History of medicine

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History of medicine

Vitebsk 2013

Pre-Greek

Prehistoric medicine

In the long process of discovering which plants are edible, humans in the Stone Age also identify many which seem to cure ailments or soothe a fever. Herbal medicine is the earliest scientific tradition in medical practice, and it remains an important part of medicine to this day - in a line descending directly from those distant beginnings. The early physicians stumbled upon herbal substances of real power, without understanding the manner of their working.

The snakeroot plant has traditionally been a tonic in the east to calm patients; it is now used in orthodox medical practice to reduce blood pressure. Doctors in ancient India gave an extract of foxglove to patients with legs swollen by dropsy, an excess of fluid resulting from a weak heart; digitalis, a constituent of foxglove, is now a standard stimulant for the heart. Curare, smeared on the tip of arrows in the Amazonian jungle to paralyze the prey, is an important muscle relaxant in modern surgery. The snakeroot plant has traditionally been a tonic in the east to calm patients; it is now used in orthodox medical practice to reduce blood pressure. Doctors in ancient India gave an extract of foxglove to patients with legs swollen by dropsy, an excess of fluid resulting from a weak heart; digitalis, a constituent of foxglove, is now a standard stimulant for the heart. Curare, smeared on the tip of arrows in the Amazonian jungle to paralyze the prey, is an important muscle relaxant in modern surgery.

The long centuries of primitive experiment mean that Susruta, a physician working in India in about the 6th century BC, is able to list hundreds of herbal remedies.

Even so, herbal substances form only a small part of the repertoire of the tribal physician, for it is generally agreed that serious illnesses have spiritual rather than physical causes. The doctor's main duty is to appease or expel the evil spirit troubling the sick person. Incantation, spells and self-induced trances (often assisted by herbal drugs) form the standard practice of the medicine man or shaman. Even the world's earliest surgical operation, practiced at least 4000 years ago, is more probably intended to strengthen the doctor's own powers than to cure a patient.

A hole in the head: perhaps from 2000 BC.

The earliest surgical operation in human history is carried out in prehistoric times in several parts of the world - in Europe, in Asia and particularly in Peru, where well-preserved mummies survive. Many of these mummies have the hole in the skull which is the result of trepanning (also known as trephining or trephination). Healing in the bone around the wound in these mummies, and in skulls found elsewhere, suggests that as many as 50 percent of the 'patients' survive the operation. The reason for the alarming decision to cut a hole in a living skull is likely to have been religious rather than medical in any modern sense. To let out evil spirits perhaps; or to give spiritual authority to a shaman who submits himself to the knife. Merely by surviving the operation the shaman proves that he is favoured by the spirits. And his hole in the head, healed over with a flap of skin, will continue to suggest that he has an open channel of communication with unseen influences. It is not known how such operations were done. One method may be cutting and scraping away at the bone of the skull with a sharp flint, until a hole is virtually rubbed away. Another may be making a circle of small holes with a flint drill and then cutting between them. Whatever the method, it is to be hoped that there is a herbal mixture of some kind to serve as at least a mild form of anaesthetic.

Medicine in India

From the 6th century BC Susruta, the founding father of Indian medicine, establishes a tradition later enshrined in a classic text, the Susruta samhita. He identifies 1120 diseases, lists 760 medicinal drugs, and says that the surgeon's equipment amounts to 20 sharp instruments (including knives, scissors, saws and needles) and 101 blunt ones (such as forceps, tubes, levers, hooks and probes). His explanation of how to rebuild a patient's nose has given him the status of the first plastic surgeon. This is an important operation in ancient India. Amputation of the nose is a punishment for adultery. Indian medicine enshrines the theory that the human body consists of three substances, and that health requires a balance between them. They are usually translated as spirit, phlegm and bile. Greek medicine will later advance a similar theory, but one based on four humours rather than three.

Greece and China

The Hippocratic Oath and the four humours: 4th c. BC

Hippocrates practices and teaches medicine in about 400 BC on the Greek island of Kos. He will later be regarded as the father of medicine - partly because he is unlike his more theoretical contemporaries in paying close attention to the symptoms of disease, but also because a century or more after his death a group of medical works is gathered together under his name. This Hippocratic Collection, and in particular the Hippocratic oath which is part of it, has remained the broad basis of medical principle up to our own day.

