History - Medicine through Time

Prehistoric Medicine
1. how do we know about it?
  1. Skeletal remains
  2. aboriginal cultures still live as they did in prehistoric times
2. What did they die from?
  1. warfare
  2. pregnancy + childbirth
  3. infection
  4. famine and food shortages
3. The people were hunter gatherers (living nomadic lives) until 10,000 BC and farmers afterwards
4. Beliefs and Treatments
  1. Natural
    1. Trephining (cutting holes in people's heads) to release evil spirits. Skulls found show that people survived the operation as the bone continued to grow afterwards.
    2. Women were in charge of everyday health + knew about healing power of herbs. For everyday injuries they had range of simple effective remedies, passed down through generations.
    3. Covered broken bones in mud and leaves, like a cast.
    4. herbs and honey for sore throats
  2. Supernatural
    1. Medicine Men dealt with evil spirits causing disease by praying and using charms.
    2. Evil spirits, witches, spirits of the dead etc. caused disease
    3. Lucky charms kept away evil spirits
Egyptions
1. Society - agricultural civilisation around River Nile. Every year the Nile floods fertilised the fields and the river provided water for irrigation.
2. Natural Beliefs and treatments
  1. Like the Nile, the body was full of channels. Sickness was caused by the blockage of one of your body's channels. Purging, vomiting and blood-letting was used to unblock the channels.
  2. Diet was important. Doctors recommended certain foods to patients.
  3. Hygiene - cleanliness was valued. They bathed, shaved their heads, had toilets, changed clothes etc.
  4. Trained specialist doctors observed their patient's and recognised the symptoms. Wrote down symptoms and treatments.
3. Supernatural beliefs and treatments
  1. Gods could cause and cause disease. Priests recorded treatments and spells.
  2. Some drugs (e.g. opium) are used today. They were probably thought of as driving away evil.
  3. Mummification - Body was needed in the afterlife, so they were preserved through mummification.
    1. Experimental dissection not allowed as believed that destroying someone's body meant they wouldn't go to the afterlife. This limited the amount of knowledge gained (knew about the main organs but not about their purpose).
      1. Removed soft organs (e.g. brain and intestines) - dried what remained with salt - knowledge of anatomy.
Ancient Greek
1. Background - used slaves so had time to educate themselves, war wounds needed treatments and helped doctors learn about anatomy, wealthy people employed doctors.
2. Natural beliefs and treatments
  1. Hippocrates
    1. Theory of 4 Humours
      1. Blood
        Spring
      2. Phlegm
        Winter
      3. Yellow bile
        Summer
      4. Black bile
        Autumn
      5. The body is made up of 4 humours which are like dot the 4 seasons and the 4 elements. They need to be in balance for good health. If you are sick, it is because your humours are unbalanced.
        Treatments aimed at brining humours back into balance
        purging
        vomiting
        blood-letting
    2. Believed in natural causes of disease and encouraged natural treatments
    3. Hippocratic Oath - promised made by doctors to obey rules of behaviour in professional lives. Still happens today!
    4. Hippocratic Corpus - a collection of medical books written by Hippocrates containing symptoms and treatments
    5. Observing and recording - 'clinical method of observation' and recorded observations to help future diagnosis
  2. Healthy living
    1. Excersised
    2. Hygiene was important
    3. Healthy diet - many followed a diet that changed with the seasons - eating lots in winter + drinking little, and in summer drinking more + eating less
3. Supernatural beliefs and treatments
  1. Asclepois (the Greek God of Healing)
    1. Asclepions were temples where ill people went. Visitors bathed, released and prayed to Asclepios. Priests performed rituals which involved placing snakes on the patient.
4. Dissection
  1. The library of Alexandria attempted to collect all the knowledge of the world. Unlike the rest of Greece, human dissection was allowed. Alexandria became famous for training medics and surgeons.
