This is a general surgical medical history gathered from various sources, knowing history can help the present and future achievements

Through his toiling and living, man has ever taken advantage of all things available in his environment, subsequently transmitting his experiences to his descendants. Popular culture, which is outcome of multi-millenary flow of such experiences, embodies all those things, that have been achieved in the arena of existence along the contacts of man with his surrounding.

Among the fabrics of popular culture, medical science, for reason of need, has always occupied an important estimable position.

Curing mental disorders by means of specific rituals, musical performances, behaviors and customs in based on a precise knowledge of man's psyche and factors affecting it was in order.

Turkmen "Por Khan", "Baba & Mama Zar"  on Southern shores (Gulf), tattooing in order to heal articular pains, which undoubtedly shares common origins with acupuncture and utilization of medicinal herbal concoctions, are but example of a science rooted in popular culture.

In some areas of Iran, including Kurdistan and Azerbaijan, long before, introduction of vaccination the people knew how to prevent small-pox epidemics by traditional means.

Likewise today people knew merits of mineral warm springs and indeed utilized those in medical treatment.

Traditional bone-binders adroitly reassemble pieces of broken jug inside a closed bag, considering this feat a more manipulator practice.

Treating sick children, healing wounds, blood-letting, cupping and the like constitute a trade, which beyond its practical uses, acquires rational expressivities, illustrating well-known saying:

"Cure the scorpion bitten with the dead scorpion."

In order to understand the milieu in which Islamic medicine was born, one has to understand the salient events in the advent of Islam and a few events just preceding the Islamic era. Arabia which was a large area covered mostly by an arid desert that was roamed by nomadic tribes of Bedouins. Certain communities had been established where the trade routes intersected and water was available. Mecca was along the Yaman- Damascus trade route. It was considered a holy city and a sanctuary. The Kaaba or house of worship was replete with idols of different gods each representing a tribe or community. These Bedouins had their own tribal moral or ethical codes of conduct and idolatry was in practice. Blood feuds were common and attacking caravans along trade routes was a way of life. Sacrifices were often offered to appease the gods and burying of live female children was common practice. Family feuds were common and settling scores in order to uphold tribal honor led to frequent bloody encounters in which many people were killed. Women and children were treated as ‘chattels’ or private possessions and became the property of the winner. This era of Arabia is frequently referred by Muslims as ‘Jahilliya’ or age of ignorance. Islam was not only to bring dramatic changes in the religious practices of these warring nomadic tribes but also unite them into an unprecedented social and cultural nation that very quickly was to develop into a strong political entity, with its own system of administration, justice, and military power, all under one leadership. The first leader of the Islamic State was no doubt the Prophet of Islam, Mohammed but then his four successors called the ‘Pious Caliphs’ were to quickly consolidated and expand the nation. Within one hundred years of coming into existence, the Islamic empire had spread from Spain in the west, to China in the east, and encompassed in its midst, the whole of northern Africa ,Egypt, Syria, Palestine, Transjordan ,Central Asia and parts of western India. Later it was to be even carried further by the Muslim merchants to the shores of the far east including the Malaysian peninsula, the islands of the East Indies and Indonesia. In its early era and for several centuries, the Islamic empire was centrally governed by a leader or ‘Caliph’ and administered by provincial governors. The first four Caliphs were elected democratically but the later the Caliphate became dynastic. Later still a western Caliphate was established in Spain. In later history the Islamic Nation was to break up into various kingdoms, as the provincial rulers become more autonomous and independent of the center and was ultimately to be overrun by the Sejluk Turks who were the forerunners of the Ottoman empire.

The early era of Islamic Medicine and the School of medicine at Jundishapur:

Jundishapur or ‘Gondeshapur’ was a city in Khuzistan founded by a Sasnid emperor Shapur I (241-272 AD) before the advent of ISLAM.It was to settle Greek prisoners, hence the name ‘Wandew Shapur’ or ‘acquired by Shapur.’ In present day western Persia the site is marked by the ruins of Shahbad near the city of Ahwaz. The town was taken by Muslims during the caliphate of Hadrat Umar, by Abu Musa Al-Ashari in (17 AH/738 AD ). At this time it already had a well established Hospital and Medical school.

Many Syrians took refuge in the city when Antioch was captured by Shapur I. In fact the latter nicknamed the city ‘Vehaz-Andevi Shapur’ or ‘Shapur is better than Antioch.’ The closing of the Nestorian School of Edessa by Emperor Zeno in 489 AD led to the Nestorians fleeing from there and seeking refuge in Jundishapur under patronage of Shapur II, which got an academic boost as a result. The Greek influence was already predominant in Jundishapur when the closing of the Athenian school in 529 AD by order of the Byzantine emperor Justinian drove many learned Greek physicians to this town. A University with a medical school and a hospital were established by Khusraw Anushirwan the wise (531-579 AD) where the Greeco-Syriac medicine blossomed. To this was added medical knowledge from India brought by the physician vizier of Anushirwan called ‘Burzuyah.’ On his return the latter brought back from India the famous ‘Fables of Bidpai’, several Indian Physicians, details of Indian Medical Texts and a Pahlavi translation of the ‘Kalila and Dimma.’ Khusraw was even presented a translation of Aristotleian Logic and philosophy. Thus at the time of the Islamic invasion the school of Jundishapur was well established and had become renowned as a medical center of Greek, Syriac and Indian learning. This knowledge had intermingled to create a highly acclaimed and state of the art Medical school and hospital. After the advent of Islamic rule the University continued to thrive. In fact the first recorded Muslim Physician Harith bin Kalada, who was a contemporary of the Prophet acquired his medical knowledge at medical school and hospital at Jundishapur.

It is likely that the medical teaching at Jundishapur was modeled after the teaching at Alexandria with some influence from Antioch but it is important to note that ‘the treatment was based entirely on scientific analysis, in true Hippocratic tradition’, rather than a mix-up with superstition and rituals as was the case in Greek ‘asclepieia’ and Byzantine ‘nosocomia’. This hospital and Medical Center was to become the model on which all later Islamic Medical Scools and Hospitals were to be built .The School none the less thrived during the Ummayid caliphate and Sergius of Rasul‘ayn translated medical and philosophical works of both Hippocrates and Galen into Syriac.These were later to be translated into Arabic casting an everlasting imprint onto all the future of Islamic Medicine.

It was during the Abbasid Caliphate that Caliph al-Mansur the founder of the city of Baghdad invited the then head of the Jundishapur School to treat him. This physician was Jirjis Bukhtyishu, a Christian whose name meant ‘Jesus has saved’. He treated the Caliph successfully and got appointed to the court. He however did not stay permanently in Baghdad returning to Jundishapur before his death, but the migration to Baghdad had begun. Thus his son Jibrail Bukhtishu established practice in the city and became a prominent physician. Another family that migrated from Jundishapur to Baghdad was the family of Masawayh who went at the invitation of Caliph Harun-ul-Rashid and became a famous Ophthalmologist. Most famous amongst his three sons who were physicians was Yuhanna ibn Masawayh (Mesue Senior). He wrote prolifically and 42 works are attributed to him. By this time second half of 2nd century after hijra (8th century AD) the fame of Baghdad began to rise as also the political power of the caliphate. Many hospitals and medical centers were established and tremendous intellectual activity was recorded. This culminated into the period of Islamic Renaissance and the golden era of Islamic Medicine of which description is given under a separate section.

 The resources for development of Islamic Medicine: The Bait-ul-Hikma or ‘The House of Wisdom’:

‘Bait-ul-Hikma’ or House of Wisdom was founded in 214 AH 830 AD by the Caliph Al-Mamun an Abbasid Caliph. Ibn Al Nadim, who was the son of a bookseller and whose famous catalogue of books ‘Firhist of Nadim’ tells us of many of the Books of his time, relates this story of the Caliph: Aristotle appeared in the dream of the learned Caliph and told him that there was no conflict between reason and revelation. The Caliph thus set about searching for books and manuscripts of the ancient Greek philosophers and scientists. He sent an emissary to the Byzantine Emperor to get all the scientific manuscripts that were apparently stored in an old and dilapidated building. After initially turning him down the emperor granted him his request. Among the emissaries sent to select the works was the first director of the house of wisdom Salman, who was the one that led the delegation .Others in it were al Hajjaj Ibn Matar, Ibn al Batrik.They brought back with them many Greek scientific works and manuscripts. Translations of all of these was immediately started.However the translation of the medical works of the Greeks had started earlier during the reign of Caliph Harun al Rashid, with the building of the first hospital under the Caliph’s patronage.

Ibn Nadim lists 57 Translators associated with he House of Wisdom. The one’s who formed the first delegation to the Byzantine King have already been named. Other famous ones are as follows:

1. al Hajjaj ibn Yusuf ibn Matar completed translation of Euclid’s elements. Other Greek authors including Aristotle, Archimedes, Pythogras, Theodesius, Jerash, Apollonius, Theon and Menelaus all were translated.

2. Muhammad ibn Mujsa al-Khwarizimi born in Khiva systematically explored arithmetic and al-gebra. The latter derived its name from his discourse: ‘Kitab al-Jabr wa al-Muqabla.’ Algebra was derived from the second letter and meant ‘bone setting’ a graphic description of operations on solving quadrantic equations.

3. The knowledge of geometry flourished and with it architecture and design. Ibn Khaldun was later to describe geometry as a science that ‘enlightens the intelligence of man and cultivates rational thinking.’

4. Mamun’s court astronomer was Musa ibn Shakir. His three sons Muhammad, Ahmad and al-Hassan devoted their lives to the search of knowledge. They exemplified the Prophetic traditions and dicta: ‘Seek learning even if it be in China.’ ‘The search for knowledge is obligatory on every Muslim.’ ‘The ink of scholars is worth more than the blood of martyrs.’

5. The works of these learned men or ‘Sons of Musa" were exceptionally creative. They wrote on: celestial mechanics, the atom, the origins of earth, Ptolemic universe, the properties of the ellipse, Planes and spheres, The knowledge of geometry served in practice to create canals, bridges and architectural designs.

6. Muhammad ibn Musa on one of his travels met Thabit ibn Qurra. The latter was master in three languages. Greek, Syraic and Arabic and soon got appointed to become the court astrologer to Caliph al-Mutadid. He was invaluable addition to the House of Wisdom. In 70 original works he wrote on every conceivable subject including mathematics, astronomy astrology, ethics, mechanics, physics, philosophy, and published commentaries on Euclid, Ptolemy, and other Greek thinkers and philosophers.

7. The two sons of Thabit ibn Qurra also became famous. Sinan was a famous physician in Baghdad. He was director of several hospitals and was court physician to three successive caliphs. His son Ibrahim also became a prominent scientist. He invented sundials and wrote a special treatise on this subject on this subject.

8. The greatest medical mind in the House of Wisdom was Hunain ibn Ishaq. Born in Hira Hunain was the son of an apothecary. He soon translated entire collection of Greek medical works including Galen, Hippocrates. Hunain was an extremely gifted and talented translator. From being just a literal translator he tended to be more scientific and duly interpreted the original text by cross reference, annotation and citing glossaries. His original contributions included 10 works on ophthalmology which were extremely systematic. He rose to the highest honor by being appointed the director of the House of Wisdom by Caliph al Mutawakkil.

9. Qusta ibn Luqa was another accomplished translator and scholar. He has 40 original contributions to his credit. He wrote on diverse subjects such as ‘mirrors, hairs, fans, winds, logic, geometry and astronomy to name a few.

10. Yuhanna ibn Masawaih (Mesuse senior) was an early director of the House of Wisdom. He served under four caliphs. Al Mamun, al-Mutassim, al-Wathik and al-Mutawakkil. He wrote about medical especially gynecological problems.

11. The effect of the House of wisdom was tremendous. Islamic Science, philosophy, art and architecture all felt its effects. Agriculture, Government, prosperity and economic wealth were the benefactors. It ultimately was responsible to produce figures like Al-Kindi, Al-Farabi, some of the greatest thinkers, scientists and philosophers of Islam. Also some of the greatest Islamic Physicians had available to them all the knowledge of ancient Greece, Syria, India and Persia available to them and in turn they contributed by their astute observation and originality. The giants of Islamic Medicine and their achievements are described elsewhere.

Hospitals during the Islamic era:

The idea of a hospital as an institutional place for the caring of the sick has not been recorded in antiqiuty. There were sanatoria and ‘travel lodges’ that were attached to temples where the sick were attended to by attendant priests. Most of the therapy in these sanatoria consisted of prayers and sacrifices to the gods of healing especially to Aaescalapius. Cures that ocured were thought to result from divine interventions.

A large number of hospitals were developed early during the Islamic era.They were to be called ‘Bimaristan’ or ‘Maristan’. The idea of a hospital as a place where sick could get attention was totally adopted by the early Caliphs. The first hospital is creditied to Caliph Al-Walid I an Ummayad Caliph (86-96 AH 705-715 AD), by some it was however considered no more than a leprosoria because it allowed the seggregation of lepers from others. It did have on staff ‘salaried doctors’ to attend the sick.

The first true Islamic hospital was built during the reign of Caliph Harun-ul-Rashid (170-193 AH 786-809 AD). Having heard of the famous medical institution at Jundishapur already described above the Caliph invited the son of the chief physician, Jibrail Bakhtishu to come to Baghdad and head the new ‘bimaristan’ which he did.It rapidly achieved fame and led quickly to developments of other hospitals in Baghdad. One of these the ‘Audidi’ hospital was to be built under the instructions of the great Islamic Physician Al-Razi. It is said that in order to select the best site for the hospital he had pieces of meat hung in various quartters of the city and watched their putrefaction and advised the Caliph to site the hospital where the putrefaction was the slowest and the least ! At its inception it had 24 physicians on staff including specialists categorized as Physiologists, oculists, surgeons and bonesetters. When Djubair visitied Baghdad in 580 AH/ 1184 AD he recorded that this hospital was ‘like a great castle’ with water supply from the tigris and all appurtenances of Royal Palaces.

