach to art, now part of Belgium, was caught
Medicine relied on the great works the teachings of Claudius Galen architecture, and literature, up in a war between the Holy
of ancient Greece and Rome, (see pp.40–41). At a time when allowing room for innovation and Roman Empire and France (see
although these gradually came to new attitudes and the quest for invention. However, medicine, p.75). In 1536 he made his way
be distorted as new findings were fresh knowledge were regarded and science in general, lagged back to Belgium via the University
behind. Although some advances of Leuven (Louvain), before
were made by practitioners such moving on to Venice and then to
as the Italian physician Mondino Padua in northeast Italy, where
de Luzzi and French physician he studied for his doctorate in
and surgeon Guy de Chauliac, the medicine (Padua had an exceptional
influence of Galen, Hippocrates, reputation as a seat of learning).
and other ancient physicians On qualification as a physician in
was so great that most medical 1537, Vesalius was immediately
authorities saw no need to follow appointed professor of surgery and
the new Renaissance trends, and anatomy at the age of just 22 years.
any challenges to the accepted Vesalius soon began to show his
traditions were suppressed. independent attitude, adopting a
hands-on approach rather than
The breakthrough following the established method.
In 1543 Flemish physician and He focused on the demonstration
anatomist Andreas Vesalius of anatomy by dissection, believing
produced De Humani Corporis it was fundamental to medical
Fabrica Libri Septum. It is now knowledge and surgical practice.
considered to be the first major Following the example of his
anatomical work of the modern mentor in Paris, Jacques Dubois
era, yet at the time it was ridiculed (also known as Jacobus Sylvius),
by some members of the medical he opened up bodies himself
during anatomy lessons. He and
his students peered inside and
◁ Leonardo’s anatomy of the shoulder they studied what they saw.
Vesalius was inspired by the works of artist Vesalius illustrated the actual
and scientist Leonardo da Vinci, who had anatomy in front of them, using
also produced anatomical illustrations. his own skills and the guidance he
Both were interested in the way form obtained from his artist colleagues.
(shape) reflected function in the body. This observational, empirical

“ Aristotle… says men have more


teeth than women… no one
is prevented from counting….”
ANDREAS VESALIUS, FROM THE CHINA ROOT EPISTLE,1546

72
T H E A N AT O M Y R E V O L U T I O N

approach was very unusual for the △ Vesalius in Padua


time. Traditionally, an assistant or This 1859 work is by Belgian artist Edouard
barber-surgeon (see pp.76–77) Hamman, who specialized in portraying
carried out dissections and the famous people. Vesalius is shown lecturing
corpse received only a brief survey, and demonstrating at Padua, while reading
as the demonstration was deemed from a traditional text (perhaps by Galen)
secondary to the professor reading held by an assistant.
out texts by Galen and others.
Around 1840 Vesalius began
to notice discrepancies between
Galen’s time-honored works
and what he was seeing with
his own eyes. He realized that
Galen had only been allowed ▷ Padua’s anatomy theater
to dissect animals and had then Part of Vesalius’s legacy was the promotion
made assumptions based on their of anatomy to an essential medical subject
anatomy about the human body. for physicians and surgeons. This anatomy
Vesalius also studied animal theater was built in his honor at Padua, and
anatomy, but unlike Galen he opened in 1595 to allow students a close
could compare it directly with view of the proceedings.

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▷ Natural realism his knowledge of human


As well as illustrating what he actually anatomy gained by dissection.
saw, Vesalius posed his subjects in De Vesalius’s view began to clash with
Humani in a lifelike way among the that of other anatomists at Padua.
towns and fields of the area, rather However, a local judge was
than flat on an autopsy slab. interested in Vesalius’s approach
and he agreed to provide him with
the bodies of executed criminals,
thereby allowing him much more
freedom to dissect, scrutinize, and
analyze at great length.

The medical tome


△ Skeleton and skull By 1538 Vesalius had published six
Illustrations of bones, muscles, joints, posters of anatomical illustrations,
and ligaments featured greatly in Tabulae Anatomicae Sex (Six
De Humani. This is plate 22 of the Anatomical Plates), for his students.
first section, set in the appropriate He decided that a full-length book
scene of a graveyard. derived solely from his own
anatomical studies was needed.
De Humani, published in 1543,
was an immense and ground-
breaking work in many ways.

400 ILLUSTRATIONS in 260


scenes depicted in
De Humani, which had a page
size of 16.5 x 11 in (42 x 28 cm).

A huge book, with more than 600


pages, it comprised seven sections:
bones and ligaments; muscles and
tendons; blood vessels; nerves;
digestion; heart and lungs; and
brain and sense organs. The images
were based on observations and
studies of real dissections. They
were beautifully executed with
contours and shading to give a
three-dimensional effect. The artist
is unknown, but is unlikely to
have been Vesalius himself. The
illustrations may instead have
been drawn by noted painter
Jan van Calcar, whom Vesalius
had met in Venice and who
probably also contributed to
Tabulae Anatomicae Sex. In De
Humani, the bodies are shown
in inventive lifelike poses, many
set in the Italian countryside.
Vesalius chose the eminent
Joannis Oporini of Basel for the
printing to ensure that the book
was of the highest quality and
used the latest technology. The
size, scale, clarity, and content of
the work astounded everyone in
the medical profession, and
despite its high price, it soon sold
out. In his work, Vesalius took the
standpoint that, as in nature, as

74
T H E A N AT O M Y R E V O L U T I O N

◁ Colored frontispiece FLEMISH PHYSICIAN (1514–1564)


The first printings of De
Humani and Epitome were ANDREAS VESALIUS
in black and white. Special
presentation copies and Vesalius was born in a series of abdications, he
later editions were Brussels into a well- continued as physician to
hand-colored, like this educated family— Charles’s son Philip II, King
frontispiece from Epitome. his father being an of Spain. Again, Vesalius had
apothecary to both the already dedicated to Philip
Holy Roman Emperor a condensed edition of De
Maximilian I and his Humani, usually called
successor Charles V. After Epitome. Vesalius and his
publishing De Humani family continued to enjoy
at the age of 28 years, the privileges of the royal court,
Vesalius’s fame spread to the court but in 1564 he left Spain,
of the Holy Roman Emperor Charles perhaps to avoid rumored
V, who invited him to join him as accusations of heresy by the Spanish
imperial physician in 1544. This may Inquisition. His wife and daughter
have been in part because Vesalius went to Brussels while he journeyed
had presented to Charles a specially on a pilgrimage and medicinal
dedicated, bound, and hand-colored plant-hunting expedition to the
copy of De Humani. That same year Holy Land. In Jerusalem he received
Vesalius married and the couple had a request to return to Padua, but
a daughter in 1545. on the way his ship was wrecked.
Vesalius traveled widely as a Vesalius was stranded and died in
practicing court physician and from obscurity on the Greek island of
1556, when Charles stood down in Zante (Zakynthos).

well as technology and mechanics, contradicted the knowledge of


form and function are closely Galen and others. Vesalius was
linked. He made many corrections also accused of being antireligious.
to traditional beliefs—for example, However, more progressive
showing that men and women members of the medical profession
have the same number of ribs; soon recognized that they could
that the mandible (lower jaw) not deny what was in front of
is a single bone, not two; that them. In 1555 Vesalius produced
the liver has two lobes, not five; a revised edition of De Humani
that nerves run from the organs that corrected some of his own
to the brain, and not between errors and extended the scope
organs; that the kidneys do to include more on female
not produce urine through the anatomy and pregnancy.
filtration of blood (though this In establishing the modern
was later proved to be true); and science of anatomy, the bold
that the heart’s central dividing and independent Vesalius
wall, the septum, does not have corrected long-held misconceptions
visible pores and so blood cannot and introduced new theories.
pass from one side to the other He also inspired a fresh breed
(see pp.82–83). of anatomists, physicians, and
surgeons, including the Italians
Observations and results Gabriele Falloppio and Bartolomeo
Some medical experts were Eustachi, both famed anatomists
horrified at the way De Humani in their own right.

“ I am not accustomed to saying


anything with certainty after only
one or two observations.” ANDREAS VESALIUS DEMONSTRATES MUSCLE DISSECTION
ANDREAS VESALIUS, FLEMISH PHYSICIAN, FROM THE CHINA ROOT EPISTLE,1546

75
REVIVAL AND RENAISSANCE 700 –1800

Barber-surgeons
The 11th and 12th centuries saw the birth of a new
profession in Europe—that of barber-surgeons. Less
well bred and educated than doctors, barbers—with
their haircutting and shaving tools of sharp blades and
potions, as well as their knowledge of skin and blood—
were well equipped to take on medical challenges.

Doctors in the medieval period were wealthy and educated. They


were well versed in the works of Hippocrates (see pp.36–37)
and Galen (see pp.40–41), but they did not undertake hands-on
activities such as blood-letting, administering enemas, wound
dressing, and callus and worm removal. This was where barber-
surgeons came in. Originally apprentices to the doctors and
physicians, barber-surgeons gradually gained importance as
indispensable medical practitioners in their own right. They
moved up from their local barber shops to more official medical
premises, rubbing shoulders with the medical elite. The scope
of their work widened from setting broken bones to dressing
wounds; soon they were appearing on battlefields across
Europe, where their practical skills and pragmatic approach
saved many lives.
In the 16th century, ambitious practitioners, such as Ambroise
Paré (see pp.78–79), helped the barber-surgeon community gain
legitimate recognition. However, the role of barber-surgeons
faded by the 1700s, when medical training became more formal
and organized. Specialized surgeons with university training and
hands-on experience came to dominate the field of surgery and
barbers went back to hair and beards.

“ At this, I resolved never again


cruelly to burn poor people
who had suffered gunshot.”
AMBROISE PARÉ, FRENCH BARBER-SURGEON, AFTER SUCCESSFULLY APPLYING
A WOUND DRESSING OF EGG WHITE, ROSE OIL, AND TURPENTINE, 1537

▷ All in a day’s work


This painting from the 1670s by Flemish artist David Teniers II
shows barber-surgeons busy at work. The chamber is cluttered
with instruments, jars, and other equipment—distinctly different
from the elegant consulting rooms of physicians of the time.

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R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0

FRENCH BARBER-SURGEON Born 1510 Died 1590

Ambroise Paré
“I dressed him, and God
healed him.”
AMBROISE PARÉ’S MOTTO

F
rench barber-surgeon Ambroise medicine and surgery. He decided
Paré started a quiet revolution to observe carefully, use his own
in surgery in the mid-1500s. judgment, try new ideas, and assess
The changes he brought about the results. This experimental
were the result of his harrowing approach went against the blind
battlefield experience, which led acceptance of age-old methods
him to question many established used by most physicians and
surgical practices. surgeons at the time.
A key moment for Paré came in
1537, when he was serving as an Humble beginnings
army surgeon during the Siege of Born into a working-class family
Turin. Paré ran out of the boiling in France, Paré was apprenticed to
oil concoction used at the time to his elder brother, a barber-surgeon
cauterize (sear and seal) wounds (see pp.76–77) in Paris, when he
involving gunpowder, a process was a teenager. At the age of 22,
that allegedly “detoxified” the body Paré was accepted as an apprentice
of poisons believed to be carried by barber-surgeon at the Hôtel-Dieu
gunpowder and projectiles. In need in Paris, which was linked to
of an immediate alternative, the forward-looking Faculty of
Paré recalled an ancient Medicine at the Paris University.
treatment. He mixed a potion Unlike in other such institutions,
of egg yolks, rose oil, and the apprentices here attended
turpentine and applied it lectures, and received extensive
to the soldiers’ wounds. The training in medical theory, diagnosis,
next day, Paré saw that the and complex surgical procedures.
injuries were beginning to They often worked alongside the
heal. Moreover, the horrific highly qualified surgeons and
pain caused by the boiling oil physicians, rather than as assistants.
treatment had been avoided. The Hôtel-Dieu also introduced
In light of this experience, examinations and qualifications,
Paré resolved to change giving barber-surgeons professional
his attitude toward recognition for the first time.
Paré progressed well toward
his exams, but when his funds
ran low he joined the army as

◁ Father of modern surgery


In the great Hippocratic tradition,
Paré believed that his role was
to ease suffering rather than
increase it, and to assist the
body’s natural curing powers
rather than challenge them.
A M B R O I S E PA R É

◁ Army surgeon TIMELINE


Paré’s experience with amputations during his
time as a battlefield surgeon led him to investigate ■ c.1510 Born in Bourg-Hersent, part
the use of ligatures—strings or threads tied of Laval in western France. Paré develops
around the stump or vessel to stop blood loss. an interest in medicine on account
of his older brother being a barber-
surgeon, and works as an unofficial
apprentice to him.
obstetric procedure of repositioning
■ 1532 Begins training at the Hôtel-Dieu
an unborn baby to increase the
Hospital in Paris as a barber-surgeon,
chances of successful delivery. He
with hopes of becoming a general
disproved the myth of the antidotal
physician. He shows early promise and
power of the bezoar stone—a
progresses rapidly.
lump found in the intestines of
various creatures. He tested a
poison on a royal cook who
had been sentenced to death,
on the condition that should
he survive, his life would be
spared. The cook died seven
hours after receiving the
poison despite being given
the bezoar stone.
Paré wrote at length about
his experiences in French
rather than the usual Latin
a regimental surgeon to raise Paré secure his finances and allowed of medical texts. This allowed ILLUSTRATION OF
money (he would pass the him more time to experiment. He less-educated barber-surgeons to SURGICAL INSTRUMENTS FROM PARÉ’S
LA MÉTHODE CURATIVE DES PLAIES ET
exams later, on his return). devised several new forms of learn from his experiences. With FRACTURES DE LA TÊTE HUMAINE (TREATMENT
prostheses, including hands, arms, this readership in mind his books METHOD FOR WOUNDS AND FRACTURES
OF THE HUMAN HEAD)
Novel methods and legs—some with working were also highly illustrated—yet
Emergency amputations were mechanics—as well as false eyes another of Paré’s innovations. ■ 1536 Appointed a regimental surgeon
usually followed by cauterization. and noses. In obstetrics, Paré in the French army, at a busy time with
Paré noted that this method was is credited with reviving several battles being fought by France
ineffective in containing blood podalic version—the against many enemies, including Spain,
Portugal, and the Holy Roman Empire.
■ 1537 Runs out of the boiling oil solution

“ See how I learned to used to “detoxify” gunshot wounds and


tries a new concoction with considerable
success. Paré resolves to become more
treat gunshot wounds; gentle, more experimental, observe
sharply, and follow his instincts.

not by books.” ■ 1545 His first major work La Méthode


de Traiter les Plaies Faites par les
AMBROISE PARÉ, FROM LES VOYAGES FAITS EN DIVERS LIEUX Arquebuses et Aultres Bastons à feu
(JOURNEYS IN DIVERSE PLACES), C.1580 (The Method of Curing Wounds Caused
by Arquebus and Firearms) is published.
■ 1552 Joins the House of Valois French royal
loss and began using ligatures court as physician to Henry II of France.
for the purpose. However, unlike Catches and ■ 1559 Henry II dies of septicemia following
cauterization, ligatures tended to spring to an eye wound from jousting. Paré is
encourage infection. So some operate hand commended for his efforts in trying to
of Paré’s colleagues began to save the king and continues as physician
combine the two methods. to the next three kings.
Medical experts recognized ▷ Helping hand ■ 1564 Writes Dix livres de la chirurgie
and accepted Paré’s abilities and Paré designed more than (Treatise on Surgery), describing the use
innovations. He helped raise the 50 kinds of false body parts, of ligatures to prevent bleeding after
status of barber-surgeons because including this working hand. amputation, and other pioneering
their profession gradually merged The mechanics were ingenious approaches to treatment.
with that of surgery. His talents also and based on true anatomy, ■ 1590 Dies at the age of 79, still
led to his appointment as royal but too elaborate and holding his position of royal physician.
physician to Henry II of France. ambitious for
Working at the royal courts helped routine use.

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Repair and Reconstruction


Physical defects and disfigurements can occur for many different reasons, ranging
from genetic problems to injuries in warfare. Throughout history, numerous
techniques have been developed to repair, reshape, and reconstruct body parts,
in order to restore function and create a more natural appearance.

T
he reasons for malformations It has been used since ancient
and deformities of the face times in India, Greece, and
and body have changed Rome, along with prostheses
through time. In past centuries (see pp.236–37). One
leading causes were infectious of the first mentions of
diseases such as smallpox and reconstruction appears
leprosy, as well as growths and in the Indian text
tumors, gangrene, skin ulcers, Susruta Samhita (see
and radical surgery. Other causes pp.30–31), which
include wounds and trauma, dates back more
accidental burns, and amputations than 2,500 years.
by machinery. Congenital Conspicuous in this,
problems (present at birth), and other works too,
such as a cleft lip and palate, may is the nose, partly
occur due to inherited or genetic because in ancient India,
defects or malformation in the nose amputation was a
developing fetus. common punishment for
crimes such as adultery.
Ancient origins Susruta Samhita describes
Reconstructive surgery aims to the transplantation of
repair, rebuild, and restore the patches of skin and even
shape and function of a body part. whole noses from one
individual to another. The
ancient Egyptian Smith
papyrus (see pp.20–21),
dating back to about the
same time, also mentions
nose repair. Around 2,000
years ago, Roman writer
Aulus Celsus included
techniques for the
reconstruction of noses and
other parts in De Medicina
(On Medicine).

Rebuilding noses damage. The


Due to its prominence, 16th-century
the nose is particularly astronomer Tycho
vulnerable to traumatic Brahe was famed for
wearing false noses—
allegedly made of silver,
◁ The Indian method gold, copper, brass, or
This 1795 engraving shows an Indian wood—after his was sliced
patient about 10 months after off in a sword duel in 1566.
undergoing rhinoplasty to repair his In the same century in Europe,
nose, which had been cut off during syphilis (see pp.186–87)—a
his time as a prisoner of war. His disease newly arrived from the
forehead retains a scar from where Americas—swept through the
flesh was sliced and folded over to population, causing all kinds
cover the exposed nasal cavity. of terrible symptoms. Among

80
R E PA I R A N D R E C O N S T R U C T I O N

“ We… rebuild those parts which IN PRACTICE

THE GUINEA PIG CLUB


nature hath given, but… fortune Finding volunteers to take part Most members were patients of New

has taken away.” in experimental procedures is a


common challenge for medical
Zealand surgeon Archibald McIndoe.
While working with the veterans,
GASPARE TAGLIACOZZI, FROM DE CURTORUM CHIRURGIA PER INSITIONEM, 1597 projects. The UK’s Guinea Pig Club McIndoe developed new techniques
was formed in 1941 for World War II to save lives, restore function,
military air crew who had suffered improve appearance, and help
the most visible of these was a similar headgear. The Indian disfiguring injuries, especially burns. rehabilitation. Patients continued to
collapsed nose, or “saddle nose.” method of rhinoplasty was These were treated by skin grafts join the club after the war, including
As a result, nasal reconstruction, observed by traveling Europeans and other pioneering reconstructions servicemen who had suffered injuries
also known as rhinoplasty, and also made its way to Europe at Queen Victoria Hospital, East during the 1982 Falklands War. The
became a major medical via Islamic texts. Grinstead, Sussex. club was officially disbanded in 2007.
procedure of the time.
Ancient Indian techniques Refining the art
for rhinoplasty involved In 1412 barber-surgeon Gustavo
slicing a thin flap of skin Branca was licensed to practice in
from the forehead, or Sicily, Italy, where he and his son
perhaps the cheek, angling Antonio soon gained a reputation
it around, and applying it to for reconstructive surgery of the
the nose area. The flap was nose and other facial features. In
left partially attached by one 1456 Italian historian Bartolomeo
or more small stalks of skin, Facia wrote “Branca was the
called pedicles. The pedicles originator of an admirable and
contained blood vessels and nerves almost incredible procedure. He
to sustain the transferred skin until conceived how to repair and replace
it attached naturally to the nasal noses that had been mutilated or
area. Meanwhile the exposed area

1
on the forehead was reduced and MILLION The number of
camouflaged by stretching the skin rhinoplasty procedures Surgery of Mutilation by Grafting). The term plastic surgery, involving
and suturing (stitching) the edges, conducted in the US every year. This pioneering account helped reconstructive surgery for medical

4
and by wearing a turban or THOUSAND The number establish and advance several as well as cosmetic or esthetic
of rhinoplasty procedures kinds of reconstructive surgery, reasons, was introduced into
conducted in the UK every year. including the Italian method medicine in 1818. It was used in
of rhinoplasty based on using German surgeon Karl Ferdinand
cut off and developed his ideas into skin from the arm, which Branca von Gräfe’s report Rhinoplastik,
a marvelous art.” Facia reported had developed. which dealt with the procedure of
that Antonio Branca used skin Tagliacozzi reasoned that the nose reconstruction and improved
and flesh from the arm rather than option of reconstructive surgery upon older techniques. The report
the cheek or forehead, binding the involves weighing the benefits, came 90 years before the invention
patient’s arm up against the head ranging from the undoubtedly of synthetic, moldable plastics, and
for 15–20 days before severing the medical to solely cosmetic, against the term “plastic” was used to
pedicle. These techniques were potential disadvantages such as imply “being shaped or molded.”
refined by Prussian army surgeon discomfort, pain, infection, and
Heinrich von Pfolsprundt, who perhaps failure of the procedure.
wrote about the procedure in Buch For example, rhinoplasty has
der Bündth Ertznei (Book of Directions several advantages. It conceals the
for Bandaging) in 1460. deep nasal cavity visible when the
In 1597 Italian surgeon Gaspare nose is missing, which could be of
Tagliacozzi published De Curtorum great psychological benefit to the
Chirurgia per Insitionem (On the patient. It also helps keep the
mucous membranes lining the
cavity moist and free from
◁ The Italian method irritation, directs airflow in the
During the 15th and 16th centuries, a correct way, and restores more △ Prosthetic noses
series of Italian surgeons developed normal speech quality and tone. Disfigured noses were sometimes covered with
a method of using skin from the arm In addition, the nose provides prosthetics. Of the examples above, the nose on
for rhinoplasty. The arm had to be held support for eyeglasses, which were the left is made of ivory and that on the right of
in place firmly and tightly for weeks, rapidly becoming popular during plated metal. They were usually attached by pastes
otherwise the skin would easily detach. Tagliacozzi’s time. made from natural ingredients, such as plant sap.

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Discovering the Circulation


The concept of circulation—blood pumped by the heart and travelling around the body through
vessels—seems obvious today, but it was a mystery for millennia. It was not until 1628 that English
physician William Harvey gave the first accurate account of this fundamental aspect of physiology.

E
arly notions of the heart, how blood mixed with qi, or life Claudius Galen (see pp.40–41) heart, where it mixed with air
blood, and vessels were often energy, and spread around the body. showed that arteries contain bright from the lungs. Galen believed
metaphysical or fantastical. In In ancient Greece, Hippocrates red blood under high pressure, that blood emitted from the liver
ancient China, the Huangdi Neijing (see pp.36–37) believed that the while the veins through the veins

62,000
(Yellow Emperor’s Classic of Internal arteries carried air from the lungs contain dark MILES had a lowly form
Medicine, see pp.26–27) described and that the heart, thought to blood under low The total length of “natural spirit.”
have three chambers, was the pressure. He of the network of blood vessels In the heart,
seat of intelligence, vitality, and hypothesized a in the human body. blood seeped
▽ The dissection of Thomas Parr warmth. Another Greek physician, system in which through tiny
William Harvey carried out many dissections, Erasistratus, believed that the heart digested food went to the liver, pores in the wall, or septum,
including the bodies of his father and sister. Here produced a “life vapor,” or pneuma, where it was made into new blood, from the right to left side, and so
his subject is Thomas Parr, an Englishman who and blood ebbed to and fro in the which was then sent via the veins into the arteries. Here it became
was said to have lived to the age of 152 years. veins. In ancient Rome, physician to various body parts, including the charged with a higher form, or
D I S C O V E R I N G T H E C I R C U L AT I O N

in 1628. As chief physician at


St. Bartholomew’s Hospital, London,
and royal physician to James I and
his heir Charles I, Harvey had
been dissecting animal species and
“vital spirit,” and travelled to the ◁ Human error cadavers for almost 20 years. In his
brain, where it received the highest Andreas Vesalius’s six anatomical plates, Tabulae seminal book De Motu Cordis (On the
form, known as “psychic spirit.” Anatomicae Sex, were based on his own Motion of the Heart and Blood), he
dissections. However, he was unwilling to introduced the idea of a pulmonary
Debunking old myths contradict the 1,300 year-old teachings of circulation pumped from the heart’s
More than a thousand years passed Galen, and the heart and aorta in this diagram right side to the left, via the lungs;
before anatomists and physicians are similar to those of Galen’s dissected apes. and a systemic circulation pumped
began to question Galen’s from the heart’s left side around the
theories. Arabic physician Ibn body and back to the right. Harvey
al-Nafis (see p.49) challenged to force blood into the arteries. had the faith, but no microscope, to
the notion of tiny pores in the Italian physician Andrea Cesalpino identify the connections between the
heart: “The thick septum of is credited with founding the tiny arteries and veins that complete
the heart is not perforated and concept of general circulation when the circulation. Italian scientist
does not have pores… The blood he concluded in 1569: “the blood Marcello Malpighi revealed these
from the right chamber must is driven to the heart through the as capillaries in 1661 (see p.96).
flow through the vena arteriosa veins, where it attains its last
[pulmonary artery] to the lungs, perfection, and having acquired
spread through its substances, this perfection, it is brought by the ▽ Revolutionary book
be mingled there with air, pass arteries throughout the body.” William Harvey’s De Motu Cordis signaled a new
through the arteria venosa The puzzle pieces were finally era in medicine. Physicians now understood
[pulmonary vein] to reach the assembled into the double circulation and why for example, maintaining
left chamber of the heart, and circulatory system we know today both arterial and venous blood supply to a
there form the vital spirit.” Here by William Harvey (see pp.84–85) body tissue would help avoid gangrene.
was the first account of pulmonary
circulation from the heart’s right
side via the lungs to the left side.
In the early 1500s Italian artist-
anatomist Leonardo da Vinci made
accurate anatomical drawings of the
heart, indicating septal pores in his
illustrations, even though he was
unable to locate them. Flemish-born
anatomist Andreas Vesalius (see allowed only a one-way flow
p.75) also searched for the pores of blood, not the two-way ebb
during studies for his great work and flow of Galen’s system.
De Humani Corporis Fabrica (On the
Fabric of the Human Body), and Double circulation
concluded “even a fine bristle Al-Nafis’s prescient description of a
cannot be made to penetrate from pulmonary circulation was refined
one ventricle to another.” by Spanish anatomist and scientist
The gradual debunking of ancient Michael Servetus in his 1553
wisdom continued when Spanish work Christianismi Restitutio (The
physician Andres Laguna affirmed Restoration of Christianity). Six years
in 1535 that the heart had just two later, Italian anatomy professor
ventricles, rather than three. There Realdo Colombo published De Re
was further development in the Anatomica (On Things Anatomical),
1540s when Portuguese-born which supported the idea of
physician Amato Lusitano showed a pulmonary circulation and
how valves within blood vessels described how the heart contracted

“ The concept of a circuit of the


blood does not destroy, but rather
advances traditional medicine.”
WILLIAM HARVEY, FROM EXERCITATIONES DUAE ANATOMICAE DE CIRCULATIONE SANGUINIS, 1649

83
REVIVAL AND RENAISSANCE 700 –1800

The Circulation
Revolution
William Harvey’s classic work De Motu Cordis (1628) was
badly printed and relatively short at 72 pages. However,
it contained a well-rounded explanation of the circulatory
system that revolutionized physiology and medical theory.

In De Motu Cordis—short for Exercitatio Anatomica de Motu


Cordis et Sanguinis in Animalibus (An Anatomical Exercise on
the Motion of the Heart and Blood in Animals)—British physician
William Harvey compiled many concepts to do with the
circulatory system, some dating back to ancient Greece and
Rome, and integrated them with his own theories and evidence.
He carried out various studies, dissections, and experiments on
humans and more than 60 animal species over a period of more
than 20 years. From this mass of data, he drew a number of
sensible conclusions, such as that, “The blood does pass through
the lungs and the heart by the pulse of the ventricles, and is…
sent into the whole body, and… returns from the little veins to
the greater… from whence it comes… into the ear [atrium] of the
heart.” In particular, Harvey understood that there were two
circulations—from the heart via the lungs and back (pulmonary),
and from the heart through the body and back (systemic).
De Motu Cordis received a cautious welcome from some but
outright hostility from others. Because it denied the teachings of
Galen (see pp.40–41) and other revered ancients, critics claimed
Harvey was “crackbrained.” However, opinions gradually shifted
and the science of De Motu Cordis prevailed.

