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Galen (c.130 AD - c.210 AD)
Claudius Galen © Galen was a physician, writer and philosopher who became the most famous doctor in the Roman Empire and whose theories dominated European medicine for 1,500 years.
Claudius Galen was born in Pergamum (modern-day Turkey) of Greek parents. He studied in Greece, in Alexandria and other parts of Asia Minor and returned home to become chief physician to the gladiator school in Pergamum, gaining much experience of treating wounds.
In the early 160s AD, Galen moved to Rome to work and, with the exception of a brief return to Pergamum, spent the remainder of his life in the Roman capital. He became physician to the emperor Marcus Aurelius and would later serve in the same role to Aurelius's successors, Commodus and Septimius Severus.
Galen was the originator of the experimental method in medical investigation, and throughout his life dissected animals in his quest to understand how the body functions. Some of his anatomical and physiological observations were accurate - for example, he proved that urine was formed in the kidney (as opposed to the bladder which was common belief). His most important discovery was that arteries carry blood although he did not discover circulation.
Galen was prolific, with hundreds of treatises to his name. He compiled all significant Greek and Roman medical thought to date, and added his own discoveries and theories. His influence reigned supreme over medicine for 15 centuries after his death. It was not until the Renaissance that many of his theories were refuted.
A visit to Galena is truly like stepping back in time. Fully eighty-five percent of Galena's buildings are in a National Register Historic District. Even the scenic beauty of the surrounding hills and valleys is a testament to being untouched by time.
With the decline of the lead mining industry and the start of the California Gold Rush, the population of Galena began to decline and stands at approximately 3,600 today. Although many of the people left, the legacy that remains is a city rich in architectural beauty and history. A history so intact still today, that we are often referred to as the town that time forgot.
Galen Timeline - History
The theory was created around 2000 BC. It is one of the oldest personality theories around.
Galen's inspiration came from the four elements which include fire, earth, water, and air. As well as Ancient Greek medicine and philosophy. Galen associated the four temperaments to humors. The temperaments include warm, cold, moist, or dry. The combinations of warm and moist, warm and dry, cold and dry or cold and moist are the dominated combos. The humors include sanguine, choleric, melancholic, and phlegmatic. A temperament is the combo of physical, emotional, and mental characteristics of a person. A humor refers to personality. Sanguine is optimistic. Its' fluid is blood. Its corresponding trait is openness to experience. Choleric is irritable. Its' bodily fluid is yellow bile. Its' corresponding trait is agreeableness. Melancholic is depressed. Its' bodily fluid is black bile. Its' corresponding trait is neuroticism. Phlegmatic is calm. Its' bodily fluid is phlegm. Its' corresponding trait is neuroticism. Humors' also corresponded with the weather. Sanguine corresponds with spring. Choleric corresponds with summer. Melancholic corresponds with autumn. Phlegmatic corresponds with winter.
Galen Timeline - History
A HISTORY OF THE NERVOUS SYSTEM
"By means of nerves, the pathways of the senses are distributed like the roots and fibers of a tree." --Alessandro Benedetti, 1497
Nerves proved to be a fairly difficult part of the body to categorize. The origins of the word "nerve" -- initially a Greek word meaning tendon or sinew -- suggests a certain confusion between connective tissues and other, more subtle types of physical connections within the body. As late as the twelfth century, the Jewish philosopher Moses Maimonides observed: "One who is not knowledgeable in anatomy may mistake ligaments, tendons and chords for nerves." Nonetheless, ancient medical practitioners did understand that nerves served roughly two functions: movement and sensation. The question was how they operated and under the direction of which principal organ.
In the fourth century B. C., the Greek philosopher Aristotle believed firmly that the nerves were controlled by and originated in the heart because it was, in his interpretation, the first organ of the body and the seat of all motion and sensation. Not surprisingly, he was misled by his confusion between ligaments and nerves in drawing this conclusion. Six centuries later, the Roman physician Galen contradicted him, disparaging those "who know nothing of what is to be seen in dissection." Instead he concluded that the brain was the most important organ of the body, with the nerves emanating from it:
"I have shown in my book On the Teachings of Hippocrates and Plato that the source of the nerves, of all sensation, and of voluntary motion is the encephalon [the brain] and that the source of the arteries and of the innate heat is the heart."
