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S4 E32: The History of Medicine
52 Plays3 months ago
Today John and Dejan are discussing the History of Medicine. Watch to hear them discuss the greatest development and events in this field.
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Transcript
Introduction to Debatable Discussions
00:00:01
John Gartside
Hello and welcome back to another episode of the Debatable Discussions podcast. Today you join us for another exciting episode as we're going to delve into the history of medicine.
Importance of Medical History
00:00:13
John Gartside
A field of history, Diane, which is often quite perhaps underappreciated, I think, is quite fascinating. It traces some of the largest developments in humanity in many ways, developments which have enabled us to live as long as we do and have caused a fundamental change in our lives.
Challenges in Studying Medical History
00:00:33
Dejan
Yeah, John, definitely. I think, you know, very difficult field, perhaps, because it's, it requires a decent amount of scientific knowledge as well.
00:00:44
Dejan
And also, it's, you know, it's not a very glamorous field. There's a lot of people dying for sort of quite banal reasons, some might say. There aren't the sort of big battles, the big wars, the famous sort of political moves but it is a very important field because public health is based on history it's based on how we respond to the past and how we will respond to the same events in the future
Quarantine: Historical and Modern Context
00:01:16
John Gartside
Yes. So to dive right in there, Diane, you mentioned how public health is quite steeped in history, is how respond to pandemics, to crisis.
00:01:26
John Gartside
And I think one of the most interesting concepts in the history of medicine is the idea of quarantine. It's something that I'm sure our listeners know very well, having experienced one only a few years ago for the COVID-19 pandemic.
00:01:40
John Gartside
But can you explain to us what is the history of this concept of quarantine and why is it so important?
00:01:47
Dejan
Yeah, so firstly, I'd like to say that quarantine is the act of people being restricted to their homes for most of the time, unless going out for essential activities, such as buying food or whatever. But quarantine, obviously very important, the COVID pandemic, very important in other times in history as well. But it all really started in the Middle Ages with the plagues and Other today we're talking mainly about the Black Death
00:02:17
Dejan
that plague, not plague, but that plague. And in a small village in England, cases started rising up. And then in order to deal with those cases, no one was allowed to leave the town and no one was allowed to enter the town as well. So they basically isolated this small town away from the world. And in between the town, people were sort of had to stay in their areas, didn't really go to church anymore, didn't go to mass. So it was a very solitary practice. And then also in Paris and in Venice and in other places, you performed quarantine during these plague epidemics. And from the sort of windows, depending if you had your blinds on off at the time of day, sort of, you could be, could be inferred whether you were alive, you were ill, you were dead. So it's really interesting practice really. And it stems back from a lot longer than we think, I think.
00:03:18
John Gartside
Yeah, and as you mentioned there, it sort of evolved quarantine, perhaps became most prominently known during the Black Death. the mid-14th century, around the year 1350. It killed around 50 million people, predominantly in Europe. So it is one of the most, as I've mentioned there, catastrophic pandemics.
The Black Death and Quarantine Evolution
00:03:42
John Gartside
And it's this concept of quarantine, of having to isolate yourself, especially merchants have had to isolate themselves and venison was one of the trading hubs of europe at the time and they had to isolate themselves for 14 days and then you know far more italian than i do and isn't quarantino 14 italian And I think that's where the word quarantine comes from.
00:03:50
Dejan
Yeah. Yeah.
00:04:07
John Gartside
It's a reference to how merchants would have to spend 40 days before going into Venice or other Italian cities. So it's a very interesting concept. Could you perhaps expand on the Black Death and its significance? Because obviously introduced this concept of quarantine. What else do pandemics like this show from a historical perspective?
00:04:32
Dejan
Yes, I mean, looking at the Black Death, I think probably the most famous thing, if I say to a random person to think of the Black Death, I think of the plague doctors. And, you know, the big masks and the black suits and looking a bit goofy. But the reason was that back then was unclear how bacteria spread and how these sort of diseases came about. But what was clear to them was that they were contagious.
00:04:58
Dejan
So the mask actually was filled with herbs and other spices that were sort of, yeah, with odours so that they would apparently disinfect an odours to sort of,
00:05:05
John Gartside
Oh yes.
