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Rise of Modern Medicine

19th Century: Rise of Modern Medicine

The practice of medicine changed in the face of rapid advances in science, as well as new approaches by physicians. Hospital doctors began much more tematic analysis of patients' symptoms in diagnosis.  Among the more powerful new techniques were anaesthesia, and the development of both antiseptic and aseptic operating theatres.  Actual cures were developed for certain emic infectious diseases. However the decline in many of the most lethal diseases was more due to improvements in public health and nutrition than to medicine. It was not until the 20th century that the application of the scientific method to medical research began to produce multiple important developments in medicine, with great advances in pharmacology and surgery.

Medicine was revolutionized in the 19th century and beyond by advances in chemistry and laboratory techniques and equipment, old ideas of infectious disease epidemiology were replaced with bacteriology and virology. Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating the scientific field microbiology.

Germ theory
In Vienna Ignaz Semmelweis (1818-1865) in 1847 dramatically reduced the death rate of new mothers from childbed fever by the simple expedient of requiring physicians to clean their handsbefore atting to women in childbirth. His discovery pre-dated the germ theory of disease. However, his discoveries were not appreciated by his contemporaries and came into general use only with discoveries of British surgeon Joseph Lister, who in 1865 proved the principles of antisepsis in the treatment of wound.
Louis Pasteur, by laboratory work that linked microorganisms with disease, brought about a revolution in medicine he successfully reached out to instruct the educated classes of France in the importance of the germ theory.  Pasteur with Claude Bernard (1813-1878) invented the process of pasteurization still in use today. Pasteur, along with Robert Koch founded bacteriology. Koch, who was awarded the Nobel Prize in 1905, became famous for the discovery of the tubercle bacillus (1882) and the cholera bacillus (1883) and for his development of Koch's postulates.
The quality of military medicine differed sharply among nations. A comparison of British and French surgical work on wounded sailors at the Battle of Trafalgar of 1805 shows that Royal Navy surgeons practiced triage, amputated immediately rather than delay the operation, and kept surgical areas clean. They were well trained and practiced up-to-date methods of surgery and hygiene. By contrast, French surgeons tolerated unhygienic facilities and had less training and s, resulting in much higher mortality rates for their patients.

Women
 Women as nurses
Women had always served in ancillary roles, and as midwives and healers. The professionalization of medicine forced them increasingly to the sidelines. As hospitals multiplied they relied in Europe on orders of Roman Catholic nun-nurses, and German Protestant and Anglican deaconesses in the early 19th century. They were trained in traditional methods of physical care that involved little knowledge of medicine. The breakthrough to professionalization based on knowledge of advanced medicine was led by Florence Nightingale in England. She resolved to provide more advanced training than she saw on the Continent. At Kaiserswerth, where the first German nursing schools was founded in 1836 by Theodor Fliedner, she said, "The nursing was nil and the hygiene horrible." Britain"s male doctors preferred the old tem, but Nightingale won out and her Nightingale Training School opened in 1860 and became a model. The Nightingale solution deped on the patronage of upper class women, and they proved eager to serve. Royalty became involved. In 1902 the wife of the British king took control of the nursing unit of the British army, became its president, and renamed it after herself as the Queen Alexandra's Royal Army Nursing Corps when she died the next queen became president. Today its Colonel In Chief is the daughter-in-law of Queen Elizabeth. In the United States, upper middle class women who already supported hospitals promoted nursing. The new profession proved highly attractive to women of all backgrounds, and schools of nursing opened in the late 19th century. They soon a function of large hospitals, where they provided a steady stream of low-paid idealistic workers. The International Red Cross began operations in numerous countries in the late 19th century, promoting nursing as an ideal profession for middle class women.
The Nightingale model was widely copied. Linda Rids (1841-1930) studied in London and became the professionally trained American nurse. She established nursing training programs in the United States and Japan, and d the first tem for keeping individual medical records for hospitalized patients.  The Russian Orthodox Church sponsored seven orders of nursing sisters in the late 19th century. They ran hospitals, clinics, almshouses, pharmacies, and shelters as well as training schools for nurses. In the Soviet era (1917-1991), with the aristocratic sponsors gone, nursing became a low-prestige occupation based in poorly maintained hospitals.
 Women as doctors
It was very difficult for women to become doctors before the 1970s. Elizabeth Blackwell (1821-1910) became the first woman to formally study and practice medicine in the United States. She was a leader in women's medical education. While Blackwell viewed medicine as a means for social and moral reform, her student Mary Putnam Jacobi (1842-1906) focused on curing disease. At a deeper level of disagreement, Blackwell felt that women would succeed in medicine because of their humane female values, but Jacobi believed that women should participate as the equals of men in all medical specialties using identical methods, values and insights.

