Professional Documents
Culture Documents
Medicine Becomes A Science 1840-1999
Medicine Becomes A Science 1840-1999
History
of
Medicine
Medicine
BecoMes a
science
18401999
tHe
History
of
Medicine
Medicine
BecoMes a
science
18401999
Kate Kelly
Contents
Preface
Acknowledgments
Introduction
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4 Advances in Medications
Aspirin: Simple and Effective
How Aspirin Works
The Discovery of Penicillin Changes Medicine
The Creation of Other Antibiotics
The Search for a Magic Bullet
Superbugs and Resistance to Antibiotics
The Oral Contraceptive Pill
Conclusion
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Chronology
Glossary
Further Resources
Index
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PreFaCe
You have to know the past to understand the present.
American scientist Carl Sagan (193496)
viii
Preface
ix
for high school students and the general public how and when
various medical discoveries were made and how that information
affected health care of the time period. The set starts with primitive humans and concludes with a final volume that presents readers with the very vital information they will need as they must
answer societys questions of the future about everything from
understanding ones personal risk of certain diseases to the ethics
of organ transplants and the increasingly complex questions about
preservation of life.
Each volume is interdisciplinary, blending discussions of the
history, biology, chemistry, medicine and economic issues and public policy that are associated with each topic. Early Civilizations,
the first volume, presents new research about very old cultures
because modern technology has yielded new information on the
study of ancient civilizations. The healing practices of primitive
humans and of the ancient civilizations in India and China are
outlined, and this volume describes the many contributions of
the Greeks and Romans, including Hippocrates patient-centric
approach to illness and how the Romans improved public health.
The Middle Ages addresses the religious influence on the practice of medicine and the eventual growth of universities that provided a medical education. During the Middle Ages, sanitation
became a major issue, and necessity eventually drove improvements to public health. Women also made contributions to the
medical field during this time. The Middle Ages describes the
manner in which medieval society coped with the Black Death
(bubonic plague) and leprosy, as illustrative of the medical thinking of this era. The volume concludes with information on the
golden age of Islamic medicine, during which considerable medical
progress was made.
The Scientific Revolution and Medicine describes how disease
flourished because of an increase in population, and the book
describes the numerous discoveries that were an important aspect
of this time. The volume explains the progress made by Andreas
Vesalius (151464) who transformed Western concepts of the
structure of the human body; William Harvey (15781657), who
Preface xi
terms and concepts, a helpful list of Internet resources, and an
array of historical and current print sources for further research.
Photographs, tables, and line art accompany the text.
I am a science and medical writer with the good fortune to be
assigned this set. For a number of years I have written books in
collaboration with physicians who wanted to share their medical knowledge with laypeople, and this has provided an excellent background in understanding the science and medicine of
good health. In addition, I am a frequent guest at middle and high
schools and at public libraries addressing audiences on the history
of U.S. presidential election days, and this regular experience with
students keeps me fresh when it comes to understanding how best
to convey information to these audiences.
What is happening in the world of medicine and health technology today may affect the career choices of many, and it will
affect the health care of all, so the topics are of vital importance.
In addition, the public health policies under consideration (what
medicines to develop, whether to permit stem cell research, what
health records to put online, and how and when to use what types
of technology, etc.) will have a big impact on all people in the
future. These subjects are in the news daily, and students who can
turn to authoritative science volumes on the topic will be better
prepared to understand the story behind the news.
aCKnoWledgMents
his book, as well as the others in the set, was made possible
because of the guidance, inspiration, and advice offered by
many generous individuals who have helped me better understand
science and medicine and their histories. I would like to express
my heartfelt appreciation to Frank Darmstadt, whose vision and
enthusiastic encouragement, patience, and support helped shape
the set and saw it through to completion. Thank you, too, to the
Facts On File staff members who worked on it.
The line art and the photographs for the entire set were provided by two very helpful professionalsBobbi McCutcheon provided all the line art; she frequently reached out to me from her
office in Juneau, Alaska, to offer very welcome advice and support as we worked through the complexities of the renderings. A
very warm thank you to Elizabeth Oakes for finding a wealth of
wonderful photographs that helped bring the information to life.
Carol Sailors got me off to a great start, and Carole Johnson kept
me sane by providing able help on the back matter of all the books.
My agent Bob Diforio has remained steadfast in his shepherding
of the work.
I also want to acknowledge the wonderful archive collections
that have provided information for the book. Without places such
as the Sophia Smith Collection at the Smith College Library, firsthand accounts of the Civil War battlefield treatment or reports
such as Lillian Gilbreths on helping the disabled after World War
I would be lost to history.
xii
introduCtion
If it is a terrifying thought that life is at the mercy of the
multiplication of these minute bodies, it is a consoling
hope that Science will not always remain powerless before
such enemies . . .
Louis Pasteur in a paper read before the
French Academy of Sciences, April 29, 1878
nly 150 years ago, scientists did not know what made people sick. There were many theories of how and why illness
spread, but none of them were accurate. Though very primitive
microscopes had permitted the examination of bacteria as early
as the 1660s, it was not until the mid-19th century that bacterias
contribution to the spread of illness was understood. Medicine
Becomes a Science describes the historic events, scientific principles, and technical breakthroughs that led to a century and a half
of rapid advancement in combating disease.
Medicine Becomes a Science: 18401999 briefly introduces
Antoni van Leeuwenhoek, a Dutch cloth merchant who was first
to see and identify various forms of bacteria. However, heand
no one elsefully understood what he was seeing. Then in the
mid-1800s, Louis Pasteur, a professor of chemistry at Strasbourg
University, came up with the concept of germ theory, which was to
change the world of medicine forever. The German microbiologist
Robert Koch built on this theory by adding his own three laws in
1883. These laws provided a system that led to an understanding
of how to identify the organisms that cause disease.
From this time forward, medical progress has moved swiftly.
Louis Pasteur himself went on to make other important discoveries. His work on ways to prevent the transmission of rabies was
instrumental in laying the groundwork for vaccinesa method of
disease prevention we rely upon today.
xiii
Introduction xv
Today, medical diagnosis and treatment follow what has come
to be called evidence-based medicine, which involves integrating
individual clinical expertise with the best available evidence from
systematic research. Scientists and medical practitioners rely on
science, engineering, the statistics from studies and randomizedcontrol trials, before they choose the medical treatment that seems
best for each individual.
Readers of this volume will come away with an understanding
of the state of medical care as it existed before the 21st century.
Chapter 1 describes the stunning discoveries made by Louis Pasteur and Robert Koch that finally provided an understanding of
what caused disease. Germ theory opened a whole new world in
medicine by creating a way for physicians to do more than offer
palliative care. Chapter 2 introduces womens contributions to
medicine, including information about the first woman doctor,
the founding of the profession of nursing, and the contributions
of women like Florence Nightingale and Clara Barton. Chapter 3
describes how X-rays were discovered and notes the contributions
of Marie and Pierre Curie. Chapter 4 highlights the accidental
discovery of penicillin, a medicine that became a vital part of
doctors weapons against disease. Chapter 5 focuses on polio and
explains how Jonas Salk and Albert Sabin both contributed to the
eradication of the disease. The chapter continues with a description of the new ideas behind evidence-based medicineideas
that have resulted in a new and more scientific way of looking
at disease. Chapter 6 examines the aftermath of 20th-century
warfare and what it meant for the disabled. For the first time,
considerable numbers of soldiers were surviving major injuries,
and this provided the impetus for improving treatment of people
who returned from war but had to cope with some type of handicap. Chapter 7 traces how scientists came to understand the science of the blood and continues with information about artificial
hearts, heart transplants, and what is known about heart disease.
