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A History of Occidental (Western) Medicine

September 10, 2013

 

     The presence of an established tariff for the practice of medicine and surgery in the Code of Hammurabi (the sixth king of Babylon), 1800 BCE (Before Christian Era), suggests that the profession had begun to establish itself well before then, perhaps dating to the Sumerian civilization (between the Tigris and Euphrates Rivers) of 4000 BCE.

     Understanding the cause of disease and the operation of remedies in ancient Babylon (modern day Iraq) was deeply intertwined with primitive folk medicine and a belief in supernatural forces.  Rational understanding of organ systems and functions of the human body was impossible.  There was, however, categorization of a wide variety of ailments, grouped according to the part of the body that was affected.  Treatment consisted of a long list of vegetable, mineral and animal substances, including excreta.  The treatments were specially prepared for administration, in ways impossible to ascertain, and either applied directly to the affected area, given by mouth, and or administered by rectal suppository.  There is little indication that medicine during this time was helpful for the underlying condition, with written records revealing that the physician of the time moved through the long list of treatments for the same disease, mostly without success.   

 

The first documented physician in Egypt was Imhotep in 2725 BCE.  Egyptian medicine was influenced by Babylonian practices and beliefs, but expanded with knowledge of anatomy and the availability of instruments developed for primitive surgical procedures and the mummification process.  Doctors in ancient Egypt went through years of medical education, conducted by high priests in the temple, learning the art of interrogation, inspection and palpation.  Medical practice in Egypt included magical spells to ward off supernatural intervention on diagnosis and treatment.  With a greater understanding of anatomy, however, Egyptian treatments were more successful, with standardized prescriptions for wound healing, skin disorders, intestinal parasites, and migraines, often with treatments made and used personally by the “gods”.

     The Greeks, with an independent, sea-faring spirit and quest for knowledge, moved medicine into the modern age.  Greek medical thought combined ancient empirical lay medicine with the science of mathematics, geometry, astronomy, physics and alchemy, the precursor to modern chemistry.  The Greeks laid the groundwork for a rational approach to the practice of medicine.    

     From the Pythagorean school of thought, as developed by Empedocles of Agrigentum  (504 – 443 BCE), came the doctrine of the four humors (blood, yellow bile, black bile and phlegm) matched to the four elements (fire, air, water, earth) and the four sacred colors of the alchemists:  red, yellow, black and white.  From the school of Philolaus of Tarentum (480 – 400 BCE), came the doctrine of the three spirits.  The vegetative spirits, located at the navel, were shared with all things that grow.  The animal spirits, centered in the heart and giving rise to movement and sensation, were shared by all beasts.  The rational spirit was situated in the brain and shared by man alone.  Advancements in anatomy were hampered by a Greek taboo against dissection, believing that the physical body was connected to the soul, even in death.    

 

Because of this taboo and likely bearing witness to countless iatrogenic and poisoning deaths, Hippocrates (460-377 BCE), relied on careful observation of the evolution of the disease process, espousing primum no nocere, first do no harm.  He saw disease not a punishment from the gods, but a consequence of environmental factors, diet, and living habits, which holds true to this very day.  He observed that nature had an innate ability to re-balance the four humors and heal itself.  Hippocratic therapy focused on supporting the natural process, with “food as the medicine and medicine as the food”.  Hippocrates developed the first traction bed for the treatment of orthopaedic injuries.  He was the first to separate medicine from mysticism and the temple, describing a rational practice based on observation and rigorous attention to detail, which included meticulous documentation of the natural course of disease, leading to the ability to diagnose and prognosticate the course of an illness.  Using the Hippocratic method, the physician became a servant of nature, a doctor, not a sorcerer.   

 

Galen of Pergamum (129 – 200 CE), a Roman of Greek ethnicity, was a physician, surgeon and philosopher, schooled in the Greek tradition.  At the age of 19 he traveled to Alexandria to study medicine and returned to Pergamum (Eastern Turkey) at age 28 as physician to the gladiators of the High Priest of Asia.  While in Alexandria, Galen learned anatomy and physiology by dissection and vivisection of monkeys and pigs, restricted by the Greek and Roman prohibition against human dissection.   His knowledge was advanced through his work in Pergamum.  Interestingly, only five gladiators died in the four years of his service as opposed to sixty under the care of his predecessor.  He considered the wounds of the gladiators a “window into the body” and used the opportunity wisely.

    Galen remained grounded in the Greek theory of humorism.  He was a prolific writer, with his contributions in anatomy, physiology, pharmacology, pathology, neurology and philosophy influencing the practice of medicine for over 1300 years.  He perfected and promoted the practice of venesection and bloodletting, the most common practice of the medical profession until the late 19th century.    

