2. A Very Brief History of Science and Medicine

The history of science and medicine are important because knowing the past helps us to understand the present. This chapter aims to put the present into perspective. It shows how much has been known for a very long time, the fundamental errors that have been made over the years with dogma based on unproven ideas and how difficult it can be to correct those errors.
This section is divided into the following headings:

If you wish to go directly to any of the topics, click on the blue underlined title above.

Those who fail to learn from history are condemned to repeat it.
Sir Winston Churchill

Introduction

This is not a definitive history of science and medicine. A vast tome would fail in this. I have called it a very brief history but even this truncated version is quite long. Something that has been “fact” or “accepted wisdom” for many years may be fundamentally wrong. As Sir William Osler (1849-1919) observed, “The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday becomes the wisdom of Tomorrow”. Much of scientific advance is based on overcoming dogma of previous generations. The author and film maker Michael Crichton (1942-2008) said, “Science is based on evidence and proof, not popular consensus”.

Rodin’s the thinker

The Ancient Greeks were ardent thinkers and they had advanced mathematics but they did not experiment. The Age of Reason saw much ancient dogma toppled by observation and experimentation. Many of the experimenters were skilful technicians and this led to the practical man and the Industrial Revolution. Science is not a quest to prove a point but a search for the truth. However, scientists are humans and often have human foibles. They are unwilling to see their pet theory disproved or to miss the fame and glory of being the one to make a significant advance. Robert Youngson’s book 1(Scientific Blunders) may sound like an anti-science book but it is far from that and shows how human frailty has resulted in wrong ideas over the centuries.

The term scientist is relatively new and was coined by the British philosopher William Whewell (1794-1866) in 1833 at the request of Samuel Coleridge (1772-1834), the British romantic poet. The romantic movement was not anti-science. They saw it as the way to elucidate the wonders of the universe and to improve living conditions for all. In the past scientists were called natural philosophers. At the University of Glasgow, it was only in 1986 that the Department of Natural Philosophy changed its name to the Department of Physics and Astronomy.

The Ancients

Primitive man developed tools and experimented to find the best and most effective. He learned to harness fire and how to use it to keep warm and to cook. He soon learned its dangers but he did not reject fire because it had some dangers. Instead he learned how to maximise benefit and minimise risk. Nothing is completely safe. This is an important principle and we must learn to balance benefits and risks in all things.

A Stone Age spear

Early man was a hunter and gatherer but as he developed he learned how to cultivate crops and to herd animals. As life became less of a struggle for existence, leisure time developed and civilisations began.2 (Jacob Bronowski. The Ascent of Man. BBC books. First published 1973. Latest edition 2011) A number of other species live in communities, often with a hierarchy. A few have learned to use implements. A number of animals communicate by sound but none with the sophistication that we call language. No other species has developed civilisation. No other species has religion.

Man was starkly vulnerable to the seasons, to weather and to natural phenomena. He could see his vulnerability and worshiped gods in various forms, begging the deities for benevolence and freedom from droughts, floods, earthquakes and plagues. He noted the changing seasons and the cycles of the moon and stars. He started to build and this required a degree of mathematics to calculate what was required. Plato (427-347BC) argued that knowledge of mathematics is essential to understand the natural world.

Stonehenge was built about 5,000 years ago but different parts at different times

There were large stone constructions across Europe in the Neolithic period. Stonehenge was erected about 5,000 years ago.3 Stonehenge website About 500 years later stones were brought in from the Preseli Hills in Pembrokeshire, West Wales which is about 150 miles away. It was an amazing feat of engineering for its time but it was also constructed with geometrical accuracy. The sun’s trajectory is shown with sunrise in midsummer and sunset in midwinter.

It is an enormous ancient calendar. For early man in northern temperate climates, it is important to know when to plant and when to reap. However, a recent archaeological investigation suggested that the stones were used for healing.4 The healing stones: why was Stonehenge built?

History is not dry facts, but it is open to interpretation and misrepresentation. Most sources are not the original as that would have decayed or become unusable, but copies made over the centuries. How reliable and accurate are the copies? There are always two sides to a story. A caveat of historians is that history is written by the victors. In more recent years we may add that war criminals appear always to be on the side of the defeated. The dictum is generally true but the tribes who attacked and plundered the Roman Empire in its last days did not write history, but the Romans did. Hence our view of the Goths, the Vandals and the Huns may be of people rather more primitive than they really were.

The earliest pyramids were built about 4,600 years ago, in the bronze age, but with amazing accuracy.

The Ancient Egyptians would erase from all steles or monuments the name of anyone who fell from favour. An example is Akenhaten, the father of Tutankhamen, who dismissed the many gods of Ancient Egypt in favour of a monotheistic system.5 Akhenaten and the Amarna Period. Another was Pharaoh Hatshepsut, one of several female pharoahs. The Romans would also erase the undesirable from history and they used the term “damnatio memoriae” from which we get the word “damnation”. The Ancient Greeks however, erected zanes which were statues of Zeus on which were inscribed the misdeeds of those who cheated in the Olympics such as bribing an opponent to lose.6 (Sex and drugs and sport and cheating by Paul Anthony DB Publishing 2014. Page 22.) These were the original “name and shame”.

We all know about good King Richard and bad King John, but this is unfair. Richard had no interest in England except as a source of revenue for his foreign exploits. Richard was fighting the Pope’s crusade and so Papal propaganda made him a hero but I am not suggesting the John was a good guy. It was well known that Richard III was a hunchback. Shakespeare makes much of it in his play. Contemporary pictures and writing give no evidence of any deformity and it seemed likely that this was just Tudor propaganda. However, his skeleton was found under a car park in Leicester and it is obvious that he had a marked scoliosis or sideways deformity of his lumbar spine, not the mythical hunchback of a kyphosis or forward and back deformity of the thorax.7 DNA confirms skeleton under Leicester car park to be Richard III. We must consider the source of our information before passing judgement. This will be considered later with regard to papers “ghost written” by pharmaceutical companies or the tobacco industry.

The Abu Simbel Temple of Ramesses the Great at Aswan in Egypt.

Most ancient civilisations were born in the more salubrious climates. With less concern about mere survival there is more time for the finer things in life. The Ancient Egyptians were aware of their dependence on the inundation of the Nile and their religious ceremonies were orientated towards this. The temple of Abu Simbel was built around 1244BC during the reign of Ramses II. The temple complex was arranged so that on 22nd February and 22nd October, the pharaoh’s birthday and the anniversary of his coronation respectively, the light of the rising sun would enter the temple and illuminate the statue of the pharaoh in the inner sanctuary.8 Abu Simbel: Temples of Ramesses II

When the Aswan Dam was built the rising water threatened to submerge the temples and they would be lost. Each temple was cut into large blocks and moved 65 metres higher and 200 metres back to be reassembled and fixed together with concrete. Despite careful positioning of the temples both in relation to each other and to the sun, it was not possible for modern engineering to reproduce the accuracy of the ancient builders and the sun no longer illuminates the statues on those anniversaries but a day later. However, as the sun will shine in twice a year regardless of the alignment, these original anniversaries may not be as exact as we presumed.9 Sun to Illuminate Inner Sanctuary of Pharaoh’s Temple. Each temple had a priest who was educated in reading and writing, in arithmetic and geometry, in engineering, astronomy and the calculation of time.

The pyramids of ancient Egypt were built during the Bronze Age. Bronze tools were used to cut the stones before they were dragged into place up ramps.10 Building the Great Pyramids. Wheels were not used. The Incas of South America never developed the wheel before Europeans arrived. The oldest known wheel probably dates to 3500BC in Mesopotamia.11 Invention of the Wheel. The oriental civilisations were rather ahead and India may have been even earlier. The Egyptians appear to have had wheels on chariots from about 1600BC and they had spokes rather than being of solid wood.

Three of the greats: Socrates’ pupil was Plato and his pupil was Aristotle.

The Greeks were renowned as both philosophers and mathematicians. They estimated Pi (π) to be able to calculate the circumference or area of a circle from its radius. They calculated the area of a cone and work recently uncovered that had been hidden for many centuries suggests that Archimedes (circa 287-212BC) even invented calculus many centuries ahead of Sir Isaac Newton.12 (Netz, R, Noel W. The Archimedes Codex.) Greek philosophers expounded rationalism, the theory that reliable knowledge and ultimate truth can be obtained through reason, evidence and logic. Three of the greats of that era were Socrates (470-399BC) whose pupil was Plato (427-347BC) whose pupil was Aristotle (384-322BC). However, their philosophy was based on theory and they shunned practice. Thought and mathematics were for philosophers but practical application was fit only for slaves. This led to many errors as theories were not tested.

Galileo never mentioned the Leaning Tower of Pisa in his writings.

Aristotle believed that a heavy object would fall faster than a light one. This was untested but it was accepted until Galileo (1564-1642). Legend has it that he dropped two objects of different weights simultaneously from the Leaning Tower of Pisa and they hit the ground together.13 Falling Bodies. However, it is unlikely that he used the Leaning Tower of Pisa as it is not mentioned in his writings. He probably used two different weights on a slope but he did rectify Aristotle’s mistake.

Ever since the pupils of Plato, philosophers have agreed that it is impossible to be absolutely certain about anything. Something may be beyond reasonable doubt but nothing is absolutely certain. This is an important scientific principle but it may seem strange, coming from the people who brought the concept of theorems in geometry and their proof.

Benjamin Franklin (1705-1790) the American inventor and politician wrote, “There are only two certainties in life, death and taxation”. The 20th century philosopher Karl Popper also advised that we can never be absolutely certain about anything. Therefore we can never prove anything. The best we can do is to show that despite having tried to disprove something, we have failed. This technique will be discussed in a later section.

Even in religion, that usually boasts absolute certainty, the Greeks were careful. They built the Pantheon to all gods, not just one.14 The Greek Pantheon. When St Paul addressed the Court of Areopagus in Athens he said, “I noticed among other things an altar bearing the inscription, ‘To an Unknown God’. What you worship but do not know. This is what I now proclaim.”15 (Acts of the Apostles, Chapter 17, v23. New English Bible.)

It is often thought that people believed that the world was flat and this prevailed until the time of Christopher Columbus. This is untrue. Observation from a cliff shows a round horizon and as a tall ship approaches the top of the mast is seen first, then the rest of the mast and finally the decks. Similarly, from the ship the cliff disappears from the bottom upwards as it sails away and then there is just a circular horizon of sea. Pythagoras suggested that the world was spherical in the 6thcentury BC. In the 4th century BC Aristotle agreed. Presumably, millennia ahead of Sir Isaac Newton, they understood that gravity attracts towards the centre of the earth or people in the southern hemisphere would fall off.

