Historical Perspective: The Long and Winding Road

Historical Perspective:

The Long by Michael Shea, MD and Winding Road

In ancient times, disease was believed to be a curse of the Gods. If they favored you, you were healthy. If you were sick, you had done something to displease them.

In 460 BC, a man named Hippocrates was born. He had different ideas on the cause and treatment of diseases. He believed that disease might be transported by something in the air or in the water. He suspected that epidemics occurred due to contaminated winds coming in contact with large masses of people. He proposed dietetics, exercise, cleanliness, and nutrition as the basis for prevention of illness. He also believed in the Four Humor Theory to explain and treat some illnesses. This theory proposes that the body functions on the proper proportion of these humors or liquids. They are blood, phlegm, yellow bile, and black bile. The correct balance between them was necessary to maintain good health. This led to the use of bloodletting and purgatives to treat the majority of illnesses.

This medical model was also favored by another famous Greek physician, Aelius Galenus, born in 130 AD. The Four Humor Theory lasted well into the nineteenth century.

Benjamin Rush was born on January 4, 1746 in Byberry Township, Pennsylvania. Perhaps no other physician in American history has influenced US medical practice as this man did. He was the surgeon general of his time. Dr. Rush championed the use of bloodletting and purgatives to treat most acute illnesses. He is most remembered for treating the yellow fever epidemic in 1793 with bloodletting and calomel. There was growing opposition to this approach, and by the mid to late 1800s, bloodletting was on the wane.

It must be remembered that bacteria were unknown to doctors until 1856, when Louis Pasteur, a French biologist, discovered them while investigating the spoilage of wine. This led to the Germ Theory, and ultimately to the discovery of penicillin.

Pasteur’s discovery caught the attention of Joseph Lister, a Scottish surgeon who, in 1865, used an antiseptic solution (carbolic acid) to prevent infection in wounds and surgical cases. This, plus the discovery of anesthesia, changed surgery from a “game of chance” to a safer scientific field.

Also noticing Pasteur’s work was a Hungarian born physician, Ignaz Semmelweis. He changed the maternal mortality rate of childbirth from eleven to fifteen percent to near one percent. He did this by insisting on frequent hand washing with a chlorinated solution. Like Lister, his findings were, at first, rejected by his colleagues, and it was twenty years later (1899) before these antiseptic measures were widely used.

There were many other discoveries along the way that brought more science into the medical world. The compound microscope was invented in Holland circa 1590 by two spectacle makers, Hans Jannsen, and his son, Zacharias. The stethoscope was created by a French physician, Rene Laennec, in 1816. A funnel shaped otoscope was created by Austrian physician, Ignaz Gruber in 1838. The ophthalmoscope was made in 1851 by a German physicist, Hermann von Helmhaltz. This led to the Welch and Allen version in 1915. The first sphygmomanometer was invented by Samuel Von Bosch in 1881. The syringe and needle came into existence in 1853, and discovery of diagnostic x-ray was credited to William Roentgen, a German professor of physics, in 1895.

One of the blockbuster discoveries of the past was penicillin. It was discovered in 1928 by a Scottish physician, Alexander Fleming. It would save thousands of military lives during WWII, and even more in the civilian population.

Diabetes was first described by Egyptian physicians about 3,500 years ago. It was a devastating disease, killing children and adults in just a few years after onset. The scene changed dramatically when insulin was discovered in the 1920s by two Canadian researchers, Frederich Banting, MD and Charles Best, MD. The Nobel prize for medicine was awarded to Dr. Banting, who shared it with Dr. Best.

In the early twentieth century, polio was one of the most feared diseases in the United States. It affected mainly children under the age of five, with one out of two hundred suffering permanent paralysis. In 1952, there were 58,000 cases in the United States with 3,145 dying, and 21,269 left with mild to disabling paralysis. A dedicated scientist, Jonas Salk, MD, developed the polio vaccine in 1952, and it was successfully used nationwide in 1955. An oral vaccine was developed by Albert Sabin in the 1950s. It was also an effective vaccine.

The dark ages were definitely over. Surgical advances were surging. Coronary bypass, arterial stents and heart transplants all brought new life to thousands of patients. New drugs to lower cholesterol, maintain regular rhythm, maintain normal blood pressure, and dissolve clots, all contributed to the breakthroughs in maintaining health in cardiovascular and cerebral vascular disorders. Breakthroughs in radiation techniques and new chemotherapeutic drugs are extending the five-year survival rate in cancer patients.

Medical progress has not always been consistent. It has faltered along the way, and during the Middle Ages, must have seemed hopeless. Scientific breakthroughs came in clusters. They came from all over the world, but in the nineteenth and twentieth centuries, they were largely from Europe and the United States.

Is the end in sight? The answer is sadly no. Alzheimer’s Disease and cancer are just two examples of mountains still to climb, but they will be climbed. Medical research is relentless and will continue to uncover the secrets to a healthy life.

That long and winding road is getting shorter!