“ The blood is driven into a


round by a circular motion…
it moves perpetually.”
WILLIAM HARVEY, FROM DE MOTU CORDIS, 1628

◁ Ligature sequence
This illustration from De Motu Cordis shows the valves that prevent
the reverse flow of blood in veins. A ligature, or tight band, around the
upper arm compresses superficial veins, where blood collects, unable
to flow toward the heart. Massaging blood toward the hand has no
effect due to the one-way valves, which appear as small lumps.

85
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Cataract Surgery
The world’s leading cause of poor vision and blindness is the misting, or clouding, of the
eye’s lens, known as cataract. While simple treatments began more than 2,000 years ago,
major advances made since 1967 now enable sight to be restored to millions each year.

T
he chief factor in cataract ◁ Anatomy of the eye and the cornea) to remove any
formation is advancing This semi-anatomical illustration is from the
fragments and fill the space in the
years. Other possible 13th-century Treatise on the Eye by Arabic capsule. With this development,
factors are tobacco smoking and physician al-Mutadibid. At that time, treatments
incisions in the cornea shrank to a
prolonged exposure to strong for eye conditions varying from bruising tofew millimeters. Cataract removal
sunlight. As a cataract forms, infection were in regular use. was transformed from a significant
the clear, flexible lens of the operation to a routine, one-visit
eye—through which light passes procedure that spread worldwide.
after the pupil (hole) and before suture the incision, so patients Kelman’s technique left the rear
the retina—gradually develops were immobilized for days while of the lens capsule in place, which
misty or opaque patches. healing. Topical anesthetics— facilitated the next development, a
Eventually in a “ripe” cataract applied to the surface of a body synthetic lens to make vision clearer.
the lens becomes toughened, stiff, part to numb it—were developed This intraocular lens (IOL) was
and milky, and blocks all vision. in the late developed in the

Early removal
1800s, and
these, along with 32MILLION PER YEAR The World
Health Organization’s (WHO)
1950s by British
ophthalmologist
global target of number of cataract Harold Ridley,
Cataracts were mentioned smaller, finer
millennia ago, in works such as sutures, allowed surgeries to be achieved by 2020. and after many
the Indian Susruta Samhita (see physicians. While the benefit was surgeons to trials IOLs
pp.30–31). In ancient Rome, that the lens could not slip back experiment with smaller corneal became routine from the 1970s.
Greek philosopher Celsus’s across the pupil, the risk of incisions at different sites. An IOL is often inserted into the eye
De Medicina described an already it breaking remained and the right after cataract removal. The
well-established cataract treatment technique was not widely adopted. Advances in surgery lens is shaped for the individual
called couching. In this procedure, In Paris in 1748, French eye doctor In 1967 US ophthalmologist patient’s optical prescription.
a sharp-pointed, but not slender, Jacques Daviel pioneered a new Charles Kelman devised the Newer, flexible materials allow
needle was pushed through the technique. He cut a C-shaped slit phacoemulsification, or “lens lenses to be folded or rolled so they
eye’s surface, its cornea, and the in the cornea; inserted a narrow jellification,” technique of cataract can be implanted through a small
pupil until it met the toughened spatula to hold the cornea away removal. This method uses incision, then opened out. Advanced
lens, which was then manipulated from the lens; freed the lens from ultrasound vibrations to emulsify surgery may use accommodative
downward within the eye. This its surrounding capsule with a the lens, which is then sucked out IOLs, which the inner eye muscles
allowed light to pass to the retina needle; and manipulated the spatula using a hollow needle. At the same can move and alter to focus both
again, although the loss of a so that pressure around the lens time fluid is washed through the far and near, thereby minimizing
focusing lens meant some blurring. caused it to pop out of the capsule, anterior chamber (between the iris the need for reading glasses.
An alternative to needle-couching and through the incision. Leaving
was to strike the eye with a blunt the lens capsule in the eye
instrument, so that the tiny meant less risk of fragments
ligaments holding the lens in place making their way to the
ruptured and the lens slid away of interior. Daviel’s method
its own accord. However with both was painful and there
these procedures an “unripe” were no stitches
cataract could rupture and spill lens small enough to
fragments into the eyeball’s jellylike
interior, risking inflammation,
pain, and further visual problems. ▷ Surgical detail
Couching remained the chief One of the earliest works with
cataract treatment for centuries. pictorial details of cataract
Progress of a sort occurred in the excision was Complete Human
10th century with the use of a Anatomy Treatise Including Surgical
wider, hollow needle to suck out the Treatments by French physician
whole lens, as described by al-Razi Jean-Baptiste Bourgery, completed in
(see pp.48–51) and other Islamic 1850. This edition dates from 1866.

86
Medieval cataract operation
In 1583 German barber-surgeon Georg Bartisch
published the illustrated text Ophthalmodouleia Das
ist Augendienst (In the Service of the Eyes). It described
cataract operations, correcting squints, and the removal
of growths and foreign bodies.
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Exchanging Epidemics
with the New World
When Europeans first came to the Americas in the late 15th century, they
triggered one of the greatest series of epidemics in world history. Without
natural immunity or appropriate medical care, tens of millions of native
Americans succumbed to infectious diseases brought by the newcomers.

T
he arrival of Europeans in fever, yellow fever, pertussis, resistance to their offspring; those △ Cinchona bag
the Americas is usually dated and malaria (see pp.174–75). with little resistence do not. The Used to treat a variety of maladies, cinchona
to explorer Christopher The main reason for the huge Europeans had lived with most of bark was collected in serons, or rawhide bags,
Columbus’s voyage there in 1492. death toll was that the native these diseases for millennia and such as this Peruvian example from the 1770s.
At this time, the population of the people had no immunity against had inherited resistance to the The bark could be chewed in its natural state
New World was estimated to be infections. During this time, they or dried, powdered, and added to drinks.
40–60 million. However, within a
century, the number had declined 5–8 MILLION had also developed preventative
measures, medical care, and
by as much as nine-tenths in some The estimated number of Aztecs treatments—none of which were Syphilis arrived in Europe around
areas, partly due to warfare, but who died of European diseases available to the native Americans. 1495. In the following decades, the
chiefly as the result of huge waves around 1519–20. infection had an estimated death
of infectious diseases inadvertently Two-way exchange rate of more than 75 percent.
brought by the Europeans. the new diseases. Through The Europeans also carried several This rate reduced noticeably within
These imported diseases included generations of evolution, the diseases back home from the a century as the population built
diphtheria, measles, bubonic human body’s immune system Americas. These included syphilis up immunity aided by several
plague (see pp.66–67), smallpox has adapted to combat infectious (see pp.186–87); pinta and bejel— factors. One of these was that
(see pp.100–01), cholera (see organisms in its environment. skin infections linked to syphilis; Europeans had lived closely with
pp.122–23), influenza (see pp.196– People with some degree of natural and Chagas disease (American domestic animals for thousands of
97), typhus, chickenpox, scarlet immunity survive and pass on their trypanosomiasis). years, and had accumulated some
immunity to their diseases—many
◁ Decimated empire related to human illnesses such as

5
This illustration from the
Florentine Codex shows CENTURIES The time it took
Aztecs dying of smallpox, for Central and South
which was allegedly America to recover their
introduced by one African population numbers
slave in the Spanish army. after the deaths that occurred
Almost half of the Aztec following the arrival of the
population succumbed first Europeans.
to the disease, including
their ruler Cuitláhuac.
smallpox and cowpox (see pp.100–
01). In contrast, native Americans
tended to follow a hunter-gatherer
lifestyle, and kept less domestic
stock. Also, Europeans lived in
towns and cities that were densely
populated, and tended to travel
extensively for warfare, trade, and
other reasons. Native populations
in the Americas were less dense
and more scattered, and individuals
traveled less widely and frequently.
So Europeans had a long history of
their bodies being challenged by a
variety of harmful microbes, which

88
EXCHANGING EPIDEMICS WITH THE NEW WORLD

helped build their immunity. the Columbian Exchange, which such as fever, diarrhea, aches, △ Sharing medicine
Therefore, when new diseases also involved an interchange of muscle spasms, and fatigue. In the Peruvian people offer bark from the cinchona
spread from the Americas, domesticated and wild animals 1620s Jesuit priests in the area tree to Europeans suffering from malaria.
resistance to them in Europe’s and plants, and human cultures, discovered that it was especially The Europeans learned much from the native
general population developed customs, and technologies. useful against malaria. In 1630 Americans about plant treatments, including
relatively rapidly—in contrast to One of the most significant a cinchona bark preparation arrowroot, yerba mate, and tobacco—initially
the situation in the Americas. exchanges of plants was that of the produced a malaria cure for Ana regarded as a cure-all for many illnesses.
bark of the cinchona tree, native to de Osorio, the Countess of Chincon
Miracle cure the Andes in South America. Local and wife of the Spanish Viceroy in
The exchange of infectious people, such as the Quechua of Lima, Peru. This encouraged the malaria and many other diseases.
organisms between Europe and present day Peru and Bolivia, knew widespread collection and export In 1820 the bark’s active ingredient
the Americas was part of a larger that ground preparations of the of the bark to Europe, where it was extracted by French chemist
trans-Atlantic phenomenon called bark were effective against ailments was heralded as a miracle cure for Pierre-Joseph Pelletier and his
colleagues, allowing the drug to be

“ In most provinces more than one half of the


produced in pure, accurate doses.
Named quinine, after the Quechua
term for cinchona bark, it has the
population died… in heaps, like bedbugs.” reputation, after antibiotics, of
helping more people than any other
TORIBIO MOTOLINÍA, SPANISH MISSIONARY, ON THE IMPACT OF THE SMALLPOX EPIDEMIC IN MEXICO IN THE 16TH CENTURY medication for infectious diseases.

89
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ENGLISH PHYSICIAN Born 1624 Died 1689

Thomas Sydenham
“ You must go to the bedside.
It is there alone that you
can learn disease.”
THOMAS SYDENHAM, ADDRESSING A YOUNG PHYSICIAN

O
ne of the most respected Plague (see pp.66–67), which
names in the history of swept through London in 1665–66.
British medicine, Thomas This work led to his first book
Sydenham is credited with Methodus curandi febres (The Method
describing and defining specific of Curing Fevers) in 1666, which was
diseases, as well as bringing doctors expanded into Observationes Medicae
out of the laboratories and into the (Observations of Medicine) in 1676,
sick room. His enduring influence a standard medical textbook for
led him to be called the “English over two centuries. His treatise on
Hippocrates” after his death. gout—a condition he suffered from
Sydenham did not devote himself himself—was published in 1683,
to medical practice until middle and is regarded as his masterpiece.
age. He had served under Oliver
Cromwell as a Puritan in the English Diagnosis and drugs
Civil War, and only began to practice A follower of Hippocrates (see
medicine in about 1656, in London. pp.36–37), Sydenham shared
Here, he made a thorough study of his belief in the healing
epidemics, inspired by the Great powers of nature, and kept

△ Of the bloody flux


Sydenham’s description of the bloody flux, or dysentery, is
part of his collected writings, The Whole Works of That
Excellent Practical Physician Dr. Thomas Sydenham. Based
on personal observation, it is full of vivid descriptions.

90
THOMAS SYDENHAM

an open mind about the medical ▽ Laudanum TIMELINE


teaching of the day and his own This drug is made by dissolving opium in
alcohol. First discovered in the 16th century ■ 1624 Born to wealthy landowners
clinical observations. While the
by Paracelsus, it was largely unknown until in a small English village in the county
traditional humors (see pp.34–35)
Sydenham popularized it as a treatment for of Dorset.
provided a foundation for his
work, he began to base his clinical a variety of ailments, particularly pain. ■ 1642 Joins Magdalen College at Oxford;
practice on what he saw. his studies are interrupted by the English
Sydenham had little regard for Civil War, in which he serves as a Puritan.
standard professional etiquette or ■ 1645 Returns to Oxford and enters
theoretical dogma. A compassionate Wadham College.
doctor, he reminded physicians that ■ 1648 Graduates as a Bachelor of
their main duty was to get to know Medicine. However, there is conjecture
and care for their patients. He that he was aided by his family’s
was influential in depicting and connection with the Parliamentarians.
classifying identifiable “species” He is elected a fellow of All Souls
of diseases, which greatly improved College at the same time.
medical diagnosis. For example, ■ 1665 Leaves London during the Great
he described rheumatic fever and Plague. While in the countryside, he
Sydenham’s chorea, distinguished about smallpox and dysentery. There, his views were welcomed writes his first book on the subject of
between scarlatina (scarlet fever) Sydenham wanted nature to take as a return to encouraging the fevers. He dedicates the book to his
and measles, and made observations its course, and prescribed fresh body’s natural defenses, rather than friend, Irish-born chemist Robert Boyle.
air, exercise, and drinking beer challenging it with harsh, powerful ■ 1666 Popularizes the use of quinine
in moderation. “chemical cures.” to treat malaria.
◁ Doctor with compassion Sydenham prescribed drugs that Sydenham’s contemporaries at ■ 1676 Includes important studies of
Sydenham did not blindly trust scientific theories were based on herbalism, such as home were, however, annoyed the London epidemics of the day
when treating patients. Instead, he relied on the juice of willow leaves to treat by the forceful way in which he in his book Observationes Medicae
bedside observations and common sense in his a fever, and he advised restraint, expressed his opinions. He was (Observations of Medicine) and is the
effort to provide effective care and cure. rather than large doses. He not elected to the College of first to attempt to classify diseases
believed that a patient’s symptoms Physicians, and did not endear (this work is considered the basis of
were not the effect of the disease, himself to that esteemed body by the science of epidemiology). He also
but the body’s struggle to overcome saying “physic is not to be learned graduates as a doctor of medicine from
the disease. The introduction of by going to the universities; one Pembroke Hall, Cambridge, nearly 30
quinine in Europe to treat malaria might as well send a man to years after graduating from Oxford.
in the 1630s was a vindication for Oxford to learn shoemaking ■ 1680 Publishes a book on epidemics,
Sydenham. It worked, he stated, by as practicing physic.” Epistolae responsoriae (Letters and
stoking up fever and encouraging However, over time, Sydenham Replies);
nature’s resistance to disease. became the most respected name dedicates it
Opium, used to relieve pain, was in the history of British medicine, to Regius
first mixed to create laudanum by for placing great emphasis on Professor
of Physic at
Cambridge,

“… the doctor… should be Robert Brady.


■ 1682 Writes

diligent and tender in about the


treatment of
smallpox,
relieving his suffering patients… ” and hysteria,
in his book
THOMAS SYDENHAM, FROM MEDICAL OBSERVATIONS CONCERNING Dissertatio
THE HISTORY AND CURE OF ACUTE DISEASES, 1668 epistolaris
(Dissertation
on Letters). EPISTOLAE
RESPONSORIAE,
Paracelsus (see pp.70–71), but clinical observation and accurate ■ 1683 Publishes 1680
Tractatus de
Sydenham’s different mixture— descriptions of disease. Sydenham
Padagra et Hydrope (The Treatise on
a tincture of opium mixed with was not concerned with flowery
Gout and Dropsy). It distinguishes gout
wine or water—popularized the medical theory and derided those
from rheumatism, and is considered
medicine. It was so revered it was who were. He believed that disease
Seydenham’s greatest work.
named Laudanum Sydenhamii. “visits” a patient, rather than being
■ 1689 Dies in London; is buried
an integral and ongoing aspect of
in St. James’s Church, Piccadilly.
Gaining popularity the patient—a revolutionary
It was in mainland Europe that concept and one that changed the
Sydenham made the greatest impact. way physicians practiced medicine.

91
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Early Microscopists
Some technological advances, such as X-rays (see pp.172–73), were quickly assimilated
into medical practice. The microscope on the other hand, invented in the 1590s, only
began to be used for medical research half a century after its invention (see pp.96–97).

S
imple magnifiers using a ◁ Janssen’s microscope
single glass convex lens— Made around 1876, this is a replica of
bulging in the middle—were a very early Janssen microscope from
in use in ancient Rome some 2,000 the 1590s. It has three tubular sections,
years ago. Lens-making improved which slide in and out to focus, and two lenses.
from the 13th century when the Maximum magnification was about 10 times.
use of eyeglasses began to
spread, and magnifiers
known as “flea glasses” curiosities with this time as the “microscopium”;
that could provide little scientific use. the English term “microscope”
magnifications of 10 They suffered from blurring came into use in the 1650s. In
to 15 times were also and chromatic aberration—a 1644 Italian astronomer Giovanni
invented. In the 1590s the problem where light waves of Hodierna reported that he had
compound microscope, using different lengths come into focus at used a telescope modified as a
two or more convex lenses, was different places to produce colored microscope to count 30,000 “little
invented. Some historians credit fringes—and their magnification squares” on a fly’s eye. In 1655
the invention of the microscope was limited to 15 to 20 times. Peter Borel, physician to King
to the Dutch lens-makers, father- Louis XIV of France, wrote De Vero
and-son duo Hans and Zacharias Early microscopic studies Telescopii Inventore (The True Inventor
Janssen. Others believe the Dutch One of the first publications to use of the Telescope). The telescope was
inventor and eyeglass-maker Hans microscopic studies was the 1625 now being improved at a much
Lippershey made the first Anatomy of the Bee, as Revealed by the faster rate and at the end of his
microscope. Italian polymath Microscope, by Italian scientist and text Borel included microscope
Galileo Galilei worked on writer Francesco Stelluti. He information and observations,
improving microscope lenses achieved clear magnifications of saying: “A microscope, whether
in the early 17th century, but around five to seven times. The it be a flea glass or a fly glass,
early microscopes were mainly device was known in Italy during whereby a flea is enlarged to the
size of a camel, and a fly to the size
DUTCH SCIENTIST (1632–1723)
of an elephant, is made out of two
glasses enclosed in a small tube:
ANTONI VAN LEEUWENHOEK the glass nearest the eye is convex
and made out of a small segment of
Originally a textile merchant, a spherule, whose diameter should
Antoni van Leeuwenhoek became be two inches: the other glass is
interested in microscopy while plane [has one flat side].”
trying to improve magnifier lenses
for inspecting cloth threads. He Pioneering microscopists
used an unusual single-lens Two people who helped the
design, through which he achieved microscope gain greater fame, and
magnifications of more than 250 encouraged its use in medicine,
times. As a merchant Leeuwenhoek were British polymath Robert
understood the need for trade Hooke and Dutch polymath Antoni
secrets and kept his methods to
himself—his unique lens-making
procedures were not rediscovered ▷ Campani’s microscope
until the 1950s. With almost 200 Dated 1686, this is the first illustration of
scientific articles published by the a microscope in medical use—to examine a
Royal Society by the time of his patient’s leg. The device (enlarged on the left),
death, Leeuwenhoek can be seen made by Italian inventor Giuseppe Campani, had
as the first expert microbiologist. a screw thread for focusing. Light concentrated
from a candle was used to illuminate the area.

92
E A R LY M I C R O S C O P I S T S

“ There were many very ▷ Drawing of a flea


Robert Hooke’s

little living animalcules


Micrographia
popularized the
microscope. He helped
very prettily moving.” improve viewing with
techniques for brightly
ANTONI VAN LEEUWENHOEK, DUTCH SCIENTIST, DESCRIBING illuminating specimens. Tiny
BACTERIA IN AN EARLY LETTER TO THE ROYAL SOCIETY, 1683 pests could now be identified
with certainty, such as which
kinds of fleas carried plague.
van Leeuwenhoek. Hooke was one the smallest self-contained units
of the first and most prominent of living things (see pp.150–51).
members of the Royal Society of Van Leeuwenhoek devised an
London for Improving Natural unusual microscope using a single,
Knowledge. In 1665 he published almost spherical lens. Using this,
Micrographia, with drawings of he was able to observe, describe, Leeuwenhoek’s findings were Cohn who, in the 1870s,
many tiny objects, from parts of and draw a range of biological published by the Royal Society from classified bacteria into the four
plants to insect eyes and legs. The specimens, such as animalcules 1673. In 1877 the Leeuwenhoek groups—spheres, rods, threads,
book was one of the first scientific (single-celled microorganisms) in Medal was established in his honor and spirals—still used today. By
bestsellers. Hooke coined the term pond water and other fluids, blood by the Royal Netherlands Academy this stage microscopy was being
“cell,” which would soon gain cells, sperm cells, and the banding of Arts and Sciences. It was won in applied to the human body and
general usage when referring to patterns of skeletal muscle. Van 1885 by German biologist Ferdinand medicine (see pp.96–97).
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Eyepiece lens Series of


swivel nuts

1 SMALL COMPOUND 2 HOOKE’S MICROSCOPE


MICROSCOPE (C.1665)

Water container 3 LYONNET’S MICROSCOPE


(LATE 1700S)

Planar mirror to
illuminate specimen
Lamp-oil
reservoir
Drawer to store
specimen and
instruments

Focusing
screw
Objective
lens

Stage for
holding
specimen
Device with
Illuminating polarizing
mirror prisms
Eyepiece

4 CULPEPER
MICROSCOPE
(C.1740)

5 SIMPLE MICROSCOPE

Lens lodged between


two brass plates

Brass stage

Screw to move
specimen up
or down

6 LEEUWENHOEK’S
MICROSCOPE (C.1674)

94
EVOLUTION OF MICROSCOPES

Evolution of Microscopes Eyepiece

The first microscopes were simple devices with two lenses fixed together in a
tube. The magnified images they produced revealed a new world for scientists
to explore in minute detail. As the quality of lenses improved, so did the images.
Optical lens on top of
conical part of tube Bull’s eye lens
1 Small compound microscope This early voyage aboard the Beagle. 6 Leeuwenhoek’s focuses light
from source
microscope comprises two lenses. As a result, the image microscope Dutch scientist Antonie van Leeuwenhoek onto specimen
is twice magnified. 2 Hooke’s microscope This built this simple microscope, using a biconvex lens.
replica of British scientist Robert Hooke’s compound 7 Polarizing microscope Designed by British
microscope uses a water-filled glass container to focus geologist Allen Dick, this device uses polarized
light from a lamp onto the specimen being observed. light—with light waves undulating in a single plane.
3 Lyonnet’s microscope Dutch naturalist Pierre 8 Cary-Gould microscope This Gould-type
Lyonnet designed this simple microscope with a lens compound microscope by manufacturer Cary, London,
mounted on top of a series of ball-and-socket joints consists of three lenses. 9 Binocular microscope
attached to a small dissecting table. 4 Culpeper A complex microscope, this device has a built-in
microscope Built by British instrument-maker Edward illumination system and its twin eyepieces reduce strain
Culpeper, this compound microscope had an inflexible, on the eyes when used for longer periods. 10 Electron
upright style. 5 Simple microscope This simple microscope This microscope uses an electron beam
aquatic microscope is very similar to the one used by rather than light to form an image, and allows for
British naturalist Charles Darwin on his exploratory increased magnification and improved resolution.

7 POLARIZING 8 CARY-GOULD Substage


MICROSCOPE MICROSCOPE (1800S) mirror
(C.1890)

High voltage

Electron gun

9 BINOCULAR 10 ELECTRON
Revolving
MICROSCOPE MICROSCOPE
nosepiece
holding
objective
lenses

Coarse Monitor for viewing


focusing magnified image

Fine focusing

Illuminator with lens; can


be replaced with a mirror
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The First Microanatomists


The first microscopists studied tiny objects from the natural world, such as insects.
But from the late 17th century, the microscope had become a potent tool for anatomical
and medical research and was used to study cells, tissues, and microbial germs.

T
he invention of the light produced the irritation and pain of ▷ Seeing neurons
microscope in the 1590s conjunctivitis, and that removing The long, thin fibres of
uncovered a new world them solved the problem. nerve cells, or neurons,
of tiny objects and living things. Marcello Malpighi (see panel, are visualized here using
By the late 17th century, several below) was a principal pioneer a Golgi stain, containing
researchers were investigating the in microanatomy and medicine, silver compounds.
previously unknown and unseen and studied a huge variety of plant, Golgi discovered this
world of human tissues and animal, and human tissues. In staining technique in
cells, and the harmful microbes, about 1661 he identified tiny 1873 and called it the
“black reaction”.
or pathogens, that cause disease. channels or vessels in frog lungs
that had minute bodies moving
Microanatomy through them. This was one of the
In 1653 Peter Borel (see pp.92–93), first descriptions of capillaries—the also to stain or inject them with of the first automatic cutting
physician to the French King Louis “missing link” between arteries and substances so they could be better machines—the microtome.
XIV, provided one of the first veins in the circulatory system, as seen under the microscope. This device was improved in
accounts of the microscope for described by William Harvey (see the late 18th century, by Scottish
medical use. He described how tiny pp.84–85) in 1628. Malpighi also Beginnings of histology instrument-maker Alexander
ingrowing eyelashes, which could devised new methods to illuminate In the late 17th century, Malpighi Cumming, and then significantly
only be seen using a microscope, tiny specimens more brightly, and laid the foundations for histology, advanced by Swiss anatomist
a new branch of science. Derived Wilhelm His in the 1860s.
from the Greek word histos— A second area of progress for
I TA L I A N B I O L O G I S T A N D P H Y S I C I A N ( 1 6 2 8 – 1 6 9 4 )
meaning web or tissue—histology histology was in the treatment and
MARCELLO MALPIGHI is the study of tissues, which are a preservation of tissue samples with
collection of similar cells, such as chemicals. This made them firm,
Born near Bologna in Italy, to the Pope in Rome. He died muscle, bone, nerve, or cartilage. and therefore, easier to slice. In the
Malpighi received his there, probably of a stroke, French anatomist Marie-François 19th century this procedure was
doctoral degree in in 1694. His name is Bichat further developed the improved when the use of salts and
philosophy and medicine commemorated in many understanding of living tissues acids was replaced by the use of
from the University of areas of biology and in the 1790s. paraffin wax to penetrate and
Bologna in 1653. human microanatomy, The quality of microscopes support the sample during sectioning.
Alhough he showed from Malpighian tubules improved with time, and so did In the 1890s formalin came into
some interest in in the excretory system of the techniques used for examining fashion as a preservative-fixative—
teaching, by 1660 he had insects, to the Malpighian specimens. One method was to use a compound that hardened fresh
become a doctor and layer of the skin’s epidermis, a very thin slice, or section, of tissues, helping retain the minute
researcher in microanatomy, and Malpighian corpuscles— tissue. At first, sections were cut details of the cells. Another
and studied different kinds of clumps of white blood cells by hand using a razor blade; but in advance in histology was the
plants and animals at his estate near that are found in the spleen. 1770 George Adams invented one development of stains, or dyes, to
Bologna. He accepted professorships
at the universities of Pisa and
Messina, in 1656 and 1662,
respectively. However, his discoveries
“ Observation by means of the
challenged the approaches and
beliefs current at the time, provoking
microscope will reveal
controversy and making him
unpopular among his colleagues. more wonderful things
than those viewed in regard
In 1668 Malpighi became a
member of Britain’s Royal Society,
which reported much of his work.
Toward the end of his life in 1691,
Malpighi was appointed physician
CAPILLARIES IN
THE LUNGS DRAWN
BY MALPIGHI
to mere structure.”
MARCELLO MALPIGHI, ON THE DISCOVERY OF CAPILLARIES, DE PULMONIBUS, 1661

96
T H E F I R S T M I C R O A N AT O M I S T S

color certain structures and cells blue, while eosin stains Johannes Müller in 1838. During △ Artist at work
substances to be viewed under the the cytoplasm or “jelly” pink. the 19th century, microanatomy, In addition to being a histologist, Cajal was
microscope. One of the first stains, Hundreds of stains have since been histology, and histopathology were also a talented artist. He produced hundreds
introduced in 1774, was Prussian invented for specialist applications. responsible for many momentous of illustrations mapping the nervous system,
blue. A version devised in the medical advances, including germ which are still used as teaching aids today.
1860s to show up iron-containing Advances in histology theory (see pp.146–47), identifying
substances, such as hemoglobin, Histology is partnered with infectious microbes, vaccine
was known as Perls’ blue stain after histopathology in the study of development, and unraveling the
German pathologist Max Perls. abnormal tissues and how they microstructure of body systems, Golgi from Italy, and Santiago
The H&E (hematoxylin and eosin) lead to diseases. The first work to especially the brain (see pp.160– Ramón y Cajal from Spain. Golgi
stain, first described in 1876 by describe histopathology and its 61) and nerves. developed a stain to show the
chemist A. Wissowzky, is still the techniques was On the Nature and In 1906 the Nobel Prize in details of nerve cells, while Cajal
most popular stain used today. Structural Characteristics of Cancer by Physiology or Medicine was jointly described the organization of these
Hematoxylin colors the nuclei in German physiologist and scientist awarded to two histologists—Camillo cells in the brain.