Eratosthenes (circa 276-194BC) was head of the great library of Alexandria. By reading books he was aware that at the summer solstice the sun was overhead in Syene. This is the Ancient Greek name for Aswan in Egypt. On that same day he noted the length of a shadow cast by a pole at midday in Alexandria and he calculated the angle of the sun. He knew the distance from Syene to Alexandria which is almost due north, and from his figures he calculated the circumference of the earth. His result was very close to modern calculations.16 Eratosthenes – Measuring the Circumference of the Earth in 240 BC

Eratosthenes calculated the circumference of the earth and his result is close to modern estimates

Shortly before Eratosthenes, the Greek scholar Aristarchus of Saros, also working in Alexandria, postulated that the earth revolved around the sun rather than the other way round. This was many centuries ahead of Copernicus and Galileo.

The “four corners of the earth” probably represents north, east, south and west rather than a belief in a flat, quadrilateral earth

The opponents of Christopher Columbus’ voyage at the Salamanca Council did not base their argument on the assumption that the world was flat but that Columbus had underestimated its size and the sailors would die for lack of food or water before they reached land.17 They all laughed at Christopher Columbus Columbus had estimated the earth to be about half its actual size.18 (When the Earth was Flat. By Graeme Donald.) The theological argument for the earth being flat is that in the Book of Revelation it refers to “the four corners of the earth”19 (The Book of Revelation. Chapter 7 verse 1) and so it must be a quadrilateral.

All ancient civilisations studied the skies. They noticed the cycles of the moon. They noticed how stars moved. The stars that moved together were the Milky Way but the others are not stars but planets. The ancients noted that Mars, Jupiter and Saturn move in the same direction as the other celestial bodies but then their course reverses. As the skies were observed and it became possible to predict events, the science of astronomy was born. However, it was common to believe that other significant events could be foretold and astrology began.

The Star of Bethlehem was probably far less prominent than Christmas cards would have us believe

The Magi who visited the infant Jesus were obviously wealthy and educated men but not kings. The nature of the Star of Bethlehem is still debated. Theories include a nova which is a cataclysmic nuclear explosion caused by the accretion of hydrogen onto the surface of a white dwarf star, which ignites and starts nuclear fusion in a runaway manner. Other theories for the Star of Bethlehem are a comet, a planet or a conjunction of planets. 20 The Star of Bethlehem

The Antikythera mechanism was discovered in 1900 in a ship wreck from Ancient Greece. It shows that the Ancient Greeks had great technical skills to build this mechanical computer that was more complex than anything known for the next 1,000 years. 21 The Antikythera Mechanism Research Project It would seem to be a clock and a navigation device based on the stars. More than a century after its discovery its precise use is still being examined.

With the fall of the Roman Empire, the Dark Ages descended on Europe, but the Roman Catholic Church became more powerful and important not only politically but as the font of knowledge and wisdom. Few people could read and most that could were within the hierarchy of the Church. The words clergy and clerk have a common origin. For a very long time most education was through the auspices of the Church. The splitting of Christianity into the Roman Catholic and Eastern Orthodox divisions resulted in much loss of Greek learning to the west. A few tracts had been translated into Latin.

The Prophet Mohammed died in AD632 and within a century there had been a considerable spread of Islam. Its academics emphasised observation and experimentation far more than did their Christian counterparts. They studied writings from Greece, Persia and India. An Arabic scholar called Ibn al-Haytham (965-1039), better known as Alhazen wrote a “Book of Optics” in 1021.22 Optics The basis was observation followed by hypothesis and then testing of that hypothesis. This approach was way ahead of his time. He had great influence on the thinking of Sir Isaac Newton.

Science requires mathematics as Plato insisted and a numerical system must be friendly for calculation. The Ancient Greeks used a decimal system but whilst Roman numerals may look impressive to give a date on a monument, they are very impractical for calculations.

Try this simple calculation:

0263
+451
=714

Now try this:

CCLXIII
+CDLI
=DCCXIV

That was just a simple addition. Imagine long multiplication or long division. What we call Arabic numerals has origins further east, especially in India. It may seem strange that the concept of zero in mathematics rather than as a philosophical entity is comparatively recent. It probably originated in Mesopotamia around 3BC, but it did not take hold in European mathematics until the 12th century.23 The origin of zero

Aristotle expounded the theory that all matter was based on four elements. These were earth, water, air and fire. Combined in various proportions they could produce any substance. However, this may date back to Empedocles (circa 495-435BC). We still believe in the basic building blocks of elements but not those elements. Hippocrates (circa 460-370BC) argued that there were four basic humours in the body. These were black bile, yellow bile, phlegm and blood. A balance was required for health and imbalance produced disease but also certain types of personality. This has persisted in our language and people that we describe as melancholic were said to have too much black bile, the phlegmatic had too much phlegm and the sanguine too much blood.

Bloodletting was done by the Ancient Greeks, Egyptians and the Mayans of Mexico. It was used until the late 1800s.

From this comes the notion that if illness is due to an imbalance of these humours, then correction will lead to recovery. Thus blood-letting and purgation were used over many centuries in an apparently logical manner. This is attributed largely to the teachings of Galen (circa AD131-200). He came from Pergamum in Greece, studied medicine at Alexandria in Egypt and went to Rome to revive the ideas of Hippocrates and other Greek doctors. 24 Claudius Galen In a later section we shall discuss how treatments can be tested for efficacy and safety and that just because a treatment has been around for a long time does not mean that it works.

The Greek word hystera means uterus and is the origin of both hysteria and hysterectomy. Hippocrates thought that hysteria was unique to women and caused by movement of the uterus from its normal place. 25 Hysteria and the wandering womb

The goddesses Hygeia and Panacea were the goddesses of health and healing respectively. From their names we get hygiene and panacea, a cure-all.

Hippocrates is seen as the father of medicine.

Hippocrates was the best known of the ancient physicians. He is known as the father of medicine. He taught his pupils to observe. A little more observation and less reliance on laboratory investigations would not go amiss today. He believed in a rational approach. “Men believe only that it is a divine disease because of their ignorance and amazement.” However, he is most renowned for setting the ethical basis of medical practice although it is suspected that he did not write the Hippocratic Oath. 26 The Hippocratic oath

Hippocrates also realised that the brain was the seat of thought and that epilepsy is a disease of the brain rather than possession by an evil spirit. 27 Origins of neurosurgery However, Aristotle taught that the heart was the seat of rational thought and the soul. This teaching persisted until the time of William Harvey. We still associate hearts with love. We say “Use your head, not your heart”.

Both the Caduceus and the Staff of Asclepius are used as medical logos in the modern world.

The oldest known treatise on surgery is called the Edwin Smith papyrus and dates from the 17th century BC in Ancient Egypt. 28 The Edwin Smith Papyrus It reports 48 cases and shows good insight into the structure and function of the brain.

Building the pyramids and temples resulted in head injuries and the ancient physicians observed the injury and the result and drew valid conclusions. However, it is often said that this knowledge was not shared by the embalmers who carefully preserved the heart in situ whilst removing the brain down the nose and discarding the bits. Other organs were preserved in canopic jars. This theory is disputed with evidence from 18th dynasty mummies when the embalmer’s art was at its height. X-rays and MRI have shown that the brain remains in place, although markedly shrunken by the embalming process.29 MRI and Multinuclear MR Spectroscopy of 3,200-Year-Old Egyptian Mummy Brain This involved natron, a very concentrated salt and sodium carbonate solution which extracted water from the corpse by osmosis.

However, I have since seen reports that have used CT scans to examine the heads of mummies of pharaohs and nobles from Ancient Egypt, and they find that there is no evidence of brain remaining in the skull. The ethmoid bone has been fractured to facilitate scraping out the brain. I think that we can still assume that this was standard practice.

The Renaissance

The most influential figure over the centuries was not Hippocrates but Galen (AD129-210). Although Galen’s method was based on observation and experimentation, much was lost with an emphasis on dogma that persisted for many centuries. He conducted dissections and vivisections on animals and extrapolated his findings to humans. He clamped the ureters of living apes, causing the kidneys to swell, from which he concluded that the kidneys produce urine. He cut or stimulated spinal nerve roots to show which muscles they controlled. 30 Galen. Greek Medicine This may seem diabolical treatment without anaesthetic by today’s standards but anaesthesia did not exist. It laid a firm foundation of knowledge.

Roman law forbade human dissection or autopsy. A few of the Ancient Greek physicians had dissected humans but most confined their studies to animals. It is widely believed that human dissection was illegal in the middle ages and that Leonardo da Vinci had to hide his activities in that field. In medieval Christianity, dissection was often practiced.31 Debunking a myth However, it does seem that superstition and taboos limited its use. Licences to dissect humans were granted to universities by the Pope.32 History of the Warfare of Science with Theology in Christendom

The red and white barber’s pole outside the shop

Great Britain is the only country in the world with the tradition of calling surgeons Mister rather than Doctor. This is inverted snobbery from the days when surgeons were not medically qualified. They were barbers who were used to handling sharp instruments. Before that the clergy performed operations. However, at the Council of Tours in 1163, the clergy were forbidden to draw blood or to act as physicians and surgeons claiming that it was sacrilegious for ministers of God to draw blood from the human body. 33 Council of Tours Without this ruling perhaps we would be calling our surgeons Reverend. The red and white barber’s pole represented blood-stained bandages hung out to dry. Blue was added later, to represent veins, it is said.

Vesalius was meticulous and and revolutionised knowledge of anatomy

The dogma of Galen was beyond reproach through the centuries although even anatomy was wrong. Andreas Vesalius (1514-1564) took dissection to a new height. He obtained many bodies from a variety of sources, even reputedly cutting one down from a gibbet to take home a fresh specimen for dissection. He published many books and the accuracy of his anatomy is excellent.34 Andreas Vesalius and the Challenge to Galen Now Galen was challenged and a new approach to medicine was ready to unfold.

Ptolemy (AD100-170) was an Egyptian astronomer and mathematician of Greek descent. He declared that the earth was the centre of the universe and that the sun, the moon and the known planets all rotated around the earth. He agreed with Aristotle that the perfect motion for heavenly bodies was a circle. This was not a problem for the moon and the sun but the required orbits of the planets around the earth produced some rather tortuous patterns.

