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Wednesday, January 15, 2014

7 things initially rejected by the medical community

The following post was written by John Bottrell, LRT, RRT

If you work amid the medical community you may observe that things new are rarely accepted with open arms.  This is because the medical community tends to be very proud and dogmatic (stubborn).

Being proud and stubborn is both good and bad.  It's good because it prevents the medical community from jumping at every new idea.  For instance, during the 19th century their was a fad where non-physicians were selling patent medicine and marketing it as real medicine.  Most patent medicines were basically alcohol mixed with a bunch of herbs that truly did nothing more than make a patient thing they were getting the "cure all" for some ailment.

Thankfully the medical community did not buy into patent medicine, and it was this type of quackery that lead to Congress making laws regulating what can and cannot be sold as medicine.  It also lead to laws regulating who could be a physician, and who could sell medicine.

That the medical community is proud and stubborn is bad because it prevents them from accepting new ideas and new equipment that would improve their ability to care for patients.  The following are but a few examples of things that were initially rejected by the medical community.

1.  Science:  For thousands of years people believed that health and sickness was determined by the whims and wishes of the gods.  The ancient Greeks based medicine on philosophy, and created theories to rationalize how people became sick and how medicine worked.

Because the human body was considered sacrosanct, it was therefore illegal on religious grounds to tough a corpse except to prepare it for burial.  This made it impossible for physicians to learn the true nature of diseases, and which medicines worked best for them, other than making up theories, and through empirical means.

Galen was a physician of the 2nd century who wrote extensively on medicine.  Most of what he wrote was medical theories, not science.  As the Roman Empire collapsed, his words would be worshiped for the next thousand years.

In the 15th century it was common for a medical professor to read from one of Galen's books, while an assistant dissected a cadaver, showing what Galen was saying.  A bright student by the name Andreas Vesalius was attending a class one day where  Jacobus Sylvius (1478-1555) was reading from one of Galen's books.  Vesalius observed that what Galen was saying and what the assistant was showing were not the same.

By accident one day, Vesalius happened to be dissecting an ape.  He realized that what Galen was describing was the anatomy of an ape.  As it was illegal to dissect a human body in ancient Rome, Galen must have dissected apes instead as he was writing his books.  Vesalius proved Galen was wrong.

While the medical community ridiculed and rejected Vesalius, including his own teacher, Sylvius.  However, within a short period of time medical students were coming in from all over Europe to hear one of the lectures of Vesalius, whereby he dissected and described accurately what he was dissecting.

As it turned out, artists new more about anatomy at this time than physicians.  So Vesalius (1514-1564) hired artist  jan Stephen van Calcar (1499-1546) to draw the human body, and he published his book  in 1543 the first accurate book of the human anatomy: De Humani Corporuis Fabrica.

From that point on physicians slowly stopped ancient theories (such as those of Galen) and started learning the truth about the human body and the diseases that plague it.  However, progress would be slow.  Anatomy took a leap forward during the 18th century, and during the 19th century medical theory would take a back seat during the scientific revolution.

2.  Pulse watch:   The early 17th century centered around a struggle by Western men who were losing their enchantment with the old world and increasing curiosities about the truth obtained by scientific progress and thought. John Floyer (1649-1734) was born into this world in 1649 and he rejected it. He, thus, was among the members of the old school of medicine who rejected science.  He even went as far as to call physicians who believed in science as quacks.

In 1682 Andreas Cleyer's Specimen medicinae Sinicae introduced the West to the ancient Chinese method of counting a pulse to diagnose diseases.  Floyer liked this idea, and he expanded it and made taking a pulse a routine task when assessing a patient. (5)

To make the task easier he invented a "pulse watch" that had a second hand that ran for one minute.  Alex Sakula, "Sir John Floyer's A Treatise on Asthma (1698)," wrote that one of the reasons this "pulse watch" was so important for his study was because he believed that each disease was associated with a specific pulse. (1)

He wrote about his watch in "The Physician's Pulse Watch" volume 1, in 1707.  You can read about it in more detail here. The pulse watch was advanced many times even during Floyer's own life, and it soon became a popular site to see your neighborhood physician with a pocket watch. The practice of taking vitals, a pulse and respiratory rate, became commonplace.

But this did not happen before it was rejected.  Physicians were known to carry around with them nothing more than their brains, and for it to be mandatory for them to carry "a pulse watch" was ridiculous.  However, the idea was a good one, and the watch was ultimately accepted.  John Floyer became famous for introducing the watch to the medical community.

