The History of Medicine

The History of Medicine

اسلاید 1: www.tabaye.ir

اسلاید 2: The History of MedicineBy George Sarka MD,MPH,FACP,FACRDrPH Candidate in Public Health at UCLAAssistant Clinical Professor in Medicine at UCLAGovernor-Elect of the ACP Southern CA, Region 2President of the LA Neurological SocietyPresident of LA County Medical Association-District 1Staff Neurologist at SMMCStaff Rheumatologist at CSMCStaff Physician at the Klotz SHC at CSUNMedical Historian and Medical LecturerDiplomate in Internal Medicine, Rheumatology,Neurology, Headache Medicine, Sports Medicine, Geriatrics and Emergency Medicine

اسلاید 3: Objectives for the LectureAt the end of this lecture, the physician should be able to do the following:1. Discuss the evolution and significant events in the history of medicine.2. Discuss the significant individuals responsible for the advances in medicine.3. Discuss how this subject is germane to medical issues today.

اسلاید 4: William Osler said of Medicine and ArtMedicine is a science of uncertainty and an art of probability. SirWilliam Osler

اسلاید 5: In the Beginning…In September 1940, four teenagers around the northern slopes of France’s Pyrenees mountains stumbled upon one of the most famous and astounding repositories of Paleolithic art in the world: the cave of Lascaux

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اسلاید 7: Cave of LascauxHundreds of paintings and etchings of red cows, yellow horses, bulls and black stags fan out across the cave’s walls and ceilings in a literal stampede.It is the world’s oldest example of medicine in art, dating back 15,000 years.

اسلاید 8: Cave of LascauxThe lone human figure among all the animals is the man with a head of a bird, who appears to be in some kind of trance during a confrontation with a bull. Beside him is a staff.It is widely believed that the human figure is some sort of shaman. Shaman were in charge of the knowledge of health, and of life & death.

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اسلاید 11: TrepanningPrimitive man believed that head pain was the work of evil spirits who invaded the body of unfortunate individuals.If headache was caused by the invasion of evil spirits, then letting the spirits out of the skull should bring relief.Thus was born the surgical procedure known as trepanning which dates back ten thousand years or more.Such procedures were found in the South Pacific, Europe, North America and South America.

اسلاید 12: Themes in MedicineSuperstition, Evil Spirits, HumoursBlind Loyalty and Downright StupidityThe Emergence of IconoclastsIngenuityCommon SenseSerendipityKindling PhenomenonThe Art and Science of MedicineHard Work and DedicationTechologyImagination

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اسلاید 14: Imhotep- “the One Who Walked in Peace”Vizier of a Pharaoh, lived about 2900 BC;He is credited with many accomplishments in many fields and one of his activities seems to have been that of a successful physician.He is one of the first medical men whose name is on record and rose from the role of medical hero to become God of Medicine.He began using simple surgery instead of just magic.

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اسلاید 16: Sir William Osler tells us that Imhotep was the:..first figure of a physician to stand out clearly from the mists of antiquity. Imhotep diagnosed and treated over 200 diseases, 15 diseases of the abdomen, 11 of the bladder, 10 of the rectum, 29 of the eyes, and 18 of the skin, hair, nails and tongue. Imhotep treated tuberculosis, gallstones, appendicitis, gout and arthritis. He also performed surgery and practiced some dentistry. Imhotep extracted medicine from plants. He also knew the position and function of the vital organs and circulation of the blood system. The Encyclopedia Britannica says, The evidence afforded by Egyptian and Greek texts support the view that Imhoteps reputation was very respected in early times. His prestige increased with the lapse of centuries and his temples in Greek times were the centers of medical teachings. 

اسلاید 17: The Healing Art and DiseasePhysicians based their healing art upon the belief that evil spirits, hateful demons, and vengeful gods struck people with diseases. Invisible arrows shot by the Greek god Apollo caused pain.One treatment for disease was for the victim to travel to one of the many pagan temples in Greece.

اسلاید 18: The Healing Art and DiseaseThe sick person made a sacrifice and then spent the night in the temple. As he slept, he was supposed to dream away the sickness.

