Mercury Thermometer                                                Digital Thermometer 

                                                  Digital Pacifier Thermometer                                                  

                                                                 Digital Tympanic Thermometer                   

Thermometer
            Thermometers measure temperature, by using materials that change in some way when they are heated or cooled. In a mercury or alcohol thermometer the liquid expands as it is heated and contracts when it is cooled, so the length of the liquid column is longer or shorter depending on the temperature. Modern thermometers are calibrated in standard temperature units such as Fahrenheit or Celsius.

            A mercury-in-glass thermometer, invented by German physicist Daniel Gabriel Fahrenheit, is a thermometer consisting of mercury in a glass tube. Calibrated marks on the tube allow the temperature to be read by the length of the mercury within the tube, which varies according to the temperature. To increase the sensitivity, there is usually a bulb of mercury at the end of the thermometer which contains most of the mercury; expansion and contraction of this volume of mercury is then amplified in the much narrower bore of the tube. The space above the mercury may be filled with nitrogen or it may be a vacuum.

Maximum thermometer

            A special kind of mercury thermometer, called a maximum thermometer, works by having a constriction in the neck close to the bulb. As the temperature rises the mercury is pushed up through the constriction by the force of expansion. When the temperature falls the column of mercury breaks at the constriction and cannot return to the bulb thus remaining stationary in the tube. The observer can then read the maximum temperature over a set period of time. To reset the thermometer it must be swung sharply, or the constriction may be pulled down with a magnet. This is similar to the design of a medical thermometer.

Physical properties

            Mercury will solidify (freeze) at -38.83 °C (-37.89 °F) and so may only be used at higher temperatures. Mercury, unlike water, does not expand upon solidification and will not break the glass tube, making it difficult to notice when frozen. If the thermometer contains nitrogen the gas may flow down into the column and be trapped there when the temperature rises. If this happens the thermometer will be unusable until returned to the factory for reconditioning. To avoid this some weather services require that all mercury thermometers be brought indoors when the temperature falls to -37 °C (-34.6 °F). In areas where the maximum temperature is not expected to rise above -38.83 °C (-37.89 °F) a thermometer containing a mercury-thallium alloy may be used. This has a solidification (freezing) point of -61.1 °C (-78 °F). 

Early History            The first thermometers were called thermoscopes and while several inventors invented a version of the thermoscope at the same time, Italian inventor Santorio Santorio was the first inventor to put a numerical scale on the instrument. Galileo Galilei invented a rudimentary water thermometer in 1593 which, for the first time, allowed temperature variations to be measured. In 1714, Gabriel Fahrenheit invented the first mercury thermometer, the modern thermometer.

b. Vaccination            The two public health interventions that have had the greatest impact on the world’s health is clean water and vaccines. Thanks to such pioneers as Jenner and Pasteur, a handful of vaccines prevent illness or death for millions of individuals every year. But there is still a long way to go. Immunization, the most cost-effective public health intervention, continues to be under-used. It is profoundly tragic that almost two million children still die each year from diseases for which vaccines are available at low cost. And over 90,000 fall victim to paralytic polio, which could also have been prevented by immunization. Indeed many years elapsed between the invention of current vaccines and their widespread use in immunization programs. The reasons for these delays are many and complex. If history is to serve any useful purpose, it should help us to find ways to such delays in future.

            The closing years of the 19th century and the early years of the 20th century were marked by the achievements of great vaccine scientists such as Pasteur. Since the introduction of vaccinia by Jenner 200 years ago (“vaccination” in its true sense), nine major diseases of man have been controlled to a greater or lesser extent through the use of vaccines (Table 1). Several other vaccines have been used in individuals at risk from disease of such as rabies and plague, but have not been systemetically applied on a global scale. While BCG has been widely administered to newborns, thus successfully preventing complications such as meningitis and miliary tuberculosis, administration of the vaccine has not resulted in control of the disease.Table: The date of introduction of first generation of vaccines for use in humans.

* 1798 Smallpox

* 1855 Rabies

* 1897 Plague

* 1923 Diptheria

* 1926 Pertussis

* 1927 Tuberculosis (BCG)

* 1927 Tetanus

* 1935 Yellow FeverAfter World War II

* 1955 Injectible Polio Vaccine (IPV)

* 1962 Oral Polio Vaccine (OPV)

* 1964 Measles

* 1967 Mumps

* 1970 Rubella

* 1981 Hepatitis B

            Although the first vaccines were, in some respects, crude, they have proved to be robust and efficient, and continue to be the workhorses of global immunization programs. They have dramatically reduced the burden of death and disease from these nine infections, and have given credibility to the entire preventive health movement. During the 1920s, diphtheria and tetanus toxiods, whole cell pertussis vaccine and BCG were introduced. Thanks to the development of the chorioallantoic membrane for culturing viruses, a yellow fever vaccine was available by 1935. After the Second World War, there followed an explosion of technology, resulting in the emergence of other vaccines still in use today. These included the killed and oral polio vaccines, and the measles, mumps and rubella vaccines.Early National Immunization Programmes 1900-1973.            During this period, the use of available vaccines was largely confined to industrialized countries. For instance, smallpox vaccine was offered to all age groups, but only those at risk – health care workers and travellers – were specially targeted. As a result, coverage was patchy and outbreaks continued to occur throughout the world. When this happened, massive vaccination efforts were mounted by health authorities, often very successfully, to contain the infection through vaccination and isolation or quarantine of infected individuals or suspected cases.

            Other vaccines such as BCG were gradually introduced in the West, (Table 2) as they became available. Better off-families who could afford vaccination benefited most – the poor benefited the least. Because of low, irregular coverage, communities continued to be devastated intermittently by outbreaks of these vaccines – preventable diseases throughout the 1930s and 1940s.

            An injectable form of killed polio vaccine (IPV) became available in 1955, resulting in widespread administration in schools and clinics in industrialized countries across a broad age range resulting in a marked drop in cases in these countries. In 1962, the oral polio vaccine (OPV) replaced IPV and continues to be the vaccine of choice for eradication of the virus. Despite initial low coverage, the vaccine showed itself capable of dramatically reducing the number of polio cases when administered to a wide age range over a short period of time.Table: Vaccines used in national immunization programs upto 1974.

* Small pox

* BCG

* Diphtheria toxiod

* Tetanus toxiod

* Pertussis

* IPV & OPV

* Measles

            In terms of strategy, the early programs offered routine immunization through regular maternal and child health services. While efforts were made to encourage acceptance, no major effort was made to achieve total coverage. The implied target was to raise coverage, but there was no disease reduction target specified.            The early years of 19th century saw widespread but haphazard use of Jenner’s vaccine. However, application of smallpox vaccine was systematic in Mexico and
Guatemala around 1805 (ref 2). The first attempt to use it on a global scale began in 1956 when the World Health Organization and others selected smallpox for eradication from the globe.

            It was not the first time disease eradication had been mooted. Already the scientific community had considered the possibility of eradicating bovine contagious pleuropneumonia (a highly fatal disease of cattle), hookworm, yellow fever, malaria and yaws. Now with a clear strategy and a highly effective, affordable vaccine, it wa possible to unite all countries in a mighty effort to rid themselves of this disease and the tremendous annual cost it incurred. To meet this special circumstance, very high population coverage with the smallpox vaccine was used. Finally in the late 1960s, an additional strategy was developed whereby cases were identified through intensive surveillance and confined (“attainment”), and possible contacts within a given radius were vaccinated. Details of this effort are chronicled elsewhere (ref 3).

            The next notable attempt at large-scale control was undertaken in
Gambia in 1967-1970 when Foege and his team administered measles vaccine in a mass country-wide campaign. As a result, indigenous measles was entirely absent from
Gambia until 1972. However, due to inability to sustain immunization coverage, the situation soon reverted to pre-campaign levels (ref 4).

The Expanded Program On Immunization (EPI)            Following the impressive success of the smallpox eradication programme, the World Health Organization looked for otheractivities that could build on what had already been achieved. In 1974 the Expanded Programme On Immunization was created. “Expanded” because most programmes until then had only used smallpox, BCG and diptheria, tetanus and pertussis (DTP) vaccines. EPI would include two new diseases. The six diseases chosen were tuberculosis, diptheria, neonatal tetanus, whooping cough, poliomyelitis and measles. Selection was made on the basis of a high burden of disease and the availability of a well-tried vaccines at an affordable price. “Expanded” also meant increased coverage – incredibly, less than 5% of children in developing countries were being reached at that time by immunization services.

            Gradually, global coverage for the six vaccines rose, although success was not uniform. Regions and countries with the greatest resources, infrastructure and political will were able to raise coverage faster and higher. Many organizations such as UNICEF and Rotary International became partners in the program. Between 1974 and 1980, the program developed training materials and disseminated them widely. In those busy years, almost every country in the world adopted the principle of a national immunization program. (Many used and continue to use the name “EPI” which has become a trade mark). Hundreds of training courses in dozens of languages were conducted resulting in a huge mobilization of human resources. Personnel were trained in the management of the program so that every community was reached (at least in theory) by some form of immunization service. The number of doses administered and the number of target diseases occurring were recorded and reported.

 Table: Vaccines used by the Expanded Program on Immunization from 1974 onwards* BCG

* Polio

* DTP

* Measles 

Added Later

* Yellow Fever  * Hepatitis B

c. Stethoscope

Modern acoustic stethoscope            The stethoscope (Greek words, stéthos – chest and skopé – examination) is an acoustic medical device for auscultation, i.e. listening to internal sounds in the human body. It is most often used to listen to heart sounds and breathing (breath sounds), though it is also used to listen to intestines and blood flow in arteries and veins.

