How was Fever Interpreted before the advent of Germ

theory?

And what lessons can we learn from it?

By Patrick LongStudent reference number: 91028278

The germ must be found in every case of that disease.

The germ should captured and grown in a lab.

If the germ if given to anouther person or animal it should cause a disease.

This disease should be the same disease as before.

Modern Germ TheoryIn 1890 Robert Koch made four statements which are considered the basis or modern medical understanding of the germ theory of disease.He said that for a germ to be blamed for a disease it needed to show that: -

In ancient Egyptian and Greek civilisation fevers were interpreted as madness of possession and sufferers were left by family on the street for strangers to offer help if they could.

FeverToday we tend to classify a body temperature over 37.50C as a Fever.

However the thermometer is a modern invention and the concept of fever has existed throughout antiquity.

“I’m not feeling so good!”

Hippocrates and humorsHippocrates is considered the father of modern Medicine.

He was one of the first people to attribute disease to physical processes rather than through divine action.

These “humors” could be interpreted also by their four elements

1.Hot

2.Dry

3.Wet

4.Cold

Hippocrates and humorsHippocrates described a persons health as a balance between four “humors”

Disease was caused when these “Humors” went out of balance with each other.

Humorism and EpidemicsThe Presence of Epidemics was a threat to the theory of Humorism. It couldn’t explain why a large group of people’s humors would become unbalanced all at the same time.

Physicians at the time reconciled this by theorizing that the areas where the disease was localized was likely to be corrupted in some form. Some argued that the people themselves were innately corrupted.

We can see this dilemma being played out in Thomas Fuller’s book – Exanthematologia (1707)

Suggested that fever was instead caused by passage of small bodies from one individual to anotherThis challenged humorism and initiated the contagion view of fevers.

Girolamo Fracastoro

Regardless of Fracastoro’s ideas other theories also propagated.

Fever as a state of excitement

We can see an example of this in a book by John Brown (1787) who believed that fever was caused by excess excitability of the body.

Humorism resulted in odd practices such as of blood letting and emetics.

How did this manifest in the treatment of fevers.

“the general view that physicians…nothing can be more uniform than they, in their practice in bleeding” – John Brown (1787)

However progress in chemistry at the time also resulted in various concoctions becoming produced.

Moses Griffith’s on how to treat Fevers

What Type of Fever is it?

Salt of Wormwood (larger dose)Myrrh (smaller dose)Chamemel - flowerNitrous.

Give Four times a day:Salt of Wormwood,

MyrrhSalt of steel (most likely

magnesium)Waters of Alexandria

Slow Fever Hectic Fever

Did it Work? No?

Give the other medicine!

Compared to a modern treatment algorithm for children alone!

Case Study Example

"A poor woman of a thin and tender habit, had an immoderate flux of the menses, and, long after its being stopped, continued very weak, faint, and low-spirited, with unquiet sleeps, and a slow hectic fever. I ordered her this medicine, and after she had taken about fifteen doses of it, became perfectly well.“ – Moses Griffith

Conclusions – What can we lessons can be learnt?

Dealing With

Uncertainty

Holistic approach in the

face of the unknown

Dogma – The story shows how

previously held beliefs can impede

progress.Scientific

Process – Focus on objectivity and scientific

rigor.

Acknowledgments to the Plymouth Medical Soceity and Discovery Library for access to the Historical Collection.All images obtained from Wikipedia Creative Commons

Acknowledgement

Gian Franco Gensini, Andrea A Conti. The evolution of the concept of ‘fever’ in the history of medicine: from pathological picture per se to clinical epiphenomenon (and vice versa). Journal of Infection 2004; 49(2): 85-87.

Fuller, Thomas. Exanthematologia: or, an attempt to give a rational account of eruptive fevers, especially of the measles and small pox. : ; 1707.

Griffith, Moses. Moses Griffith's on fevers. : ; 1776.

Griffith, Moses. Practical Observations on the cure of hectic and slow fevers, and the pulmonary consumption: to which is added, a method of treating several kinds of internal hemorrhages. . : ; 1776.

Reid, Thomas. an essay on the nature and cure of the phthisis pulmonalis . : ; 1787.

Brown, John. Observations on the principles of the old system of physic, exhibiting a compend of the new doctrine: the whole containing a new account of the state of medicine from the present times, backward, to the restoration of the Grecian learning in the western. England: ; 1787.

5. NICE. Feverish illness in children overview. http://pathways.nice.org.uk/pathways/feverish-illness-in-children (accessed 21/03/2014)

References