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Date posted: April 8, 2012

Dr. Ameer Khalid

Pre historic era
History of medicine is related with the beginning of the mankind.  Nothing documentary writing and evidences in respect of medical thoughts can be produced from storage of man, except certain drawings and specimens that have survived from Stone Age.  In those ages medical professional personal were known as “Magicians”.  A drawing on the wall of the trois freres cave in Pyrenees is the portrait probably of an oldest medical man.

Every culture occurred in the world had developed a system of medicine.  Numerous stones and tools probably of 15,000 B.C. have been employed as surgical instruments. Diseases were viewed as a result of malevolent influences exercised by god or super natural being or another human being alive or dead.  The method of primitive healing was not concentrated on logic and scientific data but on belief and crude methods of transference of evil sprits and using certain methods like herbs or animal extracts which was monopoly of certain group of people.  It may be said that it is a mere exploitation than real healing and occasionally it occurred some natural process of  healing and which was claimed as their credits or hereditary monopoly.

Study of folk medicines reveals many curious believes and creeds, a very important part of medical history.  The use of remedies was not only internal but used to be carried as charms and talismans, as a part of treatment.  The skin of snake, patella, of sheep, the nail of coffin etc. were used as charms.  Another important aspect is put up coloured hangings in the sick room to prevent small-pox, red flannel used to prevent sore throat and to wear red thread with nine knots to prevent nose bleeding.

The problem of death was thought as a punishment for man’s disobedience.  The basic thing to the whole subject of folk medicine was full of superstitious and believes. But it will not be wise to under mine all their knowledge because specimen of trephining of skull evidently proves for their knowledge artisan skill which we have gathered from excavation.  

Egyptian Medicine
Egypt had one of the oldest civilizations about 2000 BC.  History of Egyptian medicine can be traced back to 2900BC.  Main sources of Egyptian medicine are the “MEDICAL PAPYRI”, “CLAY TABLETS” and excavated materials like small knives. Archeological excavations, old paintings and engravings in the doors of tombs of the burial grounds have revealed many lights.

Egyptians invented the method of pictorial writings on papyrus and the best known medical manuscript was EBERS PAPYRUS. There are mainly six types of papyrus.

1. The first papyrus derived from KOHUN, it is the earliest recorded medical treatise, it was written by IMHOTEP.  It deals with

  • a) Vaginal and uterine disorders.
  • b) Identification of pregnancy.
  • c) Determining sex of child in utero.

2. George ebers papyrus- It contains description about 800 remedies prepared from 700 drugs.

3.Dwin smith papyrus- This deals with peculiar class of surgery called traumatic surgery particularly of fractures, operations amputations and war wounds.

4.Herst papyrus- This deals  with incantation(magical formula)

5.Berlin papyrus-treatise on pediatrics.

6.London papyrus- Deals with preservations of bodies.

In Egyptian times the art of medicine was mingled with religion.

Egyptian physicians were co-equals of priests. Egyptian medicine reached its peak in the days of IMHOTEP (2800 BC) who was famous as statesman architect and physician. IMHOTEP was considered both a doctor and divinity (god of medicine), on whose name temples are erected. Egyptian physicians were trained in those temples.  HORUS was considered as the god of health and he lost one of his eyes in fight with SET, the demon of evil.  This was restored miraculously and was formed a design of Rx which was used as sign of danger and in the prescription of physician.  There were no practical demonstration in anatomy, for Egyptian religion enjoined strict preservation of the human anatomy.

Egyptian considered that diseases were due to absorption of some harmful substance from the intestine which gave rise to putrefaction of blood leading to formation of pus. Diseases were treated with cathartics enema, blood letting and a wide range of drugs.  They believed that pulse was the “speech of heart”

In the field of public health, Egyptians excelled others.  They built planned cities, public baths and under ground drains (which even the modern might envy).  Hygiene was very important in this civilization i.e. both social personal.  There was also specialization like eye, ear and tooth doctors.

There is a strange custom of preserving the human body after death by injecting cedar wood oil.  Then putting the body in salt water took out brain matter and emptied the abdominal cavity and filled with cassia and other spices.  These cadavers were bandaged and soaked in heated resin.  These were called as mummies and were kept in temples or tombs.

Egyptian system of medicine was dominant in the ancient world for so many years, until it was replaced by Greek medicine.

Mesopotamian medicine
Contemporary with ancient Egyptian civilization, there existed another civilization in the land of which lies between the Euphrates and Tigris rivers.

In ancient Mesopotomia basic concept of medicine were religious, and taught and practiced as, herb doctors, knife doctors, spell doctors—classification that roughly parallels our own internist, surgeons, and psychiatrists. Mesopotomia was cradle of magic and necromacy. Medical students were busy in classifying “demons”, the causes of disease. Geomacy, the interpretation of dreams and hepatoscopic divinity (the liver was considered seat of life) are the characteristics of Mesopotomian medicine.  They were authors of medical astrology. Prescriptions were written on tablets, in cuneiform writing.

Hamurabi, one of the earliest kings of Babylon drew up code of medical ethics.  In the ethics it was stated that if a doctor treat a gentle man and open his abscess with knife and may preserve the eye of the patient the doctor will get ten silver shekels and in the case of slave the master will have to pay two silver shekels.  On the reverse, if doctor kills the patients or destroys the eyes his hands may be taken off in case of a gentle man and in case of a slave the doctor will have to replace the slave

At that time the nucleus of every thing in the medical thoughts was relating to some sorts of god or super natural power and their influences.

Greek medicine
The Greek enjoyed the reputation – the civilizers of the ancient world and considered as pioneers of advanced medicine. They taught men to think in terms of why and how. They laid to the foundation of fundamental science of medicine i.e. Anatomy, physiology and pathology.

AECULAPIUS of BC1200 was considered the leader Greek medicine.  He was considered as the grand son of ZEUS.  He had two daughters—Hygea and Panacea. Hygea worshiped as the goddess of (preventive medicine) and Panacea as the goddess of medicine (curative medicine). They give rise to two systems of medicine i.e. preventive medicine and curative medicine. These two first developed in Greek medicine. Staff of AECULAPIUS i.e. two serpents entangled on a rod was worshipped in the temples of AECULAPIUS. This is used as symbol of medical profession.

Important personalities of Greek medicine
The greatest physician in Greek medicine was HIPPOCRATES, who is often called the “father of medicine”. He was born about 460BC in the island of COS close to Asia Minor.  His contributions are He rejected the supernatural theory of diseases, challenged the tradition of magic in medicine. He attributed disease to disturbances of four humors—BLOOD, PHLEGM, YELLOW BILE AND BLACK BILE. He initiated a radically new approach to medicine i.e. Application of clinical methods in medicine. He knew little about anatomy and physiology.  He had neither the clinical thermometer nor the stethoscope, yet he practiced auscultation by placing ear to the chest and able to describe the friction sound of the pleurisy as creaking of leather.  He tried to find out real causes of epilepsy and fever.  He was able to forecast prognosis from the study of natural history of diseases.  The positions of the patient, nature of respiration, appearance of sputum were stressed by him for prognosis.