History

            The stethoscope was invented in France in 1816 by René-Théophile-Hyacinthe Laennec. It consisted of a wooden tube and was monaural. In 1851 Arthur Leared invented a binaural stethoscope, and in 1852 George Cammann perfected the design of the instrument for commercial production, which has become the standard ever since. Cammann also authored a major treatise on diagnosis by auscultation, which the refined binaural stethoscope made possible. By 1873, there were descriptions of a differential stethoscope that could connect to slightly different locations to create a slight stereo effect, though this did not become a standard tool in clinical practise.            Rappaport and Sprague designed a new stethoscope in the 1940′s which became the standard by which other stethoscopes are measured. The Rappaport-Sprague was later made by Hewlett-Packard, and today there are still cardiologists who consider it to be the finest acoustic stethoscope. Several other minor refinements were made to stethoscopes until in the early 1960′s Dr. Littmann, a Harvard Medical School professor, created a new stethoscope that was lighter than previous models. Littmann followed a long tradition — stethoscopes designed by physicians.

The Monaural Stethoscope

            The stethoscope was invented in 1816 when a young French physician named Rene Theophile Hyacinthe Laennec was examining a young female patient. Laennec was embarrassed to place his ear to her chest ( Immediate Auscultation ), which was the method of auscultation used by physicians at that time. He remembered a trick he learned as a child that sound travels through solids and thus he rolled up 24 sheets of paper, placed one end to his ear and the other end to the woman’s chest. He was delighted to discover that the sounds were not only conveyed through the paper, but they were also louder and clearer. 

            The first recorded manuscript documenting auscultation using the stethoscope ( Mediate Auscultation) was in March 8, 1817, when Laennec noted examining a Marie-Melanie Basset, who was 40 years old.

            Laennec then took his idea further. He set up a small shop in his home, with a wood-turning lathe
and many different materials. He created a stethoscope from a turned piece of wood, hollow in the center. It was made of two pieces. One end had a hole to place against the ear, and the other was hollowed out into a cone. There was a third piece that fit into this cone which had a hollow brass cylinder placed inside it. This piece was placed in the stethoscope to listen to the heart, and
removed to examine the lungs. Laennec published his classic treatise on mediate auscultation in 1819.

The Binaural Stethoscope

            In 1852, Dr. George Cammann of
New York produced the first recognized usable binaural stethoscope. He was working as a physician at the Northern Dispensary in
New York City and had seen Marsh’s model. He also had a model of a soft metal, multiple-tubed stethoscope made by H. Landouzy in 1841, which was designed for two people to listen at the same time. And Charles J. B. Williams claims to have made a binaural stethoscope with lead tubes in 1843. Cammann did not claim to have the original idea for a binaural stethoscope, only to have developed a practical instrument that could be used in clinical practice.

            Cammann’s model was made with ivory earpieces connected to metal tubes. These were held together by a simple hinge joint, and tension was applied by way of an elastic band. Attached to these were two tubes covered by wound silk. These converged into a hollow ball designed to amplify the sound, and attached to the ball was a conical shaped, bell chest piece.

Current practice

            The stethoscope is used in aid of diagnosing certain diseases and conditions. The stethoscope is able to transmit certain sounds and exclude others. Before the stethoscope was invented, doctors placed their ear next to the patient’s body in hopes of hearing something.            Stethoscopes are often considered as a symbol of the doctor’s profession, as doctors are often seen or depicted with a stethoscope hanging around their neck.            Stethoscopes are also used by mechanics to isolate sounds of a particular moving engine part for diagnosis. 

Types of stethoscopes

Acoustic

            Acoustic stethoscopes are familiar to most people, and operate on the transmission of sound from the chestpiece, via air-filled hollow tubes, to the listener’s ears. The chestpiece usually consists of two sides that can be placed against the patient for sensing sound — a diaphragm (plastic disc) or bell (hollow cup). If the diaphragm is placed on the patient, body sounds vibrate the diaphragm, creating acoustic pressure waves which travel up the tubing to the listener’s ears. If the bell is placed on the patient, the vibrations of the skin directly produce acoustic pressure waves traveling up to the listener’s ears. The bell transmits low frequency sounds, while the diaphragm transmits higher frequency sounds. This 2-sided stethoscope was invented by Rappaport and Sprague in the early part of the 20th century. The problem with acoustic stethoscope is that the sound level is extremely low, making diagnosis difficult.

Electronic

            Electronic stethoscopes overcome the low sound levels by amplifiying body sounds. Currently, a number of companies offer electronic stethoscopes, and it can be expected that within a few years, the electronic stethoscope will have eclipsed acoustic devices.            Electronic stethoscopes require conversion of acoustic sound waves to electrical signals which can then be amplified and processed for optimal listening. Unlike acoustic stethoscopes, which are all based on the same physics, transducers in electronic stethoscopes vary widely. The simplest and least effective method of sound detection is achieved by placing a microphone in the chestpiece. This method suffers from ambient noise interference and has fallen out of favor. Another method, used in Welch-Allyn’s Meditron stethoscope, comprises placement of a piezoelectric crystal at the head of a metal shaft, the bottom of the shaft making contact with a diaphragm. 3M also uses a piezo-electric crystal placed within foam behind a thick rubber-like diaphragm. Thinklabs uses a stethoscope diaphragm with an electrically conductive inner surface to form a capacitive sensor. This diaphragm responds to sound waves identically to a conventional acoustic stethoscope, with changes in an electric field replacing changes in air pressure. This preserves the sound of an acoustic stethoscope with the benefits of amplification.            More recently, ambient noise filtering has become available in electronic stethoscopes, with 3M’s Littmann 3000 and Thinklabs ds32a offering methods for eliminating ambient noise.                                                              

            Prior to 1855 George Tiemann marked his medical instruments as Tiemann, after 1855 used the mark G. Tiemann & Co. and later used the mark Tiemann & Co. The markings on the above models help date these stethoscopes and are consistent with the introduction of the Cammann stethoscope in 1852.
  

d. Antiseptic

            Antiseptic is an agent that kills or inhibits the growth of microorganisms on the external surfaces of the body. Antiseptics should generally be distinguished from drugs such as antibiotics that destroy microorganisms internally, and from disinfectants, which destroy microorganisms found on nonliving objects. Germicides include only those antiseptics that kill microorganisms. Some common antiseptics are alcohol, iodine, hydrogen peroxide, and boric acid. There is great variation in the ability of antiseptics to destroy microorganisms and in their effect on living tissue. For example, mercuric chloride is a powerful antiseptic, but it irritates delicate tissue. In contrast, silver nitrate kills fewer germs but can be used on the delicate tissues of the eyes and throat. There is also a great difference in the time required for different antiseptics to work. Iodine, one of the fastest-working antiseptics, kills bacteria within 30 sec. Other antiseptics have slower, more residual action. Since so much variability exists, systems have been devised for measuring the action of an antiseptic against certain standards. The bacteriostatic action of an antiseptic compared to that of phenol (under the same conditions and against the same microorganism) is known as its phenol coefficient. Joseph Lister was the first to employ the antiseptic phenol, or carbolic acid, in surgery, following the discovery by Louis Pasteur that microorganisms are the cause of infections. Modern surgical techniques for avoiding infection are founded on asepsis, the absence of pathogenic organisms. Sterilization is the chief means of achieving asepsis.

Use in surgery

            The widespread introduction of antiseptic surgical methods followed the publishing of the paper Antiseptic Principle of the Practice of Surgery in 1867 by Joseph Lister, inspired by Louis Pasteur‘s germ theory of putrefaction. In this paper he advocated the use of carbolic acid (phenol) as a method of ensuring that any germs present were killed. Some of this work was preceded slightly by that of Dr. George H Tichenor and Ignaz Semmelweis.            But every antiseptic, however good, is more or less toxic and irritating to a wounded surface. Hence it is that the antiseptic method has been replaced in the surgery of today by the aseptic method, which relies on keeping free from the invasion of bacteria rather than destroying them when present.

How it works

            For the growth of bacteria there must be a certain food supply, moisture, in most cases oxygen, and a certain minimum temperature. These conditions have been specially studied and applied in connection with the preserving of food and in the ancient practice of embalming the dead, which is the earliest illustration of the systematic use of antiseptics.            In early inquiries a great point was made of the prevention of putrefaction, and work was done in the way of finding how much of an agent must be added to a given solution, in order that the bacteria accidentally present might not develop. But for various reasons this was an inexact method, and to-day an antiseptic is judged by its effects on pure cultures of definite pathogenic microbes, and on their vegetative and spore forms. Their standardization has been effected in many instances, and a water solution of phenol of a certain fixed strength is now taken as the standard with which other antiseptics are compared.

Some common antiseptics

            Alcohols

Most commonly used are ethanol (60-90%), 1-propanol (60-70%) and 2-propanol/isopropanol (70-80%) or mixtures of these alcohols. They are commonly referred to as “surgical alcohol”. Used to disinfect the skin before injections are given, often along with iodine (tincture of iodine) or some cationic surfactants (benzalkonium chloride 0.05 – 0.5%, chlorhexidine 0.2 – 4.0% or octenidine dihydrochloride 0.1 – 2.0%).  

Quaternary ammonium compounds                         Also known as Quats or QAC’s, include the chemicals benzalkonium chloride (BAC), cetyl trimethylammonium bromide (CTMB), cetylpyridinium chloride (Cetrim), cetylpyridinium chloride (CPC) and benzethonium chloride (BZT). Benzalkonium chloride is used in some pre-operative skin disinfectants (conc. 0.05 – 0.5%) and antiseptic towels. The antimicrobial activity of Quats is inactivated by anionic surfactants, such as soaps. Related disinfectants include chlorhexidine and octenidine.  

Boric acid Used in suppositories to treat yeast infections of the vagina, in eyewashes, and as an antiviral to shorten the duration of cold sore attacks. Put into creams for burns. Also common in trace amounts in eye contact solution. Though it is popularly known as an antiseptic, it is in reality only a soothing fluid, and bacteria will flourish comfortably in contact with it.  

Chlorhexidine Gluconate A biguanidine derivative, used in concentrations of 0.5 – 4.0% alone or in lower concentrations in combination with other compounds, such as alcohols. Used as a skin antiseptic and to treat inflammation of the gums (gingivitis). The microbicidal action is somewhat slow, but remanent. It is a cationic surfactant, similar to Quats.  

