|Year : 2000 | Volume
| Issue : 1 | Page : 1-2
The year 2000: Looking back and looking forward
Source of Support: None, Conflict of Interest: None
Keywords: Eye Diseases, diagnosis, history, therapy, History, 15th Century, History, 16th Century, History, 17th Century, History, 18th Century, History, 19th Century, History, 20th Century,
|How to cite this article:|
Das T. The year 2000: Looking back and looking forward. Indian J Ophthalmol 2000;48:1-2
The world celebrated the beginning of a new millennium, and while doing so also successfully solved the Y2K problem that had gripped the entire world. It was yet another conquest for man. This ability to work against adversity and overcome obstacles is what makes man a superior species. This applies to health and health research too. All-round advances in diagnosis and treatment of diseases, understanding the importance of public health, and refinement of medical technology have significantly improved our health and quality of life. This knowledge is accumulated through a constant search for truth combined with the desire to reduce human suffering.
The search for freedom from disease started two and half million years ago, as soon as disease affected the human race, but historical records of events are available only for the past five thousand years. In the beginning little was known about the body, the dynamics of the body in health and disease, or the pathobiology of diseases. Therefore, treatment lacked a scientific approach. Treatment, obviously, was based mostly on superstition, and at best was arrived at through trial and error.
In 3000 B.C. the Egyptians had established one of the first great civilizations. The world's first recorded physician was Imhotep (2650 B.C.) from Egypt. The Egyptians worshipped him after his death and the Greeks identified him with their own God of healing, Ascelepius. Other Middle Eastern civilizations also contributed to medical progress from 1200 to 600 BC The Israelites had established the practice of quarantining patients with contagious diseases, and advocated avoidance of contaminated foods that were suspected to carry infection. Great human civilizations continued to flourish in China and India. The ancient Chinese medicine was based on the belief that two life forces, yin and yang, flow through the human body, and that diseases result when these two forces are not balanced. To restore the balance, the Chinese had developed acupuncture, which is still practiced in China. In ancient India ayurveda was the system of medicine that placed equal importance on treatment and prevention of illness. By 600 to 500 B.C. ayurveda had developed an impressive knowledge of both drugs and surgery, including that of cataract surgery.
During 400 B.C. the civilization of ancient Greece was at its peak. During this period, for the first time the great Greek physician Hippocrates preached that disease has only natural causes, not supernatural ones. Medicine began thus as a distinct science, separate from superstitious beliefs, or practice of religion. Today Hippocrates is remembered by every physician for the Hippocratic Oath that is the foundation of medical ethics. The great legacy of Hippocrates was furthered by Galen (100 A.D). Practicing medicine in Rome, Galen laid the foundation of experimental medicine and used his findings to develop the first medical theories based on scientific experiments. During the Middle Ages (400-1500 AD) the Islamic empire of Central Asia and Spain contributed greatly to medicine. Razes and Avicenna produced a vast medical literature. This was also the time when the world witnessed major outbreaks of epidemics. In this context of disease and destruction, many hospitals were founded in Europe, as also the first medical at Salerno, Italy.
A new scientific spirit developed during the Renaissance (1300-1600 ). Leonardo da Vinci taught human anatomy, and Vesallius wrote the first scientific textbook on human anatomy, On the Structure of the Human Body (1543). The foundation of medical research was thus established. Some of the outstanding examples are as follows. William Harvey (1628) started modern physiology with his research and publication on blood circulation; Zacharias Janssen (1590) discovered the principles of compound microscope that ultimately led Anton van Leeuwenhoek (1670) to the discovery of bacteria; Edward Jenner (1796) invented vaccination against small pox; Rene Laennec (1816) made the first stethoscope that has truly stood the test of time; William Morton (1846) demonstrated the use of choloroform and ether for effective anaesthesia; Florence Nightingale introduced modern nursing methods during the Crimean war (1853-1856); Rudolf Virchow (1850) founded the basics of pathology of diseases; Louis Pasteur and Robert Koch (1860) advanced the germ theory of diseases; Joseph Lister (1865) introduced antiseptic method to surgery; Wilhelm Roentgen (1895) discovered Xrays; Pierre and Marie Curie (1898) discovered radium, providing a powerful weapon against cancer; Christian Eijkman and Fredrick Hopkins (1900) demonstrated the existence and importance of vitamins; Frederick Banting and Charles Best (1922) isolated and prepared insulin and laid the foundation of effective treatment of diabetes mellitus; Alexander Fleming (1928) discovered penicillin, the first antibiotic; Francis Crick and James Watson (1962) unraveled the mollecular structure of DNA and Christian Barnard (1967) performed the first heart transplant. There are tremendous advances in imaging (CT and MRI scanning), organ transplants, and we have entered the exciting world of genome research. The list is endless.
