After AD 400, the study and practice of medicine in the Western Roman Empire went into deep decline. Medical services were provided, especially for the poor, in the thousands of monastic hospitals that sprang up across Europe, but the care was rudimentary and mainly palliative.[69] Most of the writings of Galen and Hippocrates were lost to the West, with the summaries and compendia of St. Isidore of Seville being the primary channel for transmitting Greek medical ideas.[70] The Carolingian renaissance brought increased contact with Byzantium and a greater awareness of ancient medicine,[71] but only with the twelfth-century renaissance and the new translations coming from Muslim and Jewish sources in Spain, and the fifteenth-century flood of resources after the fall of Constantinople did the West fully recover its acquaintance with classical antiquity.
During the 16th century there were some improvements in medicine. However it remained basically the same as in the Middle Ages. Medicine was still dominated by the theory of the four humors. In 1546 a man Girolamo Fracastoro published a book called On Contagion. He suggested that infectious diseases were caused by 'disease seeds', which were carried by the wind or transmitted by touch. Unfortunately there was no way of testing his theory.

James Maskell:  Yeah, absolutely.  And it’s cool as well.  So in this summit, we have a doctor track as well as a patient track.  And in the doctor track, we’re actually talking about some of the ways that this is actually being delivered.  And there are ways to deliver functional medicine on insurance.  We’re featuring the group visit model in one of the doctor-specific tracks.  That’s been very successful at bringing people together, developing a community around groups of people with the same disease.  They want accountability.  They want support.  They want to hear from other people that have the same issues as them.  So that’s working and that’s going to be included in the functional center at Cleveland Clinic.  And then also health coaches.  They’re looking at using different providers together, so you can have higher-cost and lower-cost providers working together.  So it’s really exciting.  I feel like once we get more and more organizations doing it that are credible, people will work out how to get this done on insurance and how to do this at a bigger scale.  The first thing is just the clinical acceptance that’s been a long time coming.
As infectious diseases have become less lethal, and the most common causes of death in developed countries are now tumors and cardiovascular diseases, these conditions have received increased attention in medical research. Tobacco smoking as a cause of lung cancer was first researched in the 1920s, but was not widely supported by publications until the 1950s. Cancer treatment has been developed with radiotherapy, chemotherapy and surgical oncology.
In 1847 in Vienna, Ignaz Semmelweis (1818–1865), dramatically reduced the death rate of new mothers (due to childbed fever) by requiring physicians to clean their hands before attending childbirth, yet his principles were marginalized and attacked by professional peers.[115] At that time most people still believed that infections were caused by foul odors called miasmas.
Pasteur realized the germs that had been left exposed to the air had been weakened. When the chickens were injected with the weakened germs they had developed immunity to the disease. Pasteur and his team went on to create a vaccine for anthrax by keeping anthrax germs heated to 42-43 degrees centigrade for 8 days. In 1882 they created a vaccine for rabies. A co-worker dried the spines of rabbits that had contracted the disease in glass jars. Pasteur tried giving a series of injections made from the dried spines to animals to test the remedy. Then, in 1885, Pasteur successfully used the vaccine on a boy who had been bitten by a rabid dog. Pasteur also invented a way of sterilizing liquids by heating them (called pasteurization). It was first used for wine (in 1864) and later for milk.
Medieval doctors also prescribed laxatives for purging. Enemas were given with a greased tube attached to a pigs bladder. Doctors also prescribed baths in scented water. They also used salves and ointments and not just for skin complaints. Doctors believed it was important when treating many illnesses to prevent heat or moisture escaping from the affected part of the body and they believed that ointments would do that.

During the 18th century medicine made slow progress. Doctors still did not know what caused disease. Some continued to believe in the four humors (although this theory declined during the 18th century). Other doctors thought disease was caused by 'miasmas' (odorless gases in the air). However surgery did make some progress. The famous 18th century surgeon John Hunter (1728-1793) is sometimes called the Father of Modern Surgery. He invented new procedures such as tracheotomy.