Galen saw the spinal cord as an extension of the brain which carried sensation to the limbs. He believed th at the nerves controlled the actions of muscles in the limbs, and that the two principal functions of the nervous system, sensation and motion, were governed by two different types of nerves: respectively soft and hard. He further insisted on a curious anatomical feature of the nerves, imagining them to be hollow tubes. Quite logically, he reasoned that this must be so in order for the animal spiritus, the body's principal source of vitality in his system, to circulate throughout the body. As the Renaissance illustration here indicates, the investigation of the nerves after Galen also became an inquiry into the effect of the brain on the body.
Medieval physicians, in agreement with Galen, believed nerves were offshoots of and controlled by the brain. The Islamic medical philosopher Avicenna wrote in the early eleventh century that "Nerves are one of the 'simple members' -- homogeneous, indivisible, the 'elementary tissues' (others include the bone, cartilage, tendons, ligaments, arteries, veins, membranes, and flesh)." He offered a more precise physical description of them -- "white, soft, pliant, difficult to tear." He and his contemporaries began to describe the complex and varied arrangements of nerves throughout the body, attempting to differentiate further their functions. In the Canon of Medicine, he observed: "Dryness in the nerves is the state which follows anger." Such statements suggest that Avicenna also believed the nerves to be entangled with and responsive to the emotions, yet another sign of their strong connections to the brain.
Slightly more than a century later, Master Nicolaus offered a more precise vocabulary to express the new complexity of the nervous system, discarding the terms "soft" and "hard" for the more familiar idea of sensory and motor nerves. He considered nerves subservient members of the brain that carried out the animal spirits to all members, endowing them with sensation and motion. He further differentiated their points of origin and termination:
"According to some authorities, all the sensory nerves originate from the cellula phantastica, the motor from the cellula memorialis. There are also five kinds of sensory nerves, which are classified according to the operations of the five senses, namely, sight, hearing, smell, taste, and touch. Two nerves arise from the cellula phantastica and cross in the middle of the forehead, one of them passing to the pupil of the right eye, the other to the left. Through these nerves visual spirits are conveyed to the pupils." Leonardo da Vinci's famous image of the human head makes these cells quite apparent in a drawing that clearly is based on medieval theories of the body rather than actual dissection. Many medieval anatomists devised elaborate theories of how the nerves created emotions and sensations in different parts of the body through their attachment to principal organs and members.
The writings of the Renaissance physicians reflect a mixture of ancient and medieval beliefs about the nervous system as well as new knowledge from anatomical dissections. In 1520, Alessandro Achillini could still write, much in the spirit of Galen, that "the nerves are light to receive the spirit and thin in order to offer swift and easy passage to the spirit and flexible to serve the members." Discussions of the nervous system increasingly reflected a mixture of close reading of ancient texts and knowledge culled from dissections. In the late fifteenth century, for example, Alessandro Be nedetti might still subscribe to the idea of spiritus, but his physical description of the nervous system was considerably more precise and detailed because of his examinations of cadavers. Similarly, his contemporary Leonardo da Vinci initially relied quite heavily on the writings of Avicenna and others in describing the nervous system and believed the heart to be the first organ. But this did not prevent him from recognizing that the nerves emanated from a different source: "The medulla is the source of the nerves which give voluntary motion to the members." Leonardo grew increasingly more confident of his own observations, ingeniously using a wax injection technique to obtain casts of the cerebral ventricles and used frogs for physiological experiments on the nervous system. From his studies he concluded that the spinal cord was the center of life. Look at his drawing of the spinal cord. How is he trying to convey the positioning of the nerves?
Throughout the sixteenth and early seventeenth centuries, ancient views of the nervous system existed in harmony with new findings. Vesalius, and even Descartes in his Treatise on Man (written between 1629 and 1633 and published in 1664), continued to speak of the place for animal spirits to roam throughout the body. In fact, Descartes continued to belief that the nerves were still hollow. Helkiah Crooke's Microcosmographia (1631) put it quite eloquently:
"The Nerves are nothing else but productions of the marrowy and slimy substance of the Brain, through which the Animal spirits do rather beam than are transported. And this substance is indeed more fit for irradiation then a conspicuous or open cavity, which would have made our motions and sensations more sudden, commotive, violent and disturbed, whereas now the members receiving a gentle and successive illumination are better commanded by our will and moderated by our reason."
