Medical Firsts!

[box] Features Editor, Anne Tan, reveals the key building blocks on the road to modern medicine [/box]

Hippocrates

Photo of Hippocrates with the Rod of Asclepius, the Greek God of healing and medicine.

 

The first person to organise medical teaching: Hippocrates (460-370 BC) was the first man to organise medical teaching and make medicine a distinct discipline. He is often seen as the father of western medicine as he revolutionised it. He did so by making it an objective science that could be studied with observation and hypothesis, rather than a mystical punishment from the gods. He is perhaps most famous for penning the first code of conduct for doctors, the Hippocratic Oath. Many people today still use it as a reference point when discussing ethical issues. (It is worth noting that there is recent evidence to suggest the Egyptians civilisation had more advanced medical practices even before Hippocrates was born.)

 

 

 

Galen

 

The first clinician scientist: Claudius Galenus better known as Galen (129-200 AD) was the first clinician scientist. A surgeon to the gladiators, he became very interested in human anatomy. However, as it was prohibited by law at that time to dissect human corpses, he based his research mainly on animal specimens.  His ground breaking research often flew in the face of the conventional understanding of the body. His perseverance (and arrogance) allowed him to continue and eventually make many significant discoveries. Among his many findings, was that he proved the diaphragm was used in breathing by cutting, what today we call the phrenic nerve, during an experiment. He is also known as being physician to Marcus Aurelius, the last of the ‘Five Good Emperor’ of Rome.

Andrea Versalius

The first anatomy textbook: Andreas Vesalius (1514 –1564) was the man responsible for the first anatomy textbook. A Belgium duringtill Andreas Vesalius published De Humani Corporis Fabrica. It showed revolutionary drawings of human anatomy and included theories on the function of organs. (On a side note, the anatomy drawings of Leonardo Da Vinci exhibited at the Queen’s Gallery (London, UK) last year is proof that Vesalius was not the only one working on anatomy drawings. If Da Vinci, in 1511, had completed and published his work, he would have beat Vesalius to this place in history)

 

'Unrivalled at the table' … William Harvey demonstrating the circulation of the blood to Charles I. Photograph: Getty Images/Universal History Archive

‘Unrivalled at the table’ … William Harvey demonstrating the circulation of the blood to Charles I. Photograph: Getty Images/Universal History Archive

 

The first person to figure out double circulation of the body: William Harvey (1578 – 1657 ) was the first person to figure out the double circulation of the human body! His discovery was based on his calculations of the volume of blood in the body and led him to further research on the anatomy and plumbing of the heart. His short book called De Motu Cordis is a summary of his work. I personally believe cardiac simulator dolls are called Harvey in honour of him.

 

 

 

Journals

 

The first medical journal: Strictly speaking, the first medical journal was published in French in 1679. The first English language
medical journal on the other hand was Medicina Curiosa, first published in 1684 The New England Journal of Medicine is the oldest medical journal still in print. It was first published in 1812.

 

 

morgagni - title page

 

The first person to relate symptoms to pathology: Giovanni Morgagni (1682 – 6 December 1771) was the first person to relate presentation of illness to pathology in the person. He was known for his thorough recording of patient history and presentation. After the patient’s death he would dissect their body to look for underlying pathology. His morbid work was based on his belief that every disease manifests in symptoms because an organ is crying out for help. Cautious about his radical hypothesis, he waited till he was 73 to publish the summary of his findings in De Generatione Animalium.

 

 

 

James-Lind-prescribing-lemons-to-limeysThe first clinical trial: We like to think of clinical trials as being modern but really the first recorded clinical trial was done on a ship by James Lind (1716 – 1794). He developed a theory that citrus fruit cured scurvy, so he did a clinical trial when 12 men were sick with scurvy. He divided them into groups and gave only one group oranges and lemons, while controlling for other dietary factors. In less than 6 days that group got better while the rest did not. When he published his research it was widely ignored till James Cook (1728 – 1779) used his methods to prevent scurvy on his voyages. His empirical research has now been given a biological mechanism as it has been proven that scurvy is caused by a deficiency of vitamin C, ascorbic acid.

