Medicine

MEDICINE. - By m. is meant any expression of defense against evil, whether it is based on empirical knowledge or is the fruit of interpretation and speculation undertaken to combat diseases, to alleviate their painful symptoms and, in one way or another, to account for the morbid entity.

From this point of view, the healing art comprises both the crudest empiricism, characteristic of primitive peoples and of those of our countryside, and sorcerous practices, and recourse to the preternatural and the supernatural, and finally that body of knowledge which forms the heritage of present-day science. Here we will deal only with these, because they are truly the fruit of thought and therefore of greater interest.

Originally the interpretation of pathological phenomena and the consequent effort to remove them was framed within a religious and animistic concept. Thus diseases were interpreted as the effect of divine punishment or wrath, when they were not personified in mysterious entities, invisible but perceptible in their sad effects.

The naturalistic interpretation of biological and physio-pathological phenomena begins in the 6th century B.C. in the Italian schools (Bruttium, Sicily) and especially through the work of Alcmaeon of Croton and Empedocles of Agrigentum. Then the principle of biological experiment is born, and in the first attempts at investigation (v. ANATOMY; PHYSIOLOGY) the first biological law of isonomy is formulated, which establishes the basis of health in the harmony and proportion of the parts constituting the organism. Practical medicine too received a notable impulse in Croton with Democedes. The medical-biological doctrine, through the concept of the Empedoclean element, is transformed into the humoral principle in the school of Cos, where Hippocrates (v.; 460 B.C.), delineating the perfect figure of the physician, morally and professionally lays the foundations of true medicine. Clinical practice is born and with it semiotics; the first medical books are written, later collected under the collective designation of Corpus Hippocraticum. From Greece medicine passes to Alexandria, where Herophilus and Erasistratus found two famous schools. Devoted as these were predominantly to anatomical and physiological study, there arose, as a reaction, the emergence of the empirical school (3rd century B.C.) through the work of Philinus of Cos and Serapion of Alexandria, a school which, abandoning all doctrine, based itself on the famous tripod: autopsia, analogia, historicon. The Alexandrian schools after some time degenerated, becoming contaminated with magism.

Medicine in Rome is linked, chronologically, to the Greek-Alexandrian era. Having arisen with autochthonous elements of empiricism and of magical and religious interpretation, Rome for six hundred years had no recognized physicians, relying on domestic medicine, on invocations to indigenous gods (Etruscan, Latin), and on legal provisions concerning public health. The exponent of domestic medicine is Cato the Elder. In 290 B.C. the cult of Aesculapius was introduced from Greece, and shortly afterwards the first immigrations of Greek physicians (Archagathus). Of obscure and doubtful personality, these first wanderers were followed by better representatives (Asclepiades), so that an edict of Caesar (46 BC) granted Roman citizenship to those foreign physicians who remained in Rome; through their work three schools arose in Rome: the Methodist, based on atomistic, anti-Hippocratic principles (Asclepiades, Themison, Musa, Soranus of Ephesus, Caelius Aurelianus); the Pneumatic, Hippocratic humoral (Athenaeus of Attalia); the Eclectic (Agathinus of Sparta, Aretaeus of Cappadocia, Archigenes of Apamea, Rufus of Ephesus).

The founding of these schools ranges from 50 BC to 100 AD. The Roman element is represented by Celsus, author of the De re medica (25-35 AD) and by Pliny, a naturalist rather than a physician. The highest expression of medicine in the Roman age is given by Galen (v.; 138-201), an eclectic who gathered together all that was good in the various theorists and formed a system that remained unassailable for 15 centuries and more. Meanwhile in the East the tradition continued with the Byzantine schools, whose representatives were Oribasius, Aetius, Alexander and Paul (4th-7th centuries).

In the West, after the brief interlude of the Kingdom of Theodoric, in which, thanks to Cassiodorus (v.), medicine too flourished, culture was dispersed. It is found again, however, in the monastic schools, where gardens of simples are cultivated, infirmarian monks are instructed, and infirmaries and hospitals are opened. In the cathedral schools too "physics" was studied, that is, medicine as well. This movement of monastic (v. MONACHISMO) and clerical medicine did not last long (7th-10th centuries) and came to an end with the rise of lay medicine, whose best-known example was the school of Salerno, clerical and lay at first, lay thereafter. It gives its first notices around the 10th century, and its period of splendor closes in the 13th century with the rise of the universities. Every medical and surgical discipline was cultivated there with great honor; among its best representatives: Archbishop Alfanus, the deacon Guarimpotus, Peter the cleric, the monk Constantine the African, the family of the Platearii, of the Ferrari, the surgeons Roger and Roland, the oculists Zacharias, Benvenuto Grafeo, the urologists Ursus, Gilles de Corbeil and Maurus.

