The History of Western Medicine

Scope of this article:

The History of Medicine is a huge topic and the subject of many large volumes and academic textbooks, such as "The Greatest Benefit to Mankind: A Medical History of Humanity" by Roy Porter.

The following notes describe some aspects, forms and changes in Western Medicine from antiquity to the present day. They include key developments documented in Europe and the English-speaking world to a greater extent than in some other cultures such as those of Africa and Asia. This reflects the relative ease of access to sources of information about cultures in different parts of the world.

Sections below include:

  • Medicine in Antiquity
  • Medieval Europe
  • Medicine in 19th Century Europe
  • Development of Western Medicine during 20th Century
  • Western Medicine in the 21st Century

Medicine in Antiquity

Some detailed information about medical knowledge and attitudes has survived for thousands of years:

Mesopotamia

Middle Eastern civilisations between the rivers Tigris and Euphrates flourished from c.3000 B.C.. Surviving clay tablets recording medical diagnoses, prognostications, and cures date from 700 B.C.. The key document among these is called "The Treatise of Medical Diagnoses and Prognosis" and includes around 3,000 entries on 40 tablets. Evidence suggests that these civilisations believed diseases to have originated from the gods as reprisals for violations of taboos and social mores; they reflected divine judgement and punishment. Both animal and vegetable based drugs were used as remedies, both for physical ailments and also as means of driving away demons.

Egypt

The earliest surviving accounts of medical practices in Ancient Egypt date from around 2000 B.C., but in some cases describe far older traditions. Examples of surviving medical documents from ancient Egypt include:
The Edwin Smith papyrus (so named after an American Egyptologist) is believed to date from around 1600 B.C. and includes an inventory of 48 case studies of various injuries and recommended remedies. The Ebers papyrus, which is thought to date from around 1550 B.C. lists over 80 medical conditions and over 700 drugs and formulae (mainly herbal but also mineral and animal-based) as remedies.

Greece

Written texts dating from around the 500 B.C. onwards indicate a movement of attitudes away from supernatural accounts of illness and suffering, associated with the view that they express the wrath of the gods.

One example of this is Hippocrates' (c. 460-377 B.C.) text "On the Sacred Disease", which reflects openness of Greek medicine and indicated a move towards physiological factors in medicine - e.g. heat as the source of life; the notion and importance of digestion; the significance of breathing; the role of blood. Hippocrates emphasised the use of reason rather than superstition and the importance of observing the patient and his experiences.

Central ideas of this time included the notions that health represents equilibrium and illness an upset; good health depends on a balance between bodily fluids ("chymoi" - in translation, humours); diagnosis requires knowledge of patient's life style, living and working conditions, and diet. That is, the approach of the days was patient-centred with a central concern embodied in the Hippocratic oath to "do no harm".

Rome

Despite the spread of Greek medicine to Italy, Rome was initially dismissive of Greek doctors regarding them as frauds and cheats. Exceptionally, a significant contribution to the advancement of medical knowledge was Celsus' (c. 30 A.D.) "Artes" (The Sciences) - the first encyclopaedic collection in Latin of diseases, diagnoses, and treatment.
Eventually Greek medicine did infiltrate into Rome with the outstanding influence coming from Galen (129 A.D. - c. 216) - a rationalist who believed that the physician must master philosophy - i.e. logic (disciplined thinking), physics (the science of nature), and ethics (reflection on human behaviour). Galen was both a clinician and medical scientist - an expert in animal dissection (though not human dissection) and a pioneer in the development of animal, vegetable, and mineral drugs and compounds.

Greek and Roman medicine progressed over several centuries to produce a rationalist foundation for the development of medical science and practice. It emphasised the notion that the human body has a constitution and framework that is intelligible, open to experience, and to reason, rather than a function of the whims and fancies of gods, sorcerers, and medicine men.

Medicine in Medieval Europe

Medical advances in Europe slowed down during the period of the Dark Ages marked by the collapse of the Roman Empire, an influx of barbarian invasions, and the associated threats to order and stability.

Progress was revived from around 1100 A.D. when extensive translations of Arabic and Greek medical texts were made into Latin (and later into local languages). Further advances also occurred due to the expansion of Medical Schools within Universities.

Religion and Medicine

Religious attitudes to medicine continued to emphasise the godly over the earthly and the soul over the body, requiring healing activities to be regulated by the Church. Care of the sick was a paramount religious duty. During the C13th and C14th there were extensive developments of healing shrines associated with religious relics and the establishment throughout Europe of hospitals that were predominantly religious foundations.

Universities and Medicine

Considerable development of Medical Studies within universities occured from C12th onwards, in places such as: Paris (1110), Bologna (1158), Oxford (1167), Montpelier (1181). This lead to the beginnings of extensive and prolonged study for medical qualification. Studies in surgery and surgical techniques developed as a central feature of medical training. Dissection and the studies in anatomy that derived from it also flourished, the main centres originating in Bologna and Padua.

