Closely related on the culture and the development of the companies, “art to cure” merged, during millenia, with the marvellous one, the beliefs in the supernatural one, the magic, the religions and the practices ritual. The history of this discipline is also that of the epidemics, the instruments, the diagnosis, the public health, the scientific reflection and the therapeutic ones.
Modern medicine goes up in the middle of the XIX E century, period during which fundamental sciences considerably made progress medical knowledge grace, in particular, with the improvement of the means of investigation of the human body.
Medicines of Antiquity One distinguishes three times, of which some overlap: that of medicines known as “primitive”, that of the hippocratic era and that of the galenical era.
Primitive medicines
Chinese medicine
The first great Chinese medical treaty, Neijing, is allotted to the mythical sovereign Huangdi, is called the Emperor yellow and born towards 2700 av. J. - C. However, according to certain indications which it carries itself, this work, also called Huangdi suwen, would have been compiled between the O C and the III E front century J. - C. the wou (wizard) and the yi (doctors) resort to acupuncture, the plants and the moxas (average to heat the interior of the body in certain points of acupuncture). During centuries, this medicine grew rich to arrive to us in his entirety at the XX E century.
Indian medicine
Contemporary of Chinese medicine, it is dominated by two doctors, Charaka (I er century apr. J. - C.) and Suçruta (IV E century apr. J. - C.), which write each one a treaty - the oldest collections (samshita) preserved - of traditional medicine, based on the analogy between the macrocosm (Universe) and microcosm (the man).
Mesopotamian medicine
Inspired by the magic and print of empiricism, this medicine is mentioned in the code of Hammourabi (XVIII E front century J. - C.), which regulates of them the practice, the scales of disability and the fees. Many shelves of clay found in Ninive, Babylon or Assour make it possible to better understand the medical practice of the doctors akkadiens; those had generally recourse to the hepatoscopy (reading of oracles in the liver of sacrificed animals) to designate the god, or the bad spirit, person in charge of the various diseases. The therapeutic one associates offerings, sacrifices, incantations, but also “natural medicine” understanding the art of the bandages, the reduction of fractures, the pharmacological regulations and the clothes industry of remedies starting from plants and various ingredients.
Egyptian medicine
It extends on nearly 3000 years. The study of the medical papyruses and the scientific examination of the mummies made it possible to know well the medical practice in old Egypt, but also to determine the nature of the diseases which could assign the Egyptians (bilharziasis, pathologies cardiovascular, rhumatologic and endocrinal diseases). In spite of the omnipresence of the divinities, like Imhotep, the god healer, the Egyptians manage to rationalize medicine by classifying the diseases by “specialities”: thus, the papyrus of Kahoun (2000 av. J. - C.) relates to gynecology and the veterinary art; the papyrus Ebers (XVII E dynasty) contains several hundreds of pathological entities and regulations; the papyrus Edwin-Smith (XVIII E dynasty), ancestor of the treaties of traumatology, comprises concepts of anatomy and surgery; the papyrus Chester-Beatty NR O 6 (time ramesside) is devoted to the proctology. In spite of the practice of the embalming and evisceration, the Egyptians have a rudimentary knowledge of the anatomy and indicate of the same term all the hollow conduits. On the other hand, they excel in ophthalmology: they operate cataracts. And they can look after many ophthalmias related on the sandstorms and the parasitoses.
The hippocratic era
Starting from the O C front century J. - C., the Greeks work out various philosophical systems to explain occurred of the diseases. To the XIX E century, the Hellenic systems will influence the thought and the medical practice in Occident.
Hippocrates de Cos
In Greece, exercise of medicine is governed by families of doctors, Asclépiades, which wants to be remote descents of Asclépios, son of Apollo and god of the Medicine whose legend locates the birth in Thessalie, where he was raised by the Chiron centaur.
The school of Cos
The medical schools most famous are in Rhodos, Cnide, Crotona, Agrigente (Sicily) and, especially, in Cos. The Large Hippocrates, most known of a line of doctors having exerted in the island of Cos, founds a medical school whose pupils write the Hippocraticum Corpus, immense medical work understanding nearly 72 pounds written in Ionian language.
For the first time in medicine, interpretations magico-nuns make place with a philosophical theory of the disease. However, if the doctors of the school of Cos apprehend symptomatology well, they hardly innovate in the identification of the clinical entities: the fever, for example, continues to be regarded a disease except for whole and not as a symptom. Moreover, the theory of moods privileges the research of the forecast and therapeutic control to the detriment of the diagnosis and anatomical knowledge - at that time, nerves and tendons are confused. Hippocrates allots occurred of diseases to a deterioration of moods compromising the balance of the human body. He admits that the organization fights against the disease and thus insists on the need for observing the patient well, to even carry out a clinical examination, throughout the various evolutionary stages of his pathological affection. Lastly, the work of Hippocrates fixes the medical rules of ethics and the deontology, with in particular the service of the Oath.
The medical school of Cnide
At the same time, the school of Cnide, rival of that of Cos and whose leader is Chrysippe (IVe front century J. - C.), writes the Sentences cnidiennes - whose extract only was preserved by Galien -, which classifies the diseases according to the affected bodies. In Cnide, the preoccupation with a pragmatism often carries it on the medico--philosophical theories of the school of Cos.
