CPR by doctor: Match of life and death: more gripping than cricket match


A young man in mid twenties was wheeled in to intensive care. He was unable to breathe and his oxygen levels and blood pressure was falling within moments. Within no time he became unconscious following which CPR was started along with other supportive measures. Echocardiography was managed meanwhile was suggestive of pulmonary embolism. CPR was continued and simultaneously, thrombolytic drugs were pushed in. His pulse kept on coming and vanishing with monitors sometimes showing activity of heart and improved oxygen levels. A team of around nine doctors and nurses was taking care of airway, central and other lines. There was almost an orchestrated movement of staff with drugs being administered with superfast speed. Commands being given by the treating doctor were followed in split seconds. In the same trice, the team leader had to think far ahead about how he would be handling the challenging dynamics of that young human life who was almost at its fag end. He had to recognize, analyze and mitigate the situation within few seconds. He had to make split decisions and still had to be flexible with his decision and plans, altering them according to the responsiveness of the patient. Doing every bit in an electrifying instant, he had put in all his energy and experience to full use in those few seconds essential to save the young life. After around 35-40 minutes of high adrenaline rush time, the efforts paid off and silent smiles on faces of the team indicated that tornado had become manageable. The doctors and nurses, with sweat on foreheads, smiled quietly with mutual admiration. There was no clapping or cheering in this match of life and death to which the doctors and nurses are well accustomed. There were no spectators to encourage the team. The return of a robust pulse is all the cheering this team needed. There was no one to witness and applaud the zeal and anxiety of these performers, not even patient himself.

Incidents such as one described above are common occurrences in medical practice. It takes a lot of inner mental as well as physical strength besides emotional resilience to tide through such situations. Even relatives, when required, are not able to sustain the adrenergic drive required at these times.

Unlike the case above, the result may not be favorable in certain cases. It is not uncommon for relatives, to then question and start sparring match with doctors and nurses in case they fail in their brave attempt. Often even in successful resuscitations, questions are asked in preposterous manner about the incident. Doctors and nurses may even be verbally and physically abused if they fail despite their best efforts. Relatives can be vengeful and drag them to court to harass and punish them. Common assertion about the wrong injection is almost universal, even in most difficult scenarios. Courts and lawyers, deliberating over years with luxury of time, may find something or other to punish the savior, by doing retrospective analysis or by the wisdom of hindsight. Even if court rules after years that the doctor was right, revenge of patient’ relatives, monetary benefit to lawyers and harassment of doctor, both mentally and emotionally is complete. But they still carry on their noble job and though pained by these issues, doctor will just go to another bed and see what he can do for another patient. This cycle continues, every minute, day and night, all year round. Thousands get gift of life every minute by this wonderful community of doctors and nurses, irrespective of injury inflicted on them.

After the abovementioned incident of successful CPR, I just went to doctor’s room to have tea and a cricket match was going on, streamed live on TV. On the screen, thousands of people were seen clapping and cheering the player who was swinging his arm ready to throw the ball and also the batsman. But to me, the adrenergic rush here was no match to what I had just experienced in the ICU. The cricket match was merely a trifling entertainment with a futile outcome. Every day in each hospital, there are one or more magnificent matches of life and death played without any spectators. Many a times our players (doctors and nurses) win and thousands of lives are salvaged back from brink of death. These extraordinary matches finish with just quiet smiles. There is no one to clap or cheer and no recognition or prizes to the player for winning these match of life and death. Few good patients and relatives, who do realize the magnitude of the act offer heartfelt thanks. The respect, trust and support of the relatives at such times is all that a doctor needs to rev up for his next case, a real match in true sense. In comparison to this frantic match of life and death, rest of all matches are insensate.

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Suicide by medical student : Global, world wide Rotten system of medical education


A Resident doctor student of Surgery at GMC  Surat allegedly committed suicide last week by jumping from ninth floor. He blamed work pressure and torture in his suicide note. Actions and conversations are generated only after some terrifying incident and finish with making few scapegoats to blame for  one, like five seniors doctors in this case. But the whole system continues to function in same      inhuman way.  This rotten system ignores the deleterious culture of medicine and dangerous working conditions to which junior doctors are subjected.

http://timesofindia.indiatimes.com/city/surat/5-booked-for-abetting-suicide-of-gmc-doctor/articleshow/59463184.cms

Medical students enter medicine as inspired, intelligent, compassionate humanitarians. Soon they turn into cynical and exhausted humans. How did all these totally amazing and high-functioning people get so disillusioned so fast?

