History of Medicine

First of all the doctor should look at the patient’s face. If he looks his usual self this is a good sign - Hippocrates 430BC

History of Medicine

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Many prominent physicians have promoted medical history as a tool to better understand diseases and to help frame the present and speculate on the future. William Osler, the English-speaking world’s leading physician a century ago, put it this way: “By the historical method alone can many problems in medicine be approached profitably.”

Paul Dudley White, America’s first academic cardiologist, also thought medical history was important. By looking back, he wrote in 1950, “we acquire a better perspective of our own place in history with the humbling realization of our role as merely a link in the long chain of the acquisition and application of medical knowledge.”

Two hundred years ago, many leading physicians of Europe and North America used leeches and lancets to bleed patients with “fever” and various other problems. George Washington’s death in 1799 was accelerated by aggressive blood-letting. During a 13-h period shortly before his death, doctors removed 2.5 quarts of blood from the former president. By current standards, this “treatment” seems incomprehensible (if not homicidal).

Then, however, blood-letting was championed by many prominent physicians, notably Benjamin Rush, a physician-signer of the Declaration of Independence. This “heroic” therapy reflected the lingering influence of Galen’s humoral pathology (after 1,500 years) and late 18th-century interpretations of pathophysiology...

History also provides many examples of the time lag that often separates the announcement of an innovation and its acceptance. The 20th-century history of the diagnosis and treatment of coronary heart disease illustrates how some new pathophysiological interpretations and innovations in diagnosis and treatment that proved correct or useful were ignored or worse. James Herrick’s comprehensive synthesis of the pathophysiology, clinical features, and consequences of coronary thrombosis (acute MI) is now considered a classic contribution to cardiological knowledge.

When Herrick published his detailed review in the Journal of the American Medical Association in 1912, it had no significant impact on practice. More than anything, doctors needed an objective tool to help them recognize coronary thrombosis (Herrick’s term). He gave them just that when he first reported the typical electrocardiographic features of coronary thrombosis in 1919. The other lesson to be learned from Herrick’s classic review is that he (like Osler) did not sense any artificial boundary between where a review of the literature ends and medical history begins...

The history of coronary angiography provides a poignant example of resistance to innovation. Mason Sones Jr. published a concise description of his technique of selective coronary angiography in 1962. This procedure made it possible for the first time to visualize the entire coronary arterial system in living humans. It is hard to imagine cardiology and cardiac surgery today without this valuable technique that catalyzed thousands of careers and a multitude of industries.

Although several cardiologists in academic centers and referral hospitals embraced the technique almost immediately, a few influential voices urged caution. Four years after Sones’s paper appeared, a writer editorialized in the Lancet(12), “Sufficient time has elapsed since the introduction of coronary arteriography for its usefulness to be assessed. As an aid to diagnosis in ischemic heart-disease, it seems at present to offer little that cannot be more easily obtained by much simpler methods, such as good history-taking and electrocardiography.”

George Burch, a prominent academic cardiologist who was editor of the American Heart Journal and a former president of the American College of Cardiology, harshly criticized selective coronary angiography more than a decade after its introduction. By then, the technique was widely accepted as the definitive tool for defining the location and severity of coronary obstructions...

When you enter the world of medical history, you have embarked on an interesting journey through time. I think you will enjoy the trip and the broader perspective it provides.

Source: W Bruce Fye MD, Excerpt from Medical history: a valuable tool to help us frame the present and predict the future, Journal of the American College of Cardiology, 2003;41(2):346-349.

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Last Updated : Friday, June 11, 2021