A slightly later Greek text, called On the Nature of Manand attributed to an author by the name of Polybus, introduces a medical theory which will be orthodox in Europe for some 2000 years. It states that human beings are composed of four substances or 'humours', just as inanimate matter is made up off our elements. India has a similar theory based on three. The humours are blood, phlegm, black bile (melancholia) and yellow bile (chole). Too much of any one will give a person certain recognizable characteristics. He or she will be sanguine, phlegmatic, melancholy or choleric.

Human vivisection: c. 300 BC

Early in the 3rd century BC two surgeons in Alexandria, Herophilus and Erasistratus, make the first scientific studies designed to discover the workings of human anatomy. The cost of their contribution to science would be considered too high in modern times (they acquire much of their information from Human vivisection, the patients being convicted criminals). But Celsus, a Roman writer on medical history, energetically justifies the suffering of the criminals as providing 'remedies for innocent people of all future ages'.

Acupuncture: 3rd century BC

A Chinese text, the Nei Ching or 'Book of Medicine', describes the practice of acupuncture. The document is written in about the 1st century BC, by which time acupuncture is already a long-established tradition. The underlying theory is that a healthy body depends on a flow of energy. This can be interrupted by blockages, which may be either the symptom or the cause of illness. Inserting a needle into the correct spot on the energy path (as many as 365 possible places are specified) will improve the energy flow by clearing a blockage or releasing pressure. The use of acupuncture as a form of anaesthetic, familiar in China today, is a modern development of the traditional science.

The influential errors of Galen: 2nd century AD

The newly appointed chief physician to the gladiators in Pergamum, in AD 158, is a native of the city. He is a Greek doctor by the name of Galen. The appointment gives him the opportunity to study wounds of all kinds. His knowledge of muscles enables him to warn his patients of the likely outcome of certain operations - a wise precaution recommended in Galen's Advice to doctors.

But it is Galen's dissection of apes and pigs which give him the detailed information for his medical tracts on the organs of the body. Nearly 100 of these tracts survive. They become the basis of Galen's great reputation in medieval medicine, unchallenged until the anatomical work of Vesalius.

Through his experiments Galen is able to overturn many long-held beliefs, such as the theory (first proposed by the Hippocratic school in about 400 BC, and maintained even by the physicians of Alexandria) that the arteries contain air - carrying it to all parts of the body from the heart and the lungs. This belief is based originally on the arteries of dead animals, which appear to be empty. Galen is able to demonstrate that living arteries contain blood. His error, which will become the established medical orthodoxy for centuries, is to assume that the blood goes back and forth from the heart in an ebb-and-flow motion. This theory holds sway in medical circles until the time of Harvey.

Middle Ages

The school of Salerno: 10th century

Medieval Europe's first college of higher learning is founded, probably in the 10th century, at Salerno. It is a medical school. It will be a long time before the medical education on offer at Salerno results in any new discoveries, for the prevailing mood is uncritical veneration of every word written by Galen - even when his theories seem directly opposed to practical experience. But Salerno is significant not only in the history of medicine. It is also the start of Europe's university tradition.

Surgeon and dentist in Spain: c. 1000

An Arab doctor, Abul Kasim, is court physician to the emir of Cordoba. He writes Al-Tasrif, the first illustrated manual of surgery. It is widely copied and used throughout the Middle Ages. He is also the first surgeon to take an informed interest in dental matters. Chapters in Al-Tasrif give Advice to dentists on basic procedures such as extraction of teeth, but also deal with much more modern concerns - including the removal of plaque.

An anaesthetic of the 13th century.

A manuscript of about 1265 contains the first detailed description of an anaesthetic, though similar mixtures are believed to have been used in the Alexandrian school of medicine 1000 years earlier. The doctor should mix in a brass vessel specific proportions of opium, hemlock and the juice of mandragora, ivy and unripe mulberry. The mixture is to be boiled with a sponge, until all has been reduced and soaked up. The sponge should then be applied to the nostrils of the patient. When the time comes to wake the patient up again, after the surgery, a sponge full of vinegar should be applied to his nose.