Chapter 8 looks at medicine in the late 1990s, how diagnoses and
treatments have been influenced by the discovery of DNA.
xvi
This book is a vital addition to literature on the history of medicine because it puts into perspective the medical discoveries of
the period and provides readers with a better understanding of
the accomplishments of the time. During this period, scientists
and physicians finally realized the cause of disease, and, with this
discovery, medical progress began flying forward.
1
Medical science
Finally advances
Although Antoni van Leeuwenhoek had seen and described bacteria in the
17th century, it was not until the 19th century with the work done by Louis
Pasteur and Robert Koch that there was any conclusive understanding
that bacteria were the root cause of many diseases.
many, and the scientist who was approached was a young microbiologist and physician named Robert Koch (18431910). In the early
1870s, farmers in Germany were having a terrible problem with
anthrax, a devastating disease that was killing their cattle. (The
term anthrax comes from the Greek word anthrakitis, meaning
anthracite, which is coal, in reference to the black skin lesions
that develop with some forms of the illness.)
In the late 19th century, anthrax was a major problem. It caused
a deadly and highly communicable disease in animals. The spore
that caused the disease was hardy and could live a long time. An
entire herd of cattle could be infected by walking over the ground
where an infected animal had died. The only hope of preventing
the spread of the disease was to kill any infected animals and bury
them deep in the ground, something that was not easy to do in the
winter. (See the sidebar Anthrax: Modern Weapon in Bioterrorism on page 11 for information on how terrorists are trying to
benefit from the hardiness of the spores.)
Robert Koch was aware of Pasteurs ideas about germs and the
work Pasteur had done in the wine and silk industries, and Koch
was interested in helping the farmers. He set up a laboratory in
An Anthrax Vaccine
A vaccine had been created to prevent smallpox, and this seemed
a logical course of action with the anthrax. However, Edward Jenner (17491823) had been able to use the weaker cowpox to inject
humans in order to create the antibodies to fight against the more
The process of vaccination was first used with smallpox and, although
scientists were now finding ways to vaccinate against some other
diseases, they did not yet have a scientific understanding of why vaccines
worked.
Kochs Postulates
In addition to investigating
anthrax, Koch continued stud- Robert Kochs postulates created
ies of various other types of dis- a framework for assessing each
disease that was studied.
eases. He made notable inroads
into creating a theory of contagion, and in 1883 he set out three laws that explained the cause of
disease. Kochs postulates have been used ever since to determine
whether an organism causes a disease and are as follows:
1. The suspected germ must be consistently associated with
the disease.
2. It must be isolated from the sick person and cultured in
the laboratory.
3. Experimental inoculation with the organism must cause
the symptoms of the disease to appear.
In 1905, a fourth rule was added:
4. Organisms must be isolated again from the experimental
infection.
(continues on page 12)
Anthrax:
Modern Weapon in Bioterrorism
As the farmers who consulted Robert Koch came to realize,
one of the challenges of anthrax is that it can form long-lived
spores that are capable of surviving in a hostile environment. The bacteria become dormant but can remain viable
for decades and perhaps centuries. When anthrax-infected
animal burial sites have been disturbed as many as 70 years
after the fact, spores have been known to reinfect living animals. (Today, anthrax infections in domestic animals are
relatively rare because of animal vaccination programs and
sterilization of waste materials. While the disease is most
common in animals, it can be transferred to humans. Some
forms are so dangerous that a person who has been exposed
needs to be quarantined.)
Exposure used to be primarily by occupational exposure to infected animals or their products (usually wool
or meat)the more dangerous form of anthrax used to be
called wool sorters disease. The exposure to this version
is via inhalation, and it is very rare. In 2006, a musician
who had brought African goatskins to make drums into the
United States became very ill from exposure to the anthrax
spores on the unprocessed skins. Hospitalized for a month,
the 44-year-old victim was able to return to performing
within a few months. Prior to this time, the last known case
in the United States was in California in 1976 when a home
weaver died after working with wool imported from Pakistan. The spores are so deadly that it was very dangerous
to do the autopsy. The body had to be carefully sealed in
plastic and then sealed again in a metal container before it
could be sent for study by scientists at University of California at Los Angeles.
Because of their potency and hardy life, anthrax spores
have been used in biological warfare. The spores were
(continued)
Ignaz Semmelweis was the first surgeon to make the connection between
unclean surgical practices and the occurrence of puerperal fever.
Semmelweis was unable to persuade many to change their ways. In the
1870s, Joseph Lister began to teach about cleanliness, and in 1878 Robert
Koch demonstrated that surgical tools could be sterilized using steam.
All of these elements helped reduce infection.
Autopsy Findings
One of his greatest accomplishments happened much later in his
career. During his lifetime, Virchow had spent a great deal of time
in the laboratory, and much of what he had learned he taught
himself by doing autopsies. By 1874, his organized and methodical system had become well known and other physicians came to
learn his technique. Virchows system is still one of the two methods used in autopsies today and involves removing each organ one
by one. Others had advocated organ removal in units.
As a result of increasing autopsies, academic institutions began
to create pathology departments to study the diseased tissues and
body parts as they were removed. This created a new focus for science. Physicians began cataloging their findings, and while much
Conclusion
The mid-19th century was a time of robust accomplishment. Virchows identification of the importance of the cell, Pasteur and
Kochs work on germ theory as well as on practical solutions to daily
While several methods of conducting an autopsy are used today, one of the
most commonly used is the one devised by Rudolf Virchow, who taught
that organs should be removed one at a time and studied separately.
problems like the spoiling of wine and the spread of anthrax brought
science into the mainstream. Businesses and government saw that
there were very practical ways to benefit from the new theories.
Ignaz Semmelweis and Joseph Lister together ushered in a new
era of hospital management that greatly reduced the infection rate
and highlighted the need for sanitation as part of any medical
treatment process.
2
Women and
Modern Medicine
21
The Lady with the Lamp from a painting by Henrietta Rae (Library of
Congress Prints and Photographs Division)
When the Crimean War broke out in 1853, Frances soldiers were
aided by women from several religious orders, but British medical
care was seriously lacking. With the approval of her friend Sidney Herbert, who held a governmental office, Nightingale selected
and trained 38 volunteer nurses whom she took with her to the
spirits up: She read to them, wrote letters for them, listened to
their personal problems, and prayed with them.
Though it was highly unusual, Barton wanted to follow the
men to the front lines and, after much effort, Barton was eventually given passes to bring her voluntary services and medical supplies to the battlefront and to field hospitals. Her first trip was to
Virginia in August 1862, and, when she arrived with her supplies,
the overwhelmed surgeon on duty wrote later, I thought that
night if heaven ever sent out a[n] ... angel, she must be oneher
assistance was so timely. She became known as the Angel of the
Battlefield.
Conclusion
Today, women physicians are so common that it is shocking to
think that only 160 years ago the women who entered the profession had a very difficult time. Elizabeth Blackwell was instrumental in helping other women enter the medical profession, and her
own contributions to the field were enormous. The field of nursing
was professionalized through the efforts of women like Florence
Nightingale, Mary Seacole, and Linda Richards. Today, nurses
can pursue a myriad of medical specialties, and there is a growing level of respect for the nursing profession. Dorothea Dix and
Alice Hamilton both made vital contributions in fields that were
getting little attention at the time. Dix addressed the needs of the
mentally ill, and Alice Hamilton brought attention to the hazards
of the workplace. Both these fields were to become increasingly
important in the 20th century.