The classical term Hippocratic facies come from the description of the face of an impending death i.e. “ sharp nose, hollow eyes sunken temples ears cold with lobes turn outward, the skin of the face parched and tense,  the colour yellow or very dusky”.  He observed the changes of finger nails of cardio vascular patients.  He was first to recognize the role of environment in causation and maintenance of diseases.  He did not confine his practice to medicine.  He was a good surgeon. He drained pus, set fractures, reduced dislocation (using special bench or table and even trephined skull as he clearly describes in the work on wounds in the head.  His use of tar for wounds was a surprising forerunner of the antiseptic method.  He was first man to separate medicine from philosophy and set up high standards of ethics in the form of aphorisms in his collection of work (Corpus Hippocraticum).  He formulated the code of conduct to physician which is called the Hippocratic Oath.   But unfortunately he made little use of drugs for the treatment and depended mainly on nature (VIS MEDICATRICS NATURE) for cure.

Aristotle (384-322 BC) was born in Athens and was a student of Plato.  He was a profound philosopher, great biologist and scholar in medicine. He laid the foundation of comparative anatomy and embryology. He dissected fishes and molluscus and gave description of entire living world and its classification.

THEOPHRATUS he was a botanist and explained the use of plants for therapeutics. He was a follower of Aristotle. His famous work “Historia plantarum” comprised morphology, natural history and their therapeutic use.

AESCLEPIADES He is called “PRINCE OF PHYSCICANS” (124BC). He was the follower of Hippocratus, but denied to depend wholly on vis medicatrx naturae. According to him physician has an active role. He originated the idea that disease should be treated speedily, safely and agreeably (CITU, TUTO, ET JECUNDO). This theory of methodism was later replaced by BROUSSAIS as theory of irritation and by BROWN as brunonian theory of STHENIC and ASTHENIC states.

Dioscrides (AD 60) was the surgeon to the emperor, NERO. He compiled books on materia medica and explained the use of lead, copper and 600 plants.

Medieval medicine
This is the period between A.D 500 to1500.  With the fall of the Roman Kingdom the field of medicine was transferred to the hands of Christian church and Mohammedans.  Practice of medicine reverted back to primitive medicine and dominated by superstition and dogmas. Dissection of body was prohibited. So this period of medicine was called as PERIOD OF DARK AGES.

Early hospitals
Hospitals were a major contribution from the period of monastic medicine but during that time were primarily refuges for the sick and poor with wards and apothe­cary shops and were not actually medical institutions. When Jerusalem was captured by the Crusaders in 1099, they were surprised to ­find a Christian hospital open to receive their sick and wounded. This hospital was opened thirty years earlier by Brother Gerard in order to care for pilgrims to the Holy Land and was run by a small group of monks-the Poor Brethren of the Hospital of St. John. They were given buildings after the capture of Jerusalem and Brother Gerard formed his group into a religious order. They were called the “Knights of St. John” or the “Hospitallers” and were the first important Christian nursing order. They served the sick and wounded regardless of race or creed for eight hundred and fifty years, from the days of the Crusades to this century. Raymond Du Puy was their second master and taught the order the defense of the sick as well as nursing.

Saladin recaptured Jerusalem in 1187 and allowed the Knights of St. John to withdraw with their patients. They stopped at Tyre, Margot and Acre (with Richard Coeur de Lion). When Acre fell, they withdrew to Cyprus. In the mean­time, the idea of hospitals was spreading to Europe. The Knights had seven hospitals in Italy as well as in Montpellier and in East Prussia. They moved to Rhodes from Cyprus. The Order of St. John now be­came a sovereign state with its own army, navy, diplomatic corps and laws. An im­mense hospital resembling a fortress was constructed on Rhodes but the knights were obliged to leave Rhodes when it was captured by Suleiman the Magnificent. In that the island of Malta had been given to them by King Charles V, the Order of St.John built a new hospital which became one of the most famous institutions of the world, the Order becoming known as the “Knights of Malta.” The Hospitallers suc­cessfully defended themselves against the Saracens in 1565, lost to Napoleon Bona­parte in 1798 and then migrated to Rome where they still carry on in reduced num­bers.

Arabic medical science eventually en­tered Europe through the wielders of the pen and the School of Salerno.

The school of salerno
It was the seat of first organized medical school. It is said, the school was founded by four masters: Elinus the Jew, Pontus the Greek, Adale the Arabian and Salermus the Latin. There were some renowned persons like GARIOPONTUS (1050). BARTHOLOMEUS ANGLICUS compiled some important medical books like “Passionaries Practice”.

It is a great matter of interesting that Ladies who had medical training from Salerno like TROTULA, ABELLA, REBECCA, CONSTANZA and other, whose names were found in the history. Trotula also wrote a book on obstetrics (1050 A.D.)

Medical teaching was not haphazard at Salerno. In this early twelfth century medical practice was brought under official jurisdiction by king. Roger II of Sicily and later on by Emperor Frederick II.

The School of Salerno was the first to employ local anesthesia for operations. Hyoscyamus and mandragora were made into a cataplasm and placed on the spot where an incision or operation was to be performed. This abolished sensation so that pain was not felt. (The formula for sopo­rific mixtures is believed to have been of Arabic origin.)

The School of Salerno taught not only medicine but also philosophy, law and theology-the basic quartet of the university system. Several well-known books origi­nated from members of this school. Gario­pontus produced an authoritative text on therapeutics in 1050 (Passionarius Gal­eni). Nicolas Salernitanus wrote Antidota­rium, a book on prescriptions. Trotula’s book was the first in Western Europe on the subject of obstetrics by a Christian author. This treatise, Diseases of Women, was a practical book describing the conduct of labor, the care of the newborn, the feeding of infants, the treatment of prolapse of the uterus and of uterine polyps. The text does not confine itself to obstetrics and gynecol­ogy but also treats epilepsy and diseases of the teeth and gums as well. Regimen Sanitatis Saleni is probably the most interesting and famous publica­tion associated with Salerno. The poem is made up of medical advice on health.

