(a) Brief History of Biomedicine (Western medicine)

The onset of modern scientific biomedicine can be traced to the rise of the scientific revolution in the Age of Enlightenment (the seventeenth to eighteenth centuries Common Era) when natural sciences began to advance, or even earlier in the Renaissance (the fourteenth to sixteenth centuries) in Europe when there was a resurgence of interest in Greco-Roman culture and a strong urge for change–acquisition of new thoughts and actions and abandonment of traditional knowledge. In the Renaissance, scientific study of anatomy and physiology–on the structure and the function of the physical body respectively–flourished, and this formed the foundation for the later development of scientific medicine (Encyclopædia Britannica (Encyclopӕdia Britannica Online), s.v. “history of medicine”;^[1] Levinson and Gacchione 1997, 47). However, the rational approach of ancient Greek medicine can be regarded as the groundwork for the later biomedicine. In order to give a more complete picture of biomedicine, its history may be depicted from the time of ancient Greece.

Before the fifth to sixth centuries Before Common Era, most of the ancient cultures conceived sickness as related to supernatural forces such as curses, witchcraft, harmful spirits, punishment by gods, etc., and treatment often involved magicoreligious activities removing such forces. In the fifth century Before Common Era, Greek medicine repudiated supernatural powers as causes of sickness, and espoused natural principles for disease and healing (Levinson and Gacchione 1997, 47; Porter 1999, 7-9). The empirico-rational Greek medicine was based on the theory of four natural elements (fire, water, air, and earth) and four bodily humours (blood, phlegm, yellow bile, and black bile); balance of the latter determined health (Porter 1999, 9). Moreover, studies of anatomy and physiology of animals supplied further knowledge for this medical system, which had accumulated since the Greek era (Levinson and Gaccione 1997, 47). The Greek medical tradition formed the basis for the later Roman medicine and medieval medicine in Europe and the Islamic world, and it lasted even up to the eighteenth century (Porter 1999, 9-10). Medicine in the Roman era, in effect, sustained the Greek knowledge and practice. The contribution of Rome to medicine was chiefly in the scope of public health, such as water supply, public baths, domestic sanitation, sewage system, and so on (Encyclopӕdia Britannica Online, s.v. “history of medicine”).

Amongst the many contributors to Graeco-Roman medicine and medical sciences,^[2] two important figures have to be specifically mentioned: Hippocrates and Galen. Hippocrates (circa 460-377 Before Common Era) is regarded as the “father of medicine.” He was born on the island of Cos and lived a long life; but little is known about his life. Attributed to him is the Corpus Hippocraticum (The Hippocratic Collection), though historians consider that there was more than one author for this collection. Hippocrates wrote about the four humours, and that health was the result of the balance of these humours. He expressed the natural causes of diseases, and advocated the tendency to natural cure together with emphasis on diet, living conditions, climate, and the use of a few drugs. The famous Hippocratic Oath, which virtually is a guide to proper medical conduct by physicians, has been adopted by Western medicine throughout history (Encyclopӕdia Britannica Online, s.v. “history of medicine”; Kang 1997, 10-11). Galen (circa 130-200 Common Era) was the most eminent physician in the Roman era. He adopted the Hippocratic theory and the practice of the four humours. He emphasised the importance of anatomy and physiology–performing many experiments on animals–and contributed much in such areas, especially in the early knowledge of blood circulation. He was a prolific writer and his teachings became the authority for more than a thousand years in the Middle Ages in Europe and the Islamic world (Encyclopӕdia Britannica Online, s.v. “history of medicine”; Kang 1997, 11).

After the fall of the Roman Empire, the Christian church became dominant in the epoch of the Middle Ages (from the fifth to fifteenth centuries Common Era). Medicine was controlled and monopolised by the Church. Scientific study and experiment were not encouraged. By reclaiming that disease was due to punishment for sin and thus it had to be treated by prayer and contrition–which was a return to the magicoreligious model of medicine–the Christian church had a negative effect on medical progress. However, Hippocratic-Galenic medical knowledge still prevailed and medical practice of diagnosis and treatment remained unchanged (Encyclopӕdia Britannica Online, s.v. “history of medicine”;Kang 1997, 11). But the Christian church was not totally detrimental to medicine. It contributed to medicine in two aspects: healthcare provision and the preservation of medical texts. Hospitals and infirmaries were established by the Church, and healthcare was provided by doctors and nurses who often came from the religious orders. Ancient Greek medical texts were translated into Latin (and also into Arabic in some places) and preserved in many monasteries (Encyclopӕdia Britannica Online, s.v. “history of medicine”).

