An incredibly brief history of medicine

hello I'm John Gaeta I career in the Himalayas of all places many years ago and then I fell in love with general practice in New Zealand and returned eventually to the UK where again I pursued a career in general practice and in training future general practitioners and since well really since it started I have been the international director of prime partnerships in international medical education which has taken me to many parts of the world meeting many wonderful and inspiring people and seeing the vast potential there is for really developing the full understanding of whole person medicine within excellent scientific clinical practice now they say that the the past helps us understand the present and may be a guide to the future the things to aspire to in the future the things to avoid in the future and so what I thought we would do in this presentation is to take an incredibly brief look at the entire history of medicine principally in the Western world and of necessity I mean the history medicine such a vast topic we're going to make huge time leaps huge cultural things and huge assumptions and miss out many details but I hope in this short presentation we will start to see where medicine has come from how we've got to where we are now and where the future might lie so an incredibly brief history of medicine if we go back to the very earliest recorded times of mankind we find that illness was due to divine displeasure when I was working in Bhutan they they put green branches in front of the houses to keep out the the evil spirits that would cause disease and throughout history this is the the concept in other words you got sick because you made God angry to certain extent this this attitude it certainly prevailed in the time of Jesus 2,000 years ago because they asked him who sinned this man or his parents to which he replied neither we get sick because we're human even when I had cancer people said it's not right it's happening to a good person like you and whilst I was quite pleased they thought I was good then I thought maybe they didn't think I was good because I got sick but we still have these inherent attitudes about deserving illness and it being some sort of judgment what have I done to deserve this many people say into this world this animistic world of disease being due to this divine displeasure came Hippocrates now we're going back two and a half thousand years Hippocrates is called the father of modern medicine he introduced the concept that we should always look for natural causes of illness that it doesn't say they're always caused by natural causes but we should always look for them we should seek to prevent disease by lifestyle changes and of course moderation in all things except the zeal to be a good health care practitioner he also brought in the concept of ethics up till the time of Hippocrates the doctors apothecaries the witch doctors of the time it could not be trusted they might give you a poison because they've been paid that way by an enemy or they might give you something they hoped would make you better he brought in the concept of integrity it concept of the patient's good being the absolute be-all and end-all of what we practice and he didn't just make this a good code he actually said I swear by the great god Apollo and all the other gods and goddesses this is something intrinsically in the relationship between man and God when the Christian era began we didn't change the Hippocratic oath except we attributed I swear by Almighty God when we enter into health care we enter into something which is more than just a medical practice just a job we enter into something which is fundamental at the roots of humankind Aristotle coming slightly later he sought to marry the natural causes that Hippocrates had talked about with philosophy he taught that the liver was the organ that was to do with food the brain to do with motion because after all if you hit somebody on the head they stopped moving and the heart the heart was the the the seat of the Spirit the source of life the passion and feeling we still use this word heart absolutely interchangeable with with with spirits with with life Galen took this thought further now he observed of course that red blood came from the heart through the aorta black blood came through the portal system from the liver so Blackbird was something negative the spirit the life was carried in the red blood and of course from that derived the concept of bleeding if the black blood was a greater proportion and predominance to the red blood then you were sick so you bled out the venous blood and it shows the danger of making observations but not fully understanding them and from this mismatch of observation and and concept and extrapolating it just a stage too far came a thousand years or more well over a thousand years of the practice of leeches venesection which actually made people worse rather than better we have to be careful even in this modern era that we don't make such assumptions and so for a thousand years or more medicine health care became an eclectic mixture of divine displeasure demons and curses I've had people come to me and say that someone has cursed them and they are ill deficiencies and spiritual devotion you're not godly enough and then physical causes the time of the plague they thought it was the damn foul air rising from the River Thames and the treatments were equally eclectic