One of the largest hospitals ever built was the Mansuri Hospital in Cairo it was completed in 1248 by the orders of the Mameluke ruler of Egypt, Mansur Qalaun. It was most elaborate. It had a total capacity of 8000 people ! The annual income from endowments alone was One million dirhams. Men and women were admitted to separate wards. Irrespective of race religion and creed or citizenship (as specifically stated in the Waqf documents) nobody was ever turned away .There was no limit to the time the patient was treated as an inpatient ! ( what a contrast from present HMO’s !) . There were separate wards for men and women and medicine, surgery, fevers and eye diseases had separate wards. It had its own pharmacy, library and lecture halls. It had a mosque for Muslim patients as well a chapel for Christian patients !

The Waqf document specifically stated: ‘The hospital shall keep all patients, men and women until they are completely recovered. All costs are to be borne by the hospital whether the people come from afar or near, whether they are residents or foreigners, strong or weak, low or high, rich or poor, employed or unemployed, blind or sigted, physically or mentally ill, learned or illiterate. There are no conditions of consideration and payment; none is objected to or even indirectly hinted at for non-payment. The entire service is through the magnificence of Allah, the generous one.’

As to the physical conditions of these hospitals especially those established by princes, rulers and viziers it can be stated that some of these were luxurious and were actual palaces that had been converted to hospitals. Even contemporary Europe could not boast of a single hospital that came close to the facilities that were provided in these intitutions. Some of them especially in Baghdad, Egypt and Syria had furnishings were similar to those in the palaces.Most of theser being under the patronage of the viziers, sultans and caliphs were no doubt inspired by the Islamic teaching of the welfare of the poor and needy. The Quran tells us: ‘You shall not attend to virtue unless you spend for the welfare of the poor from the choicest part of your wealth’ (3,92) and again: ‘O you who believe spend (for the poor) from the worthiest part of what you have earned and what your crop yields, and do not give away from its unworthy parts- such that you yourselves will not take until you examine the quality minutely- and know that Allah is not in your need and all praise belongs to Him.’ (2,267).

As to the salaries of Physicians here is some information from authentic sources. The annual income of Jibrail ibn Bakitshu who was the Chief of Staff at a Baghdad hospital during the reign of Mamun ArRashid (d c.e 833/218 A.H.) as recorded by his own secretary was 4.9 million dirhams. His son also a doctor lived in a house in Baghdad that was air-conditioned by ice in summer and heated by charcoal in winter ! A resident by comparison who was supposed to be on duty for two days and two nights a week, was paid 300 dirhams a month. (Remind you of Denton Cooley and his fellows ?).

The great physicians of Islamic Medicine:

The era of Islamic Medicine produced some very famous and notable physicians.These physicians were not only responsible to get all the existing information on Medicine of the time together but add to this knowledge by their own astute observations, experimentation and skills. Many of them were skilled in medical writing and produced encyclopedic works which became standard texts and reference works for centuries. With the coming of European Rennaicanse they formed the basis on which the european authors gained insight into the medicine of the ‘ancients’ or early greek authors whose works weree only preserved in Arabic. In addition many re-discoveries took place which had already been recorded by the Islamic physicians but hitherto had been unknown until recently uncovered. The classical example of the discovery of Pulmonary circulation originally given to Servetus was found to have been succintly describned by Ibn Nafis an Islamic Physician who lived centuries earlier. Ibn Nafis repudiated the earlier concepts held by Galen and described the lesser circulation so succinctly that nothing more could be added until Malphigi could describe the alveoli and the pulmonary cappillaries with the asdvent of the microscope discovered by Anthony Von Luwenheek in mid 19th Century.Some of them form the basis of instruction of students of Tibb and Hikma the traditional Islamic Medicine practiced in the subcontinent of India and Pakistan, even today under the banner of Tibb or Unani Meidicne.! It would be out of scope for us in this chapter to describe the accomplishments of each of these physicians, however we will proceed with giving you the salient accomplishments of some of the most notable amongst them. For sake of classsifiction the historic periods of the Islamic Physicians can be divided into three parts: 1. The period of Islamic Rennaisance: From the beginning of Islam to the end of the Abbasid dynasty. 2. The period of Islamic Epoch: When all sciences including Medicine reached the pinnacle of development under the Islamic patronage. 3. The period of decline: during which the knowlege of Islamic Medicine was translated into european languages and became the basis of further development and discoveries and ultimately led to basis for the development of Modern Medicine.

 The Period of Islamic Rennaisance:

The notable physicians during this period were as follows:

Bukhtishu family of Physicians. The oldest amongst these was Jibrail Bukhtishu who was the Chief Physician at the Hospital in Jundishapur. He came from a Christain family and was summoned to the court of Caliph Mamun (148AH/765 AD) when the latter fell ill. After having treated him successfully he was invited to stay in Baghdad and head a hospital there but he declined and returned to his native Jundishapur.(152 AH/769 AD) It was his son Jurjis Bukhtishu who was later invited by Caliph Harun-ul-Rashid to come to Baghdad to treat him (171AH/787 AD) and then offered to be the Chief Physician and head a hospital in Baghdad which he did till he died in 185 AH/801 AD).

Masawaih is another family of physicians associated with early Islamic History.During the reign of Caliph Harun-ul-Rashid the elder of the family migratd from Jundishapur t Baghdad and become a celebrated Ophthalmologist. He wrote the first Arabic treatise on ophthalmology. His son known to the west as Mesue Senior with real name of Yuhanna ibn Masawayh wrote several medical works in Arabic while translating other works from Greek.He is known for somewhat of a sarcastic temperament none the less commanded great repect becuase of his medical expertise.

Hunayn ibn Ishaq who was a student of ibn Masawayh became the greatest translator of Greek and Syriac medical texts during the 3rd century AH/9th century AD. He was responsible for masterly translations of Galen,Hippocrates, Aristotle into Arabic. He also improved the Arabic Medical lexicon giving it a rich technical medical language to express medical terninology and thus laid the foundations of the rich medical expression in Arabic language far superceeding the later translations from Arabic to Latin.He was himself an astute physician and wrote two original works on ophthalmology.

The credit of the first sytematic work on medicine during this era goes to a muslim physician Ali ibn Rabban al-Tabbari hailing from Persia but settling in Baghdad in the first half of the 3rd century AH/9th century AD. His work called ‘Firdaws a--Hikma’ or ‘Paradise of Wisdom’ contained extensive information from all extant sources including Greek, Syriac,Persian and Indian and contained an extensive treatment of Anatomy

.http://www.iiim.org/islamed3.html

Claudius Galen was a Greek physician who went to Rome and revived the ideas of Hippocrates and other Greek doctors. The Romans had shown little interest in the work of Hippocrates and it took Galen to push it forward in Rome.

Galen was born in 131 AD. He was a gifted intellect who studied at the famous medical school in Alexandria in Egypt. At the age of 28, Galen became the surgeon to a school of gladiators but in 161 AD he moved to Rome apparently with the sole intention of seeking fame and fortune. He certainly achieved his fame but for some Romans this became too much. As a Greek, many Romans viewed Galen with suspicion and in 166 AD, he was forced to flee the city. Two years later he went back to the city in response to an invitation by the emperor. With this protection, Galen remained in the city until his death, aged about 70, in 201 AD.

Galen revived the methods favoured by Hippocrates and other Greek doctors who lived at the time of Hippocrates. He put great emphasis on clinical observation – examining a patient very thoroughly and noting their symptoms. Galen also accepted the view that disease was the result of an imbalance between blood, phlegm, yellow bile and blood bile. Galen also believed in the healing power of nature and he developed treatments to restore the balance of the four humours. Galen believed in the use of opposites – if a man appeared to have a fever, he treated it with something cold; if a man appeared to have a cold, he would be treated with heat. People who were weak were given hard physical exercises to do to build up their muscles. People who had breathing problems due to a weak chest were given singing exercises.

Galen extended his knowledge of anatomy by dissecting pigs and apes and studying their bone structure and muscles. Galen was also interested in human anatomy but there is no evidence that he dissected human bodies – though rumours persisted that he did. In "On Anatomical Procedures", Galen advised his students to dissect apes but take whatever opportunities that existed to study the human body. Galen also studied how the body worked, concentrating on the movement of blood and the working of the nervous system. For the latter, he experimented with the spinal cords of pigs.

Galen’s influence was great. Protected by the emperors, he could work free from his jealous rivals in Rome. Galen also believed that his knowledge should be shared and he was a prodigious writer of books. These books were still being used in the Middle Ages and, for many medical students, they were the primary source of information on medicine

Robert Koch was born in 1843. Koch worked on anthrax and tuberculosis (TB) and he further developed the work of Louis Pasteur. Koch’s fame, alongside that of Alexander Fleming, Edward Jenner, Joseph Lister and Pasteur himself, is firmly cemented in medical history.

Koch came from a poor mining family and it took him a lot of determination to get a university place where he first studied mathematics and natural science and then studied medicine.

Pasteur was convinced that microbes caused diseases in humans but his work on cholera had failed. He was never able to directly link one microbe with a disease. Koch succeeded in doing this.

Koch was a doctor and he had a detailed knowledge of the human body – something that Pasteur, as a research scientist – lacked. He was also skilled in experiments, the result of his work in natural sciences. Qualities that also proved to be important were his ability to work for long periods of time and his patience. However, Koch was also difficult to work with and could not tolerate anyone telling him that his theories were wrong.

In 1872, Koch became district medical officer for a rural area near Berlin. He started to experiment with microbes in a small laboratory he had built for himself in his surgery.

The first disease that Koch investigated was anthrax. This was a disease that could seriously affect herds of farm animals and farmers were rightly in fear of it. Other scientists had also been working on anthrax. In 1868, a French scientist called Davaine had proved that a healthy animal that did not have anthrax could get the disease if it was injected with blood containing anthrax. Koch developed this work further and for three years he spent all his spare time finding out what he could about the disease, including its life cycle.

Koch found out that the anthrax microbe produced spores that lived for a long time after an animal had died. He also proved that these spores could then develop into the anthrax germ and could infect other animals.

After this, Koch moved onto germs that specifically affected humans. In 1878, he identified the germ that caused blood poisoning and septicaemia. He also developed new techniques for conducting experiments that influenced the way many other scientists carried out their experiments. He knew that infected blood contained the septicaemia germ but he could not see these germs under a microscope, and therefore, other scientists were unlikely to believe what he thought to be true without the evidence.

Koch discovered that methyl violet dye showed up the septicaemia germ under a microscope by staining it. He also photographed the germs so that people outside of his laboratory could see them.

Koch also devised a method of proving which germ caused an infection. His work was rewarded in 1880 when he was appointed to a post at the Imperial Health Office in Berlin. Here, Koch perfected the technique of growing pure cultures of germs using a mix of potatoes and gelatine. This was a solid enough substance to allow for the germs to be studied better. Koch gathered round him a team of researchers in Berlin in 1881 and began to work on one of the worst diseases of the nineteenth century – tuberculosis (TB).

The TB germ was much smaller than the anthrax germ so the search for it was difficult. Using a more specialised version of his dye technique, Koch and his team searched for the TB germ. In May 1882, Koch announced that his team had found the germ. His announcement caused great excitement. It also generated what became known as ‘microbe hunters’ – a new generation of young scientists who were inspired by the work of both Koch and Pasteur. One of those who was inspired by Koch was Paul Ehrlich.

What was Koch’s legacy? He had finally laid to rest the belief that ‘bad air’ caused disease. He had inspired many other younger researchers to build on his work. He had found the germs of two feared diseases – anthrax and TB. He had developed research techniques that others could use throughout the world.

By 1900, twenty-one germs that caused diseases had been identified in just 21 years. "As soon as the right method was found, discoveries came as easily as ripe apples from a tree." (Koch) It was Koch who had developed the right methods.

Leonardo da Vinci

In addition to being just about the smartest person ever, Leonardo is reported to have been a strikingly handsome man with great strength and a fine singing voice. And unlike his fellow 15th-century Italians, he was a vegetarian and followed strict dietary rules. In fact, he loved animals so much that he would often buy caged animals at the market just to set them free.

Native American tribes are known to have had “medicine men” that excelled in knowledge and use of the healing properties of herbs and other plants. These healers played an important part in the cultural life and physical well-being of their people. 
 

Chief Red Cloud, Oglala Lakota (1822-1909)

The Susutra "Textbook" of Indian Medicine used by several groups of Native Americans clearly shows that some ancient Indian physicians were obsessed with classification. For example, there were 66 diseases of the oral cavity and 6 of the ear lobe. Surgery was used and describe into divisions including incision, excision, scraping, puncturing, probing, extraction, provoking secretion, and suturing. Over 100 surgical instruments were described by various tribes. The hand was considered to be the most important instrument. In some cultures, wine and hypnotism were used as the first anesthetics.

Theodor Billroth

Billroth was a surgeon from Vienna who was a pioneer abdominal surgeon, and perfected many procedures, including gastric resections still used daily in general surgery. He helped establish the foundations of academic training and university direction of surgical sciences. 
 