Yet the space for animal spirits grew smaller and smaller as the anatomy and physiology of the nervous system became more elaborate. By 1653, William Harvey still might cite medieval authorities: "According to Avicenna, the nerves are like plantings of the brain, and provide ready intelligence for the organs of sensation like the fingers of the hand wherefore the brain neither sees or hears, yet knows all things." But he also took great pride in his century's extensive anatomical studies that had identified the optic, auditory, and olfactory nerves. And despite Descartes' insistence on the hollow nerve, the Scottish medical student John Moir record in his 1620 lecture notes: "nerves have no perceptible cavity internally, as the veins and arteries have."
Both Harvey and Descartes represent a transitional moment in which the animate powers of the nervous system were in doubt but no fully satisfactory alternative, that would explain how unseen messages were transmitted through the body, was yet in place. Harvey wrote in his Lectures on the Whole of Anatomy: "For the nerves only carry down, they do not act, move, nor are they sentient by a faculty, but are organs." Descartes offered an important revision of the nervous system as responding to "different kinds of particle motion (we should term these stimuli)" which stimulated the nerve endings, producing a series of successive motions that connected nervous fibers -- a new and much more physically precise description of the structure of the nerve -- to the brain. He concluded: "The essence of motor control is, then, the direction of animal spirits into the proper interfilamentous channels for transmission to the proper nerve."
As of 1681, a new word had appeared in English -- "neurologie" -- coined by Thomas Willis to described the study of neuroanatomy. Not until the late eighteenth century did physiologists begin to make the connection between recent work on electricity and theories of the nervous system.
QUESTIONS: WHAT DIFFERENCE DOES IT MAKE IF THE NERVE IS A HOLLOW TUBE OR A FIBER? WHY WAS THE THEORY OF ANIMAL SPIRITUS SO LONG-LIVED?
Human Dissection – From Galen to the Great Revelations of Andreas Vesalius
Humans have been cutting open cadavers and dissecting corpses almost since the beginning of recorded human history. Ancient Egyptians went to great lengths to mummify their dead, including cutting open bodies, dissecting out organs, and preserving remains. Following closely in their footsteps, ancient Greeks also pursued human dissection, in much more of a scientific vein. Rather than an immoral view of desecrating the human body, Greeks thought of human dissection as an extension of the empirical nature of science.
Two early Greek physicians, Erasistratus and Herophilus made the first systematic, scientific explorations of the human body, and they are now thought to be the first physiologist and the founder of human anatomy, respectively. Together, these two doctors advanced the study of the interior of the human body, which was once a sacrosanct mystery, into a field of scientific query. Herophilus dissected the entire human body, and differed from the authority at the time, Aristotle, when he claimed that consciousness was stored in the brain rather than in the heart. Erasistratus explained the workings of human organs in mechanical terms.
Unfortunately, the spark of empirical study of human anatomy that these two physicians should have set off did not light, as their two schools reverted to bickering over theoretical disputes. As if the fire of human dissection was not already flickering, it was snuffed out completely with the burning of the library of Alexandria and the widespread introduction of Christianity, when it became impossible to dissect human bodies anywhere in the Hellenistic world. This marked a great transition in the study of human anatomy, and for hundreds of years the European world valued the sanctity of the church more than scientific inquiry.
Galen’s Anatomical Influence
The first of the great anatomists was Galen of Pergamon (AD 130-200) who made vast achievements in the understanding of the heart, the nervous system, and the mechanics of breathing. Because human dissection was forbidden, he performed many of his dissections on Barbary apes, which he considered similar enough to the human form. The system of anatomy he developed was so influential that it was used for the next 1400 years. Galen continued to be influential into the 16th century, when a young and rebellious physician began the practice of using real human bodies to study the inner workings of the human body.
Enter Andreas Vesalius
Vesalius, who came from a line of four prominent family physicians, began as a young and precocious anatomy student. As a child, he would often catch and dissect small animals, and later as a medical student, he would go to great lengths to obtain human remains to study. At age 18, he entered the University of Paris, where they strictly adhered to the antiquated works of Hippocrates and Galen, and the medical professors thought it below themselves to perform actual dissections. During any actual demonstrations, the professor would lecture on high as a barber-surgeon did the actual cutting on the dissection floor.
Unlike Britain, in which only the bodies of executed murderers could be used for dissection by medical men, France’s revolutionary edicts made it easy for medically minded men to obtain bodies to study. This did not mean, however, that lowly students such as Andreas Vesalius would have direct access to any of these bodies.