Problem does pertain to doctors all over the world, as evidenced by suicide by Dr Chloe Abbott in Australia in January. Her sister Micaela said she was Eaten Alive by the medical profession.

http://www.dailymail.co.uk/news/article-4325812/Investigation-medical-profession-suicide-epidemic.html

 

Inhuman duties, neglect, apathy of regulators towards genuine problems, chaotic  system of working have left doctors, specially in residencies vulnerable to mental illness. Sometimes even driving them to suicides  because of  system failures of medical  administration and inaction by Government.

The terrible conditions have engulfed not only junior phase of doctors, but continue for longer period of their lives, for most of doctors. Because medical professionals find themselves  at the wrong end of stick of government, courts, media for brutal expectations. They face public wrath for system failure.  There is an urgent need for change in work culture and regulations, to make conditions safe for doctors. Grueling shifts, inhuman working hours have to end now, if society really wants to be treated by good doctors.

 

Untenable working conditions, long inhuman hours, unrealistic expectations of patients and thereby creating pressure situations, fear of complaints, physical assaults and medical lawsuits have killed profession largely. Bullying and harassment from all possible quarters is unavoidable consequence.

My earlier article “ enslavement of medical profession” highlights the plight of doctors.

  Almost every doctor will have horror stories to tell, about working conditions. For which medical regulators should be ashamed, there is nothing to be proud of.

      

Ancient Medicine: Introduction of woman as nurses and doctors


 

Introduction of Woman Nurses and Doctors in 19th century Modern medicine 

Women as physicians

It was very difficult for women to become doctors in any field before the 1970s. Elizabeth Blackwell (1821–1910) became the first woman to formally study and practice medicine in the United States. She was a leader in women’s medical education. While Blackwell viewed medicine as a means for social and moral reform, her student Mary Putnam Jacobi (1842–1906) focused on curing disease. At a deeper level of disagreement, Blackwell felt that women would succeed in medicine because of their humane female values, but Jacobi believed that women should participate as the equals of men in all medical specialties using identical methods, values and insights. In the Soviet Union although the majority of medical doctors were women, they were paid less than the mostly male factory workers.

Women as nurses

Florence Nightingale triggered the professionalization of nursing.

Women had always served in ancillary roles, and as midwives and healers. The professionalization of medicine forced them increasingly to the sidelines. As hospitals multiplied they relied in Europe on orders of Roman Catholic nun-nurses, and German Protestant and Anglican deaconesses in the early 19th century. They were trained in traditional methods of physical care that involved little knowledge of medicine. The breakthrough to professionalization based on knowledge of advanced medicine was led by Florence Nightingale in England. She resolved to provide more advanced training than she saw on the Continent. Britain’s male doctors preferred the old system, but Nightingale won out and her Nightingale Training School opened in 1860 and became a model. The Nightingale solution depended on the patronage of upper class women, and they proved eager to serve. Royalty became involved. In 1902 the wife of the British king took control of the nursing unit of the British army, became its president, and renamed it after herself as the Queen Alexandra’s Royal Army Nursing Corps, when she died the next queen became president.

           In the United States, upper middle class women who already supported hospitals promoted nursing. The new profession proved highly attractive to women of all backgrounds, and schools of nursing opened in the late 19th century. They soon a function of large hospitals, where they provided a steady stream of low-paid idealistic workers. The International Red Cross began operations in numerous countries in the late 19th century, promoting nursing as an ideal profession for middle class women.

The Nightingale model was widely copied. Linda Richards (1841 – 1930) studied in London and became the first professionally trained American nurse. She established nursing training programs in the United States and Japan, and created the first system for keeping individual medical records for hospitalized patients. The Russian Orthodox Church sponsored seven orders of nursing sisters in the late 19th century. They ran hospitals, clinics, almshouses, pharmacies, and shelters as well as training schools for nurses. In the Soviet era (1917–1991), with the aristocratic sponsors gone, nursing became a low-prestige occupation based in poorly maintained hospitals.

