Medical Milestones: Part 2

by Food and Drug Administration (FDA)

(Page 2 of 2)

Surgery and a Shave (1492 to 1776)

As the Renaissance emerged out of the Middle Ages, a new scientific spirit developed. The next few centuries showed an eagerness for discovery and a desire to escape from the limitations of tradition and explore new fields of thought and action. Even so, a layer of superstition still remained.

The physician prescribed and the apothecary dispensed. Before the 18th century, doctors were rarely present at childbirth. This was left to midwives, who relied on folklore and tradition. Giving birth was not a private event — rather, it was a long, drawn-out public ritual.

Lower in status than the "physician" was the surgeon. His was a craft, not a science, involving the hand not the head. Dubbed "Mr. Sawbones," the surgeon was likened to a butcher — because of his direct association with cutting and bleeding — but lumped together with barbering because both professions involved arts of the knife. Barber-surgeons had their own books on abdominal injuries, anal fistulae, bladder stones, and cataracts, and their treatments involved primarily cauterizing (burning) and bloodletting, a means of ridding the body of poisons by opening a vein. (Some critics of this technique believed that George Washington was bled to death in his last illness on Friday, Dec. 13, 1799.)

Laws against dissecting human corpses also began to relax during the Renaissance. As a result, the first truly scientific studies of the human body began. Surgery rose in quality (and surgeons in status) by the 18th century, largely due to this new outlook towards anatomy. The painful practice of cautery to stop bleeding, for example, was replaced by ligatures and dressings.

While the 18th century witnessed advances in medicine, more importantly, it began to transform perceptions of medicine's place in society.

Addiction and Antitoxin (1800 to 1900)

The industrial revolution created conditions for an explosion in both population and illness, including some new diseases brought on by filth, such as tuberculosis. Injectable opioids, such as opium, morphine, heroin, and cocaine, brought addiction along with pain relief. The old family doctors gave morphine at the drop of a hat, and tales are rampant of patients whom these physicians casually addicted.

Opioids were sold without restriction, and labels on bottles of elixirs and 'snake oil' gave no hint of addictive ingredients. At the same time, harmless and almost always useless preparations were touted for the cure of every disease and symptom. For example, typical products claimed to "renovate" the stomach, liver and kidneys, and to cure diabetes, gallstones, and weak hearts. According to the 1859 Family Medical Almanac, one medicine that was hailed as a cure-all for as many as eight different illnesses in fact hurried thousands to a premature grave. Without lists of ingredients and warnings against misuse, what little information the public received came mostly from bitter experience.

Federal controls over the drug supply didn't begin until 1848, when Congress required the U.S. Customs Service to stop entry of adulterated drugs from overseas.

A sensation occurred in the late 19th century when an antitoxin for diphtheria was developed from the blood serum of animals injected with diphtheria toxin. Its introduction sharply upgraded the doctor's image in the eyes of the public, because for the first time medicine was truly capable of curing an infectious disease that threatened the children of every home in the nation.

Aspirin and Vaccines (1900 to 2000)

Emil Corwin was one such child. Though his memory of suffering from diphtheria in 1910 as a boy of about 7 is scanty at best, the now 96-year-old public affairs specialist, who retired at the end of 1999 after nearly 30 years with the Food and Drug Administration, is grateful to have survived the horrors of a once-raging epidemic.

"Lucky for me they had a vaccine when I got diphtheria," Corwin reflects. "The number of deaths from this and other epidemics, including the flu, was evident by the wreaths hanging on our neighbors' doors, and most of them had one." Of that experience, Corwin remembers only how sick he was at the time, and the image of his doctor arriving at the house by horse and buggy to administer his shot.

Corwin also remembers the relief stations that predated hospitals, a time when balanced diets were of no concern, and pharmacies of long ago, when "the guy behind the counter would come around to the other side and take something from your eye, if you had a problem." The pharmacist, he says, thought nothing of providing these extra services at no extra fees.

The American doctor of the early 1900s carried few drugs when he made housecalls, but according to the American Medical Association, he knew the quality of each one of them. Calomel, opium, quinine, buchu (a diuretic to stimulate the kidneys), ipecac (an emetic), and Dover's powder (a laxative) made up his supply. At this time, medical therapeutics had not experienced the same level of scientific revolution as medical diagnostics.

Since its introduction in 1899, aspirin (acetylsalicylic acid) has been the most popular drug of all time. By 1909, it ranked among the 10 items most prescribed by American physicians, and the aspirin family had come to symbolize medicine's new therapeutic accomplishments.

"In this century, medicine has seen the biggest change," says John P. Swann, Ph.D., an FDA historian. "The history of drugs in the 20th century has completely changed the face of therapeutics." Swann attributes the increase in overall life expectancy to improvements in surgery and medical technology, changes in nutrition and lifestyle, dedicated researchers, evolving sciences, committed institutions, economic and political circumstances, and courageous practitioners and patients — all social, intellectual and technical links, he says, to good public health.

In 1906, Congress passed the Food and Drugs Act in an effort to stop food adulteration and quack remedies — the two major evils and targets of a 25-year crusade for federal regulation of food and drugs. And the 1938 Federal Food, Drug, and Cosmetic Act expanded the government's power to fight problems such as an upsurge of cheap, easy-to-get medical devices, which were promoted at the expense of reputable medicine.

The magnitude of changes that have occurred in the human race's relationship to infectious diseases during the 20th century is, according to historians, one of our biggest health successes. Vaccinations have essentially eradicated infectious childhood diseases in industrialized countries. As a result of improved health conditions, and particularly as a result of reduced infantile mortality, the average life expectancy, according to the national Centers for Disease Control and Prevention, increased in 1900 from 47 years to 67 years in 1950. And the U.S. Bureau of the Census projects that people born today can expect to live well into their 70s.

Current advances in modern medicine may, to the later skeptic, seem obsolete in the next millennium. Historian Riddle, however, believes that medicine of the future will be an outgrowth of past and present medicine, but with the promise of even more effective remedies gleaned from new observations and experimentation.

"In the end," Riddle says, "we shall learn and marvel that our ancestors were as intelligent and clever as we are."

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.