Michael DeBakey

DeBakey was a pioneer in cardiovascular surgery. In 1934, he designed the first roller pump, which remains the basis for all cardiac bypass surgery performed today. He is also credited for the development of many valuable surgical instruments, and has been a leader as a spokesman for medical research. 

DNA is a double-stranded molecule twisted into a helix (like a spiral staircase). Each spiraling strand is comprised of a sugar-phosphate backbone with attached base molecules, which are adenine, thymine, cytosine and guanine. These molecules are connected to a complementary strand of hydrogen that bonds with paired bases. Adenine and thymine are connected by two hydrogen bonds. Guanine and cytosine are connected by three hydrogen bonds. 
 

During this period, medical healing went from the antibiotic age to molecular age. Scientific discoveries were applied to bio-technological solutions of the patient’s needs, such as sophisticated laboratory tests, computerized imaging techniques, and mechanical innovations.
 

1955:  Dr. Jonas Salk develops a dead virus vaccine for polio
1955:  Albert Sabin develops oral live-virus vaccine for polio
1967:  Dr. Christiaan Barnard, South Africa, performs first human heart transplant. The patient lives 18 days.
1972:  British engineers invent CT Scanner

1978: Louise Brown, the first test tube baby, is born in England 
1979: Smallpox is eradicated world-wide
1981: First case of AIDS is reported in San Francisco
1982: MRI is approved for medical use in the U.S.
1982: FDA approves the first drug developed with recombinant DNA technology, a form of human insulin. This was the first time scientists were able to manufacture a substance in nearly the exact form it occurs naturally in the body.
1983: erythropoietin (Epoetin) stimulates bone marrow to manufacture red blood cells.
 

1984: Barney Clark receives 1st artificial heart (Jarvick 7) at the University of Utah: He lives 112 days.

Great progress has been made in public awareness and education. Patients are being taught the role of lifestyle, habits and environment on their health. There has been a combined scientific and government campaign to warn the public about health risks such as smoking. Community safety standards have been established and there is vastly improved hospital and emergency care. Education has played an important role to improve the health of patients. For example, expectant mothers now receive pre-natal care, which has significantly decreased infant mortality rates. 

We Live in a Time of "Small Miracles"
According to the mother who had the surgery, Vanderbilt University where the procedure took place, and he photographer who took the picture, this story is true. 

Dr. Joseph Bruner at Vanderbilt is known for his work in fetal surgery, especially on babies with spina bifida, a condition in which the spine does not close properly during development.   Vanderbilt confirms that little Samuel Armus was 21 weeks-old in the womb which makes the surgery very risky because if anything goes wrong, the baby cannot survive on its own.  Dr. Bruner and his colleagues, however, have done numerous successful spina bifida surgeries on fetuses that are not yet viable. In this particular surgery, the baby's hand poked out of the incision in its mother's womb and Dr. Bruner says he instinctively offered his finger for the baby to hold.  When the baby's hand popped out of the surgical opening on its own, the doctor put his finger into the baby's hand, the baby squeezed his finger and held on. 

Baptiste Joseph Jean Fourier was born in France (1768-1830). He was a genius in mathematics and developed theories of sinus waves and the transformation of wave energy. He made significant contributions to math, physics, and engineering principles used in x-ray production today. Fourier transformation is the basis of MRI technology.   Michael Faraday  (1791-1867). Born to a poor family in London, he was extremely curious, questioning everything. He is credited with discovering the Law of electromagnetic induction. In 1819, he discovered that electricity produces magnetism. Later, he proved that magnetic fields induce electrical current, which is the very basis of detection of MRI signals, as they pass through a receiver coil.   Nikola Tesla was a French/American physicist. In 1884, he invented the first electric motor. Later he invented the tesla coil, a wireless electronic frequency receiver. The Tesla unit, used to measure magnetism, was named in his honor.  (1 T=10,000 gauss)   Albert Einstein, the Nobel Prize winning German/American physicist proposed in 1905 the Law of Conservation of Energy (Theory of Relativity: E=mc2). This discovery pioneered the atomic age. He explained to President Roosevelt in 1939 the enormous destructive potential of  the atomic bomb. Honors awarded to Albert Einstein include the Nobel Prize 1921, Fellow of the Royal Society 1921, and the Royal Society Copley Medal in 1925. 1940 Einstein became a citizen of the United States, but also retained his Swiss citizenship. He made many contributions to peace during his life. In 1944 he made a contribution to the war effort by hand writing his 1905 paper on special relativity and putting it up for auction. It raised six million dollars. The manuscript is currently in the Library of Congress, Washington, DC.   Neils Bohr (1885-1962), a Danish Physicist, theorized the similarity of the atom to that of the solar system. He was the first to teach that the arrangement of electrons around a nucleus determines the energy level of each element in the periodic chart of elements. Bohr wrote the letter signed by Einstein to President Roosevelt in 1939 explaining the power of uranium 235 and the atomic bomb.   no photo available Otto Stern (1888-1969), an American Physicist, theorized in 1930 that the human body consists of cells oriented in magnetic orientations. The stimulation/relaxation theory was developed, which opened the door for MRI imaging. He was awarded the Nobel Prize for Physics in 1943.   Felix Bloch and Edward Purcell, American Theoretical Physicists discovered magnetic resonance spectroscopy. They were the first to use radio frequency (RF) pulses for imaging. They were able to detect and record emitted molecular signals and convert those signals into an image. Bloch was the first to use the terms T1 and T2. They shared Nobel Prize for physics in 1952.   Raymond Damadian, MD, theorized that MRI technology could be applied safely to humans. In 1970, he designed and built the first whole body scanner and performed the first transaxial scan. His first exam was of the thoracic spine. The procedure took 5 hours to complete. He was also the first to discover that cellular water in healthy cells varies in appearance from water in diseased cells.   Paul Lauterbur, Ph.D. proposed that by placing gradients onto the magnetic induction field, spatial (multi-planar) imaging could be achieved. He tested the theory out by scanning pine branches, pecans and walnuts. He discovered that MRI could be used for exceptional soft tissue contrast by employing selective excitation of cells.  A Look Back at Major Discoveries in Radiology   1895: Wilhelm Roentgen discovers the x-ray 1896: First medical application of x-rays. 1901: Roentgen awarded the Nobel Prize in physics. 1902: American Roentgen Ray Society was founded. 1905: Albert Einstein introduces the theory of relativity 1913: Bohr introduces a model of the atom featuring a nucleus and orbiting electrons.  1913: The Coolidge hot-filament x-ray tube is developed. .1916: Cellulose nitrate film base is used as the first x-ray film. 1919: Researchers use soluble iodinated contrast agents. 1920: American Society of Radiologic Technologists was founded.  1921: Grids and the Potter-Bucky diaphragm are introduced. 1922: Compton describes scatter x-rays & their adverse effect on image quality. 1929: Werner Forssmann demonstrates cardiac catheterization (with himself as the patient). Forssmann, a young surgical resident, anesthetized his own elbow, inserted a catheter in his vein and with the catheter hanging from his arm, entered an x-ray room where he proved that a catheter could be inserted safely into a human heart. Forssmann's goal was to find a safe way to inject drugs for cardiac resuscitation. He was determined that catheterization was the key, but it was believed at the time that any entry into the heart would be fatal. Forssmann was immediately fired for his self-experimentation, despite the significance of his discovery. Discouraged by his lack of acceptance in cardiology he switched to urology and eventually became a country doctor. He never returned to cardiology research but was awarded a Nobel Prize in 1956. 1929: Rotating anode x-ray tube is developed. 1930: Tomography is invented. 1942: Morgan develops the first electronic phototiming device.  1948: Coltman develops the first fluoroscopic image intensifier. 1956: Automatic film processors are manufactured. No more hand-dipping films.  1966: Diagnostic ultrasound is approved for medical imaging. 1973: Hounsfield, a British Engineer, completes development of the first CT scanner. 1982: MRI becomes available for medical imaging in the U.S.  1996: Film-less radiology departments and digital radiography systems The impressive list of radiologic develops continues to grow at an astonishing rate!  X-ray and the Assassination of an American President An interesting story is told about the use of x-ray in 1901. President William McKinley had just begun his second term as President. He was standing in a receiving line at the Pan-American Exposition in Buffalo, New York, an important international event. In those days, when an invention or scientific discovery was made, it was placed on display for the world to see at the "Expo". Suddenly a gunman jumped out of the crowd and shot the President twice. As the president lay bleeding, doctors rushed to his aid. He was taken to a temporary medical station. His injuries were serious, even life-threatening. Doctors decided to operate immediately. The first bullet was quickly located, but the second was no where to be found, and there was no exit wound. It was obvious to the surgeons that the second bullet was causing a great deal of internal bleeding and had to be removed. Further surgery on the already weakened president was considered too great a risk. The surgery was terminated and the President was transported to a nearby hospital. Eight days later, President McKinley died.  As the surgeons discussed what they could have done to save the president, they were told that Wilhelm Roentgen’s “x-ray light” was on display at the Expo only a few booths away from where the President had been shot. Had the surgeons obtained an x-ray of the still living president, they likely would have been able to repair the damage and save his life.  That same year, 1901, Wilhelm Roentgen received the Nobel Prize in physics for his discovery of the x-ray, truly one of the most important medical discoveries in the history of medicine.    President William McKinleyWilhelm Conrad Roentgen   1845  Born March 27 in Kennep, Germany. 1848  The Roentgen family moved to Appeldorn, Netherlands. 1864  He finished technical school at Utrecht and continued on with his education at the University of Utrecht. 1868  Received a diploma in mechanical engineering at the Technical University in Zürich. 1870  He moved to Würzburg, Germany and worked as a scientific assistant. 1872  Married Bertha Ludwig (1839-1919). They had one adopted daughter.  1872  Moved to Straßburg, Germany. 1875  Became a Professor at the "Landwirtschaftlichen Akademie Hohenheim". 1888  Was  recruited to be a Professor at the University in Würzburg, Germany. 1895  Discovers X-rays November 8. 1900  Became a Professor at the University of Munich. 1901  Awarded the Nobel Prize in physics. Roentgen refused to patent his discoveries and rejected all commercial offers relating to them. In his later years, he was embittered by the suggestion that he had taken credit for his laboratory assistant's discovery, and withdrew from public life. Roentgen Died February 10, 1923 in Munich of colon cancer. Buried beside his wife in Giessen, Germany. Roentgen's Discovery of X-ray On November 8, 1895, at the University of Wurzburg, Roentgen's attention was drawn to a glowing fluorescent screen on a nearby table. He immediately determined that the fluorescence was caused by invisible rays originating from the glass Hittorf-Crookes tube he was using to study cathode rays (electrons). The mysterious rays were able to penetrate through the opaque black paper covering the tube. Roentgen had discovered x-rays, a momentous event that instantly revolutionized the field of physics and medicine.   Prior to his first formal correspondence to the University Physical-Medical Society, Roentgen spent two months thoroughly investigating the properties of X rays. For his discovery, Roentgen received the first Nobel Prize in physics in 1901. When later asked what his thoughts were at the moment of his discovery, he replied "I didn't think, I investigated”. It was the crowning achievement in a career beset by many difficulties.  As a student in Holland, Roentgen was expelled from the Utrecht Technical School for a prank committed by another student. Even after receiving a doctorate, his lack of a diploma initially prevented him from obtaining a position at the University of Wurzburg. He even was accused of having stolen the discovery of X rays by a lab assistant. Roentgen was a brilliant experimentalist who never sought honors or financial profit for his research. He rejected a title (von Roentgen) that would have provided entry into the German nobility, and donated the money he received from the Nobel Prize to his University. Roentgen did accept the honorary degree of Doctor of Medicine offered to him by the medical faculty of his own University of Wurzburg. However, he refused to take out any patents in order that the world could freely benefit from his work. At the time of his death, Roentgen was nearly bankrupt from the inflation that followed World War I.    Roentgen’s office where he discovered x-rays. The most famous x-ray image-  Roentgen asked his wife Bertha Ludwig Roentgen,  to be his “patient” for the first x-ray image ever taken, shown above.

Hippocrates: The "Greek Miracle" in Medicine

Al-Razi is attributed to be the first to use the Seton in surgery  and animal gut for sutures . He was the first to use silk sutures and alcohol for hemostasis . He was the first to use alcohol as an antiseptic .

 

Ibn Sina originated the idea of the use of oral anesthetics . The Arabs invented the soporific sponge, which was the precursor of modern anesthesia. It was a sponge soaked with aromatics and narcotics and held to the patient's nostrils . The use of anesthesia was one of the reasons for the rise of surgery in the Islamic world to the level of an honorable specialty, while in Europe, surgery was belittled and practiced by barbers and quacks. The Council of Tours in 1163 CE declared "Surgery is to be abandoned by the schools of medicine and by all decent physicians." . Burton  stated that "anesthetics have been used in surgery throughout the East for centuries before ether and chloroform became the fashion in civilized west.."