Nor were women lacking: the midwife Trotula, Abella, Calenda, etc. The best-known work was the Regimen Salernitanum. Contemporary with the school of Salerno was that of Montpellier, which was its rival and likewise had excellent practitioners, though of lesser fame.

In parallel, in the East the Arab school developed, itself also a continuer of classical culture through the schools that the Nestorians and the school of Athens, closed by Justinian, had founded in Syria, Mesopotamia and Persia. The Arabs gave impetus to therapeutics and to alchemy, which gave rise to pharmacy, and produced notable works that became fundamental in the West, when Arabism was introduced there especially through the work of Constantine the African. Its principal representatives were Mesue the Elder and Serapion the Elder (9th-10th centuries) for the first period, Rhazes (850-923), Avicenna (980-1037), Abulcasis (1013-1106) for the second, Averroes (1126-98), Avenzoar (1113-62), Maimonides (1135-1204) for the third. Arabism was introduced into Europe especially in the schools of Montpellier and Padua.

With the rise of the universities, medicine found its most natural and secure expansion. The school of Bologna was famous, where Taddeo degli Alderotti (1223-95) taught, the founder of the clinical method; Torrigiano dei Torrigiani (d. 1327); Buono, Dino and Tommaso del Garbo. The anatomist Mondino de' Liuzzi (1270-1326) introduced there the anatomical study of the cadaver; Ugo and Teodorico de' Borgognoni (1205-98) taught and practiced surgery there, introducing important modifications in the treatment of wounds.

Like that of Bologna, the school of Padua was famous, with Averroistic tendencies; there taught Pietro d'Abano (1250-1316), the S. Sofia, the Dondi dall'Orologio, etc. Surgery in Italy had its greatest representatives in Guido Lanfranchi (13th-14th centuries) and Guglielmo da Saliceto (1210-77), besides the already mentioned Teodorico.

Abroad, the schools of Montpellier became famous, where Arnald of Villanova (1235-1315) taught, one of the assertors of the freedom of scientific thought, like Roger Bacon (1214-92). Foreign surgeons were Henry de Mondeville, Guy de Chauliac (b. 1300), Jean Yperman, etc.

The Renaissance announces itself with the revision of the classics, especially in anatomy (v.) and with the discovery of the circulation of the blood (v. FISIOLOGIA). In medicine Theophrastus Paracelsus (1493-1541) revolutionizes old thought by establishing the chemical-biological concept, and G. Fracastoro (1478-1553) gives the first notice of the microbial world in his De contagione et contagiosis morbis. Worthy of mention are also F. Ingrassia (1510-80), G. B. Codronchi (1547-1628) and F. Fedele for legal medicine; G. Cardano (1501-76) for psychiatry and criminology, G. Mercuriale, G. Trunconi, O. F. Ferrari, etc. for pediatrics. Surgery boasts the names of A. Paré (1510-90), of M. Santo (b. 1488) for the operation for the stone; of C. Bartisch for ophthalmology (1583); of B. Maggi for amputations, etc. In obstetrics the cesarean operation on a living woman is introduced.

The true scientific renaissance begins in the 17th century, chiefly through the work of G. Galilei with the establishment of the experimental method. Anatomy widens its boundaries in microscopic investigation (v. ANATOMIA) and physiology lays its first foundations. In medicine the two orientations, iatrochemical and iatromechanical, take shape, headed respectively by G. B. von Helmont (1577-1644), F. de la Boe (1614-72), S. Santorio (1561-1636) and A. Borelli (1608-79), while the Hippocratic clinical approach is taken up again by T. Sydenham (1624-89). Physicians worthy of remembrance are G. Baglivi (1668-1707), L. Bellini (1643-1704), G. M. Lancisi (1654-1720) and others. Pathological anatomy begins; surgery is renewed in the treatment of wounds thanks to C. Magati (1579-1647). Surgeons worthy of remembrance are also M. A. Severino (1580-1656), P. E.