  2. Erasistratus identified differences between arteries, veins and nerves.
5. Surgery
  1. Advanced slightly, but still risky (a last resort).
    1. Good techniques for setting broken bones and amputations.
      1. Range of surgical instruments from iron, steel and brass.
Ancient Rome
1. Background - Romans were very wealthy. People of Roman Empire were taxed. Slave owning society.
2. Public Health
  1. Bad smells, unclean drinking water, sewage, swamps and dirt made people sick
  2. Aqueducts carried clean water into cities
  3. Public baths, toilets, sewers
  4. Ideas of public health spread through empire
3. Galen
  1. Developed on Theory of 4 Humours with Theory of Opposites
    1. The treatment had to be opposite to the cause
  2. Brain, not heart, controls speech
  3. Arteries, as well as veins, carry blood through body
  4. Animal's anatomy different from humans
  5. BUT...
    1. Made mistakes as he only used animals
    2. Said holes in septum of heart to let blood pass from right to left side
    3. Believed blood was consumed not circulated
4. Surgery
  1. Common surgery was bleeding, amputations + trephining
  2. Internal operations rare (as still risky)
5. Beliefs and treatments
  1. Not as interested as Greeks in developing theories on causes of disease.
  2. Doctors recommended exercise, diet change + prescribed herbal medicines as opposites.
  3. Doctors too expensive for most. Head of family expected to look after household (using herbal remedies).
Medieval
1. Background
  1. Wars destroyed Roman public health system + medical libraries. Rulers of small kingdoms built up armies rather than improving medical skills/public health. War disrupted trade, so countries became poorer. Travel become dangerous, reducing communication between doctors. Training of doctors abandoned, Galen's books lost/ hidden for safety.
  2. LATER... church set up universities where doctors were trained. Armies took trained doctors to war where they gained experience as surgeons. Rulers cleaned up towns. Merchants and scholars travelled around Europe, sharing ideas.
2. Influence of Christian Church
  1. Church grew stronger. Monasteries controlled education, priests and monks only people who could read. Church opened medical schools where Galen's ideas were taught. Only libraries were in monasteries, churched manned book they disapproved of. Monasteries provided clean water and toilets.
3. Hospitals
  1. Medical care for poor - hospitals sets up by monasteries, provided 'hospitality for visitors.'
  2. Genuinely ill turned away - fear of spreading disease.
4. Return of Hippocrates and Galen
  1. Galen's ideas rediscovered. Church look at Galen's works and decided what fitted with Christian ideas (e.g of a 'Creator'). Doctors believed he was correct and was impossible to improve his work.
  2. Medical schools in Western Europe where translations of Galen's and Hippocrates' work accepted as absolute truth.
  3. 4 Humours - still believed by doctors. Theory developed into more complex system using position of stars. Human dissection carried out in medical schools, findings were interpreted as theory of 4 humours - but later doctors challenged traditional theories
5. Arab medicine
  1. Islamic scholars picked up and developed Greek ideas. 4 Humours, treatment of opposites and clinical observation lived on.
  2. Books brought together ideas of Galen and Hippocrates
  3. Attitude of Muslims towards Koran meant they were unwilling to criticise Galen
6. New Developments
  1. More schools, human dissection allowed. Doubts about classical texts.
  2. New techniques - diagnosis by urine sample
  3. Stars caused disease - used astrology to decide treatments
  4. Trained doctors expensive, most treated by monks and housewife-physicians
  5. Surgery
    1. Warfare caused a big demand for surgery. Wine used as antiseptic, surgical treatments were simple and major surgery risky.
7. Black Death - 1348
  1. Spread by coughs sneezes, black rat flea bites (rates carried overseas by ships).
  2. Arrived in Britain in 1348
  3. Symptoms
    1. exhaustion
    2. High temp
    3. Swellings
    4. Breathing difficulties
  4. Causes and treatments
    1. Miasma - carried sweet smelling herbs
    2. God - prayed, flagellants
    3. 4 Humours - opposites, purging, vomiting, blood letting
    4. Poisoned water - blamed Jews
8. Supernatural beliefs + treatments - Church believed illness was punishment for sins (prayed to God). Pilgrimages to holy shrines to cure illness. Doctors had superstitious beliefs, saying magical words and consulting stars.