97
REVIVAL AND RENAISSANCE 700 –1800

Scurvy
For more than 400 years, scurvy was the bane of sailors.
A breakthrough in understanding the disease came in
1747 when Scottish physician James Lind proposed that
scurvy was caused by vitamin C deficiency.

Although scurvy had been prevalent since ancient times, the


disease did not become problematic until the growth in European
exploration and trade saw men set off for increasingly long
periods at sea. Crews were forced to eat salted meat and biscuits
for long periods, which deprived them of essential vitamins. After
about 30 weeks without vitamin C (ascorbic acid) in their diet
crews began to show the classic symptoms of scurvy—bleeding
gums, blackened skin, rictus of the limbs, and loose teeth.
In the 18th century, James Lind, a physician in a Portsmouth
naval hospital, became interested in the disease and carried out
a small clinical trial on HMS Salisbury. He discovered that scurvy
resulted from an inadequate diet and recommended that a ration
of fresh fruit be supplied daily to prevent it. In 1753 Lind
published his findings in A Treatise of the Scurvy. British captain
James Cook tried a variety of methods to combat scurvy. In 1768
he carried sauercrat on his three-year circumnavigation of the
world aboard HMS Endeavour and his crew remained scurvy-
free, thus showing the effectiveness of the methods proposed by
Lind. But despite a lot of evidence, it took another decade before
the navy gave citrus juice to its sailors as standard daily issue.

“ … the most sudden and visible


good effects were perceived
from the use of oranges
and lemons.”
JAMES LIND, SCOTTISH PHYSICIAN, FROM A TREATISE OF
THE SCURVY, 1753

▷ Scurvy
This page from the journal of British naval surgeon Henry Walsh
Mahon from his time aboard HM Convict Ship Barrossa (1842)
shows the effects of scurvy. Here, he describes typical symptoms
that develop on a patient’s leg, including lesions; open, festering
wounds; dark patches; and bleeding.

98
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0

Smallpox:
The Red Plague
Of all human diseases, smallpox has perhaps the most
claims to fame—or rather, infamy. It has featured in all
of recorded history, killed billions, and inflicted lasting
suffering on billions more. It was the first infection to
be immunized against, as well as the first—and currently
only—major global disease to have been eradicated.

S
mallpox was caused by were left with disfiguring scars,
several forms of the Variola physical disabilities that sometimes
virus. In typical cases it included blindness, and mental
attacked small blood vessels in anguish since they were shunned
the skin, mouth, and throat, by or even cast out of society.
causing fluid-filled blisters. The Smallpox and its virus were part
most virulent forms killed an of a group of diseases that included
estimated one-third of victims. cowpox, horsepox, camelpox, and
However, during monkeypox. The

1
sudden, fast- The number of deaths term “pox” refers
spreading caused per second by to skin eruptions
epidemics the smallpox in the 19th century. or sacs that leave
death toll could be pitted pockmarks,
as high as 80 percent. and it has been applied to a wide
Smallpox spread through the range of diseases from acne to
inhalation of airborne droplets syphilis. The name “small pockes”
from an infected person’s mouth, was introduced in England in the
nose, and airways. It also spread late 15th century to distinguish
by direct contact with bodily the viral disease from syphilis,
fluids or shared objects such as which was then called the “great
clothing. Survivors of the disease pockes.” Smallpox was also

◁ Poxified mummies
Several Egyptian mummies have pitted, pockmarked skin
indicating smallpox infection. One of the victims was
Pharaoh Ramesses II (shown here), who died around
1213 BCE aged 90 years. His mummy was discovered in
1898 and has facial skin lesions. The remains of Ramesses V,
who died in about 1145 BCE, show similar evidence.

100
SMALLPOX: THE RED PLAGUE

“ For no one was ever attacked a second


time, or not with a fatal result.”
THUCYDIDES, GREEK GENERAL AND HISTORIAN, FROM
HISTORY OF THE PELOPONNESIAN WAR, 431 BCE

known as the “red plague”—a Possible descriptions occur in


name derived from the red rash, ancient Chinese and Indian texts
blisters, and extensive bleeding dating back more than 3,000 years.
that characterized the more Accounts of the Egyptian Hittite
serious forms of the disease. Wars also mention a smallpoxlike
epidemic in about 1350 bce, and the
Origin of the virus ancient Greek historian Thucydides
Studies of the smallpox virus documented a plague in Athens in
genes suggest that it probably 430 bce that killed an estimated
originated in rodents and then 30,000 people and may have been
transferred to humans about smallpox too.
10,000 to 50,000 years ago. Gradually, descriptions of the
Various forms of smallpox disease became clearer and more
then developed, notably in accurate. In about 910 one of
Africa and Asia. the greatest Islamic physicians,
Because the infection was highly al-Razi, explained how to
variable—some forms were relatively distinguish smallpox from other
mild and led to quick recovery, pustule-forming diseases in his
others were severe and fatal—it Kitab al-Jadari wa ‘l-Hasba (Treatise
is difficult to identify the earliest on Smallpox and Measles). He also
presence of smallpox in history. recorded that the disease spread
from person to person, and that
survivors did not develop it again.
◁ God of smallpox Through the medieval period,
Yu Hoa Long was the Chinese god new forms of the virus emerged
of smallpox. Many ancient cultures and followed trade, migration,
viewed smallpox and similar diseases and slave routes in the Old World. In the 1790s the disease reached △ Symptoms of smallpox
as punishment from spirits and When Christopher Columbus Australia and killed up to half of In 1720 the Japanese doctor Kanda Gensen
deities for sins committed in this and his crew began the European the Aboriginals in eastern regions. published Toshin Seiyo (Essentials of Smallpox),
life or a previous one. colonization of the Americas in an illustrated explanatory work that carried
1492 they brought smallpox to Conquering the dreaded pox numerous coloured illustrations of the different
the New World. The indigenous Back in Europe, Asia, and Africa, symptoms of smallpox. This illustration shows
populations had no natural smallpox continued to be a major a face marked with smallpox scars.
immunity against the disease, cause of deaths, killing over 500
and within half a century tens million during the 18th century.
of millions of them succumbed, However, in 1798, experimental introduced in 1809, and the UK
helping the invading Europeans vaccinations by English physician followed suit in 1853. By the
destroy the Aztec, Inca, and many Edward Jenner, based on the 1940s research into freeze-dry
other civilizations (see pp.88–89). technology made vaccines less

1978 The year when the expensive, more stable in storage,


last recorded death and considerably easier to prepare
CONCEPT
from smallpox occurred. Janet and administer.
VARIOLA VIRUS Parker was infected due to an In 1967 the World Health
accidental release of laboratory- Organization set up its Smallpox
The causative agent of smallpox kept viruses at her workplace in Eradication Campaign. With a vast
is the Variola virus. It is about the University of Birmingham effort and much monitoring, case
0.3 µm long—placed end to Medical School, England. numbers declined. The last case in
end 3,000 viruses together would South America occurred in Brazil
stretch one millimeter. In this procedure known as variolation, in 1971, and in South Asia in 1975,
electron micrograph, the red provided immunity against the and the last known case of natural
area shows genetic material— disease (see pp.102–03). Within smallpox infection was identified
DNA with about 200 genes. The a decade, immunization programs in Somalia, Africa, in 1977. The
tough outer coat of protein is were being taken up around WHO declared the world free of
colored yellow. the world. In Massachusetts, this age-old scourge in 1980, and
compulsory vaccination was in 1986 vaccination ceased.

101
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0

The First Vaccination


A technique established by Edward Jenner in the 1790s, vaccination greatly reduces
the risk of infectious diseases by helping the body develop immunity. Along with
antibiotics, it is regarded as one of the foremost advances in medical history.

I
mmunization is the process of Early variolation for its acceptance in Britain. By Several others had investigated this
making the body resistant to an It was widely known in ancient 1721 with smallpox again on the link, such as the English physician
infectious disease by working times that the body develops rise, Lady Montagu persuaded John Fewster, who wrote a paper
with the body’s natural defenses. natural resistance to diseases. the royal doctor Hans Sloane to “Cow Pox and Its Ability to Prevent
Natural immunity starts to develop The earliest attempts to induce try variolation. Informal tests on Smallpox” in 1765, but it was largely
when infecting microbes invade immunity artificially may date prisoners were successful and ignored. In 1774 Benjamin Jesty, a
the body and the immune system back more than variolation gained farmer, reportedly used a darning
fights them by releasing antibodies. 2,000 years in India, popularity, having needle to introduce cowpox sore pus
After infection, the immune system
“remembers” those microbes and if
but the idea of
immunization rose
249 People given
variolation in been accepted by
1721 by physician Zabdiel members of royalty.
into his family, but he was mocked
when his wife became very ill.
it encounters them again it quickly to prominence in Boylston in Boston—the Variolation became
produces antibodies to prevent China in the first US inoculations. more common
the body from attack. Vaccination medieval period, throughout the
induces immunity artificially by when individuals were inoculated 18th century, but it continued to
imitating an infection, but without with the smallpox virus (see be unpredictable, with occasional
causing illness. An essential part of pp.100–01). Procedures involved serious cases and even deaths.
modern medicine, vaccines have taking blister fluids, pus, or scabs Another disadvantage was that
been developed against many from a person infected with a mild variolation necessitated the isolation
dangerous infectious diseases. case of smallpox and giving them to of the recipient for two weeks.
an uninfected person. This was done
by rubbing them into cuts in the Jenner’s breakthrough
skin or blowing ground scabs up the Edward Jenner was a successful
nose. While there was a slight risk country physician-surgeon in
of developing severe smallpox, this Berkeley, southwest England, as
method had a much greater chance well as a talented naturalist. He had
of offering protection, reducing undergone variolation in his youth,
mortality rates caused by smallpox which had made him ill for a time.

“ Future nations will know…


smallpox has existed and by
you has been extirpated.”
THOMAS JEFFERSON, IN A LETTER TO EDWARD JENNER, 1806

from 30 percent to less than 5 As a doctor, Jenner was aware of


percent. The English later named the common belief that catching
the process variolation (from the cowpox somehow gave protection
Latin varius, meaning speckled). against smallpox—very few
milkmaids and cattle herdsmen
Increasing popularity seemed to suffer from the latter.
The popularity of variolation in
Britain is mostly credited to Lady
△ Lady Mary Montagu Mary Montagu who, having seen its ▷ At work
Wife of the British Ambassador to the Ottoman success in Constantinople (modern Jenner’s Case 17 in 1796 involved vaccinating
Empire in Constantinople, Lady Montagu started Istanbul, Turkey), was convinced eight-year-old James Phipps with cowpox, which
a successful campaign to introduce variolation of its worth and had her own son caused slight symptoms. Six weeks later, Jenner
to Britain. She had suffered from smallpox in her variolated around 1716. She began deliberately infected him with smallpox and
youth and also lost her brother to the disease. to gather evidence and campaigned recorded: “No disease followed.”

102
T H E F I R S T V A C C I N AT I O N

◁ Cowpox sores patients by first vaccinating them


The sore material used for the with cowpox material and then
vaccination of James Phipps giving them smallpox. He noted
(below) came from the hand of that after the cowpox vaccine his
a local dairymaid, Sarah Nelmes. patients did not catch smallpox.
Case 16 in Jenner’s report, she had Although the medical community
caught cowpox naturally, and did had doubts about the ethics of such
not suffer from the disease. an experiment, Jenner’s thorough,
scientific account of vaccination
and its success gained immediate
attention. His procedures were later
Jenner knew that for the link to be improved by others and rapidly
taken seriously a report on careful spread around the world.
medical trials was needed. In 1798
he published An Enquiry into the
Causes and Effects of the Variolae ▷ Ridiculing the vaccine
Vaccinae: A Disease Discovered in Some This caricature of Edward Jenner vaccinating
of the Western Counties of England, his patients against smallpox using the cowpox
Particularly Gloucestershire, and Known virus aptly reflects the mindset of the public
by the Name of the Cow Pox, which before the treatment was established. His
described his treatment of 23 patients are shown growing cow heads.

103
REVIVAL AND RENAISSANCE 700 –1800

Phrenology
The practice of phrenology—ascertaining a person’s
character, morality, and intellect by feeling and measuring
the contours of the head—is regarded as outdated and
unscientific today. Yet this field enjoyed considerable
success in the first half of the 19th century, chiefly in
Britain, Ireland, parts of mainland Europe, and the US.

Phrenology grew from concepts developed by German physician


Franz Gall (1758–1828). At school, he noticed a fellow pupil who
had an unusually proportioned head and a great talent for foreign
languages. Gall began to investigate links between the shape of
the brain and the skull, and traits of the personality. He proposed
that the brain was composed of 27 “organs,” each the center of
a different trait: the larger the “organ,” the more it contributed
to the character. The skull bone’s contours, which could be
discerned by observing, feeling, and measuring, followed the
location and development of the organs beneath. By 1800
Gall was lecturing and writing articles about his ideas, which
were then built upon by his followers.
It is now known that phrenology has no scientific basis, but
at the time, it was used by many people as a tool to substantiate
controversial causes—for example, to demonstrate the supposed
superiority of one ethnic group over others. Although phrenology
had waned by the 1850s, some of Gall’s ideas are echoed in
modern neurology and psychology, such as the belief that certain
regions of the brain perform particular mental functions.

“ The convolutions of the


brain… are the parts in which
the instincts, sentiments,
propensities are exercised…”
FRANZ GALL, FROM ON THE FUNCTIONS OF THE BRAIN
AND OF EACH OF ITS PARTS, 1796

▷ Head cases
This collection of around 60 model heads was sculpted by
Swiss-born, England-based wax modeler and phrenologist
William Bally to explain the principles of phrenology. Sets of
plaster casts such as these were sold as teaching aids and
displayed at Britain’s Great Exhibition in 1851.

104
Islamic hospitals
An Arab doctor carries out an inspection of a
ward in a hospital in Córdoba, Spain, which
was under Muslim rule until 1236. Islamic
hospitals practised advanced techniques,
including the use of willow as an antiseptic.

The Modern Hospital


The 19th century saw the rapid growth of specialized hospitals, formal medical training schools,
and a professional nursing corps. This provided much greater access to hospitals, and far higher
levels of care for a greater number of patients from a wider variety of backgrounds.

A
lthough the Roman most frequently cared for lepers, The Dissolution of the Monasteries of religiously run institutions.
army had established or, from the 14th century onward, under Henry VIII, between 1536 In Vienna, the Allgemeines
valetudinarian, or hospitals, for plague victims, those suffering and 1540, led to the closure of Krankenhaus (general hospital)
for wounded or sick soldiers (see from other infectious diseases, and hundreds of former monastic was remodeled by Emperor
pp.38–39), there is no evidence the mentally ill. hospitals in England. Only a few Joseph II in 1784, and included six
of specialized buildings to provide More formal hospitals did exist were refounded, so by 1700, medical and four surgical wards.
medical care for civilians before the in the Islamic world (see pp.48–51), London, a city of 500,000 people,
4th century CE, when charitable the oldest having originated in had only two substantial medical New hospitals
Christian donors began founding Baghdad around 805. Medical hospitals—St. Bartholomew’s and As London’s population grew
establishments to tend to the training was undertaken in some St. Thomas’s. Elsewhere in Europe and became more prosperous,
impoverished sick. Hospitals in of them, but they cared mainly the situation was slightly better there was increased pressure for
medieval times were commonly for the poor rather than the because the Reformation had not better medical coverage. Helped
associated with monasteries, and general populace. led to the wholesale closure by donations from rich merchants,

106
T H E M O D E R N H O S P I TA L

“ A place set up on purpose for sick


children; where the good doctors…
comfort and cure none but children.”
CHARLES DICKENS, DESCRIPTION OF GREAT ORMOND STREET HOSPITAL FOR SICK CHILDREN,
IN OUR MUTUAL FRIEND, 1864–65

more hospitals were built: the Massachusetts Eye and Ear


Westminster in 1720, Guy’s in Infirmary, established in 1824.
1724, St. George’s in 1733, and Specialized maternity hospitals
The London in 1740. Provincial appeared for the first time too,
cities acquired their own beginning with the British
hospitals—at Bristol in 1737 and Lying-In Hospital in 1749.
at York in 1740—while in Scotland The Hospital for Sick Children at
the Edinburgh Royal Infirmary Great Ormond Street was founded
was built in 1745. In the United in 1852, but pediatric hospitals
States, the first general hospital had already been established in
was founded in Philadelphia in Paris (1802), Berlin (1830), and Training nurses △ Charity hospital in Paris
1751, and the New York Hospital Vienna (1837). In the 19th century nursing also In France, a series of charités, or hospitals for
followed in 1771. Hospital doctors were now better became a formal profession. the poor, were founded in the early 17th century.
trained than ever before. In 1750 Theodore Fliedner, a Lutheran Like most hospitals at the time, The Hôpital de
Specialization begins the Edinburgh Royal Infirmary pastor, established the Deaconess la Charité, established in 1602, was staffed by
For the first time, specialized established a special clinical ward, Institutions at Kaiserwerth near a religious order—the Brothers of Charity.
hospitals began to be established where medical students were taught Düsseldorf, Germany, in 1836,
that allowed doctors and surgeons with direct reference to the patients, to provide training for women
to gain experience in the treatment and by the 1770s the concept of to become “nurse-deaconesses” the British troops during the
of a particular ailment. In England, clinical lecturing on wards had in religious orders. It became a Crimean War (1853–56). On her
the Moorfields Eye Hospital was the spread to Vienna. The formalization magnet for nursing reformers from return, a public subscription of
first (in 1804), followed by about of medical education took a step other European countries. Florence more than £44,000 was raised,
65 others by 1860, including the further in 1834 when University Nightingale (see pp.142–43) spent which enabled her to found a

900
Royal Hospital for Diseases of College London established its own three months at the institute in
the Chest (1814). In the US the hospital dedicated to instructing 1851 before practicing what she PERCENT
earliest specialized hospital was medical students. had learned in field hospitals for The increase
in the
number
▷ Clarence ambulance of outpatients attended to
Adapted four-wheeled Clarence carriages, at St. Thomas’ Hospital, London,
drawn by two horses, were used as between 1800 and 1890.
ambulances in Scotland until the early
20th century. The first Scottish nursing school in Britain. From
ambulances were a pair of 1860 Nightingale’s institute
sedan chairs, purchased provided trained nurses to the
for the Edinburgh new English hospitals.
Royal Infirmary. As the medical services offered
by hospitals increased, there was
a danger that poor patients would
be squeezed out. Hospitals started
Carriage was harnessed charging patients a small fee, and
to horses middle-class patients began to
pay more for access to private
rooms. To counter this trend, new
Canvas stretched
across poles to carry “dispensaries” appeared, which
weight of patient provided medical care to the poor
for free. These institutions, such
as the New York Dispensary
(1790), the Public Dispensary
of Edinburgh (1776), and the
Finsbury Dispensary (1780),
were the true descendants of
their medieval forerunners.

107
R E V I VA L A N D R E N A I S S A N C E 7 0 0 – 1 8 0 0

Homeopathy
A healing system developed in Germany in the 19th century,
homeopathy is based on the principle that “like cures like” or
the “law of similars.” It is one of several therapies that takes a
different approach from that of conventional Western medicine.

T
he basis of homeopathy—that ▷ Homeopathic medicine chest
a substance that causes certain This early 19th-century medicine chest contains
symptoms in a healthy body 69 small glass vials and six large bottles.
can, in lesser quantities, be used Professional homeopaths prepared and
to treat an illness with the same prescribed dozens of remedies, and dispensed
symptoms—was first recognized in them according to various lists and guides
ancient Greece and later developed compiled by Hahnemann and his followers.
by the Romans. In the 4th century
bce, the Greek physician Hippocrates
was making homeopathic remedies, were poisonous in quantity could
and homeopathic medicine was be beneficial in smaller doses. Von
described by Greek-born Roman Storck reported on experiments
apothecary Dioscorides in his De using some of the most feared
Materia Medica (see pp.38–39). herbs, such as hemlock.
In the 1790s German physician However the technology to
Samuel Hahnemann began to extract active ingredients in
develop a set of therapies based on their pure form was not
this theory, which became known available at the time, so
as homeopathy. Prior to this, von Storck’s results were
Greek-Swiss physician Paracelsus inconclusive. Hahnemann
(p.70) and Austrian physician began to investigate these
Anton von Storck, among others, claims, often using himself
had suggested that materials that as an experimental subject.
He tested plant materials
such as cinchona bark—
later found to be a source
of the antimalarial
compound quinine
(see pp.174–75)—
and the leaves and
berries of belladonna
(known as deadly
nightshade).

Diluted remedies
Hahnemann suspected
that if smaller doses of
a substance could treat a
symptom, even smaller
ones would have a greater
effect while reducing any
unwanted side effects. He
developed the technique of diluting
his extracts in water or alcohol
many times shaking the container
△ The cinchona bark experiment at each stage of dilution (known as
Hahnemann consumed an extract of the cinchona “succussion”). He also devised the
plant—traditionally used as a cure for malaria— centesimal scale, or “C-scale,” in
to show that in a healthy person it led to order to measure the potency of the
symptoms similar to malaria. solution. A 1C dilution consisted of

108
H O M E O P AT H Y

“That which GERMAN PHYSICIAN (1755–1843)

SAMUEL HAHNEMANN
can produce… Born in Meissen, near Dresden,

symptoms in a Germany, Hahnemann started off


as a country physician in Saxony,

healthy individual, but was quickly disillusioned by


the crude methods and unproven

can treat a sick


treatments that were prevalent at
the time, especially in rural areas.
He gave up conventional medicine
individual who by 1785 and turned his attention
to chemistry and writing. Having

manifests similar… a great flair for foreign languages


(he spoke a total of 10), Hahnemann

symptoms.” made his living as a translator while


traveling widely and developing his
“art” of homeopathy. He died in
MOTTO OF SAMUEL HAHNEMANN, C.1800
Paris in 1843.

one part remedy in 99 parts Institute of Homeopathy in 1844. and 1970s, alongside other aspects he or she considers to be helpful,
water, 2C referred to a 1C This popularity was probably led of counterculture or “alternative” not knowing that it is a placebo
solution diluted in another by the fact that homeopathy was lifestyles, literature, and music. (ineffective preparation). Even if
hundred-parts liquid, and so gentler than some of the other there is no discernible improvement
on. This process of dilution is brutal treatments of the day. The placebo effect in objective terms, the patient may
called “potentization” because, Another advantage was that Despite millions vouching for the perceive one. Modern medicine is
paradoxically, the more dilute patients could be treated at home effectiveness of homeopathy, many still investigating the mechanism
the remedy is, the higher the rather than in a hospital, where studies claim it is in fact the “placebo of the placebo effect, which is
potency; some remedies are they sometimes caught additional effect” at work—that is, if someone often observed but is difficult to
so dilute they no longer infections or faced conventional believes that they will get better, explain. Some studies tie it to active
contain any molecules of treatments that often did more they have an increased chance of substances found naturally in the
the original substance. harm than good. Another wave improvement. This is especially true brain, such as endorphins, which
of popularity came in the 1960s if a patient takes a substance that cause an improvement in health.
Growing popularity
Hahnemann set forth his
findings in The Organon of the
Healing Art (1810). He proposed
that diseases were caused by
underlying weaknesses (“miasms”)
and that homeopathy could gently
coax these out of the body. His
publications were circulated widely
and homeopathic practitioners,
journals, and organizations began
to emerge in Europe and North
America. The German Central
Association of Homeopathic
Doctors was founded in 1829,
and many other similar groups
followed, such as the American

▷ The need for an alternative


This 1857 painting by Alexander Beydeman
shows the figure “Homeopathy” horrified
at the practices of conventional treatments.
Hahnemann was driven to a new approach
in medicine after experiencing the harm
done by common medical treatments in
the 18th century, such as blood-letting.

109
SCIENCE TAKES
CHARGE
1800 –1900

First achromatic microscope


S C I E N C E TA K E S C H A R G E

SCIENCE TAKES CHARGE


1800 –1900
1800 1840 1860
1842 1847 1860
William Clarke Ignaz Semmelweis The first modern nursing
anesthetizes a patient speculates that school opens at St. Thomas’
for tooth extraction; “cadaverous material” Hospital, London.
Crawford Long uses is responsible for many
anesthesia to remove cases of childbed fever 1862
a patient’s neck cysts. in Vienna; his hand- Louis Pasteur carries out his 1873
washing regime drastically “swan-neck” glass flask Camillo Golgi introduces a
reduces the death toll but experiments, proving that if silver-staining technique to
his work is not recognized contaminating microbes are show details of nerve tissue
for some time. kept away from a nutrient under the microscope.
liquid, germs do not grow.

1802 The Burke and Hare murders 1845 1849


Europe’s first pediatric Dentist Horace Wells Elizabeth Blackwell is the
hospital, Hôpital des Enfants 1828 conducts a demonstration to first woman to receive a
Malades, opens in Paris. Burke and Hare not only rob show the effects of ether as medical degree in the US.
graves in Edinburgh, an anesthetic but the patient
Scotland, but cries out in pain.
1808 also murder
Johann Christian Reil people, to sell
introduces the term their corpses to
psychiatry, proposing doctors for
it should become a anatomical
recognized medical speciality. study.

1816 1830S Lister’s carbolic spray to 1876


René Laënnec invents Pediatrics 1854 deliver antiseptic
Robert Koch shows that a
Morton Florence Nightingale
a simple but hugely becomes more ether inhaler 1867 bacterium, now known as
significant diagnostic established as arrives at Scutari Bacillus anthracis, causes
Barracks to care for Joseph Lister publishes
instrument—the specialized wards and a report—Antiseptic anthrax—dealing a death
stethoscope. hospitals open in soldiers wounded during blow to miasma theory.
the Crimean War. Principle of the Practice
Berlin, St. Petersburg, of Surgery.
Vienna, and Wroclaw. 1846
Early stethoscope William Morton successfully
in use demonstrates ether
anesthesia at Massachusetts
General Hospital.

1838 1847 1858 1868 1876


Ueber den feineren Bau und James Simpson begins the Anatomy: Descriptive and Jean-Martin Charcot, The hematoxylin and
die Formen der krankhaften use of chloroform for pain Surgical is published. Written a principal founder of eosin, or H&E, stain is
Geschwülste (On the Nature relief during childbirth. by Henry Gray, later editions neurology, begins his studies first described and
and Structural Characteristics will come to be known as of Parkinson’s disease. becomes one of the
of Cancer) by Johannes Gray’s Anatomy. most useful techniques
Muller lays foundations for for visualizing cells and
the field of histopathology. Illustrations from Gray’s Anatomy tissues in histology (the
study of cells and tissue).

1828 1839 1872 1879


James Blundell revives Publication of the first Elizabeth Garrett Pasteur makes his first
the idea of human- dental journal,The Anderson founds vaccine discovery, for
to-human blood American Journal of the New Hospital for chicken cholera, and
transfusions to treat Dental Science. Women and Children, extends his research
mothers suffering from London (later renamed into human diseases.
excessive blood loss the Elizabeth Garrett
after childbirth. Anderson Hospital).

112
1800–1900

Some of medicine’s greatest achievements came during the responsible for mass killers such as cholera, tuberculosis, and
19th century, including anesthesia, antiseptic procedures, and rapid tetanus. Microscopes also encouraged great progress in histology
advances in vaccination. Louis Pasteur and Robert Koch led the way and pathology. Women began to qualify as doctors, and nursing
in replacing age-old ideas of spontaneous generation and miasma became a recognized profession. In the last decade, X-rays opened
with germ theory, while microscopic studies revealed the bacteria up a new world of noninvasive medical imaging.