 

 

 

AL-ZAHRAWI

 

 

Abu al-Qasim Khalaf Ibn Abbas al-Zahrawi (930-1013 CE) known to the west as Abulcasis, Bucasis, or

 

Alzahravius is considered to be the most famous surgeon in Islamic medicine. In his book Al-Tasrif, he described hemophilia for the first time in medical history. The book contains the description and illustration of about 200 surgical instruments, many of which devised by Zahrawi himself . In it Zahrawi stresses the importance of the study of Anatomy as a fundamental prerequisite to surgery . He advocated the reimplantation of a fallen tooth and the use of dental prosthesis carved from cow's bone, and improvement over the wooden dentures worn by the first President of America, George Washington, seven centuries later . Zahrawi appears to be the first surgeon in history to sue cotton (Arabic word) in surgical dressings in the control of hemorrhage, as padding in the splinting of fractures, as a vaginal padding in fractures of the pubic, and in dentistry. He introduced the method for the removal of kidney stones by cutting into the urinary bladder. He was the first to teach the lithotomy position for vaginal operations . He described tracheotomy, distinguished between goiter and cancer of the thyroid, and the invention of a cauterizing iron, which he also used to control bleeding. His description of varicose veins stripping, even after ten centuries, is almost like modern surgery . In orthopedic surgery he introduced what is called today Kocher's method of reduction of shoulder dislocation and patelectomy . 1,000 years before Brook reintroduced it in 1937 .

 

 

IBN SINA

Pre-op, 10th century style - Ibn Sina is known to have operated on a friend's gall bladder 

 

Ibn Sina's description of the surgical treatment of cancer holds true even today after 1,000 years. He says the excision must be wide and bold; all veins running to the tumor must be included in the amputation. Even if this is not sufficient, then the area affected should be cauterized . His recommendation of wine as the best dressing for wounds was very popular in medireview practice .

 

 

 

The surgeons of Islam practiced three types of surgery; vascular, general, and orthopedic. Ophthalmic surgery was a specialty, which was quite distinct both from medicine and surgery. They freely opened the abdomen and drained the peritoneal cavity in the approved modern style. To an unnamed surgeon of Shiraz is attributed the first colostomy operation. Liver abscesses were treated by puncture and exploration.

 

 

Surgeons all over the world practice today unknowingly several surgical procedures that Zahrawi introduced 1,000 years ago .

 

 

Edward Jenner is alongside the likes of Joseph Lister, Robert Koch and Louis Pasteur in medical history. Edward Jenner was born in 1749 and died in 1823. Edward Jenner’s great gift to the world was his vaccination for smallpox. This disease was greatly feared at the time as it killed one in three of those who caught it and badly disfigured those who were lucky enough to survive catching it.

Edward Jenner was a country doctor who had studied nature and his natural surroundings since childhood. He had always been fascinated by the rural old wives tale that milkmaids could not get smallpox. He believed that there was a connection between the fact that milkmaids only got a weak version of smallpox – the non-life threatening cowpox – but did not get smallpox itself. A milkmaid who caught cowpox got blisters on her hands and Jenner concluded that it must be the pus in the blisters that somehow protected the milkmaids.

Jenner decided to try out a theory he had developed. A young boy called James Phipps would be his guinea pig. He took some pus from cowpox blisters found on the hand of a milkmaid called Sarah. She had milked a cow called Blossom and had developed the tell-tale blisters. Jenner ‘injected’ some of the pus into James. This process he repeated over a number of days gradually increasing the amount of pus he put into the boy. He then deliberately injected Phipps with smallpox. James became ill but after a few days made a full recovery with no side effects. It seemed that Jenner had made a brilliant discovery.

He then encountered the prejudices and conservatism of the medical world that dominated London. They could not accept that a country doctor had made such an important discovery and Jenner was publicly humiliated when he brought his findings to London. However, what he had discovered could not be denied and eventually his discovery had to be accepted – a discovery that was to change the world.

So successful was Jenner's discovery, that in 1840 the government of the day banned any other treatment for smallpox other than Jenner's. 

Jenner did not patent his discovery as it would have made the vaccination more expensive and out of the reach of many. It was his gift to the world. A small museum now exists in his home town. It was felt that this was appropriate for a man who shunned the limelight and London. In the museum are the horns of Blossom the cow. The word vaccination comes from the Latin ‘vacca’ which means cow – in honour of the part played by Blossom and Sarah in Jenner’s research. A more formal statue of Jenner is tucked away in one of the more quiet areas of Hyde Park in London.

As a young man, Jenner also wrote about what he had seen cuckoos doing. His were the first written records to describe a baby cuckoo pushing the eggs and the young of its host out of the nest so that the baby cuckoo was the only one to receive food from its foster parents. This was only confirmed many years later but it stands as a testament to the importance of the countryside for Jenner. If he had gone to a city to further his career, would he had been in the right environment to make his famous discovery? In 1980, the World Health Organisation declared that smallpox was extinct throughout the world.

The impact of Jenner's vaccination can be seen in its impact in London in 1844:

Smallpox was a major killer before Edward Jenner's vaccination that was to change medical history. Whilst Jenner’s vaccinatioon did not eradicate smallpox, it had a marked impact on fatality rates in large and dirty cities such as London.

Smallpox casualties in London in 1844:

Alexander Fleming is alongside the likes of Edward Jenner, Robert Koch, Christian Barnard and Louis Pasteur in medical history. Alexander Fleming discovered what was to be one of the most powerful of all antibiotics – penicillin. This drug was to change the way disease was treated and cement Fleming’s name in history.

One of the most important medical advances in history began by accident. On the morning of September 3^rd, 1928, Professor Alexander Fleming was having a clear up of his cluttered laboratory. He was sorting through a number of glass plates that had previously been coated with staphyloccus bacteria as part of research Fleming was doing.

One of the plates had mould on it. The mould was in the shape of a ring and the area around the ring seemed to be free of the bacteria staphyloccus. The mould was penicillium notatum. Fleming had a life long interest in ways of killing off bacteria and he concluded that the bacteria on the plate around the ring had been killed off by some substance that had come from the mould.

Further research on the mould found that it could kill other bacteria and that it could be given to small animals without any side effects. However, within a year, Fleming had moved onto other medical issues and it was ten years later that Howard Florey and Ernst Chain, working at Oxford University, isolated the bacteria-killing substance found in the mould - penicillin.

IN 1941, a doctor, Charles Fletcher, at a hospital in Oxford had heard of their work. He had a patient who was near to death as a result of bacteria getting into a wound. Fletcher used some of Chain’s and Florey’s penicillin on the patient and the wound made a spectacular recovery. Unfortunately, Fletcher did not have enough penicillin to fully rid the patient’s body of bacteria and he died a few weeks later as the bacteria took a hold. However, penicillin had shown what it could do on what had been a lost cause. The only reason the patient did not survive was because they did not have enough of the drug - not that it did not work.

Florey got an American drugs company to mass produce it and by D-Day (June 6^th 1944), enough was available to treat all the bacterial infections that broke out among the troops. Penicillin got nicknamed "the wonder drug" and in 1945 Fleming, Chain and Florey were awarded the Nobel Prize for medicine. Post-1945 was the era of the antobiotics.

Howard Florey is as linked to penicillin as Sir Alexander Fleming is. Howard Florey, who developed a way of mass producing penicillin, should be seen as being as important as Jenner, Koch, Pasteur and Lister in the history of medicine.

Florey was born on September 24^th 1898, in Adelaide, Australia. He died on February 21^st, 1968, at Oxford in England. He trained as a pathologist who, with Ernst Chain isolated and purified penicillin (discovered in 1928 by Sir Alexander Fleming) for general clinical use. This mass production of penicillin proved to e vital to soldiers during World War Two where diseases that had previously been difficult to cure in a combat situation could now be treated far more effectively. For this research and achievement, Florey, Chain, and Fleming shared the Nobel Prize for Physiology or Medicine in 1945.

Florey studied medicine at Adelaide and Oxford universities until 1924. After holding teaching and research posts at Cambridge and Sheffield universities, he was professor of pathology at Oxford between 1935 and 1962. He was appointed provost of Queen's College, Oxford in 1962, and chancellor of the Australian National University, Canberra (1965), positions he held until his death. He was knighted in 1944 and made life peer in 1965.

Florey investigated tissue inflammation and secretion of mucous membranes. He succeeded in purifying lysozyme, a bacteria-destroying enzyme found in tears and saliva, and characterized the substances acted upon by the enzyme. In 1939 he surveyed other naturally occurring anti-bacterial substances, concentrating on penicillin. With Chain, he demonstrated its curative properties in human studies and developed methods for its mass production. Following World War II and the work of his research team in North Africa, penicillin came into widespread clinical use

Christian Barnard’s place in medial history is based on the fact that Barnard performed the first open heart transplant in history. In 2002 such operations are common but in the late 1960’s operations on the heart were rarely performed because of the risk of death and heart transplants were unheard of. Christian Barnard was a pioneer of organ transplants and he must be placed alongside the likes of Pasteur, Lister, Koch, Fleming, Florey and Jenner in any list of medical giants.

Christian Barnard was born in South Africa in 1922. He worked as a surgeon at the Groote Schuur hospital in Cape Town. After further training in America, he became a leading heart surgeon.

Barnard studied heart surgery at the University of Minnesota in the US and returned to South Africa to set up a cardiac unit in Cape Town. In December 1967 he transplanted the heart of a road accident victim into a 59 year old man, Louis Washkansky. This was the first operation of its kind and made Barnard a household name worldwide - fame that took him by surprise. Asked to describe his feelings after the Washkansky transplant, Barnard said:

 Unfortunately, Washkansky died 18 days later from pneumonia. The drugs used to prevent the body rejecting the new heart adversely weakened his resistance to infection.

One of Barnard's patients lived for over a year and a half after surgery, but patients needed drugs to prevent the body rejecting the donor heart. These left them open to infection and many died, just like Louis Washkansky. After a while, all heart operations stopped because the risk of failure was considered too high.

In 1974 a researcher working in Norway discovered a new drug called cyclosporin. This drug helped to overcome the body's rejection of the donor organs and protected the patient against infection. Subsequent heart transplants were more successful and since the late 1980s, the majority of patients have survived for more than two years after surgery.

Barnard had demonstrated that heart transplants were possible. Even though many of his patients died soon after their operation, he had taken the first steps into a new form of surgery which is now routine in medical practice. In 1974, Christian Barnard carried out the first double heart transplant. He ended his career in surgery because of the impact of arthritis. 

Barnard died in 2001, ironically of disease to his heart.

What is your biggest achievement in life? "It's difficult to say. I you ask me what I would like to be remembered for, I would not say the transplants but the surgery. I have performed on children with abnormal hearts. It is much more difficult that transplantation and much more satisfying. With the surgical facilities we give a child a chance to lead a normal life."

1840's amputation set by Wiegand and Snowden of Philadelphia, Pa.  Note the shape of the blade of the large amputation knives which have a curved downward shape.  This shape is typical of the blades on early American surgical instruments after the Revolutionary War and before the Civil War.  Click here for more information on blade anatomy and dating instruments

 

before anesthesia time

The Demonstration of anesthesia Massachusetts 1846

Laughing Gas N20 at a party

Mastectomy 1655 illustrates that the horror had not changed in 150 years

The real pioneer in the use of obstetric forceps was William Smellie. (1697-1763) Smellie practised family medicine in Lanark, Scotland for a number of years. He carried in his pocket, wherever he went his three tried remedies, spirits of hartshorn, tincture of castor, and liquid laudanum. An account rendered to one of his patients still exists:

Seven pounds sterling for amputation and cure of your leg.

As a young doctor he was particularly interested in obstetrics, and distressed by the sadness of the results. He started to use such forceps as were then available, with little success. He set off in 1739, to study in London, and briefly Paris. Finally he returned to London, and set up in a very mean apothecary's shop, on or just off Pall Mall, with a paper lantern at the door --Midwifery taught for five shillings.

CAESAREAN SECTION

The other treatment for obstructed labour is Caesarean section. The oldest reference to Caesarean section on the dead mother was in the Roman Law of Numa Pompilius. (715-673 BC). There is no doubt that this was sometimes successful, but there is no good documentation of section with survival of both mother and child.

The practice was revived at the Renaissance, and good stories abound. One tells how in 1500 Jacob Nufer, a Swiss sow gelder called in all thirteen of the local midwives unsuccessfully. Then he called in the two local lithotomists, in vain. So he did the obvious and did the job himself. Mother and child survived, she to bear him several more children.

Over the next two centuries a few more sections were probably carried out with survival of mother and child. The most clearly documented acount is that by Scipione Mercurio (1540- 1615) given in his text first published in 1596. He gives a detailed and illustrated account of how to make the incision, with four strong assistants to hold the patient down. Afterwards he applied a decoction of artemisia, agrimony, betony, mallow, flowers of pomegranate, dried roses, birthwort, sedge and sweet smelling bulrushes in sour black wine. The survival statistics were not clear.

There is a gap in the historical record; then in 1793 in Manchester England, Jane Foster, whose pelvis was deformed after being crushed accidentally, survived a Caesarean section by Dr James Barlow; the baby was dead. There followed a period during which several mothers and babies were lost, and in which the opponents of section offered symphysiotomy and the use of the crotchet to destroy the foetus. Section won out, as the better of two bad options.

At this time the famous French obstetrician Baudeloque published a book reviewing the 31 successful Caesarean sections done in the previous fifty years. A copy of the English translation of this book passed to a backwoods Virginia doctor, who recorded the fact that he performed caesarean section on his own wife by annotation in the margin of his own copy "14 Jany 1794 JB on EB up 9 Feby walked 15 Feby Cured on 1 March." The mother survived for 25 years, and the baby for 77. The operation was done under laudanum, on two planks set across two barrels. Dr Jesse Bennett removed both ovaries remarking as he did so that he would not be subjected to such an ordeal again. But Caesarian section was rarely attempted and rarely successful before Listerian antisepsis. Thus in 1849 Dr Radford of Manchester reported that he had lost 3 mothers and babies out of 5 attempts, even with anaesthesia; in 1900 Dr Sinclair at the same centre reported 10 out of 10 successes.

