Contents

• The Body & the Brain
• Pre-Med Society Announcements
• Milestones in the History of Western Medicine Part I
• Food Drink Man & Woman

The Body & the Brain
By Clement Zai

~ An interview with Dr. Sandor, M. D., F. R. C. P.  (C), Director of the Tourette's Syndrome clinic at the Toronto Hospital, Western Division and director of the Neuropharmacology program.  Dr. Sandor is also an assistant professor in U of T’s Department of Psychiatry

Psychiatry is the science and practice of treating mental diseases.  Studying the nature of these illnesses helps us to better understand one of the greatest mysteries of the universe, the brain, and its interactions with the body.  Tourette's Syndrome  (TS)  is one of the examples of neuropsychiatric disorders that Dr. Sandor suggests are "good models for this study".

TS was first discovered by a French physician, Georges Gilles de la Tourette in 1885, and is a psychiatric disorder characterized by involuntary movements in the limbs, face and head often accompanied by vocal tics that are sometimes obscene.  These tics tend to be more frequent and intense during times of stress and anger. Because of this kind of interaction, "the body and the mind cannot be separated".  When Dr. Sandor first became involved in psychiatry, TS was thought of as a psychological condition which could only be treated with psychotherapies and psychoanalyses.  Then in the 1960's came the discovery of Haloperidol, a drug which blocks off dopamine receptors and thus controls some of these symptoms.  TS became a more biological condition which could be treated with the aid of pharmacological research. More attention was being focused on this syndrome, and the number of cases increased from the original fifty.  Now, it is estimated that TS affects approximately one to two per cent of the general population.

According to Dr. Sandor, psychotherapies and psychoanalyses are still very important today.  However, new information and techniques in molecular biology and imaging, like positronic emission tomography (PET) and magnetic resonance imaging (MRI) provide us with better pictures of the brain and how the different nerve cells communicate with one another. 

X-rays suggest that some parts of the brains of TS patients are in fact shaped differently than those people without TS.  Genetic research in the past fifteen years also indicates that the frequency of TS is higher in certain families than others.  This finding suggests that the disorder is autosomal dominant, meaning that if one of the parents has TS, each of the children has a 50 per cent chance of getting TS.  It also suggests that TS can be associated with other psychiatric disorders like Obsessive Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD). 

Dr. Sandor thinks that psychiatry is the most exciting field because "the object of this study, the human brain, is the most complex object known in the universe, because it has billions of cells, each of which has many thousands of connections".  It will be a challenge and it will provide exciting opportunities for studies and research for years to come. 

"I think we are at a point where we are beginning to really break the code and start to understand how it works." 

Pre-Med Society Announcements

To be made available soon.

Milestones in the History of Western Medicine Part I
By Alan Fung
 

"The history of medicine is, in fact, the history of humanity itself, with its ups and downs, its brave aspirations after truth and finality, its pathetic failures." 

                                                        -- Fielding Garrison, 1913

The history of western medicine can be traced back to the Hellenic civilization in the classical era. Since then, there have been countless practitioners and events that have shaped the development of the profession. We will examine some of the most prominent individuals and schools of thought contributing to the development of western medicine prior to the 1650s.

Classical Era 

The Greeks believed that sickness could be ascribed to divine intervention. The gods could make people well again if people made the appropriate sacrifices. 

Hippocrates  (460BC - ?)

Regarded as the "Father of Medicine", Hippocrates laid the foundation for Greek medicine. He sought to find a natural cause of sickness. He believed that a healthy body was the natural condition, and that any sickness was due to a disturbance in nature. A moderate and harmonious life was crucial to maintain good health. Suffering would thus be alleviated by proven cures and by hygiene, not supernatural power.

Hippocrates emphasized the importance of patient-care of doctors. He brought about the concept of disease by relating all medical knowledge of his time. He also devised a systematic method of diagnostic investigation based on observation. 

His ideas are to be found in various collections of work. The Aphorisms contained the 406 day-to- day sayings of Hippocrates. The first one is well known: "Life is short, the Art is long, opportunity fleeting, experience delusive, judgement difficult." The  Hippocratic Oath, which set a high standard of professional conduct, and other ethical works formed part of the Corpus Hippocraticum, a group of medical treatises of various schools and epochs collected in the third century B.C. 

Hippocratic teaching, however, suffered from a lack in anatomy and physiology, the foundations of modern medicine. This could be attributed to the respect for the dead of the Greeks. Dissection was thus strictly prohibited and made in-depth study of the human body impossible. 

Nonetheless, Hippocrates became so famous and was awed highly. It was widely believed that honey from the bees on his grave had miraculous healing power! 