Hydrogen peroxide             Used as a 6% (20Vols) solution to clean and deodorise wounds and ulcers. More common 1% or 2% solutions of hydrogen peroxide have been used in household first aid for scrapes, etc. However, even this less potent form is no longer recommended for typical wound care as the strong oxidization causes scar formation and increases healing time. Gentle washing with mild soap and water or rinsing a scrape with sterile saline is a better practice.  

Iodine  

            Usually used in an alcoholic solution (called tincture of iodine) or as Lugol’s iodine solution as a pre- and post-operative antiseptic. No longer recommended to disinfect minor wounds because it induces scar tissue formation and increases healing time. Gentle washing with mild soap and water or rinsing a scrape with sterile saline is a better practice. Novel iodine antiseptics containing iodopovidone/PVP-I (an iodophor, complex of povidone, a water-soluble polymer, with triiodide anions I₃^-, containing about 10% of active iodine, with the commercial name Betadine) are far better tolerated, don’t affect wound healing negativelly and leave a depot of active iodine, creating the so-called “remanent,” or persistent, effect. The great advantage of iodine antiseptics is the widest scope of antimicrobial activity, killing all principial pathogenes and given enough time even spores, which are considered to be the most difficult form of microorganisms to be inactivated by disinfectants and antiseptics.  

Mercurochrome             Not recognized as safe and effective by the U.S. Food and Drug Administration (FDA) due to concerns about its mercury content. Another obsolete organomercury antiseptics include bis-(fenylmercury) monohydrogenborate (Famosept).  

Octenidine dihydrochloride             A cationic surfactant and bis-(dihydropyridinyl)-decane derivative, used in concentrations of 0.1 – 2.0%. It is similar in its action to the Quats, but is of somewhat broader spectrum of activity. Octenidine is currently increasingly used in continental
Europe as a QAC’s and chlorhexidine (with respect to its slow action and concerns about the carcinogenic impurity 4-chloroaniline) substitute in water- or alcohol-based skin, mucosa and wound antiseptic. In aqueous formulations, it is often potentiated with addition of 2-phenoxyethanol.  

Phenol (carbolic acid) compounds             Phenol is germicidal in strong solution, inhibitory in weaker ones. Used as a “scrub” for pre-operative hand cleansing. Used in the form of a powder as an antiseptic baby powder, where it is dusted onto the belly button as it heals. Also used in mouthwashes and throat lozenges, where it has a methadone-like painkilling effect as well as an antiseptic one. Example: TCP. Other phenolic antiseptics include historically important, but today rarely used (sometimes in dental surgery) thymol, today obsolete hexachlorophene, still used triclosan and sodium 3,5-dibromo-4-hydroxybenzenesulfonate (Dibromol).  

Sodium chloride             Used as a general cleanser. Also used as an antiseptic mouthwash. Only a weak antiseptic effect, due to hyperosmolality of the solution above 0.9%.  

Sodium hypochlorite             Used in the past, diluted, neutralised and combined with potassium permanganate in the Daquin’s solution. Nowadays used only as disinfectant.  

e. X-Ray            

               Mrs. Röntgen’s hand, the first X-ray picture of the human body ever taken.             X-rays are electromagnetic waves of short wavelength, capable of penetrating some thickness of matter. Medical x-rays are produced by letting a stream of fast electrons come to a sudden stop at a metal plate; it is believed that X-rays emitted by the Sun or stars also come from fast electrons. Both light and radio waves belong to the electromagnetic spectrum, the range containing all different electromagnetic waves. Over the years scientists and engineers have created EM waves of other frequencies–microwaves and various IR bands whose waves are longer than those of visible light (between radio and the visible), and UV, EUV, X-rays and g-rays (gamma rays) with shorter wavelengths. The electromagnetic nature of x-rays became evident when it was found that crystals bent their path in the same way as gratings bent visible light: the orderly rows of atoms in the crystal acted like the grooves of a grating.

            On 8 Nov, 1895, Wilhelm Conrad Röntgen (accidentally) discovered an image cast from his cathode ray generator, projected far beyond the possible range of the cathode rays (now known as an electron beam). Further investigation showed that the rays were generated at the point of contact of the cathode ray beam on the interior of the vacuum tube, that they were not deflected by magnetic fields, and they penetrated many kinds of matter.

            A week after his discovery,  Rontgen took an X-ray photograph of his wife’s hand which clearly revealed her wedding ring and her bones. The photograph electrified the general public and aroused great scientific interest in the new form of radiation. Röntgen named the new form of radiation X-radiation (X standing for “Unknown”). Hence the term X-rays (also referred as Röntgen rays, though this term is unusual outside of
Germany).

            The images produced by X-rays are due to the different absorption rates of different tissues. Calcium in bones absorbs X-rays the most, so bones look white on a film recording of the X-ray image , called a radiograph. Fat and other soft tissues absorb less, and look gray. Air absorbs the least, so lungs look black on a radiograph.

f. Electrocardiogram

            An electrocardiogram (EKG, ECG) is a test that measures the electrical signals that control the rhythm of your heartbeat.

                                                                                                                                ECG as done by Willem Einthoven            In 1856 Kolliker and Muller discovered the electrical activity of the heart when a frog sciatic nerve/gastrocenemius preparation fell onto an isolated frog heart and both muscles contracted synchronously. Alexander Muirhead attached wires to a feverish patient’s wrist to obtain a record of the patient’s heartbeat while studying for his DSc (in electricity) in 1872 at St Bartholomew’s HospitalThis activity was directly recorded and visualized using a Lippmann capillary electrometer by the British physiologist John Burdon Sanderson.The first to systematically approach the heart from an electrical point-of-view was Augustus Waller, working in St Mary’s Hospital in Paddington, London.His electrocardiograph machine consisted of a Lippmann capillary electrometer fixed to a projector. The trace from the heartbeat was projected onto a photographic plate which was itself fixed to a toy train.  This allowed a heartbeat to be recorded in real time. In 1911 he still saw little clinical application for his work.            The breakthrough came when Willem Einthoven, working in Leiden, The Netherlands, used the string galvanometer invented by him in 1901, which was much more sensitive than the capillary electrometer that Waller used.^[5] Einthoven assigned the letters P, Q, R, S and T to the various deflections, and described the electrocardiographic features of a number of cardiovascular disorders. In 1924, he was awarded the Nobel Prize in Medicine for his discovery. 

An electrocardiogram may show: ·         Evidence of heart enlargement. ·         Signs of insufficient blood flow to the heart. ·         Signs of a new or previous injury to the heart (heart attack). ·         Heart rhythm problems (arrhythmias). ·         Changes in the electrical activity of the heart caused by an electrolyte imbalance in the body. ·         Signs of inflammation of the sac surrounding the heart (pericarditis). An electrocardiogram cannot predict whether you will have a heart attack. 

Why It Is Done An electrocardiogram (EKG, ECG) is done to:·         Evaluate unexplained chest pain, especially when a heart attack is a possibility. Other possible causes of chest pain or discomfort that can be identified by an EKG include irregular heartbeats (arrhythmias), a heart chamber with thickened walls (hypertrophy), inflammation of the sac surrounding the heart (pericarditis), and reduced blood flow to the heart muscle (ischemia). ·         Monitor the heart’s electrical activity. ·         Determine whether thickening of the walls (hypertrophy) of a ventricle is present. ·         Monitor the effectiveness and possible side effects of certain medications that may affect the heart. ·         Check the function of mechanical devices (pacemakers or defibrillators) implanted in the heart to maintain a regular heart rhythm.             An electrocardiogram may be used to evaluate symptoms of heart disease (such as unexplained chest pain, shortness of breath, dizziness, faintness, or palpitations) or when risk factors for heart disease (such as high blood pressure, high cholesterol, cigarette smoking, diabetes, or a family history of early heart disease) are present. 

g. Antibiotic

            Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. Originally, an antibiotic was a substance produced by one microorganism that selectively inhibits the growth of another. Synthetic antibiotics, usually chemically related to natural antibiotics, have since been produced that accomplish comparable tasks.

            In 1926, Alexander Fleming discovered penicillin, a substance produced by fungi that appeared able to inhibit bacterial growth. In 1939, Edward Chain and Howard Florey further studied penicillin and later carried out trials of penicillin on humans (with what were deemed fatal bacterial infections). Fleming, Florey and Chain shared the Nobel Prize in 1945 for their work which ushered in the era of antibiotics.

            Another antibiotic, for example, is tetracycline (brand names: Achromycin and Sumycin), a broad-spectrum agent effective against a wide variety of bacteria including Hemophilus influenzae, Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia psittaci, Chlamydia trachomatis, Neisseria gonorrhoea, and many others. The first drug of the tetracycline family, chlortetracycline, was introduced in 1948.

h. Pacemaker 

Other names                Artificial pacemaker; Permanent pacemaker; Internal pacemaker; Cardiac resynchronization therapy; CRT; Biventricular pacemaker             A pacemaker is a small, battery-operated device that helps the heart beat regularly and at an appropriate rate.A pacemaker generally has two parts:

• Generator – contains the battery and the information to control the heartbeat
• Leads – wires used to connect the heart to the generator and send the electrical impulses to the heart to tell it to beat

            Today’s generators weigh a little less than an ounce (30 grams). The pacemaker’s battery can last about 7 to 8 years. It will be regularly checked by your doctor, and replaced when necessary.            Traditional pacemakers help control the right side of the heart to control the heart beat. This is called AV synchronization. A special type of pacemaker, called a biventricular pacemaker, works on both sides of the heart,. It synchronizes the right and left chambers (ventricles) of the heart and keeps them pumping together. This is called cardiac resynchronization therapy. All of today’s biventricular pacemakers can also work as an implantable cardio-defibrillator (ICD).IMPLANT SURGERY            A pacemaker must be implanted under the skin. This procedure usually takes about 1 hour. You will be given a sedative to help you relax, but you will be awake during the procedure. Pain medicine will be given during the procedure.            A small cut is made, usually on the left side of the chest. The health care provider uses x-rays to place the wires (leads) in the heart. After the leads are in place, they are connected to the pacemaker. The pacemaker is placed into the chest area, and the skin around it is closed with stitches. Most patients go home within 1 day of the procedure.COMPLICATIONS            Complications of pacemaker surgery include bleeding, infection, dropped lung (uncommon), abnormal heart rhythms, and puncture of heart leading to bleeding around the heart (rare).            A pacemaker can usually sense if the heartbeat is above a certain level, at which point it will automatically turn off. Likewise, the pacemaker can sense when the heartbeat slows down too much, and will automatically turn back on in order to start pacing again.WHY IT IS USED            A pacemaker is often the treatment of choice for people who have a heart condition that causes their heart to beat too slowly (bradycardia).            Less commonly, pacemakers may also be used to stop an abnormally rapid heart rate (tachycardia).            Biventricular pacemakers have been used to treat severe heart failure.INTERFERENCE            There are only a few devices in the environment today that which can interfere with a pacemaker.