1880 1895
1881 1882 1890 1897
The first professional Robert Koch identifies Giovanni Grassi and Chemists at Bayer in
midwives organization, the cause of tuberculosis: Raimondo Filetti discover Germany, including Felix
Matrons’ Aid Society, is Mycobacterium tuberculosis. there are several kinds of Hoffman and Heinrich
founded in Britain, and malarial parasites; Ronald Dreser, produce a
soon changes its name to Ross demonstrates that synthetically modified
the Midwives 1884 mosquitoes transfer these version of salicylic acid
Institute. Robert Koch isolates parasites between humans. that is better tolerated
the causative germ for by the body; it is
cholera and describes how named Aspirin.
it is spread, and prevention
and control measures.

1893 1899
William Einthoven introduces Aspirin goes on sale
Sphygmomanometer the term “electrocardiogram” worldwide and
and publishes New Methods becomes one of the
for Clinical Investigation most successful and
concerning the heart’s adaptable medical
electrical activity and drugs of all time.
its relevance to disease
and diagnosis.

1894 Early X-ray examination 1896 Aspirin


carton
Kitasato Shibasaburo John Hall-Edwards
and Alexandre Yersin uses X-ray imaging
1885 independently identify the for the first time during
Louis Pasteur carries microbe of bubonic plague, a surgical operation.
out the first successful which is named Pasteurella The same year the
rabies vaccination, pestis, and later renamed 1895 first reports of harm
1881 on a young boy. Yersinia pestis. Wilhelm Röntgen caused by X-rays,
Samuel von Basch invents discovers X-rays and including hair loss,
the first sphygmomanometer, their ability to “see” blisters, burns, and
a device to measure bones and hard tissues swelling, appear.
blood pressure. Administering rabies vaccination inside the body.

1895 1896
In Vienna, Karl Landsteiner The sphygmomanometer
begins his studies of is improved by Scipione
immunity, antibodies, and Riva-Rocci, who adds a 1899
blood, especially how cuff around the arm to Sigmund Freud publishes
and why it clots. apply even pressure The Interpretation of
to the limb. Dreams setting out various
1895 psychological theories,
Sigmund Freud and Josef including a model of mental
Breuer coauthor Studies on structure based on the
Hysteria, the first main work unconscious, preconscious,
in psychoanalysis. and conscious.

1896 1897 1899


Almroth Edward A vaccine for plague is Santiago Ramón y
Wright develops and developed, but limited Cajal publishes
introduces the first effectiveness and the Comparative Study of
effective typhoid vaccine. infection’s complex the Sensory Areas
nature mean it does not of the Human Cortex,
become widely used. greatly advancing
the neurosciences.

113
SCIENCE TAKES CHARGE 1800 –1900

The First
Stethoscope
The invention of the stethoscope in 1816 gave doctors
a new way to listen to sounds inside the body. One of the
most important—and simplest—diagnostic innovations in
all of medicine, it soon became a vital piece of equipment
for physicians and an enduring symbol of their profession.

The first stethoscope bore little resemblance to its modern


equivalent. In the early 19th century, French doctor René
Laënnec used a rolled-up piece of paper to listen to the heartbeat
of a female patient suffering from heart disease. Previously,
doctors would place their ear directly over the area they wished
to examine—a practice called auscultation (the act of listening).
Laënnec thought it improper to put his face so close to his female
patient, so he improvised. He found that a paper tube placed
against her chest magnified the sound of her heart and lungs.
A skilled wood turner, he created a hollow wooden tube with a
hole at one end—to place against the ear—and a funnel-shaped
cone at the other end. Laënnec called his invention a stethoscope,
after the Greek words for “I see” and “the chest.” By the 1850s
the stethoscope was being used extensively by physicians.
Using the stethoscope, Laënnec diagnosed many ailments, such
as bronchitis, tuberculosis, and pneumonia. He published his
findings in Traité de L’Auscultation médiate (A Treatise on the Diseases
of the Chest) in 1819. The mucus brought up by asthmatics is
named “Laënnec’s pearls” after him. In a cruel twist of fate,
Laënnec himself was diagnosed with tuberculosis in 1826 by
his physician nephew Mériadec Laënnec, using a stethoscope.

“ I was surprised and gratified to


hear the beating of the heart.”
RENÉ LAËNNEC, AFTER USING A TIGHTLY ROLLED-UP TUBE OF PAPER
ON HIS FEMALE PATIENT, 1816

◁ Early stethoscope
This sketch shows a stethoscope being used by Surgeon Captain
Whiston in a field hospital in Sudan, 1867, as Anglo-Egyptian
forces fought to retake the country. The monaural—held to one
ear—stethoscope resembles a small telescope.

115
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

1 PART OF LAËNNEC’S
Plate shaped
STETHOSCOPE (EARLY 4 CYLINDRICAL like an ear
19TH CENTURY) STETHOSCOPE (1830S)
Large ear
plate
Hollow
tube

Ivory
earpieces Small ear plate
for children

Narrow
metallic
cylinder

Plate fit
snugly
over ear

2 WOODEN 3 EARLY 5 HUGHES’ 6 HARE’S 7 CELLULOID


STETHOSCOPE BINAURAL STETHOSCOPE (1890) STETHOSCOPE (1890) STETHOSCOPE (1910)
(1860S) STETHOSCOPE
(1870)

Two metal prongs 8 TUNING FORK

Diagnostic Instruments
Over thousands of years, advances and breakthroughs in understanding
the human body, as well as innovations in technology, have improved
the way diseases are diagnosed and treated.

1 Laënnec’s stethoscope Invented by French physician Hoffmann, this was used to look inside a patient’s ears.
René Laënnec, this stethoscope was essentially a wooden 10 Sphygmomanometer This device was used
tube. The first model had three detachable parts. to measure blood pressure. 11 Laryngoscope Spanish
2 Wooden stethoscope This device was monoaural— vocal specialist Manuel Garcia used this device to view the
its user could only listen with one ear. 3 Early binaural glottis and larynx for the first time. 12 Ophthalmoscope
stethoscope The binaural stethoscope enabled physicians This model had a mirror that reflected light into the eye
to listen in with both ears. 4 Cylindrical stethoscope and a peep hole in the center to look inside the eye.
This device had a disk-shaped sound collector at one end 13 Ophthalmoscope Some ophthalmoscopes, such 9 OTOSCOPE
that could help pick up high-pitched sounds. 5 Hughes’ as this one, came with a variety of lenses. 14 Brass (1841)
stethoscope Another monoaural, this stethoscope usually endoscope This was used for examining the bladder
had a wooden earplate. 6 Hare’s stethoscope This and urinary tract. 15 Percussor This device was designed
stethoscope is made of wood but later versions were made to detect abnormalities in the chest. 16 Glass clinical
of ivory. 7 Celluloid stethoscope Celluloid replaced thermometer British physician Thomas Allbutt
Rubber bulb
ivory in this model’s ear plate, which also had a metal body. invented this compact clinical thermometer.
8 Tuning fork This was used to detect hearing disorders. 17 Albumenometer This tested the amount of the
9 Otoscope Invented by German medical officer Friedrich protein albumen in urine to detect kidney problems.

116
DIAGNOSTIC INSTRUMENTS

11 LARYNGOSCOPE
(1854)

Mirror

12 OPHTHALMOSCOPE
Pressure
gauge

10 SPHYGMOMANOMETER 13 OPHTHALMOSCOPE (1875)


(1883)

Funnel concentrating
Rubber Candle light
tubing
15 PERCUSSOR
(1860)

14 BRASS
ENDOSCOPE (1853)

Viewing lens

16 GLASS CLINICAL
THERMOMETER
(18TH CENTURY) 17 ALBUMENOMETER

117
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Resurrection Men
In the 18th and 19th centuries the insufficient supply of corpses to medical schools in Britain
for the purpose of dissection gave rise to the “resurrection men.” Often operating in gangs,
resurrectionists disinterred fresh corpses and supplied them to anatomists. Outrage at such
activity led to a change in the law so that medical schools could acquire cadavers legally.

A
dvances in anatomical countries took a more pragmatic for dissections. Even after the This sinister but highly lucrative
science since the medieval approach, allowing the unclaimed Murder Act 1752 decreed that practice became so widespread
period had come about as corpses of the poor to be supplied criminals could be dissected by that the Edinburgh College of
a result of the dissection of human to anatomical schools. The detail anatomists after execution, the Surgeons introduced a clause in
corpses. Although Pope Benedict and accuracy of Flemish physician supply was wholly inadequate to their contracts in 1721 forbidding
VIII had forbidden the practice in Vesalius’s (see pp.72–75) drawings meet the needs of medical schools. trainees from dealing with the
1300 on pain of excommunication, of many anatomical features in For this reason, surgeons turned resurrectionists. However, the
the authorities in most European his 1543 work De Humani Corporis to the service of resurrection men, restriction was largely ignored,
Fabrica (On the Fabric of the Human who would disinter freshly buried since anyone with aspirations to
Body) was only made possible corpses and sell them for dissection be a surgeon needed to witness
▽ The Burke and Hare murders through human dissections. for a fee ranging from 2 to 20
Burke and Hare’s first corpse was a pensioner, In Britain, the law was much guineas (the latter being
who died of natural causes at their lodgings. stricter. In 1540 Henry VIII gave well over 20 times
After that they lured potential victims—mainly the Company of Barber Surgeons the average weekly
vulnerable women—with the promise of alcohol, the right to take four corpses of wage of a surgeon
then got them drunk and smothered them. executed felons each year to use at the time).
RESURRECTION MEN

or to perform dissections, and so ◁ Demonstrating anatomy


the resurrection men found a Anatomy lesson by Velpeau (1864), a lithograph
ready supply of keen customers by Louis-Eugene Pirodon, shows the leading
for their wares. French surgical anatomist Alfred Velpeau (center)
demonstrating human anatomy to artists and
The resurrectionist gangs observers. He was a professor of clinical surgery
Professional resurrection men at the Académie des Sciences in Paris.
often operated in gangs, supplying
dozens of dead bodies to medical
schools each year (one gang that These murders and those carried
was uncovered in Lambeth in 1795 out in London in 1831–32 by the
had 15 members). For corpses of “Burkers”—those who modeled
well-known people or “freaks”— themselves on Burke and Hare—
such as the highwayman Dick led to a call for reform. Medical
Turpin, whose grave was robbed self-interest played a part; when a
in 1739, or the “Irish Giant” Liverpool surgeon William Gill was
O’Brien, who was over 7 ft convicted of receiving a corpse in
(2.1 m) tall, respectively—the fee 1828, doctors realized that they,
could rise to as much as £500. too, were now liable to prosecution
The activities of the resurrection for the activities of the resurrection
men became so widespread that men. The same year, a House of
at times confrontations broke out Commons Select Committee was
in cemeteries as mourners realized set up and issued a report about
that the men with shovels and the need for anatomical science

349
and dissection, but it faced initial
The number opposition from those who were
of corpses against a relaxation of the law.
supplied by Finally, in 1832 an Anatomy Act
resurrection was passed that allowed licensed
men in 1809–10, from evidence anatomy lecturers to use unclaimed
given to the House of Commons dead bodies from workhouses,
Select Committee in 1828. hospitals, and prisons. As medical
schools no longer needed illegally
picks lurking in the shadows were thousand people. However, as Burke and William Hare sold 16 acquired corpses, demand dropped
not in fact gravediggers, but “body long as the authorities turned a corpses to the Edinburgh-based and the price that the resurrection
snatchers.” In desperation, some blind eye, little was done about physician Robert Knox. It turned men could charge for their services
local communities funded graveyard them. In England, the removal of out, after the body of a dead plummeted; within a few years,
patrols, and wealthy families paid a corpse was not officially an offense woman was found under a bed at they had disappeared entirely.
for security measures, such as the until 1788, when courts ruled that their address, that they had never
mortsafes (iron cages) or the “Patent “common decency” required the dug up any corpses. Instead, they
Coffin,” invented in 1818, with practice to stop; even then, there had murdered their victims and
its metal-sprung catches that were was no specific statute against it. sold the fresh corpses to Dr. Knox.
designed to thwart tools used by After a notorious trial, Burke was
the resurrectionists to open coffins. Motive for murder hanged on January 28, 1829, and
The resurrectionists were never Such was the demand for corpses, his body was publicly dissected
popular—a riot in Greenwich in some resurrectionists took things the following day. Hare escaped
1832 against the activities of the even further. Between 1827 and by giving evidence against his
West Kent gang involved several 1828 Irish immigrants William former partner.

“ The coffin was forced… and the melancholy


relics, clad in sack-cloth after being rattled
for hours on moonless by–ways, were at △ Caged graves

length exposed to uttermost indignities In Scotland, the graves of well-to-do residents


were often protected by sturdy iron cages
(“mortsafes”), to foil the efforts of grave
before a class of gaping boys.” robbers and “body snatchers.” These cages
encased buried coffins or were set in a concrete
ROBERT LOUIS STEVENSON, SCOTTISH AUTHOR, FROM THE BODY SNATCHER, 1884 foundation and covered the whole grave.

119
SCIENCE TAKES CHARGE 1800 –1900

Miasma Theory
Bad smells, which are associated with rot and decay,
have long been linked with illness. The miasma theory,
believed since ancient times, held that diseases were
caused and spread by a mix of foul-smelling vapors,
gases, and possibly tiny particles present within them.

The notion that poisonous air was the cause of illness grew from
observations that disease was more common in crowded areas
and in places where unsanitary conditions such as rot, mold, dirty
water, excrement, and putrid odors abounded. In the medieval
period, as towns and cities grew, outbreaks of diseases such as
plague, tuberculosis, cholera, and malaria (from the Italian for
bad air, “mala aria”) increased with them.
By the 18th century, with the discovery of many previously
unseen microscopic menaces, the miasma theory was redefined.
It was believed that poisonous vapors and tiny particles from
decomposing matter, too small for microscopes but identified by
their offensive smell, were released into the air, and made their
way into the body and caused disease. Although the work of
John Snow during the London cholera outbreaks (see pp.122–23)
pointed to contaminated water as the disease’s source, rather
than bad air, his findings were dismissed at the time as the ideas
of the miasma theory prevailed. It was not until the 1870s and
the work of Robert Koch and others, that miasma theory was
finally replaced with the germ theory of disease (see pp.146–47).
Yet, despite their inaccurate basis, anti-miasma public health
measures, such as clean drinking water and sanitation, had been
beneficial as they had helped not only remove the smells but also
the germ-causing microbes.

“ First rule of nursing, to keep


the air within as pure as
the air without.”
FLORENCE NIGHTINGALE, ENGLISH NURSE, FROM NOTES ON NURSING:
WHAT IT IS, WHAT IT IS NOT, 1898

◁ Poisonous air
This mid-19th century cartoon by British illustrator Robert
Seymour, titled Cholera Tramples the Victor and the Vanquished
Both, shows a ghostlike figure spreading cholera across
the battlefield.

121
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Cholera
One of the most virulent diseases ever known, cholera has killed millions of
people and had a huge social impact around the world. The study of microbiology
during the 19th century contributed to the understanding and control of this
disease but, without safe water available to all, outbreaks continue to occur.

C “ Death from sickness at a level


holera has affected people for Instead, he suggested that
many centuries. Records excrement contained infectious
from India, dated to around material that could infect the
1000 CE, describe a disease thought
to be cholera that induced severe
populace if it found its way into
the water supply. During a cholera
not seen since the Black Death.”
diarrhea and vomiting, outbreak in 1854, he noted that MARTIN DAUNTON, PROFESSOR AT THE UNIVERSITY OF CAMBRIDGE,
leading to dehydration, a number of cases were FROM LONDON’S “GREAT STINK”: THE SOUR SMELL OF SUCCESS, 2004
and often death. clustered around one
However, cholera hand pump on Broad
did not spread Street in Soho, bacterium, belonging to the Koch observed that the bacteria
beyond the London; when he bacillus group, which he called flourished in moist places, such
subcontinent until removed the handle Vibrio. However, his findings did as wet linen. His scientific peers
1817, when infected of the pump, the not become well known until accepted his findings and
travelers carried it out cholera stopped 1965—more than 80 years acknowledged him as the discoverer
of India along trade spreading. Snow after his death. of the cholera-causing bacterium.
routes. By the 1830s was a pioneer In 1883 thirty years on from Koch’s discovery had important
it had reached but, despite his Pacini’s studies, German physician social consequences—people
as far as the US. attempts, he could Robert Koch began researching the became aware that exposure to
Before the study not identify the cholera-causing microorganism. contaminated water caused disease,
of bacteria gained pathogen that He traveled to Egypt, where cholera and that bacteria could return to
importance, and prior caused cholera. was widespread, and studied the the water supply through sewage.
to the linking of germs, intestines of deceased victims. Like The introduction of filtered water
or microorganisms, Identifying Pacini, he also found Bacillus in pipes led to a dramatic fall in the
to infectious diseases, the cause their intestinal mucosa. He moved incidence of the disease. However,
it was believed that In the middle of the to India to further his research. the knowledge that cholera was
cholera was caused by 19th century, when There he was able to grow the caused by contaminated water
excessive production cholera reached bacterium in a pure culture, and was not enough to cure people or
of bile—the term Florence, Italian noticed the distinctive commalike save their lives—clean drinking
“cholera” is derived △ Water-testing kit scientist Filippo shape of the Bacillus; in 1965 it was water was a luxury many in the
from the Greek word Frederick Danchell, a civil Pacini—an expert officially named Vibrio cholerae. developing world could not enjoy.
khole, meaning “illness engineer, introduced this simple microscopist—
from bile.” It was water testing kit in the 1860s was determined
hard to discriminate to test for organic matter and to study the onset
cholera from other chemical pollutants, after John of the disease and
diseases associated Snow argued that cholera was find out how it
with diarrhea and a waterborne disease. was transmitted.
vomiting, but the He performed
enormity of human suffering in autopsies on victims and studied
the 19th century led to intensive their intestines. His tests resulted
research and lengthy debates in the isolation of a comma-shaped
about the nature and causes
of the disease. The scientific
world became embroiled in ▷ Treatment center
discussing the merits of germ Cholera emerged in Haiti following the 2010
theory (see pp.146–47) over earthquake, which resulted in water supplies
miasma theory (see pp.120–21). being infected and rapidly transmitting the
One of the key people involved disease to thousands. In this treatment center,
was English physician John Snow patients lie on a “Watten bed,” or cholera bed,
(see pp.124–25), who believed with holes cut out to catch the watery diarrhea
that the disease was not airborne. common to cholera patients.

122
CHOLERA

Developing treatment
The recurring epidemics of the
19th century made the need for
effective treatment increasingly
pressing. In the 1830s physicians
began to realize that dehydration
was the real cause of death in
cholera patients. This led to
new experiments with fluid
replacement therapies, involving
intravenous injections of water
and salt. Improvements in the
salt concentrations, the amount
of fluid given, and the rate of
delivery gradually reduced
fatalities, but it took until the
mid-20th century for major
advances to be made.
In 1958 US Navy medical
researcher Raymond Watten
invented a cot with a hole in the
middle, allowing for an accurate
measurement of excrement, so
that rehydration fluids could be
given in the right amount, and of
the same chemical composition as
was being lost. The “Watten cot”

3–5 recordedNumber
MILLION of
cholera cases
every year, killing more than
100,000, according to the World
Health Organization (WHO).

is still used routinely in treatment


centers. Even more significant
was the discovery in the 1960s
that glucose helps the gut absorb
salt, enabling the creation of the
first oral rehydration therapies.
Effective, easy to administer, and
relatively cheap, this treatment
(and appropriate antibiotics) has
become the most widely used
means of managing cholera and
other diarrhea-related diseases.
Since the first recorded
pandemic in 1817, there have
been seven further outbreaks of
cholera. The need for improved
vaccination, and effective
approaches to both prevention
and control remains.

▷ Cholera defeats the Turkish Army


The triumphant grim reaper, Death, is shown
on the cover of this Paris newspaper in 1912.
The Turkish army is defeated not by the
enemy, but by cholera. The disease swept
through the camps, killing 100 men a day
during the First Balkan War (1912–13).

123
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

ENGLISH PHYSICIAN Born 1813 Died 1858 Water bath inside

John Snow
the bottle helps
ether to vaporize

“ The cholera extended to… houses in


which the water was thus tainted…”
JOHN SNOW, FROM MODE OF COMMUNICATION OF CHOLERA, 1855

A
quiet, modest, hard-working In 1836 he moved to London, ▷ Ether inhaler
English physician, John where he acquired membership of This device was invented by Snow in 1847, just
Snow brought about vast prestigious medical colleges, became one year after the first demonstrations of ether
Mouthpiece
changes in our understanding of president of the Westminster in the US. The temperature of the water bath,
how infectious diseases spread, Medical Society, and in 1849 top right, could be altered to adjust the dose.
the need for public health and became a founder member of the
sanitation, and the significance of Epidemiological Society of London,
epidemiology (see pp.126–27) as which aimed to examine the origin, surgery. Snow read avidly on the in Killingworth colliery in northern
a specialist area of study. However, propagation, mitigation, and subject of anesthetics and began England. In 1849 he witnessed more
Snow’s reasoning, which ultimately prevention of epidemic diseases. to devise his own equipment. He cases and began to investigate the
led to these advances, was rejected tested new gases—especially cause and spread of the disease.
at the time and he did not live to see Ether and anesthetics chloroform—on animals and, to Since its major early symptoms
his work accepted, dying at the early During the 1840s Snow developed his detriment, himself (modern- were vomiting and diarrhea, he
age of 45 years old. an interest in anesthesia (see day scientists speculate that his suspected that it was a digestive
After an education in which pp.128–31). The medical use self-experimentation may have problem and probably transmitted
he showed an aptitude for of chemicals to dull sensation exacerbated preexisting health by eating or drinking contaminated
mathematics and statistics, and pain and to induce problems and led to his early death). matter. However, the miasma theory
Snow gained early unconsciousness was a He wrote articles on the subject (see pp.120–21) was also prevalent
medical experience in popular area of research and also created the profession of at the time, and many experts
Newcastle upon Tyne. at the time. In 1846 there “specialist anesthetist.” The Royal regarded cholera as a blood-based
was news from Boston, Medical and Chirurgical Society (a sickness. In the first edition of
Massachusetts, that ether forerunner of the Royal Society of his pamphlet, On the Mode of
could be safely used Medicine) described him as “more Communication of Cholera (1849),
as an anesthetic in extensively conversant with its Snow wrote: “It is quite true that
dentistry and general operation, and more successful in a great deal of argument has been
administering it, than any living employed on the opposite side, and
person.” Snow gained much that many eminent men hold an
◁ Death’s recognition and was instrumental opposite opinion.”
dispensary in making anesthetics safer, more In 1854 Snow applied an
A cartoon from 1866 effective, and more widely accepted. epidemiological approach when he
shows how Snow’s studied a cholera epidemic centered
deductions about the Studying cholera on Broad Street in Soho, London. He
spread of cholera by Snow’s first encounter with the visited houses, interviewed residents,
water were accepted bacterial infection of cholera and delved into plans of the area’s
a decade later. (see pp.122–23) was in 1831–32 water supplies and sewage disposal.

“ This journal… failed to recognize


Dr. Snow’s… visionary work in deducing
the mode of cholera transmission.”
APOLOGY FOR OMISSIONS IN SNOW’S OBITUARY, FROM THE MEDICAL JOURNAL THE LANCET, 1958

124
JOHN SNOW

He recorded straightforward ▷ A simple man TIMELINE


information but his skill lay in his Snow was far from flamboyant and
fame-seeking. A close friend remarked ■ 1813 Born in York, England, the eldest
analysis of the data. He made maps
that he “clothed plainly, kept no son of a farm and general laborer. He
showing that cases were clustered
company, and found every amusement attends a local private school.
around a public water pump in
Broad Street—an innovative idea in his science books, his experiments, ■ 1827 Becomes apprentice to Newcastle
at the time. In light of his suspicions, and simple exercise.” surgeon William Hardcastle, and works
and with the help of the parish as a colliery physician during the cholera
epidemic of 1831–32.
authorities, Snow arranged for the
handle of the public water pump to three years later, he had ■ 1836 Enrolls as a student at the
be removed so that local people had not witnessed the rewards Hunterian School of Medicine, London;
to obtain their supplies elsewhere. of his work. However, the later works at Westminster Hospital.
The outbreak was already subsiding, next decade saw further ■ 1838 Becomes a member of the Royal
but Snow believed that disabling the cholera outbreaks with College of Surgeons and, a few months
pump would speed its end. more detailed studies, and later, of the Society of Apothecaries.
The next year, Snow published the establishment of germ ■ 1846 Becomes interested in the
the updated edition of On the Mode of theory (see pp.146–47), properties of the anesthetizing agent
Communication of Cholera. Although all of which vindicated ether, and works to make improvements
his evidence was convincing, it was Snow’s conclusions and in its administration, along with testing
passed over for various reasons, sealed his place in other agents.
including the high costs of public medical history. ■ 1847 Publishes On the Inhalation of
works to provide clean water the Vapour of Ether.
supplies and hygienic sewage ■ 1849 On the Mode of Communication
disposal, and rival theories, such of Cholera, his first report on the
as that of Bristol-based physician transmission of cholera through
William Budd, who blamed the contaminated water supplies, wins
cholera outbreak on a fungus an award from the Institut de France.
spread through drinking water. ■ 1850 Joins the Royal College of
Snow was rebuffed and Physicians.
disappointed and,
■ 1853 Administers chloroform to Queen
when he died Victoria during the birth of Prince
Leopold. He will do the same again in
1857 for the birth of Princess Beatrice.
■ 1855 Publishes an updated edition
of On the Mode of Communication of
Cholera that includes the Soho, London,
outbreak of 1854.

JOHN SNOW’S MAP OF SOHO, ILLUSTRATING


INCIDENTS OF DEATH BY CHOLERA

■ 1858 On Chloroform and Other


Anaesthetics is published. Snow dies
from a combination of stroke, and kidney
failure brought on by experimenting
with anesthetic gases. He is buried in
Brompton Cemetery, London.

125
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Epidemiology and
Public Health
Until the 19th century, little progress was made in containing epidemics in the
rapidly growing cities. However, the breakthrough came when medical scientists
began to discover the causative agents of diseases, leading to effective control
and prevention strategies and considerable advancements in public health.

