Happy birthday to Andreas Vesalius

Vesalius

This year marks the 500th anniversary of the birth of anatomist Andreas Vesalius. Born in 1514 in modern-day Brussels, he was educated in France before taking up a position teaching surgery and anatomy at the University of Padua in Italy.

At the time, knowledge of the human body was based on the study of classical texts rather than empirical observations and medical practice relied heavily on the writings of the Greco-Roman physician Galen. Understandings of anatomy were limited, despite the rising interest in human sciences and popularity of naturalistic illustrations in the 16th century. Furthermore, many assumptions were inaccurate as they were based upon findings made in the dissection of animals such as monkeys and dogs.

Unlike many of his colleagues, Vesalius rejected this theoretical approach to medicine. Instead he taught anatomy through personal demonstrations and the dissection of human cadavers. From 1538 he began to publish anatomical illustrations and in 1543 released his famous work De Humani Corporis Fabrica (On the Fabric of the Human Body). This ground breaking book contained over 600 woodblock engravings and its 7 volumes detailed the skeleton, muscles, vascular system, nerves, abdomen, thorax and brain. While it was not the first time that the human body had been shown after autopsy the intricacy of the illustrations meant that it was the most accurate anatomy text to date. It disproved many of Galen’s theories and the integration of images with textual descriptions was considered highly innovative at the time.

Through his teaching and publications Vesalius revolutionised the study of anatomy by demonstrating the importance of first-hand observation for medical training and scientific discovery. De Humani Corporis Fabrica thus represents a radical change in the way anatomy was approached by promoting dissection as the most scientific way of studying form and function. Anyone who has seen images from the book will no doubt agree that it is also a work of great artistic value as it depicts bodies in dynamic poses against beautiful classical backgrounds.

Vesalius later left teaching to work as the imperial physician for Emperor Charles V. He continued to perform dissections and publish on anatomy until his death in 1564.

Image credit

R. C., C. (2005). Vesalius [Image]. Retrieved from https://www.flickr.com/photos/celesterc/415837587

References

Dominiczak, M. H. (2013). Andreas Vesalius: his science, teaching, and exceptional books. Clinical Chemistry, 59(11), 1687-1589.

Kemp, M. (1998). Vesalius’s veracity: implications of illustrations of surgical tools and anatomy by Andreas Vesalius. Nature, 393(6684), 421.

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Joseph Lister: the father of antisepsis

445px-Joseph_Lister_1902

Hospitals have not always been the places of cleanliness we know them as today. For centuries they were places where people were just as likely to die as they were to be cured. Even if a person was able to survive the ordeal of surgery without anaesthesia, the unsanitary conditions of operating rooms meant that a postoperative infection was likely to result in their demise. By the late 19th century this began to change, thanks to the work of English surgeon Joseph Lister.

Born in 1827, Lister graduated as a doctor in 1852 and spent much of his early career working in Scotland. It was there that he noticed a mortality rate of nearly 50% in patients following surgery. Infections in wounds resulted in fatal systemic inflammation known as sepsis and this phenomenon was so common in hospital settings that it earned the nicknames “ward fever” and “hospitalism”.

Infection was poorly understood at the time and most people subscribed to one of two alternative theories. The first was known as miasma and stated that infectious diseases were caused by impure air and noxious gases. The second was called contagionism and proposed that infections in wounds arose spontaneously by an unknown action of the tissue itself. Neither explanation connected the practices of doctors to the outcomes of surgery and although French chemist and microbiologist Louis Pasteur had demonstrated the existence of micro-organisms in the mid-1860s, germ theory was not yet accepted by the medical establishment.

After witnessing how patients with simple fractures survived whilst those with compound fractures in which the bones pierced the skin often died, Lister became convinced that infections in surgical patients were being caused by outside agents. After reading the work of Pasteur, he took measures to kill the pathogens that he believed were causing infections in wounds. Suspecting that it was an antiseptic, Lister diluted the carbolic acid used to treat sewage and applied it to dressings. He also used it to sterilise surgical equipment and wash his hands. He sprayed it around operating theatres to eliminate airborne pathogens and soaked catgut sutures in the solution in further attempts to reduce infection.

His techniques were remarkablly successful and the incidence of infection was drastically reduced. The death rate of Lister’s surgical patients fell from 45% in 1866 to just 15% by 1870. He took measures to eliminate pathogens that had already entered wounds and prevent others from entering sterile operating rooms (antiseptic and aseptic techniques).

After publishing his results in the Lancet, Lister’s work began to receive a great deal of attention. While some hailed his findimgs as a breakthrough in surgical technique, others viewed it with scepticism. His methods were not immediately adopted as it took over a decade of work before he could convince others of his theories and sanitary surgical procedures became accepted as common practice. Yet once doctors began paying better attention to hygiene in hospitals patient health dramatically improved and the field of surgery was able to advance rapidly. Joseph Lister continued to refine his surgical techniques for the rest of his life and was knighted for his services to medicine in 1883.

Image credit

Unknown. (1902). Joseph Lister [Image]. Retrieved from http://commons.wikimedia.org/wiki/File:Joseph_Lister_1902.jpg?uselang=en-gb

References

Osborn, G. G. (1986). Joseph Lister and the origins of antisepsis. The Journal of Medical Humanities and Bioethics, 7(2), 91-105. Retrieved from JSTOR.

Hippocrates: the father of medicine

"Hippocrate".

This is the first of several short posts looking at how important historical figures have impacted on the practise of medicine and the study of human biology today. Modern approaches to science are informed by understandings of the past and few individuals have made a more lasting contribution to the field of medicine than the ancient Greek physician Hippocrates of Cos.

Hippocrates was born in the 5th century BC into a noble family that had been practising medicine for a number of generations. Although some of his theories, such as humourism, have long been discredited he pioneered the rational approach to treatment that forms the foundation of Western medicine.

While Hippocrates is often known as the “father of medicine”, he should perhaps be known as “the father of clinical medicine”, as the careful observation and documentation of clinical symptoms was a hallmark of the Hippocratic school of thought. He and his followers used diagnostic procedures that aimed to determine the cause of disease based on a patient’s symptomatology, taking into account family history and lifestyle factors. They dismissed supernatural causes of illness and prescribed holistic treatments that involved drug therapies, dietary changes, mental relaxation and physical exercise. Patients were also advised to get plenty of sleep and fresh air.

Despite working to ensure that medicine became regarded as a discipline distinct from theology and philosophy, he also laid out a number of ethical principles to guide medical practice. The benevolence, concern for confidentiality and standards of care described in the Hippocratic Oath still guide the professional conduct of doctors today.

Image credit

University of Seville. (2010). Hippocrates [Image]. Retrieved from https://www.flickr.com/photos/fdctsevilla/4842887491

References

Orfanos, C. (2007). From Hippocrates to modern medicine. Journal of the European Academy of Dermatology and Venereology, 21(6), 852-858. Retrieved from Academic Search Premier.