Nicolaus Copernicus

Nicolaus Copernicus (1473-1543) had a novel model with the sun as the centre of the universe. The moon rotated around the earth but the planets and the earth rotated around the sun. He had considerable opposition from academic and philosophical circles and his book De Revolutionibus was deemed heretical by the Church in 1616 which was 73 years after his death. It was placed on the list of prohibited books whilst “pending correction”. It was not just the Roman Catholic Church that was critical. Martin Luther (1483-1546) was scathing of Copernicus in 1539. John Calvin wrote, “Who will venture to place the authority of Copernicus above that of the Holy Spirit?”

I think that the heliocentric view of the universe is theologically more sound than the geocentric one. The geocentric one puts the earth, representing man or the ego, at the centre of the universe whilst the heliocentric view puts the sun, representing the light of the world or God at the centre. Without the sun, the light of the world, there would be no light, heat or life. The philosophers and theologians regarded man as God’s greatest and ultimate work. Man has an enormous potential but often behaviour leaves much to be desired. This includes the sort of arrogance that leads to the dogma of the geocentric theory of the universe.

The Bible shows the way to heaven, not the way the heavens go. Galileo Galilei

Galileo Galilei (1564–1642) took many observations from Middle Eastern and oriental astronomers and made a more cogent case for Copernicus’ theory. He published several books with a well-argued case which landed him in direct conflict with the Church of Rome. Despite poor health he was summoned to Rome to appear before the Holy Office of the Inquisition. There is controversy and uncertainty about exactly what happened at Galileo’s trial and how many times he had to appear but it is agreed that he was made to kneel and recant his teachings. “I abjure with a sincere heart and unfeigned faith, I curse and detest the said errors and heresies, and generally all and every error, heresy, and sect contrary to the Holy Catholic Church”.35 (William R. Shea and Mariano Artigas. Galileo in Rome: The Rise and fall of a Troublesome Genius.) Galileo avoided being burned at the stake but he was placed under house arrest before he was allowed to retire to his villa in Arcetri, outside Florence. There he finished his final book Discourses on the Two New Sciences but he avoided mentioning Copernicus in it.

The belated statue of Galileo in the Vatican

Copernicus was rather more fortunate than Galileo for two reasons. Galileo was later and this was the time of the paranoia of the counter- reformation. The other reason is that his work was not taken very seriously. However, even the Roman Catholic Church could not continue to deny that the universe is heliocentric (sun at the centre) rather than geocentric (earth at the centre) indefinitely and in 1980 Pope John Paul II ordered a new look at the evidence. In 1992, Galileo was acquitted. It took them 12 years to decide that Galileo was right. This was 23 years after men walked on the moon. The Church’s response to the rehabilitation of Galileo has often been criticised as half-hearted. A statue to honour him has at last been erected but funded by public donations.36 Vatican recants with statue of Galileo

The Sacred Congregation of the Universal Inquisition was founded by Pope Paul III in 1542. Its name was changed to the Sacred Congregation of the Holy Office in 1908 and to The Congregation for the Doctrine of the Faith in 1965.37 Vatican website It is different from the Spanish Inquisition. A recent head was Cardinal Josef Ratzinger, better known as Pope Benedict XVI. Although it no longer has people tortured and burned, it is still a substantial force for conservatism. He has been accused of condoning the heresy verdict 38 Galileo protest halts pope’s visit but he has since denied this and praised Galileo. 39 Pope Praises Galileo

A satire of the ceiling in the Sistine Chapel, showing God giving Adam a condom

That is not to suggest that the Vatican now embraces science. Even the Irish Tribune News was scathing as it reported in 2009: “Pope Benedict XVI has put himself in the eye of yet another international storm with his patently untrue declaration in Africa last week that condoms do not prevent the spread of Aids.” The World Health Bulletin found that whilst condoms are not 100% effective in preventing sexually transmitted diseases they afford a considerable degree of protection and are much better than nothing. 40 Effectiveness of condoms in preventing sexually transmitted infections Italians have also criticised this stance whilst the world tries to combat the spread of AIDS. 41 Aids, physicians, Catholic Church The Church argues that condoms will not even stop spermatozoa, so they have no chance of stopping the much smaller virus 42 Pope wrong on condoms The latex of condoms is not permeable to spermatozoa or viruses. If they were useless and permeable to spermatozoa there would be no point in the Church of Rome opposing their use.

A source very close to the late Pope John Paul II, Monsignor Carlo Cafara, Dean of the Institute for Marriage and Family Studies at the Vatican, told a conference that when one partner of a married couple is positive for HIV, it is preferable to risk catching the AIDS virus than to use condoms. 43 Papal policy, poverty, and AIDS This is a needless waste of human life and it means that instead of children losing one parent they lose both.

The Enlightenment and
the Age of Reason

The Church, particularly the Church of Rome, is usually seen as having been antagonistic to science and to progress. Whilst this view is not without some foundation, it is far from wholly true. The idea of either science or God as if one excludes the other is a recent and undesirable concept. Both the Roman Catholic scholars and the Protestant ones of the Age of Enlightenment saw themselves as trying to elucidate the wonders of God’s creation. They did not see themselves as showing that science rather than religion explains the universe, making God redundant.

Many of the great minds in history have been polymaths rather than specialists. They were highly intelligent people who had skills in languages, art, philosophy and mathematics as well as natural philosophy to use the usual name before the word science was invented. Some, like Leonardo da Vinci, were also wonderful artists.

Roger Bacon was unappreciated for centuries

One such polymath was Roger Bacon who was probably born between 1214 and 1220 and died in 1292. He became a Franciscan Friar and his linguistic skills enabled him to read the works of Aristotle and Plato as well as the Arab writers including Alhazem. He embraced empirical observation and theory based on it. His works included optics, reform of the calendar and alchemy. In 1267 Bacon presented to Pope Clement IV, at the pope’s request his Opus Magnus or great work which outlined his scientific method in the context of theological and philosophical thought. However, it was not published in its entirety until 1897, some 620 years later. His contribution was not original work but a collation of knowledge from Ancient Greece, from the Middle East and India. China was too distant to be an influence until at least the time of Marco Polo. The Chinese had gun powder and used it in warfare. They also invented the printing press and paper way ahead of the west.

Dr Faustus was based on a real person

To regard alchemy as the quest to turn base metal such as lead into gold is simplistic. There was far more philosophy, experimentation and recording of results. Dr Faustus (1480-1520), who was immortalised in the play by Christopher Marlow, really did exist. He had fallen out with the local clergy who accused him of being in league with the devil. He may have been experimenting with glycerine, boiling it with acids in a quest for the elixir of life when he met his end. If he boiled glycerine with nitric acid, he would have produced nitro-glycerine many years ahead of his time, and the resultant explosion would have been so destructive that the clergy were able to claim that the devil came for him and took him away.44 (When the Earth Was Flat: All the Bits of Science We Got Wrong)

Evolution

Church and science were in conflict again in the second half of the 19th century and this time it was the Church of England. Charles Darwin (1809-1882) had been an unpaid naturalist on the voyage of HMS Beagle to map the South American coastline. The voyage took five years and included the wonderful Galapagos Islands. He returned in 1836. The Islands were far enough from the mainland for species to be developing separately. Darwin could see how species might develop within a habitat and that any survival advantage that they had would predispose them to succeed and to breed whilst those with disadvantages would perish.

Statue of Charles Darwin in the Natural History Museum, London

His thesis was carefully studied and documented with examples and evidence. He published many books 45 Charles Darwin online but he was reluctant to publish his most famous work because he knew how much controversy it would cause. It was called On the origin of species by means of natural selection, or the preservation of favoured races in the struggle for life.46 Origin of Species They did not like short, catchy titles in those days. He eventually published in 1859 when he heard that another author was about to publish a similar theory. He suggested that various species had evolved from others but he failed to go the final step to include the evolution of man. However, this was a step that took no great leap of imagination. He was right about the predicted outcry.

Samuel Wilberforce and TH Huxley

His health was failing and it was left to his followers to support his position. The most famous of these encounters was between TH Huxley and Samuel Wilberforce, Bishop of Oxford, at the British Association in Oxford on 30 June 1860. Darwin’s views were in danger of being overwhelmed by a mass of misrepresentation. The bishop was known as “Soapy Sam” after Benjamin Disraeli had described him as “unctuous, oleaginous, saponaceous” (slippery, evasive and soapy). He was an impressive public speaker of the “hell and damnation” school of preaching. Wilberforce’s speech is generally noted only for his question as to whether it was through his grandmother or his grandfather that Huxley considered himself descended from a monkey. Thomas Huxley replied that he would not be ashamed to have a monkey for his ancestor, but he would be ashamed to be connected with a man who used his great gifts to obscure the truth. Darwin was not present but the exchange was reported to him.

Darwin died having lost his faith in God but this was not because of the Theory of Evolution or recalcitrant clergy. He had ten children, two of whom died in infancy and his daughter Annie died at the age of ten. It was the loss of Annie that affected him most profoundly and made him question the benevolence of God.

Gregor Mendels’ work was unrecognised until 1900

Gregor Mendel (1822-1884) was ordained to the Augustinian order of monks in 1847. He spent two years at the University of Vienna where he trained as a teacher but he failed the course. Nevertheless, his studies gave him the necessary skills that were so important to him when he returned and started to observe the offspring and hybrids of peas. His work was published but in an obscure journal and he was not a recognised scientist. It was largely ignored until 1900 when three botanists independently verified his findings. 47 Gregor Mendel He is regarded as the father of genetics. He had to be surreptitious about his studies as the bishop would not let the monks teach biology. It seems reminiscent of the attitude towards sex education when I was at school.

Jean-Baptiste Lamarck

Darwin did not understand how characteristics were transmitted from one generation to the next. The works of Gregor Mendel had been published but were not recognized until after 1900. He was tempted towards the theory originated by Jean-Baptiste Lamarck (1744-1829) that characteristics such as a lean physique from exercise or large muscles from heavy work were transmitted to the next generation. This theory would suggest that a man who has lost a leg would father children with just one leg. Observation shows this to be untrue. For thousands of years and through hundreds of generations, Jewish boys have been circumcised at the age of eight days. Still their sons are born with foreskins. We now know that what happens to an individual in life, such as a mutilation or exercise, does not affect the genes. If it did, babies should be born with the knowledge possessed by their parents. An understanding of DNA and its role in the genetic code did not occur until the latter part of the 20th century.

