Wednesday, April 30, 2014

A Very Brief History of Medicine

“Medicine is not only a science; it is also an art. It does not consist of compounding pills and plasters; it deals with the very processes of life, which must be understood before they may be guided.”- Paracelsus

At the Museum of Archaeology in Malta, the Sleeping Lady of Malta hails from a time more than 5000 years ago. Was it a decadent time filled with latent cynicism, or a time of great thought and action.

An Egyptian polymath named Imhotep served as the high priest to the sun god Ra and was the chancellor to King Djoser of the Third Dynasty. He extracted medicine from plants and is considered the earliest known physician. He was also “Chancellor of the King of Egypt, Doctor, First in line after the King of Upper Egypt, Administrator of the Great Palace, Hereditary nobleman, High Priest of Heliopolis, Builder, Chief Carpenter, Chief Sculptor, and Maker of Vases in Chief. He was one of only a few commoners ever to be accorded divine status after death.” He was a doctor, an engineer, an architect, a poet and a philosopher. The earliest surgery was performed by him.

During the First Babylonian Dynasty (1069-1046 BC) a “Diagnostic Handbook” written by Ummanu or chief scholar became the definitive medical text as a source for treating all known ailments of that time with bandages, herbs and creams. The text was based on empirical evidence and combined the diagnosis to render a prognosis for the ill. The rational use of symptom complex and examined physical evidence revealed the nature of the illness. If the rendered treatment failed to succeed then exorcism of curses was undertaken as the last resort.

In the 5th century BC the next notable was Hippocrates of Kos (460-370 BC) who is also considered the “Father of Western Medicine” because he categorized illnesses into acute chronic and endemic vs. epidemic. At about the same time in India two tomes were crafted over the next two hundred years one called Chakra and the other named Sushruta that were based on the traditional Ayurveda medicine of the times. During the same time in isolation the Chinese created the The foundational text of Chinese medicine in the Yellow Emperor's Inner Canon, written 5th century to 3rd century BC)

Claudius Galenus (129-216 AD) better known as Galen of Pergamon, a physician, surgeon and a philosopher broke down medicine into different subspecialty disciplines. He was also the first to operate on the brain and the eye. He was a disciplined empiricist who learned from experimenting with animals and advancing his knowledge of anatomy and physiology.

After 400 AD medical research and understanding declined dramatically until the 12th century AD when the first school of medicine “Schola Medica Salernitana,” was built in Salerno in Italy. The medical education was rehabilitated with more systems of school began popping up in other parts of Italy. This was the first time that a graduate from the school were called “Doctor.”

Not until Avicenna (980-1037 AD) was there light shone on medicine. Avicenna wrote two tomes one called the "The Book of Healing" and the other "The Canon of Medicine," both were regarded as the state of the art in thoughts related to medical care for the time.

Philippus Aureolus Theophrastus Bombastus von Hohenheim (1493-1541) also known as Paracelsus, a Swiss German botanist and physician through experimentation. He rejected Galen’s ideas on Medicine but was more in tune with Aristotle’s four elements. His expertise in Botany and knowledge of medical sciences also made him known as the “father of toxicology.”

William Harvey (1578-1657) came along and discovered that heart was the seat of the circulation and dissected the veins and arteries to understand the network within the human body.

The 18th century brought Renaissance to Europe and with it the “germ theory of disease.” Foremost in the field was Louis Pasteur (1822-1895) who along with Ferdinand Cohn and Robert Koch are considered the most important figures in medical microbiology. He developed vaccines for rabies and anthrax and also realized and created a method for “pasteurization of milk,” to prevent disease transmission. Ignaz Semmelweis (181-1865) determined that the high mortality during childbirth was due to unwashed hands and became the springboard for modern hygiene. Public Health measures became notable in disease spread through communities and were the springboard for people like John Snow to determine that Cholera was not air borne but water borne in London.

Sir William Osler (1849-1919), a Canadian physician considered the “Father of Modern Medicine” established a hospital now known as the Johns Hopkins Hospital with three others. He created lecture halls and brought in students to view surgical procedures performed by the physicians.

Medicine was on its way to more discoveries. The ABO blood grouping in early 20th century laid the foundation for safe blood transfusion and Marie Curie’s (1867-1934) discovery of radioactivity laid the foundation for radiation therapy. And in 1953 the greatest modern discovery by Watson and Crick on the x-ray crystallography photos of proteins of Rosalind Franklin herald the era of genetics through the discovery of the DNA.

Today we are rushing at breakneck speeds in capturing newer vistas into the human cells and peering into the heart of the atom. We can see the tick and the tock of inner cellular pathways. We can see the interaction of the cellular surface and these pathways. We have learned how various genes create various proteins and how the methylation of various genes can speed up or shut down a gene function. We know about interfering RNAs and how they might alter the color of the iris in an eye.
We understand the microbiome of the intestinal tract and the need for different bacteria to keep us healthy. We have used nanotechnology to create nano-wires and nano-dots to determine the molecular damage created by disease. The merger of man and machine is upon us with neuro-receptors, bionic eyes, motor pathway inhibition, miniature acoustic devices, electrical stimulation of the olfactory centers, bionic arms and legs and exoskeletons to leverage physical abilities. As the old jingle goes, “We have come a long way baby!” The watershed moments are happening daily and encompassing the geometric scale of the Moore’s Law. We are able to create 3D printed organs to replace diseased ones. We are on the move to understand the brain and the farthest frontier of the mind.

Medicine is indeed in a constant state of evolution. It is scaling heights seemed impossible at the turn of the 21st century. What will the next 50 or even 10 years at the rate we are progressing makes tomorrow bright and full of real hope. But the alarm that rings is one of caution. There is a disproportionate focus on costs and through it the laxity on science as well the art of medicine that has brought us to today. Innovation is being stifled. In the name of cost, innovation is being rendered “too expensive” for patients that might benefit them. Medicine must remain an unbridled territory to foster its own timely research. Only then the future we seek shall be seen.

Pioneers and innovators abound with the fast heartbeats of discovery, but what about the doctor, the physician? With the new lust for IBM’s Watson, Is it time to wither away…

He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.- William Osler

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