Galen, Claudius (AD 130 - 203)

Claudius Galen is a giant in the development of Western medicine tradition. He summarized and systematized all the medical knowledge of ancient times with reasoning that was always based on observation and experience.  He believed in the importance of repeating dissections over and over again in order to verify results and to improve the skills of dissection. His observations of the human body were on the whole very accurate, and have impressed anatomists ever since. The first printed edition of his work in 1586, together with Corpus Hippocraticum, represented the sum of medical achievement in classical antiquity.

Sounding ridiculous today, Galen believed that blood was made in the liver, mixed in brain and the lungs with a substance known as 'spirit' and then used up in other parts of the body. To get into arteries it went through holes in the septum. Galen also strongly believed in the four humours theory of the Greeks, and based many treatments on it.

Despite these beliefs, Galen is held in high regard in history because both his important discoveries and false assumptions remain unchallenged for nearly fifteen hundred years.

Medieval Era

The immediate collapse of the Roman Empire was the result of a series of epidemics and plagues. 
Doctors were powerless in the face of these disasters, which led to a universal reaction against scientific and rational approach to disease.  Medicine assumed its superstitious practice. 

School of Salerno

During the Middle Ages, it was the Islamics who collected and passed on the knowledge of the Greeks. Their own contributions were then preserved in European medical thought, notably in the School of Salerno. Opened in 1224, Salerno was Europe's first officially recognised medical school. The knowledge of the school was mainly set down in light verse. Perhaps the most encouraging feature in the male-dominated society of the Middle Ages was the presence of many female students, who are frequently referred to in the writings.

Renaissance

A cultural movement that revived ancient learning of the Greeks and Romans marked the end of the Middle Ages. This was the beginning of Humanism, part of the Renaissance movement.

Paracelsus (1493-1541)

The German-speaking Philippus Aureolus Theophrastus Bombastus von Hohenheim, with the Latinised name Paracelsus, was the author of more than three hundred works, ranging from practical works on medicine containing much original observation, to studies on alchemy and metaphysics. He realized that medicine must forsake the teaching of Galen and start afresh. However, he was in error in thinking that matter was composed of sulphur, mercury and salt.

Andreas Vesalius  (1514-63)

Celebrated as the "father of anatomy" (ham, pp77), Vesalius courageously discarded the dogma of Galen at the age of twenty-eight (1543), and published De Humani corporis fabrica libri septum (seven books on the structure of the human body). Though not completely free of errors, the set of works was monumental and became the foundation for modern medicine. It illustrated the first systematic effort to correct the erroneous Galenian teaching, which prevailed in Western medical tradition for over a millenium. 

Vesalius's work revealed that the most serious errors of Galen's teachings were the anatomy of liver, bile duct, upper jaw and uterus. He also discovered that there were no holes in the septum, thereby weakening Galen's theory of blood circulation.

Ambroise Pare (1517-90)

The French-born surgeon learned on the job rather than from books. 'Surgery is learned with the hand and the eye,' said Pare, and became the leading surgeon in the sixteenth century. 

The increased use of gunpowder in the wars at that time led to infections in gunshot wounds. The accepted treatment was to pour hot oil into gunshot wounds, and to seal the blood vessels of the wound by searing with a red hot iron ('cautery'). Pare reformed the treatment of gunshot wounds by tying off the arteries with a silk thread. This method greatly relieved the pain accompanying the treatment of wounds. However, it also meant that the wound was more likely to go septic and kill the patient. As a result, Pare's method could not be fully used until the development of antiseptics by Joseph Lister (1827-1912) centuries later.

William Harvey (1578-1657) 

The discovery of the circulation of blood by William Harvey was a turning point in medical history. 
Harvey's use of careful experiment and measurement set a good model for other scientific workers. Most importantly, it proved beyond any doubt that Galen had been wrong in explaining how the circulatory system worked. It followed that Galen might be wrong about other teachings as well. 

This discovery was crucial to the development of knowledge about the function of blood in various parts of the body. However, the development was purely scientific. It did not bring about any improvement in treatment for the succeeding two hundred years.

Further Readings
Conrad, Lawrence I. & others. The Western Medical Tradition 800BC- 1800AD. Great Britain: Cambridge University Press, 1995.

Margotta, Roberto. The Hamlyn History of Medicine. London: Reed International Books Limited, 1996.

Nuland, Sherwin B. Doctors: The Biography of Medicine. New York: Alfred A. Knopf, Inc., 1988.

Siraisi, Nancy G. Medieval & Early Renaissance Medicine. United States: The University of Chicago Press, 1990.

Food, Drink, Man & Woman

To be made available soon.