3.  Antiseptics:  Ignaz Phillipp Semmelweis (1818-1865) became an assistant in an obstetric ward in Vienna where there was such a high death rate from child bed fever that women feared to go there. 

In 1846 Semmelweis observed the death rate was higher in the 1st ward where he and his fellow male physicians worked compared to the 2nd ward where female mid wives worked.  Upon investigation he learned the women were much cleaner in appearance than the physicians, who often proudly walked around with blood stained hands and aprons. 

 The physicians also were more likely to perform postmortem investigations just prior to checking the vagina.  The women, on the other hand, did not have blood stained clothes and washed their hands in calcium chloride solution (an early antiseptic) between patients. 

When he insisted his physicians likewise wash their hands and put on clean clothes prior to checking women in child bed, the death rate fell from 9.92% to 3.8%.  The following year it was down to 1.27%.  

The proud physicians were unhappy, however, and eventually rejected Semmelweis.   After they went back to their old poor habits, the death rate once again duly rose. Yet that didn't matter, because the proud medical doctors got their way.  (4, pages 457-8)

4.  Stethoscope:  During the 1820s it was normal for physicians to place their heads to the victims chest to listen to lung sounds, although this was difficult to do.  It was especially difficult on a hot and humid day in 1816 when a large lady presented to Dr. Rene Laennec's (1781-1826) office in respiratory distress.  

In order to assess her, he used his experience as a musician to, he grabbed 24 sheets of paper, rolled them up, and placed one end to his ear and the other end to the ladies chest.  He was delighted to learn he could easily hear her lung sounds. This allowed him to better assess her and come with a more accurate diagnosis.  

He tinkered with this device, and came up with a better tool. He actually wanted to name the device le cylindre claiming it was frivolous to name such a device.  Since he didn't like names given to his device by his colleagues, he later called it a stethoscope.

is model was pretty much a wooden tube that you put in one ear.  In the ensuing years the model was adjusted by others, and eventually a stethoscope with two ear pieces (binaural) was invented.  In 1850 George Camman (1809 - 1878) fine tuned the stethoscope so it was similar to the models we use today.

However, before this device would be accepted by the medical community, it was flat out rejected.  One of his colleagues chanted, "What a ridiculous idea!   "We doctors are called upon for our brilliant medical minds.  To say we should carry some frivolous tool around with us is absolutely ridiculous and below us." (2)

Another colleague wrote, ""He that hath ears to hear, let him use his ears and not a stethoscope."

In fact, Laennec was ridiculed so much that he would end up retiring early and moved to the country side.  Yet Laennec would end up with the last laugh, as by the time he passed away  in August of 1836 the stethoscope became a standard tool to assess and diagnose.

Before he died, however, he used his stethoscope to help him better define many diseases of the lungs, including asthma, bronchitis, emphysema, pneumonia, and tuberculosis.  In fact, it was his own invention that was used to diagnose him with tuberculosis.

5.  The term allergy:  In 1901 two scientists, Paul Portier and Charles Richet,  were "commissioned by the Prince of Morrocoo to find a way of protecting swimmers in the Mediterranean Sea from the painful stings of the Portuguese man-of-war."

In 1901 two scientists in Paris were "commissioned by the Prince of Morrocco to find a way of protecting swimmers in the Mediterranean Sea from the painful stings of the Portuguese man-of-war."   The two men were Paul Portier and Charles Richet.  (1, page 608)

Initially, the two believed the painful blisters were caused by toxins from the animals tentacles that were entered into the skin of humans.  Back then vaccination was becoming a household name, and so the two set out to create an antitoxin vaccine.  (3, page 608)

Richet started the experiment by extracting toxins from sea anemones, and gave it in small amounts to test dogs.  After the initial injection they figured the dogs would develop antibodies that would protect them from a second exposure of the toxin.  In this way they would develop a natural protection against it, or prophylaxis.

Yet, when they extracted the toxin of sea anemones and inserted it into test animals (dogs in this case), the reaction they got was the opposite of what they expected.  The first two doses did no harm to the animals, but subsequent doses caused many of the dogs to go into a state of shock, and most did not recover.  Richet and Portier determined the animals died due to the effects of the toxins.

Instead of prophylaxis , the animals developed anyphylaxis, a new term devised by the two men.

In 1906 an Austrian pediatrician named Clemons Von Pirquet observed many of his patients were hypersensitive to substances that didn't bother other people.  These normally innocuous substances were pollen, dust mites and some foods.  These substances are allergens.