 

 

Hunter

 

The first British anatomist/pathologist: One of John Hunter’s (1728 – 1793) great legacy is the Hunterian Museum (which is now owned by the Royal College of Surgeons in Holborn, London). This impressive collection of pathological specimens was the personal collection of Hunter, who was also fondly called ‘Hunter the hunter’.  This extensive collection is evidence of a life time of curiosity and a passion for science and medicine. Working as an army surgeon his experimental surgery led him to make discoveries in previously unexamined spheres of dentistry/maxillary-facial surgery, gunshot management and inflammation. Not particularly eloquent, the treatises he wrote were not particularly popular. Rather, Hunter lives on because his experimental dissection methodology revolutionised research, and of course his museum. If you have a chance it is definitely worth a visit!

 

 

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The first time CPR was done: This is a bit tricky as trying to resuscitate a person by clearing the airway and to give mouth to mouth is
old. The earliest record is in the book of Kings in the Bible when the prophet Elisha placed is mouth on the mouth of an unconscious child to give the child breath. However, in modern Western medicine, the first documented artificial breathing was done by William Tossach. This British surgeon in 1732 gave mouth to mouth to an injured coal miner. Friedrich Maass in 1891, was the first person to be documented to have performed chest compressions to keep the heart beating in an unconscious patient.

Jenner

The first successful vaccine: Edward Jenner (1749 – 26 January 1823) was the inventor of the first successful vaccine, the smallpox vaccine. He based the vaccine on the observation that milk maids, exposed to the less virulent cow pox were immune to the human strain, which had a high mortality. His experimental work was notable because he specifically challenged his vaccinated patients to the human small pox to ensure that they were indeed immune. This ground breaking work is the foundation of modern immunology.  Jenner’s vaccine with the help of some good public health initiatives have eradicated small pox by the 1980s and saved countless of lives. There are few people in history who have so directly benefitted mankind. Hence it is no surprise that in the UK wide vote organised by the BBC, Jenner was recognised as one of the 100 greatest Britons ever!

First GA

 

 

The first surgery done under general anaesthetic: The first recorded surgery under general anaesthetic was done by Seishu Hanaoka (1760 – 1835), a Japanese doctor, in 1804. He experimented with herbs to make an anaesthetic he called tseusensan. Reportedly, the tseusensan would be made into a drink the patient would have before an operation, his first recorded surgery under anaesthetic being a mastectomy. This place in history could have belonged to William Green Morton, who in 1846 demonstrated the use of inhaled anaesthetics in Massachusetts General Hospital.

 

 

Laennec

The first person to use the stethoscope: Rene Laennec (1781- 1826) is the French doctor credited with inventing the stethoscope in 1816. A post Morgagni (mentioned above) doctor, his medical training included pathology and many were trying to find ways to investigate pathology in a body before the post mortem. In Laennec’s Treatise of Mediate Auscultation (1819) he describes how the stethoscope was a product of necessity. He was attending a young plump female patient with heart problems and he wanted to better listen to her heart so he simply rolled up some paper and the stethoscope was born. Once he realised the benefits of using an intermediate to listen to the chest, he strove to fashion a more precise instrument, settling for a wooden hollow tube with only one ear piece. It was George Cammann in 1852, who made the binaural stethoscope, we are familiar with today. A keen musician, Laennec also greatly contributed to the vocabulary used to describe chest sounds.(Before the stethoscope, Austrian Auenbrugger pioneered percussion of the chest to determine if there was consolidation or liquid in the lungs. It is said he was inspired by watching a bartender tap his beer barrel to determine the volume he had left!)

 

The London Hospital

Photo of The Royal London, courtesy of Royal London Hospital Archives:

 

The first medical school in London: The Medical College at The London Hospital became not only London’s but England’s first medical school when it opened in 1785. St Bartholomew’s Hospital which it is now merged with, is the oldest remaining hospital in the United Kingdom. Both institutions are now part of Queen Mary, University of London.

 

 

First powder based pill was made using compressor invented by William Brockedon. This is his self portrait

First powder based pill was made using compressor invented by William Brockedon. This is his self portrait

The first powder based pill: In the pill popping culture we live in, have you ever stopped to think about when the first pill was made? The production of the powder based pill is a good example of how technology developed for another industry benefitted medicine. William Brockedon (1787 – 1854) was an artist in pursuit of a good pencil when he invented the machine that would compress graphite powder into solid pencil lead without the use of traditional adhesives. This machine was then adapted to compress medicines to make the pills we are all familiar with.

 

 

 

 

 

Early-Blood-Transfusion-300x215

The first human to human blood transfusion: James Blundell (1791 – 1878) in 1818 did the first effective human to human blood transfusion, when he transfused blood to a woman haemorrhaging during child birth from her husband. Blundell’s work has origins in Jean-Baptiste Denis’s, (1643 – 1704) who transfused blood from animals into humans. Despite the success of these blood transfusion, transfusion did not become wide spread practice till Karl Landsteiner (1868 – 1943) works on blood groups.