The medical school of Alexandria
From the IV E front century J. - C., Alexandria becomes the intellectual capital of Greece. Ptolémée Ier Sôtêr carries out the synthesis between medical knowledge Greek and Eastern, it authorizes the dissections and makes build the large library. Erasistrate de Céos and Hérophile de Chalcédoine, from the medical school of Alexandria, distinguish the arteries from the veins, discover the sensory nerves and driving, the cerebral convolutions describe and the cardiac valvules, attach the various intellectual functions to the brain and highlight the lymphatic system. Their anatomical and physiological discoveries will not influence the medical practice, which is entirely subjected to the theories of Aristote, Master of the comparative anatomy and whose thought will dominate medicine to the XVII E century. For Aristote, the heart, central body of circulation, are the hearth of animal heat, the seat of the heart and the thought, the lungs and the brain being only used to refresh it.
Medical schools of Rome
By conquering Greece, the Romans will adopt Greek medicine in its entirety. Starting from Ier front century J. - C., the doctors of the school of Alexandria go to Rome, where they gather in other schools, kinds of “sects” rivals having each one her specific doctrines. The nuclear physicists, led by Asclépiade de Bithynie (124-40), oppose the doctrines humorale of Hippocrates and regard the human body as a set of “atoms” being exchanged through “pores”; the bad provision of these atoms would determine the fever, the ignition or the pains.
The school of Methodist, outlined by Thémison de Laodicée, takes its rise, in Ier century apr. J. - C., with Soranos d' Ephèse, disciple of Asclépiade, which looks further into and schematizes the doctrines of the atoms. Other schools are founded in Rome: the empiricist ones - in opposition to the dogmatists - seek to determine the symptoms without being concerned with causes; the pneumatists, school dogmatist rested by Athenaeum of Attalia, compare any disease to a deterioration of the pneuma, single vital principle; the eclectists dissociate the preceding ones towards 90 on the instigation of Agathon de Sparte. To I er and II E centuries of our era, certain scholars were characterized by quality from their medical writings: Dioscoride in pharmacology, Arétée de Cappadoce - which belonged to no school - in pneumology and physiopathology, Rufus d' Ephèse in psychiatry and anatomy, Soranos d' Ephèse in gynecology-obstetrics and pediatry.
Lastly, Celse tries, in a true methodical treaty, Of Re medica, the first rational classification of the diseases by inventing the concept of syndrome (regrouping of symptoms to define a disease) and by differentiating the general diseases from the diseases located with a body. Celse, like Galien, rejects the doctrines and the dogmas, it makes confidence with the experiment.
The galenical era
Claude Galien is, after Hippocrates, the second eminent doctor of Antiquity. The influence of its work extends over fifteen centuries and covers all Middle Ages. On the 500 works which it wrote, only 83 reached us, in particular those which relate to the anatomy, pathology and physiology. Of Greek origin, he exerts in Rome and attempts to found a new system associating the theory of moods of Hippocrates, the objective data of the anatomy and those of physiology.
Surgeon of the gladiators, it in addition practices dissections on the animals and transposes his anatomical observations to the man. In spite of some important physiological discoveries (roles of the diaphragm, brain and marrow), its anatomical observations comprise many errors as for the number of vertebrae, with the formation of blood in the liver, with the circulation of air in the arteries or with the cardiac communication interventriculaire.
For Galien, blood is animated of a to and from in the veins and is linked with the pneuma in the heart. The galenical system wants to be rational and tries to define for each disease the cause, the injured body and the nature of the affection (responsible mood). Galien is also a large therapeutist, who left the pharmacopeia known as “galenical”.
Spirituality and medicine of the Middle Ages After the collapse of the Roman Empire of Occident, the teaching of medicine is not exempted any more, the writings of the ancient authors are lost or dispersed, and the practice becomes the reserved domain of the monks. The Church entirely adapts the medical practice, prohibited the dissections under penalty of excommunication, allots the name of a saint to the majority of the diseases, founds the application of the relics like therapeutic and refuses that the human body is explored, fearing to disturb the divine order.
In Ve and VIe centuries, Constantinople replaced Alexandria, and some rare doctors emergent in their writings: Oribase writes a medical Collection in 70 volumes, left compilation of the medical knowledge of the time; Alexandre de Tralles composes an internal treaty of pathology in 12 pounds; Paul d' Egine summarizes his surgical practice and obstétricale in a summary of medicine in 7 volumes. These three authors are studied to the XVIII E century by the students of the medical college of Paris.
Several events explain the progressive revival of medicine at the end of the Middle Ages: the foundation of the medieval universities; translation of Arabic to Latin, by the Jewish doctors and the Christians of Syria, of the “lost” treaties of the authors of Antiquity; establishment of hospitals to accommodate leprous, pestiferous and mentally ill people; finally, the emergence of the Arab doctors, whose original works constitute the only medical innovation with the Middle Ages.
Arab schools
As of IXe century, the brilliant Arab schools of Andalusia, of Persia, of Cairo and Baghdad translate the hippocratico-galenical medical comments. The Arab authors bring many complementary observations in surgery, ophthalmology, pharmacopeia and physiology. In Baghdad, the Rhazès surgeon, exceptional clinician, are the first to describe certain eruptive diseases, like variola and measles. Avicenne, called the “Prince of the doctors”, is the author of 150 works, whose Canon of medicine celebrates it, poem of 1300 worms translates of Arabic to Latin by Gerard de Crémone and considered to the XVII E century as the medical work of reference. In Cordoue, Abulcasis writes one of the most remarkable treaties of surgery of the Middle Ages, and the Jewish doctor Moïse Maimonide, exiled in Cairo, is famous for his Treaty of asthma. In Seville, Avenzoar is interested in therapeutic and the cerebral affections, while its Averroès pupil announces that variola never repeats.
