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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 Na´ve
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?

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