 

 

 

hommedia

The first hypodermic needle: Hypodermic literally means ‘below the skin’ and are needles that pierce the skin to deliver drugs or draw blood. Charles Pravaz (1791 – 1853), a French veterinary surgeon, and Alexander Wood (1817 – 1884), a Scottish doctor, were the two that invented the hypodermic needle. In the 1850s when they were first in use, they were originally made of a metal needle and syringe. These were not very popular as doctors could not see what they were injecting. It was only in 1866 were the syringes made of glass! Now of course the syringes are plastic and the whole set is for one time use.

 

Modern photo of IV fluids being used to treat Cholera today

Modern photo of IV fluids being used to treat Cholera today

 

 

The first intravenous fluid given: Thomas Latta (1796 – 1833) was a doctor working during the cholera epidemic of 1829-1830. Itbecame apparent to doctors practising during the epidemic that patients had blood with little fluid, causing them to die of dehydration. Bearing in this mind, Latta came up with the idea to use a syringe with a flexible injecting tube to give patients fluid directly into their blood, starting the practise we are so familiar with today of giving Intravenous (IV) fluids.

 

 

 

 

elizabeth-blackwell-quotes-67792

The first openly identified woman to graduate from medical school:  Traditionally a male dominated profession, women before Elizabeth Blackwell (1821-1910) had tried to enter medical schools by pretending to be boys. Blackwell was however the first to openly identify as a woman and successfully complete her education, graduating from Hobart College (New York, USA) in 1849. Known to not suffer fools, it was said that her presence in the class made the other male students far more attentive.

 

 

 

Virchow

“The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.” Rudolf Virchow

The first doctor to understand the molecular origin of disease: Rudolf Virchow (1821 – 1902). Heard of the Virchow’s triad? This Prussian doctor is known to be the first to describe the molecular origin of disease and how diseased cells form diseased tissue which eventually leads to a diseased body. He is also known for being the first to describe how a deep vein thrombosis can become a pulmonary embolism. He also believed his ideas on how parts affect the whole could be applied to society and was a great proponent for public health initiatives.

 

 

 

PasteurThe first to describe the ‘germ theory of disease’: Louis Pasteur (1822 – September 28, 1895). Ever had some pasteurised milk? The process of pasteurisation (to boil milk to remove the bacteria in milk that turns it bad), was named after Louis Pasteur who was the first to describe the ‘germ theory of disease’. This theory acknowledges that disease can be caused by tiny infectious organisms and such microorganisms also cause processes such as fermentation.  Other than pasteurisation, this theory also resulted in Pasteur coming up with the anthrax and rabies vaccine. It is also worth noting that he was a great chemist as well! If you ever have a chance, visit the Pasteur’ museum in Paris which was the home of Pasteur and his family in the last few years of his life. Now a museum, it houses some of his original equipment among other family paraphernalia and gives insight into the life of this brilliant man.

 

Lister

 

The first person to make surgery antiseptic: Joseph Lister (1827 – 1912) was the first to make surgery antiseptic by applying Pasteur’s germ theory to surgery. He did so by introducing the use of carbolic acid (aka Phenol) to sterilise surgical instruments. This allowed surgery to be much safer as it reduced the risk of infection. An innovative surgeon, the Lister medal is still the most prestigious prize for a surgeon to win! If you walk around London you may see Lister’s name on a blue plaque as he lived in London during the second half his career.

 

Elizabeth Garret Anderson

 

 

 

 

The first female doctor to graduate from a UK medical school: Some of you may have already heard of Elizabeth Garett Anderson (1836 – 1917) who was the first British female doctor. Her long and tumultuous journey to becoming a doctor, which started with her being a nurse at North Middlesex Hospital (London), shows how tenacious and determined she was. She was also the co-founder of the London School of Medicine for women, as well as its first dean. This was at that time, the only hospital that taught and hired women. It was later renamed the Royal Free and is now part of UCL. She was also elected Mayor of Aldeburgh in 1908.

 

 

x-ray-lg

 

The first X- Rays images: Today, ordering an X-Ray to image the insides of a patient is common place. Have you ever wondered when the first radiograph was taken? Wilhelm Conrad Roentgen (1845 – 1923) was a German physics professor, who was the first to make X –ray images. His first image was of his wife was made in 1895. When he examined the image he created, he noted that the density of the material affected how it appeared on the radiograph, with opaque structures, such as bone and her wedding ring, being differentiated from translucent soft tissue. The first X-ray imaging department would be set up in Glasgow as soon as 1896.