Prehistoric and Primitive Medicine

Archaeologists and anthropologists who study prehistoric man and primitive tribes tell us human societies have always had special individuals, both men and women, who took the job of healer and were responsible for preventing illness and curing the sick and injured.  These shaman almost always held multiple roles as healers, magicians, rulers, or priests.  

Primitive medicine men learned how to splint, but probably not set, bone fractures.  They also frequently performed a type of brain surgery that we today call trephination.  Trephination was done by using stone instruments to bore or grind holes in the skull.  Researchers do not know if the procedure was done to relieve demon spirits, treat skull fractures, or remove bone splinters.  It is possible that trephination was done at different times for all of these reasons. 

In addition to magic, spells, prayers, and charms, shaman and healers often used signature, or symbolic, items to treat their patients.  These signature treatments included things like drinking the blood of a warrior to increase strength or eating leaves shaped like body organs to cure a disease.  Sometimes, through chance, these signatures worked.  When they did, the medicine men, or shamans, would pass the information to the next generation of priests.  Digitalis, morphine, quinine, and ephedrine are all modern medicines that have been passed down to us from prehistoric signature practice.   

---

Imhotep -- Father of Egyptian Medicine

Most educated estimates of when medicine first appeared lead us to Ancient Egypt. Around 2725 B.C., a man by the name of Imhotep was practicing medicine, building pyramids, and indulging in astrology. Imhotep existed as a mythological figure in the minds of most scholars until the end of the nineteenth century, when he was established as a real historical personage.

"This statue is a depiction of Imhotep as an idol of the people of Ancient Egypt. Statues such as this fueled the debate over whether Imhotep was a true to life figure or a mythical manifestation." (To see more objects of Imhotep and other Egyptian physicians, click on the statue.)

 

The Egyptian civilization is one of the oldest in history. The history of Ancient Egypt is divided into thirty dynasties, the last dynasty ending with the invasion of Egypt by Alexander the Great in 332 BC. This classification was proposed by Manethon in 280 BC. The Graeco-Roman Period (332 BC-641 AD) ended with Egypt becoming a province of the Empire of the Caliphs. Table I summarizes the different periods of Ancient Egypt, it is of note that different authors may give different dates. The Egyptian civilization was renowned for its scientific and artistic achievements. The great monuments it left behind are its living evidence. Medicine was no exception and mummification stands out as one of the most famous achievements in that field.

 

Doctors in Ancient Egypt

Homer (c.700 BC) describes the Egyptian doctors in the Odyssey thus: 'For the fertile soil of Egypt is most rich in herbs, many of which are wholesome in solution, though many are poisonous. In medical knowledge the Egyptian leaves the rest of the world behind. He is a true son of Paeon the Healer'.

The Greeks used to go to Egypt to study medicine and there is enough evidence to show that Hippocrates (460-375 BC) and the Hippocratic School were much influenced by the Ancient Egyptian writings when they wrote their treatises. The god Thoth was called the first physician and the first surgeon. A doctor in Ancient Egypt was named Sinw, which in Coptic is written (CENI). The prefix (Met) is added to form the noun, thus (Metceni). It is worth mentioning that the word medicine derives its origin from Sinw. The symbol for doctor comprised of a scalpel (or lancet), a container for medicines and a seated man. It is thus appropriate to say that physicians should rest assured that the word 'medicine' does not mean them exclusively, but it encompasses the surgeons as well! A lady doctor is Sinw.t (t is the feminine sign). The first lady doctor in history is Peseshet, of the 6th Dynasty. There were physicians for the public; and physicians for the Royal Court, Sinw pr-c, who may be for the King and/or Queen, as well as the royal household and employees of the palace. Some of the Sinw pr-c also had the title of 'Physicians delegated to foreign lands'. They would be sent by the pharaoh of Egypt at the request of the ruler of another country, who used to ask pharaoh to send a trusted physician from Egypt, the land of medicine at the time, for treating their illnesses.

 

There were also spiritual doctors, Sa.u, who were mostly priests (a kind of psychiatrist). The highest rank among the hierarchy of doctors was Chief of Physicians of the North, of the South, of the North and South or of the South and North (of the country as a whole): wr sinw mhw-sm, and Master Physicians, hry-sinw. The highest rank among physicians was responsible to the Vizier, a politician who was next to the Monarch. Table II illustrates the medical hierarchy in Ancient Egypt and its present day equivalent.

 

There were different grades of doctors in Ancient Egypt, thus there was the ordinary Sinw who was a physician, Wrsinw who was a Chief Physician, the Sahsinw who was a Medical Inspector, Imj-ra-sinw who was a Director of Medicine (Overseer) and Hrp-sinw who was the Commander (Controller, Master) of Medicine. Ghaliounguie numerated one hundred and fifty five physicians in Ancient Egypt, but it is possible that only one hundred and twenty of these had the title of Sinw, 'medical man'.

collection and images of John Wickham's nineteenth-century mansion

 

 

 

 

Physicians were assisted by aides, nurses, masseurs and bandagists. Some would have their own textbooks as the 'Book of the Bandagists'. Among the doctors in Ancient Egypt were specialists and it is worth recounting the words of Herodotus (Euterpe II, 84) 'The art of medicine thus divided amongst them: each physician applies himself to only one disease, and not more. All places abound in physicians; some physicians are for the eyes, others for the head, others for the teeth and others for the parts about the belly and others for internal disorders' .It is quite clear that Herodotus took this point of specialization too far as there were also general practitioners; perhaps he did not emphasize this as it was too obvious! One of the most famous specialities was ophthalmology and an occulist was known as sinw ir.tj as blindness was not uncommon in Ancient Egypt being caused by trachoma that was prevalent then, as nowadays. Seven occulists have been identified in Ancient Egypt. There were also internists, gynaecologists, but there were also some vague specialities such as 'guardian of the anus' considered as "protologists". There were also doctors for the cemeteries. In the Middle Kingdom appeared a physician assigned to the troops. In the New Kingdom appeared a title of 'Chief Physician of the Palace of Life' that seems to be mostly an administrative position- a kind of Minster of Health. There were also dentists and makers of false teeth. There were physicians on the boats sailed by Ancient Egyptians on the high seas. Groups of labourers, e.g., miners had their own doctors.

 

There are some authorities who believe that priests of Sekhmet (an Ancient Egyptian goddess) were surgeons, but Grapow threw doubt on this idea. There were no ENT surgeons as such, but there were 'Head Doctors', supposedly including those who dealt with the nose and throat and ears. Ni-Ankh-Sekhmet is supposed to have been the first rhinologist in history. Table III illustrates the different types of doctors in Ancient Egypt.

In Ancient Egypt there was no money economy; barter and services were an alternative. Diodorus Siculus (1,82,3) mentioned that in Egypt many people had free medical care. Temple physicians also served the general public. Many physicians were paid by the state or private persons but private medicine flourished after some time. Some physicians attained great wealth and this can be evidenced from ancient writings and also by the splendour of their bombs. To physicians was ascribed the duties of veterinaries; supervising cattle and possibly healing them. The Kahun Papyrus deals in part with veterinary medicine. Pharmacists were a separate profession.

 

Papyri

Our knowledge of the nature of medicine in Ancient Egypt is contrived mostly from the medical papyri, which outlived the mighty hand of time to reach us nowadays. Most of these papyri are fragmented, but they do give a reasonable idea of how medicine was at that time. These papyri have the name of those who discovered them or the places they were or their later site of location. The most famous are the Ebers Papyrus, the Edwin Smith Papyrus, the Kahun Papyrus and the Hearst Papyrus (see Table IV). The Berlin Papyrus (c.1300 BC, 19th Dynasty) contains a few paragraphs on diseases of the ear.

 

The Edwin Smith Papyrus (c.1600 BC) resembles the Hippocratic treatises suggesting a long foreground to Greek medicine. At its outset it deals with the heart and arteries and possibly the counting of the pulse is mentioned. Though there was no apparatus to accurately measure time, it is possible that the physician counted the pulse of the patient against his own, thus recognizing whether the pulse is normal, slow or rapid.

 

There are forty-eight clinical cases of surgical importance mentioned in topographical order of the organs affected starting with the head first:

 

Skull, overlying soft tissue, brain  Cases 1-10

Nose  Cases 11-14

Maxillary Region  Cases 15-17

Temporal Region  Cases 18-22

Ears, mandible, lips and chin  Cases 23-27

Throat, neck, cervical vertebrae  Cases 28-33

 

The script includes sound anatomical, physiological, diagnostic and prognostic information. Some of the treatments prescribed still hold true till our present day such as reduction of a dislocated jaw and reduction of fractures of the clavicle.

 

The following therapeutic accessories are mentioned in the papyrus:

 

Dressings for wounds:

Lint (ftt) is of vegetable origin: it can be used dry to absorb secretions (on throat, Edwin Smith, case 28) or impregnated with medicaments for local application (in ear, Ebers, Case 91, 767).

Linen: made of flax, is used in different forms (Ebers, Case 91, 767).

Sutures (Edwin Smith, Case 10); the first description in the history of suturing (Sullivan, 1996).

Splints: 3 types (possibly 4) are described:

Brace of wood padded with linen (Edwin Smith, Case 7) is inserted into the mouth to help feeding the patient.

Splint made of linen (Edwin Smith, Case 35, fractured clavicle).

Stiff post-like roll of linen (Edwin Smith, Cases 11 and 12, fractured nose).

It is possible that cartonnage was used, similar to our plaster of Paris to splint fractures, also made of linen.

Cautery: either by means of the fire-drill or with a heated scalpel.

Breasted attributes the Edwin Smith Papyrus to Imhotep, the Vizier, physician, architect and High Priest of Heliopolis, who built the first pyramid (Step Pyramid) for King Zoser (3rd Dynasty, c.2800 BC). Imhotep was also known as a sage, scribe and astronomer. He was later ranked as full god and accepted as the deity of medicine. He was identified with Aesculapius. It is also believed that the Berlin Medical Papyrus and much of the Ebers Papyrus, as well as the Edwin Smith papyrus, are copies of an original written by an early physician, perhaps Imhotep.

 

The Ebers Papyrus (c.1500 BC), the longest and only complete one of all the papyri, deals with 250 clinical pictures in 887 paragraphs which include leprosy, anasarca, heart disease (causing oedema or faintness) with sections on the nose, ears, tongue, gums and teeth. It is of interest that the sections on the nose and ear follow each other (Cases 90-92, 761-770).

 

The circulation of the blood was mentioned in this papyrus well before the time of William Harvey (1578-1657) and percussion was also mentioned as a method of diagnosis more than 30 centuries before Auenbrugger (1722-1809). It is considered to be the only surviving book of the so-called Hermetic Books. Clement of Alexandria (AD 200) recorded that the Egyptian Priests possessed forty-two books that contained the sum of human knowledge. These books were called by the Greeks the 'Hermetic Books', because their authorship was ascribed to the god Hermes, being the Greek name for the God Thoth, the Ancient Egyptian god of the Healing Art. It is thought that either Athotis (c. 3200 BC) or Imhotep could have written these books.

 

Other Sources

Beside the medical papyri, our knowledge about the state of medicine in Ancient Egypt is derived from:

 

Other papyri, writings, chronicles, documents, referring to medical conditions and the practice of medicine. Such references prove the existence of medical writings since the first and second dynasties.

Tomb paintings and writings.

Statues, especially those depicting pathological conditions.

Instruments, appliances, etc.

Human remains:

Mummies.

Skeletal remains.

 

The word mummy is derived from Latin 'mummia' which refers to bitumen, a material dark in colour. 'Mummia' itself may be derived from the Arabic word for mummy: Mümiya. It is of note that both Jacob and Joseph were mummified (Genesis 50, 2-3, 26). Mummification in Ancient Egypt passed through different stages:

 

Pre-dynastic (before 3200 BC) - mummification was by desiccation (Riad, 1965).

Early dynastic period - there were early attempts to preserve viscera.

Middle Kingdom (2100-1700 BC) - Visceral removal was more common.

New Kingdom (1555-712 BC) - mummification was more elaborate (Iskander, 1980; Pirsig and Parsche, 1991). However, in some mummies so much force had been used that the skeleton was destroyed.

Graeco-Roman period (332 BC - 641 AD) - The art of mummification was in decline. The Birmingham Mummy is an example of that period.

It is unlikely that mummification was practiced after the 4th century AD. Both Herodotus (fifth century BC) and Diodorus Siculus (first century BC) wrote about mummification when they visited Ancient Egypt. They described three different types of mummification, which were practiced at the time they visited Egypt, depending on the expenses incurred.

 

Most discovered mummies were frequently unwrapped, sometimes this was carried out as a public performance. Pettigrew, in the first half of the 19th century, gave courses (of six lectures) that concluded with the unwrapping of a mummy. Such practices continued till recently.

 

Mummies were used for different "purposes", including being shoveled into the fireboxes of locomotives. Nowadays, with modern techniques, it should be possible to study mummies with non-invasive methods (Macleod et al, 2000), that would allow the survival of the "few" remaining mummies for future generations. Even badly preserved mummies can be treated to be more "preservable".

 

Bedside Diagnosis

Kindness and care were the maxims adopted by the ancient physicians when approaching their patient. We read in Ebers (Case 40, 200): 'Go to him (i.e., the patient) and do not abandon him'. In Edwin Smith (Case 7) that of the patient suffering from tetanus it ends 'Undertake him, do not desert him, in view of the exhaustion'.