3 Schwarz, Richard W. “John Harvey Kellogg, M.D.: Pioneering Health Reformer.” John Harvery Kellogg, M.D.: Pioneering Health Reformer – Richard W. Schwarz – Google Books. Google Books, 2006. Web. 26 Jan. 2014. .
^ Jump up to: a b Askitopoulou, H.; Konsolaki, E.; Ramoutsaki, I.; Anastassaki, E. (2002). Surgical cures by sleep induction as the Asclepieion of Epidaurus. The history of anesthesia: proceedings of the Fifth International Symposium, by José Carlos Diz, Avelino Franco, Douglas R. Bacon, J. Rupreht, Julián Alvarez. Elsevier Science B.V., International Congress Series 1242. pp. 11–17. ISBN 978-0444512932.
Bodies from the Stone Age show signs of medical treatment: broken limbs that have been set and healed, dislocations replaced and wounds treated successfully. Bone needles from the Upper Palaeolithic (c.30,000 years ago) may indicate that wounds were stitched (sutured) at this time. A widespread practice from the late Palaeolithic, which flourished in Neolithic Europe (c.7,000 years ago), was trepanation (making a hole through the frontal or parietal bones of the skull). Whilst the reasons for this practice are unknown, the high survival rate of patients, indicated by the healing and remodelling of bone, proves great technical skill. Major blood vessels in the skull had to be avoided, haemorrhage was minimised by turning back the flaps of skull created by the incision and the operation site had to be kept free from infection.
Public health measures became particular important during the 1918 flu pandemic, which killed at least 50 million people around the world.[171] It became an important case study in epidemiology.[172] Bristow shows there was a gendered response of health caregivers to the pandemic in the United States. Male doctors were unable to cure the patients, and they felt like failures. Women nurses also saw their patients die, but they took pride in their success in fulfilling their professional role of caring for, ministering, comforting, and easing the last hours of their patients, and helping the families of the patients cope as well.[173]
This week on the Evolution of Medicine, we continue our series called The Future of Patient Compliance with Mac Gambill from Nudge Coach. Nudge Coach is lifestyle coaching software that aims to better connect practitioners with their patients.  It allows practitioners to empower patients through online lifestyle coaching through technology  in between visits.

^ Bynum, W.F. (1974). "Rationales for therapy in British psychiatry: 1780–1835". Medical History. 18 (4): 317–34. doi:10.1017/s0025727300019761. PMC 1081592. PMID 4618306.; Digby, Anne (1988). "Moral Treatment at the Retreat 1796–1846". In Porter, Roy; Bynum, W.F.; Shepherd, Michael. The Anatomy of Madness: Essays in the History of Psychiatry. 2. London & New York: Tavistock. pp. 52–71. ISBN 978-0415008594.
^ Bynum, W.F. (1974). "Rationales for therapy in British psychiatry: 1780–1835". Medical History. 18 (4): 317–34. doi:10.1017/s0025727300019761. PMC 1081592. PMID 4618306.; Digby, Anne (1988). "Moral Treatment at the Retreat 1796–1846". In Porter, Roy; Bynum, W.F.; Shepherd, Michael. The Anatomy of Madness: Essays in the History of Psychiatry. 2. London & New York: Tavistock. pp. 52–71. ISBN 978-0415008594.

James Maskell:  Cool.  I’d love to leave your listeners with something just to get them thinking, Chris, before the summit comes up.  Because we did have one talk that I think is going to really change people’s thoughts on a lot of things.  You know, a lot of it is great information, but I know that you’re passionate about the biome, the microbiome, and our understanding of germs.  But if you don’t mind, I’d love to just share one concept that was shared that I think that you’ll really like.  I’d love to get your comment on it.

During the 18th century medicine made slow progress. Doctors still did not know what caused disease. Some continued to believe in the four humors (although this theory declined during the 18th century). Other doctors thought disease was caused by 'miasmas' (odorless gases in the air). However surgery did make some progress. The famous 18th century surgeon John Hunter (1728-1793) is sometimes called the Father of Modern Surgery. He invented new procedures such as tracheotomy.