 

 

 

 

 

 

 

 

OslerThe first person to formalise specialist training aka residency programs: William Osler (1849-1919) was a Canadian doctor who was one of the founders of Johns Hopkins Hospital. Osler was a medical education visionary who got medical students out of the library and onto the wards, formalising residency programs in North America. His lucid style of teaching, epitomised by the medical textbook he wrote The Principles and Practice of Medicine (1892), was immensely popular. Known for his wit and sense of humour, it is very likely that any clever quote you hear about medicine was said by him!

Just to give you a flavour of the many quotes of William Osler:

The trained nurse has become one of the great blessings of humanity, taking a place beside the physician and the priest, and not inferior to either in her mission.’ Address at John Hopkins Hospital (1897)

The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish.”

He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”

 

 

Fleming

The first antibiotic: Alexander Fleming (1881 – 1955) was a Scottish biologist who accidentally discovered antibiotics. He did so because he realised that the fungus contaminating his Staphylococci samples, Penicillium, were producing a lysozyme that was killing the disease causing bacteria. Proof that sometimes being messy is a good thing! He announced his discovery on 14 Feb 1929. A former University of London lecturer, he shared the Nobel Prize in medicine (1945) with Howard Florey and Ernst Boris Chain.

Taussig

 

 

 

 

The first paediatric cardiologist: Helen Taussig (1898 –1986) is most famous for her work on the ‘blue baby syndrome’. She helped develop the surgical technique called the Blalock-Thomas-Taussig Shunt as she noticed that babies with patent ductus arteriosus lived longer than those without and the shunt was developed to mimic it. She is also known for her early opposition to the use of Thalidomide during pregnancy. Perhaps what makes her achievements even more impressive are the facts that she was dyslexic and had lost her hearing by the age of 29. A very caring doctor she always saw patients as people first and did extensive follow ups on her patients.

 

 

 

AmbulanceThe first motorised ambulance: Chicago (1899) was where the first motorised ambulances were introduced. Prior to them horse drawn carts were used, mainly on battlefields to bring wounded soldiers to hospital. These motorised ambulances were faster and boasted a smoother ride for the patient. They helped to reduce mortality by allowing for faster response times.

 

 

 

 

 

Photo of Obs machine we know so well. Courtesy of shutterstock

Photo of Obs machine we know so well. Courtesy of shutterstock

The first sphygmanometer: Strictly speaking, the first person to ever measure blood pressure (BP) was Rev Stephen Hales in 1733, when he recorded the BP of a horse by inserting a glass tube into an artery. However, the technique we are more familiar with was pioneered by Nikolai Korotkoff (1874 – 1920). Korotkoff discovered systolic and diastolic blood pressure in 1905, whilst inflating a cuff over a patient’s arm and listening to the soft murmurs of blood rushing through the artery with a stethoscope. A vascular surgical trainee during the Soviet – Japanese war in 1904, Korotkoff had a lot of experience with arteries damaged by trauma. When he published his findings they were not well received, it would be his doctoral advisor, Federov Yanovski would pick up where he left off allowing BP to become a standard observation.

 

 

 

 

 

 

 

Laparoscopic-Surgery

The first laproscopic surgery on humans: In 1910, Hans Christian Jacobaeus (1879-1937) performed the first laproscopic surgery on a human. His work was based on George Kelling’s (1866-1945) surgeries on dogs. Jacobaeus was Swedish and a member of the Nobel Prize committee, even if he never won one.

 

 

 

 

WHO

league of nations

The first international health organisation: Before the World Health Organisation (WHO), there was the League of Nations Health Organisation (LNHO). The League of Nations was set up in 1919 during the aftermath of World War I and was aimed at avoiding war and promoting humanitarian ideals. Not surprisingly, public health was one of the things it was interested in, setting up the LNHO in 1920. The LNHO, unlike most of the work of the League was actually quite successful. Unfortunately, little is known about it due to the political situation of the inter-war period.

 

 

aed

 

 

 

 

The first defibrillator: Claude Beck was in surgery when he performed the first defibrillation by shocking his patient’s heart out of ventricular fibulation in 1947, saving the patient’s life. His work was based on early experiments done on dogs that suggested defibrillation would shock a heart back into sinus rhythm. Although the success rate of defibrillation is not as high as the media portrays, it is certainly a lifesaving tool. Hence Automated Electronic Defibrillators (AED) are available in most public places, see if you can spot them.

