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L'histoire de la médecine Partie 2 - UPH #10
Histoire de la médecine Partie 1(antiquité) - UPH #9
50 AMAZING Facts to Blow your Mind! #45
Hi everyone ! In the first part, we saw that there were many different practices of medicine and many different forms. From the shaman to the pragmatic doctor, from the public service to the charged and unaffordable service, methods evolved, and so did their framework. Let's find out together how did medicine evolve, starting from the Middle Ages to nowadays. In the first part of the episode, I concluded on the fact that Claudius Gallienus, one of the most amazing doctors in his times, accomplished an enormous work in medicine, but most of his work disappeared at the fall of the Western Roman Empire. In fact, this work became protected by the Eastern Roman Empire, which translated all the writings in Arabic, which resurfaced in Europe around the XIth century. This loss of medical heritage in Europe will lead medicine to develop in the Arab countries, while on our continent, it will stagnate for a relatively long period. After the fall of the Western Roman Empire, incidents burst in the ancient regions of the empire. Admnistrative, political, cultural and religious issues led to perpetual territory conquests, mixing the populations and languages : Celtic, Germanic, etc. Most of the medical writings won't be translated to be passed on these populations. Added to this lack of information is the resurfacing of traditional medicine in the different cultures, like the Celts and their druids. And it is this kind of mixing that provoked a sort of decline into a more mystic, religious and wobbly medicine. The only true keepers of the old medicine were monks, who didn't have a lot of material to work with, and who had to make it do with what they had to hand. By the way, although abbeys were often competing with other abbeys, the monks managed to unite around this knowledge transmission, and traded the few available writings they had. In these monasteries were developed the medicinal gardens, where monks grew herbs and plants in order to cook potions and remedies to cure the sick. On a side note, those gardens also allowed them to produce their own liquors, that they willingly named as medicinal liquors. For some of them, liquors represented a significant source of income. Anyway, although initiatives were taken until the Xth and the XIth century, few progress is made in Europe. In the meantime, Arabs picked up the medicine torch during the fall of the Western Roman Empire, based their thinking on Hippocrates and Gallienus essays. For some centuries, they worked relentlessly to improve significantly medicine in every domains, without hesitating to question some prior thesis of the two founding fathers of medicine like Humorism, which was set aside to develop new ones. It was the beginning of experimental methodology, we analyze, and we test a solution over and over until we can confirm a hypothesis. Around the Xth century, Avicenna, a Persian doctor wrote two reference books which had a tremendous impact on Arabian and Western medicine when they were translated a few times later. Those two books were "The Canon of Medicine", written in 1020 and "The Book of Healing", written around the XIth century and served as basis to teach medicine in Europe until the XVIIth century. Avicenna's experimental method was commonly used, and he set up clinical trials on patients in order to determine which treatments were effective. He introduced several new things in medicine like quarantine for some diseases, he gave a precise description of STDs and discovered among other things bacteria. Therefore, he was one of the major character in medicine, and he was not the only one, since at that time of Arabian grandeur, several doctors made new discoveries in surgery, ophtalmology, in psychology too, and who developed several tools like the injection syringes. Those progress allowed in particular to prove the existence of the immune system in Men, of micro-organisms that cause or trigger diseases, etc... To sum it up, if Europeans stagnated, Arabs did the complete opposite ! One main question is to know how this Arab knowledge came to Western Europe. The answer is actually pretty simple, since it was men, who dedicated a major part of their lives translating Arabic writings in Latin, who helped this medical knowledge to spread. For instance, we can hold Constantine the African as an example, who translated around the XIth century many short handbooks, but also and on the top of it one main writing, from the famous doctor Haly Abbas written one century earlier, which was entitled "The complete book of the medical art". This book was nothing less than one of the very first major Arabic encyclopedia entirely dedicated to medicine. Although the translating work was fairly amazing, because it allowed knowledge to spread, there were still some translating issues. Indeed, the original texts were already simplified in Arabic to constitute an encyclopedia, so exactitude was already lost. Beyond the source issue, Constantine himself made his writings simpler to allow the information to be translated in Latin. We can also add on the top of that, that Arabian medicine was itslef based on Greek texts. Therefore we translated texts from Greek to Arabic, then from Arabic to Latin to be spread in Europe. All these translations will cause understanding issues, and even contradictions within Constantine's writings. Unfortunately, all of this attenuated the importance of the original information. Finally, the last thing to mention about these translations is that they were not based upon the most influential books of Arabian medicine. Avicennes for instance was not among Constantine's translations, which was quite a shame. On the other hand, Gerard of Cremona translated during the XIIth century some of Avicenne's books, and others from different doctors, flooding Western Europe with this medical knowledge. He will even look for Gallienus' original writings to translate them directly into Latin, bypassing all the aforementioned translating issues. Thanks to people like Constantine the African and Gerard of Cremona among else, we start to bring back to Europe, more or less correctly, the old and Antique medicine, complemented with Arabian knowledge. And in order to reconstitute all this knowledge, translators will need almost two centuries, until the end of the XIIIth century. translators will need almost