Medieval universities
The foundation of universities in all the Christian Occident was going to stimulate the exchanges with the Muslim world and to create the conditions of a general revival of the knowledge. With X E century, the town of Salerno has already its medical school. The notoriety of this first medical university attracts many Jewish experts, come from the Muslim world, and Lombardic Masters, who write the Mode salernitain collectively.
Teaching remains faithful to the graeco-latin tradition, and of the doctors travellers as Constantin the African translate of Arabic to Latin of the texts of Galien, Hippocrates and the Arab authors, with sometimes admittedly of the considerable semantic losses or the important misinterpretations. One must to a midwife, Trotula (XIe century), a work of obstetrics, diseases of the front women, during and after the layers. From XIe century, the Masters salernitains found universities in Bologna (second half of XIIe century), in Montpellier (teaching begins there in 1137, but the statutes are established in 1220) and in all Europe: in Padoue, Paris, Salamanque, Oxford, Cambridge or Valladolid.
All the eminent doctors of XIIe and XIIIe century studied in Salerno and are trained in the galenical tradition: Gilles of Corbeil, author of a treaty on the urines, Arnaud of Villeneuve, the surgeon Henry de Mondeville and Guy de Chauliac appear among the Christian authors most famous of this time. During all Middle Ages, the medical knowledge does not progress, because Hippocrates, Galien, Aristote and Avicenne remain the absolute references of a medicine which lives in the obsession of the heresy and religious persecutions.
The medicine of the Rebirth
Two great events were going to mark the Rebirth: the invention of printing works and the discovery of the New World (1492). The “reappearing spirit”, it is before all freedom to think, the independence of mind, the individual judgment, the alarm clock of the culture and the rejection of the systems inherited the Middle Ages.
By inventing the metal mobile characters, in 1455, Gutenberg gives to the book - and the knowledge - a universal character. The time of the manuscripts reserved to the only clerks or for the college libraries is completed: medical knowledge can from now on leave the restricted circle of the initiates. The first printed medical book, in Mainz, in 1457, is a calendar of purgings. As of the end of the XV E century, the medical treaties of Celse, Rhazès, Avicenne, Avenzoar are printed and largely diffused in all Europe. It is the same for the anatomophysiologic philosopher's stones of the authors of the Rebirth.
The discovery of America
The discovery of America brings to its batch of new epidemics caused by microbial exchanges mortals between two ecological niches, those of the populations of Old and the New World, separated since from the millenia. During the extraordinary extension of syphilis, Jerome Fracastor announces, around 1546, the theory of the micro-organisms and the contagion. The “reappearing spirit” registered the exploration of the world and that of the body in the same movement (discovery of the anatomical organization). The doctors start to regard health as an invaluable good, thus dissociating principles of the Church, which reduced the body to an envelope of the heart. Paracelse marks the transition between Moyen-âge and Rebirth. Its medical work is not of considerable importance, but its spectacular standpoint will make followers: he refuses to write his Latin works and is expressed in German; and especially, extremely of its nomination as head doctor of the town of Basle, it publicly burns there, in 1527, at Midsummer's Day, works of Hippocrates, Galien, Aristote and Avicenne to mark its contempt of the scholastic of Old.
Anatomy and surgery in XVIe century
The first public dissection is authorized in Paris around 1478, and the “anatomical amphitheater” of the medical college of Padoue (created in 1228) is inaugurated in 1490. Leonardo da Vinci dissects about thirty corpses and carries out remarkable drawings, which will be published only in the XVIIe century. If the medieval anatomy represented the man in two dimensions, in the shape of a “burst frog”, from now on the human anatomy is dynamic: one understands the role of the articulations, muscular insertions, the tendons; the anatomical cuts carried out make it possible to appreciate the relief, volumes, the anatomical reports of the bodies between them.
André Vésale creates a nomenclature of the bones, muscles and vessels in his famous work Of humani corporis fabrica libri septem, appeared in Basle in 1543. Following those of Vésale, many work upsets anatomical knowledge: Charles Estienne describes the veins and the nervous system; Michel Servet, burned alive in Geneva for his theological writings, guesses pulmonary circulation and denies the communication between the two ventricles of the heart; Gabriel Fallopio describes the chorda tympani, the small intestine, the nerves of the eye and the vessels cerebral; Bartolomeo Eustachi, who gave her name to the horn of the ear, studies the kidneys, lymphatic circulation, the teeth and the suprarenals; finally, André Césalpin has a presentiment of blood circulation without being able however to make the demonstration of it.
The surgery profits from progress of the anatomy and, indirectly, the development of the firearms, which cause wounds very dilapidating. Ambroise Paré, surgeon of four kings de France, gives up the cauterization of the wounds with red iron and recommends the arterial binding. In Germany, Fabrice de Hilden transforms the technique of the amputations and the treatment of the burns. The cure of hernia, the extraction of calculations of the bladder and the lowering of the cataract are improved by Pierre Franco.
The biological revolution of the XVIIe century
Whereas the anatomists complete to describe the human body, biology will profit from a major innovation, the microscope, and of two great discoveries: the blood circulation and processes of fecundation. Sanctorius (Santorio Santorio, 1561-1636) is one of the first to want to apply to medicine knowledge of physics: it makes use of the thermometer, the balance and the pulsometer, instruments which will not be used, in practice medical current, before the end of the XIX E century!