3
science Moves Forward
in diagnosis and treatment
39
Diagnostic Radiology
Diagnostic radiology permits physicians to obtain both static
(still) and dynamic (moving) images of body tissues and functions to study both normal anatomy and physiology and abnormalities caused by disease or injury. The process involves
passing a localized beam of radiation through the part of the
body being examined to produce an X-ray, which can take several forms. It can be a plain image such as the common chest
X-ray; a mammogram (an X-ray image of the female breast
used to scan for cancerous tumors); a tomograph (an image
that reveals depth within a structure by using a series of Xrays); or a computed tomography (CT or CAT) scan, a computer analysis of a cross-sectional image of the body.
Some body parts (certain organ systems and muscular
and skeletal structures) cannot be viewed using normal diagnostic radiology. However, physicians learned that if patients
drink, inhale, or are injected with substances called contrast
media, radiation can then be used to reveal these systems.
Contrast media can be used to study the upper gastrointestinal tract, or a contrast substance can be injected into an
artery, vein, or lymph vessel in order to produce an angiogram so that doctors can obtain more information about a
patients bodily functions. To capture these systems in action,
radiologists can use fluoroscopy to obtain dynamic images
of the intestinal tract or the flow of contrast material through
blood vessels or the spinal canal. Fluoroscopy can either be
Therapeutic Radiology
Therapeutic radiology uses ionizing radiation in the treatment
of cancer. Normal tissues have a greater ability to recover from
the effects of radiation than tumors and tumor cells. A radiation dose sufficient to destroy cancerous cells only temporarily injures adjacent normal cells. (Certain cancers are resistant
to radiology, and then radiation is not part of the therapy.)
Radiation therapy is commonly employed either before
or shortly after surgical removal of certain tumors to destroy
tumor cells that could (or may already have) spread beyond
the surgical margins. Radiation therapy may be used alone
as the treatment of choice in most cancers of the skin, in certain stages of cancers involving the cervix, uterus, breast,
and prostate gland, and in some types of leukemia and lymphoma, particularly Hodgkins disease. Radiation is also used
in conjunction with cancer-treatment drugs.
Scientists are exploring therapies for brain-controlled
movement disorders such as tremors, epilepsy, and Parkinsons disease that would use targeted radiation.
(continues)
(continued)
Interventional Radiology
Interventional radiology uses radiologic imaging to guide
catheters (hollow, flexible tubes), balloons, filters, and other
tiny instruments through the bodys blood vessels and other
organs in order to bring about a solution without surgery.
These types of interventional uses of radiology include balloon angioplasty, the use of a balloon to open blocked or
narrowed arteries; chemo-embolization, the delivery of anticancer drugs directly to a tumor; fallopian tube catheterization, which opens blocked fallopian tubes, a common cause
of infertility in women; and thrombolysis, which dissolves
blood clots.
Curie was one of the most famous women of her time. Though
she resented the time fame took away from her work, she was able
to use her good name to promote the medical uses of radium by
facilitating the foundation of radium therapy institutes in France,
Poland, and the United States.
Conclusion
The progress in medicine during this erathe late 1800s and early
1900swas truly remarkable, but different segments of the population would give very different answers if they were asked to
identify the most significant advance during the time period. Certainly, some scientists would point to the discovery of radiation
that is now used diagnostically, therapeutically, and interventionally; others would highlight the discovery of viruses. But anesthesia would undoubtedly be cited by patients as the most significant
progress of the era. At last, patients could receive surgical treatment without undergoing the searing pain of the process.
4
advances in Medications
58
Advances in Medications
59
But medicine was truly transformed by the accidental discovery of penicillin, which marked the start of modern antibiotics.
Initially penicillin and the antibiotics that followed were greeted
as miracle drugs that could wipe out serious illness, and, of course,
they were. However, today physicians are much more cautious.
They now have witnessed that a number of patients develop allergies to the medications from overuse, and, more frighteningly, bacteria have proven capable of evolving and developing into what are
unscientifically referred to as superbugs, which are not controlled
or eliminated by the current arsenal of antibiotics.
Three other drugs are worthy of highlighting in this chapter.
The first, aspirin, preceded the development of penicillin, and
physicians still marvel that this very simple medication is highly
effective; scientists today continue to explore ways it can be used.
This chapter introduces Salversan, a drug that was developed by
the scientist Paul Ehrlich. Salversan was the first effective drug
against syphilis, and it is particularly significant because it is considered the first of the chemotherapy drugs, which are primarily
used to fight cancer.
The final medication that is described in this chapter is one
that also changed historythe birth control pill. For the first time,
women were given an increased ability to choose their own fate by
managing their childbearing. This has had an enormous effect on
developed countries, and the manner in which the medication was
created required the confluence of both science and social opinion.
Advances in Medications 61
stomach distress. Hoffmann assumed that the damage was occurring because the drug was an acid, so he worked to find something
that would mask the acidic aspect of the drug without harming its
ability to help with pain and swelling. He eventually discovered
that he could cover the acidic parts by converting it to acetylsalicylic acid (ASA), which seemed to work well for patients without
damaging the stomach.
Though today the names Bayer and aspirin are deeply
interconnected and the worldwide market for this over-the-counter drug is huge, Bayer did not respond enthusiastically to Felix
Hoffmanns discovery after he revealed what he was working on.
It turned out that Hoffmann and his drug became entangled in
a company turf war. Hoffmann worked in the research department under a fellow named Arthur Eichengrn; Eichengrn and
Hoffmann had contracts with Bayer by which they would receive
a royalty on any patentable product they invented, and Eichengrn knew that Hoffmanns discovery held that potential. They
encountered stalling and resistance from Heinrich Dreser, who
was in charge of Bayers pharmacological testing and standardization department. Dreser had an agreement with Bayer by which
he would receive a royalty on any product he introduced. If Dreser could introduce the project, and Hoffmann and Eichengrn
never patented it, they were out of the picture. When the drug
finally entered the marketplace under the Bayer name, Dreser
was the financial beneficiary. This was the way it eventually
worked out. As for calling it aspirin, the people at Bayer came
up with the term: A was for acetyl chloride, and spir was
for the spiraea ulmaria plant (the plant from which the salicylic
acid was derived), and in was added as a common ending for
medications.
While aspirin was the perfect drug for wide introduction
since it had many applications and could help with many types
of pain, the Bayer Company was also the perfect company to be
the first major manufacturer of it. Bayer had been started in 1863
as a dye-manufacturing plant, but as the dye industry began to
fade during the 1880s, the company decided to switch from dyes
Advances in Medications 63
concluding the war involved reparations by specific companies.
Bayer had trademarks on aspirin as well as heroin (at this time,
heroin was used medicinally as a very powerful cough suppressant and pain reliever) and had to give up both trademarks to
France, England, and Russia. This agreement was actually part
of the Treaty of Versailles.
Advances in Medications 65
sore lasts, and may decrease the odds of a person getting Alzheimers by reducing inflammation in the brain.
Aspirin may also prove helpful with cancer. Researchers at
Newcastle University in England explored a biological process that
makes blood vessels grow, and they have observed that aspirin
Advances in Medications 67
In 1928, Fleming noticed
something that was to lead to
a significant discovery. He was
cleaning up his laboratory from
some earlier experiments when
he observed that mold had
developed on a staphylococcus
culture plate. Inexplicably, the
mold had created a bacteriafree circle around itselfthe
staph infection culture that
was growing elsewhere in the
plate disappeared around the
mold. Curious, Fleming grew
Sir Alexander Fleming (18811955)
the mold (Penicillium notatum) discovered penicillin in 1928, thus
in a pure culture and found making one of the greatest contributhat it produced a substance tions to medicine.
that killed a number of disease-causing bacteria.