 

After Galen, the next major influence in the practice of modern Western medicine was a radical, Renaissance physician, botanist, alchemist and astrologer, Philippus Aureolus Theophrastus Bombastus von Hohenheim (1493 – 1541 CE) born in Switzerland, to a father who was both physician and chemist.  He insisted on using observations of nature, as opposed to following the ancient texts, which included openly burning these texts, antagonizing many of the practicing physicians of the day.  He changed his name to Paracelsus, which means equal to or greater than Celsus, a Roman encyclopedist who wrote De Medicina in the 1st century CE, considered the best surviving treatise on Alexandrian medicine, which included sections on diet, exercise, treatment, pharmacology, mental illness, surgery and the importance of the patient/physician relationship.

     Paracelsus believed in the Greek concept of the four elements, but opined that the cosmos was composed of three spiritual substances, the tria prima of mercury, sulfur, and salt, broad principles giving every object its inner and outer form.  Sulfur embodied the soul, (the emotions and desires); salt represented the body; mercury represented the spirit (imagination, moral judgment, and the higher mental faculties.  By understanding the chemical nature of these three elements, a physician could discover the means of curing disease.  Providing minerals and chemicals created balance and health in the human body.  He recognized there were beneficial substances in herbs, minerals and various combinations thereof.  He also recognized that within these same substances were poisons. “All things are poison, and nothing is without poison; only the dose permits something not to be poisonous”.  Paracelsus discovered zinc and pioneered the use of chemicals and minerals in medicine.  He is considered the father of modern toxicology.     

 

Medical science advanced after the death of Paracelesus, highlighted by the work of Carl Wilhelm Scheele (1742 – 1746 BCE), a pharmaceutical chemist, born in Strasland, Pomerania (Northeastern Germany).  In addition to his joint recognition for the discovery of oxygen, Scheele is argued to have been the first to discover other chemical elements such as barium, manganese, molybdenum, and tungsten as well as several chemical compounds, including citric acid, lactic acid, glycerol, hydrogen cyanide, hydrogen fluoride and hydrogen sulfide.  He discovered a process similar to pasteurization, along with a means of mass-producing the phosphorous used in matches.  Arguably, his most important discovery was that of chlorine, a yellow green gas isolated from pyrolusite (impure manganese dioxide).  Scheele immediately recognized the bleaching properties, which ultimately led to the disinfection of water and eradication of the water borne plagues responsible for millions of deaths over the preceding centuries.  He died at the age of 43, a result of repeated exposure to the hazardous materials he handled, isolated and even tasted, including mercury, lead and arsenic.    

 

The work of Paracelsus was refined by Christian Friedrich Samuel Hahnemann (1755 – 1843 CE), born to a painter and porcelain designer in Meissen, Germany, near Dresden.  Hahnemann was a linguist, a chemist, a botanist, a medical doctor and the founder of Homœopathy.  Like Paracelsus, Hahnemann understood the presence of poisons in all medicinal substances, and also recognized that within the substance that contains the poison is also the cure.  Through “prüfung” (the German word for testing) of chemical substances formulated using his expertise in drug preparation, Hahnemann noted that a “drug” in concentrated, “molecular” form worked in a different way from the same “drug” taken through a series of dilutions and succussions, a technique applying heat and friction in a closed space, breaking the molecule down into its component elements

     Drugs in concentrated, molecular form, acted in an “allopathic” way.  Allopathy, derived from the Greek word ἄλλος, állos, for other and pathos, πάϑος, páthos, for suffering, meant that the drug affected a process other than the disease itself, in fact acting on the part most exempt from the disease, i.e. the healthy part of the body.  Allopathic actions were noted to induce conditions unrelated to the disease (side-effects), in an infinite number of ways.  Drugs in diluted and succussed form acted in a “homœopathic” way.  Homœopathy, ὅμοιος, hómoios, for similar + πάϑος, páthos, meant that the drug acted in similar ways to the disease itself, affecting the diseased tissues in a like manner, and curiously and substantively, affecting a cure.  For this similar effect, Dr. Hahnemann coined the term, similia similibus curantor, “the law of cures”, meaning that what produces similar symptoms in a healthy person will act to cure a sick person with similar symptoms.  A third drug effect was also understood by Hahnemann, the “enantiopathic” or “antipathic”, απέναντι, enantíos, for opposite, πάϑος, páthos, and meant that the drug acted in direct opposition to the disease itself, contraria contraiis curantor, “the law of contraries or opposites”. 

     Perhaps the most remarkable and heroic prüfung was accomplished by one of Dr. Hahnemann’s students and later colleague, Constantine Hering, himself a medical doctor.  Hering obtained a deadly snake, the Surukuku of the Amazon valley, delivered alive in a bamboo box by terrified natives.  After stunning the seven foot snake with one inch long hinged fangs, he milked the venom and worked, with the help of his wife, to dilute and succuss the dosing he imbibed.  He fell into a fever, with delirium and mania.  By the next morning, he awoke and his mind was clear.  Trigonocephalus lachesis remains one of the most powerful remedies in the homœopathic Materia Medica. 