Many doctors, in agreement with the mechanical theory of Descartes, compare the human body with a machine; these iatrophysicians, or iatromecanists, oppose to the iatrochimists, who believe in the omnipresence of the chemical reactions and the “leavens” in the human body.
The world of the infinitely small
The first microscopes are manufactured at the end of the XVI E century by Jansen, family of Dutch opticians. In 1609, Galileo improves the technique and develops the telescope; but it is one half-century later that the first great microscopic discoveries are reported. Robert Hooke mentions for the first time the concept of “cell” around 1665, in Micrographia. Antonie Van Leeuwenhoek, who built more than 250 microscopes, makes appear his complete works, Découvertes, of 1693 to 1718; he describes in particular the red globules, the protozoa (known as then “infusoires”), the striations of muscle fibers and the bacteria. The XVIII E century, the microscope will make it possible to look further into the anatomical investigations and to explain many physiological mechanisms, of which that of the reproduction.
This question touching with the mysteries of the life had practically never been tackled during the previous centuries, and one believed readily, except for Francesco Redi, with the “spontaneous generation”, i.e. with the presence of “small men” already trained in sperm. Reinier De Graaf, also known for his work on pancreatic juice, gives the first description of the ovarian follicule in 1672. Five years later, Louis de Hamm contributes on a tour of spermatozoa. William Harvey proposes the theory of the formation of “egg” in her Exercices work on the animal generation, appeared in London in 1651, and a few years later the role of the placenta is specified.
Controversies around blood circulation
Harvey, doctor of Jacques I er and Charles I er of England, discovers before 1616 the principle of circulation by carrying out experiments on deer. It publishes in 1628, in Frankfurt, its work Exercitatio anatomica of motu cordis and sanguinis in animalibus (“anatomical Exercise on the movement of the heart and blood in the animals”), in which it shows and describes circulation, cardiac contractions and the hemodynamic arteriovenous one. This revolutionary principle will start a polemic through all Europe, and in particular at the medical college of Paris. Two famous “anticirculateurs”, Jean Riolan and GUI Shoe, preferred targets of Molière (the Hypochondriac), lead the combat against the theories of Harvey and persist in believing that the arteries contain air and not blood.
Favorable to the circulatory thesis, Louis XIV fact of opening in 1672 a course of anatomy to the Garden of Roy and load Pierre Dionis to teach circulation there, putting a term at the rearguard action carried out by the Faculty of Paris and the Parliament. The circulation of as much will be understood better than Marcello Malpighi discovers the pulmonary capillaries in 1661. Integrating new knowledge on the blood circulation and the role of the heart, Richard Lower publishes, in 1669, the first great treaty of cardiology (Tractatus of cord, item of motu and colors sanguinis). The discovery of blood circulation by Harvey especially shakes all the system humoral hippocratic, which still dominates medicine, when Jean Pecquet shows that the lymph is also actuated by a circulatory movement.
The beginning of great medical classifications
At the end of the XVII E century, the first nosologies make their appearance, and the phenomenon will develop at the next century. Thomas Sydenham, called “English Hippocrates”, seeks for each disease the precise symptoms which allow the identification of it. Faithful to hippocratic medicine, he wants especially to carry out a clinical description of each affection and to announce the various symptomatologic variations met in each case. He individualizes the drop, erysipelas, the dysentery, the scarlet fever, the measles and the clinical forms of variola. This clinical work, brilliant, remains however very poor on the therapeutic level, and the bleeding has the appearance of a universal cure.
However, certain new products are very in vogue, like the ipéca (vomitory), the tea and the coffee (two new psychotoniques) and especially the cinchona (febrifuge paid of Peru); in the same way in Paris, in 1638, a register of the drugs appears, the Codex medicamentarius seu pharmacopea Parisiensis - there is another in Lyon. It is to the XVII E century that the first tracheotomies are practiced, in the case of the diphteria, as well as the intravenous injections and the transfusions of the animal to the man. The epidemics also change nature: syphilis loses its virulence, the last large leper-houses close their doors, and one witnesses some resurgences of the plague, as in London (1665). The development of the maritime transport involves the diffusion of paludism and the yellow fever whereas certain deficiency diseases, like the rickets, beriberi or the scurvy, is the object of precise clinical descriptions.
The medicine of the XVIIIe century
The medicine of the Age of Enlightenment, while forwarding itself to “modernity”, remains sullied with archaisms. Physiology and the pathological anatomy know true projections thanks to the development of the experimentation and with the fundamental advances in knowledge. On the other hand, the private clinic remains limed in the systems and, especially, abstract nosologies built according to the dogmas of Antiquity. Voltaire, like had made Molière at the previous century, scoffs these doctors who quote Hippocrates and Galien to mask their impotence, and which quarrels to know if it is necessary to bleed on the sick side or the healthy side. It is however at the end of this XVIII E century, characterized by a intellectual expansion, that one of the most important events of the history of medicine occurs: the focusing of vaccination.
The temptation of the systems and the nosologies
In the absence of being able to indicate the precise causes of the diseases, the doctors seek to determine the modifications undergone by the sick organization. Coexist then the theory humorale and the new designs of the XVIIe century dependant on a tour of principle of circulation (congestion, damning up, plethora). The iatrophysicians and the iatrochimists continue their demonstrations on the respective role of the physical and chemical laws controlling the human biological mechanisms.