In 2009 Archbishop Gianfranco Ravasi, head of the Pontifical Council for Culture, said that while the Church of Rome had been hostile to Darwin’s Theory of Evolution in the past, the idea of evolution could be traced to St Augustine and St Thomas Aquinas. 48 Vatican claims Darwin’s theory of evolution is compatible with Christianity This sounds like someone looking for excuses. As early as 1951 the Church of Rome had embraced the Big Bang Theory but that was really because it was so easily compatible with the concept of a divine order to start creation. 49 (Stephen Hawking in A Brief History of Time. p55)

John Scopes at his trial

Opposition to the Theory of Evolution continued, especially in the “Bible Belt” of the USA. In 1925 the Tennessee Evolution Statutes was passed which forbade the teaching of Darwin in any state funded school in Tennessee. A prosecution of a teacher called John Scopes later that year led to national ridicule for the state. 50The Scopes Monkey Trial, 1925 The trial lasted eight days. The judge told the jury that it was a crime to teach evolution in that state and after nine minutes they found him guilty. He was fined $100 which was a great deal of money then. This was overturned by the Tennessee Supreme Court the following year but only on a technicality. Even in 1999 the School State Board in Kansas passed by six votes to four a new curriculum that eliminated the teaching of evolution. 51 Kansas rejects theory of evolution

At the time of writing, the five American states of Florida, Illinois, Kentucky, Mississippi and Oklahoma all have no references to evolution in their state school curriculums, according to the National Center for Science Education. They look to the Bible and claim that the world is about 6,500 years old and certainly less than 10,000 years. Bishop James Ussher, (1581-1656) was Bishop of Armagh and Primate of all Ireland and he diligently counted back to calculate the age of the earth based on the Bible. His conclusion was that the earth was created on Sunday 23rd October 4004BC.52 The world born in 4004BC? Both geology and carbon dating show that this cannot be true. This shows the absurdity of taking a source such as the early books of the Old Testament and treating them as historical documents.

This picture is from 1925 but in some parts of the USA little has changed in terms of
attitude and enlightenment.

In many ways the USA is a very advanced and developed country but in many others it is really quite primitive. It still has the death penalty in a number of states, a feature which excludes any potential applicant for the European Union. Despite some of the best healthcare in the world, about 15% of the population have inadequate or no insurance cover although there have been some attempts to change this despite massive opposition. It has the highest maternal mortality in the western world despite nearly 1 in 3 deliveries being by caesarean section.

In the UK, the Theory of Evolution is not taught in many Moslem Faith Schools. Their excuse for the lack of sex education is also pitifully inadequate. Christian extremists and Moslem extremists have much in common in terms of ignorance and bigotry. From 2014, evolution became a compulsory part of state middle school education in Israel but it is unlikely to find its way into more conservative religious schools.

Natural selection is not random selection but survival of the fittest

A new pseudo-science has appeared called “intelligent design”53Intelligent Design which claims that life is not the result of random selection but is arranged by a greater being. Darwin did not use the term “random selection” but “natural selection” or “survival of the fittest”. This is far from random but the term shows either failure to grasp the basics or intentional misrepresentation. They claim that anything as wonderful as creation could not have been formed by accident. They quote Einstein, “God does not play dice,”54 God does not play dice by Stephen Hawking but this is taken out of context and relates to quantum mechanics. The idea that random or chance means totally unpredictable is wrong. Otherwise there would be no science of statistics. Even chaos has rules and there is a new maths called chaos theory that is in its infancy but it aims to find the rules of chaos theory as statistics has uncovered probability.

They say that God does not take risks, and yet He gave man freedom of choice, which must be the most enormous risk ever. Creation is far from perfect. It is the fittest who survive. If everything was designed for its current function, why are there vestigial organs such as the appendix in humans or the wings of flightless birds and why do snakes have a pelvis and vestigial limbs? Creationists like to present themselves as reasonable people who are persecuted by the intolerant who believe in evolution. They pretend to be scientifically robust in their methods but there is neither scientific validity nor an open mind, only an underlying neo-conservative political agenda. It is typical of fake news and “alternative facts” to accuse their opponents of having the vices that they embody.

Thomas Malthus is often misunderstood and misrepresented

An important influence at the time of Charles Darwin was the Reverend Thomas Malthus (1766-1834). He argued in his book “An essay on the principle of population”55 Malthus on population in 1798 that if the population in an area was more than could be supported, it would be culled by war, pestilence or famine. He influenced the thinking of Darwin. Unfortunately, his work has often been interpreted as a condemnation of the poor for overproduction of children and suggesting that welfare will only encourage indolence and unbridled reproduction. It has also been used as the rationale for eugenics as practised by the Nazis, trying to eradicate all those whom they deemed as undesirable or inadequate.

Evolution by natural selection takes many generations and in humans with a rather long generation this takes a very long time. There are two good examples of natural selection within a much shorter time.

The generation time for bacteria is very short; perhaps even a couple of hours. The fungus Penicillium produces an antibiotic to kill bacteria that may be competing for nutrients but some bacteria, especially Staphylococcus aureus can produce an enzyme called penicillinase that destroys penicillin. Methicillin is a synthetic penicillin that is resistant to pencillinase. MRSA means methicillin resistant Staphylococcus aureus. Do not take the following figures as factual but simply as numbers to illustrate the point. Suppose that one in a million Staphylococcus aureus normally has the gene that confers methicillin resistance. It is not normally a favoured gene as it confers no advantage. However, if there is an infection of perhaps 100 million bacteria and penicillin is used they will all be killed except for those that are resistant. Of the 100 million, just 100 will survive. They will reproduce rapidly and the result will be a resistant strain. If the antibiotics are withdrawn this advantage if removed and so the resistance is no longer favoured and the resistant bacteria will again become a small minority. The moral is that whilst antibiotics are invaluable, their injudicious use will result in resistance but it can be reversed by withdrawing them.

However, the new science of epigenetics suggests that the idea of mutation may not be quite correct. Epigenetics will be discussed fairly briefly in the genetics section of Basic Maths in Medical Research and Decision Making. Epigenetics concerns switching genes on and off. It may even be that Lamarck was not entirely wrong and acquired characteristics can be brought to the next generation.

The peppered moth, light and dark

The other example of evolution both ways, or possible epigenetics, is the peppered moth.56 Truth in Science It was a light grey mottled colour and lived on the trunk of trees. The trees had lichen on their bark and the colour of the moth afforded excellent camouflage so that birds could not see it and so would not eat it. In the Industrial Revolution smoke from factories killed the lichen and turned the tree bark black. The grey moths were now visible and eaten by birds. However, a number developed a darker colour and this adaption allowed them to be camouflaged against the now black bark. The species had undergone change. In 1956 the Clean Air Act removed the pollution and gradually the lichen returned to the trees and their old colour returned as the smoke disappeared. Now the lighter moths are at an advantage and we now have the old colour of the peppered moth again. Like MRSA, this is an example of natural selection and evolution there and back.

Ideas and Technology

Sir Roger Bacon

To return to The Age of Enlightenment, one of the most influential figures was Sir Francis Bacon (1561-1626), not to be confused with the monk Roger Bacon or Francis Bacon the 20th century artist. He was both Attorney General and Lord Chancellor under James I of England, VI of Scotland. He promoted a methodical approach to new knowledge and discovery. His book Advancement of Learning in 1605 was highly critical of universities and other seats of learning that “hunt more after words than matter.” In his fictional work New Atlantis published in 1620, he described an isolated island in which research was conducted for the good of the community. Bacon saw change. The new method was simple experimentation and explanation. The philosophical interpretation was omitted. Often experiments were witnessed by an audience so that not one, but many minds could be turned to discussing a logical explanation for what was observed.

Harvey, like Darwin after him, realised that his work would cause ructions and so he waited 12 years before making his work public.

A man who observed this principle was William Harvey (1578-1657). Galen had viewed the body as consisting of three connected systems. The brain and nerves were responsible for sensation and thought. The heart and arteries gave energy or “vital spirit”. The liver and veins were responsible for nutrition and growth. Galen proposed that blood was formed in the liver from food that had been carried there from the stomach and intestines by the portal vein. Blood entered the veins and was carried to all parts of the body by an ebb and flow. There it was consumed as nutrient or transformed into flesh. Blood was constantly consumed and replenished by the right ventricle and great veins. The left ventricle produced pulses of blood in the arteries which absorbed “pneuma” or spirit from the lungs. The blood in the left ventricle oozed through from the right ventricle through pores in the septum, the wall between the chambers although these pores were too small to be seen. The function of the “vital” arterial blood, distinct from the “natural” venous blood, was to deliver pneuma or spiritus vitalus to the peripheral tissues. Arterial and venous blood had separate purposes and did not mix.

Leonardo da Vinci had made some excellent drawings of the heart and its valves but he had not taken the next step of seeing that Galen’s view was false. As the theories of Galen were the dogma of the day and considering where he was working and for whom, this was wise or he may have suffered the fate of Galileo or worse.

In 1628 William Harvey published Anatomical Essay on the Motion of the Heart and Blood in Animals better known as De Motu Cordis. By simple experiment he showed that the beating heart could empty the entire circulation in a matter of minutes. Therefore, presumably the blood came back. His work on veins was elegantly simple and can be performed on the living human without danger or distress.

This shows how to massage blood out of veins and demonstrate that it can flow in only one direction.

Ask a friend to bear his arm and to hold it horizontally, perhaps clutching something like a broom handle. Apply a band or tourniquet to the upper arm and note how the veins fill. Place both index fingers on a vein, exerting a moderate amount of pressure. Keep the lower one still and move the one nearer the top of the arm to massage out blood in the direction of the heart. Notice how this empties the vein. Remove the upper finger and see that the vein does not fill from above. Remove the lower finger and see how it fills from below. Again place both index fingers on a vein and try to massage the blood to empty the vein away from the heart. This does not work. Blood will flow in only one direction in veins.

Harvey had noted the valves of the veins and the valves of the heart. They allow flow in one direction only. If a very tight tourniquet is applied to squeeze the arteries, the veins will not fill and the arm goes white. This is evidence that blood from the arteries fills the veins. Harvey did not know how the blood went from the small arteries back to the veins and he postulated something like a sponge.

It took the development of the microscope to demonstrate capillaries and this was done by Marcello Malpighi in 1661, shortly after William Harvey’s death.

Technology was important in scientific advancement. Galileo had a great advantage over the ancients as he had a telescope. The microscope enabled us to see better how the body works and to understand the germ theory of disease. In the past technicians were seen as artisans and of a rather lower order than the academic natural philosophers. In the Industrial Revolution this changed. We need both theory and practice.