Salerno’s reputation as a center of medical learning apparently came more from the group than from any one individual with the possible exceptions of Roger of Palermo, Roland of Parma, Gilles de Cor­beil and Gilbertus.Roger of Palermo taught clinical surgery at Salerno for many years. Roger’s Surgery was the first medieval textbook on surgery and dominated surgical teaching and prac­tice in Europe for a full century. In considering fractures of the skull, Roger advised that a finger be inserted in the wound “because there is no better method of recognizing a fracture of the skull than digital palpation.” He then describes removal of the fragment and plac­ing a cloth between the dura mater and cranium with pressure to hold the scalp together and the use of a cloth dressing soaked in the white of egg. He also described  the treatment  of nasal polyps hemorrhoids fractures of the jaw intestinal anastomosis and bladder stones

Roland of Parma reedited Roger’s text in about 1250 and added observations of his own.

Gilles de Corbeil studied at Salerno and went to Montpellier in 1180. His strong championship of Salerno and its Greek tradition made him unpopular because of the local Arabic influence and so he moved to Paris. He soon became the leading figure in medicine in Paris because of his writing and teaching and has been described as founder of the Paris School of Medicine. His medical works on the urine and   the pulse were standard reference for nearly three centuries.

Gilbertus (1180-1250) was educated in England but was taught medicine at Sal­erno by Roger and his associates and was possibly also a student of Gilles de Corbeil. He was physician to the Archbishop of Canterbury of England. He completed his Comperndium Medicinae in 1240. This work included the medicine of the ancients and of his contemporaries but contained nothing, original.

A regular curriculum of study was devel­oped in the School of Salerno during the twelfth century. By1224, Frederick II ordered that no one should practice medicine in the Two Sicilies without having passed an examination before the Faculty of Salerno. In a decree of 1240 it was stipulated that before starting medicine, the candidate should have studied logic for at least three years  and that he must study medicine for five years following which he must serve for one year as an assistant to an older physician.

The School of Salerno began to decline during twelfth and thirteenth centuries but during this period universities were de­veloped in Italy. France and England and these institutions picked up the torch of learning, developed and subsequently have been emulated, for better or worse, else­where.

Early medieval universities
The origins of medieval universities and the work of a few of their leading physicians contributed considerably to medieval medicine and future developments.

Bologna, Montpellier, Paris, Oxford, Cambridge and Padua provided the beginnings for a series of remarkable accomplishments.

Bologna
Bologna is located between Florence and Venice in Italy. It started with a private law school and developed into a university in 1158, including a corporation of doctors who taught medicine. Some regard this university as the oldest in Europe. Its charter granted Bolognese student privileges of freedom of travel and freedom from the jurisdiction of civil courts. The students elected their masters as well as their rector. The professors were originally paid by the students for their instruction but were later paid by the city. The city was proud of its university and decreed a death penalty to anyone who attempted to move it elsewhere or to suggest to the students that they study elsewhere. The same penalty was decreed for any teacher who taught elsewhere without permission. Bologna was a university of students from the beginninmention has been made that Roger’s pupil Roland of Parma became professor of Bologna after leaving Salerno and reedited Roger’s great text on surgery in 1250. Hugo of Lucca who had been a surgeon with the Bolognese army during the Crusades was offered a very large salary to come to Bologna to be a public lecturer on surgery. He is known today largely because of his pupil, Theodoric.

Theodoric was a Dominican who became physician to Pope Innocent IV later became the Bishop of Cervia. He lived most of his life in Bologna where he practiced and taught. Theodoric’s Chirurgia was written in 1267.His writings record the surgical principles and practice of Hugo of Lucca. He introduced a revolutionary treatment of wounds; He was concerned about contamination of air of wounds and advised immediate closure with Sutures in order to avoid suppuration. This concern and theory of preventing the formation of pus in wounds stands Theodoric as one of the most original surgeons of all time; six hundred years were to elapse before Lister elaborated on this theory and made surgery safer from infection. Theodoric credits the idea to Hugo. Writers on surgical history mention the “soporific sponge” of Theodoric as land mark in anesthesia but Theodoric ascribes this also to Hugo. His famous pupil, Henri de Mondeville, spread these ideas to Paris.

William of Saliceto was said to have been the first to dissect a human body in Bologna and was considered by many to be the greatest surgeon of the thirteenth century. His famous pupil was Lanfranchi who became a leader of surgery in Paris along with Henri de Mondeville.The School of Surgery in Paris, therefore, stemmed directly from Bologna.

The School of Anatomy in Bologna be­came one of her greatest contributions and was linked to the name Mondino.

Mondino was a graduate in medicine from Bologna. After joining the faculty of medical school in 1306 he devoted himself to anatomy. He wrote the first modern textbook on anatomy. His Anatoma, which was s published in 1316, was a practical manual and had no illustrations.  It rapidly gained a wide circulation, was written in rather poor Latin and was also full of Arabic terms. Mondino started his dissections in person and then turned the work over to his assistant so that he could mount his chair and explain the anatomy to his students. This method became the com­mon practice for centuries and is depicted in the first anatomical text with illustrations, that of Johannes in 1481. The later editions show the well-known picture of Mondino presiding at a dissection. His knowledge was somewhat sketchy but he did sow the seed fo further anatomical study His pupil, Bertuccio, became the most famous teacher of anatomy at Bologna and taught Guy Chauliac. De Chauliac carried the traditions of Bologna anatomy to Montpellier.

Montpellier
Montpellier grew rapidly as a cultural and commercial center of importance in southern France near the Mediterranean Sea. Medical teaching was provided as early as 1000, but was apparently inferior to Salerno until 1181 when a decree was issued which granted anyone, regardless of nationality or origin the right to teach at Montpellier. The timing of the decree was because of two important factors (l) the beginning of the decline of the school Salerno, and (2) the exodus of scholars from Cordova because of an edict that all must become Moslems. This brought Christians, Jews, Moslems and others to Montpellier Arabic medicine was thereby reinjected into medieval Europe. The medical school was established by Charter of Conrad in 1220. Cardinal Conrad had been delegated by Pope Honorius to supervise the teaching of medicine at Montpellier,to approve all of the professors and to see that no student  of medicine could graduate without instruction from an approved master. The standards of the early teachers and students established the reputation of Montpellier and Arabic influence was strong for the next several centuries. Two of the outstanding personages of the Middle Ages were associated with this school. They were Arnold of Villanova and Guy de Chauliac.

Arnold of Villanova was born in 1235 and educated by the Dominicans in theology. He later studied the worldly sciences and became physician to popes and kings, Spanish ambassador to Paris and a student of alchemy He assigned a leading place to natural sciences in education and was indefatigable experimenter. He maintained that “all true knowledge arises from senses.” He was in frequent verbal strife with his former teachers and was followed constantly by the vigilant eyes of the Inquisition.