Dionis (d. 1718), F. Hildanus (1560-1634). In obstetrics there are the invention of the forceps, thanks to P. Chamberlen (1647), and the work of F. Mauriceau (1637-1709), of S. Mercuri and others. In psychiatry mention must be made of P. Zacchia (1584-1659), who was chiefly a legal physician, author of the first systematic treatise on that subject. In dermatology D. Cestoni (1637-1718) and G. C. Bonomo discovered the parasitic origin of scabies (the mite); in therapy, the antipyretic action of cinchona bark (1640), on which subject F. Toti wrote his celebrated work. B. Ramazzini (1633-1714) was the founder of occupational hygiene. F. Folli devised the system of blood transfusion (1654) and the technique of intravenous injection was introduced into practice.

Old medical thought, not yet vanquished, re-emerges in the 18th century in the work of G. E. Stahl (1660-1734), an animist, and in part in F. Hoffmann (1660-1742). From this, through W. Cullen (1712-90) and G. Brown (1735-88), the concept of the importance of the nervous system in determining vital phenomena takes life, until it reaches the subversive theory of G. Rasori, of stimulus and counter-stimulus (1766-1837), which opposes Hippocratic humoralism. Thus the conflict explodes that is the crisis between old and modern thought. A return to ancient concepts occurs in the astrologism of F. Mesmer (1734-1815), mingled with intuitions of magnetism, while S. Hahnemann (1755-1843) creates homeopathy (v.) in clear opposition to official medicine. Thanks to G. B. Morgagni, pathological anatomy takes its place alongside clinical practice.

The Hippocratic approach was followed by E. Boerhaave (1668-1738) and by von Swieten (1700-72), while in Italy D. Cotugno and G. B. Borsieri (1725-87) distinguished themselves. In semiotics it should be remembered that through the work of L. Auenbrugger percussion was introduced (1781). Surgery progressed through the merits of A. Scarpa (1752-1832), of G. A. Brambilla (1728-1800), who was a military surgeon, of J. and W. Hunter, P. Port, L. Heister, etc. Obstetrics developed especially in France through the merits of N. Puzos (1686-1753), A. Levret (1703-80), G. Palfyn (1650-1730). In Italy P. Assalini (1759-1840) and F. Asdrubali (1756-1832) are to be remembered; in England W. Hunter and W. Smellie. Ophthalmology was perfected especially in the operation for cataract (G. Daviel and A. Maitre Jean). The treatment of the insane became humane through the merits of V. Chiarugi (1759-1820), while F. Pinel (1745-1826) studied madness more theoretically and G. Gall (1758-1828) created phrenology (v.). The organization of public hygiene found a tenacious champion in P. Frank (1745-1821), author of a treatise on political medicine. Hydrotherapy spread and established itself, while electrotherapy took its first steps. Preventive medicine acquired a precious weapon against smallpox epidemics in the vaccination discovered by E. Jenner (1749-1823) in 1796. In this way medicine was moving toward the definitive systematization that was to take place in the 19th century.

The development of pathological anatomy ever more intimately linked with clinical practice, the establishment of microbiological science in the modern sense, the progress of semiotics, the conscious application of antisepsis and the discovery of asepsis, the implementation of surgical narcosis, the refinement of technique, the multiplication of instruments, the development of the collateral sciences and many other reasons besides brought it about that medicine finally, in the 19th century, succeeded in emancipating itself from a past to which it was still, without even knowing it, so bound.

Apart from the developments of biology, physiology and anatomy, which contributed enormously to that of medicine, two above all were the architects of its new life: pathological anatomy and microbiology. Clinical practice, for its part, derived precious advantages from auscultation, introduced by G. Laënnec (1781-1826) with the stethoscope, and from the various laboratory examinations which, begun with Cotugno in the previous century, had their official birth with Bright and with Fehling. In 1895 G. Roentgen (1845-1923) discovered X-rays, opening a new field to investigation. Bacteriology was raised to the status of a science by L. Pasteur (1822-95) on the basis of previous discoveries of microbes, of which A. Bassi (1773-1856) had priority. To R. Koch (1843-1910) was due the perfecting of technique and the discovery of numerous pathogenic agents, among them that of tuberculosis. Pathological anatomy had champions such as Laënnec, R. Virchow (1821-1902), founder of cellular pathology, Cruveilhier, Charcot, etc.

