In the Middle Ages monasteries had sanitation. Streams provided clean water. Dirty water was used to clear toilets, which were in a separate room. Monks also had a room called a laver where they washed their hands before meals. However for most people sanitation was non-existent. In castles the toilet was simply a long passage built into the thickness of the walls. Often it emptied into the castle moat. Despite the lack of public health many towns had public bath-houses were you could pay to have a bath.
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.
James Maskell:  Dr. Larry Palevsky is speaking, and he’s speaking on the pediatrics day.  He’s an awesome doctor.  He was lecturing about the microbiome five years ago, before the human microbiome came out.  And so I asked him, he spoke at my Functional Forum, and he brought up some concepts that were new, and I was sitting next to storied integrative medicine doctors who were just sort of blown away.  And his thought is this: We all know now that 99% of our bacteria and fungus and viruses and so forth are mutually beneficial, and they help us, and they help with metabolism and digestion and immunity.  That’s our sort of main understanding.  So I asked him, “Dr. Palevsky, what are we going to learn next?  What are we really going to understand next about the microbiome that we don’t understand now?”  And he basically—you have to listen to it on the summit, but he basically says this—“We have trillions of non-redundant viruses in our chromosomes, in our DNA.  So these are trillions of viruses that we’ve evolved with over time.”  And so his question is, “When you get a viral illness, how many more viruses have to come into the body for you to get a viral illness?  10?  20?  100?”  I mean, when you look at the numbers compared to what’s actually in our chromosomes and in our DNA, the numbers just don’t add up.  His thought is, and his concept is, that these viruses, there’s different transmission mechanisms.  His thought is that the next understanding that we’re going to have of the microbiome, the next level of understanding is going to be that the body and these viruses work together to be able to return the body to homeostasis.  So when you get to a point where the body is just so stressed and there’s too many toxins and things for it to deal with, and it can’t get back to homeostasis by itself, it communes with viruses to be able to instigate what we think of as a viral illness, to be able to get the patient to just slow down, so that we can get back to homeostasis.  And it made such an impression on me because I had a friend last year who got viral pneumonia.  And what was happening before viral pneumonia?  She was working for three months on a project about 15 hours a day.  And suddenly, it finished and she did great with it, and then she was sick for a month with viral pneumonia.  So what, pneumonia just came along and attacked at that moment?  Obviously, not.  So I’d love to get your thoughts on that.  Because when he shared that, I was like, “This seems so obvious.”  And I’m really excited to think what our understanding is going to be like when we start to appreciate that our evolution with viruses is a big part of our evolution, and that there may be a lot more to it than thinking a virus is just something that comes from outside all the time.
This week on the Evolution of Medicine podcast, we welcome Dr. Jean Golden-Tevald. We continue our Success Leaves Clues series with Dr. Tevald where we feature a practitioner who has found the right tools and systems to run a successful practice. Dr. Tevald practices functional medicine at Morning Star Family Health Center in Clinton, New Jersey. We're excited to share how she has set up her membership based family practice. 
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.
The practice of medicine changed in the face of rapid advances in science, as well as new approaches by physicians. Hospital doctors began much more systematic analysis of patients' symptoms in diagnosis.[113] Among the more powerful new techniques were anaesthesia, and the development of both antiseptic and aseptic operating theatres.[114] Effective cures were developed for certain endemic infectious diseases. However the decline in many of the most lethal diseases was due more to improvements in public health and nutrition than to advances in medicine.
When the Roman Empire split into the Western and Eastern Empires, the Western Empire, centered on Rome, went into a deep decline and the art of medicine slowly slipped away, with the physicians becoming pale shadows of their illustrious predecessors and generally causing more harm than good. Western Europe would not appear again in the history of medicine until long after the decline of Islam.
1867 Joseph Lister publishes Antiseptic Principle of the Practice of Surgery, one of the most important developments in medicine. Lister was convinced of the need for cleanliness in the operating room, a revolutionary idea at the time. He develops antiseptic surgical methods, using carbolic acid to clean wounds and surgical instruments. The immediate success of his methods leads to general adoption. In one hospital that adopts his methods, deaths from infection decrease from nearly 60% to just 4%.
The underlying principle of most medieval medicine was Galen's theory of humours. This was derived from the ancient medical works, and dominated all western medicine until the 19th century. The theory stated that within every individual there were four humours, or principal fluids—black bile, yellow bile, phlegm, and blood, these were produced by various organs in the body, and they had to be in balance for a person to remain healthy. Too much phlegm in the body, for example, caused lung problems; and the body tried to cough up the phlegm to restore a balance. The balance of humours in humans could be achieved by diet, medicines, and by blood-letting, using leeches. The four humours were also associated with the four seasons, black bile-autumn, yellow bile-summer, phlegm-winter and blood-spring.[75]

