The British National Health Service (NHS) reaches 70 years of age on 5 July 2018. There is much to be thankful for and celebrations to mark this anniversary are taking place all over the United Kingdom. In that time there have been previously unimaginable changes in medical treatment. In the UK it is remarkable how the NHS has evolved to continue to provide universal health care for the whole population, while still being free at the point of delivery. However, in the overall history of medicine the NHS is relatively recent.
This 30 minute video by John Geater seeks to summarise the history of medicine and explain how our understanding has changed and evolved over the last 2,500 years or so.
Of course such a brief overview will have major gaps, make significant assumptions and miss out many details, but I think it provides a helpful summary. There are 10 significant observations:
1. Illness was first regarded as a sign of divine displeasure. We still have a tendency to think like this when after falling sick or being diagnosed with a major illness we say something along the lines of, "What have I done to deserve this?" Our tendency to look for someone to blame, be that ourselves or God is an understandable human reaction.
2. Hippocrates (460-377 BC), often regarded as the father of modern medicine, introduced the understanding that we should look for natural causes of illness. As well as advocating changes in lifestyle to deal with illness he introduced the concept of the good of the patient being the highest ideal to aim for. Over 2000 years later this understanding of the clinician being there first and foremost for the patient is central to medical treatment. Treating human beings should be seen as more than just a job, but a high and noble calling. The value and dignity of human life is a key value in any truly civilised society.
3. Aristotle (384-322 BC) combined this natural cause understanding of illness with philosophy. In particular this was with the heart as more than just a mechanical pump, but the source of passion and the spirit. We still talk of the heart metaphorically in this way.
4. Galen (200-130 AD) observed how red blood flowed from the heart and how 'black' (dark) blood flowed from the liver and in the veins. From this he made the conclusion that if the black blood was removed then patients would improve. For the next thousand years the use of leeches and venesection to get rid of the black blood was the main form of medical treatment available. In many ways medical treatment became stuck in viewing illness as a combination of any of the following:
A sign of divine displeasure
Demons and spirits
Deficiency of spiritual devotion
Coming from damp, foul air.
Available treatments involved a combination of prayer, priestly intercession, pilgrimages to the bones of saints, penances, poultices and leeches as well as potions and herbal remedies.
While there was much deficient in this understanding with poor science and poor theology, there was a recognition of human beings being made up of body, mind and spirit.
5. The next shift only came from a combination of Arabic Islamic science through scholars who had preserved and translated the writings of the Greeks, and Christian caring.
6. An important practical example of that was the setting up in the 11th century of the Santa Maria della Scala Hospital in Siena, Italy. It was one of Europe's first hospitals and is one of the oldest hospitals still surviving in the world. Now a museum, it was once an important civic hospital dedicated to caring for abandoned children, the poor, the sick, and pilgrims. Revenues were earned partially from bequests and donations from the citizens of Siena, particularly the wealthy.
7. From such hospitals developed the understanding that it was vital to treat not just the physical aspects of disease, but the spiritual and emotional sides of the person. The inner aspect of human beings were being recognised as important and worthy of care and attention.
8. Further understanding of this is that as well as having a physical body we have a spiritual body and a mind that in some mysterious and wonderful way links the two together. Where the body ends and the spiritual body begins is impossible to accurate determine. They are integrated together. Whatever our worldview we all function as body, mind and spirit as the inner being communicates with the outside world through the mind. So even something as apparently simple as a fractured bone has non-physical components. We can explore that with questions such as, 'Why has it been fractured? Why does the person with the fracture feel anxious and maybe guilty? Are there concerns about their family's welfare and income? Is there anxiety leading to physical effects on the person's body?'
9. William Harvey (1578-1657) is regarded as the first person to describe the accurate circulation of the blood that arteries carry the blood away from the heart and of veins bringing it back to the heart. This was a revolutionary understanding that profoundly challenged Aristotle's view that the heart was the seat of the spirit and the source of life. From this point onwards and into the 18th century came the great divide of the Enlightenment which has come to dominate Western European thinking. What can be seen and measured came to be seen as the 'real world' of science. In contrast was the humanities of religion and art that was more subjective and harder to define.
10. This great divide has accelerated into the twentieth century with a so called dualistic approach that treats the illness or disease but fails to recognise the whole person. John Geater gives some vivid patient examples of this. What has developed is an organ centered medicine of increased specialisation in smaller and smaller areas of expertise with the assumption that the top doctor is the top scientist. Here is how one quoted writer from 2004 has put it:
"Medical training seems to be focussed on how to deal with things - a liver, an MRI scan - rather than how to deal with people, such as patients and colleagues.
This lack of training on how to deal with people could mean doctors are ill-equipped for this vital part of their jobs and explains much of their subsequent stress."
While medical advances have been enormous, we appear to be rediscovering the need to treat the whole person as articulated by the World Health Organisation in 1998
"This mechanistic view of patients focussing on medicines and surgery is no longer satisfactory. Patients and physicians have begun to realise the value of elements such as faith, hope and compassion in the healing process."
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