I
n the 4th century BCE, Greek faster than the means of preventing The cholera epidemic that struck △ “Typhoid Mary”
physician Hippocrates tried to the diseases it scrutinized. In 1662 London in 1831–32 led to calls In the early 20th century, it became clear that
explain diseases in terms of British statistician John Graunt for reform. In 1842 British lawyer people without symptoms could still carry the
external and environmental factors analyzed mortality records in Edwin Chadwick compiled a report typhoid pathogen and transmit the disease.
rather than divine displeasure, as England, differentiating deaths on sanitary conditions in cities. Mary Mallon, a cook, infected more than 50
had always been the case. However, by the age and sex of the deceased, This prompted the establishment of people in several households where she worked.
doctors were unable to understand, the time of year, and the location. a Royal Commission on the Health
let alone control, the spread of Similar studies by Louis Villermé in of Towns and also local boards of
infectious diseases. Nonetheless, France in 1826 concluded that the health, which were responsible for efforts turned to the use of vaccines
during the Black poor had higher enforcing sanitary and hygiene (or in some cases drug treatments)

30.6
Death in Italy in the PER THOUSAND The rates of mortality regulations in their districts. Public for fatal diseases. Britain began the
14th century, death rate in Paris’s than their middle- Health Acts gave these bodies first mass vaccination program—for
the introduction poorest districts in 1826. and upper-class greater powers, starting in 1848, smallpox (see pp.100–01)—in

19.1
of quarantine and PER THOUSAND The counterparts. The when they were given a remit to 1853, which extended worldwide
isolation hospitals death rate in Paris’s “miasma theory” inspect lodging houses and provide over following decades, eventually
(see pp.68–69) richest districts the same year. (see pp.120–21), sewers. Clean water had become leading to the disease’s global
showed an which was popular a concern after British physician eradication in 1977. Other similar
awareness that reducing contact in the 19th century, maintained John Snow’s discovery of the programs for polio, typhoid,
with infected persons was the most that bad vapors in the air caused by waterborne nature of cholera mumps, and measles gradually led
obvious way to contain the disease. filth were the primary agents of (see p.122). In 1858 the British to these once-common, often fatal,
disease, and efforts were made to parliament gave £3 million to the infections becoming rarities.
Supporting sanitation clean up cities that were growing Metropolitan Board of Works to
The science of epidemiology—the uncontrollably as a result of the build new sewers for London; when Noncommunicable diseases
study of disease patterns, causes, Industrial Revolution, which drew completed in 1870, these finally As epidemics of infectious diseases
and epidemics—at first progressed workers from rural to urban areas. put an end to the cholera epidemics became rarer in industrialized
of the previous four decades. countries after World War II, global
BRITISH PHYSICIAN 1877–1967
public health efforts turned to
Mass vaccination programs noncommunicable diseases—for
JANET LANE-CLAYPON The discovery that diseases were example, cancer and diabetes—and
transmitted by bacteria and viruses to those, like malaria, whose main
The first woman to receive a research (see pp.166–67) meant that, in the impact was felt by poorer countries.
scholarship from the British Medical late 19th century, public health Studies in the early 1950s linked
Council, physician Janet Lane-Claypon
pioneered two research methods that
are key to the field of epidemiology.
She used cohort studies to compare
“ The primary and most important
weight gain between one group of
children who were breast-fed and
measures… are drainage, the removal
another group who were bottle-fed of all refuse from habitations, streets
milk. In 1923 she used a case-control
study to conclude that women who and roads, and the improvement of
married earlier, had more children,
and breast-fed them were less likely the supplies of water.”
to develop breast cancer. EDWIN CHADWICK, BRITISH LAWYER, FROM THE SANITARY CONDITION OF THE LABOURING
POPULATION OF GREAT BRITAIN, 1850

126
E P I D E M I O L O G Y A N D P U B L I C H E A LT H

▷ Crimean War deaths


Produced by Florence Nightingale during the
Crimean War, this chart illustrates that more
soldiers died as a direct result of infectious
diseases than battlefield wounds. Nightingale
used it in her hard-fought campaign to improve DEATHS FROM PREVENTABLE OR
the standards of hygiene in field hospitals. ACUTE INFECTIOUS DISEASES

DEATHS FROM OTHER CAUSES

smoking and lung cancer for the


DEATHS FROM WOUNDS
first time, eventually leading to
attempts to curb tobacco usage
through taxation, public health
campaigns, and, in some countries,
banning smoking in public areas.

Post-war health organizations


At a national level, epidemiology
and public health campaigns came
to be managed by bodies such as
the US Communicable Disease
Center, known today as Centers for
Disease Control and Prevention
(CDC), established in 1946, and
Britain’s National Health Service
(NHS), founded in 1948. At a
global level, the World Health
Organization (WHO), set up in
1948, coordinates international
responses to crises—for example,
the Ebola epidemic in West Africa
in 2014–15—as well as setting up
longer-term global eradication
programs (pp.266–67).

△ Smoking and lung cancer


Before medical studies emerged making the
connection between smoking and lung cancer,
some advertisements actually promoted the
habit as having health benefits. In 1960 over
one-third of American doctors still did not
believe that smoking and cancer were linked.

127
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Anesthetics
Since antiquity surgeons have looked for ways to dull the pain experienced by their patients
during an operation. In 1846 American dentist William Morton finally came up with an effective
solution by using gas to anesthetize a patient, and the era of modern pain-free surgery began.

I
n ancient times surgery was not Nitrous oxide ▷ Mandrake
only dangerous but also very A more promising avenue for pain The root of the mandrake
painful, although surgeons tried relief during surgery proved to be plant contains hallucinogenic
many methods of pain relief. Hemp the inhalation of gases and vapours. and narcotic compounds and
was used as an anesthetic in China In 1799 British chemist Humphry was used in the medieval
in the 2nd century CE, while in the Davy observed the intoxicating period as an anesthetic,
medieval period Arab doctors soaked effect of nitrous oxide and suggested sometimes mixed with
“sleep sponges” in aromatics and that “it may be used with advantage opium. In too large a dose,
soporifics, such as mandragora during surgical operations”. He did it could cause delirium
and even death.
and opium. Extreme not pursue this idea,

80
compression of the PER CENT The however, and nitrous
nerves near the part approximate rate oxide, often called
of the body being of death after operations “laughing gas”, was was pain free.
operated on using before the 19th century. for decades taken However, in 1845
screw-clamps was mainly at parties. a demonstration
tried in the 18th century, but this The real advances came from by Wells in Boston
often caused the patient as much dentists in the US. In the 1840s failed, since the
pain as the operation itself. More dentist Horace Wells experimented patient experienced
effectively, in the 1770s German with administering nitrous oxide pain. This operation
physician Anton Mesmer pioneered through a wooden tube attached was performed on
mesmerism (see p.160)—a form to an animal bladder. He even had William Morton—a
of hypnosis that could induce a one of his own teeth extracted former dental partner
trance in patients and reduce their under the influence of nitrous of Wells—and Morton
sensitivity to pain. oxide to prove that the procedure resolved to try a
different approach.

“ This Yankee dodge, gentlemen,


a handkerchief. The patient felt no
Ether and chloroform pain and word of Morton’s success
The properties of diethyl ether spread. He was invited a few days
beats mesmerism hollow.” (commonly known as ether) had
been known since the 16th century
later to conduct an operation to
remove a benign tumor from a
ROBERT LISTON, SCOTTISH SURGEON, AFTER PERFORMING THE FIRST AMPUTATION and had been used as a general patient’s neck at Massachusetts
USING GAS ANESTHESIA IN BRITAIN, DECEMBER 21 ,1846 anesthetic in 1842 by Crawford General Hospital. By this time he
Long, a general practitioner from had refined his method of ether
Georgia. However, Long did not delivery to incorporate a double-
publicize his findings, and it was necked glass globe, with air entering
Morton who was credited with one section that then passed via an
the first successful series of ether-soaked sponge to be inhaled
operations under anesthetics. by the patient. The operation was
Having first tried ether on himself, carried out in front of a crowd of
a dog, and several assistants, on medical professionals and was again
September 30,1846, Morton carried a success.
out a tooth extraction on a patient, By November that year, surgeons
Eben Frost, using ether saturated in felt confident enough in Morton’s
methods to perform an amputation
on a seven-year-old girl, who was
◁ Laughing gas suffering from tuberculosis of the
After Humphry Davy’s discovery of the exhilarating knee, under the influence of ether.
effects of nitrous oxide, it became popular at Use of the technique spread rapidly,
parties. By the 1840s it was substituted by ether, and on December 19, 1846, the
which could be more easily transported, giving first anesthetic operation in
such events the nickname “ether frolics.” Britain—the extraction of a

128
ANESTHETICS

molar—was carried out, and the By January 1847 anesthesia gas—chloroform—was pioneered easing pain during childbirth after
second—an amputation—was reached France, and six months by obstetrician James Young pioneer anesthetist John Snow
performed just two days later. The later an operation was carried out Simpson, Professor of Midwifery gave Queen Victoria chloroform
amputation was so successful in Australia. However, ether fell in Edinburgh, Scotland, who first for her last two births (pp.124–25).
that the patient asked when the out of fashion because it was slow used it in 1847. It was faster-acting
operation was going to begin, after to take effect and often induced and gentler than ether, and in the The road ahead
his leg had been sawn off. vomiting in the patient. A new 1850s became a popular method of Within a year of Morton’s first
effective anesthetic operation,
surgery had been revolutionized.
Operations could be longer, and
Hanaoka Seishu surgeons could work more slowly
Japanese physician Hanaoka Seishu and carefully without fear of their
devised an anesthetic drink made from patients dying from shock. Through
a variety of herbs, including angelica. In the second half of the 19th century
1804 he used it as a general anesthetic anesthesia continued to undergo
during a mastectomy operation.
many refinements. As the gases
improved, better masks and pumps
were devised to administer them
more effectively. Local anesthetics
appeared in 1884—the first one to
be used was cocaine, used as eye
drops in optical surgery. Intravenous
anesthetics, which acted far more
swiftly than those administered
through inhalation, were first used
in 1874, and spinal anesthesia was
introduced in the 1890s.
The remarkable developments
that had occurred in anesthesia
in the 19th century transformed
surgery, and they paved the way
for more complex operations in
the 20th and 21st centuries, most
notably those on internal organs.

△ Chloroform apparatus
In 1862 English doctor Joseph Thomas
Clover devised an apparatus, shown here,
to deliver chloroform in accurate and measured
doses, overcoming the earlier problem of
patients dying from an overdose.

129
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

4 19TH-CENTURY
REPLICA OF MORTON
ETHER INHALER

Seed capsule

1 POPPY SEEDS AND CAPSULE

2 CHLOROFORM INHALER (1848) 3 HEWITT DROP BOTTLE (1886) 5 MINNITT GAS-AIR ANALGESIA APPARATUS (1950)

6 ANESTHETIC

Early Anesthetics
FACE MASK (19TH
CENTURY)

Gauze
mask
cover
The administration of anesthesia (see pp.128–29) at first required
complex apparatus to create, mix, store, and deliver the gas. Over
time instruments became more compact and manageable.
7 COMBINED-GAS
APPARATUS
1 Poppy seed capsule The seeds of the opium poppy over a wire frame, with a sponge soaked in ether that
have a sedative effect and were used in ancient times to sat over the patient’s nose and mouth. 7 Combined-
provide pain relief. 2 Chloroform inhaler Invented by gas apparatus This had a large cylinder from which
John Snow, this inhaler had two tubes. Chloroform was chloroform or ether was passed to the smaller portable Cylinder
pumped in through one tube and breathed out of the brass cylinder. A tube connected the smaller cylinder to with
chloroform
other. 3 Hewitt drop bottle This bottle was used to the patient’s face mask. 8 Hypodermic syringe This
administer drops of chloroform or ether at a controlled allowed the easy intravenous injection of drugs. 9 Boyle’s
rate. 4 Morton ether inhaler This inhaler was first used apparatus The Boyle bottle allowed anesthetists to control
by William Morton in 1846. Ether was passed through the the vaporization of gas from a liquid to create a safe
tap, soaked by the sponge, and released through a rubber mixture of gases. 10 Clayfield’s mercurial holder This
tube and mask. 5 Minnitt gas-air analgesia device measured the amount of nitrous oxide inhaled by
apparatus This gas-air machine was designed to produce a patient. 11 Basket Boyle anesthesia machine This
a mixture of nitrous oxide and air to provide pain relief machine allowed a continuous flow of anesthetic gases.
for women in labor. 6 Anesthetic face mask This 12 Nitrous oxide cylinders These were commonly used
Cylinder
19th-century face mask consists of a gauze cloth stretched in dentistry from the 1850s. with ether

130
E A R LY A N E S T H E T I C S

Ether
vaporizer
8 HYPODERMIC SYRINGE (20TH CENTURY)

Patient circuit
9 BOYLE’S through
APPARATUS (1930) which gas is
administered

Gas
tubing

10 CLAYFIELD’S
MERCURIAL
HOLDER
(20TH-CENTURY
REPLICA)

11 BASKET BOYLE ANESTHESIA MACHINE (1950)

Movement
of weights
indicate
level of gas
remaining
in the jar
above the
mercury

12 NITROUS OXIDE
Connector
CYLINDERS (20TH CENTURY) for mask

131
SCIENCE TAKES CHARGE 1800 –1900

Dentistry
Advances in dental technology have dramatically
improved oral health. Where once complete extraction
was the only solution for widespread tooth decay, now
dental patients are far more likely to retain most, if not
all, of their own teeth.

Contrary to the popular perception that people in the medieval


period suffered from rotting and missing teeth, most understood
the importance of dental health and cleaned their teeth regularly.
Although not a fully fledged profession at the time, dentistry was
practiced among the wealthy and included extractions, fillings,
and the fitting of false teeth, but tools and techniques were
basic, and procedures painful.
Historians estimate that 20 percent of the medieval European
population suffered from tooth decay. With the widespread intake
of sugar, this figure had risen to 90 percent by the 19th century.
As the demand for treatment increased, dentistry was transformed.
Many advances occurred in the 1800s, such as the reclining
dental chair, amalgam fillings, and the use of anesthesia.
In the late 19th century, drills replaced files and chisels,
to remove decay and prepare cavities, and the filling of teeth
became a viable alternative to extraction. The Harrington
windup dental drill of 1864 was followed by the foot-operated
drill invented by American dentist James Morrison in 1872.
Just a few years later, in 1875, the invention of the first electric
drill heralded the dawn of modern dentistry. In 1957 the
advent of the air turbine drill ushered in the era of high-speed
dentistry and joined other innovations of the latter half of the
20th century such as fluoride toothpaste, lasers, resin filling
materials, ceramic polymer implants, and “invisible” braces,
which all helped bring dentistry into the modern era.

“ Dentistry is the practice of a


special branch of medicine.”
CHARLES MAYO, AMERICAN MEDICAL PRACTIONER, IN AN ADDRESS TO
THE AMERICAN MEDICAL ASSOCIATION, 1928

▷ Elecro-anesthesia
From the 1840s electricity was tried as a dental anesthetic, especially
in France, as shown in this 1870s dental school in Paris. Results were
disappointing and injectable anesthesia eventually took over.

132
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Pregnancy and Childbirth


In many cultures, care of women and their babies during pregnancy, birth,
and infancy was often separate from mainstream medicine. The role of the
midwife only became formally recognized from about 100 years ago.

M
odern medical specialties One of the first texts on women’s physician and
relating to women’s health and childbirth was Gynaikeia apothecary
health, childbirth, and (Gynecology), written by the Eucharius
children include gynecology, for 1st-century CE Greek physician Rösslin helped
dealing with female reproductive Soranus of Ephesus. The first disseminate
health; midwifery, for health care major Chinese work on obstetrics medical
during uncomplicated pregnancy and gynaecology was Jing Xiao knowledge
and birth; obstetrics, for more Chan Bao (Treasured Knowledge of with his 1513
medically involved pregnancy and Obstetrics) published c.850 by the publication
birth; and pediatrics, for infants Chinese physician Zan Yin. It Der Schwangeren
and children through to puberty. covers treatments from traditional Frauen und Hebammen Rosengarten △ Cesarean operation in Uganda
However, such specialties have Chinese medicine (see pp.26–27), (The Rose Garden for Pregnant The original purpose of a cesarean section was
not always been in existence. and herbal remedies for pregnancy- Women and Midwives). to save a baby when the mother would probably
related conditions from morning In 1609 the practical and die. However, medical advances in the 19th
Ancient wisdom sickness to miscarriage. progressive midwife to French century, such as anesthesia and antiseptics,
For millennia, pregnancy and birth Cesarean section—the delivery royalty, Louyse Bourgeois, became improved the mothers’ chances of survival too.
were private matters involving of a baby through an incision—is the first woman to write a medical
female family members and close one of the oldest known surgical treatise on obstetrics, Observations
friends, who were usually non- procedures, with descriptions of diverses sur la stérilité, perte de fruits,
Japanese
medical. In ancient Mesopotamia this surgery dating back 3,000 fécondité, accouchements et maladies ivory doll
and Egypt, female birth attendants years in China and 2,200 years des femmes et enfants nouveaux-nés
helped the mother give birth, and in India. The term is said to be (Various Observations on the Sterility,
specialists—the midwives of their derived from the name of Roman Fruit loss, Fertility, Childbirth and
day—were described in the Ebers emperor Julius Caesar, allegedly Diseases of Women and Newborn
papyrus (see pp.20–21). born by this method in 100 BCE, Infants). But the male takeover
but the more likely origin is of the traditionally female
caedare, Latin for “to cut.” practice of midwifery
In 1598 French royal surgeon continued, giving rise to
Jacques Guillemeau introduced the often derogatory term
the term “section” rather accoucheur, or man-midwife.
than operation in his book on
midwifery. German gynecologist Japanese
Ferdinand Kehrer is credited with ivory doll
successfully performing the first
modern cesarean section in
Meckesheim village, Germany,
in 1881. This involved making an
incision across the lower part of
the mother’s uterus to deliver the
baby, while minimizing blood loss.

Men in women’s health


In 16th-century Europe medical
men such as French military
barber-surgeon Ambroise Paré
(see pp.78–79) discovered that Ivory Japanese
△ A Man-Midwife doll with robe
This 1793 cartoon satirizes the movement their general medical knowledge draped over
into traditional female midwifery of men. Often could be applied to a field that a portion of
the figure
eminent surgeons, these men were seen as keen was dominated by female birth
to extend their own fame and influence, rather attendants who were not
than to do the best for mothers and babies. medically trained. German

134
PREGNANCY AND CHILDBIRTH

In the first half of the 1700s was acknowledged and formalized AMERICAN MIDWIFE AND AUTHOR (1940– )
obstetric forceps were introduced the world over. In 1861 the
by Scottish obstetrician William Professional Midwifery Education INA MAY GASKIN
Smellie, who also published Foundation was set up in the
A Treatise on the Theory and Practice of Netherlands. In Britain, meanwhile, Born in Iowa, Gaskin published
Midwifery in the 1750s. The vaginal women’s rights campaigner Louisa Spiritual Midwifery in 1977. In this
speculum, known since Roman Hubbard founded what became the book, she explained pregnancy,
times (see pp.42–43), also came into Midwives’ Institute in 1881. In 1902 delivery, and infant feeding from a
wider use. By this time, more births the Midwives Act in England and natural viewpoint, emphasizing the
were happening in hospitals than Wales established midwifery as a mental, intellectual, emotional, and
homes, reinforcing the power of specialized profession with training traditional aspects of childbirth, as
obstetricians over midwives. This and certification. The UK Midwives’ well as the medically mediated
trend had its own problems, such Institute became the Royal College physical processes. She supported
as childbed fever (see pp.138–39)— of Midwives in 1947, the French the natural childbirth movement,
caused by lack of hygiene, leading College of Midwives was set up in advocating minimal intervention,
to infections on the wards—and the 1949, and the American College of active roles for family and friends,
new male “experts” often lacked the Nurse-Midwifery in 1955. By the and home births as the norm. Her
empathy, experience, and traditional mid-20th century many other Guide to Childbirth (2003) has
knowledge of female midwives. nations had established similar become a bestseller.
recognitions and qualifications.
Midwives recognized
Following the work of Florence
Nightingale and other pioneers “ Our bodies must work pretty well, or there
in nursing (see pp.142–43),
midwives, too, began receiving wouldn’t be so many humans on the planet.”
recognition. Gradually, midwifery INA MAY GASKIN, AMERICAN MIDWIFE AND WRITER, INA MAY’S GUIDE TO CHILDBIRTH, 2003

Bun indicative of Ivory Chinese doll


an adult woman wearing bangles

▽ Diagnostic dolls
Cultural taboos, or perhaps
simple modesty, often prevented
male physicians from examining
a woman’s genital area, so
the female patient would explain
her predicament using a diagnostic
doll. These examples of such dolls
are from China and Japan in the
18th and 19th centuries.

Shoes worn to
meet demands
of traditional
modesty, which
insisted that Ivory
women’s feet Chinese doll
be covered at with feet
all times covered

135
SCIENCE TAKES CHARGE 1800 –1900

Midwives
Sculptures and papyri from ancient Egypt record specially
trained women attending mothers during pregnancy and
birth, and in Islamic medicine the midwife was a highly
regarded specialist. However, this status did not last, and
not until the 19th century did female midwives regain
their standing within the medical community.

During the medieval period, especially in Europe, the profession


lost some of its importance, and the role of the midwife was
usually given to an older woman of the community. She was
often illiterate and had no formal training, but she did have
experience and knowledge of traditional techniques and folk
remedies. Most countries continue to have this kind of “lay
midwife,” or Traditional Birth Attendant (TBA). In the 1400s
the midwife’s role became recognized again, albeit informally.
However, its practitioners still had low status in what was a
male-dominated medical system. In Britain, a 1512 Church
Act brought in some regulation and necessitated that midwives
swear an oath concerning their training and duties.
From the 1600s male physicians and surgeons began
incorporating midwifery into their practices. The next century,
especially in Britain, was the era of the “man-midwife,” and
various advances were made, such as improved obstetric
forceps by Scottish obstetrician William Smellie in the 1750s.
The 19th century saw a swing toward female midwives with
recognized qualifications, and the establishment of professional
bodies such as the UK Matron’s Aid (1881). Midwifery joined
mainstream medical specialities in many countries, with the
International Confederation of Midwives established in 1919.

“ A world where every


childbearing woman has
access to a midwife’s care.”
THE VISION OF THE INTERNATIONAL CONFEDERATION OF MIDWIVES

▷ School for midwives


The Maternité de Paris in Port-Royal, France, was a “lying-in”
hospital for poor women as well as a school for midwives. In this
illustration, midwives of the Maternité de Paris are seen attending
to infants in the first incubators, introduced there in the 1880s.

136
△ Handwashing in maternity wards

Childbed Fever
In 1847 Ignaz Semmelweis noted that after he
advocated regular handwashing, death rates at
the First Clinic in the Vienna General Hospital
fell from 12–13 percent to 1–2 percent.

In the 1840s simple observations and actions by Ignaz Semmelweis dramatically reduced
occurrences of childbed (or puerperal) fever. However, his work was initially ridiculed and
its importance was only recognized years later, once the germ theory was widely accepted.

C
hildbed fever has long been epidemic proportions—but only The only significant difference that and that the course of his infection
a dreaded infection for in one of its two maternity clinics. he discovered was the visiting staff: was very similar to that of childbed
new mothers and infants, Semmelweis was puzzled by the the First Clinic was a training center fever. From this, Semmelweis
but the first major reduction in difference in infection and death for apprentice physicians, while the inferred that Kolletschka had died
the death rate did not come until rates between the First and Second Second Clinic was for the teaching from the same disease and it was
Ignaz Semmelweis implemented Clinic: it was well known that of student midwives only. likely that the wound made by the
changes on a maternity ward in there were many more maternal contaminated knife had caused his
Vienna, Austria. fatalities in the First Clinic, but Deadly particles colleague’s death.
After completing his medical no one knew why. Methodically, In March 1847 Semmelweis was While there seemed to be a link,
training in Vienna, Semmelweis Semmelweis eliminated possible saddened by the untimely death of the nature of the contamination
was appointed assistant to the factors, such as food and drink, a colleague and professor of forensic remained a mystery, because the
professor at the maternity unit temperature, humidity, and other medicine, Jakob Kolletschka. The existence of germs was not yet
in the Vienna General Hospital. environmental conditions; he postmortem showed that he had proven. Semmelweis suggested that
At the time, new mothers were noted the age of patients, their suffered an accidental knife wound some kind of infective matter, which
dying from childbed fever in backgrounds, and even religion. during an autopsy demonstration, he named “cadaverous particles,”

138
CHILDBED FEVER

HUNGARIAN PHYSICIAN (1818–1865)

IGNAZ SEMMELWEIS
Born in Budapest, Hungary, he introduced the same hand-
Semmelweis received his washing routine that he had
doctoral degree in medicine introduced in Vienna. In
from the University of 1855 he was appointed
Vienna, Austria, in 1844. professor at the University
He was then appointed of Pest, Hungary, and he
to the Vienna General published his principal work
Hospital’s obstetrics clinic, on childbed fever in 1861
where he became involved but generally it was not well
with the problem of childbed received. Semmelweis’s behaviour
fever. After being passed over for became increasingly erratic after he
promotion, in 1850 he returned to developed a kind of dementia, and
Budapest and joined the Szent Rokus he died only two weeks after being
Hospital as Head of Obstetrics, where admitted to an asylum in Vienna.

was to blame for both Kolletschka’s (calcium hypochlorite) for all his that the “cadaverous particles” Childbed Fever), but his work was
death and childbed fever. He argued staff. The results were sudden and existed and his theory did not fit in generally rejected. Semmelweis
that surgeons and medical students very startling. Death rates from with long-established beliefs, such died in obscurity in Vienna in 1865.
often came from autopsies and childbed fever fell drastically in the as the concept of the four humors The same year, pioneering British
corpse dissections directly to the First Clinic to about the same level (see pp.34–35) or the miasma surgeon Joseph Lister began using
maternity clinics (in the case of as those in the Second Clinic, and theory (see pp.120–21). Also, the phenol antiseptics (see pp.154–55)
Vienna, the First Clinic), and that they continued to fall through the surgeons he accused of carrying the after reading Louis Pasteur’s
they carried the particles on their following year. contamination were important men theory—partly derived from an
hands and equipment, which then Semmelweis regarded his views as who refused to accept that they interest in childbed fever—that
infected the mothers. proven and vitally important. Yet he were to blame. In addition, political unseen germs cause disease
was met with enormous criticism and religious factors came into play, (see pp.146–47). It was only
Handwashing routine and inaction by the medical given that Semmelweis was a after this advance that the work
Semmelweis was convinced that establishment who, Jewish Hungarian living in Austria. of Semmelweis came to be fully
the solution to the problem of typically, were In 1861 Semmelweis published a appreciated. Today, he is praised for
cross-contamination was thorough sceptical of book about his findings titled Die his great work on childbed fever and
handwashing. Believing that soap the new and Ätiologie, der Begriff und die improving hygiene in hospitals, as
was not sufficently powerful, he untested ideas. Prophylaxis des Kindbettfiebers well as his research into antiseptics,
introduced a routine of regular Semmelweis (The Etiology, Concept, how contagious diseases spread, and
handwashing using chlorina liquida could not prove and Prophylaxis of how microbial germs cause disease.

“ Cleanliness was out


of place. It was considered ◁ Infection carriers
Childbirth forceps came into general
use from the early 1700s. However,
finicking and affected.” without an understanding of hygiene,
they were a reservoir of infection that
SIR FREDERICK TRAVERS, BRITISH ROYAL SURGEON TO KING EDWARD VII, 1853–1923 repeatedly spread childbed fever.

139
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Women in
Medicine
Over the millennia and around the world, the medical
profession has often reflected wider society. As a result,
medical practitioners, especially at senior levels, have been
overwhelmingly male. A degree of equality has only been
achieved during the past century, but not yet in all nations.

W
omen have always played 2,300 years ago, however nothing
important roles as more is known of her life. Another
caregivers, nurses (see ancient Greek woman, Agnodice,
pp.142–43), and midwives (see is said to have practiced medicine
pp.136–37), but until the 19th while disguised as a man.
century, only a few rose to higher
ranks in the medical profession. Early influencers
One of the earliest known female There are records of female healers
physicians was ancient Egypt’s in the medieval Islamic world
Merit-Ptah, around 4,700 years from the 8th century, although, in
ago. Not much is known about her, common with many other cultures
except her tomb inscription, which through history, they only treated
reads “chief physician.” At Heliopolis other women. Female surgeons are
in Egypt, female students attended depicted in the illustrated manual
medical school around 3,500 years Cerrahiyyetu’l-Haniyye (Imperial
ago, but little detail is known. Surgery) by male Turkish surgeon
Women’s involvement in medicine Sabuncuoglu Serefeddin. Christian
in ancient Greece was also limited. Europe was far less enlightened and
Greek physician Metrodora is only a few female physicians are and physician. Her works from △ Interview panel
recognized as the first female writer known from the period. Hildegard the 1150s include Liber Simplicis Despite gaining a medical license in England,
on medicine. She wrote On the of Bingen (see pp.56–59) was a Medicinae (Book of Simple Medicine), Elizabeth Garrett Anderson was forbidden from
Diseases and Cures of Women around prominent abbess, poet, musician, later called Physica, which describes working in hospitals. She traveled to Paris to
hundreds of treatments made gain a French medical degree and worked there.
from minerals, herbs, and animal This illustration shows her being interviewed by
parts. Trotula de Ruggiero, a more the Faculty of Medicine of the Sorbonne, Paris.
shadowy personality who, if real,
lived during the latter half of the
11th century, is associated with subjects such as feminine hygiene,
several medical publications. fertility, conception, pregnancy,
“The Trotula” became the collective and childbirth.
name for several works, including
Diseases of Women, Treatments for Female medical pioneers
Women, and Women’s Cosmetics. The The acceptance of women into the
writings were refreshingly practical, medical profession began to happen
and covered a wide range of in the 18th century. In 1732 Italian
Laura Bassi was named professor
of anatomy at the University of
◁ Hildegard of Bingen Bologna, before continuing her
This altarpiece depicts the arrival of Hildegard career in physics. In Prussia,
with her family at the Benedictine Abbey of Dorothea Erxleben, with special
Disibodenberg, in about 1112. Hildegard wrote permission from King Frederick the
a number of scientific and medical works, and Great, graduated in medicine from
founded several monasteries. In 2012 she was the University of Halle in 1754.
named “Doctor of the Church” by the Pope. But these were still isolated cases.