He was inspired to experiment further, and he found that a
mold culture prevented growth of staphylococci, even when it was
diluted. He continued his research and determined that the mold
could kill other types of bacteria. In experiments with small animals, it seemed to have no ill effect. Fleming published his discovery in 1929 in the British Journal of Experimental Pathology. He
noted that his discovery might have therapeutic value if it could
be produced in quantity. Fleming continued working but found
that cultivating it was quite difficult, and he was unsuccessful at
isolating the antibiotic agent involved. As he experimented, he
found the penicillium he was working with was slow to act, and
he determined it would not last long enough to fight bacteria in
the human body. Fleming also worried that it would be hard to
produce in quantity.
Other research tasks interrupted Flemings work on penicillium, and it was a full 10 years later that two Oxford University
scientists Howard Florey and Ernst Chain took the investigation
Advances in Medications 69
came from a strain of penicillin from a moldy cantaloupe purchased by Florey in a Peoria grocery store.
By November 26, 1941, Dr. Heatley and Andrew J. Moyer,
one of the lab scientists familiar with mold, succeeded in greatly
increasing the yield of penicillin that was possible, and, for the
first time, it seemed viable that penicillin might one day be mass
produced. In 1943, penicillin was tested in clinical trials, and it
was shown to be the most effective antibacterial agent anyone had
Advances in Medications 71
otics, nystatin was developed from a bacteria. It was isolated from Streptomyces noursei found in a soil sample in
1950 by Elizabeth Lee Hazen and Rachel Fuller Brown,
who were employed by the Division of Laboratories and
Research of the New York State Department of Health.
In 1954, Hazen and Brown named nystatin after the
New York State Public Health Department. In addition
to human ailments, the drug has been used to treat such
problems as Dutch elm disease and to restore water-damaged artwork from the effects of mold. The two scientists
donated the royalties from their invention, more than
$13 million, to a nonprofit corporation for the advancement of academic scientific study.
Amoxicillin. SmithKline Beecham patented Amoxicillin or amoxicillin/clavulanate potassium tablets in
1981 and first sold the antibiotic in 1998 under the trade
names of Amoxicillin, Amoxil, and Trimox. Amoxicillin is a semi-synthetic antibiotic. It is a commonly prescribed drug because it is administered orally and is well
absorbed and well tolerated by most people.
When antibiotics were first introduced, no one predicted that
overuse of these medications would cause the emergence of stronger, antibiotic-resistant bacteria. The mutations in these infectious
agents pose huge dangers for the future. Currently, government
health groups worldwide are recommending that doctors curb the
number of antibiotics prescribed and use them only when no other
remedy will help.
Advances in Medications 73
The spirochete that causes syphilis was discovered by two
researchers in Berlin. Ehrlich decided to look for a drug that would
be effective against this particular bacterium and began exploring
some arsenic-based drugs. Though arsenic was poisonous, Ehrlich
Advances in Medications 75
differences in Corning. She observed that the wealthy families
had fewer children and seemed to have fewer problems, while
poorer families had more offspring and also encountered other
difficult family issues including unemployment, drunkenness,
and fighting.
With help from her sisters, Sanger worked her way through
nursing school and married a young architect. When Sanger
first began her nursing career, she frequently was asked by poor
women for the secret that rich women, who had fewer children,
seemed to know. By law, only doctors could talk about birth control; nurses were not to comment. In addition, the only methods available to doctors for women who wanted to limit their
pregnancies were condoms and diaphragmswhat are known as
barrier methods. If a womans doctor did not tell her about these
methods, it was not easy to get the information. Federal and state
laws prohibited birth control information to exist in print. Both
married women and single women frequently were desperate to
avoid childbirth, and when they became pregnant and felt they
could not cope with a pregnancy, they went to back-alley abortionists. Some died during the abortion; others died afterward
from infection. Those who survived often had difficulty having
children in the future.
Sanger and her husband started a family but rejected the normal
suburban lifestyle. Margaret and her husband spent time in Greenwich Village and were friends with social activists, free thinkers,
labor activists, and womens rights leaders. Sanger happened to
attend a lecture by the famous psychiatrist Sigmund Freud (1856
1939), and, for her, his comments on sexuality and sexualization
of women provided inspiration to fight against female repression.
To Sanger, this social subjugation began with the lack of control
women had over their bodies. In 1914, she published a newspaper
The Woman Rebel that offered a platform for her views and in the
June issue she used the term birth control for the first time.
Since there were laws that banned any written material about
ways to prevent conception, the government indicted Sanger on
an indecency charge and pronounced her publication obscene. If
Advances in Medications 77
he was denied tenure. He and a scientist friend started a company,
the Worcester Foundation for Experimental Biology. Sanger felt
Pincuss expansive thinking made him right to approach about
looking for a safe oral contraceptive. Pincus was familiar with
research that had identified progesterone, and researchers at the
University of Rochester had shown that progesterone prohibited
ovulation. This was further extended in 1937 by researchers at the
University of Pennsylvania who successfully used progesterone to
block ovulation in rabbits.
Pincus knew the next thing he needed was affordable synthetic
hormones, and he turned to Russell Marker, an organic chemist at
the University of Pennsylvania who developed a method of creating hormones from natural substances. Marker was soon replaced
by the chemist Carl Djerassi who extended the method and perfected an oral form of progesterone that was effective at halting
ovulation.
Next, Pincus added a physician to his team, a Catholic doctor named John Rock (18901984) who specialized in fertility
problems. Rock had angered the Catholic Church by supporting
the right for medical doctors to talk about contraception, and
he wrote a book called Voluntary Parenthood. Rock was an able
and well-qualified person to work on the product. Pincus and
Rock wanted to establish some drug trials to see how it worked
in women. A network of health clinics in Puerto Rico permitted
the trials to be conducted and asked for volunteers from their
patient base. Women came eagerly to get what became known as
the Pill. The statistics gathered from these trials were promising.
Pincus and Rock noted that it seemed to be 30 times more effective than other forms of birth control, but 17 percent of women
suffered side effects (some of which were quite debilitating, such
as daily vomiting). The possibilities of these side effects did not
deter women, the scientists, or even the Food and Drug Administration, the governmental body that needed to approve the drug
before it could be marketed. When Pincuss group approached
the FDA, the approval actually went through quite easily. One of
the main ingredients, Enovid, had been approved in 1957 for the
Advances in Medications 79
Conclusion
As the cause of illnesses became better understood, scientists
finally could make notable inroads in creating pharmacological
treatments. Antibacterial medications like penicillin and other
antibiotics meant that more patients could survive serious infections, and the search for a magic bullet not only gave the medical
world a way to cure syphilis but Salvarsan was the first of the medications now known as a chemotherapy treatment, a class of drugs
that creates the main arsenal against cancer. The development of
the oral contraceptive pill made a major difference in womens lives
by giving them an opportunity to control child-bearing, and there
are doubtless more gains in store in this field as efforts are made
to create a male contraceptive pill. Not to be forgotten is the basic
wonder drug of the chapter, aspirin, an inexpensive nonprescription medication for which scientists continue to find new uses.