Guy de Chauliac (1300-1368) carried the anatomic tradition of Mondino of Bologna to Montpellier. Dissections were permitted at Montpellier after 1340 A.D. He took orders in the Church, became Canon in Lyonand also practiced surgery in that city. He later became physician to Pope Clement VI and remained there as physician to Clement’s successors, Innocent VI and Urban V.He completed his Chirugia Magna in 1363 A.D. This text was authoritative until the eighteenth century. He was a Galenist and did not follow Theodoric’s ideas about wound healing. His teaching was based on surgical experience. His book contains extensive materia medica and also his description of the plague which visited Avignon in 11348. This picture of the Black Death is one of the best and most accurate in medical literature. He believed in astrology as did most of the learned men of his time.  Although he did not teach in Montpellier, he made it famous as an alumnus. Fallopius called him the” Father of surgery”, as Hippocrates was the father of medicine. Many historians believed him to have been the greatest surgeon of the Middle Ages. The following lines tell something of his surgical philosophy.

PARIS
Peter Abelard (1079-1142) was the em­inent theologian and teacher who is given the chief credit for he founding of the University of Paris. The university was created by charter in 1231, from Pope GregoryIX, included various schools including medicine. By charter, the University ­of Paris was a university of masters where clerical control was complete, in contrast to Bologna where lay influence was predominant including that of the students. Theology- was the main subject and celibacy was enforced upon medical stu­dents and masters until it was abolished in 1452.The medical faculty remained under control of the Church until 1595. The medical school did not achieve the wide reputation of Salerno, Bologna and Mont­pellier. Anatomy lagged behind, because it not legalized in Paris until 1551 and the standards could not have been high because ­there were no failures on examinatio­ns of students for a century. Several out-­ standing men require mention, including Gilles de Corbeil, Albertus Magnus, Petrus Hispanus, Lanfranchi of Milan and Henri de Mondevlle.

Gilles de Corbeil has been described as founder of the Paris School of Medici­ne. He was born two years after the death of Peter Abelard and he brought the traditions of Salerno to Paris. He wrote and taught in Paris prior to the formal chartering ­of the university including its School of Medicine in 1231. It is known that he was born in 1140 went to Montpellier from Salerno in 1180 and then to Paris. The exact date of his death is not known.

Albertus Magnus has been regarded as ­beginning the Experimental School.” He was one of the most learned men of the twelfth and thirteenth centuries. He was an Influential teacher and prolific writer. He was an investigator with plants, ani­mals, chemicals and minerals. He was can­onized by PopeGregory XV in 1622.

Petrus Hispanus studied theology, logic and medicine at the University of Paris. Originally from Spain he advanced rapidly in the Church and became the first and only physician to be elevated to the rank of Pope. This occurred in 1276.

Lanfranchi of Milan was educated in Bologna and was a pupil of William of Saliceto. Like his teacher, he was a cleric and practiced both medicine and surgery with emphasis s on surgery. He moved to Paris in 1295, taught surgery at the university and completed a textbook on surgery. Surgery was separated from medicine in France prior to Lanfranchi and was done primarily by itinerant unlettered surgeons. He deplored the separation of surgery from medicine and as an educated cultured indi­vidual was not without influence.

Henri de Mondeville (1260-1320) pre­pared in medicine at Paris and at Montpel­lier and then went to Bologna where he became a pupil of Theodoric. He remained Theodoric’s faithful disciple. On his return to France, he became surgeon to the King in 1301 and remained in this capacity for the remainder of his professional career. He served Phillip the Fair and Louis X at home and at war. His wound treatment was strikingly successful. He attributed this to the methodology of Theodoric. He taught at Montpellier and wrote his Chirurgia which was the first French surgical text. This was circulated in many manu­scripts but was not published until after the discovery of printing. If printing had been discovered earlier,   this book had been widely diffused, the whole course of French surgery might have been changed because of his remarkable section on wounds. Surgery in Paris lapsed after Henri de Mondeville.        Disdain for operations grew and they were left to laity. The chair of surgery remained vacant and 1350 a statute required students to vow that they would not practice manual surgery Addendum: With the coming of Gilles de Cobeilto Paris and the injection of ideas from the School of Salerno, the faculty grew and lines became sharply drawn between physicians and N surgeons. Surgical practice was actually forbidden to physicians and since the teachers of Paris from 1231 until 1595, were under the control of the Church, they could not operate. The practice of surgery by monks was for­bidden because of shedding of blood and surgery relegated to persons of an infe­rior social status-surgical quacks and montebanks, for the most part. During these years, the Confrerie (College) of St. Come was founded by Jean Pitard (1228-1315). The college began as a mu­tual assistance society formed by those sur­geons outside of the faculty of medicine. It was chartered in l 1370 and slowly raised the status of surgeons. Surgery in Italy, by con­trast, was highly regarded and the surgeons themselves were learned and cultured men. Unfortunately the influence of Henri de Mondeville and Lanfranchi in Paris was mainly during their own time.

Oxford
0xford University was founded about 1167 by English students who migrated from the University of Paris because of an order by Henry II of England. He decreed all English students in Paris who were in Holy Orders to return to England or lose their support. This occurred during the quarrel with Thomas Becker who had the backing of the French king. Oxford was made a university of masters rather than of students and became a great center for classical learning during the Middle Ages. It never ranked as a medical center with the universities on the continent but did produce scholars whose investigations included medicine. Some of these individuals were Michael Scot, Bartholomaeus, Anglicus, Roger Bacon and John of Gaddesden.

Michael Scot (1175-1223) was best known for his works on alchemy, astrology, physiognomy and on astrological medicine.

Bartholomaes anglicus wrote concerning the properties of things in 1250. This composition shows the first illustration of t dissection in its French translation (1482) and in its English translation (1495) Roger Bacon was a Franciscan who wrote on gunpowder, the magnetic compass, the lens for reading, flying machines and is claimed by some to have predicted the discovery of America.

John of Gaddesden was probably the best best-known English Physician of the Middle Ages. He was born about1280.His text, Rosa Angelica, was printed in 1492 and was the first to be printed by an English author. He was a cleric and had considerable scorn for lay practitioners and barbers.

Padua
The university in Padua began in1222 when a group of students from Bologna migrated to Padua as a result of the worst of many quarrels between the students and citizens of Bologna. Padua is located a few miles inland from Venice in Italy. The uni­versity was largely free from clerical domi­nation and was much like Bologna and un­like either Paris or Oxford. It became a university of students. Padua soon rivaled Bologna and surpassed her except for his­torical prestige. The university enjoyed its greatest      prosperity after Padua passed under the rule of Venice in 1 1405 and rapidly became outstanding center of learning in Italy. Protestants and Jews obtained diplomas indicating the tolerance which existed. However in 1564, Pope Pius IV decreed that every scholar who graduated and received a degree from an Italian university must profess the Catholic faith and receive the degree in the church. To avoid this regulation, Padua began to confer her degrees outside of the church.