00:05:11
Dejan
you know, purify the air that the doctor breathes and that it doesn't affect him. Now, you know, looking back to that, it's probably a bit of a foolish practice, but having the sort of barrier in the first place is the equivalent of wearing a mask now.
00:05:26
Dejan
And I think also much disease spread in history through migration.
Plague Doctors and Early Protective Measures
00:05:33
Dejan
So very famous instance during the plague of Justinian,
00:05:40
Dejan
was during a siege, I think, somewhere in Italy, some of the French soldiers become ill with the plague and they die. And what the French did, they just catapulted them over the city walls.
00:05:56
Dejan
So then the local population that were being under siege started being ill and they started fleeing.
00:05:59
John Gartside
Yeah.
00:06:01
Dejan
And when they fled of 10 days later,
00:06:01
John Gartside
Yeah.
00:06:04
Dejan
And they arrived in somewhere else, 10 days later, they then spread the illness with them because of this very unorthodox tactic. So biological weapons existed way before, sort of chemical development and, and, and sort of synthesis and all that kind of stuff.
Smallpox and the Birth of Vaccination
00:06:22
Dejan
People were used as biological weapons when they were just being catapulted over the fence.
00:06:28
John Gartside
And I think it's almost a weapon in a way, things like pandemics, they've occurred throughout human to people, obviously an example which is very well known as the Native Americans, when early travellers or explorers went over to America, such as Marco Polo, that he's known to have spread disease and many early settlers caught diseases themselves.
00:06:49
Dejan
Yeah.
00:06:53
John Gartside
Around that period as well was another famous pandemic, which perhaps had one of the most fundamental changes in the history of medicine. And I like to think about sort fundamental changes in history, about those which had a significant impact upon the ways in which humans lived and human society functions.
00:07:15
John Gartside
And that was obviously the smallpox pandemic, this pandemic in the sort late 18th century and after, but largely obviously before, was known for leading to the creation of the smallpox vaccine by Edward Jenner in 1796, which as a vaccine was one of the most revolutionary things ever.
00:07:37
John Gartside
Because simply in a syringe, he managed to find a way, or not in a syringe at the time, I suppose, but he managed to find digestible way problems.
00:07:48
Dejan
Yeah.
00:07:48
John Gartside
human medicine, human society. So, Diane, for our listeners who don't know, because I think this is the advantage of history of medicine, as you mentioned, can you explain how vaccines came to existence and what they also do?
00:08:01
John Gartside
Because I think that's quite a complex thing itself.
00:08:05
Dejan
Yeah, so vaccinations, to just summarise how they work, there's two types of vaccines and these sort of old school type of vaccines having a live virus vaccine or You've got a live specimen of the pathogen that is weakened and that doesn't really hurt you, but that your immune system can recognise, build up an immunity against and when there's an actual infection, if there is an actual infection, they can sort of be crushed immediately by the antibodies who already know what they're looking for. They don't need go around and be like, okay, is this it or not?
00:08:44
Dejan
and then for vaccines i'm i'm actually going to read something because i i do not want get stuff wrong with with this fairly exact science so
00:08:57
Dejan
Few samples still exist in laboratories, talking about smallpox, for ongoing study, but to all intents and purposes, smallpox is now extinct in the wild. The last known case occurred in 1977 in Somalia, and in 1980, WHO declared the disease have been eradicated.
00:09:13
Dejan
Smallpox appeared around 10,000 years BC, scarred Egyptian pharaohs, quite probably contributed to the decline of the Roman Empire, and played a part in the fall of the Aztecs and the Incas in the Americas. It killed millions of people throughout history and caused disfiguring, scarring to many of its survivors, but it has been successfully extinguished by vaccination.
00:09:32
Dejan
So, as I've mentioned before, vaccination works by a weakened body, especially for the smallpox vaccine. The history of vaccination. There's good evidence that the ancient Chinese vaccination against smallpox.
00:09:46
John Gartside
We're about to, yeah.