5
an answer to Polio and
other Changes in Medicine
80
81
With a public that was gripped by fear of this terribly frightening disease, the news of a preventive vaccine was greeted with
great excitement, only to have that excitement dashed by a manufacturing error that resulted in many children being sickened by
the vaccine and even causing the deaths of a few. While the situation was remedied and other vaccines were quickly ushered forward, the experience with polio explains the medical world into
which Archie Cochrane, known as the father of evidence-based
medicine, entered. Cochrane advocated for a new way of managing patient care, one that relied on clinical evidence as viewed
through the lens of the physician, who was also expected to factor
in the specific needs of the patient when recommendations for
treatment were made.
The chapter begins with a description of the devastating effect
polio had on American children and how two different physicians
Jonas Salk and Albert
Sabinsought to find a
way to prevent the disease.
Though the two men were
never able to reconcile their
different approaches, a polio
vaccine did emerge and has
saved the world from more
outbreaks of this terrible
scourge. As doctors fought
to create better vaccines
and improved treatments,
they began to realize the
importance of a systematic
approach to medicine. The
chapter concludes with
an explanation of Archie
Cochranes campaign for
Jonas Salk (191495) is best known for
evidence-based medical creating the killed-virus polio vaccine.
practices.
(Centers for Disease Control)
Iron lung ward of Ranchos Los Amigos Hospital, Downey, California, ca.
1953 (USDA)
The polio virus enters the body via the intestinal tract and
then moves to the bloodstream. If it goes on to attack the
nerves, the patient may suffer one of the two more serious
forms of polio.
When Jonas Salks killed-virus polio vaccine was first made available, it
was given by injection. Later on, Albert Sabin developed a vaccine using a
weakened form of the virus, and it could be given in liquid form or placed
in sugar cubes, making it easier to administer.
A global effort has been made to eradicate polio, and cases have
decreased by over 99 percent since 1988 (from an estimated more than
350,000 cases to only 1,997 reported cases in 2006). Today, only four
countries in the world remain polio-endemic (India, Nigeria, Pakistan,
and Afghanistan).
Archie Cochrane believed strongly that the only way to judge medical
effectiveness was to apply the scientific method to the process of
evaluating how to treat a disease. By looking for specific evidence of
whether or not a particular treatment worked, Cochrane believed that
physicians could make better decisions. He called this evidence-based
medicine.
Clinical trials are a vital part of the medical system because they provide
an unbiased evaluation of whether a particular treatment or medication
is effective. To make certain that trials reflect accurate information, they
must be carefully supervised and all must abide by the same protocol so
that the results are valid.
Conclusion
Polio was a frightening illness that terrified the public. Jonas Salk
and Albert Sabin worked separately to create vaccines that could
be used effectively, and today in most of the world the threat of
polio is just a dim memory.
On the heels of the progress with polio, physicians began to
realize the importance of systematizing care. Archie Cochrane and
his work toward an evidence-based practice of medicine increased
the level of professionalism for practitioners, and today clinical trials and a better examination of treatment efficacy are important
aspects of the medical profession.
In 2009, there is renewed interest in evidence-based medicine and further pinning down what is effective and what is not.
President Barack Obama has indicated that part of the solution
to halting spiraling health care costs involves reexamining what
constitutes effective medicine. He has stated that he wants the
98
6
More Changes
Brought about by War
Advances in Prosthetics
The American Civil War brought about the need for a field of
prosthetic medicine. It is reported that there were at least 30,000
amputations on the Union side alone, but at the time the best doctors could do was provide a very primitive limb substitute.
An advance in another area, the development of anesthesia,
created an opportunity for better surgical procedures. Later in
the 19th century, with the introduction of anesthesia, doctors
could perform surgeries that were more detailed and took longer, because the patient could be adequately anesthetized. As
a result, physicians began to develop ways to operate on the
patients stump in such a way that a prosthetic device could more
easily and more comfortably be fitted on to the persons limb. As
surgeons improved their techniques and learned successful ways
to prevent infections, their success rate improved. In addition to
better prosthetics, another important development that occurred
in the early 20th century was
a social movement inspired
by two efficiency experts
who encouraged acceptance
of people with disabilities in
the workplace. (See the sidebar Pioneers in Helping the
Handicapped on page 107.)
World War II was the next
occasion that encouraged the
improvement of prosthetics.
In 1945, the National Academy of Sciences, an American
People have always wanted to look government agency, estabas normal as possible. A person lished the artificial limb prowho lost an eye preferred to have a gram in response to the influx
prosthetic. Glass eyes were created
of World War II amputees and
so that a thin thread could hold the
piece in; todays acrylic materials are for the purpose of advancing
scientific progress in artifimuch lighter and easier to wear.
(continued)
Frank and Lillian Gilbreth with 11 of their 12 children, ca. 1920s (Purdue
Libraries Archives and Special Collections)
The need for improved civilian emergency care is further highlighted in the sidebar John Wiegenstein (19302004): Father of
Emergency Medicine on page 112.
11
ConClusion
While it is hard to think of war having a silver lining, the medical profession and citizens alike would probably reluctantly agree
that some good does come out of the horror of war. Scientists and
physicians and emergency responders all rise to the occasion and
provide the best care possible to soldiers. The lessons they learn
are brought back home and employed in civilian facilities.
7
the science of the heart
hysicians today know that blood is the key to life. They can
withdraw small amounts to analyze a patients health; they
can safely give a transfusion to a person who has lost too much
blood; and they can separate blood to extract blood plasma or platelets or various other components in ways they could not have previously imagined. All these elements can be used in a myriad of
ways for both different types of diagnoses as well as treatment.
Well into the 19th century, physicians continued to perform
bloodletting, but they were beginning to note that there were
times when it might be valuable to be able to add blood, not take
it away. When the first human-to-human blood transfusions were
performed, the failure rate was high, and progress moved in fits
and starts before the Austrian physician Karl Landsteiner came
up with an answer for successful transfusions.
As scientists grasped that the heart was actually a very
mechanical organ, they began to think about whether it could be
replaced with anything else if it became weakened or diseased. In
the process, many scientists investigated the creation of artificial
pumps that could mimic the hearts action and eventually began
to experiment with the possibility of transplanting a good heart
into a person whose heart was giving out.
115
The A blood allele is somewhat more common around the world than B. The A allele apparently was absent among
Central and South American Indians so there are few people with that blood type in South and Central America.
The B blood type is highest in Central Asia, and it is less prevalent in the Americas and Australia. However, there are relatively
high-frequency pockets in Africa as well. Overall in the world, B is the rarest blood allele. Only 16 percent of people have it.
The O blood type (usually resulting from the absence of both A and B alleles) is very common around the world. About
63 percent of humans share it.
the now well-known A, B, and O groups (three groups were identified initially). He went on to demonstrate that if transfusions were
restricted to people of the same blood type, then all went smoothly;
catastrophe occurred only when a person was transfused with the
blood of a person belonging to a different group.
In 1902, two other scientists identified a fourth main blood
type, AB. Shortly after this, Reuben Ottenberg performed the first
blood transfusion using blood typing and cross-matching. Ottenberg also recognized that blood group types seemed to be dictated
by inheritance.