 

The consultation involved taking detailed history, asking the patient and observing his reaction: 'If thou ask of him concerning his malady and he speak not to thee…'. The general appearance of the patient and his nutritional state are noted: '(a patient) whose body shrinks' (Ebers, Case 39, 197) or 'he turned deathly pale' (Ebers, Case 39, 198). Also the physician noticed special signs as facial palsy (Edwin Smith, Case 7), squint (Edwin Smith, Case 8), nystagmus (Ebers, Case 99,855) and ptosis (Ebers, Case 62, 408).

 

The physician uses his nose as well e.g., a wound on the skull smells like 'the urine of sheep' (Edwin Smith, Case 7) breath of patient compared to 'a latrine' (Ebers, Case 37, 190).

 

Feeling of the pulse was emphasized. Palpation of masses was meticulous and recorded in detail e.g. fluctuation (Ebers, Case 107, 867), sebaceous cyst with punctum (Ebers, Case 107, 869 and 870). A case of aneurysm is described thus (Ebers, Case 108, 872): '... a swelling of vessels… and thou findest that it is hemispherical (?) and grows under thy fingers on every going (i.e., pulsation of the heart), but if it is separated from its body, it cannot on account of that become big and not give out (i.e. diminish), then thou shalt say concerning it: it is a swelling of a vessel.... It is vessels that case it, and it arises through injury to a vessel'.

 

Cirsoidaneurysm or A-V fistula is described (Ebers, Case 108,873). '...if thou examinest a swelling of vessels on the leather layers of any limbs and its appearance is growing on account of serpentininig of the serpentry and they have formed many knots ... it is swelling of vessels.... that jumps (i.e. pulsates) in the midst of these limbs' (Ebell, Case 198, 1937).

 

The temperature of a part was noted (Ebers, Case 46,189), crepitations in fractures felt (Edwin Smith, Cases 17, 24 and 44), pulsation of brain perceived (Edwin Smith, Case 6). The physician also observes the reaction of the patient on palpating the offending site (Edwin Smith, Case 20): 'if thou examinest a man having a wound in his temple, penetrating to the bone (and) perforating his temporal bone... if thou pullest thy fingers on the mouth of that would (and) he shudder exceedingly'. Percussion was resorted to (Ebers, Case 36, 189 and 106, 864).

 

The physician also carries out some clinical tests as asking the patient to look to both shoulders and to the chest to test neck movement (Edwin Smith, Case 30), inability to close the mouth was noted (Edwin Smith, Case 25). The physician would resort to 'laboratory tests for fertility, pregnancy, and to know the sex of an unborn child' (Riad, 1965).

 

Causation of 'disease'

Egyptians assumed that man was born healthy, and that every disease has a cause. These causes can be visible or occult, internal or exernal:

 

Exogenous causes: overeating, drunkenness, air, worms and insects.

Endogenous causes: whdw originates from a putrid process in the intestines and can circulate in the body; thus the practice of using purgatives. However, the appearance of whdw is related to external factors as food and aaa, which some authorities suggest as bilharziasis. Other such materials as the whdw were st.t: mucous, n.wt: bile.

 

In their physiology, they believed in the presence of 'conduits' that carry blood and humour, blockage of these conduits leads to flooding and droughts in the body with resulting illnesses. Agents causing disease can enter through natural openings in the body, and can similarly, leave the body. They also believed in occult causes, spirits and demons. Psychological factors were recognized as cause of 'dis-ease'.

Wounds

The edges of a clean cut wound were brought together either with adhesive tape (Edwin Smith, Case 10 - eyebrow, and Case 27 - chin) or stitching (Edwin Smith, Case 23 - ear, and Case 26 -upper lip). This is the first time in history a mention of 'stitching' a wound was described. However, Ebell translated the text as 'stapling', still the first ever to be mentioned. Other wounds were not sutured, but kept open. Fresh meat was applied on the first day as an efficient haemostatic and mechanical agent, as we use muscle grafts nowadays! In the following days, the ancient surgeon used astringents, herbs and honey, the latter being hygroscopic. They also applied sour or mouldy bread to wounds (Ebers, Case 70, 522), the antibiotic of their time. Further, they applied a special mud that has been shown to contain tetracyclines. They recognized granulation tissue and that at times was encouraged and others discouraged (Case 71; Ebell, 1937).

 

Human bites were dealt with (Ebers, Case 64, 432-435) as their potential dangers were recognized then as now. Though no specific anatomical area is mentioned in the section on human bites, yet, it is very likely that some were seen by the 'Head Doctors'. The author has seen three cases of human bites in his 'modern' clinical practice: two to the ears (auricles) and one to the nose (tip).

 

Materia Medica

Caution should be experienced when analyzing the Ancient Egyptian pharmacopoeae as a large number of the drugs used then cannot today be identified for certain. The names of those translated should not be taken literally e.g. it is possible that fly's blood (Ebers, Case 104, 857 and 858) or fly's dirt (Ebers, Case 92, 782) refer to plants, i.e. are nicknames for vegetable drugs.

 

Drugs included mineral, vegetable and animal products. Some of these drugs had active ingredients and thus are all useful, e.g. liver for night blindness (Ebers, Case 57, 351). Honey was used extensively on wounds and as part of other remedies. Honey as a wound dressing can be beneficial as it inhibits growth of micro-organisms and is hygroscopic thus attracting an abundant secretion of leucocytes and antibodies. Onion juice is known to have bactericidal effect. Egyptian onion is known to have plenty of juice (onion on wounds in Ebers, Case 70, 519). Onion juice was used in the ear after being warmed. Also garlic juice was used locally in cases of discharging ears.

 

Medicines were used generally or locally. Local application depended on the site or organ treated and condition dealt with. Thus, in ear disease powders or liquids were used, also remedies impregnated in lint or linen. Gargles were given in conditions affecting the mouth.

 

Directions for the production and administration of prescriptions were documented. Measurements were mentioned always in capacity even for dried material, the ordinary measure of capacity was 4.785 litres, the standard measurement was 1/320, about 15cc i.e. a tablespoon.

 

Incantations and spells were of common usage, but obviously it was meant, at least in part, to deal with the psychology of the patient, especially if the case was hopeless or unlikely to respond to known remedies. An example of a foetid nose (ozaena) was given when first date-wine is recommended, but this is followed by an incantation; the ancient way of our present day reassurance! Inhalations were known as in prescription 46, Berlin Papyrus.

 

It is worth mentioning that the word 'chemistry' is derived from (KEMI), the name by which the Ancient Egyptians called their country. It is also thought that the word 'pharmacy' is derived either from 'pharmaki', an Ancient Egyptian word meaning 'that procures security', or alternatively is a compound of Coptic 'phahri' (medicament) and Ancient Egyptian 'haki' (magic).

 

Linen

Flax used to be cultivated in Egypt from the very early times as fabrics were found in Neolithic, Bardarian, Pre-dynastic and 1st Dynasty periods, and there is still flax cultivation in Egypt till now. Egyptian linen was highly prized in the Old World (Proverbs 7, 16). The linen produced varied in texture from the finest silk-like gauze to a canvas-like coarseness, this is evident in the specimens seen in different museums of the world that house any sizeable Egyptian collection. In the British Museum in London is a complaint of one embalmer against suppliers who supplied him with a different type of linen to that which he had agreed upon. It is also known that there were different taxes for the different types.

 

Those who have seen a mummy must have found a good example of the Egyptian embalmers mastery in the art of applying and arranging bandages. The same skill was still available for the benefit of patients who were wounded. Bandages were used to cover and keep in place the medicaments described or as a mechanical support for healing broken bones. One type of bandage was made by the embalmers for the use of the surgeons (Edwin Smith, Case 9). Others were made by the surgeon himself (Edwin Smith, Case 7).

 

Linen was also used in small pieces as swabs to clean (Edwin Smith, Cases, 11, 12 and 22) and at times impregnated with medicaments and used locally. Some splints were made of linen. Adhesive plaster was also made of linen (Edwin Smith, Case 10); these were used in pairs and made to bring the edges of a wound together. Linen was also used to make nets to hold injured ears in place, also strips made of linen were used if an injured ear proceeded to necrosis (Case 41, Ebbell, 1937). Linseed was used medicinally either applied externally on abscesses and local inflammatory conditions or internally as linseed tea for cough.

 

Surgical Instruments

The following are some of the surgical instruments identified in texts and exhibits:

 

Knives: Different types of knives were used for different purposes, some were straight, some had curves or points. Khept - used in cases of otorrhoea (Ebers, Case 91, 767) Shas and Das - for myiasis (Ebers, Case 108, 875). A reed was used at times to make an incision (Ebers, Case 108, 876).

Forceps were straight or curved, some with toothed ends, some with a sliding ring to secure a firm grip.

Cautery was used to treat aneurysms (Ebers, Case 108, 872). A heat drill was used to make holes in abscesses of the mandible.

Thorn to pierce blisters (Ebers, Case 69, 504).

Swabs on sticks were used; linen was wound round ends of reeds (Fig.1), possibly to clean clots.

A graphic representation of instruments (Fig.2) is seen on a wall engraving in Kom Ombo Temple, built by Ptolemy V (2nd Century BC). A collection of scalpels (Fig. 3) and forceps (Fig. 4) are present in the Egyptian Museum, Cairo.

Anaesthesia

Sedative drugs like opium and hyoscyamus were known. Dioscorides (V, 158) and Pliny (xxxvi, ch.2) relate that the round stone of Memphis (marble) was applied with vinegar to the skin area as an anaesthetic. It is thought that the carbonic acid formed anaesthetized the skin. In Ebers Case 782, opium is used to remedy 'much crying'.

[see pic below]

Legal Aspects

There was a strict legal system in Ancient Egypt as evidenced by the presence of legislative laws and of the different levels of courts. The most famous legislative law in Ancient Egypt we know of in its complete origin is that of Hor-m-heb (Pahor Labib and Sophy Abu-Taleb, 1972). However, in that law there is nothing related to doctors or the practice of medicine. There were other legislative laws in Ancient Egypt, but of these only fragments are referred to in some inscriptions like that of the minister of justice, Rekhmire, during the reign of Thutmose III, 18th Dynasty. The only known laws related to medicine are those concerning the stealing of the mummies where there were many law suits against robbers during the Ramesside period (1330 to 1085 BC).

 

Diodorus Siculus described how the physicians were judged: 'If whilst following the rules laid down in the sacred book, they do not succeed in saving their patients, they are held free from all guilt, if on the other hand, they do anything contrary to those rules, they undergo capital punishment' (Oppenheimer, 1910). Only one example of such punishment is known.

 

Imhotep

From the foregoing, it is certain that the medical knowledge of the Ancient Egyptians is worthy, of Ebbell's remark 'Since, then, Egypt and not Greece must be considered the original home of the medical art, we ought not to set up the Greek Aesculapius as the patron genius of medicine, but rather the physician whom the Egyptians gave this dignity, viz Imhotep.'

 

 

OTORHINOLARYNGOLOGY

 

THE EARS

I. Anatomy

 

The Tympanic Membrane: It is generally believed that Hippocrates was the first to mention the tympanic membrane. However, we find the mention of the tympanic membrane in the Ancient Egyptian medical writings. "The ear that contain inside the tympanic membrane would be deaf from the eye vessels," though Ebbell's translation reads differently.

The Auricle: In a relief from Sakkara the ear shows the incisura that nowadays is an important anatomical landmark when operating on ears through an endaural incision.

The Eustachian Tube: It is generally believed that Aristotle was the first to mention the eustachian tube, and this was in goats, but in Ebers Papyrus (Case 100) we read: "There are four vessels to his two ears together with the ear canal, namely two on his right side and two on his left side. The breath of life enters into the right ear, and the breath of death enters into the left ear, another section: it (i.e. the breath of life) enters into the right side, and the breath of death enters into the left side" (Ebbell, 1937).

 

II. Physiology

The relation between hearing and speech was known, thus in Ebers Papyrus (Case 99): "When he is deaf, his mouth cannot be opened (i.e. he cannot speak)" (Ebbell, 1937).

III. Secretory Otitis Media

Flu was known in Ancient Egypt and Ebers Papyrus (Case 763) we read: "Flow out, those who breakest bones, destroyest the skull, diggest in the bone marrow and makest ill the seven holes in the head". Thus, here is describing flu with sinusitis thus affecting the eyes and also affecting the ears as well with the possibility of secretory otitis media. This description of secretory otitis media antedates that of Hippocrates by more than a thousand years.

 

IV. Discharging Ear

This was recorded as a result of acute otitis media (Berlin Papyrus, Cases 201, 202, 203): chronic suppurative otitis media (Ebers Papyrus, Cases 765, 766, 767, 768, 769 and 770) or mastoid disease. In the Berlin Papyrus, a 6 prescriptions for the ear, 4 pharmacological: for "pressure in the ears" (Case 200 - is this possibly Menieres!) and for mucous discharge (Cases 201-203).

 

V. Ear Piercing

This was practiced in Ancient Egypt and in some mummies the holes are large and drawn by the weight of the ring.

 

VI. Injury to the Ear

In the Edwin Smith Papyrus, Cases 22 and 23 were injuries involving the ear. In Case 22 the injury is to the temporal bone and the ear is included, so that in the course of his examination, the surgeon is charged to probe the ear and seemingly to remove splinters of the bone (Breasted, 1930). Case 23 is the only case in Edwin Smith Papyrus that deals exclusively with the ear, although a number of described injuries to the head involved the ear. In this case the surgeon sutures the wound "with stitching behind the hollow of his ear," the skin on that side being more amiable for such procedures! Bandaging with linen is practiced.