00:09:47
Dejan
inoculating individuals with pus isolated from smallpox sufferers. However, written reports from time are unreliable. It is likely that other cultures around the world develop similar methods of inoculation. So inoculation is basically introducing a weakened form of a virus or a pathogen. This crude immunization appears to have arrived in the early 1700s, possibly brought by travelers from modern day Istanbul. And by 1714,
00:10:12
Dejan
The Royal Society of London has been made aware of this technique by European scientists. And Lady Montagu suffered from a bout of smallpox, which left her severely disfigured. The disease killed her brother.
00:10:25
Dejan
Her husband was then appointed ambassador to the Ottoman Empire and travelled to Istanbul. And soon after they arrived, Lady Montagu wrote about the issue. And she went on to be convinced of the effectiveness of their relation.
00:10:41
Dejan
And then she ordered the embassy to do it on her five-year-old son. He survived, returned to England, and then basically was all right. And that's when inoculation started in England as well with the same process. So as we can see, it's a story of...
00:10:58
Dejan
quite an aristocratic start, I'd say. It was a bit of a new technique in Europe and people were obviously sceptical, but then when someone from a high social caste decided to take the step and do it, it gained a lot more credibility.
00:11:15
Dejan
And a lot of religious people, it says here as well, did not accept Jenna's work on vaccination for the reason that they just didn't seem...
00:11:26
Dejan
You know, didn't seem Christian.
00:11:28
Dejan
And yeah, he received £30,000 in all of his work at that time.
00:11:34
John Gartside
Yeah, and I think it's very interesting because you described there, Diane, gave us a bit of a journey through vaccines and how they work.
Pandemics' Influence on Society
00:11:42
John Gartside
But Jenner played a key role in formulating vaccine, which had a huge effect on social, on science.
00:11:45
Dejan
Yeah.
00:11:49
John Gartside
Another one we can quickly talk about because it's another fascinating pandemic called the Spanish influenza, which started just at the end of World War II, started...
00:12:02
John Gartside
So at the end of all, as mentioned, in 1980, the first reported case was actually in the States, in the United States of America. However, quickly spread to Europe and ended up infecting something like they estimate third of the world's population.
00:12:16
Dejan
Yeah.
00:12:17
John Gartside
So a huge figure. And then it killed after that an estimated around up to 50 million people. So it was easily one of the most catastrophic pandemics of human history and a real tragedy. But that as well was a historical event in itself because the influenza had a lasting impact on public health.
00:12:40
John Gartside
So one can easily see that it led to more efficient vaccine response to formulate a vaccine, but also to increase the efficiency of public health institutions, quarantines, things even like wearing masks. These are all concepts which gain so much more prominence. after the Spanish influenza, which is historically significant, not just because of its death toll and its destruction, but like with so much of the history of medicine, it also led lasting scientific achievements, which influenced how we lived.
00:13:16
John Gartside
What do you have to say about this, Diane? How do you, as a more general, in a more general sense, how that pandemic shape human society and into the future?
00:13:28
Dejan
I mean, I think they're sort monumental. There are very few things that can change our perception of the world as much as a pandemic. And we've seen this with COVID, remote learning, remote working.
00:13:40
Dejan
And so a lot of our habits have changed. lot of people are complaining now with Avatar 3 being released about people not going to cinemas anymore. And do believe that is...
00:13:51
Dejan
an issue that is as a result COVID, you know, because you were stuck in house in your house so long, just became sort of accustomed to that. And you became accustomed to work from there and everything like that.
00:14:02
Dejan
Spanish influenza as well. Huge, huge impact. And it had it from everything to sort disease control and public health to people because was so, so brutal. And it created so much panic and so much fear that people began to, again, approach their health differently and approach their interactions differently.
00:14:25
John Gartside
Yeah, definitely. These are fundamental changes in human
Braudel's Theory on Historical Change
00:14:30
John Gartside
life. And I think it's an interesting concept because I'll ask you, Dan, about the standardisation of medical practice in a second, which is another big biological change in the history.
00:14:40
Dejan
Thank you.
00:14:42
John Gartside
But all discussions in history of medicine, part of the field of history of science, always make me think back to one theory of history, which is perhaps the most relatable to my understanding of the past.
