Modern Medicine—How High Can It Reach?
MANY children learn early: To pick an apple beyond their reach, they climb onto the shoulders of a playmate. Within the field of medicine, something similar has taken place. Medical researchers have reached higher and higher up the scale of achievement by standing on the shoulders of eminent practitioners of the past.
Among those earlier healers were well-known men such as Hippocrates and Pasteur, along with men such as Vesalius and William Morton—names unfamiliar to many. What does modern medicine owe to them?
In ancient times the healing arts were often not a scientific venture but an exercise in superstition and religious ritual. The book The Epic of Medicine, edited by Dr. Felix Marti-Ibañez, says: “To fight disease . . . , the Mesopotamians resorted to a medico-religious medicine, since they believed that disease was their punishment by the gods.” Egyptian medicine, which soon followed, was likewise rooted in religion. Thus, from the very beginning, the healer was viewed with a sense of religious admiration.
In his book The Clay Pedestal, Dr. Thomas A. Preston observes: “Many beliefs of the ancients left imprints on the practice of medicine that survive to this day. One such belief was that disease was beyond the control of the patient, and only through the magical power of the physician was there hope for recovery.”
Laying the Foundations
In time, though, medical practice became increasingly scientific in its approach. The foremost ancient scientific healer was Hippocrates. He was born about 460 B.C.E. on the Greek island of Kos and is regarded by many as the father of Western medicine. Hippocrates laid the basis for a rational approach to medicine. He rejected the notion that disease was a punishment from a deity, arguing that it had a natural cause. Epilepsy, for example, had long been called a sacred disease because of the belief that it was curable only by the gods. But Hippocrates wrote: “With regard to the disease called Sacred: it appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause.” Hippocrates was also the first known healer to observe the symptoms of various diseases and record them for future reference.
Centuries later, Galen, a Greek physician born in 129 C.E., likewise did innovative scientific research. Based on dissections of humans and animals, Galen produced a textbook on anatomy that was used by doctors for centuries! Andreas Vesalius, born in Brussels in 1514, wrote the book On the Structure of the Human Body. It met with opposition, since it contradicted many of Galen’s conclusions, but it laid the foundation for modern anatomy. According to the book Die Grossen (The Great Ones), Vesalius thus became “one of the most important medical researchers of all peoples and all times.”
Galen’s theories about the heart and the circulation of the blood were likewise overturned in time.a English physician William Harvey spent years dissecting animals and birds. He observed the function of the heart valves, measured the volume of blood in each of the heart’s chambers, and estimated the amount of blood in the body. Harvey published his findings in 1628 in a book called On the Motion of the Heart and Blood in Animals. He was criticized, opposed, attacked, and insulted. But his work was a turning point in medicine—the body’s circulatory system had been discovered!
From Barbering to Surgery
Huge strides were also being made in the surgical arts. During the Middle Ages, surgery was oftentimes the work of barbers. Not surprisingly, some say that the father of modern surgery was 16th-century Frenchman Ambroise Paré—a pioneer barber-surgeon who served four kings of France. Paré invented a number of surgical instruments as well.
One of the major problems still facing the surgeon in the 19th century was his inability to dull the pain of surgery. But in 1846 a dental surgeon named William Morton opened the way to the widespread use of anesthetics in surgery.b
In 1895, while experimenting with electricity, German physicist Wilhelm Röntgen saw rays passing through flesh but not bone. He did not know the origin of the rays, so he called them X rays, a name that has stuck in the English-speaking world. (Germans know them as Röntgenstrahlen.) According to the book Die Großen Deutschen (Great Germans), Röntgen told his wife: “People will say: ‘Röntgen has gone mad.’” Some did. But his discovery revolutionized surgery. Surgeons could now look inside the body without cutting it open.
Throughout the ages infectious diseases such as smallpox recurrently brought epidemics, terror, and death. Ar-Rāzī, a ninth-century Persian considered by some to have been the greatest physician of the Islamic world of that time, wrote the first medically accurate description of smallpox. But it was centuries later that a British physician named Edward Jenner found a way to cure it. Jenner noted that once a person contracted cowpox—a harmless disease—he was immune to smallpox. Based on this observation, Jenner used cowpox lesions to develop a vaccine against smallpox. That was in 1796. Like other innovators before him, Jenner was criticized and opposed. But his discovery of the process of vaccination eventually led to the elimination of the disease and provided medicine with a powerful new tool.
Frenchman Louis Pasteur used vaccination to fight rabies and anthrax. He also proved that germs play a key role in causing disease. In 1882, Robert Koch identified the germ that causes tuberculosis, described by one historian as “the greatest killer disease of the nineteenth century.” About a year later, Koch identified the germ that causes cholera. Says Life magazine: “The work of Pasteur and Koch ushered in the science of microbiology and led to advances in immunology, sanitation and hygiene that have done more to increase the life span of humans than any other scientific advance of the past 1,000 years.”
At the beginning of the 20th century, medicine found itself standing on the shoulders of these and other brilliant practitioners. Since then, medical advances have been made at a breathtaking rate—insulin for diabetes, chemotherapy for cancer, hormone treatment for glandular disorders, antibiotics for tuberculosis, chloroquine for certain types of malaria, and dialysis for kidney complaints, as well as open-heart surgery and organ transplants, to name a few.