Paris
Paris and Vienna were the two leading medical centers on the Continent in the era 1750-1914.
In 1770s-1850s Paris became a world center of medical research and teaching. The "Paris School" emphasized that teaching and research should be based in large hospitals and promoted the professionalization of the medical profession and the emphasis on sanitation and public health. A major reformer was Jean-Antoine Chaptal (1756-1832), a physician who was Minister of Internal Affairs. He d the Paris Hospital, health councils, and other bodies.
Louis Pasteur (1822-1895) was one of the most important founders of medical microbiology. He is remembered for his remarkable breakthroughs in the causes and preventions of diseases. His discoveries reduced mortality from puerperal fever, and he d the first vaccines for rabies and anthrax. His experiments supported the germ theory of disease. He was best known to the general public for inventing a method to treat milk and wine in order to prevent it from causing sickness, a process that came to be called pasteurization. He is regarded as one of the three main founders of microbiology, together with Ferdinand Cohn and Robert Koch. He worked chiefly in Paris and in 1887 founded the Pasteur Institute there to perpetuate his commitment to basic research and its practical applications. As soon as his institute was d, Pasteur brought together scientists with various specialties. The first five departments were directed by Emile Duclaux (general microbiology research) and Charles Chamberland (microbe research applied to hygiene), as well as a biologist, Ilya Ilyich Mechnikov (morphological microbe research) and twophysicians, Jacques-Joseph Grancher (rabies) and Emile Roux (technical microbe research). One year after the inauguration of the Institut Pasteur, Roux set up the first course of microbiology ever taught in the world, then entitled Cours de Microbie Technique (Course of microbe research techniques). It became the model for numeous research centers around the world named "Pasteur Institutes."

Vienna
The First Viennese School of Medicine, 1750-1800, was led by the Dutchman Gerard van Swieten (1700-1772), who aimed to put medicine on new scientific foundations - promoting unprejudiced clinical observation, botanical and chemical research, and introducing simple but powerful remedies. When the Vienna General Hospital opened in 1784, it at once became the world's largest hospital and physicians acquired a facility that gradually developed into the most important research centre. Progress ed with the Napoleonic wars and the government shutdown in 1819 of all liberal journals and schools this caused a general return to traditionalism and eclecticism in medicine.
Vienna was the capital of a diverse empire and attracted not just Germans but Czechs, Hungarians, Jews, Poles and others to its world-class medical facilities. After 1820 the Second Viennese School of Medicine emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef & Scaronkoda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Basic medical science expanded and specialization advanced. Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded in Vienna. The textbook of ophthalmologist Georg Joseph Beer (1763-1821) Lehre von den Augenkrankheiten combined practical research and philosophical speculations, and became the standard reference work for decades.

Berlin
After 1871 Berlin, the capital of the new German Empire, became a leading center for medical research. Robert Koch (1843-1910) was a representative leader. He became famous for isolatingBacillus anthracis (1877), the Tuberculosis bacillus (1882) and Vibrio cholerae (1883) and for his development of Koch's postulates. He was awarded the Nobel Prize in Physiology or Medicine in 1905 for his tuberculosis findings. Koch is one of the founders of microbiology, inspiring such major figures as Paul Ehrlich and Gerhard Domagk.