 

Woman : Renaissance to Early Modern period 16th-18th century

Catholic women played large roles in health and healing in medieval and early modern Europe. A life as a nun was a prestigious role. Wealthy families provided dowries for their daughters, and these funded the convents, while the nuns provided free nursing care for the poor.

The Catholic elites provided hospital services because of their theology of salvation that good works were the route to heaven. The Protestant reformers rejected the notion that rich men could gain God’s grace through good works, and thereby escape purgatory, by providing cash endowments to charitable institutions. They also rejected the Catholic idea that the poor patients earned grace and salvation through their suffering.  Protestants generally closed all the convents and most of the hospitals, sending women home to become housewives, often against their will. On the other hand, local officials recognized the public value of hospitals, and some were continued in Protestant lands, but without monks or nuns and in the control of local governments.

In London, the crown allowed two hospitals to continue their charitable work, under nonreligious control of city officials. The convents were all shut down but Harkness finds that women, some of them former nuns, were part of a new system that delivered essential medical services to people outside their family. They were employed by parishes and hospitals, as well as by private families, and provided nursing care as well as some medical, pharmaceutical, and surgical services.

Meanwhile, in Catholic lands such as France, rich families continued to fund convents and monasteries, and enrolled their daughters as nuns who provided free health services to the poor. Nursing was a religious role for the nurse, and there was little call for science. 

 

 

 

        Permanent link: https://en.wikipedia.org/w/index.php?title=History_of_medicine&oldid=783167827

            Link    https://en.wikipedia.org/wiki/History_of_medicine

National Doctor’s Day: India, USA


India

Also celebrated on July 1 all across India to honor the legendary physician and the second Chief Minister of West Bengal, Dr Bidhan Chandra Roy. He was born on July 1, 1882 and died on the same date in 1962, aged 80 years. Dr Roy was honored with the country’s highest civilian award, Bharat Ratna on February 4, 1961. The Doctor’s Day is observed today to lay emphasis on the value of doctors in our lives. It is an occasion to give them their due respect through commemorating one of their greatest representatives. India has shown remarkable improvements in the medical field and July 1 pays a perfect tribute to all the doctors who have made relentless efforts towards achieving this goal irrespective of the odds.

 

United States

In the United States, National Doctors’ Day is a day on which the service of physicians to the nation is recognized annually. The idea came from Eudora Brown Almond, wife of Dr. Charles B. Almond, and the date chosen was the anniversary of the first use of general anesthesia in surgery. On March 30, 1842, in Jefferson, Georgia, Dr Crawford Long used ether used to anesthetize a patient, James Venable, and painlessly excised a tumor from his neck.

The first Doctors’ Day observance was March 30th, 1933, in Winder, Georgia. This first observance included the mailing of cards to the physicians and their wives, flowers placed on graves of deceased doctors, including Dr. Long, and a formal dinner in the home of Dr. and Mrs. William T. Randolph. After the Barrow County Alliance adopted Mrs. Almond’s resolution to pay tribute to the doctors, the plan was presented to the Georgia State Medical Alliance in 1933 by Mrs. E. R. Harris of Winder, president of the Barrow County Alliance. On May 10, 1934, the resolution was adopted at the annual state meeting in Augusta, Georgia. The resolution was introduced to the Women’s Alliance of the Southern Medical Association at its 29th annual meeting held in St. Louis, Missouri, November 19-22, 1935, by the Alliance president, Mrs. J. Bonar White. Since then, Doctors’ Day has become an integral part of and synonymous with, the Southern Medical Association Alliance. Through the years, the red carnation has been used as the symbol of Doctors’ Day.

 

Permanent link: https://en.wikipedia.org/w/index.php?title=National_Doctors%27_Day&oldid=785811878

https://en.wikipedia.org/wiki/National_Doctors%27_Day

India

Also celebrated on July 1 all across India to honor the legendary physician and the second Chief Minister of West Bengal, Dr Bidhan Chandra Roy. He was born on July 1, 1882 and died on the same date in 1962, aged 80 years. Dr Roy was honored with the country’s highest civilian award, Bharat Ratna on February 4, 1961. The Doctor’s Day is observed today to lay emphasis on the value of doctors in our lives. It is an occasion to give them their due respect through commemorating one of their greatest representatives. India has shown remarkable improvements in the medical field and July 1 pays a perfect tribute to all the doctors who have made relentless efforts towards achieving this goal irrespective of the odds.