Twenty years later, physicians were still encountering occasional difficulties performing transfusions. In 193940, Karl
Landsteiner and three other scientistsAlex Wiener, Philip
Levine, and R. E. Stetsonidentified the Rh factor as the cause of
the majority of transfusion reactions. The Rh factor is a protein
substance found in the red blood cells of 85 percent of the population (they are referred to as Rh positive). Fifteen percent of people
lack this factor (termed Rh negative). If Rh negative is transfused
into someone who is Rh positive, the outcome may be a serious,
even a fatal, reaction. Once a reliable way to test for Rh negative or
Rh positive was identified, another important piece of knowledge
had been acquired.
where he could open a small hole in the cardiac wall and insert
his finger to remove the foreign element. His early results were
poor, but he began to see some successes with practice; animals
were surviving the surgery. By the time he felt confident enough to
try the surgery on soldiers, most procedures went quite well. The
significance of this surgery exceeded the lives saved, because for
the first time, a surgeon had proven that it was possible to operate
on the heart.
Despite Harkens success, both physicians and surgeons were
aware that the variety of problems that could affect the heart were
numerous, and they still lacked a blueprint for other types of heart
surgery. They did not know what to do about children born with
congenital heart defects or victims whose heart valves were narrowed or stuck, so they knew that additional experimentation was
necessary. Surgeons needed to be able to work inside the heart without their patients bleeding to death. They had learned that a patients
circulation could be stopped temporarily permitting some surgery,
but they found that this technique provided surgeons with only
about four minutes before the brain became damaged from oxygen
Progress continues, and during the 21st century there will undoubtedly be even more advanced ways of performing heart surgery.
signs of rejection so that the higher doses of the immunosuppressive drugs were increased only as needed. In the meantime, scientists in Norway identified a fungus that revolutionized transplant
surgery. The substance was cyclosporin, and it appeared to have
the perfect immunosuppressant propertiescontrolling organ
rejection without knocking out all resistance to infection. In 1980,
Dr. Shumways team was the first to embrace the new medicine,
and it transformed the picture for heart transplant recipients.
Transplant surgeons today face a new problem: finding enough
healthy hearts. In the United States alone, 2 million people suffer
from congestive heart failure. When drug treatments fail, transplants are the best hope. But fewer than 2,500 donor hearts are
available each year.
Scientists were taken with the idea that it might be possible to create an
artificial heart that could do the job of the human heart. Robert Jarvik
created one of the first.
Plasma Therapy:
A Possible New Sports Treatment
In a giant step away from bloodletting, the latest form of
therapy being used for some sports injuries involves reinjecting a patient with his or her own blood that has been
processed to enrich its platelets. (Platelets are involved in
releasing proteins and other particles that encourage the
bodys self-healing.)
The method involves injecting portions of a patients
blood directly into the injured area. This seems to encourage the bodys natural effort to repair muscle, bone, and tissue. The process is not considered difficult by physicians
and has been tested on professional athletes whose injuries
keep them off the field, the court, or the baseball diamond.
According to the New York Times (February 16, 2009), the
method was used on Takashi Saito, a pitcher for the Los
Angeles Dodgers who suffered a partially torn ligament in
his throwing arm. By injecting Saitos elbow with his own
platelet-enriched blood, he was able to return to pitching
within a couple of months. Surgery would have sidelined
him for about a year. While the team doctor noted that 25
percent of these injuries heal on their own (and certainly
there is no way to know if Saitos would have), medical professionals are encouraged by what they are seeing, and clinical trials are underway.
The process of creating blood plasma with a higher
platelet count involves withdrawing a small amount of the
patients blood and putting it in a filtration system that separates the platelets from red blood cells. The physician then
injects a very small quantity (a teaspoon or two) of the substance into the area where the person has been injured. The
platelet-rich plasma seems to enhance the bodys ability to
(continues)
(continued)
Conclusion
People living only 150 years ago might well have undergone
bloodletting as part of a medical treatment, so the fact that today
blood transfusions, open heart surgery, and heart transplants are
conducted with frequency is all the more amazing. While physicians would prefer to teach people to live healthy lifestyles so that
heart transplants and heart surgery are unnecessary, the reality is
that these medical treatments are going to continue to be needed.
Advances in fixing a patients own heart will be a top priority,
but with the difficulty in finding hearts available to transplant,
the most promising frontier may be in the creation of miniature
artificial hearts.
8
dna Changes the
Medical Knowledge Base
136
13
along the DNA strand, and this order spells out the exact instructions required to provide unique traits for each particular organism as well as how it develops and functions. As scientists come
to better understand the DNA of each human being as well as the
DNA of various illnesses, they feel there will be notable medical
breakthroughs.
Before DNA could even be conceived of, advances in understanding genetics and inherited traits were necessary. Ancient
people understood some basics about breeding and inheritance
in animals: Certain animals, when bred together, begat animals
with the same strengths as the parent animal. While some cultures worked to refine these planned breedings, it was mostly a
hit-or-miss process, and no one had any idea about the mechanics
of how this worked scientifically.
When the structure of DNA was discovered by James Watson
and Francis Crick, it was referred to as the secret of life, but today
scientists know DNA is not really the secret to life. It is more
like a special keywith it, they have only just begun to unlock
some of the mysteries of human development, which in turn, may
make possible a new form of personalized medicine. This chapter
explains how DNA was discovered and how it may affect medical
developments of the future. Most people know of DNAs application in crime cases, and the chapter also explains how DNA helps
solve crimes. (See the sidebar DNA and the Criminal Justice System on page 142.)
Crick and Watson with their DNA model (A. Barrington Brown/Science
Photo Library)
Genetic counseling has traditionally been most useful for single gene
disorders like Huntingtons disease or Tay-Sachs disease, for which there
are genetic diagnostic tests. For such diseases, affected patients may
wonder about the risks of passing on an illness to their children, while
children of affected patients will want to know their statistical risk of
developing the disease.
As scientists continue to pursue these leads, this list of undertakings will certainly change and grow.
Conclusion
When scientists and physicians contemplate the personalized
medicine that will eventually be made possible because of research
into DNA, medical science is only at the beginning of the journey.
Over the course of the next few years, scientists will be devising
more and better ways to treat each person based on the persons
own genetics as well as the genetics of their particular illness.
Chronology
180s
182
18
189
185
1855
1858
1862
186
186
180
183
1881
188182
1883
1888
150
chronology
151
1890
1890s
Viruses are identified (but not seen until electron microscope invented in 1930).