اسلاید 19: The Two Great Names in the History of Greek MedicineHippocrates-dominated the beginning of a period of remarkable scientific creativity, which lasted more than 700 yearsGalen—near the end of the period, both furthered scientific knowledge and crystallized it in an amazing volume of written works. His influence lasted for 1500 years/45 generations.

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اسلاید 21: Hippocrates(460B.C.-377B.C.Hippocrates is know as the “Father of Medicine.” He is considered one of the greatest physicians the world has ever known. He was the first to attempt to separate the practice of medicine from religion and superstition.Hippocrates developed his pledge of proper conduct for doctors. “I will use treatment to help the sick according to my ability and judgment, but never with the view to injury and wrong doing…Into whatsoever houses I enter, I will enter to help the sick.”

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اسلاید 23: “On Airs, Waters, and Places” around 400B.C.Hippocrates penned a tract called “On Airs, Waters, and Places.”This was the earliest reference to epidemiologic thinking.He emphasized familiarity not only with the patient’s symptoms, but also with the season of the year and the patient’s living conditions, diet fluid intake, and exercise habits:

اسلاید 24: “On Airs, Waters and Places”“For if one knows all these things well, or at least the greater part of them, he cannot miss knowing, when he comes into a strange city, either the diseases peculiar to the place, or the particular nature of common diseases, so that he will not be in doubt as to the treatment of the diseases, or commit mistakes, as is likely to be the case provided one had not previously considered these matters. And in particular, as the season and the year advances, he can tell what epidemic diseases will attack the city, either in summer or in winter, and what each individual will be in danger of experiencing from the change of regimen.

اسلاید 25: Hippocrates Refusing Gift from Alexander by Anne-Louis Girodet(1816)

اسلاید 26: The Hippocratic OathHippocrates also made changes in how physicians looked upon their profession.During his time, a doctor was sometimes bribed to see that a patient died, or asked to prepare poison to kill an enemy. If a ruler wanted to rid himself of a rival, he could hire a court physician who would see that the rival became sick and died.Hippocrates taught against such improper conduct. He told his students to treat everyone the same.“Sometimes give your services for nothing…for where there is love of man, there is also love of medicine.”

اسلاید 27: The Hippocratic OathA statement describing proper conduct.It was a pledge and is a guideline for honorable standards of action.“I will use treatment to help the sick according to my ability and judgment, but never with the view to knjury and wrong doing…Into whatsoever houses I enter, I will enter to help the sick.”

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اسلاید 29: Allegories of the Healing ArtsAn allegory, or a pictorial symbol, serves to formulate into some tangible aspect an idea or point of view that may exist vaguely in the minds of many.The allegories of the Healing Arts—visual images around which are centered the faith and hope of mankind.

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اسلاید 32: Head of Asklepios(Greek Coin, II Century B.C.)The earliest icon of medical significanceHead of Asklepios was pictured on a silver drachma, a Greek coin minted on the island of CosHe was the son of ApolloThe centers of his cult were temples where the sick went, similar to our modern day sanatoriums, with emphasis on diet, massage, baths and the like.

اسلاید 33: Head of Asklepios(Greek Coin, II Century B.C.)The god was supposed to reveal to the patient in a dream the cure for his/her disease.The serpent, symbolic of regenerative power, was sacred to Asklepios and to Apollo.The emblem, in the form of a rod with a coiled serpent, is still used to represent the art of medicine

اسلاید 34: Note the Hippocratic Oath“I swear by Apollo the physician and Asklepios and his daughters, Hygeia and Panacea, and all the Gods and Goddesses…”Hippocrates was also born on the Island of Cos

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اسلاید 36: Galen Described Wounds as “Windows to the Body”Galen, the great 2nd century physician and anatomist, spent his early medical career as a surgeon to the gladiators.He employed as many as 20 scribes to write down all that he said in the work.He dissected countless animals in his prolific medical research.Galen also studied philosophy and wrote that a motive of profit was incompatible with a serious devotion to medicine, stating that doctors must learn to despise money.He was a proponent of the miasma theory of infection, which essentially blamed infection on clouds of poisonous gases.

