Transcription
It's Medicos Perfectionalis, one more time, to brief history of hematology. It's fascinating. It's absolutely amazing, and let's get started.
I'm not a historian, as you might imagine. So, what's my reference? My reference is a book called "Medicine: The Definitive Illustrated History." Many people graduate medical school every year with knowing nothing about the history of medicine. Listen to this: "It's important to know whence we came so that we may understand where we [Music] going." Some words of wisdom from yours truly: "You can't be good at what you don't adore."
So, we're getting ready to talk about platelet disorders and coagulation disorders and stuff like that. First, you have to to love the subject. If you love the subject, it'll be a piece of cake, no matter how hard it is.
So, let's first start with, guess what? The Greeks. Bloodletting. They had a theory about the four humors, and of course, as you know, the word "humor" means fluid. It doesn't mean blood, it means fluid. That's why humoral immunity is about fluids. They had four humors: blood, phlegm, yellow bile, and black bile. And it's like, it's like a, the, for everything. You're angry? Oh, this is because you have lots of blood. Let's draw some blood from you, and you'll be fine. Oh, you're lazy? Maybe you have lots of yellow bile. Let's draw some yellow bile from you. You'll be just fine.
And that's why we have phlebotomy. Flebo means vein, and tomy means to cut. That's why the word anatomy means to cut. To me, cut. And and Anna means up. So, anatomy literally means to cut up. That's why we have a word called the microtome. It's a device that cuts tissue into slices. To means cut, and micro because it's very small.
Today, do we use phlebotomy? Very rarely. Such as what? Such as polycythemia vera and hemochromatosis.
Now, let's leave the Greeks alone and let's go to the Romans. Galen. Galen discovered masses and he called them oncos. That's where we get the word oncology from, the study of masses. So, tumors are very old, actually. From a historic standpoint, I'm a proud Egyptian here, so let me talk about my ancestors. The Egyptians. They discovered early evidence of bone cancer in mummies and manuscripts. Yes, very old, thousands of years ago. Cancer is very old because many supposedly smart people today believe that tumors and cancers are caused by big corporations.
So, come visit us in Egypt. We have got basis, beta-thalassemia, and Familial Mediterranean Fever. And only in Egypt, you may be able to palpate the spleen in the right iliac fossa because in choisis, there is massive splenomegaly, and the spleen enlarged from the left hypochondriac region all the way to the right iliac fossa. I'm not kidding.
Fast forward to the Islamic Golden Age. Ibn al-Nafis discovered the pulmonary circulation. First, we discovered the pulmonary circulation before we discovered the systemic circulation. And by the way, the fact that blood goes in circles was something very new and extraordinary for people at that age.
Then, 1590, we discovered the compound light microscopy, and then we will be able to see peripheral smears under the microscope. The Americans call it peripheral smear, the British call it the blood film. I couldn't care less.
1682, William Harvey described the systemic circulation. After that, all of Rotbeck discovered the lymphatic system. By the way, lymph is from the Greek word lympha, which is an ancient goddess of fresh water because the aspect of lymph is clearer than that of blood.
Anthony van Leeuwenhoek, the same guy who discovered the nucleus, is the same person who discovered the blood cells. He didn't have a Facebook account, which allowed for a lot of free time.
1770, William Hewson discovered that blood can clot, and then we named him the father of hematology. Anyone who discovered that blood clots will call him the father of hematology. But that's not fair. Shut up. Blood coagulation is the most important decision your body can make. It can save your life, and it can kill you.
1828, blood transfusion was possible. First, we tried transfusing blood from animals, but the patients would die. Why? Because animals have foreign antigens. I'm sorry, but your cute little puppy cannot give you blood. Then, we tried blood transfusion from other people. Again, the patient would die. Why? Incompatibility. We hadn't discovered the systems yet. I'm sorry, but your cute golf buddy cannot give you blood. Maybe it's a mismatch.
Then we discovered the system, and then we store blood in bottles, but the blood would coagulate. Oh, then we added anticoagulants into the bottles, but the patient would still die from air embolism because the bottles weren't changed, and as after the blood, there was air. So now we use plastic blood bags that collapse. But plastic is harmful. Okay, what do you want to do with your life? Next time you are in the ER, demand that your doctor transfuse your blood from a mason jar.
And this is by far my favorite guy. People call him Virchow. This is wrong. It's Virchow. Virchow. He's German. Respect the language. And here's a quick question for you: What, what's the name of this car make? Okay, if you say Volkswagen, you're wrong. If you say Volkswagen, you're also wrong. It's called Volkswagen. Respect the language. It's actually funny that an Egyptian guy is teaching you German.
Virchow was the first guy to say leukemia. He was the first one to propose that cancer can be treated, not cured, but treated. And he discovered the famous triad. He said blood clots are caused by changes in blood vessel wall, that's number one, blood flow, and its composition. So, here is the Virchow's triad: Blood stasis, endothelial damage, and hypercoagulability. This guy is classic. He's old school. Old school pair of glasses, old school suit, and old school beard with no wax. #allnatural.
He was not only a great scientist, he was also a great mentor. His student, von Recklinghausen, discovered thrombosis, embolism, and infarction. These people are amazing. Here is another trick question for you: There is a disease in medicine that you all know that's called Von Recklinghausen's disease. What's that? And the answer is neurofibromatosis type one.