James Maskell:  Yeah.  Well, obviously, you have, some of the ideas you talked about there are perfect I think. I just wrote a blog for The ZocDoc Blog about why doctors should curate their patient education.  And curating resources is much more efficient than just telling people stuff.  You don’t need people to do that, you just need to use the resources that are available.  And so actually, one of the ways that we designed this summit was that it would be almost like the perfect thing for a doctor to curate for their patient—because there is a patient track.  It’s going to basically teach the patient how to be a great patient and how to look after the four major modifiable causes of chronic disease: diet and stress, toxicity, immunity, and the microbiome.  These are all things that patients have the majority of control over.  This is not medicine that’s done to you.  And so, we were just—so that’s part of the track in the doctor track.  I think the curation of patient education can take a lot of the time out of the appointments, because you see one of the biggest things about functional medicine is that it takes a lot of time to do it, because you have to listen and so forth.  So that’s one of the things.  But like you said, technology can play a key role.  And we have doctors in the summit that are talking about how they’re using technology even in poorer, rural areas of the country, where they’re building community-orientated practices that serve a blue-collar type of patient, and it’s working.  And if it could work in rural Indiana, it can work anywhere.  And that’s really exciting.  You know, our vision for this, Chris, is just a nationwide network of remarkable community-orientated functional practices.  In the same ways you saw the natural response to Walmart was farmers’ markets—you know, going directly to the farmer and having that direct interaction—I think the natural reaction to big medicine is these small micropractices that deliver exceptional value to patients in local areas into the community.