9. Public health
  1. cesspits, wells, waste disposed of in streets, drank beer not water etc.
Rennaisance
1. Background
  1. 'rebirth'
  2. began with close study of classic texts + being critical of old translations
  3. greater interest on how human body worked (observation + dissection)
  4. return of classical texts renewed faith in 4 Humours + Opposites theory
2. Vesalius - Anatomy
  1. Studied anatomy, became professor of surgery and anatomy. Did dissections + wrote books based on his observations using accurate diagrams. 1543 - wrote 'On The Fabric of the Human Body.'
  2. Pointed out Galen's mistakes by proving...
    1. No holes in septum of heart
    2. Jaw bone one bone, not two
3. Paré - Surgery
  1. Battlefield surgeon, in battle he ran out of boiling oil (used to treat gunshot wounds) so made an ointment of roses, turpentine + egg yolk.
  2. Develops ligatures to seal wounds
  3. Disproves Galen by proving the bezoar stone ins't a treatment for poison
4. Harvey - circulation of blood
  1. Disproves Galen by discovering circulation of blood
  2. Identifies difference between arteries + veins
5. Black Death 1665
  1. Worst appearance. Death toll = 100 000
  2. To control spread households locked in + red crosses painted on doors
  3. Carts organised by police roamed city collecting corpses for mass burial
  4. People realised disease was contagious, but not that germs caused it
6. Public health
  1. Many wars which took up resources
  2. Increasing urban population - strain on clean water supplies + sewage systems
7. FACTORS
  1. Printing Press - ideas spread
  2. Weakening power of Church - no religious beliefs on causes of disease -> looked for natural causes + could dissect
  3. Renewed interest in Ancient learning - people wanted to learn how to read, challenged old medical ideas
  4. Artists drawing from life - medical drawings drawn + shared
1750 - 1900
1. Why did they stop reading Galen in 19c?
  1. New understanding of body and Galen's descriptions were incomplete/wrong
  2. 4 Humours not accepted. People initially thought miasma caused disease.
  3. Doctors did dissections + used microscopes. Galen's books not important.
2. Smallpox + Edward Jenner
  1. Inoculation
    1. In 18c, small pox was a big killer. People immunised against smallpox using pus from sores of a sufferer. But sometimes led to death.
  2. Edward Jenner
    1. Country doctors, heard that milkmaids didn't get smallpox, instead milder cowpox. Discovered that people who had cowpox didn't get small pox. 1796 - inoculated small boy with pus from sores of cowpox sufferer. Then injected James with smallpox, James didn't catch the disease!
  3. Opposition to smallpox vaccine
    1. Jenner could't scientifically explain who it worked. Inoculators afraid of losing money. Worried about side effects (e.g cowpox). Church believed vaccination wasn't natural.
3. Developments in nursing
  1. Mary Seacole - poor Jamaican background. Volunteers to be nurse in Crimean war, is rejected but does anyway self-financing journey. Nursed soldiers on battlefields and built 'British Hotel.' Goes bankrupt when returns to UK - receives support due to press interest in story + write autobiography.
  2. Florence Nightingale - Brought discipline + professionalism to a job with bad reputation. Wealthy background, became nurse despite family opposing. Went to Crimean War to sort out nursing care in English camp. Improved death rates, due to improvements in ward hygiene. Returned home + wrote book 'Notes on Nursing' + sets up hospital in London.
4. How did scientists discover the causes of disease?
  1. Louis Pasteur's Germ Theory (1857) - Scientists thought microbes were caused by disease + appeared because of illness (spontaneous generation). Instead of blaming microbes, people looked for miasmas. Pasteur proved that there are germs in the air by sterilising water and keeping it in a flask that didn't allow airborne particles to enter. This stayed sterile - but sterilised water kept in an open flask bred microbes.
  2. Robert Koch - German scientist. Linked diseases to the specific microbe. Developed dying techniques to colour microbes, which he viewed through microscopes. Identified anthrax spores and bacteria causing septicaemia, tuberculosis + cholera.