Vesalius and other like-minded anatomy students would raid the gallows of Paris for half-decomposed bodies and skeletons to dissect. They would sometimes find the courage to go outside of the walls of Paris, braving the feral dogs and stench, in order to steal cadavers from the mound of Monfaucon, where the bodies of executed criminals were hung until they disintegrated.
Rather than considering dissection a lowering of his prestige as a doctor, Vesalius prided himself in being the only physician to directly study human anatomy since the ancients. During only his second anatomical lecture, Vesalius stepped onto the dissecting floor, took the knife away from the barber-surgeon, and began cutting at the cadaver himself, demonstrating his great skill with the knife.
His professors quickly noticed his great knowledge and ability, and by the age of 22 he was giving his own anatomical lectures, all of which centered on a dissection. Some of his subjects were animals, but more often than not they were human cadavers. He also suspended a skeleton above the dissecting table during his lectures, and taught that the skeleton was the foundation of the body.
Similar to the influential works of Galen, Vesalius’ work on human anatomy revolutionized the scientific world. The publication of his book De humani corporis fabrica (On the Fabric of the Human Body) stands as a monument in the history of science and medicine. Whereas his contemporaries relied on the antiquated accounts of Galen, who dissected animals rather than humans, Vesalius relied on the actual human body to inform his theories.
Vesalius’ work provided the first accurate description of the internal structures and workings of the human body, and more importantly, revived the use of the scientific method for studying human anatomy. The birth of Christianity supplanted hands-on, empirical study of the human body with the philosophical reliance on a Supreme Intellect. This idea was that every human body part was a product of the Supreme Intellect’s design, whether or not it coincided with what actually lay out on the dissecting table.
Vesalius, on the other hand, could not support the ancient writings of Galen, who relied on this idea of Supreme design. Although he revered him highly, Vesalius often found that his study of the human form did not fit with the descriptions provided by Galen, whose descriptions often matched the anatomies of dogs, apes, or sheep. He eventually found over 200 discrepancies such as these, and publicly announced his break from the Galenic tradition.
A Revolutionary Physician
De humani corporis fabrica, published in 1543, was a turning point in the history of modern medicine. For the first time, the understanding of medicine and the treatment of disease was rooted in an accurate representation of the human body. This book revolutionized the medical world. Similar to the findings of Copernicus and Galileo, Vesalius’ works help spur an empirically-based, scientific study of the world around us.
Like his fellow revolutionary scientists, Vesalius’ masterpiece was met with harsh criticism. Many of these criticisms understandably came from the church, but the most strident of all came from Galenic anatomists. These critics vowed that Galen was in no way incorrect, and so if the human anatomy of which he wrote was different from that which was proved by Vesalius, it was because the human body had changed in the time between the two.
As a response to the harsh criticisms of his work, Vesalius vowed to never again bring forth truth to an ungrateful world. In the same year that he published de humani, he burned the remainder of his unpublished works, further criticisms of Galen, and preparations for his future studies. He left medical school, married, and lived out the rest of his conservative life as a court physician.
Even though Vesalius abandoned further studies of human anatomy, before he died he recognized the great contributions he had made to the scientific world. He understood that his revelations represented an awakening of inquiry into the human body, and a reliance on facts, rather than adherence to an antiquated text.
The remainder of the history of human dissection is just as rocky. Although France in the 16th century was open-minded about the use of human cadavers for scientific inquiry, the rest of the European world was not so revolutionary. Great Britain had its own tradition of illegal trade in dead bodies, and even the United States had a hard time opening up to the idea that human bodies should be used for scientific study.
Adler, Robert E. Medical Firsts: From Hippocrates to the Human Genome. Hoboken, New Jersey: John Wiley &Sons, Inc., 2004.
MacDonald, Helen. Human Remains: Dissection and Its Histories. London: Yale University Press, 2005.
Galen Timeline - History
Integrative Touch and Bodywork
Natural Pain Care
Through Massage Therapy
A Brief History of Massage
(The Mother of Medical Care - see the spiral timeline)
Massage therapy is a field that takes that very basic principle and evolves it into a science. The word ‘massage’ comes to us from the Arabic root “mass’h” which means to touch, knead or squeeze.
Many believe that massage therapy is the precursor to all other forms of manual therapy including physical therapy, chiropractic and orthopedics.
The oldest written record of massage is approximately 4000 years old. It was found in a Chinese medical text, Con-Fu of the Toa-Tse, dated at about 1800 BC. These early accounts detailed the application of massage techniques for therapeutic purposes.