اسلاید 37: Galen(Galenos) meaning calm or serene— “The Infallible Master”The profession of medicine gained a wealth of facts and ideas from Galen.He gave to the world a synthesis of medical thought and knowledge solid enough to last nearly 1500 years. His mind was quick and well organized.He was well informed on many subjects.In the earlier period of his life, he continually insisted on experiments and on demonstrable proofs.But the open-minded young Galen later became one of the great dogmatists of all times. The magnitude of his dogmatism was increased by his followers and commentators.

اسلاید 38: GalenGalen believed that disease resulted from an imbalance of the vital fluids, or humors, of the body. This idea was developed by Hippocrates, and consolidated by Galen.“The body has in itself blood, phlegm, yellow bile, and black bile…We enjoy the most perfect health when these elements are in the right proportion.”The medicine and pathology Galen practiced, and about which he wrote, were based mainly on speculative Hippocratic theories of the 4 humors, on critical days, and on fallacious theories regarding pulse and urine.

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اسلاید 40: The Four HumoursDeveloped out of the humoral theory of Empedocles(500 to 430B.C.), the Scilian philosopher.Developed by Hippocrates and consolidated by Galen.From the 4 elements: earth, air, fire and water derived the idea of the 4 humours(or fluids) of black bile, yellow bile, blood and phlegm with their associated meancholic, choleric, sanguine and phlegmatic temperments.It was believed that the balance of these humours in the body determined physical states of health.

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اسلاید 42: GalenGalen made the first attempts to master anatomy. He studied the anatomy of animals and applied it to humans. Medical schools used Galen’s books as textbooks for more than a thousand years. He became the undisputed authority. NO ONE DARED TO EVER DIFFER WITH HIM!From physicians to emperors as well as commoners in the Roman Empire, Galen was considered a shrewd observer who gained much experience through experimentation.

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اسلاید 44: The PictureGalen, whose teachings were accepted as dogma by medical men for 1500 years, is pictured in a 2nd century Roman home applying cupping, a form of treatment that he advocated. Galen was a pillar of medicine and the last important pillar in the millennium of Greek domination of the medical world.

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اسلاید 46: St. Cosmas and St. DamianTraditionally acclaimed the patron saints of the physician and apothecaryThese 2 brothers were Syrian Christians who were reputed to have effected many miraculous cures before their matyrdom in the reign of Emperor Diocletian(A.D.303)Seen frequently in paintings, miniatures, or prints

اسلاید 47: Rome Falls in 476A.D.The Dark Ages of Medicine begin.

اسلاید 48: Medicine in the Dark Ages (roughly 500-1050 AD)Massive decline in the number, and quality, of medical writings available.2 important features stand out during this decline:A) Preeminence of ‘do-it-yourself’ handbooks, primarily of dietetic medicine.B) The ecclesiastical takeover of medical learning and learning in general. For few could read outside the ecclesiastical community.

اسلاید 49: Medicine in the Dark Ages (roughly 500-1050 AD)The relatively learned medicine was supplemented by the healing offered at shrines and by holy men.Tales abound of miraculous cures via shrines and icons.Some saints were almost specialists:

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اسلاید 52: Some Saints as Medical SpecialistsSt. Dymphna was favored for mental diseasesSt. Roch for plagueSt. Hubert for rabies sufferersSt. Blaise for throat complaints

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اسلاید 54: The King’s/Queen’s EvilMedieval people seemed to have suffered much from TB but most probably had the glandular form scrofula.In England and France, it was believed that royalty had the power to cure the affliction by touching the sufferers, and from the 12th to the 18th century, ‘the king’s/queen’s touch” was regularly used against this condition.

اسلاید 55: The King’s/Queen’s EvilRemember after the Reformation, the Church of England rejected all forms of recourse to Saints, relics, holy water, and so on, which the Roman Catholic Church had recommended.This practice involved the ruling monarch curing victims of scrofula and similar ailments.

اسلاید 56: The King’s/Queen’s EvilThe king touched the victim and often also a gold coin  - usually an Angel, showing the Archangel Michael killing the dragon -  that was then worn around the victims neck, and the person promptly recovered.