Anatomical dissections were practiced at Padua during the fourteenth and fifteenth centuries in an attempt to emulate the ana­tomical work of the Bolognese. Padua became the center of anatomical learning during the sixteenth century.

Distinguished teachers and pupils from the school of medicine at Padua were important factors not only in spreading the fame of the school, but in creating the Renaissance period in medicine and in laying the ground work for modern medicine. Some of these remarkable men were Peter of Abano, Gentile,Linacre, John Caius,Versalius, Fallopio, Marcurio, Fabrizi, Harvey, Santorio, Colombo, da Monte, Cardano Fracastoro and Morgagni.

Cambridge
Cambridge University was founded about 1229 by a migration of students from Oxford after a riot had occurred between the students and citizens of Oxford.

Epidemics
Epidemics of the middle ages were Leprosy, plague and dancing mania (as early as 1374, large crowds men and women seemed to become obsessed by a strange mania.  They first appeared on the streets of Aachen formed circles hand in hand and danced widely for hours .This was mass hysteria.)

18th CENTURY MEDICINE

1. George ernst stahl (1661 -1734)
In his opinion soul and body were closely blended and the source of all vital movement was the soul or `anima’. Putrefaction only takes place after death in a soulless body. Death occurs when the body becomes unsuitable for the habitation of the soul.

2. Joseph barthez of montpellier (1734 -1806)
He found difficulty in advocating the claim of the `soul’ and introduced a new conception of a dominant force `vital principle’

3. Friedrich hoffman (1660 -1742)
His system of medicine was based upon the belief that the universe was pervaded by a vital substance which is finer than all other matter but not exactly spirit, soul or mind, which maintained the body in a state of “tonic equilibrium”. In Hoffman’s views disease resulted from excess or deficiency of tonus.

4. Giovanni battista morgagni (1682 – 1771).
The man who created the science, who taught us to think anatomically of disease, was Morgagni, whose “De sedibus et causis morborum per anatomen indagatis” is one of the great books in our literature. During the seventeenth century, the practice of making post-mortem examinations had extended greatly, and in the “Sepulchretum anatomicum” of Bonetus (1679), these scattered fragments are collected, But the work of Morgagni is of a different type, for in it are the clinical and anatomical observations of an able physician during a long and active life.  Born in 1682, Morgagni studied at Bologna under Valsalva and Albertini. In 1711, he was elected professor of medicine at Padua. He published numerous anatomical observations and several smaller works of less importance. The great work which has made his name immorta in the profession, appeared in his eightieth year, and represents the accumulated experience of a long life. Though written in the form of letters, the work is arranged systematically and has an index of exceptional value.

From no section does one get a better idea of the character and scope of the work than from that relating to the heart and arteries — affections of the pericardium, diseases of the valves, ulceration, rupture, dilation and hypertrophy and affections of the aorta are very fully described. The section on aneurysm of the aorta remains one of the best ever written. It is not the anatomical observations alone that make the work of unusual value, but the combination of clinical with anatomical records.

What could be more correct than this account of angina pectoris -­probably the first in the literature? “A lady forty-two years of age, who for a long time, had been a valetudinarian, and within the same period, on using pretty quick exercise of body, she was subject to attacks of violent anguish in the upper part of the chest on the left side, accompanied with a difficulty of breathing, and numbness of the left arm; but these paroxysms soon subsided when she ceased from exertion. In these circumstances, but with cheerfulness of mind, she undertook a journey from Venice, purposing to travel along the continent, when she was seized with a paroxysm, and died on the spot. I examined the body on the following day…. The aorta was considerably dilated at its curvature; and, in places, through its whole tract, the inner surface was unequal and ossified.

These appearances were propagated into the arteria innominata. The aortic valves were indurated….” He remarks, “The delay of blood in the aorta, in the heart, in the pulmonary vessels, and in the vena cave, would occasion the symptoms of which the woman complained during life; namely, the violent uneasiness, the difficulty of breathing, and the numbness of the arm. ” The profession was literally ravaged by theories, schools and systems -­iatromechanics, iatrochemistry, humoralism, the animism of Stahl, the vitalistic doctrines of Van Helmont and his followers — and into this metaphysical confusion Morgagni came like an old Greek with his clear observation, sensible thinking and ripe scholarship. Using the approach they learned from De Sedibus, Morgagni’s successors formulated the basic principles that lie at the core of all modern clinical medicine.

5. Hermann boerhaave (1668 -1738).
Often spoken of as the Dutch Hippocrates, Boerhaave has inspired a group of distinguished students. After teaching botany and chemistry, Boerhaave succeeded to the chair of physic in 1714. With an unusually wide general training, a profound knowledge of the chemistry of the day and an accurate acquaintance with all aspects of the history of the profession, he had a strongly objective attitude of mind towards disease, following closely the methods of Hippocrates and Sydenham. He adopted no special system, but studied disease as one of the phenomena of nature. His clinical lectures, held bi-weekly, became exceedingly popular and were made attractive not less by the accuracy and care with which the cases were studied than by the freedom from fanciful doctrines and the frank honesty of the man. He was much greater than his published work would indicate, and, as is the case with many teachers of the first rank, his greatest contributions were his pupils. No other teacher of modern times has had such a following. Among his favorite pupils may be mentioned HALLER, the physiologist, and VAN SWIETEN and ANTON DE HAEN (1704 – 1776), the founders of the Vienna school.

His chief works are ” INSTITUTIONES MEDICAE” (1708) and “APHORISMI” (1710) both of which had many editions.

6. Albrecht von haller (1708-1777)
A student of Boerhaave and Celebrated as a physician, he was proficient in various fields, being equally famed in his own time as poet, botanist, and statesman, and dividing his attention between art and science. As a child Haller was so sickly that he was unable to amuse himself with the sports and games common to boys of his age, and so passed most of his time poring over books. When ten years of age he began writing poems in Latin and German, and at fifteen entered the University of Tubingen. At seventeen he wrote learned articles in opposition to certain accepted doctrines, and at nineteen he received his degree of doctor.

Soon after this he visited England, where his zeal in dissecting brought him under suspicion of grave-robbery, which suspicion made it expedient for him to return to the Continent. After studying botany in Basel for some time he made an extended botanical journey through Switzerland, finally settling in his native city, Berne, as a practising physician. During this time he did not neglect either poetry or botany, publishing anonymously a collection of poems.

In 1736 he was called to Gottingen as professor of anatomy, surgery, chemistry, and botany. During his labors in the university he never neglected his literary work, sometimes living and sleeping for days and nights together in his library, eating his meals while delving in his books, and sleeping only when actually compelled to do so by fatigue. During all this time he was in correspondence with savants from all over the world, and it is said of him that he never left a letter of any kind unanswered.

Haller’s greatest contribution to medical science was his famous doctrine of irritability, which has given him the name of “father of modern nervous physiology”.