Specific massage modalities, such as Reflexology, have been depicted in Egyptian hieroglyphs (see illustration) as forms of hand and foot therapy. This particular pictograph was found in the tomb of Ankmahor, thought to have been the physician to the Pharoah. Unfortunately, much of the healing knowledge and wisdom of the ancients has been lost through the passage of time.
Rubbing can bind and loosen can make flesh (referring to the ability to tone muscle tissue) and cause parts to waste (soften and relax).
Hard rubbing binds soft rubbing loosens much rubbing causes parts to waste moderate rubbing makes them grow.”
Before becoming a notable physician to a number of Emperors in the first century AD, he spent several years ‘interning’ as physician to the Gladiators of the Circus Maximus. He developed a complete regiment for the application of massage techniques for diseases and physical injuries. For all practical purposes, he was the original innovator of what we would today call Sports Massage or Orthopedic Massage.
Upon overhearing a derogatory slur about his beloved profession, he wrote, “These are all wanton witticisms, not at all befitting a man learned in so august an art.” Unfortunately, this stereotype is a social stigma that has carried on to this day.
Europe turned away from the teachings of Hippocrates and Galen during the Dark Ages. Conservative and repressive religious dogma frowned upon any act that involved touching that felt pleasurable to the recipient. These acts were unacceptable and often considered sinful.
- Effleurage – gliding or stroking
- Friction – rubbing or pressing
- Petrissage – squeezing or kneading
- Tapotement – striking, beating or percussion
- Vibration – oscillations on the skin
The general public, through funding (AMTA and FSMTA) and researchers like Tiffany Fields at the University of Miami, is gradually sloughing off outdated stereotypes and dispelling myths about massage. A growing number of Americans are not only learning but enjoying the benefits of massage therapy performed by qualified therapists.
History of Anatomy
275 BCE Herophilus teaches anatomy, Alexandria, Egypt performs dissections of human bodies.
ca. 150 Galen dissects apes, monkeys, cows, dogs writes treatises on human anatomy.
ca. 600-1100 Knowledge of Greek anatomical treatises lost to Western Europeans, but retained in Byzantium and the Islamic world. Islamic scholars translate Greek anatomical treatises into Arabic.
1100s-1500s Galen’s anatomical treatises translated from Arabic into Latin, later from the Greek originals.
1235 First European medical school founded at Salerno, Italy human bodies are publicly dissected.
1316 Mondino de’Liuzzi stages public dissections, Bologna, Italy writes Anatomia.
1450s Moveable type invented Gutenberg Bible printed (1455). Copperplate engraving invented.
1490 Anatomical theater opens in Padua, Italy.
1491 First illustrated printed medical book published in Venice, Johannes de Ketham, Fasciculus medicinae.
ca. 1500-1540 Earliest printed illustrated anatomies.
1510 Leonardo da Vinci dissects human beings, makes anatomical drawings.
1543 First profusely illustrated printed anatomy, Vesalius’ De Humani Corporis Fabrica.
1670s-1690s Schwammerdam, Ruysch and others start making anatomical specimens and museums.
Bidloo starts movement toward greater anatomical realism.
First art academies founded anatomy is a key part of the curriculum.
1600-1900 Anatomy plays an important role in medical education and research.
William James Publishes The Principles of Psychology
In 1890, a full ten years after starting work on it, William James , one of the most prominent early American psychologists, published The Principles of Psychology.
The massive text was understood at the time to be ground-breaking in the manner in which it described the still relatively new field of psychology. In it, James managed to bring current understandings of mental science together with biological disciplines, which allowed him to explain how physical processes can influence mental processes.
Today, it is recognized as one of the seminal works in the field, having established a description and understanding of functional psychology.
Why this event is important: The Principles of Psychology gave credence to psychology’s credibility as a science. It also described James’ theory of emotion (known as the James-Lange Theory), which postulated that emotions are the result of a physical response to a stimulus.
The history of bloodletting
With a history spanning at least 3000 years, bloodletting has only recently—in the late 19th century—been discredited as a treatment for most ailments.
With a history spanning at least 3000 years, bloodletting has only recently—in the late 19th century—been discredited as a treatment for most ailments.