140
WOMEN IN MEDICINE

BRITISH–AMERICAN
PHYSICIAN (1821–1910)

ELIZABETH BLACKWELL

In 1847 Elizabeth Blackwell enrolled


at Geneva Medical College, New
York State. She graduated in
1849, becoming the first woman
to receive a Doctor of Medicine
degree from a US medical school.
She faced prejudice when trying
to enter the profession, so in 1851
she set up her own medical practice
and dispensary in New York for
disadvantaged women, followed by
the New York Infirmary for Indigent
Women and Children in 1857.

“ It is not easy to be a pioneer— Elizabeth Garrett Anderson. Jex-


Blake was one of the first female
on campaigning for women’s rights
for the rest of her life. In 1876

but oh, it is fascinating!”


doctors in Britain, and she went on British law changed to allow women
to found the Edinburgh School of full access to the medical profession,

49
Medicine for although an
ELIZABETH BLACKWELL, BRITISH–AMERICAN PHYSICIAN Women in 1886. PERCENT of all underlying
In 1859 Garrett general practitioners prejudice still
In 1849 Elizabeth Blackwell became Anderson had in the UK in 2015 remained for
the first American medical graduate, met and been were women. many decades.
and went on to have a long and inspired by Women were
distinguished career, pioneering Blackwell. She became also gaining access to the medical
women’s roles in medicine (see a nurse at London’s Middlesex profession in other nations, especially
panel, right). In England, she Hospital, and in 1862 joined the in Europe. Madeleine Brès was the
helped establish the London Society of Apothecaries to gain a first Frenchwoman to receive a
School of Medicine for Women license for medical practice—a first medical license in 1875. The trend
in 1874 with British physicians for a British woman. She opened spread and, in Japan, physician’s
Sophia Jex-Blake and a private practice, then St. and women’s rights campaigner
Mary’s Dispensary for Women Yoshioka Yayoi founded the Tokyo
and Children, and in 1872 the Women’s Medical University in
▷ Agnodice New Hospital for Women 1900. By this time the women’s
Around the 4th century BCE, in ancient (later renamed the Elizabeth rights and suffragette movements
Greece, Agnodice disguised herself Garrett Anderson Hospital). were also gaining momentum,
as a man to help women during Continuing her pioneering and from about 1914 feminist
pregnancy and childbirth. At this time, work, she became the first campaigner Margaret Sanger (see
women were banned from working female member of the British pp.226–27) also fought for women
as doctors and could be executed. Medical Association, and carried as patients and health services users.

141
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Nursing
Although nursing is one of the oldest medical occupations, it has not always had a good reputation.
It took the influence of one extraordinary woman—Florence Nightingale—to transform nurses from
uneducated “ward maids” to the academically qualified, skilled professionals that we know today.

I
n Europe during the medieval gained a reputation for Nursing was on the
period hospitals were usually ignorance, drunkenness, threshold of reform.
attached to religious institutions, and promiscuity. In 1860 Nightingale
such as monasteries and convents, The push for nursing realized her dream of
with patients nursed by monks and reform in Europe began establishing a training
nuns. However, in the 16th century in the 19th century, school for nurses at
many hospitals were shut down as largely instigated by the St. Thomas’ Hospital
a result of Protestant reformations. Christian community. in London; it became
With the growth of industrialization Many visitors to Germany a blueprint that was
in the 18th century, new secular were impressed by the copied throughout
hospitals were founded. During this work of pastor Theodor the British Empire
period, sometimes termed the Fliedner, who opened a and the US. Nursing
“Dark Ages of nursing,” the quality hospital on the Rhine in associations were
of care was frequently dire—nurses 1836 (see pp.106–07). established across the
tended to be recovering patients, or Nurses were given simple world, which brought
hired men and women who could clinical instruction and in standardization
not read or write and often drawn studied pharmacy—the of training and finally recognized
from the poorhouses. Nurses practice of preparing and △ Wartime nursing recruitment poster nursing as a profession. In 1863
dispensing drugs. The nursing Thousands of nurses flocked to the Western the International Red Cross (see
course was quite advanced for its Front in the early months of World War I as a pp.266–67) was set up to offer
BRITISH NURSE (1820–1910)
time, and Fliedner’s most famous result of recruitment posters such as this. The neutrality and protection to those
FLORENCE NIGHTINGALE student—Florence Nightingale— first trained nurses reached France just eight wounded in armed conflict, and it
spent three months at his hospital days after the war on the Western Front began. endorsed the training of nursing.
Born into a wealthy English family, in 1851. By the mid-19th century,
Florence Nightingale reformed the the concept of women being trained A modern profession
profession of nursing. A woman to nurse was well established. English General Hospitals in Until World War I the Nightingale
of very strong will, her tireless Turkey”—a powerful position that legacy prevailed. Nurses were seen
work caring for soldiers during the Nurses go to war gathered huge attention. as the guardians of hygiene, the
Crimean War established her as The advent of the Crimean War Nightingale enforced a strict code dispensers of compassion, and the
“The Lady with the Lamp.” Her (1853–56) transformed nursing. of discipline, discouraging nurses center of calm amid the chaos of
reforms led to a dramatic reduction Cholera spread rapidly in the from fraternizing with the patients the hospital. However, the nurses’
in deaths. She founded a training British army camp, and surgeons and doctors, as well as promoting actual duties were rather vaguely
school for nurses at St. Thomas’ had to perform major operations hygiene, sobriety at all times, and described. During World War I the
Hospital, London, in 1860, and and amputations without light, good manners. Nightingale and her

90,000
helped promote nursing as a anesthetics, or even bandages. small band of nurses were a great The number of
respectable career for women. When the British press reported inspiration to women, showing volunteers with
that the wounded and the sick that war was no longer a male the Red Cross’s Voluntary Aid
were not being properly cared for, preserve. When the American Civil Detachments during World War I.
the government responded by War broke out in 1861, the Sanitary
sending female nurses abroad to Commission—a forerunner to the boundaries between medicine and
tend to the casualties. Florence Red Cross—was founded. Armed nursing broke down. As doctors
Nightingale was appointed as the with the knowledge of good hygiene struggled to cope with emergency
“Superintendent of the Female practices from the Crimean War, it surgery, trained nursing staff took
Nursing Establishment of the recruited a large number of nurses. on duties that would not normally

“… the very first requirement… do the sick no harm.”


FLORENCE NIGHTINGALE, FROM NOTES ON HOSPITALS, 1859

142
NURSING

fall to them, including triage (see of new wartime technology—for ▷ Modern nurses
p.256), the administration of saline example, learning how to use The role of nurses has
drips and intravenous injections, oxygen cylinders for soldiers with developed to occupy
and the dispensing of narcotic lungs filled with mustard gas, and an ever-wider range
drugs. The nursing staff were also applying sodium bicarbonate to of healthcare duties.
responsible for implementing many their blinded eyes. Modern nurses are not
of the new developments aimed at World Wars I and II emphasized merely caregivers—
combating infection and passing the growing need for fully trained, they have to display a
on their knowledge to volunteers well-educated nurses, and today high level of technical
competence and may
from the Red Cross’s Voluntary Aid many countries demand that nurses
also act as clinicians,
Detachments (VADs), which were have a university degree. From an
diagnosing illness and
set up to provide supplementary occupation of the poor and illiterate,
making decisions about
first aid and nursing to the medical nursing has evolved to become one
suitable treatments.
service in wartime. In addition, of the most important professions
nurses had to cope with the effects within the healthcare industry.

Night After the Battle


This painting by Robert Neal and D.J.
Pound shows Florence Nightingale
tending to a wounded soldier amid
the carnage of the battlefield during the
Battle of the Alma (1854) in Turkey.

143
SCIENCE TAKES CHARGE 1800 –1900

Medical Publishing
In 1858 English anatomist Henry Gray wrote Anatomy:
Descriptive and Surgical, illustrated by his colleague
Henry Vandyke Carter. Gray died just three years later,
at the age of 34 years, but his name lives on in the best-
known educational and reference work in all of medicine.

In 1853 Gray became an anatomy lecturer at St. George’s


Hospital Medical School, London. His aim was to write a
compact illustrated textbook for students that was low-cost
yet accurate and authoritative. He enlisted the artistic skills
of Carter, who was studying at St. George’s for his medical
qualifications. The two men dissected the bodies of deceased
people who had no family or friends and wrote and illustrated
their findings. The work rapidly expanded and the first edition
ran to 750 pages with more than 360 pictures.
Gray died of smallpox soon after preparing the second edition
in 1860, while Carter moved to the Indian medical service in
1858. Their book was retitled Gray’s Anatomy and there
followed regular updated, enlarged editions with distinguished
editorial panels. The scope widened to include new material such
as microscopy, X-rays, scans, and physiology diagrams; by the
time the 38th edition was printed in 1995, it had more than
2,000 pages. The work entered a new era in 2004 with a newly
organized, slimmed-down 39th edition of 1,600 pages, with
almost 2,000 illustrations—400 of them new—and digital and
online versions. Gray’s Anatomy has remained a vital teaching
and reference work for generations of medical students,
surgeons, and all other health practitioners.

“ Every living physician


today has been exposed
to Gray’s Anatomy.”
JOHN CROCCO, ASSISTANT PROFESSOR OF CLINICAL MEDICINE,
INTRODUCTION TO THE COLLECTOR’S EDITION OF GRAY’S ANATOMY, 1977

◁ Bones of the hand


Basic human anatomy remains much the same, but updates to
Gray’s original work regularly provide additional details. After
Carter’s departure, John Westmacott made the illustrations for the
second and later versions, such as this one from the 20th edition.

145
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Microbiology and
Germ Theory
Less than 200 years ago, the existence of the germs that are now known to cause
infections was unsuspected. The gradual discovery of these harmful microbes and
methods to combat them were among the greatest advances in all of medicine.

N
ature can generate life almost scientists and physicians began to Henle proposed: “The material
anywhere, minute plants infer that these could be responsible of contagions is not only an
sprouting and infinitesimal for the transmission of diseases. organic but a living one.” In 1847
animals appearing as if out of In 1668 Italian naturalist-physician Hungarian obstetrician Ignaz
the air. With no evidence to the Francesco Redi began investigating Semmelweis reasoned that △ The cause of anthrax
contrary, people assumed that living the supposedly spontaneous “cadaverous particles” caused Koch cultured and tested 20 generations of the
things could arise from nonliving appearance of maggots on dead childbed fever (see pp.138–39). rod-shaped anthrax bacterium (Bacillus anthracis)
matter—a concept known as meat. He carried out experiments In 1854 British physician John to prove that it caused the disease. He also noted
spontaneous generation. Another with old meat in jars—some open Snow suspected contagion during that the bacteria could survive tough environments
popular notion was miasma theory to the air, some covered with cloth, a cholera outbreak (see pp.122–23). by transforming into dormant spores, which would
(see pp.120–21), which stated and some stoppered. Redi noted The contagion, or germ, theory reactivate when conditions improved.
that noxious vapors and gases that maggots would develop only of disease—according to which
somehow penetrated the body if flies could land on the meat. transmissible living particles are
to produce diseases. After the A century later, Italian priest responsible for human diseases— Initially a colleague of Pasteur
invention of the microscope (see Lazzaro Spallanzani boiled meat was gaining ground, although but later a bitter rival, German
pp.92–93) in around 1600, these broth and sealed some samples miasma theory still prevailed. physician Robert Koch qualified
perceptions gradually began to in glass vessels while leaving with distinction in medicine at
change. This novel instrument others open. The sealed samples Isolating harmful microbes Göttingen University in 1866 and
showed for the very first time stayed uncontaminated, but the In 1862 French biologist Louis was inspired by his professor Jakob
that there were minute animals, others soon began to deteriorate. Pasteur (see pp.148–49) performed Henle to pursue microbiology.
or “animalcules,” everywhere, and The 19th century saw a steady pivotal experiments with boiled He set up a home laboratory in
stream of discoveries. In 1835, meat broth and glass “swan-neck” Wollstein (now Wolsztyn, Poland),
while studying a silkworm disease, flasks. He concluded that some where he began a series of studies
▽ Refuting spontaneous generation Italian entomologist Agostino kind of contagion led to the with far-reaching effects. Koch’s
Francesco Redi’s 1668 work Experiments on Bassi deduced that the condition development of molds in broths first subject was anthrax—a highly
the Generation of Insects showed that maggots occurred due to some kind of open to the air, but not in those infectious disease of herbivores.
hatched in old meat not through spontaneous “contagion” or “transmissible broths that were protected from He inoculated some mice with
generation but from eggs laid by visiting flies. particle” spread by contact or contamination. Despite protests samples from healthy, and some
However, the theory of spontaneous generation close proximity. In 1840 German from supporters of spontaneous with samples from diseased, farm
persisted for another two centuries. anatomist and histologist Jakob generation, Pasteur’s evidence animals. The former did not
boosted the notion of germ develop the disease, but the latter
theory—and that transmissible did. He then set about purifying
living particles might cause anthrax bacteria, growing them
human diseases. in a laboratory culture medium,

“ The earth… has never produced


any kinds of plants or animals…
everything we know… [comes] from
the true seeds of the plants and
animals themselves.”
FRANCESCO REDI, FROM EXPERIMENTS ON THE GENERATION OF INSECTS, 1668

146
MICROBIOLOGY AND GERM THEORY

“The pure culture is the foundation for ▷ Bacteria cultures


This illustration shows laboratory test tubes
all research on infectious disease.” containing bacteria cultures of tuberculosis (left)
and cholera (right), both discovered by Koch.
ROBERT KOCH, FROM STUDIES OF PATHOLOGICAL ORGANISMS,1881 His team devised many techniques for growing,
staining, observing, identifying, and photographing
microbes that benefited medical research.
and studying them under the devised a set of criteria linking
microscope. He published his particular microbes to specific
findings in 1876, establishing diseases. These came to be known contaminated water and food,
for the first time the connection as Koch’s postulates and are still and suggested prevention and
between a specific disease and in use today. control measures.
a microorganism. In 1880 Koch Next, he studied tuberculosis and Koch’s contributions to medical
discovered its causative agent— research were recognized in 1905
Koch’s bacillus, or Mycobacterium when he received the Nobel Prize
▽ Attempting to cure tuberculosis tuberculosis—in 1882. After that in Physiology or Medicine for his
A patient is given Koch’s treatment for tuberculosis he turned his attention to cholera “investigations and discoveries in
at the Royal Hospital, Berlin, in around 1890. (see pp.122–23), traveling to Egypt relation to tuberculosis.” The award
Koch’s remedy for tuberculosis, named tuberculin, and India as part of his research. gave credence to the work of Koch
failed amid great controversy, as did a revised In 1884 he isolated the causative and others, who replaced ideas of
version in 1897. Tuberculin was later used to germ, since named Vibrio cholerae, miasma and spontaneous generation
develop a test to diagnose tuberculosis infection. defined how it spread via with the germ theory of disease.
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

FRENCH CHEMIST Born 1822 Died 1895

Louis Pasteur
“In the field of observation,
chance favors only
the prepared minds.”
LOUIS PASTEUR, ON APPOINTMENT AS DEAN OF SCIENCE FACULTY, LILLE UNIVERSITY, 1845

O
◁ Founder of microbiology ne of France’s greatest
Along with Robert Koch—at first his colleague scientists, Louis Pasteur made
but then great rival—Pasteur placed the study significant contributions to
of microbial life onto a scientific footing and almost every field he ventured into.
moved it into mainstream medical research. He developed the process of killing
germs using heat, now called
pasteurization; helped replace the
theory of spontaneous generation
with germ theory (see pp.146–47);
and aided the silk industry by
identifying a disease of silkworm
caterpillars. From the 1870s he
developed vaccinations for chicken
cholera, forms of animal anthrax,
and rabies in animals and humans
(see pp.168–69).

Breakthrough research
Pasteur’s first major contribution
to life sciences was to investigate
why alcoholic drinks sometimes
“spoil”(go bad or sour)—a costly
problem for the French beer and
wine industries. After exhaustive
microscopic studies he drew two
conclusions. First, fermentation
was not a simple chemical change,
as believed, but a living process
carried out by yeast microbes.
Second, souring was caused by
contamination with bacterial
microbes. The remedy he devised
in 1864 was to heat the drinks
briefly to 122–140°F (50–60°C),
to kill off disease-causing bacteria
without altering the beverage’s
aging process, taste, or appearance.
In the 1880s the process became
known as pasteurization—in his
honor. Medically it helped save
many lives, for example preventing
diseases such as tuberculosis, which
L O U I S PA S T E U R

spread through contaminated milk. ▷ Making milk safe


TIMELINE
Pasteur also questioned the theory of Contaminated milk causes
spontaneous generation—that living many diseases. The heat ■ 1822 Born in Dole, eastern France; grows
things could arise from nonliving treatment devised by up in Arbois.
matter. In 1862 he conducted Pasteur for alcoholic ■ 1840 Gains his Bachelor of Arts degree,
experiments using glass flasks drinks was applied to followed by a science degree at the Royal
with S-shaped necks (see below). mass milk production College of Besançon, France.
He proved that if contaminating from the 1880s. This milk
■ 1847 Receives a doctorate from the École
microbes were kept away from pasteurization equipment
Normale Supérieure, Paris.
is from French science
a nutrient liquid, germs did not grow ■ 1848 After researching and teaching at
magazine La Science
even if the liquid was in contact various locations, Pasteur is appointed
Illustree, 1898.
with air. Pasteur’s experiments chemistry professor at the University of
were powerful evidence against Strasbourg, France. He marries Marie
spontaneous generation and led to Laurent. They have five children,
its rapid demise in the following few although three die young from
decades, it was replaced by germ infections, which inspires Pasteur’s
Milk container
theory, according to which microbes later work. Studying a chemical
cause infections and contamination. called tartaric acid, Pasteur discovers
In 1865 Pasteur’s research revealed that molecules can exist as mirror-image
left- and right-handed versions. This
fundamental discovery leads to the
1881 The year that
Pasteur coined the
term vaccination, from Latin
growing, fresh cholera microbes.
However, his research was
germs; a similar group was not
vaccinated. When both groups
field called stereochemistry.
■ 1854 Appointed professor
vacca, meaning cow. interrupted by a vacation. On his later received full-strength anthrax, of chemistry and dean of
return, he gave the month-old the treated animals survived science at Lille University,
that harmful microbes were cultures to chickens, who did not while the untreated ones died. France, and begins
responsible for a ruinous disease die of infection. Pasteur suspected In 1885 he carried out the first work on “souring”
affecting silkworms. He was also that the germs were weakened and successful rabies vaccination on alcoholic drinks.
able to isolate infected silkworms gave immunity to the chickens a young boy. This was among his ■ 1857 Becomes director
from healthy ones and prevent (see pp.158–59). This finding last research projects, although of Sscience at the
further contamination. subsequently resulted in his he continued to lecture, fundraise, École Normale
developing a vaccine using a accept awards and medals, and set Supérieure.
Vaccination weakened form of the disease- up the prestigious Institut Pasteur ■ 1865 Shows that
The same year France suffered a bearing organism. in Paris. His death in 1895 was microbes attack
cholera epidemic and Pasteur began Animal anthrax was another deeply mourned across the world. silkworm eggs
studying it, as well as anthrax and disease causing great damage to Although he never actually qualified causing disease,
other human and animal diseases. French farming. In 1881 Pasteur as a medical doctor, Pasteur’s and that this can
He made little progress until 1879, gave a group of cows, sheep, and work helped save countless be prevented. His
when he started culturing, or goats a vaccine of weakened anthrax human—and animal—lives. advice is quickly REPLICA OF THE FLASK
USED BY PASTEUR TO
adopted by silk SHOW THAT GERMS
producers around CAUSE DISEASE

“ There are no such things ▽ The swan-neck experiment


the world.
■ 1868 Partially paralyzed by a

as applied sciences, only Pasteur did many experiments with S-shaped,


or swan-neck, flasks. Once the flasks were
stroke, but continues to work.
■ 1879 Develops his first vaccine for
sterilized by heat treatment, nutrient broth did
applications of science.” not spoil if dust, microbes, and other particles
were prevented from falling into it by the long,
chicken cholera; extends this research
to human diseases.
LOUIS PASTEUR, FROM REVUE SCIENTIFIQUE, 1871 bent tube—even if it was open to the air. ■ 1882 Already an associate member
of the Académie de Médecine since
1873, Pasteur is accepted into the
Air can get in Microorganisms get Académie Française.
through tube trapped in the curve
■ 1885 Vaccinates Joseph Meister, a
boy bitten by a rabid dog.
TILTING THE
TUBE ALLOWS
■ 1888 Sets up the Institut Pasteur in Paris,
MICROORGANISMS France, for the study of microbiology.
INTO THE BROTH
■ 1895 Dies and is buried in Notre
Dame Cathedral. The next year, his
remains are moved to a special
crypt at the Institut Pasteur.
WHEN THE MICRO-
THE BROTH IS BOILED BROTH COOLS IT ORGANISMS
TO KILL ANY MICRO- REMAINS FREE OF QUICKLY
ORGANISMS IN IT MICROORGANISMS MULTIPLY

149
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Cell Theory
Before the 19th century no one had a clear notion of the basic building blocks of life. The
use of microscopes (see pp.92–93) allowed the development of cell theory—that living
organisms are composed of cells—which had enormous effects in many fields of medicine.

T
he invention of the the term “cell” because the angular skeletal rod (notochord) of existing ones—a process
microscope in the 1590s structures reminded him of the primitive fish. Schwann took he had observed in algae.
made it possible for the first cells, or living quarters, of monks. Schleiden’s theory a step further, As early as 1842 Swiss
time to observe animal and plant In 1682 Dutch polymath Antoni applying it to animals as well as botanist Karl von Nägeli had
matter at a level that had van Leeuwenhoek observed the plants, and defining the three identified small structures in the
previously been invisible to the nucleus of a cell in the red blood structural parts of a cell—the nucleus, which came to be called
naked eye. Plant cells were first corpuscles (RBCs) of a salmon. wall, nucleus, and cellulose, or chromosomes, and which contain
described by British polymath Some hundred years later, in 1800, fluid content. In 1839 Schwann the cell’s genetic material. By the
Robert Hooke in 1665. He coined French anatomist and physiologist published the paper Microscopic 1850s microscopes had become
Marie-François Investigations on powerful enough to allow scientists
G E R M A N B O TA N I S T
(1804–1881)
Bichat took
advantage of 37
TRILLION A 2013 estimate
of the number of cells in
the human body.
the Accordance in
the Structure and
to see cell division taking place,
and in 1879 German military
improvements in Growth of Animals physician Walther Flemming
MATTHIAS SCHLEIDEN the magnification and Plants, in observed chromosomes separating
levels of microscopes to catalog which he famously observed that, as the cell divided, in a process he
Educated in law at Heidelberg the structure of human skin, which “all living things are composed of named “mitosis.” Other components
University in Germany, Schleiden he compared to a woven fabric. cells and cell products.” of cells were also identified. These
found legal practice distasteful and However, it was not yet understood However, how cells are created included, in 1890, mitochondria—
became a botanist instead. He had that all life forms are composed and how growth occurs were not the cell’s “powerhouses,” which
already rejected the contemporary of these small structures, or that yet understood. Schleiden believed, play a role in processing sugars
botanical preoccupation with all cells are derived from other and Schwann accepted, that new and oxygen to produce energy,
classification—which he mockingly cells by cell division or cell-based cells were crystallized from the decribed by German pathologist
described as recognizing plants reproduction. Indeed, in the early fluid that lay between previously Richard Altmann.
“with the least possible bother”— 19th century it was thought that existing cells. This focus on the
in favor of examining samples with cells could spontaneously generate material outside the cell held back A basis for new advances
the microscope. His observations from nonorganic matter, or from cell biology for some years. The development of cell theory
led him to conclude that all plants decomposing living material. Finally in 1851 German botanist gave scientists a firm basis for
are composed of cells, which Hugo von Mohl proposed that new the understanding of heredity.
formed the basis of cell theory. Recognizing building blocks cells are formed by the division of In 1869 Swiss biochemist Friedrich
After a brief stint as a lecturer in In 1838 Matthias Schleiden,
Russian-ruled Dorpat (in Estonia), professor of botany at the University
he returned to Germany, where he of Jena, Germany, wrote the
was a private teacher. article “Contributions to Plant
Phytogenesis,” in which he used
previous scientific observations and
his own observations through a
microscope to deduce that all parts
of plants are composed of cells. He
explained his theory to his friend
German physiologist Theodor
Schwann, who had seen similar
cell-like structures in the internal

▷ Schwann’s drawings
Schwann’s 1839 publication included drawings
of different types of animal cells. Although they
varied widely in form, the presence in all of them
of a nucleus and an enclosing membrane, or cell
wall, convinced him that they were all versions
of the same basic cellular building block.

150
CELL THEORY

Centrosome,
containing Chromosomes
microtubules have replicated
and begin to
condense
Cell nucleus,
INTERPHASE
containing replicating
chromosomes Microtubules
move into a
spindle
formation
Original cell ▷ Cell division
forms two
separate cells
Cell mitosis is the process by which a cell EARLY PROPHASE
divides to create two identical daughter cells.
In this process the membrane of the nucleus
dissolves, the replicated chromosomes split Chromotids (newly copied
Nuclear chromosomes that are
membrane has into two sets and these are pulled to opposite
still joined in pairs)
formed around ends of the cell when the nuclear membranes
each set of re-form. Finally the cell itself splits to form
chromosomes Spindles
two new cells.

Chromosomes LATE PROPHASE


become less
condensed Spindle microtubules
shorten, pulling the
chromatids apart
Chromatids
are pulled into
alignment
Chromatids split to
form “daughter
chromosomes“

CYTOKINESIS

METAPHASE

TELOPHASE ANAPHASE

Miescher identified nucleic


acid, which in the form of DNA “Omnis cellula e cellula
(all cells come from
(deoxyribonucleic acid) is the
building block of genes and
chromosomes. In 1905 English
biologists John Farmer and
John Moore coined the term
cells).”
“meiosis” to describe a consecutive, RUDOLF VIRCHOW, PRUSSIAN ANATOMIST, 1855
double division of cells that halves
the amount of chromosomes
passed to spermatazoa or ova in None of these advances would
sexually reproducing organisms. have been possible without the ▷ Single-celled
Cell theory also contributed work of Schleiden and Schwann in parasite
to the understanding of cellular establishing the universal nature of Even tiny unicellular
pathology and disease. In 1863 cells. Building on their discoveries, organisms such as the
the Prussian anatomist Rudolf cell theory continues to inform Trypanosoma brucei
Virchow advanced the idea that our understanding of the structure protozoa, which cause
cancer occurs at sites of chronic and mechanics of the body, as well African sleeping sickness,
inflammation in the body, and that as underpinning modern research have a nucleus. Bacteria,
this can cause cells to proliferate in reproductive medicine, genetics, however, are even simpler
unnaturally, causing tumors. pathology, and pharmacology. in structure, and lack nuclei.

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Pathology and Medical


Autopsy
Much medical knowledge arose from examining dead
bodies—autopsy. At first this was with the naked eye, but
microscopes allowed massive advances in understanding
disease and the birth of cellular pathology.

T
he period from the late 1700s including Italian anatomist Marco
to the early 1800s proved Aurelio and the Dutch surgeon
to be a watershed for the Nicolaes Tulp. Some physicians
science of pathology—the branch even published “autopsy reports,”
of medicine that focuses on the the most important of which was
examination of organs, tissues, and Italian anatomist Giovanni Batista
bodily fluids in order to diagnose Morgagni’s De Sedibus et Causis
disease. This emerging field thrived Morborum per Anatomen Indagatis
on autopsies (postmortems).