Vitalism and animism
Two new theories make their appearance: vitalism and animism. The first doctrines occur in Montpellier with Theophilus de Bordeu and Paul Joseph Barthez, who consider that the human body is animated by a “vital dash” impossible to materialize but whose deterioration causes the disease. The animists as Georg Ernst Stahl think that, inside the body, the exchanges are regulated by a “significant heart” which is opposed to death. From these confused theories were going to be born from many systems of classification of the diseases in cash, classes, subspecies - categories already used in botany, zoology or chemistry. The nosologies of François Boissier de Sauvages, William Cullen and Philippe Pinel are among most famous.
Taste of the experimentation
The pathological anatomy and physiology make true great strides thanks to the development of the “cabinets of experiments” and, later, of the laboratories. After having multiplied the dissections and descriptions of injured fabrics, Jean-Baptiste Morgagni publishes her monumental work, bearing on 600 autopsies, Of sedibus and causis morborum per anatomen indagatis (“Of the seat and the causes of the diseases studied using the anatomy”), in 1761. For each autopsy, Morgagni tries to establish a correlation between clinical symptomatology and the anatomopathology.
Physiology is dominated by work of Albrecht von Haller over the muscular contraction and the nervous sensitivity. Réaumur determines the chemical composition of the gastric juice and explains the mode of action of it; Jean Astruc is interested in the reflexes and the gastric juices; Lazzaro Spallanzani, clever experimenter, complete important work on the reproduction, the hémodynamique one and digestion; Stephen Hales carries out the first measurement of the blood pressures arterial and venous in the mare; Luigi Galvani and Alessandro Volta study neuromuscular physiology, and Lavoisier explains the mechanism of breathing.
These physiological discoveries will not modify of anything the medical practice, which is always carried out without any clinical examination of the patient. Contrary to the doctors, the surgeons can palpate and practice the various touches (rectal, vaginal or oral), which explains great progress of the surgical act to the XVIII E century - and this in spite of the absence of any anesthesia.
Public health
The epidemics (eruptive diphteria, whooping-cough, diseases, ear-pieces, plague, variola) continue to decimate the European population. The concern of the public health and the safeguarding of the public health animates the governments; investigations and statistical studies are carried out. The prevention becomes a priority, as prove it the publication in 1762 of the work of S.A. Tissot Avis to the people on his health, or Treated the most frequent diseases, intended for the general public, but also the accumulation of reports on the organization of the hospitals, the installation of the sewers, the regulation of the chemical plants or the slaughter-houses, the displacement of the cemeteries out of the cities.
Vaccination
The most important discovery is probably that of antivariolar vaccination by Edward Jenner: it notes that the farm ones never contract variola and that their hands are in contact with worse cows at the time of the draft; however these animals are affected by a disease, the cow-pox (or vaccinates), which seems to be at the origin of the immunization against variola. After many experiments, Jenner proves that the pus of vaccinates introduced by scarification into the human organism protects it indeed from variola. This new process still divides the doctors, but vaccination will end up being essential on the beginning of the XIX E century, and of the massive vaccination campaigns will be organized in all Europe.
Medicine at the XIXe century
While medicine is detached definitively from philosophy to enter the modern era, the sum of knowledge and the medical discoveries acquired between 1800 and 1895 exceeds that which was accumulated during the former millenia. The private clinic, the surgery and physiology progress to step of giant, always leaving with the drag the therapeutic one, which will have to await the XX E century to become credible. However, in less than one century, the clinical examination, the anesthesia, the antisepsy, bacteriology and, finally, radiology upset the medical forecast and make it possible to lengthen the life expectancy.
Anatomoclinic method
With the French revolution and the Empire of Napoleon, medicine will make true great strides under the impulse of the French clinicians. Medical teaching entirely is renovated and unified on all the territory of the Republic; the abstract theoretical matters, of rule under the Former regime, are removed with the profit of an obligatory hands-on training; Latin yields the place to French. The hospital, little attended hitherto by the doctors, becomes the guaranteeing one of a high level medicine: the establishments are laicized, and of the hospital contests (like the boarding school, in 1802) organized.
The doctors seek to examine their patients objectively, and especially systematically to compare the data of the private clinic with those of the pathological anatomy. The medicine of the systems died, only counts the anatomoclinic method definite by Xavier Bichat in his two famous works the Treaty of the membranes and Research physiological on the life and death. Is tickled pink defines each membrane (human tissue) according to its anatomofonctionnelle structure and its physiological role. From now on, the teaching of the anatomy will be done on the level of fabrics and either only of the bodies.
Incipient sounding
The medical practice is revolutionized by the discovery of two new means of clinical investigation: the percussion and sounding. Jean Nicolas Corvisart translated in 1808 a work of Johann Leopold Auenbrugger on the percussion, whose publication in 1761, in Vienna, was remained completely unperceived. Thus, the thoracic “caves” or the “liquid collections” can be diagnosed thanks to the percussion, simple technique applicable at the bedside of patient. In 1807, Laennec discovers the sounding and develops its famous cylinder out of wood, which will become the stethoscope. Twelve years later, it publishes its Treaty of the mediate sounding, in which it fixes the rules of the pulmonary and cardiac sounding. Joseph Récamier upsets the gynaecological practice thanks to his vaginal speculum (1812).