The practice of bloodletting began around 3000 years ago with the Egyptians, then continued with the Greeks and Romans, the Arabs and Asians, then spread through Europe during the Middle Ages and the Renaissance. It reached its peak in Europe in the 19th century but subsequently declined and today in Western medicine is used only for a few select conditions.
Humors, Hippocrates, and Galen
To appreciate the rationale for bloodletting one must first understand the paradigm of disease 2300 years ago in the time of Hippocrates (
460–370 BC). He believed that existence was represented by the four basic elements—earth, air, fire, and water—which in humans were related to the four basic humors: blood, phlegm, black bile, yellow bile.
Each humor was centred in a particular organ—brain, lung, spleen, and gall bladder—and related to a particular personality type—sanguine, phlegmatic, melancholic, and choleric.
Being ill meant having an imbalance of the four humors. Therefore treatment consisted of removing an amount of the excessive humor by various means such as bloodletting, purging, catharsis, diuresis, and so on. By the 1st century bloodletting was already a common treatment, but when Galen of Pergamum (129–200 AD) declared blood as the most dominant humor, the practice of venesection gained even greater importance.
Galen was able to propagate his ideas through the force of personality and the power of the pen his total written output exceeds two million words. He had an extraordinary effect on medical practice and his teaching persisted for many centuries. His ideas and writings were disseminated by several physicians in the Middle Ages when bloodletting became accepted as the standard treatment for many conditions.
Methods of bloodletting
Bloodletting was divided into a generalized method done by venesection and arteriotomy, and a localized method done by scarification with cupping and leeches. Venesection was the most common procedure and usually involved the median cubital vein at the elbow, but many different veins could be used. The main instruments for this technique were called lancets and fleams.
Thumb lancets were small sharp-pointed, two-edged instruments often with an ivory or tortoise shell case that the physician could carry in his pocket. Fleams were usually devices with multiple, variably sized blades that folded into a case like a pocketknife.
Localized bloodletting often involved scarification, which meant scraping the skin with a cube-shaped brass box containing multiple small knives, followed by cupping, which involved placing a dome-shaped glass over the skin and extracting the air by suction or prior heating.
Leeches used for bloodletting usually involved the medicinal leech, Hirudo medicinalis. At each feeding a leech can ingest about 5 to 10 ml of blood, almost 10 times its own weight. The use of leeches was greatly influenced by Dr François Broussais (1772–1838), a Parisian physician who claimed that all fevers were due to specific organ inflammation. He was a great proponent of leech therapy along with aggressive bloodletting. He believed in placing leeches over the organ of the body that was deemed to be inflamed.
his therapy was very popular in Europe in the 1830s, especially France, where 5 to 6 million leeches per year were used in Paris alone and about 35 million in the country as a whole. By the late 1800s, however, enthusiasm for leech therapy had waned, but leeches are still used today in select situations.
When Charles II (1630–1685) suffered a seizure he was immediately treated with 16 ounces of bloodletting from the left arm followed by another 8 ounces from cupping. Then he endured a vigorous regimen of emetics, enemas, purgatives, and mustard plasters followed by more bleeding from the jugular veins. He had more seizures and received further treatment with herbs and quinine. In total he had about 24 ounces of blood taken before he died.
After riding in snowy weather, George Washington (1732–1799) developed a fever and respiratory distress. Under the care of his three physicians he had copious amounts of blood drawn, blisterings, emetics, and laxatives. He died the next night of what has been diagnosed retrospectively as epiglottitis and shock. His medical treatment aroused significant controversy, particularly the bloodletting.
The practice of bloodletting aroused deep emotions in both practitioners and detractors, with intense argument about the benefit and harm of venesection. Drs Benjamin Rush, William Alison, and Hughes Bennett exemplify this conflict.
Dr Benjamin Rush (1745–1813) was one of the most controversial physicians in his time. He was arrogant and paternalistic but dedicated to eradicating illness wherever he saw it. He worked tirelessly during the yellow fever epidemics in Philadelphia in 1793 and 1797 and devoted much time to the problem of mental illness.
Unfortunately he had a very simplistic view of disease and thought that all febrile illnesses were due to an “irregular convulsive action of the blood vessels.” Therefore in his mind all therapy was directed at dampening down this vascular overexcitement. He was a great proponent of “depletion therapy,” which meant aggressive bloodletting and vigorous purging.