But in recent times, sadly “ Happy Doctor’s Day” is just a Tokenism, a hollow slogan”.

United States

In the United States, National Doctors’ Day is a day on which the service of physicians to the nation is recognized annually. The idea came from Eudora Brown Almond, wife of Dr. Charles B. Almond, and the date chosen was the anniversary of the first use of general anesthesia in surgery. On March 30, 1842, in Jefferson, Georgia, Dr Crawford Long used ether used to anesthetize a patient, James Venable, and painlessly excised a tumor from his neck.

The first Doctors’ Day observance was March 30th, 1933, in Winder, Georgia. This first observance included the mailing of cards to the physicians and their wives, flowers placed on graves of deceased doctors, including Dr. Long, and a formal dinner in the home of Dr. and Mrs. William T. Randolph. After the Barrow County Alliance adopted Mrs. Almond’s resolution to pay tribute to the doctors, the plan was presented to the Georgia State Medical Alliance in 1933 by Mrs. E. R. Harris of Winder, president of the Barrow County Alliance. On May 10, 1934, the resolution was adopted at the annual state meeting in Augusta, Georgia. The resolution was introduced to the Women’s Alliance of the Southern Medical Association at its 29th annual meeting held in St. Louis, Missouri, November 19-22, 1935, by the Alliance president, Mrs. J. Bonar White. Since then, Doctors’ Day has become an integral part of and synonymous with, the Southern Medical Association Alliance. Through the years, the red carnation has been used as the symbol of Doctors’ Day.

 

 

Permanent link: https://en.wikipedia.org/w/index.php?title=National_Doctors%27_Day&oldid=785811878

https://en.wikipedia.org/wiki/National_Doctors%27_Day

 

 

Happy doctors day:  merely a hollow slogan?


On 1st of July, doctors are usually greeted from multiple quarters. Newspapers, media and some prominent people  congratulate doctors in their speeches or on their social media pages. However, what doctors need are not just verbal wishes but reinforcement of public’s belief in them . It is this renewal of faith in their saviour which will help  doctors in discharging their duties smoothly and in alleviating their problems.

National Doctor’s Day: India, USA

Despite the paucity of the highly trained medical professionals, the identity of medical professionals as a community in society is not getting its due right  because of  misplaced priorities of  certain people. The society tries to impose a stereotype role on them in an effort to control them fully. And as a result of these various controls, regulations and public pressure, doctors experience unrealistic performance pressure on professional front.

     Doctor is the pivot  point between patients, medical industry, government and insurance sector. Huge number of patients, expensive medicines, poor medical infrastructure has produced tremendous resentment against medical system amongst public. But the brunt of this entire angst has to be borne by the doctor or medical professionals alone. Often they are blamed for circumstances beyond their control and punished for system failure. Fear of public wrath and lawsuits is smothering the medical profession.  And increasingly there is a feeling amongst medical professionals that they are getting a raw deal despite doing their very best.

     In such a situation, there should be some introspection by all stakeholders every year, on doctor’s day. The doctor’s day should be more than just greetings and wishes for doctors. Some real resolutions need to be  taken so that their working atmosphere and eventually delivery of medical care is improved and this ultimately will benefit patients only.  I can think of some much needed changes-

1.       Government should take some concrete decision to improve medical  infrastructure and manpower. A better planning needs to be done to spend more for health of people, availability of resources and for improving the working conditions for doctors. Government should ensure that doctors are better protected.

2.       Medical industry should collectively think of protecting doctors or there should be provision for some financialresponsibility of medical lawsuits of all doctors.  Pharmacy industry, medical device industry, insurance industry  and others earn huge profits because doctors need to use their products. Although medical industry makes huge profits still they remain behind the scene.

3.       Police should provide  assured protection to  doctors better against physical violence.

4.       Medical education institutes should resolve to promote the education of best doctors and not indulge in profiteering in education of doctors.

