The Transition

Progress requires an advance in technology or the appearance of a gifted individual. Science and technology had advanced to a point where a breakthrough on some other front was required. Two historic events that meet this requirement are the invention of movable type by Johann Gutenberg in the 15 th century and the Reformation. Movable type and the printing press had the potential to make information available to large numbers of scholars. Experiments and data could be corroborated by other professionals, and groundless claims could become less common. Education, in all its forms, would be a benefactor. Education needs an appropriate environment. The Reformation provided that environment. The individual was acquiring more freedom in life, and the old way or restricted and regimented thought was passing. In this time of change, there were individuals of the proper education and personality to take advantage of the situation.

Andreas Vesalius, who is credited as the founder of modern anatomy, was such an individual. He was the first to do extensive dissections and accurately document the anatomical information in text and illustration (4). The importance of this lies in the transition from animal to human dissections. Accurate anatomical data would become available and true progress in the other anatomical sciences, histology and zoology, could take place (4). Another individual of this type was Giovanni Battista Morgagni, a successor to Vesalius, who combined anatomic dissection with clinical history to describe pathologic anatomy (4). This was arguably the beginning of modern pathology.

It was during the 17th century that the science of laboratory medicine began to acquire the characteristics that are easily recognized today. Laboratories were being established in homes in which research and development was being conducted (4). The results of this cottage industry were the development of equipment for laboratory and diagnostic use. Thermometers and hydrometers were two such pieces of equipment (4). Although the thermometer was described by Galileo in the late 1500s, it was not used for patient evaluation until the 17th century. The arguments waged as to which fluid was the best indicator of change and the best way to calibrate the instrument (4). Given these and other practical problems, some physicians were quick to realize that a quantitative measure of body temperature was an improvement over using one's hand. For other physicians, the problems with obtaining and using the thermometer were too great. After this brief flurry of activity, the thermometer returned to a quiescent state until the 1800s. By the 1800s, many of the original problems had been either resolved or minimized, so it became a more practical matter to measure temperature. Articles appeared regarding the value of temperature in diagnosis and prognosis in major medical journals (5).

The hydrometer had relatively little difficulty in its acceptance. The instruments were made small and reliable, so they could be taken on home visits to the sick. Specific gravity was one of the well-entrenched measurements of uroscopy. A reliable and simple instrument catered to the needs of the common practitioner. Urinalysis was still king.

The home lab contributed to the refinement of equipment and methods. It should be remembered that alchemy was slowly giving way to organic chemistry, which was defined as the chemistry of living organisms (6). It was not until the synthesis of urea in 1828 that organic chemistry became the chemistry of carbon compounds. Consequently, the efforts of the more inquisitive chemist-physicians turned to chemical procedures on body fluids (6). Paracelsus and, later, Willis suggested chemical analysis of urine (6). To separate the fluid into its component parts was thought to yield better diagnostic or prognostic information (6). True to history, a new hypothesis always has its detractors. Perseverance by the investigators and positive, predictable results from the applications generated broader acceptance.

It was an extension of this philosophy of active investigation rather than passive observation that led Robert Boyle to analyze blood. He had done chemical analysis on urine and continued this approach on human blood (5,6). Boyle had the disadvantage of not being a physician and so did not have the opportunity to analyze the blood of sick patients (5). He did have the insight to propose that knowing the results of his chemical analysis on healthy people, the evaluation of the sick would be made easier (5). Boyle was obviously an early proponent of normal reference intervals. This concept was carried further by the French physician Raymond Vieussens, who chemically analyzed the blood of large numbers of people of all descriptions (5). Normals, abnormals, men, women, and those of different temperaments were included in his study. These studies of defined populations were exceptional in their time.

Diagnostic testing had achieved a credibility that made it acceptable to perform chemical analysis on blood and urine and use the information in a diagnostic workup. Laboratories were beginning to grow in number and they were developing techniques that could be applied to medicine. Laboratory skills were gaining respectability along with laboratory testing and laboratory data.

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