History Of Medical Science

Why History Matters

Constant Change for 150+ Years

Limited Development of Societal Consensus

Always Ahead (or Behind) The Law

Classic Divisions Still Prevail

Shamanism

Greco-Roman Rationalism

The Best and Worst of Times

Shamanism

Oldest Medicine

Primitive Tribes

Alternative Medicine

Integrates Religion And Medicine

Persists Even Today In So Called Modern Cultures

Explicitly Ministers To The Psyche And The Body

Driven By Myths

Trial And Error And Careful Observation

Often Sophisticated Rituals And Herbals

Some Cure, Most Do Not

Leviticus

Public Health Code

Rules Reduce Food Poisoning

Useful Pharmacopeia

Ethnobotany

Study Of Plants Used By Ritual Healer

Many Drugs Have Been Discovered This Way

Witches Used Foxglove - Digitalis

Medicinal Chemists

Refine And Modify Botanicals

Conflicts Over Ownership of Indigenous Remedies

Greco-Roman Rationalism

Galen And Successors

Driven By Rational Theories

Religion Is Left To Priests

Observations Forced To Fit Into The Theory

Plato Was Terrible About This

Mistakes Are Not Corrected

Predominant Until 16th Century

Still Lurks in Clinical Decisionmaking

Modern Medicine/Scientific Medicine

Not The Philosopher's Scientific Method

The Imperative To Disprove Theories

The Full Disclosure Of Information

Science Is Constantly Questioning And Rethinking

Systematic Observation is the Key

Diseases Have Variable Courses

Patient's Have Variable Conditions

Serious Participant-Observer Problem

Controlled Studies Are Key

Problems With Controlled Studies

CCU

Cannot Control Variables Well

Many Things Do Not Work

Rating The Severity Of The Patient's Condition

Treatment Of Controls

Someone Gets The Old/No Treatment

Cannot Use Drugs Until Trials Are Over

AIDS Example

Science Versus Scientists

Scientists Are Just People

Probably More Honest Than Most

Some Are Corrupt

Some Are Naïve

Science Is Process, Not People

Weeds out the Bad Stuff

Can Take Time

Lawyers Seek Out The Worst

A Brief Chronology of Medicine

Paracelsus

Philippus Aureolus Theophrastus Bombastus Von Hohenheim

Early 16th Century

Transition From Alchemy

Experiments And Systematic Observations

Antimony

Anatomy And Function

Andreas Vesalius

Mid 16th Century

Accurate Anatomy

William Harvey

Early 17th Century

Flow Of The Blood And Operation Of The Heart

Edward Jenner

Smallpox

Major Killer

Wiped Out The Indigenous Peoples

1798 - Published His Book On Cowpox

John Snow

Cholera In London

Broad Street Pump

Proved Cholera Is Waterborne

1854

Ignaz Philipp Semmelweis

Childbed Fever

Fellow Medical Student Died

Controlled Studies

1849

Louis Pasteur

Scientific Method

Germ Theory

Vaccination For Rabies

Pasteurization

1860s-1880s

Foundation of Modern Surgery

William Morton

Anesthesia

1846

Joseph Lister

Antisepsis

1867-1880s

Surgery Became Big Business

Drove Development of Hospitals

Infectious Diseases

Koch's Postulates - 1880s

Agent Must Be Present In Every Case;

Agent Must Be Isolated From The Host And Grown In Vitro [In A Lab Dish];

Agent Must Cause Disease When Inoculated Into A Healthy Susceptible Host; And

Agent Must Be Recovered Again From The Experimentally Infected Host.

Limitations

Tuberculosis Control - 1900

The Major Killer

Koch And Pasteur

Sanatoria

Pasteurization Of Milk

Disease Control Of Dairy Herds

Drug Chemistry - 1880s

German/Swiss Dye Industry

Bayer

Hoffman La Roche

Ciba

Antibiotics

Sulfa Drugs In The 1930s

Penicillin

Alexander Flemming - 1928

Purified By Chain And Florey In 1939

World War II - Coconut Grove Fire (1942)

Streptomycin - 1944

First Antituberculosis Drug

Selman Abraham Waksman - 1944

(Coined The Term Antibiotic

Post World War II

Conquering Microbial Diseases

Vaccines

Antibiotics

Chronic Diseases

Better Drugs

Better Studies

Leukemia

Technology

Microelectronics

Monitors

Pacemakers

Ventilators

Heart-Lung Machines

Dialysis

Most Depend On Drugs

Infections

Rejections

New Challenges

Aging Population

Failure of Public Health

Antimicrobial Resistance

Justice Issues

How To Pay For Health Care

How To Deliver Health Care

Should Health Care be a Right?