5.       Courts should take an initiative to protect doctors against frivolous lawsuits ( which are often done to prevent paying their bills), revengeful attitude of patients  and harassment?

6.       On doctor’s day, public should resolve that they will not unnecessarily fight or abuse the doctor.

7.       And last but most important is that all medical practioners , be it allopathic, ayurvedic, unani, homoeopathic or others who play a role in maintaining health of patients, affirm that they will do everything to protect dignity and integrity of this profession.

If the above are not practised and followed, then mere sloganeering on doctor’s day  makes no sense . The  effort to improve training and working condition of doctors has to come from the bottom of the heart of all those involve, both giver and taker.  Mere tokenism on a day in a year is of no real purpose. If the present scenario continues, soon a common man will have problem in accessing good medical care which is currently available at nominal cost . One needs to ponder seriously, if we do not save doctors, who will save us? 

Death declaration by doctor: complex communication skill. “No negligence in alive baby declared dead: hospital “


Source: Death declaration by doctor: complex communication skill. “No negligence in alive baby declared dead: hospital “

Death declaration by doctor: complex communication skill. “No negligence in alive baby declared dead: hospital “


The death pronouncement is one of the most sensitive and complex part of communication in and out of hospital, intensive care. It comprises more than the actual declaration of death. It may be a relatively straight forward when the death is expected and the family is mentally prepared and accepting the outcome. However, when the doctor is interacting with a grief-stricken family, dealing with the death of a child, or coming to terms with the death of a personal patient, a death pronouncement becomes complex. Problem is compounded often in presence of violent relatives, non acceptance of death, medico legal cases and   especially in cases of unnatural causes for the death. Relatives often refuse to accept death and within no time mobs swell in number, threatening of physical and verbal assaults and revenge against the doctor in various forms. Although there can be specific protocols and hospital policies, it will still depend upon the timely thoughts and skills of the doctor, how to handle the situation. Doctors should be better trained for handling of death as it can put them in risky situation, because of following reasons.

  1. Death itself is a complex issue. Even today modern science has not reached scientifically at the bottom of life and death.
  2. Communication of death is complex. It varies with each patient, type of relatives, place, country and every situation in same hospital is different.
  3. Declaration of death is a legal matter. How a doctor verifies death, communicates and documents death, it can create legal and other problems for doctor.

Any problem related to declaration of death is immediately picked by media and the initial reaction is to blame the doctors. The doctors in such cases are projected as incompetent and callous, and that makes a media news. Invariably one stray incidence is used as to project whole medical community in negative manner. Later inquiries and further inquiring continue, and even later truth emerges, that is not enough to bring back the lost prestige for medical profession.

Take for example the latest news of “ Alive Baby declared dead.”

http://timesofindia.indiatimes.com/city/delhi/alive-newborn-declared-dead/articleshow/59208765.cms

Later after two days, news was “ hospital enquiry claims No negligence in alive baby declared dead”

link   http://www.dnaindia.com/india/report-no-medical-negligence-in-case-where-newborn-was-declared-dead-2479826

Above news just conveys the complexity of situation, doctors often face. My aim here is to convey  that communication of death is a very complex subject. Ironically no structured training of emotional, communicative and legal issues is imparted to medical students. But they are supposed to face the situation everyday, when they function as doctors.

 

Most legal determinations of death are certified by medical professionals who pronounce death when specific criteria are met. Two categories of legal death are death determined by irreversible cessation of heartbeat and breathing (cardiopulmonary death), and death determined by irreversible cessation of functions of the brain (brain death).

Especially new doctors need to realize that the structure of modern society is to make life and death, medical and then legal matters, and to subject the most basic elements of our existence to professional authority. The birth certificate and the death certificate are signed by doctors, and then registered by the civil authorities.  Because of all  these sensitive issues, emotional aspects and legal dimensions of death being  huge, so need more attention. .

In remote areas doctors are totally alone and helpless, so security issues will remain. There is no solution in sight for these problems. Already I have written about a “real story of female doctor assault”.