Lastly, Pierre Charles Louis invents the “numerical method”, which consists in following the evolution of the diseases - it is interested in particular in tuberculosis and the typhoid fever - by regularly noting all the quantified variations accessible to the private clinic. From this method were going to rise from the statistical studies on the diseases allowing to determine with precision the forecast, the clinical evolution and the therapeutic effectiveness.
These considerable contributions involve a complete redefinition of a large number of diseases scattered in the complex nosologies of the XVIII E century. Gaspard Laurent Bayle describes tuberculosis; Jean Baptiste Bouillaud studies the acute rheumatoid arthritis; Orfila founds toxicology and legal medicine, and Bretonneau is interested in two large plagues of the XIX E century: the typhoid fever and diphteria.
Lastly, Jean Cruveilhier publishes of 1830 to 1848 his Treaty of general pathological anatomy, which contains multiple lithographies and describes the simple ulcer of the stomach. The French school makes followers through all Europe, and soon of other schools teaching the anatomoclinic method open in Austria, England and Germany.
De Magendie with Claude Bernard
According to François Magendie, the anatomoclinic method is insufficient to give an account of the evolution of the pathological process. In other words, the autopsy cannot, with it only, to in vivo replace the physiological studies. During one half-century, it multiplies the animal experiments, and bases its method on the laws of physics and chemistry. Its philosopher's stone, the elementary Precis of physiology, will be republished many times. Magendie founds experimental pharmacology, carries out the first cardiac catheterization and studies the physiology of the nervous system (formation of the retinal image and sensitive role of the posterior roots of marrow).
Claude Bernard, raises of Magendie, succeeds to him the Collège de France. By publishing its Introduction under investigation experimental medicine, in 1865, it fixes the rules of research in biology and the procedures of the animal experimentation. Baited worker, Claude Bernard studies the glycogenic function of the liver, the pancreas, the vasomotor nerves, the glands with internal secretion (endocrine) and external secretion (exocrines). Especially, it assigns to each fabric a function and proves that the variations of the interior medium can have remote effects on a body. The methodology of Claude Bernard was going to inspire by many researchers in France and Europe, which will adopt the same scientific rigor.
The definition of new medical fields
Gregor Mendel states the laws of the genetics; Etienne Jules Marey, genious physiologist, are interested in the muscular movements, hemodynamic, and carry out with Auguste Chauveau the first electric layouts of the heart; Emil Of Wood-Reymond founds electrophysiology; Carl Ludwig works on the physiology of cardiac mechanics. Rudolf Virchow studies the pathological anatomy under the cellular angle and publishes in 1858 his cellular Pathologie work, fundamental theory in physiological and pathological histology, which allows a microscopic approach of the disease. By prolonging work of Is tickled pink, Virchow proves that the cell confers its specificity on fabric, and identifies certain leukemias and some varieties of tumors. The technical improvement of the microscopes, the discovery of new cellular dyes by an chemical industry incipient and the practice from the biopsies by Ernest Besnier make it possible the medical diagnosis to be based on a histopathologic proof.
These fundamental discoveries in physiology and histology involve an avalanche of clinical descriptions and individualization of very many diseases. Certain doctors acquired their notoriety in a particular discipline, and their hospital service specialized. The cardiology, neurology, dermatologist-venereology, pediatry, psychiatry are the first medical specialities to emerge from the joint base.
The anesthesia and antisepsy
In 1830, a surgeon operated in town suit, without gloves; he could pass from a meeting of dissection to an intervention without very washing the hands, seldom carried a blouse, did not disinfect the wounds nor the skin of the patient and, finally, operated with sharp, without anesthesia! Mortality per- and postoperative was enormous, without evoking the sufferings of the patient. Moreover, the good surgeons, like Jean Dominique Larrey or Guillaume Dupuytren, drew their reputation the speed to which they could disjoint a shoulder or extract a tumoral mass. However, the idea to remove the suffering during an surgical operation is very old (as testify to it the use of the stone of Memphis by the Egyptians or that of the sponges sleeping pills to the Middle Ages), but the anesthesia is not put so much so that in 1846, in the United States; one year later, the technique gains Europe, which gives place to tumultuous debates. However, of many models of masks are invented, and it chloroform is tested successfully. The intravenous anesthesia will not be possible that after focusing, by Gabriel Pravaz, of the syringe with piston.
The rules of the antisepsy are enacted by Joseph Lister, who invents an apparatus to pulverize phrenic acid in the operative field. It recommends to let soak the instruments in phenol, to bandage the wounds with phénolées compresses, to use a wire with joining résorbable and to take care of cleanliness meticulous person of the hands and blouses. Work of Louis Pasteur on the pathogenic role of the microbes will consolidate it in its research. The obstetricians will be the first to apply these new directives disinfectants and will note a very clear reduction in mortality after the childbirth. In parallel, industry médicochirurgicale develops and of new instruments are manufactured, as the hemostatic grip of Jules Péan or that of Theodor Kocher. The surgeons become more daring.
Bacteriology
In 1877, Louis Pasteur begins his work on the role of the “microbes” in occurred of the infectious illness. The scientist is already famous, because its studies on fermentation, the wine, beer, the vinegar, “pasteurization” and the diseases of the worms with silk refer directly to the daily life of the French. Pasteur definitively cut down the thousand-year-old myth of the “spontaneous generation” and shows that the cholera of hens is well a contagious disease caused by a bacterium. Not being neither doctor nor veterinary surgeon, it will have to battle firm to make admit, in 1878, his theory of the germs and his applications to medicine and the surgery with the members of the Academy of medicine of Paris. Pasteur isolates the staphilococcus (1878), the streptococcus (1879) and prepares the first human vaccine with virulence attenuated against the rage (1885).
