^ 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.
Another great surgeon was Ambroise Pare. In the 16th century surgeons put oil on wounds. However in 1536 during the siege of Turin Pare ran out of oil. He made a mixture of egg whites, rose oil and turpentine and discovered it worked better than oil. Pare also designed artificial limbs. In 1513 a man named Eucharius Roslin published a book about childbirth called Rosengarten. In 1540 an English translation called The Birth of Mankind was published. It became a standard text although midwives were women.
There are more examples, and collective they provide a compelling case that evolutionary principles are important to understanding populations, genetics, infectious diseasease, diet, and other issues of public health – in diagnosis, treatment, and research. Therefore, the authors argue, evolution is an important topic for medical professionals to understand, and I completely agree.
The means of dressing the incision was also highly developed: the surgeon used seven polished iron spikes to bring the edges of the wound together, tying them in place with bark-cloth string. He then applied a thick layer of herbal paste and covered this with a warm banana leaf held in place with a bandage. According to Felkin’s account, the mother and her baby were still doing well when he left the village 11 days later.
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.
Chris Kresser: Yeah, that’s really exciting to me. I think another frontier is lab testing. I mean, that’s one of the, as a practitioner, that’s one of the things that troubles me the most, is how expensive these labs are. And in a lot of cases, the insurance isn’t covering them because they don’t deem them to be medically necessary, which just makes me want to pull my hair out, because of course, you know, if we do these labs and we identify the underlying problems initially, we’re potentially heading off tens of thousands of dollars, if not more, in medical costs to the insurance company later on down the line. So I guess it just depends on how you define medically necessary, but that’s a whole different discussion. Some of these labs can be hundreds or even thousands of dollars. So I know there are some pretty exciting, new movements out there to make this lab testing more affordable financially. And then some of the tech tools that are becoming available, like the Quantified Self Revolution, that could really help in terms of not only gathering the necessary data, but organizing it and then presenting it back to the clinician in a way that makes sense and makes it easy for the clinician to track progress. So I know this is an area of interest for both us, James. Maybe you could talk a little bit about some of them, the more exciting technologies that you’ve seen, and that people have talked about in the summit.
A number of Greeks speculated that the human body was made up of elements. If they were properly balanced the person was healthy. However if they became unbalanced the person fell ill. Finally Aristotle (384-322 BC) thought the body was made up of four humors or liquids. They were phlegm, blood, yellow bile and black bile. If a person had too much of one humor they fell ill. For instance if a person had a fever he must have too much blood. The treatment was to cut the patient and let him bleed.
A nearby tomb reveals the image of Merit Ptah, the first female doctor known by name. She lived in approximately 2,700 BC and hieroglyphs on the tomb describe her as ‘the Chief Physician’. That’s pretty much all that’s known about her career, but the inscription reveals that it was possible for women to hold high-status medical roles in Ancient Egypt.
1901 Austrian-American Karl Landsteiner describes blood compatibility and rejection (i.e., what happens when a person receives a blood transfusion from another human of either compatible or incompatible blood type), developing the ABO system of blood typing. This system classifies the bloods of human beings into A, B, AB, and O groups. Landsteiner receives the 1930 Nobel Prize for Physiology or Medicine for this discovery.
All the way through the Functional Forum and the Evolution of Medicine we've sighted the future of "primary care" to be enhanced through technology, the Functional Medicine operating systems, and coaching for behavior change and this is such a great example. One of the powerful tools that Powell has taken advantage is Nudge Coach, a behavior change technology we love. By taking advantage of their white label solution, they have a branded experience for their patients to use to track behavior change between visits.
Unethical human subject research, and killing of patients with disabilities, peaked during the Nazi era, with Nazi human experimentation and Aktion T4 during the Holocaust as the most significant examples. Many of the details of these and related events were the focus of the Doctors' Trial. Subsequently, principles of medical ethics, such as the Nuremberg Code, were introduced to prevent a recurrence of such atrocities. After 1937, the Japanese Army established programs of biological warfare in China. In Unit 731, Japanese doctors and research scientists conducted large numbers of vivisections and experiments on human beings, mostly Chinese victims.
In spite of this tension, Dom Agaya showed Cartier how to make a decoction from a tree called Annedda and, although the Frenchmen wondered if it were a plot to poison them, a couple of them gave it a go and were cured within days. After that, there was such a rush for the medicine that “they were ready to kill one another”, and used up a whole large tree.