Problem is that doctors during training days or residency are not trained in such kind of communication. Although while doing their duties they observe seniors and learn how they are communicating. But still when actual situations arise, which can be diverse, complex and challenging, and everyday getting more demanding. In view of current scenario against doctors, they need better training on these issues. Basic question is, if doctor needs help, where can he turn to for help or information. The resources, other staff and the setup is not of much help in difficult scenarios.  It is not uncommon that doctors are left to themselves, if a difficult situation arises. Medical education and Hospital systems need to be better equipped to provide more support to doctors in present era. For doctors, if they make a mistake, there is no one to support them or save them from verbal, physical assaults, law and medico legal cases.

Harassment is tremendous. Therefore   doctors, be careful – save the patient, but save yourself also.

Advantages-Disadvantage of being a doctor

25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

Medical-Consumer protection Act- Pros and Cons

Ancient Medicine during Renaissance to Early Modern period 16th-18th century


 

The Renaissance brought an intense focus on scholarship to Christian Europe. A major effort to translate the Arabic and Greek scientific works into Latin emerged. Europeans gradually became experts not only the ancient writings of the Romans and Greeks, but in the contemporary writings of Islamic scientists. During the later centuries of the Renaissance came an increase in experimental investigation, particularly in the field of dissection and body examination, thus advancing our knowledge of human anatomy.

 

The development of modern neurology began in the 16th century with Vesalius, who described the anatomy of the brain and other organs. He had little knowledge of the brain’s function, thinking that it resided mainly in the ventricles. Over his lifetime he corrected over 200 of Galen’s mistakes. Understanding of medical sciences and diagnosis improved, but with little direct benefit to health care. Few effective drugs existed, beyond opium and quinine. Folklore cures and potentially poisonous metal-based compounds were popular treatments. Independently from Ibn al-Nafis, Michael Servetus rediscovered the Pulmonary circulation. But this discovery did not reach the public because it was written down for the first time in the “Manuscript of Paris” in 1546, and later published in the theological work which he paid with his life in 1553. Later this was perfected by Renaldus Columbus and Andrea Cesalpino.  Later William Harvey correctly described the circulatory system. The most useful tomes in medicine used both by students and expert physicians were De Materia  Medica and Pharmacopoea

Paracelsus

Paracelsus (1493–1541), was an erratic and abusive innovator who rejected Galen and bookish knowledge, calling for experimental research, with heavy doses of mysticism, alchemy and magic mixed in. He rejected sacred magic (miracles) under Church auspices and looked for cures in nature.  He preached but he also pioneered the use of chemicals and minerals in medicine. His hermetical views were that sickness and health in the body relied on the harmony of man (microcosm) and Nature (macrocorm). He took an approach different from those before him, using this analogy not in the manner of soul-purification but in the manner that humans must have certain balances of minerals in their bodies, and that certain illnesses of the body had chemical remedies that could cure them..  Most of his influence came after his death. Paracelsus is a highly controversial figure in the history of medicine, with most experts hailing him as a Father of Modern Medicine for shaking off religious orthodoxy and inspiring many researchers; others say he was a mystic more than a scientist and downplay his importance.

Padua and Bologna

University training of physicians began in the 13th century.

The University of Padua was founded about 1220 by walkouts from the  University of Bologna, and began teaching medicine in 1222. It played a leading role in the identification and treatment of diseases and ailments, specializing in autopsies and the inner workings of the body. Starting in 1595, Padua’s famous anatomical theatre drew artists and scientists studying the human body during public dissections. The intensive study of Galen led to critiques of Galen modeled on his own writing, as in the first book of Vesalius’s De Humani  Corporis Fabrica. Andreas Vesalius held the chair of Surgery and Anatomy  and in 1543 published his anatomical discoveries in  De Humani  Corporis Fabrica. He portrayed the human body as an interdependent system of organ groupings. The book triggered great public interest in dissections and caused many other European cities to establish anatomical theatres.