The principle of general irritability had been laid down by Francis Glisson (1597-1677) from deductive studies, but Haller proved by experiments along the line of inductive methods that this irritability was not common to all “fibre as well as to the fluids of the body,” but something entirely special, and peculiar only to muscular substance. He distinguished between irritability of muscles and sensibility of nerves.

In 1747 he gave as the three forces that produce muscular movements: elasticity, or “dead nervous force”; irritability, or “innate nervous force”; and nervous force in itself.

And in 1752 he described one hundred and ninety experiments for determining what parts of the body possess “irritability”–that is, the property of contracting when stimulated. His conclusion that this irritability exists in muscular substance alone and is quite independent of the nerves proceeding to it aroused a controversy that was never definitely settled until late in the nineteenth century, when Haller’s theory was found to be entirely correct.

It was in pursuit of experiments to establish his theory of irritability that Haller made his chief discoveries in embryology and development. He proved that in the process of incubation of the egg the first trace of the heart of the chick shows itself in the thirty-eighth hour, and that the first trace of red blood showed in the forty-first hour. By his investigations upon the lower animals he attempted to confirm the theory that since the creation of genus every individual is derived from a preceding individual-­the existing theory of preformation, in which he believed, and which taught that “every individual is fully and completely preformed in the germ, simply growing from microscopic to visible proportions, without developing any new parts.”

In physiology, besides his studies of the nervous system, Haller studied the mechanism of respiration, refuting the teachings of Hamberger (1697-

1755), who maintained that the lungs contract independently. Haller, however, in common with his contemporaries, failed utterly to understand the true function of the lungs. The great physiologist’s influence upon practical medicine, while most profound, was largely indirect. He was a theoretical rather than a practical physician, yet he is credited with being the first physician to use the watch in counting the pulse.

He advocated proving on healthy human beings.

His ELEMENTA PHYSIOLOGIAE IN 8 volumes was a great work (1759 – 1766)

7. Anton de haen (1704 – 1776)
He was the author of treatise on therapeutics in which he highly condemned the excess drugging which was prevalent at that time. He came to Vienna and reconstructed the medical school along with GERHARD VAN SWIETEN, both of them being students of Boerhaave.

8. Sir robert sibbald (1641 -1722)
He was famous as the founder of Royal college of Physician at Edinburgh.

9. Alexander monro secundus ( 1733 -1817)
He discovered the `foramen of Monro’ and published the original observation of the “Bursae Mucosae” and on “lymphatics”.

10. Benjamin bell (1749 – 1806)
The first of Edinburgh Scinetific Surgeon. He wrote a book ” system of surgery”

11. Robert whytt (1714 -1766)
He was the first to localize the seat of Reflex action in the spinal cord and to demonstrate that it was independent of the brain. His description of Tuberculous meningitis and Diphtheria are a medical classics.

12. John pringle (1707 – 1782)
He was appointed as the professor of Medical philosophy. He got his MD from Leyden. In 1742, he was appointed physician to the Earl of Stair, then in command of the British army. At the battle of Dettingen in 1743, between France and England, based on his suggestion it was agreed that the military hospitals to be considered as sanctuaries and be protected mutually by both sides. This arrangement to protect eventually lead to the formation of “red cross”. He published in 1752 his observation on the “DISEASES OF THE ARMY”. Another work was that ” EXPERIMENTS UPON SEPTIC AND ANTISEPTIC SUBSTANCE” in which the word antiseptic is used for the first time.

13. Joseph lind (1716 – 1794)
He was surgeon to the British navy. He wrote a book on the “TREATISE ON SCURVEY”, which was a classic literature in medicine. He was the first person to advocate the use of lemon or lime juice for scurvey.

14. William giffard
First to use the Extractor or Forceps in Obstetrics.

15. Sir fielding ould
He was from Ireland, famous for rendering help to establish ‘Dublin School of Midwifery’

16. William smellie (1697 – 1763)
He studied in Glasgow and after a short training settled in London in the year 1739. He wrote a book on `treatise on MIDWIFERY’ which gave a detailed account of the mechanism of labor and corrected many errors practised during the time. He was the foremost person to use forceps.

17. William cheselden (1688 -1752)
He was the first man to perform Iridectomy and he had nice hand, for removing stones. He was very famous and had the opportunity to attend Sir Issac Newton and Alexander Pope.

18. Percival pott (1714 – 1788)
He tried to put surgery on a rational basis keeping in conformity with the development of Physiology and Medicine. He has described `Pott’s disease’ and `Pott’s Fracture’. He has written a number of treatises on Hernia, Head injury, Hydrocele, Fistulo-in-ano, Fracture and dislocation, Chimney a sweep cancer, Palasy from spinal caries.

19. Giovanni maria lancisi
Lancisi, one of the early students of disease of the heart, left an excellent monograph on the subject, and was the first to call special attention to the association of syphilis with cardio-vascular disease.

20. Giorgio baglivi
A younger contemporary of his at Rome, Baglivi, was unceasing in his call to the profession to return to Hippocratic methods, to stop reading philosophical theories and to give up what he calls the “fatal itch” to make systems.

21. Wi liam cullen (1712 – 1790)
He was born at Hamilton in Lankashire. From the grammer school of Hamilton, he proceeded to Glasgow University. During that period, there was no medical faculty, so he became an apprentice to a surgeon and later to an apothecary in London. He had a good friendship with William Hunter. During his practice time he was keen in lecturing not only in Chemistry, but also in Botany, Materia Medica and Physics. He is regarded as the founder of Glasgow school of Medicine. At different time he had the privilege of occupying the highest chair of the institution of Theory of Medicine and Professor of Medicine. He was the author of a textbook known as ” FIRST LINES OF THE PRACTICE OF THE PHYSIC” and also “treatise on materia medica”.

Cullen’s theory of spasm and atony exercised a profound influence on practice, particularly in this country, where it had the warm advocacy of Benjamin Rush. Even more widespread became the theories of a pupil of Cullen’s.

22. John brown (1735 – 1788)
He was born in Scotland. He was twice the president of the Royal Medical Society. John Brown, regarded excitability or continous stimulation as the fundamental property of all living creatures. The stimulants were warmth, food, muscular movement, intellectual energy, emotion etc; too much of this excitability produced what were known as STHENIC maladies, too little, ASTHENIC.. The treatment was aimed to apply large and heroic doses of medicine specially stimulating drugs. This was called by the name `Brunonian System’. Few systems of medicine have ever stirred such bitter controversy, particularly on the Continent, and in Charles Creighton’s account of Brown we read that as late as 1802 the University of Gottingen was so convulsed by controversies as to the merits of the Brunonian system that contending factions of students in enormous numbers, not unaided by the professors, met in combat in the streets on two consecutive days and had to be dispersed by a troop of Hanoverian horse.

