^ Porter, Roy (1999). The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. London: Fontana. p. 493. ISBN 978-0393319804.; 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.; Suzuki, A. (1991). "Lunacy in seventeenth- and eighteenth-century England: Analysis of Quarter Sessions records Part I". History of Psychiatry. 2 (8): 437–56. doi:10.1177/0957154X9100200807. PMID 11612606.; Suzuki, A. (1992). "Lunacy in seventeenth- and eighteenth-century England: Analysis of Quarter Sessions records Part II". History of Psychiatry. 3 (9): 29–44. doi:10.1177/0957154X9200300903. PMID 11612665.
Some 200 years later another doctor, Peseshet, was immortalised on a monument in the tomb of her son, Akhet-Hetep (aka Akhethetep), a high priest. Peseshet held the title ‘overseer of female physicians’, suggesting that women doctors weren’t just occasional one-offs. Peseshet herself was either one of them or a director responsible for their organisation and training.
In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. There was also increasing opposition to the use of psychiatric hospitals, and attempts to move people back into the community on a collaborative user-led group approach ("therapeutic communities") not controlled by psychiatry. Campaigns against masturbation were done in the Victorian era and elsewhere. Lobotomy was used until the 1970s to treat schizophrenia. This was denounced by the anti-psychiatric movement in the 1960s and later.
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.
Chris Kresser: Yeah, sure. I’m sure a lot of my listeners know this about me, but for those people who are new to this especially, I think Paleo—and I’ve said this before—is a fantastic starting place, but it’s not a destination. What I mean by that, is we know that Paleo foods are safe and well tolerated for most of us because we’ve eaten them for such a long period of time. And by we, I mean human beings. And they’re the least likely to cause problems, allergies, food intolerances, and issues like that, because human beings have been consuming them for thousands of generations. But that doesn’t mean that we absolutely need to restrict our diet to those foods, because even though we’re largely the same genetically as we were 10,000 years ago, there have been significant changes. In fact, as much as 10% of our genome shows evidence of recent selection. And the pace of genetic change today is occurring at a rate 100 times faster than the average over 6 million years of hominid evolution. So we’re similar to our Paleolithic ancestors, but we’re different in some important ways. And those differences actually do affect our tolerance of certain agricultural foods, like full-fat and fermented dairy products, even legumes and grains, some of the newly introduced foods like alcohol and chocolate and coffee. These are all foods that modern research actually suggests can be beneficial when they are well tolerated, but I call them gray-area foods because our tolerance of them really depends on the individual. So for one person who is casein intolerant or intolerant to some of the proteins in dairy, eating any dairy is going to be problematic. But for someone who has no problem with casein or lactose, the sugar in dairy, all of the research on full-fat dairy suggests that it’s beneficial and may reduce the risk of cardiovascular and metabolic disease, and even obesity. So those are just a few examples of how our diet has changed. And I think as a healthcare practitioner, my focus is always on the science—what the science shows, and what I see in the clinic in my work with patients. And I’m generally kind of allergic to extremely rigid, dogmatic approaches, especially when they’re not flexible enough to evolve and adapt with what the changing science tells us. So that was one of the big focuses of my talk at the summit.
Since its founding in 1967, the Medical School’s Program in the History of Medicine has been dedicated to research and teaching in the intellectual, political, cultural, and social history of disease, health care, and medical science. The history of medicine provides students with a historical perspective on the role health, medicine, and disease play in society today. It prepares students to think critically about historical and contemporary health issues.
On this podcast we will be announcing our most expansive and exciting adventure to date, called Journey to 100. It will be held on June 30th and available for live streaming through the Functional Forum. You might remember Evolution of Medicine co-founder James Maskell presented his TEDx talk in 2015 from Guernsey called Community, Not Medicine, Creates Health. He's heading back to Guernsey to host the event, along with Dr. Rangan Chatterjee, the BBC’s "Doctor in the House". Journey to 100 will host 20 leading global healthcare, lifestyle and longevity experts, who will share their perspectives and help us all understand how we can live healthier, happier lives, from zero to 100 years old and beyond. Expect over 20 international speakers from all over the world including some past Functional Forum presenters like Dr. Janet Settle, Dr. Michael Ash, Tom Blue and Dr. Sachin Patel. Beyond progressive medicine models, there will also be talks on fascinating topics indirectly related to healthcare like sustainable farming, universal basic income and community support structures.