 

In the Ebers Papyrus is a description of management of a wound to the ear. In this case a net is used to hold the ear in place and healing by primary intention is encouraged.

 

NOSE

 

Mummification

In the process of mummification, the brain was evacuated from the skull. The embalmers used to remove the brain through the roof of the nose and evacuate it with fine instruments. In later dates, they used to remove a vertebra from the back of the neck and evacuate the brain through the foramen magnum and then replace the vertebrae back.

 

Nasal Catarrh

Ebers (Cases 192 and 762) deals with nasal catarrh possibly with sinusitis. Ozaena was described in Ebers Papyrus (Case 761): "The beginning of remedies against a fetid nose: date-wine, its (i.e., the nose) opening is filled therewith".

 

Hypertrophied Turbinates

Hypertrophied turbinate bones were discovered by Ruffer in a skull of 1000 BC and in two skulls of the Greek period.

 

Foreign Bodies

In a mummy of a priest of Amon of the 21st Dynasty, a large vesical calculus (6.5cms in diameter) was found in the nostril being placed by the embalmer. It consisted of uricacid nucleus surrounded by phosphates (Rowling, 1967). Did the Ancient Egyptians believe that the vesical stones bring luck as Trichobezoars (hair-ball in the stomach)!

 

Injuries

In Edwin Smith Papyrus we find the following cases of injuries to the nose:

 

Case 11: "Break in the column of his nose", meant the bridge, swelling and blood discharge from nostrils. The linen mentioned in the treatment had different names signifying the different types. The type used for cleaning and packing is probably smaller and softer (also used in Case 12 and Case 22 to clean inside the ear). The linen used for splinting is "stiff rolls, root-like in shape (used in Case 12, also in Case 23 for supporting slit in the auricle of the ear and Case 34 to support clavicle). In this case a depressed fracture was present without lateral displacement and was set back and splintered. The idea that this case is just a soft tissue injury as expressed by Breasted in his introduction to Case 12 is born out by the literal translation of Breasted himself.

 

Case 12: "Break in the chamber of his nose", meant fracture of nasal bones, and also findest his nose bent, which his face is disfigured, (and) the swelling which is over it is protruding" (Breasted, 1930).

 

Case 13: In this case is a fracture of the nose with crepitations and with bleeding from the ear on the same side. An ailment not to be treated. This must be a case of fracture base of skull.

 

Case 14: Piercing wound of nostril stitching being used (Breasted, 1930) and fresh meat was used as a dressing.

 

 

THE THROAT

Tracheostomy

Two slabs were discovered dating to the beginning of the 1st Dynasty, one in Abydos concerning King Aha and the other in Sakkara, concerning King Djer. Each slab depicts a seated person directing a pointed instrument to the throat or chest of another person who is kneeling backwards with his arms tied behind his back. Petrie, Emery and Zaki Saaed believed that this denotes human sacrifice whereas Vikentiesf and Hussain believe it to be a tracheostomy being performed. The latter view is more appropriate as the lancet is used as a determinative "to breath" rather than the habitual signs of the nose or the sail. In Aha's slab the sign Ankh is present; the way the scalpel is handled is more appropriately directed to the trachea than the neck vessels as obviously the best way for slaughtering was known even at prehistoric times! The arms placed behind the person to be operated on will be explained on similar grounds to our present-day practice of placing a sandbag between the shoulder blades, thus hyper-extending the neck, when patients are having tracheostomies, beside they did not use general anaesthetic then!

 

Nasopharynx

Wells (1963) describes a skull dating from 3rd to 5thdynasty, with erosion of alveolus of left maxillar and destruction of the same side of the hard palate, pterygoid plates and posterior wall of maxillary sinus. The vault of the skull shows multiple translucent areas. The likely diagnosis is plasmacytoma of upper respiratory tract (nasopharynx) with bony deposits in the scalp indicating a multiple myeloma change. The vault deposits are typical of the multiple myeloma type.

 

Derry in 1909 described a case with destructive lesions involving the cribriform plate, ethmoids and sphenoids. Elliot Smith thinks this case is a malignant process arising in the nasal mucus membrane.

 

Oesophagus

The case described in Ebers (Case 206) can be cancer of the lower oesophagus, though it is generally believed to be cancer of the stomach. The symptom of dysphagia and the signs of dehydration are described.

 

Endocrine Glands

Thyroid Gland

Goitre was known to the Ancient Egyptians and was given a name. Two statues of father and son (Fefi and Tesen) show signs of Grave's disease (Ghaliongui and Dawakhly, 1965). Also a further statue, but for an anonymous person, was excavated from the same tomb, shows signs of Grave's disease, expothalmous, lid retraction and pre-tibial myoedema.

 

Pituitary Gland

Aldred and Sandison (1962) have discussed in detail the case of Pharaoh Akhenaten and concluded from studying the monuments that he presented an acromegaloid facies and an eunuchoid obesity. It is suggested that Akhenaten had a pituitary adenoma that led first to acromegally but later on pressure hypofunction of the pituitary gland developed. Ghalioungui (1963) suggested Akhenaten's breast fullness may have been due to liver disease caused by bilharziasis, a common disease in Egypt then and nowadays. Elliot Smith considered Akhenaten had suffered from Fröhlich's syndrome.

 

 

 

--------------------------------------------------------------------------------

 

TABLES

 

TABLE I: ANCIENT EGYPTIAN HISTORY

 

Pre-dynastic period  Before 3200 BC  Pre-dynastic

Old Kingdom  3200-2270 BC  1st-6th Dynasties

First Intermediate Period  2270-2100 BC  7th-10th Dynasties

Middle Kingdom  2100-1700 BC  11th-12th Dynasties

Second Intermediate Period  1700-1555 BC  13th-17th Dynasties

New Kingdom  1555-712 BC  18th-24th Dynasties

Late Dynastic Period  712-332 BC  25th-30th Dynasties

Graeco-Roman  332 BC-641 AD

 

 

 

 

--------------------------------------------------------------------------------

 

TABLE II: MEDICAL HIERARCHY IN ANCIENT EGYPT

 

Ancient Egyptian Title  Today's Equivalent

Physician  Generalist

Chief Physician  Specialist

Medical Inspector  District Medical Officer

Director of Medicine  Regional Medical Officer

Chief of Physicians  Chief Medical Officer

Chief Physician of the Palace of Life  Minister of Health

Ultimate responsibility to Vizier (Politician)  Prime Minister

 

 

 

 

--------------------------------------------------------------------------------

 

TABLE III: DOCTORS AND THEIR AIDS IN ANCIENT EGYPT

 

GENERAL  SPECIALISTS  AIDS

Physician for the Public  Eye  Nurses

Physician for the Palace  Dentists  Masseurs

Physician to Foreign Lands  Enternist (Belly)  Manicurists

Physician assigned to:

Army, Fleet, Miners, etc.  Gynaecologists  Bandagists

Head doctors  Embalmers  Surgeons

 

 

 

 

--------------------------------------------------------------------------------

 

 

TABLE IV: THE PRINCIPAL MEDICAL PAPYRI

Name  Period  Location  Condition  Contents

Kahun  1900 BC  London  Frag.  Women's diseases

Edwin-Smith  1600 BC  New York  Unfinished  Surgical (48 cases)

Ebers  1550 BC  Leipzig  Complete  Medical (108 cols)

Hearst  1550 BC  Berkeley  Incomplete  Practioner's (18 cols) recipe book

Erman  1550 BC  Berlin  9 cols  Charms for childcare/infants

London  1350 BC  London  Fragmentary  Recipe book (19 cols)

Berlin  1350 BC  Berlin  21 cols  Recipes

Chester-Beatty  1200 BC  London  Incomplete  Oral diseases

Medical and Laboratory items

A) In Iran Bastan Museum (National Museum of Iran), ceramic, glass and metal cupping-glasses manufactured in workshops of Rey, Gorgan and Neishabour, during 9th and 10th centuries A.D., are exhibited.

Those shape is similar to that of a drinking glass, with rounded bottom and smooth rim, tapering into a tubular end.

Horn-like shape of these medical instruments has caused it to be called as such.
Glass cupping-glasses are of the blown type and no adornment is visible upon those.

B) Other glass items on display include specimen preserved in Glassware and Ceramic Museum of Iran (Abguineh):

1- Medicine container of thin glass, height: 13.5 cm., North-west of Iran, 2nd-3rd century A.D., Arsacid period.

2- Medicine container of thin glass, height: 7.6 cm., North of Iran, 2nd-3rd century A.D., Arsacid period.

3- Cupping-glass, iridescent, rim diameter: 3.7 cm., Khorasan, 13-14th century A.D.

4- Cupping-glass, iridescent, rim diameter: 5 cm., Khorasan, 13-14th century A.D.

5- Glass laboratory container, iridescent, length: 19.5 cm., Neishabour, 10-11 century A.D.

6- Glass medicine mortar, diameter: 4.8 cm., Gorgan, 11th century A.D.

7- Glass medicine mortar with square rim, length: 11.7 cm., Gorgan, 10-11th century A.D.

8- Glass laboratory container, iridescent, length: 18.5 cm., Neishabour, 13th century A.D.

C) Also among lacquered preserved in Reza Abbasi Museum, A barber's toolbox from 19th century, signed "Sadeqolvadeh" and decorated with flower and bird motives, could be admired. Inside it, complete panoply of a barber could be seen.

History and development of every nation's literature, knowledge and art are truthfully and realistically reflected within the pages of its handwritten books.

Brief survey shows, that more than 1480 identified medical manuscripts, ranging from 11th to 19th century A.D., are currently preserved in various museums and cultural or scientific institutions in Iran and all over the world. These include some 500 title of books, translations and independent works, written by various physicians and reminder comprises duplicate copies.

Surveying titles and contents of these books, one realizes that Iranian Physicians have left us works in every medical field and dealt with all things related with man's interior and exterior, generally or specifically covering infectious and venereal diseases, gynecology and child-birth, embryology and pregnancy, infantile illnesses and child growth, senility and gerontology, ophthalmologic disorders, nervous and mental malfunctions, reproduction maladies, hygiene and health preservation, particular ailments, dermatology and hair care, digestion troubles, otorhinolaryngologic ailments, hair loss, pharmacology, surgery, dissection, veterinary science, ...

Besides writing specialized books, many physicians have also published bi-lingual lexicons and scores of literary medical works, entitled "Teb Manzoum" (Versified Medicine).

Most of these manuscripts deal with general hygiene and preventive care, ophthalmology, infectious and epidemic diseases, gynecology, anatomy and physiology, internal diseases, surgery, pharmacology and drug making, botany and zoology.

It seems Iranian doctors were also very keen upon hygiene and preventive care and considered it more important than treatment following sickness.

In terms of the number of extant copies, appears following books were of particular importance, as well as the most read:
1- Zakhireh Kharazmshahi : 88 copies  
2- Ekhtiarat Badii, by Haj Zeinoddin Attar (1329-1404 A.D.), 64 copies
3- Hakim Momen's Tohfeh, 59 copies
4- Tashrihol Abdan Mansouri, 37 copies
5- Mozafar Shafai Qarabadin, 26 copies
6- Ajaebol Makhluqat, 21 copies

More information on some medical manuscript, which are in Iran Museums:

1- Zakhireh Kharazmshahi
2-Kamalol Tabir
3- Ajaebol Makhluqat
4- Ajaebol Makhluqat
5- Ajaebol Makhluqat
6- Hashayesh
7- Hakim Momen's Tohfeh
8- Tashrihol Abdan Mansouri
9- Tafzil Madreseh Darolfonoun

Joseph Lister is alongside the likes Louis Pasteur, Robert Koch, Alexander Fleming and Edward Jenner in the work he did to further medical knowledge. Joseph Lister did not discover a new drug but he did make the like between lack of cleanliness in hospitals and deaths after operations. For this reason, he is known as the ‘Father of Antiseptic Surgery’.

Lister was born in 1827 and died in 1912. As Professor of Surgery at Glasgow University, he was very aware that many people survived the trauma of an operation but died afterwards of what was known as ‘ward fever’.

Work on ward cleanliness and the link between germs and good post-operative health had already been studied by a Hungarian doctor called Ignaz Semmelweiss. He argued that if a doctor went from one patient to another after doing surgery, that doctor would pass on to the next visited patient a potentially life threatening disease. He insisted that those doctors who worked for him wash their hands in calcium chloride after an operation and before visiting a new patient.

Deaths on the wards Semmelweiss was in charge of fell from 12% to just 1%. But despite this, he came up against the conservatism of those who dominated Hungarian medicine and his findings were ignored. Semmelweiss died in 1865 of blood poisoning.

In 1865, Lister read about the work done by Louis Pasteur on how wine was soured. Lister believed that it was microbes carried in the air that caused diseases to be spread in wards. People who had been operated on were especially vulnerable as their bodies were weak and their skin had been cut open so that germs could get into the body with more ease.

Lister decided that the wound itself had to be thoroughly cleaned. He then covered the wound with a piece of lint covered in carbolic acid. He used this treatment on patients who had a compound fracture. This is where the broken bone had penetrated the skin thus leaving a wound that was open to germs. Death by gangrene was common after such an accident. Lister covered the wound made with lint soaked in carbolic acid. His success rate for survival was very high.

Lister then developed his idea further by devising a machine that pumped out a fine mist of carbolic acid into the air around an operation. The number of patients operated on by Lister who died fell dramatically.