The story of aspirin is absolutely fascinating. We call it the wonder drug. It's the active ingredient in willow. Ancient Egyptians, my ancestors, used willow tree extract to relieve pain. Then Hippocrates, the father of medicine, prescribed willow leaf tea to women to relieve pain of childbirth. In 1750, an English clergyman explained that dried powdered willow helped cure fever. So now we know that aspirin is analgesic and antipyretic. A professor of pharmacy at Munich extracted willow bark and named it salicin. But it was so weak. From salicin, we added chloride to form salicylic acid. But it was so strong, it caused stomach pain, diarrhea, and GI bleed. So, a French chemist buffered salicylic acid by adding acetyl chloride to it, and boom, we have acetylsalicylic acid. Then Felix Hoffmann, a chemist and employee of the dye manufacturer Bayer, a company in Germany, made aspirin available for the first time for the masses. And now Bayer changed its business model from a dye manufacturer to a giant pharmaceutical corporation.
Up until this time, aspirin was used only as an antipyretic and analgesic. Antipyretic means anti-fever, analgesic means anti-pain because algesia is pain. But we had no clue that aspirin is anti-platelet and can prevent thrombosis. After 70 years, aspirin for the first time was discovered to have anti-platelet qualities. It can prevent clot formation. It's a wonder drug. The sales of aspirin skyrocketed. It's the best-selling medicine of all time. In 2017, they sold 40,000 tons of aspirin, earned 35 billion euros. Good for you, Bayer. I'm glad you did that. I don't envy them. They have done more good than I did, and they deserve it.
Let's have some fun. Look at this logo. Why would any company do this? Like Bayer, like this, and Bayer, like this, unless their patients all have astigmatism?
1901, Karl Landsteiner discovered the blood groups A, B, and he called it C. He was just learning the alphabets. But now we call it O. Why O? Because there are no antigens in the blood group O. So, O means, "Oh my gosh, I don't have antigens." But still, some patients died from incompatibility. So, the same guy discovered the Rh, or the Rhesus antigen system. He also discovered MNP system.
1916, the discovery of heparin by a second-year medical student called J. M. H. Best in the physiology department of Johns Hopkins University. Isolated heparin from the liver of a dog. That's why we call it heparin because hepa means liver. That's why we have hepatology, hepatic vein, hepatic artery, hepatitis, etc. Believe it or not, you actually have heparin in your body without taking any medicine. You have heparin. Heparin is a naturally occurring glycosaminoglycan. So, whenever somebody says, "The little man can't get ahead, you have to have a PhD in order to contribute," shut up. A second-year medical student did it. And if any website by a guru tells you to cure your thrombosis naturally, just tell them that heparin is natural. But so many students unfortunately only care about, "Should I study from Kaplan or should I study from First Aid?" Shut up. People of your age were discovering heparin.
Next, in the 1920s, some American and Canadian farmers observed that their cows are bleeding. Yes, actually bleeding. They were terrified. What's going on here? Until they discovered that they were eating from sweet clover leaves. And here is the nice guy from Texas, as they say, "Big hat, no cattle." He says, "Well, my cows are bleeding. Yesterday, I had a bull oozing blood from his nose. What's going on? What's going on? What's going on? How's this a business? I want to feed my kids. I guess I'll just be wandering around the field trying to find the fins." Until we discovered warfarin.
During World War II, blood donations became very common, and the American Red Cross was working actively to supply the soldiers with blood banks. And then we have blood constituents. So, instead of giving whole blood, we could give plasma alone, packed red cells alone.
The tragic story of thalidomide. Thalidomide was introduced in 1956 or '57 in Germany as a sedative, anti-emetic. Then they recommended thalidomide to pregnant women to help them with the vomiting and morning sickness. Thalidomide was discovered to cause flipper limbs. It's teratogenic, and it was taken off market in 1961. It was a tragic story.
Then, after thalidomide was taken off the market in 1961, in 1994, thalidomide was discovered to have anti-angiogenic properties. Angiogenesis, as you know, is new blood vessel formation involved in cancer pathophysiology. And then the wife of a man dying from multiple myeloma called Dr. Folman and asked him about thalidomide as the use in anti-angiogenesis. "It's your idea, doctor. Can you please try it on my husband?" Folman persuaded the patient's doctor to try thalidomide. So, the doctors conducted a clinical trial on thalidomide for people with multiple myeloma, and then it was successful. The results were published in 1999, and in 2006, thalidomide was approved for treatment in cases of multiple myeloma. Today, we have better drugs than thalidomide called lenalidomide. Same concept. So, we dropped the "ide" and we use lenalidomide.
Now, you should love hematology because it's absolutely fascinating. And that's how education should be. It came from a Latin word called educere, to induce from within. Education is not to spit some facts in your face like your broke professors with his theories. No, induce from within. I encourage you to rise up, to make something of yourself, even if you're a second-year medical student.
Quick time: Is there a difference between the word clot and the word thrombus? Is there any difference? Let me know down below in the comments. Thank you so much for watching. This is Medicos Perfectionalis. You can get all of my notes if you go to patreon.com/medicos. And please help me reach 35,000 subscribers on YouTube so that we can begin uploading videos on bleeding and coagulation disorders. They're going to be awesome. Thank you so much.