Today, we try to locate the seat of disease. The
University of Houston's College of Engineering
presents this series about the machines that make our
civilization run, and the people whose ingenuity
created them.
Imagine that you're an
18th-century doctor. A patient complains of, say, a
pain in his side. Whatever's wrong with him, you
have no way of looking inside him. You can count
his pulse and feel his forehead. You can look for
changes in skin tone. You listen to his own report
of symptoms. Your information is all external --
you cannot see inside. But that's about to change.
Medical historian Stanley Reiser talks about the
way attention was about to shift to what he calls
the "lesion within." Medicine was just about to
start identifying disease with abnormalities we
can't see from outside. Three major landmarks in
that process were a new concept of dissection; the
invention of the stethoscope; and the discovery of
X-rays.
Doctors had done dissections for many centuries by
the mid-1700s, but they did it to see how the body
functioned -- not to locate seats of illness. Then,
in 1761, Giovanni Battista
Morgagni wrote The Seats and Causes of
Diseases Investigated by Anatomy. It was a
huge collection of case histories of autopsies. A
fine index provided the first road map through the
internal symptoms of disease.
But doctors still couldn't see inside their
patients. They continued to touch their foreheads
and study their pallor. The second breakthrough was
more psychological than practical. In 1816 a French
doctor, René Laënnec, invented the
stethoscope. Stethoscopes don't really reveal any
more than an ear to the patient's chest. But they
redirected medical attention to the inside of the
patient. Down through the 1800s, doctors became
increasingly aware of the various lesions within:
cancers, ulcers, embolisms.
Then, in 1895, Roentgen gave us the X-ray -- a
direct window through the skin. During the last
century, medicine has focused increasingly accurate
rays, ultrasound, and fiber-optical devices on the
precise lesion within our bodies.
Still, we pay a price for new technology. Doctors
once had to focus on the whole human organism
without reducing illness to a detached point within
the body. And disease seldom exists in simple
isolation. Medicine must now find its way back to
the tough problem of curing the whole body -- not
just one piece of it.
That recently came home to me in a dramatic way. I
suffered two broken legs followed by a pulmonary
embolism. Fortunately, I was in the hands of a
crack trauma team. Surgeons, pulmonary specialists,
hematologists, and radiologists all converged and
compared notes in a delicate ballet. As
specialists, they pinpointed the lesions within me.
But as a carefully choreographed team, they also
reconstructed my body as a single organism.
Today, I'm in a remarkable state of repair for the
very reason that doctors are finally creating
strategies for seeing the whole body at the same
time they focus, even more closely, upon -- the
lesion within.
I'm John Lienhard, at the University of Houston,
where we're interested in the way inventive minds
work.
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