Louis Pasteur was born in 1822 in Dole, France. Louis Pasteur’s name is forever cemented in the history of medicine. He, along with Alexander Fleming, Edward Jenner, Robert Koch and Joseph Lister, is of great importance when studying medical history. Pasteur’s discovery – that of germs – may seem reasonably tame by the standards of 2002, but his discovery was to transform medicine and see his name forever immortalised on a day-to-day basis in pasteurised milk – named in his honour.

Pasteur is important for three reasons:

• Pasteur showed that airborne microbes were the cause of disease.
• Pasteur built on the work of Edward Jenner and helped to develop more vaccines
• Pasteur’s career showed how conservative the medical establishment was at the time.

As a young man, Pasteur studied at the Ecôle Normale in Paris. In 1843, he became a research chemist. He developed such a reputation, that in 1854, aged just 32, he became Dean of the Faculty of Science at the University of Lille. At this time, Lille was the centre of alcohol manufacture in France. IN 1856, Pasteur received a visit from a man called Bigo who worked at a factory that made alcohol from sugar beet. Bigo’s problem was that many of his vats of fermented beer were turning sour and, as a result, the beer had gone off and had to be thrown away. From a business point of view, this was a disaster. Bigo asked Pasteur to find out why this was happening.

After using a microscope to analyse samples from the vats, Pasteur found thousands of tiny micro-organisms. He became convinced that they were responsible for the beer going sour. Pasteur believed that they caused the putrefaction of the beer – not that they were the result of the putrefaction.

Pasteur continued his work on this theme by studying other liquids such as milk, wine and vinegar. In 1857, he was appointed Director of Scientific Studies at the Ecôle Normale in Paris. Between 1857 and 1859, Pasteur became convinced that the liquids he had studied were being contaminated with microbes that floated in the air. The medical establishment ridiculed him:

"I am afraid that the experiments you quote, M. Pasteur, will turn against you. The world into which you wish to take us is really too fantastic." (La Presse, 1860)

Pasteur was vilified in public but rather than give up, he determined to fight for what he believed in. Pasteur started to devise tests to prove that he was right. He was able to prove that:

• Air contained living organisms
• That these microbes can produce putrefaction
• That these microbes could be killed by the heating of the liquid they were in
• That these microbes were not uniformly distributed in the air.

In April 1864, Pasteur explained his beliefs in front of a gathering of famous scientists at the University of Paris. He proved his case beyond doubt – even if some of those present refused to believe him including Dr. Charlton Bastian who maintained his belief that putrefaction came from within and not from invading micro-organisms.

Up to 1865, Pasteur’s work only involved beer, wine and milk. In 1865, he was asked to investigate his first disease called pébrine that affected the silk worm industry. Within a year, Pasteur had established that the disease was caused by a living organism and he now became convinced that microbes could also affect humans as well as beer and silk worms. In this sense, Pasteur believed that microbes could spread diseases among humans. Three of Pasteur’s daughters had died between 1859 and 1865; two from typhoid and one from a brain tumour.

In 1865, a cholera epidemic hit Marseilles. Pasteur carried out a number of experiments in a hospital in the hope of finding the germ that caused this feared disease. He was not successful.

In 1868, Pasteur suffered from a brain haemorrhage that affected the left side of his body. This affected his ability to work but the work that he had done up to 1868, had inspired a number of younger scientists.

Pasteur developed his work by finding out ways humans could be prevented from getting a disease. He was inspired by his own desire to develop his knowledge but also by patriotism. Robert Koch was getting a great deal of attention throughout Europe for his discoveries and the French versus German rivalry that occurred provided a great spur to medical advances. In 1881, Pasteur met Koch at a meeting in London when the German was giving a lecture on what he had discovered up to that date. All Pasteur said to Koch after the lecture was "That is great progress".

Koch had gathered around him a team of skilled research scientists. Pasteur frequently worked by himself. He realised that this was not the way to proceed and he also gathered around him a team of research scientists. Pasteur had always lacked detailed medical knowledge. Because of this he introduced into his team two brilliant young doctors, Emile Roux and Charles Chamberland. The first disease this team worked on was chicken cholera – a disease that affected many poultry farmers.

Pasteur knew about the work done by Edward Jenner regarding smallpox. Pasteur reasoned that if a vaccine could be found for smallpox, then a vaccine could be found for all diseases. Pasteur did not know how Jenner’s vaccination worked so he had to proceed searching for a chicken cholera vaccine using a process of trial and error.

In the summer of 1880, he found a vaccine by chance. Chamberland had inoculated some chickens with chicken cholera germs from an old culture that had been around for some time. The chickens did not die. Pasteur asked Chamberland to repeat what he had done but with a fresh culture of chicken cholera germs. Pasteur reasoned that a new culture would provide more potent germs.

Two groups of chickens were inoculated; one that had been given the old culture and one group that had not. Those chickens that had been given the old culture survived, those that had not died. The chickens that had been inoculated with the old culture had become immune to chicken cholera. Pasteur believed that their bodies had used the weaker strain of germ to form a defence against the more powerful germs in the fresher culture.

In April 1881, Pasteur announced that his team had found a way to weaken anthrax germs and so could produce a vaccine against it. Despite his fame, there were still those in the medical world who mocked Pasteur.

Rossignol was the editor of "The Veterinary Press" and in 1882 he challenged Pasteur to a public test of his anthrax vaccine. The tests were held in May 1882. Sixty sheep used in the test. Pasteur kept ten as they were and divided the other fifty into two groups of twenty-five. One group was inoculated with his vaccine while twenty-five were not. All fifty were then injected with the anthrax virus. Those that were not inoculated died within two days. The inoculated group suffered no ill-effects and were described as being "sound, and (they) frolicked and gave signs of perfect health". They proved that Pasteur was not exaggerating the powers of his vaccine. "The Times" in Great Britain called Pasteur "one of the scientific glories of France".

Pasteur and his team turned next to the disease of rabies. Most human victims of rabies died a painful death and the disease appeared to be getting more and more common in France. Though the team could not identify the germ, they did find that the rabies germ attacked the nervous system only after it had made its way to the brain. The team traced the germ to the brain and spinal cord of infected animals and by using dried spinal cords, they produced a vaccine for rabies. The vaccine was first tried out on animals.

Pasteur injected ‘clean’ animals with the rabies germ found in spinal cord that was fourteen days old. At this age, the germ was relatively weak and unlikely to threaten the life of the animals. He then used spinal cords that were thirteen days old, twelve days etc. on the animals until they were injected with the most virulent germ found in infected spinal cord that was fresh. All survived this. But Pasteur faced a serious problem. What worked on animals might not work on humans.

In 1885, a young boy, Joseph Meister, had been bitten by a rabid dog, and was brought to Pasteur. The boy almost certainly would have died an agonising death if nothing was done so Pasteur took the risk on using his untested vaccine.

The boy survived and Pasteur knew that he had found a vaccine for rabies. Three months later, when he examined Meister again, Pasteur reported that the boy was in good health.

Ironically, though Pasteur and his team knew that the vaccine worked, no one then in the world of science knew how it worked!

Post-1945, many advances were made in the management of pregnancy and childbirth. This included the ability to induce labour and the use of epidurals to ease difficult pregnancies. As a balance to this, there was a move for less state intervention in childbirth and the development of the right for women to have more natural childbirth. In 1956, the National Childbirth Trust was set up. The chance of infant survival also improved as medical knowledge developed – as was seen in the work done to increase the survival rate of ‘blue’ babies. The greater use of scans after 1945 also helped to detect problems earlier.

More vaccines were developed to control childhood diseases. After the war the health of children was generally better than at any other time in history. Vaccines against polio, measles and rubella were developed in the 1950’s and 1960’s. Tests were also developed for defects in babies such as the amniocentesis for spina bifida and Down’s Syndrome. Treatments were also developed for children with heart disease.

After 1945, major advances were also made in birth control. In earlier times there had been advances in rubber sheaths but they were seen more as a protection against syphilis as opposed to a form of birth control. The cap or diaphragm had been developed in the 1880’s but its availability had been very much limited as people were kept in the dark as to its very existence. Marie Stopes did much to change attitudes as to give women more freedom when concerning birth control. However, pre-war social conventions had done much to prevent the total spread of her ideas throughout Britain. Many social conventions had been swept away during the war and by the 1950’s the contraceptive pill had been introduced as was seen as a way of giving women more control over their own destiny – and certainly taking this away from domineering men. By the 1960’s, the contraceptive pill was widely available, as was the IUD (Intrauterine device). This had first been developed in 1909 but was more widely available after 1945. Certain types of IUD were also linked to pelvic infection and septic abortions as late as the 1970’s and 1980’s. Such concerns did much to stymie its use.

Many very significant medical advances were also made after 1945. One of the most important was the discovery of DNA by Wilkins, Crick and Watson. These three were also helped by the work done by Rosalind Franklin. DNA is the substance that makes life – a human cell that contains genes, which are made up of chromosomes, the basis of living tissue. This has in turn allowed the study of disease caused by defective genes such as in cystic fibrosis and Down’s Syndrome. In recent years, researchers have been able to identify specific genes that are responsible for specific diseases.

New drugs have also been created post-1945. The success of penicillin during the war, prodded researchers to study other moulds. Streptomycin, found in chickens, was used successfully to treat TB. This treatment was pioneered primarily in America after 1946. Streptomycin was also found to be capable of treating many other diseases that penicillin could not. However, it was found that too much use of streptomycin could lead to the TB germ developing a resistance to its use. After 1951, streptomycin was used with Isoniazid in the fight against TB. This again was developed in America. By the 1970’s, five antibiotics existed which could be used against TB. In recent years, despite this array of drugs against TB, there have been fears that TB can be resistant to all drugs that have been developed to fight it. The recent rise of TB in the more depressed areas of Britain’s cities has concerned many doctors. The problems with streptomycin did lead scientists to study why drugs lost their effectiveness and also why some people suffered side effects when they were used and others did not. The development in pharmacology has been a major development since 1945.

Since 1945, there has been a greater use of steroids in medicine. These were used to relieve pain and inflammation. Cortisone was used in injection form to treat rheumatoid arthritis. Cortisone also had the important side effect of reducing the body’s immune system. This made it useful to prevent the rejection of skin and kidney transplants. This in turn lead to the idea of using drugs to suppress the growth of cancers using cytotoxins.

The use of ultrasound and magnetic resonance since 1945 has also made it easier to diagnose disease. Ian Donald, Professor of Midwifery at Glasgow developed ultrasound in the 1950’s for looking at unborn babies. Magnetic Resonance Imaging can be used to detect diseases without the use of radiation making it less harmful to the patient. Three-dimensional CAT scans can also be used. The less use of radiation the better as some patients can be harmed by exposure to large doses of radiation. MRI (Magnetic Resonance Imaging) does away with this problem. The use of modern equipment such as the endoscope has also allowed for the internal examination of patients without the need for surgery.

Kidney dialysis was first tried in 1914 but only became more widely available in the 1960’s. The introduction of long term and repeated dialysis gave hope to patients who almost certainly would have died without this particular development.

Surgery in general has witnessed major developments since 1945. Far more operations can be carried out now on areas of the body that were rarely touched before 1945. Christian Barnard’s heart transplant was on an organ that few surgeons would have operated on. His pioneering surgery inspired others to do likewise and now heart operations are very common, as is surgery on organs such as the liver and kidneys etc. Microsurgery and keyhole surgery are common place now – as is the use of lasers in surgery. The major – though not exclusive – developments in surgery are as follows:

Post 1953: the development of a successful heart lung machine allowed more complicated heart surgery to take place. Techniques have improved greatly here with coronary bypasses to improve blood supply to the heart since 1953 and the replacement of heart valves since the 1960’s. Artificial arteries have also been developed to improve blood flow. After 1961, pacemakers were introduced to maintain a regular heart beat.

From 1960 on, lasers were used to treat eye tumours etc.

Transplant surgery has also developed aided by drugs like cortisone, azathioprine and cyclosporin which have helped to reduce rejection. The first successful kidney transplant was done in Boston in 1954; the first heart transplant was in 1967 (performed by Christian Barnard); the first liver transplant was in 1963; the first heart and lung transplant was in 1982 and the first brain tissue transplant was in 1987.

Since 1945, there have been major developments in replacement surgery. Hip replacement was pioneered by John Charnley, orthopaedic surgeon at Manchester Royal Infirmary. Since then, there have been knees and elbows have been replaced.

In the area of reproduction, the development of IVF by Patrick Steptoe, led to the first test tube baby – Louise Brown – born in 1978. Steptoe’s work has given much hope to those couples who want children but have had difficulties producing them. However, the issue of IVF brought with it many ethical issues which cause controversy to this day.

Since 1945, there have been massive strides in the treatment of cancer. The use of a combination of drugs, radiotherapy and surgery have greatly increased a cancer patient’s chances of survival. During the 1950’s, research linked smoking to lung cancer and other external factors have also been identified – such as excess sunlight potentially causing skin cancer. It is now thought that 15% of all cancers are caused by viruses.

The major disease that has tested the medical world since the 1980’s has been HIV/AIDS. In the 1980’s, government’s touted HIV as near enough a death sentence and in Britain issued public health warnings on television showing icebergs crashing into the sea. Now, just twenty years on, combination drug therapy offers sufferers hope and a huge amount of research has gone into finding a cure or vaccination for this world-wide disease. ‘New’ diseases have also come to the fore including the Ebola virus.

There is a vast difference in the medical world of 1945 to that of 2002. Developments within medicine would have been expected but they have been in leaps in the last decades. Diseases that would have almost certainly killed in 1945 to 1950 are now usually treatable and in many instances curable.