  3. Pasteur - Chicken Cholera Vaccine - Hearing of Koch's work Pasteur decided to find new microbes and combat them. Looked for cures to anthrax + chicken cholera. Chamberland (worked for Pasteur) was supposed to inject chickens with chicken cholera but forgot. Left germs and injected them when he returned from holiday. Chickens survived, and survived when new germs were injected. Cholera was weakened by being left out and had made the chickens immune.
  4. Pasteur - Anthrax vaccine - Produced weakened version of anthrax spore that would make sheep immune.
5. Overcoming the problems of surgery
  1. Surgery in the 18000s was dangerous + painful.
    1. main problems
      1. Pain - die of shock
        How was the problem of pain overcome?
        In 1800, surgeons would ease suffering of patients by getting the drunk, knocking them out, opium etc.
        Anaesthetics
        Nitrous Oxide - 'laughing gas' discovered by Sir Humphrey Davy.
        Ether - used by J.R. Listen during leg amputation. Unpleasant side effects.
        Chloroform - used by James Simpson + friends at home. Realised it could be used during surgery. But, led to unexplained deaths. Dosage not measured/controlled.
        Opposition - uncomfortable for patients, pain good of healing, didn't understand how they worked or side effects, pain from God, encouraged riskier operations
        Final acceptance - Queen Vic used chloroform in delivery of 8th child
      2. Infection
        How was the problem of infection overcome?
        Until Germ Theory in 1850s, surgeons didn't take precautions to protect open wounds (reused bandages, didn't wash hands, didn't sterilise surgical equipment etc.)
        Joseph Lister + the discovery of antiseptics - He heard that carbolic spray was used on sewage + knew sewage had similar smell to gangrene. Read Pasteur's germ theory. Prepared to take risks.
        Opposition
        Lister's methods slowed down surgery
        Spray was uncomfortable for doctors to use (affected skin)
        Germ theory not widely accepted in 1857
        Surgeons didn't copy methods correctly so were disappointed with results
        Final development of ASEPTIC surgery - by late 1890s Listers methods led to aseptic surgery (removal of all possible germs form theatres to ensure absolute cleanliness).
        Operating theatres + hospitals rigorously cleaned
        All surgical instruments steam sterilised
        Sterilised rubber gloves first used and surgeon's hands scrubbed
      3. Blood loss
        How was the problem of blood loss overcome?
        Once William Harvey discovered the circulation of blood, the first blood transfusions were attempted
        Early blood transfusions were often disastrous because....
        blood groups not discovered
        couldn't prevent blood clotting
        infection
6. Developments in Public Health
  1. Public Health Problems in early 1800s - conditions in British towns became increasingly worse. Crowded towns + cities due to industrial revolution. Towns couldn't cope with providing water + sewage to more people. In squalid conditions, disease spread rapidly.
    1. Battle to improve public health - some thought government should force local councils to clean up towns. But, many believed in 'laissez-faire' attitude + that government should allow local areas to control its own affairs.
      1. Edwin Chadwick - 1842 - asked by government to report on living conditions in towns. Concluded that poverty was caused by ill health which was caused by terrible living conditions. Said in 'Report on the Sanitary Conditions of the Labouring Population' that towns should 1) organise drainage + refuse collection. 2) provide water supply. 3) appoint medical officer of health.
        1848 Public Health Act - outbreak of cholera put pressure on government to pass Public Health Act. Not compulsory. Government set up Board of Health to encourage local authorities to improve conditions. Gave them money to make improvements, but only a few local authorities took new measures. 1854 - Board of Health abandoned
        1853 John Snow - proved there was a link between cholera + water supply. Used research, observation + door-to-door interviews to build a detailed map of cholera epidemic in Broad Street. Nearly all deaths had taken place within short distance from water pump. Near to pump, there was a brewery and none of the people had cholera because the brewery had its own water pump. So they didn't use the Broad Street Pump. Snow removed the handle + there were no more deaths. Later came to light that ta cesspit near the pump had cracked, leaking into the water supply. Put pressure on water companies to clean up their water supplies.