U.S. Civil War
In the American Civil War (1861-65), as was typical of the 19th century, more soldiers died of disease than in battle, and even larger numbers were temporarily incapacitated by wounds, disease and accidents.  Conditions were poor in the Confederacy, where doctors and medical supplies were in short supply.  The war had a dramatic long-term impact on American medicine, from surgerical technique to hospitals to nursing and to research facilities.
The hygiene of the training and field camps was poor, especially at the beginning of the war when men who had seldom been far from home were brought together for training with thousands of strangers. First came epidemics of the childhood diseases of chicken pox, mumps, whooping cough, and, especially, measles. Operations in the South meant a dangerous and new disease environment, bringing diarrhea, dysentery, typhoid fever, and malaria. There were no antibiotics, so the surgeons prescribed coffee, whiskey, and quinine. Harsh weather, bad water, inadequate shelter in winter quarters, poor policing of camps, and dirty camp hospitals took their toll.
This was a common scenario in wars from time immemorial, and conditions faced by the Confederate army were even worse. The Union responded by building army hospitals in every state. What was different in the Union was the emergence of sed, well-funded medical organizers who took proactive action, especially in the much enlarged United States Army Medical Department,  and the United States Sanitary Commission, a new private agency. Numerous other new agencies also targeted the medical and morale needs of soldiers, including theUnited States Christian Commission as well as smaller private agencies.  The U.S. Army learned many lessons and in 1886, it established the Hospital Corps.

Statistical methods
A major breakthrough in epidemiology came with the introduction of statistical maps and graphs. They allowed careful analysis of seasonality issues in disease incidents, and the maps allowed public health officials to identifical critical loci for the dissemination of disease. John Snow in London developed the methods. English nurse Florence Nightingale pioneered analysis of large amounts of statistical data, using graphs and s, regarding the condition of thousands of patients in the Crimean War to evaluate the efficacy of hospital services. Her methods proved convincing and led to reforms in military and civilian hospitals, usually with the full support of the government.
By the late 19th and early 20th century English statisticians led by Francis Galton, Karl Pearson and Ronald Fisher developed the mathematical tools such as correlations and hypothesis tests that made possible much more sophisticated analysis of statistical data.
During the U.S. Civil War the Sanitary Commission collected enormous amounts of statistical data, and opened up the problems of storing information for fast access and mechanically searching for data patterns. The pioneer was John Shaw Billings (1838-1913). A senior surgeon in the war, Billings built the Library of the Surgeon General"s Office (now the National Library of Medicine, the centerpiece of modern medical information tems.  Billings figured out how to mechanically analyze medical and demographic data by turning facts into numbers and punching the numbers onto cardboard cards that could be sorted and counted by machine. The applications were developed by his assistant Herman Hollerith Hollerith invented the punch card and counter-sorter tem that dominated statistical data manipulation until the 1970s. Hollerith's company became International Business Machines (IBM) in 1911.
 
Worldwide dissemination
European ideas of modern medicine were spread widely through the world by medical missionaries, and the dissemination of textbooks. Japanese elites enthusiastically embraced Western medicine after the Meiji Restoration of the 1860s. However they had been prepared by their knowledge of the Dutch and German medicine, for they had some contact with Europe through the Dutch. Highly influential was the 1765 edition of Hrik van Deventer's pioneer work Nieuw Ligt ("A New Light") on Japanese obstetrics, especially on Katakura Kakuryo's publication in 1799 ofSanka Hatsumo ("Enlightenment of Obstetrics").  A cadre of Japanese physicians began to interact with Dutch doctors, who introduced smallpox vaccinations. By 1820 Japanese ranpô medical practitioners not only translated Dutch medical texts, they integrated their readings with clinical diagnoses. These men became leaders of the modernization of medicine in their country. They broke from Japanese traditions of closed medical fraternities and adopted the European approach of an open community of collaboration based on expertise in the latest scientific methods.  
Kitasato Shibasaburō (1853-1931) studied bacteriology in Germany under Robert Koch. In 1891 he founded the Institute of Infectious Diseases in Tokyo, which introduced the study of bacteriology to Japan. He and French researcher Alexandre Yersin went to Hong Kong in 1894, where Kitasato confirmed Yersin"s discovery that the bacterium Yersinia pestis is the agent of the plague. In 1897 he isolates and described the organism that caused dysentery. He became the first dean of medicine at Keio University, and the first president of the Japan Medical Association.
Japanese physicians immediately recognized the values of X-Rays. They were able to purchase the equipment locally from the Shimadzu Company, which developed, manufactured, marketed, and distributed X-Ray machines after 1900.  Japan not only adopted German methods of public health in the home islands, but implemented them in its colonies, especially Korea and Taiwan, and after 1931 in Manchuria.  A heavy investment in sanitation resulted in a dramatic increase of life life expectancy.