The great polymath, Sir Isaac Newton, looking rather like Brian May from Queen. He is seen as the father of modern science but he is also called the last alchemist

In 1660 the monarchy was restored after 11 years of puritan rule. Times had been austere with fun virtually outlawed. Oliver Cromwell banned the celebration of Christmas. People could reflect on the significance of the birth of Christ but they were not permitted to eat, drink, dance and be merry. Charles II (1630-1685) ascended the throne and some gaiety and colour returned to life. In 1660 he founded the Royal Society to encourage scientific knowledge of astronomy, biology, geographical exploration, navigation and seamanship. He founded the Royal Observatory at Greenwich in 1675, home of Greenwich Mean Time. The Royal Navy was formed in 1660 and in 1664 he inaugurated the Royal Marines.57 Royal Navy Museum The Navy was refurbished. In 1666 the Great Fire of London destroyed a vast amount of the city and new buildings were designed by modern architects. Sir Christopher Wren was a renowned astronomer and polymath who put his talents to architecture, designing St Paul’s Cathedral and many other churches and buildings in London.

It is a sad reflection that most people remember Charles II for his mistresses and illegitimate children rather than the many great achievements of his reign.

From that time science bloomed. There were far more scientists doing far more work of scientific merit and this almost exponential growth has continued to today. The first Curator of Experiments at the Royal Society was Robert Hooke who was a gifted technician as well as a researcher. He gave us with Hooke’s Law of elasticity. The society was as interested in technology as it was in pure science.

Sir Isaac Newton (1642-1727) was an early president of the Royal Society. He was seen as one of the foremost scientific intellects of all time. His work included optics, mathematics including the introduction of calculus as well as mechanics and gravity. He was also interested in alchemy and is called “the last alchemist”. There was much philosophy involved but the mood was a move to scientific and rational experimentation.

He wrote on Judaeo-Christian prophecy arguing that the first Council of Nicaea propounded erroneous doctrines of the nature of Christ in the 4th century AD. He became Member of Parliament for Cambridge University, opposing the plans of James II to make the universities into Catholic institutions. He informed Edmond Halley, the discoverer of Halley’s Comet, that heavenly bodies move in an ellipse rather than a circle. His work with prisms showed that the light is split into colours and can be reinstated as white light by a second prism. A single colour from a prism cannot be split or changed by another prism. These colours are components of light and not inserted by the prism.

Newton’s work with prisms helped to understand the nature of light

Light was often thought of as being particles but Newton showed that it was a wave form instead. We think of it as having no mass but Albert Einstein (1879-1955) proposed that if light passed close by a large celestial body it would be bent by gravity. He was proved right at an eclipse of the sun on 29th May 1919. He also proposed that a body with an enormous mass would have such an intense gravitational pull that even light would be unable to escape. He called them black holes. His equation E=mc2 is well known. E is energy, m is mass and c is the speed of light which is a very large number, so that squared is an enormous figure. Hence a miniscule amount of mass produces a phenomenal amount of energy.

The most famous face in science

There is an apocryphal story that Albert Einstein was sitting in a restaurant with a friend when someone came up and asked him for his autograph. He obliged but then moaned to his friend about being famous and recognised wherever he went. “You could start by getting your hair cut,” advised his friend. Einstein did not take the advice but perhaps he really did like being famous and recognised.

Sir Frank Whittle developed the jet engine

The best known of Newton’s Laws of Motion is the third one. For every action there is an equal and opposite reaction. This is the principle of the jet engine that was invented by Sir Frank Whittle (1907-1996). Exhaust is expelled backwards from the engine causing a reaction that drives the engine forwards. This allows propulsion in the rarefied upper atmosphere and even in space. In the long jump in the Ancient Olympics the competitors had weights in their hands. These weights, known as “halteres”, were thrown backwards as the athlete leapt through the air to help propel him forwards.58 Ancient Greece Olympics Perhaps Archimedes had done some athletics coaching and was ahead of Newton with his third Law of Motion as well as the invention of calculus.

The Industrial Revolution

Science progressed at a great pace with far fewer fundamental errors than in previous times. James Watt (1736-1819) did not invent the steam engine but he considerably improved it so that it required 75% less coal. The first steam engine is often attributed to Archimedes but it was actually designed by Hero or Heron of Alexandria (circa AD10-85). Its design suggests a jet engine throwing out steam to achieve an equal and opposite reaction. It was used to open the large, heavy doors of temples. 59 The amazing steam engines of the first century. This reference also shows how the steam engine was used to open the doors.

Hero’s steam engine.

Coal and steam powered the industrial revolution. Working on the land was not idyllic but hard and insecure. Many workers left for the metropolis to find employment in the new factories. Hours were long and conditions very unsafe but at least it was a job. Mechanisation of agriculture followed to cope with the fewer workers left on the land. Mechanisation of agriculture was the result, not the cause of the movement of labour from the country to the cities.

For centuries before the industrial revolution young men had set off for the cities hoping to find the streets paved with gold. What they really were paved with was rather more disgusting. There was no sewage system and animal and human excrement ran down the streets. Waste from butchers’ shops and tanneries lay in the streets. It was extremely unpleasant and a great threat to health. As cities grew the problem grew. It is often suggested that the motor vehicle is responsible for much pollution whilst before it all was clean and fragrant. This ignores how we travelled and what powered transport. It was necessary to shovel more than 10,000 tons of horse excrement from the streets of London every year. Crossing the street was very unpleasant and people were still killed or injured in road traffic accidents.

Death on the Thames

The vast improvement in the health and life expectancy of the population is due more to improvements in social conditions than to advances in medicine. Improving health and safety at work and reducing the risk of famine are important but a good sewerage system is the most important of all. The hot summer of 1858 produced “the great stink of London”. Parliament was unable to sit and politicians had to start talking about excrement, instead of just talking a load of it. London suffered epidemics of cholera and in 1853 and 1854 more than 10,000 Londoners died of the disease.

The London sewers were a massive piece of engineering

Joseph Bazalgette (1819-1891) (pronounced Bazal Jet) was appointed as chief engineer to the Metropolitan Board of Works in 1856 and he was charged with building a new system. It was vast and expensive but the only solution. His scheme involved 1,000 labourers building more than 85 miles of brick sewers beneath London and it took eight years to complete. 60 Smells like Thames sewage The flow of foul water from old sewers and underground rivers was intercepted, and diverted along new, low-level sewers, built behind embankments on the riverfront and taken to new treatment works. 61 Bazalgette and London’s sewage In the old days they were really just pumping stations and not like modern sewerage treatment works. Instead of dumping London’s waste on its own doorstep, they took it downstream and dumped it in the Thames estuary. Nowadays we have sewage treatment plants. It was a massive piece of Victorian engineering and most of it remains today as part of the London sewerage system although in need of attention after so many years.

The water pump in Soho is now a public monument

Dr John Snow (1813-1858) is regarded as the father of epidemiology for his piece of detective work in a cholera outbreak in Soho in 1854. He took a street map and marked where all those who were affected lived. From it he deduced that the source of the outbreak was the water pump in Broad Street. He rapidly convinced anxious officials to have the handle removed from the pump in Broad Street and this swiftly ended the epidemic.

The plague doctor

People associated foul stench with disease and thought that it was the smell that caused disease. In the light of current knowledge, it was a reasonable assumption. People would carry posies or orange peel not just to give something more pleasant to smell but to ward off disease. This illustrates the fundamental principle that association and causation are not the same and this theme will be visited often in later sections. The plague doctor in the picture looks quite frightening. The beak would contain orange peel and aromatic herbs to cover the stench and supposedly to protect him from the disease that it caused. Something like the plague doctor mask can be found in Venice to wear for Carnevale.

The nursery rhyme “ring a ring of roses” mentions “a pocket full of posies”. 62 Historic Nursery Rhymes. The sneeze followed by “we all fall down” was not a cold but the plague. The word “malaria” means “bad air” in Italian. It was thought to be due to the bad air around marshes. From the 16th to the 18th century there was malaria in England. 63 Malaria in England

Not all diseases are due to infection. Navigation had advanced considerably and long voyages were undertaken but scurvy was a major problem. The remarkable navigator Ferdinand Magellan (1480 -1521) sailed around the world but lost 80% of his crew, mainly to scurvy.

In 1747 a Royal Navy ship’s surgeon called James Lind on board the Salisbury conducted what was probably the first controlled trial of a treatment. He had twelve sailors with scurvy and he divided them into six groups. Two had a quart of cider a day. Two others took elixir of vitriol (a mixture of sulphuric acid, alcohol, and aromatics, usually ginger and cinnamon) three times a day. Two others took two spoonfuls of vinegar three times a day. Two were put on a course of sea water. Two others each had two oranges and one lemon every day but only for six days as this was all that could be spared. The two remaining sailors took “the bigness of a nutmeg three times a day of an electuray made of garlic, mustard seed, rad raphan, balsam of Peru and gum myrrh, using for common drink narley water well acidulated with tamarinds, by a decoction of which, with the addition of cremor tartar, they were gently purged three or four times during the course”.

Some of these treatments sound quite horrific. He concluded, “The consequence was that the most sudden and visible good effects were perceived from the use of the oranges and lemons; one of those who had taken them being at the end of six days fit for duty.”

The report of 1753 is recommended to read. 64 A Treatise on the Scurvy in Three Parts The full name of the work was: A Treatise of the Scurvy in Three Parts. Containing an inquiry into the Nature, Causes and Cure of that Disease, together with a Critical and Chronological View of what has been published on the subject. Again it was not a pithy, catchy title.

James Lind invented the clinical trial

Lind’s work was seminal but not the first. In 1593 Admiral Sir Richard Hawkins advocated drinking orange and lemon juice to prevent scurvy. In 1614 John Woodall, Surgeon General of the East India Company, published “The Surgion’s Mate” for apprentice surgeons aboard the company’s ships. He described scurvy and recommended fresh food or, if not available, oranges, lemons, limes and tamarinds, or as a last resort, Oil of Vitriol (sulphuric acid). That last resort is totally useless. It took the admiralty forty years to implement Lind’s recommendations and other navies took even longer.65 James Lind They were swift to sneer, coining the name “limeys” but meanwhile, Britannia ruled the waves.