     Advancement of medical science throughout the ages could not have occurred but through discoveries in other disciplines.  Sir Isaac Newton (1642 – 1727 CE), an English physicist and mathematician, described the laws of motion and universal gravitation.  He also developed the reflecting telescope, understood the spectrum of color to be an intrinsic property of light, laid the foundation for classical mechanics and invented infinitesimal calculus.    

 

Antonie Philips van Leeuwenhoek (1632 – 1723 CE), a Dutch tradesman and scientist, familiar with glass processing, and with significant technical insight, manufactured more than 500 spherical lenses along with numerous microscopes, capable of up to 500X magnification.  Leeuwenhoek was the first explorer of the microscopic world, identifying cells and seeing the structure of muscle fibers, mouth bacteria, and spermatozoa and observing blood flow in capillaries.  The secrets of his work were carried to his grave.  He is regarded as the “Father of Microbiology”. 

     Dmitri Mendeleev (1869 – 1907 CE), a Russian chemist and inventor, described the behavior of elements (atoms identified based on a unique number of protons in the nucleus), formulated The Periodic Law, which described patterns of behavior of elements based on electron configuration, and published a periodic chart of elements in 1869, which replaced previous versions and predicted the properties of elements yet to be discovered.    

Max Karl Ernst Ludwig Planck (1858 – 1947 CE), a German theoretical physicist, originated quantum theory and supported the work of then unknown, Albert Einstein (1879 – 1955 CE), likewise, a German theoretical physicist, who produced a theory of quantum mechanics and the general theory of relativity, revolutionizing understanding of time and space.  Einstein understood the connection between energy and matter and described photoconductivity and the photoelectrochemical effect, revealing how energy moves through matter, from the deep recesses of the cell to the broad expanse of the universe.  Einstein described the quantum nature of light and electrons and influenced the formulation of the concept of wave – particle duality, realizing that energy and matter exist at the same time, not in an either or relationship.

     

 

Mikhail Semyonovich Tsvet (1872-1919), a Russian – Italian botanist, developed a technique he named chromatography in 1906, allowing identification of plant pigments by separation into component colors.  Advances in technique since then allow the separation of increasingly similar molecules from an endless variety of substances.  Chromatogaphy  identifies molecules in plants, herbs, minerals, medications and food in any form, whether raw, steamed, poached, broiled, fried, baked, char-grilled, braised, stewed, etc., scientifically validating what Paracelsus and Hahnemann could only intuit, that within each substance is a poison as well as a cure.

     Component identification down to the atomic and subatomic level was advanced with the discovery of the Rāman affect in 1928 by Sir Chandrasekhara Venkata Rāman (1888 – 1970 CE) and Kariamanickam Srinivasa Krishnan (1898 – 1961), both from Tamil Nadu India, physicists and colleagues.  Rāman spectroscopy, based on scattering of light energy through a substance, allows the identification of the component parts of solids, liquids and gases and has application across a wide spectrum of industry.  Rāman spectroscopy identifies the substances facilitating the “law of cures” Hahnemann observed, but could not explain.

     Medicine in the 21st century is endowed with a rich and storied legacy of sickness, tragedy, sacrifice, persistence, dedication, humility, heroics and triumph, propelled by a thirst for discovery and a desire to elevate the human condition.  The legacy has eradicated communicable disease and plague that decimated populations, advanced trauma and emergency care, and outlined diagnosis, management and treatment of illness.  Importantly, the legacy has provided scientific evidence for the mysticism, the soul, the dynamism, the cosmos or the vital energy known to imbue all matter, which for lack of “rational proof” engendered raucous debate, vehement objection and even discount of the principles being advanced by enlightened explorers throughout the ages.

     Atoms, which Greek scholars could only surmise, have been identified, categorized and subdivided into protons, neutrons, electrons, hadrons, mesons, quarks, leptons, photons and waves.  DNA, RNA, histones, cellular organelles, enzymes and cellular metabolism have been defined and function of cells and cell systems, human systems and universal systems of the “microcosm” and the “macrocosm” have been delineated in exhaustive detail. 

     From basic inorganic and organic chemistry, basic physics and quantum theory emerge the tools for 21st century therapeutics to sustain and support the needs of a person composed of trillions of cells running  photoelectric energy.  Scientifically sustaining and supporting the needs of a cell evolves prior theories of “diet”, “nutrition”, and “exercise”.  Evolution has always involved the surrender of old beliefs, which history has shown does not occur without resistance.  Those who make the effort to meet the needs of the cells, however, will be rewarded with optimal health.  TRUTH, and scientific truth describing natural law, always prevails.

 

 

 

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