00:14:57
John Gartside
And this is Fernand Braudel, famous French Algerian historian, who articulated his theory of history and its structure as being based on the Mediterranean Sea.
00:15:10
John Gartside
So he broke down history into three sections. His first sections corresponding to the structure of the sea. So in the sea, as you know, Diane, you've got the surface, which is constantly changing, constantly moving.
00:15:23
Dejan
Yeah. Yeah.
00:15:25
John Gartside
You never quite know what's happening. Then perhaps an inch beneath the surface, you've got the middle section, which is a bit more resilient, but it still goes with the tide. But when there's a shift, it's a bit more fundamental there.
00:15:41
John Gartside
And the bottom section of the sea is the deep sea. are known throughout the ocean. And Braudel compared these three sections to different studies of history.
00:15:52
John Gartside
So his top section, the ever-changing part, is what he used to describe military or political history. It's the top of the ocean, it's constantly changing, constantly evolving.
00:16:03
John Gartside
And then the section beneath that, this middle section, he gave to economic and social history. So slightly more significant is in the course of history, slightly more significant changes. And these are changes, his lens of what made up a significant change was how it impacts human life.
00:16:25
John Gartside
So political event can impact human life, but he viewed it as being quite short term. Wars last a matter of years. Economic issues, though, perhaps the introduction of currencies, are far more long term.
00:16:39
John Gartside
However, the bottom of his ocean, what he used to describe deep ocean, these fundamental changes in the ocean and fundamental changes in history, were things such as geographical history, environmental history and the history of science.
00:16:55
John Gartside
And he viewed developments or changes in any of these fields as truly fundamental to how humans lived.
Impact of Medical Advancements on Society
00:17:03
John Gartside
So we've obviously mentioned already in the episode Vaccines.
00:17:07
John Gartside
Braudel argued that vaccines were fundamental changing the way of human life. Ever since finding a vaccine, human life has constantly followed that path and it's constantly changed economic, social, political and military history in a way that those others can't really affect the history of science. I think before we get into bit more of the actual sort scientific part, it's a nice thought to think about how history of science and really the history of medicine has caused perhaps the most fundamental shifts in how humans actually live. It's changed the way we actually live in the sense that it's changed our social, economic, political interactions by, with the example of vaccines, it's given us perhaps doubled our lifespan.
00:17:57
John Gartside
But Diane, to get back to the actual science, can you please explain what is this concept of the standardisation of medical practice and why is it important historically?
00:18:06
Dejan
Yes.
00:18:08
Dejan
Yeah. So, so this comes mainly from sort of Michel Foucault's essay, which is called the birth social medicine. And he makes the argument that the standardization medical practice started in Prussia, modern day Germany, for the reason that there wasn't a sort of unified, very rich, very politically able state, unlike in France and England.
00:18:33
Dejan
And so they needed to invest in this sort of science of the state and how to make the state more efficient and better and better managed. And not only did that happen with sort of having people train for civil service jobs and all of that kind of stuff, but also in the medical region.
00:18:43
John Gartside
Thank you.
00:18:51
Dejan
Exams were standardized. So there was this body that was governing medicine and was governing doctors and was governing the way people were interacting with the healthcare system. So all became a lot more standardized and a lot more efficiently run.
00:19:08
Dejan
And this is very important because it allowed a new level of control that didn't really exist previous to this. You know, if we think back...
00:19:20
Dejan
doctors were sort self-employed people who just you know gave you some remedies and maybe they were maybe they didn't but if they didn't know i could like take into account basically and with this standardization you could have a bit more control over who's actually practicing over who actually gets the knowledge and gets to share the knowledge and then this then happened as well in paris And France, because of Paris growing to being such a massive city, there needed to be people responsible for each arrondissement.
00:19:54
Dejan
And that's, again, another measure of control because Paris was such a big commercial centre. Every had a sort of person responsible for it, and then there was a person responsible for the whole region and for the whole city, et cetera, et cetera, et cetera. And that was...
00:20:09
Dejan
again, as a city with the... And Paris is a very interesting case because if you think about Paris, initially it's quite... it's basically marshland.
