When we suffer from any disease today, we generally know a lot about it. First of all, its cause. With this knowledge, we can find out how it works and from there derive possible therapies, whether palliative, curative or preventive.
The amazing thing about this entire body of knowledge is that it did not exist just 160 years ago. In other words, practically everything we know about physiology, anatomy, heredity, pharmacology, and biology is the product of human work from the mid-nineteenth century. Just like how online poker is entirely a twenty first century invention.
Today, however, we live under a medical reality, especially in societies that have better economic conditions but not only in them. It is hard for us to imagine what a world was like almost without painkillers, without antibiotics, without anesthetics, without insulin, without transfusions, without transplants, without vaccines, without all the elements that we have at our service in case of illness or injury.
The evolution of medicine
The evolution of medicine has a long journey with procedures carried out since times as old as the Paleolithic. In prehistory, medicine was immersed in magical rituals, where shamans and similar figures used preparations based on plants, animals, and minerals.
In the history of medicine, the Egyptians recorded an extensive study of diseases and treatments, dating back to 3,000 BC. Doctors at the service of the pharaohs and their instruments have been reflected in tombs and temples.
The so-called medical papyri (2040 to 1795 BC) include Egyptian diagnoses, treatments, and medications. The Ebers papyrus stands out in this period for its details of recipes, ointments, and instructions for treatments.
Next, we are going to learn how the historical evolution of medicine was enriched by the research of great philosophers.
Greece and Hippocratic thought in the evolution of medicine
An important medical school flourished in Alexandria with exponents such as Herophilus, Erasistratus, and Galen. These philosophers, among others, helped develop scientific and philosophical thought and the Hippocratic orientation of medicine.
Herophilus of Chalcedon (335-280 BC) developed the first comprehensive work on the anatomy and connections of the nervous system. Erasistratus of Ceos (304-250 BC) studied the brain, blood vessels, and nerves.
Aelius Galen or Galen of Pergamon (128-200), studied medicine with followers of Hippocrates and was a physician to several Roman emperors. He was a talented anatomist and also influenced the definition of ethical aspects of medicine with his treatises (Campohermoso, 2016).
Socrates and the ethics of medicine
Socrates the Greek (470 BC) has gone down in history as one of the most important classical philosophers. Noted for his approaches to ethics and morals in patient care.
Socrates conducted studies regarding the functioning of the mind and the understanding of the world. From his practices derive the maieutics and the Socratic method, still in use. Also studies on the psyche, the development of the inductive method, and constructivism, among other areas.
Medical knowledge, before the Scientific Revolution that began in the 16th century, faced enormous limitations, so that it was replaced by speculations rather of a philosophical nature or reasoned, argued, or common-sense conclusions, but which had no proof. ascertainable. Thus, for example, the Romans prohibited the dissection of the human body, so that knowledge of anatomy was derived from the treatment of soldiers in combat or gladiators in the arena, and from the dissection of animals.
That made the most influential doctor before the appearance of science, Galen, a Greek who lived under the Roman Empire. He believed that the human body was made up of four senses of humor (yellow bile, black bile, blood, and phlegm) and that the imbalance between them was the cause of the disease, which in turn came from “miasmas” or “bad winds”.
The idea was not unreasonable, because at least it correlated the lack of hygiene, unpleasant odors such as those of decomposing food or stagnant water, with the disease, but assuming a causal relationship that did not exist. Galen described the human body using his work on animals, accumulating a large number of errors. For example, he claimed that the human jaw was made up of two bones, like in dogs, when in fact it is a single bone.
Thousands of years of trial and error, especially in surgery, developed in part due to the warlike tendency that our species has shown, were not totally in vain. In fact, it is amazing that some techniques of reconstructive surgery, cataract surgery, or some battle operations, in particular amputations, are so similar to those we use today, although in much less frightening conditions for patients.
Little more could have been done at the time by the doctor of the second century of the Common Era. But little more would be done in the following 1,400 years. Galen’s statements became part of the authority of antiquity, which could not be questioned, along with views that prevented the development of chemistry or biology.