He was known to remove extraordinary amounts of blood and often bled patients several times. “It frequently strangles a fever… imparts strength to the body… renders the pulse more frequent when it is preternaturally slow… renders the bowels, when costive, more easily moved by purging physic… removes or lessens pain in every part of the body, and more especially the head… removes or lessens the burning heat of the skin, and the burning heat of the stomach…”
In addition he held a firm belief in his calomel purgatives, which were loaded with mercury and which he called “the Samson of medicine.” In numerous articles he boldly proclaimed the benefits of his therapy.
He aroused both extremely positive and negative reactions in those around him, including many physicians. Some doctors referred to his practices as “murderous” and his prescribed doses as “fit for a horse.” He had a long-running feud with his college of physicians, which forced him to resign, and his application to the faculty of Columbia Medical School in New York was denied. However, Rush Medical College in Chicago was named in his honor and gained its charter in 1837.
At the Edinburgh School of Medicine Dr William Alison (1790–1859) and Dr Hughes Bennett (1812–1875) were a study in contrasts. The former was a dignified old-timer and strong believer in bloodletting, while the latter was an arrogant newcomer and resolute debunker of bloodletting. Whereas Dr Alison followed the old tradition of clinical experience and empirical observation, Dr Bennett believed in the new methods of pathology and physiology supported by the microscope and the stethoscope.
Central to their debate was the observation that the improved outcome of patients with pneumonia paralleled the decreased usage of bloodletting. While Dr Alison ascribed this to a “change in type” of illness which had gone from sthenic (strong) to asthenic (weak), Dr Bennett believed it due to diminished use of a dangerous therapy.
Both were implacable in their point of view, thereby underlining the significant gap between their beliefs in empirical observation versus scientific verification. Dr Bennett had the advantage of the latest techniques and “grounded his rejection of bloodletting on pathologic concepts of inflammation and pneumonia derived from microscopic studies of inflamed tissues.”
The tide turns
In Paris Dr Pierre Louis (1787–1872) was another scientific-minded physician who wanted to assess the efficacy of bloodletting. He examined the clinical course and outcomes of 77 patients with acute pneumonia taken from his own and hospital records.
He compared the results in patients treated with bloodletting in the early phase versus the late phase of the illness. In his conclusions he did not condemn bloodletting but concluded that the effect of this procedure “was actually much less than has been commonly believed.”
Subsequent studies by Pasteur, Koch, Virchow, and others confirmed the validity of the new scientific methods, and the use of bloodletting gradually diminished to a few select conditions.
Today phlebotomy therapy is primarily used in Western medicine for a few conditions such as hemochromatosis, polycythemia vera, and porphyria cutanea tarda.
Hemochromatosis is a genetic disorder of iron metabolism leading to abnormal iron accumulation in liver, pancreas, heart, pituitary, joints, and skin. It is treated with periodic phlebotomy to maintain ferritin levels at a reasonable level so as to minimize further iron deposition.
Polycythemia vera is a stem cell bone marrow disorder leading to overproduction of red blood cells and variable overproduction of white blood cells and platelets. Its treatment includes phlebotomy to reduce the red blood cell mass and decrease the chance of dangerous clots.
Porphyria cutanea tarda is a group of disorders of heme metabolism with an associated abnormality in iron metabolism. Phlebotomy is also used to decrease iron levels and prevent accumulation in various organs.
In the last 25 years leech therapy has made a comeback in the area of microsurgery and reimplantation surgery. Hirudo medicinalis can secrete several biologically active substances including hyaluronidase, fibrinase, proteinase inhibitors, and hirudin, an anticoagulant.
The leech can help reduce venous congestion and prevent tissue necrosis. In this way it can be used in the postoperative care of skin grafts and reimplanted fingers, ears, and toes. Because of concern regarding secondary infections a “mechanical leech” has been developed at the University of Wisconsin.
Why did it persist?
We may wonder why the practice of bloodletting persisted for so long, especially when discoveries by Vesalius and Harvey in the 16th and 17th centuries exposed the significant errors of Galenic anatomy and physiology. However as Kerridge and Lowe have stated, “that bloodletting survived for so long is not an intellectual anomaly—it resulted from the dynamic interaction of social, economic, and intellectual pressures, a process that continues to determine medical practice.”
With our present understanding of pathophysiology we might be tempted to laugh at such methods of therapy. But what will physicians think of our current medical practice 100 years from now? They may be astonished at our overuse of antibiotics, our tendency to polypharmacy, and the bluntness of treatments like radiation and chemotherapy.