00:20:21
Dejan
So it's quite wet, quite drainy, which are quite bad conditions if we think about growth of bacteria, really.
00:20:32
Dejan
Stagnant water... with overcrowdedness is never a good idea. So in this time when they began to stand out and put these people in place, they also drained the swamp,
00:20:43
Dejan
They also, know, lifted houses, take care of the catacombs, take care of the bones and all that kind of stuff as well. And you have England also doing the same thing. But here Foucault's argument is that it came as a result of industrialization and sort of factory owners wanting their workers to be healthier.
00:21:05
Dejan
And that's why they implemented this system with as to improve the quality of care. If you have a standardized system, in theory, you can have a better control of the quality of care people receive. And generally that goes up because you don't have just a random guy on the street giving potions out that can kill people.
00:21:25
John Gartside
Yeah, and I think that's fascinating. And it reflects so many political and economic themes as well, the history of medicine.
HIV/AIDS Pandemic and Social Stigma
00:21:31
John Gartside
To sort of follow on with that, Diane, as with any history of medicine podcast, I imagine, and as we've already done, it's vital to discuss the pandemics and endemics which the world has endured. So perhaps we could just discuss quickly the HIV and AIDS pandemic and then the COVID-19 pandemic.
00:21:54
John Gartside
These are obviously two pandemics which have happened far more recently in human history, but also had quite profound impacts in a social and political sense. The HIV pandemic we can start with, and this was obviously the first recognised case being in 1981. And it was pandemic which was very disproportionate in the sense that it largely affected sub-Saharan Africa people who injected drugs. And it was one of the most monumental, I think, moments just from someone doesn't know a lot of history, who's not about history of science, but has lightly looked into it. It revealed so much about history, about medicine, in a social sense. I think it was the stigma surrounding it.
00:22:40
John Gartside
And also perhaps this sense of there are developments in medicine and science. in which one cannot solve. Nowadays there's more prevention and treatment mechanisms for things like HIV and AIDS, but when it was this global pandemic, it appears to be nowadays that there really did not seem to be a solution. The NSO studies biology, what is the situation? What was this HIV-AIDS pandemic like?
00:23:08
Dejan
Yeah, so HIV is virus that then causes the disease of AIDS. So when HIV becomes developed, then it's AIDS. And AIDS this autoimmune disease, as it stands in the name, that basically means that your own body attacks you and that your immune system doesn't work to the level it should. So you've a weakened immune system which can...
00:23:34
Dejan
which isn't able to fight against any infection so you're much more likely to be infected by small things so for example a flu could be fatal which is obviously not the case for most people and it's got really big quality of life issues but also HIV is not a disease that is contagious in the sense that you know
00:23:56
Dejan
you then it's not contagious in the same way that COVID is. It's not contagious in the sense that you cough and or you shake hands.
00:24:05
John Gartside
No respiratory.
00:24:06
Dejan
It's not a respiratory thing. It's not a droplet thing. It is a very active thing. Either it's through blood or through semen. It's it's it's yeah.
00:24:17
Dejan
So people weren't really aware of that or there was this sort of bad stigma around as you've mentioned and that's why i think we had this sort of blowing out of proportion of how uh serious the pandemic was because developed countries the risk for most people was about zero i mean unless you lived unless you worked in a dangerous field such as being a doctor or a nurse or social worker where you could be exposed unless you are sex worker unless you had unprotected sex or you
00:25:00
Dejan
injected yourself with reused needles and drugs, you didn't really have a risk of getting the virus. But the issue was that it was so, because it was so severe, people were so scared that it began to ostracize these people. But again, this isn't new. I mean, leprosy was the same. And leper colonies existed all throughout the 20th century.
00:25:20
Dejan
And Leprosy, again, isn't really a very contagious disease to the point that you have to isolate people on a separate island or in a separate city, which did happen. And it happened for thousands of years.
00:25:34
Dejan
And I think that AIDS, HIV pandemic was very similar.
00:25:39
John Gartside
Yeah. And yes, but quite differently, as you described there, a disease which was far more easily spread was the COVID-19 pandemic.