189
1895
18991901
1901
1903
1906
1911
1915
1920s
1921
1928
152
193
19
1952
1953
195
1960
1961
196
1969
1981
2003
2008
glossary
a branch of morphology that deals with the structure of
organisms
antibiotic a substance produced by or semisynthetic substance
derived from a microorganism and able to dilute solution to inhibit
or kill another microorganism
antiseptic opposing sepsis, putrefaction, or decay; preventing or
arresting the growth of microorganisms
antitoxin an antibody that is capable of neutralizing the specific
toxin (as a specific causative agent of disease) that stimulated its
production in the body and is produced in animals for medical
purpose by injection of a toxin or toxoid with the resulting serum
being used to counteract the toxin in other individuals
aseptic preventing infection
bacteriophage a virus that infects bacteria
chemotherapy the use of chemical agents in the treatment or control
of disease
dormant marked by a suspension of activity; temporarily devoid of
external activity
hemoglobinuria the presence of free hemoglobin in the urine
microbe microorganism, germ
nitrous oxide (n2 o) a colorless gas that when inhaled produces loss of
sensibility to pain preceded by exhilaration and sometimes laughter, that is used especially as an anesthetic in dentistry and as
a fuel, and that is an atmospheric pollutant and greenhouse gas
produced by combustion; known as laughing gas
nucleotide any of several compounds that consist of a ribose or deoxyribose sugar joined to a purine or pyrimidine base and to a phosphate group and that are the basic structural units of nucleic acids
pasteurization partial sterilization of a substance, especially a liquid, at a temperature and for a period of exposure that destroys
objectionable organisms without major chemical alteration of the
substance
anatomy
153
activities of life or of living matter and of the physical and chemical phenomena involved
pitchblende a brown to black material that consists of massive uraninite, has a distinctive luster, contains radium, and is the chief
ore-mineral source of uranium
poliomyelitis an acute infectious disease caused by poliovirus and
characterized by fever, motor paralysis, and atrophy of skeletal
muscles often with permanent disability and deformity and
marked by inflammation of nerve cells in the anterior gray matter in each lateral half of the spinal cord
postulate a hypothesis advanced as an essential presupposition, condition, or premise of a train of reasoning
prion a protein particle that lacks nucleic acid and has been implicated as a source of various neurodegenerative diseases (i.e.,
bovine spongiform encephalopathy)
proprietary possessing, owning, or holding exclusive rights to
something
septicemia invasion of the bloodstream by virulent microorganisms
and especially bacteria; blood poisoning
serum a watery portion of an animal fluid remaining after
coagulation
spirochete any of an order of slender spirally undulating bacteria
suffragette a woman who advocates voting rights for women
synthetic something resulting from synthesis rather than occurring
naturally
tomography a method of producing a three-dimensional image of the
internal structures of a solid object by the observation and recording of the differences in the effects on the passage of waves of
energy impinging on those structures
vector an organism that transmits a pathogen
viroid any of two families (Pospiviroidae and Avsunviroidae) of subviral particles that consist of a small single-stranded RNA arranged
in a closed loop without a protein shell and that replicate in their
host plants where they may or may not be pathogenic
virus the causative agent of an infectious disease; also any of a large
group of submicroscopic infective agents that are regarded as
Glossary 155
either as extremely simple microorganisms or as extremely complex molecules, that typically contain a protein coat surrounding
an RNA or DNA core of genetic material but no semipermeable
membrane, that are capable of growth and multiplication only in
living cells, and that cause various important diseases in humans,
lower animals, or plants
X-ray any of the electromagnetic radiations that have an extremely
short wavelength of less than 100 angstroms and have the properties of penetrating various thicknesses of all solids, of producing
secondary radiations by impinging on material bodies, and of acting on photographic films and plates as light does
Further resourCes
aBout sCienCe and history
Diamond, Jared. Guns, Germs, and Steel: The Fates of Human Societies.
New York: W. W. Norton, 1999. Diamond places the development
of human society in context, which is vital to understanding the
development of medicine.
Hazen, Robert M., and James Trefil. Science Matters: Achieving Scientific Literacy. New York: Doubleday, 1991. A clear and readable
overview of scientific principles and how they apply in todays
world, including the world of medicine.
Internet History of Science Sourcebook. Available online. URL: http://
www.fordham.edu/halsall/science/sciencsbook.html. Accessed
July 9, 2008. A rich resource of links related to every era of science
history, broken down by disciplines, and exploring philosophical
and ethical issues relevant to science and science history.
Lindberg, David C. The Beginnings of Western Science, 2nd ed. Chicago: University of Chicago Press, 2007. A helpful explanation
of the beginning of science and scientific thought. Though the
emphasis is on science in general, there is a chapter on Greek and
Roman medicine as well as medicine in medieval times.
Roberts, J. M. A Short History of the World. Oxford: Oxford University Press, 1993. This helps place medical developments in context
with world events.
Silver, Brian L. The Ascent of Science. New York: Oxford University
Press, 1998. A sweeping overview of the history of science from
the Renaissance to the present.
Spangenburg, Ray, and Diane Kit Moser. Science Frontiers: 1946 to the
Present, rev. ed. New York: Facts On File, 2004. A highly readable
book with key chapters on some of the most significant developments in medicine.
156
Further Resources
15
160
other resourCes
Collins, Gail. Americas Women: 400 Years of Dolls, Drudges, Helpmates, and Heroines. New York: William Morrow, 2003. Collinss
book contains some very interesting stories about women and
their roles in health care during the early days of America.
iindex
ndex
Note: Page numbers in italic refer
to illustrations; m indicates a map; t
indicates a table.
A
AB blood type 121
A blood type 118m, 121
abortive polio 82
Academy of Sciences (Paris) 3
acetylsalicylic acid (ASA) 61
agar 13, 13
AHA (American Heart Association)
134
Akutsu, T. 128
alcohol 40
American College of Emergency
Physicians 113
American Heart Association (AHA)
134
American Red Cross 21, 2933
amoxicillin 71
amputations
limb replacement 104
physical therapy 105, 106
prosthetics 101104, 101104
anatomy 38
anesthesia 38, 39, 4044
anesthesiology 44
angiograms 50
anthrax 38, 6, 1012
antibiotics
amoxicillin 71
nystatin 7071
penicillin 59, 6670, 69
Salvarsan/Neosalvarsan 59,
7174
sulfonamide drugs (sulfa drugs)
58
b
bacteria, identification of 12, 6,
39, 58. See also antibiotics; germ
theory
bacteriophages 54
balloon angioplasty 52
Barnard, Christiaan 129
Barton, Clara 21, 2933, 32
battlefield medicine 99114
blood management 109
MASH units 110
nursing 26, 2728, 29, 3031,
34
pain management 111113
prosthetics 101104, 101104
rehabilitation 107108
vaccines 106, 109