two centuries, until the end of the XIIIth century. All this scientific progress coming into Europe provoked some kind of consciousness awakening. Medicine schools opened here and there, the most famous one being Salerno's in Italy, which was a hospital built between the VIIth and the IXth century, progressively became a school around the XIth century. This school was quite original, since its teachers and pupils formed quite a heterogeneous population, all coming from different horizons, and who could therefore analyze and compare the different methodologies in medicine. Several texts were translated inside the building, and original books summarizing the main schools of thought in medicine were written. The legend itself claims that the school was built by a Jewish Master, an Arab, a Latin and a Greek. We could almost believe it's Hogwarts... What's also important about that school is that even women could learn, but also teach there -and this was not insignificant. Salerno was the very first European school of Medicine, but certainly not the last one, since it will open the way to many others in Europe. In France, two major schools of medicine will be created, in Paris and in Montpellier around the XIIIth century. With all this excitment, diseases were better understood, nevertheless, the progress done in treating them was not that obvious. Still, surgery started a steady development, and around the XIVth century, we started to authorize the schools to dissect human bodies. At first, only one is delivered a year, then two to help them in their courses demonstrations, but we'll have to wait a couple more years to see this practice skyrocket, allowing at the same time massive progress in anatomy. Although most of the doctors were based on Gallienus' writings, those principles were questioned around the XIVth century, with the arrival of the Black Death, which killed approximately 1/3 of the European population, and against which Gallienus and Hippocrates knowledge were of no use. Sanitary prevention plans started to be developed to reinfoce hygiene, and the City was cleaned to limit any risk of epidemic spreading. We also reinstaured the quarantine that Arabs had already set up at the time. We should also notice that starting from the XIIth century on, and with the boom of doctor's apprentices, the Church gradually forbade its monks to practice medicine in the big cities, to focus more on rural population, since they judged most of the other doctors more qualified to do this job. Although it took quite some time before this choice was applied, we can start to see what's religious and what's scientific gradually separate once again, which allowed the mentalities to evolve. To summarize, the Middle Ages were not a period frozen in time, at least concerning medicine, and there were evolutions both in medical practices, but also in medical institutions, with the creation of hospitals. This evolution was particularly obvious around the end of the Middle Ages, when different schools confronted each others, like the hellenist school of thought which stood behind Hippocrates and Gallienus, and the Arabian school of thought which stood behind Arabian influences. Still, we'll have to wait until the Renaissance to see a renewal of medicine. Still, we'll have to wait until the Renaissance to see a renewal of medicine. As we said earlier, around the XIVth century, a couple of shy dissection attempts started to appear, but it was not until the XVth century that the practice really developed with a school of anatomy in Paris, and in 1531 when the very first anatomy teacher was named, Jacques Dubois. Jacques Dubois multiplied the dissections in front of his students, and he discovered quite a lot of things that went against the prejudices inherited from Gallienus. and he discovered quite a lot of things that went against the prejudices inherited from Gallienus. But all this dedication will not suffice to one of his students, who will take over from him to deepen the investigation : The famous Andreas Vesalus. Not only did he continue the dissections, going deeper than his master and collecting the maximum of data from each body until the flesh was way too rotten to practice it correctly, but he also developed new surgery methods that revolutionized this domain, making out of surgery, which had been depreciated for centuries, a disciplin in itself, One part of his success can even be attributed to the fact that Vesalius taught at the University of Padova, which was dependent on Venice, which at that time was moving away from religion, allowing more liberty to sciences. He collaborated with other surgeons such as Ambroise Paré, the very first real French surgeon, who he tried to operate Henri II with, unsuccessfully. Henry II had indeed received a piece of spear in his eye. We can therefore consider that by the end of the XVIth century, there was such an enthusiasm about anatomy that we had already quite a good basis of knowledge. One of the medicine's pillars was just added. that we had already quite a good basis of knowledge. One of the medicine's pillars was just added. Around the XVIIth and XVIIIth centuries, doctors tackled another task, studying the body's mechanics, commonly known as physiology. Indeed, we knew quite well what was inside our body, but how everything worked, how the organs were articulated, that we didn't know yet. our body, but how everything worked, how the organs were articulated, that we didn't know yet. Several experiments were carried out, and vivisections were conducted on animals. Just to clear things up, vivisection is a sort of dissection, conducted on a living being. Although it may seem extremely cruel, various things were highlighted, like the blood circulation system and what role did the heart play. These discoveries were made by William Harvey, a British doctor, who realized it in 1628, and dealt a fatal blow to Hippocrates' main theory. The debates and divisions within the medical body were stronger than ever, but eventually, all admitted that Harvey was right. By the way, in France, Louis XIV cut the debate short, as he decreed that the blood circulation theory must be taught in every schools of medicine. This will not be the only intervention of Louis XIV in medicine, since he was the one who caused the construction of large hospitals in every main cities of France, which was no small achievement. The XVIIth century was bubbling with progress in many domains, whether it was physics with Newton, philosophy and Descartes, or