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02 Foundations of Scientific Medicine I HPM

LE 2
Rafael M. Valenzuela, MD |September 24, 2018 TRANS 2

OUTLINE
I. Pre-Scientific Revolution
II. Scientific Revolution
A. Francis Bacon
B. Sir William Harvey
C. Thomas Sydenham
III. The Dramatic Origin of Germ Theory
A. Girolamo Fracastoro
B. Anton Van Leeuwenhoek
C. Ignaz Semmelweiss
IV. Industrial Revolution
A. John Snow

OBJECTIVES

1. To understand how Greco-Roman concepts of medicine and

health were challenged by the Age of Enlightenment
2. To analyse how Francis Bacon’s scientific method catalysed
changes in clinical practice and medical research. Figure 2. Scientific Method Process
3. To understand the impact of William Harvey’s discovery of
blood circulation. B. SIR WILLIAM HARVEY
4. To know that plagues and epidemics stimulated advances in
public health medicine and vaccination.
5. To realize how the accumulated work of microscopists,
epidemiologists and other researchers gave rise to the Germ
Theory of Disease.
6. To recognize how the advent of anesthesia and antisepsis gave
rise to Modern Surgery.

I. PRE-SCIENTIFIC REVOLUTION

● For centuries, the ancient medical theories of Hippocrates,

Galen and Avicenna dominated the world Figure 3. William Harvey
→ Miasma Theory of Disease
▪ The belief that noxious air arising from decaying organic ● Greatest contribution: Blood circulation (1628)
matter was the primary cause of disease persisted into the ● He was a renowned physician. He was the royal physician of
19th century King Charles I of England
→ Theory of Four Humors ● He was trained in Cambridge, England and later in the
University of Padua in Italy
II. SCIENTIFIC REVOLUTION → Andreas Vesalius also studied in the University of Padua
→ Here, public human dissections were allowed and
● Reason began to rule the 17th Century, after the Black Death conducted (may be due to the numerous corpses from the
and during the Renaissance –The Scientific Revolution. black plague)
● Guttenberg’s Printing Press ● He became an enthusiastic anatomist. He dissected his
→ The internet during that time deceased father and sister before burying them.
→ People became more knowledgeable ● In order to learn how the blood circulates, he also dissected
animals (live snakes, frogs, and dogs)
A. FRANCIS BACON ● He was also the doctor of Sir Francis Bacon. This might have
influenced him to use the scientific method in his researches.
● He challenged the 1,400 year old dogma of Galen on
circulation.
→ Galen’s Circulation Theory
▪ He believed that there was blood and pneuma.
▪ He said that blood (“natural spirit”) is produced in the
liver
Figure 1. Francis Bacon ▪ Pulmonary veins carry the pneuma (“vital spirit”) from
the lungs to the heart.
● Philosopher and scientist who pioneered a system to explore ▪ The heart pumps both blood and pneuma, through the
the world veins and arteries respectively, to all parts of the body.
● Came up with the Scientific Method, a method of inductive ▪ Blood can pass from the R ventricle to the L ventricle
reasoning through tiny pores in the septum.
● He served as both Attorney General and as Lord Chancellor in ● Harvey was able to make his discoveries because he ignored
England medical textbooks, and preferred his own observations and
deductions during dissections of human and animals.

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● In the year 1628, after 20 years of research and ● He was proposing the Germ Theory of Disease more than 300
experimentation, Harvey published “De Motu Cordis” (Motion years before its formal articulation by Louis Pasteur and Robert
of the Heart and Blood in Animals) Koch.
● Harvey’s Circulation Theory ● “De contagione et contagiosis morbis”
→ “Blood is driven in circular motion… It moves perpetually” → Outlined his concept of epidemic diseases
→ Blood flows in a forward direction, because of one-way → Speculated that each disease was caused by a different
valves that prevent backflow. type of rapidly multiplying “seed” and could be transmitted
→ There are two circulations: by direct contact, air, or clothing and linens.
▪ Systemic - from the heart through the body and back ● Proposed Personal Hygiene to prevent disease
▪ Pulmonary - from the heart via the lungs and back
● At that time, Harvey’s circulation theory was greatly criticized. B. ANTON VAN LEEUWENHOEK (1670s)
His medical practice also suffered because of this, especially
after King Charles' execution.

C. THOMAS SYDENHAM (1624-1689)

● He was a physician during the English civil war, known as the

“Hippocrates of England”
● He believed in the theory of four humors and the healing
powers of nature. However, he emphasized the importance of
“clinical observation”.
● He made detailed descriptions of gout, smallpox, scarlet
fever, epilepsy, and other illnesses.
● He was also the first to describe Sydenham’s Chorea Figure 5. Anton Van Leeuwenhoek
(traditionally called St. Vitus Dance)
→ Neurological disorder; rapid jerky, irregular, involuntary ● He was Dutch and was The Father of Microscopy
movements, especially of the face and limbs (NIH) ● An apprentice in a dry goods store where magnifying glasses
● His book, “Observationes Medicae” , became a standard were used to inspect the quality of cloth.
textbook of medicine for two centuries. ● Fascinated with the lenses, he experimented new methods for
● He developed the concept of “species of disease” to improve grinding and polishing more powerful lenses.
medical diagnosis by describing and classifying different ● Studied all kinds of specimens: pond water, scrapings from
illnesses. This is the basis of epidemiology. his teeth, blood and semen(where he discovered the sperm)
● He thought that diseases could be classified into categories, ● He called these minute organisms "animalcules"
just as botanists could classify plants and to prescribe a specific ● Public awareness of microscopic life increased but was still not
remedy for that disease. linked to disease causation due to their size.
● Greatest contribution: Correlate disease categories with the
course and outcome, giving them predictive value. C. IGNAZ SEMMELWEISS (1818-1865)
● He re-introduced the Hippocratic method of clinical
observation based on broad personal experience.
● “Doctors must go to the patient’s bedside to learn about
disease... not the other way around”
→ For him observation was more important than curing the
illness
● He prescribed drugs based on herbal treatments:
→ Popularized peruvian bark (quinine) - to treat intermittent
fever
→ Laudanum (opium+wine) - for pain relief
● He was not always popular with his contemporaries. He was
scornful of flowery medical theory and university learning.
● But in time, he became the most respected name in British
medicine.
Figure 6.Ignaz Semmelweiss