At the University of Bologna, the training of physicians began in 1219. The Italian city attracted students from across Europe. Taddeo Alderotti built a tradition of medical education that established the characteristic features of Italian learned medicine and was copied by medical schools elsewhere. Turisanus (d. 1320) was his student.  The curriculum was revised and strengthened in 1560–1590.  A representative professor was Julius Caesar Aranzi (Arantius) (1530–89). He became Professor of Anatomy and Surgery at the University of Bologna in 1556, where he established anatomy as a major branch of medicine for the first time. Aranzi combined anatomy with a description of pathological processes, based largely on his own research, Galen, and the work of his contemporary Italians. Aranzi discovered the ‘Nodules of Aranzio’ in the semilunar valves of the heart and wrote the first description of the superior levator palpebral and the coracobrachialis muscles. His books (in Latin) covered surgical techniques for many conditions, including hydrocephalous, nasal polyp, goiter and tumours to phimosis, ascitis, haemorrhoids, anal abscess and fistulae.

 

Link    https://en.wikipedia.org/wiki/History_of_medicine

Ancient medicine: The Middle Ages AD 400 to 1400:Europe and Islamic medicine:


Ancient medicine: medicine in medieval Islamic World

The  Islamic civilization rose to primacy in medical science as its physicians contributed significantly to the field of medicine, including  anatomy, ophthalmology, pharmacology, pharmacy, physiology,  surgery  and the pharmaceutical sciences. The Arabs were influenced by ancient Indian, Greek, Roman and Byzantine medical practices, and developed these further. Galen and  Hippocrates were pre-eminent authorities. The translation of 129 of Galen’s works into Arabic by the Nestorian Christian Hunayn ibn Ishaq and his assistants, and in particular Galen’s insistence on a rational systematic approach to medicine, set the template for Islamic medicine, which rapidly spread throughout the arab Empire.

Ancient medicine: medieval medicine of Europe

After A.D. 400, the study and practice of medicine in the Western Roman Empire went into deep decline. Medical services were provided, especially for the poor, in the thousands of monastic hospitals that sprang up across Europe, but the care was rudimentary and mainly palliative.

 Most of the writings of Galen and Hippocrates were lost to the West, with the summaries and compendia of St. Isidore of Seville being the primary channel for transmitting Greek medical ideas.  The Carolingian renaissance brought increased contact with Byzantium and a greater awareness of ancient medicine, but only with the twelfth century renaissance and the new translations coming from Muslim and Jewish sources in Spain, and the fifteenth century flood of resources after the fall of Constantinople did the West fully recover its acquaintance with classical antiquity.

Wallis identifies a prestige hierarchy with university educated physicians on top, followed by learned surgeons; craft-trained surgeons; barber surgeons; itinerant specialists such as dentist and oculists; empirics; and midwives.

Schools

The first medical schools were opened in the 9th century, most notably the Schola  Medica at Salerno in southern Italy. The cosmopolitan influences from Greek, Latin, Arabic, and Hebrew sources gave it an international reputation as the Hippocratic City. Students from wealthy families came for three years of preliminary studies and five of medical studies. By the thirteenth century the medical school at Montpellier began to eclipse the Salernitan school. In the 12th century universities were founded in Italy, France and England which soon developed schools of medicine. The University of Montpellier in France and Italy’s University of Padua and University of Bologna were leading schools. Nearly all the learning was from lectures and readings in Hippocrates, Galen, Avicenna and Aristotle. There was little clinical work or dissection.

Humours

The underlying principle of most medieval medicine was Galen’s theory of  humours. This was derived from the ancient medical works, and dominated all western medicine until the 19th century. The theory stated that within every individual there were four humours, or principal fluids – black bile, yellow bile, phlegm, and blood, these were produced by various organs in the body, and they had to be in balance for a person to remain healthy. Too much phlegm in the body, for example, caused lung problems; and the body tried to cough up the phlegm to restore a balance. The balance of humours in humans could be achieved by diet, medicines, and by blood  letting, using leeches. The four humours were also associated with the four seasons, black bile-autumn, yellow bile-summer, phlegm-winter and blood-spring.

Healing included both physical and spiritual therapeutics, such as the right herbs, a suitable diet, clean bedding, and the sense that care was always at hand. Other procedures used to help patients included the Mass, prayers, relics of saints, and music used to calm a troubled mind or quickened pulse.

 

·        Permanent link: https://en.wikipedia.org/w/index.php?title=History_of_medicine&oldid=783167827

            Link    https://en.wikipedia.org/wiki/History_of_medicine

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