BOOK: ‘Great Discoveries in Medicine’ shows how modern advances are rooted in ancient methods

Medicine isn’t magic.

It used to be thought of that way. Even today, it’s still often wrapped in mystery. But its pragmatic practitioners aren’t very different from mechanics, and their jobs are pretty much the same.

First, figure out what’s wrong. Then, find what you need to fix it.

That’s how breakthroughs happen, as explained in essays collected in “Great Discoveries in Medicine: From Ayurveda to X-rays, Cancer to Covid” and edited by William and Helen Bynum.

Divided into broad sections — “Discovering the Body” and “Tools of the Trade” ― the book explains how, over thousands of years, people have studied how our bodies work and invented an array of chemicals and machines to make them work better.

But before doctors could understand how the body’s parts fit together, they had to take them apart. And they did it with style.

“Early modern dissections were as much about showmanship as scholarship,” writes contributor Simon Chaplin. “Conducted in churches before crowds of onlookers, public dissection not only celebrated the divine wonder of the body, but also provided a chance for self-promotion.”

How and where dissections were done morphed over the centuries and, at times, were controversial.

Physicians who preferred studying the texts of ancient doctors like Hippocrates shunned dissection as a crude tool for those whose “wit is limited.” Enthusiastic adherents mocked colleagues averse to cutting up cadavers as “lily-livered and effeminate.”

Yet dissection soon became a standard part of medical training — even as the need for subjects sometimes led to grave robbing and even murder.

Far less disturbing was medicine’s continuing, ingenious invention of tools to help diagnose and even treat disease.

As science progressed, these instruments became more of a necessity. Doctors were beginning to understand how the body worked. But to know even more, they had to see it at work.

However, “two fundamental problems remained,” essayist Rodney Taylor writes. “Most of the inner parts of the body are not straight, and it is dark inside.”

For centuries, physicians tried looking inside the body with rigid tubes. In 1868, a German doctor used an 18-inch-long pipe to peek inside a man’s stomach. Conveniently, the patient was a professional sword swallower.

It took almost another century for fiber optics to provide a way to truly probe our nooks and crannies and even take pictures along the way.

Other breakthroughs were borne of modesty. Doctors had been trying to diagnose heart complaints by listening to patients’ chests since the days when everyone wore togas. But when medicine moved into the modern 19th century, that intimacy was deemed somehow improper.

In 1816, Dr. Rene Laennec “was consulted by a young woman who seemed to be suffering from heart disease,” writes essayist Malcolm Nicholson. “She was plump and Laennec was unable to get her chest to resonate upon percussion, and he felt inhibited from pressing his head firmly against the bosom of his female patient.”

Laennec had his eureka moment.

“Remembering a game he had seen played by children,” Nicholson writes, “he rolled several sheets of paper into a tube and placed one end against the woman’s chest. Putting his ear to the other end, he was pleased to be able to hear the sounds of her heart quite distinctly. The stethoscope had been invented.”

The earliest models weren’t much of an improvement. Most doctors agreed they achieved identical results the old-fashioned way. But it allowed the physicians to maintain their dignity and the patients their modesty. It helped create the classic doctor/patient relationship.

Another invention was inspired by a trip to the zoo. French obstetrician Étienne Stéphane Tarnier was at the Paris menagerie in 1881 when he saw a display of baby chicks in incubators. He immediately ordered the machines for his hospital’s maternity ward. The mortality rate for premature infants soon dropped by almost half.

“‘Incubator baby’ shows featuring live infants sprang up in storefront institutes and world fairs,” contributor Jeffrey Baker writes. “These exhibits, whose popularity peaked at the turn of the 20th century, resembled not so much side shows as today’s medical dramas celebrating the power of technology.”

There were many advances to celebrate. Medical innovations were constant in the 19th century, as American and European doctors pushed science forward, adding new ideas and new gadgets. Like the sphygmomanometer, made to measure blood pressure. Or the X-ray machine, developed by Wilhelm Conrad Röntgen.

Few advances, however, saved more lives than antiseptics.

Originally, operations were fast and gory. “Surgeons operated in old blood-stained and often pus-crusted coats, with undisinfected hands, using undisinfected instruments,” writes essayist Thomas Schlich. Those practices were only reformed thanks to 19th-century British surgeon Joseph Lister, who recommended disinfecting everything.

Mortality rates plummeted, Schlich notes, and operations “began to look very much as we know them today, with surgeons and theatre personnel clothed in sterilized gowns, wearing rubber gloves and face masks, moving in a highly restrained and disciplined manner and working a thoroughly isolated, brightly lit operating room.”

Those changes didn’t all spring from interesting science or even altruism; rubber gloves were introduced, Schlich says, only because one doctor complained that the disinfectant he had to use gave him a rash. But the idea of a hospital as a clean, well-lighted place ensured life-saving reforms.

Other advances sprang from the natural world.

In 1770s, the physician William Withering heard that an old lady in Shropshire could cure dropsy — an accumulation of fluids in the body — with a botanical mixture including the foxglove flower. Taking a sample of her remedy into his laboratory, he discovered foxglove contained a powerful drug, digitalis. It’s since become an important tool for treating heart disease, proving there’s a thin line separating folk medicine and science-based medicine.

And in the 17th century, Jesuit missionaries to South America noticed that the indigenous people brewed tea from the bark of a particular tree. The beverage had the advantage of treating fevers, particularly the dangerous ones caused by malaria. The native people called it quinquina, “the bark of barks.” It wasn’t until the 19th century, however, that European chemists were able to isolate the active chemical, which they dubbed quinine.

The medicine had a downside, though. While it saved countless lives, it also made the mosquito-riddled tropics safe for conquest and war. By 1916, the leading manufacturer was selling 65 million doses of quinine — just to the world’s armies. Although other drugs have since been synthesized to take its place, quinine still holds on — although, these days, chiefly as a flavoring agent for tonic water.

Other miracle drugs originated in the natural world, notably opium from poppies and penicillin from mold. The first artificial sex hormones were derived from a chemical found in a Mexican yam. And as doctors have learned more about once mysterious diseases, the equipment used to diagnose and treat them has grown ever more complicated and sophisticated, too — from MRIs to dialysis machines.

Yet all of these advances have come with a price.

“All these tools of the trade have shaped medical diagnosis and treatment,” write editors William and Helen Bynum. “They have also fueled the spiraling costs of medical care, and, in many people’s eyes, made modern medicine more impersonal and cold. No one has yet invented a sympathetic machine.”