In the future we can anticipate that with further advances in medical knowledge our diagnoses will become more refined and our treatments less invasive. We can hope that medical research will proceed unhampered by commercial pressures and unfettered by political ideology. And if we truly believe that we can move closer to the pure goal of scientific truth.
A (Very) Brief History of Neuroscience
The great Greek philosopher and scientist Aristotle believed that our consciousness, imagination and memory was rooted in the human heart. It was a belief he shared with the ancient Egyptians, whose Book of the Dead endorses carefully preserving the heart of a mummy, but recommends scooping out and discarding the brain. Today, the supreme role of the heart lives on only as a metaphor for our intuitive, emotional selves.
There is evidence, however, that at least some Egyptians knew about the importance of the brain. The Edwin Smith Papyrus, dating back to 1700 BC, is the earliest known medical text in history. The papyrus discusses the brain, the meninges, the spinal cord and cerebrospinal fluid. It contains details of 48 medical cases, including seven that deal directly with the brain, which indicate that the Egyptian author knew the brain controls movement. However, the serious cases of brain injury are described in the papyrus as untreatable.
We have come a long way since ancient Egypt. We now know the parts of the brain responsible for many of its functions we can operate successfully on the brain, and use medication to effectively treat many neurological disorders.
Getting to this point hasn’t been easy. Have you ever heard of trepanation? It’s the once popular belief that cutting a hole in your skull would relieve pressure on your brain and lead to enlightenment. Or how about phrenology, popular in the 1800s? Phrenologists thought that you could learn everything you needed to know about someone’s character by measuring the shape of his or her skull.
These missteps aside, neuroscience has advanced like most sciences: one small step after another — until the 20th century, when it flies into a sprint.
- 170 B.C. the Roman physician Galen, whose day job was fixing up gladiators, insists that a person’s temperament and bodily functions are controlled by the brain. His theories are dominant for the next 1200 years.
- 1000 A.D. The great Islamic surgeon Abu al-Qasim al-Zahrawi describes several treatments for neurological disorders in his 35-volume encyclopedia of medical practices, the Kitab al-Tasrif.
- 1543 The first true medical textbook to deal with neuroscience, “On the Workings of the Human Body,” is published by Andreas Vesalius.
- 1649 The French philosopher René Descartes comes up with the influential idea that while the brain may control the body, the mind is something intangible, distinct from the brain, where the soul and thought resides. This concept is still with us, much to the chagrin of many neuroscientists.
- 1664 Thomas Willis publishes “Anatomy of the Brain,” which describes reflexes, epilepsy, apoplexy and paralysis. He uses the term neurology for the first time.
- 1791 Italian physiologist Luigi Galvani proposes that nerves operate through electricity.
- 1837 J. E. Purkinje is the first man to describe a neuron.
- 1862 Paul Broca pinpoints the part of the brain necessary for speech, henceforth known as Broca’s area.
- 1878 William McEwen performs the first successful modern neurosurgery.
- 1911 Aptly named British neuroscientist Henry Head publishes “Studies in Neurology.”
- 1929 Hans Berger invents the EEG (electroencephalography), a device that measures electrical activity in the brain.
- 1932 Lord Edgar Douglas Adrian and Sir Charles S. Sherrington win the Nobel Prize for describing how neurons transmit messages.
- 1938 Isidor Rabi discovers nuclear magnetic resonance, facilitating the development of magnetic resonance imaging (MRI). Rabi’s discovery would go on to win the Nobel Prize in 1944.
- 1950 Karl Spencer Lashley determines that memory relies on several sites in the brain working together.
- 1970 The Society for Neuroscience is established.
- 1973 Candace Pert discovers opiate receptors in the brain.
- 1974 A mouse is the subject of the first nuclear magnetic resonance (NMR) scan.
- 1974 The first Positron Emission Tomography (PET) scanner is invented, providing visual information about brain activity.
- 1987 Prozac is introduced.
- 1990 George H. W. Bush declares the last decade of the 20th century as the Decade of the Brain.
- 1992 Functional magnetic resonance imaging (fMRI) is first used to map activity in the human brain. Neuroscience booms.
The rapid pace of developments in neuroscience facilitated by modern imaging techniques is astounding. Yet many of the most important questions regarding the brain have yet to be answered. Why do we sleep and dream? How does the chemical and electrical activity in the brain result in consciousness? These and other questions will fuel neuroscience in the 21st century.