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No. 1095:
The Lesion Within

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.

(Theme music)

Reiser, S.J., Medicine and the Reign of Technology. Cambridge: Cambridge University Press, 1978.

Nuland, S.B., Doctors: The Biography of Medicine. New York: Vintage Books, 1989, Chapter 6.



New 19th century tools for finding the lesion within