COVID-19's Societal Transformation
00:25:49
John Gartside
It's a pandemic which I'm sure all our listeners, I'm not just sure that I'm certain all our listeners know very well because it's something we've all experienced and it's generations generations.
00:26:01
John Gartside
for in the 20th century it's our monumental moment in the history of medicine so just refresh everyone because it's gone by pretty quickly but it was in on the 23rd of March 2020 when when official restrictions such as the notable lockdown were placed upon people in the United Kingdom. However, COVID-19, hence the name 19, had been lingering perhaps largely in the UK from the December 2019
00:26:32
John Gartside
And it was really monumental moment in the history of the world. It saw this economic almost shutdown because everyone just retreated into their houses. It was perhaps quite unusual for the economy because it saw the evolution of this digital age.
00:26:50
John Gartside
We record our podcast digitally And for those who don't know, it's a system that's very like Zoom.
00:26:52
Dejan
Yeah.
00:26:58
John Gartside
And Zoom, you know, really Zoom during COVID-19 economically in the sense that no one had really heard of it before. It was a bit of niche product, but it became fundamental part of human life during the COVID-19 pandemic.
00:27:13
John Gartside
As did things like online shopping, which were already important, But the convenience and the dependence upon that was really highlighted. So, Diane, to conclude the episode, could you please touch on COVID-19 and its medical side, but also its impact for society at large?
00:27:31
Dejan
Yeah, so COVID is a very interesting one because it is... Obviously, the mRNA vaccine was sort of piloted with COVID and that was a huge victory for science.
00:27:45
Dejan
But also COVID gets a lot of bad rep for being exaggerated. Now, some people say it was exaggerated on purpose as a means to control. I disagree with that. I think it exaggerated a little bit, maybe, at the start, because people were unsure they were dealing with and didn't know what to do. And, you know, for very good reason, if you have people dying, you're going to get very panicked very quickly because you don't know what to do. You don't know what this virus is. takes a while to get adjusted to it.
00:28:17
Dejan
And maybe were the measures a bit too punitive, especially in closing schools and that kind of stuff? Probably. Maybe. I don't know. I'm not, you don't think we're qualified to say. But what I think is extraordinary about COVID is that it completely changed everyone's working habits.
00:28:33
Dejan
Everyone's entertainment habits.
00:28:33
John Gartside
Yeah.
00:28:35
Dejan
As I've said, Netflix boomed.
00:28:38
John Gartside
Yeah.
00:28:44
John Gartside
Yeah.
00:28:46
Dejan
People just went so much more digital, as you've mentioned, Zoom, and there's so many other platforms that sort of blew up during the COVID pandemic and everyone had to adapt.
00:28:58
Dejan
The education system had to adapt.
00:29:02
Dejan
So I think, I think COVID is probably going to be, I think the most important event of our lifetime, to be honest.
Conclusion and Listener Engagement
00:29:09
John Gartside
And it was slightly draconian in the sense that just to look at it from our perspective now, were locked in our houses.
00:29:11
Dejan
Yeah.
00:29:16
John Gartside
We even had limited hours of outside time. It was almost like perhaps being in a prison, one could say, in that sense.
00:29:20
Dejan
Yeah.
00:29:25
John Gartside
But as you mentioned there, Diane, and this to go back to Fernand Braudel's structure of history, As you were describing, the COVID-19 pandemic had effects upon all areas of society and marked this huge fundamental change in how we live, really in the transitioning towards a digital era.
00:29:46
John Gartside
And that shows the importance of the history of medicine. It enacts fundamental changes in human life, human interactions and everything else from politics to economics.
00:29:59
John Gartside
So we hope you enjoyed the episode today. We've touched on a few pandemics as well as delving into, especially Diane, the real scientific side behind the history of medicine, how vaccines work and the standardisation of medical practice.
00:30:15
Dejan
Thank you for listening. And if you enjoyed the episode, do leave us comment, a review, or just a like and a share. We'd be very grateful to you. And we look forward to seeing you next week.
00:30:27
John Gartside
See soon.
00:30:28
Dejan
Bye-bye.