1897 Ronald Ross, a British officer in the Indian Medical Service, demonstrates that malaria parasites are transmitted via mosquitoes, although French army surgeon Charles Louis Alphonse Laveran identified parasites in the blood of a malaria patient in 1880. The treatment for malaria was identified much earlier (and is still used today). The Qinghao plant (Artemisia annua) was described in a Chinese medical treatise from the 2nd century BCE; the active ingredient, known as artemisinin, was isolated by Chinese scientists in 1971 and is still used today. The more commonly known treatment, quinine, was derived from the bark of a tree called Peruvian bark or Cinchona and was introduced to the Spanish by indigenous people in South America during the 17th century.
The Romans may not have understood the exact mechanisms behind disease but their superb level of personal hygiene and obsession with cleanliness certainly acted to reduce the number of epidemics in the major cities. Otherwise, they continued the tradition of the Greeks although, due to the fact that a Roman soldier was seen as a highly trained and expensive commodity, the military surgeons developed into fine practitioners of their art. Their refined procedures ensured that Roman soldiers had a much lower chance of dying from infection than those in other armies.
510-430 BC - Alcmaeon of Croton scientific anatomic dissections. He studied the optic nerves and the brain, arguing that the brain was the seat of the senses and intelligence. He distinguished veins from the arteries and had at least vague understanding of the circulation of the blood.[2] Variously described by modern scholars as Father of Anatomy; Father of Physiology; Father of Embryology; Father of Psychology; Creator of Psychiatry; Founder of Gynecology; and as the Father of Medicine itself.[6] There is little evidence to support the claims but he is, nonetheless, important.[5][7]
This week on the Evolution of Medicine podcast, we take a look back at a very special presentation from Dr. Leo Galland from our 2014 Evolution of Medicine Summit. Our next Functional Forum is entitled the "Evolution of Primary Care", which will address the most significant way functional medicine can impact medicine as a whole... as an updated operating system for primary care.
In the 1770s–1850s Paris became a world center of medical research and teaching. The "Paris School" emphasized that teaching and research should be based in large hospitals and promoted the professionalization of the medical profession and the emphasis on sanitation and public health. A major reformer was Jean-Antoine Chaptal (1756–1832), a physician who was Minister of Internal Affairs. He created the Paris Hospital, health councils, and other bodies.[125]
If you've been following the Functional Forum, you know we've taken the show on the road to engage with as many members of our community as possible.  As we bring the show to Chicago in September, DC in October, Miami in November and back to NY in December, the Future of Functional in 5 will give members of our tribe the opportunity to share and be heard.
Why is this program so special? If you have patients that are preparing for surgery, this is something that you can curate for your community without having to do all the work yourself. We strive to bring you resources that make your practice more efficient and effective and this program offers both. We're so excited to share this with you because this program uses email autoresponder technology. Autoresponders are messages set to go out automatically. They allow you to automate campaigns and manage one-to-one communication with your patients. This is the core technology that we focus on in the Practice Accelerator. Thousands of practitioners have shared with us that automating patient education and setting up systems that work while they are not "on the job" brings convenience and value to their patients - and bonus, it doubles as marketing. As early adopters of this new era of medicine, many practitioners are working with entrepreneurs that have identified problems and have created programs that offer scalable solutions.
This week on the Evolution of Medicine podcast, we welcome Gladys McGarey. At 97 years old, Galdys is a true pioneer in holistic and living medicine and we're absolutely thrilled to welcome her to the podcast. Dr. Gladys is internationally recognized as the Mother of Holistic Medicine.  Dr. Gladys, as she is affectionately known, is board certified in Holistic and Integrated Medicine and has held a family practice for more than sixty years.  
The medicinal leech has been in use for thousands of years, and is even today considered to be a way of restoring venous circulation after reconstructive surgery. But it was in the early 19th century that the leech really soared in popularity. Led by French physician François-Joseph-Victor Broussais (1772–1838), who postulated that all disease stemmed from local inflammation treatable by bloodletting, the ‘leech craze’ saw barrels of the creatures shipped across the globe, wild leech populations decimated almost to extinction, and the establishment of prosperous leech farms.
Contrary to what might be expected, the widespread practice of embalming the dead body did not stimulate study of human anatomy. The preservation of mummies has, however, revealed some of the diseases suffered at that time, including arthritis, tuberculosis of the bone, gout, tooth decay, bladder stones, and gallstones; there is evidence too of the parasitic disease schistosomiasis, which remains a scourge still. There seems to have been no syphilis or rickets.
e nation's highest civilian award was established by President Harry S. Truman in 1945 to recognize notable service during World War II. In 1963, President John F. Kennedy reintroduced it as an honor for any citizen who has made exemplary contributions to the security or national interest of the United States, to world peace, or to cultural or other significant endeavors.
^ Bynum, W.F. (1974). "Rationales for therapy in British psychiatry: 1780–1835". Medical History. 18 (4): 317–34. doi:10.1017/s0025727300019761. PMC 1081592. PMID 4618306.; Digby, Anne (1988). "Moral Treatment at the Retreat 1796–1846". In Porter, Roy; Bynum, W.F.; Shepherd, Michael. The Anatomy of Madness: Essays in the History of Psychiatry. 2. London & New York: Tavistock. pp. 52–71. ISBN 978-0415008594.
But there are less obvious ways in which evolutionary principles apply to infectious diseases. It has been known for a long time that sickle-cell trait provides resistance to malaria (the blood cells are less hospitable to the P. falciparum protozoan parasite that is one cause of malaria). This explains the persistence of sickle cell disease in populations where malaria is endemic.
During the U.S. Civil War the Sanitary Commission collected enormous amounts of statistical data, and opened up the problems of storing information for fast access and mechanically searching for data patterns. The pioneer was John Shaw Billings (1838–1913). A senior surgeon in the war, Billings built the Library of the Surgeon General's Office (now the National Library of Medicine), the centerpiece of modern medical information systems.[142] Billings figured out how to mechanically analyze medical and demographic data by turning facts into numbers and punching the numbers onto cardboard cards that could be sorted and counted by machine. The applications were developed by his assistant Herman Hollerith; Hollerith invented the punch card and counter-sorter system that dominated statistical data manipulation until the 1970s. Hollerith's company became International Business Machines (IBM) in 1911.[143]
^ Houstoun, Robert; Cheselden, William; Arbuthnot, John (1723). Lithotomus castratus; or Mr. Cheselden's Treatise on the high operation for the stone: thoroughly examin'd and plainly found to be Lithotomia Douglassiana, under another title: in a letter to Dr. John Arbuthnot. With an appendix, wherein both authors are fairly compar'd. T. Payne. Retrieved 7 December 2012.
This week on the Evolution of Medicine podcast, we're thrilled to welcome Danny Iny, the founder of Mirasee. Danny is a serial entrepreneur and has been involved in the online education space for more than a decade. We've been working very closely with Danny at the Evolution of Medicine to help us build out our online courses like the Practice Accelerator, the New Patient GPS, and the Membership Practice Builder. 

One of the oldest known medical textbooks is the Sushruta Samhita, written in Sanskrit in India. Its exact date is tentative, as no original version survives and it is only known from later copies, but the current consensus is that it was written in around 600 BC. Sushruta is thought to have been a physician and teacher working in the North Indian city of Benares (now Varanasi in the state of Uttar Pradesh). His Samhita – a compilation of knowledge – provides detailed information on medicine, surgery, pharmacology and patient management.