• Arc welding equipment and equipment with powerful magnets have the potential to interfere with the pace generator.
• Most home appliances, such as a microwave, do NOT interfere with a pacemaker.
• Cell phones in the
  U.S. do NOT interfere with pacemakers, but you should still keep them away from the pacemaker area (for example, do not store your cell phone in your shirt pocket).

i. Ultrasound scanner 

            The textbook definition of ultrasound is energy generated by sound waves of 20,000 or more vibrations per second. Ultrasound is used in a large array of imaging tools. Often used for medical diagnostics, ultrasound uses sound waves that are far above the frequency heard by the human ear. A transducer gives off the sound waves and reflected back from organs and a tissue, allowing a picture of what is inside the body to be drawn on a screen. Ultrasound can be used to look for tumors, analyze bone structure, or examine the health of an unborn baby.

            Two researchers are noted in the history of ultrasound and medical imaging. They are: Doctor Karl Theodore Dussik of Austria, who published the first paper on medical ultrasonics in 1942, based on his research on transmission ultrasound investigation of the brain; and Professor Ian Donald of
Scotland, who developed practical technology and applications for ultrasound in the 1950s.

j. Genetic engineering

            Genetic engineering is the use of various methods to manipulate the deoxyribonucleic acid (DNA) of cells to produce biological products or to change hereditary traits. Techniques used include using needles to insert DNA into an ovum, hybridomas (hybrids of cancer cells and of cells that make a desired antibody), and recombinant DNA, in which the DNA of a desired gene is inserted into the DNA of a bacterium. The bacterium then reproduces itself, yielding more of the desired gene. Another type is the polymerase chain reaction (PCR) which refers to a lab process in which a particular DNA segment is quickly replicated to create a large, easily analyzable sample. The process makes perfect copies of DNA fragments and is used in DNA fingerprinting.

            The Human Genome Project, an ambitious attempt to map each human gene, was completed in 2003. Armed with this information, scientists hope to treat and cure many types of chronic diseases such as cancer, diabetes, Huntington’s disease, and neurofibromatosis (Elephant Man’s disease.)

            Many genetically engineered products are already on the market. These include bacteria designed to digest oil slicks and industrial waste products, growth hormones for both humans and cows, drugs such as interferon and insulin, and plants that are resistant to insects and disease.

            Genetic engineering techniques have also been used in the alteration of livestock and laboratory animals. The most famous of these animals was Dolly, the first cloned sheep. Genetically engineered products require the approval of at least one
U.S. government agency, such as the Food and Drug Administration or the Environmental Protection Agency.

            The first genetically engineered pet was marketed in 2003 when scientists inserted a jellyfish gene into the common zebrafish to make them glow yellow-green in the dark. “Frankenfish” was expected to be a big novelty item but sales were flat.

            Many people question both the ethics and the safety of genetic engineering. Because the science is so new, there is no way of predicting potential consequences to human health and safety should a genetically engineered animal escape the lab or if genetically altered food should turn out to have unexpected consequences. Several cases of genetically altered wheat infecting normal wheat crops have been reported. The infected crops were destroyed.

“Antiseptic.” Fact Monster. 2006. Pearson Education. 18 Jan. 2007 <http://www.factmonster.com/ce6/sci/A0804274.html>.

“Antiseptic.” WIkipedia. 18 Jan. 2006. Wikipedia Foundation, Inc. 18 Jan. 2007 <http://en.wikipedia.org/wiki/Antiseptic>.

Bellis, Mary. “The History of Ultrasound.” About : Inventors. 2007. 18 Jan. 2007 <http://inventors.about.com/library/inventors/blultrasound.htm>.

Bellis, Mary. “X-Ray.” About : Inventors. 2007. 18 Jan. 2007 <http://inventors.about.com/library/inventors/blxray.htm>.

“Definition of Antibiotic.” MedicineNet. 2007. 18 Jan. 2007 <http://www.medterms.com/script/main/art.asp?articlekey=8121>.

Glenn Gandelman, Md, Mph. “Pacemaker.” MedlinePlus. 11 Jan. 2007. 18 Jan. 2007 <http://www.nlm.nih.gov/medlineplus/ency/article/007070.htm>.

Khan, Dr Zahid Masood. “http://www.angelfire.com/80s/emed/history_of_vaccination.htm.” Angelfire. EMED. 18 Jan. 2007 <http://inventors.about.com/library/inventors/blthermometer.htm>.

“Mercury-in-Glass Thermometer.” Wikipedia. 14 Jan. 2007. Wikipedia Foundations, Inc. 18 Jan. 2007 <http://en.wikipedia.org/wiki/Mercury-in-glass_thermometer>.

Nissl, Jan Rn, Bs, Et. Al. “-Z Health Guide From WebMD: Medical Tests: Electrocardiogram.” WebMD. 22 Apr. 2004. 18 Jan. 2007 <http://www.webmd.com/hw/heart_disease/hw213248.asp>.

“Stethoscope History.” About : Inventors. 2007. The New York Times Company. 18 Jan. 2007 <http://inventors.about.com/library/inventors/blstethoscope.htm>.

“What is Genetic Engineering?” WiseGEEK. 2007. Conjecture Corporation. 18 Jan. 2007 <http://www.wisegeek.com/what-is-genetic-engineering.htm>.

• Conventional medicine is preferred in the treatment of trauma and emergencies while alternative medicine excels in the treatment of chronic disease, although homeopathy can also be very effective as a first-aid.
• Conventional medicine focuses on the relief of symptoms and rarely places emphasis on prevention or the treatment of the cause of a disorder. All alternative systems, on the other hand, strive to find and treat the cause of a disorder and frown on covering up the symptoms. Alternative therapies are also much more focused on prevention.
• Conventional medicine is organ specific, hence ophthalmologists, cardiologists, nephrologists, neurologists, etc. Alternative medicine, without exception, considers each person as a unique individual and uses a holistic approach in treatment.
• Conventional medicine believes in aggressive intervention to treat disease. It revels in terms such as “magic bullet” and “war” (“the war on cancer”), and prefers quick fixes (as do many patients). Alternative medicine believes in gentle, long-term support to enable the body’s own innate powers to do the healing.
• Conventional medicine’s main “arsenal” consists of surgery, chemotherapy, radiation, and powerful pharmaceutical drugs. Alternative medicine uses time-tested, natural remedies and gentle, hands-on treatments.
• Conventional medicine practitioners are guided in their treatment by strict rules set out by the Colleges of Physicians and Surgeons. This often leads to a “one size fits all” approach. Practitioners of alternative medicine, on the other hand, treat each patient as an individual and do what, in their opinion, is best rather than what is specified in a “rule book”.
• Conventional medicine sees the body as a mechanical system (the heart is a pump and the kidneys are a filter) and believes most disorders can be traced to chemical imbalances and therefore are best treated with powerful chemicals (drugs). Alternative medicine systems, almost without exception, accept that the body is suffused by a network of channels (meridians) that carry a subtle form of life energy. Imbalances or blockages of this energy are what lead to disease and clearing of the blockages and strengthening of the energy is the ultimate goal of alternative medicine.
• Conventional medicine prefers patients to be passive and accept their treatment without too many questions. Alternative medicine, in contrast, prefers and indeed, in many cases, requires the patient to take a highly active part in both prevention and treatment.
• Both conventional and alternative medicine ascribe to the principle “Do no harm”. However, while alternative medicine is essentially achieving this goal, conventional medicine seems to have almost totally lost sight of it. Hospitals are now the third largest killer in
  Australia and over one million people are seriously injured in American hospitals every year. Blood infections acquired in American hospitals cause 62,000 fatalities every year and bypass surgery results in 25,000 strokes a year. Two million patients experience adverse drug reactions in hospitals in the
  United States every year; of these, over 100,000 die making hospital-induced adverse drug reactions the fourth leading cause of death after heart disease, cancer, and stroke(5-11).
• The practice of conventional medicine is intimately tied in with the whole medico-pharmaceutical-industrial complex whose first priority is to make a profit. Although most conventional physicians have “healing the patient” as their first priority, they find it increasingly difficult to do so while operating within the system with its pharmaceutical salesmen, its rule books, its fear of malpractice suits, its endless paperwork to satisfy bureaucrats and insurance companies, and its time pressures. Most alternative medicine practitioners have no such constraints and pressures and can give the patient their undivided attention.
• Conventional medicine generally resists the use of natural remedies long after their efficacy has been scientifically proven (
  Germany is an exception to this). Most alternative medicine practitioners eagerly embrace new remedies and, in many cases, can point to years of safe use. Ginkgo biloba is now the most prescribed drug in
  Germany and has been found effective in the prevention and treatment of Alzheimer’s disease(12). Also in Germany the herb saw palmetto is now prescribed in 90 per cent of all cases of enlarged prostate; in the United States 300,000 prostate operations are performed each year to solve this problem. More profitable for sure, but dangerous and unpleasant for the patient(13).
• The major source of funds for medical research is pharmaceutical companies who, not surprisingly, are very reluctant to support investigations into lifestyle modifications, vitamins, and other unpatentable products. Nevertheless, a growing number of medical researchers are focusing their attention on natural supplements and remedies and are publishing their work in mainstream journals. The benefits of antioxidants have now been thoroughly documented by researchers at the

  Harvard
  Medical
  School and similar prestigious institutions. Folic acid, a simple B vitamin, has also been extensively studied in university laboratories and has been found to be effective in preventing or ameliorating heart attacks, strokes, angina, intermittent claudication, atherosclerosis, kidney disease, colon cancer, hearing loss, and Alzheimer’s disease(14-18).