Not all innovations required high technology. Simple observation can produce good ideas. Josef Leopold Auenbrugger (1722-1809) was the son of a wealthy innkeeper. He had seen his father tapping barrels to indicate how much wine was left in them and in 1754 he used this technique for tapping chests to see if there was fluid in them. This was common with tuberculosis and severe heart failure. Auenbrugger published his discovery in Vienna in 1861 in a book entitled A New Discovery that Enables the Physician from the Percussion of the Human Thorax to Detect the Diseases Hidden within the Chest. Again it was a tortuous title. He described the characteristics of different diseases of the chest. He was also a competent musician with a good ear for tone but this is not essential to elicit this clinical sign.

Doctors would place their ear directly on the chest of a patient to listen to the sound of the heart and lungs. A French physician and inventor called Rene Laennec (1781-1826) is credited with inventing the stethoscope, the doctor’s badge of office. In 1816 he saw some children playing near the Louvre. The children placed their ears to the ends of long pieces of wood to listen to the transmission of soft sounds such as the scratching of a pin from the other end. Laennec rolled sheets of paper into a cylinder and applied this roll to a patient’s chest with his ear pressed to the other end. It worked and he began to experiment with other materials. His final design was a hollowed-out cylinder of wood, about 30cm long and 4 cm wide. He coined the name stethoscope from the Greek word stethos for chest and scope for see or watch. An American doctor called George Cammann invented the modern stethoscope with two earpieces in 1852.

Laennec undertook a massive project to categorize heart sounds in disease. He identified their causes by conducting autopsies when the patient died. He gave names to sounds that are still used today, such as rhonci and râles. Basically, rhonci are wheezes and râles are crackles. His classic work De l’Auscultation Mediate was published in 1819. This book has been called one of the most important in medical history.

The ancients attributed sickness to evil spirits. In biblical times it was seen as divine retribution for sins. “Your sins are forgiven,” Jesus would say as He healed people. Even the Son of God had to conform to social expectations. Still today the idea that certain diseases such as AIDS are divine punishment for a type of lifestyle has backing, including from people who ought to know better. 66 Moral beliefs of physicians, medical students, clergy and lay public concerning AIDS. An understanding of what caused infectious diseases would have to wait until after the invention of the microscope.

Early microscopes were not like today’s

In the first century the Romans realised that glass could have magnifying properties but eye glasses were not invented until the 13th century. In the 1590s a Dutchman called Zacharias Jansen with his father Hans started to experiment with using more than one lens, called a compound microscope. 67 History of the microscope This produced much greater magnification. Robert Hooke used magnification to make some amazing drawings in his Micrographia of 1665. Some credit him with invention of the compound microscope but it was the Dutchman Anton van Leeuwenhoek (1632-1723), who made the most progress as he managed to develop lenses of much better quality than before. Whilst other struggled to obtain magnification of x50 he achieved x270 and was the first person to see bacteria.

Robert Koch

This was not a “eureka” moment when he realised that he had discovered the cause of so many diseases. Not all bacteria cause disease and some are beneficial. The average adult has about 1014 bacteria (that is a one with fourteen zeros after it) in the gut, weighing about a kilogram. There are more bacterial cells in the body than human cells. The germ theory of disease was not properly developed until the 1870s. The German physician Robert Koch (1843-1920) discovered the elusive bacterium that causes tuberculosis and was awarded the Nobel Prize in 1905. He also set the rules for deciding if an organism is responsible for a disease and today these are known as Koch’s Postulates. They are:

  • The microorganism must be found in abundance in all organisms suffering from the disease, but should not be found in healthy organisms.
  • The microorganism must be isolated from a diseased organism and grown in pure culture.
  • The cultured microorganism should cause disease when introduced into a healthy organism.
  • The microorganism must be re-isolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.

However, even Koch abandoned some of his postulates at times. They are not fulfilled for syphilis, leprosy or new variant Creutzfeldt–Jakob disease. They are a guide rather than a rigid law.

Ignaz Semmelweis

About thirty years before the germ theory was established a Hungarian doctor called Ignaz Semmelweis 68 Ignaz Semmelweis (1818-1865) was Director of the maternity clinic at the Vienna General Hospital in Austria. It was well known amongst the patients that those who were delivered by medical students or doctors were much more likely to develop puerperal fever. This is when infection travels up into the mother’s pelvic organs. Even today, with antibiotics, it is a very serious condition. Then it carried a very high mortality. Medical staff went from patient to patient without washing their hands and even from the dissecting room to patients without washing. He insisted that all staff should wash their hands before examining patients. He also insisted that different clothes were worn for the dissecting room and the wards. He had to be very persistent and aggressive to get this rule followed. This is unsurprising considering that the infective nature of puerperal (childbed) fever was not generally accepted. It is difficult enough to get medical staff to use an antiseptic hand gel between patients today. They used chlorinated lime that was much more unpleasant than modern alcohol based gels. Nevertheless, he achieved a substantial reduction in the incidence of the infection.

Although he became known as the “saviour of mothers” he did not get the acknowledgement due from his colleagues. He had to move to another hospital where he employed the same regimen and achieved the same results. Semmelweis was again heavily criticised and lost his job. He was declared insane and taken to a lunatic asylum where he was beaten by the staff and died from his injuries. Dissident voices are rarely welcomed and not just in totalitarian states. In the old Soviet Union dissidents were often declared insane.

Louis Pasteur

The germ theory is attributed to a French chemist named Louis Pasteur (1822-1895). He found that liquids such as beer and milk went bad because of the growth of micro-organisms. Heating could destroy these organisms and the process now known as pasteurisation was born. He also found that bacteria were responsible for the decay of solids such as meat. He argued that this could explain disease as well as decay, if disease was caused by the multiplication of germs in the body. He investigated his theory using silkworms and went on to develop a new form of vaccination. He discovered by chance that germs which had been weakened by long exposure to the air caused immunity to cholera in chickens.

Edward Jenner vaccinates James Phipps

He did not invent vaccination. This accolade goes to Edward Jenner (1749-1823). He was a country doctor who knew the old wives’ tale that milkmaids did not get smallpox. On 14th May 1796 he inoculated fluid from the pustules of cowpox into a boy called James Phipps, the son of his gardener. On 1st July 1796 he infected him with smallpox but, much to the relief of all, the boy did not develop the disease. 69 Edward Jenner Museum This may be a landmark but it was a grossly unethical experiment. In 1774, some 22 years before Jenner, a farmer in Gloucestershire called Benjamin Jesty intentionally gave cowpox to his three sons and pregnant wife to protect them from smallpox. 70 First recorded vaccination The story came out when the farmer had to call the doctor as his wife became rather ill. Today we regard pregnancy as a contraindication to vaccination as the virus can affect the baby and cause stillbirth. The Chinese may have had something rather similar to vaccination as early as AD900. 71 NHS Choices

Vaccination is a general term often used for all immunisations although strictly it refers to giving vaccinia (cowpox) to prevent variola (smallpox). Most viruses are fairly limited in which species they will infect and cowpox does not normally cause more than a very mild illness in humans. However, as this virus has antigens in common with smallpox it will induce immunity against that disease. Other vaccines often use weakened “attenuated” forms of a virus or a toxin that has been treated by heat or in another way to make it harmless whilst still inducing immunity. Smallpox affects humans only. This means that if it can be eradicated from humans it can be eradicated totally. In 1980 the World Health Organisation announced the global eradication of smallpox. This is the first time that such a disease has been conquered.

The popular cartoonist James Gilray shows cows spurting from the bodies of those who have been vaccinated in a print of 1802. Absurd claims about vaccines are nothing new.

By modern standards smallpox vaccination is not a very safe immunisation procedure but its achievements speak for themselves. However, this did not prevent some wild and ridiculous opposition in the early days or with other immunisations in years to come. 72(Durbach N. Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907 )

Advances in Surgery

In the 19th century surgery was very dangerous with a very high mortality. The nearest to an anaesthetic was to give the patient a bottle of rum before an amputation. It was a “smash and grab” as the patient could die from the shock. Surgeons would pride themselves on their speed. They wore their blood-stained frock coats as a badge of pride to indicate their experience. Trauma was not the only risk. Sepsis after operations was common. Pasteur’s work on micro-organisms influenced Joseph Lister (1827-1912). He experimented with dressings soaked in phenol, also called carbolic acid. It is an effective antiseptic but a rather nasty chemical. He experimented with hand-washing, sterilising instruments and spraying phenol in a fine mist over the wound whilst operating. The results were very good.

Since then we have moved from antiseptic surgery to aseptic surgery, using clean instruments, gloves and clean environments rather than antiseptics. Joseph Lister and colleagues used surgical gloves and gowns but these were not so much to protect the patient from infection as to protect their hands and clothes from the carbolic acid. 73 Gowns, gloves and clothing Even in the 1920 gloves were not always changed between patients. 74 Science Museum, surgery The Science Museum gives an interesting history of surgery. Both the website and the museum are well worth a visit.

Antiseptic surgery reduced mortality from infection considerably.
Note the phenol spray to the left of the picture.

The other great advance in surgery around that time was the introduction of anaesthesia. James Young Simpson (1811-1970) pioneered the use of anaesthesia in obstetrics. There was still a belief that relieving the pain of childbirth was to interfere with the will of God and in the past a woman who gave pain relief in labour could have been burned as a witch. Previously, alcohol, opium or narcotics were used but their effectiveness was variable and overdose and death was common. 75 Science Museum, anaesthesia They also sedate the baby and may impair breathing when the child is born. Acupuncture was commonly used in China and Japan. A Japanese doctor called Seishu Hanaoka (1760-1835) used a formula based on traditional Chinese herbs in 1804. It contained atropine and scopolamine that are drugs still used today. Simpson used chloroform and is said to have given it to Queen Victoria for relief during childbirth. Ether was used and nitrous oxide and over the years much better and safer techniques have been developed. The development of anaesthetics has been fundamental to the development of surgery.

Advances in surgery were impossible without advances in anaesthesia

It is said that when a layperson is to have an operation he asks who the surgeon will be but a doctor in a similar position will ask who the anaesthetist will be. The failure to understand the pivotal role of the anaesthetist is well illustrated in the black comedy MASH about a mobile army surgical unit in the Korean War. Surgery is performed by four eccentric but wonderfully able surgeons whilst the anaesthetic for all four of them is provided by just two people, neither of whom is even medically qualified. They are the padre and Klinger, the transvestite corporal who is trying to work his ticket home with a psychiatric discharge. Some modern television series give the impression that hospitals are staffed by surgeons with the occasional anaesthetist and no one has even heard of a physician. The portrayal of hospitals in films and television shows a lot of dramatic licence.