Medicine and Regulation

Despite the professionalisation of medicine during the Medieval period, qualified practitioners throughout Europe were a small proportion of those offering medical services. Others included barbers, pedlars, midwives, and purveyors of folk remedies. The growth of medical guilds and professional organisations took many forms and assumed various functions. Establishment of regulatory bodies in Paris (1210), Florence (1236), and London (1368) were typical of those intended to oversee apprenticeships and the assessment of trainees, to supervise control of drugs and medicines, and to safeguard the interests of both practitioners and the public.

In short, by the end of the Middle Ages (c. 1500) medicine had become increasingly regulated and established within public institutions. Medical influences were playing an increasing, though still limited, role in public life - in areas such as hygiene, control of epidemics (despite limited success - e.g. the plague/Black Death), and the treatment of illness.

Medicine in 19th Century Europe (1800-1899)

Private Practice

Increasing demand for doctors encouraged self-employment - i.e. the development of private practice. Practitioners varied widely in status, some akin to mere tradesmen, others elevated and extremely successful. Harley Street (London) emerged as a prestigious address for medical consultants. Medical care was enhanced by the state's promotion of public health and the associated appointment of doctors.

In Britain the Medical Act of 1858 provided for a register of approved practitioners, leading to the establishment of the General Medical Council (G.M.C.).

Women in Medicine

Up to and for much of C19th medicine was virtually an all-male profession. However some womem made progress in this field from the late C19th onwards. Examples include Elizabeth Garrett (1836-1917), who in 1865 became the first woman to be enrolled on the Medical Register in England - albeit by the use of 'legal loophole' and Sophia Jex-Blake (1840-1913) who in 1874 founded the London School of Medicine for Women. In Britain in 1876 an Act of Parliament enabled women to formally qualify as medical doctors.

Surgery

There was extensive development of surgical techniques throughout the nineteenth century. Much scope for practice, mainly relating to breakages and amputations, was provided by frequent wars during the C19th century. During this time the excruciating pain and trauma of surgery were gradually reduced due to the development of anaesthia. The latter progressed initially through the use of nitrous oxide in dentistry, to ether, and then to chloroform.

Antiseptics

Although anaesthesia considerably reduced pain, infection was a major impediment to recovery. Joseph Lister (1827-1912) pioneered the use of carbolic acid to combat bacterial infection. Nevertheless, recognition of the role of bacteria was not, at first, recognized by all medical authorities. Aseptic pre-operative cleansing procedures were later added to by the use of rubber gloves.

Nursing

Increasing recognition of the need for good order and systematic procedures in the growing number of hospitals encouraged the development of nursing as a profession.

Religious institutions, both Catholic and Protestant, played a significant role in nurse training. The key figure in Britain was Florence Nightingale (1820-1910), principally known for pioneering work at Scutari during the Crimea War (1854-1856) and extolling the virtues of efficiency and humanity in the treatment of patients. The British Nurses' Association was founded in 1867.

Specialization

Specialiszation had a variety of focal points: e.g. body areas; diseases; life stages. Examples are evident in the range of contemporary medical specialisms. Early forerunners included dentistry, midwifery, obstetrics, paediatrics, and orthopaedics.

Alternative Medicine in C19th

Advances in medical specialisation with its increasing bureaucratisation, status enhancement, and perceived (by some!) self-interest, encouraged the emergence of alternatives. Considerable reservation and mistrust was the basis of much of the rejection of conventional medicine by the alternative proponents of that time.

Early alternative approaches included homeopathy pioneered by Samuel Hahnemann (1755-1833) in Germany and Austria, and incorporating emphasis on "natural" remedies including clean air, exercise, and plant remedies.

Hydropathy (later termed hydrotherapy) was promoted by Vincent Priessnitz (1799-1851) and argued for the healing powers of water and its capacity to purge the body of poisons. Associated treatments including sweating, the use of cold baths, and wet bandage compresses were frequently advocated treatments.

"Thomsonianism" - an American healing strategy derived from the work of Samual A. Thomson (1769-1843) was contemptuous of contemporary medicine and favoured cures based on vegetable preparations, especially plants that would induce body heat since he believed that all illnesses are associated with cold.

Alternative approaches reflected some tensions in nineteenth century medicine and a degree of scepticism about it.

Development of Western Medicine during 20th Century (1900-1999)

Medical Physics

Whereas chemistry and the associated sciences of pharmacology and micro-biology emerged as the new force of 'modern medicine' towards the latter parts of the 19th Century, the contributions of modern physics became increasingly important in medicine as the 20th Century progressed.
See Meandering in Medical Physics: A personal account of hospital physics by J.E.Roberts.

Western Medicine in the 21st Century (2000-present)

New developments in medicine are continually being reported and discussed. It is not possible to predict accurately which medical discoveries and new techniques will be considered most important and successful over the long-term.

At the time of writing animal research is still being conducted in many research laboratories worldwide. Nevertheless, new drugs and treatment methods are and can only be considered "safe" (let alone "successful", for which the bar is obviously much higher) after they have been used on many people who have gone on to recover or at least not to have suffered adverse effects that would not have been expected without the treatment and have not been significantly adversely affected in any other ways, e.g. due to so-called "side-effects" or other unintended consequences such as addictions or other unintended consequences such as impact on future generations.

Some of the major subject areas and themes of current medical research and development include genetics, personalized medicine and many types of transplant surgery.

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