German physician Robert Koch, noting fellow German Ferdinand Cohn's report of a spore stage of a certain bacterial species, traced the life cycle of Davaine's bacteridia, identified spores, inoculated laboratory animals with them, and reproduced anthrax—a breakthrough for experimental pathology and germ theory of disease. Pasteur's group added ecological investigations confirming spores' role in the natural setting, while Koch published a landmark treatise in 1878 on the bacterial pathology of wounds. In 1881, Koch reported discovery of the "tubercle bacillus", cementing germ theory and Koch's acclaim.
1796 Edward Jenner develops a method to protect people from smallpox by exposing them to the cowpox virus. In his famous experiment, he rubs pus from a dairymaid's cowpox postule into scratches on the arm of his gardener's 8-year-old son, and then exposes him to smallpox six weeks later (which he does not develop). The process becomes known as vaccination from the Latin vacca for cow. Vaccination with cowpox is made compulsory in Britain in 1853. Jenner is sometimes called the founding father of immunology.
^ Nesse RM, Bergstrom CT, Ellison PT, Flier JS, Gluckman P, Govindaraju DR, Niethammer D, Omenn GS, Perlman RL, Schwartz MD, Thomas MG, Stearns SC, Valle D (January 2010). "Evolution in health and medicine Sackler colloquium: Making evolutionary biology a basic science for medicine". Proceedings of the National Academy of Sciences of the United States of America. 107. 107 Suppl 1 (suppl_1): 1800–7. doi:10.1073/pnas.0906224106. PMC 2868284. PMID 19918069.
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.
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. 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.
Many contemporary humans engage in little physical exercise compared to the physically active lifestyles of ancestral hunter-gatherers. Prolonged periods of inactivity may have only occurred in early humans following illness or injury, so a modern sedentary lifestyle may continuously cue the body to trigger life preserving metabolic and stress-related responses such as inflammation, and some theorize that this causes chronic diseases.
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.
But that is not the whole story. Humans did not at first regard death and disease as natural phenomena. Common maladies, such as colds or constipation, were accepted as part of existence and dealt with by means of such herbal remedies as were available. Serious and disabling diseases, however, were placed in a very different category. These were of supernatural origin. They might be the result of a spell cast upon the victim by some enemy, visitation by a malevolent demon, or the work of an offended god who had either projected some object—a dart, a stone, a worm—into the body of the victim or had abstracted something, usually the soul of the patient. The treatment then applied was to lure the errant soul back to its proper habitat within the body or to extract the evil intruder, be it dart or demon, by counterspells, incantations, potions, suction, or other means.
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.
Chris Kresser: Mm-hmm. So let’s talk a little, since we’re on the topic, let’s talk a little bit more about scalability. We’re actually, you mentioned combining higher-cost services with lower-cost services or personnel for implementation. I’m expanding my own clinic now and we’re getting ready. I’ve hired an intern here that I’m training, and we’re going to be hiring, probably in the future, some nurse practitioners and physician assistants that can help to implement some of the treatment protocols that I’m designing and researching. We’re using technology now a lot more efficiently with electronic health records, and handouts and documents that can be delivered through that on specific health conditions that patients have. So rather than spending time clinically to talk them through these things, we can give them a handout or even direct them to a video or webinar to watch, which is a lot more time-efficient for me, and cost-efficient for them, because they’re not paying me to just tell them something that they could learn by watching a video or a webinar. So what’s your take on how functional medicine will scale and become available? And what role does technology play in that?
This week on the Evolution of Medicine podcast continues our “Success Leaves Clues” series, “From Matrix to Action” and welcome former Functional Forum guest Dr. Lara Salyer of Health Innate. Dr. Salyer, DO was featured on the Functional Forum this year, is an enthusiastic member of our Practice Accelerator program, and runs a functional medicine practice in rural Wisconsin.