From E. Metchnikoff (1845-1916), H. Buchner, E. Behring (1854-1917) began the studies on immunity which, through the merits of the latter, led to the discovery of serotherapy. Meanwhile clinical medicine boasts glorious names: G. Laënnec, G. Skoda, G. N. Corvisart, F. Broussais, R. Bright, M. Bufalini, S. Tommasi, G. Baccelli, A. Cardarelli, A. De Giovanni, A. Murri, C. Forlanini, to whose name the treatment of pneumothorax is linked (1882); modern neuropsychiatry recognizes in M. Charcot (1845-93) its principal founder, while C. Lombroso (1836-1909) founded modern criminology; dermatology was born in the schools of F. Hebra (1815-80) and of P. Unna (1850-1929), while F. Ricord (1799-1880) established the classic distinction between blennorrhagia and syphilis. Surgery benefited from the discovery of antisepsis, implemented by E. Bottini (1837-1905) and G. Lister (1827-1912), but already anticipated in obstetrics by J. F. Semmelweis (1818-65), and from narcosis through the attempts of O. Wells (laughing gas), Jackson and Morton (ether), Simpson (chloroform). As a consequence of Pasteur's studies, antisepsis gave way to asepsis, while pharmacology entered a clearly experimental field; the syringe for injections was devised by Pravaz in 1851 and G. Baccelli in 1890 revived the use of intravenous injections. P. Ehrlich's studies on arsenobenzols opened the way to the new field of chemotherapy, of which the sulfonamides are the most recent conquest. Endocrinology, which has risen to such importance at present, had its origin in 1889 with Brown-Séquard's experiments on the rejuvenation of guinea pigs by injection of testicular extracts. The development of hydrotherapy is linked to the name of V. Priessnitz (1799-1851); in 1898 the Curies discovered radium, while electro-roentgen-therapy assumed greater and better development. Preventive medicine developed in the field of antimalarial prophylaxis with G. B. Grassi's discovery of the transmitting agent, the anopheles mosquito, and with the description of the life cycle of the malarial parasite in birds (R. Ross) and in man (Grassi).

Present-day medicine marks a return to the Hippocratic tendency, so much so that it is called neo-Hippocratic. On the other hand, the high perfection of technique and of the sciences collateral to medicine provide such aids to clinical practice as to make its task considerably easier and more reduced. The fundamental bases of 20th-century medicine are still those of the end of the previous century, with the addition of a broader knowledge of physio-pathological phenomena; a minute investigation of anatomopathological findings, a subtle experimentation in the field of general pathology and of clinical practice allow a more exact interpretation of the pathogenesis of morbid phenomena; meanwhile the progress of bacteriology and the studies still under way on ultraviruses open new horizons to general biological knowledge, ample probabilities of modifying certain classic etiological and pathogenetic concepts, and effective means of treatment with sera and vaccines. Meanwhile parasitology increasingly illuminates obscure points concerning the transmission of certain diseases and the knowledge of the causative agent and the intermediate host, making the fight against parasitosis easier and more effective.

On these bases, the pathological knowledge and the curative means of the diseases of the blood, of its morphological elements, of the hematopoietic organs (bone marrow, spleen, lymph glands), previously quite limited, have made a leap forward. Similarly the diseases of the renal apparatus have become far better known through the merits of advanced chemico-biological knowledge and of perfected functional examination. Framed within the modern concept of "allergy", bronchial asthma, pollinosis, food intolerances, urticaria, anaphylactic crises and serum diseases, and idiosyncrasies show a common pathogenetic basis; the diseases of the organs of internal secretion (v. ENDOCRINE, GLANDOLE) have opened a new horizon to the study of pathology and of constitution. Collaterally, the so-called deficiency diseases, due to a lack of vitamins (v.), assume ever vaster importance; knowledge of them extends day by day, revealing unsuspected horizons.

Surgery, through the high perfection reached by investigative and working instruments and by technical refinement, launches into the most daring interventions in the neurological, pulmonary and circulatory fields.

Prophylaxis and hygiene, rich in the aids of microbiology, parasitology, climatology and epidemiology, succeed in preventing the spread of infectious diseases; while therapy, equipped with ever more effective means, up to the antibiotics (penicillin, streptomycin, chloromycetin, etc.) in continuous improvement, emerges victorious over a wide range of infectious diseases.

Adalberto Pazzini