اسلاید 57: The Emergence of Medicine from the Dark AgesOccurred around 1050 in the region of Salerno, southern Italy where this thriving medical community was in touch with the Greek and Arab worlds as well as the wealthiest and intellectually most advanced abbey of Europe, Monte Cassino.In 1080, the Salernitan masters reintroduced theoretical speculation into medical teaching.

اسلاید 58: The Emergence of Medicine from the Dark AgesFrom 1200, Latin translations of some Arabic texts by Constantine the African, re-established Galenic academic learning, combining commentary on a few set texts with philosophical discussion of wider issues.By 1250, practical demonstrations of animal anatomy was introduced.

اسلاید 59: The Three Consequences of Translation Movement1.The amount of learned medical material suddenly burgeoned beyond all recognition2.The language of medicine was heavily arabized and its therapeutics depended heavily on Arabic sources, especially in pharmacology/surgery.3.Now, there was a heavy philosophical component, based on Aristotle (natural philosophy) in the new medicine.

اسلاید 60: The Arab InfluenceArab medicine, so-called because of the language in which it was written down, greatly influenced the medical thinking of the West from the 12th to 15th centuries.The Arabs played an import part in teaching the art of prescribing and surgery.Avicenna(980-1037 A.D.), the “prince of physicians,” is noted for his Canon of Medicine.

اسلاید 61: Avicenna(980-1037 A.D.) and the Canon of Medicine

اسلاید 62: The Development of University MedicineFirst occurred in northern Italy, in the wealthy towns of Bologna and Padua, then in France (Paris and Montpellier), and in England (Oxford).Germany lagged behind, but by 1400 many areas of Western Europe had their own institutions of higher learning.

اسلاید 63: The Development of University MedicineMedicine came late into the universities. Professional associations of medical teachers, as at Salerno, joined universities only when they saw the advantages of the new institutions’ ability to secure their own rights and privileges in law and theology, and many universities, especially in France, never had a medical faculty.

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اسلاید 65: Hotel Dieu, 1500 by TriptychTriptych showing the Hôtel Dieu in Paris, about ad 1500. The comparatively well patients (on the right) were separated from the very ill (on the left). Note there were always two patients to a bed.

اسلاید 66: The Father of Modern ToxicologyPhillipus Aureolus Theophrastus Bombastus von Hohenheim“All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy.”

اسلاید 67: Paracelsus(1493-1541) and Chemical RemediesOne of the most famous questioners of medical authority.Paracelsus was an enigmatic character, flamboyant, quarrelsome and reforming. His somewhat eccentric behavior prevented his settling down in any one place and gave his life a vagabond flavour.Not content with refuting the authority of Galen and Avicenna, he publicly burned their books.He is credited with enlisting the help of chemicals in therapeutics and vigorously opposing polypharmacy, or the prescription of multiple ingredients in a single medicine.

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اسلاید 69: Andreas Versalius(1514-1564)Was the first master of human anatomy.His careful studies provided doctors with the accurate information that they need to save lives. Versalius did not accept the teachings of Galen without experimenting on his own.Versalius kept a copy of Galen’s books on hand and made changes in them. He found over 200 mistakes in the ancient books—mistakes that were still being taught by doctors of his day!

اسلاید 70: Andreas Versalius(1514-1564)Versalius learned human anatomy by looking at humans not just animals.He made detailed drawings of his findings so others could also learn.

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اسلاید 72: The Fabric of the Human BodyVaresalius was just 28 when he published the above.It was published in 1543, contained 663 pages and 300 beautiful illustrations.Versalius spent his personal fortune and all his enthusiasm on it.The publication of Fabric marked a turning point in the history of medicine.

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اسلاید 76: The Father of Modern SurgeryProfessors in medical schools seldom performed surgery. They did not think that it was proper for a professional man to do such work.Surgeon is from a French word meaning “one who works with his hands.”In the Europe of the 1500s, barbers, not doctors, performed minor operations, pulled teeth, and treated cuts.Barbers who gained skill in closing wounds were called barber-surgeons.