16^th-18^th century

Vesalius and the science of anatomy: 1533-1543

A young medical student, born in Brussels and known to history as Vesalius, attends anatomy lectures in the university of Paris. The lecturer explains human anatomy, as revealed by Galen more than 1000 years earlier, while an assistant points to the equivalent details in a dissected corpse. Often the assistant cannot find the organ as described, but invariably the corpse rather than Galen is held to be in error. Vesalius decides that he will dissect corpses himself and trust to the evidence of what he finds. His approach is highly controversial. But his evident skill leads to his appointment in 1537 as professor of surgery and anatomy at the university of Padua. In 1540 Vesalius gives a public demonstration of the inaccuracies of Galen's anatomical theories, which are still the orthodoxy of the medical profession. Galen did many of his experiments on apes. Vesalius now has on display - for comparison - the skeletons of a human being and of an ape. Vesalius is able to show that in many cases Galen's observations are indeed correct for the ape, but bear little relation to the man. Clearly what is needed is a new account of human anatomy. Vesalius sets himself the task of providing it, illustrated in a series of dissections and drawings. He has at his disposal a method, relatively new in Europe, of ensuring accurate distribution of an image in printed form - the art of the woodcut. His studies inaugurate the modern science of anatomy. At Basel, in Switzerland, Vesalius publishes in 1543 his great work - De humani corporis fabrica (The Structure of the Human Body). There are seven volumes including numerous magnificent woodcut illustrations. The book is an immediate success, though naturally it enrages the traditionalists who follow Galen. Galen's theories have, after all, the clear merit of seniority. They are by now some 1400 years old. But for those willing to look with clear eyes, the plates in Vesalius's volumes are a revelation. For the first time human beings can peer beneath their own skins, in these strikingly clear images of what lies hidden.

Surgery: 16th-17th century

In an age before anaesthetics, surgery is inevitably a limited branch of medicine. It is also considered a rather lowly craft, despised by doctors whose reputation is based on their knowledge of the approved authorities rather than clinical skills. Surgeons are linked with barbers, who also require sharp instruments to practise their trade. The most frequent use of the surgeon's knife is to open patients' veins for blood-letting, also known as bleeding. This is the treatment most often prescribed by the learned physicians, because Galen has pronounced that fevers and apoplexy result from an excessive build-up of blood in the system. However there is one area where surgeons are increasingly in demand from the 16th century, and where they rapidly learn and acquire new skills - on the battlefield. The arrival of artillery and muskets alters the nature of wounds. Instead of the clean cut inflicted by sword thrust or pike, there are now gaping holes of torn flesh and shattered bones. The greatest surgeon of the 16th century, Ambroise Parй, rises from the humble status of a barber's apprentice to become surgeon to the kings of France, and does so mainly through knowledge acquired in the treatment of war wounds. Parй publishes in 1545 the first account of his military experiences under the title La Methode de traicter les playes faictes par Hacquebutes, et aultres bastons a feu (The Method of treating wounds caused by Arquebuses and other firearms). His most significant discovery is that the traditional treatment of any gunshot wound (violently cauterizing it with boiling oil because it is assumed to be poisoned by the gunpowder), does considerable extra harm to the patient. Parй achieves much greater success by simply dressing the wounds with a mixture of egg yolk, oil of roses and turpentine. Parй also makes advances in the use of ligatures for sealing blood vessels to staunch the flow of blood. As many as fifty-three are needed after the amputation of a thigh. Amputation is the only form of major surgery which surgeons of this period are able to practice. The other major operations of modern surgery, by incision into the abdomen or other cavities of the body, were at the time too dangerous to perform. There is one exception to this - the removal of stones from the bladder. A medical text by Celsus, writing in Rome in the 1st century AD, reveals that this operation is performed in classical times. It is relatively easy to achieve because a large stone can be pressed by the surgeon's finger hard against the patient's skin for incision and extraction.

A famous patient, Samue Pepys, is 'cut for the stone' in London on 26 March 1658. The operation is carried out by Thomas Hollyer of St Thomas's Hospital. It takes place not in the hospital but in a large room in a house of one of Pepys's relations. It needs to be large. The whole family gathers in case the event turns out to be a death scene. With no effective pain-killer available (Pepys is offered rose water with white of egg and liquorice), the speed of the surgeon is all-important. The record for this operation in the next century is fifty-four seconds. Pepys survives, to begin his diary two years later. He has a cabinet built to display the two-ounce stone, and resolves to keep March 26 as a festival each year.