III. THE DRAMATIC ORIGIN OF GERM THEORY ● During his time, childbed fever (puerperal fever) was the
● 19th century belief: Miasma Theory dreaded infection of new mothers and infants with high death
rates
A. GIROLAMO FRACASTORO (1546) ● He was a Jewish-Hungarian obstetrician who assisted at two
maternity clinics in the Vienna General Hospital.
→ Noted higher death rates in the first clinic but fewer in the
second with no apparent reason.
→ He ruled out factors such as food, drink, humidity, patient
age, background, and even their religion
→ The only difference was the first was a training center for
apprentice doctors while the second was for student
midwives.
→ 1847, A colleague dies from an accidental knife wound
during an autopsy which led to an infection similar to
childbed fever.
Figure 4. Girolamo Fracastoro
→ Semmelweiss concluded that the wound from the
contaminated knife caused his friend’s death.
● Italian Physician
→ This led him to demand a strict program of handwashing
● Wrote about “disease seeds” carried by wind or direct
by his staff, using a calcium hypochlorite solution
contact(while studying and naming “syphilis”)

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→ A dramatic decline in maternal deaths occured in the first ● Dr. Snow examined the victims and found that their initial
clinic to about the same level as the second. symptoms were always related to the gastrointestinal tract
● Hailed the "Saviour of Mothers", but was unable to prove his → If cholera was spread by bad air, it should cause pulmonary
“cadaverous particles", so his theory was criticized symptoms. Since the symptoms were gastrointestinal, it may
● This led him to question surgeons who were important men in have been transmitted by water or food consumption
Vienn (he was a Hungarian Jew) ● In August 1853, cholera broke out in the Broad Street area
● He died in 1865, 14 days after he was committed to an asylum → A hand pump was located on Broad Street and Snow was
due to septicaemia from the wounds he sustained following a immediately suspicious
beating by theguadxs during a prison break. This is the same → Proposed a new hypothesis for how cholera was transmitted
year Joseph Lister introduced antiseptic techniques. → Tested this hypothesis systematically by making
● The Semmelweiss Reflex: the metaphor for the tendency to comparisons between groups of people
reject new knowledge because it is against the norm. → Provided evidence for an association between drinking from
the Broad St. well and getting cholera
IV. INDUSTRIAL REVOLUTION → Argued for the removal of the pump handle, which prevented
additional cases
● The Industrial Revolution brought an explosion of ● The Father of Epidemiology
development: new jobs, new goods, increased trade → Epidemiology is the study of patterns, causes, and effects
● Expansion of the population and mass migration caused of disease in populations
exponential growth of cities. → It investigates and analyzes disease patterns in an effort to
● Working conditions were difficult control them and prevent their return
→ Exposed employees to many risks and dangers
▪ Cramped work areas with poor ventilation REVIEW QUESTIONS
▪ Trauma from machinery
▪ Toxic exposures 1. He is the philosopher and scientist who pioneered a
● Progress brought a whole new set of health problems, system to explore the world.
widespread in Europe and in America a. Francis Bacon
b. William Harvey
c. Thomas Sydenham
● Epidemic - Greek: epi - “upon or above” + demos “people” d. Anton van Leeuwenhoek
→ Rapid spread of infectious disease to a large number of 2. He is the Father of Microscopy.
people in a given population within a short period of time, a. Ignaz Semmelweis
usually 2 weeks or less b. John Snow
→ Throughout history, epidemics have destroyed whole c. Anton Van Leeuwenhoek
populations and altered the economic, social, intellectual d. Francesco Redi
and political aspects of populations significantly
● Pandemic - Greek: pan - “all” + demos - “people”
→ An epidemic of infectious disease that has spread through Answers: a, c
human populations across a large region (multiple
continents, even worldwide; e.g. ebola) REFERENCES
[DPC]2018/09/24. Foundations of Scientific Medicine 17th to 19th
Century I. Rafael M. Valenzuela, MD.
A. JOHN SNOW (1813-1858)
Edwards, S. A. (2011, December 15). The Circulatory System,
from Galen to Harvey. Retrieved from American Association for the
Advancement of Science (AAAS):
https://www.aaas.org/blog/scientia/circulatory-system-galen-harvey

NIH-Genetic and Rare Diseases Information Center. (n.d.).

Sydenham's Chorea. Retrieved from NIH-Genetic and Rare
Diseases Information Center:
https://rarediseases.info.nih.gov/diseases/7716/sydenhams-chorea

Walker, K., & Wilmshurst, J. (2010). An update on the treatment of

Sydenham’s chorea: the evidence for established and evolving
interventions. Therapeutic Advances in Neurological Disorders ,
301-309

2021C Trans
2021B Trans
2021A Trans
Figure 7 Dr. John Snow

● In 1854, during the great Cholera outbreak, bacteria were still

not recognized as a cause of disease.
→ Cholera is an infectious disease that became a major threat
to health during the 1800s
→ There were large epidemics of cholera in Europe and
American that killed thousands of people in the 1800s
→ John Snow was a physician who spent several decades
studying cholera in a systematic way
● In 1800s, opinion was that cholera was spread by miasmas or
person-to-person contact

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