اسلاید 77: The Striped Barber PoleThe barber pole is a symbol of the profession and is a legacy of bloodletting. After the operation, the bandages would be hung on the staff and sometimes placed outside as advertisement.Twirled by wind, they would form a red & white spiral pattern that was later adopted for painted poles. The earliest poles were surmounted by a leech basin, which in time was transformed into a ball. The stripes of a barber pole still show the red for blood and the white for bandages. Sometimes there were poles with blue representing the veins.

اسلاید 78: Ambroise Pare(1510-1590)Pare used ointments and silk thread to repair injuries in place of burning oil and hot pokers.Pare discovered new techniques that made surgery practical.He published his book in French with useful information that all doctors could use.Pare did not have a formal education. He never earned a medical degree. Yet he became France’s most skilled surgeon. In 1562, he was given the dignified title, “First Surgeon of the King.”“I treated him. God healed him.”

اسلاید 79: Medicine Prior to the 17th CenturyThe old-style physician had almost no diagnostic technology nor did he conduct a full, hands-on physical exam. Rather, he worked on the basis of his senses: sight, touch (of the wrist for the pulse), hearing, smell and taste (sampling urine for the sweetness symptomatic for DM.

اسلاید 80: UroscopyElaborate diagnostic charts exist, correlating these indications with various maladies.Even in the written literature of William Shakespeare does the above exist: “Sirrah, you giant, what says the doctor to my water?...He said, sir, the water itself was a good healthy water; but for the party that owned it he might have more diseases than he knew for.” from Henry IV. Uroscopy

اسلاید 81: The Village Doctor by David Teniers the Younger(17th Century)

اسلاید 82: Uroscopy WheelThis is taken from The Fasciculus Medicinae by Johannes De Kethan, 1491. This was a collection of medical treatises dealing with medicine and surgery dating back to the 13th century and included the first “modern” anatomic illustration.

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اسلاید 84: Galen’s View of Blood Circulation-Based on False IdeasGalen said that blood in the veins always carried blood away from the heart.The flow was slow and irregular. Blood ebbed and flowed like tides.Galen taught that the liver manufactured new blood to replace the old.Blood surging through the heart caused it to beat. He had no ideas that the heart itself pumped blood.

اسلاید 85: The Age of Enlightment

اسلاید 86: Medicine in the 17th CenturyThe greatest physiological advance of the 17th century was the discovery of the circulation of blood.Credit goes to the Englishman William Harvey(1578-1657).In 1628, Harvey’s De Motu Cordis which concerned with the mechanical process of circulation.

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اسلاید 89: The Four Humors and William HarveyThe humors theory of the body was centered on vital spirits moving from the heart; they regulated the balance of the four humors and could be disturbed by the spiritual intervention of the devil. Once Harvey’s notion that the heart was just a muscular pump moving blood around the body became prevalent, explanations in terms of demonic spirits no longer convinced.

اسلاید 90: “William Harvey” by Robert Hannah, 1848Harvey is famous for his discovery that blood circulates around the human body.He proved that blood circulates through the body in one direction.

اسلاید 91: Antoni van Leeuwenhoek (1632-1723)Developed the most powerful microscopes of his day.He discovered one-celled protozoans and bacteria.His work eventually led to the discovery of the causes of diseases, such as the Black Death.

اسلاید 92: The Art of Medicine Becomes ScientificAlthough this movement was launched in the 17th century during the Age of Enlightment, it was not until the 19th century that the true age of science was born.

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اسلاید 96: Edward Jenner(1749-1823)Jenner was ridiculed and resented by his fellow doctors. This cartoon makes fun of Jenner’s inoculations. In a crowded room, Jenner prepares to vaccinate a young woman sitting in a chair. The scene about them is mayhem as several former patients demonstrate the effects of the vaccine with cows sprouting from various parts of their bodies.

اسلاید 97: Edward Jenner(1749-1823)Jenner discovered that having cowpox protected a person against smallpox.Jenner’s cowpox serum saved many lives, and almost eliminated the disease of smallpox.His discovery of vaccination is considered one of the most important discoveries in medicine. Jenner nor any other doctor knew the cause of infectious diseases or why vaccination worked.

اسلاید 98: The Birth of AnesthesiaA nineteenth-century physician administering chloroform prior to surgery. Ether was one of the earliest anesthetics to be used but it was difficult to administer as it usually made the patient choke.