Harvey and the circulation of the blood: 1628

A book is published in 1628 which provides one of the greatest breakthroughs in the understanding of the human body - indeed perhaps the greatest until the discovery of the structure of DNA in the 20th century. The book consists of just fifty-two tightly argued pages. Its text is in Latin. Its title is Exercitatio anatomica de motu cordis et sanguinis in animalibus ('The Anatomical Function of the Movement of the Heart and the Blood in Animals'). Its author is William Harvey. In this book he demonstrates beyond any reasonable doubt an entirely new concept. Blood, he shows, does not drift in the body in any sort of random ebb and flow. Instead it is pumped endlessly round a very precise circuit. Until now it has been assumed that the blood in arteries and the blood in veins are different in kind. It is well known that they are of a different colour, and there have been many theories as to what each supply of blood does. The most commonly held belief is that arterial blood carries some sort of energy connected with air to the body (not far from the truth), and that blood in the veins distributes food from the liver (less accurate). By a long series of dissections (from dogs and pigs down to slugs and oysters), and by a process of logical argument, Harvey is able to prove that the body contains only a single supply of blood; and that the heart is a muscle pumping it round a circuit. This circuit, as he can demonstrate, brings the blood up from the veins into the right ventricle of the heart; sends it from there through the lungs to the left ventricle of the heart; and then distributes it through the arteries back to the various regions of the body. After much initial opposition, Harvey's argument eventually convinces most of his contemporaries. But there are two missing ingredients. His theory implies that there must be a network of tiny blood vessels bringing the blood from the arterial system to the venous system and completing the circuit. But his dissections are not adequate to demonstrate this. It is not till four years after his death that Marcello Malpighi observes the capillaries. And Harvey is unable to explain why the heart should circulate the blood. That explanation will have to await the discovery of oxygen.

Malpighi and the microscope: 1661

Marcello Malpighi, a lecturer in theoretical medicine at the university of Bologna, has been pioneering the use of the microscope in biology. One evening in 1661, on a hill near Bologna, he uses the setting sun as his light source, shining it into his lens through a thin prepared section of a frog's lung. In the enlarged image it is clear that the blood is all contained within little tubes.

Malpighi thus becomes the first scientist to observe the capillaries, the tiny blood vessels in which blood circulates through flesh. They are so fine, and so numerous, that each of our bodies contains more than 100,000 km of these microscopic ducts. With their discovery, the missing link in Harvey's circulation of the blood has been found. For the capillaries are literally the link through which oxygen-rich blood from the arteries first delivers its energy to the cells of the body and then finds its way back to the veins to be returned to the heart.

Blood transfusion: 1665-1670

At a meeting of the recently established Royal Society in London, on 14 November 1665, an experiment is made in transferring blood from one dog to another. The artery of a small mastiff is joined by a quill to the vein of a spaniel. Another of the spaniel's veins is opened to let out an equivalent amount of its own blood.

The mastiff bleeds to death in front of the Society. The spaniel is produced at the equivalent meeting a week later and is found to be in fine health. Two years later, in France, a much more ambitious step is taken along these same lines. Jean Baptiste Denis, royal physician to Louis XIV, conducts a bold experiment in 1667 in Paris. In an attempt to save the life of a 15-year-old boy, weakened by too much blood-letting, he inserts into his veins, through a quill, about half a pint of the blood of a lamb. Contemporary reports say that the condition of the boy is greatly improved. Later in the same year, following this impressive example from Paris, the Royal Society in London becomes more bold in its experiments. Arthur Coga, a divinity student from Cambridge who is said to be slightly 'frantic', is hired for a transfusion. Half a pint of sheep's blood is passed into his vein. The scientists hope that this will cool his own blood and thus make him less frantic. Opinions differ as to whether this desirable effect is achieved. When asked why he has received sheep's blood, rather than that of any other creature, the divinity student replies that it is because Christ is the Lamb of God. A week later Mr Coga addresses the Society in Latin and declares that he feels much better. Later on the same day Pepys meets him at dinner and still finds him 'cracked a little in his head'. Pepys is rather shocked to hear that Coga 'had but 20 shillings for his suffering it, and is to have the same again tried on him'. He receives a second transfusion three weeks after the first, and apparently experiences no lasting ill effects. Pepys says that Coga is the first healthy man to have had the experiment tried upon him, apart from a porter in France hired for the same purpose 'by the virtuosi'. But a disaster in France is about to put an end to this run of experiments. Following his success in 1667, Jean Baptiste Denis has given blood to several other patients with continuing success. But in 1668, after a third transfusion, one of his patients dies. Denis is sued by the widow. He loses the case, though he is cleared of murder. The result is that the entire experiment falls into disrepute, after a turmoil of excitement lasting three years. In 1670 a law is passed in France making blood transfusion illegal. For another two centuries no more is heard of it anywhere - until it is again attempted fairly regularly in mid-19th century England, now usually with human blood. But it remains a hazardous procedure until the discovery, in 1900, of the human blood groups

