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 14^th 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!

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-19^th 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.

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.

These developments planted the seeds for the changes that would occur during and just before the 20^th century.

Modern Medicine History

The accelerations in medical development began in the 1890s. This timeline marks some of the key breakthroughs.

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 20^th 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.

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.

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.

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 20^th 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.

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 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.