اسلاید 99: Sir Humphry Davy (1778-1829)Humphry Davy discovered laughing gas(nitrous oxide) which has made dentistry much less painful.

اسلاید 100: Sir James Young Simpson (1811-1870)James Young Simpson discovered chloroform could be used as an anesthetic.Simpson fought to make anesthesia an established part of surgery.

اسلاید 101: William Thomas Green Morton(1819-1868)Invented a special glass inhaler and added perfume to ether.Successfully used either to pull a tooth and to then perform painless surgery.His tutor Dr. Charles Jackson gave Morton some advise on using ether and then later claimed it was all his idea.

اسلاید 102: The Recognition of Nutrition and Disease

اسلاید 103: James Lind(1716-1794)In James Lind’s experiment, those that ate citrus fruit stayed healthier.Captain Cook took Lind’s advice and his crew stayed health for a four-year journey.The British Navy finally ordered sailors to drink lime juice.Lind had found the cure for scurvy—vitamin C.

اسلاید 104: Christian Eijkman(1858-1930)Found that bacteria did not cause beriberi.He found that brown rice was a cure for beriberi because of a vitamin (now know to be thiamine) in the husks.

اسلاید 105: Jean Boussingault (1802-1887)Jean Boussingault found that a mineral called iodine could cure a goiter of the thyroid gland.

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اسلاید 108: Rene-Theophile-Hyacinthe Laennec and the stethoscope“In 1816 I was consulted by a young woman presenting general symptoms of disease of the heart. Owing to her stoutness little information could be gathered by application of the hand and percussion…I recalled a well-known acoutic phenomenon:namely, if you place your ear against one end of a wooden beam the scratch of a pin at the other extremity is distinctly audible. It occurred to me that this physical property might serve a useful…

اسلاید 109: Rene-Theophile-Hyacinthe Laennec and the stethoscopeThis physical property might serve a useful purpose in the case with which I was then dealing. Taking a sheet of paper I rolled it into a very tight roll, one end of which I place on the precordial region, whilst I put my ear to the other. I was both surprised and gratified at being able to hear the beating of the heart with much greater clearness and distinctness that I hever before by direct application of my ear.”

اسلاید 110: The StethoscopeRene Laennec, who invented the first stethoscope, commented that no patient report could suffice to characterize disease, and that for a certain diagnosis, mediate auscultation is required.

اسلاید 111: “Miasmata”Originated from GalenPoisons in the atmosphere emanating from cesspits and rotting material caused illness.In 1840, the German pathologist Jakob Henle(1809-1885) published his essay: “On miasmata and contaia,” in which he tried to show that tiny living creatures in the human body caused infectious diseases.The idea of “germs” began to challenge the prevailing theory were caused by “miasmata.”The above was supported by the work of Frechman Louis Pasteur and the British surgeon Joseph Lister.

اسلاید 112: Public HealthThe concept had it origins in Biblical rules on health and hygiene as well as in great architectural works such as the building of the aqueducts to supply fresh water to Rome and the removal of waste by means of the great drain, the cloaca maxima.Principles regarding safe diets and person hygiene were taught by the great religions. These were reinforced by later miasmatic notions. Evil smells do indicate poor sanitation and their removal reduces sources of infection.

اسلاید 113: John Snow(1813-1858), the Father of Public HealthEffectively brought an end to the 1854 epidemic in Soho, London by demonstrating only those who drank from the infected Broad Street pump contracted the disease.

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اسلاید 115: Ignaz Phillipp Semmelweiss1. Childbed fever was taking thousands of lives of young mothers2. More women were dying under the care of doctors than midwives.3. Some doctors were more interested in their reputations than in saving lives.

اسلاید 116: Ignaz Phillipp Semmelweiss1. Discovered that the doctors were spreading childbed fever.2. He proved that doctors were carrying the disease from corpses to their patients.3. He proved that cleanliness could prevent childbed fever.

اسلاید 117: Problem in SurgeryInfection was a major problem during surgery.People often died after surgery from the infection alone. Compound bone fractures almost always ended in death because of infections.