Caroline Rance blogs at www.thequackdoctor.com about the history of medical advertising and health fraud. Her book The History of Medicine in 100 Facts (Amberley Publishing, 2015) explores medicine’s history in bite-sized topics, from prehistoric parasites to the threat of antibiotic resistance. You can follow Caroline on Twitter @quackwriter and on Facebook at www.facebook.com/quackdoctor

Small Intestinal Bacteria Overgrowth - it's become a buzzword in medicine the past few years and Chris has been on the cutting edge of treating it. We'll be discussing the standard diagnosis, why it's problematic, and what we can do about it. There podcast has tons of value for practitioners who are on the front lines of dealing with a range of digestive and other related issues. 


^ Porter, Roy (1992). "Madness and its Institutions". In Wear, Andrew. Medicine in Society: Historical Essays. Cambridge: Cambridge University Press. pp. 277–302. ISBN 978-0521336390.; Goldstein, Jan (2001) [1987]. Console and Classify: The French Psychiatric Profession in the Nineteenth Century. Chicago & London: University of Chicago Press. p. 42. ISBN 978-0226301600.; Grob, Gerald N. (1994). Mad Among Us. Simon and Schuster. pp. 25–30. ISBN 978-1439105719.
Sushruta advises his students that however well read they are, they are not competent to treat disease until they have practical experience. Surgical incisions were to be tried out on the skin of fruits, while carefully extracting fruit seeds enabled the student to develop the skill of removing foreign bodies from flesh. They also practised on dead animals and on leather bags filled with water, before being let loose on real patients.
"By 1944 most casualties were receiving treatment within hours of wounding, due to the increased mobility of field hospitals and the extensive use of aeroplanes as ambulances. The care of the sick and wounded had also been revolutionized by new medical technologies, such as active immunization against tetanus, sulphonamide drugs, and penicillin."[175]
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.

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.[134]
c.484 – 425 BC Herodotus tells us Egyptian doctors were specialists: Medicine is practiced among them on a plan of separation; each physician treats a single disorder, and no more. Thus the country swarms with medical practitioners, some undertaking to cure diseases of the eye, others of the head, others again of the teeth, others of the intestines,and some those which are not local.[2]
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]
The foundational text of Chinese medicine is the Huangdi neijing, (or Yellow Emperor's Inner Canon), written 5th century to 3rd century BCE.[31] Near the end of the 2nd century CE, during the Han dynasty, Zhang Zhongjing, wrote a Treatise on Cold Damage, which contains the earliest known reference to the Neijing Suwen. The Jin Dynasty practitioner and advocate of acupuncture and moxibustion, Huangfu Mi (215–282), also quotes the Yellow Emperor in his Jiayi jing, c. 265. During the Tang Dynasty, the Suwen was expanded and revised, and is now the best extant representation of the foundational roots of traditional Chinese medicine. Traditional Chinese Medicine that is based on the use of herbal medicine, acupuncture, massage and other forms of therapy has been practiced in China for thousands of years.

Over the centuries, reports occasionally surfaced of caesarean sections saving the lives of both mother and baby, but even after the introduction of antiseptic methods and anaesthesia, caesareans remained a dangerous last resort. So Edinburgh surgeons were surprised to hear a lecture by Robert Felkin, a missionary doctor, about a successful operation that he had witnessed in the African kingdom of Bunyoro Kitara five years earlier.
Byzantine physicians often compiled and standardized medical knowledge into textbooks. Their records tended to include both diagnostic explanations and technical drawings. The Medical Compendium in Seven Books, written by the leading physician Paul of Aegina, survived as a particularly thorough source of medical knowledge. This compendium, written in the late seventh century, remained in use as a standard textbook for the following 800 years.

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.
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