医学史简论 （ 9) A Brief History of Medicine

1. 医学史简论（9)ABrief History of Medicine 浙江大学医学院 余 海 Yuhai@zju.edu.cn

2. The History of Therapeutics • The ups and down of blood-letting therapy • The origin and development of surgery

3. The ups and down of bloodletting • The therapy of Bloodletting (phlebotomy) began before Hippocrates time • The theological basis of bloodletting is Four Humors Theory, it was said to cure inflammation, infection strokes, manic psychosis  and more Ancient Greek painting in a vase, showing a physician (iatros) bleeding a patient

4. The ups and down of bloodletting • Blood letting was widely applied in the Middle Ages • The barber-surgeons undertook the procedure 1540-1745

5. The ups and down of bloodletting • Apartfrom phlebotomy， skin scratch, cupping and leeches were also used.“Leech”becamethe nick name for a doctor .

6. 放血术的兴盛和衰落 • In 18th century medical text books described the detailed of bloodletting including the indications, location, the methods and tools used

7. The ups and down of bloodletting • The tragedy of Washington：December 13, 1799 George Washington got acute epiglottitis, the remedy his doctors gave was mixture of honey, vinegar and butter for gargle and bloodletting; within 24 hours total 82 ounces blood (2500ml)was drained and he died 2 days later George Washington 1731-1799

8. The ups and down of bloodletting • 1840, French physician Pierre Louis conducted a clinical trial proving that bloodletting was useless or harmful for treatment of pneumonia • Bloodletting, the therapy used for over 2000 year was abandoned except for some rare conditions like hemochromatosis, polycythemia vera and porphyria cutanea tarda. Pierre Louis

9. The History of Surgery

10. trephination 颅骨环钻术

11. The Historyof Surgery The early surgery-trephination (7000-3000B.C. Neolithic period) for both medical reasons (epileptic  seizures, migraines and mental disorders and mystical practices by letting evil spirits escape

12. Trephination • Trepanationis surgery in which a hole is drilled into the human skull to treat epidural and subdural hematomas  • 400BCHippocratestreated head injuries with • Trephination • 1st century • Celsus • and Galen • performing • trephination 1497 Trephination 18th Century French trephination

13. Modern Neurosurgery: Remove Brain Hematoma

14. The early surgery was developed from the treatment of battle wounds: suturing lacerations, amputating insalvageable limbs, set bone and draining and cauterizing open wounds Iliad Odessey Roman surgeon

15. Hippocratic Corpus described many methods for treatment of bone fractures (crookback)

16. According to History of Three Kingdoms (184-280) Hua Tuo invented the general anesthesia with Mafeisan which render a person unconscious and allow him to perform surgical procedures 145-208

17. Surgery in ancient IndiaIn Susrutha Samhita, he describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures on performing various forms of plastic surgery, Sushruta600 BC (妙闻）

18. Italian Gasparo Tagliacozzi （1546－1599） Indian Rhinoplasty“nacta” –the nose cut off as a punishment Carpue’s Rhinoplasty 1814

19. 外科学的产生和发展 Since the Pope Innocence Ⅲ banned surgery，there had been a career Barber-surgeon who performed the surgical procedures.1735, The Royal College of Surgeon was established and the surgeon became an independent career and should have a formal training was required the status of surgeon gradually became equal to physicians

20. Early Surgical Treatment • Surgical treatment used be a cruel and painful experience- no anesthesia, no antisepsis, with boiled oil and burned iron to stop bleeding cauters cauterization

21. 初期的外科治疗 • 截肢 amputation

22. Early surgery-amputation

23. 乳腺切除术Mastectomy Johnnes Scultetus the Elder: Armetarium Chirurgicum (1744) Wilhelm Hildanus 1560－1634

24. Break

25. Three Breakthroughs in Modern Surgery Pain, infection, bleeding were the three major problems to prevent surgery from progressing into modern science. The development of modern surgery has been benefited from three inventions: • Anesthesia麻醉术 • antisepsis and disinfection防腐消毒术 • transfusion输血术

26. Invention of anesthesia • Before invention of anesthesia the most commonly used analgesic agents were: marijuana, opium, stramonium, belladonna, alcohol or hypnogenesis. • The effects were rather poor, which cumber the number of elective surgical procedures

27. Invention of anesthesia 1772, British chemist Joseph Priesley seprated nitrous oxide (N2O), because it can relax diaphragm muscle and make people laughing so called laughing gas 1800,Humphry Davy found the analgesic effect of nitrous oxide

28. Invention of anesthesia Due to the euphoric effects of inhaling it, a property that has led to its recreational use as an inhalant drug As dancing outreach (ecstasy) today

29. Invention of anesthesia • March 30,1842a country doctor Crawford Long（1815－1878）successfully remove a neck tumor with ether anesthesia for a child, but the results not published • His Alma Mater Johns Hopkins University recognized him as the first one using ether as anesthetic agent • National Doctor’s Day – March 30 in USA (since 1993)

30. Invention of anesthesia • December1844 a American dentist Horace Wells(1815-1848) successfully extracted his own cheek teeth with inhaled N2O • But he failed in demonstration in Harvard Medical School Hospital February 1844 • 1864, American Association of Dentists gave the credit of invention of anesthesia to him.