Although alternative practitioners and a small group of conventional physicians do embrace the use of natural therapies and products the vast majority of “establishment” physicians are still dragging their heels and even denigrating and ridiculing alternative medicine. This fact, perhaps more than anything else, is what is driving the rapid and massive switch from conventional to alternative medicine. http://www.yourhealthbase.com/alternative_medicine.html

Stem Cell Basics

Stem cells have the remarkable potential to develop into many different cell types in the body. Serving as a sort of repair system for the body, they can theoretically divide without limit to replenish other cells as long as the person or animal is still alive. When a stem cell divides, each new cell has the potential to either remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell. 

II. What are the unique properties of all stem cells?

Stem cells differ from other kinds of cells in the body. All stem cells—regardless of their source—have three general properties: they are capable of dividing and renewing themselves for long periods; they are unspecialized; and they can give rise to specialized cell types.Scientists are trying to understand two fundamental properties of stem cells that relate to their long-term self-renewal:1.                  why can embryonic stem cells proliferate for a year or more in the laboratory without differentiating, but most adult stem cells cannot; and 2.                  what are the factors in living organisms that normally regulate stem cell proliferation and self-renewal? Discovering the answers to these questions may make it possible to understand how cell proliferation is regulated during normal embryonic development or during the abnormal cell division that leads to cancer. Importantly, such information would enable scientists to grow embryonic and adult stem cells more efficiently in the laboratory.Stem cells are unspecialized. One of the fundamental properties of a stem cell is that it does not have any tissue-specific structures that allow it to perform specialized functions. A stem cell cannot work with its neighbors to pump blood through the body (like a heart muscle cell); it cannot carry molecules of oxygen through the bloodstream (like a red blood cell); and it cannot fire electrochemical signals to other cells that allow the body to move or speak (like a nerve cell). However, unspecialized stem cells can give rise to specialized cells, including heart muscle cells, blood cells, or nerve cells.Stem cells are capable of dividing and renewing themselves for long periods. Unlike muscle cells, blood cells, or nerve cells—which do not normally replicate themselves—stem cells may replicate many times. When cells replicate themselves many times over it is called proliferation. A starting population of stem cells that proliferates for many months in the laboratory can yield millions of cells. If the resulting cells continue to be unspecialized, like the parent stem cells, the cells are said to be capable of long-term self-renewal.The specific factors and conditions that allow stem cells to remain unspecialized are of great interest to scientists. It has taken scientists many years of trial and error to learn to grow stem cells in the laboratory without them spontaneously differentiating into specific cell types. For example, it took 20 years to learn how to grow human embryonic stem cells in the laboratory following the development of conditions for growing mouse stem cells. Therefore, an important area of research is understanding the signals in a mature organism that cause a stem cell population to proliferate and remain unspecialized until the cells are needed for repair of a specific tissue. Such information is critical for scientists to be able to grow large numbers of unspecialized stem cells in the laboratory for further experimentation.Stem cells can give rise to specialized cells. When unspecialized stem cells give rise to specialized cells, the process is called differentiation. Scientists are just beginning to understand the signals inside and outside cells that trigger stem cell differentiation. The internal signals are controlled by a cell’s genes, which are interspersed across long strands of DNA, and carry coded instructions for all the structures and functions of a cell. The external signals for cell differentiation include chemicals secreted by other cells, physical contact with neighboring cells, and certain molecules in the microenvironment.Therefore, many questions about stem cell differentiation remain. For example, are the internal and external signals for cell differentiation similar for all kinds of stem cells? Can specific sets of signals be identified that promote differentiation into specific cell types? Addressing these questions is critical because the answers may lead scientists to find new ways of controlling stem cell differentiation in the laboratory, thereby growing cells or tissues that can be used for specific purposes including cell-based therapies.Adult stem cells typically generate the cell types of the tissue in which they reside. A blood-forming adult stem cell in the bone marrow, for example, normally gives rise to the many types of blood cells such as red blood cells, white blood cells and platelets. Until recently, it had been thought that a blood-forming cell in the bone marrow—which is called a hematopoietic stem cell—could not give rise to the cells of a very different tissue, such as nerve cells in the brain. However, a number of experiments over the last several years have raised the possibility that stem cells from one tissue may be able to give rise to cell types of a completely different tissue, a phenomenon known as plasticity. Examples of such plasticity include blood cells becoming neurons, liver cells that can be made to produce insulin, and hematopoietic stem cells that can develop into heart muscle. Therefore, exploring the possibility of using adult stem cells for cell-based therapies has become a very active area of investigation by researchers. 

V. What are the similarities and differences between embryonic and adult stem cells?

Human embryonic and adult stem cells each have advantages and disadvantages regarding potential use for cell-based regenerative therapies. Of course, adult and embryonic stem cells differ in the number and type of differentiated cells types they can become. Embryonic stem cells can become all cell types of the body because they are pluripotent. Adult stem cells are generally limited to differentiating into different cell types of their tissue of origin. However, some evidence suggests that adult stem cell plasticity may exist, increasing the number of cell types a given adult stem cell can become.Large numbers of embryonic stem cells can be relatively easily grown in culture, while adult stem cells are rare in mature tissues and methods for expanding their numbers in cell culture have not yet been worked out. This is an important distinction, as large numbers of cells are needed for stem cell replacement therapies.A potential advantage of using stem cells from an adult is that the patient’s own cells could be expanded in culture and then reintroduced into the patient. The use of the patient’s own adult stem cells would mean that the cells would not be rejected by the immune system. This represents a significant advantage as immune rejection is a difficult problem that can only be circumvented with immunosuppressive drugs.Embryonic stem cells from a donor introduced into a patient could cause transplant rejection. However, whether the recipient would reject donor embryonic stem cells has not been determined in human experiments. 

VI. What are the potential uses of human stem cells and the obstacles that must be overcome before these potential uses will be realized?

There are many ways in which human stem cells can be used in basic research and in clinical research. However, there are many technical hurdles between the promise of stem cells and the realization of these uses, which will only be overcome by continued intensive stem cell research.Studies of human embryonic stem cells may yield information about the complex events that occur during human development. A primary goal of this work is to identify how undifferentiated stem cells become differentiated. Scientists know that turning genes on and off is central to this process. Some of the most serious medical conditions, such as cancer and birth defects, are due to abnormal cell division and differentiation. A better understanding of the genetic and molecular controls of these processes may yield information about how such diseases arise and suggest new strategies for therapy. A significant hurdle to this use and most uses of stem cells is that scientists do not yet fully understand the signals that turn specific genes on and off to influence the differentiation of the stem cell.Human stem cells could also be used to test new drugs. For example, new medications could be tested for safety on differentiated cells generated from human pluripotent cell lines. Other kinds of cell lines are already used in this way. Cancer cell lines, for example, are used to screen potential anti-tumor drugs. But, the availability of pluripotent stem cells would allow drug testing in a wider range of cell types. However, to screen drugs effectively, the conditions must be identical when comparing different drugs. Therefore, scientists will have to be able to precisely control the differentiation of stem cells into the specific cell type on which drugs will be tested. Current knowledge of the signals controlling differentiation fall well short of being able to mimic these conditions precisely to consistently have identical differentiated cells for each drug being tested.Perhaps the most important potential application of human stem cells is the generation of cells and tissues that could be used for cell-based therapies. Today, donated organs and tissues are often used to replace ailing or destroyed tissue, but the need for transplantable tissues and organs far outweighs the available supply. Stem cells, directed to differentiate into specific cell types, offer the possibility of a renewable source of replacement cells and tissues to treat diseases including Parkinson’s and Alzheimer’s diseases, spinal cord injury, stroke, burns, heart disease, diabetes, osteoarthritis, and rheumatoid arthritis. 

For example, it may become possible to generate healthy heart muscle cells in the laboratory and then transplant those cells into patients with chronic heart disease. Preliminary research in mice and other animals indicates that bone marrow stem cells, transplanted into a damaged heart, can generate heart muscle cells and successfully repopulate the heart tissue. Other recent studies in cell culture systems indicate that it may be possible to direct the differentiation of embryonic stem cells or adult bone marrow cells into heart muscle cells (Figure 4).In people who suffer from type I diabetes, the cells of the pancreas that normally produce insulin are destroyed by the patient’s own immune system. New studies indicate that it may be possible to direct the differentiation of human embryonic stem cells in cell culture to form insulin-producing cells that eventually could be used in transplantation therapy for diabetics.To realize the promise of novel cell-based therapies for such pervasive and debilitating diseases, scientists must be able to easily and reproducibly manipulate stem cells so that they possess the necessary characteristics for successful differentiation, transplantation and engraftment. The following is a list of steps in successful cell-based treatments that scientists will have to learn to precisely control to bring such treatments to the clinic. To be useful for transplant purposes, stem cells must be reproducibly made to: ·                     Proliferate extensively and generate sufficient quantities of tissue. ·                     Differentiate into the desired cell type(s). ·                     Survive in the recipient after transplant. ·                     Integrate into the surrounding tissue after transplant. ·                     Function appropriately for the duration of the recipient’s life. ·                     Avoid harming the recipient in any way. Also, to avoid the problem of immune rejection, scientists are experimenting with different research strategies to generate tissues that will not be rejected.To summarize, the promise of stem cell therapies is an exciting one, but significant technical hurdles remain that will only be overcome through years of intensive research.The NIH has a wide array of new scientific programs designed to support research that uses embryonic stem cell lines. 

