#2 A Brief History of Medicine

The great Stephen Hawking summarised the history of time, from the big bang to black holes. Here lies the history of healthcare, from the Greek physician to prosthetic toes. Healthcare has gone through monumental changes over time. It has been used as a strategy by our ancestors to improve both the quality and length of life. Here’s how they did it.

Ancient Times (4000–3000 BC)

Let’s rewind six thousand years to our great ancestors in prehistoric times. The average life expectancy was just 20 years, it’s hard to imagine that I would be considered old! Why was it so short? People did not understand what caused disease. In fact, they believed it was provoked by demons and spirits in the soul. They did not have the luxury of getting prescribed drugs by their GPs. Instead, an illness was (apparently) treated by visiting the tribal witch doctor, who would cast spells to free demons from their body.

There was another method taken to rid demons from one’s body — Trepanation (trust me it’s worse than it sounds). Drilling a hole in one’s skull to let light in and devils out.[1] It was used to treat headaches, epilepsy and migraines. I think I’d rather take a Panadol. As ludicrous as it sounds, the technique survived millennia and in some cases still persists today. Here’s a fascinating interview with Amanda Feilding who performed self-trepanation at home with an electric drill. Not to worry, she had a juicy steak afterwards to replenish the lost blood!

Ancient Egyptians ( 3000–300 BC)

The Egyptian healthcare strategy was to be more religious in their medical practice. They prayed to Gods and asked to receive help from divine healers.[2] We owe a lot of credit to the healthcare advancements that Egyptians made. Unlike prehistoric people, Egyptians could read and write, becoming the first to maintain health records. The script ‘Ebers Papyrus’ is the oldest preserved medical document in existence, containing over 700 remedies and magical formulae.[3]

The Egyptians had a basic understanding of the cardiac system. The knowledge at the time was that the body was made up of a system of channels. Blockages in the system, inflicted by spirits, would be the cause of disease. To rebalance the channels and hence cure disease, people would take laxatives or drain blood. Indeed, leeches were a common method of bloodletting, not a sight for sore eyes.

They were the first to use prosthetic devices to replace human parts. Illustrating one of the first instances, that technology was strategically applied to revamp the quality of life. Below, an Egyptian prosthetic toe dating back to 950BC.[4]

Ancient Greeks (1200–200 BC)

The Greeks are renowned for beginning the science of medicine. One man called Hippocrates is accredited the title, ‘father of medicine’. He began medical science by observing and studying the human body. However, a large amount of credit is due to the Egyptians, where a lot of his medical knowledge originated.[5]

The study of anatomy was founded by a Greek philosopher, Artistole, who began dissecting animals to gain a deeper understanding of how the body functions. As a result of their research, Greeks discovered that disease was impacted by diet and cleanliness, disproving the demon theory. These discoveries and knowledge increased the average life expectancy to around 30 years.

Ancient Romans (753 BC — 470 AD)

The Romans were keen on expanding their empire across Europe. In order to ensure their soldiers were healthy enough to fight wars, they devised a strategy to provide organised medical care to their people. The public health system was mapped out, where they would have aqueducts to provide water and sewers to remove waste. This maintained sanitary conditions for individuals which greatly improved their quality of life and the prevention of disease.

Claudius Galen, pictured below, was the most famous Roman physician. He was prolific, having hundreds of treatises to his name, most notable for understanding arteries and the urinary system.[6]

On a side note, feel free to check out this article, outlining some of the most eccentric medical techniques across history such as the Romans using urine as teeth whitener or the Greeks believing that a womb could wander like a “living animal”.[7]

Dark Ages (400–800)

The progression we have seen so far in medical advancements takes a major halt as we visit the dark ages. The study of medicine was prohibited. Prayer was the only strategy that could be used to solve disease. Conditions were unsanitary and epidemics spread like wildfire. Smallpox, the black plague and typhus all had a destructive impact on population levels. The lack of a formula to understand and tackle disease stunted life expectancy back to 25 years.

Middle Ages (800–1500)

The ban on medical studies was revoked. Strategies were formulated to spread the word of medical knowledge, by establishing medical universities across Europe. The major diseases from the dark ages were still prominent and had devastating impacts on life expectancy. The bubonic plague wiped away three-quarters of the population in Europe and Asia. It was decided that in order to tackle these diseases, physicians were granted permission to dissect human bodies to further medical understanding of the body.

The regulation of male physicians was introduced. Bloodletting, still around since the Egyptians, was performed by local barbers who would style people’s hair and simultaneously drain their blood. Fun fact: The red and white barber pole, symbolises bloodletting, red for blood and white for bandages. Be careful next time you ask for a “dry-cut”.

The Renaissance (1400–1600)

Known as the age of enlightenment, the Renaissance had a monumental impact on advancements in healthcare. To name but a few: Guttenberg’s printing press allowed medical knowledge to spread quickly, the scientific method established a standardised, unbiased approach to conducting experiments and the microscope enabled visibility beyond the naked eye. Artists such as Leonardo Da Vinci started accurately drawing the human body, showing that the Renaissance led to a deeper perception of complex systems, that predecessors overlooked.