Research through autopsy


The study of disease through
1832 The year that the
Anatomy Act was
introduced in England, allowing to an imbalance of body fluids (see △ Anatomy lesson
autopsy was not new. Dissections licensed anatomists to dissect pp.34–35), an idea that had been a In this 1632 painting by Rembrandt, Nicolaes
had been used to further scientific unclaimed bodies. part of mainstream medical belief Tulp explains the musculature of the arm to
discovery since ancient times, for almost two thousand years. an engrossed audience. People paid to attend
although human dissection was (On the Seats and Causes of Diseases From the mid-19th century such autopsies, which could only be performed
against Roman law. Autopsy as Investigated by Anatomy) in 1761, onward, a more scientific approach on male criminals.
was legalized in several European which described his observation of to the study of disease, led by two
countries from the 13th century more than 640 autopsies. Modern brilliant figures, Karl Rokitansky
onward, and during the 17th pathology emerged from these and Rudolph Virchow, drove altered how the autopsy was
century it became the practice precise accounts. Disease was now pathology into a new era. Austrian performed. He insisted on a routine
of a number of leading physicians, linked to body organs rather than physician Rokitansky radically for dissection that was thorough
and systematic, and was concluded
with an accurate documentation of
G E R M A N PAT H O L O G I S T ( 1 8 2 1 – 1 9 0 2 )
the findings in a report. However,
RUDOLF VIRCHOW Rokitansky was reluctant to use
a microscope, and some of his
Regarded as the most important figure blood vessels, in blood’s flow, and its theories about diseases proved
in the history of modern pathology, composition. This became known as to be incorrect.
Virchow studied medicine at the Kaiser “Virchow’s Triad.” He was the first to use
Wilhelm Institute in Berlin, Germany. microscopes extensively in tissue analysis. Shift to cellular pathology
He showed that blood clots were In 1855 he published his seminal work Unlike Rokitansky, Rudolph
caused by changes in the walls of popularizing the idea of Omnis cellula e Virchow (see panel, left) was
cellula, “Every cell stems from an advocate of the use of
Few white White cells Red cells
Platelets cells proliferate crowded out another cell”; so launching the microscopes, urging his students
Red cells field of cellular pathology. He to “think microscopically.”
explained how tumors grow In 1858 Virchow published Die
and, for the first time, gave cellularpathologie (Cellular Pathology),
hope that malignancies— in which he asserted that the cause
cancers—could be treated. He of disease should always be looked
coined the term leukemia in for in the cell. He argued that
1847 to describe blood cancers, diseases arise from abnormal
after noting that they cause an changes within cells, and from
NORMAL BLOOD LEUKEMIA excess of white blood cells. those altered cells then multiplying
through the process of cell division.

152
P AT H O L O G Y A N D M E D I C A L A U T O P S Y

▷ Postmortem instruments
A more rigorous scientific approach
to postmortems in the 19th century
required dedicated instruments.
This box includes a head clamp, bone
saw, chisels, scissors, and a mallet.

This shift from the idea


of organ-based disease
to cell-based disease was
an important step in the
“new pathology.”
Later in the 19th century
German Friedrich von
Recklinghausen rose to
prominence. A pupil of
Virchow, he published
important studies on
thrombosis (blood clots);
embolism (blockage
in a blood vessel);
and infarction (tissue
death due to lack
of oxygen), among
many other pathology-
based conditions.

Links and methods


Another student of
Virchow, German-Swiss
pathologist Edwin Klebs,
made connections
between bacteriology
and infectious disease;
he is chiefly credited
with identifying the
bacteria that cause
diphtheria in 1883.
Another German
pathologist, Julius
Cohnheim, devised
a method for
freezing tissue
before slicing it
into thin sections
for microscopic
examination that
is still a standard
procedure today. His
pupil, Carl Weigert, went
on to describe the mechanisms of
degeneration and necrosis—the
death of cells and living tissue as
“Those who have dissected or inspected
a result of disease or injury.
By the 20th century pathology many [bodies] have at least learned to
doubt; while others who are ignorant of
was well established and the pace
of development accelerated. Today’s
advances in technology, especially
in microscopy and computer-aided
image processing, enable more
anatomy… are in no doubt at all.”
precise diagnoses than ever before. GIOVANNI BATTISTA MORGAGNI, ITALIAN ANATOMIST, FROM DE SEDIBUS ET CAUSIS MORBORUM PER ANATOMEN INDAGATIS, 1761

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The First Antiseptics


The tendency of wounds—in particular incisions in the flesh made during surgery—to
become infected led to significant loss of life in premodern times. It was not until the
mid-19th century when Joseph Lister devised a solution—the use of antiseptics—that
the number of postoperative deaths was radically reduced.

T
he fact that pus forms in to combat the problem: in the ▷ Sterilizing instruments
wounds when they become 4th century BCE, Hippocrates (see The autoclave, a closed pressure chamber for
infected and fester was well pp.36–37) recommended the use the sterilization of surgical instruments using
known to physicians. This “sepsis,” of wine and vinegar in wound high-pressure steam was invented by French
or putrefaction of flesh, was so dressings, as both are mild antiseptics microbiologist Charles Chamberland in 1879. It
difficult to treat that many doctors that he thought should prevent represented a major advance in aseptic surgery.
even came to regard it as a natural sepsis. Although it was successful
part of the healing process, in spite in some instances, it never worked
of the fact that so many of their with compound fractures. These Vienna, ordered a regime
patients died. Attempts were made injuries are especially susceptible of rigorous hand-washing
to infection since many shattered in chlorinated water and the
bone fragments are exposed to air, cleansing of surgical instruments
BRITISH SURGEON
(1827–1912) allowing germs access to the body. and dressings (see pp.138–39),
Progress did come in 1812 when which reduced infection rates.
JOSEPH LISTER French chemist Bernard Courtois However, the real cause of such
discovered iodine—a more potent infections was not fully understood Carlisle, UK, and asked for samples
antiseptic agent—while searching until the 1850s when Louis Pasteur of the acid. In August 1865 he
for a substitute for the saltpeter (see pp.148–49) showed that the applied it to the wound of an
used in making gunpowder. It was culprits were microorganisms 11-year-old boy with a compound
not widely adopted at the time as entering wounds, not just bad fracture of the leg during surgery.
its use was not backed by research. vapors. Joseph Lister, a young Although the acid caused mild
Edinburgh doctor, hypothesized flesh burns, the boy’s leg did not
Banishing filth that finding a way of preventing become infected. Over the next
The belief that “miasmas” (bad the microorganisms from entering year he used the acid on nine
vapors in the air, see pp.120–21) a wound might solve the problem. patients, seven of whom came
caused infections was common He experimented with a variety of through surgery without infection.
in the 19th century, and led to substances, including zinc chloride,
an emphasis on cleanliness, which but nothing seemed to work with Spraying clean
did yield results. For example, in compound fractures. He then So effective was Lister’s
1847 Hungarian physician Ignaz heard about the use of carbolic “antiseptic” acid that its use soon
Semmelweiz, who worked in acid in the treatment of sewage in became routine at his Glasgow

46
Lister inherited his scientific PERCENT The proportion
curiosity from his wine-merchant
father, an amateur physicist with “It occurred to me that of amputation patients
at Glasgow Royal Infirmary who

decomposition of the injured


an interest in microscopes. Lister died of infection before antiseptics.
studied medicine at University
College London, where he wrote 15 PERCENT The proportion of
amputation patients who
a paper on inflammation. He
transferred to Edinburgh University
part might be avoided… died of infection after the
introduction of antiseptics.
in 1853, and then to Glasgow in
1860 as Regius Professor of
by applying as a dressing hospital, and death rates from
Surgery. It was here that he carried
out his work on antiseptics. He some material capable of infection during amputations
fell. In 1869 Lister devised an

destroying the life of


returned to England in 1877, and antiseptic spray that combined a
had to overcome initial strong local anesthetic with carbolic acid.
resistance to his ideas on antiseptics. Where before, surgeons had been
In 1897 he was the first surgeon to
be given a British peerage.
the floating particles.” reluctant to make incisions in skin,
for fear of infection, more complex
JOSEPH LISTER, DELIVERING THE HUXLEY LECTURE, CHARING CROSS HOSPITAL,1900 operations now became possible.

154
THE FIRST ANTISEPTICS

Lister’s carbolic spray


Lister developed a hand spray to deliver
a dose of his antiseptic to the wound site.
It was later replaced by a larger tripod-
mounted model to prevent doctors and
nurses coming into direct contact with the
corrosive acid droplets it produced.

By the 1870s, however, the use the number of cases of infection—


of carbolic sprays began falling until then surgeons had worked
out of fashion as attention shifted with bare hands. “Asepsis”
from the risk of infection from (the absence of microorganisms)
airborne pathogens to the greater combined with “antisepsis”
risk posed by poorly cleaned (killing microorganisms that
instruments and unwashed had become present) led to a
hands. Scottish surgeon William new era in surgery. The risk of
Macewen pioneered the use infection, although not eliminated,
of steam to cleanse surgical was dramatically reduced.
instruments and masks. He also
devised a set of all-steel surgical
instruments that could be sterilized ▷ Iodine tincture
at high temperatures. The use of Iodine was found useful as an antiseptic in its
rubber gloves that could be boiled diluted form. Its main medical use, however, was
(their first recorded use was in as treatment for goiter, an enlargement of the
1897 in Estonia) further reduced thyroid gland causing swelling in the neck.

155
SCIENCE TAKES CHARGE 1800 –1900

Tuberculosis
Also known as TB, phthisis, consumption, and white
plague, tuberculosis is one of the world’s longest-known,
most widespread, and deadliest diseases. Even today,
it affects 8–10 million people every year.

Stone Age remains suggest that tuberculosis was present more


than 15,000 years ago, and evidence of it from recorded history
goes back 7,000 years. Hippocrates (see pp.36–37) claimed that
it was the most widespread disease of his time, and that it was
hereditary. The expanding cities of Renaissance Europe saw
numerous outbreaks, and a number of theories for its cause
emerged. It is now known that tuberculosis is a bacterial disease
that mainly affects the lungs, and that it spreads through the air.
Yet symptoms can be so varied that it was only recognized and
named as a single disease in the 1830s. The first sanatoria for
TB patients opened soon after. They were mostly situated
in upland locations where patients could rest, breathe pure air,
and eat well, in the hope that this would help them recover.
In 1882 Robert Koch (see pp.146–47) identified the microbe
that causes TB—Mycobacterium tuberculosis. However, it was not
until 1947, when medical trials showed the curative effects of
the recently discovered antibiotic streptomycin, that the disease
came under partial control. Tuberculosis remains common
in developing regions, chiefly Africa, and South, East, and
Southeast Asia. One of the World Health Organization’s
major goals is ending the TB epidemic by 2030.

“… the overcrowded
dwellings of the poor…
[are] the real breeding places
of consumption.”
ROBERT KOCH, GERMAN PHYSICIAN, FROM THE ADDRESS
TO THE BRITISH CONGRESS ON TUBERCULOSIS, 1901

▷ Fading away
During the 18th to early 20th centuries, tuberculosis was
“romanticized” by writers, poets, playwrights, and artists as a
disease of the able, intelligent, and creative. This serene scene
is part of a five-image montage of a young, dying woman that
was composed by English photographer Henry Peach Robinson.

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S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Vaccines Come of Age


In the late 19th century, discoveries concerning the mechanisms of disease transmission and
immunity revolutionized medicine. They led to the development of new vaccines to protect
against infectious diseases that had hitherto killed tens of thousands of people each year.

R
esearch by French neglected to do so. A month later, New vaccines are discovered
microbiologist Louis Pasteur the chickens were injected with By the late 1880s researchers had
(see pp.148–49) on the “old” batch, still sitting on the realized that toxins in blood serum,
microorganisms and the germ shelf. The birds, while showing released by certain bacteria such
theory (see pp.146–47) gave hope mild signs of the disease, survived. as diphtheria and tetanus, were
that agents might be developed Pasteur then injected them with responsible for the diseases’
to combat a range of diseases, fresh bacteria and they did not symptoms. German physiologist
and that more vaccines might be become ill. He had discovered the Emil von Behring discovered that
created in addition to the one principle of attenuation, by which by injecting nonlethal doses of
Edward Jenner had devised a weakened form of a disease- diphtheria into guinea pigs, and
against smallpox (see pp.102–03). bearing organism bestows immunity later horses, he was able to extract
A major breakthrough came in to the full form of the disease if a serum from the test subjects that
1879, when Pasteur produced the administered to a patient. In 1882 then conferred immunity on other
first laboratory-developed vaccine. Pasteur extended the principle to animals that were injected with it.
He was researching chicken cholera anthrax and, in 1885, to rabies. The discovery of the tetanus toxin
by injecting birds with live in 1889 enabled von Behring and
bacteria and then his colleague Shibasaburo Kitasato
observing the to develop an antitoxin against △ Vaccine ampoules
◁ Symptoms
progression the disease the following year. The ampoules shown here, from 1915, contain
of diphtheria
of the fatal A diphtheria vaccination became serums that were used to vaccinate against
This disease is characterized
disease. One commercially available in 1892, typhoid and paratyphoid. These vaccines were
by a fever, severe cough,
day, he asked and the death rate declined especially important in wartime, as more soldiers
and a gray coating over the
his assistant to dramatically. In 1921 there were tended to die from typhoid than battle injuries.
infected areas, particularly
inject the birds the throat and tonsils. If left 206,000 cases of diphtheria in the
with a fresh untreated, diphtheria is fatal US; now, there are less than five
bacterial culture, in young children in about cases annually. Noguchi found that he could grow
but the assistant 20 percent of cases. the Vaccinia virus (related to the
Working on viruses Variola virus that caused smallpox)
Most of the early advances in inside the testes of live rabbits.
GERMAN PHYSIOLOGIST (1854–1917)
the development of vaccinations By the 1930s viruses were being
EMIL VON BEHRING involved diseases transmitted by cultured inside chicken eggs,

Born into a poor family, Emil von


Behring could not afford to go “ The immunity… against tetanus
to university and so he undertook
his medical studies in the German consists in the power of the cell-free
army. In the early 1880s he showed
that while the compound iodoform
blood fluid to render innocuous
did not kill microbes it seemed to
neutralize the bacterial toxins they
the toxic substance that the tetanus
produced, rendering them harmless.
In 1888 he began work at the
bacilli produce.”
EMIL VON BEHRING AND SHIBASABURO KITASATO, IN A PAPER IN
Institute of Hygiene in Berlin. Here
DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT (GERMAN MEDICINE WEEKLY), 1891
he discovered that cultures in which
diphtheria microbes had been killed
leaving their toxin could provoke bacteria rather than viruses. which enabled the widespread
immunity in animals injected with Although viral agents had been production of vaccinations against
them. Von Behring was awarded the discovered in the 1890s, they typhus (which had first been tested
first ever Nobel Prize for Medicine proved more difficult to cultivate in 1898) and the creation of an
in 1901 in recognition of his work. than bacteria. However, in 1915 effective vaccination against polio
Japanese physician Hideyo (which was first trialed in 1954).

158
△ Plague inoculation against measles and mumps were
CONCEPT
The 1906 outbreak of plague in Burma (now
developed, in 1963 and 1968
Myanmar) led to a widespread program of respectively, and soon became part HOW VACCINES WORK
inoculation using a vaccine devised in 1897.
of a regular schedule of childhood
Unfortunately, this vaccine was limited in its
vaccinations in most countries. Vaccination involves introducing a The antibodies bind themselves to
effectiveness and 6,000 people still died.The public health benefits of weakened form of a bacterium or virus modified cells, which persist in the
vaccination are incalculable in into a living host. The disease-causing host’s bloodstream as “memory cells.”
terms of lives saved and medical agent carries antigens—substances The next time the host encounters the
Promoting vaccination resources that do not have to be that provoke the host’s immune system disease, its body already has antibodies
As vaccines became more widely expended on sufferers of infectious into producing special proteins, called to fight it, and so will either suffer a
available, many nations introduced diseases. Research scientists antibodies, to fight the infection. very mild form of it or not suffer at all.
public health programs to promote continue to develop vaccines for
Antigen Disease-causing pathogen
their take-up or even to make serious diseases that are difficult binds to memory cells
them compulsory. One of the to treat, especially viral infections Weakened pathogen produced from vaccination
earliest such programs such as HIV/AIDS (see pp.242–43)
was established and Ebola (see
27,000The number Memory cell
in the UK, where pp.268–69). Other Destroyed
of people who Antibody pathogen
the Vaccination targets include
contracted polio during the
Act was passed diseases where White
1916 outbreak in the US. blood cell
in 1853 ordering the method of
the mandatory
vaccination of all
73
The number of polio
cases worldwide in 2015.
transmission
is hard to control,
Antigen Antibodies are
released to kill
infants against smallpox (see for instance, malaria (see pp.174– infection
pp.100–03) within four months of 75) or the Zika virus disease, which RESPONSE TO VACCINE RESPONSE TO INFECTION AFTER VACCINATION
birth. In the 20th century, vaccines are both spread by mosquitoes.

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Mysteries of the Brain


Medical knowledge of the brain generally lagged behind that of other body systems, partly
due to the organ’s inert, featureless appearance. In the 19th century a growing awareness
of the brain’s role in behavior led pioneers to establish a new speciality—neurology.

T
he brain’s uniform structure, With the revival of anatomy as During the 18th century there △ Brain cell of a fish
few obvious demarcations, a science in the 14th century, the were major advances in the Advances in microscopy enabled scientists such
and lack of moving parts give gross structure of the brain—the understanding of the brain, but as Santiago Ramón y Cajal (see p.97) to study
little clue to the magnitude of its parts visible with the unaided also fashions concerning mind and nerve cells. This fish brain cell has been colored
functions. Access is difficult since eye—became clearer. In 1543 behavior with little scientific basis. with Boveri stain (silver nitrate).
the brain is heavily protected by Flemish physician Andreas Vesalius Phrenology (see pp.104–05),
the skull. Nevertheless, physicians (see pp.72–75) depicted the brain’s the reading of skull contours,
throughout history have tried coverings, or meninges, its outer was popular in the early 1800s. methods of staining or coloring.
to treat its physical disorders surface, inner chambers, nerves, Another since discredited theory, These advances enabled 19th-
by methods as and blood vessels. that of “animal magnetism,” was century clinicians such as French
drastic as boring
holes in the skull 3,000 The number
of neurological
The chambers or
“cells” were
developed by German physician
Franz Anton Mesmer. He believed
professor Jean-Martin Charcot
to establish neurology as a major
(see pp.16–17). patients under Charcot’s care allocated functions: that an unseen force or energy, branch of medicine.
The nerves, too, at the Salpêtrière Hospital, imagination to subject to the laws of magnetism, Charcot was a talented clinician,
look like pale France, in the 1860s–70s. the anterior; flows through all living things. interviewing and examining
strings with no reason to the Those who were able to manipulate patients, diagnosing diseases, and
clear indication as to how they middle; and memory to the this force could use it for healing. At prescribing treatment. Over a
work. Neurological conditions such posterior chamber. These cerebral Mesmer’s gatherings or “banquets” career of more than 40 years, he
as epilepsy and migraines were ventricles, as they have since patients were placed in a trancelike recorded patterns of symptoms
often attributed to evil spirits or been named, actually contain state. “Mesmerism” is now thought in patients and linked his clinical
to divine punishment. cerebrospinal fluid, which has to have had close links to hypnosis. findings to postmortem findings
In the 4th century BCE, Aristotle no part in mental processes. using tools of anatomy, pathology,
claimed that the heart was the In 1664 English physician The birth of neurology and microscopy. He defined
center of emotion and intelligence, Thomas Willis published Cerebri The development of anatomy numerous neurological conditions:
while Roman physician Galen Anatome (Anatomy of the Brain), and pathology through the 18th as many as 20 still bear his name.
(see pp.40–41) associated the brain which offered a detailed anatomy century was aided by microscopy Charcot was influential in
with “animal spirits” or “psychic of the brain and nerves, and (pp.92–93) and histology—the distinguishing between neurology
faculties,” such as reason, thought, introduced the term “neurology” study of the microscopic anatomy and psychiatry. While neurology
perception, and memory. for the study of nerves. of tissues and cells, often using concerns mainly the physical brain,
and how problems of anatomy and
physiology cause conditions such
as stroke and multiple sclerosis,
psychiatry developed to focus on
mental health, and disorders of
mood, emotions, and thoughts
such as anxiety, depression, and
schizophrenia that have few or
no physical signs.
Charcot considered French
physician Guillaume-Benjamin-
Amand Duchenne, who was
the first to describe and devise
treatment for several nervous

◁ A Mesmer banquet
Mesmer held healing “banquets,” at which
wealthy patients held metal rods immersed
in a tub of “magnetic water” and entered
a trancelike state. They believed this would
remedy the “imbalance” within and cure them.

160
MYSTERIES OF THE BRAIN

△ Master at work neurologists such as Gilles de la


FRENCH NEUROLOGIST (1825–93)
Charcot was an innovative teacher, examining, Tourette (Tourette’s syndrome).
interviewing, and even hypnotizing patients Charcot himself became interested JEAN-MARTIN CHARCOT
during lectures. He also used visual aids such in hypnosis and its links with
as his own paintings and medical photographs. hysterical mental states, using it Born in Paris in 1825, Jean-Martin
in lectures and as a possible cure. Charcot qualified in medicine and
In the late 19th century pioneering spent most of his working life at
and muscular disorders, to be his operations in the neurosurgery the Salpêtrière Hospital, Paris.
“teacher in neurology.” Charcot, field included excision of a tumor of Proficient in many languages, he
in turn, inspired others, including the meninges by Scottish surgeon absorbed new medical knowledge
the founder of psychoanalysis William Macewen in 1878, and from around Europe. In 1856 he
Sigmund Freud (see pp.182–83); removal of a spinal cord tumor was appointed “physician to the
Pierre Janet, who established in 1887 by English surgeon and hospitals of Paris,” and became
psychology in France; and notable pathologist Victor Horsley. professor of Pathological Anatomy
at the University of Paris in 1872.
By the 1880s the Salpêtrière

“ To… treat a disease… learn


Hospital was Europe’s leading
neurology centers, with its own
microscopy and photography
how to recognize it.” departments. Charcot died in
Paris in 1893.
JEAN-MARTIN CHARCOT, FRENCH NEUROLOGIST

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Mental Illness
The idea that the mentally ill should be separated from society and treated in asylums
may have seemed like progress in the 18th and 19th centuries, but the reality of their
confinement and treatment continues to haunt the history of medicine.

T
wo hundred years ago (hence the word “lunatic”) or seen those not sheltered by their family △ Fool’s tower
there was still very little as communications or prophesies risked appalling abuse unless they The Narrenturm, or Fool’s Tower, at the Vienna
understanding of the causes from the gods. A supposed link were taken in by convents, General Hospital, Austria, was the first specially
of mental illness. In early times between mental problems and the monasteries, or workhouses. built mental asylum. It was constructed in 1784
episodes of madness had been balance of the four humors (see with 139 cells to house inmates.
linked to the phases of the moon pp.34–35) was first made in ancient First asylums
Greece and remained popular into Models for the safekeeping of
medieval times and beyond. the mentally ill had existed for approach to asylums in Europe
▽ Advocating humane treatment In communities with a deep hundreds of years, since the first from the early 15th century
French physician Philippe Pinel was one of the sense of ancestral pride and honor, facilities were provided in 8th- onward was based on brutality
first to insist on “moral” treatment for patients madness was a stain on the family, century Baghdad, based on the and incarceration: “treatment”
suffering from mental illness. In this painting he and sufferers were concealed from Qur’an’s principle of humane included whipping, stripping,
is shown releasing inmates from their chains at public life or even abandoned. treatment for those “weak of and restraining with chains.
the Bicêtre Hospital asylum in Paris in 1793. In Europe in the medieval period, understanding.” However, the Early establishments included

162
M E N TA L I L L N E S S

the notorious Maison de Charenton with minimal coercion. This ◁ Electroconvulsive therapy
in Paris in the 1640s and the emphasis on “moral treatment” The Ectonustim 3 machine transmitted a current
Narrenturm in Vienna in 1784. traveled from Europe to the US. through the brain by means of electrodes
In the 19th century the drive for After visiting humane Quaker attached to the scalp of the anesthetized
the mentally ill to be placed in establishments in England in her patient. The current induced convulsions in the
madhouses, or asylums, gathered campaign for reform, American hope of alleviating mental disorders
momentum. In Britain the Lunacy teacher Dorothea Dix visited such as severe depression.
Act and County Asylum Act 1845 public and private mental facilities
insisted that local authorities take in the US, and documented
responsibility for the “mad.” Asylums appalling conditions.
multiplied throughout Europe and Yet old habits prevailed. As
North America in this period too. asylums became overcrowded,
practices such as the use of
Moral treatment straightjackets and seclusion
Although harsh treatment made a comeback. Patients became
prevailed, there had been pockets institutionalized, and asylums
of resistance since the late 18th remained a testing ground for
century when, in Paris, Philippe unscientific theories. One popular
Pinel and Jean-Baptiste Pussin treatment saw patients swung on
stated that the mentally ill were a harness to “calm the nerves.” as a treatment for mental problems environment in which physicians
patients and not criminals (see that lay buried deep within the could practice novel treatments.
pp.164–65). In England, Quaker New approaches unconscious mind of the patient. Lobotomy, in which surgery was
philanthropist William Tuke From the 1890s Austrian physician Freud believed that mental illness, used to sever physical connections
advocated that patients be housed Sigmund Freud developed and in particular hysteria, stemmed between the prefrontal, frontal,
in pleasant settings and treated psychoanalysis (see pp.182–83) from repressed emotions and and other parts of the brain, had
memories, which could be unlocked unpredictable and sometimes
through therapy. In Freud’s “talking disastrous results.
cure,” patients were encouraged to The first of what became known
talk freely about their urges, desires, as convulsive therapies was
and dreams, initiated in 1934

250,000
which were The number in Budapest,
analyzed by of inmates Hungary, when
the therapist. in asylums in the US in 1900. psychiatrist
World War I In 1880 the figure was 40,000. Ladislas von
(1914–18) saw a Meduna began
new approach to treating mental a regime of drug-induced seizures
illness, when many thousands to treat schizophrenia. This was
of soldiers who were traumatized replaced by electroconvulsive
by war were taken to specialized treatment (ECT), initiated in 1938,
hospitals. Shell shock became which involved passing an electric
recognized as a mental disorder current through the brain to trigger
affecting all ranks and classes, a seizure. By the 1960s ECT was
although numerous shell-shocked used to treat a variety of conditions,
soldiers were charged with desertion. notably severe depression. It
After World War I there was a remains in limited use, but it has
renewed enthusiasm for “physical been largely replaced by new drug
therapies” to cure mental illness. therapies developed in the second
Again, asylums were the perfect half of the 20th century.

“ Could we in fancy place


ourselves in the situation of
some of these poor wretches,
bereft of reason, deserted of
friends, hopeless…”
ASYLUM REFORMER DOROTHEA DIX, MEMORIAL TO THE LEGISLATURE OF MASSACHUSETTS, 1843

163
SCIENCE TAKES CHARGE 1800 –1900

Horror of the Asylum


Hippocrates and his followers stated: “Wherever the art
of medicine is loved, there is also a love of humanity.”
However, humanity deserted much of the medical
profession in Europe during the 15th–18th centuries,
when people with mental illness were locked up,
abused, and even tortured in horrendous ways.

For centuries, mental and psychiatric conditions were attributed


to an imbalance in the humors (see pp.34–35) or evil spirits and
demonic possession. People dreaded and isolated sufferers,
and many doctors believed such illnesses were incurable. From
the 1400s patients were locked away from society in terrible
conditions in prisons or asylums. Some were chained up, thrown
occasional scraps, and left to die. Others suffered all manner
of appalling “cures,” such as blood-letting, to restore humoral
balance. Severe traumas and shocks to exorcise the demons
included being whipped or hung up by the arms or legs, and being
nearly suffocated, drowned, or starved. Worse, some asylums
became places of curiosity and entertainment, where people
came to watch the inmates’ plight, even paying for the experience.
Toward the end of the 18th century, the horrors of asylums
came to the notice of reformers. In 1793 French doctor Philippe
Pinel joined the staff at Bicêtre Hospital, an asylum for men in
Paris. Together with the hospital governor Jean-Baptiste Pussin
and his wife Marguerite, he began a series of improvements that
returned humanity into the care and treatment of the mentally
ill. Pinel and Pussin continued their reforms at Paris’s Salpêtrière
Hospital for women, introducing a rational and scientific
approach. Chains were removed, living conditions improved, and
prisoners became patients, encouraging a new enlightened era.

“ Mental disorders are…


nervous diseases… ”
HENRY MAUDSLEY, FOUNDER OF LONDON’S PSYCHIATRIC MAUDSLEY
HOSPITAL, FROM BODY AND MIND, 1870

◁ Frightful fate
“The Madhouse” is an 1835 engraving by Swiss draftsman Heinrich
Merz, after a drawing by German painter Wilhelm von Kaulbach.
The varied facial expressions of mentally ill patients convey their
emotional states amid crowded, bleak conditions typical of the time.