In other human societies, disease theories were also not supported by an objective approach to reality. Some invoked supernatural issues, such as divine punishment for sin, demonic intervention (such as possessions or witchcraft enchantments) as the origins of disease. Others blamed the individual for having an incorrect or unhealthy attitude or vision. And others looked for causes abroad, in food, in water, or in the air.
Pine resin and feces
Therapies that were available to people were equally unreliable. Some were the product of empirical knowledge derived from the use of plants within the reach of each society, which could contain, without doctors or patients actually knowing it, some active ingredient that had an effect on health, such as willow bark, which has acid salicylic, an analgesic.
Others stemmed from magical visions, such as the belief that beet juice is “good for the blood” because of its red color, or that walnuts are good for the brain because of their resemblance to it. Other therapies were simply prayers, donations to the temples (such as that of Aesculapius, where Galen learned a lot of the knowledge about medicine), penances, or prayers to saints.
Some therapies today challenge our ability to understand their origin. When King Charles II of England fell seriously ill in 1685, his fourteen doctors entered into a competition to see who was the best and who “cured” the monarch, subsequently benefiting from his approval.
Since it was a question of recovering the “balance” of the royal humor, they made several blood extractions in addition to treating him with vomitives, enemas, purges, and poultices designed to cause him to sweat and act as diuretics, in addition to powders to induce sneezing; they shaved it and gave it blisters on which they applied cantharidae powder, a poisonous beetle.
However, the list that we know of treatments applied to the unhappy king includes elements as difficult to explain even in the pre-scientific view as an ointment of pine resin and pigeon feces on the feet and the skull powder of an innocent man who had suffered a violent death.
The attentive care of the fourteen doctors, however, failed to prevent the death of the monarch after four days of these violent attentions. Some medical historians claim that the real cause of Charles II’s death at the young age of 55 was his doctors.
In the world before medicine, there were no vaccines, and diseases now forgotten or eradicated, such as smallpox, typhus, and cholera, unstoppably ravaged millions of lives. The concept of hygiene did not exist either. As pathogenic microorganisms were not known, the idea of contagion was limited to the belief that it was carried out, again, through the air.
Doctors who treated infectious patients went on to attend to others who were rather healthy without washing their hands or their primitive instruments. And there was no anesthesia, which made almost impossible a huge number of surgeries that are now routine.
Although the greatest advances in medicine are still a mere hope in the poorest countries, the results of knowledge of the human body and its diseases, its chemistry and its biological processes have also affected them. Hygiene, the growing network of drinking water and vaccination have offered everyone a clear improvement in the quality and quantity of our lives, increasing life expectancy at birth for all of us, although making us forget how much things have changed in only 160 years.
Evolution of medicine: current advances in this field
The main medical advances of today have been possible thanks to the combination of technological innovation and research development. Here are three examples with important technological applications for the present and future of medicine.
Dr. Michael A. Teitell, Director of the UCLA Jonsson Comprehensive Cancer Center, highlights how advances in immunotherapies have enabled the development of more effective treatments.
For some types of cancer, clinical studies are being carried out that represent important niches in the evolution of medicine:
Multiple Sclerosis (MS) is a disease where the immune system attacks elements of nerve fibers (myelin sheaths). Causing gradual and progressive damage.
The most recent advances in MS immunotherapies include:
The pandemic has accelerated the application of existing technologies and innovation, and the adaptation of online health care approaches, in order to serve millions of people sheltered from contagion in their homes. An example of this is telemedicine. At the same time, we have seen how the development of vaccines has accelerated, seeking solutions to stop the advance of the pandemic or reduce its effects.
Technology once again shows its contributions to the evolution of medicine, responding with innovations such as:
Future expectations in the evolution of medicine
The main medical advances reviewed by Science magazine in its 2020 Breakthrough of the Year point to:
Telecommunications technologies, big data analysis, artificial intelligence, and the Internet of Things support medical praxis, expanding the scope of telemedicine.
The combination between medicine and technology is inseparable, creating new approaches or improving existing ones. Therefore, the evolution of medicine will continue to amaze us, improving our life expectancies.