31. Invention of anesthesia • October 16,1846, Wells’ assistant William Morton (1819-1868) during a public demonstration in MGH let a patient to inhale ether, and the famous surgeon Warrendissected a mandible tumor from the unconscious patient. • Morton was recognized the inventor of surgical anesthesia

32. The first operation under anesthesiaby Dr Morton 1846.10.16

33. 麻醉术的发明 Obstetrician James Simpson（1811-1870)applied Chloroform instead ether as anesthetic agent，the Queen Victoria inhaled chloroform during the child birth.

34. Invention of anesthesia • “Inventor and Revealer of Inhalation Anesthesia: Before Whom, in All Time, Surgery was Agony; By Whom, Pain in Surgery was Averted and Annulled; Since Whom, Science has Control of Pain.“ (to William Morton） • Who was the first one to use anesthesia has always been a big debate • 1868, in Boston a monument was erected to commemorate the first operation under anesthesia in 1846, in which engraved: “To Ether or Either”

35. Invention of Surgical Antisepsis • Semmelweis a Hungarian obstetrician investigated the cause of high incidence of puerperal fever （childbed fever） in Vienna General Hospital and advocated hand wash with chloride of lime solution leading to the maternal death rate dropping from 18% to 1%. Ignac Semmelweis 1818-1865

37. Invention of Surgical Antisepsis • Semmelweis was attacked by his conserved colleagues and incurred persecution. • Ironically he died at 47 in an asylum from septicemia, but was honored as the “savior of mothers” after his death IQ Vs EQ  Your character is your destiny

38. Invention of Surgical Antisepsis • In middle of 19th century the sepsis caused by operation was most popular with a mortality rate of 50% • Inspired by Pasteur’s discovery Joseph Lister created using carbolic acid in surgical antisepsis，with this method he saved a 11-year boy’s life who suffered a open complicated fracture in 1865 • The fetal rate for amputation，before antisepsis invention：16/35(45.7%)，after 6/40(15.0%) Joseph Lister 1827-1912

40. 外科防腐消毒法 • Lister’s antisepsis method was ignored in Britain and US • 1870, German adapted his method in Prussian-French warand saved many soldiers’ life. • 1877, Lister took the position of Department Head of Surgery in King’s College，and made his name in surgical circle and his surgical antisepsis was popularized • 1895－1900Lister was appointed as the Chairman of British Royal Society. Your character is your destiny

41. Progress of Surgical Techniques • 1877 German doctor von Bergmann sterilized the surgical instrument and dressing with high-temperature vapor • 1885German surgeon Neuber: surgical gown • 1889 American surgeon Halsted: rubber gloves，Austrian surgeon Mikulicz-Radecki: surgical mask • 1890,Halstedproposed the basic principles of surgery，laid the foundation of modern surgery

42. surgery 1870s (Dr Gross) surgery 1889 (Dr Billroth)

43. Operatingtheater in early 20th century Surgery 1902

44. Modern operating theater

45. Invention of Blood transfusion • Blood loss is a threat for patient’s life, to control blood loss: cauterization, ligature, and blood replace • 1665, British physician Richard Lower first tried transfuse blood from sheep to a psychiatric patient • Transfusion was soon banned because of death caused by transfusing animal blood

46. Invention of Blood transfusion • 1818, Britishobstetrician Blundellfirst transfused blood to a postpartum bleeding woman from her husband • Afterwards he tried 10 times and 5 was successful

47. Invention of Blood transfusion • 1875,Landoisfound the cause of transfusion reaction- agglutination of red cells • 1900, Austrian scientist Landsteiner discovered agglutination was caused by immune reaction，and proposed the ABO blood types • 1939－41 Rh type was found （Rhesus monkey ） Karl Landsteiner 1868-1943

48. . ABO blood type system

49. RhBlood Type Rh-Caucasian15%，Chinese 0.3%

50. Therapy for newborn jaundice： intrauterine transfusion Blood replacement Phototherapy