It is hard to believe that less than 200 years ago, people did not know what a germ was. Now medicine is a well-respected science. How did we arrive at the polished emphasis on Public Health and Modern Medicine we rely on today? A series of fundamental discoveries transformed medical knowledge and treatment, but what were they? Let's find out!
Origin of Modern Medicine
Modern medicine has its roots in Ancient Greece, where a practising physician was the widely accepted father of modern medicine.
Father of Modern Medicine
A true visionary, despite living well over 2,000 years ago in Ancient Greece, Hippocrates (460 - 375 BCE) profoundly influenced modern medicine. His belief that medicine was a science and his emphasis on diet are ideas that remain important today. With the failures of medieval medicine, the Renaissance brought a rebirth of classical theories such as those of Hippocrates.
Fig. 1 - Hippocrates statue in Leiden, the Netherlands
Most of all, Hippocrates' legacy is evident in the Hippocratic Oath, a code of ethics and professionalism that many new doctors still take to this day. He established the duties of the doctor as a respected field. Despite this, medical progress largely stood still until the nineteenth century.
Modern Medicine vs Traditional Medicine
Before charting the development of medicine into modern science, let's contrast it with the traditional methods that prevailed for so long.
Causes and Diagnoses
Without knowledge of germs, there was a belief in the miasma theory of bad air. This meant the environments were generally filthy. People often resorted to superstition to explain illness. During the Black Death plagues of the 14th century, flagellants whipped themselves to show repentance for their sins, believing that God was punishing them.
Treatment
Since there was little to no understanding of the causes of diseases, treatments could not be precise. The sick relied on apothecaries and 'wise women' to sell remedies that were often herbal. Herbs, spices, minerals, and sometimes parts of animals would be made into a concoction that may or may not have helped!
Apothecaries
A predecessor of modern-day chemists, this was the first stop for medicines before the pharmaceutical industry.
Bloodletting
The removal of blood to relieve the illness of patients, often at the elbow or the knee.
In addition, bloodletting had long been used in conjunction with Hippocrates' Four Humours theory. Blood, phlegm, yellow bile, and black bile needed to be balanced. The loss of blood often proved fatal.
Surgery
Surgery was also a grisly business before modern medicine, taking place in dirty environments that routinely caused infections. Drugs such as alcohol and opium were common as general anaesthetics to make a patient unconscious.
Early experiments with more advanced anaesthetics were unsuccessful because of the danger of substances such as chloroform and the lack of understanding about infectious environments. Finally, there was no certainty when finding the exact part of the body or problem which needed to be operated on. Blood loss and the inability to transfuse blood successfully were other causes of death.
Government
Perhaps the biggest problem was in the British government. The accepted opinion was that governments should not play a significant role in public health. This laissez-faire attitude was the downfall of Britain until an understanding of the Germ Theory in the mid-19th century forced them to act with legislation, but more on that later!
Medicine in the Nineteenth Century
While Hippocrates was an essential reference point, some critical medical developments laid the foundation for the modern medical revolution, which accelerated at the turn of the century (around 1900).
In Victorian Britain, the Industrial Revolution brought disease to London. Up to this point, the vague miasma theory of 'bad air' had prevailed. However, there was no knowledge of bacteria, germs, or viruses and a laissez-faire attitude came from the government. Diseased sewage water had been causing cholera for over 20 years when doctor John Snow noticed the link between water, pump handles, and deaths in 1854.
Laissez-faire
French for 'let it be', laissez-faire is a political attitude that avoids upsetting or changing laws. This contributed to the lack of progress in British public health for hundreds of years.
This discovery gained little recognition until the publication of Germ Theory by French physician Louis Pasteur in 1861, who proved that there were germ microbes in the air and that they caused disease. Robert Koch developed this work by identifying microbes of specific diseases such as anthrax, tuberculosis, and cholera. Joseph Lister's use of antiseptics in the early 1860s and the subsequent promotion of an aseptic (germ-free) environment resulted from this. Finally, the Public Health Act in 1875 reinforced widespread acceptance that germs existed. Medicine was truly becoming a science.
A Vital Breakthrough
Although similar in content to another Public Health Act of 1848, the 1875 Public Health Act had a far more positive effect because it was mandatory. Thanks to individuals including John Snow, Louis Pasteur and Joseph Lister, the Germ Theory was becoming increasingly accepted. Prime Minister Benjamin Disraeli recognised that previous legislation did not go far enough to tackle public health.