astronomy and Galileo. Galileo was one of the possible inventors of an instrument that will revolutionize the understanding of our world : the microscope. Indeed, if the astronomer was used to examine the skies, it is said that some day he got the idea of revert the process to examine the infinitesimally small, and that he was quite surprised of the results. We can easily understand him, since a couple of years later, thanks to another doctor who improved the microscope and whose name I can't pronounce (Antoni van) Leeuwenhoek), we could for the first time observe microbs, discover the red blood cells, the cells, etc... This is the beginning of bacteriology, microbiology, etc.. Our body became less and less of a mystery to us, but still we lacked of one thing for medicine to be trully efficient : drugs to cure quickly, well, and massively. Some trials were led in chemistry, but nothing was really of significance. well, and massively. Some trials were led in chemistry, but nothing was really of significance. Still, epidemics kept wreaking havoc, and doctors were still looking for solutions to counter these murdering evils. At the XVIIIth century, we imported in Europe an ancient technique that we managed to trace back until the XIth century in China : Variolization. an ancient technique that we managed to trace back until the XIth century in China : Variolization. It was actually one of the very first vaccines , where, to counteract the smallpox (for instance), we placed a healthy patient untouched by the disease, with the pus from an infected patient. Although in 1 or 2% of the cases, this practice led to the healthy patient's death, in the vast majority, it helped people to develop a form of immunity to smallpox. This procedure became improved by, for instance, Louis Pasteur, quite famous in France for developing the vaccine against rage, and linked the disease with micro-organisms. Around the XIXth century, there is a total professionalization of the doctors. Before, medicine students had almost no experience, but were instead stuffed with theories, although some demonstrations are realized from time to time. In France, medical students must from now on do an internship within a hospital, in order to acquire experience, get something concrete before they can get their doctor's degree. By the way, in order to practice, you must possess a doctor degree from this time on. By the way, in order to practice, you must possess a doctor degree from this time on. There is also an improvement in obstetrics that goes back way before the XIXth century, which became generalized in France with male doctors, who handled birth delivery, this practice being before that done by women. Also, in the XVIIIth century, Angélique du Coudray, a midwife, became the very first midwives teacher, and she contributed largely in improving the birth delivery conditions. Anyway, around the XIXth century were built the first maternity wards, and this was also quite a revolution, even if birth deliveries were still mostly realized at home. Indeed, the death rate in hospitals was quite high. Some people therefore looked into this situation, like the doctor Ignaz Semmelweis, who noticed that when the professionnals cleaned their hands before delivering a child, the results were encouraging, and the death rate dropped considerably. He therefore promoted his finding, and soon enough, this practice will spread in many other domains, like surgery. This discovery, coupled with the invention of antiseptic solutions, saved many lives. domains, like surgery. This discovery, coupled with the invention of antiseptic solutions, saved many lives. What also really helped was the discovery of real anesthetic methods. Before the XIXth century, many solutions already existed to ease the pain, but nothing totally efficient or certain. Around half of the XIXth century, ether was used to put asleep a patient in order to operate on him, and that is a massive progress both for the patient, who won't feel the pain of the operation anymore, and for the doctor who can finally work at ease while he slices and cuts. The end of the XIXth century is marked by the discovery of radiology, which allowed one to identify more easily a fracture. The global progresses in medicine then stagnated around the beginning of the XXth century. We then had to wait until the 30s and 40s, with the invention and use of penicillin by the doctor Alexander Flemming, to really discover the benefits of the first antibiotic. Here we are, almost at the end of this history of medicine, because sometimes it's better to take a step back before we analyze the period we live in, this way we won't say too many idiocies. But the one sure thing is that the second half of the XXth century is marked by quite a whole bunch of evolutions, in the way to consider medicine too, since we now use the scientific method to apprehend a case, understand it and treat him well. Still, in order to give you a brief insight on the state of our contemporary medicine, just keep in mind that we made more progress in the past 50 years, than we have donne since the beginning of the history of medicine. We invented the scanner, ultrasound scan, many advances were made in pharmacology... Also, don't forget that nowadays, surgeons can transplant hearts in their patients, which was the central element of the soul and life a few thousands years ago. We also develop amazing and efficient prosthesis, artificial organs and so on. Basically, yes we did pretty impressive progress. amazing and efficient prosthesis, artificial organs and so on. Basically, yes we did pretty impressive progress. The one sure thing is that, as we have just seen in this rough summary of the history of medicine, theories were developed, practices were used, just to be replaced by others later, that seemed more efficient. So even if today, we could be tempted to claim that the advances we have done could never be improved, we might see other revolutions in medicine, that will cause future generations to wonder in 1, 2 or 5 centuries, how it was possible for us to die from a small cancer in the 2000s... But hey, we still have to support research if we want that to happen ! That's it folks, it's over ! I hope that you enjoyed this summary, if you have any precisions to add, things you'd like to highlight or to share, feel free to comment ! Once again, thank you all, keep supporting the show on tipeee if your heart tells you to do so, in the meantime, see you next time for another bit of history.