Inoculation: 17th-18th century

At some time before the end of the 17th century a bold procedure, possibly practiced already for several centuries in parts of Asia, becomes established in Turkish medicine. It is the use of inoculation to protect against the extremely infectious and frequently fatal disease of smallpox. Inoculation is based on an easily observed medical fact - that those who contact an infectious disease and survive are protected against catching it again. Inoculation is a precautionary measure, though in the case of smallpox a dangerous one. Pustulent matter from the skin of a lightly infected smallpox victim is rubbed into a fresh scratch in the skin of the person being inoculated, with the intention of inducing a mild attack of the disease. Most of those undergoing the treatment survive and are protected. The unfortunate few die. The procedure reaches Europe because of a sequence of events in the early 18th century. In 1715 Lady Mary Wortley Montagu, a young beauty and wit in fashionable London, catches smallpox. She survives but is left with disfiguring scars. A year later her husband is appointed ambassador to the court of the Turkish sultan. She accompanies him to Istanbul, together with their three-year-old son. In Istanbul she sees inoculation successfully carried out. Her own recent experience prompts her to a possibly reckless decision. She submits her infant son to this Turkish procedure. He survives. Back in London, in 1718, Lady Mary has a second child, a daughter. She has this child inoculated in England. She too survives. With characteristic vigour Lady Mary now begins campaigning for this basic measure of preventive medicine. She has sufficient success for inoculation to become an increasingly common practice in England during the 18th century. But it remains, inevitably, a hazardous one - until Edward Jenner discovers a safer method.

Practical measures: 1752-1785

The middle years of the 18th century are notable for practical advances in medicine, based on close observation by working practitioners. Some of those who record their experiences are at the academic end of the medical profession, others are country doctors paying attention to detail. Their efforts raise the scientific standards of medicine and introduce techniques and drugs of lasting benefit.

An early example is William Smellie, the first obstetrician to make a scientific study of the physical process of childbirth.

From 1741 Smellie gives midwives and medical students in London unprecedented practical lectures on childbirth. He achieves this by offering his services to poor women on condition that his students may attend the birth. In this way he is able to develop a scientific account of the mechanism of labour, describing previously unobserved details - such as how the child's head is adapted for the passage through the pelvic canal. Smellie publishes his findings in the three-volume Treatises on the Theory and Practice of Midwifery (1752-64). His text provides a new scientific basis for the ancient skills of the midwife. A similarly thorough groundwork is provided for pathology in a book of 1761. Its author, Giovanni Battista Morgagni, is seventy-nine at the time of publication. He has spent nearly five decades as professor of anatomy at Padua (a post once occupied by Vesalius). During that time Morgagni has kept detailed notes of his dissections of corpses.

This is not new in itself, for there have by now been many published accounts of post-mortem examinations. Morgagni's originality lies in his related notes, describing the symptoms of his patients before they died. Morgagni's book is De Sedibus et Causis Morborum per Anatomen Indagatis (On the Seats and Causes of Diseases, investigated by Anatomy). It describes 640 post-mort ems with the related clinical records. Symptoms from now on can be interpreted as external signs of known internal conditions.

In the year of Morgagni's publication, 1761, a book comes out in Vienna offering the general practitioner a useful new technique in the analysis of a patient's internal condition. It is the work of Leopold Auenbrugger, an Austrian physician employed in a military hospital. Many of his patients have fluid in the chest. To discover how much, he adapts a technique learnt in his childhood.

As a boy Auenbrugger worked in his father's tavern and learnt how to judge the amount of wine in a barrel by tapping on its top. He now finds that the same technique works well on a patient's chest. Auenbrugger has stumbled upon the basic diagnostic technique known as percussion. He describes his findings in 1761 in Novum Inventum (New Invention). Auenbrugger's process is disregarded at first by the medical profession. It becomes of more evident use after an invention of half a century later - that of the stethoscope.

Two important developments later in the 18th century are the result of intelligent observation by general practitioners in England. William Withering notices that his country patients use an extract of herbs to alleviate dropsy. By experiment he establishes that the active ingredient is the foxglove. In his Account of the Foxglove (1785) Withering gives clinical details of how to prescribe extract of foxglove, or digitalis, in the treatment of dropsy and hints that it may be of use for heart disease (for which it remains an important drug to this day). An even more dramatic result of country observations is achieved in the following decade by Edward Jenner.