The Public Health Act of 1875 meant that local councils must:
- Maintain clean streets.
- Use health inspectors to maintain high hygiene and water supply standards.
- Look after sewage systems to avoid cholera germs.
In addition to this, the Artisan Dwellings Act of the same year, which reduced slum living conditions and the River Pollution Prevention Act (1876), forbidding the dumping of waste into rivers, underlined the government's stance. The Act was essential in stopping the spread of diseases through dirty water, such as cholera. Its success vindicated the Germ Theory.
There were more Public Health Acts in 1936 and 1961, each of which sought to place more responsibility at the feet of local councils in terms of public health. Now, those responsible for poor sanitation needed to cover the remedial costs themselves. More recently, legislation has focused on particular aspects of public health, including food safety, smoking, alcohol, and mental health.
These developments planted the seeds for the changes that would occur during and just before the 20th century.
Modern Medicine History
The accelerations in medical development began in the 1890s. This timeline marks some of the key breakthroughs.
| Year | Event |
| 1890 | German scientist Emil Behring developed a new way of combatting diseases. He used the bacteria in diphtheria and tetanus to help the body to create antitoxins that fought the harmful bacteria. |
| 1892 | Russian microbiologist Dmitry Ivanovsky discovered a disease that killed tobacco plants. This helped explain the cause of diseases too small to identify as bacteria. Subsequently, the Dutch scientist Martinus Beijernick defined such diseases as a virus. This discovery paved the way for antiviral drug treatments that halt the progress of a virus. |
| 1895 | Another German scientist, Wilhelm Röntgen, created x-rays using electromagnetic radiation. This was incredibly beneficial in diagnosing the location of injuries, particularly in World War I. |
| 1897 | Chemical company Bayer found a way to make the painkiller aspirin palatable. It was widely available in powder form, finally available without prescription in 1915. |
| 1898 | Pierre and Marie Curie found that radium and polonium effectively destroy tissue. Radiotherapy was born as a method of treating cancer growth. After analysing mustard gas in 1945, chemotherapy (chemical therapy) also became a way of destroying cancerous cells. |
| 1900 | With the arrival of the twentieth century, modern medicine was set to progress rapidly in the coming years. |
| 1901 | Austrian-born Karl Landsteiner distinguished different blood groups. He laid the foundation for blood transfusions and blood banks to be effective. |
| 1905 | Performance of the first cornea (outer eye) transplant. |
| 1907 | Paul Ehrlich knew antibodies were the body's defensive method against bacterial germs. He created the synthetic antibody, or 'magic bullet', Salvarsan 606, to treat syphilis. The first human trial was in 1911. |
| 1917 | In London, Harold Gillies set up a specialised hospital that focused on skin transplants for World War I soldiers, a precursor to plastic surgery. |
| 1928 | Alexander Fleming realised, by mistake, that penicillin killed bacteria. It became the first antibiotic that could fight against bacteria. Soon in World War II, the newly created Pharmaceutical Industry allowed this medicine to be widely distributed. |
| 1948 | The creation of the National Health Service (NHS) brought free healthcare to all in the UK. |
| 1953 | Francis Crick and James Watson found that the DNA genetic structure is a 'double helix'. This allowed future doctors to understand genetic illnesses or conditions passed from generation to generation, such as haemophilia. |
Now let's dig into some of the factors that allowed medicine to become modern.
Fig. 2 - Marie Curie, who helped to discover radiotherapy
What made medicine modern?
Advancements in several specific areas meant that by the 20th century, modern medicine had arrived. Let's explore some of the key ones here.
Causes and Diagnoses
A greater understanding of what caused diseases made diagnoses far more accurate. Louis Pasteur's Germ Theory in 1861 heralded the discovery of bacteria, and Martinus Beijernick named the different disease microbes viruses. This pinpointed the cause of diseases. Additionally, the development of understanding from Landsteiner's definition of blood groups led to blood tests to detect harmful warning signs (cholesterol, blood pressure, or blood sugar levels) and prescribe treatment accordingly.
Röntgen and Curie's knowledge of x-rays and radiation was effective in locating the cause of injuries. Furthermore, technology allowed more sophisticated scans like Computer Tomography (for the detection of cancers) and Magnetic Radiation Imaging (MRI) scans in the 1970s. Finally, Crick and Watson's understanding of DNA meant that after 1953 genetic conditions could be diagnosed.