prayer priestly intercession pilgrimages to the bones of saints you know to some of these things to apply penances poultices and applications of course leeches and then some of the predecessors of our modern pharmacopoeias as sort of potions and herbal remedies from which eventually have derived so much of our modern therapeutic armament and I said I saved this this is poor science and it's very doubtful theology but it's a recognition of the essential makeup of human beings body mind and spirit meanwhile in the Arab world the Arab scholars had preserved the writings of the Greeks the scientists translated many of them into Arabic and developed practices of surgery practices of therapeutics they had a formulary and some of this knowledge then started to filter back where the Islamic and the Christian worlds met in place like Solano in Sicily in Toledo in Spain and here is Constantine the African as he was known who studied in the north african countries and then brought some of that knowledge back into the medical centers run by the churches in the south of europe and here's a picture of him examining urine very much they thought they could discern an awful lot from the examination of urine as very often we can so what did medical care look like in the first part of the second millennium it was of great mixture here is probably at its best the hospitality de santa maria della scala opposite the great Cathedral in Siena in Italy so one of the places that this marriage of Christian caring and an Arab science had come together and in the middle of the 11th century the church built a hospital to serve the needs of the poor poor beggars orphans and poor pilgrims they said the rich could afford their own doctors but the poor needed the care of the church they set this up it functioned as a hospital till 1930 must be a absolute record in the Great Hall in 1452 1451 artist painted life in the hospital at the time and here we see some of the care being given it was run by a Christian Brotherhood some of whom would classify as doctors some as apostles carers but here we see a beggar obviously who's been seriously injured we look at his face he is terrified he's received a huge wound which in many times would have killed a person in those days and this attendant is washing his feet watching you feet partly because it's touch and touch is healing but partly because Jesus washed the feet of his disciples and he following in the example of Jesus is doing exactly the same saying here am I an educated man learners here am i washing your fees a beggar not because it was a ritual but because he was devoted to the care of those who had nothing and the interesting thing is you can see the surgeon in the background with his forceps and his sponge not pushing the attendant out of the way saying here I'm busy get out of my way he's recognizing that dealing with this person's inner hurt is every bit as important as dealing with that wound now that bleeding has stopped that the dealing with the spiritual the mental emotional aspects of his injury and that's what we're finding more and more in how to treat victims of disaster the the the need to avoid post-traumatic stress disorder if ever possible here we see in another corner there's a a one of the Leigh brothers attached to this order listening to the spiritual problems of a patient and then the medical relationship didn't stop there here they're restoring this healed beggar to dignity they they gave everyone discharge new clothes not secondhand ones rags they sent them out newly clothes healed in body but now able to hold their head up with respect within society and so often we forget this need our duty to our patients doesn't just end when we've given the right medical treatment they're only fully healed when they are restored that's what healing means wholeness and here they took this task very seriously we talked about body mind and spirit and the way I view this is is that we have a physical body we're aware of that but we also have a spiritual body we have a mind that links the two together and these components are as integrally linked as this mosaic on the floor of a late Roman Church probably about some third or fourth century showing it into linking of the component parts of human nature and also as they saw it the nature of God totally integrated we can't separate it and if we try to we end up with bad medicine let me explain it this way I often teach overseas and when I go home one of my eight grandchildren usually comes running up to me and flings their arms around me and says granddad I love you one of the great things about growing old you have grandchildren and the physical air vibrates the tympanic membrane physically vibrates this is my body the ossicles vibrate and then there's a a chemical physical electrical reaction which transfers that vibration into an electrical impulse travels to the acoustic cortex of my brain but there my mind transforms it into a thought a concept but as my spirit that rejoices it's me my inner me and out of that rejoicing of my spirit my mind transforms that rejoicing into a electrical impulse travels down my laryngeal nerve my vocal cords and I say I love you too whether we like it or not whatever our theology whatever our worldview we all function as body mind and spirit the inner being communicating with the outside world through the mind and all diseases actually contain all these three components we call it psycho spiritual