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اسلاید 119: Joseph Lister(1827-1912) and InfectionDiscovered that carbolic acid prevented infection on compound infections.By insisting that everything be kept clean and disinfected, he lowered the death rate in his surgeries.He discovered it was not the presence of acid bit the absence of germs that mattered in surgery.

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اسلاید 122: The Search for the Etiology of DiseaseRobert Koch discovered that anthrax was caused by bacteria.He discovered how to grow bacteria in cultures for study, and how to add stain in order to see them.Robert Koch proved that most diseases are caused by a particular bacteria. Microbiologist, Robert Koch discovered the tubercle bacillus in 1882 where one in seven deaths in Europe was due to TB.

اسلاید 123: Koch’s Postulates to Advance the Germ TheoryThe causative agent must be present in every case of the disease and must not be present in healthy animals.The pathogen must be isolated from the diseased host animal and must be grown in pure culture.The same disease must be produced when microbes from the pure culture are inoculated into healthy, susceptible animals.The same pathogen must be recoverable once again from this artificially infected animal and must be able to be grown in pure culture.

اسلاید 124: Louis Pasteur(1822-1895)Louis Pasteur dismissed t he “miasmatic” theory of disease. He argued that diseases were caused by germs and so effectively established bacteriology as a science.

اسلاید 125: Louis Pasteur Returns to the SceneLouis Pasteur discovered that chickens could survive cholera when given a weakened form of the disease.He found that an anthrax vaccine could be made by heating the bacteria.He discovered rabies was caused by a virus instead of bacteria and then developed a vaccine for humans.

اسلاید 126: Medical Schools in the United StatesHigh-quality medical schools and clinical investigations developed more slowly.In its laissez-faire, business-dominated atmosphere, many schools were blatantly commercial, inadequately staffed and offering cut-price degrees.

اسلاید 127: What Was It Like to be a Medical Student 140 years ago?No one worried about admissions, for entrance requirements were lower than they are for a good high school student.Instruction was superficial and brief.The terms lasted only 16 weeks, and after the second term the M.D. was automatically given, regardless of a student’s academic performance

اسلاید 128: What Was It Like to be a Medical Student 140 years ago?Teaching was by lecture alone. Thus, students were spared the onerous chores of attending labs, clinics and hospital wards.It was not uncommon for students to graduate without ever having touched a patient.

اسلاید 129: Medical Schools in the 1860s and 1870sMany were privately owned, operated for profit and without university affiliation.Physicians often had little to offer their patients other than sympathy and tender care for ailments they lacked the means to cure.The medical profession was held in low regard by the general public.

اسلاید 130: The Birth of Johns Hopkins University and Medical SchoolAt Hopkins, a new era of American medicine was born, with rigorous admission requirements and a quality of training that set new standards in the United States and compared favorably with the venerable European institutions.

اسلاید 131: At Johns Hopkins University and Medical SchoolCandidates for admission to Hopkins were required to have a four-year college degree, including two years of premedical training in biology, chemistry and physics, and a reading knowledge of French and German.

اسلاید 132: The Four Doctors by John Singer Sargent(1905)

اسلاید 133: The “Big Four” of HopkinsWilliam H. Welch in pathology and the future DeanOsler in medicineWilliam S. Halsted in surgeryHoward A Kelly in gynecologyAll younger than 40 years old, organized the hospital departments.

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اسلاید 136: Evolution of DiseaseIn the 19th century, diarrheal diseases were the biggest killer of children, and tuberculosis was the leading cause of adult mortality.In the 20th and 21st centuries, chronic diseases are now the leading cause of disease and death in adults.

اسلاید 137: Technology Reigns SupremeWilliam Crookes invented the Crookes’ tube which developed into TV’s and monitors.Wilhelm Roentgen invented the x-ray machine by using the Crookes’ tube.Because of its ability to see inside the body, x-ray photography is one of the most important medical discoveries.

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اسلاید 140: The Use of RadiationHenri Becquerel proved that radiation from uranium is like x-rays but more powerful and is credited in discovering radioactivity in 1896.Pierre and Marie Curie discovered radium and other radioactive elements.When controlled, these radioactive elements can be used to enhance x-rays and fight cancer.