165
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

A
t the close of the 19th infected plant, filtering the liquid that the contagion was not able
century, the first vaccines through paper to remove bacteria, to grow on its own—it needed a
were being administered and then rubbing the liquid onto living host in order to replicate.
and began to be incorporated an uninfected plant. Mayer had Beijerinck’s work established
into public health programs, laid the foundations for the without doubt that a new type of
thanks to the pioneering efforts discovery of the first known virus. infectious agent existed—a virus,
of English physician Edward A few years later, in 1892, Dmitry from a Latin word meaning
Jenner (see pp.102–03) and French Ivanovsky repeated the principle of “poison” or “slimy liquid.”
chemist and microbiologist Louis Mayer’s experiments by applying
Pasteur (see pp.148–49). Jenner the technique of filtration to The virus particle
had developed the world’s first tobacco plants with mosaic disease. Whereas Beijerinck had asserted
vaccine for smallpox, using the Unlike Mayer, however, Ivanovsky that a virus was a liquid, a study
cowpox virus, in the 1790s. used a more stringent method of of livestock by German scientists
Pasteur, who was born the year filtration—the Chamberland filter, Friedrich Loeffler and Paul Frosch,
before Jenner’s death, devised a porcelain tube that uses water the same year, found evidence that
vaccines for rabies and anthrax to separate any trace of bacterial it was actually a particle. They had
in the 1880s. However, the nature toxin from a sample. Invented discovered the world’s second
of the diseases targeted by these by French microbiologist Charles known virus—foot and mouth
vaccines was not fully understood. Chamberland in 1884, and used by disease. By the 1920s more than

Viruses and △ Chamberland filter


Developed for Louis Pasteur’s work on vaccines
in the 1880s, the porcelain Chamberland water

How they Work


filter was key to discovering viruses. It had
pores so fine that it could filter out bacteria
from any liquid sample.

Genetic material—DNA
(deoxyribonucleic acid)
Viral infections wreaked havoc on the populations of three or RNA (ribonucleic acid)
continents in the 18th century, fueling efforts to deliver Capsid, or
the world’s first vaccines. Yet it took a further century shell, made
of protein Virus shell binds to
the cell membrane
to identify and understand the nature of the viruses of host cell
responsible for these diseases, and how they spread.

1 ATTACHMENT
Scientists did not comprehend the Louis Pasteur in his development
mechanics of viral activity until of vaccines, the filter allowed
Russian microbiologist Dmitry Ivanovsky to remove all bacteria
Ivanovsky described the first known from the liquid concentrate that
virus in 1892, almost a hundred had been taken from a diseased
years after the development of the tobacco plant. The filtered sample
first vaccine. was still infectious, proving that
the disease was not transmitted 2 PENETRATION
Virology begins by bacteria.
The history of virology, the study Building on
of viruses, began with a sick Ivanovsky’s findings,
tobacco plant in the laboratory Dutch microbiologist Virus shell disintegrates to
release its genetic material
of Adolf Mayer in 1879. Mayer, Martinus Beijerinck
a German agricultural chemist, went one step further
was studying mosaic disease, which in 1898, concluding
contaminated tobacco plants and that not only was
destroyed entire tobacco crops. mosaic disease
Over the following 10 years, he still infectious 3 REPLICATION
demonstrated that the disease after being
could be artificially spread to other filtered for
plants by taking sap from an bacteria, but Nucleus of host cell

166
VIRUSES AND HOW THEY WORK

“ In a flash I understood… RUSSIAN MICROBIOLOGIST (1864–1920)

DMITRY IVANOVSKY
a filterable virus… a virus In 1887 Dmitry Ivanovsky, a

parasitic on bacteria.” botany student at St. Petersburg


University, began to investigate
FÉLIX D’HÉRELLE, CANADIAN MICROBIOLOGIST, 1917 tobacco plant diseases that had
affected plantations in Moldova
and the Crimea. Ivanovsky found
65 different animal and human found in certain bacteria. He that a bacteria-free sample could
viruses had been identified, named this type of virus a still infect other plants, proving
including the first human virus, “bacteriophage,” or bacteria-eater. the existence of a new type of
yellow fever in 1901, the rabies virus As more viruses were discovered infectious organism—a virus.
in 1903, and the polio virus in 1908. in the first few decades of the Despite this discovery, Ivanovsky
20th century, attention turned to did not pursue virology. Instead, he
Bacteria-invading viruses developing vaccines for some of the spent the rest of his career focused
The next milestone in the history most devastating viral diseases—the on researching chloroplasts and the
of virology came in 1915, when polio vaccine (see pp.210–11), for role of pigment in leaves.
English bacteriologist Frederik example, which is still in use today.
Twort proposed that some viruses Modern research continues to
were capable of infecting bacteria investigate how different viruses
and using them as hosts in mutate and replicate, because this 6 RELEASE
which to replicate. At the Pasteur is key to developing effective
Institute in Paris, Canadian-born treatments for viral infections.
microbiologist Félix d’Herelle
advanced the concept further
by working out how to count the 5 ASSEMBLY
number of viruses that could be

New virus
Cytoplasm
of host cell
New virus is
released from ▽ Virus mechanism
dying cell A bacteriophage virus acts like a parasite,
injecting its genetic material into the cell of
a host bacteria, which is typically found in
soil, seawater, or in the stomach of an animal.
Once the virus’s DNA or RNA has penetrated
the cell, it begins to replicate, destroying or
taking over the machinery of the cell.

Capsid proteins gather around


the new viral genetic material
to make a new virus
Genetic material of
virus enters nucleus
of host cell

Virus instructs
production of new
viral genetic material

4 SYNTHESIS

167
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Fighting Rabies
Dreaded since antiquity, rabies—which spreads through the nervous system to the
brain—causes terrible suffering, aggressive behavior, paralysis, and eventual death.
Louis Pasteur’s development of a vaccine was therefore a very welcome breakthrough.

I
n the late 19th century the microscopes, which use focused Building immunity △ Rabies vaccine warning sign
dreaded “mad dog” disease (as light and a lens to enlarge small To create a vaccine, Pasteur first This German sign warns that vaccine-containing
rabies was known) continued to samples, did not provide sufficient needed to weaken the virus enough pellets have been left out for foxes, to make
confound physicians, who struggled magnification to see the rabies that it would provide immunity them immune so they would not spread rabies,
to treat those who were affected. A virus—a type of rhabdovirus from rabies without causing the so dogs must be kept away.
breakthrough came in 1880, when called Lyssavirus—which is less disease. Working with Roux and
French microbiologist Louis Pasteur than 0.0002mm long. Also, since others, Pasteur tried the idea of
(see pp.148–49) became interested viruses multiply in living cells, dissecting the spinal cords of whose disease was too advanced
in the disease. At the time France Pasteur and his collaborator, Émile infected, freshly dead rabbits, then to be treated. But on July 6, 1885,
was increasingly Roux, had to placing them in open flasks that a distraught mother brought her
troubled by carry out tests contained potassium hydroxide, nine-year-old son Joseph Meister,
packs of feral
dogs, some of
60 HOURS The time after being
bitten, when French boy
Joseph Meister had the first of 13
on live animals
—including
which acted as a drying and who had been repeatedly bitten

them rabid. injections administered over 12 dogs, monkeys,


Knowing that
rabies spread
days. He became the first person
to be inoculated against rabies.
and rabbits. In
addition, rabies “ When meditating over
a disease, I never think
through the bites can take
of infected animals, a vet in Paris anything from a few days to
sent Pasteur saliva specimens from several months to cause symptoms,
two dogs that had died from the
disease and asked for his help.
depending on how quickly it
spreads through the nervous
of finding a remedy for it,
Creating a vaccine
system to the brain. Pasteur tested
many strains of the virus, selected
but, instead, a means
Working with viruses in the late
19th century was a protracted,
the fastest-acting ones, and injected
them directly into the brains of of preventing it.”
difficult, and dangerous task. Light test animals.
LOUIS PASTEUR, FRENCH CHEMIST AND MICROBIOLOGIST, 1884

anti-decay agent. First, Pasteur by a rabid dog two days earlier, to


injected healthy animals with the Pasteur for treatment. Pasteur was
rabies virus present in spinal cord initially reluctant to administer the
that had been dried for 14 days. At vaccine, since the boy had not
this late stage, the virus was weak yet shown symptoms of the
and unlikely to do harm. He then disease and might not
repeated the test every couple of develop rabies—although
days using infected spinal cords it was likely that he
that were 13 days old, then 12 days would. Finally, Pasteur
old—the idea being they would agreed to treat the boy.
build up immunity to the virus. He gave Meister a
Finally, he injected the animals with series of 13 injections,
extracts taken from a fresh infected starting with extracts
◁ Ancient remedy spinal cord, which contained the from 15-day-old
All manner of rabies most virulent virus; all the animals spinal cord, and
treatments had been tried survived. His challenge now was building up to stronger
throughout history, with to create a vaccine for humans. preparations. Pasteur
virtually no success. This noted: “On the last
13th-century physician Human trials days, I inoculated
applies vervain herb to Pasteur then started trials of human Joseph Meister with
the wound of a patient vaccines, but there were two false the most virulent virus
bitten by a rabid dog, starts: an older man who left after of rabies.” The young
which lies dead below. only one injection, and a young girl, boy survived.

168
FIGHTING RABIES

Pasteur repeated the procedure on A vaccine for the future returned home healthy. More rabies centers in the US, Brazil, Europe,
a shepherd, who had been attacked That December, four boys who patients flocked to France to be India, and China. Today the rabies
and severely bitten by a rabid dog, had been bitten by a dog thought treated—largely the result of the US vaccine, which has been improved,
then gradually others followed. to be rabid arrived from New Jersey. campaign. In March 1886 Pasteur is on the essential medicines list
Later that year Pasteur officially A national campaign had been announced that he had treated 350 of the World Health Organization
reported the results from the Paris launched to fund their travel to patients with only one loss, and by (WHO) and is thought to save up
trials, and news spread worldwide. Pasteur for treatment, and they 1890 there were rabies vaccination to 300,000 lives annually.

▽ Treating rabies
As news of Pasteur’s vaccine spread, lines
formed to see him. Some wanted treatment
for bites, others sought immunity in case of
a future bite, which was the aim of
Pasteur’s initial research.
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

The Discovery of Aspirin


Throughout history, many different civilizations have used willow to alleviate aches
and discomfort. In the 1800s scientists identified the active ingredient in willow and
experimented with it. The white powder that resulted, aspirin, would become the
most widely used drug in the modern world.

T
he quest to find an effective In the 19th century science began meadowsweet flower, but it was △ Willow bark
remedy for pain is as old as to be seen as a true profession not until 1853 that French chemist In 1763 it was discovered that willow bark
human civilization. Perhaps rather than natural philosophy, Charles Frédéric Gerhardt made dramatically reduced ague, a fever with
remarkably, the people of the and it flourished, partly spurred the breakthrough that opened the symptoms similar to malaria. It was later found
ancient world found solutions to on by growth in industry and way for potential mass production that the active ingredient in willow bark is
pain relief containing the same key commercial activity. The goal of the medication. salicylic acid, which forms the basis of aspirin.
ingredient as modern-day aspirin. of many researchers was to find Salicin, as it is found in willow
Ancient Egyptians used willow tree useful medicines, and efforts and meadowsweet, is relatively
extract to ease aches and pains, to pinpoint exactly how willow low strength, with a mild effect of patients with rheumatism had
while Greek physician Hippocrates worked gained momentum. on pain. Gerhardt extracted a more experienced reduced fever and
recommended willow-leaf tea potent derivative of salicin, called joint inflammation after taking the
to women to relieve the pain of Experiments with salicin salicylic acid, and worked out the chemical compound. Maclagan had
childbirth. Almost two thousand In 1828 Joseph Buchner, professor molecular formula, which enabled chosen to use salicin rather than
years later, in the 1750s, the of pharmacy at Munich University, him to produce it in a laboratory, at the stronger salicylic acid because
English clergyman Edward Stone extracted a small quantity of a much higher concentrations than it was gentler on the stomach,
conducted a five-year experiment compound from willow bark and it was found in plants. However, making it more suitable for the
that demonstrated that dried, named it salicin. The following year, although salicylic acid provides subjects of his trial.
powdered willow bark helped French chemist Henri Le Roux effective pain relief, it is hard on
to cure fever. The Royal Society refined the process further to the stomach and can cause nausea, Final steps
published his results in 1763. extract salicin in crystal form. bleeding, and diarrhoea, so it needs The chemist who finally succeeded
Interest grew among scientists Around the same time Swiss to be “buffered” or neutralized in in creating a powerful pain
and medical practitioners in the pharmacist Johann Pagenstecher order to avoid these effects. In medication without severe side
potential of willow for pain relief. also found salicin in the the course of his effects was Felix

40,000
work on acid TONS The Hoffmann, an
FRENCH CHEMIST (1816–1856)
anhydrides, quantity of aspirin employee of dye
Gerhardt took consumed globally each year. manufacturer
CHARLES FRÉDÉRIC GERHARDT the first step in Friedrich Bayer
addressing the side effects when he & Co. in Germany. Hoffmann’s
Born in Strasbourg, France, Charles mixed acetyl chloride with salicylic father suffered from rheumatism
Gerhardt learned about chemistry acid, which created a rudimentary and urged his son to develop a
from a young age. His father form of acetylsalicylic acid for pain remedy that was less irritating
owned a lead production plant but the first time. Although Gerhardt on the stomach than existing
had little scientific understanding showed little interest in pursuing medicines based on salicylic acid.
of the processes in his factory, so his discovery further, other Hoffmann and his colleagues at
young Gerhardt was sent to study scientists did. Bayer successfully developed an
chemistry at Karlsruhe Polytechnic in Two decades later, in 1876, the easily synthesized, effective form
Germany. In later years, Gerhardt medical journal The Lancet published of acetylsalicylic acid, which caused
also attended the University the results of the first clinical trial less upset to the stomach than
of Giessen, Germany, and the of salicin. Scottish doctor Thomas salicylic acid. They produced the
University of Paris, France, where Maclagan concluded that a group first sample of pure acetylsalicylic
he benefitted from the best
chemistry teaching available in
both countries. He devoted his
research career to simplifying the “ Aspirin is a drug that has been used
classification and formulas used
in chemistry, but his greatest
for many years—it is effective,
achievement was the synthesis of
acid anhydrides, which ultimately
inexpensive, and widely available.”
led to the discovery of aspirin. JEFFREY BERGER, AMERICAN DOCTOR, FROM JOURNAL OF THE
AMERICAN MEDICAL ASSOCIATION, 2006

170
THE DISCOVERY OF ASPIRIN

acid in 1897. Friedrich Bayer & Co. prevent stroke, peptic ulcers, and ◁ Aspirin crystals
patented the invention and began certain types of cancer. Hoffmann Aspirin is a white, crystalline, weakly acidic
distributing the medication under could scarcely have imagined that substance. This color-enhanced scanning
the trademark “Aspirin” in 1899. more than a century after his electron microscope image shows a closeup
discovery, aspirin would become view of the analgesic.
The “wonder” drug a multipurpose wonder drug
In its first 50 years, aspirin capable of saving lives.
dominated the market as the
world’s most frequently sold
painkiller, but by the 1970s
researchers had discovered a
radical new application for aspirin.
Controlled trials indicated that
aspirin thins the blood and helps
prevent blood clots from forming.
More recent research has also
confirmed that taking low doses of
aspirin as a preventative measure
can reduce the chance of having
a heart attack. It can also help to

△ Aspirin carton
Aspirin—with a capital “A”—
remains a registered trademark
of Bayer in Germany, but
“aspirin” has become a generic
word used worldwide.
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

X-rays
The chance discovery of X-rays by a German physicist at the end of the 19th century
sparked a new age of medical imaging. Medical diagnosis was revolutionized—for
the first time, physicians could look inside the body without the need for surgery.

G
erman physicist Wilhelm materials, including wood, copper, X-rays were soon being used △ Barium X-ray imaging
Röntgen conducted an and aluminum, but the rays to diagnose a wide range of The insoluble salt barium sulfate shows up on
experiment on cathode rays penetrated all of them. conditions. Within a year, the X-rays in the same manner as metal or bone. It
in his laboratory on November 8, world’s first radiology department can be administered orally into the gastrointestinal
1895. He removed all air from a Looking inside the body was set up at a hospital in Glasgow, tract, which is not visible on standard X-rays, so
glass tube, filled it with a special However, when he held a lead disk Scotland, and produced the first that its lining, size, and shape can be examined.
gas, and passed a high-voltage in front of the tube he was amazed X-rays of a kidney stone and a
current through it. As he did this, to see the bones of his own hand coin stuck in a child’s throat.
the tube emitted a fluorescent glowing on the screen—it was the The first machines were basic and However, in 1904 American
glow. Next, Röntgen darkened the first ever radiographic image. He emitted weak radiation, so patients inventor Thomas Edison’s assistant,
room and shielded his tube in a then placed his had to remain Clarence Dally, who worked
casing of thick black cardboard to wife’s hand in still for more extensively with X-rays, died of
exclude all light. To his surprise, he the path of the “ I did not think, than 30 minutes cancer. His death caused scientists
noted that even though his tube
was completely encased a nearby
rays over a
photographic I investigated.” for images to be
captured. It also
to begin to take the risks of X-ray
radiation more seriously.
screen that was coated with a plate, capturing became apparent
WILHELM RÖNTGEN, IN AN INTERVIEW
fluorescent chemical glowed. the world’s first
FOR MCCLURE’S MAGAZINE, 1896
that X-rays Further developments
Röntgen studied this for several X-ray image. caused burns More work was needed to fully
weeks and concluded that the glow The bones were and hair loss. comprehend the nature of X-rays.
must result from an undiscovered clearly visible, while the soft tissue But by the early 1900s scientists In 1912 German physicist Max
kind of ray—a type of radiation was barely noticeable. Six weeks had also discovered that controlled von Laue decided to transmit
that differed from visible light. later, Röntgen published a paper doses of X-ray radiation could be X-rays through crystals, and in
He named it “X-ray”—“x” being titled Über eine Neue Art von Strahlen used positively to fight cancers and the process demonstrated that
the mathematical term for an (On a New Kind of Rays). skin diseases. X-rays proved useful X-rays, like light, were subject to
unknown quantity. Röntgen’s discovery caused a in wartime—during World War I diffraction (interaction after being
Röntgen subsequently tried to public sensation. The implications military doctors used X-ray machines split). The diffraction pattern
block the path of the X-rays to his of being able to look inside the to locate bullets and shell fragments showed how a crystal’s atoms were
screen with a selection of denser human body were immense, and in soldiers’ bodies. arranged—a technique crucial to
the analysis of molecular structure.
GERMAN PHYSICIST (1845–1923)
X-ray crystallographic techniques
were later used to study the
WILHELM CONRAD RÖNTGEN structure of proteins and were
employed by researchers worldwide.
Born into a family of cloth merchants This work has lead to incalculable
in Lennep, Prussia (now Germany), advances in chemistry and
Wilhelm Röntgen spent part of his molecular biology.
childhood in the Netherlands. Far Although X-rays continue to be
from being a brilliant pupil, he was used for medical diagnosis, they
expelled from school, and found are employed in a wide range of
his vocation only after he was taken other fields, from biotechnology,
under the wing of an inspiring tutor. genetics, and astronomy, to
Although he is best known for his scanning luggage for security.
discovery of X-rays, Röntgen studied Röntgen was a modest man who
several areas of physics, including loathed all the attention that was
gases, heat transfer, and light. He died heaped on him after his discovery.
of intestinal cancer (not thought to be In 1901 he was awarded the first
related to his work with X-radiation). Nobel Prize for physics, but he
bequeathed the prize money to
X-RAY IMAGE OF RÖNTGEN’S WIFE’S LEFT HAND,
scientific research and deliberately
WITH HER WEDDING RING VISIBLE never patented the X-ray, ensuring
that the public could benefit.

172
Early X-ray examination
Wilhelm Röntgen is shown preparing a young patient
for a chest X-ray in this woodcut from 1900. Shortly
after they were discovered, X-rays became a critical
diagnostic tool for physicians, permitting them to see
inside a patient’s body without intrusive methods.
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The Struggle
against Malaria
One of the deadliest diseases, malaria has shaped much of world history. It has dictated
patterns of migration and settlement, decided wars, and shattered peace. The ongoing
search for a malaria vaccine is one of the most intensive in medicine.

M
alaria is caused by several Herbal treatments for the disease ▷ Malaria parasite
kinds of single-celled are mentioned in two texts dating The red blobs seen here are egg clusters of the
parasites belonging to the back more than 2,000 years: malaria parasite in the mosquito gut. Each cluster
Plasmodium genus. It is transmitted the Chinese Huangdi Neijing produces thousands of infectious, actively moving
when a female Anopheles mosquito, (Yellow Emperor’s Classic of Internal parasites, which travel to the mosquito’s salivary
having fed on the blood of an Medicine) and the Indian Susruta glands and are injected into people when it bites.
infected human, bites a healthy Samhita. The latter asserted that
individual. The main symptoms of the illness was associated with
malaria are flulike and include a 21). In the medieval period, this
high temperature (fever), shaking,
chills, headaches, muscle aches, 220 MILLION The estimated
number of cases of
malaria each year.
notion remained popular and the
name “malaria” came into use,
and fatigue. Vomiting, nausea, and from the Italian for “bad air.”
diarrhea may also occur. In severe
cases, malaria may lead to kidney insect bites. The ancient Greek Treatments and causes
failure, confusion, seizures, coma, physician Hippocrates noted the One of the first effective malarial
and sometimes death. Symptoms effects of malaria, and the ancient treatments was cinchona bark
usually start 7 to 30 days after Romans called it “swamp fever” (see pp.88–89), brought back from
infection, although they can take because they believed that the South America to Europe in the
up to one year to develop. In some disease was caused by the noxious 1630s. The bark’s active ingredient
forms, the illness recurs for many fumes of foul-smelling, swampy was identified as quinine—still a
years, because the parasite can areas—an idea that became known mainstay of malaria medication.
remain dormant in the liver cells. as the miasma theory (see pp.120– However, the cause of the infection
was not known until a series of

“The belief is growing on me that the discoveries starting in 1880, when


the French army surgeon Charles
disease is communicated by the bite Laveran found microscopic parasites
in the blood of a malaria sufferer.
of the mosquito. ” Around 1886 Italian physician
Camillo Golgi showed that there
RONALD ROSS, IN A LETTER TO SCOTTISH PHYSICIAN PATRICK MANSON, 1896 are different kinds of malaria and
that fever and chills coincide with
the release of the parasite in the
blood. In 1890 Italian researchers
Giovanni Grassi and Raimondo
Filetti identified several kinds of
malarial parasites. The same
year, Ronald Ross showed that

◁ Malaria vector
The mosquito shown here is the South
American malaria vector mosquito (Anopheles
albimanus). Although there are approximately
430 Anopheles species, only 30 to 40 of these
transmit malaria. Anopheles mosquitoes are
found throughout the world, except Antarctica.

174
THE STRUGGLE AGAINST MALARIA

◁ Antimalarial spray
This device was used to
Wooden
spray the insecticide powder
bellows
Paris Green—a poisonous
mix of copper and arsenic.
The insecticide was common
in the 1940s, until it was
discovered to be fairly toxic
to plants and damaging to
human health.

Tin-plate nozzle

mosquitoes that bite humans became a global weapon against


take up the parasite and transmit insect pests and vectors, but when
it between individuals. In 1898–99, its harmful environmental effects
Grassi claimed, correctly, that only came to light in the 1960s and 1970s
female mosquitoes of the Anopheles it was phased out. Meanwhile, in
genus are the vectors (transmitters) 1955 the World Health Organization
of human malaria. (WHO) set up a campaign to wipe
out malaria, using prevention (such
Tackling the problem as mosquito nets), insecticides, and
In 1904 the US took over the drug treatments. In the 1980s simple
construction of the Panama Canal tests were developed to diagnose
after the French malaria, allowing
had to stop, largely
due to massive 450,000 The outbreaks to be
approximate addressed rapidly.
number of deaths each year
illness caused In 1981 Chinese
by malaria and from malaria. pharmacologist
yellow fever. The Tu Youyou showed
US Army initiated a program to that artemisinin was an effective
drain swamps where mosquitoes antimalarial treatment.
bred, to use insecticides, and to However, malaria is a complex and
protect their workers with mosquito persistent disease—further strains
nets, screens, and medicine. As a and species of mosquito vectors were
result, the hospitalization rate for discovered in the 20th century, and
canal workers fell drastically. some strains have become resistant
In 1939 Swiss chemist Paul Müller to drug treatments. Although many
discovered that dichloro-diphenyl- nations are now malaria-free, the
trichloroethane (DDT) was a infection remains endemic in about
powerful insect-killer, and it quickly 100 countries.

BRITISH PHYSICIAN (1857–1932)

RONALD ROSS
Born in India, Ronald Ross studied
medicine at St. Bartholomew’s
Hospital, London, UK. He joined
the Indian Medical Service in 1881
and became interested in malaria in
1892. In 1899 Ross returned to the
UK to teach at the Liverpool School
of Tropical Medicine and worked
as a medical troubleshooter for the
government during World War I.
He was also the first director of the
Ross Institute for Tropical Diseases,
London, founded in recognition
of his work in 1926.

175
S C I E N C E TA K E S C H A R G E 1 8 0 0 – 1 9 0 0

Transfusion Breakthrough
Today, blood transfusions are everyday procedures, responsible for saving millions of lives.
However, it took many failed attempts and false starts—and an important discovery at the
turn of the 20th century—before blood tranfusions became a practical reality.

A
fter British physician William transfer blood directly between two same year, Lower and his colleague AUSTRIAN-BORN PHYSICIAN
Harvey’s account of blood’s patients, using slim tubes inserted Edmund King transfused blood (1868–1943)
continual circulation (see into the donor’s and the recipient’s from a lamb into an ailing patient;
pp.84–85) was published in 1628, vessels. However, he did not record the man survived and said his KARL LANDSTEINER
medical minds began to consider his results. condition was much improved.
the possibility of transferring blood Further experiments followed,
between living beings—both from Early developments mainly in France, Italy, and
animals to humans and between In 1665 British physician Richard England, but the results were so
humans. However, a major problem Lower showed how blood could be unpredictable that governments
observed in the early experiments transferred between two dogs by and religious authorities banned
was that blood tends to clot the joining their blood vessels. In 1667 the practice.
moment it is exposed to air. In French physician Jean-Baptiste In 1828 London-based obstetrician
1654 Italian physician Francesco Denys described using lamb’s blood James Blundell revived the idea,
Folli wrote that he had managed to to treat a feverish patient. The to treat new mothers who suffered

▷ Animal–human
blood transfusion
“A single pint can save
The apparent similarity between
the blood of humans and other
three lives… create a
mammals led to experimental
transfusions in the 17th century. million smiles.” Born in Baden bei Wien near
Lamb’s blood was often used, with Vienna, Austria, Landsteiner
AMERICAN POSTER TO RAISE AWARENESS
the additional aim of qualified in medicine at Vienna
FOR WORLD BLOOD DONOR DAY, 2012
conferring youth University in 1891. Five years later,
and vitality to
he joined the Vienna Hygiene
the human
from excessive bleeding after Institute, where he carried out
recipient.
childbirth. The donor was often a much of his research into blood.
close family member, and the blood After World War I, he moved
flowed directly between donor and to the Rockefeller Institute for
recipient. Others developed the Medical Research, New York.
procedure by using apparatus He received the Nobel Prize in
such as funnels, syringes, and Physiology or Medicine in 1930
valves. Again, the results were for his “discovery of human blood
inconsistent. Attempts to delay groups.” Landsteiner died of heart
clotting using chemicals, in order failure in New York City in 1943.
to do away with the necessity of
having a donor next to the patient
at the time of transfusion, were In 1895 Karl Landsteiner became
also unsuccessful. interested in immunity and how
the body defends itself using
The A-B-C-O of blood antibodies to “fight” alien matter
In 1875 German physiologist such as invading germs. He focused
Leonard Landois described the his studies on blood serum—that
process of mixing blood plasma— is, blood plasma from which cells
the liquid without cel