During the Middle Ages, Graeco-Roman medicine was transmitted to Islamic areas and significantly contributed to Arabic medicine. Two most eminent Persian physicians in this period were Rhazes and Avicenna. Both of them were prolific writers; their teachings on medicine spread to Europe and became influential. Muhammad ibn Zakariyā Rāzī, known as Rhazes in the West (circa 865-925 Common Era) wrote many texts; one famous book is the Kitāb al-ḥāwī (The Comprehensive Book), which is an encyclopaedia of medicine. Abū ‘Alī al-Ḥusayn ibn ‘Abd Allāh ibn Sīnā (Avicenna) (980-1037 Common Era) was another polymath. One of his books, the al-Qānūn fī al-Ṭibb (The Canon of Medicine), is another distinguished medical encyclopaedia which was used by many medical schools in Europe (Kang 1997, 12; Porter 1999, 96-99).

Another important contribution to medicine by the Islamic world was related to chemistry. Arabic alchemists in the Middle Ages were trying to find the philosopher’s stone which would make gold from ordinary metals, and also the drugs which would lead to longevity. Through their experiments, many chemicals were discovered and some were used as medicines, as well as many processes (such as distillation, sublimation, crystallisation, etc.) became known. These contributed to the knowledge not only of chemistry but also of drug production (Encyclopӕdia Britannica Online, s.v. “history of medicine”; Kang 1997, 12).

During the period of the Renaissance in Europe, there was an interest in the artistic works of the human form. This aroused the study and development of sciences especially anatomy and physiology. Experimental investigation of these two subjects acted as the foundation for further development of other medical sciences such as biochemistry, pathology, surgery, and so on. With the scientific revolution during the Enlightenment in the seventeenth and eighteenth centuries, medicine achieved significant advances by means of the new experimental methods and apparatuses. New scientific medical knowledge was gained, and the GraecoRoman-Islamic tradition became obsolete and was abandoned.^[3]

Several extraordinary persons in the period of the Renaissance and the Enlightenment are worth special mention: Paracelsus (1493-1541), whose original name was Theophrastus Philippus Aureolus Bombastus von Hohenheim, was outstanding for his enthusiasm for reform of the traditional authority. He publicly burned the works of Galen and Avicenna, and emphasised empiricism and rationality in diagnosis and treatment. He also introduced some chemicals such as laudanum (i.e. a tincture of opium), sulphur, lead, and mercury into therapeutic usage (Encyclopӕdia Britannica Online, s.v. “history of medicine”; Walton, Beeson, and Bodley Scott 1986, 1004). Andreas Vesalius (1514-1564) was renowned for revealing and correcting many mistakes of Galen’s teaching on anatomy (which was based on the dissection of animals) through dissection of human corpses. Vesalius published his work De humani corporis fabrica (On the Structure of the Human Body) in 1543, which was one of the most influential works in the Renaissance (Encyclopӕdia Britannica Online, s.v. “history of medicine”; Kang 1997, 13). William Harvey (1578-1657) was another who challenged the authority of Galen. By careful experimentation, Harvey demonstrated the circulation of blood and the role of the heart in the circulatory system. His findings were published in his book Exercitatio anatomica de motu cordis et sanguinis in animalibus (An Anatomical Treatise Concerning the Movement of the Heart and the Blood in Animals), which was a milestone for experimental medicine (Encyclopӕdia Britannica Online, s.v. “history of medicine”; Kang 1997, 13). René Descartes (1596-1650) proposed the dualism of mind and body, and a mechanistic view of the human body. This view is significant for scientific medicine, for the human body is just physical matter which follows the law of nature and can be examined scientifically (Porter 1999, 217-218). These figures were particularly noteworthy for making revolutionary contributions to modern medicine.

Apart from these persons who had great influence on the development of medicine, there were also discoveries or inventions, especially during the Enlightenment period, that had a significant impact on medical advancement. The microscope was one of them. It was invented around 1600. Since then, scientists have made good use of it. Two renowned ones were Marcello Malpighi (1628-1694) and Antoni van Leeuwenhoek (1632-1723), who utilised microscopy to examine various types of body tissues (such as blood capillaries, red blood cells, etc.) (Kang 1997, 13-14; Porter 1999, 223-226). Vaccination was another important innovation. Lady Mary Wortley Montagu, after observing the practice of smallpox inoculations in Turkey,^[4] performed this practice in England in 1721. But it was Edward Jenner (1749-1823) who later made such practice popular, after experimenting and publishing the method (in 1796 and 1798 respectively)–by giving a smallpox inoculation (using cowpox material) to a boy who later became immune to smallpox (Porter 1999, 275-277). With the advancement of anatomical knowledge by means of dissection, pathology was another scope that gained significance in the eighteenth century. Particularly, Giovanni Battista Morgagni (1682-1771), by conducting postmortem examinations on about 700 corpses, published the findings in his great work, De sedibus et causis morborum (The Seats and Causes of Diseases), and demonstrated that diseases are due to morbid changes of organs (Porter 1999, 263264). The above-mentioned are several amongst the many prominent discoveries/ innovations in the eighteenth century.