23. William hunter (1718-1783)
William Hunter must always be remembered as one of the greatest physicians and anatomists of the eighteenth century, and particularly as the first great teacher of anatomy in England; but his fame has been somewhat overshadowed by that of his younger brother John.

Hunter had been intended and educated for the Church, but on the advice of the surgeon William Cullen he turned his attention to the study of medicine. His first attempt at teaching was in 1746, when he delivered a series of lectures on surgery for the Society of Naval Practitioners. These lectures proved so interesting and instructive that he was at once invited to give others, and his reputation as a lecturer was soon established. He was a natural orator and story-teller, and he combined with these attractive qualities that of thoroughness and clearness in demonstrations, and although his lectures were two hours long he made them so full of interest that his pupils seldom tired of listening. He believed that he could do greater good to the world by “publicly teaching his art than by practising it,” and even during the last few days of his life, when he was so weak that his friends remonstrated against it, he continued his teaching, fainting from exhaustion at the end of his last lecture, which preceded his death by only a few days.

For many years it was Hunter’s ambition to establish a museum where the study of anatomy, surgery, and medicine might be advanced, and in 1765 he asked for a grant of a plot of ground for this purpose, offering to spend seven thousand pounds on its, erection besides endowing it with a professorship of anatomy. Not being able to obtain this grant, however, he built a house, in which were lecture and dissecting rooms, and his museum. In this museum were anatomical preparations, coins, minerals, and natural-history specimens.

Hunter’s weakness was his love of controversy and his resentment of contradiction. Hunter is said to have excused his own irritability on the grounds that being an anatomist, and accustomed to “the passive submission of dead bodies,” contradictions became the more unbearable. Many of the physiological researches begun by him were carried on and perfected by his more famous brother, particularly his investigations of the capillaries, but he added much to the anatomical knowledge of several structures of the body, notably as to the structure of cartilages and joints.

24. John hunter (1728 -1793)
In Abbot Islip’s chapel in Westminster Abbey, close to the resting-place of Ben Jonson rest the remains of John Hunter, famous in the annals of medicine as among the greatest physiologists and surgeons that the world has ever produced.

Until about twenty years of age young Hunter had shown little aptitude for study, being unusually fond of out-door sports and amusements; but about that time, realizing that some occupation must be selected, he asked permission of his brother William to attempt some dissections in his anatomical school in London. To the surprise of his brother he made this dissection unusually well; By his second year in dissection he had become so skilful that he was given charge of some of the classes in his brother’s school; in 1754 he became a surgeon’s pupil in St. George’s Hospital, and two years later house-surgeon. Having by overwork brought on symptoms that seemed to threaten consumption, he accepted the position of staff­surgeon to an expedition to Belleisle in 1760, and two years later was serving with the English army at Portugal.

During all this time he was constantly engaged in scientific researches, many of which, such as his observations of gun-shot wounds, he put to excellent use in later life. On returning to England much improved in health in 1763, he entered at once upon his career as a London surgeon, and from that time forward his progress was a practically uninterrupted series of successes in his profession.

Hunter’s work on the study of the lymphatics was of great service to the medical profession. In 1758, he was the first to discover the lymphatics in the neck of birds, although it was his brother William who advanced the theory that the function of these vessels was that of absorbents.

In 1767 he met with an accident by which he suffered a rupture of the tendo Achillis. From observations of this accident, and subsequent experiments upon dogs, he laid the foundation for the now simple and effective operation for the cure of club feet and other deformities involving the tendons.

In 1772 he moved into his residence at Earlscourt, Brompton, where he gathered about him a great menagerie of animals, birds, reptiles, insects, and fishes, which he used in his physiological and surgical experiments. With the help of students he collected almost 30,000 specimens. Here he performed a countless number of experiments–more, probably, than “any man engaged in professional practice has ever conducted.” These experiments varied in nature from observations of the habits of bees and wasps to major surgical operations performed upon hedgehogs, dogs, leopards, etc. It is said that for fifteen years he kept a flock of geese for the sole purpose of studying the process of development in eggs.

Hunter began his first course of lectures in 1772, being forced to do this because he had been so repeatedly misquoted, and because he felt that he could better gauge his own knowledge in this way. Lecturing was a sore trial to him, as he was extremely diffident, and without writing out his lectures in advance he was scarcely able to speak at all. In this he presented a marked contrast to his brother William, who was a fluent and brilliant speaker.

He discovered the “collateral circulation” of the blood, which led, to successful operation upon aneurisms. The thorough understanding of this collateral circulation is one of the most important steps in surgery, for until it was discovered amputations were thought necessary in such cases as those involving the artery supplying a leg or arm, since it was supposed that, the artery being stopped, death of the limb and the subsequent necessity for amputation were sure to follow. Hunter solved this problem by a single operation upon a deer, and his practicality as a surgeon led him soon after to apply this knowledge to a certain class of surgical cases in a most revolutionary and satisfactory manner.

What led to Hunter’s far-reaching discovery was his investigation as to the cause of the growth of the antlers of the deer.Wishing to ascertain just what part the blood-supply on the opposite sides of the neck played in the process of development, or, perhaps more correctly, to see what effect cutting off the main blood-supply would have, Hunter had one of the deer of Richmond Park caught and tied, while he placed a ligature around one of the carotid arteries. He observed that shortly after this the antler (which was only half grown and consequently very vascular) on the side of the obliterated artery became cold to the touch. There was nothing unexpected in this, and Hunter thought nothing of it until a few days later, when he found, to his surprise, that the antler had become as warm as its fellow, and was apparently increasing in size. Puzzled as to how this could be, and suspecting that in some way his ligature around the artery had not been effective, he ordered the deer killed, and on examination was astonished to find that while his ligature had completely shut off the blood-supply from the source of that carotid artery, the smaller arteries had become enlarged so as to supply the antler with blood as well as ever, only by a different route.

He accidently inoculated himself with lues and purposely delayed treatment in order to study the disease in his own system. He described shock, phlebitis, pyemia and intussusception. He differentiated between hard chancre and chancroid ulcer.

His literary works include ” Natural history of the Human Teeth” (1771)

“On venereal diseases” (1786)

” Observations on the certain parts of the animal economy”

” Treatise on blood, inflammation and Gunshot wounds”

The great services of Hunter were recognized both at home and abroad, and honors and positions of honor and responsibility were given him.

In 1776 he was appointed surgeon-extraordinary to the king;

In 1783 he was elected a member of the Royal Society of Medicine and of the Royal Academy of Surgery at Paris;

In 1786 he became deputy surgeon-general of the army; and

in 1790 he was appointed surgeon-general and inspector-general of hospitals. All these positions he filled with credit, and he was actively engaged in his tireless pursuit of knowledge and in discharging his many duties when in October, 1793, he was stricken while addressing some colleagues, and fell dead in the arms of a fellow-physician.

