Lecture 6 World and Ukrainian Medicine in the хіх–xx-th century
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By the beginning of the 19th century, the structure of the human body was almost fully known, due to new methods of microscopy and of injections. Even the body's microscopic structure was understood. But as important as anatomical knowledge was an understanding of physiological processes, which were rapidly being elucidated.
In Germany physiology became established as a distinct science under the guidance of Johannes Müller, who was a professor at Bonn and then at the University of Berlin. An energetic worker and an inspiring teacher, he described his discoveries in a famous textbook, Handbuch der Physiologie des Menschen (“Manual of Human Physiology”), published in the 1830s.
Among Müller's illustrious pupils were Hermann von Helmholtz, who made significant discoveries relating to sight and hearing and who invented the ophthalmoscope; and Rudolf Virchow, one of the century's great medical scientists, whose outstanding achievement was his conception of the cell as the centre of all pathological changes.
Rudolf Virchow (1821—1902)
In France the most brilliant physiologist of the time was Claude Bernard, whose many important discoveries were the outcome of carefully planned experiments. His researches clarified the role of the pancreas in digestion, revealed the presence of glycogen in the liver, and explained how the contraction and expansion of the blood vessels are controlled by vasomotor nerves. He proposed the concept of the internal environment — the chemical balance in and around the cells — and the importance of its stability.
Claude Bernard (1813—1878)
Perhaps the overarching medical advance of the 19th century, certainly the most spectacular, was the conclusive demonstration that certain diseases, as well as the infection of surgical wounds, were directly caused by minute living organisms. This discovery changed the whole face of pathology and effected a complete revolution in the practice of surgery.
19th-century pioneer in this field, regarded by some as founder of the parasitic theory of infection, was Agostino Bassi of Italy, who showed that a disease of silkworms was caused by a fungus that could be destroyed by chemical agents.
The main credit for establishing the science of bacteriology must be accorded to the French chemist Louis Pasteur. It was Pasteur who, by a brilliant series of experiments, proved that the fermentation of wine and the souring of milk are caused by living microorganisms. His work led to the pasteurization of milk and solved problems of agriculture and industry as well as those of animal and human diseases. He successfully employed inoculations to prevent anthrax in sheep and cattle, chicken cholera in fowl, and finally rabies in humans and dogs.
Louis Pasteur studied alcoholic fermentation and lactic fermentation in sour milk; he found that both fermentations were caused by minute organisms, and were hastened by exposure to the air. He proved that the microscopic organisms were not spontaneously generated, but were introduced by air.
From Pasteur, Joseph Lister derived the concepts that enabled him to introduce the antiseptic principle into surgery. In 1865 Lister, a professor of surgery at Glasgow University, began placing an antiseptic barrier of carbolic acid between the wound and the germ-containing atmosphere. Infections and deaths fell dramatically, and his pioneering work led to more refined techniques of sterilizing the surgical environment.
Joseph Lister saw that sepsis was the principal obstacle to any great advantage in surgery. Finally, noting that closed wounds did not suppurate while open ones exposed to the air did, he concluded that suppuration was in some manner due to contact with the air, but that the air alone did not cause suppuration.
Another pioneer in bacteriology was the German physician Robert Koch, who showed how bacteria could be cultivated, isolated, and examined in the laboratory. A meticulous investigator, Koch discovered the organisms of tuberculosis, in 1882, and cholera, in 1883. By the end of the century many other disease-producing microorganisms had been identified.
Robert Koch (1843—1910)
In 1882 Koch discovered tuberculosis bacilli. Due to his discovery Koch became known all over the world. In 1884 Koch published his book on cholera. This book included the investigations of his research work carried out during the cholera epidemic in Egypt and India. From the intestines of the men with cholera Koch isolated a small comma-shaped bacterium. He determined that these bacteria spread through drinking water.
Crawford Long, American physician, is traditionally considered the first to have used ether as an anesthetic in surgery. He observed that persons injured in “ether frolics” (social gatherings of people who were in a playful state of ether-induced intoxication) seemed to suffer no pain, and in 1842 he painlessly removed a tumour from the neck of a patient, to whom he had administered ether.