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اسلاید 144: The Birth of the EKGSir Thomas Lewis mastered the technology of the electrocardiogram in 1912.

اسلاید 145: Andrew W. “Doc” FleischerIn 1921, the above developed the mercurial sphygmomanometer and spent his career refining medical instruments, including the modern stethoscope.

اسلاید 146: The Birth of Medical Organizations/SocietiesACP-1915;Joining of the ACP and ASIMAANAAFPACRAGSEtc.

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اسلاید 148: The Advent of DrugsDr. Gerhard Domagk(1895-1964) discovered sulfa drugs.This drug became world famous when Dr. Perrin H. Long used sulfa drugs to treat Franklin Roosevelt Jr.Sulfa was called a “wonder drug” because it killed bacteria but did not hurt the cells of human tissue.

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اسلاید 150: Mold Becomes A Medical Ally in the Battle Against BacteriaAlexander Fleming(1881-1955) discovered penicillin which killed staphylococcal bacteria. Florey and Chain isolated the chemical and found that it could be mass-produced, making it more affordable.Penicillin was stronger(bacteriocidal) that sulfa(bacteriostatic) and had fewer side effects.

اسلاید 151: Technology Transform the Medical ArenaDr. Richard Drew(1904-1950) established the use of transfusion and blood banks.Dr. Christian Barnard(1922-2001) performed the first heart transplant in 1967.Dr. William Kolff developed an artificial kidney machine.James Watson and Francis Crick discovered DNA.

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اسلاید 155: Technology and the 20th/21st Century(Medicines)AntisepticsAntibioticsAntiepilepticsAntipsychoticsChemotherapiesMyoclonal AntibodiesVaccinesBiologic AgentsContinuing Story of AspirinBlood Transfusions and Blood Banks

اسلاید 156: Technology and the 20th/21st Century(Evaluative Procedures)Electron MicroscopeCT ScansMRI ScansMRA ScansPet ScansFunctional MRIThe Human GenomeGenetic TestingGenetic Enzyme Replacements Therapy

اسلاید 157: Technology and the 20th/21st Century(Surgeries)Artificial Kidney Machine—Dialysis—Kidney TransplantsCoronary Artery BypassAngioplasty Total Hip and Knee ReplacementsNeurosurgeryLasik SurgeryOrgan Transplants—Heart, Kidney, Lung, Liver, Pancreas, etc.

اسلاید 158: The Transformation of Medical EducationMedical Schools and the Gender GapMedical Schools and DiversityThe Soaring Cost of a Medical EducationThe Primary Care Physician v. the SpecialistBoard Certification The Integration of Complimentary Alternative MedicineThe Introduction of the Medical Home--ACP

اسلاید 159: Transformation of Medical CareThe Advent of Chronic Disease as a Major Cause of Morbidity/MortalityHome Care to the Office to Hospital CareThe Private Practictioner to the Medical UniversityThe Advent of Medicare/Medicaid in the USAUniversal Coverage in Many CountriesManaged CareHMOs, IPOs, PPOs, POSPrimary Care Physician v. the SubspecialistThe Advent of Medical Home Model(ACP)Hospice CareAccreditation, Quality Assurance, Board CertificationHIPPAMedical Malpractice/Lawyers

اسلاید 160: Ethics and MedicineSexualityAbortionWhat is Death?Growing OldEuthanasia/Right to Life/Pro lifeQuality of Life IssuesLimited Health Care ResourcesRationing of Health CareThe Uninsured, The Undocumented WorkerUniversal Health CareThe Use of Physicians in State Executions—i.e.,California

اسلاید 161: Challenges for the Future

اسلاید 162: Challenges for the FutureObesity/Diabetes MellitusSmokingThe Geriatric PopulationDrugs/MedicationsAlzheimer’s DiseaseDepressionMedicare/MedicaidEuthanasiaEtc.

اسلاید 163: The Future of MedicineBalance between the art of medicine and the science/technology of medicine with imagination, ingenuity and a little luck.

اسلاید 164: “The Giant”(1923) by N. C. Wyeth

اسلاید 165: The End

اسلاید 166: Thank You!