25. William hewson (1739-1774),
One of John Hunter’s pupils, he was first to give an account, in 1768, of the lymphatics in reptiles and fishes, and added to his teacher’s investigations of the lymphatics in birds. He described that the coagulation of the blood is

not because of solidification of the corpuscles but due to a substance he called it as “FOBROGEN”.

26. John abernethy (1764 -1831)
He was a pupil of John Hunter. He was the first person to ligate the external iliac artery for operation of aneurism. Abernethy was of the opinion that all diseases which were not surgical or external were due to Digestive troubles and he gave his own favourite remedies (calomel and blue pills)for it.

27. Asteley cooper (1768 – 1841)
He has done ligation of the aorta in case of an aneurysm. He was the first to amputate hip joint. He received the Copley Medal in 1802.

28. Antonio scarpa (1747- 1832)
He was a good anatomist from Pavia. Scarpa is memorable for his discovery of membranous labyrinth, the nasopalatine nerve, and the triangle of the high, that bears his name. He wrote important treatise on hernia and eye diseases and originated the procedure for iridodialysis and made shoes for clubfoot which is still the model for orthopaedics.

29. Domenico cotugno (1736 -1822)
He discovered the Cerebro-spinal and Labyrinthine fluid and gave a presentive theory of hearing. He had written a famous article on sciatica.

30. Joseph desault (1744 -1795)
He had devised a better technique of amputation and treating fractures.

31. Francois xavier bichat (1771 – 1802)
He was the pupil and assistant to Desault in Paris. Bichat founded the science of histology. He studied the Pathological changes occurred in the tissue or the membrane of twentyone type. His views were published in 1800. He was of the opinion that pathological changes occurred in the tissue rather than in the organ.

32. Mathew baillie
He is the nephew of John Hunter. He published a book on Morbid Anatomy with illustrations. He described transposition of the viscera, hydrosalpinx, dermoid cyst of the ovary and pxeynibua, distinguished ordinary renal cyst from renal hydatids. He gave a nice description of endocarditis and in the second edition gave a description of rheumatism of heart.

33. Lady wortley montagu
Wife of Birtish Ambassador in Turkey, introduced “inoculation” in England against Small pox. First tried successfully upon the criminals and then the members of the royal family were inoculated.

34. Thomas dimsdale (1712 -1800)
He was a quack physician and one of the famous inoculators.

35. Edward jenner (1749 -1823)
Before the eighteenth century closed practical medicine had made great advance. Smallpox, though not one of the great scourges like plague or cholera, was a prevalent and much dreaded disease, and in civilized countries few reached adult life without an attack. Edward Jenner, a practitioner in Gloucestershire, and the pupil to whom John Hunter gave the famous advice: “Don’t think, try!” had noticed that milkmaids who had been infected with cowpox from the udder of the cow were insusceptible to smallpox. I show you here the hand of Sarah Nelmes with cowpox, 1796. A vague notion had prevailed among the dairies from time immemorial that this disease was a preventive of the smallpox. Jenner put the matter to the test of experiment. Let me quote here his own words: “The first experiment was made upon a lad of the name of Phipps, in whose arm a little vaccine virus was inserted, taken from the hand of a young woman who had been accidentally infected by a cow. Notwithstanding the resemblance which the pustule, thus excited on the boy’s arm, bore to variolous inoculation, yet as the indisposition attending it was barely perceptible, I could scarcely persuade myself the patient was secure from the Small Pox. However, on his being inoculated some months afterwards, it proved that he was secure.” The results of his experiments were published in a famous small quarto volume in 1798. the title of the bool ` AN INQUIRY INTO THE CAUSES AND EFFECTS OF THE VARIOLAE VACCINE, A DISEASE DISCOVEREOUS INSOME OF THE WESTERN COUNTRIES OF ENGLAND, PARTICULARLY GLOCUESTERHIRE AND KNOWN BY THE NAME OF `COW POX’. From this date, smallpox has been under control.

36. John fothergill (1712 -1780)
He was and assistant to Monro. In 1748 he wrote a treatise on “ACCOUNT ON SORE THROAT” which came out from a malignant form of scarlatina. He was an authority on materia medica and used Chinchona bark extensively, advised conium for neuralgia. He directed his effort for registration of birth and death though until 1837 it did not become compulsory.

37. Richard mead (1673 – 1754)
He made some original observations on snake venom in his work ` A mechanical account of poisons’.

38. William heberden (1710 – 1801)
Was a graduate from Cambridge and a great physician. He wrote commentaries of a large number of case records of different diseases like Angina Pectoris. He wrote ” there is a disorder of the heart marked with strong and peculiar symptoms, considerable for the danger belonging to it and not extremely rare. The seat of it, and the sense of strangling and anxiety with which it is attended, may make it not improperly called Angina Pectoris. The termination is remarkable. The patients all suddenly fall down, and perish almost immediately”

39. William withering (1741 – 1799)
He graduated in Edinburgh in 1766 and started to practise for 10 years. He showed that dropsy might be due to cardiac disease and DIGITALIS if carefully used and stopped, might be an excellent remedy.

40. John floyer (1649 – 1734)
He introduced PULSE WATCH. It had recorded the seconds on the dial.

41. Thermometer james currie (1756 – 1805)
Currie checked the results after treating typhoid fever with THERMOMETER, PERCUSSION AND AUSCULTATION.

42. Leopold auenbrugger (1722 – 1809)
He was a physician to the Military Hospital of Vienna. He was the son of an innkeeper of Graz and had often used Percussion to asses the level of wine in his father’s casks. This principle he applied to human chest when he was attached to a military hospital as a physician. He published a monograph on the title ` INVENTUM NOVUM EXPERCUSSIONE THORACIS GUMANT UT SINGO ABSTRUSOS INTERNT PECTORIS MORBOS DETEGENDI ” in the year 1761

43. Bernardino ramazzini (1633 – 1714)
He was a professor at Modeua and Padua. He published a comprehensive work on `occupational disease’. He described the lung diseases of miners, stonemasons, the eye diseases of blacksmith, guilders, lead poisoning of printers and potters.

44. Johann pater frank (1745 -1821) He evolved rules for sanitary hygiene

45. Stephen hales (1677 -1761)
He inserted a glass tube into the artery of a horse and tried to demonstrate and measure the blood pressure. He used ventilator fitted in the roof of a prison. Thus introduced artificial ventilation.

46. Franz anton mesmer (1734 -1815)
He claimed that he could cure by just touching the patient. He could do this by influx of animal magnetism. At first he used magnets, until he found that he could achieve similar results by using his hands.

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