The 20th Century and Beyond

If a person has lost so much blood that it endangers life it makes sense to replace it. This clearly logical step was often tried, usually with catastrophic results, especially when the donor was an animal. It was not until 1901, when the Austrian Karl Landsteiner (1868-1943) discovered the ABO blood group that blood transfusions became a practical issue. This was further improved when the Rhesus blood group (named after Rhesus monkeys) was discovered in 1940 by Karl Landsteiner again but in association with Alexander Wiener. It was also important in understanding and preventing Rhesus disease in new-born babies. This can include a range of problems including severe jaundice that can cause brain damage from kernicterus and stillbirth from heart failure. 76 Rhesus disease

We must be grateful to blood donors

Not only does blood transfusion save the lives of those who have lost much blood, but without it, much surgery would be unimaginable. We must be grateful to the many blood donors, all unpaid volunteers in the UK, who give their blood to help strangers.

Pierre and Marie Curie

As always, pure science has been mixed with the practical issues of technology to produce real benefits for society. Wilhelm Conrad Röntgen (1845-1923) discovered x-rays in 1895 and received the first Nobel Prize for physics in 1901. Pierre and Marie Curie made notable discoveries and she paid the price by dying from a radiation induced disease. Today we would say that the early experimenters took absurd risk with exposing themselves to radiation but, back then, no one knew of the dangers. Many others also paid the price.

Computerised tomography (CT) scans, also known as computerised axial tomography (CAT) along with magnetic resonance imaging (MRI) have produced images with such detail that they look like a picture from a textbook of anatomy. Linear accelerators can produce precise and targeted x-ray treatment for cancers. Now, proton beam therapy is even more accurate and can kill tumours with minimal collateral damage. Ultrasound has transformed diagnosis, especially in obstetrics and the clarity with which a tiny unborn baby can be seen is quite amazing. Electron microscopes that can produce images of particles far smaller than can be seen by light microscopes have allowed the discovery of viruses.

Ultrasound of 11 weeks fetus.
The detail is amazing and it is without the dangers of x-rays.

Modern imaging gives quite astounding clarity and resolution.

On the left, a CT scan gives a wonderful image of the brain.
On the right an MRI scan gives even better definition.

The concept of “animal magnetism” or electricity has been around since about the 16th Century but to make sense of it required an adequate electrometer. 77A Concise History of the ECG Willem Einthoven (1860-1927) invented a string galvanometer that enabled him to investigate the electrocardiogram and he described the basic features that we know today. His string galvanometer weighed about 600lbs or around 270kg. A modern ECG machine weighs a few kilograms. The electrocardiogram (ECG) has made an enormous difference to the management of heart disease. Some American sources call it the EKG although more recently they also call it ECG. EKG is not because Americans spell cardiac with a ‘K’ even if they do spell oesophagus and oestrogen without an ‘O’. It is from the German. Modern machines are light and accurate and can even give a computer generated diagnosis. However, it is a rash doctor who does not check that he agrees with the machine’s opinion.

Penicillium mould. Note the area around with no bacterial growth

The story of the discovery of penicillin is too well known to repeat but Sir Alexander Fleming’s (1881-1965) discovery was only the beginning. It took Howard Florey (1898-1968) and Ernest Chain (1906-79) to convert an interesting observation into an industrial reality. Vaccines and antibiotics have dramatically changed the importance of the infectious diseases as killers in developed societies. Control of infection and knowledge of immunology has permitted transplants. Cardio-pulmonary bypass machines allow the heart to be stopped whilst it is repaired.

Fibreoptic technology has revolutionised both diagnosis and treatment. Minimal access surgery, colloquially called key-hole surgery, is common. There is not room to expand on these important innovations but they reduce the trauma of surgery and so speed recovery as well as giving a better cosmetic result.

There is no room here to discuss the remarkable history of birth control but a website from the Family Planning Association is recommended. 78 Contraception past and present Effective condoms and other barrier methods were not available until after the vulcanisation of rubber by Charles Goodyear in 1839. Before that condoms had been made from skins. The originator is often said to be Giacomo Casanova who formed condoms from animal’s intestines to protect against syphilis, called the great pox. However, one of the pictures in William Hogarth’s The Rake’s Progress is said to show a condom over the back of a chair. The Rake’s Progress was painted when Casanova was just 7 years old. Condoms to prevent sexually transmitted diseases go back much further. The Egyptians used linen condoms about 1000BC. King Minos of Crete was said to have used a goat’s bladder around 3000BC. 79 The story of the condom

The original painting, now in the Sir John Soanes Museum is almost a mirror image of the print and there is no condom over the chair. In both, the whores have black spots on their faces which are supposed to suggest syphilis.

The early condoms were to prevent sexually transmitted diseases rather than being used as contraceptives.

A print of William Hogarth’s The Rake’s Progress. I think the condom is over the chair where the prostitute is sitting to adjust her stocking in the right foreground.

Marie Stopes (1880-1958) was a great pioneer of birth control. 80Marie Stopes This caused outrage from the Church, especially the Church of Rome, politicians and also from doctors. In 1921 she opened the first family planning clinic in Holloway in London for married women. Even in the 1960s getting family planning often required the pretence of being married.

The origin of oral contraceptives (the pill) is interesting. It was said that the hormones were originally developed as a treatment for infertility. The idea was to suppress ovulation and then, on stopping the treatment, there would be rebound excess fertility. This did not occur but someone had the bright idea that this would be a good form of contraception instead. The first pill called Enovid was released in 1960. Unfortunately it nearly fell into disrepute because of side effects but it was soon realised that the dose was several times higher than was necessary.

There are so many forms of reliable contraception, freely available, that there is no excuse for being lax

There is now a wide array of different types of reversible contraception as opposed to sterilisation, including low dose pills, pills without oestrogens, coils including those that carry a hormone, injections and implants but only barrier methods confer any protection against sexually transmitted diseases. In Holland a technique called “double Dutch” is popular with young people. It involves using oral contraceptives for highly effective contraception and simultaneous condoms to reduce the spread of disease.

Rosalind Franklin

A discovery from the 20th century that must not go unmentioned, is the elucidation of DNA. DNA or deoxyribonucleic acid is the basic substance of chromosomes and genes. It was really Rosalind Franklin at King’s College London, who discovered the double-helix shape of DNA from her work with Maurice Wilkins on x-ray diffraction. However, it was James Watson and Francis Crick at Cambridge who broke the news with a paper in Nature in 1953.81The Discovery of the DNA Structure Watson and Crick were awarded the Nobel Prize in 1962. Some people complain that Rosalind Franklin did not join them in the accolade. However, she had sadly died in 1958 and the Nobel Prize cannot be awarded posthumously.

The well-known double helix of DNA

The human genome project ran from 1990 to 2003 and it unravelled the basic information about the sequences of the three billion chemical base pairs that make up DNA.82The Human Genome Project There are just four bases called adenine [A], thymine [T], guanine [G], and cytosine [C]. Adenine and thymine always pair together as do cytosine and guanine. In 2000 both Bill Clinton and Tony Blair announced that this major international project was complete. There was hope that this would lead to better understanding of genetic conditions and with it the ability to treat them. Diseases such as cystic fibrosis and haemophilia could be treated and genetic predisposition to heart disease and other conditions could be modified. There was even talk of “designer babies” and genetically enhanced athletes. However, it all seemed reminiscent of the mid 19th century when it was thought that all there was to know would soon be known and Niels Bohr’s professor, who advised him that there was nothing left in physics to discover. They had forgotten Aristotle’s tenet that “The more you know, the more you know you don’t know”.

Gene editing in humans has become a reality. Just after Christmas 2019, The Times reported that a patient in the USA with sickle cell disease had been well for the past five months after gene editing and in Germany, a patent with thalassemia had been well for the past nine months. Previously she had required 16 blood transfusions a year.83Sickle cell patient is pain free after gene editing trial altered her DNA

Methylation of a cytosine inactivates the gene

Genetics is not so simple, and we have now moved on to epigenetics. Every cell in the body has a full 46 chromosomes and with it the full complement of DNA and genetic material. Exceptions are the gametes (sperm or ovum) which have just half and erythrocytes (red blood cells) and platelets which do not have a nucleus, but they developed from cells with one. So if all cells have the potential to become any type of cell, why do some develop into muscle cells, some skin, others nerves, liver or whatever? It seems that most of the genetic material is suppressed. This is done by methylation or adding a methyl (CH3) group to the cysteine base. Genes can be switched on by demethylation and they are also controlled by proteins called histones. Histones are regarded as not so much an on-off switch as a volume control. There is a vast amount to learn about this fascinating discovery and a good source is The Epigenetics Revolution by Nessa Carey. Another interesting on is Identically Different by Tim Spector. He has considerable experience with identical twins, who are not always as identical as supposed. Both are available on Amazon Kindle as well as in book form.

Computers

Computers have had an enormous impact on all aspects of our lives. Perhaps the first computer was the Chinese abacus. The first real computer was mechanical rather than electrical and made by Charles Babbage (1791-1871).84The Babbage Engine

The Babbage Difference Engine was an early computer.
It was mechanical rather than electrical

An enormous electrical computer with thousands of valves was built at Bletchley Park during World War II to help crack the enigma code.85 Bletchley Park. The machines It was called Colossus. In 1947 the transistor was invented by John Bardeen, Walter Brattain, and William Shockley and they shared the Nobel Prize in 1959. Compared with the valve, it is much smaller, more reliable and substantially more robust as well as using less power. It made an enormous difference to electronics in the 20th century. Both the memory and processing power of computers, including those for personal use at home, has increased astronomically.

An enormous computer called Colossus was built at Bletchley Park to help with code breaking. If one of its many valves blew it would have to be found and replaced.

In 1998 the Department of Health produced a strategy called Information for Health. It aimed to provide electronic health records for patients, online access to patient records for clinicians and information about best clinical practice for all. In 2001 a plan was produced which outlined the information and IT developments which were needed. There were nationally controlled standards and better management including a national programme. The Department for Health produced, “Delivering 21st Century IT Support for the NHS”, and the National Programme for IT (NPfIT) was born. This was to provide electronic prescriptions and other services. It would connect 30,000 GPs to 300 hospitals “providing secure and audited access to these records by authorised health professionals”. It would provide a single electronic records system for 50 million patients in England. It was a good idea. It was to be the largest computer system in the world outside the military.