IV. What are adult stem cells?

An adult stem cell is an undifferentiated cell found among differentiated cells in a tissue or organ, can renew itself, and can differentiate to yield the major specialized cell types of the tissue or organ. The primary roles of adult stem cells in a living organism are to maintain and repair the tissue in which they are found. Some scientists now use the term somatic stem cell instead of adult stem cell. Unlike embryonic stem cells, which are defined by their origin (the inner cell mass of the blastocyst), the origin of adult stem cells in mature tissues is unknown.Research on adult stem cells has recently generated a great deal of excitement. Scientists have found adult stem cells in many more tissues than they once thought possible. This finding has led scientists to ask whether adult stem cells could be used for transplants. In fact, adult blood forming stem cells from bone marrow have been used in transplants for 30 years. Certain kinds of adult stem cells seem to have the ability to differentiate into a number of different cell types, given the right conditions. If this differentiation of adult stem cells can be controlled in the laboratory, these cells may become the basis of therapies for many serious common diseases.The history of research on adult stem cells began about 40 years ago. In the 1960s, researchers discovered that the bone marrow contains at least two kinds of stem cells. One population, called hematopoietic stem cells, forms all the types of blood cells in the body. A second population, called bone marrow stromal cells, was discovered a few years later. Stromal cells are a mixed cell population that generates bone, cartilage, fat, and fibrous connective tissue. Also in the 1960s, scientists who were studying rats discovered two regions of the brain that contained dividing cells, which become nerve cells. Despite these reports, most scientists believed that new nerve cells could not be generated in the adult brain. It was not until the 1990s that scientists agreed that the adult brain does contain stem cells that are able to generate the brain’s three major cell types—astrocytes and oligodendrocytes, which are non-neuronal cells, and neurons, or nerve cells.

A. Where are adult stem cells found and what do they normally do?

adult stem cells have been identified in many organs and tissues. One important point to understand about adult stem cells is that there are a very small number of stem cells in each tissue. Stem cells are thought to reside in a specific area of each tissue where they may remain quiescent (non-dividing) for many years until they are activated by disease or tissue injury. The adult tissues reported to contain stem cells include brain, bone marrow, peripheral blood, blood vessels, skeletal muscle, skin and liver.Scientists in many laboratories are trying to find ways to grow adult stem cells in cell culture and manipulate them to generate specific cell types so they can be used to treat injury or disease. Some examples of potential treatments include replacing the dopamine-producing cells in the brains of Parkinson’s patients, developing insulin-producing cells for type I diabetes and repairing damaged heart muscle following a heart attack with cardiac muscle cells.

B. What tests are used for identifying adult stem cells?

Scientists do not agree on the criteria that should be used to identify and test adult stem cells. However, they often use one or more of the following three methods: (1) labeling the cells in a living tissue with molecular markers and then determining the specialized cell types they generate; (2) removing the cells from a living animal, labeling them in cell culture, and transplanting them back into another animal to determine whether the cells repopulate their tissue of origin; and (3) isolating the cells, growing them in cell culture, and manipulating them, often by adding growth factors or introducing new genes, to determine what differentiated cells types they can become.Also, a single adult stem cell should be able to generate a line of genetically identical cells—known as a clone—which then gives rise to all the appropriate differentiated cell types of the tissue. Scientists tend to show either that a stem cell can give rise to a clone of cells in cell culture, or that a purified population of candidate stem cells can repopulate the tissue after transplant into an animal. Recently, by infecting adult stem cells with a virus that gives a unique identifier to each individual cell, scientists have been able to demonstrate that individual adult stem cell clones have the ability to repopulate injured tissues in a living animal.

C. What is known about adult stem cell differentiation?

Figure 2. Hematopoietic and stromal stem cell differentiation. Click here for larger image.As indicated above, scientists have reported that adult stem cells occur in many tissues and that they enter normal differentiation pathways to form the specialized cell types of the tissue in which they reside. Adult stem cells may also exhibit the ability to form specialized cell types of other tissues, which is known as transdifferentiation or plasticity.Normal differentiation pathways of adult stem cells. In a living animal, adult stem cells can divide for a long period and can give rise to mature cell types that have characteristic shapes and specialized structures and functions of a particular tissue. The following are examples of differentiation pathways of adult stem cells (Figure 2).·                     Hematopoietic stem cells give rise to all the types of blood cells: red blood cells, B lymphocytes, T lymphocytes, natural killer cells, neutrophils, basophils, eosinophils, monocytes, macrophages, and platelets. ·                     Bone marrow stromal cells (mesenchymal stem cells) give rise to a variety of cell types: bone cells (osteocytes), cartilage cells (chondrocytes), fat cells (adipocytes), and other kinds of connective tissue cells such as those in tendons. ·                     neural stem cells in the brain give rise to its three major cell types: nerve cells (neurons) and two categories of non-neuronal cells—astrocytes and oligodendrocytes. ·                     Epithelial stem cells in the lining of the digestive tract occur in deep crypts and give rise to several cell types: absorptive cells, goblet cells, Paneth cells, and enteroendocrine cells. ·                     Skin stem cells occur in the basal layer of the epidermis and at the base of hair follicles. The epidermal stem cells give rise to keratinocytes, which migrate to the surface of the skin and form a protective layer. The follicular stem cells can give rise to both the hair follicle and to the epidermis. Adult stem cell plasticity and transdifferentiation. A number of experiments have suggested that certain adult stem cell types are pluripotent. This ability to differentiate into multiple cell types is called plasticity or transdifferentiation. The following list offers examples of adult stem cell plasticity that have been reported during the past few years.·                     Hematopoietic stem cells may differentiate into: three major types of brain cells (neurons, oligodendrocytes, and astrocytes); skeletal muscle cells; cardiac muscle cells; and liver cells. ·                     Bone marrow stromal cells may differentiate into: cardiac muscle cells and skeletal muscle cells. ·                     Brain stem cells may differentiate into: blood cells and skeletal muscle cells. Current research is aimed at determining the mechanisms that underlie adult stem cell plasticity. If such mechanisms can be identified and controlled, existing stem cells from a healthy tissue might be induced to repopulate and repair a diseased tissue (Figure 3).

D. What are the key questions about adult stem cells?

Many important questions about adult stem cells remain to be answered. They include:·                     How many kinds of adult stem cells exist, and in which tissues do they exist? ·                     What are the sources of adult stem cells in the body? Are they “leftover” embryonic stem cells, or do they arise in some other way? Why do they remain in an undifferentiated state when all the cells around them have differentiated? ·                     Do adult stem cells normally exhibit plasticity, or do they only transdifferentiate when scientists manipulate them experimentally? What are the signals that regulate the proliferation and differentiation of stem cells that demonstrate plasticity? ·                     Is it possible to manipulate adult stem cells to enhance their proliferation so that sufficient tissue for transplants can be produced? ·                     Does a single type of stem cell exist—possibly in the bone marrow or circulating in the blood—that can generate the cells of any organ or tissue? ·                     What are the factors that stimulate stem cells to relocate to sites of injury or damage?  

http://stemcells.nih.gov/

Birth Control Medications

Birth control (contraceptive) medications contain hormones (estrogen and progesterone, or progesterone alone). The medications are available in various forms, such as pills, injections (into a muscle), topical (skin) patches, and slow-release systems (vaginal rings, skin implants, and contraceptive-infused intrauterine devices [Mirena]). Choosing which estrogen and progesterone dose, type, and administration method is highly patient specific, meaning that the choice greatly depends on factors unique to an individual. General goals are to choose a product that provides good menstrual cycle control with the fewest adverse (side) effects and to use the lowest hormone dose possible. After beginning birth control medications, it may be necessary to adjust the dose or to choose a different product.

• How birth control medications work: Hormonal birth control medications prevent pregnancy through the following ways:
  • By blocking ovulation (release of an egg from the ovaries), thus preventing pregnancy
  • By altering mucus in the cervix, which makes it hard for sperm to travel further
  • By changing the endometrium (lining of the uterus) so that it cannot support a fertilized egg
  • By altering the fallopian tubes (the tubes through which eggs move from the ovaries to the uterus) so that they cannot effectively move eggs toward the uterus
• Who should not use these medications: Women with the following conditions should not use estrogen-containing birth control medications:
  • Allergy to any component of the product
  • History of blood clot disorders
  • History of stroke or heart attack
  • Heart valve disease with complications
  • Severe hypertension
  • Diabetes that causes blood vessel problems
  • Poorly controlled diabetes
  • Severe headaches (for example, migraines)
  • Recent major surgery with prolonged bed rest
  • Breast cancer
  • Liver cancer (or liver disease)
  • Uterine cancer or other known or suspected estrogen-dependent cancers
  • Unexplained abnormal bleeding from the uterus
  • Jaundice during pregnancy or jaundice with prior hormonal contraceptive use
  • Known or possible pregnancy
  •  

• Side effects: Birth control may cause a change in vision, necessitating a change in prescription, or an inability to wear contact lens. Birth control pills do not provide protection from sexually transmitted diseases (STDs). The pills must be taken daily and consistently (at the same time every day). If a woman stops taking birth control pills, it may take a few months for her normal ovulatory cycle to return; however, once stopped, a woman can become pregnant even if her cycle has not returned to normal. The following general side effects apply to all the hormonal birth control medications, regardless of how they are taken (for example, pills, topical patch, injection): nausea, breast tenderness, fluid retention, weight gain, acne, breakthrough bleeding, missed periods, headaches, depression, anxiety, other mood changes, and lower sexual desire. Additionally, the following more serious side effects may occur:
  • Thromboembolism (blood clots): Women who use estrogen-containing birth control pills are at a 3- to 6-fold increased risk of developing blood clots. Blood clots may lead to deep vein thrombosis, heart attack, or stroke. Additional causes of blood clots include advanced age, obesity, family history, recent surgery, and pregnancy. Low-dose (less than 50 mcg of ethinyl estradiol) oral contraceptives pose less risk than older, higher-dose formulations. Cigarette smoking increases the risk of blood clots in women using combination contraceptives, particularly for women older than 35 years and those who smoke more than 15 cigarettes per day.
  • Breast cancer: The association of birth control pill use and breast cancer in young women is controversial. The Collaborative Group on Hormonal Factors in Breast Cancer performed the most comprehensive study in 1996. The results demonstrated that current pill users and those who had used birth control pills within the past 1-4 years had a slightly increased risk of breast cancer. Although these observations support the possibility of a marginally elevated risk, the group noted that pill users had more breast examinations and breast imaging studies than nonusers. Thus, although the consensus states that birth control pills can lead to breast cancer, the risk is small, and the resulting tumors spread less aggressively than usual. Most doctors currently believe that birth control pill use might interact with another primary cause to stimulate breast cancer.
  •  

  • Cervical cancer: The relationship between birth control pill use and cervical cancer is also quite controversial. The risk is not related to the contraceptive agent itself but to how it leaves a woman unprotected from STDs. Early sexual intercourse, numerous lifetime sexual partners, and exposure to human papillomavirus are all important risk factors. Most authorities now believe that, if birth control pills increase the risk of cervical cancer at all, the risk is small.
  • Benign liver tumors: Hormones are metabolized by the liver. A small increase in the frequency of benign liver tumors may exist, particularly after 4-8 years of birth control pill use.
  • Diabetes: Progesterone and high estrogen doses may alter blood glucose (sugar) levels in diabetic women.