Benefitted from the scientific revolution in the Enlightenment, new scientific methods and experiments boosted various fields of science, which formed a firm scientific foundation for the rapid progress in biomedical sciences and clinical practice. New inventions in technology and enhanced communication between scientists also assisted the tremendously rapid progress. Since the nineteenth century there have been multiple advances in medicine. Numerous discoveries have been made by many eminent doctors and researchers (Encyclopӕdia Britannica Online, s.v. “history of medicine”). Modern scientific biomedicine, in fact, was established in the last two to three centuries. It is difficult to enumerate all the scientific or medical accomplishments; some significant discoveries contributing to medical progress are briefly mentioned here.

Anatomy and physiology have always been fundamental to medicine. By the nineteenth century, human anatomy and physiology had already been comprehensively studied. Important in the field of experimental physiology in this epoch is Claude Bernard (1813-1878), who made wide-ranging discoveries in physiology. Bernard also is renowned for his definition of the term “milieu intérieur”, which was later termed as “homeostasis” by Walter Cannon (1871-1945) (Porter 1999, 338-340).^[5]

With the increase in utilisation of microscopy, various types of cells and tissues were examined. Rudolf Virchow (1821-1902) applied the cell theory to pathology. In his book Die Cellularpathologie (Cellular Pathology), he explained that diseases were due to abnormal changes within cells. He therefore founded the field of cytopathology (i.e. cellular pathology) (Kang 1997, 14; Porter 1999, 330331).

Establishment of the germ theory of infection in the late nineteenth century had a remarkable impact on medicine. Louis Pasteur (1822-1895) and Heinrich Hermann Robert Koch (1843-1910) were two significant figures contributing to this theory. Pasteur discovered that the fermentation of wine/beer and the souring of milk were due to microorganisms. This led to the invention of pasteurisation of milk. He also identified the role of some microbes in causing certain diseases in human and animals, such as anthrax, rabies, and chicken cholera. These discoveries resulted in his development of vaccines against these diseases, and also contributed to the study of microbiology (Encyclopӕdia Britannica Online, s.v. “history of medicine”; Walton, Beeson, and Bodley Scott 1986, 1011). Likewise, Koch plays a crucial role in microbiology. He identified the bacteria responsible for tuberculosis and cholera. More importantly, he formalised the laboratory procedures for cultivating and isolating microorganisms, and set the criteria for proving a microorganism as the causative agent for a particular disease (i.e. Koch’s postulates). Koch’s method and criteria led to the later identification of many pathogenic bacteria (Porter 1999, 436-437).

Progress in microbiology opened up the development of cures and preventives for infectious diseases. A synthetic antibiotic–arsphenamine (also known as compound 606 or by its trade name Salvarsan) which is an organic arsenical compound–was identified as effective by Paul Ehrlich (1854-1915) and his colleague Sahachiro Hata in treating syphilis in 1909 (Porter 1999, 452). Another effective antibacterial drug, penicillin, was isolated from a mould (Penicillium notatum) by Alexander Fleming (1881-1955) in 1928 (Porter 1999, 456). It is a very effective antibiotic for treating many types of infection. Since then, many antibiotics were gradually developed. In addition, many vaccines against bacteria and viruses have been produced since the nineteenth century, such as the vaccines for typhoid, tetanus, diphtheria, tuberculosis, measles, mumps, rubella, poliomyelitis, and so on (Encyclopӕdia Britannica Online, s.v. “history of medicine”).

Surgery progressed a lot in the latter half of the nineteenth century owing to the advances in microbiology, anaesthesiology, physiology, and immunology. Before these advances, surgical operations were often unsatisfactory because of three major obstacles: wound infection, surgical pain, and shock (i.e. acute circulatory failure usually due to blood loss) (Encyclopӕdia Britannica Online, s.v. “history of medicine; Kang 1997, 15). Combating these obstacles, new innovations were made in the areas of surgical antisepsis and asepsis, anaesthesia, as well as blood transfusion and bleeding control. Joseph Lister (1827-1912), inspired by Pasteur’s discovery that putrefaction was due to microorganisms and hence wound infection was caused by air-borne bacteria, introduced antisepsis (destruction of microorganisms) during surgery. He applied an antiseptic substance (carbolic acid) on wounds and the occurrence of wound infection (as well as postoperative death) reduced remarkably. Later techniques of asepsis (prevention of contamination with microorganisms) and steam sterilisation of surgical instruments were developed by Ernst von Bergmann (1836-1907) and these brought further improvements in surgery (Porter 1999, 370373). The introduction of general anaesthesia–the first drug being used was ether, and chloroform was soon found preferable–not only has relieved the patients from surgical pain but also enabled surgeons to carry out more complicated operations (and to help develop new surgical fields such as brain surgery, heart operation, organ transplant, etc.). Later local anaesthetics–the first one being cocaine–were developed for less invasive surgery (Encyclopӕdia Britannica Online, s.v. “history of medicine”;Porter 1999, 365-368). Shock due to blood loss during operations was another major obstacle for surgery. With the discovery of ABO blood types by Karl Landsteiner (1868-1943), blood transfusion became more successful and helped hurdle this difficulty of shock. In addition, with the invention of special surgical tools and skills (such as the use of tourniquets and vascular clamps), bleeding during operation could be better controlled (Kang 1997, 15; Porter 1999, 590-591).