Its work upsets, once more, the diagnosis and the forecast of the contagious diseases, which raise all from now on of an identifiable cause. Moreover, the surgeons, who had already had to assimilate the rules of the antisepsy, must conform to the new Pasteurian designs on the asepsis: pot, instruments, bindings, compresses and gloves must systematically pass to the autoclave or be sterilized by boiling according to the recommendations of Terrillon Octave and Louis Felix Terrier. The rubber glovees, developped at the point into 1885 in the United States, will appear in Europe around 1889.
The “Pasteurian ones”
They continue the work of the Master: Alexandre Yersin isolates the pesteux bacillus in 1894 and highlights, with Emile Roux, the diphteric toxin (1888). In Germany, Robert Koch discovers the bacillus of tuberculosis in 1882 and the choleraic vibrio in 1883. Moreover, the techniques of coloring of the bacteria focusings, in particular, by Hans Gram make it possible to refine the identification of the germs. Lastly, the first serodiagnoses are discovered by Fernand Widal for the typhoid one and Almroth Edward Wright for brucellosis. Most pathogenic bacteria are identified at the end of the XIX E century; on the other hand, research on the viruses will develop only in the years 1930.
Beginnings of the “medical technique”
Thanks to the development of the techniques of investigation on the human body, the doctors were going finally to find what they sought since always: the objective proof allowing to carry a diagnosis with more safety.
X-rays and radiographies
On November 8th, 1895, the German physicist Wilhelm Röntgen discovers the X-rays later. Three months, the first medical radiographies are carried out in England, in Austria, in France, in the United States. Medical radiology is taught since 1897 in most great Western nations: it intervenes in the systematic tracking of the pulmonary tuberculosis.
Rare fact in the history of medicine, an invention puts less than two years to be adopted in the whole world. In addition to their immense diagnostic interest, the “Röntgen rays” have a therapeutic power, quickly put in obviousness by Leopold Freund, dermatology.
The first radiologists did not protect themselves and were unaware of the risks of radiodermatitis, and the patients were to keep the installation during more than twenty minutes, because the first radiographic bulbs were of low power. In 1896, Henri Becquerel discovers the radioactivity, whose medical application will be later. Two years later, Pierre and Marie Curie isolate radium.
First methods of investigation
The endoscopy, allowing the internal exploration of the bodies and the hollow conduits, develops thanks to max Nitze, which improves the technique - already old (1807) - by the introduction of a coolant circuit to water into the instruments. The source of light (an incandescent candle or lamp) released a quantity of important heat, which limited the duration of the examination. The electricity and the use of flexible rubber tubes will complete to popularize the endoscopy. The lumbar puncture, which makes it possible to examine the chemical composition, cellular and bacteriological céphalo-rachidian liquid, is standardized by Heinrich Quincke in 1890.
Then, Scipione Riva-Rocci proposes her sphygmomanometer, ancestor of the tensiometer, thanks to which it blood-pressure is taken correctly and easily. At that time, indeed, the doctors start to measure the biological constants of the body, to make use of the balance, the clinical thermometer and many other instruments allowing to pose a surer diagnosis. The first test laboratories medical start to integrate the hospital under the impulse of Widal; they can quantify the urea (1828), the glycemia, the glycosurie (1848), the albuminuria (1874).
Great therapeutic discoveries
The therapeutic one progresses thanks to the considerable development of fundamental knowledge in analytical chemistry, with the improvement of the processes of chemical extraction and with the foundation of the first large industrial pharmaceutical laboratories. The capsule is a process patented in 1834; the tablets appear in 1843, and the first subcutaneous injections in 1845.
The artificial respiration is proposed in 1858 by Silvester, and, around 1860, Auguste Nélaton invents the flexible urinary rubber probe. But it is especially the extraction of the active ingredients of plants employed since of the millenia which allows a new adjustment of therapeutic and the birth of the chemistry of synthesis: morphine is isolated in 1817, quinine (antipyrétique) and cafeine in 1820, chloroform in 1831, the acetylsalicylic acid (aspirine) in 1856, digitalin (for the treatment of cardiac failure) in 1871, the methylene blue in 1876 and the trinitrine (for the treatment of the angina pectoris) in 1879.
The way traversed by medicine during the XIX E century is immense, especially in physiology and private clinic. In one century, the confused nosographies and the systems will have disappeared with the profit from an objective medicine, to which lack still the therapeutic success, because of large plagues - tuberculosis, typhoid fever, influenza, cholera, plague - still devastate the world. Dominated by the European nations, the medical research will have to take account of a new participant: the United States.
The medicine of the XXe century
During centuries, the medical knowledge gradually moved macrocosm towards the exploration of microcosm. Philosophical theories of Antiquity to anatomical descriptions of the Rebirth, via the study of the bodies and of their function, then with tissue and cellular physiopathology, medicine is from now on able to detect biological variations with the molecular scales. The XX E century still moved back the limits of the human investigation thanks to the multiplication of the complementary examinations, which authorize an increasingly selective approach of the pathological processes being able to relate to one element of the cell (organoids, core, membranes).