Vaginal Ring

Etonogestrel/ethinyl estradiol (NuvaRing)

• Use: The ring is self-inserted into the vagina. Exact positioning is not required for it to be effective. The vaginal ring must be inserted within 5 days of the onset of the menstrual period, even if bleeding is still occurring. During the first cycle, an additional method of contraception, such as male condoms or spermicide, is recommended until after the first 7 days of continuous ring use. The ring remains in place continuously for 3 weeks. The ring is then removed for 1 week. Menstruation should begin during this week. The next ring is inserted 1 week after the last ring was removed.
• Side effects: Since the ring affects the female reproductive organs directly, side effects such as weight gain and mood changes are avoided. However, other side effects are similar to those of other birth control medications containing both estrogen and progesterone. Additionally, a vaginal ring may not be suitable for women experiencing vaginal irritation or ulcerations. A ring may be accidentally expelled, for example, when it has not been inserted properly, during tampon removal, or while moving the bowels or straining, especially with severe constipation. If this occurs, the vaginal ring can be rinsed with cool to lukewarm (not hot) water and reinserted promptly. If the ring is not replaced within 3 hours of expulsion, then a backup method, such as male condoms and spermicide, should also be used following reinsertion of the ring for at least 7 days.

The possibility of human cloning, raised when Scottish scientists at Roslin Institute created the much-celebrated sheep “Dolly” aroused worldwide interest and concern because of its scientific and ethical implications. The feat, cited by Science magazine as the breakthrough of 1997, also generated uncertainty over the meaning of “cloning” –an umbrella term traditionally used by scientists to describe different processes for duplicating biological material.

What is cloning? Are there different types of cloning?

When the media report on cloning in the news, they are usually talking about only one type called reproductive cloning. There are different types of cloning however, and cloning technologies can be used for other purposes besides producing the genetic twin of another organism. A basic understanding of the different types of cloning is key to taking an informed stance on current public policy issues and making the best possible personal decisions. The following three types of cloning technologies will be discussed: (1) recombinant DNA technology or DNA cloning, (2) reproductive cloning, and (3) therapeutic cloning.
Recombinant DNA Technology or DNA Cloning The terms “recombinant DNA technology,” “DNA cloning,” “molecular cloning,”or “gene cloning” all refer to the same process: the transfer of a DNA fragment of interest from one organism to a self-replicating genetic element such as a bacterial plasmid. The DNA of interest can then be propagated in a foreign host cell. This technology has been around since the 1970s, and it has become a common practice in molecular biology labs today. Scientists studying a particular gene often use bacterial plasmids to generate multiple copies of the same gene. Plasmids are self-replicating extra-chromosomal circular DNA molecules, distinct from the normal bacterial genome Plasmids and other types of cloning vectors are used by Human Genome Project researchers to copy genes and other pieces of chromosomes to generate enough identical material for further study. To “clone a gene,” a DNA fragment containing the gene of interest is isolated from chromosomal DNA using restriction enzymes and then united with a plasmid that has been cut with the same restriction enzymes. When the fragment of chromosomal DNA is joined with its cloning vector in the lab, it is called a “recombinant DNA molecule.” Following introduction into suitable host cells, the recombinant DNA can then be reproduced along with the host cell DNA. Plasmids can carry up to 20,000 bp of foreign DNA. Besides bacterial plasmids, some other cloning vectors include viruses, bacteria artificial chromosomes (BACs), and yeast artificial chromosomes (YACs). Cosmids are artificially constructed cloning vectors that carry up to 45 kb of foreign DNA and can be packaged in lambda phage particles for infection into E. coli cells. BACs utilize the naturally occurring F-factor plasmid found in E. coli to carry 100 to 300 kb DNA inserts. A YAC is a functional chromosome derived from yeast that can carry up to 1 MB of foreign DNA. Bacteria are most often used as the host cells for recombinant DNA molecules, but yeast and mammalian cells also are used.
Reproductive CloningReproductive cloning is a technology used to generate an animal that has the same nuclear DNA as another currently or previously existing animal. Dolly was created by reproductive cloning technology. In a process called “somatic cell nuclear transfer” (SCNT), scientists transfer genetic material from the nucleus of a donor adult cell to an egg whose nucleus, and thus its genetic material, has been removed. The reconstructed egg containing the DNA from a donor cell must be treated with chemicals or electric current in order to stimulate cell division. Once the cloned embryo reaches a suitable stage, it is transferred to the uterus of a female host where it continues to develop until birth. Dolly or any other animal created using nuclear transfer technology is not truly an identical clone of the donor animal. Only the clone’s chromosomal or nuclear DNA is the same as the donor. Some of the clone’s genetic materials come from the mitochondria in the cytoplasm of the enucleated egg. Mitochondria, which are organelles that serve as power sources to the cell, contain their own short segments of DNA. Acquired mutations in mitochondrial DNA are believed to play an important role in the aging process. Dolly’s success is truly remarkable because it proved that the genetic material from a specialized adult cell, such as an udder cell programmed to express only those genes needed by udder cells, could be reprogrammed to generate an entire new organism. Before this demonstration, scientists believed that once a cell became specialized as a liver, heart, udder, bone, or any other type of cell, the change was permanent and other unneeded genes in the cell would become inactive. Some scientists believe that errors or incompleteness in the reprogramming process cause the high rates of death, deformity, and disability observed among animal clones.
Therapeutic Cloning Therapeutic cloning, also called “embryo cloning,” is the production of human embryos for use in research. The goal of this process is not to create cloned human beings, but rather to harvest stem cells that can be used to study human development and to treat disease. Stem cells are important to biomedical researchers because they can be used to generate virtually any type of specialized cell in the human body. Stem cells are extracted from the egg after it has divided for 5 days. The egg at this stage of development is called a blastocyst. The extraction process destroys the embryo, which raises a variety of ethical concerns. Many researchers hope that one day stem cells can be used to serve as replacement cells to treat heart disease, Alzheimer’s, cancer, and other diseases. In November 2001, scientists from Advanced Cell Technologies (ACT), a biotechnology company in
Massachusetts, announced that they had cloned the first human embryos for the purpose of advancing therapeutic research. To do this, they collected eggs from women’s ovaries and then removed the genetic material from these eggs with a needle less than 2/10,000th of an inch wide. A skin cell was inserted inside the enucleated egg to serve as a new nucleus. The egg began to divide after it was stimulated with a chemical called ionomycin. The results were limited in success. Although this process was carried out with eight eggs, only three began dividing, and only one was able to divide into six cells before stopping.

How can cloning technologies be used?

Recombinant DNA technology is important for learning about other related technologies, such as gene therapy, genetic engineering of organisms, and sequencing genomes. Gene therapy can be used to treat certain genetic conditions by introducing virus vectors that carry corrected copies of faulty genes into the cells of a host organism. Genes from different organisms that improve taste and nutritional value or provide resistance to particular types of disease can be used to genetically engineer food crops. With genome sequencing, fragments of chromosomal DNA must be inserted into different cloning vectors to generate fragments of an appropriate size for sequencing. If the low success rates can be improved (Dolly was only one success out of 276 tries), reproductive cloning can be used to develop efficient ways to reliably reproduce animals with special qualities. For example, drug-producing animals or animals that have been genetically altered to serve as models for studying human disease could be mass-produced. Reproductive cloning also could be used to repopulate endangered animals or animals that are difficult to breed. In 2001, the first clone of an endangered wild animal was born, a wild ox called a gaur. The young gaur died from an infection about 48 hours after its birth. In 2001, scientists in
Italy reported the successful cloning of a healthy baby mouflon, an endangered wild sheep. The cloned mouflon is living at a wildlife center in
Sardinia. Other endangered species that are potential candidates for cloning include the African bongo antelope, the Sumatran tiger, and the giant panda. Cloning extinct animals presents a much greater challenge to scientists because the egg and the surrogate needed to create the cloned embryo would be of a species different from the clone. Therapeutic cloning technology may some day be used in humans to produce whole organs from single cells or to produce healthy cells that can replace damaged cells in degenerative diseases such as Alzheimer’s or Parkinson’s. Much work still needs to be done before therapeutic cloning can become a realistic option for the treatment of disorders.
What animals have been cloned? Scientists have been cloning animals for many years. In 1952, the first animal, a tadpole, was cloned. Before the creation of Dolly, the first mammal cloned from the cell of an adult animal, clones were created from embryonic cells. Since Dolly, researchers have cloned a number of large and small animals including sheep, goats, cows, mice, pigs, cats, rabbits, and a gaur. Hundreds of cloned animals exist today, but the number of different species is limited. Attempts at cloning certain species such as monkeys, chickens, horses, and dogs, have been unsuccessful. Some species may be more resistant to somatic cell nuclear transfer than others. The process of stripping the nucleus from an egg cell and replacing it with the nucleus of a donor cell is a traumatic one, and improvements in cloning technologies may be needed before many species can be cloned successfully.

Can organs be cloned for use in transplants?