Gardner Colton, American anesthetist and inventor, was among the first to utilize the anesthetic properties of nitrous oxide in medical practice. After a dentist suggested the use of the gas as an anesthetic, Colton safely used it in extracting thousands of teeth. As he was studying medicine in New York (without taking a degree), Colton learned that the inhalation of nitrous oxide, or laughing gas, produced exhilaration. After a public demonstration of its effects in New York City proved to be a financial success, he began a lecture tour of other cities.
Horace Wells, American dentist, was a pioneer in the use of surgical anesthesia. While practicing in Hartford, Connecticut, in 1844, Wells noted the pain-killing properties of nitrous oxide (“laughing gas”) during a laughing gas road show and there after used it in performing painless dental operations. He was allowed to demonstrate the method at the Massachusetts General Hospital in January 1845, but when the patient proved unresponsive to the gas, Wells was exposed to ridicule.
It was William Thomas Morton who, in October, 16, 1846, at Massachusetts General Hospital, in Boston, first demonstrated before a gathering of physicians the use of ether as a general anaesthetic. He is credited with gaining the medical world's acceptance of surgical anesthesia. The news quickly reached Europe, and general anaesthesia soon became prevalent in surgery.
At Edinburgh, the professor of midwifery, James Young Simpson, had been experimenting upon himself and his assistants, inhaling various vapours with the object of discovering an effective anaesthetic. He was the first to use chloroform in obstetrics and the first in Britain to use ether. In November 1847 chloroform was tried with complete success, and soon it was preferred to ether and became the anaesthetic of choice.
In the years following the turn of the century, ongoing research concentrated on the nature of infectious diseases and their means of transmission. Increasing numbers of pathogenic organisms were discovered and classified. Some, such as the rickettsias, which cause diseases like typhus, were smaller than bacteria; some were larger, such as the protozoans that engender malaria and other tropical diseases. The smallest to be identified were the viruses, producers of many diseases, among them mumps, measles, German measles, and poliomyelitis; and in 1910 Peyton Rous showed that a virus could also cause a malignant tumour, a sarcoma in chickens.
In 1932 the German bacteriologist Gerhard Domagk announced that the red dye Prontosil is active against streptococcal infections in mice and humans.
Alexander Fleming (1881-1955)
Dramatic though they undoubtedly were, the advances in chemotherapy still left one important area vulnerable, that of the viruses. It was in bringing viruses under control that advances in immunology played such a striking part. One of the paradoxes of medicine is that the first large-scale immunization against a viral disease was instituted and established long before viruses were discovered. When Edward Jenner introduced vaccination against the virus that causes smallpox, the identification of viruses was still 100 years in the future. It took almost another half century to discover an effective method of producing antiviral vaccines that were both safe and effective.
Emil von Behring
The first of the viral vaccines to result from these advances was for yellow fever, developed by the microbiologist Max Theiler in the late 1930s. About 1945 the first relatively effective vaccine was produced for influenza; in 1954 the American physician Jonas E. Salk introduced a vaccine for poliomyelitis; and in 1960 an oral poliomyelitis vaccine, developed by the virologist Albert B. Sabin, came into wide use.
Jonas E. Salk
Charles H. Best
Edward C. Kendall
F. Gowland Hopkins
Victor Alexander Haden Horsley
Wilhelm Conrad Röntgen
Between the world wars
Anesthesia and surgery
Modern Ukrainian medicine
The Ukrainian National Museum of Medicine
Mykola Amosov was a Ukrainian doctor, heart surgeon, inventor, enthusiast, known for his inventions of several surgical procedures for treating heart defects.
The clinic established by Amosov, produced about 7000 lung resections, more than 95000 operations for heart diseases, including about 36000 operations with extracorporeal blood circulation.
Volodymyr Petrovych Filatov
Volodymyr Filatov was a Ukrainian ophthalmologist and surgeon best known for his development of tissue therapy. He introduced the tube flap grafting method, corneal transplantation and preservation of grafts from cadaver eyes. He founded The Filatov Institute of Eye Diseases & Tissue Therapy in Odessa. Filatov is also credited for restoring Vasily Zaytsev’s sight when he suffered an injury to his eyes from a mortar attack during Battle of Stalingrad.
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