Jenner and vaccination: 1796-1798

Working as a country doctor in the Gloucestershire village of Berkeley, Edward Jenner is aware of a local theory that people who have suffered a mild form of pox - caught from the infected udders of cows - never catch the much more dangerous smallpox. Cowpox is a relatively rare disease, unrecognized at the time by the medical profession, and it is not until 1796 that Jenner has an opportunity to test this theory of immunity. In that year a dairymaid develops the symptoms. Jenner takes material from an eruption on her hand and (using a thorn) inoculates an 8-year-old boy, James Phipps, with the substance. Phipps develops cowpox and soon recovers.

The principle of inoculation has become well established since the efforts of Lady Mary Wortley Montagu to encourage the use of infected matter from smallpox victims as a preventive measure. Six weeks after the cowpox inoculation, Jenner gives James Phipps a conventional small poxinoculation. The expectation would be that he develops a mild attack of smallpox, survives it and becomes immune. In the event, as Jenner hopes, Phipps shows no sign at all of being infected by the smallpox virus. Continuing his experiments, Jenner proves that even in a long line of inoculation (taking new vaccine from each successive patient suffering from cowpox) the procedure still confers immunity.

Jenner publishes his findings in 1798 in the splendidly titled An Inquiry into the Causes and Effects of the Variolae Vaccinae, a disease discovered in some of the Western Counties of England, particularly Gloucestershire, and known by the name of Cow Pox.

Variolae Vaccinae, meaning literally 'smallpox of cows', is Jenner's scholarly name for cowpox. The phrase soon provides the word vaccination (initially coined in France as a term of mockery) for this new form of inoculation against smallpox. After some initial opposition from the medical establishment, vaccination proves its merits and the use of it rapidly spreads. As early as 1807 it is made compulsory in Bav In 1806 the president of the USA, Thomas Jefferson, writes to Jenner: 'Future generations will know by history only that the loathsome smallpox existed and by you has been extirpated.' He is right, but the process takes longer than the president probably expects - even though the immediate effects are impressive. In Britain the annual death rate from smallpox falls during the 19th century from about 2000 per million to well under 100. But diseases are difficult to extirpate on a worldwide basis. Nevertheless smallpox is the first disease with which that aim is eventually achieved. After intensive international vaccination programmes, there is by 1980 no case of smallpox on the planet. Sections are as yet missing at this point.

19^th century

Laлnnec and the stethoscope: 1816-1819

Renй Laлnnec, a physician at the Necker Hospital in Paris, specializes in diseases of the chest. Two events in 1816 give him the idea for a significant contribution to medical practice.Walking in a courtyard of the Louvre he sees children playing an acoustic game with a long strip of wood. A boy scratches one end of the wood; his friend, with the other end to his ear, hears the sound clearly. Soon after this Laлnnec is visited by a female patient too plump for her heartbeat to be easily discernible but too young for him to press his ear to her chest with decorum. Following the example of the boys, he rolls a sheet of paper into a tube. He places one end gently on the lady's bosom and the other to his ear.

Laлnnec is surprised to discover that through the tube he hears the heart with much greater clarity than with his ear to a patient's chest. He has stumbled upon the principle of the stethoscope.

Laлnnec now constructs a hollow wooden tube, about nine inches long with ends designed to fit snugly against the chest and into the ear. He spends three years analysing the weird and often tumultuous sounds which reach him as patients breathe. At first he has no way of interpreting them. But he notes the variety of noises heard in terminally ill patients, and in subsequent post mortems he observes the condition of their lungs and heart. By this means Laлnnec is able to identify and describe the characteristic sounds of various stages of bronchitis, pneumonia and - increasingly important as one of the most prevalent diseases of the 19th century - tuberculosis. Laлnnec's researches are published in 1819 in Traitй de l'auscultation mйdiate(Treatise on Mediate Auscultation). Auscultation, or listening to the body for diagnostic purposes, has until now always been 'immediate' - with the physician's ear pressed to the patient's body. The stethoscope becomes the mediating instrument.

Later in the century a tube of rubber is found to be more convenient. And in 1852 the familiar modern version is introduced, enabling the physician to use both his ears.

A large percentage of the medicinal philosophies of these cultures was based off of a natural philosophy, and still are to this day. They are also quite popular today, and many people are turning back to the older ways of medicinal practices since modern western medicine has many more dangers associated with it, especially when it comes to prescriptions. Western medicine does play a big role in the history of medicine as well, and many major breakthroughs have stemmed from modern day western medicine. Over time there are always new illnesses and diseases entering into our society but there are also many solutions to these problems, with more advancements coming every day.

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