During the Renaissance, understanding of anatomy improved, and the microscope was invented. Prior to the 19th century, humorism (also known as humoralism) was thought to explain the cause of disease but it was gradually replaced by the germ theory of disease, leading to effective treatments and even cures for many infectious diseases. Military doctors advanced the methods of trauma treatment and surgery. Public health measures were developed especially in the 19th century as the rapid growth of cities required systematic sanitary measures. Advanced research centers opened in the early 20th century, often connected with major hospitals. The mid-20th century was characterized by new biological treatments, such as antibiotics. These advancements, along with developments in chemistry, genetics, and radiography led to modern medicine. Medicine was heavily professionalized in the 20th century, and new careers opened to women as nurses (from the 1870s) and as physicians (especially after 1970).

During the 16th century there were some improvements in medicine. However it remained basically the same as in the Middle Ages. Medicine was still dominated by the theory of the four humors. In 1546 a man Girolamo Fracastoro published a book called On Contagion. He suggested that infectious diseases were caused by 'disease seeds', which were carried by the wind or transmitted by touch. Unfortunately there was no way of testing his theory.

According to the compendium of Charaka, the Charakasamhitā, health and disease are not predetermined and life may be prolonged by human effort. The compendium of Suśruta, the Suśrutasamhitā defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Suśrutasamhitā is notable for describing procedures on various forms of surgery, including rhinoplasty, the repair of torn ear lobes, perineal lithotomy, cataract surgery, and several other excisions and other surgical procedures. Most remarkable is Sushruta's penchant for scientific classification: His medical treatise consists of 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to aging and mental illness.
The earliest known physician is also credited to ancient Egypt: Hesy-Ra, "Chief of Dentists and Physicians" for King Djoser in the 27th century BCE.[26] Also, the earliest known woman physician, Peseshet, practiced in Ancient Egypt at the time of the 4th dynasty. Her title was "Lady Overseer of the Lady Physicians." In addition to her supervisory role, Peseshet trained midwives at an ancient Egyptian medical school in Sais.[citation needed]
Later Louis Pasteur (1822-1895) proved that microscopic organisms caused disease. In the early 19th century many scientists believed in spontaneous generation i.e. that some living things spontaneously grew from non-living matter. In a series of experiments between 1857 and 1863 Pasteur proved this was not so. Once doctors knew what caused disease they made rapid headway in finding cures or prevention.
Two great Alexandrians laid the foundations for the scientific study of anatomy and physiology, Herophilus of Chalcedon and Erasistratus of Ceos.[48] Other Alexandrian surgeons gave us ligature (hemostasis), lithotomy, hernia operations, ophthalmic surgery, plastic surgery, methods of reduction of dislocations and fractures, tracheotomy, and mandrake as an anaesthetic. Some of what we know of them comes from Celsus and Galen of Pergamum.[49]
This was a common scenario in wars from time immemorial, and conditions faced by the Confederate army were even worse. The Union responded by building army hospitals in every state. What was different in the Union was the emergence of skilled, well-funded medical organizers who took proactive action, especially in the much enlarged United States Army Medical Department,[135] and the United States Sanitary Commission, a new private agency.[136] Numerous other new agencies also targeted the medical and morale needs of soldiers, including the United States Christian Commission as well as smaller private agencies.[137]
European ideas of modern medicine were spread widely through the world by medical missionaries, and the dissemination of textbooks. Japanese elites enthusiastically embraced Western medicine after the Meiji Restoration of the 1860s. However they had been prepared by their knowledge of the Dutch and German medicine, for they had some contact with Europe through the Dutch. Highly influential was the 1765 edition of Hendrik van Deventer's pioneer work Nieuw Ligt ("A New Light") on Japanese obstetrics, especially on Katakura Kakuryo's publication in 1799 of Sanka Hatsumo ("Enlightenment of Obstetrics").[144][145] A cadre of Japanese physicians began to interact with Dutch doctors, who introduced smallpox vaccinations. By 1820 Japanese ranpô medical practitioners not only translated Dutch medical texts, they integrated their readings with clinical diagnoses. These men became leaders of the modernization of medicine in their country. They broke from Japanese traditions of closed medical fraternities and adopted the European approach of an open community of collaboration based on expertise in the latest scientific methods.[146]

As you pointed out, 80% just want a prescription and are not willing to find the causes of their illness, I have chosen to focus on the 20% who are willing to discover the causes and make lifestyle changes. Patient satisfaction is up, and I am getting control back of my practice. I believe this the medicine of the future, that will appeal to my grandchildren.
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