Psychiatry
The Quaker-run York Retreat, founded in 1796, gained international prominence as a centre for moral treatment and a model of asylum reform following the publication of Samuel Tuke's Description of the Retreat(1813).
Until the nineteenth century, the care of the insane was largely a communal and family responsibility rather than a medical one. The vast majority of the mentally ill were treated in domestic contexts with only the most unmanageable or burdensome likely to be institutionally confined.  This situation was transformed radically from the late eighteenth century as, amid changing cultural conceptions of madness, a new-found optimism in the curability of insanity within the asylum setting emerged.  Increasingly, lunacy was perceived less as a physiological condition than as a mental and moral one  to which the correct response was persuasion, aimed at inculcating internal restraint, rather than external coercion. This new therapeutic sensibility, referred to as moral treatment, was epitomised in French physician Philippe Pinel's quasi-mythological unchaining of the lunatics of the Bicêtre Hospital in Paris  and realised in an institutional setting with the foundation in 1796 of the Quaker-run York Retreat in England.
From the early nineteenth century, as lay-led lunacy reform movements gained in influence, ever more state governments in the West exted their authority and responsibility over the mentally ill. Small-scale asylums, conceived as instruments to reshape both the mind and behaviour of the disturbed,  proliferated across these regions.  By the 1830s, moral treatment, together with the asylum itself, became increasingly medicalised   and asylum doctors began to establish a distinct medical identity with the establishment in the 1840s of associations for their members in France, Germany, the United Kingdom and America, together with the founding of medico-psychological journals.  Medical optimism in the capacity of the asylum to cure insanity soured by the close of the nineteenth century as the growth of the asylum population far outstripped that of the general population.  Processes of long-term institutional segregation, allowing for the psychiatric conceptualisation of the natural course of mental illness, supported the perspective that the insane were a distinct population, subject to mental pathologies stemming from specific medical causes.  As degeneration theory grew in influence from the mid-nineteenth century,  heredity was seen as the central causal element in chronic mental illness,  and, with national asylum tems overcrowded and insanity apparently undergoing an inexorable rise, the focus of psychiatric therapeutics shifted from a concern with treating the individual to maintaining the racial and biological health of national populations.  
Emil Kraepelin (1856&ndash1926) introduced new medical categories of mental illness, which eventually came into psychiatric usage despite their basis in behavior rather than pathology or etiology. Shell shock among frontline soldiers exposed to heavy artillery bombardment was first diagnosed by British Army doctors in 1915. By 1916, similar symptoms were also noted in soldiers not exposed to explosive shocks, leading to questions as to whether the disorder was physical or psychiatric.  In the 1920s surrealist opposition to psychiatry was expressed in a number of surrealist publications. In the 1930s several controversial medical practices were introduced including inducing seizures (by electroshock, insulin or other drugs) or cutting parts of the brain apart (leucotomy or lobotomy). Both came into widespread use by psychiatry, but there were grave concerns and much opposition on grounds of basic morality, harmful effects, or misuse.  
In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. There was also increasing opposition to the use of psychiatric hospitals, and attempts to move people back into the community on a collaborative user-led group approach ("therapeutic communities") not controlled by psychiatry. Campaigns against masturbation were done in the Victorian era and elsewhere. Lobotomywas used until the 1970s to treat schizophrenia. This was denounced by the anti-psychiatric movement in the 1960s and later.
The Quaker-run York Retreat, founded in 1796, gained international prominence as a centre for moral treatment and a model of asylum reform following the publication ofSamuel Tuke's Description of the Retreat(1813).
Until the nineteenth century, the care of the insane was largely a communal and family responsibility rather than a medical one. The vast majority of the mentally ill were treated in domestic contexts with only the most unmanageable or burdensome likely to be institutionally confined. This situation was transformed radically from the late eighteenth century as, amid changing cultural conceptions of madness, a new-found optimism in the curability of insanity within the asylum setting emerged. Increasingly, lunacy was perceived less as a physiological condition than as a mental and moral one to which the correct response was persuasion, aimed at inculcating internal restraint, rather than external coercion. This new therapeutic sensibility, referred to as moral treatment, was epitomised in French physician Philippe Pinel's quasi-mythological unchaining of the lunatics of the Bicêtre Hospital in Paris and realised in an institutional setting with the foundation in 1796 of the Quaker-run York Retreat in England.
Patient, Surrey County Lunatic Asylum, c.1850-58. The asylum population in England and Wales rose from 1,027 in 1827 to 74,004 in 1900.