This picture has the caption, “Turn off the computer and listen to the patient”

However, delays in development and rapidly escalating costs made it rather like a defence procurement programme. This was a quest into the unknown as no one had done anything liked it before, even the large health maintenance organisations in the USA. Nevertheless the project management by Connecting for Health seemed to have assumed at that it would be a smooth run with no significant problems. The initial estimate was for £2.3 billion over three years but by 2006 this had risen to £12.4 billion over ten years. The final figure would be nearer £20 billion. There has been lack of functionality. There has been failure of confidentiality with records. It has not been impressive. To run such a project with unpredictable demands requires exceptional leadership and this appeared to have been lacking. With countless delays and the budget multiplying coupled with a national debt crisis, this could not be tolerated indefinitely. The provision of medical records may seem very mundane but accurate and up to date medical records available near the patient are fundamental for good and safe treatment.

In September 2010 the coalition government asked the Cabinet Office to review the project and in September 2011, it was announced that the programme would be scrapped. 86 £11bn NHS computer project to be scrapped. An original budget of £6 billion had soared to £12.7 billion before cost-cutting and compromises chipped away at the comprehensive vision of a standardised electronic record for all patients in England. The Cabinet Office concluded that they had no confidence that the programme had delivered or could be delivered as originally conceived. There were problems with the original target dates, functionality, usage and levels of benefit. Systems already in place would be kept but delivery of others was suspended. A National Audit Office report in May 2011 found that in the North, Midlands and East of England, only 4 of 97 systems ordered had been delivered to hospitals.

Alan Turing

Computers are not just a means of storing information, but they can be programmed to manipulate this information in a way that is called artificial intelligence or AI. I do not intend to expand much on this fast-changing field or to consider the Turing test for AI, devised by the famous Alan Turing who did such wonderful war-time work in code breaking at Bletchley Park but the reference gives the reader a little more. 87 Artificial Intelligence in Medicine: an Introduction This is being developed to aid diagnosis in two important areas where the work is very demanding but, I would suggest, also very tedious but computers do not get bored.

One area is the scanning of cervical smears. This involves looking down the microscope at stained cells that have been scraped off the cervix. Abnormalities of these cells include double nuclei and abnormal staining of the nuclei. These are just cells and not blocks of tissue which is why it is called cytology and not histology. AI seems to be quite promising in this field saving manpower and giving accuracy in diagnosis. 88 Automated smear classification

The reading of mammograms for breast cancer screening is another field. 89 AI in Mammography It requires a detailed look at the pictures to detect minor changes which may indicate malignancy. It usually involves two doctors to read each film and radiology is a speciality with a greater shortage than most. I would also suggest that sitting in dim light looking at monochrome pictures is not a great way to spend the day. Again, the results are promising. AI is also looking promising for reading chest x-rays

Are protocols best practice or painting by numbers?

A company called Babylon Health has been very active in developing AI to make diagnosis or at least triage where patients may be divided into groups according to whether they need reassurance, see a pharmacist, get a routine appointment or an urgent appointment or go to an A&E department. Much of medicine is about decision making. What goes through the doctor’s mind is like an algorithm which is a pathway where the result of each question leads to the next. These pathways are used by nurses in situations such as NHS Direct and they can be very effective. Doctors tend to regard them as “painting by numbers” and the same applies to “care pathways”. Others argue that they represent best practice and so everything that deviates from them is not best practice and is hence unacceptable.

Computers are very good at following algorithms and an interesting but often controversial direction is the use of artificial intelligence in diagnosis and clinical management. Babylon have developed an app that people can use and then have a video consultation with a doctor if necessary. This has been used in London where it has been controversial because the company gets the capitation payment that a GP would normally receive, and it is claimed that Babylon are creaming off the young and computer literate, leaving the real GPs defunded and having to cope with the much more demanding group of elderly and chronically sick. Their triage and diagnosis have been compared with real doctors and found to be not quite as good but by no means awful. This can be of value in developing countries where there may be only one doctor of any kind for thousands of people, but most people have mobile phones. I find it astounding how many impoverished people from developing countries as well as refugees fleeing war zones have a better mobile phone than me.

People sometimes ask if Artificial Intelligence will replace doctors. I think that the future of AI in medicine is not one of replacing doctors but assisting them. The human input may prevent gross errors. Remember the old adage, “To err is human, but to really screw up big-time takes a computer”. There is still quite a long way to go but this is a rapid and exciting field.

Conclusion

Rudolph Virchow

This has been a rapid romp through history. It has ignored Joseph Priestley (1733-1804) and Antoine Lavoisier (1743-1796) who plagiarised much of Priestley’s work. They discovered oxygen and re-wrote Aristotle’s concepts about gases. It has ignored Ernest Rutherford (1871-1937) and the splitting of the atom. It has ignored Rudolf Virchow (1821-1902) and his considerable contribution to the understanding of pathology and disease processes. He was also a politician and did much for public health, sewage disposal, the design of hospitals, meat inspection, and school hygiene. He was a vigorous opponent of Otto von Bismarck who challenged him to a duel but Virchow wisely declined. It has skimmed over the work of James Watson (born 1928) and Francis Crick (1916-2004) along with the work of Rosalind Franklin (1920-1958) who is often overlooked, in understanding the structure and functioning of DNA. 90 Watson and Crick The role in health of scientific agriculture to provide plentiful, nutritious and affordable food must not be forgotten. This has ignored much more too but space is limited.

With such magnificent achievements one may be tempted to think that man is becoming invincible, but this is far from true. Around the middle of the 19th century there was a feeling that science had progressed so far that before long all that is to be known will be known. As a student, Max Planck who won the Nobel Prize for Physics in 1918 had been advised by one of his professors of physics not to choose physics as a career as everything had already been discovered. More than a couple of millennia earlier Aristotle (344-322BC) had expounded a philosophy that can be summarized as “The more you know, the more you know you don’t know”. We must agree with Aristotle. Ignorance, superstition and prejudice have dogged science throughout the years and this battle is far from won. Furthermore, the more we know, the more we know that there is still more to learn and then there are the ethical questions that knowledge throws up.

Remember Aristotle’s great adage.
Ask questions. Seek answers. Never accept trite explanations

Further Resources

  • History of Science, a beginner’s guide by Sean F Johnson. One World Books. Oxford. 2009.
    About 200 pages and easy to read. It gives a history of science was a more bias more towards physics, chemistry and engineering than my medical bias. It also includes some thought provoking chapters about how we interpret history.
  • The Story of Science by Michael Mosley and John Lynch. Octopus Publishing Group 2010.
    About 275 pages with many illustrations. Based on a BBC series. Easy to read and full of interest.
  • The Story of Medicine by Anne Rooney. Rosen Pub Group.
    Also about 200 pages with plenty of illustrations. Completely orientated towards medicine rather than more generally towards science. Easy to read and very interesting.
  • The Ascent of Man by Jacob Brownowski. BBC books. First published 1973 but latest edition 2011.
    Also based on a television series. A very interesting perspective of how man and science has evolved. He looks at civilisation, the progress of science, social change and the industrial revolution. He examines religion and politics. He also shows a good acquaintance with English literature. A very thought provoking read
  • The Science Museum London Website gives much interesting information.http://www.sciencemuseum.org.uk/ gives the homepage. Online science also gives some fascinating subjects at
    http://www.sciencemuseum.org.uk/onlinestuff.aspx and to learn about specific people look them up from http://www.sciencemuseum.org.uk/onlinestuff/people.aspx
    The museum in London is well worth a visit with or without children.
  • Another interesting site is http://www.nobelprize.org/
    Find out about the Nobel Prize and its laureates.
  • Belief and Medicine. Science Museum.
    http://broughttolife.sciencemuseum.org.uk/broughttolife/themes/belief
    A most readable, brief piece with the authority of the Science Museum, London
  • Health & Medicine in the 19th Century. Victoria and Albert Museum
    http://www.vam.ac.uk/content/articles/h/health-and-medicine-in-the-19th-century/
    Both the website and the museum are well worth a visit

A Selection of Quotations

The following have been confirmed from the Oxford Book of Quotations:

  • Nothing is certain in life except death and taxes.
    Letter from Benjamin Franklin to Jean Baptiste, 13th November 1789, recorded in The works of Benjamin Franklin.
  • There are three kinds of lies: lies, damned lies and statistics.
    Mark Twain attributed the quotation to Benjamin Disraeli in his autobiography of 1924.
  • If a man begin with certainties, he will end in doubt; but if he will be content to begin with doubts, he will end in certainties.
    Francis Bacon. The advancement of learning 1605.
  • The most exciting phrase to hear in science is not “Eureka!” (I have found it!) but “That’s funny!” Isaac Asimov. Professor of Biochemistry at Boston University but most known as a science fiction writer. (1920-1992)

The following are from the Internet and hence of more dubious authenticity. The name is followed by the years in which the individual lived.

  • There is no such uncertainty as a sure thing.
    Robert Burns (1759-1796)
  • Education is the path from cocky ignorance to miserable uncertainty.
    Mark Twain (1835-1910)

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Site Index

I have now completed all the chapters on this website but the project is not finished as I go back to update as required. Just click on the title in blue to go to that part of the site.

1 Introduction
2 A Very Brief History of Science And Medicine
Fundamentals of Medical Science
3 Finding Good Medical Advice and Evidence Based Medicine
4 Randomised Controlled Trials
5 Cohort or Longitudinal and Epidemiological Studies
6 Qualitative Research
7 Basic Maths in Medical Research and Decision Making
8 How Good is the Evidence?
9 Ethics in Practice and Research
Public Health Issues
10 Screening Programmes
11 Fake News and Vaccine Scares
12 Electronic Cigarettes (E-Cigarettes)
13 Motor Vehicle Emissions, Air Pollution and Health
14 COVID-19. What You Need to Know
15 What we Must Learn from the COVID-19 Pandemic
Nutrition
16 Basics of Nutrition
17 Exercise, Obesity and Diets for Weight Loss
18 Diets and Nutrition for Health and Fitness
19 Supplements
Complementary and Alternative Medicine
20 Introduction to Alternative Healthcare
21 Homeopathy
22 Acupuncture
23 Manipulation of the Spine
24 Reflexology
25 Herbal Remedies
26 Other Natural Products
27 Chelation Therapy
28 Hypnosis
29 Other Modalities of Complementary and Alternative Medicine
Some Controversial Diseases
30 Fibromyalgia
31 Chronic Fatigue Syndrome (CFS) or Myalgic Encephalitis (ME)
32 Systemic Candidiasis and Leaky Gut Syndrome
33 Mobile Phones, Masts, Wi-Fi and Electro-sensitivity
The Environment
34 Global Warming and Climate Change
35 Alternative Energy
Some Final Thoughts
36 Still Searching for the Age of Reason