Advances in diagnostic methods and instruments are noteworthy since the nineteenth century. Many clinical diagnostic tools were invented, and here are some commonly used ones: the stethoscope was devised by René Laennec (1781-1826) in 1816 (Porter 1999, 308-309); the ophthalmoscope (for inspecting the interior of the eye) was created by Hermann von Helmholtz (1821-1894) in 1851 (Porter 1999, 327-328); the clinical thermometer was introduced by Clifford Allbutt (1836-1925) in 1867 (Porter 1999, 346). The discovery of X-rays was instrumental to diagnostic medicine. Wilhelm Conrad Röntgen (1845-1923) discovered the penetrating power of X-rays in 1895. This immediately was exploited for diagnostic purposes. Röntgen also noticed the burning effect of X-rays, and its promising therapeutic value was used by physicians (Porter 1999, 605-607). Subsequently, more sophisticated diagnostic imaging and techniques, such as ultrasonography, computerised axial tomography (CAT), positron emission tomography (PET), magnetic resonance imaging (MRI), endoscopy, etc.,^[6] have been invented for diagnostic purposes and therapeutic applications in the twentieth century.^[7]

Another field worth specifying is genetics. It has long been known that some human features and diseases are hereditary. Heredity was not researched until the nineteenth century, when Gregor Mendel (1822-1884) first studied the crossbreeding of garden peas and demonstrated some rules of heredity. Though some diseases have been confirmed to relate to genetic abnormality (such as sickle cell disease and Down’s syndrome), the breakthrough in the study of genetics took place in the 1920s, when DNA (deoxyribonucleic acid) and RNA (ribonucleic acid) were discovered. In 1953, Francis Crick (1916-2004) and James Watson (born 1928) discovered the double helical structure of DNA. Since then, genetics has flourished with abundant scientific studies and findings, with genomics explored, genetic diseases identified, and technology of gene therapy developed (Porter 1999, 586589).

At the end of the twentieth century, there emerged a new area of biomedical research, namely the stem cell research, which has gained significant attention. It investigates the specialisation of stem cells to various specific tissue cells, and hence the potential application of these cells to repair or replace the damaged tissue or organ, as in the case of degenerative disease (such as Parkinson’s disease), injury, cancer, organ failure, and other diseases. Thus, this new research led to the new field of regenerative medicine (Frazier and Drzymkowski 2013, 25-26).

Footnotes and references:

[1]:

Encyclopædia Britannica Online, s.v. “history of medicine” [accessed November 15, 2014, http://academic.eb.com/EBchecked/topic/372460/history-of-medicine].

[2]:

Examples of prominent contributors were Aristotle (384-322 Before Common Era), Praxagoras (floruit 340 Before Common Era), Herophilus (circa 330-260 Before Common Era), Erasistratus (circa 330-255 Before Common Era), Asclepiades of Bithynia (circa 120-30 Before Common Era), Aulus Cornelius Celsus (floruit 60 Common Era), Soranus of Ephesus (circa 100 Common Era), and Dioscorides (circa 40-90 Common Era) (Porter 1999, 64-80).

[3]:

This brief description of medical history in the Renaissance and the Enlightenment is gathered from Encyclopӕdia Britannica Online, s.v. “history of medicine”; Levinson and Gaccione 1997, 47-48; Porter 1999, 8, 10; and Saethre 2008, 64.

[4]:

The practice of smallpox inoculation was already known in China in the 1500s, during the Ming dynasty (Lo and Stanley-Baker 2011, 161).

[5]:

Milieu intérieur, literally means “internal environment”, refers to the physiological capacity of the body to maintain a stable internal environment so as to have a free and independent life.

[6]:

For further development in diagnostic imaging since the discovery of X-rays, see Porter 1999, 607610.

[7]:

There are numerous discoveries and inventions in medicine and medical technology. It is impossible to enumerate (even briefly) all of them here. The above-mentioned ones are only some major and commonly known ones.