From the early nineteenth century, as lay-led lunacy reform movements gained in influence, ever more state governments in the West exted their authority and responsibility over the mentally ill. Small-scale asylums, conceived as instruments to reshape both the mind and behaviour of the disturbed, proliferated across these regions. By the 1830s, moral treatment, together with the asylum itself, became increasingly medicalised  and asylum doctors began to establish a distinct medical identity with the establishment in the 1840s of associations for their members in France, Germany, the United Kingdom and America, together with the founding of medico-psychological journals. Medical optimism in the capacity of the asylum to cure insanity soured by the close of the nineteenth century as the growth of the asylum population far outstripped that of the general population. Processes of long-term institutional segregation, allowing for the psychiatric conceptualisation of the natural course of mental illness, supported the perspective that the insane were a distinct population, subject to mental pathologies stemming from specific medical causes. As degeneration theory grew in influence from the mid-nineteenth century,heredity was seen as the central causal element in chronic mental illness, and, with national asylum tems overcrowded and insanity apparently undergoing an inexorable rise, the focus of psychiatric therapeutics shifted from a concern with treating the individual to maintaining the racial and biological health of national populations.
Emil Kraepelin (1856-1926) introduced new medical categories of mental illness, which eventually came into psychiatric usage despite their basis in behavior rather than pathology or etiology. Shell shock among frontline soldiers exposed to heavy artillery bombardment was first diagnosed by British Army doctors in 1915. By 1916, similar symptoms were also noted in soldiers not exposed to explosive shocks, leading to questions as to whether the disorder was physical or psychiatric. In the 1920s surrealist opposition to psychiatry was expressed in a number of surrealist publications. In the 1930s several controversial medical practices were introduced including inducing seizures (by electroshock, insulin or other drugs) or cutting parts of the brain apart (leucotomy or lobotomy). Both came into widespread use by psychiatry, but there were grave concerns and much opposition on grounds of basic morality, harmful effects, or misuse.
In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. There was also increasing opposition to the use of psychiatric hospitals, and attempts to move people back into the community on a collaborative user-led group approach ("therapeutic communities") not controlled by psychiatry. Campaigns against masturbation were done in the Victorian era and elsewhere. Lobotomywas used until the 1970s to treat schizophrenia. This was denounced by the anti-psychiatric movement in the 1960s and later.

Compiled By: Dr.Kamran Jalali
http://en.wikipedia.org/wiki/History_of_medicine
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History of Medicine