In 1954 Joseph Murray, J. Hartwell Harrison and others accomplished the first kidney transplantation. Transplantations of other organs, such as heart, liver and pancreas, were also introduced during the later 20th century. The first partial face transplant was performed in 2005, and the first full one in 2010. By the end of the 20th century, microtechnology had been used to create tiny robotic devices to assist microsurgery using micro-video and fiber-optic cameras to view internal tissues during surgery with minimally invasive practices.
Evolutionary principles may also improve our vaccine strategy. Vaccines are another way to create selective pressures on infectious organisms. We may inadvertently target vaccines against proteins that select out less virulent strains, selecting for the more virulent or infectious strains. Understanding of this allows us to instead target vaccines against virulence without targeting less deadly strains.
In this episode, we followed on from last week's Functional Forum and talked about the role of education in the future of medicine, and particularly the role of delivery of content. Danny introduces us to a great resource for practitioners who are interested in creating dynamic content. The book is available for download May 4th through May 8th at goevomed.com/teach. If you're listening to this podcast between May 4th and May 8th, go get it right now. We had a great half-an-hour discussion. Send us your thoughts and feedback!
^ 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.
In the paper, Radin explores how frozen colonial pasts operate in the service of biological futures. Radin’s research refigures sample collection, induction and cryogenic suspension as modes of colonial science. Following histories of frozen blood samples collected from indigenous populations in the postwar period, Radin reveals a cryopolitics of “not letting die,” in the service of some future biological development. Radin’s impressive body of work offers unique contributions to the study of Cold War, postcolonial technoscience, genomics, big data, climate history, extinction, science fiction and speculative futures.
The First Viennese School of Medicine, 1750–1800, was led by the Dutchman Gerard van Swieten (1700–1772), who aimed to put medicine on new scientific foundations—promoting unprejudiced clinical observation, botanical and chemical research, and introducing simple but powerful remedies. When the Vienna General Hospital opened in 1784, it at once became the world's largest hospital and physicians acquired a facility that gradually developed into the most important research centre. Progress ended with the Napoleonic wars and the government shutdown in 1819 of all liberal journals and schools; this caused a general return to traditionalism and eclecticism in medicine.
The hygiene of the training and field camps was poor, especially at the beginning of the war when men who had seldom been far from home were brought together for training with thousands of strangers. First came epidemics of the childhood diseases of chicken pox, mumps, whooping cough, and, especially, measles. Operations in the South meant a dangerous and new disease environment, bringing diarrhea, dysentery, typhoid fever, and malaria. There were no antibiotics, so the surgeons prescribed coffee, whiskey, and quinine. Harsh weather, bad water, inadequate shelter in winter quarters, poor policing of camps, and dirty camp hospitals took their toll.
Starting in World War II, DDT was used as insecticide to combat insect vectors carrying malaria, which was endemic in most tropical regions of the world. The first goal was to protect soldiers, but it was widely adopted as a public health device. In Liberia, for example, the United States had large military operations during the war and the U.S. Public Health Service began the use of DDT for indoor residual spraying (IRS) and as a larvicide, with the goal of controlling malaria in Monrovia, the Liberian capital. In the early 1950s, the project was expanded to nearby villages. In 1953, the World Health Organization (WHO) launched an antimalaria program in parts of Liberia as a pilot project to determine the feasibility of malaria eradication in tropical Africa. However these projects encountered a spate of difficulties that foreshadowed the general retreat from malaria eradication efforts across tropical Africa by the mid-1960s.
During the 20th century, large-scale wars were attended with medics and mobile hospital units which developed advanced techniques for healing massive injuries and controlling infections rampant in battlefield conditions. During the Mexican Revolution (1910–1920), General Pancho Villa organized hospital trains for wounded soldiers. Boxcars marked Servicio Sanitario ("sanitary service") were re-purposed as surgical operating theaters and areas for recuperation, and staffed by up to 40 Mexican and U.S. physicians. Severely wounded soldiers were shuttled back to base hospitals. Canadian physician Norman Bethune, M.D. developed a mobile blood-transfusion service for frontline operations in the Spanish Civil War (1936–1939), but ironically, he himself died of blood poisoning. Thousands of scarred troops provided the need for improved prosthetic limbs and expanded techniques in plastic surgery or reconstructive surgery. Those practices were combined to broaden cosmetic surgery and other forms of elective surgery.
So much great stuff here in how to build a low overhead practice, some of the technology that she's learned how to use through the Evolution of Medicine Practice Accelerator, how to keep a low overhead practice, how to build a connection with local integrative providers that now pay her rent, and just so many other ways in which Sonza has built such an amazing practice. I think there's value in here, no matter what kind of practitioner you are, and I really hope you'll enjoy it. This is part of our Success Leaves Clues podcast series, enjoy.