        1858 Great Stink - The hot weather caused the human waste in the River Thames to stink. Putrid smell right under Parliament's nose, they considered moving and had to coat curtains with deodorant to get rid of smell. Great Stink prompted Parliament to sort out London's sewage + drainage system + to clean up Thames.
        1867 Second Reform Act - working class men given vote. MPs wanted to win support of working class so improved living conditions of poor.
        1875 Second Public Health Act - Forced local authorities to 1) provide clean water 2) provide drainage + sewage 3) appoint Medical Officer of Health. But why was it introduced?
        Results of the Public Health Act of 1875 - improved standards of living, stopped pollution of rivers form which people got water, shortened working hours in factories for women + children, made it illegal to add ingredients that made food unhealthy, made education compulsory.
20th Cenutry
1. What medical progress did WW1 bring about?
  1. Surgeons experimented with new techniques (developed new ways to repair broken bones + perform skin grafts -plastic surgery).
  2. Soliders promised good housing upon return. So got rid of unhealthy slum housing.
  3. Surgery of eye, ear, nose + throat improve rapidly (incl. brain surgery).
  4. Development of X-rays - first discovered 20 years before WW1. Hospitals installed X-ray machines, but WW1 confirmed their importance. More were manufactured to meet demand, installed in hospitals along Western Front. Immediately improved success rate of surgeons removing bullets which could have caused fatal infections.
  5. Blood transfusions - in Renaissance, Harvey proved blood circulates,e ncnoruaging transfusions, which sometimes worked + sometimes failed. Blood groups were discovered in 1901 which made transfusions more successful. During WW1 vast amounts of blood was needed. The search of better method of storage + transfusion was needed. Doctors discovered how blood can be bottled, packed in ice + stored where needed.
2. Penicillin
  1. 1) Fleming discovered mould killed germs. Writes articles. 2) Florey + Chain begin research after reading article by Fleming. 3) Penicillin first tested on human in Oxford. 4) U.S. + Britain fund production of penicillin. 5) Enough penicillin produced to treat all allied forces wounded on D-Day.
    1. How was it discovered? - 1928, Fleming left a petri dish o bacteria, it had gone mouldy + the mould had killed the bacteria. Chance.
    2. How was it developed?
      1. 1930s, Florey + Chain became interested in Fleming's paper. 1939, gathered research team + asked UK Gov to fund team's research into penicillin. UK firms too busy with war effort to mass produce - so went to US. US Gov helped by giving interest free loans. By 1944 mass production was sufficient for needs of military medics. Fleming, Florey + Chain given Nobel Prize in 1945.
    3. Factors leading to development
      1. Government - UK Gov funded Florey's research, U.S. Gov funded mass production
      2. Tech - microscopes
      3. Individuals + Chance
      4. War - growing casualties of WW2 added urgency to mass produce
3. Impact of WW2
  1. Blood transfusion - blood could be stored for longer, civilians donated blood
  2. Diet - rationing improved some people's diet, government encouraged healthy eating
  3. Drugs - penicillin developed as first antibiotic
  4. Poverty - evacuation took children out of urban areas, highlighted contrast between rich + poor
  5. Surgery - development in use of skin grafts + treatment of burns
  6. Hygiene - government posters educating people about health + hygiene
4. National Health Service
  1. Influence of WW2
    1. Broke down social distinctions. Raising armies made powerful people take notice of health problems of poor. Evacuation of children increased awareness of poor. After WW2 people wanted to improve society.
  2. Introduction of NHS
    1. Beveridge Report in 1942 called for state provision of social security. Aneurin Behave was Labour Minister for Helath who introduced NHS. National Insurance introduced to pay for NHS.
  3. Stills has few problems... Government reduced how much of NHS free (i.e. charging for prescriptions). Long waiting lists + doubts of quality of treatment mean some go outside NHS. Longer life expectancies mean more care for elderly + increased costs for NHS.

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