The eye has always occupied pride of a place among human organs. The ancient Indian scriptures describe the eye as the most important sense organ of the body. Gifting of sight is considered nothing short of miraculous. Repair and reconstruction ofthe eye is recorded in Egyptian mythology. According to the myth, the God's eye was torn by the wicked God Seth into sixty-four pieces. These were put together by God Thoth to become the Uadjat, "the whole eye". Some of the historical milestones in development of ophthalmology as a separate science are as follows. Leonardo da Vinci (1470) recognized the retina as the organ of sight; Isaac Newton (1666) described the colour vision theory; Pierre Brissean and Antoine Maitre-Jan (1710) independently demonstrated that cataract is clouding and hardening of lens; Jacquies Daviel (1745) described the modern method of treating cataract by lens extraction; Jan E Purkinje (1823) examined the vitreous cavity for the first time; William Mackenzie (1830) recognized and classified glaucoma, and later Alberecht von Graefe (1828-1870) described his famous iridectomy; Heinrich Muller (1845) and William Bowman (1847) described the anatomy of retina; Hermann Helmholtz (1851) invented the direct ophthalmoscope; Franz Reisinger (1768-1855) proposed keratoplasty; Allvar Gullstrand (1862) designed the slitlamp biomicroscope for which he was later awarded the Nobel Prize; Hjalmar Schiotz (1850-1927) designed the indentation tonometer; Niels Bjerrum (1889) introduced perimetry; Jules Gonin (1931) laid down the principles of retinal reattachment surgery; Charles Schepens (1945) redesigned and popularized the modern binocular indirect ophthalmoscope; Novotny and Alvis (1960) discovered fluorescein angiography; and Robert Machemer (1971) demonstrated pars plana vitreous surgery. The list continues.
In this quest for truth the driving force has been scientific curiosity and the unquenched desire for improvement in quality of life, health and the conquest of disease. Today, in Ophthalmology advances continue to be made in wound healing, discovery of newer drugs, intraocular sustained drug delivery systems, immunomodulation of ocular inflammatory diseases, new biomaterials, tissue engineering, laser imaging of ocular tissues, newer application of ultrasound technology, and finally, telemedicine.
In view of such an explosion of technology and knowledge, the world should have been a very healthy and prosperous one. However, the existence of therapeutic options does not guarantee clinical impact. Patients must have access to these options and services. There are a few factors that still worry health planners: one, varying standards of health care and unequal distribution of health-care providers; and two, the cost of medical care. The industrialized nations are far ahead of many regions in Asia and Africa. It is time that these barriers are overcome, and health care becomes truly global in organization, practice and delivery. The World Health Organization (WHO) in 1978 declared the cherished goal of Health for All by Year 2000. Many important steps have certainly been taken to achieve this, but we are still far from the goal. Last year WHO along with other international agencies launched Vision 2020, a global initiative for elimination of avoidable blindness in a time-bound period. The editorial by Gullapalli N Rao, Secretary General, International Agency for Prevention of Blindness (IAPB) gives more insight into this program. These efforts are necessary to create a healthier world. All of us need to unite and resolve at the beginning of this new millennium to contribute our might to human health and eye care. Let there be sight.
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