But now that we stand at the dawn of the 21st century, how near is medicine to the goal of guaranteeing “an acceptable level of health for all the people of the world”?
A Goal out of Reach?
Children learn that climbing onto the shoulders of a playmate does not bring every apple within reach. Some of the juiciest apples are at the top of the tree, still way out of range. In the same way, medicine has gone from one achievement to the next, higher and higher. But the most treasured goal—good health for everyone—elusively remains at the top of the tree.
Thus, while in 1998 the European Commission reported that “Europeans have never enjoyed such long and healthy lives,” the report added: “One person in every five will die prematurely before the age of 65. Cancer will account for some 40% of these deaths, cardiovascular diseases for another 30% . . . Better protection must be provided against new health threats.”
The German health magazine Gesundheit reported in November 1998 that infectious diseases like cholera and tuberculosis are presenting an increasing threat. Why? Antibiotics “are losing their effectiveness. More and more bacteria are resistant to at least one common medicament; indeed, many are resistant to several.” Not only are old diseases on the way back but new diseases like AIDS have appeared. The German pharmaceutical publication Statistics ’97 reminds us: “For two thirds of all known sicknesses—about 20,000—there is so far no way of treating the cause.”
Does Gene Therapy Hold the Answer?
Granted, innovative treatments continue to be developed. For example, many feel that genetic engineering may hold the key to better health. Following research in the United States in the 1990’s by physicians such as Dr. W. French Anderson, gene therapy was described as “the hottest new area of medical research.” The book Heilen mit Genen (Healing With Genes) states that with gene therapy “medical science could be on the brink of a pioneer development. This is especially the case with the treatment of sicknesses that have until now been incurable.”
Scientists expect in time to be able to cure inborn genetic diseases by injecting patients with corrective genes. Even harmful cells, such as cancer cells, will perhaps be made to self-destruct. Genetic screening to identify a person’s predisposition to certain illnesses is already possible. Some say that pharmacogenomics—adjusting medicaments to suit the patient’s genetic makeup—will be the next development. One prominent researcher suggests that doctors will one day be able to “diagnose their patients’ illnesses and give them the proper snippets of molecular thread to cure them.”
However, not everyone is convinced that gene therapy offers the “silver bullet” cure of the future. Indeed, according to surveys, people may not even want to have their genetic makeup analyzed. Many also fear that gene therapy might be a dangerous interference with nature.
Time will tell whether or not genetic engineering or other high-tech approaches to medicine will live up to their extravagant promises. However, there is reason to avoid undue optimism. The book The Clay Pedestal describes an all-too-familiar cycle: “A new therapy comes out, heralded at medical meetings and in the professional journals. Its creators become celebrities within the profession, and the media hail the advance. After a period of euphoria and well-documented testimonials in support of the wonder treatment, a gradual disillusionment begins, lasting from a few months to a few decades. Then a new remedy is discovered, and almost overnight, it replaces the old one, which is then summarily abandoned as worthless.” Indeed, many of the remedies that have been abandoned by most doctors as ineffective were standard treatment not too long ago.
Although doctors today are no longer granted the religious status given to healers in ancient times, there is a tendency among some people to attribute almost godlike powers to medical practitioners and to imagine that a cure for all of mankind’s ills is a scientific inevitability. However, reality falls painfully short of this ideal. In his book How and Why We Age, Dr. Leonard Hayflick observes: “In 1900, 75 percent of the people in the United States died before they reached the age of sixty-five. Today, this statistic is almost reversed: about 70 percent of people die after the age of sixty-five.” What caused this remarkable increase in life span? Hayflick explains that it “was largely due to reductions in the mortality of newborns.” Now suppose that medical science could eliminate the major causes of death in the elderly—heart disease, cancer, and stroke. Would that amount to a grant of immortality? Hardly. Dr. Hayflick notes that even then, “most people would live to be about one hundred years old.” He adds: “These centenarians would still not be immortal. But what would they die from? They would simply become weaker and weaker until death occurred.”
Despite the best efforts of medical science, the elimination of death is thus still beyond medicine’s reach. Why is this the case? And is the goal of good health for all an impossible dream?
a According to The World Book Encyclopedia, Galen thought that the liver changed digested food into blood, which then flowed to the rest of the body and was absorbed.
[Blurb on page 4]
“Many beliefs of the ancients left imprints on the practice of medicine that survive to this day.”—The Clay Pedestal
[Pictures on page 4, 5]
Hippocrates, Galen, and Vesalius laid the foundations of modern medicine
Kos Island, Greece
Courtesy National Library of Medicine
Woodcut by Jan Steven von Kalkar of A. Vesalius, taken from Meyer’s Encyclopedic Lexicon
[Pictures on page 6]
Ambroise Paré was a pioneer barber-surgeon who served four kings of France
Persian physician Ar-Rāzī (left), and British physician Edward Jenner (right)
Paré and Ar-Rāzī: Courtesy National Library of Medicine
From the book Great Men and Famous Women
[Picture on page 7]
Frenchman Louis Pasteur proved that germs cause disease
© Institut Pasteur
[Pictures on page 8]
Even if the major causes of death could be eliminated, old age would still result in death