Scientists hope that one day therapeutic cloning can be used to generate tissues and organs for transplants. To do this, DNA would be extracted from the person in need of a transplant and inserted into an enucleated egg. After the egg containing the patient’s DNA starts to divide, embryonic stem cells that can be transformed into any type of tissue would be harvested. The stem cells would be used to generate an organ or tissue that is a genetic match to the recipient. In theory, the cloned organ could then be transplanted into the patient without the risk of tissue rejection. If organs could be generated from cloned human embryos, the need for organ donation could be significantly reduced. Many challenges must be overcome before “cloned organ” transplants become reality. More effective technologies for creating human embryos, harvesting stem cells, and producing organs from stem cells would have to be developed. In 2001, scientists with the biotechnology company Advanced Cell Technology (ACT) reported that they had cloned the first human embryos; however, the only embryo to survive the cloning process stopped developing after dividing into six cells. In February 2002, scientists with the same biotech company reported that they had successfully transplanted kidney-like organs into cows. The team of researchers created a cloned cow embryo by removing the DNA from an egg cell and then injecting the DNA from the skin cell of the donor cow’s ear. Since little is known about manipulating embryonic stem cells from cows, the scientists let the cloned embryos develop into fetuses. The scientists then harvested fetal tissue from the clones and transplanted it into the donor cow. In the three months of observation following the transplant, no sign of immune rejection was observed in the transplant recipient. Another potential application of cloning to organ transplants is the creation of genetically modified pigs from which organs suitable for human transplants could be harvested . The transplant of organs and tissues from animals to humans is called xenotransplantation. Why pigs? Primates would be a closer match genetically to humans, but they are more difficult to clone and have a much lower rate of reproduction. Of the animal species that have been cloned successfully, pig tissues and organs are more similar to those of humans. To create a “knock-out” pig, scientists must inactivate the genes that cause the human immune system to reject an implanted pig organ. The genes are knocked out in individual cells, which are then used to create clones from which organs can be harvested. In 2002, a British biotechnology company reported that it was the first to produce “double knock-out” pigs that have been genetically engineered to lack both copies of a gene involved in transplant rejection. More research is needed to study the transplantation of organs from “knock-out” pigs to other animals.

What are the risks of cloning?

Reproductive cloning is expensive and highly inefficient. More than 90% of cloning attempts fail to produce viable offspring. More than 100 nuclear transfer procedures could be required to produce one viable clone. In addition to low success rates, cloned animals tend to have more compromised immune function and higher rates of infection, tumor growth, and other disorders. Japanese studies have shown that cloned mice live in poor health and die early. About a third of the cloned calves born alive have died young, and many of them were abnormally large. Many cloned animals have not lived long enough to generate good data about how clones age. Appearing healthy at a young age unfortunately is not a good indicator of long term survival. Clones have been known to die mysteriously. For example,
Australia’s first cloned sheep appeared healthy and energetic on the day she died, and the results from her autopsy failed to determine a cause of death. In 2002, researchers at the Whitehead Institute for Biomedical Research in
Cambridge, Massachusetts, reported that the genomes of cloned mice are compromised. In analyzing more than 10,000 liver and placenta cells of cloned mice, they discovered that about 4% of genes function abnormally. The abnormalities do not arise from mutations in the genes but from changes in the normal activation or expression of certain genes. Problems also may result from programming errors in the genetic material from a donor cell. When an embryo is created from the union of a sperm and an egg, the embryo receives copies of most genes from both parents. A process called “imprinting” chemically marks the DNA from the mother and father so that only one copy of a gene (either the maternal or paternal gene) is turned on. Defects in the genetic imprint of DNA from a single donor cell may lead to some of the developmental abnormalities of cloned embryos.
Should humans be cloned? Physicians from the American Medical Association and scientists with the American Association for the Advancement of Science have issued formal public statements advising against human reproductive cloning. Currently, the U.S. Congress is considering the passage of legislation that could ban human cloning. Due to the inefficiency of animal cloning (only about 1 or 2 viable offspring for every 100 experiments) and the lack of understanding about reproductive cloning, many scientists and physicians strongly believe that it would be unethical to attempt to clone humans. Not only do most attempts to clone mammals fail, about 30% of clones born alive are affected with “large offspring syndrome” and other debilitating conditions. Several cloned animals have died prematurely from infections and other complications. The same problems would be expected in human cloning. In addition, scientists do not know how cloning could impact mental development. While factors such as intellect and mood may not be as important for a cow or a mouse, they are crucial for the development of healthy humans. With so many unknowns concerning reproductive cloning, the attempt to clone humans at this time is considered potentially dangerous and ethically irresponsible.

Medicine in Medieval and Early Modern Europe

Medicine during the Medieval period changed in a number of ways, often for the worse.

Medieval Europe was a place that placed less importance on the value of Public Health facilities. Through a lack of care, or a lack of ability to maintain the aqueducts et al built by the romans, medieval Europe became a place where medical practice was in places regressing rather than progressing.

It was over 400 years after the fall of the Roman Empire that Europe was again a place that was peaceful and relatively stable. Larger nations were beginning to emerge, such as Anglo-Saxon England, but Europe suffered from only being united by the Christian faith.

Little remained of the Roman era, only Latin, which was a universal language for the priesthood of the day. As a result there were a variety of different medical practices available to people in Medieval Times: they may have been treated by monks following the Hippocratic theory of the Four Humours, by apothecaries who specialised in herbal remedies or by doctors who made use of charms.

As the church taught that God sent illness, and that repenting would cure all evils, many people at the time believed that pilgrimage would cure them. Other theories were based upon astrology, the movement of the sun and stars.

Despite this disparate range of theories, there were many examples of good practice and advances were made. Most well trained doctors used Hippocrates teachings and diagnosis was developed, the use of Urine samples being a significant step forward. Even so, some ‘physical’ cures were administered for purely superstitious reasons: herbal remedies being prescribed as they would rid the body of evil spirits, for example.

http://www.schoolshistory.org.uk/medievalmedicine.htm

HEBREW MEDICINE

   THE medicine of the Old Testament betrays both Egyptian and Babylonian influences; the social hygiene is a reflex of regulations the origin of which may be traced in the Pyramid Texts and in the papyri. The regulations in the Pentateuch codes revert in part to primitive times, in part represent advanced views of hygiene. There are doubts if the Pentateuch code really goes back to the days of Moses, but certainly someone “learned in the wisdom of the Egyptians” drew it up. As Neuburger briefly summarizes:

   ”The commands concern prophylaxis and suppression of epidemics, suppression of venereal disease and prostitution, care of the skin, baths, food, housing and clothing, regulation of labour, sexual life, discipline of the people, etc. Many of these commands, such as Sabbath rest, circumcision, laws concerning food (interdiction of blood and pork), measures concerning menstruating and lying-in women and those suffering from gonorrhoea, isolation of lepers, and hygiene of the camp, are, in view of the conditions of the climate, surprisingly rational.”²³

   Divination, not very widely practiced, was borrowed, no doubt, from Babylonia. Joseph’s cup was used for the purpose.
Numbers, the elders of Balak went to Balaam with the rewards of divination in their hands. The belief in enchantments and witchcraft was universal, and the strong enactments against witches in the Old Testament made a belief in them almost imperative until more rational beliefs came into vogue in the eighteenth and nineteenth centuries.

   Whatever view we may take of it, the medicine of the New Testament is full of interest. Divination is only referred to once in the Acts (xvi, 16), where a damsel is said to be possessed of a spirit of divination “which brought her masters much gain by soothsaying.” There is only one mention of astrology (Acts vii, 43); there are no witches, neither are there charms or incantations. The diseases mentioned are numerous: demoniac possession, convulsions, paralysis, skin diseases, — as leprosy, — dropsy, hæmorrhages, fever, fluxes, blind- ness and deafness. And the cure is simple usually a fiat of the Lord, rarely with a prayer, or with the use of means such as spittle. They are all miraculous, and the same power was granted to the apostles — “power against unclean spirits, to cast them out, to heal all manner of sickness and all manner of disease.” And more than this, not only the blind received their sight, the lame walked, the lepers were cleansed, the deaf heard, but even the dead were raised up. No question of the mandate. He who went about doing good was a physician of the body as well as of the soul, and could the rich promises of the Gospel have been fulfilled, there would have been no need of a new dispensation of science. It may be because the children of this world have never been able to accept its hard sayings — the insistence upon poverty, upon humility, upon peace that Christianity has lost touch no less with the practice than with the principles of its Founder. Yet, all through the centuries, the Church has never wholly abandoned the claim to apostolic healing; nor is there any reason why she should. To the miraculous there should be no time limit — only conditions have changed and nowadays to have a mountain-moving faith is not easy. Still, the possession is cherished, and it adds enormously to the spice and variety of life to know that men of great intelligence

http://etext.virginia.edu/etcbin/toccer-new2?id=OslEvol.sgm&images=images/modeng&data=/texts/english/modeng/parsed&tag=public&part=5&division=div2

RAMON
MAGSAYSAY
MEMORIAL
MEDICAL
CENTER

College of
Nursing 

Topic Outline 

I.                    Introduction

II.                 History an Development of Science in Medicine

A.     Herbalism

B.     Indian Medicine

C.     Egyptian Medicine

D.     Persian Medicine

E.      Chinese Medicine

F.      Hebrew Medicine

G.     Early European Medicine

1.      Ancient
Greece

2.      Medieval Medicine

H.     Islamic Medicine

I.        European Renaissance and Enlightenment Medicine

J.       Modern Medicine

1.      Louis Pasteur

2.      Robert Koch

3.     
Florence Nightingale

4.      Alexis Carrel and Henry Dakin

K.    Medical Interventions

1.      mercury thermometer

2.      vaccination

3.      stethoscope

4.      antiseptic

5.      x-ray

6.      electrocardiograph

7.      antibiotics

8.      pacemaker

9.      ultrasound scan

10.  genetic engineering

III.               History of Alternative Medicine

IV.              Ethical Issues

V.                 Medical Technology

A.     Contraceptives

B.     Cloning

C.     Stem Cell

D.     In Vitro Fertilization

VI.              Conclusion