because where the mind ends and the spirit begins is difficult to say where the body ends and the mind begins is again difficult to say but some diseases are essentially biological by a physical a fractured bone but a fractured bone why is it been fractured what was the cause the person who has it has anxiety they feel guilty that they've done this thing that they're going to be unable to work that their family's welfare their family's income might suffer so a a fractured femur has all sorts of psychological and even deep spiritual attachments to it and then of course something like an anxiety state until that of the mind well anxiety state arises maybe because of a lack of trust like a trust in yourself in your surroundings in God but even that it has physical effects and you can think of some of them palpitations raised catecholamine levels in the blood tremor sweating pallor you see we are body mind and spirit now Along Came this gentleman in this picture William Harvey now William Harvey as we I think most of us know was reputedly the first person to describe the accurate circulation of the blood that arteries carry the blood away from the heart veins bring it to the heart and it's hard for us in 21st century to to imagine the impact that had on society at the time they were still under this stata learn concept that the heart was the seat of the spirit the source of life is where where we exist and then suddenly it became a mechanical pump now that doesn't cause us great problems today but it has great impact at the beginning of the 18th century which was the time of what's called the Enlightenment across Western Europe the concept came that if we divided humanities from science if we took away the religion music literature art these were things which actually were a feat there were things which were not real and there were things that caused disagreement and it would put things the hard science the physics the chemistry the biology where you could actually observe and measure things nobody can disagree about a measurement and so this concept came that the the one was real and the other one was illusory the BSC and the BA and medicine came firmly in the camp of the science leaving behind the humanity of the person so medicine is investigative it's material it's the real world it's it's biology whereas the humanities communication the spiritual the understanding what makes us human that is different now what followed what followed we started to develop organs centred medicine that's good I suffered cancer I'm glad that this organ sense of medicine we got increasing specialization in smaller and smaller areas we started having hospitals for eyes hospitals for skins students were selected for their scientific ability medicine and indeed in nursing now science rules a concept within the medical profession develop the top doctor is the top scientist professorships are given on research rather than communication top doctor is always a specialist communication skills were not important now in UK thankfully and many other countries they are starting to come back into the curriculum but generalism generalism was devalued how did this affect the way that we educate our doctors and nowadays increasingly our nurses my introduction to a patient was some 45 years ago when I was starting medicine at blenheim University it was a great medical school still is and the introduction said report at 9 a.m. on the 1st of October to the dissection room and so my introduction to a patient was to actually peel the skin off the back of a cadaver and we do this we peel the skin off the face we study the course of the jugular vein study the courses trigeminal nerve but so often we actually forget to put the skin back on and to look for that flicker of emotion look for what the expression means look for the eyes the anxiety the distress that is there we learn our physiology from frogs at least I did and inevitably you start to think of yourself and others really as overgrown Franck's it's subtle but pervasive we learn krebs cycle now when I show this usually people laugh because it's a nightmare to me and we spent a lot of time learning there's now I'm glad we've got correct cycle we all need it to exist but we learn this and yet tend to leave behind the chemistry of relationship which is I think much more important than learning some of these names and formulas okay how does that affect how we see our patients well here we have the patient 48 year-old man he presents with breathlessness when lying flat he has chest pain on exertion he has this pain it radiates into his left arm and he's got a history of hypertension and unfortunately his defaulted from follow-up now you can think of the diagnosis most probably it's its left ventricular failure it's the heart he's developed at atherosclerosis s which has led on to angina so we've learned the anatomy of the heart we can picture the left ventricle with also I hope learned the process of atherosclerosis and we need to know these things these are things we really need to understand the process that is affecting our patients but when the patient now let's give him a name we don't just have the patient the thyroid case in the fifth bed down on the right a patient has a name and he isn't going to be saying to you when he comes at least he's not going to say in his head what stage of atherosclerosis have I got are the calcium deposits he's going to have other questions just think if you