The purpose of the immune system is to attack foreign particles that want to harm the human body.  Yet sometimes the immune system attacks allergens that are not meant to cause harm.  Von Pirquet and Schlick observed this, and they coined the term allergy to describe when the immune system causes harm.  (4, page 53)(5)

Von Pirquot went as far as to diseases like asthma and hay fever were allergic.  Yet these notions, and the term allergy, were rejected by the medical community, particularly by Portier and Richet, who believed their term anaphylaxis was a good enough term.

Yet in the end, both the terms anaphylaxis and allergy found a place in the medical nomenclature.

6.  Blood circulates through the body: William Harvey (1578-1657) was educated about medicine from some of the best physicians and anatomists in the history of the world.  From them he was introduced to veins and arteries and became very interested in learning more about them.  (6)(7)

Then, in he became a physician at Bartholomew's Hospital, and in 1615 became professor of anatomy and surgery at the college.  It was here began his own anatomical research.(7)

Like Andreas before him, he wasn't satisfied with the current method of just speculating about the movement of the blood and heart, or that assuming it was knowledge only God was privy to. He studied the heart and vessels, and came to the conclusion that the heart was a pump, and it circulates the blood through the body. (8, page 168-169)

He also discovered that the pumping of the heart, or pulse, could be felt at various points of the body.  Surely even Galen new of the pulse, although Harvey was the first person to conclude that it was specifically caused by the beating of the heart, which is the pump that pushes blood through the vessels. (8)

Of course, once Harvey published his discovery, his medical practice took a hit, and he was criticized by a dogmatic medical profession.  His discovery was rejected by his peers and his patients.  This was simply the way it always was and always will be in the medical profession.  Physicians typically reject anything new.  (6)(7)

Thankfully, however, Harvey had a friend in a high place.  While his comrades initially rejected his theory that blood circulates through the body, King Charles took great interest in these discoveries and witnessed several experiments. Historically, those who can convince Royalty that they are right will have their ideas accepted by the masses, and this is exactly what happened with Harvey.  (7)

Several years after he made this discovery, and when he was 50 years old, he wrote a book defending his discovery.  So Harvey would get the last laugh, as before he died in 1657 his theory that blood really does circulate through the body, from the venous system to the heart, and from the heart to the lungs where it picks up a vital substance, and from the heart to the rest of the body, where it takes this vital substance to the various organs of the body.  (6)

He had everything down except how the venous system connects with the arterial system. Marcello Malpighi (1628-1694) discovered the alveoli and capillary in 1661, and observed exchange of air from the lungs to capillaries in a frog.  (9)  This was the missing link that Harvey was looking for regarding the complete circulation of blood through the body.  (6).  

Medical historian Fielding Hudson Garrison said the name "William Harvey" has gone down in history as the "greatest name in the seventeenth century... and whose work has exerted a profounder influence upon modern medicine than that of any other man save Vesalius... it was the most momentous discovery since Galen's time." (6)

7.  That tuberculosis is contagious:  While he was physician to the French military, Jean Antoine Villemin observed that tuberculosis was most common among soldiers sleeping in closed quarters in barracks.  He obtained some tissue from a soldier who had passed away from the disease, and inoculated it into some rabbits.  After three months he observed tuberculosis lesions in the rabbits, and learned that his assumption had been right.  He published his results in 1867, and his ideas were ignored by the medical community.  

  1. Sakula, Alex "John Floyer:  A Treaties on Asthma," Thorax, 1984, 39: 248-254
  2. Barchers,Suzanne, "I've Discovered Sound," Brainworks, 2009, page 9
  3. Klein, Jan and Vaclav Horejsi, "Immunology," 1997, page 608
  4. Mittman, Gregg, "Breathing Space," 2007, New Haven, London, Yale University Press
  5. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
  6. Garrison, Fielding Hudson, "Introduction to the history of medicine," 1921, London, page 246-247
  7. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey, page 119-122,
  8. Osler, William Henry, "The evolution of Modern Medicine: A series of lectures delivered at Yale University on the Sillman Foundation in April, 1913," 1921, New Haven, Yale University Press
  9. Hill, Leonard, Benjamin Moore, Arthur Phillip Beddard, John James Rickard, etc., editors, "Recent Advances in Physiology and bio-chemistry," 1908, London, Edward Arnold
  10. "Jean Antoine Villemin,",, accessed 3/3/14

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