 

 

test-tube-baby-time-magazine

 

 

The first baby to be born via In-Vitro Fertilisation (IVF): Louise Brown on 25July 1978 was the first successful ‘test – tube baby’. She born in Britain to Leslie and John Brown who h
ad been infertile for 9 years due to Leslie’s blocked fallopian tubes. The IVF technique was developed by Patrick Steptoe and Robert Edwards. Edwards was awarded the Nobel Prize in Medicine (2010) for this invention. The now common place procedure was and still raises ethical issues about whether it will turn women into baby factories and commercialise motherhood.

 

 

B0007277 Monoclonal antibodies

The first monoclonal antibody to be used therapeutically: Monoclonal antibodies are very clever drugs that have vastly improved the outcomes for so many patients with auto-immune diseases, cancer and transplants. The first monoclonal antibody that was licensed for humans is Muromonab – CD3 in 1986. It is from mice and is targeted CD3 receptors on T-cells and was used to prevent tissue rejection.

 

 

 

First face transplant

 

The first face transplant: Isabelle Dinoire in 2005 received the first partial face transplant. Dinoire had taken an overdose and lay unconscious when her pet dog mauled her face trying to wake her. This ground breaking surgery reconstructed her face with the help of a donor. Having a donor means that Dinoire is on immune suppressing drugs for the rest of her life and this toxic cocktail of drugs is one of the reasons why the surgery was not done before. However, the surgery was successful and so far Dinoire continues to look in the mirror and see ‘a mixture of the two of us’. She said, ‘the donor is always with me…She saved my life.’

 

inv_bionic_hand

 

The first bionic hand: A bionic limb is no artificial replacement, it is one that is ‘life-like’, which means it can also move. The first bionic hand was invented by Touch Bionics who created a multi –articulating hand in 2008. These hands are used in reconstruction surgeries where either patients with paralytic hands have them electively amputated or patients that have lost their hands in accidents. The new hand is connected to the existing nerve and tissue in the patient’s wrist. New technologies are allowing patients to even feel with the new hands!

 

 

Photo of first surgeon, Shafi Ahmed, and Google Glass eyewear which was used to stream surgery live

Photo of first surgeon, Shafi Ahmed, and Google Glass eyewear which was used to stream surgery live

 

 

The first surgery to be streamed live: At the Royal London Hospital in May 2014, Google Glass eyewear made it possible, for the first time, to stream a surgery live. The surgery to remove a tumour from the liver and bowel of a 78 year old man was streamed live to 1300 surgical students round the world from 115 countries. Using the internet from a mobile phone or a computer they could even ask the surgeons directly during the surgery. It will be interesting to see what kind of impact this invention will have on surgical training. Fad or Revolution?

 

 

I hope you have enjoyed this Feature on the Firsts of Medicine. Please feel free to comment on the site/post on our Facebook page and let me know what you think. Did things surprise you? What did you find most interesting?

It is our hope that in in ten, fifty, a hundred years from now, when someone else does a feature on the ‘firsts of medicine’ that one of you reading this page will be among them due to your significant 

 

If you want to know more, these are some sources that we found useful as we wrote this feature:

Doctors by Sherwin Nuland, published on 1988 is a good resource about the personalities that shaped medicine.

The Pain Clinic IV: Proceedings of the fourth international symposium. Edited by M. Hyodo, T. Oyama and M. Swerdlow. First published in 1992.

http://listverse.com/2013/05/11/10-important-firsts-of-modern-medicine/– this is a website that gives more information about technological advances in medicine.

http://www.nature.com/news/history-great-myths-die-hard-1.13839  – this website gives interesting insights into the historical approach and the making of myths and heroes in science.

http://www.nlm.nih.gov/changingthefaceofmedicine/   and http://womenshistory.answers.com/notable-women/female-firsts-in-medicine – these are both good websites about women who have made a difference to medicine.

http://emj.bmj.com/content/20/4/316.full – this is a good online article about the Cholera epidemic and the use of IV fluids

http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/History-of-CPR_UCM_307549_Article.jsp – gives a good history of CPR

http://beckerexhibits.wustl.edu/rare/collections/classics.html is a good website for an overall view on the great medical texts published through history.

The websites the photos are taken from are also very good! (Click on the photos to get there!)

 

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