are mr. Smith and you've come in because you've got this symptom and they say you've got advanced heart disease what questions are you going to ask am I going to die am I going to die will my wife leave me for a younger fitter man can I have sex with my wife there are so many questions that are in the patient's mind and we tend to think asterisk erotic process and referrals and stenting and tablets maybe he's got a little child will I see my little boy grow up what happens to his education if I'm not there to provide for him will he be able to continue at school will he be able to go to university and mr. Smith has parents maybe they're alive maybe they've died and they will have endowed him with things they would have been doubted not just with the genes which may have given him the propensity to develop the heart disease but they'll have given him attitudes one prevailing attitude in so many countries is big boys don't cry many men think it's unmanly to seek treatment maybe that's why mr. Smith didn't have his blood pressure followed up it's not manly to be ill they give him attitudes to diet which may be a causative factor or maybe he's got to look after them maybe their age it and how is he going to care for them as they get increasingly frail in old age maybe his laborer will he be able to work at all or maybe it's his job and the stress that have contributed to his heart disease now all these are important questions they're all relational questions they're all to do with the social environment the relational environment in which our patients live and we've studied the trigeminal nerve and not built the skin back on the face this is an article from the British Medical Journal of 2004 and here it says medical training seems focused onto how to deal with things a liver and MRI scan rather than how to deal with people such as patients and colleagues and then he goes on to say this lack of training on how to deal with people could mean doctors are ill-equipped to do this vital part of their jobs and explains much of their subsequent stress if we're any treating half the patient with half of us then we are going to develop stress because we need to be the same inside as out we need to be practicing as whole people with whole patience we're very good at being trained to use our biophysical component to use our hands to palpate our ears to auscultate a chest our eyes to look at x-rays to look with an ophthalmoscope at the fundus we're very good at that to use our rational brain our left brain if you like to run through differential diagnosis to make action plans but we tend to keep our own inner being a relational part our psychological our spiritual component we tend to keep that away so we don't meet great relationships I was actually taught keep yourself apart from the patient because you can't bear their pain well I think part of the skill of being a really good doctor or nurse is to actually learn how to share that pain with the patient but then shed that pain but that's another topic so what we are doing is using our biophysical component to treat the biological part of our patient what we really need to do is to be able to be flexible to been run be excellent at medical science we owe that to our patients but we also need to be able to meet heart-to-heart with our patients we need to be able to look deeper than just that which presents on the surface or even deep inside but the the biological thing is relatively easy to discern MRI scans are brilliant but we can't have an MRI scan of the of the real things which cause patients to present the way their illness affects them the things that will lead to compliance the things that will help them feel better and give them more hope in the future and that's where we need to use that machinery that's been given to us our own intrinsic understanding of human nature and indeed this is now widely recognized the World Health Organization in 1998 said the mechanistic view of patience which focuses on medicine and surgery is no longer satisfactory patients and physicians have begun to realize the value of elements such as faith hope and compassion in the healing process faith hope and compassion vital elements in healing where do we learn them do we lose them during our training or are they increased it makes good medicine it makes for a far better understanding of ourselves it makes our practice much more enjoyable Lister did 9 when I retired some years ago I had over 200 letters from patients and while some of them said thanks to your brilliant diagnosis whether it was brilliant or not I don't know but thanks to your diagnosis I'm still here today but more of them said when my mother died you were there when my marriage broke apart you gave me such hope for the future when my child was born I was so glad you were there and were able to see them grow up this relational aspect of medicine must be one that goes on into the future but it's learned from the past let us take the wonderful advance of science that has given us so many medical cures let's accelerate it but let's not soon lose sight of the fact as the World Health Organization said that faith hope and compassion are vital ingredients of what we do thank you

Channel: PrimeNetworkInt

Views: 78,942

Rating: 4.7842321 out of 5

Keywords: PRIME Network, International, Medical Education, History Of Medicine (Field Of Study)

Id: MtAjIG45O64

Length: 28min 45sec (1725 seconds)

Published: Thu Feb 13 2014