The therapeutic one is the profit second of this remarkable advanced scientist, because the treatments (medical and surgical) can them also be imagined at the level of the molecule, of gene or the cell, even if the limit between physiology and pathology is increasingly difficult to distinguish. The medical act brings today, generally, an effective response to the suffering and the request of the patient while being based on the scientific investigation, sometimes to the detriment of the human relation between doctor and patient. The discoveries and the innovations of the XX E century are so numerous that it is difficult to count them in an exhaustive way - as it is often impossible for the historian to designate with certainty the research team indeed responsible for such or such discovery.
The era of the examinations paraclinic
Conceived and imagined in the laboratories, the complementary examinations develop after the First World War; they make it possible to the doctor to refine his diagnosis and to follow the evolution of the diseases.
The contribution of the medical imagery
Radiology does not cease improving its technique: replacement of the glass plates by films, use of products of contrast in order to determine a body or a cavity, use of probes of exploration.
Since the focusing of the tomodensitometry (scanner) and nuclear magnetic resonance, in the years 1970, the medical imagery provides to the expert a three-dimensional topography and shows the true nature of pathological lesions of less than 1 cm diameter (more easily accessible to the surgeon). The nuclear medicine lost its only curative power to become also an exploratory technique.
Since the years 1950, thanks to the scintiscanning (or gammagraphy), with the use of cells marked by an isotope, it is possible to study the metabolism of the bodies. The endoscopy benefitted from same progress with the miniaturization of equipment and the addition of grips allowing the biopsies. Today, the endoscopes are able to explore the articulations interphalangiennes! Most bodies can also undergo biopsies. Moreover, it is now possible to detect in utero the great genetic diseases of the fetus. Two great innovations mark the XX E century: ultrasonography, applied to medicine in the years 1960 (detection of calculations, liquid collections, anomalies of the vascular walls), and electric recordings, like the electrocardiogram (1903) or the electroencephalogram (1921).
Assets in biochemistry
Biochemistry profited from immense progress of the techniques of examination (ultracentrifugation, 1926; electrophoresis, 1937; immunoelectrophoresis, 1948); from now on, thanks to electronics, of the autoanalyseurs were developed. The biological reagents purified and of the cases of reagents make it possible to carry ambulatory diagnoses to carry out trackings of mass. The intradermal reactions are proposed since 1907 to diagnose tuberculosis; the test of pregnancy is developed in 1928. But it is especially the blood which is the subject of all the investigations since the discovery of the blood groups by Karl Landsteiner, in 1900. The study of the hémostase and immunology (coagulation) begins with R. Coombs in 1945. The identification and the synthesis of the majority of the vitamins and the hormones are carried out between 1920 and 1940. Lastly, the genetics experienced a considerable development in the years 1950, under the rigorous control of the principles of the medical ethics. In 1953, the molecular structures of the nucleic acids are determined by Watson and Crick, who propose their model of the double helix of the DNA. Consequently, the human genome and that of the pathogenic living organisms (bacteria, virus) can be identified.
Therapeutic effectiveness
After the Second world war, the industry of the drug obtained with considerable means making it possible to begin long and expensive research on natural substances or synthesis. The industrial production of penicillin since 1943, to meet the needs for the hospitals during the war, starts one new therapeutic era. Other antibiotics are discovered - the streptomycine (1943) or isoniazid (1951), credits against the bacillus of Koch (tuberculosis) -, so that most bacterial infections become accessible to the treatment; an end (provisional) is put to millenia of epidemics face to which the man remained impotent.
But each success has its reverse: the bacteria can, by modifying their genetic material (changes), to become resistant to an antibiotic treatment - from where the need for the researchers for putting constantly at the disposal of patients of new antibiotics. In the same way, of the new infections appear, and the curative treatment of the virus diseases remains always dubious, in spite of the appearance of first the antiviral specific ones to the beginning of the year 1980.
The treatment of arterial hypertension and the majority of the cardiovascular diseases benefitted from the medicamentous discoveries, and in particular from the anticoagulant treatment (to heparin, 1937) and from diuretic (during the years 1950). In fact, all the medical specialities saw appearing products which transformed diseases said hitherto “incurable” into “remissible” diseases.
Psychiatry is marked by the appearance of nerve sedatives in the years 1950; endocrinology, by that of insulin (1924) and cortisone (1948); cancerology, by the hormone therapy, in cancers of the prostate (1940), and the antimitotic ones, which prevent the multiplication of the cells (in the years 1970). Lastly, among the recent therapeutic innovations can be quoted the kidney machine (Kolff and Merill, 1944), the stéréotaxie in intracranial neurosurgery (Spiegel, 1947), the exsanguinotransfusion (Tzanck and Bessis, 1948), the prosthesis of acrylic resin hip (Judet, 1950), the artificial respirator (Engstrom, 1952), the polio vaccination (Salk then Sabin, 1954), extracorporal circulation (Lillehei, 1953).
The medicine of thousand-year-old IIIe
The life expectancy of the medieval man was 25 years, it borders today the 80 years in the Western countries. This report is however tarnished by the disparities shouting between the nations, which tries to fight the World Health Organization (WHO), founded in 1948. If variola were eradicated of planet, of new infections appeared, like the AIDS, which implies the concentration of large research efforts on the intimate structure of the viruses, immunizing processes and antiviral molecules.
Indeed, new diseases do not cease appearing, because of the modifications which the man makes to his environment and his lifestyle; not counting, of course, clean evolution of the pathogenic organizations. If the life expectancy still lengthens in the years to come, it will be thanks to new technologies, like the laser, the assistance by computer, the medical imagery and the biomaterials, which make it possible to replace an injured fabric, even a sick body.