Bavolek, Cecelia 126
161
C
cancer
and aspirin 65
chemotherapy drugs 59, 72
genetics and 147
therapeutic radiology 51
Cancer Genome Atlas 147
carbolic acid 15
cardiac surgery 123127
Carrel, Alexis 127
CAT or CT (computed tomography)
scans 50
Cavendish Laboratory 140
Celera Genomics 144145
cells 1617
cellular pathology 16
D
Dally, Clarence 47
Da Vinci robotic system 127
Davy, Humphry 40
DeBakey, Michael 110, 128129, 131
DeLisi, Charles 144
dentistry 4142, 44
deoxyribonucleic acid. See DNA
(deoxyribonucleic acid)
Index 163
DeVries, William 132
diagnostics
Curie, Marie and Pierre 4849,
49, 53
DNA and 149
radiology 5051
X-rays and X-ray devices 44
47, 45
diphtheria 56
Dix, Dorothea 21, 33, 3335
Djerassi, Carl 77
DNA (deoxyribonucleic acid) 136
149
in court cases 142143
Crick, Francis 138, 139143
discovery of structure of 139
143, 141
ethical issues 148
function of 136137
future of 145148
genes and genetics 137139
genetic counseling 146
human genome project 143
145
and undiagnosed cases 149
Watson, James 138, 139143
dormancy 10
double-blind studies 97
Dreser, Heinrich 61
Drew, Charles 109
Duggar, Benjamin Minge 70
Dunant, Henry 32
E
Ebers papyrus 59
Edison, Thomas 46
Effectiveness and Efficiency: Random
Reflections on Health Services
(Cochrane) 91
Ehrlich, Paul 56, 59, 7174
Eichengrn, Arthur 61
emergency medicine 110, 111, 112
113
Enovid 7778
F
fallopian tube catheterization 52
Family Limitation (Sanger) 76
Fantus, Bernard 122
Faraday, Michael 40
fermentation 5
fevers 63
Finlay, Carlos 55
Fleming, Alexander 6670, 67
Fletcher, Charles 68
Florence Nightingale School of
Nursing and Midwifery 27
Florey, Howard 66, 6770
flu (influenza) 84
fluoroscopy 4647, 47, 5051
Food and Drug Administration 77
Fracastoro, Giralamo 2
Francis, Thomas 84, 85
Franklin, Rosalind 139143
Friedman, Cindy 73
G
genes and genetics 137139, 145
gene testing 147
gene therapy 147
genetically modified foods 148
genetic counseling 146
Geneva College (Hobart and William
Smith Colleges) 2223
Geneva Conventions 32
Gerhardt, Charles-Frdric 60
germ theory
concept of xiiixiv
identification of bacteria 12
H
Hamilton, Alice 3537
Hamilton, Edith 35
handicapped people 107108
Harken, Dwight 123124
Harvard University 36, 7677
Harvey, William 116
Hata, Sahachiro 74
Hazen, Elizabeth Lee 71
heart health 134135
heart-lung bypass machines 126
heart scan 124
heart surgery 123127
heart transplants 115, 127132
Heatley, Norman 68
Herbert, Sidney 27
heroin 60
HIV (human immunodeficiency
virus) 56
Hobart and William Smith Colleges
(Geneva College) 2223
Hodgkin, Dorothy Crowfoot 70
Hoffmann, Felix 6061
Hooke, Robert 12
human genome project 143145
human immunodeficiency virus
(HIV) 56
I
Illinois Commission on
Occupational Diseases 36
J
Jackson, Charles 4243, 44
Jarvik-7 131132, 132
Journal of the American Medical
Association 72
K
Kaiserwerth 26
Kennedy, Michael 8990
Kings College 15, 27
Kitasato, Shibasaburo 56
Klebanoff, Gerald 109
Koch, Robert xiii, 2, 59, 9, 1213
Kochs postulates 9, 1213
Kolff, Willem 127128
Index 165
L
La Maternit de Paris 23
Lancet 66
Landsteiner, Karl 115, 117, 121
Lane, Samuel Armstrong 117
Larrey, Dominique-Jean 110
laughing gas (nitrous oxide) 39,
4041, 4142, 44
Lectures on the Laws of Life
(Blackwell) 24
Leeuwenhoek, Antoni van 12
left ventricular assist device (LVAD)
128129
Levine, Philip 121
Liebig, Justin von 15
Lillehei, C. Walton 125126
limb replacement 104
Lind, James 96
Lindbergh, Charles 127
Lister, Joseph 1416
London School of Medicine 24
Long, Crawford 41, 44
lunacy reform movement 3334
LVAD (left ventricular assist device)
128129
M
magnetic resonance imaging (MRI)
51
male contraceptive pills 78
Marker, Russell 77
MASH units 110
Massachusetts General Hospital
4243
Mayer, Adolf 53
McCormick, Katherine Dexter 76
MEDEVAC (Medical Evacuation)
111
Medicine as a Profession for Women
(Blackwell) 24
Mendel, Gregor 137139
mental illness 3335
miasmas 1
microbes 34
N
National Academy of Sciences 102
National Foundation for Infantile
Paralysis 85
National Institutes of Health 128,
144, 149
Nature 142, 144145
nematodes 2
neuromuscular electrical
stimulation 105
New England Hospital for Women
and Children 31
New York Infirmary for Indigent
Women and Children 23
New York State Department of
Health 71
New York Times, The 12, 133
Nightingale, Florence 20, 2628,
27
nitrous oxide (laughing gas) 39,
4041, 4142, 44
nonparalytic polio 82
Notes on Nursing (Nightingale) 27
nucleotide sequences 143144
nursing 2021, 2433
Barton, Clara 2933, 32
Dix, Dorothea 33, 3335
Nightingale, Florence 2628,
27
Richards, Linda 3031
role of nurses 25
forms of 8283
Roosevelt, Franklin Delano 80
Sabin, Albert 81, 8688
Salk, Jonas 81, 81, 8486, 8788
polonium 48
positron emission tomography (PET)
scans 51
Priestley, Joseph 40
prions 55
progesterone 77
proprietary products 43, 4344
prostaglandins 6465
prosthetics 101104, 101104
puerperal fever (childbirth fever)
1314, 14
rabies 89, 53
radiation exposure 47, 49
radioactivity 4849, 53
radiology 5051
radium 48
Red Cross 21, 2933, 49
Redi, Francesco 3
Reed, Walter 55
Rh factor 121
Richards, Linda 3031
RNA 136
robot-assisted surgery 126, 127, 130
Rock, John 77
Rntgen, Wilhelm 39, 4446
Roosevelt, Franklin Delano 80
Royal Society 2
Royal Statistical Society 26
RU-486 (morning-after pill) 78
S
Sabin, Albert 81, 8688
Saito, Takashi 133
salicin 60
Salk, Jonas 81, 81, 8486, 8788
Salvarsan/Neosalvarsan 59, 7174
Sanger, Margaret 7478
Index 167
SARS (severe acute respiratory
syndrome) 56
Schleiden, Matthias Jakob 16
Schroeder, William 132
Schwann, Theodor 16
Science 145
scientific method 89, 90
scurvy 96
Seacole, Mary 2021, 2829
Semmelweis, Ignaz 3, 1314
sepsis 1416
septicemia 66
serum therapies 39
settlement houses 3536
severe acute respiratory syndrome
(SARS) 56
shoe-fitting fluoroscopes 4647, 47
short tandem repeats (STR) 143
Shumway, Norman 129, 130
silk industry 5
Simpson, O. J. 143
SmithKline Beecham 71
Southern Medical and Surgical
Journal 41
spinal cord injuries 105
spontaneous generation 35
spores 10
sports injuries 133134
Staphylococcus (MRSA) 72
Staphylococcus aureus 7273
Stetson, R. E. 121
Stone, Edmund 59
STR (short tandem repeats) 143
Streptomyces noursei 71
suffragettes 22
sulfonamide drugs (sulfa drugs) 58
super bugs 7273
surgery
anesthesia 38, 39, 4044
antiseptic methods 1416
evidence-based medicine and
8890
heart surgery 123132
Swammerdam, Jan 2
syphilis 59, 7374
T
TB (tuberculosis) 12
tetanus 56, 106
tetracycline 70
therapeutic radiology 51
thorium 48
thrombolysis 52
tobacco industry 5354
tobacco mosaic virus 54
tonsillectomies 8990
toxic shock syndrome 72
triage 111
tuberculosis (TB) 12
typhoid fever 36, 106
typhus 17
U
ultrasound 51
United States Department of Energy
144
United States Office of the Surgeon
General 110
United States Post Office 12
United States Sanitary Commission
2324, 3031
V
vaccines and vaccination
anthrax 78
battlefield medicine 106, 109
DNA and 148
polio 8488
process of 7
rabies 89
viruses 5556
Vane, John 64
vectors 55
Venable, James 41
Venter, Craig 144
Virchow, Rudolf 2, 1618
viroids 55
virology 53
viruses 38, 39, 5356, 73
W
war. See battlefield medicine
Warren, John Collins 4243
Washkansky, Louis 129
Watson, James 138, 139143
Wellcome Trust 144
Wells, Horace 4142, 44
Wiegenstein, John 112113
Wiener, Alex 121
Wilkins, Maurice 139140, 140
141
willow tree bark 5960
wine industry 5
Woman Rebel, The 75
Womans Central Association of
Relief 21, 2324
X
X-ray crystallography 139140
X-rays and X-ray devices 38, 39,
4447, 45
Y
yellow fever 55
Z
Zakrzewska, Marie 23, 31