The Industrial Revolution (1760–1800s)

The transition to new manufacturing processes enabled medicine to be created at large scale. This strategy enabled medicine to be available at an affordable price for many. Vast notable inventions occurred in this period and it would be impossible to credit all in a brief summary. Here are three that stood out:

1. Louis Pasteur discovered that microorganisms caused disease. He unveiled the rabies vaccine which paved way for every other vaccine.[8]
2. During the Crimean war, Florence Nightingale, known as ‘the Lady with the Lamp’, established sanitary care units for the soldiers which became the foundation for modern nursing.
3. Rene Laennec developed the stethoscope by attempting to diagnose a woman with a heart condition.[9] Out of respect, he rolled up a newspaper to listen to her heart from a safe distance from her bare chest. To his surprise, the heartbeat was more pronounced. Inadvertently, he created the medical device still used today.

The average life expectancy had almost doubled to 40 years as a result of the mass production of medicine and the numerous inventions of this time.

Modern Times (1900s — 2000s)

The 20th century gave us more than just “The Simpsons”. It increased the global life expectancy to around 70 years, perhaps society’s greatest achievement. In 1900, 30% of all deaths were children less than 5 years old. In 1997, this was 1.4%.[10]

This was not as a result of the disappearance of disease. In fact, the 1918 influenza pandemic was one of the most catastrophic events of our existence, resulting in 20 million deaths in one year. A viral infection, HIV, recognised in 1981, led to an estimated 13.9 million casualties. So, what changed that led to increased life expectancy even with these pandemics? For a start, tobacco was eventually recognised as a health hazard (were they surprised?!). The answer is the tremendous achievements in healthcare…

Public health systems were reinforced across the globe to improve the health of the population through better sanitation and hygiene. The chlorination of water was an approach taken that combated waterborne diseases.

Penicillin was discovered accidentally, by a Scottish man Sir Alexander Fleming. This changed the course of medicine with the invention of antibiotics to fight bacterial infections.

Strategic vaccination campaigns were prepared and virtually eliminated common diseases such as tetanus, rubella and measles. The success of these programs inspired the concept of ‘disease eradication’ from the global population. Smallpox was completely eradicated by 1977.[10]

Technology has also had a big impact on the development of medical devices such as X-rays, CT scans, MRIs and Ultrasounds. Surgery benefited from technology with the introduction of laser, micro and computerised surgery. The Da Vinci robotic system, displayed below, helps doctors make tiny incisions causing less trauma to the body resulting in shorter hospital stays.

However, the spread of healthcare across the world was far from even in the 20th century. This is exemplified in a (must-watch) clip by Hans Rosling (below), where he visualises the lifespan of countries in the last two hundred years. He illustrates the impact of both world wars and the Spanish flu on the population. What resonated with me most, was the improvements made in healthcare in the developing countries. Since 1948, the lifespan of developing countries has enlarged, catching up with the west and ultimately, raising the global average.[11]

Hans Rosling’s 200 Countries, 200 Years, 4 Minutes

The Present and Future

Congratulations, you’ve made it through the History of Healthcare 101. You’ve seen the strategies our ancestors have deployed to improve both the quality and length of life in their respective eras. Now that you are up to date, it’s time to explore how OUR generation is devising strategies to improve healthcare, with technology being the key driver. Unfortunately, you will have to sit tight until next week.

Slán,

Gavin,

Team Checkmate

References

1. Vice. (2018). An Interview with the Woman Who Drilled a Hole in Her Head to Open Up Her Mind. [online] Available at: https://www.vice.com/en_us/article/bnj4qv/drilling-a-hole-in-your-head-for-a-higher-state-of-consciousness
2. Sciencedirect.com. (2018). Ancient Egyptian medicine — an overview | ScienceDirect Topics. [online] Available at: https://www.sciencedirect.com/topics/medicine-and-dentistry/ancient-egyptian-medicine
3. Medical News Today. (2018). What Is Ancient Egyptian Medicine?. [online] Available at: https://www.medicalnewstoday.com/info/medicine/ancient-egyptian-medicine.php
4. Science, L. (2018). 3,000-Year-Old Wooden Toe Prosthetic Discovered on Egyptian Mummy. [online] Live Science. Available at: https://www.livescience.com/59581-ancient-prosthetic-toe-found-in-egyptian-grave.html
5. Nielsen, A. (2013). Gua Sha: A Traditional Technique for Modern Practice. 2nd ed. Churchill Livingstone, pp.1–10.
6. Bbc.co.uk. (2018). BBC — History — Historic Figures: Galen (c.130 AD — c.210 AD). [online] Available at: http://www.bbc.co.uk/history/historic_figures/galen.shtml
7. Andrews, E. (2018). 7 Unusual Ancient Medical Techniques. [online] HISTORY. Available at: https://www.history.com/news/7-unusual-ancient-medical-techniques
8. Boseley, S. (2018). Milestones that showed the way to modern medicine. [online] the Guardian. Available at: https://www.theguardian.com/science/2007/jan/05/medicineandhealth.health
9. Rock Health. (2018). A Brief History of Health Technology | Rock Health. [online] Available at: https://rockhealth.com/a-brief-history-of-health-technology/
10. Cdc.gov. (2018). Achievements in Public Health, 1900–1999: Control of Infectious Diseases. [online] Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm
11. Hans Rosling’s 200 Countries, 200 Years, 4 Minutes — The Joy of Stats. (2010). [video] Directed by H. Rosling. BBC.