With such a flurry of breakthroughs before World War I, medical science played a crucial role in saving lives during the conflict. Pasteur's Germ Theory meant that soldiers could be treated in aseptic environments. Landsteiner's understanding of blood led to the creation of blood banks and transfusions with the correct blood group. The invention of x-rays allowed for precise diagnoses of illnesses.
Fig. 3 - 3D depiction of DNA
Treatment
Considerable improvements in identifying the cause of different medical issues led to success with new methods of treatment. Discoveries of antibodies and antitoxins led to the creation of a synthetic antibody or 'magic bullet' by Paul Ehrlich and his scientists.
Antibodies
The body's natural defence mechanism for fighting disease.
Salvarsan 606 effectively treated syphilis in 1911. Alexander Fleming found penicillin, the world's first antibiotic (to combat bacteria), in 1928. Since the 1960s, the use of antiviral drugs to decrease the impact of viruses has been widespread. The work of Pierre and Marie Curie and their use of radiotherapy and later chemotherapy have been developed to treat cancer.
We have already commented on the success of x-rays, using radiation, for diagnosing illnesses, but Marie Curie's understanding of radiation led to radiotherapy as a treatment for cancer. Radiotherapy involves using high levels of radiation to target and kill cancer cells. The use of it has become more refined since it was first used in 1903 and remains employed by doctors alongside chemical and laser therapy to combat cancer today.
Surgery
The promotion of a germ-free or aseptic environment by Victorian surgeons such as Joseph Lister was instrumental in the continued development of surgical procedures in the 20th century. Landsteiner's understanding of blood groups also addressed the issue of blood loss. Now, transfusions could be effective. Methods of storing blood were found during World War I, with the successful employment of blood banks. At the turn of the century, cornea and skin transplants gave hope for more significant transplants to follow.
Fig. 4 - The face of Karl Landsteiner, who discovered blood groups
However, the issue was the rejection of foreign organs by the body, which viewed them as viruses and attacked them. This often led to fatalities, but the introduction of immunosuppressant drugs in the 1970s gave organ transplants a far higher survival rate. New, more precise surgical methods like keyhole surgery and robot-assisted surgery mean that only necessary incisions and scars are left during an operation, and patients can recover faster.
Government
Since the Public Health Act in 1875, UK governments have taken a more active role in addressing public health. This led to improvements in the general well-being of the population. Successful vaccination campaigns have eradicated diphtheria and polio. In addition, a greater public consciousness about smoking, alcohol, obesity, and sexual health has often come from TV programmes or government-backed advertisements.
Perhaps most noticeably, a Labour government banned smoking indoors in public places in 2007 due to the clear links to lung cancer.
In the UK, the greatest contribution of the government to modern medicine is undoubtedly its creation of the NHS in 1948, which, despite some issues, has expanded and transformed the widespread availability of healthcare.
Public Health and Modern Medicine: Summary
After such a long malaise, modern medicine and public health have developed at a staggering speed. Factors such as individual brilliance, war, science, and government all played a role. Underpinning its growth is the elevation of medicine to a noble and respected profession, echoing the sentiments of the Hippocratic Oath, which is still used in different variations by doctors and physicians today.
The Hippocratic Oath remains a commitment to the idea that there are ideals and principles in the profession of medicine, a heritage worth claiming.1
- Dale C. Smith
The sky seems the limit for the future of medicine as it continues to dovetail with science. Laser therapy, 3D printing and an even greater understanding of genetics promise much, with the double-speed creation of the Covid-19 vaccine demonstrating just how far we have come.
Public Health and Modern Medicine - Key takeaways
- Some ideas of modern medicine and its scientific origins can be traced to the writings of the Greek physician Hippocrates.
- Pasteur's Germ Theory of 1861 and the resulting knowledge of aseptic environments were vital for the development of modern medicine.
- A series of crucial breakthroughs occurred, starting in 1890.
- Thanks to these breakthroughs, immense progress has been made in important areas of medicine. There is now a far greater knowledge of the causes of medical issues, which has enhanced doctors' ability to diagnose diseases.
- Treatment has developed with a series of different solutions for problems that have been correctly diagnosed.
- Surgery is much more accurate and safer. X-rays and blood transfusions played a key role in this, coupled with the creation of an aseptic environment.
- The UK government now plays a much more active role in public health and has moved on from a laissez-faire approach.
References
- Dale C. Smith, 'The Hippocratic Oath and Modern Medicine', Journal of the History of Medicine and Allied Sciences, Vol. 51, No. 4 (OCTOBER 1996), pp. 484-500.
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